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|---|---|---|---|---|---|---|---|
19907502-RR-8
| 19,907,502 | 27,996,858 |
RR
| 8 |
2168-03-04 13:30:00
|
2168-03-04 13:38:00
|
INDICATION: ___ going to OR for finger amputation // pre-op
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is normal. No acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19907527-RR-35
| 19,907,527 | 27,177,954 |
RR
| 35 |
2173-03-19 22:57:00
|
2173-03-20 09:40:00
|
EXAMINATION: MRCP
INDICATION: ___ year old man with elevated T bili, fever, abdominal pain //
elevated T bili, fever, abdominal pain
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 11 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT of the abdomen and pelvis from ___.
Abdominal ultrasound from ___.
FINDINGS:
Lower Thorax: Mild bibasilar atelectasis. No pleural or pericardial effusion.
Liver: Normal in morphology without significant steatosis or deposition. In
hepatic segment VII, there is a 1.2 cm T2 intermediate to hyperintense focus
which demonstrates mild progressive peripheral nodular enhancement compatible
with a hemangioma (series 5, image 21). No other focal hepatic lesions
identified within the limits the examination which is mildly limited by
motion.
Biliary: No intrahepatic or extrahepatic biliary dilation. Cholelithiasis
without evidence of cholecystitis.
Pancreas: Normal in signal and bulk. No main ductal dilation or focal
lesions.
Spleen: Normal size and signal. No focal lesions.
Adrenal Glands: Normal in size and shape bilaterally.
Kidneys: As seen on prior CT, centered in the interpolar region and lower pole
of the right kidney is a heterogeneous enhancing mass which appears to involve
the renal pelvis and measures 5.3 x 6.6 x 5.6 cm (series 5, image 41; series
1403, image 129). There is no hydronephrosis or evidence of tumor thrombus in
the renal vessels although the right renal vein comes in close proximity to
the mass as it enters the renal pelvis (series 1403, image 133).. In the
interpolar region of the left kidney a T2 hyperintense nonenhancing cyst
demonstrates thin septation (series 5, image 38). No hydronephrosis.
Gastrointestinal Tract: No evidence bowel obstruction or inflammation.
Colonic diverticulosis again noted.
Lymph Nodes: No pathologically enlarged lymph nodes identified.
Vasculature: Single bilateral renal arteries and veins. Hepatic arterial
anatomy is conventional. Patent hepatic and mesenteric vasculature.
Osseous and Soft Tissue Structures: No definite osseous lesions. Degenerative
changes in the spine.
IMPRESSION:
1. No evidence of biliary obstruction or abscess.
2. No definite cholangitis although motion limits assessment.
3. Cholelithiasis without evidence of cholecystitis.
4. Redemonstrated 6.6 cm enhancing right renal mass encroaches on the renal
pelvis and is concerning for renal cell carcinoma. No evidence of vascular
invasion or metastasis.
|
19907622-RR-14
| 19,907,622 | 27,564,876 |
RR
| 14 |
2153-05-27 12:59:00
|
2153-05-27 14:42:00
|
INDICATION: Fall down 10 stairs.
COMPARISON: None.
SUPINE AP VIEW OF THE CHEST: Overlying trauma board limits evaluation.
Cardiac silhouette size is normal. The mediastinal and hilar contours are
unremarkable. Minimal streaky opacities in both lung bases may reflect
atelectasis. No pleural effusion or pneumothorax is present. Fractures of
the right eighth and ninth ribs anterolaterally are noted.
IMPRESSION: Fractures of the right eighth and ninth anterolateral ribs.
Bibasilar atelectasis.
|
19907622-RR-15
| 19,907,622 | 27,564,876 |
RR
| 15 |
2153-05-27 13:20:00
|
2153-05-27 13:51:00
|
INDICATION: Fall down 10 stairs. Evaluate for acute intracranial process.
TECHNIQUE: Contiguous axial images were obtained through the brain. Coronal
and sagittal reformations were obtained. No contrast was administered.
COMPARISONS: None.
FINDINGS: There is no evidence of hemorrhage, edema, shift of midline
structures, or major vascular territorial infarction. The ventricles and
sulci are prominent, consistent with central atrophy. No fracture is
identified. There is mild mucosal thickening in the right maxillary sinus.
The remaining visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear.
IMPRESSION: No acute intracranial abnormality.
|
19907622-RR-16
| 19,907,622 | 27,564,876 |
RR
| 16 |
2153-05-27 13:21:00
|
2153-05-27 14:09:00
|
INDICATION: Fall down 10 stairs. Evaluate for fracture.
TECHNIQUE: Helical 2.5 mm axial images were obtained from the skull base to
the T2 level. Coronal and sagittal reformations were obtained. No contrast
was administered.
COMPARISON: None.
FINDINGS: There is no fracture or malalignment of the cervical spine. There
is no prevertebral soft tissue edema. The craniocervical junction is intact.
There is no cervical lymphadenopathy. The thyroid gland is unremarkable.
There is a focal ground-glass opacity in the right lung apex. Partially imaged
is an aberrant right subclavian artery.
IMPRESSION:
1. No acute fracture, dislocation, or malalignment of the cervical spine.
2. Please correlate right apical lung opacity with concurrent CT-Torso.
|
19907622-RR-17
| 19,907,622 | 27,564,876 |
RR
| 17 |
2153-05-27 13:22:00
|
2153-05-27 15:32:00
|
INDICATION: Fall down 10 stairs. Evaluate for bleeding or fracture.
TECHNIQUE: MDCT images were obtained from the thoracic outlet to the pelvic
outlet after the administration of intravenous contrast. Coronal and sagittal
reformations were obtained.
COMPARISON: None.
FINDINGS:
CT OF THE THORAX: There are segmental fractures of the right eighth and ninth
ribs involving the posterior and anterolateral aspects. There is no
pneumothorax. There is a focal consolidative opacity in the right lower lobe
anteriorly adjacent to the major fissure. There is a focal area of
groundglass opacity in the right apex, which is non-specific. There is no
pleural effusion. The thyroid gland is unremarkable. There is no
supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. The great
vessels, heart, and pericardium are unremarkable. The aorta is normal without
evidence of acute injury. The airways are patent to the subsegmental level. An
aberrant right subclavian artery is noted.
CT OF THE ABDOMEN: The liver enhances homogeneously, and there are no focal
liver lesions. The hepatic and portal veins are patent. The gallbladder,
pancreas, spleen, adrenal glands are unremarkable. The kidneys enhance and
excrete contrast without evidence of hydronephrosis or stones. Note is made
of a duplicated right collecting system. There is no free air or free fluid.
Abdominal aorta is normal in caliber.
CT OF THE PELVIS: The appendix is normal. The colon, rectum, uterus, and
adnexa are unremarkable. The urinary bladder is distended. There is no
pelvic or inguinal lymphadenopathy. There is no pelvic free fluid.
IMPRESSION:
1. Segmental fractures of the right eighth and ninth ribs. No pneumothorax.
2. Focal consolidation in the right lower lobe. This may represent
pneumonia. Recommend followup chest radiographs after treatment to document
resolution of this finding.
3. No intra-abdominal traumatic injury identified.
The case was discussed by Dr. ___ with Dr. ___ in person
at 2:10 p.m. on ___.
|
19907622-RR-18
| 19,907,622 | 27,564,876 |
RR
| 18 |
2153-05-28 05:27:00
|
2153-05-28 12:35:00
|
CHEST RADIOGRAPH
TECHNIQUE: Portable semi-erect chest view was read in comparison with prior
chest radiograph from ___.
FINDINGS: Mild biapical scarring is unchanged. Heart size, mediastinal and
hilar contours are normal. Mild atelectasis is present at the right lung
base. No lung opacities concerning for pneumonia. There is no pleural
abnormality. Fracture of the right ninth anterolateral rib is seen, however
fracture of eighth rib seen on prior radiograph could not be visualized due to
overlying monitoring and supporting device.
IMPRESSION:
1. No pneumonia.
2. Mild right lower lung atelectasis.
|
19907692-RR-19
| 19,907,692 | 20,302,559 |
RR
| 19 |
2186-05-31 09:21:00
|
2186-05-31 10:50:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p right-sided dual chamber PPM // Assess leads
placement and r/o PTx.
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided.
New place right chest wall dual-chamber pacemaker appears with leads
projecting over the right atrium and right ventricle. No evidence of
pneumothorax. No pleural effusions. Lungs are fully inflated and clear.
Cardiomediastinal silhouette and hilar contours are normal.
IMPRESSION:
1. Newly placed right chest wall dual chamber pacemaker with leads projecting
over the right atrium and right ventricle.
2. No radiographic evidence of acute cardiopulmonary abnormality.
|
19907884-RR-117
| 19,907,884 | 28,354,879 |
RR
| 117 |
2187-09-28 14:35:00
|
2187-09-28 14:53:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with DKA// pNA
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Multiple chest radiographs, most recently dated ___.
FINDINGS:
The lung volumes are persistently low. There is evidence of prior surgery
along the right apex with numerous surgical clips. Otherwise,the lungs are
clear without focal consolidation. No pleural effusion or pneumothorax is
seen. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
No acute cardiopulmonary abnormalities.
|
19907884-RR-118
| 19,907,884 | 28,354,879 |
RR
| 118 |
2187-09-28 18:10:00
|
2187-09-28 20:21:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: ___ woman with abdominal pain, nausea, vomiting. NO_PO
contrast. Evaluate for diverticulitis, GB pathology.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 6.7 s, 53.1 cm; CTDIvol = 9.8 mGy (Body) DLP = 518.8
mGy-cm.
Total DLP (Body) = 533 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___. abdominal ultrasound
dated ___.
FINDINGS:
LOWER CHEST: Small focal peripheral relatively linear ground-glass opacity in
the right middle lobe is nonspecific, but seen on the prior study, and could
be focal atelectasis or sequelae of chronic inflammation or infection (series
2, image 4). No evidence of a pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No
evidence of focal lesions. The 2.9 cm possible hemangioma on prior exams is
not well visualized on this exam, likely related to the phase of imaging.
Ectasia of the common bile duct to 8 mm is similar to the prior ultrasound and
CT and within normal limits for cholecystectomy status. Mild prominence of
the central intrahepatic biliary ducts is similar to the prior exam.
PANCREAS: The patient has had prior distal pancreatectomy with surgical clips
at the margin of the remaining proximal pancreas. The remaining pancreas is
slightly atrophic but has normal attenuation without evidence of a focal mass.
No evidence of main pancreatic ductal dilation. No peripancreatic fat
stranding or fluid collections.
SPLEEN: The spleen is surgically absent.
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.
Bilateral renal cortical hypodensities are again demonstrated, statistically
most likely cysts. No hydronephrosis or perinephric abnormality.
GASTROINTESTINAL: A hiatal hernia is small. The distal esophagus may be
thickened. The stomach is distended with ingested fluid and oral tablets.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. The colon has a moderate to abundant diffuse stool burden. The
appendix is not definitely visualized, although there are no secondary signs
of acute appendicitis.
PELVIS: The urinary bladder and distal ureters are unremarkable. Bilateral
ureteral jets of intravenous contrast are demonstrated. There is a small
amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. No concerning adnexal
masses. A 2-cm follicle/corpus luteum is seen in the left ovary. Trace
pelvic free fluid is within physiologic range.
LYMPH NODES: A lymph node at the hiatus measuring 7 mm in short axis is
unchanged (series 2, image 23). No retroperitoneal or mesenteric
lymphadenopathy. No pelvic or inguinal lymphadenopathy.
VASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is
noted. The main portal vein and SMV appear patent.
BONES: No evidence of worrisome osseous lesions or acute fracture.
Multilevel degenerative changes in the spine are most pronounced at L5-S1 with
a small broad-based disc bulge indenting the anterior thecal sac and mild
retrolisthesis of L5 on S1, unchanged.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Status post distal pancreatectomy, splenectomy, and cholecystectomy. No CT
findings of acute pancreatitis.
2. Prominent CBD with mild central intrahepatic biliary ductal dilation,
similar to prior.
3. Small hiatal hernia. Partially imaged distal esophagus appears thickened.
If this has not been recently evaluated, suggest further assessment with
endoscopy or upper GI series.
4. Moderately distended stomach.
5. Moderate to abundant colonic stool burden.
6. Left ovarian corpus luteum. Physiologic amount of free fluid in the
pelvis.
|
19907884-RR-119
| 19,907,884 | 20,895,196 |
RR
| 119 |
2188-02-21 16:05:00
|
2188-02-21 17:15:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ ___ recurrent pancreatitis, DKA and insulin
deficiency, marked insulin resistance requiring very large doses of insulin
despite normal BMI found to have FSG 759 at ___ s/p 35 units Humalog
presenting to ED for further mx// Eval for pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
There is persistent mild elevation of the right hemidiaphragm. No focal
consolidation is seen. No pleural effusion or pneumothorax is seen. The
cardiac and mediastinal silhouettes are unremarkable. Right upper
mediastinal/apical surgical clips are again noted.
IMPRESSION:
No acute cardiopulmonary process.
|
19907884-RR-148
| 19,907,884 | 27,481,511 |
RR
| 148 |
2188-07-27 10:49:00
|
2188-07-27 13:58:00
|
EXAMINATION: INJ/ASP MAJOR JT W/FLUORO
INDICATION: ___ year old woman with recent E. coli hip infection now
presenting with recurrent infection// R hip arthrocentesis
COMPARISON: Correlation CT pelvis from ___.
PROCEDURE: The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
5 cc of 1% Lidocaine was used to achieve local anesthesia. Under intermittent
fluoroscopic guidance, a 18-gauge spinal needle was advanced into the right
hip joint. A total of 3 cc of serosanguineous fluid containing a small amount
of purulent debris were aspirated.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in good
condition. There were no immediate complications or complaints.
FINDINGS:
The patient has a right proximal femoral prosthesis.
IMPRESSION:
Technically successful right hip aspiration. Samples were sent for
microbiology and hematology as requested
I Dr. ___ personally supervised the Resident/Fellow during the key
components of the above procedure and I have reviewed and agree with the
Resident/Fellow findings/dictation.
|
19907884-RR-149
| 19,907,884 | 27,481,511 |
RR
| 149 |
2188-07-27 11:53:00
|
2188-07-27 12:43:00
|
EXAMINATION: US, OTHER SOFT TISSUE AREA
INDICATION: ___ year old woman with recent J tube insertion, with concern for
J tube insertion site infection.
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left mid abdomen in the area of the J-tube.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left mid abdomen in the area of the patient's J-tube. The J-tube balloon
appears well positioned within a loop of small bowel no evidence of a fluid
collection along the course of the catheter. There is mild subcutaneous edema
without associated increased color Doppler flow. This is associated with mild
skin thickening. No drainable fluid collection is identified.
IMPRESSION:
Mild skin thickening and subcutaneous edema in the area of the patient's
J-tube without evidence of a drainable fluid collection, or deeper infection.
The J-tube was otherwise appropriately positioned.
|
19907884-RR-151
| 19,907,884 | 27,481,511 |
RR
| 151 |
2188-07-28 19:40:00
|
2188-07-28 23:56:00
|
EXAMINATION: Q62R
INDICATION: ___ year old woman with recent R hip septic arthritis s/p femoral
headremoval with antibiotic spacer placed ___ who presents w/ fever+
confusion.// please eval for fluid collection/abscess in lower portion of leg
not imaged on CT pelvis
TECHNIQUE: Multiaxial CT of images of the right hip and femur were performed
after intravenous contrast.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.7 s, 58.9 cm; CTDIvol = 13.6 mGy (Body) DLP = 801.1
mGy-cm.
Total DLP (Body) = 801 mGy-cm.
COMPARISON: CT study from ___ and prior.
FINDINGS:
Redemonstrated postsurgical changes of right hip arthroplasty with associated
metallic artifact which obscures the adjacent structures. There are areas of
heterotopic ossification/calcification about the hip joint.
Redemonstrated is a rim enhancing collection posterior to the right hip joint
measuring at least to 3.2 cm in diameter. However current Size and extent is
suboptimally evaluated due to the metallic artifact.
There is suggestion of foci of gas within this collection, concerning for
ongoing infection.
No other drainable collections or rim is abscesses are seen in the right hip
and thigh.
There is circumferential skin thickening and subcutaneous edema most
pronounced about the proximal lateral aspect of the right thigh, which may
represent cellulitis in the correct clinical context. There is no evidence of
soft tissue gas seen.
There are no osseous erosions seen in the visualized osseous structures which
are not obscured.
There is circumferential bladder wall thickening which can be seen in the
context of cystitis.
There are vascular calcifications..
IMPRESSION:
Suboptimal examination is secondary to metallic hardware artifact.
Persistent rim enhancing collection measuring at least 3.2 cm in diameter
posterior to the right hip joint in keeping with ongoing septic arthritis.
Circumferential skin thickening and subcutaneous edema most pronounced about
the lower aspect of the proximal thigh which may represent cellulitis in the
correct clinical context. Recommend clinical correlation.
Circumferential bladder wall thickening which may represent cystitis.
Recommend clinical correlation with urinalysis.
|
19907884-RR-152
| 19,907,884 | 27,481,511 |
RR
| 152 |
2188-07-31 16:35:00
|
2188-07-31 17:49:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with infected R hip joint.// assess for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None available.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst. Subcutaneous soft tissue
edema is noted in the distal right thigh.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
Subcutaneous soft tissue edema in the distal right thigh.
|
19907884-RR-153
| 19,907,884 | 27,481,511 |
RR
| 153 |
2188-08-02 02:42:00
|
2188-08-02 11:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with septic joint. s/p pRBC, evaluate for edema
versus pna.
TECHNIQUE: Chest AP
COMPARISON: Comparisons to multiple prior radiograph studies dated ___, and ___.
FINDINGS:
Lung volumes are decreased. Mild prominence of the hilar contours appears
increased, which may represent worsening adenopathy and could be reactive.
Unchanged linear opacity in the right mid and upper lung, which may represent
atelectasis. No acute focal consolidation. No pneumothorax or pleural
effusion. No pulmonary vascular congestion. Right PICC line is in stable
position with tip terminating in the mid SVC. Surgical clips are again seen
in the area projecting over the right upper mediastinum.
IMPRESSION:
1. No pulmonary edema.
2. Increased hilar contours, which may represent worsening adenopathy.
3. No definitive evidence of pneumonia.
|
19907884-RR-155
| 19,907,884 | 27,481,511 |
RR
| 155 |
2188-08-02 03:50:00
|
2188-08-02 04:51:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with chronic pancreatitis and worsening
abdominal pain with recent R septic hip and antibiotic space placement and
removal of the spacer on ___// source of infection, abscess? active
pancreatitis?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 15.9 s, 0.2 cm; CTDIvol = 266.2 mGy (Body) DLP =
53.2 mGy-cm.
3) Spiral Acquisition 13.6 s, 72.2 cm; CTDIvol = 12.6 mGy (Body) DLP =
912.7 mGy-cm.
Total DLP (Body) = 968 mGy-cm.
COMPARISON: CT abdomen and pelvis of ___ and CT of the pelvis of
___ and CT of the right lower extremity ___.
FINDINGS:
LOWER CHEST: Mild atelectatic changes in both lung bases.
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 removed.
PANCREAS: Post distal pancreatectomy, normal enhancement of the remaining
pancreas without focal lesion identified. There is no peripancreatic
stranding.
SPLEEN: Spleen is surgically absent.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is a new area of hypoenhancement at the middle third of left
kidney, that could be concerning for nephritis/pyelonephritis, less likely
infarcts. Bilateral simple renal cysts.
GASTROINTESTINAL: The stomach is unremarkable. Left abdominal percutaneous
jejunostomy tube is seen. Soft tissue thickening and edema bordering the
jejunostomy site. The colon and rectum are within normal limits. The appendix
is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. New small
amount of free fluid located in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: Multiple retroperitoneal lymph nodes unchanged.
There are stable pelvic lymph nodes thickest measuring 10 mm in the on the
left .
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: ) Since ___, there has been removal of a right hip
prosthesis. Surgical bed demonstrating collection of fluid and gas in the
joint capsule and also extending posteriorly and laterally to the vastus
musculature for a length of approximately 16 cm. Posteriorly we see air and
edema involving the gluteus musculature and there is extensive soft tissue and
subcutaneous edema of the right hip area and right thigh.
SOFT TISSUES: No abdominopelvic hernia.
IMPRESSION:
1. Hypoenhancing area involving the left kidney could represent
pyelonephritis.
2. Interval removal of right hip prosthesis, gas containing collection now
seen at this level and involving the right thigh. Postsurgical changes can
have this aspect, although this is concerning for superinfection. Correlate
clinically.
|
19907884-RR-156
| 19,907,884 | 27,481,511 |
RR
| 156 |
2188-08-05 11:00:00
|
2188-08-05 14:27:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with chronic idiopathic pancreatitis,
cholecystectomy, MDR ecoli septic hip with recurrent infection developing
worsening pain and new transaminitis// evaluation of new transaminitis
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.
CHD: 8 mm, unchanged from prior.
GALLBLADDER: Gallbladder is surgically absent.
PANCREAS: Status post distal pancreatectomy. Small visualized portion the
pancreatic head is unremarkable.
SPLEEN: Status post splenectomy.
KIDNEYS: Limited views of the right kidney shows no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Status post splenectomy and distal pancreatectomy. Otherwise unremarkable
right upper quadrant ultrasound.
|
19907884-RR-76
| 19,907,884 | 25,339,336 |
RR
| 76 |
2181-10-12 15:03:00
|
2181-10-12 16:12:00
|
CLINICAL HISTORY: ___ woman with tube placement. Question tube
placement.
COMPARISON: ___ chest x-ray.
SINGLE AP VIEW OF THE CHEST: No endotracheal tube is seen. Patient is status
post right upper lung surgery with unchanged appearance of the right
hemithorax and evidence of right sided volume loss. Lungs are clear.
Cardiomediastinal silhouette and hilar contours are unremarkable. No pulmonary
edema is present.
IMPRESSION: No evidence of acute intrathoracic process. No evidence of the
ET tube.
These results were communicated with Dr ___ of the ED by Dr ___
at 4:10 pm via telephone on the date of the study. The wrong requisition was
entered. The clinical history is ___ year old women with shortness of breath.
|
19907884-RR-77
| 19,907,884 | 25,339,336 |
RR
| 77 |
2181-10-14 15:37:00
|
2181-10-14 19:55:00
|
HISTORY: ___ female presenting with a history of chronic pancreatitis
status post a Whipple procedure, now presenting with abdominal pain. Please
evaluate for an acute process.
COMPARISON: CT scan from ___.
TECHNIQUE: Contiguous axial images were obtained through the abdomen and
pelvis before and after the injection of IV contrast. In addition, enteric
contrast was administered. Coronal and sagittal reformatted images were also
available for review. Total exam DLP is 606.27.
FINDINGS: The visualized lower lungs reveal mild bibasilar atelectasis.
Since the prior examination, the gallbladder, distal pancreas, and spleen have
been removed. The liver enhances homogeneously without focal mass. The
common bile duct measures up to 7.5 mm, presumably related to the recent
surgery. As on the prior examination, there are at least three walled off
collections in the pancreas that probably represent hematomas and are slightly
smaller from prior exam. The pancreatic duct is normal. The remaining
pancreas is atrophic without calcifications.
Multiple hypodensities are seen in both kidneys that are too small to
adequately characterize but likely represent cysts. The largest is in the
upper pole of the left kidney and measures up to 1 cm. The kidneys otherwise
enhance symmetrically with symmetric excretion of contrast. No adrenal nodule
is identified.
There is a Foley catheter in a mildly distended bladder. Air within the
bladder lumen is presumably iatrogenic from Foley catheter placement.
Multiple fluid-filled structures posterior to the uterine body are more
apparent on the current examination. The largest measures up to 3.4 x 2.8 cm.
These likely are related to the patient's ovaries representing ovarian cysts.
There is some free fluid in the pelvis.
Oral contrast is seen extending to the hepatic flexure. There is a
jejunostomy tube extending into a small bowel loop through the left anterior
abdominal wall. There is a 4 x 1.2 cm well circumscribed indurated fat
structure along the left lateral aspect of the omentum consistent with an
omental infarct.
The portal vein and SMV are patent. The splenic vein is no longer visualized,
presumably secondary to the recent surgery. The celiac axis, SMA, and renal
arteries are patent. There is a venous catheter with its tip in the left
external iliac vein.
No osseous abnormalities are identified.
IMPRESSION:
1. Omental infarct along the left lateral aspect of the abdomen. Clinically
correlate with the patient's pain.
2. The patient is status post distal pancreatectomy, splenectomy, and
cholecystectomy.
3. At least three walled off collections are again seen in the pancreas which
probably represent chronic hematomas and are slightly smaller. No evidence
for chronic pancreatitis.
4. Mild dilation of the common bile duct. MRCP may be performed to further
evaluate.
These findings were discussed with Dr. ___ telephone by Dr. ___ on
___.
|
19907884-RR-79
| 19,907,884 | 25,339,336 |
RR
| 79 |
2181-10-20 15:13:00
|
2181-10-20 22:49:00
|
PROCEDURE: JEJUNOSTOMY TUBE CHECK AND UNCLOGGING: ___.
INDICATION: ___ woman with a clogged J-tube, needs replacement or
unclogging.
OPERATORS: Dr. ___, radiology fellow, and Dr. ___ (attending
radiologist).
TECHNIQUE/FINDINGS:
The patient presented with a clogged J-tube. The patient was positioned
supine of the angiography table. 10 cc of cola was placed through the tube,
and then a 0.035-inch ___ wire was used to open up the J-tube. This was
successful. After flushing with saline, contrast injection demonstrated free
passage of contrast through the tube into the distal jejunal loops.
The patient tolerated the procedure well. No immediate post-procedure
complications were noted.
IMPRESSION:
Successful unclogging of the J-tube with cola and ___ wire. The tube is
ready to use.
|
19907884-RR-84
| 19,907,884 | 21,322,115 |
RR
| 84 |
2181-12-31 16:53:00
|
2181-12-31 19:53:00
|
CLINICAL INFORMATION: ___ female with history of fever.
COMPARISON: None.
FINDINGS: Frontal and lateral views of the chest were obtained. There are
low lung volumes and bronchovascular crowding. There is prominence of the
hila suggesting pulmonary vascular engorgement with possible mild pulmonary
vascular congestion. No pleural effusion or pneumothorax is seen. Left
infrahilar and left basilar opacity may relate to vascular crowding, although
infectious process cannot be excluded in the appropriate clinical setting.
There are right paramediastinal surgical clips. Cardiac and mediastinal
silhouettes are stable.
|
19907884-RR-85
| 19,907,884 | 21,322,115 |
RR
| 85 |
2181-12-31 16:54:00
|
2181-12-31 20:09:00
|
EXAM: Abdomen single supine portable view.
CLINICAL INFORMATION: ___ female with history of J-tube not flushing,
presenting with abdominal pain. Please evaluate J-tube.
___.
FINDINGS: Single supine AP portable view of the chest was obtained. A
tubular structure extends into the left lower quadrant, lower in position than
on the prior study. There is some question whether it has been dislodged. No
lateral view. Air and stool filled loops of colon are seen without frank
bowel obstruction.
IMPRESSION: Tube/catheter projecting over left lower quadrant is migrated in
position as compared to the prior study. If the tube has not been changed,
question migration out of position. Consider tube check with contrast for
further evaluation.
|
19907884-RR-86
| 19,907,884 | 21,322,115 |
RR
| 86 |
2181-12-31 18:21:00
|
2181-12-31 22:02:00
|
EXAM: Contrast-enhanced CT of the abdomen and pelvis.
CLINICAL INFORMATION: ___ female with history of abdominal pain
around the J-tube, question abscess.
___.
TECHNIQUE: MDCT of the abdomen and pelvis were obtained following
administration of 130 cc of Omnipaque intravenous contrast and without oral
contrast administration. Reformatted coronal and sagittal images were also
obtained.
FINDINGS:
LUNG BASES: There is minimal bibasilar atelectasis. No pleural effusion is
seen.
ABDOMEN: No focal intrahepatic lesion is seen. There is radiographic
differences in attenuation in the liver which are likely perfusional. Main
portal vein and portal vein branches appear patent. There is a hypodensity in
the liver (series 2, image 19), not clearly present on the prior study. The
gallbladder is not seen and may be surgically absent. Patient is status post
splenectomy, cholecystectomy and distal pancreatectomy. At least three cystic
lesions seen in the pancreas are grossly stable as compared to prior studies,
measuring 1.5 x 1.3 x and 1.1 cm. The adrenal glands are unremarkable. There
is a subcentimeter hypodensity in the right kidney, too small to further
characterize. Additional hypodensities in the left kidney measure up to 1.2
cm. No hydronephrosis are seen bilaterally. There is no evidence of bowel
obstruction in the upper abdomen. No free air is seen.
PELVIS: Tube, probably J-tube is seen entering into the left lower quadrant.
The tube is coiled in the anterior left lower abdominal wall and appears to
extend to loops of small bowel; unable to assess patency of the tube, cannot
assess for block since no contrast was injected within. There is soft tissue
thickening around the tube at the anterior abdominal wall without drainable
fluid collection. Tiny focus of gas is seen in subcutaneous tissue along the
tube, question due to its insertion, cannot exclude infection. No bowel
obstruction is seen. There is no bowel wall thickening. The bladder is
markedly distended. Query whether patient needs Foley catheter/can urinate on
own. There is small amount of pelvic free fluid. Uterus and adnexa are
grossly unremarkable. No free fluid is seen. There is no pelvic free fluid.
There is subcutaneous edema along the left flank.
OSSEOUS STRUCTURES:
IMPRESSION: Tube entering in left lower quadrant is coiled in the anterior
abdominal wall with adjacent soft tissues thickening/stranding without
drainable fluid collection seen. Tiny focus of gas along the subcutaneous
tissues along the tube site, could relate to tube insertion, although
superimposed infections cannot be excluded. No drainable abscess seen.
Bladder is markedly distended, and thin-walled. Query whether patient
requires Foley catheter or can urinate on own.
Small amount of pelvic free fluid.
Pancreatic pseudocysts again seen. Left flank subcutaneous edema.
|
19907884-RR-87
| 19,907,884 | 21,322,115 |
RR
| 87 |
2182-01-03 09:25:00
|
2182-01-03 13:46:00
|
J-TUBE Change
OPERATORS: Drs. ___ (fellow) and ___ (attending radiologist). Dr
___ was present in in the room and supervised throughout the procedure.
INDICATION: ___ year old woman with displaced J-tube.
CONTRAST: Sterile 15 mL Omnipaque 350.
PROCEDURE AND FINDINGS: Consent was obtained after explaining the benefits,
risks, and alternatives. Patient was placed supine on the imaging table in the
interventional suite. The patient was prepped and draped in usual sterile
fashion. Timeout and huddle were performed as per ___ protocol.
A ___ wire was advanced through the catheter, and negotiated into the
bowel. A 5
___ Kumpe catheter was placed over the wire and after removing the wire, a
small amount of sterile contrast material was injected to confirm position of
the catheter tip within the jejunum. Wire was replaced into the catheter and a
new 12 ___ ___ catheter was then placed over the wire and
advanced into the jejunum. After removing the wire, a small amount of sterile
contrast material was injected to confirm position. String was withdrawn,
secured, and trimmed. Retention pigtail loop was placed within the jejunal
lumen. Tube was flushed with sterile saline. It was then secured with
Flexi-Trak. Site was appropriately dressed. Patient tolerated the procedure
well and no immediate post-procedure complication was seen.
IMPRESSION: Uncomplicated replacement of 12 ___ ___ tube with
its tip and retention pigtail loop within the jejunal lumen. J-tube is ready
for use.
|
19907884-RR-88
| 19,907,884 | 26,463,137 |
RR
| 88 |
2182-01-29 09:39:00
|
2182-01-29 12:52:00
|
INDICATION: ___ woman with recurrent J-tube leakage. Please evaluate
and upsize the tube.
RADIOLOGISTS: Dr. ___ (fellow) performed the procedure. Dr.
___ (attending physician) was present and supervised throughout
the procedure.
ANESTHESIA: Moderate sedation was provided by administering divided doses of
75 mcg of fentanyl and 1.5 mg of Versed throughout the total intraservice time
of 22 minutes, during which the patient's hemodynamic parameters were
continuously monitored.
PROCEDURE: Written informed consent was obtained from the patient after
explaining the risks, benefits and alternatives to procedure. The patient was
brought to the angiographic suite and laid supine on the table. A
preprocedural huddle and timeout were performed per ___ protocol after
prepping and draping the indwelling J-tube in a sterile fashion.
An initial scout was obtained which demonstrated no breakage of the indwelling
12 ___ ___ tube. Contrast was injected to confirm the presence
of the tube in the jejunum. ___ wire was then advanced into the jejunum
and the ___ was exchanged with a Kumpe. The Kumpe was used to
direct the wire further down the jejunum. The Kumpe was then exchanged for a
14 ___ ___. The retaining pigtail was formed and contrast was injected
to confirm intraluminal position.
Sterile dressings were applied. The patient tolerated the procedure well.
There were no immediate complications.
IMPRESSION:
Successful exchange of a 12 ___ ___ J-tube to a 14 ___ ___
J tube.
|
19908221-RR-14
| 19,908,221 | 21,397,883 |
RR
| 14 |
2141-04-22 13:21:00
|
2141-04-22 15:12:00
|
INDICATION: ___ year old man with HCV cirrhosis c/b cryoglobulins, MPGN, rash
and recent pulmonary hemorrhage // Please place double lumen tunneled
pheresis catheter. ___ aware. Please place as early as possible, pt needs
phresis ___
COMPARISON: Reference is made to a prior radiograph of ___.
TECHNIQUE: OPERATORS: Dr. ___ (interventional radiology attending)
performed the procedure. The attending, Dr. ___ was present and
supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
1 mcg of fentanyl and 50 mg of midazolam throughout the total intra-service
time of 33 min 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.
PROCEDURE: 1. Tunneled non-dialysis line 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 access site 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 for stability.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 12 ___ triple-lumen trifusion catheter was selected.
The catheter was tunneled from the entry site towards the venotomy site from
where it was brought out using a tunneling device. The venotomy tract was
dilated using the introducer of the peel-away sheath supplied. Following this,
the 12.5 ___ peel-away sheath was placed over the ___ wire through which
the catheter was threaded into the right side of the heart with the tip in the
right atrium. The sheath was then peeled away. Final spot fluoroscopic image
demonstrating good alignment of the catheter and no kinking. The tip is in the
right atrium. The catheter was flushed and each lumen was capped. The
catheter was sutured in place with 0 silk sutures. ___ subcuticular Vicryl
sutures were also used to close the venotomy incision site. Steri-Strips were
applied. Sterile dressings were applied. The patient tolerated the procedure
well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing right IJ
approach 12 ___ tunneled trifusion catheter with tip terminating in the
right atrium.
IMPRESSION:
Successful placement of a 12 ___ triple-lumen tunneled line via the right
internal jugular venous approach. The tip of the catheter terminates in the
right atrium. The catheter is ready for use.
|
19908221-RR-16
| 19,908,221 | 21,397,883 |
RR
| 16 |
2141-04-23 11:36:00
|
2141-04-23 13:31:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with HCV and cryos, now seizing. R/o bleed //
Eval for bleed
TECHNIQUE: Contiguous axial images were obtained through the head without the
administration of intravenous contrast. Coronal and sagittal reformatted
images as well as thin section images in a bone window algorithm were
generated and reviewed.
DOSE: DLP: 1118.8 mGy-cm; CTDI: 55.8 mGy
COMPARISON: No prior studies available.
FINDINGS:
There is no acute intracranial hemorrhage, edema, mass effect or shift of
normally midline structures. The ventricles and sulci are normal in size and
configuration for the patient's age. The basal cisterns appear patent and
gray-white matter differentiation is preserved. Tiny periventricular
hypodensity near the head of the left caudate likely represents chronic small
vessel ischemic disease. The orbits and globes are unremarkable. The imaged
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
bony calvaria appear intact.
IMPRESSION:
No acute intracranial abnormality.
|
19908221-RR-17
| 19,908,221 | 21,397,883 |
RR
| 17 |
2141-04-23 17:17:00
|
2141-04-23 22:20:00
|
EXAMINATION: MRI AND MRA BRAIN
INDICATION: ___ year old man with Hep C cirrhosis with cryoglobulinemia
vasculitis, now with focal seizure after pheresis session. This examination is
performed to assess for stroke, PRES and evidence of CNS vasculitis.
TECHNIQUE: Multiplanar, multi sequence MR images of the head were obtained
without the use of intravenous contrast. MR angiogram images of the head were
obtained using a 3D time-of-flight technique (no gadolinium).
COMPARISON: CT head without contrast ___.
FINDINGS:
Confluent areas of T2 and FLAIR hyperintensity are present within the
periventricular, subcortical and deep white matter as well as within the pons.
There are scattered white matter foci of T2 and FLAIR hyperintensity
superimposed on the more confluent regions of signal abnormality. In addition,
there is a focal area of T2 and FLAIR hyperintensity within the right frontal
lobe which extends to the cortex.
There is no acute infarct or intracranial hemorrhage. The ventricles, cerebral
sulci and cisterns are mildly prominent, reflecting a mild degree of cerebral
atrophy. Flow voids for the major intracranial vessels are preserved.
The visualized orbits and soft tissues are unremarkable.
MRA head: The major intracranial vessels are patent without evidence of
stenosis or occlusion. Infundibular origin of the left posterior communicating
artery is noted. No aneurysm or arterial venous malformation is detected.
IMPRESSION:
Confluent regions of T2/FLAIR hyperintensity in the periventricular white
matter and a focal FLAIR hyperintense right frontal lobe lesion extending to
the cortex. This may represent an infiltrating neoplasm such as gliomatosis
cerebri. The right frontal lobe lesion is less likely to reflect infarct
given the fast diffusion. It is also unlikely to be the result of seizure
given the deep white matter component of the lesion, and is unlikely to
represent a prior contusion given name lack of atrophy. Further
characterization with postcontrast images is recommended.
|
19908221-RR-18
| 19,908,221 | 21,397,883 |
RR
| 18 |
2141-04-24 16:09:00
|
2141-04-25 12:25:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with cirrhosis and recent seizure.
TECHNIQUE: Axial FLAIR and T1 axial postcontrast and sagittal MPRAGE
postcontrast and reformatted images were obtained.
COMPARISON: MR ___ without contrast ___.
FINDINGS:
The confluent periventricular FLAIR hyperintensities are less obvious than on
the previous examination. Again seen is a focal area of FLAIR hyperintensity
involving the cortex and extending into the deep white matter within the right
frontal lobe. There appears to be slightly less cortical swelling when
compared with the previous examination. There are slight technical differences
between the way the FLAIR scans were acquired (though the examinations were
performed on the same machine) which may have, but are unlikely to have,
caused the differences in the contrast on the FLAIR images. The differences
may be due to changes in oxygen tension, as the patient is no longer
intubated. However, the apparent change in the cortical swelling of the right
frontal lobe lesion may be real.
There is no abnormal enhancement.
IMPRESSION:
1. Differences in FLAIR contrast may be due to changes in the oxygen tension
rather than technical differences. On the current FLAIR images, the white
matter signal is not strikingly abnormal and now is now in keeping with what
can normally be seen in a ___ patient with small vessel ischemic
disease.
2. The etiology of the right frontal lobe lesion remains unclear though there
may be slightly less cortical swelling associated with the lesion, and this
may be due to seizure swelling with an area of underlying tissue loss in the
deep white matter secondary to previous injury. There is no abnormal
enhancement. Followup is recommended.
|
19908221-RR-19
| 19,908,221 | 21,397,883 |
RR
| 19 |
2141-04-25 21:45:00
|
2141-04-26 09:21:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with productive cough, e. coli in sputum, rhonchi
at bilateral bases // eval for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Cardiac size is top-normal. There is new mild to moderate pulmonary edema.
There is no pneumothorax or pleural effusion. The osseous structures are
unremarkable central catheter is in standard position
IMPRESSION:
New mild to moderate pulmonary edema.
|
19908221-RR-20
| 19,908,221 | 21,397,883 |
RR
| 20 |
2141-04-29 14:20:00
|
2141-04-29 19:31:00
|
PROCEDURE: Tunneled pheresis catheter removal.
INDICATION: Treatment incomplete.
The tube site was cleaned and draped in sterile fashion. The sutures were
cut. ___ traction was placed on the tube. The cuff released and
the tube easily was removed from the tract. Pressure was held at the venotomy
site for approximately 10 minutes. There was no bleeding following pressure
holding. A small bandage was placed.
Patient tolerated the procedure well. No complications.
SUMMARY:
Uncomplicated removal of tunneled pheresis catheter within the right internal
jugular vein. No complications.
|
19908221-RR-21
| 19,908,221 | 22,170,002 |
RR
| 21 |
2141-05-08 17:35:00
|
2141-05-08 23:29:00
|
INDICATION: ___ with renal failure // ? pulm edema
TECHNIQUE: Portable chest x-ray.
COMPARISON: Chest radiographs dated ___ through ___.
FINDINGS:
Portable semi-upright radiograph of the chest demonstrates low lung volumes
results in bronchovascular crowding. Engorged pulmonary vasculature and
increase interstitial markings is suggestive of mild pulmonary edema.
Cardiomediastinal and hilar contours are unchanged. No pneumothorax or pleural
effusion.
IMPRESSION:
Mild pulmonary edema.
|
19908221-RR-22
| 19,908,221 | 22,170,002 |
RR
| 22 |
2141-05-09 07:59:00
|
2141-05-09 12:36:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with severe ___ // e/o obstruction?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal ultrasound dated ___
FINDINGS:
The right kidney measures 13.8 cm. The left kidney measures 13.7 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is decompressed by Foley catheter.
There is a small amount of ascites.
IMPRESSION:
1. No evidence of hydronephrosis. Normal renal ultrasound.
2. Small amount of ascites.
|
19908221-RR-23
| 19,908,221 | 22,170,002 |
RR
| 23 |
2141-05-09 10:57:00
|
2141-05-09 11:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with ___ year old male with hep. C cirrhosis s/p
IFN (___) c/b cryoglobulinemia, leukocytoclastic vasculitis with MPGN,
pulmonary hemorrhage treated with plasmapharesis (___), chronic anasarca,
dCHF (EF 55%), IDDM, morbid obesity, COPD, CAD presenting with worsening renal
function, AMS and h/o fall. // rule out acute intracranial bleed
TECHNIQUE: Multi detector CT images were obtained of the head without the
administration of intravenous contrast material. Multiplanar reformatted
images in coronal and sagittal planes are provided.
DOSE: DLP: 1114.91 mGy-cm
CTDI: 55.75 mGy
COMPARISON: CT of the head dated ___.
FINDINGS:
There is no acute hemorrhage, edema, mass effect or acute large vascular
territorial infarction. The ventricles and sulci are normal in size and
configuration. Periventricular white matter hypodensities are consistent with
chronic small vessel ischemic disease. The basal cisterns appear patent and
there is preservation of gray-white matter differentiation.
No fracture is identified. The mastoid air cells and middle ear cavities are
clear. There is mucosal thickening in the right maxillary sinus. The globes
are unremarkable.
IMPRESSION:
No acute intracranial process.
|
19908221-RR-24
| 19,908,221 | 22,170,002 |
RR
| 24 |
2141-05-09 11:24:00
|
2141-05-09 12:33:00
|
EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old man with ___ year old male with hep. C cirrhosis s/p
IFN (___) c/b cryoglobulinemia, leukocytoclastic vasculitis with MPGN,
pulmonary hemorrhage treated with plasmapharesis (___), chronic anasarca,
dCHF (EF 55%), IDDM, morbid obesity, COPD, CAD presenting with worsening renal
function. // look at liver and abdomen, r/o cirrhosis, ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Renal ultrasound dated ___.
FINDINGS:
LIVER: The echogenicity of the liver is homogeneous. The contour of the liver
is smooth. There is no focal liver mass. Main portal vein is patent with
hepatopetal flow. There is small ascites.
VASCULATURE: Patent flow was seen in the main portal vein, right and left
portal veins. Appropriate waveforms are is seen in the main hepatic artery.
The hepatic veins and IVC are patent.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: Cholelithiasis without galbladder wall thickening.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
SPLEEN: Splenomegaly, measuring 17.3 cm.
KIDNEYS: The right kidney measures 13.8 cm. The left kidney measures 13 cm.
Limited views of the kidneys are unremarkable.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Normal liver ultrasound. Patent hepatic vasculature.
2. Cholelithiasis without gallbladder wall thickening.
3. Splenomegaly.
4. Small ascites.
|
19908221-RR-25
| 19,908,221 | 22,170,002 |
RR
| 25 |
2141-05-12 13:37:00
|
2141-05-12 18:20:00
|
INDICATION: Hepatitis-C virus with worsening renal failure needing
hemodialysis.
COMPARISON: Tunnel catheter placement ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology resident) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: 1% lidocaine and 1% lidocaine with epinephrine injected in the
skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2 min 12 seconds, 14 mGy
PROCEDURE: 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 right/left, upper chest/groin was prepped
and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent internal jugular vein on the
right 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 tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 23 cm double lumen hemodialysis catheter was selected.
The catheter was tunneled from the entry site towards the venotomy site from
where it was brought out using a tunneling device. 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 catheter
was threaded into the right side of the heart with the tip in the right
atrium. The sheath was then peeled away. The catheter was sutured in place
with 0 silk sutures. Steri-Strips were also used to close the venotomy
incision site. Final spot fluoroscopic image demonstrating good alignment of
the catheter and no kinking. The tip is in the right atrium. The catheter was
flushed and both lumens were capped. Sterile dressings were applied. The
patient tolerated the procedure well.
FINDINGS:
Patent internal jugular vein on the right. Final fluoroscopic image showing
hemodialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a right internal jugular tunneled dialysis line. The
tip of the catheter terminates in the right atrium. The catheter is ready for
use.
|
19908221-RR-26
| 19,908,221 | 22,170,002 |
RR
| 26 |
2141-05-13 18:15:00
|
2141-05-14 09:14:00
|
INDICATION:
Cirrhosis. Pain.
TECHNIQUE:
3 views of the right wrist and distal forearm.
FINDINGS:
No fracture or bone destruction. Minimal degenerative changes first see IMC
joint with no joint space narrowing here or elsewhere. Soft tissue changes
probably reflect a bandage over the distal forearm and wrist. Equivocal
incidental slight positive ulnar variance. Vascular calcifications are
noteworthy in this age group. Normal mineralization.
IMPRESSION:
No fracture. Vasculopathy
|
19908221-RR-27
| 19,908,221 | 22,170,002 |
RR
| 27 |
2141-05-13 18:15:00
|
2141-05-14 09:06:00
|
INDICATION:
Cirrhosis. Pain forearm.
TECHNIQUE:
3 views of the right elbow were ordered and obtained. Only the proximal right
forearm is imaged (see wrist exam reported separately same day).
FINDINGS:
There are soft tissue changes and presumed edema along the medial aspect of
the elbow. No fracture, bone destruction, or other osseous abnormality. I
doubt the presence of an effusion. Normal mineralization.
IMPRESSION:
Normal osseous structures.
|
19908221-RR-28
| 19,908,221 | 22,170,002 |
RR
| 28 |
2141-05-15 10:19:00
|
2141-05-15 14:02:00
|
EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL
INDICATION: ___ year old man with significant right forearm pain and swelling.
// evaluate for any RUE DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right Upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular and axillary veins are patent and compressible with
transducer pressure.
The right brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
Images of the right forearm demonstrate a superficial vein which is
thrombosed. This vein does not demonstrate vascular flow on doppler imaging.
Superficial edema is noted in the right forearm.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity. There is a
small thrombosed superficial vein noted in the right forearm. Superficial
edema is also noted in the right forearm.
NOTIFICATION: Findings of thrombosed right arm superficial vein were
discovered at 11:30 on ___ and were conveyed by telephone to Dr.
___ at 11:40 on the same day.
|
19908221-RR-30
| 19,908,221 | 22,170,002 |
RR
| 30 |
2141-05-16 09:44:00
|
2141-05-16 15:01:00
|
EXAMINATION: MR ARM W/O CONTRAST RIGHT
INDICATION: ___ year old man with HCV cirrhosis, cryoglobulinemia now with
five days of severe right forearm pain surrounding the elbow and extending
towards the wrist. // any evidence of bone infarction? Soft tissue
abnormalities?
TECHNIQUE: Imaging performed at 1.5 using the HD body full coil. Sequences
include axial and sagittal T1 weighted and sagittal STIR sequences.
COMPARISON: Radiographs of the elbow ___.
FINDINGS:
Limited sequences through the forearm demonstrate diffuse expansion of the
volar compartment musculature with diffusely heterogeneous T1 and STIR signal
containing areas of T1 hyperintensity suggestive of hemorrhage or
proteinaceous material. There is diffuse edema of the subcutaneous soft
tissues and muscles of the whole are compartment. The bone marrow signal is
normal in appearance.
IMPRESSION:
Findings suggesting myonecrosis involving the volar compartment musculature of
the forearm with areas of hemorrhage and diffuse subcutaneous soft tissue
edema. Infection is not excluded, however is considered less likely.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ on the telephone on ___ at 2:30 ___, 5 minutes after discovery of
the findings.
|
19908221-RR-31
| 19,908,221 | 22,170,002 |
RR
| 31 |
2141-05-17 15:27:00
|
2141-05-17 18:13:00
|
INDICATION: ___ year old man with worsening swelling, erythema, and pain of
right arm. Treating as cellulitis // Concerned for fluid collection. Please
assess for interval development of abscess/fluid collection of RIGHT ARM
TECHNIQUE: Grayscale and color Doppler ultrasound evaluation of the right arm
and forearm.
COMPARISON: MR examination of the right forearm ___ on the ___.
FINDINGS:
On the volar aspect of the right forearm approximately 6 cm distal to the
antecubital fossa a complex heterogeneous collection with no internal
vascularity corresponds to the area of myonecrosis with areas of hemorrhage
and overlying subcutaneous soft tissue edema seen on the prior MR examination
performed 1 day prior.
IMPRESSION:
Complex collection in the volar aspect of the right forearm corresponds to the
area of myonecrosis with areas of hemorrhage and overlying subcutaneous edema
as seen on the prior MR examination performed 1 day prior.
|
19908221-RR-32
| 19,908,221 | 22,170,002 |
RR
| 32 |
2141-05-17 18:41:00
|
2141-05-17 19:47:00
|
EXAMINATION: CT right upper extremity without contrast
INDICATION: ___ year old man with right upper extremity pain, swelling, and
rapidly progressive erythema on antibiotics. // Please evaluate for fluid
collection, evidence of gas
TECHNIQUE: Axial helical multi detector CT images were acquired of the right
upper extremity without contrast. Multiplanar reformats were generated in the
coronal and sagittal planes.
DOSE: DLP: 1761.18 mGy cm
COMPARISON: Right upper extremity ultrasound ___, right arm MRI ___.
FINDINGS:
There is skin thickening particularly around the elbow with mild superficial
soft tissue fat stranding mainly in the ventral soft tissues starting from the
mid humerus level extending to the level of the wrist. There is no fluid
collection. There is no subcutaneous gas. An extensive abnormality in the
volar musculature of the forearm is probably unchanged from the recent prior
studies allowing for differences in modality.
There is no fracture or dislocation. There is no focal cortical erosion.
Alignment across the right wrist and elbow is maintained. There are no focal
bony lesions. Mild degenerative changes are noted at the right glenohumeral
joint.
Though technique is not tailored for evaluating the intracranial structures,
the brain is grossly unremarkable. The visualized portion of the thyroid is
unremarkable. There is partial visualization of a a right internal jugular
central venous catheter.
IMPRESSION:
Extensive ill-defined fluid along deep fascia and subcutaneous fatty
components. Similar marked abnormality of the volar musculature of the
forearm although without convincing evidence for liquefaction. No gas
demonstrated.
|
19908221-RR-37
| 19,908,221 | 27,717,842 |
RR
| 37 |
2141-09-27 01:49:00
|
2141-09-27 03:27:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with fever, AMS // Please eval for intracranial
process
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: CTDIvol: 52.71 mGy
DLP: ___ mGy-cm
COMPARISON: ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction. Prominent ventricles and sulci suggest
age-related involutional changes or atrophy. Subcortical and periventricular
white matter hypodensities are consistent with chronic small vessel ischemic
disease. The basal cisterns appear patent and there is preservation of
gray-white matter differentiation.
The visualized bony structures are grossly unremarkable. There is mucosal
thickening seen within the bilateral frontal sinuses, bilateral ethmoid air
cells, and right maxillary sinus. The bilateral mastoid air cells and middle
ear cavities are clear. Atherosclerotic mural calcification of the bilateral
internal carotid arteries is noted. The globes are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial hemorrhage or large vascular territory
infarction.
2. Moderate cerebral atrophy and sequelae of chronic small vessel ischemic
disease.
Correlate clinically to decide on the need for further workup or followup.
3. Multifocal paranasal sinus disease, as above.
|
19908221-RR-38
| 19,908,221 | 27,717,842 |
RR
| 38 |
2141-09-27 02:06:00
|
2141-09-27 03:31:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: NO_PO contrast; History: ___ with AMS, fever, LUQ abd painNO_PO
contrast // Please eval for intraabdominal source of infection
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis without the administration of intravenous contrast. Axial images
were interpreted in conjunction with coronal and sagittal reformats.
DLP: 836.0 mGy-cm
COMPARISON: Reference CT abdomen dated ___, abdominal ultrasound
dated ___.
FINDINGS:
Depending, bibasilar atelectasis is noted. Mild cardiomegaly. There is no
evidence of pericardial effusion.
ABDOMEN:
The examination is limited secondary to the lack of intravenous contrast.
Within this limitation, the non-contrast enhanced appearance of the liver,
gallbladder, pancreas, and bilateral adrenal glands, and kidneys are normal.
The extrahepatic CBD is mildly prominent, but stable from the prior
examination. There is no intrahepatic biliary ductal dilation. The spleen is
enlarged.
The stomach, small bowel, and large bowel are unremarkable in appearance
without dilation or wall thickening. The appendix is air-filled and normal in
appearance. Numerous prominent retroperitoneal lymph nodes are identified,
none of which are pathologically enlarged by CT size criteria. There is no
free abdominal fluid or pneumoperitoneum. The aorta and its major branches
contain calcifications.
PELVIS:
The bladder, sigmoid colon, and rectum are grossly unremarkable. There is no
pelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free
pelvic fluid is identified.
OSSEOUS STRUCTURES: Multilevel degenerative changes are seen throughout the
visualized thoracolumbar spine. On the left, there is a recent-appearing ___
rib fracture and chronic fractures of the left ___ and 9th ribs. No focal
lytic or sclerotic lesion concerning for malignancy.
IMPRESSION:
1. No acute intra-abdominal process. Normal appendix.
2. Splenomegaly, similar to prior examinations.
3. Recent appearing left seventh rib fracture.
|
19908221-RR-39
| 19,908,221 | 27,717,842 |
RR
| 39 |
2141-09-27 06:24:00
|
2141-09-27 09:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ESRD and cirrhosis with fever and confusion
// rule out pneumonia
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Hema dialysis line terminates in the right atrium. Cardiomediastinal
silhouette is unchanged. Bibasal consolidations are minimal, unchanged. No
new consolidation to suggest interval development of infectious process
demonstrated although gradual progression which is currently radiographically
occult cannot be excluded. There is no pneumothorax.
|
19908221-RR-40
| 19,908,221 | 27,717,842 |
RR
| 40 |
2141-09-27 20:35:00
|
2141-09-28 10:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HCV cirrhosis, diastolic CHF, diabetes, ESRD
admitted with encephalopathy and possible HCAP. Now febrile to 102.1 //
please assess for signs of pneumonia
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___ obtained at 06:35
IMPRESSION:
Central venous line catheter tip terminates at the level of the right atrium.
Heart size and mediastinum are unremarkable. Questionable focal enlargement
at the level of the azygos vein is noted and might represent dilated azygos
vein or potentially lymph nodes and further correlation with chest CT is
recommended. Improvement of bibasilar radiation is demonstrated. There is no
pleural effusion or pneumothorax detected
|
19908221-RR-41
| 19,908,221 | 27,717,842 |
RR
| 41 |
2141-09-29 16:02:00
|
2141-09-29 18:04:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with Hep C cirrhosis p/w confusion and fever //
follow-up enlarged lymph nodes/?pneumonia?
TECHNIQUE: Contrast-enhanced chest CT was performed acquiring sequential
axial images from the thoracic inlet through the adrenal glands. Thin section
axial, coronal, sagittal and axial MIP's were also obtained.
DOSE: Total DLP = 795.52mGy-cm
COMPARISON: Outside imported CT scan dated ___.
FINDINGS:
The thyroid gland is unremarkable. Multiple mildly prominent mediastinal
lymph nodes are present. Subcarinal lymphadenopathy measuring 15 mm in
maximal thickness is not appreciably changed since ___ (2, 30).
Heart size is top-normal with minimal coronary artery calcifications. There is
no pericardial effusion. Main pulmonary artery and thoracic aorta are normal
caliber. No incidental pulmonary embolus is identified.
Right upper lobe and bronchiolar nodules are not appreciably changed since
___ (4, 78). Lower lobe predominant bronchial wall thickening with
peribronchial ground-glass opacities and focal consolidations have increased
since ___. Bilateral lower lobe bronchiolar nodules have increased.
Small bilateral pleural effusions have resolved. A single calcified pleural
plaque is identified along the nondependent aspect of the left upper lobe (4,
105).
Images of the upper abdomen show splenomegaly with a splenorenal shunt
compatible with the provided history of cirrhosis. The partially imaged
gallbladder is moderately distended (2, 68).
Old healed bilateral rib fractures and right sided bridging ossification are
incidentally noted, unchanged.
IMPRESSION:
Lower lobe predominant bronchial wall thickening with peribronchial
ground-glass opacities and consolidations are likely due to chronic
aspiration. Stable infectious or inflammatory small airways disease in the
right upper and both lower lobes.
Resolved small bilateral pleural effusions.
Splenomegaly with associated splenorenal shunt is in keeping with the provided
history of cirrhosis.
Moderately distended partially imaged gallbladder.
Stable mediastinal lymphadenopathy, which is likely reactive in nature.
|
19908221-RR-46
| 19,908,221 | 29,801,241 |
RR
| 46 |
2142-12-07 08:16:00
|
2142-12-07 10:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with vomiting and OSH imaging
COMPARISON: CT A/P ___ 02:48 a.m., outside hospital study
FINDINGS:
PA and lateral views of the chest provided. A right IJ access double lumen
catheter terminates at the expected location of the SVC. There is a small
right pleural effusion and mild right basilar atelectasis, as seen on same
date CT a/p. The left lung is clear. The cardiomediastinal silhouette is
normal. Imaged osseous structures are intact. Chronic left 7 & 8th rib
deformities again noted. No free air below the right hemidiaphragm is seen.
IMPRESSION:
Small right pleural effusion and mild right basilar atelectasis.
|
19908221-RR-47
| 19,908,221 | 29,801,241 |
RR
| 47 |
2142-12-07 15:46:00
|
2142-12-07 16:13:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ pain, being admitted to surgery // assess GB
TECHNIQUE: Grey scale and color Doppler ultrasound images of the right upper
quadrant were obtained.
COMPARISON: Reference CT torso dated ___.
FINDINGS:
LIVER: The visualized portions of the hepatic parenchyma appears within normal
limits. The contour of the liver is smooth. There is no focal liver mass.
There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: The gallbladder is moderately distended without evidence of focal
wall thickening or gallstones. Shadowing seen at the gallbladder fundus
corresponds with intraluminal air secondary to ERCP, as seen on the
concomitant reference CT torso examination.
IMPRESSION:
Moderately distended gallbladder containing intraluminal air status post ERCP,
better visualized on the patient's reference CT torso performed on the same
day. No gallbladder wall thickening, gallstones, or pericholecystic fluid.
|
19908277-RR-3
| 19,908,277 | 29,906,543 |
RR
| 3 |
2175-07-28 18:25:00
|
2175-07-28 18:42:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with DM, HTN, DVT/PE, ? ITP, here with rash,
___// assess for obstruction, cause for ___
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 12.1 cm. The left kidney measures 13.9 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Unremarkable renal ultrasound. No hydronephrosis.
|
19908451-RR-20
| 19,908,451 | 23,247,757 |
RR
| 20 |
2119-04-14 03:56:00
|
2119-04-14 07:32:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hypoxia.
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Intact medial sternal hardware. Evidence of prior CABG. Heart size is normal.
Mediastinal and hilar contours are unremarkable. No evidence of pneumonia,
pulmonary edema, or pleural effusions. Lungs are clear.
IMPRESSION:
No acute cardiopulmonary process.
|
19908451-RR-21
| 19,908,451 | 23,247,757 |
RR
| 21 |
2119-04-14 09:28:00
|
2119-04-14 10:08:00
|
EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: ___ year old man with ___ edema, R>L // Eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right 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.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19908844-RR-10
| 19,908,844 | 24,760,592 |
RR
| 10 |
2148-07-20 12:04:00
|
2148-07-20 12:54:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ year old woman with fall // fractures? fractures?
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
DOSE: CTDIvol: 32.2 mGy
DLP: 678.1 mGy-cm
COMPARISON: Outside hospital cervical spine CT from ___
FINDINGS:
There is no acute fracture, traumatic malalignment or prevertebral soft tissue
swelling. Vertebral body heights are maintained. There is mild multilevel
degenerative changes with disc space narrowing at C5-C6 and uncovertebral
hypertrophy at C5-C6 with moderate to severe narrowing of the right neural
foramen. The outline of the thecal sac is preserved. The visualized soft
tissues are unremarkable. The thyroid gland is unremarkable. Lung apices are
clear.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Degenerative changes at C5-C6 as described above.
|
19908844-RR-11
| 19,908,844 | 24,760,592 |
RR
| 11 |
2148-07-21 04:31:00
|
2148-07-21 10:22:00
|
INDICATION: ___ year old woman with pain s/p fall // ? fracture
TECHNIQUE: Frontal, lateral and oblique projections of the left wrist for a
total of 3 images.
COMPARISON: Left wrist radiographs ___.
FINDINGS:
The bones are demineralized. There is no fracture. There is no periosteal
reaction or erosive change.
There is no dislocation. The scapholunate interval is within normal limits.
Mild degenerative changes are noted at the radiocarpal, triscaphe and first
carpometacarpal joints.
Soft tissues are unremarkable
IMPRESSION:
No fracture or dislocation.
Mild degenerative changes at the first carpometacarpal, radiocarpal and
triscaphe joints.
|
19908844-RR-8
| 19,908,844 | 24,760,592 |
RR
| 8 |
2148-07-20 02:57:00
|
2148-07-20 03:50:00
|
EXAMINATION: CT TORSO W/CONTRAST
INDICATION: ___ with s/p fall, transfer from OSH, known SAH and L hip
hematoma, also w/ T, L-spine tenderness to palpation, intoxicated, evaluate
rib fractures, T/L spine injury, intra-abdominal injury.
TECHNIQUE: MDCT acquired axial images of the chest, abdomen, and pelvis were
obtained after administration of 130 mL Omnipaque intravenous contrast.
Enteric contrast was not given. Coronal and sagittal reformats were prepared
and reviewed.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 6.4 s, 69.5 cm; CTDIvol = 11.0 mGy (Body) DLP = 761.7
mGy-cm.
4) Spiral Acquisition 1.5 s, 16.0 cm; CTDIvol = 11.6 mGy (Body) DLP = 185.2
mGy-cm.
Total DLP (Body) = 947 mGy-cm.
COMPARISON: Outside hospital pelvic CT ___
FINDINGS:
CHEST: The thoracic aorta appears intact. There is no mediastinal hematoma.
The heart is unremarkable. There is no pericardial effusion. There is no
lymphadenopathy. There is a 5 mm hypodense right thyroid nodule.
The lungs are clear without worrisome nodule, mass, or consolidation. There
is no evidence of contusion or laceration. There is no pneumothorax or
pleural effusion.
ABDOMEN: The liver is intact without focal lesion of signs of acute injury.
The spleen is intact and normal in size. The gallbladder is surgically
absent. There is no intrahepatic biliary duct dilation. The portal vein is
patent. The spleen, adrenal glands, and pancreas are unremarkable. The
kidneys enhance and excrete contrast symmetrically. A 2.1 cm simple cyst is
seen in the lower pole of the right kidney. Other subcentimeter hypodensities
are too small to characterize, but statistically also likely represent simple
cysts. There is no evidence of renal or collecting system injury. The
abdominal aorta is normal in course and caliber with widely patent major
branches. No lymphadenopathy, free air, or free fluid.
Postsurgical changes from prior Roux-en-Y gastric bypass are present. The
small bowel is normal in caliber without focal wall thickening. The large
bowel is also normal in caliber without wall thickening. The appendix is
well-visualized and normal.
PELVIS: A Foley catheter seen within a decompressed bladder. Reproductive
organs are unremarkable. There is no pelvic sidewall or inguinal adenopathy.
BONES: Spinal alignment and vertebral body height is maintained. There is no
evidence of fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: There is a large left lateral thigh hematoma measuring
approximately 7.8 x 6.1 cm with extensive surrounding stranding, not
significantly changed from outside hospital pelvic CT.
IMPRESSION:
Unchanged left lateral thigh hematoma. No additional sequela of trauma.
|
19908844-RR-9
| 19,908,844 | 24,760,592 |
RR
| 9 |
2148-07-20 12:03:00
|
2148-07-20 12:46:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with SAH - interval change // please do at
11am - 24 hours after OSH NCHCT
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 891.9 mGy-cm
CTDI: 54.2 mGy
COMPARISON: Outside hospital CT head without contrast from ___.
FINDINGS:
Subarachnoid hemorrhage within the left parietal sulci (series 2, image 23)
and within the right frontal, parietal sulci and within the right inferior
frontal lobe are unchanged since the prior study. A small amount of
subarachnoid hemorrhage within the left temporal lobe is also unchanged
(series 2, image 14). There are no and newly area of hemorrhage, edema, mass
effect or acute territorial infarction. The ventricles and sulci are normal
in size and configuration.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
Stable subarachnoid hemorrhage as described above without significant mass
effect. No new intracranial hemorrhage.
|
19908911-RR-14
| 19,908,911 | 29,807,161 |
RR
| 14 |
2157-07-28 21:29:00
|
2157-07-29 09:31:00
|
CHEST RADIOGRAPH
INDICATION: Connective tissue disease, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, no relevant change is seen.
The lung volumes are normal. No evidence of parenchymal fibrosis or other
pathologic parenchymal process. Mild scoliosis of the thoracic spine. No
pleural effusions. Normal size and appearance of the cardiac silhouette.
|
19908911-RR-15
| 19,908,911 | 29,807,161 |
RR
| 15 |
2157-07-29 21:35:00
|
2157-07-29 22:55:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ w/ unclear connective tissue disorder who has right
temporal hyperintensity on MRI concerning for CNS vasculitis // eval for CNS
vasculitis
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of 70 cc of Omnipaque
intravenous contrast material. Images were processed on a separate workstation
with display of curved reformats, 3D volume rendered images, and maximum
intensity projection images.
DOSE: DLP: ___ MGy-cm
COMPARISON: Brain MRI dated ___.
FINDINGS:
HEAD CT: There is a hypodensity within the posterior limb of the right
internal capsule with extension into the medial right temporal lobe and right
cerebral peduncle. Findings are grossly unchanged when compared to recent MRI.
There is no hemorrhage, vascular territorial infarct or mass effect. The
ventricles, and sulci are normal.
The orbits, mastoid air cells and visualized soft tissues are unremarkable.
There is a retention cyst within the right side of the sphenoid sinus.
HEAD CTA: there is a hypoplastic left A1 segment. The anterior and posterior
circulations are otherwise unremarkable. There is no significant stenosis,
vessel occlusion or aneurysm greater than 2 mm. There are no definite imaging
findings of vasculitis.
NECK CTA: Incidentally noted is a left vertebral artery arising from the
aortic arch. The vertebral arteries are otherwise unremarkable.
The common carotid, internal carotid and external carotid arteries are widely
patent without evidence of significant stenosis based on NASCET criteria.
There is no evidence of arterial dissection.
IMPRESSION:
There is a hypodensity corresponding to the MRI signal abnormalities within
the posterior limb of the right internal capsule with extension into the
medial right temporal lobe and cerebral peduncle. There is no hemorrhage.
Unremarkable head and neck CTA without evidence of significant stenosis,
aneurysm or dissection.
CASE REVIEWED WITH ___. ___.
|
19909210-RR-45
| 19,909,210 | 24,421,958 |
RR
| 45 |
2124-09-11 21:32:00
|
2124-09-11 22:59:00
|
EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: Dullness at right base.
___ and ___ at outside institution, 15:52.
FINDINGS: Frontal and lateral views of the chest were obtained. There is a
small right pleural effusion and overlying atelectasis. There may also be
some fluid tracking in the right fissure. The cardiac silhouette is mildly
enlarged. There is no overt pulmonary edema. No evidence of pneumothorax is
seen. The mediastinal contours are stable, and there is calcification of the
aortic knob.
IMPRESSION: Small right pleural effusion and enlargement of the cardiac
silhouette.
|
19909210-RR-46
| 19,909,210 | 24,421,958 |
RR
| 46 |
2124-09-15 15:10:00
|
2124-09-15 16:09:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Acute shortness of breath.
Comparison is made to prior study of ___.
Opacities in the right lower lobe are consistent with increasing pleural
effusion. There is moderate increase in adjacent atelectasis. There is mild
vascular congestion. Left retrocardiac opacities consistent with atelectasis
are increasing. There is no pneumothorax. Cardiomegaly is stable. There are
no other interval changes.
|
19909406-RR-8
| 19,909,406 | 23,136,411 |
RR
| 8 |
2134-07-12 01:19:00
|
2134-07-12 07:39:00
|
INDICATION: ___ female with headache, low grade fever
TECHNIQUE: Frontal and lateral chest radiographs were obtained with the
patient in the upright position.
COMPARISON: None available.
FINDINGS:
Posterior lower opacity projecting over the spine on the lateral view likely
reflects right lower lobe pneumonia. There is no pleural effusion or
pneumothorax. The heart size is normal. The mediastinal contours are normal.
IMPRESSION:
Right lower lobe pneumonia.
|
19909671-RR-10
| 19,909,671 | 20,359,453 |
RR
| 10 |
2191-09-29 04:07:00
|
2191-09-29 04:47:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: History: ___ with melenic stools, lower abd cramping // ? GI
bleed, infectious process
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 45.5 cm; CTDIvol = 5.1 mGy (Body) DLP = 232.5
mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
3) Spiral Acquisition 5.8 s, 45.1 cm; CTDIvol = 14.6 mGy (Body) DLP = 660.9
mGy-cm.
4) Spiral Acquisition 5.8 s, 45.1 cm; CTDIvol = 14.7 mGy (Body) DLP = 661.1
mGy-cm.
Total DLP (Body) = 1,562 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is moderate calcium burden in
the abdominal aorta and great abdominal arteries.
LOWER CHEST: Emphysematous changes are noted at the lung bases. A 3 mm
pulmonary nodule is noted at the left lung base (series 3A, image 10). There
is no pleural or pericardial effusion. Cardiomegaly is mild.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. Rounded soft tissue and
partially calcified hypodensity along the greater curvature of the stomach
measures 2.1 x 1.9 cm. This appears to have a soft tissue component. 2
additional lesions along the greater curvature of the stomach on image 34 and
31 to not have soft tissue components and are entirely calcified. Small bowel
loops demonstrate normal caliber, wall thickness and enhancement throughout.
Hyperdense material within several loops of small bowel and the sigmoid colon
are present on the noncontrast images and likely represent ingested material.
Colon and rectum are within normal limits. Appendix contains air, has normal
caliber without evidence of fat stranding. There is no evidence of mesenteric
lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Brachytherapy seeds are noted in the prostate.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Subchondral cystic changes noted at the right sacroiliac joint.
SOFT TISSUES: At the proximal most portion of the left inguinal canal there is
a small focus of soft tissue, likely post surgical. There is a small fat
containing umbilical hernia.
IMPRESSION:
1. No evidence of GI bleed.
2. 2.1 cm lesion along the greater curvature of the stomach. Contains
calcifications but also has a soft tissue component. As 2 additional
completely calcified lesions are seen in this location these may represent
calcified, torsed epiploic appendages, however the appearance of the largest
lesion is unusual due to its larger soft tissue component in 3 months followup
with MRI is recommended to exclude a gist tumor.
3. Small hiatal hernia.
4. A small focus of soft tissue at the proximal-most portion of the left
inguinal canal is nonspecific. Correlation with prior surgery is recommended.
5. 3 mm pulmonary nodule at the left lung base.
RECOMMENDATION(S): 1. 3 months followup MRI for evaluation of lesion along
the greater curvature of the stomach
2. The ___ society pulmonary nodule recommendations
are intended as guidelines for follow-up and management of newly incidentally
detected pulmonary nodules smaller than 8 mm, in patients ___ years of age or
older. Low risk patients have minimal or absent history of smoking or other
known risk factors for primary lung neoplasm. High risk patients have a
history of smoking or other known risk factors for primary lung neoplasm.
In the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.
For high risk patients, recommend follow-up at 12 months and if no change, no
further imaging needed.
NOTIFICATION: An email sent to the to ED QA nurses by Dr. ___ at 11:01
|
19909671-RR-9
| 19,909,671 | 20,359,453 |
RR
| 9 |
2191-09-29 02:19:00
|
2191-09-29 05:25:00
|
EXAMINATION: Chest radiograph.
INDICATION: History: ___ with chest pain, recent tx for pna // ? effusion,
infectious process
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Streaky opacities more prominent in the left upper lung and bilateral lung
bases in the appropriate clinical setting may represent pneumonia. There is
multilevel mild loss of vertebral body height throughout the thoracic spine.
Cardiomegaly is mild.
IMPRESSION:
Bibasilar and left upper lobe opacities in the appropriate clinical setting
are concerning for pneumonia.
RECOMMENDATION(S): Followup of the patient 4 weeks after completion of
antibiotic therapy is required, in particular to document the resolution of
left upper lobe perihilar opacity. If findings are unchanged, assessment with
chest CT is required.
Additionally giving the presence of left lower lobe pulmonary nodule, followup
with chest CT in 3 months based on the size of the left lower lobe nodule is
recommended as well.
|
19909906-RR-36
| 19,909,906 | 22,846,620 |
RR
| 36 |
2190-04-04 12:31:00
|
2190-04-04 12:56:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with productive cough, chest pain// Pneumonia, effusion
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. There are no
signs of congestion or edema. The cardiomediastinal silhouette is normal.
Imaged osseous structures are intact. No free air below the right
hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
19909991-RR-10
| 19,909,991 | 21,532,847 |
RR
| 10 |
2146-04-02 20:48:00
|
2146-04-02 23:38:00
|
HISTORY: Abnormal protrusions at the bilateral antecubital fossa.
COMPARISON: None.
FINDINGS:
There is noncompressible, expansile thrombus within the right basilic vein for
a short 4-5 cm segment in the region of the palpable abnormality.
There is a short segment of noncompressible, occlusive thrombus within the
left cephalic vein over 4-5 cm in the area of palpable abnormality.
IMPRESSION:
Focal left cephalic vein thrombophlebitis and focal right basilic vein
thrombophlebitis in the regions of recent peripheral IV insertion attempts.
No extension into the deep venous system.
Findings were discussed with Dr. ___ phone at ___ on ___.
|
19909991-RR-11
| 19,909,991 | 21,532,847 |
RR
| 11 |
2146-04-04 18:01:00
|
2146-04-04 22:16:00
|
INDICATION: ___ year old woman s/p left frontal brain and meningeal biopsy.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DLP: [922] mGy-cm
CTDI: [52.6] mGy
COMPARISON: Comparison is made with CT head from ___.
FINDINGS: The patient is status post left frontal craniotomy with mild
associated pneumocephalus. There is small amount of hyperdense blood in the
left frontal sulci +/- parenchyma, as well as minimal parenchymal edema,
underlying the craniotomy. The left lateral ventricle is again noted to be
smaller than the right. Mild rightward shift of midline structures is stable.
The suprasellar and cisterns are effaced with bilateral uncal herniation,
similar to prior exam.
Visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear. The orbits are unremarkable.
IMPRESSION: Status post left frontal craniotomy with expected changes in the
left frontal surgical bed, including small amount of blood and minimal edema.
Unchanged intracranial mass effect.
|
19909991-RR-12
| 19,909,991 | 21,532,847 |
RR
| 12 |
2146-04-05 12:29:00
|
2146-04-05 13:53:00
|
HISTORY: Post-brain biopsy fever.
FINDINGS: No previous images. Cardiac silhouette is mildly enlarged and
there is some tortuosity of the aorta. No definite vascular congestion or
pleural effusion.
Specifically, no convincing evidence of acute focal pneumonia.
|
19909991-RR-14
| 19,909,991 | 21,532,847 |
RR
| 14 |
2146-04-06 16:31:00
|
2146-04-06 17:26:00
|
INDICATION: Left PICC placement.
COMPARISON: ___.
FINDINGS: AP view of the chest. The cardiomediastinal and hilar contours are
stable. There is no focal consolidation, pleural effusion or pneumothorax.
The left-sided PICC ends in the upper SVC.
IMPRESSION: Left PICC ends in the upper SVC. No acute process.
|
19909991-RR-15
| 19,909,991 | 21,532,847 |
RR
| 15 |
2146-04-09 21:14:00
|
2146-04-10 08:40:00
|
CHEST RADIOGRAPH
INDICATION: Seizures, spiking fevers, evaluation for pneumonia.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, no relevant change is seen.
Low lung volumes. Borderline size of the cardiac silhouette. Mild fluid
overload might be present. However, there is no evidence of pneumonia,
atelectasis or pleural effusions. No pneumothorax. The left PICC line is in
unchanged position.
|
19909991-RR-16
| 19,909,991 | 21,532,847 |
RR
| 16 |
2146-04-11 09:08:00
|
2146-04-11 10:18:00
|
CHEST RADIOGRAPH
INDICATION: PICC line placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the left PICC line has been
advanced. The course of the line is now unremarkable, the tip of the line
projects over the cavoatrial junction. There is no evidence of complications,
notably no pneumothorax. The lung volumes remain low. Borderline size of the
cardiac silhouette with mild overinflation of the stomach. No pulmonary
edema. No pneumonia.
|
19909991-RR-18
| 19,909,991 | 21,532,847 |
RR
| 18 |
2146-04-16 08:26:00
|
2146-04-16 13:50:00
|
PORTABLE CHEST FILM ___ AT 8:27
CLINICAL INDICATION: ___ with PICC, check positioning.
Comparison to ___ at 9:21.
A portable upright chest film, ___ at 8:27 is submitted.
IMPRESSION:
1. The left subclavian PICC line now has its tip in the mid-to-distal
brachiocephalic vein. Lungs remain well inflated without evidence of focal
airspace consolidation, pleural effusions, pulmonary edema or pneumothorax.
Overall cardiac and mediastinal contours are unchanged.
|
19909991-RR-19
| 19,909,991 | 21,532,847 |
RR
| 19 |
2146-04-16 16:29:00
|
2146-04-17 11:54:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ woman with new PICC line.
Comparison is made to prior study from ___ at 8:27 a.m.
FINDINGS: There is a left-sided PICC line which has a kink in the mid SVC
possibly within azygous vein. This could be readjusted for more optimal
placement. There are no pneumothoraces. Findings were discussed with the IV
nurse, ___, by Dr. ___.
|
19909991-RR-20
| 19,909,991 | 21,532,847 |
RR
| 20 |
2146-04-16 19:19:00
|
2146-04-17 11:51:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ woman with malpositioned PICC line.
FINDINGS: Comparison is made to the prior study performed three hours
earlier.
The PICC line has been readjusted and distal tip is in the mid SVC without a
kink. The heart size is within normal limits. Lungs are grossly clear.
There are no pneumothoraces.
|
19909991-RR-21
| 19,909,991 | 21,532,847 |
RR
| 21 |
2146-04-22 13:58:00
|
2146-04-22 16:47:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with cognitive decline // Change compared to
prior?
TECHNIQUE: Multi sequence, multiplanar brain MRI was performed pre and post
intravenous administration of Gadavist. The following sequences were utilized:
Sagittal T1, axial T1 pre, axial GRE, axial FLAIR, axial T2, axial T2 trace,
axial T1 post and sagittal MPRAGE post.
Multi voxel MR spectroscopy also performed.
COMPARISON: Brain MRI dated ___.
FINDINGS:
Patient status post left frontal lobe of biopsy with associated blood products
in the left frontal lobe. There is a small left subdural hematoma. The
pachymeningeal enhancement has essentially resolved. Also the enhancement in
the internal auditory canals is no longer present. There is improved mass
effect on the left lateral ventricle, and the midbrain. There is persistent
but improved bilateral uncal herniation with a better visualization of the
ambient cistern
There is no infarct. The principal intracranial flow voids are present. There
is mild ethmoid mucosal thickening. There is fluid in bilateral mastoid air
cells.
Multi voxel MR spectroscopy centered at the level of the midbrain and
bilateral hippocampal- the is unremarkable. There is no elevated choline to
NAA ratio to suggest a neoplasm.
IMPRESSION:
The pachymeningeal enhancement has essentially resolved. There is improved
mass effect on the left lateral ventricle, and the midbrain. There is
persistent but improved bilateral uncal herniation with a better visualization
of the ambient cistern.
Posst-operative changes are seen.
MR spectroscopy is unremarkable without evidence of elevated choline to NAA
ratio to suggest a neoplasm.
|
19909991-RR-22
| 19,909,991 | 21,532,847 |
RR
| 22 |
2146-04-22 13:58:00
|
2146-04-25 18:23:00
|
MR EXAMINATION OF THE ENTIRE SPINE WITH CONTRAST, ___
HISTORY: ___ female with behavioral decline over one year, tremor x 6
months, and now with intractable seizures, and cranial MRI with
pachymeningitis and uncal herniation; evaluate for pachymeningeal along the
spine, as possible site for dural biopsy.
TECHNIQUE: The study is limited to large-field-of-view sagittal T1,
T2-weighted and IDEAL FSE sequences through the cervicothoracic and
thoracolumbar spine, following contrast administration (for the concurrent
enhanced cranial MR examination, with spectroscopy).
FINDINGS: This study, dated ___, has become available for interpretation
on ___. It is compared with the concurrent as well as the previous
enhanced MR examination of the brain, the latter dated ___ there is no
previous dedicated MR imaging of the spine on PACS, and comparison is made
with the CECT of the torso, dated ___.
Allowing for the large imaging FOV, as well as the lack of available sagittal
MP-RAGE sequence from the previous cranial MR study, there has been
significant improvement in the uniform thick pachymeningeal enhancement
involving the visualized posterior fossa, as well as the craniocervical
junction and upper cervical spine. There is no evidence of abnormal
pachymeningeal enhancement caudal to approximately the C3-4 disc space level,
including in the most caudal portions of the thecal sac. Again, allowing for
limitations, above, as well as the lack of axial sequences, there is no
pathologic leptomeningeal, intramedullary or radicular enhancement. There is
no evidence of enhancing epidural or paraspinal mass.
The spinal cord is normal in caliber and intrinsic signal intensity from the
cervicomedullary junction through the mid-L1 level. Incidentally noted are
prominent sub-perineurial (Tarlov) cysts, expanding the S2 and, to a lesser
extent, S3 neural foramina, right more than left, with additional cysts
extending along those nerve roots, to the caudal margin of the imaging volume.
However, there is no immediately adjacent edema or discrete fluid collection
to specifically suggest "CSF leak." Also demonstrated are numerous additional
sub-perineurial cysts in the thoracolumbar neural foramina, bilaterally.
Again, there is no adjacent edema or fluid collection to specifically suggest
leak.
Incidentally noted, and incompletely imaged, is underlying spondylosis as well
as likely DISH. In the cervical spine, these findings are most marked at the
C5-6 and C6-7 levels, where there is effacement of the ventral CSF and slight
remodeling of that aspect of the spinal cord. There is only mild degenerative
disc disease throughout the thoracic spine with multilevel disc bulges, but no
significant canal stenosis. There is also marked degeneration of the T12-L1
and L1-2 discs with moderate bulging and ventral canal narrowing without
significant deformity of the distal spinal cord. Finally, there is
degeneration of the L4-5 disc with L4 inferior endplate spondylosis eccentric
to the right, which significantly narrows this neural foramen, deforming and
likely impinging upon the exiting right L4 nerve root. Similar, but less
marked findings are present at the L5-S1 level, where there is deformity of
the exiting left L5 nerve root.
IMPRESSION: Study limited to large-field-of-view sequences, obtained after
contrast administration, with:
1. Apparent significant improvement in the diffuse pachymeningeal thickening
and enhancement involving the visualized posterior fossa and craniocervical
junction, with no evidence of involvement caudal to the C4 superior endplate
level.
2. No pathologic leptomeningeal or intramedullary focus of enhancement.
3. Multilevel small sub-perineurial cysts throughout the thoracic and upper
lumbar spine, with prominent Tarlov cysts at the S2 and S3 level and along the
exiting nerve root sheaths, bilaterally; however, there is no immediately
adjacent edema or fluid collection (allowing the lack of axial imaging) to
specifically suggest a site of "CSF leak".
4. Normal spinal cord caliber and intrinsic signal intensity, through the
conus medullaris.
5. No vertebral bone marrow or paraspinal soft tissue edema.
6. Cervical and lumbar spondylosis, with ventral cord remodeling and exiting
right L4 and left L5 neural impingement, as detailed above, incompletely
imaged.
COMMENT: Both this study and the patient's previous examinations were
reviewed with Dr. ___ (the patient's attending neurologist),
in-person, at approximately 1500h, ___.
|
19909991-RR-23
| 19,909,991 | 21,532,847 |
RR
| 23 |
2146-04-29 02:58:00
|
2146-04-29 06:16:00
|
INDICATION: Seizures, encephalopathy. Fell and hit head. Please assess for
traumatic injury.
COMPARISON: CT head ___. MR brain ___.
TECHNIQUE: Axial MDCT images were obtained through the brain without IV
contrast. Multiplanar coronal, sagittal and thin-section bone algorithm
reconstructed images were generated.
TOTAL BODY DLP: 891 mGy-cm
CTDIvol: 49 mGy
FINDINGS: The patient is status post left frontal craniotomy with left
frontal lobe biopsy. Pneumocephalus has resolved. No extra-axial hemorrhage
is detected. Mild parenchymal edema underlying the craniotomy persists
(2:18). There is no shift of normally midline structures. There is no
evidence of large territorial infarct. Mild rightward shift of midline
structures is approximately 3 mm, unchanged. The basal cisterns are patent.
Gray-white matter differentiation is preserved.
The partially visualized paranasal sinuses, mastoid air cells and middle ear
cavities are clear.
IMPRESSION: No acute intracranial abnormality. Mild edema at the biopsy site
persists. Post-surgical pneumocephalus has resolved. There is no evidence of
acute hemorrhage.
|
19909991-RR-27
| 19,909,991 | 23,267,730 |
RR
| 27 |
2146-07-27 11:10:00
|
2146-07-27 14:57:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ year old woman with possible intermittent CSF rhinorrhea //
?skull base defect to account for CSF leak; please do thin cuts through skull
base
TECHNIQUE: Helical axial MDCT images were acquired through the paranasal
sinuses. Coronal reformatted images were prepared.
DOSE: CTDIvol: 36.18 mGy
DLP: 764.61 mGy-cm
COMPARISON: Comparison is made to CT head dated ___.
FINDINGS:
Trace mucosal thickening is seen within the bilateral maxillary sinuses,
including a left maxillary mucous retention cyst. The remainder of the
paranasal sinuses are otherwise normally aerated, without mucosal thickening
or air-fluid levels identified. The ostiomeatal units are patent. The anterior
clinoid processes are not pneumatized. The lamina papyracea is intact. The
nasal septum is deviated towards the left with the centric left bone spur. The
temporomandibular joints are symmetric and unremarkable. The orbits and
nasopharyngeal soft tissues are unremarkable.
Atherosclerotic calcifications of the bilateral internal carotid arteries are
noted. Mild, multilevel, multifactorial degenerative changes are seen
throughout the visualized upper cervical spine. Allowing for helical
acquisition, reconstruction algorithm, and section thickness, the visualized
brain is grossly unremarkable.
IMPRESSION:
Minimal mucosal thickening of the bilateral maxillary sinuses and leftward
deviation of the nasal septum. Otherwise, unremarkable CT examination of the
sinuses.
|
19909991-RR-28
| 19,909,991 | 23,267,730 |
RR
| 28 |
2146-07-28 07:55:00
|
2146-07-28 09:20:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ female with history pachymeningitis and uncal
herniation now with altered mental status.
TECHNIQUE: Axial diffusion-weighted images, axial diffusion corrected images,
sagittal T1, axial T2, axial FLAIR, axial GRE, and axial T to images were
obtained through the brain.
COMPARISON: MR head dated ___ as well as ___.
FINDINGS:
Again seen are changes related to the left frontal lobe biopsy with regions of
gliosis and chronic blood products at the biopsy site. This appears unchanged
when compared to most recent study dated ___. Allowing for
differences in technique, diffuse pachymeningeal thickening persists,
unchanged. Basilar cisterns are patent with partial effacement of the
suprasellar cistern compatible with bilateral uncal herniation, stable since
prior examination.
There is no acute infarction or intracranial hemorrhage. No diffusion
abnormality is identified. There is no pathologic intracranial enhancement.
Intracranial flow voids are maintained. Visualized paranasal sinuses and
mastoid air cells are clear. The visualized orbits and soft tissues are
unremarkable.
IMPRESSION:
Unchanged pachymeningeal thickening and bilateral uncal herniation. No new
acute intracranial abnormality. Re- demonstration of post biopsy changes
within the left frontal lobe, unchanged.
|
19909991-RR-29
| 19,909,991 | 23,267,730 |
RR
| 29 |
2146-08-01 15:28:00
|
2146-08-02 13:36:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with h/o uncal herniation and seizures //
assess for interval change. please obtain SPGR sequences and
coronal/axial/sagittal reformats
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T-weighted, axial fast spin echo T2-weighted,axial flair,
axial diffusion weighted and axial gradient echo images. The T1 weighted
images were repeated after the administration of intravenous gadolinium
contrast.
COMPARISON: Multiple MRIs of the brain. Most recent dated ___.
FINDINGS:
Patient is status post left frontal lobe biopsy. Gliosis and and chronic blood
products in this region are unchanged.
There has been interval worsening of diffuse pachymeningeal thickening and
enhancement when compared to prior studies, particularly in the posterior
fossa. There is also increased deformity of the midbrain noted with worsening
bilateral uncal herniation and recurrent effacement of the basal cisterns.
However, there is no sign of associated parenchymal edema. There is no
abnormal parenchymal enhancement seen on post contrast images.
Slight asymmetry of the ventricles and a megacisterna magna are again noted.
There is no acute infarction, intracranial hemorrhage, or extracerebral fluid
collection. No diffusion abnormalities are detected. The major vascular flow
voids are maintained. The orbits are unremarkable, the paranasal sinuses and
mastoid air cells are clear
IMPRESSION:
Interval worsening of diffuse pachymeningeal thickening and enhancement, and
bilateral uncal herniation with associated deformity of the midbrain. Again,
these findings may reflect intracranial hypotension, related to occult "CSF
leak."
NOTIFICATION: These findings were reviewed in detail with Dr. ___
___ service) in-person by Dr. ___ at 10:46 am on ___. Dr.
___ is considering empiric epidural "blood patch.
|
19909991-RR-30
| 19,909,991 | 23,267,730 |
RR
| 30 |
2146-08-03 18:40:00
|
2146-08-03 21:46:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with pachymeningitis and chronic uncal
herniation on MRI. Assess for occult malignancy.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after the administration of oral and intravenous contrast (130 cc of
Omnipaque). Axial images were interpreted in conjunction with coronal and
sagittal reformats.
DLP: 679 mGy-cm
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
Please see the dedicated CT chest report from ___ for thoracic
findings.
ABDOMEN:
The liver is normal in appearance and without focal abnormality. The portal
venous system is patent. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder, pancreas, spleen, bilateral adrenal
glands, and right kidney are unremarkable in appearance. There are two small
left renal hypodensities, which are too small to characterize on the current
exam, but appear unchanged in appearance from the prior study.
The stomach is grossly unremarkable in appearance. The small and large bowel
are normal in caliber and without evidence of wall thickening. There is a
small fat-containing umbilical hernia. There is no retroperitoneal
lymphadenopathy by CT size criteria. There is no free abdominal fluid or
pneumoperitoneum. The aorta contains minor and is normal in course and
caliber. The celiac trunk and SMA are grossly patent.
PELVIS:
The bladder, sigmoid colon, and rectum are grossly unremarkable. There is no
pelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free
pelvic fluid is identified. There is a 3.7 x 2.7 cm left paratubal rounded
hypodensity (5:111), with attenuation less than 20 Hounsfield units. This
likely represents a simple cyst. It is larger than seen on the prior study,
in which it measured 3.4 x 2.4 cm. Pelvic ultrasound is recommended for
further characterization and evaluation.
OSSEOUS STRUCTURES: The spine is scoliotic. Multilevel, multifactorial
degenerative changes are seen within the visualized thoracolumbar spine. No
focal lytic or sclerotic lesion concerning for malignancy.
IMPRESSION:
1. No evidence of intrapelvic or intra-abdominal malignant disease.
2. 3.7 x 2.7 cm left paraovarian lesion, which is slightly enlarged from the
prior exam. However, pelvic ultrasound is recommended for further evaluation
and characterization.
|
19909991-RR-32
| 19,909,991 | 23,267,730 |
RR
| 32 |
2146-08-04 01:40:00
|
2146-08-04 14:59:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR
INDICATION: ___ year old woman with h/o bilateral uncal herniation and
pachymeningitis // with and without contrast please. assess for edema / CSF
leak. Please obtain axial cuts through the cervical and thoracic spine (we are
most interested in the cervical-thoracic junction)
TECHNIQUE: Routine MRI of the cervical spine using sagittal and axial T1, T2
and STIR images
COMPARISON: Prior MRI of the cervical, thoracic, and lumbar spine dated ___.
FINDINGS:
MR cervical spine:
The spinal cord is normal in course and signal. There is normal alignment of
the cervical spine. Findings consistent with dish are again seen in the
cervical spine. There are posterior disc osteophyte complexes again noted at
C5-C6 and C6-C7 which are effacing the ventral CSF.
MR thoracic spine:
There is S-shaped scoliosis of the thoracolumbar spine. The thoracic spinal
cord is normal in morphology and signal. There are multilevel mild disc bulges
in the thoracic spinal cord. There is more severe degenerative disk disease at
T12-L1 where there is a moderate size posterior disc osteophyte complex mildly
effacing the ventral CSF unchanged from prior study. There are again noted to
be multiple perineural cysts in the thoracolumbar neural foramen bilaterally
which have not significantly changed. There are no fluid collections in
these regions to suggest CSF leak.
MR lumbar spine:
There is normal alignment of the lumbar spine. There is multilevel
degenerative disc disease with loss of normal disc signal and height
throughout the lumbar spine.
At L1-L2, there is a posterior disc osteophyte complex asymmetric to the right
which is resulting in mild right neural foraminal narrowing. There is mild
left greater than right facet arthropathy at this level. There is no
significant central canal stenosis.
At L2-L3 and L3-L4, there are mild posterior disc bulges with mild bilateral
facet hypertrophy and ligamentum flavum thickening at these levels. There is
no significant central canal or neural foraminal stenosis.
At L4- L5, there is diffuse disc annulus bulge with a superimposed left
foraminal disc protrusion moderately narrowing the right neural foramen and
likely impinging upon the exiting right L4 nerve root.
At L5-S1, there is mild diffuse disc annulus bulge with a tiny central
component and mild left greater than right neural foraminal narrowing.
The degenerative findings have not significantly changed compared to recent
prior study.
Again seen are multiple prominent perineural Tarlov cysts expanding the S2
and S3 neural foramen right slightly greater than left. These cysts appear
similar in size to on prior study. There is no fluid collection to suggest
CSF leak.
There is dural thickening and enhancement which extends within posterior fossa
intermittently down the length of the entire spine. This finding is most
pronounced in the proximal cervical spine and in the lumbar spine. This
finding has worsened when compared to prior study.
IMPRESSION:
1. Interval worsening of previously noted dural thickening and enhancement
which now extends intermittently down the length of the spine.
2. No interval change in large perineural cysts in the thoracic spine and
multiple Tarlov cysts. No findings to suggest CSF leak.
3. Multilevel degenerative changes as described above which have not
significantly changed.
|
19909991-RR-33
| 19,909,991 | 23,267,730 |
RR
| 33 |
2146-08-03 18:41:00
|
2146-08-03 21:53:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ woman with pachymeningitis and chronic uncal
herniation on MRI.// assess for occult malignancy
TECHNIQUE: MULTI DETECTOR HELICAL SCANNING OF THE CHEST WAS COORDINATED WITH
INTRAVENOUS INFUSION OF NONIONIC CONTRAST AGENT, RECONSTRUCTED AS CONTIGUOUS 5
AND 1.25 MM THICK AXIAL, 5 MM THICK CORONAL AND PARASAGITTAL, AND 8 MM MIP
AXIAL IMAGES. SUBSEQUENT SCANNING OF THE ABDOMEN AND PELVIS AND THE TOTAL
DOSAGE OF SCANNING THE ENTIRE TORSO WILL BE REPORTED SEPARATELY.
DOSAGE: TOTAL DLP mGy-cm
COMPARISON: Chest images on torso CT ___
FINDINGS:
For a 13 x 19 mm right pre scapular bursa or benign cyst, 5:4, is unchanged
since ___. Numerous lymph nodes in both axillae are stable or slightly
decreased since ___, ranging in size up to a per 9 x 17 mm left axillary
node, 05:11, previously 10 x 17 mm and another 9 x 16 mm, 05:15, previously 9
x 18 mm. There are no soft tissue findings in the chest wall suspicious for
malignancy but evaluation of the breasts requires mammography.
Small lucencies in the right thyroid lobe do not warrant further imaging
evaluation. There is no obvious atherosclerotic calcification, or pericardial
or pleural abnormality. Findings below the diaphragm will be reported
separately.
Central lymph nodes are not pathologically enlarged ranging in diameter up to
a 6 mm right lower paratracheal lymph node with a punctate calcification,
6:101 aorta and pulmonary arteries are normal size. .
Small region of paraspinal atelectasis in the right lower lobe, 9 B: 19, was
present in ___ and previous adjacent consolidation has nearly cleared.
Subpleural linear atelectasis in the lung bases, right greater than left is a
new finding in the right lower lobe, without obvious explanation. There is no
appreciable bronchiectasis or any bronchial obstruction, and the adjacent
pleura is not thickened.
IMPRESSION:
No evidence of intrathoracic malignancy.
Mild bilateral axillary adenopathy improved since ___. No
intrathoracic lymph node enlargement.
Right periscapular bursal cyst does not require further evaluation unless the
patient is symptomatic.
|
19909991-RR-34
| 19,909,991 | 23,267,730 |
RR
| 34 |
2146-08-04 15:56:00
|
2146-08-04 16:55:00
|
EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with complicated history of uncal herniation
and pachymeningitis concerning for malignancy // assess ovarian mass seen on
CT torso prior to discharge today
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: Abdomen pelvic CT ___
FINDINGS:
The uterus is anteverted and measures 6.7 x 3.7 x 4.7 cm. The endometrium is
homogenous and measures 2 mm. The right ovary is normal measuring 2.4 x 0.8 x
1.3 cm. The left ovary is normal measuring 1.8 x 0.9 x 1.3 cm. There is a
simple left paraovarian cyst which measures 3.1 x 3.9 x 2.2 cm. This cyst does
not contain any suspicious nodularity or vascularity. There is no free fluid.
IMPRESSION:
Normal uterus and ovaries.
Parovarian cyst which does not demonstrate any features suggestive of ovarian
neoplasm.
|
19909991-RR-5
| 19,909,991 | 21,532,847 |
RR
| 5 |
2146-03-31 13:03:00
|
2146-03-31 13:50:00
|
EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ year old woman with altered mental status and brain swelling,
with acute onset somnolence // Increase in swelling or mass effect?
TECHNIQUE: Contiguous axial images were obtained through the head without the
administration of intravenous contrast. Coronal and sagittal reformatted
images as well as thin section images in a bone window algorithm were
generated and reviewed.
DOSE: DLP: 892 mGy-cm; CTDI: 56 mGy
COMPARISON: MRI of the head with and without contrast dated ___.
FINDINGS:
HEAD CT: Allowing for differences in imaging modality, the overall appearance
of the brain is unchanged from ___. Note is again made of asymmetry
of the brain with the left lateral ventricle appearing smaller than the right.
The right cerebral sulci are effaced. The suprasellar and ambient cisterns are
effaced with bilateral uncal herniation as seen on the preceding MRI. Minimal
left to right midline shift is also unchanged. There is no evidence of
hemorrhage. The small extra axial fluid collections seen on the MR study are
not detected on this CT examination. There is no evidence of generalized
edema. The gray-white matter interface is preserved without evidence of
infarciont. The orbits and globes are unremarkable. The imaged paranasal
sinuses, middle ear cavities and mastoid air cells are clear bilaterally. The
bony calvaria appear intact. Significant hyperostosis frontalis interna is
noted.
IMPRESSION:
No significant interval change in appearance of the brain from ___
allowing for differences in imaging modality. Unchanged effacement of the
right cerebral sulci and the suprasellar and ambient cisterns with uncal
herniation bilaterally possibly related to metabolic encephalopathy given lack
of mass effect or cerebral edema.
|
19909991-RR-6
| 19,909,991 | 21,532,847 |
RR
| 6 |
2146-04-02 13:46:00
|
2146-04-02 18:50:00
|
HISTORY: Cognitive decline, dural thickening potential for malignancy such as
lymphoma. Assess for other foci of potential malignancy.
TECHNIQUE: Axial helical MDCT of the abdomen was performed with multiple
phases after the administration of oral and 130 cc of Omnipaque intravenous
contrast. Multiplanar sagittal and coronal reformatted images were generated.
A CT chest was also performed and will be dictated separately. DLP: 1005
mGy-cm.
COMPARISON: No previous examinations are available for comparison.
FINDINGS:
CT ABDOMEN:
There is a nasogastric tube with the distal tip terminating within the body of
the stomach. The liver, gallbladder, pancreas, spleen, adrenal glands, and
right kidney appear unremarkable. There is a tiny left renal hypodensity
which is too small to characterize. There are few small retroperitoneal and
para-aortic lymph nodes; however, they are not enlarged by CT size criteria.
The small bowel and colon appear unremarkable. There is minimal
atherosclerosis of the abdominal aorta without aneurysm or dissection of the
abdominal aorta or major branch vessels. There is no ascites. There is a
small fat-containing umbilical hernia.
CT PELVIS:
There is a 3.5 x 2.4 cm left adnexal lesion which contains simple fluid and
may represent a cyst. The bladder and uterus appear unremarkable.
OSSEOUS STRUCTURES:
There are mild degenerative changes of the lumbar spine. There are no
suspicious lytic or sclerotic bone lesions.
IMPRESSION:
1. No definite intra-abdominal malignancy.
2. 3.5cm simple cystic lesion arising from the left ovary for which a six
month follow-up pelvic ultrasound is recommended for further assessment.
Please refer to separately dictated CT chest for details of chest findings.
Findings discussed with Dr. ___ at 7:25pm on ___, 3
hours after discovery of the findings.
|
19909991-RR-8
| 19,909,991 | 21,532,847 |
RR
| 8 |
2146-04-02 13:46:00
|
2146-04-02 18:52:00
|
HISTORY: Cognitive decline, dural thickening with potential for malignancy
such as lymphoma, please assess for possible other foci of malignancy.
TECHNIQUE: Axial helical MDCT of the chest was performed with intravenous
contrast after the administration of 130 cc of Omnipaque intravenous contrast.
Multiplanar sagittal and coronal reformatted images were generated. A CT
abdomen was performed and will be dictated separately. DLP: 1005 mGy-cm.
COMPARISON: No previous examinations available for comparison.
FINDINGS:
CT CHEST:
There is a 7-mm nodule within the right lobe of the thyroid gland (13:7). A
nasogastric tube is noted with the distal tip within the body of the stomach.
The pulmonary artery and thoracic aorta appear unremarkable. There is no
mediastinal, hilar or right axillary lymphadenopathy. The left axilary lymph
nodes are at the upper limits of normal.
There are no pleural or pericardial effusions. The tracheobronchial tree is
patent. There is mild atelectasis at the lung bases. There are a few patchy
and ground-glass opacities seen within the left upper lobe, right middle lobe,
as well as the superior segment of the right lower lobe which may be of
infectious or inflammatory etiology.
OSSEOUS STRUCTURES:
There are no suspicious lytic or sclerotic bone lesions. There are mild
degenerative changes of the thoracic spine.
IMPRESSION:
1. A few bilateral patchy and ground-glass opacities, which may be of
infectious or inflammatory etiology; however, follow-up after treatment in ___
months is recommended.
2. Left axillary lymph nodes are at upper limits of normal.
3. Tiny right lobe of thyroid nodule.
Please refer to separately dictated CT abdomen for details of abdominal
findings.
Findings discussed with Dr. ___ at 7:25pm on ___, 3
hours after discovery of the findings.
|
19910237-RR-10
| 19,910,237 | 29,164,900 |
RR
| 10 |
2131-08-15 16:12:00
|
2131-08-16 06:26:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with IPH // IPH etiology
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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 redemonstration of intraparenchymal hemorrhage centered in the right
occipitotemporal region, which demonstrate predominantly hypointensity on T2
weighted image and heterogeneous hyperintensity on T1 weighted image. There
is a mild surrounding vasogenic edema resulting in mild mass effect on the
adjacent parenchyma. No evidence of midline shift. Given the presence of
intrinsic T1 hyperintensity of the hemorrhage, it is difficult to evaluate the
extent of enhancement. The hemorrhage is grossly unchanged in size compared
to prior CT, and measures 3.0 x 2.3 cm.
No additional area of hemorrhage is identified.
There is no evidence of infarction. The ventricles and sulci are normal in
caliber and configuration. The visualized major vascular flow voids are
grossly preserved. The paranasal sinuses are clear. There is mild effusion
in the left mastoid air cells. The globes and orbits are unremarkable. No
abnormal marrow signal is identified.
IMPRESSION:
1. No significant change in size of the acute intraparenchymal hemorrhage
centered in the rightoccipitotemporal region. Given the presence of intrinsic
T1 hyperintensity of the hemorrhage, it is difficult to evaluate the extent of
the enhancement. Please consider follow-up MRI with contrast after the
resolution of the hemorrhage to exclude any underlying enhancing lesion.
2. No evidence of an acute infarct.
|
19910990-RR-8
| 19,910,990 | 24,031,375 |
RR
| 8 |
2175-06-11 19:24:00
|
2175-06-11 21:37:00
|
INDICATION: ___ with fevers.
TECHNIQUE:
Frontal and lateral radiographs of the chest were obtained.
COMPARISON: There are no comparison studies available.
FINDINGS:
There are right middle and anterior segment of the right upper lobe involving
confluent opacities with an oval component in the upper lobe consistent with
pneumonia. There is no pleural effusion and no pneumothorax. The
cardiomediastinal shilhouette and hila are normal.
IMPRESSION:
Right middle and upper lobe pneumonia with widespread dense consolidation.
Short-term follow-up chest radiographs are recommended within six weeks to
resolution is recommended to rule out underlying coinciding malignancy noting
a area of somewhat oval confluent opacification in the right upper lobe. In a
high risk patient chest CT could also be considered preferably with
intravenous contrast if that course is pursued.
|
19910997-RR-18
| 19,910,997 | 22,925,411 |
RR
| 18 |
2162-10-06 01:15:00
|
2162-10-06 02:00:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with intractable headache // Rule out bleed, mass
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, 16.1 cm; CTDIvol = 50.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture, acute large territory
infarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in
size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are normal.
IMPRESSION:
No acute intracranial abnormality.
|
19910997-RR-19
| 19,910,997 | 22,925,411 |
RR
| 19 |
2162-10-06 11:11:00
|
2162-10-06 14:05:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ female with refractory headache, evaluate for venous
sinus thrombosis.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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: Head CT ___
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. The major intracranial arteries appear patent without
significant flow limiting stenosis. The dural sinuses are patent without
venous sinus thrombosis.
IMPRESSION:
Dural sinuses are patent without venous sinus thrombosis.
|
19911133-RR-10
| 19,911,133 | 20,826,988 |
RR
| 10 |
2146-06-12 00:18:00
|
2146-06-12 04:18:00
|
INDICATION: Shortness of breath.
COMPARISONS: None available.
FINDINGS:
Upright portable view of the chest demonstrates moderate bilateral pleural
effusions. Right pleural effusion with probable subpulmonic component. Left
lung base consolidation is noted. Right lung base opacities are also seen.
There is mild pulmonary edema. Heart size is difficult to assess due to the
adjacent opacities, which is likely enlarged. Aortic arch calcifications are
noted. Pacemaker leads are in place, projecting over right atrium and
ventricle. There is no pneumothorax. Bones are diffusely demineralized.
IMPRESSION:
Moderate bilateral pleural effusions, cardiomegaly and pulmonary edema. Left
lung base consolidation, likely atelectasis, however, superimposed infection
cannot be excluded.
|
19911133-RR-12
| 19,911,133 | 20,826,988 |
RR
| 12 |
2146-06-13 08:52:00
|
2146-06-13 09:40:00
|
CHEST RADIOGRAPH
INDICATION: Chronic heart failure, exacerbation, evaluation for interval
change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, a pre-existing left pleural
effusion has slightly increased in extent. The pre-existing right pleural
effusion is constant. Bilateral areas of atelectasis at the lung bases.
Borderline size of the cardiac silhouette without pulmonary edema. No
evidence of pneumonia in the well-ventilated lung areas. Left pectoral
pacemaker. Normal course and position of the pacemaker leads.
|
19911159-RR-22
| 19,911,159 | 25,747,548 |
RR
| 22 |
2174-12-26 00:16:00
|
2174-12-26 01:04:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD
INDICATION: History: ___ with right sided headache x 1 week, found to have
left frontal 1.6 cm hemorrhage on outside imaging, per discussion with
neurosurgery requesting CT head, CTA, CTV to further evaluate.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain in the arterial and venous phases during the uneventful infusion of
70 mL of Omnipaque intravenous contrast material. Three-dimensional
angiographic volume rendered and segmented images were then generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 32.7 mGy (Head) DLP =
16.3 mGy-cm.
3) Spiral Acquisition 2.7 s, 20.8 cm; CTDIvol = 30.9 mGy (Head) DLP = 643.9
mGy-cm.
4) Spiral Acquisition 2.7 s, 20.8 cm; CTDIvol = 31.0 mGy (Head) DLP = 644.9
mGy-cm.
Total DLP (Head) = 2,108 mGy-cm.
COMPARISON: None available. The outside prior studies not available.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
An ill-defined intraparenchymal hematoma in the superficial anterior left
frontal lobe measures 1.3 x 0.8 cm. There is a small amount of adjacent
subarachnoid hemorrhage. There is minimal associated edema. There is no
shift of midline structures. Ventricles and basal cisterns are normal in
size.
The right sphenoid sinus contains 2 small mucous retention cyst. There is a
partially visualized small mucous retention cyst in the included portion of
right maxillary sinus and a small focus of mucosal thickening in the partially
visual left maxillary sinus. The mastoid air cells and middle ear cavities
are clear. The orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear patent without evidence for flow-limiting stenosis or aneurysm. There
is no evidence of an arteriovenous malformation.
CTV HEAD:
The superior sagittal sinus, transverse sinuses, sigmoid sinuses, proximal
internal jugular veins, straight sinus, and inferior sagittal sinus are
patent. There is no evidence of dural venous sinus thrombosis.
IMPRESSION:
1. 1.3 cm superficial anterior left frontal intraparenchymal hematoma with a
small amount of adjacent subarachnoid hemorrhage and mild surrounding edema.
2. No evidence of an arteriovenous malformation or aneurysm.
3. No evidence for dural venous sinus thrombosis.
|
19911159-RR-23
| 19,911,159 | 25,747,548 |
RR
| 23 |
2174-12-26 09:26:00
|
2174-12-26 12:28:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with L frontal hyperdensity - hematoma vs mass
vs other? // further evaluation of lesion seen on CT
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 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 and neck ___
FINDINGS:
A 1.8 x 1.2 cm lesion in the left frontal lobe is heterogeneous in signal with
areas of T2/T1 hypointensity and hyperintensity. This lesion has a T2
hypointense rim. There is a small amount of adjacent subarachnoid hemorrhage
in the left frontal sulci. No new hemorrhages are identified. There is no
nodular enhancement within this lesion. There is minimal, thin peripheral
enhancement along the inferior aspect of this lesion.
There is no evidence of edema, masses, mass effect, midline shift or
infarction. The ventricles and sulci are normal in caliber and
configuration.
The paranasal sinuses and mastoid air cells are clear. The orbits are
unremarkable.
IMPRESSION:
Left frontal lobe intraparenchymal hematoma with a small amount of adjacent
subarachnoid hemorrhage, containing acute and subacute blood products, which
may be due to an underlying occult vascular malformation. However, the
possibility of a neoplasm should also be considered. No nodular enhancement.
Serial follow-up contrast-enhanced MRI is recommended.
RECOMMENDATION(S): Serial follow-up contrast-enhanced MRI is recommended.
|
19911351-RR-11
| 19,911,351 | 25,037,898 |
RR
| 11 |
2139-02-28 12:19:00
|
2139-02-28 15:28:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ s/p reported mechanical trip and fall without LOC presents to
___ from OSH with identified C2-C7 spinal process fractures, C4 vertebral
body fracture, and bilateral femur fractures// Eval C-spine in setting of
known fx Eval C-spine in setting of known fx
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: CT cervical spine from outside facility dated ___ at
14:40.
FINDINGS:
Alignment is normal. There is mild height loss of the C7 vertebral body,
which demonstrates marrow edema and a linear transverse line compatible with
an acute fracture. There is marrow edema in the anterior, inferior C4
vertebral body at the site of the anteroinferior endplate fracture seen on the
prior CT. Remaining vertebral heights are preserved. Marrow signal elsewhere
in the cervical spine is within normal limits. The cervical spinal cord is
normal in caliber and signal intensity.
There is a likely acute extra axial hematoma within the cervical spine
posteriorly, extending from the level of approximately C3 at the left
superolateral aspect of the spinal canal, where it is small in caliber,
inferiorly into the thoracic spine, widest in caliber over an approximately 7
cm distance at the level of the T1-T4 vertebral bodies, where measures up to
0.9 cm in width, causing at least moderate overall spinal canal narrowing with
contact and anterolateral displacement of the spinal cord and slight cord
remodeling. No cord signal abnormality.
There is marrow edema in the pars interarticularis and lamina and pedicles of
C3 and C4 on the right, with trace intervening facet joint fluid, raising
suspicion for facet joint capsule disruption at this level. There is also
trace right C2-3 and C4-5 facet joint fluid, degenerative change versus acute
injury.
There is extensive edema and likely hematoma within the suboccipital and
posterior paraspinal musculature overlying the mid to upper cervical spine.
There is extensive STIR hyperintense signal in the region of the interspinous
ligaments, consistent with injury or disruption, from at least C2-3 inferiorly
to the level of C5-6. Known multilevel spinous process fractures extending
from C2-C7, as well as involving the bilateral C7 pars interarticularis, were
better assessed on prior outside hospital CT.
There is probable focal disruption of the anterior longitudinal ligament at
the level of C4-5 (see series 3, image 9). The posterior longitudinal
ligaments appears intact.
There is trace prevertebral edema throughout the cervical spine, most
conspicuous at the level of the C7 fracture.
There is background moderate cervical spine degenerative changes, with
multilevel posterior disc bulges causing moderate spinal canal narrowing at
C3-4, C4-5, and C5-6, with slight ventral cord contact and cord remodeling at
these levels. Neural foraminal narrowing due to degenerative changes is seen
at multiple levels, worst (moderate) bilaterally at C5-6 due to uncovertebral
and facet osteophytes.
IMPRESSION:
1. Posterior acute spinal hematoma, likely with both epidural and subdural
components, extending from C3 to at least the level of T4, largest in diameter
(up to 9-10 mm) from T1-T4 over an approximately 8 cm range length, with mass
effect on the cord, causing central canal narrowing and right anterolateral
displacement of the thoracic cord. No cord signal abnormality.
2. Extensive posterior ligamentous complex injury, including evidence of
injury or disruption to the interspinous ligaments spanning at least C2-3
inferiorly to the level of C5-6.
3. Apparent focal disruption of the anterior longitudinal ligament (ALL) at
C4-5.
4. Although no discrete fracture is seen on the CT or on this study, there is
marrow edema on either side of the right C3-4 facet joint, with trace facet
joint fluid, raising the possibility of injury to the joint capsule at this
level. Similarly, trace but less conspicuous facet joint fluid also on the
right at C2-3 and ___ reflect degenerative changes or subtle injury to
these joint capsules.
5. Known fractures through the C2-C7 spinous processes as well as the right
and left C7 pars interarticularis, better assessed on outside hospital CT.
6. Marrow edema associated with the transverse fracture through the C7
vertebral body and the anteroinferior endplate fracture of the C4 vertebral
body, also better visualized by CT.
7. Small volume multilevel prevertebral fluid, most conspicuous at C7.
NOTIFICATION: The findings were discussed with ___ M.D. by
___, M.D. on the telephone on ___ at 3:25 pm and again
at 4:15 p.m. after modification to impression points #'s 1 and 3, 5 minutes
after discovery of the findings.
|
19911351-RR-12
| 19,911,351 | 25,037,898 |
RR
| 12 |
2139-03-01 12:58:00
|
2139-03-01 14:51:00
|
EXAMINATION: FEMUR (AP AND LAT) IN O.R. LEFT
IMPRESSION:
Images from the operating suite show placement of an extensive fixation device
in the proximal femur. Further information can be gathered from the operative
report.
|
19911351-RR-13
| 19,911,351 | 25,037,898 |
RR
| 13 |
2139-03-01 14:27:00
|
2139-03-01 16:56:00
|
EXAMINATION: Intraoperative fluoroscopy, bilateral femurs.
INDICATION: ORIF of bilateral femurs.
TECHNIQUE: 54 fluoroscopic spot images of the right femur were obtained in
the operating room without presence of radiologist during ongoing open
reduction internal fixation of each femur.
DOSE: Fluoroscopy time: 146.7 seconds, cumulative dose 1.39 rad.
COMPARISON: Radiographs from ___.
FINDINGS:
These fluoroscopic spot images show ongoing open reduction internal fixation
of bilateral femur fractures.
IMPRESSION:
Bilateral femoral ORIF surgeries. Please see the operative note for details
if needed.
|
19911351-RR-14
| 19,911,351 | 25,037,898 |
RR
| 14 |
2139-03-02 05:28:00
|
2139-03-02 08:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall w C2-C7 fx, b/l femur fx sp ORIF bilateral
femurs// Eval for interval change
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Support lines and tubes are unchanged. Cardiomediastinal silhouette is
stable. Interstitial abnormality is unchanged. There is no pleural effusion.
No pneumothorax is seen. There are multiple left-sided rib fractures.
|
19911351-RR-15
| 19,911,351 | 25,037,898 |
RR
| 15 |
2139-03-02 10:37:00
|
2139-03-02 13:29:00
|
INDICATION: ___ year old man with trauma// clear T and L spine
TECHNIQUE: Multidetector CT images were obtained in soft tissue and bone
kernel after the administration of intravenous contrast at an outside
institution. Axial and coronal reformats were reviewed. Assessment is mildly
limited by motion and streak artifact however images are overall suitable for
interpretation.
DOSE: Performed at outside institution.
COMPARISON: None available.
FINDINGS:
CHEST:
HEART AND VASCULATURE: There is concentric left ventricular hypertrophy with
atrophy and thinning at the apex. Coronary artery calcifications are present.
No pericardial effusion. No incidental pulmonary embolus.
AXILLA, HILA, AND MEDIASTINUM: No significant mediastinal hematoma or
lymphadenopathy.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Mild biapical scarring. Bibasilar atelectasis parenchymal
evaluation mildly limited by motion. The airways appear patent to the level
of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal 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. Trace perisplenic ascites appears simple.
ADRENALS: 1.9 cm nodule in the right adrenal gland measures 22 Hounsfield
units (08:22). The left adrenal gland is normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of hydronephrosis. Bilateral renal cysts appear simple
measuring up to 6.3 cm in the right kidney. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no free
intraperitoneal fluid or free air.
PELVIS: Limited assessment due to streak artifact from orthopedic hardware.
The urinary bladder and distal ureters are unremarkable. No visualized free
fluid in the pelvis.
REPRODUCTIVE ORGANS: Normal appearance of the prostate.
LYMPH NODES: No lymphadenopathy by CT size criteria
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted. Vascular structures adjacent to the clavicular fractures
are intact. No evidence of intraabdominal bleeding.
BONES AND SOFT TISSUES: Posterior spinal fusion hardware extends from T10
through L5. Streak artifact limits assessment, however no hardware fractures
identified. Post treatment/kyphoplasty changes are noted in L4 and L5.
Degenerative changes are extensive. Disruption of calcified anterior
longitudinal ligament at L1 and disruption of the lateral osteophytes at this
level is highly concerning for a fracture with 12 mm retropulsion of anterior
superior aspect of this vertebral body (7:65, 6:54). Assessment of the spinal
cord is limited at this level although there is no severe bony retropulsion.
Disruption of the posterior cortex of vertebral body suggests that this
fracture involves 2 columns (10:73). There is no surrounding hematoma.
Acute comminuted left medial clavicular shaft fracture with 1 shaft with
anterior displacement of the distal fragment, adjacent hematoma, and close
proximity to the skin with evidence of skin tenting (5:9). Acute nondisplaced
fracture of the right clavicle midshaft with posterior angulation of the
distal fragment and adjacent hematoma. Chronic appearing left humeral neck
deformity demonstrates callus formation, suggesting a chronic fracture,
partially visualized (7:33).
The patient is post right total hip arthroplasty. At the inferior aspect of
the femoral stem through the cement, there is an acute displaced comminuted
fracture of the femoral shaft with approximately ___ shaft width displacement
laterally of the inferior largest fragment. An 8.0 x 0.8 cm fragment resides
medially to the fracture (09:24).
There is an extensively comminuted acute left proximal femur fracture with
fracture lines involving the intratrochanteric region and the femoral neck
(9:34, 9:35, 9:29). Severe apex medial angulation is present with more than 7
cm of foreshortening of the distal fragment.
Numerous bilateral subacute to chronic rib fractures. No acute displaced rib
fractures seen. Angulation with callus formation and posterior cortical
disruption of the sternum is without adjacent soft tissue changes (06:51).
IMPRESSION:
1. Acute comminuted bilateral proximal femur fractures. Periprosthetic on the
right involving the femoral shaft. Severely comminuted and angulated with
fracture planes involving the intertrochanteric region and femoral neck on the
left.
2. Transverse L1 vertebral body 2 column fracture. Absence of surrounding
hematoma and presence of fusion hardware above and below but not involving
this level suggests that it is an already treated recent fracture.
Correlation with history of prior fracture repair suggested. No severe
retropulsion.
3. No additional acute fractures identified in the thoracic or lumbar spine.
4. Acute bilateral clavicle fractures; comminuted and displaced on the left
and nondisplaced but angulated on the right.
5. No intraabdominal traumatic injury. Trace simple perisplenic ascites,
likely third spacing.
6. Numerous bilateral subacute to chronic rib and sternal fractures. No acute
displaced rib fracture or pneumothorax.
7. 2 cm right adrenal cyst or adenoma.
|
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