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19911351-RR-16
| 19,911,351 | 25,037,898 |
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2139-03-03 11:11:00
|
2139-03-03 18:05:00
|
EXAMINATION: CTA CHEST
INDICATION: ___ multiple fx s/p fall, now s/p ORIF, tachypneic, tachycardia//
Rule out PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 512 mGy-cm.
COMPARISON: Second opinion CT torso from outside hospital dated ___.
FINDINGS:
Cardiac size is within normal limits. There is moderate calcified
atherosclerosis of the coronary arteries. No evidence of pericardial
effusion. The aorta and its major branch vessels are patent, with no evidence
of stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears heterogenous without definite thyroid nodules.
No pericardial effusion. Pleural effusions are noted bilaterally, moderate on
the right and small on the left with associated compressive atelectasis in the
lower lungs.
A 4 mm subpleural pulmonary nodule is demonstrated in the right middle lobe,
(series 301, image 169). A 5 mm subpleural pulmonary nodule is also
demonstrated in the right middle lobe, (series 301, image 167).
The airways are patent to the subsegmental level without evidence of bronchial
wall thickening.
Limited images of the upper abdomen demonstrates a liver which is diffusely
hypoenhancing when compared to the spleen suggesting diffuse hepatic
steatosis.
Bones: Osseous structures are diffusely osteopenic. Posterior spinal fusion
is seen extending inferiorly from T9. There is an oblique oriented fracture
extending anterior inferior corner of T5 through the body of T6 and T7. There
is new alignment abnormality with posterior translation of 8 mm of T5 relative
to T6. This finding is concerning for an unstable distraction injury and
neurosurgical consult is advised. A fracture involving the T12 vertebral body
is again noted, which given the presence of associated fixation hardware is
likely subacute. Midbody sternal fracture appears unchanged. Bilateral
proximal clavicular shaft fractures are again noted. Bilateral chronic
appearing rib deformities are unchanged.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Unstable fractures of the thoracic spine extending from T5 through T7 with
associated posterior translation measuring 8 mm. Neurosurgical consult
advised.
3. Moderate right and small left pleural effusions with compressive lower lobe
atelectasis.
4. Bilateral proximal clavicular shaft fractures.
5. Acute sternal body fracture.
6. Multiple chronic bilateral rib deformities.
7. There are 2 subpleural pulmonary nodules in the right middle lobe measuring
4-5 mm respectively. Attention on followup advised.
RECOMMENDATION(S): Neuro surgical or ortho spine consult is recommended for
the unstable fracture at T6-T7 with increased posterior translation.
For incidentally detected multiple solid pulmonary nodules smaller than 6mm,
no CT follow-up is recommended in a low-risk patient, and an optional CT
follow-up in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:37 pm, 5 minutes after
discovery of the findings.
The findings were discussed with ___, M.D. by ___, M.D.
on the telephone on ___ at 5:56 pm, 2 minutes after discovery of the
findings.
|
19911351-RR-17
| 19,911,351 | 25,037,898 |
RR
| 17 |
2139-03-03 09:38:00
|
2139-03-03 17:15:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ yo M sp fall w C2-C7 fx, b/l femur fx sp ORIF bilateral
femurs// please eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility and flow of the bilateral common femoral,
femoral, and popliteal veins. Normal color flow is demonstrated in the right
posterior tibial and peroneal veins. The left posterior tibial and peroneal
veins are not adequately visualized on this study.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Limited exam with low overall suspicion for deep venous thrombosis in the
bilateral lower extremity veins.
|
19911351-RR-18
| 19,911,351 | 25,037,898 |
RR
| 18 |
2139-03-04 01:03:00
|
2139-03-04 11:29:00
|
EXAMINATION: MR THORACIC SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with interval increase in posterior translation
of T6 on T7// interval increase in posterior translation of T6 on T7
interval increase in posterior translation of T6 on T7
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: CTA chest ___, cervical spine MRI ___,
CT torso ___
FINDINGS:
When compared to CT torso ___, there is interval development of
an acute fracture through the ossified anterior longitudinal ligament at T5-T6
extending through the T6 vertebral body and bilateral pedicles. This results
in interval severe retrolisthesis T5 on T6, bony retropulsion of the posterior
superior T6 vertebral body and retrolisthesis of the T6 vertebral body, and
severe spinal canal narrowing, remodeling the cord. There is no definite cord
signal abnormality. Additionally, there is disruption of the anterior and
posterior longitudinal ligaments at this level.
At C7, there is marrow edema and a linear transverse line compatible with an
acute fracture, unchanged from MR cervical spine ___.
Extending from the level of T1-T4, there is a T2 hypointense, T1 mildly
hyperintense collection compatible with extramedullary hematoma, unchanged in
size (4:8). The collection contacts the spinal cord at the level of T3.
Surgical hardware extends from T9 through L1 and limits evaluation.
There are background severe thoracic spine degenerative changes. This
includes loss of intervertebral disc height (most notably at T6-T7), disc
desiccation, disc bulge (resulting in contact of the spinal cord at T1),
vertebral body disc height loss (most notably at T6 and T7), marrow signal
changes, and joint osteophytosis.
Other: Bilateral pleural effusions. Bilateral renal cysts.
IMPRESSION:
1. Severe spinal canal narrowing at T5-T6, with remodeling of the cord without
definite cord signal abnormality. This is secondary to a Chance type fracture
of the ossified T5-T6 anterior longitudinal ligament with extension through
the T6 vertebral body and bilateral pedicles with bony retropulsion and
retrolisthesis of the posterosuperior T6 vertebral body.
2. Extramedullary hematoma extending from T1-T4 is unchanged in size.
3. Additional findings as described above.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 12:07 pm, 15 minutes after
discovery of the findings.
|
19911351-RR-19
| 19,911,351 | 25,037,898 |
RR
| 19 |
2139-03-04 05:26:00
|
2139-03-04 11:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cervical frx// interval change
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: ___ chest CT, ___ chest radiograph.
FINDINGS:
The lung volumes are low. When compared to ___ chest radiograph,
there is increased prominence of the pulmonary vasculature bilaterally and
increased bilateral interstitial opacities consistent with pulmonary edema.
Bilateral small pleural effusions are also seen. No pneumothorax. Left
retrocardiac opacity is unchanged, this may represent atelectasis however
pneumonia could have a similar appearance. The bones are markedly
demineralized. Posterior thoracolumbar spinal fusion hardware is partially
imaged.
IMPRESSION:
1. Cardiomegaly with pulmonary vascular congestion and moderate pulmonary
edema; pulmonary edema has progressed since ___.
2. Small bilateral pleural effusions.
|
19911351-RR-20
| 19,911,351 | 25,037,898 |
RR
| 20 |
2139-03-04 12:02:00
|
2139-03-05 09:21:00
|
EXAMINATION: CERVICAL SINGLE VIEW IN OR
INDICATION: C5-T7 FUSION LAMINECTOMY
IMPRESSION:
Fluoroscopic documentation of cervical fusion. No radiologist was present.
|
19911351-RR-21
| 19,911,351 | 25,037,898 |
RR
| 21 |
2139-03-04 20:47:00
|
2139-03-04 21:46:00
|
EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ yo M sp fall w C2-C7 fx, T5-T6 unstable fracture, b/l femur fx
sp ORIF bilateral femurs// Eval for interval change, ETT position
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___ at 05:39.
FINDINGS:
There are postsurgical changes from posterior spinal fusion of the
cervicothoracic spine. The endotracheal tube terminates 5.7 cm above the
carina.
Mild pulmonary edema and small bilateral pleural effusions are unchanged.
There is no focal consolidation or pneumothorax. A retrocardiac opacity is
also unchanged and most likely represents left lower lobe atelectasis. The
cardiomediastinal silhouette is stable in appearance. Bilateral displaced rib
fractures are noted. There are additional healed chronic rib fractures.
IMPRESSION:
1. The endotracheal tube terminates 5.7 cm above the carina. Advancement by
2-3 cm is recommended.
2. Unchanged small pleural effusions and mild pulmonary edema.
3. Displaced bilateral rib fractures.
|
19911351-RR-22
| 19,911,351 | 25,037,898 |
RR
| 22 |
2139-03-05 05:52:00
|
2139-03-05 09:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall w C2-C7 fx, T5-T6 unstable fracture, b/l femur fx
sp ORIF bilateral femurs and C3-T9 fusion// Eval for interval change Eval
for interval change
IMPRESSION:
Comparison to ___. The vertebral fixation devices are in stable
correct position. Stable appearance of the heart and the lung parenchyma. No
pneumothorax.
|
19911351-RR-23
| 19,911,351 | 25,037,898 |
RR
| 23 |
2139-03-05 11:16:00
|
2139-03-05 12:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ETT and OGT non-visualized on CXR// Eval for
tube position Eval for tube position
IMPRESSION:
Comparison to ___. The endotracheal tube projects approximately
6 cm above the carinal. The feeding tube shows a normal course, the tip is
located in the proximal parts of the stomach, the side hole is at the level of
the gastroesophageal junction. The device could be advanced by approximately
5 cm. No change in appearance of the cardiac silhouette and the lung
parenchyma.
|
19911351-RR-24
| 19,911,351 | 25,037,898 |
RR
| 24 |
2139-03-05 14:34:00
|
2139-03-05 14:53:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new line// new left PICC 46 ___ ___
Contact name: ___: ___ new left PICC 46 ___ ___
IMPRESSION:
Comparison to ___, 11:31. The patient has received a new
left-sided PICC line. The course of the line is unremarkable, the tip of the
line projects over the mid SVC. No complications, notably no pneumothorax.
The other monitoring and support devices are in stable correct position.
Stable appearance of the lung parenchyma and the cardiac silhouette.
|
19911351-RR-25
| 19,911,351 | 25,037,898 |
RR
| 25 |
2139-03-06 11:53:00
|
2139-03-06 12:46:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 6 EXAMS
INDICATION: ___ year old man with Cervical frx// dobhoff place dobhoff
place
IMPRESSION:
6 attempts of feeding tube placement are documented. On image number 6, the
last of the series, no feeding tube is seen in the esophagus or in the
stomach.
|
19911351-RR-26
| 19,911,351 | 25,037,898 |
RR
| 26 |
2139-03-06 12:26:00
|
2139-03-06 13:23:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with cerv frx// dobhoff dobhoff
IMPRESSION:
Comparison to ___. The current radiograph shows postsurgical
clips, vertebral fixation devices, an endotracheal tube as well as a
left-sided PICC line, but no feeding tube is visualized. Stable appearance of
the heart and the lung parenchyma, as compared to the previous image.
|
19911351-RR-27
| 19,911,351 | 25,037,898 |
RR
| 27 |
2139-03-06 13:21:00
|
2139-03-06 14:16:00
|
EXAMINATION: CHEST PORT LINE/TUBE PLCT 1 EXAM
INDICATION: ___ year old man with cerv frx// dobhoff dobhoff
IMPRESSION:
Comparison to ___, 12:21. 2 images document feeding tube
placement, the second image shows the tube malpositioned in the right
bronchial system. No complications.
|
19911351-RR-28
| 19,911,351 | 25,037,898 |
RR
| 28 |
2139-03-06 14:06:00
|
2139-03-06 14:14:00
|
EXAMINATION: CHEST PORT LINE/TUBE PLCT 1 EXAM
INDICATION: ___ year old man with cerv frx// dhf dhf
IMPRESSION:
Comparison to ___, 13:25. The second of 2 images shows the
feeding tube in the stomach, the tip projecting over the proximal parts of the
stomach. The course of the tube is unremarkable. No complications.
|
19911351-RR-30
| 19,911,351 | 25,037,898 |
RR
| 30 |
2139-03-07 13:27:00
|
2139-03-07 17:06:00
|
EXAMINATION: T-SPINE
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion// AP lat C
and T spine. Check hardware. s/p spine drains removal
TECHNIQUE: Portable AP view of the thoracic spine
COMPARISON: Thoracic spine MRI dated ___
FINDINGS:
Single portable AP radiograph of the thoracic spine demonstrates extensive
metallic hardware projecting over the entire portion of the visualized
thoracic spine.
A weighted feeding tube tip projects over the left upper quadrant.
Surgical staples project over the upper chest wall in the midline.
IMPRESSION:
Extensive spinal fixation hardware projects over the visualized portions of
the thoracic spine.
|
19911351-RR-31
| 19,911,351 | 25,037,898 |
RR
| 31 |
2139-03-07 13:36:00
|
2139-03-07 17:09:00
|
EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture,// hardware check
TECHNIQUE: AP and lateral radiographs of the cervical and upper thoracic
spine
COMPARISON: MRI of the cervical spine dated ___
FINDINGS:
Spinal fixation hardware projects over the cervical and upper thoracic spine.
The fourth spinal fixation screw on the right side appears slightly
malaligned. Rest of the hardware is intact.
Cervical lordosis is lost.
Enteric tube courses anterior to the cervical spine.
No abnormal pre or paravertebral soft tissue noted.
Left PICC, partially imaged, terminates in the distal SVC.
IMPRESSION:
Spinal fixation hardware projects over the thoracic and lower cervical spine.
The fourth screw on the right side at the cervicothoracic junction appears
slightly malaligned. Rest of the hardware appears intact.
|
19911351-RR-32
| 19,911,351 | 25,037,898 |
RR
| 32 |
2139-03-08 05:38:00
|
2139-03-08 08:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion// Daily CRX
Daily CRX
IMPRESSION:
Comparison to ___. The patient appears to be extubated. The
feeding tube and the left PICC line are in stable position. Stable alignment
of the vertebral fixation devices. Minimally increasing right pleural
effusion. Stable left retrocardiac atelectasis. No change in appearance of
the cardiac silhouette.
|
19911351-RR-33
| 19,911,351 | 25,037,898 |
RR
| 33 |
2139-03-10 05:51:00
|
2139-03-10 08:20:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cerv frx ?pulm ed// change change
IMPRESSION:
Comparison to ___. Stable vertebral fixation devices. Stable
position of the feeding tube and of the left PICC line. Stable extent of a
moderate right pleural effusion and of a small left pleural effusion, with
subsequent proportional areas of atelectasis at the lung bases. No new
parenchymal abnormalities.
|
19911351-RR-34
| 19,911,351 | 25,037,898 |
RR
| 34 |
2139-03-11 05:32:00
|
2139-03-11 08:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion// Eval for
interval change Eval for interval change
IMPRESSION:
Comparison to ___. The feeding tube and the left PICC line are
in stable position. Stable position of the vertebral fixation devices.
Stable moderate right pleural effusion and minimal left pleural effusion.
Borderline size of the cardiac silhouette. The signs indicative of mild to
moderate pulmonary edema, with a decrease in radio lucency of the right
hemithorax, are overall also stable.
|
19911351-RR-35
| 19,911,351 | 25,037,898 |
RR
| 35 |
2139-03-12 05:16:00
|
2139-03-12 13:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with episode of hypoxia// Please evaluate for
interval change Please evaluate for interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Large right pleural effusion is stable, severe right basal atelectasis has
worsened and mild pulmonary edema is unchanged since ___. Heart is
probably not appreciably enlarged. Spinal stabilization hardware grossly
unchanged. No pneumothorax.
Left PIC line ends in the low SVC.
|
19911351-RR-36
| 19,911,351 | 25,037,898 |
RR
| 36 |
2139-03-13 05:39:00
|
2139-03-13 12:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumonia// Please eval for interval change
Please eval for interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Large right pleural effusion persists, obscuring the right lung and any
pneumonia. Pulmonary vascular congestion is evident in the left lung. Left
hemidiaphragm remains elevated and there is still a pleural or extra pleural
collection in the left upper chest parallel to the fourth posterior
interspace, presumably loculated hematoma. Heart is not enlarged.
Left PIC line ends in the mid SVC. Feeding tube ends in the stomach.
|
19911351-RR-37
| 19,911,351 | 25,037,898 |
RR
| 37 |
2139-03-13 19:26:00
|
2139-03-13 20:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion// Eval for
interval change
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Extensive thoracolumbar spinal hardware is incompletely evaluated. Skin
staples are seen overlying the spine. AP enteric tube projects over the
stomach and the tip of a left PICC line projects over the cavoatrial junction.
Compared to the radiograph from earlier today, there is no significant change
in a large right pleural effusion as well as a left pleural/extrapleural
collection. Underlying pneumonia would be hard to exclude in the proper
clinical context. The size and appearance of the cardiomediastinal silhouette
is unchanged. Extensive degenerative changes are present around the left
shoulder.
IMPRESSION:
No significant interval change since the radiograph performed earlier today.
|
19911351-RR-38
| 19,911,351 | 25,037,898 |
RR
| 38 |
2139-03-14 05:41:00
|
2139-03-14 09:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion// Eval for
interval change
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Pulmonary edema is unchanged. Left-sided PICC line projects to the SVC.
Cardiomediastinal silhouette is stable. Bilateral effusions right greater
than left are also unchanged. The Dobhoff tube tip projects over the stomach.
There is evidence of internal fixation of the cervical and thoracic spine. No
pneumothorax is seen
|
19911351-RR-39
| 19,911,351 | 25,037,898 |
RR
| 39 |
2139-03-15 04:03:00
|
2139-03-15 13:27:00
|
EXAMINATION: FEMUR (AP AND LAT) BILAT PORT
INDICATION: ___ year old man with bilateral femur frx 2 wks// change
TECHNIQUE: Frontal and lateral views of both femurs. Total of 6 radiographs.
COMPARISON: Bilateral femur radiographs ___.
FINDINGS:
Left femur: Patient is status post gamma nail fixation of a comminuted all
inter trochanteric and proximal diaphyseal fracture of the left femur. There
is no appreciable bony callus formation. No evidence of hardware loosening or
hardware fracture. Postoperative soft tissue swelling and surgical staples
are re-demonstrated. Moderate degenerative changes of the left hip joint.
Right femur: The patient is status post internal fixation with plate and
screws of a periprosthetic obliquely oriented fracture of the proximal right
femur. There is no evidence of hardware related complications. A right total
hip arthroplasty remains in place. There is soft tissue swelling and
cutaneous surgical staples. There calcifications are noted.
IMPRESSION:
Status post fixation of a left proximal femur fracture without evidence of
hardware related complication. Status post plate and screw fixation of a
periprosthetic right femoral diaphysis fracture without evidence of hardware
related complication.
|
19911351-RR-40
| 19,911,351 | 25,037,898 |
RR
| 40 |
2139-03-14 18:18:00
|
2139-03-14 19:24:00
|
EXAMINATION: Chest radiograph, portable AP semi-upright.
INDICATION: Right pleural effusion status post chest tube placement.
COMPARISON: Earlier on the same day.
FINDINGS:
New PICC pigtail catheter terminates at the base of the right chest. Pleural
effusion has markedly decreased in size, now very small if any is left. Small
to medium sized left-sided pleural effusion appears unchanged. Left-sided PICC
line again terminates in the mid to upper superior vena cava. A feeding tube
with weighted tip again terminates in the stomach. Vertical staple line noted
in addition to spinal hardware, incompletely characterized. Mild interstitial
process appears very similar allowing for differences in technique, suggesting
mild vascular congestion. Very small pneumothorax is now found on the right.
IMPRESSION:
Marked decrease in right-sided pleural effusion. Trace pneumothorax. Chest
tube projecting over the base of the right chest.
|
19911351-RR-42
| 19,911,351 | 25,037,898 |
RR
| 42 |
2139-03-14 22:51:00
|
2139-03-15 10:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with tachypnea and tachycardia after chest tube
placement// eval progression of pneumothorax eval progression of
pneumothorax
IMPRESSION:
Compared to chest radiographs ___ through ___.
No right pneumothorax. Small right pleural effusion has recurred following
insertion of a right basal pleural drainage cathete which cleared the previous
moderate right pleural effusion. Bibasilar consolidation has increased on the
right. Since there is probable new mild edema in the upper lungs I would
attribute this first to pulmonary edema, but concurrent pneumonia is certainly
not excluded. Heart size is normal.
|
19911351-RR-43
| 19,911,351 | 25,037,898 |
RR
| 43 |
2139-03-16 03:18:00
|
2139-03-16 11:38:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with acute hypoxic respiratory failure, sp R
chest tube. Pt had dobhoff replaced at bedside, please confirm placement//
replacement of Dobhoff tube
TECHNIQUE: Frontal radiographic view centered at the diaphragm with bilateral
lung apices outside of view.
COMPARISON: Chest radiograph dated ___
FINDINGS:
Frontal radiographic view is centered at the diaphragm with bilateral lung
apices outside of view.
A Dobhoff tube terminates in the stomach. Again seen is a pigtail catheter at
the right lung base. A left PICC line terminates in the mid to upper SVC.
Multiple spinal fusion hardware visualized
Lung volumes are low bilaterally. There are unchanged small pleural effusions
and mild-to-moderate pulmonary edema bilaterally. No pneumothorax. The
visualized mediastinum is normal. There is mild cardiomegaly.
IMPRESSION:
1. A Dobhoff tube terminates in the stomach.
2. Unchanged small right pleural effusion; right lung base pigtail catheter
remains in place.
3. Grossly unchanged small left pleural effusion.
4. Stable bilateral mild to moderate pulmonary edema.
|
19911351-RR-44
| 19,911,351 | 25,037,898 |
RR
| 44 |
2139-03-17 05:20:00
|
2139-03-17 12:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent R chest tube placement// eval for
interval change eval for interval change
IMPRESSION:
Type of tube passes below the diaphragm terminating in the stomach. Left PICC
line tip is at the level of mid SVC. Spinal hardware is in place. Right
pigtail catheter is in place. Multiple rib fractures are re-demonstrated.
Interstitial pulmonary edema is mild to moderate. Heart size and mediastinum
are stable. No appreciable pneumothorax. Small left pleural effusion.
|
19911351-RR-45
| 19,911,351 | 25,037,898 |
RR
| 45 |
2139-03-16 18:55:00
|
2139-03-16 19:49:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with bilateral femur fx, tachycardia, tachypnea//
Eval for ___ DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Bilateral lower extremity ultrasound dated ___.
FINDINGS:
There is normal compressibility and flow of the bilateral 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. Bilateral subcutaneous
edema is noted from mid thighs to calves.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins.
2. Bilateral subcutaneous edema from mid thighs to calves.
|
19911351-RR-46
| 19,911,351 | 25,037,898 |
RR
| 46 |
2139-03-17 20:31:00
|
2139-03-17 21:59:00
|
EXAMINATION: CTA CHEST
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion. s/p chest
tube// eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 39.4 cm; CTDIvol = 14.0 mGy (Body) DLP = 551.8
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
4) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
Total DLP (Body) = 557 mGy-cm.
COMPARISON: Chest CTA from ___
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the segmental level, with no
evidence of filling defect within the main, right, left, lobar or segmental
pulmonary arteries. The subsegmental arteries are not well evaluated because
of respiratory artifacts and adjacent lung parenchymal abnormalities.
The pulmonary trunk is mildly dilated measuring 3.2 cm. The right main
pulmonary artery measures 2.7 cm and the left main pulmonary artery measures
2.5 cm.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable. There is a left PICC line in place.
There is no evidence of pericardial effusion. Bilateral small to moderate
pleural effusions with loculations along the posterior and superior aspect of
both lungs. A right pigtail catheter is seen in the right pleural space.
There is bilateral interstitial thickening with fluid along the fissures as
well as peribronchial thickening all suggestive of interstitial pulmonary
edema. There are bilateral lower lobe distal endobronchial secretions.
Limited images of the upper abdomen are unremarkable. There is a nasogastric
tube in the fundus of the stomach. Again seen is a 1.8 cm right adrenal
nodule.
Patient known with an unstable fracture of vertebral body of T5/T6 as well as
fracture of T12 vertebral body previously described on recent thoracolumbar
MRI. Status post extensive fixation of the thoracolumbar spine.
Additional fracture of vertebral body of C7 is also stable.
There is also a partially visualized nondisplaced anterior-inferior fracture
of vertebral body of C4.
Multiple bilateral rib fractures are again noted as well as bilateral
minimally displaced proximal clavicles fractures and mid-sternal fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Signs of interstitial pulmonary edema.
3. Multiple ribs, clavicles and vertebral body fractures. Unstable T5-T6
vertebral body fractures is again noted with extensive orthopedic hardware in
place.
NOTIFICATION: The findings were discussed with MEANS, ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:50 pm, 10 minutes after
discovery of the findings.
|
19911351-RR-47
| 19,911,351 | 25,037,898 |
RR
| 47 |
2139-03-18 05:39:00
|
2139-03-18 08:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent R chest tube placement// eval for
interval change
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Left-sided PICC line is unchanged. NG tube projects below the left
hemidiaphragm the tip projects over the stomach. Pulmonary edema is
unchanged. Bilateral effusions are stable. The pigtail catheter in the right
lower chest is also unchanged. No pneumothorax.
|
19911351-RR-48
| 19,911,351 | 25,037,898 |
RR
| 48 |
2139-03-17 18:30:00
|
2139-03-17 21:36:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ s/p chest tube to water seal// eval for interval change
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
A right basal pleural catheter is again noted. The tip of the Dobhoff
projects over the stomach. Extensive spinal hardware is present. The tip of
a left PICC line projects over the mid SVC.
There is no discrete pneumothorax identified. Multiple rib fractures are
again seen. Interstitial pulmonary edema is unchanged. The size and
appearance of the cardiomediastinal silhouette is stable. There is a small
left pleural effusion.
IMPRESSION:
No significant interval change since the radiograph performed earlier today.
No pneumothorax.
|
19911351-RR-49
| 19,911,351 | 25,037,898 |
RR
| 49 |
2139-03-19 00:58:00
|
2139-03-19 09:12:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with pulled Dobhoff// Please evaluate for Dobhoff
placement
TECHNIQUE: Frontal view the chest
COMPARISON: ___
FINDINGS:
The Dobhoff tube appears to be in the stomach. The left PICC line remains
unchanged in the proximal to mid SVC. Pulmonary edema is slightly worsened.
No pneumothorax. Mild cardiomegaly again noted. Partially visualized spinal
hardware in the thoracic and lumbar spine again noted
IMPRESSION:
Pulmonary edema is slightly worsened. Dobhoff tube is in the stomach
|
19911351-RR-51
| 19,911,351 | 25,037,898 |
RR
| 51 |
2139-03-20 23:53:00
|
2139-03-21 09:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p removal of chest tube// ***Please obtain at
midnight ___ to assess for PTX 4h after removal of CT*** ***Please
obtain at midnight ___ to assess for PTX 4h after removal of CT***
IMPRESSION:
Compared to chest radiographs ___ through ___.
Mild to moderate pulmonary edema has increased company by increasing moderate
right pleural effusion. Right pigtail pleural drainage catheter has been
removed. No pneumothorax. Heart size normal. Persistent small left pleural
effusion, elevation left hemidiaphragm and pleural thickening adjacent to
multiple lower lateral rib fractures.
Left PIC line ends in the low SVC.
|
19911351-RR-52
| 19,911,351 | 25,037,898 |
RR
| 52 |
2139-03-22 05:28:00
|
2139-03-22 08:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall w C2-C7 fx, T5-T6 unstable fracture, b/l femur fx
sp ORIF bilateral femurs and C3-T9 fusion// assess for interval change
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
The left-sided PICC line is unchanged. The extensive degenerative changes
involving the the left shoulder joint. Pulmonary edema is unchanged
cardiomediastinal silhouette is stable. Bilateral effusions left greater than
right are stable. No pneumothorax.
|
19911351-RR-53
| 19,911,351 | 25,037,898 |
RR
| 53 |
2139-03-23 07:29:00
|
2139-03-23 10:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall w C2-C7 fx, T5-T6 unstable fracture, b/l femur fx
sp ORIF bilateral femurs and C3-T9 fusion// assess for interval change
assess for interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Borderline edema and right basal atelectasis have improved since ___,
small right pleural effusion has increased since ___. No pneumothorax.
Left PIC line in upper SVC.
Spinal stabilization rods grossly unchanged thoracic and lumbar spine.
Fractures, lateral left lower ribs partially healed.
|
19911351-RR-54
| 19,911,351 | 25,037,898 |
RR
| 54 |
2139-03-24 05:05:00
|
2139-03-24 05:52:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo M sp fall down 6 concrete stairs w C2-C7 fx, T5-T6 unstable
fracture, b/l femur fx sp ORIF bilateral femurs and C3-T9 fusion s/p PEG//
increased pleural effusion
TECHNIQUE: AP portable chest radiograph.
COMPARISON: Chest radiograph ___ 08:50
FINDINGS:
Mild pulmonary edema has increased. Small right pleural effusion may be
slightly larger. Heart size normal. No pneumothorax.
Left PIC line ends in the low SVC.
IMPRESSION:
Mild pulmonary edema and small right pleural effusion increased.
|
19911351-RR-55
| 19,911,351 | 25,037,898 |
RR
| 55 |
2139-03-24 17:05:00
|
2139-03-24 17:50:00
|
EXAMINATION: Chest radiograph, portable AP semi-upright.
INDICATION: Poly trauma. Tachypnea. Query mucous plug.
COMPARISON: ___, earlier on the same day.
FINDINGS:
Spinal fusion hardware is incompletely assessed but appears unchanged. PICC
line again terminates in the mid superior vena cava. Chest appears very
similar aside from decrease in severity of interstitial process. There are
small to medium size bilateral pleural effusions, left greater than right with
left basilar opacity in volume loss probably due to atelectasis. Left-sided
rib fractures are not well assessed with this technique.
IMPRESSION:
Persistent mild pulmonary edema, but decreased. Persistent basilar opacities
suggesting pleural effusions and, at least on the left, substantial basilar
atelectasis, but probably not new.
|
19911351-RR-56
| 19,911,351 | 25,037,898 |
RR
| 56 |
2139-03-26 11:49:00
|
2139-03-26 16:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with previous volume overload// ?interval change
TECHNIQUE: Portable chest x-ray
COMPARISON: ___
FINDINGS:
Thoracic spinal fusion hardware is incompletely assessed but appears grossly
intact. Left upper extremity PICC line terminates in the SVC. Small bilateral
pleural effusions larger on the left. Multiple acute left-sided rib
fractures. Multiple right-sided rib deformities which are probably chronic.
Bilateral interstitial pulmonary pattern which could represent mild
interstitial pulmonary edema not significantly changed from the prior study.
The heart is normal in size.
IMPRESSION:
Mild interstitial pulmonary edema with small bilateral pleural effusions-left
larger than right.
|
19911351-RR-57
| 19,911,351 | 25,037,898 |
RR
| 57 |
2139-03-28 03:33:00
|
2139-03-28 08:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with a PMH of HTN, HLD, HFpEF (EF >60%), LLL partial
lobectomy (___) who presented from OSH w/ mechanical fall causing C2-C7
spinous process fractures, C2-C6 ligamentous complex injury, C4 vertebral
fracture, T5-T6 unstable fracture, bilateral femur fractures, spinal hematoma
now s/p multiple spinal/orthopedic surgeries with course c/b hypotension, HAP,
pleural effusion and respiratory distress.// explanation for tachypnea in
patient with known HF exacerbation and prolonged hospitalization at risk for
HAP.explanation for tachypnea in patient with known HF exacerbation and
prolonged hospitalization at risk for HAP.
IMPRESSION:
Compared to chest radiographs ___ through ___.
Mild pulmonary edema developed on ___ a and has subsequently improved.
Small pleural effusions remain, including the right fissural component.
Consolidation could be present and obscured but there is no good evidence for
pneumonia. Heart size normal. No pneumothorax.
Left PIC line ends in the mid SVC.
|
19911351-RR-58
| 19,911,351 | 25,037,898 |
RR
| 58 |
2139-03-31 11:29:00
|
2139-03-31 12:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with a PMH of HTN, HLD, HFpEF (EF >60%), LLL partial
lobectomy (___) who presented from OSH w/ mechanical fall causing C2-C7
spinous process fractures, C2-C6 ligamentous complex injury, C4 vertebral
fracture, T5-T6 unstable fracture, bilateral femur fractures, spinal hematoma
now s/p multiple spinal/orthopedic surgeries with course c/b hypotension, HAP,
pleural effusion and respiratory distress.// eval pulmonary edema
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left-sided PICC line projects to the distal SVC. Bilateral effusions left
greater than right are unchanged. Cardiomediastinal silhouette is stable. No
pneumothorax is seen. There is worsening interstitial edema extensive
degenerative changes involving both shoulder joints.
|
19911351-RR-61
| 19,911,351 | 25,037,898 |
RR
| 61 |
2139-03-31 20:24:00
|
2139-03-31 21:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with a PMH of likely HFpEF (EF >60%), LLL partial
___ who presented from OSH w/ mechanical fall causing C2-C7
spinous process fractures, C2-C6 ligamentous complex injury, C4 vertebral
fracture, T5-T6 unstable fracture, bilateral femur fractures, spinal hematoma
now s/p multiple spinal/orthopedic surgeries with course c/b anemia, HAP,
pleural effusion respiratory distress and hypotension. Now with increasing O2
requirement.// Evaluate for possible aspiration PNA vs. edema.
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
IMPRESSION:
The tip of the left PICC line projects over the distal SVC. Bilateral pleural
effusions are again seen and likely not significantly changed. There may
however be increased fluid within the right minor fissure. Interstitial edema
is similar to prior. Atelectasis at both lung bases are present. Superimposed
pneumonia would be hard to exclude in the proper clinical context. The size
and appearance of the cardiomediastinal silhouette is unchanged.
|
19911351-RR-62
| 19,911,351 | 25,037,898 |
RR
| 62 |
2139-04-01 09:03:00
|
2139-04-01 12:12:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with new fevers, leukocytosis, and sepsis, as
well as some nausea/vomiting// ? Evidence of cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 4 mm
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 13.8 cm
KIDNEYS: There is a well-circumscribed, avascular, anechoic lesion at the
right renal pelvis which is likely parapelvic cyst measuring 3.8 x 2.6 x 4.3
cm. There is an exophytic simple renal cyst in the midpole region of the
right kidney which measures 5.1 by 6.2 x 5.9 cm. Limited views of the kidneys
show no hydronephrosis.
Right kidney: 10.9 cm
Left kidney: 11.9 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. The patient is status post cholecystectomy without evidence of biliary
ductal dilatation.
2. Normal liver parenchyma without evidence of suspicious focal hepatic
lesions.
3. Mild splenomegaly measuring up to 13.8 cm.
|
19911351-RR-63
| 19,911,351 | 25,037,898 |
RR
| 63 |
2139-04-02 03:31:00
|
2139-04-02 10:11:00
|
INDICATION: ___ year old man with hypoxemic resp failure, possible hap// ?
interval evolution in effusions and infiltrates
COMPARISON: Radiographs from ___
IMPRESSION:
Spinal hardware is again seen. There are moderate sized bilateral pleural
effusions, stable. Left-sided PICC line has been removed. There has been
mild improvement of the pulmonary edema. There are no pneumothoraces.
|
19911351-RR-64
| 19,911,351 | 25,037,898 |
RR
| 64 |
2139-04-04 17:10:00
|
2139-04-04 17:52:00
|
EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with new picc// Right basilic 43cm picc placed, ?
tip picc position. Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___ at 04:07
IMPRESSION:
Study is limited by multiple external equipment and devices projecting over
the chest.
There has been interval placement of a right upper extremity PICC which
appears to cross the right atrium in terminate in the inferior vena cava.
Retraction by 10 cm is recommended.
There is no focal consolidation or pneumothorax. Small to moderate bilateral
pleural effusions are unchanged. The cardiomediastinal silhouette is stable
in appearance. Mild pulmonary edema is unchanged. There are no acute osseous
abnormalities.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 5:49 pm, 5 minutes
after discovery of the findings.
|
19911351-RR-65
| 19,911,351 | 25,037,898 |
RR
| 65 |
2139-04-04 19:16:00
|
2139-04-04 19:47:00
|
EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with Right PICC reposition//PICC tip location
after retraction Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___ at 17:24.
IMPRESSION:
The right upper extremity PICC has been retracted and now terminates in the
superior vena cava. Otherwise, no significant interval change compared to
most recent prior study from earlier today.
|
19911351-RR-67
| 19,911,351 | 25,037,898 |
RR
| 67 |
2139-04-07 11:34:00
|
2139-04-07 12:38:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with tachypnea and increased work of breathing//
?pulm edema? ?effusions ?consolidation ?pulm edema? ?effusions
?consolidation
IMPRESSION:
Comparison to ___. Improved ventilation of the right lung apex.
However widespread parenchymal opacities, predominating in the right lung base
and in the left perihilar areas, are overall stable. Stable vertebral
fixation devices. Stable size of the cardiac silhouette. No evidence of
pulmonary edema.
|
19911351-RR-70
| 19,911,351 | 25,037,898 |
RR
| 70 |
2139-04-07 16:15:00
|
2139-04-08 13:41:00
|
EXAMINATION: LUMBO-SACRAL SPINE (AP AND LAT)
INDICATION: ___ year old man s/p mechanical fall and c3-t9 fusion; 5 week
post-op check// c3-t9 post op check
IMPRESSION:
No previous images. There is an extensive fusion involving d what appears to
be L4 extending at least to the lower thoracic region. No definite
hardware-related complication, but the absence of a film for comparison makes
assessment difficult. Kyphoplasty material is seen at what appears to be L3
and L4. There is substantial loss of height that was appears to be the T12
vertebral body with retrolisthesis of the superior vertebral body. Severe
diffuse degenerative changes seen.
|
19911351-RR-71
| 19,911,351 | 25,037,898 |
RR
| 71 |
2139-04-07 16:15:00
|
2139-04-08 10:53:00
|
EXAMINATION: Femur radiographs
INDICATION: ___ year old man with mechanical fall s/p b/l ORIF femurs// 5 week
post op ORIF
TECHNIQUE: 10 images of both the right and left femur
COMPARISON: Radiograph ___
FINDINGS:
Left femur: Re-demonstrated comminuted intratrochanteric fracture with
subtrochanteric extension with fixation by intramedullary rod, gamma nail in a
cerclage wire. Alignment is unchanged from ___ and there is
minimally increased mineralization at the fracture margin.
Right femur: Right hip hemiarthroplasty hardware appears stable. Lateral
fixation hardware and cerclage wiring is in unchanged position across a
comminuted obliquely oriented midshaft left femur fracture. There is
increased mineralization of the fracture margin.
IMPRESSION:
Healing bilateral femur fractures status post ORIF.
|
19911351-RR-72
| 19,911,351 | 25,037,898 |
RR
| 72 |
2139-04-07 16:15:00
|
2139-04-07 17:37:00
|
INDICATION: Fall and fractures
TECHNIQUE: Two views of each clavicle
COMPARISON: Note is made of the CT chest dated ___
FINDINGS:
Right clavicle: Again seen is the minimally displaced fracture of the proximal
clavicle. The acromioclavicular joint is preserved with moderate degenerative
change.
Left clavicle: There is a minimally displaced distal clavicle fracture as
before as well as a proximal clavicle fracture which is more difficult to
visualize. The acromioclavicular joint appears preserved.
There are pleural effusions at both lung apices.
|
19911351-RR-73
| 19,911,351 | 25,037,898 |
RR
| 73 |
2139-04-07 16:15:00
|
2139-04-08 10:56:00
|
EXAMINATION: Thoracic and lumbar spine radiographs
INDICATION: ___ year old man s/p mechanical fall and c3-t9 fusion; 5 week
post-op check// c3-t9 post op check
TECHNIQUE: Five views of the thoracic and cervical spine.
COMPARISON: CT ___, radiograph ___
FINDINGS:
Multilevel posterior spinal fusion hardware is intact, but demonstrates mild
bending similar to prior, which is likely postsurgical. 16 mm retrolisthesis
of T5 relative to T6 and 10 mm of retrolisthesis of T11 relative to T12,
appears similar to ___, allowing for differences in modality.
Nondisplaced anterior-inferior vertebral body fracture at C4 appears similar
to ___. Mild widening of the anterior C4-5 disc space is again
seen. Loss of vertebral body height worse in the upper thoracic spine appears
similar to prior. Limited evaluation of additional known fractures. Flowing
anterior osteophytes noted throughout the thoracic and lumbar spine suggesting
possible ankylosing spondylitis.
IMPRESSION:
Vertebral body fractures at C4, T6 and T12 allowing for technical differences
appears similar. Allowing for technical differences and limited assessment
alignment of the thoracic spine with retrolisthesis of T5 relative to T6 and
T11 relative to T12 appears relatively unchanged. Additional fractures not
well seen.
Multilevel flowing osteophytes of the thoracic and lumbar spine suggestive of
ankylosing spondylitis.
|
19911351-RR-74
| 19,911,351 | 25,037,898 |
RR
| 74 |
2139-04-08 10:38:00
|
2139-04-08 15:44:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man s/p mechanical fall with multiple fxs and
prolonged hospital course with worsening dyspnea. Evaluate for PE vs
worsening pleural effusions/pulmonary edema.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 33.4 cm; CTDIvol = 7.7 mGy (Body) DLP = 258.5
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
mGy-cm.
Total DLP (Body) = 261 mGy-cm.
COMPARISON: CTA chest performed ___ and ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
segmental level without filling defect to indicate a pulmonary embolus. The
subsegmental arteries are not well evaluated secondary to respiratory and
spinal hardware artifact. The thoracic aorta is normal in caliber without
evidence of dissection or intramural hematoma. Coronary artery calcifications
are moderate. The main pulmonary artery is top normal in size measuring up to
3.3 cm, previously 3.2 cm (301:120). The right main pulmonary artery measures
2.6 cm in the left main pulmonary artery measures 2.7 cm. No pericardial
effusion is seen. Right-sided central venous catheter terminates at the
superior cavoatrial junction.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Small to moderate right pleural effusion appears increased in
size compared to prior exam and is associated with overlying compressive
atelectasis. Small left pleural effusion with loculated fissural component
does not appear substantially changed. There has been interval removal of a
right pleural drain. No pneumothorax.
LUNGS/AIRWAYS: Evaluation of the lung parenchyma is limited in the setting of
respiratory motion artifact. Within this limitation there is interstitial
thickening slightly improved from prior exam. The airways are patent to the
level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable. There has
been interval removal of an enteric tube compared to ___.
BONES: Again demonstrated is a T5-T6 Chance type fracture which is better
evaluated on prior MR cervical spine dated ___. Posterior spinal
fusion hardware is again seen but incompletely evaluated. Multiple bilateral
rib fractures are again seen, some of which demonstrate interval periosteal
new bone formation indicative of healing. Bilateral clavicular fractures
demonstrate marked callus formation. A midsternal fractures is not
substantially changed.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Interval worsening of small to moderate right pleural effusion and
unchanged appearance of a small left pleural effusion.
3. Slight interval improvement in interstitial pulmonary edema.
4. Stable vertebral, rib, clavicular, and sternal fractures as described
above. Unchanged appearance of the posterior spinal fusion hardware.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 1:25 pm, 5 minutes after
discovery of the findings.
|
19911351-RR-75
| 19,911,351 | 25,037,898 |
RR
| 75 |
2139-04-08 19:08:00
|
2139-04-08 20:45:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with right pleural effusion s/p chest tube//
chest tube placement Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT chest dated ___ from earlier in the day
FINDINGS:
There has been interval placement of a right basal chest tube with interval
decrease in volume of right pleural fluid. A small right apical pneumothorax
is present. Atelectasis is present at the right lung base. A small left
pleural effusion is present with subjacent atelectasis. The size and
appearance of the cardiomediastinal silhouette is unchanged when compared to
___. Extensive spinal hardware is noted. There is a chronic
appearing deformity of the left humeral head. The tip of a right PICC line
projects over the mid SVC.
IMPRESSION:
Small right apical pneumothorax following placement of a right basal chest
tube. Interval decrease in volume of right pleural fluid.
NOTIFICATION: Findings were communicated to and acknowledged by Dr. ___
at 20h43
|
19911351-RR-77
| 19,911,351 | 25,037,898 |
RR
| 77 |
2139-04-09 10:05:00
|
2139-04-09 11:20:00
|
INDICATION: ___ year old man with hypoxia// ?pleural effusion, pulm edema,
pneumothorax
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Right pigtail catheter remains in place and the degree of pneumothorax is
unchanged.
|
19911351-RR-78
| 19,911,351 | 25,037,898 |
RR
| 78 |
2139-04-09 13:56:00
|
2139-04-09 14:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with right pleural effusion s/p chest tube
currently clamped// r/o ptx
IMPRESSION:
In comparison with the earlier study of this date, with the chest tube
clamped, the degree of pneumothorax appears essentially unchanged.
|
19911351-RR-8
| 19,911,351 | 25,037,898 |
RR
| 8 |
2139-02-27 22:48:00
|
2139-02-28 11:14:00
|
EXAMINATION: FEMUR (AP AND LAT) BILAT
INDICATION: ___ year old man with bilateral femur fractures// s/p fall with
bilateral femur fractures from OSH, requested by ortho for surgical planning
TECHNIQUE: 12 views of bilateral femurs.
COMPARISON: CT torso ___
FINDINGS:
Right: Patient is status post right total hip arthroplasty. Hip joint
alignment is congruent. Comminuted periprosthetic fracture is identified in
the proximal to mid femoral diaphysis with varus angulation of the distal
femur. The dominant distal fracture fragment is laterally displaced by
approximately half width of the diaphysis.
Left: Comminuted fracture is identified in the intertrochanteric region and
proximal femoral diaphysis. Multiple butterfly fracture fragments were better
demonstrated on prior CT. The dominant distal femoral fracture fragment is
medially displaced by slightly less than half width of the diaphysis.
IMPRESSION:
1. Comminuted displaced fracture of the right proximal to mid femoral
diaphysis fracture with varus angulation, distal to the femoral stem.
2. Comminuted displaced fracture of the left proximal femoral fracture.
|
19911351-RR-9
| 19,911,351 | 25,037,898 |
RR
| 9 |
2139-02-27 23:51:00
|
2139-02-28 12:31:00
|
EXAMINATION: CHEST (SINGLE VIEW) IN O.R.
INDICATION: ___ year old man with s/p fall// Please evaluate for pneumonia,
effusion, or rib fractures Surg: ___ (Femur fixation) Please evaluate
for pneumonia, effusion, or rib fractures
IMPRESSION:
Read in conjunction with chest torso CT 14:56 on ___.
Lung volumes are low. No focal consolidation or collapse. No pneumothorax or
pleural effusion. Heart size normal.
Although no acute or other chest wall lesion is seen, conventional chest
radiographs are not sufficient for detection or characterization of most such
abnormalities. If the demonstration of trauma or other soft tissue abnormality
involving the chest wall is clinically warranted, the location of any
referable focal findings should be clearly marked and imaged with either bone
detail radiographs or Chest CT scanning.
|
19911351-RR-90
| 19,911,351 | 26,733,842 |
RR
| 90 |
2139-10-01 19:45:00
|
2139-10-02 10:31:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE.
INDICATION: ___ year old man with ankylosing spondylitis, prior c3-T9 fusion
presents from ___ with interval hardware failure// preoperative planning for
___ OR hardware revision. preoperative planning for ___ OR hardware
revision.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed.
COMPARISON: CT whole spine ___.
FINDINGS:
CERVICAL:
The moderate to severe C7 vertebral body compression fracture is unchanged.
There is no retropulsion, however disc protrusion remains unchanged causing
anterior thecal sac deformity, there is no evidence of lesion or abnormal
signal within the spinal cord at this level.
C2-C3: Posterior disc bulge and ligamentum flavum thickening causing mild
spinal canal narrowing. No neural foraminal stenosis.
C3-C4: Posterior disc bulge and ligamentum flavum thickening causing mild
spinal canal narrowing. Mild right neural foraminal narrowing.
C4-C5: Posterior disc bulge and ligamentum flavum thickening causing moderate
spinal canal narrowing. Mild right neural foraminal narrowing.
C5-6: Posterior disc bulge and ligamentum with thickening within mild spinal
canal narrowing and moderate right neural foraminal narrowing.
C6-C7: Posterior disc bulge not causing spinal canal or neural foraminal
stenosis.
C7-T1: Posterior disc bulge indenting the thecal sac, not causing significant
spinal canal or neural foraminal narrowing.
Alignment is normal. There is mild loss of intervertebral disc height at
C5-C6. Vertebral body and intervertebral disc signal intensity otherwise
appear normal.The spinal cord appears normal in caliber and configuration.
There is a fluid collection posterior to the posterior elements of C4 and C5,
in the left side of the neck, measuring 23 mm (SI) x 6.7 mm (AP) x 23 mm (TV).
This may be postoperative in nature and may represent a seroma. Does the
patient have any symptoms or signs of infection?
THORACIC:
Chronic T6 and T12 vertebral body fractures with retropulsion and associated
retrolisthesis T5 on T6 and T11 on T12, appear unchanged. The spinal cord is
deviated at the level of retropulsion at T6, but there is no spinal cord
compression. No definite T2 hyperintensity is identified within the
cord.Vertebral body and intervertebral disc signal intensity appear normal.
There is no evidence of infection or neoplasm. Note is made of a loculated
right pleural effusion, which is chronic.
LUMBAR:
Chronic L2, L3 and L4 vertebral fractures. Vertebroplasty at L3 and L4.
Appearances are unchanged. The spinal cord appears normal in caliber and
configuration, on terminates at L1-L2 level.There is no evidence of infection
or neoplasm.
L1-L2: Diffuse disc bulge causing mild spinal canal narrowing. No neural
foraminal narrowing.
L2-L3: Diffuse disc bulge causing mild spinal canal narrowing. No neural
foraminal narrowing.
L3-L4: Central disc/posterior osteophyte causing mild-to-moderate spinal canal
narrowing. Bilateral facet joint arthropathy causing moderate bilateral
neural foraminal narrowing.
L4-L5: Posterior osteophyte and ligamentum flavum thickening causing moderate
spinal canal narrowing. In association with bilateral facet joint arthropathy
there is bilateral neural foraminal narrowing, moderate on the right and mild
on the left.
L5-S1: Diffuse disc bulge causing mild spinal canal narrowing. There is no
significant neural foraminal narrowing.
OTHER: There is a 1.8 cm right adrenal mass, which is not fully characterized
on this MRI and may represent an adrenal adenoma. Note is made of bilateral
simple renal cysts.
IMPRESSION:
1. Chronic T6 vertebral body fracture with retropulsion associated
retrolisthesis of T5 and T6, with deviation of the cord at this level but no
frank evidence of cord compression, there is persistent CSF fluid surrounding
the cord at the level of the retropulsion.
2. No change compared with previous, post spinal fusion.
3. Fluid collection noted in the left posterior neck posterior to C4 and C5.
This may represent a postoperative seroma. Does the patient have any symptoms
or signs of infection?
|
19911351-RR-91
| 19,911,351 | 26,733,842 |
RR
| 91 |
2139-10-02 13:36:00
|
2139-10-02 14:09:00
|
EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ year old man with c3-t9 fusion, ankylosing spondylitis, HTN,
HLD, now failure of cervical hardware.// Preop for cervical hardware removal,
exploration of wound. Surg: ___ (cervical removal of hardware, wound
exploration)
IMPRESSION:
In comparison with the study of ___, there is little overall change and
no evidence of acute pneumonia. In extensive cervical, thoracic, and lumbar
hardware remain in place.
|
19911351-RR-92
| 19,911,351 | 26,733,842 |
RR
| 92 |
2139-10-05 19:00:00
|
2139-10-05 19:48:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with tachycardia and new cough// Rule out
pneumonia
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
IMPRESSION:
Low lung volumes are noted. There are small bilateral pleural effusions. No
focal consolidation or pneumothorax is identified. The cardiomediastinal
silhouette is stable in appearance. There is no pulmonary edema. Spinal
hardware and osseous structures are unchanged in appearance.
|
19911351-RR-93
| 19,911,351 | 26,733,842 |
RR
| 93 |
2139-10-06 11:08:00
|
2139-10-06 12:42:00
|
EXAMINATION: CTA CHEST ___
INDICATION: ___ year old man hx of prior C3-T9 fusion, T6 laminectomy presents
with hardware failure. patient with persistent tachycardia, chest pain, and
desaturation, concern for PE// Evaluate for PE
TECHNIQUE:
Axial multidetector CT images were obtained through the thorax after the
uneventful administration of intravenous contrast. Reformatted coronal,
sagittal, thin slice axial images, and oblique maximal intensity projection
images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 33.2 cm; CTDIvol = 13.4 mGy (Body) DLP = 443.2
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
4) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.2 mGy (Body) DLP =
11.6 mGy-cm.
Total DLP (Body) = 458 mGy-cm.
COMPARISON:
Chest CTA ___
FINDINGS:
CHEST PERIMETER: No incidental thyroid findings. No supraclavicular or left
axillary adenopathy. There may be a new 13 mm right subpectoral lymph node.
301:107. No other soft tissue abnormalities in the chest wall. This study is
not appropriate for subdiaphragmatic diagnosis but shows no subphrenic
collection or adrenal mass.
CARDIO-MEDIASTINUM: Esophagus is unremarkable. Atherosclerotic calcification
mild in head and neck vessels, is heavy in at least left anterior descending
coronary artery. Minimally calcified ascending thoracic aorta normal caliber.
Pericardium is physiologic.
PULMONARY ARTERIES:
Pulmonary arteries are enlarged, main 35 mm, right 29 mm, previously 34 mm and
31 mm. No pulmonary emboli to the segmental level.
THORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged
or growing.
LUNGS, AIRWAYS, PLEURAE: Moderate, right and small left, generally dependent
nonhemorrhagic pleural effusions, including the right fissural component are
comparable in volume to that on ___. No pleural mass or hematoma.
Moderate atelectasis, posterior segment right upper lobe and severe
atelectasis right basal lower lobe segments unchanged. No bronchial
obstruction.
CHEST CAGE: No interval change except for slight progression of callus
formation in multiple healing fractures of the chest cage. No new fractures
or evidence of chest wall infection. No migration of stabilized thoracic
spine trauma or hardware.
IMPRESSION:
No pulmonary embolism. Chronic pulmonary hypertension.
Moderate right and small left pleural effusions stable or recurrent.
Stable atelectasis, moderate, right upper and severe, right lower lobes.
|
19911519-RR-19
| 19,911,519 | 27,636,003 |
RR
| 19 |
2160-01-02 14:45:00
|
2160-01-02 16:19:00
|
INDICATION: ___ female with lethargy. Evaluate for evidence of acute
cardiopulmonary process.
COMPARISONS: None available.
TECHNIQUE: Upright AP and lateral chest radiographs.
FINDINGS: Lungs are well expanded and clear. Cardiomediastinal and hilar
contours are unremarkable. There is no pleural effusion or pneumothorax. Of
note, degenerative changes of the right AC joint are noted.
IMPRESSION: No evidence of acute cardiopulmonary process.
|
19911519-RR-20
| 19,911,519 | 27,636,003 |
RR
| 20 |
2160-01-02 14:27:00
|
2160-01-02 18:39:00
|
INDICATION: ___ woman with hyperglycemia and altered mental status.
COMPARISON: None at this institution.
TECHNIQUE: Contiguous axial MDCT data were acquired through the head without
intravenous contrast.
FINDINGS: No hemorrhage, major vascular territorial infarction, edema, mass,
or shift of normally midline structures is present. Prominence of the
ventricles and sulci is consistent with cortical atrophy. Moderate
periventricular and subcortical hypodensities are consistent with small vessel
ischemic changes. Minimal basal ganglia calcifications are noted. The
visualized paranasal sinuses and mastoid air cells are clear.
IMPRESSION: No acute intracranial process. Moderate sequela of small vessel
ischemic disease.
|
19911542-RR-49
| 19,911,542 | 20,158,711 |
RR
| 49 |
2131-09-24 16:25:00
|
2131-09-24 16:43:00
|
HISTORY: Shortness of breath.
TECHNIQUE: Upright AP view of the chest.
COMPARISON: ___.
FINDINGS:
Heart size likely is moderately enlarged but difficult to assess given the
presence of moderate bilateral pleural effusions, increased from the prior
exam. Bibasilar airspace opacities may reflect compressive atelectasis.
There is mild to moderate pulmonary edema. No pneumothorax is identified.
There are no acute osseous abnormalities.
IMPRESSION:
Moderate congestive heart failure with moderate size bilateral pleural
effusions, bibasilar atelectasis, mild to moderate pulmonary edema.
|
19911542-RR-50
| 19,911,542 | 20,158,711 |
RR
| 50 |
2131-09-27 14:15:00
|
2131-09-27 15:07:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ man with aortic stenosis and CHF. Evaluate
pleural effusions.
FINDINGS: Comparison is made to the prior study from ___.
There is again seen moderate congestive heart failure with increased vascular
cephalization, stable. There are large bilateral pleural effusions but
decreased since previous. There is cardiomegaly. No pneumothoraces are
identified. Calcifications of thoracic aorta are present.
|
19911629-RR-15
| 19,911,629 | 22,262,825 |
RR
| 15 |
2123-08-24 04:14:00
|
2123-08-24 04:53:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with AMS< fever// eval for ICH
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
Mild mucosal thickening of bilateral maxillary sinuses and moderate thickening
of the bilateral anterior ethmoid air cells. The remaining imaged paranasal
sinuses are clear. Mastoid air cells and middle ear cavities are well aerated.
The bony calvarium is intact.
IMPRESSION:
-No acute intracranial abnormality on noncontrast head CT. Specifically no
intracranial hemorrhage or large territory infarct.
-Moderate mucosal thickening of the anterior ethmoid air cells and mild
mucosal thickening of the maxillary sinuses.
|
19911969-RR-17
| 19,911,969 | 26,326,405 |
RR
| 17 |
2154-06-07 02:38:00
|
2154-06-07 04:28:00
|
INDICATION: +PO contrast; History: ___ with recent colonic resection and
anastomosis, now with peritonitis on exam, needs gastrografin PO+PO contrast
// abscess? peritonitis? perforation?
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 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
2) Spiral Acquisition 4.7 s, 51.0 cm; CTDIvol = 7.6 mGy (Body) DLP = 387.4
mGy-cm.
Total DLP (Body) = 395 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis. No pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Multiple hypodensities are seen within the liver some of which measure fluid
density consistent with cysts. Others are too small to characterize by CT
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder there is cholecystitis. There is possible gallbladder wall edema.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The patient is
status post right hemicolectomy with anastomosis in the right upper quadrant.
The anastomosis appears intact. There is no extraluminal air or fluid to
suggest leak.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no
evidence of adnexal abnormality bilaterally.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No free air or extraluminal fluid to suggest leak.
2. Cholelithiasis with possible mild gallbladder wall edema. If there is
clinical concern for cholecystitis this could be further evaluated with right
upper quadrant ultrasound.
|
19911969-RR-18
| 19,911,969 | 26,326,405 |
RR
| 18 |
2154-06-07 06:53:00
|
2154-06-07 08:20:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ tenderness // cholecystitis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. Multiple cysts are seen in the liver including 1 in the left
lobe measuring 2.1 cm and 1 in the right lobe measuring 1.7 cm. There is no
focal liver mass. The main portal vein is patent with hepatopetal flow. There
is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening. Sonographic
___ sign was negative.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 9.7 cm.
IMPRESSION:
Cholelithiasis without evidence of acute cholecystitis.
|
19912242-RR-14
| 19,912,242 | 20,940,637 |
RR
| 14 |
2169-01-03 06:04:00
|
2169-01-03 06:50:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with choledocholithiasis p/w concern for cholangitis
// Eval for stone
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRI of the abdomen dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. Several calcified hepatic granulomas are seen. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is mild central intrahepatic biliary dilation. The CHD
measures 9 mm.
GALLBLADDER: Layering sludge and stones are seen within the gallbladder,
without evidence of gallbladder-wall thickening or pericholecystic fluid.
Sludge also appears to be layering within the common hepatic duct.
PANCREAS: The imaged portion the pancreas appears somewhat echogenic, without
focal mass. Pancreatic duct is mildly dilated, similar to prior, measuring
approximately 5 mm.
SPLEEN: Normal echogenicity, measuring 11.3 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Gallbladder contains layering sludge and stones, without evidence of
gallbladder-wall thickening or pericholecystic fluid. Sludge also appears to
be layering within the common hepatic duct.
2. Mild central intrahepatic biliary ductal dilatation and extrahepatic
biliary ductal dilatation, as well as mild dilatation of the pancreatic duct.
|
19912242-RR-15
| 19,912,242 | 20,940,637 |
RR
| 15 |
2169-01-03 14:35:00
|
2169-01-03 14:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sepsis // ? PNA, source of infection ?
PNA, source of infection
IMPRESSION:
In comparison with the study of ___ T11, there is little overall change.
Cardiac silhouette is within normal limits and there is mild tortuosity of the
descending aorta. Mild prominence of interstitial markings that could reflect
chronic pulmonary disease. No acute pneumonia or vascular congestion or
pleural effusion.
|
19912242-RR-16
| 19,912,242 | 20,940,637 |
RR
| 16 |
2169-01-03 19:36:00
|
2169-01-03 23:36:00
|
EXAMINATION: MRCP
INDICATION: ___ year old gentleman with history of HTN, OSA, s/p roux en y and
recent diagnosis of choledocholithiasis s/p incomplete ERCP presenting with
fevers, chills, and hypotension concerning for cholangitis // Eval for
cholangitis
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 8 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MRI abdomen ___
FINDINGS:
Lower Thorax: Unremarkable. No pleural or pericardial effusion.
Liver: There is mild hepatic steatosis. There is an accessory left hepatic
artery arising from the left gastric. There is a replaced right hepatic
artery which extends directly off the celiac axis. There is a focal segment
of the right hepatic vein which is thrombosed, new from prior MRI. In the
left lobe of the liver there is an 8 mm T2 hyperintense structure with no post
contrast enhancement compatible with a hepatic cyst. An additional hepatic
cyst is seen measuring 1.4 x 1.1 cm.
Biliary: The gallbladder demonstrates dependent stones and/or sludge. The
common bile duct is mildly enlarged measuring 9 mm. There is mild
intrahepatic biliary ductal dilatation. No intraductal filling defects are
seen. There is increased enhancement of the wall of the cystic duct and to a
lesser degree of the CBD. There is no include enhancement of the common
hepatic duct wall or the walls of the intrahepatic ducts.
Pancreas: There is dilation of the pancreas duct at the pancreatic head up to
6 mm, unchanged from prior exam. There is fatty replacement of the pancreas.
No definite peripancreatic inflammatory changes are seen.
Spleen: Normal in size and signal intensity.
Adrenal Glands: Symmetric in size and normal in signal intensity.
Kidneys: The kidneys enhance symmetrically. There is no focal lesion. There
is no hydronephrosis.
Gastrointestinal Tract: Visualized portions of the gastrointestinal tract
appear within normal limits.
Lymph Nodes: Prominent lymph nodes in the porta hepatis may be reactive.
Vasculature: Unremarkable. No abdominal aortic aneurysm.
Osseous and Soft Tissue Structures: No suspicious osseous lesion. The
visualized subcutaneous soft tissues appear unremarkable.
IMPRESSION:
1. No intraductal filling defects to indicate choledocholithiasis.
2. Increased enhancement of the wall of the cystic duct and to a lesser degree
the CBD without intrahepatic ductal wall enhancement, suggests a component of
cholangitis. Sludge/stones within the gallbladder without evidence of acute
cholecystitis.
|
19912242-RR-17
| 19,912,242 | 20,940,637 |
RR
| 17 |
2169-01-04 08:04:00
|
2169-01-04 09:09:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with bacteremia, R sided mild facial droop, fever
// r/o septic emboli/CVA; non-con only given ___
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 45.5 mGy (Head) DLP =
855.5 mGy-cm.
Total DLP (Head) = 856 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration. No osseous abnormalities seen.
The paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
The orbits are unremarkable. Vascular calcifications are prominent in keeping
with history of renal disease.
IMPRESSION:
No of hemorrhage or infarction. Please note, MRI would be significantly more
sensitive.
|
19912242-RR-18
| 19,912,242 | 20,940,637 |
RR
| 18 |
2169-01-04 07:45:00
|
2169-01-04 11:02:00
|
INDICATION: ___ year old man with GNR bacteremia, dyspnea. // ?PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Pulmonary hyperinflation. The heart size normal. Mild unfolding of the
aorta. Mild prominence of the main pulmonary artery and right interlobar
artery which suggest pulmonary hypertension. No airspace consolidation. No
suspicious pulmonary nodules or masses. Spondylotic changes of the thoracic
spine.
IMPRESSION:
No airspace consolidation to suggest pneumonia.
Pulmonary hyperinflation suggesting COPD.
Mild prominence of the main pulmonary artery and right interlobar pulmonary
artery may be in keeping with pulmonary hypertension.
|
19912242-RR-19
| 19,912,242 | 20,940,637 |
RR
| 19 |
2169-01-04 11:35:00
|
2169-01-04 16:04:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___
INDICATION: ___ year old man with GNR bacteremia, presenting with diplopia and
possible L-sided facial asymmetry. CT head negative. // ?stroke
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
Dynamic MRA of the neck was performed during administration of 17 mL of
Multihance intravenous contrast.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: None.
FINDINGS:
MRI BRAIN:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are mildly enlarged in an atrophic
pattern. There is no abnormal enhancement after contrast administration.
There is scattered white matter hyperintensity on the FLAIR images of doubtful
clinical significance. This is often attributed to mild chronic small vessel
ischemia.
MRA BRAIN:
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis, occlusion, or aneurysm
formation.
MRA NECK:
There is mild atherosclerotic dilatation at the origin of the right internal
carotid artery. Otherwise, the common, internal and external carotid arteries
appear normal. There is no evidence of internal carotid artery stenosis by
NASCET criteria. The origins of the great vessels, subclavian and vertebral
arteries appear normal bilaterally.
IMPRESSION:
1. Mild atrophy and white matter hyperintensity on FLAIR. Otherwise normal
study.
2. No evidence of hemorrhage or infarction.
3. No evidence of vascular occlusion or stenosis.
4. Mild dilatation of the proximal right internal carotid artery, likely due
to atheromatous disease.
|
19912403-RR-33
| 19,912,403 | 27,781,958 |
RR
| 33 |
2169-11-23 09:42:00
|
2169-11-23 11:36:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: History: ___ with hx NMO, concern for CVA.// CVA?.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque350 intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 4.9 s, 38.9 cm; CTDIvol = 30.9 mGy (Head) DLP =
1,201.9 mGy-cm.
Total DLP (Head) = 2,026 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of infarction, hemorrhage, edema, or mass.
The ventricles and sulci are normal in size and configuration. Periventricular
white matter hypodensities are suggestive of small vessel ischemic disease.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
The carotid and vertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria. Atherosclerotic calcifications of the right
carotid bulb are seen without evidence of stenosis.
OTHER:
There is minimal dependent atelectasis in the lungs bilaterally. There is
pleural scarring in the right upper lobe of the lung. There is a 0.9 cm nodule
in the right lobe of the thyroid with peripheral calcifications and slightly
heterogeneous for which further evaluation with ultrasound is recommended.
There is no lymphadenopathy by CT size criteria. Mild multilevel degenerative
changes are visualized throughout the cervical spine.
IMPRESSION:
1. Normal head and neck CTA.
2. 9 mm peripherally calcified nodule in the right lobe of the thyroid.
RECOMMENDATION(S): Impression 2. Correlation with thyroid ultrasound is
recommended.
|
19912403-RR-34
| 19,912,403 | 27,781,958 |
RR
| 34 |
2169-11-23 12:25:00
|
2169-11-23 15:21:00
|
EXAMINATION: STROKE PROTOCOL (BRAIN W/O).
INDICATION: History: ___ with left sided weakness, hx NMO.// CVA?.
TECHNIQUE: Sagittal T1, axial FLAIR, axial T2, axial magnetic susceptibility
and axial diffusion-weighted images were obtained through the brain. No
contrast was administered.
COMPARISON: CTA of the head and neck dated ___, prior MRI of the head
dated ___.
FINDINGS:
There is no evidence of intracranial hemorrhage, mass, mass effect or shifting
of the normally midline structures. The ventricles and sulci are slightly
prominent, likely age related and involutional in nature. Periventricular and
subcortical scattered areas of high-signal intensity are seen on FLAIR and T2
weighted images, which are nonspecific and may reflect changes due to small
vessel disease. No diffusion abnormalities are detected. Punctate focus of
susceptibility is identified in the midline (image 16, series 11), consistent
with dural calcification as demonstrated on the concurrent head CTA. The
major vascular flow voids are present and demonstrate normal distribution.
The orbits are unremarkable, the paranasal sinuses and the mastoid air cells
are clear.
IMPRESSION:
1. There is no evidence of acute intracranial process hemorrhage or diffusion
abnormalities to indicate acute/subacute ischemic changes.
2. Scattered foci of high signal intensity identified on FLAIR and T2
weighted images, distributed in the subcortical white matter, which are
nonspecific and may reflect changes due to small vessel disease.
|
19912403-RR-36
| 19,912,403 | 27,781,958 |
RR
| 36 |
2169-11-24 01:35:00
|
2169-11-24 10:15:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with NMO presents with L sided weakness// ?NMO
flare
TECHNIQUE: Sagittal 3D FLAIR, axial T1 pre contrast turbo spin echo sequences
the head. Following administration of 7 cc IV Gadavist, sagittal MP-RAGE and
axial T1 turbo spin echo postcontrast images performed. Coronal and axial
reformats of 3D FLAIR and MP-RAGE sequences performed.
COMPARISON: MRI noncontrast head of ___ and MRI head with without
contrast of ___.
FINDINGS:
Please note, only 3D FLAIR and T1 pre and postcontrast sequences were
obtained.
Re-identified are subcortical and periventricular FLAIR white matter
hyperintensities, unchanged from examination of ___, and progressed
from examination of ___. The ventricles sulci and cisterns are within
expected limits for the patient's mild senescent related global cerebral
volume loss. No abnormal postcontrast enhancement is identified. The dural
venous sinuses are patent on postcontrast MP rage. Mild mucosal thickening of
the ethmoid air cells and inferior frontal sinuses is noted.
IMPRESSION:
1. No evidence of abnormal enhancement to suggest active process.
2. Please refer to MRI head without contrast of ___ for additional
details.
|
19912403-RR-37
| 19,912,403 | 27,781,958 |
RR
| 37 |
2169-11-24 02:07:00
|
2169-11-24 09:55:00
|
EXAMINATION: MR ___ SCAN WITH CONTRAST T___ MR ___ SPINE
INDICATION: ___ year old woman with NMO presents with L sided weakness// ?NMO
flaire
TECHNIQUE: Sagittal postcontrast imaging was performed with T2, T1, and STIR
technique. Axial T2 and T1 postcontrast imaging were next performed. 7 cc IV
Gadavist administered.
COMPARISON: MRI brain without contrast of ___, MRI head with without
contrast of ___, MRI cervical, thoracic and lumbar spine of ___.
FINDINGS:
New from prior examination of ___ is T2 hyperintense central cord the signal
with associated cord expansion extending from the cervicomedullary junction to
the to C5 vertebral level. There is 2.0 x 0.6 x 0.4 cm (SI, AP, TRV)
enhancement along the left aspect of the cord at the C2 level. Subtle T2
hyperintense nonenhancing signal of the T2 cord corresponds to prior lesion
described on examination of ___, significantly improved in size, with
associated mild cord volume loss. The visualized posterior fossa is otherwise
grossly unremarkable.
Cervical alignment is anatomic. Vertebral body heights are preserved. There
is no focal suspicious marrow lesion on STIR sequences. Degenerative loss of
disc height and signal is mild at C3-C4 and C4-C5.
C2-C3: A small central protrusion does not narrow the spinal canal. There is
no significant neural foraminal narrowing.
C3-C4: A small central protrusion and thickening ligamentum flavum results in
mild spinal canal narrowing. Uncovertebral and facet arthropathy results in
mild bilateral neural foraminal narrowing.
C4-C5: There is no significant spinal canal narrowing. Uncovertebral and
facet arthropathy results in mild left and no significant right neural
foraminal narrowing.
C5-C6: There is no significant spinal canal or neural foraminal narrowing.
Uncovertebral facet arthropathy results in mild bilateral neural foraminal
narrowing.
C6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.
Incidental note is made of a 4 mm right lobe of the thyroid T2 hyperintense
nodule, for which no further evaluation is suggested by current ACR
recommendations for incidentally noted thyroid nodules. Otherwise,
prevertebral and paraspinal soft tissues are unremarkable.
IMPRESSION:
1. T2 hyperintense central cord signal with expansion of the cord spanning the
cervicomedullary junction to the C5 level, with enhancement along the left
aspect of the C2 level. The findings are overall compatible with NMO given
prior history.
2. Subtle T2 hyperintense signal of the T2 cord with associated mild volume
loss corresponding to lesion described on prior examination of ___.
3. Additional findings as described above.
|
19912403-RR-38
| 19,912,403 | 27,781,958 |
RR
| 38 |
2169-11-24 19:00:00
|
2169-11-24 20:18:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with L sided weakness, r/o infection for
recrudescence of symptoms// ?PNA
TECHNIQUE: Chest two views
COMPARISON: ___
FINDINGS:
Borderline heart size, pulmonary vascularity. Right medial basilar opacities
new since prior, may represent pneumonia or atelectasis. Left lung is clear.
Trace left effusion.
IMPRESSION:
New medial right basilar opacity, may represent atelectasis or pneumonia.
Trace left pleural effusion.
|
19912403-RR-39
| 19,912,403 | 27,781,958 |
RR
| 39 |
2169-11-26 10:40:00
|
2169-11-26 13:05:00
|
INDICATION: ___ year old woman with NMO, admitted with NMO flare.// Please
place tunneled double lumen pheresis line. ___ aware.
COMPARISON: Chest x-ray dated ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 20 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
with and without epinephrine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: As above.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.6 min, 11 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 neck and upper chest were prepped and
draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a 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 19 cm tip-to-cuff length dual-lumen DuraFlow HD 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. ___ Vicryl sutures 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 right internal jugular vein. Final fluoroscopic image showing 19 cm
tip-to-cuff length dual-lumen DuraFlow HD catheter with tip terminating in the
right atrium.
IMPRESSION:
Successful placement of a 19 cm tip-to-cuff length dual-lumen DuraFlow HD
tunneled catheter serving as a pheresis catheter. The tip of the catheter
terminates in the right atrium. The catheter is ready for use.
|
19912403-RR-40
| 19,912,403 | 27,781,958 |
RR
| 40 |
2169-12-04 11:10:00
|
2169-12-04 11:42:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with rising LFTs and INR. undergoing
plasmapheresis// rising LFTs and INR, ? liver pathology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears mildly echogenic. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 2 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears unremarkable. The distal
pancreas is obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 9.5 cm.
KIDNEYS: Left kidney measures 9.5 cm and. Right kidney measures 9.9 cm in
length. Limited views of the bilateral kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Echogenic liver likely due to steatosis. Other forms of liver disease and
more advanced liver disease including steatohepatitis or significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
|
19912403-RR-41
| 19,912,403 | 27,781,958 |
RR
| 41 |
2169-12-07 10:45:00
|
2169-12-07 11:19:00
|
INDICATION: ___ year old woman with NMO s/p plasma pharesis// removal of line
COMPARISON: Tunneled pheresis line placement from ___
TECHNIQUE: OPERATORS: Dr. ___ (radiology resident) and Dr. ___
___ (interventional radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the
procedure.
ANESTHESIA: None
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: None
PROCEDURE: 1. Right chest tunneled pheresis catheter removal.
PROCEDURE DETAILS: The procedure was performed at bedside. The Right chest
tunneled line site was cleaned and draped in standard sterile fashion. 1%
lidocaine was administered around the tube track. The cuff was loosened with a
bent forceps. The catheter was removed with gentle traction while manual
pressure was held at the venotomy site. Hemostasis was achieved after 5 min of
manual pressure. A clean sterile dressing was applied. The patient tolerated
the procedure well. There were no immediate postprocedural complications.
FINDINGS:
Expected appearance after tunneled line removal.
IMPRESSION:
Successful removal of a right chest tunneled line.
|
19912403-RR-42
| 19,912,403 | 29,695,735 |
RR
| 42 |
2170-09-15 17:00:00
|
2170-09-15 18:15:00
|
INDICATION: ___ year old woman with NMO// double lumen temporary double lumen
pheresis line with VIP port for emergent procedure today, pt is in ED to be
admitted to undetermined unit, spoke with ___
COMPARISON: ___
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___,
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Sedation was provided by administrating divided doses of 75 mcg of
fentanyl. The patient's hemodynamic parameters were continuously monitored by
an independent trained radiology nurse. 1% lidocaine was injected in the skin
and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, lidocaine
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: 0.3 min, 1 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 neck 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 into the IVC.
After sequential dilation of the soft tissue tract using 12 ___ and 14
___ dilators, a double lumen 14 ___ pheresis catheter was advanced over
the wire into the superior vena cava with the tip in the distal SVC. Both
access ports were aspirated, flushed and capped. The catheter was secured to
the skin with a 0 silk suture and sterile dressings were applied. Final spot
fluoroscopic image demonstrating good alignment of the catheter and no
kinking.
The patient tolerated the procedure well without immediate complications.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing double
lumen temporary pheresis catheter with catheter tip terminating in the distal
superior vena cava.
IMPRESSION:
Successful placement of a right internal jugular approach double lumen
temporary pheresis catheter. The line is ready to use.
|
19912537-RR-20
| 19,912,537 | 29,825,378 |
RR
| 20 |
2161-02-22 14:35:00
|
2161-02-22 16:11:00
|
EXAMINATION: Chest radiographs.
INDICATION: Hemoptysis.
COMPARISON: None.
TECHNIQUE: Chest, PA and lateral.
FINDINGS:
The heart is normal in size. The mediastinal and hilar contours appear within
normal limits. The chest is hyperinflated. There is no pleural effusion or
pneumothorax. The lungs appear clear. Mild degenerative changes are noted
along the mid through lower thoracic spine.
IMPRESSION:
No evidence of acute cardiopulmonary disease.
|
19912537-RR-21
| 19,912,537 | 29,825,378 |
RR
| 21 |
2161-02-22 16:17:00
|
2161-02-27 17:41:00
|
EXAMINATION: Chest radiograph.
INDICATION: Status post endotracheal intubation.
COMPARISON: Earlier on the same day.
TECHNIQUE: Chest, portable AP.
FINDINGS:
The patient has been intubated. The endotracheal tube closely approaches the
carinal within about 1 cm. An orogastric tube passes into the stomach on and
terminates there. The cardiac, mediastinal and hilar contours appear stable.
The lung volumes are decreased with patchy left basilar opacity which is
probably due to atelectasis.
IMPRESSION:
Status post endotracheal intubation. Low-lying endotracheal tube, although at
the time of this dictation, it had already been retracted on a subsequent
film. Left basilar opacity, probably due to atelectasis. Attention in
follow-up is suggested.
|
19912537-RR-22
| 19,912,537 | 29,825,378 |
RR
| 22 |
2161-02-22 17:23:00
|
2161-02-22 19:00:00
|
EXAMINATION: CTA CHEST AND CT ABDOMEN AND PELVIS
INDICATION: ___ with upper GI bleeding, high volume. Eval for active
bleeding
TECHNIQUE: MDCT images were obtained through the torso, initially without
contrast, and subsequently in the arterial phase after administration of IV
Omnipaque contrast. Axial images were interpreted in conjunction with
coronal, sagittal, and MIP reformats.
DLP: ___ MGy-cm
COMPARISON: None.
FINDINGS:
CTA TORSO:
Mild aortic ectasia noted. The thoracic and abdominal aorta are otherwise
normal in caliber and without evidence of aneurysm or dissection.The celiac
axis, SMA, bilateral renal arteries, and ___ are grossly patent.
Atherosclerotic calcified and noncalcified mural calcifications are seen
throughout the aorta and its major branches. The hepatic arterial anatomy is
conventional. No active arterial extravasation within the chest, abdomen, or
pelvis.
CHEST:
The thyroid is normal.No axillary, supraclavicular, mediastinal, or hilar
lymph node enlargement. The heart and mediastinum are normal. Trace
pericardial effusion.Right mainstem bronchus intubation. The airways are
patent to the subsegmental levels. Ill-defined solid and ground-glass opacity
within the right lower lobe is consistent with pneumonia. (4a: 38). No active
arterial extravasation. A 0.8 x 0.5 cm (4a: 44) solid appearing nodule is seen
within the left lower lobe. Nodularity in the RML on series 4a:41 likely
represents scarring though given the change in density on CTA which follows
blood pool, the possibility of a tiny aneurysm or AVM is considered. There
are no adjacent bronchi which appear to communicate with this nodular lesion.
Bibasilar atelectasis is noted. No pleural effusion or pneumothorax.
ABDOMEN:
Multiple arterially enhancing lesions are noted throughout the liver largest
measuring 2.4 x 2.1 cm (4a: 52) within segment 8 which is hypodense on portal
venous phase. Additional hepatic lesions demonstrate discontinuous peripheral
filling most consistent with hemangiomas. The portal vein, SMA, and splenic
vein are patent. No intra or extrahepatic biliary dilatation. The gallbladder,
pancreas, and bilateral adrenal glands are normal.A 2.3 x 2.1 cm (4b: 250)
hypodense lesion with discontinuous peripheral enhancement is most consistent
with a splenic hemangioma. The kidneys enhance symmetrically. A 1.5 x 1.2 cm
(4 b: 258) hypodensity within the interpolar region of the left kidney is
intermediate in density. Additional subcentimeter hypodensities are seen
within the left kidney, too small to characterize.
The stomach is grossly unremarkable in appearance.The small and large bowel
are normal in caliber and without evidence of wall thickening. The appendix is
not visualized however no evidence acute appendicitis. Colonic diverticulosis
is present without evidence of diverticulitis. No retroperitoneal or
mesenteric lymph node enlargement by CT size criteria.No free abdominal fluid,
abdominal wall hernia, or pneumoperitoneum.
PELVIS:
The bladder is unremarkable with air from recent Foley catheter placement. No
pelvic side-wall or inguinal lymph node enlargement.No free pelvic fluid is
identified.
OSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen
within the visualized thoracolumbar spine. No focal lytic or sclerotic lesion
concerning for malignancy.
IMPRESSION:
1. Right mainstem bronchus intubation. Retraction by at least 3 cm is
advised.
2. No arterial extravasation within the chest, abdomen, or pelvis.
3. Right lower lobe opacity most consistent with pneumonia.
4. 0.8 cm solid-appearing nodule within left lower lobe is likely
inflammatory in nature. Followup in ___ months is recommended
5. Right middle lobe nodule could represent scarring however given history of
hemoptysis differential includes tiny aneurysm or AVM. Considering causes of
hemoptysis pneumonia is likely the etiology rather then the RML lesion given
absence of bronchial involvement. Recommend short interval followup
6. Trace pericardial effusion.
7. Multiple hepatic and splenic hemangiomas.
8. Renal hypodensities, too small to characterize.
9. Diverticulosis without evidence of acute diverticulitis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 9:40PM ___, 5 minutes after
discovery of updated findings.
|
19912537-RR-23
| 19,912,537 | 29,825,378 |
RR
| 23 |
2161-02-22 22:13:00
|
2161-02-23 07:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hematemesis and right mainstem bronchus
intubation s/p 3cm retraction. // Please eval for ET tube placement.
COMPARISON: ___
IMPRESSION:
As compared to the previous image, the endotracheal tube has been pulled back.
The tip of the tube now projects approximately 2.3 cm above the carinal. The
course of the nasogastric tube is unchanged. The lung volumes remain low.
There is left and right basilar atelectasis but no larger pleural effusions
and no evidence of pneumonia or pulmonary edema.
|
19912537-RR-25
| 19,912,537 | 29,825,378 |
RR
| 25 |
2161-02-24 16:30:00
|
2161-02-24 16:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hematemesis s/p intubation // eval ETT
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
ET tube tip is 4.5 cm above the carinal. Heart size and mediastinum are
unchanged. Bibasal consolidations have increased in the interim.
|
19912537-RR-26
| 19,912,537 | 29,825,378 |
RR
| 26 |
2161-02-25 05:14:00
|
2161-02-25 09:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ intubated // Evaluate for interval change
IMPRESSION:
Allowing for differences in technique and positioning, there has been little
interval change in the appearance of the chest since the recent study of 1 day
earlier, except for slight worsening of bibasilar atelectasis.
|
19912537-RR-27
| 19,912,537 | 29,825,378 |
RR
| 27 |
2161-02-25 13:49:00
|
2161-02-25 14:51:00
|
INDICATION: new R PICC // 35cm R basilic DL PICC - ___ ___ Contact
name: ___: ___
FINDINGS:
Right PICC terminates just below the expected junction of the superior vena
cava and right atrium. Exam is otherwise similar to the prior study except
for improving right lower lobe and slight worsening left retrocardiac
atelectasis.
|
19912537-RR-28
| 19,912,537 | 29,825,378 |
RR
| 28 |
2161-02-28 19:16:00
|
2161-02-28 20:15:00
|
EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS)
INDICATION: ___ year old woman with ?hematemesis, no GI source on EGD, noted
to have mass at base of tongue
TECHNIQUE: Routine enhanced CT study of the neck was performed with images
obtained from the skull base to the thoracic inlet. Sagittal and coronal
reconstructions were performed.
DOSE: DLP: 391 mGy-cm; CTDI: 13 mGy
COMPARISON: CTA chest and abdomen dated ___.
FINDINGS:
At the base of the tongue to the right of the midline and extending into the
right vallecula, there is a 1.2 x 0.7 cm centrally hypodense peripherally
hyperdense focus with rim calcification seen. This appears well circumscribed
and without local extension. Degree of enhancement is difficult to assess in
the absence of a non contrast study.
The aerodigestive tract is otherwise unremarkable. Airways are patent.
Evaluation of the cervical lymph chains demonstrate no pathologic
lymphadenopathy by imaging criteria. The visualized submandibular and parotid
glands are unremarkable in appearance. The thyroid gland appears enlarged
though no nodule was seen. Neck vessels are patent. Moderate calcifications
are identified within the aortic arch and origins of the left subclavian
artery. Additional calcifications within the right carotid artery at the
carotid bulb is additionally noted. Bilateral trace pleural effusions are
noted. Dependent atelectasis is additionally seen. No bony abnormality is
seen.
IMPRESSION:
1. 1.2 x 0.7 cm tongue base mass with peripheral calcification. Differential
would include a malignant lesion of the oral cavity, though lack of local
extension or adenopathy is noted suggesting alternative diagnosis. Minor
salivary gland tumors such as adenoid cystic lesion should additionally be
considered as well as mucoepidermoid carcinoma or adenocarcinoma.
2. Enlarged thyroid gland without a focal nodule identified. Correlation with
thyroid function tests recommended.
|
19912620-RR-20
| 19,912,620 | 29,903,947 |
RR
| 20 |
2121-05-28 16:51:00
|
2121-05-28 18:46:00
|
INDICATION: Status post biliary stent placement and outside ERCP, now with
upper abdominal pain, here to evaluate for choledocholithiasis.
COMPARISON: Outside CT of the abdomen dated ___.
TECHNIQUE: Right upper quadrant sonogram.
FINDINGS: The liver echotexture is within normal limits with no focal hepatic
lesion detected. The main portal vein is patent with normal hepatopetal flow.
There is moderate intrahepatic biliary dilation and pneumobilia. The patient
is status post common bile duct stent placement with wall-to-wall stent
distending the CBD. No stones are visualized in the CBD stent. The
gallbladder is distended with small layering sludge balls or non-shadowing
gallstones in the body of the gallbladder. The gallbladder wall is not
thickened or edematous and the sonographic ___ sign is negative. The
spleen is not enlarged, measuring 7.7 cm. No ascites is present. The
pancreas is not well visualized due to obscuration by overlying bowel gas and
cannot be assessed on this study.
IMPRESSION:
1. Moderate intrahepatic biliary dilation and pneumobilia status post biliary
stent placement. No stones are visualized in the common bile duct stent.
2. Distended gallbladder with layering sludge balls or small, non shadowing
gallstones. No wall thickening or sonographic ___ sign to suggest acute
cholecystitis.
|
19912620-RR-21
| 19,912,620 | 29,903,947 |
RR
| 21 |
2121-05-29 10:16:00
|
2121-05-29 10:49:00
|
INDICATION: ___ woman status post ERCP for pancreatitis, to assess
migration of the pancreatic duct stent.
COMPARISON: Reference CT abdomen ___, ERCP images ___.
SUPINE ABDOMEN RADIOGRAPHS: Both the CBD and pancreatic stent have an
abnormal orientation compared to the ERCP image from ___, suggesting
that both stents have dislodged and migrated to the duodenal loop. Moderate
amount of fecal material is seen within the right colon. There is gaseous
distention of the left colon. There is no evidence of bowel obstruction or
intra-abdominal free air in these supine images.
|
19912620-RR-22
| 19,912,620 | 29,903,947 |
RR
| 22 |
2121-05-30 00:14:00
|
2121-05-30 11:10:00
|
AP CHEST, 12:17 A.M., ___
HISTORY: ___ woman with pancreatitis. Hypoxia after ERCP. Evaluate
possible fluid overload.
IMPRESSION: AP chest reviewed in the absence of prior chest radiographs:
Lung volumes are quite low, exaggerating what is mild pulmonary edema and
bibasilar atelectasis, which could in combination explain hypoxia. Heart is
poorly defined, but mildly enlarged. There is no pneumothorax. Markedly
elevated right hemidiaphragm could obscure right pleural effusion.
Transvenous right atrial and right ventricular pacer leads follow their
expected courses.
|
19912620-RR-23
| 19,912,620 | 29,903,947 |
RR
| 23 |
2121-05-30 11:34:00
|
2121-05-30 14:44:00
|
INDICATION: Status post ERCP, with pancreatitis versus bowel perforation.
COMPARISON: Outside hospital CT abdomen from ___.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following the administration of oral contrast material only. Multiplanar
reformats were performed.
TOTAL DLP: 1421 mGy-cm.
ABDOMEN CT: There is minimal right lower lobe dependent atelectasis. Lack of
intravenous contrast material limits assessment of the abdominal organs. The
remainder of the visualized portions of the lung bases are clear. There is
incomplete evaluation of two cardiac pacer leads. The liver is mildly
heterogeneous and diffusely hypoattenuating, consistent with fat deposition.
There is marked circumferential gallbladder wall thickening and minimal
pericholecystic fat stranding. No gallstones are identified. The spleen is
normal. Mild fat stranding is seen along the pancreas, particularly adjacent
to its tail (2:12). There is no drainable fluid collection. There are two
biliary stents, one of which extends from the lower common duct to the
second/third portion of the duodenum, with the second stent extending from the
level of the ampulla to the level of the ligament of Treitz. A 2.5 x 2.3 cm
lesion in the right adrenal gland is not significantly changed in size
compared to prior CT from ___, likey an adenoma. A 1.7 cm simple
cyst is seen within the right upper renal pole. An additional 9 mm cyst is
also seen within the right upper renal pole. A 14 mm non-obstructing calculus
is seen within the left lower renal pole, not significantly changed compared
to CT from ___.
The stomach, small bowel, colon, and appendix are normal. There is no free
fluid or free air in the abdomen. No pathologically enlarged abdominal lymph
nodes are seen. The abdominal aorta is normal in caliber. Aortic and
bi-iliac artery calcifications are noted.
PELVIS CT: The bladder is collapsed around a Foley catheter. There is no
free fluid in the pelvis. No pathologically enlarged pelvic lymph nodes are
seen.
BONE WINDOW: No suspicious lytic or blastic lesions are identified.
Multilevel degenerative changes of the thoracolumbar spine are noted.
IMPRESSION:
1. Circumferential gallbladder wall thickening and mild pericholecystic fat
stranding, concerning for acute cholecystitis. HIDA correlation is advised.
2. Peripancreatic fat stranding, suggestive of acute pancreatitis.
Correlation with serum lipase is recommended.
3. Biliary stents, one of which extends from the lower common duct into the
duodenum and the other of which extends from the ampulla to the duodenojejunal
junction.
4. Nonobstructing 14 mm left lower pole renal calculus, not significantly
changed compared to CT from ___.
5. 2.5 cm right adrenal lesion, unchanged in size compared to CT from ___, likely an adenoma.
6. Hepatic steatosis.
Pertinent findings were discussed with Dr. ___ by Dr. ___ at 2:40
p.m. via telephone on the day of the study. Impression point #1 was discussed
in full with Dr. ___ by Dr. ___ at 5:37 p.m. via telephone on the day of
the study.
|
19912620-RR-24
| 19,912,620 | 29,903,947 |
RR
| 24 |
2121-05-30 15:14:00
|
2121-05-30 16:13:00
|
HISTORY: Hypoxia, assess for DVT.
COMPARISON: None.
FINDINGS:
Gray scale and color Doppler sonographic evaluation was performed of the
bilateral lower extremities. Normal compressibility, flow and response to
augmentation is seen in the common femoral, superficial femoral and popliteal
veins bilaterally. Normal color flow and compressibility is seen in the
posterior tibial and peroneal veins bilaterally.
IMPRESSION:
No lower extremity DVT.
|
19912620-RR-26
| 19,912,620 | 29,903,947 |
RR
| 26 |
2121-05-31 06:43:00
|
2121-05-31 09:46:00
|
CHEST RADIOGRAPH
INDICATION: Post-ERCP, pancreatitis, evaluation for pulmonary edema or
pleural effusions.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the pre-existing mild
pulmonary edema has not increased in severity, nor extent. Although minimal
pleural effusions are masqued by a large left ventricle on the left and
ascending hemidiaphragm on the right, there is no indication for larger
pleural effusions. No newly appeared parenchymal opacities. Unchanged course
of the pacemaker leads.
|
19912620-RR-27
| 19,912,620 | 29,903,947 |
RR
| 27 |
2121-06-01 14:01:00
|
2121-06-01 14:59:00
|
HISTORY: ___ female patient with severe pancreatitis, cholecystitis
and renal failure. Study requested to rule out obstruction.
COMPARISON: Prior abdominal/pelvic CT from ___.
FINDINGS:
The right kidney measures 11.2 cm. The left kidney measures 12.6 cm. A small
hypoechoic lesion measuring 1.7 x 1.4 x 1.3 cm is seen along the upper pole of
right kidney, too small to characterize. There is a 13 mm non obstructive
stone in the lower pole of the left kidney. There is no hydronephrosis or
obstruction. Renal echogenicity and corticomedullary architecture is within
normal limits. The bladder is collapsed due to the presence of a Foley
catheter.
IMPRESSION: 13 mm non-obstructive left kidney stone with no evidence of
hydronephrosis.
|
19912620-RR-28
| 19,912,620 | 29,903,947 |
RR
| 28 |
2121-06-02 13:49:00
|
2121-06-02 14:43:00
|
CLINICAL HISTORY: Post-ERCP pancreatitis and gram-negative bacteremia.
CHEST, AP SEMIERECT:
Dual-chamber pacemaker is present. The heart is enlarged, but no failure is
identified. Atelectasis in the right middle lobe is present with probably
also some volume loss in the right lower lobe with likely effusion.
Nasogastric tube is present.
IMPRESSION: Atelectasis in the right middle lobe and probably right lower
lobe as well right effusion.
|
19912620-RR-29
| 19,912,620 | 29,903,947 |
RR
| 29 |
2121-06-02 15:33:00
|
2121-06-03 09:05:00
|
CLINICAL HISTORY: ___ with sepsis, central line placed, check
position.
The right IJ line lies deep within the right atrium and should be withdrawn
approximately 6 cm. No other changes since the prior chest x-ray.
Atelectasis at the right base with elevation of the right hemidiaphragm is
again seen.
IMPRESSION: Tip of central line in right atrium.
|
19912620-RR-30
| 19,912,620 | 29,903,947 |
RR
| 30 |
2121-06-02 18:56:00
|
2121-06-03 09:06:00
|
CLINICAL HISTORY: Right IJ line repositioned. Check current position.
The tip of the right IJ line has been withdrawn and now lies in the region of
the cavoatrial junction.
|
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