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19912620-RR-31
19,912,620
29,903,947
RR
31
2121-06-03 13:53:00
2121-06-03 16:52:00
HISTORY: ___ followup pancreatitis, cholangitis, cholecystitis. Please evaluate for interval CBD stent placement, other abscesses or source of infection. COMPARISON: ___. TECHNIQUE: Axial MDCT images through the abdomen and pelvis were obtained following oral contrast administration. Sagittal and coronal reformats were made. The total exam DLP is 1268.6 mG-cm FINDINGS: LUNG BASES: There is dependent atelectasis at the lung bases, new from ___. Pacing wires are seen in the right heart. ABDOMEN: There is an nasojejunal tube in situ in good position. There are two common bile duct stents within the CBD in good position. There is a proximal pancreatic duct stent in good position. There are multiple hepatic hypodensities in a predominantly peripheral distribution, larger and more conspicuous compared to the ___ CT scan and new compared to ___ CT scan. The largest lesion is seen within hepatic segment 8 measuring 2.8 cm, previously 2.4 cm. (21: 2a). Post stenting the gallbladder has slightly decompressed. There is pericholecystic inflammatory stranding and wall thickening appreciated, stable. The pancreatic parenchyma is also edematous with surrounding peripancreatic inflammatory stranding, compatible with pancreatitis. There is surrounding inflammatory stranding within the anterior pararenal space extending to the left lateral conal fascia. There is inflammatory stranding surrounding the retroperitoneal portion of the duodenum. There is perinephric stranding bilaterally. There is no evidence of fluid collection or abscess formation. The visualized large and small bowel are unremarkable. There is scattered sigmoid diverticulosis. There is no evidence of a bowel obstruction. The spleen and left adrenal appear normal. There is a 2.5 x 2.3 cm right adrenal lesion, which is stable since CT ___. There is a right upper pole renal cyst, simple in its appearance. There is a nonobstructing 8 mm right ureteric calculus seen within the mid ureter. There is a 1.2 x 0.8 cm nonobstructing left lower pole renal calculus sitting within a nondistended renal calyx. There is a moderate amount of aortic atherosclerosis. There is heavy calcification at the celiac axis and the renal ostia . PELVIS: The bladder is decompressed around a Foley catheter. Air is seen within the bladder which is likely related to the instrumentation. There is a rectal tube in situ. Bones: there are no suspicious bony abnormalities. Discogenic degenerative changes are seen within the lumbar spine. IMPRESSION: 1. Multiple hepatic hypodensities, new compared to ___ and minimally increased in size compared to ___. Differential considerations for this would include hepatic abscesses. Metastatic disease is less likely. Dedicated cross-sectional imaging with contrast-enhanced CT or MRI is recommended. 2. The gallbladder has decompressed compared to the previous examination. There is persistent wall thickening and pericholecystic inflammatory stranding. 3. Post ERCP pancreatitis and peripancreatic inflammatory changes. No evidence of abscess or phlegmonous formation. 4. Incidentals findings are stable and include the left lower pole renal calculus, right ureteric calculus, and the right adrenal nodule. Findings discussed with Dr. ___ on ___ @ 5:22 pm.
19912620-RR-33
19,912,620
29,903,947
RR
33
2121-06-07 15:02:00
2121-06-07 16:46:00
TYPE OF EXAMINATION: Chest AP portable single view. INDICATION: ___ female patient status post ERCP with pancreatitis. Line placement. Does PICC line need to be repositioned? Contact name: ___ ___. FINDINGS: AP single view of the chest has been obtained with patient in semi-upright position. Available for comparison is the next preceding similar study of ___. On the present examination, a right internal jugular approach central venous line can be identified and is seen in unchanged position. Previously described permanent pacer in left axillary position connected to two intracavitary electrodes is unchanged. An NG tube passes through the midline and reaches well below the diaphragm. On the right side, there is a catheter line resembling a PICC line seen to terminate in the axillary area overlying the scapula at the level of the fourth right-sided rib. A second linear density located 2 cm more caudally has the structures of a wire and is supposed to be external. Contact was established with referring physician, ___. It was concluded that the line terminating in the right axillary area was the unsuccessful approach of a PICC line made earlier by another physician. It was therefore planned to place a new line. On the present image, there is no evidence of any pneumothorax.
19912620-RR-34
19,912,620
29,903,947
RR
34
2121-06-08 11:10:00
2121-06-13 12:01:00
INDICATION: ___ woman with post-ERCP pancreatitis for PICC readjustment. PHYSICIANS: Dr. ___ (radiology fellow) and Dr. ___ ___ (radiology attending) who was present throughout and supervised the procedure. PROCEDURE DETAILS: The patient was brought to the angiographic suite and placed supine on the table. A preprocedure timeout was performed using three patient identifiers. The skin of the right upper extremity was prepped and draped in the usual sterile fashion including the indwelling double-lumen PICC. Approximately 1 cc of 1% lidocaine was infiltrated into the skin and subcutaneous tissues around the PICC and a wire was advanced through the PICC without difficulty. The PICC was removed and a 5 ___ peel-away sheath was advanced over the wire. The wire was then advanced into the distal SVC and measured for the length of catheter required. The catheter tubing was cut to 44 cm, the line was flushed and then advanced over the wire. A peel-away sheath was gradually removed as was the wire. Following completion of this maneuver, the tip was in the distal SVC. Both lumens were aspirated and flushed without difficulty. The catheter was secured to the skin with StatLock device. IMPRESSION: Successful repositioning of a right upper extremity PICC, the tip is now in the distal SVC and the catheter is ready for use.
19912620-RR-35
19,912,620
29,903,947
RR
35
2121-06-08 09:18:00
2121-06-08 21:18:00
INDICATION: ___ woman with post-ERCP pancreatitis with liver abscess on prior imaging, please assess for further evaluation, progression or resolution. COMPARISON: CT abdomen and pelvis without contrast from ___. TECHNIQUE: Sonographic grayscale and Doppler images of the liver were obtained. FINDINGS: The liver demonstrates multiple hypodense lesions predominantly within the right hepatic lobe, the largest dominant lesion measures 3 x 1.7 x 2.9 cm, similar in size to CT, accounting for subjective and technical differences. Additionally, there is a cluster of peripheral hypodense lesions in segment VII/VII, which measure up to 1.4 cm, similar to prior examinations. There is no definitive change in size within these liver lesions. However, this is difficult to compare between the prior non-contrast CT examination and today's ultrasound exam. An additional rounded echogenic lesion within segment VIII posterior aspect which measures up to 1.6 cm, likely representing a hemangioma. There is a nonspecific underlying coarse echotexture of the lesion. Stable pancreatic duct dilatation measuring up to 7 mm. A pancreatic stent is not seen and there is a question of its underlying function. The common bile duct remains enlarged measuring up to 1 cm with a portion visualized, similar to the CT exam. Mild centralized intrahepatic biliary ductal dilatation is noted. The gallbladder remains thickened measuring up to 6 mm along its wall with mild surrounding pericholecystic fluid. Mild amount of internal sludge is also appreciated. The vasculature remains patent. IMPRESSION: 1. Accounting for subjective and technical differences, no overall definitive change in the discrete multiple hypoechoic lesions within the right hepatic lobe; the dominant lesion is in the anterior aspect of segment VI. Underlying nonspecific coarse echotexture of the liver. 2. Small hemangioma in the posterior aspect of segment VIII. 3. Persistent common bile duct and mild centralized intrahepatic biliary ductal dilatation with CBD stent in place. 4. Stable pancreatic ductal dilatation. Known pancreatic stent as seen on prior CT. 5. Stable inflamed gallbladder with thickened wall and underlying sludge.
19912620-RR-37
19,912,620
29,903,947
RR
37
2121-06-11 18:41:00
2121-06-11 19:46:00
HISTORY: ___ female with pancreatic cancer and right upper extremity swelling. COMPARISON: None. FINDINGS: Grayscale, color, and spectral Doppler evaluation was performed of the right upper extremity veins. There is normal phasicity of the subclavian veins bilaterally. There is normal compression of the right internal jugular vein. Occlusive thrombus adherent to a PICC is present in the right axillary and one of the right brachial veins. The second brachial vein is patent with normal flow. The basilic and cephalic veins are not visualized. IMPRESSION: Occlusive PICC-associated thrombus within the right axillary and one of the right brachial veins. Findings were communicated via phone call by Dr. ___ to Dr. ___ ___ on ___ at 19:43 ___, within 10 minutes of discovery.
19912620-RR-38
19,912,620
29,903,947
RR
38
2121-06-12 10:07:00
2121-06-12 11:38:00
HISTORY: Hepatic abscess, rising white count. Evaluate for progression of abscess. TECHNIQUE: Grayscale color Doppler ultrasound images of the abdomen. COMPARISON: Abdominal ultrasound ___. FINDINGS: Multiple hypoechoic foci are re-demonstrated in the liver. The dominant hypoechoic focus measures 2.8 x 1.6 x 2.3 cm, and previously measured 3.1 x 1.7 x 2.9 cm. Allowing for slice selection this particular focus is unchanged to slightly decreased in size. The cluster of peripheral hypodense lesions in segment ___ measure up to 1.4 cm, unchanged since the prior study. A stable 1.6 x 1.6 x 1.1 cm echogenic focus in the right lobe of the liver may represent a hemangioma. There is mild intrahepatic biliary dilation up to 0.6 cm. The common bile duct is dilated up to 1.8 cm. As on the prior study the gallbladder wall is thickened measuring up to 0.5 cm with irregular internal echoes likely representing sludge. Pericholecystic fluid has decreased. There is stable pancreatic duct dilation up to 0.7 cm. There is no evidence of focal pancreatic lesions in the visualized portions of the head or body. Portions of the pancreatic tail are obscured by overlying bowel gas. The portal vein is patent with hepatopetal flow. The spleen measures 8.8 cm. Visualized portions of the inferior vena cava appear normal. IMPRESSION: 1. Accounting for differences in technique and slice selection there is no significant difference in size or burden of hypoechoic hepatic lesions representing known abscesses. The largest focus measures 2.8 cm compared to 3.1 cm on the prior study. 2. Persistent dilation of the intrahepatic bile ducts and increased prominence of the CBD which now measures 1.8 cm. 3. Stable gallbladder wall thickening and sludge with decrease in pericholecystic fluid. 4. Stable pancreatic duct dilation. 5. Echogenic focus in the right hepatic lobe is unchanged and as previously suggested may represent a hemangioma.
19912620-RR-40
19,912,620
29,903,947
RR
40
2121-06-14 09:11:00
2121-06-15 09:55:00
INDICATION: ___ woman with pancreatic cancer and bacteremia. Right-sided occlusive PICC with associated thrombus within the axillary vein; in need for a new PICC line. OPERATORS: Dr. ___. Using sterile technique and local anesthesia, the left cephalic vein was punctured under direct ultrasound guidance using a micropuncture set. As the wire could not be advanced, contrast was injected demonstrating central occlusion of the cephalic vein with multiple collaterals. Subsequently, access was obtained into the brachial vein and a wire again could not be advanced centrally. Given the combination of partial occlusion of the central venous left arm outflow and presence of a left-sided pacemaker, the electrophysiology team was contacted at this point. After discussion with Dr. ___ was made to not place a PICC line via the left side, so as to not trigger further central vein occlusion or risk infection on this side. Hence the procedure was aborted at this time , and the wires and microsheaths were withdrawn. If the referring teams are agreeable in the future , an attempt at left sided PICC placement can be made. IMPRESSION: Aborted PICC line placement on the right with no attempt made on the left due to concerns from the electrophysiology department.If the referring teams are agreeable in the future , an attempt at left sided PICC placement can be made.
19912620-RR-41
19,912,620
29,903,947
RR
41
2121-06-15 13:11:00
2121-06-15 19:10:00
PICC LINE PLACEMENT INDICATION: IV access needed for antibiotics. The procedure was explained to the patient. A timeout was performed. Following discussion between the referring physcicians and the ___ tream a decision was made to proceed with left sided PICC placement despite the presence of left sided pacing wires. ( The procedure was initially aborted yesterday for this reason). RADIOLOGIST: Dr. ___ the procedure. TECHNIQUE: Using sterile technique and local anesthesia, the left brachial vein was punctured under direct ultrasound guidance using a micropuncture set. Hard copies of ultrasound images were obtained before and immediately after establishing intravenous access. A peel-away sheath was then placed over a guidewire and a single-lumen PICC line measuring 38 cm in length was then placed through the peel-away sheath with its tip positioned in the SVC under fluoroscopic guidance. Position of the catheter was confirmed by a fluoroscopic spot film of the chest. The peel-away sheath and guidewire were then removed. The catheter was secured to the skin, flushed, and a sterile dressing applied. The patient tolerated the procedure well. There were no immediate complications. IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided single-lumen PICC line placement via the left brachial venous approach. Final internal length is 38 cm, with the tip positioned in SVC. The line is ready to use.
19913456-RR-30
19,913,456
24,965,231
RR
30
2188-04-22 16:10:00
2188-04-22 17:10:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with SOB swelling// r/o CHF TECHNIQUE: Chest: Frontal and Lateral COMPARISON: ___ FINDINGS: Right-sided Port-A-Cath is stable in position. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette mildly enlarged. There is bibasilar atelectasis without definite focal consolidation. No pleural effusion is seen. There is no pneumothorax. No overt pulmonary edema is seen. Linear structure projecting over the mid to lower left hemithorax is felt to likely be external to the patient. IMPRESSION: Bibasilar atelectasis without definite focal consolidation. No pleural effusion or pulmonary edema.
19913456-RR-31
19,913,456
24,965,231
RR
31
2188-04-22 14:43:00
2188-04-22 16:17:00
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT) INDICATION: ___ year old woman with ___ edema, brast cancer s/p surgery// r/o DVT TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the bilateral lower extremity veins. COMPARISON: ___ FINDINGS: There is normal compressibility, flow, and augmentation 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. IMPRESSION: No evidence of deep venous thrombosis in the right or left lower extremity veins.
19913456-RR-32
19,913,456
24,965,231
RR
32
2188-04-22 18:26:00
2188-04-22 19:20:00
EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: History: ___ with ___ swelling, recently post op, SOB// r/o PE. Patient is status post left mastectomy with tram flap on ___ and evacuation of a left-sided chest hematoma in the bulking in the flap on ___. 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) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.4 mGy (Body) DLP = 1.2 mGy-cm. 2) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.4 mGy (Body) DLP = 1.2 mGy-cm. 3) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 9.6 mGy (Body) DLP = 4.8 mGy-cm. 4) Spiral Acquisition 3.7 s, 28.8 cm; CTDIvol = 23.2 mGy (Body) DLP = 669.1 mGy-cm. Total DLP (Body) = 676 mGy-cm. COMPARISON: CTA chest ___ CT chest ___ FINDINGS: HEART AND VASCULATURE: There is somewhat poor opacification of the segmental and subsegmental pulmonary arteries, particularly in the lower lobes, partially due to noise artifact from patient body habitus and patient's left arm being down.. Given this, no concerning filling defect is seen to suggest pulmonary embolism. The thoracic aorta is normal in caliber without evidence of acute dissection. No pericardial effusion is seen. Right-sided port-A-Cath terminates in the right atrium. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Linear branching opacities in the bilateral lower lobes, right upper lobe, and lingula are compatible with subsegmental atelectasis. There is no focal consolidation. 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. Thyroid is unremarkable. ABDOMEN: There is a small paraesophageal hernia. BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. Tram flap with postoperative changes in the left breast is partially imaged, grossly similar to prior. IMPRESSION: 1. Somewhat poor opacification of the segmental and subsegmental pulmonary arteries, particularly in the lower lobes, part due to noise artifact from patient body habitus shin patient's left arm being down. Given this, no evidence of pulmonary embolism. No evidence of aortic dissection. 2. Subsegmental atelectasis in the bilateral lower lobes, right upper lobe, and lingula. 3. TRAM flap in the left breast is partially imaged, with postoperative changes grossly similar compared to the prior study from ___.
19913456-RR-33
19,913,456
25,567,316
RR
33
2188-05-13 17:56:00
2188-05-13 19:23:00
EXAMINATION: CT torso with contrast INDICATION: ___ with recent surgery, ___ incision w/ breast and lower abdomen swelling/pain w/ concern for abscess// Breast Abscess, Lower incision abscess TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 1,310 mGy-cm. COMPARISON: CTA chest from ___ CT abdomen pelvis with contrast from ___ FINDINGS: CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without evidence of acute injury. The heart, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. The tip of a right chest wall port catheter is seen terminating in the low SVC. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass or hematoma. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Linear atelectasis is seen in the lung bases. Otherwise, the lungs are clear without masses or areas of parenchymal opacification. Calcified granuloma is noted in the right lower lobe. The airways are patent to the level of the segmental bronchi bilaterally. BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesion or laceration. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically absent. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesion or laceration. Calcified granuloma is incidentally noted. ADRENALS: A 0.6 cm nodule seen in the right adrenal gland, statistically most likely to represent adenoma. The left adrenal gland appears normal. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is a 1.8 cm hypodensity in the right upper renal pole compatible with a simple cyst. There is no evidence of focal renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: Small hiatal hernia is incidentally noted. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Extensive colonic diverticulosis is noted without evidence of acute diverticulitis. Otherwise, the colon and rectum are within normal limits. The appendix is normal. There is no free fluid or free air in the abdomen. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. Mild atherosclerotic disease is noted. BONES: There is no acute fracture. No suspicious osseous lesion. Degenerative changes are noted in the lumbar spine with intervertebral disc height loss, endplate osteophytes and facet joint hypertrophy. SOFT TISSUES: Patient is status post right mastectomy and left breast reconstruction. Postoperative changes are seen along the chest wall from left breast reconstruction, including a fluid collection along the lateral aspect of the left reconstructed breast with posterior extension, likely representing seroma (series 5: Image 36). Postoperative changes are seen along the anterior abdominal wall with extensive subcutaneous edema and surgical clips. There is a large fluid collection seen along the tram flap donor site measuring 14.7 x 3.8 x 10.8 cm (series 5: Image 61 and series 8b: Image 13) with possible mild rim enhancement, likely representing either seroma. A second fluid collection is seen inferior and lateral to this dominant collection measuring approximately 3.4 x 8.3 x 6.7 cm, is similar in appearance. IMPRESSION: 1. Patient is status post left mastectomy. Postoperative changes are seen following left breast reconstruction including probable seroma along the lateral aspect of the reconstructed breast. 2. Postoperative changes seen along the anterior abdominal wall donor site following left breast tram flap reconstruction with a dominant 14.7 cm fluid collection with possible rim enhancement. This is compatible with a seroma, noting that superimposed infection cannot be excluded by imaging. 3. A second thin linear fluid collection is seen inferior and lateral to the dominant collection, also similar in appearance. 4. Extensive diverticulosis without diverticulitis. 5. A 0.6 cm cm right adrenal nodule, unchanged.
19913456-RR-34
19,913,456
25,567,316
RR
34
2188-05-14 10:33:00
2188-05-14 16:43:00
EXAMINATION: Ultrasound-guided seroma drainage of 2 abdominal wall fluid collections INDICATION: ___ year old woman s/p TRAM flap now with 14 cm seroma// Drainage of fluid collection recurrent fluid collections with fever and abdominal pain. COMPARISON: CT chest abdomen and pelvis ___ PROCEDURE: Ultrasound-guided drainage of two abdominal wall collections, suspected infected seromas. OPERATORS: Dr. ___ trainee and Dr. ___ radiologist. Dr. ___ supervised the trainee during the key components of the procedure and reviewed and agree with the trainee's findings. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. The patient was placed in a supine position on the US scan table. Limited preprocedure ultrasound was performed to localize the more lateral collection (#1). Based on the ultrasound findings an appropriate skin entry site for the drain placement was chosen. The site was marked. Local anesthesia was administered with 1% Lidocaine solution. Using continuous sonographic guidance, ___ drainage catheter was advanced via trocar technique into the more lateral collection (#1). A sample of fluid was aspirated, confirming catheter position within the collection. The pigtail was deployed. The position of the pigtail was confirmed within the collection via ultrasound. Approximately 40 cc of slightly cloudy, straw-colored fluid was drained with a sample sent for microbiology evaluation. The catheter was secured by a StatLock. The catheter was attached to bag. Sterile dressing was applied. The patient was placed in a supine position on the US scan table. Limited preprocedure ultrasound was performed to localize the more medial collection (#2). Based on the ultrasound findings an appropriate skin entry site for the drain placement was chosen. The site was marked. Local anesthesia was administered with 1% Lidocaine solution. Using continuous sonographic guidance, ___ drainage catheter was advanced via trocar technique into the more medial collection (#2.). A sample of fluid was aspirated, confirming catheter position within the collection. The pigtail was deployed. The position of the pigtail was confirmed within the collection via ultrasound. Approximately 500 cc of slightly cloudy, serosanguineous fluid was drained with a sample sent for microbiology evaluation. The catheter was secured by a StatLock. The catheter was attached to bag. Sterile dressing was applied. Fluid component of both seromas were completely aspirated. Both seromas are also lavaged with 20 cc of sterile saline with reaspiration of the fluid. The procedure was tolerated well, and there were no immediate post-procedural complications. SEDATION: Moderate sedation was provided by administering divided doses of 3 mg Versed and 100 mcg fentanyl throughout the total intra-service time of 30 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: Successful CT-guided placement of two 10 ___ catheters into two seromas in the anterolateral abdominal wall, with samples sent for microbiology. IMPRESSION: Successful US-guided placement of ___ pigtail catheter into the collection. Samples was sent for microbiology evaluation.
19913536-RR-15
19,913,536
23,298,703
RR
15
2163-08-15 01:01:00
2163-08-15 01:55:00
EXAMINATION: PELVIS, NON-OBSTETRIC INDICATION: ___ year old woman with fetal demise ___, s/p D C with lower abd pain and cramping and clots. // assess for retained POCs TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with transabdominal approach followed by transvaginal approach for further delineation of uterine and ovarian anatomy. COMPARISON: None. LMP: Fetal demise on ___ at 10 weeks. FINDINGS: The uterus measures 12.3 cm x 8.1 cm x 7.5 cm. The endometrial cavity demonstrate extensive heterogeneous material without definite evidence of vascularity. The left ovary was visualized and appears to be normal. The right ovary could not be seen on this exam. There is trace pelvic free fluid. IMPRESSION: Extensive heterogeneous material within the endometrial cavity may be secondary to blood products from patient's prior D&C, however is highly concerning for non vascularized retained products of conception.
19913536-RR-16
19,913,536
23,298,703
RR
16
2163-08-15 12:51:00
2163-08-15 16:55:00
EXAMINATION: Intraoperative ultrasound guidance. INDICATION: ___ year old woman with retained POCs // please provide intraop guidance for retained POCs TECHNIQUE: Transabdominal pelvic ultrasound guidance for intraoperative D&C. COMPARISON: ___ FINDINGS: Transabdominal images of the uterus were obtained for intraoperative ultrasound-guided D&C with Dr. ___. A total of 18 images were obtained. IMPRESSION: Intraoperative ultrasound guidance was provided.
19913577-RR-20
19,913,577
20,973,939
RR
20
2113-10-09 16:50:00
2113-10-09 17:13:00
INDICATION: History: ___ with syncope, fall with head strike, headache TECHNIQUE: Supine AP view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Left-sided AICD device is noted with leads terminating in the regions of the right atrium and right ventricle. The patient is status post median sternotomy and CABG. Moderate to severe enlargement of the cardiac silhouette may be accentuated by a VP technique and supine positioning. There is mild pulmonary edema, new in the interval, with hazy opacification in both hemithoraces likely reflective of small layering pleural effusions. No focal consolidation or pneumothorax is present. Moderate multilevel degenerative changes are seen in the thoracic spine. IMPRESSION: Moderate to severe cardiomegaly with mild pulmonary edema and probable small bilateral pleural effusions.
19913577-RR-21
19,913,577
20,973,939
RR
21
2113-10-09 16:50:00
2113-10-09 17:15:00
INDICATION: History: ___ with syncope, abdominal pain TECHNIQUE: Left knee, three views COMPARISON: None. FINDINGS: No acute fracture or dislocation is present. Moderate degenerative changes are seen in all 3 compartments of the knee with mild joint space narrowing and osteophyte formation. Chondrocalcinosis is also visualized. There are no concerning lytic or sclerotic osseous abnormalities. No sizeable joint effusion is present. Diffuse vascular calcifications are present along with multiple clips along the medial aspect of the knee. IMPRESSION: No acute fracture or dislocation. Moderate osteoarthritis with chondrocalcinosis.
19913577-RR-22
19,913,577
20,973,939
RR
22
2113-10-09 16:21:00
2113-10-09 16:41:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ with syncope, fall with head strike, headache TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.3 cm; CTDIvol = 49.2 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence of acute infarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in size and configuration. There is a tiny right parietal subgaleal hematoma (601b:67). There is no evidence of fracture. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. Cavernous carotid atherosclerotic calcifications are noted. IMPRESSION: Tiny right parietal subgaleal hematoma. No fracture, intracranial hemorrhage, or large territorial infarction.
19913577-RR-23
19,913,577
20,973,939
RR
23
2113-10-09 16:22:00
2113-10-09 17:01:00
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE INDICATION: ___ with syncope, fall with head strike, headache TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue and bone algorithm images were generated. Coronal and sagittal reformations were then constructed. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.7 s, 22.3 cm; CTDIvol = 37.1 mGy (Body) DLP = 828.8 mGy-cm. Total DLP (Body) = 829 mGy-cm. COMPARISON: None. FINDINGS: Alignment is normal. No fractures are identified.Multilevel moderate to severe degenerative changes are noted with ossification of the posterior longitudinal ligament and posterior disc bulges causing moderate to severe vertebral canal narrowing, most pronounced at C4-C5 and C6-C7. Multilevel anterior, posterior, and uncovertebral osteophytosis is worse at C4-C5. There is multilevel facet arthropathy including facet arthrosis at C3-C4. There is mild osseous right neural foraminal narrowing at C3-C4 and moderate bilateral neural foraminal narrowing at C4-C5. There is no prevertebral soft tissue swelling. There is no evidence of infection or neoplasm. Evaluation of the lung apices is limited by respiratory motion artifact. Despite this limitation, there are no gross abnormalities. Atherosclerotic calcifications are worst at the carotid bifurcations. IMPRESSION: 1. No evidence of fracture or traumatic malalignment. 2. Moderate to severe multilevel degenerative changes include ossification of the posterior longitudinal ligament and posterior disc bulges causing moderate to severe vertebral canal narrowing at C4-C5 and C6-C7. Mild to moderate osseous neural foraminal narrowing caused by osteophytosis is also present at C3-C4 and C4-C5.
19913577-RR-24
19,913,577
20,973,939
RR
24
2113-10-09 16:22:00
2113-10-09 17:43:00
EXAMINATION: CT abdomen/pelvis with IV contrast INDICATION: ___ with syncope, abdominal pain TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 7.1 s, 55.9 cm; CTDIvol = 19.2 mGy (Body) DLP = 1,071.8 mGy-cm. Total DLP (Body) = 1,072 mGy-cm. COMPARISON: ___ CT chest/abdomen/pelvis ___ CTA runoff FINDINGS: LOWER CHEST: Severe cardiomegaly is unchanged. There is mild interlobular septal thickening and reflux of contrast into the hepatic veins. The main pulmonary artery is again enlarged to 3.7 cm suggestive of pulmonary hypertension. Small nonhemorrhagic left and trace right pleural effusions have decreased in size. Multiple new peripheral nodular pulmonary ground glass opacities include a 1.0 x 0.6 cm subpleural opacity (02:34) within the lateral right middle lobe, and 0.8 x 0.6 cm ground-glass opacity (02:20) in the posterior right upper lobe. In the inferior right upper lobe, there is a 0.4 x 0.3 cm pulmonary nodule (02:32). A 0.7 cm calcified granuloma in left lower lobe is unchanged. There is no evidence of pericardial effusion. Median sternotomy wires are noted. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder has a small calcified stone in the neck. Peripheral calcification of the gallbladder fundus may be related to a large peripherally calcified stone or calcification within the wall. There is trace perihepatic ascites. 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 nodular appearing, likely adenomatous hyperplasia. The inferior left adrenal gland has been previously characterized as an adenoma (2:81). 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. Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening and fat stranding. The appendix is normal. PELVIS: The urinary bladder is markedly distended, but otherwise unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. LYMPH NODES: Prominent mediastinal lymph nodes are essentially unchanged measuring up to 1.2 cm in short axis in the right pretracheal station. There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. A chronic dissection flap in the infrarenal abdominal aorta is unchanged when compared to prior CTA (2:100). Extensive and diffuse atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Extensive degenerative changes are seen throughout the visualized spine. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. New peripheral nodular pulmonary ground glass opacities raise the possibility of septic emboli or fungal infection. 2. Small calcified gallstone in the gallbladder neck. Peripheral calcification of the gallbladder fundus may be related to a large underlying gallstone or porcelain gallbladder. No evidence of cholecystitis. 3. Mild interlobular septal thickening, small pleural effusions, severe cardiomegaly, and reflux of contrast into the hepatic veins suggest a component of heart failure. 4. Trace perihepatic ascites. 5. Nodular adrenal glands likely reflect adrenal hyperplasia. 6. Severe atherosclerotic calcification and a chronic dissection flap of the infrarenal abdominal aorta are unchanged. 7. No acute traumatic injury identified including no fracture.
19913577-RR-25
19,913,577
20,973,939
RR
25
2113-10-10 16:53:00
2113-10-10 17:11:00
EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT INDICATION: ___ year old man with recent fall, now c/o left ankle pain, TTP lateral malleolus, +1 edema, has known PAD, DM. // assess for fracture or acute process assess for fracture or acute process TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left ankle COMPARISON: None available FINDINGS: No acute fracture or dislocation identified. There are mild degenerative changes around the ankle joint and midfoot. Dorsal and plantar calcaneal enthesophytes are noted as is mild enthesopathic change around the base of the fifth metatarsal. The mortise is congruent on this non stress view. The tibial talar joint space is preserved and no talar dome osteochondral lesion is identified. No suspicious lytic or sclerotic lesion is identified. Vascular calcification is present. Mild diffuse soft tissue swelling around the ankle may be secondary to venous stasis. IMPRESSION: No acute fracture or dislocation of the left ankle. Mild degenerative changes are present as described above.
19913597-RR-19
19,913,597
24,520,975
RR
19
2162-12-11 15:14:00
2162-12-11 17:21:00
INDICATION: Bilateral lower quadrant pain. COMPARISON: None. TECHNIQUE: Contiguous axial MDCT images were taken through the abdomen and pelvis without the administration of IV or oral contrast. Coronal and sagittal reformats were also examined. FINDINGS: The lung bases are clear. The heart size is top normal. There is no pleural or pericardial effusion. The unenhanced appearance of the liver, spleen, pancreas, and adrenal glands is unremarkable. Dependent stones seen in the gallbladder which is otherwise unremarkable. The patient is status post right nephrectomy with atrophy of the right paraspinal muscles. There is hydronephrosis of the left kidney with punctate calcifications in the collecting system and a mild amount of fat stranding. The left ureter is dilated with nonobstructive layering calcification just proximal to the UVJ. A Foley is in expected position. There are multiple bladder calculi. Despite being decompressed, the bladder has an irregular lobulated appearance. There is also mild fat stranding adjacent to the bladder with several soft tissue nodules, likely lymph nodes. The seminal vesicles are unremarkable. The stomach and small bowel are unremarkable without any evidence of wall thickening or obstruction. The colon is unremarkable. A circular fat density is seen along the antimesenteric border of the colon in the right lower quadrant, likely an epiploic appendage. There is no retroperitoneal or mesenteric lymphadenopathy. There is no abdominal or pelvic free fluid or free air. There is a small fat-containing umbilical hernia. Atherosclerotic calcifications are present in the abdominal aorta and the common iliac vessels. No suspicious lesion is seen in the visualized osseous structures. IMPRESSION: 1. Irregular lobulated appearance of the bladder with adjacent small lymph nodes and fat stranding concerning for a malignant process. Correlation with urine cytology and urinalysis is recommended. An MRI or CT cystogram may be obtained for further assessment. 2. Left hydronephrosis with punctate calcifications in the collecting system and layering non-obstructing calcifications in the distal ureter. 3. Right nephrectomy.
19913597-RR-20
19,913,597
24,520,975
RR
20
2162-12-12 14:26:00
2162-12-12 16:16:00
HISTORY: New bladder mass, chills, sweats, and cough. COMPARISON: No prior imaging at this institution. FINDINGS: AP upright and lateral chest radiographs were obtained. The exam is limited by body habitus. Despite these limitations, the lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiomegaly is severe. IMPRESSION: Severe cardiomegaly. No acute cardiopulmonary process.
19913597-RR-21
19,913,597
24,520,975
RR
21
2162-12-12 15:07:00
2162-12-12 16:33:00
HISTORY: Word finding difficulties. COMPARISON: None. TECHNIQUE: Non contrast head CT FINDINGS: There is no evidence of acute intracranial hemorrhage, mass effect, shift of the normally midline structures or vascular territory infarct. Gray-white matter differentiation is preserved throughout. Ventricles and sulci are enlarged consistent with age related global atrophy. Periventricular white matter hypodensities are consistent with a sequelae of chronic small vessel ischemic disease. Mastoid air cells are well aerated. Paranasal sinuses are well aerated. No osseous or soft tissue abnormalities. IMPRESSION: No evidence of acute intracranial process.
19913597-RR-22
19,913,597
24,520,975
RR
22
2162-12-13 14:15:00
2162-12-13 15:56:00
HISTORY: New onset right upper quadrant pain, denies passing gas, increased distention, evaluate for small bowel obstruction. COMPARISON: CT abdomen and pelvis from ___. FINDINGS: Frontal and left lateral decubitus images of the abdomen demonstrate dilated air-filled loops of small and large bowel with multiple air-fluid levels in the colon, favoring ileus. No free intraperitoneal air is identified. Enlargement of the cardiac silhouette is better evaluated on the chest radiograph of ___. IMPRESSION: Air-filled distended loops of small and large bowel favoring ileus.
19913597-RR-23
19,913,597
24,520,975
RR
23
2162-12-14 08:02:00
2162-12-14 09:40:00
HISTORY: Altered mental status with abdominal pain, KUB yesterday showed ileus. Patient has increasing distention is morning and is more lethargic. Evaluate for evidence of small bowel obstruction or progression from yesterday. COMPARISON: Abdominal radiograph from ___ and CT abdomen and pelvis ___. FINDINGS: Supine frontal and left lateral decubitus radiographs of the abdomen demonstrate air filled markedly dilated loops of small and large bowel. Compared to yesterday's radiograph, there is more distention of the small bowel with persistent distention of the large bowel with multiple air-fluid levels. No air is seen within the rectum. There is equivocal increased density in the left inguinal region. No free intraperitoneal air is identified. Rounded calcifications projecting over the lower pelvis consistent with bladder stones seen on CT. IMPRESSION: Markedly dilated air-filled loops of small and large bowel, could represent progressive ileus; however, potentially concerning for distal colonic obstruction. Equivocal increased density in left inguinal region could be artifactual, but correlate with palpation to exclude an inguinal hernia. If there is clinical concern for obstruction,recommend CT for further evaluation. NOTIFICATION: Telephone notification to Dr. ___ by Dr. ___ at 9:30 on ___ at time of review study per request.
19913597-RR-25
19,913,597
24,520,975
RR
25
2162-12-14 23:18:00
2162-12-15 11:03:00
ABDOMINAL PLAIN FILM AND UPRIGHT ___ AT 2339 INDICATION: ___ with ileus, worsening pain. Comparison to prior study of ___ at 918. Portable AP upright and supine images of the abdomen and pelvis ___ at 2339 are submitted. Overall, there is slight increase in distention of both small and large bowel loops which does raise concern for a distal colonic obstruction. Although the left inguinal area is not included on the current image, there was a question of some lucency in this vicinity on the previous examination raising the possibility of an inguinal hernia. Correlation with physical examination is advised. No free air is seen. IMPRESSION: 1. Slight interval increase in colonic and small bowel dilatation which could reflect severe ileus, although distal colonic obstruction should be considered.
19913597-RR-26
19,913,597
24,520,975
RR
26
2162-12-26 21:03:00
2162-12-27 07:31:00
HISTORY: ___ year old man with altered mental status, likely chronic dementia, CT scan suggestive of frontotemporal dementia. COMPARISON: Head CT, ___. TECHNIQUE: Sagittal T1, and axial FLAIR, T2, GRE, and diffusion images were acquired through the cervical spine without contrast. Additionally, axial and coronal MPRAGE images were acquired. FINDINGS: There is global generalized volume loss. There is both punctate and confluent FLAIR hyperintensity in the periventricular subcortical white matter bilaterally as well as T2 FLAIR hyperintensity in the midbrain and pons likely representing the sequela of chronic small vessel disease. There is no evidence of acute infarct or hemorrhage. There is no mass lesion, mass effect or shift of the midline structures. There is no abnormal intra or extra-axial fluid collection. There are normal major intracranial vascular flow voids. The visualized paranasal sinuses, mastoids, and orbits are unremarkable. IMPRESSION: 1. No acute intracranial abnormality, with no evidence of acute infarct. 2. Global atrophy. Extensive white matter signal abnormality likely represents the sequela of severe chronic small vessel disease.
19913597-RR-27
19,913,597
24,520,975
RR
27
2162-12-26 15:03:00
2162-12-27 09:51:00
STUDY: Cervical ___. CLINICAL HISTORY: ___ man with possible metal. Anticipating MRI. FINDINGS: Comparison is made to the prior head CT from ___. There are no metallic densities projecting over the soft tissues in the cervical spine. The patient is edentulous. Paranasal sinuses are within normal limits. There are severe degenerative changes and reversal of normal lordosis of the cervical spine. Loss of intervertebral disc height is seen at multiple levels. There is retrolisthesis of C4 over C5. Prevertebral soft tissues are grossly normal. The visualized lung apices are clear.
19913597-RR-28
19,913,597
24,520,975
RR
28
2162-12-30 16:29:00
2162-12-30 17:19:00
REASON FOR EXAMINATION: Fever. Portable AP radiograph of the chest was reviewed in comparison to ___. There is a re-demonstration of the left ventricular enlargement. Mediastinum is unremarkable. Lungs are essentially clear. Prominence of the pulmonary arteries might be consistent with pulmonary hypertension. No pleural effusion or pneumothorax is seen. Degenerative changes in both humeral heads are noted.
19913597-RR-29
19,913,597
24,520,975
RR
29
2163-01-04 14:54:00
2163-01-04 17:17:00
CHEST CT WITH CONTRAST INDICATION: Cough, leukocytosis, hemoptysis, pneumonia versus lesion. COMPARISON: No prior chest CT. Abdominal CT of ___. FINDINGS: There is significant pulmonary emboli with thrombus in the distal right main pulmonary artery, going down into segmental and subsegmental level in the right lower lobe. Most of the ground-glass opacities and triangular subpleural consolidation are found in the same area as the pulmonary emboli and probably represent infarct and pulmonary hemorrhage. A superimposed infection in the consolidated part cannot be excluded. A few less than 4 mm lung nodules are seen throughout the lungs. They are in series 5, image 54, 118, 149 and are nonspecific. Two of them are calcified, images 80 and 87. Secretion is seen in the trachea and right main stem. Thyroid is unremarkable. Mildly enlarged lymph nodes could be reactive, but will have to be followed up. The biggest one in subcarinal station measures 27 x 15 mm. The main pulmonary artery is dilated to 3.3 cm, but the right heart chambers are not dilated. Coronary arteries are moderately calcified. The aorta is atheromatous. There is no pericardial effusion. Associated right pleural effusion is small. Multiple venous collaterals are seen, possibly due to partial stenosis of the left subclavian vein which remains patent. UPPER ABDOMEN: This study is not tailored for assessment of intra-abdominal organs in this patient with right nephrectomy for renal cancer. The hypertrophic left kidney is not fully included in this study. There is a gallstone without any sign of cholecystitis and the stomach is moderately distended. OSSEOUS STRUCTURES: There is no bony lesion concerning for malignancy. CONCLUSION: 1. Significant pulmonary emboli in the distal right main pulmonary artery going into the segmental and subsegmental levels in the right lower lobe, accompanied by pulmonary infarct and hemorrhage. 2. Superimposed right lower lobe pneumonia cannot be excluded. 3. Mildly enlarged central lymph nodes and a few lung nodules could be followed up with a chest CT in three months considering the past medical history of renal cancer. 4. Stigmata of previous granulomatous infection. The results have been discussed with Dr. ___ at 3:30 p.m. at the time of discovery.
19913620-RR-9
19,913,620
28,109,286
RR
9
2178-05-28 18:30:00
2178-05-28 18:36:00
HISTORY: Fever. TECHNIQUE: PA and lateral views of the chest. COMPARISON: None. FINDINGS: The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present. IMPRESSION: Normal chest radiograph.
19913645-RR-11
19,913,645
26,440,030
RR
11
2122-08-07 19:04:00
2122-08-07 19:24:00
INDICATION: History: ___ with aspirin ingestion// eval for bezoar TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: None. FINDINGS: There are no abnormally dilated loops of large or small bowel. There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. Lung bases are clear. IMPRESSION: No radiopaque foreign body seen. Nonobstructive bowel gas pattern.
19913645-RR-12
19,913,645
26,440,030
RR
12
2122-08-07 19:03:00
2122-08-07 19:16:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with aspirin ingestion// eval for bezoar TECHNIQUE: Chest: Frontal and Lateral COMPARISON: None. FINDINGS: Patient is rotated slightly to the right. Given this, no focal consolidation is seen.There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. Air-fluid level is incidentally noted in the stomach. IMPRESSION: No acute cardiopulmonary process. Air-fluid level is incidentally noted in the stomach without definite radiographic findings to suggest bezoar.
19913743-RR-29
19,913,743
20,807,239
RR
29
2131-03-12 18:08:00
2131-03-12 19:47:00
HISTORY: ___ female with dyspnea. COMPARISON: ___. FINDINGS: A single portable view of the chest. Indistinctness of the pulmonary vascular markings is seen. There is no definite confluent consolidation. Blunting of the costophrenic angles may be due to small effusions, more apparent on the left. Cardiac silhouette is enlarged but given lower lung volumes and portable technique has not significantly changed. No acute osseous abnormality detected. IMPRESSION: Mild pulmonary vascular congestion without consolidation.
19914232-RR-21
19,914,232
23,287,814
RR
21
2164-03-21 03:36:00
2164-03-21 04:01:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with PNA// evaluate for PNA TECHNIQUE: Single frontal view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Lung volumes are slightly low. The uppermost median sternotomy wire is fractured as seen on the prior study. Mediastinal clips are again noted, unchanged since the prior study. Increased interstitial opacities at the lung bases bilaterally are again seen. Again seen is mild pulmonary vascular congestion, improved since the prior study. No pneumothorax or pleural effusion is seen. IMPRESSION: 1. Bibasilar interstitial opacities likely reflect an underlying chronic interstitial process, however a superimposed infectious process cannot be excluded. 2. Mild pulmonary vascular congestion, improved since the prior study.
19914232-RR-22
19,914,232
23,287,814
RR
22
2164-03-21 04:53:00
2164-03-21 05:35:00
EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: History: ___ with hypotension// evaluate for PNA, cause of chest pain 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) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 7.6 mGy (Body) DLP = 3.8 mGy-cm. 2) Spiral Acquisition 3.6 s, 28.1 cm; CTDIvol = 8.8 mGy (Body) DLP = 246.2 mGy-cm. Total DLP (Body) = 250 mGy-cm. COMPARISON: None FINDINGS: HEART AND VASCULATURE: Patient is status post CABG with postsurgical changes noted in the mediastinum. Minimal air in the main pulmonary artery is likely secondary to injection of contrast injection (3:92). Pulmonary vasculature is well opacified to the subsegmental level without filling defect to indicate a pulmonary embolus. The thoracic aorta is normal in caliber without evidence of dissection or intramural hematoma. The heart, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. AXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy. Right hilar and mediastinal lymphadenopathy is noted which may be reactive. Pathy airsace opaciyies...pulm GGO pulm edema ___ infectios process..scattered throughout the lungs PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Patchy ground-glass opacities are scattered throughout the lungs which may be secondary to pulmonary edema however an infectious process cannot be excluded. Honeycombing noted predominantly in the lower lobes bilaterally. 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. BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. IMPRESSION: 1. No evidence of pulmonary embolism or aortic abnormality. 2. Patchy ground-glass opacities in the lungs likely reflect pulmonary edema, however infectious process cannot be excluded. 3. Mediastinal and right hilar lymphadenopathy likely reactive in the setting of recent CABG versus a superimposed infectious process.. 4. Patient is status post CABG with postsurgical changes noted in the mediastinum. 5. Minimal air in the main pulmonary artery is likely secondary to injection of contrast injection (3:92). 6. Fibrosis predominantly in the lower lobes compatible with chronic interstitial lung disease. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 9:02 am, 5 minutes after discovery of the findings.
19914232-RR-23
19,914,232
23,287,814
RR
23
2164-03-23 20:33:00
2164-03-23 22:06:00
INDICATION: ___ year old man with acute on chronic hypoxia// eval for pulm edema, new infiltrate TECHNIQUE: Semi upright portable chest radiograph. COMPARISON: Chest radiograph and CT chest dated ___. FINDINGS: When compared to chest radiograph performed 2 days prior, bilateral diffuse hazy opacities have worsened. Air bronchogram is also demonstrated in the left upper lobe. Constellation of findings is concerning for worsening alveolar edema. However, superimposed infection cannot be ruled out. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is overall stable given technique differences. No acute osseous abnormalities. Midline sternotomy wires are intact. IMPRESSION: Worsening bilateral diffuse hazy opacities with air bronchogram in the left upper lobe, likely representing alveolar edema. Superimposed infection cannot be ruled out. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 9:58 pm, 5 minutes after discovery of the findings.
19914314-RR-8
19,914,314
23,447,403
RR
8
2176-07-22 07:07:00
2176-07-22 08:53:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman w/stemi sp cath // any infiltrate? any infiltrate? COMPARISON: ___ IMPRESSION: Heart size and mediastinum are stable. Lungs are essentially clear. Small amount of left pleural effusion is present. Left minimal basal atelectasis is noted but improved as compared to the prior study. Overall no new consolidations to suggest infectious process noted.
19914512-RR-6
19,914,512
29,040,656
RR
6
2187-06-09 10:46:00
2187-06-09 11:21:00
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST INDICATION: Patient with history of kidney stone presents with right lower quadrant pain. Eval for kidney stone and obstruction TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed without contrast with patient in prone position. Multiplanar reformations were provided. DOSE: DLP: 492 mGy-cm COMPARISON: None. FINDINGS: Lung Bases: The imaged lung bases are clear. Abdomen: Liver is low in attenuation, suggestive of fatty liver. The spleen, gallbladder, adrenal glands, and pancreas appear unremarkable. There is a 3 mm stone in the distal right ureter at the pelvic brim with upstream mild hydroureteronephrosis and right perinephric stranding. Three 1mm nonobstructing renal calculi are identified in the left kidney. The abdominal aorta is normal in course and caliber with scattered atherosclerotic calcifications. Peripherally calcified splenic artery aneurysm measures 9mm. No lymphadenopathy, free air or free fluid is seen. The stomach and duodenum appear normal. Pelvis: Loops of small and large bowel demonstrate no signs of ileus or obstruction. The appendix is unremarkable. There are bilateral fat containing inguinal hernias. Bones: No worrisome lytic or blastic osseous lesion is seen. There is transitional anatomy at the lumbosacral junction with partial sacralization of L5. IMPRESSION: 1. There is an obstructing 3 mm stone in the distal right ureter at the pelvic brim with upstream mild hydroureteronephrosis and right perinephric stranding. 2. Hepatic steatosis. 3. Chronic appearing 9mm splenic artery aneurysm. NOTIFICATION: The updated with read was discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12PM
19914556-RR-77
19,914,556
21,171,044
RR
77
2191-01-14 21:51:00
2191-01-14 22:24:00
INDICATION: Status epilepticus, intubated. Evaluate endotracheal tube position. COMPARISON: None. FINDINGS: A single AP radiograph of the chest was acquired. The patient is rotated to the left. The endotracheal tube ends 4.2 cm above the level of the carina. There is minimal bilateral lower lung atelectasis. The lungs are otherwise clear. The heart size is top normal. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax is seen. IMPRESSION: 1. Appropriately positioned endotracheal tube, ending 4.2 cm above the level of the carina. 2. No acute cardiac or pulmonary process.
19914556-RR-79
19,914,556
21,171,044
RR
79
2191-01-15 00:12:00
2191-01-15 01:34:00
INDICATION: Status epilepticus, with increasing seizures. Evaluate for intracranial ischemia or hemorrhage. TECHNIQUE: Sequential axial images were acquired through the head without the administration of intravenous contrast material. Multiplanar reformats were performed. COMPARISON: None. FINDINGS: There is no evidence of intracranial hemorrhage, edema, or mass effect. There is a right craniotomy and evidence of right temporal lobectomy, with contiguous encephalomalacia and gliosis in the inferior parietal lobe. There is mild associated ex vacuo dilatation of the posterior right lateral ventricle. Mild global prominence of the sulci indicates age-related involutional change. Mild periventricular white matter hypodensities are a non-specific finding that can be seen in the setting of chronic small vessel ischemic disease. The imaged aspects of the paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: No evidence of an acute intracranial process. Evidence of right temporal lobectomy. If clinically warranted, MRI would be more sensitive for evaluation of worsening seizures.
19914556-RR-80
19,914,556
21,171,044
RR
80
2191-01-15 12:47:00
2191-01-17 11:34:00
REASON FOR EXAMINATION: Evaluation of the patient after OG tube placement. AP radiograph of the chest was reviewed in comparison to ___. The ET tube tip is approximately 4.5 cm above the carina. The NG tube tip is in the stomach. Heart size and mediastinum are unchanged in appearance. Lungs are essentially clear with no evidence of pneumothorax.
19914556-RR-81
19,914,556
21,171,044
RR
81
2191-01-16 14:37:00
2191-01-16 16:23:00
INDICATION: ___ male who presents for evaluation of a right upper lobe abnormality. COMPARISONS: Chest radiograph from ___ ___ and ___. TECHNIQUE: PA and lateral radiographs of the chest. FINDINGS: The right upper lobe demonstrates a sclerotic reaction likely at the first rib. This appears to have been stable compared to multiple prior exams dating back to ___. However, to delineate if this is truly at the rib or intraparenchymal, would recommend additional apical lordotic views for further evaluation. There is mild bibasilar atelectasis; otherwise, no focal consolidations are seen. There is no pleural effusion or pneumothorax. The heart size is stable. The hilar and mediastinal contours are unremarkable. IMPRESSION: There is a sclerotic lesion at the right upper lobe which appears to have been stable compared to multiple prior exams dating back to ___. However, to truly delineate if this is intraparenchymal or part of the rib, would recommend apical lordotic views.
19914556-RR-83
19,914,556
21,171,044
RR
83
2191-01-18 14:35:00
2191-01-18 17:20:00
HISTORY: ___ male with seizure disorder and recent status epilepticus. COMPARISON: Comparison is made with MR ___ from ___. TECHNIQUE: MR examination of the head without and then with IV contrast was performed. Sequences include axial and sagittal T1 images, axial FLAIR images, axial T2 images, axial T1 post-contrast images, axial, coronal, and sagittal MPRAGE images, and diffusion images. FINDINGS: The patient is status post right temporal lobectomy. A tiny punctate focus of diffusion abnormality is seen in the right putamen. This is possibly an artifact or may represent a small acute infarct. Otherwise, there is no evidence of acute infarct or intracerebral hemorrhage. No extra-axial blood or fluid collection is present. The ventricles and sulci are normal in size and configuration. No intracranial mass is identified. The major intracranial vessel flow voids are preserved. White-matter hyperintensities in the periventricular region and in the pons are consistent with chronic small vessel ischemic disease. The brainstem, posterior fossa, and cervical medullary junction are preserved. The orbits and periorbital and paracavernous spaces are normal. No abnormality of the skull base or calvarium is identified. A small retention cyst is seen in the left maxillary sinus. The there is fluid in the left mastoid air cells. The other visualized paranasal sinuses, right mastoid air cells, and middle ear cavities are clear. There is no abnormal enhancement after contrast administration. IMPRESSION: 1. No abnormal enhancement after contrast administration. 2. Tiny punctate focus of diffusion abnormality in the right putamen, likely artifact but may represent a small acute infarct. 3. Status post right temporal lobectomy. 4. Chronic small vessel disease in the periventricular white matter and pons. 5. Retention cyst in the left maxillary sinus and fluid in the left mastoid air cells.
19914556-RR-92
19,914,556
20,088,959
RR
92
2194-11-24 17:04:00
2194-11-24 18:01:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: ___ with seizure // Eval for infectious process TECHNIQUE: Chest: Frontal and Lateral COMPARISON: Chest radiograph from ___ and ___ FINDINGS: The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. A left pectoral generator device is again noted, with a wire extending superiorly into the lower neck. There is scoliosis of the thoracic spine. IMPRESSION: No acute cardiopulmonary process.
19915124-RR-54
19,915,124
29,902,030
RR
54
2164-12-12 10:22:00
2164-12-12 11:09:00
HISTORY: ___ man with hemoptysis. COMPARISON: Comparison is made to chest radiographs from ___. FINDINGS: The lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace opacification. IMPRESSION: No acute cardiopulmonary process.
19915270-RR-4
19,915,270
29,339,659
RR
4
2127-03-24 15:00:00
2127-03-24 15:28:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with cough, weakness// ? pna TECHNIQUE: Chest PA and lateral COMPARISON: None. FINDINGS: Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary abnormality.
19915715-RR-3
19,915,715
23,569,430
RR
3
2146-02-04 11:44:00
2146-02-04 14:18:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ with chest pain // Eval acute process TECHNIQUE: Chest PA and lateral COMPARISON: None. FINDINGS: No focal consolidation. No large pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. IMPRESSION: No acute cardiopulmonary process.
19915727-RR-29
19,915,727
22,326,711
RR
29
2169-06-15 20:28:00
2169-06-15 21:43:00
HISTORY: Right calf tenderness with recent induction chemotherapy for AML. TECHNIQUE: Duplex Doppler examination was performed on the right lower extremity. COMPARISON: Right lower extremity ultrasound ___. FINDINGS: There is normal compression and augmentation in the right common femoral, superficial femoral and popliteal veins. There is normal flow seen within the calf veins. Normal respiratory phasicity is seen within the common femoral veins bilaterally. Again, seen with in the distal medial portion of the calf is a heterogeneous nodule which has increased in size, now measuring 3.65 x 1.25 x 1.4 cm and previously measuring 2.7 x 1 x 1.7 cm. This nodule again demonstrates internal flow as demonstrated on Power Doppler. A small amount of fluid is seen superior to the calcaneus. IMPRESSION: 1. No right lower extremity DVT. 2. Right lower extremity nodule with internal vascularity which has increased in size from approximately 2 days prior. Again, this may represent a hematoma, although, a another solid lesion is also a possibility. If this doesn't resolve clinically, either followup ultrasound in 4 weeks or MRI is recommended.
19915727-RR-32
19,915,727
22,326,711
RR
32
2169-06-16 17:11:00
2169-06-17 11:04:00
HISTORY: ___ female with AML and new nodule on right lower extremity ultrasound. COMPARISON: Right lower extremity ultrasound of ___. TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the right calf were obtained on a 1.5 T magnet. Sequences were acquired before and after administration of 6 cc of IV gadolinium contrast. FINDINGS: 1.8 x 1.3 x 3.2 cm (transverse x AP x sagittal ___ lesion centered in the mid-calf between the flexor hallucis longus and soleus muscles is faintly T1-hyperintense to muscle, heterogeneously T2-hyperintense, and has a thick rim of peripheral enhancement with small central nonenhancement. There is moderate adjacent soft tissue edema. The muscular structures of the calf otherwise have normal bulk and signal. This examination is not tailored for evaluation of the ligamentous structures. Within this limitation, the lateral ligamentous structures, deep and superficial deltoid ligaments appear intact. The anterior extensor tendons, medial flexor tendons, and peroneal brevis and longus tendons are intact. The Achilles tendon is normal. The retrocalcaneal and superficial bursa are unremarkable. The cartilage of the tibiotalar and subtalar joints is maintained. The marrow signal is within normal limits. No ankle joint effusion. IMPRESSION: 3.2 x 1.8 x 1.3 x cm lesion centered between the flexor hallucis longus and soleus muscles is faintly T1-hyperintense, heterogeneously T2-hyperintense, and has a thick rim of peripheral enhancement with central nonenhancement. This is of uncertain etiology and could represent a developing hematoma, abscess, or a leukemic focus with central necrosis. This lesion should be followed to resolution. Dr. ___ was unable to be contacted via the paging system and findings were entered into the critical results dashboard for direct notification of the ordering provider.
19915727-RR-35
19,915,727
29,860,853
RR
35
2169-06-22 00:52:00
2169-06-22 02:22:00
INDICATION: History of AML, now with sudden onset pleuritic left lower chest/upper abdominal pain, here to evaluate for evidence of pulmonary embolism or splenic injury. COMPARISON: CT torso with contrast dated ___. TECHNIQUE: Multidetector CT imaging of the chest was obtained using the CTA protocol following the uneventful administration of 100 cc Omnipaque intravenous contrast. Sagittal and coronal reformations as well as bilateral oblique maximum intensity projections were generated and reviewed. Additional axial imaging of the abdomen was obtained in the late arterial phase was also performed. FINDINGS: CHEST: The pulmonary arteries are well opacified to the subsegmental levels without evidence of filling defect to suggest pulmonary embolism. The pulmonary arterial trunk is normal in caliber. The heart is normal in size without pericardial effusion. There is no evidence of acute right heart strain. The thoracic aorta is normal in caliber without evidence of acute aortic syndrome. The thyroid gland is unremarkable. No pathologically enlarged mediastinal, hilar or axillary lymph nodes are detected. The esophagus is within normal limits. The tracheobronchial tree is patent to the subsegmental levels bilaterally. Within the pulmonary parenchyma, two solid pulmonary nodules with surrounding ground-glass change in the left upper lobe measuring 12 x 10 mm (3:97) and in the subpleural left lower lobe measuring 18 x 9 mm (3:117) are decreased in size from ___. No new pulmonary nodules are detected. There is no focal consolidation, pleural effusion or pneumothorax. The patient is status post bilateral subpectoral saline implants. ABDOMEN: A 21 x 17 mm hypodensity in the right hepatic dome (2:99) demonstrates peripheral puddling of contrast on this early phase of imaging, compatible with a benign hemangioma, stable in comparison to the prior CT. An ill-defined hypodensity in the peripheral right lobe measuring 13 mm with surrounding hyper-enhancement (2:104) is incompletely characterized on the current examination. A similar-appearing lesion in the hepatic segment VI (2:133) is also noted. These lesions are not definitely seen on the prior CTs. Two foci of hyper-enhancement measuring less than 5 mm in size are also incompletely characterized on this single phase (2:143, 148) and might be tiny hemangiomas. A 13-mm hypodensity adjacent to the gallbladder fossa (2:153) with peripheral contrast may represent another hemangioma and appears stable. Several smaller hypodensities are unchanged from the prior CT. Central filling defect in the right and main portal vein (2:123) may represent mixing of contrast on this early phase imaging; however, acute thrombus is not entirely excluded. The spleen is mildly enlarged, measuring 13 cm on coronal imaging (previously 14 cm). The gallbladder and biliary tree appear normal. The pancreas and adrenal glands are within normal limits. The kidneys enhance symmetrically without evidence of hydronephrosis. The intra-abdominal loops of bowel are normal in caliber. OSSEOUS STRUCTURES: No osseous destructive lesions concerning for malignancy are detected. IMPRESSION: 1. No evidence of pulmonary embolism or acute aortic pathology. 2. Decreased size of left pulmonary nodules with surrounding ground-glass opacity compared to ___, which may represent atypical/fungal pneumonia in the setting of neutropenia. 3. Filling defect in the right and main portal vein most likely reflects contrast mixing on this late arterial /early venous phase of imaging given patency and normal flow on same day abdominal ultrasound ; however, acute thrombus is not entirely excluded. 4. Stable hepatic hemangioma and additional hepatic lesions incompletely characterized on this single phase of imaging, some of which are not seen on the prior CT and could represent new possibly infectious lesions. Further evaluation with MRI is recommended for characterization. 5. Stable splenomegaly. NOTIFICATION: Findings and recommendations for #4 were communicated by Dr. ___ to Dr. ___ telephone at 8:12 am on ___.
19915727-RR-36
19,915,727
29,860,853
RR
36
2169-06-23 15:38:00
2169-06-23 17:12:00
HISTORY: AML and new onset left upper quadrant pain. CT on admission shows new liver lesions. ?Characterization of new liver lesions. COMPARISON: CT dated ___ and ___. TECHNIQUE: Multiplanar T1 and T2 weighted images were acquired on a 1.5 Tesla magnet including dynamic 3D imaging obtained prior to, during and after the uneventful intravenous administration of 6 mL of Gadavist. FINDINGS: There are multiple ill-defined T2 hyperintense lesions within the liver involving both lobes which are new since the previous CT in ___. These lesions demonstrate a small central area of no enhancement, with thin rim enhancement, and on the arterial phase, there is a larger surrounding area of hyperenhancement which fades on the portal venous and equilibrium phase images (for example, 1001:19). The largest lesion measures 1.1 cm in segment V (1001:64). There are also T2 hyperintense lesions within segment VIII measuring 2 cm and segment IVb measuring 1.7 cm that demonstrate peripheral nodular enhancement on the arterial phase (1001:14 and 1001:99) with centripetal filling in consistent with cavernous hemangiomas. These are unchanged since previous. The liver is otherwise unremarkable. The portal and hepatic veins are patent. The hepatic artery is patent. There is variant hepatic arterial anatomy with the left hepatic artery replaced to the left gastric artery and the right hepatic artery replaced to the SMA. No intra or extrahepatic duct dilatation. The gallbladder is normal. There is a subcentimeter simple cyst within the interpolar region of the right kidney (6:32). The kidneys are otherwise unremarkable. No hydronephrosis. There are single renal arteries bilaterally that are patent. There are two subcentimeter T2 hyperintense lesions within the periphery of the spleen which appear consistent with small cysts. The spleen is otherwise unremarkable. The spleen measures 12 cm in length. The adrenals and pancreas are within normal limits. The visualized small and large bowel is unremarkable. No retroperitoneal or mesenteric adenopathy. Note is made of bilateral breast implants. The lung bases are clear. Bone marrow signal is normal. No destructive osseous lesions. IMPRESSION: 1. Multiple ill-defined T2 hyperintense lesions within the liver that demonstrate rim enhancement post-contrast. These are new since ___ and appear most consistent with multiple small liver abscesses, likely secondary to fungal infection. 2. Two cavernous hemangiomas within segments VIII and IVb of the liver. The findings were issued to Dr ___ (pager ___ by Dr ___ (body MRI fellow) by telephone at 17:00, ___.
19915864-RR-44
19,915,864
29,831,147
RR
44
2155-03-03 18:26:00
2155-03-03 18:51:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with dizziness// eval for acute cardiopulmonary process TECHNIQUE: Portable AP view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Mild to moderate cardiac enlargement is re-demonstrated. There is central mediastinal venous distension with mild interstitial pulmonary edema. Mediastinal and hilar contours are otherwise unremarkable. No focal consolidation, pleural effusion, or pneumothorax. No acute osseous abnormality. IMPRESSION: Mild interstitial pulmonary edema.
19915864-RR-45
19,915,864
29,831,147
RR
45
2155-03-04 13:44:00
2155-03-04 14:28:00
EXAMINATION: BILAT LOWER EXT VEINS INDICATION: ___ year old woman with PMH diabetes, CKD, p/w new lower extremity edema, anemia// eval for DVT TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the bilateral lower extremity veins. COMPARISON: ___ FINDINGS: There is normal compressibility, flow, and augmentation of the bilateral common femoral, femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the left posterior tibial and peroneal veins. The right calf veins could not be visualized. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. IMPRESSION: No evidence of deep venous thrombosis in the right or left lower extremity veins. The right calf veins were not visualized.
19915864-RR-47
19,915,864
21,418,790
RR
47
2156-02-07 10:54:00
2156-02-07 11:49:00
INDICATION: ___ year old woman with acute on chronic anemia s/p capsule endoscopy. Exam to evaluate for position of capsule. // Location of capsule. TECHNIQUE: Frontal, supine radiograph of the abdomen and pelvis. COMPARISON: There was no prior imaging of the abdomen available for comparison. FINDINGS: There are no abnormally dilated loops of large or small bowel. There is no gross free intraperitoneal air, however this examination is somewhat limited due to the supine assessment. The lower lumbar spine shows moderate degenerative changes in the form of osteophytosis and disc space narrowing. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. There is an endoscopy capsule overlying the right upper quadrant. IMPRESSION: There is an endoscopy capsule projecting over the right upper quadrant, likely within the ascending colon. No features of bowel obstruction.
19915923-RR-12
19,915,923
22,730,128
RR
12
2177-03-30 13:04:00
2177-03-30 14:22:00
INDICATION: ___ with anti synthetase syndrome here with myalgias and weakness// rule out pneumonia TECHNIQUE: Frontal and lateral views of the chest. COMPARISON: Chest x-ray from ___. CT chest from ___. FINDINGS: There is no consolidation or effusion. Cardiac silhouette is within normal limits. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary process.
19915923-RR-13
19,915,923
22,730,128
RR
13
2177-04-03 10:49:00
2177-04-05 09:59:00
INDICATION: ___ year old woman with hypothyroidism and anti-synthetase syndrome, admitted for weakness, getting IVIG, now with severe abdominal pain.// ?bowel obstruction, free air TECHNIQUE: Portable supine and upright abdominal radiographs were obtained. COMPARISON: CT abdomen pelvis from ___ FINDINGS: There are no abnormally dilated loops of large or small bowel with gas and stool visualized throughout the colon to the level of the rectum. There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Nonspecific, nonobstructive bowel gas pattern with no pneumoperitoneum identified.
19915985-RR-7
19,915,985
28,996,362
RR
7
2132-11-22 12:53:00
2132-11-22 13:31:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: NO_PO contrast; History: ___ with rlq painNO_PO contrast// r/o appy TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.2 mGy (Body) DLP = 14.1 mGy-cm. 2) Spiral Acquisition 7.7 s, 59.3 cm; CTDIvol = 22.1 mGy (Body) DLP = 1,309.0 mGy-cm. 3) Spiral Acquisition 0.6 s, 3.3 cm; CTDIvol = 23.6 mGy (Body) DLP = 78.2 mGy-cm. Total DLP (Body) = 1,401 mGy-cm. COMPARISON: None. FINDINGS: LOWER CHEST: Visualized lung fields are within normal limits. There is no evidence of pleural or pericardial effusion. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. No hydronephrosis. There is a 1.2 cm left renal cortical cyst. Additional hypodensities are seen bilaterally and are too small to characterize by CT but statistically likely represent additional cysts.. There is no perinephric abnormality. GASTROINTESTINAL: The appendix is edematous and dilated up to 1.2 cm with mural edema and hyperemia. A hyperdensity near the proximal appendix is consistent with represent a fecalith (series 2, image 71). There is severe right lower quadrant stranding with trace, nonenhancing fluid. There is also thickening of the cecum and the terminal ileum, which is likely reactive to the adjacent inflammation (series 2, image 74). Tiny foci of extraluminal air are concerning for perforation (series 601, image 31). The stomach and small bowel are otherwise within normal limits. There is diverticulosis of the colon. PELVIS: The urinary bladder is normal. There is some prominence of the right mid to distal ureter as it passes near the appendiceal inflammation (series 2, image 73). Otherwise the ureters are normal. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly unremarkable. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. No substantial 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. Appendicitis with dilatation of the appendix to 1.2 cm near the tip. Trace foci of free air are concerning for perforation. A focal area of high density near the base of the appendix could represent an appendicolith. There is a small amount of free fluid. Small volume fluid at the base of the cecum, with no evidence of organized drainable collection. 2. Adjacent to the appendicitis there is substantial right lower quadrant stranding and thickening involving the nearby cecum and terminal ileum as well as a focal area of prominence of the mid to distal ureter, most likely secondary to the appendicitis.
19916349-RR-14
19,916,349
29,238,144
RR
14
2201-09-05 15:03:00
2201-09-05 15:52:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ with ruq pain+ ___ // ? acute chole 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. Main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm. GALLBLADDER: There are multiple gallstones in a distended gallbladder. There is no evidence of gallbladder wall thickening or pericholecystic fluid. PANCREAS: Imaged portion of the pancreas appears within normal limits, without masses or pancreatic ductal dilation, with portions of the pancreatic body and tail obscured by overlying bowel gas. KIDNEYS: Visualized portions of the right kidney are normal. RETROPERITONEUM: Visualized portions of aorta and IVC are within normal limits. IMPRESSION: The gallbladder is distended and contains multiple gallstones. These findings can be seen in the setting of acute cholecystitis in the correct clinical setting although no other findings of acute cholecystitis are noted.
19916349-RR-15
19,916,349
29,238,144
RR
15
2201-09-05 19:22:00
2201-09-05 19:54:00
INDICATION: ___ with RUQ abd pain. Please eval for intraabdominal source of infection TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after the uneventful administration of intravenous contrast. Images were displayed in multiple planes. DOSE: DLP: 290.68 mGy-cm COMPARISON: Abdominal ultrasound ___. FINDINGS: The lung bases are clear. Limited imaging of the heart reveals no pericardial effusion or cardiomegaly. CT ABDOMEN: The liver enhances homogeneously. There are no focal liver lesions. The portal and hepatic veins are patent. There is no intra or extrahepatic biliary dilatation. The gallbladder is distended and there is pericholecystic fluid. The pancreas enhances homogeneously. The spleen and adrenal glands are normal. The kidneys enhance and excrete contrast promptly. There are no concerning renal lesions. There is no retroperitoneal or abdominal adenopathy. No free air or free fluid is present. The aorta and its major branches are patent and not dilated. The stomach and intra-abdominal loops of bowel are normal caliber and appearance. The appendix is visualized in the right lower quadrant and appears normal. CT PELVIS: The remainder of the bowel is normal. The bladder is very distended. The uterus appears normal. There is no free pelvic fluid. There is no inguinal or pelvic adenopathy. OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion identified. IMPRESSION: Distended gallbladder with pericholecystic fluid. In the appropriate clinical setting these findings could represent acute cholecystitis. Markedly distended bladder.
19916836-RR-7
19,916,836
20,562,862
RR
7
2141-12-03 15:22:00
2141-12-04 10:25:00
STUDY: Unilateral lower extremity arterial duplex. REASON: Left calf claudication. FINDINGS: Duplex was performed of the left lower extremity arterial system. Common femoral artery is patent with a triphasic waveform. The profunda is patent with a monophasic waveform. The SFA is patent with triphasic waveforms. Popliteal is patent with triphasic waveforms. The posterior tibial, peroneal and anterior tibial are patent with biphasic waveforms. Plaque is seen within the common femoral artery. Peak velocities are 154 in the external iliac distally, 141 in the common femoral, 131 in the profunda, 117, 123, 179 and 125 in the SFA, 53 and 47 in the popliteal, 41 in the posterior tibial, 34 in the peroneal and 43 in the anterior tibial. IMPRESSION: Left common femoral plaque without evidence of velocity step up from the external iliac through the tibial vessels.
19916836-RR-8
19,916,836
20,562,862
RR
8
2141-12-03 17:42:00
2141-12-03 18:32:00
INDICATION: Left lower extremity pain. Evaluate for DVT. COMPARISON: None. FINDINGS: Grayscale and color sonograms were acquired of the left common femoral, superficial femoral, popliteal, posterior tibial, and peroneal veins. There is normal compressibility, flow, and augmentation throughout. IMPRESSION: No evidence of DVT in the left lower extremity.
19916836-RR-9
19,916,836
20,562,862
RR
9
2141-12-04 09:31:00
2141-12-04 11:31:00
LEFT TIB-FIB SERIES, ___ AT 9:32 CLINICAL INDICATION: ___ with worsening left calf pain with walking, question stress fracture. No comparison studies. Two views of the left tibia and fibula are submitted. Bony mineralization is normal. There is no evidence of a displaced fracture or dislocation. No periosteal reaction is identified. No radiopaque foreign bodies are seen within the overlying soft tissues. If the patient's symptoms persist, followup imaging could be performed. IMPRESSION: No evidence of displaced fracture or dislocation of the left tibia or fibula.
19916882-RR-32
19,916,882
26,055,942
RR
32
2141-02-04 05:58:00
2141-02-04 09:28:00
INDICATION: ___ with multiple SBOs in the past. Evaluate for SBO. TECHNIQUE: Supine and upright AP films of the abdomen. COMPARISON: Abdominal radiograph from ___ FINDINGS: There are no abnormally dilated loops of large or small bowel. There is no free intraperitoneal air. Incidentally noted are well-healed left superior and inferior pubic ramus fractures. . Skin staples are seen in the midline. T IMPRESSION: No evidence small bowel obstruction.
19916882-RR-33
19,916,882
26,055,942
RR
33
2141-02-04 06:46:00
2141-02-04 07:57:00
EXAMINATION: Chest radiograph INDICATION: History: ___ with SBO s/p NGT*** WARNING *** Multiple patients with same last name! // Confirm NGT placement TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph from ___ FINDINGS: An enteric tube terminates in the stomach. The bilateral lung apices are cut off from the exam a cannot be evaluated. However, the remaining visualized lungs appear clear without evidence of focal consolidation or pulmonary edema. The heart size is normal. The mediastinal silhouette, hilar contours, and pleural surfaces are normal. IMPRESSION: An enteric tube terminates in the stomach. Otherwise, no acute cardiopulmonary process in the visualized lungs.
19916931-RR-12
19,916,931
21,668,263
RR
12
2132-12-23 12:53:00
2132-12-23 13:50:00
INDICATION: A ___ man with history of smoking and delayed gastric emptying. Please assess for consolidation. TECHNIQUE: Frontal and lateral radiographs of the chest were obtained. COMPARISON: There are no comparison studies available. FINDINGS: The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. IMPRESSION: No acute cardiothoracic process.
19916931-RR-13
19,916,931
21,668,263
RR
13
2132-12-23 14:23:00
2132-12-23 16:30:00
INDICATION: ___ man presenting with delayed gastric emptying and abdominal pain and vomiting. Question gastric outlet obstruction. COMPARISONS: None. TECHNIQUE: MDCT axial imaging was obtained from the lung bases through the pubic symphysis following the administration of intravenous and oral contrast material. Coronal and sagittal reformats were completed. FINDINGS: CT ABDOMEN WITH CONTRAST: The visualized heart and pericardium are unremarkable. There is no pericardial effusion. The lung bases are clear. The liver enhances homogenously without any focal lesions. The portal vein is patent. There is no intra- or extra-hepatic biliary dilatation. The gallbladder, pancreas, and spleen are unremarkable. The adrenal glands are unremarkable. The kidneys enhance and excrete contrast symmetrically without any hydronephrosis. There is a 1.8 cm left parapelvic cyst. Additional small cortical hypodensities are seen in the left and right kidneys which are too small to characterize but likely represent cysts. The stomach is markedly distended consistent with gastric outlet obstruction. There is soft tissue thickening of the pylorus and duodenum (image 2:23 and 601B:25) that may be due to inflammatory changes from ulcer disease as seen on recent EGD, however malignancy cannot be excluded. There is no lymphadenopathy seen. The visualized intra-abdominal small and large bowel are unremarkable. The appendix is normal. There is no free fluid or free air within the abdomen. There is a small infrarenal aortic aneurysm measuring up to 3.2 cm (image 2:36). CT PELVIS: The bladder, rectum, and prostate gland are unremarkable. There is diverticulosis of the sigmoid colon but no diverticulitis. There is no free fluid or free air or lymphadenopathy within the pelvis. OSSEOUS STRUCTURES: There are mild degenerative changes in lumbar spine as demonstrated by anterior osteophytes. IMPRESSION: 1. Gastric outlet obstruction with soft tissue thickening of the pylorus and duodenum which may be due to inflammatory changes from ulcer disease, as seen on recent prior EGD. While malignancy cannot be excluded, there is no evidence of metastatic disease. 2. Diverticulosis without diverticulitis. 3. Left parapelvic cyst. Cortical hypodensities in the kidneys that are too small to characterize but most likely represent cysts. 4. 3.2 cm infrarenal abdominal aortic aneurysm.
19916931-RR-14
19,916,931
21,668,263
RR
14
2132-12-26 14:52:00
2132-12-26 17:01:00
REASON FOR EXAMINATION: Evaluation of the patient with NG tube placement for gastric outlet obstruction. AP radiograph of the chest was reviewed in comparison to ___. The NG tube tip is in the stomach. The heart size and mediastinum are unremarkable. Lungs are essentially clear. No pleural effusion or pneumothorax is seen.
19916931-RR-15
19,916,931
21,668,263
RR
15
2132-12-27 03:59:00
2132-12-27 13:25:00
AP CHEST, 3:53 A.M., ___ HISTORY: Gastric outlet obstruction. NG tube placed. IMPRESSION: AP chest compared to ___: Lungs are clear. Heart size normal. No pleural abnormality. Nasogastric tube passes to the region of pylorus.
19916931-RR-16
19,916,931
21,668,263
RR
16
2132-12-27 05:12:00
2132-12-27 10:59:00
INDICATION: ___ male with gastric outlet obstruction, status post nasogastric tube replacement. SINGLE FRONTAL CHEST RADIOGRAPH. ___. An enteric feeding tube courses through the stomach with tip out of field of view. The lungs are essentially clear. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are normal. Pulmonary vascularity is normal. IMPRESSION: Enteric feeding tube courses through the stomach with tip out of field of view.
19916931-RR-17
19,916,931
21,668,263
RR
17
2132-12-27 10:43:00
2132-12-27 16:39:00
INDICATION: Gastric outlet obstruction at duodenal bulb. Evaluate for pancreatic mass. TECHNIQUE: Pre- and post-contrast CTA of the abdomen using pancreatic CTA protocol. Coronal and sagittal reformats were obtained. COMPARISON: CT of the abdomen and pelvis on ___. FINDINGS: There has been interval decompression of the stomach, a nasogastric tube is noted terminating in the body of the stomach. There is diffuse mucosal thickening throughout the stomach with enhancement and obstruction at the pylorus. There is a 3.9 x 3.8 cm enhancing ill-defined mass lesion in the first portion. There are focal areas in the body of the stomach with oral contrast layering deep within the wall that may represent ulcers (4:53). There is no periportal, mesenteric, or retroperitoneal lymphadenopathy. There is no free air or free fluid. No pancreatic mass is noted. There is no intra- or extra-hepatic biliary ductal dilatation or pancreatic duct dilatation. The liver enhances homogenously and there are no focal liver lesions. The gallbladder, spleen, and adrenal glands are unremarkable. The kidneys enhance and excrete contrast without evidence of hydronephrosis or mass. Bilateral subcentimeter hypodensities in the kidneys are noted, likely representing simple cysts. An 18-mm hypodensity in the lower pole of left kidney likely represents a parapelvic cyst. The visualized portions of the small bowel are unremarkable. A dense amount of oral contrast is noted in the hepatic flexure of the colon with significant streak artifact, but is otherwise unremarkable. Diverticula of the descending colon without surrounding fat stranding or mucosal enhancement are noted. The lung bases are clear. The visualized portions of the heart and pericardium are unremarkable. Mild atherosclerotic changes of the descending aorta and a 3.1 cm infrarenal abdominal aortic aneurysm are noted. OSSEOUS STRUCTURES: There are no suspicious lytic or blastic lesions. IMPRESSION: 1. Interval decompression of the stomach following NG tube insertion with persistent obstruction at the pylorus/first portion of the duodenum. There is an ill-defined, enhancing mass lesion measuring 3.9 cm. The differential of this finding is wide. Possibilities include lymphoma, granulomatous infiltration, ulcerative gastritis, ___ syndrome, infectious etiology such as TB, eosinophilic gastritis, or metastatic disease. No pancreatic mass is identified. 2. Diverticulosis without diverticulitis. 3. 3.1 infrarenal abdominal aortic aneurysm.
19916931-RR-18
19,916,931
21,668,263
RR
18
2132-12-30 15:12:00
2132-12-30 17:20:00
INDICATION: Need for TPN, PICC line placement. COMPARISON: Chest radiograph on ___. FINDINGS: One upright portable view of the chest. The right PICC line ends in the mid SVC. Enteric feeding tube is seen with its tip out of view on this film. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. There is no pulmonary vascular engorgement. IMPRESSION: Right PICC line ends in mid SVC. These findings were reported to the IV nurse at 3:30 p.m. on ___ by telephone.
19916931-RR-19
19,916,931
21,668,263
RR
19
2133-01-03 14:44:00
2133-01-03 16:09:00
TYPE OF EXAMINATION: Chest AP portable single view. INDICATION: ___ male patient with gastric outlet obstruction with concerns for NG tube misplacement, evaluate for NG tube position. FINDINGS: AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Previously described right-sided subclavian central venous line is unchanged. An NG tube present at that time apparently has been withdrawn and been replaced with a new tube. The new tube reaches well into the lower esophagus but only advances some few centimeters beyond the diaphragmatic contour. It is recommended to advance it another 10 cm or so to achieve the desired position. No other interval changes can be seen in the chest examination. The information was transmitted by telephone to the ward at the time of dictation.
19917153-RR-13
19,917,153
20,579,779
RR
13
2163-08-17 20:53:00
2163-08-18 10:51:00
MRI LIVER: INDICATION: Elevated LFTs. Evaluation of liver mass. COMPARISON: Outside hospital CT ___. TECHNIQUE: Multiplanar T1- and T2-weighted imaging were acquired on a 1.5 Tesla magnet including dynamic 3D imaging obtained prior to, during and after the uneventful intravenous administration of 15 mL of Magnevist. FINDINGS: A 4 mm nodule is noted peripherally within the left lower lobe as previously described on prior CT examination from ___. No pleural or pericardial effusions are identified. There is diffuse drop in signal intensity on the out-of-phase imaging of the hepatic parenchyma consistent with fatty deposition within the liver with focal areas of sparing in the gallbladder fossa (series 6, image 21). Within the subcapsular aspect of segments V-VI of the liver, a 2.5 x 3.7 cm lesion is identified. It has a peripheral hyperintense ring on T1-weighted imaging with some central areas of isointense signal intensity on T1-weighted imaging (series 5, image 47) and it is minimally hyperintense relative to hepatic parenchyma on T2-weighted imaging (series 6, image 29). It demonstrates no internal enhancement post-contrast (series 1101, image 40). Findings are associated with volume loss within the adjacent segments and associated capsular retraction and most likely represents a chronic hematoma; most likely related to sequelae of previous trauma or prior liver biopsy if there is a history of same. There are no concerning focal hepatic liver lesions. There is no intra- or extra-hepatic biliary dilatation. No gallstones are evident within the gallbladder. There is conventional hepatic arterial anatomy, and the visualized hepatic and portal veins are patent. The spleen is normal in size with a congenital cleft seen posteriorly (series 6, image 21). The splenic vein is somewhat attenuated (series 6, image 22), however, is patent throughout its length. Pancreas is homogeneous in parenchymal signal intensity on the T1-weighted imaging. There is marked peripancreatic stranding and free fluid, most notable surrounding the distal body and tail of the pancreas. There are numerous peripancreatic collections identified which are of heterogeneous increased signal intensity on T2-weighted imaging and most likely represent walled-off regions of ___ fat necrosis, which appears to have liquefied. The first is seen lateral to the greater curvature of the stomach measuring 2.7 x 2.6 cm and inferior to this measuring 3.2 x 4.4 cm. There is a larger collection seen longitudinally along the body of the pancreas inferiorly measuring 3.3 x 6.9 cm. Post- contrast administration, there is homogeneous enhancement of the gland except in the region of the tail which is surrounded by extensive peripancreatic stranding and early necrosis cannot be entirely excluded. There are no pancreatic cystic or solid lesions. There is no pancreatic ductal dilatation. The adrenal glands are unremarkable. Posteriorly in the interpolar region of the right kidney, there is a 5 mm lesion identified which is hyperintense relative to renal parenchyma on T1-weighted imaging (series 5, image 15) and does not demonstrate enhancement post-contrast (series 1101, image 11) consistent with a hemorrhagic / proteinaceous cyst. In addition, a 5 mm simple cyst is noted in the upper pole of the right kidney which is hyperintense relative to renal parenchyma on T2-weighted imaging and does not enhance post-contrast (series 1101, image 29). There are no retroperitoneal masses or adenopathy. No abnormally dilated or thickened small or large bowel loop in the visualized upper abdomen. Bone marrow signal is normal, and no osseous lesions are identified. IMPRESSION: 1. Subcapsular segment V-VI liver lesion which has MR imaging characteristics consistent with a chronic hematoma. Findings most likely represent prior sequelae of trauma or liver biopsy if this has been performed previously. No concerning focal hepatic lesion seen. 2. Evidence for resolving pancreatitis with minimal decreased enhancement noted within the tail of the pancreas, and early necrosis of the gland cannot be entirely excluded. There is peripancreatic stranding and free fluid most notable surrounding the tail of the pancreas. 3. Numerous walled-off regions of peripancreatic fat necrosis, which appear to have liquefied surrounding the pancreas, as described. FINDINGS WERE DISCUSSED WITH ___. ___ VIA TELEPHONE AT 9:04AM ON ___.
19917153-RR-15
19,917,153
27,795,890
RR
15
2167-10-12 14:06:00
2167-10-12 16:13:00
EXAMINATION: CTA ABD AND PELVIS INDICATION: ___ year old woman with biliary obstruction and longstanding EtOH dependence. // hypoechoic nodules on ultrasound in ___. Have they progressed? TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast images were acquired through the abdomen and pelvis. Oral contrast was not administered. MIP reconstructions were performed on independent workstation and reviewed on PACS. DOSE: Total DLP (Body) = 1,664 mGy-cm. COMPARISON: MRCP ___, abdominal ultrasound ___, CT abdomen pelvis ___. FINDINGS: VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium burden in the abdominal aorta and great abdominal arteries. LOWER CHEST: Bibasilar atelectasis is greater on the right. There is no pleural or pericardial effusion. The heart is normal in size. ABDOMEN: HEPATOBILIARY: Diffuse low-density of the liver is consistent with steatosis. There are no suspicious focal liver lesions. A 3.0 x 1.7 cm lesion along segment ___ with capsular retraction is again noted, consistent with a chronic hematoma. Mild central intrahepatic biliary duct dilatation is noted with dilation of the common bile duct. This appears stable compared to the prior MRCP. The distal CBD tapers as expected without evidence of focal lesions. The gallbladder is nondistended. PANCREAS: The pancreas has normal attenuation throughout, without evidence of pancreatic ductal dilatation. A hypodensity along the ventral aspect of the pancreatic body is again noted, compatible with a chronic hematoma (series 3, image 52). A small amount of stranding adjacent to the pancreatic head is new. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of stones, concerning focal renal lesions, or hydronephrosis. Several punctate hypodensities in both kidneys are too small for further characterization. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable in appearance. A small amount of stranding and fluid is present adjacent to the second portion of the duodenum and the pancreatic head. The remaining small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. Colon and rectum are within normal limits. Appendix is not visualized. A small amount of free fluid is present in the right lower quadrant. There is no evidence of mesenteric lymphadenopathy. RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. A small amount of free fluid is present pelvis. REPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable. 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. Hepatic steatosis without evidence of concerning focal hepatic lesions. 2. New mild stranding adjacent to the duodenum and pancreatic head, compatible with mild pancreatitis after ERCP. 3. Stable CBD and intrahepatic ductal dilation. 4. Stable hepatic and pancreatic fluid collections, previously characterized as chronic hematomas.
19917153-RR-16
19,917,153
27,795,890
RR
16
2167-10-12 14:06:00
2167-10-12 14:23:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old woman with pancreatitis, new cough, neutropenia // pneumonia? Crackles in RLL. pneumonia? Crackles in RLL. IMPRESSION: In comparison with the radiographs of ___ and ___, there has been essentially complete clearing of the previously described consolidation. No evidence of acute focal pneumonia or vascular congestion at this time.
19917249-RR-101
19,917,249
23,538,355
RR
101
2185-01-11 01:05:00
2185-01-11 01:57:00
EXAMINATION: DX TIB/FIB AND ANKLE INDICATION: History: ___ with ankle and tib/fib pain// Fracture TECHNIQUE: Frontal and lateral views of the left tib-fib. COMPARISON: Multiple prior radiographs, most recently ___. FINDINGS: As before, the patient is status post ORIF of a proximal tibia and distal fibular fracture with placement of medial and lateral fixation plates and screws in the proximal to mid tibia as well as a lateral fixation plate and screws in the distal fibula. Compared to ___, there is a new lucency in the mid tibial diaphysis at approximately the level of the inferior most screw with increased lucency surrounding the inferior most aspect of the lateral fixation plate. As before, there is bridging callus formation in the mid fibula. Numerous ghost tracks are seen within the mid to distal tibia. IMPRESSION: 1. There is an acute nondisplaced fracture through the mid tibial diaphysis at approximately the level of the inferior most screw. 2. Increased lucency surrounding the inferior most screw and the distal aspect of the lateral fixation plate in the tibia suggest hardware loosening at this level. 3. Evidence of continued healing of the mid fibular fracture, which is in unchanged alignment.
19917249-RR-102
19,917,249
23,538,355
RR
102
2185-01-11 02:34:00
2185-01-11 04:45:00
EXAMINATION: CHEST (SINGLE VIEW) INDICATION: History: ___ with left leg pain iso tib/fib fracture with splint applied; pre-op cxr// Plain Film: eval for post-splint CXR: eval for PNA COMPARISON: Multiple prior chest radiographs dating back to ___, most recently ___. FINDINGS: AP portable upright view of the chest provided. Lung volumes remain slightly low bilaterally with bibasilar atelectasis. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is borderline enlarged, although this may be exaggerated by the AP technique and low lung volumes. No acute osseous abnormalities are seen. IMPRESSION: Low lung volumes with bibasilar atelectasis.
19917249-RR-103
19,917,249
23,538,355
RR
103
2185-01-11 02:35:00
2185-01-11 04:57:00
EXAMINATION: TIB/FIB (AP AND LAT) LEFT INDICATION: History: ___ with left leg pain iso tib/fib fracture with splint applied; pre-op cxr// Plain Film: eval for post-splint CXR: eval for PNA TECHNIQUE: Frontal and lateral view radiographs of the left tibia and fibula. COMPARISON: Multiple prior tib-fib radiographs, most recently ___ at 01:22. FINDINGS: As before, the patient is status post ORIF of the proximal tibia and distal fibular fracture with placement of mediolateral fixation plates and screws in the proximal to mid tibia as well as the lateral fixation plate and screws in the distal fibula. Again seen is a nondisplaced periprosthetic fracture in the mid tibial diaphysis approximately the level of the inferior most screw. There is similar lucency surrounding the lateral fixation plate suggesting loosening at this level. As before, there is bridging callus formation in the mid fibula, although the fracture lucency remains visible. Numerous ghost tracks are again seen in the mid to distal tibia. The bones are diffusely demineralized secondary to disuse. Limited views of the knee and ankle demonstrate no additional fractures. There is no knee joint effusion. Incidentally noted is an os trigonum as well as an os peroneum. IMPRESSION: 1. Re-demonstration of a nondisplaced periprosthetic fracture in the mid tibial diaphysis at approximately the level of the inferior most screw. No additional fractures are identified. 2. Unchanged lucency surrounding the lateral fixation plate may suggest hardware loosening.
19917249-RR-105
19,917,249
23,538,355
RR
105
2185-01-12 12:04:00
2185-01-12 14:53:00
EXAMINATION: TIB/FIB (AP AND LAT) LEFT INDICATION: ORIF Left tibia. COMPARISON: Preoperative radiographs of the Left tibia fibula ___. FINDINGS: 7 intraoperative fluoroscopic images, obtained without a radiologist present, demonstrates placement of intramedullary nail and distal interlocking screws, for fixation of a periprosthetic fracture in the mid tibial diaphysis, with removal of the proximal-most screws about the buttress plates. Total intraoperative fluoroscopic time is 173.3 seconds. IMPRESSION: Please refer to operative report.
19917249-RR-107
19,917,249
23,538,355
RR
107
2185-01-13 10:01:00
2185-01-13 12:03:00
INDICATION: ___ year old man with L tibia fx, now s/p ___ screws and tibial ___// s/p ___ and ___ COMPARISON: Intraoperative study from ___ and prior study from ___ IMPRESSION: There has been removal of the screws within the medial fracture plate. There is an intramedullary rod with proximal and distal interlocking screws within the tibia. There are several screw fragments within the proximal tibia. Distal fibular fracture plate is also seen. Fractures of the proximal and mid fibular shafts are seen. Healed fracture deformities throughout the tibia are also seen. There are skin staples consistent with the recent surgery. Forming of the calcaneus remains unchanged.
19917249-RR-108
19,917,249
23,538,355
RR
108
2185-01-13 13:38:00
2185-01-13 15:51:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with evaluation for pulm edema// is there pulmonary edema? TECHNIQUE: Chest frontal and lateral radiograph COMPARISON: Multiple prior chest radiographs most recently from ___ FINDINGS: Enlarged cardiac silhouette is stable. Lung volumes are low with bibasilar atelectasis. Minimal indistinctness of pulmonary vessels may represent minimal pulmonary vascular congestion. No focal consolidation is seen. No large pleural effusion. No pneumothorax. IMPRESSION: Stably enlarged heart with minimal pulmonary vascular congestion.
19917249-RR-109
19,917,249
23,538,355
RR
109
2185-01-14 16:00:00
2185-01-14 16:45:00
EXAMINATION: RENAL TRANSPLANT U.S. RIGHT INDICATION: ___ PMH ESRD ___ diabetic nephropathy s/p DCD kidney transplant on ___, diabetes, multiple fractures in his tibia and fibula status post repair, who presents as a transfer with a left tibia and fibula fracture. Postop course c/b ___// any e/o hydronephrosis or other acute process? TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images of the renal transplant were obtained. COMPARISON: Renal transplant ultrasound ___ FINDINGS: The right iliac fossa transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. There is no hydronephrosis and no perinephric fluid collection. The resistive index of intrarenal arteries ranges from 0.82 to 0.85, within the elevated range. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 83 cm per second. Vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. IMPRESSION: Elevated resistive indices of the intrarenal arteries. No hydronephrosis is identified.
19917249-RR-110
19,917,249
23,538,355
RR
110
2185-01-18 15:29:00
2185-01-18 17:28:00
EXAMINATION: TIB/FIB (AP AND LAT) LEFT INDICATION: surgery// post op TECHNIQUE: AP and lateral views of the left tibia and fibula COMPARISON: Left tibia and fibula radiographs ___ FINDINGS: As seen previously the patient is status post revision and removal of hardware. An intramedullary rod is seen in the tibia with proximal and distal interlocking screws. Multiple screw fragments are seen in the proximal tibia. Medial and lateral fracture plates remain in-situ, unchanged in appearance. The fracture in the mid tibial diaphysis remains visible. There has been prior open reduction internal fixation of a distal fibular fracture, the fibular hardware appears intact and unchanged in appearance. Fractures of the proximal and mid fibular shaft are also seen, unchanged in appearance. Deformity of the subtalar joint is incompletely assessed on this study. The patient is status post amputation of the first ray at the level of the mid metatarsal. IMPRESSION: Postoperative changes as described, no significant interval change when compared to the prior study.
19917249-RR-58
19,917,249
27,437,373
RR
58
2183-06-25 04:32:00
2183-06-25 05:29:00
EXAMINATION: Chest radiograph INDICATION: History: ___ with L tib fib fracture. pre-op CXR// Pre-op CXR TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph from ___ FINDINGS: Lung volumes are low. No focal consolidations identified. There is no pulmonary edema, pneumothorax, or pleural effusion. The cardiomediastinal silhouette is accentuated by low lung volumes, but unchanged. IMPRESSION: Hypoinflated lungs without acute cardiopulmonary process.
19917249-RR-59
19,917,249
27,437,373
RR
59
2183-06-25 14:24:00
2183-06-25 19:04:00
INDICATION: Surgical guidance during operative fixation. TECHNIQUE: Intraoperative fluoroscopic images with continuous fluoroscopic time of 178.1 seconds. COMPARISON: Reference study from ___ FINDINGS: 5 intraoperative images were acquired without a radiologist present. Images show fixation hardware within the tibia and fibula with tibial IM rod and lateral plate and screw fixation of the distal fibula. IMPRESSION: Intraoperative images were obtained during ORIF. Please refer to the operative note for details of the procedure.
19917249-RR-60
19,917,249
27,437,373
RR
60
2183-06-26 09:49:00
2183-06-26 12:05:00
EXAMINATION: RENAL TRANSPLANT U.S. RIGHT INDICATION: ___ year old man with hx renal transplant, increasing Cr. Recommended per nephrology// to assess kidneys in setting of increasing Cr TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images of the renal transplant were obtained. COMPARISON: Renal transplant ultrasound ___ FINDINGS: The right lower quadrant transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. There is no hydronephrosis and no perinephric fluid collection. The resistive index of intrarenal arteries ranges from 0.77-0.85 within the elevated range. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 92 cm/sec. Vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. IMPRESSION: Normal appearance of the transplanted kidney with no hydronephrosis or perinephric collections identified. The resistive indices of the intrarenal arteries are mildly elevated, stable when compared to the prior ultrasound from ___.
19917249-RR-69
19,917,249
24,378,207
RR
69
2183-09-13 01:13:00
2183-09-13 01:45:00
EXAMINATION: CT left lower extremity. INDICATION: ___ year old man with recent rod, cellulitis now// eval for deep space infection. any questions, please page orthopedics resident (___) TECHNIQUE: MDCT images of the left lower extremity from the left knee through the left but were obtained without IV contrast. Coronal and sagittal reformats were provided. DOSE: Acquisition sequence: 1) Spiral Acquisition 7.2 s, 56.6 cm; CTDIvol = 16.9 mGy (Body) DLP = 959.2 mGy-cm. Total DLP (Body) = 959 mGy-cm. COMPARISON: ___ FINDINGS: There is diffuse subcutaneous edema of the left lower extremity extending from proximal calf to the distal calf, centered predominantly anteriorly and extending into the margin of the anterior tibia. This is overall grossly stable compared to exam in ___ there is no discrete fluid collection or subcutaneous emphysema seen. Healing fractures across the proximal tibia and fibula as well as the distal tibia and fibula are again noted. Intramedullary rod is seen in the tibia. Plate and screws are seen at the distal fibula. The loosening of a interlocking screw in the proximal tibia with approximately 1.0 cm of withdrawal beyond the cortex, grossly stable from prior. Additional loosening of an interlocking screw in the distal tibia with approximately 0.4 cm a draw from the cortex is grossly stable from prior. There is small joint effusion of the left knee. IMPRESSION: 1. Stable diffuse edema and fluid in the subcutaneous tissues of the left calf reflecting cellulitis, extending into the proximal tibia. No drainable fluid collection. No subcutaneous or deep tissue emphysema. 2. Redemonstration of healing fractures of the tibia and fibula. 3. Grossly stable loosening of a screw in the proximal tibia and a screw in the distal tibia.
19917249-RR-70
19,917,249
24,378,207
RR
70
2183-09-14 15:44:00
2183-09-14 17:00:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: pre-op bone bx// pre-op Surg: ___ (bone bx) TECHNIQUE: Chest single view COMPARISON: ___ FINDINGS: Stable heart size, pulmonary vascularity. No pulmonary edema. Few strands of basilar atelectasis, improved since prior. No pleural effusion. No pneumothorax. IMPRESSION: No acute findings.
19917249-RR-71
19,917,249
24,378,207
RR
71
2183-09-15 07:48:00
2183-09-15 09:18:00
EXAMINATION: TIB/FIB (AP AND LAT) LEFT INDICATION: Left tibia hardware removal TECHNIQUE: 4 spot fluoroscopic images obtained in the OR without radiologist present Fluoroscopy time: 31.2 seconds COMPARISON: Left tibia and fibula radiographs ___ FINDINGS: The available images show that there has been interval removal of hardware from the distal tibia with removal of the interlocking screws from the intramedullary rod. A fibular fracture plate and screw fixation device remains in-situ. Proximally, 1 of the interlocking screws has been removed.. There is callus formation around the proximal tibial and fibular fractures. Please see the operative report further details.
19917249-RR-72
19,917,249
24,378,207
RR
72
2183-09-18 09:20:00
2183-09-18 11:33:00
EXAMINATION: Portable AP chest radiograph. INDICATION: ___ year old man with new line// new right PICC 50 cm ___ ___ Contact name: ___: ___ TECHNIQUE: AP chest x-ray COMPARISON: Chest radiograph ___. FINDINGS: New right PICC terminates in the distal SVC. Lungs are clear. No pneumothorax. Heart size and mediastinal contour are normal. No fracture or concerning bone findings. IMPRESSION: 1. New right PICC which terminates in the distal SVC.
19917318-RR-35
19,917,318
23,197,120
RR
35
2160-10-15 00:37:00
2160-10-15 03:48:00
INDICATION: History: ___ with TIA// eval ischemia; PNA TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph dated ___. FINDINGS: The lungs are clear. The pulmonary vasculature is unremarkable. No pleural abnormalities. The cardiomediastinal silhouette is unremarkable. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary process.
19917318-RR-36
19,917,318
23,197,120
RR
36
2160-10-15 01:37:00
2160-10-15 02:36:00
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK INDICATION: History: ___ with TIA// eval ischemia; PNA TECHNIQUE: Contiguous MDCT axial images were obtained through the brain without contrast material. Subsequently, helically acquired rapid axial imaging was performed from the aortic arch through the brain during the infusion of intravenous contrast material. Three-dimensional angiographic volume rendered, curved reformatted and segmented images were generated on a dedicated workstation. This report is based on interpretation of all of these images. DOSE: Acquisition sequence: 1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP = 747.4 mGy-cm. 2) Spiral Acquisition 4.8 s, 38.0 cm; CTDIvol = 13.3 mGy (Body) DLP = 504.0 mGy-cm. 3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5 mGy-cm. 4) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 20.8 mGy (Body) DLP = 10.4 mGy-cm. Total DLP (Body) = 516 mGy-cm. Total DLP (Head) = 747 mGy-cm. COMPARISON: Head CT ___. FINDINGS: CT HEAD WITHOUT CONTRAST: There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci are normal for age in size and configuration. Again seen is periventricular white matter hypodensity similar to that present in ___. Although nonspecific, this is often attributed to chronic small vessel ischemia. Also again seen and unchanged is a chronic left putamen lacune. 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 A1 segment of the right anterior cerebral artery is hypoplastic, a normal variant. The dural venous sinuses are patent. CTA NECK: There are calcified plaques at the origins the internal carotid arteries bilaterally without stenosis on the left by NASCET criteria. The plaque produces an approximately 20% stenosis of the right internal carotid artery by NASCET criteria. Otherwise, the carotid and vertebral arteries and their major branches appear normal with no evidence of stenosis or occlusion. OTHER: The visualized portion of the lungs are clear. The visualized portion of the thyroid gland is within normal limits. There is no lymphadenopathy by CT size criteria. IMPRESSION: 1. No evidence of mass, hemorrhage or recent infarction. 2. Chronic left putamen lacune and extensive white matter hypodensity suggesting chronic small vessel ischemia. 3. Normal head CTA. 4. Calcified plaque at the origins of the internal carotid arteries bilaterally. On the right, this results in approximately 20% stenosis
19917318-RR-37
19,917,318
23,197,120
RR
37
2160-10-15 08:38:00
2160-10-15 11:35:00
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD INDICATION: ___ year old man with 30-seconds of vision loss In RUQ field of vision// eval for infarct TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was performed with gradient echo, FLAIR, diffusion, and T2 technique were then obtained. COMPARISON MRI brain ___. CT head, CTA ___. FINDINGS: There is no evidence of hemorrhage, edema, masses, mass effect, midline shift or infarction. There are confluent deep and periventricular white matter T2 signal abnormalities, most consistent with severe chronic small vessel ischemic changes, worsened since ___. Component of chronic demyelination cannot be excluded; sequela of distant metabolic or inflammatory process is statistically unlikely. Brain parenchymal atrophy. Vascular flow voids are preserved. Minimal paranasal sinus disease. Minimal opacification right mastoids. Clear left mastoids IMPRESSION: 1. No acute infarct. 2. Findings most consistent with severe chronic small vessel ischemic changes. 3. Brain parenchymal atrophy.
19917446-RR-15
19,917,446
20,856,545
RR
15
2123-11-27 05:11:00
2123-11-27 10:14:00
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE INDICATION: History: ___ with lower back pain and concern for positive blood culturesIV contrast to be given at radiologist discretion as clinically needed// Evaluate for osteomyelitis TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique. Axial T2 imaging was performed. Axial GRE images of the cervical spine were performed. After the uneventful administration of Gadavist contrast agent, additional axial and sagittal T1 images were obtained. COMPARISON: None. FINDINGS: CERVICAL: There is no evidence of vertebral body height loss. Millimetric anterolisthesis of C7 on T1 is noted, likely degenerative. The bone marrow signal is normal. Multilevel degenerative changes are as follows: C2-C3: There is no definite spinal canal stenosis or neural foraminal narrowing. C3-C4: A posterior disc bulge indents the ventral thecal sac with moderate to severe canal narrowing. This combines with uncovertebral osteophytes result in moderate severe right and severe left neural foraminal narrowing. C4-C5: Posterior disc bulging with a superimposed central disc protrusion and left-sided foraminal disc protrusion results in moderate canal stenosis, indenting mildly contacting the ventral cord at this level. This combines with uncovertebral joint osteophytes to result in moderate severe right and severe left neural foraminal narrowing. C5-C6: A mild posterior disc bulge is seen without significant canal narrowing, combining with uncovertebral joint osteophytes result in moderate right and moderate to severe left neural foraminal narrowing. C6-C7: Posterior disc bulging indents the ventral thecal sac, contacting and deforming the ventral cord with moderate canal narrowing, combining with uncovertebral osteophytes result in moderate severe right and severe left neural foraminal narrowing. C7-T1: There is no definite spinal canal stenosis or neural foraminal narrowing. THORACIC: There is mild anterior vertebral body wedging and height loss at T7 and T8 with mild focal kyphosis. Additionally, increased T2/stir signal with associated T1 hypointensity and postcontrast enhancement is seen involving the T7 inferior and T8 superior endplates. The intervertebral disc also enhances, and is worrisome for findings of osteomyelitis with discitis. Traumatic compression fractures alternative there is an appropriate history. No evidence of epidural extension or paraspinal spread. Mild multilevel disc bulging is seen throughout the thoracic spine, without appreciable canal stenosis or neural foraminal narrowing within the thoracic spine. LUMBAR: Vertebral body heights are maintained. There is grade 1 anterolisthesis of L4 on L5. The remainder of the sagittal spinal alignment is grossly maintained. The conus medullaris terminates at the level of L1-L2. Focal T2/stir signal is noted involving predominantly the inferior endplate of L4 posteriorly, with minimal involvement of the superior endplate of L5, with extension across the intervertebral disc space. This is associated with T1 hypointensity and postcontrast enhancement. Again, there is no evidence for epidural/intraspinal or paraspinal spread. No appreciable prevertebral edema. T12-L1: There is no spinal canal or neural foraminal stenosis. L1-L2: Mild posterior disc bulging is seen without appreciable canal or neural foraminal narrowing. L2-L3: There is no spinal canal or neural foraminal stenosis. L3-L4: Posterior disc bulging flattens the ventral thecal sac combining with facet arthropathy and thickening of ligamentum flavum to result in moderate canal narrowing with crowding of the cauda equina nerve roots. The disc bulge minimally contacts the bilateral descending L4 nerve roots. Neural foraminal narrowing is moderate on the left mild-to-moderate on the right. L4-L5: A large posterior disc bulge with superimposed central disc protrusion flattens and slightly indents the ventral thecal sac. This combines with thickening of the omentum flavum, facet arthropathy, and a small left facet joint effusion to result in moderate canal narrowing with crowding of the cauda equina nerve roots. Additionally, there is bilateral subarticular recess narrowing with a disc bulge contacting the bilateral descending L5 nerve root. Neural foraminal narrowing is moderate severe on the right and moderate on the left, with disc bulge contacting the bilateral exiting L4 nerve roots at this level. L5-S1: Posterior disc bulging with a superimposed central disc protrusion are noted without appreciable canal narrowing. However, neural foraminal narrowing is moderate on the right and moderate to severe on the left with a disc bulge contacting the bilateral exiting L5 nerve roots at this level. There is a punctate, 1-2 mm focus of equivocal enhancement seen along a descending right cauda equina nerve root at the level of L4 (16:10, 20:24). Otherwise, there is no evidence for intramedullary, additional sites of leptomeningeal, or epidural enhancement. No epidural fluid collection is identified. There are large, bilateral pleural effusions seen with adjacent atelectasis. IMPRESSION: 1. Focal endplate irregularity with T2 hyperintensity, T1 hypointensity, and postcontrast enhancement extending across the intervertebral disc spaces seen at T7-T8 and T4-T5. In the appropriate clinical context, these findings are worrisome for ostiomyelitis and discitis. ___ type 1 degenerative changes are felt much less likely. 2. No evidence of epidural extension, paraspinal extension, or epidural collection/abscess. 3. Solitary punctate focus of equivocal enhancement involving a descending right-sided nerve root at the level of L4. Findings may represent a small nerve sheath tumor versus leptomeningeal involvement, potentially inflammatory, infectious, or neoplastic. Recommend close attention on follow-up. 4. Background degenerative changes of the cervical spine, as detailed above. Findings are most notable at the level of C4-5 with moderate canal stenosis, severe left and moderate to severe right neural foraminal narrowing. 5. Multilevel degenerative changes of the lumbar spine, also detailed above. Findings are most notable at the level of L4-L5 with moderate canal narrowing, severe right and moderate left neural foraminal narrowing. NOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___ telephone at 09:56 on ___, 2 minutes after interpretation.
19917446-RR-16
19,917,446
20,856,545
RR
16
2123-11-26 22:45:00
2123-11-27 09:56:00
EXAMINATION: CR-CHEST (PORTABLE AP) INDICATION: ___ year old man with HTN, HLD, impaired glucose tolerance, CAD s/p CABG x3 (___), aortic stenosis s/p prosthetic AVR (___), and HF who presents with several month history of increased weakness, weight loss, worsened appetite, and worsened BLE edema- found have GPC bacteremia.// PNA, volume overload? TECHNIQUE: Portable chest x-ray. COMPARISON: None. FINDINGS: Portable semi-upright radiograph of the chest demonstrates an enlarged cardiac silhouette. Midline sternal wires and CABG clips are noted. There is a small left-sided pleural effusion. There is bibasilar atelectasis. Possible mild edema. Focal consolidation is not definitively excluded. IMPRESSION: Small left-sided pleural effusion with atelectasis. Possible mild edema. Consolidation is not entirely excluded.
19917446-RR-18
19,917,446
20,856,545
RR
18
2123-12-03 16:35:00
2123-12-03 17:33:00
EXAMINATION: CT CHEST W/O CONTRAST INDICATION: ___ year old man with endocarditis// pre-cardiac surgery evaluation TECHNIQUE: Multi detector CT of the chest was performed without the administration of intravenous contrast. Axial coronal and sagittal reconstructions were acquired. Maximum intensity projections were also acquired DOSE: Acquisition sequence: 1) Spiral Acquisition 4.6 s, 36.0 cm; CTDIvol = 7.0 mGy (Body) DLP = 250.3 mGy-cm. 2) Spiral Acquisition 4.1 s, 32.0 cm; CTDIvol = 3.1 mGy (Body) DLP = 99.6 mGy-cm. Total DLP (Body) = 350 mGy-cm. COMPARISON: no prior CT chest is available for comparisons FINDINGS: THORACIC INLET: The thyroid is unremarkable. There are no enlarged axillary lymph nodes. BREAST AND AXILLA : There are no enlarged axillary lymph nodes. MEDIASTINUM: There are small mediastinal lymph nodes. There is a 12 mm right paratracheal lymph node there is a 10 mm right lower paratracheal lymph node. There is moderate cardiomegaly. The ascending aorta is dilated and measures 3.2 cm. The main pulmonary artery measures 31 mm. There is a prosthetic aortic valve in place. There is extensive atherosclerotic calcification involving the aorta. There is no pericardial effusion PLEURA: There are moderate bilateral effusions left greater than right. LUNG: There is passive atelectasis in both lower lobes left greater than right. There is diffuse bilateral ground-glass opacification which most likely represents pulmonary edema. No evidence of pneumonia No evidence of septic emboli. BONES AND CHEST WALL : Review of bones shows degenerative changes involving the thoracic spine. Sternal sutures are intact. UPPER ABDOMEN: Limited sections through the upper abdomen shows a hypodense lesion in the left lobe of liver. No adrenal masses are seen. IMPRESSION: Moderate bilateral pleural effusions left greater than right with passive atelectasis in both lower lobes. Moderate to severe cardiomegaly. Atherosclerotic calcification involving the aorta. Prosthetic aortic valve. Diffuse mild interstitial edema. No evidence of septic emboli.
19917446-RR-19
19,917,446
20,856,545
RR
19
2123-12-03 09:17:00
2123-12-03 13:40:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with endocarditis. Evaluate prior to cardiac surgery. TECHNIQUE: Chest PA and lateral COMPARISON: Chest x-ray ___. FINDINGS: A left pleural effusion is moderate in size. The right pleural effusion is small. Compared to the most recent prior study, opacification of the right lower lung has mildly increased. Pulmonary edema is mild. No pneumothorax. Median sternotomy wires are intact and aligned. The aortic valve is in place. IMPRESSION: 1. Mild pulmonary edema. 2. Moderate left and small right pleural effusions. 3. Interval increased opacification of the right lower lung, which may be atelectasis or pneumonia.
19917446-RR-20
19,917,446
20,856,545
RR
20
2123-12-05 15:07:00
2123-12-06 10:05:00
INDICATION: ___ year old man s/p redo-sternotomy, AVR/MVR. Please ___ ___ at ___ with abnormalities.// FAST TRACK EXTUBATION CARDIAC SURGERY, ?line placement, r/o PTX/Effusion Contact name: ___: ___ COMPARISON: Compared to radiographs from 1 hour earlier. IMPRESSION: Support lines and tubes are unchanged in position. Cardiomediastinal silhouette is within normal limits. There has been improvement of the pulmonary interstitial edema. There are no large pleural effusions or pneumothoraces.