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19917446-RR-22
| 19,917,446 | 20,856,545 |
RR
| 22 |
2123-12-05 13:26:00
|
2123-12-05 17:30:00
|
EXAMINATION: Portable intraoperative radiographs of the chest
INDICATION: Search for missing needle
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
No radiopaque foreign body to correspond to the missing needle is identified
in the chest. There are multiple surgical and support devices projecting over
the chest. The tip of a Swan-Ganz catheter terminates in the distal right
pulmonary artery. A chest tube projects over the left upper lung.
The cardiomediastinal silhouette is enlarged. There is mild diffuse
interstitial prominence. No large pleural effusions are seen.
IMPRESSION:
-Intraoperative chest radiograph without identification of radiopaque foreign
body to correspond to the missing needle.
-Multiple cardiopulmonary support devices.
NOTIFICATION: Per request, a wet read was called to ___
___, M.D. by ___, M.D. on the telephone on ___ at
2:45 pm, 5 minutes after discovery of the findings.
|
19917446-RR-23
| 19,917,446 | 20,856,545 |
RR
| 23 |
2123-12-05 23:56:00
|
2123-12-09 14:43:00
|
EXAMINATION: Portable chest radiograph.
INDICATION: ___ year old man with s/p AVR/MVR/TVr, with redo sternotomy.
Evaluate for hemothorax, bleeding.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___ and ___.
FINDINGS:
Compared to the prior exam from ___ at 15:25 there is interval
opacification and consolidation of the right upper lobe associated with
bronchogram, which could represent fluid, pneumonia, or volume loss. The
position of the tubes and lines is unchanged from prior exam.
IMPRESSION:
Postoperative changes now with consolidation with bronchogram in right upper
lobe, could represent fluid, volume loss, or pneumonia.
|
19917446-RR-24
| 19,917,446 | 20,856,545 |
RR
| 24 |
2123-12-07 07:16:00
|
2123-12-07 10:59:00
|
INDICATION: ___ year old man with as above// s/p MVR/AVR/TVrepair
w/hypotension r/o effusion
COMPARISON: Radiographs from ___
IMPRESSION:
Support lines and tubes are unchanged in position. Heart size is enlarged but
stable. There has been improved aeration of the right upper lobe
consolidation. There is a faint left retrocardiac opacity. There are no
pneumothoraces.
|
19917446-RR-25
| 19,917,446 | 20,856,545 |
RR
| 25 |
2123-12-07 16:36:00
|
2123-12-07 17:22:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man with post open heart surgery post chest tube
removal.// R/O pneumo
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 07:40.
IMPRESSION:
Compared the earlier same day examination, left base consolidation is slightly
worsened, and may be atelectatic, though infection is not excluded. A lateral
view may be helpful. Right IJ approach Swan-Ganz catheter, endotracheal tube,
and upper enteric tube are unchanged. There are postsurgical changes from
aortic valve replacement. There is no edema. The lungs are otherwise clear.
There is no right-sided effusion. Right chest tube has been removed. There
is no pneumothorax. There may be a small left-sided pleural effusion.
|
19917446-RR-26
| 19,917,446 | 20,856,545 |
RR
| 26 |
2123-12-07 19:58:00
|
2123-12-07 20:12:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man with as above// s/p redo mvr/avr/tv repair w/?sq
air r/o PTX
TECHNIQUE: Portable frontal views of the chest.
COMPARISON: ___ 16:44.
IMPRESSION:
Compared to the earlier same day examination, there is slightly improved
aeration of the left lung base with persistent tiny left-sided effusion. This
was likely atelectatic. Central pulmonary vascular congestion without frank
interstitial edema is unchanged. No other short-term interval changes are
seen. Support devices remain in unchanged, satisfactory position. No
appreciable pneumothorax.
|
19917446-RR-27
| 19,917,446 | 20,856,545 |
RR
| 27 |
2123-12-08 14:51:00
|
2123-12-08 15:35:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man with s/p redo AVR/MVR/TVr// eval ptx
TECHNIQUE: Single AP radiograph of the chest.
COMPARISON: Radiographs from ___
IMPRESSION:
Endotracheal tube, Swan-Ganz catheter, enteric tube are unchanged in position.
There is a new large pneumothorax on the right side. There is consolidation
at the left base and a left-sided pleural effusion. There is also
subcutaneous gas seen within the left chest wall.
NOTIFICATION: The findings were discussed with ___, PA by ___
___, M.D. on the telephone on ___ at 3:34 pm, 5 minutes after
discovery of the findings.
|
19917446-RR-28
| 19,917,446 | 20,856,545 |
RR
| 28 |
2123-12-08 15:30:00
|
2123-12-08 15:57:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man with s/p AVR/MVR/TVr// eval ptx Contact name:
___: ___
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 14:51.
IMPRESSION:
Compared to the earlier same day examination, there has been placement of a
right-sided chest tube with interval resolution of the large right-sided
pneumothorax pre-existing support devices remain in unchanged, satisfactory
position. Cardiomediastinal silhouette is unchanged. There is no new
consolidation. A small left-sided pleural effusion with likely left base
atelectasis is unchanged. Extensive subcutaneous emphysema along the chest
wall left-greater-than-right is unchanged.
|
19917446-RR-29
| 19,917,446 | 20,856,545 |
RR
| 29 |
2123-12-09 06:59:00
|
2123-12-09 08:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p redo MVR/AVR/TVr// eval ptx
IMPRESSION:
In comparison with study of ___, there appears to be a small right
apical pneumothorax, though this area is difficult to assess due to overlying
bony structures.
Monitoring and support devices are unchanged. Continued enlargement of the
cardiac silhouette with small left effusion and atelectasis.
Subcutaneous gas is most prominent along the left lateral chest wall, as on
the previous study.
|
19917446-RR-30
| 19,917,446 | 20,856,545 |
RR
| 30 |
2123-12-09 15:18:00
|
2123-12-09 16:07:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with AVR/MVR// check dobhoff tube placement
IMPRESSION:
In comparison with the earlier study of this date, there is an placement of a
Dobhoff tube that extends to the distal antrum and then coils back on itself
for approximately 5 cm.
Otherwise, the left hemidiaphragm is not as well seen and there is increased
opacification at the base, consistent with volume loss in left lower lobe and
pleural effusion.
|
19917446-RR-31
| 19,917,446 | 20,856,545 |
RR
| 31 |
2123-12-10 13:24:00
|
2123-12-10 17:39:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ year old man with DHT displaced// eval for position
TECHNIQUE: AP chest x-ray
COMPARISON: ___.
FINDINGS:
The Dobhoff tube is seen terminating near the pylorus.
The previously seen small right apical pneumothorax is unchanged. Overall no
significant change in the appearance of the bilateral lung fields. A right
jugular Swan Ganz introducer and a right-sided chest tube are unchanged in
position. The cardiomediastinal border is unchanged from prior. No acute
fracture or concerning bone findings.
IMPRESSION:
1. Double of tube terminating near the pylorus.
2. No significant change in the right apical pneumothorax.
|
19917446-RR-32
| 19,917,446 | 20,856,545 |
RR
| 32 |
2123-12-11 10:27:00
|
2123-12-11 11:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p Redosternotomy, MVRt(#27), AVRt(#19)/TVr(#28)
___// eval for pneumothorax with CT on waterseal
IMPRESSION:
In comparison with the study of ___, the with the chest tube on water
seal, there is no evidence of any increase in the small apical pneumothorax.
The remainder the study is essentially unchanged.
|
19917446-RR-33
| 19,917,446 | 20,856,545 |
RR
| 33 |
2123-12-11 10:54:00
|
2123-12-11 11:11:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with picc repo// R picc 40cm Contact name: sal,
___: ___
IMPRESSION:
In comparison with the earlier study of this date, the right subclavian PICC
line has been redirected so that the tip is in the mid to lower SVC.
Otherwise no change.
|
19917446-RR-34
| 19,917,446 | 20,856,545 |
RR
| 34 |
2123-12-14 12:59:00
|
2123-12-14 13:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old with CT pull// eval for ptx- please do at 1 ___
IMPRESSION:
In comparison with the study of ___, the right chest tube has been
removed and there is a small and relatively stable pneumothorax. Mild
decrease in the subcutaneous gas on the right and more prominent decrease in
the subcutaneous gas on the left.
There are 2 areas of opacification in the right mid and lower zones. This
raises the possibility of loculated effusions. The possibility of
superimposed aspiration could be considered in the appropriate clinical
setting.
|
19917446-RR-35
| 19,917,446 | 20,856,545 |
RR
| 35 |
2123-12-14 13:55:00
|
2123-12-14 14:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s.p right CT removal// eval for right ptx
IMPRESSION:
In comparison with the study of earlier in this date, following chest tube
removal there has been development of a substantial right pneumothorax. There
is some shift of mediastinal contents to the right suggesting some element of
tension.
NOTIFICATION: Dr. ___.
|
19917446-RR-36
| 19,917,446 | 20,856,545 |
RR
| 36 |
2123-12-14 15:38:00
|
2123-12-14 16:33:00
|
INDICATION: ___ year old man with right ptx// eval for expansion- Please do
at 4 ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
There is a minimally increased right pneumothorax, particularly the basal
component. Persisting subcutaneous emphysema over the chest. Retrocardiac
opacities are unchanged. A feeding tube extends below the level the diaphragm
but beyond the field of view of this radiograph and the tip of the right PICC
line again projects over the mid SVC.
IMPRESSION:
Minimally increased right pneumothorax.
|
19917446-RR-37
| 19,917,446 | 20,856,545 |
RR
| 37 |
2123-12-14 17:26:00
|
2123-12-14 18:20:00
|
INDICATION: ___ year old man with right ct placed for ptx// eval for CT
position/ resolution of PTX
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There has been interval placement of a right apically directed chest tube with
interval decrease in the right pneumothorax, now barely perceptible. The
right PICC line and feeding tube are unchanged. Extensive subcutaneous
emphysema again projects over the chest. A hazy opacity in the medial lower
right lung likely reflects atelectasis.
IMPRESSION:
Interval placement of a right chest tube with re-expansion of the right lung
and a now barely perceptible right pneumothorax.
|
19917446-RR-38
| 19,917,446 | 20,856,545 |
RR
| 38 |
2123-12-15 07:10:00
|
2123-12-15 08:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with right CT placed for ptx// eval for ?
bilateral ptx
IMPRESSION:
In comparison with the study of ___, the loculated right lung basilar
collection of gas is no longer seen. No apical pneumothorax is appreciated.
On the left, no evidence of pneumothorax.
Residual subcutaneous gas is decreasing.
No change in the appearance of the heart and lungs.
|
19917446-RR-39
| 19,917,446 | 20,856,545 |
RR
| 39 |
2123-12-14 20:19:00
|
2123-12-14 21:40:00
|
INDICATION: ___ year old man with SC air, eval for ptx// eval for ptx
TECHNIQUE: AP portable chest radiograph
COMPARISON: Multiple prior radiographs from earlier today
FINDINGS:
Since most recent prior radiograph, there is no significant interval change
with a tiny persisting right pneumothorax, best seen at the right lung base.
IMPRESSION:
No significant interval change since the immediate prior chest radiograph.
|
19917446-RR-40
| 19,917,446 | 20,856,545 |
RR
| 40 |
2123-12-16 08:41:00
|
2123-12-16 13:38:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ year old man with new picc// L picc 41cm. Contact name: sal,
___: ___
TECHNIQUE: Portable chest AP.
COMPARISON: Chest radiograph from ___.
FINDINGS:
In comparison with the study of ___ there is a new left
subclavian PICC line. The tip projects over the low superior vena cava.
There is no evidence of pneumothorax. Slight blunting of the costophrenic
angles bilaterally, probably representing small pleural effusions. Otherwise,
the heart and lungs are similar to the previous exam. There is interval
worsening in the subcutaneous emphysema along the left chest wall. A right
apical chest tube in similar in position.
IMPRESSION:
New left subclavian PICC line with the tip projecting over the low superior
vena cava. Interval increase of subcutaneous emphysema along the left chest
wall.
|
19917446-RR-41
| 19,917,446 | 20,856,545 |
RR
| 41 |
2123-12-18 07:41:00
|
2123-12-18 09:30:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ptx// ___ year old man with ptx ___ year
old man with ptx
IMPRESSION:
Compared to chest radiographs ___ through ___.
Small right apical pneumothorax at the level of the posterior third interspace
is probably larger today than on ___. Substantial subcutaneous
emphysema in the right chest wall is redistributed since ___, but
probably not changed in overall size. Small dependent right pleural effusion
stable. Right thoracostomy tube is been partially withdrawn, the tip is now
below the level of the aortic knob, previously at the apex of the chest. The
course of the tube is consistent with though not diagnostic fissural
placement.
Moderate left pleural effusion and left lower lobe collapse persist. No
pulmonary edema. Normal postoperative cardiomediastinal silhouette unchanged.
|
19917446-RR-42
| 19,917,446 | 20,856,545 |
RR
| 42 |
2123-12-19 07:20:00
|
2123-12-19 09:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p redo, MVR, AVR, TV repair// eval for
pneumothorax with chest tube clamped
IMPRESSION:
In comparison with the earlier image of this date, with the right chest tube
clamped, there is a mild increase in the degree of right apical pneumothorax.
Subcutaneous emphysema is unchanged. The bilateral pleural effusions appear
slightly more prominent, though this may merely reflect a more supine position
of the patient. The area of suspected opacification along the course of the
right chest tube is less prominent on this study.
|
19917446-RR-43
| 19,917,446 | 20,856,545 |
RR
| 43 |
2123-12-19 00:08:00
|
2123-12-19 09:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with as above// s/p MVR/AVR/TV repair
w/hypotension r/o PTX
IMPRESSION:
In comparison with the study of ___, there is little change in the right
apical pneumothorax. The subcutaneous emphysema bilaterally is decreasing.
The bilateral pleural effusions, more prominent on the left, are slightly
decreasing and there again is substantial volume loss in the left lower lobe.
Area of opacification is again seen along the course of the right chest tube.
In in the appropriate clinical setting, aspiration/pneumonia in this region
could be considered.
|
19917446-RR-44
| 19,917,446 | 20,856,545 |
RR
| 44 |
2123-12-19 13:49:00
|
2123-12-19 14:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p ___ s/p Redo, MVRt(#27), AVRt(#19)/TVr(#28)
___ back for bleeding ___// eval for pneumothorax in patient with
chest tube clamped who is newly in acute respiratory distress
IMPRESSION:
In comparison with the earlier study of this date, there is little change in
the degree of right pleural effusion following clamping of the chest tube.
The hazy opacification of the lungs, consistent with layering pleural
effusions and more prominent on the left, may appear more prominent due to a
more supine position of the patient.
|
19917446-RR-45
| 19,917,446 | 20,856,545 |
RR
| 45 |
2123-12-20 07:12:00
|
2123-12-20 15:17:00
|
INDICATION: ___ year old man with s/p redo stern/MVR/AVR/TVrepair// eval for
pneumothorax w chest clamped for over 24 hours
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
When compared to prior, there has been no significant interval change. Left
greater than right pleural effusions are again seen, unchanged in degree given
differences in technique. Right chest tube remains in place and a right
apical pneumothorax is similar in size. Other lines and tubes are unchanged.
IMPRESSION:
No significant interval change.
|
19917446-RR-46
| 19,917,446 | 20,856,545 |
RR
| 46 |
2123-12-20 11:56:00
|
2123-12-20 15:17:00
|
INDICATION: ___ year old man with acute SOB// interval change
TECHNIQUE: Single portable view of the chest
COMPARISON: Chest x-ray from earlier the same day, ___ at 07:32.
FINDINGS:
Right-sided chest tube is again seen. Enteric tube passes below the field of
view. Left PICC tip projects over the upper SVC. There is a right apical
pneumothorax which is similar compared to prior exam. Otherwise, there has
been no change. Hazy opacity in the left hemithorax is likely due to layering
effusion. Right-sided pleural fluid is less extensive than on the left though
similar compared to prior. Subcutaneous gas overlies the right chest wall.
IMPRESSION:
No significant interval change. Bilateral pleural effusions, larger on the
left, with right chest tube in place and small right apical pneumothorax.
|
19917446-RR-47
| 19,917,446 | 20,856,545 |
RR
| 47 |
2123-12-20 19:40:00
|
2123-12-20 20:36:00
|
EXAMINATION: Chest x-ray
INDICATION: ___ year old man with SOB// ___ year old man with SOB
TECHNIQUE: Portable chest x-ray
COMPARISON: Chest x-ray ___, approximately 7 hours previous
FINDINGS:
The right-sided chest tube appears stable in position. The enteric tube
courses below the left hemidiaphragm, the tip is not visualized but is at
least in the distal stomach.
There is a right apical pneumothorax, similar to previous. Heart and lungs
appear stable. Sternal wires are intact. Subcutaneous gas has decreased
slightly compared to the previous x-ray. There is a right pleural effusion,
similar to prior. There is a left pleural effusion layering posteriorly, also
similar to previous.
IMPRESSION:
As above.
|
19917446-RR-48
| 19,917,446 | 20,856,545 |
RR
| 48 |
2123-12-21 08:48:00
|
2123-12-21 09:40:00
|
INDICATION: ___ year old man s/p redosternotomy MVR/AVR tiss, TV repair//
follow up pneumothorax
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-rays over the past few days with most recent from ___.
FINDINGS:
Enteric, left PICC and right chest tubes remain in place. There is a small
persistent right apical pneumothorax, unchanged. Moderate left pleural
effusion with atelectasis and fluid on the right along the fissure is
unchanged. Cardiac enlargement and additional right basilar opacity are again
noted.
IMPRESSION:
No significant interval change.
|
19917446-RR-49
| 19,917,446 | 20,856,545 |
RR
| 49 |
2123-12-21 18:11:00
|
2123-12-21 18:37:00
|
INDICATION: ___ year old man s/p redosternotomy,MVR/AVR, TV repair// ** please
check CXR 6pm **eval for pneumothorax s/p
TECHNIQUE: Portable chest x-ray
COMPARISON: Chest x-ray ___ approximately 9 hours previous
FINDINGS:
The right chest tube has been removed in the interim. A previously seen right
apical pneumothorax is not evident on this study. An NG tube descends below
the left hemidiaphragm. The patient is status post valve replacement.
Sternal wires appear intact.
There is moderate left pleural effusion with atelectasis. There is a small
right pleural effusion with fluid along the fissure. The heart is enlarged.
Patchy right lower lobe lung density persists, possibly atelectasis.
Superimposed pneumonia cannot be excluded. There is minimal density in the
region of the previous chest tube.
IMPRESSION:
As above
|
19917446-RR-50
| 19,917,446 | 20,856,545 |
RR
| 50 |
2123-12-22 07:14:00
|
2123-12-22 09:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumothorax after chest tube removal//
interval change in right ptx or left pleural effusion
IMPRESSION:
In comparison with the study of ___, there is little overall change. No
definite pneumothorax. Left pleural effusion with volume loss in the lower
lung is unchanged. In no change in the right effusion with apparent fissural
fluid.
|
19917446-RR-51
| 19,917,446 | 20,856,545 |
RR
| 51 |
2123-12-22 16:27:00
|
2123-12-22 16:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p left thoracentesis// eval for effusion/ ptx
IMPRESSION:
In comparison with the study of earlier in this date, there has been a left
thoracentesis with removal of substantial fluid from the pleural space. No
evidence of post procedure pneumothorax.
Otherwise, little change.
|
19917446-RR-52
| 19,917,446 | 20,856,545 |
RR
| 52 |
2123-12-23 16:59:00
|
2123-12-23 17:22:00
|
EXAMINATION: Chest x-ray
INDICATION: ___ year old man s/p redo, MV/AVReplac, TV repair// follow up
effusions
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___ obtained approximately 16:30
FINDINGS:
The lateral images are compromised secondary to motion degradation and patient
positioning. There are low lung volumes. There is a small left effusion.
This has increased since yesterday. There is a trace right effusion with
fluid in the fissure, similar to previous. The cardiomediastinal silhouette
is unchanged.
An NG tube descends below the left hemidiaphragm. Multiple lines overlie the
patient. Sternal wires appear intact. The patient is status post valve
replacement.
The left PICC appears to have been pulled back slightly, the tip is in the mid
SVC.
IMPRESSION:
Small left effusion layering posteriorly, increased compared to the 430 p.m. ___ study. The left PICC appears to been pulled back slightly, with
the tip at the mid SVC.
|
19917446-RR-53
| 19,917,446 | 20,856,545 |
RR
| 53 |
2123-12-26 08:54:00
|
2123-12-26 16:36:00
|
EXAMINATION: Video oropharyngeal swallow study
INDICATION: ___ year old man with ? aspiration// eval for aspiration
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 5 minutes 3 seconds
COMPARISON: None available.
FINDINGS:
There is aspiration noted with thin liquids, most notably with mixed
consistency. Residuals were noted within the vallecula.
IMPRESSION:
Aspiration of thin liquids, most notably with mixed consistency.
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
19917446-RR-54
| 19,917,446 | 20,856,545 |
RR
| 54 |
2123-12-26 09:36:00
|
2123-12-26 11:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with s/p mvr avr tv repair// eval left effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The cardiomediastinal silhouette is stable since the most recent comparison.
Midline sternal wires are well aligned and intact. Other support catheter are
unchanged. Fluid within the right major fissure is unchanged since the prior
studies. Vascular congestion may be slightly improved since the most recent
prior.
IMPRESSION:
Minimally improved edema since the most recent prior.
|
19917446-RR-55
| 19,917,446 | 20,856,545 |
RR
| 55 |
2123-12-31 09:40:00
|
2123-12-31 11:30:00
|
INDICATION: ___ year old man with SOB// ___ year old man with SOB
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Multiple prior chest radiographs from ___ to ___
FINDINGS:
Compared to the prior study 5 days ago, the left lung is now completely
opacified. Given the trachea remains central, this could represent marked
increase in pleural effusion with left lung volume loss. Small right pleural
effusion is slightly worse. Fluid within the right major fissure is
unchanged. Assessment of the cardiac silhouette is impossible due to the
surrounding opacification, although the right heart border grossly unchanged.
IMPRESSION:
Interval complete opacification of the left lung may represent marked increase
in pleural effusion with left lung volume loss.
|
19917446-RR-56
| 19,917,446 | 20,856,545 |
RR
| 56 |
2123-12-31 16:11:00
|
2123-12-31 17:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p pig-tail placement for left effusion//
evaluate for pneumothorax and effusion
IMPRESSION:
In comparison with the earlier study of this date, this and placement of a
left pigtail catheter removal of a large amount of pleural fluid. No evidence
of appreciable pneumothorax.
Otherwise, little overall change.
|
19917446-RR-57
| 19,917,446 | 20,856,545 |
RR
| 57 |
2124-01-01 08:09:00
|
2124-01-01 11:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man eval effusion// ___ year old man eval effusion
___ year old man eval effusion
IMPRESSION:
Left pigtail catheter is in place. Heart size is enlarged. Mediastinum is
stable. Loculated effusions are present. Left perihilar consolidation has
progressed concerning for infectious process. Type of tube tip is in the
stomach. There is no pneumothorax.
|
19917446-RR-59
| 19,917,446 | 20,856,545 |
RR
| 59 |
2124-01-03 09:33:00
|
2124-01-03 10:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pigtail to water seal// eval for PTX
IMPRESSION:
In comparison with the study of ___, with the left chest tube on water
seal, there is no evidence of pneumothorax. Hazy opacification at the left
base with obscuration of the hemidiaphragm is consistent with layering
effusion and volume loss.
On the right, there again is some perihilar and infrahilar opacification
concerning for an infectious process. Round opacification in the region of
the minor fissure is consistent with loculated effusion and there is a small
free pleural effusion with atelectasis at the right base.
There has been interval development of an area of increased opacification in
the right apical region. Although this is a somewhat unusual appearance for
right upper lobe collapse, this is the clinical suspicion of the physician
taking care the patient, who will be undergoing a bronchoscopy.
NOTIFICATION: Dr. ___.
|
19917446-RR-60
| 19,917,446 | 20,856,545 |
RR
| 60 |
2124-01-04 07:13:00
|
2124-01-04 09:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p Redo, MVRt(#27), AVRt(#19)/TVr(#28)
___// follow up PNA, effusions
IMPRESSION:
In comparison with the study of ___, there is now complete opacification
of the right hemithorax, most likely reflecting collapse of the right lung due
to a mucous plug. Displacement of mediastinal structures to this side are
seen.
The left lung remains clear with chest tube in place. Monitoring and support
devices appear stable.
NOTIFICATION: Ido, the nurse taking care the patient in the ICU, who will
transfer this message to the PA. This was conveyed by telephone at 09:25 on
___, within 2 minutes of discovery.
|
19917446-RR-61
| 19,917,446 | 20,856,545 |
RR
| 61 |
2124-01-04 11:18:00
|
2124-01-04 12:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p redo MVR/TVR// follow up R collapse s/p NT
suctioning
IMPRESSION:
In comparison with study of of earlier in this date, there is affectively no
change in the total opacification of the right hemithorax. Remainder the
study is unchanged.
|
19917446-RR-62
| 19,917,446 | 20,856,545 |
RR
| 62 |
2124-01-05 07:11:00
|
2124-01-05 10:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with right sided white out// eval for effusion/
ptx/ infiltrate eval for effusion/ ptx/ infiltrate
IMPRESSION:
Left pigtail catheter is in place. The up of tube is in place. Heart size
and mediastinum are stable.
There has been most likely interval bronchoscopy with opening of the right
lung collapse. Current ___ right lung is relatively well aerated. Small
amount of loculated pleural effusion along the fissure is noted.
|
19917446-RR-63
| 19,917,446 | 20,856,545 |
RR
| 63 |
2124-01-06 07:09:00
|
2124-01-06 10:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CABG// eval for collapse eval for
collapse
IMPRESSION:
Compared to chest radiographs ___ through ___.
Mild pulmonary edema has worsened. Left lower lobe still collapsed. Moderate
right pleural effusion has increased, is with multiple components, perhaps
loculated, and concluding apex and fissures.
Moderate enlargement cardiac silhouette stable. No pneumothorax.
Pigtail pleural drainage catheter has been repositioned slightly in the left
hemithorax.
PIC line can be traced as far as the origin of the SVC, where it was
yesterday, but the tip is indistinct.
Feeding tube passes into the duodenum and out of view.
|
19917446-RR-64
| 19,917,446 | 20,856,545 |
RR
| 64 |
2124-01-07 14:08:00
|
2124-01-07 16:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p DHT placement// ___ year old man s/p DHT
placement ___ year old man s/p DHT placement
IMPRESSION:
Comparison to ___. In the interval, the patient has received the
new feeding tube. The course of the tube is unremarkable, the tip of the tube
is not visualized on the image. The other monitoring and support devices are
stable, in particular the left-sided pleural pigtail catheter. Moderate
cardiomegaly persists. Fissural right pleural effusion is stable. Stable
alignment of the sternal wires.
|
19917446-RR-65
| 19,917,446 | 20,856,545 |
RR
| 65 |
2124-01-07 15:35:00
|
2124-01-07 17:09:00
|
INDICATION: ___ year old man s/p DHT adjusment// ___ year old man s/p DHT
adjustment
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Chest radiographs performed on the same date.
FINDINGS:
The Dobhoff feeding tube extends below level of diaphragm with tip projecting
over the distal stomach, however, the exact location is difficult to determine
in the absence of contrast. There are no abnormally dilated loops of large or
small bowel. The visualized portion of the thorax demonstrates opacification
of the right lower lobe suggestive of right lower lobe collapse.
Additionally, there is a rounded opacity overlying the right fissure
consistent with a loculated fissural pleural effusion. Moderate cardiomegaly
is unchanged. Median sternotomy wires are intact. Left pigtail catheter is
again seen projecting over the mid to lower left lung field.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
1. The Dobhoff feeding tube extends below the level diaphragm with tip likely
projecting over the distal stomach.
2. Right lower lobe collapse, loculated right fissural pleural effusion and
moderate cardiomegaly are unchanged.
|
19917446-RR-66
| 19,917,446 | 20,856,545 |
RR
| 66 |
2124-01-07 16:19:00
|
2124-01-07 17:21:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man s/p dht adjustment// ___ year old man s/p dht
adjustment
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 15:12.
IMPRESSION:
Compared the earlier same day examination, the Dobhoff tube tip is more
clearly visualized projecting over the expected location of the pylorus. No
other short-term interval changes. Other support devices remain in unchanged
position. Rounded opacity projecting over the right midlung field is
unchanged. No new consolidation.
|
19917446-RR-67
| 19,917,446 | 20,856,545 |
RR
| 67 |
2124-01-09 08:09:00
|
2124-01-09 10:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p MVR/AVR/TVr// ___ year old man s/p MVR/AVR/TVr
___ year old man s/p MVR/AVR/TVr
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Moderate multiloculated right pleural effusion improved slightly. Mild
pulmonary edema persists. Moderate cardiomegaly is improved. No
pneumothorax. Left pigtail pleural drainage catheter in place.
|
19917446-RR-69
| 19,917,446 | 20,856,545 |
RR
| 69 |
2124-01-10 08:29:00
|
2124-01-10 09:44:00
|
EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA LEFT
INDICATION: ___ year old man s/p redosternotomy, tiss MVR/AVR, TV repair//
eval ?source of L shoulder pain eval ?source of L shoulder pain
IMPRESSION:
No comparison. 3 projections of the left shoulder are provided. Moderately
decreased acromiohumeral space. Minimally increased subcortical sclerosis at
the insertion site of the rotator cuff. The new humero-glenoidal joint space
is of normal width.
|
19917446-RR-70
| 19,917,446 | 20,856,545 |
RR
| 70 |
2124-01-10 08:29:00
|
2124-01-10 08:54:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p redosternotomy, tiss MVR/AVR, TV repair// **
please check at 8am **eval for pneumothorax with CT clamped ** please
check at 8am **eval for pneumothorax with CT clamped
IMPRESSION:
Comparison to ___. Stable appearance of the loculated right-sided
pleural effusions. Stable correct position of the left-sided pleural pigtail
catheter. The heart continues to be enlarged. No pneumothorax. Areas of
bilateral basilar atelectasis, left more than right, but no evidence of
pneumonia.
|
19917446-RR-71
| 19,917,446 | 20,856,545 |
RR
| 71 |
2124-01-10 13:21:00
|
2124-01-10 13:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man L pigtail d/c// evaluate for PTX evaluate
for PTX
IMPRESSION:
Comparison to ___. In the interval, the left pigtail catheter has
been removed. There is no pneumothorax or other complication. Otherwise
unchanged radiograph as compared to this morning, 08:42.
|
19917446-RR-72
| 19,917,446 | 20,856,545 |
RR
| 72 |
2124-01-11 08:48:00
|
2124-01-11 10:05:00
|
INDICATION: ___ year old man with SOB/desaturation// effusions
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Loculated right pleural effusion has slightly increased in volume. Pulmonary
edema has worsened. Cardiomediastinal silhouette is stable. Small left
pleural effusion stable. No pneumothorax is seen. Left-sided PICC line
projects to the SVC
|
19917446-RR-73
| 19,917,446 | 20,856,545 |
RR
| 73 |
2124-01-11 09:53:00
|
2124-01-11 12:55:00
|
INDICATION: ___ year old man with hypoxia// s/p intubation
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Loculated right pleural effusions unchanged. Pulmonary edema has improved.
Left-sided PICC line is unchanged. An ET tube has been placed in the interim
which projects approximately 2 cm from the carina. Cardiomediastinal
silhouette is stable. No pneumothorax is seen
|
19917446-RR-74
| 19,917,446 | 20,856,545 |
RR
| 74 |
2124-01-11 11:12:00
|
2124-01-11 12:57:00
|
INDICATION: ___ year old man// eval effusion/collapse s/p ___
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
The loculated right pleural effusions unchanged. Pulmonary edema has slightly
improved. Left-sided PICC line is unchanged. The ET tube is unchanged.
Cardiomediastinal silhouette is stable. No pneumothorax is seen
|
19917446-RR-75
| 19,917,446 | 20,856,545 |
RR
| 75 |
2124-01-15 10:43:00
|
2124-01-15 11:37:00
|
INDICATION: ___ year old man// eval for ileus/obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Chest radiograph dated ___ and CT and pelvis dated ___.
FINDINGS:
There are multiple dilated loops of air-filled colon measuring up to 7.1 cm in
the right mid abdomen, consistent with colonic ileus. There are no abnormally
dilated loops small bowel. Re-demonstrated is a loculated right pleural
effusion.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable. A single visualized median sternotomy
wire is intact. Surgical clips are seen overlying the left lower thorax.
Rounded opacity in the left upper quadrant likely represents the surgically
placed PEG tube.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
1. Multiple dilated loops of air-filled colon consistent with colonic ileus.
2. Loculated right pleural effusion, similar to prior.
|
19917446-RR-76
| 19,917,446 | 20,856,545 |
RR
| 76 |
2124-01-15 13:20:00
|
2124-01-15 16:51:00
|
INDICATION: ___ year old man with new trach// eval trach
TECHNIQUE: AP portable
COMPARISON: ___
IMPRESSION:
Patient has been extubated. New tracheostomy is in midline position.
Left-sided PICC line with the tip in the SVC. Median sternotomy wires
unchanged. Mitral and aortic valve replacement. Surgical clips projecting
over the left mediastinal contour.
Redistribution of bilateral pleural effusions, large on the right, small on
the left. Right lung is more expanded than prior radiograph, likely due to
redistribution of the fluid.
New retrocardiac opacity suggests atelectasis. There is no pneumothorax.
|
19917446-RR-77
| 19,917,446 | 20,856,545 |
RR
| 77 |
2124-01-18 07:25:00
|
2124-01-18 13:40:00
|
INDICATION: ___ year old man s/p redo MVR/AVR// follow up edema
COMPARISON: ___
IMPRESSION:
The tracheostomy and left-sided PICC line are again seen. Mediastinal wires
are present. There is cardiomegaly. There are bilateral pleural effusions
and a left retrocardiac opacity, stable. Partially loculated pleural fluid is
seen within the right minor fissure, unchanged. There is moderate pulmonary
edema. There are no pneumothoraces.
|
19917510-RR-13
| 19,917,510 | 26,039,287 |
RR
| 13 |
2168-06-18 13:25:00
|
2168-06-18 13:38:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with pleuritic chest pain
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Left-sided dual-chamber pacemaker device is noted with leads terminating in
the right atrium and right ventricle. Moderate cardiomegaly is re-
demonstrated along with tortuosity of the thoracic aorta. Mediastinal and
hilar contours otherwise are stable. Lungs are clear. Pulmonary vasculature
is normal. No pleural effusion or pneumothorax is present. No acute osseous
abnormality is detected.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19917746-RR-44
| 19,917,746 | 22,227,729 |
RR
| 44 |
2194-10-09 21:40:00
|
2194-10-09 23:08:00
|
CHEST RADIOGRAPH
HISTORY: Chest pain and shortness of breath.
COMPARISONS: ___.
TECHNIQUE: Chest, portable AP upright.
FINDINGS: There is increased opacification of the right hemithorax suggesting
a large pleural effusion with associated lung collapse, noting nearly balanced
mass effect. There is no evidence for pleural effusion on the left.
Calcified pleural plaques are again noted along the left mid hemithorax.
IMPRESSION: Increased opacification of the right lung, probably reflecting
increasing pleural effusion and lung collapse.
|
19917746-RR-45
| 19,917,746 | 22,227,729 |
RR
| 45 |
2194-10-09 22:43:00
|
2194-10-10 01:22:00
|
INDICATION: Known lung cancer, presenting with new AFib, shortness of breath,
chest pain. Assess for pulmonary embolism.
COMPARISON: Comparison is made to CT chest with contrast performed ___.
TECHNIQUE: Intravenous contrast was administered and arterial phase imaging
was acquired through the chest. Coronal, sagittal and oblique reformats
provided.
FINDINGS: Compared to next preceding study of ___, there is stable
significant lymphadenopathy with representative measurements including a left
peripectoral lymph node conglomerate measuring 3.2 x 1.7 cm (2:16). A right
subpectoral lymph node measuring 13 mm (2:25) as well as stable severe
mediastinal lymphadenopathy with representative measurements including a right
upper paratracheal lymph node measuring 14 x 18 mm (2:19), as well as a right
lower paratracheal lymph node measuring 14 x 18 mm (2:32).
There has been interval near complete collapse of the right lung with abrupt
___ of the right upper lung bronchus and right bronchus intermedius. The
extent of the right hilar mass is poorly evaluated due to adjacent collapsed
lung but given its proximity to mass better evaluated on prior examination,
suspect that the right bronchus intermedius if not both main bronchial
occlusions are due to direct tumor ingrowth. In addition, there is also
progressive occlusion of the right descending pulmonary artery as it crosses
the newly occluded bronchus intermedius with worsening severe impingement of
the posteroinferior aspect of the invaded artery (2:47). Despite the invasion
of the pulmonary artery, there is no evidence of pulmonary embolus, bland or
malignant.
Apart from minimal calcified atherosclerotic disease, the aorta is
unremarkable. The heart is normal in size and demonstrates a stable if not
minimally increased moderate pericardial effusion. However, there is no
collapse of the right atrium, nor coronary sinus, nor enlargement of the
superior or inferior vena cava to suggest tamponade. There is no definite
infiltration of the epicardial fat, though evaluation is somewhat limited by
motion.
On the left, there is a new small non-hemorrhagic layering pleural effusion
with minimal associated atelectasis. However, the most significant interval
change on the left is development of approximately 27 x 21 mm irregular
peribronchiolar opacifications within the lingula at the site of previously
millimetric nodules. Multiple other millimetric nodules are also slightly
increased in size, particularly in the anterior aspect of the lingula (3:98).
There is increased beaded septal thickening as well as beading of the pleural
surfaces, concerning for lymphangitic spread of malignancy.
Dense calcified pleural plaques, particularly in the left lung base are
longstanding and thought to be related to asbestosis.
Limited assessment of the upper abdomen demonstrates marked elevation of the
right hemidiaphragm consistent with lobar collapse. In addition, incompletely
assessed intra-abdominal retroperitoneal and mesenteric lymphadenopathy is
evident, including a stable large right retrocrural lymph node measuring 11
mm.
No suspicious lytic or blastic lesions present.
IMPRESSION:
1. Interval progression of malignant disease with new complete right lung
consolidation and occlusion of the central right upper lobe bronchus as well
as bronchus intermedius, with at least the latter likely due to direct tumor
invasion. Worsening severe attenuation and invasion of the right main
pulmonary artery, but no large pulmonary embolus identified.
2. Increased size of left lingular peribronchiolar opacifications, previously
millimetric nodules, concerning for metastatic disease. In addition,
increased beading of the interlobular septa and pleural surfaces concerning
for lymphangitic spread.
3. New small left layering non-complex pleural effusion.
4. Stable small to moderate pericardial effusion without evidence of cardiac
tamponade.
|
19917746-RR-46
| 19,917,746 | 22,227,729 |
RR
| 46 |
2194-10-10 23:06:00
|
2194-10-11 08:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with tachycardia and resp distress // r/o acute
process
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, there is unchanged complete collapse
of the right lung, which shift of the mediastinum to the right. The left
perihilar vessels show slight increase in diameter, potentially reflecting
mild pulmonary edema. Increasing retrocardiac and left basilar atelectasis.
|
19917861-RR-10
| 19,917,861 | 20,674,522 |
RR
| 10 |
2157-09-01 16:32:00
|
2157-09-01 17:05:00
|
INDICATION: ___ male with increased weakness. Question pneumonia.
COMPARISON: None available.
FINDINGS: Frontal and lateral views of the chest demonstrate normal
cardiomediastinal silhouette. The thoracic aorta is mildly unfolded. The
lungs are clear. There is no pneumothorax, vascular congestion, or pleural
effusion.
IMPRESSION: No acute cardiopulmonary process. Specifically, no pneumonia.
|
19917861-RR-11
| 19,917,861 | 20,674,522 |
RR
| 11 |
2157-09-01 16:36:00
|
2157-09-01 17:06:00
|
INDICATION: Leg pain with leg externally rotated.
COMPARISON: None.
AP VIEW OF THE PELVIS, TWO VIEWS OF THE RIGHT HIP: No acute fracture or
dislocation is identified. Hips and sacroiliac joints are not diastatic.
Heterotopic ossification is seen medial to the lesser trochanter on the left.
Mild joint space narrowing is seen involving both hips, with mild degenerative
changes in the imaged lumbar spine. No suspicious lytic or sclerotic osseous
abnormalities are present.
IMPRESSION: No acute fracture or dislocation.
|
19917861-RR-12
| 19,917,861 | 20,674,522 |
RR
| 12 |
2157-09-01 17:02:00
|
2157-09-01 18:08:00
|
INDICATION: ___ male status post fall. Question intracranial
hemorrhage.
COMPARISON: None available.
TECHNIQUE: Contiguous non-contrast axial images were acquired through the
brain with multiplanar reformations.
FINDINGS: There is no intracranial hemorrhage, mass effect, edema, or shift
of normally midline structures. The gray-white matter differentiation is
preserved. Ventricles and sulci are prominent, consistent with age-related
involution. There are scattered areas of subcortical and periventricular
white matter hypoattenuation, consistent with small vessel ischemic disease.
Suprasellar and basilar cisterns are patent.
Paranasal sinuses and mastoid air cells are well aerated. There is no skull
base fracture. Trace vascular calcification is seen in the cavernous carotid
artery. Right orbital prosthesis is seen. The left globe appears within
normal limits.
IMPRESSION:
1. No acute intracranial process or evidence of fracture.
2. Age-related involution and small vessel ischemic disease.
|
19917861-RR-13
| 19,917,861 | 20,674,522 |
RR
| 13 |
2157-09-01 17:03:00
|
2157-09-01 18:38:00
|
INDICATION: ___ male status post fall. Question fracture.
COMPARISON: None available.
TECHNIQUE: MDCT of the cervical spine was performed without contrast
administration with multiplanar reformations.
FINDINGS: There is no evidence of fracture or subluxation in the cervical
spine. The prevertebral and paravertebral soft tissues are within normal
limits. There are mild multilevel degenerative changes including mild disc
bulging at C5-6 and C6-7 resulting in mild central canal narrowing. No
critical canal or neural foraminal narrowing is identified.
Mastoid air cells are well aerated. Posterior fossa content is within normal
limits. Deep cervical soft tissues are unremarkable. Lung apices are clear,
with minimal emphysema.
IMPRESSION: No fracture or subluxation.
|
19917861-RR-14
| 19,917,861 | 20,674,522 |
RR
| 14 |
2157-09-01 18:55:00
|
2157-09-01 19:31:00
|
INDICATION: Knee pain after fall.
COMPARISON: None.
RIGHT KNEE, THREE VIEWS: No acute fracture or dislocation is identified.
There are moderate to severe tricompartmental degenerative changes, worst in
the lateral and patellofemoral compartments with severe joint space narrowing,
osteophyte formation, subchondral irregularity. There is a moderate-sized
joint effusion. No suspicious lytic or sclerotic osseous abnormalities are
seen.
IMPRESSION: No acute fracture or dislocation. Moderate to severe
osteoarthritis.
|
19917861-RR-15
| 19,917,861 | 23,447,757 |
RR
| 15 |
2158-04-26 12:10:00
|
2158-04-26 13:09:00
|
INDICATION: ___ male with fall and knee pain. Assess for fracture.
COMPARISONS: Right knee radiographs of ___.
FINDINGS: Three views of the right knee were obtained. There is no evidence
of fracture or dislocation. Tricompartmental degenerative changes of the
right knee are moderate with joint space narrowing of the lateral and medial
tibiofemoral compartments, sharpening of the tibial spine, marginal osteophyte
formation, and patellar spurring. A small joint effusion is present without
lipohemarthrosis. A fabella is incidentally noted. No focal lytic or
sclerotic lesion. No radiopaque foreign body.
IMPRESSION:
Small right knee effusion, similar to ___. No acute fracture or
dislocation.
|
19917861-RR-16
| 19,917,861 | 23,447,757 |
RR
| 16 |
2158-04-26 12:10:00
|
2158-04-26 12:32:00
|
INDICATION: ___ male with fall. Evaluate for acute intrathoracic
process.
COMPARISONS: Chest radiograph of ___.
FINDINGS: Frontal and lateral views of the chest were obtained. The heart is
of top normal size, although exaggerated by low lung volumes. The thoracic
aorta is slightly unfolded. Lungs are clear without focal or diffuse
abnormality. No pleural effusion or pneumothorax. No radiopaque foreign
body. No displaced fracture seen.
IMPRESSION: No acute cardiopulmonary process. No displaced fracture seen.
|
19917861-RR-17
| 19,917,861 | 23,447,757 |
RR
| 17 |
2158-04-26 12:08:00
|
2158-04-26 12:58:00
|
INDICATION: ___ male with fall. Assess for intracranial hemorrhage.
COMPARISON: Head NECT of ___.
TECHNIQUE: Contiguous axial MDCT sections were obtained through the brain
without administration of IV contrast. Axial images were interpreted in
conjunction with coronal, sagittal, and thin slice bone algorithm reformats.
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or large territorial
infarction. The ventricles and sulci are prominent, compatible with
age-related volume loss. Mild periventricular white matter hypodensities are
compatible with chronic small vessel ischemic disease. The basal cisterns
appear patent and there is preservation of gray-white matter differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. A right globe prosthesis is
present, similar to prior. The left globe is unremarkable.
IMPRESSION: No intracranial hemorrhage or calvarial fracture.
|
19917861-RR-18
| 19,917,861 | 23,447,757 |
RR
| 18 |
2158-04-26 12:08:00
|
2158-04-26 13:05:00
|
INDICATION: ___ male with fall. Rule out fracture.
COMPARISONS: ___ cervical spine CT.
TECHNIQUE: 2.5-mm helical axial MDCT sections were obtained through the
cervical spine from the skull base to the superior endplate of T2. Axial
images were interpreted in conjunction with coronal and sagittal reformats.
FINDINGS:
No fracture is identified. Vertebral body heights are maintained. Multilevel
degenerative changes are present with intervertebral disc space narrowing,
most prominent at C6-7. Posterior disc bulges at C6-7 and C7-T1 indent the
thecal sac without significant spinal canal narrowing. No acute alignment
abnormality is present.
No prevertebral soft tissue abnormality. No cervical lymphadenopathy. The
thyroid gland is unremarkable. The visualized lung apices are clear.
IMPRESSION: No acute cervical spine fracture or dislocation.
|
19917861-RR-20
| 19,917,861 | 24,725,844 |
RR
| 20 |
2159-01-23 20:19:00
|
2159-01-23 21:48:00
|
INDICATION: History of worsening weakness and refusal to eat. Rule out mass
or edema.
COMPARISON: Head CT from ___.
TECHNIQUE: ___ MDCT images were obtained through the brain without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes were generated and reviewed.
FINDINGS: There are new bilateral subdural hypodense collections causing mild
mass-effect on the frontal lobes with smaller sulci compared to the prior
study. There is no evidence of herniation. There is no acute intracranial
hemorrhage. The ventricles are otherwise unremarkable. The basilar cisterns
are patent and there is preservation of the gray-white matter differentiation.
There is no large acute territorial infarction.
No fracture is identified. The visualized paranasal sinuses are clear.
Mastoid air cells and middle ear cavities are unremarkable. No facial or
cranial soft tissue abnormalities are identified. Note is made of a prosthetic
right eye.
IMPRESSION:
New bilateral subdural hypodense collections causing mild mass effect likely
secondary to subdural hygromas or chronic subdural hematomas. No evidence of
herniation.
|
19917861-RR-21
| 19,917,861 | 24,725,844 |
RR
| 21 |
2159-01-24 01:36:00
|
2159-01-24 10:42:00
|
HISTORY: Failure to thrive, firm mildly tender abdomen. Rule out obstruction
or other intra-abdominal process.
COMPARISON: None available.
FINDINGS:
Supine frontal and left lateral decubitus radiographs of the abdomen
demonstrate rectal and right colonic fecal retention with formed stool in the
remaining colon. Air is seen throughout the small and large bowel. No free
air is identified. Visualized osseous structures are unremarkable.
IMPRESSION:
Air filled loops of small and large bowel could represent mild ileus; fecal
retention within the rectum and right colon.
|
19917861-RR-22
| 19,917,861 | 24,725,844 |
RR
| 22 |
2159-01-24 01:36:00
|
2159-01-24 08:24:00
|
CHEST RADIOGRAPH
INDICATION: Failure to thrive, rule out infectious process.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, lung volumes have
decreased. As a consequence, there is minimal crowding of vascular and
bronchial structures at the lung bases, but no current evidence of pulmonary
edema, pleural effusion, or other acute parenchymal change. Moderate
cardiomegaly. No pneumothorax.
|
19917861-RR-23
| 19,917,861 | 24,725,844 |
RR
| 23 |
2159-01-26 10:29:00
|
2159-01-26 11:03:00
|
REASON FOR EXAMINATION: Evaluation of the patient with suspected aspiration.
AP and lateral radiographs of the chest were reviewed in comparison to ___.
There is increase in the left retrocardiac opacity concerning for aspiration.
Heart size and mediastinal contours are stable. Lungs are otherwise
essentially clear with no appreciable pleural effusion or pneumothorax
demonstrated.
|
19917945-RR-10
| 19,917,945 | 23,176,017 |
RR
| 10 |
2124-05-16 19:35:00
|
2124-05-17 17:09:00
|
CLINICAL HISTORY: Bilateral stent placement. Four images from the operating
suite were submitted for review. No radiologist was present.
FINDINGS: Right-sided pyelogram was performed which appears to show some
questionable stricturing and filling defects in the proximal ureter. A
left-sided double-J stent is present. For full details, please refer to the
operative note in the OMR.
|
19917945-RR-9
| 19,917,945 | 23,176,017 |
RR
| 9 |
2124-05-16 09:08:00
|
2124-05-16 11:44:00
|
INDICATION: History of gastric cancer on chemotherapy, now with right-sided
flank pain, evaluate for stone.
COMPARISON: PET-CT ___ and CT abdomen and pelvis ___.
TECHNIQUE: MDCT axial images were obtained from the dome of the liver to the
pubic symphysis after the uneventful administration of 130 mL of Omnipaque.
Coronal and sagittal reformations were provided and reviewed.
ABDOMEN: The visualized lung bases are clear without nodules. There is no
pleural effusion or pneumothorax. The imaged heart is unremarkable.
The liver contour is normal. A subcentimeter hypodensity in the lateral
portion of segment II is unchanged and is too small to characterize but likely
represents a cyst. The stomach wall is slightly thickened particularly
distally, and there has been loss of the normal rugal folds, consistent with
known diagnosis of linitis plastica. The gallbladder is normal and there is
no intrahepatic biliary duct dilatation. The spleen, pancreas and adrenal
glands are unremarkable. There is no free air. There is small amount of
ascites. There is a non-specific haziness to the omentum. No retroperitoneal
or mesenteric lymphadenopathy is seen. There is mild atherosclerosis about
the abdominal aorta. Incidental note is made of a duplicated right renal
artery.
There is mild hydronephrosis and hydroureter in the right kidney, not seen on
the prior exams. The dilated right ureter can only be traced to its mid
portion, and is not well seen distally. There is no evidence of
nephrolithiasis or ureterolithiasis. Although there is slight
hyperenhancement of the right ureteral wall within its mid segment, possibly
due to inflammation, a stricture or more subtle underlying ureteral lesion
cannot be fully excluded. A ureteral stent is seen within the left kidney
with the proximal portion in the lower pole and the distal portion coiled in
the bladder. No hydronephrosis or hydroureter is seen on the left. The kidneys
enhance symmetrically.
PELVIS: The bladder is full without calculi or masses. Again noted is an
enlarged uterus, consistent with multiple small fibroids. A small amount of
free fluid is again seen within the pelvis. There is prominence to the left
ovarian veins and dilatation of the left gonadal vein, raising the possibility
of pelvic congestion syndrome. The appendix is not visualized; however, there
are no secondary signs of appendicitis. The rectum and sigmoid are normal.
BONES: There are no suspicious osseous lesions.
IMPRESSION:
1. New right sided mild hydronephroureter. Dilated ureter can only be traced
to its midportion where slight enhancement of the ureteral walls may be due to
inflammation. Findings may be due to a mid ureteral stricture or subtle
ureteral lesion and further characterization may be performed with MR
urography or direct visualization. Urologic consult is recommended.
2. Left ureteral stent appears to be in appropriate position.
3. Mildly thickened gastric wall compatible with known diagnosis of gastric
cancer. Haziness of the omentum which is non-specific but attention on
followup studies is recommended.
4. Trace amount of simple free pelvic fluid and ascites.
5. Left sided pelvic varices and dilated left gonadal vein can be seen with
pelvic congestion syndrome and clinical correlation is recommended.
|
19918048-RR-22
| 19,918,048 | 22,309,325 |
RR
| 22 |
2135-03-05 20:41:00
|
2135-03-05 21:47:00
|
EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: ___ male with history of fever, recent surgery.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. There has
been interval removal of a left-sided PICC. No focal consolidation, pleural
effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal
silhouettes are stable and unremarkable. Degenerative changes are seen along
the spine.
IMPRESSION: No acute cardiopulmonary process.
|
19918048-RR-23
| 19,918,048 | 22,309,325 |
RR
| 23 |
2135-03-07 11:15:00
|
2135-03-07 16:33:00
|
HISTORY: Bladder cancer, radical cystectomy with neobladder creation, now
with fever, insufficient opened at bedside.
TECHNIQUE: Multidetector CT imaging was performed from the hemidiaphragms
through to the pubic symphysis during intravenous contrast administration.
Sagittal and coronal reformatted images were also generated.
CT OF THE ABDOMEN WITH CONTRAST, FINDINGS: Current study is compared to a
prior contrast-enhanced study of ___, from an outside institution as
well as the CT cystogram performed on ___ at this institution. Lung
bases demonstrate some pleural parenchymal scarring or atelectasis
bilaterally.
The liver demonstrates two well-delineated hypodense areas, one in segment II,
a second in segment V, both compatible with simple cysts and unchanged.
Within segment V, there is also a well-delineated but irregular shaped
vascular blush. This demonstrates a feeding portal branch as well as a
draining hepatic vein. This either represents a flash hemangioma or a
congenital AV malformation, which has now associated consequences such as
parenchymal loss. The gallbladder appears unremarkable.
There is no free fluid, no significant adenopathy. Some atherosclerotic
disease of the aorta and its branches. The visualized loops of large and
small bowel appear normal. The pancreas also appears unremarkable as do both
adrenal glands.
The kidneys, most notably on the left, demonstrate a striated nephrogram.
There is some lack of corticomedullary delineation involving much of the
superior pole of the left kidney. There is also a subtle area of lack of
delineation involving the superior pole on the right. Multiple more areas on
the left than the right. Findings are most consistent with bilateral
pyelonephritis, left to a greater extent than the right. There is no
hydronephrosis and no perirenal abnormalities.
CT OF THE PELVIS WITH CONTRAST, FINDINGS: Again appreciated is
atherosclerotic disease of the aorta and its branches. Recent percutaneous
catheter decompressing this patient's neobladder has been removed with
remaining ghost track. There are expected postoperative changes along the
ghost track. There is fairly prominent right inguinal lymph node measuring 12
mm and minimum ___, just adjacent to the common femoral vein (series 3,
image 72). This was present on the prior outside study but has increased
somewhat in size and attention to this area on followup is warranted.
There is no free fluid in the pelvis, there is no significant internal iliac
adenopathy on either the left or right. The iliac nodal dissection clips are
seen. The visualized large and small bowel appear normal.
Bone windows demonstrate significant degenerative changes only.
IMPRESSION:
1. Loss of corticomedullary delineation involving both kidneys, most marked
on the left. Findings consistent with bilateral pyelonephritis, left greater
than right. This overall appears uncomplicated without any associated abscess
or perirenal abnormality.
2. Flash hemangioma versus arteriovenous malformation involving the liver as
described, no sequela, this is likely congenital and unchanged compared to the
prior outside study.
3. No confirmed on a prior No evidence of pelvic fluid to suggest leak from
this patient's neobladder.
4. Mildly prominent right inguinal lymph node adjacent to the common femoral
vein. Not meeting size criteria for pathologic enlargement but has increased
in size compared to the prior exams and therefore attention to this area on
followup is warranted.
Open midline incision, appearing overall, unremarkable.
|
19918048-RR-24
| 19,918,048 | 22,309,325 |
RR
| 24 |
2135-03-09 13:57:00
|
2135-03-09 16:56:00
|
INDICATION: ___ male with new right-sided PICC.
COMPARISON: PA and lateral chest radiographs, ___.
TECHNIQUE: AP portable upright radiograph of the chest.
FINDINGS: Right-sided PICC line is seen in appropriate position, entering
this right subclavian and terminating within the low SVC. There is no
pneumothorax. The lungs are mildly hyperinflated bilaterally with no focal
consolidation, mass lesions or pleural effusion. The cardiomediastinal
silhouette exhibits a mildly tortuous aorta, but is otherwise within normal
limits. The pleural surfaces are unremarkable.
IMPRESSION: Successful placement of right-sided PICC.
|
19918048-RR-39
| 19,918,048 | 29,564,451 |
RR
| 39 |
2136-09-01 19:08:00
|
2136-09-01 19:30:00
|
HISTORY: History of bladder cancer with 1 day of nausea and severe abdominal
pain.
TECHNIQUE: Upright and supine AP views of the abdomen.
COMPARISON: ___.
FINDINGS:
Multiple dilated loops of small bowel measuring up to 6.5 cm are noted within
predominantly the left hemiabdomen with several differential air-fluid levels
noted. Paucity of gas is seen within the colon. Left lower quadrant
colostomy is visualized. Numerous clips are demonstrated within the pelvis.
There is no free intraperitoneal air. Moderate to severe degenerative changes
are noted in the hips bilaterally.
IMPRESSION:
Small bowel obstruction. No evidence for free intraperitoneal air.
|
19918125-RR-109
| 19,918,125 | 26,757,981 |
RR
| 109 |
2170-01-30 00:23:00
|
2170-01-30 00:48:00
|
EXAMINATION: RENAL U.S.
INDICATION: History: ___ with non-draining rt nephrostomy tube// eval for
hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound ___.
FINDINGS:
There is mild fullness of the right renal pelvis, without frank
hydronephrosis. There is no left hydronephrosis. No suspicious focal renal
lesions.
Right kidney: 9.5 cm
Left kidney: 12.3 cm
The bladder is decompressed, which limits evaluation.
IMPRESSION:
Mild fullness of the right renal pelvis without frank hydronephrosis. No
left-sided hydronephrosis.
|
19918125-RR-110
| 19,918,125 | 26,757,981 |
RR
| 110 |
2170-01-30 11:14:00
|
2170-01-30 14:47:00
|
INDICATION: ___ year old man with nondraining right percutaneous nephrostomy
tube// This perform percutaneous nephrostomy tube check
COMPARISON: Nephroureteral stent placement dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
performed the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 14 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed, lidocaine
CONTRAST: 20 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 6.9, 33 mGy
PROCEDURE:
1. Bilateral diagnostic antegrade nephrostogram.
2. Bilateral 8 ___ nephroureterostomy tube exchange.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient.The patient was then brought to the angiography suite and placed prone
on the exam table. A pre-procedure time-out was performed per ___ protocol.
The right and left flank were prepped and draped in the usual sterile fashion.
Diluted contrast was injected into the left nephroureterostomy tube to confirm
catheter position. The image was stored on PACS. Local anesthesia was
administered with instillation of lidocaine jelly and 1% subcutaneous
lidocaine injection. The catheter was cut. A ___ wire was advanced into
the left nephrostomy tube and advanced into the distal ureter. The stay
sutures were cut and the catheter was removed over the wire. A new 8 ___ by
24 cm nephroureterostomy catheter was flushed and advanced into appropriate
position. The wire was removed and the pigtail was formed. Contrast injection
confirmed appropriate positioning. The final image was saved. The catheter was
then flushed, stay sutures applied and the catheter was secured with a
Flexitrac device and sterile dressings. The catheter was attached to a bag
for drainage.
Diluted contrast was injected into the right nephroureterostomy tube to
confirm catheter position. The image was stored on PACS. Local anesthesia was
administered with instillation of lidocaine jelly and 1% subcutaneous
lidocaine injection. The catheter was cut. A ___ wire was advanced into
the right nephrostomy tube and advanced into the distal ureter. The stay
sutures were cut and the catheter was removed over the wire. A new 8 ___ by
22 cm nephroureterostomy catheter was flushed and advanced over the wire into
appropriate position. The wire and stiffener were removed and the pigtail was
formed. Contrast injection confirmed appropriate positioning. The final image
was saved. The catheter was then flushed, and the catheter was secured with a
Flexitrac device and sterile dressings. The catheter was attached to a bag
for drainage.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Bilateral antegrade nephrostogram shows distal ureteral obstruction with no
flow through the nephroureterostomy stents into the bladder. Both tubes
appeared pulled back.
2. Appropriate final position of bilateral 8 ___ nephroureterostomy tubes.
IMPRESSION:
Technically successful bilateral 8 ___ nephroureterostomy exchange. The
left nephroureterostomy is 8 x 24 and the right is 8 x 22.
RECOMMENDATION(S): If there is continued occlusion of the tubes,
consideration for upsize to 10 ___ should be considered
|
19918125-RR-111
| 19,918,125 | 26,757,981 |
RR
| 111 |
2170-01-31 20:06:00
|
2170-01-31 20:44:00
|
INDICATION: ___ year old man with fever, eval for pna// ___ year old man with
fever, eval for pna
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiac silhouette is within normal limits.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19918125-RR-112
| 19,918,125 | 26,757,981 |
RR
| 112 |
2170-02-02 14:56:00
|
2170-02-02 17:39:00
|
INDICATION: ___ year old man with NET and obstructive uropathy with a R PCNU
that failed capping.// ___ year old man with NET and obstructive uropathy with
a R PCNU that failed capping.
COMPARISON: Nephroureteral stent placement dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and
Dr. ___, Interventional Radiology fellow performed the procedure.
Dr. ___ supervised the trainee during any key components of
the procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
75mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 15 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None
CONTRAST: 50 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 4.4 minutes, 19 mGy
PROCEDURE:
1. Bilateral diagnostic antegrade nephrostogram.
2. Right 8 ___ 22 cm PCNU exchange for a 10 ___ 24 cm PCNU.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient.The patient was then brought to the angiography suite and placed prone
on the exam table. A pre-procedure time-out was performed per ___ protocol.
The right and left flank were prepped and draped in the usual sterile fashion.
Diluted contrast was injected into the left nephrostomy to confirm catheter
position. The image was stored on PACS. Contrast injection confirmed
appropriate positioning and patent lumen. The final image was saved. The
catheter was then flushed, the catheter was secured with a flexi track and
sterile dressings. The catheter was capped.
Diluted contrast was injected into the right nephrostomy to confirm catheter
position. Anterograde nephrostogram demonstrated a clogged tube. The image
was stored on PACS. Local anesthesia was administered with instillation of
lidocaine jelly and 1% subcutaneous lidocaine injection. The catheter was cut.
A ___ wire was advanced into the right nephrostomy tube and advanced into
the distal ureter and into the bladder. The catheter was removed over the
wire. A new 10 ___ 24 cm PCNU catheter was flushed and advanced over the
wire into appropriate position. The wire was removed and the distal pigtail
was formed and the proximal loop was blocked in place in the left renal
pelvis. Contrast injection confirmed appropriate positioning. The final image
was saved. The catheter was then flushed, stay sutures applied and the
catheter was secured with a flexi track device and sterile dressings. The
catheter was capped.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Left antegrade nephrostogram shows a patent left PCNU.
2. Right antegrade nephrostogram demonstrates a obstructed right PCNU with
contrast flowing down to the mid ureter with no opacification of the tube
lumen distally.
3. Post exchange and upsize of the right tube, there is rapid transit of
contrast to the bladder.
4. Appropriate final position of bilateral PCNU tubes.
IMPRESSION:
Technically successful right 8 ___ 22cm PCNU exchange for a 10 ___ 24cm
PCNU.
Patent left 8 ___ 24 cm PCNU.
Both tubes were capped.
|
19918125-RR-139
| 19,918,125 | 29,631,735 |
RR
| 139 |
2171-02-02 01:33:00
|
2171-02-02 02:34:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with right lower quadrant pain and
decreased output from right nephrostomy tubeNO_PO contrast// Assess for right
hydronephrosis, right lower quadrant pathology, obstruction
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 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 6.7 s, 52.6 cm; CTDIvol = 24.4 mGy (Body) DLP =
1,282.4 mGy-cm.
Total DLP (Body) = 1,293 mGy-cm.
COMPARISON: CT of the abdomen pelvis from ___
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.
Again seen is the sub diaphragmaticd dome lesion that measures 3.9 x 3.8 cm,
unchanged from prior (series 2, image 16). Additional right hepatic lesions
in segment 8 is unchanged measuring 2.0 cm and in segment 7 measuring 0.8 cm.
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: Re-demonstrated are bilateral percutaneous nephrostomy tubes appear
in stable position. There is new severe hydronephrosis of the right kidney
and right hydroureter. Hydroureter extends into the pelvis and appears to be
a obstructed due to a previously known pelvic mass. The left kidney
demonstrates interval resolution of mild hydronephrosis. There is no evidence
of solid renal lesions. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Surgical clips
are seen scattered throughout the abdomen. Patient is status post right
hemicolectomy. Otherwise, the colon and rectum are within normal limits. The
appendix is surgically absent.
Previously known nodules in the right pericolic gutter, perisplenic and
Morison's pouch are unchanged. (Series 2, image 46, 19).
PELVIS: Re-demonstrated are ovoid pelvic masses that measure 3.8 x 5.0 cm and
6.2 x 2.8 cm, previously 3.5 x 5.2 cm and 3.8 x 7.0 cm respectively (series
601, 42). Bladder is decompressed. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate gland is the upper limit of normal for size.
LYMPH NODES: 1.1 cm aortocaval lymph node is unchanged (series 2, image 22).
There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Unchanged 1.2 cm lytic lesion in the right iliac bone (series 2, image 50).
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Progressed right hydroureteronephrosis, now moderate to severe, and
interval resolution of left hydroureteronephrosis. Bilateral percutaneous
nephrostomy tubes are in unchanged positions.
2. Stable metastatic disease involving the liver, lymph nodes, peritoneal and
retroperitoneal implants, pelvic masses and possible right iliac bone.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:10 am, 5 minutes after discovery
of the findings.
|
19918125-RR-141
| 19,918,125 | 29,631,735 |
RR
| 141 |
2171-02-03 11:37:00
|
2171-02-03 14:08:00
|
INDICATION: ___ year old man with malfunctioning right ___// B/L ___ with new
right hydro and cloudy urine with fever
COMPARISON: Bilateral ___ exchange from ___
TECHNIQUE: OPERATORS: Dr. ___, attending Interventional
Radiologist and Dr. ___ resident performed the
procedure. Dr. ___ personally supervised the trainee during
any key components of the procedure where applicable and reviewed and agrees
with the findings as reported below.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 30 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Versed and fentanyl
CONTRAST: 10 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 4.3 minutes, 19 mGy
PROCEDURE:
1. Bilateral diagnostic antegrade nephrostogram.
2. Bilateral 10 ___ nephrostomy exchange.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. Discussion with the patient prior to the procedure regarding
adequate drainage of current tubes determine that trial of larger 10 ___
bilateral percutaneous nephrostomy tubes will be attempted on this exchange in
order to improve functionality and quality of life the patient was then
brought to the angiography suite and placed prone on the exam table. A
pre-procedure time-out was performed per ___ protocol. The right and left
flank were prepped and draped in the usual sterile fashion.
Diluted contrast was injected into the left nephrostomy to confirm catheter
position. The image was stored on PACS. Local anesthesia was administered with
instillation of lidocaine jelly and 1% subcutaneous lidocaine injection. The
catheter was cut. A ___ wire was advanced into the left nephrostomy tube
and advanced into the distal ureter. The stay sutures were cut and the
catheter was removed over the wire. A new 10 ___ nephrostomy catheter was
flushed and advanced with its plastic stiffener over the wire into appropriate
position. The wire and stiffener were removed and the pigtail was formed.
Contrast injection confirmed appropriate positioning. The final image was
saved. The catheter was then flushed, stay sutures applied and the catheter
was secured with a Stat Lock device and sterile dressings. The catheter was
attached to a bag for drainage.
Diluted contrast was injected into the right nephrostomy to confirm catheter
position. The image was stored on PACS. Local anesthesia was administered with
instillation of lidocaine jelly and 1% subcutaneous lidocaine injection. The
catheter was cut. A ___ wire was advanced into the right nephrostomy tube
and advanced into the distal ureter. The stay sutures were cut and the
catheter was removed over the wire. A new 10 ___ nephrostomy catheter was
flushed and advanced with its plastic stiffener over the wire into appropriate
position. The wire and stiffener were removed and the pigtail was formed.
Contrast injection confirmed appropriate positioning. The final image was
saved. The catheter was then flushed, stay sutures applied and the catheter
was secured with a Stat Lock device and sterile dressings. The catheter was
attached to a bag for drainage.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Bilateral antegrade nephrostogram shows contrast filling to the mid to
distal ureters bilaterally with reflux bilaterally and no contrast passage
into the bladder.
2. Appropriate final position of bilateral ___ F nephrostomy tubes. The right
8.5 ___ was upsized to a ___ F APDL. PCNUs were not attempted
after discussion with urology as the patient has had recurrent infections
while in place previously. A ___ was placed previously on the
rigtht after the patient experienced pain, however, given recent infection
development of hydronephrosis and the fact the new tube has been in place
since ___ (different tract ___, a ___ F was placed and seemed well tolerated
by the patient.
IMPRESSION:
Technically successful Bilateral 10 ___ nephrostomy exchange.
RECOMMENDATION(S): The patient should return in 3 months for routine check
and change.
|
19918125-RR-96
| 19,918,125 | 29,294,931 |
RR
| 96 |
2169-11-05 15:06:00
|
2169-11-05 15:28:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with fever, diabetes mellitus//?pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Heart size is mildly enlarged. Mediastinal and hilar contours are
unremarkable. Pulmonary vasculature is not engorged. Patchy opacity in the
left lower lobe may reflect atelectasis. No focal consolidation, pleural
effusion, or pneumothorax is seen. Mild degenerative changes are noted in the
thoracic spine.
IMPRESSION:
Mild patchy left lower lobe opacity, likely atelectasis .
|
19918125-RR-97
| 19,918,125 | 29,294,931 |
RR
| 97 |
2169-11-05 17:46:00
|
2169-11-05 18:55:00
|
EXAMINATION: CT abdomen pelvis with contrast
INDICATION: NO_PO contrast; History: ___ with LLQ abd pain, nephrostomy
tubesNO_PO contrast// ?diverticulitis patent nephrostomy tubes
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.
Multidetector helical scanning of the chest was coordinated with intravenous
infusion of nonionic iodinated contrast agent and reconstructed as contiguous
5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm
MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 54.7 cm; CTDIvol = 19.0 mGy (Body) DLP =
1,036.2 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.4 mGy (Body) DLP =
6.7 mGy-cm.
Total DLP (Body) = 1,045 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
LOWER CHEST: Re-demonstrated is consolidation at the right lung base. No
evidence of pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 1.0
cm metastatic lesion at the hepatic dome is unchanged in size compared to the
prior study (601:31). Multiple hyperenhancing foci are also unchanged
(601:34) and likely represent hemangiomas. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas is diffusely atrophic. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. A small accessory splenule is again noted.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Bilateral percutaneous nephrostomy tubes and bilateral ureteral
stents are in place. There has been interval improvement in bilateral
hydronephrosis, however, there is a slightly delayed nephrogram on the right
as before. There is no perinephric abnormality.
GASTROINTESTINAL: No bowel obstruction is seen. The patient is status post
right colectomy with surgical sutures seen in the right lower quadrant.
Surgical clips in the right mid to lower abdomen are again present. Adjacent
spiculated tissue could represent normal postsurgical change or may be related
to underlying malignancy (02:52). However, this appears stable compared to
___.
PELVIS: Re-demonstrated are 2 soft tissue masses in the lower pelvis adjacent
to the ureters measuring 4.6 x 3.5 cm on the right (previously 4.5 x 3.5 cm)
and 3.9 x 2.2 cm on the left (previously 3.5 x 2.3 cm). As before, the
inferior portion of the left mass is contiguous with the left seminal vesicle.
There is mild circumferential thickening of the bladder wall, which could be
secondary to underdistention.. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is unremarkable. The above described pelvic
masses involve the left seminal vesicle.
LYMPH NODES: The previously noted subcentimeter nodules in the right pericolic
gutter likely represent metastatic disease and are unchanged (02: 44 and 45).
Several aortocaval nodes are also unchanged (2: 23 and 30). There is no new
retroperitoneal mesenteric lymphadenopathy. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mild thickening of the bladder wall could be secondary to underdistention,
however, correlation with urinalysis is recommended. Otherwise, no acute CT
findings in the abdomen or pelvis.
2. Interval improvement in bilateral hydronephrosis, however, there is a
persistently delayed nephrogram on the right.
3. No significant change in known metastatic disease, as described above.
|
19918413-RR-30
| 19,918,413 | 27,785,816 |
RR
| 30 |
2130-09-21 05:57:00
|
2130-09-21 06:42:00
|
EXAMINATION: Chest radiograph
INDICATION: History: ___ with fevers and cough// ?pna
TECHNIQUE: AP upright and lateral views of the chest
COMPARISON: Will prior comparisons, most recent from ___
FINDINGS:
There is large opacification in the left lower lobe, in the retrocardiac area,
consistent with a combination parenchymal opacification and moderate left
pleural effusion. Additionally, there is opacification in the right lower
lobe which may represent an additional focus of infection. These findings are
concerning for multifocal pneumonia with a moderate left pleural effusion.
Cardiac silhouette is moderately enlarged. Mediastinal and hilar contours
appear within normal limits.
IMPRESSION:
Findings concerning for left lower and right lower lobe pneumonias with
moderate left pleural effusion.
|
19918413-RR-35
| 19,918,413 | 20,849,922 |
RR
| 35 |
2130-11-28 07:48:00
|
2130-11-28 08:30:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with known pneumonia with worsening fever and
tiredness// CXR: eval for PNA
TECHNIQUE: Portable AP chest
COMPARISON: Multiple prior chest radiographs, most recently ___
FINDINGS:
There has been interval removal of the right IJ catheter. Since prior there
is been improved aeration of bilateral upper lungs. Opacification in the
right lower hemithorax has increased, due to moderate to large layering
pleural effusion. Left lower lobe is consolidated once more, either chronic
atelectasis or recurrence pneumonia, pointing to aspiration. Superimposed
infectious process cannot be excluded. Moderate cardiomegaly has improved and
previous pulmonary vascular congestion and borderline edema have resolved.
IMPRESSION:
1. Pleural effusion increased since ___..
2. Chronic left lower lobe consolidation, collapse or infection.
3. Chronic moderate cardiomegaly, slightly improved. Pulmonary vascular
engorgement decreased. No pulmonary edema.
4. Heavy atherosclerotic calcification, carotid arteries.
|
19918413-RR-36
| 19,918,413 | 20,849,922 |
RR
| 36 |
2130-11-30 14:14:00
|
2130-11-30 15:05:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with left pleural effusion s/p chest tube// chest
tube placement Contact name: ___, Phone: ___ chest tube placement
IMPRESSION:
Comparison to ___. The pre-existing right pleural effusion or was
drained with a right pigtail catheter. There only some minimal basal portion
of effusion but the patient has developed a small pneumothorax at the site of
tube insertion. There is no evidence of tension. Stable moderate
cardiomegaly and retrocardiac atelectasis.
|
19918413-RR-37
| 19,918,413 | 20,849,922 |
RR
| 37 |
2130-12-01 08:13:00
|
2130-12-01 10:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumonia, R pleural effusion s/p CT
placement ___// status of R pleural effusion? pneumothorax?
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest radiographs, most recently ___.
FINDINGS:
The right pleural drain is unchanged in position however there is
reaccumulation of a right pleural effusion, now moderate.
No appreciable left pleural effusion.
The lungs are otherwise clear.
No pneumothoraces are noted.
Stable mild cardiomegaly with unremarkable cardiomediastinal silhouette.
IMPRESSION:
Re-accumulation of right pleural effusion despite unchanged position of the
right pleural drain.
|
19918413-RR-38
| 19,918,413 | 20,849,922 |
RR
| 38 |
2130-12-02 13:25:00
|
2130-12-02 16:43:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) PORT
INDICATION: ___ with spinal stenosis, ESRD with Transaminitis.// ___ with
spinal stenosis, ESRD with Transaminitis. Please evaluate for any
liver/gallbladder disease.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound from ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is mild ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The common hepatic
duct measures 3 mm, similar to the prior ultrasound, while the common bile
duct measures up to 9 mm. This also appears similar to images from the
previous ultrasound showing dilation of the common duct in the free segment.
This is most likely nonobstructive.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 11.9 cm
KIDNEYS: Limited views of the echogenic native right kidney show no
hydronephrosis. The native left kidney was not imaged. There is a transplant
kidney in the left lower quadrant with preserved corticomedullary
differentiation and moderate to severe hydronephrosis. The degree of
hydronephrosis is increased from the previous ultrasound and CT.
Right kidney: 8.3 cm
Left lower quadrant transplant kidney: 10.0 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
Note is made of bilateral pleural effusions.
IMPRESSION:
Normal appearance of the liver and gallbladder. Extrahepatic biliary dilation
appears stable from prior. Increased hydronephrosis in the left lower
quadrant transplant kidney is noted.
|
19918694-RR-94
| 19,918,694 | 23,585,993 |
RR
| 94 |
2189-06-15 13:51:00
|
2189-06-16 07:07:00
|
STUDY: Lower extremity arterial noninvasives at rest.
REASON: Status post multiple bypass and stent placements.
FINDINGS: Doppler waveform analysis reveals monophasic waveforms at the right
common femoral, popliteal and ___. The DP is absent. On the left, there are
monophasic waveforms at the common femoral and popliteal and absent DP and ___.
The right ABI is 0.3, left ABI is 0.
Pulse volume recordings show significant blunting in the thigh bilaterally,
worse on the left than the right. There is further dampening bilaterally and
nearly flat tracings at the metatarsal level bilaterally.
IMPRESSION: Severe bilateral multilevel arterial occlusive disease.
|
19918694-RR-95
| 19,918,694 | 23,585,993 |
RR
| 95 |
2189-06-15 11:56:00
|
2189-06-15 15:29:00
|
EXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF W/ AND W/O C AND RECONS
INDICATION: ___ year old man with rest pain multiple bypasses // iliac/tibial
patency, anatomy
TECHNIQUE: MDCT-acquired axial images were first acquired from the lung bases
through the feet using low radiation dose technique. Next, immediately after
rapid intravenous administration of 100 mL Omnipaque, early arterial-phase
axial images were acquired from the lung bases through the feet. Lower
extremity runoff images were obtained by scanning from the feet to the knees
in reverse direction. Multiplanar reformations performed to generate 2.5 mm
slice thickness axial images, coronal MIPs, and sagittal MIPs. Curved
reformats, 3D MIPs, and volumetric rendering was performed by the Imaging Lab,
on a separate 3D workstation.
DOSE: DLP: 2469 mGy-cm.
COMPARISON: CT of the abdomen pelvis from ___ was reviewed.
FINDINGS:
CTA ABDOMEN/PELVIS:
The abdominal aorta is normal in caliber and without evidence of aneurysmal
dilation or dissection. The celiac axis, SMA, bilateral renal arteries, and
___ are grossly patent. There are bilateral endoluminal stent grafts extending
from the aortic bifurcation in the common iliacs to the level of the external
iliacs bilaterally. There is internal soft plaque bilaterally with mild to
moderate stenosis of the right common and external iliac artery (3a:112) and
mild stenosis of the left external iliac artery (3a:128). Atherosclerotic
mural calcifications are seen throughout the aorta and its major branches.
Hepatic arterial anatomy is conventional. Assessment of the venous
vasculature is limited by the timing of contrast.
CTA LOWER EXTREMITIES:
On the right, there is an unchanged ectasia of the common femoral artery
measuring 1.8 x 1.7 cm (3a:150) at the graft anastamosis. There is complete
occlusion of the right superficial femoral artery which contains a stent graft
extending to the level of the popliteal artery. There is reconstitution of
the popliteal artery through collaterals from the deep femoral artery, with
diminished caliber. A three-vessel runoff is demonstrated proximally, but
there is severe attenution of the anterior tibial, posterior tibial, and
peroneal arteries until the distal third of the lower leg where the peroneal
artery and posterior tibial artery are no longer opacified. The dorsalis
pedis is diminutive. There has been prior amputation of the right forefoot.
On the left are two grafts extending from the common femoral artery, both of
which are occluded, one within the superficial femoral artery terminating in
the distal medial thigh, and a femoral-to-anterior tibial artery bypass. The
bypass graft demonstrates two insertions into the anterior tibial artery
(3a:334, 390), with both limbs completely occluded. There is mild stenosis at
the graft insertion site of the left common femoral artery. There is
reconstitution of the popliteal artery, which is diminutive, via collaterals
from the deep femoral artery. A three-vessel runoff is demonstrated with
moderate attention of the anterior tibial, peroneal and posterior tibial
arteries until the mid lower leg, where the anterior tibial artery is
partially obscured by the lower portion of the femoral-AT bypass. The
posterior tibial artery is opacified throughout its course mild irregular
attenuation along the distal portion. The peroneal artery is opacified to the
level of the ankle joint. The dorsalis pedis artery is patent.
ABDOMEN:
Evaluation is limited by the arterial phase of image acquisition. The liver is
steatotic with no concerning focal lesion. The gallbladder and biliary tree
are normal. In the pancreas, there is an unchanged 7 mm hypodense lesion that
may represent an IPMN (03:31). The spleen is normal in size, without focal
lesion. The adrenal glands are normal. In the kidneys, there is unchanged
right upper pole renal cyst and another 2 left renal hypo enhancing lesions
that may also represent cysts (3a:24, 3a:34, 3a:68). There may be a small
duodenum diverticulum involving the second stage of the duodenum ( 3a:51).
There is colonic diverticulosis. The small bowel and large bowel are normal in
caliber, without wall thickening or mass. There is no intra- or
retroperitoneal lymphadenopathy. There is no ascites, fluid collection, or
pneumoperitoneum.
PELVIS:
The urinary bladder is without wall thickening or mass. The rectum is
unremarkable. The prostate gland is mildly enlarged with coarse
calcifications. There is no free fluid. There is no pelvic or inguinal
lymphadenopathy.
BONES AND SOFT TISSUES:
There are degenerative changes within the lumbosacral spine with no fracture.
There are no destructive osseous lesions concerning for malignancy or
infection. There are no soft tissue masses.
IMPRESSION:
1. Complete occlusion of bilateral superficial femoral arteries and left
femoral to anterior tibial grafts, with popliteal reconstitution from the deep
femoral collaterals.
2. Moderate attention of the left anterior tibial, peroneal and posterior
tibial arteries, appearing patent to the level of the ankles. Patent dorsalis
pedis.
3. Severe attenuation of the right peroneal and posterior tibial arteries
with no appreciable flow beyond the distal third segment. Severe attenuation
of the right anterior tibial artery with flow extending to the dorsalis pedis
artery. Post right forefoot amputation.
4. Patent bilateral iliac stents with mild to moderate stenosis as described
above.
5. Likely 7 mm side-branch IPMN in the pancreatic body remains stable and can
be followed in ___ years to ensure stability.
|
19918694-RR-98
| 19,918,694 | 28,820,960 |
RR
| 98 |
2192-09-16 19:53:00
|
2192-09-16 21:43:00
|
EXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF
INDICATION: ___ year old man with pulseless limb// assess arterial flow to
bilateral lower etremities
TECHNIQUE: Non-contrast and post-contrast CTA images were acquired through
the chest, abdomen and pelvis, with lower extremity runoff. Oral contrast was
not administered. MIP and 3D reconstructions were performed on independent
workstation and reviewed on PACS.
DOSE: Total DLP (Body) = 2,195 mGy-cm.
COMPARISON: CT abdomen and pelvis with runoff ___
FINDINGS:
CTA CHEST ABDOMEN PELVIS: Reflux of contrast within veins of the right chest
wall reflect IJ occlusion around the Port-A-Cath. A tiny filling defect is
noted adjacent to the tip of the Port-A-Cath in the ___, series 301, image 39.
Thoracic aorta is normal in course and caliber with mild atherosclerotic
calcification. Coronary artery calcification is moderate. Main pulmonary
artery and central branches appear patent. The celiac artery origin is patent
with conventional anatomy. The SMA artery origin is patent. Both renal
arteries are widely patent at their origin. The ___ appears slightly narrowed
at its origin. There is been prior aortoiliac stent graft with chronically
occluded left common iliac limb. The stent extends from the aortic
bifurcation along the course of the external iliac artery. The stent excludes
the internal iliac arteries which appear chronically occluded at their origins
from the right and left common iliac artery. There is evidence of collateral
flow within the right and left internal iliac arteries, with contrast seen
just beyond their origin from the common iliacs.
LEFT LOWER EXTREMITY CTA RUNOFF: There is occlusion of the left superficial
femoral artery as well as the stents and bypass graft is in the left leg. The
profundus femora is is occluded at its origin though there is collateral flow
which appears to be supplied by branches from the ilio lumbar and left
internal iliac arteries. There is flow within the upper calf at the level of
the trifurcation supplied by collateral branches from the profundus
circulation. However, flow in the left anterior tibial artery appears
markedly attenuated at the level of the lower leg/ankle region. On the
delayed series, flow within the left anterior tibial artery remains
attenuated.
RIGHT LOWER EXTREMITY CTA RUNOFF: At the distal aspect of the right external
iliac artery which is stented, the lumen is markedly narrowed though this is
similar to prior. Just distal to this point, there is focal aneurysmal
dilation of the right common femoral artery, similar to the prior exam,
measuring up to 19 x 18 mm, series 301, image 231. The right common femoral
artery gives rise to a patent profundus femoris, however the fem-pop bypass
stent is occluded. There is minimal flow within the native right superficial
femoral artery to the level of the popliteal artery which is primarily
supplied by branches of the profundus femora is. There is a patent 3 vessel
runoff into the right calf though flow appears attenuated likely reflecting
inflow stenosis. Again noted is amputation of the right forefoot.
CHEST: Paramediastinal fibrosis likely reflect prior radiation treatment.
Prominence of anterior mediastinal lymph nodes for instance on series 301,
image 39, with these nodes measuring up to 12 mm in short axis dimension. A
pretracheal lymph node measures up to 11 mm in short axis on series 301, image
42. A superior mediastinal lymph node measures 9 mm in short axis on series
301, image 31. The heart appears within normal limits of size. No pleural or
pericardial effusion. Multiple bilateral pulmonary nodules measure up to 8 mm
(301:49) in the right lower lobe. Mild fat stranding in the left axilla is
noted, with several mildly prominent lymph nodes which are likely reactive.
Port-A-Cath over the right chest wall with right IJ access terminates in the
mid SVC. A small thrombus is seen within the SVC likely adherent to the
catheter, series 301 images 38 through 40.
ABDOMEN: The liver appears grossly unremarkable. The spleen, gallbladder, and
adrenals are unremarkable. Renal hypodensities most likely represent simple
cysts, the largest of which is seen arising from the upper pole right kidney
measuring 4.3 x 4.0 cm. No adenopathy, free air or free fluid. The stomach
and duodenum appear normal. Cystic lesions within the proximal body of the
pancreas appear similar to the prior exam and can be further evaluated by MRCP
if not already performed. The stomach is decompressed. The duodenum appears
normal.
PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.
Diverticulosis of the colon is noted without diverticulitis. The appendix is
not visualized though there are no secondary signs of appendicitis. Urinary
bladder is well distended appearing normal. No pelvic free fluid. No
adenopathy along the pelvic sidewall or inguinal region.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Evidence of prior right forefoot amputation.
SOFT TISSUES: Multiple subcutaneous nodules overlying the anterior abdominal
wall measuring up to 2.1 cm are new since ___, may be injection
related.
IMPRESSION:
1. Abnormal CTA runoff with chronic occlusion of the stented left external
iliac artery and severe narrowing of the stented right external iliac artery
distally. Occluded stent and bypass graft in the lower extremities. Flow
preserved through the lower extremities due to collateral flow on the right
from the patent profundus femoris and on the left through left external iliac
artery collaterals supplying the profundus femoris, which in turn supplies the
popliteal artery and calf branches. Significant attenuation of the left
anterior tibial artery.
2. Pancreatic cystic lesions measuring up to 1.0 cm branch IPMNs. MRCP
advised in the absence of prior work-up.
3. Multiple bilateral pulmonary nodules measuring up to 8 mm. See ___
guidelines below. Prominent mediastinal lymph nodes can also be further
assessed at the time of follow-up chest CT.
4. Chronic occlusion of the right internal jugular vein surrounding the porta
catheter. Tiny thrombus in the SVC, likely adherent to the Port-A-Cath tip.
RECOMMENDATION(S): MRCP.
For incidentally detected multiple solid pulmonary nodules measuring 6 to 8mm,
a CT follow-up in 3 to 6 months is recommended in a low-risk patient, with an
optional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT
follow-up in 3 to 6 months and in 18 to 24 months is recommended.
|
19918888-RR-20
| 19,918,888 | 22,777,662 |
RR
| 20 |
2135-11-21 14:36:00
|
2135-11-21 15:53:00
|
HISTORY: Fracture.
TECHNIQUE: Portable AP view of the chest.
COMPARISON: None.
FINDINGS:
The heart size is normal. The mediastinal and hilar contours are notable for
calcified lymph nodes, but otherwise are unremarkable. The pulmonary
vascularity is not engorged. The lungs are clear without focal consolidation.
No pleural effusion or pneumothorax is identified. No acute osseous
abnormalities seen.
IMPRESSION:
No acute cardiopulmonary abnormality. Calcified mediastinal and hilar lymph
nodes compatible with prior granulomatous disease.
|
19918888-RR-21
| 19,918,888 | 22,777,662 |
RR
| 21 |
2135-11-21 14:36:00
|
2135-11-21 16:07:00
|
HISTORY: Fracture of the left femur.
TECHNIQUE: AP view of the pelvis, 2 views of the left hip, 2 views of the
left femur, 3 views of the left knee.
COMPARISON: ___ at 11: 30.
FINDINGS:
Mildly displaced fracture of the left femoral neck with slight varus
angulation is again demonstrated without significant interval change. There
is no dislocation. The hips demonstrate mild degenerative changes with joint
space narrowing. There is no diastasis of the pubic symphysis or sacroiliac
joints. No suspicious lytic or sclerotic osseous abnormalities are seen.
Within the right knee, there are mild degenerative changes, most pronounced in
the medial compartment with osteophytic spurring and joint space narrowing.
Chondrocalcinosis is also demonstrated. A joint effusion is not appreciated.
There are no radiopaque foreign bodies. Vascular calcifications are present.
IMPRESSION:
Mildly displaced and angulated fracture involving the left femoral neck.
|
19918888-RR-22
| 19,918,888 | 22,777,662 |
RR
| 22 |
2135-11-22 12:06:00
|
2135-11-22 16:28:00
|
HISTORY: ORIF.
FINDINGS: Multiple fluoroscopic images show stages in the metallic fixation
of a fracture of the proximal femur. Further information can be gathered from
the operative report.
|
19918916-RR-12
| 19,918,916 | 20,063,422 |
RR
| 12 |
2167-03-14 12:38:00
|
2167-03-14 14:12:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ female with concern for brainstem stroke. Assess for
stroke, prior pontine 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 head without contrast dated ___.
CT head without contrast dated ___.
FINDINGS:
Small, somewhat wedge-shaped acute infarction in the left find, does not
extend to the right side. Addition punctate focus of acute/early subacute
small infarcts in the left sub insula temporal lobe, and left internal
capsule.
Chronic infarcts have evolved in the right pons and medulla, left thalamus,
left internal capsule, and left basal ganglia compared to ___.
Wallerian degeneration left midbrain.
Findings of moderate chronic small vessel ischemic disease. With areas of
confluence in the deep white matter, likely microvascular chronic small vessel
ischemic changes, occasionally similar changes can be seen with metabolic or
inflammatory etiologies. Mild-to-moderate involutional changes. No
hydrocephalus. Preserved vascular flow voids, preserved basilar artery flow
void.
Mild mucosal thickening of the paranasal sinuses. Clear mastoid air cells.
Unremarkable intraorbital contents.
IMPRESSION:
1. Moderate size acute infarct left pons. Punctate acute/early subacute
infarcts left temporal lobe, left internal capsule.
2. Chronic infarcts left thalamus, internal capsule, globus pallidus, and
right pons.
3. No hemorrhage.
4. Remainder as above.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:03 pm, 5
minutes after discovery of the findings.
|
19918916-RR-14
| 19,918,916 | 20,063,422 |
RR
| 14 |
2167-03-15 11:14:00
|
2167-03-15 12:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with NGT placement// Confirm NGT placement
Confirm NGT placement
IMPRESSION:
Comparison to ___. The patient has received a nasogastric tube.
The tip of the tube projects over the proximal parts of the stomach. Moderate
cardiomegaly persists. Lung volumes are low. No pulmonary edema. No pleural
effusions. No pneumothorax.
|
19918916-RR-15
| 19,918,916 | 20,063,422 |
RR
| 15 |
2167-03-15 16:16:00
|
2167-03-15 16:39:00
|
EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old woman with redness, swelling of right arm// Assess
for DVT in Right upper extremity
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
vein.
The right internal jugular, axillary and brachial veins are patent, show
normal color flow and compressibility. The right basilic and cephalic veins
are patent, compressible and show normal color flow.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
19918916-RR-16
| 19,918,916 | 20,063,422 |
RR
| 16 |
2167-03-16 15:48:00
|
2167-03-16 17:16:00
|
INDICATION: ___ year old woman who needs PEG// Pre-PEG KUB requested by
surgery
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: No prior comparisons
FINDINGS:
Severely limited study secondary to body habitus and multiple telemetry leads.
A NG tube is seen with the side port at the GE junction with tip in the
stomach. A nonobstructive bowel gas pattern is seen with gas and stool in the
rectum.
IMPRESSION:
Severely limited study secondary to habitus and telemetry leads. NG tube is
seen with the side port at the GE junction and the tip in the body of the
stomach, recommend advancement by 5 cm.
|
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