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|---|---|---|---|---|---|---|---|
19918916-RR-17
| 19,918,916 | 20,063,422 |
RR
| 17 |
2167-03-17 10:26:00
|
2167-03-17 13:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with wheezes, hypoxia// Assess for
pneumonitis/pneumonia
IMPRESSION:
In comparison with the study of ___, the cardiomediastinal silhouette
remains within normal limits and there is no evidence of vascular congestion,
pleural effusion, or acute focal pneumonia. There are improved lung volumes.
The nasogastric tube is been removed.
|
19918916-RR-18
| 19,918,916 | 20,063,422 |
RR
| 18 |
2167-03-17 18:08:00
|
2167-03-17 19:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pontine infarcts.// NGT placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the enteric tube projects over the upper stomach. There are low
bilateral lung volumes with left lower lobe atelectasis. No pleural effusion
or pneumothorax. The size and appearance of the cardiomediastinal silhouette
is unchanged, given differences in patient positioning.
IMPRESSION:
The tip of the nasogastric tube projects over the upper stomach. Continued
advancement is recommended to ensure that the side port lies beyond the GE
junction.
|
19918916-RR-19
| 19,918,916 | 20,063,422 |
RR
| 19 |
2167-03-17 21:44:00
|
2167-03-18 16:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new line placement// NGT placement
NGT placement
IMPRESSION:
Frontal view centered at the diaphragm shows nasogastric drainage tube ending
in the upper portion of a nondistended stomach.
|
19918916-RR-20
| 19,918,916 | 20,063,422 |
RR
| 20 |
2167-03-25 05:11:00
|
2167-03-25 09:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pontine infarctions.// NGT repositioned.
TECHNIQUE: Frontal view the chest
COMPARISON: ___
FINDINGS:
Linear atelectasis left lung base. No infiltrate, edema, effusion, or
pneumothorax.
Mild cardiomegaly stable.
NG tube tip has been slightly advanced and is within the left upper quadrant
of the abdomen, likely in the body of stomach
IMPRESSION:
No acute pulmonary disease. NG tube tip in the stomach
|
19918916-RR-21
| 19,918,916 | 20,063,422 |
RR
| 21 |
2167-04-01 15:42:00
|
2167-04-01 16:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HTN, bilateral pontine infarcts// r/o pna,
effusion, edema
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There is increased elevation of the left hemidiaphragm with a large amount of
air beneath it, presumably within the stomach. There is no focal
consolidation, pleural effusion or pneumothorax identified. The size of the
cardiomediastinal silhouette is within normal limits.
IMPRESSION:
No acute cardiopulmonary abnormality. Elevation of the left hemidiaphragm,
presumably secondary to gas within the stomach.
|
19918916-RR-22
| 19,918,916 | 20,063,422 |
RR
| 22 |
2167-04-01 20:05:00
|
2167-04-01 20:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with bilateral pontine infarcts, HTN, DM2 has
acute GI bleed possibly from PEG.// stat upright CXR per ACS. r/o
pneumoperitoneum?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
No focal consolidation, pleural effusion or pneumothorax identified. The size
of the cardiomediastinal silhouette is within normal limits. No evidence of
free air under the diaphragm.
IMPRESSION:
No evidence of pneumoperitoneum on this upright portable chest radiograph.
|
19918916-RR-23
| 19,918,916 | 20,063,422 |
RR
| 23 |
2167-04-07 22:40:00
|
2167-04-07 23:13:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with multiple infarcts with c/f
hypercoagulability of malignancy// malignancy? other evidence of infarct?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 71.2 cm; CTDIvol = 23.6 mGy (Body) DLP =
1,681.7 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.5 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 1,695 mGy-cm.
COMPARISON: Chest CT done ___
FINDINGS:
LOWER CHEST: Reference is made to CT chest report of the same date.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: 15 mm left adrenal nodule is indeterminate. The right adrenal is
normal.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A couple of simple appearing right renal cysts, the largest measuring 21 mm in
diameter. There is no perinephric abnormality.
GASTROINTESTINAL: Gastrostomy tube in situ. Mild pneumoperitoneum, likely
related to the gastrostomy tube placement. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: 41 x 34 mm left adnexal soft tissue lesion. Nonspecific
hypodense lesion in relation to the proximal vagina (series 2, image 126).
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Hemangioma in the left lateral aspect of the T7 vertebral body.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 4 cm left adnexal soft tissue lesion for which pelvic ultrasound is
recommended.
2. Nonspecific hypodense lesion in relation to the proximal vagina. Clinical
correlation advised.
3. 15 mm left adrenal nodule is indeterminate.
4. Mild pneumoperitoneum likely related to recent gastrostomy tube placement.
5. Reference is made to CT chest report of the same day for chest findings.
RECOMMENDATION(S): Pelvic ultrasound.
Incidentally discovered adrenal lesion without prior studies for comparison
measuring 1-2 cm. If there is no history of malignancy, this is probably
benign. Follow up dedicated adrenal CT in 12 months could be considered. If
there is a history of malignancy, a dedicated adrenal CT is recommended.
Recommendations based on ___ ACR guidelines:
___
|
19918916-RR-24
| 19,918,916 | 20,063,422 |
RR
| 24 |
2167-04-07 22:41:00
|
2167-04-07 23:16:00
|
EXAMINATION: CT CHEST WITH CONTRAST
INDICATION: ___ year old woman with multiple infarcts with c/f
hypercoagulability of malignancy// malignancy? other evidence of infarct?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images were submitted to PACS and
reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 71.2 cm; CTDIvol = 23.6 mGy (Body) DLP =
1,681.7 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.5 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 1,695 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest radiograph ___.
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber and morphology.
There is mild calcified atherosclerotic plaque involving the aortic arch.
Main pulmonary artery is normal caliber. While the current exam is not
tailored for such evaluation there is no central pulmonary artery filling
defect. There are extensive coronary artery calcifications. Heart is normal
in size. No pericardial effusion. Great vessels are unremarkable.
AXILLA, HILA, AND MEDIASTINUM: Measurable axillary mediastinal lymph nodes are
not enlarged by CT size criteria and are normal in morphology. No hilar
lymphadenopathy. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally. There are no suspicious pulmonary nodules. Evaluation for small
nodules is limited secondary to respiratory motion artifact.
BASE OF NECK: There is a 7 mm hypodense nodule in the inferior left thyroid
lobe. Visualized portions of the base of the neck otherwise show no
abnormality.
ABDOMEN: Please refer to the separately dictated CT abdomen pelvis for full
description of the subdiaphragmatic findings.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No acute intrathoracic findings. No evidence of malignancy within the
chest.
2. Extensive coronary artery calcification.
3. 7 mm left thyroid lobe hypodense nodule. No dedicated follow-up is
recommended per ACR criteria however clinical correlation is recommended.
4. Please refer to the separately dictated CT abdomen pelvis for full
description of the subdiaphragmatic findings.
RECOMMENDATION(S): Thyroid nodule. No follow up recommended.
Absent suspicious imaging features, unless there is additional clinical
concern, ___ College of Radiology guidelines do not recommend further
evaluation for incidental thyroid nodules less than 1.0 cm in patients under
age ___ or less than 1.5 cm in patients age ___ or ___.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
19918916-RR-25
| 19,918,916 | 20,063,422 |
RR
| 25 |
2167-04-08 10:51:00
|
2167-04-08 11:31:00
|
EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with stroke, hypercoagulable state. Concern for
possible undiagnosed malignancy.// Evaluate 4.1 x 3.4 cm left adnexal lesion
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: Multiple prior examinations, most recent CT abdomen pelvis from
___ at 22:52
FINDINGS:
Exam is mildly limited due to inability to perform transvaginal exam due to
patient's poor mental status.
The uterus is anteverted and measures 6.4 x 3.0 x 5.1 cm. The endometrium is
homogeneous and thickened, measuring 9 mm in size.
Right ovary is normal. Left ovary shows a 4.0 x 3.6 x 3.5 cm complex cyst
with low level internal echoes and reticular, lace-like areas of echogenicity.
There is no demonstrable internal vascularity. This appearance is likely
consistent with hemorrhagic cyst. There is no free fluid.
IMPRESSION:
Exam is mildly limited due to inability to perform transvaginal exam due to
patient's poor mental status.
1. 4.0 x 3.6 x 3.5 cm complex cyst with low level internal echoes and
reticular, lace-like areas of echogenicity, likely hemorrhagic cyst. No
demonstrable internal vascularity. Follow-up pelvic ultrasound in 3 months
versus nonemergent pelvic MRI for further characterization.
2. Homogeneous thickening of the endometrium in this postmenopausal patient,
measuring 9 mm. Recommend endometrial biopsy for further evaluation as
neoplasia cannot be excluded.
RECOMMENDATION(S):
-Pelvic ultrasound in ___ year to ensure stability of complex cysts versus
nonemergent MRI of the pelvis to further characterize.
-Thickened endometrium for which endometrial biopsy is recommended.
|
19918916-RR-5
| 19,918,916 | 28,208,760 |
RR
| 5 |
2164-08-23 17:43:00
|
2164-08-23 18:19:00
|
EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ female patient status post TPA administration and new
change in neurological exam. Evaluate extent of intracranial hemorrhage and
for vascular occlusion.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
1,009.3 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 5.3 s, 41.5 cm; CTDIvol = 32.0 mGy (Head) DLP =
1,327.1 mGy-cm.
Total DLP (Head) = 2,358 mGy-cm.
COMPARISON: None.
FINDINGS:
Dental amalgam streak artifact limits study.
CT HEAD WITHOUT CONTRAST:
Focal hypodensity in the posterior limb of the left internal capsule raises
concern for acute infarction. There is no evidence of hemorrhage, edema, or
mass. There is mild prominence of the ventricles and sulci suggestive of
involutional changes. Mild periventricular white matter hypodensities are
likely the sequela of chronic small vessel ischemic disease.
There is mucosal thickening of the anterior ethmoidal air cells and left
sphenoid sinus with aerated mucosal thickening and air-fluid level in left
sphenoid sinus. Two tiny mucous retention cysts are present in the left
maxillary sinus. The remaining visualized portion of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
CTA HEAD:
There are densely calcified carotid siphons. Irregular narrowing without
definite occlusion is noted of bilateral V4 segments (see 650 06:13). . The
vessels of the circle of ___ and their principal intracranial branches
appear normal without occlusion, or aneurysm formation. The dural venous
sinuses are patent with a hypoplastic appearance to the left transverse and
sigmoid sinuses. In the region of the right thalamus vascular blush is noted,
suggestive of a capillary telangiectasia.
CTA NECK:
There is moderate amount of atherosclerotic plaque at the left carotid
bifurcation. There is no evidence of right internal carotid stenosis by
NASCET criteria. There is 33% stenosis of the left internal carotid artery by
NASCET criteria (series ___, image 46).
Thevertebral arteries and their major branches appear normal with no evidence
of stenosis or occlusion. There is a small focus of calcified plaque at the
takeoff of the left ___ (series 5, image 211). The origin of each vertebral
artery is normal.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland appears mildly enlarged with no definite discrete nodule
identified. Small scattered bilateral level IB and IIB lymph nodes are not
pathologically enlarged. There is no cervical lymphadenopathy by CT size
criteria. Bilateral mandibular periodontal disease is noted (see 5:182).
IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Focal hypodensity in the posterior limb of the left internal capsule
concerning for acute infarction. Please note MRI of the brain is more
sensitive for the detection of acute infarct.
3. No intracranial hemorrhage.
4. Nonocclusive narrowing of bilateral V4 segments.
5. Patent intracranial vasculature with no evidence of aneurysm formation or
dissection.
6. Patent cervical vasculature with 33% stenosis of the left internal carotid
artery by NASCET criteria.
7. Paranasal sinus disease as described.
8. Periodontal disease as described.
9. Right thalamic probable capillary telangiectasia.
NOTIFICATION: Final report, specifically findings #2, #4, #6, #8 and #9 were
discussed with Dr. ___. by ___, on the telephone on
___ at 9:04 AM, 30 minutes after discovery of the findings.
|
19918916-RR-6
| 19,918,916 | 28,208,760 |
RR
| 6 |
2164-08-23 21:26:00
|
2164-08-23 22:04:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ female presenting with altered mental status, status
post tPA
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: CTA head/neck ___
FINDINGS:
There is a 1.2 x 0.9 cm hypodensity in the posterior limb left internal
capsule (02:14), consistent with an infarction. This is unchanged in
appearance compared to the prior CTA performed several hours earlier. No
other findings concerning for acute major vascular territorial infarction. No
hemorrhage, edema or large mass. Ventricles and sulci are normal in size and
configuration.
There is no evidence of fracture. Mild secretions in the left sphenoid.
Remainder of the visualized paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute hemorrhage.
2. Re- demonstration of hypodensity within the left internal capsule remains
concerning for acute infarction.
|
19918916-RR-7
| 19,918,916 | 28,208,760 |
RR
| 7 |
2164-08-23 23:47:00
|
2164-08-24 13:16:00
|
EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with acute stroke // eval for infiltrate
TECHNIQUE: Portable chest
COMPARISON: None
FINDINGS:
Subtle right perihilar opacities are new. Lungs are otherwise clear. No
pleural abnormalities. Moderate cardiomegaly without pulmonary vascular
congestion or edema. Cardiomediastinal and hilar silhouettes are normal.
IMPRESSION:
Subtle right perihilar opacities likely reflect aspiration or atelectasis.
|
19918916-RR-8
| 19,918,916 | 28,208,760 |
RR
| 8 |
2164-08-24 13:32:00
|
2164-08-24 15:35:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ woman with acute stroke syndrome; right sided
weakness and aphasia; evaluate for stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with FLAIR, diffusion, and T2 technique were then obtained.
Gradient echo sequences were not performed because the patient was unable to
tolerate the entire exam and the exam was stopped prematurely.
COMPARISON CTA Head and CT Head, ___.
FINDINGS:
Exam is motion-limited. Restricted diffusion in the left basal ganglia and
left hypothalamus is consistent with acute infarct (se 4, im 15, 18).
Background bilateral T2/FLAIR prolongation without other correlate are
nonspecific but may reflect sequelae of chronic small vessel ischemic disease.
No gradient echo sequence is available to adequately assess for presence of
hemorrhage.There is no evidence of masses or midline shift. The ventricles
and sulci are normal in caliber and configuration. The visualized orbits are
unremarkable. The visualized portions of the paranasal sinuses are centrally
clear. Major intracranial vascular flow voids are preserved.
IMPRESSION:
Acute left basal ganglia and hypothalamic infarct.
No new GRE sequence was performed to assess for hemorrhage due to patient
inability to tolerate the entire exam.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:13 ___, 1 minutes after
discovery of the findings.
|
19918917-RR-7
| 19,918,917 | 20,083,057 |
RR
| 7 |
2127-06-07 04:46:00
|
2127-06-07 10:01:00
|
EXAMINATION: Chest radiograph
INDICATION: History: ___ with blunt abdominal injury, please eval for chest
injury // ?PTX
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
The lungs are well-expanded and clear. No focal consolidation, effusion,
edema, or pneumothorax. The heart is normal in size. The mediastinum is not
widened. No acute osseous abnormality is identified on this nondedicated
exam.
IMPRESSION:
No acute cardiopulmonary process. No pneumothorax.
RECOMMENDATION(S): Note that this exam is not dedicated for imaging of subtle
fractures. If focal exam findings are concerning for fracture, dedicated
radiographs of these areas is recommended.
|
19918971-RR-117
| 19,918,971 | 25,439,611 |
RR
| 117 |
2150-09-09 20:14:00
|
2150-09-10 17:47:00
|
HISTORY: ___ female with history of chronic pancreatitis and
recurrent pseudo-obstruction.
COMPARISON: Comparison is made to CT of the abdomen and pelvis from ___.
FINDINGS: Two frontal images of the abdomen show air-filled loops of small
bowel and colon with some nonspecific air-fluid levels with no evidence of
obstruction. There is no pneumatosis or free gas. Chain sutures are seen in
the mid abdomen and left lower quadrant. There is a small soft tissue
calcification in the right upper quadrant. Visualized osseous structures are
unremarkable.
IMPRESSION: No evidence of bowel obstruction or ileus.
|
19918971-RR-118
| 19,918,971 | 25,439,611 |
RR
| 118 |
2150-09-10 00:20:00
|
2150-09-10 09:53:00
|
INDICATION: ___ woman with chronic pancreatitis, history of
small-bowel obstruction, status post partial pancreatectomy, now returns with
abdominal pain.
COMPARISONS: ___.
TECHNIQUE: CT of the abdomen and pelvis was performed with IV and oral
contrast.
FINDINGS:
CT OF THE ABDOMEN: There is bilateral dependent atelectasis, left greater
than right. Otherwise, the lungs are clear of infectious appearing
etiologies. No pericardial effusion is identified.
The liver is again enlarged extending across the left upper quadrant. No
focal liver lesions are identified. The main portal vein is patent. Spleen
is surgically absent. Patient is status post distal pancreatectomy and
creation of a pancreaticojejunostomy with unremarkable appearance. The
jejunojejunostomy site (2:30) has free passage of contrast through it, but
does appear to have a small amount of post anastomotic dilatation which can be
normal post-surgery (2:30). Otherwise, p.o. contrast flows freely through the
small bowel up into the colon.
Bilateral kidneys excrete and enhance contrast symmetrically with no evidence
of hydronephrosis or solid masses. No abdominal or retroperitoneal
lymphadenopathy by CT criteria is identified.
CT OF THE PELVIS: There is no pelvic free fluid. Bladder, rectum and uterus
are unremarkable in appearance. No pelvic or inguinal lymphadenopathy by CT
criteria is identified.
BONES: No suspicious lytic or sclerotic lesions are seen.
IMPRESSION: No evidence of obstruction as p.o. contrast is seen flowing
freely through to the large bowel. Unremarkable appearance of the
pancreaticojejunostomy site. Slight post-stenotic dilatation at the
jejunojejunostomy site is grossly unchanged from the prior study and could be
due to a side to side anastomosis.
|
19918971-RR-141
| 19,918,971 | 26,908,409 |
RR
| 141 |
2151-10-17 19:03:00
|
2151-10-17 20:38:00
|
HISTORY: ___ female with abdominal pain and distention. Question
obstruction.
COMPARISON: Abdominal films from ___ and CT abdomen from ___.
FINDINGS:
Upright and supine views of the abdomen in addition to chest x-ray.
Right basilar opacity is thought to be due to atelectasis. Elsewhere the
lungs are clear. The cardiomediastinal silhouette is within normal limits.
Enteric tube seen with tip in the gastric body with side port is above the GE
junction.
Gas seen throughout the abdomen which is mostly within the colon. Distended
loop of bowel within the left mid abdomen adjacent to surgical chain sutures
is noted and is likely due to small bowel anastomotic site that is similar in
configuration compared to prior and is likely normal. There are no dilated
loops of bowel elsewhere and overall there is less distention when compared to
prior. The upright exam demonstrates no abnormal air-fluid levels or free
intraperitoneal air.
IMPRESSION:
Nonspecific bowel gas pattern without findings to suggest obstruction. NG
tube side port above the diaphragm and should be advanced at least several cm
for optimal positioning
|
19919213-RR-90
| 19,919,213 | 27,654,579 |
RR
| 90 |
2202-12-22 06:20:00
|
2202-12-22 06:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with acute headache, photophobia// eval for
SAH/bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 19.5 cm; CTDIvol = 46.4 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head ___. MR head ___.
FINDINGS:
New small area of right frontal extra-axial hyperdensity measuring 0.5 cm in
thickness (4 1; 21) is concerning for acute or subacute on chronic subdural
hematoma. Right frontal convexity prominent extra-axial low-density CSF
attenuation measuring 1.2 cm in greatest thickness may represent component of
chronic subdural hematoma or subdural hygroma on a background of brain
parenchymal atrophic changes similar to prior. Patient is status post right
frontoparietal craniotomy for prior subdural evacuation.
Chronic lacunar infarcts posterior limb right internal capsule, right caudate
nucleus, stable since prior. Severe generalized brain parenchymal atrophy,
similar. Mild-to-moderate chronic small vessel ischemic changes, similar.
There is no evidence of infarction,edema,or mass effect. Benign arachnoid
cyst left middle cranial fossa.
Dense atherosclerotic calcifications are noted in the bilateral cavernous
carotid arteries.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. New small right frontal subdural acute to early subacute hemorrhage.
Remainder as above.
|
19919213-RR-91
| 19,919,213 | 27,654,579 |
RR
| 91 |
2202-12-22 06:59:00
|
2202-12-22 07:30:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with wekness, eval for pneumonia// wekness, eval for
pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
Increased bilateral interstitial markings suggestive of severe bilateral
interstitial pulmonary edema. Small bilateral pleural effusions are noted.
No pneumothorax is seen. The enlarged cardiac and mediastinal silhouettes are
unchanged.
IMPRESSION:
Increased bilateral interstitial markings suggestive of severe bilateral
interstitial pulmonary edema. Small bilateral pleural effusions.
|
19919213-RR-92
| 19,919,213 | 27,654,579 |
RR
| 92 |
2202-12-22 08:20:00
|
2202-12-22 11:39:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with headache, left ptosis, eval for exrtav//
headache, left ptosis, eval for exrtav
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of Omnipaque intravenous contrast material. Three-dimensional
angiographic volume rendered, curved reformatted and segmented images were
generated on a dedicated workstation. This report is based on interpretation
of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 8.0 s, 8.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
401.4 mGy-cm.
2) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 70.8 mGy (Head) DLP =
35.4 mGy-cm.
3) Spiral Acquisition 5.6 s, 43.7 cm; CTDIvol = 31.1 mGy (Head) DLP =
1,360.6 mGy-cm.
Total DLP (Head) = 1,797 mGy-cm.
COMPARISON: Subsequent CT head ___,, MR ___ ___,
MR ___ ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is only partial visualization of the brain from the foramen magnum
through of the orbits. There is no evidence of acute major vascular
territorial infarction. Hypodensities in the subcortical, periventricular,
deep white matter nonspecific but are likely related to chronic microvascular
disease in a patient of this age.
The ventricles and sulci are prominent, suggesting involutional changes.
Prominent extra-exial space overlying the right frontotemporal lobe may be
secondary to volume loss or represent a collection such as a chronic subdural
hematoma or hygroma. As seen on the subsequent CTA examination, there is a 5
mm thick acute on chronic subdural hematoma noted along the right frontal
convexity (3:306).
There are dense calcifications of bilateral V4 segments of the vertebral
arteries. There is evidence of right frontoparietal craniotomy.
CTA HEAD:
Moderate calcifications are seen in the bilateral cavernous and supraclinoid
internal carotid arteries, in addition to the bilateral V4 segments and
proximal basilar artery. There is mild irregularity and narrowing of the
bilateral P1 segments and the right M1 segment, without high-grade stenosis or
occlusion.
The remaining vessels of the circle of ___ and their principal intracranial
branches appear normal without stenosis, occlusion, or aneurysm formation.
The right transverse sinus is hypoplastic, likely a congenital finding.
CTA NECK:
Dense atherosclerotic calcifications are seen at the aorta and the origins of
the great vessels, without definite high-grade stenosis. There is a normal 3
vessel aortic arch.
Atherosclerotic calcifications at the bilateral vertebral origins result in
moderate narrowing of the right V1 segment, and mild-to-moderate narrowing of
the left V1 segment.
Calcifications are also noted at the bilateral carotid bulbs. There is
prominent fibrofatty plaque with a rim of calcification at the left carotid
bifurcation measuring up to 3.3 mm.
There is 38% stenosis of the left internal carotid artery by NASCET criteria.
There is narrowing of the right internal carotid artery with 33% stenosis by
NASCET criteria.
OTHER:
There are bilateral pleural effusions, right greater than left. There is
evidence of interlobular thickening and ground-glass opacifications in both
lungs more prominent on the right, suggestive of pulmonary edema. The
thyroid is unremarkable in appearance. There are no pathologically enlarged
cervical lymph nodes identified.
IMPRESSION:
1. No convincing evidence for acute territorial infarction.
2. Stable appearance of a 5 mm thick acute on chronic right frontal subdural
hematoma.
3. Multifocal atherosclerotic disease throughout the cervical vasculature, as
detailed above. Findings result in 33% stenosis of the proximal right and 38%
stenosis of the proximal left internal carotid arteries by NASCET criteria.
4. Multifocal atherosclerotic disease within the intracranial vasculature,
also detailed above, without high-grade stenosis, occlusion, or aneurysm.
5. Bilateral pleural effusions and slightly asymmetric right greater than left
pulmonary edema, better evaluated on recent CT chest examination.
|
19919213-RR-93
| 19,919,213 | 27,654,579 |
RR
| 93 |
2202-12-22 23:58:00
|
2202-12-23 10:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with CHF/pulm edema with increased SOB //
interval evaluation interval evaluation
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
New right apical consolidation is probably pneumonia. Moderate cardiomegaly,
mild pulmonary edema and small bilateral pleural effusions have not changed in
a week.
|
19919213-RR-94
| 19,919,213 | 27,654,579 |
RR
| 94 |
2202-12-23 05:13:00
|
2202-12-23 05:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with small right frontal SDH// eval for interval
change- please obtain @ 0500
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.4 cm; CTDIvol = 49.0 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head without contrast ___.
FINDINGS:
There is re-demonstration of the right frontal extra-axial hyperdensity
measuring 0.6 cm in greatest thickness consistent with an acute or subacute on
chronic subdural hematoma similar to prior. Right frontal convexity prominent
extra-axial low-density CSF attenuation which likely represents chronic
subdural hematoma or subdural hygroma with background of age related atrophy
again is similar to prior. No new foci of hemorrhage. There is no evidence
of infarction, edema,or midline should. There is prominence of the ventricles
and sulci suggestive of involutional changes. Periventricular and subcortical
white matter hypodensities are nonspecific but suggest chronic small vessel
ischemic changes. Re-demonstration of chronic lacunar infarcts in the
posterior limb of the right internal capsule and right caudate nucleus.
Unchanged arachnoid cyst in the left middle cranial fossa.
Patient is status post right frontoparietal craniotomy for prior subdural
evacuation. The visualized portion of the paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. No significant interval change in acute to subacute on chronic subdural
hematoma/effusion over the right frontal region. No new foci of hemorrhage.
|
19919213-RR-95
| 19,919,213 | 27,654,579 |
RR
| 95 |
2202-12-25 14:58:00
|
2202-12-25 15:39:00
|
INDICATION: ___ year old man with a fib, severe MR, HFpEF with worsening
hypoxia and cough// Change in pulm edema, consolidation evolving?
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest radiographs most recently dated ___
FINDINGS:
There is no significant interval change in extent of the mild pulmonary edema
and small bilateral pleural effusions. A right upper lobe consolidation is
again noted and possibly reflective of pneumonia. The size and appearance of
the cardiomediastinal silhouette is unchanged.
IMPRESSION:
No significant interval change since the chest radiograph dated ___.
|
19919930-RR-14
| 19,919,930 | 22,621,778 |
RR
| 14 |
2176-03-04 16:56:00
|
2176-03-04 19:08:00
|
INDICATION: ___ female with recent stone, now returning with similar
pain, but clean urinalysis, rule out kidney stone or acute intra-abdominal
process.
COMPARISONS: CT abdomen and pelvis ___.
TECHNIQUE: MDCT axial images were obtained through the dome of liver to the
pubic symphysis in the prone position without the administration of IV
contrast. Coronal and sagittal reformations were provided and reviewed.
FINDINGS: The visualized lung bases are unremarkable. A small left Bochdalek
hernia is seen.
ABDOMEN: Assessment of the intra-abdominal organs is limited by lack of IV
contrast. Within this limitation, the liver, spleen, pancreas, right adrenal
gland are normal. Slight thickening of the left adrenal gland is unchanged
from prior studies.
A non-obstructing 2-mm stone is again seen within the right kidney. There is
no hydronephrosis in the right kidney. Again seen within the left kidney is
mild hydronephrosis and hydroureter, unchanged in degree from prior. There
is a similar amount of perinephric stranding. Again seen in the left UVJ is a
2-mm stone, unchanged in position from prior (2:61).
The stomach, large and small bowel are normal. Retained enteric contrast is
seen within the large bowel. There is no free air or free fluid. There is
mild-to-moderate atherosclerosis within a non-aneurysmal abdominal aorta.
PELVIS: The bladder is unremarkable. The uterus is not visualized. The
rectum is normal. There is no inguinal or pelvic lymphadenopathy. A small
fat-containing umbilical hernia is again seen.
BONES: There are no suspicious osseous lesions. A lobulated calcification is
again seen within the anterior right chest wall.
IMPRESSION: Obstructing 2-mm left UVJ stone with mild hydroureteronephrosis,
unchanged from three days prior.
|
19919951-RR-6
| 19,919,951 | 25,997,087 |
RR
| 6 |
2139-12-22 10:29:00
|
2139-12-22 14:03:00
|
HISTORY: Large bowel obstruction going to OR for ex lap, possible ___,
pre-op.
CHEST, SINGLE AP PORTABLE VIEW:
There are slightly low inspiratory volumes. Probable mild cardiomegaly. The
aorta is tortuous. There is slight patchy opacity at the left lung. No CHF
or other focal infiltrate. No effusion. Trace atelectasis right base.
IMPRESSION:
1. Probable mild cardiomegaly.
2. Minimal patchy opacity left base. While this likely represents
atelectasis, in the appropriate clinical setting, the differential diagnosis
could include an early pneumonic infiltrate.
|
19920091-RR-26
| 19,920,091 | 29,749,483 |
RR
| 26 |
2128-04-22 20:27:00
|
2128-04-22 22:23:00
|
HISTORY: ___ -year-old female with low back pain at L5-S1 after bending over
today. History of osteoporosis.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the lumbosacral spine. There are 5 non
rib-bearing lumbar type vertebral bodies which are maintained in height and
alignment. Degenerative changes are noted with mild endplate osteophyte
formation. The intervertebral discs are grossly preserved in height. The
bones are diffusely osteopenic. Soft tissues are unremarkable.
IMPRESSION:
No fracture or subluxation.
|
19920484-RR-40
| 19,920,484 | 27,474,215 |
RR
| 40 |
2199-09-25 19:21:00
|
2199-09-25 21:21:00
|
EXAM: AP view of the pelvis and AP and lateral views of the right femur.
CLINICAL INFORMATION: ___ female with history of fall.
COMPARISON: None.
FINDINGS: AP view of the pelvis and AP and lateral views of the right femur
were obtained. There is a right intertrochanteric fracture with varus
angulation of the right femoral head. No frank dislocation is seen. The
pubic symphysis and sacroiliac joints are intact. The bones are somewhat
osteopenic. Degenerative changes are seen along the visualized aspect of the
lower lumbar spine.
IMPRESSION: Comminuted right intertrochanteric fracture with varus angulation
of the right femoral head.
|
19920484-RR-41
| 19,920,484 | 27,474,215 |
RR
| 41 |
2199-09-25 19:21:00
|
2199-09-25 21:31:00
|
EXAM: Chest, single frontal view.
CLINICAL INFORMATION: ___ female with history of fall.
___.
FINDINGS: Single frontal view of the chest was obtained. No focal
consolidation, pleural effusion, or evidence of pneumothorax is seen. The
cardiac and mediastinal silhouettes are stable. The bones are diffusely
osteopenic. The left humeral head appears high riding which can be seen in
rotator cuff disease, although is not optimally evaluated on this study.
IMPRESSION: No acute intrathoracic process. Bones are osteopenic and not
well evaluated on this study.
|
19920484-RR-42
| 19,920,484 | 27,474,215 |
RR
| 42 |
2199-09-25 19:06:00
|
2199-09-25 20:29:00
|
EXAM: Non-contrast-enhanced head CT.
CLINICAL INFORMATION: ___ female with history of fall.
COMPARISON: No prior head CT. Reference made to brain MRI from ___.
FINDINGS: There is no evidence of acute intracranial hemorrhage, midline
shift, mass effect, or acute large vascular territorial infarct. Gray-white
matter differentiation is preserved. Mild prominence of the ventricles and
sulci is most consistent with age-related global parenchymal loss with
slightly more prominent extra-axial space in the right posterior fossa, as
also seen on the prior MRI. A prominent perivascular space is noted at the
right inferior basal ganglia region, as also seen on the prior MRI. Mucus
retention cyst/mucosal thickening seen in bilateral maxillary sinuses. There
is also mucosal thickening in the bilateral ethmoid air cells. Minimal
mucosal thickening is also seen in the bilateral sphenoid sinuses with some
aerosolized secretions in the left sphenoid sinus. No acute fracture is seen.
IMPRESSION:
1. No acute intracranial process. Chronic changes as above.
2. Sinus disease as above.
|
19920484-RR-43
| 19,920,484 | 27,474,215 |
RR
| 43 |
2199-09-25 19:06:00
|
2199-09-25 21:34:00
|
INDICATION: Status post fall. Evaluate for fracture or malalignment.
TECHNIQUE: MDCT axial images were acquired through the cervical spine without
the administration of intravenous contrast material. Multiplanar reformations
were performed.
COMPARISON: None.
FINDINGS: There is no acute fracture. Grade 1 anterolisthesis of C4 on C5 is
likely degenerative in nature. Similarly, minimal grade 1 retrolisthesis of
C5 on C6 is also likely degenerative. There is no prevertebral soft tissue
hematoma or edema. There are large anterior osteophytes extending from C5
through C7. Marked disc space narrowing is seen at both C5-C6 and C6-C7.
Posterior disc osteophyte complexes cause narrowing of the spinal canal that
is most prominent at C6-7 where there is mild canal narrowing. Multilevel
uncovertebral and facet joint hypertrophy cause neural foraminal narrowing at
several levels including on the right at C5-6 where there is
moderate-to-severe narrowing.
There is biapical pleural parenchymal thickening, scarring, and calcification.
The visualized portions of the lungs are otherwise clear. The thyroid gland
is not identified and may be surgically absent. There are no pathologically
enlarged cervical lymph nodes. The visualized portion of the aerodigestive
tract is unremarkable.
This study was not optimized for evaluation of the intracranial contents.
Limited assessment of the posterior fossa is unremarkable. There are
bilateral maxillary sinus mucus-retention cysts. Mucosal thickening is also
seen within the right sphenoid sinus. The imaged portions of the mastoid air
cells are well aerated.
IMPRESSION: No acute fracture. Grade 1 anterolisthesis of C4 on C5 and
minimal grade 1 retrolisthesis of C5 on C6 are likely degenerative in nature.
Additional multilevel degenerative changes of the cervical spine are fully
described above.
|
19920484-RR-44
| 19,920,484 | 27,474,215 |
RR
| 44 |
2199-09-26 17:26:00
|
2199-09-27 11:35:00
|
HISTORY: Fracture fixation.
AP AND LATERAL INTRAOPERATIVE RADIOGRAPHS OF THE RIGHT HIP: Since
preoperative exam one day previous (showing markedly displaced of
intertrochanteric fracture of the proximal right femur) this fracture has been
fixated with a dynamic compression screw with major fragments now in normal
alignment. Proximal lateral femoral plate has been fixated by three
normal-appearing screws.
|
19920484-RR-45
| 19,920,484 | 27,474,215 |
RR
| 45 |
2199-09-29 09:51:00
|
2199-09-29 10:10:00
|
INDICATION: ___ female with productive cough. Evaluate for
pneumonia.
COMPARISON: ___.
CHEST, PA AND LATERAL VIEWS: A calcified granuloma in the left lung is
probably related to prior infection. There is minimal atelectasis in the left
upper lobe best seen on the lateral view. Lungs are elsewhere clear. There is
no pleural effusion or pneumothorax. Heart size is mildly enlarged with
possible calcification of the aortic annulus. Hilar contours and pulmonary
vasculature are normal. Marked enlargement of the entire esophagus with distal
tapering is noted.
IMPRESSION:
1. No acute intrathoracic abnormality or evidence of pneumonia.
2. Marked enlargement of the esophagus could be further evaluated with and
barium swallow or endoscopy.
3. Mild cardiomegaly and aortic annular calcification.
Findings discussed by phone with Dr. ___ at 11 am on ___.
|
19920625-RR-26
| 19,920,625 | 28,853,019 |
RR
| 26 |
2146-08-23 15:50:00
|
2146-08-23 18:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with MI. // Eval of cardiac silhouette, lung
fields.
COMPARISON: Chest radiograph from ___ at 10:18.
FINDINGS:
AP portable upright view of the chest.
This examination is limited by very low lung volumes and suboptimal patient
positioning. Central pulmonary vascular congestion appears new since the
___ examination, without overt edema. Multiple intact sternal wires
are again seen. There is no large pneumothorax or pleural effusion.
IMPRESSION:
Central pulmonary vascular congestion appears new since the earlier study
today, without overt edema. Very low lung volumes.
|
19920625-RR-27
| 19,920,625 | 28,853,019 |
RR
| 27 |
2146-08-26 14:22:00
|
2146-08-26 15:02:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with pulmonary edema // Pulmonary edema?
Pulmonary edema?
IMPRESSION:
In comparison with the study of ___, there again are very low lung
volumes. The degree of pulmonary vascular congestion appears to have
decreased, though some of this could reflect the more upright position of the
patient. Mild atelectatic changes and possible small effusions at the bases.
|
19920625-RR-28
| 19,920,625 | 28,853,019 |
RR
| 28 |
2146-08-27 07:04:00
|
2146-08-27 10:45:00
|
INDICATION: STEMI in pulmonary edema, evaluate pulmonary edema.
TECHNIQUE: Upright frontal bedside chest radiograph.
COMPARISON: Chest radiograph ___.
FINDINGS:
The lung volumes are low. Pulmonary edema has resolved. There is no pleural
effusion or pneumothorax. Heart size is top-normal. Mediastinal and hilar
structures are unchanged. The patient has median sternotomy closures and
mediastinal clips consistent with coronary artery bypass graft.
IMPRESSION:
No pulmonary edema.
|
19920625-RR-29
| 19,920,625 | 28,853,019 |
RR
| 29 |
2146-08-28 07:10:00
|
2146-08-28 09:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with myocardial infarction and pulmonary edema
// Concern for pulmonary fibrosis vs pulmonary edema
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. The lung
volumes are very low. Vascular enlargement at the level of the right hilus.
Calcified granulomas in the right upper lobe. No acute changes such as
pneumonia or pulmonary edema. No larger pleural effusions. The patient is of
the sternotomy, with unchanged normal alignment of the sternotomy wires.
|
19920828-RR-135
| 19,920,828 | 22,990,000 |
RR
| 135 |
2205-02-20 16:17:00
|
2205-02-20 17:15:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with significant smoking history who presents
with weight loss, weakness, nausea/vomiting and diarrhea // ?lung malignancy,
GI abnormality
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after the administration of intravenous contrast. Axial images were
interpreted in conjunction with coronal and sagittal reformats.
DLP: 976.56 mGy-cm
COMPARISON: CT abdomen and pelvis dated ___, MRI abdomen dated ___, and CT abdomen and pelvis dated ___.
FINDINGS:
CHEST:
Please see the separate dedicated chest CT report dictated by the
cardiothoracic imaging section.
ABDOMEN:
The liver again demonstrates a 4.8 x 3.3 cm cystic hepatic lesion at the
junction of the left and right hepatic lobes (2:54), previously measuring 4.6
x 3.5 cm on ___. However, it should be noted that this lesion
measured only 2.7 x 2.0 cm on CT in ___. The remainder of the liver
parenchyma is otherwise unremarkable, and no additional hepatic lesions are
identified. The portal venous system is patent. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder, spleen, and
bilateral adrenal glands are normal. A subcentimeter pancreatic head cystic
lesion is not well identified on this examination, and better seen on recent
MRI. The kidneys enhance symmetrically and are without suspicious solid mass.
The stomach is grossly unremarkable in appearance. The small and large bowel
are normal in caliber and without evidence of wall thickening. The appendix is
air-filled and normal (601b:26). Colonic diverticulosis is present without
evidence of diverticulitis. There is no retroperitoneal lymphadenopathy by CT
size criteria. There is no free abdominal fluid or pneumoperitoneum. The aorta
and iliac branches are normal in course and caliber. The celiac trunk and SMA
are grossly patent. There is recanalization of the umbilical vein. The left
ovarian vein is mildly enlarged, but unchanged in appearance as compared to
___.
PELVIS:
The urinary bladder and rectum are grossly unremarkable. There is no pelvic
side-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic
fluid is identified.
OSSEOUS STRUCTURES: A small, focal sclerotic lesion within the right femoral
head is stable and likely represents a bone island. No focal lytic or
sclerotic lesion concerning for malignancy.
IMPRESSION:
1. 4.8 x 3.3 cm cystic hepatic lesion at the junction of the left and right
hepatic lobes. Although this lesion has only minimally increased in size
compared to the prior MRI abdomen dated ___, it has more than
doubled in volume as compared to ___. Given this interval growth,
surgical resection is a valid consideration.
2. Ill-defined, subcentimeter cystic lesion within the pancreatic head, better
characterized on prior MRI. Please see recommended follow up per MR imaging.
3. Diverticulosis without evidence of diverticulitis.
4. For description of the intrathoracic findings, please see the separate CT
chest report.
NOTIFICATION: Findings were entered into the radiology dashboard by Dr.
___ at 10:05 on ___.
|
19920828-RR-136
| 19,920,828 | 22,990,000 |
RR
| 136 |
2205-02-20 16:19:00
|
2205-02-20 17:17:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ female with significant smoking history who presents
with weight loss, weakness, nausea, vomiting and diarrhea. Assess for lung
malignancy.
TECHNIQUE: Contrast-enhanced chest CT was performed acquiring sequential
axial images from the thoracic inlet through the adrenal glands. Thin section
axial, coronal, sagittal and axial MIP's were also obtained. 100 cc of
Omnipaque 350 were administered intravenously without reported complication.
DOSE: As per CT abdomen/pelvis.
COMPARISON: No prior chest CT available for comparison.
FINDINGS:
There is a punctate 2 mm hypodense right thyroid lobe nodule. There is no
supraclavicular, mediastinal, hilar or axillary lymphadenopathy.
Although this study is not designed to assess cardiac anatomy, the left
ventricle appears dilated and thin-walled. There is no pericardial effusion.
The main pulmonary artery and thoracic aorta are normal caliber. No incidental
central pulmonary embolus is identified.
Apical predominant paraseptal and centrilobular emphysema is mild. Bilateral
lower lobe linear atelectasis is incidentally noted. There is a 1.8 x 1.9 cm
left upper lobe part solid ground-glass opacity with irregular borders (4,
30). A mixed attenuation 8 x 7 mm sub solid right lower lobe nodule is
indeterminate (4, 84). A handful of solid and sub solid pulmonary nodules
measure up to 3 mm in the right upper lobe (4: 36, 46, 58, 74, 76, 102).
For a detailed discussion of the upper abdomen, please refer to the separate
report from the CT abdomen/pelvis performed concurrently.
There are no bone lesions in the thorax worrisome for infection or malignancy.
IMPRESSION:
1.8 x 1.9 cm left upper lobe part-solid ground-glass opacity may be infectious
or inflammatory in etiology. 8 x 7 mm mixed attenuation sub-solid right lower
lobe nodule may also be infectious or inflammatory in etiology, however a
three-month followup chest CT is recommended for both of these lesions to
exclude neoplasia.
Mild centrilobular and paraseptal emphysema.
|
19920914-RR-19
| 19,920,914 | 27,145,902 |
RR
| 19 |
2134-07-03 16:59:00
|
2134-07-03 18:03:00
|
HISTORY: ___ female with hypoxia. Question PE. Further history
reveals that this patient had a left thoracotomy and left pneumonectomy on ___.
COMPARISON: Reference CT chest from ___. Most recently ___
chest x-ray.
FINDINGS: The right-sided pulmonary arterial tree demonstrates no evidence of
filling defects to the subsegmental level. The left main pulmonary artery has
been ligated at its origin. Scattered mediastinal lymph nodes are once again
present. The left hemithorax is filled with air and layering fluid. Expected
status post pneumonectomy. The mediastinum has shifted to the left
post-surgery.
The right lung is notable for emphysema but no opacities worrisome for
maligancy or infection.
There is a trace pericardial effusion, but otherwise the heart is
unremarkable. The aorta demonstrates atherosclerotic calcifications
throughout the aortic arch as well as the descending aorta, but no evidence of
dissection.
Subdiaphragmatically, no gross abnormalities are evident.
BONES: No suspicious osseous or lytic lesions are present within the thorax.
IMPRESSION:
1) No evidence of pulmonary arterial embolism in the right pulmonary arterial
tree.
2) Status post left pneumonectomy with ligation of the left pulmonary artery.
Left hemithorax contains fluid and air as would be expected post
pneumonectomy.
|
19921006-RR-19
| 19,921,006 | 23,788,788 |
RR
| 19 |
2145-04-25 18:48:00
|
2145-04-26 09:03:00
|
INDICATION: ___ year old woman with sigmoid colon bleed// ___ year old woman
with sigmoid colon bleed
COMPARISON: Outside CTA 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: 50 mcg Fentanyl was administered for pain relief. 1% lidocaine was
injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS:
CONTRAST: 55 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 21.2 minutes, 55 mGy
PROCEDURE: 1. Right common femoral artery access.
2. Inferior mesenteric arteriogram.
3. Cone beam CT aortogram.
PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per ___ protocol. Both groins were
prepped and draped in the usual sterile fashion.
Using palpatory and fluoroscopic guidance, the right common femoral artery was
punctured using a micropuncture set at the level of the mid-femoral head. A
0.018 wire was passed easily into the vessel lumen. A small skin incision was
made over the needle. Then the inner dilator and wire were removed and a
___ wire was advanced under fluoroscopy into the aorta. The micropuncture
sheath was exchanged for a 5 ___ sheath which was attached to a continuous
heparinized saline side arm flush.
A C2 Cobra catheter was advanced over ___ wire into the aorta and the
wire was removed. However, the Cobra catheter failed to select the inferior
mesenteric artery, so the ___ wire was advanced of through the catheter and
the catheter was exchanged for a Sos catheter.
The Sos catheter was used to selectively cannulate the inferior mesenteric
artery and a small amount of contrast was injected to confirm positioning.
Inferior mesenteric arteriogram demonstrated active extravasation in the
region of the sigmoid colon.
___ preloaded with a headliner was advanced through the catheter. After
initial difficulty advancing headliner wire more than 1-2 cm into the inferior
mesenteric artery. A small amount of contrast was injected through the wire
dap after and demonstrated small inferior mesenteric artery dissection.
Wire, microcatheter and catheter were all retracted, and the headliner
microwire was used to gently probe for the ostium of the inferior mesenteric
artery, however due to the risk of further damaging the inferior mesenteric
artery persistent attempts were not made.
Microcatheter and microwire were removed. ___ wire was advanced through
the Sos catheter and the Sos catheter was exchanged for a straight flush
catheter. Small amount of contrast was injected to confirm positioning within
the aorta.
Rotational cone-beam CT angiography was performed to help delineate the
anatomy. Multiplanar CT images were reconstructed and 3D volume-rendered
images of the arterial anatomy required post-processing on an independent
workstation under direct physician ___. These images were used in the
interpretation, decision making for intervention and reporting of this
procedure.
This demonstrated dissection of the inferior mesenteric artery ostium, with
only a few mm distal extension, no associated aortic dissection, and patent
inferior mesenteric artery distal to the short-segment dissection.
Due to the risk of further damage potentially causing iatrogenic ischemia the
procedure was and at this timed.
The catheter was then removed over the wire and the sheath was removed. Manual
pressure was held until hemostasis was achieved. Sterile dressings were
applied. The patient tolerated the procedure well.
FINDINGS:
Inferior mesenteric arteriogram demonstrated active extravasation into the
sigmoid colon.
Cone beam CT aortogram dissection of the inferior mesenteric artery ostium,
with only a few mm distal extension, no associated aortic dissection, and
patent inferior mesenteric artery distal to the short-segment dissection.
IMPRESSION:
Active extravasation was seen into the sigmoid colon from a branch of the
inferior mesenteric artery, however due to iatrogenic short-segment inferior
mesenteric artery dissection, embolization could not be safely performed.
The inferior mesenteric artery remains patent distal to the ostium.
|
19921130-RR-36
| 19,921,130 | 20,086,609 |
RR
| 36 |
2164-05-15 20:36:00
|
2164-05-15 21:22:00
|
EXAMINATION: Chest radiograph
INDICATION: Fever.
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Heart size is top-normal. Cardiomediastinal silhouette and hilar contours are
unremarkable. Lungs are hyperinflated but clear. There is no large pleural
effusion or pneumothorax. Clips are noted in the right anterior chest wall
and right axilla. Degenerative changes seen at the shoulders bilaterally.
Old healed right lateral rib fractures are noted.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19921130-RR-37
| 19,921,130 | 20,086,609 |
RR
| 37 |
2164-05-16 02:03:00
|
2164-05-16 02:39:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with R lower extremity swelling 7 days post op
with fever // ?DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19921217-RR-38
| 19,921,217 | 22,370,196 |
RR
| 38 |
2146-06-27 09:46:00
|
2146-06-27 10:38:00
|
HISTORY: ___ woman, with significant vascular disease and non-healing
wound on the fourth toe. Assess for evidence of osteomyelitis.
COMPARISON: Left foot radiograph on ___.
LEFT FOOT RADIOGRAPH, THREE VIEWS: The distal first phalanx is surgically
absent. There is no acute fracture or dislocation. Special attention is paid
at the fourth digit, without cortical erosion or suspicious soft tissue gas
lucency. Degenerative changes are mild to moderate, with a prominent plantar
calcaneal spur. Vascular calcifications are noted.
IMPRESSION: No radiographic evidence of osteomyelitis. If clinical suspicion
remains high, recommend cross-sectional imaging.
|
19921217-RR-39
| 19,921,217 | 22,370,196 |
RR
| 39 |
2146-06-27 09:46:00
|
2146-06-27 10:50:00
|
INDICATION: Significant vascular disease and non-healing wound in left toe
with progressive worsening with episodic chest pain and presyncope. Assess
for cardiomegaly.
TECHNIQUE: PA and lateral radiographs of the chest.
COMPARISON: Chest radiographs from ___.
FINDINGS: Lungs are low in volume but appear clear. There is no pleural
effusion or vascular congestion. The heart is likely top normal in size with
normal cardiomediastinal silhouette.
IMPRESSION: No acute intrathoracic process with top normal heart size.
|
19921217-RR-42
| 19,921,217 | 22,370,196 |
RR
| 42 |
2146-06-29 09:18:00
|
2146-06-29 16:08:00
|
MRA BRAIN, MRI BRAIN WITHOUT CONTRAST AND MRA NECK WITH CONTRAST, ___
HISTORY: Possible transient ischemic attacks.
Sagittal short TR short TE spin echo imaging was performed through the brain.
Axial imaging was performed with three-dimensional time-of-flight, FLAIR, long
TR long TE fast spin echo, gradient echo, and diffusion technique. Dynamic
MRA of the neck was performed during infusion of 16 cc of Magnevist
intravenous contrast. No prior brain imaging studies are available for
comparison.
FINDINGS: There is no evidence of hemorrhage or infarction. Images of the
brain appear normal. No diffusion abnormalities are detected.
The MRA of the neck demonstrates a normal appearance of the common and
cervical internal carotid arteries. There appears to be irregular narrowing
of the petrous portions of the internal carotid arteries bilaterally. This
suggests atheromatous disease. There is also irregular narrowing of the
vertebral arteries bilaterally and of the proximal basilar artery. Again,
this suggests atheromatous disease.
MRA imaging of the brain again demonstrates irregularity of the petrous
internal carotid arteries and the basilar artery. In addition, there is
narrowing of the M1 segments of the middle cerebral arteries bilaterally, also
suggesting atheromatous disease. There is no evidence of vascular occlusion
or aneurysm formation.
A preliminary report was issued that read "no apparent diffusion coefficient
abnormalities to suggest acute or subacute ischemia. MRA shows focal moderate
stenosis of the left internal carotid artery (18:18). Axial 3D time-of-flight
shows apparent linear defect across the left ICA, but this may be artifactual
since no corresponding signal abnormalities are seen on other sequences or on
the contrast-enhanced portion. Reported by ___
Incidentally noted are bilateral ocular staphylomas.
CONCLUSION: Intracranial atheromatous disease as described above. No
evidence of infarction.
|
19921217-RR-53
| 19,921,217 | 24,498,868 |
RR
| 53 |
2147-09-30 22:41:00
|
2147-09-30 23:34:00
|
INDICATION: Ulcer adjacent to the fifth toe. Evaluate for osteomyelitis.
COMPARISONS: None.
TECHNIQUE: PA, lateral, and oblique views of the right foot were obtained.
FINDINGS: There is soft tissue swelling overlying the left fifth toe. There
is no subcutaneous gas. The underlying bone appears normal without erosions
or resorption. No fracture or dislocation is identified. There is a moderate
amount of degenerative changes with spurring at the tibiotalar joint and the
calcaneus. Vascular calcifications are noted.
IMPRESSION: Soft tissue swelling overlying the fifth toe. No radiographic
evidence of osteomyelitis.
|
19921217-RR-54
| 19,921,217 | 24,498,868 |
RR
| 54 |
2147-09-30 22:41:00
|
2147-09-30 23:46:00
|
INDICATION: Toe pain and chest pain.
COMPARISONS: Chest radiograph ___.
TECHNIQUE: PA and lateral views of the chest were obtained.
FINDINGS: The lungs are clear without consolidation or edema. There is no
pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.
IMPRESSION: No acute cardiopulmonary process.
|
19921217-RR-55
| 19,921,217 | 24,498,868 |
RR
| 55 |
2147-10-01 15:32:00
|
2147-10-01 19:46:00
|
ARTERIAL DOPPLER RESTING STUDY ONLY
CLINICAL INFORMATION: ___ woman with peripheral vascular disease and
right fifth toe gangrene and status post left great toe amputation.
ABIs, Doppler waveforms and PVRs were obtained bilaterally at rest.
ABI: Right ___ 0.55, DP 0.63, digital 0.818. Left ___ 0.96, DP 0.84.
Doppler waveforms show triphasic flow in the proximal femoral, SFA and
popliteal arteries on both sides with monophasic flow below the knees
bilaterally. PVRs show significant depression of below-knee waveforms. The
segmental pressures also show a significant drop from the calf to the ankles
on both sides. This is worse on the right.
IMPRESSION: Findings suggest significant bilateral tibial disease, right more
than left.
|
19921217-RR-56
| 19,921,217 | 24,498,868 |
RR
| 56 |
2147-10-02 15:04:00
|
2147-10-03 10:44:00
|
INDICATION: Venous mapping requested prior to bypass surgery.
TECHNIQUE AND FINDINGS: The lower extremity venous system was evaluated with
B-mode ultrasound.
The right great saphenous vein is patent with diameters ranging between 0.25
and 0.37 cm. The right small saphenous vein is patent with diameters ranging
between 0.31 and 0.32 cm.
The left great saphenous vein was not identified.
The left small saphenous vein is patent with diameters ranging between 0.24
and 0.33 cm.
IMPRESSION: Patent right great saphenous vein and bilateral small saphenous
veins with diameters as described above. The left great saphenous vein was
not visualized.
|
19921217-RR-57
| 19,921,217 | 24,498,868 |
RR
| 57 |
2147-10-02 15:04:00
|
2147-10-03 10:45:00
|
INDICATION: Vein mapping requested prior to bypass surgery.
The proximal right cephalic vein was not visualized; however, the distal
cephalic vein in the forearm was patent with diameters ranging between 0.3 and
0.39 cm. The left basilic vein was not identified.
The left cephalic vein is patent with diameters ranging between 0.32 and 0.23
cm. There is an intravenous access in the distal left cephalic vein in the
forearm. The left basilic vein is patent with diameters ranging between 0.35
and 0.54 cm.
IMPRESSION: The right basilic vein and the proximal right cephalic vein were
not visualized.
Patent left basilic and cephalic veins with diameters as described above.
|
19921217-RR-61
| 19,921,217 | 20,697,883 |
RR
| 61 |
2149-01-05 15:07:00
|
2149-01-05 15:56:00
|
EXAMINATION: Right foot three views
INDICATION: History: ___ with swelling, +ulcer // ?osteo of ___ toe
TECHNIQUE: Three views right foot
COMPARISON: ___
FINDINGS:
There is cortical destruction and lucency involving the mid to distal first
distal phalanx most consistent with acute osteomyelitis. There are adjacent
few lucencies in the soft tissue worrisome for soft tissue gas. The patient
appears to be status post amputation at the base of the fifth distal phalanx,
new since the prior study. Plantar calcaneal spur is again seen. Degenerative
changes at the tibiotalar joint are noted vascular calcifications are seen.
There is soft tissue swelling.
IMPRESSION:
Findings highly worrisome for acute osteomyelitis involving the first distal
phalanx, as above, with associated gas in the soft tissue which may in part
relate ulceration versus additional focus of subcutaneous gas. Soft tissue
swelling.
|
19921217-RR-62
| 19,921,217 | 20,697,883 |
RR
| 62 |
2149-01-05 15:06:00
|
2149-01-05 15:47:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with cough // ?pna
TECHNIQUE: Chest Frontal and Lateral
COMPARISON: ___
FINDINGS:
There are relatively low lung volumes and mild right basilar atelectasis. No
focal consolidation, pleural effusion or pneumothorax is seen. The cardiac and
mediastinal silhouettes are unremarkable. Aortic calcifications are noted.
There are some degenerative changes along the spine.
IMPRESSION:
No acute cardiopulmonary process. Relatively low lung volumes.
|
19921217-RR-65
| 19,921,217 | 20,697,883 |
RR
| 65 |
2149-01-06 15:38:00
|
2149-01-10 18:13:00
|
EXAMINATION: Limited duplex evaluation of the left groin region.
HISTORY: ___ female with reduced flow in the left lower extremity
graft and nonhealing toe ulcer. Request to evaluate for graft patency.
COMPARISON: Reference is made to the study of ___, which
demonstrated no identifiable graft.
FINDINGS:
Patient had a dressing over the LCFA from an arterial access performed on the
same date, limiting evaluation.
A single image is saved of a satisfactory waveform in the native SFA with a
peak velocity of 41 cm/sec.
No demonstrable graft was identified and is presumed to be occluded
IMPRESSION:
Limited study with only one saved image.
Native proximal SFA is patent; however, no graft was identified.
|
19921217-RR-66
| 19,921,217 | 20,697,883 |
RR
| 66 |
2149-01-06 15:39:00
|
2149-01-06 20:53:00
|
EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ female with nonhealing toe ulcer. Vein mapping for
potential lower extremity bypass. History of bilateral great saphenous vein
harvesting.
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both small
saphenous veins was performed.
COMPARISON: Prior lower extremity venous mapping from ___.
FINDINGS:
Bilateral great saphenous veins were not identified, consistent with given
clinical history of great saphenous vein harvesting.
The right small saphenous vein is patent and ranges in diameter from 0.25-0.34
cm. The right small saphenous vein measures 0.34 cm at the level of the knee
and 0.25 cm at the level of the ankle.
The left small saphenous vein is patent and ranges in diameter from 0.14cm to
0.22 cm. The left small saphenous vein measures 0.22 cm at the level of the
knee and 0.14 cm at the level of the ankle.
IMPRESSION:
Patent bilateral small saphenous veins with measurements as described above.
|
19921217-RR-67
| 19,921,217 | 20,697,883 |
RR
| 67 |
2149-01-06 15:39:00
|
2149-01-06 20:08:00
|
EXAMINATION: VENOUS MAPPING OF THE UPPER EXTREMITIES
INDICATION: ___ female with nonhealing ulcer. Vein mapping for
potential lower extremity bypass.
COMPARISON: Upper extremity vein mapping from ___.
TECHNIQUE Bilateral cephalic and basilic veins were imaged utilizing
grayscale, color flow and spectral Doppler techniques.
FINDINGS:
RIGHT:
The cephalic vein is patent and ranges in measurements from 0.11-0.19 cm,
measuring 0.11 cm at the wrist, 0.14 cm at the mid forearm, 0.19 cm at the
antecubital fossa, 0.19 cm at the proximal arm. The upper portion of the right
cephalic vein was harvested and is not visualized. The basilic vein is patent
and ranges in measurements from 0.11-0.30 cm, measuring 0.11 cm at the
forearm, 0.21 cm at the antecubital fossa, and 0.30 cm in the axillary region.
LEFT:
The cephalic vein ranges in measurements from 0.15-0.24 cm, measuring 0.18 cm
at the wrist, 0.15 cm at the mid forearm, 0.24 cm at the proximal arm, and
0.20 cm at the level of the shoulder. Note is made of a tiny thrombus within
the left cephalic vein at the antecubital fossa. The basilic vein is patent
and ranges in measurements from 0.11-0.30 cm, measuring 0.11 cm at the
forearm, 0.22 cm at the antecubital fossa, and 0.30 cm in the axillary region.
IMPRESSION:
1. Patent right cephalic and basilic veins, with measurements as described
above.
2. Patent left basilic vein. Incidental note is made of a small thrombus in
the left cephalic vein at the antecubital fossa. The remainder of the left
cephalic vein is patent. Measurements as described above.
|
19921217-RR-68
| 19,921,217 | 20,697,883 |
RR
| 68 |
2149-01-08 10:17:00
|
2149-01-08 10:42:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new Picc // 45 cm right Picc ___ ___
Contact name: ___: ___
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the patient has received a right-sided
PICC line. The tip of the line projects over the right atrium, the line must
be pulled back by 5 cm to be positioned in the mid to low SVC. No evidence of
complications, notably no pneumothorax. Normal size of the cardiac silhouette.
|
19921217-RR-69
| 19,921,217 | 20,697,883 |
RR
| 69 |
2149-01-10 10:07:00
|
2149-01-10 11:14:00
|
INDICATION: ___ year old woman s/p R hallux partial amputation.
TECHNIQUE: 3 views of the right foot.
COMPARISON: Right foot radiographs ___, and ___.
FINDINGS:
There is been interval osteotomy of the distal first phalanx and the part of
the first proximal phalanx. Soft tissue swelling and a small amount of gas in
the soft tissue is consistent with recent postop state. No new fracture is
visualized.
|
19921217-RR-76
| 19,921,217 | 28,251,378 |
RR
| 76 |
2151-10-24 19:27:00
|
2151-10-24 20:40:00
|
EXAMINATION: CT abdomen/pelvis
INDICATION: ___ with diffuse abdominal pain most notable on RLQ.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.0 s, 0.5 cm; CTDIvol = 4.8 mGy (Body) DLP = 2.4
mGy-cm.
2) Spiral Acquisition 4.9 s, 53.9 cm; CTDIvol = 16.3 mGy (Body) DLP = 877.5
mGy-cm.
Total DLP (Body) = 880 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis. Trace right pleural effusion.
Severe coronary artery calcifications. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder contains gallstones but
is relatively decompressed. There is apparent wall thickening at the fundus
with not clearly defined margins.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. There is a focally dilated
loop of proximal jejunum measuring up to 4.3 cm in diameter with an apparent
transition point in the mid abdomen where there is apparent fibrosis and
tethering of multiple loops of bowel (series 601b, image 28). There is
extensive diverticulosis without focal wall thickening or adjacent fat
stranding. The appendix is not visualized.
PERITONEUM/OMENTUM: There is small volume ascites with areas of prominent
peritoneal enhancement. There is extensive omental stranding and nodularity
with the single largest nodule located anterior to the inferior edge of the
liver measuring 1.0 x 0.6 cm (series 2, image 44).
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
small volume free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is anteverted. The adnexae are nonenlarged.
LYMPH NODES: Retroperitoneal and mesenteric lymph nodes are prominent, but not
pathologically enlarged by size criteria. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted. Significant narrowing of the proximal left external iliac
artery due to atherosclerosis (2:62)
BONES: Severe left hip osteoarthritis includes osteophytosis, joint space
narrowing, subchondral sclerosis, and subchondral cyst formation.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Extensive omental fat stranding and nodularity with small volume ascites
and areas of avid peritoneal enhancement. While these are findings most
commonly seen with ovarian and GI metastatic disease, no primary candidate is
identified. If infection is a strong clinical consideration, tuberculous
peritonitis is a consideration, though metastasis with a nonvisualized primary
remains more likely. Much less likely on the differential is primary
abdominal mesothelioma.
2. Wall thickening at the fundus of the gallbladder with poorly defined
margins. While this could be secondary to findings detailed above, dedicated
imaging of the gallbladder is suggested to further characterize to exclude
possible underlying primary lesion, preferably by MRI.
3. A focal loop of proximal jejunum demonstrates dilation to 4.3 cm with a
transition point in the mid abdomen associated with tethering of multiple
loops of bowel. This finding is concerning for partial small bowel
obstruction, though the duodenum just proximal to this loop of jejunum is not
dilated.
4. Cholelithiasis.
5. Severe left hip osteoarthritis.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 8:38 pm, approximately
20 minutes after discovery of the findings. Update of impression point 3
subsequently discussed with Dr. ___ by Dr. ___.
|
19921217-RR-77
| 19,921,217 | 28,251,378 |
RR
| 77 |
2151-10-24 21:25:00
|
2151-10-24 21:39:00
|
INDICATION: ___ with abdominal CAT scan with some concern for possible
peritoneal TB with risk factors// Evaluate for any evidence of tuberculosis
TECHNIQUE: AP and lateral views the chest.
COMPARISON: ___ chest x-ray.
FINDINGS:
The lungs are clear besides subsegmental right basilar atelectasis. There is
no effusion or edema. The cardiomediastinal silhouette is within normal
limits. Hilar contours are also unremarkable. Atherosclerotic calcifications
seen at the aortic arch. No acute osseous abnormalities. Surgical clips
project over the right axilla.
IMPRESSION:
No acute cardiopulmonary process.
|
19921217-RR-79
| 19,921,217 | 28,251,378 |
RR
| 79 |
2151-10-26 09:01:00
|
2151-10-26 19:38:00
|
EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with ?pSBO, abdominal pain, weight loss, CT
scan shows dilated loops of small bowel, omental thickening. Here for
interval evaluation.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 855 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast from ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a small amount of perihepatic ascites, new since the prior study in
___. There is no evidence of focal lesions. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder contains
gallstones without wall thickening or surrounding inflammation. Wall
thickening along the fundus of the gallbladder and adjacent to the hepatic
flexure, which may be secondary to adjacent omental thickening vs primary
lesion, unchanged since recent prior exam.
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: There are regions of cortical thinning seen in the left kidney, which
may be due to prior insult. The right kidney is grossly normal. There is no
evidence of focal renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. There is again extensive
omental fat stranding and nodularity with small volume ascites and areas of
peritoneal enhancement, concerning for metastatic disease. The small bowel
loops are grossly normal in size without evidence of obstruction. There is a
small amount of paracolic fluid bilaterally, right greater than left.
Diverticulosis is noted in the sigmoid colon without evidence of acute
diverticulitis. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. Small amount
of free pelvic fluid is seen.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.
LYMPH NODES: There is no retroperitoneal lymphadenopathy. Prominent
mesenteric lymph nodes are noted without meeting CT size criteria for
lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: Severe degenerative changes are re-demonstrated in the left hip.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Re-demonstration of extensive omental fat stranding and nodularity with
small volume ascites and areas of peritoneal enhancement concerning for
malignancy. CT guided omental biopsy is recommended for further evaluation.
2. Small amount of perihepatic ascites is new since the prior study in ___.
3. Cholelithiasis with wall thickening along the fundus of the gallbladder,
adjacent to the hepatic flexure, may be secondary to adjacent omental
thickening vs primary lesion, unchanged since recent prior exam. As
previously mentioned, further evaluation by MRI could be obtained.
4. Severe left hip osteoarthritis.
|
19921217-RR-81
| 19,921,217 | 28,251,378 |
RR
| 81 |
2151-10-26 09:01:00
|
2151-10-26 19:50:00
|
EXAMINATION: CT chest with contrast
INDICATION: ___ female with concern for metastatic disease in the
abdomen and pelvis. Please evaluate for intrathoracic metastatic disease.
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: Chest radiograph from ___
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. Heart size
is normal in configuration. There is a trace pericardial effusion, likely
physiologic. Of note, this study is not optimized for the evaluation of the
pulmonary vasculature, however, no pulmonary embolus is identified.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Dependent atelectasis is seen in the lungs bilaterally, right
greater than left, with linear atelectasis seen in the right lung base.
Otherwise, no focal parenchymal opacification or suspicious nodules
identified. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck are remarkable for a
calcifications seen in the left thyroid lobe, likely calcified nodule.
ABDOMEN: Please refer to same-day CT abdomen and pelvis for full description
of subdiaphragmatic findings.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of metastatic disease in the chest.
2. Please refer to the same day CT Abdomen and pelvis report for full
description of subdiaphragmatic findings.
|
19921217-RR-82
| 19,921,217 | 28,251,378 |
RR
| 82 |
2151-10-28 09:50:00
|
2151-10-28 15:47:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with omental disease highly suspicious for
malignancy. Onc recommended brain MRI for staging.// ?metastatic disease to
brain
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT head ___
MRA brain without contrast ___
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. There is mild prominence of the ventricles and sulci
consistent with age-appropriate involutional changes. There is no abnormal
enhancement after contrast administration. Nonspecific periventricular T2
white matter hyperintensities likely reflect sequela of chronic small vessel
ischemic disease.
IMPRESSION:
1. No evidence of metastatic disease.
|
19921217-RR-83
| 19,921,217 | 28,251,378 |
RR
| 83 |
2151-10-27 13:17:00
|
2151-10-27 15:21:00
|
INDICATION: ___ year old woman with SBO found to have omental nodularity
concerning for GI vs GYN malignancy.// omental biopsy with ascites sampling-
malignancy vs TB
COMPARISON: CT scan from yesterday.
TECHNIQUE: OPERATORS: Dr. ___, Attending radiologist performed the
procedure.
ANESTHESIA: Lidocaine 1% 10 mL
MEDICATIONS: Fentanyl 50 mcg
PROCEDURE:
1. Transabdominal ultrasound.
2. Ultrasound guided core biopsy of omental thickening.
3. Diagnostic paracentesis.
PROCEDURE DETAILS:
Following the discussion of the risks, benefits, and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the stretcher.
A pre-procedure time-out was performed per ___ protocol. The right abdomen
was prepped and draped in the usual sterile fashion.
Under Ultrasound guidance, a 17 gauge cannula was advanced into omental
thickening. Images of the access were stored on PACS. 2 18 gauge core
biopsies were obtained under direct ultrasound guidance. Those were placed
into formalin and sent for pathological analysis.
The cannula was then directed more inferiorly into the ascites. 10 mL of
ascites were aspirated and sent for analysis as requested per the primary
medical team: Cytology, culture, acid-fast and TB investigation. The cannula
was removed. A sterile dressing was applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
Successful core biopsy and diagnostic paracentesis.
IMPRESSION:
Percutaneous ultrasound-guided biopsy of omental thickening and diagnostic
paracentesis of ascitic fluid.
|
19921217-RR-84
| 19,921,217 | 28,251,378 |
RR
| 84 |
2151-10-28 08:45:00
|
2151-10-28 09:48:00
|
EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ year old woman with SBO found to have omental nodules
concerning for metastatic disease concerning for GYN primary. Transvaginal
ultrasound to assess for primary GYN cancer (ovarian, endometrial)
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: CT abdomen/pelvis with contrast ___
FINDINGS:
The uterus is anteverted and measures 5.2 x 3.2 x 4.5 cm. The endometrium is
homogenous and measures 2.4 mm. Myometrial calcifications are noted.
The right ovary is not visualized. The left ovary measures 2.7 x 1.8 x 2.2 cm
and is unremarkable. Small amount of free fluid is noted.
IMPRESSION:
1. Small amount of pelvic free fluid.
2. Right ovary not visualized. Left ovary is unremarkable.
3. Atrophic uterus with myometrial calcifications and endometrial thickness
within normal range for the age of the patient.
|
19921217-RR-85
| 19,921,217 | 28,251,378 |
RR
| 85 |
2151-10-29 13:17:00
|
2151-10-29 16:10:00
|
INDICATION: ___ year old woman with SBO and suspected malignant disease. SBO
seemed to have resolved now with vomiting and worsening abdominal pain.// ?SBO
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel with contrast
visualized within the large bowel and rectum. There is no free intraperitoneal
air.
Osseous structures are notable for multilevel degenerative changes of the
thoracolumbar spine as well as degenerative changes of the bilateral hips,
severe on the left.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No radiographic evidence of bowel obstruction.
|
19921217-RR-86
| 19,921,217 | 28,251,378 |
RR
| 86 |
2151-10-30 09:43:00
|
2151-10-30 10:04:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with chest pain.// Please evaluate for etiology
of chest pain.
IMPRESSION:
In comparison with study of ___, there again are low lung volumes that
accentuate the prominence of the transverse diameter of the heart. Blunting
of the costophrenic angles is consistent with small pleural effusions with
associated atelectatic changes bilaterally. No pulmonary vascular congestion
or acute focal pneumonia.
|
19921217-RR-87
| 19,921,217 | 28,251,378 |
RR
| 87 |
2151-11-01 08:11:00
|
2151-11-01 09:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with newly diagnosed metastatic adenocarcinoma
w/ hospital course complicated by NSTEMI now with fever.// ?PNA
IMPRESSION:
In comparison with the study of ___, there again are low lung volumes that
accentuate the prominence of the transverse diameter of the heart. Blunting
of the costophrenic angles are again seen, consistent with small pleural
effusions and atelectatic changes at the bases. No definite vascular
congestion or acute focal pneumonia.
|
19921217-RR-88
| 19,921,217 | 28,251,378 |
RR
| 88 |
2151-11-04 15:05:00
|
2151-11-04 17:20:00
|
INDICATION: ___ year old woman with decreased BMs, c/f ileus vs obstruction//
c/f ileus vs obstruction
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Abdominal radiographs ___
FINDINGS:
Again, there is contrast visualized in the large bowel to the rectum without
abnormal dilation. There are no abnormally dilated loops of small bowel.
Diverticulosis coated with contrast noted throughout descending and the
sigmoid colon.
There is no free intraperitoneal air.
Osseous structures are notable for multilevel degenerative changes of
thoracolumbar spine and bilateral hips, more severe on the left.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Atherosclerotic calcifications are noted in the splenic artery.
Surgical clips are noted surrounding the left hip.
IMPRESSION:
No evidence of small-bowel obstruction. Contrast is seen again within the
large bowel, which are not dilated.
|
19921217-RR-89
| 19,921,217 | 28,251,378 |
RR
| 89 |
2151-11-05 09:25:00
|
2151-11-05 14:25:00
|
INDICATION: ___ year old woman with peritoneal cancer worsening Nausea and
vomiting// signs of obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph ___.
FINDINGS:
There is no significant interval change in extent of contrast visualized in
the large bowel loops without abnormal dilation. There is slight decrease in
the contrast seen in the rectum. Interval decrease in distention of stomach.
Assessment for free intraperitoneal air is limited on supine radiographs. If
there is clinical concern for pneumoperitoneum, advise upright or left lateral
decubitus radiograph, or cross-sectional imaging.
Osseous structures are notable for multilevel degenerative changes in the
lumbar spine and bilateral hips left greater than right.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Atherosclerotic calcifications are noted in the splenic artery.
Surgical clips are again seen surrounding left hip.
IMPRESSION:
Re-demonstration of contrast in large bowel loops from the ascending colon to
the rectum. Slight decrease in contrast seen in the rectum. Slight interval
decrease in stomach distention.
|
19921217-RR-90
| 19,921,217 | 28,251,378 |
RR
| 90 |
2151-11-05 12:18:00
|
2151-11-05 14:54:00
|
EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with NGT placement// NGT placement
TECHNIQUE: Portable chest radiograph
COMPARISON: ___ portable chest radiograph, ___ portable chest
radiograph, ___ portable chest radiograph
FINDINGS:
The side port and distal tube of the newly placed NG tube projects over the
left upper abdomen, below the level of the GE junction. There is no
postprocedure pneumothorax. The right and left low lung volumes remain low,
demonstrating bibasilar linear atelectasis. Stable small right pleural
effusion is again noted. The cardiomediastinal and hilar contour is unchanged
since ___.
IMPRESSION:
1. Appropriately placed NG tube. No evidence of pneumothorax.
2. Stable low lung volumes with linear bibasilar atelectasis.
|
19921217-RR-91
| 19,921,217 | 28,251,378 |
RR
| 91 |
2151-11-06 08:12:00
|
2151-11-06 11:28:00
|
INDICATION: ___ year old woman with metastatic adenocarcinoma, omental caking
and malignant ascites, now with worsening nausea and vomiting.// obstruction?
TECHNIQUE: Portable supine abdominal radiographs.
COMPARISON: Portable abdomen plain film dated ___.
FINDINGS:
Compared to most recent prior from ___, there is no appreciable change
in the extent of contrast within the large bowel. There are no abnormally
dilated loops of large or small bowel. Multiple tics are again seen in the
descending colon.
Assessment for free intraperitoneal air is limited on supine radiographs. If
there is clinical concern for pneumoperitoneum, advise upright or left lateral
decubitus radiograph, or cross-sectional imaging.
Osseous structures are notable for multilevel degenerative disease of the
lumbar spine and bilateral hips, left greater than right.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Again noted is atherosclerotic calcification of the splenic artery,
and surgical clips projecting over the left hip..
IMPRESSION:
Contrast is seen filling the large bowel from the ascending colon to the
rectum, without appreciable change from most recent prior.
|
19921471-RR-104
| 19,921,471 | 26,949,917 |
RR
| 104 |
2153-09-19 01:41:00
|
2153-09-19 05:07:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with kidney cancer, productive cough// eval for pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Again noted are severe emphysematous changes and chronic scarring, unchanged
since the prior study. Hyperinflation of the right hemithorax is unchanged.No
focal consolidation is seen. No pleural effusion or pneumothorax is seen.
Rightward mediastinal shift is unchanged.
IMPRESSION:
No acute cardiopulmonary process.
|
19921471-RR-105
| 19,921,471 | 26,949,917 |
RR
| 105 |
2153-09-19 01:24:00
|
2153-09-19 02:10:00
|
INDICATION: History: ___ with flank pain, UTI// Flank pain, UTI
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 52.1 cm; CTDIvol = 13.5 mGy (Body) DLP = 704.9
mGy-cm.
Total DLP (Body) = 705 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: Again seen are severe emphysematous changes in the lung bases. A
3 mm nodule is seen in the right lower lobe (2:3). There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains gallstones without wall thickening or
evidence of inflammation.
PANCREAS: The pancreas is atrophic, without evidence of focal lesions within
the limitations of an unenhanced scan. There is no pancreatic ductal
dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right adrenal gland is normal in size and shape. 1.9 cm left
adrenal adenoma.
URINARY: Patient is status post left nephrectomy. The right kidney is not
enlarged. Multiple cysts are seen in the right kidney the largest measuring
2.8 cm in the lower pole. There is no hydronephrosis. A few punctate
hyperdensities in the right kidney are compatible with nonobstructing stones.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is not visualized.
PELVIS: The urinary bladder is under distended and contains a Foley catheter.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is enlarged.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: An umbilical hernia containing fat is noted. A supraumbilical
hernia containing a loop of transverse colon is noted.
IMPRESSION:
1. No acute abnormality in the abdomen or pelvis.
2. Stable left adrenal adenoma.
3. 3 mm right lower lobe nodule.
For incidentally detected nodules smaller than 6mm in the setting of an
incomplete chest CT, no CT follow-up is recommended.
|
19921471-RR-106
| 19,921,471 | 28,870,061 |
RR
| 106 |
2153-09-28 01:03:00
|
2153-09-28 01:44:00
|
EXAMINATION: RENAL U.S.
INDICATION: History: ___ with BPH, kidney cancer s/p L nephrectomy ___ years
ago, known bladder mets and recurrent UTIs with foley, presents with b/l flank
pain.// r/o hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal ultrasound dated ___.
FINDINGS:
The right kidney measures 12.7 cm. The patient is status post left
nephrectomy. Multiple simple cysts are seen throughout the right kidney
measuring up to 3.1 cm. There is no hydronephrosis, stones, or masses.
Normal cortical echogenicity and corticomedullary differentiation is seen on
the right.
The bladder is decompressed by Foley catheter.
IMPRESSION:
No evidence of hydronephrosis on the right. Status post left nephrectomy.
|
19921471-RR-107
| 19,921,471 | 28,870,061 |
RR
| 107 |
2153-09-28 01:43:00
|
2153-09-28 07:19:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough// pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Chronic emphysematous changes with hyperinflation, architectural distortion,
and scarring. No new focal consolidations. No pulmonary edema. Unchanged
appearance of the cardiomediastinal silhouette. No pleural effusion. No
pneumothorax.
IMPRESSION:
Chronic emphysema, but no focal consolidations.
|
19921471-RR-108
| 19,921,471 | 24,675,778 |
RR
| 108 |
2153-10-09 01:41:00
|
2153-10-09 05:02:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ with cough// pna
TECHNIQUE: Frontal and lateral views of the chest
COMPARISON: Multiple prior comparisons, most recent from ___
FINDINGS:
Again seen are chronic emphysematous changes throughout the bilateral lung
fields with hyperinflation, architectural distortion, and scarring. No
definite new focal consolidation. No pulmonary edema. Unchanged appearance
of the cardiomediastinal silhouette. No pleural effusion or pneumothorax.
Multiple old healed rib fractures on the left.
IMPRESSION:
Chronic emphysema without definite new focal consolidation.
|
19921471-RR-109
| 19,921,471 | 24,675,778 |
RR
| 109 |
2153-10-09 01:45:00
|
2153-10-09 03:07:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with headache// ich, mass
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.6 cm; CTDIvol = 48.7 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 3.0 s, 6.2 cm; CTDIvol = 48.7 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: Head CT ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Generalized
brain parenchymal atrophy. No hydrocephalus.
There is no evidence of fracture. There few well-defined lucent abnormalities
involving calvarium, stable since ___, most likely benign given stability,
may represent arachnoid granulations, venous lakes.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
2. Brain parenchymal atrophy.
|
19921471-RR-114
| 19,921,471 | 22,817,414 |
RR
| 114 |
2153-10-18 15:37:00
|
2153-10-18 17:02:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with bladder CA s/p TURB who presents with
hematuria// assess for hydronephrosis, clot burden in bladder
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound from ___.
CT abdomen and pelvis without contrast from ___
FINDINGS:
The right kidney measures 12.0 cm. Patient is status post left nephrectomy.
There is new mild-to-moderate right hydroureteronephrosis since prior renal
ultrasound from ___, extending to at least the proximal ureter.
The mid to distal ureter is not visualized sonographically. The right kidney
demonstrates normal cortical echogenicity and corticomedullary
differentiation. Again noted are multiple simple cysts in the right kidney,
with representative cyst measuring 1.1 cm in the interpolar region.
The bladder is mildly distended with avascular echogenic material, likely
debris and blood products. A Foley catheter seen within the bladder lumen.
IMPRESSION:
1. New mild to moderate right hydroureteronephrosis since prior renal
ultrasound from ___. Status post left nephrectomy.
2. Bladder is mildly distended with debris and blood products. A Foley
catheter is seen within the bladder lumen.
|
19921471-RR-115
| 19,921,471 | 22,817,414 |
RR
| 115 |
2153-10-21 08:35:00
|
2153-10-21 09:07:00
|
INDICATION: ___ year old man with bladder cancer s/p resection here with
hematuria, now fever// fever
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
There is upper lobe predominant emphysema with superimposed patchy parenchymal
opacities left greater than right which could represent pneumonia. There are
healing left-sided rib fractures. There is stable elevation of left
hemidiaphragm. Cardiomediastinal silhouette is stable. There are no pleural
effusions. No pneumothorax is seen
|
19921471-RR-116
| 19,921,471 | 22,817,414 |
RR
| 116 |
2153-10-27 21:13:00
|
2153-10-27 21:48:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with chest pain, dizziness// pneumonia progression, COPD?
COMPARISON: Prior exam is dated ___, CT chest from ___
FINDINGS:
PA and lateral views of the chest provided. In this patient with known severe
bullous emphysema, and known architectural distortion better assessed on prior
CT, there is no definite evidence for a superimposed pneumonia. Mesh is seen
projecting over the left diaphragm which is slightly elevated as on prior.
There is no focal consolidation to suggest pneumonia. No large effusion,
pneumothorax or signs of edema. The cardiomediastinal silhouette appears
unchanged. Multiple chronic appearing left posterior rib deformities are
again seen.
IMPRESSION:
As above.
|
19921471-RR-117
| 19,921,471 | 27,901,425 |
RR
| 117 |
2153-10-29 16:28:00
|
2153-10-29 16:52:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with cp/sob recent pna// acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
The appearance of the lungs is similar compared to the prior study. Again seen
evidence of severe bolus emphysema, particularly involving the right lower
lung. Mesh is again seen projecting over the left hemidiaphragm which remains
elevated. No new focal consolidation is seen. There is no pleural effusion
or pneumothorax. Cardiac mediastinal silhouettes are stable. Multiple
left-sided rib deformities/old rib fractures, are re-demonstrated.
IMPRESSION:
No significant interval change from 2 days prior.
|
19921471-RR-118
| 19,921,471 | 22,396,114 |
RR
| 118 |
2153-11-01 20:18:00
|
2153-11-01 20:47:00
|
EXAMINATION: Chest radiograph
INDICATION: History: ___ with recent dx of PNA and recent fall// pna?shoulder
fx?
TECHNIQUE: PA and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
There is unchanged elevation of the left hemidiaphragm with associated mesh.
The cardiomediastinal silhouette is within normal limits. The lungs appear
stable with prominence of interstitial lung markings and bullous emphysema,
compatible with interstitial lung disease.
Multiple old rib fractures are noted on the left.
IMPRESSION:
Stable appearance of the lungs with interstitial lung disease.
|
19921471-RR-119
| 19,921,471 | 22,396,114 |
RR
| 119 |
2153-11-01 20:18:00
|
2153-11-01 21:07:00
|
INDICATION: History: ___ with recent dx of PNA and recent fall// pna?shoulder
fx?
TECHNIQUE: Four views of the right shoulder
COMPARISON: None.
FINDINGS:
No acute fracture or dislocation is seen. The right acromioclavicular joint
is intact with mild degenerative change seen. No periarticular soft tissue
calcification is seen. Chronic changes of the right lung are partially
imaged, including chronic lung disease and several areas of chain sutures.
IMPRESSION:
No acute fracture or dislocation of the right shoulder.
|
19921471-RR-120
| 19,921,471 | 22,396,114 |
RR
| 120 |
2153-11-01 20:39:00
|
2153-11-01 21:12:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall + head strike. now w/ persistent
dizziness// Bleed?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.5 cm; CTDIvol = 47.4 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 842 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
1. No acute intracranial abnormality.
|
19921471-RR-121
| 19,921,471 | 22,396,114 |
RR
| 121 |
2153-11-03 10:39:00
|
2153-11-03 11:04:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with h/o bladder cancer, renal cell carcinoma s/p
L nephrectomy, urinary retention, vesicular ureteral reflux, orthostatic
hypotension, COPD, T2DM, CDK, recurrent UTIs p/w dizziness and orthostatic
hypotension and recent urine cultures positive for VRE.// does right kidney
show signs of hydronephrosis vs. evidence of pyelonephritis vs. stone
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: ___.
FINDINGS:
The right kidney measures 12.4 cm. The left kidney is surgically removed.
There is now only minimal right pelvocaliectasis, markedly improved from the
prior scan. 2 simple cysts are noted in the right kidney ranging up to 2.5 cm
in diameter. Cortical echogenicity and architecture is normal. No stones are
identified.
The bladder is empty via a Foley catheter in place.
IMPRESSION:
Status post left nephrectomy.
Near complete resolution of the right hydronephrosis following insertion of
Foley catheter..
|
19921471-RR-122
| 19,921,471 | 23,035,956 |
RR
| 122 |
2153-12-10 01:51:00
|
2153-12-10 02:24:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with ruq pain.// cbd dilation? cholecystitis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
SPLEEN: Normal echogenicity, measuring 13.4 cm.
KIDNEYS: Limited sagittal views of the right kidney demonstrate no evidence of
hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Cholelithiasis. No evidence of acute cholecystitis. Normal CBD and
intrahepatic biliary tree.
|
19921471-RR-131
| 19,921,471 | 29,068,055 |
RR
| 131 |
2154-05-19 09:31:00
|
2154-05-19 10:20:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with here w/ delusions. underlying UTI. intermittent
fevers at home// infectious w/u
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___ and ___.
FINDINGS:
Heart size is normal. There is continued rightward shift of mediastinal
structures, as seen previously, likely due to right-sided volume loss. The
mediastinal and hilar contours are unchanged. Sutures are again noted in the
right apex. There is hyperinflation of the lungs with marked emphysematous
changes particularly in the right lung base where large bulla are present.
Increased interstitial opacities are again noted diffusely, but unchanged from
prior exams. No focal consolidation, pleural effusion, or pneumothorax is
demonstrated. Spiral tacks from prior hernia repair project over the left
upper quadrant of the abdomen, and there is continued elevation of the left
hemidiaphragm. There are multiple remote left-sided rib fractures.
IMPRESSION:
No definite new focal consolidation to suggest pneumonia. Severe bullous
emphysema with unchanged mild chronic interstitial abnormality.
|
19921471-RR-132
| 19,921,471 | 29,068,055 |
RR
| 132 |
2154-05-21 18:32:00
|
2154-05-21 19:53:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old man with recurrent bladder cancer s/p 12+ TURBTs
(resulting low-volume bladder), RCC s/p L nephrectomy, recurrent
UTI/pyelonephritis, present with urinary sx and RLQ/back pain.// ___ with
recurrent bladder cancer s/p 12+ TURBTs (resulting low-volume bladder), RCC
s/p L nephrectomy, recurrent UTI/pyelonephritis, present with urinary sx and
RLQ/back pain. Please assess for kidney stone/pyelo.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: No dose reported.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
LOWER CHEST: Severe emphysema in the visualized lower lungs is
re-demonstrated. Suture material/surgical clips is again seen at the right
lung base. Multiple surgical clips along the left hemidiaphragm are again
seen and unchanged.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder contains gallstones without
wall thickening or surrounding inflammation.
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: A 1.4 cm low-density left adrenal nodule is re-demonstrated and
unchanged. The right adrenal gland is normal in size and shape.
URINARY: Patient is status post left nephrectomy. The right kidney is
dysmorphic in appearance with cortical scarring and moderate
hydroureteronephrosis which tapers in the proximal ureter and enlarges in the
mid and distal ureter to the level of the ureterovesicular junction. Multiple
cortical renal cysts are again seen measuring up to 1.8 cm. There is no
perinephric abnormality. Multiple nonobstructing punctate renal
calcifications are demonstrated.
The bladder contour is irregular in appearance with bladder diverticula and
hyperdense thickening of the posterior bladder wall though new nodularity is
demonstrated measuring up to 14 mm (06:44) with associated calcifications
which may represent recurrent malignancy.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. There is extensive fecal loading throughout the colon the appendix
is normal.
PELVIS: There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is enlarged and contains calcifications.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Vascular clips along the retroperitoneum and left pelvic wall are
re-demonstrated and unchanged. There is no abdominal aortic aneurysm. Mild
atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Moderate right hydroureteronephrosis to the level of the bladder with
posterior bladder wall thickening and new nodularity measuring up to 14 mm
with associated calcifications concerning for recurrent malignancy.
2. No obstructing renal, ureteral, or bladder stones identified. Multiple
punctate nonobstructing renal stones demonstrated.
3. Cholelithiasis without findings to suggest cholecystitis.
4. Diverticulosis without findings of diverticulitis.
|
19921471-RR-141
| 19,921,471 | 29,020,907 |
RR
| 141 |
2155-02-18 20:02:00
|
2155-02-18 20:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with copd, rcc s/p l nephrectomy, r
hydronephrosis, bladder mass here w/ UTI, now SOB// ? pna, pulmonary edema
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
There is a surgical mesh along the left hemidiaphragm, which is chronically
elevated. The lungs are hyperinflated with flattening of the diaphragm, which
is consistent with chronic emphysematous changes. There are increased
interstitial markings which are not significantly changed from prior study and
most likely represent chronic fibrotic changes. No focal consolidation,
pleural effusion or pneumothorax is identified. The cardiomediastinal
silhouette is stable in appearance. There are no acute osseous abnormalities.
Healed left rib fractures are noted.
IMPRESSION:
No pneumonia or acute cardiopulmonary process.
|
19921471-RR-142
| 19,921,471 | 29,980,163 |
RR
| 142 |
2155-03-03 17:37:00
|
2155-03-03 18:43:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old man with hx of RCC s/p left nephrectomy, bladder CA
s/p transurtheral resection, chronic UTIs representing with ongoing/worsening
right flank pain// evaluate right flank pain
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.1 s, 59.4 cm; CTDIvol = 18.1 mGy (Body) DLP =
1,066.0 mGy-cm.
Total DLP (Body) = 1,066 mGy-cm.
COMPARISON: CT abdomen pelvis without contrast ___
FINDINGS:
LOWER CHEST: There is stable postoperative changes at the right lung base.
There is moderate to severe bibasilar centrilobular emphysema with bullae,
unchanged from prior imaging. No pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. There is cholelithiasis without
cholecystitis.
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: Again seen is a 1.9 x 1.4 cm left adrenal adenoma. The right
adrenal gland is normal in size and shape.
URINARY: Postsurgical changes from left nephrectomy. The right kidney has a
lobulated contour consistent with scarring. Again seen are multiple
hypodensities which most likely represent simple cysts. Again seen is
moderate right hydroureteronephrosis, grossly unchanged from ___ and
slightly increased from ___. This continues to extend down to
the level of the bladder without evidence of an obstructing stone or lesion.
Again seen is a punctate nonobstructing right renal stone.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The appendix is
normal. The colon and rectum are within normal limits. The appendix is
normal.
PELVIS: The bladder has a lobulated contour. There is soft tissue thickening
of the dome of the bladder similar to ___. There is suggestion of
bladder diverticula. There are no new masses or lesions. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate measures 5.7 cm in diameter consistent with
prostatomegaly.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Again seen are supraumbilical fat and bowel containing ventral
hernias without evidence of obstruction.There is a small left fat containing
inguinal hernia.
IMPRESSION:
1. Persistent right hydroureteronephrosis and perinephric stranding similar in
appearance to ___. There is no evidence of an obstructing stone or
lesion.
2. Lobulated contour of the bladder, soft tissue thickening at the dome and
multiple diverticula are similar in appearance to the recent imaging.
|
19921471-RR-143
| 19,921,471 | 29,980,163 |
RR
| 143 |
2155-03-06 16:06:00
|
2155-03-06 19:34:00
|
EXAMINATION: CT UROGRAM WITHOUT AND WITH CONTRAST
INDICATION: ___ year old man with recurrent urothelial carcinoma// evaluate
for filling defect in ureter.
History of ___ status post left nephrectomy in ___. Urinary bladder cancer
status post transurethral tumor resection in ___ with recent recurrence.
Persistent worsening right flank pain.
TECHNIQUE: CTU: Multidetector CT of the abdomen and pelvis were acquired
prior to and after intravenous contrast administration with the patient in
prone position. The non-contrast scan was done with low radiation dose
technique. The contrast scan was performed with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.6 s, 55.6 cm; CTDIvol = 5.7 mGy (Body) DLP = 311.3
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
3) Stationary Acquisition 17.4 s, 0.2 cm; CTDIvol = 294.1 mGy (Body) DLP =
58.8 mGy-cm.
4) Spiral Acquisition 8.7 s, 56.2 cm; CTDIvol = 15.9 mGy (Body) DLP = 884.4
mGy-cm.
5) Spiral Acquisition 6.2 s, 40.0 cm; CTDIvol = 5.7 mGy (Body) DLP = 222.9
mGy-cm.
Total DLP (Body) = 1,479 mGy-cm.
COMPARISON: Multiple prior CTs of the abdomen and pelvis, most recent of ___
FINDINGS:
LOWER CHEST: Elevation of the left hemidiaphragm, unchanged since multiple
priors. Included lower lungs demonstrate severe emphysematous changes. No
pleural effusion or pericardial effusion is identified.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. The gallbladder is contracted and
demonstrates an intraluminal calculus without evidence of wall thickening or
adjacent fluid. There is no evidence of intrahepatic or extrahepatic biliary
dilatation.
PANCREAS: The pancreas is mildly atrophic and 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. A couple accessory small spleens are noted in the
region of the hilum.
ADRENALS: The right adrenal gland is normal in size and shape. There is
redemonstration of a 1.5 cm left adrenal nodule consistent with an adenoma and
stable for multiple prior examinations.
URINARY: The patient is status post left nephrectomy. The right kidney
demonstrates moderate hydronephrosis, similar to minimally increased compared
to prior examination. There is mild perinephric fat stranding, similar to
examination of ___. Few cortical cysts are again demonstrated in the
right kidney, the largest measuring 2.3 cm.
On delayed postcontrast imaging, contrast poles only visualized within the
proximal right ureter without evidence of filling defect. There is mild
diffuse hydroureter without surrounding fat stranding. Of note, a segment of
fixed kinking is identified along the mid ureter (20:49 through 53) that
appears to be becoming more pronounced over subsequent examinations. Contrast
is not visualized distal to this portion of the ureter, however mild ureteric
dilatation remains.
No contrast has reached the bladder on the delayed phase. Lobulation with the
stranding/scarring at the bladder dome is similar to multiple previous
examinations. The urinary bladder is mildly distended.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: Postsurgical changes in the left pelvis are again noted. There is no
free fluid.
REPRODUCTIVE ORGANS: The prostate gland is mildly enlarged measuring up to 4.6
x 5.0 cm. At in the right seminal vesicle is asymmetrically more prominent
compared to the left, however appearance is stable since prior examinations,
likely postsurgical sequela.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: A fat containing umbilical hernia is present. There is also a
supraumbilical anterior abdominal hernia containing omentum and a few loops of
nonobstructive small bowel..
IMPRESSION:
1. Moderate right hydroureteronephrosis with fixed kinking in the mid third
ureter and mild dilatation of the more distal ureter is unchanged compared to
the most recent exams in ___. However, compared to ___, this
has become slightly more apparent.
2. Lobulation and scarring at the bladder dome, similar compared to prior
exams. Of note intravenous contrast has never reached the bladder and its
evaluation remains limited. Per OMR, patient is scheduled for a cystoscopy.
3. Gallstones.
RECOMMENDATION(S): Cystoscopy is recommended for further evaluation. Per
OMR, patient is already scheduled
|
19921471-RR-17
| 19,921,471 | 22,171,330 |
RR
| 17 |
2150-08-19 12:29:00
|
2150-08-19 15:42:00
|
INDICATION: ___ with dyspnea
TECHNIQUE: PA and lateral views of the chest
COMPARISON: ___
FINDINGS:
Elevation of the left hemidiaphragm is unchanged compared to the prior
examination. Lungs are markedly hyperinflated suggestive of underlying
emphysema. Relative lucency at the right base corresponds to bullous changes
on a CT dated ___. Since the prior study, there is coarsening of the
interstitium with associated parenchymal distortion and scarring, particularly
in the upper lungs. There are scattered nodular opacities, some of which are
stable, but some of which have developed, especially a 1cm irregular opacity
at the left apex. Further imaging evaluation with chest CT is recommended at
this time. There is no focal consolidation, pleural effusion, or
pneumothorax. Cardiomediastinal silhouette is stable. Healed left sided rib
fractures are noted.
IMPRESSION:
Increased upper lobe predominant interstitial abnormality and bilateral
nodular opacities. Further imaging evaluation with dedicated chest CT is
recommended at this time.
|
19921471-RR-18
| 19,921,471 | 22,171,330 |
RR
| 18 |
2150-08-19 14:06:00
|
2150-08-19 15:35:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ man with a history of left nephrectomy for malignancy
presenting with pain over ventral hernia. Evaluate for bowel obstruction.
TECHNIQUE: MDCT-acquired axial images of the abdomen and pelvis were obtained
without intravenous contrast. Enteric contrast was given. Coronal and sagittal
reformats prepared and reviewed.
DOSE: DLP: 938.71 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is severe emphysema. There are multiple pulmonary nodules, up to 7 mm
(2b:91). The patient is status post prior right lower lobe wedge resection.
There is also evidence of left hemi diaphragmatic hernia repair with
persistent elevation of the left hemidiaphragm.
Assessment of the solid visceral structures of the abdomen and pelvis is
limited without IV contrast.
ABDOMEN:
The liver is homogeneous in attenuation, without focal lesion. The gallbladder
and biliary tree are normal. The pancreas and spleen are unremarkable. There
is a low attenuation 1.6 x 1.8 cm left adrenal nodule, compatible with a
benign adenoma (2a:15). The patient is status post left nephrectomy. There
is no evidence of mass at the nephrectomy site, although evaluation is
markedly limited by lack of intravenous contrast. There is moderate
right-sided hydronephrosis and hydroureter without evident obstructing stone.
There is a 1.7 cm cyst in the right kidney (2a:35).
The small bowel and large bowel are normal in caliber and there is no
mesenteric fat stranding. There is no definite true ventral hernia on this
non Valsalva, supine examination, only eventration of the fascia. There is no
intra- or retroperitoneal lymphadenopathy. There is no ascites, fluid
collection, or pneumoperitoneum. The abdominal aorta is normal caliber.
PELVIS:
The rectum is normal. The urinary bladder is abnormal and lobulated in
contour. There is focal outpouching of the superior lateral left aspect of
the bladder. There are no calcified stones. The prostate is enlarged and
there are coarse calcifications within it. There are small bilateral fat
containing inguinal hernias. There are surgical clips along the left pelvic
sidewall, suggestive of prior lymph node dissection.
MUSCULOSKELETAL:
There is no acute fracture. There is no concerning destructive osseous
lesion.
IMPRESSION:
1. No bowel obstruction or true ventral hernia.
2. Moderate right-sided hydronephrosis and hydroureter without obstructing
stone evident. The acuity is unknown, but last renal cortex is not
significantly thinned. Urology followup for further evaluation is advised.
3. Markedly abnormal bladder contour, however evaluation for mass is not
possible without intravenous contrast. Correlation with patient's surgical and
oncologic history, as well as comparison to prior imaging is recommended.
4. Multiple pulmonary nodules up to 7 mm should be correlated with prior
imaging, since they could represent metastatic disease. If imaging cannot be
obtained, nonemergent evaluation with chest CT is recommended.
5. Severe emphysema.
6. Left adrenal adenoma.
|
19921471-RR-20
| 19,921,471 | 22,209,661 |
RR
| 20 |
2150-09-04 07:55:00
|
2150-09-04 14:14:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with COPD and history of occupational exposure in
shipyards with new nodule seen on chest radiograph.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm maximum intensity projection axial images.
DOSE: DLP: 679.32 mGy-cm.
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
MEDIASTINUM: There is evidence of surgical repair of the left hemidiaphragm
with abdominal contents causing paradoxical rightward shift of the mediastinum
despite severe right lung emphysema. The imaged thyroid is normal.
The borderline enlarged left hilar lymph node measures 1.7 x 0.9 cm (2:29).
There is no supraclavicular, axillary, mediastinal, or right hilar
lymphadenopathy.
The aorta is normal in caliber. Enlargement of the central pulmonary arteries
is suggestive of pulmonary hypertension. The heart size is normal and there
is no pericardial effusion. There are sparse coronary arterial calcifications.
PLEURA: There is no pneumothorax. There is no pleural effusion.
LUNGS: The airways are patent. There is diffuse bronchial wall thickening.
There is no airspace consolidation. There is severe panlobular emphysema with
multifocal linear calcified scarring. There are a large number of peripherally
distributed peribronchovascular pulmonary nodules up to 7 mm in diameter.
Many of these nodules are surrounded by a small halo of ground-glass opacity.
There is no dominant nodule.
BONES: There are no destructive focal osseous lesions concerning for
malignancy within the imaged thoracic skeleton.
UPPER ABDOMEN: This study is not tailored to evaluate the abdomen. Within
these limitations no gross abnormality is seen.
IMPRESSION:
1. There are a large number of peribronchovascular pulmonary nodules up to 7
mm the differential diagnosis for which includes metastasis or infection.
Followup evaluation with CT in 3 months is recommended to document change.
2. Severe panlobular emphysema and diffuse bronchial wall thickening
consistent with bronchitis.
3. Borderline left hilar lymph node can also be re-evaluated on the followup
study.
4. Probable pulmonary arterial hypertension
NOTIFICATION: Impression #1 was entered by Dr. ___ on ___ at
14:10 into the Department of Radiology critical communications system for
direct communication to the referring provider.
|
19921471-RR-32
| 19,921,471 | 22,494,573 |
RR
| 32 |
2150-12-21 17:41:00
|
2150-12-21 19:43:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with COPD, SOB // ? infiltrate
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Patient is status post left diaphragmatic hernia repair with elevation of the
left hemidiaphragm and shift of the cardiac silhouette to the right, similar
in appearance as compared to the prior study. The right lung is hyperinflated
and there is chronic blunting of the right costophrenic angle. Chain sutures
in the lungs bilaterally are compatible with prior wedge resections.
Panlobular and centrilobular emphysema are again seen with chronic
interstitial nodular abnormality, most pronounced in the upper lobes, similar
in appearance as compared to the recent prior study. The cardiac and
mediastinal silhouettes are stable. Multiple old left-sided rib deformities
are re- demonstrated.
IMPRESSION:
No significant interval change as compared to ___
|
19921471-RR-33
| 19,921,471 | 22,494,573 |
RR
| 33 |
2150-12-21 17:21:00
|
2150-12-21 18:44:00
|
EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
INDICATION: +PO contrast; History: ___ with ventral hernia, ?
incarceration/strangulation, ? SBO+PO contrast // ? ventral hernia
incarceration/strangulation, ? SBO
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis without
the administration of IV contrast. Coronal and sagittal reformations were
performed and submitted to PACS for review. Oral contrast was administered.
DOSE: DLP: 882 mGy-cm (abdomen and pelvis.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: The appearance of the lungs is unchanged with a few small
nodular opacities in the right lung base, stable. Patient is status post right
lower lobe wedge resection and left hemidiaphragmatic hernia repair. There is
persistent elevation of the left hemidiaphragm.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. Accessory spleen is noted at the splenic hilum.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation.
ADRENALS: The right adrenal gland is normal. Stable 1.6 x 1.8 cm left adrenal
adenoma (series 601b, image 37.
URINARY: Stable, moderate right hydronephrosis and hydroureter. No
obstructing stone is identified. Stable simple cysts are noted in the right
kidney. The left kidney is surgically absent.
GASTROINTESTINAL: The small and large bowel are normal in course and caliber
without obstruction. Colon and rectum are within normal limits. Appendix has
normal caliber without evidence of fat stranding.
MESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and
mesenteric lymphadenopathy. There is no free air.
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder has a markedly abnormal appearance. There is a
rounded thickening of the superior bladder wall (series 601 b, image 39),
which appears increased from ___. There is no evidence of pelvic or
inguinal lymphadenopathy.
BONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy
is seen. Moderate fat containing ventral hernia measuring 9 cm in diameter.
IMPRESSION:
1. Moderate fat-containing ventral hernia without evidence of complication.
2. Stable, moderate right hydronephrosis and hydroureter without obstructing
stone identified.
3. Focal, rounded thickening of the superior bladder wall appears more
prominent in comparison to ___. Urology followup with possible tissue
sampling or cystoscopy is recommended.
4. Stable left adrenal adenoma.
5. Severe emphysema.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 13:44 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
19921471-RR-42
| 19,921,471 | 27,461,335 |
RR
| 42 |
2151-06-11 19:54:00
|
2151-06-11 20:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough and mucous
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is normal. Mediastinal and hilar contours are unchanged with
rightward shift of mediastinal structures again noted. There is similar
elevation of the left hemidiaphragm with mesh material projecting over the
diaphragmatic contour. Post thoracotomy changes are again noted on the left
with chain sutures seen in both lung apices. The pulmonary vasculature is not
engorged. Bullous emphysematous changes are re- demonstrated, with the
largest bulla seen at in the right lung base. Unchanged linear opacities in
both upper lobes likely reflect areas of scarring. No new focal
consolidation, pleural effusion or pneumothorax is present. There are no
acute osseous abnormalities.
IMPRESSION:
No interval change from the previous exam without new acute cardiopulmonary
abnormality.
|
19921471-RR-43
| 19,921,471 | 24,078,680 |
RR
| 43 |
2151-06-20 12:01:00
|
2151-06-20 12:21:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with wheezing, and increased inhaler use. // R/O
PNA R/O PNA
COMPARISON: Chest radiographs ___.
IMPRESSION:
Emphysema is severe. Elevation of the left hemidiaphragm is chronic, and may
be related to the chest trauma responsible for multiple healed left rib
fractures. Patient may have had wedge resection from the left upper lobe as
well.
There is no evidence of current cardiac decompensation or pneumonia. No
pleural effusion.
|
19921471-RR-44
| 19,921,471 | 24,078,680 |
RR
| 44 |
2151-06-20 09:15:00
|
2151-06-20 12:22:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with hx renal cancer presenting with UTI // r/o
hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound ___.
FINDINGS:
The right kidney measures 12.1 cm. The left kidney surgically absent. There
is no hydronephrosis, stones, or masses in the right kidney. Normal cortical
echogenicity and corticomedullary differentiation are seen in the right
kidney. Multiple renal cysts are again noted. Within the lower pole a mostly
simple cyst with a thin septation is seen measuring 1.3 x 2.0 x 1.3 cm. A
simple cyst is seen in the upper to midportion of the right kidney measuring
2.6 x 2.2 x 1.6 cm.
The bladder is moderately well distended and markedly abnormal in appearance.
There are multiple wall irregularities and mass like protrusions with areas of
fibrinous, band-like septations. These could be consistent with post
resection changes versus recurrent tumor. Correlation with cystoscopy is
recommended as clinically indicated.
IMPRESSION:
1. No hydronephrosis in the right kidney. The patient is status post left
nephrectomy.
2. Markedly abnormal appearance of the bladder with multiple mass-like
protrusions from the bladder wall. These areas could be consistent with post
resection changes versus recurrent tumor, correlation with cystoscopy is
recommended as clinically indicated.
|
19921471-RR-45
| 19,921,471 | 29,783,497 |
RR
| 45 |
2151-07-29 13:22:00
|
2151-07-29 15:41:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with malaise, elevated WBC // ? pneumonia
COMPARISON: ___
FINDINGS:
AP upright and lateral views of the chest provided. Mildly elevated left
hemidiaphragm again noted with underlying mesh coils. Numerous left rib cage
deformities are again noted. Severe emphysema and hyperinflation again noted.
Subtle micronodular opacities in the right mid lung raise potential concern
for atypical infection versus aspiration. A similar cluster of micronodular
opacity is noted in the left lower lung.
Heart size cannot be assessed. Mediastinal contour is unchanged. Bony
structures are intact. Suture is seen projecting over the right apex likely
reflecting an old resection site. No acute fracture.
IMPRESSION:
Subtle nodular opacities in the right mid lung and left lower lung raise
concern for atypical infection versus chronic aspiration. Severe background
emphysema.
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