note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
19921471-RR-46
| 19,921,471 | 29,783,497 |
RR
| 46 |
2151-07-31 04:30:00
|
2151-07-31 06:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with RCC presenting with UTI now with fall and
head strike. Evaluate for subdural hematoma are intracranial hemorrhage.
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) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 18.0 s, 18.3 cm; CTDIvol = 49.3 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular and subcortical white matter
hypodensities are nonspecific, but likely reflect sequelae of chronic small
vessel ischemic disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Patient is
status post lens replacements bilaterally. Atherosclerotic calcifications of
the carotid siphons are noted.
IMPRESSION:
1. No acute intracranial abnormality on noncontrast head CT.
2. Parenchymal atrophy and chronic small vessel ischemic disease.
|
19921471-RR-53
| 19,921,471 | 23,611,859 |
RR
| 53 |
2151-10-15 08:41:00
|
2151-10-15 10:09:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with hematuria with clots and ___ // r/o new
hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Ultrasound ___ and multiple priors.
FINDINGS:
The right kidney measures 11.7 cm. The patient is status post left
nephrectomy. There is no hydronephrosis, stones, or masses in the right
kidney. A 2.0 cm simple cyst is noted in the lower pole of the right kidney.
Normal cortical echogenicity and corticomedullary differentiation are seen in
the right kidney.
Note is made of the patient's history of bladder cancer. The bladder wall is
moderately thickened, but not well distended. A rounded echogenic focus the
dependent portion of the partially collapsed bladder is consistent with a
hematoma, given that this lesion was not seen on ultrasound ___.
Gallstones or tiny polyps are incidentally noted on limited evaluation of the
gallbladder.
IMPRESSION:
1. A large echogenic focus in the dependent portion of the bladder is
consistent with an intravesicular blood clot given that this lesion is new
from ultrasound of ___.
|
19921471-RR-54
| 19,921,471 | 23,371,091 |
RR
| 54 |
2151-10-25 11:12:00
|
2151-10-25 14:40:00
|
EXAMINATION: CT abdomen/pelvis without contrast
INDICATION: ___ year old man with recurrent UTIs, severe CVAT, s/p TURBT/TURP
on ___ c/b MDR enterococcus UTI, now sever right sided back pain // r/o
renal calculi vs abscess
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 16.2 s, 55.8 cm; CTDIvol = 11.7 mGy (Body) DLP =
636.1 mGy-cm.
Total DLP (Body) = 650 mGy-cm.
COMPARISON: ___ CT abdomen/pelvis without contrast
FINDINGS:
LOWER CHEST: There is severe emphysematous changes the bilateral lung bases.
There is elevation of the left hemidiaphragm with numerous round surgical
clips. There is no 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 is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, 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. Incidental note is made of 2 small accessory
spleens.
ADRENALS: The right adrenal gland is normal in size and shape. An
approximately 1.7 x 1.4 cm left adrenal adenoma is stable.
URINARY: Evaluation the kidneys is limited on this unenhanced CT scan. Within
this limitation, multiple simple appearing renal cysts are unchanged. There
is new gas within the collecting system (3:45, 3:47). There is no
hydronephrosis or nephrolithiasis. The distal right ureter is dilated with an
additional focus of loculated gas (3:84). A Foley catheter is placed within
the prostate, likely the TURPT defect, with a small amount of dependent gas
and a single locule of anti dependent gas (3:81). The patient is status-post
left nephrectomy. There are no abnormal soft tissue nodules within the left
nephrectomy bed. Calcifications are noted within the bladder wall. On best
seen on series 3, ___ 81 and 87.
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 normal.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Irregularities of the posterior eleventh and twelfth ribs a post or fifth rib
are compatible with prior, healed fractures.
SOFT TISSUES: There is a large, fat containing ventral hernia (5b:45).
IMPRESSION:
1. Locules of gas in the distal right ureter and within the right renal
collecting system are new, raising the possibility of emphysematous pyelitis.
2. A Foley catheter is placed within the prostate, and should be advanced
approximately 6 cm.
3. Several renal cysts.
4. Calcifications in the bladder wall may relate to chronic inflammation over
be due to be in known tumor recurrence. .
NOTIFICATION: The findings concerning for emphysematous pyelitis were
discussed with ___, M.D. by ___, M.D. on the telephone
on ___ at 12:02 ___, approximately 10 minutes after discovery of the
findings.
The findings related to the Foley catheter balloon were discussed with ___
___, M.D. by ___, M.D. on the telephone on ___ at 14:39,
approximately 10 minutes after discovery of the findings.
|
19921471-RR-55
| 19,921,471 | 23,371,091 |
RR
| 55 |
2151-10-27 10:52:00
|
2151-10-27 11:15:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with receurrent URT MDR concern pna CP sob //
r/o pna r/o pna
IMPRESSION:
Comparison to ___. Unchanged moderate overinflation on the right
and elevation of the left hemidiaphragm. Healed left-sided rib fractures.
Right mid lung and right apical calcified granulomas. Relatively extensive
apical scarring as well as right perihilar scarring. In addition, there is
unchanged mild right perihilar nodularity. Overall, the changes continue to
suggest the presence of an atypical mycobacterial or viral infection. Neither
the frontal nor the lateral radiograph show evidence of pleural effusions.
|
19921471-RR-56
| 19,921,471 | 20,860,951 |
RR
| 56 |
2151-11-19 22:51:00
|
2151-11-19 23:45:00
|
EXAMINATION: RENAL U.S.
INDICATION: History: ___ with flank pain, hematuria // hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: ___ ultrasound.
FINDINGS:
The right kidney measures 10.4 cm. A 1.9 cm simple cyst in the lower pole of
the right kidney is unchanged. The left kidney is surgically absent. There
is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally. A
Foley catheter is noted in a nearly collapsed bladder. There is some
suggestion of debris, although assessment is limited due to bladder
underdistention.
IMPRESSION:
The bladder is not well-distended and assessment is significantly limited,
however there is suggestion of some debris, likely intravesicular clot given
the patient's history of hematuria and previously seen clot.
|
19921471-RR-60
| 19,921,471 | 28,048,361 |
RR
| 60 |
2152-01-20 13:29:00
|
2152-01-20 16:19:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man s/p L nephrectomy presenting with R flank pain
concerning for pyelonephritis. // rule out hydro, rule in pyelo
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Ultrasound from ___, CT from ___.
FINDINGS:
The right kidney measures 12.5 cm. The patient is status post left
nephrectomy.
There is mild-to-moderate right-sided hydronephrosis, slightly worse than on
prior evaluation. There are 2 simple appearing renal cysts seen at the lower
pole measuring 1.4 x 2.3 cm and 1.8 x 1.6 cm.
A definite ureteral jet was not identified at the left UVJ.
A 1.4 x 2.7 cm diverticular was seen at the superior aspect of the bladder.
IMPRESSION:
1. Mild-to-moderate right-sided hydronephrosis, slightly worse on prior
evaluation. No definite cause for obstruction identified on the current
evaluation. Further evaluation may be performed by CT abdomen and pelvis - as
clinically warranted.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:18 ___, 15 minutes
after discovery of the findings.
|
19921471-RR-61
| 19,921,471 | 28,048,361 |
RR
| 61 |
2152-01-21 08:23:00
|
2152-01-21 10:36:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man s/p L nephrectomy with R flank pain, UTI. Mod
hydro seen on u/s from ___. Now s/p foley catheter placement. suspect hydro
was due to BPH and noncompliance with straight caths at home. // f/u for
improvement of hydro since prior study after foley catheter placement
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound from ___
FINDINGS:
The right kidney measures 12.0 cm. The patient is status post left
nephrectomy.
There is been improvement in the degree of right hydronephrosis, which is now
only mild in degree and seen only at two lower pole calices.
Re- demonstration of 2 simple appearing cysts as previously described at the
lower pole, measuring 2.4 x 2.0 x 2.3 cm and 1.7 x 2.8 x 1.7 cm respectively.
The bladder is completely collapsed, with an indwelling Foley catheter.
IMPRESSION:
Interval improvement of the hydronephrosis status post Foley catheter
insertion, with only mild hydronephrosis seen at 2 lower pole calices as
detailed above..
|
19921471-RR-62
| 19,921,471 | 22,566,005 |
RR
| 62 |
2152-02-20 12:10:00
|
2152-02-20 12:48:00
|
EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old man with R flank pain/ h/o hydro and pyelo. Now in
with + UA and CVA tenderness // Pt with left nephrectomy, and history of
right sided pyelo and hydro in with UTI and flank pain. please evaluate for
hydro and pyelo
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound dated ___.
FINDINGS:
The patient is status post left nephrectomy. The right kidney measures 11.2
cm. There are multiple simple cysts measuring up to 2.2 cm within the lower
pole. There is no hydronephrosis, stones, or solid masses on the right.
Normal cortical echogenicity and corticomedullary differentiation are seen on
the right.
Prostate is enlarged. There is bladder wall thickening and trabeculation,
likely due to chronic bladder outlet obstruction. Prevoid bladder volume is
58.1 cc with a postvoid residual of 23.0 cc.
IMPRESSION:
1. Resolution of right hydronephrosis.
2. Enlarged prostate with bladder wall thickening and trabeculation, likely
due to chronic bladder outlet obstruction.
3. Postvoid residual of 23 cc.
|
19921471-RR-83
| 19,921,471 | 24,624,119 |
RR
| 83 |
2153-07-09 15:26:00
|
2153-07-09 16:32:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with lower extreme swelling/pain.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: ___ and ___ lower extremity ultrasounds
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19921864-RR-15
| 19,921,864 | 28,873,591 |
RR
| 15 |
2132-06-05 00:43:00
|
2132-06-05 01:30:00
|
INDICATION: ___ s/p central line placement in RIJ, please confirm line
placement// ___ s/p central line placement in RIJ, please confirm line
placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: Chest radiograph dated ___ at 10:34
FINDINGS:
AP portable chest radiograph demonstrates interval placement of a right
internal jugular central venous catheter, its tip which projects within the
right atrium. Lung volumes are low. Overall appearance of the chest is not
changed relative to prior examination with atelectasis or early airspace
disease at the left lung base. There is no evidence of pulmonary edema.
Blunting of the costophrenic angles bilaterally may reflect scarring or small
pleural effusions. There is no pneumothorax. There is no air under the right
hemidiaphragm.
IMPRESSION:
Interval placement of a right internal jugular venous central catheter, its
tip projecting within the right atrium. Chest is otherwise unchanged in
appearance with persistent atelectasis or early airspace disease involving the
left lung base.
|
19921864-RR-16
| 19,921,864 | 28,873,591 |
RR
| 16 |
2132-06-05 10:09:00
|
2132-06-05 12:12:00
|
EXAMINATION: Ultrasound-guided procedure
INDICATION: ___ year old man with cholangitis// requires percutaneous
cholecystostomy
COMPARISON: CT from ___
PROCEDURE: Ultrasound-guided percutaneous cholecystostomy.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a left lateral decubitus supine position on the
ultrasound table. Limited preprocedure imaging was performed to localize the
gallbladder. An appropriate skin entry site was chosen and the site marked.
Local anesthesia was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, an ___ ___ drainage catheter
was advanced via trocar technique into the gallbladder. A sample of fluid was
aspirated, confirming catheter position within the collection. The stiffener
was removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via ultrasound. Ultrasound images were stored
on PACS.
Approximately 10 cc of bilious fluid was drained with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 30
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Distended gallbladder with sludge is present.
2. Successful percutaneous placement of an 8 ___ catheter into the
gallbladder using ultrasound guidance.
IMPRESSION:
Successful ultrasound-guided placement of ___ pigtail catheter into the
gallbladder. Samples was sent for microbiology evaluation.
|
19921864-RR-17
| 19,921,864 | 28,873,591 |
RR
| 17 |
2132-06-05 14:12:00
|
2132-06-05 15:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new fever and rigors after perc choly//
assess for pneumonia or acute change assess for pneumonia or acute change
IMPRESSION:
Right internal jugular line tip is in the proximal right atrium. Heart size
and mediastinum are unchanged. Mild interstitial pulmonary edema is present.
There is no appreciable pleural effusion or pneumothorax.
|
19921864-RR-18
| 19,921,864 | 28,873,591 |
RR
| 18 |
2132-06-05 15:53:00
|
2132-06-05 17:38:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old man with recent perc chole, now with tachycardia
concern for stool in drain** IV CONTRAST ONLY IS OK **// Any fistula? Any
drainage from bowel thru perc chole tube?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.8 s, 59.7 cm; CTDIvol = 20.2 mGy (Body) DLP =
1,205.9 mGy-cm.
2) Stationary Acquisition 4.6 s, 0.5 cm; CTDIvol = 25.1 mGy (Body) DLP =
12.6 mGy-cm.
Total DLP (Body) = 1,218 mGy-cm.
COMPARISON: CT from ___
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions with bibasilar
atelectasis. Atherosclerotic calcification includes extensive coronary artery
calcification. Central venous catheter with tip terminating at the cavoatrial
junction
ABDOMEN:
There is a small amount of perihepatic and a small amount of perisplenic
fluid.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no focal lesion. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder wall is thickened and
edematous. Interval placement of a cholecystostomy tube.
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 are bilateral small simple cysts. There is no solid lesion or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. The
colon and rectum are within normal limits.
PELVIS: A Foley catheter is present in the bladder which contains a small
amount of air. There is a small amount of free fluid in the left pelvis.
REPRODUCTIVE ORGANS: The prostate gland is mildly enlarged. The seminal
vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.
There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate
atherosclerotic disease is noted.
BONES: The patient is status post fusion of the lower lumbar spine from
L3-L5. Rods and screws are in place. There are degenerative changes in
the spine compression deformity of the L1, L2 and L3 vertebral bodies
which appears stable. There is again evidence of vertebroplasty at L1 and
L2. There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: A small to moderate size umbilical hernia contains fat and is
unchanged.
IMPRESSION:
Interval placement of a transhepatic cholecystostomy tube which is well placed
within the gallbladder. The gallbladder wall continues to show a small amount
of edema and wall thickening. The gallbladder is decompressed.
There is trace perisplenic and perihepatic ascites. There is no free air.
Small bilateral pleural effusions with associated bibasilar subsegmental
atelectasis.
|
19921864-RR-20
| 19,921,864 | 28,873,591 |
RR
| 20 |
2132-06-06 16:44:00
|
2132-06-06 19:08:00
|
INDICATION: ___ year old man with bibasilar crackles on exam, cough, and
concern for an aspiration event// Evidence of consolidation or other changes
consistent with aspiration PNA?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the right internal jugular central venous catheter projects over
the right atrium. The size and appearance of the cardiomediastinal silhouette
is unchanged. Low bilateral lung volumes with unchanged mild interstitial
pulmonary edema. No pneumothorax. A small left pleural effusion is suspected
with subjacent atelectasis/consolidation.
IMPRESSION:
Low bilateral lung volumes. Increasing opacities at the left lung base may
reflect a small pleural effusion with subjacent atelectasis/consolidation.
Persisting mild pulmonary edema.
|
19921864-RR-21
| 19,921,864 | 28,873,591 |
RR
| 21 |
2132-06-07 16:19:00
|
2132-06-07 17:31:00
|
EXAMINATION: T-TUBE CHOLANGIO (POST-OP)
INDICATION: ___ year old man with cholangitis s/p perc choly, ___ ERCP
consulted// Please perform cholangiogram through current perc choly to assess
drainage for any leaks. page ___ (___) with any questions
TECHNIQUE: Water soluble contrast was hand injected into the pre-existing
cholecystostomy tube. Selected fluoroscopic images were obtained.
DOSE: Acc air kerma: 12 mGy; Accum DAP: 294 uGym2; Fluoro time: 0.2 minutes
COMPARISON: None.
FINDINGS:
Contrast readily opacified the gallbladder and cystic duct, passing freely
into the common bile duct and proximal small bowel. No filling defects or
ductal irregularity were identified.
IMPRESSION:
Patent cystic duct with contrast passing into the small bowel. No evidence of
leak.
|
19921864-RR-22
| 19,921,864 | 28,873,591 |
RR
| 22 |
2132-06-08 10:22:00
|
2132-06-08 10:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with continued hypoxia despite appropriate
antibiotics// Infiltrate, effusion, or edema? Infiltrate, effusion, or
edema?
IMPRESSION:
Comparison to ___. Minimally improved inspiration with resulting
increased lung volumes. Moderate cardiomegaly persists. Minimal right basal
parenchymal opacity, improved since the previous examination. Stable moderate
cardiomegaly with mild fluid overload but no overt pulmonary edema.
|
19921885-RR-8
| 19,921,885 | 21,011,050 |
RR
| 8 |
2181-02-17 14:18:00
|
2181-02-18 10:35:00
|
EXAMINATION: Limited abdominal ultrasound to evaluate for ascites
INDICATION: ___ year old woman with cirrhosis here s/p fall.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
There is a trace perihepatic ascites. When comparing to the recent CT there
is suggestion of a 1 cm enhancing focus in the right lobe of the liver,
without definite US correlate. Given this finding and underlying nodularity
of the liver, MRI is recommended for further evaluation.
IMPRESSION:
Trace perihepatic ascites. Suggestion of 1 cm enhancing focus in the right
lobe of the liver, not seen on US. Liver MRI is recommended to rule out
underlying lesion.
RECOMMENDATION(S): Liver MRI
|
19922115-RR-19
| 19,922,115 | 27,034,872 |
RR
| 19 |
2115-07-14 15:22:00
|
2115-07-14 15:53:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with left leg swelling// Rule out DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, proximal femoral vein and popliteal veins.
There is nonocclusive thrombus in the left mid and distal femoral vein.
The calf veins are not visualized due to patient body habitus and subcutaneous
edema.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst. Enlarged left groin nodes
noted.
IMPRESSION:
Nonocclusive deep venous thrombus in the left mid and distal femoral vein.
Enlarged left groin lymph node, nonspecific.
|
19922271-RR-10
| 19,922,271 | 23,647,306 |
RR
| 10 |
2142-04-06 16:51:00
|
2142-04-06 17:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with pneumothorax and chest tube placement
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: ___ at 12:38
FINDINGS:
Left-sided chest tube is new in the interval with tip overlying the medial
aspect of the left lower lung field. Previously noted large left pneumothorax
is markedly decreased in size with only a small apical pneumothorax now
visualized. The left lung has re-expanded with streaky opacities in the left
lung base likely reflective of atelectasis. Right subclavian central venous
catheter tip terminates in the lower SVC. Right lung is clear. Cardiac and
mediastinal contours are normal. There is no evidence of pulmonary vascular
congestion or pleural effusion. No acute osseous abnormalities visualized.
IMPRESSION:
Interval placement of left-sided chest tube with decreased size of left-sided
pneumothorax, now small, with re-expansion of the left lung. Streaky left
basilar atelectasis.
|
19922271-RR-11
| 19,922,271 | 23,647,306 |
RR
| 11 |
2142-04-07 09:05:00
|
2142-04-07 09:42:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ w portacath placement c/b L PTX; now s/p chest tube to water
seal. Pls perform at 8am on ___ // eval L PTX s/p chest tube to water seal;
Pls perform at 8am on ___ eval L PTX s/p chest tube to water seal; Pls
perform at 8am
IMPRESSION:
In comparison with the study of ___, with the left chest tube on water
seal, in the residual pneumothorax is tiny. The patient has taken a much
better inspiration. Some residual atelectatic changes are seen at the left
base.
|
19922271-RR-12
| 19,922,271 | 23,647,306 |
RR
| 12 |
2142-04-07 13:16:00
|
2142-04-07 15:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman s/p chest tube removal of left after resolution
of PTX // eval for PTX s/p chest tube removal. Please obtain filp 1pm (3
hours after tube removal) eval for PTX s/p chest tube removal. Please
obtain filp 1pm
IMPRESSION:
In comparison with the earlier study of this day, the left chest tube has been
removed. There is a moderate left pneumothorax, with a pleural line at about
the upper fourth posterior rib. An otherwise little change.
NOTIFICATION: This information was conveyed by telephone to Dr. ___
at about 15:00 on ___, immediately after detection.
|
19922271-RR-13
| 19,922,271 | 23,647,306 |
RR
| 13 |
2142-04-07 18:26:00
|
2142-04-07 18:57:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with pneumothorax s/p chest tube placement and
removal. // PneumothoraxPlease perform at 6PM.
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___ obtained at 01:19
IMPRESSION:
Left apical pneumothorax is moderate and unchanged. Heart size and mediastinum
are stable. Lungs are essentially clear. No change in minimal left pleural
effusion is demonstrated
|
19922271-RR-14
| 19,922,271 | 23,647,306 |
RR
| 14 |
2142-04-08 04:31:00
|
2142-04-08 11:15:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with pneumothorax s/p chest tube placement and
removal. // interval change in Pneumothorax. PLEASE PERFORM AT 4AM
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Left apical pneumothorax is moderate and unchanged. Lungs are well-aerated.
Heart size and mediastinum are stable. Port-A-Cath catheter is unchanged in
appearance. No pleural effusion. Can be definitely seen on the current
examination although small amount of pleural fluid cannot be excluded
|
19922271-RR-9
| 19,922,271 | 23,647,306 |
RR
| 9 |
2142-04-06 12:35:00
|
2142-04-06 15:21:00
|
INDICATION: History: ___ with sudden cp eval for PTX // PTX
TECHNIQUE: Portable AP of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
There is a new large left pneumothorax without signs of mediastinal shift. The
mediastinal and hilar contours are otherwise unremarkable. There is no pleural
effusion. The right lung is well expanded and otherwise unremarkable. A right
chest port is present with tip terminating mid SVC. The upper abdomen is
unremarkable.
IMPRESSION:
New large left pneumothorax.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 3:15 ___, 0 minutes after discovery of the findings.
|
19922982-RR-21
| 19,922,982 | 22,336,612 |
RR
| 21 |
2157-04-28 15:43:00
|
2157-04-29 09:13:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___
INDICATION: ___ year old woman with right hand weakness. Evaluate for acute
stroke.
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
Dynamic MRA of the neck was performed during administration of 11 mL of
Multihance intravenous contrast.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: None
FINDINGS:
MRI BRAIN:
There is slow diffusion surrounding the left paracentral gyrus with associated
FLAIR hyperintensity. There is no evidence of intracranial hemorrhage. There
is mild diffuse parenchymal volume loss. There is moderate nonspecific
periventricular subcortical FLAIR hyperintensities, likely a sequela of
chronic small vessel ischemic disease. There is a focus of chronic infarction
in the left midbrain (8:8). The ventricles are normal in size without mass
effect or midline shift. The major visualized arterial vascular flow voids
are preserved. There is mild mucosal thickening of the bilateral ethmoid air
cells. There is a 1.3 x 1.2 cm cystic lesion within the left nasal cavity
anteriorly demonstrating intrinsic T1 and T2 hyperintensity with layering
hemorrhagic content, likely representing a nasolabial cyst with proteinaceous
content.
MRA BRAIN:
The bilateral intracranial internal carotid arteries and vertebral arteries in
the principal intracranial branches appear patent without stenosis, occlusion,
or aneurysm.
MRA NECK:
The bilateral common carotid arteries and internal carotid arteries appear
patent without internal carotid artery stenosis by NASCET criteria. The
bilateral vertebral arteries appear patent. The bilateral visualized
subclavian arteries and origins of great vessels appear patent.
IMPRESSION:
1. Acute to early subacute infarction in the left paracentral gyrus.
2. No evidence of intracranial hemorrhage.
3. Diffuse parenchymal volume loss with moderate chronic small vessel ischemic
disease.
4. Focus of chronic infarction in the left midbrain.
5. 1.3 cm left nasal labial proteinaceous cyst with hemorrhagic content.
6. MRA brain demonstrates no stenosis, occlusion, or aneurysm of the major
intracranial branches.
7. MRA neck demonstrates patency of the bilateral common and internal carotid
arteries and the vertebral arteries.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 9:11 am, 2
minutes after discovery of the findings.
|
19923013-RR-49
| 19,923,013 | 28,442,398 |
RR
| 49 |
2206-03-05 19:28:00
|
2206-03-05 20:47:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with essential thrombocythemia and severe
headache// Please eval venous sinuses, concern for venous sinus thrombosis.
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
Sagittal and axial T1 weighted imaging were performed along with diffusion
imaging.
After administration of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, T2, and T1 technique. Sagittal MPRAGE
imaging was performed and re-formatted in axial and coronal orientations.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images.
COMPARISON: MRI head ___.
FINDINGS:
MRI BRAIN:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. There is no abnormal enhancement after contrast
administration. No significant change in mild bifrontal volume loss. The
ventricles and sulci are normal in caliber and configuration. The major
intracranial vascular flow voids are maintained. There is mild mucosal
thickening of the ethmoid air cells. The mastoid air cells and orbits are
normal.
MRA brain: The intracranial vertebral and internal carotid arteries and their
major branches appear normal without evidence of stenosis, occlusion, or
aneurysm formation.
There is no evidence of hemorrhage, edema, masses, mass effect, midline
shiftorinfarction.
IMPRESSION:
1. No acute intracranial abnormality. Specifically, no evidence for dural
venous thrombosis.
2. Patent Circle of ___ without evidence of significant stenosis.
3. Mild inflammatory changes of the ethmoid air cells.
4. Unchanged mild bifrontal volume loss.
|
19923191-RR-89
| 19,923,191 | 25,876,678 |
RR
| 89 |
2144-03-28 01:50:00
|
2144-03-28 04:12:00
|
INDICATION: ___ with s/p RIJ // eval for line placement
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph from ___ at 18:21.
FINDINGS:
There has been interval placement of a right internal jugular central venous
catheter with tip terminating in the right atrium approximately 2 cm in below
the cavoatrial junction. No pneumothorax or pleural effusion. The lungs are
well expanded and clear. Mediastinal contours, hila, and cardiac silhouette
are normal.
IMPRESSION:
Interval placement of a right internal jugular central venous catheter
terminating in the right atrium. No pneumothorax.
|
19923506-RR-40
| 19,923,506 | 21,528,712 |
RR
| 40 |
2160-05-22 14:38:00
|
2160-05-22 17:37:00
|
INDICATION: Recent spine surgery with fever. Evaluate for pneumonia.
TECHNIQUE: A single AP supine view of the chest was obtained.
COMPARISON: Chest radiograph from ___.
FINDINGS:
Posterior spinal fusion hardware is suboptimally imaged on this limited
frontal radiograph. Please see the CT report for further description of the
hardware. A halo brace is present, limiting evaluation of the upper lobes.
Within the limitations, the lungs are clear without evidence of a
consolidation. There is no pulmonary edema, pleural effusion, or pneumothorax.
The cardiomediastinal silhouette is normal.
IMPRESSION:
No acute cardiopulmonary process.
|
19923506-RR-41
| 19,923,506 | 21,528,712 |
RR
| 41 |
2160-05-22 14:38:00
|
2160-05-22 17:39:00
|
EXAMINATION: DX THORACIC AND LUMBAR SPINES
INDICATION: Status post thoracic spine fusion with increased swelling and
fevers. Evaluate hardware.
TECHNIQUE: AP and cross-table lateral views of the thoracic and lumbar spine
were obtained with a total of 5 exposures.
COMPARISON: Thoracic spine radiographs from ___ and ___. Note, these radiographs are read in conjunction with a CT of the
thoracic spine which was obtained immediately after these radiographs.
FINDINGS:
The most superior aspect of the thoracic spine hardware appears to be
positioned more posteriorly than on the intraoperative radiographs from ___. This may represent hardware migration. The mid and distal
portions of the thoracic spinal hardware appear to be unchanged. These are
better evaluated on the recent CT. The lumbar spinal fusion appears stable
without evidence of a hardware complication. There is evidence of osseous
fusion of the lumbar vertebral bodies. There is no significant residual
scoliosis. No acute fracture is identified.
The imaged portions of the lungs are clear. The cardiac silhouette is normal
in size. The bowel gas pattern is nonobstructive. No free intraperitoneal air
is identified.
IMPRESSION:
The most superior aspect of the thoracic spinal fusion hardware appears to be
positioned more posteriorly than on in the intraoperative radiographs,
potentially due to hardware migration. Please see the thoracic CT report for
more details.
|
19923506-RR-42
| 19,923,506 | 21,528,712 |
RR
| 42 |
2160-05-22 14:09:00
|
2160-05-22 15:57:00
|
EXAMINATION: CT T-SPINE W/O CONTRAST
INDICATION: 6 ___ female with history of scoliosis status post op day
9 after thoracic spine instrumentation revision, now with increased swelling
to upper thoracic spine. Assess for new fracture, infection, or hardware
migration.
TECHNIQUE: Aaxial, helical, MDCT images were acquired through the lumbar
spine without the administration of intravenous contrast. Coronal, sagittal,
and bone algorithm thin section reformatted images were generated.
DOSE: CTDIvol: 48.76 mGy
DLP: ___ mGy-cm
COMPARISON: T-spine radiographs ___. CT thoracic spine ___.
FINDINGS:
Please note study is substantially limited due to patient positioning, beam
hardening artifact, and lack of intravenous contrast.
For the purposes of numbering, the highest rib-bearing vertebral body was
designate the T1 level. Please note that this method is inappropriate for
surgical planning and that prior to any intervention appropriate levels must
be established.
Patient is status post fusion of T1 through 11 with postoperative changes
involving the entire thoracic spine with bilateral posterior fixation rods and
hooks, posterior mid line staples, and bone graft material. There is mild
levoscoliosis with apex at T9. Multiple posterior laminectomies are again
noted most prominent at T1. Significant soft tissue swelling and stranding is
seen throughout the course of the posterior spinal fusion, most prominent
along the upper thoracic spine from T1 through T4. At T1 through T4 posterior
spinal rods and hooks are within bone graft material approximately 1.5-2cm cm
posterior to the level of the lamina.
Subcutaneous emphysema is seen throughout the surgical site most prominent at
C7 the T1. At the level of T1-T2 bony changes are post laminectomy given clean
margins and absence of cortical irregularity. No locules of air within the
central canal. Given absence of IV contrast and beam hardening artifact from
hardware limited evaluation for fluid collection.
The prevertebral and soft tissues are within normal limits. Evidence of
chronic healed fracture along posterior right twelfth rib. A small right
pleural effusion is stable. Again seen is probable mild left hydronephrosis,
only partially imaged. There is of an enlarged approximately 12 mm mesenteric
lymph node (see series 2 image 132). Allowing for difference in technique,
this structure is also noted on the ___ prior CT thoracic spine
study (series 2a image 107).
Partially visualized liver demonstrates an approximately 8 mm left hepatic
lobe hypoattenuating structure that is obscured by streak artifact (see series
3, image 130).
IMPRESSION:
1. Limited evaluation due to patient positioning, absence of IV contrast and
beam hardening artifact.
2. Subcutaneous emphysema at T1-2 is nonspecific, and may be postsurgical in
nature. However emphysematous changes secondary to infection cannot be
excluded on the basis of this examination. Recommend clinical correlation.
3. Within limits of examination, no definite CT evidence of osteomyelitis or
discitis identified in thoracic spine. If additional evaluation is warranted a
contrast enhanced study may be helpful, however this will be limited in
evaluation due to beam hardening artifact.
4. At T1 through T4 posterior spinal rods and hooks are suggested to being
within bone graft material approximately 1.5 -2 cm posterior to the lamina.
Recommend clinical correlation and correlation with surgical history for
evaluation of hardware orientation.
5. Probable mild left hydronephrosis, partially imaged.
6. Stable small right pleural effusion.
7. Approximately 12 mm mesenteric lymph node as described. Recommend clinical
correlation.
8. Limited evaluation of the liver suggests at least one 8 mm hypoattenuating
area that is nonspecific. Recommend clinical correlation. If clinically
indicated, further evaluation may be obtained via dedicated hepatic imaging.
NOTIFICATION: Findings and recommendation discussed by Dr. ___ with Dr.
___ at 17:45 on ___.
|
19923506-RR-43
| 19,923,506 | 21,528,712 |
RR
| 43 |
2160-05-22 18:58:00
|
2160-05-25 10:12:00
|
INDICATION: Hardware removal.
TECHNIQUE: 2 intraoperative frontal projection of the thoracic spine were
obtained without the radiologist present.
COMPARISON: Radiographs of the thoracic spine ___.
FINDINGS:
There has been interval removal of paraspinal rods from the thoracic spine.
The paraspinal rods extending from the inferior thoracic spine into the lumbar
spine remain in place. A skin staple line projects over the mid thorax. The
distal tip of an endotracheal tube projects above the carina. Visualized
portions of the lungs are unremarkable.
IMPRESSION:
Status post thoracic spine hardware removal. Please see the operative report
for further details.
|
19923506-RR-44
| 19,923,506 | 21,528,712 |
RR
| 44 |
2160-05-29 11:25:00
|
2160-05-29 11:48:00
|
EXAMINATION: SCOLIOSIS SERIES
INDICATION: ___ year old woman s/p removal of instrumentation thoracic spine
after loss of fixation and possible infection. // evaluation of kyphosis and
spinal alignment. Please have patient stand with CTLSO on.
TECHNIQUE: AP and lateral views of spine.
COMPARISON: ___.
FINDINGS:
Levoconvex scoliosis in the thoracic spine is noted. There is been removal of
thoracic spine posterior hardware since previous radiograph. Posterior fusion
hardware from lower thoracic spine through S1 remains in-situ. There is
multilevel mature osseous fusion of vertebral bodies in the lumbar spine
There are degenerative changes in the thoracic spine, with some mild loss of
vertical height anteriorly at several levels appearing similar to prior study.
There is degenerative change in the cervical spine, and there is grade 2
anterolisthesis of C4 with respect to C5. There is also grade 1
anterolisthesis of C5 with respect to C4. This was difficult to assess on the
most recent exam, excluded from the field of view, but appears similar to
previous radiograph on ___. MRI cervical spine has also been
previously performed on ___, with these alignment changes visible,
and there is also mild retrolisthesis of C2 with respect to C3 which appears
similar the current radiograph.
Heterogeneous density of the right iliac bone may reflect previous graft
harvest site. Mild bilateral hip joint degenerative change.
IMPRESSION:
Degenerative changes, scoliosis, alignment abnormalities as detailed above.
Interval removal of thoracic hardware. No evidence of complication of
remaining hardware.
|
19923506-RR-45
| 19,923,506 | 21,528,712 |
RR
| 45 |
2160-05-29 14:00:00
|
2160-05-29 14:34:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new picc // 43cm left picc. ___ ___
Contact name: ___: ___ left picc. ___ ___
IMPRESSION:
In comparison with study of ___, there is an placement of a left
subclavian PICC line that extends to the mid to lower portion of the SVC. The
upper spinal fusion device has been removed. No evidence of acute focal
pneumonia or vascular congestion.
NOTIFICATION: ___, a venous access nurse.
|
19923506-RR-46
| 19,923,506 | 21,528,712 |
RR
| 46 |
2160-06-02 13:15:00
|
2160-06-02 20:10:00
|
INDICATION: ___ year old woman s/p removal of thoracic instrumentation. //
for evaluation of spinal alignment. please obtain x-ray while in traction.
COMPARISON:
Compared to radiographs from ___
IMPRESSION:
There is a new left-sided central venous catheter with the distal lead tip in
the distal SVC. Visualized lung fields are grossly clear. There is moderate
thoracolumbar scoliosis with convexity to the left side centered at T7 and to
the right side centered at T12. There is minimal anterior wedging of several
mid to lower thoracic vertebral bodies causing thoracic kyphosis, unchanged.
There is again seen posterior fixation hardware from T11 down to S1 with
metallic disc prostheses at L4-L5 and L5-S1. Overall, these findings appear
unchanged from the previous.
|
19923624-RR-10
| 19,923,624 | 28,094,656 |
RR
| 10 |
2137-06-10 15:24:00
|
2137-06-10 19:37:00
|
STUDY: Right hand, ___.
CLINICAL HISTORY: ___ man with multiple injuries status post fall
from 15 foot ladder, now with increased swelling and pain of the right elbow.
FINDINGS: There is a peripheral IV catheter in the dorsal soft tissues of the
hand. There are degenerative changes of the first CMC and triscaphe joints.
No acute fractures or dislocations are seen. There are degenerative changes
of the distal radioulnar joint. There are no bony erosions.
|
19923624-RR-8
| 19,923,624 | 28,094,656 |
RR
| 8 |
2137-06-10 09:32:00
|
2137-06-10 10:30:00
|
CHEST RADIOGRAPH
INDICATION: Multiple rib fractures, evaluation for changes.
COMPARISON: ___.
FINDINGS: Known rib fractures, known lung contusion. The conclusion is less
severe and extensive than on the previous image. The presence of a minimal
right pleural effusion is better appreciated on the lateral than on the
frontal view. The rib fractures are better visualized on the CT examination
performed on ___.
|
19923624-RR-9
| 19,923,624 | 28,094,656 |
RR
| 9 |
2137-06-10 15:24:00
|
2137-06-10 19:31:00
|
STUDY: Right elbow, ___.
CLINICAL HISTORY: ___ man with multiple injuries status post fall off
a 15-foot ladder.
FINDINGS: There is a small elbow joint effusion. However, no definite
fracture of the radial head is seen. There are spurs about the radial head
and capitellum which limits evaluation for subtle fractures. There is also
joint space narrowing between the radius and capitellum. A peripheral
intravenous catheter is seen. Along the posterior aspect of the joint, there
are loose bodies within the olecranon fossa.
IMPRESSION:
1. Small joint effusion. No obvious fractures seen. Although there has been
trauma, given the degenerative change involving the radiocapitellar joint, the
effusion maybe related to the osteoarthritis. If there is persistent pain,
would recommend repeat images in ___ days to exclude a radial head fracture.
Alternatively, MRI could be performed to establish for an occult fracture.
2. Degenerative changes of the radiocapitellar joint as well as loose bodies
versus spurring in the olecranon fossa.
|
19923690-RR-65
| 19,923,690 | 26,079,417 |
RR
| 65 |
2139-03-14 12:32:00
|
2139-03-14 17:48:00
|
INDICATION: ___ female with left lower quadrant abdominal pain,
nausea and vomiting, here to evaluate for diverticulitis or acute
intra-abdominal process.
COMPARISON: No prior studies available.
TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases to
the pubic symphysis following the uneventful administration of 130 cc
Omnipaque intravenous contrast. Coronally and sagittally reformatted images
were generated and reviewed.
FINDINGS: CT ABDOMEN WITH CONTRAST: Although this study is not tailored for
the evaluation of supradiaphragmatic contents, the visualized lung bases show
mild dependent positional changes. No pleural effusion, focal consolidation
or pulmonary nodules are detected. Limited evaluation of the heart
demonstrates enlargement of the right-sided heart chambers. No pericardial
effusion. There is fat herniating through a defect in the right diaphragm
into the right thorax.
The liver enhances homogeneously without perfusion defects or focal liver
lesions. The portal venous system is satisfactorily opacified with contrast.
No intra- or extra-hepatic biliary dilation is seen. The gallbladder, spleen
and bilateral adrenal glands are unremarkable. The pancreas is atrophic and
fatty replaced with a 7-mm hypodensity in the proximal body of the pancreas
(2A:22). No other pancreatic lesions are identified. The left kidney appears
slightly atrophic. The right kidney contains a 2.1 x 1.6 cm exophytic
hypodensity with complex internal fluid density (2A:16) which may represent a
complex renal cyst. Both kidneys enhance symmetrically and excrete contrast
normally without evidence of hydronephrosis or solid renal mass.
The stomach and intra-abdominal loops of small bowel are unremarkable without
evidence of wall thickening or obstruction. There is a 3-cm defect in the
right lower quadrant abdominal wall with a right inguinal hernia containing a
loop of distal ileum without evidence of ischemia. The large bowel contains
diffuse colonic diverticula without inflammatory changes. The descending
colon from the level of the splenic flexure shows slight thickening of the
bowel wall with hyperemia although evaluation is suboptimal due to collapse of
the bowel on these images. No free air or ascites is present. No
pathologically enlarged lymph nodes are identified. There is extensive
calcified atherosclerosis of the infrarenal abdominal aorta and its branches.
CT PELVIS WITH CONTRAST: The rectosigmoid colon contains a moderate-to-large
amount of stool. The sigmoid colon shows diffuse diverticulosis without
evidence of diverticulitis. The urinary bladder is relatively decompressed by
a Foley catheter in appropriate position. The uterus is retroverted and
contains multiple large dense dystrophic calcifications consistent with
calcified, involuted fibroids. The left adnexa contains a 1.8-cm hypodensity
(2A:55) which is incompletely evaluated on CT. There is no free pelvic fluid
or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: The patient is status post left total hip arthroplasty.
Multilevel severe degenerative changes are noted throughout the lumbar spine
with loss of intervertebral disc height and associated vacuum phenomenon,
endplate sclerosis and anterior/posterior osteophytosis. No suspicious lytic
or sclerotic lesions are identified.
IMPRESSION:
1. Right inguinal hernia containing a loop of distal ileum without evidence of
bowel ischemia or obstruction.
2. Mild thickening of descending colon wall with hyperemia although not well
evaluated due to collapsed bowel. Underlying mild colitis may be present
3. Moderate to large amount of stool in the rectosigmoid vault.
4. 1.8 cm left adnexal cyst. Recommend non-urgent followup with ultrasound.
5. 7 mm pancreatic hypodensity for which further evaluation with MRCP would be
recommended if clinically appropriate given patient age.
|
19923690-RR-66
| 19,923,690 | 26,079,417 |
RR
| 66 |
2139-03-14 14:22:00
|
2139-03-14 15:03:00
|
INDICATION: Abdominal pain, nausea and vomiting with left lower quadrant
pain, evaluate for infiltrate.
COMPARISON: ___.
AP & LATERAL VIEW CHEST: Lung volumes are low resulting in vascular crowding.
Again noted is atelectasis of the left lung base which makes assessment of the
heart size difficult. There are calcifications within the aorta and a
moderately sized hiatal hernia is noted. Bibasilar opacities are most likely
due to atelectasis, but consolidation due to infection/aspiration not excluded
in the appropriate clinical setting. No pneumothorax or large consolidation
is seen.
IMPRESSION: Bibasilar opacities are most likely due to atelectasis, but
consolidation due to infection/aspiration not excluded in the appropriate
clinical setting.
|
19923870-RR-5
| 19,923,870 | 21,666,788 |
RR
| 5 |
2168-11-08 17:05:00
|
2168-11-08 18:33:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with occipital bleed w/ surrouding edema. ? avm vs.
tumor// AMV?
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 4.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
200.7 mGy-cm.
2) Sequenced Acquisition 12.0 s, 12.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
602.1 mGy-cm.
3) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.9 mGy (Body) DLP =
10.0 mGy-cm.
4) Spiral Acquisition 4.8 s, 37.9 cm; CTDIvol = 15.2 mGy (Body) DLP = 575.6
mGy-cm.
Total DLP (Body) = 586 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head dated ___ at 11:45
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is redemonstration of an evolving intraparenchymal hemorrhage in the
right occipital lobe measuring approximate 2.2 x 1.9 cm, stable since the
prior study obtained 5 hours earlier. There is mild regional edema and mass
effect including partial effacement of the regional cerebral sulci and
occipital horn of the right lateral ventricle. No significant midline shift
is present. There is no new hemorrhage or definite intraventricular
extension. There is no evidence of acute large territory infarction,. Focal
hypodensities in the anterior limb of the right internal capsule and bilateral
basal ganglia are noted, likely related to chronic lacunar infarcts. There is
prominence of the cerebral sulci and ventricles suggestive of involutional
changes in this age group.
The visualized portion of the paranasal sinuses, mastoid air cells,and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
Moderate calcified atherosclerotic plaque in the bilateral carotid siphons
without high-grade stenosis. There is fetal origin of the left posterior
cerebral artery, a normal variant. The vessels of the circle of ___ and
their principal intracranial branches otherwise appear normal without
stenosis, occlusion, arteriovenous malformation or aneurysm formation greater
the right posterior communicating artery is not visualized and may be
hypoplastic or congenitally absent. Than 3mm. The dural venous sinuses are
patent.
CTA NECK:
Mild calcified atherosclerotic plaque of the aortic arch and origins of the
right innominate, left common carotid and left subclavian is present.
Bilateral carotid and vertebral artery origins are patent.
Mild calcified atherosclerotic plaque at the bilateral common carotid
bifurcations without high-grade stenosis. There is no evidence of internal
carotid stenosis by NASCET criteria.
Mild calcified atherosclerotic plaque the V4 segment of the left vertebral
artery without high-grade stenosis. The carotidandvertebral arteries and
their major branches are otherwise normal with no evidence of stenosis or
occlusion.
OTHER:
The visualized portion of the lungs demonstrate left apical scarring. The
visualized portion of the thyroid gland is within normal limits. There is no
lymphadenopathy by CT size criteria.
IMPRESSION:
1. Evolving intraparenchymal hemorrhage in the right occipital lobe, overall
similar in size when compared with the prior study obtained 5 hours earlier.
Similar mild regional edema and mass effect. No significant midline shift.
2. No new intracranial hemorrhage or acute large vessel infarct.
3. Patent circle of ___ without definite evidence of arteriovenous
malformation, aneurysm, high-grade stenosis or occlusion.
4. Patent bilateral cervical carotid and vertebral arteries without definite
evidence of stenosis, occlusion, or dissection.
5. Chronic lacunar infarcts in the anterior limb of the right internal capsule
bilateral basal ganglia.
|
19923870-RR-7
| 19,923,870 | 21,666,788 |
RR
| 7 |
2168-11-09 05:56:00
|
2168-11-09 07:45:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with R occipital IPH, evaluate for progression
of hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.4 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CT head dated ___
FINDINGS:
There is redemonstration of intraparenchymal hemorrhage within the right
occipital lobe measuring approximately 2.2 x 1.8 cm, previously measuring 2.2
x 1.9 cm on study from 12 hours prior (02:13). Mild adjacent edema is
unchanged. There is no significant midline shift or mass-effect. There is no
new intracranial hemorrhage.
Periventricular and subcortical white matter hypo densities are likely sequela
of chronic small vessel disease. 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. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No substantial interval change in the right occipital lobe intraparenchymal
hemorrhage compared to study from 12 hours prior. There is no significant
mass effect or midline shift. No new intracranial hemorrhage.
|
19923870-RR-8
| 19,923,870 | 21,666,788 |
RR
| 8 |
2168-11-13 10:59:00
|
2168-11-13 11:15:00
|
EXAMINATION: US NECK, SOFT TISSUE
INDICATION: ___ year old woman with small occipital CAA bleed// is there any
concern for induration or fluctuance on right anterolateral neck
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right neck.
COMPARISON: CTA neck dated ___.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right neck.
Deep to the palpable area of concern, there is no drainable fluid collection.
IMPRESSION:
Targeted exam evaluating a palpable abnormality in the right anterolateral
neck demonstrates no drainable fluid collection.
RECOMMENDATION(S): If there is any concern for an intramuscular hematoma, an
MRI of the neck may be performed.
|
19924542-RR-10
| 19,924,542 | 26,500,551 |
RR
| 10 |
2162-08-14 00:43:00
|
2162-08-14 18:29:00
|
HISTORY: Ankle reduction.
RIGHT ANKLE, THREE VIEWS: Detail is obscured by cast. Allowing for this,
there is a transverse fracture at the base of the medial malleolus, with
approximately 5.3 mm distraction and slight lateral displacement of the distal
fragment. There is also an oblique fracture of the distal fibular
metadiaphysis (Weber C), in grossly anatomic alignment.
|
19924542-RR-11
| 19,924,542 | 26,500,551 |
RR
| 11 |
2162-08-14 08:59:00
|
2162-08-14 18:40:00
|
HISTORY: ORIF right ankle fracture.
Fluoroscopic assistance provided to surgeon in the OR without the radiologist
present. Six spot views obtained. These demonstrate hardware in relation to
medial malleolus and distal fibula, with a syndesmotic screw. Correlation
with real-time findings and when appropriate, conventional radiographs is
recommended for full assessment. Fluoro time not recorded on the electronic
requisition.
|
19924542-RR-12
| 19,924,542 | 26,500,551 |
RR
| 12 |
2162-08-16 20:20:00
|
2162-08-17 09:10:00
|
HISTORY: ___ woman with known L1 vertebral body compression fracture.
Reevaluation.
TECHNIQUE: Three views of the lumbar spine.
COMPARISON: CT examination of lumbar spine performed ___.
FINDINGS:
Fracture is again present within the superior aspect of the L1 vertebral body
with approximately 25% vertebral body height loss is again present within the
anterosuperior aspect of the L1 vertebral body. Remaining lumbar vertebral
bodies are normal in height and alignment.
Decreased intervertebral disc space heights are present within the lumbar
spine, most prominent at the L2-L3 level. Endplate sclerosis and minimal
osteophyte formation is present. Mild facet joint arthropathy is present at
the L5-S1 level.
Imaged portions of the ribs demonstrate no displaced fractures. Sacroiliac
joints are bilaterally symmetric. Imaged portions of the pelvis are intact.
Non-obstructive bowel gas pattern. Prominent stool is present within the
colon.
IMPRESSION:
1. No significant interval change of an acute fracture of the superior
endplate of the L1 vertebral body with approximately 25% vertebral body loss.
2. Mild multilevel degenerative disc disease within the lumbar spine.
No significant interval change since ___.
|
19924597-RR-23
| 19,924,597 | 21,017,999 |
RR
| 23 |
2197-12-06 16:28:00
|
2197-12-06 17:22:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with fever, RUQ pain, x 3d, transaminitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: The gallbladder is surgically absent.
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 8.4 cm.
KIDNEYS: Limited views of the right kidney are unremarkable.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Status post cholecystectomy. No biliary ductal dilatation.
|
19924597-RR-24
| 19,924,597 | 21,017,999 |
RR
| 24 |
2197-12-06 20:13:00
|
2197-12-06 23:45:00
|
EXAMINATION: MRCP (MR ___
INDICATION: ___ year old woman with transaminitis, had fever and pain,
?improving, hx of cholelithiasis // evaluate for choledocolithiasis, CBD
obstruction
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen were
obtained on a 1.5 Tesla magnet including dynamic 3D imaging prior to, during,
and after the administration of 6 mL Gadavist gadolinium based contrast. 1 mL
Gadavist mixed with 50 mL water was also administered for oral contrast.
COMPARISON: Ultrasound from same date.
FINDINGS:
The lung bases are grossly clear. There is no pleural or pericardial effusion.
The patient is status post cholecystectomy and hepaticojejunostomy (12:1).
The intrahepatic biliary ducts are diffusely irregularly and moderately
dilated up to the level of the hepaticojejunostomy, concerning for stricture.
Pneumobilia is present. There is no choledocholithiasis. There is no arterial
hyperenhancement or restricted diffusion in the walls of the biliary ducts to
suggest active cholangitis. There is no evidence of abscess.
The left hepatic lobe is atrophic and demonstrates progressive enhancement,
consistent with fibrosis. There is hypertrophy of the caudate lobe. Several
arterially hyperenhancing foci throughout the liver do not have correlates on
later phases of the postcontrast study or on T2 WI or DWI, consistent with
transient hepatic intensity differences (15:13, 23, 35, 40, 58). There are no
hepatic lesions concerning for malignancy.
There is variant arterial hepatic anatomy, with right hepatic artery arising
from the SMA (15:53) and left hepatic artery arising from the left gastric
artery (15:39). The portal and hepatic veins are patent.
The pancreas is normal in size and signal, with normal appearing duct. 3 mm T2
hyperintense nonenhancing lesion in the pancreatic head is consistent with
side branch IPMN (04:33).
There are multiple accessory spleens versus splenosis in the left upper
quadrant, in the expected location of the spleen and posterior to the stomach
(4:21).
In the inferior pole of the right kidney there is 1.2 cm lesion, which is
hyperintense on T2 WI and on T1WI, and at the lower level of the scan does not
enhance, consistent with a hemorrhagic cyst. Several subcentimeter cortical
renal cysts are present bilaterally. The adrenals are normal. There is single
renal artery bilaterally.
Short segment jejuno-jejunal intussusception is present in the left upper
quadrant (04:31). There is no evidence of a lead mass or obstruction.
There is no free fluid in the abdomen.
There is no retroperitoneal or mesenteric lymphadenopathy.
There is intramuscular lipoma in the left paraspinal muscles (4:10).
No focal bone marrow lesion concerning for malignancy is identified.
IMPRESSION:
1. Irregular, moderate dilatation of the intrahepatic biliary ducts with
atrophy and fibrosis of the left hepatic lobe, findings compatible with
chronic cholangitis, potentially recurrent pyogenic cholangitis with concern
for a stricture at the level of the hepaticojejunostomy. No
choledocholithiasis is present.
2. 3 mm cystic pancreatic head lesion, likely side branch IPMN. ___ year
followup is recommended.
3. Transient jejuno-jejunal intussusception.
|
19924597-RR-27
| 19,924,597 | 25,269,610 |
RR
| 27 |
2200-02-22 21:21:00
|
2200-02-22 22:30:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with elevated lfts, fever, abdominal pain// ?bile
duct occlusion
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___ ___
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened and heterogeneous with left
lobe atrophy, as seen on previous MRCP. The contour of the liver is nodular.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow.
BILE DUCTS: Patient is status post hepaticojejunostomy. There is moderate
intrahepatic biliary dilatation and pneumobilia in the left greater than right
hepatic lobes, grossly unchanged from the previous exam. The CHD measures 3
mm.
GALLBLADDER: Status post cholecystectomy.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Moderate intrahepatic biliary dilatation, worse in the left lobe compared
to the right, with coarsened heterogeneous appearance of the hepatic
parenchyma. Findings appear grossly unchanged as compared to ___ ___
and compatible with history of chronic cholangitis.
2. Status post hepaticojejunostomy with unchanged pneumobilia.
3. No choledocholithiasis. No extrahepatic biliary dilatation.
RECOMMENDATION(S): Please note that MRCP would provide improved evaluation of
the biliary tree.
|
19924597-RR-28
| 19,924,597 | 25,269,610 |
RR
| 28 |
2200-02-24 03:49:00
|
2200-02-24 09:04:00
|
EXAMINATION: MRCP
INDICATION: ___ female with the past medical history including history of
cholangitis s/p hepaticojejunostomy who presents with fevers and abdominal
pain, ERCP concerned about anatomy. Assess for cholangitis.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MR abdomen ___
MRCP ___
FINDINGS:
Lower Thorax: Limited evaluation of the lung bases are clear. No pleural
effusion. No pericardial effusion
Liver: There is persistent atrophy of the left hepatic lobe with caudate lobe
hypertrophy. No hepatic steatosis. Few scattered arterially hyperenhancing
foci do not persist on additional sequences and are consistent with transient
hepatic intensity differences (1300:31). Largest is band shaped in
configuration within segment 4A/4B (13:71). There is a new 2.7 x 1.3 cm
segment VII peripherally located lesion with subtle ill-defined T2
hyperintensity and a rounded 0.5 cm T2 hyperintense nonenhancing component
centrally which demonstrates restricted diffusion, consistent with a hepatic
abscess and reactive hyperemia (1300:69). No drainable collection.
Biliary: Status post cholecystectomy and hepaticojejunostomy. Again seen is
moderate irregular central and left intrahepatic biliary duct dilatation with
persistent narrowing at the hepaticojejunostomy anastomosis, unchanged in
configuration dating back to ___ (600:1). Largest caliber measures 0.5
cm within the left intrahepatic biliary ducts (previously 0.5 cm) (04:10). No
choledocholithiasis. Mild enhancement with wall thickening and restricted
diffusion of the right anterior segmental bile ducts is consistent with
cholangitis.
Pancreas: The pancreas is atrophic but normal in signal intensity. 0.4 cm
pancreatic head cystic lesion is unchanged since ___ and statistically
likely to represent a side branch IPMN (05:38). No worrisome lesion. No
dilatation of main pancreatic duct.
Spleen: The spleen is normal in size. Splenosis in the left upper quadrant
again noted.
Adrenal Glands: The adrenal glands are normal in size and shape.
Kidneys: Subcentimeter right renal cysts are noted. The kidneys are otherwise
unremarkable. No hydronephrosis. No perinephric fat stranding.
Gastrointestinal Tract: Unremarkable. No obstruction. No ascites.
Lymph Nodes: No retroperitoneal or mesenteric lymph node enlargement.
Vasculature: No abdominal aortic aneurysm. Marked narrowing at the celiac
axis origin, without poststenotic dilatation, may be related to median arcuate
ligament effect. Celiac axis, SMA, bilateral renal arteries are otherwise
patent. Again seen is the right hepatic artery arising from the SMA and left
hepatic artery arising left gastric artery. Hepatic veins main portal vein,
splenic vein, and proximal SMV are patent.
Osseous and Soft Tissue Structures: 3.3 x 1.2 cm left paraspinal muscle lipoma
is stable (05:18). Osseous structures and soft tissues otherwise
unremarkable. Note is made of a osseous hemangioma in the L1 vertebral body.
IMPRESSION:
1. Active segmental cholangitis of the anterior right biliary ducts. 0.5 cm
segment VII hepatic microabscess with peripheral hyperemia. No drainable
collection.
2. Moderate central and intrahepatic biliary duct dilatation with narrowing
at hepaticojejunostomy, unchanged in configuration since ___.
3. Unchanged 0.4 cm pancreatic head cystic lesion, likely to represent a side
branch IPMN.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 9:05 am, 5 minutes after
discovery of the findings.
|
19924849-RR-26
| 19,924,849 | 20,413,690 |
RR
| 26 |
2182-09-23 14:30:00
|
2182-09-23 16:56:00
|
CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Fever, question pneumonia.
FINDINGS: PA and lateral views of the chest were provided. There is stable
area of scarring at the left lung base. No new consolidation, effusion, or
pneumothorax. Heart and mediastinal contours are normal. Bony structures are
intact. No free air below the right hemidiaphragm.
IMPRESSION: Chronic scarring at the left lung base. No evidence of
pneumonia.
|
19924849-RR-27
| 19,924,849 | 20,413,690 |
RR
| 27 |
2182-09-24 09:48:00
|
2182-09-24 13:41:00
|
HISTORY: ___ female with SLE, now presenting with severe anemia and
recent INR of 15. Assess for hemorrhage.
COMPARISON: None available in the ___ system
TECHNIQUE: ___ MDCT-acquired axial images from the lung bases to pubic
symphysis were displayed with 5-mm slice thickness. No oral or intravenous
contrast was administered. Coronal and sagittal reformations were prepared.
CT ABDOMEN WITHOUT INTRAVENOUS CONTRAST: Trace nonhemorrhagic bilateral
pleural effusions with mild compressive atelectasis are noted. The image
cardiac apex is within normal limits.
Complete evaluation of the abdominal solid viscera is limited secondary to the
noncontrast technique. However, the liver, spleen, pancreas, gallbladder, and
adrenal glands appear within normal limits. The kidneys are symmetric without
focal lesion or hydronephrosis. The abdominal aorta is non-aneurysmal
throughout its course. Stomach and loops of small bowel appear normal without
signs of obstruction or inflammation. There is moderate mesenteric edema.
There is a large volume of high density free fluid within the abdomen and
pelvis, findings consistent with hemoperitoneum.
CT PELVIS WITHOUT INTRAVENOUS CONTRAST: Within the pelvis, there is a large
complex pelvic hematoma measuring 11.2 x 5.3 x 5.7 cm. A portion of this
hematoma demonstrates a hematocrit level with high-density hemorrhage layering
posteriorly (2:70). The uterus appears separate from this and appears normal
in morphology. The adnexa is incompletely evaluated. The source of the
hemorrhage is unclear on this limited non-contrast CT evaluation, though may
be due to a ruptured adnexal hemorrhagic cyst. Correlate with follow-up CTA
performed a few hours later.
The rectum and colon appear normal in caliber and configuration without
evidence of obstruction or inflammation. The bladder is mildly distended,
though appears normal.
BONES AND SOFT TISSUES: No bone destructive lesion or acute fracture is
identified.
IMPRESSION:
1. Large volume hemorrhagic ascites with complex hematoma centered in the
midline pelvis.
2. Hematocrit level within the right posterior pelvis, suggesting that the
source of the hemorrhage may be pelvic origin, possibly due to rupture of a
hemorrhagic ovarian cyst.
Given the large volume of hemorrhagic fluid, followup CTA is recommended for
further assessment for active extravasation.
Dr. ___ communicated the above results to Dr. ___ at
11:50 a.m. on ___ by telephone, ___ minutes after discovery.
|
19924849-RR-28
| 19,924,849 | 20,413,690 |
RR
| 28 |
2182-09-24 12:09:00
|
2182-09-24 15:12:00
|
HISTORY: ___ female with history of SLE, admitted with low hematocrit
and recent non-contrast CT demonstrating hemoperitoneum. Assess for active
extravasation.
COMPARISON: Non-contrast CT abdomen and pelvis from ___, 11:04
a.m.
TECHNIQUE: ___ axial images from the lung bases to the pubic
symphysis were displayed with 2.5-mm slice thickness. Initial axial images
were acquired in an arterial phase, followed by portal venous phase delayed
imaging. Coronal and sagittal reformations were prepared.
CT ABDOMEN WITH INTRAVENOUS CONTRAST: There are small bilateral
nonhemorrhagic pleural effusions with associated compressive atelectasis. The
imaged cardiac apex is within normal limits.
In segment VII of the liver, there is an ill-defined too small to characterize
hypodensity measuring 7 mm. Findings may reflect a small hemangioma, which
could be further evaluated with ultrasound if clinically indicated (2b:203 and
2a:29). No other focal hepatic lesion is identified. The hepatic veins and
portal venous system are grossly patent. No intra- or extra-hepatic biliary
ductal dilatation is identified. The gallbladder, spleen, pancreas, and
adrenal glands appear normal. There is symmetric enhancement of both kidneys
without suspicious focal lesion or hydronephrosis. Focal densities within the
distal esophagus and in a small hiatal hernia are likely ingested pills. The
stomach and small bowel loops are normal in caliber and configuration without
evidence of obstruction or inflammation. Redemonstrated is a large amount of
free fluid throughout the abdomen and pelvis with indeterminate attenuation
values, though previously concerning for hemoperitoneum on prior non-contrast
examination. No visceral injury is evident within the abdomen to explain the
large amount of hemorrhagic fluid.
CT PELVIS WITH INTRAVENOUS CONTRAST: Within the left adnexa, there is a
rim-enhancing, indeterminate attenuation lesion measuring approximately 3.8 x
4.1 cm. The posterior inferior wall of this lesion does not appear
continuous. The overall findings are most suggestive of a ruptured
hemorrhagic cyst resulting in hemoperitoneum in this coagulopathic patient.
Additionally, there is a large organized hematoma within the pelvis with a
fluid-fluid level seen on the right. The hematoma measures 10.6 x 7.8 x 6.0
cm (41b:34 and 2b:308). The uterus appears normal. A small probable follicle
is identified within the right ovary. The bladder is moderately distended and
appears unremarkable. The rectum and colon are normal in caliber and
configuration without evidence of obstruction or inflammation. No focal area
of active extravasation is seen on the current examination. There is a small
locule of fluid seen within a right inguinal hernia measuring 1.4 x 1.5 cm
(2b:330).
CTA: The abdominal aorta and its branch vessels are widely patent without flow
limiting stenosis. The celiac axis and SMA demonstrate normal conventional
arterial anatomy. There are three right renal arteries and a single left
renal artery. The ___ is widely patent. No clear site of active
extravasation is identified.
BONES AND SOFT TISSUES: No bone destructive lesion or acute fracture is
identified.
IMPRESSION:
1. Large volume hemoperitoneum and organized pelvic hematoma. No focal
active extravasation within the abdomen or pelvis.
2. Rim-enhancing left adnexal lesion with apparent discontinuity of the
posterior inferior wall, findings suggestive of a ruptured hemorrhagic cyst as
the source of hemorrhage. If clinically indicated, pelvic ultrasound could be
performed for further evaluation of the adnexa.
3. Ill-defined 7-mm hypodensity within segment VII of the liver, likely a
small hemangioma. Non-emergent ultrasound could be performed for further
evaluation if clinically indicated.
4. Trace bilateral non-hemorrhagic pleural effusions.
|
19924849-RR-31
| 19,924,849 | 20,413,690 |
RR
| 31 |
2182-09-26 16:18:00
|
2182-09-27 08:40:00
|
HISTORY: ___ woman with history of lupus, complicated by pericarditis
and pleuritis, now with pleuritic chest pain and anterior auscultation
revealing a friction rub. The patient was originally admitted for
hemoperitoneum in the setting of an INR of 22. Please evaluate for pleural
pathology, hemothorax or lung process.
COMPARISON: CT of the abdomen from four days prior.
TECHNIQUE: CT of the chest with IV contrast.
FINDINGS: MEDIASTINUM: There is no mediastinal, hilar, or axillary
lymphadenopathy by CT criteria.
HEART AND PERICARDIUM: The heart and pericardium appear unremarkable with no
evidence of lesions or significant pericardial effusion. The pulmonary
vessels show no central filling defects.
LUNGS: The lungs are clear of any opacities concerning for an infectious
process. There is bilateral atelectasis, left greater than right.
PLEURA: Bilateral small-to-moderate pleural effusions, greater on the right,
are layering, but slightly more dense than would be expected of simple pleural
fluid, consistent with a known hemoperitoneum.
BONES: No suspicious lytic or sclerotic lesions are seen.
IMPRESSION: Bilateral pleural effusions, moderate in size on the left,
small-to-moderate in size on the right with associated adjacent compressive
atelectasis. No evidence of pericardial abnormality on the CT.
|
19924849-RR-32
| 19,924,849 | 20,413,690 |
RR
| 32 |
2182-09-26 17:00:00
|
2182-09-26 20:11:00
|
INDICATION: History of lupus and DVT in ___, currently off anticoagulation
for recent bleed. Now with left arm swelling and right arm erythema.
Evaluate for DVT and thrombophlebitis in the bilateral upper extremities.
COMPARISON: None.
FINDINGS: Grayscale and color sonograms were acquired of the bilateral
internal jugular, subclavian, axillary, brachial, basilic, and cephalic veins.
There is occlusive thrombus within the right cephalic vein extending from its
mid-to-lower portion. The upper portion of the right cephalic vein is patent.
Wispy echogenic strands, synechiae, are seen in the left internal jugular
vein, although this vessel fully compresses and shows wall-to-wall color
Doppler flow. The remainder of the imaged bilateral upper extremity veins are
patent with normal compressibility, flow, and augmentation.
IMPRESSION:
1. Occlusive thrombus within the right cephalic vein. Of note, the cephalic
vein is not a deep vein. No ceep venoud thrombosis.
2. Wispy echogenic strands within the left internal jugular vein, which
compresses fully and shows wall-to-wall flow. These echogenic strands are not
thought to represent an acute thrombus and could be sequela from prior clot
that has recanalized.
|
19925345-RR-14
| 19,925,345 | 27,277,627 |
RR
| 14 |
2110-01-30 11:31:00
|
2110-01-30 14:03:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: History: ___ with C2 lateral mass fracture. Please assess for
ligamentous injury.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: Cervical spine CT from ___ at 04:42 performed at
___.
FINDINGS:
Nondisplaced fracture of the right lateral mass of C2, which extends to the
anterior margin of the right transverse foramen, is better assessed on the
preceding CT. There is fluid in the joint between the right lateral masses of
C1 and C2, and mild posterior paravertebral edema along the right lateral mass
of C2. There is a mild edema in the interspinous ligament at C1-C2. No clear
involvement of the ligamentum flavum is seen. Posterior longitudinal and
anterior longitudinal ligaments appear intact. No evidence for prevertebral
edema. No edema in the discs or vertebral body bone marrow. No
spondylolisthesis.
No epidural collection. Normal spinal cord morphology and signal.
The cerebellar tonsils are normally positioned. Visualized posterior fossa
appears unremarkable.
No spinal canal narrowing. Mild right C3-C4 neural foraminal narrowing by
uncovertebral and facet osteophytes.
IMPRESSION:
1. Nondisplaced fracture of the right lateral mass at C 2, which extends to
the anterior margin of the right transverse foramen, is better assessed on the
preceding CT.
2. Fluid in the joint between the right lateral masses of C1 and C 2. Mild
posterior paravertebral edema along the right lateral mass of C2. Mild edema
in the C1-C2 interspinous ligament without clear evidence for ligamentum
flavum involved.
3. Anterior and posterior longitudinal ligaments appear intact. No
spondylolisthesis, disc edema, vertebral body marrow edema.
4. No epidural collection. Normal spinal cord signal.
RECOMMENDATION(S): If clinically warranted, MRA neck with fat-suppressed
axial T1 weighted images could better assess for right vertebral artery
intramural hematoma/dissection at C2.
NOTIFICATION: Preliminary report in PACS by Dr. ___ ___
at 14:03 states "Alignment is anatomical. No evidence of significant central
canal or neural foraminal stenosis. No cord signal abnormality. No evidence of
ligamentous injury. No prevertebral abnormality."
|
19925345-RR-15
| 19,925,345 | 27,277,627 |
RR
| 15 |
2110-01-30 11:19:00
|
2110-01-30 12:44:00
|
INDICATION: History: ___ with fall, L chest pain, sternal pain, scapula
pain// eval for fx
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: No prior imaging for comparison at this institution
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. The heart,
pericardium, and great vessels are within normal limits based on an unenhanced
scan. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Anterior mediastinal soft tissue density likely
represent thymus tissue. No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Bibasilar subsegmental atelectasis in dependent portions of the
lung. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the unenhanced upper abdomen is unremarkable.
BONES: A small non displaced fracture is seen in the left eleventh posterior
rib. No other fractures are noted. The visualized portion of the left
scapula is unremarkable.
IMPRESSION:
Nondisplaced fracture of the left eleventh posterior rib. Ground-glass
opacity in the left lower lobe likely secondary to poor respiratory effort.
NOTIFICATION: Updated final read was communicated to Dr. ___ at
15:15 on ___ by ___ MD over the phone.
|
19925583-RR-8
| 19,925,583 | 20,379,432 |
RR
| 8 |
2123-03-15 20:17:00
|
2123-03-15 21:37:00
|
HISTORY: Miscarriage diagnosed at outside hospital. Evaluate for
progression.
COMPARISON: None available.
TECHNIQUE: Transabdominal and transvaginal approach gray-scale and color
Doppler ultrasound images were obtained of the pelvis in order to better
visualize conceptus.
FINDINGS:
LAST MENSTRUAL PERIOD: ___.
There is single irregular gestational sac within the uterus with a fetal pole
crown-rump length measuring 1.06 cm for dates of 7 weeks 2 days. No cardiac
activity is identified. There are multiple uterine fibroids with the largest
in the left uterine body measuring 3.1 x 2.4 x 2.6 cm. The uterus is
otherwise unremarkable. The ovaries are unremarkable and normal in size
bilaterally. There is no free pelvic fluid.
IMPRESSION:
1. Findings compatible with compatible with embryonic demise.
2. Fibroid uterus.
|
19925814-RR-10
| 19,925,814 | 22,422,521 |
RR
| 10 |
2155-04-13 17:01:00
|
2155-04-13 20:15:00
|
INDICATION: Portable chest radiograph ___ male presenting with trauma
TECHNIQUE: Portable chest radiograph
COMPARISON: Same day ___ 15:04 chest radiograph from outside
facility CT torso performed earlier the same day at 15:11.
FINDINGS:
The lung volumes are low. There are multifocal patchy and consolidating
bilateral pulmonary opacities which likely reflect pulmonary contusions in the
setting of multiple rib fractures. There is a small right-sided pneumothorax.
Slightly displaced fractures are noted in the right posterior second, third,
and fourth ribs. There is also a displaced fracture of the right lateral
fifth rib and full-width displaced fracture of the right mid clavicle.
IMPRESSION:
1. Multiple right-sided rib fractures and a full-width displaced fracture of
the right midclavicle.
2. Low lung volumes and multifocal bilateral pulmonary opacities which may
reflect lung contusions in the setting of multiple fractures.
3. Small right-sided pneumothorax.
|
19925814-RR-12
| 19,925,814 | 22,422,521 |
RR
| 12 |
2155-04-13 21:25:00
|
2155-04-13 22:19:00
|
INDICATION: ___, s/p MCC p/w R SAH/SDH, R clavicle scapula ___ rib fx, R
PTX,R renal hilum hematoma, R gluteal hematoma.// post transport to ICU
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There is an unchanged right pneumothorax. No left pneumothorax. The lung
volumes are low. Multifocal opacities are slightly decreased since prior.
There is no pleural effusion. Multiple rib fractures are again seen on the
right as well as a displaced right clavicular fracture. The size of the
cardiac silhouette is within normal limits.
IMPRESSION:
Unchanged small right pneumothorax.
Slight interval decrease in multifocal opacities. No pleural effusion.
|
19925814-RR-13
| 19,925,814 | 22,422,521 |
RR
| 13 |
2155-04-13 22:14:00
|
2155-04-14 10:31:00
|
EXAMINATION: MR THORACIC SPINE W/O CONTRAST T9421 MR ___ SPINE
INDICATION: ___ year old man with MVC with L leg weakness// spinal insult.
TECHNIQUE: Sagittal imaging was performed with T1 and STIR technique.
Examination was terminated early due to patient discomfort and inability to
follow commands during scan.
COMPARISON: CT chest, abdomen and pelvis with contrast dated ___
from outside facility.
FINDINGS:
Examination is limited due to acquisition of limited sequences.
There is rightward curvature of the thoracic spine. Mild degenerative changes
thoracic spine. Few small Schmorl's nodes. No acute fracture. No paraspinal
edema. No focal marrow signal abnormalities are evident..
Limited evaluation of the right thorax demonstrates patchy areas of dependent
consolidation in the right lung, small right pleural effusion, better
demonstrated on the recent CT. Comparison CT ___ at 03:11 p.m.
also demonstrates moderate anterior right pneumothorax.
IMPRESSION:
1. Limited MRI examination.
2. No evidence of acute fracture.
3. CT from ___ demonstrates moderate right pneumothorax.
|
19925814-RR-14
| 19,925,814 | 22,422,521 |
RR
| 14 |
2155-04-13 22:09:00
|
2155-04-13 22:39:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with SAH, IPH// worsening bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
933.8 mGy-cm.
2) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
933.4 mGy-cm.
Total DLP (Head) = 1,867 mGy-cm.
COMPARISON: CT scan of the head from earlier today
FINDINGS:
Multiple foci of acute hemorrhage, most likely subarachnoid are seen
throughout both cerebral hemispheres. These are more conspicuous than on the
prior imaging and/or noted to involve the vertex, rectus gyri, temporal lobes
and right occipital lobe. Additionally there is hyperdense blood product
noted along the falx in keeping with an element of subdural blood. There is
no evidence of intraventricular extension of hemorrhage or hydrocephalus.
There is no midline shift, significant mass effect or herniation. The basal
cisterns are patent.
There is no acute fracture identified. The sinuses, mastoid air cells and
middle ear cavities are clear. The orbits are unremarkable. No significant
soft tissue swelling.
IMPRESSION:
Scattered supratentorial foci of subarachnoid hemorrhage as well as a probable
subdural bleed along the posterior falx are more conspicuous than on the
imaging performed several hours prior. No midline shift or evidence of
herniation.
|
19925814-RR-15
| 19,925,814 | 22,422,521 |
RR
| 15 |
2155-04-13 23:49:00
|
2155-04-14 10:02:00
|
INDICATION: ___ year old man with flail chest, s/p intubation// ET tube
placement, pneumothorax
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
There are multiple displaced right-sided rib fractures. Lungs are very low
volume. Right-sided chest tube is in place. There is a small right apical
pneumothorax. The ET and NG tube are unchanged. There is a mild interstitial
edema. There is also subsegmental atelectasis in the left lung base.
Cardiomediastinal silhouette is stable. Displaced right known clavicular and
scapular fracture is not well seen.
|
19925814-RR-16
| 19,925,814 | 22,422,521 |
RR
| 16 |
2155-04-14 00:53:00
|
2155-04-14 11:32:00
|
EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE
INDICATION: ___ year old man with MVC crash with L Lower extremity weakness.
Spinal insult.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 10 mL of
Gadavist contrast agent.
COMPARISON: MRI thoracic spine without contrast dated ___.
CT chest, abdomen and pelvis with contrast dated ___ from outside
facility. Chest x-ray ___.
FINDINGS:
THORACIC SPINE:
There is mild rightward curvature of the thoracic spine. Otherwise, alignment
is normal. There is mild superior endplate deformity of the T4, T5 vertebral
bodies, consistent with Schmorl's nodes, no associated edema in the vertebral
bodies or paravertebral edema to suggest acute fractures. Mild degenerative
changes pre
Intervertebral disc signal intensity is maintained. The spinal cord appears
normal in caliber and configuration without evidence of edema. There is no
evidence of spinal canal or neural foraminal narrowing. There is no evidence
of infection or neoplasm.
No focal fluid collections are identified.
LUMBAR SPINE:
The lumbar vertebral body heights and alignment are grossly maintained. No
focal marrow signal abnormalities are identified to suggest acute fracture.
Nonenhancing sclerotic lesion identified in the posterior L1 vertebral body,
most likely benign bone island. Mild multilevel intervertebral disc
desiccation.
The visualized spinal cord is normal in caliber and configuration with no
evidence of edema. The conus medullaris terminates at the level of T12-L1.
At T12-L1, L1-L2, and L2-L3, patent central canal, patent foramina.
L3-L4: Small shallow left central disc protrusion with tiny annular fissure,
ligamentum flavum thickening, and facet hypertrophy. Patent central canal.
Mild foraminal narrowing.
L4-L5: Minimal posterior disc bulge, ligamentum flavum thickening, and facet
hypertrophy without significant spinal canal narrowing. Mild-to-moderate
right, mild left foraminal narrowing.
L5-S1: Disc bulge, tiny central disc protrusion,, ligamentum flavum
thickening, and facet hypertrophy without significant spinal canal narrowing.
No neural foraminal narrowing.
Benign left innominate bone island.
Other: Consolidation within the dependent portion of the right greater than
left lungs may reflect a combination of atelectasis and contusion given the
clinical history. Component of aspiration cannot be excluded. New right
chest tube is partially visualized. Trace bilateral pleural effusions.
Multiple displaced right-sided rib fractures better seen on CT.
Edema is noted in the right rotator cuff musculature. Paraspinal musculature
is unremarkable.
A nasoenteric tube is visualized coursing through the esophagus. An
endotracheal tube is partially visualized. Secretions are present in the
trachea.
T2 hyperintense lesions in the left greater than right kidneys without
evidence of enhancement are more consistent with cysts, no further follow-up
is indicated.
IMPRESSION:
1. Normal cord. No vertebral body fracture. No ligamentous injury..
2. Dependent consolidations in the right greater than left lungs, largely
atelectasis, consider component of contusion, aspiration.
3. Rib fractures..
4. Degenerative changes lumbar spine, as above.
|
19925814-RR-18
| 19,925,814 | 22,422,521 |
RR
| 18 |
2155-04-14 08:04:00
|
2155-04-14 09:34:00
|
EXAMINATION: DX SHOULDER AND CLAVICLE; HUMERUS (AP AND LAT) RIGHT
INDICATION: ___ year old man with polytrauma// evaluate for fracture
TECHNIQUE: Three views of the right shoulder and two views of the clavicle.
Two views of the left humerus.
COMPARISON: ___.
FINDINGS:
Redemonstrated is a completely inferiorly displaced transverse fracture of the
right mid clavicle. There is a comminuted fracture of the scapula and
multiple displaced right rib fractures. Again seen is a small right apical
pneumothorax and airspace opacities consistent with atelectasis and contusion.
There is a right chest tube in place and endotracheal tube is partially
visualized. There are mild degenerative changes of the glenohumeral and
acromioclavicular joints.
There is a well demarcated sclerotic lesion in the proximal right humerus,
possibly chondroid matrix lesion or sclerosed fibro-osseous lesion.
IMPRESSION:
1. Completely inferiorly displaced fracture of the right mid clavicle.
2. Comminuted fracture of the scapula, better depicted on prior
cross-sectional imaging.
3. Multiple right-sided rib fractures and small right apical pneumothorax.
Right chest tube in place.
|
19925814-RR-19
| 19,925,814 | 22,422,521 |
RR
| 19 |
2155-04-15 05:28:00
|
2155-04-15 10:31:00
|
INDICATION: ___ yo m with pmh of HTN, substance abuse presents from OSH with
multiple injuries including rib fracture, clavicle fracture, scapula fracture,
R renal hilar hematoma, and brain bleed// ETT, chest tube
TECHNIQUE: Portable semi upright radiograph of the chest.
COMPARISON: Radiograph of the chest performed 1 day prior
FINDINGS:
Re-demonstrated are multiple right-sided displaced rib fractures. Chest tube
within the mid right lung is unchanged in position. Previously seen right
apical pneumothorax is not discerned on the current exam however please note
that the apices of the lungs have been excluded from the field of view of this
film. Mild interstitial edema is unchanged. Subsegmental atelectasis at the
left lung base is re-demonstrated.
IMPRESSION:
The apices of the lungs are incompletely evaluated. Repeat imaging with
inclusion of the apices is recommended.
Stable position of the right-sided chest tube. The remainder of the lungs
appear grossly unchanged in appearance.
RECOMMENDATION(S): Repeat imaging of the chest with inclusion of the apices
of the lungs.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 10:28 am, 10 minutes after discovery of
the findings.
|
19925814-RR-20
| 19,925,814 | 22,422,521 |
RR
| 20 |
2155-04-15 10:31:00
|
2155-04-15 11:57:00
|
INDICATION: ___ year old man with multiple rib fx, pneumothorax// pneumothorax
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 5 hours prior.
FINDINGS:
Small right apical pneumothorax is unchanged. Right-sided rib fractures are
re-demonstrated. Right chest tube is seen overlying the mid right lung. Mild
interstitial edema is unchanged. Subsegmental atelectasis at the left lung
base is persistent. Possible small left pleural effusion. Right-sided
pleural thickening appears unchanged compared to the prior exam, given
differences in acquisition technique.
IMPRESSION:
Overall, similar appearance of the small right apical pneumothorax. Stable
mild pulmonary edema.
|
19925814-RR-21
| 19,925,814 | 22,422,521 |
RR
| 21 |
2155-04-15 17:38:00
|
2155-04-15 18:52:00
|
INDICATION: ___ year old man with right pneumothorax and rib fractures s/p R
CT placement, now to water seal// evaluate for pneumothoraxPLEASE PERFORM CXR
at 6pm
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
A right chest tube is present. There is no discrete pneumothorax identified
however there is unchanged right pleural thickening. A small left pleural
effusion and mild interstitial edema are also unchanged. Opacities at both
lung bases may reflect atelectasis or pneumonia. Multiple right rib fractures
are again seen.
IMPRESSION:
No significant interval change since prior. No discrete pneumothorax is
identified.
|
19925814-RR-22
| 19,925,814 | 22,422,521 |
RR
| 22 |
2155-04-16 08:17:00
|
2155-04-16 09:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___, s/p MCC p/w R SAH/SDH, R clavicle scapula ___ Lateral
rib fx, R PTX,R R renal hilum hematoma, R gluteal hematoma with chest tube to
water seal.// compare to prior study to be obtained ___ compare to
prior study to be obtained ___
IMPRESSION:
Comparison to ___. No relevant change is seen. Stable position
of the right-sided chest tube. Stable right lateral pleural thickening.
Stable known displaced rib fractures as well as clavicular and scapular
fractures on the right. On the left, the heart remains minimally enlarged and
a small retrocardiac atelectasis is present. No pleural effusions. No
pneumothorax.
|
19925814-RR-23
| 19,925,814 | 22,422,521 |
RR
| 23 |
2155-04-16 18:45:00
|
2155-04-16 21:06:00
|
INDICATION: ___ year old man, chest tube removed.// interval change. Please
check at 7pm
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There are low bilateral lung volumes. The right chest tube has been removed.
There is grossly unchanged loculated right pleural fluid. There is no
pneumothorax identified. Minimal retrocardiac atelectasis is present.
Multiple displaced rib fractures, a clavicular as well as a scapular fracture
are again visualized.
IMPRESSION:
Interval removal of the right chest tube. No discrete pneumothorax
identified. Grossly unchanged cardiopulmonary findings.
|
19925814-RR-24
| 19,925,814 | 22,422,521 |
RR
| 24 |
2155-04-18 17:38:00
|
2155-04-18 18:27:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with new urinary contrast, c/f hydro// Interval
change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.0 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Noncontrast head CT ___
FINDINGS:
Small amount of hemorrhage along the posterior falx, likely subdural is
unchanged from prior. Multiple scattered foci of subarachnoid hemorrhage
bilaterally at the vertex are stable to slightly conspicuous compared to prior
in keeping with expected evolution of blood products. Small amount of
probably intraparenchymal hemorrhage in the left occipital lobe, right
temporal lobe, and left frontal lobe at the rectus gyrus is also unchanged.
No new hemorrhage identified. The there is no evidence of infarction. The
ventricles and sulci are unchanged and normal in size and configuration.
There is no evidence of fracture. Small mucous retention cyst is seen in the
right maxillary sinus. Otherwise, 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. Expected evolution of multiple foci of subarachnoid, intraparenchymal, and
subdural hemorrhage as described above. No evidence of new hemorrhage.
2. Stable size and configuration of the ventricles.
|
19926301-RR-26
| 19,926,301 | 24,898,520 |
RR
| 26 |
2135-07-15 11:16:00
|
2135-07-15 11:36:00
|
HISTORY: Right knee pain, most pronounced over the medial aspect of the
tibia. Assess for fracture.
TECHNIQUE: 3 views of the right knee.
COMPARISON: None.
FINDINGS:
There is no fracture or dislocation. Mild degenerative changes are seen with
minimal spurring along the tibial plateau medially and at the patella.
Extensive vascular calcifications are noted. No large joint effusion is seen.
IMPRESSION:
No fracture or dislocation. Extensive vascular calcifications.
|
19926301-RR-27
| 19,926,301 | 24,898,520 |
RR
| 27 |
2135-07-15 12:12:00
|
2135-07-15 15:10:00
|
HISTORY: Fever.
TECHNIQUE: AP upright and lateral radiographs of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are markedly hyperinflated with significant elevation of the left
hemidiaphragm similar, with overlying atelectasis. Streaky linear opacities
in the mid and lower right lung are increased from the previous examination
but their appearance is more suggestive of a chronic process. There is mild
blunting of the posterior right costophrenic angle, which may be due to a
small pleural effusion or pleural thickening. Cardiac silhouette and
mediastinal contours are unchanged.
IMPRESSION:
Increased mid and lower right lung streaky opacities are more suggestive of a
chronic pulmonary process. Comparison with any priors since ___ and
continued follow-up.
Mild blunting of the posterior right costophrenic angle, small pleural
effusion vs pleural thickening.
|
19926355-RR-11
| 19,926,355 | 20,454,530 |
RR
| 11 |
2149-09-26 08:29:00
|
2149-09-26 10:42:00
|
EXAMINATION: CT torso with contrast from an outside institution
INDICATION: ___ year old man with long history of Crohns presenting with 2
weeks of abdominal pain and diarrhea, found to have positive C diff and severe
ulceration on colonscopy as above.// Patient found to have severe deep
circumferential ulceration on colonoscopy 60cm to 35 cm from the distal end of
the transverse colon through the sigmoid colon. Wondering if the CT scan can
provide any clue to the etiology, thanks!
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: CT DLP Dose ___ MCy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Linear atelectasis seen in both bases of the lungs. There is no
pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Small 5 mm hypodensity in the left lower pole, too small to characterize but
likely represents a renal cyst. There is no evidence of focal renal lesions
or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: Fat containing diaphragmatic hiatal hernia. The stomach is
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. The terminal ileum is unremarkable.
There is thickening of the wall of the descending colon from the splenic
flexure to the mid descending colon with hyperenhancement of the mucosa,
target sign and stratification of the wall, as well as mesenteric fat
stranding indicating colitis. There is also colonic wall thickening from the
hepatic flexure throughout the transverse colon with dilation (02:32). There
is no free air. There is no free fluid.
The appendix is normal.
Calcified granuloma in the anterior left mesentery.
LYMPH NODES: There are multiple subcentimeter lymph nodes in the mesentery
along the transverse and ascending colon. There is no retroperitoneal
lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The partially visualized prostate and seminal glands
appear unremarkable.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Patient is status post right hip total arthroplasty. Multilevel
degenerative changes. There is no evidence of worrisome osseous lesions or
acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Extensive colitis from the splenic flexure to the mid portion of the
descending colon with extension to the transverse colon without signs of
perforation. Small bowel and terminal ileum are intact.
|
19926355-RR-12
| 19,926,355 | 20,454,530 |
RR
| 12 |
2149-09-26 09:33:00
|
2149-09-26 11:35:00
|
INDICATION: ___ year old man with h/o Crohn's disease, C diff positive, with
increasing abdominal pain. Colonoscopy inconclusive but concern for ischemia
also. Study performed evaluate for interval change.
TECHNIQUE: Supine abdominal radiographs were obtained.
COMPARISON: CT from outside hospital dated ___.
FINDINGS:
Gaseous distention of the large and small bowel. The gaseous distention is
seen to taper at the level of the descending and sigmoid colon. Decreased
haustral markings are noted 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 remarkable for right hip arthroplasty.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Gaseous distention of the large and small bowel which tapers at the level of
the descending and sigmoid colon. Decreased haustral markings are noted in the
descending colon. There is no gross pneumoperitoneum, however evaluation for
free intraperitoneal air is limited on supine radiographs.
|
19926355-RR-13
| 19,926,355 | 20,454,530 |
RR
| 13 |
2149-09-30 08:16:00
|
2149-09-30 11:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with Crohn's disease, admitted with a abdominal
pain and diarrhea suspicious for Crohn's flare. Work up for potentially
initiating anti TNF therapy.// CXR workup prior to anti TNP therapy CXR
workup prior to anti TNP therapy
IMPRESSION:
There are no prior chest radiographs available for review. Left lower lobe
atelectasis, chronicity indeterminate, is reflected in elevation of left
hemidiaphragm, could be due to splinting from abdominal pain. Lungs otherwise
clear. Heart size normal. No pleural abnormality.
|
19926655-RR-10
| 19,926,655 | 28,059,348 |
RR
| 10 |
2136-09-16 07:23:00
|
2136-09-16 09:39:00
|
INDICATION: History of leukemia with weakness, status post fall. Now with
right hip pain. Evaluate for fracture.
COMPARISON: None.
AP PELVIS, ONE VIEW: There is no acute fracture or dislocation. Mild
degenerative changes of both femoroacetabular joints are noted. Marked
degenerative changes of the lower lumbar spine are seen. Vascular
calcifications are present.
IMPRESSION: No fracture or dislocation.
|
19926655-RR-11
| 19,926,655 | 28,059,348 |
RR
| 11 |
2136-09-16 07:23:00
|
2136-09-16 09:44:00
|
INDICATION: History of leukemia with weakness, status post fall. Evaluate
for trauma or acute cardiac/pulmonary process.
COMPARISON: Chest radiograph from ___.
FINDINGS: A single AP radiograph of the chest was obtained. There has been
interval resolution of previously seen bibasilar heterogeneous opacities on
radiographs from ___. The lungs are clear. Moderate
cardiomegaly is unchanged. The mediastinal contours are normal. There are no
pleural effusions. No pneumothorax is seen. An old posterior right fifth rib
fracture is noted, as before. The bony thorax is otherwise grossly intact.
IMPRESSION:
1. No acute cardiac or pulmonary process.
2. Unchanged moderate cardiomegaly.
|
19926727-RR-10
| 19,926,727 | 25,546,472 |
RR
| 10 |
2185-05-22 08:17:00
|
2185-05-22 08:41:00
|
HISTORY: ___ male with left leg edema and calf pain. Rule out DVT.
COMPARISON: None.
FINDINGS:
Grayscale, color, and spectral Doppler evaluation was performed of the left
lower extremity veins. There is normal phasicity of the common femoral veins
bilaterally. There is normal compression and augmentation of the left common
femoral, proximal femoral, mid femoral, distal femoral, popliteal, posterior
tibial, and peroneal veins.
IMPRESSION:
No evidence of DVT in the left lower extremity.
|
19926727-RR-11
| 19,926,727 | 25,546,472 |
RR
| 11 |
2185-05-30 20:05:00
|
2185-05-31 12:37:00
|
LEFT KNEE
INDICATION: History of gout, left knee swelling with negative fluid.
COMPARISON: ___.
FINDINGS: Mild periarticular soft tissue swelling. Suspicion of joint
effusion is strong. The pre-existing minimal patellofemoral spurring has
minimally increased in severity. The joint space is normal and shows no
evidence of major degenerative changes. There is no safe evidence of any
meniscal calcification. The cortical surfaces are intact. No evidence of
fractures. No erosions potentially indicative of a chronic inflammatory joint
disease.
|
19926727-RR-12
| 19,926,727 | 21,367,380 |
RR
| 12 |
2185-06-07 20:26:00
|
2185-06-07 21:10:00
|
EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: Chest pain, recent pericardial effusion.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. No focal
consolidation, pleural effusion, or pneumothorax is seen. The cardiac
silhouette is top normal to mildly enlarged but decreased in size as compared
to ___. No overt pulmonary edema is seen. The mediastinal contours are
unremarkable.
IMPRESSION: Top normal to mildly enlargement of the cardiac silhouette,
decreased in size as compared to the prior study.
|
19926727-RR-35
| 19,926,727 | 29,182,633 |
RR
| 35 |
2190-10-07 18:03:00
|
2190-10-07 18:59:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB, weakness// r/o acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Left-sided large-bore catheter is again seen, terminating in the right atrium.
There is mild interstitial pulmonary edema a central pulmonary vascular
congestion. Slight blunting of the costophrenic angles suggests trace pleural
effusions. No definite focal consolidation is seen. There is no evidence of
pneumothorax. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
Mild interstitial pulmonary edema with central pulmonary vascular congestion,
increased compared the prior study.
Trace bilateral pleural effusions.
|
19926727-RR-38
| 19,926,727 | 25,228,652 |
RR
| 38 |
2191-10-31 13:54:00
|
2191-10-31 15:00:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with cough and new phlegm production and dyspnea on
dialysis with missed dialysis today// eval for PNA vs pulm edema
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
No focal consolidation, pleural effusion, or evidence of pneumothorax is seen.
Previously seen vascular congestion on priors x-ray from ___ year prior has
improved. Cardiac silhouette size is borderline to mildly enlarged.
Mediastinal contours are stable.
IMPRESSION:
No focal consolidation. Minimal pulmonary vascular congestion without overt
pulmonary edema.
|
19926727-RR-39
| 19,926,727 | 25,228,652 |
RR
| 39 |
2191-10-31 16:23:00
|
2191-10-31 18:28:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with RUE AV graft and acute onset swelling. Plan
for ___ fituolgram possibly outpatient// eval for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Prior ultrasound from ___
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right brachiocephalic AV graft is patent throughout without evidence of
thrombosis. There is mild subcutaneous edema within the right upper extremity
near the graft. Wall to wall flow is seen within brachial, axillary, and
internal jugular veins. Evaluation for compression of the brachial and
axillary veins is limited due to edema and patient discomfort.
IMPRESSION:
1. Patent right brachiocephalic AV graft.
2. No evidence of deep vein thrombosis in the right upper extremity, though
exam limited for evaluation of compressibility of the axillary and brachial
veins.
|
19926727-RR-40
| 19,926,727 | 25,228,652 |
RR
| 40 |
2191-11-01 07:19:00
|
2191-11-01 10:28:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with AV fistula worsening arm swelling. Interval
change.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The right basilic,
and cephalic veins are patent, compressible and show normal color flow.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
19926727-RR-42
| 19,926,727 | 28,936,456 |
RR
| 42 |
2192-04-05 13:29:00
|
2192-04-05 14:08:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with sob // ?acute process
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is mild to moderately enlarged, unchanged. The mediastinal and
hilar contours are unremarkable. The pulmonary vasculature is normal. Lungs
are clear. No pleural effusion or pneumothorax is seen. There are no acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19926727-RR-43
| 19,926,727 | 28,936,456 |
RR
| 43 |
2192-04-05 12:30:00
|
2192-04-05 14:08:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with R arm swelling // ?DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Prior venous duplex of the right upper extremity dated ___..
FINDINGS:
There is normal flow in the bilateral subclavian veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, and compressibility. Pulsatile flow is seen in the right
axillary vein and brachial veins. The right axillary, brachial, basilic, and
cephalic veins are patent, compressible and show normal color flow.
The dialysis fistula/graft is not fully evaluated however appears patent where
seen.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
19926727-RR-9
| 19,926,727 | 25,546,472 |
RR
| 9 |
2185-05-21 14:38:00
|
2185-05-21 15:23:00
|
HISTORY: ___ male with worsening shortness of breath and cough for 2
weeks.
COMPARISON: ___.
FINDINGS:
Frontal and lateral views of the chest. There are new small bilateral
effusions. There is mild engorgement of the central vasculature and
enlargement of the azygous and suggesting mild fluid overload. Cardiac
silhouette is enlarged, slightly more so on compared to prior poor. No acute
osseous abnormality detected.
IMPRESSION:
New mild fluid overload and small effusions. No consolidation.
|
19926820-RR-11
| 19,926,820 | 27,364,080 |
RR
| 11 |
2162-07-05 09:09:00
|
2162-07-05 12:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with hx ETOH cirrhosis with worsening jaundice, marked epig
COMPARISON: ___
FINDINGS:
AP portable upright view of the chest. Lung volumes are low. Overlying EKG
leads are present. Heart size cannot be reliably assessed given low lung
volumes. There is no convincing evidence for pneumonia or edema. No large
effusion or pneumothorax is seen. The mediastinal contour is unchanged. Bony
structures are intact.
IMPRESSION:
No acute findings on this limited chest radiograph.
|
19926820-RR-12
| 19,926,820 | 27,364,080 |
RR
| 12 |
2162-07-05 11:25:00
|
2162-07-05 12:36:00
|
EXAMINATION: CT abdomen and pelvis without contrast
INDICATION:
___ with ETOH cirrhosis w/ worsening jaundice, recent fall, epig-> LUQ TTP. No
obvious large ascites on bedside ultrasound. Evaluate for extravasation,
colitis, cholecystitis, anterior L lower rib injury.
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. Coronal and sagittal bone reformats were provided and reviewed on
PACS. Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,309 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of
pleural or pericardial effusion. Coronary artery calcifications are noted.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken and has a nodular contour, which is
compatible with cirrhosis.There are perisplenic varices. 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
is within normal limits. There is no ascites.
PANCREAS: The pancreas has normal attenuation throughout, 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 is enlarged, and measures 13.7 cm.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a hiatal hernia. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: There is a small diverticulum noted in the dome of the bladder. The
distal ureters are unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Ectasia of the common iliac arteries, measure up to 1.5 cm and 1.6
cm on the right and left respectively. There is no abdominal aortic aneurysm.
Mild atherosclerotic disease is noted.
BONES: There are acute anterior left seventh through ninth rib fractures.
SOFT TISSUES: A small umbilical hernia containing fat is noted. Bilateral
small fat containing inguinal hernias are noted and is status-post left
inguinal hernia repair.
IMPRESSION:
1. Acute left seventh through ninth anterior rib fractures.
2. Cirrhotic liver with mild splenomegaly. No ascites.
3. Ectatic common iliac arteries.
|
19926820-RR-13
| 19,926,820 | 27,364,080 |
RR
| 13 |
2162-07-05 17:18:00
|
2162-07-05 18:44:00
|
INDICATION: ___ year old man with right IJ catheter in place. // Please
evaluate location of right IJ catheter. Contact name: ___ , ___:
___
TECHNIQUE: AP portable chest radiograph
COMPARISON: Chest radiograph and CT scan of the abdomen and pelvis dated ___
FINDINGS:
Interval placement of a right internal jugular central venous catheter, the
tip projecting over the cavoatrial junction. There is no focal consolidation,
pneumothorax or pleural effusion identified. Minimal bibasilar atelectasis.
The size the cardiac silhouette is mildly enlarged.
The known acute left rib fractures were better evaluated on the earlier CT
scan.
IMPRESSION:
Interval placement of a right internal jugular central venous catheter, the
tip projecting over the cavoatrial junction.
Minimal bibasilar atelectasis. The known acute left rib fractureswere better
evaluated on today's CT scan of the abdomen and pelvis.
|
19926820-RR-14
| 19,926,820 | 27,364,080 |
RR
| 14 |
2162-07-06 08:21:00
|
2162-07-06 12:00:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with history of EtOH cirrhosis with acute rise in
bilirubin. // Please evaluate liver parenchyma and for evidence of portal
venous thrombus.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound from ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with slow flow.
There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
Biliary sludge is seen.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, mildly enlarged measuring 13.6 cm.
KIDNEYS: Limited views of the left and right kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
2. Patent portal vein with slow flow.
3. Mild splenomegaly.
|
19926820-RR-16
| 19,926,820 | 27,364,080 |
RR
| 16 |
2162-07-07 08:38:00
|
2162-07-07 09:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with history of alcohol abuse with resultant
cirrhosis, w/ leukocytosis // ? PNA ? PNA
IMPRESSION:
Compared to chest radiographs ___ through ___.
Mild cardiomegaly is chronic. Lungs clear. No pleural abnormality. Hilar
and mediastinal contours normal.
|
19926820-RR-17
| 19,926,820 | 27,364,080 |
RR
| 17 |
2162-07-07 15:06:00
|
2162-07-07 16:46:00
|
EXAMINATION: US RENAL ARTERY DOPPLER
INDICATION: ___ year old man with alc hep, ___ to cr 9 // evaluate for renal
artery stenosis, w/ Doppler pls
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON: Liver gallbladder ultrasound from ___.
CT abdomen pelvis from ___.
FINDINGS:
The right kidney measures 11.8 cm. The left kidney measures 11.9 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Renal Doppler: Intrarenal arteries show normal waveforms with sharp systolic
peaks and continuous antegrade diastolic flow. The resistive indices of the
right intra renal arteries range from 0.70-0.75, which is normal to minimally
elevated. The resistive indices on the left range from 0.63-0.73, which is
normal to minimally elevated. Bilaterally, the main renal arteries are patent
with normal waveforms. The peak systolic velocity on the right is ___
centimeters/second. The peak systolic velocity on the left is approximately
150 centimeters/second. Main renal veins are patent bilaterally with normal
waveforms.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Normal renal ultrasound. No specific evidence of renal artery stenosis.
|
19926820-RR-18
| 19,926,820 | 27,364,080 |
RR
| 18 |
2162-07-09 11:58:00
|
2162-07-09 13:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with alcohol hepatitis, had NGT placed in
endoscopy // evaluate NGT placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
NG tube tip is out of view, below the diaphragm. No other interval change
from prior study.
|
19926820-RR-20
| 19,926,820 | 27,364,080 |
RR
| 20 |
2162-07-11 14:11:00
|
2162-07-11 15:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis, alc hepatitis, with new dobhoff
placement // evaluate dobhoff placement
TECHNIQUE: Chest single view
COMPARISON: ___ 12:12
FINDINGS:
Feeding tube tip is in the mid stomach. Shallow inspiration accentuates heart
size, pulmonary vascularity. Mild left basilar opacity, likely atelectasis,
consider pneumonitis in the appropriate clinical setting, more prominent since
prior. Right lung is clear.
IMPRESSION:
Feeding tube tip in the mid stomach. Mild left basilar opacity, likely
atelectasis, consider pneumonitis in the appropriate clinical setting
|
19926820-RR-21
| 19,926,820 | 27,364,080 |
RR
| 21 |
2162-07-12 11:09:00
|
2162-07-12 15:42:00
|
EXAMINATION: Post pyloric advancement of NG tube
INDICATION: ___ year old man with alc cirrhosis, alc hepatitis requiring
dobhoff for nutrition // please advance already placed tube post-pyloric,
with bridle if possible pls
DOSE: Acc air kerma: 14 mGy; Accum DAP: 333.1 uGym2; Fluoro time: 01:00
COMPARISON: None.
FINDINGS:
The nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, the existing Dobhoff feeding tube was advanced
post-pylorically using a guidewire.
10 cc of Optiray contrast were used to confirm post pyloric placement. Final
fluoroscopic spot images demonstrated the tip of the feeding tube in the third
portion of the duodenum.
The feeding tube was affixed to the patient's nose using tape.
IMPRESSION:
Successful post-pyloric advancement of a Dobhoff feeding tube. The tube is
ready to use.
|
19926820-RR-23
| 19,926,820 | 27,364,080 |
RR
| 23 |
2162-07-15 14:06:00
|
2162-07-15 14:56:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with alcoholic hepatitis HFrEF with rising
leukocytosis // evidence of infiltrate or atelectasis evidence of
infiltrate or atelectasis
IMPRESSION:
Compared to chest radiographs starting ___, most recently ___. Mild cardiomegaly is chronic. Pulmonary vasculature is
unremarkable. Lungs are clear. No pleural abnormality. Feeding tube passes
into the stomach and out of view
|
19926820-RR-24
| 19,926,820 | 27,364,080 |
RR
| 24 |
2162-07-15 14:18:00
|
2162-07-15 15:51:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with alcoholic cirrhosis here with alcoholic
hepatitis with rising leukocytosis // evidence of ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
Transverse ultrasound images were obtained of the 4 quadrants of the abdominal
cavity. No intra-abdominal free fluid is identified.
IMPRESSION:
No evidence of ascites.
|
19926820-RR-25
| 19,926,820 | 27,364,080 |
RR
| 25 |
2162-07-23 14:26:00
|
2162-07-23 15:11:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with alcoholic hepatitis, ___, HFrEF, now with
worsening cough. Evaluate for infection or volume overload.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph of ___.
FINDINGS:
Mild cardiomegaly is unchanged. There is new mild pulmonary edema, evidenced
by peribronchial cuffing and increased interstitial lung markings. No new
focal consolidation, pleural effusion, or pneumothorax. Lung volumes are
slightly lower. Enteric tube courses below the left hemidiaphragm and out of
view.
IMPRESSION:
New mild pulmonary edema, evidenced by peribronchial cuffing and increased
interstitial lung markings. No new focal consolidation.
|
19926820-RR-26
| 19,926,820 | 27,364,080 |
RR
| 26 |
2162-07-24 15:12:00
|
2162-07-24 16:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new NGT // NGT placement
TECHNIQUE: Chest single view
COMPARISON: ___ 14:29
FINDINGS:
Enteric tube tip is well below diaphragm, tip not included on the radiograph.
Shallow inspiration accentuates heart size, pulmonary vascularity, which are
prominent and stable since prior. Stable mild interstitial prominence.
IMPRESSION:
Enteric tube tip well below diaphragm.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.