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|---|---|---|---|---|---|---|---|
19926820-RR-27
| 19,926,820 | 27,364,080 |
RR
| 27 |
2162-07-26 16:06:00
|
2162-07-26 16:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis now with expiratory wheezes on
exam // ?pulm edema
IMPRESSION:
In comparison to ___, lung volumes remain relatively low,
accentuating the cardiac silhouette and resulting in crowding bronchovascular
structures, particularly at the lung bases. There is no radiographic evidence
of pulmonary edema or new areas of consolidation to suggest pneumonia.
|
19926820-RR-28
| 19,926,820 | 27,364,080 |
RR
| 28 |
2162-07-27 09:39:00
|
2162-07-27 11:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis and new shortness of breath at
rest // ?pulmonary edema or pleural effusions?
IMPRESSION:
In comparison to previous radiograph of 1 day earlier, the cardiac silhouette
remains enlarged. Mild pulmonary vascular congestion is present without overt
pulmonary edema. No focal areas of consolidation are evident within the
lungs.
|
19926820-RR-29
| 19,926,820 | 27,364,080 |
RR
| 29 |
2162-07-27 14:52:00
|
2162-07-27 15:26:00
|
EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old man with alcohol cirrhosis, worsening course //
evaluate ascites; pvt
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdomen ultrasound ___
FINDINGS:
LIVER: The hepatic parenchyma is coarse and nodular consistent the patient's
known cirrhosis. The contour of the liver is nodule. There is no focal liver
mass. There is a moderate volume of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
SPLEEN: The spleen is again noted to be enlarged.
DOPPLER EXAMINATION: The main and right portal veins are patent with
hepatopetal flow. The left portal vein and left hepatic vein could not be
identified due to motion artifact. The middle and right hepatic veins are
also patent. Appropriate arterial waveforms are seen in the main hepatic
artery.
IMPRESSION:
1. No portal vein thrombus identified.
2. Coarsened nodular hepatic architecture consistent with the patient's known
cirrhosis.
3. Splenomegaly.
4. Moderate ascites.
|
19926992-RR-11
| 19,926,992 | 23,088,200 |
RR
| 11 |
2158-05-29 16:54:00
|
2158-05-29 19:53:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with afib s/p fall on ___ on warfarin, son concern for
decrease mental status and decrease po intkae // ct head rule out
intracranial hemorrhage c-spine rule out fratureCXR eval for worsening pna
COMPARISON: Chest CT from ___.
FINDINGS:
AP upright and lateral views of the chest provided. Retrocardiac opacity with
an air-fluid level is compatible with known hiatal hernia. There is a small
right pleural effusion. The lungs appear clear without convincing sign of
pneumonia or overt edema. Cardiomediastinal silhouette appears within normal
limits. No acute osseous abnormality.
IMPRESSION:
Hiatal hernia, small right pleural effusion. No overt edema or pneumonia.
|
19926992-RR-12
| 19,926,992 | 23,088,200 |
RR
| 12 |
2158-05-29 17:25:00
|
2158-05-29 17:55:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Status post fall 5 days prior with decreased mental status and PO
intake, in a patient with atrial fibrillation on anticoagulation.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 52.9 mGy-cm
CTDI: 891.9 mGy
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Prominent
ventricles and sulci are suggestive of age-related involutional change.
Periventricular white matter hypodensities are consistent with severe chronic
small vessel ischemic disease. No osseous abnormalities seen. There is mild
mucosal thickening in the right maxillary sinus. The other visualized
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
orbits are unremarkable.
IMPRESSION:
1. No acute infarct, hemorrhage, or fracture.
2. Age-related involutional changes and sequela of chronic small vessel
ischemic disease.
|
19926992-RR-13
| 19,926,992 | 23,088,200 |
RR
| 13 |
2158-05-29 17:25:00
|
2158-05-29 17:59:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: Status post fall 5 days prior with decreased mental status and PO
intake, in a patient with atrial fibrillation on anticoagulation.
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 36.7 mGy
DLP: 710.3 mGy-cm
COMPARISON: None
FINDINGS:
Alignment is normal. No fractures are identified. There is no evidence of
spinal canal or neural foraminal narrowing. There is no evidence of infection
or neoplasm.
IMPRESSION:
No acute fracture, malalignment, or prevertebral soft tissue abnormality.
|
19926992-RR-14
| 19,926,992 | 23,088,200 |
RR
| 14 |
2158-05-29 21:15:00
|
2158-05-29 22:07:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ women with hypotension, generalize weakness and
lethargy, question acute intra-abdominal process.
TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed without
contrast. Multiplanar reformations were provided. IV contrast withheld due
to compromised renal function.
DOSE: DOSE: 486 mGy-cm
COMPARISON: Abdominal MRI from ___, PET-CT from ___.
FINDINGS:
Lung Bases: There is a large hiatal hernia again seen. Tiny right pleural
effusion noted. Imaged portion of the heart unremarkable. The imaged lung
bases are clear.
Abdomen: The unenhanced appearance of the liver is normal. The gallbladder is
unremarkable. The pancreas is atrophic. Known pancreatic IPMN not visualized
on this non contrast exam. The spleen appears normal. Dense aortic
atherosclerotic calcification is noted without aneurysmal dilation. There is
no retroperitoneal lymphadenopathy or hematoma. Adrenal glands are normal
bilaterally. The kidneys appear unremarkable.
Pelvis: Loops of small and large bowel demonstrate no signs of ileus or
obstruction. A candidate appendix is seen on series 2, image 55 appearing
normal. Large fecal loading in the colon noted most severe in the rectum.
There is mild perirectal fat stranding of the possibility of mild proctitis is
raised. Foley catheter seen within the decompressed bladder. No free pelvic
fluid. No free air.
Bones: No worrisome lytic or blastic osseous lesion is seen. Diffuse bony
demineralization is noted. 3 pins stabilize the right femoral neck. There is a
grade 1 anterolisthesis of L4 on L5 which appears unchanged compared to ___ radiograph.
IMPRESSION:
1. Large fecal loading of the colon, most severe in the rectum, with probable
mild proctitis.
2. Large hiatal hernia.
|
19926992-RR-15
| 19,926,992 | 23,088,200 |
RR
| 15 |
2158-06-01 11:49:00
|
2158-06-01 15:02:00
|
INDICATION: New infection.
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal and lateral chest radiographs.
IMPRESSION:
The heart is mildly enlarged, slightly increased in size since ___. There is increased central pulmonary vascular congestion, without overt
edema. There is no pneumothorax, focal consolidation, or pleural effusion.
Moderate degenerative changes throughout the thoracic spine appear stable.
|
19926992-RR-16
| 19,926,992 | 23,088,200 |
RR
| 16 |
2158-06-01 11:15:00
|
2158-06-01 12:18:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with dementia, AF on coumadin, and multiple
other medical problems who was admitted for AMS following OSH treatment for
PNA. Of note, fall w/ headstrike 4 days PTA, no hemorrhage visualized on CT in
ED on day of admission. Now with AMS and INR 4.1. // Evaluate for acute or
subacute hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 785 mGy-cm
CTDI: 55 mGy
COMPARISON: Prior head CT from ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass effect.
Prominence of ventricles and sulci is consistent with age related involutional
changes. Periventricular white matter hypodensities are likely the sequela of
severe chronic small vessel ischemic disease.
No osseous abnormalities seen. There is mild mucosal thickening of the
anterior ethmoidal air cells and right maxillary sinus. The remaining
visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear. The orbits are unremarkable. Dense atherosclerotic calcifications noted
a the carotid siphons bilaterally.
IMPRESSION:
No acute intracranial hemorrhage or mass effect.
Other details as above.
Correlate clinically the to decide on the need for further workup or followup.
|
19927180-RR-21
| 19,927,180 | 26,488,138 |
RR
| 21 |
2178-03-21 13:39:00
|
2178-03-21 14:23:00
|
HISTORY: Known fibroids presenting with heavy vaginal bleeding.
COMPARISON: MRI dated ___ and ultrasound dated ___.
TECHNIQUE: Grayscale and Doppler ultrasound images of the pelvis were
obtained by transabdominal approach followed by transvaginal approach for
further delineation of uterine anatomy.
FINDINGS:
LMP ___.
There is an enlarged uterus which measures 11 x 8.3 x 14.5 cm. There are
multiple masses consistent with fibroids. The largest fibroid is located in
the fundus of the uterus and measures 5.5 x 5.7 x 5.7 cm and is unchanged
since the previous MRI. There is a 1.4 cm hyperechoic focus within the
posterior body of the uterus which demonstrates posterior acoustic shadowing
and likely represents a partially calcified fibroid. The endometrium is
homogeneous and measures 5 mm.
The ovaries were not visualized. The right-sided dermoid cyst evident on the
previous MRI is not identified on current examination. No adnexal masses were
identified. No free fluid.
IMPRESSION:
Fibroid uterus, unchanged since the previous MRI.
|
19927870-RR-10
| 19,927,870 | 23,539,302 |
RR
| 10 |
2124-08-27 12:21:00
|
2124-08-27 12:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with cough // ?pna
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
There is persistent hyperinflation of the lungs which may be due to chronic
obstructive pulmonary disease. No focal consolidation is seen. There is no
pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
Hyperinflated lungs suggesting COPD. No focal consolidation.
|
19927870-RR-11
| 19,927,870 | 23,539,302 |
RR
| 11 |
2124-08-29 00:06:00
|
2124-08-29 10:00:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old R handed man with CKD, prostate CA, HTN intermittent
altered mental status, R sided weakness (arm and leg), no recent falls or
trauma. // evidence of stroke, explanation of R sided weakness
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique.
COMPARISON: No prior MRI of the head. Prior CT scan of the head dated ___.
FINDINGS:
The ventricles and sulci are enlarged likely reflective of age related
parenchymal volume loss. There is no evidence of hemorrhage, edema, masses,
mass effect, or acute infarction. There is confluent T2/FLAIR signal
hyperintensity in the periventricular, subcortical, and deep white matter
which is nonspecific but likely on the basis of chronic small vessel ischemic
disease. There is also mild T2/FLAIR signal hyperintensity in the central pons
which also is likely secondary to chronic small vessel ischemic disease. There
is a more focal region of T2 hyperintensity in the pons (series 9, image 11)
disease which may reflect a prior region of infarction. There are a few
scattered foci of susceptibility artifact in the right insula, medial left
temporal lobe, palms, and right cerebellar hemisphere. There is a prominent
CSF space intensity noted in the right aspect of the sella which may represent
a partially empty sella versus a sellar arachnoid cyst. Vascular flow voids
are preserved. Patient is status post right lens replacement. There is mucosal
thickening within the ethmoid air cells. The remaining paranasal sinuses are
clear. There is a small amount of fluid in the right mastoid air cells.
IMPRESSION:
1. No evidence of acute infarction or acute hemorrhage.
2. Generalized parenchymal volume loss.
3. Confluent T2/FLAIR signal hyperintensity in the white matter of the
bilateral cerebral hemispheres which is nonspecific but likely on the basis of
chronic small vessel ischemic disease.
4. Multiple small foci of susceptibility artifact in the bilateral cerebral
hemispheres and pons as detailed above. Findings may represent chronic
microhemorrhage or amyloid angiography.
5. Slightly prominent empty sella versus arachnoid cyst. If clinical concern
over this finding warrants, a dedicated MR of the pituitary gland could be
obtained for further evaluation.
|
19928034-RR-18
| 19,928,034 | 23,557,338 |
RR
| 18 |
2148-08-17 09:18:00
|
2148-08-17 09:33:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with febrile neutropenia. // Evaluate for
pneumonia/infectious process. Evaluate for pneumonia/infectious process.
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear within the
limitations of chest radiograph technique. There is no pleural effusion.
There is no pneumothorax.
If clinically warranted, correlation with chest CT to exclude the possibility
of radiographically occult neutropenic pneumonia is to be considered.
|
19928034-RR-19
| 19,928,034 | 29,255,503 |
RR
| 19 |
2148-08-24 05:25:00
|
2148-08-24 07:40:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with fever without source, on chemotherapy. Evaluate for
pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Low lung volumes. There is consolidation in
the left lower lobe, concerning for pneumonia. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities. Multilevel
degenerative changes of the visualized spine.
IMPRESSION:
Consolidation in the left lower lobe, concerning for pneumonia.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 9:23 AM, 3 minutes
after discovery of the findings.
|
19928034-RR-20
| 19,928,034 | 29,255,503 |
RR
| 20 |
2148-08-24 20:33:00
|
2148-08-24 22:08:00
|
INDICATION: ___ with s/p R CVL placement // eval CVL placement
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___ at 05:22.
FINDINGS:
New right-sided central venous catheter seen with tip in the region of the RA
SVC junction. There is no visualized pneumothorax. Despite lower lung
volumes with bronchovascular crowding, there has been interval development of
perihilar opacities increased interstitial markings suggesting pulmonary
edema. Cardiomediastinal silhouette is within normal limits. No acute
osseous abnormalities.
|
19928034-RR-21
| 19,928,034 | 29,255,503 |
RR
| 21 |
2148-08-26 15:55:00
|
2148-08-26 16:28:00
|
INDICATION: ___ year old woman with concern for left lower lobe pneumonia,
however no clinical evidence of PNA except for fever without other source. //
Any changes in left sided opacity?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Interval removal of the right internal jugular central venous catheter.
There has been interval resolution of the pulmonary edema. A small left
pleural effusion with subjacent atelectasis/consolidation is noted. The right
lung is clear. There is no pneumothorax identified.
The size of the cardiac silhouette is within normal limits.
IMPRESSION:
Trace left pleural effusion with subjacent atelectasis and/or consolidation.
|
19928034-RR-24
| 19,928,034 | 28,270,387 |
RR
| 24 |
2148-09-30 07:49:00
|
2148-09-30 09:17:00
|
EXAMINATION: Chest radiograph.
INDICATION: History: ___ with DLBCL on R-CHOP, last dose ___ presenting
with fever. // R/o PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
A right chest port terminates in the low SVC. The heart is within normal
limits. There is no pleural effusion. Mild prominence of the pulmonary veins
is unchanged from ___. There is no pneumothorax. There is no
focal airspace opacity.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19928034-RR-43
| 19,928,034 | 28,000,352 |
RR
| 43 |
2149-02-11 10:39:00
|
2149-02-11 11:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with CNS lymphoma admitted with acute worsening
of aphasia. Neutropenic// Eval for infectious etiology of recrudescence of
neuro symptoms
IMPRESSION:
In comparison with study of ___, there is little overall change. Again
there are low volumes that accentuate the transverse diameter of the heart.
Increased opacification at the right base most likely represents crowding of
vessels. In the appropriate clinical setting, it would be difficult to
unequivocally exclude superimposed pneumonia, especially in the absence of a
lateral view.
The right IJ Port-A-Cath remains in place.
|
19928034-RR-44
| 19,928,034 | 28,000,352 |
RR
| 44 |
2149-02-15 12:34:00
|
2149-02-15 13:45:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with worsening word finding difficulty, known
CNS involvement of bone marrow lymphoma and edema.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 752 mGy-cm.
COMPARISON: Head CT from ___.
Brain MRI from ___.
FINDINGS:
No evidence of intracranial hemorrhage. There is edema within the left
parietal, temporal, white matter, and swelling within the bilateral splenium
of the corpus callosum, similar to the recent CT and MRI. Some of the
enhancing areas on the ___ MRI, corresponding to the known lymphoma,
are mildly hyperdense on the present CT, for example in the right splenium of
the corpus callosum on image 4:18, and in the left periatrial white matter on
image 4:17. There persistent effacement of the occipital horn of the left
lateral ventricle. There is no shift of midline structures.
No suspicious bone lesion is seen. Paranasal sinuses and mastoid air cells
appear grossly well-aerated.
IMPRESSION:
No acute hemorrhage. The extent of edema in bilateral splenium of the corpus
callosum and left cerebral hemisphere is similar to the ___ CT.
|
19928152-RR-10
| 19,928,152 | 22,631,194 |
RR
| 10 |
2149-07-06 13:40:00
|
2149-07-06 15:29:00
|
EXAMINATION: ULTRASOUND-GUIDED RENAL BIOPSY BY NEPHROLOGIST
INDICATION: ___ year old man history of DM presented with worsening renal
function(from 1.2-2.2 in 3 months with 10g proteinuria// etiology for
worsening renal function
TECHNIQUE: Real-time grayscale ultrasound imaging for biopsy guidance.
COMPARISON: Renal ultrasound ___
OPERATORS: Dr. ___ Dr. ___ sonographic guidance for biopsy
that was performed by the Nephrology team.
FINDINGS:
This procedure was performed by the Nephrology team; please see Nephrology
procedure note for further details.
Real-time ultrasound guidance for percutaneous renal biopsy was provided by
radiologist. The lower pole of the left kidney was targeted and 2 biopsy
passes performed.
SEDATION: Moderate sedation was provided by administering divided doses of
Fentanyl and Versed throughout the total intra-service time of 12 minutes
during which the patient's hemodynamic parameters were continuously monitored
by an independent, trained radiology nurse.
IMPRESSION:
Ultrasound guidance for percutaneous left kidney biopsy.
|
19928152-RR-8
| 19,928,152 | 22,631,194 |
RR
| 8 |
2149-06-30 02:00:00
|
2149-06-30 02:26:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ male with acute renal failure. Eval for obstruction
or hydro.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 13.9 cm. The left kidney measures 14.2 cm. There
are small shadow forming echogenic foci in the left kidney likely representing
nonobstructive calculi. There is no hydronephrosis.
The bladder is moderately well distended and normal in appearance. Both
ureteral jets are visualized.
IMPRESSION:
1. No hydronephrosis. Both ureteral jets are visualized.
2. Nonobstructive nephrolithiasis of the left kidney.
|
19928152-RR-9
| 19,928,152 | 22,631,194 |
RR
| 9 |
2149-07-02 15:47:00
|
2149-07-02 16:37:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ w/ HTN, HLD, ___ (Plavix), MI ___ process, clean
coronaries ___ and T2DM who p/w two weeks of cough and dyspnea and found to
have pulmonary infiltrates and acute kidney injury concerning for GN.//
re-evaluate infiltrates. Considering bronch if infiltrates still persist
TECHNIQUE: Multi detector CT of the chest was performed without the
administration of intravenous contrast. Axial coronal and sagittal
reconstructions were acquired. Maximum intensity projections were also
acquired
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 40.2 cm; CTDIvol = 15.1 mGy (Body) DLP = 605.3
mGy-cm.
Total DLP (Body) = 605 mGy-cm.
COMPARISON: No prior CT chest is available for comparisons.
FINDINGS:
THORACIC INLET: The thyroid is unremarkable. There are no enlarged
supraclavicular lymph nodes
BREAST AND AXILLA : There are no enlarged axillary lymph nodes.
MEDIASTINUM: The multiple small mediastinal lymph nodes. A right paratracheal
node measures 12 mm. A pre-vascular lymph node measures 10 mm. The
subcarinal nodes measure up to 1.9 cm. There is moderate cardiomegaly. There
is moderate coronary artery calcification. The main pulmonary artery measures
3.7 cm. The aorta is normal in caliber. There is mild atherosclerotic
calcification involving the descending thoracic aorta. There is no
pericardial effusion
PLEURA: There are small bilateral effusions right greater than left.
LUNG: There are multifocal bilateral parenchymal opacities in a bronchus
centric distribution a predominantly within the right upper lobe but also
within both lower lobes. Findings are suggestive of a multifocal pneumonia.
There is mild interstitial edema.
BONES AND CHEST WALL : Review of bones shows degenerative changes involving
the thoracic spine.
UPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of
splenomegaly. No focal liver lesions are seen.
IMPRESSION:
Bronchus centric opacities in the right upper lobe and both lower lobes
concerning for multifocal pneumonia.
Small bilateral effusions and mild interstitial edema.
Small mediastinal lymph nodes could be reactive.
|
19928285-RR-23
| 19,928,285 | 24,197,782 |
RR
| 23 |
2152-01-10 11:07:00
|
2152-01-10 12:09:00
|
INDICATION: Evaluation of patient status post liver biopsy with syncope.
COMPARISON: Chest radiograph from ___, Ct abdomen ___.
FINDINGS: There is mild bibasilar atelectasis; otherwise, the lungs are clear
with no evidence of consolidation, effusion, or pneumothorax.
Cardiomediastinal silhouette is normal. No acute fractures are identified.
No free air is noted under the hemidiaphragms. A tube is visualized overlying
the sternum in the lateral projection, is likely external to the patient, but
clinical correlation is recommended. Nodular opacity over left lung base is
likely nipple as this area of lung is clear on CT performed the same day.
Calcific densities are again noted in the region of the pancreatic tail and
consistent with patient's history of chronic pancreatitis.
IMPRESSION: No acute cardiopulmonary process.
|
19928285-RR-24
| 19,928,285 | 24,197,782 |
RR
| 24 |
2152-01-10 11:22:00
|
2152-01-10 12:15:00
|
INDICATION: Recent liver biopsy, now with hematocrit drop and abdominal pain.
Evaluate for RP hematoma for fluid around the liver.
COMPARISON: Ultrasound ___ and CT abdomen and pelvis ___.
TECHNIQUE: MDCT axial images were obtained from the dome of the liver to the
pubic symphysis without the administration of IV or oral contrast. Coronal
and sagittal reformations were provided and reviewed.
ABDOMEN: The visualized lung bases demonstrate dependent atelectasis without
pleural effusions or nodules. The heart is normal and there is no pericardial
effusion.
The liver contour is normal. Air within the gallbladder, common bile duct and
left lobe of the liver is compatible with prior sphincterotomy. Evaluation
for focal liver lesions is limited by the lack of IV contrast. Free fluid is
seen within the abdomen and demonstrates multiple degrees of attenuation. The
highest attenuating fluid is seen lateral to the liver. A cresent band medial
to this fluid surrounds the liver and is likely subcapsular. A high density
band of fluid is seen lateral to the spleen and tracks along the paracolic
gutter into the pelvis. Finally, a lower attenuating collection of fluid is
seen in the anterior abdomen. These are thought to represents various stages
of bleeding, the volume of which has increased since the day of biopsy.
The spleen and adrenal glands are normal. Diffuse calcifications are seen
throughout the entire pancreas compatible with known chronic pancreatitis.
Multiple simple cysts are seen throughout both kidneys; however, there is no
hydronephrosis or nephrolithiasis. Cortical thinning is again noted within
the left kidney. There is no retroperitoneal or mesenteric lymphadenopathy.
There is no free air. The small and large bowel are normal. Evaluation of
the intra-abdominal vasculature is limited by the lack of IV contrast. There
is no retroperitoneal hematoma. A small fat-containing umbilical hernia is
noted.
PELVIS: The bladder, sigmoid, and rectum are normal. A small amount of lower
attenuating free fluid is seen anterior to the bladder. There is no inguinal
or pelvic lymphadenopathy. The prostate is normal.
BONES: There are no suspicious osseous lesions.
IMPRESSION:
1. Moderate sized subcapsular hematoma and moderate to large amount of
hemoperitoneum with varying degrees of acuity. The volume of bleed has
increased since the day of biopsy.
2. Chronic pancreatitis.
3. Pneumobilia compatible with prior sphincterotomy.
These findings were discussed with Dr. ___ by Dr. ___ at 1520 on ___ by
telephone.
|
19928285-RR-25
| 19,928,285 | 24,197,782 |
RR
| 25 |
2152-01-12 14:02:00
|
2152-01-13 20:09:00
|
STUDY: Bilateral upper extremity venous duplex.
REASON: Preop vein mapping for dialysis access.
FINDINGS: Duplex was performed of bilateral upper extremity veins. Limited
views of the brachial and radial arteries were obtained bilaterally.
RIGHT: Phasic flow is seen in the subclavian vein. Triphasic flow is seen in
the brachial artery with a normal-appearing lumen without calcification;
however diameter was not measured. Thrombus is seen in upper arm basilic
vein. An IV is present in the forearm cephalic vein above the wrist. The
remainder of forearm cephalic diameters range from 1.4-2.0 mm. Upper arm
cephalic vein diameters range from 1.6-3.1 mm.
LEFT: Phasic flow is seen in the subclavian vein. Brachial artery has
triphasic waveform without calcification and a normal-appearing lumen,
although diameter was not measured. The cephalic vein is 1 mm or less
throughout the arm. The forearm basilic is small at the wrist at 1.6 mm, 4.7
mm at the antecubital fossa and 4.5-5.8 mm in the upper arm.
IMPRESSION: Small right cephalic vein. There is thrombus in the right
basilic vein at the axilla. The left cephalic is very small. The left
basilic has reasonable diameters from the mid forearm through the axilla.
|
19928285-RR-29
| 19,928,285 | 20,462,480 |
RR
| 29 |
2152-12-04 22:28:00
|
2152-12-04 22:35:00
|
HISTORY: Fever.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The cardiac silhouette size is borderline enlarged. Mediastinal and hilar
contours are normal. The pulmonary vascularity is normal. The lungs are
clear. No pleural effusion or pneumothorax is present. No acute osseous
abnormalities visualized. Degenerative spurring of the right
acromioclavicular joint is present.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19928323-RR-11
| 19,928,323 | 23,697,420 |
RR
| 11 |
2163-11-23 08:41:00
|
2163-11-23 10:18:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: ___ with right hip pain, evaluate for fracture.
TECHNIQUE: A single AP view radiograph of the pelvis as well as AP and
frog-leg view radiographs of the right hip.
COMPARISON: None.
FINDINGS:
There is no fracture, dislocation, or radiopaque foreign body. There is mild
loss of joint space bilaterally.
IMPRESSION:
Mild degenerative changes of the right hip without acute fracture.
|
19928323-RR-12
| 19,928,323 | 23,697,420 |
RR
| 12 |
2163-11-23 17:30:00
|
2163-11-23 20:43:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with seizure // ? eval left sided
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 5cc of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI ___.
FINDINGS:
There is persistent sulcal enhancement within the left frontal and left
cerebral hemispheres, not significantly changed when compared to prior exam.
Additionally, there is confluent T2/FLAIR signal hyperintensity/edema centered
predominantly within the left parietal lobe which is increased when compared
to prior exam. There are foci of gradient signal hypointensity throughout the
bilateral cerebral hemispheres indicating chronic microhemorrhage. There is
new gradient signal hypointensity within the left parietal lobe, indicating
interval hemorrhage. The overall appearance may represent metastatic disease
versus amyloid angiopathy related inflammation, less likely sarcoid or
lymphoma.
There are normal vascular flow voids. There is no evidence of acute infarct
based on diffusion-weighted imaging. Cerebral form foci of slow diffusion
within the left cerebral hemisphere may be related to subarachnoid blood
products. There are additional punctate in confluent subcortical and
periventricular T2/FLAIR hyperintensities which are nonspecific though may
relate to sequelae of chronic small vessel ischemic disease. There is diffuse
brain parenchymal volume loss.
The orbits, skull base, and paranasal sinuses appear unremarkable.
IMPRESSION:
1. Persistent left cerebral hemisphere sulcal effacement with interval
increase and left frontal and left parietal lobe edema, subarachnoid blood
products, and areas of more chronic micro-hemorrhage within the bilateral
cerebral hemispheres, including a new focus within left parietal lobe. The
overall findings may represent metastatic disease versus amyloid angiopathy
related inflammation, less likely sarcoid or lymphoma.
|
19928323-RR-13
| 19,928,323 | 23,697,420 |
RR
| 13 |
2163-11-24 11:25:00
|
2163-11-24 18:08:00
|
EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old woman with fall // r/o fracture
TECHNIQUE: Two views of the right knee.
COMPARISON: None available.
FINDINGS:
No fracture or dislocation. There are minimal spurs in the medial compartment
and minimal chondrocalcinosis. No suspicious lytic or sclerotic lesion is
identified. No joint effusion is seen. Vascular calcifications are noted. No
radiopaque foreign body.
IMPRESSION:
No acute fracture or dislocation. Mild degenerative changes of the knee.
|
19928323-RR-14
| 19,928,323 | 23,697,420 |
RR
| 14 |
2163-11-24 11:26:00
|
2163-11-24 16:20:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ year old woman with fall // r/o fracture
COMPARISON: None.
FINDINGS:
Extreme posterior edge of calcaneus excluded from the film. Allowing for
this, no fracture or dislocation detected involving the right ankle. The
mortise joint is congruent on these nonstress views. There is minimal
spurring along the distal tibia anteriorly and along the inferior calcaneus.
Vascular calcification is present.
IMPRESSION:
No fracture or dislocation detected. If symptoms persist, consider followup
radiographs in ___ days.
|
19928323-RR-15
| 19,928,323 | 23,697,420 |
RR
| 15 |
2163-11-26 09:05:00
|
2163-11-26 12:06:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with meningeal enhancement and small SDH //
r/o bleed or stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 7.2 s, 18.3 cm; CTDIvol = 55.3 mGy (Head) DLP =
1,009.3 mGy-cm.
Total DLP (Head) = 1,009 mGy-cm.
COMPARISON: ___ MRI brain, ___ noncontrast CT head
FINDINGS:
There is no evidence of acute major vascular territorial infarction or acute
intracranial hemorrhage. There is persistent mildly hyperdense cortical
thickening and sulcal effacement along the left parietal lobe (3:25) that is
unchanged from prior studies. Again seen is extensive left cerebral white
matter edema that is unchanged from the recent MRI dated ___. No new
loss of gray-white matter differentiation. Prominent ventricles and sulci are
likely due to age-related volume loss.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
Overall no significant interval change in extensive left cerebral white matter
edema and cortical thickening/sulcal effacement along the left parietal lobe
better characterized on MRI ___. No evidence of acute infarct or
hemorrhage.
|
19928323-RR-17
| 19,928,323 | 23,697,420 |
RR
| 17 |
2163-12-02 09:34:00
|
2163-12-02 12:09:00
|
EXAMINATION: Video oropharyngeal swallow study.
INDICATION: ___ woman with an enhancing meningeal lesion and right
sided weakness and chronic dysarthria.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
Fluoroscopy time is recorded as 2 min, 12 seconds.
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was laryngeal penetration noted with thin liquids, without
evidence of aspiration. No laryngeal penetration or aspiration was seen with
nectar thick liquids or mixed consistency solids. A mild amount of residual
contrast material seen in the piriform sinuses and valleculae is compatible
with some degree of pharyngeal stasis.
IMPRESSION:
1. Laryngeal penetration with thin liquids.
2. No gross aspiration.
3. Pharyngeal stasis.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19928728-RR-10
| 19,928,728 | 21,394,753 |
RR
| 10 |
2177-09-23 05:59:00
|
2177-09-23 13:33:00
|
INDICATION: Evaluate for vascular injury. Patient for fracture of C4
vertebra.
COMPARISON: CT of the C-spine from ___.
TECHNIQUE: Rapid axial imaging of the neck was performed from the skull base
through the aortic arch during infusion of 70 cc Omnipaque intravenous
contrast material. Images were processed on a separate workstation with
display of curved reformats, 3D volume-rendered images, and maximum intensity
projection images.
FINDINGS: The carotid and vertebral arteries and their major branches are
patent with no evidence of stenosis. A fracture through the left transverse
foramen of C4 is once again seen. There is no evidence of vertebral artery
injury at this location. There are minimal calcifications at the carotid
bifurcations bilaterally. The distal cervical internal carotid arteries
measure 4 mm in diameter on the left and 4 mm in diameter on the right. There
is no evidence of aneurysm formation or other vascular abnormality. At left
dominant vertebral artery configuration is noted.
Further review of the osseous structures once again demonstrates a fracture of
the right first rib. Scout images reveal abnormal intramedullary density with
thick trabeculation within the left humerus, suggestive of Paget's disease.
Further evaluation is advised. Within the visualized aspects of the lung
apices, there is left greater than right apical scarring.
IMPRESSION:
1. Acute fracture of the left transverse foramen of C4 without evidence of
vascular injury.
2. Right first rib fracture.
3. Probable Paget's disease of the bone involving the left humerus,
incompletely imaged.
|
19928728-RR-11
| 19,928,728 | 21,394,753 |
RR
| 11 |
2177-09-23 07:20:00
|
2177-09-23 09:46:00
|
INDICATION: Supine portable chest view was read in comparison with the most
recent radiograph done on the same day ___ hours apart.
FINDINGS: Endotracheal tube tip is 3.6 cm above the carina and is adequately
positioned. Bilateral lungs demonstrate diffuse interstitial opacities
concerning for interstitial edema, worse since prior radiograph acquired ___
hours apart. There are no other discrete opacities of concern. Heart size is
top normal. Mediastinal and hilar contours are unchanged. There is no
pneumothorax or pleural effusion. Diffuse increased density with lucency
within the left humeral shaft is probably sequelae of chronic infection and/or
left humeral surgery as reflected by the presence of a prosthetic device in
the left elbow joint and lower humerus on the CT topogram dated ___.
|
19928728-RR-12
| 19,928,728 | 21,394,753 |
RR
| 12 |
2177-09-24 04:33:00
|
2177-09-24 11:21:00
|
INDICATION: ___ woman status post fall with first rib fracture, now
intubated.
COMPARISON: ___ chest radiographs and CT.
FINDINGS: A single portable supine chest radiograph is obtained.
Endotracheal tube ends in the mid airway. An enteric tube projects over the
stomach. The lungs are well inflated. Blunting of the bilateral costophrenic
angles suggests small bilateral effusions. Aeration of the lungs has mildly
improved. Airspace opacities remain in the right lower lobe. Sclerotic
changes of the left humerus is unchanged. A nondisplaced right first rib
fracture noted on CT is not seen on radiography. Lower thoracic vertebral
compression fractures are again seen.
IMPRESSION:
Focal opacity in the right lower lobe may be atelectasis or developing
consolidation. Suggest attention on follow up radiography.
|
19928728-RR-13
| 19,928,728 | 21,394,753 |
RR
| 13 |
2177-09-23 10:03:00
|
2177-09-23 15:20:00
|
INDICATION: Evaluate for underlying aneurysm in patient with subarachnoid
hemorrhage following fall.
COMPARISON: CT head from ___ and outside hospital reference CT head
from the same day, ___ at 02:33, for which a radiologist's report was
not available for review.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed through
the head during infusion of 70 mL Omnipaque intravenous contrast material.
Images were processed on a separate workstation with display of curved
reformats, 3D volume-rendered images, and maximum intensity projection images.
FINDINGS: NECT OF THE HEAD: There is an enlarging subarachnoid hemorrhage
centered at the left operculum. There is increased attenuation of the blood
products at this location as well as new intraventricular extension as
evidenced by layering blood products in the occipital horn of the right
lateral ventricle. There is minimal effacement of the frontal horn of the
left lateral ventricle as well as the adjacent sulci. There is no shift of
midline structures. There is mucosal thickening and air-fluid levels in the
bilateral maxillary sinuses, several ethmoid air cells, and the left
sphenoidal sinus. Mastoid air cells are clear. There is no fracture
identified.
CTA HEAD: The carotid arteries and their major branches are patent with no
evidence of stenosis. There is no evidence of aneurysm formation or other
vascular abnormality within the vessels of the circle of ___. A left
vertebral dominant circulation is once again demonstrated. The intracranial
portion of the right vertebral artery is markedly diminutive, a congenital
variant. There is no evidence of vascular abnormality or aneurysm formation
within the intracranial portions of the bilateral vertebral arteries.
IMPRESSION:
1. Enlarging subarachnoid hemorrhage centered at the left operculum, with
minimal mass effect, and new extension into the intraventricular space.
2. No evidence of vascular malformation, aneurysm, or mass.
3. Paranasal sinus disease featuring mucosal thickening and air-fluid levels.
|
19928728-RR-14
| 19,928,728 | 21,394,753 |
RR
| 14 |
2177-09-23 15:34:00
|
2177-09-24 09:24:00
|
INDICATION: ___ woman with recent history of trauma. Evaluate for
ligamentous or spinal cord injury.
COMPARISON: Same day CT of the neck.
TECHNIQUE: Multiplanar multisequence images of the cervical and thoracic
spine were performed without contrast.
FINDINGS:
CERVICAL SPINE: There is grade 1 retrolisthesis of C4 on C5 and C5 on C6.
There is irregularity and abnormal signal of C4, C5, and C6 vertebral bodies.
The previously described fracture of the C4 left transverse foramen cannot be
appreciated in this exam. There is a 3 x 25 mm collection anterior to C3 and
C4 vertebral bodies. The cerebellar tonsils are displaced 1 cm inferiorly
through the foramen magnum. There is bilateral maxillary sinus disease. The
spinal cord demonstrates normal signal intensity. There is no evidence of
retropulsion.
At C2-3 and C3-4 levels, there is no significant disc bulge, spinal canal
stenosis, or neural foraminal narrowing.
At C4-5 level, there is a grade 1 retrolisthesis and mild right uncovertebral
and facet arthrosis causing mild narrowing of the right neural foramen.
From C5-6 level through C7-T1, there is no significant spinal canal stenosis
or neural foraminal narrowing.
THORACIC SPINE: There is abnormal signal of T4 and T5 vertebral bodies,
likely representing a mild compression fracture. There is a burst fracture of
T11 vertebral body with 40% loss of vertebral body height. There is a 7.5-mm
retropulsion of the superior endplate of T11 indenting the thecal sac and
flattening the spinal cord and causing mild spinal cord signal abnormality.
No other fracture is identified. The spinal cord terminates at L1-2 level.
There is bilateral small pleural effusion and lower lobe atelectasis. The
remaining levels demonstrate no significant evidence of spinal canal stenosis
and neural foraminal narrowing.
IMPRESSION:
1. The cervical spine demonstrates irregularity and abnormal signal of C4,
C5, and C6 vertebral bodies which may be degenerative in nature. The fracture
described at the left transverse foramen of C4 cannot be appreciated in this
MRI. There is a fluid collection in the prevertebral soft tissues measuring
2.4 x 0.25 cm anterior to C3 and C4. This may represent edema or fluid
collection related to the recent history of trauma. The cerebellar tonsils
are displaced 1 cm inferiorly through the foramen magnum which may be due to
Chiari 1 malformation or due to increased intracranial pressure related to the
intracranial hemorrhage.
2. The thoracic spine demonstrates a compression fracture of T11 vertebral
body with 7.5-mm retropulsion, causing deformity of the anterior aspect of the
spinal cord and mild abnormal signal in the spinal cord. Additionally, there
are nondisplaced fractures of T4 and T5 vertebral bodies. There is no
evidence of epidural hematoma.
3. Bilateral pleural effusion and atelectasis.
|
19928728-RR-15
| 19,928,728 | 21,394,753 |
RR
| 15 |
2177-09-23 17:34:00
|
2177-09-24 09:08:00
|
REASON FOR EXAMINATION: OG tube placement.
AP radiograph of the chest was reviewed in comparison to ___ obtained
earlier.
The ET tube tip is 4 cm above the carina. The NG tube tip is in the stomach.
Heart size is normal. Mediastinum is slightly widened, unchanged. As
compared to the prior study, there is slight interval improvement in
widespread parenchymal opacities which are still present, substantially
involving lungs bilaterally. Sclerosis within the left humerus is most likely
related to prior surgical treatment. They might potentially reflect improving
pulmonary edema, but attention to those areas to exclude the possibility of
infectious process is recommended.
As previously mentioned, the lower thoracic vertebral fractures can be seen on
current examination.
|
19928728-RR-16
| 19,928,728 | 21,394,753 |
RR
| 16 |
2177-09-24 07:26:00
|
2177-09-24 10:03:00
|
EXAM: CT of the head.
CLINICAL INFORMATION: Patient with injury, for further evaluation in
followup.
TECHNIQUE: Axial images of the head were obtained without contrast and
compared with the CT head from ___.
FINDINGS: Left frontal intraparenchymal blood products as well as
subarachnoid hemorrhage predominantly along the left cerebral hemisphere are
again identified. There has been some evolution of the blood products. There
is some blood seen within the occipital horn of the right lateral ventricle.
Overall, there has been no significant interval change. There is no midline
shift. The basal cisterns remain patent. There is fluid likely blood within
both maxillary sinuses.
IMPRESSION: Overall, no significant change in the intraparenchymal and
subarachnoid blood compared to the prior CT. Small amount of intraventricular
blood also is seen. No evidence of hydrocephalus or midline shift.
|
19928728-RR-17
| 19,928,728 | 21,394,753 |
RR
| 17 |
2177-09-25 05:15:00
|
2177-09-25 11:11:00
|
AP CHEST 5:06 A.M. ___
HISTORY: ___ woman after fall with multiple T-spine and first rib
fractures. Intubated.
IMPRESSION: AP chest compared to ___:
Small right pleural effusion and heterogeneous opacification in the right
lower lung are new. This could reflect recent aspiration, warranting close
followup. The heart size top normal. Left lung grossly clear. No left
pleural effusion or pneumothorax. Left PIC line previously curled in the left
brachiocephalic vein or azygos vein is re-positioned in the mid SVC. ET tube
in standard placement. Nasogastric tube passes below the diaphragm and out of
view.
|
19928728-RR-18
| 19,928,728 | 21,394,753 |
RR
| 18 |
2177-09-24 14:18:00
|
2177-09-24 18:10:00
|
INDICATION: ___ woman with PICC placement.
FINDINGS: Two portable frontal chest radiographs were submitted for review.
In the first image taken at 1430 hours, a left-sided PICC is folded back on
itself in the central left brachiocephalic vein. On the second film, taken at
1440 after flushing the catheter, the catheter tip is now in the mid
subclavian vein. An endotracheal tube is in stable position. An enteric tube
extends inferiorly below the film. The lungs are well expanded. A focal
opacity previously seen in the right lower lobe is not visualized and was
likely due to vascular shadows. No consolidation, effusion, or pneumothorax
is present.
IMPRESSION: Left-sided PICC line tip in the mid SVC after flushing
|
19928728-RR-19
| 19,928,728 | 21,394,753 |
RR
| 19 |
2177-09-24 16:52:00
|
2177-09-25 12:58:00
|
HISTORY: Back pain. Fusion.
Three intraoperative radiographs of the thoracic spine are obtained during
posterior fusion of T9 through T12 with corresponding pedicle screws and
vertical posterior metallic rods.
|
19928728-RR-20
| 19,928,728 | 21,394,753 |
RR
| 20 |
2177-09-25 06:21:00
|
2177-09-25 07:01:00
|
INDICATION: ___ woman with change in neurologic exam, and subdural,
subarachnoid and intraventricular hemorrhage; assess for interval change.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. No reformations were prepared. N.B. Several of the
original acquisitions were motion-degraded, and repeated with better result.
COMPARISONS: NECT ___, roughly 22 hours earlier.
FINDINGS: Left frontal parenchymal hemorrhage is unchanged in size, with
stable zone of surrounding edema. Overall, the extent of subarachnoid
hemorrhage, left greater than right, is likely unchanged, though this
examination is somewhat limited by motion artifact. Dependently-layering
blood is again seen in the occipital horn of the right lateral ventricle,
without evidence of hydrocephalus. No shift of normally-midline structures.
Basal cisterns remain patent.
No fracture is seen. There is fluid in both maxillary sinuses with complete
opacification of the anterior ethmoid air cells, bilaterally, and the left
sphenoid air cell. Mastoid air cells are well-aerated.
IMPRESSION: Overall, the parenchymal and subarachnoid blood is unchanged
compared to the most recent examination, with minimal intraventricular blood,
also unchanged, and no evidence of hydrocephalus or central herniation.
|
19928728-RR-21
| 19,928,728 | 21,394,753 |
RR
| 21 |
2177-09-26 04:15:00
|
2177-09-26 09:01:00
|
REASON FOR EXAMINATION: Evaluation of the patient with subarachnoid
hemorrhage. Spinal fusion.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The NG tube tip is in the stomach. Heart size and mediastinum are unchanged
in appearance as well as there is no change in pulmonary edema.
|
19928728-RR-22
| 19,928,728 | 21,394,753 |
RR
| 22 |
2177-09-25 17:57:00
|
2177-09-26 08:40:00
|
REASON FOR EXAMINATION: NG tube placement.
COMPARISON: Prior study obtained the same day earlier.
The NG tube tip is in the stomach. Left PICC line tip is at the mid SVC. The
lung apices were excluded from the field of view. Overall, there is no change
in the cardiomediastinal silhouette as well as widespread parenchymal
opacities and pleural effusion.
|
19928728-RR-23
| 19,928,728 | 21,394,753 |
RR
| 23 |
2177-09-27 04:07:00
|
2177-09-27 11:04:00
|
INDICATION: ___ woman with subarachnoid hemorrhage, posterior lumbar
spinal fusion.
COMPARISON: ___ to ___.
FINDINGS: The lungs are well aerated. Blunting of the bilateral costophrenic
angles is unchanged. An endotracheal tube is positioned low, only 1.7 cm from
the carina. A left subclavian central line terminates at the SVC
brachiocephalic junction. Mid thoracic spinal fusion hardware is intact
without evidence of periprosthetic lucency. The enteric catheter projects
over the stomach, the side hole is at the level of the gastroesophageal
junction.
IMPRESSION:
1. Low position of endotracheal tube.
2. Stable small bibasilar effusions.
3. Side hole of enteric tube at the diaphragmatic hiatus. The tube could be
advanced 6cm to ensure the side hole is in the stomach.
Findings were communicated with Dr. ___ with via telephone at ___.
|
19928728-RR-24
| 19,928,728 | 21,394,753 |
RR
| 24 |
2177-09-26 20:43:00
|
2177-09-27 11:18:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Status post intubation and respiratory distress.
Comparison is made with prior study ___ earlier in the morning.
ET tube tip is only 1.7 cm above the carina, can be withdrawn couple of
centimeters for a more standard position. Left PICC tip is in the upper SVC.
NG tube tip is in the stomach but the side port at the GE junction, should be
advanced for a more standard position. There has been progressive interval
worsening of right lower lobe opacity consistent with worsening atelectasis,
almost collapsed right lower lobe. Left lower lobe opacities have increased.
Could be due to atelectasis and/or aspiration. There is no pneumothorax.
Bilateral pleural effusions are probably small. Spinal hardware is again
noted.
Findings were discussed with Dr. ___ by phone on ___ at 10:15 a.m.
at the time of the discovery of the findings.
|
19928728-RR-25
| 19,928,728 | 21,394,753 |
RR
| 25 |
2177-09-27 11:18:00
|
2177-09-27 17:51:00
|
INDICATION: Asses for vasospasm in patient with traumatic intraparenchymal
and subarachnoid hemorrhage.
COMPARISON: CTA of the head from ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed through
the brain during infusion of 70 cc of Omnipaque intravenous contrast material.
Images were processed on a separate workstation with display of curved
reformats, 3D volume-rendered images, and maximum intensity projection images.
FINDINGS:
NECT HEAD: Redemonstrated is a left frontoparietal intraparenchymal
hemorrhage which is unchanged in size but with slightly increased surrounding
vasogenic edema when compared to prior study. There is minimal effacement of
the frontal horn of the left lateral ventricle as well as localized sulcal
effacement, unchanged from the prior study. There has been interval
redistribution of subarachnoid hemorrhage as well as clearing from the right
hemisphere. A small amount of blood layers within the occipital horns of the
bilateral lateral ventricles. There is no evidence of new hemorrhage or
infarction. The basal cisterns are preserved. No fracture is present. There
are aerosolized secretions and mucosal thickening within the bilateral
maxillary sinuses as well as fluid opacification in the ethmoid air cells and
left sphenoid sinus, all of which is unchanged.
CTA HEAD: The intracranial carotid and vertebral arteries and their major
branches are patent. There is minimal vasospasm of the left MCA near the
region of the hemorrhage, but no evidence of high-grade stenosis or occlusion.
The distal opercular branches are patent. The remainder of principal vessels
of the circle of ___ remains patent without aneurysm or abnormality.
IMPRESSION:
1. Minimal vasospasm of the left MCA in the vicinity of the hemorrhage
without evidence of high-grade stenosis or occlusion.
2. Slightly increased vasogenic edema surrounding the left frontoparietal
intraparenchymal hemorrhage without striking increase in mass effect.
3. Redistribution/clearing of blood away from the right hemispheric
subarachnoid spaces. Minimal residual blood in the occipital horns of the
lateral ventricles.
|
19928728-RR-26
| 19,928,728 | 21,394,753 |
RR
| 26 |
2177-09-28 04:36:00
|
2177-09-28 13:26:00
|
AP CHEST, 5:05 A.M., ___
HISTORY: After spinal fusion, re-intubated for thick secretions and
tachypnea.
IMPRESSION: AP chest compared to ___:
Interval increase in the diameter of the heart and mediastinal and pulmonary
vascular caliber suggests that worsening interstitial abnormality is due to
asymmetric pulmonary edema. Small right pleural effusion is stable. ET tube
is in standard position. Nasogastric tube passes at least as far as the upper
esophagus, but I cannot locate whether all the side ports have been moved
beyond the GE junction.
In the setting of heart failure, worsening consolidation at the left lung base
is difficult to distinguish pneumonia from progressive atelectasis.
Findings were discussed with the resident caring for this patient at 1:00
p.m., 2 minutes after discovery.
|
19928728-RR-27
| 19,928,728 | 21,394,753 |
RR
| 27 |
2177-09-29 05:14:00
|
2177-09-29 12:58:00
|
AP CHEST 5:21 A.M. ___
HISTORY: Traumatic hemorrhage and spinal fractures.
IMPRESSION: AP chest compared to ___:
Moderate cardiomegaly and somewhat asymmetric moderately severe pulmonary
edema worsened minimally since ___. Small pleural effusions are presumed.
No pneumothorax. ET tube and nasogastric tube and a left PIC line are in
standard placements respectively.
|
19928728-RR-28
| 19,928,728 | 21,394,753 |
RR
| 28 |
2177-09-30 05:12:00
|
2177-09-30 11:20:00
|
CHEST RADIOGRAPH
INDICATION: ___ woman with respiratory failure and pneumonia. To
evaluate for consolidation, effusion, collapse.
TECHNIQUE: Single semi-erect portable chest view was read in comparison with
prior chest radiographs with the most recent from ___.
FINDINGS:
Endotracheal tube tip is 2.8 cm above the carina, left PICC line tip ends at
mid SVC, and the orogastric tube is appropriately positioned into the stomach.
Mild and diffuse pulmonary edema has improved over 24 hours. More discrete
and ill-defined opacity in the right lower lung, concerning for an evolving
infection is no different since yesterday. Small bilateral pleural effusions
are presumed and unchanged. No other interval changes in the chest.
|
19928728-RR-29
| 19,928,728 | 21,394,753 |
RR
| 29 |
2177-10-01 05:17:00
|
2177-10-01 11:22:00
|
INDICATION: Respiratory failure in one year. To look for interval changes.
TECHNIQUE: Semi-erect portable chest view was read in comparison with prior
chest radiographs, the most recent from ___.
FINDINGS:
Endotracheal tube ends approximately 3 cm above the carina and orogastric tube
reaches to the stomach. In addition, there is another line overlapping upper
neck, reaching to the level of the mid clavicle, which could be another
indwelling line or outside the patient. Correlation with local inspection is
suggested. Left PICC line tip ends at the confluence of the brachiocephalic
vessels. Mild asymmetric pulmonary edema has improved since yesterday. Mild
opacity in the right infrahilar region is probably aspiration or atelectasis
or evolving infection, unchanged since ___. Increased retrocardiac
density reflecting atelectasis and/or consolidation is minimally worse since
yesterday. Moderately enlarged heart size is stable. Dr. ___
discussed the findings with Dr. ___ by phone on ___ at
8:22 a.m.
|
19928728-RR-30
| 19,928,728 | 21,394,753 |
RR
| 30 |
2177-10-02 04:44:00
|
2177-10-02 10:56:00
|
INDICATION: ___ female with respiratory failure and pneumonia.
___.
CHEST, AP: Endotracheal tube again terminates 3 cm above the carina.
Orogastric tube terminates in the stomach. Left PICC terminates at the left
brachiocephalic/SVC junction. No significant pneumothorax. There are small
bilateral pleural effusions. There has been slight increase in central venous
congestion and interstitial edema. Pulmonary aeration is improved, with
decreased bibasilar atelectasis. Mild cardiomegaly is unchanged. The aorta
is tortuous and calcified. Multilevel fusion hardware noted in the mid
thoracic spine. Cement is present in the left humeral shaft.
IMPRESSION:
1. Increased pulmonary edema.
2. Improved lung aeration.
|
19928728-RR-31
| 19,928,728 | 21,394,753 |
RR
| 31 |
2177-10-03 03:32:00
|
2177-10-03 09:01:00
|
CHEST RADIOGRAPH
INDICATION: Respiratory failure and pneumonia, assessment for interval
change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is improved
ventilation of the lung parenchyma, notably at the lung bases. Otherwise, the
radiograph is unchanged, including the surgical clips, vertebral fixation
devices and size of the cardiac silhouette. The support and monitoring
devices are constant.
|
19928728-RR-32
| 19,928,728 | 21,394,753 |
RR
| 32 |
2177-10-04 05:08:00
|
2177-10-04 11:13:00
|
CHEST RADIOGRAPH
INDICATION: Respiratory failure and pneumonia, assessment for interval
change.
COMPARISON: ___, 4:19 a.m.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. The monitoring and support devices, the post-surgical devices and the
aspect of the cardiac silhouette and the pulmonary parenchyma are constant.
|
19928728-RR-33
| 19,928,728 | 21,394,753 |
RR
| 33 |
2177-10-03 11:45:00
|
2177-10-03 16:32:00
|
HISTORY: ___ female history of DVT, anticoagulation, extending bed
rest.
COMPARISON: No previous exam for comparison.
FINDINGS:
Grayscale, color Doppler images were obtained of bilateral common femoral,
femoral, popliteal and tibial veins. Normal flow, compression and
augmentation is seen in all of the vessels.
IMPRESSION:
No evidence of deep vein thrombosis in either leg.
|
19928728-RR-34
| 19,928,728 | 21,394,753 |
RR
| 34 |
2177-10-05 05:35:00
|
2177-10-05 12:39:00
|
STUDY: AP chest.
CLINICAL HISTORY: ___ woman with respiratory failure. Bilateral
subarachnoid hemorrhage. Evaluate for pneumonia.
FINDINGS: Comparison is made to previous study from ___.
There is hardware seen in the lower lumbar spine. There is a tracheostomy
tube whose distal tip is 4.3 cm above the carina, appropriately sited. There
is a left-sided PICC line whose distal tip is in the mid SVC and is oblique to
the SVC wall. There is a feeding tube whose distal tip and side port are
below the gastroesophageal junction. Heart size is enlarged. There is
prominence of the pulmonary interstitial markings suggestive of minimal fluid
overload. These findings are all stable.
|
19928728-RR-36
| 19,928,728 | 21,394,753 |
RR
| 36 |
2177-10-06 05:19:00
|
2177-10-06 10:38:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ woman with respiratory failure.
FINDINGS: Comparison is made to prior study from ___.
Hardware within the lower thoracic spine is seen. There is endotracheal tube
whose tip is 2.8 cm above the carina. There is a feeding tube whose tip and
side port are below the gastroesophageal junction. There is a left-sided PICC
line with distal lead tip in the distal SVC. There is persistent
cardiomegaly. There is mild pulmonary edema, stable. No focal consolidation
or large pleural effusions are seen. There are no pneumothoraces.
|
19928728-RR-37
| 19,928,728 | 21,394,753 |
RR
| 37 |
2177-10-06 09:32:00
|
2177-10-06 13:51:00
|
INDICATION: ___ woman status post fall with extensive bilateral
subarachnoid hemorrhage 13 days ago, known to have therapeutic heparin for
history of DVT. Please evaluate for progression of subarachnoid hemorrhage or
new bleed.
COMPARISON: Head CT from CTA ___.
TECHNIQUE: MDCT images were acquired through the head without contrast.
FINDINGS:
An area of hyperattenuation in the left frontal lobe consistent with known
intraparenchymal bleed is less dense compared to the previous examination.
There is resolving hyperattenuating fluid within the subarachnoid spaces of
the left cerebral hemisphere in the frontal region, unchanged. No new areas
of hemorrhage are noted. Effacement of sulci and mild mass effect on left
lateral ventricle unchanged.
No acute vascular territory infarct, shift of midline structure present.
Hypoattenuation surrounding the left frontal intraparenchymal hemorrhage
consistent with vasogenic edema. There is opacification of the left
maxillary, ethmoidal and sphenoidal air cells, likely related to intubation.
Also noted is fluid within both mastoid air cells.
Low lying cerebellar tonsils with fullness of the spinal canal at foramen
magnum unchanged compared to the MR ___ spine of ___.
IMPRESSION:
1. No acute hemorrhage. Resolving left frontal intraparenchymal and left
frontal subarachnoid hemorrhage.
2. New non-hemorrhagic fluid in the left maxillary sinus, ethmoidal sinus,
sphenoidal sinus and both mastoid air cells.
3. Low lying cerebellar tonsils- ? Chiari 1 malformation
|
19928728-RR-38
| 19,928,728 | 21,394,753 |
RR
| 38 |
2177-10-07 04:46:00
|
2177-10-07 10:14:00
|
STUDY: AP chest, ___.
CLINICAL HISTORY: ___ woman with pneumonia. Evaluate for
progression.
FINDINGS:
Comparison is made to previous study from ___.
The spinal hardware is again identified. There is an endotracheal tube whose
tip is low, 1.8 cm above the carina. This could be pulled back an additional
2-3 cm for more optimal placement. There is a left-sided central venous
catheter with the distal lead tip in the mid SVC perpendicular to SVC wall,
unchanged. There is a nasogastric tube whose side port is below the
gastroesophageal junction. There is an area of consolidation at the right
base which is more apparent than on the prior study. There is sclerosis of
the left humeral shaft with some central lucency. If there is pain in the
shoulder, then would recommend dedicated left shoulder radiographs.
|
19928728-RR-39
| 19,928,728 | 21,394,753 |
RR
| 39 |
2177-10-08 04:42:00
|
2177-10-08 09:54:00
|
AP CHEST, 4:56 A.M., ___
HISTORY: ___ woman intubated after a fall.
IMPRESSION: AP chest compared to ___ through ___:
Mild pulmonary edema, mild cardiomegaly. Tiny right pleural effusion
persists. Previous consolidation at the base of the right lung that appeared
on ___ is improving.
ET tube in standard placement. Left central venous catheter ends at the
junction of brachiocephalic veins and a nasogastric tube passes below the
diaphragm and out of view.
|
19928728-RR-40
| 19,928,728 | 21,394,753 |
RR
| 40 |
2177-10-09 04:53:00
|
2177-10-09 10:13:00
|
REASON FOR EXAMINATION: Fall.
COMPARISON: Multiple prior studies with the most recent one obtained on ___.
The ET tube tip is 3 cm above the carina. The left PICC line tip is at the
level of mid SVC. The NG tube tip is in the stomach. Heart size and
mediastinum are stable. Slight interval improvement in the right lower lung
aeration may be consistent with slight improvement of pulmonary edema. Small
pleural effusion is most likely present on the right. No pneumothorax is
seen.
|
19928728-RR-41
| 19,928,728 | 21,394,753 |
RR
| 41 |
2177-10-08 20:14:00
|
2177-10-09 10:13:00
|
REASON FOR EXAMINATION: New OGT placement.
AP radiograph of the chest was reviewed in comparison to ___.
The ET tube tip is 2.5 cm above the carina. The NG tube tip passes below the
diaphragm, most likely terminating in the stomach. Left PICC line tip is at
the level of mid SVC. As compared to prior study obtained several hours
earlier, there is no substantial change in the cardiomediastinal silhouette
and appearance of the lungs.
|
19928728-RR-42
| 19,928,728 | 21,394,753 |
RR
| 42 |
2177-10-09 13:20:00
|
2177-10-09 15:50:00
|
INDICATION: ___ female here for IVC filter insertion.
COMPARISON: No prior studies available.
FINDINGS/IMPRESSION: A single intraoperative fluoroscopic spot image
demonstrates an introducer in place and an IVC filter in its expected location
to the right of the lumbar spine at the L3 vertebral level. Surgical clips in
the right upper quadrant are consistent with prior cholecystectomy. Retained
barium is noted in several loops of bowel in the right abdomen. In total, 143
seconds of continuous fluoroscopic time was used during the procedure.
|
19928728-RR-43
| 19,928,728 | 21,394,753 |
RR
| 43 |
2177-10-09 15:55:00
|
2177-10-09 16:44:00
|
CHEST RADIOGRAPH
INDICATION: Nasogastric tube placement, evaluation.
COMPARISON: ___, 5:08 a.m.
FINDINGS: As compared to the previous radiograph, the patient was extubated.
Currently, the nasogastric tube is in correct position, with its sidehole
approximately 2 cm below the gastroesophageal junction and its tip projecting
over the middle parts of the stomach. There is no evidence of complications,
notably no pneumothorax.
The patient has received a tracheostomy tube. The tube is in correct
position.
Otherwise, no changes. Vertebral stabilization devices. Borderline size of
the cardiac silhouette with signs of mild to moderate fluid overload. No
larger pleural effusions.
|
19928728-RR-44
| 19,928,728 | 21,394,753 |
RR
| 44 |
2177-10-10 03:54:00
|
2177-10-10 09:56:00
|
CHEST RADIOGRAPH
INDICATION: Fall, assessment for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. The monitoring and support devices are constant, vertebral
stabilization devices are also constant. Unchanged lung volumes. Moderate
cardiomegaly and mild fluid overload. No pleural effusions. No evidence of
pneumonia.
|
19928728-RR-45
| 19,928,728 | 21,394,753 |
RR
| 45 |
2177-10-11 04:49:00
|
2177-10-11 10:03:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Fall.
Comparison is made with prior study, ___.
Tracheostomy tube is in a standard position. NG tube tip is out of view,
below the diaphragm. Left PICC tip is in the mid SVC. There is no
pneumothorax. If any, there is a small left pleural effusion. Mild
cardiomegaly is stable. Right lower lobe opacities have increased, worrisome
for aspiration. There is mild vascular congestion. Spinal hardware is again
noted.
|
19928728-RR-46
| 19,928,728 | 21,394,753 |
RR
| 46 |
2177-10-12 04:58:00
|
2177-10-12 09:22:00
|
CHEST
HISTORY: Status post fall.
REFERENCE EXAM: ___.
Compared to the prior exam, there is no significant interval change.
|
19928728-RR-47
| 19,928,728 | 21,394,753 |
RR
| 47 |
2177-10-11 08:40:00
|
2177-10-11 12:30:00
|
RADIOGRAPHS OF THE RIGHT WRIST AND FOREARM
HISTORY: Rheumatoid arthritis with new onset of wrist pain after a fall.
COMPARISONS: None available.
TECHNIQUE: Right wrist and forearm, total of five views.
FINDINGS: There is severe chronic-appearing bone destruction involving the
proximal and mid portions of the carpus with marked irregularity of the
radiocarpal joint and negative ulnar variance including degenerative changes
of the radiocarpal, radioulnar and intercarpal joints superimposed upon
presumed prior marked inflammatory change. The appearance includes many of
lucencies suggesting subchondral cystic changes. There is slight spurring
along the radial head. The second through fifth carpometacarpal joints are
mildly narrowed. There is no definite evidence for fracture, dislocation or
bone destruction. The bones appear probably demineralized.
IMPRESSION: Severe chronic-appearing degenerative changes superimposed on a
prior inflammatory process involving the wrist, but with no definite
superimposed injury. Bony demineralization.
|
19928728-RR-7
| 19,928,728 | 21,394,753 |
RR
| 7 |
2177-09-23 04:42:00
|
2177-09-23 05:43:00
|
INDICATION: ___ woman status post fall.
COMPARISONS: CT torso from ___.
FINDINGS: Overyling material limits evaluation to some degree. Lungs are low
in volume with mild apical scarringand increased interstitial markings
suggesting preexisting interstitial lung disease. No definite effusion or
pneumothorax is seen. The heart is likely top normal. Irregularity of T10
and T11 on the frontal projection is compatible with the fracture seen on the
outside imaging.
IMPRESSION: No acute process with poor visualization of the T10 and T11
fractures, better assessed on the previously obtained CT. Likely preexisting
interstitial lung disease.
|
19928728-RR-8
| 19,928,728 | 21,394,753 |
RR
| 8 |
2177-09-23 06:19:00
|
2177-09-23 09:24:00
|
INDICATION: ___ woman status post fall down 10 stairs with knee pain.
COMPARISONS: None.
TECHNIQUE: Three views of the left knee.
FINDINGS: No fracture or dislocation is seen. Degenerative changes are seen
predominantly in the medial compartment with osteophytes, subchondral
sclerosis and joint space narrowing. Soft tissue calcification or heterotopic
ossification is seen adjacent to the medial tibial plateau. No joint effusion
is seen.
IMPRESSION: Degenerative changes. No acute fracture. If there is continued
concern for a fracture, MRI may be considered.
|
19928728-RR-9
| 19,928,728 | 21,394,753 |
RR
| 9 |
2177-09-23 05:58:00
|
2177-09-23 09:42:00
|
INDICATION: ___ woman status post fall with known intracranial
hemorrhage and altered, assess for progression.
COMPARISONS: ___ at 0233 hours from ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Coronal and sagittal reformations were prepared.
FINDINGS: Compared to the previous study, a left inferior frontotemporal
hemorrhagic contusion with surrounding vasogenic edema is more conspicuous and
organized compatible with continued evolution and measures 2.8 x 2.5 cm
axially. It exerts mass effect on the surrounding tissues with sulcal
effacement and what appears to be an initial effacement of the suprasellar
cistern worrisome for impending downward transtentorial herniation.
Diffuse left subarachnoid hemorrhages is stable to minimally increased.
Right-sided subarachnoid hemorrhage is unchanged. There is increased blood
product in the occipital horn of the right lateral ventricle without evidence
of hydrocephalus. No shift of midline structures is seen. There is no
fracture. Imaged paranasal sinuses reveal air-fluid levels in the bilateral
maxillary sinuses and opacification of the anterior and posterior ethmoid air
cells. The remainder of the mastoid air cells and paranasal sinuses appear
well aerated. Large left occipital subgaleal hematoma is also slightly
increased.
IMPRESSION:
1. Increase in size of now 2.8 cm left inferior frontotemporal hemorrhagic
contusion with surrounding edema, with resultant mass effect leading to
partial effacement of the suprasellar cistern and concern for developing
downward transtentorial herniation.
2. Unchanged to minimally increased left greater than right multifocal
subarachnoid hemorrhage with extension in the occipital horn of the right
lateral ventricle without evidence of hydrocephalus or shift of midline
structures.
3. Left occipital subgaleal hematoma.
Findings were discussed with Dr. ___ by Dr. ___ in person at 0615 on
___ at the time of discovery.
NOTE ADDED AT ATTENDING REVIEW: I agree with the above, except that there is
not evidence of uncal herniation. The left ambient cistern is partially
obscured by blood in the subarachnoid space, but there is no evidence of
displacement of the brainstem, compression of the lateral ventricle, or
midline shift.
|
19929060-RR-13
| 19,929,060 | 28,158,118 |
RR
| 13 |
2138-10-17 15:35:00
|
2138-10-17 16:27:00
|
INDICATION: ___ year old woman with acute appendicitis, ?mucocele //
appendiceal mucocele
TECHNIQUE: Contrast enhanced CT of the abdomen pelvis was performed at an
outside institution, ___, and submitted here after ___
for second interpretation reading
Coronal and sagittal reformations were obtained and reviewed on PACS.
DOSE: Total exam DLP: 300.18 mGy per cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: The partially imaged lower chest demonstrates pectus deformity.
Minimal left base atelectasis is seen. There is no focal consolidation. No
pleural or pericardial effusion is seen.
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 relatively collapsed, but
grossly unremarkable.
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 uptake contrast symmetrically bilaterally. No frank
hydronephrosis is seen. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is relatively collapsed. No bowel obstruction
is seen. No bowel wall thickening is seen. The mid to distal aspect of the
appendix is dilated to 13 mm and contains intraluminal hypodensity. The more
proximal appendix (the base) is collapsed. It is difficult to discern whether
maybe subtle minimal periappendiceal inflammation.
PELVIS: The urinary bladder is relatively decompressed, but grossly
unremarkable. There may be very trace pelvic free fluid
REPRODUCTIVE ORGANS: There is a 2.0 cm likely left ovarian corpus luteum. The
right ovary is grossly unremarkable by CT appearance.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mid to distal aspect of the appendix is dilated to 13 mm and contains
intraluminal hypodensity. The more proximal appendix (the base) is collapsed.
It is difficult to discern whether there may be subtle minimal periappendiceal
inflammation. Differential diagnosis includes appendicitis vs appendiceal
mucocele.
|
19929203-RR-10
| 19,929,203 | 26,994,637 |
RR
| 10 |
2159-11-30 02:44:00
|
2159-11-30 09:18:00
|
EXAMINATION: MRCP
INDICATION: Cholangitis w/ bacteremia// Cholangitis (recurrent)
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 8 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
Lower Thorax: There small bilateral pleural effusions with associated
atelectasis. There is no pericardial effusion.
Liver: Hepatic morphology is within normal limits. There is no significant
hepatic steatosis. There is no suspicious liver lesion. The portal and
hepatic veins are patent.
Biliary: Diffuse mild intrahepatic and extrahepatic biliary ductal dilatation
is likely attributable to post cholecystectomy state. There is extensive
peribiliary edema, enhancement, and restricted diffusion throughout segment V
and segment VIII with associated segmental biliary dilatation consistent with
underlying cholangitis. There is no hepatic abscess. On the MRCP images, the
right anterior hepatic duct does not appear to communicate with the common
bile duct, which may be due to artifact related to the traversing right
hepatic artery at this level or a small function biliary stricture (23:2,
9:40). There is no choledocholithiasis.
Pancreas: Pancreas is normal in signal intensity without ductal dilatation or
focal lesion. Pancreas divisum morphology is noted. There is a large
periampullary duodenal diverticulum, similar to the prior CT.
Spleen: Normal in size without focal lesion.
Adrenal Glands: Unremarkable.
Kidneys: Simple cysts are present bilaterally. There is no suspicious lesion
or hydronephrosis.
Gastrointestinal Tract: There is moderate colonic diverticulosis. The
visualized loops of large and small bowel are otherwise unremarkable.
Lymph Nodes: No suspicious adenopathy.
Vasculature: There is severe atherosclerotic disease of the visualized
abdominal aorta without aortic aneurysm. There is a severe stenosis at the
origin of the celiac axis and SMA without poststenotic dilatation. Hepatic
arterial anatomy is conventional.
Osseous and Soft Tissue Structures: There are moderate multilevel degenerative
changes of the lumbar spine. There is no suspicious osseous lesion.
Susceptibility artifact related to right hip arthroplasty is partially imaged.
IMPRESSION:
1. Moderate right anterior hepatic cholangitis without hepatic abscess.
2. Discontinuity of the right anterior hepatic duct from the common bile duct,
which may be seen as an artifact due to crossing of the right hepatic artery.
However, given the slight intrahepatic biliary ductal dilatation and
associated right hepatic cholangitis, a mild functional stricture may be
present.
|
19929203-RR-7
| 19,929,203 | 26,994,637 |
RR
| 7 |
2159-11-28 01:23:00
|
2159-11-28 03:44:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: History: ___ with fever, ams, back pain IV contrast to be given
at radiologist discretion as clinically needed// ?epidural abscess
?epidural abscess
?epidural abscess
?epidural abscess
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of Gadavist contrast agent,
additional axial and sagittal T1 images were obtained.
COMPARISON: CT of the abdomen and pelvis from ___
FINDINGS:
CERVICAL:
There is 2 mm retrolisthesis of C3 on C4. Vertebral body height and alignment
is otherwise preserved. There is multilevel degenerative disc disease
resulting in mild disc space height loss at C3-C4 and C6-C7.
Bone marrow signal intensity is within normal limits.
There are mild degenerative changes along the cervical levels with small disc
bulges or disc protrusions partially resulting in mild flattening of the
ventral cord but without cord signal abnormality. The spinal cord is
otherwise normal in caliber and configuration. There is no epidural
collection or abnormal enhancement after contrast administration.
In addition, there is facet joint arthropathy, uncovertebral hypertrophy and
mild ligamentum flavum thickening throughout the cervical levels which
partially results in mild and moderate neural foraminal narrowing.
THORACIC:
Vertebral body height and alignment is preserved. Intervertebral disc spaces
appear grossly maintained. Note is made of a Schmorl's node along the
superior endplate of the T6 vertebral body. Bone marrow signal intensity is
otherwise within normal limits.
The spinal cord is normal in caliber and configuration. There is no evidence
of cord compression, severe spinal canal stenosis or significant neural
foraminal narrowing along the lumbar levels. There is no epidural collection
or abnormal enhancement after contrast administration.
LUMBAR:
Postsurgical changes after right L3-L4 hemilaminectomy are again noted. There
is increased STIR signal throughout the operative bed, paraspinal muscles,
right psoas muscle, as well as involving the endplates at L3-4 on the right,
all of which is most likely postoperative in nature. Enhancing granulation
tissue seen throughout the resection bed.
Note is made of a small fluid collection in the subcutaneous soft tissues
subjacent to the surgical incision site measuring up to 5.1 cm in maximum SI
dimension and 2.8 cm in maximum AP dimension which demonstrates minimal
surrounding enhancement on the postcontrast sequence and therefore most likely
represents a postoperative seroma (series 25, image 21 and series 21, image
11).
Is unchanged 3 mm retrolisthesis of L2 on L3 and 4 mm anterolisthesis of L4 on
L5. Vertebral body height and alignment is otherwise preserved. There is
multilevel degenerative disc disease, most pronounced at L4-L5 and L5-S1 where
there is moderate to severe disc space height loss and ___ type 2
degenerative endplate changes.
The spinal cord is normal in caliber and configuration. The conus terminates
normally at the L1-L2 level. The cauda equina nerve roots appear
unremarkable. There is no epidural collection or abnormal enhancement after
contrast administration.
There are multilevel degenerative changes of the lumbar spine, most pronounced
at L2-L3 with there is a disc bulge, facet joint arthropathy, moderate
ligamentum flavum thickening and prominence of the posterior epidural fat, all
of which results in moderate spinal canal stenosis and moderate bilateral
neural foraminal narrowing. There is also effacement of the lateral recesses
bilaterally with likely compression of the traversing L3 nerve roots.
At L3-L4, there is a disc bulge, facet joint arthropathy and asymmetric severe
left ligamentum flavum thickening, all of which results in moderate bilateral
neural foraminal narrowing but no spinal canal stenosis. There is effacement
of the left lateral recess with the disc bulge at least contacting the left
traversing L4 nerve root.
Otherwise, there is no evidence of cord compression or severe spinal canal
stenosis along meaning lumbar levels.
Severe bilateral neural foraminal narrowing is noted at L4-L5 and L5-S1,
partially with compression of the nerve roots within the neuroforamen.
OTHER: Small right pleural effusion and bibasilar dependent atelectasis.
Subcentimeter T2 hyperintense lesions in both kidneys most likely represent
renal cysts.
IMPRESSION:
1. No evidence of epidural collection, cord compression or severe spinal canal
stenosis.
2. Postsurgical changes after right L3-L4 hemilaminectomy with expected
postsurgical changes.
3. Small fluid collection in the subcutaneous soft tissues subjacent to the
incision site with minimal surrounding enhancement most likely represents a
postoperative seroma. However, an early phlegmon or abscess formation is not
entirely excluded and clinical correlation is suggested.
4. Mild multilevel degenerative changes throughout the cervical spine
partially with mild remodeling of the ventral cord secondary to small disc
herniations but without cord signal abnormality.
5. Degenerative changes of the lumbar spine are most pronounced at L2-L3 where
there is moderate spinal canal stenosis and compression of the traversing L3
nerve roots as well as at L4-L5 and L5-S1 where there is compression of the
exiting nerve roots within the neuroforamen.
|
19929203-RR-9
| 19,929,203 | 26,994,637 |
RR
| 9 |
2159-11-28 00:01:00
|
2159-11-28 00:30:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with fever, AMSNO_PO contrast//
?cholangitis, collitis
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 7.3 s, 57.6 cm; CTDIvol = 21.7 mGy (Body) DLP =
1,248.6 mGy-cm.
Total DLP (Body) = 1,261 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild dependent atelectasis bilaterally. No pleural or
pericardial effusion. The heart is moderately enlarged. Severe aortic
valvular and coronary calcifications.
ABDOMEN:
HEPATOBILIARY: Status post cholecystectomy. Mild intrahepatic biliary
dilatation. Linear hypodensities surrounding the bile ducts within the right
lobe of the liver may represent the sequela of cholangitis, however there are
no priors for comparison (series 2, image 16). No extrahepatic biliary
dilatation. There is no evidence of enhancing lesions.
PANCREAS: Pancreas is atrophic. No focal pancreatic lesions. No ductal
dilatation. 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: Subcentimeter hypodensities within kidneys bilaterally, too small to
characterize, but likely represent cysts. Otherwise, the kidneys are of
normal and symmetric size with normal nephrogram. There is no evidence of
enhancing renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Large
periampullary duodenal diverticulum. Otherwise, small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding.
PELVIS: The urinary bladder and 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: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted. Heavy atherosclerotic calcifications at the origins of the
major intra-abdominal vessels.
BONES: Patient is status post total right hip arthroplasty with streak
artifact that limits evaluation in this area. Severe degenerative changes
within the lumbar spine. Mild retrolisthesis of L3 on L4 and mild
anterolisthesis of L4 on L5. There is no evidence of worrisome osseous
lesions or acute fracture.
SOFT TISSUES: Small fat containing umbilical hernia. Mild subcutaneous edema
overlying the lumbar spine.
IMPRESSION:
1. Mild intrahepatic biliary dilatation. Linear hypodensities surrounding the
bile ducts within the right lobe of the liver may represent the sequela of
cholangitis, however there are no priors for comparison. No focal fluid
collections.
2. Incidental findings include a large periampullary duodenal diverticulum and
severe atherosclerosis.
|
19929207-RR-17
| 19,929,207 | 22,677,634 |
RR
| 17 |
2160-08-04 11:15:00
|
2160-08-04 14:53:00
|
HISTORY: Rib pain, right flank, question rib fracture.
CHEST, TWO VIEWS. RIBS, THREE VIEWS.
CHEST: There are low inspiratory volumes and lordotic positioning. This
likely accounts for prominence of the cardiomediastinal silhouette. There is
slight prominence of the vascular markings. No frank consolidation, effusion,
or pneumothorax is identified.
RIBS: Three views of the right ribs were obtained. A marker was placed and
overlies the mid abdomen, slightly lower than the twelfth rib. No lucent or
sclerotic fracture line. No displaced fracture is detected involving the
right-sided ribs.
IMPRESSION: Low inspiratory volumes. No rib fracture and no acute pulmonary
process identified.
|
19929286-RR-32
| 19,929,286 | 22,584,344 |
RR
| 32 |
2192-12-05 00:16:00
|
2192-12-05 02:13:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with hx of TAVR// eval for edema
TECHNIQUE: AP upright portable view of the chest
COMPARISON: Multiple prior comparisons, most recent from ___
FINDINGS:
Median sternotomy wires are aligned and intact. Left chest wall cardiac
conduction device leads terminate in the right atrium and right ventricle.
There is mild redundancy in the right ventricular lead, unchanged dating back
to ___. Patient is status post aortic valve replacement.
Lung volumes are low. There is bibasilar atelectasis without focal
consolidation. There is no pulmonary edema. Pleural spaces are normal.
Cardiomediastinal silhouette is unchanged.
IMPRESSION:
Low lung volumes. No focal consolidation. No pulmonary edema.
|
19929286-RR-33
| 19,929,286 | 22,584,344 |
RR
| 33 |
2192-12-05 01:24:00
|
2192-12-05 02:12:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with new NG tube// eval for tube placement
TECHNIQUE: Upright AP portable CT chest
COMPARISON: Multiple prior comparisons, most recent from ___ at
___ at 07:52
FINDINGS:
Enteric tube traverses below the left hemidiaphragm with tip terminating in
the gastric body. Left chest wall cardiac conduction device shows leads
terminating in the right atrium and right ventricle. Right ventricle aspect
has a small amount of redundancy, which is unchanged dating back to ___.
Median sternotomy wires are aligned and intact. Patient is status post aortic
valve replacement.
Lung volumes are low. There is bibasilar atelectasis without convincing focal
consolidation. Pleural spaces are within normal limits. Cardiomediastinal
silhouette is unchanged.
IMPRESSION:
1. Enteric tube tip terminates below the left hemidiaphragm, in the body of
the stomach. Additional tubes and lines, as above.
2. No focal consolidation.
|
19929286-RR-34
| 19,929,286 | 22,584,344 |
RR
| 34 |
2192-12-05 01:50:00
|
2192-12-05 03:00:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with ischemic bowel vs large bowel obstruction due to
chronic stricture// ****please perform with rectal contrast to assess for
etiology of possible large bowel obstruction****
TECHNIQUE: Abdomen and pelvis CTA: Multiphasic post-contrast images were
acquired through the abdomen and pelvis.
Rectal contrast was administered on delayed phase imaging.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.5 s, 50.8 cm; CTDIvol = 14.1 mGy (Body) DLP = 714.2
mGy-cm.
2) Spiral Acquisition 6.5 s, 51.1 cm; CTDIvol = 13.4 mGy (Body) DLP = 682.4
mGy-cm.
Total DLP (Body) = 1,397 mGy-cm.
COMPARISON: Outside, noncontrast CT abdomen pelvis from ___ and
multiple prior additional priors, most recent from ___
FINDINGS:
VASCULAR:
There are multiple areas of ectasia of the distal abdominal aorta without
frank aneurysmal dilatation. There is moderate to severe, mixed calcified and
noncalcified, atherosclerotic plaque. There is at least moderate narrowing of
the superior mesenteric axis by noncalcified atherosclerotic plaque (series
602; image 80). Celiac and inferior mesenteric axes are patent.
LOWER CHEST: There is linear atelectasis at both lung bases without concerning
parenchymal opacification. There is no pleural or pericardial effusions.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is moderate intrahepatic biliary
dilatation, of unknown etiology. The extrahepatic common bile duct is
enlarged, measuring approximately 1.0 cm in cross-section. The gallbladder is
surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is left interpolar renal cortical thinning, suggestive of prior
insult. Multiple bilateral renal hypodensities are too small to characterize.
There is no hydronephrosis. There is no significant perinephric abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. There is dilation of the colon throughout its
course with transition point in the sigmoid colon, likely due to underlying
soft tissue colonic mass which spans approximately 8.7 cm (series 4; image
70). These findings are concerning for large-bowel obstruction. There is
surrounding stranding and colonic wall edema and hyper enhancement consistent
with colitis, most notable in the distal descending/sigmoid colon as well as
possible pneumatosis in the cecum. Area of irregularity and narrowing in the
distal sigmoid colon (series 2; image 134) may represent colocolonic
intussusception as result of the colonic mass. Locule of air within the
descending colonic wall (series 2; image 63) cannot be seen on additional
planes and is concerning for pneumatosis. There are multiple locules of
anti-dependent air in the cecum, which are also concerning for pneumatosis.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is small volume free
fluid in the pelvis.
REPRODUCTIVE ORGANS: There is a 5.7 x 3.7 x 4.9 cm hypodensity in the left
adnexa, which measures simple fluid in density. This finding is incompletely
assessed on this exam. Uterus appears within normal limits.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are moderate degenerative changes of the visualized lumbar spine, most
notable at L5-S1.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Dilation of the colon throughout its course with transition point at a
large 8.7 cm soft tissue mass in the sigmoid colon, highly concerning for
underlying colonic neoplasm. These findings result in mild dilatation of the
large bowel loops concerning for obstruction. Area of irregularity and
narrowing in the distal sigmoid colon may represent a ___
intussusception as result of the mass. Fat stranding and colonic wall
edema/hyperenhancement is consistent with colitis, most notable in the distal
descending/sigmoid colon and the cecum. Distention and locules of anti
dependent air in the cecum are concerning for pneumatosis. There is no frank
free intraperitoneal air.
2. 5.7 x 3.7 x 4.9 cm hypodensity in the left adnexa measures simple fluid in
density. This finding is incompletely assessed on this exam, however does
appear to abut the colonic mass.
3. Moderate intra and extrahepatic biliary dilatation of indeterminate
etiology. No definite obstructive lesion is identified on CT.
4. Moderate to severe atherosclerotic disease with ectasia of the distal
abdominal aorta. There is at least moderate narrowing of the superior
mesenteric axis. Celiac and inferior mesenteric axes are patent.
NOTIFICATION: The findings were discussed with ACS B resident, by ___
___, M.D. after attending review on the telephone on ___ at 9:11 am,
5 minutes after discovery of the findings.
|
19929286-RR-35
| 19,929,286 | 22,584,344 |
RR
| 35 |
2192-12-05 08:38:00
|
2192-12-05 09:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ETT, NGT s/p OR// confirm location of
tubes/lines confirm location of tubes/lines
IMPRESSION:
Comparison to ___. All monitoring and support devices are in correct
position. Borderline size of the cardiac silhouette. Minimal atelectasis at
the right lung bases. No pneumothorax. No pleural effusions. No pulmonary
edema.
|
19929286-RR-36
| 19,929,286 | 22,584,344 |
RR
| 36 |
2192-12-06 05:33:00
|
2192-12-06 08:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with PMH of CAD, MI, PPM, AVR/TAVR, and diverticulosis, p/w
LLQ abdominal pain, AMS and lactic acidosis s/p ex-lap + partial colectomy on
___// evaluate for interval change evaluate for interval change
IMPRESSION:
Comparison to ___. As compared to the previous radiograph, the
patient has developed a left lower lobe atelectasis. In addition, there is
evidence of a small left pleural effusion. A pre-existing atelectasis at the
right lung bases has slightly increased in extent and severity. The
monitoring and support devices are stable. No pneumothorax.
|
19929286-RR-38
| 19,929,286 | 22,584,344 |
RR
| 38 |
2192-12-06 10:06:00
|
2192-12-06 10:20:00
|
INDICATION: Assess retained surgical instrument
COMPARISON: Prior CT from ___
FINDINGS:
Two views of the abdomen pelvis provided with portable supine technique.
There are partially imaged midline sternotomy wires and cardiac pacing wires
in the lower chest as well as a prosthetic aortic valve. Nasogastric tube
terminates in the left upper abdomen. Surgical clips are noted in the right
upper quadrant. There is no unexpected surgical instrument within the imaged
field.
IMPRESSION:
No evidence of retained surgical instrument. Findings were discussed with Dr.
___ at the time of initial review.
|
19929286-RR-39
| 19,929,286 | 22,584,344 |
RR
| 39 |
2192-12-07 04:07:00
|
2192-12-07 09:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p ex lap subtotal colectomy and washout,
second look with end ileostomy// Eval interval change Eval interval change
IMPRESSION:
Compared to chest radiographs since ___ most recently ___. Severe heterogeneous opacification in the left mid and
lower lung zones has worsened substantially over the past 24 hours, probably
pneumonia. There is a component of atelectasis reflected in leftward
mediastinal shift. Small region of residual edema persists at the right lung
base. Right upper lung clear. No pneumothorax. Small pleural effusions are
likely, left greater than right.
Heart size normal. ET tube in standard placement. Transvenous right atrial
right ventricular pacer leads in standard placements. Right jugular line ends
in the low SVC. T AVR in place.
|
19929286-RR-40
| 19,929,286 | 22,584,344 |
RR
| 40 |
2192-12-12 17:48:00
|
2192-12-12 20:23:00
|
EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST
INDICATION: ___ w/ h/o MI, AS s/p TAVR, pacemaker s/p exlap, subtotal
colectomy, SBR ___ colonic ischemia now s/p resection of rectum, L
salpingooph, fascial closure, ileostomy creation. ********BOTH PO AND IV
CONTRAST PLEASE// abscess? anastamotic leak?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 7.5 s, 1.0 cm; CTDIvol = 17.4 mGy (Body) DLP =
17.4 mGy-cm.
4) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
5) Stationary Acquisition 7.5 s, 1.0 cm; CTDIvol = 17.4 mGy (Body) DLP =
17.4 mGy-cm.
6) Spiral Acquisition 15.6 s, 53.6 cm; CTDIvol = 13.0 mGy (Body) DLP = 677.5
mGy-cm.
Total DLP (Body) = 785 mGy-cm.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: There is a new small left and trace right pleural effusion with
associated atelectasis. Patient is status post TAVR. Midline sternotomy
wires are seen. Pacemaker is partially visualized in left anterior chest wall
with leads ending in the right atrium and right ventricle.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates nodular contours. There is no evidence
of focal lesions. There is no evidence of intrahepatic biliary dilatation.
The gallbladder is surgically absent. There is mild dilatation of the common
bile duct measuring 1.0 cm which tapers down inferiorly, unchanged from prior
exam. There is a moderate amount of fluid in the abdomen and pelvis.
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: Cortical scars are seen in the left kidney. The right kidney is of
normal and symmetric size with normal nephrogram.
GASTROINTESTINAL: Patient is status post recent subtotal colectomy, resection
of the rectum, right lower quadrant ileostomy, partial removal of omentum and
left salpingo-oophorectomy for resection of the previously seen rectosigmoid
mass. The proximal small bowel is dilated measuring up to a 4.3 cm. There is
gradual tapering of the small bowel loops in the region of the distal jejunum.
The remainder of the small bowel is normal in caliber. Moderate volume of
postoperative free fluid is seen in the abdomen and pelvis. No definite
loculated fluid collection is seen. There is no evidence of contrast leak.
PELVIS: The urinary bladder is 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: There is no evidence of worrisome osseous lesions or acute fracture.
Marked degenerative changes noted in lumbar spine.
SOFT TISSUES: Midline abdominal wound is seen.
IMPRESSION:
1. Status post recent subtotal colectomy, resection of the rectum, right lower
quadrant ileostomy, partial removal of omentum and left salpingo-oophorectomy.
No evidence of an abscess or enteric contrast leak.
2. Dilated loops of proximal small bowel with gradual tapering in the distal
jejunum which most likely represents postoperative ileus.
3. Moderate amount of free fluid in the abdomen pelvis which most likely
represents post surgical changes.
4. New small left and trace right pleural effusions with associated
atelectasis.
|
19929286-RR-41
| 19,929,286 | 22,584,344 |
RR
| 41 |
2192-12-13 08:42:00
|
2192-12-13 11:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ y/o F with leukocytosis// eval for pneumonia
IMPRESSION:
In comparison with the study of ___, the heterogeneous opacification in
the left mid and lower zone has decreased, with bibasilar atelectatic changes.
The endotracheal and nasogastric tube and right IJ catheter have all been
removed.
Cardiac silhouette is within normal limits and there is no appreciable
vascular congestion. The upper lungs are clear.
|
19929286-RR-42
| 19,929,286 | 22,584,344 |
RR
| 42 |
2192-12-13 18:02:00
|
2192-12-13 19:08:00
|
INDICATION: ___ year old woman with NG tube placement// Check NG placement
TECHNIQUE: Portable AP radiograph of the chest and upper abdomen.
COMPARISON: Chest radiograph ___ at 09:58
FINDINGS:
There has been interval placement of a nasogastric tube, which terminates in
the body of the stomach.
There is redemonstration of the distended stomach and multiple dilated loops
of small wall bowel in the left upper quadrant of the abdomen. There is no
evidence of free intraperitoneal air, although evaluation is limited by
portable supine technique. Surgical clips are noted in the right upper
quadrant of the abdomen. There are postsurgical changes from TAVR and left
pacemaker placement. There are bibasilar lung opacities which most likely
represents left lower lobe atelectasis. Mild blunting of the left
costophrenic angle is consistent with atelectasis and a small pleural
effusion.
IMPRESSION:
1. Interval placement of a nasogastric tube, which terminates in the body of
the stomach.
2. Unchanged distended stomach and multiple dilated loops of small wall bowel
in the left upper quadrant of the abdomen.
|
19929286-RR-43
| 19,929,286 | 22,584,344 |
RR
| 43 |
2192-12-14 09:02:00
|
2192-12-14 10:08:00
|
EXAMINATION: Diagnostic and therapeutic paracentesis
INDICATION: ___ y/o F w/ moderate amount of free fluid in the abdomen/pelvis.
Patient with nausea/vomiting// assess for paracentesis, may leave drain if
necessary
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Multiple prior examinations, most recent CT abdomen and pelvis
from ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower quadrant and 400 cc of slightly turbid, straw-colored fluid were
removed. Fluid samples were submitted to the laboratory for cell count,
differential, and culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 400 cc of fluid were removed.
|
19929286-RR-44
| 19,929,286 | 22,584,344 |
RR
| 44 |
2192-12-26 14:54:00
|
2192-12-26 17:12:00
|
EXAMINATION: CT abdomen and pelvis with intravenous contrast
INDICATION: ___ w/ h/o MI, AS s/p TAVR, pacemaker s/p exlap, subtotal
colectomy, SBR ___ colonic ischemia now s/p resection of rectum, L
salpingooph, fascial closure, ileostomy creation, c/b UGI bleed Now with
nausea/emesis POD21.// ?abcess or fluid collection. Compare to prior study.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 659 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: Trace left pleural effusion is decreased in size from CT abdomen
pelvis ___. The there is mild dependent atelectasis in the
bilateral lower lobes. 2 pacer leads are partially visualized and an aortic
valve prosthesis is noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
There is moderate volume ascites in the abdomen and pelvis with peritoneal
thickening and enhancement likely representing peritonitis. There is possible
loculation of the site is in the infrahepatic region (02:39).
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: Cortical thinning in the upper pole of the left kidney likely
represents atrophy. There are sub-centimeter hypodensities in both kidneys
which are too small to characterize. There is no hydronephrosis or
perinephric abnormality.
GASTROINTESTINAL: Patient is status post proctocolectomy and diverting
ileostomy in the right lower quadrant. Oral contrast is noted in a ___
pouch. Mildly dilated small bowel loops measuring up to 3.4 cm in the jejunum
are decreased in degree of dilatation since ___.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
moderate amount of ascites in the pelvis with associated peritoneal thickening
enhancement likely representing peritonitis and a small amount of free fluid
in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. Patient is status post left
salpingo-oophorectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is ectasia of the infrarenal aorta measuring up to 2.8 cm
across maximal diameter (02:35) grossly unchanged dating back to CT abdomen
pelvis ___.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: And ileostomy is noted in the right lower quadrant. Defect in
the subcutaneous tissues of the midline anterior abdominal wall is a new since
___.
IMPRESSION:
1. Mildly dilated small bowel loops measuring up to 3.4 cm is decreased, and
degree of dilatation, since ___, and likely represents an ileus. No
evidence of obstruction.
2. Moderate volume ascites in the abdomen and pelvis is decreased in size as
compared to ___. Possible loculated ascites in the
infrahepatic region. There is peritoneal enhancement and thickening likely
representing peritonitis.
3. No evidence of abscess in the abdomen or pelvis.
|
19929286-RR-45
| 19,929,286 | 22,584,344 |
RR
| 45 |
2192-12-27 10:54:00
|
2192-12-27 14:14:00
|
EXAMINATION: CT guided drainage of 2 peritoneal fluid collections.
INDICATION: ___ w/ h/o MI, AS s/p TAVR, pacemaker s/p exlap, subtotal
colectomy, SBR ___ colonic ischemia now s/p resection of rectum, L
salpingooph, fascial closure, ileostomy creation, c/b UGI bleed now s/p
clipping with CT findings ___ c/f abscess within intra abd cavity// CT abd
findings today concerning for intra-abdominal abscess requiring drainage
COMPARISON: CT abdomen and pelvis dated ___.
PROCEDURE: CT-guided drainage of right upper quadrant and left hemipelvis
peritoneal collections.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending 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 supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collections. Based on the
CT findings appropriate skin entry sites for drain placement were chosen
within the right upper quadrant in the perihepatic region, and within the low
left hemipelvis. The sites were marked. Local anesthesia was administered
with 1% Lidocaine solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into each collection. Samples of fluid were aspirated, confirming
needle position within the collections. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collections. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collections via CT fluoroscopy.
Approximately cc of serosanguineous fluid was aspirated from the right upper
quadrant fluid collection with a sample sent for microbiology evaluation.
Approximately 6 cc of serous fluid was aspirated from the left lower
hemipelvis fluid collection with a sample sent for microbiology evaluation.
The catheters were secured by a StatLock. The catheters were attached to
suction bulb. Sterile dressings were applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Total exam DLP: 599 mGy cm
SEDATION: Moderate sedation was provided by administering divided doses of 0
mg Versed and 125 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:
Trace left pleural effusion. Bibasilar atelectasis. The patient is status
post aortic valve replacement. Pacemaker wires are seen terminating within
the right atrium and right ventricle.
There is diffuse peritoneal thickening, as described on the prior CT,
compatible with peritonitis. There is a moderate-sized peritoneal fluid
collection extending along the inferolateral margin of the liver into the
right pericolic gutter. There is a larger fluid collection extending from the
left pericolic gutter into the left hemipelvis. These 2 collections were
targeted for CT-guided drainage.
Status post total colectomy with ___ pouch and diverting ileostomy,
which is unremarkable in appearance. Midline abdominal wall surgical incision
is also unremarkable in appearance. Punctate calcifications within the liver.
Status post cholecystectomy. Retained contrast is seen within the kidneys and
bladder. Severe atherosclerotic calcifications with infrarenal abdominal
aortic ectasia.
IMPRESSION:
1. Successful CT-guided placement of an ___ pigtail catheter into the
right upper quadrant peritoneal collection. 20 cc of serosanguineous fluid
was sampled and sent for microbiology evaluation.
2. Successful CT-guided placement of an ___ pigtail catheter into the
left lower hemipelvis collection. 15 cc of serous fluid was sampled and sent
for microbiology evaluation.
|
19929286-RR-46
| 19,929,286 | 22,584,344 |
RR
| 46 |
2192-12-27 15:23:00
|
2192-12-27 16:03:00
|
INDICATION: ___ w/ h/o MI, AS s/p TAVR, pacemaker s/p exlap, subtotal
colectomy, SBR ___ colonic ischemia now s/p resection of rectum, L
salpingooph, ileostomy c/b VRE fluid collection// s/p enteral feeding
placement
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left-sided pacemaker is unchanged. The Dobhoff tube projects below the left
hemidiaphragm the tip projects over the stomach. Cardiomediastinal silhouette
is stable. There is no pleural effusion. No pneumothorax is seen. Lung
volumes have improved
|
19929286-RR-47
| 19,929,286 | 22,584,344 |
RR
| 47 |
2192-12-28 19:27:00
|
2192-12-28 19:59:00
|
EXAMINATION: Chest radiograph, single AP upright portable view.
INDICATION: Dobhoff tube placement.
COMPARISON: Prior study from ___.
FINDINGS:
Dobhoff tube terminates in the stomach. Patient is status post endovascular
aortic valve repair. Sternotomy has also been performed. Dual lead
pacemaker/ICD device appears unchanged. Cardiac, mediastinal and hilar
contours appear stable. Opacities suggests minimal atelectasis along the left
costophrenic sulcus, but decreased. Left pleural effusion is also no longer
apparent. There is no pneumothorax.
IMPRESSION:
Dobhoff tube terminating in the stomach.
|
19929286-RR-48
| 19,929,286 | 22,584,344 |
RR
| 48 |
2192-12-29 10:32:00
|
2192-12-29 11:16:00
|
INDICATION: ___ year old woman with complicated post operative course with
rising WBC.// ?pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
Left-sided pacemaker is unchanged. The NG tube projects below the left
hemidiaphragm and projects over the stomach. There is minimal subsegmental
atelectasis in the right lung base. There is also subsegmental atelectasis in
the left lung base. Cardiomediastinal silhouette is stable. There is no
pleural effusion. No pneumothorax is seen.
|
19929286-RR-49
| 19,929,286 | 22,584,344 |
RR
| 49 |
2193-01-03 13:41:00
|
2193-01-03 17:52:00
|
INDICATION: ___ w/ h/o MI, AS s/p TAVR, pacemaker s/p exlap, subtotal
colectomy, SBR ___ colonic ischemia now s/p resection of rectum, L
salpingooph, ileostomy c/b VRE fluid collection now drained// Rule out
obstruction
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT guided drainage of 2 peritoneal fluid collections dated ___, CT abdomen pelvis dated ___
FINDINGS:
Nonobstructive bowel gas pattern. There are no abnormally dilated loops of
large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There is redemonstration of 2 pigtail catheters that project over the
bilateral lower abdomen. Additionally, cholecystectomy clips are seen in the
right upper abdomen and 2 radiopaque clips are seen projecting over the lower
left upper abdomen. There 2 pacer wires, several intact median sternotomy
wires, and a TAVR stent seen within the lower thorax. There are no
unexplained soft tissue calcifications or radiopaque foreign bodies.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
19929286-RR-59
| 19,929,286 | 24,868,766 |
RR
| 59 |
2193-11-13 14:33:00
|
2193-11-13 17:17:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with colonic ischemia s/p subtotal colectomy
and ileostomy, CAD s/p CABG, CHB s/p pacemaker, AVR and then TAVR, PAD s/p
embolectomy with recent admission for enterococcus faecalis bacteremia
presenting with AMS and hypotension concerning for sepsis in setting of + MRSA
blood cultures and known hardware concerning for bacterial endocarditis. She
is on home apixaban and Plavix for PAD.// septic emboli contributing to AMS?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 752 mGy-cm.
COMPARISON: None.
FINDINGS:
There is a hypodensity of the right occipital-parietal lobe, concerning for
subacute infarction. The wedge shape of the hypodensity and its involvement
of the cortex without surrounding edema is consistent with a sterile infarct.
By CT, suspicion for infection is low given the lack of surrounding edema.
However, MR would be more sensitive for detecting edema or enhancement
associated with aseptic infarction. MR may also be helpful for detecting a
possible mycotic aneurysm, although the optimal timing of such in examination
is unclear.
There is an additional area of tissue loss in the right frontal lobe, which is
consistent with evolution of a chronic infarct.
There are calcifications in the right sylvian fissure suspicious for vessel
wall calcification versus calcified emboli; however, these are not proximal to
the infarcted brain.
The ventricles and sulci are within normal limits for age.
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:
1. Right occipital parietal subacute infarction without edema.
2. MR may be helpful for further characterization to investigate the
possibility of infection as well as any evidence for mycotic aneurysm.
3. Evidence of chronic infarct in the right frontal lobe.
RECOMMENDATION(S): By CT, suspicion for infection history low. If clinical
suspicion is high for infection, would recommend obtaining MR/MRA to further
clarify the presence infection. Additionally, an MR/MRA may help to determine
the presence of possible mycotic aneurysm. MR/MRA would also help to further
characterize the infarcts.
|
19929286-RR-61
| 19,929,286 | 24,868,766 |
RR
| 61 |
2193-11-14 18:37:00
|
2193-11-14 19:17:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with hx of PAD c/o of LLE pain.// Pt with hx of
PAD with LLE pain.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: Prior lower extremity ultrasound from ___.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
19929373-RR-23
| 19,929,373 | 29,613,563 |
RR
| 23 |
2160-04-25 18:23:00
|
2160-04-26 14:36:00
|
EXAMINATION: MRCP (MR ABD ___
INDICATION: ___ year old woman s/p lap chole , concern for CBD transection vs
cystic duct leak vs other GB pathology (abd pain, abd fluid concerning for
bile). // ___ year old woman s/p lap chole , concern for CBD transection vs
cystic duct leak vs other GB pathology (abd pain, abd fluid concerning for
bile).
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 9 mL Gadavist gadolinium based contrast. 1 mL
Gadavist mixed with 50 mL water was also administered for oral contrast.
COMPARISON: HIDA scan from ___.
FINDINGS:
Unfortunately, the examination was not performed with hepatobiliary contrast
agent, and thus biliary leak cannot be directly visualized.
Atelectasis is present in the left lung base. Bilateral breast implants are
demonstrated.
The patient is status post recent cholecystectomy. Intrinsically T1
hyperintense material is present adjacent to the cholecystectomy clips and
tracking along the second portion of the duodenum down to the level of the
genu inferior (15:65, 75). The T1 hyperintense material could represent
either blood products or leaking oral gadolinium based contrast administered
for MRCP.
Large loculated, mostly continuous fluid collection is seen involving the
peritoneal spaces surrounding the liver and the spleen (05:20, 14:1). The
largest perihepatic pocket measures 13.3 x 7.2 cm in size (05:26). A left
subdiaphragmatic pocket measures 12.2 x 4.9 cm (05:15). The left hepatic
lobe, the spleen and the stomach are extrinsically compressed by the fluid
collection.
The CBD is not dilated and seems to be intact (14:1). There is no evidence of
choledocholithiasis. There is variant intrahepatic biliary anatomy, with
posterior right duct inserting into the left duct. The stump of the cystic
duct is not identified. Linear T2 hyperintense peripheral structure is seen
tracking from the hepatic parenchyma towards the gallbladder surgical bed
(05:30), suspected to represent an aberrant bile duct.
Conventional arterial hepatic anatomy is present. The portal and hepatic
veins are patent.
The kidneys and adrenals are normal.
The pancreas is normal in size and signal, without focal masses or ductal
dilatation.
There is no concerning retroperitoneal or mesenteric lymphadenopathy.
The bone marrow signal is normal.
IMPRESSION:
Large, loculated, continuous, upper abdominal collection, involving the
gallbladder fossa, surrounding the left hepatic lobe and extending around the
spleen. Unfortunately, biliary leak cannot be directly assessed, since a
specific hepatobiliary contrast agent was not used. However, a linear T2
hyperintensity tracking from segment V into the collection is concerning for
an aberrant bile duct.
RECOMMENDATION(S): Additional imaging using hepatobiliary contrast and
delayed imaging to evaluate path of biliary elimination was recommended, but
patient is planned to have percutaneous transhepatic drainage and
cholangiogram today.
|
19929373-RR-24
| 19,929,373 | 29,613,563 |
RR
| 24 |
2160-04-25 12:39:00
|
2160-04-25 14:39:00
|
INDICATION: ___ s/p lap chole, now w/ abd pain and HIDA from OSH c/w biliary
leak. Concern for CBD transection causing biliary leak into abdomen. // ___
s/p lap chole, now w/ abd pain and HIDA from OSH c/w biliary leak. Concern for
CBD transection causing biliary leak into abdomen.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Reference CT abdomen ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower abdomen and 1 L of dark brown/ biliousfluid was removed. Fluid samples
were submitted to the laboratory for cell count, differential, and culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Successful ultrasound-guided diagnostic and therapeutic paracentesis with
removal of approximately 1 L of bilious fluid.
|
19929373-RR-28
| 19,929,373 | 29,613,563 |
RR
| 28 |
2160-04-29 10:25:00
|
2160-04-29 14:35:00
|
INDICATION: ___ s/p laparoscopic cholecystectomy now with large bile leak.
The patient will require PTC and PTBD placement in the b/l biliary systems
before undergoing definitive repair by transplant surgery in ___ weeks //
Requesting PTBD placement in the b/l biliary systems per transplant surgery
recs
COMPARISON: MRCP from ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
Dr. ___ radiologist, personally supervised the trainee during
the key components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: General anesthesia was provided by the anesthesia service.
MEDICATIONS: Please see anesthesia records.
CONTRAST: 25 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 15.8 minutes, 259 mGy
PROCEDURE:
1. Transabdominal ultrasound.
2. Ultrasound and fluoroscopic guided right percutaneous transhepatic bile
duct access.
3. Cholangiogram with cone beam CT.
4. ___ right biliary drain.
PROCEDURE DETAILS:
Following the discussion of the risks, benefits, and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per ___ protocol. The right and mid
abdomen were prepped and draped in the usual sterile fashion.
Using both fluoroscopic and ultrasound guidance, a 21 gauge cook needle was
advanced into the right anterior biliary system. Images of the access were
stored on PACS. A Headliner wire was advanced under fluoroscopic guidance into
the common bile duct. A skin ___ was made over the needle and the needle was
removed over the wire. The inner portion of an Accustick sheath was advanced
over the wire and into the common bile duct. A contrast injection was
performed to confirm biliary anatomy.
Rotational cone-beam CT cholangiography was then performed to help delineate
the anatomy. Multiplanar CT images were reconstructed and 3D volume-rendered
images of the biliary anatomy required post-processing on an independent
workstation under direct physician supervision by the attending, Dr. ___.
These images were used in the interpretation, decision making for intervention
and reporting of this procedure.
The headliner wire was then exchanged for a Glidewire which was placed through
the common bile duct and into the small bowel. A Kumpe catheter was used to
direct the Glidewire more distal into small bowel. The Glidewire was then
exchanged for an Amplatz wire. Following sequential dilatation with 8 and 10
___ dilators, a 10 ___ internal external biliary drainage catheter was
advanced, the wire and inner stiffener were removed and the pigtail was
formed. Contrast injection confirmed appropriate position. The catheter was
flushed with saline, secured with Flexi Trak device and 0 silk sutures to the
skin and sterile dressings were applied. The catheter was attached to a bag.
The patient tolerated the procedure well. There were no immediate
complications. The patient was transferred to the PACU in stable condition.
FINDINGS:
1. Cone beam cholangiography demonstrates an area of contrast extravasation
which originates from a small branch duct off the right anterior hepatic duct.
This may represent an accessory cystic duct.
2. Successful placement of 10 ___ internal external biliary drainage
catheter.
IMPRESSION:
Successful placement of a right anterior 10 ___ internal-external biliary
drain.
|
19929373-RR-29
| 19,929,373 | 29,613,563 |
RR
| 29 |
2160-05-01 20:53:00
|
2160-05-04 17:33:00
|
EXAMINATION: ABDOMEN (SUPINE ONLY)
INDICATION: ___ year old woman s/p ___ PTBD due to biliary leak s/p lap chole
// eval drain placement
TECHNIQUE: Two views of the abdomen
COMPARISON: MRCP ___
FINDINGS:
The PTBD appears in unchanged position. A surgical drain terminates in the
right upper quadrant. The bowel gas pattern is nonspecific and
nonobstructive. There are no abnormally dilated loops of small or large bowel.
There is no evidence of pneumatosis or pneumoperitoneum. The visualized
osseous structures are unremarkable. Surgical clips are noted in the right
upper quadrant and mid abdomen.
IMPRESSION:
A PTBD is in unchanged position from the previous PTBD procedure images.
|
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