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19929373-RR-30
| 19,929,373 | 29,613,563 |
RR
| 30 |
2160-05-01 22:01:00
|
2160-05-03 11:40:00
|
INDICATION: ___ year old woman with R PTBD placed for biliary diversion in
setting of post CCY bile leak/peritonitis. pt w/ new fever and severe abd pain
and drain misplaced by ___ // exchange and reposition R PTBD
COMPARISON: Comparison is made to PTBD placed ___ and MRCP performed
___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed 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: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 20 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed, lidocaine, 4 mg of Zofran.
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.1 min, 70 mGy
PROCEDURE:
1. Exchange of the existing percutaneous trans-hepatic biliary drainage
catheter with a new 10 ___ PTBD catheter.
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 abdomen was prepped and draped in the usual sterile
fashion.
Initial scout images showed biliary drain had been withdrawn with radiopaque
marker at the liver edge. The right tubes were injected with dilute contrast.
The images were stored on PACS.
Following the subcutaneous injection of 1% lidocaine and instillation of
lidocaine jelly into the skin site, the right catheter was cut and ___
wire was advanced through the catheter into the duodenum. The catheter was
removed over the wire and a 10 ___ percutaneous trans hepatic biliary
drainage catheter was advanced into the duodenum. Side holes were positioned
above and below the level of obstruction to facilitate internal drainage. The
wire and inner stiffener were removed, the catheter was flushed, the loop was
formed, the catheter was attached to a bag and sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Indwelling right 10 ___ percutaneous transhepatic biliary drainage
catheter malpositioned.
2. Successful exchange of 10 percutaneous transhepatic biliary drainage
catheter with new 10 ___ catheters.
IMPRESSION:
Successful exchange of existing percutaneous transhepatic biliary drainage
catheters with new 10 ___ percutaneous transhepatic biliary catheter.
|
19929625-RR-25
| 19,929,625 | 20,538,997 |
RR
| 25 |
2153-06-02 13:44:00
|
2153-06-02 15:42:00
|
EXAMINATION: CT abdomen and pelvis with IV contrast
INDICATION: ___ year old woman with pancreatic cancer, PCT biliary drain with
nausea and vomiting
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous contrast administration with split bolus technique.
DOSE: DLP: 878 mGy-cm (abdomen and pelvis.
IV Contrast: 150 mL Omnipaque
COMPARISON: MRCP ___. CT abdomen from ___.
FINDINGS:
CHEST:
With the exception of mild dependent atelectasis, the visualized lung bases
are clear. No pleural effusion. The heart size is normal, and there is small
amount of pericardial fluid (2:4) similar to prior.
ABDOMEN:
The liver enhances homogeneously, and there are no suspicious focal lesions.
Patient is status post cholecystectomy. A PTC drain is visualized and there is
pneumobilia in the left lobe. The spleen and adrenal glands are normal. There
is normal enhancement of the kidneys, and symmetrical excretion of contrast is
noted. The known pancreatic head mass measures approximately in 3.2 x 1.6 cm
(TV x AP), grossly unchanged compared to the prior MRCP dated ___. Two
fluid collections are noted in close association with pancreas; The first is a
heterogeneous predominately hypodense attenuation with peripheral areas of
higher density and appearance of septations measuring 6.5 x 5.9 x 5.8 cm. It
involves the body of the pancreas and peripancreatic soft tissues (2:27), and
has the appearance of walled-off necrosis. A second homogeneous hypodense
collection is seen adjacent the gastric fundus measures 7.9 x 6.5 x 5.5 cm
(2:18), most compatible with a pseudocyst. This fluid collection causes mass
effect with narrowing of the gastric lumen. Given recent episode of acute
pancreatitis and relative short interval developed of these findings since the
prior study, these findings are most suggestive of complications of
pancreatitis, and less likely due to tumor progression.
The small and large bowel are normal in caliber, and there is no focal wall
thickening. Diverticulosis is noted without diverticulitis. The appendix is
normal. No ascites. No pneumoperitoneum. Atherosclerotic calcifications are
noted throughout the abdominal aorta and iliac branches. The aorta is normal
in course and caliber. The celiac axis, SMA, renal arteries, and ___ appear
patent. Compared to the prior CT on ___, the splenic artery appears
attenuated where it courses posterior to the complex fluid collection in the
body of the pancreas, most notable on series 2, image 28; however, it appears
patent. Of note, varices adjacent to the greater curvature of the stomach are
more apparent. There is a 2.2 x 0.9 cm heterogeneous partially low density
structure posteromedial to the complex fluid collection (2:30), lateral to
the SMA, which may be inflammatory in nature although metastatic involvement
and subsequent necrotic node cannot be excluded. This is new since prior CT
from ___.
PELVIS:
The bladder is mildly distended. The uterus is not visualized. No adnexal
abnormalities are identified. No free fluid within the pelvis.
MUSCULOSKELETAL:
Degenerative changes are noted throughout the lower thoracic and lumbar spine.
Degenerative changes including partial fusion seen at the SI joints. There are
no lytic or sclerotic bony lesions that are concerning for malignancy.
IMPRESSION:
1. No small bowel obstruction. No pneumoperitoneum.
2. A complex fluid collection involving the body of the pancreas is
compatible with walled off necrosis. A second homogeneous fluid collection
adjacent to with secondary mass effect on the stomach, is likely a pseudocyst.
Given
short interval development of these findings and recent episode of acute
pancreatitis, these findings are most likely complications of acute
pancreatitis and less likely due to tumor progression.
3. A 2.2 x 0.7 cm low-density soft tissue structure adjacent to the SMA, new
since ___, is also most likely inflammatory, although followup will be
necessary as metastatic involvement cannot be excluded.
4. Known pancreatic head mass grossly unchanged.
5. A portion of the splenic vein appears attenuated due to mass effect
from adjacent changes of pancreatitis.
|
19929769-RR-7
| 19,929,769 | 27,411,511 |
RR
| 7 |
2121-06-08 22:06:00
|
2121-06-08 23:01:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB // eval for pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Patchy basilar opacities could be due to atelectasis but raise concern for
pneumonia in the appropriate clinical setting. No pleural effusion or
pneumothorax is seen. Cardiac silhouette is top-normal to mildly enlarged.
Mediastinal contours are unremarkable.
IMPRESSION:
Patchy basilar opacity could be due to atelectasis, aspiration, and/or
pneumonia.
|
19930063-RR-17
| 19,930,063 | 28,032,041 |
RR
| 17 |
2137-11-22 08:19:00
|
2137-11-22 09:34:00
|
EXAMINATION: CT left ankle and foot without contrast
INDICATION: Status post fall. Evaluate calcaneal fracture.
TECHNIQUE: Axial helical multi detector CT images of the left ankle and foot
were acquired without contrast. Multiplanar reformats were generated in the
coronal and sagittal planes.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) CT Localizer Radiograph
4) Spiral Acquisition 13.2 s, 23.4 cm; CTDIvol = 20.1 mGy (Body) DLP =
469.7 mGy-cm.
Total DLP (Body) = 470 mGy-cm.
COMPARISON: Outside hospital left foot and ankle radiographs ___.
FINDINGS:
There is a severely comminuted, depressed fracture of the left calcaneus with
intra-articular extension to the anterior, posterior and middle articular
facet. More than 3 fracture lines are present. Maximum articular step-off of
5 mm at the posterior facet (401b:83). Small fracture fragments are seen in
the subtalar joint. There is prominent surrounding soft tissue edema. No
other fracture is identified.
No joint effusion is identified. Otherwise, there is no significant
degenerative change. Though CT evaluation of the soft tissues is limited, the
imaged tendons appear grossly intact. No tendon entrapment is seen. Muscles
appear normal in bulk.
IMPRESSION:
Type 4 left calcaneal fracture with severe combination, extension to the
anterior, posterior and medial articular facets and maximum articular step-off
of 5 mm at the posterior facet. No tendon entrapment seen.
|
19930063-RR-18
| 19,930,063 | 28,032,041 |
RR
| 18 |
2137-11-22 08:24:00
|
2137-11-22 09:41:00
|
EXAMINATION: DX ANKLE AND FOOT
INDICATION: ___ year old man with fall with a left calcaneal fracture.
Evaluate for right foot or ankle fracture.
TECHNIQUE: Right foot, three views. Right ankle, three views.
COMPARISON: None
FINDINGS:
There are longitudinally oriented lucencies extending from the tibiotalar
joint proximally up the tibia, representing fractures. The fracture is best
seen on the lateral view as a slight depression of the distal tibia as well as
a hook-like fragment extending anteriorly from the tibial surface.
The lateral malleolus and talus appear normal. The tarsal bones, metatarsals,
and phalanges are intact. Lisfranc interval is maintained. There is no
radiopaque foreign body in the soft tissues.
IMPRESSION:
1. Depressed, intra-articular fracture of the anterior/medial aspect of the
distal tibia.
2. No evidence of fracture in the foot.
|
19930063-RR-19
| 19,930,063 | 28,032,041 |
RR
| 19 |
2137-11-22 18:07:00
|
2137-11-24 10:45:00
|
INDICATION: ___ man with a left calcaneal fracture in a distal right
tibia fracture, evaluate tibia fracture.
TECHNIQUE: Axial MDCT images of the right lower extremity were obtained
without the administration of contrast. Multiplanar reformations in the
sagittal and coronal planes were obtained and reviewed.
DOSE: Total DLP (Body) = 593 mGy-cm.
COMPARISON: Right right ankle and foot radiographs ___.
FINDINGS:
There is a vertically-oriented fracture through the distal tibia medially
extending to the articular surface along the medial tibial plafond (400b:127).
A transverse component extends into the medial malleolus (400b:113). An
additional fracture line is seen extending to the lateral aspect of the tibial
plafond (400b:109). The appearances suggest an impaction injury with mild
narrowing of the lateral portion of the ankle mortise. There is minimal,
approximately 1 mm, depression of the tibial plafond (series 400b, image 110).
The dome of the talus is intact. No additional fractures are identified.
There is no dislocation. A small bone island is seen within the talus.
There are no concerning focal lytic or sclerotic osseous lesions. There is no
periostitis or focal bony erosion. There is a small ankle effusion, with a
fat-fluid level. Fluid is seen around the distal posterior tibilias tendon.
Otherwise, the imaged tendons are unremarkable. The imaged subcutaneous and
deep soft tissues of the right ankle and foot are unremarkable.
IMPRESSION:
1. Non-displaced, minimally impacted intra-articular fracture extending from
the distal left medial tibial metadiaphysis to the tibial plafond and
involving the medial malleolus, along with a minimally depressed tibial
plafond fracture, detailed above.
2. Small ankle lipohemarthrosis.
|
19930063-RR-20
| 19,930,063 | 28,032,041 |
RR
| 20 |
2137-11-24 07:57:00
|
2137-11-24 09:15:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: RT TIB FX.,ORIF
IMPRESSION:
Images from the operating suite show placement of a fixation device about
fracture of the distal tibia. Further information can be gathered from the
operative report.
|
19930120-RR-160
| 19,930,120 | 23,731,549 |
RR
| 160 |
2179-09-07 14:26:00
|
2179-09-07 16:16:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: ___ w/crackles in bases, AMS, please eval for CHF, please eval
for PNA// ___ w/crackles in bases, AMS, please eval for CHF, please eval for
PNA
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Patient is somewhat kyphotic in position. Right-sided Port-A-Cath terminates
at the cavoatrial junction. No pneumothorax is seen. There relatively low
lung volumes but no focal consolidation. No pleural effusion or pneumothorax
is seen. Cardiac and mediastinal silhouettes are stable. No pulmonary edema
is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
19930120-RR-161
| 19,930,120 | 23,731,549 |
RR
| 161 |
2179-09-07 14:17:00
|
2179-09-07 14:52:00
|
EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: ___ w/AMS, please eval for mass or bleed// ___ w/AMS, please eval
for mass or bleed ___ w/AMS, please eval for mass or bleed
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.5 cm; CTDIvol = 48.8 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Prior MRI from ___
FINDINGS:
Prominence of the ventricles and left frontal lobe encephalomalacia with ex
vacuo dilatation of the left lateral ventricle is similar compared the prior
study. Confluent bilateral periventricular and subcortical white matter
hypodensity, a similar in distribution to T2 hyperintensity seen on FLAIR
images on the prior study. Re-demonstrated left basal ganglia
encephalomalacia. Prominence of the sulci is again seen. No acute
intracranial hemorrhage is seen. There is no midline shift. MRI would be
more sensitive in assessing for acute ischemia. Patient is status post left
frontal craniotomy. The paranasal sinuses and mastoid air cells are clear.
Subtle mottled appearance of the calvarium could relate to underlying
lymphoproliferative disease, or renal insufficiency
IMPRESSION:
No acute intracranial hemorrhage. Chronic changes including prominence of the
ventricular system, ex vacuo dilatation of the left frontal horn with left
frontal lobe encephalomalacia, and confluent bilateral periventricular and
subcortical white matter hypodensity, similar in distribution compared to
prior MRI. If concern for acute ischemia, MRI would be more sensitive.
No midline shift.
|
19930120-RR-162
| 19,930,120 | 23,731,549 |
RR
| 162 |
2179-09-13 13:19:00
|
2179-09-13 15:46:00
|
INDICATION: ___ year old woman with history of G tube (removed years ago), CNS
lymphoma, needs G tube. Placement attempted by GI, however, unsuccessful given
scarring. Attempt Gtube placement for hydration, medication administration,
feeds.
COMPARISON: CT abdomen and pelvis dated ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: General anesthesia was administered by the anesthesiology
department. Please refer to anesthesiology notes for details.
MEDICATIONS: 1 mg of intravenous glucagon.
CONTRAST: 20 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 6.6 min, 13.0 mGy
PROCEDURE: 1. Placement of a ___ F Wills ___ gastrostomy tube.
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 abdomen was prepped and draped in the usual sterile fashion. A
nasogastric tube was placed using a ___ angled glide catheter.
A scout image of the abdomen was obtained. The stomach was insufflated through
the indwelling nasogastric tube. Targeted ultrasound of the upper abdomen
ensured that the liver was not in the field. Under fluoroscopic guidance, 3 T
fastener buttons were sequentially deployed in a triangular position elevating
the stomach to the anterior abdominal wall. Intra-gastric position was
confirmed with aspiration of air and injection of contrast. A small skin
incision between the T-fasteners was made. A 19 gauge needle was introduced
under fluoroscopic guidance and position confirmed using an injection of
dilute contrast. A ___ wire was introduced into the stomach. The needle was
removed.
After sequential dilation using 10 and 12 ___ dilators, a ___ F Wills
___ gastrostomy tube was advanced over the wire into position. The
catheter was secured by forming the retaining loop in the stomach after
confirming the position of the catheter with a contrast injection. The
catheter was then flushed, capped and secured to the skin with 0-silk sutures
and a StatLock. Sterile dressings were applied. The patient tolerated the
procedure well and there were no immediate complications.
FINDINGS:
1. Successful placement of a ___ F Wills ___ gastrostomy tube.
IMPRESSION:
Successful placement of a ___ F Wills ___ gastrostomy tube. The catheter
should not be used for 24 hours.
|
19930120-RR-164
| 19,930,120 | 23,731,549 |
RR
| 164 |
2179-09-15 10:42:00
|
2179-09-15 12:28:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with CNS lymphoma on treatment// eval for
improvement vs progression
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI brain ___, MRI brain ___
FINDINGS:
There is small focus of mildly increased signal on diffusion weighted images
in the right Corona radiata, less conspicuous compared with ___,
with associated mild enhancement, which has improved since ___.
There is 2.9 cm x 2.5 cm right periatrial masslike FLAIR abnormality, with
intermediate T2 signal, compared with 2.8 cm x 2.5 cm on ___.
There is associated zone of periventricular restricted diffusion. Enhancement
seen on ___ has significantly improved with minimal residual
discontinuous enhancement on today's exam, with some intrinsic T1
hyperintensity evident on pre gadolinium images. Previously seen small focus
of enhancement posterior to the left insula has nearly resolved, without
associated restricted diffusion on today's scan. There is generalized brain
parenchymal atrophy. There are extensive confluent T2 signal abnormalities in
bilateral cerebral hemispheres, likely posttreatment change. Postoperative
change of prior left frontal drain placement with focus of encephalomalacia
along the drain tract. There is stable chronic infarct in the left basal
ganglia.
There is no evidence of new mass or infarct. No new enhancing abnormalities.
Paranasal sinuses, mastoid air cells are clear. Preserved intracranial
vascular flow voids.
IMPRESSION:
1. There has been near resolution of right periatrial enhancement since ___. Persistent stable periatrial FLAIR masslike hyperintensity and
associated restricted diffusion may be treatment related or pseudo response,
and is unchanged since ___.
2. Interval decrease of small focus of enhancement in the right Corona
radiata, and near resolved small focus of enhancement posterior to the left
insula.
3. Extensive confluent parenchymal T2 hyperintensities, likely treatment
related. Chronic encephalomalacia left frontal lobe, with chronic left basal
ganglia infarct, stable.
4. No new infarcts.
|
19930120-RR-165
| 19,930,120 | 23,731,549 |
RR
| 165 |
2179-09-15 13:42:00
|
2179-09-15 16:48:00
|
EXAMINATION: Video oropharyngeal swallow study
INDICATION: ___ year old woman with dysphagia// evaluate what kind of
dysphagia
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 5:03 min.
COMPARISON: None
FINDINGS:
The patient had delayed initiation of swallowing. Barium passes freely through
the oropharynx and esophagus without evidence of obstruction. There is
spillover into the piriforms. Both penetration and aspiration is seen with
thin and thick liquids. There is a significant amount of residue seen in the
vallecula.
IMPRESSION:
Penetration and aspiration is seen with thin and thick liquids.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19930170-RR-3
| 19,930,170 | 28,627,767 |
RR
| 3 |
2167-03-28 08:11:00
|
2167-03-28 09:19:00
|
HISTORY: Right upper quadrant pain, nausea/vomiting for 2 days, report of
dilated CBD on prior outside imaging.
TECHNIQUE: Grayscale and Doppler ultrasound imaging of the abdomen was
performed.
COMPARISON: CT from ___.
FINDINGS:
The liver is normal in size and echogenicity without evidence of focal mass.
The gallbladder appears normal without evidence of stones or wall thickening.
The CBD is dilated up to 8 mm. No obstructing stone or mass is identified.
The spleen is normal in size and echogenicity measuring 10.1 cm. Both kidneys
are normal in size and echogenicity measuring 11 cm on the left and 11.7 cm on
the right. There is no evidence of solid renal mass, calculus, or
hydronephrosis. The visualized portions of the pancreas are normal without
evidence of mass or ductal dilatation. The main portal vein is widely patent
with hepatopetal flow. The visualized portions of the aorta and IVC are
normal.
IMPRESSION:
No evidence of cholelithiasis. Dilated common bile duct up to 8 mm without
obstructing stone or mass identified, without intrahepatic biliar dilatation.
Further evaluation with MRCP for cause of obstruction should be considered.
|
19930170-RR-4
| 19,930,170 | 28,627,767 |
RR
| 4 |
2167-03-28 13:39:00
|
2167-03-29 09:05:00
|
INDICATION: ___ woman with right upper quadrant pain, nausea and
vomiting. Recent ultrasound demonstrating mildly dilated CBD.
COMPARISON: Abdomen ultrasound ___ and CT abdomen ___.
TECHNIQUE: Multiplanar T1- and T2-weighted MR images of the abdomen were
performed prior to and after the uneventful intravenous administration of 5 mL
Gadovist. 1 mL of Gadovist mixed with 50 cc of water was administered as
negative oral contrast.
FINDINGS: The liver is normal in signal intensity, with prominence of the
central biliary tree and CBD, which maximally measures 11 mm. There is mild
drop in hepatic signal in the out of phase images, compared to the in-phase
images, consistent with hepatic steatosis. No obstructing intraductal stones
or masses are seen. No gallstones are identified. The main pancreatic duct
is mildly prominent, measuring up to 2.7 mm. Few dilated pancreatic duct
sidebranches are unlikely to be due to chronic pancreatitis, given the
relatively normal pancreatic parenchyma and lack of main duct irregularity.
The intersphincteric segment of the CBD and pancreatic duct are not visualized
and likely relates to sphincter of Oddi dysfunction or ampullary stenosis.
The gallbladder is mildly distended, without gallstones. There is mild
hyperemia in the gallbladder wall and adjacent liver. There is trace
perihepatic and pericholecystic fluid. The adrenal glands, spleen and
kidneys are normal. The stomach, imaged abdominal loops of small and large
bowel are unremarkable.
The abdominal aorta is normal in caliber. The celiac trunk, superior
mesenteric, and renal arteries are patent. There is a conventional hepatic
arterial anatomy. The hepatic veins and IVC are patent. The portal, splenic
and superior mesenteric veins are patent. Mild degenerative changes at L5-S1
and mild dextroconvex scoliosis of the thoracolumbar spine are seen. No focal
marrow signal abnormality is seen.
IMPRESSION:
1. Mild intrahepatic and extrahepatic bile duct dilation. Prominent main
pancreatic duct with many slightly dilated side-branches. Mild gallbladder
wall hyperemia associated with trace perihepatic and pericholecystic fluid.
The above findings could relate to a recently passed gallstone or are
secondary to sphincter of Oddi dysfunction or ampullary stenosis. No
obstructing gallstones are seen in the CBD or cystic duct.
2. Mild hepatic steatosis.
Findings discussed with Dr. ___ at 11.00 A.M on ___.
|
19930170-RR-6
| 19,930,170 | 28,627,767 |
RR
| 6 |
2167-03-31 17:45:00
|
2167-04-01 08:32:00
|
HISTORY: Pre-operative.
FINDINGS: No previous images. The heart is normal in size and the lungs are
clear without vascular congestion or pleural effusion. Moderate scoliosis
convexed to the right in the lower thoracic region.
|
19930293-RR-18
| 19,930,293 | 21,037,600 |
RR
| 18 |
2133-06-16 18:49:00
|
2133-06-16 20:20:00
|
INDICATION: ___ with shortness of breath and fever// ?PNA
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___. Chest CT from ___.
FINDINGS:
Lung volumes are slightly low with secondary bronchovascular crowding. There
may be superimposed pulmonary vascular congestion, overall unchanged from
prior. No definite focal consolidation or large effusion. Cardiomediastinal
silhouette is stable.
IMPRESSION:
Pulmonary vascular congestion without definite focal consolidation.
|
19930293-RR-35
| 19,930,293 | 27,917,243 |
RR
| 35 |
2134-02-07 11:09:00
|
2134-02-07 11:38:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: History: ___ with poor healing ulcer over the lateral aspect of
plantar surface of left foot evaluate for osteomyelitis.
TECHNIQUE: Left foot three views.
COMPARISON: Comparison is made to radiographs dated ___.
FINDINGS:
Again demonstrated is a skin defect seen along the lateral forefoot adjacent
to the head of the fifth metatarsal, consistent with ulceration. Large
erosion of the head of the fifth metatarsal appears unchanged compared to exam
performed ___ and is concerning for osteomyelitis in the setting
of infection. Small erosion of the lateral base of the proximal phalanx of
the fifth toe is also concerning for osteomyelitis. Previously described
fracture of the base of the fifth metatarsal is unchanged compared to most
recent prior.
Stable moderate degenerative changes of the great toe MTP joint and IP joints.
Vascular calcifications are unchanged. Prominent plantar calcaneal spur and
small Achilles enthesophyte are stable in appearance. Moderate soft tissue
swelling of the forefoot is again demonstrated.
IMPRESSION:
1. No significant change compared to most recent prior. Large erosion of the
head of the fifth metatarsal and smaller erosion at the lateral base of the
proximal phalanx of the fifth toe is concerning for osteomyelitis in the
setting of infection.
2. Previously described fracture of the base of the fifth metatarsal is
unchanged compared to most recent prior.
|
19930293-RR-36
| 19,930,293 | 27,917,243 |
RR
| 36 |
2134-02-08 16:52:00
|
2134-02-08 17:33:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man with osteomyelitis of L ___ metatarsal// s/p
debridement/amputation
TECHNIQUE: Three views of the left foot were obtained
COMPARISON: ___
FINDINGS:
The patient is status post left fifth metatarsal debridement and amputation at
the level of the mid metatarsal through the diaphysis of the proximal fifth
phalanx. Skin swelling and a small amount of subcutaneous emphysema is noted
around the surgical site. There is an unchanged chronic appearing fracture at
the base of the fifth metatarsal. There are no new erosions.
IMPRESSION:
Postsurgical changes at the level of the left fifth metatarsal and proximal
fifth phalanx as described above.
|
19930554-RR-61
| 19,930,554 | 27,090,024 |
RR
| 61 |
2197-10-26 04:27:00
|
2197-10-26 05:13:00
|
HISTORY: Breast cancer status post lymph node removal of left arm swelling.
Question upper extremity DVT.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed on
the left upper extremity veins.
COMPARISON: None available.
FINDINGS:
The left jugular vein is patent and compressible with transducer pressure.
The left subclavian, axillary and basilic veins are distended with echogenic
contents, noncompressible with transducer pressure and do not show color flow
consistent with thrombus. There is normal flow with respiratory variation in
the right subclavian vein. The brachial and cephalic veins are patent,
compressible with transducer pressure and show normal color flow. Enlarged
abnormal lymph nodes are noted in the left axilla measuring up to 3.5 x 2.7
cm.
IMPRESSION:
1. Deep venous thrombosis in the left subclavian, axillary and basilic veins.
2. Enlarged abnormal lymph nodes in the left axilla. While possibly reactive,
these require short term follow-up US after resolution of the acute findings
given the history of breast cancer.
Findings discussed with Dr. ___ on ___ @ 11:40 am.
|
19930554-RR-70
| 19,930,554 | 21,205,318 |
RR
| 70 |
2197-11-29 21:45:00
|
2197-11-29 22:36:00
|
HISTORY: Metastatic breast cancer on chemotherapy with abdominal pain,
nausea, vomiting.
COMPARISON: CT abdomen and pelvis and CT Chest from ___.
TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases
through the abdomen and pelvis after the administration of IV contrast.
Multiplanar reformatted images were prepared and reviewed.
FINDINGS:
CT ABDOMEN WITH IV CONTRAST:
The visualized lung bases again demonstrate innumerable pulmonary nodules as
well as necrotic left breast mass. The patient is status post right
mastectomy.
The liver, gallbladder, spleen, bilateral adrenal glands, pancreas, stomach,
and visualized loops of small large bowel are within normal limits. Bilateral
kidneys are normal with no evidence of hydronephrosis or stones. The appendix
is not clearly visualized but there are no secondary signs of appendicitis.
There is no free fluid or free air. There is no mesenteric or retroperitoneal
lymphadenopathy. Abdominal aorta is normal in caliber. There is no free air
or free fluid.
CT PELVIS WITH IV CONTRAST:
The uterus appears within normal limits with an IUD in place. The rectum,
sigmoid colon, and bladder appear unremarkable. There is a small amount of
free fluid, likely physiologic.
OSSEOUS STRUCTURES: There are no lytic or sclerotic osseous lesions
suspicious for malignancy. Mild diffuse body anasarca is again noted.
Subcutaneous gas is noted in the anterior subcutaneous tissues, likely from
injections.
IMPRESSION:
1. No acute abdominal or pelvic process.
2. Visualized lung bases again demonstrate innumerable pulmonary nodules as
well as a necrotic left breast mass.
|
19930554-RR-71
| 19,930,554 | 24,162,042 |
RR
| 71 |
2197-12-08 07:31:00
|
2197-12-08 11:41:00
|
HISTORY: Chest pain. Evaluate for injury.
COMPARISON: CT chest from ___.
FINDINGS: PA and lateral views of the chest were obtained. The central
catheter tip of the right chest port terminates in the distal SVC. The
patient is slightly rotated. There is a nodular opacity adjacent to the left
heart border, which is compatible with the known history of pulmonary nodules.
There is no clear sign of effusion or pneumonia, although assessment is
limited by the patient's rotation, and no correlating of effusion or pneumonia
on the lateral view. The cardiomediastinal silhouette is normal. No bony
abnormality is identified.
IMPRESSION:
1. No acute findings.
2. Nodular opacity adjacent to the left heart border, compatible with known
history of pulmonary nodules.
3. No clear sign of effusion or pneumonia, although assessment is limited by
rotation.
|
19930554-RR-72
| 19,930,554 | 24,162,042 |
RR
| 72 |
2197-12-08 12:50:00
|
2197-12-08 14:07:00
|
HISTORY: Sharp midsternal chest pain, with a history of DVT in the setting of
metastatic breast cancer. Evaluate for PE.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen without contrast and low-dose radiation at first,
followed by an early arterial phase scanning after the administration of 100
cc of Omnipaque. Multiplanar reformatted images in coronal and sagittal axes
were generated. Oblique MIPs were prepared in an independent workstation.
DLP: 335.70 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
CT thorax: There is a right chest port with the tip terminating in the right
atrium. The aorta and main thoracic vessels are well opacified. The aorta
demonstrates normal caliber throughout the thorax without intramural hematoma
or dissection. The pulmonary arteries are opacified to the segmental level
and there is no filling defect to suggest pulmonary embolism. No
arteriovenous malformation is seen.
Multiple pulmonary nodules are again seen in a similar distribution as before,
but with some nodules increased in size. The largest pulmonary nodule, in the
lingula, measures 14 x 16 mm (previously 8 x 9 mm) (3:101). The right
infrahilar mass/conglomeration of lymph nodes appears larger than before as
well, measuring 2.2 x 2.2 cm (previously 1.1 x 1.6 cm). Additionally there is
a lymph node adjacent to the left pulmonary artery main pulmonary artery,
which has increased in size from 7 x 14 mm to 16 x 20 mm (3:62).
The left axillary mass has increased in size, now measuring 3.5 x 4.6 cm (from
3.1 x 3.8 cm). There are multiple left breast masses and skin thickening
which appears similar to prior CT.
Osseous structures: No blastic or lytic lesions suspicious for malignancy
present.
IMPRESSION:
1. No pulmonary embolus.
2. Increased tumor burden with increase in size of the left axillary mass,
multiple left breast masses, and pulmonary nodules.
|
19930554-RR-73
| 19,930,554 | 24,162,042 |
RR
| 73 |
2197-12-08 12:51:00
|
2197-12-08 13:31:00
|
HISTORY: Sharp midsternal chest pain with a history of DVT in the setting of
metastatic breast cancer. Evaluate for metastasis or intracranial hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm-reconstructed images were acquired.
DLP: 1025.72 mGy-cm.
COMPARISON: Noncontrast CT head from ___.
FINDINGS:
There is no evidence of acute hemorrhage, edema, mass effect, or large
territorial infarct. The ventricles and sulci are normal in size and
configuration. The basal cisterns are patent and there is preservation of
gray-white matter differentiation.
No fracture or bony lesion suspicious for metastasis is identified. The
visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear.
IMPRESSION:
No acute intracranial abnormality. Please note that MR is more sensitive for
the detection of intracranial metastatic lesions.
|
19930554-RR-79
| 19,930,554 | 22,024,416 |
RR
| 79 |
2198-03-26 04:45:00
|
2198-03-26 06:15:00
|
HISTORY: ___ female with metastatic breast cancer and chest pain.
COMPARISON: ___ and CT dated ___.
TECHNIQUE: Frontal and lateral chest radiographs were obtained.
FINDINGS:
No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is
seen. Heart and mediastinal contours are normal. Lung nodules, largest in
the left mid lung, are better evaluated with CT. Right-sided Port-A-Cath
terminates in the low SVC, unchanged. Lytic sternal metastasis is better seen
on recent CT. No large thoracic spine lesion is detected.
IMPRESSION:
Lung and sternal metastases, better evaluated with CT, without radiographic
evidence for acute cardiopulmonary process.
|
19930554-RR-80
| 19,930,554 | 22,024,416 |
RR
| 80 |
2198-03-26 13:02:00
|
2198-03-26 14:30:00
|
HISTORY: ___ woman with advanced metastatic left breast cancer with
prior left-sided subclavian DVTs. On anticoagulation but now with
thrombocytopenia. Assess present and magnitude of chronic left upper
extremity DVTs.
COMPARISON: Prior upper extremity color Doppler DVT study from ___ was reviewed. CT chest from ___ was also reviewed.
TECHNIQUE: Grayscale, color Doppler flow and spectral wave analysis of the
deep venous system of the left upper extremity was performed.
FINDINGS:
The right subclavian vein demonstrates normal color Doppler flow, waveform and
augmentation.
The left subclavian vein demonstrates markedly diminutive color Doppler flow,
with multiple adjacent collateral veins, suggestive of chronic occlusive
thrombosis. 2 conglomerate ill-defined nodal masses are identified adjacent
to the subclavian vein all measuring up to 1.7 cm and 1.8 cm, demonstrating
color Doppler flow indicative of vascularity. These are suggestive of breast
carcinoma nodal metastases.
The left axillary vein demonstrated normal compressibility, color Doppler flow
and waveform. The left brachial vein and basilic vein demonstrated incomplete
compressibility, in keeping with nonocclusive chronic thrombosis. The left
cephalic vein is patent demonstrating almost complete compressibility and
color doppler flow, however the flow is not wall to wall, suggestive of
chronic nonocclusive thrombosis.
IMPRESSION:
1. Markedly diminutive color Doppler flow within the left subclavian vein with
multiple adjacent collateral veins suggestive of chronic occlusive thrombosis.
Conglomerate ill-defined nodal masses are identified adjacent to the left
subclavian vein, in keeping with breast carcinoma nodal metastases.
2. Patent left axillary vein.
3. Chronic nonocclusive thrombosis of the left brachial vein and basilic vein.
4. Left cephalic vein demonstrates almost complete compressibility, however
does not demonstrate wall to wall flow, suggestive of chronic nonocclusive
thrombosis.
These findings were discussed with Dr. ___ telephone on ___ at 13:45, 5 min following discovery.
|
19930655-RR-21
| 19,930,655 | 21,445,420 |
RR
| 21 |
2160-06-05 21:55:00
|
2160-06-05 22:05:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with DKA. // pneumonia?
COMPARISON: None
FINDINGS:
PA and lateral views the chest provided demonstrate no focal consolidation,
large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony
structures are intact. No free air below the right hemidiaphragm.
IMPRESSION:
No acute intrathoracic process.
|
19930660-RR-24
| 19,930,660 | 26,058,756 |
RR
| 24 |
2141-08-30 17:43:00
|
2141-08-31 00:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SBO // check NG position, stomach vs
post-pyloric check NG position, stomach vs post-pyloric
COMPARISON: There no prior chest radiographs for comparison.
IMPRESSION:
Nasogastric drainage tube ends in the upper portion of a mildly distended
stomach. Lungs are well expanded and clear. Cardiomediastinal and hilar
silhouettes and pleural surfaces are normal. Upper thoracic scoliosis is mild
to moderate. Obliteration of the T5-6 intervertebral disc space could have
been post traumatic. Clinical correlation advised.
|
19930660-RR-25
| 19,930,660 | 26,058,756 |
RR
| 25 |
2141-09-01 20:29:00
|
2141-09-01 21:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p SBR with NGT in place // NGT position
NGT position
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Nasogastric tube again extends to the stomach, though the side port is at or
just above the esophagogastric junction. It could be pushed forward 5-10 cm
for better positioning.
Little change in the appearance of the heart and lungs.
|
19930660-RR-26
| 19,930,660 | 26,058,756 |
RR
| 26 |
2141-09-04 16:13:00
|
2141-09-05 00:33:00
|
INDICATION: ___ year old woman with recurrent SBO // bowel gas pattern? SBO?
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
Small bowel loops are dilated up to 44 mm. Multiple air-fluid levels are
noted. Colon is relatively decompressed.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Dilated small bowel loops are consistent with small bowel obstruction, as seen
on prior CT.
|
19930769-RR-18
| 19,930,769 | 29,077,714 |
RR
| 18 |
2164-09-29 20:57:00
|
2164-09-29 21:26:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with NG placement and large hiatial hernia.//
Location of NGT. (most if not all of the stomach is in the chest.
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___.
IMPRESSION:
Heart size is borderline. There is minimal unfolding of the thoracic aorta.
Hilar contours are preserved. Re-identified is a large hiatal hernia with NG
tube tip residing within the hiatal hernia, though the side-port appears high
and advancing the 2 x 3 cm is recommended. There is probable associated left
basilar atelectasis. Lungs are otherwise clear. There is no effusion or
pneumothorax.
|
19930769-RR-19
| 19,930,769 | 29,077,714 |
RR
| 19 |
2164-09-30 13:18:00
|
2164-09-30 16:39:00
|
EXAMINATION: MRCP
INDICATION: ___ year old woman with paraesophageal hernia with abd pain and
concern for obstructive biliary process// is there concern for obstructive
biliary process
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT abdomen pelvis with contrast ___
FINDINGS:
Lower Thorax: Large hiatal hernia is again demonstrated, with the entire
stomach in the thoracic cavity. There is atelectasis along the margins of the
hernia.
Liver: The liver is normal in size and signal intensity. There is no evidence
of hepatic steatosis. No concerning lesion is identified.
Biliary: There is mild central intrahepatic biliary ductal dilatation. Common
bile duct is dilated up to 11 mm in diameter. The distal CBD appears blunted
on the T2 weighted and MRCP sequences, but appears open into the ampulla on
the delayed postcontrast sequence (16:42). Findings are most compatible with
sphincter of Oddi dysfunction. Gallbladder is unremarkable.
Pancreas: Pancreas demonstrates homogeneous attenuation throughout. There is
no focal pancreatic lesion or main ductal dilatation.
Spleen: Spleen is normal in size signal intensity.
Adrenal Glands: Bilateral adrenal glands are unremarkable.
Kidneys: The kidneys are symmetric in size and demonstrate normal nephrograms.
Few millimetric cysts are noted in bilateral kidneys. There is no
hydronephrosis.
Gastrointestinal Tract: Large hiatal hernia with the entire stomach in the
thoracic cavity. Small and large bowel loops are normal in caliber.
Lymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.
Vasculature: There is no abdominal aortic aneurysm.
Osseous and Soft Tissue Structures: No concerning focal lesion is identified.
Chronic mild L1 compression fracture is again demonstrated.
IMPRESSION:
1. Mild central intrahepatic and extrahepatic biliary ductal dilatation, with
the common bile duct measuring up to 11 mm in diameter. Transient opening of
the common bile duct into the ampulla is demonstrated. Findings are most
compatible with sphincter of Oddi dysfunction.
|
19930769-RR-20
| 19,930,769 | 29,077,714 |
RR
| 20 |
2164-10-02 04:19:00
|
2164-10-02 17:45:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with worsening abdominal pain and concern for
volvulus// Evaluate for volvulus in setting of increasing vomiting
TECHNIQUE: Single AP portable view of the abdomen.
COMPARISON: ___ abdominal CT
FINDINGS:
Previously administered oral contrast is now seen throughout the colon which
also contains air. No dilated loops of small or large bowel are identified.
There is paucity of small bowel gas. There is no evidence of free air within
limitations of a supine radiograph.
IMPRESSION:
Nonspecific nonobstructive bowel gas pattern.
|
19930769-RR-21
| 19,930,769 | 29,077,714 |
RR
| 21 |
2164-10-02 10:57:00
|
2164-10-02 12:05:00
|
INDICATION: ___ year old woman with hiatal hernia, ? volvulus, decrease in
breath sounds R base. please eval for pleural effusion// r/o pleural effusion
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Enteric tube is no longer visualized. There is a large hiatal hernia
occupying the left lower thorax with adjacent atelectasis. The hernia is also
seen at the right lung base medially. There is no obvious effusion or
consolidation. Cardiac silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
Persistent large hiatal hernia, not significantly changed.
|
19930769-RR-22
| 19,930,769 | 29,077,714 |
RR
| 22 |
2164-10-06 10:22:00
|
2164-10-06 12:02:00
|
INDICATION: ___ year old woman with vomiting, hiatal hernia. Surgical service
requesting barium swallow for workup.// has a hiatal hernia, rule out possible
causes for abdominal pain, and nausea.
TECHNIQUE: Double contrast upper GI series
DOSE: Acc air kerma: mGy; Accum DAP: uGym2; Fluoro time:
FINDINGS:
ESOPHAGUS:
The esophagus was not dilated. There was no esophageal web, ring, or
stricture. There was no esophageal mass. "Feline esophagus" appearance of
the distal esophagus is suggestive of chronic gastroesophageal reflux (e.g.
Image 18).
Contrast passed readily from the esophagus into the stomach. The lower
esophageal sphincter opened and closed normally.
There is a large hiatal hernia with the entirety of the stomach seen above the
diaphragm.
STOMACH:
Views of the stomach show appropriate distention. No focal lesion is
identified. Only trace amount of barium is seen passing into duodenum even 35
minutes after initiation of the study.
IMPRESSION:
1. Large hiatal hernia with the entirety of the stomach residing within the
thorax.
2. Very delayed passage of contrast from the stomach into the duodenum. Only
a trace amount of barium is noted in the duodenum after 35 minutes.
3. Feline esophagus appearance of the distal esophagus suggestive of chronic
gastroesophageal reflux.
|
19930769-RR-23
| 19,930,769 | 29,856,553 |
RR
| 23 |
2164-10-10 12:39:00
|
2164-10-10 13:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with nausea and vomiting, h/o hiatal hernia and
volvulus, concern for obstruction, placing Dobhoff// Dobhoff placement
Dobhoff placement
IMPRESSION:
Comparison to ___. The feeding tube is projecting over the central
parts of the stomach. The course is unremarkable. Stable large hernia. No
pathologic changes in the lung parenchyma.
|
19930769-RR-24
| 19,930,769 | 29,856,553 |
RR
| 24 |
2164-10-10 12:39:00
|
2164-10-10 16:53:00
|
INDICATION: ___ year old woman with nausea and vomiting, h/o hiatal hernia and
volvulus, concern for obstruction// evidence of obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Prior abdominal radiograph from ___ and CT abdomen and
pelvis from ___
FINDINGS:
Nasogastric tube with the tip in the stomach.
There are no abnormally dilated loops of large or small bowel. There is
remnant barium from recent upper GI study in the stomach and also throughout
the entire colon.
Large hiatal hernia. There is no free intraperitoneal air in the left lateral
decubitus radiograph.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
There is no small or large bowel obstruction. Barium contrast seen throughout
the colon and in the stomach.
|
19930769-RR-25
| 19,930,769 | 29,856,553 |
RR
| 25 |
2164-10-10 18:58:00
|
2164-10-10 19:43:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with altered mental status, hiatal hernia.//
Evaluate for intracranial abnormality.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT dated ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
Re-demonstrated are confluent periventricular and subcortical hypodensities,
which may represent small vessel ischemic changes.
There is no evidence of fracture. There is mild mucosal thickening of the
bilateral maxillary sinuses. The visualized portion of the remaining
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
|
19930769-RR-27
| 19,930,769 | 29,856,553 |
RR
| 27 |
2164-10-11 18:05:00
|
2164-10-11 19:41:00
|
INDICATION: ___ year old woman with hiatal hernia requiring surgery and will
do TPN in interim. Bedside PICC unable to thread, requires repositioning//
PICC repositioning
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___, attending radiologist, performed
the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.8 min, 2 mGy
PROCEDURE: 1. Repositioning of left PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
double lumen PIC line measuring 43 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing left approach PICC with tip in the subclavian vein replaced with a
new double lumen PIC line with tip in the distal SVC.
IMPRESSION:
Successful placement of a 43 cm left approach double lumen PowerPICC with tip
in the distal SVC. The line is ready to use.
|
19930769-RR-28
| 19,930,769 | 29,856,553 |
RR
| 28 |
2164-10-16 20:30:00
|
2164-10-16 21:18:00
|
INDICATION: ___ large paraesophageal hernia s/p lap hiatal hernia repair +
Nissen with concern for aspiration// baseline CXR to eval
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
The tip of a left PICC line projects over the cavoatrial junction. There is
elevation of the left hemidiaphragm. Overlying opacities may reflect
atelectasis and/or pneumonia. There is no pneumothorax. The right lung is
clear. The size of the cardiac silhouette is unchanged.
|
19930769-RR-33
| 19,930,769 | 29,566,994 |
RR
| 33 |
2165-10-21 04:06:00
|
2165-10-21 08:57:00
|
EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: History: ___ with fall// fall fall
FINDINGS:
AP and lateral views of the left femur show no fracture or dislocation. No
destructive bone lesion. No radiopaque foreign body.
IMPRESSION:
No acute fracture or dislocation.
|
19930769-RR-34
| 19,930,769 | 29,566,994 |
RR
| 34 |
2165-10-21 04:49:00
|
2165-10-21 06:00:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: History: ___ with fall// fall
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent and reconstructed as contiguous 5 mm and 1.25 mm
thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.2 s, 40.6 cm; CTDIvol = 8.2 mGy (Body) DLP = 330.8
mGy-cm.
Total DLP (Body) = 331 mGy-cm.
COMPARISON: None.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is severe coronary arterial
calcification. There is a trace pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
PULMONARY PARENCHYMA: There is linear subsegmental atelectasis at the lung
bases. There is no evidence of infection or malignancy. There is no
emphysema.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is no pleural effusion.
CHEST WALL AND BONES: There are chronic fractures of the left anterolateral
third through seventh ribs. Chronic L1 mild compression deformity is again
noted. There is no worrisome lytic or sclerotic lesion. Multilevel
degenerative changes are mild. Mild stranding is noted along the upper left
lateral chest (3: 49-54), presumably ecchymosis.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen demonstrates
postsurgical changes of hiatal hernia repair. The common bile duct is
markedly dilated, measuring up to 16 mm, previously 11 mm on MRCP from ___.
IMPRESSION:
1. Mild ecchymosis along the left lateral upper chest. No evidence of acute
fractures.
2. Chronic left-sided rib fractures and chronic mild L1 compression deformity.
3. Markedly dilated common bile duct, measuring up to 16 mm, increased
compared to MRCP from ___. Correlation with LFTs is recommended,
and repeat MRCP on an outpatient basis could be considered.
4. Severe coronary calcification.
|
19930769-RR-35
| 19,930,769 | 29,566,994 |
RR
| 35 |
2165-10-21 04:50:00
|
2165-10-21 07:28:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with trauma, left rib pain// rib fx, ptx
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest CT ___
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable. Multiple chronic left-sided rib fractures are better evaluated
on same day chest CT.
IMPRESSION:
No acute cardiopulmonary process. Multiple chronic left-sided rib fractures
are better evaluated on same-day chest CT.
|
19930769-RR-36
| 19,930,769 | 29,566,994 |
RR
| 36 |
2165-10-21 11:56:00
|
2165-10-21 12:23:00
|
EXAMINATION: US LOWER EXTREMITY, SOFT TISSUE LEFT
INDICATION: ___ year old woman with left upper leg hematoma// ?left leg
hematoma
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left upper thigh.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left upper thigh.
Along the posterior lateral upper to mid left thigh, there is a complex fluid
collection deep to the subcutaneous fat which measures approximately 8.0 x 1.8
x 3.7 cm and does not demonstrate internal vascularity.
IMPRESSION:
8.0 x 1.8 x 3.7 cm complex fluid collection likely represents a hematoma.
However, given recent trauma and its location near the greater trochanter and
along the deep subcutaneous fat, Morel ___ lesion cannot be excluded.
Clinical and/or ultrasound follow-up to resolution is recommended.
|
19930769-RR-37
| 19,930,769 | 29,566,994 |
RR
| 37 |
2165-10-22 16:21:00
|
2165-10-22 18:58:00
|
EXAMINATION: MR THIGH ___ CONTRAST LEFT
INDICATION: ___ with blindness who presents s/p fall now with a left thigh
hematoma could not exclude Morel ___ lesion// Morel ___ lesion ?
TECHNIQUE: Multiplanar images of the left thigh were performed before and
after the administration of intravenous contrast using a musculoskeletal mass
MR protocol.
COMPARISON: CT abdomen pelvis from ___ and prior.
FINDINGS:
In the subcutaneous soft tissues of the posterolateral proximal left thigh
there is a 5.3 x 3.3 x 9.3 cm heterogeneous high T1, heterogeneous on STIR
with low intensity rim lesion. There is no convincing internal
hyperenhancement on postcontrast images. There is associated mildly enhancing
soft tissue edema surrounding the lesion.More proximally there is faint
irregular STIR hypointense subcutaneous signal, which may be sequela of prior
injury/soft tissue stranding seen on CT of ___, series 3, image
___. Additionally there is curvilinear T1/STIR in the superficial fascia
overlying the lateral gluteal musculature and in the intermuscular septum,
series 3, image ___, which may be related to prior injury. There is no
significant muscle atrophy seen.
There is no bone marrow edema or acute fracture seen. There is suboptimal
evaluation for internal derangement of the hip on this nondedicated study. No
gross abnormality of the visualized left hemipelvis.
IMPRESSION:
1. Favored 5.3 x 3.3 x 9.3 cm subcutaneous hematoma in the posterolateral
proximal left thigh, not fitting criteria for Morel ___ lesion.
Recommend follow-up to resolution. If the lesion enlarges or persists after 3
months, recommend repeat ultrasound or MRI imaging.
2. Sequela of prior soft tissue injury seen in the proximal left
thigh/gluteal region.
|
19930907-RR-44
| 19,930,907 | 20,588,915 |
RR
| 44 |
2128-02-03 17:57:00
|
2128-02-04 08:55:00
|
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ male with right MCA syndrome status post tPA and
neurovascular intervention. Evaluate for ischemia.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON ___ noncontrast head CT. ___ cerebral
angiogram of the head neck.
FINDINGS:
There is geographic slow diffusion involving the right frontal operculum and
right insular cortices. There are numerous small punctate foci of slow
diffusion within the right temporo-occipital cortex (___). There small
foci of slow diffusion within the posterior right external capsule and
anterior limb right internal capsule (302:17, 14). There is correlate FLAIR
hyperintensity and mild mass effect correspond next to the sites of slow
diffusion, without evidence of hemorrhage.
There are background periventricular and subcortical white matter FLAIR
hyperintense foci, likely representing sequela of chronic microangiopathy.
The ventricles and cortical sulci are normal in caliber and configuration.
The extra-axial spaces are unremarkable. The vascular flow voids are
preserved.
The orbits, calvarium, and soft tissues are unremarkable. There is mild
mucosal thickening within the paranasal sinuses with a left maxillary mucous
retention cysts. The mastoid air cells and middle ears are clear.
IMPRESSION:
1. Territorial acute infarction involving the right frontal operculum and
insular cortices corresponding to the middle cerebral artery.
2. Numerous punctate infarcts involving the right temporo-occipital cortex.
Punctate infarcts involving the right anterior limb internal capsule and
posterior external capsule. No evidence of hemorrhagic conversion. The
parietal infarcts may be in watershed distribution.
3. Background sequela chronic microangiopathy.
|
19930907-RR-45
| 19,930,907 | 20,588,915 |
RR
| 45 |
2128-02-03 02:29:00
|
2128-02-03 03:08:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: Evaluate for interval change in a patient with a right MCA
infarct status post tPA and right internal carotid artery stent.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CTA head from approximately 3 hours prior.
FINDINGS:
Mild loss of gray-white matter differentiation in the right frontal lobe is
unchanged. There is no evidence of hemorrhagic transformation. There is no
mass effect. The ventricles and sulci are normal in size and configuration.
A new right ICA stent is incompletely imaged. Other than mucous retention
cyst within the left maxillary sinus, the visualized paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
IMPRESSION:
Unchanged mild loss of gray-white matter differentiation in the right frontal
lobe, without evidence of new hemorrhage.
|
19931382-RR-103
| 19,931,382 | 29,381,057 |
RR
| 103 |
2149-08-27 07:28:00
|
2149-08-27 12:53:00
|
PORTABLE AP CHEST ON ___ AT 7:38
CLINICAL INDICATION: ___ with alcohol abuse who now presents with
chest pain and is diffusely wheezing. Comparison is made to the patient's
prior study of ___ at 16:46.
Portable semi-erect chest film dated ___ at 7:38 is submitted.
IMPRESSION:
1. Lungs appear grossly clear and well inflated without evidence of pleural
effusions, pulmonary edema or pneumothorax. Overall, cardiac and mediastinal
contours are stable. No pneumothorax. Calcification of the aortic knob,
consistent with atherosclerosis.
|
19931382-RR-109
| 19,931,382 | 25,407,424 |
RR
| 109 |
2150-12-18 10:00:00
|
2150-12-18 11:06:00
|
CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Chest pain, question pneumonia.
FINDINGS: PA and lateral views of the chest provided demonstrate dense
consolidation within the right lower lobe posterior segment, compatible with
pneumonia. Otherwise, the lungs are clear. No effusions or pneumothorax.
Cardiomediastinal silhouette is normal. Bony structures are intact.
IMPRESSION: Right lower lobe consolidation, compatible with pneumonia.
Followup to resolution.
|
19931382-RR-110
| 19,931,382 | 25,407,424 |
RR
| 110 |
2150-12-19 02:00:00
|
2150-12-19 09:30:00
|
AP CHEST, 2:04 A.M., ___
HISTORY: ___ man with cirrhosis, alcohol abuse, pneumonia and
worsening tachypnea.
IMPRESSION: AP chest compared to ___:
Moderate to large right pleural effusion is larger obscuring much of the right
lower lung, where probable right lower pneumonia was previously visible.
Another definite change is substantial increase in caliber of mediastinal
vessels suggesting volume overload, although heart size is normal and there is
no appreciable vascular engorgement. Subsequent chest radiograph, 5:29 a.m.,
reported separately.
|
19931382-RR-111
| 19,931,382 | 25,407,424 |
RR
| 111 |
2150-12-19 05:27:00
|
2150-12-19 10:18:00
|
AP CHEST, 5:29 A.M., ___
HISTORY: ___ man with pneumonia and septic shock, now intubated.
Central venous line placed.
IMPRESSION: AP chest compared to ___ at 10:04 a.m. and ___, 2:04 a.m.
show new endotracheal tube in standard placement, right internal jugular line
in the mid SVC, no pneumothorax or mediastinal widening or pleural effusion to
suggest any complications. Left lung is clear. Heart size is normal. Large
right pleural effusion is the dominant, if not the only abnormality, changed
in distribution but probably not in size since 2:04 a.m.
Dr. ___ was paged as requested.
|
19931382-RR-112
| 19,931,382 | 25,407,424 |
RR
| 112 |
2150-12-21 01:46:00
|
2150-12-21 08:24:00
|
CHEST RADIOGRAPH
INDICATION: Cirrhosis, hypoxemic respiratory distress, ARDS, evaluation for
pneumonia.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient is still
intubated, carries a nasogastric tube and right internal jugular vein
catheter. The size of the cardiac silhouette is unchanged. The extensive
opacity at the right lung base, potentially combined to a small right pleural
effusion, has minimally decreased in extent and severity. In the left lung, a
small retrocardiac atelectasis is visible. Unchanged normal size of the
cardiac silhouette. No pneumothorax.
|
19931382-RR-113
| 19,931,382 | 25,407,424 |
RR
| 113 |
2150-12-22 07:46:00
|
2150-12-22 10:17:00
|
REASON FOR EXAMINATION: Evaluation of the patient who is intubated for
pneumonia.
COMPARISON: ___.
AP chest radiograph
Right lower lobe consolidation appears to be unchanged and there is currently
evidence of increased pleural effusion on the right. The ET tube tip is 4.2
cm above the carina. The right internal jugular line tip is at the level of
low SVC. No other abnormality is demonstrated developing in the interim. The
NG tube tip passes below the diaphragm terminating in the stomach.
|
19931382-RR-114
| 19,931,382 | 25,407,424 |
RR
| 114 |
2150-12-23 14:03:00
|
2150-12-23 14:42:00
|
REASON FOR EXAMINATION: Evaluation of the patient with history of alcoholism
and delirium tremens after extubation.
AP radiograph of the chest was reviewed in comparison to ___.
Right internal jugular line tip is at the level of mid SVC. Heart size and
mediastinum are stable. There is interval improvement of right basal
consolidation. Still present bilateral pleural effusions are noted.
Improvement in the consolidation is most likely consistent with improvement of
infection/aspiration.
|
19931382-RR-115
| 19,931,382 | 25,407,424 |
RR
| 115 |
2150-12-27 20:12:00
|
2150-12-28 00:15:00
|
HISTORY: ___ year old man with recent worsening of lower extremity strength,
peripheral neuropathy. Infection with significant worsening ___ strength.
COMPARISON: MRI thoracic and lumbar spine dated ___.
TECHNIQUE: Multi sequence multi planar imaging of the thoracic and lumbar
spine was performed both prior to and following the intravenous administration
of 8 mL Gadavist as per standard department protocol.
FINDINGS:
Thoracic spine: Compared to the prior examination, the bone marrow signal is
now abnormal with new heterogeneous hypointensity on the T1 sequence. T1 and
T2 hyperintense lesions in the T8 and T9 vertebral bodies which partially
suppress on the STIR sequence, likely reflecting hemangiomas, are unchanged
from the prior examination. The vertebral body heights and alignments are
normal. Intervertebral discs show loss of signal and height at several
levels, with Schmorl's nodes in the inferior endplates of the T5 and T6
vertebral bodies. There is no epidural or paraspinal fluid collection, and no
marrow edema or disc signal changes to suggest discitis/osteomyelitis. The
spinal cord is normal in signal intensity and morphology. There is no
evidence of spinal cord compression.
There is a moderate right pleural effusion. The paraspinal soft tissues are
normal.
Lumbar spine: The bone marrow is heterogeneous and hypointense on T1
sequence, with an unchanged T1 and T2 hyperintense lesion in the L4 vertebral
body likely representing a hemangioma. The vertebral heights and alignments
are normal. There is mild loss of intervertebral disc height, with Schmorl's
nodes in the L1, L2, and L3 superior end plates. The distal spinal cord and
conus medullaris are normal in appearance, with the conus terminating at L1.
The paraspinal soft tissues are unremarkable. There is no abnormal
enhancement.
From T12-L1 through L2-L3, there is no significant disc bulge or spinal canal
or neural foraminal narrowing.
At L3-L4, there is a diffuse disc bulge with a left foraminal component which
has increased in size from the prior examination, as well as facet
degenerative changes resulting in mild bilateral neural foraminal narrowing,
left more than right.
At L4-5, there is a diffuse bulge with left paracentral protrusion, similar to
the prior examination, with facet degenerative changes narrowing the left
subarticular zone with contact of the traversing L5 nerve root and in mild
bilateral left greater than right neural foraminal narrowing without
significant narrowing of the spinal canal.
At L5-S1, there is a diffuse disc bulge with annular tear and left paracentral
protrusion without significant narrowing of the spinal canal. There is
minimal left neural foraminal narrowing.
IMPRESSION:
1. New diffuse bone marrow signal abnormality with heterogeneous
hypointensity on the T1 sequence. This may be seen in the setting of red
marrow reconversion with chronic anemia or other marrow replacement processes
such as multiple myeloma or diffuse metastasis. Correlation with laboratory
values is recommended.
2. No evidence of epidural abscess or discitis/osteomyelitis. No evidence of
spinal cord compression.
3. Mild lumbar spine degenerative changes as described above have mildly
progressed from the prior examination.
4. Moderate right pleural effusion.
Findings discussed with Dr. ___ telephone at 12:29 pm on ___.
|
19931382-RR-116
| 19,931,382 | 25,407,424 |
RR
| 116 |
2150-12-28 23:06:00
|
2150-12-29 01:03:00
|
INDICATION: ___ male with recent pneumonia, now presenting with
shortness of breath. Evaluate for acute cardiopulmonary process.
COMPARISON: Multiple prior chest radiographs, most recent one on ___.
TECHNIQUE: Frontal semi-upright chest radiograph.
FINDINGS: Right lower lobe consolidation has been present since at least ___, with no improvement since ___. Cardiomediastinal and hilar contours are
unremarkable. There is no pleural effusion or pneumothorax. Interval removal
of right-sided IJ line.
IMPRESSION: Persistence of severe RLL consolidation over at least 10 indicates
inadequate treatment and merits an explanation. ___ d/w ___ by
telephone at 9:10 AM.
|
19931382-RR-118
| 19,931,382 | 24,728,221 |
RR
| 118 |
2150-12-29 10:35:00
|
2150-12-29 13:13:00
|
HISTORY: Question pneumonia.
COMPARISON: ___ through ___.
FINDINGS:
Two lateral chest radiographs were obtained. A radiographic spine sign
correlates with the right lower lobe opacity seen on the frontal view from
last night. No pneumothorax is appreciated.
IMPRESSION:
Two lateral views confirm a right lower lobe pneumonia.
|
19931382-RR-119
| 19,931,382 | 28,486,659 |
RR
| 119 |
2151-03-09 19:10:00
|
2151-03-09 21:08:00
|
HISTORY: History of substance abuse, presented here intoxicated, now
complains of vertigo, worsening gait issues. Assess for intracranial
hemorrhage, evidence of stroke.
TECHNIQUE: Axial helical MDCT images were obtained through the brain without
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes and thin-section bone algorithm reconstructed images were
acquired.
DLP: 1025.7 mGy/cm
COMPARISON: Nonenhanced head CT from ___
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect or acute large vascular
territory infarction. Prominent ventricles and sulci suggest age-related
atrophy. Periventricular white matter hypodensities are consistent with
chronic small vessel ischemic disease. The basal cisterns appear patent and
there is preservation of gray-white differentiation.
There is a deformity of the right lamina papyracea, consistent with healed
fracture. No acute fracture is identified. There is fluid in the right
mastoid air cells, new since ___. The remaining visualized paranasal
sinuses, mastoid air cells and middle ear cavities are clear. The globes are
unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Fluid in the right mastoid air cells, is nonspecific but could represent
mastoiditis. Correlate clinically.
|
19931382-RR-120
| 19,931,382 | 28,486,659 |
RR
| 120 |
2151-03-10 07:24:00
|
2151-03-10 14:16:00
|
AP CHEST, ___, 7:15 A.M.
HISTORY: A ___ man with alcohol intoxication, vomiting and tachypnea.
IMPRESSION: AP chest compared to ___:
Still a large region of consolidation at the right lung base, not appreciably
changed, and now there is a substantial increase in consolidation on the left.
Findings point toward recurrent bilateral aspiration pneumonia.
Upper lobes show no findings of pulmonary edema. The heart is top normal
size. Pleural effusion is small if any. No pneumothorax.
|
19931382-RR-121
| 19,931,382 | 28,486,659 |
RR
| 121 |
2151-03-10 22:22:00
|
2151-03-11 08:56:00
|
CLINICAL HISTORY: Pneumonia post-intubation placement.
CHEST AP
The endotracheal tube lies 5.5 cm from the carinal angle. Tip of the
nasogastric tube lies in the subdiaphragmatic position. The PICC line lies in
the lower SVC.
Diffuse interstitial patten is present in both sides, worse than on the prior
chest x-ray consistent either with aspiration pneumonia or a possible failure
though effusions are not present.
IMPRESSION: Support lines and tubes in satisfactory position, worsening lung
pattern.
|
19931382-RR-122
| 19,931,382 | 28,486,659 |
RR
| 122 |
2151-03-11 07:31:00
|
2151-03-11 10:09:00
|
CLINICAL HISTORY: Bilateral pneumonia.
CHEST SEMI-ERECT AP
___.
Position of the various lines and tubes is unchanged. The interstitial patten
present on the prior chest x-ray is unchanged. No effusions are seen, and
this would favor aspiration pneumonia rather than failure as a cause.
IMPRESSION: No change.
|
19931382-RR-123
| 19,931,382 | 28,486,659 |
RR
| 123 |
2151-03-12 07:32:00
|
2151-03-12 09:05:00
|
PORTABLE CHEST ___
COMPARISON: ___ radiograph.
FINDINGS: Indwelling support and monitoring devices are unchanged in
position, and cardiomediastinal contours are stable. Multifocal opacities in
the mid and lower lungs show interval improvement, particularly in the mid
lung region bilaterally. No new or worsening areas of consolidation are
present.
|
19931382-RR-124
| 19,931,382 | 28,486,659 |
RR
| 124 |
2151-03-13 03:16:00
|
2151-03-13 11:13:00
|
HISTORY: ___ male with ARDS. Evaluate interval change.
TECHNIQUE: Portable semi-erect AP chest radiograph obtained.
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
The ET tube is in appropriate position, and the orogastric tube ends in the
stomach outside the view of this radiograph. A right IJ central venous line
ends at the cavoatrial junction. Multifocal opacities in the mid and lower
lungs persist. A right middle lobe opacity has appeared comparison to the
chest radiograph from ___. The cardiac, mediastinal and hilar
contours are normal.
IMPRESSION:
Multifocal opacities in the mid and lower lung continue with a new right
middle lung opacity likely representing aspiration.
|
19931382-RR-125
| 19,931,382 | 28,486,659 |
RR
| 125 |
2151-03-13 20:39:00
|
2151-03-14 10:41:00
|
AP CHEST, 8:44 P.M. ON ___
HISTORY: ___ man with bilateral pneumonia. Recently extubated. Now
with experiencing increased work of breathing.
IMPRESSION: AP chest compared to ___ through ___ at 3:29 a.m.:
Following extubation, allowing for an expected decrease in lung volume, there
may have been an increase in consolidation in just the left lower lobe
component of multifocal pneumonia, since 3:30 a.m. today. Pleural effusion is
small if any on the left. Heart is normal size. There is no pulmonary edema.
Right internal jugular line ends in the low SVC, as before. There is no
pneumothorax.
|
19931382-RR-126
| 19,931,382 | 28,486,659 |
RR
| 126 |
2151-03-14 10:22:00
|
2151-03-14 11:41:00
|
INDICATION: Multifocal pneumonia. NG tube placed. Evaluation for position.
COMPARISON: Multiple priors from ___.
FINDINGS: Portable AP chest radiograph. NG tube courses below the diaphragm
and terminates outside the field of view. Right IJ catheter is in stable
position. Multifocal consolidations are slightly worsen in the right upper
lobe. Confluent consolidation of the left lower lobe and a small effusion
are stable. There is no pneumothorax. The cardiomediastinal silhouette is
stable.
IMPRESSION:
1. NG tube tip is below the diaphragm.
2. Multifocal pneumonia, worsening in the right upper lobe.
|
19931382-RR-127
| 19,931,382 | 28,486,659 |
RR
| 127 |
2151-03-15 10:15:00
|
2151-03-15 11:32:00
|
INDICATION: Alcohol withdrawal with multifocal pneumonia. Evaluation for
interval change.
COMPARISON: Multiple priors from ___.
FINDINGS: Portable AP chest radiograph. Right-sided IJ catheter and NGT are
in stable position. Multifocal consolidations and peribronchial
consolidations involving the right lung have progressed from 24 hours prior.
However, confluent opacification of the left lower lobe remains the worst
site. There is no pneumothorax. The cardiomediastinal silhouette is not well
delineated due to the consolidations.
IMPRESSION: Worsening multifocal pneumonia in the right lung.
|
19931382-RR-128
| 19,931,382 | 28,486,659 |
RR
| 128 |
2151-03-16 01:25:00
|
2151-03-16 08:54:00
|
INDICATION: Multifocal pneumonia and ARDS in the setting of cirrhosis.
COMPARISON: Multiple priors from ___ - ___.
FINDINGS: Portable AP chest radiograph. NGT courses below the diaphragm and
terminates outside the field of view. Right IJ catheter tip is in the right
atrium. Multifocal consolidations have continued to worsen, most notably in
the right lung base. Moderate bilateral pleural effusions have also developed
in the interim. There is no pneumothorax. The cardiomediastinal silhouette
is stable.
IMPRESSION: Worsening multifocal pneumonia, most notably in the right lung
base.
|
19931382-RR-129
| 19,931,382 | 28,486,659 |
RR
| 129 |
2151-03-19 14:30:00
|
2151-03-19 16:09:00
|
HISTORY: E. coli bacteremia and diarrhea. Evaluate for an abdominal process.
TECHNIQUE: MDCT axial images were acquired from the dome of the liver to the
pubic symphysis after the uneventful administration of 100 mL Visipaque and
oral contrast. Coronal and sagittal reformations were provided and reviewed.
DLP: 828.27 mGy/cm.
COMPARISON: CTA chest ___.
FINDINGS:
Abdomen: The imaged lung bases show bilateral consolidations, left greater
than right, consistent with multifocal pneumonia. Small, simple pleural
effusions are noted. The included portion of the heart is normal in size and
there is no pericardial effusion. Focal coronary artery calcifications are
noted.
The liver is nodular in contour, concerning for cirrhosis. Additionally,
hypoattenuation of the liver parenchyma is likely from steatosis. There are
no concerning focal liver lesions identified. The gallbladder is normal and
there is no intrahepatic biliary ductal dilation. The spleen is normal in
size. The adrenal glands are unremarkable. The kidneys show a delay in
enhancement. There is no hydronephrosis or nephrolithiasis. There is a 3.4 x
1.7 lobulated, well-circumscribed hypodensity arising exophytically from the
tail of the pancreas (series 2, image 32). This appears likely to communicate
with the pancreatic duct. There is no dilation of the main pancreatic duct or
parenchymal atrophy.
The stomach is unremarkable. An enteric tube terminates within the fundus.
Rounded low attenuating structures are seen within the duodenum. The
remainder of the small bowel is unremarkable. There is no bowel wall
thickening or obstruction. The appendix and large bowel are normal. There is
no free air or free fluid.
There is no retroperitoneal or mesenteric lymphadenopathy. Prominent
periportal lymph nodes likely relate to chronic liver disease. There is
moderate atherosclerosis within a non aneurysmal aorta. The portal vein,
splenic vein and superior mesenteric vein are patent.
Pelvis: The rectum and sigmoid are normal. There is a trace amount of free
pelvic fluid. A Foley catheter is seen within a bladder containing air.
There is no inguinal or pelvic lymphadenopathy.
Bones and soft tissues: There is mild anasarca. A fat containing umbilical
hernia is present. There are no concerning lytic or blastic osseous lesions.
Severe degenerative changes of both hips with bone-on-bone articulation are
noted.
IMPRESSION:
1. No acute intra-abdominal or pelvic process.
2. Hypodensity arising from the tail of the pancreas appears likely to
communicate with the pancreatic duct and appears similar compared to ___, may
represent intraductal papillary mucinous neoplasm (IMPN) or possibly a
pseudocyst if the patient has history of prior pancreatitis. and should be
further evaluated with MRCP or EUS.
3. Partially imaged multifocal pneumonia with small bilateral pleural
effusions are stable from the recent chest radiograph.
4. Nodular and hypoattenuating liver concerning for underlying cirrhosis and
fatty liver.
5. Hypodensities within the duodenum may represent ingested material,
although, small lipomas are difficult to exclude without prior imaging.
|
19931382-RR-130
| 19,931,382 | 28,486,659 |
RR
| 130 |
2151-03-20 15:18:00
|
2151-03-20 16:35:00
|
TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with NG tube placement. Check position.
FINDINGS: AP single view of the chest has been obtained with patient in
semi-upright position. Comparison is made with the next preceding similar
study of ___. During the interval, an NG tube has been placed seen
to pass well below the diaphragm into the abdominal area. The tip of the line
is too advanced to identify as it escapes the lower image field. Comparison
of chest findings suggests some regression of the basal infiltrates. It is
observed that a right internal jugular approach central venous line has been
removed without occurrence of pneumothorax.
|
19931382-RR-131
| 19,931,382 | 28,486,659 |
RR
| 131 |
2151-03-23 15:44:00
|
2151-03-23 16:50:00
|
HISTORY: Alcohol hepatitis C with elevated LFTs. Evaluate for acute liver
changes.
TECHNIQUE: Grayscale and color Doppler ultrasound imaging of the abdomen is
performed.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
There is coarsened echotexture of the liver without intraparenchymal mass.
The portal vein is patent with normal directional flow. There are multiple
small mildly echogenic foci within the gallbladder, which may represent small
stones. The gallbladder wall is not thickened and there is no pericholecystic
free fluid.
Normal appearance of the visualized pancreas. Of note, the known cystic mass
at the tail of the pancreas is not seen. A small periportal lymph node is
visualized. There is no ascites. The right kidney is normal in size,
measuring 12.2 cm.
IMPRESSION:
1. Coarsened echotexture of the liver.
2. Probable tiny gallstones.
3. Of note, the known pancreatic tail cystic lesion is not seen on ultrasound
due to early termination of the exam due to patient refusal.
|
19931495-RR-7
| 19,931,495 | 25,870,551 |
RR
| 7 |
2114-04-18 17:21:00
|
2114-04-18 18:46:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: History: ___ with POD 11 from a left groin pseudoaneurysm repair,
with leg swelling and pain, // eval pseudoaneurysm repair, ? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: ___.
FINDINGS:
The previously described pseudoaneurysm in the left groin is now
devascularized, with no color flow identified within the pseudoaneurysm sac,
or neck. The underlying hepatic artery remains patent. Overlying skin
thickening and subcutaneous edema is noted.
There is normal compressibility, flow and augmentation 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:
1. Interval thrombosis of pseudoaneurysm following operative repair.
2. No evidence of DVT in the left lower extremity veins.
|
19931495-RR-8
| 19,931,495 | 25,870,551 |
RR
| 8 |
2114-04-18 22:15:00
|
2114-04-18 23:49:00
|
EXAMINATION: CT pelvis
INDICATION: History: ___ with sanguinous drainage after L groin cutdown and
primary repair of pseudoaneursym // Size of hematoma?
TECHNIQUE: MDCT axial images were acquired through the pelvis following
intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
No oral contrast was administered.
DOSE: DLP: 274.38 mGy-cm (pelvis).
IV Contrast: 130 mL Omnipaque
COMPARISON: Comparison made with CTA pelvis from ___.
FINDINGS:
LOWER ABDOMEN: The visualized lower abdominal organs are unremarkable.
PELVIS: The left groin hematoma measures 5.7 x 5.0 x 9.3 cm (previously 2.8 x
2.1 cm). The hematoma that extends superiorly through the subcutaneous
tissues to a greater extent than seen on prior exam. No site of active
extravasation is seen. No adjacent fat stranding is seen to suggest infection,
but cannot completely exclude superinfection biopsy.
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is trace free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
Interval increase in size left groin hematoma, which now measures 5.7 x 5.0 x
9.3 cm and extends superiorly through the subcutaneous tissues to a greater
extent than seen on prior exam. No site of active extravasation is seen. No
adjacent fat stranding is seen to suggest infection, but cannot completely
exclude superinfection by imaging.
|
19931495-RR-9
| 19,931,495 | 25,870,551 |
RR
| 9 |
2114-04-24 09:33:00
|
2114-04-24 12:24:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with swollen lower extremity L>R s/p L groin
hematoma evacuation // question DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: ___ DVT study ___
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
The left proximal CFV is not compressible, but flow is seen with augmentation
in this segment on color doppler. This is consistent with a non-occlusive
thrombus. This finding is new compared to prior study on ___. There is
normal compressibility of the left distal CFV, popliteal, and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Non occlusive thrombus in the left proximal CFV.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 12:21 ___, 10 minutes after discovery of the
findings.
|
19932024-RR-10
| 19,932,024 | 29,514,568 |
RR
| 10 |
2146-02-08 11:21:00
|
2146-02-09 11:21:00
|
INDICATION: ___ year old woman with Hep C cirrhosis, being worked up for liver
transplant. // Assess for ___, pre-transplant workup
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: Gadavist 8 cc.
COMPARISON: Ultrasound from ___.
FINDINGS:
This study is limited due to motion artifact.
Liver: There is minimal bibasilar atelectasis. The liver is nodular in contour
with increased reticular enhancement compatible with cirrhosis and fibrosis.
The main portal vein is patent. There are no arterially enhancing lesions
identified.The gallbladder is not visualized. Note is made of a recannalized
paraumbilical vein and multiple paraesophageal and gastric varices. There is
trace perihepatic and perisplenic ascites.
Biliary: There is no intra or extrahepatic biliary dilation.
Pancreas: The pancreas is of normal signal intensity without any focal lesions
or ductal dilation.
Spleen: The spleen is enlarged measuring 15.9 cm.
Adrenal Glands: The adrenal glands are unremarkable.
Kidneys: The kidneys enhance excrete contrast symmetrically without any focal
lesions or hydronephrosis.
Gastrointestinal Tract: The visualized small and large bowel loops are
unremarkable.
Lymph Nodes: Multiple periportal lymph nodes are enlarged including a 2.1 x
2.0 cm lymph node (series 12, image 46). Inferiorly adjacent to the IVC
another lymph node measures 1.9 x 1.5 cm.
Vasculature: The aorta is normal caliber without evidence of aneurysm. Its
major branch are patent.
IMPRESSION:
1. Limited exam due to motion. No arterially enhancing lesions are identified.
2. Findings compatible with cirrhosis and portal hypertension including a
recanalized paraumbilical vein, esophageal and gastric varices, splenomegaly
and trace perihepatic and perisplenic ascites.
3. Multiple periportal lymph nodes, likely reactive.
|
19932024-RR-11
| 19,932,024 | 29,514,568 |
RR
| 11 |
2146-02-08 15:31:00
|
2146-02-09 08:21:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with SIADH and smoking history, concern for
lung CA // ? mass/cancer
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images.
DOSAGE: TOTAL DLP 540mGy-cm
COMPARISON: Chest radiograph ___.
FINDINGS:
Enlarged mediastinal lymph nodes are present. In the bilateral paratracheal,
precarinal and subcarinal nodal stations, the latter extending into the azygos
esophageal recess. Additional cluster of nodes is present in the pericardial
region. A representative lymph node in the lower left paratracheal region
measures 1.3 x 1.4 cm (76, 4).
The esophagus is difficult to assess without oral contrast, but demonstrates a
mass-like thickening just above the diaphragm, in a region surrounded by
apparent esophageal varices. Heart size is normal, and there is no
pericardial or pleural effusion.
Assessment of the lungs is limited by submaximal inspiratory level, reducing
sensitivity for small pulmonary nodules and subtle interstitial lung disease.
Note is made of minimal apical emphysema. Dependent areas of atelectasis are
present in both lung bases. No suspicious nodule or mass is evident is suggest
a primary lung cancer.
Exam was not tailored for the sub- diaphragmatic assessment, but note is made
of cirrhotic liver, splenomegaly, small volume ascites, varices, upper
abdominal lymph nodes and diffuse soft tissue stranding of the mesentery These
findings will be more fully assessed along with more complete characterization
of the liver by concurrently performed MRI of the abdomen from the same date.
Skeletal structures of the thorax demonstrate no suspicious lytic or blastic
lesions.
IMPRESSION:
1. No CT evidence of suspicious lung nodule or mass to suggest a primary
non-small cell lung cancer as a cause of paraneoplastic syndrome.
2. Diffuse mediastinal lymphadenopathy is a nonspecific finding that could be
due to inflammatory, infectious or neoplastic etiology. If warranted
clinically, correlated PET-CT imaging could be performed.
3. Masslike appearance of lower thoracic esophagus, difficult to assess in the
absence of oral contrast. This may be secondary to extensive paraesophageal
varices, but correlative barium swallow may be helpful to exclude an intrinsic
esophageal abnormality if warranted clinically.
4. Cirrhotic liver and sequela of portal hypertension, which will be more
fully assessed on concurrent MRI of
the abdomen, performed the same date and dictated separately.
|
19932024-RR-12
| 19,932,024 | 29,514,568 |
RR
| 12 |
2146-02-11 14:01:00
|
2146-02-11 16:37:00
|
EXAMINATION: CT Colonography
INDICATION: ___ year old woman with hep C cirrhosis being worked up for liver
transplant who had an incomplete colonscopy due to a tortuous colon and so was
able to reach the start of the right colon but unable to get to the TI.
TECHNIQUE: Axial contiguous slices were obtained from the lung bases to the
pubis symphysis after insufflation of intrarectal air in the prone and supine
positions. Intravenous contrast was not administered.
DOSE: 487 mGy-cm
COMPARISON: Liver MRI ___.
FINDINGS:
CT COLONOGRAPHY: There is significant fluid within the ascending and
descending colon with minor retained fecal matter. The fluid displaces with
repositioning.
No suspicious lesions are seen. There is no evidence of polyps or mass. (If
there is a suspicious lesion, describe location including segment of colon,
wall location, morphology and size.) There is no evidence of stricture or
inflammatory disease.
CT ABDOMEN WITHOUT IV CONTRAST: The liver is nodular in appearance,
consistent with known history of cirrhosis. There is small volume simple
perihepatic ascites. The gallbladder surgically absent. There is no intra or
extrahepatic biliary duct dilation. Non contrast views of the pancreas,
adrenal glands, and kidneys are unremarkable. The spleen is enlarged. Multiple
paraesophageal and gastric varices are present. There is minimal
atherosclerotic disease of the abdominal aorta. There is no abdominal aortic
aneurysm.
CT PELVIS WITHOUT IV CONTRAST: The bladder and rectum are within normal
limits.
BONE WINDOWS: There are no suspicious osseous lesions.
Multiplanar reformatted images and 3D endoluminal navigation performed in the
antegrade and retrograde direction were utilized to confirm the above
findings.
IMPRESSION:
1. No significant polyp or mass identified (greater than 1 cm). The
sensitivity of CT colonography for polyps greater than 1 cm is 85-90%. The
sensitivity for polyps 6-9mm is about 60-70%. Flat lesions may be missed with
CT Colonography.
2. Cirrhotic liver with sequela of portal hypertension including splenomegaly
and esophageal and gastric varices.
|
19932024-RR-14
| 19,932,024 | 29,514,568 |
RR
| 14 |
2146-02-14 14:53:00
|
2146-02-14 15:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with increased O2 requirement postop. // ?
fluid overload
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Despite the low lung volumes. The increase in the perihilar interstitial
opacities and increase in the azygos vein is consistent with interstitial
pulmonary edema. Small bilateral pleural effusions are most likely present.
|
19932024-RR-15
| 19,932,024 | 29,514,568 |
RR
| 15 |
2146-02-15 08:38:00
|
2146-02-15 12:59:00
|
INDICATION: ___ year old woman with Hep C cirrhosis, with acute
decompensation, s/p 6 teeth extractions, now with fever and oxygen
requirement. // evidence of infiltrate? evidence of fluid overload?
TECHNIQUE: APsingle view
COMPARISON: ___
FINDINGS:
The lung volumes are low. There are bibasilar linear opacities, atelectasis
and/ or consolidation. Diffuse vascular prominence and cardiomegaly noted.
No pleural effusion or pneumothorax present. EKG leads overlie the anterior
chest. Bony thorax is stable.
IMPRESSION:
Low lung volumes with bibasilar atelectasis and/or consolidation. Underlying
mild pulmonary edema also noted.
|
19932024-RR-17
| 19,932,024 | 29,514,568 |
RR
| 17 |
2146-02-22 07:43:00
|
2146-02-22 11:58:00
|
INDICATION: ___ year old woman with HCV cirrhosis, decompensated, here for
expedited liver transplant, now with worsening encephalopathy. Looking for
infectious source. // EVidence of infiltrate?
TECHNIQUE: APsingle view
COMPARISON: ___
FINDINGS:
Moderately well inflated lungs with no change in prominence of pulmonary
vasculature. Stable cardiomegaly. Enlarged left atrial shadow is again
identified. No pleural effusions or pneumothorax. No change in bony thorax.
IMPRESSION:
No change in mild to moderate pulmonary edema and cardiomegaly. No lobar
consolidation.
|
19932024-RR-18
| 19,932,024 | 29,514,568 |
RR
| 18 |
2146-02-22 08:42:00
|
2146-02-22 13:17:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: Evidence of thrombosis
TECHNIQUE: Grey scale and duplex Doppler ultrasound images of the liver were
acquired.
COMPARISON: ___
FINDINGS:
LIVER: The liver is coarsened in echotexture. No focal suspicious liver
lesions are identified. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilatation. The CBD measures 4
mm.
LIVER DOPPLER: The main, right, and left portal veins are patent with normal
color Doppler and appropriate hepatopetal flow. The right, middle, and left
hepatic veins are patent with appropriate hepatofugal flow. The main, right,
and left hepatic arteries are patent with normal spectral Doppler waveforms.
SPLEEN: The spleen is homogeneous in echotexture and measures 19 cm maximum
diameter.
IMPRESSION:
Patent hepatic vasculature. No evidence of portal vein thrombus.
Cirrhotic liver without focal lesion identified. No ascites.
Splenomegaly
|
19932024-RR-19
| 19,932,024 | 29,514,568 |
RR
| 19 |
2146-02-22 16:23:00
|
2146-02-22 17:27:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with AMS/ asterixis, evaluate for intracranial
hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 1120 mGy-cm
CTDI: 108 mGy
COMPARISON: None of the
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration. The basal cisterns appear
patent and there is preservation of gray-white matter differentiation.
No osseous abnormalities seen. There is mucosal thickening in the left
maxillary sinus. The remaining paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial process.
|
19932024-RR-21
| 19,932,024 | 24,609,514 |
RR
| 21 |
2146-03-12 05:45:00
|
2146-03-12 06:15:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ woman with end-stage liver disease an altered mental
status.
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: 892 mGy-cm
CTDI: 55 mGy
COMPARISON: Comparison is made to head CT from ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration. The basal cisterns are patent
and there is preservation of gray-white matter differentiation.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial process.
|
19932024-RR-22
| 19,932,024 | 24,609,514 |
RR
| 22 |
2146-03-12 05:45:00
|
2146-03-12 06:39:00
|
EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST.
INDICATION: ___ with ESLD, abdominal tenderness.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
4) Spiral Acquisition 5.4 s, 59.0 cm; CTDIvol = 15.9 mGy (Body) DLP = 934.6
mGy-cm.
Total DLP (Body) = 945 mGy-cm.
IV Contrast: 130 mL Omnipaque
COMPARISON: Abdominal ultrasound ___ and abdominal MRI from ___.
FINDINGS:
LOWER CHEST: The lung bases are clear. There is no pericardial or pleural
effusion.
ABDOMEN:
HEPATOBILIARY: The liver is cirrhotic. There is mild central biliary duct
dilation. The gallbladder is surgically absent. No focal liver lesions
identified. The portal vein is patent. There is extensive porta hepatic
lymphadenopathy measuring up to 2.3 x 3.1 cm (series 2, image 24). Enlarged
perigastric lymph nodes are also present measuring up to 1.4 x 3.8 cm (series
2, image 24). Overall, lymphadenopathy not significantly changed from ___.
There is no intra-abdominal ascites.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation.
SPLEEN: The spleen is enlarged measuring 14.9 cm.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a small to moderate hiatal hernia. The small
bowel is normal in caliber without focal wall thickening. The large bowel is
also normal in caliber without wall thickening. The appendix is
well-visualized, air-filled, and normal. There is misting of the mesentery
(series 2, image 45), a nonspecific finding. Scattered enlarged mesenteric
lymph nodes are present measuring up to 1.1 x 2.2 cm (series 2, image 33).
RETROPERITONEUM: There are scattered mildly enlarged retroperitoneal lymph
nodes with the largest left para-aortic node measuring approximately 1.0 x 1.2
cm (series 2, image 54).
VASCULAR: There is no abdominal aortic aneurysm. There are minimal aortic
calcifications. The major branches off of the aorta are patent. There are a
extensive perigastric, perisplenic, and paraesophageal varices.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Mild degenerative changes are
present, most pronounced at the L5/S1 level.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Cirrhotic liver with sequela of portal hypertension including splenomegaly
and paraesophageal and intra-abdominal varices. No ascites. Please note
hepatocellular carcinoma cannot be excluded on this single phase study.
2. Extensive porta hepatic lymphadenopathy, likely related to chronic liver
disease however, other neoplastic processes are not excluded.
3. Moderate hiatal hernia.
|
19932024-RR-23
| 19,932,024 | 24,609,514 |
RR
| 23 |
2146-03-12 15:11:00
|
2146-03-12 19:09:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with cirrhosis and acute decompensation with
HE. // PVT r/o Please perform with dopplers.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis obtained earlier the same date.
FINDINGS:
LIVER: The liver demonstrates diffusely coarsened architecture with nodular
contour, in keeping with history of cirrhosis. No focal liver mass is
identified. The main portal vein is patent with hepatopetal flow. There is no
ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD is dilated at
0.9 cm, likely secondary to cholecystectomy.
GALLBLADDER: The gallbladder is absent.
PANCREAS: The pancreas is largely obscured by overlying bowel gas.
SPLEEN: The spleen is enlarged, measuring 16.3 cm in length, without focal
abnormality.
KIDNEYS: Limited views of the left kidney are unremarkable. The right kidney
is not imaged.
IMPRESSION:
1. Patent portal vein with normal direction of flow.
2. Cirrhosis and splenomegaly without ascites. No suspicious hepatic lesion.
|
19932024-RR-24
| 19,932,024 | 24,609,514 |
RR
| 24 |
2146-03-12 16:44:00
|
2146-03-12 17:04:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with cirrhosis and acute HE. // PNA
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
pleural effusion or pneumothorax.
|
19932024-RR-8
| 19,932,024 | 29,514,568 |
RR
| 8 |
2146-02-07 11:19:00
|
2146-02-07 12:56:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ woman with hep C cirrhosis and hepatic
decompensation.
TECHNIQUE: Gray scale, color and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: None available.
FINDINGS:
Liver: The hepatic parenchyma is coarsened in echotexture. Nofocal liver
lesions are identified. There is trace perihepatic ascites ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common bile
duct measures 8mm.
Gallbladder: The gallbladder surgically absent.
Pancreas: Imaged portion of the pancreas appears within normal limits, with
portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 16.7 cm.
Kidneys: Limited view of the right kidney is unremarkable.
Enlarged porta hepatic lymph nodes up to 2.1 cm, likely secondary to chronic
liver disease.
Doppler evaluation:
Main portal vein is patent, with flow in the appropriate direction. Right
portal veins are patent, with antegrade flow. Left portal vein shows reversal
of flow.
Main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
1. Cirrhotic liver without focal lesion identified. Trace perihepatic ascites.
2. Sequela of portal hypertension including splenomegaly.
3. Patent hepatic vasculature with reversal of flow in the left portal vein.
|
19932024-RR-9
| 19,932,024 | 29,514,568 |
RR
| 9 |
2146-02-07 12:46:00
|
2146-02-07 13:12:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with worsening hepatic function // r/o pna
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19932242-RR-46
| 19,932,242 | 22,352,403 |
RR
| 46 |
2159-08-08 11:32:00
|
2159-08-08 15:21:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: A ___ man with a fall,, thrombocytopenia, evaluate for
intracranial hemorrhage or maxillofacial fractures.
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: Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute infarction, hemorrhage, edema, mass, or mass
effect. The basal cisterns are patent, and there is no shift of normally
midline structures. Hypodensities involving the right external capsule and
the anterior limb of the left internal capsule may represent sequelae of
prior/old lacunar infarcts. Mild prominence of the ventricles and sulci is
compatible with age related involutional change. Periventricular white matter
hypodensity is compatible with the sequelae of chronic small vessel ischemia.
Multiple facial fractures are seen. In particular, there is a comminuted
fracture of the nasal bone anteriorly, (series 3, image 4), as well as a more
posterior displaced/angulated fracture of the nasal septum (series 3, image
1). Although not clearly seen on this exam, there may be of fractures through
the inferomedial wall of the right orbit (series 3, image 9) simple this is
better evaluated on same-day CT facial bones. Hyperdense fluid and small foci
of air fills the right maxillary sinus, compatible with acute blood products.
A smaller amount of layering hyperdense material is seen in the left maxillary
sinus as well as filling the paranasal sinuses and partially opacifying the
frontal sinuses and ethmoid air cells. There is partial left mastoid air cell
opacification, but no fracture is seen. The right mastoid air cells are
clear. There is no evidence of calvarial fracture. Bilateral carotid siphon
calcifications are noted. The globes appear intact.
IMPRESSION:
1. No evidence of intracranial hemorrhage or acute infarction.
2. Multiple facial bone fractures, at least including the nasal bone, the
nasal septum, and likely the inferomedial wall of the right bony orbit/lamina
papyracea. These are better evaluated on same-day CT facial bones.
3. Chronic findings including white matter small vessel ischemic changes and
volume loss.
|
19932242-RR-47
| 19,932,242 | 22,352,403 |
RR
| 47 |
2159-08-08 11:33:00
|
2159-08-08 15:50:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: History: ___ with fall, thrombocytopenia, // ICH, maxillofacial
fractures
TECHNIQUE: Helical axial images were acquired through the paranasal sinuses.
Coronal and sagittal reformatted images were also obtained.
DOSE: Total DLP (Head) = 584 mGy-cm.
COMPARISON: None.
FINDINGS:
Multiple facial bone fractures are identified. There are bilateral medial and
lateral pterygoid plate fractures, as well as fractures involving the medial
and lateral walls of the right maxillary sinus, compatible with right Lefort I
fracture. On the left, there is lucency through the lateral wall of the
maxillary sinus, potentially nondisplaced fracture although prominent vascular
channel is possible.
There bilateral nasal bone fractures, as well as a slightly angulated nasal
septal fracture. Finally, there is a fracture of the inferomedial wall of the
right orbital floor/lamina papyracea. The left lamina papyracea appears
intact. The globes are intact.
Hyperdense fluid opacifies the right maxillary sinus as well as much of the
paranasal sinuses, with small internal foci of gas, compatible with acute
blood products stemming from recent facial trauma. There is additional
hyperdense fluid layering in the sphenoid sinuses, as well as the left
maxillary sinus, and the frontal sinuses.
There is partial opacification of left mastoid air cells without visualized
fracture, noting that the entirety of the temporal bone is not included.
Fluid is seen within the middle ear on the right. The right mastoid air cells
are clear. Diffuse soft tissue swelling of the face appear centered on the
nasal bone.
Also noted is significant erosion of the alveolar process of the maxilla,
right greater than left, not secondary to recent trauma. Correlate clinically
with physical exam findings, as this may relate to pre-existing peridontogenic
disease, underlying malignancy, or chronic inflammation.
IMPRESSION:
1. Right Lefort I fracture. Fractures through the left pterygoid plates and
suspected maxillary sinus fracture suspicious for left ___ I. Additional
fractures included comminuted fracture of the nasal bone, fracture through the
nasal septum, and a fracture of the inferomedial wall of the right orbital
floor/lamina papyracea.
2. Significant erosion of the alveolar process of the maxilla right greater
the left, not due to trauma. Correlate clinically with physical exam findings,
as this may relate to pre-existing peridontogenic disease, underlying
malignancy, or chronic inflammation.
3. Sequelae of trauma including diffuse soft tissue swelling of the face
centered on the nasal bone, as well as blood products and small foci of air
seen throughout the facial sinuses, as above.
|
19932242-RR-55
| 19,932,242 | 20,351,538 |
RR
| 55 |
2159-11-25 10:00:00
|
2159-11-25 10:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with dyspnea // PORTABLE CXR - DYSPNEA-
CONGESTION ? PORTABLE CXR - DYSPNEA- CONGESTION ?
IMPRESSION:
As compared to the previous image, there is now mild to moderate pulmonary
edema. Moderate cardiomegaly. No pleural effusions. No pneumonia.
|
19932572-RR-10
| 19,932,572 | 24,050,017 |
RR
| 10 |
2180-11-04 05:22:00
|
2180-11-04 07:57:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with right CVL placement// right IJ placement
Contact name: ___: ___ right IJ placement
IMPRESSION:
No comparison. Lung volumes are low. Moderate cardiomegaly. Mild pulmonary
edema. Right internal jugular vein catheter. The course of the line is
unremarkable, the tip projects over the cavoatrial junction. No
complications, notably no pneumothorax.
|
19932572-RR-11
| 19,932,572 | 24,050,017 |
RR
| 11 |
2180-11-06 10:22:00
|
2180-11-06 14:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new O2 requirement. Admitted for sepsis
(resolving) from UTI/nepholithiasis s/p perc nephrostomy. Evaluate for
consolidation concerning for pneumonia and or pulmonary edema.
TECHNIQUE: Frontal views of the chest.
COMPARISON: Chest x-ray ___.
FINDINGS:
Compared to the prior study, opacification at the lung bases has increased,
which may represent atelectasis, although a superimposed pneumonia or
aspiration cannot be excluded. Pulmonary vascular congestion and pulmonary
edema has increased. Mild-to-moderate cardiomegaly is unchanged. Small
bilateral pleural effusions. The right IJ line terminates at the cavoatrial
junction.
IMPRESSION:
1. Interval increase in pulmonary edema.
2. Interval increase in bibasilar opacification, which may represent
atelectasis, although a superimposed pneumonia or aspiration cannot be
excluded.
3. Small bilateral pleural effusions.
|
19932572-RR-9
| 19,932,572 | 24,050,017 |
RR
| 9 |
2180-11-03 19:26:00
|
2180-11-03 22:27:00
|
INDICATION: ___ year old woman with infected left ureteral stone// please
place perc nephrostomy
COMPARISON: CT on ___
TECHNIQUE: OPERATORS: Dr. ___ (Interventional Radiology Fellow) and
Dr. ___ 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: Moderate sedation was provided by administrating divided doses of
50mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 10 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1.3 min, 7 mGy
PROCEDURE: 1. Left ultrasound guided renal collecting system access.
2. Left nephrostogram.
3. 8 ___ left nephrostomy tube placement.
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 left flank was prepped and draped in the usual sterile fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the left renal collecting system was accessed through a posterior lower pole
calyx under ultrasound guidance using a 21 gauge Cook needle. Ultrasound
images of the access were stored on PACS. Prompt return of urine confirmed
appropriate positioning. Injection of a small amount of contrast outlined a
dilated renal collecting system. Under fluoroscopic guidance, a Nitinol wire
was advanced into the renal collecting system. After a skin ___, the needle
was exchanged for an Accustick sheath. Once the tip of the sheath was in the
collecting system; the sheath was advanced over the wire, inner dilator and
metallic stiffener. The wire and inner dilator were then removed and diluted
contrast was injected into the collecting system to confirm position. A ___
wire was advanced through the sheath and coiled in the collecting system. The
sheath was then removed and a 8 ___ nephrostomy tube was advanced into the
renal collecting system. The wire was then removed and the pigtail was formed
in the collecting system. Contrast injection confirmed appropriate
positioning. The catheter was then flushed, 0 silk stay sutures applied and
the catheter was secured with a Stat Lock device and sterile dressings. The
catheter was attached to a bag.
FINDINGS:
Appropriately placed 8 ___ left-sided percutaneous nephrostomy.
IMPRESSION:
Successful placement of 8 ___ nephrostomy on the right.
RECOMMENDATION(S): Percutaneous nephrostomy catheter most remain attached to
bag drainage.
|
19932649-RR-17
| 19,932,649 | 26,105,867 |
RR
| 17 |
2154-01-28 11:18:00
|
2154-01-28 12:59:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: History: ___ with fall with ankle pain// eval for fracture
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left knee.
COMPARISON: None.
FINDINGS:
No fracture or dislocation is seen. There are moderate tricompartmental
degenerative changes. There is no knee joint effusion. There is diffuse
osteopenia. No suspicious lytic or sclerotic lesions are identified.
IMPRESSION:
No acute fracture or dislocation.
Moderate tricompartmental degenerative changes.
|
19932649-RR-18
| 19,932,649 | 26,105,867 |
RR
| 18 |
2154-01-28 11:19:00
|
2154-01-28 12:56:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT
INDICATION: History: ___ with fall with ankle pain// eval for fracture
eval for fracture
TECHNIQUE: AP, lateral and oblique views of the left ankle.
COMPARISON: None.
FINDINGS:
There is a comminuted, laterally and superiorly displaced, left lateral
malleolar fracture. In addition, there is a completely displaced transverse
fracture of the left medial malleolus. Probable posterior malleolar fracture
is as well. The ankle mortise is disrupted. The talus is lateral in location
in relation to the distal tibia.
IMPRESSION:
Trimalleolar fracture. Comminuted and displaced left lateral malleolar
fracture.
Completely displaced transverse left medial malleolar fracture.
Probable posterior malleolar fracture.
Disrupted ankle mortise.
|
19932649-RR-19
| 19,932,649 | 26,105,867 |
RR
| 19 |
2154-01-28 11:20:00
|
2154-01-28 12:58:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: History: ___ with fall with ankle pain// eval for fracture
TECHNIQUE: Frontal and lateral view radiographs of the left tibia and fibula.
COMPARISON: None.
FINDINGS:
Left distal fibular and malleolar fractures are better characterized on
dedicated ankle radiograph. Otherwise, no additional fracture is detected in
the proximal tibia or fibula. No soft tissue calcification or radio-opaque
foreign bodies are detected.
IMPRESSION:
Left distal fibular and malleolar fractures better characterized on dedicated
ankle radiograph. Otherwise, no additional fractures identified more
proximally.
|
19932649-RR-20
| 19,932,649 | 26,105,867 |
RR
| 20 |
2154-01-28 11:03:00
|
2154-01-28 11:21:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with fall// eval for bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 19.5 cm; CTDIvol = 46.4 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute large territorial infarction, intracranial
hemorrhage, edema, or mass.
There is prominence of the ventricles and sulci suggestive of age-related
cerebral volume loss. Periventricular and subcortical white matter
hypodensities are nonspecific, though likely sequelae of chronic small vessel
ischemic disease. Atherosclerotic vascular calcifications are noted of
bilateral vertebral and cavernous portions of internal carotid arteries.
There is evidence of a right occipital craniotomy. Otherwise, no acute
osseous abnormalities seen. The partially imaged paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The orbits demonstrate no acute
abnormalities.
IMPRESSION:
No acute intracranial process. No evidence of acute intracranial hemorrhage
or fracture.
|
19932649-RR-21
| 19,932,649 | 26,105,867 |
RR
| 21 |
2154-01-28 11:03:00
|
2154-01-28 11:47:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall// eval for bleed
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 21.0 cm; CTDIvol = 22.7 mGy (Body) DLP = 476.6
mGy-cm.
Total DLP (Body) = 477 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified.Multilevel degenerative
changes are seen, most extensive at C3-C4 and C4-C5 notable for severe right
and severe left neural foraminal stenosis, respectively. There is no
prevertebral edema.
The thyroid is enlarged and contains multiple nodules. The included lung
apices are unremarkable.
IMPRESSION:
No acute fracture or traumatic malalignment.
Moderate to severe multilevel degenerative changes.
Multinodular thyroid. If not previously performed, thyroid ultrasound may be
considered.
|
19932649-RR-22
| 19,932,649 | 26,105,867 |
RR
| 22 |
2154-01-28 14:27:00
|
2154-01-28 17:11:00
|
TECHNIQUE: 3 fluoroscopic spot images of the left ankle were obtained in the
operating room without presence of radiologist.
DOSE: Fluoroscopy time 45.7 seconds, cumulative dose 181.55 mrad.
COMPARISON: Earlier on the same day.
FINDINGS:
Status post open reduction and internal fixation of medial and lateral
malleoli with a single medial screw and a lateral fibular fixation plate with
multiple screws including 2 syndesmotic screws.
IMPRESSION:
Status post open reduction internal fixation of ankle fractures.
|
19933011-RR-10
| 19,933,011 | 23,790,955 |
RR
| 10 |
2175-12-21 18:42:00
|
2175-12-21 19:00:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with CKD, chest pain // pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. Surgical clips noted in the upper abdomen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19933011-RR-11
| 19,933,011 | 23,790,955 |
RR
| 11 |
2175-12-22 02:21:00
|
2175-12-22 02:40:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with rapidly worsening renal function and
pyelonephritis, status post left nephrectomy and multiple surgeries for
bladder cancer. Please assess for acute changes/abscess
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: MR from ___ and ultrasound from ___. .
FINDINGS:
The right kidney measures 12.3 cm. The patient is status post left
nephrectomy. There is severe right hydroureteronephrosis with cortical
thinning. There is normal corticomedullary differentiation.
The bladder is minimally distended and normal in appearance. No abscess or
fluid collection is seen.
IMPRESSION:
Severe right hydroureteronephrosis, similar to prior MR exam from ___.
RECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 4:31 AM.
|
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