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19933011-RR-12
| 19,933,011 | 23,790,955 |
RR
| 12 |
2175-12-22 10:23:00
|
2175-12-22 12:29:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman with ___ yo female with CKD in planning stages
for dialysis, bladder cancer, L nephrectomy, chronic hydronephrosis, and
reurrent pyelonephritis with plans for ureterostomy who presents with
pyelonephritis and worsening CKD with evidence of right sided hydronephrosis
on US. // Evaluate for stone/ cause of hydronephrosis
TECHNIQUE: Multiple contiguous slices were obtained from the lung bases to
the pubic symphysis without IV contrast injection. Oral contrast was
administered.
COMPARISON: Renal ultrasound from same day and MRI of the pelvis from ___
FINDINGS:
Findings are limited by the lack of IV contrast.
Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.
Peritoneal Cavity: There is no free air, free fluid or focal fluid collection.
Liver: There is a 1.4 cm hypodense lesion in segment II that is not well
characterized without contrast but likely represents a cyst ( ___:13 ).
Gallbladder and Biliary System: The gallbladder is not distended and there are
no calcified gallstones.There is no significant intra or extrahepatic biliary
ductal dilatation.
Pancreas: The pancreas is normal in size with no focal lesion, ductal
dilatation or calcifications.
Spleen: The spleen is not enlarged.There is no focal splenic lesion.
Kidneys and Adrenals: The left kidney has been removed with surgical clips in
the left renal fossa (___:26 ). On the right, there is marked hydronephrosis
and hydroureter extending to the level of the ureterovesical junction. There
is fat stranding within the perinephric fat that was not present on the recent
MRI (03:25, 03:40). There is no obvious obstructing mass lesion or stone.The
adrenal glands are normal bilaterally.
Bowel: The visualized bowel loops and mesentery are grossly normal with no
evidence of bowel obstruction.
Pelvis: The urinary bladder demonstrates diffuse wall thickening with
adjacent perivesical fat stranding. Anteriorly, there is tethering and a soft
tissue nodule that measures approximately 2.0 cm, grossly stable compared to
the MRI, allowing for differences in technique and measurement. The uterus and
ovaries are unremarkable with no adnexal mass.
Lymph Nodes: There are multiple prominent retroperitoneal lymph nodes
measuring 11 mm a retrocaval location (03:24 ) and 10 mm in the paraaortic
region (03:36), which appear increased in size and are likely reactive.
There is atheromatous calcification involving the abdominal aorta with no
aneurysm.
Bones: The osseous structures are unremarkable and there is no suspicious bone
lesion.
IMPRESSION:
1. Right perinephric fat stranding is new since the MR examination from ___ and may reflect pyelonephritis. Multiple adjacent enlarged
retroperitoneal lymph nodes are likely reactive.
2. Severe right hydronephrosis and hydroureter extending to the
ureterovesical junction is unchanged since the previous MRI, with no stone or
obvious obstructing mass.
3. Diffuse mild bladder wall thickening with a stable known anterior wall
mass.
4.
|
19933011-RR-13
| 19,933,011 | 23,790,955 |
RR
| 13 |
2175-12-22 10:40:00
|
2175-12-22 16:05:00
|
EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old woman with ___ yo female with CKD in planning stages
for dialysis, bladder cancer, L nephrectomy, and chronic hydronephrosis who
presents with worsening renal failure in the setting of pyelonephritis. //
Evaluation for initiation of dialysis
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
COMPARISON: None.
FINDINGS:
The central venous waveforms have normal cardiac and respirophasicity the
bilaterally.
RIGHT:
The cephalic vein measures 0.3 cm at the wrist, 0.2 cm at the mid forearm,
0.18 cm at the proximal forearm, 0.33 cm at the antecubital fossa, 0.26 cm at
the proximal arm, 0.24 cm at the mid arm and 0.27 cm at the distal arm. The
basilic vein measures 0.28 cm at the antecubital fossa, 0.4 cm at its mid
portion, and 0.45 cm at the proximal portion.
The radial artery measures 0.15 cm. The brachial artery has a high bifurcation
or duplication. The 2 brachial arteries measure 0.24, 0.23 cm respectively. No
arterial calcifications are present.
LEFT:
The cephalic vein measures 0.24 cm at the wrist, 0.25 cm at the distal
forearm, 0.23 cm at the mid forearm, 0.26 cm at the proximal forearm, cm at
the antecubital fossa, 0.12 cm at the proximal arm, 0.08 cm at the mid arm and
0.11 cm at the distal arm. The basilic vein measures cm at the forearm, 0.41
cm at the antecubital fossa, 0.45 cm at its mid portion, and 0.48 cm at the
proximal portion.
The radial artery measures 0.17 cm. The brachial artery measures 0.28 cm. No
arterial calcifications are present.
IMPRESSION:
Patent central veins bilaterally. Patent cephalic and basilic veins with
diameters as noted. The left upper arm cephalic vein is diminutive.
|
19933011-RR-18
| 19,933,011 | 28,900,589 |
RR
| 18 |
2176-09-30 19:42:00
|
2176-09-30 21:15:00
|
EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT IV CONTRAST.
INDICATION: ___ year old woman with hematuria, bladder spasms, s/p nephrectomy
for bladder cancer // please evaluate for stone
TECHNIQUE: CTU: Multidetector CT of the abdomen and pelvis were acquired
without intravenous contrast administration with the patient in prone
position. Non-contrast scan has several limitations in detecting vascular and
parenchymal organ abnormalities, specifically including tumor detection.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP (Body) = 92 mGy-cm.
COMPARISON: CT abdomen and pelvis and renal ultrasound from ___
and MRI of the pelvis from ___.
FINDINGS:
LOWER CHEST: Right basilar atelectasis is noted. There is no pleural or
pericardial effusion. There is no evidence of pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The patient is post left nephrectomy. Known massive right
hydronephrosis is unchanged compared to prior studies from ___, with
hydroureter extending to the level of the ureterovesicular junction. There is
right renal cortical atrophy, as before. Previously described right
perinephric fat stranding has improved compared to the prior CT from ___.
There is no evidence of nephrolithiasis or ureterolithiasis. Within the
limitations of this noncontrast examination, there is no evidence of large
obstructing mass.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: A Foley catheter is present within the urinary bladder, which is
decompressed. Surgical clips are noted in the area adjacent to the superior
bladder margin from prior bladder mass resection.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Severe right hydroureteronephrosis is unchanged in extent since ___, with
no discrete obstructing mass identified on this noncontrast examination.
2. Previously described right perinephric fat stranding on the prior exam has
improved.
3. Postoperative changes related to prior left nephrectomy and bladder mass
resection, as described above.
|
19933011-RR-19
| 19,933,011 | 25,749,618 |
RR
| 19 |
2176-12-12 14:50:00
|
2176-12-12 15:23:00
|
INDICATION: ___ with ESRD on HD who missed ___ HD, evaluate for pneumonia,
fluid overload.
TECHNIQUE: PA and lateral chest radiograph.
COMPARISON: Chest x-ray ___.
FINDINGS:
Re-identified is a tunneled left IJ dialysis catheter with distal tip
projecting over the high right atrium. A right axillary region vascular graft
is new since prior. The cardiomediastinal contours are within normal limits.
The bilateral hila are unremarkable. The lungs are clear without focal
consolidation. There is no evidence of pulmonary vascular congestion. There
is no pneumothorax or pleural effusion.
IMPRESSION:
No acute cardiopulmonary process. No pneumonia. No pulmonary edema or
pulmonary vascular congestion.
|
19933011-RR-20
| 19,933,011 | 25,749,618 |
RR
| 20 |
2176-12-12 15:40:00
|
2176-12-12 16:23:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ with hx nephrectomy and recurrent pyelo, on HD.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
The left kidney is surgically absent. The right kidney measures 11.4 cm.
There is severe right hydroureteronephrosis with cortical thinning. No debris
is seen within the collecting system. A small nodular mass is seen within the
bladder, abutting the anterior bladder wall.
IMPRESSION:
1. Severe right hydroureteronephrosis with cortical thinning. No debris seen
within the renal collecting system.
2. A small nodular lesion is seen along the bladder wall. Consider
cystoscopy to further assess.
RECOMMENDATION(S): A small nodular mass is seen within the bladder, adherent
to the bladder wall. This should be further evaluated with cystoscopy, if not
previously performed.
|
19933011-RR-21
| 19,933,011 | 23,084,777 |
RR
| 21 |
2177-03-19 05:02:00
|
2177-03-19 05:10:00
|
EXAMINATION: Chest radiograph
INDICATION: Upper flank pain and chills.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___.
FINDINGS:
Left internal jugular approach dual lumen catheter tip terminates in the high
right atrium. Heart size is normal. Cardiomediastinal silhouette and hilar
contours are unremarkable. Lungs are clear. Pleural surfaces are clear
without effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19933011-RR-22
| 19,933,011 | 23,084,777 |
RR
| 22 |
2177-03-19 11:17:00
|
2177-03-19 12:12:00
|
INDICATION: ___ year old woman with h/o bladder cancer s/p left nephrectomy,
recurrent pyelonephritis, and ESRD who p/w fever, leukocytosis, R CVA
tenderness, and positive UA suggestive of pyelonephritis, evaluate for
obstruction or renal stone.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast in the prone position. Non-contrast scan has
several limitations in detecting vascular and parenchymal organ abnormalities,
including tumor detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 52.0 cm; CTDIvol = 2.1 mGy (Body) DLP = 107.5
mGy-cm.
Total DLP (Body) = 108 mGy-cm.
COMPARISON: CTUs dated ___ and ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. Hypodensity along the falciform ligament likely represents focal fat.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is not visualized.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The patient is status post left nephrectomy with multiple surgical
clips in the nephrectomy bed. There is no evidence of local disease
recurrence. Marked right-sided hydroureteronephrosis is unchanged dating back
to ___ without evidence of calculus formation. Cortical thinning
has progressed compared with ___ compatible with long-standing obstruction.
There is no evidence of focal renal lesions within the limitations of an
unenhanced scan.
Renal and para-aortic lymphadenopathy is not significantly changed from ___ including a prominent right para-aortic lymph node (02:24), and
a prominent left para-aortic lymph node (02:38).
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is not visualized.
PELVIS: Patient is status post bladder mass resection with stable postsurgical
changes in the pelvis. There is no new or enlarging soft tissue mass in this
area. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Unchanged marked right-sided hydroureteronephrosis without calculus
formation. Superimposed pyelonephritis cannot be excluded without the use of
intravenous contrast.
2. Interval progression of right renal cortical thinning compatible with
longstanding partial or complete right-sided obstruction.
3. Status post bladder mass resection and left nephrectomy with expected
postsurgical changes. Prominent para-aortic lymphadenopathy is not
significantly changed from ___.
|
19933011-RR-24
| 19,933,011 | 27,437,666 |
RR
| 24 |
2177-12-19 09:11:00
|
2177-12-19 10:10:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ pain and CT at OSH w/ wall thickening //
?cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT torso from 3 hr prior.
FINDINGS:
A small right-sided pleural effusion is partially visualized.
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is small ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 6 mm.
GALLBLADDER: The gallbladder is mildly distended. There is extensive
gallbladder wall edema. No shadowing calculi are identified.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 16 cm.
KIDNEYS: Limited views of the right kidney show severe hydronephrosis,
comparable to the comparison CT.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Mildly distended gallbladder with gallbladder wall edema. In the absence
of calculi, these findings are equivocal and may be also seen in the setting
of liver disease and third-spacing. If there is continued concern for acute
cholecystitis, HIDA scan can be obtained for further evaluation.
2. Severe right-sided hydronephrosis, comparable to the findings seen on
recent CT.
|
19933011-RR-25
| 19,933,011 | 27,437,666 |
RR
| 25 |
2177-12-20 20:49:00
|
2177-12-20 21:54:00
|
EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA LEFT
INDICATION: ___ year old woman with L shoulder pain s/p fall. // Evaluate for
MSK abnormalities.
TECHNIQUE: Left shoulder three views
COMPARISON: None
FINDINGS:
Widened left AC joint, stable since ___, may be
from prior trauma or surgery. Normal glenohumeral joint alignment. No
fractures. Remainder normal.
IMPRESSION:
Stable widening left AC joint, may be from prior trauma or surgery.
|
19933011-RR-26
| 19,933,011 | 20,782,858 |
RR
| 26 |
2178-05-11 01:05:00
|
2178-05-11 02:10:00
|
EXAMINATION: Chest radiograph
INDICATION: History: ___ with shortness of breath// ? pneumonia
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: Chest radiographs from ___ through ___
FINDINGS:
Heart size is top-normal. The aorta is somewhat tortuous and demonstrates
calcification. There moderate pulmonary edema. No evidence of focal
consolidation. There may be a trace left pleural effusion. No pneumothorax.
A catheter projects in the right upper quadrant
IMPRESSION:
Moderate pulmonary edema. Trace left effusion.
|
19933011-RR-27
| 19,933,011 | 20,782,858 |
RR
| 27 |
2178-05-11 10:53:00
|
2178-05-11 12:10:00
|
EXAMINATION: RENAL U.S.
INDICATION: h/o solitary right kidney, ESRD on HD (R AVF), h/o low grade
noninvasive bladder CA s/p multiple surgeries, recent hospitalization at ___ 2
weeks ago for nephrostomy tube placement ___ to obstruction from cancer, who
presents with nausea, vomiting, nonbloody diarrhea for 1 week.// Evidence of
obstruction, abscess?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal ultrasound from ___.
CTU from ___.
FINDINGS:
Limited examination due to overlying soft tissue. The solitary right kidney
measures at least 13.0 cm, partially visualized. Corticomedullary
differentiation is absent. A percutaneous nephrostomy tube is in place
extending into a re-demonstrated dilated proximal right ureter. No
hydronephrosis is seen. Small right pleural effusion is present. No focal
lesion or abscess is identified on limited examination.
IMPRESSION:
1. Percutaneous nephrostomy tube in place without hydronephrosis.
2. No focal lesion or abscess identified on limited examination. If persistent
clinical concern for abscess, consider cross-sectional imaging with
contrast-enhanced CT of the abdomen and pelvis or MRI.
3. Small right pleural effusion.
|
19933011-RR-38
| 19,933,011 | 25,570,323 |
RR
| 38 |
2178-11-06 16:22:00
|
2178-11-06 18:46:00
|
EXAMINATION: CT ABDOMEN PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with RLQ pain. h/o ureteral tumor
NO_PO contrast*** WARNING *** Multiple patients with same last name!// assess
for interval change in malignancy, appendicitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
2) Spiral Acquisition 6.6 s, 52.1 cm; CTDIvol = 9.9 mGy (Body) DLP = 515.9
mGy-cm.
Total DLP (Body) = 529 mGy-cm.
COMPARISON: MR abdomen pelvis from ___. Outside reference CT
abdomen pelvis from ___.
FINDINGS:
LOWER CHEST: There is mild dependent atelectasis. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. Probable adenomyomatosis of the
gallbladder fundus is noted. The gallbladder is otherwise unremarkable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The left kidney is surgically absent. A right percutaneous
nephrostomy tube is noted. There is a 5.4 x 3.8 x 6.5 cm heterogeneous,
hypoattenuating structure in the region the right renal pelvis (2:33, 601:34),
inseparable from the right kidney. This extends down along the proximal right
ureter. Adjacent fat stranding is noted. This is similar to mildly larger
from prior MR abdomen pelvis from ___. A second enhancing mass
spans a 4.5 cm portion of the distal right ureter (602:28).
GASTROINTESTINAL: The stomach is unremarkable. There is no evidence of
gastrointestinal obstruction or free intra-abdominal fluid. The appendix is
normal (2:62).
PELVIS: A shrunken, dysmorphic appearance of the bladder is similar to priors.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is grossly unremarkable. No adnexal masses
are seen.
LYMPH NODES: Enlarged right caval and aortocaval lymph nodes measuring up to
2.2 x 1.5 cm (2:28) are similar to prior. There is no pelvic or inguinal
lymphadenopathy by CT size criteria.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Normal appendix.
2. Large heterogeneous, hypoattenuating area in the region of the right renal
pelvis with extension down the right proximal is similar to mildly bigger than
prior MR abdomen pelvis ___, lying for differences and study
modality. This may represent perinephric hematoma related to prior
percutaneous nephrostomy, underlying soft tissue difficult to exclude.
3. 4.5 cm segment of enhancing soft tissue mass involving the distal right
ureter is concerning for malignancy, similar to prior.
4. Shrunken, dysmorphic appearance of the bladder is similar to prior and also
suspicious for malignancy.
5. Retroperitoneal lymphadenopathy with an enlarged right caval lymph node
measuring up to 2.2 cm
|
19933011-RR-39
| 19,933,011 | 25,570,323 |
RR
| 39 |
2178-11-07 14:37:00
|
2178-11-07 16:07:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ y/o female with CKD/ESRD on dialysis MWF secondary to
chronicpyelonephritis, hydronephrosis, and scarring, long history ofbladder
cancer, L Nephroureterectomy, with an obstructed rightkidney (due to invading
bladder cancer into the R ureter) s/pright PCN with asymmetric swelling of
lower extremities (L>R) and pain in right calf while walking. Evaluate for
DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19933011-RR-40
| 19,933,011 | 25,570,323 |
RR
| 40 |
2178-11-07 18:38:00
|
2178-11-07 20:22:00
|
INDICATION: ___ year old woman with bright red blood per urethra and abdominal
pain.// Right PCN check and possible change. Recently exchanged ___.
COMPARISON: Right PCN check change ___
TECHNIQUE: OPERATORS: Dr. ___ Radiologist and Dr. ___
___, Interventional Radiology fellow performed the procedure. Dr.
___ supervised the trainee during any key components of the
procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
75mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 15 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS:
CONTRAST: 10 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 1.7 minutes, 4 mGy
PROCEDURE:
1. Right diagnostic antegrade nephrostogram.
2. Right 8 ___ nephrostomy exchange.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient.The patient was then brought to the angiography suite and placed prone
on the exam table. A pre-procedure time-out was performed per ___ protocol.
The right flank was prepped and draped in the usual sterile fashion.
Diluted contrast was injected into the right nephrostomy to confirm catheter
position. The image was stored on PACS. Local anesthesia was administered
with instillation of lidocaine jelly and 1% subcutaneous lidocaine injection.
The catheter was cut. A ___ wire was advanced into the right nephrostomy
tube and advanced into the distal ureter. The stay sutures were cut and the
catheter was removed over the wire. A new 8 ___ nephrostomy catheter was
flushed and advanced with its plastic stiffener over the wire into appropriate
position. The wire and stiffener were removed and the pigtail was formed.
Contrast injection confirmed appropriate positioning. The final image was
saved. The catheter was then flushed, stay sutures applied and the catheter
was secured with a Stat Lock device and sterile dressings. The catheter was
attached to a bag for drainage.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Right antegrade nephrostogram shows the right PCN slightly retracted though
still positioned within the collecting system.
2. Appropriate final position of right nephrostomy tube in the renal pelvis.
IMPRESSION:
Technically successful right 8 ___ nephrostomy exchange.
RECOMMENDATION(S): Patient will return in 3 months for routine exchange.
|
19933117-RR-14
| 19,933,117 | 24,522,455 |
RR
| 14 |
2151-05-28 20:25:00
|
2151-05-28 20:43:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with pmh spontaneous pnx//pnx?
COMPARISON: Prior exam is dated ___
FINDINGS:
PA and lateral views of the chest provided. Again seen is a moderate size
right pneumothorax which is not significantly changed from prior. There is an
associated right pleural effusion, small in volume. There is no evidence of
tension. Left lung remains clear. Cardiomediastinal silhouette is normal.
Bony structures are intact.
IMPRESSION:
Moderate right pneumothorax, small right pleural effusion. Overall findings
are not significantly changed from prior. No evidence of tension.
|
19933117-RR-15
| 19,933,117 | 24,522,455 |
RR
| 15 |
2151-05-29 08:20:00
|
2151-05-29 10:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ recent history of spontaneous R PTX p/w recurrent R PTX//
Evaluate for interval change in pneumothorax Surg: ___
(Blebectomy/pleurodesis) Evaluate for interval change in pneumothorax
IMPRESSION:
Comparison to ___. There is a large and overall unchanged right basal
pneumothorax. The air-fluid level previously present is no longer seen. No
evidence of tension. Borderline size of the cardiac silhouette. No pulmonary
edema. No pneumonia,
|
19933117-RR-16
| 19,933,117 | 24,522,455 |
RR
| 16 |
2151-05-29 19:18:00
|
2151-05-29 19:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p R VATS wedge pleurodesis// ?ptx
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
The patient is post right VATS wedge resection and a chest tube is present.
There is a small apical pneumothorax. Interstitial opacities bilaterally may
reflect elevated venous pressures and postoperative change. There is no
pleural effusion or left pneumothorax. Subcutaneous emphysema over the right
chest wall is noted.
|
19933117-RR-17
| 19,933,117 | 24,522,455 |
RR
| 17 |
2151-05-30 08:04:00
|
2151-05-30 10:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p R VATS wedge pleurodesis// ? ptx
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph the chest performed 13 hours prior.
FINDINGS:
Heart size is normal. Hilar and mediastinal contours are normal. The patient
is status post right VATS resection. Small right apical pneumothorax is
unchanged compared to the prior exam. Interstitial opacities bilaterally are
re-demonstrated. Subcutaneous emphysema over the right chest wall likely
postprocedural in etiology.
IMPRESSION:
Unchanged small right apical pneumothorax.
|
19933117-RR-19
| 19,933,117 | 24,522,455 |
RR
| 19 |
2151-05-31 14:19:00
|
2151-05-31 14:28:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p R VATS now s/p CT removal// interval
assessment for PTX after CT removal. **PLEASE PERFORM AT 1430**
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
Right-sided chest tube has been removed in the interim. Small right apical
pneumothorax is seen. There is subsegmental atelectasis in the right lower
lobe. Subcutaneous emphysema seen in the right lateral chest wall. Left lung
remains clear.
|
19933219-RR-13
| 19,933,219 | 24,660,278 |
RR
| 13 |
2148-11-12 10:58:00
|
2148-11-12 11:32:00
|
EXAMINATION: Focused ultrasound of the gallbladder fossa.
INDICATION: ___ year old man with bile leak s/p lap ccy, s/p ERCP with
stenting yes. with increased abdominal pain// the status of his biloma, is it
drainable?
TECHNIQUE: Grayscale and color Doppler images of the gallbladder fossa or
obtained.
COMPARISON: A prior MRI dated ___ and a prior CT study of the
abdomen dated ___
FINDINGS:
Within the gallbladder fossa, adjacent to the left portal vein there is a non
loculated nondistended fluid pocket which is similar in size when compared to
the prior MRI study. It has a maximum dimension of 1.1 x 1.5 x 6 cm. It is
compatible the patient's known cystic duct stump leak. Few septations are
identified.
IMPRESSION:
Nondistended non loculated fluid collection within the gallbladder fossa which
measures 1.1 x 1.5 x 6 cm. This is not significant changed from the prior MRI
study.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:30 am, 10 minutes after
discovery of the findings.
|
19933258-RR-16
| 19,933,258 | 25,827,452 |
RR
| 16 |
2131-11-09 20:30:00
|
2131-11-09 22:34:00
|
HISTORY: Small bowel obstruction.
COMPARISON: Same day CT abdomen and pelvis.
TECHNIQUE: Frontal abdominal radiograph, four views.
FINDINGS: Previously ingested contrast material is retained within a
distended stomach. Again seen are multiple dilated loops of central small
bowel measuring up to roughly 5 cm in diameter, with multiple air-fluid
levels, compatible with small bowel obstruction as on earlier CT examination.
There is no evidence of pneumatosis or pneumoperitoneum. Contrast material is
seen within the bladder.
IMPRESSION: Multiple dilated loops of small bowel with multiple air-fluid
levels consistent with small bowel obstruction as described on earlier same
day CT.
|
19933258-RR-17
| 19,933,258 | 25,827,452 |
RR
| 17 |
2131-11-10 00:16:00
|
2131-11-11 23:26:00
|
ABDOMEN 12:20 A.M. ON ___
HISTORY: ___ woman. Check NG tube position.
IMPRESSION: Feeding tube is barely visible but appears to traverse the
gastroesophageal junction, denoted by the gastric band, coiling in the upper
portion of a moderately distended stomach.
|
19933258-RR-18
| 19,933,258 | 25,827,452 |
RR
| 18 |
2131-11-10 08:38:00
|
2131-11-10 17:33:00
|
ABDOMEN 8:48 A.M., ___
HISTORY: Previous lap band surgery, ___. Nausea, vomiting, abdominal pain.
Chest CT consistent with partial small-bowel obstruction. Band has been
deflated, but patient has had only minimal output from the nasogastric tube.
Confirm placement of the tube.
Upper enteric drainage tube appears to enter the nondistended stomach as
denoted by the band, ending in the mid portion. The insufflation tubing
cannot be traced continuously, but is best evaluated empirically by inflating
the band if there is any doubt. Intestinal gas pattern is essentially normal.
Pneumoperitoneum is not assessed by the supine imaging.
|
19933418-RR-10
| 19,933,418 | 28,709,233 |
RR
| 10 |
2195-10-12 18:28:00
|
2195-10-12 19:57:00
|
EXAMINATION: CT torso with intravenous contrast
INDICATION: ___ intoxicated male with floor level fall. Evaluate for
acute injury.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,527 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart is not enlarged. There is extensive
calcification of the left anterior descending coronary artery. There is no
pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is dependent atelectasis in the apicoposterior segment of
the left upper lobe and dependent atelectasis of the right lung. There is
subsegmental atelectasis in the bilateral left worse than right lower lobes.
The airways are patent to the level of the segmental bronchi bilaterally.
There is no consolidation or suspicious pulmonary nodule.
BASE OF NECK: The thyroid is unremarkable.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates low attenuation compatible with hepatic
steatosis. There is a nodular contour to the liver which may be suggestive of
a cirrhotic morphology. There is no evidence of focal lesion or laceration.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder contains gallstones without wall thickening or surrounding
inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is mildly enlarged measuring up to 16 cm in AP diameter.
There is no focal lesion.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are sub-centimeter hypodensities in both kidneys which are too small to
characterize. There is no hydronephrosis or perinephric abnormality.
GASTROINTESTINAL: Enteric tube terminates in the gastric antrum. The stomach
is otherwise unremarkable. Small bowel loops demonstrate normal caliber, wall
thickness, and enhancement throughout. The colon and rectum are within normal
limits. The appendix is normal. There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: There is a Foley which terminates in bladder. There is air in the
bladder, likely related to Foley insertion. There is diffuse bladder wall
thickening, nonspecific in etiology.
REPRODUCTIVE ORGANS: The prostate is grossly unremarkable..
LYMPH NODES: There is a periportal lymph node measuring 1.3 cm in short axis
(2:119). There is no retroperitoneal lymphadenopathy. There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of fracture or soft tissue injury in the torso. No free fluid
in the abdomen pelvis.
2. Diffuse wall thickening the bladder which is nonspecific but can be seen in
cystitis or chronic bladder outlet obstruction.
3. Cirrhotic morphology of the liver and splenomegaly. There is a prominent
periportal lymph node which is nonspecific but can be seen in chronic liver
disease.
4. Cholelithiasis without gallbladder wall thickening.
|
19933418-RR-11
| 19,933,418 | 28,709,233 |
RR
| 11 |
2195-10-12 18:29:00
|
2195-10-12 19:39:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ male for with ground level fall. Evaluate for facial
fractures.
TECHNIQUE: Helical axial images were acquired through the facial bones. Bone
and soft tissue reconstructed images were generated. Coronal and sagittal
reformatted images were also obtained.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.7 s, 20.9 cm; CTDIvol = 25.8 mGy (Head) DLP = 539.4
mGy-cm.
Total DLP (Head) = 539 mGy-cm.
COMPARISON: None.
FINDINGS:
There are minimally displaced fractures of the left lateral orbital rim
(2:36), lateral orbital wall (2:40), and the left zygomatic arch (2:53 and
61). The anterior zygomatic arch fracture fragment is displaced medially by
approximately 4 mm. There is a comminuted mildly displaced fracture of the
left orbital floor (601:77) without CT evidence of ocular muscle entrapment.
There is a mildly displaced fracture of the right orbital roof (601:104) which
is close to the right orbital apex. There is and associated right
retro-bulbar, extraconal hematoma measuring up to 6 mm in thickness with foci
of air. This hematoma abuts the superior rectus muscle which is displaced
inferiorly. There is perhaps minimal irregularity of the right lamina
papyracea (02:45) which could represent a nondisplaced fracture which is
suspected given adjacent foci of intraorbital air.
There is a large right frontal subgaleal hematoma extending to the right
periorbital region. The globes themselves are unremarkable.
Pterygoid plates are intact. There is no mandibular fracture and the
temporomandibular joints are anatomically aligned.
There is partial opacification of the bilateral sphenoid sinuses, bilateral
ethmoid air cells, right frontal sinus, and mucosal thickening of the left
maxillary sinus. Mastoids are patent as are the middle ears. An endotracheal
tube and enteric tube are partially visualized.
IMPRESSION:
1. Left zygomaticomaxillary complex (ZMC) fracture.
2. Mildly displaced right orbital roof fracture, in close proximity to the
orbital apex with associated retrobulbar, extraconal orbital hematoma.
3. Possible nondisplaced right lamina papyracea fracture.
4. Large right frontal subgaleal hematoma.
|
19933418-RR-12
| 19,933,418 | 28,709,233 |
RR
| 12 |
2195-10-13 05:24:00
|
2195-10-13 11:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p fall from standing, intubated// interval
change
TECHNIQUE: Chest PA and lateral
COMPARISON: Prior chest CT and radiograph, dated ___.
FINDINGS:
Mild bilateral vascular congestion with no overt pulmonary edema.
Lungs are moderately expanded.
No pleural effusions or pneumothoraces bilaterally.
The ET tube is unchanged in position on well placed, as is the esophageal
feeding tube.
Stable heart size and unremarkable cardiomediastinal silhouette..
IMPRESSION:
No significant interval change compared to prior study. Mild vascular
congestion remains with no overt pulmonary edema. No superimposed
consolidations. Stable and well placed monitoring devices.
|
19933418-RR-14
| 19,933,418 | 28,709,233 |
RR
| 14 |
2195-10-14 14:35:00
|
2195-10-15 11:25:00
|
EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with right hand pain and swelling s/p fall// eval
for traumatic injury eval for traumatic injury
IMPRESSION:
There is no evidence of fracture, dislocation, lytic or sclerotic lesions
demonstrated. No soft tissue abnormalities seen.
|
19933418-RR-15
| 19,933,418 | 28,709,233 |
RR
| 15 |
2195-10-14 14:35:00
|
2195-10-15 11:24:00
|
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT
INDICATION: ___ year old man with right shoulder pain w/ palpation and ROM//
eval for traumatic injury eval for traumatic injury
IMPRESSION:
There is no evidence of fracture, dislocation, lytic or sclerotic lesion
demonstrated. Image portion of the lung parenchyma is unremarkable.
|
19933418-RR-7
| 19,933,418 | 28,709,233 |
RR
| 7 |
2195-10-12 17:31:00
|
2195-10-12 18:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ fall and trauma. Evaluate for acute injury.
TECHNIQUE: Portable AP frontal view radiograph of the chest.
COMPARISON: Endotracheal tube terminates in the upper thoracic trachea.
Enteric tube terminates in the expected location of the gastric antrum.
Lung volumes are low. There is mild central vascular engorgement. There is
no pleural effusion, pneumothorax based on this supine film. No definite
consolidation. There is no evidence of an acute fracture.
FINDINGS:
No acute intrathoracic abnormality.
|
19933418-RR-8
| 19,933,418 | 28,709,233 |
RR
| 8 |
2195-10-12 18:27:00
|
2195-10-12 19:13:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ male with fall and trauma. Evaluate for acute
injury.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.8 cm; CTDIvol = 48.1 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction.
There is a large right sided subgaleal hematoma extending from the right
frontal region into the right periorbital region. There is a right-sided
superior retrobulbar extraconal hematoma with internal foci of air (2:13).
Please see dedicated maxillofacial CT for additional details including
multiple facial fractures.
IMPRESSION:
1. No intracranial hemorrhage.
2. Large right-sided subgaleal hematoma extending from the right frontal
region to the right periorbital region.
3. Multiple facial fractures, fully outlined on concurrent maxillofacial CT.
|
19933418-RR-9
| 19,933,418 | 28,709,233 |
RR
| 9 |
2195-10-12 18:27:00
|
2195-10-12 19:18:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: ___ male with ground level fall. Evaluate for fracture.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 537 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified. There is mild
intervertebral disc space narrowing and spurring at the C5-C6 level. There is
no evidence of significant spinal canal or neural foraminal stenosis. There is
no prevertebral soft tissue swelling.
There is pneumatized fluid in the oropharynx. Fractures of the left maxilla
and zygomatic process are better evaluated on same day maxillofacial CT.
There is a hemangioma of the T1 vertebral body (2:664). Endotracheal tube and
enteric tube are partially visualized. There is there is consolidation at the
posterior aspect of the left upper lung, better assessed on concurrent CT
chest.
IMPRESSION:
1. No fracture or malalignment of the cervical spine.
2. Left-sided facial fractures are better evaluated on same day maxillofacial
CT.
|
19933622-RR-17
| 19,933,622 | 23,666,993 |
RR
| 17 |
2142-04-12 01:57:00
|
2142-04-12 07:47:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ s/p gastric bypass in ___, now with nausea and abdominal
pain. Evaluate for small bowel obstruction.
TECHNIQUE: Upright and supine abdominal radiographs
COMPARISON: Outside hospital CT from earlier on the same evening
FINDINGS:
Tip of the nasogastric tube projects in the region of the gastroesophageal
junction. There are a few dilated loops of small bowel in the mid abdomen. No
evidence of pneumoperitoneum. There is otherwise a relative paucity of bowel
gas. Incidentally noted is an IUD projecting with the midline of the pelvis,
and hyperdense material the bladder, likely from CT scan obtained at the
outside hospital.
IMPRESSION:
1. Nasogastric tube terminating in the region of the gastroesophageal
junction.
2. A few mildly dilated loops of bowel in mid abdomen correlate to focally
dilated loops of bowel on the concurrently obtained abdomen CT, possibly
representing segmental obstruction. No free air is seen.
|
19933692-RR-36
| 19,933,692 | 29,309,294 |
RR
| 36 |
2166-03-18 18:26:00
|
2166-03-18 19:10:00
|
HISTORY: ___ male with right lower quadrant pain.
TECHNIQUE: Contiguous axial images obtained through the abdomen and pelvis
after the administration of intravenous contrast. Coronal and sagittal
reformats were reviewed.
COMPARISON: None.
FINDINGS:
Dependent regions of ground-glass in the lungs are most likely due to
atelectasis. The lung bases are otherwise clear.
The liver, gallbladder, spleen, kidneys, adrenal glands, and pancreas are
unremarkable. The stomach and small bowel are unremarkable without evidence
of obstruction. A few scattered diverticula are noted in the colon without
evidence of diverticulitis.
The appendix is dilated to 15 mm and is fluid-filled with hyperemia of the
wall. There is surrounding fatty stranding. There is no extraluminal air or
drainable collection.
The bladder, prostate, and seminal vesicles are unremarkable. There is no
free intraperitoneal fluid nor free air. There is no intra-abdominal
adenopathy noting scattered subcentimeter retroperitoneal and mesenteric
nodes. Partially calcified atherosclerotic plaque seen in the abdominal aorta
without evidence of aneurysm.
Degenerative changes are seen spine without suspicious osseous lesion.
IMPRESSION:
Findings compatible with acute appendicitis.
|
19933827-RR-21
| 19,933,827 | 27,449,021 |
RR
| 21 |
2139-09-28 00:26:00
|
2139-09-28 02:28:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ female with altered mental status. Evaluate for
acute intracranial hemorrhage or large territorial infarct.
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) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 14.0 s, 14.7 cm; CTDIvol = 47.9 mGy (Head) DLP =
702.4 mGy-cm.
Total DLP (Head) = 702 mGy-cm.
COMPARISON: None.
FINDINGS:
Punctate, 1 mm density in medial left basal ganglia at midline (02:12, 602:42
601b:48) measures between 70 and 80 ___. There is no evidence of acute
territorial infarction, edema, or large mass. The ventricles and sulci are
normal in size and configuration. Atherosclerotic vascular calcifications are
noted of bilateral cavernous portions of internal carotid arteries.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. Punctate medial left basal ganglia punctate hyperdensity. While finding
may represent a punctate parenchymal calcification or volume averaging of
calcified choroid within adjacent third ventricle, differential consideration
of punctate hemorrhage is not excluded on the basis of this examination.
Recommend clinical correlation. If available, consider comparison with prior
imaging. If clinically indicated, consider short-term follow-up imaging
further evaluation.
2. Please note MRI of the brain is more sensitive for the detection of acute
infarct.
RECOMMENDATION(S): Recommend clinical correlation. If available, consider
comparison with prior imaging. If clinically indicated, consider short-term
follow-up imaging further evaluation.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 2:25 AM.
|
19933827-RR-23
| 19,933,827 | 27,449,021 |
RR
| 23 |
2139-09-28 16:21:00
|
2139-09-28 18:07:00
|
INDICATION: ___ year old woman with history of IDDM presenting with altered
mental status and fever of 103. Growing GNR in blood. // Search for
infection source given GN sepsis
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
before and after the uneventful administration of 100 cc of Omnipaque
intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: 1693 mGy-cm
COMPARISON: None
FINDINGS:
The partially imaged thyroid is unremarkable. There is no supraclavicular,
axillary, hilar or mediastinal lymphadenopathy. The esophagus is grossly
normal. There is a small hiatal hernia.
Heart is mildly enlarged without pericardial effusion. The thoracic aorta and
proximal great vessels are normal in caliber and well opacified with a notable
paucity of atherosclerotic calcification. There is mild enlargement of the
main pulmonary artery to 3.3 cm.
Lung volumes are slightly low. There is no pleural effusion or pneumothorax.
Atelectasis at the lung bases is minimal. There is a small peripheral
ground-glass opacity in the right upper lobe anteriorly (4a:49). 8 x 6 mm
right middle lobe nodule (4a:115). 3 mm right upper lobe nodule (4a:38). 4
mm granuloma at the left base (4a:32) and a few other scattered small
granulomas.
CT of the abdomen pelvis will be reported separately.
IMPRESSION:
1. Small area of opacification in the right upper lobe could reflect scarring
or atelectasis.
2. Several pulmonary nodules, the largest 8 x 6 mm in the right middle lobe
require follow-up.
3. Mild cardiomegaly.
RECOMMENDATION(S): 8 x 6 mm right middle lobe nodule.
The ___ pulmonary nodule recommendations are intended as
guidelines for follow-up and management of newly incidentally detected
pulmonary nodules smaller than 8 mm, in patients ___ years of age or older. Low
risk patients have minimal or absent history of smoking or other known risk
factors for primary lung neoplasm. High risk patients have a history of
smoking or other known risk factors for primary lung neoplasm.
For low risk patients, initial follow-up CT at ___ months and then at ___
months if no change. For high risk patients - initial follow-up CT at ___
months and then at ___ and 24 months if no change.
|
19933827-RR-24
| 19,933,827 | 27,449,021 |
RR
| 24 |
2139-09-28 16:22:00
|
2139-09-28 18:19:00
|
INDICATION: ___ year old woman with history of IDDM presenting with altered
mental status and fever of 103. Growing GNR in blood. // Identify infectious
source given GNR growth in her blood cultures.
TECHNIQUE: Single phase split bolus contrast: 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.
IV Contrast: 130 mL Omnipaque.
Oral contrast was administered.
DOSE: Total body DLP: 1693 mGy cm
COMPARISON: Abdominal ultrasound ___
FINDINGS:
ABDOMEN:
HEPATOBILIARY: Hypoattenuation of the liver suggests fatty deposition. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Both kidneys enhance symmetrically without hydronephrosis. In the
interpolar region of the right kidney is a 3.8 x 3.1 cm heterogeneous mass
with solid and small cystic components. There is minimal right perinephric
stranding about the mass.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There both calcified and noncalcified uterine fibroids.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Nonspecific 1.3 cm area of sclerosis in the left sacrum (2:98) may be a
bone island. Degenerative changes in the lumbar spine are mild to moderate.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Solid and cystic 3.8 cm mass in the right kidney was not seen on abdominal
ultrasound of ___ and is most suspicious for developing renal
abscess.
2. 1.3 cm area of sclerosis in the left sacrum is most likely a bone island.
3. Diverticulosis without evidence of diverticulitis.
4. Fibroid uterus.
NOTIFICATION: The findings were telephoned to ___ by ___ at
19:58, ___, 5 min after discovery.
|
19933827-RR-25
| 19,933,827 | 27,449,021 |
RR
| 25 |
2139-10-01 10:09:00
|
2139-10-01 11:23:00
|
EXAMINATION: AP chest radiograph.
INDICATION: ___ year old woman with new left PICC 50 cm // new left sl PICC
___ ___ Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: Chest radiograph dated ___.
FINDINGS:
In comparison to chest radiograph dated ___, a new left-sided
PICC terminates in the mid to lower SVC. Lung volumes are decreased
bilaterally. The mild cardiomegaly is unchanged. No focal consolidations,
pleural effusions, or pneumothoraces.
IMPRESSION:
A new left-sided PICC terminates in the mid to lower SVC. Stable
cardiomegaly.
|
19934176-RR-36
| 19,934,176 | 23,386,744 |
RR
| 36 |
2190-10-02 21:36:00
|
2190-10-02 22:36:00
|
PORTABLE CHEST RADIOGRAPH PERFORMED ON ___
Comparison is made with a prior CT torso from ___ as well as a PET-CT
scan from ___.
CLINICAL HISTORY: Known lung cancer with altered mental status, assess for
pneumonia.
FINDINGS: Single AP semi-upright portable view of the chest was provided.
Patient is rotated to her right which somewhat limits the evaluation. The
lungs appear clear bilaterally without focal consolidation, effusion, or
pneumothorax. There is some prominence of the right paratracheal stripe which
could reflect mediastinal lymphadenopathy in this patient with known
metastatic lung cancer. The heart size appears normal. No pleural effusion
or pneumothorax is seen though the left CP angle and the inferior right CP
angle are excluded. The imaged osseous structures appear intact.
IMPRESSION: Widened mediastinum which could reflect lymphadenopathy in this
patient with metastatic lung cancer. No signs of pneumonia or CHF.
|
19934176-RR-37
| 19,934,176 | 23,386,744 |
RR
| 37 |
2190-10-02 21:15:00
|
2190-10-03 01:22:00
|
INDICATION: ___ woman with history of NSCLC and brain metastasis,
presents with altered mental status for eight hours.
COMPARISON: Reference MRI head ___.
TECHNIQUE: MDCT images were acquired through the head without intravenous
contrast. Sagittal and coronal reformats were generated and reviewed.
FINDINGS: There is vasogenic edema in both cerebral hemispheres,
predominantly in both parietal lobes. Subtle round lesions with hyperdense rim
are seen in the right parietal lobe measuring 10 mm and the right frontal area
7 mm (2A:15). No acute intracranial hemorrhage is detected. Vasogenic edema
is also seen in the left mid brain and cerebellar hemispheres, consistent with
known metastatic disease. In comparison to the prior MRI of ___, there
has been significant increase in edema, allowing for differences in technique.
The ventricles and sulci are dilated, consistent with age-related involutional
changes. The basal cisterns are patent without evidence of acute herniation.
BONES AND SOFT TISSUES: No lytic or sclerotic bone lesion is seen. The
imaged paranasal sinuses and mastoid air cells are clear.
IMPRESSION:
1. Multifocal cortical, cerebral, midbrain and cerebellar edema, consistent
with underlying metastatic disease. Interval progression of vasogenic edema
since ___, indicating worsening metastatic disease.
2. No evidence of herniation or hemorrhage.
|
19934176-RR-38
| 19,934,176 | 23,386,744 |
RR
| 38 |
2190-10-03 13:22:00
|
2190-10-03 18:08:00
|
INDICATION: ___ female with stage IV non-small-cell lung cancer with
brain metastases, status post whole brain radiation, presents with altered
mental status. Question edema and extensive metastases.
COMPARISON: Multiple prior reference MRIs dated ___.
TECHNIQUE: MRI of the brain was performed prior to and following the
administration of intravenous gadolinium. Sagittal T1, axial T1, T2, FLAIR,
GRE, sagittal MP-RAGE, axial T1 post-gadolinium, diffusion-weighted, coronal,
and axial MPR images were acquired.
FINDINGS: There are innumerable widespread diffuse brain metastases involving
the supratentorial and infratentorial brain, largest lesion in the pons,
measuring 1 cm with hemorrhagic component. There has been significantly
increased cerebral edema since ___, likely a combination of
progressive metastatic disease and post-radiation change. This involves all
cerebral lobes, cerebellar hemispheres, and pons as well as mid brain. There
is no major vascular territorial acute infarction. Ventricles and sulci are
prominent, consistent with age-related involution. Suprasellar and basilar
cisterns are patent. There is no definite marrow abnormality. Paranasal
sinuses and mastoid air cells are reasonably aerated. Globes and soft tissues
are unremarkable. The cervicomedullary junction appears intact.
Note is made of a small mucous retention cyst in the left maxillary sinus.
The remainder of paranasal sinuses and mastoid air cells are reasonably well
aerated.
IMPRESSION: Significant progression of widespread diffuse metastases
involving the supratentorial and infratentorial brain, some of which are
hemorrhagic. No major vascular territorial infarct or evidence of herniation.
|
19934547-RR-32
| 19,934,547 | 28,909,836 |
RR
| 32 |
2202-06-23 09:16:00
|
2202-06-24 10:23:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man with L hallux osteomyelitis // Please evaluate
s/p L hallux arthroplasty and distal phalanx debridement Please evaluate
s/p L hallux arthroplasty and distal phalanx
IMPRESSION:
In comparison with the study of ___, there has been an arthroplasty at
the interphalangeal joint of the great toe with debridement. There is soft
tissue prominence, phone no definite acute destructive changes at the
operative site. However, there is what appears to be gas within soft tissues
about the distal phalanx. It is difficult to assess spleen cortex of the
distal tip of the distal phalanx, though it does not appear as sharp as on the
previous study. If there is concern for osteomyelitis, MRI could be considered
for further evaluation.
|
19934566-RR-3
| 19,934,566 | 23,719,068 |
RR
| 3 |
2113-11-11 12:35:00
|
2113-11-11 13:10:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with Chest Pain, Nausea// Cardiomegaly
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
No focal consolidation, pleural effusion, or evidence of pneumothorax is seen.
The cardiac silhouette size is borderline to mildly enlarged. Mediastinal
contours are unremarkable. No pulmonary edema is seen.
IMPRESSION:
Borderline to mildly enlarged cardiac silhouette size, likely accentuated by
AP technique.
|
19934566-RR-4
| 19,934,566 | 23,719,068 |
RR
| 4 |
2113-11-11 16:46:00
|
2113-11-11 17:21:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: History: ___ with above// CVL Placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is unchanged. There is a new
right internal jugular central line whose tip projects over the mid to distal
SVC.
|
19934566-RR-5
| 19,934,566 | 23,719,068 |
RR
| 5 |
2113-11-11 17:49:00
|
2113-11-11 18:54:00
|
EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST
INDICATION: History: ___ on chemo w/ sepsis of unknown origin// liver
abvscess? pna?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 9.1 s, 71.6 cm; CTDIvol = 13.4 mGy (Body) DLP = 957.3
mGy-cm.
Total DLP (Body) = 968 mGy-cm.
COMPARISON: CT scan of the abdomen and pelvis dated ___.
FINDINGS:
CHEST: Right jugular venous catheter terminates in mid SVC. Thyroid is
unremarkable. Multiple enlarged lymph nodes are identified in bilateral
axillary regions, measuring up to 1.4 cm, located in the right axilla (03:13).
The largest lymph node conglomerate in the mediastinum measures 2.0 x 3.1 cm,
located in the lower left paratracheal region (03:19).
Trace right pleural effusion is present. Airways are patent to subsegmental
levels. Multiple small ground-glass and ___ opacities are identified
scattered in both lungs (03:37, 24). Several of the opacities demonstrate a
solid component surrounded by a ground-glass halo.
ABDOMEN:
Ascites is small.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Enlarged spleen measures 19.1 cm, decreased since ___ when it
measured 21.5 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.
0.3 cm nonobstructing stone is identified in the lower pole of right kidney.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Small hiatal hernia is noted. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.
Borderline enlarged lymph nodes are identified along bilateral pelvic walls
(3:109 110).
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Multifocal small ground-glass opacities and bronchiolitis are suspicious
for pneumonia. Given that there are several nodular opacities surrounded by a
ground-glass halo, angioinvasive aspergillosis or other fungal infection
should be strongly considered.
2. Mediastinal and axillary lymphadenopathy. Borderline enlarged bilateral
pelvic wall external iliac lymph nodes as well as numerous retroperitoneal
lymph nodes are present.
3. Splenomegaly.
|
19934566-RR-6
| 19,934,566 | 23,719,068 |
RR
| 6 |
2113-11-13 16:03:00
|
2113-11-13 16:24:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ w/ mantle zone lymphoma s/p 1 dose of rituxan 1 w ago, here
w/ ?thrombocytopenia, initially elevated INR, and initially low hapto. R calf
?bigger than left.// please examine for DVT in BLE
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19934566-RR-7
| 19,934,566 | 23,719,068 |
RR
| 7 |
2113-11-14 08:54:00
|
2113-11-14 14:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: Dr. ___ is a ___ with h/o marginal zone lymphoma,
hypertrophic obstructive cardiomyopathy, paroxysmal atrial fibrillation, last
infusion of rituximab was on ___ and recent trip to ___ who presented
with nausea, vomiting, rash, hypotension and was found to have CT findings
concerning for fungal infection, now on empiric broad-spectrum antibiotics,
atypical coverage, and antifungals. Now w/ new cough.// ?PNA
TECHNIQUE: Frontal view of the chest
COMPARISON: ___ chest CT and chest x-ray
FINDINGS:
No focal infiltrate or edema.
Moderate cardiomegaly stable.
No significant pleural effusion or pneumothorax. Right IJ central catheter
terminates in the mid SVC as before.
IMPRESSION:
No acute pulmonary disease.
|
19934880-RR-19
| 19,934,880 | 28,186,624 |
RR
| 19 |
2161-09-20 11:46:00
|
2161-09-20 12:23:00
|
INDICATION: Hypoxia and fever. Evaluate for pneumonia.
TECHNIQUE: Bedside frontal chest radiograph
COMPARISON: None
FINDINGS:
The lungs are hyperinflated. There are streaky retrocardiac opacities. No
pleural effusion or pneumothorax. Heart is normal size. There is no pulmonary
edema. The mediastinal and hilar structures are unremarkable.
Sternotomy wires, some fractured, and cervical hardware are noted.
IMPRESSION:
Streaky retrocardiac opacities may reflect atelectasis but pneumonia is not
excluded in the correct clinical setting. If necessary, a lateral view could
be obtained for further evaluation.
|
19934880-RR-20
| 19,934,880 | 28,186,624 |
RR
| 20 |
2161-09-21 05:00:00
|
2161-09-21 07:21:00
|
INDICATION: History: ___ with back pain, IVDU, fever, ___ weakness, cough //
evaluate for epidural abscess
TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 axial images of the
cervical, thoracic and lumbar spine were obtained. Following gadolinium T1
sagittal and axial images were obtained.
COMPARISON: None
FINDINGS:
There is an anterior epidural fluid collection identified measuring 16 x 7 mm
in size and extending from C5-T2 level. There is posterior displacement of the
spinal cord are identified. There is increased signal within the spinal cord
at C3 and C4 levels. Postoperative changes are identified in the cervical
region spinal fusion from C5-C7. Small prevertebral fluid collection is
identified on the right side at T1 level measuring approximately 15 mm. There
is no fluid collection or abnormal enhancement seen in the thoracic or lumbar
region.
IMPRESSION:
Anterior Epidural abscess extending from C4-5 to T2 level with compression of
the spinal cord. Increased signal within the spinal cord at C3 and C4 levels.
Small paraspinal fluid collection at T1 level most suggestive for paraspinal
abscess.
|
19934880-RR-21
| 19,934,880 | 28,186,624 |
RR
| 21 |
2161-09-20 13:45:00
|
2161-09-20 15:02:00
|
EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION:
Hypoxia with a clear chest x-ray. Evaluate for pulmonary embolus or acute
process.
TECHNIQUE: Multidetector CT through the chest performed with 100 ml of IV
contrast. Coronal and sagittal reformations were provided and reviewed.
Oblique maximum intensity projection images were created and reviewed as well.
DOSE: 301.66 mGy-cm
COMPARISON: Same-day chest radiograph
FINDINGS:
The contrast bolus is deemed adequate for diagnostic interpretation. There are
pulmonary emboli seen within the right and left main pulmonary arteries and
distal segmental and subsegmental branches. The left lower lobe pulmonary
arteries are spared. The main pulmonary artery is normal caliber. There is no
CT evidence for right heart strain.
The heart is normal size. There is no pericardial effusion. The aorta is
normal caliber and there is no evidence for aortic injury.
Secretions are seen throughout the proximal tracheobronchial tree. There is
complete collapse of the left lower lobe with occlusion at the left lower lobe
bronchus, likely from mucous impaction. Mild bronchial wall thickening is
noted. There is no pleural effusion. A tiny amount of clinically insignificant
pneumomediastinum is seen in the anterior mediastinal fat (602b:48) without
definite evidence for a pneumothorax. There is no evidence for active
infection. 3 mm ground-glass opacities are seen within the right upper lobe
(02:13, 28). A single dilated bronchiole or old tiny cavitation is noted in
the right upper lobe (02:33).
There is no axillary, supraclavicular or central lymphadenopathy. The included
liver and spleen are unremarkable. There are no lytic or blastic osseous
lesions. Sternotomy wires are noted.
IMPRESSION:
1. Extensive bilateral pulmonary emboli. No CT evidence for right heart
strain.
2. Left lower lobe collapse, likely from mucous plugging. Mild, diffuse
bronchial wall thickening.
3. Tiny amount of pneumomediastinum, clinically insignificant.
|
19934880-RR-22
| 19,934,880 | 28,186,624 |
RR
| 22 |
2161-09-20 17:34:00
|
2161-09-20 18:08:00
|
INDICATION: ___ with intubation, PEs // evaluate tube placement
TECHNIQUE: Single supine view of the chest.
COMPARISON: Fell from a earlier the same day at 11:34 on ___.
FINDINGS:
Endotracheal tube tip is approximately 5.2 cm from the carinal. There is
progression of a now dense retrocardiac opacity silhouetting the medial
hemidiaphragm. Elsewhere, the lungs are clear. The cardiomediastinal
silhouette is within normal limits for technique. Anterior cervical spine
fixation hardware is identified. Median sternotomy wires are also noted.
IMPRESSION:
ET tube 5.2 cm from the carina. Worsening retrocardiac opacity potentially
atelectasis although aspiration or pneumonia are possible.
|
19934880-RR-23
| 19,934,880 | 28,186,624 |
RR
| 23 |
2161-09-20 19:34:00
|
2161-09-20 21:25:00
|
INDICATION: History: ___ with OGT, intubated // evaluate OGT placement
___ with OGT, intubated // evaluate OGT placement
TECHNIQUE:
Single portable view of the chest.
COMPARISON:
Film from earlier the same day at 19:23
IMPRESSION:
ET tube is 4.5 cm from the carina. Enteric tube passes below the inferior
field of view. The appearance of the lungs is unchanged noting dense
retrocardiac opacity. There is no other change
|
19934880-RR-24
| 19,934,880 | 28,186,624 |
RR
| 24 |
2161-09-20 22:31:00
|
2161-09-20 23:12:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: History: ___ with new line, right IJ // Eval new line Eval
new line
TECHNIQUE: Frontal view of the chest.
COMPARISON: Chest radiograph from ___ at 19:23
FINDINGS:
A new right internal jugular approach central venous catheter terminates at
the mid SVC. Endotracheal tube terminates approximately 5.2 cm. An orogastric
tube courses below the diaphragm, tip is not included in this examination.
Evaluation of the lung parenchyma is somewhat limited secondary to overlying
respiratory tubing. Findings however are unchanged since prior examination
with dense retrocardiac opacity. No pneumothorax identified based on this
supine film.
IMPRESSION:
New right internal jugular approach central venous catheter terminates in the
mid SVC. No pneumothorax.
|
19934880-RR-25
| 19,934,880 | 28,186,624 |
RR
| 25 |
2161-09-21 03:09:00
|
2161-09-21 11:00:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ year old woman with known IVDU and past epidural abscess, now
with bilateral PEs and ?pneumonia // R/o focal pneumonia
TECHNIQUE: Single, AP, portable view of the chest.
COMPARISON: ___.
FINDINGS:
A right internal jugular central venous catheter terminates within the mid
SVC. An endotracheal tube terminates 5.0 cm above the level of the carina. An
orogastric tube courses into the stomach and out of view. As compared to the
prior examination, there has been no relevant change. Redemonstrated is a
dense retrocardiac left lower lobe opacity. The remainder of the visualized
lungs are grossly clear. There is no pneumothorax. The cardiomediastinal
silhouette is stable.
IMPRESSION:
Persistent, dense left lower lobe retrocardiac opacity. No relevant interval
change.
|
19934880-RR-26
| 19,934,880 | 28,186,624 |
RR
| 26 |
2161-09-21 08:06:00
|
2161-09-21 17:07:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with newly recognized PEs and epidural abscess
// R/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins. The study was performed portably.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, superficial femoral, and popliteal veins.
Nonocclusive, echogenic eccentric organized thrombus is seen within one of
right peroneal veins, compatible with chronic thrombus. The second right
peroneal vein demonstrates normal color flow and compressibility. Normal color
flow and compressibility are demonstrated in the bilateral posterior tibial
veins and the left peroneal veins.
Slow flow is seen in the bilateral common femoral veins. There is normal
respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Nonocclusive, chronic appearing thrombus within one right peroneal vein.
The patient is already on heparin for pulmonary embolism.
2. No evidence of deep venous thrombosis in the left lower extremity veins.
|
19934880-RR-27
| 19,934,880 | 28,186,624 |
RR
| 27 |
2161-09-21 17:40:00
|
2161-09-21 18:04:00
|
EXAMINATION: Cervical spine CT without contrast
INDICATION: ___ year old woman with epidural abscess, concern for cord
compression, prior spinal surgery. // evaluate bony anatomy
TECHNIQUE: Axial helical multi detector CT images were acquired through the
cervical spine without contrast. Multiplanar reformats were generated in the
coronal and sagittal planes.
DOSE: DLP: 615.27 mGy cm
CTDI vol: 32.22 mGy.
COMPARISON: Total spine MR, ___.
FINDINGS:
Anterior fusion hardware spanning C5 through C7 without evidence for hardware
failure. There is 3 mm anterolisthesis of C3 on C4 with a partial fusion
posteriorly. The remainder of the vertebral body heights are well maintained.
There is no suspicious focal osseous lesion.
There are multilevel, multifactorial degenerative changes of the visualized
cervical spine including the aforementioned intervertebral disc space loss.
There are multilevel degenerative changes of the posterior elements with
fusion of the facets at the level of C3 and C4. The prevertebral soft tissue
is unremarkable. The neural foramina appear grossly patent.
The previously identified anterior epidural fluid collection extending from
the C5 through T2 level is far better appreciated on the same day MR
examination and is not well appreciated on today's CT exam.
Endotracheal tube and upper enteric tube are partially visualized.
The imaged lung apices are unremarkable.
A small ground-glass attenuation nodule in the right upper lung measuring
approximately 2 mm, there is also seen on the prior CTA chest of ___.
IMPRESSION:
1. Anterior epidural fluid collection from C5 through T2 level is better
evaluated on the same day MR and is not well characterized on today's CT exam.
2. Anterior fusion of C5 through C7 without evidence for hardware failure.
3. Multilevel degenerative changes as above.
4. A small ground-glass attenuation nodule in the right upper lung measuring
approximately 2 mm, there is also seen on the prior CTA chest of ___.
|
19934880-RR-28
| 19,934,880 | 28,186,624 |
RR
| 28 |
2161-09-21 17:41:00
|
2161-09-21 19:24:00
|
EXAMINATION: Thoracic spine CT without contrast
INDICATION: ___ year old woman with epidural abscess, concern for cord
compression, prior spinal surgery. // evaluate bony anatomy
TECHNIQUE: Axial helical multi detector CT images were acquired of the
thoracic spine without contrast. Multiplanar reformats were generated in the
coronal and sagittal planes.
DOSE: DLP: 1134.24 mGy cm
CT DI vol: 31.42 mGy.
COMPARISON: Total spine MR ___ 05:35.
FINDINGS:
Anterior epidural abscess extending from the C4/5 level through to the T-tube
level is not readily apparent on the CT examination and was for better
characterized on the prior MR.
___ post posterior spine surgery, in the mid thoracic spine, with bilateral
laminectomy.
No obvious fluid collections noted on the CT. The thoracic vertebral body
heights and alignment are well maintained without fracture or malalignment.
There are mild multilevel degenerative changes with some intervertebral disk
space narrowing. The neural foramina appear patent. The posterior spinal
elements are well preserved. There is no prevertebral soft tissue swelling.
There is no suspicious focal osseous lesion.
There is partial collapse/ consolidation of the left lower lobe with left
pleural effusion.
Small right upper lobe nodule, better seen on prior CTA Chest of ___.
The remainder the visualized lungs are clear. Endotracheal tube, right central
venous catheter and upper enteric tube are in place. The visualized portion of
the retroperitoneum is grossly unremarkable.
IMPRESSION:
1. Anterior epidural abscess is better characterized on the same day MR and is
not readily characterized on CT.
2. No fracture or malalignment of the thoracic spine or suspicious focal bony
lesions. Status post prior posterior spine surgery.
3. Partial atelectatic collapse of the left lower lobe.
|
19934880-RR-29
| 19,934,880 | 28,186,624 |
RR
| 29 |
2161-09-22 04:14:00
|
2161-09-22 13:36:00
|
INDICATION: The extensive pulmonary emboli with recurrent epidural abscess.
Concern for pneumonia or pneumomediastinum.
COMPARISON: Radiographs from ___.
TECHNIQUE: Frontal chest radiograph.
FINDINGS:
A persistent left retrocardiac density is again seen, reflecting left lower
lobe atelectasis or consolidation. No new consolidation, effusion, or
pneumothorax is detected. An endotracheal tube and right IJ catheter are
unchanged in position. An orogastric tube terminates within the stomach.
IMPRESSION:
1. Persistent left lower lobe retrocardiac opacity.
2. No new superimposed consolidation or effusion.
|
19934880-RR-30
| 19,934,880 | 28,186,624 |
RR
| 30 |
2161-09-22 01:00:00
|
2161-09-22 12:30:00
|
INDICATION: Cervical fusion, C6-C7.
COMPARISON: CT C-spine examination from ___.
IMPRESSION:
Fusion hardware at C6/7 is visualized on an intraoperative radiograph obtained
without the presence of a radiologist. Please refer to the operative report
for further details.
|
19934880-RR-31
| 19,934,880 | 28,186,624 |
RR
| 31 |
2161-09-22 15:27:00
|
2161-09-23 17:27:00
|
INDICATION: ___ w/cervico-thoracic epidural abscess. // Evaluate for dural
leak and cord status. PLEASE image all the way down to T3.
TECHNIQUE: MRI of the cervical spine without and with IV contrast
COMPARISON: MRI of the total spine ___ and postoperative CT of
the cervical spine ___
FINDINGS:
Status post anterior spine surgery from C5 to approximately T2 levels.
Limited assessment of the position and integrity of the hardware on MRI.
Status post decompression of the previously noted large anterior epidural
abscess from C5-T1 levels.
Persistent small anterior epidural collection with mild peripheral enhancement
noted at the level of C6 level, causing indentation on the thecal sac outline,
with mild canal narrowing.
There is new anterior epidural fluid collection with mild peripheral
enhancement posterior to two thoracic vertebral bodies, below the level of the
interbody cage. (accurate numbering of the vertebral body level is somewhat
difficult due to the presence of interbody cage)
This causes significant indentation and mass effect on the thoracic spinal
cord at this level. Series 3, image 8.
New since the recent study of ___, there is diffusely increased
signal intensity in the spinal cord in the cervical and the upper thoracic
regions.
There is also minimal prominence of the central canal of the cord
superimposed.
Limited assessment for dural leak as the outlines of the thecal sac is not
well may adopt at these levels.
Mild anterolisthesis of C4 over C5, as before.
Mild degenerative changes, as before.
Small perineural cysts at multiple levels, as before.
Prevertebral and retropharyngeal fluid noted.
The craniocervical junction region is unremarkable.
The vertebral arterial flow voids are noted. Fluid in the mastoid air cells on
both sides and in the nasopharynx.
IMPRESSION:
Persistent small anterior epidural fluid collection with peripheral
enhancement at C6-7 level causing canal narrowing and deformity on the cord.
New anterior epidural fluid collection posterior to T1 level with peripheral
enhancement (where there is interval corpectomy with body cage placement)
moderate canal narrowing and deformity on the cord.
Limited assessment for infection as immediate post-surgery with post-surgical
changes; however, cannot be excluded.
Diffuse Increased T2 signal in cervical and upper thoracic cord from C4
downwards, lower limit not completely included - edema, contusion, ischemia,
infarction, inflammation, etc. Correlate clinically and close followup
Limited assessment for anterior dural leak given the epidural collections and
deformity on thecal sac with decreased conspicuity of dural outline.
|
19934880-RR-32
| 19,934,880 | 28,186,624 |
RR
| 32 |
2161-09-23 04:25:00
|
2161-09-23 12:43:00
|
INDICATION: Post inspiration.
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal chest radiograph.
FINDINGS:
A right IJ terminates at the caval atrial junction. The endotracheal tube
terminates 4.9 cm above the carinal. An orogastric tube is appropriately
positioned. The cardiac and mediastinal contours are stable since the ___ examination, remaining within normal limits. There is no
pneumothorax or pleural effusion. A persistent left retrocardiac opacity,
likely reflecting atelectasis, is minimally changed over several recent
radiographs.
IMPRESSION:
1. Unchanged persistent left retrocardiac opacity.
2. No new consolidation, effusion, or pneumothorax.
|
19934880-RR-33
| 19,934,880 | 28,186,624 |
RR
| 33 |
2161-09-24 03:48:00
|
2161-09-24 09:31:00
|
INDICATION: Recurrent epidural abscess with pulmonary emboli.
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal chest radiograph.
FINDINGS:
A right IJ catheter terminates at the caval atrial junction. An endotracheal
tube is unchanged in position, terminating 6.2 cm above the carina. The
cardiac and mediastinal contours are unchanged. There is a trace left pleural
effusion. A persistent left retrocardiac opacity likely reflects atelectasis.
There is no pneumothorax or new consolidation.
IMPRESSION:
Persistent left retrocardiac opacity, likely atelectasis, though underlying
consolidation cannot be excluded. No new opacities. Unchanged small left
pleural effusion.
|
19934880-RR-35
| 19,934,880 | 28,186,624 |
RR
| 35 |
2161-09-24 12:32:00
|
2161-09-24 12:45:00
|
INDICATION: Anterior cervical discectomy and fusion at C6-7.
COMPARISON: None.
TECHNIQUE: Intraoperative radiographs.
IMPRESSION:
Two intraoperative radiographs were obtained without the presence of
radiologist. Surgical hardware is seen at C6/7. Please see the operative notes
for further details.
|
19934880-RR-36
| 19,934,880 | 28,186,624 |
RR
| 36 |
2161-09-25 03:08:00
|
2161-09-25 08:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ IVDU, intubated w/epidural abscess, GPC bacteremia, ?HCAP,l
?diaphragmatic dysfunction // Evaluate for interval change
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. Moderate
cardiomegaly. Extensive retrocardiac atelectasis with, potentially, the
presence of a small left pleural effusion. No pneumonia, no pulmonary edema.
No pneumothorax. The monitoring and support devices are constant.
|
19934880-RR-38
| 19,934,880 | 28,186,624 |
RR
| 38 |
2161-09-26 03:03:00
|
2161-09-26 11:32:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with ? PNA, epidural abscess // Please assess
for interval change
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
Severe left lower lobe atelectasis persists, accompanied by any indeterminate
but not substantial volume of left pleural effusion. Atelectasis at the right
lung base medially is relatively mild. The upper lungs are clear. The heart is
normal size since it is obscured KS it is obscured by combination collapse and
left pleural. Mediastinum is unremarkable. ET tube and right internal jugular
line are in standard placements respectively and the nasogastric tube passes
below the diaphragm and out of view.
|
19934880-RR-39
| 19,934,880 | 28,186,624 |
RR
| 39 |
2161-09-27 03:32:00
|
2161-09-27 10:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with epidural abscess, ?PNA, bilateral PEs //
Please assess for interval change
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Since the prior study there is interval development of left lower lobe
atelectasis. Bilateral pleural effusions are present. Right internal jugular
line tip is at the level of cavoatrial junction. ET tube tip is 5.3 cm above
the Carina. There is also interval development of right basal opacity,
concerning for aspiration. No pneumothorax is seen.
|
19934880-RR-40
| 19,934,880 | 28,186,624 |
RR
| 40 |
2161-09-28 02:52:00
|
2161-09-28 12:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure, on ventilator //
Please assess for interval change
COMPARISON: Chest radiographs ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Tiny bilateral effusions, right inferomedial
opacity, and left lower lobe atelectasis are not significantly changed. No
pneumothorax.
Lines and tubes:
ET tube tip is approximately 3.5 cm above the carina. Right IJ venous line is
in the lower SVC. Enteric tube extends into the stomach and passes out of
view, but the side port is seen below the GE junction.
IMPRESSION:
Tiny bilateral effusions, right inferomedial opacity, and left lower lobe
atelectasis are not significantly changed.
|
19934880-RR-41
| 19,934,880 | 28,186,624 |
RR
| 41 |
2161-09-30 15:41:00
|
2161-09-30 16:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with epidural abscess, intubated, now with
increasing O2 requirement // Please evaluate for interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Cardiac size is normal. Left lower lobe almost total collapse is unchanged.
Blunting of the lateral CP angles suggests small bilateral effusions
Lines and tubes are in standard position. There is no evidence of pulmonary
edema. There is no pneumothorax .
IMPRESSION:
Persistent almost complete collapse of the left lower lobe.
|
19934880-RR-42
| 19,934,880 | 28,186,624 |
RR
| 42 |
2161-10-01 15:43:00
|
2161-10-01 16:48:00
|
EXAMINATION: Abdominal radiograph
INDICATION: ___ year old woman with obstipation // ?ileus
TECHNIQUE: Portable
COMPARISON: Chest radiograph ___
FINDINGS:
An enteric tube terminates in the stomach. IVC filter is incidentally noted.
The bowel gas pattern is unremarkable, with gas noted in non-dilated loops of
bowel. Multiple circular radiodensities in the left hemipelvis are probably
phleboliths. No acute osseous abnormalities.
IMPRESSION:
Non-obstructive bowel gas pattern.
|
19934880-RR-43
| 19,934,880 | 28,186,624 |
RR
| 43 |
2161-10-02 03:40:00
|
2161-10-02 12:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with epidural abscess, respiratory failure //
intubated
COMPARISON: Chest radiographs since ___
FINDINGS:
Lines and tubes:
ETT tip is approximately 4.4 cm above the carina. Enteric tube passes into the
stomach with the side port below the GE junction and the tip out of view.
Right IJ venous line tip is in the lower SVC.
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Left retrocardiac opacity is not
significantly changed. No pleural effusion or pneumothorax.
IMPRESSION:
Left lower lobe atelectasis is not significantly changed from yesterday.
|
19934880-RR-46
| 19,934,880 | 28,186,624 |
RR
| 46 |
2161-10-05 02:52:00
|
2161-10-05 11:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with epidural abscess, intubated with desats
overnight // Please assess for interval change
COMPARISON: Chest radiographs ___
FINDINGS:
Lines and tubes:
ET tube tip is approximately 3 cm above the carina. Right IJ venous line tip
is approximately at the CA junction. NG tube passes into the stomach and the
tip is not imaged, but the side port is at least 5 cm below the GE junction.
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Substantial left lower lobe atelectasis
persists. No pleural effusion or pneumothorax. The tip of an IVC filter is
seen in the upper abdomen, but cannot be localized on this view alone
IMPRESSION:
Persistent severe left lower lobe atelectasis.
|
19934880-RR-48
| 19,934,880 | 28,186,624 |
RR
| 48 |
2161-10-05 08:44:00
|
2161-10-05 11:54:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new picc // 40cm right picc. Contact
name: ___: ___
COMPARISON: Chest radiographs since ___ and CT T-spine from ___
FINDINGS:
PICC line tip is approximately 1-2 cm below the CA junction. Right IJ venous
line position is unchanged. The ET tube tip is approximately 3.2 cm above the
carina. NG tube passes into the stomach and neither the side port nor the tip
are imaged.
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Substantial left retrocardiac opacity is not
significantly changed. Left basilar atelectasis is similar to earlier this
morning. No pleural effusion or pneumothorax.
IMPRESSION:
PICC line tip is approximately 1-2 cm below the CA junction. Persistent
severe left lower lobe atelectasis.
NOTIFICATION: The findings were discussed with the ___ nurse on the
telephone on ___ at approximately 09:30.
|
19934880-RR-49
| 19,934,880 | 28,186,624 |
RR
| 49 |
2161-10-05 14:24:00
|
2161-10-05 15:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with spinal abscess and desaturations on vent
// pls eval for interval change
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, there is a slightly progressive left
lower lobe atelectasis. A minimal left pleural effusion is visible. No other
relevant change. The right internal jugular vein catheter has been removed.
|
19934880-RR-50
| 19,934,880 | 28,186,624 |
RR
| 50 |
2161-10-05 20:05:00
|
2161-10-09 10:06:00
|
EXAMINATION:
CERVICAL SINGLE VIEW IN OR
INDICATION:
FUSION LAMI CSPINE
TECHNIQUE: 5 intraoperative lateral projections of the lower cervical and
upper thoracic spine were obtained without the radiologist present.
COMPARISON: Radiographs of the cervical spine ___.
FINDINGS:
Sequential images demonstrate a localizing device posterior to an upper
thoracic vertebral level with subsequent placement of pedicle screws spanning
C5 to an in indeterminate upper thoracic vertebral body level. Please see the
operative report for further details.
IMPRESSION:
Status post fusion with laminectomy spanning C5 to an indeterminate upper
thoracic vertebral body level. Please see the operative report for further
details.
|
19934880-RR-51
| 19,934,880 | 28,186,624 |
RR
| 51 |
2161-10-05 23:13:00
|
2161-10-08 11:08:00
|
EXAMINATION:
CERVICAL SINGLE VIEW IN OR
INDICATION:
FUSION LAMI C-SPINE
TECHNIQUE: Frontal projections of the cervical and thoracic spine for total
of 2 projections on 4 images.
COMPARISON: Intraoperative radiographs of the cervical and thoracic spine ___. MRI and CT of the cervical spine and thoracic spine ___.
FINDINGS:
There is redemonstration of fixation hardware spanning the lower cervical
spine to the upper thoracic spine with limited evaluation in the absence of
lateral projections. There are multiple overlying wires. The patient is again
noted to be status post median sternotomy with a fractured inferior-most wire.
Surgical staples project over the mid hemithoraces bilaterally. The distal tip
of an enteric tube projects over the left upper quadrant of the abdomen. There
is redemonstration of a right-sided PICC line with distal tip projecting over
the right atrium. There is an endotracheal tube with the distal tip projecting
just above the carinal.
IMPRESSION:
Limited postoperative evaluation of spinal fusion hardware spanning the lower
cervical spine to the upper thoracic spine.
|
19934880-RR-52
| 19,934,880 | 28,186,624 |
RR
| 52 |
2161-10-06 10:31:00
|
2161-10-06 13:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with MRSA spinal abscess s/p peg with worsening
O2 requirement. // pls eval for interval change pls eval for interval
change
COMPARISON: Comparison to prior study ___ at 14 25
FINDINGS:
AP upright chest film ___ at 10:40 is submitted.
IMPRESSION:
Spinal hardware is now seen overlying the lower cervical and upper thoracic
spine. Right subclavian PICC line is unchanged in position. The nasogastric
tube has been removed. An endotracheal tube remains in place with the tip
approximately 2.5 cm above the carina. There is improved aeration but
persistent consolidation in the retrocardiac area suggestive of partial lower
lobe atelectasis, although pneumonia cannot be entirely excluded. There has
been interval appearance of free air within the peritoneal space likely
related to recent PEG placement. No pneumothorax.
|
19934880-RR-53
| 19,934,880 | 28,186,624 |
RR
| 53 |
2161-10-08 09:36:00
|
2161-10-08 10:31:00
|
INDICATION: ___ year old woman with recent C5-T4 fusion // Please obtain
upright c-spine film to evaluate for for post-surgical changes
COMPARISON: Compared to radiographs from ___.
IMPRESSION:
There has been posterior cervical fusion extending from C5-T4. There has been
removal of the anterior plate at C5-C7 since the prior study. No hardware
related complications are seen. The visualized lung apices are grossly clear.
There is a right-sided central venous line with its distal lead tip in the
distal SVC.
|
19934880-RR-54
| 19,934,880 | 28,186,624 |
RR
| 54 |
2161-10-08 06:44:00
|
2161-10-08 12:58:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with epidural abscess, new trach, increased
agitation on vent // Please assess for interval change
COMPARISON: Chest radiograph ___ through ___.
IMPRESSION:
Left lower lobe collapse has recurred, a chronic problem, now accompanied by
moderate left pleural effusion. There is no pneumothorax. Right lung is
hyperexpanded in compensation, perhaps emphysematous as well. Heart is normal
size. The study is not adequate to assess positioning of spinal stabilization
devices.
NOTIFICATION: Dr. ___ reported the findings to Dr ___ by telephone on
___ at 12:54 ___, 5 minutes after discovery of the findings.
|
19934880-RR-55
| 19,934,880 | 28,186,624 |
RR
| 55 |
2161-10-09 03:28:00
|
2161-10-09 11:02:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with MRSA osteomyelitis, with last CXR
concerning for LL collapse // ?improvement in consolidation
COMPARISON: Chest radiographs ___ through ___ at 06:50
IMPRESSION:
Left lower lobe is still collapsed, reflected in persistent leftward
mediastinal shift and dense left infrahilar consolidation obscuring the
diaphragmatic pleural interface. Small accompanying left pleural effusion is
unchanged. Right lung is clear, hyperinflated in compensation. Right PIC line
ends in the mid SVC. Spinal stabilization hardware is not evaluated by this
slightly turned and should be evaluated clinically to see if it is
appropriately supported and positionned.
|
19934880-RR-56
| 19,934,880 | 28,186,624 |
RR
| 56 |
2161-10-10 01:57:00
|
2161-10-10 09:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ventilator associated pna // Interval
change
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. Minimal
left pleural effusion with retrocardiac atelectasis. No pneumonia, no
pulmonary edema. The right PICC line is in unchanged position. Unchanged
appearance of the stabilization devices projecting over the cervical spine.
|
19934880-RR-57
| 19,934,880 | 28,186,624 |
RR
| 57 |
2161-10-11 11:27:00
|
2161-10-11 13:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with tracheostomy, fever, copd // Please
evaluate for infection
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. Mild
decrease in severity of the retrocardiac atelectasis. No new parenchymal
opacities suggesting pneumonia. No pulmonary edema.
|
19934880-RR-58
| 19,934,880 | 28,186,624 |
RR
| 58 |
2161-10-12 02:53:00
|
2161-10-12 09:25:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with trach and hypoxia // ?pneumonia
COMPARISON: Chest radiographs ___
IMPRESSION:
Tracheostomy tube has been removed. Small left pleural effusion is stable.
Left lower lobe atelectasis has improved substantially since ___.
Right lung is clear. Heart size is normal. Right PIC line ends in the region
of the superior cavoatrial junction. No pneumothorax.
|
19934880-RR-60
| 19,934,880 | 28,186,624 |
RR
| 60 |
2161-10-16 09:07:00
|
2161-10-16 11:34:00
|
INDICATION: ___ year old woman with C4 epidural abscess s/p trach/peg //
?aspiration
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: None available
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was aspiration of thin liquids with and without using a
straw. There was also aspiration of nectar thick liquids with a straw.
IMPRESSION:
Aspiration of think liquids with and without a straw. Aspiration of nectar
thick liquids with a straw.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19934880-RR-61
| 19,934,880 | 28,186,624 |
RR
| 61 |
2161-10-16 09:07:00
|
2161-10-16 12:44:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with MRSA C4 epidural abscess s/p washout with
her hospital course complicated by submassive PE, ARDS, PNA, and delirium. //
interval change
TECHNIQUE: PA and lateral view radiographs of the chest.
COMPARISON: Prior chest radiographs dating back ___.
FINDINGS:
Hyperexpansion of the left upper lobe and leftward mediastinal shift are
explained by recurrent left lower lobe collapse, little changed from prior
chest radiographs dating back to ___. Small pleural effusions
have increased. There is no focal consolidation, pneumothorax, or pulmonary
edema. The cardiomediastinal silhouette is normal.
IMPRESSION:
1. Recurrent left lower lobe collapse.
2. Small pleural effusions, increased.
|
19934880-RR-67
| 19,934,880 | 24,811,153 |
RR
| 67 |
2163-03-02 14:19:00
|
2163-03-02 16:02:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ woman with a history of PE, leg swelling, here for
evaluation for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Lower extremity DVT ultrasound ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial veins. The peroneal veins are not
visualized and either calf.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the visualized right or left lower
extremity veins. Nonvisualization of the peroneal veins in either calf.
|
19934880-RR-68
| 19,934,880 | 24,811,153 |
RR
| 68 |
2163-03-02 17:35:00
|
2163-03-02 18:22:00
|
EXAMINATION: CT abdomen pelvis
INDICATION: ___ w/abdominal pain and distention, also with urinary retention,
frequent UTIs fever, please eval for pyelonephritis, other abdominal
pathology, has RLQ ttp, please eval appendix
TECHNIQUE: Multidetector CT through the abdomen pelvis performed following IV
contrast only. Multiplanar reformations were provided.
DOSE: Total DLP (Body) = 842 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild basal subsegmental atelectasis is noted, left greater than
right. The imaged portion of the heart is unremarkable.
ABDOMEN:
HEPATOBILIARY: The liver contains a hypodense lesion within segment 8 best
seen on series 2, image 13 measuring 12 x 9 mm, indeterminate. There is a
tiny hypodensity in segment 3 of the liver on series 2, image 24 which is too
small to characterize. No intrahepatic biliary ductal dilation. Main portal
vein is patent. The gallbladder appears normal. The common bile duct appears
normal in caliber.
PANCREAS: The pancreas enhances normally. No focal lesion or signs of
pancreatitis.
SPLEEN: The spleen appears normal.
ADRENALS: Adrenal glands appear normal.
URINARY: Kidneys enhance symmetrically and excrete contrast promptly. No
signs of pyelonephritis or hydronephrosis. No worrisome renal lesions seen.
GASTROINTESTINAL: Stomach is decompressed. The duodenum appears normal.
Loops of small bowel demonstrate no signs of ileus or obstruction. The
appendix is normal. The colon contains a mild to moderate fecal load. There
is thickening and hyperemic mucosa involving the distal sigmoid and rectum
concerning for proctocolitis. Mild adjacent fat stranding is noted. No free
air.
PELVIS: The urinary bladder is decompressed around a Foley catheter. The
urinary bladder wall appears mildly thickened and correlation with UA
recommended to exclude infection. Patient status post hysterectomy. There is
no adnexal mass. The ovaries appear grossly unremarkable.
LYMPH NODES: No lymphadenopathy in the abdomen or pelvis.
VASCULAR: The abdominal aorta is normal in course and caliber without
significant atherosclerosis. There is an IVC filter in place, infrarenal in
location.
BONES: A mild superior endplate compression deformity at L1 appears new from
CT chest dated ___. There is mild resultant loss of vertebral body
height. No bony retropulsion or malalignment.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Acute proctocolitis.
2. Indeterminate hepatic hypodense lesion within segment 8 for which MRI is
recommended on a nonemergent basis to further assess.
3. Mild L1 superior endplate compression deformity, new from ___.
Correlate for focal pain.
4. No evidence of pyelonephritis. Mild thickening of the urinary bladder for
which correlation with UA is advised to exclude underlying infection.
RECOMMENDATION(S): MRI liver, nonemergent, to further assess indeterminate
liver lesion.
|
19934880-RR-69
| 19,934,880 | 27,116,021 |
RR
| 69 |
2163-03-25 13:48:00
|
2163-03-25 14:05:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain, fever
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Patient is status post median sternotomy. Heart size is mildly enlarged.
Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is
not engorged. Streaky left basilar opacity likely reflects left lower lobe
atelectasis. Right lung is clear. No pleural effusion or pneumothorax is
seen. Cervical spinal fusion hardware is re- demonstrated, partially imaged.
IMPRESSION:
Streaky left basilar opacity, likely reflective of left lower lobe
atelectasis. Early infection is not excluded in the correct setting.
|
19934880-RR-70
| 19,934,880 | 27,116,021 |
RR
| 70 |
2163-03-26 15:36:00
|
2163-03-26 17:20:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with h/o PE and former ___ filter // Eval for
PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 4.6
mGy-cm.
2) Spiral Acquisition 4.5 s, 35.6 cm; CTDIvol = 14.7 mGy (Body) DLP = 524.3
mGy-cm.
Total DLP (Body) = 529 mGy-cm.
COMPARISON: CTA chest from ___.
Chest radiograph from ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits.
AXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy is present.
Subcarinal lymphadenopathy is noted the largest nodule measures 1.4 x 1.0 cm
(2:55). There is a small amount of simple mediastinal fluid, slightly
increased from previous examination, likely representing fluid in the
pericardial recess (02:41, 02:39).
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without parenchymal opacification. There is
trace bilateral atelectasis. The airways are patent to the level of the
segmental bronchi bilaterally. In the right upper lobe is a 4 mm pulmonary
nodule, unchanged from prior (02:15). A right lower lobe ground-glass nodule
appears unchanged from prior (02:26).
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: Partially visualized is posterior spinal fusion hardware in the lower
cervical spine and vertebral bodies of T2 and T3.
SOFT TISSUES: Sternotomy wires are present, the most inferior of which is
fractured.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Simple mediastinal fluid slightly more prominent than on prior exam, likely
representing fluid in the pericardial recess.
3. Subcarinal lymphadenopathy.
4. Unchanged right upper and lower lobe pulmonary nodules.
|
19934880-RR-83
| 19,934,880 | 21,076,931 |
RR
| 83 |
2164-09-17 01:28:00
|
2164-09-17 04:51:00
|
INDICATION: History: ___ with cough and subjective fever// eval for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
CT of the chest from ___.
FINDINGS:
Lung volumes are slightly low accentuating pulmonary vascular crowding.
Subsegmental atelectasis and mild pulmonary congestion. No frank pulmonary
edema or focal consolidation concerning for pneumonia. Stable mild
cardiomegaly and postoperative mediastinum. No pneumothorax or pleural
effusion
IMPRESSION:
1. No focal consolidation concerning for pneumonia.
2. Pulmonary vascular congestion and low lung volumes.
|
19934880-RR-84
| 19,934,880 | 21,076,931 |
RR
| 84 |
2164-09-17 01:28:00
|
2164-09-17 06:17:00
|
EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA RIGHT
INDICATION: ___ year old woman with history of right shoulder pain// eval for
fracture or obvious effusion eval for fracture or obvious effusion
TECHNIQUE: Three views lower right shoulder
COMPARISON: None
FINDINGS:
There is no fracture or dislocation involving the glenohumeral or AC joint.
Insertional degenerative change noted at the greater tuberosity. Mild
degenerative changes of the acromioclavicular joint with trace inferior
spurring. No suspicious lytic or sclerotic lesions are identified. No
radio-opaque foreign body is seen.
IMPRESSION:
No fracture or dislocation. Degenerative changes as described.
|
19935359-RR-104
| 19,935,359 | 23,033,564 |
RR
| 104 |
2205-03-21 19:03:00
|
2205-03-22 13:58:00
|
EXAMINATION: MR KNEE W/O CONTRAST LEFT
INDICATION: ___ year old woman with significant acute knee pain evaluate for
meniscal tear.
TECHNIQUE: Imaging performed at 1.5 Tesla using the knee coil. Sequences
include axial fat sat proton density, sagittal fat sat proton density,
sagittal T2 fat sat, and coronal fat-sat proton density.
COMPARISON: Left knee radiograph ___.
FINDINGS:
There is no joint effusion.
In the medial compartment, the meniscus is intact. Hyaline cartilage is
preserved. No subchondral marrow edema.
In the lateral compartment, there is a horizontal tear extending from the
anterior to the posterior body of the lateral meniscus with an associated
parameniscal cyst (series 7, image 19). In addition, there is degenerative
intermediate intensity signal within the posterior horn. There is partial
thickness cartilage loss involving the lateral tibial plateau. There is
probable full-thickness cartilage loss deep to the posterior horn. There is
no underlying marrow edema.
In the patellofemoral compartment, cartilage is preserved. No subchondral
marrow edema.
The cruciate and collateral ligaments are intact. There is intermediate
signal within the femoral attachment of the fibular collateral ligament
(series 6, image 20), consistent with a small focus of degeneration. There is
associated surrounding interstitial soft tissue edema.
The quadriceps and patellar tendons are intact, within normal limits.
Muscles are within normal limits.
There is no ___ cyst.
Single popliteal lymph node that is top-normal in short axis diameter, but
with preserved fatty component (5:15, 6:14, 4:14).
IMPRESSION:
1. Horizontal tear of the body of the lateral meniscus.
2. Intact medial meniscus, cruciate ligaments, and collateral ligaments.
3. Mild degenerative changes of the lateral compartment with partial thickness
cartilage loss and probably some areas of full-thickness cartilage loss.
|
19935359-RR-105
| 19,935,359 | 23,033,564 |
RR
| 105 |
2205-03-22 15:21:00
|
2205-03-22 17:24:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman h.o esophageal, breast CA admitted with acute
PE. Assess for recurrence in setting of PE
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with a single bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: Total DLP (Body) = 1,324 mGy-cm.
IV Contrast: 150 mL Omnipaque
COMPARISON: CTA chest from ___, CT abdomen pelvis from ___, and ___.
FINDINGS:
LOWER CHEST: Lung bases are clear without pleural effusions. Please refer to
the CTA chest from 2 days prior for complete intrathoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The nondistended gallbladder is
unremarkable in appearance.
PANCREAS: Pancreas demonstrates moderate fatty infiltration, as seen on the
study from ___. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: A 0.9 x 0.9 cm left adrenal gland nodule has been previously
described as an adenoma, and is unchanged in size since at least ___.
The right adrenal gland is unremarkable.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesion or hydronephrosis.
GASTROINTESTINAL: The visualized distal esophagus is unchanged in appearance
since ___, and unremarkable. The stomach demonstrates intramural
fat, as seen in ___. The colon and rectum are within normal limits.
There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
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: Large heterogeneously enhancing and partially calcified
masses in the uterus, compatible fibroids, are similar in appearance to the
study from ___.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.
Moderate degenerative changes of the lumbar spine are again seen, and most
pronounced at L4-L5 and L5-S1. Mild soft tissue stranding and foci of air in
the right anterior abdominal wall are likely due to recent subcutaneous
injections (4:31, 36).
IMPRESSION:
1. No evidence of intra-abdominal or intrapelvic malignancy or metastatic
disease. Visualized esophagus is unchanged appearance since ___.
2. Please refer to the CTA chest from 2 days prior for intrathoracic
findings.
|
19935888-RR-19
| 19,935,888 | 21,178,042 |
RR
| 19 |
2143-11-07 04:38:00
|
2143-11-07 07:47:00
|
EXAMINATION: CT L-SPINE W/O CONTRAST
INDICATION: ___ year old man with h/o multiple back surgery, nerve stimulator
implant, presented with fecal incontinence and decreased rectal tone // eval
for signs of compression
TECHNIQUE: Contiguous helical images were obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: DLP: 908.5 mGy-cm
CTDI: 32.1 mGy
COMPARISON: Multiple L spine radiographs.
FINDINGS:
There are 5 non-rib-bearing lumbar type vertebral bodies. Fusion hardware is
present at L3 and L4. Old screw tracts are noted in L5 where there has been a
prior laminectomy. There mild degenerate changes moderate canal stenosis
L2-L3. Evaluation of the intrathecal sac is limited by modality. Evaluation of
cord compression is limited.
The paraspinal soft tissues are unremarkable.
IMPRESSION:
Lumbar spine hardware and moderate canal stenosis the L2-L3 stenosis.
Evaluation of the intrathecal sac is limited by modality.
|
19935888-RR-20
| 19,935,888 | 21,178,042 |
RR
| 20 |
2143-11-07 11:43:00
|
2143-11-07 12:54:00
|
EXAMINATION: CT of the thoracic and lumbar spine post intrathecal injection
of contrast.
INDICATION: ___ year old man with stool incontinence and worsening lower back
pain with hx of prior fusions, laminectomy, revision, nerve stimulator //
STAT CT MYELOGRAM - RULE OUT CAUDA EQUINA SYNDROME
TECHNIQUE: Contiguous axial MDCT sections were obtained through the thoracic
and ___ coronal and r spine post intrathecal injection of nonionic contrast.
Sagittal reformatted images were reviewed.
CTDIvol: 31.86 mGy.
DLP: 1874.71 mGy-cm.
COMPARISON: CT lumbar spine ___.
FINDINGS:
Thoracic spine: There is multilevel degenerative disc disease of the thoracic
spine. There are multilevel small posterior disc protrusions without evidence
of cord compression or neural impingement within the thoracic spine. There is
also multilevel facet arthropathy.
The paraspinal and prevertebral soft tissues surrounding the thoracic spine
are unremarkable. There is a nerve stimulator spanning the T8-T10 levels.
Lumbar spine: There is multilevel degenerative disc disease of the lumbar
spine. There are postoperative changes of a prior L3 through S1 laminectomies
with posterior stabilization hardware at the L3-L4 level.
At the T12-L1 level, the spinal canal and neural foramina appear normal.
At the L1-L2 level, there is mild bilateral facet arthropathy. The spinal
canal and neural foramina appear normal.
At the L2-L3 level, there is a disc bulge with posterior disc protrusion and
bilateral facet arthropathy and ligamentum flavum thickening which cause
severe spinal canal narrowing.
At the L3-L4 level, there are postoperative changes, as described. The spinal
canal and neural foramina appear normal.
At the L4-L5 level, there are postoperative changes, as described. The spinal
canal and neural foramina appear normal.
At the L5-S1 level, there are postoperative changes, as described. The spinal
canal appears normal. There is probable mild bilateral neural foraminal
narrowing, right greater than left.
IMPRESSION:
1. Postoperative changes, as described, including multilevel laminectomies and
stabilization hardware at L3-L4.
2. Disc bulge, disc protrusion, bilateral facet arthropathy, and ligamentum
flavum thickening at the L2-L3 level which causes severe spinal canal
narrowing.
|
19935888-RR-21
| 19,935,888 | 21,178,042 |
RR
| 21 |
2143-11-07 10:43:00
|
2143-11-07 12:17:00
|
EXAMINATION: Fluoroscopy guided lumbar puncture and myelogram.
INDICATION: ___ year old man with stool incontinence and worsening lower back
pain with hx of prior fusions, laminectomy, revision, nerve stimulator //
RULE OUT CAUDA EQUINA SYNDROME - STAT CT MYELOGRAM
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient and informed consent was obtained. The patient was
subsequently transported to the fluoroscopy suite. A preprocedure time-out was
performed confirming the patient's identity, relevant history, and intended
procedure. The lower back was prepped and draped in sterile fashion. The L3-L4
interspace was localized and local anesthesia was obtained utilizing 1%
lidocaine subcutaneously. A 20 gauge spinal needle was guided into the thecal
sac under fluoroscopic control. A fluoroscopic image was obtained confirming
the needle's position and archived in PACS. Approximately 10 mL of Isovue M
300 was injected into the thecal sac. The needle was subsequently removed
without immediate complications.
AP and oblique views of the lumbar spine demonstrate spinal canal narrowing at
the L2-L3 level. Please see CT myelogram for further details.
This procedure was performed by Dr. ___ (neuroradiology fellow)
and Dr. ___ attending). Dr. ___ was present during the
entire procedure.
COMPARISON:
CT lumbar spine ___.
FINDINGS:
AP and oblique views demonstrates spinal canal narrowing at the L2-L3 level.
Please see CT report for further details.
IMPRESSION:
1. Successful fluoroscopically guided lumbar puncture with intrathecal
injection of nonionic contrast for lumbar and thoracic myelogram.
2. AP and oblique views demonstrates spinal canal narrowing at the L2-L3
level. Please see CT report for further details.
|
19935888-RR-22
| 19,935,888 | 21,178,042 |
RR
| 22 |
2143-11-08 19:01:00
|
2143-11-08 19:22:00
|
INDICATION: Status post spinal fusion.
TECHNIQUE: A single lateral radiograph of the lumbar spine was acquired
intraoperatively.
COMPARISON: Lumbar spine CT from ___.
FINDINGS:
Pedicle screws are seen at the presumed L2 through L4 levels localization
hardware posterior to the L2 and L4 vertebral bodies. There is no hardware
complication. Alignment of the lumbar spine is unchanged compared to the prior
lumbar spine CT. Multilevel degenerative changes seen throughout the imaged
aspect of the spine. Spinal stimulator leads are partially imaged. For
additional details, please see the operative note in the ___
medical record.
IMPRESSION:
As above.
|
19935888-RR-23
| 19,935,888 | 21,178,042 |
RR
| 23 |
2143-11-08 20:33:00
|
2143-11-09 09:41:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENTCHEST PORT. LINE PLACEMENTi
INDICATION: ___ year old man s/p revision spinal fusion // confirm placement
of central line Contact name: ___: ___
COMPARISON: ___
IMPRESSION:
Right subclavian catheter ends in the low SVC. No pneumothorax pleural
effusion or mediastinal widening. Lungs clear. Heart size normal.
An orthopedic device projects over the midline lower thoracic spine.
Additional surgical materiel projecting over the left upper abdominal quadrant
has been present since ___, but I cannot identify it. Has the patient had
bariatric surgery?
|
19935891-RR-10
| 19,935,891 | 23,458,917 |
RR
| 10 |
2139-03-29 11:27:00
|
2139-03-29 13:35:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new PICC needs tip confirmation// New Rt.
Basilic ___. 39 cm. DL Power PICC ___ ___ Contact name: ___: ___
New Rt. Basilic ___. 39 cm. DL Power PICC ___ ___
IMPRESSION:
Heart size and mediastinum are stable. Pacemaker leads terminate in right
atrium expected location of the right ventricle and left epicardial vein.
Lungs overall clear. There is minimal pleural thickening bilaterally,
unchanged. No pneumothorax. No pulmonary edema
Right PICC line tip terminates at the level of mid SVC.
|
19935891-RR-8
| 19,935,891 | 23,458,917 |
RR
| 8 |
2139-03-25 00:24:00
|
2139-03-25 01:24:00
|
EXAMINATION: CTA TORSO
INDICATION: History: ___ with symptomatic AAA planning for EVAR// assess for
AAA
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.5 s, 67.1 cm; CTDIvol = 4.0 mGy (Body) DLP = 266.9
mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP =
10.6 mGy-cm.
3) Spiral Acquisition 8.2 s, 64.8 cm; CTDIvol = 9.5 mGy (Body) DLP = 614.2
mGy-cm.
Total DLP (Body) = 892 mGy-cm.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Pacemaker leads noted in both ventricle and right
atrium. The heart is normal in size, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Centrilobular and paraseptal emphysema is upper lobe
predominant. Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
biliary dilatation. The common bile duct measures up to 7 mm however tapers
smoothly at the level of the ampulla. The gallbladder is within normal
limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right adrenal gland is normal in size and shape. A 1.5 cm hypo
dense enhancing round lesion arising from the left adrenal gland likely
represents an adenoma.
URINARY: The kidneys are of symmetric size with normal nephrogram, with mild
cortical atrophy bilaterally. There is no evidence of focal renal lesions or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized. There is no
free intraperitoneal fluid or free air.
PELVIS:
The urinary bladder is significantly distended. Distal ureters are
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Thoracic aorta measures up to 3.1 cm. Infrarenal abdominal aorta is
very tortuous and contains a large peripherally calcified with mural thrombus
measuring up to 8.6 cm and extending into both common iliac arteries. The
right iliac artery measures up to 1.8 cm, the left common iliac artery
measures up to 1.6 cm. An outpouching dilation of the aneurysm in the left
aspect of the inferior border the peripheral calcification is also noted
(3:156). There is slightly slower flow through the aneurysm. Common iliacs
and its branches are heavily calcified. There is lack of intraluminal
contrast in bilateral internal iliac artery.
In the abdominal aorta, at the level of the celiac axis, is an area of
possible focal dissection (602:37).
Celiac axis is tortuous taking a vertical orientation at origin, but patent.
Celiac trunk, SMA and ___ are patent. Heavy calcifications in bilateral renal
arteries, both patent.
BONES AND SOFT TISSUES: Patient is status post median sternotomy. Multilevel
degenerative changes are seen in the lumbar spine with large anterior
osteophytosis at L2-L3 particularly. There is no evidence of worrisome
osseous lesions or acute fracture. The abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. Nonruptured 8.6 cm infrarenal abdominal aorta aneurysm with mural thrombus
extends into both common iliac arteries. Flow through the aneurysm and into
both common iliac arteries is noted.
2. Extensive atherosclerotic disease involving the majority of the aortic
branches with lack of contrast opacification through the bilateral internal
iliac arteries.
3. Significantly distended urinary bladder.
4. Moderate paraseptal and centrilobular emphysema.
|
19935891-RR-9
| 19,935,891 | 23,458,917 |
RR
| 9 |
2139-03-26 02:23:00
|
2139-03-26 03:51:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old man with know symptomatic AAA, now with hypotension//
assess for rupture/RP hematoma, no contrast given CKD and recent CTA
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.0 s, 47.6 cm; CTDIvol = 8.3 mGy (Body) DLP = 396.9
mGy-cm.
Total DLP (Body) = 397 mGy-cm.
COMPARISON: Recent CTA done ___
FINDINGS:
LOWER CHEST: No suspicious pulmonary nodules or masses. Emphysematous changes
with associated bronchial wall thickening in keeping with inflammation appear
similar compared to prior. Mild pleural thickening and scarring in the left
lower lobe is similar compared to prior.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. Hyperdense material in the gallbladder most likely in keeping
with vicarious excretion of contrast.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Lipid rich left adrenal adenoma is unchanged.
URINARY: Hyperdense and hypotrophic appearance of the renal cortices in
keeping with chronic renal disease and suspected delay in contrast excretion.
Simple right renal cortical cyst is unchanged. There is no hydronephrosis.
There is no nephrolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal
caliber and wall thickness throughout. Diverticulosis of the sigmoid colon is
noted, without evidence of wall thickening and fat stranding. Appendix is
poorly identified.
PELVIS: Foley's catheter in situ in the bladder with intra bladder air most
likely secondary to instrumentation. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostatic calcifications are noted.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Tortuous abdominal aorta. Infrarenal abdominal aortic aneurysm
measuring up to 72 x 95 mm in the axial plane as previously described in
detail on recent CTA done yesterday appear similar compared to prior imaging.
There is no periaortic stranding nor free fluid to suggest active
extravasation. The lobulated left anterior out pouching in the lower aspect
of the aneurysm appear similar compared to prior, suggesting impending
rupture. Involvement of the common iliac arteries are also stable. There is
no retroperitoneal hematoma. Mild relative hypodensity of the blood pool
suggests anemia.
BONES: Degenerative changes of the thoracolumbar spine with degenerative
narrowing of the lower lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Stable imaging findings of the large infrarenal abdominal aortic aneurysm
compared to CTA done yesterday.
2. No features of abdominal aortic rupture/acute extravasation. Focal out
pouching in the anterior left lower aspect of the aneurysm suggest impending
rupture appear similar compared to prior CTA done yesterday. No evidence of
hyperdense crescent/intramural hematoma. The flow channel is suboptimally
assessed due to the lack of IV contrast and reference is made to CTA report of
Estrace.
3. No acute abdominopelvic findings of note.
4. Incidental findings as described above.
|
19935894-RR-22
| 19,935,894 | 22,497,123 |
RR
| 22 |
2192-05-20 07:49:00
|
2192-05-20 12:36:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with new suacute occipital infarct // assess
ischemic lesion
TECHNIQUE: MRI of the brain without contrast. Three dimensional noncontrast
time of flight MR arteriography was performed with rotational reconstructions.
2D time-of-flight noncontrast MRA of the neck was also performed.
COMPARISON: MRI ___.
FINDINGS:
New areas of slow diffusion predominantly involving the right posterior
parietal cortex with additional punctate focus of slow diffusion within the
left posterior parietal cortex. Previously described infarct within left
parietal region again shows increased diffusion signal and is compatible with
now subacute to chronic infarct. Given distribution, findings are suggestive
of a central source.
There is no evidence of acute intracranial hemorrhage or mass effect. White
matter signal abnormality is presumably on the basis of chronic small vessel
ischemic disease, in combination with multiple bilateral lacunar infarcts.
The orbits and paranasal sinuses are unremarkable.
Evaluation of the intracranial vasculature demonstrates no large vessel
occlusion, aneurysm, or vascular malformation. The distal intracranial vessels
are not well-visualized which is potentially on an artifactual basis although
atheromatous narrowing is also possible. Incidental note is made of fetal
origin of right PCA.
Evaluation of vasculature within the neck on 2D time-of-flight images
demonstrates no large vessel occlusion or vascular malformation.
IMPRESSION:
1. New areas of slow diffusion within the bilateral parietal lobes, right
greater than left, compatible with acute ischemia. Pattern, in combination
with prior findings, is suggestive of central source.
2. No pathologic large vessel occlusion or vascular malformation within the
head or neck.
3. Distal intracranial vessels are not well visualized which is potentially an
artifactual basis although atheromatous narrowing is possible.
|
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