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19936081-RR-8 | 19,936,081 | 28,944,965 | RR | 8 | 2138-09-12 21:23:00 | 2138-09-12 23:09:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior exam from earlier the same day.
CLINICAL HISTORY: Intractable seizures, assess for pneumonia.
FINDINGS: Semi-upright AP portable view of the chest provided. The lungs
appear grossly clear, though volumes are low. No large effusion or
pneumothorax. Cardiomediastinal silhouette is stable. Bony structures appear
intact with mild levoscoliosis of the T spine.
|
19936081-RR-9 | 19,936,081 | 28,944,965 | RR | 9 | 2138-09-15 12:40:00 | 2138-09-15 14:57:00 | REASON FOR EXAMINATION: Evaluation of the patient with chest pain, who
presents with new fever.
Portable AP radiograph of the chest was reviewed in comparison to ___.
Heart size and mediastinum appear to be grossly unchanged. There is new right
lower lobe opacity concerning for infectious process in the right lower lobe.
Small amount of pleural effusion cannot be excluded.
|
19936193-RR-65 | 19,936,193 | 29,898,007 | RR | 65 | 2189-10-16 18:29:00 | 2189-10-16 19:08:00 | EXAMINATION: CHEST (AP AND LATERAL)
INDICATION: History: ___ with recurrent seizure like activity
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: ___ chest radiograph, ___ chest CT
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is
normal. Elevation of the right hemidiaphragm is re- demonstrated along with
streaky opacities in the lung bases compatible with areas of chronic scarring.
No focal consolidation, pleural effusion or pneumothorax is present. Moderate
multilevel degenerative changes are seen in the thoracic spine.
IMPRESSION:
Chronically elevated right hemidiaphragm with chronic bibasilar scarring. No
focal consolidation.
|
19936193-RR-66 | 19,936,193 | 29,898,007 | RR | 66 | 2189-10-16 18:14:00 | 2189-10-16 18:44:00 | INDICATION: ___ with procedure disease presents with unwitnessed seizure now
with seizure like activity in ED. Assess for mass.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal, and
thin section bone algorithm reconstructed images were generated.
DOSE: DLP: 922 MGy-cm
CTDI: 54.21 mGy
COMPARISON: Noncontrast head CT ___.
FINDINGS:
Subarachnoid hemorrhage is noted involving both frontal lobes, left temporal
region, and possibly right temporal lobe inferiorly in with a slightly more
focal area within the left frontal region. Small parenchymal hemorrhagic
contusions in the inferior frontal lobes bilaterally as well as both inferior
temporal regions are likely present (602a, 38 and 46). No mass-effect or
shift of midline structures. Small curvilinear hypodense extra-axial
collection along the left posterior parietal region may reflect a subacute to
chronic subdural hematoma (series 3, image 32). No acute large territorial
infarction.The ventricles and sulci are normal in size and configuration.
Cerebellar atrophy noted. Mild prominence of the ventricles and sulci are
consistent with age-related cortical volume loss.
The basal cisterns are patent and there is preservation of gray-white matter
differentiation.
A fracture is seen extending along the left frontal bone through the sagittal
suture and along the right parietal bone with minimal distraction. Small
subgaleal hematoma is seen along the fracture path. The visualized paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The globes are
unremarkable.
IMPRESSION:
1. Subarachnoid hemorrhage involving both frontal lobes, left temporal lobe,
and likely right inferior temporal lobe with hemorrhagic contusions involving
the inferior frontal lobes bilaterally as well as both inferior temporal
lobes. No evidence of herniation.
2. Small subacute to chronic subdural hematoma overlying the left posterior
parietal lobe.
3. Fracture extending along the left frontal bone through the sagittal suture
and along the right parietal bone with minimal distraction. Small subgaleal
hematoma along fracture path.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 12:16 AM.
|
19936193-RR-67 | 19,936,193 | 29,898,007 | RR | 67 | 2189-10-17 00:18:00 | 2189-10-17 06:37:00 | INDICATION: ___ year old man with seizures, new left frontal subarachnoid
hemorrhage, left frontal skull fracture.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm-reconstructed images were acquired.
DOSE: DLP: 133 mGy-cm.
CTDIvol: ___ MGy.
COMPARISON: CT from ___
FINDINGS:
Subarachnoid hemorrhage is noted in the bilateral frontal, temporal and
parietal lobes (5:24). Bilateral inferior frontal hemorrhagic contusions are
also noted. A small amount of dependent intraventricular hemorrhage is new.
There is a new extra-axial hematoma is noted along the right posterior
parieto-occipital convexity measuring 7 mm in width from the inner table
(___:35, 5:24). This overlies a skull fracture and appears to be epidural. A
left parietal extra-axial collection measuring 4 mm in width from the inner
table is also noted and slight increased in size from the exam performed 12
hours prior (___:53). There is no mass effect or shift of midline structures.
Prominent ventricles and sulci are likely due to age-related atrophy. There
is preservation of normal gray-white matter differentiation. The basilar
cisterns are patent. A fracture through the left frontal bone through the
sagittal suture into the right parietal bone is again seen. Partial
opacification of the bilateral ethmoid air cells is noted, and fluid is
partially visualized in the right maxillary sinus.
IMPRESSION:
1. Subarachnoid hemorrhage in the bilateral frontal, parietal and temporal
lobes. Bilateral inferior frontal hemorrhagic contusions.
2. Slight increase in size of the left parietal extra-axial hematoma measuring
4 mm.
3. New right posterior parieto-occipital extra-axillary collection, likely
epidural, measuring 7 mm.
4. Fracture of the right frontal bone into the sagittal suture and right
parietal bone.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ On the
telephone on ___ at 6:15 AM, 5 minutes after discovery of the findings.
|
19936204-RR-66 | 19,936,204 | 23,249,562 | RR | 66 | 2143-12-01 14:28:00 | 2143-12-01 15:27:00 | INDICATION: ___ woman with fever, evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray from ___
FINDINGS:
The lungs are well inflated and clear. There is stable elevation of the right
hemidiaphragm. The cardiomediastinal silhouette and hilar contours are
stable. There is no pleural effusion or pneumothorax. A right chest
Port-A-Cath terminates at the distal SVC, as before. A metallic CBD stent is
again noted projecting over the right upper quadrant.
IMPRESSION:
No acute cardiopulmonary process.
|
19936204-RR-67 | 19,936,204 | 23,249,562 | RR | 67 | 2143-12-01 13:50:00 | 2143-12-01 14:32:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with history of cholangiocarcinoma s/p biliary stenting with
reported fevers and chills with elevated WBC, evaluate for patency of biliary
stents.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Prior abdominal ultrasounds dated ___ and ___, and
CT of the abdomen and pelvis dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. Pneumobilia, predominantly within the left lobe of the
liver, is unchanged from the prior study, suggesting stent patency. The CBD
stent is in expected location. There is no focal liver mass. The main portal
vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD cannot be
measured due to the presence of stents.
GALLBLADDER: The gallbladder is decompressed but otherwise normal in
appearance.
IMPRESSION:
1. Left hepatic pneumobilia suggests biliary stent patency.
2. No intrahepatic biliary ductal dilatation.
|
19936204-RR-68 | 19,936,204 | 23,910,112 | RR | 68 | 2144-01-07 13:33:00 | 2144-01-07 16:48:00 | INDICATION: Evaluate for biliary obstruction in a patient with a history of
cholangiocarcinoma and medically treated perforated gallbladder,, now
presenting with concern for bacteremia.
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 925.9 mGy-cm (abdomen and pelvis.
IV Contrast: 130 mL Omnipaque
COMPARISON: CT abdomen/ pelvis from ___ and ___.
FINDINGS:
LOWER CHEST:
There is mild linear atelectasis, without focal consolidation, pleural
effusion, or pneumothorax in the visualized lung bases.
ABDOMEN:
HEPATOBILIARY: The liver is homogeneous in attenuation. There is again
biliary duct dilation and pneumobilia, unchanged compared to ___.
Multiple biliary stents are unchanged in position. The gallbladder is the
gallbladder again demonstrates wall thickening and hyper enhancement. The
adjacent fluid collection is increased compared to ___, now measuring 1.6
x 3.6 cm in axial plane. There is increased thickening of the adjacent
peritoneal wall.
PANCREAS: The pancreas is normal in attenuation, without evidence of focal
lesion or ductal dilation. There is no peripancreatic stranding or fluid
collection.
SPLEEN: The spleen is homogeneous and normal in size..
ADRENALS: The right adrenal gland is normal in configuration and caliber. A
left adrenal nodule is unchanged, again measuring 3.2 x 2.9 cm.
URINARY: The kidneys are atrophic bilaterally but symmetric, with unchanged
multiple hypodensities common the largest of which are consistent with simple
renal cysts and the others of which are too small to characterize but also
likely represent simple renal cysts.
GASTROINTESTINAL: Small bowel loops are normal in caliber, without wall
thickening or evidence of obstruction. The colon is normal in caliber,
without wall thickening or evidence of obstruction or mass. A normal appendix
is visualized.
RETROPERITONEUM: Retroperitoneal and mesenteric lymph nodes are not
pathologically enlarged by CT size criteria.
VASCULAR: There is no abdominal aortic aneurysm. There is heavy 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: The patient is status post hysterectomy.
BONES AND SOFT TISSUES:
There is no focal lytic or sclerotic lesion to suggest neoplasm or infection.
IMPRESSION:
1. Increased size of a fluid collection adjacent to the perforated gallbladder
fundus, now measuring 1.6 x 3.6 cm in axial plane, with increased thickening
of the adjacent peritoneal wall.
2. Unchanged intrahepatic biliary duct dilation and pneumobilia, with multiple
biliary stents similar in position.
|
19936204-RR-70 | 19,936,204 | 23,910,112 | RR | 70 | 2144-01-13 14:30:00 | 2144-01-13 18:30:00 | INDICATION: ___ year old woman with cholangiocarcinoma, recent episode of
bacteremia, history of gallbladder perforation // diagnostic aspiration of
fluid surrounding gallbladder at site of perforation. Patient with recurrent
bacteremia thus eval for possible reservoir of infection
COMPARISON: CT examination from ___.
PROCEDURE: Ultrasound-guided percutaneous drainage of a pericholecystic fluid
collection.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the ultrasound table. Limited
preprocedure imaging was performed to localize the gallbladder and a known
pericholecystic fluid collection. An appropriate skin entry site was chosen
and the site marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using continuous sonographic guidance, an 18 gauge spinal needle was advanced
into the pericholecystic fluid collection. 3 cc of purulent fluid were
aspirated into 2 separate 10 cc syringes. Both syringes were sent for Gram
stain and microbiology and fungal culture.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses
totaling 100 mcg fentanyl throughout the total intra-service time of 20
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
A small pericholecystic fluid collection is again identified, corresponding to
the findings from the recent CT examination on ___. This collection
was targeted for aspiration.
IMPRESSION:
Successful ultrasound-guided aspiration of a pericholecystic fluid collection.
3 cc of purulent material aspirated and sent to the microbiology lab.
|
19936219-RR-12 | 19,936,219 | 21,435,770 | RR | 12 | 2167-11-27 09:09:00 | 2167-11-27 14:03:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with falcine SDH. // Assessment for interval
change.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: DLP: 891 mGy-cm
COMPARISON: CT head without contrast ___
FINDINGS:
The bilateral parafalcine subdural hematomas are minimally changed since
___, with maximum thickness measuring 5 mm. There is no evidence of new
intracranial hemorrhage or infarction. The ventricles and sulci are normal in
size and configuration. The basal cisterns appear patent and there is
preservation of gray-white matter differentiation.
No fracture is identified. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear.
The globes are unremarkable.
IMPRESSION:
Thin bilateral parafalcine subdural hemorrhage, stable since ___. No
new intracranial hemorrhage.
|
19936782-RR-19 | 19,936,782 | 20,393,290 | RR | 19 | 2153-02-27 17:57:00 | 2153-02-27 20:03:00 | INDICATION: ___ female with right hand injuries after fall.
Evaluate for fracture.
COMPARISONS: Single AP view of the chest from ___.
FINDINGS: There is prominence of the interstitial markings similar in
appearance to ___ likely due to chronic heart failure. There is
no definite focal consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette is unchanged and unremarkable. Ovoid lucent
lesion in the sixth anterior rib was present on the prior radiograph and
appears non-aggressive. No acute fractures.
IMPRESSION: Findings consistent with chronic heart failure. Ovoid lucent
lesion in the sixth anterior rib is stable and probably benign, suggestive of
an area of focal increased demineralization in the setting of generalized
substantial demineralization and perhaps prior injury.
|
19936782-RR-20 | 19,936,782 | 20,393,290 | RR | 20 | 2153-02-27 17:57:00 | 2153-02-27 20:13:00 | INDICATION: ___ female with right hand injuries after fall.
Evaluate for fracture.
COMPARISONS: None.
FINDINGS: Multiple views of the right hand and wrist were provided. There is
an obliquely oriented non-displaced fracture through the mid and distal shaft
of the fourth metacarpal.
There is substantial widening of the fifth MCP joint in addition to marked
subluxation. However, calcification within the joint suggests that this may
be a chronic process, but would correlate clinically. Second through fourth
metacarpophalangeal joints are also subluxed substantially and probably on a
chronic basis.
There is loss of the radiocarpal joint space and irregularity along the radial
styloid which may be post-traumatic or degenerative. The carpal bones show
mild malalignment including widening of the scapholunated interval on the
oblique view.
There is general demineralization of the bones with loss of joint space at the
first CMC and MCP joints. Soft tissue swelling is present around the fifth
digit, but no radiopaque foreign body or calcifications.
IMPRESSION:
1. Acute fracture through the mid and distal shaft of the fourth metacarpal.
2. Widening the fifth MCP joint may be chronic due to calcifications within
the joint, but effusion or hemorrhage associated with acute injury and
malalignment could be considered.
3. Severe degenerative changes at multiple joints and metacarpophalangeal
subluxations without erosions; this appearance can sometimes be seen with
collagen vascular disease.
4. Severe bony demineralization.
5. Probably chronic malalignment at the wrist which may reflect prior
scapholunate ligament injury with associated superimposed degenerative
changes.
|
19936782-RR-21 | 19,936,782 | 20,393,290 | RR | 21 | 2153-02-27 18:06:00 | 2153-02-27 18:52:00 | INDICATION: ___ female with right hand injuries after fall.
Evaluate for fracture.
COMPARISONS: CT head without contrast from ___.
TECHNIQUE: Contiguous axial imaging was obtained through the brain without
the administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
FINDINGS: There is no acute hemorrhage, edema, mass effect, or territorial
infarction. The ventricles, sulci, and frontal extra-axial spaces are
prominent, likely due to atrophy. There is periventricular white matter
hypodensity consistent with small vessel ischemic disease. A heterogeneous
appearing soft tissue mass measuring 4.1 x 1.6 cm in the expected location of
the superior portion of the right parotid gland may represent a parotid tumor.
It is similar in appearance to the prior study from ___. Patient is
status post bilateral scleral banding in the globes. There is mild mucosal
thickening of the bilateral maxillary sinuses. The remainder of the paranasal
sinuses, mastoid air cells and middle ear cavities are clear. There is no
fracture. There is calcification of the carotid siphons. There is thickening
of the ethmoidal sinuses similar in appearance to the prior exam.
IMPRESSION:
1. No acute intracranial process. Prominent ventricles, sulci and extra-axial
spaces consistent with atrophy, small vessel ischemic disease.
2. Mass in the region the the right parotid gland, similar in appearance to
___ may represent a parotid tumor. Ultrasound is suggested to evaluate
further when clinically appropriate.
The findings regarding the parotid tumor were discussed via telephone by Dr.
___ with the ___ resident caring for the patient at 830pm.
|
19936782-RR-22 | 19,936,782 | 20,393,290 | RR | 22 | 2153-02-27 18:08:00 | 2153-02-27 19:46:00 | INDICATION: Fall, rule out fracture.
COMPARISONS: CT spine without contrast from ___.
TECHNIQUE: Contiguous axial imaging was obtained through the cervical spine
without the administration of intravenous contrast material. Coronal and
sagittal reformats were completed.
FINDINGS: There is no acute fracture, traumatic malalignment, or prevertebral
soft tissue swelling. There are multilevel degenerative changes with large
anterior osteophytes and disc space narrowing, most prominent at C5-C6,
similar to the prior exam. Grade I anterolisthesis at C4-C5 is stable. There
is no severe canal stenosis. Ground-glass opacities in the visualized lung
apices, which may reflect volume overload but, however, is nonspecific. The
visualized portion of the thyroid gland is unremarkable.
IMPRESSION:
1. No evidence of acute fracture or traumatic malalignment. Degenerative
changes at multiple levels, most prominent at C5-C6 levels. Stable grade I
anterolisthesis of C4 on C5.
2. Ground-glass opacities in the lung apices may reflect volume overload.
|
19936782-RR-23 | 19,936,782 | 20,393,290 | RR | 23 | 2153-02-27 21:22:00 | 2153-02-27 22:31:00 | LEFT HAND RADIOGRAPHS
HISTORY: Finger dislocation status post reduction.
COMPARISONS: Earlier on the same day.
TECHNIQUE: Right hand, three views.
FINDINGS: A limited view shows that the fifth metacarpophalangeal joint is
still substantially subluxed although difficult to compare to the prior study
to orientational differenes and new overlying splinting material. Alignment
appears probably improved somewhat, however. There is also a mildly angulated
fracture of the fourth metacarpal.
IMPRESSION: Fracture of the fourth metacarpal. Marked subluxation at the
fifth metacarpophalangeal joint.
|
19936782-RR-26 | 19,936,782 | 28,486,132 | RR | 26 | 2154-02-09 03:17:00 | 2154-02-09 03:49:00 | HISTORY: ___ woman with fall and head strike. The patient does not
remember the fall. She is blind at baseline in the right eye.
TECHNIQUE: MDCT acquired contiguous axial images were obtained through the
head and facial bones without contrast. Coronal and sagittal reformats
provided reviewed.
COMPARISON: CTs of the head from ___ and ___.
FINDINGS:
The there is a 4 mm-thick acute subdural hemorrhage along the right
frontoparietal convexity. There are two foci of acute parenchymal hemorrhage
in the right frontal lobe, and one in the left frontal lobe, likely
hemorrhagic contusions (5:20, 401:35). In addition, high attenuation is seen
within a major branch of the right MCA, in the Sylvian fissure (___),
best-appreciated on the sagittal reformations (___). No significant
mass effect is seen. There is no shift of normally midline structures. The
ventricles and sulci are diffusely prominent, consistent with age-related
involutional changes. Periventricular white matter hypodensities are
suggestive of chronic small vessel ischemic disease. There is a small
hypodensity in the right putamen, likely an old lacunar infarct (5:18). There
is no significant edema or evidence of acute vascular territorial infarction.
There is a large preseptal hematoma lateral to the right orbit. There is
hemorrhage within the right globe (5:11). There are multiple fractures of the
right maxillary sinus with blood pooling within the sinus (5:6). The
fractures are found in the anterior and lateral walls (3:5), as well as the
orbital floor (400:29). There is air tracking into the orbit but there is no
evidence of herniation of orbital contents into the maxillary sinus (401:29).
No other facial fracture is seen. A right parotid mass is better-evaluated on
the cervical spine CT.
IMPRESSION:
1. Acute right subdural hematoma.
2. Multiple foci of hemorrhagic contusion within both frontal lobes.
3. Multiple fractures of the walls of the right maxillary sinus, including an
orbital floor fracture, with air tracking into the orbit.
4. Large preseptal hematoma lateral to the right orbit as well as hemorrhage
within the right globe.
5. Dense appearance of a sylvian branch of the right MCA within the Sylvian
fissure ("Sylvian dot" sign) may represent acute thrombus. Alternatively,
there may be layering surrounding hemorrhage within the subarachnoid space
within the fissure, although this would be less likely given the focal nature
of the finding. There is no evidence of associated territorial infarction, at
this time.
6. Large right parotid mass, better-evaluated on the concurrent cervical spine
CT.
|
19936782-RR-27 | 19,936,782 | 28,486,132 | RR | 27 | 2154-02-09 03:18:00 | 2154-02-09 04:16:00 | HISTORY: ___ woman status post fall.
TECHNIQUE: MDCT acquired axial images were obtained from the mid maxillary
sinuses through the lung apices. Coronal and sagittal re-formatted images
provided and reviewed.
COMPARISON: NECTs of the cervical spine from ___ and ___.
FINDINGS:
There is no evidence of acute cervical spine fracture or alignment
abnormality. There is severe multilevel degenerative disease, similar to the
prior studies. There is no prevertebral soft tissue abnormality. No
mandibular fracture is seen. There is minimal mucosal thickening in the left
maxillary sinus and multiple fractures of the right maxillary sinus with blood
contained within, as detailed in the report for the concurrent CT of the head.
There is a 5.0 x 2.7 cm heterogeneous mass replacing the right parotid gland
with foci of lower attenuation likely representing necrosis (2:30). This mass
has been slowly enlarging from ___, when it measured only 3.3 x 1.6 cm. The
mass effaces or possibly, invades the right internal jugular vein and carotid
artery. A non-hemorrhagic right pleural effusion is noted.
IMPRESSION:
1. No evidence of acute fracture or alignment abnormality to the cervical
spine. Stable multilevel severe degenerative changes.
2. Heterogeneous right parotid gland mass, with likey central foci of
necrosis, slowly growing over the last ___ years. These findings are highly
suspicious for malignancy.
3. Non-hemorrhagic right pleural effusion may be substantially larger than
imaged, given that it extends to the right apex.
NOTE ADDED IN ATTENDING REVIEW: As above, the mass replacing both the
superficial and deep lobes of the right parotid gland is highly suspicious for
malignancy. It appears to transgress both the pre- and post-styloid
parapharyngeal space. There is no evident cervical lymphadenopathy.
There are right greater than left pleural effusions with smooth interlobular
septal thickening, likely CHF; these findings, along with ground-glass
opacity, likely alveolar edema, were present on the study of ___.
|
19936782-RR-28 | 19,936,782 | 28,486,132 | RR | 28 | 2154-02-09 04:51:00 | 2154-02-09 06:55:00 | HISTORY: ___ woman with pain after fall.
COMPARISON: Radiographs of the pelvis from ___. CT torso later
the same day.
FINDINGS:
2 views of the right hip were provided. Market osteopenia limits assessment.
There is cortical disruption at the superolateral aspect of the right femoral
neck with a irregular dense line through the neck which was not present on the
prior examination. There is also impaction. There are moderate degenerative
changes of the hip with acetabular subchondral sclerosis and spurring. There
are vascular calcifications and multiple phleboliths. Soft tissues are
otherwise unremarkable.
IMPRESSION:
Subtle impacted fracture of the right subcapital femoral neck. Please see CT
for further details.
|
19936782-RR-29 | 19,936,782 | 28,486,132 | RR | 29 | 2154-02-09 04:51:00 | 2154-02-09 07:03:00 | HISTORY: ___ woman with fall and pain.
COMPARISON: Chest radiographs from ___. Radiograph of the pelvis
from ___. CT torso later the same day.
FINDINGS:
AP supine radiograph of the chest: The lungs are hyperinflated but grossly
clear. There is a background of prominent interstitial pulmonary markings and
cardiomegaly, stable from the prior examination, and likely secondary to
chronic congestive heart failure. There are right greater than left pleural
effusions as well as likely pleural thickening. No obvious displaced fracture
is seen. Degenerative changes of the thoracic spine.
Single AP view of the pelvis: Again noted are the findings a subcapital
femoral neck fracture on the right, described in detail in the separate hip
radiographs report. Right hip degenerative changes. The left hip features
severe degenerative changes with near bone-on-bone joint space narrowing and
sclerosis. Degenerative changes of the lower lumbar spine, SI joints, and
pubic symphysis. There is diffuse osteopenia. No pelvic ring fracture is
identified. Soft tissues are unremarkable aside from vascular calcifications
and phleboliths.
IMPRESSION:
1. Cardiomegaly and chronic prominence of the interstitial markings.
2. Bilateral pleural effusions.
3. Right subcapital femoral neck fracture as described in the separate report.
4. No other acute fracture or dislocation identified in the chest or pelvis.
Please see CT for further details.
|
19936782-RR-30 | 19,936,782 | 28,486,132 | RR | 30 | 2154-02-09 05:49:00 | 2154-02-09 07:13:00 | HISTORY: ___ woman after fall and multiple injuries. Evaluate for
further traumatic injury.
TECHNIQUE: MDCT acquired axial images from the thoracic inlet through the
pubic symphysis were obtained without intravenous or enteric contrast.
Coronal and sagittal reformats reviewed.
DLP: 340.25 mGy-cm.
COMPARISON: Radiographs of the right hip from ___ at 5:07.
FINDINGS:
CHEST: The imaged thyroid gland is unremarkable. There is no intra or
extrathoracic lymphadenopathy. Of the thoracic aorta and and the arch vessels
are heavily calcified but patent there also coronary arterial, mitral annular,
and aortic valvular calcifications. There is no pericardial effusion. The
heart is enlarged. The airways are patent. The there is no pneumothorax.
Diffuse septal thickening is noted. There are moderate right and small left
nonhemorrhagic pleural effusions.
ABDOMEN: Noncontrast view of the liver, spleen, pancreas, and kidneys is
unremarkable. There is a right adrenal nodule, of low-attenuation,
statistically likely a benign adrenal adenoma. There are several small
radiopaque gallstones without evidence of cholecystitis. The small bowel is
normal in caliber. The large bowel is also normal in caliber, with a large
stool burden, especially in the rectum. There is colonic diverticulosis but
no evidence of diverticulitis. There is no abdominal free fluid or fluid
collection. There is no lymphadenopathy. The abdominal aorta and all of the
major branch vessels are heavily calcified. A 3.4 cm infrarenal abdominal
aortic aneurysm is seen (2:58).
PELVIS: The urinary bladder appears normal. The uterus is not well seen and
is either surgically absent or atrophic. The ovaries are also not well seen.
There is a large, well-formed, sphere of stool in the rectum. There is no
pelvic free fluid, lymphadenopathy, or mass.
MUSCULOSKELETAL: There are severe but stable degenerative changes of the
entire spine. No acute fracture or alignment abnormality is seen in the
osseous structures of the chest and abdomen. Within the right femoral neck,
there are cortical step-offs both anteriorly and posteriorly, along with an
impacted horizontal fracture line (104:14). No other fracture is seen within
the pelvis. There are no osseous lesions concerning for malignancy.
IMPRESSION:
1. Minimally impacted acute fracture of the right femoral neck.
2. Cardiomegaly, interstitial pulmonary edema, moderate right and small left
nonhemorrhagic pleural effusions, consistent with mild decompensated
congestive heart failure.
3. No evidence of clavicular dislocation as suspected on the prior radiograph.
4. 3.4 cm infrarenal abdominal aortic aneurysm.
5. Cholelithiasis and diverticulosis without evidence of acute inflammatory
changes.
6. No other evidence of acute traumatic injury to the chest, abdomen, or
pelvis.
NOTIFICATION: The new findings regarding the right femoral neck fracture,
which was confirmed after attending review, was communicated to Dr.
___ by Dr. ___ telephone on ___ at 8:24 am, shortly
before the change in the wet read was made.
|
19936782-RR-32 | 19,936,782 | 28,486,132 | RR | 32 | 2154-02-10 12:12:00 | 2154-02-10 13:37:00 | INDICATION: Right subdural hematoma and bilateral frontal intraparenchymal
hematoma after a fall. Questionable right MCA sign.
TECHNIQUE: MDCT data were acquired through the head without intravenous
contrast.
FINDINGS: Bilateral subdural hematomas have increased in size since ___,
3:00 a.m. The right and left subdural hematomas measure 9 and 12 mm in
thickness, respectively, compared with 6 and 7 mm respectively on the prior
exam. The acute blood previously seen in the right subdural hematoma is no
longer present. A hyperdense focus is again seen in the right sylvian fissure
(2:16). In addition, there is a small amount of new subarachnoid blood
layering in a right parietal lobe sulcus (2:8). Foci of intraparenchymal
hemorrhage in the bilateral frontal lobes are unchanged. There is no mass
effect or edema, major vascular territorial infarction, or shift of the
normally midline structures. The size and configuration of the ventricles and
sulci have not changed. Basal cisterns are patent. Periorbital hematoma
around the right eye is again seen. There is now a layering hematocrit level
within the right orbit (2:13). There is mild left periorbital hematoma. A
right parotid mass is incompletely assessed. Hypodensity in the right putamen
is likely an old lacune. Multiple fractures of the right maxillary sinus and
hemorrhage within the sinus are again seen.
IMPRESSION:
1. Increasing size of bilateral subdural collections and decreasing
hyperdense component compatible with redistribution and evolution of subdural
hematoma.
2. Stable appearance of bifrontal intraparenchymal contusions.
3. Hyperdensity in the right sylvian fissure is most likely subarachnoid
hemorrhage. There is redistribution of subarachnoid hemorrhage along a right
parietal lobe fissure. In addition, there is no new major vascular
territorial infarction, which would be expected if the previously seen
hypodensity had been an MCA branch clot.
4. Stable appearance of bilateral periorbital hematomas and blood in the
right globe.
5. Incompletely assessed right maxillary sinus fractures and hemorrhage in
the sinus.
6. Incomplete assessment of right parotid mass.
Findings were discussed with Dr. ___ phone at 12:50.
|
19936782-RR-33 | 19,936,782 | 28,486,132 | RR | 33 | 2154-02-10 13:27:00 | 2154-02-10 14:30:00 | HISTORY: Right hip fracture ORIF.
TECHNIQUE: 2 intraoperative fluoroscopic images of the right hip ___.
COMPARISON: Radiographs ___. CT torso ___.
FINDINGS:
2 views of the right hip. Status post ORIF of the right hip with partially
threaded cannulated screws and washers. The hardware appears intact. Again
seen is the subcapital fracture. No dislocation. No intraoperative
fluoroscopic imaging time 67.4 cm.
IMPRESSION:
Postsurgical changes. Please see operative report for further details.
|
19936782-RR-35 | 19,936,782 | 28,486,132 | RR | 35 | 2154-02-11 10:34:00 | 2154-02-11 12:13:00 | HISTORY: Patient with subdural hematoma for follow up.
TECHNIQUE: Axial images of the head were obtained without contrast.
COMPARISON: Comparison is made with the previous CT of ___.
FINDINGS:
There has been no significant interval change. Bilateral predominantly
hypodense subdural identified in the frontal region. The subdurals are not
significantly changed compared to the prior study when accounting for
differences in angulation and slice selection. A small focus of right frontal
intraparenchymal blood and subarachnoid blood along the left frontal region
and right sylvian fissure are unchanged. Small amount of blood along the
tentorium and posterior falx is also unchanged. There is no hydrocephalus or
midline shift. Brain atrophy seen. Hyperdensity in the right lobe is again
partially visualized.
IMPRESSION:
No significant interval change in the subdural collections intraparenchymal
and subarachnoid and subdural blood compared to the previous CT examination.
No significant new interval findings are seen.
|
19936782-RR-36 | 19,936,782 | 28,291,720 | RR | 36 | 2154-02-23 14:44:00 | 2154-02-23 15:57:00 | HISTORY: Recent fall and failure to thrive. Evaluate for infection,
progression of subdural hematoma, interval change.
TECHNIQUE: Axial helical MDCT images were obtained through the brain without
IV contrast. Multiplanar coronal, sagittal, and thin-section bone algorithm
reconstructed images were acquired.
COMPARISON: Multiple prior CTs of the head most recent ___.
FINDINGS:
Prominent extraaxial space due to combination of volume loss and low density
chronic subdural hematomas are unchanged. There is resolution of prior high
density bifrontal intraparenchymal contusions. There is mild persistent high
density along the falx posteriorly. There is no evidence of new hemorrhage.
There is no edema or evidence of large territorial infarction.
Periventricular white-matter hypodensities are nonspecific but can be seen in
setting of chronic microvascular ischemic disease. Basal cisterns are patent
and there is preservation of gray-white differentiation.
Chronic large right parotid mass is redemonstrated. There are several
chronically opacified mastoid air cells bilaterally. Old right orbital and
maxillary sinus fractures are again seen with hematoma collection persisting
in the right maxillary sinus and right globe. The remaining visualized
paranasal sinuses and middle ear cavities are clear. There are
atherosclerotic mural calcifications of the internal carotid arteries.
IMPRESSION:
1. No significant change in bilateral frontal subdural hematomas.
2. Expected evolution of bifrontal intraparenchymal contusions with no new
hemorrhage.
3. Old right orbital and maxillary sinus fractures.
|
19936782-RR-37 | 19,936,782 | 28,291,720 | RR | 37 | 2154-02-23 15:25:00 | 2154-02-23 16:38:00 | HISTORY: ___ with recent fall and failure to thrive.
COMPARISON: ___.
FINDINGS:
Frontal and lateral views of the chest. As on prior, there is increased
interstitial markings throughout the lungs potentially chronic heart failure.
Increased soft tissue density seen at the right lung apex medially. This area
was not well evaluated on the most recent prior. There has been interval
development of an apparent right air-fluid level on the frontal. There is
also a moderate left pleural effusion. Cardiac silhouette is enlarged but
unchanged. Diffuse osteopenia is noted. No displaced fractures seen.
IMPRESSION:
1. Air-fluid level in the right hemithorax raising concern for
hydropneumothorax. Additional imaging with CT is suggested.
2. Increased density at the right lung apex medially, potentially within the
lung apex versus tortuosity of vessels and possible thyroid enlargement. This
can be further assessed at time of CT.
|
19936782-RR-38 | 19,936,782 | 28,291,720 | RR | 38 | 2154-02-23 15:37:00 | 2154-02-23 16:32:00 | HISTORY: ___ female with recent fall and failure to thrive.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the left tibia and fibula. The bones are
diffusely osteopenic. There is no displaced fracture identified. No
subcutaneous gas or radiopaque foreign body.
IMPRESSION:
No visualized fracture. Diffuse osteopenia.
|
19936782-RR-39 | 19,936,782 | 28,291,720 | RR | 39 | 2154-02-23 17:28:00 | 2154-02-24 14:58:00 | CHEST CT, ___
HISTORY: Assess hydrothorax.
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial and 5-mm thick coronal and parasagittal and 8 x 8 mm MIPS images. Most
recent prior chest imaging, torso CT on ___ is not available for
side-by-side comparison.
FINDINGS:
Moderate-to-large non-hemorrhagic bilateral pleural effusion layers
posteriorly and, by report, has increased since ___, when patient had
findings of cardiac decompensation. There is no pericardial effusion or
pulmonary edema. Severe atelectasis at the lung bases is accompanied by
milder atelectasis in the lingula and right middle lobe. There are no
findings to suggest pneumonia. Atherosclerotic coronary calcification is
widespread and severe. Aortic valvular calcification is also severe.
Atherosclerotic calcification is heavy throughout normal caliber thoracic
aorta, extending into the abdomen. Calcification is also heavy in the head
and neck vessels, particularly origin of the left subclavian artery.
IMPRESSION:
1. Increase in moderate-to-large layering nonhemorrhagic bilateral pleural
effusion with attendant atelectasis.
2. Atherosclerotic calcification heavy in the coronaries, left subclavian
artery, and normal caliber thoracic and upper abdominal aorta. Probable
calcific aortic stenosis.
3. No pneumonia.
|
19936782-RR-40 | 19,936,782 | 28,291,720 | RR | 40 | 2154-02-25 11:43:00 | 2154-02-25 16:32:00 | STUDY: Right hip, ___.
CLINICAL HISTORY: ___ woman with hip fracture of the femoral neck.
FINDINGS: There is a fracture at the subcapital portion of the right femoral
neck. This is fixated by three cannulated screws and washers. This is
unchanged from prior. There are no hardware-related complications. There is
some foreshortening at the site of the femoral neck fracture. Lateral
surgical skin staples are seen. The left hip demonstrates there are severe
degenerative changes of the left hip with complete loss of joint space and
spurring. Degenerative changes of the lower lumbar spine are also seen.
There is some generalized demineralization. Vascular calcifications are
present.
|
19936849-RR-7 | 19,936,849 | 26,242,025 | RR | 7 | 2119-11-17 05:13:00 | 2119-11-17 09:56:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Chest pain.
Comparison is made with prior study, ___.
Moderate-to-severe cardiomegaly is stable. Very tortuous aorta is stable.
The appearance of the mediastinum is unchanged. Linear bibasilar atelectasis
have increased on the right. There is no pneumothorax or effusion. S-shaped
scoliosis is again noted.
|
19937166-RR-33 | 19,937,166 | 20,549,473 | RR | 33 | 2172-10-30 10:42:00 | 2172-10-30 11:56:00 | INDICATION: ___ male with two episodes of syncope and sick contacts.
COMPARISON: None available.
TECHNIQUE: Frontal and lateral chest radiographs were obtained.
FINDINGS: The lungs are clear. No effusion or pneumothorax is noted. Heart
and mediastinal contours are within normal limits.
IMPRESSION: No acute process.
|
19937166-RR-34 | 19,937,166 | 20,549,473 | RR | 34 | 2172-10-30 10:22:00 | 2172-10-30 11:15:00 | INDICATION: ___ male with two syncopal episodes and headache.
Question bleed.
COMPARISON: None available.
TECHNIQUE: Contiguous non-contrast axial images were acquired through the
brain with multiplanar reformations.
FINDINGS: There is no intracranial hemorrhage, mass effect, edema, or shift
of normally midline structures. The gray-white matter differentiation appears
preserved. Ventricles and sulci are normal in caliber for each. Suprasellar
and basilar cisterns are patent.
There is layering intermediate density fluid within the right maxillary sinus,
suggestive of an acute component to the sinus disease. Minimal mucosal
thickening may be present in the ethmoidal air cells. Remainder of paranasal
sinuses and mastoid air cells are well aerated. There is no evidence of skull
base fracture. Globes and soft tissues appear unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Right maxillary sinus disease with layering fluid suggestive of acute
component.
|
19937166-RR-35 | 19,937,166 | 20,549,473 | RR | 35 | 2172-10-30 10:25:00 | 2172-10-30 11:29:00 | INDICATION: ___ male with two syncopal episodes. Question C-spine
injury.
COMPARISON: None available.
TECHNIQUE: MDCT of the C-spine was performed without contrast administration
with multiplanar reformations.
FINDINGS: There are oblique lucencies through the left anterior superior
endplates of C6 and C7 vertebral bodies (2, 55 and 62), age indeterminate and
could represent remote injury as there is no significant surrounding soft
tissue inflammation. The cervical spine demonstrates significant
straightening, likely due to presence of a collar. There is no displaced
fracture. Pre- and para-vertebral soft tissues are unremarkable. There is
minimal disc bulging at C6-7, causing mild ventral canal narrowing. There is
no critical canal or neural foraminal narrowing.
Complete opacification of the right maxillary sinus is noted. Oral and
nasopharyngeal soft tissues are symmetric. Deep cervical soft tissues are
unremarkable. There is no thyroid lesion. Lung apices are clear.
IMPRESSION:
1. Oblique lucencies through the superior endplates of C6 and C7 vertebral
bodies on the left traversing disc spaces may represent non-displaced
fractures, age indeterminate. Recommend clinical correlation with focal
tenderness.
ATTENDING NOTE: The lucencies can also be due to incompletely ossified
osteophytes. Correlate with point tenderness or MRI if concern persists.
|
19937166-RR-36 | 19,937,166 | 20,549,473 | RR | 36 | 2172-10-31 11:11:00 | 2172-10-31 13:19:00 | STUDY: Cervical spine with flexion and extension views, ___.
CLINICAL HISTORY: ___ male with syncope and head trauma. With
C-spine tenderness.
FINDINGS: Comparison is made to the CT scan performed on ___.
There are degenerative changes of the cervical spine with loss of
intervertebral disc space, worse at C5-C6 and C6-C7. There is 1.5 mm of
anterolisthesis of C4 over C5, which does not change with flexion or
extension. Prevertebral soft tissues are normal. No definite compression
fractures are seen, although there is mild wedging at C5 and C6. Prevertebral
soft tissues are normal. The visualized lung apices are clear.
IMPRESSION:
Degenerative changes of the mid to lower cervical spine without signs for
acute bony injury or abnormal motion.
|
19937166-RR-37 | 19,937,166 | 20,549,473 | RR | 37 | 2172-11-02 14:57:00 | 2172-11-04 13:52:00 | Patient Name: ___
MR#: ___
Status: Inpatient
Study Date: ___
Indication: ___ year old man with syncope, head trauma, and wall motion
abnormality on echocardiogram. Evaluate for myocarditis.
Requesting Physician: Dr. ___
Height (in): 71
Weight (lbs): 180
Body Surface Area (m2): 2.02
Hemodynamic Measurements
Measurement ___
Blood Pressure (mmHg) 120 / 66
Heart Rate (bpm) 55
Rhythm: Sinus
___ Measurements
Measurement ___ Male Normal
___
LV End-Diastolic Dimension (mm) 61 <62
LV End-Diastolic Dimension Index (mm/m2) 30 <32
LV End-Systolic Dimension (mm) 42
LV End-Diastolic Volume (ml) *217 <196
LV End-Diastolic Volume Index (ml/m2) *107 <95
LV End-Systolic Volume (ml) 104
LV Stroke Volume (ml) 113
LV Ejection Fraction (%) *52 >54
LV Anteroseptal Wall Thickness (mm) 9 <12
LV Inferolateral Wall Thickness (mm) 8 <11
LV Mass Index (g/m2) 65 <80
RV End-Diastolic Volume (ml) 232
RV End-Diastolic Volume Index (ml/m2) *115 <114
RV End-Systolic Volume (ml) 119
RV Stroke Volume (ml) 113
RV Ejection Fraction (%) 49 >46
QFlow Net Aortic Forward Stroke Volume
(QS net, ml) 102
QFlow Net Pulmonary Artery Forward Stroke Volume
(Qp net, ml) 119
QP/QS 1.14 0.8 - 1.2
QFlow Aortic Cardiac Output (l/min) 5.9
QFlow Aortic Cardiac Index (l/min/m2) 2.9 >2.0
QFlow Aortic Valve Regurgitant Volume (ml) 1
QFlow Aortic Valve Regurgitant Fraction (%) 1 <5
Mitral Valve Regurgitant Volume (ml) 10
Mitral Valve Regurgitant Fraction (%) *9 <5
Effective Forward LVEF (%) *47 >54
Pulmonic Valve Regurgitant Volume (ml) 3
Pulmonic Valve Regurgitant Fraction (%) 3 <5
Tricuspid Valve Regurgitant Volume (ml) 0
Tricuspid Valve Regurgitant Fraction (%) 0 <5
Aortic Valve Area (2-D) (cm2) 4.5 >3.0
Aortic Valve Area Index (cm2/m2) 2.2
Ascending Aorta diameter (mm) 24 <39
Ascending Aorta diameter Index (mm/m2) 12 <20
Transverse Aorta diameter (mm) 20 <31
Descending Aorta diameter (mm) 18 <28
Descending Aorta Index (mm/m2) 9 <14
Main Pulmonary Artery diameter (mm) 25 <29
Main Pulmonary Artery diameter Index (mm/m2) 12 <15
Left Atrium (Parasternal Long Axis) (mm) 29 <40
Left Atrium Length (4-Chamber) (mm) 42 <52
Right Atrium (4-Chamber) (mm) 46 <50
Pericardial Thickness (mm) 2 <4
Coronary Sinus diameter (mm) 9 <15
* = Mildly abnormal, ** =moderately abnormal, *** = severely abnormal
___ Technical Information:
___ Technologists: ___, RT
Nursing support: ___, RN
eGFR: >75 ml/min1.73m2 based on creatinine 0.9 mg/dl on ___
Total Gd-BOPTA (Multihance ) contrast: 16 ml (0.1 mmol/kg)
Injection site: Right antecubital vein
Complications: None.
1) Structure: Axial dual-inversion T1-weighted images of the myocardium were
obtained without spectral fat saturation pre-pulses in 5-mm contiguous slices.
2) Function: Breath-hold cine SSFP images were acquired in the left
ventricular 2-chamber, 4-chamber, horizontal long axis, short axis slices (8-
mm slices with 2-mm gaps), sagittal and coronal orientations of the left
ventricular outflow tract, and aortic valve short axis orientations.
3) Flow: Phase-contrast cine images were obtained transverse to the aorta
(axial plane) and main pulmonary artery (oblique plane).
4) Myocardial Viability/Fibrosis: Late gadolinium enhancement (LGE) images
were obtained using Phase Sensitive Inversion Recovery (PSIR) sequences.
Navigator gated PSIR 3D short-axis (10-mm slices with 5-mm gaps) was obtained
25 minutes after injection of a total of 16 ml Multihance solution.
5) T2W STIR- An ECG gated, T2 weighted STIR sequence was performed in the
short axis plane in 5-mm contiguous slices for assessment of myocardial edema.
Findings:
Structure and Function
There was normal epicardial fat distribution. The myocardium appeared to have
homogenous signal intensity. The pericardial thickness was normal. There was a
trace pericardial effusion. There was a trace left pleural effusion. The
indexed diameters of the ascending and descending thoracic aorta were normal.
The main pulmonary artery diameter index was normal. The left atrial AP
dimension was normal. The right and left atrial lengths in the 4-chamber view
were normal. The coronary sinus diameter was normal.
The left ventricular end-diastolic dimension index was normal. The end-
diastolic volume index was mildly increased. The calculated left ventricular
ejection fraction was mildly decreased at 52% with a focal wall motion
abnormality in the mid-to-distal lateral wall (best appreciated on the long-
axis views). The anteroseptal and inferolateral wall thicknesses were normal.
The left ventricular mass index was normal. The right ventricular end-
diastolic volume index was mildly increased. The calculated right ventricular
ejection fraction was normal at 49%, with normal free wall motion.
The aortic valve was tri-leaflet with normal valve area. A signal void was
seen in the left atrium during systole consistent with mitral regurgitation.
Quantitative Flow
There was no significant intra-cardiac shunt. Aortic flow demonstrated no
significant aortic regurgitation. The calculated mitral valve regurgitant
fraction was consistent with mild mitral regurgitation. The resultant
effective forward LVEF was mildly decreased at 47%. The right ventricular
stroke volume and pulmonic flow demonstrated no significant pulmonic and no
tricuspid regurgitation.
Myocardial Fibrosis
There were no areas of focal hyperenhancement, consistent with the absence of
myocardial scarring/infarction.
Non-Cardiac Findings
There was a left upper lobe consolidation, which may represent atelectasis,
aspiration, or infection.
Impression:
1. Mildly increased left ventricular cavity size with focal wall motion
abnormality (mid-to-distal lateral wall. The LVEF was mildly decreased at
49%. The effective forward LVEF was normal at 47%. No ___ evidence of prior
myocardial scarring/infarction*.
2. Normal right ventricular cavity size and systolic function. The RVEF was
normal at 49%.
3. Mild mitral regurgitation.
4. The indexed diameters of the ascending and descending thoracic aorta were
normal. The main pulmonary artery diameter index was normal.
5. Left upper lobe consolidation, which may represent atelectasis, aspiration,
or infection. Further assessment with chest radiographs or CT may be
considered, if clinically indicated.
*While there is no evidence of myocardial fibrosis or inflammation by late
gadolinium enhancement, the focal wall motion abnormality on both ___ and
echocardiography is suspicious for underlying cardiac pathology. Given the
patient's history of syncope with head trauma, a family history of sudden
cardiac death (brother died of 'heart attack' at age ___, and these abnormal
cardiac findings on two non-invasive imaging modalities, a formal cardiology
consultation is recommended.
Preliminary findings were discussed with Dr. ___ at approximately 4:15
p.m. on ___.
The images were reviewed by Drs. ___
___, and ___.
|
19937166-RR-38 | 19,937,166 | 20,549,473 | RR | 38 | 2172-11-03 11:04:00 | 2172-11-03 13:08:00 | REASON FOR EXAMINATION: Cough, wheezing, and exposure to pneumonia.
PA and lateral upright chest radiographs were reviewed.
No prior studies available for comparison.
Large pneumonia in the lingula is demonstrated in both PA and lateral views.
The rest of the lungs are clear. There is no appreciable pleural effusion or
pneumothorax. The heart size and cardiomediastinal silhouette are
unremarkable.
Followup of the patient in four weeks after completion of antibiotic therapy
is recommended for documentation of resolution.
Findings were submitted to radiology dashboard for documentation of critical
results by Dr ___ on ___ at 2:30 pm
|
19937166-RR-39 | 19,937,166 | 20,549,473 | RR | 39 | 2172-11-03 18:31:00 | 2172-11-04 10:24:00 | CT OF THE CHEST WITH IV CONTRAST
INDICATION: ___ man with syncope, pneumonia, evaluate for PE.
CT OF THE CHEST WITH IV CONTRAST: Multiple small lymph nodes are identified
in the axilla bilaterally and in the anterior mediastinum, they measure up to
0.7 cm in short axis and thus do not qualify as pathologically enlarged. A
1.2-cm lymph node is seen in the right hilum. Lymphadenopathy is also noted
along the left hilum measuring up to 1.1 cm. There are no pleural effusions.
There are no filling defects within the pulmonary arteries. A 3-mm
noncalcified lung nodule is seen in the right middle lobe (series 4, ___ 45).
In the left lung there is consolidation in the posterior segment of the upper
lobe. No lung nodules or masses are seen.
The depicted portions of the liver and spleen are unremarkable.
On bone windows, there are no concerning osteolytic or osteosclerotic lesions.
IMPRESSION:
1. No evidence of PE.
2. Pneumonia in the left upper lobe with reactive bilateral hilar
lymphadenopathy.
3. 3 mm noncalcified lung nodule. In a patient at low risk, no further
followup is necessary, in a patient at high-risk for lung cancer, a one-year
followup CT of the chest is recommended to ensure stability.
|
19937193-RR-19 | 19,937,193 | 28,366,652 | RR | 19 | 2135-05-31 14:58:00 | 2135-05-31 16:14:00 | HISTORY: Syncope, fall with subdural hematoma.
COMPARISON: None.
FINDINGS: Single supine AP view is provided. There are low lung volumes
resulting in bronchovascular crowding, but the lungs appear clear. The
superior mediastinum appears widened, which may reflect supine AP technique,
however, if there is clinical concern for mediastinal or aortic injury
consider chest CTA. There is no pneumothorax or pleural effusion.
IMPRESSION: superior mediastinum appears widened, which may reflect supine
position and AP technique, however, if there is clinical concern for
mediastinal or aortic injury chest CTA should be considered.
Communicated to Dr. ___ at 5:28 p.m. on ___ by phone by Dr.
___.
|
19937193-RR-20 | 19,937,193 | 28,366,652 | RR | 20 | 2135-05-31 17:59:00 | 2135-05-31 21:16:00 | HISTORY: Chest pain, syncope, widened mediastinum on chest radiograph.
TECHNIQUE: MDCT imaging of the chest without intravenous contrast was
performed. Multiplanar reformats were prepared and reviewed.
COMPARISON: Comparison is made with chest radiographs from earlier the same
day, ___.
FINDINGS: The lungs are clear. There is no mass, or consolidation, but
multiple tiny perpheral lung nodules are seen (Right- Se2, Im38, 40, 48; Left-
Se4, Im128, 136, 224). Airways are patent to the subsegmental levels
bilaterally. No pathologically enlarged axillary, mediastinal, or hilar lymph
nodes are identified. There is no pleural effusion or pneumothroax.
Moderate atherosclerotic disease is seen in the aorta. The heart,
pericardium, and great vessels are otherwise within normal limits. There is
no evidence of aortic dilatation. The finding of widened mediastinum on
recent chest radiograph appears to be attributable to a lateralized course of
the SVC. The thyroid gland is unremarkable.
This study is not tailored for subdiaphragmatic evaluation, but a hypodensity
consistent with a cyst is seen in the liver. The visualized abdominal organs
are otherwise unremarkable.
BONE WINDOWS: No focal lytic or sclerotic osseous lesion suspicious for
infection or malignancy is seen. Degenerative changes are seen throughout the
spine.
IMPRESSION:
1. No evidence of aortic aneurysmal dilatation or other acute findings. The
finding of widened mediastinum on recent chest radiograph appears to be
attributable to a lateralized course of the SVC.
2. Multiple very small peripheral pulmonary nodules bilaterally, the largest
measuring 4mm. In the absence of specific risk factors for primary or
secondary pulmonary malignancy, a followup CT is recommended in 12 months. If
risk factors are known, followup in 6 months.
|
19937193-RR-22 | 19,937,193 | 28,366,652 | RR | 22 | 2135-06-01 04:54:00 | 2135-06-01 05:46:00 | INDICATION: Status post fall with subarachnoid hemorrhage and subdural
hematoma. Assess for interval change.
COMPARISON: Head CT on ___ at 1309.
TOTAL DLP: 898 mGy-cm.
CTDIvol: 61 mGy.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered. Coronal and sagittal reformations were performed.
Bone algorithm was obtained.
FINDINGS: Again seen is the subarachnoid hemorrhage along the sylvian
fissures bilaterally and right and left parietal lobes and left frontal lobe,
which are unchanged. There is a new small amount of blood in the collicular
cistern. (2, 11). There is no evidence of hydrocephalus. The ventricles are
unchanged in size and configuration. The left parietal subdural hematoma
measuring up to 14 mm in thickness, unchanged. There is mild mass effect on
the adjacent sulci. There is no shift of normally midline structures. Again
seen is a small-to-moderate subgaleal hematoma along the left parietal bone.
There is no fracture. The visualized paranasal sinuses and mastoid air cells
are well aerated.
IMPRESSION:
1. New small amount of blood in the right collicular cistern. No
hydrocephalus.
2. Unchanged subarachnoid hemorrhage involving the sylvian fissures
bilaterally, parietal lobes bilaterally and left frontal lobe.
3. Unchanged left subdural hematoma.
4. No significant mass effect.
|
19937193-RR-23 | 19,937,193 | 28,366,652 | RR | 23 | 2135-06-02 11:22:00 | 2135-06-02 12:46:00 | ___
Department of Radiology
Standard Report- Carotid Series Complete
Reason: ___ year old s/p syncopal episode
Findings: Duplex evaluation was performed of bilateral carotid arteries. On
the right there is no plaque in the ICA. On the left there is no plaque in the
ICA. Tortuous ICAs bilaterally.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 63/13, 55/9, 66/8 cm/sec. CCA peak systolic velocity
is 59 cm/sec. ECA peak systolic velocity is 41 cm/sec. The ICA/CCA ratio is
1.4. These findings are consistent with no stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 62/13, 80/20, 56/13 cm/sec. CCA peak systolic velocity
is 70 cm/sec. ECA peak systolic velocity is 74 cm/sec. The ICA/CCA ratio is
1.1. These findings are consistent with no stenosis.
There is antegrade right vertebral artery flow.
There is antegrade left vertebral artery flow.
Impression: Right ICA with no stenosis.
Left ICA with no stenosis.
|
19937193-RR-25 | 19,937,193 | 29,759,889 | RR | 25 | 2135-06-07 11:53:00 | 2135-06-07 13:43:00 | PA AND LATERAL CHEST, ___
COMPARISON: Radiograph of one day earlier.
FINDINGS: Stable cardiomegaly and tortuosity of the thoracic aorta. Minimal
linear atelectasis at the left lung base, but no focal areas of consolidation
to suggest the presence of pneumonia. Relative flattening of hemidiaphragms
suggests the possibility of COPD in the appropriate clinical setting. Bones
are diffusely demineralized, and degenerative changes are present within the
spine.
IMPRESSION: Linear left basilar atelectasis. No evidence of pneumonia.
|
19937193-RR-26 | 19,937,193 | 29,759,889 | RR | 26 | 2135-06-08 13:55:00 | 2135-06-08 14:35:00 | HISTORY: Recurrent syncope and subdural hematoma from fall now with altered
mental status, lethargy. Please evaluate for new bleeds and existing subdural
hematoma.
COMPARISON: Prior head CT from ___.
TECHNIQUE: Contigouous axial MDCT images were obtained through the brain
without IV contrast.
Total exam DLP: 1093 mGy-cm.
FINDINGS:
As compared to prior head CT from ___, mild diffuse subarachnoid
hemorrhage along the Sylvian fissures bilaterally persists, but is less
prominent. There still remains a small amount of subarachnoid hemorrhage at
the left frontal lobe (3:27) and right and left parietal lobes. There is no
evidence of hydrocephalus. Ventricles and sulci remain stable. Left parietal
subdural hematoma measures 8 mm, decreased ins size when compared to prior
examination and causing mild mass effect of adjacent sulci. There is no shift
of normally midline structures. Subgaleal hematoma along the left parietal
bone has also decreased in size. No new areas of hemorrhage identified.
No fracture identified. Visualized paranasal sinuses, mastoid air cells and
middle ear cavities are clear.
IMPRESSION:
1. No new areas of hemorrhage identified. Subarachnoid hemorrhage involving
the Sylvian fissures bilaterally has resolved. Small amount of subarachnoid
hemorrhage remains at the left frontal lobe and parietal lobes bilaterally.
2. Interval decrease of left parietal subdural hematoma and subgaleal
hematoma.
|
19937193-RR-32 | 19,937,193 | 27,795,852 | RR | 32 | 2137-10-30 18:37:00 | 2137-10-30 18:56:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with seizures // ?pna
COMPARISON: PRIOR EXAM FROM ___.
FINDINGS:
AP upright and lateral views of the chest provided. Lung volumes are low
limiting assessment. There is mild left basal atelectasis which appears
unchanged. There is likely mild hilar congestion with mild stable
cardiomegaly. The aorta is calcified and somewhat unfolded. No convincing
evidence for pneumonia, large effusion or pneumothorax. Visualized osseous
structures appear intact.
IMPRESSION:
As above.
|
19937193-RR-33 | 19,937,193 | 27,795,852 | RR | 33 | 2137-10-30 19:44:00 | 2137-10-30 20:26:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with recent SDH, seizures // ?interval change SDH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI of the brain from ___ and CT of the head from ___.
FINDINGS:
There is an mixed density right cerebral subdural hematoma measuring up to 8
mm in maximal thickness and causing right cerebral sulcal effacement and
minimal shift of midline structures to the left, approximately 4 mm. The
majority of this right cerebral subdural hematoma contains intermediate
density material likely subacute hemorrhage with a small hyperdense acute
component (02:20). There is a subacute infarct in the right frontal cortex,
with mild interval evolution. Ventricular size is unchanged and there is no
intraparenchymal or intraventricular hemorrhage.
There is no fracture or scalp hematoma. The paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
IMPRESSION:
1. Right cerebral subdural hematoma containing acute and subacute hemorrhagic
components, measures up to 8 mm an causes 4 mm of leftward shift of midline
structures. Minimal change from prior.
2. Expected evolution of the subacute infarct in the right frontal cortex.
|
19937193-RR-34 | 19,937,193 | 27,795,852 | RR | 34 | 2137-10-31 02:10:00 | 2137-10-31 10:12:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with seizure and new cough, now has increased
O2 requirement // ?infiltrate ?infiltrate
IMPRESSION:
There no prior chest radiographs since ___ most recently ___.
In the setting of chronic moderate cardiomegaly and persistent pulmonary
vascular congestion, new opacification at the lung bases should be treated as
possible edema. Alternatively this could represent aspiration, particularly
in the right lower lobe.
Small left pleural effusion is new. No pneumothorax.
|
19937193-RR-35 | 19,937,193 | 27,795,852 | RR | 35 | 2137-10-31 11:19:00 | 2137-10-31 16:53:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with RT SDH and increased midline shift. //
Please assess for interval change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.3 cm; CTDIvol = 52.0 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: Noncontrast head CT dated ___.
MRI with and without contrast dated ___ to
FINDINGS:
Images are degraded by motion artifact.
There is a subdural fluid collection on the right, which is unchanged in size
compared to the prior examination. The right subdural fluid collection
contains mixed density, likely representing evolution of the acute hemorrhage
visualized on the prior exams. There is effacement of the sulci and of the
right lateral ventricle, which is unchanged compared to prior. There is
minimal right-to-left midline shift, also unchanged. There is an evolving
infarction involving the right frontal lobe, better visualized on the MRI
dated ___. No evidence of new hemorrhage.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The patient is
status post bilateral cataract surgery. Otherwise, the visualized portion of
the orbits are unremarkable.
IMPRESSION:
1. Evolution of the subdural fluid collection on the right, without evidence
of new hemorrhage.
2. Minimal right-to-left midline shift with effacement of the sulci and right
lateral ventricle, unchanged from prior.
3. Evolving infarct involving the right frontal lobe, better visualized on the
prior MRI.
|
19937193-RR-36 | 19,937,193 | 27,795,852 | RR | 36 | 2137-11-01 09:54:00 | 2137-11-01 12:42:00 | EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ year old woman with PMH of subdural hematoma due to traumatic
head injury after a fall. In the EP lab, while being prepped for a pacemaker,
the patient became unresponsive. Was very animated prior to that episode. No
sedation meds given prior to the episode. Stroke code was called. CTA is
requested for further evaluation.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 7.0 s, 0.5 cm; CTDIvol = 76.2 mGy (Head) DLP =
38.1 mGy-cm.
3) Spiral Acquisition 4.3 s, 33.9 cm; CTDIvol = 30.8 mGy (Head) DLP =
1,043.0 mGy-cm.
Total DLP (Head) = 1,884 mGy-cm.
COMPARISON: Noncontrast head CT dated ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Again visualized is the mixed density right subdural collection, which is
unchanged in size compared to the prior CT. There is small focus of
hyperdense blood within this collection anteriorly, which appear slightly
denser than on the prior CT on images 2:21, 2:22, but this is most likely
artifactual given the lack of enlargement. Stable hypodensity within the right
frontal lobe represents evolving subacute infarction. No evidence of new
hemorrhage or large vascular territorial infarction. The ventricles and sulci
are stable in size and configuration. Minimal leftward shift of the septum
pellucidum is stable.
The patient is status post bilateral cataract surgery.
CTA HEAD:
There is calcified plaque within bilateral carotid siphons without evidence
for flow-limiting stenosis. There is calcified plaque causing short-segment
mild stenosis of the proximal V4 segment of the left vertebral artery. No
flow-limiting stenosis is seen elsewhere in the intracranial circulation.
There is no evidence for an aneurysm. The major dural venous sinuses are
patent.
CTA NECK:
There is atherosclerotic calcification of the aortic arch and the great vessel
origins. There is at least mild narrowing of the proximal left subclavian
artery. There is mild plaque in the proximal right subclavian artery without
associated stenosis.
There is a tortuous right common carotid artery with medialization of its
distal portion, indenting the posterior pharyngeal wall. There is no internal
carotid atherosclerosis or stenosis by NASCET criteria. There is a high-grade
stenosis at the origin of the left vertebral artery. The right vertebral
artery appears widely patent.
OTHER:
There is dependent atelectasis with the lungs bilaterally. There is fluid
within the superior pericardial recesses. The thyroid gland is grossly
unremarkable. There is no cervical lymphadenopathy by CT size criteria. There
are degenerative changes within the cervical spine.
IMPRESSION:
1. The mixed density right subdural hematoma is stable in size. The small
focus of hyperdense blood within the anterior aspect of the collection appears
slightly denser than on the prior CT, but this is most likely artifactual
given the lack of enlargement. This may be reassessed on follow-up
noncontrast CT.
2. Stable appearance of evolving subacute infarction in the right frontal
lobe.
3. High-grade stenosis at origin of the left vertebral artery
4. Mild short-segment stenosis of the proximal V4 segment of the left
vertebral artery.
5. At least mild narrowing of the proximal left subclavian artery.
6. No evidence for carotid stenosis.
|
19937193-RR-37 | 19,937,193 | 27,795,852 | RR | 37 | 2137-11-02 14:17:00 | 2137-11-02 14:48:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with CHB, s/p PPM // ___ year old woman with
CHB, s/p PPM ___ year old woman with CHB, s/p PPM
IMPRESSION:
In comparison to study of ___, there is an placement of a single lead
pacer that extends to the apex of the right ventricle. Lower lung volumes
with continued enlargement of the cardiac silhouette and persistent pulmonary
vascular congestion. Opacification at the left base is consistent with volume
loss in the lower lobe and pleural fluid.
|
19937419-RR-35 | 19,937,419 | 28,594,237 | RR | 35 | 2136-03-02 23:11:00 | 2136-03-03 03:24:00 | CLINICAL INDICATION: Recent pneumonia. Evaluation for pneumonia.
COMPARISON: Chest radiograph ___.
FRONTAL AND LATERAL VIEWS OF THE CHEST: Compared to the prior chest
radiograph of ___, the previously seen right upper lobe opacity
persists and is relatively unchanged. The lung volumes have slightly
improved; however, a left pleural effusion is new or increased since ___. There is no pneumothorax. Median sternotomy wires and clips projecting
over the left heart are again noted.
IMPRESSION: Relatively unchanged right upper lobe pneumonia. New or
increased left pleural effusion.
|
19937419-RR-37 | 19,937,419 | 24,524,345 | RR | 37 | 2136-06-29 10:39:00 | 2136-06-29 11:20:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Evaluate for subdural bleed
TECHNIQUE: Contiguous axial images MDCT images of the brain were obtained
without intravenous contrast. Coronal and sagittal as well as thin
bone-algorithm reconstructed images were obtained. The scan was repeated due
to severe patient motion.
DLP: 1226 mGy-cm
COMPARISON: Head CT dated ___.
FINDINGS:
There is no hemorrhage, edema, mass effect, midline shift, or mass. Prominence
of ventricles and sulci as indicative of age-advanced involutional change.
Periventricular and subcortical white matter hypodensities are nonspecific but
most likely due to chronic small vessel ischemia. Focal hypodensity in the
left thalamus likely represents a prior lacunar infarct. Encephalomalacia
adjacent to the occipital horns bilaterally are indicative of chronic
infarcts. The basal cisterns are patent and there is normal gray-white matter
differentiation.
No bony abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
Sequela of chronic small vessel ischemic disease and evidence of prior
infarcts, but no evidence of subdural fluid collection.
|
19937419-RR-38 | 19,937,419 | 24,524,345 | RR | 38 | 2136-06-30 12:50:00 | 2136-06-30 14:16:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man poor historian, has anoxic brain injury, now with
question of change in mental status. Need to rule out infection. // Evaluate
for infection
TECHNIQUE: Portable chest
___
FINDINGS:
There is volume loss in both lower lungs. Early infiltrates in these regions
cannot be excluded. Compared to the study from 4 months ago the right upper
lobe process has resolved the heart continues to be mildly enlarged. Sternal
wires are again seen. Mediastinal clips are again visualized. There are tiny
bilateral pleural effusions
IMPRESSION:
Volume loss/early infiltrates in both bases.
|
19937419-RR-39 | 19,937,419 | 21,585,853 | RR | 39 | 2136-07-10 02:30:00 | 2136-07-10 05:14:00 | INDICATION: Hypoxia with altered mental status. Evaluate for intracranial
injury.
COMPARISON: NECT head, ___ and ___.
TECHNIQUE: Axial MDCT images were obtained through the brain without IV
contrast. Multiplanar axial, coronal, sagittal, and thin section bone
algorithm reconstructed images were generated.
TOTAL BODY DLP: 1003 mGy-cm.
CTDIvol: 50 mGy.
FINDINGS: There is no evidence of acute intracranial hemorrhage, edema, mass
effect or large territorial infarction. The ventricles and sulci as on the
prior study are quite prominent, suggesting age-related atrophy.
Periventricular and subcortical white matter hypodensities are unchanged,
compatible with small vessel ischemic disease. The basal cisterns are patent.
There is no fracture. The paranasal sinuses, mastoid air cells, and middle
ear cavities are clear.
IMPRESSION:
1. No acute intracranial abnormality.
2. Global atrophy, sequelae of chronic small vessel ischemic disease, and
right more than left parieto-occipital encephalomalacia, unchanged since
___, related to remote infarction.
|
19937419-RR-40 | 19,937,419 | 21,585,853 | RR | 40 | 2136-07-10 02:43:00 | 2136-07-10 07:13:00 | INDICATION: Hypoxia. Evaluate for pneumonia.
COMPARISON: Chest radiograph ___ through ___.
TECHNIQUE: Portable supine AP chest.
FINDINGS: Lung volumes are low. There may be a left retrocardiac opacity.
There is bibasilar atelectasis. There is no large pleural effusion or
pneumothorax. The heart is not enlarged. The mediastinal and hilar contours
are normal. Upper median sternotomy wire is in minimally different
orientation since ___ and possibly fractured.
IMPRESSION:
1. Possible left retrocardiac opacity may reflect pneumonia in the right
clinical setting.
2. Possible fractured or minimally displaced superior median sternotomy wire.
Please correlate for site of pain, if any, on physical exam.
|
19937419-RR-41 | 19,937,419 | 21,585,853 | RR | 41 | 2136-07-10 04:17:00 | 2136-07-10 07:12:00 | INDICATION: History of TBI, with new hypoxia and unable to get CT given renal
failure. Evaluate for DVT.
COMPARISON: None available.
TECHNIQUE: Grayscale, color and spectral Doppler ultrasound evaluation of the
bilateral lower extremity veins.
FINDINGS: There is normal compressibility, flow and augmentation in the
bilateral common femoral, proximal femoral, mid femoral, distal femoral and
popliteal veins. Normal color flow is demonstrated in the posterior tibial
and peroneal veins. There is normal respiratory variation in the common
femoral veins bilaterally.
IMPRESSION: No evidence of DVT in the right or left lower extremity veins.
|
19937419-RR-42 | 19,937,419 | 21,585,853 | RR | 42 | 2136-07-10 10:09:00 | 2136-07-10 13:40:00 | HISTORY: ___ male with hypoxia of unclear source.
COMPARISON: None available.
TECHNIQUE: Multidetector CT images through the chest were obtained in the
absence of intravenous contrast. Soft tissue and lung algorithm images were
acquired. Coronal and sagittal reformations as well as axial maximum
intensity projection images were generated and reviewed.
DLP: 696 mGy-cm.
FINDINGS: The thyroid gland is unremarkable. There is no axillary,
mediastinal, or hilar adenopathy. The esophagus demonstrates no abnormality.
Unenhanced images of the heart and pericardium are unremarkable and within
normal limits. Post-surgical clips are identified within the coronary artery
vasculature as are median sternotomy wires. The thoracic aorta demonstrates
mild atherosclerotic calcifications, without aneurysmal dilatation. No
evidence of intramural hematoma.
Lung windows demonstrate bibasilar atelectatic changes. There is a right lower
lobe consolidation with air bronchograms concerning for pneumonia. There is
no pleural effusion or pneumothorax. There is a 6 mm nodule within the left
lower lobe (3:36). An additional 3 mm subpleural nodule within the right lower
lobe (2:28) is identified.
Limited images of the abdomen demonstrate incidental peripheral calcifications
within the spleen posteriorly, possible sequela of prior trauma.
OSSEOUS STRUCTURES: No focal lytic or blastic lesion is identified. Patient
is status post sternotomy with intact wires identified.
IMPRESSION:
1. Right lower lobe opacity with air bronchograms concerning for pneumonia.
Bibasilar atelectatic changes.
2. 6 mm left lower lobe nodule. In the absence of risk factors or history of
smoking, per ___ criteria, a followup chest CT is recommended in 12
months, otherwise ___ month followup is suggested.
|
19937419-RR-43 | 19,937,419 | 21,585,853 | RR | 43 | 2136-07-11 12:34:00 | 2136-07-13 10:27:00 | EXAMINATION: CHEST PORT. LINE PLACEMENTCHEST PORT. LINE PLACEMENTi
INDICATION: ___ year old man with PICC. // Pt had a right picc placed,38cm
___ ___ Contact name: ___ , ___: ___
TECHNIQUE: .
COMPARISON: Chest radiographs ___.
IMPRESSION:
This examination was presented for review on ___ at 10:20.
New right PIC line ends in the right neck, no less than 10 cm into the right
internal jugular vein. Previous right lower lobe collapse has been replaced by
consolidation concerning for pneumonia or pulmonary hemorrhage. Left lung
clear. Heart size normal. No pneumothorax
|
19937419-RR-44 | 19,937,419 | 21,585,853 | RR | 44 | 2136-07-11 13:47:00 | 2136-07-11 16:52:00 | INDICATION: PICC line placement.
COMPARISON: ___ at 12:43.
FINDINGS: Right PICC continues to course superiorly off the superior portion
of the image in the right internal jugular vein. Otherwise, the study is
unchanged. Right lower lung consolidation is again seen but less apparent.
IMPRESSION: Right IJ central venous line continues to course up the upper
right IJ. Right lower lobe consolidation again seen but less apparent and may
represent atelectasis or pneumonia.
|
19937419-RR-45 | 19,937,419 | 21,585,853 | RR | 45 | 2136-07-12 13:33:00 | 2136-07-12 14:43:00 | INDICATION: ___ year old man with pneumonia on vanc/cefepime. Please assess
placement of PICC line.
TECHNIQUE: Portable AP Upright view of the chest
COMPARISON: ___
FINDINGS:
There is interval placement of a right PICC with tip in the mid SVC. Right
lower lobe and retrocardiac opacity is relatively unchanged, and remains
concerning for pneumonia. Cardiomediastinal silhouette is stable. There is no
pleural effusion or pneumothorax. Midline sternotomy wires again noted.
IMPRESSION:
Interval placement of right PICC terminating in the mid SVC, otherwise
unchanged.
|
19937688-RR-27 | 19,937,688 | 20,981,455 | RR | 27 | 2142-02-12 10:12:00 | 2142-02-12 12:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sepsis, assess for new focal opacity
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
AP view of the chest provided.
Compared to prior study, the cardiac silhouette has increased in size. There
is also increased opacity in bilateral lung bases. These findings are
suggestive of pulmonary vascular congestion. However, in view of the clinical
history provided, these findings could also reflect multifocal pneumonia. Old
deformity of the left clavicle is again seen.
IMPRESSION:
Bilateral lung base opacity, in association with increase in cardiac size,
likely refecting pulmonary vascular congestion. However, given clinical
history, multifocal pneumonia is also a possibility.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 11:28 AM, 10 minutes after the images were radiology.
|
19937688-RR-29 | 19,937,688 | 20,981,455 | RR | 29 | 2142-02-14 13:48:00 | 2142-02-14 15:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: Mr. ___ is a ___ legally blind M h/o CAD, hypertension,
prostate cancer s/p surgery and laminectomy with residual right foot drop, as
well as recent spinal surgery for L5-S1 disc herniation on ___ transferred
from ___ with Afib with RVR in setting of likely viral gastroenteritis
and sepsis. Currently hemodynamically stable, afebrile. But persistent
leukocytosis. Looking for possible infectious pulmonary source. // evidence
of infiltrate? compared to previous CXR evidence of infiltrate? compared to
previous CXR
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
Mild pulmonary edema has improved since ___, but greater opacification at
the right lung base is concerning for pneumonia, accompanied by increasing
small right pleural effusion. Heart size is normal. No pneumothorax.
|
19937688-RR-30 | 19,937,688 | 20,981,455 | RR | 30 | 2142-02-16 18:33:00 | 2142-02-19 17:46:00 | EXAMINATION: MRI abdomen with and without contrast.
INDICATION: ___ year old man with persistent leukocytosis and suprapubic pain
and abnormal findings on recent CT (pancreatic mass, splenic abnormality,
mesenteric mass/calcifications). // Please further eval abnormalities seen on
CT and look for potential source of infection given leukocytosis.
TECHNIQUE: Multiplanar T1 and T2 weighted sequences were obtained in a 1.5
Tesla magnet including T1-weighted imaging performed prior to, during, and
after the uneventful administration 8cc of Gadavist using a non-breath-hold
protocol.
COMPARISON: CT abdomen pelvis of ___.
FINDINGS:
LOWER CHEST: Bibasilar atelectasis with small pleural effusions.
ABDOMEN: Study is significantly limited by motion and by non-breath-hold
technique. The liver demonstrates signal loss on out of phase as opposed to in
phase sequences, consistent with fatty liver. The gallbladder and bile ducts
are normal. No intra or extrahepatic bile duct dilatation. 2.5 x 1.7 cm cystic
lesion in the head of the pancreas is consistent with a side-branch IPMN.
There is no obvious nodularity or concerning enhancement within this lesion.
The pancreatic duct is dilated to 5 mm in the pancreatic head, but is not
dilated proximally. A few additional 3 mm and smaller T2 hyperintense lesions
in the pancreas (05: 27, 31, 39) are also consistent with side branch IPMNs.
Linear band of T2 hyperintensity without enhancement or evidence of hemorrhage
within the spleen is consistent with splenic infarction. Adrenal glands are
normal. Simple cysts are seen in both kidneys. Heterogeneous appearance of
the left kidney upper pole is not well characterized on this exam because of
respiratory motion with mild hyperintensity on T2-WI and heterogeneous
hypoenhancement, potentially an infarct. The ureters are normal caliber.
The stomach, small bowel, and large bowel are unremarkable other than
diverticulosis. No retroperitoneal lymphadenopathy. Mesenteric nodes in the
left mid abdomen with associated fat stranding is consistent with sclerosing
mesenteritis, given calcification within the mesentery on ___ CT.
Trace ascites and pelvic fluid.
The aorta is tortuous and thrombus is identified extending from the left
common iliac artery through the left external iliac artery into the left
common femoral artery. Thrombus appears near occlusive in the left external
iliac artery and partially occlusive within the common femoral and common
iliac arteries. There is also suggestion of thrombus in the left internal
iliac vein (17:23).
The bladder is unremarkable other than a small air-fluid level likely related
to recent Foley catheterization. No pelvic sidewall or inguinal
lymphadenopathy. The bone marrow signal is normal.
IMPRESSION:
1. Near-occlusive thrombus in the left external iliac artery and partially
occlusive thrombus in the left common iliac and left common femoral arteries.
Probable thrombus in the left internal iliac vein. CTA could be obtained for
further assessment if clinically desired.
2. Multiple cystic lesions in the pancreas, the largest of which measures 2.5
x 1.7 cm in the pancreatic head. Findings are consistent with multiple side
branch IPMNs, though combined type cannot be excluded given mild dilatation of
the downstream main pancreatic duct.
3. Heterogeneous appearance of the left kidney upper pole is poorly
characterized due to respiratory motion and may represent an infarct or
potentially a complex cystic lesion. If needed, this can be further
characterized with ultrasound.
4. Prominent left mesenteric nodes with surrounding hazy fat stranding,
consistent with sclerosing mesenteritis.
5. Fatty liver.
6. Trace ascites and pelvic fluid. Small bilateral pleural effusions.
7. Splenic infarction.
NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr.
___ on ___ at 9:48 AM, 10 minutes after discovery of the
findings.
|
19937688-RR-31 | 19,937,688 | 20,981,455 | RR | 31 | 2142-02-16 22:22:00 | 2142-02-16 22:57:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ male with new onset altered mental status. Evaluate
for acute infarct.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 891.9 mGy-cm
CTDI: 53.8 mGy
COMPARISON: ___ noncontrast head CT.
FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass. Hypodensities in the basal ganglia bilaterally are unchanged
compared to ___, and likely related to prior infarct. Prominent
ventricles and sulci are suggestive of age-related involutional change.
Periventricular white matter hypodensities are consistent with chronic small
vessel ischemic disease. Right thalamic and bilateral basal ganglia lacunar
infarcts are again seen. Atherosclerotic vascular calcifications are noted of
bilateral vertebral and cavernous portions of internal carotid arteries.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits again demonstrate change related to
bilateral orbital surgery.
IMPRESSION:
1. No evidence of acute large territorial infarct or hemorrhage. Please note,
however, that MR is more sensitive in the detection of acute stroke.
2. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
|
19937688-RR-32 | 19,937,688 | 20,981,455 | RR | 32 | 2142-02-17 14:51:00 | 2142-02-17 18:09:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old man with history of atrial fibrillation, now with
aphasia. Evaluate for acute infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique.
COMPARISON: ___ noncontrast head CT and ___ brain MRI.
FINDINGS:
Please note the study is degraded by motion. There is prominence of the
ventricles and sulci suggestive involutional changes. Periventricular and
subcortical T2 and FLAIR hyperintensities are noted, which may represent small
vessel ischemic changes. There is a punctate focus of hemorrhage within the
left frontal lobe (see series 7, image 15), that is new since the ___
prior brain MRI.
There is an approximately 1.5 cm left parietal wedge-shaped area of subacute
infarct. Additional punctate acute infarcts are noted within the left frontal,
left occipital and right parietal lobes.
There is no evidence of edema, masses, mass effect. There is a chronic right
cerebellar infarct again noted. There is a stable right maxillary sinus mucous
retention cyst versus polyp. The visualized portion of the orbits are
preserved. Small nonspecific left mastoid fluid is present.
IMPRESSION:
1. Study is degraded by motion.
2. Wedge shape subacute left parietal infarct as described.
3. Punctate left frontal, left occipital, and right parietal acute infarcts.
In the setting of atrial fibrillation, findings concerning for embolic
etiology. Recommend clinical correlation.
4. Atrophy and small vessel ischemic changes as described.
5. Paranasal sinus disease as described.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 5:55 ___, immediately after discovery of the
findings.
|
19937688-RR-33 | 19,937,688 | 20,981,455 | RR | 33 | 2142-02-19 08:49:00 | 2142-02-19 11:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ legally blind M h/o CAD, hypertension, prostate cancer s/p
surgery and laminectomy with residual right foot drop, as well as recent
spinal surgery for L5-S1 disc herniation on ___ transferred from BI
___ with Afib with RVR in setting of likely viral gastroenteritis and
sepsis. Sepsis resolved. Now with persistent leukocytosis, most likely from
aspiration pneumonia. // Progression vs resolution of RLL infiltrate. If
worse or stable, may give empiric abx
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Heart size and mediastinum appear to be unchanged since the prior study. The
bibasal atelectasis are unchanged but there is interval improvement in
pulmonary edema. Right basal consolidation appears to be improved as well.
|
19937688-RR-34 | 19,937,688 | 20,981,455 | RR | 34 | 2142-02-19 22:52:00 | 2142-02-20 08:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CAD, afib on apixaban, and multiple arterial
thrombi now with worsening dyspnea and pleuritic chest pain. // Please eval
for e/o PTX, PNA, CHF.
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, there are now moderately increasing
bilateral pleural effusions and a increasing retrocardiac atelectasis. The
size of the cardiac silhouette continues to be enlarged. Mild moderate
pulmonary edema is present and has minimally increased in severity since the
previous image. No evidence of pneumonia.
|
19937688-RR-35 | 19,937,688 | 20,981,455 | RR | 35 | 2142-02-20 10:54:00 | 2142-02-20 17:43:00 | EXAMINATION: CHEST CTA
INDICATION: A ___ man with a history of prostate cancer status post
recent surgery, now with AFib with RVR, evaluate for pneumonia or pulmonary
embolism.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen in early arterial phase scanning after the
administration of 100 cc of Omnipaque.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DLP: 487.27 mGy-cm.
COMPARISON:
1. Chest x-ray ___.
2. CT abdomen pelvis ___.
3. CT chest ___.
FINDINGS:
CTA THORAX: The aorta and main thoracic vessels are well-opacified. There is
stable aneurysmal dilatation of the ascending aorta to 3.4 cm. There is stable
moderate-to-severe mixed atherosclerotic disease most prominent in the aortic
arch. A focal outpouching of contrast at the medial margin of the aortic arch
may represent an ulcerative plaque, unchanged since prior (series 3, image
36). There is no evidence of intramural hematoma or dissection. There is a
3-vessel aortic arch, with major branches appearing normal and patent. The
pulmonary artery is well opacified to subsegmental levels. There is no
intraluminal filling defects seen in the main, right, left, lobar, or
subsegmental branches. No arteriovenous malformation is seen.
CT OF THE THORAX:
The thyroid is unremarkable. The airways are patent to subsegmental levels.
Diffuse coronary artery and aortic and mitral valve calcifications are seen.
There is no pericardial effusion. There is no hiatus hernia or other
esophageal abnormality. A prominent AP window lymph node measures 13 mm in
short axis (series 2, image 28), not appreciably changed in comparison to
chest CT from ___. Prominent anterior mediastinal lymph nodes do not
meet CT size criteria for lymphadenopathy. There is no supraclavicular or
axillary lymphadenopathy. There is no pericardial effusion.
There is a large right and moderate left layering simple pleural effusion.
There is relaxation atelectasis of the dependent portions of the adjacent
right and left lower lobes. A small calcified granuloma is seen in the right
upper lobe. Diffuse bilateral subpleural predominant scarring is consistent
with chronic lung disease, appearing similar to chest CT from ___.
There is no evidence of focal or lobar lung consolidation.
The partially imaged solid and hollow viscous organs of the upper abdomen are
unremarkable.
MUSCULOSKELETAL:
There is moderate to severe degenerative change of the imaged thoracic spine,
with large anterior osteophytes and intervertebral vacuum disc phenomenon. No
concerning focal lytic or sclerotic osseous lesions are seen.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Moderate to severe mixed atherosclerotic disease of the thoracic aorta. No
intramural hematoma or dissection. Stable 3.4 cm ascending aortic aneurysmal
dilation.
3. Large right and moderate left layering simple pleural effusions. No
evidence of focal or lobar lung consolidation.
4. Diffuse coronary artery and aortic and mitral valve calcifications.
|
19937688-RR-36 | 19,937,688 | 20,981,455 | RR | 36 | 2142-02-21 10:11:00 | 2142-02-21 11:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CAD, afib on heparin drip, and multiple
arterial thrombi. Noted to have bilateral pleural effusions. Having increasing
dyspnea. Exam concerning for worsening of the pleural effusions. // Interval
change in size of pleural effusions. New opacities?
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the radiographic appearance is mildly
improved. The right lung base has increased in radiolucency, likely reflecting
a decrease in pleural effusion and pulmonary edema. The retrocardiac
atelectasis is unchanged, also unchanged is the small left pleural effusion
but overall, the signs of pulmonary edema have decreased in extent and
severity. No new focal parenchymal opacities. No pneumothorax. Moderate
cardiomegaly persists.
|
19938337-RR-25 | 19,938,337 | 28,021,083 | RR | 25 | 2174-10-28 06:39:00 | 2174-10-28 10:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with GI bleed now electively intubated prior to
egd // new intubation
COMPARISON: No comparison
IMPRESSION:
Normal lung volumes. The patient is intubated. The tip of the endotracheal
tube projects 2 cm above the carina. No pulmonary edema. Mild fluid overload
is present. Borderline size of the cardiac silhouette. No pleural effusions.
No pneumonia.
|
19938337-RR-26 | 19,938,337 | 28,021,083 | RR | 26 | 2174-11-02 10:43:00 | 2174-11-02 18:17:00 | INDICATION: ___ year old woman with PBC cirrhosis, admitted with GI bleed s/p
EGD and glue. TIPS to further reduce risk of GI bleed.
COMPARISON: Liver ultrasound from ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow), Dr.
___ radiology fellow) and Dr. ___
radiology attending) performed the procedure. The attending, Dr. ___ was
present and supervising throughout the procedure. Dr. ___
radiologist, personally supervised the trainee during the key components of
the procedure and reviewed and agreed with the trainee's findings.
ANESTHESIA: General anesthesia was provided by the anesthesia service.
MEDICATIONS: Please see anesthesia records.
CONTRAST: 142 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 43 minutes, 851 mGy
PROCEDURE:
1. Ultrasound-guided paracentesis.
2. Right internal jugular venous access using ultrasound.
3. Pre TIPS right atrial and portal vein pressure measurements.
4. Contrast enhanced portal venogram.
5. Placement of a 10 mm x 6 cm x 2 cm Viatorr covered stent.
6. Post-stenting balloon angioplasty of the TIPS shunt with a 10 mm balloon.
7. Post-stenting portal venogram.
8. Post TIPS right atrial and portal vein pressure measurements.
9. Proximal extension of the TIPS with a 12 mm x 60 mm Luminexx stent.
10. Post-stent extension balloon angioplasty of the TIPS with a 12 mm balloon.
11. Post-stent extension portal venogram
12. Post-stent extension right atrial and portal vein pressure measurements.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck and abdomen were prepped and draped in the usual sterile
fashion.
First, under continuous ultrasound guidance ___ needle was inserted into
the right abdomen at the site of the deepest pocket of ascites identified.
Permanent images were stored in PACs. Upon return of ascitic fluid, the inner
stylet was removed and ___ wire was advanced into the peritoneal cavity.
The catheter was removed and an Omni flush catheter was advanced over the wire
and into the peritoneal cavity. The catheter was connected for suction
drainage over the course of the procedure.
Next, under continuous ultrasound guidance, the patent right internal jugular
vein was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a ___ wire was advanced distally into
the IVC.
The micropuncture sheath was then removed and a 10 ___ sheath was advanced
over the wire into the inferior vena cava. An Amplatz wire was advanced in the
sheath next to the ___ wire and passed into the IVC for stability. Using a
MPA catheter and a Glidewire, access was obtained in the right hepatic vein.
Appropriate position was confirmed with contrast injection and fluoroscopy in
AP and lateral views. The Glidewire was then exchanged for ___ wire and
following removal of the Amplatz safety wire, the sheath was advanced over the
catheter into the right hepatic vein for stability.
Once the sheath was placed in an appropriate position, the cannula device was
inserted over the ___ wire and the wire was exchanged for ___
needle. The angled sheath was turned anteriorly. The needle was then advanced
through liver parenchyma and the needle was withdrawn over its sheath. The
___ sheath was withdrawn while gentle suction was applied. Upon blood
return, a Glidewire was introduced into the catheter to pass into the portal
vein. The sheath was then advanced into the main portal vein for stability.
A straight flush catheter was advanced over the wire and a contrast enhanced
portal venogram was performed. Next right atrial and main portal pressure
measurements were obtained.
An Amplatz wire was advanced through the straight flush catheter into the
superior mesenteric vein. The catheter was removed and a 10 mm x 6 cm x 2 cm
Viatorr covered covered stent was advanced into appropriate position and
deployed. Following stent deployment, the stent was dilated using a 10 mm
balloon.
The straight flush catheter was advanced over the wire and the wire was
removed. Repeat right atrial and portal venous pressure measurements were
performed. A repeat main portal venogram was performed.
After reviewing the post TIPS portal venogram, the decision was made to extend
the stent proximally. The Amplatz wire was then replaced down into the
superior mesenteric vein through the straight flush catheter. The straight
flush catheter was removed and a 12 mm x 60 mm x 80 cm Luminexx stent was
advanced over the wire and into position. The stent was then deployed
followed by balloon dilatation with a 12 mm balloon.
The straight flush catheter was then replaced into the main portal vein.
Repeat right atrial and portal venous pressure measurements were obtained,
followed by a completion contrast-enhanced portal venogram.
The sheath was then removed from the right internal jugular vein site and
pressure held for 10 minutes to achieve hemostasis. Steri-strips and sterile
dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Pre-TIPS right atrial pressure of 13 mm Hg and portal pressure measurement
of 32 mm Hg resulting in portosystemic gradient of 19 mmHg.
2. Contrast-enhanced portal venogram demonstrates widely patent portal vein.
There is filling of a gastroesophageal varix which bifurcates with the more
prominent limb occluded with glue injection during EGD. The second limb is
smaller in caliber. Additionally, filling of some mesenteric varices can be
seen.
3. Post TIPS portal venogram demonstrates preferential flow through the TIPS
stent, although mild filling of the gastroesophageal varix is still present.
4. Post TIPS right atrial pressure of 13 mm Hg and portal venous pressure of
21 mm Hg, resulting in a portosystemic gradient of 8 mm Hg.
5. Contrast in enhanced portal venogram following TIPS extension demonstrates
continued preferential flow through the TIPS, although mild residual filling
of the varices is still present, felt to be significantly reduced and not
warranted embolization at this time.
6. Post TIPS extension right atrial pressure of the 13 mm Hg and main portal
pressure of 19 mm Hg, with resulting further reduction in the portosystemic
gradient to 6 mm Hg.
7. 2 L of serous straw-colored ascites removed.
IMPRESSION:
1. Successful right internal jugular access with transjugular intrahepatic
portosystemic shunt placement with decrease in porto-systemic pressure
gradient from 19 mm Hg to 6 mm Hg.
2. 2 L of ascites drained.
|
19938337-RR-27 | 19,938,337 | 28,021,083 | RR | 27 | 2174-11-03 15:31:00 | 2174-11-03 16:59:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with cirrhosis, recurrent GI bleeds, s/p TIPS
on ___, now with rising bilirubin, worsening LFTs. Needs RUQ with dopplers
and TIPS eval. // Any evidence of TIPS malfunction? Need RUQ with doppler.
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound dated ___
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. There is moderate ascites.
There is slightly decreased splenomegaly, with the spleen measuring 14.3 cm.
Varices are seen in the region of the splenic hilum. The patient is status
post cholecystectomy. There is no intrahepatic biliary dilatation. The common
bile duct is ectatic measuring 11 mm, decreased from ___ when it
measured 2 cm.
The main portal vein is patent with hepatopetal flow.
The TIPS is unable to be evaluated due to shadowing from the gas in the wall
related to recent placement of the TIPS.
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior and right posterior portal vein is towards the TIPS.
Appropriate flow is seen in the hepatic veins and IVC.
IMPRESSION:
1. TIPS cannot be assessed due to recent placement of TIPS.
2. Cirrhosis with sequela of portal hypertension including ascites, varices
and splenomegaly
RECOMMENDATION(S): Recommend obtaining baseline TIPS evaluation after 5 days
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 4 ___, 10 minutes after discovery of the findings.
|
19938337-RR-28 | 19,938,337 | 28,021,083 | RR | 28 | 2174-11-04 00:59:00 | 2174-11-04 08:30:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with PBC cirrhosis c/b multiple upper GI bleeds
presenting from OSH with hemetemesis found to have high risk varices and
bleeding ___ ulcer s/p glue. S/p TIPS today c/b rising direct tbili with
new fever // PNA?
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the patient was extubated. The lungs
are better ventilated than on the previous image. Normal size of the cardiac
silhouette. No pleural effusions. Calcifications at the level of the first
costosternal junction on the right.
|
19938337-RR-52 | 19,938,337 | 26,615,463 | RR | 52 | 2178-09-02 11:32:00 | 2178-09-02 12:44:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with cirrhosis, worsening ascites// portal vein thrombus?
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: ___.
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. There is small amount of
ascites. There is stable splenomegaly, with the spleen measuring 17.1 cm.
There is no intrahepatic biliary dilation. The CHD measures 1.4 cm mm,
potentially related to post cholecystectomy state. Gallbladder not
visualized.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 26.7 cm/sec, previously 32.5 cm/sec
Proximal TIPS: 188 cm/sec, previously 163cm/sec
Mid TIPS: 130 cm/sec, previously 118 cm/sec
Distal TIPS: 139 cm/sec, previously 81 cm/sec
No convincing flow is noted within the left portal vein as seen previously.
Additionally, no demonstrable flow is noted in the anterior right portal vein
on the current exam. Appropriate flow is seen in the hepatic veins and IVC.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis. The
right kidney measures 11.5 cm.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Patent TIPS and main portal vein.
2. No demonstrable flow in the left or anterior right portal veins. This
could be due to slow flow though thrombosis would be possible.
3. Cirrhotic morphology of the liver with findings of portal hypertension
including ascites and splenomegaly.
|
19938337-RR-53 | 19,938,337 | 26,615,463 | RR | 53 | 2178-09-02 12:33:00 | 2178-09-02 13:45:00 | INDICATION: ___ with ascities, sob// effusion?
TECHNIQUE: Frontal and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Lung volumes are relatively low. There is no focal consolidation, effusion,
or edema. Cardiomediastinal silhouette is stable. No acute osseous
abnormalities. TIPS is faintly visualized, better seen on the lateral view.
IMPRESSION:
No acute cardiopulmonary process.
|
19938337-RR-54 | 19,938,337 | 26,615,463 | RR | 54 | 2178-09-03 11:15:00 | 2178-09-03 13:50:00 | EXAMINATION: Therapeutic paracentesis
INDICATION: ___ yo woman w/ PBC cirrhosis c/b HE, EV, ascites, pancytopenia
s/p TIPS ___ w/ redo ___, who presented with abdominal distention and
lightheadedness.// paracentesis of the abdomen--large volume
TECHNIQUE: Therapeutic paracentesis described below.
COMPARISON: Ultrasound dated ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: Ultrasound guided therapeutic paracentesis
Location: right lower quadrant
Fluid: 3.9 L of clear, straw-colored fluid
Samples: None
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components
of the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic paracentesis.
2. 3.9 L of straw-colored fluid were removed.
|
19938337-RR-55 | 19,938,337 | 26,615,463 | RR | 55 | 2178-09-05 17:54:00 | 2178-09-05 20:09:00 | INDICATION: ___ yo F with PBC cirrhosis s/p TIPS now with worsening ascites//
TIPS venogram +/- revision
COMPARISON: TIPS revision ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
performed the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
125mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 30 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: None
CONTRAST: 40 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 16 minutes, 90 mGy
PROCEDURE:
1. Paracentesis
2. Right internal jugular venous access using ultrasound.
3. Pre-procedure right atrial and splenic vein pressure measurements.
4. Splenic venogram.
5. Angioplasty of the TIPS with a 12 mm balloon.
6. Post angioplasty right atrial and splenic vein pressure measurement.
7. Post angioplasty splenic venogram.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck and abdomen were prepped and draped in the usual
sterile fashion.
Under continuous ultrasound guidance a pocket of fluid was localized in the
right lower quadrant. Images stored to PACs. Following the installation of
1% lidocaine in the subcutaneous tissues, ___ needle was advanced into the
pocket of fluid. 2.5 L of clear yellow fluid were removed. A sterile
dressing was applied.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a ___ wire was advanced distally into
the IVC.
The micropuncture sheath was then removed and a 10 ___ sheath was advanced
over the wire into the right atrium. A right atrial pressure measurement was
obtained. Next using the ___ wire and a MPA catheter, the TIPS was
catheterize and the MPA was successfully advanced into the splenic vein.
Exchange was made for a straight flush catheter. Splenic vein pressure
measurement was obtained and splenic venogram was performed. Next an Amplatz
wire was advanced into the splenic vein and the catheter was removed. A 12 mm
atlas balloon was advanced and overlapping balloon angioplasty was performed
within the TIPS. Post angioplasty right atrial and splenic pressure
measurement were obtained. Splenic venogram was performed.
The sheath was then removed from the right internal jugular vein site and
pressure held for 10 minutes to achieve hemostasis. Steri-strips and sterile
dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Pre angioplasty right atrial pressure of 7 and splenic pressure measurement
of 27 resulting in portosystemic gradient of 20 mmHg.
2. Splenic venogram showing narrowing of the hepatic venous end of the TIPS.
3. Post-angioplasty right atrial pressure of 10 and splenic pressure of 17
resulting in portosystemic gradient of 7 mmHg.
4. 2.5 L clear yellow ascites drained
IMPRESSION:
Successful right internal jugular access with transjugular intrahepatic
portosystemic shunt revision with decrease in porto-systemic pressure
gradient.
|
19938337-RR-58 | 19,938,337 | 28,534,048 | RR | 58 | 2178-11-21 02:11:00 | 2178-11-21 02:29:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with ams// ? free air RUQ w/ doppler ro r/o thrombus
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior radiographs, most recently dated ___.
FINDINGS:
Lung volumes are well expanded. The lungs are clear. The cardiomediastinal
silhouette and hilar silhouette are normal. Pleural surfaces are normal. No
evidence of free intraperitoneal air.
IMPRESSION:
No acute cardiopulmonary process. No evidence of free intraperitoneal air.
|
19938337-RR-59 | 19,938,337 | 28,534,048 | RR | 59 | 2178-11-21 02:23:00 | 2178-11-21 03:00:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with ams// ? free air RUQ w/ doppler ro r/o thrombus
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Liver TIPS ultrasound ___.
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified.
There is moderate ascites, similar prior.
There is stable splenomegaly, with the spleen measuring 15.8 cm.
There is no intrahepatic biliary dilation. The CHD measures 11 mm, similar to
prior likely secondary to post cholecystectomy state.
The patient is status post cholecystectomy.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 40 cm/sec, previously 40 cm/sec
Proximal TIPS: 128 cm/sec, previously 50 cm/sec
Mid TIPS: 174 cm/sec, previously 181 cm/sec
Distal TIPS: 179 cm/sec, previously 187 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Patent TIPS. Slightly elevated proximal TIPS velocity compared to prior,
which is likely due to technical differences. Attention on follow-up imaging
is recommended.
2. Patent hepatic vasculature.
3. Cirrhotic liver morphology with moderate ascites and splenomegaly.
|
19938337-RR-60 | 19,938,337 | 28,534,048 | RR | 60 | 2178-11-21 12:37:00 | 2178-11-21 14:51:00 | EXAMINATION: Ultrasound-guided diagnostic and therapeutic paracentesis
INDICATION: ___ year old woman with PBC cirrhosis, s/p TIPS, presents with
ascites and worsening encephalopathy// Assess for spontaneous bacterial
peritonitis
TECHNIQUE: Ultrasound-guided diagnostic and therapeutic paracentesis
COMPARISON: Abdominal ultrasound ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis
Location: right lower quadrant
Fluid: 2.75 L of clear, straw-colored fluid
Samples: Fluid samples were submitted to the laboratory the requested
analysis.
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
|
19938358-RR-28 | 19,938,358 | 26,736,205 | RR | 28 | 2159-05-30 18:23:00 | 2159-05-30 19:07:00 | INDICATION: ___ with cp and sob // r/o infiltrate
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear without focal consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. Atherosclerotic
calcifications seen at the aortic arch. No acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19938391-RR-36 | 19,938,391 | 20,649,140 | RR | 36 | 2130-07-31 21:26:00 | 2130-07-31 22:35:00 | HISTORY: Seizure.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. The lungs
are clear without focal consolidation. No pleural effusion or pneumothorax is
seen. The lungs are relatively hyperinflated. Cardiac and mediastinal
silhouettes are unremarkable.
IMPRESSION: No focal consolidation.
|
19938391-RR-37 | 19,938,391 | 20,649,140 | RR | 37 | 2130-08-01 15:18:00 | 2130-08-02 10:03:00 | CLINICAL INFORMATION: ___ male with history of ADEM, with seizure.
Question recurrence of lesions or other acute process.
COMPARISON: MRI brain dated ___.
TECHNIQUE: Multisequence multiplanar imaging of the brain was performed both
prior to and following the intravenous administration of 8 mL Gadovist.
FINDINGS: There is marked interval improvement in the previous confluent
FLAIR signal hyperintensity in the white matter, only minimal residual
hyperintensity persisting. There is no evidence of hemorrhage, ischemia, and
there is no abnormal enhancement. A developmental venous anomaly is noted in
the left cerebellar hemisphere.
The visualized paranasal sinuses reveal mucosal thickening in the ethmoid air
cells. There is mild increased fluid signal in the mastoid air cells
bilaterally. The orbits are unremarkable.
IMPRESSION: Interval marked improvement in the previous diffuse T2 FLAIR
signal hyperintensity in the white matter without new abnormality identified.
|
19938391-RR-39 | 19,938,391 | 20,649,140 | RR | 39 | 2130-08-02 18:46:00 | 2130-08-03 09:03:00 | CLINICAL INFORMATION: ___ man with history of ADEM, persistent
Lhermitte's sign and increased lower extremity tone. Question myelopathy.
COMPARISON: MRI of the spine dated ___.
TECHNIQUE: Multisequence and multiplanar imaging of the cervical spine was
performed both prior to and following the intravenous administration of 8 mL
Gadovist.
FINDINGS: The vertebral bodies are normal in height, signal intensity and
alignment. Intervertebral discs are normal in signal intensity. The
previously seen extensive confluent spinal cord signal abnormality on the
prior examination has almost completely resolved. There is minimal residual T2
signal hyperintensity in the in the dorsal spinal cord. There is no abnormal
enhancement. The paraspinal soft tissues are unremarkable.
IMPRESSION:
Minimal residual signal hyperintensity in the dorsal spinal cord, nearly
completely resolved, compared to the prior examination. No abnormal
enhancement.
|
19938958-RR-34 | 19,938,958 | 21,970,619 | RR | 34 | 2165-03-29 19:39:00 | 2165-03-29 21:43:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: History: ___ with headache, vertigo, "hx of "brain clot"" //
evaluate for acute clot, stroke
TECHNIQUE: MRI of the head was performed before and following intravenous
administration of 15 cc MultiHance. Sagittal T1, axial T1, axial gradient,
axial FLAIR, axial T2, axial diffusion and ADC, axial T1 post, and sagittal
MPRAGE postcontrast sequences with axial and coronal reformats were obtained.
Three dimensional time of flight MR arteriography was performed through the
brain with MIP reconstructions. MRV of the head was performed with phase
contrast technique. MIP reconstructions were created. Dynamic MRA of the neck
was performed during administration of intravenous contrast.
COMPARISON: CTA head and neck ___
FINDINGS:
MRI Brain: There is no evidence of hemorrhage, edema, masses or infarction.
Ventricles and sulci are normal in caliber and configuration. There is no
pathologic enhancement. There are multiple foci of T2/FLAIR hyperintensity in
the subcortical, deep, and periventricular white matter. There is no lesion of
the brainstem or corpus callosum. Major intravascular flow voids are
preserved.
There is minimal mucosal thickening of the ethmoid sinuses the paranasal
sinuses are otherwise clear. The mastoid air cells are clear. The orbits are
normal.
MRA brain: The intracranial internal carotid arteries and their major branches
appear normal without evidence of stenosis, occlusion, or aneurysm formation.
There is a right fetal type PCA, a developmental variant. There is congenital
hypoplasia of the left vertebral artery, as seen on CTA from ___.
The intracranial vertebral arteries are otherwise unremarkable.
MRV head: The dural venous sinuses and major cerebral veins are patent.
MRA neck: The origins of the great vessels, subclavian and vertebral arteries
appear normal bilaterally.
The right common, internal and external carotid arteries appear normal. There
is no evidence of right internal carotid artery stenosis by NASCET criteria.
The left common carotid artery is normal. There is mild atherosclerotic
irregularity of the left proximal internal carotid artery, as seen on CTA from
___. There is no evidence of left internal carotid artery stenosis
by NASCET criteria. The left external carotid artery appears normal.
The left vertebral artery is nondominant, as seen on CTA from ___.
The right vertebral artery is dominant.
The bilateral internal jugular veins, brachiocephalic veins, and visualized
SVC are normal.
IMPRESSION:
1. No intracranial hemorrhage or acute infarct.
2. Multiple scattered T2/FLAIR hyperintensity is in the cerebral white
matter. These are nonspecific and are commonly seen due to chronic small
vessel ischemic disease.
3. Normal MRA head with developmental variants detailed above.
4. No dural venous sinus or major cortical vein thrombosis.
5. Mild atherosclerosis of the left proximal internal carotid artery,
unchanged from CTA on ___.
6. Hypoplastic left vertebral artery, as seen on recent CTA.
|
19938968-RR-17 | 19,938,968 | 29,315,149 | RR | 17 | 2111-08-25 00:10:00 | 2111-08-25 06:24:00 | EXAMINATION: DX FEMUR AND KNEE
INDICATION: History: ___ with above// Left thigh osteo-and soft tissue
abscess, getting plain films for operative planning per orthopedics.
TECHNIQUE: Frontal and lateral views of the left femur.
COMPARISON: None.
FINDINGS:
Severe degenerative changes of the left hip are noted. A 1.2 cm calcific
density at the lesser trochanter may represent a chronic avulsion injury.
There is a fracture deformity of the distal femur with prominent callus
formation. The fracture line is still visualized. There is severe medial
knee compartment narrowing. Multiple ghost tracks are seen in the distal
femur from prior fracture plate and screws. There is diffuse osteopenia.
There is no soft tissue gas.
IMPRESSION:
As above.
|
19938968-RR-18 | 19,938,968 | 29,315,149 | RR | 18 | 2111-08-25 01:43:00 | 2111-08-25 02:06:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with fevers, leg swelling// Preop clearance
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
Patient is mildly rotated.The lungs are clear without focal consolidation. No
pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
19938968-RR-19 | 19,938,968 | 29,315,149 | RR | 19 | 2111-08-29 16:16:00 | 2111-08-29 16:50:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new line// new left PICC 50cm out 2 cm
___ ___ Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
There has been interval placement of a left upper extremity PICC which
terminates in the mid superior vena cava.
Linear opacities in the left lung base most likely represent subsegmental
atelectasis. There is no focal consolidation, pleural effusion or
pneumothorax. The cardiomediastinal silhouette is within normal limits. No
acute osseous abnormalities are identified.
IMPRESSION:
1. The left upper extremity PICC terminates in the mid superior vena cava.
2. No pneumonia or acute cardiopulmonary process.
|
19939036-RR-10 | 19,939,036 | 23,442,391 | RR | 10 | 2134-03-17 07:55:00 | 2134-03-17 09:12:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD
INDICATION: ___ year old man with L MCA infarct// please perform by 0800. now
with right facial droop, on heparin, r/o hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 1202 mGy cm
COMPARISON: CT head without contrast ___
FINDINGS:
Area of hypodensity in the left parietal region is more hypodense compared to
1 day ago, likely reflecting interval evolution of recent infarct. Hypodensity
in the left cerebellar hemisphere is unchanged and likely reflect sequela of
old infarct. There is no evidence of new infarction,hemorrhage,edema, or
mass. The ventricles and sulci are stable in size and configuration.
2 burr holes are noted in left frontal and parietal regions. Mucosal
thickening is mild in bilateral maxillary sinuses. The visualized portion of
the orbits are unremarkable.
IMPRESSION:
1. Interval evolution of recent left parietal infarct.
2. No intracranial hemorrhage is identified.
|
19939036-RR-11 | 19,939,036 | 23,442,391 | RR | 11 | 2134-03-17 17:09:00 | 2134-03-17 18:37:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with L ICA occlusion s/p embolectomy attempt w/o
reperfusion. L parietal hypodensity on NCHCT// ?stroke, 24 hour post
intervention scan
TECHNIQUE: Localizer and diffusion-weighted images were obtained. The
patient was unable to continue the exam.
COMPARISON CT head without contrast ___.
FINDINGS:
Limited study as patient was unable to continue the exam.
Allowing for this, there is evidence of slow diffusion correlating to the
previously described hypoattenuation involving the left temporal, parietal and
occipital lobes. No additional areas slow diffusion are identified.
Prominence of the ventricles and cerebral sulci are compatible with age
related involutional changes.
IMPRESSION:
1. Acute infarct within the left parieto-occipital and temporal lobes.
2. Generalized parenchymal volume loss, likely age related.
|
19939036-RR-5 | 19,939,036 | 23,442,391 | RR | 5 | 2134-03-16 16:26:00 | 2134-03-18 18:12:00 | EXAMINATION: Diagnostic cerebral angiogram for possible thrombectomy in the
setting of left CVA
During the procedure the following vessels were selectively catheterized
angiograms were performed:
Left common carotid artery
Three-dimensional rotational angiography of the left common carotid artery
circulation in the cervical region requiring post processing on an independent
workstation and concurrent attending physician interpretation and review
Right common femoral artery
INDICATION: This ___ gentleman who presented with right sided
neglect. He is left-handed. There was concern on outside imaging for left
ICA occlusion. He was given tPA as deficit persisted. He was felt to be
candidate for attempted endovascular intervention.
ANESTHESIA: The patient was maintained initially understands sedation then
intubated due to inability to cooperate an significant moving during the case
that into injured the safety of the patient. This was performed during the
entirety of the case by trained anesthesia provider. Please see separately
dictated anesthesia documentation. Patient's hemodynamic and respiratory
parameters were monitored continuously during the entirety of the case by a
trained an independent observer.
TECHNIQUE: Diagnostic cerebral angiogram, single-vessel
COMPARISON: Outside hospital CTA
PROCEDURE: The patient was identified and brought to the neuro radiology
suite. He was transferred to the fluoroscopic table supine. Moderate
sedation was administered. Bilateral groins were prepped and draped in
standard sterile fashion. An emergent time-out was performed. The right
common femoral artery was identified using anatomic and radiographic
landmarks. The right common femoral artery was accessed using standard
micropuncture technique after infiltration of local anesthetic. A long 8
___ sheath was introduced, connected to continuous heparinized saline
flush, and secured.
Next a stiff ___ 2 diagnostic catheter was introduced. It was connected
continuous heparinized saline flush as well as the power injector. It was
advanced over 038 glidewire through the aorta into the aortic arch. The
patient was moving continuously during this and was unsafe to proceed with the
procedure. There is also a kink at the sheath that may navigation difficult.
The patient was electively intubated by Anesthesia and the case was then
resumed. The wire was used to select left common carotid artery. The
catheter was positioned over the wire into the left common carotid artery.
The wire was removed. Vessel patency was confirmed via hand injection.
Standard AP and lateral views of the neck and intracranial circulation were
obtained.
As suspected, there was a left internal carotid artery occlusion just beyond
the bifurcation the cervical region. An Amplatz exchange wire was positioned
in the external carotid artery after roadmap was performed. The diagnostic
catheter was exchanged off and a ___ shuttle catheter was exchanged into the
left common carotid artery. The exchange length wire and inner obturator were
removed. A Prowler Select Plus catheter loaded with a synchro standard wire
was advanced into the common carotid artery on the left. Attempts were made
to pass through the left internal carotid artery occlusion without success. A
V18 wire as well as the Amplatz exchange wire were also attempted without
success. It was determined that this was a chronic occlusion and additional
efforts to open the occlusion were aborted.
Next the guide catheter was removed. Right common femoral angiogram was
performed via hand injection through the sheath. The sheath was removed and
the arteriotomy was closed using a 6 ___ Perclose. Following extubation,
the patient was removed from the fluoroscopy table remained at his neurologic
baseline without any evidence of additional thromboembolic complications.
OPERATORS: Dr. ___ Dr. ___ physician performed the
procedure. Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings.
FINDINGS:
Left Common carotid artery: There is filling of the distal external carotid
artery branches. There is occlusion of the internal carotid artery just
distal to the bifurcation. There is anastomosis and reconstitution of the
artery in the petrous portion. There is possibly a persistent trigeminal that
is helping to fill at that juncture. There is significant calcification noted
at the internal carotid artery plaque. Intracranially, there is minimal flow
intracranially. There is filling of the external carotid artery branches.
Based on CTA imaging it is suspected that the majority of this hemisphere is
filled via cross-filling from alternate circulations. The closure was
confirmed on the three-dimensional rotational imaging.
Right common femoral artery: Arteriotomy is above the bifurcation. There is
good distal runoff. There is no evidence of dissection. Vessel caliber
appropriate for closure device.
IMPRESSION:
Chronic occlusion of the left internal carotid artery with heavily calcified
thick plaque. Unable to cross plaque with a variety of micro catheters.
RECOMMENDATION(S):
1. Care per neurology
|
19939036-RR-6 | 19,939,036 | 23,442,391 | RR | 6 | 2134-03-16 16:26:00 | 2134-03-16 17:28:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ year old man with L ICA stroke// CT perfusion
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 19.2 s, 8.0 cm; CTDIvol = 314.2 mGy (Head) DLP =
2,513.8 mGy-cm.
3) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
4) Spiral Acquisition 5.1 s, 39.9 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,274.0 mGy-cm.
Total DLP (Head) = 4,618 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Area of hypodensity is identified in the left parietal region with loss of
gray-white differentiation.
Encephalomalacia is noted in the right cerebellar hemisphere. There is no
acute intracranial hemorrhage.
Prominence of ventricles and sulci likely reflect involutional changes.
2 burr holes are noted in the left frontal and parietal regions. Mucosal
thickening is mild in the left maxillary sinus. The visualized portion of the
orbits are unremarkable.
CTA HEAD:
Left internal carotid artery is completely occluded at the petrous segment.
Supraclinoid segment is stenotic.
Focal 5 mm heavy calcification at right vertebral artery V4 segment limits
evaluation of the vessel patency at the location.
Left vertebral artery V4 segment ends in posterior inferior cerebellar artery.
There is a lack of distal MCA branches in the left parietal region.
Otherwise, the vessels of the circle of ___ and their principal
intracranial branches appear patent without stenosis, occlusion, or aneurysm
formation.
The dural venous sinuses are patent.
CTA NECK:
Severe stenosis (70-99%) is identified at the bilateral internal carotid
artery origins. Left cervical internal carotid artery is diminutive with a
diameter measuring 1-2 mm. The left internal carotid artery becomes
completely occluded at the petrous segment. Left lacerum internal carotid
artery and more distal segments are diminutive but patent.
Right vertebral artery is completely occluded from the origin to the right C7
transverse foramen.
Right vertebral artery V3 segment is completely occluded below the right C1
transverse foramen and patent above.
CT PERFUSION:
Area of increased mean transit time is identified in the left
parieto-occipital region, involving estimated volume of 212 mL. Smaller area
of decreased cerebral blood flow is identified in the left parietal region,
involving estimated volume of 39 mL.
Findings are consistent with acute infarct with estimated ischemic penumbra
volume of 173 mL.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy.
IMPRESSION:
1. Findings consistent with acute left parietal infarct with surrounding
ischemic penumbra in the left parieto-occipital region.
2. Severe stenosis (70-99%) is identified at bilateral internal carotid artery
origins.
3. Left internal carotid artery is diminutive and is completely occluded at
the petrous segment.
4. Right vertebral artery is completely occluded from the origin to C7 level.
Second site of occlusion is at V3 segment, below C1 transverse foramen. Focal
calcification in V4 segment limits evaluation of vessel patency at that
location.
5. Left vertebral artery ends in posterior inferior cerebellar artery.
6. There is a lack of distal MCA branches in the left parietal region.
Otherwise, the vessels of the circle of ___ and their principal
intracranial branches appear patent.
7. Right cerebellar encephalomalacia is likely an old infarct.
NOTIFICATION: The findings were discussed with a neurosurgery resident
working with Dr. ___ by ___, M.D. on the telephone on ___ at
5:10 pm, 10 minutes after discovery of the findings. Patient was already at
the angio suite for arteriogram. The resident had to cut the conversation
short before giving her name for documentation.
|
19939036-RR-8 | 19,939,036 | 23,442,391 | RR | 8 | 2134-03-16 18:23:00 | 2134-03-16 19:09:00 | INDICATION: ___ year old man with stroke// screen
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiac silhouette is within normal limits.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19939036-RR-9 | 19,939,036 | 23,442,391 | RR | 9 | 2134-03-16 23:04:00 | 2134-03-17 06:50:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111
INDICATION: ___ year old man with L MCA infarct, worsening R hand weakness, on
heparin// r/o hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.8 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 844 mGy-cm.
COMPARISON: CT head and neck with the same date.
FINDINGS:
A region of hypodensity with decreased gray-white differentiation is seen
within the left parietal lobe, unchanged compared to prior, compatible with
evolving infarct. Effacement of the adjacent sulci, but no significant mass
effect. There is no evidence of hemorrhagic transformation.
Chronic encephalomalacia is seen within the right cerebellum. There is no
evidence of mass. Mild white matter hypodensities are nonspecific, but likely
represent the sequela of chronic microvascular ischemia. There is prominence
of the ventricles and sulci suggestive of involutional changes.
Patient is status post left parietal craniotomy. There is no evidence of
fracture. Soft tissue within the left ear canal likely represents cerumen.
Mild mucosal thickening within the left frontal and bilateral maxillary
sinuses. Otherwise, the visualized portion of the paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
Evolving infarct within the left parietal lobe without evidence of hemorrhagic
transformation. No significant mass effect.
|
19939336-RR-16 | 19,939,336 | 29,130,518 | RR | 16 | 2141-09-13 14:29:00 | 2141-09-13 17:05:00 | INDICATION: I and D
TECHNIQUE: 5 fluoroscopic spot images of the left lower extremity
COMPARISON: ___
FINDINGS:
5 fluoroscopic spot images are provided for localization purposes and
demonstrate instrumentation overlying the distal femur and proximal tibia. The
total fluoroscopic time is 8.6 seconds. For further details please see the
operative note.
|
19939336-RR-17 | 19,939,336 | 29,130,518 | RR | 17 | 2141-09-15 13:08:00 | 2141-09-15 14:18:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new PICC// New Rt. ___ Fr. 36 cm. SL PICC
___ ___ Contact name: ___: ___
TECHNIQUE: Single AP view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Interval placement of a right PICC line tip terminates at the level of the
upper to mid SVC.
Lung volumes are slightly lower on the left compared to prior. There is
increased retrocardiac opacity which may represent atelectasis or pneumonia in
the appropriate clinical setting. The cardiomediastinal silhouette mildly
enlarged but unchanged. There is likely a small new left pleural effusion.
No right pleural effusion. No appreciable pneumothorax.
IMPRESSION:
Interval placement of right PICC line which terminates at the mid SVC.
Likely new small left pleural effusion. Increased retrocardiac opacity likely
represents atelectasis, however infection cannot be excluded in the
appropriate clinical setting.
|
19939579-RR-6 | 19,939,579 | 25,525,274 | RR | 6 | 2180-02-04 09:22:00 | 2180-02-04 11:09:00 | EXAMINATION: MRCP (MR ___
INDICATION: ___ year old woman with abdominal pain post cholecystectomy // ?
biliary or pancreatic duct obstruction, dilation, leak
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen were
obtained on a 1.5 Tesla magnet including dynamic 3D imaging prior to, during,
and after the administration of 7.5 cc Gadavist and 15 cc Eovist.
COMPARISON: CT abdomen and pelvis, ___ and ___.
FINDINGS:
There is a 1 cm filling defect within the distal CBD, seen both on axial and
coronal T2 weighted sequences, with mild intra and extrahepatic biliary ductal
dilatation (15:40). There is no ductal excretion of the hepatobiliary contrast
agent on the 20 minutes delayed images. Numerous areas of wedge like
enhancement in the liver during the arterial phase and mild central
peribiliary enhancement are compatible with mild cholangitis (11:29,46,67).
There is mild periportal edema. The patient is post cholecystectomy. The
hepatic parenchyma demonstrates moderate signal drop-off on T1 weighted out of
phase images in comparison to in phase images, denoting steatosis.
The pancreas, spleen, and adrenal glands are normal. There is a tiny simple
cyst in the left kidney (15:35). Prominent portacaval lymph nodes are likely
reactive (15:27). There is no mesenteric or retroperitoneal lymphadenopathy.
The stomach and visualized bowel are unremarkable. There is no fluid
collection or ascites. The bone marrow signal is normal.
IMPRESSION:
1. 1 cm obstructing distal CBD stone with mild intra and extrahepatic bile
duct dilatation, mild cholangitis, and delayed excretion of hepatobiliary
contrast.
2. No hepatic fluid collection.
3. Moderate hepatic steatosis.
|
19939579-RR-8 | 19,939,579 | 23,371,760 | RR | 8 | 2180-03-02 00:16:00 | 2180-03-02 00:51:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: A ___ old woman with recent cholecystectomy and ERCP presenting
with nausea and vomiting, evaluate for biliary abnormality.
TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and
pelvis without contrast. Multiplanar reformations were generated and reviewed.
Oral contrast was administered.
DLP: 992.40 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast performed ___.
FINDINGS:
LUNG BASES:
Respiratory motion somewhat limits interpretation of the lung bases. Within
this limitation, there is minimal bibasilar atelectasis. Otherwise the lung
bases are clear. There is no evidence of pleural effusion.
CT ABDOMEN:
Lack of administration of IV contrast limits interpretation of the
intra-abdominal solid and hollow viscous organs.
The liver is of homogeneous attenuation throughout without evidence of focal
lesion. There is no evidence of intrahepatic biliary ductal dilatation.
Cholecystectomy clips are seen in the gallbladder fossa. Air is seen within
the common duct, as well as the left greater than right intrahepatic biliary
tree, a normal finding status post ERCP. The spleen mildly enlarged, with a
craniocaudal diameter of 13.5 cm. There is no evidence of focal splenic
lesion.
The pancreas is of homogeneous attenuation without evidence of ductal
dilatation or peripancreatic stranding. The adrenal glands are within normal
limits. There are normal, symmetric nephrograms. There is no hydronephrosis.
Non-dilated loops of small bowel are normal in course and caliber. A duodenal
diverticulum is noted. There is no evidence of obstruction. Oral contrast
fills the colon. There is distal colonic diverticulosis without evidence of
diverticulitis. The colon was otherwise unremarkable. The appendix is not well
visualized. There is no evidence of mesenteric or retroperitoneal
lymphadenopathy by CT size criteria.
There are scattered atherosclerotic mural calcifications of the abdominal
aorta. There is no evidence of dilation or aneurysm. There is no
intra-abdominal free air or fluid.
CT PELVIS:
The imaged pelvic organs, including the bladder and terminal ureters, are
normal. There is no evidence of pelvic or inguinal lymphadenopathy by CT size
criteria.
BONES AND SOFT TISSUES:
There is a large fat containing paraumbilical hernia, unchanged from prior
exam. There is mild to moderate degenerative joint disease of the imaged
thoracolumbar spine. Alignment is normal. There are no suspicious osteolytic
or osteosclerotic lesions identified.
IMPRESSION:
1. Pneumobilia, a normal finding after ERCP.
2. No evidence of acute intra-abdominal or intrapelvic process.
3. Large unchanged paraumbilical hernia.
4. Mild splenomegaly.
5. Diverticulosis.
6. Status post cholecystectomy.
|
19939665-RR-20 | 19,939,665 | 28,666,537 | RR | 20 | 2187-01-11 19:34:00 | 2187-01-11 20:41:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ male with history of hepatitis C cirrhosis, hepatic
encephalopathy, presents with abdominal pain, distention for 4 days. Evaluate
for acute intra-abdominal process.
TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed with IV
contrast only.. Multiplanar reformations were provided.
DOSE: DLP 921.23 mGy cm
COMPARISON: Prior MR abdomen from ___.
FINDINGS:
Lung Bases: Minimal dependent atelectasis is noted at the lung bases. The
imaged portion of the heart is unremarkable. The distal esophagus appears
mildly thickened.
Abdomen: The liver enhances normally without focal lesion. A subtle
micronodular contour of the liver especially along the inferior extent is
compatible with known cirrhosis. The gallbladder is surgically absent. The
spleen is enlarged and measures up to 13.1 cm in length. Adrenal glands,
pancreas, and kidneys appear normal. The kidneys enhance symmetrically and
excrete contrast promptly without hydronephrosis or focal renal lesion. There
are portosystemic varices in the upper abdomen notably along the proximal
stomach. The abdominal aorta is normal in course and caliber with extensive
atherosclerotic calcification noted and without aneurysmal dilation. There is
no retroperitoneal lymphadenopathy seen. There is no free air or free fluid.
The stomach is decompressed. The duodenum appears normal.
Pelvis: Loops of small and large bowel demonstrate no signs of ileus or
obstruction. The appendix is normal. The colon contains a mild fecal load
without bowel wall thickening or obstruction. There is no free pelvic fluid.
Urinary bladder is partially distended appearing normal. No pelvic or inguinal
lymphadenopathy is seen.
Bones: Old rib deformities are noted bilaterally involving the ninth and tenth
ribs. No acute bony injury or worrisome bony lesion.
IMPRESSION:
1. Cirrhotic liver with splenomegaly and varices. No ascites.
2. Mildly thickened distal esophagus for which clinical correlation is
advised for possible esophagitis.
3. Atherosclerosis of the abdominal aorta without aneurysm.
|
19939665-RR-21 | 19,939,665 | 28,666,537 | RR | 21 | 2187-01-12 08:28:00 | 2187-01-12 10:18:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with cirrhosis p/w abd pain // ?ascites, RUQ
pathology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT performed on ___.
FINDINGS:
LIVER: The echogenicity of the liver is slightly increased and course. The
contour of the liver is smooth. There is this. Main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: Patient status post cholecystectomy.
SPLEEN: Normal echogenicity, measuring 15.1 cm.
KIDNEYS: Limited images of the right kidney demonstrates no hydronephrosis.
No ascites is noted.
IMPRESSION:
No imaging explanation for the patient's abdominal pain in the right upper
quadrant.
1. Echogenic liver consistent with known history of cirrhosis.
2. Patient is status post cholecystectomy, without abnormality evident in the
right upper quadrant.
3. No evidence of ascites.
|
19939665-RR-22 | 19,939,665 | 28,666,537 | RR | 22 | 2187-01-12 08:59:00 | 2187-01-12 12:25:00 | EXAMINATION: Chest radiograph PA and lateral
INDICATION: ___ year old man with cirrhosis p/w abd pain w/ crackles on lung
exam // ?pulm edema
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
There are low lung volumes bilaterally. The lungs are clear. No evidence of
focal consolidations, pulmonary edema, pleural effusions, or pneumothorax. The
mediastinum is slightly widened, likely due to tortuosity of ascending aorta.
The hila and heart are within normal limits. No acute osseous abnormalities.
IMPRESSION:
There is no pulmonary edema.
|
19940147-RR-58 | 19,940,147 | 25,969,058 | RR | 58 | 2127-12-08 23:31:00 | 2127-12-09 10:18:00 | AP CHEST, 11:33 P.M., ___
HISTORY: Accelerated CML. Tracheostomy.
IMPRESSION: AP chest compared to ___:
Tracheostomy tube in standard position. Feeding tube ends in the mid
duodenum. Lungs are low in volume but clear. Pleural effusion is small, on
the left, decreased since ___, and explains resolution of previous left
lower lobe atelectasis. The lungs are now clear. Right PIC line ends in the
low SVC as before. Heart size top normal.
|
Subsets and Splits