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19940147-RR-59
| 19,940,147 | 25,969,058 |
RR
| 59 |
2127-12-11 09:27:00
|
2127-12-11 10:21:00
|
INDICATION: Dysphagia.
COMPARISON: None.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS: Barium passed freely through the oropharynx and esophagus without
evidence of obstruction. There was a small amount of penetration with thin
liquids. For details, please refer to speech and swallow division note in
OMR.
IMPRESSION: Small amount of penetration with thin liquids.
|
19940147-RR-61
| 19,940,147 | 25,969,058 |
RR
| 61 |
2127-12-19 13:51:00
|
2127-12-19 15:25:00
|
INDICATION: Accelerated CML status post stem cell transplant with history of
silent aspiration.
COMPARISONS: Video oropharyngeal swallow study ___.
VIDEO OROPHARYNGEAL SWALLOW: A video oropharyngeal swallow study was
performed in conjunction with the speech and swallow team. Multiple
consistencies of barium were administered. There is no evidence of aspiration
or penetration with any of the consistencies.
IMPRESSION:
1. No evidence of aspiration or penetration.
2. For complete report, please see speech and swallow note in OMR.
|
19940147-RR-62
| 19,940,147 | 25,969,058 |
RR
| 62 |
2127-12-19 13:43:00
|
2127-12-19 15:28:00
|
INDICATION: ___ female with CML and graft-versus-host disease,
presents with left lower extremity more than right swelling. Question DVT.
COMPARISON: ___.
FINDINGS: Grayscale and color Doppler sonograms were performed of bilateral
lower extremities, demonstrating non-compressibility and echogenic
intraluminal material involving the right common femoral, superficial femoral,
and popliteal veins, consistent with near occlusive thrombosis. There may be
nonocclusive thrombosis extending into the posterior tibial and peroneal
veins.
Similarly, on the left, there is near complete thrombosis of the common
femoral, superficial femoral, and popliteal veins, with extension into the
posterior tibial and peroneal veins.
IMPRESSION: Extensive bilateral lower extremity DVTs involving the common
femoral, superficial femoral, popliteal, and posterior tibial and peroneal
veins on the left greater than the right.
Findings were reported to Dr. ___ by phone at 02:55 p.m. on ___.
|
19940147-RR-63
| 19,940,147 | 25,969,058 |
RR
| 63 |
2127-12-22 08:43:00
|
2127-12-22 18:15:00
|
INDICATION: ___ female with accelerated CML status post allograft
stem cell transplant ___ complicated by graft-versus-host disease
involving the abdomen. Evaluate for intrathoracic process and change.
EXAMINATION: CT of the chest without intravenous contrast using a
high-resolution interstitial CT protocol.
COMPARISONS: ___ and ___.
TECHNIQUE: MDCT of the chest using high-resolution interstitial CT technique
as per departmental protocol was performed. Intravenous contrast was not
administered. Axial images were provided at both 1.25- and 5-mm collimation.
The patient was positioned in both supine and prone positioning. Both
inspiratory and expiratory phases were performed.
FINDINGS:
Since examination from ___, there is diffuse narrowing of the airways
most conspicuous within the lower lobes, but also present within the upper
lobes. For example demonstrated within a right upper lobe segmental bronchus
(10:111), there is apparent narrowing to 4 mm (previously 6 mm on ___
(4:82)). In the lower lobes, a right lower lobe basal segmental branch
(10:160) now measures 4 mm (previously 7 mm on ___ (4:129)).
There is increased secretions within the lower lobe bronchi predominantly on
the right (10:155). There is no associated bronchial wall thickening or
peribronchiolar opacification. There is no associated air trapping
identified.
There are no new areas of parenchymal consolidation concerning for infection.
There are no pleural effusions or pneumothorax.
There is no axillary, mediastinal or hilar lymphadenopathy. There are stable
changes related to CABG. In addition, pericardial calcification is unchanged,
compatible with residua of prior pericarditis.
There is diffuse atrophy of the visualized musculature. A collection
demonstrated within the soft tissues adjacent to the right breast parenchyma
(416) measuring 3.0 x 1.7 cm is smaller since ___ and demonstrates
attenuation characteristics higher than expected for simple fluid.
A right approach PICC is demonstrated within the right atrium.
Note is made of extensive atherosclerotic calcification involving the thoracic
aorta. In addition, there is aortic valvular and coronary artery
calcification.
This examination is not tailored for subdiaphragmatic evaluation.
Incidentally noted is diffusely increased attenuation of the liver that may be
seen in iron deposition. The visualized upper abdomen is otherwise
unremarkable.
BONE WINDOWS: There are no osseous findings to suggest malignancy or
infection.
IMPRESSION:
1. Diffuse narrowing of the airways without associated air trapping or
peribronchial inflammation may represent early changes related to
bronchiolitis obliterans. No air trapping or evidence of infection.
2. Right approach PICC terminates within the right atrium.
3. Diffusely increased attenuation of the liver most compatible with iron
deposition.
4. Pericardial calcification likely the residual of prior pericarditis.
5. 3.0 fluid collection within the right breast is smaller since ___,
likely related to a seroma or resolving hematoma, for which clinical
correlation is recommended.
6. Diffusely atrophied chest wall musculature.
|
19940468-RR-10
| 19,940,468 | 21,877,812 |
RR
| 10 |
2127-01-13 13:39:00
|
2127-01-14 16:20:00
|
EXAMINATION: HIP 1 VIEW
INDICATION: Left hip hemiarthroplasty.
TECHNIQUE: AP view of the left hip.
COMPARISON: ___ and prior.
FINDINGS:
Intraoperative images during placement of left hip hemiarthroplasty with
template seen in the left femoral shaft.There is expected soft tissue edema
and gas about the hip.
IMPRESSION:
Intraoperative images during left hip hemiarthroplasty. Please refer to
operative report for details.
|
19940468-RR-11
| 19,940,468 | 21,877,812 |
RR
| 11 |
2127-01-13 15:59:00
|
2127-01-13 17:13:00
|
INDICATION: ___ year old woman status post left hip conversion to
hemiarthroplasty; please obtain low AP pelvis through distal extent of hip
implant // ___ year old woman status post left hip conversion to
hemiarthroplasty; please obtain low AP pelvis through distal extent of hip
implant
COMPARISON: ___
IMPRESSION:
There is a left bipolar hemiarthroplasty. No hardware related complications
are seen. There are moderate degenerative changes of the right hip with joint
space narrowing and spurring.
|
19940468-RR-5
| 19,940,468 | 21,877,812 |
RR
| 5 |
2127-01-09 15:57:00
|
2127-01-09 16:48:00
|
EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) LEFT
INDICATION: ___ with L hip pain s/p previous fracture repair // eval
fracture
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal
cross-table views of the left hip.
COMPARISON: None.
FINDINGS:
There is an impacted fracture of the left femoral neck, which is not
necessarily acute. 3 screws are visualized traversing the distal fracture
fragment however do not appear well anchored in the femoral head. The left
hip fragments are not properly aligned. Degenerative changes noted in the
lower lumbar spine.
IMPRESSION:
Left femoral neck fracture line with transfixing screws which do not appear to
be well anchored in the femoral head.
|
19940468-RR-6
| 19,940,468 | 21,877,812 |
RR
| 6 |
2127-01-09 15:57:00
|
2127-01-09 16:42:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with left lower leg swelling. Eval DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is partial thrombus involving the left common femoral vein through the
superficial femoral vein, popliteal vein and likely through the calf, however
the calf veins are limited in assessment.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Deep venous thrombosis involving the left common femoral vein, superficial
femoral vein, popliteal vein with limited views of the calf veins, which are
also likely partially occluded.
|
19940468-RR-7
| 19,940,468 | 21,877,812 |
RR
| 7 |
2127-01-10 13:11:00
|
2127-01-10 14:13:00
|
EXAMINATION: INJ/ASP MAJOR JT W/FLUORO
INDICATION: ___ year old woman with left hip fracture s/p repair at OSH now
presenting with nonunion // Prosthetic joint infection as cause of nonunion?
TECHNIQUE: Fluoroscopy guided left hip joint aspiration.
COMPARISON: Radiographs from ___
PROCEDURE: The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
7 cc of 1% Lidocaine was used to achieve local anesthesia. Under intermittent
fluoroscopic guidance, a 18-gauge spinal needle was advanced into the left
hip joint. Approximately 5 cc of fluid was aspirated from the left hip joint.
This was sent for microbiology and cell count.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in good
condition. There were no immediate complications or complaints.
FINDINGS:
Nonunited left femoral neck fracture with 3 cannulated screws in situ.
IMPRESSION:
1. Imaging Findings-as above
2. Procedure - Technically successful left hip aspiration
I, Dr. ___, personally supervised the Resident/Fellow during
the key components of the above procedure and I have reviewed and agree with
the Resident/Fellow findings/dictation.
|
19940468-RR-8
| 19,940,468 | 21,877,812 |
RR
| 8 |
2127-01-10 23:04:00
|
2127-01-11 09:41:00
|
EXAMINATION: CT LOW EXT W/O C LEFT Q61L
INDICATION: left leg pain // ___ with recent L hip fracture s/p ORIF now
with pain concerning for nonunion , ct for surgical planning for OR ___
TECHNIQUE: ___ MD CT imaging was performed through the left hip without
intravenous contrast. Coronal and sagittal reformats were produced and
reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.5 s, 32.5 cm; CTDIvol = 30.6 mGy (Body) DLP = 972.6
mGy-cm.
Total DLP (Body) = 973 mGy-cm.
COMPARISON: Left hip aspiration ___ and left hip radiographs ___
FINDINGS:
The patient is status post open reduction internal fixation of a subcapital
femur fracture. There is persistent visualization of the fracture line with
sclerosis along the margins of both the femoral head and femoral neck portions
(2:75). Small amount of gas in in the fracture gap, likely related to the
recent aspiration. There has been retraction of the 3 cannulated screws which
are no longer flush with the femoral cortex. The screw stands proud from the
femoral cortex over distance of approximately 2.5 cm. The screws do not have
purchase within the residual bony component of the femoral head. No ___
hardware lucency seen.
No callus formation seen. Mild fragmentation of the residual femoral head
(6:34, 28).
There is severe degenerative disc disease at the presumed L4-L5 level (7:115).
Evaluation of the pelvic parenchymal structures is limited, no free fluid seen
in the pelvis. No pelvic lymphadenopathy no free fluid in the pelvis.
Calcified granulomata in the gluteal fat. Moderate atherosclerotic vascular
calcification
IMPRESSION:
No bony ___ seen at the subcapital left femur fracture. 3 cannulated screws
have retracted over distance of approximately 2.5 cm.
|
19940534-RR-11
| 19,940,534 | 25,690,529 |
RR
| 11 |
2151-06-01 03:42:00
|
2151-06-01 04:20:00
|
EXAMINATION: CT left upper extremity without contrast
INDICATION: ___ year old man with fall, elbow fx// evaluate elbow fx for
operative planning
TECHNIQUE: ___ MD CT imaging was performed through the left elbow without
intravenous contrast. Coronal and sagittal reformats were produced and
reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.1 s, 17.1 cm; CTDIvol = 16.7 mGy (Body) DLP = 286.7
mGy-cm.
Total DLP (Body) = 287 mGy-cm.
COMPARISON: Left elbow radiographs ___
FINDINGS:
A previously seen left elbow dislocation has been reduced. There is
persistent subluxation at the ulnar trochlear articulation, likely in part due
to a moderately large joint effusion. In addition there is a mildly displaced
fracture through the coronoid process (401:67). This is distracted by
approximately 5 mm.
There is a fracture dislocation of the radiocapitellar joint with a comminuted
fracture of the radial neck. The dominant fragment of the radial head is
positioned posterior to the capitellum (401:45). A second fragment is
displaced more medially measuring 1 x 1 x 1.7 cm (401:55).
No humeral fracture seen.
Limited evaluation of the soft tissue structures demonstrates a moderately
large elbow effusion.
IMPRESSION:
1. Fracture dislocation of the radiocapitellar articulation with displacement
of the dominant radial head fragment posterior to the capitellum. A second
large fragment is displaced medially.
2. Fracture through the coronoid process of the ulna with subluxation of the
ulnotrochlear articulation.
3. Moderate elbow effusion.
NOTIFICATION: The patient has been admitted for open reduction internal
fixation of the elbow fractures.
|
19940534-RR-12
| 19,940,534 | 25,690,529 |
RR
| 12 |
2151-06-01 09:01:00
|
2151-06-01 09:44:00
|
EXAMINATION: FOOT AP,LAT AND OBL BILATERAL
INDICATION: History: ___ with fall from height landing on both heels.//
Please obtain standing films to evaluate for Lisfranc fracture Please
obtain standing films to evaluate for Lisfranc fracture
IMPRESSION:
No fracture or dislocation. Bony fragment protruding from the dome of the
left talus in the absence of any soft tissue swelling is a spur.
|
19940534-RR-13
| 19,940,534 | 25,690,529 |
RR
| 13 |
2151-06-03 10:08:00
|
2151-06-03 10:53:00
|
EXAMINATION: ELBOW, AP AND LAT VIEWS IN O.R. LEFT
INDICATION: ORIF LEFT ELBOW FRACTURE
IMPRESSION:
Intraoperative images were generated of the left elbow. Please refer to
dedicated operative note for further details.
|
19940534-RR-5
| 19,940,534 | 25,690,529 |
RR
| 5 |
2151-06-01 00:08:00
|
2151-06-01 00:43:00
|
EXAMINATION: Chest and pelvis radiographs.
INDICATION: ___ male with reported fall from 25 foot roof.
TECHNIQUE: Frontal view radiographs of the chest and pelvis.
COMPARISON: None available.
FINDINGS:
Low lung volumes exaggerate heart size and pulmonary vascular caliber. There
is no definite pulmonary edema or good evidence for consolidation, and no
appreciable pleural effusion or pneumothorax. For the evaluation of the
mediastinum and chest cage one is referred to the torso CT performed at an
outside hospital on ___ and uploaded to our PACs.
Single frontal view of the pelvis shows hips and pelvis are intact. Bladder
is filled with contrast agent.
IMPRESSION:
No definite thoracic or pelvic abnormality.
|
19940534-RR-6
| 19,940,534 | 25,690,529 |
RR
| 6 |
2151-06-01 01:25:00
|
2151-06-01 02:01:00
|
EXAMINATION: Second opinion read of outside hospital CT head and CT cervical
spine, this examination was performed at ___ on ___.
INDICATION: ___ year old man s/p 25 ft fall. C/o L chest, L arm, b/l heel
pain. Had CT head/c-spine/torso/? b/l feet/? L elbow at ___.// Injuries?
TECHNIQUE: Head CT. Axial images were obtained through the head, sagittal
coronal reformations were provided, the images were reviewed using soft tissue
and bone window algorithms.
Cervical spine. Axial images were obtained through the cervical spine,
coronal and sagittal reformations were provided, the images were reviewed
using soft tissue and bone window algorithms.
DOSE: Total DLP: 2030.18 mGy/cm.
COMPARISON: None.
FINDINGS:
CT head:
There is no evidence of acute intracranial hemorrhage, edema,or mass. The
ventricles and sulci are normal in size and configuration.
There is opacification of the bilateral ethmoid air cells and mucosal
thickening of the bilateral sphenoid sinuses and right maxillary sinus.
Mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
CT cervical spine: There is expansion and widening with soft tissue density in
the right neural foramina at C3-C4. There is no evidence of acute cervical
spine fracture or malalignment. There is no suspicious osseous lesion. There
is no spinal canal or neural foraminal stenosis. There is no prevertebral
edema.
IMPRESSION:
1. There is no evidence of acute intracranial process or hemorrhage.
2. Expansion and widening with soft tissue density in the right neural foramen
at C3-C4. This is nonspecific in etiology and could represent underlying
mass, a nonurgent MRI can be considered for further characterization.
RECOMMENDATION(S): Expansion and widening of the right neural foramen at
C3-C4 level as described detail above suggest underlying mass lesion,
correlation with MRI of the cervical spine with and without contrast is
recommended for further characterization.
|
19940534-RR-7
| 19,940,534 | 25,690,529 |
RR
| 7 |
2151-06-01 01:34:00
|
2151-06-01 02:33:00
|
EXAMINATION: Second opinion about outside hospital elbow radiograph
INDICATION: ___ with fall, comminuted elbow fx.
TECHNIQUE: Not available.
COMPARISON: Not available. Compared to the outside radiographs of the left
elbow, dated ___
FINDINGS:
Left elbow is contained in a plaster splint which obscures anatomic detail.
The extent of previous complete elbow dislocation has been significantly
improved. There is a fracture of the radial head. There is a probable
fracture of the coracoid process of the olecranon and displacement of the
olecranon from the olecranon fossa.
IMPRESSION:
PLEASE NOTE REVISION OF PREVIOUS INITIAL INTERPRETATION, BENEFITTING FROM
DELAYED PROVISION OF PREVIOUSLY UNAVAILABLE PRETREATMENT RADIOGRAPHS OF THE
LEFT ELBOW.
Probable fractures of the radial head and coracoid process of the olecranon;
previous complete a dislocation substantially improved. Of note, CT can be
considered for further characterization.
|
19940534-RR-8
| 19,940,534 | 25,690,529 |
RR
| 8 |
2151-06-01 01:38:00
|
2151-06-01 02:17:00
|
EXAMINATION: Second opinion read of outside hospital CT torso
INDICATION: ___ with fall.
TECHNIQUE: Outside examination performed at ___ ___.
DOSE: Outside examination.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen. There is common origin
of the left common carotid artery and innominate artery (normal variant).
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild dependent atelectasis in the bilateral lower
lobes. Otherwise, lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
1.2 cm hypodensity in right lobe of the liver (2:149) could be a hemangioma.
There is no evidence of laceration. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted.
BONES: There are mild degenerative changes at L5-S1. There is no acute
fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
No visceral injury or fracture in the torso.
|
19940534-RR-9
| 19,940,534 | 25,690,529 |
RR
| 9 |
2151-06-01 01:46:00
|
2151-06-01 02:04:00
|
EXAMINATION: Second opinion read of outside hospital CT feet
INDICATION: ___ male with fall.
TECHNIQUE: Not available.
DOSE: Not available.
COMPARISON: Compared to radiographs of bilateral feet from ___.
FINDINGS:
Left foot/ankle: There is no fracture or malalignment. Ankle mortise is
intact. Joint spaces are well maintained. There are no suspicious osseous
lesion. There is no soft tissue swelling. The calcaneal heel is within
normal limits. The Achilles tendon appears intact. The peroneal, medial, and
anterior tendons are within normal limits. There is no ankle joint effusion.
Right foot/ankle: Images are somewhat limited due to patient motion. There is
no signs acute fractures or dislocations. The ankle joint is well aligned.
There are no significant degenerative changes. The calcaneal heel appears
intact. There is normal osseous mineralization. Small bone island is seen
within the talus. There is a small 5 mm osteochondral lesion within the
lateral talar dome, best seen on series 502, image 97.
IMPRESSION:
1. No fracture or malalignment of the bilateral feet.
2. 5 mm osteochondral lesion within the right lateral talar dome.
|
19940586-RR-4
| 19,940,586 | 24,061,735 |
RR
| 4 |
2138-10-06 22:18:00
|
2138-10-06 22:56:00
|
HISTORY: Fracture of the distal tibia.
TECHNIQUE: Right tibia and fibula, 2 views, right foot, 2 views.
COMPARISON: None.
FINDINGS:
Overlying cast material limits fine osseous detail, particularly within the
foot. Oblique fracture of the distal diaphysis of the right tibia is noted
with mild lateral displacement of the dominant distal fracture fragment.
Additionally, there is an oblique fracture of the distal fibula which is
mildly displaced posteriorly. Assessment of the ankle mortise is limited on
these views. No dislocation is identified. The imaged aspects of the right
knee is grossly unremarkable. Evaluation of the right foot is markedly
limited, but no gross fracture or dislocation seen.
IMPRESSION:
Mildly displaced oblique fractures of the distal right tibia and fibula.
|
19940586-RR-5
| 19,940,586 | 24,061,735 |
RR
| 5 |
2138-10-07 12:29:00
|
2138-10-07 17:36:00
|
HISTORY: Right tibiofibular ORIF.
Fluoroscopic assistance provided to the surgeon in the OR without the
radiologist present. Eight spot views obtained. Views demonstrate steps
related to hardware fixation along the distal tibia and fibula. Fluoro time
recorded as 44.5 seconds on the electronic requisition. Correlation with
real-time findings and when appropriate conventional radiographs is
recommended for further assessment.
|
19940725-RR-13
| 19,940,725 | 27,381,801 |
RR
| 13 |
2123-10-16 13:50:00
|
2123-10-16 15:37:00
|
EXAMINATION: CT abdomen and pelvis with IV contrast.
INDICATION: ___ with bloating/abd pain and new onset of significant amount of
ascites concerning for liver disease, malignancy. Evaluate for mass.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 976 mGy-cm.
COMPARISON: None available.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is a
small intermediate density left-sided pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is thickening
and nodularity of the omentum (02:52 and 602b:50). There is also thickening
and nodularity along the right superior peritoneum (601:47, 52, 55, 61) in the
subhepatic space. There is large volume ascites.
PELVIS: There is thickening of the peritoneum along the presacral space
(602:46, 2:84) The urinary bladder and distal ureters are unremarkable. There
is a large volume ascites in the pelvis.
REPRODUCTIVE ORGANS: The uterus and ovaries are grossly unremarkable.
LYMPH NODES: There is thickening and nodularity along the right peritoneum
(601:47, 52, 55, 61). There is thickening nodularity of the omentum (02:52
and 602b:50). There is thickening of the peritoneum along the presacral space
(602:46, 2:84)
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. There is thickening and nodularity along the right peritoneum (601:47, 52,
55, 61), thickening nodularity of the omentum (02:52 and 602b:50), and
thickening of the peritoneum along the presacral space (602:46, 2:84) likely
representing peritoneal carcinomatosis.
2. Large volume ascites and intermediate density small left-sided pleural
effusion which are likely malignant.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ in person on ___ at 2:35 pm, 5 minutes after discovery of
the findings.
|
19940836-RR-21
| 19,940,836 | 21,746,727 |
RR
| 21 |
2142-03-18 00:30:00
|
2142-03-18 01:01:00
|
EXAMINATION: CT ABDOMEN PELVIS WITHOUT CONTRAST
INDICATION: History: ___ with diffuse abdominal pain with bilateral flank//
eval stone, colitis other acute process
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.9 s, 51.7 cm; CTDIvol = 15.9 mGy (Body) DLP = 820.3
mGy-cm.
Total DLP (Body) = 820 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan.
There is mild, predominantly central, intrahepatic biliary dilatation. The
common bile duct is dilated up to 2.1 cm (602:29), with tapering noted in the
pancreas head. Subtle hyperdense material in the distal CBD (02:33) is
nonspecific, but may represent sludge/stones. The gallbladder is surgically
absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No nephroureterolithiasis.
2. Common bile duct is dilated up to 2.1 cm, with tapering seen in the
pancreas head. Subtle hyperdense material seen in the distal CBD is
nonspecific, may represent sludge/stones. MRCP is recommended for further
evaluation.
RECOMMENDATION(S): MRCP.
|
19940836-RR-22
| 19,940,836 | 21,746,727 |
RR
| 22 |
2142-03-18 17:17:00
|
2142-03-18 20:50:00
|
EXAMINATION: MRCP
INDICATION: ___ year old woman with abdominal pain, CT A/P showing CBD
dilatation to 2.1 cm without clear stone, with narrowing at pancreatic head,
evaluate for mass/stricture/stenosis causing CBD dilatation?
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 9 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT dated ___.
FINDINGS:
Lower Thorax: No pleural effusion.
Liver: A 4 mm focus of arterial hyperenhancement in the junction of segment II
and segment ___ is associated with washout on the portal venous phase and drop
of signal on in and out of phase imaging (1201:42). There is a 5 mm lesion in
segment V with similar imaging characteristics. The portal and hepatic veins
are patent.
Biliary: Mild intrahepatic and extrahepatic biliary ductal dilatation with
smooth tapering the pancreatic ampulla and no focal lesion. The CBD measures
up to 2.1 cm in greatest axial dimension (1202:73). There is no
choledocholithiasis. Findings may be due to post cholecystectomy change.
Pancreas: Unremarkable.
Spleen: Unremarkable.
Adrenal Glands: Unremarkable.
Kidneys: Bilateral kidneys are unremarkable. No hydronephrosis.
Gastrointestinal Tract: No bowel obstruction or ascites in the upper abdomen.
Lymph Nodes: No upper abdominal adenopathy.
Vasculature: The celiac branching is conventional.
Osseous and Soft Tissue Structures: No suspicious osseous lesion.
IMPRESSION:
1. Dilatation of the extrahepatic common bile duct with smooth tapering
towards the ampulla without choledocholithiasis. Findings more likely
represent post cholecystectomy change rather than sphincter of Oddi
dysfunction given the normal caliber of the pancreatic duct.
2. Sub 4 mm fat containing enhancing lesions in the liver could represent
small adenomas given age and gender, however adenomas do not have a typical
imaging appearance, therefore remain indeterminate. Due to their diminutive
size, a follow-up MRI in 6 months is recommended.
RECOMMENDATION(S): 6 month follow up MRI liver with and without contrast is
recommended.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 17:13 into the Department of Radiology
critical communications system for direct communication to the referring
provider.
|
19940947-RR-19
| 19,940,947 | 28,526,241 |
RR
| 19 |
2134-09-02 06:13:00
|
2134-09-02 07:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with right weakness and numbness. Evaluate for acute
intracranial hemorrhage or large territorial infarct.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CTA head and neck ___.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, or shift of normally
midline structures. Prominent ventricles and sulci compatible with
age-related involutional changes. Periventricular subcortical white matter
hypodensities are nonspecific but likely represent chronic small vessel
ischemic disease. Atherosclerotic vascular calcifications are noted of
bilateral vertebral and cavernous portions of internal carotid arteries.
There is partial opacification of the bilateral ethmoid air cells and
bilateral maxillary sinuses. An osteoma is noted in the right frontal sinus.
Mastoid air cells and middle ear cavities are well aerated. The bony calvarium
is intact. Right frontal sinus osteoma is noted (see 2:8). 1.5 cm left
parietal scalp vertex probable sebaceous cyst is noted (see 3:64).
IMPRESSION:
1. No intracranial hemorrhage.
2. No evidence of acute large territorial infarct. Please note MRI of the
brain is more sensitive for the detection of acute infarct.
3. Paranasal sinus disease , as described.
4. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
5. Left parietal scalp vertex probable sebaceous cyst.
|
19940947-RR-20
| 19,940,947 | 28,526,241 |
RR
| 20 |
2134-09-02 06:19:00
|
2134-09-02 11:44:00
|
EXAMINATION: Left vertebral artery angiogram.
Left common carotid artery angiogram.
Right common femoral artery angiogram.
INDICATION: ___ year old man with hx of DM, HTN, prior stroke who presents w/
R facial droop and R sided weakness// Evaluate for tip of the basilar
occlusion and intervention
TECHNIQUE: ANESTHESIA: Conscious sedation anesthesia was administered by the
anesthesiology department. Please refer to anesthesiology notes for details.
Patient was brought into the angio suite, ID was confirmed via wrist band.The
patient was placed supine on fluoroscopy table and bilateral groins were
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. The location of the right mid femoral
head was located using anatomic and radiographic landmarks. 10 +10 cc of
subcutaneous lidocaine was infused into the tissue. Micropuncture kit was
used to gain access to the right femoral artery, serial dilation was
undertaken until a long 8 ___ groin sheath connected to a continuous
heparinized saline flush could be inserted. ___ catheter was
connected to the power injector and also to a continuous heparinized saline
flush. This was advanced over the 0.038 glidewire brought up the aorta used to
select The catheter was then pulled back in the aorta and the left subclavian
artery was selected. AP and lateral road map imaging was undertaken. Next,
the left vertebral artery was selected. AP and lateral views were taken from
this vessel for the posterior cerebral circulation.
Next the diagnostic catheter was exchanged to ___, ___
intermediate Catheter was mounted over a SL 10 microcatheter and a synchro 2
wire and it was positioned at the intracranial segment of the left vertebral
artery. Next the microcatheter was advanced to the tip of the basilar and a
micro injection was done trying to identify the ostium of the left PCA, as we
could not appreciate takeoff of the PCA we decided to do a left ICA diagnostic
angio first.
The whole construct was removed from the body
___ 2 was mounted again and used to select the left common carotid artery. AP
and lateral views of the anterior cerebral circulation were obtained.
As the left PCA was coming from a fetal PCOM we decided not to pursue any
further intervention, the catheter was then pulled back in the aorta fully
removed from the body. A common femoral arteriogram was performed prior to
use of a closure device, subsequently a frame Angio-Seal was put in. At the
conclusion of the procedure, there is no evidence of thromboembolic
complication and the patient was at his neurologic baseline.
COMPARISON: None
FINDINGS:
Left common carotid artery: Carotid bifurcations well-visualized. There is
no significant atherosclerosis or carotid stenosis.
Left internal carotid artery: Distal left ICA, proximal and distal MCA
branches are well-visualized. Robust PCOM compatible with fetal variant.
Otherwise, vessel caliber smooth and tapering. Normal arterial, capillary, and
venous phase . No vascular abnormalities identified .
Significant movement artifact but the left vertebral artery , basilar artery,
bilateral SCA are well-visualized. The right PCA is predominantly fed by the
basilar artery. No vascular abnormalities identified, vessel caliber smooth
and tapering.
Right common femoral artery: Well-visualized with a good caliber size for
closure device.
I, ___, participated in the procedure. I, ___, was
present for the entirety of the procedure and supervised all critical steps.
I, ___, have reviewed the report and agree with the fellow's
findings.
IMPRESSION:
Diagnostic cerebral angiogram did not demonstrate a tip of the basilar
occlusion, both PCAs were patent.
RECOMMENDATION(S): Management as per Stroke Neurology recommendations.
|
19940947-RR-21
| 19,940,947 | 28,526,241 |
RR
| 21 |
2134-09-03 00:11:00
|
2134-09-03 01:48:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: Acute right-sided weakness. Evaluate for infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Noncontrast head CT ___. CTA head neck ___.
FINDINGS:
There is an area of slow diffusion in the left posterior putamen/external
capsule leading to the left posterior frontal corona radiata with additional
punctate areas in the right splenium of the corpus callosum and numerous
punctate areas in the right occipital lobe with corresponding T2/FLAIR
hyperintensity, compatible with late acute to early subacute infarct.
There is no evidence of hemorrhage, masses, mass effect, or midline shift.
There is moderate prominence of the ventricles and sulci suggestive of
involutional change. Scattered areas of periventricular, subcortical and deep
white matter T2/FLAIR hyperintensities are in a configuration most suggestive
chronic small vessel ischemic disease. The principal intracranial vascular
flow voids are preserved.
There is a small mucous retention cyst in the right maxillary sinus. There is
trace mucosal wall thickening in the bilateral anterior ethmoid air cells
along with a another small mucous retention cyst in the right frontal sinus.
There are changes from bilateral lens replacement surgery. The orbits are
otherwise grossly unremarkable. The mastoid air cells are clear.
IMPRESSION:
1. Small late acute to early subacute infarcts in the left posterior
putamen/external capsule leading to the left posterior frontal corona radiata,
right splenium of the corpus callosum, and right occipital lobe, as described.
The distribution is suggestive of an embolic etiology.
2. No hemorrhage or suggestion of mass.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ on the telephone on ___ at 2:01 am, 5 minutes after discovery of
the findings.
|
19940947-RR-22
| 19,940,947 | 28,526,241 |
RR
| 22 |
2134-09-03 14:00:00
|
2134-09-04 15:10:00
|
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) SOFT TISSUE RIGHT
INDICATION: ___ year old man with large bruise, uncertain etiology// trauma?
trauma?
TECHNIQUE: AP in internal rotation, Grashey in external rotation, and
axillary view radiographs of the right shoulder joint
COMPARISON: None
FINDINGS:
There is no fracture or dislocation involving the glenohumeral or AC joint.
There are no degenerative changes. No suspicious lytic or sclerotic lesion is
identified. No periarticular calcification or radio-opaque foreign body is
seen.
IMPRESSION:
No fracture, lytic or blastic bone lesions. No abnormal soft tissue
calcifications. Visualized right-sided ribs are intact and right lung is
clear.
|
19941011-RR-13
| 19,941,011 | 22,616,408 |
RR
| 13 |
2143-10-08 03:08:00
|
2143-10-08 07:04:00
|
INDICATION: Leukocytosis.
COMPARISON: None available.
FINDINGS: Chest, PA and lateral. The lungs are clear. The hilar and
cardiomediastinal contours are normal. There is no pneumothorax or pleural
effusion. Pulmonary vascularity is normal.
IMPRESSION: Normal radiograph of the chest.
|
19941474-RR-41
| 19,941,474 | 21,944,435 |
RR
| 41 |
2188-01-24 10:32:00
|
2188-01-24 13:15:00
|
INDICATION: ___ year old man with lung cancer, need for port placement //
Please place single lumen chest port - leave accessed, ___ aware on IV
heparin
COMPARISON: Comparison is made to chest CTA performed ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed the procedure. Dr.
___ radiologist, personally supervised the trainee during the key
components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 35 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed, lidocaine, 1 g cefazolin.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1 min 53 seconds, 146 cGy-cm2
PROCEDURE
1. Right internal jugular approach chest single lumen Port-a-cath placement
PROCEDURE DETAILS: Following the explanation 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 upper chest was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a subcutaneous pocket over the
upper anterior chest wall. After instilling superficial and deeper local
anesthesia using lidocaine mixed with epinephrine, a 2.5 cm transverse
incision was made and a subcutaneous pocket was created by using blunt
dissection. The single lumen port was then connected to the catheter. The
catheter was tunneled from the subcutaneous pocket towards the venotomy site
from where it was brought out using a tunneling device. The port was then
connected to the catheter and checks were made for any leakage by accessing
the diaphragm using a non-coring ___ needle. No leaks were found.
The port was then placed in the subcutaneous pocket and secured with ___
prolene sutures on either side. The venotomy tract was dilated using the
introducer of the peel-away sheath supplied. Following this, the peel-away
sheath was placed over the ___ wire through which the port was threaded into
the right side of the heart with the tip in the right atrium. The sheath was
then peeled away.
The subcutaneous pocket was closed in layers with ___ interrupted and ___
subcuticular continuous Vicryl sutures. Steri-strips were used to close the
venotomy incision site. Steri-Strips were applied over the sutures. Final spot
fluoroscopic image demonstrating good alignment of the catheter and no
kinking. The tip is in the right atrium.
The port was accessed using a non coring ___ needle and could be aspirated
and flushed easily. Sterile dressings were applied. The patient tolerated the
procedure well without immediate complication. The port was left accessed as
requested.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing port with
smooth course of intact catheter tubing, terminating in the right atrium.
IMPRESSION:
Successful placement of a single lumen chest power Port-a-cath via the right
internal jugular venous approach. The tip of the catheter terminates in the
right atrium. The catheter is ready for use.
|
19941474-RR-42
| 19,941,474 | 20,997,199 |
RR
| 42 |
2188-01-26 12:03:00
|
2188-01-26 13:52:00
|
INDICATION:
___ with prior pleural effusions, interval change.
COMPARISON: Comparison is made to chest CT from ___ and chest
radiograph from same day.
TECHNIQUE
Frontal and lateral views of the chest.
FINDINGS:
Since prior, there has been a increased opacity at the left lung base
compatible with a worsening effusion. Lingular opacity is also increased.
The mediastinal contour is unremarkable. The left cardiac border is obscured.
The right lung is hyperinflated but grossly clear. There is no pneumothorax. A
right chest wall port a catheter ends in the proximal right atrium.
Lymphangitic spread better seen on prior CT.
IMPRESSION:
Increased size of left-sided pleural effusion and lingular opacity.
|
19941474-RR-43
| 19,941,474 | 20,997,199 |
RR
| 43 |
2188-01-27 15:10:00
|
2188-01-27 15:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with lung ca s/p pleurex // Please eval for
pneumothorax Please eval for pneumothorax
IMPRESSION:
In comparison with the study of ___, there may be slight increase in the
opacification at the left base, consistent with prominent pleural effusion.
There may be a curvilinear pleural line in the left apex consistent with a
small pneumothorax.
The right lung is essentially clear and there is little change in the
Port-A-Cath.
|
19941474-RR-49
| 19,941,474 | 23,188,619 |
RR
| 49 |
2188-05-09 15:28:00
|
2188-05-09 16:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with metastatic lung cancer, known meningioma, syncope //
Eval for ICH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as bone algorithm reformatted images
were obtained.
DOSE: Total DLP (Head) = 2,007 mGy-cm.
COMPARISON: MRI brain from ___
FINDINGS:
The examination is significant limited by motion artifact. Allowing for this,
no gross abnormalities are seen. The calcified left temporal meningioma
measuring 1.2 cm (05:13), is unchanged from ___. Basal cisterns are
patent. No evidence of fracture. Paranasal sinuses, mastoid air cells, and
middle ear cavities are clear aside from minimal mucous and a right anterior
ethmoid air cell.
IMPRESSION:
1. Stable left temporal meningioma from ___.
2. Limited exam due to excessive motion artifact without gross abnormality.
If there is continued concern, repeat study when patient is able to lay still.
|
19941474-RR-50
| 19,941,474 | 23,188,619 |
RR
| 50 |
2188-05-10 13:58:00
|
2188-05-10 15:54:00
|
EXAMINATION: CTA LOWER EXT W/ANDW/O C AND RECONS LEFT
INDICATION: ___ year old man with lung cancer on lovenox for upper extremity
DVT presents with thigh hematoma. HCT continues to drop // Eval active thigh
bleed/RP bleed. Please have radiologist eval initial arteriogram to determine
need for delayed phase imaging
TECHNIQUE: Lower extremity CTA: Non-contrast, arterial, portal venous, and
delayed phase images were acquired through the left thigh
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Total DLP (Body) = 1,384 mGy-cm.
IV Contrast: 130 mL of Omnipaque
COMPARISON: Reference CT on ___
FINDINGS:
VASCULAR:
There is an infrarenal saccular abdominal aortic aneurysm projecting to the
right measuring up to 4.2 x 4.3 cm (Series 5, image 208 and series 10, image
45). There is minimal peripheral thrombus within the anterior portion of the
aneurysm sac. There is moderate to severe calcium burden in the visualized
abdominal aorta and left iliac artery.
Left lower extremity CTA: There is no evidence of active arterial
extravasation within the left thigh on delayed phase imaging. There are
several moderate focal stenoses in the distal left superficial femoral artery
for a segment of roughly 5 cm due to atherosclerosis however there is no
evidence of critical stenosis or occlusion in the left common femoral, left
superficial femoral, left deep femoral or popliteal artery.
A large hematoma predominantly within the adductor magnus muscle of the left
leg is minimally increased in size from the prior examination done on ___ measuring 10.4 x 10.9 cm in its greatest dimension. (Series 4,
image 111). Hematoma is seen involving the gluteus medius muscle distinctly
as well. There is subcutaneous stranding involving the left thigh, also
minimally increased from the prior examination.
Pelvis: Limited evaluation of the pelvis shows multiple subcentimeter
hypodensities within the left kidney, which are too small to characterize on
CT. However, a 7 mm renal hypodensity seen in the interpolar region of the
left kidney (series 5, image 214) is slightly hyper attenuating. The rectum
and sigmoid colon are within normal limits. The bladder is unremarkable.
There is no pelvic lymphadenopathy. The visualized osseous structures are
within normal limits. There is mild degenerative change seen in the lumbar
spine. Note is made of a left knee prosthesis.
IMPRESSION:
1. No evidence of active arterial extravasation. Hematoma within
predominantly the left adductor magnus and gluteus medius muscles is minimally
increased in size from the prior examination on ___.
2. Extensive stranding in the subcutaneous fat of the left thigh is increased
from the prior examination.
3. Infrarenal abdominal aortic aneurysm measuring up to 4.2 cm with small
peripheral thrombus within the aneurysmal sac. Moderate focal stenoses in the
distal 5 cm of the left superficial femoral artery.
|
19941474-RR-51
| 19,941,474 | 23,188,619 |
RR
| 51 |
2188-05-11 17:38:00
|
2188-05-12 01:50:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ w/ lung ca c/b malignant effusions p/w thigh pain and per pt
family recent dx of pna // evaluate for pleural effusion and consolidations
evaluate for pleural effusion and consolidations
COMPARISON: Chest radiographs ___.
IMPRESSION:
Moderate left pleural effusion has increased since ___. Left lower
lobe is obscured, presumably atelectatic. Upper lungs are grossly clear,
hyperinflated, suggesting pneumonia. Heart size hard to determine, but not
significantly enlarged.
Central venous infusion catheter ends in the upper right atrium. No
pneumothorax.
|
19941474-RR-53
| 19,941,474 | 23,188,619 |
RR
| 53 |
2188-05-16 16:25:00
|
2188-05-16 17:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ neutropenic low grade fevers // evaluate for PNA
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph ___.
FINDINGS:
There is a persistent moderately large left pleural effusion with associated
atelectasis. Infection cannot be excluded. The right lung and left upper
lung are grossly clear. A right-sided Port-A-Cath terminates in the distal
SVC or right atrium, the tip is difficult to visualize. No pneumothorax seen.
IMPRESSION:
No significant interval change when compared to the prior study.
|
19941474-RR-54
| 19,941,474 | 23,188,619 |
RR
| 54 |
2188-05-20 10:41:00
|
2188-05-20 12:25:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with lung cancer, worsening LFTs, not eating //
eval for cholecystitis, liver mets, ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT chest with contrast ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 13.2 cm.
KIDNEYS: The right kidney measures 11.4 cm. The left kidney measures 11.7 cm.
There is no evidence of hydronephrosis.
IMPRESSION:
1. Unremarkable liver ultrasound.
2. Cholelithiasis.
3. Left pleural effusion.
|
19941474-RR-55
| 19,941,474 | 23,188,619 |
RR
| 55 |
2188-05-22 11:16:00
|
2188-05-22 11:44:00
|
INDICATION: ___ year old man with chest tube placement on left // Rule out
Ptx
COMPARISON: ___
FINDINGS:
Interval insertion of a left-sided pigtail catheter with decrease in the
left-sided pleural effusion. No pneumothorax. Left retrocardiac opacity has
improved. The right lung remains clear. Right-sided Port-A-Cath with the tip
in the right atrium.
IMPRESSION:
No pneumothorax, post left-sided chest tube placement with decrease in left
pleural effusion.
|
19941834-RR-10
| 19,941,834 | 27,307,863 |
RR
| 10 |
2174-06-16 10:17:00
|
2174-06-16 15:24:00
|
INDICATION: ___ man with intraparenchymal hemorrhage, evaluate for
possible malignancy.
COMPARISON: None available.
TECHNIQUE: Contiguous axial MDCT images were obtained through the abdomen and
pelvis with oral and intravenous contrast. Axial images were reviewed in
conjunction with coronal and sagittal reformats. Of note, CT scanning of the
chest was performed concurrently but will be reported separately.
DLP: 726 mGy-cm.
FINDINGS:
Limited view of the lung bases is notable for basalilar atelectasis. For
detailed description of chest findings, please refer to separate CT chest
report.
The liver enhances homogeneously without focal lesions. Portal vein is
patent. There is no intrahepatic biliary dilatation. Gallbladder, spleen,
pancreas, and adrenal glands are within normal limits. The right kidney
contains a 6-cm exophytic simple cyst at the upper pole and a smaller cyst
measuring approximately 2 cm at the lower pole. Multiple subcentimeter
hypodensities are also noted but remain too small to characterize. The left
kidney is severely atrophic and contains multiple simple cysts, the largest is
at the lower pole measuring 4.2 cm.
Oral contrast fills the stomach and loops of small and large bowel which
appear normal in course and caliber without signs of obstruction.
There is no mesenteric or retroperitoneal lymphadenopathy. There is no
intra-abdominal free air or free fluid.
Aorta is of normal caliber without aneurysmal dilatation. There is partial
compression of the left common iliac vein by the left common iliac artery.
The left external iliac vein appears expanded and contains a thrombus that
extends from the mid portion of the left external iliac vein to the left
common femoral vein. IVC filter is tilted, but seen at the appropriate level
in the IVC.
Bladder is within normal limits. The right ureteral jet is noted, but there
is no ureteral jet on the left, likely secondary to the nonfunctional atrophic
kidney on that side. Seminal vesicles and prostate are unremarkable. A
fat-containing left inguinal hernia is present. There is no pelvic free fluid
or lymphadenopathy.
Bones are notable for degenerative changes in the spine but no concerning
osteolytic or osteosclerotic lesions.
IMPRESSION:
1. Thrombosis of the left mid portion external iliac vein originating from
the DVT in the left common femoral and femoral veins. This could be in part
due to partial compression of the left common iliac vein by the left common
iliac artery ___ syndrome).
2. No evidence of malignancy in the abdomen or pelvis.
3. For detailed thoracic findings, please refer to separate CT chest report
from the same date.
|
19941834-RR-11
| 19,941,834 | 27,307,863 |
RR
| 11 |
2174-06-16 10:17:00
|
2174-06-16 13:18:00
|
CT HEAD WITH AND WITHOUT CONTRAST.
HISTORY: ___ male with chronic right frontal hemorrhage and acute
right frontal and left parietal bleed. Assess for tumor underlying the bleed
and leptomeningeal enhancement. Patient cannot tolerate MRI.
COMPARISON: CT head without contrast, ___ and MR head with and
without contrast, ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
initially without the administration of IV contrast, followed by
administration of IV contrast. Reformatted coronal, sagittal, and thin
section bone algorithm images were acquired.
DLP: ___.43 mGy-cm.
FINDINGS:
NON-CONTRAST HEAD CT: Mild decrease in density in the lenticular-shaped focus
of hemorrhage seen in the right frontal lobe measuring 1.2 x 0.4 cm and is
stable in size (2aA:11). Additional focus of hemorrhage seen in the left
parietal lobe is stable measuring 0.6 cm (2aA:14). No mass effect or midline
shift associated with these findings. In the area of the prior right frontal
lobe hemorrhage, there is evidence of an unresolved hematoma with enhancement,
although mass cannot be excluded at this time. Interval decrease in
associated mass effect. No new foci of hemorrhage. No blood within the
ventricular system. No leptomeningeal enhancement.
Again seen are changes of encephalomalacia in the right frontal lobe.
Prominence of the ventricles and sulci suggests age-appropriate cortical
volume loss. Faint periventricular white matter hypodensities are likely
sequelae of chronic small vessel ischemic disease. The basal cisterns are
patent. No fracture is seen. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
IMPRESSION:
1. Unresolved hematoma in the right frontal lobe measuring 2.6 x 0.8 cm with
associated enhancement, an underlying mass cannot be excluded at this time.
Interval follow-up with MR is recommended to assess for mass.
2. Stable intraparenchymal hemorrhage in the left parietal lobe.
3. Decrease in density of the intraparenchymal hemorrhage in the right
frontal lobe. No new hemorrhage.
Results entered into critical results by ___ on ___ to
be conveyed to the ordering provider.
|
19941834-RR-12
| 19,941,834 | 27,307,863 |
RR
| 12 |
2174-06-16 10:18:00
|
2174-06-16 11:43:00
|
HISTORY: Intraparenchymal head bleed. Assess for primary malignancy.
COMPARISON: No prior chest CT is available for comparison.
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. IV Omnipaque contrast was administered. Axial images were
interpreted in conjunction with sagittal and coronal reformats.
FINDINGS:
A calcified nodule is present in the left thyroid lobe. The thyroid is
otherwise unremarkable. A few mediastinal and hilar lymph nodes are prominent,
ranging in size up to 9 mm in the pretracheal and right hilar stations.
Axillary, supraclavicular, and hilar lymph nodes are not pathologically
enlarged. The great vessels are normal caliber. Scattered coronary artery
calcifications are small. The heart size is normal. No pericardial effusion.
The airways are patent to subsegmental levels. Mild bibasilar atelectasis is
present. A perifissural right lower lobe nodule (4:120) measures 6 mm. No
focal consolidation, pleural effusion, or pneumothorax.
The esophagus is unremarkable. For the subdiaphragmatic findings, please
refer to the separately issued abdominal CT report.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy. Moderate thoracic spine degenerative changes.
IMPRESSION:
Solitary 6 mm right lower lobe pulmonary nodule for which 6 month followup is
recommended.
|
19941834-RR-13
| 19,941,834 | 25,455,160 |
RR
| 13 |
2174-06-28 17:48:00
|
2174-06-28 19:36:00
|
CHEST, TWO VIEWS: ___
HISTORY: ___ male with fevers for one day.
COMPARISON: ___.
FINDINGS: As on prior, low lung volumes are seen. There has, however, been
interval clearance of the retrocardiac opacity seen on the previous lateral
view. Cardiomediastinal silhouette is unchanged and likely within normal
limits given positioning and low lung volumes. No acute osseous abnormality
is identified.
IMPRESSION: Limited exam given low lung volumes; however, no evidence of
large confluent consolidation.
|
19941834-RR-14
| 19,941,834 | 25,455,160 |
RR
| 14 |
2174-06-28 15:04:00
|
2174-06-28 18:16:00
|
HISTORY: Worsening right lower extremity swelling and redness with history of
deep vein thromboses and IVC filter placement. Assess for progression of deep
vein thrombosis.
COMPARISON: No comparison is available to assess for progression.
FINDINGS:
Gray scale and color Doppler sonogram was performed of the bilateral lower
extremity deep veins. Occlusive thrombus was identified in the right
superficial femoral, deep femoral and popliteal veins. As the patient was
becoming increasing combative, the right calf veins were not interrogated.
Occlusive thrombus is also identified in the left common femoral and
throughout the superficial femoral vein. At this point the patient became
increasingly agitated and examination was aborted.
IMPRESSION:
Occlusive thrombus of all interrogated deep veins including the right
superficial femoral, deep femoral, popliteal and left common femoral and
superficial femoral veins. Examination was aborted prematurely due to
patient's agitated state.
|
19941834-RR-2
| 19,941,834 | 23,047,258 |
RR
| 2 |
2174-02-13 04:31:00
|
2174-02-13 05:29:00
|
HISTORY: Intracranial hemorrhage. Question aspiration.
COMPARISON: None.
TECHNIQUE: AP and lateral views of the chest.
FINDINGS: The lungs are clear. Cardiac silhouette is normal in size. There
is no pleural effusion, pneumonia or evidence of pulmonary edema. Degenerative
changes of the spine are noted.
IMPRESSION: No evidence of acute cardiopulmonary process.
|
19941834-RR-3
| 19,941,834 | 23,047,258 |
RR
| 3 |
2174-02-13 04:27:00
|
2174-02-13 05:31:00
|
HISTORY: Known intracranial hemorrhage. Reassess.
COMPARISON: ___ CT from an outside hospital.
TECHNIQUE: CT of the head without IV contrast.
CTDIvol: 60 mGy
TOTAL DLP: 1025 mGy-cm.
FINDINGS: A right frontal lobar hematoma measures 4.2 x 3.1 cm and has
surrounding vasogenic edema. This causes slight mass effect upon the frontal
horn of the right lateral ventricle. Overall, it appears stable from the CT
from five hours prior. The basal cisterns are patent. There does not appear
to be intraventricular extension. There is no shift of midline structures.
There is no evidence of cytotoxic edema. Evaluation of the mastoid air cells
and paranasal sinuses is limited due to motion; however, they appear grossly
unremarkable.
IMPRESSION: Large right frontal intraparenchymal hemorrhage with adjacent
mass effect upon the sulci as well as the frontal horn of the right lateral
ventricle, overall stable in size from five hours prior.
|
19941834-RR-4
| 19,941,834 | 23,047,258 |
RR
| 4 |
2174-02-17 19:22:00
|
2174-02-18 10:56:00
|
HISTORY: ___ man with acute right frontal intraparenchymal
hemorrhage. Evaluate for any underlying lesion or vascular malformation, or
any evidence of amyloid angiopathy.
COMPARISON: Compared to a noncontrast head CT dated ___.
TECHNIQUE: A noncontrast brain MRI is obtained utilizing the following
sequences sagittal T1, axial FSE T2, axial FLAIR, axial T2 star GRE, and axial
T2 trace. A noncontrast brain MRI is obtained utilizing 3D TOF.
FINDINGS:
Brain:
There is a stable right frontal hemorrhage with mass effect on the anterior
horn of the right lateral ventricle and minimal leftward midline shift. This
hemorrhage has blood products of varying ages. The anterior most component is
T1 and T2 bright indicative of a subacute hemorrhage. The larger posterior
portion is T1 and T2 hypointense suggestive of a more acute hemorrhage. There
is also subacute hemorrhage at the periphery. There is a stable small right
frontal subarachnoid hemorrhage.
There are scattered periventricular and subcortical white matter T2 and FLAIR
hyperintensities, likely sequelae of chronic small vessel ischemic disease.
Other than the right frontal hemorrhage, there are no susceptibility foci on
the gradient echo sequence. There is no acute infarct or hydrocephalus.
The principal intracranial flow voids are present.
The orbits, paranasal sinuses and mastoid air cells are unremarkable.
Brain MRA:
The anterior and middle cerebral arteries are unremarkable. The PCOMs are not
identified. The posterior circulation is otherwise unremarkable. There is no
significant stenosis or aneurysm greater than 3 mm.
IMPRESSION:
Stable right frontal lobe hemorrhage with mass effect on the anterior horn of
the right lateral ventricle and minimal leftward midline shift. Differential
would include amyloid angiopathy, even in the absence of other chronic
microhemorrhages on the gradient echo sequence. Also, an underlying mass or
vascular malformation can not be excluded. Recommend follow up imaging.
Head MRA is unremarkable.
|
19941834-RR-5
| 19,941,834 | 23,047,258 |
RR
| 5 |
2174-02-14 16:31:00
|
2174-02-14 16:56:00
|
HISTORY: ___ man with right frontal intraparenchymal hemorrhage, now
with depressed loss of consciousness, motor impersistence versus increased
weakness on the left. Evaluate for expansion of bleed.
COMPARISON: Prior head CT from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without IV contrast. Sagittal, coronal and bone thin algorithm
reconstructions were generated.
CTDI: 63 mGy.
Total exam DLP: 1025.72 mGy-cm.
FINDINGS:
As compared to prior head CT from ___, known right frontal
intraparenchymal hemorrhage measures 4.8 x 2.2 cm, and appears essentially
unchanged from prior CT study. There has been some redistribution of blood
with persistent surrounding vasogenic brain edema, however overall, the lesion
appears stable. There is persistent effacement of the adjacent sulci and
frontal horn of the right lateral ventricle. There is no significant shift of
midline structures. There is no evidence of intraventricular hemorrhage.
There are no new areas of hemorrhage. Gray-white matter differentiation is
preserved. The basal cisterns are patent. There is mild mucosal thickening
of the anterior ethmoid air cells. Otherwise, remaining visualized paranasal
sinuses are clear.
IMPRESSION:
Large right frontal intraparenchymal hemorrhage with adjacent mass effect on
the sulci and the frontal horn of the right lateral ventricle which appears
overall stable in size. No new areas of hemorrhage.
|
19941834-RR-8
| 19,941,834 | 27,307,863 |
RR
| 8 |
2174-06-14 13:53:00
|
2174-06-14 18:53:00
|
HISTORY: Altered mental status with known intraparenchymal hemorrhage.
Evaluate for interval change.
TECHNIQUE: Continuous axial sections were acquired through the brain without
the administration of IV contrast. Coronal and sagittal reformations were
provided and reviewed. The study is severely limited by patient motion
despite 3 attempts at imaging.
COMPARISON: CT head from outside hospital ___. Head MRI ___.
FINDINGS: The vertex of the cranium could not be evaluated given patient
motion.
A lenticular shaped focus of hemorrhage is again seen within the right frontal
lobe and measures 10 x 8 mm, unchanged from prior. A second new focus of
hemorrhage is seen within the left parietal lobe and measures 6 mm. There is
no blood within the ventricular system. There is no mass effect or shift of
midline structures.
Changes of encephalomalacia involving the right frontal lobe from a prior
large intraparenchymal hemorrhage are again noted. Additionally,
periventricular white matter hypodensities, while nonspecific, are presumably
sequela from chronic small vessel ischemic disease. Otherwise, the gray-white
matter differentiation is preserved. The basal cisterns are patent. The
ventricles are unchanged in size and configuration.
The included paranasal sinuses and mastoid air cells are well aerated. The
frontal sinuses are under pneumatized. There is no definite fracture.
IMPRESSION: Severely limited study. Within this limitation, the small focus
of intraparenchymal hemorrhage within the right frontal lobe is unchanged.
There is a new, second focus of hemorrhage within the left parietal lobe,
measuring 6 mm. No shift of midline structures. Findings may be due to
amyloid angiography. An MRI can be obtained for further evaluation but would
be limited provided the current changes in mental status.
|
19942060-RR-14
| 19,942,060 | 26,995,122 |
RR
| 14 |
2161-01-11 14:02:00
|
2161-01-11 14:36:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with headache X 2 days and now with SAH// eval for
source of SAH
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 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 22.4 mGy (Body) DLP =
11.2 mGy-cm.
3) Spiral Acquisition 4.7 s, 37.0 cm; CTDIvol = 15.2 mGy (Body) DLP = 561.5
mGy-cm.
Total DLP (Body) = 573 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Outside CT head from the same day
FINDINGS:
CT HEAD WITHOUT CONTRAST:
As before, the patient is status post right frontotemporal craniotomy.
Compared to 11:48, no significant change in extensive subarachnoid hemorrhage
overlying the bilateral, right greater than left, frontal lobes and right
parietal and occipital lobes as well as tracking along the falx with layering
blood in the occipital horns of bilateral lateral ventricles and right aspect
of the fourth ventricle. Subarachnoid blood also extends throughout the
basilar cisterns. There is no evidence of acute large territorial infarction
or mass. Again seen is diffuse loss of gray-white differentiation along the
right MCA distribution, consistent with chronic infarct. The ventricles and
sulci are enlarged, consistent with involutional changes.
There is a mucous retention cyst in the left maxillary sinus. Otherwise, the
visualized portion of the paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
There is a 0.7 x 0.6 cm aneurysm arising from the proximal A2 segment of the
left anterior cerebral artery (series 3/image 232). There is an outpouching
arising from the C4 segment of the left internal carotid artery, likely
representing an infundibulum of the meningohypophyseal trunk. There is
atherosclerotic calcification of the cavernous segments of bilateral internal
carotid arteries without significant stenosis. Otherwise, the vessels of the
circle of ___ and their principal intracranial branches appear normal
without stenosis or occlusion. The dural venous sinuses are patent.
CTA NECK:
There is atherosclerotic calcification of the left carotid bifurcation without
significant stenosis. There is atherosclerotic calcification of the V4 segment
of the left vertebral artery without significant stenosis. Otherwise, the
carotid and vertebral arteries and their major branches appear normal with no
evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is prominent without evidence of focal lesion. There is no
lymphadenopathy by CT size criteria.
IMPRESSION:
1. Compared to 1148, no significant change in extensive subarachnoid
hemorrhage and moderate intraventricular hemorrhage. No evidence of new or
enlarging hemorrhage.
2. 0.7 x 0.6 cm aneurysm arising from the proximal A 2 segment of the left
anterior cerebral artery, for which neurosurgery consult is recommended.
RECOMMENDATION(S): Neurosurgery consult.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:59 pm, 5 minutes
after discovery of the findings.
|
19942060-RR-16
| 19,942,060 | 26,995,122 |
RR
| 16 |
2161-01-12 02:18:00
|
2161-01-12 09:51:00
|
INDICATION: ___ year old woman with SAH// assess for PNA- WBC 20
TECHNIQUE: Portable AP radiograph of the chest
COMPARISON: None.
FINDINGS:
A possible moderate left apical pneumothorax is seen. The aorta is tortuous.
Heart size is normal. There is mild bibasilar atelectasis. There is no
pleural effusion. The visualized osseous structures are unremarkable.
IMPRESSION:
Possible moderate left apical pneumothorax.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 9:50 am, 10 minutes after discovery of
the findings.
|
19942060-RR-17
| 19,942,060 | 26,995,122 |
RR
| 17 |
2161-01-12 07:40:00
|
2161-01-12 09:20:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD.
INDICATION: ___ year old woman with SAH.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: ___ noncontrast head CTs.
FINDINGS:
Compared to approximately 17 hours prior, there is no appreciable change in
extensive subarachnoid hemorrhage overlying the bilateral cerebral hemispheres
and nearly filling the suprasellar cistern. Small amount of intraventricular
hemorrhage layering dependently in the occipital horns of the lateral
ventricles is unchanged. Ventriculomegaly is unchanged with a third ventricle
diameter of 1.1 cm. Chronic right MCA territory infarcts with associated ex
vacuo dilation of the right lateral ventricle is unchanged. No evidence of
new, acute, large territorial infarction or new intracranial hemorrhage. No
significant midline shift.
Status-post right frontotemporal craniotomy. A mucous retention cyst in the
left maxillary sinus is unchanged. There is mild rightward nasal septum
deviation. The visualized portion of the remaining paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable. Mild carotid siphon and left V4 segment
calcifications are noted.
IMPRESSION:
Unchanged appearance of subarachnoid hemorrhage, intraventricular hemorrhage,
and mild ventriculomegaly. No evidence of new infarction or intracranial
hemorrhage.
|
19942060-RR-18
| 19,942,060 | 26,995,122 |
RR
| 18 |
2161-01-12 08:54:00
|
2161-01-12 11:20:00
|
INDICATION: ___ year old woman with SAH, now s/p intubation// eval for
placement of OGT and ETT
TECHNIQUE: Portable AP radiograph of the chest
COMPARISON: Chest radiograph perform 6 hours prior
FINDINGS:
The ET tube terminates approximately 3.9 cm above the carina. An enteric tube
extends below the diaphragm however with the tip likely at the
gastroesophageal junction. Moderate left pneumothorax appears worse compared
to the prior exam. There is no pleural effusion. There appears to be mild
splaying of the ribs. Cardiomediastinal silhouette is unchanged.
IMPRESSION:
Worsening moderate left pneumothorax with possible splaying of the ribs raises
concern for underlying tension.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 11 am, 10 minutes after
discovery of the findings.
|
19942060-RR-19
| 19,942,060 | 26,995,122 |
RR
| 19 |
2161-01-13 05:01:00
|
2161-01-13 10:29:00
|
INDICATION: ___ year old woman with SAH, intubated// eval for interval change
COMPARISON: Radiographs from ___
IMPRESSION:
Endotracheal tube and feeding tube are unchanged in position. There is
tortuosity and prominence of the mediastinum, stable. Lungs are grossly
clear. There are no pneumothoraces or focal consolidation or pleural
effusions.
|
19942060-RR-20
| 19,942,060 | 26,995,122 |
RR
| 20 |
2161-01-12 09:42:00
|
2161-01-18 10:08:00
|
EXAMINATION: Coiling of anterior communicating artery aneurysm
The following vessels were selectively catheterize injected:
Right common carotid artery
Left common carotid artery. Three-dimensional rotational angiography of the
left internal carotid artery requiring post processing on an independent
workstation and concurrent attending physician interpretation and review
Right common femoral arteriogram
INDICATION:
The patient is a ___ female who presents with 2 days of sudden onset
headache nausea vomiting. She has a previous history of aneurysmal bleed in
___ and was seen at the ___. At that time she is unable to have the aneurysm
clip O coil. She has had a left-sided hemiparesis since that episode and in
___ was started on Coumadin for PE. Imaging at reveals a subarachnoid
hemorrhage she was transferred for further intervention.
ANESTHESIA: General endotracheal anesthesia was maintained by separate
anesthesia provider throughout the entirety of the case. The anesthesia
provider also monitored the patient's hemodynamic and respiratory parameters.
TECHNIQUE: Coil embolization of previously ruptured anterior communicating
artery aneurysm.
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.
COMPARISON: None.
PROCEDURE: The patient was identified and brought to the neuro radiology
suite. The patient was loaded with ___ and aspirin prior to the
procedure and she was transferred to the fluoroscopic table supine. After a
smooth induction of general in endotracheal anesthesia bilateral groins were
prepped and draped in the usual sterile fashion. A time-out was performed.
The right common femoral artery was as accessed using standard micropuncture
technique after infiltration of local anesthetic. And long 8 ___ trees
with the introduced and connected to continuous heparinized saline flush and
secured.
The patient was loaded with 5000 units of IV heparin. Baseline and serial
ACTs were obtained and the patient was re-doses necessary in order to maintain
and level above 250. Next a 5 ___ ___ 2 catheter was used with 038
glidewire to navigate the aorta and aortic arch. Initially the right common
carotid artery was accessed. The wire was removed and AP and lateral images
were obtained in order to understand the anatomy of the A-comm and any
contribution from the right side.
Next the ___ 2 catheter was used to access the left common carotid artery.
AP, lateral, oblique and three-dimensional rotational angiography was
performed to delineate the aneurysm. The purpose of the diagnostic image was
to assess the vessel and the aneurysm anatomy intimate measurements to
determined working angles and coil and flow diverted size. Following this 2
the V 18 control wires were placed in the left internal carotid artery and the
___ 2 catheter was removed from the body. A 90 cm cook shuttle guide sheath
was then inserted over the wires into the left internal carotid artery. High
magnification special angle roadmap was then performed and an SL 10
microcatheter with a standard synchro 2 wire was then used to navigate into
the distal ICA then left A1 and then into the left A2 with wire was positioned
in case a flow to the was needed. A separate SL 10 with synchro 2 wire was
then used to navigate into the aneurysm. A 5 mm microsphere coil was then
deployed into the aneurysm. This was followed by a 3 mm target 360 ultra
coil. At this point the placement of a PED in the cute situation was
considered however conditions and anatomy were not optimal and the wire in the
A2 segment was removed. A 3 mm 360 ultra coil was then deployed followed by
an additional 2 target helical Ultra 3 mm coils. A final set of 2 x 2 mm
helical ultra calls were then also deployed into the aneurysm. At this point
good occlusion of the aneurysm and particularly the daughter sac was confirmed
with additional angiographic runs. Standard AP and lateral views then
obtained to rule out thromboembolic complications and to assess for final coil
placement.
Next the guide catheter and microcatheter was removed. A right common femoral
angiogram was performed via hand injection through the sheath. The sheath was
removed and the arthrotomy was closed using a 6 ___ Perclose closure
system. After awakening from the general into trait will anesthesia patient
was removed from the fluoroscopy table.
Devices
Cardinal ___ Ultrasound Probe
Guidant ___ Rotating Valve
3 X
Cook ___ Connecting Tubing
Baxter ___ 3-way Stopcock
4X
Terumo ___ .___" 150cm Angled Glidewire
___ ___ x 150cm ___ Wire
___ 45-___ ___ Micropuncture Set
Cardinal ___ 0 Silk Suture
___ Medical ___ Injector tubing 72"
Medrad ART 700 SYR Syringe, 150cc Mark 7 Arterion
Terumo RSS805 ___ x 25cm Terumo Sheath Set
___ PV___ ___ Berenstein .038/125cm
___ Medical ___ ___ ___ 2 Cath. 100cm
___ Scient. ___ .018 x 300cm V-18 Control Wire X2
___ ___ ___ x 90cm Shuttle Sheath ___
___ ___ ___
___ 2641 Synchro2 Standard 14 200cm Wire
___ ___ Excelsior SL-10 150cm Microcatheter
___ ___ Excelsior SL-10 150cm Microcatheter
Microvention ___ .012 x 200cm 90 degree Headliner J Guidewire
___ ___-___ Transend ES 300cm Exchange wire
___ ___ Synchro2 Standard 300cm Exchange
Wire
___ ___-___-IS Phenom Microcatheter 30cm tip, 150cm
___ ___ Connecting Cable
Codman ___-20 5mm/9.7cm Micrusphere 10 Coil lot#___
___ ___ Target 360 Ultra 3mm/10cm Coil lot#
___
___ ___ InZone Detachment System
___ ___ Target 360 Ultra 3mm/10cm Coil ___
___ ___ Target Helical Ultra 3mm/10cm Coil ___
___ ___ Target Helical Ultra 3mm/10cm Coil ___
___ ___ Target HelicalUltra 2mm/8cm Coil ___
___ ___ Target HelicalUltra 2mm/8cm Coil ___
___ ___ ___ PERCLOSE CLOSURE SYSTEM ___
FINDINGS:
Right common carotid artery: Was well visualized.
Internal carotid artery: Was well visualized the cervical, petrous, lacerum,
cavernous, ophthalmic, clinoid 0, communicating, choroidal and terminal
segments were well seen and do not reveal any abnormalities. The middle
cerebral artery was well seen as was its bifurcation is did not reveal any
abnormalities. The anterior cerebral artery was well visualized and do not
show any abnormalities. Importantly did not appear to be any contribution
from the right side to the aneurysm and a left eye 2 was not visualized
through the in internal carotid artery on the right. No early draining veins
or extracranial intracranial anastomoses were identified.
External carotid artery was well visualized no abnormalities were identified.
No abnormal extracranial to intracranial anastomoses or early draining veins
were identified.
Left common carotid artery: Was well visualized. The dominant feature was a
anterior communicating artery aneurysm of the junction of the left A1 and A2.
The internal carotid artery was well visualized the petrous, lacerum,
cavernous, clinoid, ophthalmic, communicating, choroidal and terminal segments
did not reveal any abnormalities. The middle cerebral artery was visualized
and did not show any obvious abnormalities. The anterior cerebral artery has
described showed a 15 mm x 9.5 mm aneurysm the daughter sac was approximately
5 x 5 mm. At the conclusion of coiling good obliteration of the aorta
aneurysm was seen however the remainder of the aneurysm continue to fill at
this point.
Right common femoral artery: Was well visualized did not show any
abnormalities. The caliber was suitable for placement of a closure device.
IMPRESSION:
1. Partially obliterated anterior communicating artery aneurysm based of the
A1 and A2 junction on the left side
IDr ___, was personally present and participated in the entirety of the
procedure; I have reviewed the above images and agree with the findings as
stated above.
RECOMMENDATION(S):
1. Discussion at cerebrovascular case conference regarding further definitive
treatment
|
19942060-RR-21
| 19,942,060 | 26,995,122 |
RR
| 21 |
2161-01-12 10:02:00
|
2161-01-12 11:07:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD.
INDICATION: ___ year old woman with ___ s/p EVD placement// stat portable CT
rm ___ to assess evd placement.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: Noncontrast head CT obtained 2 hours prior.
FINDINGS:
Interval placement of a right frontal approach ventriculostomy catheter
terminating near the anterior, superior aspect of the third ventricle. Mild
ventriculomegaly is unchanged, with a third ventricle diameter of 1.1 cm.
Subarachnoid and intraventricular hemorrhage previously described are
unchanged. No significant midline shift. Right frontal encephalomalacia
associated with ex vacuo dilation of the right lateral ventricle is unchanged.
No evidence of new or enlarging intracranial hemorrhage or acute territorial
infarction.
Status-post right frontotemporal craniotomy. Increased posterior ethmoid air
cell and left maxillary sinus fluid with air-fluid levels noted, probably
related to interval nasoenteric and endotracheal tube placement. The
remaining paranasal sinuses are clear. The mastoid air cells and middle ear
cavities are clear. Mild carotid siphon and left V4 segment calcifications
are again noted. The orbits appear unremarkable.
IMPRESSION:
1. Unchanged mild ventriculomegaly status-post right frontal approach
ventriculostomy catheter placement terminating near the anterior, superior
aspect of the third ventricle.
2. Unchanged subarachnoid and intraventricular hemorrhage.
3. No evidence of new infarction or intracranial hemorrhage.
|
19942060-RR-22
| 19,942,060 | 26,995,122 |
RR
| 22 |
2161-01-12 14:31:00
|
2161-01-12 15:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH// L apical pneumothorax. intubated
since 0830.
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiographs from ___
FINDINGS:
Compared to the prior chest radiographs there is no evidence of pneumothorax.
There is no focal consolidation or pleural effusion. The cardiomediastinal
silhouette is unchanged. An ET tube is seen 4 cm above the carina. An NG
tube seen with in the stomach with the side port likely at the GE junction.
IMPRESSION:
No pneumothorax. NG tube with side port likely at the GE junction, recommend
advancement.
|
19942060-RR-25
| 19,942,060 | 26,995,122 |
RR
| 25 |
2161-01-14 05:17:00
|
2161-01-14 10:44:00
|
INDICATION: ___ year old woman with Right apical pneumo// Please evaluate lung
fields
COMPARISON: Radiographs from ___
IMPRESSION:
Patient has been extubated. There is a nasogastric tube whose side port is at
the GE junction, unchanged. This again could be advanced several cm to be
within the stomach. There is subsegmental atelectasis at the right mid lung
field at the left base. There are no pneumothoraces.
|
19942060-RR-26
| 19,942,060 | 26,995,122 |
RR
| 26 |
2161-01-15 04:27:00
|
2161-01-15 10:00:00
|
INDICATION: ___ year old woman with subarachnoid hemorrhage, intubated, with
fevers.// Eval for pneumonia
TECHNIQUE: Supine portable radiograph of the chest.
COMPARISON: Radiograph of the chest performed 23 hours prior
FINDINGS:
Mild cardiomegaly is unchanged compared to the prior exam. Mild prominence of
the hilar and mediastinal contours is unchanged. The aorta is tortuous.
There is no evidence pneumothorax. Enteric tube extends below the diaphragm
with the tip in the body the stomach. No new focal consolidations concerning
for pneumonia identified.
IMPRESSION:
No new focal consolidations concerning for pneumonia identified.
|
19942060-RR-27
| 19,942,060 | 26,995,122 |
RR
| 27 |
2161-01-15 11:17:00
|
2161-01-15 12:59:00
|
EXAMINATION: CTA HEAD AND NECK WITH PERFUSION PQ149 CT HEADNECK
INDICATION: ___ year old woman with SAH from ACOM aneurysm s/p coiling//
somnolent, decrease movement in RUE. r/o vasospasm
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
2) Sequenced Acquisition 1.0 s, 4.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
186.8 mGy-cm.
3) Sequenced Acquisition 24.0 s, 8.0 cm; CTDIvol = 194.7 mGy (Head) DLP =
1,557.6 mGy-cm.
4) Spiral Acquisition 2.5 s, 39.8 cm; CTDIvol = 13.0 mGy (Body) DLP = 518.7
mGy-cm.
5) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.4
mGy-cm.
6) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 19.0 mGy (Body) DLP =
9.5 mGy-cm.
Total DLP (Body) = 530 mGy-cm.
Total DLP (Head) = 2,492 mGy-cm.
COMPARISON: CT ___, CT ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
The patient is status post right frontal craniotomy. A ventriculostomy
catheter terminates in the region of the foramina ___. Chronic right MCA
infarct. Small area of hemorrhagic blood products in the right temporal lobe
is similar. A 4 mm focus of intraparenchymal hemorrhagic in the right frontal
lobe is mildly increased since prior.
Embolization coils in the anterior suprasellar region are new from the prior
examination.
Moderate improvement in subarachnoid hemorrhage since ___. Mild
increase in intraventricular hemorrhage within left occipital horn, stable
right occipital horn hemorrhage, likely from redistribution. Small area of
subarachnoid hemorrhage overlies occipital lobes, likely from redistribution.
Stable ventricular size.
Subacute infarct left caudate nucleus, anterior limb left oral capsule,
anterior putamen,, new since ___.
The left maxillary and sphenoid sinuses contain mucous retention cysts.
Otherwise, the paranasal sinuses and mastoid air cells are clear. The orbits
are unremarkable.
CTA HEAD:
There is interval caliber decrease in the right A1, A2, A3 segment, inferior
left M 2 segment. Left A1 segment is difficult to evaluate given streak
artifact.
There is mild caliber decrease right MCA M1, and probably M2 and distal
branches.
Interval mild caliber decrease of the right P1, P2 segments. Possible caliber
decreased left P1 segment, there is significant streak artifact this level
Otherwise, the vessels of the circle of ___ and their principal
intracranial branches appear normal without stenosis, occlusion, or aneurysm
formation. The dural venous sinuses are patent.
CTA NECK:
There is mild atherosclerotic disease at the origin of the left internal
carotid artery without significant narrowing. Mild atherosclerotic narrowing
at the V4 segment of the left vertebral artery is noted. Otherwise, the
carotid and vertebral arteries and their major branches appear normal with no
evidence of stenosis or occlusion. No evidence of internal carotid stenosis
by NASCET criteria.
Perfusion:
Areas of increased Tmax and MTT in the distribution of the right MCA infarct
with smaller areas of decreased rBV is noted.
OTHER:
Evaluation the lungs is limited by respiratory motion. An enteric tube within
the esophagus is noted. There is borderline enlargement of the ascending
aorta measuring up to 4.1 cm. 5 mm hypodensity in the right lobe of the
thyroid is noted.
IMPRESSION:
1. Compared with ___ there has been decrease in subarachnoid
hemorrhage. Mild intraventricular hemorrhage, slightly increased, likely from
distribution. Stable ventricular dilatation. Chronic right MCA distribution
infarct.
2. 2 areas of parenchymal hemorrhage, stable in the right temporal lobe,
mildly increased in the right frontal lobe.
3. Early subacute left basal ganglia infarct.
4. Mild-to-moderate vasospasm.
5. Areas of increased Tmax and MTT in the right MCA territory with smaller
areas of decreased rBV is noted, consistent with mismatch.
|
19942060-RR-28
| 19,942,060 | 26,995,122 |
RR
| 28 |
2161-01-16 03:53:00
|
2161-01-16 07:48:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fevers, leukocytosis// Eval for pneumonia
IMPRESSION:
In comparison with the study ___, the monitoring and support devices
are unchanged. Cardiomediastinal silhouette is stable and there is no
evidence of vascular congestion, pleural effusion, or of acute focal
pneumonia.
Long curvilinear margin simulating a left pneumothorax merely represents a
skin fold.
|
19942060-RR-29
| 19,942,060 | 26,995,122 |
RR
| 29 |
2161-01-15 18:24:00
|
2161-01-15 20:24:00
|
INDICATION: ___ year old woman with new subclavian line.// Eval line
placement. Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of an enteric tube projects over the stomach. The tip of a new right
internal jugular central venous catheter projects over the mid SVC.
Low bilateral lung volumes with no focal consolidation, pleural effusion or
pneumothorax identified. The size and appearance of the cardiomediastinal
silhouette is unchanged.
IMPRESSION:
The tip of a new right internal jugular central venous catheter projects over
the mid SVC. No pneumothorax.
|
19942060-RR-30
| 19,942,060 | 26,995,122 |
RR
| 30 |
2161-01-16 10:36:00
|
2161-01-16 16:03:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with unexplained fever, immobile.// Eval for
DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the left posterior tibial and peroneal
veins and normal compressibility is demonstrated in the right posterior tibial
and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19942060-RR-31
| 19,942,060 | 26,995,122 |
RR
| 31 |
2161-01-16 10:43:00
|
2161-01-16 12:18:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD
INDICATION: ___ year old woman with subarachnoid hemorrhage, decreased
movement right side. Evaluate for new infarct.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 70.73
COMPARISON: CTA head and neck ___
FINDINGS:
Motion artifact limits evaluation.
The patient is status post right frontal craniotomy. A right ventriculostomy
catheter is in unchanged position. Embolization coils are again noted in the
anterior suprasellar region.
Hemorrhage in the dependent portion of the right lateral ventricle is
unchanged. There is less hemorrhage in the dependent portion of the left
lateral ventricle. The ventricles are stable in morphology.
Subdural and subarachnoid hemorrhage in the right occipital and anterior
parafalcine regions is less conspicuous in comparison to the prior
examination, compatible with evolution. A small amount of left occipital
subarachnoid hemorrhage is unchanged.
Confluent right frontotemporal MCA infarct is unchanged from the prior
examination, however an 8 mm punctate focus of intraparenchymal hemorrhage
(series 3, image 23) appears mildly increased in size (previously 4 mm),
compatible with hemorrhagic transformation. Additional intraparenchymal
hemorrhage in the periventricular right temporal lobe, appears mildly less
conspicuous in comparison to prior examinations, compatible with evolution.
A 12 mm subacute infarct in the anterior limb of the internal capsule on the
left is unchanged.
The orbits are unremarkable. There is a small mucous retention cyst in the
left maxillary sinus.
IMPRESSION:
1. A right frontal 8 mm intraparenchymal focus of hemorrhage, compatible with
hemorrhagic transformation may have minimally increased a may be more
conspicuous due to slice selection. Extensive right MCA distribution infarct
appears otherwise unchanged. No worsening mass effect or midline shift.
2. Additional foci of bilateral occipital, right temporal and parafalcine
intraparenchymal and subarachnoid hemorrhage appear unchanged or less
conspicuous, compatible with evolution.
3. Unchanged, subacute infarct in the anterior limb of the internal capsule on
the left.
NOTIFICATION: The findings were discussed with ___, N.P. by ___,
M.D. on the telephone on ___ at 12:11 pm, 5 minutes after discovery of
the findings.
|
19942060-RR-32
| 19,942,060 | 26,995,122 |
RR
| 32 |
2161-01-16 22:26:00
|
2161-01-17 05:26:00
|
EXAMINATION: CT abdomen and pelvis without intravenous contrast
INDICATION: ___ woman with a history of prior SAH who presents with
recurrent SAH likely secondary to left ACA aneurysm; evaluate for source of
fever, per ID rec's.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.2 s, 68.2 cm; CTDIvol = 12.4 mGy (Body) DLP = 846.0
mGy-cm.
Total DLP (Body) = 846 mGy-cm.
COMPARISON: No prior relevant imaging is available on PACS at the time of
this dictation.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
Detailed evaluation of the solid organs, soft tissues, and vessels is limited
without the use of intravenous contrast. Evaluation of the abdomen is limited
by streak artifact from the patient's arms being on the side and over the
anterior abdominal wall. Within this limitation:
ABDOMEN:
HEPATOBILIARY: The gallbladder is surgically absent with clips in the
gallbladder fossa creating streak artifact that limits evaluation of the
surrounding liver parenchyma. The liver otherwise demonstrates homogeneous
attenuation throughout. No evidence of focal lesions within the limitations
of an unenhanced scan. No evidence of intrahepatic or extrahepatic biliary
dilatation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. No pancreatic
ductal dilatation. No peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: A 6-mm fat-containing lesion in the right adrenal gland apex is
consistent with an adrenal myelolipoma (series 2, image 50). The left adrenal
gland is normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. No evidence of focal
renal lesions within the limitations of an unenhanced scan. There is mild
bilateral pelvicaliectasis. No frank hydronephrosis. No nephrolithiasis. No
perinephric abnormality.
GASTROINTESTINAL: A hiatal hernia is small. The nasogastric tube tip ends
proximal stomach. Small bowel loops demonstrate normal caliber and wall
thickness throughout. Cecal and ascending colonic wall edema with surrounding
moderate fat stranding is consistent with a short segment of colitis.
Evaluation of wall enhancement cannot be performed on this non contrasted
exam. The appendix is not definitely visualized. No bowel obstruction, free
air, or pneumatosis. The rectum has a rectal tube. No fluid collections.
PELVIS: The urinary bladder is distended. A small amount of anti-dependent
air within the bladder lumen is nonspecific and probably related to recent
instrumentation (series 2, image 106). No free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is within normal limits. No adnexal masses.
LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or
inguinal lymphadenopathy.
VASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is
noted. The abdominal aorta is tortuous near the bifurcation with aneurysmal
dilation of the bilateral common iliac arteries measuring up to 2 cm on the
left. An 1-cm splenic artery aneurysm has rim calcification (series 2, image
51).
BONES: No evidence of worrisome osseous lesions. Left curvature of the lumbar
spine is mild. Multilevel degenerative changes in the spine are severe.
Retrolisthesis of L1 on L2 is mild, likely degenerative. Anterolisthesis of
L4 on L5 is mild, also likely degenerative. Mild loss of anterior T11
vertebral body height is age indeterminate but does not appear acute; no
associated prevertebral soft tissue swelling or hematoma. Patient has a left
hip prosthesis, incompletely imaged.
SOFT TISSUES: Small amount of soft tissue stranding and subcutaneous emphysema
in right lower abdominal wall is likely related to subcutaneous injections
(series 2, image 97).
IMPRESSION:
1. Findings consistent with mild ascending colitis. The differential includes
infectious, less likely ischemic or inflammatory. The appendix is not
definitely visualized. No fluid collection or free air.
2. Bilateral common iliac artery aneurysms up to 2 cm.
3. 1-cm calcified splenic artery aneurysm.
4. Tiny amount of air in urinary bladder is probably from recent intervention.
Correlate with clinical assessment.
5. Small hiatal hernia.
6. 6-mm right adrenal myolipoma.
RECOMMENDATION(S): Clinical assessment for recent bladder instrumentation.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 5:25 am, 25 minutes after
discovery of the findings.
Ms. ___ was not the correct person to contact and as such ___ N.P
was contacted by Dr. ___ on the telephone at 06:10 on ___,
approximately 70 minutes after discovery of the finding.
|
19942060-RR-33
| 19,942,060 | 26,995,122 |
RR
| 33 |
2161-01-16 22:28:00
|
2161-01-17 05:06:00
|
EXAMINATION: Chest CT without intravenous contrast
INDICATION: ___ female with history of prior subarachnoid hemorrhage
who presents with recurrence subarachnoid hemorrhage. Assess for source of
fever.
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: Multiple chest radiographs dated ___, and ___.
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. There is
mild cardiomegaly. There is moderate calcifications of the aortic valve and
severe calcifications of the coronary arteries.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild dependent atelectasis in both lungs. There is no
discrete nodule consolidation. The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Please refer to dedicated CT abdomen and pelvis report on same day
for subdiaphragmatic findings.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No infectious source in the thorax.
2. Please refer to same day CT abdomen and pelvis for subdiaphragmatic
findings.
|
19942060-RR-34
| 19,942,060 | 26,995,122 |
RR
| 34 |
2161-01-19 16:36:00
|
2161-01-20 08:24:00
|
EXAMINATION: MR HEAD PT1 MR HEAD.
INDICATION: research ___ study, please perform ___ protocol on ___ 3T, please ___ number ___, needs to be done today, date
sensitive// research ___ study, please perform ___ ___ protocol on ___ 3T, please ___ number ___, needs to be done today, date
sensitive.
TECHNIQUE: Research protocol MRI brain was performed, including OSM ___ axial
research protocol sequences, axial FLAIR, axial FSPGR Bravo, and
diffusion-weighted sequences.
COMPARISON CTA head and neck ___, CT head 619 18.
FINDINGS:
Limited research examination protocol MRI was performed, and the examination
is degraded by patient motion.
The patient remains status post right frontal craniotomy with right frontal
approach ventriculostomy catheter, unchanged in position. Susceptibility
artifact from embolization coils is seen in the anterior suprasellar region.
There is a background of large subacute right MCA territory infarction.
Multiple sites of restricted diffusion are seen throughout the left basal
ganglia, external capsule, and centrum semiovale, compatible with late acute
to early subacute infarcts.
Redemonstrated are areas of subarachnoid hemorrhage seen anteriorly along the
falx, around the right ventriculostomy catheter tract, and throughout the
right sylvian fissure and basal cisterns. The overall extent of this appears
similar to the recent CT examination. Dependent bilateral intraventricular
hemorrhage is also unchanged.
FLAIR hyperintensity extending along the right cerebral peduncle into the
right midbrain likely reflects wallerian degeneration. A FLAIR hypointense
focus in the right cerebellar hemisphere (4:6) may reflect a small chronic
infarct.
There is ex vacuo dilatation of the right lateral ventricle, chronic in
appearance. Areas of chronic encephalomalacia and infarct are also seen
within the right frontal lobe and periventricular white matter.
Otherwise the background ventricles and sulci are mildly prominent diffusely,
suggesting global parenchymal volume loss. Periventricular and subcortical
white matter FLAIR hyperintensities are noted, a nonspecific finding that most
likely represents the sequelae of chronic small vessel ischemic disease.
Mucosal thickening is seen in the left maxillary sinus. The remainder of the
paranasal sinuses and mastoid air cells are grossly clear. Orbits are
unremarkable bilaterally.
IMPRESSION:
1. Research protocol MRI degraded by patient motion.
2. Late acute to early subacute scattered infarcts involving the left basal
ganglia, corona radiata, and centrum semiovale.
3. Diffuse subarachnoid and intraventricular hemorrhage, similar to the recent
prior examinations.
4. Subacute to early chronic right MCA territory infarction with ex vacuo
dilatation of the right lateral ventricle and associated wallerian
degeneration.
5. Small, punctate probable chronic infarct of the right cerebellar
hemisphere.
6. Additional findings as above.
|
19942060-RR-35
| 19,942,060 | 26,995,122 |
RR
| 35 |
2161-01-18 10:13:00
|
2161-01-18 12:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fevers, labored breathing// Eval for
pneumonia
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiographs from ___, CT chest ___
FINDINGS:
There is no focal consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette is unchanged. A right jugular line ends in the
mid SVC. An NG tube is seen within the stomach. The aorta is tortuous.
IMPRESSION:
No evidence of pneumonia.
|
19942060-RR-36
| 19,942,060 | 26,995,122 |
RR
| 36 |
2161-01-20 15:58:00
|
2161-01-20 17:57:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
INDICATION: ___ old woman with a history of prior SAH who presents with
recurrent SAH likely secondary to left ACA aneurysm.// Evaluate for vasospasm.
Exam is worsened, decreased movement in the RLE.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.4 mGy-cm.
2) Spiral Acquisition 2.2 s, 17.5 cm; CTDIvol = 27.6 mGy (Head) DLP = 481.8
mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 5.7 mGy (Body) DLP = 2.8
mGy-cm.
4) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 28.4 mGy (Body) DLP =
14.2 mGy-cm.
Total DLP (Body) = 17 mGy-cm.
Total DLP (Head) = 1,229 mGy-cm.
COMPARISON: Prior MR done ___ and prior CT a head done ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Vascular coils in relation to the known left ACA aneurysm results in beam
hardening artifact obscuring the tissues in this area.
Right frontal approach external ventricular drain terminating in the midline
at the foramina ___ is unchanged compared to prior. Ventricular profile
appear similar compared to prior imaging. Subarachnoid and intraventricular
blood is again noted and appears slightly decreased compared to prior imaging.
Hemorrhage in relation to the right insular cortex appears fairly similar
compared to prior. Right frontal hemorrhagic area (series 2, image 21) is
slightly more conspicuous compared to prior imaging. Multiple known left
basal ganglia and left internal watershed infarcts are again noted but was
better appreciated on most recent MRI. Right periventricular and deep white
matter hypodense changes are similar compared to prior. Chronic right basal
ganglia infarct is unchanged.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
There is persistent decrease in the caliber of the right ACA (A1 through A3
segment) and right MCA (M1, M 2 and M3 segments) vessels with the right ACA
narrowing appearing fairly similar and right MCA narrowing appearing similar
to slightly improved compared to prior imaging. There is also left A1 segment
narrowing, overall similar to prior exam.
Short-segment narrowing of the proximal PCAs appear similar compared to prior
imaging.
The rest of the vessels of the circle of ___ are patent. The dural the
sinuses are suboptimally assessed.
IMPRESSION:
1. There is persistent narrowing (suspected vasospasm) of the right ACA and
MCA vessels as well as left A1 segment as described above. Narrowing of the
right ACA appear similar compared to most recent prior imaging, with the MCA
vessel narrowing appearing similar to slightly improved compared to prior.
2. Mild narrowing involving the proximal PCAs bilateral are also unchanged.
3. Known right insular and right frontal lobe hemorrhages as described above.
The right frontal hemorrhage demonstrates mild interval increase in size
(could still be in the spectrum of normal expected evolution).
4. Multiple known infarcts demonstrate normal expected evolution, with the
acute infarct in the left basal ganglia and centrum semiovale (internal
watershed) better characterized on prior MRI.
5. Right external ventricular drain in situ with persistent prominence of the
ventricular system which is unchanged.
|
19942060-RR-37
| 19,942,060 | 26,995,122 |
RR
| 37 |
2161-01-24 09:26:00
|
2161-01-24 10:17:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: ___ year old woman with SAH, worsened exam. Concern for vasospasm,
eval vessel caliber.
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
intravenous administration of 55 mL of Omnipaque 350 nonionic contrast.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
2) Spiral Acquisition 4.5 s, 35.4 cm; CTDIvol = 13.3 mGy (Body) DLP = 469.5
mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
4) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 11.9 mGy (Body) DLP =
5.9 mGy-cm.
Total DLP (Body) = 477 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CTA head ___, MR ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
A right frontal ventriculostomy catheter entering via right frontal burr hole,
terminates in the region of the foramen of ___. The ventricular morphology
is unchanged. A right MCA distribution infarct with right temporal and right
frontal foci of hemorrhagic transformation is unchanged. Mild layering
hemorrhage in the occipital horns of the lateral ventricles is unchanged.
A left caudate head infarct is again noted. Trace subarachnoid hemorrhage in
the anterior interhemispheric and bilateral occipital regions is unchanged.
Embolization coils are again noted in the region of the anterior suprasellar
cistern.
Multiple left centrum semiovale infarcts are better appreciated on the MR from
___. Additional nonspecific periventricular and deep white matter
hypodensities likely represent sequela of chronic small vessel ischemic
disease.
The patient status post right frontotemporal craniotomy. The paranasal
sinuses and mastoid air cells are clear. The orbits are unremarkable.
CTA HEAD:
Vascular coil artifact obscures portions of the circle of ___. There is
unchanged mild decrease vascular caliber throughout the right ACA, worse in
the A1 segment. Mild caliber narrowing is noted throughout the M1, M2 and M3
branches of the right MCA, unchanged. Short-segment narrowing of the proximal
PCAs is unchanged from prior examination. The dural venous sinuses are
patent.
CTA NECK:
There is mild atherosclerotic disease at the origin of the internal carotid
arteries, bilaterally without stenosis by NASCET criteria. The carotid
siphons are mildly calcified. Otherwise, the carotid and vertebral arteries
and their major branches appear normal with no evidence of stenosis or
occlusion.
OTHER:
No suspicious pulmonary nodules. The thyroid contains hypodense nodules
measuring up to 6 mm. Multilevel degenerative changes throughout the cervical
spine, more significant at C5-C6 level consistent with anterior and posterior
spondylosis.
IMPRESSION:
1. Persistent mild decreased caliber of the right ACA and right MCA vessels,
suggestive of vasospasm.
2. Mild caliber decrease of the bilateral proximal PCAs are also unchanged.
3. Unchanged large right MCA distribution infarct with hemorrhagic
transformation. Foci of subarachnoid and intraventricular hemorrhage are
unchanged from the prior examination, but decreased in conspicuity from
multiple priors.
4. Unchanged, left basal ganglia and centrum semiovale infarcts, better
appreciated on recent MR.
|
19942060-RR-38
| 19,942,060 | 26,995,122 |
RR
| 38 |
2161-01-24 11:36:00
|
2161-01-24 16:22:00
|
EXAMINATION: AP portable chest radiograph.
INDICATION: ___ old woman with a history of prior SAH who presents with
recurrent SAH likely secondary to left Acomm aneurysm.// Evaluate positioning
of L PICC Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: Reference is made to the prior radiograph dated ___ as
well as multiple prior studies dating back to ___.
FINDINGS:
A new left PICC line ends in the left subclavian vein. No evidence of
pneumothorax or other procedural complication. A right IJ central venous
catheter terminates in the mid SVC, unchanged. An enteric tube terminates in
the stomach. Lung volumes remain low. There is no focal consolidation.
There is no large pleural effusion. Cardiac silhouette is unchanged. The
thoracic aorta is tortuous. Clips are noted in the right upper quadrant.
IMPRESSION:
New left PICC line terminates in the left subclavian vein. No evidence of
procedural complication.
NOTIFICATION: The findings were discussed with ___ , M.D. by
___, M.D. on the telephone on ___ at 4:20 pm, 5 minutes
after discovery of the findings.
|
19942060-RR-39
| 19,942,060 | 26,995,122 |
RR
| 39 |
2161-01-26 21:00:00
|
2161-01-27 09:59:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ old woman with a history of prior SAH who presents with
recurrent SAH likely secondary to left Acomm aneurysm.// Please perform ___
___ protocol on ___ 3T, please ___ per ___ number ___, needs to be
done today, date sensitive.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Prior CT done ___ and prior MRI done ___
FINDINGS:
Limited research examination protocol MRI.
The patient remains status post right frontal craniotomy with right frontal
approach ventriculostomy catheter, unchanged in position.
Susceptibility artifact from embolization coils seen in the anterior
suprasellar region.
There is background of large chronic right MCA territory infarct with
resultant encephalomalacia.
Left basal ganglia and left centrum semiovale infarcts are less conspicuous
compared to prior.
Subarachnoid hemorrhage in the suprasellar cistern, right sylvian fissure as
well as anterior interhemispheric fissure is again noted and improved compared
to prior. Hemorrhage in the occipital horns of the lateral ventricles are
improved compared to prior. Small amount of right subdural hemorrhage is
again noted.
FLAIR hyperintensity extending along the right corticospinal tracts into the
right cerebral peduncle likely reflects Wallerian degeneration.
Asymmetrical ventriculomegaly of the right lateral ventricle being increased
compared to the left is again noted and appears fairly similar compared to
prior imaging.
White matter microangiopathic changes are stable.
Small chronic right cerebellar insult is unchanged.
IMPRESSION:
Research protocol MRI.
No new intracranial hemorrhage or infarct.
Interval improvement in the subarachnoid hemorrhage. Vascular coil results in
susceptibility artifact in the anterior aspect of the suprasellar cistern.
Decrease in conspicuity of the known left MCA territory infarct.
Chronic right MCA territory infarct is unchanged.
Ventriculomegaly with right frontal ventriculostomy catheter is unchanged.
|
19942060-RR-40
| 19,942,060 | 26,995,122 |
RR
| 40 |
2161-01-25 19:25:00
|
2161-01-25 20:23:00
|
INDICATION: ___ year old woman with new PICC, not able to be advanced by IV
team. Needs correct placement.// PICC positioning.
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATORS: Dr. ___, ___ attending.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.6 min, 2 mGy
PROCEDURE: 1. Left cephalic venogram
2. Replacement / repositioning of left PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced.
The wire could not be advanced, and so a right cephalic venogram was
performed. This demonstrated irregularity of the cephalic vein (spasm or
mural injury) where it entered into the left subclavian vein. A nitinol wire
was then used to cross this area and positioned into the superior vena cava
(SVC). A peel-away sheath was then placed over a guidewire. A double lumen PIC
line measuring 46 cm in length was then placed through the peel-away sheath
with its tip positioned in the distal SVC under fluoroscopic guidance.
Position of the catheter was confirmed by a fluoroscopic spot film of the
chest. The peel-away sheath and guidewire were then removed. The catheter was
secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Left cephalic venogram from where the PICC tip was positioned demonstrated
focal spasm / mural injury of the cephalic vein. This was crossed with a
nitinol microwire, which was successfully positioned in the SVC.
2. Existing left arm approach PICC with tip in the cephalic vein replaced
with a new double lumen PIC line with tip in the distal SVC.
IMPRESSION:
Successful placement of a 46 cm left arm approach double lumen PowerPICC with
tip in the distal SVC. The line is ready to use.
|
19942060-RR-41
| 19,942,060 | 26,995,122 |
RR
| 41 |
2161-01-28 04:26:00
|
2161-01-28 09:47:00
|
INDICATION: ___ year old woman with Tm 101.4// r/o pneumonia
TECHNIQUE: Chest
COMPARISON: ___
IMPRESSION:
The left-sided PICC line projects to the cavoatrial junction. The NG tube
projects below the left hemidiaphragm and out of field-of-view.
Cardiomediastinal silhouette is stable. There is no pleural effusion. No
pneumothorax is seen.
|
19942060-RR-42
| 19,942,060 | 26,995,122 |
RR
| 42 |
2161-01-29 20:58:00
|
2161-01-29 21:32:00
|
EXAMINATION: CT ___ W/O CONTRAST Q111 CT ___
INDICATION: ___ year old woman with HCP s/p VPS// VPS positioning
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (___) = 747 mGy-cm.
COMPARISON: MR ___ from ___ and CTA ___ from ___
FINDINGS:
Patient is status post placement of right frontal approach VP shunt placement
with the catheter tip terminating in the right lateral ventricle just lateral
to the septum pellucidum. Right MCA distribution infarct with right temporal
and small right frontal foci of hemorrhagic transformation is unchanged. Left
caudate ___ infarct is redemonstrated. Trace subarachnoid hemorrhage in the
anterior interhemispheric and bilateral occipital regions is less conspicuous
than prior. Multiple left centrum semiovale infarcts are better appreciated
on previous MR studies. Additional nonspecific periventricular and deep white
matter hypodensities likely represent sequela of chronic small vessel ischemic
disease. There is no evidence of acute large territory infarction or new
intracranial hemorrhage. The ventricles and sulci are stable in size and
configuration.
Embolization coils are again noted in the region of the anterior suprasellar
cistern.
The patient status post right frontotemporal craniotomy. The paranasal
sinuses and mastoid air cells are clear. The orbits are unremarkable.
IMPRESSION:
1. Status post placement of right frontal approach VP shunt which terminates
in the right lateral ventricle adjacent to the septum pellucidum.
2. Unchanged large right MCA distribution infarct with small foci of
hemorrhagic transformation.
3. Foci of subarachnoid and intraventricular hemorrhage are decreased in
conspicuity from multiple priors.
4. Unchanged, left basal ganglia and centrum semiovale infarcts, better
appreciated on multiple prior MR studies.
|
19942060-RR-43
| 19,942,060 | 26,995,122 |
RR
| 43 |
2161-01-30 08:34:00
|
2161-01-30 11:30:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with potential seizure activity- infectious
w/u// ? infectious process
TECHNIQUE: Single frontal view of the chest
COMPARISON: Multiple prior chest radiographs, most recently on ___
FINDINGS:
A left-sided PICC line and enteric tube are stable in position. The lungs are
clear. No pleural effusion or pneumothorax. Heart size borderline enlarged,
stable. The aorta is tortuous. Surgical clips project over the right upper
quadrant.
IMPRESSION:
No acute cardiopulmonary abnormality
|
19942060-RR-44
| 19,942,060 | 26,995,122 |
RR
| 44 |
2161-01-30 16:37:00
|
2161-01-30 17:05:00
|
EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ year old woman s/p VP shunt placement with change in mental
status// interval post operative changes
TECHNIQUE: Axial images of the head were obtained without contrast .
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: ___
FINDINGS:
Right frontal shunt catheter tip is in the region of right lateral ventricle
unchanged from the previous study. Prior embolization in the region of
anterior communicating artery is visualized. Small amount of blood products
in the right temporal region again seen. No significant change in the
ventricular size noted. No new hemorrhage is seen.
IMPRESSION:
Unchanged study without acute abnormalities or change in ventricular size
compared with ___.
|
19942060-RR-45
| 19,942,060 | 26,995,122 |
RR
| 45 |
2161-02-01 11:29:00
|
2161-02-01 12:03:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p VPS placement with AMS// ? interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Head CT ___
FINDINGS:
Right VP shunt in place via frontal burr hole, tip in the right frontal horn,
stable. Extensive stable low-attenuation change right cerebral hemisphere
involving frontal, parietal, temporal lobes. Small volume intraventricular
hemorrhage, improved since prior. Small area of parenchymal hemorrhage right
frontal, temporal lobes, similar. Suggestion of low-density extra-axial fluid
collection overlying left upper cerebellum, stable suprasellar aneurysm
embolization coils. Chronic encephalomalacia, likely from infarct right MCA
distribution, extending into the sub insula, right thalamus, stable. Small
subacute left basal ganglia, centrum semiovale infarcts were better seen on MR
___. Findings consistent with severe chronic small vessel ischemic
changes. Prominent ventricular system, stable. Minimal pneumocephalus,
improved. Clear mastoids, paranasal sinuses.
IMPRESSION:
Essentially stable exam. Stable small volume intracranial hemorrhage. Stable
prominent ventricular system. Stable right hemispheric low-attenuation
changes. Stable subacute and chronic ischemic changes.
|
19942060-RR-46
| 19,942,060 | 26,995,122 |
RR
| 46 |
2161-02-01 21:29:00
|
2161-02-01 23:16:00
|
INDICATION: ___ year old woman with ___ with SAH and L ACA aneurysm// please
perform prior to 0500
TECHNIQUE: Frontal and lateral views of the skull and frontal views of the
chest abdomen and pelvis were obtained
COMPARISON: Concurrent chest radiograph
FINDINGS:
A right frontal approach ventriculoperitoneal shunt catheter courses along the
right neck, right thorax and right abdomen. The distal tip projects over the
right upper quadrant. There is no evidence of catheter discontinuity or
kinking. An enteric tube projects over the stomach. Multiple cardiac leads
overlie the patient.
There is no focal consolidation pleural effusion or pneumothorax identified.
There is a nonspecific but nonobstructive bowel gas pattern. The patient is
post cholecystectomy and left hip hemiarthroplasty.
IMPRESSION:
Right frontal approach ventriculoperitoneal shunt catheter is present without
catheter discontinuity or kinking. The distal tip projects over the right
upper quadrant.
|
19942060-RR-47
| 19,942,060 | 26,995,122 |
RR
| 47 |
2161-02-01 21:29:00
|
2161-02-01 22:34:00
|
INDICATION: ___ year old woman with ___ with SAH and L ACA aneurysm// pre
operative- please perform at same time as Shunt series Surg: ___ (right
VP shunt revision)
TECHNIQUE: AP portable chest radiograph
COMPARISON: Shunt series from 1 hour prior
FINDINGS:
The tip of a left PICC line projects over the cavoatrial junction. There is
no focal consolidation, pleural effusion or pneumothorax identified. The size
and appearance of the cardiomediastinal silhouette is unchanged including
unfolding of the thoracic aorta. A shunt catheter is seen coursing along the
right neck and hemithorax.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19942060-RR-48
| 19,942,060 | 26,995,122 |
RR
| 48 |
2161-02-02 08:24:00
|
2161-02-02 10:17:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with ___ with SAH and L ACA aneurysm. Please
perform at 0800 ___ for pre operative evaluation.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE:
Total DLP (Head) = 842 mGy-cm.
COMPARISON: Head CT ___.
FINDINGS:
Streak artifact from the left ACA aneurysm coil limits evaluation.
Re-demonstrated is right frontal craniotomy and right frontal approach VP
shunt with tip terminating in the frontal horn of the right lateral ventricle,
unchanged in position compared to the prior study. Minimal pneumocephalus in
the right frontal lobe is again noted unchanged compared to the prior study.
Chronic right encephalomalacia with ex vacuo dilation of the right lateral
ventricle is noted. The ventricles and sulci grossly stable in size and
configuration.
A small amount of intraparenchymal hemorrhage along the right frontotemporal
lobes is similar in appearance compared to the prior study.
Periventricular and subcortical white matter hypodensities are nonspecific,
but likely reflect sequelae of chronic small vessel ischemic disease.
Prominence of the ventricles and sulci suggest involutional changes.
Paranasal sinuses are clear. Mastoid air cells and middle ear cavities are
well aerated.
IMPRESSION:
1. Streak artifact from left ACA aneurysm coil limits evaluation.
2. Grossly stable minimal right frontotemporal intraparenchymal hemorrhage.
3. Grossly stable right frontal approach VP shunt catheter, with stable
ventricular size.
|
19942060-RR-49
| 19,942,060 | 26,995,122 |
RR
| 49 |
2161-02-05 17:48:00
|
2161-02-05 18:28:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p VP shunt placement.// Evaluate for interval
change in ventricle size.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 11.0 s, 19.3 cm; CTDIvol = 47.4 mGy (Head) DLP =
911.9 mGy-cm.
Total DLP (Head) = 926 mGy-cm.
COMPARISON: Head CT from ___.
FINDINGS:
There is a presumed aneurysm coil pack in the anterior suprasellar cistern,
with streak artifact limiting evaluation at adjacent levels. The patient is
status post right frontal craniotomy and frontal approach VP shunt catheter
placement with tip terminating slightly proximal to the foramen of ___.
There is stable diffuse ventriculomegaly with stable superimposed ex vacuo
enlargement of the right lateral ventricle secondary to the right
frontal/anterior parietal/temporal encephalomalacia. There is no evidence of
acute hemorrhage. There remains trace amount of pneumocephalus.
There is mild mucosal thickening in the ethmoid air cells and maxillary
sinuses, with a small mucous retention cyst in the left maxillary sinus.
Mastoid air cells are well aerated. Enteric tube is partially imaged in the
oropharynx.
IMPRESSION:
1. Stable position of the VP shunt catheter. Stable size and configuration of
the ventricles.
2. No evidence of acute hemorrhage.
|
19942060-RR-50
| 19,942,060 | 26,995,122 |
RR
| 50 |
2161-02-08 05:11:00
|
2161-02-08 11:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH s/p Coiling of Acomm aneurysm now
febrile// Infectious process Infectious process
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lungs are low in volume but clear. Heart is normal size. Thoracic aorta is
generally large and tortuous but not focally dilated or changed. No pleural
abnormality.
Left PIC line ends close to the superior cavoatrial junction.
|
19942060-RR-51
| 19,942,060 | 26,995,122 |
RR
| 51 |
2161-02-09 15:29:00
|
2161-02-09 17:06:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with intermittent tachycardia and fever, cannot
verbalize pain in lower extremities.// rule out DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. The bilateral calf veins are
not well visualized due to body habitus.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19942382-RR-117
| 19,942,382 | 21,399,644 |
RR
| 117 |
2202-06-21 11:28:00
|
2202-06-21 13:41:00
|
INDICATION: ___ with hx of hemorrhoidectomy ___ who presents with fever, +
blood cultures, productive cough and sputum x1-2 wks// Pneumonia?
TECHNIQUE: PA and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
The lungs remain clear. There is no effusion or consolidation. Linear right
mid to lower lung opacity is likely atelectasis versus scarring.
Cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19942382-RR-137
| 19,942,382 | 21,022,775 |
RR
| 137 |
2203-06-26 00:50:00
|
2203-06-26 04:16:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with left subclavian central line placement.
Evaluation for line placement
TECHNIQUE: Chest portable AP radiograph
COMPARISON: Comparison to radiograph from ___.
FINDINGS:
There has been interval placement of a left-sided central venous catheter,
with tip terminating at the mid SVC. Cardiomediastinal silhouette is stable.
Low lung volumes contribute to crowding of bronchovascular markings. Lungs
are clear without evidence of focal consolidation. No pleural effusion or
pneumothorax is seen.
IMPRESSION:
Interval placement of left-sided central venous line, with tip terminating at
the mid SVC. No pneumothorax is seen.
|
19942499-RR-35
| 19,942,499 | 28,649,090 |
RR
| 35 |
2192-09-29 20:27:00
|
2192-09-29 21:12:00
|
INDICATION: ___ year old woman with CKD, DM and recently placed PD catheter.
// PD catheter placement
TECHNIQUE: SUPINE abdominal radiographs were obtained.
COMPARISON: None
FINDINGS:
Peritoneal dialysis catheter is seen entering the left pelvis and coiling just
to the right of midline. Nonobstructive bowel gas pattern.
IMPRESSION:
Peritoneal dialysis catheter is seen entering the left pelvis and coiling just
to the right of midline. Nonobstructive bowel gas pattern.
|
19942499-RR-36
| 19,942,499 | 28,649,090 |
RR
| 36 |
2192-09-30 12:45:00
|
2192-09-30 15:49:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with RUQ pain, h/o cholecystectomy. // Does
patient have obstructive gallstone?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4 mm.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 12 cm.
KIDNEYS: The right kidney measures 9.6 cm. The left kidney measures 9.4 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
No biliary tree dilatation.
|
19943130-RR-4
| 19,943,130 | 28,328,726 |
RR
| 4 |
2149-10-19 17:05:00
|
2149-10-19 20:12:00
|
HISTORY: Spinal stenosis, pre-op chest radiograph.
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: None.
FINDINGS:
There are relatively low lung volumes. Right middle lobe scarring/atelectasis
is seen. There is no focal consolidation pleural effusion, or evidence of
pneumothorax. There is also minimal lateral left base linear
atelectasis/scarring. The cardiac silhouette is top-normal. The mediastinal
contours are unremarkable.
IMPRESSION:
No acute cardiopulmonary process. Right middle lobe and left lung base
atelectasis/scarring.
|
19943130-RR-5
| 19,943,130 | 28,328,726 |
RR
| 5 |
2149-10-21 10:27:00
|
2149-10-21 11:52:00
|
HISTORY: Status post L3-L4 laminectomies.
TECHNIQUE: An intraoperative lateral view of the lumbar spine ___.
COMPARISON: Outside hospital MRI ___.
FINDINGS:
Limited view of the lumbar spine as the anterior portion is not well seen.
There appears to be methylmethacrylate within the L4 and L5 vertebral bodies.
Surgical instruments are seen posterior to these vertebral bodies as well as
posterior to the L3 vertebral body. Status post laminectomies. No
malalignment. Multilevel degenerative changes. Please see operative report
for further details.
IMPRESSION:
See above.
|
19943165-RR-12
| 19,943,165 | 25,794,810 |
RR
| 12 |
2174-10-20 11:25:00
|
2174-10-23 11:07:00
|
HISTORY: Esophageal mass and complete dysphagia.
COMPARISON: CT scan ___
PHYSICIANS: Dr. ___ (___) present and supervising throughout the
procedure, Dr. ___ fellow), Dr. ___ fellow).
ANESTHESIA: Sedation with Versed only. The patient's hemodynamic parameters
were continuously monitored by an interventional radiology nurse during the
procedure. 1% local lidocaine was given at the gastrostomy site.
Fluoroscopy: Dose length product ___ mGy - cm.
PROCEDURE:
Placement of a 12 ___ Wills ___ gastrostomy tube under CT guidance.
PROCEDURE DETAILS:
Following a discussion of the risks, benefits and alternatives to the
procedure, informed consent was obtained from the patient. The patient was
brought to the CT room and placed supine on the table. A preprocedure timeout
was performed using three patient identifiers. The skin of the anterior
abdominal wall was prepped and draped in the usual sterile fashion.The patient
could not have a nasogastric tube placed due to the esophageal mass.
Under CT guidance, the antrum of the stomach was selected for puncture with a
21 gauge needle followed by insufflation with air. Once the stomach was
distended, a suitable site for gastropexy was chosen under CT fluoroscopy. 3
gastropexy T-fasteners were deployed around the planned gastrostomy site. A
19 gauge single wall needle was used to puncture the stomach, followed by
placement of ___ wire. The needle was removed and the tract was dilated
with 8 and 10 ___ dilators, followed by placement of a 12 ___ ___
___ gastrostomy tube. Under CT fluoro, position of the gastrostomy tube
was confirmed in the stomach. The gastrostomy was tube was locked and secured
to the skin with a 0 silk suture. A sterile dressing was applied.
There were no immediate post-procedure complications.
FINDINGS:
Gastrostomy tube within the stomach.
IMPRESSION:
Insertion of a 12 ___ Wills ___ gastrostomy feeding tube under CT
guidance, please wait 24 hr before tube feedings.
|
19943165-RR-3
| 19,943,165 | 25,794,810 |
RR
| 3 |
2174-10-15 18:55:00
|
2174-10-15 19:21:00
|
HISTORY: ___ male with 30 pack-year history of smoking now with
worsening dysphagia.
COMPARISON: None available.
FINDINGS:
Frontal and lateral chest radiographs demonstrate general radiolucency within
bilateral lungs to suggestive mild overinflation. The lungs are otherwise
without nodules, mass, or focal consolidation to suggest pneumonia. There is
nonspecific calcification within the right lower lung zone which may represent
calcification versus foreign body in or around the bronchi. The
cardiomediastinal and hilar contours are unremarkable. There is no pleural
effusion or pneumothorax.
IMPRESSION:
No evidence of mass or nodule. Mild overinflation consistent with
emphysematous changes.
|
19943165-RR-4
| 19,943,165 | 25,794,810 |
RR
| 4 |
2174-10-16 01:07:00
|
2174-10-16 12:44:00
|
CHEST RADIOGRAPH
INDICATION: Severe dysphagia, acute tachypnea, evaluation for aspiration.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. No acute changes in the lung parenchyma. Two linear structures
paralleling the right chest wall correspond to skin folds and do not represent
pneumothorax. No pneumonia, no pleural effusions. No pneumothorax.
|
19943165-RR-5
| 19,943,165 | 25,794,810 |
RR
| 5 |
2174-10-16 15:23:00
|
2174-10-16 16:07:00
|
HISTORY: Dysphagia, GI unable to pass endoscopy scope into esophagus
secondary to obstructing mass.
TECHNIQUE: MDCT of the neck was performed with 2.5 mm axial sections obtained
from the aorticopulmonary window through the mid orbital level, during the
dynamic IV administration of Omnipaque IV contrast. Reformatted coronal and
sagittal images were generated and reviewed.
DLP: 270.58 mGy-cm.
COMPARISON: None.
FINDINGS:
Evaluation of the aerodigestive tract demonstrates diffuse thickening of the
upper esophagus and a large retrocricoid esophageal mass, which erodes the
posterior trachea. A tracheo-esophageal fistula is best seen on series 2:76
and 602b:33. This likely represents esophageal cancer with secondary invasion
of the trachea. There is also significant edema of the supraglottic larynx,
and asymmetry suggestive of a left hypopharyngeal mass (2:12). Prominent
pre-tracheal lymph nodes measure up to 1.4 cm (2:91).
The salivary and thyroid glands are unremarkable. The neck vessels enhance
bilaterally without flow-limiting stenosis or occlusion. For detailed
evaluation of the lungs, please see the CT chest report from the same day.
IMPRESSION:
1. Large retrocricoid esophageal mass, which erodes the posterior trachea,
creating a tracheo-esophageal fistula, likely secondary to esophageal cancer
with secondary invasin of the trachea. These are better evaluated on CT chest
from the same day.
2. Edema of the supraglottic larynx with assymmetry suggestive of a left
hypopharyngeal mass.
3. Prominent pretracheal lymph nodes, measuring up to 1.4 cm.
These findings were discussed via telephone by Dr. ___ with Dr.
___ at 17:17 on ___.
|
19943165-RR-6
| 19,943,165 | 25,794,810 |
RR
| 6 |
2174-10-16 15:38:00
|
2174-10-16 17:30:00
|
INDICATION: History of dysphagia with inability to pass endoscope through the
esophagus secondary to an obstructing mass. Please evaluate.
COMPARISON: None.
TECHNIQUE: MDCT axial images were acquired through the chest following the
administration of 70 mL of intravenous Omnipaque contrast material.
Multiplanar reformats were performed, including maximum-intensity projection
axial images.
TOTAL DLP: 287 mGy-cm.
FINDINGS: There is a poorly defined mass extending along the upper to mid
aspect of the thoracic esophagus, measuring up to 4.5 x 3.2 cm in its greatest
axial ___ and extending over a craniocaudal length of approximately 9
cm (___). Superiorly, the mass reaches the level of the thoracic inlet.
Anteriorly, the mass appears to invade the posterior wall of the trachea,
although tracheal patency is preserved. There is a probable fistulous
communication between the anterior aspect of the esophagus and left
posterolateral aspect of the trachea at the level of the clavicular heads
(4:37). Inferiorly, the mass extends to the level of the carina. There are
multiple prominent mediastinal lymph nodes, measuring up to 8 mm along the
right upper paratracheal region, 10 mm in the lower right paratracheal region,
8 mm in the prevascular space, and 25 x 16 mm in the subcarinal region (2:17,
22, 24, 28). An enlarged left hilar nodal conglomerate measures 14 x 13 mm
(2:30). There are no pathologically enlarged right hilar lymph nodes or
enlarged axillary lymph nodes. The thoracic aorta is normal in caliber.
Scattered aortic calcifications are seen. There are also scattered coronary
artery calcifications. The right ventricular outflow tract and its central
branches are normal in caliber and patent. The heart is normal in size.
There is no pericardial effusion.
Scattered foci of high density within the right middle lobe are likely related
to prior aspiration of barium. There is mild-to-moderate centrilobular
emphysema. A 7-mm right middle lobe opacity is seen along the minor fissure,
likely a lymphoid aggregate (4:132). A similar-appearing 9-mm opacity is seen
within the right lower lobe adjacent to the major fissure, also likely
lymphoid aggregate (4:127). Additional high-density foci are seen medially
within the right lower lobe, also likely related to prior aspiration. There
are no pleural effusions. No pneumothorax is seen.
This study was not tailored for evaluation of the subdiaphragmatic contents.
Note is made of a 4-mm lymph node along the gastrohepatic ligament (2:56).
Multiple gallstones are seen layering within the gallbladder. There is no
associated gallbladder wall thickening or pericholecystic fluid. High-density
material within the colon likely relates to prior oral contrast
administration.
BONE WINDOW: There is diffuse demineralization. No suspicious lytic or
blastic lesions are identified. Multilevel degenerative changes of the
thoracolumbar spine are noted.
IMPRESSION:
1. Large mass extending along the proximal to mid portion of the thoracic
esophagus, correlating to the finding seen on prior endoscopy. Anteriorly,
the mass appears to invade the posterior wall of the trachea. There is a
probable fistulous tract connecting the anterior aspect of the esophagus to
the left posterolateral aspect of the trachea at the level of the clavicular
heads. Aspirated barium within the right middle and lower lobes likely
relates to passage of orally administered contrast through this fistulous
communication during a prior radiologic study.
2. Mediastinal lymphadenopathy, as described above. 4-mm nonspecific node
along the gastrohepatic ligament. PET-CT may be of value in further assessing
for subdiaphragmatic pathologic lymphadenopathy.
3. Cholelithiasis.
|
19943165-RR-7
| 19,943,165 | 25,794,810 |
RR
| 7 |
2174-10-17 11:03:00
|
2174-10-17 14:48:00
|
HISTORY: ___ male with recent tracheal stent placement.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Portable chest radiograph demonstrates interval placement of a tracheal stent
in the midline. When compared to chest film 1 day prior, there is no interval
parenchymal changes. There is no pleural effusion or pneumothorax.
Cardiomediastinal silhouette stable in appearance.
IMPRESSION:
Interval placement of tracheal stent. No new pneumothorax.
|
19943165-RR-9
| 19,943,165 | 25,794,810 |
RR
| 9 |
2174-10-19 09:33:00
|
2174-10-19 10:17:00
|
HISTORY: ___ male with a history of familial visceral myopathy and
esophageal mass. Evaluate for metastatic disease.
TECHNIQUE: Multi detector CT imaging was performed before and after the
administration of intravenous contrast material. Multiplanar reformatted
images in coronal and sagittal planes are provided.
DLP: ___ mGy-cm
COMPARISON: CT of the chest dated ___.
FINDINGS:
LUNG BASES: Scattered foci of high density within the right lower lobe are
likely related to prior aspiration of barium. There small bilateral pleural
effusions with adjacent atelectasis, right greater than left. The visualized
portion of the heart and pericardium are normal. There is no pericardial
effusion.
ABDOMEN: The liver is normal in size and homogeneous in enhancement. There
are no concerning mass lesions in the liver. The portal and hepatic veins are
patent.
The gallbladder is distended and contains numerous radiopaque gallstones. The
common bile duct is not dilated.
The spleen is normal in size and homogeneous in enhancement.
The pancreas enhances homogeneously without peripancreatic fat stranding. The
pancreatic duct is prominent but not enlarged.
The adrenal glands are normal in size and shape.
The kidneys are normal in size and display symmetric nephrograms and contrast
excretion. There are no concerning mass lesions seen in the kidneys. The
ureters are normal in caliber along their course the bladder. There is no
perinephric abnormality seen.
The distal esophagus is normal appearing with no hiatal hernia. The stomach
is under distended, but grossly normal. The small bowel does not show
abnormal dilatation or focal wall thickening. The large bowel contains feces
and does not show obstructive mass lesions, wall thickening, or
diverticulosis. There is no intraperitoneal free air or free fluid.
There are no pathologically enlarged retroperitoneal or mesenteric lymph nodes
by CT size criteria.
There is no aneurysmal dilatation of the abdominal aorta. The aorta and its
major branches are patent. There is minimal calcified atherosclerotic disease
seen in these vessels.
PELVIS: The bladder is relatively underdistended. There is diffuse bladder
wall thickening, likely related to familial visceral myopathy. Prostate gland
is unremarkable. The rectum and sigmoid are unremarkable. There is no pelvic
free fluid. There are no pathologically enlarged pelvic sidewall or inguinal
lymph nodes by CT size criteria.
OSSEOUS STRUCTURES AND SOFT TISSUES: There are no hernias seen. There are no
concerning lytic or sclerotic lesions seen.
IMPRESSION:
1. No evidence of metastatic disease in the abdomen or pelvis.
2. Gallbladder is distended with multiple radiopaque gallstones.
|
19943634-RR-21
| 19,943,634 | 22,300,726 |
RR
| 21 |
2193-02-21 21:57:00
|
2193-02-21 22:52:00
|
CHEST TWO VIEWS, ___
HISTORY: ___ female with worsening dementia. Question pneumonia.
FINDINGS: PA and lateral views of the chest were compared to previous exam
from ___. The lungs are hyperinflated but clear of confluent
consolidation or effusion. The cardiomediastinal silhouette is within normal
limits.
IMPRESSION: Hyperinflation without acute cardiopulmonary process.
|
19943634-RR-23
| 19,943,634 | 22,300,726 |
RR
| 23 |
2193-02-27 12:09:00
|
2193-02-27 15:26:00
|
INDICATION: ___ woman with established dementia presenting with
rapidly deteriorating mental status; rule out vascular dementia,
frontotemporal involvement.
COMPARISON: ___ non-enhanced cranial MRI of ___
and MRA of ___.
TECHNIQUE: Routine ___ non-enhanced MRI and MRA of the brain, with
supplemental coronal T1-weighted MP-RAGE sequence with axial reformations.
FINDINGS:
MRI: There is no evidence of hemorrhage, edema, mass, mass effect, or
infarction. There is no diffusion abnormality to suggest acute ischemia. The
ventricles and sulci are mildly prominent, consistent with global atrophy,
likely related to the patient's age. There is no evidence of preferential
central, or medial or other temporal lobar atrophy. There is
fluid-opacification of the mastoid air cells, bilaterally. The visualized
paranasal sinuses are well-aerated.
MRA: Incidental note is made of a small left posterior communicating artery
and the right PCom is not definitely seen. The major vessels of the
intracranial anterior and posterior circulation are patent without evidence of
stenosis, occlusion, vascular malformation, or aneurysm larger than 3 mm.
IMPRESSION:
1. No acute intracranial abnormality.
2. Mild global atrophy, likely related to patient's age.
3. Unremarkable cranial MRA.
COMMENT: These findings were discussed with Ms. ___ ___ medical
subintern) by Dr. ___ telephone, at 3:30pm on ___.
|
19943634-RR-25
| 19,943,634 | 22,300,726 |
RR
| 25 |
2193-03-01 15:40:00
|
2193-03-01 18:49:00
|
INDICATION: ___ female with rapidly deteriorating mental status,
known abdominal aortic aneurysm, and abdominal pain.
COMPARISON: CT abdomen and pelvis dated ___. No chest CT available for
comparison.
TECHNIQUE: Axial CT images through the chest, abdomen, and pelvis were
acquired after administration of intravenous and oral contrast. Coronal and
sagittal reformatted images were reviewed.
FINDINGS:
CHEST: There is ground-glass opacity in the anterior right lower lobe. No
pleural effusion or pneumothorax is detected. No pericardial effusion is
seen. Arterial, including coronary, calcifications are seen. The heart and
great vessels are otherwise within normal limits. No axillary, mediastinal,
or hilar lymphadenopathy is detected. The visualized portion of the thyroid
is homogeneous.
ABDOMEN: The liver, spleen, atrophic pancreas, gallbladder, adrenal glands,
right kidney, stomach, and small bowel are within normal limits. A
hypodensity in the interpolar region of the left kidney is too small to
characterize; the left kidney is otherwise within normal limits. Descending
colonic and sigmoid diverticula are seen without evidence for acute
inflammation. The appendix is normal. There is no free intraperitoneal air
or ascites. No mesenteric or retroperitoneal lymph nodes meet CT criteria for
pathologic enlargement.
There is an infrarenal abdominal aortic aneurysm with large intraluminal
thrombus; the aneurysm measures 4.2 x 4 cm in the axial plane and is new since
___. The origin of the inferior mesenteric artery appears patent. The
remainder of the visualized vasculature demonstrates arterial calcifications
and is otherwise unremarkable.
PELVIS: The bladder, uterus, adnexa, and rectum are within normal limits.
Note is made of a Bartholin duct cyst. Extensive sigmoid diverticulosis does
not demonstrate evidence for acute inflammation. There is no free fluid in
the pelvis.
No concerning lytic or sclerotic osseous lesions are detected.
IMPRESSION:
1. 4-cm infrarenal abdominal aortic aneurysm without CT evidence for acute
intra-abdominal or pelvic process.
2. Ground-glass opacity in the anterior right lower lobe, which is a
non-specific finding but could represent early infection.
These findings were discussed with Dr. ___ by Dr. ___ by phone at 6:48
p.m. on ___.
|
19943634-RR-26
| 19,943,634 | 22,300,726 |
RR
| 26 |
2193-03-07 10:24:00
|
2193-03-07 12:37:00
|
LUMBAR PUNCTURE
HISTORY: Multiple attempts for lumbar puncture on the floor by the referring
clinician were unsuccessful. Patient is referred for fluoroscopic-guided
lumbar puncture.
Informed consent was obtained after explaining the risks, indications, and
alternative management to the patient and the patient's daughter, ___.
The patient was brought to the fluoroscopic suite and placed on the
fluoroscopic table in prone position. Access to the lumbar subarachnoid space
was obtained with a 22-gauge spinal needle under local anesthesia using 1%
lidocaine with aseptic precautions. Approximately 25 cc of CSF was collected.
The patient tolerated the procedure well without any complications. The
patient was sent to the floor with post-procedure orders. Access was obtained
at the level of L4.
A preprocedure timeout and huddle per ___ standards was performed prior to
initiating the procedure.
IMPRESSION: Successful fluoro-guided lumbar puncture. Samples were sent for
laboratory analysis as requested by the referring physician.
Dr. ___, the attending interventionalist, was available during all
critical portions of the procedure.
|
19943951-RR-10
| 19,943,951 | 20,275,108 |
RR
| 10 |
2152-09-09 15:28:00
|
2152-09-09 16:53:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with NASH Cirrhosis// eval for edema vs pna
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiograph dated ___
FINDINGS:
Low lung volumes. Enlarged cardiomediastinal silhouette is unchanged. There
is increased retrocardiac opacification that cannot be lateralized on the AP
view. This may represent atelectasis or pneumonia in the appropriate clinical
setting. No evidence of pulmonary edema. Osseous structures visualized are
unchanged.
IMPRESSION:
1. On the lateral image, there is increased retrocardiac opacification that
cannot be lateralized on the AP view. The aforementioned finding may
represent pneumonia in the appropriate clinical setting however atelectasis
cannot be excluded.
|
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