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19943951-RR-11 | 19,943,951 | 20,275,108 | RR | 11 | 2152-09-13 10:08:00 | 2152-09-13 14:30:00 | INDICATION: ___ year old woman with NASH cirrhosis, persistent n/v rule out
obstruction// evaluate for obstruction
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: No prior abdominal imaging.
FINDINGS:
There is air in the stomach and bowel loops with no evidence of obstruction or
ileus.
There is no free intraperitoneal air.
No acute osseous abnormalities.
Multiple surgical clips project over the right upper quadrant. Additionally,
there is a metallic clip projecting over the periphery of the left abdomen.
There is another radiopaque object projecting over the pelvic region, possibly
representing an Endoclip.
IMPRESSION:
No radiographic evidence of bowel obstruction or ileus.
|
19943951-RR-6 | 19,943,951 | 20,275,108 | RR | 6 | 2152-09-07 17:11:00 | 2152-09-07 17:38:00 | EXAMINATION: Chest radiographs, AP and lateral.
INDICATION: Chest pain. Volume status, pneumonia.
COMPARISON: None available.
FINDINGS:
Heart is mildly enlarged. Heart is rotated toward the left. Mediastinal and
hilar contours are unremarkable. Right cardiophrenic angle shows patchy
opacification. This may represent atelectasis, potentially pneumonia. No
evidence for congestive heart failure. Mediastinal and hilar contours appear
within normal limits. There is no pleural effusion or pneumothorax.
IMPRESSION:
Medial right basilar opacity, atelectasis versus pneumonia. Re-evaluation
with short-term follow-up standard PA and lateral radiographs may be helpful
to reassess.
|
19943951-RR-7 | 19,943,951 | 20,275,108 | RR | 7 | 2152-09-07 19:36:00 | 2152-09-07 20:12:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with NASH Cirrhosis, worsening abdominal pain//
Evidence of portal vein thrombosis? Please perform w/ Doppler
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened. The contour of the liver is
nodular, consistent with cirrhosis. There is no focal liver mass. There is a
5 mm simple appearing cyst in the right hepatic lobe. The main portal vein is
patent with hepatopetal flow. There is at least moderate volume perihepatic
ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
GALLBLADDER: Patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: The spleen is enlarged measuring up to 16.7 cm.
KIDNEYS: Limited views of the kidneys show no hydronephrosis. There is a 9
mm shadowing hyperechogenicity in the midportion of the left kidney, likely
representing stone. The right kidney measures 12.6 cm. The left kidney
measures 13.7 cm.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
OTHER: There is moderate volume ascites in the right greater than left lower
quadrants.
IMPRESSION:
1. Cirrhotic liver morphology without concerning liver lesion. Main portal
vein is patent.
2. Splenomegaly measuring up to 16.7 cm.
3. Moderate volume ascites in the right greater than left lower quadrants as
well as in the right upper quadrant.
|
19943951-RR-8 | 19,943,951 | 20,275,108 | RR | 8 | 2152-09-07 20:04:00 | 2152-09-07 21:08:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with NASH cirrhosis, thrombocytopenia, unwitnessed fall this
morning w/ head strike, now with bifrontal HA// Evidence of bleed?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of territorial infarction,hemorrhage,edema, or mass.
There is prominence of the ventricles and sulci suggestive of involutional
changes.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells. The visualized portion of the remaining paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
IMPRESSION:
No evidence of acute intracranial process or injury.
|
19943951-RR-9 | 19,943,951 | 20,275,108 | RR | 9 | 2152-09-09 13:38:00 | 2152-09-09 15:28:00 | EXAMINATION: ULTRASOUND-GUIDED DIAGNOSTIC AND THERAPEUTIC PARACENTESIS
INDICATION: ___ year old woman with NASH cirrhosis and SBP.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the left lower quadrant
was selected for paracentesis.
PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis
Location: left lower quadrant
Fluid: 3.8 L of clear, straw-colored fluid
Samples: Fluid samples were submitted to the laboratory the requested analysis
(chemistry, hematology, microbiology).
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 3.8 L of fluid were removed and sent for requested analysis.
|
19944215-RR-21 | 19,944,215 | 20,267,911 | RR | 21 | 2177-08-27 17:58:00 | 2177-08-27 18:59:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with traumatic subacute subdural hemorrhage with
midline shift. Evolution of ICH, herniation or shift. Please time for 6 ___.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.8 cm; CTDIvol = 47.7 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
3) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: Outside hospital brain MRI of the same date.
FINDINGS:
There is re-demonstration of the mixed density acute on chronic subdural
hematoma overlying the right cerebral convexity, and measuring approximately
2.9 cm in maximal thickness, unchanged from the earlier MRI (2:23). There is
persistent effacement of the right lateral ventricle frontal and occipital
horns, with unchanged 7 mm leftward shift of normally midline structures
(02:17). Right-sided sulcal effacement is again seen. No new intracranial
hemorrhage detected.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Periventricular white matter hypodensities are nonspecific, likely
sequela of chronic small vessel ischemic disease. Incidental note is made of
heavy atherosclerotic calcifications involving the left vertebral artery.
Comminuted, depressed left nasal bone fracture is of indeterminate age.
Moderate mucosal thickening is identified in the bilateral maxillary sinuses
and ethmoidal air cells. 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, noting bilateral lens replacements.
IMPRESSION:
Compared with the earlier MRI, given differences in modality, no significant
interval change of the mixed density acute on chronic subdural hematoma
overlying the right cerebral convexity. Unchanged 7 mm leftward shift of
normally midline structures with effacement of the frontal and occipital horns
of the right lateral ventricle. No new hemorrhage detected.
Comminuted, depressed left nasal bone fracture, of indeterminate age. No
significant overlying soft tissue swelling seen.
|
19944215-RR-22 | 19,944,215 | 20,267,911 | RR | 22 | 2177-08-28 05:14:00 | 2177-08-28 11:30:00 | INDICATION: ___ year old man with R SDH, elevated WBC's// Evaluate for PNA
TECHNIQUE: AP and lateral
COMPARISON: None
FINDINGS:
Coronary stent better seen in the lateral view.
Moderate cardiomegaly without signs of heart failure or acute decompensation.
Mediastinal and hilar contours are normal. Lungs are clear without
consolidation to suspect pneumonia. Small left pleural effusion. There is no
pneumothorax.
IMPRESSION:
Moderate cardiomegaly without signs of acute decompensation. No pneumonia.
|
19944416-RR-30 | 19,944,416 | 29,235,727 | RR | 30 | 2150-01-14 01:59:00 | 2150-01-14 02:54:00 | EXAMINATION: Chest radiographs
INDICATION: History: ___ with three days of fever, neutropenia// PNA?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs ___.
FINDINGS:
The lungs are well expanded and clear without focal consolidation.
Cardiomediastinal silhouette is within normal limits. No pleural effusion or
pneumothorax.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19944416-RR-31 | 19,944,416 | 29,235,727 | RR | 31 | 2150-01-14 12:36:00 | 2150-01-14 14:30:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: ___ year old woman with left upper teeth swelling, and concern for
abscess. Evaluate for abscess vs. tracking infection; please assess maxilla.
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 20.0 cm; CTDIvol = 7.1 mGy (Body) DLP = 142.1
mGy-cm.
Total DLP (Body) = 142 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
No fractures are identified. There is no evidence of facial swelling.
Visualized paranasal sinuses are well aerated. There is no evidence of
abnormal fluid collections. Bilateral mastoids appear normal. The globes,
extraocular muscles, optic nerves, and retrobulbar fat appear normal. The
visualized upper aerodigestive tract appears normal. The mandible and
temporomandibular joints appear normal.
IMPRESSION:
No evidence of abscess.
|
19944416-RR-32 | 19,944,416 | 29,235,727 | RR | 32 | 2150-01-14 12:37:00 | 2150-01-14 13:41:00 | EXAMINATION: CT HEAD W/ CONTRAST Q1211 CT HEAD
INDICATION: ___ year old woman with fevers, new-onset neutropenia, possible
dental abscess or infxn in left upper back tooth, also with retro-orbital pain
and fullness. Evaluate left maxilla, orbital spaces, max sinuses.
TECHNIQUE: Contiguous axial images of the brain were obtained before and
after the intravenous administration of Omnipaque 90 cc contrast agent. Thin
bone-algorithm reconstructed images and coronal and sagittal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.4 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture, infarction, hemorrhage, edema, or mass.
The ventricles and sulci are normal in size and configuration. There is no
abnormal enhancement on post contrast images.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute hemorrhage or mass.
2. The paranasal sinuses are clear, but better assessed on the concurrent
sinus CT.
|
19944585-RR-21 | 19,944,585 | 20,765,421 | RR | 21 | 2159-05-25 13:25:00 | 2159-05-25 15:02:00 | HISTORY: Abdominal pain with midline cystic mass. Please assess mass.
COMPARISON: None.
TECHNIQUE: Axial helical MDCT images were obtained from the bases of the
lungs to the pubic symphysis after the administration of IV and oral contrast.
Multiplanar reformatted images in coronal and sagittal axes were generated.
DLP: 828.67 mGy-cm
FINDINGS:
Lungs and heart: Limited assessment of the lung bases are clear. The
visualized heart and pericardium are unremarkable.
Liver: The liver enhances homogeneously. Multiple round hypodense lesions in
segments 4A, 5, and 6, the largest measuring 0.8 x 0.7 cm in segment 6, are
too small to characterize however are likely simple cysts or hemangiomas. No
intrahepatic or extrahepatic biliary duct dilatation. The gallbladder is thin
walled with a partially calcified 1.5 x 1.6 cm gallstone in the fundus. The
main portal vein and splenic vein are patent.
Pancreas: The pancreas is atrophic without peripancreatic stranding or fluid
collection. No focal pancreatic lesion.
Spleen: The spleen is homogeneous and normal in size.
Adrenals: Adrenal glands are unremarkable.
Kidneys: There are bilateral peripelvic as well as renal cortical cysts.
Largest measures 1.3 x 1.0 cm and is in the upper pole of the right kidney.
There is symmetric cortical enhancement seen. No perinephric fat stranding or
perinephric abscess seen. No hydronephrosis or hydroureter.
GI tract: The distal esophagus and stomach are normal without hiatal hernia.
The duodenum and small bowel are within normal limits, without focal wall
thickening, adjacent fat stranding, or obstruction. The colon is slightly
displaced by the pelvic lesion however is normal without focal wall
thickening, obstruction, or adjacent fat stranding. Few sigmoid diverticula
are seen without acute diverticulitis. The appendix is not visualized but
there is no evidence of appendicitis.
Vascular: Atherosclerotic calcification is noted throughout the descending
aorta and iliac arteries bilaterally. The descending aorta and its major
branches are patent without aneurysmal dilatation.
Retroperitoneum, abdomen, soft tissue: No retroperitoneal or mesenteric lymph
node enlargement. No free air, ascites, or abdominal wall hernia seen. The
soft tissue is unremarkable. No peritoneal implants.
Pelvic CT: The urinary bladder is moderately compressed by a pelvic mass. The
terminal ureters are normal. No pelvic side wall or inguinal lymph node
enlargement by CT criteria. No free pelvic fluid. Uterus is normal with a
calcified fibroid. The left adnexa is normal. The right adnexa is not fully
visualized however the right gonadal vein can be followed to the presumed
right ovary. Extending off of the right ovary there is a 14 x 13.2 x 15.6 cm
well-delineated, thin-walled, nonenhancing, homogeneous cystic lesion without
internal septations concerning for a cystic neoplasm of the ovary that is
likely epithelial in nature.
Osseous structures: No blastic or lytic lesions suspicious for malignancy.
There is a mild compression fracture of T11 as well as Schmorl's node at T12,
with a moderate to severe anterior compression fracture of L1. Moderate
degenerative change of the lumbar thoracic spine is seen.
IMPRESSION:
1. 14 x 13.2 x 15.6 cm cystic pelvic mass is concerning for a cystic neoplasm
of the right ovary, likely epithelial in nature and may reflect a serous
cystadenoma. No ascites, peritoneal implants or lymphadenopathy. If further
assessment needed MR would be beneficial.
2. Chololithiasis without evidence of acute cholecystitis.
3. Mild diverticulosis without evidence of diverticulitis.
4. Mild anterior wedge compression fracture of T11 and moderate/severe
anterior wedge compression of L1.
|
19944585-RR-23 | 19,944,585 | 20,765,421 | RR | 23 | 2159-05-26 11:22:00 | 2159-05-26 12:34:00 | PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Preop evaluation, resection of ovarian cyst.
There is moderate cardiomegaly. The lungs are clear. There is no
pneumothorax or pleural effusion. The aorta is tortuous and elongated.
Contrast is seen in the colon and in multiple diverticula.
IMPRESSION: No evidence of acute cardiopulmonary abnormalities.
Cardiomegaly.
|
19945152-RR-23 | 19,945,152 | 26,352,487 | RR | 23 | 2139-12-08 18:34:00 | 2139-12-08 20:17:00 | INDICATION: ___ woman with scleroderma and inability to tolerate p.o.
and sensation of food impaction. Evaluate for food impaction.
COMPARISON: CT chest from ___.
FINDINGS: Barium swallow study is performed with thin barium. The esophagus
is dilated with slow passage of contrast to the GE junction. The GE junction
was not definitely seen to open but assessment is limited. There are large
filling defects consistent with debris. These findings are similar to the
findings seen on CT chest from ___ but possibly filling defects
are even larger. The patient was unable to tolerate more than one small sip
of barium.
IMPRESSION: Dilated esophagus with slow passage of contrast with multiple
filling defects consistent with debris. These findings could support
functional or anatomical obstruction by debris.
|
19945152-RR-27 | 19,945,152 | 23,400,410 | RR | 27 | 2142-05-28 10:10:00 | 2142-05-28 11:06:00 | INDICATION: ___ female with shortness of breath.
COMPARISON: Radiograph dated ___.
FINDINGS:
Single AP portable radiograph through the chest demonstrates an enlarged
heart. There is an opacity which appears to obscure the left heart border
concerning for consolidation within the lingula of the left upper lobe. There
is additional a pulmonary vascular congestion though no findings convincing of
pulmonary edema. No large pleural effusion is identified. There is no
pneumothorax. Visualized osseous structures demonstrates no acute abnormality.
IMPRESSION:
Consolidation within the lingula of the left upper lobe thought reflective of
infectious process in the correct clinical setting.
|
19945152-RR-38 | 19,945,152 | 22,721,016 | RR | 38 | 2144-11-28 16:54:00 | 2144-11-28 17:16:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with shortness of breath on exertion// Pneumonia,
cardiomegaly, edema
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___ in ___
FINDINGS:
There is mild interstitial edema. No focal consolidation is seen. There is
no large pleural effusion, but trace pleural effusion is difficult to exclude.
Surgical change sutures are again seen overlying the right lateral midlung.
Cardiac silhouette is mildly enlarged. Mediastinal contours are stable.
Prominence of the hila is stable.
IMPRESSION:
Mild interstitial pulmonary edema. Persistent mild enlargement of the cardiac
silhouette.
|
19945152-RR-39 | 19,945,152 | 22,721,016 | RR | 39 | 2144-11-29 03:52:00 | 2144-11-29 08:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with severe PAH// interval change interval
change
IMPRESSION:
Heart size is enlarged. Mediastinum is stable. Prominence of the
aortopulmonic window is similar to previous examination from ___ and
___ and dating back to ___. No evidence of interval
mediastinal widening present.
Bibasal, right more than left opacities also similar to previous examination
with no evidence of new consolidations and similar appearance compared to
multiple previous studies.
|
19945152-RR-40 | 19,945,152 | 22,721,016 | RR | 40 | 2144-11-29 11:08:00 | 2144-11-29 11:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: REPEAT EXAM
IMPRESSION:
Heart size is enlarged, unchanged. Mediastinum is stable. Surgical changes
in the right mid and lower lung are present. There is no appreciable pleural
effusion. There is no pneumothorax.
|
19945152-RR-41 | 19,945,152 | 22,721,016 | RR | 41 | 2144-12-04 10:22:00 | 2144-12-04 11:04:00 | INDICATION: ___ year old woman with R lateral foot pain// Eval for fracture,
esp ___ metatarsal
COMPARISON: None
IMPRESSION:
No acute fractures or dislocations are seen. The fifth metatarsal appears
intact. Joint spaces are preserved without significant degenerative changes.
There is mild demineralization. Lisfranc interval appears preserved.There are
no bony erosions. There are calcaneal spurs.
|
19945152-RR-45 | 19,945,152 | 29,187,537 | RR | 45 | 2145-06-18 00:14:00 | 2145-06-18 00:59:00 | EXAMINATION: CT T-SPINE W/O CONTRAST; CT L-SPINE W/O CONTRAST Q321; Q331 CT
SPINE
INDICATION: History: ___ with on daily steroids presenting with midline back
pn, low thoracic/lumbar region, concerning for osteoporotic fx// eval for fx
eval for fx
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.1 s, 32.0 cm; CTDIvol = 31.1 mGy (Body) DLP = 997.2
mGy-cm.
Total DLP (Body) = 997 mGy-cm.; Acquisition sequence:
1) Spiral Acquisition 8.5 s, 33.4 cm; CTDIvol = 31.2 mGy (Body) DLP =
1,040.9 mGy-cm.
Total DLP (Body) = 1,041 mGy-cm.
COMPARISON: CT chest from outside hospital ___, PET-CT ___
FINDINGS:
T-spine: Alignment is normal. No fractures are identified. Multilevel
degenerative changes are notable for bridging anterior osteophytes at T4-5 and
T6-11. There is no evidence of spinal canal or neural foraminal
stenosis.There is no evidence of infection or neoplasm. Esophagus is mildly
distended and fluid filled with an incidental small hiatal hernia.
L-spine: Alignment is normal. No acute fractures are identified. Compression
fractures at L3, L4, and L5 vertebral bodies are unchanged compared to ___ degenerative changes are notable for posterior disc bulge
causing moderate spinal canal narrowing at L2-3 and L3-4. There is no
evidence of neural foraminal stenosis.There is no evidence of infection or
neoplasm. 2.6 cm right renal cyst is noted.
IMPRESSION:
1. No fracture is identified.
2. Chronic compression fractures at L3, L4, L5 vertebral bodies are unchanged
compared to ___.
3. Fluid filled, distended esophagus with a small hiatal hernia.
|
19945152-RR-46 | 19,945,152 | 29,187,537 | RR | 46 | 2145-06-18 01:44:00 | 2145-06-18 06:13:00 | INDICATION: History: ___ with cough, sob// ? pna
TECHNIQUE: Chest AP and lateral
COMPARISON: ___
FINDINGS:
Borderline enlarged cardiomediastinal silhouette is similar to before.
Bilateral pulmonary vessels are prominent, similar to before. There is no
consolidation, pneumothorax or pleural effusion.
IMPRESSION:
No radiographic evidence pneumonia.
|
19945152-RR-47 | 19,945,152 | 29,187,537 | RR | 47 | 2145-06-20 12:33:00 | 2145-06-20 14:24:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old woman with severe, acute left low back pain, numbness
LLE, subjective severe weakness// evaluate for spinal cord pathology
evaluate for spinal cord pathology
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique,
followed by axial T2 imaging.
COMPARISON: ___ CT lumbar spine without contrast
FINDINGS:
There is a mild levoconvex lumbar scoliosis. Vertebral body alignment is
otherwise preserved.
There is transitional anatomy at the lumbosacral junction with lumbarization
of S1. The lowest well-formed intervertebral disc is designated as S1-2.
There are chronic compression deformities of the L5 and S1 vertebral bodies.
There is an acute to subacute compression deformity of the superior endplate
of the L1 vertebral body, with minimal loss of height.
There may is mild reactive change at the right T12 costovertebral junction
(series 4, image 17).
No suspicious bone marrow signal abnormality is identified.
The conus medullaris terminates at the L1 level. The conus medullaris and
cauda equina appear normal in morphology and signal intensity.
There is multilevel degenerative disc disease, without spinal canal narrowing.
At L4-5, there is right subarticular zone narrowing due to a disc bulge and
hypertrophied facet, without impingement on the traversing right L5 nerve
root. There is mild right neural foraminal narrowing.
At L5-S1, there is right subarticular zone narrowing due to a disc bulge and
hypertrophied facet, without impingement on the traversing right S1 nerve
root. There is mild bilateral neural foraminal narrowing.
At S1-2, there is mild right neural foraminal narrowing due to facet
hypertrophy.
There is a simple exophytic right renal cyst. The prevertebral and paraspinal
soft tissues are otherwise unremarkable.
IMPRESSION:
1. Probable acute to subacute compression fracture of the superior endplate of
L1, with minimal loss of height.
2. Mild cervical degenerative disc disease, without spinal canal narrowing or
definite nerve root impingement.
3. Chronic compression deformities of the L5 and S1 vertebral bodies. Please
note that there is transitional anatomy at the lumbosacral junction. The
lowest well-formed intervertebral disc is designated as S1-2.
|
19945476-RR-18 | 19,945,476 | 29,656,680 | RR | 18 | 2175-11-13 10:09:00 | 2175-11-13 13:11:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with pmh of recurrent DVTs ___ years ago while
pregnant, presents now 20 days post partum with ?stroke. Bilateral legs
swollen and erythematous // eval for DVTs
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19945476-RR-19 | 19,945,476 | 29,656,680 | RR | 19 | 2175-11-13 11:57:00 | 2175-11-13 13:05:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old woman with pmh of dvts while pregnant ___ years ago,
now presenting post partum *20 days ago with right arm weakness and headache
// ? eval stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Head CTA performed at ___ ___.
FINDINGS:
There is a focus of slow diffusion in the left parietal white matter that is
not accompanied by a evidence of hemorrhage and is faintly visible on the
FLAIR images. This finding suggests subacute infarction. The FLAIR images
demonstrate numerous areas of deep and subcortical white matter hyperintensity
bilaterally. These findings suggest old infarction. No masses are
identified. The ventricles and sulci are normal in caliber and configuration.
IMPRESSION:
1. Left parietal white matter lesion likely subacute infarction.
2. Multiple deep and subcortical lesions most likely representing chronic
infarction.
|
19945476-RR-20 | 19,945,476 | 29,656,680 | RR | 20 | 2175-11-13 11:57:00 | 2175-11-13 14:02:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST
INDICATION: ___ year old woman with right upper extremity weakness that
doesn't follow an upper motor neuron pattern, evaluate for cervical
spondylosis.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: Brain MR ___, head and neck CTA ___
FINDINGS:
Vertebral body alignment is preserved. Vertebral body heights are preserved.
There is no marrow signal abnormality. The visualized portion of the spinal
cord is preserved in signal and caliber. There is mild degenerative disc
signal in the lower cervical and upper thoracic spine. Within the limits of
this noncontrast study there is no evidence of infection or neoplasm. There is
no prevertebral soft tissue swelling.. The visualized portion of the are
unremarkable.
At C2-3 there is no spinal canal or neural foraminal stenosis.
At C3-4 there is there is a mild disc bulge with a superimposed central
protrusion with slight indentation of the anterior surface of the spinal cord.
There is no neural foraminal stenosis.
At C4-5 there is no spinal canal or neural foraminal stenosis.
At C5-6 there is no spinal canal or neural foraminal stenosis.
At C6-7 there is no spinal canal or neural foraminal stenosis.
At C7-T1 there is no spinal canal or neural foraminal stenosis.
IMPRESSION:
Mild multilevel degenerative changes, with a midline disc protrusion slightly
indenting the spinal cord at C3-4. No other neural foraminal or spinal canal
stenosis.
|
19945476-RR-21 | 19,945,476 | 29,656,680 | RR | 21 | 2175-11-15 13:00:00 | 2175-11-15 15:47:00 | EXAMINATION: MRI of the abdomen
INDICATION: ___ postpartum woman with hx of DVTs in admitted with RUE>RLE
weakness with acute L parietal stroke and right-sided chronic infarctions on
MRI. S/p TEE today, had nausea/emesis. Evaluate for DVT and pelvis.
TECHNIQUE: T1 and T2 weighted images of the abdomen were acquired in a 1.5 T
magnet.
COMPARISON: Lower extremity Doppler from ___
FINDINGS:
No filling defect is seen from the level of the distal IVC to the iliac and
superficial femoral veins to suggest a thrombus. Incidental note is made of
symmetric flow related artifact in the bilateral external iliac veins. Flow
voids are preserved on T2 images in both the major arterial and venous
vasculature.
The visualized liver and spleen are grossly unremarkable. The kidneys are
symmetric in size without hydronephrosis. Visualized pancreas is grossly
unremarkable. The included small and large bowel are unremarkable. The
bladder is normal in appearance. Enlarged postpartum uterus is identified
containing some heterogeneous material in the endometrium towards the left
fundus. Bilateral ovaries are normal. There is no pelvic sidewall or
inguinal lymphadenopathy. Soft tissues are grossly unremarkable. Marrow
signal is within normal limits.
IMPRESSION:
1. No evidence of pelvic DVT, though the exam is slightly limited without
intravenous contrast.
2. Heterogeneous endometrium toward the left fundus. Correlate with history
of postpartum bleeding as retained fetal products cannot be entirely excluded.
|
19945500-RR-32 | 19,945,500 | 21,615,940 | RR | 32 | 2195-08-21 15:55:00 | 2195-08-21 17:44:00 | INDICATION: ___ year old man h/o bladder cancer s/p cystectomy with
neobladder, p/w pyelonephritis and E. Coli bacteremia. // ?perforation of
diversion, pt with neobladder please give w delayed contrast.
TECHNIQUE: Multidetector axial images were performed through the pelvis prior
to and after the administration of contrast through the indwelling Foley
catheter. Additional prone images were also performed after instillation of
contrast material.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
No oral contrast was administered.
DOSE: DLP: 1049.54 mGy-cm (abdomen and pelvis.
COMPARISON: MR urogram performed on ___. CT performed on ___.
FINDINGS:
PELVIS:
Patient is status post cystectomy with creation of an ileal neobladder. There
is a Foley catheter within the neobladder. Initial noncontrast CT demonstrates
air within the neobladder, iatrogenic in etiology. In addition, there is dense
material dependently within the neo bladder lumen which may represent debris
and/or stones. Subsequently, contrast was injected through the Foley catheter
into the neobladder. Imaging performed in the supine and prone position
demonstrates no leak of contrast.
There are surgical clips along the bilateral pelvic sidewall compatible with
prior surgery. The visualized large and small bowel are normal in appearance.
There is no suspicious pelvic lymphadenopathy. There is a small amount of
mesenteric edema and trace fluid along the right pericolic gutter.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
IMPRESSION:
No evidence of contrast extravasation from the neobladder. Note is made of
calcified debris within the neobladder.
|
19945642-RR-10 | 19,945,642 | 22,576,776 | RR | 10 | 2184-01-16 15:32:00 | 2184-01-16 20:28:00 | INDICATION: ___ year old man with portomesenteric venous system thrombosis.
Perform thrombolysis/thrombectomy. // ___ year old man with portomesenteric
venous system thrombosis
COMPARISON: CT abdomen pelvis on ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: General anesthesia was administered.
MEDICATIONS: General anesthesia.
CONTRAST: 60 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 33.5 min, 523 mGy
PROCEDURE: 1. Right internal jugular venous access using ultrasound.
3. Transhepatic access of the right portal vein.
4. Portal venogram.
5. Portal venogram with cone beam CT.
6. Splenic venogram.
7. SMV venogram.
8. Placement of a tPA lysis catheter via right internal jugular TIPS approach
into the SMV. 9. Triple lumen right IJ central line placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck and abdomen 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. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a ___ wire was advanced distally into
the IVC. The micropuncture sheath was then removed and a 10 ___ sheath was
advanced over the wire into the inferior vena cava.
Next, under continuous ultrasound guidance, right portal vein access was
attempted with a 21 gauge cook needle. Cone beam CT was performed to
delineate the portal venous anatomy in relation to the transhepatic access
needle.
Rotational cone-beam CT angiography was performed to help delineate the
anatomy. Multiplanar CT images were reconstructed and 3D volume-rendered
images of the portal venous anatomy required post-processing on an independent
workstation under direct physician ___. These images were used in the
interpretation, decision making for intervention and reporting of this
procedure.
After making small adjustments under ultrasound guidance using the information
from the cone beam CT, and the right portal vein was accessed with a 21 gauge
cook needle. A Nitinol wire was placed through the Cook needle and advanced
into the portal vein. The inner of an Accustick set was advanced over the
Nitinol wire and contrast injection through the sheath was performed and
demonstrated appropriate positioning in the main portal vein.
Next, using a Glidewire and a MPA catheter, access was obtained in the right
hepatic vein. Appropriate position was confirmed with contrast injection and
fluoroscopy in AP and lateral views. Next, the dilator/sheath was advanced
through the sheath. Once the sheath was placed in an appropriate position, the
cannula device was inserted over the ___ wire and the wire was exchanged for
___ needle. The angled sheath was turned anteriorly. The needle was
then advanced through liver parenchyma and the needle was withdrawn over its
sheath. The sheath was withdrawn slightly and confirmation in the portal vein
was made by using ___ and ___ projections. Next, a Glidewire was advanced
through the sheath and into the main portal vein and splenic vein. A 4 ___
glide catheter was advanced over the Glidewire into the splenic vein and the
Glidewire was removed. A splenic venogram was performed. An Amplatz wire was
then placed through the glide catheter into the splenic vein. Next, the glide
catheter was replaced with a Kumpe the catheter and the Amplatz wire was
replaced with a glide wire and the Kumpe the catheter and Glidewire were used
to access the SMV. An SMV venogram was performed. The Glidewire was replaced
with an Amplatz wire and after appropriate measurements were obtained with a
measuring catheter, a 65 cm ___ infusion catheter was placed into
the SMV. The infusion catheter was secured to the 10 ___ sheath with
sutures. The 10 ___ sheath was sutured to the skin. Sterile dressings were
applied. The inner of the Accustick set was removed from the transhepatic
access site and sterile dressings were also applied to the transhepatic access
site.
Next, under continuous ultrasound guidance, the patent right internal jugular
vein was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced distally into
the IVC. The micropuncture sheath was then removed and a triple lumen 20 cm 7
___ temporary central line was placed with its tip in the distal SVC. The
central line was sutured to the skin and sterile dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Portal venogram demonstrates near complete thrombosis of the portal vein.
2. Portal venogram with cone beam CT better delineates the portal venous
anatomy and its relationship to the transhepatic access needle.
3. Splenic venogram demonstrates significant thrombus within the splenic vein
and portal vein.
4. SMV venogram demonstrates significant thrombus within the SMV and portal
vein.
IMPRESSION:
Successful placement of an infusion catheter via right internal jugular TIPS
approach into the SMV. This catheter will be infused with tPA. The 10 ___
TIPS sheath was left in placed an the side arm will be infused with heparin.
Successful placement of a triple-lumen temporary central line via right
internal jugular vein access.
|
19945642-RR-11 | 19,945,642 | 22,576,776 | RR | 11 | 2184-01-17 10:32:00 | 2184-01-17 11:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ male with abdominal mass, new o2 requirement/desaturation
// volume overload? volume overload?
IMPRESSION:
There there are no prior chest radiographs available for review.
Lung volumes are low. Left infrahilar opacification is probably atelectasis.
Small left pleural effusion may be present. Right lung is clear. Heart size
normal.
2 right transjugular central venous lines end in the right atrium. No
mediastinal widening. No pneumothorax.
|
19945642-RR-12 | 19,945,642 | 22,576,776 | RR | 12 | 2184-01-17 16:50:00 | 2184-01-17 17:47:00 | INDICATION: ___ year old man with extensive portomesenteric thrombus s/p tPA
lysis. // Evaluate clot s/p tPA lysis.
COMPARISON: TIPS procedure on ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: General anesthesia was administered.
MEDICATIONS: General anesthesia. 5 mg of TPA.
CONTRAST: 259 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: ___ Min, 787 mGy
PROCEDURE: 1. Access via the existing right internal jugular 10 ___ TIPS
sheath.
2. SMV venogram.
3. Splenic venogram.
4. Successful placement of a TIPS 10 mm x 7 cm x 2 cm Viatorr stent with
angioplasty to 10 mm.
6. Successful placement of a 12 mm x 60 mm Luminexx stent in the main portal
vein with angioplasty to 12 mm.
7. Successful chemical and mechanical thrombectomy of the SMV, splenic vein,
and portal vein with tPA, Angiojet, angioplasty with 6 mm x 40 mm, 8 mm x 40
mm, and 10 mm x 40 mm Mustang balloons, ___ balloon sweep, and Cleaner
device.
8. Post TIPS portal venogram.
9. Post portal vein stent portal venogram.
10. Post chemical and mechanical thrombectomy SMV, splenic and portal
venograms.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck was prepped and draped in the usual sterile fashion.
The patient arrived to the angio suite with the existing 10 ___ TIPS sheath
and lysis catheter in place via the right internal jugular vein. The lysis
catheter was removed and an Amplatz wire was placed in the SMV. A Omni Flush
catheter was placed over the Amplatz wire an Amplatz wire was removed. A SMV
venogram was performed. The Omni Flush catheter was pulled back and a
Glidewire was used to access the splenic vein. A splenic venogram was
performed.
Next, 5 mg of tPA was infused into the splenic vein and allowed to dwell for
10 minutes. Next, the Angiojet was placed over the Amplatz wire in the
splenic vein and Angiojet was performed within the splenic vein. A splenic
venogram was performed. Next, a measuring catheter was placed into the
splenic vein and appropriate measurements were obtained for TIPS stent
appointment.
The measuring catheter was removed and a 10 mm x 7 cm x 2 cm Viatorr stent
was placed and angioplastied to 10 mm with a 10 mm x 40 mm Mustang balloon.
A post TIPS portal venogram was performed. Next, angioplasty was performed
of the splenic vein with 6 mm x 40 mm, 8 mm x 40 mm, and 10 mm x 40 mm Mustang
balloons. A splenic venogram was again performed.
Residual clot was noted within the main portal vein. Next, a 6 ___
___ balloon was placed over the Amplatz wire and swept proximally from the
portal vein through the TIPS stent. Portal venogram was performed which noted
residual clot in the portal vein. The cleaner device was then placed and
deployed within the portal vein and SMV. At this point, pressure measurements
were obtained in the portal vein and right atrium. The cleaner device was
removed and a portal venogram was performed. Residual clot remained in the
main portal vein, in the decision was made to place a 12 mm x 60 mm Luminexx
stent within the main portal vein. Post main portal vein stenting venogram
was performed.
The sheath was then removed from the right internal jugular vein site and
pressure held for 20 minutes to achieve hemostasis. A V-pad and sterile
dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the ICU in stable
condition.
FINDINGS:
1. SMV venogram demonstrates residual clot within the SMV however decreased
in extent compared to prior study on ___.
2. Splenic venogram demonstrates moderate amount of thrombus within the
splenic vein as well as decreased flow of contrast into the portal vein likely
from residual clot within the portal vein and decreased inflow.
3. Post TIPS portal venogram demonstrates good flow through the TIPS with a
small amount of residual thrombus in the main portal vein.
4. Portal venogram post chemical and mechanical thrombectomy of the SMV,
splenic and portal veins demonstrates significant improvement in flow within
the SMV, splenic vein and portal vein with only minimal residual thrombus
within the main portal vein.
5. Post portal vein stenting venogram demonstrates improved brisk flow through
the portal vein stent and TIPS with minimal residual clot in the main portal
vein.
6. Post-TIPS right atrial pressure of 12 and portal pressure of 14 resulting
in portosystemic gradient of 2 mmHg.
IMPRESSION:
Successful TIPS and main portal vein stent placement.
Successful chemical and mechanical thrombectomy SMV, splenic and portal veins.
RECOMMENDATION(S): The patient should be bridged from heparin to Coumadin. He
will need a 2 week ___ ___ clinic appointment.
|
19945642-RR-13 | 19,945,642 | 22,576,776 | RR | 13 | 2184-01-18 05:06:00 | 2184-01-18 10:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent intraabdominal thrombus s/p lysis now
with GI bleed // please evaluate for pulmonary edeam please evaluate for
pulmonary edeam
IMPRESSION:
Compared to chest radiographs ___.
No pulmonary edema. Improved moderate left basal atelectasis. Probable small
left pleural effusion, chronicity indeterminate. No pneumothorax. Heart size
normal, exaggerated by low lung volumes.
Right jugular line ends in the right atrium.
|
19945642-RR-14 | 19,945,642 | 22,576,776 | RR | 14 | 2184-01-19 05:24:00 | 2184-01-19 07:47:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent intraabdominal thrombus s/p lysis now
with GI bleed // pulm edema? interval change? pulm edema? interval
change?
IMPRESSION:
Comparison to ___. The patient has been extubated. Lung volumes
continue to be low. Areas of atelectasis are seen at the left and the right
lung basis. The position of the right internal jugular vein catheter is
unchanged. No new focal parenchymal opacities. No pleural effusions.
|
19945642-RR-15 | 19,945,642 | 22,576,776 | RR | 15 | 2184-01-18 09:36:00 | 2184-01-18 13:30:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with multiple abdominal thrombosis of unclear
etiology with new acute ___ // Please perform with Doppler to evaluate for
hydronephrosis or any acute thrombosis
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
The right kidney measures 11.3 cm. The left kidney measures 12.1 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Renal Doppler: Intrarenal arteries show patent flow. Bilaterally, the main
renal arteries are patent with normal waveforms. The peak systolic velocity on
the right is 86.7 centimeters/second. The peak systolic velocity on the left
is 111 centimeters/second. Main renal veins are patent bilaterally with normal
waveforms.
IMPRESSION:
Normal renal ultrasound. No evidence of renal artery stenosis.
|
19945642-RR-16 | 19,945,642 | 22,576,776 | RR | 16 | 2184-01-18 09:36:00 | 2184-01-18 15:07:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with SMA, splenic thrombosis s/p thromylytics now
with acutely elevated bili // please evaluate for any cbd dilitation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: TIPS ___.
FINDINGS:
Study is limited by overlying bowel gas.
LIVER: The liver parenchyma cannot be adequately assessed. The TIPS cannot be
assessed at this time. The main portal vein is patent with hepatopetal flow.
There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD was not
visualized.
GALLBLADDER: The gallbladder contains echogenic stones and sludge. Although
the gallbladder is distended, the gallbladder wall is not thickened.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: The spleen is not visualized.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The aorta and IVC are not well visualized.
IMPRESSION:
1. Study limited by overlying bowel gas.
2. The gallbladder is distended with echogenic stones and sludge, but without
thickening of the gallbladder wall.
3. The liver parenchyma cannot be adequately assessed.
4. Too early to assess TIPS patency.
|
19945642-RR-17 | 19,945,642 | 22,576,776 | RR | 17 | 2184-01-18 11:44:00 | 2184-01-18 14:21:00 | EXAMINATION: CHEST PORT LINE/TUBE PLCT 1 EXAM
INDICATION: ___ year old man with upper gi bleed with elective intubation for
EGD // Please eval ETT position Please eval ETT position
IMPRESSION:
Compared to chest radiographs ___ and ___ at 05:59.
New endotracheal tube ends at the upper margin of the clavicles, with the chin
elevated. Care should be taken not to withdraw it any further.
Lungs are low in volume exaggerating heart size, probably normal. Supine
positioning contributes to vascular engorgement in mediastinal widening,
probably unchanged. Atelectasis at the lung bases is mild. No pneumothorax
or pleural effusion.
|
19945642-RR-18 | 19,945,642 | 22,576,776 | RR | 18 | 2184-01-21 11:27:00 | 2184-01-21 16:50:00 | EXAMINATION: CT abdomen and pelvis with and without contrast
INDICATION: ___ year old man with portal vein/splenic vein/SMV thrombus s/p
TIPS with lysis and thrombectomy. Do multiphasic liver with abd/pelvis on
portal venous phase. // ___ year old man with portal vein/splenic vein/SMV
thrombus s/p TIPS with lysis and thrombectomy. Do multiphasic liver with
abd/pelvis on portal venous phase.
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen and pelvis was
done as part of CT torso without and with IV contrast. Initially, the abdomen
and pelvis was scanned without IV contrast. Subsequently, a single bolus of IV
contrast was injected and the abdomen was scanned in the early arterial phase,
followed by a scan of the abdomen and pelvis in the portal venous phase,
followed by a scan of the abdomen in equilibrium phase (3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 3,050 mGy-cm.
COMPARISON: CT abdomen and pelvis on ___, MRCP
on ___
FINDINGS:
LOWER CHEST: There are trace bilateral pleural effusions and bibasilar
atelectasis. There is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. The gallbladder contains gallstones without
wall thickening or surrounding inflammation. Patient is status post TIPS from
the right hepatic artery to the portal confluence, which appears patent.
There is residual nonocclusive clot in the distal main portal vein at the
confluence, and just distal to the TIPS (3:162). The proximal SMV just distal
to the confluence is patent, however there is occlusive thrombosis in the
distal branches of the SMV (604b:60). The proximal splenic vein appears
patent, however some distal residual clot remains (3b:147, 162). There is
trace perihepatic and perisplenic ascites.
PANCREAS: The pancreas has normal attenuation throughout. Again seen is a 9
mm hypodensity in the pancreatic neck, likely representing a side branch IPMN
(3a:54). 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 a 1.2 cm simple cyst in the interpolar region of the right kidney.
An additional subcentimeter hypodensity in the right lower pole is too small
to characterize, however likely represents a cyst. There is no
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Again seen is a duodenal
diverticulum. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. Diverticulosis of the colon is noted, without
evidence of wall thickening and fat stranding. The appendix is normal.
PELVIS: Small locules of air in the bladder likely secondary to recent Foley
catheter placement. The distal ureters are unremarkable. There is a small
amount of simple free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate contains coarse calcifications, the seminal
vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Degenerative changes the lumbar spine with mild retrolisthesis of L3
on L4 are not significantly changed. There is no evidence of worrisome
osseous lesions or acute fracture.
SOFT TISSUES: There is bilateral symmetric gynecomastia. There is diffuse
subcutaneous edema. An umbilical hernia containing fat is noted.
IMPRESSION:
1. Patent TIPS, with residual nonocclusive clot at the portal confluence.
The SMV is patent, however there is occlusive thrombosis of its distal
branches. The proximal splenic vein is patent, with residual thrombosis in
the distal portion of the splenic vein.
2. Trace bilateral pleural effusions and adjacent atelectasis.
3. Trace perihepatic and perisplenic ascites, and small amount of free fluid
in the pelvis.
|
19945642-RR-20 | 19,945,642 | 22,576,776 | RR | 20 | 2184-01-22 04:38:00 | 2184-01-22 09:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new O2 requirement // interval change
interval change
IMPRESSION:
Heart size and mediastinum are stable in appearance. Left basal linear
opacities are most likely representing atelectasis in combination of small
amount of pleural effusion.
Right internal jugular line tip is at the level of cavoatrial junction or
proximal right atrium and might be pulled back 1 cm. No pneumothorax. No
pulmonary edema.
|
19945642-RR-21 | 19,945,642 | 22,576,776 | RR | 21 | 2184-01-22 17:01:00 | 2184-01-22 17:53:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old man with SMV, portal and splenic vein thrombosis s/p
thrombectomy now with new O2 requirement c/f PE. // C/f PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 3.5 s, 1.0 cm; CTDIvol = 8.1 mGy (Body) DLP = 8.1
mGy-cm.
3) Spiral Acquisition 6.7 s, 25.6 cm; CTDIvol = 11.5 mGy (Body) DLP = 275.7
mGy-cm.
Total DLP (Body) = 295 mGy-cm.
COMPARISON: None
FINDINGS:
There is significant motion artifact through the ascending aorta. The aorta
and its major branch vessels are patent, with no evidence of stenosis,
occlusion, dissection, or aneurysmal formation. There is no evidence of
penetrating atherosclerotic ulcer or aortic arch atheroma present. Coronary
artery calcifications.
The study is mildly limited by breathing artifacts. The pulmonary arteries
are well opacified to the segmental level, with no evidence of filling defect
within the main, right, left, lobar or segmental pulmonary arteries. The
main and right pulmonary arteries are normal in caliber, and there is no
evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable. A right internal jugular central line
is noted with its tip at the ___-RA junction.
There is no evidence of pericardial effusion. Trace right pleural effusion.
There is subsegmental atelectasis in the lower lobes bilaterally as well as
the lingula. Component of infiltrate in the left lower lobe is unlikely,
cannot be excluded. The airways are patent to the subsegmental level.
Limited images of the upper abdomen demonstrates a partially visualized TIPS.
There is small amount of free fluid in the upper abdomen, minimally progressed
since prior CT of the abdomen dated ___. Poor flow seen in the
suboptimally seen distal right portal vein, as seen on preoperative exam CT
abdomen pelvis ___. There is heterogeneous attenuation of the
hepatic parenchyma, likely perfusion related.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
Mild thickening and enlargement of the right posterolateral chest wall
musculature, compatible with a small intramuscular hematoma stable since prior
CT dated ___, likely related to recent intervention.
IMPRESSION:
1. Slightly limited study by breathing artifacts. No evidence of pulmonary
embolism to the segmental levels bilaterally.
2. Bibasilar atelectasis and trace right pleural effusion. Component of
infiltrate in the left lower lobe is unlikely, cannot be excluded.
|
19945642-RR-5 | 19,945,642 | 22,576,776 | RR | 5 | 2184-01-12 08:51:00 | 2184-01-12 17:05:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with 6 days of no BMs, abdominal pain, w/CT scan
showing liver mass // evaluate liver/pancreatic masses, c/f cholangiocarcinoma
vs ___ vs pancreatic cancer
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered for
oral contrast.
COMPARISON: Compared to prior CT of the abdomen dated ___.
FINDINGS:
Lower Thorax: Bibasilar atelectasis. No pleural or pericardial effusion.
Liver: Liver demonstrates normal contours without morphological signs of liver
cirrhosis. No significant drop of signal on the out of phase imaging as
compared to the in-phase imaging to suggest hepatic steatosis. There is a
geographical area of hypoenhancement at the central region of the liver within
segments IV and V extending into the caudate lobe (Series 15, image 34) that
progressively enhances becoming homogeneous with the remainder liver on the
more delayed phases, compatible with an area of hypoperfusion. There is no
mass effect on the surrounding vessels. No focal mass lesion in that region or
an area of abnormal diffusion restriction.
Biliary: The gallbladder is present containing small amount of biliary sludge
and a small gallstone at the gallbladder neck. There is however no gallbladder
wall thickening or findings to suggest acute cholecystitis. There is no
intrahepatic or extrahepatic biliary duct dilatation. The common bile duct
tapers normally towards the ampulla without obstructing filling defects.
Pancreas: The pancreas maintains its bulk and demonstrates normal signal
characteristics on the T1 weighted images. It enhances homogeneously on the
postcontrast images without focal mass lesion. There are multiple scattered
T2 hyperintense cystic lesions throughout the pancreas, the largest within the
pancreatic neck measuring 9 mm (series 3, image 32 and series 2, image 28),
most likely side-branch intraductal papillary mucinous neoplasm (IPMN). The
main pancreatic duct is not dilated. No peripancreatic inflammatory changes
or fluid collections.
Spleen: Spleen is normal in size and signal characteristics. It enhances
homogeneously without focal mass lesion.
Adrenal Glands: The adrenal glands are normal bilaterally without focal
nodules.
Kidneys: Kidneys are symmetric in size bilaterally and demonstrate good
corticomedullary differentiation. There is adequate excretion of contrast on
the more delayed phases. There are simple renal cysts in the right kidney, the
largest in the interpolar region of the right kidney measuring 1.4 cm. No
suspicious renal masses or hydronephrosis bilaterally. No perinephric
abnormality.
Gastrointestinal Tract: The stomach, visualized small bowel and colon in the
upper abdomen are within normal limits. Note is made of a Juxta papillary
duodenal diverticulum. There is a small amount of perihepatic and perisplenic
free fluid.
Lymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis
lymphadenopathy by size criteria.
Vasculature: Abdominal aorta and its major branches are patent. Hepatic
arterial anatomy is conventional. There is extensive thrombosis involving the
superior mesenteric vein, the inferior mesenteric vein, the splenic vein, and
the main, right and left portal veins, with distention, however no progressive
enhancement of the thrombus on the postcontrast images to suggest tumor
thrombosis.
Osseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass
lesions.
IMPRESSION:
1. Extensive acute likely bland thrombus involving the superior mesenteric
vein, inferior mesenteric vein, splenic vein and the main, right and left
portal veins.
2. Focal area of hypoperfusion at the hepatic hilum involving segments IV; V
and the caudate lobe - without a discrete focal mass lesion.
3. No intrahepatic or extrahepatic biliary duct dilatation. No biliary duct
mass to suggest cholangiocarcinoma.
4. No suspicious solid pancreatic mass lesion. There are scattered T2
hyperintense cystic lesions throughout the pancreas, most likely side-branch
IPMNs. Per departmental protocol, this does not need further follow-up.
NOTIFICATION: The findings were discussed with ___. ___, M.D. by
___, M.D. on the telephone on ___ at 3:32 ___, 30 minutes after
discovery of the findings.
|
19945642-RR-6 | 19,945,642 | 22,576,776 | RR | 6 | 2184-01-13 12:48:00 | 2184-01-13 16:49:00 | INDICATION: ___ year old man with abdominal pain and increasing abdominal
distension // Ileus? SBO?
TECHNIQUE: Supine and upright radiographs of the abdomen.
COMPARISON: CT of the abdomen dated ___.
FINDINGS:
While there are air-fluid levels in the ascending colon there is gas within
the rest of the colon and in the rectum, most likely related to ileus. There
are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
|
19945642-RR-7 | 19,945,642 | 22,576,776 | RR | 7 | 2184-01-14 11:24:00 | 2184-01-14 20:08:00 | INDICATION: ___ year old man with portomesenteric venous system thrombosis.
COMPARISON: CT abdomen and pelvis dated ___. MRCP dated ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___, Dr ___ Dr ___ performed the
procedure. Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings.
ANESTHESIA: General anesthesia was administered by the anesthesiology
department. Please refer to anesthesiology notes for details.
CONTRAST: 95 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 69.5 min, 1272 mGy
PROCEDURE:
1. Ultrasound guided right internal jugular vein access
2. Right atrial pressure measurement
3. Attempted ultrasound-guided trans-splenic venous access
4. Right hepatic venogram
5. Attempted intrahepatic portal venous access
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck and abdomen were prepped and draped in the usual
sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a ___ wire was advanced distally into
the IVC.
The micropuncture sheath was then removed and a 10 ___ sheath was advanced
over the wire into the right atrium. The inner dilator was removed. Right
atrial pressure measurement was obtained. A 5 ___ MPA catheter pre loaded
with a Glidewire was advanced through the sheath and used to select the right
hepatic vein. The catheter was advanced over the wire into the right hepatic
vein. Appropriate position was confirmed with a right hepatic venogram and
lateral fluoroscopy. The Glidewire was exchanged for ___ wire. The
sheath was advanced over the catheter and wire. The catheter was removed.
Once the sheath was placed in an appropriate position, the cannula device was
inserted over the ___ wire and the wire was exchanged for ___
needle. The angled sheath was turned anteriorly. The needle was then advanced
through liver parenchyma directed towards the portal vein and the needle was
withdrawn over its sheath. The needle sheath was withdrawn while gentle
suction was applied. Multiple attempts to access the portal vein were
unsuccessful.
Due to inability to access the portal vein via a transjugular intrahepatic
approach, attempted ultrasound-guided trans splenic access using a 21G Cook
needle into the splenic vein was performed. A splenic venogram was performed
.
Due to the inability to access the portal vein and extended procedure time,
the procedure was terminated. The sheath and catheter were removed from the
right neck. Manual pressure was held for 10 minutes to ensure hemostasis.
Manual pressure over the left lateral abdomen access site was held for 10
minutes to ensure hemostasis. Sterile dressings were applied over both access
sites.
There were no immediate post-procedure complications. The patient was
transferred to the PACU in stable condition.
FINDINGS:
1. Patent right internal jugular vein
2. Right atrial pressure measurement of 15 mm Hg
3. Thrombosed portal and splenic veins with splenic venogram showing
reconstitution of splenic venous outflow via likely gastric varices.
4. Unsuccessful portal vein access with multiple attempts resulting in
capsular punctures.
IMPRESSION:
Unsuccessful transjugular intrahepatic portal vein and trans splenic vein
access despite multiple attempts. The procedure was terminated due to
multiple failed attempts and extended procedure time.
RECOMMENDATION(S): The patient should restart the heparin drip in 12 hours.
A repeat attempt will be performed the next ___ days.
|
19945642-RR-8 | 19,945,642 | 22,576,776 | RR | 8 | 2184-01-15 14:56:00 | 2184-01-15 17:29:00 | INDICATION: ___ year old man with abdominal pain found to have mesenteric,
splenic and portal vein thrombosis. // evaluation prior to ___ procedure
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 5.3 s, 58.4 cm; CTDIvol = 17.0 mGy (Body) DLP = 993.5
mGy-cm.
Total DLP (Body) = 994 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast ___
FINDINGS:
LOWER CHEST: Atelectasis is mild in bilateral lung bases posteriorly. Trace
bilateral pleural effusions are noted. There is heavy aortic valve
calcification.
ABDOMEN:
HEPATOBILIARY: Small faint hyperdensity in liver segment ___ be
calcification or IV contrast from prior procedure. A 4 mm hypodensity in
liver segment 8 at the hepatic dome is too small to be characterized.
Scattered small foci of air in the hepatic segment 8 and around the hepatic
hilum are likely sequela of prior procedure. Trace nonhemorrhagic fluid is
noted at the anterolateral surface of the liver adjacent to the gallbladder.
There is no intra or extrahepatic biliary duct dilation.
Gallbladder is unremarkable.
PANCREAS: Pancreas demonstrates homogeneous attenuation throughout. There is
no pancreatic duct dilation.
SPLEEN: Spleen is not enlarged.
ADRENALS: Bilateral adrenal glands are unremarkable.
URINARY: Bilateral kidneys are normal size. A simple renal cyst is again
noted at the upper pole of right kidney.
GASTROINTESTINAL: Stomach is unremarkable. Duodenal diverticulum is noted at
the second portion. Small bowel loops are normal caliber. Colonic
diverticulosis is noted. Appendix is unremarkable.
PELVIS: Bladder is unremarkable. Small amount of free fluid is noted in the
pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild Atherosclerotic disease
is noted. Known portal vein thrombosis is not well demonstrated in this
unenhanced exam.
BONES: Severe degenerative changes are noted at multiple levels of the lumbar
spine.
SOFT TISSUES: No suspicious soft tissue lesion is identified.
IMPRESSION:
1. Small amount of intraperitoneal nonhemorrhagic free fluid is identified
without evidence of hematoma.
2. Known portal vein thrombosis is not well demonstrated on this unenhanced
exam.
|
19945642-RR-9 | 19,945,642 | 22,576,776 | RR | 9 | 2184-01-15 22:05:00 | 2184-01-15 22:45:00 | EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old man with portal, splenic and mesenteric thrombosis
now with swelling of left upper extremity. // evaluate for DVT of Left upper
extremity
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial and cephalic veins are patent,
compressible and show normal color flow and augmentation. There is echogenic
material noted within a noncompressible left basilic vein, just distal to the
antecubital fossae, compatible with thrombus.
IMPRESSION:
1. Nonocclusive thrombus within the left basilic vein, distal to the
antecubital fossa.
2. No deep venous thrombosis otherwise demonstrated within the left upper
extremity.
|
19945711-RR-12 | 19,945,711 | 22,120,331 | RR | 12 | 2160-01-29 16:33:00 | 2160-01-29 17:27:00 | CHEST, TWO VIEWS: ___.
HISTORY: ___ male with acute onset of pleuritic chest pain and pain
with inspiration.
FINDINGS: PA and lateral views of the chest. No prior. The lungs are clear
of consolidation. There is no effusion or pneumothorax. The
cardiomediastinal silhouette is normal. Osseous and soft tissue structures
are unremarkable.
IMPRESSION: No acute cardiopulmonary process.
|
19945711-RR-13 | 19,945,711 | 22,120,331 | RR | 13 | 2160-01-29 20:11:00 | 2160-01-29 21:11:00 | CT PULMONARY ANGIOGRAM: ___
HISTORY: ___ male with pleuritic chest pain, tachycardia and hypoxia
on exertion.
TECHNIQUE: Contiguous axial images were obtained through the chest after the
administration of intravenous contrast. Coronal and sagittal reformats were
reviewed. No previous exam available for comparison.
FINDINGS: There is no filling defect within the main, left, right, lobar,
segmental or subsegmental pulmonary arteries to suggest pulmonary embolism.
Visualized lungs are clear without consolidation, suspicious nodules or
effusion. The central airways are patent.
Note is made of small amount of residual thymic tissue in the anterior
mediastinum. There is no evidence of mediastinal, hilar nor axillary
adenopathy. Note is made of slightly prominent right hilar node, which
measures up to 8 mm in short axis.
The heart and great vessels are unremarkable.
No suspicious osseous lesions detected. No visualized fracture.
IMPRESSION: No acute intrathoracic process. No evidence of pulmonary
embolism.
|
19945904-RR-5 | 19,945,904 | 26,472,679 | RR | 5 | 2151-11-07 17:27:00 | 2151-11-07 18:29:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with head trauma// ich, fx
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head CT dated ___.
FINDINGS:
There is a scalp hematoma and laceration overlying the frontal bone on the
right. There is no underlying fracture.
There is no evidence of acute territorial infarctionhemorrhage,edema,or mass.
Extensive confluent subcortical, deep, and periventricular white matter
hypodensities likely represent the sequela of chronic microvascular ischemic
disease. Unchanged region of encephalomalacia within the inferior left
temporal lobe and inferior left frontal lobe as well as chronic bilateral
cerebellar infarcts. There is prominence of the ventricles and sulci
suggestive of involutional changes.
There is no fracture. There is near complete opacification of the right
maxillary sinus. There is also partial opacification of the left sphenoid
sinus with an air-fluid level. Soft tissue density within the right external
auditory canal likely represents cerumen. Visualized portion of the mastoid
air cells and middle ear cavities are clear. Patient is status post bilateral
lens resections. Bilateral senile scleral calcifications are visualized.
Again, there is a periapical lucency surrounding the right maxillary second
molar.
IMPRESSION:
1. Scalp hematoma and laceration overlying the frontal bone, but no evidence
of underlying fracture or intracranial hemorrhage.
2. Sequela of extensive chronic microangiopathy with an unchanged regions of
encephalomalacia within the left frontal and temporal lobes as well as the
bilateral cerebellar hemispheres.
3. Paranasal sinus disease with an air-fluid level, slightly improved compared
to prior. Please correlate with any clinical signs of acute sinusitis.
|
19945904-RR-6 | 19,945,904 | 26,472,679 | RR | 6 | 2151-11-07 17:27:00 | 2151-11-07 18:43:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with head trauma// ich, fx
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 653 mGy-cm.
COMPARISON: CT C-spine dated ___.
FINDINGS:
There is exaggeration of the normal cervical lordosis, unchanged compared to
prior. Otherwise, alignment is normal. No fractures are identified.There is
no prevertebral soft tissue swelling. Stable spinal cord calcification at the
level C2.
Multilevel degenerative disc disease, most severe at C5-6. There is also
moderate to severe neural foraminal stenosis at multiple levels bilaterally
due to a combination of uncovertebral and facet osteophytes. Small posterior
intervertebral osteophytes cause mild narrowing the spinal canal. No
high-grade spinal canal stenosis.
The lung apices are clear. No cervical lymphadenopathy. Again, there is a
large hypodense nodule arising from the right lobe of the thyroid measuring
approximately 3.0 x 2.0 cm.
Chronic healed right proximal humerus fracture is visualized on the scout
images.
IMPRESSION:
1. No evidence of fracture or traumatic subluxation.
2. Extensive multilevel multifactorial degenerative changes.
3. Unchanged hypodense nodule arising from the right lobe of the thyroid
measuring up to 3.0 cm.
|
19945904-RR-7 | 19,945,904 | 26,472,679 | RR | 7 | 2151-11-07 17:31:00 | 2151-11-07 18:07:00 | INDICATION: ___ with trauma// fx
TECHNIQUE: Single supine view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Given semi supine positioning and rotation, the lungs are grossly clear.
Cardiac silhouette is enlarged but grossly unchanged. Atherosclerotic
calcifications are noted at the aortic arch. Old healed right lateral rib
fractures and proximal right humerus fractures are noted.
IMPRESSION:
No definite acute cardiopulmonary process.
|
19945904-RR-8 | 19,945,904 | 26,472,679 | RR | 8 | 2151-11-07 17:31:00 | 2151-11-07 18:04:00 | INDICATION: ___ with trauma// fx
TECHNIQUE: Single supine view of the pelvis.
COMPARISON: None.
FINDINGS:
The bones are diffusely demineralized limiting detailed evaluation. Orthopedic
hardware transfixing old chronic appearing right femoral neck fracture is
noted. No definite acute fracture. Pubic symphysis and SI joints are grossly
preserved. Lumbar dextroscoliosis and degenerative changes are noted.
IMPRESSION:
Limited exam due to demineralization with chronic changes of the proximal
right femur. No visualized acute fracture.
|
19946380-RR-56 | 19,946,380 | 23,690,922 | RR | 56 | 2182-06-30 10:33:00 | 2182-06-30 11:26:00 | INDICATION: COPD exacerbation and wheezing, rule out pneumonia.
COMPARISON: Comparison is made to chest radiograph performed ___.
FINDINGS: Chest PA and lateral radiograph demonstrates unremarkable
mediastinal, hilar and cardiac contours. Lungs are clear. No pleural
effusion or pneumothorax evident. Stable mild kyphosis of the thoracic spine
with anterior osteophyte formation.
IMPRESSION: No acute cardiopulmonary process.
|
19946380-RR-57 | 19,946,380 | 23,690,922 | RR | 57 | 2182-06-30 20:14:00 | 2182-06-30 23:00:00 | CHEST, TWO VIEWS: ___.
HISTORY: ___ female. COPD exacerbation, low O2 saturation.
FINDINGS: PA and lateral views of the chest are compared to previous exam
from earlier the same day and from ___. Compared to prior,
there is slight increased conspicuity of a vague opacity at the right
costophrenic recess best seen on the frontal projection. This opacity may
represent an early pneumonia. Tiny bilateral pleural effusions are also noted.
Cardiac silhouette is stable as are the osseous and soft tissue structures.
Atherosclerotic calcifications again noted throughout the aorta.
IMPRESSION: Possible early pneumonia in the right lateral lung base with tiny
pleural effusions.
|
19946380-RR-58 | 19,946,380 | 23,690,922 | RR | 58 | 2182-07-03 13:08:00 | 2182-07-03 19:09:00 | HISTORY: COPD, hypoxia, worsening O2 requirement, acute process.
CHEST, TWO VIEWS.
The lungs are hyperinflated and the diaphragms are flattened, consistent with
COPD. There are small bilateral effusions posteriorly, with associated
haziness in the right costophrenic angle. There is vertical linear opacity
projecting over the cardiac silhouette medially - ? atelectasis/scarring.
These findings are all similar to films dated ___. There is upper zone
redistribution, without other evidence of CHF. Mild prominence of the
pulmonary hila with a tapered appearance is similar to ___ reflect the
presence of pulmonary hypertension.
IMPRESSION: Small effusions and left-sided atelectasis/scarring, unchanged
compared with ___. UZRD without other evidence of CHF. COPD and suspected
pulmonary hypertension.
|
19946593-RR-19 | 19,946,593 | 28,829,753 | RR | 19 | 2196-07-27 17:23:00 | 2196-07-27 17:45:00 | INDICATION: ___ with fever and cough // Pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CT dated ___ as well as radiograph dated ___
FINDINGS:
PA and lateral chest radiograph demonstrates a triangular opacity on the
lateral view which corresponds to an opacity projecting within the medial left
lower lung zone. This appears more conspicuous relative to prior chest
radiograph dated ___. This likely corresponds to region of
bronchiectasis, mucoid impaction, and peribronchiolar nodules as described on
CT dated ___. Nodular opacities are additionally present
projecting over the right upper lobe additionally worrisome for airspace
disease. Disease at the right cardiophrenic angle is also more conspicuous.
Cardiomediastinal and hilar contours are within normal limits. Blunting of
the left costophrenic angle may reflect a trace pleural effusion.
IMPRESSION:
Opacities within the lingula and right lung base medially are more conspicuous
relative to prior examination performed ___. Nodular opacities
within the with right upper lobe are additionally noted as well. Findings
together likely reflect bronchocentric abnormality, infectious or
inflammatory, more conspicuous compared to yesterday's exam.
|
19947284-RR-25 | 19,947,284 | 21,863,330 | RR | 25 | 2134-10-31 17:42:00 | 2134-11-01 08:38:00 | HISTORY: CABG.
FINDINGS: In comparison with the study of ___, there has been a CABG
procedure performed with intact midline sternal wires. No definite
endotracheal tube is appreciated. Swan-Ganz catheter is in the proximal
portion of the left pulmonary artery. Nasogastric tube extends to the
stomach, though the side hole lies above the cavoatrial junction. Left chest
tube is in place and there is no pneumothorax.
There is evidence of elevated pulmonary venous pressure with streaks of
atelectasis, especially at the left base. Retrocardiac opacification with
blunting of the costophrenic angle is consistent with volume loss in the left
lower lobe and pleural fluid.
|
19947284-RR-26 | 19,947,284 | 21,863,330 | RR | 26 | 2134-11-02 09:38:00 | 2134-11-02 10:41:00 | REASON FOR EXAMINATION: Chest tube removal and line change, assessment.
AP radiograph of the chest was reviewed in comparison to ___.
Swan-Ganz catheter has been replaced by right internal jugular line with its
tip slightly higher than expected, most likely at the junction of jugular vein
and SVC. Mediastinal silhouette is stable. The small amount of left pleural
effusion is grossly unchanged. Minimal right pleural effusion cannot be
excluded. No appreciable pneumothorax is seen. No pulmonary edema is noted.
|
19947284-RR-27 | 19,947,284 | 21,863,330 | RR | 27 | 2134-11-02 17:13:00 | 2134-11-03 09:31:00 | AP CHEST, 5:27 P.M. ON ___
HISTORY: ___ man after CABG. Is there a right upper lobe hematoma.
Right internal jugular line is unchanged in position, covering slightly to the
right at the thoracic inlet, tip at the lower margin of the clavicle.
Mediastinal width has decreased since the earlier postoperative study on ___, and mild relative widening at the thoracic inlet is unchanged. I doubt
there is mediastinal bleeding or appreciable extravasation. Small bilateral
pleural effusions have increased since ___ at 9:47 a.m. Moderately severe
left lower lobe atelectasis is stable. Upper lungs are grossly clear. No
pneumothorax.
|
19947284-RR-28 | 19,947,284 | 21,863,330 | RR | 28 | 2134-11-05 07:48:00 | 2134-11-05 08:55:00 | CHEST
HISTORY: Status post CABG. Evaluate for effusion.
REFERENCE EXAM: ___.
FINDINGS: There is moderate cardiomegaly that is increased compared to prior
and bilateral pleural effusions that are also larger. There is a right IJ
line with tip in the upper SVC. There is volume loss in both lower lungs.
IMPRESSION: Worsened fluid status.
|
19947284-RR-32 | 19,947,284 | 24,252,083 | RR | 32 | 2136-08-29 22:21:00 | 2136-08-30 13:49:00 | TECHNIQUE: MRI of the brain without gad. The patient refused contrast
administration
HISTORY: Seizure, right frontal lesion.
COMPARISON: CT head from ___.
FINDINGS: There is a 1.6 x 2.1 cm intrinsically T1 hyperintense lesion in the
right frontal lobe demonstrating chronic blood products on the GRE sequence.
There is associated edema in the right frontal lobe. There is minimal midline
shift to the left. There are extensive small vessel ischemic changes in the
white matter. No evidence for acute ischemia or hydrocephalus. On the
gradient-echo images, there are minimal punctate foci of signal dropout
suggesting prior micro hemorrhages. No evidence for amyloid angiopathy.
IMPRESSION:
Limited study due to lack of intravenous contrast. There is an intrinsically
T1 hyperintense lesion in the right frontal lobe with chronic blood products
within it. There is associated surrounding edema. Findings are concerning
for metastatic lesion( versus a primary subacute hematoma). Recommend
post-gadolinium imaging when clinically able, depending on the patient's
dialysis schedule.
|
19947284-RR-49 | 19,947,284 | 25,682,552 | RR | 49 | 2137-09-06 12:20:00 | 2137-09-06 13:07:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with hx met renal cell ca who presents with
worsening R sided weakness. Assess for worsening bleed.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 1003.42 mGy-cm
CTDI: 55.27 mGy
COMPARISON: None.
FINDINGS:
In comparison to ___ there appears to be new hemorrhage within the
left posterior parietal lobe metastatic lesion (02:26) measuring 2.9 x 1.8 cm
(previously 2.6 x 2 cm). An adjacent 1.4 x 1.1 cm (02:25) hemorrhagic
metastatic lesion is seen along the left parafalcine region. There is
surrounding edema with local mass effect but no shift of midline structures.
Multiple additional known supra tentorial metastatic lesions are again seen
including right frontal lobe (02:30) measuring 1.1 cm, left frontal lobe
measuring 0.7 cm (02:20), and right temporal lobe measuring 1 cm (02:13).
There is no evidence of infarction. Prominence of the ventricles and sulci
are consistent with age-related cortical volume loss. Periventricular,
subcortical, and deep white matter hypodensities are likely sequela chronic
small vessel ischemic disease. Calcification of bilateral cavernous portions
of internal carotid arteries, basilar artery, and vertebral arteries is noted.
No osseous abnormalities seen. Near-complete opacification of the left
frontal sinus with aerosolized secretions as well as air-fluid level with the
left sphenoid sinus is noted. The additional visualize paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The orbits are
unremarkable.
IMPRESSION:
1. New hemorrhage since CT of ___ within left posterior parietal lobe
metastatic lesion and left parafalcine metastatic lesion which are similar in
size to MRI of ___, and better characterized on previous MR.
2. Multiple intracranial metastatic lesion as described above. No signs of
herniation.
3. Acute on chronic sinus disease.
|
19947284-RR-50 | 19,947,284 | 25,682,552 | RR | 50 | 2137-09-06 19:40:00 | 2137-09-06 20:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with weakness, s/p seizure, known brain mets. //
r/o pna
IMPRESSION:
As compared to ___ radiograph, increasing linear opacity at the left
lung base is attributed to worsening atelectasis. Additionally, a nonspecific
patchy opacity is developed at the right lung base, which could be due to
focal aspiration, atelectasis, or developing pneumonia. No other relevant
changes.
|
19947284-RR-51 | 19,947,284 | 25,682,552 | RR | 51 | 2137-09-09 13:47:00 | 2137-09-09 16:01:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with renal cell carcinoma metastatic to the
brain, with associated hemorrhage. Please evaluate for progression of
bleeding.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 958 mGy-cm
COMPARISON: CT head from ___ and MR head from ___
FINDINGS:
New punctate hyperdense foci in the superficial left parietal lobe (4:22)
suggest new hemorrhage of unclear etiology, as no underlying metastatic
lesions were seen on the recent MRI.
Allowing for differences in positioning, the 2 x 1.6 cm left parafalcine
hemorrhagic metastasis and 3.1 x 1.6 cm left anterior parietal hemorrhagic
metastasis (04:29) are not significantly changed. Surrounding edema is
unchanged.
The left frontal operculum hemorrhagic metastasis (04:21) is grossly
unchanged, without edema.
Previously seen hyperdense metastasis in the medial right occipital lobe
(04:17) has decreased central density and appears stable in size, without
associated edema.
Additional metastases demonstrated on the recent contrast enhanced MRI are not
adequately reassessed on the present noncontrast CT. Multiple additional areas
of vasogenic edema within the cerebral hemispheres are unchanged, most
extensive in the right frontal and left parietal lobes. Compression of the
posterior body and atrium of the left lateral ventricle is unchanged. The
remainder the ventricular system is stable in size as well. There is no
evidence for edema in the posterior fossa.
No suspicious lytic or sclerotic osseous lesions are seen. Fluid within the
left sphenoid sinus and opacification of the left frontal sinus could be due
to prolonged supine positioning in the inpatient setting.
IMPRESSION:
1. New punctate hemorrhages in the superficial left parietal lobe (4:22) are
of unclear etiology, as no underlying metastatic lesions were seen on the
recent brain MRI.
2. The small hemorrhagic metastasis in the medial right occipital lobe (04:17)
is stable in size with slightly decreased density of blood products.
3. Hemorrhagic metastases in the left parafalcine, left anterior parietal, and
left frontal operculum regions are unchanged. Additional metastases
demonstrated on the recent MRI are not adequately assessed on the present
noncontrast CT.
4. Multi focal edema in the cerebral hemispheres is unchanged. No edema is
seen in the posterior fossa.
|
19947298-RR-116 | 19,947,298 | 22,844,443 | RR | 116 | 2146-12-11 10:18:00 | 2146-12-11 12:46:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with altered mental status// ?bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 17.6 cm; CTDIvol = 45.7 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT from ___, MR from ___
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass. There is
left temporoparietal encephalomalacia. Sequela of prior left sided
parenchymal hemorrhage centered in the insula is noted. The ventricles and
sulci are normal in size and configuration for patient's age. There are dense
atherosclerotic calcifications of bilateral carotid siphons.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells. The visualized portion of the remaining paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits show bilateral lens replacement.
IMPRESSION:
No acute intracranial process.
|
19947298-RR-117 | 19,947,298 | 22,844,443 | RR | 117 | 2146-12-11 11:48:00 | 2146-12-11 12:50:00 | INDICATION: ___ with confusion and weakness// ?pna, pulmonary edema, effusion
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
The lungs are clear besides linear opacity in the left midlung laterally,
likely atelectasis. There is no effusion or edema. Cardiac silhouette is
mildly enlarged. Atherosclerotic calcifications seen within the aorta.
Median sternotomy wires are intact.
IMPRESSION:
No acute cardiopulmonary process.
|
19947350-RR-77 | 19,947,350 | 29,340,802 | RR | 77 | 2182-09-06 18:49:00 | 2182-09-06 19:35:00 | HISTORY: ___ female with left lower quadrant pain and history of
diverticulitis.
COMPARISON: CT abdomen and pelvis from ___.
TECHNIQUE: Axial helical MDCT images were obtained from the lung bases to the
pubic symphysis administration of oral but no IV contrast. The patient has an
allergy to iodine contrast. Coronal and sagittal reformations were generated.
DLP: 944 mGy-cm
FINDINGS:
The lung bases are clear and the visualized heart and pericardium are
unremarkable.
CT ABDOMEN: Assessment of the abdominal viscera is lmited in this
non-enhanced examination. Allowing for this limitation:
The liver is homogeneous. The gallbladder is unremarkable. The pancreas,
spleen, adrenal glands are within normal limits. The kidneys do not show
hydronephrosis or focal lesions bilaterally, although assessment is limited
due to the lack of IV contrast. No evidence of nephrolithiasis.
There is a focus of mild pericolonic stranding in the descending colon
proximal to the region of prior diverticulitis. There is no fluid collection
or extraluminal gas. There is no bowel dilatation to suggest obstruction.
The appendix is seen and is not inflamed. The aorta is nonaneurysmal. There
is no mesenteric or retroperitoneal lymph node enlargement by CT size
criteria. There is no ascites, abdominal free air or abdominal wall hernia.
Ventriculoperitoneal shunt seen in the left upper quadrant.
CT PELVIS: The urinary bladder and ureters are unremarkable. The uterus is
within normal limits. There is no pelvic wall or inguinal lymphadenopathy. No
pelvic free fluid is observed.
OSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for
malignancy.
IMPRESSION:
Acute uncomplicated diverticulitis in the descending colon.
|
19947673-RR-16 | 19,947,673 | 26,532,892 | RR | 16 | 2182-02-15 10:35:00 | 2182-02-15 11:33:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with Crohn's disease, 3 months of symptoms, treated for
hypotension/ Evaluate for complications of Crohn's disease
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.Coronal and sagittal reformations were
performed and reviewed on PACS.
DOSE: DLP: 615 MGy-cm
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is mild bibasilar atelectasis. There is no pleural or
pericardial effusion. The imaged portion of the heart is unremarkable.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions.There is a small amount of periportal
edema. 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 solid renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Positive oral contrast limits mucosal assessment.
The stomach and duodenum appear normal. Proximal small bowel loops appear
normal in course and caliber. Contrast is seen through the level of the
transverse colon. There is an long segment of abnormally thickened small
bowel in the right lower quadrant involving distal ileum extending to the
terminal ileum. Notable fat stranding is seen at the ileocecal junction.
Adjacent prominent lymph nodes are likely reactive. No free air or
extraluminal fluid collection. No resultant bowel obstruction. Adjacent
areas of mesenteric fibrofatty proliferation suggest prior inflammation in the
right lower quadrant. This area of focal thickening persists for about 12 cm.
The appendix is normal. Cecum appears minimally thickened though the
remainder of the colon is unremarkable.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal 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:
Acute on chronic Crohn's disease with long segment acute distal/terminal
ileitis. No resultant bowel obstruction.
|
19947673-RR-17 | 19,947,673 | 26,532,892 | RR | 17 | 2182-02-16 18:24:00 | 2182-02-16 18:48:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with Crohn's disease// Evaluate for evidence of
tuberculosis, other pulmonary disease
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is within normal limits. The
bony thorax is grossly intact.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19947761-RR-3 | 19,947,761 | 26,726,803 | RR | 3 | 2133-07-14 09:36:00 | 2133-07-14 10:10:00 | EXAMINATION: CT abdomen/pelvis
INDICATION: ___ with 2 stab wounds in right lower quadrant.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.7 s, 52.8 cm; CTDIvol = 22.6 mGy (Body) DLP =
1,196.1 mGy-cm.
Total DLP (Body) = 1,196 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis. No pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: A small focus of hypoattenuation adjacent to the groove the
falciform ligament reflects a transient hepatic attenuation difference.
Otherwise, the liver enhances homogeneously. No focal lesions. The portal
veins are patent. 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.
Hypoattenuating right renal lesions are too small to completely characterize,
likely simple cysts. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Mild
diverticulosis. The colon and rectum otherwise appear unremarkable. The
appendix is normal. No pneumoperitoneum. No hemoperitoneum.
PELVIS: A small urachal remnant extends superiorly from the anterior bladder.
The bladder otherwise appears unremarkable. No free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No significant
atherosclerotic disease is noted. Incidental note is made of a replaced
hepatic artery arising from the superior mesenteric artery.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There are 2 puncture wounds in the soft tissues of the anterior
wall of the right lower quadrant. The more medial puncture wound has a larger
skin defect and a 2.4 x 0.9 x 1.8 cm underlying hematoma within the
subcutaneous fat (series 2, image 93). The hematoma abuts the rectus sheath.
No rectus hematoma. Notably, the puncture wound and small subcutaneous
hematoma are lateral to the course of the right inferior epigastric artery.
The smaller, probable puncture wound is associated with a tiny skin defect and
tiny focus of subcutaneous emphysema (series 2, image 93; series 602, images
36 and 37). No associated hematoma. Incidental small, fat containing
umbilical hernia.
IMPRESSION:
Two small puncture wounds in the right lower quadrant abdominal wall with a
small 2.4 cm subcutaneous hematoma. No definite rectus abdominus abnormality.
The right inferior epigastric artery is spared. No evidence of peritoneum
violation.
|
19948103-RR-14 | 19,948,103 | 21,009,849 | RR | 14 | 2165-03-07 08:52:00 | 2165-03-07 12:28:00 | CHEST RADIOGRAPH
INDICATION: Cough, questionable pneumonia.
COMPARISON: No comparison available at the time of dictation.
FINDINGS: A single portable view is provided. Normal lung volumes. Azygos
lobe as anatomical variant. Normal size of the cardiac silhouette. No
pleural effusions. No pulmonary edema. No pneumonia.
|
19949052-RR-21 | 19,949,052 | 24,019,823 | RR | 21 | 2160-06-20 18:13:00 | 2160-06-20 21:33:00 | EXAM: MRA of the head.
CLINICAL INFORMATION: Patient with subarachnoid hemorrhage, rule out
aneurysm.
TECHNIQUE: 3D time-of-flight MRA of the circle of ___ acquired.
Correlation was made with the head CT from an outside institution from
___.
FINDINGS: Cavernous carotid arteries are identified bilaterally. The
supraclinoid internal carotid as well as both middle cerebral arteries as well
as anterior cerebral arteries are normal in appearance. There is no evidence
of aneurysm identified in the anterior circulation. In the posterior
circulation, distal right vertebral artery is small in size. This is a normal
variation. No evidence of an aneurysm seen in the posterior circulation. No
vascular occlusion is identified.
IMPRESSION: Although evaluation for aneurysm on an MRA in presence of
subarachnoid hemorrhage would be somewhat limited, no obvious aneurysm is
identified in the arteries of anterior or posterior circulation. If there is
continued concern, a CTA would be a better examination for evaluation of an
aneurysm.
|
19949052-RR-22 | 19,949,052 | 24,019,823 | RR | 22 | 2160-06-21 09:31:00 | 2160-06-21 10:02:00 | HISTORY: Hemorrhage.
TECHNIQUE: MDCT data were acquired through the head without intravenous
contrast.
COMPARISON: ___
FINDINGS:
Intraventricular hemorrhage is again seen in the ___ ventricle. In addition,
there is now a small amount of hemorrhage layering bilaterally in the
occipital horns of the lateral ventricles. There is no other focus of
hemorrhage, major vascular territory infarction, edema, mass, or shift of
midline structures. The size and shape at the ventricles and sulci are
normal. Gray-white matter differentiation is preserved. The extracranial
soft tissues and osseous structures are unremarkable. Visualized paranasal
sinuses and mastoid air cells are clear.
IMPRESSION:
Stable intraventricular hemorrhage in the ___ ventricle. Small amount of
hemorrhage in the bilateral occipital horns likely represents redistribution
of blood products.
|
19949052-RR-23 | 19,949,052 | 24,019,823 | RR | 23 | 2160-06-22 08:16:00 | 2160-06-22 11:31:00 | INDICATION: Fourth ventricle hemorrhage. Please assess for interval change.
COMPARISON: Comparison is made to head CT performed ___.
TECHNIQUE: Non-contrast axial images were obtained through the brain.
Coronal and sagittal reformations were provided.
FINDINGS: There is persistent though slightly decreased fourth
intraventricular hemorrhage as well as stable amount of hemorrhage layering
within the occipital horns of the bilateral lateral ventricles, slightly more
dense compared to prior study consistent with evolution of blood products.
There has been interval increase in size of the bilateral lateral and third
ventricles concerning for a degree of developing obstructive hydrocephalus.
No periventricular hypodensities noted to suggest transependymal flow of CSF.
No new intra- or extraparenchymal hemorrhage identified. Gray-white matter
differentiation is preserved. No mass identified. Mastoid air cells, middle
ear cavities, and visualized paranasal sinuses are clear.
IMPRESSION: Stable degree of ventricular hemorrhage within the bilateral
lateral and fourth ventricle with increasing size of lateral and third
ventricles concerning for developing obstruction.
___ communicated these findings to Dr. ___ at 10:10 a.m.
on ___, who states the patient is in process of receiving a
ventriculostomy.
|
19949052-RR-24 | 19,949,052 | 24,019,823 | RR | 24 | 2160-06-22 12:01:00 | 2160-06-22 13:26:00 | INDICATION: Status post EVD placement.
COMPARISON: Comparison is made to head CT performed same day.
TECHNIQUE: Non-contrast axial images were obtained through the brain.
Coronal and sagittal reformations were provided.
FINDINGS: There has been interval placement of a right frontal approach
ventriculostomy catheter terminating at level of the right foramen of ___.
Given differences in head position there appears to be a slight interval
decrease in size of the bilateral lateral and third ventricles. Specifically,
the third ventricle measures 10 mm in maximal dimension on the current exam
compared to 50 mm on the prior. Intraparenchymal hemorrhage surrounds the
tract of ventriculostomy catheter. There is a stable degree of
intraventricular hemorrhage noted within the occipital horns of the lateral
ventricle and fourth ventricle. Otherwise, exam is unchanged.
IMPRESSION: Interval placement of right-sided ventriculostomy catheter with
mild interval decrease in ventricular size. Increased intraventricular or new
intraparenchymal hemorrhage identified.
|
19949052-RR-25 | 19,949,052 | 24,019,823 | RR | 25 | 2160-06-22 15:33:00 | 2160-06-23 10:19:00 | EXAM: MRI of the brain.
CLINICAL INFORMATION: Patient with subarachnoid hemorrhage, evaluate for
sinus thrombosis.
TECHNIQUE: 2D time-of-flight MRV of the head were obtained.
FINDINGS: The MRV of the head demonstrates no evidence of sinus thrombosis.
Normal flow signal is seen in the superior sagittal and transverse sinuses as
well as in the deep venous system. On the maximum intensity projection images
the flow signal within the superior sagittal sinus is not well visualized, but
it is well seen on the source images.
IMPRESSION:
Normal MRV of the head.
|
19949052-RR-26 | 19,949,052 | 24,019,823 | RR | 26 | 2160-06-22 21:54:00 | 2160-06-24 18:01:00 | INDICATION: Patient with history of subarachnoid hemorrhage. Assess for
venous sinus thrombosis.
COMPARISONS: CT head of ___, MRI head from ___.
TECHNIQUE: MRV of the head was obtained without intravenous contrast.
FINDINGS:
There is no evidence of venous sinus thrombosis. The inferior sagittal sinus
is not clearly seen and is likely diminutive. The patient's known
ventriculostomy catheter is redemonstrated with right frontal approach. The
sulci and ventricles are slightly prominent, likely age-related involutional
changes.
IMPRESSION:
No evidence of venous thrombosis.
|
19949052-RR-27 | 19,949,052 | 24,019,823 | RR | 27 | 2160-06-25 07:20:00 | 2160-06-25 10:30:00 | HISTORY: Patient with ventricular hemorrhage for followup.
TECHNIQUE: Axial images of the head were obtained without contrast.
COMPARISON: ___.
FINDINGS:
There is further evolution of blood products seen in the ventricles. Small
amount of blood products are now seen in the occipital horns of both lateral
ventricles. A right frontal drain ends in the anterior horn of the right
lateral ventricle. There is no hydrocephalus. No new hemorrhage is seen.
IMPRESSION:
Further evolution of blood products. No evidence of hydrocephalus.
|
19949052-RR-28 | 19,949,052 | 24,019,823 | RR | 28 | 2160-06-26 08:18:00 | 2160-06-26 10:06:00 | INDICATION: Patient with history of intraventricular hemorrhage; assess for
interval change.
COMPARISONS: ___, and ___.
TECHNIQUE: Contiguous MDCT-acquired images through the head were obtained
without intravenous contrast at 5 mm slice thickness.
FINDINGS:
An external ventriculostomy drain is in place with right frontal approach
terminating in the frontal horn of the right lateral ventricle, unchanged.
Small amount of blood products are seen layering within bilateral atria and
occipital horns of lateral ventricles. No new intracranial hemorrhage is
identified. Ventricles are unchanged in size and configuration since most
recent exam of ___ but have decreased in size since pre-EVD placement
exam of ___. There is no hydrocephalus. Basal cisterns are patent.
There is no mass effect or shift of normally midline structures. The sulci
and ventricles are slightly prominent, likely age related involutional
changes. There is no cerebral edema or loss of gray-white matter
differentiation to suggest an acute ischemic event. Imaged paranasal sinuses
and mastoid air cells are well aerated. Orbits are normal in appearance. No
acute fracture is seen.
IMPRESSION: In comparison to ___ exam, there is no significant interval
change in either the amount of intraventricular hemorrhage or the ventricular
size, with no new intracranial hemorrhage.
|
19949052-RR-30 | 19,949,052 | 24,019,823 | RR | 30 | 2160-06-28 13:17:00 | 2160-06-28 13:53:00 | INDICATION: Hydrocephalus. Evaluate for interval change.
TECHNIQUE: Sequential axial images were acquired through the head without
administration of intravenous contrast material.
COMPARISON: CT head from ___.
FINDINGS: There has been interval removal of a right frontal external
ventricular drainage catheter. A tiny hypodense focus is seen along the
catheter tract, possibly a region of gliosis/encephalomalacia (2A:17).
Minimal hemorrhagic material layering within the occipital horns of both
lateral ventricles is not significantly changed. There is no new intracranial
hemorrhage. There is no hydrocephalus, shift of the normally midline
structures, or acute large vascular territorial infarction. Minimal air
within the non-dependent portion of the frontal horn of the right lateral
ventricle relates to recent catheter removal. The visualized portions of the
paranasal sinuses and mastoid air cells are well aerated. The visualized
portions of the orbits are unremarkable. Skin staples overlie the frontal
region.
IMPRESSION:
1. No significant change in minimal hemorrhage layering in the occipital
horns of the lateral ventricles. No new intracranial hemorrhage.
2. Minimal air within the frontal horn of the right lateral ventricle relates
to interval removal of a right frontal external ventricular drainage catheter.
|
19949052-RR-39 | 19,949,052 | 26,305,563 | RR | 39 | 2162-04-15 08:16:00 | 2162-04-15 10:48:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with ESRD with R>L lower extremity swelling //
evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19949061-RR-40 | 19,949,061 | 27,658,829 | RR | 40 | 2189-06-02 09:26:00 | 2189-06-02 11:41:00 | INDICATION: Altered mental status.
COMPARISONS: CT head ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Sagittal and coronal reformats
were obtained and reviewed.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect, or
infarction. The ventricles and sulci are mildly prominent, suggesting mild
age-related volume loss. The basal cisterns are patent. Minimal
periventricular confluent hypodensities are stable and consistent with chronic
small vessel ischemic disease. A small intraparenchymal calcification
adjacent to the left lateral ventricle is unchanged from prior studies. This
is of unclear etiology, but given its stability, this is likely benign. No
fracture is identified. The visualized paranasal sinuses, mastoid air cells,
and middle ear cavities are clear.
IMPRESSION:
1. No acute intracranial process.
2. Stable mild age-related volume loss and mild chronic small vessel ischemic
disease.
|
19949061-RR-41 | 19,949,061 | 27,658,829 | RR | 41 | 2189-06-02 09:56:00 | 2189-06-02 11:27:00 | INDICATION: Altered mental status.
COMPARISONS: Chest radiograph, ___. CTA chest, ___.
FINDINGS: The lung volumes are low. There is interstitial prominence
consistent with mild pulmonary edema. No pleural effusion is present. The
cardiac silhouette is moderately enlarged. There is no consolidation or
pneumothorax.
IMPRESSION:
1. Mild pulmonary edema.
2. Moderate cardiomegaly.
|
19949061-RR-42 | 19,949,061 | 27,658,829 | RR | 42 | 2189-06-03 13:55:00 | 2189-06-03 15:38:00 | INDICATION: Evaluation for aspiration.
SWALLOWING VIDEO FLUROSCOPY: Oropharyngeal swallowing video fluoroscopy was
performed in conjunction with the speech and swallow division. Multiple
consistencies of barium were administered. Barium passed freely through the
oropharynx without evidence of obstruction. There was silent aspiration with
thin and nectar-thick liquids. Delayed initiation of oral phase of swallowing
was observed. There was also mild oropharyngeal residue during the exam.
IMPRESSION: Aspiraiton with thin and nectar-thick liquids. For details,
please refer to speech and swallow note in OMR.
|
19949061-RR-44 | 19,949,061 | 27,655,157 | RR | 44 | 2189-10-02 20:49:00 | 2189-10-02 21:23:00 | HISTORY: ___ male with ALS and progressive fatigue. Question
pneumonia.
COMPARISON: Chest x-ray from ___.
FINDINGS:
AP and lateral views of the chest. The lungs are clear given low lung volumes
with secondary crowding of the bronchovascular markings. There is no
consolidation or effusion. Cardiomediastinal silhouette is stable as are the
osseous and soft tissue structures.
IMPRESSION:
No definite acute cardiopulmonary process given relatively low lung volumes.
|
19949061-RR-45 | 19,949,061 | 27,655,157 | RR | 45 | 2189-10-02 20:49:00 | 2189-10-02 22:30:00 | INDICATION: Right shoulder injury.
COMPARISON: Chest CT available from ___.
THREE VIEWS OF THE RIGHT SHOULDER: There is no fracture or dislocation.
There is moderate sclerosis of the glenohumeral joint. Included views of the
right upper chest are clear. No rib fractures are detected.
IMPRESSION: No fracture or dislocation.
|
19949164-RR-15 | 19,949,164 | 25,420,009 | RR | 15 | 2136-12-04 09:36:00 | 2136-12-04 11:18:00 | INDICATION: ___ year old woman with lymphoma on chemotherapy, presenting with
volume overload, concern for CHF exacerbation// Evaluation for volume overload
COMPARISON: ___ CT scan
IMPRESSION:
There are bilateral effusions. Small on the right side and moderate to large
on the left side. There is also prominent pulmonary edema. There are no
pneumothoraces.
|
19949164-RR-16 | 19,949,164 | 25,420,009 | RR | 16 | 2136-12-08 15:13:00 | 2136-12-08 16:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new systolic heart failure and lymphoma
// Progression of bilateral pleural effusions and pulmonary edema.
TECHNIQUE: PA and lateral chest
COMPARISON: Prior chest radiographs dated to ___, most recently
___.
FINDINGS:
There has been interval improvement in the bilateral pleural effusions, most
prominently on the right, there is persistent bibasilar atelectasis and
moderate pleural effusion on the left lower lung still remaining. Pulmonary
edema is unchanged from previous. Cardiomediastinal silhouette is stable from
previous. No new focal consolidations.
IMPRESSION:
Interval improvement in the bilateral pleural effusions. Moderate pleural
effusion remaining on the left. Persistent bibasilar atelectasis and
pulmonary edema.
|
19949164-RR-17 | 19,949,164 | 25,420,009 | RR | 17 | 2136-12-09 13:23:00 | 2136-12-09 14:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with left pleural effusion// s/p thoracentesis;
eval for pneumothorax
IMPRESSION:
In comparison with the study of ___, there is been a left thoracentesis
with removal of a relatively small amount of pleural fluid, but no evidence of
pneumothorax. Curvilinear line overlying the upper portion of the right
hemithorax and mimicking a pneumothorax is seen to represent merely a skin
fold.
Otherwise, there is little overall change, and the study is limited by a
substantial obliquity of the patient.
|
19949164-RR-18 | 19,949,164 | 25,420,009 | RR | 18 | 2136-12-09 16:27:00 | 2136-12-09 17:35:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with pleural effusion s/p ___// repeat given
skin fold appearance
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 13:29.
IMPRESSION:
Compared to the examination from 3 hours prior, there has been resolution of
the curvilinear line overlying the right hemithorax, likely having represented
a skin fold. No pneumothorax is seen. Moderate left-greater-than-right
pleural effusions appear slightly increased, though this may be due to lower
lung volumes. There is also adjacent bibasilar compressive atelectasis. No
other significant interval change identified.
|
19949258-RR-21 | 19,949,258 | 29,119,619 | RR | 21 | 2172-01-30 20:48:00 | 2172-01-30 21:59:00 | INDICATION: History: ___ with Inferior and superior pelvic rami fractures on
SNF x-ray read. Fall 2 days ago on xarelto.// Fracture or intracranial
hemorrhage.
TECHNIQUE: AP view of the pelvis, two views of the left hip
COMPARISON: None.
FINDINGS:
The osseous structures are diffusely demineralized. A left superior pubic
ramus fracture is noted with approximately 11 mm of distraction. Minimally
displaced left inferior pubic ramus fracture is seen. No dislocation. No
diastases of the pubic symphysis or sacroiliac joints. Mild degenerative
changes of both hips are seen with joint space narrowing and osteophyte
formation. No concerning lytic or sclerotic osseous abnormalities. Moderate
vascular calcifications are noted. Clips are seen projecting over the lower
lumbar spine and left sacrum.
IMPRESSION:
Left superior and inferior pubic rami fractures.
|
19949258-RR-22 | 19,949,258 | 29,119,619 | RR | 22 | 2172-01-30 20:49:00 | 2172-01-30 21:42:00 | INDICATION: History: ___ with Fall 2 days ago// Fractures
TECHNIQUE: Supine AP view of the chest
COMPARISON: None.
FINDINGS:
Heart size is mildly enlarged. The aorta is diffusely calcified and mildly
tortuous. Mediastinal and hilar contours are otherwise unremarkable.
Pulmonary vasculature is not engorged. There is mild elevation of the left
hemidiaphragm. Minimal atelectasis is seen in the left lung base. No focal
consolidation, pleural effusion, or pneumothorax. No displaced fractures are
evident.
IMPRESSION:
No acute cardiopulmonary abnormality. No displaced fractures identified, but
please note that the sensitivity of chest radiographs for the detection of a
rib fracture is limited.
|
19949258-RR-23 | 19,949,258 | 29,119,619 | RR | 23 | 2172-01-30 20:49:00 | 2172-01-30 21:43:00 | EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) LEFT
INDICATION: History: ___ with Fall 2 days ago// Fractures
TECHNIQUE: Left elbow, 3 views.
COMPARISON: None
FINDINGS:
Osseous structures are diffusely demineralized. No acute fracture or
dislocation is identified. Well corticated ossific density adjacent to the
medial epicondyle may reflect the sequela of prior injury. Mild-to-moderate
degenerative spurring is seen involving the humeral ulnar and humeral radial
joints. No suspicious lytic or sclerotic osseous abnormality is identified.
No joint effusion is seen. No soft tissue calcification or radiopaque foreign
body is detected.
IMPRESSION:
No acute fracture or dislocation.
|
19949258-RR-24 | 19,949,258 | 29,119,619 | RR | 24 | 2172-01-30 20:49:00 | 2172-01-30 21:56:00 | INDICATION: History: ___ with Fall 2 days ago// Fractures
TECHNIQUE: Left knee, three views
COMPARISON: None.
FINDINGS:
The osseous structures are diffusely demineralized. No acute fracture is
present. Marked patella ___ is demonstrated, concerning for patellar tendon
disruption with soft tissue swelling overlying the inferior aspect of the
knee. Well corticated ossific densities ventral to the distal femur could
reflect the sequela of prior injury. Patient is status post total knee
arthroplasty. No hardware complications are seen. No definite focal lytic or
sclerotic osseous abnormalities are detected. Scattered vascular
calcifications are noted. No definite joint effusion.
IMPRESSION:
Marked patella ___ worrisome for patellar tendon rupture. No acute fracture.
Status post total knee arthroplasty without definite hardware complication.
|
19949258-RR-25 | 19,949,258 | 29,119,619 | RR | 25 | 2172-01-30 20:29:00 | 2172-01-30 20:59:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with Inferior and superior pelvic rami fractures on
SNF x-ray read. Fall 2 days ago on xarelto.// Fracture or intracranial
hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute territorial infarction,hemorrhage,edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Chronic infarct involving the right basal ganglia is
present with associated ex vacuo dilatation of the right lateral ventricle.
Chronic lacune in the right thalamus is also detected. Confluent
periventricular , subcortical, and deepwhite matter hypodensities are
nonspecific, but likely reflect the sequela of chronic microvascular
infarction. Punctate focus of hyperdensity within the right frontal white
matter (02:22) may reflect an area of mineralization.
There is no evidence of acute fracture. Mild mucosal thickening is seen
within the left sphenoid sinus. 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 apart from bilateral lens
replacements. Extensive atherosclerotic calcifications of the cavernous
carotid and distal left vertebral arteries are noted.
IMPRESSION:
1. No acute intracranial hemorrhage or mass effect.
2. Remote right basal ganglia infarct. Chronic small right thalamic lacunar
infarct.
3. Chronic microvascular infarction and moderate global atrophy.
|
19949258-RR-26 | 19,949,258 | 29,119,619 | RR | 26 | 2172-01-30 20:29:00 | 2172-01-30 21:04:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with Fall 2 days ago// Fractures Fractures
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 20.8 cm; CTDIvol = 22.6 mGy (Body) DLP = 470.2
mGy-cm.
Total DLP (Body) = 470 mGy-cm.
COMPARISON: None.
FINDINGS:
No fractures are identified. Very minimal C3 on C4, C4 on C5, and C5 on C6
anterolisthesis is likely degenerative in etiology. There is fusion of the C1
and C2 vertebral bodies and facets bilaterally. Extensive degenerative
changes of the atlanto-occipital joints bilaterally are demonstrated. Mild
intervertebral disc space narrowing is seen at multiple levels. No high-grade
central canal narrowing. Facet hypertrophy and uncovertebral spurring result
in bilateral moderate to severe neural foraminal narrowing. There is no
prevertebral soft tissue swelling. There is no evidence of infection or
neoplasm.
Visualized lung apices are clear. Thyroid gland is atrophic.
IMPRESSION:
1. No acute fracture or prevertebral soft tissue swelling.
2. Moderate to severe degenerative changes including fusion of the C1 and C2
vertebral bodies and facets bilaterally and marked degenerative changes of the
atlanto-occipital joints bilaterally.
3. Mild multilevel anterolisthesis is likely degenerative in etiology.
|
19949258-RR-27 | 19,949,258 | 29,119,619 | RR | 27 | 2172-01-31 01:19:00 | 2172-01-31 04:00:00 | EXAMINATION: CT PELVIS ORTHO W/O C
INDICATION: ___ year old woman with pelvic fractures after fall// evaluate for
fractures, hemorrhage
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: Total DLP (Body) = 605 mGy-cm.
COMPARISON: None.
FINDINGS:
PELVIS: Previous small-bowel anastomosis is seen. Diverticulosis is seen
throughout the large bowel. Stranding around the anterior bladder is
consistent with trauma. Air seen the bladder secondary to Foley catheter
placement. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
LYMPH NODES: There is no pelvic or inguinal lymphadenopathy.
VASCULAR: Extensive atherosclerotic disease is noted.
BONES: Displaced and comminuted fractures are seen of the superior and
inferior left pubic rami. There is an additional left sacral fracture at the
mid sacroiliac joint. A 4.0 x 2.5 cm hematoma is seen medially adjacent to
the fracture (301, 61). Additionally, high density material consistent with
hematoma is seen lateral to the left greater trochanter consistent with
hematoma (304, 40). There is severe osteopenia.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Comminuted fractures of the left superior and inferior pubic rami. Mildly
displaced left sacral fracture along the left mid sacroiliac joint.
2. Adjacent hematomas are seen just superior to the left pubic symphysis and
lateral to the left greater trochanter.
|
19949258-RR-28 | 19,949,258 | 29,119,619 | RR | 28 | 2172-02-01 13:22:00 | 2172-02-01 14:51:00 | EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST
INDICATION: ___ year old woman with pelvic fractures and L pelvic hematoma ___
unwitnessed fall, now with 2 point Hgb drop concerning for ongoing bleed//
?worsening L pelvic hematoma, ?intra-abdominal bleed
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 3.2 s, 41.7 cm; CTDIvol = 16.7 mGy (Body) DLP = 694.3
mGy-cm.
Total DLP (Body) = 694 mGy-cm.
COMPARISON: CT pelvis from ___.
FINDINGS:
LOWER CHEST: There is elevation of the left hemidiaphragm. There is mild
atelectasis at the right lung base.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas is somewhat atrophied, 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. The superior aspect of the spleen is incompletely
visualized due to elevation of the left diaphragm.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is a cyst in the
left upper pole. There is no hydronephrosis. A 9 mm calcification in the
left renal pelvic region is most likely vascular.
GASTROINTESTINAL: The stomach and small bowel are grossly unremarkable. There
is moderate diverticulosis of the distal colon.
PELVIS: The bladder is somewhat underdistended but grossly unremarkable.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The patient is status post hysterectomy. No adnexal
masses are seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: The there is severe osteopenia. There are fractures of the left
superior and inferior pubic rami and the left pubic tubercle as demonstrated
previously. There is a mildly displaced left zone 1 sacral ala fracture at
the level of the mid sacroiliac joint. There are severe compression fractures
of the L1 and L3 vertebral bodies without significant wedge deformity. These
are age indeterminate.
SOFT TISSUES: Mild extraperitoneal left pelvic hematoma related to the pelvic
fractures is unchanged from prior. There is also a subcutaneous hematoma
overlying the left greater trochanter, also grossly stable.
IMPRESSION:
Stable small left pelvic and subcutaneous proximal thigh hematomas. No new
intra-abdominal or worsening pelvic hematoma to account for hemoglobin drop.
Redemonstration of left-sided pelvic fractures. Age indeterminate compression
deformities of L1 and L3. Clinical correlation is recommended.
|
19949313-RR-29 | 19,949,313 | 25,652,319 | RR | 29 | 2178-02-28 17:47:00 | 2178-02-28 19:05:00 | EXAMINATION: SECOND OPINION CT NEURO PSO1 CT
INDICATION: ___ year old woman with worst headache of her life, nausea. Found
to have a SAH at outside hospital. Please evaluate for aneurysm. Second read
request.
TECHNIQUE: Contrast head CTA was performed on ___ 151___ at ___
___, and was submitted for second opinion review on ___.
DOSE: ___ mGy per cm
COMPARISON: ___ contrast brain MRI.
FINDINGS:
CTA image interpretation is limited due to lack of 3D reformatted images.
Within these confines:
CT HEAD WITHOUT CONTRAST:
Acute bilateral subarachnoid hemorrhage, layering within the left greater than
right ambient cisterns is noted. Small subdural hemorrhage is seen along the
parafalcine region, (2;17, 18), with a right parafalcine rounded focus of
hemorrhage measuring 0.8 cm x 0.9 cm (2;18).
There is prominence of the ventricles and sulci suggestive involutional
changes. No acute fracture is identified. The visualized paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The globes are
unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal with no evidence of stenosis, occlusion, or aneurysm. The dural
venous sinuses are patent. Note is made of bilateral fetal type PCAs. The A1
segment of the left anterior cerebral artery is hypoplastic, with the distal
anterior cerebral arteries being fed by the right anterior cerebral artery and
anterior communicating artery.
IMPRESSION:
1. CTA image interpretation is limited due to lack of 3D reformatted images.
2. Acute bilateral subarachnoid and subdural hemorrhages as described. Please
note underlying mass is not excluded on the basis examination. Recommend
contrast brain MRI for further evaluation, and follow-up imaging to
resolution.
3. Grossly patent circle of ___ without definite evidence of aneurysm
greater than 3 mm.
RECOMMENDATION(S): Acute bilateral subarachnoid and subdural hemorrhages as
described. Please note underlying mass is not excluded on the basis
examination. Recommend contrast brain MRI for further evaluation, and
follow-up imaging to resolution.
|
19949313-RR-30 | 19,949,313 | 25,652,319 | RR | 30 | 2178-03-01 07:33:00 | 2178-03-01 10:19:00 | EXAMINATION: Right common carotid artery angiogram.
Left common carotid artery angiogram.
Right subclavian artery.
Left subclavian artery.
INDICATION: ___ year old woman with SAH, CTA negative // evaluate for
aneurysm
ANESTHESIA: Conscious sedation with local analgesia, please see separate
notes for medications and dosing
TECHNIQUE: 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 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 5 ___ 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 right common carotid artery with the help of road map of the
innominate artery. AP, oblique and lateral views of the anterior cerebral
circulation were obtained . Subsequently, a 3D rotational images were
performed requiring post processing on an independent workstation under
concurrent physician supervision and used in the interpretation and reporting
of the procedure.
Catheter was then pulled back in the aorta and used to select the left common
carotid artery. AP, oblique and lateral views of the anterior cerebral
circulation were obtained. The catheter was then pulled back in the aorta and
the left subclavian artery was selected. AP road map imaging was undertaken
that showed a small left vertebral artery , due to this we elected not to
catheterized artery. T
He catheter was then pulled back in the aorta fully removed from the body.
The femoral artery sheath was left in situ, and the patient was sent to the
ICU to be removed there and to apply manual pressure. At the conclusion of
the procedure, there is no evidence of thromboembolic complication and the
patient was at his neurologic baseline.
COMPARISON: None.
FINDINGS:
Right common carotid artery- well-visualized and torturous. There is no
significant atherosclerosis or carotid stenosis. Right internal carotid
artery: The distal right ICA, proximal and distal MCA and ACA branches are
well-visualized, also cross-filling of the contralateral A2 through the
A-comm, a robust PCOM likely compatible with a fetal variant. Vessel caliber
smooth and tapering. Normal arterial, capillary, and venous phase . No
vascular abnormalities identified. Right external carotid artery: No early
shunting identified.
Right subclavian artery: Well-visualized very small right vertebral artery.
Left common carotid artery - well-visualized and torturous. There is no
significant atherosclerosis or carotid stenosis. Left internal carotid
artery: Distal left ICA, proximal and distal MCA branches are
well-visualized. Ipsilateral is a A1 A2 complex was not visualized as it was
filling from the contralateral side, a robust PCOM likely compatible with a
fetal variant.vessel caliber smooth and tapering. Normal arterial, capillary,
and venous phase . No vascular abnormalities identified .
Left external carotid artery: No early shunting identified.
Left subclavian artery: Well-visualized, very small left vertebral artery.
Due to the fact that the patient has a bilaterals large PCOM (likely
compatible with fetal variant), this could explain the very small bilateral
vertebral arteries . Subsequently we elected not to cannulate both as the
yield is low and the risk is high .
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 angiography (with limitations), did not show vascular
abnormality.
RECOMMENDATION(S):
1. MRI brain with gadolinium
2. Follow-up diagnostic cerebral angiogram in a week
|
19949313-RR-31 | 19,949,313 | 25,652,319 | RR | 31 | 2178-03-04 21:15:00 | 2178-03-05 11:27:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ woman with subarachnoid hemorrhage with cerebral
angiogram negative for aneurysm. Evaluate for intracranial mass.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ cerebral angiogram.
___ contrast head CTA.
___ contrast head MR.
___:
Study is moderately degraded by motion. There has been redistribution of
subarachnoid hemorrhage, with areas of bilateral parasagittal frontal sulcal
FLAIR hyperintensity and susceptibility artifact corresponding to hemorrhage
as previously seen on CT. Overall hemorrhage appears reduced compared to the
prior CT examination, given difference of modality. There has been
redistribution of hemorrhage, with previously noted ambient cistern hemorrhage
no longer visualized. Small 7 mm right parafalcine and 4 mm left parafalcine
bifrontal subdural hematomas with associated susceptibility artifact (11:17,
18), are grossly unchanged.
There is no evidence of new hemorrhage, masses, significant mass effect,
midline shift or infarction. There is mild prominence of the ventricles and
sulci suggestive involutional changes.. There is no abnormal enhancement
after contrast administration. The principal intracranial vascular flow voids
are preserved.
The visualized paranasal sinuses are grossly clear. There is opacification of
a single right mastoid air cell. The remainder of the mastoid air cells are
grossly clear. The orbits are grossly unremarkable.
IMPRESSION:
1. Study is moderately degraded by motion.
2. Interval decrease and redistribution of previously noted parasagittal
bifrontal subarachnoid hemorrhage.
3. Grossly unchanged subcentimeter bifrontal parafalcine subdural hematomas.
4. Within limits of study, no definite new hemorrhage.
5. Within limits of study, no definite infarct or enhancing mass.
6. Please note underlying mass is not excluded on the basis examination.
Recommend follow-up imaging to resolution.
RECOMMENDATION(S): Please note underlying mass is not excluded on the basis
examination. Recommend follow-up imaging to resolution.
|
19949313-RR-33 | 19,949,313 | 25,652,319 | RR | 33 | 2178-03-08 08:04:00 | 2178-03-14 09:26:00 | EXAMINATION: Right common carotid artery angiogram.
Left common carotid artery angiogram.
Right common femoral artery angiogram.
INDICATION: ___ year old woman with known SAH. // Please evaluate s/p SAH and
previous angio negative.
TECHNIQUE: Anesthesia: Conscious sedation with local analgesia. Please see
separate records for medications and dosing.
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 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 5 ___ 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 right common carotid artery with the help of road map of the
innominate artery. AP, oblique and lateral views of the anterior cerebral
circulation were obtained . Subsequently, a 3D rotational images were
performed requiring post processing on an independent workstation under
concurrent physician supervision and used in the interpretation and reporting
of the procedure.
Catheter was then pulled back in the aorta and used to select the left common
carotid artery. AP, oblique and lateral views of the anterior cerebral
circulation were obtained. The catheter was then pulled back in the aorta and
the left subclavian artery was selected. AP road map imaging was undertaken
that showed a small left vertebral artery , due to this we elected not to
catheterized artery. The catheter was then pulled back in the aorta fully
removed from the body. Right common femoral artery roadmap was done, which
confirmed good size vessels for closure device, subsequently a 6 ___
Angio-Seal was deployed. At the conclusion of the procedure, there is no
evidence of thromboembolic complication and the patient was at his neurologic
baseline.
___
FINDINGS:
Right common carotid artery- well-visualized and torturous. There is no
significant atherosclerosis or carotid stenosis.
Right internal carotid artery: The distal right ICA, proximal and distal MCA
and ACA branches are well-visualized, also cross-filling of the contralateral
A2 through the A-comm which has a mild bulge likely compatible with the
takeoff of perforates , a robust PCOM likely compatible with a fetal variant.
Vessel caliber smooth and tapering. Normal arterial, capillary, and venous
phase . No vascular abnormalities identified.
Right external carotid artery: No early shunting identified.
Left internal carotid artery: Distal left ICA, proximal and distal MCA
branches are well-visualized. Ipsilateral is a A1 A2 complex was not
visualized as it was filling from the contralateral side, a robust PCOM likely
compatible with a fetal variant.vessel caliber smooth and tapering. Normal
arterial, capillary, and venous phase . No vascular abnormalities identified .
Left external carotid artery: No early shunting identified.
Due to the fact that the patient has a bilaterals large PCOM (likely
compatible with fetal variant), this could explain the very small bilateral
vertebral arteries . Subsequently we elected not to cannulate both as the
yield is low and the risk is high .
IMPRESSION:
Diagnostic cerebral angiography (with limitations), did not show vascular
abnormality. Small bulge at the A-comm.
RECOMMENDATION(S): Follow-up CT angio of the head in ___ weeks.
|
19949313-RR-37 | 19,949,313 | 29,434,086 | RR | 37 | 2180-02-16 16:05:00 | 2180-02-16 18:20:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old woman with abdominal pain, nausea, elevated WBC//
?infection
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 4.0 s, 1.0 cm; CTDIvol = 9.3 mGy (Body) DLP = 9.3
mGy-cm.
3) Spiral Acquisition 14.3 s, 49.2 cm; CTDIvol = 8.7 mGy (Body) DLP = 413.1
mGy-cm.
Total DLP (Body) = 436 mGy-cm.
COMPARISON: No relevant comparison is identified.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation without evidence of focal
lesions. Pancreatic duct measures at the upper limits of normal. 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: Small hiatal hernia is incidentally noted. The stomach is
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. There appears to be circumferential wall
thickening, mural edema, and mucosal hyperemia (06:38) involving the
rectosigmoid junction. Proximal to this level, the sigmoid and descending
colon are decompressed, but there also appears to be inflammation with wall
thickening and mucosal hyperemia involving these segments as well to the level
of the mid descending colon. The appendix is not visualized. Remainder of
the colon is unremarkable.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Visualized 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. Mild-to-moderate
atherosclerotic disease is noted.
BONES: Patient is status post placement of 2 lag screws across the right
sacroiliac joint without evidence hardware complication. There is moderate
levoscoliosis of the lower lumbar spine with apex at L3. There is rightward,
lateral subluxation of L2 on L3 and L1 on L2. remote right inferior pubic
ramus fracture is noted.
SOFT TISSUES: Small umbilical hernia containing fat is noted.
IMPRESSION:
Wall thickening, mucosal hyperemia, and edema from the mid descending colon to
the rectosigmoid junction consistent with colitis. Differential includes
ischemic, inflammatory, or infectious etiologies.
|
19949666-RR-10 | 19,949,666 | 24,428,051 | RR | 10 | 2119-10-18 12:56:00 | 2119-10-18 14:08:00 | INDICATION: ___ with recent CABG p/w nausea and abd distension // assess for
ileus v.s obstructive pattern
TECHNIQUE: Portable frontal supine and upright radiographs of the abdomen
were obtained.
COMPARISON: None available
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is no
free intraperitoneal air.
A left total hip arthroplasty is partially visualized with no evidence of
complication.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Left pleural effusion is better seen on same day chest x-ray.
IMPRESSION:
No evidence of obstruction
|
Subsets and Splits