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19949666-RR-9 | 19,949,666 | 24,428,051 | RR | 9 | 2119-10-18 12:56:00 | 2119-10-18 14:15:00 | INDICATION: History: ___ with recent CABG and AVR p/w chest pain and dyspnea
// r/o pna
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
There is stable enlargement of the cardiac silhouette. There has been
interval removal of a right internal jugular central venous catheter. There
are unchanged pleural effusions greater on the left than the right. Left
lower lobe opacity is similar in appearance to prior. Median sternotomy wires
are intact. No pulmonary edema or pneumothorax.
IMPRESSION:
Stable appearance of the chest from ___ with persistent pleural
effusions and left lower lobe opacification. While this likely reflects
combination of atelectasis and effusion, superimposed infection is possible.
|
19950100-RR-15 | 19,950,100 | 22,727,730 | RR | 15 | 2184-08-31 19:21:00 | 2184-08-31 19:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever, cough dyspnea eval pna// History: ___
with fever, cough dyspnea eval pna
TECHNIQUE: Upright AP view of the chest
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19950146-RR-18 | 19,950,146 | 20,459,046 | RR | 18 | 2182-02-07 18:47:00 | 2182-02-08 01:06:00 | INDICATION: +PO contrast; History: ___ with recent colectomy with complicated
post op course. Here with stool from surgical site. febrile and
leukocytosis+PO contrast // Abscess?
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 administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
2) Spiral Acquisition 5.4 s, 58.5 cm; CTDIvol = 16.6 mGy (Body) DLP = 972.9
mGy-cm.
Total DLP (Body) = 981 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Limited view of the lower lungs shows mild subsegmental
atelectasis. No pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A large left parapelvic cyst is unchanged There is no evidence of focal renal
lesions or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is partially collapsed. Small bowel loops and
diffusely fluid-filled and mildly dilated, similar the prior examination.
Patient is status post right hemicolectomy with a patent anastomosis. Small
bowel and large bowel loops enhance normally. The colon contains a moderate
amount of predominantly fluid density stool. There is extensive mesentery
edema and a small amount of free associated with the bowel loops.
PELVIS: Air in the bladder relates to catheterization. There is no free fluid
in the pelvis.
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: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is extensive subcutaneous gas just deep to the skin
staples. Suggest likely does not appear to grossly communicate with the
abdominal cavity. Fat stranding along callus gas in the anterior abdominal
musculature is from recent surgery.
IMPRESSION:
1. Diffusely fluid-filled and mildly dilated loops of small bowel and
stool-filled colon without a transition point, grossly unchanged compared to
the prior examination likely represents adynamic ileus.
2. Diffuse extensive mesenteric edema and a small amount of free fluid next
to the bowel loops is also unchanged.
3. Increased size of a large gas filled pocket immediately deep to the skin
staples and superficial to the abdominal fascia.
|
19950146-RR-19 | 19,950,146 | 20,459,046 | RR | 19 | 2182-02-08 16:41:00 | 2182-02-08 17:26:00 | EXAMINATION: DX CHEST SGL VIEW PICC LINE PLACEMENT
INDICATION: ___ year old man with picc // r dl power picc 49cm ___ ___
Contact name: ___: ___ r dl power picc 49cm ___ ___
IMPRESSION:
In comparison with the study of ___, there has been placement of a right
subclavian PICC line that extends well into the jugular system. The a
previous right IJ catheter has been removed.
Nasogastric tube extends at least to the upper stomach, where it crosses the
lower margin of the image.
Little change in the appearance of the heart and lungs.
|
19950146-RR-20 | 19,950,146 | 20,459,046 | RR | 20 | 2182-02-09 11:40:00 | 2182-02-09 13:13:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new picc line // new right picc Contact
name: ___: ___ new right picc
IMPRESSION:
In comparison with the study of ___, the right subclavian PICC line again
extends well into the right IJ venous system. Otherwise little change.
|
19950146-RR-21 | 19,950,146 | 20,459,046 | RR | 21 | 2182-02-09 12:31:00 | 2182-02-09 17:47:00 | INDICATION: ___ with carcinoid cecal mass s/p lap-assisted R colectomy on
___ c/b abdominal compartment syndrome s/p multiple ex-laps and washouts with
delayed abdominal closure ___, now with enterocutaneous fistula s/p wash-out,
wound vac ___. requiring long term TPN and PICC line s/p failed bedside
placement with line going into IJ // please place PICC
COMPARISON: Chest radiograph ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure. The
attending, Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings
ANESTHESIA: None.
MEDICATIONS: None.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1.5 min, 0.1 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Using sterile technique, the existing PICC was aspirated
and flushed. The PICC was retracted to the subclavian vein. A Nitinol wire
was introduced into the superior vena cava followed by the PICC. The wire was
removed. The PICC was aspirated and flushed. Sterile dressing was applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
Repositioning of the existing right PICC from the right IJ to the distal SVC.
IMPRESSION:
Repositioning of the existing right PICC from the right IJ to the distal SVC.
|
19950146-RR-22 | 19,950,146 | 20,459,046 | RR | 22 | 2182-02-09 20:39:00 | 2182-02-10 09:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p ETT // ETT positioning
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___ at 12:08
FINDINGS:
Endotracheal tube terminates approximately 5.8 cm above the level of the
carina. A right-sided PICC terminates at the cavoatrial junction without
evidence of pneumothorax. There are low lung volumes. No new focal
consolidation is seen. There is no large pleural effusion. Prominence of the
right hilum is grossly stable.
IMPRESSION:
Endotracheal tube terminates 5.8 cm above the level of the carina.
Right-sided PICC now terminates at the cavoatrial junction. No evidence of
pneumothorax.
|
19950146-RR-23 | 19,950,146 | 20,459,046 | RR | 23 | 2182-02-10 08:27:00 | 2182-02-10 12:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with carcinoid cecal mass s/p lap-assisted R colectomy on
___ c/b abdominal compartment syndrome s/p multiple ex-laps and washouts with
delayed abdominal closure ___, now with enterocutaneous fistula s/p wash-out,
wound vac ___ w/ delirium // interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Right-sided PICC terminates in the low SVC without evidence of pneumothorax.
Subtle increase in right base opacity is seen which may be due to atelectasis
or aspiration, but evolving infection is not excluded. Attention at
follow-up. No large pleural effusion or pneumothorax. The left lung is
essentially clear.
|
19950146-RR-24 | 19,950,146 | 20,459,046 | RR | 24 | 2182-02-10 09:43:00 | 2182-02-10 10:20:00 | EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ with carcinoid cecal mass s/p lap-assisted R colectomy on
___ c/b abdominal compartment syndrome s/p multiple ex-laps and washouts with
delayed abdominal closure ___, now with enterocutaneous fistula s/p wash-out,
wound vac ___ w/ altered mental status, agitated delirium // interval change
to explain altered mental status
TECHNIQUE: Axial images of the head were obtained without contrast .
DOSE: Total DLP (Head) = 954 mGy-cm.
COMPARISON: None
FINDINGS:
There is no evidence of acute hemorrhage mass effect midline shift or
hydrocephalus. Gray-white matter differentiation is maintained.
The visualized paranasal sinuses are clear. No skull fracture is seen.
IMPRESSION:
No acute intracranial abnormalities are identified.
|
19950146-RR-25 | 19,950,146 | 20,459,046 | RR | 25 | 2182-02-11 05:51:00 | 2182-02-11 09:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with EC fistula, delirium // interval change
IMPRESSION:
In comparison to ___ chest radiograph, cardiomegaly is now
accompanied by pulmonary vascular congestion, minimal interstitial edema and
and increasing small to moderate right pleural effusion. No other
|
19950146-RR-26 | 19,950,146 | 20,459,046 | RR | 26 | 2182-02-11 11:41:00 | 2182-02-11 14:49:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: Enterocutaneous fistula with concern for worsening 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 administered through a drainage catheter inserted through
the enterocutaneous fistula.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 4.9 s, 53.9 cm; CTDIvol = 16.9 mGy (Body) DLP = 911.4
mGy-cm.
Total DLP (Body) = 922 mGy-cm.
COMPARISON: CT abdomen and pelvis ___ and CTA torso ___.
FINDINGS:
LOWER CHEST: Heart size is normal without significant pericardial fluid.
There are small to moderate right greater than left pleural effusions with
adjacent compressive bibasilar atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a 6.1 x 4.3 cm simple left interpolar parapelvic cyst. There is no
evidence of solid focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Postsurgical change from right
hemicolectomy with primary anastomosis. No evidence of obstruction at the
anastomotic margin. A percutaneous drain extends through the known
enterocutaneous fistula which appears to arise at the ileocolic anastomotic
junction with tip of the drain terminating at this level. Injected enteric
contrast opacifies the residual large bowel without evidence of new leak.
Dense material is seen within the central right mesenteric and left anterior
mesenteric (2:39, 46) which appears unchanged in configuration as compared to
the ___ examination likely representing extravasation of contrast at this
time. Scattered loops of small bowel appear thickened (02:52) as well as
thickening of some of the residual large bowel, likely inflammatory. .
PELVIS: Bladder is decompressed around a Foley catheter. There is no free
fluid in the pelvis. Rectal tube is in place.
REPRODUCTIVE ORGANS: Prostate is unremarkable.
LYMPH NODES: Scattered mesenteric and retroperitoneal lymph nodes are mildly
prominent but not enlarged by CT size criteria. There is no pelvic or
inguinal lymphadenopathy. There is a small amount of free abdominal fluid
with fat stranding of the majority of the mesenteric. There is no organizing
fluid collection.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is a postsurgical open abdomen with a percutaneous
abdominal drain in place.
IMPRESSION:
1. A percutaneous drainage catheter placed through the known enterocutaneous
fistula appears to connect with the bowel at the site of the ileocolonic
anastomosis with injected enteric contrast opacifying the residual large
bowel, without evidence of leak on today's exam. Dense material seen
scattered throughout the mesentery, appears unchanged in configuration
compared to the prior exam, likely related to leak at that time.
2. Persistent diffuse inflammatory stranding of the mesenteric fat as well as
wall thickening of loops of small and large bowel. Small to moderate volume
ascites without organizing or drainable fluid collection.
3. Small to moderate right greater than left pleural effusions.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:41 ___, 10 minutes after
discovery of the findings.
|
19950146-RR-27 | 19,950,146 | 20,459,046 | RR | 27 | 2182-02-12 05:44:00 | 2182-02-12 09:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with carcinoid cecal mass s/p lap-assisted R colectomy on
___ c/b abdominal compartment syndrome s/p multiple ex-laps and washouts with
delayed abdominal closure ___, now with enterocutaneous fistula s/p multiple
washout and wound vac changes with possible budding PNA // interval change
interval change
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Cardiac silhouette remains enlarged and there is mild elevation of pulmonary
venous pressure. Small right pleural effusion is again seen with some basilar
atelectatic changes.
|
19950352-RR-18 | 19,950,352 | 24,287,165 | RR | 18 | 2142-04-16 17:32:00 | 2142-04-16 18:26:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with small cell lung Ca, Hx ventral hernia repair and prior
bowel obstruction, p/w constipation, assess location of stool burden and
assess for obstruction,masses, etc.NO_PO contrast// History: ___ with small
cell lung Ca, Hx ventral hernia repair and prior bowel obstruction, p/w
constipation, assess location of stool burden and assess for
obstruction,masses, etc.
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: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 9.6 mGy (Body) DLP = 4.8
mGy-cm.
2) Spiral Acquisition 6.1 s, 48.1 cm; CTDIvol = 12.5 mGy (Body) DLP = 598.7
mGy-cm.
Total DLP (Body) = 604 mGy-cm.
COMPARISON: ___ F FDG PET-CT from ___.
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
biliary dilatation. The gallbladder is not visualized. The CBD is dilated to
1.2 cm and tapers down smoothly at the level of the ampulla.
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.
Bilateral extrarenal pelvises are noted. A 2 cm simple renal cyst arising
from the lower pole of the left kidney is noted. Additional hypodensities in
the kidneys bilaterally too small to characterize but statistically cysts.
Punctate nonobstructing right renal calculus is noted. Alternatively, this
could represent a vascular calcification. Cortical thinning compatible scar
noted at the upper pole the right kidney. There is no evidence of focal
suspicious renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable besides a small hiatal hernia.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. No bowel obstruction. Oral contrast seen up to the distal
transverse colon, distal to the a ventral hernia containing loops of
nonobstructed transverse colon. There are two additional small bowel
containing hernias inferior to this hernia without secondary obstruction.
Large amount of stool is noted in the distal transverse colon, descending
colon, sigmoid and rectum. Colonic diverticulosis without diverticulitis.
The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
LYMPH NODES/MESENTERY/OMENTUM: No abdominal or pelvic lymphadenopathy. Again
seen 2.3 cm omental infarct is noted in the right lower quadrant, similar to
___.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Ventral hernia containing loops of the small bowel and
transverse colon without causing bowel obstruction.
IMPRESSION:
1. Three nonobstructing bowel containing hernias along the anterior abdominal
wall, the superior most hernia contains transverse colon. Two more inferior
midline abdominal hernias contain nonobstructed small bowel.
2. Large amount of stool from the distal transverse colon to the rectum. No
obstruction.
3. Diverticulosis without diverticulitis.
|
19950352-RR-20 | 19,950,352 | 27,931,909 | RR | 20 | 2142-05-07 17:49:00 | 2142-05-07 18:00:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with sob// pna
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___ and head CT ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are unchanged with
dense atherosclerotic calcifications again noted at the aortic knob. The
pulmonary vasculature is normal. Ill-defined focal opacification in the right
upper lobe corresponds to the the patient's known malignancy, grossly
decreased in size and extent when compared to the scout image from the PET-CT.
Remainder of the lungs are clear. No pleural effusion or pneumothorax is
seen. There are no acute osseous abnormalities.
IMPRESSION:
No radiographic findings to suggest pneumonia. Interval decrease in size of
right upper lobe lung mass compatible with known malignancy.
|
19950400-RR-15 | 19,950,400 | 28,725,883 | RR | 15 | 2167-08-12 14:32:00 | 2167-08-12 16:00:00 | INDICATION: Chest pain and shortness of breath.
COMPARISON: Chest fluroscopy ___.
FINDINGS: PA and lateral images of the chest were obtained. The patient is
status post median sternotomy with multiple fractured wires, unchanged. Clips
are located in the left thorax. Stable enlarged cardiac silhouette. The lung
fields are clear without focal consolidation or pulmonary edema. Pleural
thickening located in the left lateral pleura, especially inferiorly. There
are no adjacent changes in the ribs. There are no bony abdnormalities. There
is no free air below the right hemidiaphragm.
IMPRESSION: Pleural thickening of the left lateral pleura could represent a
loculated effusion or prominent extrapleural fat. Stable enlarged cardiac
silhouette.
|
19950425-RR-10 | 19,950,425 | 25,448,746 | RR | 10 | 2145-12-25 21:26:00 | 2145-12-26 00:22:00 | INDICATION: ___ man with right-sided PICC line, now with clinical
concern for DVT.
COMPARISON: None.
FINDINGS: Grayscale and Doppler sonograms of right internal jugular,
subclavian, axillary, brachial, and basilic veins were performed. There is
near-complete occlusive thrombus in the right basilic, brachial, axillary and
subclavian veins surrounding the PICC line. Thrombus is also seen in the right
basilic vein.
IMPRESSION: Occlusive DVT involving the right subclavian, axillary, and
brachial veins.
|
19950425-RR-11 | 19,950,425 | 25,448,746 | RR | 11 | 2145-12-26 15:46:00 | 2145-12-26 19:42:00 | INDICATION: ___ man with history of right upper extremity DVT from
previous PICC placement, new PICC in left arm needed for antibiotic treatment.
Pacemaker present on the left side. Please reposition PICC in left arm.
PROCEDURE: PICC line exchange.
RADIOLOGISTS: Dr. ___ (resident), and Dr. ___
(attending) performed the procedure. Dr. ___, the attending, was
present throughout the procedure.
TECHNIQUE: Using sterile technique and local anesthesia, a 0.018 nitinol
guidewire was advanced through the existing left arm PICC line. The existing
PICC line was noted to be coiled in the region overlying the pacemaker.
Additional 0.018 Glidewire was introduced through the second lumen of the PICC
line and catheter was successfully unfurled. 0.018 nitinol wire was advanced
into the SVC. The old PICC line was then removed and a peel-away sheath was
placed over the guidewire. The new PICC line was unable to be advanced past
the mid subclavian vein due to stenosis demonstrated by injection of 5 cc of
contrast material. Thus, a 30-cm PICC line was placed through the peel-away
sheath with its tip positioned in the subclavian vein under fluoroscopic
guidance as a midline. Position of the catheter was confirmed by fluoroscopic
spot film of the chest. The peel-away sheath and guidewires were then
removed. The catheter was secured to the skin, flushed, and a sterile
dressing was applied. The patient tolerated the procedure well. There were no
immediate complications.
IMPRESSION: Fluoroscopically guided PICC line exchange for a new 30-cm
midline. This line terminates in the subclavian vein. Final internal length
is 30 cm, with its tip positioned in the subclavian vein. The line is ready
to use.
|
19950555-RR-27 | 19,950,555 | 20,460,004 | RR | 27 | 2153-07-21 20:59:00 | 2153-07-21 21:17:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: Chest pain and shortness of breath
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
The patient is status post median sternotomy and CABG. Heart size is normal.
An epicardial lead is noted on the lateral view. Mediastinal and hilar
contours are unremarkable. Lung volumes are somewhat low with minimal
atelectasis noted within the left lung base. No focal consolidation, pleural
effusion or pneumothorax is present. The pulmonary vasculature is normal.
Multilevel degenerative changes are seen in the thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19950628-RR-14 | 19,950,628 | 26,188,891 | RR | 14 | 2120-09-12 15:26:00 | 2120-09-12 17:04:00 | EXAMINATION: US MSK SOFT TISSUE
INDICATION: ___ female recently started on steroids for severe joint
pain, who presents for worsening pain.// BILATERAL hands ? of Any subcutaneous
edema
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the enhance.
COMPARISON: Radiograph dated ___
FINDINGS:
Limited sonographic evaluation of soft tissues of both hands does not
demonstrate any evidence of generalized subcutaneous edema.
Joints were not evaluated on this limited study.
IMPRESSION:
No evidence of generalized subcutaneous edema in the hands.
|
19950628-RR-15 | 19,950,628 | 26,188,891 | RR | 15 | 2120-09-12 18:34:00 | 2120-09-12 18:57:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman recently on steroids for severe jointpain, who
presents for worsening pain.// Question for sarcoid
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: None.
IMPRESSION:
There is some increased diffuse haziness of the lung fields. Heart size is
top-normal. There is some prominence of the lower hilar contours, with
increased density on lateral view. Further characterization with contrast
enhanced chest CT would be helpful. Otherwise no focal consolidation is seen.
There is no large effusion pneumothorax. There is no acute osseous
abnormality.
|
19950628-RR-16 | 19,950,628 | 26,188,891 | RR | 16 | 2120-09-13 15:01:00 | 2120-09-13 16:20:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ female with symmetric polyarthralgia of unclear
etiology with acute worsening in the last week unresponsive to steroids.// F/u
x-ray with diffuse haziness
TECHNIQUE: Axial multidetector CT images were acquired through the chest
after the administration of IV contrast. Coronal and sagittal reformats were
provided.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.2 s, 35.2 cm; CTDIvol = 12.9 mGy (Body) DLP = 452.1
mGy-cm.
Total DLP (Body) = 452 mGy-cm.
COMPARISON: Chest radiograph ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is
unremarkable. There is no supraclavicular lymphadenopathy. No axillary
lymphadenopathy. There are masslike areas in the right breast (e.g. Through
2:90, 65).
UPPER ABDOMEN: Limited view of the upper abdomen is notable for subcentimeter
hyperdensity in the upper pole of the right kidney which is too small to
characterize, but likely represents a simple cyst.
MEDIASTINUM: No mediastinal lymphadenopathy.
HILA: No hilar lymphadenopathy.
HEART and PERICARDIUM: Heart is of normal size. There are no significant
coronary artery calcifications. No pericardial effusion.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: There are areas of mild subsegmental atelectasis in the lower
lobes bilaterally. Subtle area of ground-glass opacification in the right
middle lobe (e.g. 302:130) is may represent early pneumonia. Diffuse
haziness on chest radiograph likely with secondary to overpenetration given
patient body habitus.
2. AIRWAYS: Airways are patent to subsegmental levels bilaterally.
3. VESSELS: Thoracic aorta and main pulmonary artery are normal caliber. No
significant atherosclerotic calcification of the thoracic aorta. No large
central pulmonary embolism on this non tailored exam.
CHEST CAGE: No worrisome osseous lesions or acute fractures.
IMPRESSION:
1. Subtle ground-glass opacity in the right middle lobe may represent early
pneumonia. Lungs are otherwise clear except for mild bibasilar atelectasis.
2. No mediastinal or hilar lymphadenopathy.
3. Mass like areas in the right breast should be further evaluated with
mammography if not recently performed.
|
19950864-RR-68 | 19,950,864 | 22,572,134 | RR | 68 | 2130-07-13 15:03:00 | 2130-07-13 15:58:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ man with chest pain and shortness of breath.
Evaluate for pneumonia.
TECHNIQUE: Chest AP upright and lateral.
COMPARISON: ___.
FINDINGS:
Parenchymal abnormality including emphysema with mild interstitial disease
appears stable. There is mild pulmonary vascular congestion and interstitial
edema. Scarring at the left lung base also unchanged. No pleural effusion or
pneumothorax. Mild cardiomegaly is noted. The aortic knob is calcified.
IMPRESSION:
Emphysema with mild congestion and edema. Bibasal atelectasis, mild
cardiomegaly.
|
19950864-RR-69 | 19,950,864 | 22,572,134 | RR | 69 | 2130-07-13 17:48:00 | 2130-07-13 19:07:00 | INDICATION: ___ man with chest pain and shortness of breath.
Evaluate for pulmonary emboli and abdominal aortic aneurysm.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 909 mGy-cm.
COMPARISON: CTA chest ___. CT colonography from ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Thin linear filling defects in the lobar pulmonary
arteries supplying the right middle and right lower lobe bronchus. Occlusive
thrombus is noted within the right middle lobe and left upper lobe segmental
branches. The thoracic aorta is normal in caliber without evidence of
dissection or intramural hematoma. The heart size is normal. There is no
pericardial effusion. There are coronary artery calcifications. There is no
evidence of right heart strain.
AXILLA, HILA, AND MEDIASTINUM: Bilateral axillary lymph nodes measure up to
10 mm in the short axis on the left and up to 9 mm on the right, not
significantly changed since ___. . No mediastinal, or hilar lymphadenopathy
is present. No mediastinal mass.
PLEURAL SPACES: There is scattered areas of pleural thickening. No pleural
effusion or pneumothorax.
LUNGS/AIRWAYS: There is severe centrilobular emphysema and multiple leads,
most marked in the left lower lobe. There is bilateral lower lobe scarring
stable back to ___. A left perifissural nodule measures 5 mm (series 2,
image 42), unchanged since ___. The airways are patent to the level of
the segmental bronchi bilaterally.
BASE OF NECK: Multinodular thyroid gland with the largest nodule located in
the right lobe measuring 2 x 1.4 cm.
ABDOMEN: Based on the arterial phase of contrast, the following observations
are made:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are multiple bilateral renal hypodensities which are too small to
further characterize that statistically most likely represents simple cysts.
In the interpolar region of the left kidney is a simple cyst measures 1.4 x
1.5 cm. There is no evidence of concerning focal renal lesions or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal. There is no free intraperitoneal fluid or
free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Accessory left renal artery is noted. Major branches are patent.
Incidentally noted is a left gastric artery arising directly from the aorta.
There is no dissection.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. There is marked multilevel degenerative changes in the lumbar
spine including intervertebral end plate sclerosis and Schmorl's node
formation. There is diastases of the rectus abdominus at and above the
umbilicus with focal herniation of nonobstructed small bowel.
IMPRESSION:
1. Pulmonary emboli in the lobar and distal pulmonary artery supplying the
right middle and right lower lobes, and left upper lobe segmental pulmonary
artery. No evidence of right heart strain.
2. No acute intra-abdominal process.
3. Multiple thyroid nodules, the largest of which measures 2 cm on the right.
RECOMMENDATION(S): Thyroid ultrasound suggested on an outpatient basis.
|
19950864-RR-71 | 19,950,864 | 28,064,275 | RR | 71 | 2130-12-20 01:34:00 | 2130-12-20 01:51:00 | INDICATION: ___ male with confusion. Evaluate for infectious
process.
TECHNIQUE: PA and lateral chest radiographs were obtained.
COMPARISON: Chest radiograph from ___.
FINDINGS:
There is mild interstitial edema, and the heart is normal in size. A left
basilar opacity may reflect atelectasis versus pneumonia. There is no pleural
effusion or pneumothorax.
IMPRESSION:
Mild interstitial edema. Left basilar opacity may reflect atelectasis though
infection can be considered in the appropriate clinical setting.
|
19951068-RR-20 | 19,951,068 | 23,671,976 | RR | 20 | 2113-02-27 10:48:00 | 2113-02-27 11:46:00 | INDICATION: Cycle a struck
TECHNIQUE: AP supine portable view of the chest.
COMPARISON: None.
FINDINGS:
Patchy opacities in the right mid lung region are worrisome for pulmonary
contusion. Right-sided rib fractures are seen involving at least the lateral
right fifth and sixth ribs and possibly the right fourth and seventh ribs. No
evidence of pneumothorax is seen. The left lung is grossly clear. There is
no large pleural effusion. The cardiac and mediastinal silhouettes are
grossly unremarkable. Comminuted right mid to distal clavicular fracture is
seen.
IMPRESSION:
Patchy opacities in the right mid lung are worrisome for pulmonary contusion.
Right-sided rib fractures involving at least the lateral right fifth and sixth
ribs and possibly the right fourth and seventh ribs. No evidence of
pneumothorax seen.
Comminuted right clavicular fracture.
|
19951068-RR-21 | 19,951,068 | 23,671,976 | RR | 21 | 2113-02-28 05:16:00 | 2113-03-01 08:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with rib fractures, pulm contusion // eval for
pulm contusion/ptx right mid clavicle is set unchanged since the later of
2 chest radiographs on ___.
IMPRESSION:
COMPARED TO CHEST RADIOGRAPHS ___.
Comminuted displaced fracture Pleural thickening adjacent to fractures of the
right middle ribs is stable. There is no pleural effusion. Right apical
pneumothorax is tiny.
Axillary component of right lung contusion has improved, but there is greater
consolidation at the right lung base medially. This is a potentially a site
of aspiration pneumonia and should be followed. Mild interstitial abnormality
is of uncertain chronicity. It could be mild pulmonary edema or pre existing
condition.
Normal cardiomediastinal and hilar silhouettes.
|
19951068-RR-22 | 19,951,068 | 23,671,976 | RR | 22 | 2113-02-28 09:33:00 | 2113-02-28 10:40:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with SAH // eval for extent of SAH
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence: 1) Sequenced Acquisition 4.2 s, 14.1 cm;
CTDIvol = 52.7 mGy (Head) DLP = 742.0 mGy-cm. Total DLP (Head) = 742 mGy-cm.
COMPARISON: Outside reference CT head from ___.
FINDINGS:
There is interval expected evolution of the subarachnoid hemorrhage seen on ___. There is no new hemorrhage. There is interval improvement in
appearance of the right posterior scalp hematoma. There is no edema, shift of
normally midline structures, or CT evidence of acute major vascular
territorial infarction. Ventricles and sulci are normal in overall size and
configuration.
The imaged paranasal sinuses are clear. Mastoid air cells and middle ear
cavities are well aerated. The bony calvarium is intact. There is a metallic
clip lateral to the orbital rim of unknown etiology but external to the
patient, possibly a ring.
IMPRESSION:
1. Expected evolution of the subarachnoid hemorrhage seen on ___ and
interval improvement in the right posterior scalp hematoma without evidence of
new hemorrhage.
|
19951068-RR-24 | 19,951,068 | 23,671,976 | RR | 24 | 2113-02-28 11:47:00 | 2113-02-28 14:59:00 | INDICATION: ___ year old man s/p fall from bike // ? acute thoracic/abdominal
pathology
TECHNIQUE: This is an outside examination from ___ was submitted
for a second freeze interpretation.
Single phase split bolus contrast: MDCT axial images were acquired through the
CHEST, abdomen and pelvis following intravenous contrast administration with
split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: This is an outside examination and no dose information is available.
COMPARISON: None.
FINDINGS:
CHEST: There is no axillary, mediastinal or hilar lymphadenopathy. There is
no fat stranding in the mediastinum. The mediastinal vessels are intact.
There are ground-glass opacities in the right upper lobe. Most prominently
seen on series 3, ___ 20 and 24. Additional areas of ground-glass opacities
are identified in the right lower lobe such as on series 3, ___ 28 there are
no pleural effusions. No pericardial effusion is identified
On bone windows there is a commuted fracture of the right clavicle and the
fifth right rib laterally on series 3, ___ 26. Fractures of the sixth -___
rib are also noted.
ABDOMEN: The evaluation of the abdomen is somewhat limited due to artifact
from overlying arm
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of hydronephrosis. There is a 2.6 x 2.6 cm hypodense
lesion in the right kidney at midpole. This measures 30 ___. However artifact
from the overlying arms is noted and and may falsely elevate this measurement.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. A duplicated IVC is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Comminuted fracture of the right clavicle
2. Fractures of the fifth through ninth right ribs
3. Lung contusions in the right upper and right lower lobe
4. No evidence for traumatic injury in the abdomen and pelvis
5. A 2.6 cm right renal lesion is indeterminate but likely represents a
complex cyst. Further evaluation with ultrasound is recommended
RECOMMENDATION(S): Renal ultrasound for evaluation of indeterminate lesion
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:57 ___, 15 minutes after
discovery of the findings.
|
19951068-RR-25 | 19,951,068 | 23,671,976 | RR | 25 | 2113-02-28 11:53:00 | 2113-02-28 14:55:00 | EXAMINATION: SECOND OPINION CT NEURO PSO1 CT
INDICATION: ___ year old man s/p fall from bike // ? acute intracranial
pathology
TECHNIQUE: Contiguous axial images of the brain were obtained after the
uneventful administration of Omnipaque intravenous contrast. Thin
bone-algorithm reconstructed images and coronal and sagittal reformatted
images were then produced.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: None.
FINDINGS:
There is a small subarachnoid hemorrhage in the left frontal lobe, seen
layering along the frontotemporal gyri. There is a large right posterior
scalp hematoma with subcutaneous emphysema. No evidence of fracture, acute
large territorial infarction, or mass. The ventricles and sulci are normal in
size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
There is a metallic foreign body on the lateral aspect of the left orbital
rim, external to the patient, and compatible with a ring.
IMPRESSION:
1. Small subarachnoid hemorrhage in the left frontal lobe from contrecoup
injury, as evidenced by a large right posterior scalp hematoma with
subcutaneous emphysema. No evidence of fracture or large territorial
infarction.
|
19951068-RR-26 | 19,951,068 | 23,671,976 | RR | 26 | 2113-02-28 11:58:00 | 2113-02-28 15:03:00 | EXAMINATION: SECOND OPINION CT NEURO
INDICATION: ___ year old man s/p fall from bike // ? fracture or dislocation
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations.
COMPARISON: None
FINDINGS:
There is no acute fracture or malalignment in the cervical spine. No
significant degenerative disease. A small 3 mm corticated well circumscribed
calcification is seen at the tip of the dens, of doubtful clinical
significance, possibly from old injury.
There is no prevertebral edema. The aerodigestive tract appears patent. Lung
apices are clear. Thyroid gland appears normal. The visualized portions of
the brain are grossly unremarkable. The known right posterior scalp hematoma
is not seen on this exam.
IMPRESSION:
No fracture or traumatic malalignment.
|
19951068-RR-27 | 19,951,068 | 23,671,976 | RR | 27 | 2113-03-01 17:06:00 | 2113-03-02 01:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with multiple rib fractures s/p bike collision,
pls assess lung volumes, etc. // pls eval interval change
IMPRESSION:
Since the prior radiograph of 1 day earlier, a tiny right apical pneumothorax
has slightly decreased in size. Cardiomediastinal contours are normal.
Patchy bibasilar opacities may reflect atelectasis or aspiration. Acute right
clavicular fracture is again demonstrated.
|
19951079-RR-17 | 19,951,079 | 25,030,566 | RR | 17 | 2165-11-26 11:36:00 | 2165-11-26 14:17:00 | REASON FOR EXAMINATION: Preoperative assessment.
Portable AP radiograph of the chest was reviewed with no prior studies
available for comparison.
Heart size is normal. Mediastinum is normal. Lungs are essentially clear
except for minimal atelectasis at the left lung base. There is no pleural
effusion or pneumothorax.
|
19951079-RR-18 | 19,951,079 | 25,030,566 | RR | 18 | 2165-11-26 13:36:00 | 2165-11-26 17:00:00 | EXAMINATION: CT chest, abdomen, and pelvis.
HISTORY: ___ male with new diagnosis of glioblastoma. Request to
evaluate for metastatic disease.
COMPARISON: No previous chest or abdominal imaging is available for review.
TECHNIQUE: Multidetector CT-acquired axial images were obtained from the lung
apices to the level of the lesser trochanters following administration of oral
and intravenous contrast. Noncontrast and post-intravenous contrast images
were obtained through the abdomen. Coronal and sagittal reformats were
generated and reviewed. The patient received 130 cc of Omnipaque.
FINDINGS:
CT OF THORAX:
The thyroid gland is normal in size and appearance. There are no
pathologically enlarged supraclavicular, axillary, or mediastinal lymph nodes.
Normal appearance of the heart and great vessels.
Normal appearance of the lung parenchyma.
A small focus of scarring is noted in the right apex, but there are no
concerning discrete pulmonary nodules (___:32).
There are no pleural or pericardial effusions.
CT OF ABDOMEN: No focal liver lesions are identified. Normal appearance of
the gallbladder, pancreas, and spleen. Both kidneys are normal in size and
enhance symmetrically. Note is made of a 4.3 x 4.3 cm low-attenuation cystic
lesion arising from the anterior aspect of the left kidney. Findings are most
consistent with a simple renal cyst. Normal appearance of both adrenal
glands. Normal appearance of the intra- and extra-hepatic portal vein,
superior mesenteric vein, and splenic vein.
CT OF PELVIS: There is sigmoid diverticulosis, but no evidence of acute
diverticulitis. Normal appearance of the bladder. No enlarged inguinal or
pelvic sidewall lymph nodes. The prostate appears mildly enlarged measuring
5.4 x 3.3 cm in maximal axial dimension (4:119).
OSSEOUS STRUCTURES: Degenerative changes are noted at L4-L5 and L5-S1 with
endplate sclerosis and early anterior osteophyte formation (___:35). Further
anterior osteophytes are noted at T8, T9, and T10. No concerning lytic or
sclerotic bone lesions are identified.
IMPRESSION:
1. Simple appaering left renal cyst as described.
2. No evidence of thoracic, abdominal, or pelvic metastatic disease. 3.
Minor degenerative changes in the axial skeleton but no lytic or sclerotic
bone lesion.
|
19951079-RR-19 | 19,951,079 | 25,030,566 | RR | 19 | 2165-11-27 06:23:00 | 2165-11-27 11:41:00 | INDICATION: ___ man with new left brain mass.
COMPARISON: Outside MRI from ___.
TECHNIQUE: Multiplanar, multisequence images of the head were performed with
and without contrast.
FINDINGS:
There is a 6.5 x 4 cm complex multiloculated enhancing mass in the left
frontotemporal region containing cystic component and septations, as well as
flow voids. This lesion demonstrates surrounding increased T2 FLAIR signal
and is causing mass effect over the adjacent brain parenchyma and left lateral
ventricle with a 1.2-cm midline shift to the right. There is mass effect over
the foramen ___ with mild dilatation of the right lateral ventricle.
There is also a 2 x 2.5 cm satellite lesion in the left frontal lobe
demonstrating rim enhancement and septations with mild surrounding increased
T2 FLAIR signal. Another satellite lesion is noted in the cingulate gyrus
extending to the corpus callosum, also with surrounding T2 FLAIR signal. There
is also a left tentorial herniation, stable since ___.
No other lesion is noted. The orbits are unremarkable. The major
intracranial vessels are within normal limits.
IMPRESSION:
Large left frontal temporoparietal complex enhancing lesion causing mass
effect over the left lateral ventricle, midline shift to the right, and
dilatation of the right lateral ventricle due to obstruction at foramen of
___. Two other satellite lesions are noted in the left frontal lobe as well
as in the left cingulate gyrus extending to the corpus callosum. Differential
diagnosis may represent glioblastoma multiforme or other high-grade glioma.
Metastatic disease is less likely but also in the differential diagnosis.
Stable left tentorial herniation, stable since ___.
Finding from the prior exam were presented at the tumor board conference on
___, and are stable in the current exam.
|
19951079-RR-20 | 19,951,079 | 25,030,566 | RR | 20 | 2165-11-27 20:12:00 | 2165-11-27 21:57:00 | INDICATION: Evaluation of patient with large left frontotemporoparietal
enhancing mass, status post biopsy.
COMPARISON: Multiple prior studies ranging from ___ head CT
from ___ to MR ___ with contrast from ___.
TECHNIQUE: Contiguous axial images were obtained through the brain, without
intravenous contrast. The original acquisition was substantially
motion-degraded and was repeated, with better result.
FINDINGS: The patient is immediately status post left frontotemporal
craniotomy with expected post-operative changes including subcutaneous air as
well as a small amount of pneumocephalus. Complex multilocular mass is again
noted in the left frontotemporoparietal region with cystic components and
septations and tiny amount of surrounding hyperdense material (2:12) which may
represent small post-surgical hemorrhage. There is 13 mm rightward shift of
normally midline structures, as well as left uncal herniation, unchanged.
Again noted is significant mass effect with effacement of the subjacent left
lateral ventricle, effacement of left frontotemporoparietal gyri, and
obstruction at the level of the foramen of ___, with "trapping" and moderate
dilatation of the right lateral ventricle. The two known satellite lesions,
with one in the left frontal lobe and the second, in the cingulate gyrus are
better-delineated on dedicated enhanced MRI, performed roughly 14 hours
earlier.
The visualized mastoid air cells and paranasal sinuses are clear.
IMPRESSION: Expected post-surgical changes status post left frontal
craniotomy, with subcutaneous emphysema, small amount of pneumocephalus, and
possible small hemorrhage in the biopsy bed. The presence of hemorrhage is
difficult to assess, given the intrinsically hyperattenuating character of
large portions of the tumor, as seen on the OSH CT.
Otherwise, there is little change in comparison to the recent MRI, which
demonstrated a large, complex left frontotemporoparietal enhancing lesion and
two satellite nodules. There is unchanged mass effect with 13 mm rightward
shift of midline structures, dilatation of the right lateral ventricle due to
obstruction at the foramen of ___, and left uncal and transtentorial
herniation.
The overall appearance is most suggestive of multicentric gliomatosis.
|
19951079-RR-21 | 19,951,079 | 25,030,566 | RR | 21 | 2165-11-28 09:49:00 | 2165-11-28 12:27:00 | INDICATION: Worsening aphasia in patient with left frontotemporal brain mass,
status post craniotomy and biopsy.
COMPARISON: NECT of the head from ___, taken approximately 13.5
hours previous to the current study. MRI from ___ and NECT of the
head and MRI of the brain from ___ dated ___, for
which a radiologist report was not available for review.
TECHNIQUE: Contiguous axial images were obtained with a portable CT scanner
and displayed with 5-mm slice thickness. No contrast was used.
FINDINGS: A complex multilobulated mass is once again seen in the left
frontotemporoparietal region. The mass has intrinsic hyperattenuation making
evaluation for underlying hemorrhage difficult; however, there is no large
hemorrhage. This mass, along with the surrounding edema, causes marked but
stable mass effect including subfalcine and downward transtentorial
herniation, and a stable 14-mm rightward shift of normally midline structures.
There is diffuse left hemispheric sulcal effacement, as well as compression of
the left and dilation of the right lateral ventricle, due to "trapping," all
of which are stable from the prior study. There are stable postoperative
changes resulting from the left frontotemporal craniotomy including soft
tissue swelling and a small amount of pneumocephalus. Gray-white matter
differentiation is overall preserved, without evidence of new large
infarction. The visualized paranasal sinuses, mastoid air cells, and middle
ear cavities are clear.
IMPRESSION:
1. Stable mass effect from frontotemporoparietal brain mass, when compared to
previous study obtained roughly 13.5 hours earlier. No evidence of new large
hemorrhage or infarction.
2. Stable and expected post-operative changes related to left frontotemporal
craniotomy.
|
19951079-RR-22 | 19,951,079 | 25,030,566 | RR | 22 | 2165-11-29 09:05:00 | 2165-11-29 09:39:00 | REASON FOR EXAMINATION: Evaluation for PICC line placement.
COMPARISON: ___.
Left PICC line was inserted in the interim with its tip in the right atrium
and should be pulled back for about 5 cm as was discussed with IV nurse,
___, over the phone by Dr. ___ at 9:14 a.m., the same time that
the findings were made. Heart size and mediastinum are unremarkable. Lungs
are essentially clear with no pleural effusion or pneumothorax.
|
19951079-RR-23 | 19,951,079 | 25,030,566 | RR | 23 | 2165-11-29 09:40:00 | 2165-11-29 10:18:00 | REASON FOR EXAMINATION: PICC placement confirmation.
Portable AP radiograph of the chest was reviewed with comparison to ___.
The left PICC line now is at the level of mid SVC. Heart size and mediastinum
are unremarkable. Lungs are clear.
|
19951079-RR-24 | 19,951,079 | 25,030,566 | RR | 24 | 2165-12-06 14:45:00 | 2165-12-06 16:47:00 | CHEST RADIOGRAPH
INDICATION: ___ man with fever.
TECHNIQUE: Single upright portable chest view was read in comparison to prior
chest radiograph from ___.
FINDINGS:
There are no lung opacities concerning for pneumonia. Both pleural spaces are
normal. Heart size is normal, mediastinal and hilar contours are
unremarkable.
IMPRESSION: No pneumonia.
|
19951079-RR-25 | 19,951,079 | 25,030,566 | RR | 25 | 2165-12-06 15:42:00 | 2165-12-06 16:56:00 | CLINICAL HISTORY: ___ man with fever.
FINDINGS: Grayscale and color Doppler sonograms with spectral analysis of the
bilateral common femoral, superficial femoral, popliteal, posterior tibial and
peroneal veins was performed. The left peroneal veins were not as well
visualized. There is normal compressibility, flow and augmentation. There is
normal phasicity of the common femoral veins bilaterally.
IMPRESSION: No lower extremity deep venous thrombosis. Left peroneal veins
not well visualized.
|
19951664-RR-18 | 19,951,664 | 25,366,197 | RR | 18 | 2159-10-07 20:02:00 | 2159-10-07 21:18:00 | CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Chest pain.
FINDINGS: PA and lateral views of the chest provided demonstrating no focal
consolidation, effusion, or pneumothorax. The heart size is normal.
Mediastinal contour is unremarkable. The imaged osseous structures are
intact. There is no free air below the right hemidiaphragm.
IMPRESSION: No acute intrathoracic process.
|
19951879-RR-20 | 19,951,879 | 21,109,516 | RR | 20 | 2168-11-19 00:02:00 | 2168-11-19 00:39:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with SOB and cough. Evaluation for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiograph from ___.
FINDINGS:
Cardiomediastinal silhouette is within normal limits. There is tortuosity of
the descending thoracic aorta. Diffuse patchy infiltrates are compatible with
moderate pulmonary edema. Small bilateral effusions, right greater than left.
No pneumothorax.
IMPRESSION:
Moderate pulmonary edema with small bilateral pleural effusions, right greater
than left.
|
19951879-RR-21 | 19,951,879 | 21,109,516 | RR | 21 | 2168-11-20 08:15:00 | 2168-11-20 10:52:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with stage V CKD and T1DM here with volume
overload and acidemia// ___ on CKD
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. The right kidney
is asymmetrically smaller than the left with diffuse cortical thinning.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
Right kidney: 8.2 cm
Left kidney: 9.8 cm
The bladder is markedly distended with a volume of 1697 cc.
IMPRESSION:
1. The right kidney is asymmetrically smaller than the left kidney with
diffuse cortical thinning, suggestive of renal atrophy. No hydronephrosis
identified.
2. Markedly distended bladder with volume of 1697 cc is concerning for a
malpositioned Foley catheter.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, RDMS on the telephone on ___ at 8:38 am, 5 minutes after
discovery of the findings.
|
19951879-RR-22 | 19,951,879 | 21,109,516 | RR | 22 | 2168-11-20 13:49:00 | 2168-11-20 19:19:00 | EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ with past medical history notable for T1DM and CKD Stage V
(plan to initiate dialysis soon)// vein mapping for AVF
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
COMPARISON: None
FINDINGS:
RIGHT:
The cephalic vein measures 0.14 cm at the wrist, clotted at the mid forearm,
0.13 cm at the proximal forearm, 0.13 cm at the antecubital fossa with thick
wall, 0.36 cm at the proximal arm, 0.34 cm at the mid arm and 0.21 cm at the
distal arm. The basilic vein measures 0.34 cm at the forearm, 0.33 cm at the
antecubital fossa, 0.41 cm at its mid portion, and 0.41 cm at the proximal
portion.
The radial artery measures 0.15 cm. The brachial artery measures 0.40 cm.
Heavy arterial calcifications are present.
LEFT:
The cephalic vein measures 0.26 cm at the wrist, 0.26 cm at the distal
forearm, 0.2 cm at the mid forearm, 0.17 cm at the proximal forearm, 0.32 cm
at the antecubital fossa, 0.28 cm at the proximal arm, 0.23 cm at the mid arm
and 0.36 cm at the distal arm. The basilic vein measures 0.3 cm at the
forearm, 0.18 cm at the antecubital fossa, 0.28 cm at its mid portion, and
0.31 cm at the proximal portion.
The radial artery measures 0.21 cm. The brachial artery measures 0.27 cm.
Heavy arterial calcifications are present.
IMPRESSION:
Clotted right cephalic Vein in the proximal forearm, with thick wall at the
antecubital fossa.
Left upper extremity venous system is patent.
Heavily calcified bilateral brachial a bilateral radial arteries.
|
19951879-RR-23 | 19,951,879 | 21,109,516 | RR | 23 | 2168-11-22 10:58:00 | 2168-11-22 15:21:00 | INDICATION: ___ year old woman with ___ on CKD// Please placed tunneled line
for dialysis on the RIGHT side per transplant surgery preference (so they can
place fistula on left side)
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ performed
the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50mcg of fentanyl and 0.5 mg of midazolam throughout the total intra-service
time of 16 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None
CONTRAST: 0 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 3.6 minute, 30 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 23cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. Steri-strips were also used to close the venotomy incision site.
Final spot fluoroscopic image demonstrating good alignment of the catheter and
no kinking. The tip is in the right atrium. The catheter was flushed and both
lumens were capped. Sterile dressings were applied. The patient tolerated the
procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing dialysis
catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 23cm tip-to-cuff length tunneled dialysis line.
The tip of the catheter terminates in the right atrium. The catheter is ready
for use.
|
19951879-RR-24 | 19,951,879 | 21,109,516 | RR | 24 | 2168-11-25 01:21:00 | 2168-11-25 09:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: Ms. ___ is an ___ with past medical history notable for
T2DMand CKD Stage V, who presented with volume overload,hyperglycemia and
metabolic acidosis in the setting of renaldysfunction, admitted to the MICU
for insulin gtt, nowtransferred to the floor on a lasix gtt with resolution
ofdyspnea and initiated on dialysis ___ after tunneled lineplacement.// New
fever, r/o pulmonary sources of infxn
IMPRESSION:
In comparison with the study of ___, there is an placement of an IJ
dialysis catheter with the tip extending well into the right atrium. Cardiac
silhouette is essentially within normal limits. There has been substantial
reduction in the pulmonary edema. No definite acute focal consolidation on
this single frontal view.
|
19952329-RR-30 | 19,952,329 | 27,949,032 | RR | 30 | 2181-05-17 17:34:00 | 2181-05-17 18:07:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with shortness of breath, wheezing // Pneumonia?
Mass?
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Right-sided Port-A-Cath tip terminates in the mid SVC. Heart size is normal.
The mediastinal and hilar contours are unchanged and unremarkable. The
pulmonary vasculature is normal. Lungs are hyperinflated with emphysematous
changes redemonstrated. Lungs are otherwise clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19952329-RR-31 | 19,952,329 | 27,949,032 | RR | 31 | 2181-05-18 02:09:00 | 2181-05-18 06:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with copd exacerbation. tachypnea // Pneumonia?
TECHNIQUE: Portable AP view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Right-sided Port-A-Cath terminates in the mid SVC, unchanged from prior.
Hyperexpansion of the lungs without clear areas of focal consolidation in
single-view.
Cardiomediastinal contours are normal. No pleural effusion or pneumothorax.
IMPRESSION:
Hyperexpanded lungs, could be secondary to COPD. No focal areas of
consolidation concerning for infection.
|
19952329-RR-33 | 19,952,329 | 27,949,032 | RR | 33 | 2181-05-22 14:53:00 | 2181-05-22 15:33:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with endometrial cancer p/w wheezing and
hypoxia secondary to COPD exacerbation, now with continued respiratory
distress despite several days of appropriate COPD therapy. Ongoing sinus
tachycardia. // please evaluate for alternative etiology of ongoing
respiratory distress including PE, but also eval parenchyma for ? edema,
effusion, or consolidation as well.
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) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.6 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 5.9 s, 38.1 cm; CTDIvol = 6.1 mGy (Body) DLP = 229.6
mGy-cm.
Total DLP (Body) = 234 mGy-cm.
COMPARISON: CT chest ___
FINDINGS:
HEART AND VASCULATURE: There is a linear central filling defect at a branch
point between segmental and subsegmental vessels within the left lower lobe
(6:173). Elsewhere, pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen. A central venous catheter
terminates in the lower SVC.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Moderate centrilobular emphysema is again seen. There are
diffuse centrilobular nodules throughout the lungs, increased in prominence
throughout. Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally. Specifically, the distal left lower lobe bronchus is now patent.
There is diffuse mild bronchial wall thickening, similar to prior.
BASE OF NECK: 0.7 cm and 0.6 cm hypoattenuating nodules within the right and
left thyroid lobes, respectively, are unchanged.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
Specifically, no new findings compared to the study performed 2 weeks prior.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Pulmonary embolus at a branch point between a left lower lobe segmental and
subsegmental vessel. No signs of right heart strain or infarcted parenchyma
2. Moderate centrilobular emphysema with increased prominence of diffuse
centrilobular nodules throughout the bilateral lungs which can be seen in
respiratory bronchiolitis or hypersensitivity pneumonitis. No focal
consolidation.
3. Persistent mild bronchial wall inflammation which is likely chronic.
NOTIFICATION: Updated findings discussed with ___, MD by ___
___, MD via telephone at 17:50 on ___, 5 minutes after discovery.
|
19952329-RR-34 | 19,952,329 | 27,949,032 | RR | 34 | 2181-05-22 19:01:00 | 2181-05-22 19:34:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with new PE, slight leg pain and swelling. //
Rule out DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is a partially occlusive thrombus within the proximal left femoral vein.
Elsewhere, there is normal compressibility, color flow, and spectral doppler
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:
Partially occlusive DVT within the proximal left femoral vein is likely acute.
No DVT within the right lower extremity.
NOTIFICATION: The physician is already aware of known pulmonary embolism.
|
19952329-RR-35 | 19,952,329 | 27,949,032 | RR | 35 | 2181-05-27 13:10:00 | 2181-05-27 14:23:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with endometrial cancer here with severe COPD
exacerbation that has slowly been improving as noted to have
segmental/subsegmental PE now on lovenox now with worsening sinus tachycardia
and rising WBC despite ongoing steroid taper. // please evaluate for
developing pneumonia.
IMPRESSION:
In comparison with the study of ___, there is little change and no
evidence of acute cardiopulmonary disease. Hyperexpansion of the lungs with
flattening hemidiaphragms is consistent with the known COPD. No acute focal
pneumonia, vascular congestion, or pleural effusion.
Port-A-Cath tip again extends to the mid to lower SVC.
|
19953009-RR-28 | 19,953,009 | 27,614,034 | RR | 28 | 2167-06-10 13:33:00 | 2167-06-10 15:10:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) BILATERAL
INDICATION: ___ male with bilateral knee pain s/p fall.// ? fracture
TECHNIQUE: AP, cross-table lateral, AP with internal rotation radiographs of
bilateral knees.
COMPARISON: Bilateral knee radiograph dated ___.
FINDINGS:
Right knee: Again seen is the intramedullary rod with proximal and distal
interlocking screws. Healing distal tibial fracture changed. Healed fracture
at distal fibula is also unchanged. There is a new lateral tibial plateau
fracture extending to the lateral proximal metaphysis with approximately 3 mm
cortical step-off at the tibial plateau. There is lipohemarthrosis. Mild
tricompartmental degenerative changes demonstrated. No abnormal soft tissue
calcification. No suspicious sclerotic or lytic lesions.
Left knee: Intramedullary rod with proximal and distal locking screws are
unchanged. Healing distal tibial and fibular fractures are unchanged.
Cortical irregularity at the lateral tibial plateau is consistent with a
fracture. There is also fracture through the intercondylar eminence extending
along the intramedullary rod to the medial proximal tibial metaphysis.
Fracture is also seen in the proximal lateral tibial metaphysis. There is
lipohemarthrosis. Mild tricompartmental degenerative changes are unchanged.
No abnormal soft tissue calcification. No suspicious sclerotic or lytic
lesions.
IMPRESSION:
1. Bilateral new tibial plateau fractures with associated lipohemarthroses.
See above for detailed description.
2. Healing bilateral distal tibial and fibular fractures with fixation
hardware without hardware failure.
|
19953009-RR-29 | 19,953,009 | 27,614,034 | RR | 29 | 2167-06-10 15:53:00 | 2167-06-10 17:10:00 | EXAMINATION: CT of bilateral tibia/fibula.
INDICATION: ___ year old man with bilateral tibial plateau fractures // eval
fractures
TECHNIQUE: CT of the tibia/fibula was performed without intravenous contrast.
Images were reviewed in axial, coronal, and sagittal planes. Bone and soft
tissue algorithms were utilized.
DOSE: Acquisition sequence: 1) Spiral Acquisition 8.0 s, 63.1 cm; CTDIvol =
17.0 mGy (Body) DLP = 1,071.4 mGy-cm. Total DLP (Body) = 1,071 mGy-cm.
COMPARISON: Bilateral tibia/fibula radiographs dated ___, and ___
FINDINGS:
As noted on the recent radiographs, the patient is status post ORIF with
intramedullary rods and screws of both tibia. There are comminuted fractures
of bilateral medial and laterally tibial plateaus.
Right:
There is a comminuted fracture involving both the medial-lateral tibial
plateau and the tibial spines. There is approximately. There is
approximately 0.8 cm of depression along the posterior aspect of the lateral
tibial plateau.. Only minimal depression of the of medial tibial plateau.
The fracture involves the tibial spines and extends into the metaphysis
laterally. Again, there is an intramedullary rod and screws within the tibia
traversing across multiple mid tibial diaphyseal fractures. There is
incomplete bony callus. A healing mid to distal diaphyseal fracture is also
noted of the fibula.
Again noted is a large lipohemarthrosis. Additionally, there is a increased
attenuation soft tissue prominence extending along the soleus and medial head
of the gastrocnemius which may represent hemorrhage. A subacute to chronic
appearing fracture deformity is noted of the proximal fibular neck. Mild
degenerative changes are noted about the knee. Subchondral cystic changes are
also noted in the lateral talar dome. Mild subcutaneous edema is noted in the
distal lower extremity.
Left:
There is a comminuted fracture involving both the medial-lateral tibial
plateau and the tibial spines. There is about 1.1cm of depression of the
central/lateral aspect of the medial tibial plateau. There is depression of
the posterior lateral tibial plateau by about 0.7 cm.. The fracture also
extends into the metaphysis medially. Again, there is an intramedullary rod
and screws within the tibia across multiple fractures with evidence of
healing. Non-united fracture of the distal fibular diaphysis. As on the
contralateral side, there is a large lipohemarthrosis. A nondisplaced
fracture is noted at the fibular head, likely acute. Degenerative changes are
noted in the knee and talar dome. Mild subcutaneous edema is noted in the
distal lower extremity.
IMPRESSION:
New bilateral tibial plateau fractures as described above with depression
deformities and involvement of the tibial spines. New fracture of the Left
fibular head.
On the right, there is likely a small hematoma tracking between the soleus and
the medial head of the gastrocnemius.
Healing bilateral mid to distal tibial and fibular fractures with intact
fixation hardware.
|
19953009-RR-30 | 19,953,009 | 27,614,034 | RR | 30 | 2167-06-11 14:25:00 | 2167-06-12 10:45:00 | EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: Interoperative fluoroscopic images
TECHNIQUE: Multiple intraoperative fluoroscopic images were obtained without
presence of a radiologist
COMPARISON: ___ lower extremity CT and ___ bilateral
tibia/fibula radiographs
IMPRESSION:
Intraoperative fluoroscopic images demonstrate surgical devices during
revision of right tibia/fibula ORIF and placement of fracture plate and screws
in the proximal tibia. Please refer to the operative report for additional
details.
|
19953167-RR-21 | 19,953,167 | 29,504,301 | RR | 21 | 2151-03-07 09:07:00 | 2151-03-07 09:54:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with etoh and new liver failure // with flow; r/p
cholecystis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is nodular.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. The right anterior portal vein has bidirectional flow. There is
moderate volume ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 5 mm
GALLBLADDER: The gallbladder contains stones and sludge. The gallbladder wall
measures 4 mm and is not distended. Pericholecystic fluid is noted.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 14.1 cm
KIDNEYS: Limited views of the right kidney shows no hydronephrosis.
RETROPERITONEUM: The visualized portions of IVC are within normal limits.
IMPRESSION:
1. Findings not suggestive of acute cholecystitis. Patient is diffusely
tender, not suggestive of sonographic ___. Gallbladder contains stones and
sludge, but the gallbladder wall is not distended or edematous.
Pericholecystic fluid is noted, however, patient also has small volume
ascites.
2. Echogenic liver with nodular contour which is suggestive cirrhosis or
chronic liver disease.
3. Patent main portal vein. Bidirectional flow in the right anterior portal
vein.
4. Splenomegaly.
5. Small to moderate volume ascites.
|
19953167-RR-22 | 19,953,167 | 29,504,301 | RR | 22 | 2151-03-07 16:25:00 | 2151-03-07 17:17:00 | EXAMINATION: Chest radiograph, portable AP upright view.
INDICATION: Decompensated cirrhosis of unclear etiology.
COMPARISON: Prior chest radiograph from ___ and CT of the
abdomen from earlier on the same day.
FINDINGS:
Lung volumes are low. Cardiac, mediastinal and hilar contours appear stable.
There is a small pleural effusion on the right with partial atelectasis of
basilar segments of the right lower lobe as well as the right middle lobe.
Elsewhere, lungs remain clear. No visible pneumothorax or pleural effusion on
the left. No evidence of free air. These findings are compatible with CT
from earlier on the same day.
IMPRESSION:
Persistent right basilar atelectasis and small pleural effusion. Low lung
volumes.
|
19953167-RR-23 | 19,953,167 | 29,504,301 | RR | 23 | 2151-03-08 08:57:00 | 2151-03-08 12:06:00 | EXAMINATION: Ultrasound-guided diagnostic and therapeutic paracentesis
INDICATION: ___ year old woman with ___ year old w/ hx of alcohol use disorder
p/w abdominal distension and pain, with low grade temps and leukocytosis,
concerning for SBP. // paracentesis
TECHNIQUE: Ultrasound-guided diagnostic and therapeutic paracentesis
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis
Location: right lower quadrant
Fluid: 500 cc of clear, straw-colored fluid
Samples: None
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ 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. 500 cc of fluid were removed and, and 20 cc were sent for analysis.
|
19953167-RR-24 | 19,953,167 | 29,504,301 | RR | 24 | 2151-03-08 21:02:00 | 2151-03-08 22:15:00 | EXAMINATION: Chest radiograph, portable AP upright view.
INDICATION: Cirrhosis and new fever.
COMPARISON: Prior study from ___.
FINDINGS:
Lung volumes remain low. Cardiac, mediastinal and hilar contours appear
stable. Right basilar opacification is very similar to the prior study. This
suggests a combination of atelectasis or pneumonia with small pleural
effusion. No definite pleural effusion on the left. No visible pneumothorax.
Bony structures are unremarkable.
IMPRESSION:
Persistent right basilar opacification, without definite change. Differential
diagnosis includes pneumonia involving the right middle and basilar portions
of the right lower lobe. Coinciding pleural effusion is not well quantified.
|
19953300-RR-23 | 19,953,300 | 29,165,479 | RR | 23 | 2152-01-05 13:33:00 | 2152-01-05 14:49:00 | HISTORY: Crohn disease status post ileocectomy complicated by abscess and
bowel fistula.
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after
administration of oral intravenous contrast.
COMPARISON: CT ___, CT ___, fluoroscopy ___.
FINDINGS:
ABDOMEN: The lung bases are clear. The liver enhances homogeneously. The
portal veins are patent. There are no focal liver lesions. The gallbladder
is thin walled and nondistended. There is minimal small amount of
pericholecystic ascites. The pancreas and spleen are unremarkable. Adrenal
glands are normal. The kidneys enhance symmetrically and excrete contrast
promptly.
Postsurgical changes in the right lower quadrant reflect prior ileocectomy.
Contrast does not pass beyond the mid ileum. Therefore, contrast leak from
the anastomosis cannot be assessed. A right abdominal catheter coils within a
tiny collection along the right iliacus muscle. The collection closely wraps
around coiled catheter measuring approximately 4.4 x 1.9 cm. The collection
is smaller when compared with CT ___ and grossly unchanged since ___. There is marked surrounding stranding and inflammation of the
adjacent soft tissues extending into the enlarged right iliacus muslce .
Communication with bowel cannot be assessed with this study. Of note, several
sideholes in the drainage catheter are remain inside the abdomen but are
outside of the focal collection (2:47).
PELVIS: There is a large volume of stool in the transverse and descending
colon, sigmoid and rectum. There is no free pelvic fluid. There is no
inguinal or pelvic adenopathy.
There are no concerning lytic or sclerotic bone lesions. Retrolisthesis of L5
over S1 is mild.
IMPRESSION:
The size of a small right lower quadrant fluid collection is unchanged since ___
___. Surrounding inflammatory changes are similar.
|
19953300-RR-41 | 19,953,300 | 28,477,924 | RR | 41 | 2153-03-10 18:50:00 | 2153-03-11 10:00:00 | EXAMINATION: MRI of the pelvis. Perianal fistula protocol.
INDICATION: ___ year old man with Crohns and recent perirectal abscess
drainage on ___ with fevers, chills // to evaluate perirectal abscess,
?fistula
TECHNIQUE: T1 and T2 weighted multiplanar images of the pelvis were acquired
within a 1.5 Tesla magnet, including 3D dynamic sequences performed prior to,
during, and following administration of 7 cc of Gadavist intravenous contrast.
COMPARISON: CT and MRI examinations available from ___ through
___.
FINDINGS:
Posterior to the anus is a 19 x 13 x 20 mm intersphincteric collection, just
above the anal verge, demonstrating high internal signal intensity on T2
weighted sequences, with rim enhancement (series 5, image 22, series 101 image
81), with an internal 3 mm focus of high in signal intensity on T1 weighted
precontrast images (series 7, image 80), representing trace hematoma or
debris. Allowing for differences in imaging technique, the collection appears
minimally changed since the ___ CT examination. A linear focus of
enhancement projecting from the 6 o'clock position of the lower anus
(posterior, lithotomy) is likely a tiny sinus track (series ___, image 81).
A track extends from the inferior aspect of this collection to exit the right
perineum (series 801, image 91).
There is moderate mucosal enhancement throughout the lower and mid rectum
(series 10,801 image 59), reflecting active inflammation. Mild sigmoid wall
thickening without wall hyperenhancement reflects chronic inflammation.
There is no intrapelvic free fluid. The bladder is normal.
There are no bony lesions concerning for malignancy or infection.
IMPRESSION:
1. 19 x 20 x 13 mm intersphincteric abscess arising from a 6 o'clock
(posterior, lithotomy) track from the lower anus, with a tract extending from
the inferior aspect of the collection to the right perineum.
2. Moderate lower/mid rectal active inflammation, and mild sigmoid chronic
inflammation, reflecting known history of Crohn's disease.
|
19953300-RR-42 | 19,953,300 | 28,477,924 | RR | 42 | 2153-03-11 16:24:00 | 2153-03-11 17:55:00 | INDICATION: ___ year old man with Crohns disease s/p ileo-cecal resection in
___ c/b anastomotic leak s/p resection and re-anastomosis s/p drainage of
perirectal abscess on ___ who presents w/ persistent fever and persistent
right paracolic gutter fluid collection which needs drainage // Patient needs
drainage of persistent fluid collection with surrounding stranding along the
right paracolic gutter. Please send fluid for culture.
COMPARISON: ___
PROCEDURE: CT-guided drainage of right lower quadrant abdominal collection.
OPERATORS: Dr. ___, radiology fellow and Dr. ___, attending
radiologist, who was present and supervising throughout the total procedure
time.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a left lateral position on the CT scan table.
Limited preprocedure CTscan was performed to localize the collection. Based
on the CT findings an appropriate skin entry site for the aspiration was
chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of 1 cc of purulent fluid was
aspirated, confirming needle position within the collection.
Approximately 1 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: DLP: 367 mGy-cm
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 40
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Preprocedure scan shows normal size liver without focal hepatic lesions. There
is no intra- or extra-hepatic biliary duct dilation. Well distended
gallbladder contains 0.7 cm gallbladder stone. Right lower quadrant 2.1 x 3.5
cm fluid collection along the right pericolic gutter is targeted for drainage.
IMPRESSION:
Successful CT-guided drainage of right pericolic gutter abscess. 1 cc
purulent fluid sample was sent for microbiology evaluation.
|
19953300-RR-43 | 19,953,300 | 28,477,924 | RR | 43 | 2153-03-16 11:34:00 | 2153-03-16 12:20:00 | INDICATION: Right PICC placement.
COMPARISON: ___.
FINDINGS:
Portable frontal radiograph of the chest demonstrates a right PICC ending in
the low SVC. Normal heart size, mediastinal and hilar contours. No focal
consolidation, pleural effusion or pneumothorax. Unchanged dextroscoliosis of
the thoracic spine.
IMPRESSION:
Right PICC ends in the low SVC.
NOTIFICATION: The findings were discussed by Dr. ___ with Ping, IV
nurse on the telephone on ___ at 12:00 ___, 5 minutes after discovery of
the findings.
|
19953567-RR-4 | 19,953,567 | 28,931,076 | RR | 4 | 2150-08-08 00:22:00 | 2150-08-08 03:17:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with infectious workup, murmur, fever// pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
19953567-RR-5 | 19,953,567 | 28,931,076 | RR | 5 | 2150-08-08 00:22:00 | 2150-08-08 03:22:00 | EXAMINATION: FOREARM (AP AND LAT) RIGHT
INDICATION: History: ___ with ivdu, cellulitis, induration// foreign body
foreign body
TECHNIQUE: Two views through the right ulna and radius.
COMPARISON: None.
FINDINGS:
No radiopaque foreign bodies are noted. No fracture is detected in the radius
or ulna. The proximal or distal radioulnar joints are congruent. No suspicious
lytic or sclerotic lesion or periosteal new bone formation is detected. No
soft tissue calcification is seen. Limited assessment of the elbow and wrist
joint is grossly unremarkable.
IMPRESSION:
No radiopaque foreign bodies are noted.
|
19953567-RR-6 | 19,953,567 | 28,931,076 | RR | 6 | 2150-08-11 13:11:00 | 2150-08-11 14:47:00 | EXAMINATION: US MSK ELBOW RIGHT
INDICATION: ___ yo with injection of suboxone into right antecubital fossa.
rule out abscess// ___ yo with injection of suboxone into right antecubital
fossa. rule out abscess
TECHNIQUE: Grayscale and color Doppler ultrasound images were obtained of the
superficial tissues of the right antecubital fossa. There is a superficial
vessel which is thrombosed and
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right antecubital fossa. A focal segment of a superficial vein is thrombosed
and demonstrates wall thickening. The surrounding tissues are edematous. The
appearance is consistent with superficial thrombophlebitis. No fluid
collection is identified.
IMPRESSION:
Superficial thrombophlebitis at the right antecubital fossa. No sonographic
evidence of abscess.
|
19953778-RR-16 | 19,953,778 | 28,745,198 | RR | 16 | 2117-01-12 04:19:00 | 2117-01-12 05:22:00 | INDICATION: History: ___ with dyspnea // ? cardiopulmonary abnormality
TECHNIQUE: Chest PA and lateral
COMPARISON: None available
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax. The
cardiomediastinal and hilar contours are normal.
IMPRESSION:
No acute cardiopulmonary process.
|
19953778-RR-17 | 19,953,778 | 28,745,198 | RR | 17 | 2117-01-12 06:10:00 | 2117-01-12 07:09:00 | INDICATION: NO_PO contrast; History: ___ with abdominal pain, L flank
painNO_PO contrast // ? acute intraabdominal process
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous contrast administration.Coronal and sagittal
reformations were performed and submitted to PACS for review.
DOSE: DLP: 369 mGy-cm (abdomen and pelvis.
IV Contrast: 100 mL Omnipaque injected at a rate of 2.5 cc/sec
COMPARISON: None.
FINDINGS:
LOWER CHEST:
Mild dependent atelectasis bilaterally, otherwise the visualized lung bases
are clear. The visualized heart and pericardium are unremarkable.
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,
without stones or gallbladder wall thickening.
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 stones, focal renal lesions or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colon and rectum are within normal
limits. The appendix is surgically absent.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden
in the abdominal aorta and great abdominal arteries.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
IMPRESSION:
No findings to explain patient's symptoms.
|
19953778-RR-18 | 19,953,778 | 28,745,198 | RR | 18 | 2117-01-12 21:57:00 | 2117-01-15 09:30:00 | EXAMINATION: MRCP (MR ___
INDICATION: ___ year old man with no PMH presented with acute pancreatitis of
unclear etiology // rule out gallstones
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen were
obtained on a 1.5 Tesla magnet including dynamic 3D imaging prior to, during,
and after the administration of 8 mL Gadavist gadolinium based contrast. 1 mL
Gadavist mixed with 50 mL water was also administered for oral contrast.
COMPARISON: CT of the abdomen and pelvis from the same date.
FINDINGS:
Small amount of pleural effusion is seen bilaterally.
The liver is normal in size and morphology. The signal characteristics of the
liver parenchyma are normal T1 and T2 WI. No focal liver lesions are
identified. The portal and hepatic veins are patent. Conventional arterial
hepatic anatomy is demonstrated.
The gallbladder is normal, without gallstones.
The intra and extrahepatic biliary ducts are not dilated. There is no evidence
of choledocholithiasis.
Pancreas is normal in size and signal. The pancreatic ductal anatomy is
conventional. There is no evidence of acute or chronic pancreatitis.
The spleen is not enlarged
The kidney and adrenals are normal. Single renal arteries present on both
sides.
There is no retroperitoneal or mesenteric lymphadenopathy.
Minimal amount of free peritoneal fluid is seen on the right (03:41).
Bone marrow signal is normal.
IMPRESSION:
1. No evidence of cholelithiasis or choledocholithiasis.
2. Normal appearing pancreas.
3. Small bilateral pleural effusions and minimal amount of ascites.
|
19953778-RR-19 | 19,953,778 | 28,745,198 | RR | 19 | 2117-01-14 12:04:00 | 2117-01-14 13:34:00 | EXAMINATION:
MRI OF THE CERVICAL SPINE
INDICATION: ___ year old man with asymmetric tingling in left to right hand
with tenderness on neck palpation. // ?disc injury to account for asymmetric
paresthesias in hands
TECHNIQUE: T1, T2 and inversion recovery sagittal and gradient sequence T2
axial images of cervical spine obtained.
COMPARISON: None
FINDINGS:
There is no evidence of bony injury or ligamentous disruption. At the
craniocervical junction and C2-3 no abnormalities are seen. At C3-4 mild disk
bulging seen without spinal stenosis or foraminal narrowing. At C4-5 level
lumbar disc bulging and mild to moderate left-sided and mild right-sided
foraminal narrowing seen. At C5-6 level cord disk bulging and mild-to-moderate
left foraminal narrowing seen.
At C6-7 through T3-4 and abnormalities are identified.
The spinal cord shows normal intrinsic signal and compression. .
IMPRESSION:
No evidence of bony or ligamentous injury. Degenerative disc disease bulging
and mild to moderate foraminal changes from C3-4 through C5-6 levels.
|
19954423-RR-3 | 19,954,423 | 26,434,264 | RR | 3 | 2141-12-02 16:45:00 | 2141-12-02 17:03:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with abdominal pain and mass// ?mass, pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac and mediastinal silhouettes are unremarkable. 2 mm left apical
punctate opacity may represent vessel on end, calcified granuloma, or a tiny
pulmonary nodule.
IMPRESSION:
No definite focal consolidation to suggest pneumonia.
2 mm left apical punctate opacity may represent vessel on end, calcified
granuloma, or a tiny pulmonary nodule. Please note that CT is more sensitive
in assessing for small pulmonary nodules.
|
19954423-RR-4 | 19,954,423 | 26,434,264 | RR | 4 | 2141-12-02 16:27:00 | 2141-12-02 16:49:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with headache, abdominal malignancy// eval for
intracranial mass, hemorrhage eval for intracranial mass, hemorrhage
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 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 intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territory infarct. Gray-white matter
differentiation is preserved. There is no hydrocephalus. The partially
imaged paranasal sinuses demonstrate opacification of a right ethmoid air cell
and minimal mucosal thickening of the right frontal sinus. The mastoid air
cells are clear. No acute fracture seen.
IMPRESSION:
No acute intracranial process. Please note that MRI is more sensitive in
detecting small intracranial lesions.
|
19954460-RR-26 | 19,954,460 | 25,451,646 | RR | 26 | 2156-05-28 03:19:00 | 2156-05-28 03:58:00 | EXAMINATION: CTA HEAD AND NECK WITH PERFUSION PQ149 CT HEADNECK
INDICATION: Suspected stroke with acute neurological deficit.// Please
exclude ICH, signs of early ischemic stroke, large vessel occlusion, or other
vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 19.2 s, 8.0 cm; CTDIvol = 314.2 mGy (Head) DLP =
2,513.8 mGy-cm.
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 98.0 mGy (Head) DLP =
49.0 mGy-cm.
4) Spiral Acquisition 5.1 s, 39.7 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,268.6 mGy-cm.
Total DLP (Head) = 4,634 mGy-cm.
COMPARISON: Head CT ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Again seen is a large to mixed chronic and recent subdural hematoma over the
left convexity. This appears unchanged since the head CT of ___.
There is unchanged mild local mass effect with effacement of sulci. There is
no midline shift.
Unchanged are areas of white matter hypodensity in the left hemisphere that
may reflect chronic ischemia as well as potential lacune in the left putamen.
There is no evidence of new infarction. No intraparenchymal hemorrhage is
identified. The ventricles and sulci are enlarged in an atrophic pattern.
The visualized portion of the paranasal sinuses, mastoid air cells,and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
Embolic material is seen along the course of the left middle meningeal artery
in the middle cranial fossa.
CT PERFUSION:
There are 20 mL of brain demonstrating T-max greater than 6 seconds. This is
located in the territory of the inferior division of the left middle cerebral
artery.
There are 23 mL of brain with cerebral blood flow less than 30%. These
correspond to the left-sided subdural hematoma and not to the left middle
cerebral artery brain parenchymal abnormality identified based on T-max
criteria.
Thus, the images suggest ischemia without core infarction.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm. The dural venous
sinuses are patent. There is a fetal left posterior cerebral artery, a common
variant. The intracranial left vertebral artery is small, perhaps related to
proximal occlusion.
CTA NECK:
Bilateral carotid and vertebral artery origins are patent.
There is atherosclerotic plaque at the right common carotid artery bifurcation
with approximately 50% stenosis of the origin of the right internal carotid
artery by NASCET criteria. The plaque is largely calcified.
There is largely noncalcified plaque involving the distal left common carotid
artery and proximal left internal carotid artery. There is a focal
outpouching of the proximal left ICA, suggesting an ulcer. There is no left
internal carotid artery stenosis by NASCET criteria.
There is a stenosis at the origin of the right vertebral artery.
There are mixed calcified and noncalcified plaques involving the the left
subclavian artery. The left vertebral artery is not identified in the neck.
OTHER:
There are bilateral large pleural effusions. There is septal thickening
bilaterally, greater on the left. The visualized portion of the thyroid gland
is within normal limits. There is no lymphadenopathy by CT size criteria.
Enlargement of the right piriform sinus and adduction of the right vocal cord
suggest vocal cord paresis or paralysis.
IMPRESSION:
1. Unchanged left subdural hematoma.
2. Multiple white matter hypodensities suggesting chronic ischemia.
3. No evidence of intraparenchymal hemorrhage or recent infarction.
4. Approximately 50% stenosis of the origin of the right internal carotid
artery.
5. Stenosis at the origin of the right vertebral artery.
6. Atherosclerotic changes throughout the left subclavian artery with stenoses
and apparent occlusion of the left vertebral artery.
7. Reconstitution of the intracranial left vertebral artery from the basilar.
8. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.
|
19954460-RR-27 | 19,954,460 | 25,451,646 | RR | 27 | 2156-05-28 16:49:00 | 2156-05-29 09:07:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with left sided acute stroke// acute
intracranial abnormalities
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head ___ and CT head ___.
FINDINGS:
There are multiple small punctate left parietal foci of slow diffusion and
some of them show corresponding reduced signal on susceptibility weighted
images. These may be intraparenchymal within the cortex, suggesting multiple
small acute infarction or in the subarachnoid space suggesting foci of
subarachnoid hemorrhage.
Redemonstration of left subdural T1 isointense and T2 hyperintense signal
intensity which is not completely suppressed on FLAIR sequence along left
cerebral convexity with layering fluid/fluid levels, foci of slow diffusion
and septations posteriorly; essentially unchanged in size since ___.
Described findings likely related to different ages subdural hematoma. There
is underlying exerted mass-effect on the opposing brain parenchyma with no
midline shift.
There is minimal left parietal subarachnoid hemosiderin staining likely
related to remote subarachnoid hemorrhage.
There is no evidence of edema, masses, mass effect or midline shift. The
ventricles and sulci are stable in caliber and configuration.
Status post right lens surgery removal. Otherwise both orbits and globes are
normal. Mild mucosal thickening involving bilateral mastoid air cells.
Paranasal sinuses are normal.
IMPRESSION:
1. Multiple small foci of slow diffusion in left parietal region, which may
reflect small cortical infarctions or small amounts of subarachnoid
hemorrhage..
2. Redemonstration of left cerebral convexity different ages subdural hematoma
with underlying mass effect on opposing brain parenchyma with no midline
shift. Unchanged in size since ___.
|
19954715-RR-10 | 19,954,715 | 20,242,622 | RR | 10 | 2129-07-17 15:16:00 | 2129-07-17 16:31:00 | ___ woman with possible pneumothorax.
COMPARISON: None.
TECHNIQUE: PA and lateral views at expiration of the chest were provided. No
pneumothorax is evident. There do appear to be bilateral pleural effusions.
No focal opacities concerning for infectious process. Cardiomediastinal
silhouette is difficult to assess given the opacities at the lung bases.
Bones appear intact.
IMPRESSION: No evidence of pneumothorax. Bilateral pleural effusions and
congestion.
|
19954715-RR-11 | 19,954,715 | 20,242,622 | RR | 11 | 2129-07-19 08:07:00 | 2129-07-19 09:22:00 | CHEST RADIOGRAPH
INDICATION: Shortness of breath, possible pneumonia, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the lung volumes have
increased, likely reflecting improved ventilation. However, extent of the
pre-existing bilateral pleural effusion is constant. Moderate areas of
atelectasis, left more than right. No newly appeared parenchymal opacities.
Unchanged size of the cardiac silhouette.
|
19954715-RR-12 | 19,954,715 | 20,242,622 | RR | 12 | 2129-07-19 14:28:00 | 2129-07-19 17:22:00 | INDICATION: ___ female with C. diff, now with fever, altered mental
status, and increasing abdominal distention.
COMPARISONS: None.
FINDINGS: Three frontal images of the abdomen including a left lateral
decubitus image demonstrate a nonspecific bowel gas pattern. There is no
evidence of ileus, megacolon, or free air along the liver edge. A sacral
stimulator is visualized. Scoliosis and pelvic deformity which appear to be
chronic are also noted.
IMPRESSION: Nonspecific bowel gas pattern with no evidence of ileus,
megacolon, or perforation.
|
19954715-RR-13 | 19,954,715 | 20,242,622 | RR | 13 | 2129-07-23 00:29:00 | 2129-07-23 09:29:00 | HISTORY: Fever.
FINDINGS: In comparison with the study of ___, there are continued low lung
volumes. There is mild enlargement of the cardiac silhouette with left
ventricular configuration. Bilateral pleural effusions with compressive
atelectasis persist. Poor definition of the left hemidiaphragm suggests
substantial volume loss in the left lower lobe.
Pulmonary vessels are somewhat ill-defined, suggesting some elevated pulmonary
venous pressure.
|
19954715-RR-14 | 19,954,715 | 20,242,622 | RR | 14 | 2129-07-25 13:10:00 | 2129-07-25 17:11:00 | INDICATION: ___ female with ___, requiring evaluation for
aspiration.
COMPARISON: None.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS: There appeared to be penetration with pudding thick liquids. The
patient was unable to perform the rest of the exam, so no further assessment
was possible.
IMPRESSION: Possible penetration with pudding thick liquids, incomplete exam
secondary to patient's inability to perform the examination.
|
19954807-RR-32 | 19,954,807 | 27,989,967 | RR | 32 | 2193-01-31 14:40:00 | 2193-01-31 15:20:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with RLE swelling and pain // 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, 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 lower extremity veins.
|
19954807-RR-33 | 19,954,807 | 27,989,967 | RR | 33 | 2193-01-31 19:30:00 | 2193-01-31 21:07:00 | EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ female with history of ovarian cancer, now presenting
with right lower quadrant pain and right lower extremity swelling. Evaluate
for venous obstruction.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were obtained in
the delayed venous phase (180 seconds) after the administration of 150 cc of
Omnipaque. Coronal and sagittal reformations were performed and reviewed on
PACS. Oral contrast was not administered.
DOSE: Total DLP: 647 mGy-cm
COMPARISON: CT chest, abdomen and pelvis ___
FINDINGS:
LOWER CHEST: There is a 7 mm wide pulmonary nodule in the left lung base
(02:14), not significantly changed from the prior chest CT on ___. No
pleural effusions. Heart size is normal, without a 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.
Portal venous system is patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. Trace free
fluid in the pelvis. There is a 6 x 8 mm enhancing nodule in the left
hemipelvis posterior to the bladder (2:130), not definitely identified on the
prior study.
REPRODUCTIVE ORGANS: Status post hysterectomy and bilateral
salpingo-oophorectomy.
LYMPH NODES: There are innumerable retroperitoneal lymph nodes along the
aortocaval chain, the largest measuring up to 12 mm in short axis (2:66). A
dominant preaortic node measures 10 mm (2:64), also similar to the prior
study. Some lymph nodes have increased in size in the interim. For example,
there are two contiguous left para-aortic lymph nodes just inferior to the
origin of the left renal vein that measure 9 mm each (2:62, 63), previously
measuring 6 mm. Notably, there is a 18 x 14 mm necrotic aortocaval node
(2:82) that anteriorly abuts causing compression of the inferior IVC, near the
iliac bifurcation, and may explain patient's symptoms of venous obstruction.
IVC however remains patent through this level.
Pelvic sidewall nodes have also enlarged. For example, there is a 12 mm right
pelvic sidewall node (2:133), previously 8 mm. Additional right pelvic
sidewall node has increased from 5 mm to 9 mm (2:141). A right external iliac
node has increased from 8 mm to 12 mm (2:133).
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 18 x 14 mm necrotic aortocaval node causing anterior compression on the
inferior IVC, without associated occlusion/ thrombosis.
2. Worsening intra-abdominal/pelvic lymphadenopathy in the short 3 weeks
interval.
3. New 8 x 6mm enhancing nodule in the left inferior hemipelvis, may represent
an additional metastatic focus. Recommend attention on follow-up studies.
4. Unchanged 7 mm left lower lobe pulmonary nodule. Short interval follow-up
in 3 months is advised, as previously recommended.
|
19954807-RR-34 | 19,954,807 | 27,989,967 | RR | 34 | 2193-02-02 19:22:00 | 2193-02-03 15:45:00 | INDICATION: ___ year old woman ovarian carcinoma status post chemotherapy,
referred in for RLE swelling and pain. She states it has been developing over
2 weeks, gradually. She has pain by her shin and in her thigh. She has
swelling and edema. Area of edema and pain from ankle to below knee. LENIS
negative for DVT. ?venous stasis or infection?
TECHNIQUE: Multiplanar MRI images of the bilateral ankle and calves were
obtained without and following the administration of 7 cc of Gadavist using a
mass/infection protocol
COMPARISON: Right lower extremity ultrasound from ___.
FINDINGS:
Please note that this protocol is designed for evaluation of mass/infection
and full evaluation of anatomical structures is limited. Assessment of the
knee and ankle joints is quite limited on these views.
There is nonspecific subcutaneous soft tissue edema overlying the anteromedial
aspect of both legs at the level of the mid to distal tibia, right much more
prominent than left. There is no abnormal enhancement following contrast
administration. There is also subcutaneous soft tissue edema in the
posterolateral aspect of the right leg at the level of the distal fibula which
does demonstrate some enhancement following contrast the known less so he
05:41).
Separate from the above subcutaneous soft tissue findings, at the distal
fibula, there is an approximately 3 cm area in the bone that is hypointense on
T1, hyperintense on fluid sensitive sequence, and demonstrate enhancement
following contrast administration. Remainder of marrow signal is otherwise
within normal limits. Limited views of the knee and ankle joints are
unremarkable. No large joint effusion is identified. The muscles are normal
in bulk and signal intensity. The tendons in the calves are unremarkable.
Prominent bilateral superficial varicosities are noted.
IMPRESSION:
1. Nonspecific, non enhancing subcutaneous soft tissue edema overlying the
anteromedial aspect of both legs, right more than left. This is not fully
characterized, but could be due to third spacing. (The patient underwent
right lower extremity ultrasound examination which reported no evidence of
DVT.)
2. Mildly enhancing soft tissue edema in the posterolateral aspect of the
right leg that is also nonspecific. This is also non-specific in appearance,
but if there are corresponding skin findings then this could represent
cellulitis.
3. Focal abnormal marrow signal in the distal right fibula spanning about 3cm
in length with mild enhancement. Further evaluation with right tib/fib
radiograph is recommended. The MR appearance is non-specific include and
includes an intraosseous vessel versus multiple stress fractures versus a
lesion in the marrow. The post-contrast images suggest a vessel going into
the marrow space. Radiographs may be helpful in further characterization.
This finding lies remote from the areas of edema in the subcutaneous fat and
is not clearly related to them.
RECOMMENDATION(S): Right tibia-fibula radiographs recommended to further
assess area of abnormal marrow signal in the distal fibula.
|
19954807-RR-46 | 19,954,807 | 20,496,916 | RR | 46 | 2193-09-04 17:21:00 | 2193-09-04 17:40:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with seizure// ? acute process
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
Right-sided Port-A-Cath tip terminates in the right atrium. Lung volumes are
lower compared to the previous study. This accentuates the size of cardiac
silhouette which appears mild to moderately enlarged. The mediastinal contour
is unremarkable. New mild pulmonary edema has developed with patchy opacities
noted in the lung bases. No focal consolidation, pleural effusion or
pneumothorax is seen. Previously noted granuloma in the left mid lung field
is obscured on the current exam. Additionally, previously noted left lower
lobe and lingular lymphangitic carcinomatosis and nodule seen on previous CT
are not well assessed on the current radiograph. Known osseous metastatic
lesions are not well evaluated on this exam..
IMPRESSION:
1. Interval development of mild pulmonary edema and patchy opacities in the
lung bases, likely atelectasis, but aspiration cannot be excluded.
2. Known lymphangitic carcinomatosis in the left lung base, pulmonary
nodules, and sclerotic osseous metastases are better assessed on the previous
CT.
|
19954807-RR-47 | 19,954,807 | 20,496,916 | RR | 47 | 2193-09-04 18:12:00 | 2193-09-04 18:30:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with new onset seizure// ? acute process
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: ___ CT head
FINDINGS:
In the left frontal lobe, there is a 1.2 x 1.2 cm round peripherally
hyperdense lesion (02:16) with surrounding vasogenic edema at the gray-white
matter junction. There is no significant sulcal effacement. In the right
frontal lobe at the gray-white matter junction, there is a 1.6 x 1.3 cm round
peripherally hyperdense lesion with surrounding vasogenic edema (02:21). In
the left centrum semiovale, there is a 7 x 5 mm hyperdense lesion with mild
surrounding vasogenic edema (02:22). In the left parietal lobe at the
gray-white matter junction, there is a 7 x 6 mm hyperdense lesion and a 11 x
11 peripherally hyperdense round mass (02:15), both with surrounding vasogenic
edema (02:19). In the right frontal periventricular white matter, there is a
9 x 7 mm hyperdense lesion (02:11). Heterogenic edema is also seen within the
cerebellar hemisphere though no discrete mass is identified. There is no
shift of the midline structures and no evidence of hemorrhage. No evidence of
acute infarct.
There is no acute fracture or scalp hematoma. There is scattered mucosal
thickening of the maxillary, posterior ethmoid, and sphenoid sinuses. Mastoid
air cells and middle ear cavities are clear. Visualized aspects of the orbits
are unremarkable.
IMPRESSION:
1. Multiple hyperdense lesions in the right and left cerebral hemispheres,
many at the gray-white matter junction, with surrounding vasogenic edema,
compatible with metastatic disease.
2. Vasogenic edema in the left cerebellar hemisphere is also suspicious for
an underlying mass lesion, though none is discretely identified. No evidence
of intracranial hemorrhage or acute infarct.
3. Please note that MRI is more sensitive for detection of smaller
metastases.
|
19954807-RR-49 | 19,954,807 | 20,496,916 | RR | 49 | 2193-09-05 13:45:00 | 2193-09-05 15:41:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: Metastatic ovarian cancer presenting with seizure and head CT
with multiple brain lesions. Evaluate for metastatic disease.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 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: Noncontrast head CT ___ and ___.
FINDINGS:
There are innumerable supra and infratentorial rim enhancing metastatic
lesions with slowed diffusion and surrounding vasogenic edema, with more
pronounced number of lesions within the cerebellum. Lesions are also seen
within the right midbrain and right pons. The dominant lesion in the left
cerebral hemisphere is in the left middle frontal lobe measuring 14 x 12 mm
with moderate surrounding vasogenic edema (1200:122). The dominant lesion in
the right cerebral hemisphere is in the right superior frontal lobe measuring
up to 17 x 13 mm (1200:137) with moderate surrounding vasogenic edema. The
dominant cerebellar lesion is located in the midline measuring 16 x 12 mm
(1200:79). A single left occipital lesion measuring 13 x 13 mm demonstrates
punctate area of associated susceptibility artifact (10:8, 7:8), suggestive of
hemorrhage. The remainder of the lesions appear nonhemorrhagic.
There is no evidence of midline shift or acute territorial infarct. The
background ventricles and sulci are normal in caliber and configuration. The
dural venous sinuses appear patent on MP-RAGE images. The principal
intracranial vascular flow voids appear preserved.
There is opacification of posterior right ethmoid air cells and right sphenoid
sinus. There is mild mucosal thickening of the right maxillary sinus. There
is mild mucosal thickening in the left frontoethmoidal recess. There are
apparent changes from functional endoscopic sinus surgery. The orbits are
grossly unremarkable. The mastoid air cells are clear.
11 x 10 mm T1 hypointense lesion abutting the inferior endplate of the C2
vertebral body, with some enhancement of the inferior aspect on MP-RAGE
images, is suspicious for osseous metastasis.
IMPRESSION:
1. Innumerable enhancing supra and infratentorial metastatic lesions, as
described, additionally with involvement of the midbrain and pons. Many of
these lesions demonstrate vasogenic edema with associated localized mass
effect. Of these, a single left occipital lesion appears hemorrhagic.
2. 11 x 10 mm lesion abutting the inferior endplate of the C2 vertebral body
is suspicious for osseous metastasis. This can be further evaluated with
contrast-enhanced dedicated cervical spine MR, if indicated.
3. Paranasal sinus disease, as described, with postsurgical changes from FESS.
|
19955235-RR-10 | 19,955,235 | 21,025,811 | RR | 10 | 2167-08-04 14:06:00 | 2167-08-04 14:38:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ abdominal pain, evaluate for cholecystitis.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT of the abdomen pelvis dated ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 8 mm.
GALLBLADDER: The gallbladder is distended with internal debris and a thickened
wall measuring up to 7 mm. Numerous gallstones are seen within the
gallbladder lumen.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 10.8 cm.
IMPRESSION:
1. Acute cholecystitis with cholelithiasis.
2. Echogenic liver with no focal lesions identified, likely representing fatty
deposition.
|
19955235-RR-9 | 19,955,235 | 21,025,811 | RR | 9 | 2167-08-04 12:27:00 | 2167-08-04 13:10:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with history of N/V, fevers as well as abscence of passing
flatus, evaluate for bowel obstruction.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
No oral contrast was administered.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
4) Spiral Acquisition 5.1 s, 56.0 cm; CTDIvol = 16.8 mGy (Body) DLP = 942.8
mGy-cm.
Total DLP = 954 mGy-cm.
IV Contrast: 150 mL Omnipaque
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion. Mild dependent atelectasis is
seen.
ABDOMEN:
HEPATOBILIARY: There is no focal liver lesion. The portal vein and hepatic
veins are patent. The gallbladder is distended with a thickened wall
measuring up to 9 mm with hyperemia of the adjacent liver consistent with
acute cholecystitis. There is no evidence of perforation or adjacent free
fluid.
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 stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits.
Appendix contains air, has normal caliber without evidence of fat stranding.
There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Acute uncomplicated cholecystitis.
2. No evidence of bowel obstruction.
|
19955371-RR-11 | 19,955,371 | 26,497,119 | RR | 11 | 2144-07-30 15:50:00 | 2144-07-30 16:45:00 | INDICATION: ___ year old woman with IDDM, seizure d/o p/w R facial
cellulitis/abscess, now with abd pain // Please evaluate for obstruction
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Mild colonic
stool burden
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Surgical clips from prior cholecystectomy are seen. There is a CGM
device seen in the right flank.
IMPRESSION:
Nonobstructive bowel gas pattern with mild colonic stool burden.
|
19955371-RR-12 | 19,955,371 | 26,497,119 | RR | 12 | 2144-07-30 22:12:00 | 2144-07-30 22:56:00 | EXAMINATION: CT NECK W/O CONTRAST (EG: PAROTIDS) Q21 CT NECK
INDICATION: ___ year old woman with DM, bipolar, pseudoseizures p/w R facial
cellulitis and R maxillary abscess s/p I D now with worsening edema extending
to the neck. // Please evaluate for deep space infection
TECHNIQUE: MDCT acquired helical axial images were obtained from the thoracic
inlet through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.1 s, 33.1 cm; CTDIvol = 14.5 mGy (Body) DLP = 469.7
mGy-cm.
Total DLP (Body) = 470 mGy-cm.
COMPARISON: CT neck ___.
FINDINGS:
Maxillofacial:
A drain is in place adjacent to the right maxilla, with surrounding fat
stranding and without discrete fluid collection. Diffuse, right
periorbital/preseptal soft tissue swelling and fat stranding has not
substantially changed. There is diffuse right malar soft tissue swelling and
fat stranding, with new, interval small locules of air with adjacent stranding
spanning approximately 2.3 x 0.9 cm (2:36). Diffuse fat stranding extends
inferiorly into the right submandibular space and posteriorly into the
masticator and parotid spaces. No drainable fluid collection.
There is no facial bone fracture. Pterygoid plates are intact. There is no
mandibular fracture and the temporomandibular joints are anatomically aligned.
The orbits are intact. Aside from the aforementioned findings, the globes and
extra-ocular muscles are unremarkable.
Included paranasal sinuses are clear.
Neck:
Evaluation of the aerodigestive tract demonstrates no mass and no areas of
focal mass effect.
Focal calcifications are seen within the inferior aspect of the right parotid
gland (2:50), which most likely represents sialoliths. The other salivary
glands are grossly without mass or adjacent fat stranding. Multiple prominent
to enlarged right-sided cervical nodes measure up to 1.1 cm (2:52).
Mild mosaic attenuation of the lung apices is nonspecific. A hypodense right
thyroid nodule measures 1.5 cm. No worrisome osseous lesions or acute
fracture.
IMPRESSION:
1. Diffuse right malar soft tissue swelling and fat stranding following
drainage of a right maxillary abscess, with a drain in situ. Small locules of
air within the right malar soft tissues may reflect postprocedural changes. No
evidence of drainable fluid collection.
2. No substantial change in diffuse right periorbital/preseptal soft tissue
swelling.
3. Right-sided cervical lymphadenopathy, likely reactive.
4. Hypodense right thyroid nodule, measuring up to 1.5 cm. Further evaluation
is recommended with thyroid ultrasound as an outpatient, if this has not been
previously worked up.
|
19955371-RR-14 | 19,955,371 | 26,497,119 | RR | 14 | 2144-08-01 10:25:00 | 2144-08-01 12:00:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with CVL placement, R IJ // location of R IJ
CVL Contact name: ___: ___
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Chest radiograph ___
FINDINGS:
Right IJ central line is in good position and terminates at the cavoatrial
junction. The heart is mildly enlarged. The mediastinal silhouette is
unremarkable. There is no pleural effusion or pneumothorax. There is linear
atelectasis in the mid lungs bilaterally. There is no focal consolidation.
IMPRESSION:
Right IJ central line terminates in the cavoatrial junction. No evidence of
procedural complication.
|
19955371-RR-15 | 19,955,371 | 26,497,119 | RR | 15 | 2144-08-01 13:45:00 | 2144-08-01 15:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with facial cellulitis, GI bleed, intubated //
Evaluate ETT placement
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Chest radiograph ___ through ___
FINDINGS:
In comparison to chest radiograph 2 hours prior there has been placement of an
endotracheal tube which terminates 2 cm superior to the carina. The right IJ
central line terminates in the proximal right atrium. If positioning in the
cavoatrial junction is desired, it could be pulled back approximately 2.5 cm.
There is stable cardiomegaly. There is increased pulmonary vascular
congestion.
IMPRESSION:
Increased pulmonary vascular congestion. ET tube terminates 2 cm superior to
the carina.The right IJ central line terminates in the proximal right atrium.
If positioning in the cavoatrial junction is desired, it could be pulled back
approximately 2.5 cm.
|
19955371-RR-16 | 19,955,371 | 26,497,119 | RR | 16 | 2144-08-01 14:29:00 | 2144-08-01 18:48:00 | INDICATION: ___ presents with facial cellulitis, course c/b GI bleed/melena,
intubated for EGD which showed large ulcer, unable to intervene in EGD but
currently with hemostasis, hoping for urgent embolization of gastroduodenal
artery // Can you urgently embolize GDA?
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___, attending Interventional
Radiologists and Dr. ___ resident performed
the procedure. The attending(s) personally supervised the trainee during any
key components of the procedure where applicable and reviewed and agrees with
the findings as reported below.
ANESTHESIA: Propofol drip was administered throughout the procedure.
MEDICATIONS: Propofol
CONTRAST: CO2
FLUOROSCOPY TIME AND DOSE: 22:12 min, 306 mGy
PROCEDURE:
1. Right common femoral artery access.
2. CO2 celiac arteriogram.
3. CO2 common hepatic arteriogram.
4. CO2 gastroduodenal arteriogram.
5. Coil embolization of the gastroduodenal artery.
6. Post embolization CO2 common hepatic arteriogram.
7. CO2 right common femoral arteriogram.
PROCEDURE DETAILS: Written informed consent could not be obtained from the
patient was intubated and sedated nor from the healthcare proxy despite
several attempts to contact them. Decision was made in conjunction with the
patient's ICU team to proceed with embolization given the urgent nature of the
situation. 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 and left groin was prepped and draped in the usual sterile
fashion.
Using ultrasound guidance, the right common femoral artery was punctured using
a micropuncture set at the level of the lower femoral head. A 0.018 wire was
passed easily into the vessel lumen. A small skin incision was made over the
needle. Then the inner dilator and wire were removed and ___ wire was
advanced under fluoroscopy into the aorta. The micropuncture sheath was
exchanged for a 5 ___ sheath which was attached to a continuous heparinized
saline side arm flush.
A C2 Cobra catheter was advanced over ___ wire into the aorta. The wire
was removed and SMA was selected. CO2 SMA arteriogram was performed. The
catheter was then disengaged and the celiac artery was selected. A CO2 celiac
arteriogram was performed. A Glidewire was advanced through the catheter and
into the common hepatic artery. The catheter was advanced over the wire. A
CO2 common hepatic arteriogram was performed. A high flow microcatheter pre
loaded with a double angled Glidewire was advanced through the catheter and
used to select the GDA. The wire was removed and a CO2 gastroduodenal
arteriogram was performed. The diagnostic angiograms were medically necessary
due to absence of prior preprocedural imaging.
The decision was made to comparison embolize the GDA. Embolization was then
performed with a 8 mm x 40 ___ coil as well as two 15 cm packing coils.
The microcatheter was removed and a repeat CO2 common hepatic arteriogram was
performed. The Cobra catheter was removed. A CO2 right common femoral
arteriogram was performed through the sheath. An Angio-Seal device was
deployed and manual pressure was held until hemostasis was achieved. Sterile
dressings were applied. The patient tolerated the procedure well.
FINDINGS:
1. Ultrasound images of the common femoral artery demonstrates a pulsatile
common femoral artery and a compressible common femoral vein.
2. SMA arteriogram demonstrates flow of CO2 without evidence of reflux within
the GDA.
3. Celiac CO2 arteriogram demonstrates antegrade flow into the common hepatic
and GDA which appears to be Vasoconstricted. No evidence of active CO2
extravasation.
4. Gastroduodenal CO2 arteriogram demonstrates no evidence of active
extravasation or vascular lesions.
5. Common hepatic arteriogram post coil embolization of the gastroduodenal
artery demonstrating no flow through the gastroduodenal artery.
6. Right common femoral arteriogram demonstrates a low femoral head puncture
without evidence of extravasation or pseudoaneurysms.
IMPRESSION:
Successful right common femoral artery approach GDA coil embolization.
|
19955371-RR-18 | 19,955,371 | 26,497,119 | RR | 18 | 2144-08-04 04:14:00 | 2144-08-04 04:51:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with facial abscess, seizure disorder, GI
bleed, now unresponsive // ?stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 45.5 mGy (Head) DLP =
855.5 mGy-cm.
2) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 1,540 mGy-cm.
COMPARISON: Head CT ___. CTA head ___ head CT ___
FINDINGS:
There is no evidence of infarction, fracture, hemorrhage, or mass. The
ventricles and sulci are normal in size and configuration.
Right facial edema and fat stranding is partially visualized. The visualized
portion of the paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are normal.
IMPRESSION:
1. There is partial visualization of known right facial infection.
2. Otherwise normal head CT.
|
19955371-RR-19 | 19,955,371 | 26,497,119 | RR | 19 | 2144-08-07 17:14:00 | 2144-08-07 18:03:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: ___ year old woman with DM, bipolar, pseudoseizures who p/w R
facial cellulitis and R maxillary abscess s/p I D. Now with new, copious
purulent drainage from lesion over right zygomatic arch. // Assess drainable
collection
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, 16.0 cm; CTDIvol = 29.9 mGy (Head) DLP = 459.4
mGy-cm.
Total DLP (Head) = 459 mGy-cm.
COMPARISON: CT head ___ and CT neck ___
FINDINGS:
Right malar soft tissue swelling and fat stranding appears similar in extent
to the study performed 7 days prior, extending to the right
periorbital/preseptal soft tissues and the right parotid gland. Including the
surrounding inflammatory changes, confluent fluid within the region of prior
abscess is similar in size measuring 2.8 x 1.3 cm (3:9), previously 2.7 x 1.3
cm. Evaluation for abscess, however, is limited in the absence of intravenous
contrast administration. Poor dentition is again seen, with essentially all
maxillary teeth missing. The cortex of the superficial alveolar ridge in the
region of the second and third teeth is interrupted, possibly related to
recent tooth extraction although source for facial abscess cannot be excluded,
especially given continuity between the confluent right facial fluid. Few
foci of gas (3:8) within an abscess cavity or between the maxilla and buccal
mucosa.
No fractures are identified.
Other than mild mucosal thickening in the right maxillary sinus, visualized
paranasal sinuses are well aerated.
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:
Evaluation for organized fluid/abscess is limited without intravenous contrast
however there is no definite evidence of a drainable collection.. The right
facial soft tissue infection appears similar, including confluent fluid in the
region of known abscess measuring 2.8 x 1.3 cm. There is soft tissue
thickening and stranding which is continuous from this confluent fluid to a
cortical defect in the superficial alveolar process of the right maxilla which
may be related to recent tooth extraction or suggest periapical abscess.
|
19955371-RR-20 | 19,955,371 | 26,497,119 | RR | 20 | 2144-08-10 09:35:00 | 2144-08-10 12:33:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/ CONTRAST Q1217 CT HEADSINUS
INDICATION: ___ year old woman with odontogenic infection which spread to face
// Assess for malar area discrete, surgically drainable collection (abscess)
given ongoing concern for lack of source control
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.8 s, 15.0 cm; CTDIvol = 27.9 mGy (Head) DLP = 425.4
mGy-cm.
Total DLP (Head) = 425 mGy-cm.
COMPARISON: CT sinus ___.
FINDINGS:
Re demonstrated right malar soft tissue swelling and fat stranding appears
slightly improved to the study performed 3 days ago, and extends to the right
infraorbital pre maxillary area. The extent of periorbital and preseptal soft
tissue thickening appears improved compared to the prior exam. Within the
region of surrounding inflammation, there is a 2.4 x 1.1 cm soft tissue
structure, previously measuring 2.8 x 1.3 cm (4; 6). There is no evidence of
drainable fluid collection.
The patient is edentulous in the upper maxilla, status post likely dental
extractions. There is irregularity and erosion involving the cortex of the
superficial alveolar ridge and region of the second and third right molars.
Gas in the region of the soft tissues overlying part of the maxilla has
coalesced into a single focus of gas measuring 5 mm (4; 4).
The paranasal sinuses are normally aerated, with no mucosal thickening or
air-fluid levels identified. The ostiomeatal units are patent.
The cribriform plates are intact. The lamina papyracea are intact.
IMPRESSION:
1. Interval improvement of right malar soft tissue swelling and fat stranding,
with no evidence of drainable fluid collection.
2. Redemonstrated irregularity and erosion in the second and third right molar
regions. Gas in the region of the soft tissues overlying the area has
coalesced.
|
19955582-RR-23 | 19,955,582 | 26,593,491 | RR | 23 | 2139-10-14 08:56:00 | 2139-10-14 10:04:00 | EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST.
INDICATION: ___ woman with acute onset periumbilical abdominal pain,
evaluate for acute appendicitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 452 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis. There is no pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Subcentimeter hypodensity in segment VII of the liver (series 2, image 29) is
too small to characterize. There is mild periportal edema, likely from fluid
resuscitation. 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.
A subcentimeter hypodensity in the lower pole of the left kidney is too small
to characterize (series series 2, image 37) There is no perinephric
abnormality.
GASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia.
Small bowel is normal in caliber without focal wall thickening. Large bowel
is also normal in caliber without focal wall thickening. There is an
appendicolith at the appendiceal base. Distally the appendix is dilated up to
13 mm with associated surrounding fat stranding. There is air in the tip of
the appendix, without evidence of extraluminal air. There are no
intra-abdominal fluid collections.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and ovaries 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. Mild atherosclerotic disease
is noted. There is dilation of the left gonadal vein.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Limbus vertebra is seen at L4. There is mild anterolisthesis of L4-L5.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Acute appendicitis. No intra-abdominal fluid collections or extraluminal air.
|
19955582-RR-24 | 19,955,582 | 26,593,491 | RR | 24 | 2139-10-16 16:34:00 | 2139-10-16 17:32:00 | INDICATION: ___ year old woman with s/p appendectomy, now with dropping hct
// rule out appendiceal stump leak ( IV contrast)
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 14.2 s, 48.7 cm; CTDIvol = 8.0 mGy (Body) DLP = 376.8
mGy-cm.
Total DLP (Body) = 390 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___
FINDINGS:
LOWER CHEST: There are moderate bilateral nonhemorrhagic pleural effusions
which are new from prior with associated atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Multiple subcentimeter hypodensities in the liver are too small to
characterize by CT but appear unchanged from prior 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 a 3 mm hypodensity in the lower pole of the left kidney which is too
small to characterize but statistically likely represents a cyst. There is no
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is surgically absent. There is
hyperdense fluid extending from the right pericolic gutter adjacent to the
surgical site into the pelvis compatible with hemoperitoneum. Though
evaluation is limited by single phase study, there is no obvious area of focal
contrast extravasation to suggest active bleed. Nonhemorrhagic free fluid is
seen in the upper abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no
evidence of adnexal abnormality bilaterally.
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: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Fluid is seen within the left anterior abdominal wall
subcutaneous tissues and extending between the abdominal musculature, likely
postsurgical. Stranding is seen at the umbilicus likely postsurgical related
to laparoscopic surgery.
IMPRESSION:
1. Moderate hemoperitoneum extending from the surgical site in right pericolic
gutter into the pelvis. Though evaluation is limited by single phase study,
there is no obvious area of focal contrast extravasation to suggest active
bleed.
2. Fluid within the left anterior lateral abdominal wall, likely postsurgical.
3. Moderate bilateral nonhemorrhagic pleural effusions with associated
atelectasis.
NOTIFICATION:
The wet read was discussed by Dr. ___ with Dr. ___ on the
___ ___ at 5:30 ___, 15 minutes after discovery of the findings.
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19955908-RR-19 | 19,955,908 | 23,511,709 | RR | 19 | 2176-03-09 07:53:00 | 2176-03-09 11:13:00 | INDICATION: ___ with fever and cough // ?pneumonia
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal
limits. No acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
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19955908-RR-20 | 19,955,908 | 23,511,709 | RR | 20 | 2176-03-09 10:08:00 | 2176-03-09 10:21:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with severe headache. Does not usually have HA. Also with L
eye pain with movement. // ?bleed or periorbital cellulitis
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: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is no evidence of fracture. There is mucosal thickening in the
bilateral maxillary sinuses, frontal sinuses and ethmoid air cells. The
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable. There is no periorbital stranding.
IMPRESSION:
1. No orbital cellulitis or acute intracranial process.
2. Mucosal thickening in the bilateral maxillary sinuses, frontal sinuses and
ethmoid air cells. Correlate clinically for sinusitis.
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19955908-RR-21 | 19,955,908 | 23,511,709 | RR | 21 | 2176-03-09 15:43:00 | 2176-03-09 17:06:00 | EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE
INDICATION: ___ man presenting with headache and fever with concern
for meningitis. Unsuccessful repeated bedside LP attempts in the emergency
department.
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A pre-procedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs.
Puncture was performed at L3-4.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 20 gauge, 15 cm spinal needle was inserted into
the thecal sac. There was good return of clear CSF. 17 mls of CSF were
collected in 4 tubes and sent for requested analysis.
Fluoroscopy time: 4 seconds
Air kerma: 2 mGy
Dose area product: 22.37 uGy m 2
COMPARISON: None.
FINDINGS:
17 mls of CSF were collected in 4 tubes.
IMPRESSION:
1. Lumbar puncture at L3-4 without complication.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
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19955908-RR-22 | 19,955,908 | 23,511,709 | RR | 22 | 2176-03-10 09:57:00 | 2176-03-10 10:45:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with ___ male with history of
hypertension, IVDU, and hepatitis C w/ HA, worsening L eye ptosis and impaired
sensation in the V1/V2 distribution of the trigeminal nerve // eval for
bleed/herniation
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.4 s, 18.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
954.0 mGy-cm.
Total DLP (Head) = 954 mGy-cm.
COMPARISON: ___ CT head without contrast
FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass efect. The ventricles and sulci are normal in size and configuration.
When compared to immediate prior examinations of ___, there is
interval increased left periorbital inflammatory is thickening and stranding,
compatible with cellulitis.
There is no evidence of fracture. There is stable moderate mucosal thickening
of the bilateral ethmoid sinuses and mild mucosal thickening of the bilateral
frontal and maxillary sinuses, as described in ___ study.
IMPRESSION:
1. There is no evidence of acute large territorial infarction, hemorrhage,
edema nor mass effect.
2. Interval increased left periorbital inflammatory stranding compatible with
cellulitis. Please refer to dedicated concurrent CT orbits for further
details.
3. Stable paranasal sinuses disease as described above.
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Subsets and Splits