note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
19955908-RR-23 | 19,955,908 | 23,511,709 | RR | 23 | 2176-03-10 09:58:00 | 2176-03-10 14:41:00 | EXAMINATION: CT ORBITS, SELLA AND IAC W/ AND W/O CONTRAST Q1216 CT HEADSUB
INDICATION: ___ year old man with ___ male with history
ofhypertension, IVDU, and hepatitis C w/ HA, worsening L eye ptosis (edema)
and ?impaired sensation in the V1/V2 distribution of the trigeminal nerve.
Vision Ok, pain with EOM // eval for orbital cellulitis
TECHNIQUE: After the intravenous administration of 90 mL of Omnipaque
contrast agent, 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 1.8 s, 13.9 cm; CTDIvol = 25.0 mGy (Head) DLP = 347.2
mGy-cm.
Total DLP (Head) = 347 mGy-cm.
COMPARISON: ___ CT head
FINDINGS:
There is edema and swelling of the left preseptal periorbital soft tissue.
Postseptal fat stranding and edema/phlegmon is also noted along the orbital
roof. The inflammation appears to be mostly localized to the
superior-medial-lateral extraconal regions with mass effect on the underlying
extraocular muscles. The left superior oblique muscle is displaced 4 mm
inferiorly when compared to the right superior oblique muscle on coronal view.
There is also a mild inflammatory stranding and thickening with lateral mass
effect along the medial orbital wall (is series 3, image 24). There is no
definitive evidence of inflammation or thickening of the left extraocular
muscles; however, faint fat stranding is seen within the intraconal region
suggesting intraconal extension of the inflammation. There is no evidence of
inflammation within the left globe.
Of note there is also a moderate to severe mucosal thickening of the adjacent
ethmoid sinus (left greater than right) that appears to have worsened when
compared to the ___ head CT. Although there is no obvious evidence of
sinus wall bony defect visible on the this CT, extension of sinusitis to the
left orbit cannot be excluded.
There is also mild mucosal thickening of the bilateral frontal, bilateral
sphenoid and bilateral maxillary sinuses.
The patient is status post right uncinectomy and partial ethmoidectomies. The
neo ostia is patent on the right. There is mucosal thickening and
opacification of the ostiomeatal units. There is no abnormal osseous
expansion or destruction of the infraorbital canal or supraorbital foramina.
The visualized skull-base foramina appear intact.
IMPRESSION:
1. Left preseptal and postseptal orbital cellulitis, not seen on prior
examination. The postseptal orbital inflammation/phlegmon is predominantly
localized to the superior-medial-lateral extraconal regions with mass effect
and inferior displacement of the underlying extraocular muscles, with
extension to the medial orbital wall. However, there is faint stranding seen
within the left intraconal region that is concerning for intraconal spread.
There is no evidence of left globe involvement.
2. No definite confluent collection to suggest abscess. These findings could
be better evaluated with dedicated MRI of the orbits.
3. There is moderate to severe sinus mucosal thickening most prominent in the
left ethmoid sinus that appears to have worsened when compared to the ___ study. Although there is no obvious evidence of sinus wall bony defect
visible on the this CT, extension of sinusitis to the left orbit cannot be
excluded. In the the appropriate clinical setting, may consider the
possibility of paranasal sinusitis as a potential source of infection and
orbital cellulitis.
|
19955908-RR-24 | 19,955,908 | 23,511,709 | RR | 24 | 2176-03-10 10:44:00 | 2176-03-10 15:20:00 | EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: ___ with HA and left eye pain, developed left eye swelling and
pain with movement overnight on vanc/ceftriaxone, concern for orbital
cellulitis vs. cavernous sinus thrombosis, please protocol for venous sinus
thrombosis
TECHNIQUE: Phase contrast MRV of the head was performed through the brain.
Sagittal and axial T1 weighted imaging were performed along with diffusion
imaging.
Axial FLAIR, T2 and T1 postcontrast sequences of the head obtained. Coronal
and axial 3 mm T1 precontrast as well as axial T1 and coronal T1 postcontrast
fat saturated sequences through the orbits. Coronal 3 mm STIR sequences of
the orbits also performed. 12 cc Gadavist.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images.
COMPARISON: Noncontrast head CT from ___.
CT orbits from ___.
FINDINGS:
MR BRAIN:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration.
The left orbit is proptotic. Adjacent T2 and FLAIR hyperintense signal in the
preseptal soft tissues is consistent with edema. On on axial T1 fat-sat
postcontrast images, asymmetric post septal enhancement within the retrobulbar
are fat of the left orbit abuts the optic nerve (19:12). There is extraconal
inflammatory stranding/phlegmon of the left medial orbit and roof, exerting
mass effect on the adjacent extra-ocular eye muscles. Mild inflammatory
enhancement of the left superior and medial rectus is noted. The globe itself
appears normal. Asymmetric pachymeningeal and leptomeningeal enhancement
superior to the orbit along the left frontal lobe is present without fluid
collection/empyema (19:1, 20:23, 20:15).
The left V1 nerve division passes through soft tissue edema superior to the
left orbit. There is no asymmetric FLAIR signal or enhancement of the V2
nerve division on coronal images. Possible asymmetric enhancement is seen on
axial images of the left V2 nerve division as it approaches the infraorbital
foramen although there is no evidence of abnormal enhancement in Meckel's
cave, the pterygopalatine fossa, foramen rotundum, or the Vidian canal
(19:16).
There is extensive sinus disease. For example, near complete opacification of
left ethmoid air cells with mucosal thickening of the right ethmoid, bilateral
sphenoid, bilateral maxillary, and bilateral frontal sinuses which enhance on
postcontrast images.
MRV brain: There is no evidence of cavernous or dural venous sinus
thrombosis. The intracranial flow voids are present and normal.
IMPRESSION:
1. Left orbital cellulitis with associated superficial soft tissue
inflammation and edema of the left face. There is abnormal enhancement and
inflammatory stranding of both the intra and extraconal fat. There is
inflammatory enhancement of the left superior and medial rectus as well as
superior oblique.
2. Extraconal inflammatory stranding/phlegmon of the orbital roof and medial
orbit exerts mild mass effect on the extraocular eye muscles without rim
enhancing collection to suggest abscess at this time.
3. Adjacent left frontal meningitis suggests intracranial extension of
infection without evidence of abscess or empyema.
4. No evidence of cavernous sinus thrombosis.
5. Extensive sinus disease, as described, a possible infectious source.
6. Left V1 and V2 nerve divisions pass near these periorbital inflammatory
changes, which may correlate to the patient's facial paresthesias. There is
questionable asymmetric enhancement of the left V2 nerve division, not
confirmed on coronal sequences.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:50 ___, 2 minutes after
discovery of the findings.
|
19955908-RR-25 | 19,955,908 | 23,511,709 | RR | 25 | 2176-03-11 16:09:00 | 2176-03-11 16:59:00 | INDICATION: ___ year old man with picc // s/p r 44cm picc ___ ___
Contact name: ___: ___
TECHNIQUE: Portable chest radiograph.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Right PICC line terminates in mid SVC. The lungs are clear. Hila and
pulmonary vascular are normal. No pleural effusion or pneumothorax. The
heart size is slightly enlarged likely due to the supine position. The
mediastinal silhouette is unchanged.
IMPRESSION:
Right PICC line terminates in mid SVC. Otherwise stable chest radiograph.
|
19955908-RR-27 | 19,955,908 | 23,511,709 | RR | 27 | 2176-03-12 11:36:00 | 2176-03-12 14:25:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/ CONTRAST Q1217 CT HEADSINUS
INDICATION: ___ year old man with orbital cellulitis, meningitis, and left
sinusitis, clinically worsening, considering surgery from ENT/ophtho.
Evaluate for interval change.
TECHNIQUE: After the intravenous administration of 90 mL of Omnipaque
contrast agent, 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 2.2 s, 17.1 cm; CTDIvol = 25.3 mGy (Head) DLP = 432.2
mGy-cm.
Total DLP (Head) = 432 mGy-cm.
COMPARISON: Contrast enhanced MR head from ___.
Contrast-enhanced CT orbits from ___.
FINDINGS:
Frontal sinus mucosal thickening with air-fluid levels is slightly increased
from ___. Opacification of the left ethmoid sinus and diffuse ethmoid
sinus mucosal thickening is slightly increased from ___ without definite
evidence of bony dehiscence although the adjacent lamina propecia is very
thin.
Bilateral maxillary sinus mucosal thickening is slightly increased from ___. The left ostiomeatal unit is occluded in the right ostiomeatal unit is
patent. Nasal septum is midline without spur. The sphenoid sinus septum is
midline with insertion upon the sellar floor.
Left orbial proptosis with retrobulbar fat stranding and adjacent soft tissue
preseptal edema and stranding increased from ___. No retrobulbar or
subperiosteal abscess is identified. Mass effect on and enhancement of the
superior and lateral rectus muscles appears overall unchanged.
Meningeal enhancement seen on MRI brain is not visualized on this examination
and there is no evidence of emphysema or intracranial abscess.
IMPRESSION:
1. Increased prominence of the left ethmoid, frontal, and maxillary sinus
sinusitis without definite bony dehiscence identified. This likely represents
an infectious source.
2. Persistent left orbital cellulitis with increased retrobulbar, preseptal,
and left facial inflammation, stable mass effect on the superior and lateral
rectus muscles, and no evidence of retrobulbar or periosteal abscess.
3. Meningeal enhancement seen on previous MRI is not well demonstrated on this
study. There is no evidence of intracranial abscess or empyema.
4. Left superior ophthalmic vein is normal in size and there is symmetric
appearance of cavernous sinuses.
|
19955908-RR-28 | 19,955,908 | 23,511,709 | RR | 28 | 2176-03-16 21:33:00 | 2176-03-16 23:30:00 | EXAMINATION: MR ORBIT ___ ANDW/O CONTRAST T9123 MR ___
INDICATION: Resolving sinusitis and orbital cellulitis with extension to the
meninges. Evaluate for interval change and for abscess.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 14 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. Orbit images acquired at 3 mm slice thickness. Precontrast
sequences included axial and coronal T1, coronal STIR. Postcontrast sequences
included axial and coronal T1 with fat saturation.
COMPARISON: CT sinus ___. MRI and MRA brain ___. CT
orbits ___. Noncontrast head CT ___ and ___.
FINDINGS:
MRI ORBITS: Compared the prior MR examination, there has been progression of
left-sided proptosis. There has been progression of left orbital cellulitis,
with increasing edema and enhancement of the intraconal fat. Again, there is
extension of inflammatory fat stranding and enhancement abutting the optic
nerve, with edema and enhancement of the optic nerve sheath. There is
extraconal extension of inflammatory fat stranding and enhancement with
similar degree of periorbital soft tissue involvement. There is involvement
of the left superior and medial rectus and superior oblique musculature. The
left globe itself is unremarkable.
There has been interval progression of left frontal pachymeningeal
enhancement, with a new 8 x 6 mm left frontal epidural rim enhancing fluid
collection (17:1).
Again, there is extensive paranasal sinus disease with moderate left and mild
right frontal sinus mucosal thickening, near complete opacification of the
left-sided ethmoid air cells, and moderate mucosal thickening in the right
ethmoid air cells, opacification of the right frontoethmoidal recess, and mild
mucosal wall thickening in the bilateral maxillary sinuses which demonstrate
enhancement. There are postsurgical changes from right ethmoidectomy and
maxillary antrostomy. Extent of paranasal sinus disease appears mildly
progressed compared the prior MR examination.
There is no evidence of cavernous sinus thrombosis.
The right orbit and preseptal soft tissues are unremarkable. The right globe
is normal. The right optic nerve complex appears normal. The right
extraocular muscles are normal. The right lacrimal apparatus is normal. The
right retrobulbar soft tissues are normal.
MRI BRAIN: There is left frontal pachymeningeal thickening and enhancement as
well as a small epidural abscess, as described above. There is no evidence of
hemorrhage, edema, masses, mass effect, midline shift or infarction. The
ventricles and sulci are normal in caliber and configuration.
IMPRESSION:
1. Progressive left orbital cellulitis with worsening proptosis and
periorbital extension with involvement of the extraocular musculature and left
optic nerve, as described.
2. Progressive left frontal pachymeningeal thickening and enhancement
consistent with meningitis from direct extension of orbital cellulitis with
interval development of an 8 x 6 mm epidural abscess.
3. Progressive extensive paranasal sinus disease, the likely infectious
source.
4. No evidence of cavernous sinus thrombosis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 23:28, 5 minutes after
discovery of the findings.
|
19956148-RR-20 | 19,956,148 | 22,450,853 | RR | 20 | 2146-07-16 14:47:00 | 2146-07-16 16:42:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ smoker s/p R subclavian stent axillary PTA p/w R ___ ___
finger pain, weakness, and discoloration, CTA shows partial SC stent
thrombosis, vertebral a. stenosis // upper extremity PVRs and digital
pressures
TECHNIQUE: Noninvasive evaluation of the arterial system of the upper
extremities was performed with Doppler signal recording and pulse volume
recordings.
COMPARISON: None
FINDINGS:
On the right side, monophasic Doppler waveforms were seen at the right
brachial, radial and ulnar arteries.
On the left side, triphasic Doppler waveforms is seen in the left brachial and
radial arteries. Monophasic Doppler waveforms are noted in the left ulnar
artery.
Pulse volume recordings are symmetric in the digits.
IMPRESSION:
Monophasic Doppler waveforms in the right brachial, radial and ulnar arteries.
|
19956148-RR-21 | 19,956,148 | 25,462,122 | RR | 21 | 2146-11-24 11:32:00 | 2146-11-24 12:20:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ with reported history of dysfunctional uterine bleeding s/p
procedure 3 wks prior (patient cannot recall if was D C vs embolization, but
no reported pregnancy history, was done at ___ now w/ 2 wks
progressively heavier uterine bleeding, small clots, mild ttp on exam LQ
abdomen // evaluate for AVM, abnormal uterine stripe, pelvic free fluid.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: None.
FINDINGS:
The uterus is anteverted and measures 7.8 x 3.6 x 3.7 cm. The endometrium is
slightly distorted but where seen appears homogenous and measures 2 mm.
The ovaries are not visualized. In the right adnexa there is a 6.5 x 7.0 x
7.4 cm cystic structure with no appreciable internal flow on color Doppler.
There is no free fluid.
IMPRESSION:
1. 7.4 cm cystic structure in the right adnexa. Clinical correlation and
correlation with outside imaging is recommended. Pelvic MRI may be obtained
to further assess if clinically warranted.
2. Ovaries not visualized.
|
19956148-RR-22 | 19,956,148 | 25,462,122 | RR | 22 | 2146-11-25 11:37:00 | 2146-11-25 16:18:00 | EXAMINATION: MRI of the Pelvis
INDICATION: ___ year old woman with pelvic mass, please characterize.
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: 11 mL Gadavist.
COMPARISON: Pelvic ultrasound ___.
FINDINGS:
UTERUS AND ADNEXA:
The uterus is midline and measures 8.1 x 3.6 x 4.5 cm.
The endometrium is normal in thickness for age and measures 2-3 mm.
The junctional zone is not thickened.
Arising from the right ovary is a large simple cyst measuring 8.0 x 7.2 cm.
No enhancing septations or mural nodularity is identified. The left ovary is
normal in appearance and contains small follicles.
No pelvic free fluid.
LYMPH NODES: No pelvic sidewall or inguinal lymphadenopathy.
BLADDER AND DISTAL URETERS: Bladder is grossly normal.
RECTUM AND INTRAPELVIC BOWEL: Visualized loops of small and large bowel are
within normal limits.
VASCULATURE: Visualized vasculature within the pelvis is patent.
OSSEOUS STRUCTURES AND SOFT TISSUES: No acute or aggressive osseous lesions
are demonstrated.
IMPRESSION:
8.0 x 7.2 cm simple cyst arising from the right ovary, as seen on recently
performed pelvic ultrasound. No concerning features are identified.
Followup-up ultrasound in ___ weeks is recommended to assess for any change in
size. If this cyst persists and further imaging surveillance is desired, a
follow-up pelvic MRI in ___ months could be considered.
RECOMMENDATION(S): Pelvic ultrasound in ___ weeks time.
|
19956148-RR-23 | 19,956,148 | 25,462,122 | RR | 23 | 2146-11-25 10:02:00 | 2146-11-27 12:08:00 | Study arterial duplex upper extremity
Reason stent
Findings. Duplex evaluation was performed starting in the proximal subclavian
artery velocities are 80, 109, 225, 118, 108
Velocities in the axillary brachial radial and ulnar are normal.
There is a PSV step-up of 2 in the subclavian stent consist with a greater
than 50% stenosis.
Impression patent right subclavian stent with greater than 50% stenosis.
|
19956148-RR-24 | 19,956,148 | 25,462,122 | RR | 24 | 2146-11-25 10:22:00 | 2146-11-26 17:01:00 | Study arterial extremity
Reason stenosis
Findings Doppler evaluation was performed of the upper extremity. The forearm
and wrist pulse volume recordings are normal. There is slight decrease in
flow to the right second and third digits the left upper extremity flow is
normal.
Impression mild decrease in flow to the right second and third digits. No
obvious macro vascular disease
|
19956148-RR-30 | 19,956,148 | 26,535,791 | RR | 30 | 2148-02-05 10:47:00 | 2148-02-05 16:21:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old woman with LUE finger cyanosis and a hx of R SC
stenting. Please obtain segmental pressures and digit waveforms// ? arterial
insufficiency
TECHNIQUE: Noninvasive evaluation of the arterial system of the upper
extremities was performed with Doppler signal recordings, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: None
FINDINGS:
Monophasic Doppler waveforms were noted in the subclavian, brachial, radial
and ulnar arteries bilaterally.
Pulse volume recordings in the upper arm and wrist showed decreased amplitudes
bilaterally. Waveforms were not detected of the level of the second digit of
the left hand.
IMPRESSION:
Monophasic waveforms in the subclavian arteries bilaterally indicating inflow
arterial insufficiency.
Decreased waveforms in the second digit of the left hand indicating
significant arterial insufficiency.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:18 pm, at the time of
discovery of the findings.
|
19956148-RR-31 | 19,956,148 | 26,535,791 | RR | 31 | 2148-02-05 10:47:00 | 2148-02-05 16:10:00 | EXAMINATION: ART DUP EXT UP UNI OR LMTD LEFT
INDICATION: ___ yo woman with known hyperoagulable state and RUE stenting now
p/w L digit ischemia// ? arterial insufficiency
TECHNIQUE: The left upper extremity arterial system was evaluated with
B-mode, color and spectral Doppler ultrasound.
COMPARISON: None
FINDINGS:
The left upper extremity arterial system is patent with monophasic Doppler
waveforms throughout.
The peak systolic velocity in the proximal left subclavian artery is 115
centimeters/second. The peak systolic velocity in the distal left subclavian
artery is 349 cm/sec. The peak systolic velocity in the left axillary artery
is 353 cm/sec. Peak systolic velocity in the left brachial artery range
between 63 and 134 cm/sec. The peak systolic velocity in the left ulnar
artery 72 cm/sec. The peak systolic velocity in the left radial artery is 63
cm/sec.
IMPRESSION:
Patent left upper extremity arterial system with peak systolic velocities as
described above.
Elevated peak systolic velocities in the distal left subclavian artery and
left axillary artery indicating areas of focal stenosis.
|
19956148-RR-32 | 19,956,148 | 26,535,791 | RR | 32 | 2148-02-05 10:47:00 | 2148-02-05 11:48:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with thromboembolic syndrome presents with PE//
Rule out lower extremity DVT's bilaterally
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None available
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19956148-RR-40 | 19,956,148 | 20,176,110 | RR | 40 | 2149-01-19 18:27:00 | 2149-01-19 19:40:00 | EXAMINATION: CTA left upper extremity
INDICATION: ___ year old woman with decreased radial and ulnar pulses in the
left wrist and with a cyanotic left index finger.// Evaluate for clot or
arterial injury
TECHNIQUE: Multidetector CT axial images were obtained of the left upper
extremity with the arm in race position within without contrast as well as
delayed phase imaging in the distal left upper extremity with coronal and
sagittal MIP reconstructions.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.2 s, 79.5 cm; CTDIvol = 2.3 mGy (Body) DLP = 180.5
mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 12.2 mGy (Body) DLP =
6.1 mGy-cm.
3) Spiral Acquisition 9.9 s, 77.6 cm; CTDIvol = 5.4 mGy (Body) DLP = 416.3
mGy-cm.
4) Spiral Acquisition 5.5 s, 43.4 cm; CTDIvol = 3.3 mGy (Body) DLP = 143.4
mGy-cm.
Total DLP (Body) = 746 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULATURE:
There is an acute thrombus in the left distal subclavian artery extending into
the left axillary artery measuring up to 2.7 cm and length with distal
reconstitution of flow. No significant atherosclerotic disease (602; 19).
The brachial artery, deep artery of the arm, and radial and ulnar arteries are
patent without evidence of occlusion or stenosis.
A stent is noted in the proximal right subclavian artery which appears patent.
An IV catheter is noted in the left aspect of the wrist.
MUSCLES AND SOFT TISSUES:
No fatty atrophy. No significant soft tissue stranding.
BONES: No acute fracture or dislocation. No joint effusion is noted in the
left elbow or glenohumeral joint. Mild degenerative changes are noted in the
left glenohumeral joint. No suspicious osseous lesions are identified.
VISUALIZED CHEST: Visualized bilateral lungs appear clear. Prominent left
axillary lymph node measures up to 0.9 cm in short axis (4; 20). No
supraclavicular lymphadenopathy visualized. Prominent AP window lymph node
measures 9 mm in short axis (4; 20).
VISUALIZED HEAD AND NECK: The thyroid is atrophic. Mild-to-moderate
atherosclerotic calcifications are noted in the bilateral carotid bifurcation,
right greater than left. Visualized paranasal sinuses and left mastoid air
cells are clear. No abnormalities were noted in the visualized portions of
the head.
IMPRESSION:
1. Acute thrombus in the left distal subclavian artery extending to the left
axillary artery over a 2.7 cm segment with distal reconstitution of flow and
patent distal arteries.
2. Prominent left axillary lymph nodes are noted, likely reactive.
NOTIFICATION: The findings were discussed with Dr. ___. by ___,
M.D. on the telephone on ___ at 7:24 pm, 5 minutes after discovery of the
findings.
|
19956148-RR-41 | 19,956,148 | 20,176,110 | RR | 41 | 2149-01-20 12:57:00 | 2149-01-21 11:56:00 | EXAMINATION: ART EXT (REST ONLY)
CLINICAL HISTORY ___ year old woman with ___ h/o subclavian thromboembolism
s/p R subclavian stent and L subclavian ___ p/w 3 days cyanotic L
index finger, decreased radial/ulnar signals, now with LLE pain// evaluate LLE
vessel runoff evaluate LLE vessel runoff
FINDINGS:
Doppler waveform analysis reveals monophasic waveforms throughout bilateral
lower extremities. Resting ABIs are 0.9 on the right and 0.7 on the left.
Toe pressures are 50 on the right and 17 on the left.
Pulse volume recordings demonstrate somewhat dampened waveforms in the thigh
bilaterally. On the right there is appropriate calf augmentation and minimal
further dampening below this. On the left there is further dampening at the
calf level and a nearly flat trace at the ankle and metatarsal.
IMPRESSION:
Bilateral multilevel arterial occlusive disease worse on the left than the
right.
|
19956204-RR-27 | 19,956,204 | 25,990,857 | RR | 27 | 2118-03-11 13:19:00 | 2118-03-11 14:57:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ F with PMH HTN, COPD, afib not on AC, HLD and LLL lobectomy in
___ for stage IA lung cancer who presents for shortness of breath, found to
have sepsis secondary to CAP and COPD exacerbation.// eval for PNA, malignancy
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent and reconstructed as contiguous 5 mm and 1.25 mm
thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.6 s, 33.1 cm; CTDIvol = 3.8 mGy (Body) DLP = 121.1
mGy-cm.
Total DLP (Body) = 130 mGy-cm.
COMPARISON: Prior Chest CTs dated ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Multiple enlarged mediastinal lymph nodes are present. An
aortopulmonary window lymph node measures up to 1.2 cm in short axis (5:100).
A precarinal lymph node measures up to 1.5 cm in short axis (5:108). A
subcarinal lymph node measures up to 1.4 cm in short axis (5:123).
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is extensive severe coronary
arterial calcification. There is trace pericardial effusion. Relative
hypodensity of the blood pool is consistent with anemia.
VESSELS: There is a common origin of the right brachiocephalic artery and the
left common carotid artery, a normal anatomic variant. Aortic caliber is
normal. The main, right, and left pulmonary arteries are normal caliber.
PULMONARY PARENCHYMA: There is extensive airspace opacification of the left
upper lobe, particularly inferiorly with minimal residual aerated lung at the
left apex where there is smooth interlobular septal thickening. Patchy areas
of airspace consolidation are noted within the right lung as well, unchanged
at the apex (___), and new in the posterior right upper lobe (5:121),
superior segment of the right lower lobe (5:135), and posteriorly within the
right lower lobe (5:223). Patient is status post left lower lobectomy with
expected postsurgical changes and volume loss. There is severe underlying
centrilobular emphysema.
AIRWAYS: There is focal airway occlusion involving the left lower lobe
bronchus due to mucous impaction (5:123). Mucous impaction of a right middle
lobe bronchus leads to subsegmental atelectasis of portions of the right
middle lobe (5:208), still overall substantially improved from the prior study
which time the entire right middle lobe bolus atelectatic.
PLEURA: There small pleural effusions bilaterally.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is unremarkable.
IMPRESSION:
1. Extensive airspace opacity of the remaining left upper lobe following left
lower lobectomy, likely a combination of postobstructive consolidation and
postobstructive atelectasis due to mucus plugging within the left lobe
bronchus.
2. Patchy areas of airspace opacity on the right likely represent additional
sites of infection, associated with reactive mediastinal lymphadenopathy.
3. Mucous impaction within the right middle lobe causing a small amount of
subsegmental collapse, overall substantially better aerated when compared with
the prior study.
4. Areas of smooth interlobular septal thickening suggesting concurrent volume
overload.
5. Severe centrilobular emphysema.
|
19956204-RR-28 | 19,956,204 | 25,990,857 | RR | 28 | 2118-03-14 08:57:00 | 2118-03-14 09:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with acute hypoxia// evaluate for PTX
evaluate for PTX
IMPRESSION:
Comparison to ___. There is a new extensive subtotal atelectasis of
the left lung, with leftward cardiac and mediastinal shift. No change in
appearance of the slightly overinflated right lung.
|
19956204-RR-29 | 19,956,204 | 25,990,857 | RR | 29 | 2118-03-14 12:01:00 | 2118-03-14 14:18:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with acute hypoxia// r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence: 1) Spiral Acquisition 2.9 s, 37.7 cm; CTDIvol =
2.5 mGy (Body) DLP = 93.3 mGy-cm. 2) Stationary Acquisition 0.6 s, 0.5 cm;
CTDIvol = 1.5 mGy (Body) DLP = 0.8 mGy-cm. 3) Stationary Acquisition 2.4 s,
0.5 cm; CTDIvol = 6.2 mGy (Body) DLP = 3.1 mGy-cm. Total DLP (Body) = 97
mGy-cm.
COMPARISON: CT chest ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defects to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber. 2 areas of ulcerative plaque are
noted in the distal thoracic aorta (301: 173 and 168) which were probably
present on the study from ___ however difficult to definitely
compare due to motion artifact on prior study. There is no evidence of
dissection or intramural hematoma. The heart, pericardium, and great vessels
are within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: Bilateral
small pleural effusions, greater on the right. There is no pneumothorax.
LUNGS/AIRWAYS: Postsurgical changes from left lower lobectomy. Since 2 days
prior there has been progression of left lung volume loss and consolidative
opacities with some patchy areas of hypodensity within the lung parenchyma.
Also progressed is consolidation in the right lower lobe (301:16 is)
associated with worsening bronchial wall thickening and mucous plugging.
Distal consolidation in the right lower lobe, right upper lobe at the apex and
right middle lobes are similar. Hypoattenuating material within the distal
left mainstem bronchus and left upper lobe completely occludes the airway.
Severe centrilobular emphysema unchanged
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Within the stomach there are 2 areas of hyperdensity along the
mucosal wall. There is no noncontrast CT prior to these to evaluate for
hyperdense material versus bleed. Otherwise the included portions of the
abdomen are unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic dissection. 2 ulcerating
plaques noted in the descending thoracic aorta.
2. Bilateral aspiration pneumonia,, particularly worsened on the left, where
there is further volume loss of the left upper lobe by obstructing material in
the distal left mainstem bronchus and left upper lobe bronchus.
3. Bilateral small pleural effusions, greater on the right.
4. Two hyperdense areas within the stomach. These could represent ingested
hyperdense material or bleed into the stomach- distinguishing one from the
other is limited due to lack of a non-contrast study. No other areas
suspicious for active extravasation. If not known, an enteric tube can be
placed to look for henorrhagic gastric contents.
NOTIFICATION: The findings were discussed with ___. by
___, M.D. on the telephone on ___ at 2:14 pm, 15 minutes
after discovery of the findings.
|
19956599-RR-14 | 19,956,599 | 26,733,373 | RR | 14 | 2124-09-19 10:58:00 | 2124-09-19 13:54:00 | CLINICAL INDICATION: Respiratory distress. Compare with outside hospital
film.
COMPARISON: None available at the time of dictation.
PORTABLE UPRIGHT FRONTAL VIEW OF THE CHEST: There are diffuse reticulonodular
opacities concerning for pulmonary edema. A component of underlying fibrosis
is possible. The costophrenic angles are blunted suggestive of small
bilateral pleural effusions. The cardiac and mediastinal contours are normal.
There is no pneumothorax. There is no free air beneath the right
hemidiaphragm. There is no acute osseous abnormality.
|
19956599-RR-17 | 19,956,599 | 26,733,373 | RR | 17 | 2124-09-20 18:35:00 | 2124-09-20 19:01:00 | HISTORY: ___ female with worsening tachypneic.
COMPARISON: Chest radiograph dated ___ at ___.
FINDINGS:
Portable chest radiograph demonstrates interval development of moderate
pulmonary edema as demonstrated by increased interstitial fluid and central
vascular congestion. Mild cardiomegaly is unchanged. Small bilateral pleural
effusions are increased in size. There is no pneumothorax. An old left
healed clavicular fracture is once again identified.
IMPRESSION:
Interval development of moderate pulmonary edema.
|
19956599-RR-18 | 19,956,599 | 26,733,373 | RR | 18 | 2124-09-21 04:24:00 | 2124-09-21 09:58:00 | HISTORY: ___ female with pulmonary edema being diuresed. Evaluate
for interval change.
COMPARISON: Chest radiograph dated ___ at 18 35.
FINDINGS:
Portable chest radiograph demonstrates improved vascular plethora and
decreased interstitial fluid consistent with overall improved pulmonary edema.
Bilateral small pleural effusions are mildly increased in size. Mild
cardiomegaly is unchanged. The right minimally enlarged hila is unchanged.
Redemonstration of old left healed clavicular fracture.
IMPRESSION:
Improved pulmonary edema with stable mild cardiomegaly.
|
19956654-RR-44 | 19,956,654 | 27,367,095 | RR | 44 | 2138-01-24 13:33:00 | 2138-01-24 16:20:00 | EXAMINATION: PA and lateral chest x-ray.
INDICATION: A ___ man with dyspnea and crackles at the left base,
evaluate for pneumonia or pulmonary edema.
TECHNIQUE: PA and lateral projections, upright positioning.
COMPARISON:
1. Chest ___.
2. Chest CT ___.
FINDINGS:
There is stable mild enlargement of the cardiac silhouette. The mediastinal
silhouette is within normal limits. The trachea is midline. Aortic arch
calcifications are noted. Linear opacities in the left lung likely reflect
post treatment lung parenchymal changes, as seen on prior exams. Linear
opacities within the right lower lung likely reflect minimal atelectasis.
There is no focal lung consolidation or pulmonary vascular congestion. There
is no pleural effusion. There is no pneumothorax. There is mild anterior
wedging of a lower thoracic vertebral body, grossly unchanged from prior CT.
IMPRESSION:
No acute cardiopulmonary process.
|
19956654-RR-45 | 19,956,654 | 27,367,095 | RR | 45 | 2138-01-24 13:21:00 | 2138-01-24 14:28:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: A ___ man with a history of lung cancer and renal cell
carcinoma, here with confusion and headaches, evaluate for evidence of
metastases or intracranial bleed.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm.
CTDI: 52.86 mGy.
COMPARISON: MRI brain ___.
FINDINGS:
There is no hemorrhage, acute large vascular territorial infarct, or brain
edema. There is preservation of gray-white matter differentiation. There is
no shift of normally midline structures. The basal cisterns are patent.
Prominence the ventricles and sulci is compatible with age related
involutional change. Periventricular and subcortical white matter confluent
hypodensities are likely the sequelae of chronic small vessel ischemia.
Bilateral intracranial carotid artery calcifications are noted. The visualized
paranasal sinuses and mastoid air cells are clear. The patient is status post
bilateral lens removal. Otherwise, the globes and bony orbits are intact.
There is no fracture.
IMPRESSION:
No acute intracranial process. Of note, MRI is more sensitive for the
detection of small intracranial lesions.
|
19956654-RR-47 | 19,956,654 | 27,367,095 | RR | 47 | 2138-01-25 17:16:00 | 2138-01-25 22:40:00 | EXAMINATION: MRI AND MRA BRAIN
INDICATION: ___ year old man with hx of limited-stage small cell CA s/p
chemoradiation and prophylactic whole brain radiation in ___. now having
acute to subacute cognitive changes including word-finding difficulties.
working up for stroke, metastatic disease, and seizures // eval for mass
lesion or stroke
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
Sagittal and axial T1 weighted imaging were performed along with diffusion
imaging. After administration of 9cc of Gadavist intravenous contrast, axial
imaging was performed with gradient echo, FLAIR, T2, and T1 technique.
Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal
orientations. Three dimensional maximum intensity projection and segmented
images were generated. This report is based on interpretation of all of these
images.
COMPARISON: CT head without contrast ___
FINDINGS:
MRI head: There is no intra or extra-axial mass, acute hemorrhage or infarct.
Sulci, ventricles and cisterns are within expected limits given the degree of
age-appropriate global cerebral volume loss. Bilateral cerebellar hemispheric
encephalomalacia is noted, presumably from prior infarct. No abnormal
enhancement. The major intracranial flow voids are preserved. The dural venous
sinuses are patent. There are confluent periventricular and subcortical
T2/FLAIR white matter hyperintensities, which are nonspecific, but commonly
seen in setting of small vessel ischemic disease in a patient of this age,
corresponding to diffuse hypointensity seen on earlier CT examination.
Other: On both MPRAGE and T1 sagittal sequences, there is a large left
paracentral disc protrusion which contacts and effaces the left ventral aspect
of the cord at C3-4 (series 1002b, image 4 and series 3, image 12). This
results in moderate spinal canal narrowing. In addition, there is associated
linear enhancement at this level (series 1002b, image 7) likely venous in
nature.
MRA head: Mild atherosclerotic narrowing of the right internal carotid artery.
Otherwise, the major intracranial arteries appear normal with no evidence of
stenosis, occlusion, or aneurysm formation. The right vertebral artery is
dominant.
IMPRESSION:
1. No evidence of intracranial metastatic disease.
2. No intracranial hemorrhage or infarct. White matter changes compatible
with small vessel ischemic disease.
3. Bilateral cerebellar hemisphere encephalomalacia.
4. Essentially unremarkable MRA of the head.
5. On MPRAGE in T1 sagittal sequences, there is a large left paracentral disc
protrusion at C3-4 which results in moderate spinal canal narrowing and
effacement of the ventral aspect of the cord. This may be further evaluated
with dedicated MRI of the cervical spine as clinically indicated.
|
19956723-RR-134 | 19,956,723 | 27,397,573 | RR | 134 | 2194-11-21 10:39:00 | 2194-11-21 15:01:00 | INDICATION: ___ man with shortness of breath, question CHF.
COMPARISONS: PA and lateral chest radiograph from ___.
FINDINGS: PA and lateral chest radiographs were provided. Compared to the
most recent prior radiograph there is no significant change. Patient is
rotated. There is subtle opacity at the right lung base which is most likely
scarring. There is no focal consolidation, pleural effusion or pneumothorax.
The cardiomediastinal silhouette is stable.
IMPRESSION: No significant change from prior study.
|
19956723-RR-136 | 19,956,723 | 27,397,573 | RR | 136 | 2194-11-21 18:13:00 | 2194-11-22 08:31:00 | HISTORY: Endotracheal tube placement.
FINDINGS: In comparison with the earlier study of this date, the tip of the
endotracheal tube measures approximately 4 cm above the carina. Obliquity of
the patient makes it difficult to evaluate the heart and lungs, but there is
no definite change from the prior examination.
|
19956723-RR-137 | 19,956,723 | 27,397,573 | RR | 137 | 2194-11-22 02:53:00 | 2194-11-22 09:06:00 | HISTORY: For ET tube position.
FINDINGS: In comparison with the study of ___, there is continued obliquity
of the patient. Tip of the endotracheal tube measures approximately 4.5 cm
above the carina. There is suggestion of some slight increased engorgement of
the pulmonary vessels, raising the possibility of a mild increase in pulmonary
venous pressure.
|
19956723-RR-138 | 19,956,723 | 27,397,573 | RR | 138 | 2194-11-21 23:47:00 | 2194-11-22 00:46:00 | HISTORY: ___ male presenting with stridor, now intubated. Evaluation
for neck mass or external airway compression causing stridor.
COMPARISON: Chest CT from ___, and cervical spine CT from ___.
TECHNIQUE: ___ MDCT-acquired axial images from the skull base to the thoracic
inlet were displayed with 2.5-mm slice thickness. Intravenous contrast was
administered. Coronal and sagittal reformations were prepared.
CT NECK WITH INTRAVENOUS CONTRAST: The endotracheal tube terminates 3.3 cm
above the level of the carina. Evaluation of the base of tongue and
oropharynx is limited due to mass effect from the adjacent tube. However, no
definite mass-lesion is identified. Simple fluid lines the posterior
nasopharynx and oropharynx and anterior and posterior laryngopharynx, likely
secondary to recent intubation. No enhancing mass lesion is identified in the
neck that would be causing extrinsic mass compression.
A nasogastric catheter enters the esophagus, though the tip is incompletely
imaged on this examination. Scattered small cervical chain lymph nodes are
identified though none meet CT size criteria for pathologic enlargement. The
salivary glands are unremarkable. The neck vessels enhance bilaterally
without significant stenosis or occlusion. The thyroid gland is homogeneous
without focal nodule. There is moderate paraseptal emphysema, otherwise, the
lung apices are clear. The visualized paranasal sinuses and mastoid air
cells are well aerated. Multilevel degenerative changes of the cervical spine
appear unchanged compared to prior examination from ___. There is
atheroscelrotic disease noted involving the carotid bifurcations and cavernous
segments.
Small foci of gas in the right IJV from injection noted.
IMPRESSION:
1. Simple fluid lining the posterior ___-, oro-, and laryngopharynx, and
anterior laryngopharynx, findings likely secondary to recent intubation. No
compressive extrinsic enhancing mass lesion to explain patient's stridor.
However,a ssessment for endoluminal lesions or abnormalities is limited due to
intubation. Follwoup as clinically indicated.
3. Endotracheal tube in standard position, 3.3 cm above the carina.
4. Mild paraseptal emphysema in the lung apices.
5. Stable degenerative changes of the cervical spine.
|
19956723-RR-139 | 19,956,723 | 27,397,573 | RR | 139 | 2194-11-23 01:52:00 | 2194-11-23 09:37:00 | AP CHEST, 1:47 A.M., ___
HISTORY: Stridor. Intubated.
IMPRESSION: AP chest compared to ___:
Previous pulmonary edema has resolved. Lungs are well expanded and aside from
mild atelectasis at the right base essentially clear. Heart size is normal.
No pleural effusion or pneumothorax. ET tube is in standard placement.
Nasogastric tube passes into the stomach and out of view. The upper airway
cannot be assessed because of the indwelling endotracheal tube.
|
19956723-RR-140 | 19,956,723 | 27,397,573 | RR | 140 | 2194-11-23 12:12:00 | 2194-11-23 13:09:00 | AP CHEST, 12:18 P.M., ___
HISTORY: Stridor. No evidence of obstruction.
IMPRESSION: AP chest compared to ___:
Endotracheal tube is in standard placement. I cannot assess the condition of
the airway above the cuff on the endotracheal tube. Nasogastric tube passes
into the stomach. Heart size normal. Heterogeneous opacification in the
right lower lobe could be aspiration, since it is more pronounced now than on
the earlier study. Healed right posterior rib fractures are noted.
|
19956723-RR-141 | 19,956,723 | 27,397,573 | RR | 141 | 2194-11-24 10:49:00 | 2194-11-24 11:51:00 | PORTABLE CHEST, ___.
COMPARISON: ___ chest x-ray.
FINDINGS: Recently described right lower lobe opacity has nearly resolved.
Rapid improvement favors aspiration or atelectasis as a likely etiology.
Cardiomediastinal contours are stable in appearance. Indwelling nasogastric
tube and endotracheal tube are unchanged in position.
|
19956723-RR-142 | 19,956,723 | 27,397,573 | RR | 142 | 2194-11-25 03:12:00 | 2194-11-25 08:48:00 | HISTORY: Difficulty breathing, to assess for aspiration.
FINDINGS: In comparison with the study of ___, the monitoring and support
devices remain in place. Again there is some obliquity of the patient making
it difficult to evaluate the heart and lungs. Minimal if any residual
bibasilar opacification. Mild indistinctness of pulmonary vessels could
reflect some mild elevation in pulmonary venous pressure.
|
19956723-RR-143 | 19,956,723 | 27,397,573 | RR | 143 | 2194-11-26 02:53:00 | 2194-11-26 20:01:00 | AP CHEST, 3:18 A.M., ___
HISTORY: Stridor. Vocal cord paralysis. Assess interval change.
IMPRESSION: AP chest compared to ___:
There has been no change over the past several days. One is unlikely to see
the cause of stridor on conventional chest radiographs, particularly
tracheostomy tube in standard placement. Heart is top normal size. Lungs are
low in volume but aside from basal atelectasis, clear of any focal
abnormality. There is no pulmonary edema or appreciable pleural effusion.
Healed right upper rib fracture is noted. No pneumothorax.
|
19956723-RR-144 | 19,956,723 | 27,397,573 | RR | 144 | 2194-11-25 12:26:00 | 2194-11-25 13:45:00 | CHEST RADIOGRAPH
INDICATION: Status post tracheostomy, assessment for tube placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has received a
tracheostomy tube. The previously placed endotracheal tube was removed. The
tracheostomy tube appears to be in correct position. There is no evident
complication, notably no pneumothorax. Unchanged appearance of the cardiac
silhouette. Unchanged appearance of the lung parenchyma.
|
19956723-RR-145 | 19,956,723 | 27,397,573 | RR | 145 | 2194-11-27 03:26:00 | 2194-11-27 10:40:00 | HISTORY: Tracheostomy.
FINDINGS: In comparison with the study of ___, there are lower lung
volumes. Tracheostomy tube is again in place without evidence of
complication. No change in the appearance of the heart and lungs, with mild
basilar atelectasis.
|
19956723-RR-147 | 19,956,723 | 27,397,573 | RR | 147 | 2194-11-27 19:07:00 | 2194-11-28 10:05:00 | AP CHEST, 7:06 P.M., ___.
HISTORY: ___ man with tracheostomy and increasing secretions. Rule
out pneumonia.
IMPRESSION: AP chest compared to ___:
A new C-shaped region of opacity in the left lower lung accompanied by more
elevation of the left hemidiaphragm is atelectasis. Volume in the right lung
has also decreased. There is greater distention of mediastinal vasculature
and a slight increase in cardiac caliber, but no pulmonary edema. Pleural
effusions are small if any. Multiple healed right rib fractures noted.
Tracheostomy tube in standard placement.
|
19956723-RR-148 | 19,956,723 | 27,397,573 | RR | 148 | 2194-11-27 19:07:00 | 2194-11-28 15:31:00 | INDICATION: Recent tracheostomy with increasing secretions and distended
abdomen.
COMPARISONS: None.
TECHNIQUE: Three images of the abdomen reveal distended small loops of bowel
measuring up to 6 cm consistent with an ileus. There are no air-fluid levels
or free air present. A right hip prosthesis is noted. Bibasilar atelectasis
is present.
IMPRESSION: Distended small loops of bowel consistent with an ileus.
|
19956723-RR-150 | 19,956,723 | 27,397,573 | RR | 150 | 2194-11-28 17:31:00 | 2194-11-29 09:12:00 | REASON FOR EXAMINATION: Evaluation of the patient with new PICC line
placement.
AP chest radiograph was reviewed in comparison to ___.
The right PICC line coursing into the neck and head, and should be
repositioned. The cardiomediastinal silhouette and appearance of the lungs is
otherwise unchanged since the prior study.
Findings were discussed with Dr. ___ by phone at 7 p.m. on ___
by Dr. ___.
|
19956723-RR-151 | 19,956,723 | 27,397,573 | RR | 151 | 2194-11-29 13:33:00 | 2194-11-29 14:35:00 | SINGLE PORTABLE VIEW
REASON FOR EXAM: Assess Dobbhoff.
Comparison is made with prior study, ___.
This examination was focused at the thoracoabdominal junction. The Dobbhoff
tube tip is distal to the GE junction, should be advanced for more standard
position. Cardiac size is normal. The apices of the lungs were not included
on the film. Bibasilar lung aeration has improved from ___. Several
right old rib fractures are again noted. There is moderate distention of
bowel loops in the upper abdomen.
|
19956723-RR-152 | 19,956,723 | 27,397,573 | RR | 152 | 2194-11-29 14:12:00 | 2194-11-30 09:00:00 | CLINICAL HISTORY: ___ man with vocal cord paralysis. To evaluate for
brain and brainstem lesions.
STUDY: MRI head without and with contrast.
COMPARISON STUDY: MRI head dated ___ and ___.
TECHNIQUE: Sagittal T1, axial T1, T2, FLAIR, gradient echo, and
diffusion-weighted images were obtained of the brain prior to administration
of contrast. Axial T1 and sagittal MP-RAGE images were obtained after
administration of contrast with axial and coronal reconstructions. Post
contrast images are degraded by motion artefact.
FINDINGS:
Focal and confluent T2 and FLAIR hyperintensities are noted in periventricular
and subcortical white matter of bilateral cerebral hemispheres, which likely
represent changes of chronic small vessel ischemic disease. There is
prominence of ventricles, cortical sulci, and extra-axial CSF spaces
suggestive of generalized cerebral atrophy.
An area of encephalomalacia is noted in the right parietal and posterior
temporal lobe which shows areas of hypointensity on gradient echo images
suggestive of old blood products. This is suggestive of sequelae of an old
hemorrhagic infarct.
There is no evidence of acute infarct or new intracranial hemorrhage. There
is no abnormal leptomeningeal or parenchymal enhancement.
T2 hyperintensities noted in bilateral mastoid air cells suggestive of fluid.
Mucosal thickening is noted in bilateral ethmoid air cells and right maxillary
sinus. The orbits are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality or abnormal enhancement.
2. Generalized cerebral parenchymal volume loss.
3. Changes of chronic small vessel ischemic disease.
4. Area of encephalomalacia in the right parietal and posterior temporal lobe
with chronic blood products, which represents sequela of old hemorrhagic
infarct.
|
19956723-RR-153 | 19,956,723 | 27,397,573 | RR | 153 | 2194-11-29 16:50:00 | 2194-11-29 20:43:00 | PICC LINE EXCHANGE
INDICATION: Malposition of indwelling PICC line.
The procedure was explained to the patient. A timeout was performed.
RADIOLOGIST: Dr. ___ performed the procedure.
TECHNIQUE: Using sterile technique and local anesthesia, a guidewire was
advanced through the indwelling right arm PICC line, and subsequently into the
SVC under fluoroscopic guidance. The old PICC line was then removed and a
peel-away sheath was then placed over the guidewire. A new single-lumen PICC
line measuring 45 cm in length was then placed through the peel-away sheath
with its tip positioned in the SVC under fluoroscopic guidance. Position of
the catheter was confirmed by a fluoroscopic spot film of the chest.
The peel-away sheath and guidewire were then removed. The catheter was
secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
A Dobbhoff tube was placed in the second part of the duodenum under
fluoroscopy guidance.
IMPRESSION:
1. Uncomplicated fluoroscopically guided PICC line exchange for a new 4
___ single-lumen PICC line. Final internal length is 40 cm, with the tip
positioned in the SVC. The line is ready to use.
2. Successful uncomplicated fluoroscopic-guided placement of a Dobbhoff tube
in the second part of the duodenum. The tube is ready to use.
|
19956777-RR-36 | 19,956,777 | 27,157,149 | RR | 36 | 2118-11-08 09:10:00 | 2118-11-08 12:11:00 | INDICATION: ___ female on Coumadin with diarrhea and vomiting.
COMPARISON: CT available from ___ and MR from ___.
TECHNIQUE: MDCT-acquired 5-mm axial images of the abdomen and pelvis were
obtained following the uneventful administration of 130 cc of Optiray
intravenous contrast. No oral contrast was administered for this exam.
Coronal and sagittal reformations were performed at 5-mm slice thickness.
ABDOMEN:
Included views of the lung bases demonstrate mild dependent atelectasis.
There is no pericardial or pleural effusion. The heart size is normal. There
is a small hiatal hernia.
The liver, gallbladder, pancreas, spleen, adrenal glands, stomach, and
intra-abdominal loops of small and large bowel are within normal limits.
There is no mesenteric or retroperitoneal lymphadenopathy, and no free air or
free fluid.
Numerous bilateral renal cysts, mostly subcentimeter in size, are similar in
appearance to the ___ examination, and further characterized on
the MRU from ___. A dominant left interpolar simple cyst
measuring 3.5 x 2.7 cm (2:21) is slightly larger. There is moderate
atherosclerotic calcification of the abdominal aorta, whch is normal in
caliber. The celiac trunk, SMA, and ___ are patent and normal in caliber.
PELVIS:
A 3.5 x 2.3 cm complex right adnexal cyst is again seen, containing internal
fat and a fat-fluid level (2:58), also seen on the CT study from ___. At the superior aspect is a solid nodular component (2:56) that is also
unchanged. The overall size of the the mass is larger since ___. These
findings remain most compatible with a dermoid, in agreement with the MR
characterization on ___ MRU.
There is no intrapelvic lymphadenopathy or free fluid. The uterus, urinary
bladder, and intrapelvic loops of small and large bowel are within normal
limits. There is lipomatosis of the ileocecal valve (2:47).
OSSEOUS STRUCTURES: There is no acute fracture. No concerning blastic or
lytic lesions are identified. Moderate levoscoliosis at the thoracolumbar
junction (601B:37) is present. There are also moderate multilevel
degenerative changes of the lumbar spine, most severe at L1/L2, including an
L2 superior endplate deformity and anterior osteophytosis.
IMPRESSION:
1. Normal-appearing small and large bowel. Early colitis cannot be excluded
with this technique.
2. Small hiatal hernia.
3. Multiple renal cysts.
4. Mild interval enlargement of a right adnexal mature teratoma.
|
19956963-RR-32 | 19,956,963 | 21,623,051 | RR | 32 | 2131-08-27 13:05:00 | 2131-08-27 14:07:00 | HISTORY: ___ female with renal transplant. She is taking Lithium for
bipolar disorder and presents with fevers and urinary tract infection.
COMPARISON: ___.
FINDINGS: The right lower quadrant transplant kidney is normal in
echogenicity and measures 11.5 cm, previously 10.8 cm. There are no focal
lesions. Note is made if urothelial thickening, and debris within the renal
pelvis and calices. There is no hydronephrosis.
Color and spectral Doppler examination of the liver: There are normal
resistive indices to the transplant kidney ranging from 0.67-0.72.
Limited images of the bladder are unremarkable.
IMPRESSION:
1. Normal color Doppler examination of the transplant kidney.
2. Urothelial thickening and debris in the collecting system, consistent with
pyelitis, pyelonephritis cannot be excluded
|
19956963-RR-33 | 19,956,963 | 21,623,051 | RR | 33 | 2131-08-29 10:01:00 | 2131-08-29 11:18:00 | HISTORY: Persistent fevers and pyelonephritis, to assess for pneumonia.
FINDINGS: In comparison with the study of ___, there is little change and
no evidence of acute cardiopulmonary disease. No pneumonia, vascular
congestion, or pleural effusion. Extensive hypertrophic spurring in the
thoracic spine and evidence of previous surgery in the right shoulder.
|
19957285-RR-27 | 19,957,285 | 20,267,759 | RR | 27 | 2118-09-12 00:23:00 | 2118-09-12 00:49:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with SAH, transfer from ___.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 5.2 s, 40.7 cm; CTDIvol = 31.1 mGy (Head) DLP =
1,262.5 mGy-cm.
Total DLP (Head) = 2,187 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Extensive diffuse bilateral subarachnoid and intraventricular hemorrhage is
seen within the bilateral sylvian fissures, anterior interhemispheric fissure,
basilar cisterns, third ventricle, fourth ventricle and bilateral lateral
ventricles. There is no evidence of acute intracranial infarction.
Hydrocephalus is present with prominent temporal horns..
No acute fracture is identified. The visualized paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The globes are unremarkable.
CTA HEAD:
The vertebral arteries are normal. The basilar artery is normal. The
posterior cerebral arteries are normal. The cavernous segment of the left
internal carotid artery demonstrates mild calcifications, which is otherwise
unremarkable. The left middle cerebral artery is normal. There is normal
arborization of the distal left MCA vessels. The cavernous segment of the
right internal carotid artery demonstrates mild calcifications. The right MCA
is normal. There is normal arborization of the distal right MCA vessels.
There is A-comm aneurysm measuring 0.6 cm in transverse diameter, 0.5 cm from
base to apex, projecting anterior inferiorly, it has 0.2 cm neck. The
anterior cerebral arteries are otherwise unremarkable. There is no evidence
of significant stenosis. No evidence of vasospasm. The dural venous sinuses
are patent.
CTA NECK:
There is approximately 20% right ICA origin narrowing by NASCET criteria.
Otherwise, the carotid and vertebral arteries and their major branches appear
normal with no evidence of stenosis or occlusion. There is no evidence of left
internal carotid stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. Multiple hypodense lesions are
seen within the thyroid lobes bilaterally measuring up to 0.7 cm, no further
follow-up is indicated. There is no cervical lymphadenopathy. There is mild
degenerative changes in the cervical spine.
IMPRESSION:
1. Significant subarachnoid, intraventricular hemorrhage with hydrocephalus.
2. There is 0.6 cm x 0.5 cm A-comm aneurysm with a 0.2 cm neck. Otherwise,
posterior and anterior circulation appears to be patent.
3. There is approximately 20% right ICA origin narrowing.
|
19957285-RR-28 | 19,957,285 | 20,267,759 | RR | 28 | 2118-09-12 03:40:00 | 2118-09-12 08:31:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with SAH// ? line placement Contact name:
___: ___ ? line placement
IMPRESSION:
ET tube tip is 3.5 cm above the carinal. NG tube tip is in the stomach.
Right central venous line tip is at the cavoatrial junction
Heart size and mediastinum are stable. Lungs overall clear. There is no
pleural effusion. There is no pneumothorax.
|
19957285-RR-29 | 19,957,285 | 20,267,759 | RR | 29 | 2118-09-12 04:22:00 | 2118-09-12 04:46:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with SAH and acomm aneurysm rupture s/p
placement of EVD. EVD at 15. STAT head CT to evaluate placement of drain.//
STAT head CT to evaluate placement of drain.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.5 cm; CTDIvol = 48.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CTA head and neck ___ at 00:23.
FINDINGS:
There is been interval placement of a right transfrontal ventricular drain,
terminating at the interventricular foramen of ___. Ventricular size is
unchanged from the prior study. Diffuse subarachnoid, basilar cistern, and
intraventricular hemorrhage is similar, however the volume of the
intraventricular component has slightly increased.
Postprocedural pneumocephalus is noted along the right frontal convexity. No
other relevant change.
IMPRESSION:
1. Right transfrontal ventricular drain terminating at the foramen of ___.
2. Re-demonstrated diffuse subarachnoid and intraventricular hemorrhage.
3. Unchanged ventricular size.
|
19957285-RR-30 | 19,957,285 | 20,267,759 | RR | 30 | 2118-09-12 14:37:00 | 2118-09-16 13:07:00 | EXAMINATION: Left internal carotid arteriogram.
Left vertebral arteriogram.
Right internal carotid arteriogram.
Coil embolization of anterior communicating artery aneurysm.
Right common femoral arteriogram.
INDICATION: Subarachnoid hemorrhage, anterior communicating artery aneurysm.
TECHNIQUE: Patient was identified and brought to the angiography suite. She
was positioned supine on the fluoroscopy table. General endotracheal
anesthesia was induced and maintained by anesthesia staff. The location of
the right common femoral artery was identified using anatomic and radiographic
landmarks. Access to this vessel was established using a 8 ___ long sheath
with micro puncture technique. The sheath was connected to continuous
heparinized saline flush and sutured in place. A 5 ___ ___ 2
diagnostic catheter was prepared and connected to continuous heparinized
saline flush and the power injector. This catheter was advanced through the
sheath into the aortic arch and reconstituted in the ___ configuration.
The left common carotid artery was next selected. Under road map guidance,
the left internal carotid artery was next selected. Intracranial AP, lateral,
and high magnification oblique views of the left internal carotid circulation
were next obtained. The catheter was next withdrawn into the aortic arch and
used to select the left subclavian artery. Under roadmap guidance, the left
vertebral artery was next selected. Intracranial AP and lateral views of the
left vertebral circulation were next obtained. The diagnostic catheter was
again withdrawn into the aortic arch and used to select the left common
carotid artery. Under roadmap guidance, the left internal carotid artery was
next selected. Intracranial AP, lateral, and three-dimensional rotational
angiographic views of the left internal carotid circulation were obtained. We
next prepared for an exchange. The patient was administered 5000 units of
heparin intravenously. A 6 ___ cook shuttle was prepared and flushed.
This catheter was exchanged for the diagnostic catheter over an 038 glidewire
in the right internal carotid artery under continuous fluoroscopic guidance.
The Cook shuttle was brought up into the proximal right internal carotid
artery. Next a 5 ___ ___ intermediate Catheter was prepared and
flushed. This catheter was assembled along with a SL 10 microcatheter and
synchro 2 standard micro wire. The entire assembly was advanced through the
Cook shuttle under continuous fluoroscopic guidance and positioned such that
the microcatheter rested within the aneurysm and the intermediate catheter
rested within the cavernous internal carotid artery. The micro wire was
removed and the entire system attached to continuous heparinized saline flush.
The aneurysm was sequentially embolized using detachable coils with
intermittent guide catheter angiography to confirm the patency of the
bilateral anterior cerebral arteries. After satisfactory embolization was
complete the microcatheter was removed and a follow-up guide catheter
angiogram was performed. The intermediate catheter and Cook shuttle were then
removed from the patient. A right common femoral arteriogram was performed
through the sheath. The arteriotomy site was closed using an 8 ___
Angio-Seal device. The patient was then released anesthesia and returned to
the intensive care unit.
This procedure was performed by Dr. ___ & Dr. ___.
I, Dr. ___, was present throughout the procedure, supervised or
performed all key portions of the procedure, and have interpreted the relevant
imaging findings.
COMPARISON: None
FINDINGS:
Left internal carotid artery: The distal left internal, anterior cerebral, and
middle cerebral arteries are well visualized. Vessel caliber is smooth and
tapering. An aneurysm is present at the anterior communicating artery
measuring 6 mm x 7 mm in greatest dimension. This lesion projects inferiorly
and is bilobed. No other aneurysm or vascular malformation is seen. The
venous phase is unremarkable.
Left vertebral artery: The distal left vertebral artery, left posterior
inferior cerebellar, bilateral superior cerebellar, and bilateral posterior
cerebral arteries are well visualized. Vessel caliber smooth and tapering.
There is no evidence of aneurysm or other vascular malformation. The venous
phase is unremarkable.
Right internal carotid artery: The distal right internal carotid, anterior
cerebral, middle cerebral arteries are well visualized. Vessel caliber is
smooth and tapering. An aneurysm is again demonstrated at the origin of the
anterior communicating artery which is bilobed in inferiorly projecting in
measuring approximately 6 x 7 mm. No other aneurysm or vascular malformation
is seen. The venous phase is unremarkable.
Right internal carotid artery, follow-up after coil embolization: There has
been interval coiling of the previously described anterior communicating
artery aneurysm. A coil mass is present inferior to the anterior
communicating artery and the right distal anterior cerebral artery is well
visualized and patent. There is no cross-filling through the anterior
communicating artery to the left hemisphere. There is no evidence of large
vessel occlusion. The venous phase is unremarkable.
Right common femoral artery: The sheath enters proximal to the common femoral
bifurcation. No evidence of vascular injury. Vessel caliber is appropriate
for Angio-Seal.
IMPRESSION:
Successful coil embolization of anterior communicating artery aneurysm,
___ and ___ grade 1.
No evidence of vasospasm.
No other aneurysm or vascular malformation is seen. The
RECOMMENDATION(S): Routine subarachnoid hemorrhage care. Follow-up
diagnostic angiogram 6 months.
|
19957285-RR-31 | 19,957,285 | 20,267,759 | RR | 31 | 2118-09-13 03:44:00 | 2118-09-13 10:00:00 | EXAMINATION: AP chest
INDICATION: ___ year old woman with SAH// FUTURE 5:30 AM on ___, ETT
placement FUTURE 5:30 AM on ___, ETT placement
IMPRESSION:
Compared to chest radiographs ___.
Tip of the endotracheal tube slightly less than 2 cm from the carina could be
withdrawn 15 mm to optimize position. Lungs are extremely low in volume, but
aside from small linear bands of atelectasis, essentially clear. Mild
cardiomegaly is exaggerated by low lung volumes, but there is no pulmonary
mediastinal vascular abnormality and no edema or appreciable pleural effusion.
No pneumothorax.
Right subclavian line ends close to the superior cavoatrial junction.
Esophageal drainage tube ends in the upper stomach but would need to be
advanced at least 5 cm to move all side ports beyond the gastroesophageal
junction.
|
19957285-RR-32 | 19,957,285 | 20,267,759 | RR | 32 | 2118-09-12 22:32:00 | 2118-09-13 00:10:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with SAH, s/p coiling of ACOMM aneusysm// s/p
coiling evaluate post coiling, please do between 10pm and midnight
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 4.8 s, 16.7 cm; CTDIvol = 50.7 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: ___ from earlier in the day
FINDINGS:
The patient is status post coiling of an A-comm aneurysm. Artifact from the
coils somewhat limits the evaluation of the surrounding brain parenchyma.
Unchanged right transfrontal ventricular drain terminating in the region of
the foramina of ___. The size of the ventricles is grossly unchanged given
differences in technique.
Diffuse subarachnoid hemorrhage is re-identified with extension into the basal
cisterns and ventricular system. There has been interval increase in amount
of intraventricular blood, particularly within the occipital horns of the
lateral ventricles. A small amount of pneumocephalus is noted in the right
frontal lobe, unchanged.
No other significant interval change.
IMPRESSION:
Interval coiling of an A-comm aneurysm as described above.
Re-demonstration of diffuse subarachnoid and intraventricular hemorrhage.
|
19957285-RR-34 | 19,957,285 | 20,267,759 | RR | 34 | 2118-09-14 04:00:00 | 2118-09-14 08:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with diffuse SAH intubated// ETT placement, OGT
placement, assess for pneumonia ETT placement, OGT placement, assess for
pneumonia
IMPRESSION:
In comparison with the study of ___, the tip of the endotracheal tube is
now approximately 3 cm above the carina. Nasogastric tube extends to the
stomach, though the side port is only just distal to the EG junction, and the
tube should be pushed forward at least 5-8 cm for improved positioning.
Continued relatively low lung volumes with streak of atelectasis in the right
mid zone and left base. Blunting of the costophrenic angles. However, no
evidence of acute focal pneumonia or appreciable vascular congestion.
|
19957285-RR-35 | 19,957,285 | 20,267,759 | RR | 35 | 2118-09-14 04:32:00 | 2118-09-14 06:41:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ s/p syncopal episode who became ___ transferred from
OSH w/ noted AComm w/ HH ___ MF 4 diffuse SAH on CTA s/p 7 coils. Please do
___// assess for interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.4 cm; CTDIvol = 51.6 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: Head CT ___.
FINDINGS:
Streak artifact from the anterior communicating artery coil pack partially
obscures evaluation of the mid brain.
In comparison to the prior head CT, there has been significant reduction in
ventricular size, now normal, and unchanged position of the right transfrontal
approach ventricular drain, terminating at the foramina of ___. The amount
of blood in the lateral ventricles appears to have increased, however this may
be due to the significant decrease in size of the ventricles overall.
Bifrontal extra-axial fluid collections are small. The amount of subarachnoid
blood in the intrahemispheric fissure has decreased as well as in the sylvian
fissures and basal cisterns. Trace residual pneumocephalus in the ventricles
noted.
No evidence of acute infarct. Minimal increased hypodensity of the medial
frontal lobes adjacent to the interhemispheric subarachnoid hemorrhage is
identified, presumably reactive edema. There is partial opacification of the
left sphenoid sinus and mastoid air cells bilaterally. The middle ear
cavities are clear.
IMPRESSION:
1. Significant interval decrease in ventricular size compared to ___.
2. While there is still a considerable amount of subarachnoid blood in the
interhemispheric fissure, basal cisterns, and lateral ventricles, the overall
volume is decreased compared to the prior study.
3. New hypodense bifrontal extra-axial fluid collections, small.
|
19957285-RR-36 | 19,957,285 | 20,267,759 | RR | 36 | 2118-09-15 03:52:00 | 2118-09-15 10:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with vent dependence// assess for aspiration,
pulmonary congestion assess for aspiration, pulmonary congestion
IMPRESSION:
ET tube tip is 3 cm above the carinal. NG tube tip in the stomach. Right
subclavian line tip is at the level of proximal right atrium. Heart size and
mediastinum are stable. Lungs are essentially clear. There is no appreciable
pleural effusion or pneumothorax.
|
19957285-RR-37 | 19,957,285 | 20,267,759 | RR | 37 | 2118-09-16 03:26:00 | 2118-09-16 08:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sah, intubated// intubated, febrile, r/o
pna intubated, febrile, r/o pna
IMPRESSION:
Compared to chest radiographs ___ through ___.
The proximal aspect of the esophageal drainage tube was looped in the
hypopharynx on ___. That region is not imaged on today's study, but
since the tip is in the same position in the upper to mid stomach, I suspect
it may still be looped. Clinical attention is advised.
ET tube is in standard placement and the right subclavian line ends at or just
below the estimated location of the superior cavoatrial junction. Heart size
top-normal. Aside from a small band of subsegmental atelectasis, lungs are
clear.
|
19957285-RR-39 | 19,957,285 | 20,267,759 | RR | 39 | 2118-09-16 10:36:00 | 2118-09-16 13:42:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 4 EXAMS
INDICATION: ___ year old woman with SAH s/p intubation// eval for placement of
DHT eval for placement of DHT
IMPRESSION:
In comparison with the study of ___, the nasogastric tube is been removed
and replaced with a Dobhoff tube, which a extends into the stomach and coils
on itself so that the tip extends horizontally in the gastric fundus.
Otherwise, little interval change.
|
19957285-RR-40 | 19,957,285 | 20,267,759 | RR | 40 | 2118-09-18 14:14:00 | 2118-09-18 15:06:00 | INDICATION: ___ year old woman with diffuse SAH with new onset tachypnea//
assess for pneumonia, pulm edema
COMPARISON: Radiographs from ___
IMPRESSION:
Endotracheal tube has been removed. There is a feeding tube whose distal tip
is looped and is pointing towards the GE junction. This could be readjusted.
There is a right-sided central venous catheter with the distal lead tip in the
distal SVC. Heart size is upper limits of normal. Lungs are grossly clear.
There are no pneumothoraces.
|
19957285-RR-41 | 19,957,285 | 20,267,759 | RR | 41 | 2118-09-19 10:52:00 | 2118-09-19 12:36:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
INDICATION: ___ year old woman with diffuse subarachnoid hemorrhage with
extraventricular drain. Assess for vasospasm
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
2) Spiral Acquisition 2.9 s, 22.5 cm; CTDIvol = 27.6 mGy (Head) DLP = 619.9
mGy-cm.
3) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 22.7 mGy (Head) DLP =
11.4 mGy-cm.
Total DLP (Head) = 1,565 mGy-cm.
COMPARISON: ___ head and neck CTA.
___ noncontrast head CT
FINDINGS:
CT HEAD WITHOUT CONTRAST:
In comparison with the prior noncontrast head CT of ___, previously
noted extensive subarachnoid hemorrhage has substantially decreased, with
moderate subarachnoid blood remaining in the anterior interhemispheric fissure
and bilateral medial frontal sulci, small amount of subarachnoid blood
remaining in the left-convexity sulci and left greater than right sylvian
fissures. There is also residual subarachnoid blood in the suprasellar
cistern, partially obscured by streak artifact from the anterior communicating
artery aneurysm coil pack. Intraventricular blood has decreased in extent,
with only a small amount of blood remaining in the occipital horns of lateral
ventricles. Allowing for the decreased hemorrhage, ventricular size is not
significantly changed. Right frontal approach EVD catheter terminates in the
region of the foramina of ___, unchanged. There is no shift of midline
structures. Allowing for the streak artifact from the anterior communicating
artery coil pack, there is no CT evidence for an acute major vascular
territorial infarction.
Fluid within the bilateral mastoid air cells and middle ear cavities as well
as fluid in the left sphenoid sinus, increased compared to the prior CTA of ___, is likely secondary to prolonged supine positioning in the
inpatient setting.
CTA HEAD:
In comparison to the prior head CTA from ___, there is interval
development of moderate to severe narrowing and irregularity of the A1
segments of bilateral anterior cerebral arteries and moderate narrowing and
multifocal irregularity of the A2 segments of bilateral anterior cerebral
arteries. There is also interval development of mild narrowing of the M1
segment of the left middle cerebral artery. This is consistent with
vasospasm. Detailed evaluation of the proximal portion of the anterior
cerebral arteries is limited by extensive streak artifact from the coil pack.
Evaluation for any residual filling of the coiled anterior communicating
artery aneurysm is also limited by streak artifact.
IMPRESSION:
1. Decreased subarachnoid and intraventricular hemorrhage compared to ___. No new hemorrhage.
2. Stable ventricular size. Stable position of the right frontal approach
EVD.
3. Interval development of vasospasm compared to ___, moderate to
severe in bilateral A1 segments, moderate in bilateral A2 segments, and mild
in the left M1 segment.
|
19957285-RR-42 | 19,957,285 | 20,267,759 | RR | 42 | 2118-09-21 03:45:00 | 2118-09-21 10:26:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old woman with SAH, reported history of recent R
metatarsal fracture// eval for R metatarsal fracture
TECHNIQUE: Three portable views of the right foot.
COMPARISON: None.
FINDINGS:
Arrows point to the ___ and fifth metatarsals. There is a subacute oblique,
comminuted fracture through the distal shaft of the second metatarsal with a
small butterfly fragment, and bony callus, with lucent fracture line
remaining. There is 3 mm lateral displacement and 5 mm overriding of the
distal fracture fragment.
Remodeling of the fifth metatarsal shaft is consistent with late subacute to
chronic fracture. No lucent fracture line is seen.
Flattening of the third metatarsal head may reflect prior osteonecrosis.
There is no fracture identified along the first ray.
There is diffuse osteopenia.
IMPRESSION:
1. Subacute, displaced fracture of the second metatarsal shaft with large
bridging callus although with lucent fracture line.
2. Late subacute to chronic fifth metatarsal shaft fracture.
3. No acute fracture identified.
4. Flattening of the third metatarsal head may reflect prior osteonecrosis
|
19957285-RR-43 | 19,957,285 | 20,267,759 | RR | 43 | 2118-09-21 12:07:00 | 2118-09-21 13:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH, s/p ACOMM aneurysm coiling/EV//
Intubated, please evaluate lung fields
IMPRESSION:
In comparison with the study of ___, the monitoring support devices are
unchanged. There again is looping of the Dobhoff tube so that the tip points
upward, just below the esophagogastric junction.
Continued low lung volumes
|
19957285-RR-44 | 19,957,285 | 20,267,759 | RR | 44 | 2118-09-21 15:03:00 | 2118-09-21 16:54:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with persistent fevers, r/o DVT. Please do
portably.// r/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19957285-RR-45 | 19,957,285 | 20,267,759 | RR | 45 | 2118-09-21 21:57:00 | 2118-09-21 23:38:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman with new NGT// NGT placement
TECHNIQUE: Chest single view
COMPARISON: ___ 12:21
FINDINGS:
Enteric tube tip is in the proximal stomach, should be advanced. Shallow
inspiration. No significant change since prior.
IMPRESSION:
Enteric tube tip is in the proximal stomach, should be advanced.
|
19957285-RR-47 | 19,957,285 | 20,267,759 | RR | 47 | 2118-09-22 17:15:00 | 2118-09-22 17:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH, NG tube repositioning// NG tube
repositioning, assess the tube placement
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Right PICC line tip is difficult to see, it overlies spine, it is probably
near cavoatrial junction. Shallow inspiration accentuates heart size. Normal
pulmonary vascularity. No sizable effusion. No consolidations. Surgical
clips right upper quadrant. Degenerative changes spine. Arterial
calcifications.
IMPRESSION:
Enteric tube tip is in the mid to distal stomach.
|
19957285-RR-48 | 19,957,285 | 20,267,759 | RR | 48 | 2118-09-23 07:24:00 | 2118-09-23 11:04:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD
INDICATION: ___ year old woman with SAH and EVD. Please do portably ___ in
am// assess for hydrocephalus s/p drain clamp
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP 1202.41 mGy-cm.
COMPARISON: CT head ___ and ___.
FINDINGS:
In comparison to the noncontrast CT head from ___ and ___,
there is continued interval redistribution of the subarachnoid hemorrhage
which is again seen in the anterior interhemispheric fissure and bilateral
medial frontal sulci and less apparent in the sylvian fissures. Again, there
is subarachnoid blood noted in the suprasellar cistern, with streak artifact
from the anterior communicating artery aneurysm coil. There is persistent
layering of blood products in the occipital horns of bilateral lateral
ventricles. Interval decreased prominence of by frontal extra-axial fluid
collections. Right frontal approach EVD catheter is again seen terminating
near the foramen of ___. There is no shift in normally midline structures.
Again, within limitations of streak artifact from the aneurysm coil, there is
no large vascular territorial infarction. The ventricles appear more
prominent bilaterally in comparison to the most recent CT head.
There is no evidence of fracture. There is opacification of bilateral mastoid
air cells and bilateral middle ear cavities with decreased fluid in the
sphenoid sinus compared to prior. Otherwise, the visualized portion of the
remaining paranasal sinuses are clear. The visualized portion of the orbits
are unremarkable.
IMPRESSION:
1. Continued redistribution in interval evolution of the subarachnoid
hemorrhage, again most prominently seen in the anterior interhemispheric
fissure.
2. The ventricles appear overall slightly more prominent in comparison to the
most recent head CT, potentially secondary decreased size of bifrontal
extra-axial collections, although developing hydrocephalus is not entirely
excluded. Close attention on follow-up.
|
19957285-RR-49 | 19,957,285 | 20,267,759 | RR | 49 | 2118-09-23 08:41:00 | 2118-09-23 11:51:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with aneurysmal SAH s/p coil with worsening
tacypnea// eval for interval change
TECHNIQUE: Chest AP
COMPARISON: Chest radiograph from ___
FINDINGS:
There has been interval removal of a right-sided subclavian central venous
catheter. An enteric tube terminates in the stomach. A developing opacity in
the right upper lobe may reflect atelectasis versus pneumonia. Opacity in the
right lower lobe is most likely atelectasis. Cardiomediastinal silhouette is
stable. No effusions or pneumothorax.
IMPRESSION:
A developing opacity in the right upper lobe is suspicious for pneumonia,
although atelectasis may have a similar appearance.
|
19957285-RR-50 | 19,957,285 | 20,267,759 | RR | 50 | 2118-09-24 07:25:00 | 2118-09-24 13:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH// fever, concern for asp pna
fever, concern for asp pna
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lungs are reasonably well expanded and clear. No pleural abnormality. Heart
size normal. Thoracic aorta is large but not focally dilated.
Esophageal drainage tube ends in the mid stomach.
|
19957285-RR-51 | 19,957,285 | 20,267,759 | RR | 51 | 2118-09-24 12:11:00 | 2118-09-24 12:42:00 | EXAMINATION: CT HEAD W/O CONTRAST.
INDICATION: ___ female with HH5 MF 4 subarachnoid hemorrhage status
post coil to acomm aneurysm on ___ status post external ventricular drain.
Evaluate for hydrocephalus.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CT head from ___ and CTA head from ___.
FINDINGS:
A right frontal approach ventriculostomy catheter is in stable position
terminating at the right foramen of ___. The ventricles are stable in size
and configuration from prior exam. A small amount of subarachnoid hemorrhage
is noted along the left frontal lobe as well as along the anterior
interhemispheric fissure. (Series 2:image 21, 15). There is a moderate
amount of intraventricular hemorrhage layering dependently in the occipital
horns bilaterally, similar in amount to ___.
No new intracranial hemorrhage, edema or mass is seen. There is no evidence
of acute vascular territorial infarction. Patient is status post coiling of
an A-comm aneurysm. There is preservation of normal gray-white matter
differentiation. The basilar cisterns are patent.
There is no evidence of fracture. Opacification of the bilateral mastoid air
cells and middle cavities may be due to supine positioning. The visualized
portion of the other paranasal sinuses are clear. The visualized portion of
the orbits are unremarkable.
IMPRESSION:
1. Stable of position of the right frontal ventriculostomy catheter and
ventricle size. Stable amount of intraventricular blood.
2. Small amount of subarachnoid hemorrhage again noted. No new intracranial
hemorrhage.
|
19957285-RR-52 | 19,957,285 | 20,267,759 | RR | 52 | 2118-09-25 03:44:00 | 2118-09-25 11:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH// respiratory insufficiency and fever
r/o pna respiratory insufficiency and fever r/o pna
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lungs are clear, heart size normal, no pleural abnormality. Thoracic aorta is
generally large but not focally dilated.
Nasogastric drainage tube ends in the mid stomach.
|
19957285-RR-53 | 19,957,285 | 20,267,759 | RR | 53 | 2118-09-25 15:42:00 | 2118-09-25 16:50:00 | INDICATION: ___ year old woman with SAH with tachypnea and tachycardia//
assess for infiltrate vs pulm edema
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
An enteric tube courses through the stomach. Surgical clips project over the
right upper quadrant.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is within normal limits.
IMPRESSION:
No pneumonia or evidence of pulmonary edema.
|
19957285-RR-54 | 19,957,285 | 20,267,759 | RR | 54 | 2118-09-25 17:42:00 | 2118-09-25 18:47:00 | EXAMINATION: CTA chest with contrast.
INDICATION: ___ year old woman with SAH, tachypnic and tachycardic, r/o PE//
r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 1.0 s, 1.0 cm; CTDIvol = 2.3 mGy (Body) DLP = 2.3
mGy-cm.
3) Spiral Acquisition 6.2 s, 23.9 cm; CTDIvol = 9.2 mGy (Body) DLP = 204.2
mGy-cm.
Total DLP (Body) = 216 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
Motion artifact limits evaluation. The pulmonary arteries are well opacified
to the segmental level, with no evidence of filling defect within the main,
right, left, lobar, segmental pulmonary arteries. There is mild prominence of
the main pulmonary artery, which can be seen in the setting of pulmonary
arterial hypertension.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
There is no evidence of pulmonary parenchymal abnormality. The airways are
patent to the subsegmental level.
Limited images of the upper abdomen demonstrate an enteric tube with the tip
in the stomach.. Diffuse hypoattenuation of the liver.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
Moderate multilevel degenerative changes of the visualized spine.
IMPRESSION:
1. Motion artifact limits evaluation. No evidence of pulmonary embolism to
the segmental level.
2. No acute aortic abnormality.
3. Mildly prominent pulmonary artery, which can be seen in the setting of
pulmonary arterial hypertension.
4. Diffuse hypoattenuation of the liver suggests hepatic steatosis.
Correlation with LFTs is recommended
|
19957285-RR-55 | 19,957,285 | 20,267,759 | RR | 55 | 2118-09-25 20:49:00 | 2118-09-25 21:32:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with increased WOB and somnolence// acute
process
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head from ___
FINDINGS:
Anterior interhemispheric fissure and corpus callosum hematoma evolution
continues with no evidence of new hemorrhage. Compared to prior exam, there
is slightly increased amount of hyperdensity along the tentorium and the
posterior falx, which may be due to small amounts of subdural hemorrhage.
Diffuse subarachnoid hemorrhage in the anterior interhemispheric fissure and
in the left sylvian fissure left appear unchanged.
Patient is status post removal of the right frontal approach ventriculostomy
tube. There is no evidence of hydrocephalus.. Layering hyperdensity in the
bilateral occipital horns are stable. The basal cisterns remain patent.
artifacts from the coiling material somewhat limits the evaluation for
infarcts. Subtle hypodensities in the right temporal lobe and left frontal
lobe gray matter likely represent volume averaging from slice selection,
rather than acute infarct.
There is mucosal retention cysts in the right maxillary sinus. There is
partial opacification of the bilateral mastoid air cells. The visualized
portion of the remaining paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
-Small subdural hematoma along the posterior falx and tentorium.
-No evidence of new subarachnoid hemorrhage.
-Status post removal of the right frontal approach ventriculostomy tube with
no hydrocephalus.
|
19957285-RR-56 | 19,957,285 | 20,267,759 | RR | 56 | 2118-09-26 03:21:00 | 2118-09-26 08:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with acute resp failure s/p intubation// ETT
placement ETT placement
IMPRESSION:
Comparison to ___. The tip of the endotracheal tube projects 4 cm
above the carinal. The patient has also received the new right internal
jugular vein catheter. The tip of the catheter projects over the lower SVC.
Stable mild elevation of the left hemidiaphragm, with minimal blunting of the
left costophrenic sinus. No abnormal parenchymal opacity. Normal size of the
heart. No signs of pulmonary edema.
|
19957285-RR-57 | 19,957,285 | 20,267,759 | RR | 57 | 2118-09-26 08:52:00 | 2118-09-26 13:15:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
INDICATION: ___ year old woman with subarachnoid hemorrhage s/p intubation
with poor neurologic exam. Assess for acute process.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque350 intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
2) Spiral Acquisition 2.4 s, 19.2 cm; CTDIvol = 27.6 mGy (Head) DLP = 528.8
mGy-cm.
3) Stationary Acquisition 1.5 s, 0.5 cm; CTDIvol = 17.0 mGy (Head) DLP =
8.5 mGy-cm.
Total DLP (Head) = 1,285 mGy-cm.
COMPARISON: Multiple prior head CTs dating back to ___, most
recently ___.
CTA head and neck dated ___.
FINDINGS:
NONCONTRAST HEAD CT:
Streak artifact from the coil pack in the treated anterior communicating
artery aneurysm limits evaluation at adjacent levels. There is continued
expected evolution of anterior interhemispheric fissure and cerebral sulci,
and of the corpus callosum hematoma. Blood in the occipital horn of the right
lateral ventricle is unchanged, and blood in the occipital horn of the left
lateral ventricle appears slightly decreased in density. There is minimal
residual subdural hemorrhage along the posterior falx. No evidence of new
hemorrhage. Ventricular size is unchanged.
No CT evidence for a new major vascular territorial infarct. Periventricular,
deep, and subcortical white matter hypodensities are nonspecific, though
likely reflect sequelae of chronic small vessel ischemic disease in this age
group.
There is moderate mucosal thickening in the right maxillary and anterior
ethmoid sinuses, including a mucous retention cyst in the right maxillary
sinus. Partial opacification of the bilateral mastoid air cells is unchanged.
CTA HEAD:
Moderate-to-severe narrowing and irregularity of the bilateral A1 segments of
the anterior cerebral arteries and moderate narrowing and irregularity of the
bilateral A2 segments of the anterior cerebral arteries, as well as mild
narrowing of the M1 segment of the left middle cerebral artery, are similar to
prior exam and consistent with vasospasm. Mild irregularity of the P2 segment
of the right posterior cerebral artery appears more pronounced with decreased
caliber compared to ___, but it is not clear whether there is any
change compared to ___. Evaluation for residual filling of the
coiled anterior communicating artery aneurysm is limited by streak artifact.
Dural venous sinuses are patent.
IMPRESSION:
1. Grossly unchanged resolving subarachnoid hemorrhage compared to ___. Hemorrhage in the occipital horns of lateral ventricles is stable on
the right and decreased in density on the left. Minimal residual subdural
hematoma along the posterior falx is stable.
2. Stable ventricular size.
3. No CT evidence for an acute major vascular territorial infarction.
4. Persistent moderate-to-severe bilateral A1, moderate bilateral A2, mild
left M1, and mild right P2 segment vasospasm.
|
19957285-RR-58 | 19,957,285 | 20,267,759 | RR | 58 | 2118-09-27 03:56:00 | 2118-09-27 08:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with diffuse SAH, intubated// assess for
pneumonia, pulm edema
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___ / ___
IMPRESSION:
Left lower lobe opacities have increased, could correspond to atelectasis but
superimposed infection cannot be excluded. There are low lung volumes. No
evident pneumothorax. Mild cardiomegaly is stable.
ET tube is in standard position. Right IJ catheter tip is in the lower SVC.
NG tube tip is out of view below the diaphragm. Surgical clips project in the
right upper quadrant.
|
19957285-RR-59 | 19,957,285 | 20,267,759 | RR | 59 | 2118-09-28 04:40:00 | 2118-09-28 09:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH, s/p intubation// interval change
interval change
IMPRESSION:
Comparison to ___. The endotracheal tube and the right internal
jugular vein catheter continue to be in correct position. Lung volumes are
low. Elevation of the left hemidiaphragm with a peak like parenchymal
consolidation is stable. No interval appearance of new parenchymal
abnormalities. No larger pleural effusions. No pulmonary edema.
|
19957285-RR-60 | 19,957,285 | 20,267,759 | RR | 60 | 2118-09-27 17:50:00 | 2118-09-27 19:14:00 | EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ patient with subarachnoid hemorrhage, vasospasm, left
lower extremity weakness. Assess for stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head ___, CT head ___
FINDINGS:
There is redemonstration of subarachnoid hemorrhage within the anterior
interhemispheric fissure, sylvian fissures, and sulci. Parenchymal hematoma
in the anterior corpus callosum is also again seen. There is stable blood in
the occipital horns of the lateral ventricles. The ventricles are stable in
size. Prominence of the ventricles and cerebral sulci is congruent with mild
parenchymal volume loss. There is mild confluent periventricular T2
hyperintensity, a nonspecific finding. A track from prior right frontal
approach ventriculostomy catheter is noted.
Prior CTs suggested a thin subdural hematoma along the posterior falx, but
there is no corresponding signal abnormality on FLAIR images.
There is a punctate focus of high signal on diffusion-weighted images within
the left frontal centrum semiovale (302:24), without a clear colored on the
ADC map, with corresponding hyperintensity on T2 weighted and FLAIR images.
The major vascular vascular flow voids are visualized. The intracranial
arteries are better assessed on the CTA from 1 day earlier from ___.
There is mild mucosal thickening of the right maxillary sinus and ethmoid air
cells and a mucous retention cyst within the right maxillary sinus. There is
near complete opacification of bilateral mastoid air cells.
IMPRESSION:
1. Punctate early subacute infarction in the left frontal centrum semiovale.
2. Subarachnoid hemorrhage with anterior interhemispheric fissure
predominance, parenchymal hemorrhage in the anterior corpus callosum, and
intraventricular hemorrhage are stable.
3. Stable size of the ventricles.
|
19957285-RR-61 | 19,957,285 | 20,267,759 | RR | 61 | 2118-09-29 04:52:00 | 2118-09-29 10:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with HH5 MF 4 SAH s/p coil to acomm aneurysm on ___ with
vent// assess for infectious process, planned extubation today assess for
infectious process, planned extubation today
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lungs clear. Heart size normal. No pleural abnormality.
Cardiopulmonary support devices in standard placements unchanged.
|
19957285-RR-62 | 19,957,285 | 20,267,759 | RR | 62 | 2118-09-29 18:52:00 | 2118-09-29 20:38:00 | INDICATION: ___ year old woman with SAH s/p extubation// ? aspiration.
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The endotracheal tube has been removed. The gastric tube extends to the
stomach and the tip of the right internal jugular central venous catheter
projects over the low SVC.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is within normal limits.
IMPRESSION:
No focal consolidation or evidence of aspiration/pneumonia.
|
19957285-RR-63 | 19,957,285 | 20,267,759 | RR | 63 | 2118-10-04 10:43:00 | 2118-10-04 11:57:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ year old woman with worsening mental status in setting of SAH.
Non-contrast head CT to evaluate for worsening hemorrhage in setting of MS
changes.// Non-contrast head CT to evaluate for worsening hemorrhage in
setting of MS changes.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Prior MRI of the head dated ___. Prior CTA of the head
___.
FINDINGS:
The patient is status post coiling of an anterior communicating artery
aneurysm, and artifact from the aneurysm coils somewhat limits evaluation.
There has been interval resolution of subarachnoid hemorrhage seen previously
in the intrahemispheric fissure, with trace of residual blood products. There
is persistent edema in the intraventricular septum anteriorly. There has been
interval resolution of intraventricular blood. There is stable size of the
ventricles. Periventricular white matter hypodensities are nonspecific but
suggestive of chronic small vessel ischemic disease. There is no evidence of
infarction or new hemorrhage.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses and middle ear cavities are clear. There is opacification of most of
the mastoid air cells bilaterally, increased from prior exam. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Interval resolution of previously seen subarachnoid hemorrhage, with
persistent edema of the anterior intraventricular septum. No evidence of new
hemorrhage.
2. Increased opacification of bilateral mastoid air cells.
|
19957285-RR-65 | 19,957,285 | 20,267,759 | RR | 65 | 2118-10-04 18:45:00 | 2118-10-04 19:36:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with right arm 44cm DL power PICC. ___ ___//
Right arm 44cm DL power PICC. ___ ___ Contact name: ___: ___
TECHNIQUE: Chest single
COMPARISON: ___
FINDINGS:
Right PICC line tip is better seen on 1 of the two views, is in the right
atrium, approximately 5 cm below cavoatrial junction. Enteric tube tip is in
mid to distal stomach. Shallow inspiration accentuates heart size, pulmonary
vascularity. No edema. No effusion. Minimal right basilar atelectasis.
Surgical clips upper abdomen. No pneumothorax.
IMPRESSION:
Right PICC line
|
19957285-RR-66 | 19,957,285 | 20,267,759 | RR | 66 | 2118-10-04 19:41:00 | 2118-10-04 20:56:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with picc repo// picc repo Contact name: sal,
___: ___
TECHNIQUE: Chest single view
COMPARISON: ___ 19:01
FINDINGS:
Right PICC line overlies spine, tip is difficult to see, is probably in the
low SVC, 1 cm above cavoatrial junction. No pneumothorax. Otherwise no
change.
IMPRESSION:
Right PICC line tip probably in the low SVC.
|
19957285-RR-67 | 19,957,285 | 20,267,759 | RR | 67 | 2118-10-04 22:15:00 | 2118-10-04 22:44:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with SAH S/P ACOMM Coiling, LLE cool and poor
cap refill, + swelling
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left 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 left lower extremity veins.
|
19957410-RR-102 | 19,957,410 | 24,167,166 | RR | 102 | 2169-03-13 03:59:00 | 2169-03-13 04:47:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old woman with headache, on tacrolimus for kidney
transplant// evaluate for PRES
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA of the head and neck from ___
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction.
There are scattered T2/FLAIR hyperintensities in the cerebral hemispheres
bilaterally, a nonspecific finding and likely related to chronic small vessel
ischemic changes.
There is mild generalized parenchymal volume loss, most likely age related.
Mild prominence of the ventricular system and extra-axial CSF spaces
consistent with the previously mentioned parenchymal volume loss.
Major vascular flow voids appear preserved.
The paranasal sinuses and mastoid air cells appear centrally clear. The
orbits appear grossly unremarkable.
IMPRESSION:
1. No evidence of acute infarction, hemorrhage or intracranial mass.
2. Scattered white matter changes in the cerebral hemispheres bilaterally,
likely sequela of chronic microangiopathy.
|
19957410-RR-103 | 19,957,410 | 24,167,166 | RR | 103 | 2169-03-13 17:58:00 | 2169-03-13 18:32:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ HCV/alcoholic cirrhosis s/p OLT ___ and DDRT ___,
complicated by and anastomotic stricture requiring multiple CBD stent
placement procedures (last replaced on ___, now in ED with headache,
nausea, vomiting and elevated bili.// Assess for biliary obstruction
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___
FINDINGS:
Liver echotexture is normal. Ill-defined hypoechoic region in the right
hepatic lobe is not as well appreciated on the current study. There is mild
pneumobilia.
CHD: 2 mm
There is no ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen has normal echotexture.
Spleen length: 13 cm
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 121 centimeters/second.
Appropriate arterial waveforms are seen in the right hepatic artery and the
left hepatic artery with resistive indices of 0.53, and 0.54, respectively.
The main portal vein and the right and left portal veins are patent with
hepatopetal flow and normal waveform. Appropriate flow is seen in the hepatic
veins and the IVC.
IMPRESSION:
1. Patent hepatic vasculature with appropriate waveforms.
2. Stable splenomegaly and mild pneumobilia.
|
19957410-RR-104 | 19,957,410 | 24,167,166 | RR | 104 | 2169-03-15 22:02:00 | 2169-03-16 07:58:00 | EXAMINATION: MRCP
INDICATION: ___ w/ PMH of hepatitis C and alcoholic cirrhosis with HRS nows/p
liver-kidney transplant (___) complicated by moderateliver rejection
(liver bx ___ s/p 5-day course of IV ___, and
anastomotic stricture requiring CBD stentplacement (___) which was found
to be inferiorly displaced,requiring subsequent repeat biliary stent (2
stents) ___ and replaced on ___, SIADH, presented with
elevated bili and abnormal LFTs.// evaluate biliary stent placement, also
characterize ill-defined hypoechoic
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 7 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Liver MRI ___
FINDINGS:
Lower Thorax: Unremarkable.
Liver: Status post liver transplant. There is no hepatic steatosis. Again
noted is residual wedge-shaped area of early enhancement in segment VII
without significant restricted diffusion. Similar wedge shaped areas are
noted in segment VIII, also unchanged.
At the junction of segments VI and VII, there is a large wedge-shaped area of
hyperenhancement demonstrating mild restricted diffusion, similar in
appearance to compared prior study.
No intrahepatic abscess.
Biliary: Mild expected pneumobilia in the setting of a biliary stent. No
intrahepatic biliary duct dilatation. Status post cholecystectomy.
Pancreas: The pancreas is normal in signal and bulk. Mild prominence of the
main pancreatic duct is unchanged. No focal pancreatic lesion.
Spleen: Splenomegaly measuring 17.5 cm, previously measured at 16.8 cm.
Adrenal Glands: Unremarkable.
Kidneys: Unremarkable. No hydronephrosis. There is a right-sided
transplanted kidney.
Gastrointestinal Tract: No bowel obstruction.
Lymph Nodes: No abdominal lymphadenopathy.
Vasculature: Multiple paraesophageal, gastric and splenic varices are noted.
No abdominal aortic aneurysm.
Osseous and Soft Tissue Structures: No concerning bone lesions.
IMPRESSION:
1. No liver abscess.
2. No new intrahepatic biliary duct dilatation in this patient with a metallic
CBD stent.
3. Wedge shaped area of enhancement in the right liver lobe are unchanged.
4. Moderate splenomegaly and multiple varices are unchanged.
|
19957410-RR-105 | 19,957,410 | 24,167,166 | RR | 105 | 2169-03-14 15:46:00 | 2169-03-14 16:35:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ w/ PMH of hepatitis C and alcoholic cirrhosis with HRS nows/p
liver-kidney transplant (___) complicated by moderateliver rejection
(liver bx ___ s/p 5-day course of IV ___, and
anastomotic stricture requiring CBD stentplacement (___) which was found
to be inferiorly displaced,requiring subsequent repeat biliary stent (2
stents) ___ and replaced on ___, SIADH. BP dropped to ___
with tachycardia.// evaluate for PNAevaluate for PNA
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
appreciable pleural effusion. There is no pneumothorax.
|
19957410-RR-106 | 19,957,410 | 24,167,166 | RR | 106 | 2169-03-15 11:29:00 | 2169-03-15 12:34:00 | INDICATION: ___ year old woman with poor access, tired of needlesticks.
Attempted PICC placement by IV team but unsuccessful, had to place midline
instead. Midline not drawing back blood, would like to replace with PICC.//
Please replace current midline with PICC
COMPARISON: None
TECHNIQUE: OPERATOR: Dr. ___ radiology attending)
performed the procedure.
PROCEDURE: 1. Replacement of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
midline was aspirated and flushed and a Nitinol guidewire was introduced into
the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
single lumen PIC line measuring 45 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach midline with tip in the axillary replaced with
a new single lumen PIC line with tip in the SVC.
IMPRESSION:
Successful placement of a 45 cm right arm approach single lumen PowerPICC with
tip in the SVC. The line is ready to use.
|
19957410-RR-107 | 19,957,410 | 24,167,166 | RR | 107 | 2169-03-17 08:45:00 | 2169-03-19 08:26:00 | EXAMINATION: Cerebral angiogram to evaluate pericallosal aneurysm
Following vessels were selectively catheterized and angiography was performed.
Right common femoral artery
Right common carotid artery
Three-dimensional rotational angiography of the Left internal carotid artery
circulation requiring post processing on an independent workstation and
concurrent attending physician interpretation and review
Left common carotid artery
Left vertebral artery
INDICATION: A ___ woman with history of liver and kidney transplant
presents with a headache and pericallosal aneurysm. No subarachnoid
hemorrhage is found on CT imaging. She does have a family history of
aneurysms. She is here today for cerebral angiography
ANESTHESIA: Moderate sedation was provided by administering divided doses of
Versed and fentanyl throughout the total intra service time of 34 minutes
during which the patient's hemodynamic parameters were continuously monitored
by a trained, independent observer. Patient received a total of 100 mcg of
fentanyl and 0.5 mg of Versed and was continuously supervised by the attending
physician.
TECHNIQUE: Cerebral angiogram, complete
COMPARISON: None.
PROCEDURE: The patient was identified and brought to the neuro radiology
suite. She was transferred to the fluoroscopic table supine. Moderate
sedation was administered. Bilateral groins were prepped and draped in
standard sterile fashion. A time-out was performed. The right common femoral
artery was identified using anatomic and radiographic landmarks. The right
common femoral artery was accessed using standard micropuncture technique
after infiltration of local anesthetic. Through the micro dilator angiography
was performed of the right common femoral artery which demonstrated that the
arteriotomy was proximal to the bifurcation the artery was amenable to closure
device placement the conclusion of the procedure. Next a long 5 ___ sheath
was introduced, connected to continuous heparinized saline flush, and secured.
Next a 5 ___ ___ catheter was brought into the field, flushed, and
connected to continuous heparinized saline flush. With a 038 glidewire this
was brought up through the aorta over the arch in selected into the right
common carotid artery. The wire was withdrawn and vessel patency was
confirmed via hand injection. Standard AP and lateral views were obtained as
well as transorbital oblique views as well as 3D rotational angiography.
Next the catheter was withdrawn while maintaining the ___ hook in selected
into the left common carotid artery. Roadmap angiography was performed.
Under roadmap guidance the wire was reintroduced and used to select the left
common carotid artery. The catheter was advanced over the wire and the wire
was withdrawn. Vessel patency was confirmed via hand injection. Standard AP
and lateral views were obtained as well as transorbital oblique views. Next
the catheter was withdrawn in selected the origin the left subclavian artery.
Roadmap angiography was performed. Under roadmap guidance the wire was
reintroduced and used to select the left vertebral artery. Catheter was
advanced over the wire and the wire was withdrawn. Vessel patency was
confirmed via hand injection. Standard AP and lateral views were obtained.
Next the diagnostic catheter was removed. Right common femoral angiogram was
performed via hand injection through the sheath. The sheath was removed and
the arteriotomy was closed using a 6 ___ Angio-Seal. The patient was
removed from the fluoroscopy table and remained at his neurologic baseline
without any evidence of thromboembolic complications.
OPERATORS: Dr. ___ Dr. ___ physician performed the
procedure. Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings.
FINDINGS:
Right common femoral artery: Arteriotomy is above the bifurcation. There is
good distal runoff. There is no evidence of dissection. Vessel caliber
appropriate for closure device.
Right Common carotid artery: Vessel caliber smooth regular. There is filling
of the anterior and middle cerebral arteries and their distal territories.
There is filling across the anterior communicating artery filling the
contralateral A2. The ophthalmic artery is patent as is posterior
communicating artery. There is a 2 mm x 1.6 mm distal left pericallosal
aneurysm over the mid body of the corpus callosum. This is an infundibular
region where multiple vessels aris. No other aneurysms or AVMs are
identified.
Left common carotid artery: Vessel caliber smooth regular. There is filling
of the anterior and middle cerebral arteries and their distal territories.
The ophthalmic arteries are patent as is posterior communicating artery which
fills the posterior cerebral circulation. There is filling across the
anterior communicating artery into the contralateral A2 and pericallosal
aneurysm is still seen on the left pericallosal artery. No other aneurysms or
AVMs are identified.
Left vertebral artery: Vessel caliber smooth regular. There is filling of the
left posterior inferior cerebellar artery, bilateral anterior-inferior
cerebellar arteries, bilateral superior cerebellar arteries, and bilateral
posterior cerebral arteries and their distal territories. No aneurysms or
AVMs are identified
IMPRESSION:
2 mm x 1.6 mm left pericallosal artery aneurysm
RECOMMENDATION(S):
1. No urgent intervention. Will come back to clinic after discharge to
discuss further treatment options.
|
19957410-RR-17 | 19,957,410 | 23,037,934 | RR | 17 | 2168-09-06 04:14:00 | 2168-09-06 08:52:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ PMHx HCV/EtOH cirrhosis (unknown baseline, c/b HE,
ascites, EV), recent acute renal failure on HD, CVA, gout, recently admitted
for decompensated cirrhosis and acute renal failure ___ in FL who
presents with volume overload// Signs of volume overload
IMPRESSION:
No previous images. There is enlargement of the cardiac silhouette
indistinctness of engorged pulmonary vessels, consistent with elevated
pulmonary venous pressure. Mild tortuosity of the descending aorta is seen.
No evidence pleural effusion or acute focal pneumonia. Hemodialysis catheter
extends to the lower SVC.
|
19957410-RR-19 | 19,957,410 | 23,037,934 | RR | 19 | 2168-09-10 20:43:00 | 2168-09-10 21:24:00 | EXAMINATION: Chest radiograph, AP and lateral views.
INDICATION: Pre transplant workup. Cirrhosis.
COMPARISON: ___.
FINDINGS:
Feeding tube courses into the stomach, its inferior course not imaged,
however. A large-bore central venous catheter terminates in the lower
superior vena cava. Cardiac, mediastinal and hilar contours appear stable.
Heart is mildly enlarged, including visible Left atrial appendage enlargement.
Mild interstitial process appears very similar and suggest mild vascular
congestion. There are no pleural effusions or pneumothorax.
IMPRESSION:
Finding suggests similar mild vascular congestion. No definite short-term
change.
|
19957410-RR-20 | 19,957,410 | 23,037,934 | RR | 20 | 2168-09-11 21:31:00 | 2168-09-11 22:22:00 | EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ year old woman with EtOH/HCV cirrhosis presenting for
transplant work up// Eval for liver volume- please quantify for pretransplant
work up
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen following intravenous contrast administration. Oral contrast was
administered.Coronal and sagittal reformations were performed and reviewed on
PACS.
DOSE: Total DLP (Body) = 2,463 mGy-cm.
COMPARISON: Prior abdominal ultrasound done ___
FINDINGS:
LOWER CHEST: No suspicious pulmonary nodules or masses. No confluent airspace
consolidation. No pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Cirrhotic morphology of the liver with a multinodular
appearance. There is no abnormally enhancing arterial lesions or early
washout to suggest HCC. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder contains multiple gallstones but no
features of cholecystitis.
Liver volume: 1549.425 CM3
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Marked splenomegaly. A few small arterially hyperenhancing lesions
(series 301 image 56, 57, 22, 54) are nonspecific, most likely represent
splenic hemangiomas.
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. ___ jejunal tube terminates
in the proximal jejunum. Visualized small and large bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout.
LYMPH NODES: No adenopathy
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Extensive portosystemic collaterals extending towards the
gastroesophageal junction and into the posterior mediastinum via the
diaphragmatic hiatus. Suspected nonocclusive/partial portal vein thrombosis at
the portal confluence (series 303, image 55).
A central line terminates in the right atrium.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Old right lateral seventh and left ninth rib fractures.
SOFT TISSUES: Moderate ascites. Marked skin thickening and interstitial edema
involving the left breast (asymmetric compared to the right) but this may be
positional in nature and clinical correlation is advised. Few locules of air
in the left abdominal wall (series 301, image 9) is nonspecific
IMPRESSION:
1. Cirrhotic morphology of the liver with sequela of portal hypertension in
the form of extensive portosystemic collaterals also extending into the
posterior mediastinum, splenomegaly and moderate ascites. No focal lesions
concerning for HCC.
2. Anasarca. Few locules of air in the left abdominal wall (series 301, image
9) is nonspecific though may be iatrogenic.
3. Asymmetrical left breast skin thickening and interstitial edema (may be
positional in nature) but clinical correlation is advised.
4. Cholelithiasis without evidence of cholecystitis.
5. ___ jejunal feeding tube in place.
|
19957410-RR-22 | 19,957,410 | 23,037,934 | RR | 22 | 2168-09-11 19:06:00 | 2168-09-11 19:23:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with potential c/f LLE DVT// evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left 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 left lower extremity veins.
|
19957410-RR-23 | 19,957,410 | 23,037,934 | RR | 23 | 2168-09-13 19:57:00 | 2168-09-13 21:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with alcoholic cirrhosis with new leukocytosis
c/f infection// eval for pneumonia
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The supporting lines and tubes are unchanged. There is mild bibasilar
atelectasis as well as pulmonary vascular congestion. No pleural effusion or
pneumothorax. The size of the cardiac silhouette is unchanged.
IMPRESSION:
Pulmonary vascular congestion and probable bibasilar atelectasis.
|
19957410-RR-24 | 19,957,410 | 23,037,934 | RR | 24 | 2168-09-15 17:29:00 | 2168-09-16 18:45:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with cirrhosis, renal failure on HD, now with
GPC bacteremia// RUE U/S to evaluate for DVT at site of previous RIJ line
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial, basilic, and cephalic veins are
patent, and compressible, with normal color flow and augmentation demonstrated
in the right brachial vein.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
19957410-RR-25 | 19,957,410 | 23,037,934 | RR | 25 | 2168-09-15 17:29:00 | 2168-09-15 18:16:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with cirrhosis, renal failure on HD, now with
GPC bacteremia. Evaluate for biliary obstruction.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound from ___.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis and similar to prior. There is no
definite focal liver mass noted. The previously seen hypoechoic lesion in the
right lobe is not well visualized in today's study. The main portal vein is
patent with hepatofugal flow. Also again demonstrated is reversal flow in
anterior and posterior right portal and left portal veins. There is moderate
ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 10 mm
GALLBLADDER: There has been interval increase of sludge compared to prior. No
definite echogenic stones are noted, although these may be difficult to
visualize. There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
SPLEEN: Normal echogenicity.
Spleen length: 16.0 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 11.4 cm
Left kidney: 13.1 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver with splenomegaly, moderate ascites, and reversal of flow
in the portal system.
2. Prominent CBD, similar to prior, without evidence of intrahepatic biliary
dilatation.
3. Splenomegaly and moderate ascites.
|
19957410-RR-26 | 19,957,410 | 23,037,934 | RR | 26 | 2168-09-16 18:29:00 | 2168-09-16 19:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cirrhosis and ARF, with worsening
hypotension.// ?PNA
TECHNIQUE: 2 AP portable chest radiographs were obtained
COMPARISON: ___
FINDINGS:
A feeding tube extends below the level the diaphragm but beyond the field of
view of this radiograph. The hemodialysis catheter has been removed.
The size of the cardiac silhouette is enlarged but unchanged. Retrocardiac
opacities with air bronchograms could reflect atelectasis and/or pneumonia.
Mild pulmonary edema is also present. There is no pneumothorax or large
pleural effusion. No focal consolidation is seen on the right.
IMPRESSION:
Dense retrocardiac opacities with air bronchograms could reflect atelectasis
and/or pneumonia.
Mild pulmonary edema.
|
19957410-RR-27 | 19,957,410 | 23,037,934 | RR | 27 | 2168-09-17 20:53:00 | 2168-09-18 09:37:00 | INDICATION: ___ year old woman with cirrhosis, renal failure on HD, now with
GPC bacteremia// please remove R tunneled HD line
COMPARISON: none
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: None
PROCEDURE: 1. Right chest tunneled dialysis catheter removal.
PROCEDURE DETAILS: The patient was brought to the angiography holding area
and positioned with his head upright on a stretcher. The Right chest tunneled
line site was cleaned and draped in standard sterile fashion. 1% lidocaine was
administered around the tube track. The catheter was removed with gentle
traction while manual pressure was held at the venotomy site. Hemostasis was
achieved after 5 min of manual pressure. A clean sterile dressing was applied.
The patient tolerated the procedure well. There were no immediate
postprocedural complications.
FINDINGS:
Expected appearance after tunneled line removal.
IMPRESSION:
Successful removal of a right chest tunneled line.
|
19957410-RR-28 | 19,957,410 | 23,037,934 | RR | 28 | 2168-09-18 22:14:00 | 2168-09-18 23:04:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old woman with EtOH cirrhosis, negative paracentesis
culture, worsening abdominal pain// ?ischemic bowel and abscess
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.5 s, 56.2 cm; CTDIvol = 5.4 mGy (Body) DLP = 305.6
mGy-cm.
2) Spiral Acquisition 4.3 s, 56.2 cm; CTDIvol = 22.8 mGy (Body) DLP =
1,280.3 mGy-cm.
Total DLP (Body) = 1,586 mGy-cm.
COMPARISON: Previous CT from ___.
FINDINGS:
VASCULAR:
There is preserved flow in the major celiac and SMA branches. The ___ is also
contrast opacified. There is minimal atherosclerotic plaque and no abdominal
aortic aneurysm. There is stable nonocclusive thrombus in the proximal main
portal vein and there are markedly extensive portosystemic varices,
particularly in the paraesophageal region. The splenic vein, SMV and left and
right portal veins are patent.
LOWER CHEST: Mild bibasal atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates advanced cirrhotic morphology with areas
of extensive fibrosis, similar to prior. No focal liver lesions worrisome for
HCC are identified. Cholelithiasis is again noted. There is no biliary
dilation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation.
SPLEEN: The spleen is enlarged at 18 cm in greatest coronal dimension, similar
to prior. There is a new peripheral wedge-shaped a hypoattenuating focus in
the superior aspect, consistent with infarct. There are a few additional
ill-defined areas of hypodensity which could represent additional small
infarcts.
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.
No stones are demonstrated and there is no hydronephrosis.
GASTROINTESTINAL: There is a nasointestinal tube with the tip in the proximal
jejunum. There is intraluminal contrast throughout much of the small bowel,
limiting evaluation of the bowel wall. However, allowing for this no obvious
hypoenhancing bowel is seen and there is no significant mural thickening.
There is no pneumatosis or free air. The colon is underdistended but grossly
unremarkable. A rectal catheter is present. There is no evidence of
mesenteric lymphadenopathy.
There is large volume ascites, increased from prior. There are no organized
collections.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The bladder is nondistended. There is no evidence of pelvic or
inguinal lymphadenopathy.
REPRODUCTIVE ORGANS: The patient is status post hysterectomy. Adnexal
structures are unremarkable.
BONES: There is no acute fracture seen. 5 level degenerative changes of the
visualized thoracic and lumbar spine. DXA includes Schmorl's nodes at
multiple levels. There is mild irregularity of the endplates of L5 and S1
with blurring of the cortex.
SOFT TISSUES: There is diffuse body wall edema, with more extensive
subcutaneous edema/fluid along the left flank. There is again noted to be
skin thickening and edema in the left breast, for which clinical correlation
has been suggested.
IMPRESSION:
1. No evidence of ischemic bowel or intra-abdominal abscess.
2. Increased ascites compared with ___.
3. New small splenic infarcts.
4. Findings of advanced cirrhosis and portal hypertension with extensive
portosystemic varices again demonstrated. Nonocclusive main portal vein
thrombus is unchanged.
5. Nonspecific irregularity of the endplates of L5-S1, with blurring of the
cortex may relate to osteolysis if there is impaired renal function, or
degenerative change. Recommend clinical correlation. However, if there is
clinical concern for possible discitis osteomyelitis consider lumbar MRI for
further evaluation.
RECOMMENDATION(S): If there is clinical concern for possible discitis
osteomyelitis consider lumbar MRI for further evaluation.
|
19957410-RR-29 | 19,957,410 | 23,037,934 | RR | 29 | 2168-09-18 15:13:00 | 2168-09-18 15:58:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new R IJ CVL// CVL placement Contact
name: ___: ___
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiograph dated ___.
FINDINGS:
A right internal jugular central venous catheter is seen, with tip projecting
over the cavoatrial junction. An enteric tube courses below the diaphragm,
with tip projecting the expected location of the fourth portion of the
duodenum. Lung volumes are low. Pulmonary edema is slightly increased from
prior. The cardiomediastinal and hilar silhouettes are unchanged, with
persistent cardiomegaly. No large pleural effusions. No pneumothorax.
IMPRESSION:
1. A right internal jugular central venous catheter tip projects the
cavoatrial junction.
2. Slight increase in pulmonary edema.
|
19957410-RR-31 | 19,957,410 | 23,037,934 | RR | 31 | 2168-09-20 13:45:00 | 2168-09-20 15:17:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with central line exchanged over wire for HD
line// eval placement of HD line Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: Multiple chest radiographs including ___ and ___.
FINDINGS:
The patient is severely rotated making evaluation thorax difficult. Low lung
volumes. Moderate cardiomegaly, unchanged. Hilar contours are unremarkable.
Stable moderate pulmonary edema. Unchanged retrocardiac opacification likely
consistent with atelectasis, however in the appropriate clinical setting
pneumonia cannot be excluded. Interval placement of right-sided hemodialysis
line which projects over the mid to distal SVC. No pneumothorax. Small left
pleural effusion.
IMPRESSION:
1. Patient is severely rotated limiting evaluation of thorax.
2. Within limitation of study, interval placement of right-sided hemodialysis
line projects over the mid to distal SVC. No pneumothorax.
3. Stable small left pleural effusion.
4. Unchanged moderate pulmonary edema.
|
19957410-RR-32 | 19,957,410 | 23,037,934 | RR | 32 | 2168-09-24 10:11:00 | 2168-09-24 12:28:00 | EXAMINATION: MR ___ AND W/O CONTRAST.
INDICATION: ___ year old woman with cirrhosis, renal failure on HD, VRE
bacteremia with CT concerning for possible L5/S1 discitis/osteomyelitis// eval
for osteomyelitis.
TECHNIQUE: Sagittal T1, T2 and sagittal STIR sequences were obtained through
the lumbar spine, axial T1 and T2 weighted images were also obtained. The T1
weighted images were repeated after the intravenous administration of 15 mL of
ProHance gadolinium base contrast agent.
COMPARISON: Abdominal CT dated ___.
FINDINGS:
Limited examination due to patient motion and habitus of the patient resulting
in poor quality signal, within this limitations, there is mild anterolisthesis
at L5 upon S1 level, likely degenerative in nature. Mild irregular contour of
the endplates at T12-L1, L2-L3 and L5-S1 levels are consistent with Schmorl's
nodes, grossly unchanged since the prior CT of the abdomen dated ___. High-signal intensity in the lower aspect of the conus medullaris is
likely artifactual, the conus terminates at the level of L1 (4:9). There is
no evidence of abnormal enhancement after contrast administration to indicate
or suggest discitis osteomyelitis. Perineural cysts are visualized at T11-T12
and T12-L1 levels, slightly more pronounced on the right (3:5). Multilevel,
multifactorial degenerative changes throughout the lumbar spine as follows:
From T10-T11 through T12-L1 levels, there is no evidence of neural foraminal
narrowing or spinal canal stenosis.
At at L1-L2 level, high-signal intensity is noted in the intervertebral disc
suggestive of annular fissure (4:9). There is no evidence of neural foraminal
narrowing or spinal canal stenosis.
At L2-L3 level, there is mild disc bulge, apparently contacting the traversing
nerve roots bilaterally towards the subarticular zones (06:16), there is no
evidence of central spinal canal stenosis, there is mild bilateral articular
joint facet hypertrophy.
At L3-L4 level, there is mild spondylosis and mild views disc bulge causing
minimal anterior thecal sac deformity, mild left and moderate right neural
foraminal narrowing, apparently the disc bulge is contacting the traversing
nerve roots bilaterally towards the subarticular zones (06:22), there is mild
bilateral articular joint facet hypertrophy with no evidence of central spinal
canal narrowing.
At L4-5 level, there is mild spondylosis and diffuse disc bulge, causing mild
bilateral neural foraminal narrowing, there is no evidence of central spinal
canal stenosis, there is mild bilateral articular joint facet hypertrophy.
At L5-S1 level, the intervertebral disc demonstrates high-signal intensity on
the STIR and T2 weighted images, suggesting an annular fissure, there is mild
spondylosis and disc bulge causing mild bilateral neural foraminal narrowing,
there is moderate articular joint facet hypertrophy, there is no evidence of
central spinal canal narrowing.
The visualized paravertebral structures demonstrates increased fat pattern
surrounding left side of the paravertebral structures suggesting all lipoma
from L4 through S1 level, otherwise, the visualized paravertebral structures
are unremarkable.
IMPRESSION:
1. Limited examination due to patient motion, within the limits of this exam,
grossly there is no evidence of abnormal enhancement after contrast
administration to indicate or suggest discitis or osteomyelitis. No fluid
collections or abscesses are seen.
2. Multilevel, multifactorial degenerative changes throughout the lumbar
spine, slightly more pronounced at L3-L4, L4-5 and L5-S1 levels, including
mild anterolisthesis L5 upon S1, likely degenerative in nature.
|
Subsets and Splits