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19959697-RR-25 | 19,959,697 | 24,526,526 | RR | 25 | 2158-04-25 01:41:00 | 2158-04-25 08:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p left BKA, now with SOB // pulmonary edema
pulmonary edema
IMPRESSION:
Comparison to ___. The patient is now in severe, predominantly
centralized pulmonary edema. The edema shows a mild interstitial component.
No pleural effusions are seen, but there is fluid marking of the minor
fissure. Borderline size of the cardiac silhouette. Stable position of the
right PICC line.
|
19959697-RR-26 | 19,959,697 | 24,526,526 | RR | 26 | 2158-04-26 08:09:00 | 2158-04-26 09:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SOB // f/u on pulmonary edema f/u on
pulmonary edema
IMPRESSION:
Comparison to ___. The pre-existing pulmonary edema has minimally
decreased in severity but is still moderate to severe. No larger pleural
effusions are present. Mild cardiomegaly persists. No pneumonia.
|
19959697-RR-27 | 19,959,697 | 24,526,526 | RR | 27 | 2158-04-27 08:35:00 | 2158-04-27 09:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SOB tachycardia // Pulmonary edema
IMPRESSION:
Allowing for differences in technique, there has not been a relevant change in
the appearance of the chest since recent study of 1 day earlier.
|
19959697-RR-28 | 19,959,697 | 24,526,526 | RR | 28 | 2158-04-28 10:25:00 | 2158-04-28 11:09:00 | INDICATION: ___ year old man with shortness of breath low O2 sat on 5L. //
Pulmonary edema
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiographs since ___, most recently ___.
FINDINGS:
Extensive diffuse airspace opacities are slightly worse than on ___,
progressively worsening since ___, accentuated by lower lung volumes. A
right PICC terminates in the mid SVC, unchanged. No pneumothorax. Stable mild
cardiomegaly. No larger pleural effusions.
IMPRESSION:
Slightly worse extensive airspace opacities since ___, progressively
worsening since ___, concerning for multifocal infection or severe
pulmonary edema.
|
19959697-RR-29 | 19,959,697 | 24,526,526 | RR | 29 | 2158-04-28 15:01:00 | 2158-04-28 15:36:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with peripheral vascular disease and ___ now with
5L O2 requirement with CXR c/f multifocal pneumonia vs pulmonary edema //
Please assess for multifocal pneumonia versus pulmonary edema
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
no administration of intravenous contrast material, multiplanar
reconstructions.
DOSE: DLP: 385 mGy-cm
COMPARISON: No comparison.
FINDINGS:
No incidental thyroid findings. No supraclavicular, infraclavicular or
axillary lymphadenopathy. Mild mediastinal lymphadenopathy with lymph node
diameters reaching 16 mm. Moderate aortic wall calcifications, mild coronary
calcifications, no valvular calcifications, no pericardial effusion. Small
hiatal hernia. Small bilateral pleural effusions. No acute abnormalities in
the upper abdomen. Mild splenomegaly. Moderate degenerative vertebral
disease. No vertebral compression fractures. No osteolytic lesions at the
level of the ribs, the sternum, or the vertebral bodies. The lung parenchyma
shows relatively diffuse ground-glass opacities, combines to areas of very
mild interstitial thickening. . The opacities are more severe in the upper
than in the lower lobes and become more focal an ill-defined in the lower
lobes. In the same lower lobes, there is no evidence of interstitial or
lobular thickening or markings. No suspicious lung nodules or masses.
IMPRESSION:
Small bilateral pleural effusions. Diffuse and severe parenchymal opacities,
with a dominating ground-glass and a mild interstitial component. The
distribution, the gradient, and the combination of the different components
strongly favor multifocal pneumonia or for pulmonary edema. Mild accompanying
mediastinal lymphadenopathy.
|
19959697-RR-30 | 19,959,697 | 24,526,526 | RR | 30 | 2158-04-29 15:45:00 | 2158-04-30 10:39:00 | INDICATION: ___ male with a history of severe peripheral arterial
disease who was admitted to the vascular surgery service for non-healing left
malleolar wound s/p BKA with hypoxia and fluid overload vs. multifocal
pneumonia gradually worsening on previous CXRs. // Improving pulmonary edema?
TECHNIQUE: Frontal view of the chest
COMPARISON: ___
FINDINGS:
Right PICC terminates at mid SVC. Lung volume remains low. Extensive
airspace opacities in bilateral lungs are less compared to 1 day ago.
Cardiomediastinal silhouette is stable. There is possible small right pleural
effusion.
IMPRESSION:
Extensive airspace opacity is less than 1 day ago, likely reflecting improved
pulmonary edema in setting of multifocal pneumonia.
|
19959697-RR-31 | 19,959,697 | 24,526,526 | RR | 31 | 2158-04-30 07:24:00 | 2158-04-30 09:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ male with a history of severe peripheral arterial
disease who was admitted to the vascular surgery service for non-healing left
malleolar wound s/p BKA with hypoxia and fluid overload vs. multifocal
pneumonia gradually worsening on previous CXRs. // Improving congestion?
Improving congestion?
IMPRESSION:
Comparison to ___. Severe bilateral parenchymal opacities, diffuse
in distribution, with the predominant vascular component and several
coexisting nodular opacities. The disease is better cardiac arrest on the CT
examination from ___. As previously noted, the findings are
suggestive of multifocal pneumonia. The pleural effusions seen on CT are not
visualized on the chest radiograph.
|
19959697-RR-33 | 19,959,697 | 24,526,526 | RR | 33 | 2158-05-02 07:29:00 | 2158-05-02 09:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with multifocal pneumonia on CT chest. //
Improving opacities? Improving opacities?
IMPRESSION:
In comparison with the study of ___, there is some decrease in the
bilateral pulmonary opacifications, seen on recent CT scan to represent
multifocal pneumonia. The cardiac silhouette is at the upper limits of normal
or mildly enlarged, indicating that some of this bilateral opacifications
could reflect an element of elevated pulmonary venous pressure.
The pleural effusions seen on CT are not appreciated on plain radiography.
|
19959697-RR-34 | 19,959,697 | 24,526,526 | RR | 34 | 2158-05-05 09:52:00 | 2158-05-05 10:50:00 | EXAMINATION: Video oropharyngeal swallow
INDICATION: ___ year old man with recurrent aspiration presenting for
multifocal PNA. // Risk of aspiration. Interval change from ___.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 2min 21sec .
COMPARISON: ___ video oropharyngeal swallow
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was silent aspiration with thin liquids. However, chin
tuck mitigates the aspiration. There is penetration with nectar thick and
thin liquids.
IMPRESSION:
Silent aspiration with thin liquids and penetration with nectar thick liquids
resolved by chin tuck.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19959697-RR-35 | 19,959,697 | 24,526,526 | RR | 35 | 2158-05-04 11:29:00 | 2158-05-04 13:16:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recurrent aspiration presenting for
multifocal PNA. // Changes/Improvement?
IMPRESSION:
In comparison to ___ chest radiograph, widespread pulmonary opacities
show substantial interval improvement, particularly within the upper lungs.
No other relevant change.
|
19959697-RR-8 | 19,959,697 | 22,344,558 | RR | 8 | 2157-05-06 02:52:00 | 2157-05-06 03:23:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: History: ___ with code stroke // eval for stroke
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
skull base during infusion of mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated. This report is based on interpretation of all
of these images.
DOSE: This study involved 5 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
1,009.3 mGy-cm.
4) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 130.7 mGy (Head) DLP =
65.3 mGy-cm.
5) Spiral Acquisition 5.4 s, 42.4 cm; CTDIvol = 35.4 mGy (Head) DLP =
1,501.1 mGy-cm.
Total DLP (Head) = 2,576 mGy-cm.
COMPARISON: None.
FINDINGS:
CT noncontrast head:
There is no acute intracranial hemorrhage, infarction, mass, mass effect, or
midline shift. The ventricles and sulci are normal in size and configuration.
CTA head:
The vessels of the circle of ___ and their principal intracranial branches
are patent without stenosis, occlusion or aneurysm formation. The right A1
segment is absent or hypoplastic. Irregularity and narrowing of the right
ophthalmic segment of the internal carotid arteries are related to
atherosclerotic calcifications. The dural venous sinuses are patent.
CTA NECK:
There is a short segment of near occlusion of the right proximal internal
carotid artery at the carotid bifurcation on 5:149 related to soft and
calcified plaque. A lumen of the right proximal internal carotid artery
measures less than 0.5 mm. The remainder of the distal right internal carotid
artery measures 5 mm. The remainder of the cervical and intracranial segments
of the right internal carotid artery are diminutive in caliber relative to the
left internal carotid artery. There is no evidence of stenosis or occlusion of
the left internal carotid artery by NASCET criteria. There are atherosclerotic
calcifications at the origins of the vertebral artery, which remain patent.
OTHER:
Subsegmental atelectasis is noted in the left upper lobe. A 3 mm solid nodule
in the right upper lobe is noted on 05:53. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria.
IMPRESSION:
1. Short-segment, near occlusion with greater than 90% estimated stenosis of
the right proximal internal carotid artery by NASCET criteria.
2. Patent circle of ___.
3. No evidence of left internal carotid artery stenosis by NASCET criteria.
4. There is a 3 mm right upper lobe nodule. If the patient is at low risk for
malignancy, no further follow-up is necessary. If the patient is at high risk
for malignancy, CT follow-up is recommended in 12 months. These guidelines
are based on ___ criteria.
RECOMMENDATION(S):
Three mm right upper lobe nodule. If the patient is at low risk for
malignancy, no further follow-up is necessary. If the patient is at high risk
for malignancy, CT follow-up is recommended in 12 months. These guidelines
are based on ___ criteria.
|
19959697-RR-9 | 19,959,697 | 22,344,558 | RR | 9 | 2157-05-06 03:04:00 | 2157-05-06 08:07:00 | EXAMINATION: Chest radiographs
INDICATION: History: ___ with prior CVA p/w acute onset RLE weakness // eval
for consolidation
TECHNIQUE: Semi upright AP image of the chest.
COMPARISON: None.
FINDINGS:
The lungs are well expanded and clear. There is no pleural effusion or
pneumothorax. The cardiomediastinal silhouette is unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
19960115-RR-57 | 19,960,115 | 22,370,556 | RR | 57 | 2113-12-31 01:43:00 | 2113-12-31 11:20:00 | INDICATION: PICC line in place // examination for placement
TECHNIQUE: Portable semi upright chest radiograph
COMPARISON: ___
FINDINGS:
Tracheostomy tube is unchanged. Although obscured along its mediastinal
course, the left PICC line appears to terminate deep in the right atrium and
should be retracted by 3 cm. Heart size is stable in bilateral pleural
effusions are unchanged since ___, right greater than left.
IMPRESSION:
Low position of the left PICC line terminating in the right atrium, could be
retracted by 3 cm.
NOTIFICATION: The findings were discussed by Dr. ___ with Nurse ___ on
the telephone on ___ at 9:55 AM, 5 minutes after discovery of the
findings.
|
19960115-RR-58 | 19,960,115 | 22,370,556 | RR | 58 | 2113-12-31 15:03:00 | 2113-12-31 17:50:00 | INDICATION:
___ year old man s/p Whipple with pancreatic leak, please place post-pyloric
Dobhoff tube // Please place post-pyloric dobhoff tube
COMPARISON: Fluoroscopic guided feeding tube advancement from ___
FINDINGS:
The existing ___ tube is seen in the appropriate position with
the tip in the stomach. Under fluoroscopic guidance, the ___
tube was advanced until the tip reached just beyond the duodenojejunal
anastomosis. The tube could not be further advanced due to luminal narrowing
and tortuosity of the jejunum at this area. Tube position was confirmed with
an injection of Optiray contrast. There were no immediate postprocedure
complications. Final fluoroscopic spot images demonstrate a feeding tube just
beyond the anastomosis.
IMPRESSION:
Feeding tube was advanced just beyond the duodenojejunostomy but could not be
further advanced into the jejunum.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 5:00PM, 5 minutes after discovery of the findings.
|
19960115-RR-59 | 19,960,115 | 22,370,556 | RR | 59 | 2114-01-01 10:09:00 | 2114-01-01 11:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with for Dobhoff placement // tachycardia
tachycardia
COMPARISON: Prior chest radiographs ___.
IMPRESSION:
Lung volumes remain quite low, exaggerating the severity of minimal residual
edema. Combination of moderate right lower lobe atelectasis and some right
pleural effusion has improved since ___, stable since ___. Mild
cardiomegaly is unchanged. Tracheostomy tube in standard placement. Feeding
tube passes into the stomach and out of view. No pneumothorax.
|
19960115-RR-60 | 19,960,115 | 22,370,556 | RR | 60 | 2114-01-01 22:01:00 | 2114-01-01 22:47:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ s/p Whipple for pancreatic adenocarcinoma c/b postop
aspiration PNA leading to septic shock, ARF, reintubation, trach readmitted
for Dobhoff placement // persistent fever - questionable 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 bilateral lower extremity veins.
|
19960115-RR-61 | 19,960,115 | 22,370,556 | RR | 61 | 2114-01-02 12:24:00 | 2114-01-02 13:55:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ man status post Whipple with fevers and tachycardia,
evaluate for infection.
TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and
pelvis with intravenous and oral contrast. Multiplanar reformations were
generated and reviewed.
Total DLP (Body) = 1,322 mGy-cm.
COMPARISON:
1. CT abdomen and pelvis ___.
2. CT abdomen ___.
FINDINGS:
LUNG BASES: Please see dictation for separately reported CT Chest
examination.
CT ABDOMEN:
The liver enhances homogeneously without evidence of focal lesion. There is
no intrahepatic biliary ductal dilation. The portal vein is patent. The
gallbladder surgically absent. Postsurgical changes are seen throughout the
upper abdomen status post Whipple procedure. The remaining pancreatic body
and tail enhance homogeneously without peripancreatic stranding or ductal
dilation. There is no splenomegaly or focal splenic lesion.
An irregularly-shaped relatively simple fluid collection is seen in the
intraperitoneal cavity anterior to the stomach and extending superiorly and
layering along the anterior splenic capsular surface. This collection appears
continuous at its inferior extent within an additional rim enhancing more
focal fluid collection with surrounding fat stranding and
inflammatory/phlegmonous change in the left mid hemi-abdomen (series 2, image
66). The adjacent transverse colon is mildly narrowed without pre-stenotic
dilatation. The collection demonstrates a relatively thin but enhancing wall.
While overall the amount fluid is decreased in comparison to most recent CT,
the collections appear more loculated with more apparent surrounding
inflammatory change. Superimposed infection cannot be excluded by CT. An
additional 3.5 x 1.7 cm (series 2, image 74) simple appearing fluid collection
anterior to the biliary limb with nearby surgical clips in the mid right
hemiabdomen may represent a small lymphocele.
The adrenal glands are unremarkable. Small renal cortical hypodensities are
too small to characterize; otherwise, there is normal symmetric renal
enhancement bilaterally. There is no hydronephrosis.
An enteric tube extends to the distal stomach/pylorus. The GJ junction is
patent. The JJ anastomosis is not definitively visualized, however there is
no evidence of small bowel dilation, wall thickening, or obstruction. There
is mild colonic diverticulosis without evidence of diverticulitis. The colon
is otherwise unremarkable. The appendix is normal.
The abdominal aorta is normal in caliber without evidence of aneurysm or
dilation. Proximal tributaries appear patent. There is no mesenteric or
retroperitoneal lymphadenopathy by CT size criteria. There is no free
intraperitoneal air.
CT PELVIS:
The imaged pelvic organs including the bladder and terminal ureters, are
unremarkable. There is no pelvic sidewall, iliac chain, or inguinal
lymphadenopathy. There is no free pelvic fluid.
MUSCULOSKELETAL:
Diffuse generalized subcutaneous soft tissue edema is compatible with a
generalized edematous state. There is mild degenerative change of the imaged
thoracolumbar spine. Alignment is normal. No concerning focal lytic or
sclerotic osseous lesions are identified.
IMPRESSION:
1. Irregular intraperitoneal fluid collection primarily seen anterior to the
stomach and spleen, and layering dependently just superior to the transverse
colon. While there has been an overall decrease in the amount of
intraperitoneal fluid, the collections now appear more loculated, with more
apparent surrounding inflammatory change, a thin but enhancing wall, and an
area of more focal possible phlegmonous change adjacent to the transverse
colon. Superimposed infection cannot be excluded by CT.
2. Small fluid collection anterior to the biliary limb may represent a small
lymphocele.
3. Status post Whipple procedure. Normal biliary limb. No evidence of
obstruction. Normal pancreatic remnant.
4. Diffuse mild mesenteric haziness and subcutaneous soft tissue edema,
compatible with a generalized edematous state.
5. Please see separate report for intrathoracic findings from same-day CT
chest.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 2:45 ___, 45 minutes after discovery of the
findings.
|
19960115-RR-62 | 19,960,115 | 22,370,556 | RR | 62 | 2114-01-02 12:25:00 | 2114-01-02 15:10:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ man status post Whipple with fevers and
tachycardia, evaluate for infection.
TECHNIQUE: Multi-detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic, iodinated contrast agent, reconstructed as
contiguous 5 mm and 1.0 or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and
parasagittal, and 8 mm MIP axial images. Subsequent scanning of the abdomen
and pelvis and a total dosage of scanning the entire torso will be reported
separately. Images of the chest were reviewed.
DOSAGE: TOTAL DLP will be noted in the separate report of the CT of the
abdomen and pelvis performed concurrently.mGy-cm
COMPARISON: CHEST CT ___ AND CTA ___.
FINDINGS:
Tracheostomy tube is midline. Esophageal drainage tube passes into the
stomach and out of view. There is no associated fluid collection or other
complication. Supraclavicular and axillary nodes are not enlarged and there
is no soft tissue abnormality in the chest wall suspicious for malignancy or
infection.
Thyroid is unremarkable. Atherosclerotic calcification is not apparent in the
head and neck vessels and only mild in the coronaries, at least in the LAD.
Pericardium is physiologic. The attenuation characteristics of small layering
bilateral pleural effusions, roughly stable in volume since ___ all, are
disturbed by artifact. Mediastinal and hilar lymph nodes are not
pathologically enlarged, ranging in diameter up to 8 mm in the left lower
paraesophageal mediastinal station, and 8 mm in the left hilus.
The a 20 x 30 mm well-circumscribed right, paraesophageal fluid collection in
the posterior mediastinum just above the diaphragm, 4:154, with a mildly
enhancing rim, was 26 x 35 mm on ___, 6:60. It is either a seroma or an
abscess, but not hematoma.
New centrilobular micro nodularity in the upper lobe, most prominent at the
right apex, 04:53, is probably bronchiolitis. What was previously a uniformly
consolidated and possibly collapsed right lower lobe on ___, and now looks
more like a large pneumonia, with a somewhat smaller component in the left
lower lobe.
There are no bone lesions in the chest cage suspicious for malignancy or
infection. The severe kyphosis is due to moderate loss of height anteriorly
in 3 contiguous thoracic vertebrae.
IMPRESSION:
Bilateral lower lobe pneumonia.
3 cm postoperative, right paraesophageal abscess or seroma at the level of the
diaphragm is smaller today than on ___.
RECOMMENDATION(S): I would recommend keeping paraesophageal lesion under
observation while treating the patient for pneumonia, since it may be
resolving spontaneously
NOTIFICATION: Dr. ___ reported the findings to ___ (In
Hospital, On Page), ___ by telephone on ___ at 3:01 ___, 1 minutes after
discovery of the findings.
|
19960115-RR-64 | 19,960,115 | 22,370,556 | RR | 64 | 2114-01-04 03:42:00 | 2114-01-04 10:00:00 | INDICATION: ___ s/p Whipple for pancreatic adenocarcinoma c/b postop
aspiration PNA leading to septic shock, ARF, reintubation, trach s/p Dobhoff
placement now c/b anemia/fever. // pneumonia work-up
COMPARISON: Radiographs from ___
IMPRESSION:
Support lines and tubes are unchanged in position. There is unchanged
cardiomegaly. There is again seen bilateral pleural effusions and markedly
low lung volumes. There is mild pulmonary edema. No pneumothoraces are seen.
|
19960115-RR-65 | 19,960,115 | 22,370,556 | RR | 65 | 2114-01-04 11:15:00 | 2114-01-04 21:47:00 | INDICATION: New intra-abdominal fluid collection after Whipple. Please drain
and send fluid for culture.
COMPARISON: CT of the abdomen and pelvis from ___.
PROCEDURE: CT-guided drainage of an anterior upper abdomen fluid collection.
OPERATORS: Dr. ___ fellow and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CTscan was performed to localize the collection. Based on the CT
findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. A dilator was placed over the wire.
Subsequently, an attempt to pass the ___ catheter was made, but due to
the thick nature of the fluid collection's anterior capsule, it was is
difficult to pass the drainage catheter into the fluid collection. The
catheter curled superficial to the collection, and retracted the guide wire.
A second pass was made with the 18 gauge ___ needle. The tract was
re-dilated. This was followed by successful placement of ___ pigtail
catheter into the collection. The plastic stiffener and the wire were removed.
The pigtail was deployed. The position of the pigtail was confirmed within the
collection via CT fluoroscopy.
Approximately 5 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications. Procedure was somewhat more difficult due to patient motion.
DOSE: DLP: 2631 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 4
mg Versed and 200 mcg fentanyl throughout the total intra-service time of 65
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Unchanged anterior abdominal fluid collection, better characterized on the
prior CT.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples was sent for microbiology evaluation.
|
19960115-RR-66 | 19,960,115 | 22,370,556 | RR | 66 | 2114-01-08 16:12:00 | 2114-01-08 17:47:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man s/p whipple complicated by pna required trach.
patient was decannulated ___ // please evaluate for possible tracheal fistula
or false tract
TECHNIQUE: Multidetector helical scanning of the chest was performed after
the uneventful administration of IV contrast and reconstructed as contiguous
5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal, and 8 x 8
mm MIPs axial images.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 3.8 s, 29.5 cm; CTDIvol = 23.3 mGy (Body) DLP = 688.7
mGy-cm.
Total DLP (Body) = 689 mGy-cm.
COMPARISON: CT chest ___
FINDINGS:
Thyroid is unremarkable. Thoracic aorta and main pulmonary artery are normal
size. There is no pericardial effusion. Coronary artery calcification is
minimal. A 11 mm left brachiocephalic lymph node is similar to prior. Other
prominent mediastinal lymph nodes are stable.
A 19x14 mm right paraesophageal fluid collection at the level of the diaphragm
similar to prior.
Airways are patent to subsegmental levels. There is irregularity in the
anterior tracheal wall at the level of the thyroid, reflective of prior
tracheostomy. There is no gas or fluid collection in the mediastinum to
suggest tracheal fistula. Bilateral lower lobe pneumonia is improved compared
to prior, as well as the centrilobular micro nodularity in the right upper
lobe. There are trace bilateral pleural effusions, also smaller.
BONES/ SOFT TISSUE: There is no worrisome lesion.
ABDOMEN: This study was not designed for subdiaphragmatic evaluation.
Limited assessment of upper abdominal organs are notable for interval drain
placement in the anterior intraperitoneal fluid collection. There is no
visible fluid collection around the drain. A transesophageal tube is coiled
in the stomach. There is small hiatal hernia.
IMPRESSION:
1. No evidence of tracheal fistula.
2. Bilateral lower lobe pneumonia is improved. Followup CT is recommended in
3 months to ensure resolution and rule out underlying malignancy.
3. Right paraesophageal fluid collection is similar to prior.
|
19960115-RR-86 | 19,960,115 | 29,779,881 | RR | 86 | 2114-09-26 07:40:00 | 2114-09-26 13:35:00 | INDICATION: ___ with CP // r/o acute process
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
Lung volumes are low secondary crowding of the bronchovascular markings.
Superimposed mild pulmonary edema is also possible. Blunting of the left
lateral costophrenic angle suggests an effusion. There may also be a small
right pleural effusion as well. Left chest wall Port-A-Cath is again noted,
catheter tip not clearly delineated but likely in the region of the RA SVC
junction.
IMPRESSION:
Low lung volumes and probable bilateral effusions, left larger than right.
Superimposed mild edema is also possible.
|
19960115-RR-87 | 19,960,115 | 29,779,881 | RR | 87 | 2114-09-26 09:39:00 | 2114-09-26 11:28:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with chest pain and history of pancreatic cancer // eval for
pulmonary embolism, aortic dissection
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: Total DLP (Body) = 459 mGy-cm.
COMPARISON: CT of the chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart and great vessels are within normal limits. No
pericardial effusion is seen. Fat stranding of the mediastinum is again seen,
unchanged from previous examination.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: There is interval removal of the right sided chest tube and
resolution of the right sided pneumothorax. There is a small right posterior
effusion at site of prior pneumothorax (2:48, 602b:29). Loculated left
moderate and small right basal pleural effusions are present, unchanged.
LUNGS/AIRWAYS: A dominant pleural-based right basilar pulmonary nodule which
measures 1.9 x 1.8 cm, previously 2.2 x 2.0 cm, although, subtle interval
changes in size are difficult to accurately assess given adjacent pleural
effusion on the current exam versus abutting pneumothorax on prior. Bilateral
scattered pulmonary nodules are grossly unchanged from previous examination.
The airways are patent to the level of the segmental bronchi bilaterally.
Diffuse peribronchial thickening, interlobar septal thickening, pleural and
perifissural nodularity suggestive of lymphangitic tumor involvement although
component of edema is possible, overall unchanged.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
The thyroid gland appears unremarkable.
ABDOMEN: There is a small hiatal hernia. Multiple ill-defined hepatic
hypodensities are seen, unchanged, consistent with metastatic disease.
BONES: A sclerotic lesion in the vertebral body of T5 was not present on CT
scan from ___ and has subsequently progressively increased in size
progressively, which is concerning for metastasis. A smaller sclerotic focus
at the superior end plate of T9 was not present on CT scan in ___,
and is also concerning for metastasis. Chronic vertebral body wedging mid
thoracic spine with accentuated kyphosis is unchanged.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Interval removal of right sided chest tube and resolution of small right
pneumothorax. Unchanged bilateral loculated pleural effusions.
3. Unchanged appearance of hepatic and pulmonary metastatic disease burden
notable for pleural based pulmonary consolidation, nodular interlobular septal
thickening and pleural thickening.
4. Progressively increased size of sclerotic lesion in the vertebral body of
T5 not present on CT scan from ___, concerning for metastasis.
Smaller sclerotic focus at the superior end plate of T9 is also concerning.
|
19960115-RR-88 | 19,960,115 | 29,779,881 | RR | 88 | 2114-09-27 10:05:00 | 2114-09-27 14:00:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with dual chamber PPM // lead placement
lead placement
IMPRESSION:
Compared to prior chest radiographs since ___, most recently ___.
Moderately severe pulmonary edema has worsened, moderate left pleural effusion
is larger and cardiomediastinal silhouette is substantially larger. This
could be due to cardiac decompensation, but since new transvenous right atrial
and right ventricular pacer leads have been inserted, it raises concern for
bleeding in the mediastinum and possibly pericardium.. There is no
pneumothorax.
NOTIFICATION: Dr. ___ reported the findings to ___, new ___ by
telephone on ___ at 1:56 ___, 1 minutes after discovery of the findings.
|
19960203-RR-27 | 19,960,203 | 23,598,678 | RR | 27 | 2140-11-06 12:58:00 | 2140-11-06 13:43:00 | INDICATION: ___ with malfunctioning PICC line, weakness// Please evaluate for
pneumonia or effusion, please evaluate PICC line placement
TECHNIQUE: AP and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Right PICC is seen with tip in the right atrium. If withdrawn by 2.5 cm it
would be closer to the superior cavoatrial junction. Opacity over the
posterior costophrenic angle on the lateral localizes to the left based on the
frontal view, improved since prior. The right lung is clear.
Cardiomediastinal silhouette is within normal limits. Peg tube projects over
the upper abdomen. No acute osseous abnormalities.
IMPRESSION:
Right PICC tip over the right atrium. Improving left basilar opacity.
|
19960203-RR-29 | 19,960,203 | 23,598,678 | RR | 29 | 2140-11-12 10:28:00 | 2140-11-12 16:27:00 | INDICATION: ___ with pancreatic adenoCA now s/p Whipple and cholecystectomy
c/b delayed gastric emptying// GJ exchange using existing PEG tube tract
COMPARISON: No relevant comparisons available.
TECHNIQUE: OPERATORS: Dr. ___ the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 50 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None
CONTRAST: 30 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 36.4 min, 210 mGy
PROCEDURE: 1. Exchange of a gastrostomy for an 18 ___ MIC
gastrojejunostomy tube.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The upper abdomen and tube site was prepped and draped in the usual
sterile fashion.
The existing tube was injected with contrast and showed opacification of the
gastric rugae. The stay sutures were cut. A ___ wire was advanced through
the tube into the stomach. The existing tube was then removed using gentle
traction. Using a Kumpe catheter and glidewire, access was obtained into the
jejunum. A 18 ___ gastrojejunostomy tube was advanced over the wire into
the distal duodenum and the balloon was inflated using contrast diluted in
sterile water. Contrast injection confirmed appropriate position. The tube was
secured in place using 0 silk sutures. Sterile dressing was applied. Patient
tolerated the procedure well and there were no immediate post-procedure
complications.
FINDINGS:
1. 18 ___ MIC gastrojejunostomy tube in the jejunum.
IMPRESSION:
Successful exchange of a gastrostomy tube for a new 18 ___ MIC
gastrojejunostomy tube. The tube is ready to use.
|
19960203-RR-30 | 19,960,203 | 23,598,678 | RR | 30 | 2140-11-13 23:36:00 | 2140-11-14 05:21:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ 1 mo s/p whipple, new GJ replacement, rising WBC, eval
placement of GJ and r/o abscess. PO and IV contrast please (OK to give PO
contrast via g-tube)// evaluate GJ placement, abscess. PO and IV contrast (ok
to give PO contrast via G tube)
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 541 mGy-cm.
COMPARISON: Multiple prior CTA abdomen and pelvis examinations most recent
dated ___
FINDINGS:
LOWER CHEST: Small right pleural effusion has resolved. Moderate size left
pleural effusion has improved with a small left pleural effusion remaining.
There is interval improvement of subsegmental left lower lobe atelectasis with
few areas focal hypoenhancing noted. 4 mm right middle lobe pulmonary nodule
(series 2, image 3), unchanged.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 1.5
cm right hepatic lobe cyst is unchanged. There is a 0.7 cm low-density lesion
in the hepatic dome (series 2, image 7) has increased in size from prior exam
which measured 0.5 cm. There is no new evidence of focal lesions. Patient is
status post hepaticojejunostomy. Postoperative fluid collections in hepatic
hilum have improved with no ring-enhancing collection is seen to suggest
abscess. There is no evidence of intrahepatic biliary dilatation. The
gallbladder is surgically absent.
PANCREAS: Patient is status post Whipple procedure. There is atrophy of the
remaining body and tail of pancreas similar to prior exam. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding. A
Fiducial marker is seen anterior to the IVC.
SPLEEN: The spleen shows normal size, without evidence of focal lesions.
ADRENALS: The right adrenal gland is normal in size and shape. There is
nodular thickening of left adrenal gland, unchanged.
URINARY: The kidney is unremarkable except for multiple bilateral simple
cysts..
GASTROINTESTINAL: Patient is status post pylorus sparing Whipple Procedure.
There is a gastrojejunostomy tube in place. The remaining bowel is normal in
appearance with no evidence obstruction
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Small low-density lesion in the hepatic dome seem slightly larger measures
0.7 cm, previously 0.5 cm. This is incompletely characterized on this exam.
2. Interval improvement of subsegmental left lower lobe atelectasis with few
areas focal hypoenhancing which could be due to retained secretions or small
areas of infection.
3. Interval resolution of small right pleural effusion.
RECOMMENDATION(S): Recommend further evaluation with liver MR after
improvement in ___ condition, preferably in no more than 1 month.
|
19960203-RR-31 | 19,960,203 | 23,598,678 | RR | 31 | 2140-11-17 08:04:00 | 2140-11-17 10:04:00 | EXAMINATION: G/GJ/GI TUBE CHECK
INDICATION: ___ male please check J-tube position. Please bring
gastrografin to the bed side. Thank you
TECHNIQUE: Multiple supine abdominal radiographs were performed on the floor
prior to and status post injection of a gastrojejunostomy tube
COMPARISON: CT abdomen pelvis dated ___ and percutaneous GJ tube
check performed ___.
FINDINGS:
3 supine radiographic images of the abdomen are provided. The initial scout
image demonstrates contrast filling nondilated loops of colon, likely from
patient's recent CT abdomen pelvis from ___. Multiple surgical
clips are seen in the right upper quadrant. A gastrojejunostomy tube is
visualized overlying the left hemiabdomen, with the tip seen in the mid lower
abdomen. Evaluation of free intraperitoneal air is limited on this supine
only projection. No concerning osseous lesions are identified.
The second portable abdominal radiographs performed after the jejunostomy port
was injected at 08:55 on ___ demonstrates contrast in the left
hemiabdomen opacifying gastric rugae, with no definite intraluminal contrast
seen within small bowel loops. No evidence of extraluminal contrast.
The third portable abdominal radiograph performed after the gastrostomy port
was injected at 08:57 on ___ demonstrates contrast opacification
in the left upper quadrant within the stomach.
IMPRESSION:
Multiple serial abdominal radiograph status post injection of a
gastrojejunostomy tube demonstrate contrast only within the gastric lumen,
consistent with proximal migration of the gastrojejunostomy tube.
The findings were discussed with ___, M.D. by ___, M.D.
on the telephone on ___ at 9:32 am, 5 minutes after discovery of the
findings.
|
19960203-RR-32 | 19,960,203 | 23,598,678 | RR | 32 | 2140-11-17 16:53:00 | 2140-11-18 09:44:00 | INDICATION: ___ with pancreatic adenoCA now s/p Whipple and cholecystectomy
c/b persistent nausea, emesis, malnutrition with GJ placed by ___ on ___
now with tube study suggesting that the J is in the stomach.// Could we
reposition? Thanks! (overnight tube feeds were found coming out of the G tube
which was to gravity)
COMPARISON: Previous G-J exchange
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
performed the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 25 mins during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS:
CONTRAST: 20 ml of OPTIRAY contrast
FLUOROSCOPY TIME AND DOSE: 10 min, 105 mGy
PROCEDURE: - MIC gastrojejunostomy attempted placement
- MIC ___ G-tube placed
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The tube site was prepped and draped in the usual sterile fashion.
The existing tube was injected with contrast and showed opacification of the
gastric rugae. The jejunal component was flipped into the stomach. The
existing feeding tube was then removed. A sheath was placed. A C2
glidecatheter was then introduced over the wire. A glidewire combination was
utilized to navigate to the jejunum. A wire was placed distal into the
jejunum and a ___ MIC G-J tube advanced into place. However, upon removal of
the wire and fluoroscopy check, the tube had already flipped into the stomach.
Further attempts were not made given the overwhelming likelihood of repeat
migration. A ___ g-tube was then placed into the stomach. The catheters
balloon was inflated with 7 ml of contrast contrast diluted in sterile water
and locked in the stomach after confirming the position of the catheter with a
contrast injection. The catheter was then flushed, capped. Sterile dressings
were applied.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
1. Continual migration of G-J tube into the stomach, therefore G-tube left
IMPRESSION:
Continual migration of G-J tube back into the stomach. Unable to maintain G-J
access with the current track access into the stomach. Therefore, G tube left
in stomach currently. If a GJ tube is needed, recommend a new enteric access
for better angulation and positioning.
|
19960274-RR-16 | 19,960,274 | 28,286,271 | RR | 16 | 2199-08-18 02:17:00 | 2199-08-18 03:46:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with ___ w/ anastomic revision p/w ab pain, epigastric,
non-radiating//Internal hernia, large ulceration or abscess
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered. Coronal and sagittal reformations were
performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,335 mGy-cm.
COMPARISON: CT from ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder contains gallstones without
wall thickening or surrounding inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Postoperative changes consistent with Roux-en-Y gastric
bypass noted. No contrast is seen within the excluded stomach. However,
there is thickening noted focally at the proximal Roux limb just beyond the
gastrojejunostomy concerning for inflammation possibly in the setting of
marginal ulcer. No adjacent free air. There is adjacent mild free fluid.
Distal to this, small bowel is unremarkable. 2 levels of jejunojejunostomy
appear uncomplicated. The appendix is normal. The colon is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Multiple subcutaneous surgical clips are seen along the lower
abdominal wall. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Status post Roux-en-Y gastric bypass with bowel wall thickening at the
proximal Roux limb just beyond the gastrojejunostomy is concerning for
enteritis possibly due to marginal ulceration, no free air though there is
trace free fluid. No bowel obstruction.
|
19960353-RR-19 | 19,960,353 | 20,782,216 | RR | 19 | 2145-01-07 10:19:00 | 2145-01-07 11:10:00 | INDICATION: History: ___ with L foot surgery on 5.31 here w/ erythema at
incision site// Rule out deep space infection
TECHNIQUE: Three views of the left foot
COMPARISON: ___
FINDINGS:
No acute fracture or dislocation is seen. No concerning osteoblastic or lytic
lesion is seen. There is no radiopaque foreign body. No soft tissue gas is
identified.
IMPRESSION:
Unremarkable left foot radiographs. If clinical concern persists for deep
space infection, MRI or CT is more sensitive.
|
19960353-RR-20 | 19,960,353 | 20,782,216 | RR | 20 | 2145-01-10 16:55:00 | 2145-01-10 18:17:00 | INDICATION: ___ year old man with new right 51cm SL PICC Line// PICC tip
location Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Radiograph of the chest performed on ___.
FINDINGS:
A right-sided PICC line is seen terminating within the level of the mid SVC.
Heart size is normal. Hilar and mediastinal contours are normal. No focal
consolidations concerning for pneumonia identified. There is no pleural
effusion or pneumothorax. The visualized osseous structures are grossly
unremarkable.
IMPRESSION:
Right-sided PICC line terminates at the level of the mid SVC.
|
19960598-RR-10 | 19,960,598 | 21,729,823 | RR | 10 | 2152-08-01 00:44:00 | 2152-08-01 10:45:00 | INDICATION: ___ female with right-sided hemiparesis, evaluate for
stroke.
TECHNIQUE: Non-contrast CT head was performed followed by CT angiography of
the head and neck with IV contrast. Multiplanar maximum intensity projection
images as well as curved coronal reformats and 3D reformatted images were
processed at a separate station.
COMPARISON: CT head of ___.
FINDINGS: Again noted is an area of low attenuation along the left frontal
lobe extending inferiorly into the insula and temporal lobe, consistent with
MCA territory acute infarct. There is no evidence of mass effect or midline
shift. The ventricles and extra-axial CSF spaces are within normal limits.
The basal cisterns are patent.
There is no evidence of acute hemorrhage.
The visualized orbits and soft tissues are within normal limits.
The paranasal sinuses and mastoid air cells are unremarkable.
CTA HEAD AND NECK: There is a three-vessel aortic arch. There is mild
atherosclerotic calcification of the aortic arch and origins of the
brachiocephalic vessels. The origins of the vertebral arteries are patent.
There is a left vertebral artery dominant. There is mild atherosclerotic
plaque of the bilateral carotid bulbs. The cervical common carotid and
internal carotid arteries are otherwise patent.
There is mild atherosclerotic calcification of the cavernous carotid arteries
with mild narrowing of the supraclinoid segments.
There is an abrupt cutoff of the distal M1 segment of the left middle cerebral
artery in keeping with occlusion. The anterior cerebral , right middle
cerebral, and posterior cerebral arteries are all patent with normal branching
pattern.
There are linear opacities in both apices, likely representing scarring.
There are multilevel degenerative changes of the cervical spine.
IMPRESSION:
1. Occlusion of the distal M1 segment of the left middle cerebral artery with
associated acute/subacute infarct of the left frontal lobe extending into the
insula and temporal lobe.
2. Mild atherosclerotic calcification of the carotid bulbs without
significant stenosis.
A preliminary wet read was given by Dr. ___ at 1:40 am on ___.
|
19960598-RR-11 | 19,960,598 | 21,729,823 | RR | 11 | 2152-08-01 10:20:00 | 2152-08-01 11:20:00 | PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Tachycardia, patient with CVA.
Cardiomediastinal contours are normal. Aside from minimal atelectasis in the
left lower lobe, the lungs are grossly clear. There is no pleural effusion.
IMPRESSION: No evidence of acute cardiopulmonary abnormalities.
|
19960598-RR-12 | 19,960,598 | 21,729,823 | RR | 12 | 2152-08-01 10:20:00 | 2152-08-02 17:16:00 | REASON FOR EXAMINATION: Pre-MRI clearance.
AP and lateral radiographs of the skull demonstrate no evidence of radiopaque
foreign body, worrisome for metallic object. Crowns in the mandibular teeth
are noted.
Lumbar spine and abdomen also demonstrate no evidence of foreign object.
Cervical spine shows no evidence of radiopaque foreign object as well.
|
19960598-RR-13 | 19,960,598 | 21,729,823 | RR | 13 | 2152-08-02 00:18:00 | 2152-08-02 16:54:00 | STUDY: MRI of the head.
CLINICAL INDICATION: ___ woman with left MCA stroke.
COMPARISON: Prior head CT dated ___ from an outside
institution and prior CTA of the head and neck dated ___.
TECHNIQUE: Sagittal T1, axial FLAIR, axial T2, axial magnetic susceptibility
and axial diffusion-weighted images were obtained through the brain.
FINDINGS: Restricted diffusion is identified at the left opercular region
involving the left insula, left temporal lobe and frontal lobe, there is
extension of the restricted diffusion at the caudate nucleus posteriorly and
posterior limb of the left internal capsule, there is no evidence of
hemorrhagic transformation. Mild effacement of the sulci is identified in the
left insular region with no evidence of midline shifting. The right
cerebellar hemisphere, mid brain, and posterior fossa are unremarkable. The
orbits appear normal, the paranasal sinuses are clear as well as the mastoid
air cells.
IMPRESSION: Left opercular acute/subacute infarction, previously demonstrated
by CT of the head in ___. There is no evidence of significant
mass effect or hemorrhagic transformation, extension of the ischemic changes
is visualized at the left caudate nucleus and posterior limb of the left
internal capsule.
|
19960665-RR-48 | 19,960,665 | 22,734,875 | RR | 48 | 2156-01-25 19:47:00 | 2156-01-25 20:00:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with history of lymphoma on chemotherapy with
tachycardia and fever// Evidence of infection?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CT ___, chest radiograph ___
FINDINGS:
Right sided Port-A-Cath tip terminates at the low SVC. Heart size is normal.
Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary
vasculature is normal. No pleural effusion or pneumothorax is present. No
acute osseous abnormality is visualized.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19960731-RR-12 | 19,960,731 | 20,752,309 | RR | 12 | 2120-06-13 10:53:00 | 2120-06-13 12:03:00 | INDICATION: ___ year old woman with NASH cirrhosis, p/w hyperK, with
subjective report of confusion // ?PNA/infectious process
COMPARISON: ___
IMPRESSION:
Cardiomediastinal silhouette is within normal limits. Lungs are clear. There
are no pneumothoraces. There are degenerative changes thoracic spine.
|
19960731-RR-13 | 19,960,731 | 20,752,309 | RR | 13 | 2120-06-12 22:37:00 | 2120-06-12 23:02:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with NASH cirrhosis p/w hyperK and b/l leg
weakness w/ subj confusion // ?ascites, portal vein thrombosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened. The contour of the liver is
nodular, consistent with cirrhosis. There is no focal liver mass. The main
portal vein is patent with hepatofugal flow. There is mild ascites. Numerous
varices are redemonstrated in the porta hepatis area. The hepatic veins are
patent by color Doppler.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 7 mm
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 10.3 cm
KIDNEYS: Limited views of the kidneys show mild fullness of the collecting
system but no overt hydronephrosis.
Right kidney: 11.6 cm
Left kidney: 11.8 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Patent portal vein with reversal of flow in the main, left, and right
portal veins, unchanged.
2. Cirrhotic liver with mild ascites and portosystemic varices.
3. Cholelithiasis without evidence of acute cholecystitis.
|
19960743-RR-31 | 19,960,743 | 23,680,914 | RR | 31 | 2141-08-04 09:21:00 | 2141-08-04 10:13:00 | EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL
INDICATION: ___ year old woman with increased swelling of left arm, evaluate
left arm and left IJ.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: Prior left upper extremity ultrasound dated ___.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left axillary veins are patent, show normal color flow and
compressibility. The left brachial, basilic, and cephalic veins are patent,
compressible and show normal color flow and augmentation.
In the left internal jugular nonocclusive thrombus is again identified,
similar in distribution and appearance to the immediate prior study. There is
persistent moderate edema of the left upper extremity.
IMPRESSION:
Unchanged appearance of nonocclusive deep venous thrombosis of the left
internal jugular vein with persistent moderate left upper extremity edema. No
evidence of propagation into any other left upper extremity vein.
|
19960743-RR-32 | 19,960,743 | 23,680,914 | RR | 32 | 2141-08-05 15:22:00 | 2141-08-05 17:10:00 | INDICATION: ___ year old woman with need for a PICC line for IV antibiotics.
Only can use right arm because patient has known IJ thrombus. IV team
attempted at bedside and could not get line in.// Please insert PICC line RUE
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA:1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: 3.4 min, 14.6 mGy
PROCEDURE:
1. Single lumen PICC placement through the right brachial vein.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the right
brachial vein was punctured under direct ultrasound guidance using a
micropuncture set. Permanent ultrasound images were obtained before and after
intravenous access, which confirmed vein patency. A peel-away sheath was then
placed over a guidewire. The guidewire was then advanced into the superior
vena cava using fluoroscopic guidance. A single lumen PIC line measuring 40 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. The accessed vein was patent and compressible.
2. Brachialvein approach single lumen right PICC with tip in the distal SVC.
IMPRESSION:
Successful placement of a right 40 cm brachial approach single lumen PowerPICC
with tip in the distal SVC. The line is ready to use.
|
19960743-RR-33 | 19,960,743 | 28,131,106 | RR | 33 | 2141-08-07 06:59:00 | 2141-08-07 07:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with dyspnea, intubated// post intubation
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph ___.
FINDINGS:
The endotracheal tube terminates approximately 5 cm above the carina. Enteric
tube extends beyond the GE junction with tip out of view. Median sternotomy
wires are intact. Multiple clips are noted projecting over the lower lungs
and mediastinum. A right subclavian line terminates in the mid SVC. The
heart is moderately enlarged. There is moderate to severe bilateral pulmonary
edema. Bilateral layering pleural effusions are present. There is no
pneumothorax.
IMPRESSION:
1. Moderate to severe bilateral pulmonary edema and moderate cardiomegaly,
progressed compared to the prior exam from ___.
2. Bilateral layering pleural effusions given supine acquisition of images.
|
19960743-RR-34 | 19,960,743 | 28,131,106 | RR | 34 | 2141-08-07 09:32:00 | 2141-08-07 10:09:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ woman with respiratory distress. Evaluate for
pulmonary embolism.
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: Total DLP (Body) = 593 mGy-cm.
COMPARISON: CTA chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Patient is post mitral valve repair. Small pericardial
effusion is likely physiologic. The heart is moderately enlarged.
The main pulmonary artery measures 3.0 cm, which is slightly prominent.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lung volumes are low, with a background of centrilobular
emphysema, as described previously. An endotracheal tube terminates
approximately 5 cm above the carina. There are bilateral nonhemorrhagic
pleural effusions, large on the right and moderate-sized on the left, with
adjacent compressive atelectasis in the bilateral lower lobes. The airways
are otherwise patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portion of the right lobe of thyroid is heterogeneous
as seen on prior. Visualized portions of the base of the neck show no
abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable, noting the
nasogastric tube in the proximal stomach.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Median sternotomy wires are intact.
SOFT TISSUES: Patient is post bilateral breast reconstruction. Previous
surgical drains are no longer present.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Diminished lung volumes with enlarged bilateral nonhemorrhagic pleural
effusions, large on the right and moderate sized on the left. There is
adjacent compressive atelectasis in both lower lobes.
3. Prominent main pulmonary artery, suggesting pulmonary arterial
hypertension.
|
19960743-RR-35 | 19,960,743 | 28,131,106 | RR | 35 | 2141-08-08 03:45:00 | 2141-08-08 10:47:00 | INDICATION: ___ year old woman with hypoxic resp failure/ septic shock//
evolution of pulm edema, pna
COMPARISON: Radiographs from ___
IMPRESSION:
Endotracheal tube, feeding tube, and right-sided PICC line appear unchanged
position. Heart size is within normal limits. There is again seen is the
pulmonary edema with more confluent opacities within the bases bilaterally.
Bilateral effusions are unchanged. Overall findings are stable. There are no
pneumothoraces.
|
19960743-RR-36 | 19,960,743 | 28,131,106 | RR | 36 | 2141-08-07 13:56:00 | 2141-08-07 17:27:00 | INDICATION: ___ year old woman with respiratory failure// ETT tube placement
TECHNIQUE: Supine portable radiograph of the chest.
COMPARISON: Radiograph of the chest from ___.
FINDINGS:
The ET tube terminates approximately 5.5 cm above the carina. An enteric tube
is seen extending down below the diaphragm with the tip out of view of this
film. Otherwise, moderate pulmonary edema appears to have improved compared
to the prior exam. Layering bilateral pleural effusions are re-demonstrated.
There is no evidence of pneumothorax.
IMPRESSION:
ET tube terminates approximately 5.5 cm above the carina. Otherwise, slight
interval improvement in the appearance of the lungs compared to the prior
radiograph.
|
19960743-RR-38 | 19,960,743 | 28,131,106 | RR | 38 | 2141-08-09 03:30:00 | 2141-08-09 09:20:00 | INDICATION: ___ year old woman with sepsis, intubated in CCU// interval
changes
COMPARISON: Radiographs from ___
IMPRESSION:
Support lines and tubes are unchanged in position. There is unchanged
cardiomegaly. There is again seen bilateral effusions, left retrocardiac
opacity, and moderate pulmonary edema. There are no pneumothoraces.
|
19960743-RR-39 | 19,960,743 | 28,131,106 | RR | 39 | 2141-08-10 03:39:00 | 2141-08-10 08:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sepsis now intubated// ETT placement,
edema?
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are unchanged, as is the cardiomediastinal silhouette. Substantial layering
bilateral pleural effusions with compressive atelectasis are again seen. This
makes it difficult to assess the pulmonary vascularity, though there is
probably little change in the degree of pulmonary edema.
Given the extensive changes described above, it would be impossible to exclude
superimposed pneumonia in the appropriate clinical setting.
|
19960743-RR-40 | 19,960,743 | 28,131,106 | RR | 40 | 2141-08-10 16:38:00 | 2141-08-10 17:27:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with new central line on R IJ// R IJ central
line placement Contact name: ___: ___
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 04:02
IMPRESSION:
Compared to the earlier same day examination, there has been placement of a
right internal jugular approach central venous catheter terminating in the
high right atrium, satisfactory, without pneumothorax. No other significant
interval changes seen. The remainder of the support devices are unchanged.
The cardiomediastinal silhouette is unchanged. Bilateral effusions, vascular
congestion, and moderate edema appears unchanged. No new consolidation is
seen, though infection remains difficult to exclude.
|
19960743-RR-41 | 19,960,743 | 28,131,106 | RR | 41 | 2141-08-11 02:58:00 | 2141-08-11 11:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sepsis and acute on chronic CHF currently
intubated// ETT positioning ETT positioning
IMPRESSION:
Comparison to ___. Stable monitoring and support devices. The tip
of the endotracheal tube projects 2.5 cm above the carina. Mild cardiomegaly.
Moderate bilateral pleural effusions. Stable moderate pulmonary edema.
Stable retrocardiac atelectasis.
|
19960743-RR-42 | 19,960,743 | 28,131,106 | RR | 42 | 2141-08-11 02:36:00 | 2141-08-11 07:40:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old woman with hx breast cancer, admitted to ICU in mixed
cardiogenic/septic shock. Has Takotsubo cardiomyopathy. Still spiking daily
fevers despite broad spectrum antibiotics.// Eval for occult source of
infection. Abscesses?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 5.5 s, 59.9 cm; CTDIvol = 10.8 mGy (Body) DLP = 648.8
mGy-cm.
Total DLP (Body) = 658 mGy-cm.
COMPARISON: CT dated ___
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions and compressive
atelectasis in the lower lobes.
ABDOMEN:
HEPATOBILIARY: There is diffuse heterogeneous enhancement of the liver
parenchyma. There is no evidence of focal lesions. There is mild dilatation
of the central intrahepatic bile ducts. The CBD is also mildly distended
measuring up to 11 mm. There is no distal obstructive mass or calculus. The
gallbladder is within normal limits.
PANCREAS: The pancreas is slightly atrophic. There is no focal pancreatic
lesion. Main pancreatic duct is within normal limits. There is no
peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The ascending and
transverse colon are fluid filled and mildly dilated. Descending colon is
collapsed. There is no evidence of colitis. Rectal catheter noted in place.
The appendix is not visualized.
PELVIS: The urinary bladder is collapsed around a Foley catheter. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Note is made of prior left mastectomy. Soft tissue defect in
the anterior abdominal wall is likely from recent ___ flap breast
reconstruction. There is no abdominal wall fluid collection.
IMPRESSION:
1. No clear source of infection identified in the abdomen and pelvis.
2. Heterogeneous enhancement of the liver is nonspecific and may be secondary
to mild congestion.
3. Mild biliary duct dilatation with no obstructive cause.
4. Small bilateral pleural effusions and bibasilar atelectasis.
|
19960743-RR-43 | 19,960,743 | 28,131,106 | RR | 43 | 2141-08-12 07:14:00 | 2141-08-12 09:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with acute on chronic heart failure and sepsis
currently intubated// ETT positioning ETT positioning
IMPRESSION:
Comparison to ___. The tip of the endotracheal tube projects 3 cm
above the carinal on today's image. The remaining monitoring and support
devices are also unchanged. Decrease in extent of the pre-existing pleural
effusions. Stable retrocardiac atelectasis. Stable mild cardiomegaly.
|
19960743-RR-44 | 19,960,743 | 28,131,106 | RR | 44 | 2141-08-12 12:56:00 | 2141-08-12 13:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pleural effusion// chest tube
IMPRESSION:
In comparison with study earlier in this date, the there is been placement of
a right chest tube with removal pleural fluid with no definite residual
appreciated on the supine radiograph. No evidence of post procedure
pneumothorax.
Otherwise, little change.
|
19960743-RR-45 | 19,960,743 | 28,131,106 | RR | 45 | 2141-08-13 07:15:00 | 2141-08-13 08:45:00 | INDICATION: ___ year old woman with R chest tube// chest tube position
TECHNIQUE: Chest AP view
COMPARISON: ___
FINDINGS:
The patient has been extubated and the NG tube has been removed in the
interim. The right IJ line is unchanged in position with its tip projecting
over the cavoatrial junction. The right-sided PICC line is also unchanged in
position. Lung volumes are similar with stable small left pleural effusion.
Cardiomediastinal silhouette is unchanged. The right basilar pigtail catheter
has been also removed in the interim. Small right apical pneumothorax is
stable
IMPRESSION:
Interval removal of the ET tube, NG tube and right-sided pigtail catheter
Small left pleural effusions unchanged.
Stable small right apical pneumothorax.
|
19960743-RR-46 | 19,960,743 | 28,131,106 | RR | 46 | 2141-08-14 09:43:00 | 2141-08-14 10:20:00 | EXAMINATION: ___
INDICATION: ___ year old woman with infection// ? pneumonia, line
TECHNIQUE: Chest PA and lateral
IMPRESSION:
The right IJ line is unchanged in position. Moderate cardiomegaly is again
seen and unchanged. Trace right apical pneumothorax is slightly less
apparent. Small left effusion has minimally improved. Lungs are well
expanded. Right-sided PICC line is also unchanged in position.
Cardiomediastinal silhouette is stable.
|
19960743-RR-47 | 19,960,743 | 28,131,106 | RR | 47 | 2141-08-14 20:39:00 | 2141-08-14 22:58:00 | INDICATION: ___ year old woman with takutsubo now s/p NGT// Eval location of
NGT
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
There is an abnormal course of the Dobhoff which is likely within the left
bronchial tree.
The tip of the right PICC line projects over the mid SVC.
The lungs are hyperexpanded. Opacities in both lower lung zones likely
reflect atelectasis. There is no pneumothorax identified. A small left
pleural effusion is unchanged.
IMPRESSION:
The tip of the Dobhoff is likely within the left bronchial tree and removal is
recommended. At the time of this dictation, a follow-up chest radiograph is
performed demonstrating removal of the Dobhoff.
Unchanged cardiopulmonary findings. No pneumothorax is identified.
|
19960743-RR-48 | 19,960,743 | 28,131,106 | RR | 48 | 2141-08-14 21:09:00 | 2141-08-14 21:32:00 | INDICATION: ___ year old woman with Dobhoff//Dobhoff placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the evening
FINDINGS:
The Dobhoff has been removed. The tip of the right PICC line projects over
the mid to distal SVC.
Unchanged cardiopulmonary findings.
IMPRESSION:
The Dobhoff has been removed. No pneumothorax is identified.
|
19960743-RR-52 | 19,960,743 | 28,131,106 | RR | 52 | 2141-08-15 16:46:00 | 2141-08-15 18:26:00 | INDICATION: ___ year old woman with cardiogenic and septic shock now with
increased work of breathing, hypertension.// Flash pulmonary edema?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The lungs are again noted to be hyperinflated. There is new pulmonary
vascular congestion and mild pulmonary edema. Small bilateral pleural
effusions are present but not significantly changed since prior. There is no
pneumothorax. The tip of the right PICC line projects over the mid SVC. The
size of the cardiac silhouette is within normal limits.
IMPRESSION:
New mild pulmonary edema.
|
19960879-RR-16 | 19,960,879 | 29,288,546 | RR | 16 | 2169-05-08 12:05:00 | 2169-05-08 12:28:00 | HISTORY: Status post fall with reported head bleed. Headache. Patient is a
same day transfer from an outside facility without reads attached to studies.
TECHNIQUE: Outside hospital contiguous axial helical MDCT of images of the
brain were obtained without IV contrast. Multiplanar reformatted images were
generated in the coronal and sagittal planes as well as thin section bone
algorithm images.
DLP: 616.76 mGy-cm.
COMPARISON: None available.
FINDINGS: A nondisplaced, nondepressed fracture is noted in the occipital bone
extending from the posterior midline to the left skull base. There is
subjacent blood in the posterior fossa, likely a small left cerebellar
contusion and small subdural hematoma along the left tentorium. There is a
small subdural along the posterior falx near the vertex. There is no
pneumocephalus. Fracture of the skull base does not approximate the major
vascular foramina. There is focal parenchymal hemorrhagic contusion of the
left inferior temporal lobe with mild surrounding cerebral edema (2:9). Small
adjacent subdural hematoma is noted overlying the left middle cranial fossa
(2:10). Subarachnoid blood is seen layering in the bilateral inferior frontal
lobes, left temporal sulci, left sylvian fissure, left postcentral sulcus and
left posterior fossa. There is no significant mass effect or signs of acute
large territory infarct. Prominent ventricles and sulci suggest age-related
involutional change although there is ventriculomegaly which seems out of
proportion to the sulci. There is a persistent cavum septum pellucidum. The
basal cisterns appear patent, and there is preservation of gray-white matter
differentiation.
The visualized paranasal sinuses, mastoid air cells and middle ear cavities
are clear. Atherosclerotic mural calcifications are noted within bilateral
internal carotid arteries. The globes are unremarkable.
IMPRESSION: Nondepressed occipital fracture with scattered extra-axial
hemorrhage (SDH and SAH) as detailed above, and focal parenchymal contusion in
the left inferior temporal lobe and left cerebellum.
|
19960879-RR-17 | 19,960,879 | 29,288,546 | RR | 17 | 2169-05-08 12:06:00 | 2169-05-08 12:32:00 | HISTORY: Status post fall with purported head bleed. Presents with neck pain
and headache. Patient is a same day transfer from an outside facility without
reads attached to studies.
TECHNIQUE: Outside hospital axial helical MDCT images were obtained from the
skullbase to the level of the superior endplate of T2. Multiplanar
reformatted images were generated in the coronal and sagittal planes.
DLP: 379.1 mGy-cm.
COMPARISON: None available.
FINDINGS: There is no evidence of cervical spine fracture fracture. There is
mild anterolisthesis of C4 on C5 with mild edema of the posterior soft
tissues. Noted is a fracture through the occipital bone better evaluated on
same day head CT. Multilevel multifactorial degenerative changes are noted
with anterior and posterior osteophytes at multiple levels. Prominent
posterior osteophytes at the level of C3-C4, C4-C5, C5-C6 and C6-C7 mildly
indents the thecal sac. Multilevel facet joint and uncovertebral hypertrophy
minimally narrows the neural foramina.
IMPRESSION:
1. No evidence of cervical spine fracture. Nondisplaced occipital bone
fracture better evaluated on the same day head CT.
2. Mild anterolisthesis of C4 on C5 with mild edema of the posterior soft
tissues at this level suggesting possible posterior ligamentous injury in the
setting of hyperflexion injury. Consider MR to further assess.
|
19960879-RR-18 | 19,960,879 | 29,288,546 | RR | 18 | 2169-05-08 12:50:00 | 2169-05-08 14:20:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: ___ woman with unwitnessed fall with intracranial
hemorrhage, assess for acute intrathoracic injury.
FINDINGS: Portable AP upright chest radiograph obtained. There is bibasilar
opacity, likely atelectasis, though a component of aspiration not excluded.
No large effusion or pneumothorax. Cardiomediastinal silhouette appears
grossly unremarkable aside from an unfolded partially calcified thoracic
aorta. No definite bony injuries are seen.
IMPRESSION: Bibasilar atelectasis, possible mild aspiration. Otherwise, no
acute findings.
|
19960879-RR-19 | 19,960,879 | 29,288,546 | RR | 19 | 2169-05-09 07:24:00 | 2169-05-09 17:37:00 | HISTORY: ___ female with left occipital fracture, left-sided
intracranial hemorrhage and right frontal lobe contusions. Assess interval
change.
COMPARISON: Comparison is made with CT head from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast.
FINDINGS: Compared with prior exam, there is a general progression of
intracranial hemorrhage. The left temporal and left posterior cerebellar
hemisphere hemorrhagic contusions have increased in size. New bilateral
inferior frontal contusions are now seen. Bilateral sulcal subarachnoid
hemorrhage has increased in extent, left greater than right. There has been a
mild increase in size of subdural hematoma along the left anterior cerebellum.
There is unchanged extraaxial blood in the midline posterior fossa, adjacent
to the nondisplaced left occipital bone fracture. The amount of blood in the
occipital horn of the left lateral ventricle has increased, and there is new
blood in the occipital horn of the right lateral ventricle. The ventricles are
stable in size, prominent due to cerebral atrophy, and proportionate to
prominent sulci. A cavum septum pellucidum is again noted. Periventricular
white matter hypodensities are likely sequela of chronic small vessel ischemic
disease. The basal cisterns are not compressed.
Secretions are seen in the inferior frontal sinus.
IMPRESSION: Increased extent of multicompartmental intracranial hemorrhage,
as detailed above.
These findings were communicated to Dr. ___ at 5:18 p.m. on ___ by phone by Dr. ___.
|
19961152-RR-13 | 19,961,152 | 25,444,212 | RR | 13 | 2148-05-20 03:47:00 | 2148-05-20 10:44:00 | EXAMINATION: DX HAND, WRIST AND FOREARM
INDICATION: History: ___ with fall degloving injury // r/o foreign body.
TECHNIQUE: AP, lateral, oblique radiograph views of the left hand, wrist, and
forearm were obtained for a total of 6 images.
COMPARISON: No prior relevant imaging is available on PACS at the time of
this dictation.
FINDINGS:
Evaluation of the soft tissues and bones is slightly limited secondary to what
appears to be overlying material external to the patient. Vascular
calcifications are seen. The distal left radial ulnar joint appears subluxed
dorsally. Lucent lesion at distal ulna could reflect a focal lesion or large
subchondral cyst related to the distal radioulnar joint osteoarthritis.
Irregularity and deformity of the distal radius is likely due to severe
radiocarpal degenerative changes, however, a fracture would be difficult to
exclude. There is prominent soft tissue swelling. Extensive degenerative
changes of the first MCP and triscaphe are noted.
IMPRESSION:
1. No definite fractures however study is limited due to technique and the
severe degenerative changes of the radiocarpal joint.
2. Lucent lesion involving distal ulna likely a subchondral cyst related to
the distal radial ulnar joint osteoarthritis.
3. There is some subluxation at the distal radioulnar joint.
RECOMMENDATION(S): If there is high concern for occult fracture, CT or MRI is
recommended.
|
19961152-RR-14 | 19,961,152 | 25,444,212 | RR | 14 | 2148-05-20 04:53:00 | 2148-05-20 10:45:00 | EXAMINATION: ELBOW, AP AND LAT VIEWS LEFT
INDICATION: History: ___ with trauma. Evaluate for fracture dislocation.
TECHNIQUE: A single cross-table lateral radiograph view of the left elbow was
obtained.
COMPARISON: The left elbow is evaluated in conjunction with views from the
radiograph obtained earlier on the same day.
FINDINGS:
Again, superimposed external material over the left forearm limits detailed
evaluation of the soft tissues and bones. No definite joint effusion is seen.
No discrete fracture line is identified. There is a bony spur arising from
the olecranon at the expected attachment of the triceps tendon.
IMPRESSION:
No evidence of fracture or dislocation of the left elbow.
|
19961152-RR-15 | 19,961,152 | 25,444,212 | RR | 15 | 2148-05-20 05:46:00 | 2148-05-20 11:19:00 | INDICATION: ___ with trauma, heel pain // eval for fracture
TECHNIQUE: AP, lateral, and oblique views of the if left ankle. AP, lateral,
oblique views of the right ankle.
COMPARISON: None.
FINDINGS:
Left: There is no fracture or acute osseous abnormality. Small plantar
calcaneal spur is identified. Ankle mortise is preserved on these nonstress
views. Small vessel atherosclerotic calcifications are noted. Surgical clip
projects within the tissues overlying the distal left tibia. Soft tissue
swelling seen overlying the medial malleolus.
Right: There is no acute fracture. Well corticated osseous fragment seen
adjacent to the tip of the medial malleolus. Ankle mortise are preserved on
these nonstress views. Atherosclerotic calcifications are noted. Diffuse
soft tissue swelling is noted without radiopaque foreign body.
IMPRESSION:
Soft tissue swelling bilaterally, right greater than left. No acute fracture.
|
19961152-RR-16 | 19,961,152 | 25,444,212 | RR | 16 | 2148-05-20 05:46:00 | 2148-05-20 11:25:00 | INDICATION: ___ with trauma, heel pain // eval for fracture
TECHNIQUE: AP, lateral oblique views of the right foot. AP, lateral and
oblique views of the left foot.
COMPARISON: None.
FINDINGS:
Right: There is no fracture or focal osseous abnormality. Joint spaces are
grossly preserved. Diffuse soft tissue swelling seen. There is no
subcutaneous gas or radiopaque foreign body.
Left: There is no acute fracture. Small plantar calcaneal spur is
identified. There is diffuse soft tissue swelling. Surgical clip projects
over the ankle. No other radiopaque foreign body identified.
IMPRESSION:
No fracture.
|
19961152-RR-17 | 19,961,152 | 25,444,212 | RR | 17 | 2148-05-21 13:56:00 | 2148-05-21 15:06:00 | EXAMINATION: DX HAND, WRIST AND FOREARM
INDICATION: ___ year old man with fall, ecchymosis swelling // fracture or
dislocation
TECHNIQUE: Three views right forearm, lateral view of the right elbow, three
views right wrist, two views right hand
COMPARISON: None available
FINDINGS:
Right hand: No fracture or dislocation seen. There are mild degenerative
changes at the interphalangeal joint and metacarpophalangeal joint of the
thumb. Radiocarpal degenerative changes are better evaluated on the wrist
radiograph.
Right wrist:
There are moderate degenerative changes at the radio carpal articulation.
There is widening of the scapholunate interval, consistent with injury to the
scapholunate ligament. The ulnar styloid is not visualized, this likely
relates to a remote fracture as there is no bony fragment seen. Extensive
vascular calcification noted.
Right forearm:
Degenerative changes are noted at the wrist joint. No fracture or dislocation
seen. An IV cannula is noted at the antecubital fossa.
IMPRESSION:
Degenerative changes as described. No acute fracture seen.
|
19961152-RR-18 | 19,961,152 | 25,444,212 | RR | 18 | 2148-05-23 09:27:00 | 2148-05-23 10:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man admitted after fall, now w/acute on chronic CHF.
// ? pulmonary edema, determine type of ___ ? pulmonary edema, determine
type of ___
COMPARISON: There are no prior chest radiographs available for review, but
the study is read in conjunction with chest CT on ___ which showed
large dependent, non trans UT 80 of, but nonhemorrhagic bilateral pleural
effusion, and asbestos related pleural plaques, largely calcified.
Heart is moderately enlarged. Pulmonary edema is mild if any. Most of the
abnormalities due to persistence of the pleural effusions and new left lower
lobe atelectasis. There is no pneumothorax. Atrioventricular pacer leads
follow their expected courses, continuous from the left pectoral generator.
No pneumothorax.
Although no acute fracture or other chest wall lesion is seen, conventional
chest radiographs are not sufficient for detection or characterization of most
such abnormalities. If the demonstration of trauma to the chest wall is
clinically warranted, the location of any referrable focal findings should
be clearly marked and imaged with either bone detail radiographs or Chest CT
scanning. There is a healed fracture deformity of the proximal right humerus
with severe degenerative changes at the shoulder.
|
19961152-RR-19 | 19,961,152 | 25,444,212 | RR | 19 | 2148-05-24 16:31:00 | 2148-05-24 17:01:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man with left greater than right lower extremity
edema and pain, and recent fall. Evaluate for deep vein thrombosis.
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 veins. The peroneal veins were not
well seen. Subcutaneous edema is noted in the calf.
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,
though the peroneal veins were not well seen. Subcutaneous edema in the calf.
|
19961152-RR-21 | 19,961,152 | 25,444,212 | RR | 21 | 2148-05-28 10:30:00 | 2148-05-28 15:41:00 | EXAMINATION: CTA chest
INDICATION: ___ year old man with past medical history of CAD s/p CABG x3,
CHF, PPM, T2DM, HTN, prostate cancer, and multiple falls who presents with
injuries sustained from a mechanical fall. Patient with new O2 requirement,
subjective dyspnea, tachypnea. // ? r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: Acquisition sequence: 1) CT Localizer Radiograph 2) CT
Localizer Radiograph 3) Spiral Acquisition 3.9 s, 30.8 cm; CTDIvol = 26.9
mGy (Body) DLP = 828.2 mGy-cm. 4) Spiral Acquisition 1.4 s, 11.1 cm; CTDIvol
= 25.1 mGy (Body) DLP = 279.2 mGy-cm. Total DLP (Body) = 1,107 mGy-cm. mGy-cm
COMPARISON: Chest radiograph ___
FINDINGS:
There are atherosclerotic calcifications in the thoracic ascending, thoracic
descending, and aortic arch. There are atherosclerotic calcifications in the
bilateral common carotids and bilateral subclavian arteries. There is no
evidence of stenosis, occlusion, aneurysm, or dissection in the aorta and its
major branch vessels.
A pacemaker generator is seen in the left axilla with 2 pacemaker leads
terminating in the right atrium and right ventricle, respectively. There are
stents visualized in left main, left anterior descending, and left circumflex
arteries. There is cardiomegaly. There is no evidence of pericardial
effusion. Median sternotomy wires are visualized.
The pulmonary arteries are patent with no filling defect seen within the main,
right, left, lobar, segmental, and subsegmental pulmonary arteries. The main
and right pulmonary arteries are normal in caliber, and there is no evidence
of right heart strain.
There are scattered mediastinal lymph nodes, the largest of which is a right
lower paratracheal lymph node measuring 7 mm (02:36), however none of these
mediastinal lymph nodes are pathologically enlarged by CT size criteria.
There is no supraclavicular, axillary, or hilar lymphadenopathy. The thyroid
gland is incompletely visualized but appears unremarkable.
There are large pleural effusions in the dependent areas of the bilateral
lungs diffusely, most prominent at the lung bases and on right side. There is
adjacent dependent atelectasis in the dependent areas of the lungs
bilaterally. There is a subpleural calcified granuloma in the right upper
lobe (02:40) There are diffuse pleural calcifications bilaterally, most
prominently in the anterior aspect of the right upper lobe.
Limited images of the upper abdomen are unremarkable.
There is an age indeterminate mild compression fracture of the T7 vertebral
body (302b:34). The relative lack of sclerosis in the T7 vertebral body
suggests that this is likely to be more acute than chronic. There are
fractures of the sixth and seventh posterior left ribs(2: 43, 57).
Significant degenerative change in the thoracic and upper lumbar vertebral
bodies.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Large bilateral pleural effusions and bilateral dependent atelectasis.
3. Diffuse pleural calcifications.
4. Compression fracture of the T7 vertebral body which is age-indeterminate
but likely to be more acute than chronic based on imaging findings.
5. Fractures of the posterior left ___ and 7th ribs.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ on the telephone on ___ at 3:38 ___, 10 minutes after discovery of
the findings.
|
19961152-RR-22 | 19,961,152 | 25,444,212 | RR | 22 | 2148-05-30 12:50:00 | 2148-05-30 13:56:00 | INDICATION: ___ year old man with bilateral newly placed chest tubes // r/o
PTX
TECHNIQUE: Chest PA and lateral
FINDINGS:
Interval insertion of bilateral chest tubes, appear low. Heart is moderately
enlarged. Mild pulmonary edema unchanged. Most of the abnormalities due to
persistence of the pleural effusions and left lower lobe atelectasis. There
is no pneumothorax. Atrioventricular pacer leads follow their expected
courses, continuous from the left pectoral generator. No pneumothorax.
IMPRESSION:
No pneumothorax. No substantial change in bilateral moderate effusions.
Bilateral chest tubes appear low.
|
19961152-RR-24 | 19,961,152 | 25,444,212 | RR | 24 | 2148-05-31 05:58:00 | 2148-05-31 10:14:00 | INDICATION: ___ year old man with bilateral pleural effusions s/p right and
left chest tubes. // Please evaluate interval change in pleural effusions.
Please obtain at 5AM.
COMPARISON: Radiographs from ___
IMPRESSION:
Bilateral pigtail catheters are seen projecting over the lower chest/upper
abdomen, stable. Heart size upper limits of normal. There is a dual lead
left-sided pacemaker. There is persistent mild pulmonary edema and a left
retrocardiac opacity. There are no pneumothoraces. Irregularity of the right
proximal humerus may be related to prior old trauma. There is elevation of
the left humeral head likely due to rotator cuff rupture.
|
19961152-RR-25 | 19,961,152 | 25,444,212 | RR | 25 | 2148-06-01 07:15:00 | 2148-06-01 08:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with bilateral pleural effusions s/p right and
left chest tubes. // Please evaluate for interval change in pleural effusion.
Please obtain at 5AM. Please evaluate for interval change in pleural
effusion. Please obtain at 5AM.
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Bilateral pigtail catheters remain in place and there is no evidence of
pneumothorax. Continued enlargement of the cardiac silhouette with pulmonary
vascular congestion. Monitoring and support devices are unchanged.
|
19961152-RR-26 | 19,961,152 | 25,444,212 | RR | 26 | 2148-06-02 06:00:00 | 2148-06-02 11:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with bilateral pleural effusions s/p right and
left chest tubes. // Please evaluate for interval change in pleural effusion.
Please obtain at 5AM.
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Heart size is top-normal. Mediastinum is normal. Pacemaker leads are
unremarkable. Vascular congestion has substantially improved. No interval
increase in pleural effusion demonstrated.
|
19961152-RR-27 | 19,961,152 | 25,444,212 | RR | 27 | 2148-06-01 11:08:00 | 2148-06-01 12:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CAD, CHF, PPM, T2DM, HTN, prostate CA s/p
mechanical fall with dyspnea and bilateral pleural effusion s/p B/l chest tube
placement // eval for interval change eval for interval change
COMPARISON: ___
IMPRESSION:
Left pigtail catheter is in place. Cardiomediastinal silhouette is stable.
Pacemaker leads are unremarkable. Parenchymal opacities are unchanged as well
as pleural calcifications.
No pneumothorax seen.
|
19961152-RR-29 | 19,961,152 | 25,444,212 | RR | 29 | 2148-06-03 11:12:00 | 2148-06-03 18:31:00 | INDICATION: ___ year old man with degloving injury of left arm, history of
dCHF, with poor peripheral access. // Please place PICC in preparation for OR
procedure.
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATORS: Dr. ___ radiologist performed the
procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: 1.4 min, 4 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line 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
double lumen PIC line measuring 37 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 PICC with tip in the axillary vein replaced
with a new double lumen PIC line with tip in the low SVC.
IMPRESSION:
Successful placement of a 37 cm right arm approach double lumen PowerPICC with
tip in the low SVC. The line is ready to use.
|
19961180-RR-24 | 19,961,180 | 20,189,169 | RR | 24 | 2118-07-26 14:16:00 | 2118-07-26 17:21:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ woman with a history of Child's B NASH cirrhosis who
was referred in for observation after variceal banding with post-procedure
oozing and noted to have increase bili. // Please perform with
doppler.Evidence of bile duct obstruction, thrombosis, other etiology of
increased bilirubin.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdomen MRI ___ and liver ultrasound ___
FINDINGS:
LIVER: The hepatic architecture is coarsened and nodular in appearance. There
is no focal liver mass. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD is again noted
to be dilated measuring 1.2 cm. This is unchanged from the MRI of ___
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to overlying bowel gas.
SPLEEN: The spleen is enlarged measuring 18.4 cm.
KIDNEYS: No hydronephrosis is seen in either kidney. The right kidney
measures 10.4 cm and the left kidney measures 11.2 cm. A simple cyst is again
seen in the right kidney measuring 7.2 x 5.5 x 6.1 cm.
DOPPLER EXAMINATION: The main, right and left portal veins are patent with
hepatopetal flow. There is a patent umbilical vein. Appropriate arterial
waveforms are seen in the main, right and left hepatic arteries. The hepatic
veins are patent. Hepatopetal flow is seen in the splenic vein and SMV in the
midline.
IMPRESSION:
1. Coarsened nodular hepatic architecture. No concerning liver lesion
identified.
2. No intrahepatic biliary dilatation. The common bile duct is again noted to
be dilated measuring 1.2 cm but is unchanged from the abdomen MRI ___.
3. Patent hepatic vasculature. A patent umbilical vein is noted.
4. Splenomegaly.
5. Simple right renal cyst stable from prior imaging.
|
19961180-RR-29 | 19,961,180 | 27,821,728 | RR | 29 | 2120-04-15 10:27:00 | 2120-04-15 15:39:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old woman with decompensated NASH cirrhosis // Is there
e/o PVT?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Liver ultrasound ___
FINDINGS:
LIVER: The hepatic parenchyma is coarse. The contour of the liver is nodular.
There is no focal liver mass identified. There is moderate ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD is not well
visualized.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is obscured from view by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 18.6 cm.
KIDNEYS: No hydronephrosis is seen on limited views of the kidneys. A simple
cyst is again seen in the right kidney measuring 7.8 x 6.7 x 7.0 cm.
DOPPLER EXAMINATION: The main, right and left portal veins are patent with
hepatopetal flow. A patent umbilical vein is again noted.
IMPRESSION:
1. Patent portal veins with patent umbilical vein again noted.
2. Coarse and nodular hepatic architecture consistent with the patient's known
cirrhosis. Splenomegaly.
3. Moderate ascites.
4. No hydronephrosis. A simple cyst is again noted in the right kidney.
|
19961282-RR-3 | 19,961,282 | 28,809,895 | RR | 3 | 2115-02-14 05:13:00 | 2115-02-14 05:56:00 | EXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF W/WANDWO C AND RECONS
INDICATION: ___ year old man with cold left foot/calf likely iliac disease.
TECHNIQUE: Multiphasic CT scan of the abdomen through the toes was obtained.
Low dose technique was used for a noncontrast phase. Subsequently, images were
taken in the arterial phase after the administration of contrast. Delayed
images were taken from the toes through the mid thighs.
DOSE: 2660.47 mGy-cm.
COMPARISON: None.
FINDINGS:
CTA: The aorta and pulmonary arteries are well opacified. There is no evidence
of pulmonary embolism. The aorta maintains a normal contour or without any
evidence of aneurysm. The celiac, SMA, bilateral renal arteries, and ___ are
patent. Atherosclerotic disease with hard and soft plaque is noted throughout.
Atherosclerotic disease is also noted at the aortic bifurcation. Soon after
the bifurcation of the left common iliac artery, the left external iliac
artery is completely occluded for a short segment than partly reconstitutes.
The common femoral arteries patent. At the knee, the popliteal artery becomes
occluded for a long segment (series 404, image 21). In the mid calf for a
short time there is a normal 3 vessel runoff, but for the majority of the left
calf there is no arterial opacification. Slightly more of the normal 3 vessel
runoff on the left is noted on the delayed phase scan. The right lower
extremity vasculature is patent with a normal 3 vessel runoff.
The lung bases are clear. Assessment of intraabdominal organs is limited in
the arterial phase. However, the liver, gallbladder, spleen, pancreas, and
adrenal glands are unremarkable. The kidneys present symmetric nephrograms.
Several hypodensities are present within the right kidney, some too small to
characterize and others consistent with simple cysts. The largest is in the
right interpolar region and measures 4.6 cm. The stomach, small bowel, and
large bowel are unremarkable without any evidence of wall thickening or
obstruction. There is no abdominal free air or free fluid. There is no
mesenteric or retroperitoneal lymphadenopathy.
IMPRESSION:
1. Occlusion of a large segment of the left popliteal artery without any
arterial supply distally into the left foot.
2. Short segment occlusion of the left external iliac artery with partial
reconstitution.
3. Diffuse atherosclerotic disease of the abdominal aorta.
|
19961282-RR-4 | 19,961,282 | 28,809,895 | RR | 4 | 2115-02-14 12:44:00 | 2115-02-14 14:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p iliac stent/popliteal thromboembolectomy.
Still intubated // ETT position ETT position
IMPRESSION:
No previous images. There is enlargement of the cardiac silhouette with
elevation of pulmonary venous pressure. Obscuration of the left hemidiaphragm
is consistent with volume loss in the left lower lobe. Endotracheal tube tip
lies at about 2.3 cm above the carina. Nasogastric tube extends at least to
the upper stomach where it crosses the lower margin of the image.
Of incidental note is a break in the second sternal wire from the top.
|
19961282-RR-5 | 19,961,282 | 28,809,895 | RR | 5 | 2115-02-18 11:42:00 | 2115-02-19 21:46:00 | STUDY: Unilateral lower extremity arterial duplex.
REASON: Status post left groin cutdown thrombectomy, iliac stent and common
femoral artery interposition graft.
FINDINGS: Duplex was performed of the left lower extremity arterial system.
Views from the groin were somewhat limited by staples. The common iliac is
patent with velocities of 78, 88 and 118. The external iliac is patent with
velocity of 285. Common femoral is patent with velocity of 189. The SFA and
profunda are patent with velocities of 92 and 73 cm/sec respectively.
Triphasic flow is seen in the common femoral artery.
IMPRESSION: Patent left common iliac, external iliac, common femoral, SFA and
profunda.
|
19961925-RR-15 | 19,961,925 | 20,139,648 | RR | 15 | 2196-12-11 01:56:00 | 2196-12-11 09:59:00 | HISTORY: ___ with hx of CVA, AIDS now with confusion for weeks, no focal
neuro deficits, ?epidural abscess on MR spine.
TECHNIQUE: Multiplanar multi sequence pre- and postcontrast MR images of the
brain were obtained.
COMPARISON: Outside noncontrast CT head ___.
FINDINGS:
There susceptibility artifact from dental amalgam. There is no evidence of
acute intracranial infarct or hemorrhage. There are a few small scattered
T2/FLAIR high signal foci throughout the brain which are nonspecific. Gray
white matter differentiation is maintained. Ventricles and extra axial spaces
are within normal limits. The major intracranial vessels exhibit the expected
signal void related to vascular flow. There is small nodular enhancement
within the right frontoparietal lobe near the vertex with mild associated
susceptibility, but is too small to accurately characterize.
The paranasal sinuses demonstrate scattered diffuse mucosal thickening. The
mastoid air cells demonstrate normal signal. The sella turcica,
craniocervical junction, and orbits are unremarkable.
IMPRESSION:
Small nodular enhancement within the right frontoparietal lobe near the
vertex. Differential considerations would include subacute infarct, vascular
malformation (such as capillary telangectasia), infection, or neoplasm.
Recommend repeat examination in ___ days for further characterization.
|
19961925-RR-16 | 19,961,925 | 20,139,648 | RR | 16 | 2196-12-11 15:27:00 | 2196-12-13 09:07:00 | HISTORY: HIV and a CD4 count of 140. The patient presented with confusion
and lethargy and there is a 6 mm epidural abscess on an MRI. Please biopsy
the area of abnormality.
COMPARISON: MRI of the lumbar spine from an outside hospital from ___.
TECHNIQUE:
OPERATORS: Dr. ___ radiology fellow) and Dr. ___
___ radiology attending) performed the procedure. The attending
was present and supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
200 mcg of fentanyl and 2 mg of Versed throughout the total intra-service time
of 40 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independently-trained radiology nurse.
MEDICATIONS: none.
CONTRAST: none.
PROCEDURE:
1. CT-guided biopsy of the left pedicle and facet joint at L5-S1
PROCEDURE DETAILS:
Following explanation of the risks, benefits and alternatives to the
procedure, written informed consent was obtained. The patient was then
brought to the CT suite and placed prone on the CT gantry. The lower back was
prepped and draped in the usual sterile fashion following scout imaging. A
preprocedural time out was performed according to departmental protocol.
Under CT guidance, an appropriate spot was marked on the skin. After
injection of 1% subcutaneous lidocaine, a spinal needle was inserted up to the
area of interest and deeper injection of 1% lidocaine was performed.
Following this, ___ biopsy needle introducer was inserted under
continuous CT guidance to the area of interest. The introducer was anchored
in the bone and a 12 ___ needle was inserted through the introducer
into the area of interest. 2 samples were obtained. Once adequacy of the
samples was confirmed, the needles were removed and sterile dressings were
applied. The patient tolerated the procedure well.
FINDINGS:
Successful core biopsy of the left L5-S1 pedicle and facet joint.
IMPRESSION:
Successful core biopsy of the left L5-S1 pedicle and facet joint. The samples
were sent for microbiology, fungal, acid-fast bacilli cultures, Gram stain and
acid fast bacilli smear.
|
19961925-RR-18 | 19,961,925 | 20,139,648 | RR | 18 | 2196-12-13 16:57:00 | 2196-12-14 09:24:00 | HISTORY: ___ year old man with AIDS, neck pain, ataxia.
TECHNIQUE: Multiplanar multisequence pre- and post-contrast MR images of the
cervical spine were obtained.
COMPARISON: None.
FINDINGS:
The visualized osseous structures exhibit normal alignment.
C2-C3: No disc herniation, or spinal canal or neural foraminal narrowing.
C3-C4: Loss of disc space segment is desiccation. Posterior osteophytosis
with mild disc protrusion eccentric to the left effacing the ventral thecal
sac without significant spinal canal narrowing. These findings in conjunction
with facet arthrosis and uncovertebral hypertrophy cause moderate/severe
bilateral neural foraminal narrowing.
C4-C5: Some loss of disk space height with disc desiccation. Type 2
degenerate endplate changes. Endplate spurring with mild disc protrusion
partially effaces the ventral thecal sac without significant spinal canal
narrowing. Facet arthrosis and uncovertebral hypertrophy cause mild right and
severe left neural foraminal narrowing.
C5-C6: Loss of disk space height with disc desiccation. Type 1 degenerative
endplate changes with increased STIR signal possibly representing active
degeneration. Broad-based disc protrusion effacing the ventral thecal sac and
deforming the ventral aspect of the cord causing moderate spinal canal
narrowing. Uncovertebral joint hypertrophy and facet arthrosis cause severe
bilateral neural foraminal narrowing.
C6-C7: Loss of disc space height with disc desiccation. Type 2 degenerative
endplate changes. Endplate spurring with disc protrusion partially effacing
the ventral thecal sac without significant spinal canal narrowing.
Uncovertebral joint hypertrophy and facet arthrosis cause mild bilateral
neural foraminal narrowing.
C7-T1: No disc herniation, or spinal canal or neural foraminal narrowing.
The cervical spinal cord otherwise demonstrates normal signal intensity and
caliber throughout its visualized extent. No areas of abnormal enhancement
are identified.
The visualized portions of the posterior fossa and superior mediastinum appear
unremarkable. The included upper lungs demonstrate biapical scarring and
hypoventilatory dependent changes. Mucous retention cysts are noted within
the right maxillary sinus.
IMPRESSION:
No abnormal enhancement identified.
Multilevel cervical spondylosis with moderate/severe bilateral C3-4, severe
left C4-5, and severe bilateral C5-6 neural foraminal narrowing; moderate
C5-C6 canal narrowing.
|
19961925-RR-22 | 19,961,925 | 25,038,426 | RR | 22 | 2197-02-15 17:25:00 | 2197-02-15 18:01:00 | HISTORY: HIV and altered mental status.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The heart size is mildly enlarged. The mediastinal and hilar contours are
unremarkable. There is no pulmonary vascular congestion. Minimal streaky
opacities in the lung bases are compatible with atelectasis. No focal
consolidation, pleural effusion or pneumothorax is seen. There are no acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19961925-RR-23 | 19,961,925 | 25,038,426 | RR | 23 | 2197-02-15 17:06:00 | 2197-02-15 17:49:00 | HISTORY: ___ male with HIV positive status and acute change in mental
status
COMPARISON: Head MR brain ___ on ___
TECHNIQUE: Axial contiguous MDCT images were obtained through the head
without administration of IV contrast. Coronal, sagittal, and thin slice bone
reformations were generated.
DLP: 1114.91 mGy-cm
CTDI: 55.75 mGy
FINDINGS:
There is no hemorrhage, edema, mass, mass effect, large territorial
infarction. The sulci and ventricles are prominent and advanced for age,
likely related to HIV disease. There is preservation of gray-white matter
differentiation and the basal cisterns appear patent.
There is no fracture. There is concentric mucosal thickening of both
maxillary sinuses, right worse than left, with a mucous retention cyst seen in
the left. Minimal mucosal thickening in the left sphenoidal sinus is also
present. Otherwise the remaining paranasal sinuses, mastoid air cells and
middle ear cavities are clear. Atherosclerotic calcification of the carotid
siphons and vertebral arteries is present.
IMPRESSION:
No evidence of acute intracranial process. Chronic sinus disease.
|
19961925-RR-24 | 19,961,925 | 25,038,426 | RR | 24 | 2197-02-17 21:07:00 | 2197-02-18 09:14:00 | EXAM: MR head with and without contrast.
INDICATION: Photophobia and blurred vision in the setting of immune
reconstitution syndrome. The patient is a ___ man with HIV-associated
neurocognitive disorder, presenting with a two-week history of photophobia and
blurred vision status post restarting cART for HIV-associated neurocognitive
disorder.
TECHNIQUE: Multiplanar, multisequence MR images of the head were obtained
before and after the administration of intravenous contrast.
COMPARISON: MR head with and without contrast ___.
FINDINGS: No acute infarct or intracranial hemorrhage is identified. There
is no mass, mass effect or midline shift. No regions of abnormal signal
intensity are seen within the brain parenchyma. Again noted is a
developmental venous anomaly within the right frontal lobe. There is no
abnormal enhancement. Mild prominence of the cisterns, sulci and ventricles
is present reflecting a degree of cerebral atrophy.
Mild maxillary sinus disease is present.
IMPRESSION:
No MR evidence of ___ or PML.
No acute infarct or intracranial hemorrhage.
Mild cerebral atrophy, unchanged.
|
19961925-RR-25 | 19,961,925 | 25,038,426 | RR | 25 | 2197-02-24 22:23:00 | 2197-02-25 10:05:00 | AP CHEST, 10:24 P.M., ___
HISTORY: ___ man with altered mental status and hypoxia.
IMPRESSION: AP chest compared to ___:
Lungs are minimally lower and there is a new linear region of atelectasis at
the left base, and more of the same at the right. Upper lungs are clear.
Heart size is normal. This examination neither suggests nor excludes the
diagnosis of acute pulmonary embolism which could be responsible for hypoxia
and/or atelectasis.
|
19961925-RR-26 | 19,961,925 | 21,099,120 | RR | 26 | 2198-05-07 16:35:00 | 2198-05-07 18:02:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with hx of cp, hx pericarditis // eval for effusion
COMPARISON: ___.
FINDINGS:
AP upright and lateral views of the chest provided. Low lung volumes limits
the evaluation. The patient's chin also obscures the superior mediastinum and
portions of the lung apices. There are bibasilar opacities which may reflect
atelectasis and small effusions. There is hilar engorgement and mild
congestion noted. Heart size appears mildly enlarged. The mediastinal
contour is stable. The imaged bony structures appear intact.
IMPRESSION:
As above.
|
19961925-RR-27 | 19,961,925 | 21,099,120 | RR | 27 | 2198-05-07 18:35:00 | 2198-05-07 19:44:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with HIV, fever // ?mass
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: DLP: 1003 mGy-cm
COMPARISON: CT head ___
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction. Prominent ventricles and sulci may be related
to HIV. The basal cisterns appear patent and there is preservation of
gray-white matter differentiation. The visualized bony structures are grossly
unremarkable. There is mild mucosal thickening of bilateral ethmoid air cells
and maxillary sinuses. The remaining paranasal sinuses, mastoid air cells,
and middle ear cavities are clear.
The globes are unremarkable.
IMPRESSION:
No acute intracranial process.
|
19961925-RR-28 | 19,961,925 | 21,099,120 | RR | 28 | 2198-05-10 14:28:00 | 2198-05-10 16:10:00 | EXAMINATION: CT abdomen and pelvis.
INDICATION: ___ year old man with HIV and recurrent fevers and pericarditis
// evaluate for lymphadenopathy to suggest underlying lymphoma
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 753 mGy-cm (abdomen and pelvis).
IV Contrast: 130 mL Omnipaque
COMPARISON: None available.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder contains tiny layering
gallstones but evidence of gallbladder wall thickening or distention.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. Tiny
bilateral renal hypodensities are too small to characterize but likely cysts.
There is no perinephric abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Appendix is not visualized. There is no evidence
of mesenteric lymphadenopathy.
LYMPH NODES: There are nonenlarged retroperitoneal lymph nodes. Scattered
retrocrural lymph nodes are also noted. There are lymph nodes measuring up to
6 mm at dated GE junction (5: 40 ___. .
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
BONES AND SOFT TISSUES: There is no evidence of worrisome lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of acute intra-abdominal process. Nonvisualized appendix.
2. Cholelithiasis without evidence of acute cholecystitis.
3. Scattered nonenlarged lymph nodes. Cluster of nonenlarged lymph nodes is
noted near the GE junction. If clinically indicated, consider endoscopy.
|
19961925-RR-29 | 19,961,925 | 21,099,120 | RR | 29 | 2198-05-10 14:30:00 | 2198-05-10 16:17:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ male with a history of HIV, recurrent fevers, and
pericarditis. Evaluate for lymphadenopathy.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images.
DOSE: DLP: 753 mGy-cm.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
The thyroid is normal. Scattered axillary and mediastinal lymph nodes are
identified, none of which are pathologically enlarged by CT size criteria.
For example, a prominent epicardial lymph node measures 7 mm in short axis
(05:29). There are no enlarged supraclavicular or hilar lymph nodes
identified.
Aorta and pulmonary arteries are normal size. No incidental large/central
pulmonary embolus is detected. Mild coronary artery calcifications are noted.
The heart size is within normal limits. A small hyperdense pericardial
effusion is present.
Bilateral, simple-appearing small pleural effusions are noted. Adjacent
atelectasis is noted at the bilateral lung bases. There is scarring or linear
atelectasis in the right lower lobe laterally. Paraseptal emphysematous
changes are most significant at the bilateral lung apices. The airways are
patent to the subsegmental level.
No suspicious osseous lesion is identified.
For description of the intra findings, please see the separate CT abdomen and
pelvis report.
IMPRESSION:
1. Small bilateral pleural effusions with adjacent atelectasis.
2. Small hyperdense pericardial effusion.
3. Moderate biapical paraseptal emphysema.
|
19962126-RR-35 | 19,962,126 | 21,472,938 | RR | 35 | 2145-02-20 11:06:00 | 2145-02-20 16:02:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ status post arrest
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.0 cm;
CTDIvol = 50.1 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm.
mGy-cm
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Prominence of the ventricles and sulci are compatible with age
related global atrophy. Ill-defined periventricular and subcortical white
matter hypodensities are nonspecific but likely due to sequela of chronic
ischemic small vessel changes.
There are mucous retention cysts in the bilateral maxillary sinuses. Mucosal
thickening is noted in the bilateral ethmoid sinuses. An air fluid level seen
in the left maxillary sinus and fluid is noted within the posterior
nasopharynx, findings which may be related to recent intubation. Mastoid air
cells and middle ear cavities are well aerated. The bony calvarium is intact.
Periapical lucencies and dental caries within the maxillary teeth are
consistent with periodontal disease. Patient is intubated.
IMPRESSION:
No acute intracranial process.
|
19962126-RR-36 | 19,962,126 | 21,472,938 | RR | 36 | 2145-02-20 11:06:00 | 2145-02-20 11:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ status post arrest
TECHNIQUE: Supine AP view of the chest
COMPARISON: None. Patient is currently listed as EU critical.
FINDINGS:
Heart size is normal. Mediastinal contours are unremarkable. Hilar contours
are prominent suggestive of underlying pulmonary arterial enlargement.
Relative paucity of pulmonary vascular markings towards the apices indicates
underlying emphysema. Streaky and patchy opacities are seen within the right
mid lung field of both lung bases, potentially areas of atelectasis and/or
infection. No large pneumothorax or pleural effusion is detected on this
supine exam. Multiple bilateral rib fractures are noted, potentially related
to recent resuscitation.
IMPRESSION:
Emphysema and probable underlying pulmonary arterial hypertension. Patchy
opacities within the right mid lung and both lung bases, potentially
atelectasis and/or infection. Multiple bilateral rib fractures which may be
related to recent resuscitation, without large pneumothorax identified.
|
19962126-RR-37 | 19,962,126 | 21,472,938 | RR | 37 | 2145-02-20 11:06:00 | 2145-02-20 14:57:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ status post arrest
TECHNIQUE: Non-contrast helical multidetector CT was performed of the
cervical spine. Soft tissue and bone algorithm images were generated. Coronal
and sagittal reformations were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.6 s, 21.8 cm; CTDIvol = 37.2 mGy (Body) DLP = 811.7
mGy-cm.
Total DLP (Body) = 812 mGy-cm.
COMPARISON: None.
FINDINGS:
No fractures are identified.Alignment is normal. There are moderate
multilevel degenerative changes in the cervical spine with intervertebral disk
space narrowing and anterior and posterior osteophytes. Mild central canal
narrowing is seen at the C3-C4, C4-C5, and C5-C6 vertebral levels due to
posterior disc-osteophyte complexes without critical stenosis. There is mild
neural foraminal narrowing, most pronounced on the right at C4-5 and C5-6.
There is no evidence of prevertebral swelling. There is no evidence of
infection or neoplasm.
Patient is intubated with enteric tube seen in the esophagus. Emphysematous
changes are noted in the lung apices.
IMPRESSION:
1. No acute fracture or subluxation in the cervical spine.
2. Moderate multilevel degenerative changes, particularly at the C3-C6
vertebral levels.
3. Emphysematous changes in the lung apices.
|
19962126-RR-38 | 19,962,126 | 21,472,938 | RR | 38 | 2145-02-20 13:28:00 | 2145-02-20 14:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with shortness of breath now intubated
TECHNIQUE: Upright AP view of the chest
COMPARISON: ___ at 10:57
FINDINGS:
An endotracheal tube has been placed in the interval, terminating
approximately 8.5 cm from the carina. An enteric tube courses below the left
hemidiaphragm, into the stomach and tip located off the inferior borders of
the film. Heart size remains within normal limits. Mediastinal contours
unchanged. Bilateral hilar enlargement compatible with underlying pulmonary
arterial hypertension is re- demonstrated. Emphysema is again noted along
with patchy airspace opacities within the right mid lung field and both lung
bases, unchanged. No pneumothorax or pleural effusion is present. Bilateral
rib fractures are unchanged.
IMPRESSION:
1. Endotracheal tube tip is slightly high, terminating 8 cm from the carina.
Enteric tube in standard position.
2. Unchanged right mid and bibasilar patchy airspace opacities, findings which
may reflect atelectasis and/or infection. No pneumothorax.
|
19962126-RR-39 | 19,962,126 | 21,472,938 | RR | 39 | 2145-02-20 13:55:00 | 2145-02-20 15:54:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man post arrest, chest pain
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.3 s, 33.6 cm; CTDIvol = 14.1 mGy (Body) DLP = 473.4
mGy-cm.
Total DLP (Body) = 473 mGy-cm.
COMPARISON: None prior
FINDINGS:
The thyroid is normal. The aorta is normal in appearance and caliber. The
main pulmonary artery is mildly enlarged, measuring 3.1 cm. Cardiac
configuration is normal and there is no appreciable coronary calcification.
Atherosclerotic calcifications are seen in the aortic arch. There is a small
anterior mediastinal hematoma tracking from a sternal fracture, likely due to
chest compression trauma following cardiac arrest.
Diffuse airway wall thickening with extensive areas of mucosal plugging are
most notably seen in the right lower lobe. Patchy opacities are seen in the
dependent right upper and lower lobes, possibly a combination of aspiration
and atelectasis. Ill-defined small nodular opacities are also noted in the
left upper lobe, left lower lobe, right upper lobe, and right middle lobe
(3:22,27,29,31,34,35,38,41,53,54) which may all be related to the current
acute process, but should be monitored for resolution on follow up exams.
Extensive centrilobular emphysematous changes are noted in the lungs. Smooth
septal thickening is indicative of mild pulmonary edema. No pleural effusion
or pneumothorax is present.
There is fullness of the right hilum suspicious for hilar lymphadenopathy,
likely reactive. Supraclavicular and axillary lymph nodes are not enlarged.
Patient is intubated with the endotracheal tube in the appropriate position. A
saber sheath trachea is compatible with COPD history.
Limited views of the upper abdomen is grossly unremarkable. An enteric tube
is seen in the stomach.
Moderate degenerative changes are noted in the thoracolumbar spine. There are
bilateral anterolateral non-displaced rib fractures, involving the ___
ribs on the right, and ___ and 7th ribs on the left. There is a
transverse non-displaced sternal fracture with adjacent stranding and
hematoma.
IMPRESSION:
1. Bilateral anterolateral rib fractures, notably the ___ ribs on the
right, and ___ and 7th ribs on the left. Additionally, there is a sternal
fracture with a small anterior mediastinal hematoma.
2. Diffuse airway wall thickening with extensive areas of mucosal plugging,
most notably in the right lower lobe, compatible with diffuse airway
inflammation or infection. Patchy opacities in the dependent aspect of the
right upper and lower lobes may reflect a combination of aspiration and
atelectasis.
3. Probable right hilar lymphadenopathy, likely reactive.
4. Ill-defined small nodular opacities are noted in the lungs bilaterally,
possibly related to small airways disease, but should be reassessed on follow
up CT exam.
5. Severe centrilobular emphysema.
RECOMMENDATION(S): Recommend attention on follow up imaging for the multiple
ill-defined nodular opacities in the lungs.
|
19962126-RR-41 | 19,962,126 | 21,472,938 | RR | 41 | 2145-02-20 16:43:00 | 2145-02-20 19:47:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: Evaluate for DVT in a patient found down with cardiac arrest.
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.
|
19962126-RR-42 | 19,962,126 | 21,472,938 | RR | 42 | 2145-02-21 07:08:00 | 2145-02-21 08:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man found down with cardiac arrest // Assess for ET
tube placement and lung pathology Assess for ET tube placement and lung
pathology
IMPRESSION:
Comparison to ___. No relevant change. The endotracheal tube
and the nasogastric tube are in stable position. The lung remains
overinflated and the size of the cardiac silhouette is normal. Pre-existing
mild opacities at the right lung basis and at the bases of the right upper
lobe are stable in appearance. No new opacities. No evidence of larger
pleural effusions.
|
19962126-RR-43 | 19,962,126 | 21,472,938 | RR | 43 | 2145-02-22 07:51:00 | 2145-02-22 11:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ett // ett ett
IMPRESSION:
ET tube tip is a medius above the carinal. NG tube tip is in the stomach.
Heart size and mediastinum are stable. Widespread parenchymal opacities in
the middle lower lung zones appear to be unchanged since the prior study.
|
19962126-RR-44 | 19,962,126 | 21,472,938 | RR | 44 | 2145-02-21 14:19:00 | 2145-02-21 15:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ett // ett ett
IMPRESSION:
ET tube tip is 7 cm above the carinal. NG tube is in the stomach. Heart size
and mediastinum are stable. There is interval progression of bibasal
opacities concerning for a combination of interstitial edema and multifocal
infection. No interval increase in pleural effusion noted.
|
Subsets and Splits