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19962126-RR-45 | 19,962,126 | 21,472,938 | RR | 45 | 2145-02-23 07:28:00 | 2145-02-23 09:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ett // ett
IMPRESSION:
Allowing for differences in technique and projection, there has not been a
substantial change in the appearance of the chest since recent study of 1 day
earlier.
|
19962126-RR-46 | 19,962,126 | 21,472,938 | RR | 46 | 2145-02-22 11:04:00 | 2145-02-22 12:42:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: The patient is a ___ year old man with COPD, alcohol dependence,
and schizophrenia on risperidone BIBA after he was found down without a pulse.
// 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:
Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 7.6 mGy (Body) DLP = 3.8
mGy-cm.
2) Spiral Acquisition 4.6 s, 35.8 cm; CTDIvol = 10.8 mGy (Body) DLP = 385.5
mGy-cm.
Total DLP (Body) = 389 mGy-cm.
COMPARISON: ___
FINDINGS:
THYROID: The thyroid is minimally heterogeneous.
LYMPH NODES: A 1.8 x 1.1 cm right hilar lymph node is re- demonstrated showing
partial calcification. Of note, there are few scattered, prominent
mediastinal lymph nodes without pathologic enlargement.
HEART AND VESSELS: The heart is top-normal in size. There is a trace
pericardial effusion. The great vessels are normal in caliber. There is mild
to moderate calcified and noncalcified atherosclerosis of the aortic arch and
proximal cervical vessels. There is no evidence of aortic dissection. There
is no evidence of pulmonary embolism to the subsegmental level. Of note,
there is a small locular of air seen within the left internal jugular vein
(2:8).
LUNGS & AIRWAYS: There is extensive severe emphysema throughout both lungs.
There is a small right-sided pleural effusion and trace left pleural effusion.
There is consolidation of the right and left lower lobes which suggests
infection or aspiration, increased from the prior examination. Additionally,
there is minimal consolidation within the inferior portion of the right upper
lobe. Diffuse, moderate bronchial wall thickening is demonstrated, most
severe involving the right lower lobe. There is material within the right
lower lobe bronchus and posterior lower lobe bronchi. Dependent material is
also seen in the left main bronchus and left lower lobe bronchi.
UPPER ABDOMEN: An endotracheal tube terminates above the carina in expected
position. An enteric tube terminates below the field of view. There is mild
intra-abdominal free fluid slightly increased from the prior exam.
OSSEOUS STRUCTURES & SOFT TISSUES: Moderate degenerative changes are noted
throughout the thoracolumbar spine. Multiple nondisplaced rib fractures are
unchanged. A sternal fracture is again demonstrated.
IMPRESSION:
No evidence of pulmonary embolism or aortic dissection.
Increasing consolidation within the bilateral lower lobes and inferior portion
of the right upper lobe suggests infection or aspiration, increased from the
prior examination on ___. Material within airways may reflect
aspiration as detailed above. Small right pleural effusion and trace left
pleural effusion also minimally increased.
Minimal intra-abdominal ascites, slightly increased from the prior
examination.
|
19962126-RR-47 | 19,962,126 | 21,472,938 | RR | 47 | 2145-02-22 16:41:00 | 2145-02-22 17:43:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with 44cm right arm DL power PICC. ___ ___
// Right arm DL power PICC. ___ ___ Contact name: ___: ___
IMPRESSION:
Since the recent study of earlier the same date, a right PICC is been placed,
terminating in the mid superior vena cava. Heterogeneous consolidation in the
right mid and lower lung has slightly worsened, and a left retrocardiac
opacity has slightly improved in the interval. Moderate right pleural
effusion is unchanged.
|
19962126-RR-48 | 19,962,126 | 21,472,938 | RR | 48 | 2145-02-24 07:54:00 | 2145-02-24 09:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ett // ett
IMPRESSION:
In comparison to previous radiograph of 1 day earlier, support and monitoring
devices are in standard position, and cardiomediastinal contours are
unchanged. Interval worsening heterogeneous consolidation involving the lower
lobes, right greater than left, concerning for progressive pneumonia. Small
left and moderate right pleural effusions appear slightly larger, but
positional differences limit comparison.
|
19962126-RR-50 | 19,962,126 | 21,472,938 | RR | 50 | 2145-02-25 07:33:00 | 2145-02-25 11:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with COPD, extubated ___ // eval for
progression of pulm edema eval for progression of pulm edema
IMPRESSION:
Compared to prior chest radiographs, ___ through ___.
Mild pulmonary edema has not changed for several days. Moderate right pleural
effusion accompanied by extensive consolidation in the right mid and lower
lung has not appreciably changed, concerning for persistent pneumonia.
Heart size normal. Right PIC line ends in the mid SVC. No pneumothorax.
|
19962126-RR-52 | 19,962,126 | 21,472,938 | RR | 52 | 2145-02-26 04:02:00 | 2145-02-26 16:30:00 | INDICATION: ___ year old man with COPD exacerbation // please evaluate for
obstruction; bilious emesis today
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Comparison is made with CT abdomen and pelvis from ___.
FINDINGS:
Multiple dilated air-filled loops of small bowel are noted in the abdomen,
with relative paucity of air in the colon, consistent with small bowel
obstruction.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Multiple dilated air-filled loops of small bowel, consistent with small bowel
obstruction.
|
19962126-RR-53 | 19,962,126 | 21,472,938 | RR | 53 | 2145-02-26 05:06:00 | 2145-02-26 11:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with emesis, s/p ng placement. // please
evaluate for focal infectious process please evaluate for focal
infectious process
IMPRESSION:
Compared to chest radiographs ___ through ___ one.
Previous the hila right basal opacification due to pleural effusion or large
scale lower lobe atelectasis has improved. There is still at least segmental
collapse in the posterior basal segment. More heterogeneous opacification at
the left lung base could be atelectasis is well unchanged, however in
consolidation in the right upper lobe posterior segment has not improved since
___ one.
Heart size is normal. No pneumothorax. Left pleural effusion small if any.
Right PIC line ends in the low SVC.
|
19962126-RR-54 | 19,962,126 | 21,472,938 | RR | 54 | 2145-02-27 04:02:00 | 2145-02-27 11:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with aspiration pneumonia // Please assess for
interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Enteric tube in right-sided PICC line are similar in position. There are
persistent bibasilar opacities without significant interval change since the
prior study.
IMPRESSION:
No significant interval change.
|
19962126-RR-56 | 19,962,126 | 21,472,938 | RR | 56 | 2145-02-28 10:12:00 | 2145-02-28 11:35:00 | INDICATION: ___ year old man s/p PEA arrest with COPD and pneumonia with
concern for aspiration and pharyngeal weakness. // eval for
swallow/aspiration risk
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 03:42 min.
Air kerma: 34 mGy
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. Mild penetration and aspiration appreciated on thin nectar,
which improved with chin tuck. There was retention of solids, which the
patient was able to clear.
IMPRESSION:
Mild penetration and aspiration with the nectar, improved which chin tuck.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19962126-RR-57 | 19,962,126 | 21,472,938 | RR | 57 | 2145-02-28 15:08:00 | 2145-02-28 17:02:00 | INDICATION: ___ year old man with ileus // enlargement of bowel loops?
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: Comparison is made with abdominal radiographs from ___.
FINDINGS:
Residual oral contrast is noted in multiple small bowel loops. There are no
abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No abnormally dilated loops of large or small bowel.
|
19962126-RR-58 | 19,962,126 | 21,472,938 | RR | 58 | 2145-03-06 11:39:00 | 2145-03-06 13:24:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with recent pna, copd, now SOB // eval for
interval change eval for interval change
IMPRESSION:
In comparison with the study of ___, the nasogastric tube is been removed.
PICC line is unchanged.
The cardiac silhouette is within normal limits and there is mild
indistinctness of pulmonary vessels consistent with elevation of pulmonary
venous pressure. Continued hyperexpansion of the lungs is consistent with
chronic obstructive pulmonary disease. Bilateral basilar opacifications
reflects pleural effusions and underlying compressive atelectasis.
|
19962126-RR-60 | 19,962,126 | 23,209,050 | RR | 60 | 2145-04-12 00:21:00 | 2145-04-12 06:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ male intubated, evaluate endotracheal tube placement.
TECHNIQUE: Supine chest radiograph.
COMPARISON: None available.
FINDINGS:
Endotracheal tube terminates 6.6 cm above the carina, and advancement is
recommended. Tip of the enteric tube extends to the proximal fundus of the
body, but the sidehole is at the GE junction, and advancement is also
recommended. Lungs are hyperinflated, with moderate to severe emphysema. No
focal consolidation to suggest pneumonia. Ill-defined opacities are noted in
the right upper lobe and left lower lobe, which are of unclear clinical
significance. No pleural effusion or pneumothorax. Heart size is normal.
There are multiple old bilateral rib fractures.
IMPRESSION:
1. Endotracheal tube terminates 6.6 cm above the carina. Recommend
advancement of both the endotracheal and enteric tubes.
2. Moderate to severe emphysema.
3. Ill-defined opacities in the right upper and left lower lung, of unclear
clinical significance. Close interval follow-up is recommended, with
consideration for a repeat PA and lateral chest radiograph if appropriate.
|
19962126-RR-61 | 19,962,126 | 23,209,050 | RR | 61 | 2145-04-13 04:05:00 | 2145-04-13 10:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with COPD respiratory failure intubated // eval
for interval change eval for interval change
IMPRESSION:
Compared to chest radiographs ___.
Lung volumes are lower but there is clearly progression of consolidation in
the axillary and basal regions of the right chest, probably due to developing
pneumonia. Left lung is essentially clear. The heart is normal size and
there is no appreciable vascular engorgement in either the lungs or
mediastinum.
ET tube is in standard placement, at new esophageal drainage tube passes into
the stomach and out of view, and the apparent advance of the right PIC line
from the superior cavoatrial junction into the upper right atrium is probably
a function of lower lung volumes.
|
19962126-RR-62 | 19,962,126 | 23,209,050 | RR | 62 | 2145-04-12 12:03:00 | 2145-04-12 12:47:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new line // new right PICC 47 cm ___
___ Contact name: ___: ___ new right PICC 47 cm ___
___
IMPRESSION:
Compared to chest radiograph ___ at 00:31.
Previous borderline interstitial edema has cleared. Consolidation in the
right midlung is concerning for pneumonia. Emphysema is severe. Heart size
is normal. No pleural abnormality.
ET tube, standard placement. Nasogastric drainage tube should be advanced
several cm to move all the side ports into the stomach.
New right PIC line ends close to the superior cavoatrial junction.
|
19962126-RR-63 | 19,962,126 | 23,209,050 | RR | 63 | 2145-04-14 03:46:00 | 2145-04-14 08:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxic resp failure, now s/p extubation //
Eval for interval change
IMPRESSION:
In comparison to ___ chest radiograph, worsening, poorly defined
areas of consolidation in the right mid and both lower lungs are concerning
for developing multifocal pneumonia. Small bilateral pleural effusions are
also demonstrated.
|
19962242-RR-10 | 19,962,242 | 25,769,651 | RR | 10 | 2133-09-24 09:57:00 | 2133-09-24 11:11:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with R SDH // interval change
TECHNIQUE: Contiguous axial images were obtained through the head without the
administration of intravenous contrast. Coronal and sagittal reformatted
images as well as thin section images in a bone window algorithm were
generated and reviewed.
DOSE: DLP: 891.93 mGy-cm; CTDI: 52.86 mGy
COMPARISON: NECT the head from ___, ___.
FINDINGS:
Right-sided subdural hematoma is stable in thickness, measuring 4 mm. Blood
products have redistributed posteriorly into the right parietal region. There
is no shift of normally midline structures or evidence of central herniation.
There is no new hemorrhage. The ventricles and sulci are normal in size and
configuration for the patient's age. The basal cisterns appear patent and
gray-white matter differentiation is preserved. The orbits and globes are
unremarkable. The imaged paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The bony calvaria appear intact.
IMPRESSION:
Stable right parietal subdural hematoma. No new hemorrhage or mass effect.
|
19962242-RR-11 | 19,962,242 | 25,769,651 | RR | 11 | 2133-09-24 15:29:00 | 2133-09-24 17:27:00 | EXAMINATION: CAROTID DOPPLER ULTRASOUND
INDICATION: ___ year old woman with syncopal episode. // Evaluate for
stenosis.
TECHNIQUE: Real-time grayscale and color and spectral Doppler ultrasound
imaging of carotid arteries was obtained.
COMPARISON: No relevant comparisons available.
FINDINGS:
RIGHT:
The right carotid vasculature has mild heterogeneous atherosclerotic plaque.
The right common carotid artery had peak systolic/diastolic velocities of
66/22 cm/sec.
The right internal carotid artery had peak systolic/diastolic velocities of
81/34 cm/sec in its proximal portion, 89/30 cm/sec in its mid portion and
92/32 cm/sec in its distal portion.
The external carotid artery has peak systolic velocity of 74cm/sec.
The vertebral artery has peak systolic velocity of 41 cm/sec with normal
antegrade flow.
The right ICA/CCA ratio is 1.3..
LEFT:
The leftcarotid vasculature has mild heterogeneous atherosclerotic plaque.
The left common carotid artery had peak systolic/diastolic velocities of 78/24
cm/sec.
The left internal carotid artery had peaks ystolic/diastolic velocities of
55/22 cm/sec in its proximal portion, 63/26 cm/sec in its mid portion and
74/28 cm/sec in its distal portion.
The external carotid artery has peak systolic velocity of 127cm/sec.
The vertebral artery has peak systolic velocity of 76 cm/sec with normal
antegrade flow.
The left ICA/CCA ratio is 0.94.
IMPRESSION:
Less than 40% stenosis in the bilateral internal carotid arteries.
|
19962724-RR-25 | 19,962,724 | 29,247,919 | RR | 25 | 2203-10-29 15:11:00 | 2203-10-29 16:03:00 | INDICATION: Left lower quadrant pain, evaluate for diverticulitis
TECHNIQUE: Axial helical MDCT scan of the abdomen and pelvis following the
administration of IV contrast . Coronal and sagittal reformatted images were
also generated for review.
DOSE: 920 mGy-cm
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
LOWER CHEST: There is mild bibasilar dependent atelectasis. The visualized
portions of the heart and pericardium are unremarkable. There is no pleural
effusion.
LIVER: The liver enhances homogeneously, with no focal lesions or
intrahepatic biliary duct dilatation. The gallbladder contains small
radiopaque gallstones without evidence of wall thickening or pericholecystic
fluid. The portal vein is patent.
PANCREAS: The pancreas does not demonstrate focal lesions or peripancreatic
stranding or fluid collection.
SPLEEN The spleen is homogeneous and normal in size. Note is made of a small
splenule.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys do not show solid or cystic lesions and demonstrate
symmetric nephrograms and excretion of contrast. No pelvicaliceal dilatation
or perinephric abnormalities are present.
GI TRACT: The stomach, duodenum, and small bowel show no evidence of wall
thickening or obstruction. There is extensive colonic diverticulosis. There is
wall thickening and extensive surrounding fat stranding and phlegmonous
changes involving a segment of the sigmoid colon compatible with acute
diverticulitis. There is no evidence of macroperforation or abscess formation.
The remaining colon is non-dilated without obstructive lesions. The appendix
is visualized and normal.
VASCULAR: The aorta contains moderate atherosclerotic calcification but is
normal in caliber without aneurysmal dilatation. The origins of the celiac
axis, SMA, bilateral renal arteries, and ___ are patent.
RETROPERITONEUM AND ABDOMEN: There is no retroperitoneal or mesenteric lymph
node enlargement. No ascites, free air, or abdominal wall hernias are noted.
PELVIC CT: The urinary bladder and distal ureters are unremarkable. No
pelvic wall or inguinal lymph node enlargement is seen. There is no pelvic
free fluid.
OSSEOUS STRUCTURES: No blastic or lytic lesions suspicious for malignancy is
present.
IMPRESSION:
1. Acute sigmoid diverticulitis. Extensive surrounding fat stranding and
phlegmonous changes without evidence of macroperforation or drainable abscess
formation.
2. Cholelithiasis without evidence of acute cholecystitis.
|
19963038-RR-193 | 19,963,038 | 26,480,413 | RR | 193 | 2163-09-17 15:57:00 | 2163-09-17 16:13:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with NSIP presenting with two weeks of cough and
fevers.// Assess for pnuemonia
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: PET-CT ___, chest CT ___, chest radiograph ___ and ___
FINDINGS:
Right-sided Port-A-Cath tip terminates the low SVC. Lung volumes remain low.
Patient is status post median sternotomy and transcatheter AVR. Cardiac
silhouette size is unchanged, appearing moderately enlarged. Mediastinal and
hilar contours are similar with diffuse tortuosity and atherosclerotic
calcification of the thoracic aorta. Known lymphadenopathy of the mediastinum
and hila are better seen on prior chest CT. Pulmonary vasculature does not
appear engorged. Increased interstitial opacities primarily involving the
periphery of the lungs and the lung bases bilaterally, right greater than left
are not substantially changed in the interval. Slight increased left lateral
lung opacification may be present. No pleural effusion or pneumothorax.
Moderate to severe multilevel degenerative changes of the thoracic spine are
noted.
IMPRESSION:
Low lung volumes. Subtle increased opacity in the left lateral lung could
reflect an area of infection or inflammation, somewhat more pronounced than on
___. Redemonstration of chronic fibrosing interstitial lung
disease better characterized on prior chest CT.
|
19963038-RR-194 | 19,963,038 | 26,480,413 | RR | 194 | 2163-09-17 20:00:00 | 2163-09-17 21:19:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: History: ___ with ILD presenting with cough and fever.// Assess
for pneumonia vs. ILD flare
TECHNIQUE: Multidetector CT of the chest was obtained without intravenous
contrast administration. Coronal, sagittal, and maximal intensity projection
images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.9 s, 30.5 cm; CTDIvol = 9.7 mGy (Body) DLP = 296.7
mGy-cm.
Total DLP (Body) = 297 mGy-cm.
COMPARISON: Chest CT from ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Redemonstrated 1 cm right thyroid
hypodense nodule which does not require dedicated follow-up imaging based on
ACR recommendations. Otherwise unremarkable.
UPPER ABDOMEN: Stable porta hepatis lymph node measures 1 cm in short axis
with calcifications. Cholelithiasis without acute cholecystitis. Other than
atherosclerotic calcifications, visualized upper abdomen appears unremarkable.
MEDIASTINUM: Stable lymph nodes measure up to 1.5 cm in short axis in the
right lower paratracheal station (5:79). Subcarinal lymph node contains
calcifications as seen previously.
HILA: No definite lymphadenopathy.
HEART and PERICARDIUM: The heart is not enlarged. Status post transcatheter
aortic valve replacement. Coronary artery calcifications and stents
redemonstrated. No pericardial effusion.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: Redemonstrated of bilateral interstitial opacities with
traction bronchiectasis and fibrotic changes in a subpleural distribution with
lower lobe predominance in both lungs, minimally worse in the lateral aspect
of the left upper lobe (5:88). Slight interval worsening of ground-glass
opacities in both upper lobes since ___ (for example 5:67, 42, 45,
76, 86).
2. AIRWAYS: Traction bronchiectasis is re-demonstrated, most severe in the
lower lobes. Patent to the subsegmental level bilaterally.
3. VESSELS: Right chest port catheter terminates in the lower SVC.
Redemonstrated enlarged pulmonary arteries as seen previously. Limited
assessment on noncontrast examination. Ascending aorta is not dilated. There
is moderate calcifications in the aortic arch and mild calcifications in the
origins of the great vessels. Low-density blood pool suggests anemia.
CHEST CAGE: No acute fracture or suspicious lesions. Status post median
sternotomy.
IMPRESSION:
1. Slight interval worsening ground-glass opacities in both upper lobes when
compared to ___, a nonspecific finding which could be due to an
infectious or inflammatory etiology, including exacerbation of underlying
known chronic interstitial lung disease.
2. Redemonstration of chronic fibrotic interstitial lung disease with lower
lobe predominance, minimally worse in the peripheral aspect of the left upper
lobe.
3. Stable enlarged mediastinal lymph nodes may be reactive.
4. Stable dilation of the main pulmonary artery may be reflective of
underlying pulmonary arterial hypertension.
|
19963038-RR-195 | 19,963,038 | 23,433,058 | RR | 195 | 2163-09-24 15:11:00 | 2163-09-24 15:28:00 | EXAMINATION: Chest radiographs, PA and lateral views.
INDICATION: Cough and hypoxia.
COMPARISON: Radiographs and CT from ___.
FINDINGS:
Port terminates at the cavoatrial junction. Patient is status post
sternotomy. Status post replacement of the aortic valve. Cardiac,
mediastinal and hilar contours appear stable. There is no pleural effusion or
pneumothorax. Moderately severe widespread peripheral reticulation, greater
at the lower than upper lungs is consistent with underlying interstitial lung
disease as seen previously. There is no evidence of superimposed process.
IMPRESSION:
Similar findings associated with underlying moderately severe interstitial
lung disease. No definite acute superimposed pulmonary abnormality.
|
19963038-RR-83 | 19,963,038 | 23,414,579 | RR | 83 | 2159-10-02 19:40:00 | 2159-10-02 20:13:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with neutropenia, cough
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph and chest CT
FINDINGS:
The patient is status post median sternotomy and aortic valve replacement.
Mild enlargement of the cardiac silhouette is again noted. Mediastinal
lymphadenopathy is again noted, most pronounced within the region of the AP
window. Pulmonary vasculature is normal. Increased interstitial markings are
seen within the periphery of the lung bases compatible with chronic lung
disease, better characterized on the recent CT. Lungs are hyperinflated. No
focal consolidation, pleural effusion or pneumothorax is present. There are
mild degenerative changes noted within the thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality. Unchanged mediastinal lymphadenopathy
and mild chronic interstitial abnormality.
|
19963063-RR-2 | 19,963,063 | 24,560,750 | RR | 2 | 2138-09-07 07:08:00 | 2138-09-07 08:34:00 | EXAMINATION: EARLY OB US <14WEEKS
INDICATION: History: ___ with 7 wk pregnancy, vag bleed, abd pain// evaluate
for IUP
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: None.
FINDINGS:
There is no intrauterine gestational sac. The right ovary is unremarkable.
There is a corpus luteal cyst noted in the right ovary.
The left ovary demonstrates a corpus luteal cyst and also demonstrates normal
color Doppler vascularity. In the left adnexa, there is a gestational sac
that contains an embryo with cardiac activity compatible with a tubal ectopic
pregnancy. Heterogeneous complex fluid surrounding the gestational sac is
consistent with hemorrhage, extending into the right adnexa.
IMPRESSION:
Findings compatible with a ruptured left tubal ectopic. The embryo within the
ectopic gestational sac demonstrates cardiac activity.
NOTIFICATION: The findings were discussed with Dr. ___. by ___,
M.D. on the telephone on ___ at 8:06 am, 1 minutes after discovery of the
findings.
|
19963063-RR-3 | 19,963,063 | 24,560,750 | RR | 3 | 2138-09-09 09:12:00 | 2138-09-09 13:31:00 | INDICATION: ___ year old woman with abdominal pain and distention. 2 days s/p
laparoscopy for ruptured ectopic. Evaluate for ileus or small-bowel
obstruction.
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None.
FINDINGS:
Multiple loops of large bowel filled with predominantly air, but also stool,
are mildly dilated. There is no free intraperitoneal air. The lung bases
appear clear.
IMPRESSION:
Multiple dilated loops of large bowel, most consistent with colonic ileus.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 1:29 pm, 5 minutes after
discovery of the findings.
|
19963242-RR-43 | 19,963,242 | 26,363,470 | RR | 43 | 2178-10-23 06:17:00 | 2178-10-23 06:49:00 | INDICATION: History: ___ with left flank pain since ___.
?nephrolithaiasis or other intra-abdominal process
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast in the prone position. Non-contrast scan has
several limitations in detecting vascular and parenchymal organ abnormalities,
including tumor detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 753 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
LOWER CHEST: Minimal atelectasis versus scarring is seen in the right lower
lobe. No pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains gallstones without wall thickening or
evidence of inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is moderate left hydronephrosis and proximal hydroureter. A 4
mm obstructing stone is seen in the midportion of the left ureter. Note is
made of mild left-sided perinephric and periureteral stranding. Punctate
cortical hypodensities within the kidneys are too small to fully characterize,
but likely represent cysts. There is no right hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening and fat stranding. The
appendix is normal.
PELVIS: The urinary bladder is minimally distended. There is no free fluid in
the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. 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. Moderate left hydronephrosis and proximal hydroureter, with a 4 mm
obstructing stone in the midportion of the left ureter. There is mild left
perinephric and periureteral stranding.
2. Diverticulosis.
3. Cholelithiasis.
|
19963242-RR-44 | 19,963,242 | 26,363,470 | RR | 44 | 2178-10-24 12:04:00 | 2178-10-24 14:37:00 | EXAMINATION: Intraoperative fluoroscopy without a radiologist present
INDICATION: ___ male status post ureteral stent placement
TECHNIQUE: Intraoperative fluoroscopy without a radiologist present
COMPARISON: None
FINDINGS:
1 intraoperative image was acquired without a radiologist present.
Images show a ureteral stent terminating at the region of the renal pelvis
with contrast filling of the renal pelvis..
IMPRESSION:
Intraoperative images were obtained during ureteral stent placement. Images
show a ureteral stent terminating at the region of the renal pelvis with
contrast filling of the renal pelvis..
Please refer to the operative note for details of the procedure.
|
19963323-RR-31 | 19,963,323 | 21,312,275 | RR | 31 | 2171-05-11 11:15:00 | 2171-05-11 12:21:00 | INDICATION: ___ woman with vision changes and headache, question
acute process.
COMPARISON: CT head without contrast from ___.
TECHNIQUE: Contiguous axial imaging was obtained through the brain without
the administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect or acute
territorial infarction. Ventricles and sulci are normal in size and
configuration. There is mild subcortical white matter hypodensity, more
prominent in the left frontal lobe likely representing chronic small vessel
ischemic disease. There is a focal hypodense lesion in the left cerebellar
hemisphere most likely represents an old infarct. The visualized paranasal
sinuses, mastoid air cells and middle ear cavities are clear. Osseous
structures are unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Subcortical white matter hypodensity, likely sequela of chronic small
vessel ischemic disease.
3. Focal hypodense lesion in the left cerebellar hemisphere, likely old
infarct.
|
19963323-RR-32 | 19,963,323 | 21,312,275 | RR | 32 | 2171-05-14 15:52:00 | 2171-05-14 17:55:00 | STUDY: Duplex sonogram of the left lower extremity.
INDICATION: ___ female with left leg aching and tenderness. Evaluate
for deep vein thrombosis.
FINDINGS: There is normal flow, compression and augmentation involving deep
veins of the left lower extremity.
IMPRESSION: Negative study for deep vein thrombosis in the left lower
extremity.
|
19963844-RR-20 | 19,963,844 | 29,666,518 | RR | 20 | 2122-12-15 16:11:00 | 2122-12-15 17:09:00 | EXAMINATION: Abdominal radiographs supine and upright.
INDICATION: ___ with ulcerative colitis p/w bloating // evaluate stool vs.
inflammation
TECHNIQUE: Upright and supine views of the abdomen were obtained, for a total
of 3 exposures.
COMPARISON: Comparison is made to abdominal radiographs from ___, and MR enterography from ___.
FINDINGS:
There is re- demonstration of gaseous distension of colonic loops at the level
of the splenic flexure, with multiple large bowel air-fluid levels similar in
appearance compared to the prior radiograph from ___, with a
relatively ahaustral appearance of the gas distended loops. There is bowel
gas to the level of the rectum. A small amount of air is seen within the
stomach. There is no intraperitoneal free air or evidence of pneumatosis.
IMPRESSION:
Similar bowel gas pattern compared to the prior radiograph from ___. No evidence of small-bowel obstruction, free air or pneumatosis.
|
19963970-RR-22 | 19,963,970 | 21,016,234 | RR | 22 | 2168-06-23 00:04:00 | 2168-06-23 20:37:00 | CTA OF THE HEAD AND NECK, ___
INDICATION: Left arm numbness.
COMPARISON: CTA of the head and neck from ___, performed for the
same indication. Head MRI from ___.
TECHNIQUE: Following a non-contrast head CT, axial multidetector CT images of
the head and neck were obtained during intravenous contrast administration
with multiplanar maximal intensity projection reformatted images, curved
reformatted images, and volume-rendered three-dimensional reformatted images.
FINDINGS:
NON-CONTRAST HEAD CT: There is no acute intracranial hemorrhage, edema, mass
effect, or loss of gray/white matter differentiation. There is mild cerebral
atrophy with associated prominence of the ventricles and sulci. There are
areas of low density in the deep and periventricular white matter of the
cerebral hemispheres, likely sequela of chronic small vessel ischemic disease
in a patient of this age. Small embolic infarctions in the right frontal and
parietal lobes, which were acute on the ___ MRI, are not readily
discernible on this CT. There is fluid and aerosolized secretions in
bilateral maxillary sinuses. There is mucosal thickening in bilateral
anterior ethmoidal air cells. Mastoid air cells are well aerated.
CTA NECK: There is a bovine configuration of the aortic arch. There is
predominantly non-calcified plaque in the proximal right internal carotid
artery and mixed plaque in the proximal left internal carotid artery, without
hemodynamically significant stenoses, unchanged since the prior study. The
distal cervical internal carotid arteries measure 4 mm in diameter on the
right and 5 mm in diameter on the left. There is calcified plaque at the
origin of the right vertebral artery with moderate narrowing. This finding is
unchanged. The remainder of the cervical right vertebral artery is widely
patent.
The imaged upper lungs appear clear. A left thyroid nodule is again seen,
measuring 7 mm. Degenerative changes are again seen in the cervical spine.
CTA HEAD: There is a mild narrowing in the proximal M1 segment of the right
middle cerebral artery, which appears more prominent since the prior study.
The remainder of the M1 segment and its branches appear patent and symmetric
compared to the left. Intracranial internal carotid arteries and anterior
cerebral arteries are patent without evidence of hemodynamically significant
stenoses. The intracranial vertebral arteries, basilar artery, and their
major branches are patent without evidence of hemodynamically significant
stenoses. Fetal configuration of the right posterior cerebral artery is again
noted. An ___ complex is again noted on the right. An infundibulum is
again noted at the origin of the left superior cerebellar artery. There is no
evidence for an intracranial aneurysm.
IMPRESSION:
1. No evidence of acute intracranial abnormalities. MRI would be more
sensitive for an acute infarction, if clinically indicated.
2. Mild short-segment narrowing of the proximal M1 segment of the right
middle cerebral artery, which appears more prominent than on ___. No
evidence of distal occlusion.
3. Atherosclerosis in the proximal right and left internal carotid arteries
without evidence of a hemodynamically significant stenosis, unchanged since
___. Atherosclerosis at the origin of the right vertebral artery with
moderate narrowing, unchanged.
4. Left thyroid nodule. Recommend further evaluation by sonography, if not
previously performed elsewhere.
|
19963970-RR-23 | 19,963,970 | 21,016,234 | RR | 23 | 2168-06-23 00:06:00 | 2168-06-23 02:38:00 | HISTORY: Left arm weakness, code stroke.
COMPARISON: Chest radiograph ___ and ___.
FINDINGS: A single portable frontal view of the chest was performed. There is
no pleural effusion, pneumothorax or focal airspace consolidation. The
cardiac and mediastinal contours are normal. The hilar structures and pleural
surfaces are unremarkable. There are no acute osseous abnormalities
appreciated.
IMPRESSION: No acute cardiopulmonary process.
|
19963970-RR-24 | 19,963,970 | 21,016,234 | RR | 24 | 2168-06-24 01:51:00 | 2168-06-24 13:45:00 | HEAD MRI WITHOUT CONTRAST, ___
INDICATION: ___ man with history of stroke, high blood pressure, high
cholesterol, presenting with transient left arm numbness, concerning for
transient ischemic attack or stroke.
COMPARISON: Head MRI from ___. CTA of the head and neck from
___.
TECHNIQUE: Sagittal T1-weighted, and axial T2-weighted, FLAIR, gradient echo,
and diffusion-weighted images of the head were obtained without intravenous
contrast.
FINDINGS: Evaluation of the superior frontal lobes on all axial images is
limited by artifacts which are not evident on sagittal images or localizer
images. No artifact was seen on the prior MRI in this location. Skull
radiographs obtained immediately prior to the present study do not reveal any
source of artifacts.
The diffusion tracer sequence demonstrates a 4 mm linear area of high signal
in the superior posterior right frontal lobe (image 9:17), without the
corresponding signal abnormality on the ADC map. There is associated high
signal on FLAIR images (image 3:17), which is new compared to ___.
These findings are consistent with a small subacute infarction. T2-weighted
and FLAIR images also demonstrate numerous foci of high signal in the
subcortical, deep, and periventricular white matter, consistent with sequela
of chronic microvascular infarcts. There is no evidence of intracranial blood
products in areas not obscured by artifacts. There is unchanged cerebral
atrophy with associated prominence of the ventricles and sulci. The major
arterial flow voids are grossly preserved. There are aerosolized secretions
and mucosal thickening in the right maxillary sinus, and fluid in the left
maxillary sinus, similar to the preceding CTA.
IMPRESSION:
1. Small subacute infarction in the right superior posterior frontal lobe,
new since ___.
2. Evaluation of the superior frontal lobes is otherwise limited by artifacts
bilaterally.
|
19963970-RR-25 | 19,963,970 | 21,016,234 | RR | 25 | 2168-06-24 00:46:00 | 2168-06-24 09:30:00 | CLINICAL HISTORY: Recent admission with multiple right-sided embolic strokes,
hypertension, evaluate for metal prior to MRI.
SKULL: No evidence of metallic densities other than in the teeth is present.
CERVICAL SPINE: No evidence of metallic densities is present. Degenerative
changes in the mid cervical spine are noted.
CHEST: The heart and mediastinum are normal. The lung fields are clear. No
metallic densities.
ABDOMEN: Distribution of gas is unremarkable. No metallic densities are
present.
|
19963970-RR-26 | 19,963,970 | 23,399,468 | RR | 26 | 2168-07-15 18:58:00 | 2168-07-16 10:20:00 | HISTORY: ___ male, with vision changes. Assess for intracranial
hemorrhage.
COMPARISON: MR ___ on ___, CTA head and neck on ___.
TECHNIQUE: Non-contrast MDCT images were first acquired through the head.
Following administration of IV contrast, MDCT images were acquired from the
aortic arch to the vertex per CTA head and neck protocol. On a separate
workstation, dedicated 3D rendering was performed to better assess the
underlying vasculature.
DOSE REPORT: DLP 3082 mGy-cm.
FINDINGS:
NON-CONTRAST CT HEAD: There is no acute intracranial hemorrhage, edema, mass
effect or major vascular territorial infarcts. The ventricles and sulci are
slightly prominent, compatible with age-related global atrophy. There is no
shift of normally midline structures. The gray-white matter differentiation
is preserved. There is no displaced calvarial fracture.
There is mild mucosal thickening at the alveolar recesses of the maxillary
sinuses. The remaining paranasal sinuses and mastoid air cells are clear.
The petrous apices are pneumatized and clear. The globes are unremarkable.
The crown of a right mandibular molar ___ # 29) is missing, with periapical
lucency at the remaining roots. There is also mild periapical lucency at a
left maxillary molar ___ #14).
CTA NECK: Again noted is a bovine variant of the aortic arch. There is a
focal mild stenosis at the origin of the right vertebral artery. The origins
of the great mediastinal vessels and the left vertebral artery are patent and
unremarkable. There is mild atherosclerotic disease at the carotid
bifurcations.
The Dmin of the proximal and distal right internal carotid artery measures 3.5
mm and 4.5 mm, respectively, and corresponding to 22% stenosis by NASCET
criteria.
The Dmin of the proximal and distal left internal carotid artery measures 4.0
mm and 4.5 mm, respectively, and corresponding to 11% stenosis by NASCET
criteria.
The visualized lung apices are unremarkable. Mild-to-moderate multilevel
degenerative changes are noted at the visualized cervicothoracic spine.
CTA HEAD: Major intracranial vessels are patent. There is a focal stenosis
at the proximal right M1 segment, unchanged. There is normal opacification of
the distal right MCA branches. There is a fetal-type right PCA, normal
variant. The distal left vertebral artery is dominant.
There is no aneurysm greater than 3 mm. There is no vascular malformation or
distal vascular occlusion.
ANCILLARY FINDINGS: A 6-mm hypodense left thyroid nodule is again noted.
IMPRESSION:
1. No acute intracranial abnormalities.
2. Major intracranial vessels remain patent. No evidence of aneurysm,
dissection, or occlusion. Unchanged focal stenosis at the proximal right M1
segment.
3. 22% right and 11% left proximal ICA stenosis by NASCET criteria.
Unchanged focal stenosis at the origin of the right vertebral artery. Major
cervical vessels remain patent.
4. Dental disease as described above.
|
19963970-RR-27 | 19,963,970 | 23,399,468 | RR | 27 | 2168-07-16 18:56:00 | 2168-07-17 08:44:00 | HISTORY: ___ man, with transient left eye blurriness. Assess for
stroke.
COMPARISON: CTA head and neck on ___.
TECHNIQUE: Non-contrast multiplanar, multisequence T1- and T2-weighted images
were acquired through the head. Diffusion-weighted images and ADC maps were
also obtained for evaluation.
FINDINGS: There is no acute infarct or hemorrhage. The ventricles and sulci
are prominent in size but remain symmetric in configuration, compatible with
age-related global atrophy. The temporal horns are prominent, slightly more
pronounced than the global atrophy. There are mild confluent periventricular
and scattered subcortical white matter T2/FLAIR hyperintensity, nonspecific
but likely representing chronic microangiopathy. Major vascular flow voids
are present. There is no shift of normally midline structures.
There is mild-to-moderate mucosal thickening in the ethmoid air cells. There
is minimal mucosal thickening at the alveolar recesses of the maxillary
sinuses. The remaining paranasal sinuses and mastoid air cells are clear.
The globes are symmetric and unremarkable.
IMPRESSION:
1. No acute intracranial abnormalities, including no acute hemorrhage or
infarct.
2. Mild global atrophy. Mild-to-moderate medial temporal atrophy.
3. Mild chronic microangiopathy.
|
19964059-RR-23 | 19,964,059 | 23,234,986 | RR | 23 | 2188-03-31 18:34:00 | 2188-03-31 22:26:00 | CHEST RADIOGRAPH PERFORMED ON ___.
COMPARISON: None.
CLINICAL HISTORY: Syncope and head strike, question traumatic injury.
FINDINGS: Frontal and lateral views of the chest provided demonstrate midline
sternotomy wires and mediastinal clips. The heart is normal in size.
Mediastinal contour is normal. lungs are clear. No pneumothorax or pleural
effusion. Bones appear intact.
IMPRESSION: No acute traumatic injury seen.
|
19964059-RR-24 | 19,964,059 | 23,234,986 | RR | 24 | 2188-03-31 18:10:00 | 2188-03-31 20:06:00 | INDICATION: Syncope, head strike. Please evaluate for trauma.
COMPARISON: No prior studies available for comparison.
TECHNIQUE: Non-contrast axial images were obtained through the brain.
Coronal and sagittal reformations were provided.
FINDINGS: There is no evidence of hemorrhage, edema, large masses, mass
effect or acute infarct. Ventricles and sulci are prominent, consistent with
age-related parenchymal involution. No fracture is identified. The mastoid
air cells, middle ear cavities are clear. Minimal opacification in ethmoid
air cells. Soft tissue swelling noted overlying the right frontoparietal
bones.
IMPRESSION: No acute intracranial process. Soft tissue swelling noted
overlying the right frontoparietal bones.
|
19964059-RR-25 | 19,964,059 | 23,234,986 | RR | 25 | 2188-03-31 18:11:00 | 2188-03-31 20:09:00 | INDICATION: Syncope, head strike. Evaluate for fracture.
COMPARISON: No prior studies available for comparison.
TECHNIQUE: Non-contrast axial images were obtained through the cervical
spine. Coronal and sagittal reformations are provided.
FINDINGS: No acute fracture or malalignment identified. Multilevel
degenerative changes are identified with a grade 1 anterolisthesis of C3 on C4
without associated spondylolysis. Multilevel facet arthropathy noted without
evidence of critical neural foramen or central canal stenosis. No prevertebral
soft tissue swellling present. Lung apices are clear. Visualized thyroid
gland is unremarkable.
IMPRESSION: No acute fracture or malalignment. Degenerative change with
Grade 1 anterolisthesis of C3 on C4.
|
19964512-RR-17 | 19,964,512 | 24,111,883 | RR | 17 | 2167-05-18 21:58:00 | 2167-05-18 22:15:00 | INDICATION: History: ___ with left tibia fracture
TECHNIQUE: Left knee, three views, left tibia and fibula, two views
COMPARISON: Left ankle radiographs ___
FINDINGS:
Within the left knee, and no acute fracture or dislocation is identified.
Small superior patellar enthesophyte is noted. There is a trace suprapatellar
joint effusion. Minimal osteophytic spurring is seen in the medial
compartment of the knee. The joint spaces are preserved. Vascular
calcifications are noted.
Re- demonstrated within the distal tibial diaphysis is a minimally displaced
spiral fracture with slight lateral and dorsal displacement of the distal
fracture fragment. No other fracture is identified. There is soft tissue
swelling seen diffusely within the lower leg.
IMPRESSION:
Minimally displaced spiral fracture involving the distal diaphysis of the
tibia. No acute fracture or dislocation within the knee.
|
19964512-RR-18 | 19,964,512 | 24,111,883 | RR | 18 | 2167-05-19 10:50:00 | 2167-05-19 12:32:00 | EXAMINATION: TIB/FIB (AP AND LAT) LEFT IN O.R.
INDICATION: LEFT TIB FX.ROFI
TECHNIQUE: 4 fluoroscopic intraoperative images obtained without the presence
of a radiologist.
COMPARISON: Left leg radiograph ___
FINDINGS:
Intraoperative fluoroscopic images demonstrate placement of a lateral plate
and screws traversing a distal left tibial fracture. The alignment appears
anatomic. There is a non linear appearance of the fourth superior screw.
IMPRESSION:
For further details, please see the operative report.
|
19964656-RR-22 | 19,964,656 | 25,807,699 | RR | 22 | 2131-02-27 14:05:00 | 2131-02-27 15:03:00 | EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: History: ___ with sudden onset dizziness and truncal ataxia// r/o
intracranial hemorrhage
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Total DLP (Body) = 655 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction, hemorrhage, edema, or parenchyma mass.
Brain parenchymal atrophy. Findings consistent with mild chronic small vessel
ischemic changes. Probable small chronic infarct right centrum semiovale.
1.1 cm calcified dural-based mass anterior left middle cranial fossa,
consistent with meningioma.
There is mild mucosal thickening within the right sphenoid sinus. The
remaining visualized portion of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. Left lens replacement is noted. Right orbit
is unremarkable.
CTA HEAD:
Atherosclerotic plaque, mild narrowing left V4 segment vertebral artery.
Atherosclerotic calcifications bilateral cavernous, supraclinoid segments,
with mild narrowing.
The remaining vessels of the circle of ___ and their principal intracranial
branches appear normal without stenosis, occlusion, or aneurysm formation.
The dural venous sinuses are patent.
CTA NECK:
There is moderate atherosclerotic calcification of the aortic arch. Mild
atherosclerotic disease bilateral carotid bifurcations. Otherwise, the
carotid and vertebral arteries and their major branches appear normal with no
evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria. Distended proximal esophagus. Proximal esophageal wall thickening,
may be reactive, inflammatory or neoplastic.. Degenerative changes spine.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Probable chronic small infarct right centrum semiovale.
3. Small left middle cranial fossa meningioma.
4. Atherosclerotic disease, mild intracranial narrowing.
5. No vascular narrowing in the neck.
6. Indeterminate circumferential wall thickening of the proximal thoracic
esophagus, may be inflammatory, neoplastic.
|
19964656-RR-23 | 19,964,656 | 25,807,699 | RR | 23 | 2131-02-28 04:49:00 | 2131-02-28 14:29:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with Hx of Afib on AC p/w vertigo. Evaluate for
infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck dated ___.
FINDINGS:
There is no evidence of hemorrhage or infarction. The ventricles and sulci
are mildly prominent in size and configuration with no mass effect or midline
shift. Scattered patchy FLAIR hyperintense periventricular and subcortical
white matter foci are nonspecific, but most likely related to chronic small
vessel ischemic disease.
The major intracranial arterial flow voids are maintained. The intraorbital
contents are normal. There is mild mucosal thickening of the ethmoid sinuses.
The mastoid air cells are clear.
IMPRESSION:
1. No evidence of hemorrhage or infarction.
2. Mild cerebral atrophy and chronic small vessel ischemic disease.
|
19964656-RR-24 | 19,964,656 | 25,807,699 | RR | 24 | 2131-02-28 04:49:00 | 2131-02-28 14:29:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with gait ataxia and dysequilibrium. Eval for
spondylosis.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: CTA head and neck needed ___.
FINDINGS:
The cervical vertebral body heights are maintained. There is mild
anterolisthesis of C7 on T1. There is multilevel loss of disc signal on the
T2 weighted images due to degenerative disease. The spinal cord signal
appears maintained. There is no evidence of infection or neoplasm.
C2-C3: Mild central disc protrusion with indentation of the spinal cord in the
midline. Spinal canal and neural foramina are patent.
C3-C4: Mild disc bulge with effacement of the anterior subarachnoid space and
abutment of the anterior aspect of the spinal cord. Moderate right and mild
left neural foraminal stenosis.
C4-C5: Moderate disc bulge with effacement of the anterior and posterior
subarachnoid space and indentation along the anterior aspect of the cord
resulting in moderate spinal canal stenosis. Mild right neural foraminal
stenosis.
C5-C6: Moderate disc bulge with effacement of the anterior subarachnoid space
and abutment of the anterior aspect of the cord. Mild right neural foraminal
stenosis.
C6-C7: There is spinal canal narrowing due to intervertebral osteophytes and
bulging of the disc. There is severe right and moderate left neural foraminal
narrowing.
C7-T1: Mild disc bulge. Spinal canal and neural foramina are patent.
IMPRESSION:
Moderate to severe multilevel degenerative disc disease, most severe at C4-C5
with effacement of the anterior and posterior subarachnoid space and
indentation along the anterior aspect of the cord.
|
19964963-RR-5 | 19,964,963 | 25,939,306 | RR | 5 | 2129-09-23 09:46:00 | 2129-09-23 10:21:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with lung cancer p/w intermittent
bloody stools with c/f pembrolizumab- induced colitis NO_PO contrast//
Colitis?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 711 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is mild
left basilar pleural thickening with adjacent surgical clips. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. The CBD is mildly enlarged measuring up
to 1 cm in this patient status post cholecystectomy. There is no evidence of
intrahepatic biliary dilatation.
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 adrenal gland contains a 1.4 cm heterogeneously enhancing
nodule in the left adrenal gland contains a 1.0 cm heterogeneously enhancing
nodule.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon is
within normal limits. The distal rectum is thickened without significant
stranding and likely reflects internal hemorrhoids.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within
normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No findings of bowel ischemia or colitis.
2. Bilateral heterogeneously enhancing adrenal nodules for which nonemergent
follow-up imaging can be obtained, if not previously characterized.
|
19964998-RR-10 | 19,964,998 | 21,387,214 | RR | 10 | 2130-04-07 17:49:00 | 2130-04-07 20:20:00 | EXAMINATION: CT scan of the abdomen and pelvis
INDICATION: ___ year old man with SBO now with resolution, metastatic
neuroendocrine cancer,// r/o acute process
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) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 11.0 s, 0.2 cm; CTDIvol = 186.7 mGy (Body) DLP =
37.3 mGy-cm.
3) Spiral Acquisition 11.1 s, 72.4 cm; CTDIvol = 11.3 mGy (Body) DLP =
813.1 mGy-cm.
Total DLP (Body) = 852 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: Liver demonstrates replacement with multiple hepatic masses,
consistent with metastatic disease. Some of these lesions are now more
hypodense compared to the prior exam, consistent with necrosis. For example,
in the left lobe of liver the, there is a lesion measuring 3.7 x 3.3 cm. This
appears unchanged in size compared to the prior exam. A conglomerate lesion
in the right lobe liver measures 3.8 x 3.5 cm. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent.
PANCREAS: In the body and tail of the pancreas is largely replaced by tumor
which now demonstrates marked hypoattenuation, consistent with necrosis. The
component within the body measures approximately 6.4 x 4.9 cm. The component
extending into the tail measures approximately 6.5 x 3.2 cm. There is an
exophytic nodular component extending from the superior aspect of the tumor
measuring 2.0 x 2.3 cm (02:59). The head and uncinate process are normal in
appearance.
There is hypoattenuating intravascular tumor within the superior most aspect
of the superior mesenteric vein extending into the proximal aspect of the main
portal vein measuring a length of approximately 6.2 cm. There is persistent
expansion of the superior aspect of the inferior mesenteric vein. The splenic
vein is thrombosed with multiple upper abdominal collateral vessels noted.
The splenic artery appears patent.
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.
Multiple hypoattenuating lesions within the kidneys bilaterally are too small
to definitively characterize. There is no perinephric abnormality.
GASTROINTESTINAL: Moderate hiatal hernia. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. No evidence of
bowel obstruction. Diverticulosis of the sigmoid colon is noted, without
evidence of wall thickening and fat stranding.
Moderate volume ascites is demonstrated.
PELVIS: The urinary bladder and distal ureters are unremarkable.
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. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Marked stranding within the subcutaneous soft tissues is
consistent with anasarca.
IMPRESSION:
1. Large mass replacing the body and tail of the pancreas demonstrates new
hypoattenuation, consistent with tumor necrosis.
2. Intravascular tumor within the proximal portion of the main portal vein and
superior aspect of the SMV also demonstrates new hypodensity but not
significantly changed in size. Stable thrombosis of the splenic vein.
3. Innumerable hepatic metastases are not significantly changed in size.
Several lesions demonstrate new hypodensity, consistent with necrosis.
4. No evidence of bowel obstruction.
5. Moderate volume ascites.
6. Please refer to separate report of CT chest performed the same day for
description of the thoracic findings.
|
19964998-RR-11 | 19,964,998 | 21,387,214 | RR | 11 | 2130-04-07 17:49:00 | 2130-04-07 19:40:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with leukocytosis, metastatic neuroendocrine
tumor// r/o pulm infection
TECHNIQUE: Multidetector CT performed of the entire volume of the thorqax
with multiplanar reformations and MIP reconstructions. Intravenous contrast
was administered.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 11.0 s, 0.2 cm; CTDIvol = 186.7 mGy (Body) DLP =
37.3 mGy-cm.
3) Spiral Acquisition 11.1 s, 72.4 cm; CTDIvol = 11.3 mGy (Body) DLP =
813.1 mGy-cm.
Total DLP (Body) = 852 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: CT chest from ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.
No supraclavicular or axillary lymphadenopathy.
MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.
HEART and PERICARDIUM: Heart is unremarkable. No pericardial effusion.
PLEURA: Bilateral small to moderate-sized simple pleural effusions.
LUNG:
1. PARENCHYMA: Compressive atelectasis is noted in the lung bases
bilaterally. 5 mm pulmonary nodule in the right upper lobe is unchanged
(2:171).
2. AIRWAYS: Central airways are widely patent.
3. VESSELS: Although not a dedicated study, no central pulmonary embolism.
CHEST CAGE: No acute fracture or suspicious osseous lesion.
IMPRESSION:
1. Small to moderate simple bilateral pleural effusions with compressive
atelectasis.
2. No evidence of pneumonia.
|
19964998-RR-3 | 19,964,998 | 21,387,214 | RR | 3 | 2130-03-24 14:39:00 | 2130-03-24 16:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new onset afib rvr// r/o pna
TECHNIQUE: Chest single view
COMPARISON: CT chest ___, CT abdomen ___
FINDINGS:
Shallow inspiration. Enteric tube is coiled within esophageal hiatal hernia,
tip is within either very distal esophagus or proximal intrathoracic stomach,
advancement is suggested. Heart size is accentuated by shallow inspiration.
Bibasilar opacities, may represent atelectasis, aspiration or pneumonia. No
sizable left pleural effusion, small right pleural effusion is likely. Normal
pulmonary vascularity, no edema. No pneumothorax. Multiple distended bowel
loops in the upper abdomen.
IMPRESSION:
Enteric tube is coiled within esophageal hiatal hernia or near GE junction,
should be advanced. Dilated proximal upper abdominal bowel loops, partially
seen.
Bibasilar opacities, may represent atelectasis or pneumonia/aspiration. Trace
right pleural effusion is likely.
RECOMMENDATION(S): Advancement of enteric tube.
|
19964998-RR-4 | 19,964,998 | 21,387,214 | RR | 4 | 2130-04-04 16:20:00 | 2130-04-04 17:34:00 | INDICATION: ___ year old man with no passing gas today, abd distension, no bm
today// r/o obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Scout of CT abdomen pelvis dated ___.
FINDINGS:
No bowel obstruction demonstrated. Improved colonic distension.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Cholecystectomy clips are again seen.
IMPRESSION:
Improved colonic distension compared to CT dated ___. Nonobstructive
bowel gas pattern.
|
19964998-RR-6 | 19,964,998 | 21,387,214 | RR | 6 | 2130-04-04 17:51:00 | 2130-04-05 08:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with potential SBO, NGT placed// eval tube
placement
IMPRESSION:
In comparison with the study of ___, the nasogastric tube is difficult to
see beyond the mid stomach. An abdomen study could be obtained if the precise
position of the tube is of clinical importance.
Bibasilar opacifications again could merely reflect atelectasis and small
pleural effusions. However, in the appropriate clinical setting, more
coalescent opacification at the left base would be worrisome for
aspiration/pneumonia.
|
19964998-RR-7 | 19,964,998 | 21,387,214 | RR | 7 | 2130-04-04 18:20:00 | 2130-04-04 23:37:00 | INDICATION: ___ year old man with ngt misplacement// ngt placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Low bilateral lung volumes. Bibasilar opacities are consistent with
atelectasis/consolidation and pleural effusions. The tip of the nasogastric
tube projects over the stomach. The size of the cardiac silhouette is within
normal limits..
IMPRESSION:
The tip of the nasogastric tube projects over the stomach.
|
19964998-RR-8 | 19,964,998 | 21,387,214 | RR | 8 | 2130-04-06 12:35:00 | 2130-04-06 13:48:00 | INDICATION: ___ year old man with nausea vomiting. Evaluate for small bowel
obstruction.
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph dated ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Since most
recent prior, there is less distension of the small bowel, and more gas is now
seen in the colon.
Supine assessment limits detection for free air; there is no gross evidence
for pneumoperitoneum.
Osseous structures are notable for degenerative changes of the spine.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Cholecystectomy clips are again seen in the right upper quadrant.
IMPRESSION:
Nonobstructive bowel gas pattern. Decreased distention of the small bowel and
increased gas in the colon compared to ___.
|
19965408-RR-15 | 19,965,408 | 21,767,071 | RR | 15 | 2132-07-23 11:42:00 | 2132-07-23 12:14:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ woman with left facial droop. Evaluate for stroke.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
Total DLP (Head) = 897 mGy-cm.
COMPARISON: No prior imaging is available on PACS at the time of this
dictation.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration the patient's age.
Subtle areas of low density in the subcortical white matter are nonspecific
and may reflect changes due to small vessel disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. No hemorrhage or evidence of acute infarct. Please note that MR is more
sensitive for the detection of early stroke.
|
19965408-RR-16 | 19,965,408 | 21,767,071 | RR | 16 | 2132-07-23 18:32:00 | 2132-07-24 10:42:00 | INDICATION: ___ year old woman with stroke // rule out infection
TECHNIQUE: AP portable chest radiograph
COMPARISON: None available
FINDINGS:
The lungs appear hyperexpanded. No focal consolidation, pleural effusion or
pneumothorax identified. The size of the cardiac silhouette is within normal
limits.
IMPRESSION:
Hyperexpanded lungs.
No radiographic evidence of acute cardiopulmonary disease.
|
19965408-RR-17 | 19,965,408 | 21,767,071 | RR | 17 | 2132-07-24 00:29:00 | 2132-07-24 09:35:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR HEAD NECK.
INDICATION: ___ year old woman with new L facial droop, Evaluate for acute CVA
or vascular abnormalities.
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
Dynamic MRA of the neck was performed during administration of 11 mL of
Multihance intravenous contrast.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: ___ noncontrast head CT.
FINDINGS:
MRI BRAIN:
There is no slow diffusion to suggest acute infarction. Multiple focal areas
of fast diffusion (low signal on DWI, high signal on the ADC map) along the
periphery of the cerebellar hemispheres bilaterally are consistent with
chronic infarcts (___). Susceptibility artifact in the basal ganglia
bilaterally, particularly on the right, probably represents mineralization.
Multifocal punctate and more confluent periventricular and subcortical foci of
high T2/FLAIR signal are nonspecific but likely sequelae of chronic
microangiopathy in a patient of this age. Prominence of the ventricles and
sulci is in keeping with global atrophy. Intracranial vascular flow voids are
preserved. The orbits are unremarkable.
MRA BRAIN:
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis, occlusion, or aneurysm
formation.
MRA NECK:
There is a central filling defect in the proximal left internal carotid artery
on the arterial phase postcontrast sequences (22:18). The right internal
carotid artery demonstrates normal caliber and signal intensity distal to this
area. A similar finding is noted in the proximal left external carotid artery
on the same sequence. Both filling defects are no longer visualized on the
more delayed coronal sequence and are consistent with flow related artifact.
The internal and external carotid arteries otherwise appear normal. There is
no evidence of internal carotid artery stenosis by NASCET criteria. The
origins of the great vessels, subclavian and vertebral arteries appear normal
bilaterally.
IMPRESSION:
1. Global atrophy, chronic small vessel ischemic change, and chronic
cerebellar infarcts. No acute infarction.
2. Susceptibility changes in the basal ganglia and may represent changes due
to mineralization. No intra or extra-axial hemorrhage otherwise.
3. Unremarkable brain MRA.
4. Unremarkable neck MRA.
|
19965408-RR-27 | 19,965,408 | 23,688,028 | RR | 27 | 2134-03-22 00:54:00 | 2134-03-22 05:31:00 | EXAMINATION: FOREARM (AP AND LAT) LEFT
INDICATION: History: ___ with post reduction// eval post reduction films
eval post reduction films
TECHNIQUE: Frontal and lateral views of the forearm
COMPARISON: ___ left forearm radiograph
FINDINGS:
Overlying cast limits visualization and evaluation of fine osseous details.
Within the limitations of this study the previously seen comminuted,
displaced, impacted and dorsally angulated fractures of the distal radius and
ulnar are again noted. There is interval improvement of the previously seen
dorsal angulation. There is no evidence of proximal radius and ulna fracture.
Limited visualization of the upper joint demonstrates no acute fractures or
dislocations. Incidental note is made of a supracondylar spur, congenital
variant, along the anterior aspect of the distal humerus.
IMPRESSION:
1. Status post cast placement, there is interval improvement of the previously
seen dorsal angulation involving the comminuted, displaced and impacted distal
radius and ulnar fractures.
|
19965408-RR-28 | 19,965,408 | 23,688,028 | RR | 28 | 2134-03-22 00:54:00 | 2134-03-22 05:28:00 | EXAMINATION: WRIST(3 + VIEWS) IN O.R. LEFT
INDICATION: History: ___ with post reduction// eval post reduction films
eval post reduction films
eval post reduction films
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left wrist.
COMPARISON: Same day ___ left wrist radiograph
FINDINGS:
Overlying cast limits evaluation for fine osseous details. Status post cast
placement there is improved alignment of the previously seen comminuted
impacted fractures of the distal radius and ulna. There is improved anatomic
alignment since the previous study. There is generalized demineralization.
IMPRESSION:
Status post cast placement there is improved alignment of the previously seen
comminuted, impacted, fractures of the distal radius and ulna.
|
19965408-RR-29 | 19,965,408 | 23,688,028 | RR | 29 | 2134-03-22 01:57:00 | 2134-03-22 05:33:00 | INDICATION: History: ___ with pre-op wrist fx// pre-op,, ?PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph.
FINDINGS:
The lungs are well expanded and clear. There is no focal consolidation,
pleural effusion or pneumothorax. The curvilinear opacity projecting over the
left lung base likely represents atelectasis versus chronic scarring.
Cardiomediastinal silhouette is unremarkable. Left sided rib fractures are of
varying ages, however likely chronic.
IMPRESSION:
1. No acute intrathoracic abnormalities identified..
|
19965408-RR-30 | 19,965,408 | 23,688,028 | RR | 30 | 2134-03-22 09:12:00 | 2134-03-22 10:45:00 | EXAMINATION: WRIST(3 + VIEWS) IN O.R. LEFT
IMPRESSION:
Fluoroscopic images from the operating suite show steps in internal fixation
procedure involving comminuted fractures of the distal radius and ulna.
Further information can be gathered.
|
19965802-RR-52 | 19,965,802 | 28,373,590 | RR | 52 | 2122-01-30 11:58:00 | 2122-01-30 17:07:00 | HISTORY: ___ woman with small-bowel obstruction secondary.
COMPARISON: Outside hospital abdominal radiograph, ___.
FINDINGS: Air and stool is seen within nondilated large bowel. Scant loops of
central nondilated small bowel are seen. There is a nonobstructive bowel gas
pattern. There is a feeding tube in place with tip terminating likely in the
gastric antrum. Right upper quadrant clips are seen there are multiple
scattered clips seen in the lower abdomen and pelvis. A drain is seen in
place with the pigtail in the left midabdomen and crossing over the right
hemipelvis. An IVC filter remains in place.
IMPRESSION:
Nonobstructive bowel gas pattern that is not significantly changed from
previous study.
|
19965802-RR-53 | 19,965,802 | 28,373,590 | RR | 53 | 2122-02-01 03:51:00 | 2122-02-01 12:25:00 | AP CHEST, 4:09 A.M., ___
HISTORY: ___ woman with shortness of breath, question increased
pulmonary disease.
IMPRESSION: AP chest compared to ___ through ___:
A horizontal interface just above the right hemidiaphragm has been visible
intermittently over the past several weeks. Viewed in coordination with the
abdomen CT on ___ I think this is a small-to-moderate right pleural
effusion and the lung is largely clear aside from associated atelectasis.
Left lung is entirely clear. The heart is mildly enlarged, a chronic finding.
Upper mediastinum is widened by tortuous head and neck vessels displacing the
trachea slightly to the left. Dual-channel catheter ends in the right heart.
No pneumothorax.
|
19966115-RR-10 | 19,966,115 | 29,707,865 | RR | 10 | 2183-08-23 17:36:00 | 2183-08-24 14:38:00 | EXAMINATION: MR lumbar spine without contrast.
INDICATION: ___ year old man with ___ disease c/o radicular pain
radiating down legs // Assess for lumbar stenosis, radiculopathy etc
TECHNIQUE: MRI of the lumbar spine was performed without intravenous
contrast, as per the standard departmental protocol.
COMPARISON: None
FINDINGS:
Vertebrae are normal in height. There have been bilateral laminectomies at L3
through L5 with osseous fusion of the L4 and L5 vertebral bodies. There is
bone graft material at the L3-L5 laminectomy sites. There is thin epidural
enhancement consistent with postoperative granulation tissue at L3-L5. There
is an approximately 2.4 x 1.2 cm pocket of fluid without rim enhancement
within the laminectomy bed, likely a seroma. There is grade ___
anterolisthesis at L4-5 with type ___ ___ endplate changes. There is
ill-defined T1 hypointensity, T2 hyperintensity, and contrast enhancement
within the L1 vertebral body. There is a similar pattern of abnormal
enhancement involving the L2-3 endplates. The conus is normal in appearance
and position, terminating at L1.
T12-L1: No significant disc pathology. No significant spinal canal or
foraminal stenosis.
L1-L2: There is a mild disc bulge. There is no significant spinal canal or
foraminal stenosis.
L2-L3: There is a disc bulge extending into the right foramen and causing
mild right foraminal stenosis. There is no significant spinal canal or left
foraminal stenosis.
L3-L4: There is a mild disc bulge causing mild bilateral foraminal stenosis.
There is no significant spinal canal stenosis.
L4-L5: There is grade ___ anterolisthesis causing severe left foraminal
stenosis. There is an approximately 0.8 x 0.5 cm T1 hypointense, nonenhancing
structure in the left neural foramen (series 7, image 24). This may be a
swollen nerve root or disc material. There is no significant spinal canal or
right foraminal stenosis.
L5-S1: There is a disc bulge. There is no significant spinal canal or
foraminal stenosis.
IMPRESSION:
1. Approximately 0.8 x 0.5 cm structure within the left L4-5 neural foramen,
either a swollen nerve root or less likely disc material. This is
superimposed on severe left L4-5 foraminal stenosis due to grade I-II
anterolisthesis.
2. Focal signal abnormality within the L1 vertebral body, possibly a
metastasis. Correlation with noncontrast CT of the lumbar spine is recommended
for further evaluation.
3. Abnormal signal within the L2-3 endplates, either due to degenerative
disease, compression fractures, or metastasis. Correlation with noncontrast CT
of the lumbar spine is recommended for clarification.
4. Postsurgical changes of L3-L5 laminectomy and fusion.
Findings discussed with Dr. ___ at approximately 12:00 ___.
|
19966115-RR-11 | 19,966,115 | 29,707,865 | RR | 11 | 2183-08-24 13:15:00 | 2183-08-24 15:08:00 | EXAMINATION: CT L-SPINE W/O CONTRAST
INDICATION: ___ year old man with LLE radicular pain // possible metastasis
to L-spine on MRI, needs further evaluation
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: DLP: 801 mGy-cm
CTDI: 31 mGy
COMPARISON: MRI lumbar spine from ___. PET-CT from ___.
FINDINGS:
Postoperative changes are again seen in the lower lumbar spine with L3 and L4
laminectomies and bone graft material adjacent to the facets. The L4 and L5
vertebral bodies are essentially fused. Grade 1 anterolisthesis and right
lateral subluxation of L4 on L5 is seen noting that the vertebral bodies are
essentially fused. Retrolisthesis of L1 on L2, and L2 on L3 are similar
compared to MRI. Intervertebral disc height loss at L1-L2 with vacuum disc
phenomenon is seen. There are some likely degenerative changes seen adjacent
to L1 inferior endplate with adjacent sclerosis in this region and extending
more extensively to involve the lower half of the vertebral body. Disc height
loss with vacuum disc phenomenon and degenerative changes seen centered at the
L2-3 disc with sclerosis of the adjacent endplates, eccentric to the right.
MRI provides more detailed evaluation of the spinal canal and thecal sac.
Atherosclerotic calcifications noted in a normal-caliber abdominal aorta.
There is no evidence of soft tissue abnormality in the retroperitoneum or
paraspinal soft tissues. Relative atrophy noted of the right psoas compared to
the left. There is a 6 mm calculus in the region of the mid left ureter
without visualized upstream hydroureter noting the entire kidney is not
evaluated included for evaluation of hydronephrosis. Of note, this stone was
present on PET-CT from ___.
IMPRESSION:
Degenerative and postoperative changes in the lumbar spine. Sclerosis adjacent
to the inferior endplate of L1 and endplates adjacent to the L2-L3
intervertebral disc. While metastatic disease is not entirely excluded,
degenerative changes is considered more likely.
|
19966115-RR-12 | 19,966,115 | 29,707,865 | RR | 12 | 2183-08-25 12:25:00 | 2183-08-25 15:43:00 | INDICATION: ___ year old man with LLE radicular pain // Concern for spinal
metastatic disease, evaluate for primary
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
DOSE: DLP: ___ mGy-cm (abdomen and pelvis.
IV Contrast: 130 mL Omnipaque
COMPARISON: ___ L-spine CT without contrast
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 is within normal limits,
without stones or gallbladder wall thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. A splenule anterolateral to the spleen is noted.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys have diffuse thinning of there cortices. The left mid
ureter has a 7.7 x 5.6 x 6.5 mm stone without associated fat stranding or
ipsilateral hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: A small hiatal hernia is seen. Small bowel loops
demonstrate normal caliber, wall thickness and enhancement throughout. Colon
and rectum are within normal limits. Appendix contains air, has normal caliber
without evidence of fat stranding.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is diffuse severe
calcium burden in the abdominal aorta and great abdominal arteries especially
at the SMA which displays lack of contrast likely secondary to atheromatous
plaque.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits
BONES AND SOFT TISSUES:
Extensive degenerative changes as outlined in CT L-spine without contrast
dated ___. Abdominal and pelvic wall is within normal limits. A
right total hip arthroplasty is noted.
IMPRESSION:
1. 8mm left ureteral stone without discrete signs of obstruction.
2. Small hiatal hernia
3. Extensive degenerative changes as outlined in CT L-spine dated ___.
|
19966115-RR-13 | 19,966,115 | 29,707,865 | RR | 13 | 2183-08-25 12:27:00 | 2183-08-25 14:29:00 | COMPUTED TOMOGRAPHY OF THE THORAX
INDICATION: Evaluation for potential primary tumor.
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
administration of intravenous contrast material, multiplanar reconstructions.
COMPARISON: No comparison available at the time of dictation.
FINDINGS: The examination is performed because of an unclear lesion at the
L4-L5 level.
No incidental thyroid findings. No supraclavicular, infraclavicular or
axillary lymphadenopathy. Mild calcifications of the supra-aortic branches.
Normal ___ of the ascending and descending aorta. Borderline diameter
of the pulmonary artery. No incidental pulmonary embolism. No hilar or
mediastinal lymphadenopathy. Moderate-to-severe coronary calcifications.
Mild-to-moderate valvular calcifications. No pericardial effusion. The
posterior mediastinum is unremarkable, with exception of a moderate hiatal
hernia.
Upper abdominal morphologies described in the report of the dedicated
abdominal CT examination performed today.
Moderate scoliosis. Moderate degenerative vertebral disease. The lumbar
findings are described in detail in the lumbar spine MR from ___.
At the thoracic level, there is no evidence of compression fracture. No
osteolytic lesions at the level of the ribs and the sternum.
Minimal bilateral apical scarring, symmetrical in distribution.
Several accumulations of mucus are seen in the larger airways (for example
series 5, image 87). Non-characteristic subpleural scarring at the level of
the left upper lobe (5, 101).
Moderate right paramediastinal and paravertebral fibrosis (5, 157). Minimal
left basomedial subpleural fibrosis (5, 180). The pleural surfaces are even,
there is no pleural effusion. Several millimetric subpleural micronodules, no
lesions suspicious for malignant disease.
The airways are patent.
IMPRESSION: Bilateral paravertebral fibrosis, overall mild in distribution.
Moderate-to-severe coronary calcifications, moderate valvular calcifications.
No lymphadenopathy. No evidence of malignant lung nodules. No masses, no
pleural effusions.
|
19966115-RR-16 | 19,966,115 | 23,669,560 | RR | 16 | 2184-02-05 19:19:00 | 2184-02-05 21:12:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: Leg swelling.
COMPARISON: ___.
TECHNIQUE: Chest, AP upright.
FINDINGS:
The cardiac, mediastinal and hilar contours appear unchanged. There is no
pleural effusion or pneumothorax. There is a retrocardiac opacity that is not
specific obscuring medial left hemidiaphragmatic contours. Otherwise the
lungs appear clear.
IMPRESSION:
Left lower lobe opacity, which could be seen with atelectasis, although an
infectious process is not excluded and results should be correlated with
clinical presentation. No evidence of congestive heart failure.
|
19966115-RR-17 | 19,966,115 | 23,669,560 | RR | 17 | 2184-02-05 19:08:00 | 2184-02-05 21:08:00 | EXAMINATION: RIGHT KNEE RADIOGRAPHS
INDICATION: Right knee pain.
COMPARISON: None available.
TECHNIQUE: Right knee, three views.
FINDINGS:
The patient is status post right total knee replacement. Tibial and femoral
prostheses appear well-seated. The patella appears markedly attenuated in
anteroposterior dimension, as well as fragmented, compared to what is usually
expected with apparent attenuation of unusual expected liner thickness
although there seems to be an anterior plate that is intact overlying residual
patellar fragments. Anterior soft tissues are appear mildly prominent in
width. There is probably a very small joint effusion
IMPRESSION:
Thinning of expected patellar line and attenuated fragmented appearance of
patella with apparent overlying soft tissue prominence. Small joint effusion.
To assess for the significance clinically, if any, of the appearance of the
patella, direct correlation to prior radiographs would be helpful, if
available.
|
19966115-RR-18 | 19,966,115 | 23,669,560 | RR | 18 | 2184-02-07 16:23:00 | 2184-02-07 16:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with rhinorrhea, congestion, cough and concern
for pneumonia vs. heart failure exacerbation // Evaluate for pneumonia vs.
heart failure Evaluate for pneumonia vs. heart failure
IMPRESSION:
In comparison with the study of ___, the cardiac silhouette remains at
the upper limits and normal in size. There is no evidence of vascular
congestion, pleural effusion, or acute focal pneumonia.
|
19966115-RR-28 | 19,966,115 | 27,409,352 | RR | 28 | 2184-09-21 09:25:00 | 2184-09-21 10:00:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with history of ___ who presented to ED after
syncopal vs mechanical fall, no c/o headache and right knee pain //
intracranial hematoma?Right knee injury?
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: ___, ___
FINDINGS:
There is no evidence of acute hemorrhage or infarction. Age related cerebral
volume loss is noted. There are periventricular white matter hypodensities,
consistent with small vessel ischemic changes.
No osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormalities.
|
19966115-RR-29 | 19,966,115 | 27,409,352 | RR | 29 | 2184-09-21 09:42:00 | 2184-09-23 09:48:00 | INDICATION: History: ___ with history of ___ who presented to ED
after syncopal vs mechanical fall, no c/o headache and right knee pain //
intracranial hematoma?Right knee injury?
TECHNIQUE: Four views of the right knee
COMPARISON: None.
FINDINGS:
Patient is status post right knee arthroplasty with prosthesis in anatomic
alignment without findings to suggest hardware complication. The patella is
fragmented, likely old, no prior available for comparison. There is a small
suprapatellar joint effusion. No dislocation is seen. No definite acute
fracture. Vascular calcifications are seen.
|
19966115-RR-30 | 19,966,115 | 27,409,352 | RR | 30 | 2184-09-21 09:41:00 | 2184-09-21 11:40:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with history of ___ who presented to ED after
syncopal vs mechanical fall, no c/o headache and right knee pain //
intracranial hematoma?Right knee injury?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The lungs are hypoinflated. In comparison to the prior examination, the
cardiomediastinal silhouette appears stable. The pulmonary vasculature is
mildly indistinct, though not significantly changed since prior examination.
No definite pneumothorax or pleural effusion is noted.
IMPRESSION:
No acute intrathoracic process.
|
19966115-RR-32 | 19,966,115 | 24,831,979 | RR | 32 | 2184-12-03 15:11:00 | 2184-12-03 15:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest and back pain and hypotension // eval
for dissection
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Cardiac silhouette size is mildly enlarged but unchanged. The mediastinal and
hilar contours are similar. Pulmonary vasculature is normal. Streaky
atelectasis is seen in the lung bases without focal consolidation. No pleural
effusion or pneumothorax is the benefit. Degenerative changes are noted
involving both acromioclavicular joints.
IMPRESSION:
Mild bibasilar atelectasis.
|
19966115-RR-33 | 19,966,115 | 24,831,979 | RR | 33 | 2184-12-03 17:20:00 | 2184-12-03 18:17:00 | EXAMINATION: Chest MRA.
INDICATION: ___ year old man with chest pain radiating into back // eval for
aortic dissection
TECHNIQUE: T1- and T2-weighted multiplanar images of the chestwere acquired
in a 1.5 T magnet.
Intravenous contrast: None
3D postprocessing was performed on an independent workstation, including the
creation of 3D maximum intensity projection images, which support these
findings.
COMPARISON: Comparison is made to CT chest and abdomen from ___ and
___.
FINDINGS:
MR ANGIOGRAM:
No evidence of aortic dissection. The aorta and great vessels are grossly
patent. There is a background of mild to moderate atherosclerosis.
Measurements of the aorta include:
Aortic root: 2.5 cm
Proximal ascending: 3.6 cm
Distal ascending: 3.8 cm
Proximal arch: 3.1 cm
Distal arch: 2.8 cm
Mid descending: 2.7 cm
Distal descending: 2.5 cm
LUNGS: There is a 1.6 x 1.3 cm nodule in the right hilum, which may represent
an enlarged lymph node versus mass. This is incompletely assessed in the
current study. Additionally, there is mild bilateral dependent subsegmental
atelectasis particularly involving the bases. No pleural effusion. Trace
pericardial fluid.
HEART AND MEDIASTINUM: Moderate cardiomegaly. No mediastinal lymphadenopathy.
UPPER ABDOMEN: Small hiatal hernia. The imaged portion of the liver, spleen,
and bilateral adrenals are unremarkable. The imaged pancreas is also within
normal limits. The main pancreatic duct is not dilated. No evidence of
intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is
unremarkable.
OSSEOUS STRUCTURES AND SOFT TISSUES: No worrisome osseous findings.
IMPRESSION:
1. No evidence of aortic dissection.
2. Right hilar mass measuring up to 1.6 cm. Further evaluation with dedicated
CT chest recommended.
RECOMMENDATION(S): Right hilar mass measuring up to 1.6 cm. Further
evaluation with dedicated CT chest recommended.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the ___ ___ at 6:10 ___, 2 minutes after discovery of
the findings.
|
19966115-RR-43 | 19,966,115 | 26,417,465 | RR | 43 | 2186-04-05 12:53:00 | 2186-04-05 14:01:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with confusion// Eval for acute process
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest CT ___, chest radiograph ___
FINDINGS:
Cardiac silhouette size remains mildly enlarged. The mediastinal contours
appear unremarkable. Pulmonary vasculature is not engorged. Elevation of the
right hemidiaphragm appears new, and obscures the known right hilar mass.
Patchy opacities in lung bases may reflect areas of atelectasis, though
infection or aspiration cannot be excluded. No large pleural effusion or
pneumothorax is detected. There are no acute osseous abnormalities.
IMPRESSION:
New elevation of the right hemidiaphragm which obscures the right hilar mass.
Patchy opacities in lung bases may reflect atelectasis but infection or
aspiration cannot be excluded.
|
19966115-RR-9 | 19,966,115 | 29,707,865 | RR | 9 | 2183-08-21 18:41:00 | 2183-08-21 19:13:00 | INDICATION: ___ with increased movement disorder, ? infectious trigger //
Eval for infiltrate
TECHNIQUE: AP view of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal limits
for technique. Atherosclerotic calcifications are noted at the aortic arch. No
acute osseous abnormalities identified.
IMPRESSION:
No acute cardiopulmonary process.
|
19966322-RR-19 | 19,966,322 | 27,308,251 | RR | 19 | 2140-11-08 01:05:00 | 2140-11-08 03:26:00 | INDICATION: Question chest pain radiating to back. Question aortic
dissection.
COMPARISON: Comparison is made to chest radiograph performed ___.
TECHNIQUE: Non-contrast axial images were obtained through the chest.
Subsequently, intravenous contrast was administered and arterial phase imaging
was performed. Coronal, sagittal, and oblique reformats were provided.
FINDINGS:
Chest CTA: The aorta is of normal caliber throughout and without evidence of
dissection. The pulmonary vasculature is well opacified and without filling
defect to suggest pulmonary embolism. Heart size is normal and without
pericardial effusion.
CT Chest: The thyroid gland is incompletely visualized, though demonstrated
portions are unremarkable. Minimal dependent atelectasis identified
bilaterally, otherwise, lungs are clear. Airways are normal to the
subsegmental levels. No pleural effusion or pneumothorax identified. Though
this exam is not tailored for subdiaphragmatic evaluation, the demonstrated
portions of the liver are unremarkable.
Though this exam is not tailored for subdiaphragmatic evaluation, the
visualized aspects of the liver and adrenal glands are unremarkable.
No suspicious lytic or blastic lesions are evident
IMPRESSION: No evidence of aortic dissection or pulmonary embolism. No acute
process identified.
|
19966553-RR-4 | 19,966,553 | 27,576,329 | RR | 4 | 2135-05-26 10:53:00 | 2135-05-26 11:55:00 | HISTORY: Recent right femoral artery catheterization now with indurated thigh
and hypotension.
COMPARISON: None.
TECHNIQUE: Limited grayscale, color, and spectral Doppler ultrasound of the
right groin was performed.
FINDINGS:
The right common and superficial femoral arteries are patent with normal
arterial waveforms. The right common femoral and superficial femoral veins
are patent. There is no evidence of pseudoaneurysm. A 2.9 x 1.3 x 3.7 cm
hematoma is present medial and superficial to the common femoral vessels.
IMPRESSION:
Small right groin hematoma. No evidence of pseudoaneurysm or other vascular
abnormality.
|
19966553-RR-5 | 19,966,553 | 27,576,329 | RR | 5 | 2135-05-28 21:27:00 | 2135-05-29 00:27:00 | INDICATION: Recent catheter, now with enlarging right groin hematoma.
COMPARISON: Ultrasound of the right femoral region ___.
TECHNIQUE: Grayscale, color and spectral Doppler ultrasound of the right
groin was performed.
FINDINGS: The right common femoral artery is patent with normal arterial
waveforms. The right common femoral vein is normal. There is no evidence of
pseudoaneurysm. Again there is an approximate 3 x 1 x 3 cm hematoma with
smaller adjacent foci medial and superficial to the common femoral vessels
similar to the prior study
IMPRESSION: No significant appreciable change in size of right groin
hematoma.
|
19966553-RR-6 | 19,966,553 | 27,576,329 | RR | 6 | 2135-05-29 09:47:00 | 2135-05-29 12:07:00 | PA AND LATERAL CHEST FROM ___ AT 9:52
INDICATION: ___ year-old with cough, assess for pneumonia.
No comparison studies. Please note that comparison to old films can be
helpful to detect subtle interval change.
IMPRESSION:
Focal opacity in the right medial lung base with associated air bronchograms
and corresponding to the right middle lobe location on the lateral view.
These findings are more suggestive of bronchiectasis in a patient with a
history of recurrent pneumonia, although an acute infectious process cannot be
excluded. Comparison to prior studies and clinical correlation is advised.
The remaining lungs are clear. Overall cardiac and mediastinal contours are
within normal limits. No pneumothorax or pulmonary edema. Blunting of both
posterior costophrenic angles may reflect small effusions or chronic pleural
thickening. No acute bony abnormality. Followup imaging should be based on
the clinical assessment.
|
19966553-RR-7 | 19,966,553 | 27,576,329 | RR | 7 | 2135-05-31 10:26:00 | 2135-05-31 13:47:00 | REASON FOR EXAMINATION: Persistent cough and low-grade fever.
Portable AP radiograph of the chest was reviewed in comparison to ___.
Heart size and mediastinum are stable. Bibasal opacities are noted, slightly
more pronounced on the current study, especially on the right, thus concerning
for right lower lobe pneumonia. No appreciable pneumothorax is seen, and the
patient is most likely hyperinflated.
Left base appears to be also minimally increased, thus bibasal consolidations
suggesting bibasal pneumonia are also a possibility.
|
19966553-RR-8 | 19,966,553 | 27,576,329 | RR | 8 | 2135-06-02 12:14:00 | 2135-06-02 23:49:00 | INDICATION: ___ female with history of recent right groin approach
cardiac catheterization with known hematoma at that site, now presenting with
increasing right lower extremity edema. Assess for DVT.
COMPARISON: Right femoral ultrasound from ___
RIGHT LOWER EXTREMITY DOPPLER ULTRASOUND: Grayscale and Doppler sonograms of
the bilateral common femoral, right superficial femoral, right popliteal,
right posterior tibial, and right peroneal veins were obtained. There is
normal flow, compressibility and augmentation of the above-examined veins. A
hypoechoic structure within the right groin measuring 8.2 x 4.2 x 9.3 cm is
consistent with a hematoma. Though it measures larger than prior on the
current study, differences may be due to scan technique, correlate clinically
for signs of enlargement. Additionally, small likely reactive lymph nodes are
seen within the right groin.
IMPRESSION:
1. No lower extremity DVT
2. Persistent right groin hematoma. Correlate clinically for signs of
enlargement.
Dr. ___ communicated the above results to Dr. ___ at
2:34 pm on ___ by telephone.
|
19966756-RR-61 | 19,966,756 | 21,700,620 | RR | 61 | 2153-05-31 01:42:00 | 2153-05-31 07:01:00 | INDICATION: ___ male with shortness of breath and chest pain,
evaluate for pulmonary edema.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray from ___.
FINDINGS:
There is moderate pulmonary edema, increased since prior study. No focal
consolidation is seen, although lung volumes are low. Moderate cardiomegaly
is noted. There is no pleural effusion or pneumothorax.
IMPRESSION:
Moderate pulmonary edema and moderate cardiomegaly. No focal consolidation.
|
19966756-RR-62 | 19,966,756 | 21,700,620 | RR | 62 | 2153-05-31 02:13:00 | 2153-05-31 03:08:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with headaches, on coumadin, evaluate for intracranial
hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 48.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head from ___
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular and subcortical white matter
hypodensities are nonspecific, but likely reflect sequelae of chronic small
vessel ischemic disease.
The superior ophthalmic veins are dilated and prominent bilaterally (series 2,
image 8) and there is increase proptosis of the bilateral globes when compared
to prior examination. The finding is nonspecific and may represent increased
venous pressure or intracranial pressure secondary to the patient's congestive
heart failure were hypertension. Clinical correlation is read.
There is no evidence of fracture. There is near complete opacification of the
right maxillary sinus, mild opacification of bilateral ethmoid air cells, and
minimally in the left sphenoid sinus. The remaining visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
Patient is status post bilateral lens replacements. Dense atherosclerotic
mural calcifications in the carotid siphons and vertebral arteries are noted
bilaterally.
IMPRESSION:
1. There is no evidence for acute territory infarct or intracranial
hemorrhage.
2. The bilateral ophthalmic veins are dilated and torturous with increased
proptosis of the globes. This is nonspecific and could simply represent
increased venous pressure or intracranial pressure from Valsalva or patient's
congestive heart failure. Clinical correlation is recommended as this could
be seen in setting of more concerning cavernous sinus thrombosis or CC
fistula, both which are less likely given the patient's clinical history.
Close attention on followup exam could be performed to document resolution.
3. Paranasal sinus disease as described above, new from examination of ___. Correlation with patient's symptoms is recommended.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the ___ ___ at 10:00 AM, 15 minutes after discovery of the
findings.
|
19966756-RR-63 | 19,966,756 | 21,700,620 | RR | 63 | 2153-06-02 11:18:00 | 2153-06-02 13:16:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with h/o of FBT/PE in ___ still on
anti-coagulation. No admitted with ___. Has ___ edema. // assess
bilaterally for presence of clot. Will help decision making regarding
continued anti-coagulation in the setting of GI bleed.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Bilateral lower extremity venous ultrasound dated ___.
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 bilateral posterior tibial veins.
The left peroneal veins are not well seen. Apparent non-compressibility of
the bilateral peroneal veins is suspicious for persistent left and new right
deep vein thrombus. Partial color flow within these vessels suggests that the
thrombus is nonocclusive.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Probable nonocclusive thrombus within the bilateral peroneal veins, although
the left peroneal veins are not well seen.
Remaining bilateral lower extremity deep veins appear patent as detailed
above.
RECOMMENDATION(S): Given clinical scenario, if further detection of the
bilateral deep venous system is required, MRI venogram can be considered.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the ___ ___ at 1:15 ___, 30 minutes after discovery of the
findings.
|
19966756-RR-64 | 19,966,756 | 21,700,620 | RR | 64 | 2153-06-07 15:40:00 | 2153-06-07 16:11:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with CHF exacerbation, GI bleed, with new O2
requirement and new RUL crackles in setting of recent vomiting. // ? new
consolidative process; eval progression/resolution of prior pulm edema ?
new consolidative process; eval progression/resolution of prior pulm edema
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Pulmonary vascular congestion and moderate cardiomegaly persists. There is no
appreciable pulmonary edema. Atelectasis or small pleural effusions are
responsible for apparent thickening of the fissures. There is no layering
pleural effusion or pneumothorax.
|
19966756-RR-65 | 19,966,756 | 25,743,475 | RR | 65 | 2153-08-21 00:44:00 | 2153-08-21 03:44:00 | INDICATION: ___ with chills vomiting tachycardia, evaluate for pneumonia.
TECHNIQUE: Single upright AP chest radiograph
COMPARISON: Multiple prior chest radiographs dating back to ___.
FINDINGS:
Heart is upper limits of normal in size and accompanied by mild pulmonary
vascular congestion and small right pleural effusion. Bibasilar platelike
atelectasis is slightly improved. There is no pneumothorax or focal
consolidation. The cardiomediastinal silhouette is stable. The left-sided
Bochdalek's hernia is unchanged. Impression on the right aspect of the
trachea may be related to an enlarged thyroid gland.
IMPRESSION:
1. No evidence of pneumonia.
|
19966756-RR-66 | 19,966,756 | 25,743,475 | RR | 66 | 2153-08-21 04:27:00 | 2153-08-21 04:57:00 | INDICATION: ___ with vomiting, elevated lactate, evaluate for obstruction or
colitis.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 52.0 cm; CTDIvol = 7.9 mGy (Body) DLP = 407.9
mGy-cm.
Total DLP (Body) = 408 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Bibasilar dependent atelectasis is noted. The left lower lobe
contains a 8 mm pulmonary nodule (2:8). Extensive coronary arterial
calcification and aortic valvular calcifications are noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains gallstones without wall thickening or
evidence of inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. Bilateral simple cysts
are noted. There is no hydronephrosis. There is no nephrolithiasis. There
is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Patient is status post partial
left colectomy without evidence of anastomotic complication. The appendix is
normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive 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. Patient
is status post right inguinal hernia repair.
IMPRESSION:
1. No acute intra-abdominal process within the limitations of an unenhanced
scan.
2. Extensive severe calcified atherosclerotic disease involving all of the
intra-abdominal artery is and the partially visualized coronary arteries.
3. 8 mm left lower lobe pulmonary nodule for which nonemergent completion
chest CT is recommended.
RECOMMENDATION(S): Nonemergent completion chest CT is recommended to evaluate
for additional pulmonary nodules in the setting of an 8 mm left lower lobe
pulmonary nodule and a history of colon cancer.
|
19966756-RR-67 | 19,966,756 | 25,743,475 | RR | 67 | 2153-08-21 06:19:00 | 2153-08-21 06:43:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with vomiting, hypertension evaluate for intracranial
hemorrhage or mass.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.9 cm; CTDIvol = 47.4 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Head CT dated ___.
FINDINGS:
Left frontal convexity encephalomalacia is likely related to remote prior
infarction, unchanged from ___. There is no evidence of acute
infarction, hemorrhage, edema, or mass. There is prominence of the ventricles
and sulci suggestive of involutional changes. Periventricular and deep
subcortical white matter hypodensities are compatible with moderate chronic
small vessel ischemic changes. Extensive arterial calcifications are noted.
There is no evidence of fracture. Complete opacification of the maxillary
sinus and partial opacification of the right anterior ethmoidal air cells has
worsened compared with the prior study. The visualized portion of the
mastoid air cells and middle ear cavities are clear. The visualized portion
of the orbits are notable for bilateral cataract surgery.
IMPRESSION:
1. No acute intracranial process.
2. Unchanged left frontal encephalomalacia, age related involutional changes,
and sequelae of chronic small vessel ischemic disease.
3. Of note, MRI is more sensitive for the detection of intracranial masses.
|
19966756-RR-68 | 19,966,756 | 25,743,475 | RR | 68 | 2153-08-21 15:23:00 | 2153-08-21 15:59:00 | EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ year old man with htn and unresponsive // ?acute infarct
?acute hemorrhage
TECHNIQUE: Axial images of the head were obtained without contrast .
DOSE: .
Total DLP (Head) = 848 mGy-cm.
COMPARISON: ___ obtained approximately 10 hr before the current
study. .
FINDINGS:
There is no acute hemorrhage mass effect or midline shift. Left frontal
encephalomalacia again seen. Mild to moderate brain atrophy and small vessel
disease noted. Extensive soft tissue vascular calcifications are seen.
IMPRESSION:
No acute intracranial abnormalities are identified or change since the
examination obtained 10 hr earlier. .
|
19966756-RR-71 | 19,966,756 | 20,726,020 | RR | 71 | 2155-11-23 02:48:00 | 2155-11-23 03:53:00 | INDICATION: History: ___ with dry cough and hyperglycemia// Evaluate for
pneumonia or acute process
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph
FINDINGS:
The lungs are well expanded. There is new bilateral (right greater than left
lower lobe opacities obscuring the hemidiaphragms concerning for pneumonia
and/or atelectasis. There is no pleural effusion or pneumothorax. There is
no acute osseus abnormality. Moderate cardiomegaly is again noted and similar
to prior chest radiograph. No evidence of pulmonary edema.
IMPRESSION:
1. Increased opacities in the right greater than left lower lobes is
concerning for pneumonia, atelectasis can have a similar appearance.
|
19966756-RR-72 | 19,966,756 | 20,726,020 | RR | 72 | 2155-11-23 04:38:00 | 2155-11-23 05:04:00 | INDICATION: History: ___ with increased work of breathing// Evaluate for
worsening pulmonary edema
TECHNIQUE: Chest PA and lateral
COMPARISON: Same day ___ 02:54 chest radiograph
FINDINGS:
When compared to most recent prior chest radiograph performed at 02:54, the
lung volumes remain low. Additionally there is increased opacity involving
the bilateral mid to lower lung fields with obscuration of the bilateral
costophrenic angles suggestive of worsening pulmonary edema and probable
layering bilateral pleural effusions. The cardiomediastinal silhouette
remains prominent.
IMPRESSION:
1. Increased opacities involving the bilateral mid to lower lung field with
obscuration of the bilateral costophrenic angles suggest progression of mild
pulmonary edema with probable layering bilateral pleural effusion.
|
19966756-RR-73 | 19,966,756 | 20,726,020 | RR | 73 | 2155-11-23 10:11:00 | 2155-11-23 10:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with LLL consolidation; just coded while getting
up to use restroom. ROSC within 3 minutes.// ? pneumothorax, rib fractures
after CPR ? pneumothorax, rib fractures after CPR
IMPRESSION:
Comparison to ___, 04:38. No relevant change is noted. Low lung
volumes. Moderate cardiomegaly with retrocardiac atelectasis that has
minimally increased in extent. Mild pulmonary edema. No pleural effusions.
No pneumonia.
|
19966756-RR-74 | 19,966,756 | 20,726,020 | RR | 74 | 2155-11-28 17:39:00 | 2155-11-28 18:06:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ with PMH IDDM, CKD IV, hypertension, HFrEF (EF 15%), and CAD
s/p NSTEMI with DES to LAD in ___, PEA arrest ___, with worsening ___
thought to be ___ ATN and overdiuresis// eval for obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound ___.
FINDINGS:
The right kidney measures 8.7 cm. The left kidney measures 9.3 cm. There are
bilateral renal cysts which appear simple the largest measuring approximately
2.1 cm in the midpole of the right kidney. Otherwise, there is no
hydronephrosis, stones, or concerning masses bilaterally. There is an
echogenic appearance of the renal cortex bilaterally reflecting known chronic
medical renal disease.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. No hydronephrosis.
2. Bilateral simple renal cysts.
3. Slightly echogenic appearance of the renal cortices may reflect known
medical renal disease.
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19966756-RR-75 | 19,966,756 | 20,726,020 | RR | 75 | 2155-11-30 22:04:00 | 2155-12-01 08:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with IDDM, CKD IV, HTN, HLD, HFrEF CAD s/p NSTEMI
with hx pneumonia cb PEA arrest with new O2 requirement// ?pulmonary edema
?pulmonary edema
IMPRESSION:
Comparison to ___. Stable low lung volumes persist. Moderate
cardiomegaly is unchanged. Mild pulmonary edema is present on today's
radiograph. No pleural effusions. No pneumonia.
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19966756-RR-76 | 19,966,756 | 20,726,020 | RR | 76 | 2155-12-04 11:18:00 | 2155-12-04 14:25:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HFrEF s/p diuresis to euvolemia, ___ on CKD,
now with periodic desats to ___ on room air, afebrile. Evaluation for
pneumonia or aspiration pneumonitis.
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiograph from ___.
FINDINGS:
Low lung volumes are unchanged, contributing to crowding of bronchovascular
markings. There is tortuosity of the descending thoracic aorta. Moderate
cardiomegaly is unchanged. Mild pulmonary edema is slightly improved compared
to prior study. No focal consolidations. No pleural effusion or pneumothorax
is seen.
IMPRESSION:
1. Slight interval improvement of mild pulmonary edema and moderate
cardiomegaly.
2. Persistent low lung volumes.
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19966756-RR-77 | 19,966,756 | 20,726,020 | RR | 77 | 2155-12-07 11:49:00 | 2155-12-07 14:29:00 | INDICATION: ___ year old man with HFrEF (15%) CAD c/b NSTEMI s/p DES to LAD
___ with HFrEF exacerbation c/b ___ ___ ATN. Worsening volume overload and
renal function despite diuresis. Now with dialysis requirement.// Placement of
tunneled dialysis line for dialysis.
COMPARISON: Chest x-ray ___
TECHNIQUE: OPERATORS: Dr. ___ radiologist performed the
procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS:
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.6 min, 4 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 19 cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures and a pursestring suture was placed around the catheter as some oozing
was noted. ___ subcuticular Vicryl sutures and Steri-strips were also used to
close the venotomy incision site. Final spot fluoroscopic image demonstrating
good alignment of the catheter and no kinking. The tip is in the right atrium.
The catheter was flushed and both lumens were capped. Sterile dressings were
applied. The patient tolerated the procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing
hemodialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 19 cm tip-to-cuff length tunneled dialysis line. The
tip of the catheter terminates in the right atrium. The catheter is ready for
use.
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19966756-RR-78 | 19,966,756 | 20,726,020 | RR | 78 | 2155-12-11 10:41:00 | 2155-12-11 18:54:00 | EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old man with HFrEF (EF 15%) ___ on CKD requiring HD now
s/p 3 initial HD session.// ___ UE venous mapping for AVF evaluation
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
COMPARISON: None
FINDINGS:
RIGHT:
Normal phasic flow in the subclavian vein.
Basilic vein measures:
Mid arm: 0.55 cm at a depth of 0.8 cm
Distal arm 0.60 cm and a depth of 0.78 cm
Antecubital fossa: 0.41 at a depth of 0.59 cm
Proximal forearm: 0.20 cm a depth of 0.32 cm
Cephalic vein measures:
Antecubital fossa: 0.29 at a depth of 0.23 cm
Distal arm: 0.21 cm a depth of 0.27 cm
Mid arm 0.19 cm a depth of 0.33 cm
Right brachial artery measures 0.65 cm with mild to moderate calcification
normal peak systolic velocity.
Right radial artery measures 0.27 cm with mild to moderate calcification in
normal peak systolic velocity
LEFT:
Normal phasic flow in the subclavian vein.
Basilic vein measures:
Proximal arm 0.51 cm at a depth of 0.32 cm
Mid arm: 0.42 cm a depth of 0.31 cm
Distal arm measures 0.39 cm a depth of 0.76 cm
Antecubital fossa: 0.22 cm at a depth of 0.73 cm
Proximal forearm: 0.26 cm at a depth of 0.55 cm
Cephalic vein measures:
Proximal forearm 0.32 cm at a depth of 0.28 cm
Antecubital fossa: 0.35 cm at a depth of 0.12 cm
Distal arm: 0.25 cm a depth of 0.38 cm
Mid arm: 0.20 cm at a depth of 0.52 cm
Proximal arm: 0.24 cm a depth of 0.56 cm
Left brachial artery measures 0.53 cm with mild to moderate calcification and
normal peak systolic velocities.
Left radial artery measures 0.22 cm with moderate calcification in normal peak
systolic velocity.
IMPRESSION:
Patent bilateral basilic and cephalic veins with measurements as above.
Mild to moderate calcifications of the bilateral brachial and, moderate
calcification of the left radial artery normal peak systolic velocities.
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19966826-RR-130 | 19,966,826 | 22,744,040 | RR | 130 | 2145-01-29 21:04:00 | 2145-01-29 21:56:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with altered mental status.// Evidence of
stroke, bleed?
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.5 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Noncontrast head CT from ___.
MRI brain from ___.
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. The ventricles and sulci are prominent compatible with involutional
changes, stable from prior examinations. Periventricular and subcortical
white matter hypodensities are nonspecific and may suggest chronic small
vessel ischemic changes. A right cerebellar hypodensity is also present in
___ suggestive of a chronic infarct (2:9).
No acute fracture seen. Mucous retention cyst is noted in the sphenoid sinus.
The remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The orbits are unremarkable.
IMPRESSION:
No intracranial hemorrhage or CT evidence of acute infarct. MRI would be more
sensitive.
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19966826-RR-131 | 19,966,826 | 22,744,040 | RR | 131 | 2145-01-29 18:30:00 | 2145-01-29 19:17:00 | EXAMINATION: Chest Radiograph
INDICATION: ___ year old woman with altered mental status, increased work of
breathing.// Evidence of pneumonia?
TECHNIQUE: Portable Chest
COMPARISON: Chest radiograph ___
FINDINGS:
Patient rotation and the portable technique accounts for apparent widening of
the mediastinum. Heart is enlarged but unchanged. There is no pleural
effusion. There is no pneumothorax. There is a streaky left basilar opacity
consistent with atelectasis. No focal consolidation is seen.
IMPRESSION:
No focal lung consolidation.
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19966826-RR-133 | 19,966,826 | 22,744,040 | RR | 133 | 2145-01-29 21:13:00 | 2145-01-29 22:14:00 | EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with UTI concern for intraabodminal abscess//
c/f intraabominal abscess, plyeo
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 53.7 cm; CTDIvol = 19.2 mGy (Body) DLP =
1,030.5 mGy-cm.
2) Stationary Acquisition 10.3 s, 0.5 cm; CTDIvol = 57.0 mGy (Body) DLP =
28.5 mGy-cm.
Total DLP (Body) = 1,059 mGy-cm.
COMPARISON: CT Abdomen and Pelvis ___
FINDINGS:
LOWER CHEST: There is mild basilar atelectasis. There is a perifissural left
upper lobe pulmonary nodule requiring no specific followup (series 2, image
4). The descending thoracic aorta is tortuous. Heart is mildly enlarged.
There are moderate to severe coronary artery calcifications.
ABDOMEN:
HEPATOBILIARY: The liver is fatty in attenuation. There is no evidence of
focal lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains a large gallstone. There is no evidence
of acute cholecystitis.
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: There are bilateral simple renal cysts with the largest measuring 2.8
x 2.9 cm in the left interpolar kidney. In addition, there are scattered
subcentimeter hypodensities in the bilateral kidneys which are too small to
characterize but statistically likely represent simple cysts. The kidneys
enhance symmetrically. No perinephric abnormality is seen. There is no
hydronephrosis.
GASTROINTESTINAL: There is a small hiatal hernia. There is no small or large
bowel obstruction. There is no bowel wall thickening. There is moderate
fecal retention. Appendix is not visualized. There is no intra-abdominal
free fluid or free air.
PELVIS: The urinary bladder is distended and unremarkable. There is no
bladder wall thickening. There is no free fluid.
REPRODUCTIVE ORGANS: The uterus is absent. There is no pelvic free fluid.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic sidewall lymphadenopathy. There are stable mildly enlarged
bilateral inguinal lymph nodes measuring up to 1.4 cm on the left, likely
reactive.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is severe multilevel degenerative change of the lumbar spine most
pronounced at L4-5 and L5-S1. Mild anterolisthesis of L4-5 is stable.
SOFT TISSUES: Note is made of fluid adjacent to the right ischial tuberosity,
as seen previously.
IMPRESSION:
1. No acute intra-abdominal or pelvic process.
2. Cholelithiasis.
3. Moderate to severe degenerative changes of the lumbar spine, unchanged from
___.
4. Chronic right ischial bursitis.
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19966826-RR-134 | 19,966,826 | 22,744,040 | RR | 134 | 2145-02-01 14:13:00 | 2145-02-01 15:36:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with complaints of left and right calf pain,
immobile at baseline.// Concern for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: No prior similar exams.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
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.
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Subsets and Splits