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19966826-RR-139 | 19,966,826 | 27,596,355 | RR | 139 | 2145-10-13 00:55:00 | 2145-10-13 04:41:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with feeling off and mild cough// eval for PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___, ___
FINDINGS:
Lungs appear clear without focal consolidation there is no pleural
abnormality.
Moderate cardiomegaly, a generally enlarged and tortuous thoracic aorta and
and enlarged right hilum, probably due to large descending pulmonary artery,
are all unchanged since at least ___.
IMPRESSION:
No acute cardiopulmonary process.
|
19966826-RR-146 | 19,966,826 | 22,560,858 | RR | 146 | 2146-03-03 14:48:00 | 2146-03-03 15:06:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with confusion AMS// eval for infiltrate eval
for infiltrate
IMPRESSION:
Comparison to ___. Stable low lung volumes. Stable moderate
cardiomegaly. Potential hiatal hernia. Newly appeared bilateral parenchymal
opacities at the medial right lung bases and at the peripheral left lung
basis, highly suggestive of pneumonia in the appropriate clinical setting. No
pulmonary edema. No pleural effusions.
|
19966826-RR-147 | 19,966,826 | 22,560,858 | RR | 147 | 2146-03-05 12:32:00 | 2146-03-05 13:33:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with recurrent UTIs.// Please evaluate for
perinephric abscess.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, stones, or solid masses bilaterally. There are
bilateral simple renal cysts, the largest measuring 3.2 x 3.4 x 2.4 cm in the
upper pole of the right kidney and 1.7 x 2.5 x 2.1 cm in the upper pole of the
left kidney. Normal cortical echogenicity and corticomedullary
differentiation are seen bilaterally.
Right kidney: 9.5 cm
Left kidney: 10.6 cm
The bladder is moderately well distended and normal in appearance. Bilateral
ureteral jets are seen.
IMPRESSION:
No hydronephrosis. No sonographic evidence of renal abscess.
|
19966826-RR-149 | 19,966,826 | 23,373,567 | RR | 149 | 2146-12-26 18:29:00 | 2146-12-26 18:49:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with AMS // ?pna
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___.
FINDINGS:
Moderate enlargement of the cardiac silhouette persists with left ventricular
predominance. The aorta is tortuous as seen previously. Similar appearance
of mediastinal and hilar contours. There is mild pulmonary vascular
congestion without frank pulmonary edema. Patchy left lower lobe opacity
likely reflects atelectasis. No pleural effusion or pneumothorax. Mild
degenerative changes in the thoracic spine. Moderate degenerative changes are
seen involving the glenohumeral joint bilaterally with superior subluxation of
the left humeral head indicative of underlying rotator cuff disease.
IMPRESSION:
Left lower lobe patchy opacity likely reflects atelectasis.
|
19966826-RR-150 | 19,966,826 | 23,373,567 | RR | 150 | 2146-12-26 22:21:00 | 2146-12-26 22:53:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with AMS // ? intracranial prpocess
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: DLP 802.7 mGy cm
COMPARISON: CT head dated ___.
FINDINGS:
There is no evidence of fracture, acute large territory
infarction,hemorrhage,edema,or mass. There is prominence of the ventricles
and sulci suggestive of involutional changes. Moderate hypoattenuation of the
periventricular and subcortical white matter is nonspecific but may reflect
chronic microvascular ischemic disease. Focal hypodensity in the left basal
ganglia likely reflects a chronic lacunar infarct.
Mild mucosal thickening in the left sphenoid sinus. The visualized portion of
the remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are normal.
IMPRESSION:
1. No acute intracranial abnormality
|
19966826-RR-151 | 19,966,826 | 23,373,567 | RR | 151 | 2146-12-26 22:21:00 | 2146-12-26 23:22:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with abdominal pain, confusionNO_PO
contrast // ? acute intraabdominal process
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: Acquisition sequence:
1) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
2) Spiral Acquisition 6.3 s, 49.6 cm; CTDIvol = 27.1 mGy (Body) DLP =
1,341.4 mGy-cm.
Total DLP (Body) = 1,359 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis, otherwise the visualized lung fields
are unremarkable. Diffuse calcification of the coronary arteries. Mildly
enlarged heart. There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder contains a large stone
without evidence of gallbladder wall thickening or pericholecystic fluid.
PANCREAS: The pancreas is atrophic but has normal attenuation throughout,
without evidence of focal lesions or pancreatic ductal dilatation. There is
no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Multiple renal hypodense lesions are compatible with cysts, not substantially
changed in the interval. There is no evidence of solid renal lesions or
hydronephrosis. No urolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening or fat
stranding. Large stool ball is seen within the rectum without wall thickening
or stranding. The appendix is not visualized.
PELVIS: The urinary bladder is mildly decompressed and demonstrates mild wall
thickening. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic lymphadenopathy. Bilateral prominent inguinal lymph nodes are
redemonstrated, likely reactive.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Moderate to severe multilevel degenerative changes of the lower thoracic and
lumbar spine. Grade 1 retrolisthesis of L3 on L4 and grade 1 anterolisthesis
of L4 and L5 are unchanged.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
Redemonstration of right ischial bursitis.
IMPRESSION:
1. Mild wall thickening of the urinary bladder may be due to decompressed
state. However cystitis cannot be excluded and correlation with urinalysis
recommended.
2. Cholelithiasis without evidence of acute cholecystitis.
3. Scattered colonic diverticulosis without evidence of acute diverticulitis.
|
19967846-RR-21 | 19,967,846 | 21,070,823 | RR | 21 | 2126-07-09 09:14:00 | 2126-07-09 12:43:00 | HISTORY: ___ woman with subdural hemorrhage, interval change.
COMPARISON: Reference CT head ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm reconstructed images were acquired.
Total Exam DLP: 1026mGy-cm
CTDIvol: 59mGy
FINDINGS:
There is slight hyperdensity along the left tentorium which likely represents
a component of subdural hemorrhage. Within the left temporal lobe there is a
contusion which appears essentially unchanged from the reference CT on
___. There is a small area of biconvex hyperdense blood along the
left occipital bone without associated underlying fracture which is not
clearly seen on study from ___ and likely represents a small amount
of subdural blood (2:10). The previously seen subdural hematoma along the
left temporal bone is unchanged and measures 6 mm in width. The known
subarachnoid hemorrhage now appears more superior likely related to
redistribution. The basal cisterns appear patent and there is preservation of
gray-white matter differentiation. There is no shift of midline structures.
The fluid within the right maxillary sphenoid sinuses and ethmoid air cells is
unchanged. The mastoid air cells and the middle ear cavities are clear.
Again seen are right medial and posterior maxillary sinus fractures and a
right lateral orbital wall fracture. The known nasal fracture is not well seen
on this study. There is soft tissue swelling and foci of subcutaneous air
along the right frontal bone. The globes are unremarkable.
IMPRESSION:
1. No change to left temporal lobe contusion. No change to small left
subdural hematoma. There is new small amount hyperdensity along the left
tentorium and in the left occiptal lobe which also likely represents subdural
blood. The subarachnoid hemorrhage is now more superior likely representing
redistribution. There is no associated shift of midline structures.
2. Again seen are right medial and posterior maxillary sinus fractures and
right lateral orbital wall fracture. The other known facial fractures are
better visualized on outside hospital facial bone CT.
|
19967846-RR-22 | 19,967,846 | 21,070,823 | RR | 22 | 2126-07-09 21:48:00 | 2126-07-09 23:30:00 | HISTORY: ___ woman with subdural hematoma now with altered mental
status, here to evaluate for interval change.
COMPARISON: Non contrast head CT performed earlier the same day at 09:18.
TECHNIQUE: Multi detector CT axial imaging of the head was obtained without
intravenous contrast. Coronal and sagittal reformatted images as well as thin
section images in the bone window algorithm were generated and reviewed.
DLP: 1154 mGy-cm
CTDIvol: 61 mGy
FINDINGS:
There is persistent hyperdense thickening of the left tentorium compatible
with a component of subdural hemorrhage. A small amount of subdural blood
product is again seen along the left temporal convexity with associated
hypodensity of the subjacent brain parenchyma, which may represent contusion.
Within the left inferior temporal lobe, there is a hemorrhagic contusion,
which is not significantly changed from the most recent prior CT. There is
decreased subarachnoid blood products from the most recent prior CT most
pronounced in the left temporal occipital region and left sylvian fissure with
trace residual in the left parietal region. No new focus of hemorrhage is
identified. The basal cisterns remain patent. There is no shift of normally
midline structures. The gray-white matter interface is preserved without
evidence of acute major vascular territorial infarct.
Multiple facial fractures are redemonstrated including bilateral nasal bone
fractures, right medial and posterior maxillary sinus fractures and a fracture
of the right lateral orbital wall. Hyperdense fluid in the right maxillary
and left sphenoid sinuses is compatible with hemorrhage. The orbits and
globes are unremarkable. No skull fracture is detected. The bilateral
mastoid air cells and middle ear cavities are clear.
IMPRESSION:
1. Stable left temporal hemorrhagic contusion with unchanged small subdural
hemorrhage along the left temporal convexity and left tentorium.
2. Decreased subarachnoid blood products from the most recent prior CT
performed 10 hr earlier.
3. Multiple facial fractures as detailed above, unchanged from prior studies.
|
19968039-RR-26 | 19,968,039 | 21,464,016 | RR | 26 | 2132-05-13 14:14:00 | 2132-05-13 14:56:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with status post surgery with axis
in the left groin region, now with induration, pus drainage and feversNO_PO
contrast// Evaluate for left groin, inguinal area infection
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: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 6.7 s, 52.6 cm; CTDIvol = 15.7 mGy (Body) DLP = 824.1
mGy-cm.
Total DLP (Body) = 836 mGy-cm.
COMPARISON: MRCP ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Subcentimeter hypodensity in segment 8 is too small to characterize, but
likely represents a simple cyst or biliary hamartoma. This is unchanged
compared to prior study. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
No hydronephrosis. Simple cysts measure up to 6.3 cm in the upper pole of the
right kidney and up to 1.2 cm in the lower pole of the left kidney. There is
no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes at L5-S1 are noted.
SOFT TISSUES: There is a lobulated fluid collection with mild peripheral
enhancement centered in the low left anterior abdominal wall which extends
inferiorly along the left rectus femoris muscle and into the left inguinal
region, measuring up to 3.5 x 9.3 cm (AP by CC, 602:56). Surgical clips are
seen posterior to this collection.
IMPRESSION:
1. Fluid collection centered in the left inguinal region measures up to 9.3 cm
craniocaudally. This demonstrates ring enhancement and is concerning for
abscess
2. No acute intra-abdominal process.
|
19968039-RR-27 | 19,968,039 | 21,464,016 | RR | 27 | 2132-05-18 09:56:00 | 2132-05-18 11:50:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new picc// R picc 49cm Contact name: sal,
___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
Intervally placed right PICC terminates at the distal SVC.
There is stable postoperative changes to the left hemithorax status post left
upper lobectomy. The right lung is clear. Elevation of the left
hemidiaphragm is stable. Cardiomediastinal silhouette and pleural surfaces
are normal.
IMPRESSION:
The intervally placed right PICC terminates at the distal SVC.
|
19968039-RR-29 | 19,968,039 | 21,464,016 | RR | 29 | 2132-05-23 16:54:00 | 2132-05-23 17:24:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with left groin wound abscess// check left groin
for any undrained pockets, no oral contrast needed
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 54.2 cm; CTDIvol = 10.5 mGy (Body) DLP = 571.1
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.4 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 584 mGy-cm.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Hypodensity in segment VIII is too small to fully characterize but likely
represents a simple cyst or biliary hamartoma, unchanged from prior studies
(2:70). There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is decompressed, somewhat limiting assessment,
otherwise unremarkable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Simple cysts are seen bilaterally. Additional hypodensities that are too
small to fully characterize likely represent additional simple cysts. There
is no hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is moderate
colonic fecal loading. The cecum and portions of the ascending colon cross
the midline posteriorly and terminate in the left upper quadrant after passing
posterior to the distal branches of the SMA and SMV, a new configuration when
compared with recent prior studies suggesting a mobile cecum. The appendix is
not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are moderate multilevel degenerative changes of the lower lumbar spine,
worst at L4-S1.
SOFT TISSUES: There is a fat containing umbilical hernia. The previously seen
fluid collection involving the left inferior abdominal wall and extending into
the inguinal region is no longer present with minimal residual fat stranding
in this area. There is no drainable fluid collection.
IMPRESSION:
1. Interval resolution of the previously seen left lower quadrant superficial
abdominal wall collection with no residual drainable fluid.
2. No evidence of acute process in the abdomen or pelvis.
3. Mobile cecum and ascending colon, currently terminating in the left upper
quadrant, which may predispose to cecal volvulus, although there is no
volvulus or obstruction at this time.
4. Moderate colonic fecal loading.
|
19968619-RR-14 | 19,968,619 | 25,230,239 | RR | 14 | 2116-02-24 23:34:00 | 2116-02-25 07:11:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with pre-op CXR// pre-op eval
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
The lungs are grossly clear without focal consolidation. There is no
pulmonary edema, pneumothorax, or large pleural effusion. A streak of linear
atelectasis seen in the left lower lung. The cardiomediastinal silhouette and
hilar contours are normal.
IMPRESSION:
No acute cardiopulmonary process
|
19968619-RR-15 | 19,968,619 | 25,230,239 | RR | 15 | 2116-02-24 23:34:00 | 2116-02-25 04:29:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: History: ___ with s/p fall with tibial plateau fracture// Tibial
plateau fracture Tibial plateau fracture
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the left knee.
COMPARISON: Outside radiographs of the left tibia and fibula and left hip
from ___
FINDINGS:
There is fracture of the left tibial plateau and median eminence, extending to
the articular surface and proximal tibia, with multiple fracture fragments.
Mild depression of the lateral tibial plateau is noted. A moderate-sized
lipohemarthrosis is noted. The distal femur and patella appear to be intact.
Mineralization appears preserved. There is no radiopaque foreign body.
IMPRESSION:
1. Comminuted fracture of the left tibial plateau extending to the articular
surface and proximal tibia with multiple fracture fragments seen.
Left knee joint lipohemarthrosis.
|
19968619-RR-16 | 19,968,619 | 25,230,239 | RR | 16 | 2116-02-24 23:48:00 | 2116-02-25 16:20:00 | EXAMINATION: CT lower extremity
INDICATION: ___ year old woman with tibial plateau fracture following
mechanical fall today// tibial plateau fracture OR in AM
TECHNIQUE: MDCT images were acquired through the distal femur and proximal
tibia without intravenous contrast. Multiplanar reformats were subsequently
acquired.
DOSE: Acquisition sequence:
1) Spiral Acquisition 19.5 s, 41.5 cm; CTDIvol = 20.5 mGy (Body) DLP =
851.2 mGy-cm.
Total DLP (Body) = 851 mGy-cm.
COMPARISON: Radiograph ___
FINDINGS:
There is extensively comminuted intra-articular fracture of the tibial plateau
with involvement of the tibial spines. This involves the medial and lateral
tibial plateaus and there is separation of the metaphysis from the diaphysis.
There is minimal displacement of the medial tibial plateau and no significant
distraction or impaction. The posterolateral tibial plateau fracture is
impacted by 1.0 cm and distracted laterally 0.7 cm.
There is a tiny fracture of the posteromedial aspect of the fibular head.
A moderately sized joint effusion contains a fat-fluid level. There is a
moderate amount of soft tissue stranding and hematoma infiltrating deep to the
gastrocnemius. Fluid layering along the posterior fascia of the soleus
suggests possible muscular injury. Achilles injury cannot be excluded. No
evidence of obvious vascular injury or tendon entrapment.
IMPRESSION:
1. Schatzker type 6 comminuted, intra-articular tibial plateau fracture
involving the tibial spines with mild impaction and distraction of the
posterolateral tibial plateau, as detailed above. Minimal displacement of
medial tibial plateau.
2. Fluid layering along the posterior fascia of the soleus suggests possible
muscular injury. Achilles tendon injury cannot be excluded.
3. Tiny fibular head fracture.
|
19968619-RR-17 | 19,968,619 | 25,230,239 | RR | 17 | 2116-02-25 12:19:00 | 2116-02-25 16:25:00 | EXAMINATION: TIB/FIB (AP AND LAT) LEFT
IMPRESSION:
Fluoroscopic images show placement of external fixation devices about a
comminuted fracture of the proximal tibia. Further information can be
gathered from the operative report.
|
19969031-RR-114 | 19,969,031 | 21,704,732 | RR | 114 | 2181-04-18 12:28:00 | 2181-04-18 12:43:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ patient with non-small cell lung cancer, right-sided
weakness. Evaluate for stroke and vascular patency.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
3) Spiral Acquisition 5.0 s, 39.4 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,220.8 mGy-cm.
Total DLP (Head) = 2,051 mGy-cm.
COMPARISON: CT head without contrast of ___, CT cervical spine
without contrast of ___. MRI head with without contrast of ___.
FINDINGS:
NONCONTRAST HEAD CT:
Status post left frontal craniotomy with stable left frontoparietal
encephalomalacia. Subcortical encephalomalacia within the right precentral
gyrus is unchanged since at least ___ (2:21).
There is no evidence of acute large vascular territory infarction, hemorrhage,
edema or mass. Confluent periventricular, subcortical and deep white matter
hypodensities are nonspecific, likely sequelae of chronic small vessel
ischemic disease. Prominent ventricles and sulci suggest age-related
involutional changes.
Chronic bilateral nasal bone fractures are re-demonstrated. No acute fractures
identified. Large right maxillary sinus mucous retention cyst. Remaining
visualized paranasal sinuses, mastoid air cells and middle ear cavities are
clear. Patient is status post bilateral lens surgery.
CTA HEAD: There is a 4 x 3 mm right PCOM aneurysm (3:250). The left PCOM is
unremarkable. Otherwise, the remaining branches of the circle of ___ and
principal intracranial branches are grossly patent without additional
aneurysm, stenosis, dissection or occlusion. Dural venous sinuses are grossly
patent.
CTA NECK: Dominant left vertebral system. The V3 and V4 segments of the right
vertebral artery are diminutive, though do not demonstrate focal abrupt
caliber change. Overall, there is no evidence of stenosis, dissection, or
occlusion within the bilateral carotid or vertebral arteries. There is
moderate calcification of the V4 segment of the left vertebral artery. There
is atherosclerotic disease at the right carotid bifurcation without
significant internal carotid artery stenosis per NASCET criteria.
Other: Severe centrilobular emphysema. Postoperative changes within the right
posterior chest wall, with likely surgical mesh in place. Thyroid gland is
unremarkable without discrete nodule. No cervical lymphadenopathy by CT size
criteria. A 9 mm left level 6 lymph node is unchanged since examination of
___. There is moderate cervical spondylosis, worse at C4-C5 level.
IMPRESSION:
1. No evidence of acute infarction, hemorrhage, or edema. Status post left
frontal craniotomy with stable left frontoparietal and right precentral
encephalomalacia.
2. Right posterior communicating artery aneurysm measuring 4 x 3 mm.
3. Otherwise, patency of the intracranial vasculature without stenosis or
occlusion.
4. Mild atherosclerotic disease at the right carotid bifurcation without
internal carotid artery stenosis per NASCET criteria.
5. Severe centrilobular emphysema.
|
19969031-RR-115 | 19,969,031 | 21,704,732 | RR | 115 | 2181-04-18 12:38:00 | 2181-04-18 14:31:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall, head strike// ? traumatic injuries
? traumatic injuries
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 19.5 cm; CTDIvol = 32.1 mGy (Body) DLP = 627.2
mGy-cm.
Total DLP (Body) = 627 mGy-cm.
COMPARISON: None.
FINDINGS:
No acute fracture or dislocation is seen. Multi level degenerative changes
are re-demonstrated with disc space narrowing worst C3 through C7 where there
is also endplate sclerosis and anterior posterior osteophytes. No
prevertebral soft tissue swelling is seen. Multilevel bilateral neural
foramina narrowing is seen, left greater than right, particularly in the mid
to lower cervical spine. There is also mild central canal narrowing at C5/C6.
Partially imaged old-appearing fracture of the right clavicle.
IMPRESSION:
1. No acute fracture or dislocation. Multilevel degenerative changes
including left greater than right neural foraminal narrowing and mild central
canal narrowing, at least at C5/C6.
|
19969031-RR-118 | 19,969,031 | 21,704,732 | RR | 118 | 2181-04-19 12:48:00 | 2181-04-19 14:45:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with ___ who had fall now with new anisocoria//
eval stroke, eval dissection, h/o metastatic cancer
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT head ___. MR head ___. MRI brain
___
FINDINGS:
Patient is status post left frontoparietal craniotomy with stable postsurgical
changes. Posttreatment changes within the adjacent left frontal lobe surgical
bed is again demonstrated. There is no evidence of recurrent tumor. The
regions of T2 FLAIR hyperintensity in the periventricular and deep subcortical
white matter, left greater than right, is stable. Area of subcortical FLAIR
hyperintensity in the posterior frontal lobe, probably involving lateral
precentral gyrus is stable since ___, there is no associated enhancement.
There are no new masses or mass effect. There is no evidence of hemorrhage,
territory infarction, or midline shift. There is no abnormal enhancement after
contrast administration.
The ventricles and sulci are prominent in caliber and configuration,
suggestive of age related atrophy and involutional changes. The major
intracranial vascular flow voids are preserved. The dural venous sinuses
appear patent.
Again demonstrated is a right maxillary mucous retention cyst. There is mild
anterior nasal septum deviation to the left. Otherwise, the paranasal
sinuses, bilateral mastoid air cells and middle ear cavities are clear..
IMPRESSION:
1. There is no evidence of new or recurrent mass.
2. There are no acute intracranial changes.
3. Stable posttreatment changes.
|
19969031-RR-119 | 19,969,031 | 21,704,732 | RR | 119 | 2181-04-19 12:49:00 | 2181-04-19 15:01:00 | EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with hx of small cell lung cancer with met to
brain s/p removal now with worsening right upper extremity weakness// please
assess if lesion or any abnormality to explain worsening RUE weakness
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed. After administration
of 6 mL of Gadavist intravenous contrast, sagittal and axial T1 weighted
imaging was performed.
COMPARISON: CT ___ ___..
FINDINGS:
There has been no change since comparison exam. Alignment is anatomic with
loss of cervical lordosis. There is minimal loss height superior T2 vertebral
body, likely from Schmorl's node, there is no associated vertebral body or
paravertebral edema. Vertebral body heights are preserved. Vertebral body
signal intensity appear normal. There are multilevel degenerative changes
with loss of disc height, loss of intervertebral disc signal intensity,
intervertebral osteophyte formation, hypertrophy of ligamentum flavum, and
facet hypertrophy. There is no evidence of abnormal enhancement post contrast
administration. There are postoperative changes at the right lung apex there
is no cord T2 signal abnormality.
At C2-C3 level, central canal, right foramen are patent. There is mild left
foraminal narrowing.
At C3-C4 level, there is fusion of vertebral bodies across disc space. There
is moderate central canal narrowing, with minimal flattening of the ventral
cord secondary to prominent disc osteophyte complex. A there is moderate
severe left, and moderate right foraminal narrowing.
At C4-C5 level there is mild-to-moderate central canal narrowing. There is
severe left, and mild-to-moderate right foraminal narrowing.
At C5-C6 level there prominent endplate hypertrophic changes, diffuse disc
bulge causing moderate to severe central canal narrowing, mild flattening of
the cord, and nearly complete effacement of CSF. There is severe right, and
moderate left foraminal narrowing.
At C6-C7 level there is mild central canal narrowing. There is moderate
bilateral foraminal narrowing.
At C7-T1 level, central canal is patent. There is mild bilateral foraminal
narrowing.
IMPRESSION:
1. Multilevel advanced degenerative changes in the cervical spine.
2. Multilevel central canal narrowing, most prominent and moderate to severe
at C5-C6 level.
3. There is multilevel significant foraminal narrowing.
4. No evidence of metastases.
|
19969031-RR-120 | 19,969,031 | 21,704,732 | RR | 120 | 2181-04-19 13:48:00 | 2181-04-19 15:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hx of small cell lung cancer and brain met
s/p resection with worsening RUE weakness// new pan coast mass?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Cardiac size is normal. Cardiomediastinal structures are deviated to the
right as before. The aorta is tortuous. Postoperative changes in the right
lung and right chest wall are again noted. Allowing the deformity, no obvious
lesions are identified in the right apex. The lungs are clear. There is no
pneumothorax or pleural effusion.
IMPRESSION:
No acute cardiopulmonary abnormality
|
19969031-RR-126 | 19,969,031 | 26,728,965 | RR | 126 | 2182-02-18 11:15:00 | 2182-02-18 11:57:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with hypoxia, cough// Eval for PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison is made to chest radiograph dated ___ and ___.
FINDINGS:
Again demonstrated are postoperative changes of a prior right lobectomy, with
coarsened markings and scarring. Chronic right clavicular fracture is stable
compared to ___. Rightward deviation of the cardiomediastinal contour
is again demonstrated. Subtle right retrocardiac opacification, was not
definitely seen on prior chest radiograph and may be secondary to an
infectious etiology. Otherwise no evidence of pleural effusion. No
pneumothorax..
IMPRESSION:
Subtle right retrocardiac opacification may be secondary to an infectious
etiology versus atelectasis.
|
19969031-RR-127 | 19,969,031 | 26,728,965 | RR | 127 | 2182-02-18 14:53:00 | 2182-02-18 16:26:00 | EXAMINATION: CTA CHEST
INDICATION: ___ man with hypoxia, history of lung cancer. Evaluate
for pulmonary embolism.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 431 mGy-cm.
COMPARISON: Chest CT of ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
Aortic arch calcifications are mild.
The pulmonary arteries are well opacified to the segmental level, with no
evidence of filling defect concerning for pulmonary embolism. Evaluation of
the subsegmental pulmonary arteries is limited due to respiratory motion
artifact. The the right main pulmonary artery is increased in size, measuring
2.9 cm (3:98), as can be seen in pulmonary arterial hypertension. There is no
evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid is not completely imaged.
There is no evidence of pericardial effusion. There is no pleural effusion.
Patient is post right upper lobectomy and chest wall resection. Unchanged
appearance of the right bronchial stump. The known posterior chest wall graft
is also unchanged in appearance (3:66). Notably, there is plugging of the
right middle and lower lobe are bronchi (3:110, 142) with multifocal areas of
ground-glass opacification involving the lingula (3:96, 112), superior segment
of the left lower lobe (3:87-97), and right lower lobe (3:130). There is
bibasilar subsegmental atelectasis. Severe bilateral centrilobular emphysema
is stable, predominantly in the upper lobes and more extensive in the right
lung. Postoperative fibrotic changes in the right lower lobe are unchanged.
Previously described small area of scarring in the posterior basal segment of
the right lower lobe is somewhat obscured by the new atelectasis.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism to the segmental level. Subsegmental
pulmonary arteries are limited in evaluation, due to respiratory motion
artifact.
2. Multifocal bilateral areas of ground-glass and nodular opacification in
the lungs, concerning for developing bronchopneumonia and/or aspiration, given
the clinical history. Associated right lower lobe are bronchial
opacification, compatible with mucous plugging and secretions.
3. Postoperative changes after right upper lobectomy and chest wall
resection. Persistent severe centrilobular emphysema. Bibasilar atelectasis.
4. Increased diameter of the right and left main pulmonary artery, as can be
seen in pulmonary arterial hypertension.
|
19969118-RR-9 | 19,969,118 | 27,973,799 | RR | 9 | 2144-01-02 21:49:00 | 2144-01-03 11:32:00 | HISTORY: Multiple sclerosis with fatigue and increased confusion.
TECHNIQUE: T1 and T2 weighted multiplanar images of the brain were obtained,
including post-contrast sequences performed following the uneventful
administration of 4 cc of Magnevist. Susceptibility and diffusion-weighted
sequences were also obtained.
COMPARISON: None available.
FINDINGS:
The ventricles and sulci are normal in size and configuration. Multiple
bilateral periventricular white matter FLAIR hyperintensities, the largest
along the left corona radiata measuring 8 mm (4:17), are compatible with known
history of multiple sclerosis. No enhancing lesions are detected. There is
no mass effect, acute/subacute infarction, or hemorrhage. The paranasal
sinuses and mastoid air cells are clear.
IMPRESSION:
1. Multiple periventricular FLAIR signal abnormalities are compatible with
known history of multiple sclerosis.
2. No enhancing lesion or acute intracranial process.
|
19969137-RR-29 | 19,969,137 | 20,917,922 | RR | 29 | 2143-03-20 05:00:00 | 2143-03-20 11:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with elevated left hemidiaphragm, pulmonary
edema. Intubated.// Evaluate for infection, edema. Evaluate lines/tubes
(particularly OG tube) Evaluate for infection, edema. Evaluate
lines/tubes (particularly OG tube)
IMPRESSION:
Compared to ___.
Previous moderate right pleural effusion or mild, unilateral pulmonary edema
has resolved. Left hemidiaphragm is either markedly elevated or effectively
bypassed by contents of the left upper abdomen filling most of the left
hemithorax and displacing the lower mediastinum to the right. Heart is
somewhat enlarged, but generally obscured by the abdominal contents.
Nasogastric tube is curled just below the level of the carina, possibly in the
elevated stomach. No pneumothorax. ET tube in standard placement.
|
19969137-RR-31 | 19,969,137 | 20,917,922 | RR | 31 | 2143-03-28 12:34:00 | 2143-03-28 14:46:00 | EXAMINATION: MRA BRAIN AND NECK PT97 MR ___
INDICATION: ___ year old woman with seizure disorder, hypothermia, PEA arrest
and hypoxic respiratory failure of unknown etiology. Assess for pathology in
great vessels or intracranial lesions.
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain. Dynamic MRA of the neck was performed during administration
of 17 ml of Multihance intravenous contrast. Maximum intensity projection and
segmented images were generated for the head and neck MRIs. This report is
based on interpretation of all of these images.
COMPARISON: Noncontrast head CT from ___.
FINDINGS:
MRA NECK:
Evaluation of the aortic arch and great vessel origins is limited by artifact.
Remaining cervical courses of the common carotid arteries, as well as the
internal carotid arteries, appear widely patent without evidence for stenosis
by NASCET criteria. Evaluation of vertebral artery origins and V1 segments is
also limited by artifacts. Remaining courses of bilateral vertebral arteries
appear widely patent.
MRA BRAIN:
There is mild motion artifact. The intracranial vertebral and internal
carotid arteries and their major branchesappear widely patent without evidence
for flow-limiting stenosis or aneurysm.
IMPRESSION:
1. Technically limited evaluation of the great vessel origins and vertebral
artery origins. Otherwise, unremarkable neck MRA.
2. Unremarkable brain MRA allowing for mild motion artifact.
|
19969137-RR-32 | 19,969,137 | 20,917,922 | RR | 32 | 2143-03-29 09:08:00 | 2143-03-29 13:01:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman w/ known diaphragmatic hernia s/p intubation
and extubation yesterday, slightly hypoxic today with new fever// assess for
pna, atelectasis
TECHNIQUE: Portable AP
COMPARISON: ___
FINDINGS:
Radiographic is rotated to the right. Left hemidiaphragm is markedly elevated
by contents of the left upper abdomen passing through a paraesophageal hernia,
better demonstrated on recent CT, filling most of the left hemithorax,
unchanged.
Right subsequent mediastinal shift is essentially unchanged. Heart evaluation
is limited by bowel loops and rotation. No evidence of pleural effusion, no
consolidations concerning for pneumonia. Mild pulmonary edema is unchanged.
IMPRESSION:
No evidence of pneumonia, or pleural effusion. Mild pulmonary edema.
|
19969326-RR-19 | 19,969,326 | 20,407,284 | RR | 19 | 2136-11-01 07:34:00 | 2136-11-01 09:43:00 | HISTORY: Chest pain. Evaluate acute process.
COMPARISON: None available.
FINDINGS: Frontal and lateral radiographs show clear lungs. The lung fields
are slightly obscured by overlying soft tissue attenuation. The heart size is
top normal. The mediastinum is normal. No pleural effusion or pneumothorax
is seen.
IMPRESSION: Mild cardiomegaly.
|
19969737-RR-21 | 19,969,737 | 22,907,047 | RR | 21 | 2140-05-15 19:51:00 | 2140-05-17 14:03:00 | INDICATION: ___ year old woman with hyperactive bowel sounds on chronic
narcotics with abdominal pain // eval for bowel obstruction, constipation
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Outside abdominal radiographs dated ___
FINDINGS:
Mild stool burden. Gas is seen in the small and large bowel. There are no
abnormally dilated loops of small or large bowel. Within the limitations of
supine assessment, there is no gross pneumoperitoneum.
Osseous structures are notable for benign calcifications in the left femoral
head, unchanged from prior study. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
Mild stool burden. Non-obstructive bowel gas pattern.
|
19969737-RR-22 | 19,969,737 | 22,907,047 | RR | 22 | 2140-05-15 20:02:00 | 2140-05-15 20:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with chronic pain and crackles on exam. //
etiology of crackles etiology of crackles
COMPARISON: Comparison to outside chest CT dated ___
FINDINGS:
Portable upright chest radiograph ___ at 19:58 is submitted.
IMPRESSION:
There is volume loss in the right upper lobe with faint opacity at the right
apex likely correlating to an area in the right upper lobe seen on ___ which most likely reflects post radiation change. Clinical correlation
is recommended. Lungs are otherwise clear. No pleural effusions or pulmonary
edema. No focal airspace consolidation to suggest pneumonia. No pneumothorax.
Heart is upper limits of normal in size given portable technique. Mediastinal
contours are within normal limits. The aorta is somewhat unfolded and
tortuous. Old left-sided posterior lateral rib fractures.
|
19969737-RR-23 | 19,969,737 | 24,259,455 | RR | 23 | 2140-06-09 04:56:00 | 2140-06-09 09:36:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with AMS // Eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: ___, CT chest dated ___
FINDINGS:
Again seen is mild volume loss in the right upper lobe with peribronchial
consolidation in the right upper lobe which may correspond to consolidation
and cavitation seen on prior CT. The cardiomediastinal silhouette is stable
since the prior examination. The aorta is tortuous. There is no pleural
effusion or pneumothorax. No focal consolidation is identified. There is
evidence of healed left rib fractures.
IMPRESSION:
1. No acute intrathoracic abnormality.
2. CT of the chest is recommended on a non-emergent basis to evaluate right
upper lobe abnormality.
RECOMMENDATION(S): CT of the chest is recommended on a non-emergent basis to
evaluate right upper lobe abnormality
|
19969737-RR-24 | 19,969,737 | 24,259,455 | RR | 24 | 2140-06-09 15:43:00 | 2140-06-09 16:39:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with altered mental status and headache.
Evaluate for hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 1,082 mGy-cm.
COMPARISON: No prior relevant imaging is available on PACS at the time of
this dictation.
FINDINGS:
No evidence of infarction, hemorrhage, edema, or mass. Periventricular white
matter hypodensities are nonspecific and likely reflects sequela of chronic
small vessel ischemic disease. Bilateral, symmetric prominence of the
ventricles and sulci likely age-related involutional change.
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 other than lens replacement.
IMPRESSION:
1. No evidence of hemorrhage.
2. Age-related involutional change.
3. Sequelae of chronic small vessel ischemic disease.
|
19969918-RR-45 | 19,969,918 | 26,790,284 | RR | 45 | 2186-05-22 21:03:00 | 2186-05-22 22:27:00 | EXAM: Chest frontal view.
CLINICAL INFORMATION: ___ male with history of recent pneumonia, now
with fever.
___.
FINDINGS: Single frontal view of the chest was obtained. Midline
tracheostomy tube is again seen. There is mild left greater than right
bibasilar atelectasis. Minimal blunting of the left costophrenic angle could
be due to a trace effusion. No definite focal consolidation is seen. The
cardiac silhouette is top normal. The aortic knob is calcified.
IMPRESSION: Possible trace left pleural effusion with overlying atelectasis.
|
19969918-RR-46 | 19,969,918 | 26,790,284 | RR | 46 | 2186-05-23 14:05:00 | 2186-05-23 15:00:00 | PA AND LATERAL CHEST, ___
HISTORY: Chronic aspiration. Fever.
IMPRESSION: PA and lateral chest compared to ___ through ___:
Small region of consolidation at the medial aspect of both lung bases has been
present to varying degrees since ___. The left is more persistent and
therefore more likely atelectasis. On the right, there may be a region of
consolidation that was not present on ___. Small bilateral pleural
effusions are decreasing. Upper lungs are clear and the heart is normal size.
Tracheostomy tube above the left wall of the trachea. No evidence of central
adenopathy. No pneumothorax.
|
19969918-RR-47 | 19,969,918 | 25,664,596 | RR | 47 | 2186-06-06 18:50:00 | 2186-06-07 08:57:00 | AP CHEST, 6:52 P.M., ___
HISTORY: ___ man with respiratory distress and previous
consolidation.
IMPRESSION: AP chest compared to ___ through ___ at 10:33
a.m.:
Large scale consolidation in the right lower lung, predominantly lower lobe,
was new earlier today compared to ___. It has grown slightly more
radiodense over the past eight hours, probably active pneumonia. Small right
pleural effusion is presumed and should be monitored in order to detect any
development of empyema. Left lung is clear. Cardiomediastinal silhouette is
normal. The patient has a tracheostomy tube in standard placement. No
pneumothorax.
|
19969918-RR-48 | 19,969,918 | 25,664,596 | RR | 48 | 2186-06-07 12:01:00 | 2186-06-07 15:45:00 | AP CHEST, 12:11 P.M., ___
HISTORY: New right PIC line.
IMPRESSION: AP chest compared to ___, 6:52 p.m.:
New right PIC line is looped several times in the right axilla and terminates
just proximal to the junction with the right jugular vein. Radiograph
obtained subsequently and already reviewed at the time of this dictation
showed repositioning in the right atrium.
Extensive consolidation in the right lower lobe is minimally worse today than
it was yesterday, but there is new left lower lobe consolidation suggesting
spreading pneumonia. Small bilateral pleural effusions may be present. The
heart is normal size, and there is no distention of either mediastinal veins
or pulmonary vascularity to suggest cardiac decompensation. Tracheostomy tube
in standard position. No pneumothorax.
|
19969918-RR-49 | 19,969,918 | 25,664,596 | RR | 49 | 2186-06-07 12:38:00 | 2186-06-07 15:43:00 | AP CHEST, 12:50 P.M. ON ___
HISTORY: PICC line repositioned.
IMPRESSION: AP chest compared to ___, 12:11 p.m.:
Right PIC line has been repositioned, tip is approximately 2 cm below the
estimated location of the superior cavoatrial junction. Dr. ___ reported
this to ___ at 1:10 p.m.
Extensive consolidation right mid and lower lung zone stable since ___, increased at the left base since ___ consistent with worsening
pneumonia. There is no pulmonary edema. Heart size is normal. Tracheostomy
tube in standard placement.
|
19969918-RR-50 | 19,969,918 | 25,664,596 | RR | 50 | 2186-06-11 14:22:00 | 2186-06-11 16:13:00 | TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with MS, now status post aspiration
pneumonia, evaluate for interval change.
FINDINGS: AP single view of the chest obtained with patient in sitting
semi-upright position. Analyzed in direct comparison with the next preceding
similar study of ___. Tracheostomy as before. Unchanged
position of right-sided PICC line. The previously described bilateral basal
densities persist and may even have increased. Diffuse haze over the bases
suggests pleural effusions that probably are layering mostly in the posterior
compartments as the patient is in semi-erect position only. No pneumothorax
has developed.
IMPRESSION: Persistent and somewhat increased bilateral parenchymal
densities.
|
19969973-RR-12 | 19,969,973 | 27,702,430 | RR | 12 | 2145-09-17 19:27:00 | 2145-09-17 20:03:00 | INDICATION: History: ___ with periprosthetic femur fracture, operative
planning
TECHNIQUE: Right femur, two views
COMPARISON: None.
FINDINGS:
Patient is status post right total knee arthroplasty. Comminuted fracture
involving the proximal stem of the femoral component is present with mild
angulation of the dominant distal fracture fragment. Lucency is also noted
about the stems of the femoral and tibial components, which could suggest
loosening. No hip or knee dislocation is identified. The imaged right hip
demonstrates mild degenerative changes. There appears to be a moderate
suprapatellar joint effusion.
IMPRESSION:
1. Periprosthetic comminuted fracture involving the femoral component of the
total knee arthroplasty.
2. Lucency about the stems of the femoral and tibial components of the total
knee arthroplasty, which may suggest loosening.
|
19969973-RR-14 | 19,969,973 | 27,702,430 | RR | 14 | 2145-09-17 22:15:00 | 2145-09-17 22:47:00 | INDICATION: History: ___ with right shoulder pain
TECHNIQUE: Right shoulder, 4 views
COMPARISON: Chest radiograph obtained the same day.
FINDINGS:
No acute fracture or dislocation is visualized. Extensive bony remodeling
with destruction of the glenohumeral joint and resorption of the humeral head
is seen with subluxation of the humeral head superiorly relative to the
glenoid. Acromioclavicular joint appears preserved. There appears to be a
large shoulder joint effusion which is partially rim calcified. Visualized
right lung is clear.
IMPRESSION:
1. Findings suggestive of a neuropathic joint involving the right shoulder
with large joint effusion, destructive changes in the glenohumeral joint,
resorption of the humeral head, and superior subluxation of the humerus
relative to the glenoid. Given the location of this finding, a syringomyelia
may be present and clinical correlation is recommended.
2. No acute fracture.
|
19969973-RR-15 | 19,969,973 | 27,702,430 | RR | 15 | 2145-09-17 22:15:00 | 2145-09-17 22:36:00 | INDICATION: History: ___ with right periprostatic fracture.
TECHNIQUE: Upright AP view of the chest
COMPARISON: None.
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature
is normal. The lungs are clear without focal consolidation. No pleural
effusion or pneumothorax is detected. Extensive resorption of both
glenohumeral joints with superior subluxation of the humeri relative to the
___ bilaterally and osseous fragmentation suggest neuropathic
arthropathy.
IMPRESSION:
No acute cardiopulmonary abnormality. Charcot arthropathy involving both
shoulders.
|
19969973-RR-16 | 19,969,973 | 27,702,430 | RR | 16 | 2145-09-20 14:57:00 | 2145-09-20 15:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with periprosthetic femur fx // preop film
Surg: ___ (orif r. peripros femur fx)
TECHNIQUE: Portable chest
COMPARISON: ___.
FINDINGS:
Compared to the prior study there is no significant interval change.
IMPRESSION:
No change.
|
19969973-RR-17 | 19,969,973 | 27,702,430 | RR | 17 | 2145-09-21 17:47:00 | 2145-09-22 17:00:00 | EXAMINATION: FEMUR (AP AND LAT) RIGHT IN O.R.
INDICATION: RT FEMUR FX.ORFI
TECHNIQUE: 24 intraoperative fluoroscopic images obtained without a
radiologist present. Side not indicated.
COMPARISON: Radiographs dated ___.
FINDINGS:
The patient is status post total right knee replacement. The comminuted
femoral shaft fracture is visualized. Views demonstrate steps related to
placement of a femoral fracture fixation plate. Fluoro time recorded as 92.6
seconds on the electronic requisition.
IMPRESSION:
Steps related to femoral fixation plate and screws with distal femur.
Correlation with real-time findings and , when appropriate, conventional
radiographs is recommended for further assessment.
|
19969973-RR-18 | 19,969,973 | 27,702,430 | RR | 18 | 2145-09-24 15:37:00 | 2145-09-24 16:34:00 | EXAMINATION: FEMUR (AP AND LAT) RIGHT
INDICATION: ___ year old woman S/P ___ plate R femure // post op check
post op check
IMPRESSION:
Little change in the appearance of the total knee arthroplasty or the
periprosthetic fracture and fixation device in the mid femur. Hip joint
appears within normal limits.
|
19969991-RR-47 | 19,969,991 | 22,950,880 | RR | 47 | 2177-08-08 18:06:00 | 2177-08-08 18:37:00 | EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION: ___ with new right pleural effusion and tachycardia. Evaluate for
pulmonary embolism.
TECHNIQUE: Multi detector CT images were obtained through the chest in
arterial phase after administration of 100 cc of IV Omnipaque contrast. Axial
images were interpreted in conjunction with coronal, sagittal, right oblique
MIP and left oblique MIP reformats.
COMPARISON: None
FINDINGS:
CHEST CTA:
The thoracic aorta is normal caliber without evidence of aneurysm or
dissection. The main, lobar, segmental, and subsegmental pulmonary arteries
are well opacified without filling defect. The remainder of the great vessels
have a normal appearance.
CHEST:
The thyroid is normal. Scattered subcarinal, lower paratracheal, and
prevascular lymph nodes are not enlarged by CT size criteria. The heart is
moderately enlarged, including biatrial enlargement, and there is no
pericardial effusion. Right atrial enlargement is particularly striking.
The large airways are patent. There is a large right pleural effusion which
measures simple density, nonhemorrhagic. There is considerable opacification
suggesting atelectasis of basilar segments in the right lower lobe. Partial
right middle and upper lobe atelectasis is also noted. No discrete pulmonary
mass is identified. No pneumothorax or pneumomediastinum.
The esophagus and visualized upper abdomen is remarkable for trace perihepatic
and perisplenic ascites. (601b:15, 38).
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Large, nonhemorrhagic right pleural effusion with no obvious associated
pulmonary mass. Opacification at the right lung base is likely compressive
atelectasis.
3. Trace perisplenic and perihepatic ascites seen in the limited images of the
abdomen.
4. Cardiomegaly, particularly of the right atrium, suggesting cardiac
insufficiency as a possible cause of pleural effusion. Echocardiogram may be
helpful if clinically indicated.
|
19969991-RR-50 | 19,969,991 | 22,950,880 | RR | 50 | 2177-08-12 13:57:00 | 2177-08-12 17:27:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: Ms. ___ is a ___ old woman with atrial fibrillation on
apixaban, hypothyroidism who presents with shortness of breath x 2 months and
found to be in afib RVR and new right pleural effusion. // eval for interval
decrease in right effusion eval for interval decrease in right effusion
COMPARISON: Chest radiographs and CT scanning ___.
IMPRESSION:
Previous moderate to large right pleural effusion is smaller but still
substantial. There is no pneumothorax. Atelectasis in the medial aspect of
the right middle and right lower lobe has improved, but not cleared. Left lung
is clear. Heart is large. There is no pulmonary edema.
|
19970078-RR-214 | 19,970,078 | 29,613,932 | RR | 214 | 2197-12-07 11:19:00 | 2197-12-07 12:34:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: History: ___ with facial droop// ?bleed, stroke.
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 after the
intravenous administration of 55 mL of Omnipaque 350 nonionic contrast
material. Three-dimensional angiographic volume rendered, curved reformatted
and segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.9 mGy (Body) DLP =
12.5 mGy-cm.
3) Spiral Acquisition 4.9 s, 38.9 cm; CTDIvol = 15.2 mGy (Body) DLP = 592.1
mGy-cm.
Total DLP (Body) = 605 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI dated ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is a 2.5 x 2.9 cm heterogeneous rounded enhancing lesion in the right
frontal lobe with extensive surrounding vasogenic edema. There is
approximately 5 mm of leftward midline shift and effacement of the right
frontal lobe sulci, as well as partial effacement of the right lateral
ventricle. There is no evidence of acute large territorial infarction or
hemorrhage.
There is high-density material within an atelectatic right maxillary sinus.
The visualized portion of the remaining paranasal sinuses,mastoid air
cells,and middle ear cavities are essentially clear. The visualized portion
of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent. At the site of the previously described right
frontal lobe mass, there is associated enhancement and torturous vessels
suggestive of neovascularity.
CTA NECK:
The carotidandvertebral 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 aside from mild bilateral
dependent atelectasis. The visualized portion of the thyroid gland is notable
for left hemithyroidectomy and atrophic right lobe. There is no
lymphadenopathy by CT size criteria.
IMPRESSION:
1. There is a 2.5 x 2.9 cm a rounded heterogeneous enhancing lesion in the
right frontal lobe, with extensive surrounding vasogenic edema, the pattern of
enhancement suggest neovascularity on CTA, and is concerning for malignancy.
There is associated mass effect, with effacement of the sulci and partial
effacement of the right lateral ventricle, as well as 5 mm of leftward midline
shift. Contrast enhanced MRI is recommended.
2. Patent head and neck vessels, with no evidence of stenosis, occlusion or
aneurysm.
3. There is high density material within an atelectatic right maxillary sinus.
RECOMMENDATION(S): Correlation with MRI of the head with and without contrast
is recommended for further characterization.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 12:23 pm, at time
of discovery of the findings.
|
19970078-RR-215 | 19,970,078 | 29,613,932 | RR | 215 | 2197-12-07 16:14:00 | 2197-12-07 20:46:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: History: ___ with above// Further assessment of new mass noted on
CT scan, neurosurgery request
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: MRI and MRA of the brain and neck from ___ and CTA
of the head and neck from ___
FINDINGS:
There is a 3.4 x 3.1 x 2.6 cm (AP X TR X SI) predominantly ring enhancing
lesion in the right frontal lobe, corresponding to the previous abnormality on
the CTA which is new when compared to the prior exam from ___. The
mass demonstrates predominantly slow diffusion and speckled areas of
susceptibility artifact which most likely represent intratumoral hemorrhage.
There are some areas of fast diffusion is centrally within the necrotic
portion of the tumor. There is faintly high-signal intensity on the
precontrast T1 sequence which correspond to the area of high density on the
prior noncontrast CT.
The mass demonstrates significant surrounding edema which does not infiltrate
the corpus callosum. There is partial effacement of the right frontal lobe
gyri and sulci as well as of the right lateral ventricle with associated 4 mm
leftward midline shift which is, allowing for differences in technique,
similar to the prior CT. The ventricular system is otherwise stable in size
and configuration. The basal cisterns remain patent.
Combination of imaging findings including high density on prior noncontrast
CT, faintly high signal intensity on precontrast T1, slow diffusion and
somewhat low signal intensity on T2 weighted imaging could be seen with
lymphoma. However, the prominent vascularity surrounding the lesion can be
seen with metastatic disease. The extremely rapid progression would be
unusual for even a grade IV glioma, as would be the lack of infiltration into
the corpus callosum. Thus, although a glioblastoma remains a diagnostic
consideration, lymphoma or metastasis appears more likely.
Additional patchy T2/FLAIR hyperintensities in the cerebral hemispheres
bilaterally, a nonspecific finding and likely related to chronic small vessel
ischemic changes.
Major vascular flow voids appear preserved. Major dural venous sinuses are
patent.
There is mild mucosal thickening along the ethmoid air cells and partial
opacification of the right maxillary sinus. The mastoid air cells appear
centrally clear. The orbits appear grossly unremarkable.
IMPRESSION:
1. Predominantly ring-enhancing lesion in the right frontal lobe, new from
___ and demonstrating slow diffusion and intratumoral hemorrhage as
well as significant surrounding edema. Findings are concerning for a primary
brain malignancy such as lymphoma or an intracranial metastatic lesion and
less likely a high-grade glioma.
2. Edema surrounding the mass results in partial effacement of the right
lateral ventricle and associated 4 mm leftward midline shift, allowing for
differences in technique, not significantly changed from the prior CT. Patent
basal cisterns.
3. Additional nonspecific white matter changes in the cerebral hemispheres
bilaterally, likely sequela of chronic microangiopathy.
|
19970078-RR-216 | 19,970,078 | 29,613,932 | RR | 216 | 2197-12-08 15:50:00 | 2197-12-08 17:03:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with new right frontal brain lesion, assess for
malignancy//
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered. Coronal and sagittal reformations were
performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,102 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
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
biliary dilatation. Prominence of the CBD is unchanged. The gallbladder is
within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Large exophytic simple cyst arising from the lower pole the right
kidney. Additional subcentimeter hypodensities within kidneys bilaterally are
too small to characterize, but also likely represent cysts. Otherwise, the
kidneys are of normal and symmetric size with normal nephrogram. There is no
evidence of enhancing renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. Scattered colonic diverticula. Otherwise, the colon and rectum
are within normal limits.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: Central mesenteric nodule measuring 11 mm is unchanged compared
to prior (series 6, image 86). There is no new retroperitoneal or mesenteric
lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Severe narrowing the celiac axis is unchanged, possibly due to
compression from the median arcuate ligament.
BONES: Grade 1 anterolisthesis of L4 on L5 due to facet arthropathy. There is
no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small fat containing umbilical hernia. Otherwise, the abdominal
and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of malignancy within the abdomen or pelvis.
2. Unchanged 11 mm nodule within the central mesentery, which is indeterminate
but may represent a lymph node.
3. Please refer to the chest CT with the same date for evaluation of the
intrathoracic structures.
|
19970078-RR-217 | 19,970,078 | 29,613,932 | RR | 217 | 2197-12-08 15:51:00 | 2197-12-08 17:03:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with new right frontal brain lesion, assess for
malignancy// ___ year old woman with new right frontal brain lesion, assess for
malignancy
TECHNIQUE: Multi detector CT of the chest was performed after the
administration of intravenous contrast. Axial coronal and sagittal
reconstructions were acquired. Maximum intensity projections were also
acquired
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.8 s, 25.9 cm; CTDIvol = 7.7 mGy (Body) DLP = 186.6
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 5.0 s, 1.0 cm; CTDIvol = 11.6 mGy (Body) DLP =
11.6 mGy-cm.
4) Spiral Acquisition 16.6 s, 63.9 cm; CTDIvol = 10.8 mGy (Body) DLP =
670.8 mGy-cm.
5) Spiral Acquisition 7.1 s, 27.1 cm; CTDIvol = 8.4 mGy (Body) DLP = 213.4
mGy-cm.
Total DLP (Body) = 1,102 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: To a prior study done on ___
FINDINGS:
THORACIC INLET: Patient status post total thyroidectomy. No evidence of
supraclavicular adenopathy.
BREAST AND AXILLA : No enlarged axillary lymph nodes.
MEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes. The
esophagus is patulous and dilated. There is no pericardial effusion. The
aorta and pulmonary arteries are normal in caliber.
PLEURA: There is no pleural effusion.
LUNG: The 5 mm right upper lobe pulmonary nodule (8, 101) is unchanged. The 6
mm right lower lobe pulmonary nodule (8, 213) Is also unchanged. Another 6 mm
nodule in the right lower lobe is also unchanged. No new pulmonary nodules.
Mild bronchiectasis in both lower lobes.
BONES AND CHEST WALL : Review of bones shows degenerative changes involving
the thoracic spine. Bones osteopenic
UPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver
lesions. Please refer to dedicated report on abdomen which has been dictated
separately
IMPRESSION:
Stable bilateral pulmonary nodules ranging in size from 5-6 mm as described
above. No new pulmonary nodules.
|
19970078-RR-218 | 19,970,078 | 29,613,932 | RR | 218 | 2197-12-10 06:38:00 | 2197-12-10 08:41:00 | EXAMINATION: PRE-SURGICAL WAND OR THERAPY PLANNING ___ MR HEAD
INDICATION: ___ year old woman with left facial droop found to have a right
frontal brain lesion// ___ year old female plan for OR ___, will need
pre-surgical WAND study for right craniotomy for resection of her right
frontal lesion.
TECHNIQUE: After administration of mL of Gadavist intravenous contrast,
axial imaging was performed with MPRAGE and T1 technique. Sagittal and coronal
orientation reformatted images of the MPRAGE acquisition was then produced.
COMPARISON: MRI brain ___
FINDINGS:
Again seen is 3.7 cm x 3.3 cm x 2.7 cm mass right frontal lobe, involving
operculum, upper sub insula, extending into basal ganglia, local mass-effect..
Findings stable since ___. Restricted diffusion of the enhancing
component. Inhomogeneous enhancement centrally, consistent with cystic change
or necrosis. Stable local mass-effect, stable mild midline shift. No other
masses.
Complete opacification with moderate atelectasis and volume loss of the right
maxillary sinus.
IMPRESSION:
1. Large right frontal lobe mass, likely glioma, possibly metastasis.
|
19970078-RR-219 | 19,970,078 | 29,613,932 | RR | 219 | 2197-12-10 08:05:00 | 2197-12-10 08:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with brain tumor; OR today 12PM// preop eval
Surg: ___ (craniotomy) preop eval
IMPRESSION:
Comparison to ___. No relevant change is seen. The lung volumes
are normal. Stable borderline size of the cardiac silhouette. Stable
elongation of the descending aorta. No pneumonia, no pulmonary edema, no
pleural effusions. No pneumothorax.
|
19970078-RR-220 | 19,970,078 | 29,613,932 | RR | 220 | 2197-12-11 16:02:00 | 2197-12-12 08:00:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old woman s/p R front lesion resection// evaluate for
neoplasm
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: MRI Wand study from ___ and CT head without contrast
from ___
FINDINGS:
Postsurgical changes after right frontal craniotomy for subtotal resection of
a predominantly peripherally enhancing mass are noted. There are blood
products and fluid as well as a small amount of air within the resection
cavity. A small amount of devitalized tissues noted around the resection
cavity.
There is residual nodular enhancement superiorly, along the medial and
posterior inferior aspect of the resection cavity (series 15, image 95, 102
and 107) which corresponds to residual tumor.
A small extra-axial collection subjacent to craniotomy site with slight
extension into the right middle cranial fossa is noted measuring up to 4 mm in
maximum thickness and likely postsurgical in etiology.
There is persistent extensive edema surrounding the residual mass and site of
surgery, similar to prior and with unchanged associated 4 mm leftward midline
shift and partial effacement of the right lateral ventricle. The basal
cisterns remain patent. There is no crowding at the level of the foramen
magnum.
The ventricular system is otherwise stable in size and configuration.
There are additional patchy T2/FLAIR hyperintensities in the cerebral
hemispheres bilaterally, a nonspecific finding but unchanged and likely
related to chronic small vessel ischemic changes.
Major vascular flow voids appear preserved. Major dural venous sinuses are
patent.
There is unchanged complete opacification of the maxillary sinus. The
remainder of the paranasal sinuses and mastoid air cells appear clear. The
orbits appear grossly unremarkable.
IMPRESSION:
1. Expected postsurgical changes after subtotal resection of a right frontal
lobe mass.
2. Residual nodular enhancement superiorly to the resection cavity, along its
medial and posterior inferior border are consistent with residual tumor.
3. Unchanged extensive edema in the right frontal lobe surrounding the
resection cavity and residual mass with stable 4 mm leftward midline shift and
partial effacement of the right lateral ventricle.
4. Unchanged nonspecific additional patchy white matter changes in the
cerebral hemispheres bilaterally, likely sequela of chronic microangiopathy.
|
19970078-RR-221 | 19,970,078 | 29,613,932 | RR | 221 | 2197-12-10 21:57:00 | 2197-12-10 23:00:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p R lesion resection// evaluate for
hemorrhage, hydrocephalus, edemaPERFORM AT 20:00
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: MR head dated ___.
FINDINGS:
The patient is status post right frontal craniotomy and resection of a right
frontal lesion. There is bifrontal pneumocephalus and fluid within the
surgical bed which is likely secondary to postsurgical changes. There is
unchanged vasogenic edema involving the right frontal and parietal regions.
There is a 3 mm leftward midline shift, unchanged. There is no large
territory infarction or unexpected intracranial hemorrhage. There is
unchanged partial effacement of the right lateral and third ventricles.
The visualized portion of the orbits, paranasal sinuses, mastoid air cells,
and middle ear cavities are stable in appearance.
IMPRESSION:
1. The patient is status post right frontal craniotomy and resection of the
right frontal lesion with pneumocephalus and fluid within the surgical bed
which is likely secondary to postsurgical changes.
2. Unchanged vasogenic edema involving the right frontal and parietal regions.
3. Unchanged 3 mm left midline shift.
4. No large territory infarction or unexpected intracranial hemorrhage.
|
19970078-RR-222 | 19,970,078 | 29,613,932 | RR | 222 | 2197-12-11 15:34:00 | 2197-12-11 17:28:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman s/p dobhoff placement// evaluate dobhoff
placement Contact name: ___: ___ evaluate dobhoff placement
IMPRESSION:
2 radiographs demonstrate attempt to insert type of tube. The first 1
demonstrated up of tube going into the right lower lobe segmental bronchus and
the second 1 demonstrate that the up of tube at the level of mid esophagus or
trachea. No successful insertion of the type of tube recorded.
|
19970078-RR-224 | 19,970,078 | 29,613,932 | RR | 224 | 2197-12-12 14:51:00 | 2197-12-12 17:53:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new O2 requirement, congestive cough//
Evaluate interval change, for infection
TECHNIQUE: AP and lateral chest radiographs
COMPARISON: ___
FINDINGS:
The Dobhoff has been removed. Bibasilar opacities are increased since prior
and could reflect atelectasis or aspiration/pneumonia. There is no
pneumothorax or right pleural effusion. A small left pleural effusion is
present. The size of the cardiac silhouette is within normal limits.
IMPRESSION:
New bibasilar opacities could reflect atelectasis or aspiration/pneumonia.
Small left pleural effusion.
|
19970078-RR-225 | 19,970,078 | 29,613,932 | RR | 225 | 2197-12-12 14:40:00 | 2197-12-12 15:30:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p right crani for tumor resection, acute LUE
weakness. Evaluation for interval change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.5 mGy (Head) DLP =
824.4 mGy-cm.
Total DLP (Head) = 836 mGy-cm.
COMPARISON: Comparison to MRI brain from ___. Comparison to
noncontrast head CT from ___.
FINDINGS:
Patient is status post right frontal craniotomy for resection of right frontal
lesion. Redemonstration of expected postsurgical changes, including bifrontal
pneumocephalus and fluid within the surgical bed. Vasogenic edema within the
right frontal and parietal regions is similar to the prior study. There is 3
mm leftward shift of midline structures, unchanged. No evidence of new
hemorrhage or of infarction. Unchanged partial effacement of the right
lateral ventricle and third ventricle.
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. Status post right frontal craniotomy for resection right frontal lesion,
with overall similar appearance of expected postsurgical changes.
2. Unchanged vasogenic edema involving the right frontal and parietal regions.
3. Unchanged 3 mm leftward midline shift.
|
19970078-RR-226 | 19,970,078 | 29,613,932 | RR | 226 | 2197-12-15 15:30:00 | 2197-12-15 17:02:00 | EXAMINATION: ___ intestinal tube placement
INDICATION: ___ year old woman dysphagia// dobhoff tube placement please
DOSE: Acc air kerma: 1 mGy; Accum DAP: 31.4 uGym2; Fluoro time: 00:33
COMPARISON: None.
FINDINGS:
The left nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, ___ feeding tube was placed into the
stomach.
10 cc of Optiray contrast were used to confirm placement within the stomach.
Final fluoroscopic spot images demonstrated the tip of the feeding tube in the
stomach.
The feeding tube was affixed to the patient's nose and cheek using tape.
IMPRESSION:
Successful advancement of a feeding tube into the stomach.
|
19970078-RR-227 | 19,970,078 | 29,613,932 | RR | 227 | 2197-12-19 15:29:00 | 2197-12-19 16:06:00 | EXAMINATION: Chest radiographs, PA and lateral.
INDICATION: Status post craniotomy for tumor resection with aspiration of an
increasing leukocytosis.
COMPARISON: ___.
FINDINGS:
Heart is borderline in size. Cardiac, mediastinal and hilar contours appear
stable. Small bilateral pleural effusions are suspected. No pneumothorax.
Posterior basilar left lower lobe opacity persists and raises concern for
pneumonia in the appropriate setting.
IMPRESSION:
Persistent retrocardiac opacity. Imaging finding is not specific, but
differential includes aspiration/pneumonia.
|
19970078-RR-229 | 19,970,078 | 29,613,932 | RR | 229 | 2197-12-22 09:53:00 | 2197-12-22 16:19:00 | EXAMINATION: Video oropharyngeal swallow
INDICATION: ___ year old woman with dysphagia, NPO with PEG// evaluate for
aspiration with swallow
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 05:07 min.
COMPARISON: None.
FINDINGS:
There was penetration with thin and nectar thick liquids. Mild-to-moderate
oropharyngeal residue is noted.
IMPRESSION:
No aspiration, but there is penetration with thin and nectar thick liquids.
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
19970078-RR-238 | 19,970,078 | 22,135,897 | RR | 238 | 2198-02-26 02:52:00 | 2198-02-26 06:13:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD.
INDICATION: History: ___ with GBM// eval known GBM.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Multiple prior head CT and MRI brain examinations since ___, the most recent head CT dated ___, the most recent
MRI of the brain dated ___.
FINDINGS:
There is significant interval enlarged in size of previously partially
resected right frontal mass lesion measuring approximately 54 x 35 mm in
transverse dimension. The mass lesion show more extensive and thick irregular
marginal enhancement. There is interval increased surgical margin irregular
and nodular diffusion restriction. There is no significant interval change of
leftward midline shift by 5 mm AP. There is effacement of the right lateral
ventricle due to mass effect there is no uncal herniation or tonsillar
herniation. The basal cisterns remain patent.
There is significant interval increase of perilesional T2 FLAIR hyperintense
signal intensity with associated locoregional mass effect as well as mass
effect on the right lateral ventricle.
There are additional patchy T2/FLAIR hyperintensities in the cerebral
hemispheres bilaterally, a nonspecific finding but unchanged and likely
related to chronic small vessel ischemic changes.
Unchanged osseous postsurgical changes consistent with right craniotomy, major
vascular flow voids are preserved. Major dural venous sinuses appear patent.
There is unchanged complete opacification of the right maxillary sinus. The
remainder of the paranasal sinuses and mastoid air cells appear clear. The
orbits appear grossly unremarkable.
IMPRESSION:
1. Interval increase in size of the previously seen intra-axial enhancingmass
lesion, with increased perilesional edema, and locoregional mass effect.
Described findings suggests progression. For follow-up with advanced MR
techniques (MR perfusion and spectroscopy) is recommended
RECOMMENDATION(S): If clinically warranted for follow-up with brain tumor
perfusion and spectroscopy protocol is recommended.
|
19970078-RR-239 | 19,970,078 | 22,135,897 | RR | 239 | 2198-02-27 14:28:00 | 2198-02-27 16:14:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ PMH of HTN, Glioblastoma (s/p resection ___ then
externalbeam radiation with concomitant daily temozolomide, on hold
___, presented from home with encephalopathy, found to befebrile
with gram positive bacteremia// LUQ tenderness around gtube site, assess for
cause of gram positive bacteremia, abcess? bowel inflammation?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 13.1 s, 0.2 cm; CTDIvol = 224.0 mGy (Body) DLP =
44.8 mGy-cm.
3) Spiral Acquisition 8.1 s, 52.4 cm; CTDIvol = 13.0 mGy (Body) DLP = 672.5
mGy-cm.
Total DLP (Body) = 719 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of solid renal lesions or hydronephrosis. Several
low-density lesions throughout the kidneys bilaterally, unchanged when
compared to CT from ___ and measuring up to 6.4 cm on the right are all
likely cysts. There is no perinephric abnormality.
GASTROINTESTINAL: There is a percutaneous gastrostomy tube in situ which
appears new when compared to the CT from ___. This appears to be in
appropriate positioning. There is mild stranding of the fat surrounding the
tract to the subcutaneous tissues, but this is felt to be within normal
limits. There is diverticular disease affecting the distal ileum.
Diverticulosis affecting the cecum, ascending: None sigmoid also with no
evidence of diverticulitis.
PELVIS: The urinary bladder and distal ureters are unremarkable. Trace pelvic
free fluid.
REPRODUCTIVE ORGANS: Evidence of prior hysterectomy.
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.
Grade 1 anterolisthesis of L4 on L5 with mild degenerative change at this
level. Significant lower lumbar spine facet joint degenerative change..
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Percutaneous gastrostomy tube in situ with mild surrounding inflammatory
change that is within normal limits.
2. No intra-abdominal or pelvic acute infectious process identified.
|
19970078-RR-240 | 19,970,078 | 22,135,897 | RR | 240 | 2198-03-01 10:45:00 | 2198-03-01 11:58:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: PMH of HTN, Glioblastoma (s/p resection ___ then external beam
radiation with concomitant daily temozolomide, on hold since ___,
presented from home with encephalopathy, found to be febrile/neutropenic with
gram positive bacteremia with new alter mental status, delayed response, and
twitching.// Any acute process
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: MRI dated ___.
CT head dated ___.
FINDINGS:
Patient is status post right frontal craniotomy. There is redemonstration of
a 3.3 x 2.5 cm right frontal hypodense mass (series 6, image 17) with
extensive surrounding vasogenic edema, better characterized on recent MRI
dated ___. Subsequently, there is persistent mass-effect on the
right lateral ventricle and 4 mm leftward midline shift. There is no acute
large territory infarction or intracranial hemorrhage.
Unchanged opacification of the right maxillary sinus.
IMPRESSION:
1. No new acute intracranial abnormality.
2. Grossly stable 3.3 cm right frontal mass with extensive surrounding
vasogenic edema causing 4 mm leftward midline shift and mass-effect on the
right lateral ventricle, better characterized on MRI brain dated ___.
3. Persistent opacification of the right maxillary sinus.
4. No definite evidence of acute intracranial hemorrhage.
|
19970078-RR-241 | 19,970,078 | 22,135,897 | RR | 241 | 2198-03-01 18:43:00 | 2198-03-01 21:11:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new line// new right PICC 46 cm 4 cm out
___ ___ Contact name: ___: ___
TECHNIQUE: Portable AP chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Interval placement of a right-sided PICC, which terminates in the low SVC.
There is left lower lobe atelectasis. No large pleural effusion,
pneumothorax, or focal consolidation. Cardiomediastinal silhouette is stable.
No acute osseous abnormalities are identified.
IMPRESSION:
Right-sided PICC terminates in the low SVC. No pneumothorax.
|
19970078-RR-242 | 19,970,078 | 22,135,897 | RR | 242 | 2198-03-02 08:30:00 | 2198-03-02 09:02:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with PMH of HTN, Glioblastoma (s/p resection
___ then external beam radiation with concomitant daily temozolomide, on
hold since ___, presented from home with encephalopathy, found to be
febrile/neutropenic with gram positive bacteremia with worsening AMS// Any
acute processes or interval changes
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: Multiple priors, most recent head CT from ___ and
brain MRI from ___.
FINDINGS:
Re-demonstrated are postsurgical changes from right frontal craniotomy and
tumor resection. The known right frontal lobe mass is better defined by
previous MRI, but is noted on image 15 of series 5 where measures
approximately 4.5 x 3.1 cm. There is a thin extra-axial collection
immediately subjacent to the craniotomy site on image 13 of series 5 which
appears similar to previous examination. There is no significant change in
the degrees of effacement of the right lateral ventricle for leftward midline
shift measuring approximately 4 mm.
There is continued opacification of the right maxillary sinus with remodeling
changes of the maxillary sinus walls, partially imaged, and similar to the
previous exam. The visualized portions of the paranasal sinuses and mastoid
air cells are otherwise clear.
IMPRESSION:
No new intracranial abnormality is demonstrated.
Known right frontal lobe mass with extensive surrounding edema, mass effect on
the right lateral ventricle, and 4 mm leftward midline shift, which was better
characterized by previous MRI. Particularly in the setting of the mass and
its associated surrounding hypoattenuation, MRI would offer greater
sensitivity for acute superimposed processes, as needed clinically.
|
19970078-RR-243 | 19,970,078 | 22,135,897 | RR | 243 | 2198-03-02 08:36:00 | 2198-03-02 09:50:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ year old woman with AMS, fever// assess for evidence of
aspiration, new pneumonia
IMPRESSION:
In comparison with the study of ___, there again is increased
opacification at the left base consistent with volume loss in the lower lobe
and probable small effusion. Otherwise little change.
No discrete consolidation is appreciated, though this would be difficult to
unequivocally exclude in the appropriate clinical setting, especially in the
retrocardiac region.
|
19970078-RR-245 | 19,970,078 | 22,135,897 | RR | 245 | 2198-03-06 16:01:00 | 2198-03-06 16:37:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with glioblastoma multiforme with ongoing
neutropenia and now with rising alk phos and t. bili concerning for
cholestatic process// evaluate for cholecystitis, sludging, obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 2 mm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 8.9 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.Re-demonstrated
is a 5.2 x 5.1 x 5.3 cm exophytic simple cyst arising from the right lower
pole.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal abdominal ultrasound. No evidence of cholelithiasis or cholecystitis.
|
19970078-RR-246 | 19,970,078 | 22,135,897 | RR | 246 | 2198-03-07 11:08:00 | 2198-03-07 23:09:00 | INDICATION: ___ PMH of HTN, Glioblastoma with concerns for sepsis// any acute
process such as PNA
TECHNIQUE: Supine radiographs of the abdomen and pelvis
FINDINGS:
Air is seen in nondistended loops of colon which also has a small amount of
stool. There is a relative paucity of small bowel gas in the small bowel
cannot be well assessed. No evidence of pneumoperitoneum or pneumatosis on
this limited supine radiograph.
Opacity at the left lung base is consistent with atelectasis, slightly
decreased from ___ x-ray.
|
19970078-RR-247 | 19,970,078 | 22,135,897 | RR | 247 | 2198-03-07 19:22:00 | 2198-03-08 10:12:00 | EXAMINATION: MR ___ W AND W/O CONTRAST T9112 MR ___
INDICATION: ___ PMH of HTN, Glioblastoma (s/p resection ___ then external
beam radiation with concomitant daily temozolomide, on hold since ___,
presented from home with encephalopathy currently has left sided weakness.//
progression of disease vs acute process
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CT ___ ___, MRI ___ ___, MR ___.
FINDINGS:
There is no interval change in the size of the peripherally enhancing lesion
centered in the right frontal lobe, compared with the prior study, measuring
54 mm (AP) x 35 mm (TV), however this has increased in size compared with the
MRI ___ dated ___. The lesion demonstrates patchy restricted
diffusion, unchanged compared with prior. Stable appearance of the
surrounding vasogenic edema in the right frontal, parietal lobes, insula and
deep white matter. There is unchanged mass-effect, with partial compression
of the right lateral ventricle and mild midline shift to the left (4 mm).
Bilateral supratentorial white matter T2/FLAIR hyperintensities are
nonspecific and may represent the sequelae of microangiopathy. Note is again
made of several foci of blooming underlying the right craniotomy site, in
keeping with old hemorrhage secondary to previous surgery. There is no
evidence of acute hemorrhage, or acute territorial infarct. Apart from the
mass-effect, the ventricles and sulci are otherwise normal in caliber and
configuration.
There are secretions within the right maxillary sinus and mild mucosal
thickening in the ethmoid air cells
IMPRESSION:
-The peripherally enhancing lesion centered in the right frontal lobe is
stable in size and appearance compared with the most recent MRI ___ dated ___, however has increased in size compared with the MR ___ dated ___.
-No acute intracranial abnormality is identified.
|
19970078-RR-248 | 19,970,078 | 22,135,897 | RR | 248 | 2198-03-07 22:27:00 | 2198-03-08 14:53:00 | INDICATION: ___ year old woman with GBM now with leaking G tube// eval for
free air, abdominal pathology
TECHNIQUE: Supine abdominal radiograph
COMPARISON: Abdominal radiograph dated ___
FINDINGS:
No abnormally dilated loops of large or small bowel. Supine view limits
evaluation of free air, however no gross pneumoperitoneum. A gastrostomy tube
with the retention balloon projects over the left lower quadrant.
Mild degenerative changes of the lower lumbar spine, otherwise osseous
structures are unremarkable. There is hyperdense foci projecting over the
right iliac wing and right lower pelvis probably representing hyperdense
material in diverticula. No unexplained soft tissue calcifications or
radiopaque foreign bodies.
IMPRESSION:
Nonobstructive bowel gas pattern. Supine view limits evaluation of free air,
however no gross pneumoperitoneum.
|
19970078-RR-250 | 19,970,078 | 22,135,897 | RR | 250 | 2198-03-08 08:15:00 | 2198-03-08 16:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with glioblastoma and neutropenia with new
fevers// evaluate for PNA
TECHNIQUE: Chest frontal radiograph
COMPARISON: Chest radiograph from ___
FINDINGS:
Lung volumes are low. A right upper extremity PICC line tip projects near the
cavoatrial junction. Heart size is stable. The left hemidiaphragm is better
visualized likely reflecting improved aeration of the left lower lobe. There
is residual consolidation with air bronchograms, concerning for pneumonia. No
pulmonary edema. Left pleural effusion is small if any. No pneumothorax.
IMPRESSION:
While there is improved aeration of the left lung base, there is residual
consolidation with air bronchograms which is concerning for pneumonia.
|
19970078-RR-251 | 19,970,078 | 22,135,897 | RR | 251 | 2198-03-09 18:12:00 | 2198-03-09 19:45:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with glioblastoma s/p resection and treatment
with XRT and temozolomide here with prolonged neutropenia with new fevers and
abdominal pain// evaluate for abscess, colitis, other source of infections
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.7 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 7.6 s, 49.4 cm; CTDIvol = 16.4 mGy (Body) DLP = 800.7
mGy-cm.
Total DLP (Body) = 805 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: There is bibasilar dependent atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are a few hypoattenuating cystic lesions within the kidneys, largest at
the inferior pole on the right measuring 5.5 x 5.7 cm. There is no evidence
of solid renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a PEG tube placement within the stomach. The
stomach is otherwise unremarkable. Small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. There are few scattered
diverticula within large bowel without evidence diverticulitis. There is a
large amount of stool within the rectum with perirectal stranding and
presacral fluid.
PELVIS: There is a focus of air within the bladder, likely from recent
instrumentation. The urinary bladder and distal ureters are unremarkable.
There is trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The patient is status post hysterectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is mild narrowing of
the celiac artery at its origin. Mild atherosclerotic disease is noted.
BONES: There is anterolisthesis of L4 on L5. There are chronic degenerative
changes of the lower lumbar spine. There is no evidence of worrisome osseous
lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Large amount of stool within the rectum with associated perirectal
stranding and fluid. Findings may reflect proctitis and possibly stercoral
colitis.
|
19970078-RR-252 | 19,970,078 | 22,135,897 | RR | 252 | 2198-03-10 08:55:00 | 2198-03-10 10:25:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with glioblastoma on chemotherapy with
prolonged neutropenia now with worsening respiratory distress// evaluate for
pneumonia
IMPRESSION:
In comparison with the study of ___, there are improved lung volumes.
Continued retrocardiac opacification with obscuration of the descending
thoracic aorta, consistent with left lower lobe pneumonia.
Otherwise, little change.
|
19970078-RR-253 | 19,970,078 | 22,135,897 | RR | 253 | 2198-03-11 15:29:00 | 2198-03-11 17:57:00 | INDICATION: ___ year old woman with glioblastoma on chemotherapy with
neutropenic sepsis with persistent leakage of tube feeds around g-tube site//
please evaluate g-tube leakage
COMPARISON: CT abdomen and pelvis from ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and Dr.
___ fellow performed the procedure. Dr. ___
___ supervised the trainee during any key components of the procedure
where applicable and reviewed and agrees with the findings as reported below.
ANESTHESIA: Moderate sedation was not used for the procedure. The patient's
hemodynamic parameters were continuously monitored by an independent trained
radiology nurse. 1% lidocaine was injected in the skin and subcutaneous
tissues overlying the access site.
MEDICATIONS: None
CONTRAST: 10 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 0.9, 5 mGy
PROCEDURE: ___ gastrostomy exchange for a MIC gastrostomy tube.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
health care proxy. The patient was then brought to the angiography suite and
placed supine on the exam table. A pre-procedure time-out was performed per
___ protocol. The tube site was prepped and draped in the usual sterile
fashion.
The existing tube was injected with contrast and showed opacification of the
gastric rugae. A ___ wire was introduced into the stomach. The existing
feeding tube was then removed. A 24 ___ MIC gastrostomy catheter was
advanced over the wire into position.
The catheters balloon was inflated with 10 ml of contrast diluted in sterile
water in the proximal duodenum and locked in the stomach after confirming the
position of the catheter with a contrast injection. The catheter was then
flushed, capped. Sterile dressings were applied.
Silver nitrate cautery of the tract was also performed.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
1. Appropriately positioned new 24 ___ MIC gastrostomy tube.
IMPRESSION:
Successful exchange of a 20 ___ Ponsky tube for a new 24 ___ MIC
gastrostomy tube. The tube is ready to use.
Silver nitrate cautery of the tract was also performed.
|
19970078-RR-254 | 19,970,078 | 22,135,897 | RR | 254 | 2198-03-11 19:42:00 | 2198-03-11 20:52:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with glioblastoma admitted with neutropenic
sepsis with prolonged neutropenia and elevated B-glucan concerning for
possible fungal pneumonia with CXR showing LLL infiltrate// evaluate for
fungal pneumonia
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: CT chest on ___
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. The heart,
pericardium, and great vessels are within normal limits based on an unenhanced
scan. No pericardial effusion is seen. A right subclavian central venous
catheter terminates in the right atrium.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma. The esophagus is patulous and
contains layering ingested material to the level of the upper thorax. (5:76)
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There are small dependent consolidations at the lung bases, not
stable to slightly increased from prior CT abdomen and pelvis. There are
ground-glass opacities in the posterior bilateral upper lobes. A previously
seen right lower lobe subpleural pulmonary nodule is obscured by a
consolidation at the right lung base. A 5 mm right upper lobe pulmonary
nodule is stable (5:76). An additional 4 mm pulmonary nodule in the right
upper lung is not significantly changed (5:87). There are at least 3 new
pulmonary nodules in the right lung measuring up to 4-5 mm (5:100; 110; 121).
Mild bronchiectasis is stable. The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the unenhanced upper abdomen is unremarkable.
BONES: There are degenerative changes thoracic spine. No suspicious osseous
abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Ground-glass opacities in the bilateral posterior upper lobes and
consolidative opacities at the lung bases are in a distribution most
suggestive of a combination of atelectasis and aspiration given the patulous
esophagus containing ingested material to the level of the upper thorax.
2. Few pulmonary nodules in the right lung are stable compared with ___,
however there are at least 3 new pulmonary nodules in the right lung measuring
up to 4-5 mm, may be infectious/inflammatory nature, however metastatic
disease cannot be excluded. Recommend short-term interval follow-up with CT
chest in 3 months.
RECOMMENDATION(S): CT chest in 3 months.
|
19970078-RR-255 | 19,970,078 | 22,135,897 | RR | 255 | 2198-03-14 00:57:00 | 2198-03-14 01:58:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ PMH of HTN, Glioblastoma (s/p resection ___ then external
beam radiation with concomitant daily temozolomide, on hold since ___,
presented from home with encephalopathy, found to have neutropenic sepsis ___
strep viridans bacteremia, now with new suspected lower GI bleeding, BRBPR.//
Assess for active extravasation in the setting of GI bleeding
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Positive oral contrast has been administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.9 s, 51.4 cm; CTDIvol = 5.7 mGy (Body) DLP = 287.5
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
3) Stationary Acquisition 2.6 s, 0.2 cm; CTDIvol = 43.9 mGy (Body) DLP =
8.8 mGy-cm.
4) Spiral Acquisition 7.9 s, 51.1 cm; CTDIvol = 7.3 mGy (Body) DLP = 367.4
mGy-cm.
5) Spiral Acquisition 7.9 s, 51.1 cm; CTDIvol = 7.3 mGy (Body) DLP = 367.4
mGy-cm.
Total DLP (Body) = 1,033 mGy-cm.
COMPARISON: Multiple CTs of the abdomen dating back to ___. Most
recent CT performed ___ and ___.
FINDINGS:
VASCULAR:
Abdominal aorta is non-aneurysmal major branch vessels of the abdominal aorta
including the celiac axis, SMA, ___, and renal arteries are patent.
LOWER CHEST: Dense parenchymal changes involving dependent portions of both
lungs, consistent with atelectasis. Small volume bilateral pleural fluid,
more pronounced on the right.
ABDOMEN:
HEPATOBILIARY: Liver is normal in contour and attenuation. There is mild
focal fat deposition at the falciform ligament. Portal and hepatic veins are
patent. Normal gallbladder. No intrahepatic or extrahepatic bile duct
dilatation.
PANCREAS: Pancreas is normal in bulk and attenuation. No focal parenchymal
lesions identified. No main duct dilatation.
SPLEEN: The spleen is small, measuring approximately 7 cm in diameter. No
focal parenchymal lesions are seen.
ADRENALS: Adrenal glands are normal.
URINARY: Bilateral renal cortical cysts. The largest is seen at the lower
pole of the right kidney and measures approximately 6.2 cm in diameter.
GASTROINTESTINAL: Due to the administration of positive oral contrast,
assessment for lower GI bleed cannot be performed.Oral contrast has propagated
to the level of the rectum, where note is made of a fecaloma. This
surrounding rectal wall is thickened and there is furthermore significant
perirectal fat stranding. Constellation of findings is consistent with
stercoral colitis. There is no evidence of free intra-abdominal air. A
G-tube is in situ.
There is no abnormality of the small bowel.
Of note is pancolonic diverticulosis. In the ascending colon, there is a
focal area of mural thickening, which does not fill with contrast (series 6,
image 81). Although this may reflect a diverticulum that has not been filled
with oral contrast, this cannot be determined with certainty on today's CT.
PERITONEUM: Small volume of free fluid is noted in the pelvis and in the right
and left upper quadrants.
Lymph nodes: No inguinal, pelvic, retroperitoneal, or periportal
lymphadenopathy.
PELVIS: The urinary bladder is unremarkable.
REPRODUCTIVE ORGANS: The uterus is not seen. There is no adnexal mass.
BONES: Mild degenerative anterolisthesis of L4 on L5, and to lesser extent L5
on S1 (grade 1). No acute or focal destructive osseous lesions.
SOFT TISSUES: There is mild subcutaneous soft tissue edema along the abdominal
and pelvic wall and into the proximal thighs. Abdominal and pelvic wall
otherwise unremarkable.
IMPRESSION:
1. Due to the administration of positive oral contrast, assessment for lower
GI bleed cannot be performed.
2. There is a large fecaloma in the rectum. Surrounding the fecaloma is
rectal wall is thickened and significant perirectal fat stranding and edema.
Constellation of findings is suggestive of stercoral colitis.
3. Pancolonic diverticulosis. There is a focal area of mural thickening at
the level of the ascending colon, as above. Although this may reflect a
diverticulum that has not been filled with oral contrast, this cannot be
determined with certainty on today's CT. If clinically indicated, direct
visualization with scope may be considered.
4. Small bilateral pleural effusions with passive atelectasis.
|
19970078-RR-256 | 19,970,078 | 22,135,897 | RR | 256 | 2198-03-14 11:03:00 | 2198-03-14 14:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with glioblastoma here with neutropenic fevers
with worsening respiratory distress and rhonchi// evaluate for worsening PNA
evaluate for worsening PNA
COMPARISON: CT scan of the chest ___ chest x-ray ___
FINDINGS:
Lung volumes are low with crowding of pulmonary vasculature. There is
retrocardiac opacification which is slightly were conversant as well as right
basilar opacification. Pneumonia versus atelectasis. Distal tip of the right
PICC line overlies the SVC.
|
19970078-RR-257 | 19,970,078 | 22,135,897 | RR | 257 | 2198-03-14 11:39:00 | 2198-03-14 13:02:00 | INDICATION: ___ year old woman with tube feed leakage around ___ MIC G-tube.
Please convert to GJ tube.// Convert G to GJ tube.
COMPARISON: CT from ___, prior procedure images from ___
TECHNIQUE: OPERATORS: Dr. ___ attending, performed the procedure.
ANESTHESIA: Analgesia was provided by administrating a single dose of 12.5mcg
of fentanyl. The patient's hemodynamic parameters were continuously monitored
by an independent trained radiology nurse. 1% lidocaine was injected in the
skin and subcutaneous tissues overlying the access site.
MEDICATIONS: As above
CONTRAST: 20 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 5.6, 37 mGy
PROCEDURE: Exchange of MIC gastrostomy tube for MIC gastrojejunostomy tube.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The tube site was prepped and draped in the usual sterile fashion.
The existing tube was injected with contrast and showed opacification of the
gastric rugae. A Kumpe catheter and glide wire were advanced through the tube
into the stomach, and then advanced through the pylorus to the duodenum and
jejunum. The balloon was deflated and the tube and catheter were removed over
the wire and a new ___ gastrojejunostomy was advanced over the wire. The
catheter and wire were removed, and the balloon was infalted with 7 ml of
dilute contrast and pulled back for aposition to the abdominal wall. Contrast
in both ports confirmed appropriate position.
Sterile dressings were applied. The patient tolerated the procedure well and
there were no immediate complications.
FINDINGS:
1. Appropriately positioned new 22 ___ MIC gastrojejunostomy tube (this is
the largest available GJ tube).
IMPRESSION:
Successful exchange of a gastrostomy tube for a new 22 ___ MIC
gastrojejunostomy tube. The tube is ready to use.
|
19970078-RR-259 | 19,970,078 | 22,135,897 | RR | 259 | 2198-03-21 19:45:00 | 2198-03-22 02:20:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST ___
INDICATION: ___ year old woman with stercoral colitis, neutropenic fevers,
febrile on meorpenem // infection
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were obtained
with oral and intravenous contrast. Sagittal and coronal reformations were
also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 1.0 s, 0.2 cm; CTDIvol = 17.1 mGy (Body) DLP =
3.4 mGy-cm.
3) Spiral Acquisition 11.0 s, 71.4 cm; CTDIvol = 11.6 mGy (Body) DLP =
820.7 mGy-cm.
Total DLP (Body) = 826 mGy-cm.
COMPARISON: ___.
FINDINGS:
Chest is reported separately.
There is no biliary dilatation. No focal liver lesions are identified. The
gallbladder appears normal. Pancreas is also on remarkable. Spleen is normal
in size. There has been short-term appearance of many new subcentimeter
hypoattenuating nodules in the spleen measuring up to 5 mm in diameter. These
are suggestive of micro abscesses due to atypical infectious process such as
candidiasis in the setting of febrile neutropenia. Adrenals are unremarkable.
No evidence for stones, solid masses or hydro nephrosis involving either
kidney. A few very small hypoattenuating foci in each kidney are probably
unchanged and doubtful in significance, likely cysts. In addition a sizable
interpolar cyst measures up to 57 mm has before.
A gastro jejunostomy tube is in place. It terminates in the mid jejunum.
There is persistent dense presacral fat stranding and mild and borderline
rectal wall thickening, still with a sizable, but somewhat smaller, stool
ball. Mild thickening of the wall of the descending and sigmoid portions of
the colon is perhaps slightly improved. Moderate diverticulosis along the
cecum and sigmoid colon.
Uterus is apparently absent. There is no adnexal mass. Bladder appears
normal. There is no ascites or lymphadenopathy. Major vascular structures
appear widely patent.
There are no suspicious bone lesions. Sacroiliac joints are partly fused.
Bones appear demineralized. Moderate degenerative severe degenerative changes
affect lumbosacral facet joints. Similar sclerotic appearance of the L2
vertebral body.
IMPRESSION:
1. Many small developing hypodense lesions which are suggesting of which that
suggest micro abscesses associated with atypical infectious process such as
candidiasis.
2. Persistent but slightly improved wall thickening of the colon.
Persistent sizable but somewhat decreased stool ball in the rectum with
inflammatory changes suggestive of stercoral proctitis.
NOTIFICATION: Findings discussed with Dr. ___.
|
19970078-RR-260 | 19,970,078 | 22,135,897 | RR | 260 | 2198-03-21 19:44:00 | 2198-03-22 02:04:00 | EXAMINATION: CT CHEST W/CONTRAST Q412
INDICATION: ___ year old woman with glioblastoma, pancytopenia with
neutropenic fevers, ongoing on meropenem // infectious source
TECHNIQUE: Multidetector CT images of the chest were obtained with
intravenous contrast. Sagittal and coronal reformations were also performed.
DOSE: Not available. A posterior ground-glass opacity in the left upper lobe
is concerning for pneumonia persists while other dependent opacities have
cleared to a greater extent. This may be due to residual edema or developing
pneumonia.
COMPARISON: Chest CT is available from ___.
FINDINGS:
The whole esophagus is moderately dilated. In the lower part there is debris
and fluid. This suggests dysmotility and possibly achalasia.
A central venous catheter terminates shortly below terminates at the
cavoatrial junction.
The heart is mildly enlarged.
There is a trace right-sided pleural effusion and a very small pleural
effusion on the left, the latter somewhat increased. No pericardial effusion.
No enlarged lymph nodes are found in the chest.
Posterior ground-glass opacity in the left upper lobe has not cleared as much
as other dependent ground-glass opacities. This may represent an area of
slowly resolving edema although infectious etiology is possible. New cluster
of cysts small nodules and branching opacities suggests inflammation or
infection of lower airways in the superior segment of the left lower lobe.
Similar atelectasis at each lung base, left greater than right.
The abdomen is reported separately, but the partly imaged spleen shows many
subcentimeter hypoattenuating lesions.
There are no suspicious bone lesions. Bones appear demineralized.
Midthoracic interspaces show moderate degenerative changes with minimal
chronic appearing loss in height and slight kyphosis.
IMPRESSION:
1. Persistent posterior ground glass opacity in the left upper lobe. Patchy
bronchovascular opacities in the superior segment of the left lower lobe.
These are possible foci of infection.
2. Dilated esophagus with debris. Possible risk of aspiration based on this.
More specifically possibility of developing achalasia could be considered or
versus worsening dysmotility of less specific etiology.
|
19970078-RR-261 | 19,970,078 | 22,135,897 | RR | 261 | 2198-03-24 09:28:00 | 2198-03-24 16:27:00 | INDICATION: ___ year old woman with GBM, pancytopenia, GIB // acute process
TECHNIQUE: Frontal, supine radiograph the abdomen and pelvis.
COMPARISON: Comparisons made to multiple prior radiographs and CT the
abdomen, most recently from ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Unchanged
appearance of the gastrojejunostomy tube, with the tip terminating overlying
the left hemipelvis there is contrast within the descending colon and rectum,
along with gas.
There is no free intraperitoneal air.
There are moderate degenerative changes to the lower lumbar spine, with
osteophytosis and disc space narrowing.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Unchanged appearance of the gastrojejunostomy tube with the tip terminating
over the left hemipelvis. There is contrast within the descending colon from
prior CT scan 2 days prior.
|
19970078-RR-262 | 19,970,078 | 22,135,897 | RR | 262 | 2198-03-26 08:07:00 | 2198-03-26 09:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right PICC pulled out several cm. //
Evaluate for PICC placement. Please perform ___ after 7AM.
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Right-sided PICC line projects over the cavoatrial junction. Pulmonary edema
has worsened. Cardiomediastinal silhouette is stable. Small bilateral
effusions are unchanged. No pneumothorax.
|
19970078-RR-263 | 19,970,078 | 22,135,897 | RR | 263 | 2198-03-29 15:14:00 | 2198-03-29 17:15:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with fevers despite appropriate ABX //
abscess, PNA?, worsening sterocolitis,
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.7 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 10.2 s, 66.4 cm; CTDIvol = 10.3 mGy (Body) DLP =
680.1 mGy-cm.
Total DLP (Body) = 685 mGy-cm.
COMPARISON: Chest CT ___. CT abdomen and pelvis ___.
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 demonstrate heterogeneous enhancement. However, no
discrete lesions are identified. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen demonstrates numerous hypoattenuating lesions, which
overall appear increased in size and number, with more confluent lesions
within the inferior pole (for example, 04:56).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A simple cyst of the lower pole of the right kidney measures 5.1 cm. Other,
smaller, subcentimeter renal hypodensities are too small to characterize.
There is no perinephric abnormality.
GASTROINTESTINAL: A gastrojejunostomy tube is in place, with the tip
terminating within jejunal loops within the low left pelvis. Small bowel
loops demonstrate normal caliber, wall thickness, and enhancement throughout.
There has been interval evacuation of the large stool ball within the rectum.
Mild rectal mucosal hyperenhancement. Mild rectal wall thickening and
presacral edema have not substantially changed. Surgical clips are seen at
the left lateral aspect of the rectum, from prior ulcer repair. Colonic
diverticulosis, without evidence of acute diverticulitis. Trace fluid is seen
along the bilateral paracolic gutters.
PELVIS: The bladder appears unremarkable. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal masses.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild anterolisthesis of L4 on L5 is likely degenerative. Multilevel
degenerative changes of the thoracolumbar spine are moderate.
SOFT TISSUES: Small, fat containing umbilical hernia. Subcutaneous edema
along the lateral abdominal walls.
IMPRESSION:
1. Interval increase in number and size of numerous hypodense splenic lesions,
with more confluent lesions within the inferior pole, concerning for splenic
microabscesses.
2. Interval evacuation of the rectal stool ball, with mild mucosal
hyperenhancement and no substantial change in mild wall thickening and
presacral edema, likely reflecting residual proctitis.
3. Please refer to the separate report of the chest CT performed on the same
day for intrathoracic characterization.
|
19970078-RR-264 | 19,970,078 | 22,135,897 | RR | 264 | 2198-03-29 15:38:00 | 2198-03-29 16:52:00 | EXAMINATION: CT CHEST W/CONTRAST ___
INDICATION: ___ year old woman with fevers despite appropriate ABX //
abscess, PNA?, worsening sterocolitis,
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 0.8 s, 0.2 cm; CTDIvol = 13.7 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 10.2 s, 66.4 cm; CTDIvol = 10.3 mGy (Body) DLP =
680.1 mGy-cm.
Total DLP (Body) = 685 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest CT scans since ___ most recently ___.
FINDINGS:
CHEST PERIMETER: No abnormal soft tissue the bed of the left thyroidectomy. 6
mm high-density tissue medial to the right common carotid artery or long the
trachea could be a thyroid remnant. There is no other abnormal tissue in the
thyroid bed.
Supraclavicular and axillary lymph nodes are not enlarged. Breast evaluation
is reserved exclusively for mammography. No soft tissue abnormality elsewhere
in the chest wall. Findings below the diaphragm including the progressive
enlargement of the spleen with multiple microabscesses will be reported
separately.
CARDIO-MEDIASTINUM: Esophagus is severely dilated, retaining fluid suggesting
functional or anatomic obstruction.
Atherosclerotic calcification is mild in head and neck vessels and coronary
arteries. Aorta and pulmonary arteries are normal size despite moderate
cardiomegaly. No pericardial effusion.
THORACIC LYMPH NODES: No lymph nodes in the mediastinum right hilum are
pathologically enlarged or growing. See discussion below for possible left
hilar adenopathy
LUNGS, AIRWAYS, PLEURAE: 13 mm wide well-circumscribed low-attenuation lesion
in the posterior basal segment, right lower lobe, 5:156, unchanged since
___ could be a small lung abscess.
Lobulated low-attenuation tissue in the left lower lobe adjacent to the lower
pole of the left hilum is larger, 5:133-146 could be a cluster lung abscesses,
reactive lymph nodes or even pneumonia.
Moderate nonhemorrhagic left pleural effusion layers posteriorly, presumably
reactive to either left hilar abnormality or, less likely in the absence of
subphrenic abscess, splenic abscesses.
CHEST CAGE: Unremarkable. No evidence of infection or malignancy.
IMPRESSION:
Compared to ___:
Stable small right lung abscess, but growing left perihilar abscesses,
infected lymph nodes or pneumonia.
Moderate nonhemorrhagic non serous left pleural effusion has also increased.
Growing splenomegaly due to worsening microabscesses.
Stable severely dilated full length, esophagus, either functionally or
anatomically obstructed.
|
19970078-RR-265 | 19,970,078 | 22,135,897 | RR | 265 | 2198-03-31 09:28:00 | 2198-03-31 14:27:00 | EXAMINATION: SPLEEN ULTRASOUND
INDICATION: ___ year old woman with splenic microsbceses // Per ___, Order for
Feasibility US to evaluate for splenic abscess aspirationPatient should not
have portable US
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
The spleen measures 9.4 cm in AP dimension. Throughout essentially the entire
spleen, there are numerous near completely anechoic lesions, many
well-circumscribed, which measure up to 1.6 cm within the anterior inferior
spleen. Additionally, several of these lesions demonstrate central
echogenicity in a bull's eye/targetoid appearance. No definite internal flow
is seen within the visualized lesions. The tip of the left hepatic lobe
drapes over the spleen. There is a small to moderate left pleural effusion.
IMPRESSION:
1. Numerous splenic lesions measuring up to 1.6 cm, which in the current
clinical setting most likely represent abscesses (fungal or bacterial).
Aspiration would likely need to be performed with CT and concurrent ultrasound
guidance.
2. Small to moderate left pleural effusion.
|
19970078-RR-267 | 19,970,078 | 22,135,897 | RR | 267 | 2198-04-01 12:46:00 | 2198-04-01 17:37:00 | EXAMINATION: CT-guided intervention
INDICATION: ___ year old woman with glioblastoma, intermittent fevers on abx
with growing splenic abscesses. // Pls biopsy splenic abscess
COMPARISON: Spleen ultrasound ___ and CT abdomen and pelvis ___
PROCEDURE: CT-guided splenic abscess biopsy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee during the
key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: Initial order for the procedure was for aspiration and culture.
After discussion between ___, MD ___, MD prior to the
procedure, the decision was made to only send for pathology if the aspirate
did not appear consistent with suspected splenic abscess. Pre-emptive
pathology orders were placed in case this were the situation with the
understanding that pathology would not be obtained if aspirate appeared
infectious.
The risks, benefits, and alternatives of the procedure were explained to the
patient's healthcare proxy prior to the procedure. After a detailed
discussion, informed written consent was obtained. A pre-procedure timeout
using three patient identifiers was performed per ___ protocol.
The patient was administered general anesthesia and placed in a left anterior
oblique position on the CT scan table. Limited preprocedure CT scan of the
intended FNA area was performed. Based on the CT findings an appropriate
position for the FNA was chosen. The site was marked.
The site was prepped and draped in the usual sterile fashion. Under CT
guidance, a 18 gauge coaxial needle was introduced into the lesion. The
lesion was aspirated with a 10 cc syringe with aspiration of approximately cc
of bloody and purulent fluid. The biopsy specimen was sent for culture.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 15.7 cm; CTDIvol = 11.7 mGy (Body) DLP = 186.2
mGy-cm.
2) Spiral Acquisition 3.3 s, 17.7 cm; CTDIvol = 11.5 mGy (Body) DLP = 207.0
mGy-cm.
3) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
4) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
5) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
6) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
7) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
8) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
9) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
10) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
11) Free Acquisition 0.5 s, 1.2 cm; CTDIvol = 3.5 mGy (Body) DLP = 4.2
mGy-cm.
Total DLP (Body) = 431 mGy-cm.
SEDATION: General anesthesia was provided by the anesthesia team the total
intra service time 37 minutes. Following the procedure, the patient was
extubated and recovered in the postoperative care unit.
FINDINGS:
Multiple hypodense splenic lesions, some discrete but overall less conspicuous
due to lack of intravenous contrast, were redemonstrated. A 1.1 cm
hyperattenuating lesion ___ 114) within the interpolar region of the left
kidney (3: 20) is consistent with a hemorrhagic cyst. Small left pleural
effusion is partially visualized. Percutaneous gastrostomy tube is also
partially seen.
IMPRESSION:
Technically successful CT-guided aspiration of hemorrhagic and purulent
material from hypodense splenic lesion. The sample was sent for microbiology.
|
19970078-RR-268 | 19,970,078 | 22,135,897 | RR | 268 | 2198-04-02 09:02:00 | 2198-04-02 11:30:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with picc // picc placement picc
placement
IMPRESSION:
Comparison to ___. The right PICC line shows a normal course.
The tip of the line projects over the lower SVC. No evidence of
complications, notably no pneumothorax. The known pleural effusion on the
left has slightly increased.
|
19970078-RR-269 | 19,970,078 | 22,135,897 | RR | 269 | 2198-04-02 09:27:00 | 2198-04-02 17:52:00 | EXAMINATION: BILAT UP EXT VEINS US
INDICATION: ___ year old woman with evaluate DVT. Swelling in left arm as well
as right arm near PICC. Patient with cancer. Hypercoagulable // Please
evaluate right and left upper extremity for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the bilateral
upper extremity veins.
COMPARISON: No relevant prior studies available for comparison.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The bilateral internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The bilateral
basilic, and cephalic veins are patent, compressible and show normal color
flow.
A PICC line is seen within the right brachial, axillary, and subclavian veins.
IMPRESSION:
No evidence of deep vein thrombosis in the bilateral upper extremities.
|
19970078-RR-270 | 19,970,078 | 22,135,897 | RR | 270 | 2198-04-07 11:32:00 | 2198-04-07 15:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with left pleural effusion // eval for PTX
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
Right PICC line tip projects over the cavoatrial junction. Lung volumes are
low. Cardiac silhouette is normal. Significant interval decrease in size of
left pleural effusion, no appreciable accumulation of pleural fluid. No
pulmonary vascular congestion. There is no pneumothorax. Severe left lower
atelectasis is seen, with shift of hilar surfaces inferiorly.
IMPRESSION:
Significantly improved left pleural effusion. Severe left lower lobe
atelectasis. No pneumothorax.
|
19970078-RR-271 | 19,970,078 | 22,135,897 | RR | 271 | 2198-04-07 14:12:00 | 2198-04-07 14:51:00 | EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: ___ year old woman with recent ___ // Rapid breathing
Rapid breathing
IMPRESSION:
Compared to chest radiographs since ___ most recently today at 11:40
a.m..
New opacification in the left hemithorax marginated by the major fissure could
be fissural pleural effusion or consolidation in the left upper lobe. Lateral
view, if practical, strongly recommended for assessment. Heart size is normal
but increased since earlier in the day.
Right lung is grossly clear. No right pleural effusion.
Right PIC line ends in the low SVC.
NOTIFICATION: The findings were discussed with ___ (___), by ___
___, M.D. on the telephone at 2:45 p.m., immediately following discovery of
the findings.
|
19970078-RR-272 | 19,970,078 | 22,135,897 | RR | 272 | 2198-04-08 17:57:00 | 2198-04-08 20:06:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with PICC in place that may have been dislodged
// assess picc placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of a right PICC projects over the cavoatrial junction. Increased
retrocardiac opacities likely reflect atelectasis and layering pleural fluid.
Mild pulmonary edema is present. There is no consolidation or pleural
effusion on the right. The size of the cardiomediastinal silhouette is
enlarged.
IMPRESSION:
The tip of the right PICC projects over the cavoatrial junction.
Mild pulmonary edema and increased left lower lobe atelectasis and small
volume pleural fluid.
|
19970101-RR-46 | 19,970,101 | 22,502,365 | RR | 46 | 2187-05-18 14:20:00 | 2187-05-18 14:42:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with parapneumonic pleural effusion with right
TPC for home drainage// eval for change
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 20 hours prior.
FINDINGS:
Mild cardiomegaly is unchanged compared to the prior exam. Compared to the
scout images from the chest CT performed on ___, there appears to
be interval improvement of the right-sided pleural effusion. No evidence of
pneumothorax. Visualized osseous structures are grossly unremarkable. Mild
pulmonary vascular congestion is unchanged.
IMPRESSION:
-Overall, compared to the scout images from the chest CT performed on ___, there appears to be interval improvement of the right-sided
pleural effusion.
-Stable mild pulmonary vascular congestion.
|
19970101-RR-47 | 19,970,101 | 22,502,365 | RR | 47 | 2187-05-20 20:25:00 | 2187-05-20 21:14:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ w/ CAD s/p PCI (___) c/b in-stent thrombosis in ___ now on
ASA and ticagrelor and recent admission for R-sided empyema c/b MSSA s/p chest
tube placement ___ c/b trapped lung and pleurex placed ___, who presented
this admission for progressive dyspnea concerning for PE.// PE?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 40.2 cm; CTDIvol = 12.6 mGy (Body) DLP = 506.9
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 1.8 s, 0.5 cm; CTDIvol = 9.9 mGy (Body) DLP = 5.0
mGy-cm.
Total DLP (Body) = 513 mGy-cm.
COMPARISON: CT chest on ___
FINDINGS:
HEART AND VASCULATURE: The main pulmonary artery is mildly dilated up to 3.0
cm in the right pulmonary artery is mildly dilated up to 3.1 cm, suggestive of
pulmonary arterial hypertension. Pulmonary vasculature is well opacified to
the subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta has heavy atherosclerotic calcification and the ascending
aorta is mildly dilated up to 4.3 cm, and the descending aorta is mildly
dilated up to 3.1 cm, not significantly changed. There is common origin of
the right brachiocephalic artery and the left common carotid artery. The
heart, pericardium, and great vessels are within normal limits. No pericardial
effusion is seen. A right-sided central venous catheter terminates in the low
SVC.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: A pigtail catheter terminates in a small right pleural
effusion containing foci of air, not significantly changed. No left pleural
effusion or pneumothorax.
LUNGS/AIRWAYS: There is stable emphysema. Compared with CT chest on ___ there are new nodular and ground-glass opacities in the left
lower lobe as well as in the posterior right lower lobe (2:70,76; 301:8,102).
Compressive atelectasis at the right lung base is stable. Subpleural
reticular changes suggestive of interstitial lung disease are stable.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: There is cholelithiasis. There is heavy atherosclerotic
calcification in the upper abdominal aorta and its branches. Included portion
of the upper abdomen is otherwise unremarkable.
BONES: The bones are diffusely demineralized. There are degenerative changes
in the thoracic spine and at the bilateral sternoclavicular joints. No
suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. New nodular ground-glass opacities in the bilateral posterior lower lobes,
in a distribution most suggestive of aspiration.
3. A pigtail catheter terminates in a small right pleural effusion which
contains small foci of air, not significantly changed.
4. Cholelithiasis.
|
19970101-RR-48 | 19,970,101 | 22,502,365 | RR | 48 | 2187-05-24 14:43:00 | 2187-05-24 16:34:00 | EXAMINATION: Chest radiograph, portable AP upright view.
INDICATION: Right-sided empyema and coronary artery disease.
COMPARISON: Radiographs are available from ___ and more recent
chest CT dated ___.
FINDINGS:
Right-sided PICC line terminates at the cavoatrial junction. Cardiac,
mediastinal and hilar contours appear stable including slightly dilated
tortuous aorta. Chest tube again projects over the base of the right
hemithorax. This resides in a probably unchanged small to medium size right
pleural collection with persistent atelectasis at the right lung base. Patchy
opacities in the left lung seem to have improved. Possible trace pleural
effusion on the left. No pneumothorax.
IMPRESSION:
PICC line terminating at the cavoatrial junction.
|
19970466-RR-28 | 19,970,466 | 26,762,325 | RR | 28 | 2151-05-21 23:09:00 | 2151-05-22 08:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HfrEF, COPD, on 2L 94% having increased
SOB and wheezes. // eval fluid, pneumonia
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume with increasing pulmonary vascular congestion. Bilateral
effusions left greater than right are unchanged. The aorta is tortuous. A
stent is seen within the aorta. No pneumothorax. Stable cardiomediastinal
silhouette. No evidence of pneumonia
|
19970892-RR-19 | 19,970,892 | 25,899,573 | RR | 19 | 2116-06-14 08:52:00 | 2116-06-14 09:41:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with absent motor diminished sensation ___ // ?bleed or fx
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 3.0 s, 6.2 cm; CTDIvol = 48.9 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: CT head without contrast from ___
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
A small area of scalp stranding consistent with known forehead abrasion
without underlying fracture. The imaged paranasal sinuses are clear. Mastoid
air cells and middle ear cavities are well aerated. The patient is status post
surgical fixation of prior left facial bone fractures.
IMPRESSION:
1. Small area of scalp stranding consistent with known forehead abrasion.
2. No hemorrhage or large territorial infarction identified.
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19970892-RR-20 | 19,970,892 | 25,899,573 | RR | 20 | 2116-06-14 08:52:00 | 2116-06-14 10:02:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with absent motor diminished sensation ___ // ?bleed or fx
TECHNIQUE: Non-contrast helical multidetector CT was performed through the
cervical spine. Soft tissue and bone algorithm images were generated. Coronal
and sagittal reformations were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.8 s, 22.6 cm; CTDIvol = 37.3 mGy (Body) DLP = 842.4
mGy-cm.
Total DLP (Body) = 842 mGy-cm.
COMPARISON: C-spine CT from ___
FINDINGS:
Alignment is normal. No fractures are identified. There is no evidence of
spinal canal or neural foraminal stenosis. There is no prevertebral soft
tissue swelling.
Thyroid and lung apices are unremarkable.
IMPRESSION:
No fracture or traumatic malalignment.
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19970892-RR-21 | 19,970,892 | 25,899,573 | RR | 21 | 2116-06-14 10:37:00 | 2116-06-14 14:07:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ man with history of intentional overdose of Xanax
last night, now with absent motor function below the hips and decreased
sensation. Evaluate for cord abnormality or infarction.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique.
Axial T2 imaging was performed of the thoracic spine. Axial MERGE imaging was
performed of the cervical spine. Sagittal diffusion weighted imaging of the
cervical and thoracic spines were also obtained.
COMPARISON: ___, cervical spine CT without contrast.
___, cervical spine CT without contrast.
FINDINGS:
Study is moderately degraded by motion. Thoracic spine diffusion images are
nondiagnostic. Within these confines:
CERVICAL:
Alignment is normal. Vertebral body and intervertebral disc signal intensity
appear normal. The spinal cord appears normal in caliber and configuration.
There is no evidence of spinal canal or neural foraminal narrowing. There is
no definite slowed diffusion of the cervical spinal cord.
THORACIC and LUMBAR:
Alignment is normal. T12 superior endplate Schmorl's node is noted.
Vertebral body and intervertebral disc signal intensity appear
normal.Increased T2 and water signal in the gray matter, including anterior
and posterior horns, throughout the entire thoracic and lumbar spinal cord is
present (see series 11 and series 12). The conus medullaris terminates at the
level of L2. There is no epidural collection or evidence of hemorrhage. There
is no evidence of spinal canal or neural foraminal narrowing.
OTHER: Incidental note of a punctate T2 hyperintense focus in the interpolar
left kidney (12:31), which is incompletely characterize but may represent a
millimetric cyst. Small amount of fluid signal in the lumbar soft tissues is
incidentally noted (15:14).
IMPRESSION:
1. Study is moderately degraded by motion, and further limited by
nondiagnostic thoracic spine diffusion imaging.
2. Signal abnormality in the anterior and posterior columns of the entire
thoracic and lumbar spinal gray matter, concerning for cord infarction with
differential considerations of transverse myelitis.
3. Within limits of study, no definite evidence of fracture, epidural
hemorrhage, or cervical spinal cord infarction.
4. Nonspecific lumbosacral soft tissue edema.
NOTIFICATION: The above findings were communicated via telephone by Dr.
___ to Dr. ___ at 13:43 on ___, 5 min after discovery.
Additionally, findings were communicated via telephone by Dr. ___ to Dr.
___ at 14:00 on ___, 20 min after discovery.
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19970892-RR-22 | 19,970,892 | 25,899,573 | RR | 22 | 2116-06-15 18:11:00 | 2116-06-15 18:37:00 | INDICATION: ___ year old man with new picc // Right brachial 44cm picc
placed, ? tip position B# ___ Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: None available
FINDINGS:
The tip of a right PICC line projects over the cavoatrial junction.
No focal consolidation, pleural effusion or pneumothorax identified. The size
of the cardiac silhouette is within normal limits.
IMPRESSION:
The tip of a right PICC line projects over the cavoatrial junction. No
pneumothorax.
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19970892-RR-23 | 19,970,892 | 25,899,573 | RR | 23 | 2116-06-17 13:18:00 | 2116-06-17 17:13:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old man with spastic paraplegia concerning for transverse
myelitis vs cord infarct. // ?brain lesions
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 9 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Head CT ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. There is no abnormal enhancement after contrast
administration.
IMPRESSION:
1. Normal brain MRI.
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19970892-RR-24 | 19,970,892 | 25,899,573 | RR | 24 | 2116-06-17 13:18:00 | 2116-06-17 17:31:00 | EXAMINATION: MR ___ ANDW/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with new flaccid paraplegia, sensory level //
Re-evaluate spinal cord for infarct vs TM, obtain with MRI brain ___ year
old man with new flaccid paraplegia, sensory level // Re-evaluate spinal cord
for infarct vs TM, obtain with MRI brain Re-evaluate spinal cord for
infarct vs TM, obtain with MRI brain
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 9 mL of
Gadavist contrast agent.
COMPARISON: MR thoracic spine ___.
FINDINGS:
Again seen is hyperintensity in the thoracic spinal cord. This appears more
extensive than on the prior examination, now involving the spinal cord at the
C7-T1 level and inferiorly to the conus. The upper thoracic spinal cord
appears enlarged, a new finding since the prior study. Axial T2 weighted
images demonstrate more extensive involvement of the central spinal cord.
Although in some locations the gray matter predominant pattern persist, and
others there is more uniform involvement of the central white matter as well
as gray matter. There is no abnormal enhancement after contrast
administration.
The findings are most suspicious for infarction, given the gray matter
predominance. This pattern would not be typical for other inflammatory
causes.
Alignment is normal. Vertebral body and intervertebral disc signal intensity
appear normal. The spinal cord appears normal in caliber and configuration.
There is no evidence of spinal canal or neural foraminal narrowing. There is
no evidence of infection or neoplasm.
IMPRESSION:
1. Progression of spinal cord swelling and signal intensity abnormality since
the study of ___. The gray matter predominant pattern continues
to suggest infarction as the most likely etiology.
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Subsets and Splits