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19970934-RR-3 | 19,970,934 | 28,543,557 | RR | 3 | 2113-06-07 01:53:00 | 2113-06-07 02:43:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ woman with abdominal pain, vomiting, and elevated
lipase. Evaluate for pancreatitis.
TECHNIQUE: MDCT acquired axial images of the abdomen and pelvis were obtained
after administration of 130 mL Omnipaque intravenous contrast using split
bolus technique. Enteric contrast was not given. Coronal and sagittal
reformats prepared and reviewed.
DOSE: DLP: 291.15 mGy-cm.
COMPARISON: Abdominal ultrasound from ___ at 18:58 performed at
___.
FINDINGS:
CHEST:
There is no abnormality in the imaged portion of the lower chest.
ABDOMEN:
The liver is markedly hypoattenuated diffusely. There are no concerning
focal liver lesions. The gallbladder and biliary tree are normal. The pancreas
is normal, without focal lesion or duct dilation. There are no inflammatory
changes associated with the pancreas. The spleen is normal in size, without
focal lesion. The adrenal glands are normal. There is severe right renal
cortical atrophy secondary to chronic hydroureteronephrosis from an
obstruction of the distal ureter at the ureterovesicular junction, likely
secondary to a diverticulum. The left kidney enhances and excretes contrast
normally. The stomach and duodenum are normal. The small bowel and large bowel
are normal in caliber, without wall thickening or mass. There is sigmoid
diverticulosis without evidence of diverticulitis.
There is no intra- or retroperitoneal lymphadenopathy. There is no ascites,
fluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,
with patent main branches. The portal vein and IVC are patent. A retroaortic
left renal vein is incidentally noted.
PELVIS:
The bladder is collapsed around a Foley catheter balloon. The rectum is
unremarkable. There is no pelvic mass. There is no free fluid. There is no
pelvic or inguinal lymphadenopathy.
BONES AND SOFT TISSUES:
There is no acute fracture. There are no destructive osseous lesions
concerning for malignancy or infection. There are no soft tissue masses.
IMPRESSION:
1. Diffuse hypoattenuation of the liver, consistent with hepatic steatosis,
but hepatitis can present similarly.
2. There is no biliary obstruction or cholecystitis.
3. Normal CT appearance of the pancreas.
|
19970991-RR-17 | 19,970,991 | 23,925,038 | RR | 17 | 2145-04-02 21:12:00 | 2145-04-02 22:02:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old man with L knee pain// evaluate for effusion,
erosion, fracture evaluate for effusion, erosion, fracture
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the left knee.
COMPARISON: None
FINDINGS:
No fracture or dislocation is seen. There is severe tract compartmental
degenerative change, most pronounced around the patellofemoral component air
there is also a patella baja. There is a small to moderate left knee joint
effusion. There is normal osseous mineralization. No suspicious lytic or
sclerotic lesions are identified.
IMPRESSION:
Severe tricompartmental degenerative change, most pronounced around the
patellofemoral compartment. Patella baja.
|
19970991-RR-18 | 19,970,991 | 23,925,038 | RR | 18 | 2145-04-06 08:19:00 | 2145-04-06 15:51:00 | EXAMINATION: MR CALF ___ CONTRAST RIGHT
INDICATION: ___ yo male with history of DMII, L knee osteoarthritis,presenting
with R leg pain, pulse deficit, edema, fevers, and leukocytosis without
improvement in leg and ongoing fevers// concern for osteo- erythema below knee
into the RT foot.
TECHNIQUE: Multiplanar images of the right calf were performed with the
administration of intravenous contrast using a calf MR protocol.
COMPARISON: Radiograph ___. CTA runoff ___.
FINDINGS:
There is diffuse subcutaneous edema throughout the right calf. In addition,
there is diffuse muscular edema, most prominent in the anterior compartment
involving the anterior tibialis muscle. No evidence of drainable fluid
collections or rim enhancing collections.
There is a T1 hypointense, T2 hyperintense, enhancing multilobulated lesion
extending along the tibiofibular joint, most consistent with a intraosseous
ganglion, corresponding to subchondral cysts seen on prior CT (13:15, 7:15,
3:8). Otherwise, the bone marrow is preserved without MRI evidence of
osteomyelitis.
The superficial gastrocnemius veins appear enlarged with inhomogeneous
postcontrast enhancement and mild perivascular STIR hyperintensity which could
represent thrombosis in the appropriate clinical setting versus slow flow
(16:22).
IMPRESSION:
1. No evidence of drainable fluid collections or rim enhancing lesions. No MRI
evidence of osteomyelitis.
2. Diffuse subcutaneous edema which likely represents cellulitis in the
appropriate clinical setting.
3. Fascial and muscular edema, most prominent anterior compartment muscles,
which is nonspecific but may represent myositis.
4. Heterogeneous enhancement of enlarged superficial gastrocnemius veins may
represent thrombosis in the appropriate clinical setting. Lower extremity
ultrasound is recommended if clinical concern is present.
5. Incidental tibiofibular intraosseous ganglion.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 3:46 pm, 5 minutes
after discovery of the findings.
|
19970991-RR-19 | 19,970,991 | 23,925,038 | RR | 19 | 2145-04-06 08:20:00 | 2145-04-06 12:01:00 | EXAMINATION: MRI MSK PELVIS WANDW/O CONTRAST
INDICATION: ___ year old man with DM2, edema, persistent fevers with RT groin
inflammation and left calf cellulitis// Patient has very bad lower left leg
cellulitis also has focus on the right groin would ideally want both sites
imaged as concern for abscess or osteo
TECHNIQUE: Multiplanar multisequence MR imaging of the pelvis was performed
before and after intravenous administration of 7 cc Gadavist contrast.
COMPARISON: ___ abdomen and pelvis CT
FINDINGS:
The study is motion degraded. Additionally, there is distortion of the
magnetic field along the superior aspect of the field of view, limiting
evaluation of the superior portion of the iliac crest. Bone marrow signal in
the pelvis is diffusely heterogeneous on T1 weighted images without suspicious
focal lesions. There is no definite bone marrow signal abnormality on STIR.
The femoroacetabular joints are congruent bilaterally. There is no
significant effusion.
There is moderate subcutaneous and fascial edema in the right lower extremity
and scrotum. There is mild subcutaneous and fascial edema in the left lower
extremity. There is mild edema in the mid back and paraspinal musculature.
There is no fluid collection. Redemonstrated are bilateral prominent inguinal
lymph nodes are likely reactive. A fat containing left inguinal hernia is
also unchanged.
IMPRESSION:
1. Moderate subcutaneous and fascial edema in the right lower extremity and
scrotum and mild edema in the left lower extremity and the mid back is
nonspecific, but can be seen with cellulitis. There is mild patchy
nonspecific edema in the musculature. There is no evidence of a rim enhancing
fluid collection to suggest abscess formation.
2. Mildly heterogeneous red bone marrow signal in the pelvis without
suspicious focal lesions or evidence of osteomyelitis.
|
19970991-RR-20 | 19,970,991 | 23,925,038 | RR | 20 | 2145-04-07 14:42:00 | 2145-04-07 16:33:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with DM2, edema, fevers, and right lower leg
ulcerations// DVT in lower calf
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
A prominent, but morphologically normal lymph node is identified within the
right groin measuring 3.2 x 1.3 x 4.1 cm, as expected with the provided
clinical history.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19970991-RR-21 | 19,970,991 | 23,925,038 | RR | 21 | 2145-04-18 22:32:00 | 2145-04-18 22:52:00 | INDICATION: 58 PMH T2DM, HLD, CVA p/w RLE pain and fevers c/f deep space
infection now s/p I D RLE, now wound vac, clean LLE with unexplained fevers//
?consolidation/effusion/
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
There are small bilateral pleural effusions, right greater than left, which
are new since prior. Bibasilar opacities may reflect atelectasis and/or
consolidation. Pulmonary vascular congestion is also noted without definite
evidence of pulmonary edema. The size of the cardiac silhouette is within
normal limits.
|
19971094-RR-8 | 19,971,094 | 27,853,347 | RR | 8 | 2187-03-10 15:18:00 | 2187-03-10 17:39:00 | INDICATION: ___ with R abd/chest pain // eval PNA
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
There is evidence of right apical scarring and possible calcified node at the
right hilum. Opacity at the right cardiophrenic angle is felt most likely to
be a fat pad as seen on the lateral view. Elsewhere, lungs are clear. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19971094-RR-9 | 19,971,094 | 27,853,347 | RR | 9 | 2187-03-10 14:37:00 | 2187-03-10 17:11:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ/chest pain // eval gallstones, cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
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. The CHD measures 4 mm.
GALLBLADDER: Gallstone seen at the gallbladder neck. The gallbladder is
otherwise unremarkable without wall thickening or significant distention or
pericholecystic fluid.
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, measuring 9.6 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis. A simple
cyst is seen within the upper pole of the left kidney, measuring approximately
2.2 cm x 1.8 cm x 2.1 cm.
IMPRESSION:
Cholelithiasis with a gallstone seen at the gallbladder neck. No other
evidence of acute cholecystitis.
|
19971290-RR-8 | 19,971,290 | 21,456,551 | RR | 8 | 2122-03-03 04:52:00 | 2122-03-03 08:12:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with recent diagnosis of PE, imaging with pleural
effusion on L, now with crackles on R// Pleural effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CTA from ___ at 16:48.
Chest radiograph from ___ at 23:45
FINDINGS:
The large area of peripheral consolidation at the left lung base, accompanied
by small left pleural effusion, comparable to the appearance on chest CTA
___, is in the area of greatest arterial thrombosis and could be a large
pulmonary infarction. Peribronchial opacification at the right lung base is
new. This could be atelectasis, early infarction, or even early pneumonia.
Heart size may be slightly larger today than on the chest CTA but there is
abundant mediastinal fat making at determination difficult. The upper lungs
are clear and there is no pulmonary edema. No pneumothorax.
IMPRESSION:
Moderately extensive left lower lobe infarction or atelectasis and small
pleural effusion unchanged.
New abnormality at the right lung base could be atelectasis, developing
infarction or coincidental pneumonia.
|
19971290-RR-9 | 19,971,290 | 21,456,551 | RR | 9 | 2122-03-03 20:25:00 | 2122-03-03 21:09:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with bilateral pulmonary embolism, left leg>
right leg in setting of semidistant knee replacement// ?DVT, ?clot burden
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: CT from ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
There is a right popliteal ___ cyst which measures 1.9 x 1.2 x 1.1 cm.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins.
2. 1.9 cm right popliteal ___ cyst.
|
19972355-RR-14 | 19,972,355 | 25,983,396 | RR | 14 | 2114-03-15 21:53:00 | 2114-03-15 23:02:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Chest CT from outside hospital.
CLINICAL HISTORY: Fall down stairs with report of left rib fractures.
FINDINGS: Portable AP upright chest radiograph is obtained. The lungs appear
clear bilaterally without focal consolidation, effusion, or pneumothorax. A
left fifth rib fracture seen on CT is not evident on this chest radiograph.
Cardiomediastinal silhouette appears normal.
IMPRESSION: No acute findings. Please refer to CT chest from outside
hospital for further details.
|
19972355-RR-16 | 19,972,355 | 25,983,396 | RR | 16 | 2114-03-15 22:03:00 | 2114-03-16 00:07:00 | INDICATION: ___ woman status post fall.
COMPARISON: None.
TECHNIQUE: CT with contrast was obtained through the chest and upper abdomen.
Delayed images were also provided. Coronal and sagittal reformats were
provided. These images were obtained from an outside hospital and uploaded
for second read review by a radiologist at the ___
___.
CT OF THE CHEST: A small left bleb is noted within the lower lung (series 8,
image 16). There is no evidence of pneumothorax, focal consolidation or
pleural effusion. The visualized heart and pericardium are unremarkable. The
great vessels are within normal limits. Mediastinal, axillary and hilar lymph
nodes ___ not meet size criteria for pathologic enlargement. A 6mm cavitary
nodule in the left upper lobe anterior segment surrounded by ground glass
opacity is noted (4, 45). Calcification of the right thyroid lobe is noted.
This study is not optimized for subdiaphragmatic review. Within this
limitation, a small hypodensity is noted within the left lobe of the liver (7,
20) which is too small to characterize. The patient is status post
cholecystectomy. The spleen, pancreas, and bilateral adrenal glands appear
unremarkable. The common bile duct is mildly prominent, likely reflecting
post-cholecystectomy state. It measures approximately 8 mm. Both kidneys
enhance symmetrically without evidence of hydronephrosis. Hypodensities are
noted within bilateral kidneys, some of which are too small to characterize.
The largest hypodensity within the interpolar region of the left kidney
measures approximately 16 mm. An interpolar fat density lesion in the right
kidney measuring 1cm appears consistent with an angiomyolipoma. There is no
free air or free fluid within the visualized portions of the upper abdomen.
A left anterolateral fifth rib fracture and possible fourth rib fracture is
identified. Minimally displaced transverse process fractures of the L2 and L3
vertebral bodies are identified and are better delineated on the same day
lumbar CT spine study. There is S-shaped scoliosis with rightward convexity
in the upper thoracic portion and leftward convexity in the lower
thoracolumbar portion.
IMPRESSION:
1. Anterolateral left 4, ___ acute rib fractures.
2. Left L2 and L3 transverse process fractures, better delineated on the same
day lumbar spine CT scan.
3. 6mm cavitary nodule in the left upper lobe anterior segment with vague
surrounding ground-glass opacity. Recommend ___ month followup.
4. Small bleb at the left lung with no evidence of pneumothorax.
5. Bilateral renal hypodensities, some of which are too small to characterize
but likely representing renal cysts; the largest in the left interpolar region
measures 16 mm.
6. Right kidney angiomyolipoma. Renal cysts.
7. Hepatic hypodensity within the left lobe of the liver is too small to
characterize but statistically likely represents a simple cyst or hemangioma.
Findings discussed with Dr. ___ at 10:40 p.m. on ___ in person.
|
19972355-RR-17 | 19,972,355 | 25,983,396 | RR | 17 | 2114-03-15 22:18:00 | 2114-03-15 23:02:00 | INDICATION: ___ female status post fall from 10 feet.
COMPARISON: None.
TECHNIQUE: Contiguous axial images were obtained through the cervical spine
without the administration of IV contrast. Multiplanar reformats were
generated and reviewed.
FINDINGS: There is no evidence of acute fracture. There is a grade I
anterolisthesis of C4 on C5, likely chronic and related to ___ disease as
there is no accompanying soft tissue swelling or interspinous widening on CT
to suggest an acute hyperflexion injury. Otherwise, alignment is preserved.
Mild degenerative disc disease is noted in the C-spine. The atlanto-occipital
and atlanto-axial articulations are intact. The prevertebral soft tissues are
well maintained. Calcified nodule is noted within the right thyroid lobe.
Bilateral mastoid air cells are clear.
IMPRESSION: No acute fracture. Grade I anterolisthesis of C4 on C5 is likely
chronic though correlation for focal pain is recommended.
|
19972355-RR-18 | 19,972,355 | 25,983,396 | RR | 18 | 2114-03-15 22:19:00 | 2114-03-15 23:13:00 | INDICATION: ___ female status post fall from 10 feet with lumber
spine tenderness.
COMPARISON: None.
TECHNIQUE: Contiguous axial images were obtained through the lumbar spine
without the administration of IV contrast. Multiplanar reformats were
generated and reviewed.
FINDINGS: Displaced left transverse process fractures are noted at L2, L3 and
L4 lumbar vertebrae. Otherwise no acute fracture. Degenerative changes
including Schmorl's nodes are noted at the inferior endplate of the L2
vertebral body.
An interpolar fat density lesion in the right kidney measuring 1 cm appears
consistent with an angiomyolipoma. Hypodensities likely representing cysts are
noted within the visualized kidneys better delineated on the same day CT of
the chest.
IMPRESSION:
1. Displaced fractures of the L2, L3, and L4 left transverse processes of the
lumbar vertebrae. Findings discussed with Dr. ___ at ___.
2. Right renal 1-cm angiomyolipoma. Renal cysts.
|
19972355-RR-19 | 19,972,355 | 25,983,396 | RR | 19 | 2114-03-16 11:02:00 | 2114-03-16 15:20:00 | EXAM: MRI of the cervical spine.
CLINICAL INFORMATION: Patient with trauma, rule out ligamentous injury.
TECHNIQUE: T1, T2, and inversion recovery sagittal, gradient echo and T2
axial, and diffusion sagittal images of the cervical spine were acquired.
Correlation was made with the cervical spine CT of ___.
FINDINGS: From skull base to T2 level, there is no abnormal signal seen
within the vertebral bodies to indicate marrow edema. Although mild increased
signal is identified in the posterior soft tissues on the sagittal inversion
recovery images which extends to the interspinous regions from C2-3 to C4-5
level, there is no evidence of ligamentous disruption identified. There is no
evidence of prevertebral hematoma seen.
Degenerative changes are identified with disc bulging from C3-4 to C6-7. Mild
foraminal narrowing bilaterally is seen at C4-5 and C5-6 levels. There is no
extrinsic spinal cord compression seen. There are no intrinsic spinal cord
signal abnormalities identified. The vascular flow voids are maintained. The
prevertebral soft tissue thickness is maintained.
IMPRESSION: No evidence of ligamentous disruption seen but mild increased
signal in the posterior soft tissues and interspinous ligaments indicate mild
traumatic injury. No evidence of spinal cord compression or intrinsic spinal
cord signal abnormalities or intraspinal hematoma seen. Mild multilevel
degenerative changes noted.
|
19972371-RR-9 | 19,972,371 | 26,223,444 | RR | 9 | 2155-08-15 17:31:00 | 2155-08-15 18:01:00 | CHEST RADIOGRAPH
HISTORY: Fever and immunosuppression.
COMPARISONS: A CT torso examination is available from ___.
TECHNIQUE: Chest, AP portable.
FINDINGS: The heart is normal in size. There is mild unfolding of the
thoracic aorta. The mediastinal and hilar contours appear unchanged. The
lungs appear clear. A nipple shadow is visualized on the left. A deformity
of the left proximal humerus appears similar allowing for differences in
technique. There is mild leftward convex curvature centered along the lower
thoracic spine.
IMPRESSION: No evidence of acute disease.
|
19972786-RR-112 | 19,972,786 | 23,470,157 | RR | 112 | 2204-08-23 13:51:00 | 2204-08-23 14:58:00 | INDICATION: History: ___ with left hip pain x2 days// assess for hip fracture
or dislocation?
TECHNIQUE: AP view of the pelvis and AP and lateral views of the left hip and
femur
COMPARISON: ___
FINDINGS:
Moderate bilateral hip degenerative changes are seen. No acute fracture or
dislocation is seen. No suprapatellar joint effusion is seen. Mild to
moderate degenerative changes at the left knee are seen. There is
chondrocalcinosis at the left knee joint, at least in the lateral joint
compartment. There are extensive vascular calcifications.
Acute fracture of the anterior, inferior L4 vertebra was better assessed on
preceding CT.
IMPRESSION:
No acute fracture or dislocation of the left hip or left femur.
Acute fracture of the anterior, inferior L4 vertebra was better assessed on
preceding CT.
Left knee chondrocalcinosis.
|
19972786-RR-113 | 19,972,786 | 23,470,157 | RR | 113 | 2204-08-23 13:35:00 | 2204-08-23 14:03:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ w/ CHF, CKD (Cr 1.2-1.3), dementia presenting for LLQ and L
hip pain x2 days, significantly worse with movement or flexion of hip// cause
for LLQ pain and L hip pain- diverticulitis, abscess, avascular necrosis?-
please extend to include L pelvis/hip joint and proximal half of L thigh
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.7 s, 53.1 cm; CTDIvol = 11.8 mGy (Body) DLP = 627.0
mGy-cm.
Total DLP (Body) = 627 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: There is a small left pleural effusion with associated
compressive atelectasis, unchanged from prior study. There is mild right
basilar atelectasis. Otherwise, visualized lung fields are within normal
limits. There are extensive coronary artery and aortic valve atherosclerotic
calcifications. There is no evidence of pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits. There is a small amount
of perihepatic ascites.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: There is thickening of the lateral limb of the left adrenal gland
without discrete nodule. Otherwise, the right adrenal gland is normal in size
and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. There is moderate fecal loading
throughout colon. Otherwise, the colon and rectum are within normal limits.
The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is a small, minimally displaced acute fracture through the
anterior inferior base of the L4 vertebral body (602:images 39-43). There is
moderate to severe multilevel degenerative changes of the thoracolumbar spine,
unchanged. There is grade 2 anterolisthesis at L5-S1, unchanged from prior
study (602:39). There is no evidence of fracture dislocation of the bilateral
femoroacetabular joints. Within the limitations of a noncontrast enhanced
study, there is no radiographic evidence of osteomyelitis or osteonecrosis.
SOFT TISSUES: There are small bilateral inguinal hernias, unchanged.
Gynecomastia is again noted.
IMPRESSION:
1. Acute fracture through the anterior, inferior base of the L4 vertebral
body.
2. Small amount of perihepatic and pelvic ascites. In the presence of
gynecomastia, Findings may represent underlying liver disease. Correlation
with liver function tests is recommended.
3. No fracture of the left hip identified.
NOTIFICATION: The updated wet read was discussed with ___ MD on ___ at 14:40 by at ___ MD.
|
19972786-RR-114 | 19,972,786 | 23,470,157 | RR | 114 | 2204-08-23 14:38:00 | 2204-08-23 15:13:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with history of CHF// pulmonary edema?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Patient is status post median sternotomy. There are low lung volumes.
Bibasilar atelectasis is seen. Patchy basilar opacities could be due to
atelectasis, but aspiration or infection is not excluded. Mild pulmonary
vascular congestion is seen. The cardiac and mediastinal silhouettes are
stable.
IMPRESSION:
Mild pulmonary vascular congestion.
Low lung volumes. Patchy basilar opacities could be due to atelectasis, but
infection or aspiration is not excluded.
|
19972786-RR-115 | 19,972,786 | 23,470,157 | RR | 115 | 2204-08-28 08:20:00 | 2204-08-28 11:08:00 | EXAMINATION: Video oropharyngeal swallow
INDICATION: ___ year old man with mild dementia, noted to be pocketing food
and choking while eating.// eval swallowing function
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: 4 minutes and 33 seconds
COMPARISON: Esophagram dated ___
FINDINGS:
The oral phase is disorganized with moderate residual that is cleared with
multiple swallows and liquid washes. There is penetration without aspiration
with thin consistency due to decreased maintenance of airway closure. Constant
belching is noted throughout the study.
IMPRESSION:
Penetration without aspiration with thin consistency.
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).
|
19972786-RR-116 | 19,972,786 | 23,470,157 | RR | 116 | 2204-09-02 14:02:00 | 2204-09-02 15:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HFrEF now with worsening dyspnea// Eval for
CHF, PNA
TECHNIQUE: Portable AP view of the chest.
COMPARISON: Chest radiograph ___
FINDINGS:
Sternal wires are intact.
Lungs are well expanded. Mild pulmonary vascular congestion is unchanged.
Left basilar opacity with air bronchograms likely represents atelectasis,
however, pneumonia could be considered in the appropriate clinical setting.
Heart size is moderately enlarged, unchanged. There is no large pleural
effusion or pneumothorax.
IMPRESSION:
No significant interval change. Mild pulmonary vascular congestion. Left
basilar opacity likely represents atelectasis, however, pneumonia could be
considered in the appropriate clinical setting.
|
19972786-RR-120 | 19,972,786 | 21,739,538 | RR | 120 | 2205-02-17 00:28:00 | 2205-02-17 00:52:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with dyspnea // chf? pna?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
Median sternotomy wires are unchanged in configuration. The cardiomediastinal
silhouette is unchanged. The lung volumes are slightly lower, with
accentuation of the pulmonary vasculature. There is probable mild pulmonary
vascular congestion. Small bilateral pleural effusions, with associated
atelectasis. No pneumothorax.
IMPRESSION:
1. Probable mild pulmonary vascular congestion, allowing for bronchovascular
crowding in the setting of lower lung volumes.
2. Small bilateral pleural effusions, with associated bibasilar atelectasis.
|
19972786-RR-58 | 19,972,786 | 24,256,499 | RR | 58 | 2199-12-08 21:02:00 | 2199-12-08 22:15:00 | INDICATION: NO_PO contrast; History: ___ with abdominal pain, nauseaNO_PO
contrast // ? obstruction .
TECHNIQUE: MDCT images were obtained from the lung bases to the lesser
trochanters after administration of oral and intravenous contrast. Coronal
and sagittal reformations were prepared. DLP: 426.83 mGy-cm.
COMPARISON: CT abdomen and pelvis, ___.
FINDINGS:
CT ABDOMEN: The lung bases are clear. The heart is enlarged and there are
dense coronary artery calcifications and aortic valve calcifications. The
liver enhances homogeneously and there is no focal liver lesion. The hepatic
and portal veins are patent. The gallbladder, pancreas, spleen, and adrenals
are normal. The kidneys enhance symmetrically and excrete contrast without
evidence of hydronephrosis or mass. No bowel obstruction or bowel wall
thickening. There is no portacaval, mesenteric and retroperitoneal
lymphadenopathy. There is no free air or free fluid. There are dense
calcifications of the abdominal aorta and its major branches.
CT PELVIS: The appendix is not visualized, but there are no secondary signs of
inflammation. The colon, rectum, urinary bladder and prostate are normal.
Soft tissue densities in the bilateral inguinal canals are stable from prior
CT and likely represent undescended testes. There is no pelvic
lymphadenopathy or free fluid.
OSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for
malignancy.
IMPRESSION:
No acute CT findings to explain patient's abdominal pain.
|
19972786-RR-59 | 19,972,786 | 24,256,499 | RR | 59 | 2199-12-08 23:34:00 | 2199-12-09 05:28:00 | INDICATION: Nausea.
COMPARISONS: CT Abdomen/Pelvis, ___. Chest radiographs, ___ and ___.
FINDINGS: PA and lateral chest radiographs. There is no focal consolidation,
pleural effusion, or pneumothorax. Subsegmental areas of atelectasis in the
right lung base can be seen on CT Abdomen from same date. Eventration of the
right hemidiaphragm and tortuosity of the thoracic aorta are unchanged from
multiple priors. The heart size is top normal.
IMPRESSION: No acute cardiopulmonary process.
|
19972786-RR-60 | 19,972,786 | 29,611,193 | RR | 60 | 2200-02-13 08:51:00 | 2200-02-13 09:06:00 | INDICATION: Dyspnea. Rule out pneumonia or cardiomegaly.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and ___.
FINDINGS:
The heart is moderately enlarged, unchanged from ___. There is mild pulmonary
edema. There are small bilateral pleural effusions with fluid tracking along
the right costophrenic sulcus. Bilateral basilar opacities are likely
atelectasis. There is no pneumothorax. The mediastinal and hilar contours are
unchanged. Eventration of the right hemidiaphragm is less conspicuous on this
study.
IMPRESSION:
Moderate cardiomegaly with mild pulmonary edema, small bilateral pleural
effusions, and bibasilar atelectasis.
|
19972786-RR-61 | 19,972,786 | 29,611,193 | RR | 61 | 2200-02-13 10:04:00 | 2200-02-13 10:45:00 | INDICATION: Diffuse abdominal pain. Rule out small bowel obstruction,
mesenteric ischemia or diverticulitis.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
after the uneventful administration of ml of Omnipaque. Coronal and sagittal
reformations were provided and reviewed. Oral contrast was not administered.
DOSE: DLP: 437.49 mGy-cm
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
The included lung bases show bilateral, small non hemorrhagic pleural
effusions new from ___. There is mild pulmonary edema, better shown
on the same-day chest radiograph. The included heart is moderately enlarged.
The liver enhances homogeneously without concerning lesions. The gallbladder
is normal and there is no intra or extrahepatic biliary ductal dilation. The
spleen, pancreas and adrenal glands are unremarkable. The kidneys enhance
symmetrically and excrete contrast without hydronephrosis. The opacified
portions of the ureters are normal in course and caliber.
There is new stranding and fluid seen along the second portion of the duodenum
(601b:27) extending to the right anterior pararenal space. The underlying
duodenum is not thickened and there is no mural hyperemia. The remainder of
the small bowel is unremarkable. There is no bowel wall thickening or
obstruction. The appendix is surgically absent. There is no free air. There
is no evidence of mesenteric ischemia. There is no retroperitoneal or
mesenteric lymphadenopathy.
The abdominal aorta is extensively calcified, however, is normal in caliber.
High-grade stenosis is seen at the origins of the celiac and superior
mesenteric arteries. There is a high-grade stenosis within the mid superior
mesenteric artery (02:30). The distal vasculature opacifies normally with
contrast.
The bladder, prostate, rectum and sigmoid are normal. There is no free pelvic
fluid. There is no inguinal or pelvic sidewall lymphadenopathy.
Hypodensity within the central portion of the distal right iliopsoas muscle is
unchanged from ___ (2:68). There are no lytic or blastic osseous
lesions of concern within the abdomen or pelvis. Grade 1 anterolisthesis L5
over S1 is present with bilateral spondylolysis. Moderate degenerative changes
of the lower lumbar spine are unchanged.
IMPRESSION:
1. Small bilateral pleural effusions with mild pulmonary edema, new from ___.
2. New mild stranding and fluid along the second portion of the duodenum and
anterior right pararenal space is non-specific but could represent duodenitis.
Pancreatitis is unlikely given the normal lipase value. No small bowel
obstruction or mesenteric ischemia.
3. Severe atherosclerosis.
|
19972786-RR-64 | 19,972,786 | 27,486,130 | RR | 64 | 2200-05-14 04:17:00 | 2200-05-14 04:55:00 | INDICATION:
___ with chest pain .
COMPARISON: Comparison is made to multiple chest radiographs dating back to
___ and abdominal and pelvic CT from ___.
TECHNIQUE
Frontal lateral view of the chest.
FINDINGS:
Moderate cardiomegaly is unchanged. Eventration of the right hemidiaphragm is
noted. Blunting of the bilateral costophrenic angles, likely secondary to
pleural thickening, as demonstrated on CT from ___. Bibasilar
opacities, likely represent atelectasis. There is no pneumothorax. Mediastinal
and hilar contours are stable.
IMPRESSION:
No acute cardiopulmonary process. Chronic changes of pleural thickening at the
bilateral lung bases and moderate cardiomegaly.
|
19972786-RR-86 | 19,972,786 | 25,671,888 | RR | 86 | 2201-02-11 02:33:00 | 2201-02-11 06:27:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with sob // Pneumonia
TECHNIQUE: PA and lateral chest radiograph.
COMPARISON: Chest x-ray ___.
FINDINGS:
MILD TO MODERATE CARDIOMEGALY AND PULMONARY VASCULAR CONGESTION ARE CHRONIC.
THERE IS NO GOOD EVIDENCE FOR PULMONARY EDEMA LEFT PLEURAL THICKENING AND
ASSOCIATED LOWER LOBE ATELECTASIS ARE LONG-STANDING. SMALL RIGHT PLEURAL
EFFUSION HAS RECURRED. NO PNEUMOTHORAX.
IMPRESSION:
1. PERSISTENT LEFT LOWER LOBE ATELECTASIS ASSOCIATED WITH CHRONIC LEFT PLEURAL
SCARRING.
2. Pulmonary vascular congestion AND MILD TO MODERATE CARDIOMEGALY OR CHRONIC.
ALTHOUGH THERE IS RECURRENT SMALL RIGHT PLEURAL EFFUSION THERE IS NO PULMONARY
EDEMA.
|
19972786-RR-89 | 19,972,786 | 29,171,452 | RR | 89 | 2201-02-20 03:56:00 | 2201-02-20 05:18:00 | EXAMINATION: CTA CHEST
INDICATION: ___ man with shortness of breath and elevated D-dimer,
evaluate for pulmonary embolism.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 7.3 mGy (Body) DLP = 3.7
mGy-cm.
4) Spiral Acquisition 4.0 s, 31.4 cm; CTDIvol = 7.8 mGy (Body) DLP = 245.0
mGy-cm.
Total DLP (Body) = 249 mGy-cm.
COMPARISON: CHEST RADIOGRAPH ___.
FINDINGS:
CTA: The thoracic aorta is top-normal in size measuring 3.9 cm in the
ascending portion. There is no aortic dissection. There is moderate
atherosclerotic disease.
There is a subsegmental filling defect in a single left lower lobe pulmonary
artery branch (series 3, image 139), which is felt to be artifactual. The
pulmonary arteries are otherwise well opacified to the subsegmental level.
CHEST: Heart is moderately enlarged. There is no pericardial effusion.
Coronary artery and aortic valvular calcifications are present. Thyroid is
normal. There is no axillary, supraclavicular, or mediastinal adenopathy.
The airway is patent to the segmental level. There is mild centrilobular
emphysema. There is a small left pleural effusion with associated
atelectasis. There is atelectasis versus scarring in the left lingula. There
is no focal lung consolidation. There are no suspicious pulmonary nodules.
The thoracic esophagus unremarkable. Views of the upper abdomen are normal.
OSSEOUS STRUCTURES: Median sternotomy wires are intact. There are no
suspicious bony lesions. There are multilevel degenerative changes of the
thoracic spine.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Small left pleural effusion with atelectasis.
RECOMMENDATION(S): The findings were discussed by Dr. ___
with Dr. ___ on the ___ ___ at 9:44 AM, 5 minutes after
discovery of the findings.
|
19972786-RR-90 | 19,972,786 | 20,400,012 | RR | 90 | 2201-05-02 16:17:00 | 2201-05-02 16:31:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with weakness, fatigue
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Patient is status post median sternotomy and CABG. Cardiac silhouette size
remains moderately enlarged but unchanged. The aorta remains tortuous.
Pulmonary vasculature is mildly engorged. Linear and patchy bibasilar
opacities likely reflect areas of atelectasis. Small left pleural effusion
appears relatively unchanged compared to the previous study. No pneumothorax
is identified. There are no acute osseous abnormalities. Degenerative
changes are seen within the thoracic spine.
IMPRESSION:
Mild pulmonary vascular engorgement and unchanged small left pleural effusion.
Continued bibasilar atelectasis.
|
19972786-RR-91 | 19,972,786 | 20,400,012 | RR | 91 | 2201-05-02 16:03:00 | 2201-05-02 16:48:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with dizziness
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
4) Sequenced Acquisition 2.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
5) Sequenced Acquisition 4.0 s, 4.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: MRI brain ___, CT head ___
FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular, subcortical, and deep white matter
hypodensities are compatible with the sequela of chronic small vessel ischemic
disease. Additionally, a chronic lacune is seen within the right basal
ganglia. Extensive atherosclerotic calcifications are noted within the
cavernous carotid arteries and mild atherosclerotic calcifications are noted
within the distal vertebral arteries.
There is no evidence of fracture. Severe opacification of the maxillary
sinuses are noted bilaterally with thickening and sclerosis of the left
maxillary sinus walls indicative of chronic inflammation. Mild mucosal
thickening is also noted within the ethmoid air cells. The visualized portion
of the remaining paranasal sinuses mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
2. Extensive chronic small vessel ischemic disease.
3. Bilateral maxillary sinus disease, a component of which is chronic on the
left.
|
19973083-RR-18 | 19,973,083 | 20,741,363 | RR | 18 | 2123-10-12 02:02:00 | 2123-10-12 05:20:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with history of AVR repair, presenting with dyspnea
hypoxia. Assess for pericardial effusion, pna
TECHNIQUE: Portable AP chest.
COMPARISON: Chest radiograph from ___, and ___.
FINDINGS:
Sternotomy wires are in similar configuration. Central pulmonary vascular
congestion with interstitial and alveolar edema. Bibasilar densities likely
reflect pleural effusions, greater on the left compared to the right.
Cardiomediastinal silhouette is similarly enlarged.
IMPRESSION:
Largely unchanged cardiomegaly with increased moderate pulmonary edema.
|
19973083-RR-19 | 19,973,083 | 20,741,363 | RR | 19 | 2123-10-16 11:37:00 | 2123-10-16 12:03:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman readmitted with SOB// eval for pulm edema
eval for pulm edema
IMPRESSION:
Comparison to ___. The size of the cardiac silhouette remains
enlarged but the pre-existing pulmonary edema has completely resolved. The
current image shows no evidence of pulmonary edema. Improved ventilation of
the left and right lung bases, with a persisting minimal right pleural
effusion. No pneumothorax. No pneumonia. Stable correct alignment of the
sternal wires.
|
19973133-RR-100 | 19,973,133 | 20,505,308 | RR | 100 | 2192-08-25 10:08:00 | 2192-08-25 12:11:00 | EXAMINATION: Right hip
INDICATION: Hemiarthroplasty.
COMPARISON: Plain radiograph of the right hip and pelvis performed on ___.
FINDINGS:
2 intraoperative images were acquired without a radiologist present.
Images show hemiarthroplasty with a cerclage wire, for a femoral neck
fracture.
Total fluoroscopic time 4.9 seconds.
IMPRESSION:
Intraoperative images were obtained during right hip hemiarthroplasty. Please
refer to the operative note for details of the procedure.
|
19973133-RR-101 | 19,973,133 | 20,505,308 | RR | 101 | 2192-08-25 17:28:00 | 2192-08-25 21:44:00 | INDICATION: ___ year old woman w/ PMHx COPD on home ___ s/p hip
hemiarthroplasty p/f increased O2 requirement and repeated desats as low as
79%.// please evaluate for consolidation vs. atelectasis
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Unchanged right apical scarring. Streaky opacities in the right lower lobe
may reflect pneumonia or atelectasis. The lungs are mildly hyperinflated. No
pleural effusion or pneumothorax. The size of the cardiac silhouette is
within normal limits. A small hiatal hernia is again noted.
IMPRESSION:
New streaky opacities in the right lower lobe may reflect atelectasis or
pneumonia.
|
19973133-RR-102 | 19,973,133 | 20,505,308 | RR | 102 | 2192-08-26 01:58:00 | 2192-08-26 09:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with COPD, s/p R hip hemiarthroplasty, with
increasing O2 requirement.// eval for interval changes eval for interval
changes
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Acute hyperinflation on ___ is no longer present. Borderline
cardiomegaly is stable since ___. No pulmonary edema. Small right
pleural effusion if any. No pneumothorax. Moderate size hiatus hernia noted.
Mild heterogeneous opacification left lower lobe could be atelectasis alone,
but should be followed to exclude developing pneumonia. Calcifications and
mild bronchiectasis at the right apex are due to scarring, probably prior
tuberculosis. No evidence of reactivation infection.
|
19973133-RR-103 | 19,973,133 | 20,505,308 | RR | 103 | 2192-08-26 18:55:00 | 2192-08-26 20:02:00 | INDICATION: ___ year old woman with new tachycardia/hypoxia// ? PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.4 s, 32.2 cm; CTDIvol = 7.6 mGy (Body) DLP = 243.7
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
mGy-cm.
3) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 12.7 mGy (Body) DLP =
6.3 mGy-cm.
Total DLP (Body) = 251 mGy-cm.
COMPARISON: CT torso with contrast ___
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.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain. Heavy
calcifications are noted in the mitral valve annulus and the aortic valve.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. Bilateral pleural effusions are
small.
Atelectasis is mild in bilateral lung bases posteriorly. Centrilobular
emphysema is moderate to severe. Pleuroparenchymal scarring and
calcifications are again demonstrated in bilateral lung apices. The airways
are patent to the subsegmental level.
Limited images of the upper abdomen notable for calcifications in the spleen.
1.8 cm cyst is noted in the upper pole of left kidney and there is a moderate
sized hiatal hernia
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Small bilateral pleural effusions.
3. Moderate to severe pulmonary emphysema.
4. Biapical pleuroparenchymal scarring and calcifications are unchanged and
likely sequela of prior infection.
|
19973133-RR-104 | 19,973,133 | 20,505,308 | RR | 104 | 2192-08-26 18:53:00 | 2192-08-26 19:10:00 | INDICATION: ___ year old woman with ? fluid overload// fluid overload vs PE
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
There is mild pulmonary vascular congestion without overt pulmonary edema.
Trace bilateral pleural effusions are present. No pneumothorax. Unchanged
scarring at the right lung apex. The size the cardiomediastinal silhouette is
within normal limits.
|
19973133-RR-110 | 19,973,133 | 23,458,544 | RR | 110 | 2193-08-13 00:05:00 | 2193-08-13 00:57:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with R flank pain in context of
known UTI despite antibiotics, Hgb dropNO_PO contrast// Source of abdominal
pain, presence of RP bleed given Hgb drop of 5 points in 3 months with weakly
+ guiac. Pre-hydrating with LR
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 5.5 s, 43.1 cm; CTDIvol = 20.8 mGy (Body) DLP = 896.8
mGy-cm.
Total DLP (Body) = 911 mGy-cm.
COMPARISON: CT of the abdomen pelvis from ___.
FINDINGS:
LOWER CHEST: Bibasilar atelectasis. Visualized lung fields are within normal
limits. There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder 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. Splenic granuloma is noted.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a 4 mm nonobstructing renal calculi in the left upper pole. There is
no evidence of solid renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: Large hiatal hernia. 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.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Patient is status post right hip arthroplasty. Postsurgical changes are seen
to the lumbar spine.
SOFT TISSUES: There is a new well-circumscribed high-density collection
measuring approximately 2.3 x 5.7 x 6.7 cm concerning for an right rectus
sheath hematoma. (Series 2, image 48 and series 601, image 19). There is a
fat containing ventral wall hernia with a neck measuring 2.9 cm.
IMPRESSION:
1. Findings concerning for a right rectus sheath hematoma measuring 2.3 x 5.7
x 6.7 cm.
2. Nonobstructing 4 mm left upper pole renal calculi
3. Diverticulosis without evidence of diverticulitis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:55 am, 2 minutes after discovery
of the findings.
|
19973133-RR-111 | 19,973,133 | 23,458,544 | RR | 111 | 2193-08-13 04:01:00 | 2193-08-13 04:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with worsening sob.*** WARNING *** Multiple patients
with same last name!// Pulmonary edema
TECHNIQUE: Portable AP chest
COMPARISON: Chest CT from ___.
FINDINGS:
Apical scarring is noted bilaterally. No evidence of focal consolidation,
pleural effusion or pneumothorax. Minimal bibasal atelectasis. No pulmonary
edema. Cardiac and hilar silhouettes are normal. Prominent aortic arch
calcifications are noted.
IMPRESSION:
No evidence of pulmonary edema or pneumonia.
|
19973133-RR-112 | 19,973,133 | 25,361,247 | RR | 112 | 2193-08-20 16:06:00 | 2193-08-20 16:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with recent endoscopy, abdominal pain, melena//
Evaluate for abdominal free air
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Heart size is normal. The thoracic aorta is diffusely tortuous and calcified.
The mediastinal and hilar contours are unchanged with a moderate size hiatal
hernia again noted. The pulmonary vasculature is normal. Calcified
pleuroparenchymal scarring is seen in the lung apices. Lungs are
hyperinflated with emphysematous changes re-demonstrated. No pleural effusion
or pneumothorax is seen. There are no acute osseous abnormalities. No
subdiaphragmatic free air. Mild eventration of the right hemidiaphragm,
unchanged.
IMPRESSION:
No subdiaphragmatic free air. No acute cardiopulmonary process. Moderate
size hiatal hernia.
|
19973133-RR-75 | 19,973,133 | 20,578,132 | RR | 75 | 2189-04-01 13:25:00 | 2189-04-01 15:43:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with productive cough, COPD // r/o PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior radiographs most recently from ___.
FINDINGS:
Lungs are well-expanded. There is no focal consolidation, pleural effusion or
pneumothorax. Scarring at the right apex is unchanged. The cardiomediastinal
silhouette is unchanged. The imaged upper abdomen is unremarkable. The bones
are unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
19973404-RR-31 | 19,973,404 | 27,326,628 | RR | 31 | 2163-11-25 14:04:00 | 2163-11-25 15:33:00 | INDICATION: ___ female with severe abdominal pain and diarrhea. Per
OMR, the patient has a history of diabetes and known gastroparesis.
COMPARISON: CT of the abdomen and pelvis ___, MRCP ___.
TECHNIQUE: MDCT imaging of the abdomen was performed following the uneventful
intravenous administration of 100 cc of Omnipaque intravenous contrast.
Axial, coronal, and sagittal reformations were prepared and reviewed.
CT ABDOMEN WITH INTRAVENOUS CONTRAST:
Lung bases are clear with the exception of a 4-mm subpleural nodule in the
left lower lobe, which is stable from ___ and compatible with a benign
process. No pleural or pericardial effusion.
There is a single coarse calcification in the right lobe of the liver,
unchanged. There are no new focal liver lesions. There is no intrahepatic
biliary ductal dilation. The patient is status post cholecystectomy, which
likely accounts for mild common duct prominence, a chronic finding previously
evaluated by MRCP. There is no pancreatic mass or pancreatic ductal dilation.
The spleen and adrenal glands are normal. There is symmetric renal
parenchymal enhancement and contrast excretion. The ureters are normal
bilaterally. There is no perinephric fluid collection.
The stomach is dilated and fluid filled. Though correlation with the
patient's n.p.o. status is required, this likely relates to known
gastroparesis. The small and large bowel are normal in caliber, with no wall
thickening or adjacent inflammatory change. Some small bowel loops are fluid
filled, which can be seen in the setting of gastroenteritis, though is a
nonspecific finding. There is no free fluid or free air. There is no focal
fluid collection to suggest abscess.
The aorta is normal in caliber. The mesenteric vessels, including superior
mesenteric and portal veins are patent. There is no mesenteric or
retroperitoneal lymphadenopathy.
CT PELVIS WITH INTRAVENOUS CONTRAST:
Distal ureters and bladder are normal. Uterus and adnexa are normal. There
are no adnexal masses. There is no free pelvic fluid. The rectum and sigmoid
are normal.
BONE WINDOWS: There are no lytic or sclerotic osseous lesions concerning for
malignancy. Mild degenerative changes are seen at L5-S1, with vacuum
phenomena.
IMPRESSION:
1. Dilated, fluid-filled stomach, which may be related to the patient's known
history of gastroparesis.
2. Scattered fluid-filled small bowel loops can be seen with gastroenteritis,
though this is a nonspecific finding and must be correlated with the patient's
n.p.o. status.
3. Prominence of the common bile duct, little changed from prior studies, and
likely reflecting prior cholecystectomy.
|
19973404-RR-32 | 19,973,404 | 23,868,350 | RR | 32 | 2166-01-01 14:53:00 | 2166-01-01 16:32:00 | HISTORY: ___ female with abdominal pain. Assess for obstruction.
COMPARISON: Abdominal radiographs from ___ and CT abdomen and
pelvis from ___.
FINDINGS:
Single portable supine abdominal radiograph demonstrates a normal bowel gas
pattern without evidence of obstruction. There is no free air. Surgical
clips in the right upper quadrant are likely secondary to patient's prior
cholecystectomy.
IMPRESSION:
Normal bowel gas pattern without obstruction.
|
19973404-RR-33 | 19,973,404 | 22,452,588 | RR | 33 | 2166-01-05 20:55:00 | 2166-01-06 18:02:00 | HISTORY: A ___ woman with nausea. Rule out obstruction.
IMPRESSION: Frontal upright and supine views of the abdomen show no
pathologic distention of large or small bowel. There is formed stool in the
transverse and left colon, and no free subdiaphragmatic gas. Vascular clips
denote prior right upper quadrant surgery.
|
19973404-RR-38 | 19,973,404 | 29,788,438 | RR | 38 | 2167-09-02 22:18:00 | 2167-09-03 15:57:00 | INDICATION: ___ year old woman with gastroparesis, nausea and vomiting //
evaluate for volvulus, obstruction
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph from ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable. Right upper quadrant cholecystectomy
clips are again seen.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
19973404-RR-40 | 19,973,404 | 29,788,438 | RR | 40 | 2167-09-04 15:45:00 | 2167-09-04 16:25:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old woman with PMH T1DM here with nausea and new vertical
gaze nystagmus. Concern for posterior circ stroke // Code Stroke. Please
perform MRI Brain. Please evaluate brainstem.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck with perfusion of ___, CT head
without contrast of ___.
FINDINGS:
There is no intra or extra-axial mass effect, acute hemorrhage or infarct.
There are a very few nonspecific subcortical and periventricular T2/FLAIR
white matter hyperintensities, which may be seen in the setting of chronic
microangiopathy. There is ventriculomegaly, unchanged from prior examinations
dating back to ___. Allowing for the ventriculomegaly, sulci and cisterns
are within expected limits for the patient's age. The major intracranial flow
voids are preserved. The paranasal sinuses are essentially clear. The orbits
are unremarkable allowing for bilateral lens replacements. Fluid signal is
seen in the right mastoid tip. Incidental note is made of a metopic suture.
IMPRESSION:
1. There is no acute infarct or intracranial hemorrhage.
|
19973404-RR-41 | 19,973,404 | 29,788,438 | RR | 41 | 2167-09-09 19:01:00 | 2167-09-09 19:27:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with acute onset nystagmus, dysmetria, vertigo
// eval for bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 0.6 s, 2.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
106.0 mGy-cm.
4) Sequenced Acquisition 4.2 s, 14.2 cm; CTDIvol = 52.2 mGy (Head) DLP =
742.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: MR brain dated ___, CT head dated ___.
FINDINGS:
There is no evidence of large vascular territorial infarction, hemorrhage,
edema, or mass. Moderate ventriculomegaly is unchanged from ___.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No evidence of acute intracranial hemorrhage or large vascular territorial
infarction.
|
19973404-RR-42 | 19,973,404 | 22,873,532 | RR | 42 | 2167-09-15 18:42:00 | 2167-09-15 19:48:00 | EXAMINATION: CT abdomen and pelvis.
INDICATION: NO_PO contrast; History: ___ with history of gastroparesis,
recent EGD with botox injection presents with sudden recurrence of nausea,
vomiting, abdominal pain.NO_PO contrast // Evaluate for gastric
perforation/abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
4) Spiral Acquisition 4.7 s, 51.5 cm; CTDIvol = 12.8 mGy (Body) DLP = 660.7
mGy-cm.
Total DLP (Body) = 668 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: A 3 mm subpleural left lower lobe pulmonary nodule (2:5) is
stable from at least ___. Visualized lung fields are otherwise within normal
limits. There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates diffusely low attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
biliary dilatation. A prominent extrahepatic common hepatic duct measures 1.0
cm, unchanged from prior examination and likely secondary to the patient's
postcholecystectomy state. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: A moderate-sized, axial hiatal hernia is noted. The
stomach is unremarkable. Multiple loops of bowel are fluid-filled and some
demonstrate mild wall thickening. The colon is largely collapsed, but
demonstrates wall edema and adjacent inflammatory changes which are most
notable in the descending colon (2:45, 601b:30). The appendix is not
discretely visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. Fibroid
uterus is noted. A 2.2 cm left adnexal cyst is noted, similar the prior
examination, which may represent a dominant follicle if the patient is still
premenopausal. There is trace free fluid in the pelvis.
MESENTERY AND LYMPH NODES: Trace mesenteric fluid is noted, in addition to
small amounts of fluid along the bilateral pericolic gutters and adjacent to
the hepatic margin (02:17). There is no pathologically enlarged
retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Multiple focal regions of small bowel wall thickening with surrounding
inflammatory changes, raise concern for enteritis.
2. Mild descending colonic wall thickening and edema. While these findings
may be secondary to underdistention, the associated adjacent inflammatory
changes and mesenteric fluid suggest colitis. Findings may be secondary to
infectious, ischemic, or inflammatory causes.
3. Moderate axial hiatal hernia.
4. 2.2 cm left adnexal cyst may be physiologic if patient is premenopausal.
If patient is postmenopausal, recommend follow-up pelvic ultrasound for
further assessment.
RECOMMENDATION(S): 2.2 cm left adnexal cyst may be physiologic if patient is
premenopausal. If patient is postmenopausal, recommend follow-up pelvic
ultrasound for further assessment.
|
19973404-RR-56 | 19,973,404 | 25,995,277 | RR | 56 | 2170-07-17 14:30:00 | 2170-07-17 15:08:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with epigastric abdominal pain// eval for CBD dilation,
retained ston
TECHNIQUE: Abdominal ultrasound
COMPARISON: Prior ultrasound abdomen from ___ and CT abdomen pelvis
from ___.
FINDINGS:
Limited views of the pancreas appear unremarkable. Distal CBD measures up to
1 cm, unchanged from prior. Gallbladder is surgically absent. Minimal
prominence of the intrahepatic biliary tree is unchanged from prior. The
liver is normal in appearance and echotexture. No ascites. Main portal vein
is patent with hepatopetal flow. Right kidney measures 9.6 cm and appears
normal without hydronephrosis or worrisome lesion. Left kidney measures 9.7
cm and is normal in grayscale appearance without worrisome lesion. The spleen
is normal in size at 9.5 cm in length.
IMPRESSION:
Status post cholecystectomy. Stable prominence of the biliary tree.
|
19973404-RR-68 | 19,973,404 | 27,142,177 | RR | 68 | 2171-09-11 20:38:00 | 2171-09-11 20:53:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain // acute intrathoracic process
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
Cholecystectomy clips are seen in the right upper quadrant of the abdomen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19973404-RR-69 | 19,973,404 | 27,142,177 | RR | 69 | 2171-09-12 00:53:00 | 2171-09-12 17:18:00 | INDICATION: ___ year old woman with hx of DM1, gastroparesis, increased
abdominal pain, evaluation for increased stool burden or ileus // Eval stool
burden vs ileus
TECHNIQUE: Portable supine abdominal radiograph.
COMPARISON: Comparisons made to multiple prior radiographs, most recently
from ___, as well as same-day CT.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is gas
within the rectum. There is a moderate to severe colonic fecal burden.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. There are multiple hemostatic surgical clips overlying the right
upper quadrant. The imaged portion of the lungs is clear.
IMPRESSION:
Moderate to severe colonic fecal burden with a nonobstructive bowel gas
pattern.
|
19973580-RR-13 | 19,973,580 | 27,373,602 | RR | 13 | 2161-11-18 04:57:00 | 2161-11-18 05:30:00 | INDICATION: History: ___ with acute respiratory failure eval for interval
change
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Radiograph dated ___
FINDINGS:
AP portable chest radiograph demonstrates stable cardiomediastinal and hilar
contours. There is pulmonary vascular congestion and mild pulmonary edema.
There is no large pleural effusion. There is no pneumothorax. There is no
air under the right hemidiaphragm.
IMPRESSION:
Pulmonary vascular congestion and mild pulmonary edema.
|
19973580-RR-14 | 19,973,580 | 27,373,602 | RR | 14 | 2161-11-19 03:50:00 | 2161-11-19 08:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old with significant remote smoking history and recent
diagnosis of likely COPD (PFTs scheduled but not yet performed) presenting
with hypercarbic respiratory failure likely ___ COPD exacerbation.// Eval for
interval change/PNA Eval for interval change/PNA
IMPRESSION:
Right basal consolidation has increased concerning for progression of
infectious process. Cardiomegaly is mild, unchanged. Mediastinum is stable.
Lungs overall clear.
|
19973587-RR-47 | 19,973,587 | 23,312,973 | RR | 47 | 2143-07-16 16:48:00 | 2143-07-16 18:49:00 | INDICATION: ___ woman with cancer, now presents with shortness of
breath.
COMPARISON: Chest radiograph ___.
PA AND LATERAL CHEST RADIOGRAPHS: The cardiomediastinal and hilar contours
are stable, with enlarged cardiac silhouette, worrisome for pericardial
effusion. A left chest wall AICD device is seen with leads in expected
position of the right atrium and right ventricle. Bilateral small pleural
effusions are seen, with compressive bibasilar atelectasis. No consolidation,
pulmonary edema or pneumothorax is seen.
IMPRESSION: Enlarged cardiac silhouette, worrisome for pericardial effusion.
Bilateral small pleural effusions.
|
19973587-RR-48 | 19,973,587 | 23,312,973 | RR | 48 | 2143-07-16 20:15:00 | 2143-07-16 23:44:00 | INDICATION: ___ woman with dyspnea and lightheadedness.
COMPARISON: CT torso with contrast, ___.
TECHNIQUE: Multidetector CT imaging of the chest was obtained prior to and
after the administration of 100 cc of Omnipaque intravenous contrast.
Sagittal and coronal reformations were performed and reviewed.
FINDINGS: The pulmonary arteries are well opacified to subsegmental levels
without evidence of acute pulmonary embolism. The thoracic aorta has moderate
atherosclerotic calcification, without aneurysmal dilation or dissection.
Large amount of simple pericardial effusion has increased since the earlier
study of ___. There is a moderate-sized simple left and a small right
pleural effusion. Diffuse ground-glass opacities and interstitial thickening
in both lungs, is consistent with pulmonary edema. Bilateral lower lobe
patchy consolidation, may represent asymmetric pulmonary edema; however,
infection is not excluded. There is no pneumothorax. Previously seen right
lower lobe nodule is obscured by overlying pulmonary changes. Again seen are
multiple enlarged mediastinal and axillary adenopathy, slightly worse since
the earlier study. For example, the largest right axillary lymph node now
measures 22 x 12 mm, larger since the prior study where it measured 22 x 9 mm.
Multiple mediastinal lymph nodes are seen in the prevascular (2:22) now
measuring 14 mm, previously 12 mm and right lower paratracheal (2:23) now 17
mm, previously 10 mm. Bilateral hilar adenopathy are again seen. A left chest
wall AICD device is seen, with leads in the expected position of the right
atrium and right ventricle.
This study is not tailored for evaluation of the subdiaphragmatic organs,
within this limitation, in the imaged upper abdomen is unremarkable.
BONES AND SOFT TISSUES: No bone lesions suspicious for infection or
malignancy are detected.
IMPRESSION:
1. No acute pulmonary embolism or aortic dissection.
2. Large pericardial effusion, has enlarged since earlier study of ___.
3. Pulmonary edema. Moderate-sized simple left and a small right pleural
effusion. Bibasal patchy consolidation may represent asymmetric pulmonary
edema, infection is not excluded.
4. Interval worsening of metastatic right axillary and mediastinal adenopathy
|
19973795-RR-10 | 19,973,795 | 23,822,974 | RR | 10 | 2194-11-01 14:25:00 | 2194-11-01 17:45:00 | EXAMINATION: LUMBAR SPINE IN OR
INDICATION: ___ female undergoing anterior fusion
TECHNIQUE: 2 intraoperative lateral images of the lower lumbar spine
COMPARISON: None.
FINDINGS:
2 intraoperative images were acquired without a radiologist present.
There is severe diffuse osteopenia, which limits detailed delineation of
vertebral body contours. Background degenerative changes also noted. Levels
are assigned for this report only.
There is retrolisthesis at the presumptive L3/4 level. Possible mild
anterolisthesis at L5/S1.
On view # 1, a thin marker overlies the anterior aspect of the presumptive
L4-5 disc space. Additional surgical instruments and materials are present.
On view # 2, intervertebral fusion constructs are present at the presumptive
L4-5 and L5-S1 levels, nominal in alignment.
Surgical clips are seen overlying and anterior to the lower lumbar spine. ..
IMPRESSION:
Intraoperative images were obtained during L3-S1 anterior fusion procedure.
Please refer to the operative note for details of the procedure.
|
19973795-RR-11 | 19,973,795 | 23,822,974 | RR | 11 | 2194-11-02 16:18:00 | 2194-11-02 20:44:00 | EXAMINATION: LUMBAR SINGLE VIEW IN OR
INDICATION: L3-S1 FUSION LAMINECTOMY
TECHNIQUE: Single intraoperative lateral view of the lumbar spine.
COMPARISON: ___.
IMPRESSION:
Single intraoperative view demonstrates pre-existing L4-L5 and L5-S1 interbody
spacer and anterior fusion hardware with interval placement of L5-S1 posterior
fusion hardware, with marking of the L3 level. Refer to the operative note
for further detail.
|
19973795-RR-9 | 19,973,795 | 23,822,974 | RR | 9 | 2194-10-31 05:07:00 | 2194-10-31 07:08:00 | EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: History: ___ with back pain and weaknessIV contrast to be given
at radiologist discretion as clinically needed// ?epidural fluid collection
?epidural fluid collection
?epidural fluid collection
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 Gadavist
contrast agent.
COMPARISON: Prior MR done ___
FINDINGS:
There is extensive lumbar spondylosis and scoliosis.
The conus terminates at the L1-2 level. No conus masses.
There is a longitudinal extensive T2 hyperintense, T1 hypointense collection
not demonstrating enhancement postcontrast spanning L2 through L4 measuring a
maximum of 65 mm in craniocaudal ___, which occupies almost the entire
spinal canal with displacement and compression of the surrounding nerve roots.
This intraspinal lesion is difficult to place as intra or extradural due to
its large size. This is most compatible with a large arachnoid cyst, in the
differential diagnosis consider a liquified hematoma, but is less likely
considering there is no intrinsically T1 hyperintense components. There is a
nonenhancing T1 Iso and T2 iso to hypointense soft tissue component in its
posterior aspect at the L3 level which does not enhance postcontrast.
There are no surrounding inflammatory signs to suggest infection or epidural
abscess.
There is marked multilevel spondylotic changes in the form of disc
desiccation, broad-based disc bulge, facet joint arthropathy as well as again
mentum flavum hypertrophy as described below:
T12-L1: No cord or nerve root compromise.
L1-2: No cord compromise in the spinal canal. Moderate right and moderate
severe left neural foraminal narrowing.
L2-3: Marked spinal canal narrowing due to the lesion described above. Mild
moderate right and moderate severe left neural foraminal narrowing.
L3-4: Marked spinal canal narrowing due to the lesion described above.
Moderate severe right and severe left neural foraminal narrowing.
L4-5: Moderate severe spinal canal narrowing secondary to degenerative changes
with marked ligamentum flavum hypertrophy. Moderate severe and severe neural
foraminal narrowing bilateral.
L5-S1: Grade 2 spondylolytic spondylolisthesis of L5 on S1. This with
associated degenerative changes results in severe spinal canal stenosis.
There is also severe neural foraminal narrowing bilateral. Fluid present
between the L5-S1 spinous processes suggesting arthropathy between the spinous
process (possible Baastrup's disease), but no edema in the spinous processes.
A couple of vertebral body hemangiomas are incidental findings.
Extra-spinal: Distended bladder which may lead to fullness of the kidneys
bilaterally, right greater than left. Moderate dilatation of the CBD
measuring 10 mm in a dedicated ultrasound may be performed if clinically
indicated.
IMPRESSION:
1. Large T2 hyperintense, T1 hypointense collection in the spinal canal
extending from L2 through L4 resulting in marked displacement and compression
of the surrounding nerve roots. Differential considerations include an
arachnoid cyst vs a liquified hematoma. Nonenhancing soft tissue in this
lesion is nonspecific but is most likely felt to represent associated
thickened dura/meninges in the setting of a arachnoid cyst or retracted clot
in the setting of a liquified hematoma.There is no surrounding inflammatory
signs to suggest infection or epidural abscess.
2. There is marked multilevel spondylotic changes which results in moderate to
severe spinal canal narrowing at the L4-5 as well as grade 2 spondylolytic
spondylolisthesis of L5 on S1 which results in severe spinal canal narrowing
at this level.
3. Multilevel severe neural foraminal narrowing as described above.
4. Moderate dilatation of the CBD measuring 10 mm and a dedicated ultrasound
may be performed if clinically indicated.
5. Distended bladder - which may lead to fullness of the kidneys - right
greater than left.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 7:22 am, 5 minutes
after discovery of the findings.
|
19974480-RR-16 | 19,974,480 | 23,201,377 | RR | 16 | 2147-03-23 19:51:00 | 2147-03-23 20:25:00 | EXAMINATION: CHEST RADIOGRAPHS
INDICATION: Worsening mental status change.
TECHNIQUE: Chest, PA and lateral.
COMPARISON: None.
FINDINGS:
The heart is normal in size. The mediastinal and hilar contours appear within
normal limits. There is no pleural effusion or pneumothorax. The lungs
appear clear. There is mild reverse S-shaped thoracolumbar curvature.
IMPRESSION:
No evidence of acute cardiopulmonary disease.
|
19974480-RR-17 | 19,974,480 | 23,201,377 | RR | 17 | 2147-03-23 22:54:00 | 2147-03-24 02:18:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: History: ___ presenting with 2 weeks worsening AMS. OSH brain MRI
concerning for brain mass // eval for brain mass
TECHNIQUE: MRI of the head without IV contrast
COMPARISON: None
FINDINGS:
Study somewhat limited due to motion related artifacts on multiple sequences.
Large heterogeneously enhancing mass, approximately 6.5AP x 4.7CCx4.7TR cm,
likely intra-axial, with extensive surrounding vasogenic edema centered in the
bifrontal region, left more than right and causing effacement and exerting
local mass effect on the bilateral frontal horns of the lateral ventricles and
body of left lateral ventricle and rightward shift of midline structures.
There is indentation node invasion into the anterior part of the corpus
callosum. These also displacement of the A2 segments of the anterior cerebral
arteries towards the right side by the mass. Mild drooping of the optic
nerve/optic chiasm due to the mass effect. Multiple flow voids seen within
this lesion. Areas of negative susceptibility, may represent some hemorrhage
or mineralization within the lesion. Findings concerning for an aggressive
malignancy such as a high-grade glioma.
The major intracranial arterial flow voids are noted.
Venous sinuses are unremarkable.
Sella, pineal gland, craniocervical junction regions are unremarkable.
The imaged paranasal sinuses and the mastoid air cells are grossly clear.
The imaged orbits are unremarkable.
Bone marrow signal is unremarkable.
IMPRESSION:
Large heterogeneously enhancing mass, approximately 6.5AP x 4.7CCx4.7TR cm,
likely intra-axial, with extensive surrounding vasogenic edema centered in the
bifrontal region, left more than right and causing effacement and exerting
local mass effect as described above. Correlation with noncontrast CT can be
helpful for hemorrhage versus mineralization.
Differential diagnosis includes GBM, lymphoma, metastasis, etc.
Neurosurgery consult, further workup and followup as needed.
|
19974480-RR-18 | 19,974,480 | 23,201,377 | RR | 18 | 2147-03-24 10:46:00 | 2147-03-24 23:00:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with new brain mass. brain mass, eval for
metastatic disease, onc work up.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agentand reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images.
DOSE: DLP: 905 mGy-cmfor the entire examination of the torso.
COMPARISON: Chest radiograph from ___. The study is read in
conjunction with concurrently obtained CT of the abdomen and pelvis.
FINDINGS:
MEDIASTINUM: The thyroid is normal. There is no supraclavicular, axillary,
mediastinal, or hilar lymphadenopathy. The aorta and pulmonary arteries are
normal in size. The heart size is normal and there is no pericardial
effusion.
PLEURA: There is no pneumothorax. There is no pleural effusion.
LUNGS: The airways are patent. There is no airspace consolidation. There is
no diffuse interstitial abnormality. There are no concerning pulmonary
nodules. A punctate calcified granuloma is noted in the right apex (___).
BONES: There are no destructive focal osseous lesions concerning for
malignancy within the imaged thoracic skeleton.
UPPER ABDOMEN: Findings within the abdomen and pelvis will be reported
separately by the Abdominal Radiology division.
IMPRESSION:
No evidence of intrathoracic malignancy.
|
19974480-RR-19 | 19,974,480 | 23,201,377 | RR | 19 | 2147-03-24 10:46:00 | 2147-03-24 23:11:00 | EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ year old woman with new brain mass // onc work up, eval for
metastatic disease
TECHNIQUE: MDCT axial images were acquired through abdomen without contrast
initially, and at low-dose, followed by scanning of the abdomen and pelvis
following intravenous contrast administration with split bolus technique. 3
minute delayed images were obtained through the abdomen only.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was administered.
DOSE: DLP: 905 mGy-cm (chest, abdomen and pelvis.
COMPARISON: The study is read in conjunction with concurrently obtained CT of
the chest.
FINDINGS:
LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
ABDOMEN:
GENERAL: There is no intra-abdominal free air or free fluid.
HEPATOBILIARY: A subcentimeter hypodensity in the left hepatic lobe is too
small to characterize (06:46). Superior to the gallbladder, there are 2
adjacent hepatic simple cysts, which measure approximately 3.0 x 2.2 cm
(09:26), and 2.5 x 2.5 cm respectively (09:28). Otherwise, the liver
demonstrates homogenous attenuation throughout. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits, without stones or gallbladder wall thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colon and rectum are within normal
limits.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden
in the abdominal aorta and great abdominal arteries.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. A right total hip arthroplasty is
noted. Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of malignancy in the abdomen or pelvis.
2. Simple hepatic cysts.
|
19974480-RR-20 | 19,974,480 | 23,201,377 | RR | 20 | 2147-03-24 21:25:00 | 2147-03-25 13:11:00 | EXAMINATION: MR HEAD W/ CONTRAST
INDICATION: ___ year old woman with brain lesion, planning image guided brain
biopsy, need Wand study MRI of head.
TECHNIQUE: After administration of 6cc of Gadavist intravenous contrast,
axial imaging was performed with MPRAGE and T1 technique. MPRAGE images were
re-formatted in sagittal and coronal orientations.
COMPARISON: Complete brain MRI with and without contrast from ___.
FINDINGS:
Again seen is an irregular, rim enhancing mass involving bilateral medial
frontal lobes and the corpus callosum, more extensive on the left than right,
with extensive vasogenic edema. The mass effaces the frontal horns and
anterior bodies of the lateral ventricles and causes left-to-right subfalcine
herniation with rightward shift of the midline structures as well. There is no
uncal herniation or compression of the basal cisterns. Otherwise,
comprehensive evaluation of the brain parenchyma is not performed with this
limited exam which is targeted for surgical planning.
IMPRESSION:
Rim enhancing mass involving bilateral medial frontal lobes on the corpus
callosum is again demonstrated for surgical planning. Diagnostic
considerations include glioblastoma, or lymphoma if the patient is
immunocompromised. Metastasis less likely.
|
19974480-RR-21 | 19,974,480 | 23,201,377 | RR | 21 | 2147-03-26 20:15:00 | 2147-03-26 20:44:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ yo F, withdrawn over past few weeks with altered mental status
over 2 days, found to have large brain mass crossing midline, now s/p brain
biopsy
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 897 mGy-cm
CTDI: 53 mGy
COMPARISON: MR head ___.
FINDINGS:
There is a new left frontal burr hole. There is pneumocephalus and small
amount of hyperdense blood along the biopsy track in the left frontal lobe. A
punctate focus of hyperdensity within the left frontal lobe, likely represents
a small focus of post surgical hemorrhage (series 3, image 21).
Again seen is a large heterogeneous mass involving the medial frontal lobes
and anterior corpus callosum, larger on the left than right, with extensive
vasogenic edema, also larger on the left than right. There is unchanged degree
of mass effect causing effacement of the lateral ventricles, left greater than
right, and left to right subfalcine herniation. Basal cisterns are not
compressed.
The paranasal sinuses, mastoid air cells, and middle ear cavities are grossly
well aerated.
IMPRESSION:
1. S/p left frontal approach biopsy with pneumocephalus and small amount of
blood along the biopsy tract.
2. Large mass involving the medial frontal lobes and anterior corpus callosum,
larger on the left than right, with extensive left greater than right
vasogenic edema, is again demonstrated with stable mass effect.
|
19974520-RR-69 | 19,974,520 | 23,580,334 | RR | 69 | 2152-01-17 10:26:00 | 2152-01-17 11:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with cough, fever, sputum and underlying
bronchiectasis // assess for new pneumonia assess for new pneumonia
IMPRESSION:
Compared to chest radiographs since ___, most recently ___. Large scale pneumonia in the left lower lobe and lingula is new, a
smaller region of consolidation in the right lung base has a different
distribution than before. Previous right upper lobe pneumonia left a region
of bronchiectatic scarring. Moderate left pleural effusion is new.
Multifocal pneumonia could be due to bronchiectasis, chronic aspiration, or
even cryptogenic organizing pneumonia. Volume of left pleural effusion must
be followed for any indication that the patient may be developing empyema.
Heart size normal.
No pneumothorax.
NOTIFICATION: The findings were discussed with an internal medicine resident
working with ___, M.D. , M.D. by ___, M.D. on the
telephone on ___ at 11:42 AM, 1 minutes after discovery of the findings.
|
19974520-RR-70 | 19,974,520 | 23,580,334 | RR | 70 | 2152-01-17 18:45:00 | 2152-01-17 19:41:00 | EXAMINATION: CTA chest
INDICATION: Bronchiectasis and recurrent pneumonia.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 5.7 mGy (Body) DLP = 2.8
mGy-cm.
2) Spiral Acquisition 4.3 s, 33.6 cm; CTDIvol = 4.4 mGy (Body) DLP = 148.5
mGy-cm.
Total DLP (Body) = 151 mGy-cm.
COMPARISON: Multiple CT chest examinations dating from ___ through ___.
FINDINGS:
The thyroid gland is grossly unremarkable.
Heart size is normal without significant pericardial fluid. Thoracic aortic
arch is normal caliber without aneurysm or dissection. Main, left and right
pulmonary arteries are normal caliber and there is no pulmonary embolus to the
subsegmental level. Mediastinal and bilateral hilar lymphadenopathy is noted.
AP window lymph node measures 2.6 x 1.0 cm. A pretracheal nodal conglomerate
measures 1.8 x 1.1 cm. Largest left hilar lymph node measures approximately
1.5 x 1.3 cm. Right hilar lymph node measures approximately 1.5 x 1.1 cm.
There is no supraclavicular or axillary lymphadenopathy by CT size criteria.
There is re- demonstration of widespread bronchiectasis in the right upper
lobe, lingula and bilateral lower lobes with multiple area of mucous
impaction, most prominent in the bilateral lower lobes and appearing
significantly increased compared to the prior examination. There are
extensive inferior lingular segment, right upper lobe and left lower lobe
consolidations with additional areas of peribronchial ___ nodularity
in both areas. Consolidation is less severe in the right lower lobe with
additional areas of peribronchiolar nodularity. Masslike consolidation in the
posterior segment of the right upper lobe has improved compared to the prior
examination, now with areas of bronchiectasis and mucous plugging with a scant
areas of ___ nodularity. There is a small left-sided pleural
effusion.
The imaged upper abdomen is grossly unremarkable.
Bones and soft tissues: There is no suspicious focal bone lesion.
IMPRESSION:
1. Irregular inferior lingular, right upper lobe and bilateral lower lobe
consolidations with areas of peribronchial nodularity compatible with
multifocal pneumonia.
2. Small left-sided pleural effusion.
3. Worsening widespread bronchiectasis with bilateral lower lobe predominance
with multiple areas of mucous impaction.
4. Mild hilar and mediastinal adenopathy, increased since ___, potentially
reactive.
5. No evidence of pulmonary embolism or aortic abnormality.
|
19974576-RR-18 | 19,974,576 | 20,930,639 | RR | 18 | 2122-03-17 19:46:00 | 2122-03-17 20:11:00 | INDICATION: ___ with stomach mets and acute abd pain // any free air
TECHNIQUE: AP and lateral views the chest.
COMPARISON: Correlation made to CT from ___.
FINDINGS:
Right basilar opacities most likely atelectasis. The lungs are otherwise
clear. The cardiomediastinal silhouette is within normal limits. No acute
osseous abnormalities. There is no free intraperitoneal air.
IMPRESSION:
No acute cardiopulmonary process. Probable right basilar atelectasis.
|
19974576-RR-19 | 19,974,576 | 20,930,639 | RR | 19 | 2122-03-17 19:52:00 | 2122-03-17 21:29:00 | EXAMINATION: CT ABDOMEN PELVIS WITH IV CONTRAST.
INDICATION: ___ 2mo s/p ex lap for metastatic ca involving appendix and
stomach p/w acute severe abd pain, n/v/dNO_PO contrast // any acute abd
pathology
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 727 mGy-cm.
COMPARISON: CT ABDOMEN AND PELVIS: ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Hypodensities along the liver capsule are more prominent than
on the prior study including a posterior right hepatic lobe lesion measuring
1.7 x 1.0 cm (02:16), and a left hepatic lobe lesion measuring 1.4 x 2.3 cm
(02:22). The liver contour appears scalloped adjacent to multiple peritoneal
implants and perihepatic ascites. The portal vein is patent. There is no
intra or extrahepatic biliary ductal dilation. The gallbladder is distended,
but otherwise unremarkable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Multiple cystic lesions in the peripheral spleen are larger compared
to the prior study, measuring up to 3.4 x 2.7 cm (02:20).
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.
An interpolar right renal cyst is 2.6 cm in maximal dimension, unchanged.
Other tiny hypodensities are noted in the left kidney, too small to
characterize. There is no evidence of hydronephrosis or stones bilaterally.
There is no perinephric abnormality.
GASTROINTESTINAL: There is no evidence of bowel obstruction. The stomach is
surrounded by omental caking in the upper abdomen, extending into the
gastrohepatic recess. The small bowel is likewise also tethered by omental
caking in the anterior abdomen and left upper quadrant. Where visualized, the
appendix appears fluid filled and dilated, measuring up to 14 mm (601b:33).
PELVIS: Mass effect upon the urinary bladder secondary to cystic masses in the
right lower quadrant. Cystic masses in the bilateral adnexa have enlarged
since the prior study, including a very large multi cystic lobulated mass
arising from the right adnexa now approximately 12 x 14 cm (2:65), previously
11 x 10 cm. Ovaries cannot be delineated from the cystic lesions.
LYMPH NODES: Numerous enlarged mesenteric and ileocecal lymph nodes are noted,
including a 1.5 x 1.0 cm right lower quadrant mesenteric lymph node (02:49).
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: L2 osseous hemangioma is unchanged. There is no evidence of fracture
or lesion suspicious of infection or malignancy.
SOFT TISSUES: A small umbilical hernia contains a loop of nonobstructed bowel.
IMPRESSION:
1. Significant worsening of metastatic disease burden in the abdomen and
pelvis, with large predominantly cystic masses in the pelvis and widespread
omental caking and peritoneal metastases.
2. Parenchymal cystic lesions in the liver spleen of also enlarged since the
prior study.
3. No evidence of bowel obstruction or intraperitoneal free air.
|
19974576-RR-20 | 19,974,576 | 20,930,639 | RR | 20 | 2122-03-18 17:36:00 | 2122-03-19 00:35:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new hypoxia. metastatic peritoneal tumor.
a/w vomiting/diarrhea // new infiltrate, pulm edema new infiltrate, pulm
edema
COMPARISON: Comparison to ___ at ___
FINDINGS:
AP and lateral views of the chest ___ at 17 38 are submitted.
IMPRESSION:
Small bilateral pleural effusions with minimal patchy opacity at the right
base suggestive of improving atelectasis. No pulmonary edema. There is
central vascular congestion with slight cephalization consistent with
pulmonary venous hypertension. No developing consolidation is seen to suggest
pneumonia. Overall cardiac mediastinal contours are stable. No pneumothorax.
|
19974576-RR-21 | 19,974,576 | 20,930,639 | RR | 21 | 2122-03-18 19:35:00 | 2122-03-18 22:35:00 | INDICATION: ___ year old woman with new onset hypoxia. metastatic ca // r/o
PE
TECHNIQUE: ___ MDCT images were obtained through the chest after the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axis were generated and reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
4) Stationary Acquisition 1.9 s, 0.2 cm; CTDIvol = 31.2 mGy (Body) DLP =
6.2 mGy-cm.
5) Spiral Acquisition 5.0 s, 36.5 cm; CTDIvol = 4.7 mGy (Body) DLP = 150.8
mGy-cm.
Total DLP (Body) = 159 mGy-cm.
COMPARISON: CT abdomen and pelvis from ___ and chest CT dated ___.
FINDINGS:
The visualized portion of the thyroid gland is normal. There is no axillary,
left hilar, or mediastinal lymphadenopathy. An enlarged right hilar lymph
node is seen, measuring up to 1 cm in short axis, series 5, image 45. The
heart size is normal. There is no evidence of pericardial effusion.
CTA: The aorta is normal without evidence of focal aneurysm or dissection.
The main, lobar, segmental, and subsegmental pulmonary arteries appear to be
well opacified without evidence of a filling defect concerning for a pulmonary
embolus.
The airways are patent to the subsegmental levels. No nodules concerning for
malignancy are identified. Small bilateral pleural effusions are seen with
atelectasis at the lung bases. Incidental note is made of a right loculated
focus of effusion, along the fissure measuring approximately 2.4 cm x 1.1 cm,
series 6, image 97. Mild bronchial thickening at the lung bases also may be
secondary to bronchitis. Mild interlobular septal thickening throughout both
lungs likely represents an element of fluid overload. There is no evidence of
a pneumothorax.
The study is not tailored for evaluation of subdiaphragmatic structures,
however re demonstrated is parenchymal cystic lesions within the spleen and
liver, as well as peritoneal metastases and ascites, better evaluated on the
dedicated CT of the abdomen pelvis performed on the prior day.
Osseous structures: No lytic or blastic lesions concerning for malignancy are
identified.
IMPRESSION:
1. No evidence of a pulmonary embolus.
2. New small bilateral pleural effusions with underlying atelectasis. Mild
diffuse interlobular septal thickening likely represents mild interstitial
edema related to fluid overload. Right hilar lymphadenopathy, is likely
reactive. Recommend attention on future studies.
3. Mild bronchitis at the lung bases.
4. For further details of the abdomen, please refer to the dedicated CT of
the abdomen performed on the prior day.
|
19974576-RR-22 | 19,974,576 | 24,449,283 | RR | 22 | 2123-03-15 02:50:00 | 2123-03-15 04:17:00 | INDICATION: +PO contrast; History: ___ with ostomy, abdominal pain, vomiting,
no ostomy output+PO contrast // eval for obstruction
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
2) Spiral Acquisition 5.0 s, 55.0 cm; CTDIvol = 11.7 mGy (Body) DLP = 643.0
mGy-cm.
Total DLP (Body) = 650 mGy-cm.
COMPARISON: CT abdomen/pelvis from ___.
FINDINGS:
LOWER CHEST: There is dependent atelectasis in the visualized lung bases. No
pleural or pericardial effusion is seen.
ABDOMEN:
HEPATOBILIARY: The liver is homogeneous in background attenuation, without
focal lesion or intra or extrahepatic biliary duct dilation. The contour is
lobulated secondary to pseudomyxoma peritonei. The main portal vein appears
patent. The gallbladder is within normal limits.
PANCREAS: Pancreas is atrophic but normal in attenuation without mass, ductal
dilation, or peripancreatic stranding or fluid collection.
SPLEEN: Spleen is normal in size. Several cystic lesions are again seen,
similar in appearance and distribution compared to ___.
ADRENALS: The adrenal glands are normal in caliber and configuration
bilaterally.
URINARY: The kidneys are symmetric and normal in size. There is an unchanged
hypodensity arising from the interpolar region of the right kidney, possibly a
cyst. There is no hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are
distended with contrast proximally, with relative decompression at the level
of the distal ileum likely due to mass effect from the cystic mass. There is
no discrete transition point. The colon and rectum are within normal limits.
The large cystic mass which appears to originate in the right lower quadrant,
presumably the suspected appendiceal mucinous carcinoma, has increased in
size, now measuring 13.6 x 19.6 x 24.3 cm (previously 11.5 x 18.1 x 13.9 cm).
There are increased omental deposits and omental caking. Mucinous material
throughout the abdomen is increased and again compatible with pseudomyxoma
peritonei. This material also extends through an anterior abdominal wall
defect, presumably into the "ostomy" . There may also be a component of
ascites, but is difficult to differentiate from the mucinous deposits
throughout the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is an anterior wall defect as described above, without
evidence of enterostomy or colostomy. Peritoneal wall deposits extend through
the defect. Additional low density lesions in the subcutaneous tissues of the
right anterior abdominal wall are likely additional metastatic implants.
IMPRESSION:
1. Markedly increased primary and metastatic tumor burden. Metastatic
deposits extend through the anterior wall defect into the "ostomy".
2. Distention of proximal loops of small bowel with relative decompression but
node discrete transition point in the distal ileum, compatible with partial
obstruction likely due to mass effect by the large intra-abdominal cystic
mass.
|
19974576-RR-23 | 19,974,576 | 24,449,283 | RR | 23 | 2123-03-15 14:30:00 | 2123-03-15 17:05:00 | INDICATION: ___ year old woman with partial SBO, diffusely guaerding and
peritontic // eval for free air
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: CT abdomen pelvis dated ___ at 02:50.
FINDINGS:
Contrast material is seen in the ascending and transverse colon and bladder
consistent with recent CT abdomen and pelvis performed earlier on the same
day. There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are notable for degenerative disease of the lumbar spine.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No intraperitoneal free air. Normal bowel gas pattern.
|
19974576-RR-24 | 19,974,576 | 24,449,283 | RR | 24 | 2123-03-15 15:33:00 | 2123-03-15 16:22:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with NGT placement for SBO eval position //
eval ngt eval ngt
IMPRESSION:
In comparison with the study of ___, there are lower lung
volumes. No evidence of vascular congestion or acute focal pneumonia.
There has been placement of a nasogastric tube that extends to the lower body
of the stomach.
Residual contrast material is seen in the colon.
|
19975602-RR-9 | 19,975,602 | 28,809,966 | RR | 9 | 2181-06-16 16:31:00 | 2181-06-16 17:11:00 | EXAMINATION: SECOND OPINION CT NEURO PSO1 CT
INDICATION: ___ with right parafalcine hemorrhage from ___. Eval for
right parafalcine hemorrhage and occipital skull fracture. Please eval for
c-spine fracture.
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.
___ axial MD CT images of the cervical spine were obtained without IV
contrast. Coronal and sagittal reformations were provided and reviewed.
DOSE: DLP: 1175.78 mGy-cm
COMPARISON: None.
FINDINGS:
Please note this is a second opinion outside hospital read from the
noncontrast head and C-spine obtained at ___ on ___ (REF___)
Noncontrast CT head:
A 5 mm hyperdense extra-axial focus along the right parafalcine region
(400:49) is most compatible with provided history of a small subarachnoid
hemorrhage. There is no evidence of other acute intracranial hemorrhage.
There is no evidence of large territorial infarction, edema, or mass.
There is prominence of the ventricles and sulci suggestive of involutional
changes.
There is no evidence of calvarial fracture. Soft tissue swelling and a small
hematoma noted along the posterior occiput. There is mild mucosal thickening
in the maxillary sinuses and ethmoidal air cells. The visualized portion of
the remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are unremarkable.
Noncontrast CT cervical spine:
Alignment is normal. There is no evidence of acute fracture. Degenerative
changes in the cervical spine are moderate in severity, most pronounced at
C5-C6, where there is narrowing of the disc space, vacuum disc phenomenon, and
marginal spurring. There is mild retrolisthesis of C5 on C6. There is no
prevertebral soft tissue swelling.
Incidental note is made of a 1.2 cm hypodense left thyroid nodule, and a
smaller subcentimeter nodule in the right thyroid. Imaged lung apices are
grossly clear.
IMPRESSION:
1. 5 mm hyperdense extra-axial focus along the right parafalcine region,
compatible with provided history of small subarachnoid hemorrhage.
2. No evidence of calvarial fracture. Soft tissue swelling and a small
subgaleal hematoma noted along the posterior occiput.
3. No evidence of cervical spinal fracture or traumatic malalignment.
4. Moderate cervical spinal degenerative changes, as above.
|
19975710-RR-14 | 19,975,710 | 20,266,816 | RR | 14 | 2129-11-19 18:58:00 | 2129-11-19 22:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with intubation. Evaluation for tube placement.
TECHNIQUE: Chest AP radiograph
COMPARISON: None.
FINDINGS:
Endotracheal tube appears in appropriate position, terminating approximately
3.5 cm above the carina. Enteric tube courses below the level of the
diaphragm and into the stomach. Moderate cardiomegaly is noted. Diffuse
bilateral interstitial opacities are compatible with pulmonary edema. Small
bilateral pleural effusions, right greater than left. No pneumothorax is
seen.
IMPRESSION:
1. Endotracheal tube appears in appropriate position, terminating
approximately 3.5 cm above the carina.
2. Moderate pulmonary edema with small bilateral pleural effusions.
|
19975710-RR-15 | 19,975,710 | 20,266,816 | RR | 15 | 2129-11-19 20:19:00 | 2129-11-19 22:17:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with elevated dimer, hypoxia. 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: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 33.7 mGy (Body) DLP =
16.9 mGy-cm.
2) Spiral Acquisition 3.5 s, 27.8 cm; CTDIvol = 25.8 mGy (Body) DLP = 716.3
mGy-cm.
Total DLP (Body) = 733 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Minimal atherosclerotic calcification is seen in the
aortic arch and along the descending thoracic aorta. Mild cardiomegaly is
noted. Coronary artery, aortic valve, and mitral annular calcifications are
noted.. The heart, pericardium, and great vessels are otherwise within normal
limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: There is a moderate sized nonhemorrhagic right pleural
effusion and small nonhemorrhagic left pleural effusion. No pneumothorax.
LUNGS/AIRWAYS: Lungs demonstrate diffuse bilateral paraseptal thickening and
ground-glass opacities, likely compatible with pulmonary edema. The airways
are patent to the level of the segmental bronchi bilaterally noting
endoluminal debris in the distal trachea and right mainstem bronchus.
Endotracheal tube appears in appropriate position.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable. An enteric
tube is seen coursing into the stomach.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Cardiomegaly and diffuse bilateral ground-glass opacities and paraseptal
thickening, suggestive of pulmonary edema.
3. Moderate right pleural effusion and small left pleural effusion.
|
19975710-RR-16 | 19,975,710 | 20,266,816 | RR | 16 | 2129-11-20 04:59:00 | 2129-11-20 09:09:00 | INDICATION: ___ year old woman with NSTEMI and hypoxic respiratory failure, on
ventilator// interval change
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT chest dated ___
FINDINGS:
Increased diffuse bilateral airspace opacities as well as a right pleural
effusion. No pneumothorax. The endotracheal and gastric tubes are
appropriately positioned. The size of the cardiac silhouette is enlarged but
unchanged.
IMPRESSION:
Increased pulmonary edema and right pleural fluid.
|
19975710-RR-17 | 19,975,710 | 20,266,816 | RR | 17 | 2129-11-21 09:24:00 | 2129-11-21 10:38:00 | INDICATION: ___ year old woman with new line// new right PICC 48 cm ___
___ Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume with slight improvement in the pulmonary edema. Moderate
right and small left pleural effusions unchanged. Cardiomediastinal
silhouette is stable. The ET and NG tube is unchanged. Right PICC line
projects to the right atrium and may be pulled back approximately 3 cm
|
19975710-RR-19 | 19,975,710 | 20,266,816 | RR | 19 | 2129-11-23 09:49:00 | 2129-11-23 10:45:00 | EXAMINATION: Portable AP chest
INDICATION: ___ year old female with a history of diabetes, hypertension,
hyperlipidemia recently discharged from ___ on ___
following total right hip replacement, who presented with shortness of breath
found to be in acute hypoxic respiratory failure iso fluid overload likely due
to NSTEMI and severe AS.// concern for fluid overload
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___
FINDINGS:
In comparison to the previous film, bilateral airspace opacities are less
apparent and there is improvement in aeration bilaterally. Support lines and
tubes are unchanged. There continues to be the mild to moderate bilateral
pleural effusions, right worse than left. The cardiomediastinal silhouette is
unchanged. There is no pneumothorax.
IMPRESSION:
1. Interval improvement of bilateral airspace opacities consistent with
improved aeration.
2. Mild to moderate bilateral pleural effusions right worse than left, that
are unchanged from prior exam.
3. Support lines and tubes are unchanged
|
19975710-RR-20 | 19,975,710 | 20,266,816 | RR | 20 | 2129-11-24 08:06:00 | 2129-11-24 08:44:00 | INDICATION: ___ year old woman with acute hypoxic resp failure// interval
change?
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Support lines and tubes unchanged. Bilateral effusions right greater than
left are stable. Pulmonary edema has slightly worsened. Cardiomediastinal
silhouette is stable. No pneumothorax is seen.
|
19975710-RR-21 | 19,975,710 | 20,266,816 | RR | 21 | 2129-11-26 10:34:00 | 2129-11-26 11:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year-old female with a history of diabetes, HTN, HLD, recently
discharged from ___ on ___ following total right hip
replacement, who presented with shortness of breath found to be in acute
hypoxic respiratory failure iso fluid overload likely due to NSTEMI and severe
AS, now s/p DES to LAD, with course c/b possible HAP.// eval for PNA and fluid
overload eval for PNA and fluid overload
IMPRESSION:
Comparison to ___. The feeding tube was removed. The right PICC
line is in stable position. Borderline size of the heart. No pleural
effusion. No pulmonary edema. No pneumonia.
|
19975710-RR-22 | 19,975,710 | 20,266,816 | RR | 22 | 2129-11-28 23:19:00 | 2129-11-29 01:15:00 | EXAMINATION: CT HEAD ___ CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with s/p ___/ supratheropeutic INR now
confused.// ? hemorrhagic stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of large territorial infarctionhemorrhage,edema,or mass.
There is prominence of the ventricles and sulci suggestive of involutional
changes. There are periventricular and subcortical lucencies, which may
represent small vessel ischemic changes. Atherosclerotic calcifications are
seen in the bilateral carotid siphons. Bilateral anterior middle cranial
fossa probable arachnoid cyst is noted.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells and right maxillary sinus. Small amount of fluid is seen in
the right sphenoid sinus. Otherwise, the remaining paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are preserved.
IMPRESSION:
1. No acute intracranial process.
2. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
3. Bilateral middle cranial fossa probable arachnoid cysts.
4. Paranasal sinus disease , as described.
|
19975747-RR-5 | 19,975,747 | 28,362,274 | RR | 5 | 2148-08-27 14:15:00 | 2148-08-27 14:27:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with upper abdominal, lower chest pain// Rule out
pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is top no. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Patchy opacities in the lung bases likely
reflect areas of atelectasis. 5 mm calcified granuloma in the left lung base
is demonstrated. No pleural effusion or pneumothorax is seen. There are no
acute osseous abnormalities. Mild degenerative spurring is noted in the
thoracic spine.
IMPRESSION:
Patchy opacities in the lung bases, likely atelectasis.
|
19975747-RR-6 | 19,975,747 | 28,362,274 | RR | 6 | 2148-08-27 15:21:00 | 2148-08-27 16:26:00 | EXAMINATION: CT torso.
INDICATION: History: ___ with sudden onset abd pain. Evaluate for
dissection.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration.
IV Contrast: 130 mL Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.5 s, 0.5 cm; CTDIvol = 4.6 mGy (Body) DLP = 2.3
mGy-cm.
2) Spiral Acquisition 3.1 s, 24.7 cm; CTDIvol = 9.5 mGy (Body) DLP = 233.4
mGy-cm.
3) Spiral Acquisition 6.6 s, 52.1 cm; CTDIvol = 14.7 mGy (Body) DLP = 764.8
mGy-cm.
Total DLP (Body) = 1,000 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. Calcified left hilar lymph nodes indicate prior
granulomas disease. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Minimal dependent bibasilar atelectasis. 4 mm nodule is seen
in the left upper lobe (series 4, image 43). Also, a 5 mm calcified granuloma
is present in the left lower lobe (series 3, image 63). Otherwise, lungs are
clear without masses or areas of parenchymal opacification. Mild cylindrical
bronchiectasis with minimal airway wall thickening is present. Additionally,
secretions are seen within the cervical trachea (04:20). The airways are
otherwise patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. 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 lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Distal esophagus demonstrates circumferential wall
thickening. The stomach is markedly distended with fluid. There is marked,
fluid-filled dilatation of the duodenum and multiple loops of proximal small
bowel, with fecalized intraluminal material noted proximal to a transition
point in the lower mid abdomen, compatible with high-grade small-bowel
obstruction (series 5, image 65). Trace fluid is noted adjacent to a loop of
small bowel in the pelvis (series 5, image 69). No perforation.
Diverticulosis of the sigmoid colon is noted, without evidence of wall
thickening and fat stranding. The appendix is normal.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no
evidence of adnexal abnormality bilaterally.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: Multilevel degenerative changes of the thoracolumbar spine with
prominent anterior osteophytes at the thoracolumbar junction. There is no
acute fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: The right breast implant is present. Otherwise, the abdominal
and pelvic wall is within normal limits.
IMPRESSION:
1. High-grade small-bowel obstruction with transition point in the low mid
abdomen. Small volume pelvic free fluid. No pneumoperitoneum or organized
fluid collections.
2. Marked distension of the stomach for which enteric tube decompression is
recommended.
3. Distal esophageal wall thickening likely reflective of esophagitis from
recent vomiting.
4. No pulmonary embolism or acute aortic pathology.
5. 4 mm left upper lobe pulmonary nodule. See recommendations below.
6. Evidence of prior granulomatous disease in the chest.
7. Mild cylindrical bronchiectasis and mild airway wall thickening suggestive
of chronic bronchitis.
|
19975747-RR-7 | 19,975,747 | 28,362,274 | RR | 7 | 2148-08-27 17:38:00 | 2148-08-27 18:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with NG placement// NG placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: Earlier today, ___ at 14:25
FINDINGS:
Interval placement of an NG tube, which terminates in the expected location of
the stomach. There is bibasilar atelectasis without definite focal
consolidation. No large pleural effusion or pneumothorax is seen. Cardiac
and mediastinal silhouettes are stable. Residual contrast from preceding CT
is noted in the renal collecting systems.
IMPRESSION:
Nasogastric tube terminates in the stomach.
|
19975747-RR-8 | 19,975,747 | 28,362,274 | RR | 8 | 2148-08-28 10:05:00 | 2148-08-28 17:07:00 | INDICATION: ___ year old woman with SBO. contrast placed down NGT please eval
transit// please perform at 10:15am on ___
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis from ___
FINDINGS:
The tip of the enteric tube is out of the field of view but likely coiled
within the stomach. Air-filled small bowel loops measure up to 4.1 cm in the
mid abdomen. Enteric contrast is seen throughout the colon to the level the
rectum. Limited evaluation, but there is no free intraperitoneal air. Osseous
structures are unremarkable. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
Enteric contrast is seen throughout the colon to the level of the rectum.
Small bowel loops measure up to 4.1 cm. These findings are consistent with a
partial or resolving small bowel obstruction.
|
19975898-RR-75 | 19,975,898 | 25,531,568 | RR | 75 | 2159-12-08 06:39:00 | 2159-12-08 07:50:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ man status post orthotopic liver transplant, assess
liver with Doppler flow.
TECHNIQUE: Gray scale, color and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON:
1. CT abdomen and pelvis ___.
2. Liver gallbladder ultrasound ___.
FINDINGS:
Liver: The transplanted hepatic parenchyma is within normal limits. Nofocal
liver lesions are identified. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 2 mm.
Gallbladder: The gallbladder is surgically absent.
Pancreas: The pancreas is obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 13.9 cm.
Kidneys: The right kidney measures 8.9 cm. The left kidney measures 11.1 cm.
Again seen is a non-obstructing right upper renal pole 9 mm calculus. There
is no evidence of concerning solid renal mass. There is no hydronephrosis.
Normal corticomedullary differentiation is seen bilaterally.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 20-30 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main, right, and left hepatic arteries are patent, with appropriate
waveforms and resistive indices ranging from 0.58-0.60.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein is patent, with antegrade flow.
IMPRESSION:
1. Patent hepatic vasculature. Unremarkable liver Doppler examination.
2. Unchanged 9 mm right upper pole nonobstructing renal calculus. No
hydronephrosis.
3. Stable mild splenomegaly.
|
19975981-RR-9 | 19,975,981 | 25,927,585 | RR | 9 | 2157-09-12 11:34:00 | 2157-09-12 12:49:00 | PORTABLE AP UPRIGHT CHEST FILM, ___ AT 11:33.
CLINICAL INDICATION: ___ with anemia due to menorrhagia and 50-pound
weight loss in seven months, preop for myomectomy.
No comparison studies.
Please note that comparison to old films can be helpful to detect subtle
interval change.
Portable AP upright chest film ___ at 11:33 is submitted.
IMPRESSION:
Cardiac and mediastinal contours are within normal limits given portable
technique. Lungs appear well inflated without focal airspace consolidation,
pleural effusions, pneumothorax or pulmonary edema. No acute bony abnormality
is appreciated.
|
19975995-RR-10 | 19,975,995 | 26,284,923 | RR | 10 | 2111-03-14 21:24:00 | 2111-03-14 22:44:00 | INDICATION: ___ year old man with gangrenous appendix. now s/p appendectomy.
// eval for abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP =
15.6 mGy-cm.
2) Spiral Acquisition 5.5 s, 59.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
1,001.9 mGy-cm.
Total DLP (Body) = 1,018 mGy-cm.
COMPARISON: ___
FINDINGS:
LOWER CHEST: Bibasilar atelectasis, new since prior. No pleural or
pericardial effusions.
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 focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The patient is status post recent
appendectomy.
There are multiple rim enhancing collections throughout the abdomen and
pelvis. For example;
- adjacent to the sutures and surgical clips at the appendectomy site is a 9.0
x 20.1 x 10.1 cm lobulated fluid collection extending across midline. (Series
2, image 65 ; series 601b, image 38)
- along the left paracolic gutter is a collection which measures 2.3 x 4.6 x
5.5 cm (2:54; 601b:38)
- deep to the left anterior abdominal wall is a 9.1 x 3.2 by 5.5 cm collection
(2:69); 601b:27)
- a collection seen on the coronal image 34 likely communicates with the first
described collection above.
- above the bladder dome is a 7.4 x 7.1 by 4.8 cm collection (2:87; 601b:49)
Extensive inflammatory stranding is present throughout the mesentery and
pelvis. A trace amount of extraluminal gas is present, presumed to be
postsurgical.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Postsurgical changes in the subcutaneous tissues of the abdomen.
IMPRESSION:
1. Numerous rim enhancing collections as described above.
2. Tiny extraluminal gas locules are present, presumed to be postsurgical.
|
19975995-RR-11 | 19,975,995 | 26,284,923 | RR | 11 | 2111-03-15 12:38:00 | 2111-03-15 16:01:00 | EXAMINATION: Ultrasound-guided abscess drainage
INDICATION: ___ year old man with multiple intraabdominal abscesses which
require drainage // please place percutaneous drain for intraabdominal
abscesses
COMPARISON: CT from ___
PROCEDURE: Ultrasound-guided catheter placement within a a right lower
quadrant, midline lower abdomen, and left mid abdomen collection.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agree with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize each collection. Based on
the ultrasound findings an appropriate skin entry site for the drain placement
was chosen for the 3 separate sites (right lower quadrant, midline lower
abdomen, and left mid abdomen). These 3 sites were marked.
At the right lower quadrant site local anesthesia was administered with 1%
Lidocaine solution. Using continuous sonographic guidance local anesthesia was
delivered to the periphery of the collection. A small skin ___ was made and
an 8 ___ Exodus catheter was inserted into the collection using continuous
ultrasound guidance. The plastic stiffener and the wire were removed. Pigtail
was deployed, and the position of the pigtail was confirmed within the
collection via ultrasound.
Approximately 20 cc of serosanguinous fluid with significant debris was
drained with a sample sent for microbiology evaluation. The catheter was
attached to bag.
Next to the midline lower abdomen site was identified and local anesthesia was
administered with 1% Lidocaine solution. Using continuous sonographic
guidance local anesthesia was delivered to the periphery of the collection. A
small skin ___ was then made and an 8 ___ Exodus catheter was inserted
into the collection using continuous ultrasound guidance. The plastic
stiffener and the wire were removed. Pigtail was deployed, and the position of
the pigtail was confirmed within the collection via ultrasound.
Approximately 20 cc of yellow fluid with significant debris (likely purulent)
was drained with a sample sent for microbiology evaluation. The catheter was
attached to bag.
Finally the left mid abdomen site was identified and local anesthesia was
administered with a 1% lidocaine solution. Using continuous sonographic
guidance local anesthesia was delivered to the periphery of the collection. A
small skin ___ was then made and an 8 ___ Exodus catheter was inserted
into the collection using continuous ultrasound guidance. The plastic
stiffener and the wire were removed. Pigtail was deployed, and the position of
the pigtail was confirmed within the collection via ultrasound.
Approximately 20 cc of mostly clear yellow fluid was drained with a sample
sent for microbiology evaluation. The catheter was attached to bag.
Next, all three catheters were secured by StatLocks and sterile dressings were
applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
3.0 mg Versed and 175 mcg fentanyl throughout the total intra-service time of
60 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
A total of 270 cc of serosanguineous fluid with significant debris was removed
from the right lower quadrant drain by the time the patient left the
department.
A total of 35 cc of yellow fluid with significant debris, likely purulent, was
removed on the midline lower abdomen drain by the time the patient left the
department.
A total of 25 cc of clear yellow fluid, likely serous, was removed from the
left mid abdomen drain by the time the patient left the department.
The first 20 cc of fluid removed from each site was sent separately to the lab
for microbiology analysis (individually labeled as to site).
IMPRESSION:
Successful US-guided placement of ___ pigtail catheters into a right
lower quadrant collection, a midline lower abdomen collection, and a left mid
abdomen collection. Samples were sent for microbiology evaluation.
|
19975995-RR-14 | 19,975,995 | 29,336,309 | RR | 14 | 2111-03-25 13:58:00 | 2111-03-25 14:53:00 | EXAMINATION: CT abdomen and pelvis with contrast.
INDICATION: History: ___ with recent lap appendectomy ___, had multiple
pelvic abscesses and had 3 JP drains place. Pt presents today with one drain
dislodged and having increase abd discomfort and drainage. NO f/cNO_PO
contrast // eval abdominal abcesses
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 5.4 s, 58.5 cm; CTDIvol = 16.8 mGy (Body) DLP = 983.7
mGy-cm.
Total DLP (Body) = 993 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast dated ___.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: There is a wedge-shaped area of hyperdensity surrounding an
apparent hypodense tubular structure in segment VIII, more pronounced than on
prior study from ___, which could represent a thrombosed branch of
the middle hepatic vein, or less likely cholangitis about a dilated biliary
duct. No new focal concerning hepatic lesions are seen. There is no evidence
of 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: There is new right-sided mild hydroureteronephrosis with abrupt
caliber change of the distal right ureter near the region of phlegmonous
changes in the right lower quadrant (2:60). No focal renal lesion is
identified. No hydroureteronephrosis on the left. 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. Patient is status post appendectomy.
PELVIS: A large 8.3 x 7.3 cm rim-enhancing collection within the midline
pelvis, just posterior to the bladder, previously measuring 7.4 x 7.1 cm, is
consistent with an abscess and tracks along the anterior aspect of the left
pelvis (2:75). There is associated inflammation and phlegmonous changes
within the midline pelvis and left anterior pelvis as well as to a lesser
extent within the appendectomy bed. Three pigtail catheters are in place,
with the right lower quadrant and midline pelvic collections markedly
decreased in size. The left lateral mid abdominal fluid collection is no
longer visualized. The urinary bladder is unremarkable.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Interval increase in size of midline pelvic abscess, now measuring 8.3 x
7.3 cm which extends to the left anterior pelvis.
2. Three pigtail catheters in place with interval resolution of the left-sided
fluid collection and marked decrease in size of the two remaining collections.
No new fluid collections identified.
3. New mild right-sided hydroureteronephrosis, with transition point in the
distal right ureter as it courses in the region of phlegmonous changes in the
right lower quadrant.
4. Wedge-shaped area of hyperdensity surrounding a hypodense tubular structure
in segment VIII, more pronounced compared to prior study, which could
represent a potentially thrombosed branch of the middle hepatic vein with
thrombophlebitis, or less likely, cholangitis surrounding a dilated duct.
This could be further assessed with MRCP.
RECOMMENDATION(S): MRCP is suggested for further assessment of the segment
VIII hepatic abnormality.
|
19975995-RR-15 | 19,975,995 | 29,336,309 | RR | 15 | 2111-03-26 15:06:00 | 2111-03-26 19:01:00 | EXAMINATION:
CT-guided abscess drainage.
INDICATION: ___ year old man with undrained pelvic fluid cxn s/p lap appy c/b
multiple abscesses with ___ drains previously placed ___ // drain in pelvic
fluid collection
COMPARISON:
CT abdomen and pelvis ___
PROCEDURE: Ultrasound-guided drainage of a presacral collection.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agree with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT was performed to localize the collection. Based on the CT
findings an appropriate site for entry was chosen. The site was marked. Local
anesthesia was administered with 1% lidocaine solution. A ___ needle was
advanced to a communicating tract with the collection, within the left lower
quadrant. Subsequently a guidewire was advanced into the tract, using CT
guidance. The Glidewire coiled within the tract, and was unable to be
advanced into the deeper collection.
The patient was then repositioned in a left lateral decubitus position on the
CT scan table. Limited preprocedure CT was performed to localize the
collection. Based on the CT findings an appropriate skin entry site for the
drain placement was chosen. The site was marked. Local anesthesia was
administered with 1% Lidocaine solution.
Using continuous sonographic guidance, 18G ___ needle was inserted into
the collection. 0.038 ___ wire was placed through the needle and needle
was removed. A sample of fluid was aspirated, confirming needle position
within the collection. This was followed by placement of ___ Exodus
catheter into the collection. The plastic stiffener and the wire were removed.
Pigtail was deployed, and the position of the pigtail was confirmed within the
collection via ultrasound.
Approximately 100 cc of hemorrhagic purulent fluid was drained with a sample
sent for microbiology evaluation. The catheter was secured by a Flexitrack.
The catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
5.5 mg Versed and 200 mcg fentanyl throughout the total intra-service time of
57 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Successful CT-guided drainage of a presacral collection, with 8 ___
catheter in place.
IMPRESSION:
Successful CT-guided placement of ___ pigtail catheter into the
collection consistent with infected hematoma. Samples was sent for
microbiology evaluation.
|
19975995-RR-8 | 19,975,995 | 26,284,923 | RR | 8 | 2111-03-10 13:42:00 | 2111-03-10 15:32:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ with RLQ abd pain // eval for appendicitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,089 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder 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 focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix contains two appendicoliths and
is fluid-filled and dilated up to 2.2 cm, with a thick and hyper enhancing
wall and surrounding fat stranding, consistent with acute appendicitis (2:60;
601b:25). There is no extraluminal air or fluid collection.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Acute appendicitis with two appendicoliths and extensive surrounding soft
tissue stranding. No extraluminal air or drainable fluid collection.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in
person on ___ at 2:56 ___, 1 minutes after discovery of the findings.
|
19976024-RR-5 | 19,976,024 | 29,806,870 | RR | 5 | 2135-11-29 07:04:00 | 2135-11-29 07:26:00 | HISTORY: 1 week of right lower quadrant pain.
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after
administration of oral and intravenous contrast. Images were displayed in
multiple planes.
COMPARISON: None.
FINDINGS:
Abdomen: The lung bases are clear. The liver enhances homogeneously. The
portal veins are patent. There is no intra or extrahepatic biliary
dilatation. The gallbladder is thin walled and nondistended. The pancreas
and spleen enhance homogeneously. Adrenal glands are normal. The kidneys
enhance symmetrically and excrete contrast promptly. Subcentimeter
hypodensities in both kidneys are too small to characterize. There is no
mesenteric adenopathy. The stomach, proximal small and intra-abdominal large
bowel are of normal caliber.
Pelvis: The tip of a retrocecal appendix is dilated up to 13 mm. The
appendix is hyperemic and surrounded by fat stranding. There is no
extraluminal air or fluid collection. The remainder of the colon is normal.
The bladder and prostate are normal. There is no pelvic or inguinal
adenopathy.
There are no concerning lytic or sclerotic bone lesions.
IMPRESSION:
Acute appendicitis.
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19976911-RR-21 | 19,976,911 | 27,576,166 | RR | 21 | 2139-10-16 10:09:00 | 2139-10-16 11:54:00 | INDICATION: ___ year old man with status post PPM // evaluate for lead
placement
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Moderate left pleural effusion and left lower lobe atelectasis are unchanged
and left trans subclavian right atrial ventricular pacer leads, continuous
from the left pectoral generator pharyngeal. There is no pneumothorax or
mediastinal widening. Right lung is clear.
IMPRESSION:
No unfavorable change, stable appearance of the pacer leads and moderate left
effusion.
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19976911-RR-22 | 19,976,911 | 27,576,166 | RR | 22 | 2139-10-15 20:02:00 | 2139-10-15 21:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with status post PPM // evaluate for lead
placement evaluate for lead placement
COMPARISON: Prior chest radiograph ___.
IMPRESSION:
Moderate left pleural effusion and left lower lobe atelectasis are unchanged
and pre see the insertion of new left trans subclavian right atrial
ventricular pacer leads, continuous from the left pectoral generator. There
is no pneumothorax or mediastinal widening. Right lung is clear.
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19977310-RR-30 | 19,977,310 | 22,535,910 | RR | 30 | 2152-01-16 20:27:00 | 2152-01-16 21:00:00 | CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Productive cough, fevers, assess for pneumonia.
FINDINGS: PA and lateral views of the chest were obtained. A right IJ
dialysis catheter is seen with its tip in the expected location of the
cavoatrial junction. There is mild pulmonary venous congestion with probable
mild pulmonary edema. No large pleural effusions are seen. In the presence
of pulmonary edema the possibility of a superimposed mild/early pneumonia is
impossible to exclude, though none is clearly seen. No pneumothorax. Heart
size is top normal though stable. Aortic calcifications are noted. Bony
structures appear intact though there are degenerative spurs along the mid
thoracic spine.
IMPRESSION: Mild pulmonary edema without definite signs of pneumonia though
post-diuresis films may be obtained to further assess if clinically warranted.
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19978119-RR-53 | 19,978,119 | 20,178,379 | RR | 53 | 2189-04-19 18:13:00 | 2189-04-19 20:13:00 | INDICATION: ___ year old man with CAD s/p PCI (___), metastatic pancreatic
cancer s/p ___ (___) on FOLFOX, Afib on enoxaparin, chronic urinary
retention, and current C Diff colitis. // splenic hypodensity on prior CT
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen in the portal venous phase, followed by a scan of the abdomen in
equilibrium phase (3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 33.0 cm; CTDIvol = 5.3 mGy (Body) DLP = 173.4
mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 5.7 mGy (Body) DLP = 2.8
mGy-cm.
3) Spiral Acquisition 3.7 s, 28.8 cm; CTDIvol = 7.8 mGy (Body) DLP = 224.7
mGy-cm.
4) Spiral Acquisition 4.0 s, 31.3 cm; CTDIvol = 22.0 mGy (Body) DLP = 688.3
mGy-cm.
5) Spiral Acquisition 3.6 s, 28.6 cm; CTDIvol = 22.5 mGy (Body) DLP = 644.0
mGy-cm.
Total DLP (Body) = 1,733 mGy-cm.
COMPARISON: CT abdomen and pelvis without contrast ___
FINDINGS:
LOWER CHEST: Small bilateral pleural effusions are identified. Bibasilar
atelectasis is mild. 2 mm left lower lobe nodule and 4 mm left perifissural
nodular density are stable.
ABDOMEN:
HEPATOBILIARY: Numerous hypodense lesions in the liver are consistent with
history of metastatic pancreatic cancer. A tubular radiodense material in
the small bowel loop is again demonstrated (601b:58). The gallbladder is
surgically absent.
PANCREAS: Patient is status post Whipple procedure. There is soft tissue
density anterior to the portal vein as before likely reflecting tumor
recurrence and stable. Tiny hypodensities within the pancreatic tail could
reflect IPMN but are not fully characterize.
SPLEEN: Areas of hypodensity within the spleen likely reflects infarct. A
smaller rounded focus of hypo density is noted at the splenic tip inferiorly
and could reflect infarct or metastasis.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There are multiple hypodense lesions within the kidneys which likely
reflects cysts although some cannot be fully characterized.
GASTROINTESTINAL: The remaining stomach is unremarkable. There is no
small-bowel obstruction. Colonic wall thickening is markedly decrease and is
most severe in the splenic flexure and descending colon.
LYMPH NODES: Multiple enlarged periportal and mesenteric lymph nodes are
consistent with history of metastatic pancreatic cancer. There is diffuse
mesenteric edema. Us small to moderate amount of intra-abdominal ascites is
appreciated.
VASCULAR: Compared to the prior examination, there is new thrombosis within a
branch of the left portal vein as well as within the main portal vein at the
SMV confluence.
BONES: There is at L3 superior endplate deformity as well as anterior wedging
of the T9 vertebral body. There is an old left ninth rib fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Splenic infarcts.
2. Numerous hypodense masses in the liver are consistent with history of
metastatic pancreatic cancer.
3. Thrombus within the main portal vein and left portal vein branches.
4. Colonic wall thickening consistent with colitis is persistent but improved
compared to ___.
5. Small to moderate amount of nonhemorrhagic ascites is slightly increased.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 8:15 ___, 5 minutes after discovery of
the findings.
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19978119-RR-54 | 19,978,119 | 20,178,379 | RR | 54 | 2189-04-20 14:03:00 | 2189-04-20 14:37:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with c diff colitis, new frank blood in stool and
increased abdominal distension // Perforation? Other acute change?
Perforation? Other acute change?
IMPRESSION:
Comparison to ___. Three views of the abdomen are provided. Clips
are projecting over the middle abdomen. Mild colonic distension at the level
of the transverse and the descending colon. Colonic air-fluid levels are
visualized on the cross-table view. No evidence of free intra-abdominal air.
Several phleboliths projecting over the pelvis.
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Subsets and Splits