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19978119-RR-55 | 19,978,119 | 20,178,379 | RR | 55 | 2189-04-20 15:14:00 | 2189-04-20 16:09:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 5 EXAMS
INDICATION: ___ year old man with Dobhoff placement // 2 images to confirm
placement 2 images to confirm placement
IMPRESSION:
Comparison to ___. The fifth of 5 images shows the new feeding tube
correctly positioned in the distal parts of the stomach. An interim
malposition in the right main bronchus was rectified. No pneumothorax or
other complication. Otherwise unchanged radiograph.
|
19978119-RR-56 | 19,978,119 | 20,178,379 | RR | 56 | 2189-04-21 13:50:00 | 2189-04-21 16:01:00 | EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old man with a-fib, metastatic pancreatic cancer with
worsening L UE edema, concern for DVT given break in anticoagulation // L UE
r/o DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity.
|
19978119-RR-57 | 19,978,119 | 20,178,379 | RR | 57 | 2189-04-23 15:22:00 | 2189-04-23 16:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cdiff colitis with wet cough and increasing
labored breathing // ?PNA, pulm edema ?PNA, pulm edema
IMPRESSION:
Comparison to ___. The left Port-A-Cath is in correct position.
The lung volumes have slightly decreased. And there is unchanged presence of
an atelectasis at the left lung basis. No other changes are noted. Mild
retrocardiac atelectasis. Normal size of the cardiac silhouette. No pulmonary
edema, no pleural effusions.
|
19978119-RR-58 | 19,978,119 | 20,178,379 | RR | 58 | 2189-04-24 07:12:00 | 2189-04-24 08:25:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pancreatic cancer, c. diff colitis, new O2
requirement // eval for pulm edema, pna eval for pulm edema, pna
IMPRESSION:
Comparison to ___. No relevant change is noted. Monitoring and
support devices are stable. Low lung volumes. Bilateral small areas of
atelectasis. No pulmonary edema, no pleural effusions.
|
19978265-RR-18 | 19,978,265 | 23,713,862 | RR | 18 | 2157-05-17 02:34:00 | 2157-05-17 06:06:00 | INDICATION: History: ___ with fall, head strike, face trauma // eval for
injury
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
The cardiomediastinal and hilar contours are normal. There is no pleural
effusion or pneumothorax. Lung volumes are low, but there is no focal
consolidation concerning for pneumonia. Pulmonary vasculature is within
normal limits. The upper abdomen is unremarkable aside from cholecystectomy
clips in the right upper quadrant.
IMPRESSION:
No acute cardiopulmonary process.
|
19978265-RR-19 | 19,978,265 | 23,713,862 | RR | 19 | 2157-05-17 02:34:00 | 2157-05-17 06:05:00 | EXAMINATION: LUMBO-SACRAL SPINE (AP AND LAT)
INDICATION: History: ___ with fall, head strike, face trauma // eval for
injury eval for injury
TECHNIQUE: AP and lateral views of the lumbar spine.
COMPARISON: None.
FINDINGS:
5 non-rib-bearing lumbar vertebral bodies are present. Vertebral body and
disc heights are preserved. No fracture or subluxation is detected. Mild
degenerative changes are present with anterior osteophytes at L4 and L5. No
suspicious lytic or sclerotic lesion is identified. Surgical screws in the
left proximal femur are partly visualized.
IMPRESSION:
No fracture.
|
19978265-RR-20 | 19,978,265 | 23,713,862 | RR | 20 | 2157-05-17 01:50:00 | 2157-05-17 02:48:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall, head strike, face trauma // eval for
injury
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 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
4) CT Localizer Radiograph
5) CT Localizer Radiograph
6) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 1,605 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
There is no evidence of fracture. The visualized portion of the mastoid air
cells, and middle ear cavities are clear. Mild mucosal thickening of the
right maxillary sinus is noted. The visualized portion of the orbits are
unremarkable. Mild irregularity of the right nasal bone may indicate a
fracture.
IMPRESSION:
1. No acute intracranial process.
2. Mild irregularity of the right nasal bones may indicate a fracture.
|
19978265-RR-21 | 19,978,265 | 23,713,862 | RR | 21 | 2157-05-17 01:50:00 | 2157-05-17 02:47:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: History: ___ with fall, head strike, face trauma // eval for
injury
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 2.5 s, 20.0 cm; CTDIvol = 25.8 mGy (Head) DLP = 516.4
mGy-cm.
Total DLP (Head) = 516 mGy-cm.
COMPARISON: None.
FINDINGS:
SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other
soft tissue abnormality.
MAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.
The zygomatico-maxillary complex is intact. The lateral pterygoid plates are
intact.
MANDIBLE: A mildly displaced left mandibular fracture is present. The
mandible is without temporomandibular joint dislocation. The
temporomandibular joints are symmetric, without significant degenerative
change.
DENTITION: There are no dental fractures.Periapical lucencies of bilateral
mandibular premolar and molar teeth.
SINUSES: Mucosal thickening of bilateral maxillary sinuses is noted, more on
the right. The paranasal sinuses are intact and clear. The right ostiomeatal
unit is patent. The left ostiomeatal unit is not patent. The mastoid air
cells and middle ear cavities are clear.
NOSE: Mild irregularity of the right nasal bone may indicate a fracture.
Nasopharyngeal soft tissues are unremarkable. There is no nasal septal
hematoma.
ORBITS: The orbits, including the laminae papyracea, are intact. The globes
are intact with non-displaced lenses and no intraocular hematoma. There is no
preseptal soft tissue edema. There is no retrobulbar hematoma or fat
stranding.
IMPRESSION:
1. Mildly displaced left mandibular fracture.
2. Mild irregularity of the right nasal bone may indicate a fracture.
3. Multiple dental caries. Periapical lucencies right mandibular third molar.
|
19978265-RR-22 | 19,978,265 | 23,713,862 | RR | 22 | 2157-05-17 01:51:00 | 2157-05-17 02:41:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall, head strike, face trauma // eval for
injury
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 5.3 s, 20.6 cm; CTDIvol = 37.0 mGy (Body) DLP = 761.3
mGy-cm.
Total DLP (Body) = 761 mGy-cm.
COMPARISON: None.
FINDINGS:
The study is somewhat limited by motion artifact. Alignment is normal. No
cervical spine fractures are identified.There is no significant canal or
foraminal narrowing.There is no prevertebral edema.
The thyroid and included lung apices are unremarkable. Left mandibular
fracture is again noted.
IMPRESSION:
1. Moderately limited by motion artifact. No convincing evidence for acute
fracture.
2. Left mandibular fracture.
|
19978265-RR-23 | 19,978,265 | 23,713,862 | RR | 23 | 2157-05-17 05:16:00 | 2157-05-17 06:00:00 | INDICATION: History: ___ s/p fall with L mandibular fracture and rib pain //
assess for injuries
TECHNIQUE: MDCT axial images were acquired through the chest, 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) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 9.0 s, 70.4 cm; CTDIvol = 6.1 mGy (Body) DLP = 432.4
mGy-cm.
Total DLP (Body) = 432 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. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: Diffuse low-density of the liver is consistent with hepatic
steatosis. There is no evidence of focal lesion or laceration. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. 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 is absent. A small splenule seen in the left upper
quadrant in the region of the spleen.
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 is normal. There is no
evidence of mesenteric injury.
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 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 or retroperitoneal hematoma.
No atherosclerotic disease is noted. Incidental note is made of an accessory
right renal artery. A 1.3 cm filling defect is noted in the right external
iliac vein, which is not appear to be due to the artifact from mixing of
non-opacified blood (series 2, image 206).
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
Surgical hardware is present in both femurs.
SOFT TISSUES: A small fat containing umbilical hernia is present.
IMPRESSION:
1. No evidence of acute injury in the torso. No fractures.
2. Small filling defect in the right external iliac vein concerning for a
small thrombus.
3. Status post cholecystectomy and splenectomy.
4. Hepatic steatosis.
RECOMMENDATION(S): MRV is recommended for further evaluation of the right
external iliac vein.
NOTIFICATION: The recommendation was discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 8:53 AM.
|
19978265-RR-24 | 19,978,265 | 23,713,862 | RR | 24 | 2157-05-17 06:45:00 | 2157-05-17 07:18:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with CT showing question DVT // Eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: CT abdomen pelvis ___.
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.
An anechoic fluid collection is present in the medial popliteal fossa which is
not definitely tracking to the joint space. This collection measures 3.7 x
1.0 x 4.0 cm.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. 4.0 cm fluid collection in the right popliteal fossa, which does not
definitely connect to the joint space.
|
19978265-RR-25 | 19,978,265 | 23,713,862 | RR | 25 | 2157-05-18 21:01:00 | 2157-05-18 23:00:00 | INDICATION: CT abd/pelv with contrast showing thrombus in right ext iliac
vein and right femoral vein. Concern for thrombus. // please eval for dvt
TECHNIQUE: Multi sequence multiplanar images of the pelvis were obtained pre
and postcontrast 3
COMPARISON: CT torso ___.
FINDINGS:
MRV: There is a 1.2 cm linear, nonenhancing nonocclusive filling defect in
the right external iliac vein, as seen on recent CT (series 11, image 22). No
other filling defects are seen in the pelvic veins.
Pelvis: The rectum and intrapelvic loops of bowel are decompressed and
otherwise unremarkable. The visualized portions of the right kidney and liver
are unremarkable. The uterus and adnexa are unremarkable. There is no pelvic
sidewall or inguinal lymphadenopathy. There is no abdominal or pelvic free
fluid.
Osseous structures: No osseous lesions suspicious for malignancy or infection
is present. Bilateral hip replacements are noted.
A small fat containing umbilical hernia is present.
IMPRESSION:
Small nonocclusive, nonenhancing thrombus in the right external iliac vein, as
seen previously.
|
19978265-RR-26 | 19,978,265 | 23,713,862 | RR | 26 | 2157-05-17 10:20:00 | 2157-05-17 15:32:00 | EXAMINATION: MANDIBLE SERIES INCLUD PANOREX
INDICATION: Mildly displaced left mandibular fracture.
TECHNIQUE: Five views of the mandible including a Panorex view.
COMPARISON: None.
FINDINGS:
There is a mildly displaced fracture of the left mandibular angle. No other
fracture is seen. Several areas of dental periapical lucency along the
mandibular dentition, are better characterized on same-day CT examination.
There appears to be a tooth fragment also above the right mandibular body.
IMPRESSION:
Left mandibular angle fracture.
Additional findings as above.
|
19978265-RR-27 | 19,978,265 | 23,713,862 | RR | 27 | 2157-05-19 13:30:00 | 2157-05-19 13:49:00 | EXAMINATION: MANDIBLE (PANOREX ONLY)
INDICATION: ___ year old woman with L mandible fracture, s/p ORIF // S/P L
mandible ORIF, post-op comparison S/P L mandible ORIF, post-op comparison
IMPRESSION:
In comparison with the study of ___, there is a fixation device about
the distracted fracture in the region of the angle of the mandible on the
left.
|
19978265-RR-28 | 19,978,265 | 23,713,862 | RR | 28 | 2157-05-19 21:34:00 | 2157-05-19 21:52:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with known right external iliac thrombus.
Evaluate for possible DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
19978454-RR-28 | 19,978,454 | 26,077,022 | RR | 28 | 2176-06-06 16:56:00 | 2176-06-06 19:01:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with upper abd pain // ? free air
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process. No free air below the right hemidiaphragm.
|
19978454-RR-30 | 19,978,454 | 26,077,022 | RR | 30 | 2176-06-07 09:56:00 | 2176-06-07 11:30:00 | EXAMINATION: LIMITED ABDOMINAL ULTRASOUND.
INDICATION: ___ year old woman with cirrhosis, GIB, and abd pain, diagnostic
paracentesis to evaluate for spontaneous bacterial peritonitis.
TECHNIQUE: Grayscale ultrasound in all 4 quadrants.
COMPARISON: Abdominal MRI ___ and paracentesis from ___.
FINDINGS:
Views of all 4 quadrants demonstrate no ascites. Paracentesis was therefore
canceled.
IMPRESSION:
No ascites seen. Paracentesis was therefore canceled.
NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ the
telephone on ___ at 11:00, 5 min after they were made.
|
19978454-RR-31 | 19,978,454 | 26,077,022 | RR | 31 | 2176-06-07 18:52:00 | 2176-06-07 19:59:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with HCV cirrhosis, HCC, presenting with 4 days
hx of abd pain that lateralizes to her RLQ this morning and 2 days of melena
// r/o appendicitis and diverticulitis
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 684 mGy-cm (abdomen and pelvis).
IV Contrast: 130 mL Omnipaque
COMPARISON: Reference CT abdomen ___
FINDINGS:
LOWER CHEST:
There is an 8 mm pleural-based pulmonary nodule at the right lung base (5:7),
which appears to have enlarged compared to ___ where it measured 4 mm
(2:39, prior study). There is no pleural effusion. The heart size is normal,
and there is no pericardial effusion
ABDOMEN:
HEPATOBILIARY: There is a 3 mm heterogeneous focus along the anterior lateral
aspect of segment segment VI (5:32), compatible with the lesion that was
suspicious for ___ as seen on the recent MRI dated ___. Other hepatic
lesions described on that MRI, including the suspicious segment III lesion,
are not well visualized on this single phase study. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. A stone is visualized within
the gallbladder, but there is no wall thickening or pericholecystic fluid.
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 a 34 x 29 mm simple cyst in the lower pole of the left kidney. There
is no evidence of stones, suspicious renal masses or hydronephrosis. There are
no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a moderately large hiatal hernia. Small bowel loops
demonstrate normal caliber, wall thickness and enhancement throughout. The
colon and rectum are unremarkable, without evidence of wall thickening or
diverticulitis. Appendix contains air, has normal caliber without evidence of
fat stranding. However, there is mild non-specific fat stranding inferior to
the cecum and posterior the appendix (6b:32), which may be a sign of early
colitis.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic
calcifications are noted in the abdominal aorta and right common iliac artery.
Incidental note is made of a patent umbilical vein, splenic varices, a
splenorenal shunt (6b:33) with resulting downstream left renal vein dilation
(5:29), compatible with underlying portal hypertension.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is slightly heterogeneous in appearance, but
no discrete masses are identified.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. Mild non-specific fat stranding in the right lower quadrant inferior to
the cecum, without evidence of colonic wall thickening, may be seen in
mild/early cecal colitis. No appendicitis or diverticulitis.
2. 3 mm heterogeneous focus along the lateral aspect of segment VI,
corresponding to the ___ better evaluated on recent MRI dated ___.
Previously described suspicious segment III lesion is not well visualized on
this single-phase study.
3. Sequela of portal hypertension including patent umbilical vein, splenic
varices, and a splenorenal shunt with resulting downstream left renal vein
dilation.
4. Large hiatal hernia.
5. Cholelithiasis without evidence of cholecystitis.
6. Interval enlargement of an 8 mm, likely pleural based, pulmonary nodule at
the right lung base.
RECOMMENDATION(S): CT Chest for further evaluation of lung nodule.
NOTIFICATION: Final results telephoned to Dr. ___ by Dr. ___ at 11:42AM.
|
19978630-RR-11 | 19,978,630 | 21,940,751 | RR | 11 | 2152-08-08 08:58:00 | 2152-08-08 10:04:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall// assess for ICH
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 50.0 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 3.0 s, 6.0 cm; CTDIvol = 50.0 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are prominent, suggestive of volume loss.
There are periventricular and subcortical hypodensities, which may represent
small vessel ischemic changes. The imaged paranasal sinuses are clear. There
is opacification of left mastoid air cells, with sclerosis of the adjacent
bone, suggesting that findings may be chronic. There is slight partial
calcification of right mastoid air cells. The middle ear cavities are well
aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process.
Opacification left mastoid air cells with sclerosis of the adjacent bone,
suggesting that findings may be chronic. Mild partial opacification of right
mastoid air cells. Correlate with history of mastoiditis.
|
19978630-RR-12 | 19,978,630 | 21,940,751 | RR | 12 | 2152-08-09 13:25:00 | 2152-08-09 15:19:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT
IMPRESSION:
Fluoroscopic images show placement of a an intramedullary rod across a
fracture of the distal femur. Further information can be gathered from the
operative report.
|
19978630-RR-13 | 19,978,630 | 21,940,751 | RR | 13 | 2152-08-09 21:43:00 | 2152-08-09 22:25:00 | INDICATION: ___ year old woman s/p LLE femoral nail with difficulty weaning
vent// evaluate for acute pulmonary process
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the endotracheal tube projects over the mid thoracic trachea.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiac silhouette is within normal limits. Calcification of
the mitral annulus and aortic arch are again noted.
IMPRESSION:
No radiographic evidence of an acute cardiopulmonary abnormality.
|
19978630-RR-14 | 19,978,630 | 21,940,751 | RR | 14 | 2152-08-12 16:56:00 | 2152-08-12 17:21:00 | EXAMINATION: Portable chest x-ray
INDICATION: ___ year old woman with ams leukocytosis// assess for pna
TECHNIQUE: Portable chest x-ray
COMPARISON: Previous portable supine x-ray from ___
FINDINGS:
The endotracheal tube has been removed. There is new hazy density at the lung
bases, likely pleural effusions tracking posteriorly. The heart is mildly
enlarged. There is increased left retrocardiac density. This is likely
atelectasis however superimposed pneumonia cannot be excluded. The aorta is
atherosclerotic and tortuous. The trachea is midline. The bones are
diffusely osteopenic.
IMPRESSION:
Likely bilateral effusions. Increased left retrocardiac density, likely
atelectasis. Superimposed pneumonia cannot be excluded
|
19978766-RR-19 | 19,978,766 | 21,880,865 | RR | 19 | 2165-03-26 13:55:00 | 2165-03-26 16:10:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior chest radiograph dated ___.
CLINICAL HISTORY: Leukocytosis, known gastric ulcer, tender abdomen, question
free air.
FINDINGS: AP upright portable chest radiograph is obtained. There is no
evidence of free air below the right hemidiaphragm. The lungs appear clear
bilaterally. Cardiomediastinal silhouette is normal. Bones appear intact.
IMPRESSION: No acute findings including no sign of pneumoperitoneum.
|
19978766-RR-20 | 19,978,766 | 21,880,865 | RR | 20 | 2165-03-26 16:04:00 | 2165-03-26 23:46:00 | CT SCAN OF THE ABDOMEN AND PELVIS PERFORMED ON ___.
Comparison is made with a prior CT abdomen and pelvis dated ___.
CLINICAL HISTORY: ___ man with history of pancreatitis, extensive
alcohol history, known gastric ulcers, prior upper GI bleed, pancreatic
pseudocyst, now presents with four days of upper abdominal pain, fever to
102.6, assess pancreatic pseudocyst.
TECHNIQUE: Multidetector CT through the abdomen and pelvis was performed
following IV contrast administration. No oral contrast was administered.
Multiplanar reformations were provided.
FINDINGS:
LUNG BASES: There is dependent bibasilar atelectasis. The imaged portion of
the heart is unremarkable.
ABDOMEN: There are multiple areas of infarction involving the spleen, which
demonstrate interval evidence of healing. Extensive varices in the left upper
abdomen are seen in the setting of chronic splenic vein thrombosis. The liver
is notable for a nonspecific hypodense lesion within segment VI on series 2,
image 36, measuring 12 mm, stable from multiple prior studies, compatible with
hemangioma as characterized on a prior ultrasound (dated ___. The
adrenal glands appear unremarkable.
Since the prior study, there has been development of a complex fluid
collection which is located between the lesser curvature of the stomach and
the body of the pancreas. This collection has an irregular shape but appears
to to represent a single collection. There is a rounded component abutting the
lesser curvature of the stomach measuring approximately 3.7 x 4.3 cm. This
component appears to communicate through a narrow neck with a second
collection which abuts the pancreatic body measuring 4.5 x 2.6 cm. In
addition, there is a finger-like projection extending along the left anterior
pararenal fascia with adjacent trace free fluid. In addition, there are tiny
locules of gas within this complex peripancreatic fluid collection.
Altogether, given the contained gas, prominent rim enhancement and adjacent
fat stranding, this collection is concerning for an infected pancreatic
pseudocyst. The remainder of the pancreas appears grossly unremarkable. The
gallbladder appears unremarkable, and there is no biliary ductal dilation.
Several renal cysts are again seen, largest of which arises from the left
renal upper pole. Scattered areas of atherosclerotic calcification are seen
along the distal abdominal aorta extending into the iliac branches. There is
no retroperitoneal lymphadenopathy.
The stomach is somewhat displaced along its mid body due to the aforementioned
complex fluid collection along the lesser curvature. There is no free air or
definite signs of perforated gastric ulcer. The duodenum follows a normal
course.
PELVIS: No evidence of ileus or obstruction. No signs of appendicitis. A
few diverticula are noted, though there is no sign of diverticulitis. Trace
free fluid is seen in the deep pelvis. Urinary bladder is distended appearing
unremarkable. No pelvic or inguinal lymphadenopathy is seen.
BONES: Unremarkable.
IMPRESSION:
1. Interval development of irregular fluid collection between the body of the
pancreas and lesser curvature of the stomach concerning for an infected
pancreatic pseudocyst.
2. Healing splenic infarcts, chronic splenic vein thrombosis, extensive
portosystemic collaterals in the left upper quadrant.
3. 12-mm hypodensity within segment VI of the liver previously characterized
as hemangioma on an ultrasound from ___. Findings discussed with the
surgical team at the time of initial review.
4. Several stable renal cysts.
|
19978774-RR-28 | 19,978,774 | 20,876,246 | RR | 28 | 2132-08-30 08:49:00 | 2132-08-30 09:38:00 | HISTORY: Chest pain and left arm numbness. History of CABG in ___.
TECHNIQUE: MDCT there were acquired through the chest after administration
intravenous contrast. Images were displayed in multiple planes. A delayed CT
without intravenous contrast was performed 2.5 hours later.
COMPARISON: Chest CTA ___, prior to CABG.
FINDINGS:
CTA: Contrast bolus timing is adequate for assessment of the pulmonary
arteries to the subsegmental level. There is no pulmonary embolism. The
aorta is normal caliber appearance throughout its length. There is no aortic
aneurysm or dissection.
CHEST CT: There is a hematoma in the anterior mediastinum. Hyperdense tissue
density is seen in the anterior mediastinum forming an ill-defined collection
measuring approximately 3 cm AP x 6 cm TV x 8 cm CC. A focal hyperdensity
along the anterior wall of the ascending aorta is shown to be calcified on the
non-contrast scan. There are numerous surgical clips from prior CABG.
The lungs are well expanded and clear. There is no focal consolidation,
effusion, nodule, mass, or pneumothorax. Subsegmental basilar atelectasis is
mild. The airways are patent to the subsegmental level. The thyroid gland
enhances homogeneously. There is no supraclavicular adenopathy. A prominent
precarinal lymph node measures 11 cm in short axis. There is no additional
mediastinal, hilar, or axillary adenopathy. The size of the heart is normal.
Coronary artery calcifications are extensive. There is no pericardial
effusion.
This exam is not tailored to evaluate subdiaphragmatic structures. The
adrenal glands and visualized abdominal viscera are unremarkable.
There are no concerning lytic or sclerotic bony lesions. The sternotomy is
incompletely fused at the level of the manubrium (3: 43, 3: 56). The
sternotomy wires are intact. The margins of the bone fragments are sclerotic
indicating that this is likely an incomplete fusion rather than a dehiscence.
IMPRESSION:
1. Anterior mediastinal hematoma of unknown chronicity. No active
extravasation.
2. No pulmonary embolism, aortic dissection or aneurysm.
3. Incomplete fusion of the manubrium.
|
19978842-RR-23 | 19,978,842 | 26,698,803 | RR | 23 | 2113-05-25 09:55:00 | 2113-05-25 17:18:00 | EXAMINATION: CT NECK WITH CONTRAST
INDICATION: ___ year old woman with post operative wound infection, evaluate
for infection.
TECHNIQUE: Contiguous axial images obtained through the neck after the
administration of intravenous contrast. Coronal and sagittal reformats were
reviewed.
DOSE: DLP: 394 mGy-cm; CTDI: 13 mGy
COMPARISON: CT C-spine ___.
FINDINGS:
The patient is status post C5 corpectomy with C4 through 6 anterior spinal
fusion. Hardware position is unchanged from prior. Postoperative air in the
subcutaneous soft tissues has resolved. There is no drainable collection
identified within the soft tissues. There remains minimal fluid within the
retropharyngeal space which has overall decreased from ___.
The parotid glands, submandibular glands, and thyroid are unremarkable. There
is no cervical adenopathy.The aerodigestive tract appears normal. Included
paranasal sinuses and mastoids are clear.
Included intracranial structures appear normal.
No focal suspicious osseous lesion identified. Multilevel degenerative
changes are again noted.
Again seen, are metallic densities in the right cervical internal carotid
arteries. The patient is status post right A-comm aneurysm clipping.
IMPRESSION:
Status post C5 corpectomy and C4 through 6 anterior spinal fusion without
evidence of postoperative fluid collection. No evidence of hardware
complication.
|
19978842-RR-24 | 19,978,842 | 26,698,803 | RR | 24 | 2113-05-25 20:23:00 | 2113-05-26 08:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p ACDF 1mo ago with rising WBC, spiking
fevers // ?acute process
COMPARISON: ___
IMPRESSION:
As compared to the previous image, there is a new parenchymal opacity at the
right lung bases, projecting over the basal and lateral parts of the right
costophrenic sinus. Adjacent to this opacity and located more proximally,
between the hilus and the opacity, are several airways with thickened walls.
Although the abnormality is seen in 1 projection only, the presence of
pneumonia must be is strongly suspected.
Normal size of the cardiac silhouette. Normal hilar and mediastinal
structures. No pneumothorax. Status post vertebral fixation.
At the time of dictation and observation, 08:33, on the ___, the
referring physician ___ was not ___. Therefore, the findings were
posted to the radiology dashboard. In addition, a high priority email was
sent to the referring physician and the attending.
|
19978842-RR-25 | 19,978,842 | 26,698,803 | RR | 25 | 2113-05-26 17:37:00 | 2113-05-26 21:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with ? RLL pneumonia // Assess for pneumonia
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Heart size is mild mildly enlarged, similar to ___. Mediastinum is
unremarkable. Lobulations of both hemidiaphragms are present. No definitive
evidence of pleural effusion or pneumothorax is seen. Linear atelectasis in
the right lower lung is present but no definitive evidence of pneumonia
demonstrated.
|
19978886-RR-10 | 19,978,886 | 25,887,347 | RR | 10 | 2183-11-09 15:08:00 | 2183-11-09 17:19:00 | EXAMINATION: MYELOGRAM LUMBAR (LUMBAR INJ) W/POST CT LUMBAR SCAN ___ RF L
SPINE
INDICATION: ___ year old man with radicular back pain and paresthesias.// ?
Lumbar disc herniation.
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A pre-procedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs.
Puncture was performed at L3-4.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 22 gauge, 3.5 inch spinal needle was inserted
into the thecal sac. There was good return of clear CSF.
10 mls of Isovue M 200 contrast was administered intrathecally. Myelographic
images were obtained.
Following performance of the myelogram, the patient was transported to CT. CT
images of the lumbar spine were then obtained.
COMPARISON: None.
FINDINGS:
The thecal sac was successfully accessed at the L3-L4 level with return of
clear CSF.
A total of approximately 10 mL of Isovue M 200 were uneventfully injected into
the thecal sac and fluoroscopic images were obtained documenting the
distribution of the contrast within the thecal sac.
No sedation was administered for the Procedure. The patient tolerated the
Procedure well without complication.
IMPRESSION:
1. Successful lumbar myelogram with access at L3-L4.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
|
19978886-RR-11 | 19,978,886 | 25,887,347 | RR | 11 | 2183-11-09 16:16:00 | 2183-11-09 17:41:00 | EXAMINATION: CT L-SPINE W/O CONTRAST Q331 CT SPINE.
INDICATION: History: ___ with radicular back ___ and paresthesias.// ?
Lumbar disc herniation.? Lumbar disc herniation.
TECHNIQUE: This examination was obtained immediately after a lumbar spine
myelogram, helical multidetector CT was performed. Soft tissue and bone
algorithm images were generated. Coronal and sagittal reformations were then
constructed.
DOSE: Total DLP: 792 mYg-cm.
COMPARISON: MRI of the lumbar spine from ___. CT of the abdomen
and pelvis from ___.
FINDINGS:
Vertebral body height and alignment is maintained. Degenerative disc disease
with disc calcifications is seen at L5-S1. Postsurgical changes after
posterior instrumented L5-S1 vertebral body fusion is noted. There is no
evidence of hardware complication. There is a heterotopic ossification about
the posterior aspect of the screws with ossification of the posterior elements
of the spine and facet joints.
At T12-L1, there is no spinal canal stenosis or osseous neural foraminal
narrowing.
At L1-L2, there is mild facet joint arthropathy, no spinal canal stenosis,
mild bilateral osseous neural foraminal narrowing. Findings are similar to
___.
At L2-L3, there is no spinal canal stenosis, mild facet joint arthropathy, no
osseous neural foraminal narrowing.
At L3-L4, there is no spinal canal stenosis, mild facet joint arthropathy, or
neural foraminal narrowing.
At L4-L5, there is a diffuse disc bulge causing mild anterior thecal sac
deformity and moderate bilateral neural foraminal narrowing, facet joint
arthropathy and ligamentum flavum hypertrophy. Findings are relatively stable
when compared with the prior examination in ___.
At L5-S1, there is narrowing of the intervertebral disc space and mild
spondylosis causing mild bilateral neural foraminal narrowing, there is
articular joint facet arthropathy, no evidence of central spinal canal
stenosis. Findings are similar and grossly unchanged from ___.
Bilateral degenerative changes of the sacroiliac joints are noted.
Other findings: Note is made of mild-to-moderate atherosclerotic and
atheromatous changes of the abdominal aorta which is otherwise normal in
caliber.
IMPRESSION:
1. No evidence of cauda equina compression or severe spinal canal stenosis.
2. Stable postsurgical changes after posterior instrumentation fusion of the
L5-S1 vertebral bodies. No evidence of hardware complication.
3. Mild hypertrophic degenerative changes of the lumbar spine at L4-5 and
L5-S1 levels, not significantly changed from ___.
|
19979081-RR-13 | 19,979,081 | 22,763,407 | RR | 13 | 2179-02-04 13:29:00 | 2179-02-04 14:50:00 | INDICATION: Mass found on EGD, for further characterization of disease
status.
COMPARISON: MR abdomen from ___.
TECHNIQUE: MDCT-acquired axial images were obtained from the base of the
lungs to the pubic symphysis after administration of oral and intravenous
contrast. Multiplanar reformatted images were prepared and reviewed.
FINDINGS: The visualized lung bases demonstrate mild bibasilar atelectatic
changes, greater on the left than right. The visualized heart is normal in
size without a pericardial effusion.
The stomach is nondistended and the known mass is not clearly delineated. The
remainder of the visualized loops of small and large bowel are within normal
limits. The liver contains a bilobed 3.5 x 2.1 cm hypodense structure,
consistent with a simple cyst (2:23). Otherwise, the liver is normal in
appearance. The gallbladder, pancreas, spleen, and bilateral adrenal glands
are within normal limits. Bilateral kidneys contain multiple subcentimeter
hypodense structures, consistent with simple cysts along with 8-mm hyperdense
focus along the inferior pole of the right kidney, consistent with a
hemorrhagic cyst as characterized on MRI from ___. Mild
atherosclerotic calcifications are noted throughout the abdominal aorta, but
the aorta is normal in caliber and contour. There is no free fluid or free
air. There is no mesenteric or retroperitoneal lymphadenopathy.
CT OF THE PELVIS WITH ORAL AND IV CONTRAST: There is sigmoid diverticulosis
without diverticulitis. The bladder, uterus, and rectum are otherwise within
normal limits. There is no inguinal or pelvic lymphadenopathy.
OSSEOUS STRUCTURES: Moderate multilevel degenerative changes are noted
throughout the thoracolumbar spine. A 3-mm well-circumscribed sclerotic focus
is noted in the right acetabulum and likely representative of a bone island
(2:72). Otherwise, there are no lytic or sclerotic osseous lesions suspicious
for malignancy.
IMPRESSION:
1. In this patient with known mass along the lesser curvature of the stomach,
evaluation for gastric mass is limited due to underdistension.
2. No evidence of metastatic disease otherwise noted.
3. Simple hepatic cysts and multiple sub-cm renal cysts are again noted.
|
19979081-RR-7 | 19,979,081 | 22,763,407 | RR | 7 | 2179-02-02 00:34:00 | 2179-02-02 02:46:00 | INDICATION: Right upper quadrant tenderness. Evaluation for biliary
obstruction.
TECHNIQUE: Abdominal ultrasound, right upper quadrant protocol.
COMPARISON: None.
FINDINGS: The liver is normal in echogenicity, and architecture. 3.4 x 3.1 x
2.1 cm cyst is noted in the right lobe of liver. The main portal vein is
patent and displays hepatopetal flow. The gallbladder is distended and the
wall adjacent to the liver is mildly thickened (this may represent a small
amount of fluid alternatively). The common bile duct is dilated, measuring
1.1 cm. However, there is no intrahepatic biliary ductal dilatation. No
definite gallbladder sludge or stones are seen. The head of the pancreas is
barely visualized, but appears normal. The remaining portions of the pancreas
are not visualized, likely due to overlying bowel gas.
IMPRESSION:
1. Extra-hepatic biliary ductal dilatation, CBD measures 1.1 cm.
2. Asymmetric gallbladder wall thickening on hepatic surface. Given this
patient's elevated LFTs, this may be secondary to hepatitis.
|
19979081-RR-8 | 19,979,081 | 22,763,407 | RR | 8 | 2179-02-02 17:17:00 | 2179-02-04 11:37:00 | INDICATION: ___ woman with history of early satiety, vomiting, and
acute epigastric pain, found to have CBD dilation on recent ultrasound study.
COMPARISON: Abdomen ultrasound, ___.
TECHNIQUE: Multiplanar T1- and T2-weighted MR images of the abdomen were
performed prior to and after the uneventful intravenous administration of 6
ml of gadavist.
FINDINGS: The liver is normal in signal intensity and enhancement, without
concerning focal masses. A 36 x 26 mm (5:21) simple hepatic cyst is seen in
segment IVb (5:22). There is diffuse symmetric gallbladder wall edema,
without pericholecystic fluid or fat stranding. Mild heterogeneous
enhancement of the liver in the early phases, which normalizes on delayed
imaging, is nonspecific and can be seen in normal patients and in hepatitis.
There is no intrahepatic or extrahepatic biliary dilatation. The common bile
duct maximally measures 8 mm. No intraductal stones or masses are identified.
The right adrenal gland and spleen are normal. A 10-mm lesion in the left
adrenal gland (5:25), demonstrating signal drop in the out-of-phase imaging,
is consistent with an adrenal adenoma. The pancreas is normal in signal
intensity and enhancement, without ductal dilation or focal masses. Both
kidneys demonstrate multiple tiny subcapsular cortical cysts. An 8-mm
hemorrhagic cyst in the interpolar region of the right kidney and a 5-mm
hemorrhagic cyst in the interpolar region of the left kidney (3B:34) are
noted. The abdominal aorta and IVC are normal. No significant
retroperitoneal or mesenteric lymphadenopathy is seen. The stomach, imaged
portion of the small and large bowel loops are normal.
IMPRESSION:
1. No biliary dilation. Diffuse, homogeneous gallbladder wall edema, without
evidence of acute cholecystitis. These findings are likely secondary to the
known hepatitis.
2. Multiple subcapsular renal cortical cysts, relate to glomerular cystic
disease.
|
19979081-RR-9 | 19,979,081 | 22,763,407 | RR | 9 | 2179-02-02 21:02:00 | 2179-02-03 08:17:00 | HISTORY: Elevated LFTs with fever.
COMPARISON: None.
FINDINGS:
The lungs are clear without focal infiltrate. There are minimal bilateral
pleural effusions. The heart is upper limits normal in size. Aorta is mildly
tortuous. There is apical pleural thickening.
IMPRESSION:
No focal infiltrate.
|
19979239-RR-19 | 19,979,239 | 26,031,061 | RR | 19 | 2117-04-13 19:44:00 | 2117-04-13 23:19:00 | EXAMINATION: Lumbar spine radiograph, single lateral intraoperative view.
INDICATION: Left L4-L5 micro fusion.
COMPARISON: Prior study from ___.
FINDINGS:
Single lateral view obtained in the operating room shows metallic surgical
instruments projecting posterior to the L4 and L5 vertebral bodies.
IMPRESSION:
Intraoperative film depicting surgical instruments posterior L4 and L5.
|
19979239-RR-20 | 19,979,239 | 26,031,061 | RR | 20 | 2117-04-14 11:03:00 | 2117-04-14 11:58:00 | EXAMINATION: LUMBO-SACRAL SPINE (AP AND LAT)
INDICATION: ___ year old woman s/p L4-L5 lami fusion// standing, post-surgery
eval standing, post-surgery eval
IMPRESSION:
Postoperative radiograph demonstrates good alignment of the spine without
fracture post laminectomy. No retained products. Nonobstructive bowel gas
pattern.
|
19979275-RR-20 | 19,979,275 | 20,033,240 | RR | 20 | 2126-04-22 23:24:00 | 2126-04-23 00:47:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD.
INDICATION: History: ___ with glial sarcoma who presents with seizures //
Eval acute process.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI brain dated ___
FINDINGS:
Again noted are postsurgical changes related to right parietal craniotomy with
resection of the previously noted large right temporoparietal mass with stable
mild ex vacuo dilatation of the right occipital horn. There is minimal dural
thickening and enhancement subjacent to the craniotomy site as well as thin
linear enhancement along the inferolateral margin of the resection cavity
(10:72), which appears unchanged comparison to the prior study dated ___. There has been interval decrease in size of a rounded nonenhancing
focus within the dependent aspect of the anterior resection cavity, now
measuring 8 x 9 mm, previously measuring 17 x 16 mm on ___. Findings
likely reflect clotted blood products with interval partial resorption. The
extent of the right parietal, occipital and temporal lobe FLAIR signal
abnormality surrounding the resection cavity appears unchanged, as does the
slight FLAIR hyperintense signal within the splenium of the corpus callosum
extending along the occipital horn of the left lateral ventricle.
There is no evidence of acute intracranial hemorrhage, hydrocephalus, midline
shift or acute territorial infarction.
The paranasal sinuses, mastoid air cells, orbits and globes appear within
normal limits.
IMPRESSION:
1. Redemonstrated postsurgical changes related to resection of previously
noted right temporoparietal mass.
2. Thin linear enhancement along the inferolateral margin of the resection
cavity appears unchanged.
3. The extent of FLAIR hyperintense signal surrounding the resection cavity
and involving the splenium of the corpus callosum and white matter along the
left occipital horn appears unchanged.
4. Interval decrease in size of a rounded nonenhancing focus within the
dependent resection cavity, mild measuring 9 mm, previously measuring 17 mm on
___. Findings likely reflect clotted blood products with interval
partial resorption.
5. No new region of FLAIR signal abnormality or enhancement is seen.
|
19979469-RR-19 | 19,979,469 | 20,045,455 | RR | 19 | 2201-06-06 16:14:00 | 2201-06-06 16:35:00 | HISTORY: Multiple syncopal episodes.
COMPARISON: ___.
FINDINGS: Two views were obtained of the chest. Right Port-A-Cath terminates
with tip in the upper right atrium. The lungs appear well expanded and clear
without pleural effusion or pneumothorax. The heart is normal in size with
normal cardiomediastinal contours.
IMPRESSION: No acute intrathoracic process.
|
19979469-RR-41 | 19,979,469 | 23,317,669 | RR | 41 | 2202-08-26 14:33:00 | 2202-08-26 16:35:00 | INDICATION: Refractory ascites in a patient with ampullary carcinoma.
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: CT from ___.
FINDINGS:
Initial four quadrant ultrasound demonstrated a large pocket of free fluid
consistent with ascites.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine buffered with
sodium bicarbonate was instilled for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 4.95 L of clear, straw-fluidwas removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ attending radiologist, was present throughout the critical
portions of the procedure.
IMPRESSION:
Technically successful ultrasound-guided therapeutic paracentesis with 4.95 L
of ascites removed.
|
19979529-RR-28 | 19,979,529 | 27,918,561 | RR | 28 | 2167-09-17 11:01:00 | 2167-09-17 12:29:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: +PO contrast; History: ___ with abd pain+PO contrast*** WARNING
*** Multiple patients with same last name!// eval mass
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 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 7.2 s, 56.6 cm; CTDIvol = 25.1 mGy (Body) DLP =
1,422.0 mGy-cm.
Total DLP (Body) = 1,433 mGy-cm.
COMPARISON: CT abdomen pelvis ___
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 predominantly central mild
intrahepatic biliary dilation and extrahepatic biliary dilation with the CBD
measuring up to 1.5 cm to bring down smoothly to the level of the ampulla
(601:27), 1.3 cm on prior study from ___. The gallbladder is surgically
removed.
PANCREAS: There is fatty infiltration of the pancreatic gland without
pancreatic duct dilation or focal lesions. 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. No bowel obstruction or
ascites. Small bowel loops demonstrate normal caliber, wall thickness, and
enhancement throughout. Few scattered diverticular noted. The colon and
rectum are within normal limits.
PELVIS: The urinary bladder is markedly distended. Distal ureters are
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: 1.8 cm mildly calcified fibroid is seen in the posterior
lower uterine segment. Remainder uterus and adnexa are unremarkable.
LYMPH NODES/MESENTERY/OMENTUM/RETROPERITONEUM: Mesenteric fat stranding with
few not enlarged lymph nodes are again seen, consistent with mesenteric
panniculitis. There is no retroperitoneal or mesenteric lymphadenopathy.
There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
BONES: Degenerative changes are most pronounced in the lower thoracic and
lumbar spine with anterior spondylosis. No suspicious bone lesions or
fractures. Patient is status post left femur intramedullary rod and screws
placement.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mild intrahepatic biliary dilation and slightly increased CBD diameters are
new since ___. No evidence of stones on CT however choledocholithiasis
cannot be excluded. Correlation with hepatic function is recommended.
2. No bowel obstruction or ascites.
|
19979532-RR-15 | 19,979,532 | 26,713,659 | RR | 15 | 2116-11-01 02:03:00 | 2116-11-01 03:40:00 | EXAMINATION: CT ABDOMEN AND PELVIS
INDICATION: NO_PO contrast; History: ___ with abdominal pain, nausea,
vomiting.NO_PO contrast// Appendicitis? Acute intra-abdominal process?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 6.7 s, 53.1 cm; CTDIvol = 15.8 mGy (Body) DLP = 835.7
mGy-cm.
Total DLP (Body) = 850 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. There is an accessory spleen.
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 is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is a small fat containing umbilical hernia.
IMPRESSION:
No acute findings in the abdomen or pelvis to explain the patient's abdominal
pain, nausea or vomiting. Normal appendix.
|
19979532-RR-16 | 19,979,532 | 26,713,659 | RR | 16 | 2116-11-01 02:52:00 | 2116-11-01 04:08:00 | INDICATION: History: ___ with cough// eval for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: None available.
FINDINGS:
The lungs are moderately well expanded and clear. Cardiomediastinal
silhouette is within normal limits. No pleural effusion or pneumothorax.
IMPRESSION:
No focal consolidation or other acute cardiopulmonary abnormality.
|
19979651-RR-21 | 19,979,651 | 27,852,917 | RR | 21 | 2187-08-01 00:38:00 | 2187-08-01 01:12:00 | EXAMINATION: WRIST(3 + VIEWS) LEFT
INDICATION: ___ female with postreduction film. Evaluate post
reduction.
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left wrist.
COMPARISON: Wrist radiographs from ___ at 23:37.
FINDINGS:
An overlying cast obscures fine osseous detail. There is re- demonstration of
a comminuted impacted distal radius fracture with intra-articular extension
and volar displacement. There has been interval reduction and improvement in
anatomic alignment although there is persistent mild. An ulnar styloid
process fracture is again noted. No new fracture seen.
IMPRESSION:
Slight improvement in anatomic alignment of a comminuted distal radius
fracture.
|
19979651-RR-22 | 19,979,651 | 27,852,917 | RR | 22 | 2187-08-01 11:13:00 | 2187-08-01 12:51:00 | EXAMINATION: WRIST(3 + VIEWS) LEFT IN O.R.
INDICATION:
ORIF left distal radial fracture
TECHNIQUE: Fluoroscopic assistance provided to the clinician in the OR
without the radiologist present. 15 spot views obtained. Fluoro time
recorded as 84.7 seconds.
COMPARISON: Left wrist radiographs dated ___
FINDINGS:
Views demonstrate a volar fixation plate and screws transfixing a distal
radial fracture.
IMPRESSION:
Correlation with real-time findings and, when appropriate, conventional
radiographs is recommended for further assessment.
|
19979849-RR-26 | 19,979,849 | 21,842,247 | RR | 26 | 2135-02-04 21:21:00 | 2135-02-04 23:15:00 | INDICATION: NO_PO contrast; History: ___ with tenderness guarding in
RLQNO_PO contrast// ?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) = 926 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout
compatible with fatty liver disease. 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 symmetric size. There is an enhancing exophytic
right lower pole lesion that measures 1.6 x 1.5 cm that is indeterminate in
nature. There is right-sided hydronephrosis with 2 right distal ureteral
stones the largest measuring 10 x 5 mm in the smaller measuring 5 x 3 mm.
There is an additional intramedullary right lower pole renal stone that
measures 9 mm.
There is no evidence of focal lesions, stones, or hydronephrosis in the left
kidney.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: 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: Limbus vertebrae are incidentally noted at L3 and L4. There is no
evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Right hydronephrosis with two distal ureteral stones measuring up to 10 mm.
2. Nonobstructing 9 mm right lower pole renal stone.
3. Indeterminate right lower pole exophytic renal mass measuring 1.6 cm for
which further evaluation is recommended.
4. Hepatic steatosis.
RECOMMENDATION(S): Recommend renal MR for further characterization of
exophytic right lower pole renal mass, if not previously obtained.
|
19980241-RR-10 | 19,980,241 | 23,739,999 | RR | 10 | 2137-12-20 16:26:00 | 2137-12-20 17:25:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ morbidly obese man with ___ to 2.8 despite renal decompression
with percutaneous nephrostomy. Evaluate for hydronephrosis.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Outside hospital CT of the abdomen pelvis from ___.
FINDINGS:
The right kidney measures 11.2 cm. The left kidney measures 12.6 cm. There is
no hydronephrosis on either side. Tiny shadowing focus at the lower pole of
the left kidney likely corresponds to the nonobstructive stone seen on the
recent CT scan. Linear echogenicity of the midpole of the left kidney likely
corresponds to percutaneous nephrostomy tube.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. No evidence of hydronephrosis in either kidney.
2. Partially imaged left-sided percutaneous nephrostomy.
3. Punctate nonobstructive left lower pole renal stone.
|
19980241-RR-11 | 19,980,241 | 23,739,999 | RR | 11 | 2137-12-21 11:45:00 | 2137-12-21 12:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year morbidly obese man with periodic SOB, congestion,
productive cough // r/o acute process
TECHNIQUE: PA and lateral radiographs of the chest.
COMPARISON: ___.
FINDINGS:
There is no new consolidation.
The heart and mediastinum are within normal limits.
Trace bilateral pleural effusions are new.
IMPRESSION:
No new consolidation.
New trace bilateral pleural effusions.
|
19980241-RR-8 | 19,980,241 | 23,739,999 | RR | 8 | 2137-12-19 03:46:00 | 2137-12-19 05:21:00 | INDICATION: ___ year old man with obstructing left renal stone // left PCN
COMPARISON: ___ CT abdomen pelvis.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the proecdure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
150 mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 39 min and during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 1 g ancef
CONTRAST: 15 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 5.7 min, 101 mGy
PROCEDURE: 1. Left ultrasound guided renal collecting system access.
2. Left nephrostogram.
3. 8 ___ left nephrostomy tube placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The left flank was prepped and draped in the usual sterile fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the left renal collecting system was accessed through a posterior lower pole
calyx under ultrasound guidance using a 21 gauge Cook needle. Ultrasound
images of the access were stored on PACS. Prompt return of urine confirmed
appropriate positioning. Injection of a small amount of contrast outlined a
mildly dilated renal collecting system with a filling defect at the
ureteropelvic junction. Under fluoroscopic guidance, a Nitinol wire was
advanced into the renal collecting system. After a skin ___, the needle was
exchanged for an Accustick sheath. One the tip of the sheath was in the
collecting system; the sheath was advanced over the wire, inner dilator and
metallic stiffener. The wire and inner dilator were then removed and diluted
contrast was injected into the collecting system to confirm position. A ___
wire was advanced through the sheath and coiled in the collecting system. The
sheath was then removed and a ___ nephrostomy tube was advanced into the
renal collecting system. The wire was then removed and the pigtail was formed
in the collecting system. Contrast injection confirmed appropriate
positioning. The catheter was then flushed, 0 silk stay sutures and sterile
dressings were applied. The catheter was attached to a bag.
The patient tolerated the procedure well and there were no immediate
postprocedural complications. .
FINDINGS:
1. Mild left hydronephrosis with obstructing left ureteropelvic junction
stone. Additional nonobstructing stones within the left renal collecting
system.
2. Successful placement of 8 ___ left nephrostomy tube. The catheter was
left to bag drainage.
IMPRESSION:
Successful placement of 8 ___ nephrostomy on the left.
|
19980545-RR-9 | 19,980,545 | 21,585,596 | RR | 9 | 2179-01-03 09:09:00 | 2179-01-03 10:58:00 | INDICATION: Known PE. Chest pain.
No comparison studies available.
FRONTAL AND LATERAL CHEST RADIOGRAPHS: The heart size is normal. The hilar
and mediastinal contours are within normal limits. There is no pneumothorax,
focal consolidation, or pleural effusion.
IMPRESSION: No acute intrathoracic process.
|
19981190-RR-13 | 19,981,190 | 24,364,972 | RR | 13 | 2111-07-28 05:21:00 | 2111-07-28 06:02:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: History: ___ with left leg pain// eval for fracture- do not move
her femur, get what you can for imaging eval for fracture- do not move
her femur, get what you can for imaging
TECHNIQUE: Three views of the left knee.
COMPARISON: None available.
FINDINGS:
Examination is limited particularly on lateral views due to nonstandard
projections. Apparent step-off in the tibial plateau may be projectional. No
gross effusion however an overlying brace limits assessment. There is
prominent chondrocalcinosis in the medial and lateral femorotibial
compartments. There is vascular calcification.
IMPRESSION:
Limited assessment. No definite fracture line is seen. Step-off in the
tibial plateau on the lateral view could be projectional. Depending on
clinical concern, repeat radiographs or CT should be considered to further
assess.
NOTIFICATION: Email sent to ED QA nurse at 08:37 on ___ to
communicate above findings.
|
19981190-RR-14 | 19,981,190 | 24,364,972 | RR | 14 | 2111-07-28 12:00:00 | 2111-07-28 14:11:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: Left femur fracture.
TECHNIQUE: Screening provided in the operating room without a radiologist
present.
COMPARISON: ___ femur radiographs
FINDINGS:
Images demonstrate fixation of a femur fracture with plate, screws and
cerclage wires. For details of the procedure please see the procedure report.
Vascular calcification is noted.
|
19981210-RR-104 | 19,981,210 | 26,790,133 | RR | 104 | 2148-07-06 18:22:00 | 2148-07-06 20:16:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ male with chest pain.
COMPARISON: ___.
FINDINGS: Frontal and lateral views of the chest. Left chest wall pacing
device seen with leads in the right atrium and right ventricular apex. The
lungs are clear of consolidation, effusion or pneumothorax. Linear opacities
at the left costophrenic angle are suggestive of atelectasis.
Cardiomediastinal silhouette is within normal limits. Median sternotomy wires
and mediastinal clips again noted. No acute osseous abnormality is detected.
IMPRESSION: No acute cardiopulmonary process.
|
19981210-RR-105 | 19,981,210 | 26,790,133 | RR | 105 | 2148-07-07 08:00:00 | 2148-07-07 13:35:00 | HISTORY: New non-ST elevation MI and bibasilar crackles on exam. Evaluation
for pulmonary edema.
TECHNIQUE: Frontal view of the chest.
COMPARISON: Multiple chest radiographs the most recent on ___.
FINDINGS:
The lungs are clear with no focal opacities. There is some minimal bibasilar
atelectasis. The cardiomediastinal silhouette and hilar contours are normal.
The pleural surfaces are clear without effusion or pneumothorax. The left
chest wall pacing device and pacer leads are unchanged in appearance.
IMPRESSION:
No evidence of acute cardiopulmonary process.
|
19981210-RR-110 | 19,981,210 | 25,095,273 | RR | 110 | 2149-01-07 12:02:00 | 2149-01-07 13:03:00 | INDICATION: AVR, CAD, hypertension, asthma, presenting with dyspnea,
orthopnea and peripheral edema. Evaluate for pulmonary edema.
COMPARISON: CT chest ___. Chest radiograph ___ and
___.
TECHNIQUE: Upright PA and lateral radiographs of the chest.
FINDINGS: Median sternotomy wires appear intact. Surgical clips again
project over the mediastinum following coronary artery bypass graft. Left
chest wall pacemaker has leads in the right atrium and right ventricle. The
heart is top normal, unchanged.
There are small worsening bilateral pleural effusions and bibasilar opacities
likely atalectasis. There is calcification of the aortic arch. Interstitial
pulmonary edema is mild.
IMPRESSION:
1. Stable mild cardiomegaly with mild interstitial pulmonary edema and
interval increase in small bilateral pleural effusions.
2. Mild bibasilar opacities likely reflect atalectasis, less likely pneumonia.
|
19981210-RR-117 | 19,981,210 | 27,919,282 | RR | 117 | 2151-12-30 10:56:00 | 2151-12-30 12:24:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with CAD, cough, increasing WBC// r/o pna
r/o pna
IMPRESSION:
Comparison to ___. No relevant change is noted. No pneumonia, no
pulmonary edema. Sternal wires are in situ. Left pectoral pacemaker. Normal
size of the cardiac silhouette.
|
19981210-RR-118 | 19,981,210 | 27,919,282 | RR | 118 | 2151-12-31 13:58:00 | 2151-12-31 15:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypotension on 1 pressor with worsened
cough. r/o pna// r/o pna
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
FINDINGS:
Median sternotomy wires are intact. Postsurgical clips are again noted in the
mediastinum, unchanged since the prior study. Left pectoral pacer leads
terminate in the right atrium and right ventricle.
Cardiac size is unchanged. There is mild fluid overload, new since the prior
study. The right heart border is obscured which may be secondary to
atelectasis versus a consolidation. There is no pneumothorax or pleural
effusion.
IMPRESSION:
1. Obscured right heart border may be secondary to atelectasis versus a
consolidation. Recommend lateral view to further evaluate for a right middle
lobe pneumonia.
2. Mild fluid overload new since the prior study.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:47 pm, 10 minutes after
discovery of the findings.
|
19981210-RR-119 | 19,981,210 | 27,919,282 | RR | 119 | 2152-01-01 17:49:00 | 2152-01-01 18:38:00 | INDICATION: ___ year old man with pneumonia// lateral view of the pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
A left chest wall biventricular pacemaker is present. The patient is status
post median sternotomy and CABG.
Bibasilar opacities are present, presumed to reflect atelectasis the size of
the cardiac silhouette is within normal limits. No definite right middle lobe
pneumonia is identified. No pleural effusion or pneumothorax.
IMPRESSION:
Bibasilar atelectasis. No definite evidence of a right middle lobe pneumonia.
|
19981210-RR-99 | 19,981,210 | 27,159,051 | RR | 99 | 2146-11-29 16:51:00 | 2146-11-29 17:11:00 | INDICATION: Chest pain.
COMPARISON: Radiograph available from ___.
FRONTAL CHEST RADIOGRAPH: The heart size is normal. A left-sided generator
pack projects leads into the right atrium and ventricle. Multiple sternal
wires and mediastinal clips denote prior cardiac surgery. There is no
pneumothorax, focal consolidation, or pleural effusion. The central pulmonary
vessels are prominent; however, there is no congestion or edema.
IMPRESSION: No acute intrathoracic process.
|
19982305-RR-12 | 19,982,305 | 28,629,030 | RR | 12 | 2161-05-06 10:07:00 | 2161-05-06 10:48:00 | INDICATION: ___ with fall, left hip/femur pain, NVI// ?fx
COMPARISON: None
FINDINGS:
AP pelvis and two views of the left hip were provided. There is an acute
fracture involving the left femoral neck located mid cervical level without
significant displacement of the distal fracture fragment. The left femoral
head maintains its articulation at the acetabulum. There is mild
osteoarthritis at both hips with mild spurring and mild loss of joint space.
There is no fracture seen involving the bony pelvic ring.
IMPRESSION:
Acute fracture through the left femoral neck, mid cervical level.
|
19982305-RR-13 | 19,982,305 | 28,629,030 | RR | 13 | 2161-05-06 10:53:00 | 2161-05-06 12:25:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with fall// ?traumatic injuries
COMPARISON: None
FINDINGS:
AP portable supine view of the chest. There is no focal consolidation, or
supine evidence for effusion, or pneumothorax. The cardiomediastinal
silhouette is unchanged with unfolded thoracic aorta again noted. Imaged
osseous structures are intact. Bilateral AC joint arthropathy noted.
IMPRESSION:
No acute findings.
|
19982305-RR-14 | 19,982,305 | 28,629,030 | RR | 14 | 2161-05-06 11:18:00 | 2161-05-06 11:34:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall// ?traumatic injuries
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. There is mild subcortical white matter hypodensity, likely the
sequelae of chronic microvascular ischemic disease. Basal cisterns are
patent. Ventricles are normal in size. Mucosal thickening is noted within
the ethmoid and maxillary sinuses, mild. Mastoid air cells and middle ear
cavities are well aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process. Mild small vessel disease.
|
19982305-RR-15 | 19,982,305 | 28,629,030 | RR | 15 | 2161-05-06 11:18:00 | 2161-05-06 12:15:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall// ?traumatic injuries
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Total DLP (Body) = 907 mGy-cm.
COMPARISON: None.
FINDINGS:
No acute fractures or malalignment is identified. Multilevel degenerate
changes are seen throughout the cervical spine. There is reversal of the
normal lordotic curvature. There is posterior disc bulge of unknown
chronicity at C2-C3 and C6-C7. There is resultant encroachment upon the
thecal sac with given the associated hypertrophy of ligamentum flavum at C2-3
level, this patient may be predisposed to cord contusion in the correct
clinical setting and clinical correlation is advised. There is no
prevertebral edema.
The lung apices are unremarkable. Nodular enlargement of the right thyroid
lobe is compatible with goiter.
IMPRESSION:
1. No acute fracture or malalignment.
2. Multilevel degenerative changes, detailed above.
3. Prominent disc bulge and ligamentum flavum hypertrophy at C2-3 level,
resulting in significant canal stenosis, if there is concern for cord
contusion at this level, consider MRI to further assess.
4. Right thyroid goiter.
|
19982305-RR-18 | 19,982,305 | 28,629,030 | RR | 18 | 2161-05-08 11:13:00 | 2161-05-08 11:46:00 | EXAMINATION: HIP 1 VIEW IN O.R.
INDICATION: Left hip hemiarthroplasty.
TECHNIQUE: Portable AP view of the left hip.
COMPARISON: ___
FINDINGS:
There is a left hip hemiarthroplasty in satisfactory position on this AP view.
Soft tissue gas and skin staples compatible with recent surgery are evident.
No periprosthetic fracture is seen.
IMPRESSION:
Expected postsurgical appearance.
|
19982483-RR-10 | 19,982,483 | 28,983,948 | RR | 10 | 2184-03-22 19:29:00 | 2184-03-23 08:48:00 | HISTORY: ORIF right shoulder.
TECHNIQUE: Two intraoperative fluoroscopic images of the right shoulder ___.
COMPARISON: Radiographs ___.
FINDINGS:
Two-views of the right shoulder. Status post ORIF of the right proximal
humerus with plate and screws. The hardware appears intact. Improved
alignment of the fracture. Total intraoperative fluoroscopic imaging timed
98.1 s. Please see operative report for further details.
IMPRESSION:
See above.
|
19982483-RR-6 | 19,982,483 | 28,983,948 | RR | 6 | 2184-03-20 17:08:00 | 2184-03-20 17:18:00 | HISTORY: Fall.
TECHNIQUE: Upright AP view of the chest.
COMPARISON: Chest radiograph ___ at 12:06.
FINDINGS:
The heart size is normal. The mediastinal and hilar contours are
unremarkable. 5 mm calcified granuloma in the left mid lung field is present.
There is minimal linear atelectasis in the lung bases. No focal
consolidation, pleural effusion or pneumothorax is present. A comminuted
fracture of the right proximal humerus with medial and inferior displacement
of the dominant distal fracture fragment is present.
IMPRESSION:
No acute cardiopulmonary abnormality. Comminuted right proximal humeral
fracture.
|
19982483-RR-7 | 19,982,483 | 28,983,948 | RR | 7 | 2184-03-20 16:38:00 | 2184-03-20 18:06:00 | HISTORY: Fall and head pain.
TECHNIQUE: MDCT data were acquired through the head without intravenous
contrast. Images were displayed in multiple planes.
COMPARISON: None.
FINDINGS:
There is no hemorrhage, major vascular territory infarction, edema, mass, or
shift of the midline structures. The size and shape of the ventricles and
sulci are normal. The basal cisterns are patent. Gray-white differentiation
is preserved. The visualized paranasal sinuses and mastoid air cells are
normally pneumatized and clear. The skull and extracranial soft tissues are
unremarkable except for minimal soft tissue swelling overlying the right
frontal bone.
IMPRESSION:
No acute intracranial process.
|
19982483-RR-8 | 19,982,483 | 28,983,948 | RR | 8 | 2184-03-20 16:39:00 | 2184-03-20 18:15:00 | HISTORY: Fall, neck pain.
TECHNIQUE: MDCT data were acquired through the cervical spine without
intravenous contrast. Images were displayed in multiple planes.
COMPARISON: None.
FINDINGS:
There is no cervical spine fracture or malalignment. A focal density in the
C6 vertebral body is most likely a bone island. Degenerative disease is
minimal. There is no pre or paravertebral soft tissue swelling. The
visualized portions of the aerodigestive tract are clear. Visualized lung
apices are unremarkable. Small retention cyst is seen in the right maxillary
floor. Scout images reveal a comminuted displaced right proximal humerus
fracture.
IMPRESSION:
No cervical spine fracture or malalignment.
|
19982483-RR-9 | 19,982,483 | 28,983,948 | RR | 9 | 2184-03-20 17:50:00 | 2184-03-20 18:52:00 | HISTORY: Right humeral fracture.
TECHNIQUE: Right shoulder, 3 views.
COMPARISON: ___ at 11:52.
FINDINGS:
Comminuted fracture of the left proximal humerus involving the surgical neck
is present. There is medial and inferior displacement of the dominant distal
fracture fragment which also appears to be slightly impacted upon the inferior
and medial aspect of the humeral head. The humeral head itself is inferiorly
subluxed relative to the glenoid fossa and appears rotated. No suspicious
lytic or sclerotic osseous abnormalities are present. Degenerative changes of
the right acromioclavicular joint are noted. The imaged right lung appears
clear.
IMPRESSION:
Comminuted and displaced right proximal humeral fracture with inferior
subluxation of the humeral head relative to the glenoid fossa.
|
19982539-RR-18 | 19,982,539 | 23,136,520 | RR | 18 | 2175-04-23 08:09:00 | 2175-04-23 08:36:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
INDICATION: History: ___ with sttroke// stroke
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the thoracic inlet to the brain during the uneventful infusion of 110 mL of
Omnipaque intravenous contrast material. Three-dimensional angiographic volume
rendered and segmented images were then generated on a dedicated workstation.
This report is based on interpretation of all of these images. CT perfusion
images are also obtained.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 19.2 s, 8.0 cm; CTDIvol = 314.2 mGy (Head) DLP =
2,513.8 mGy-cm.
3) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
4) Spiral Acquisition 5.2 s, 41.2 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,314.4 mGy-cm.
Total DLP (Head) = 4,658 mGy-cm.
COMPARISON: No priors available for comparison.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
The examination is mildly motion degraded. Within this confines: No evidence
of acute large territory infarct or intracranial hemorrhage. There is
suggestion o asymmetric hyperdensity in the expected location of a left M2
division, suggesting thrombus. The sulci, ventricles and cisterns are within
expected limits for the patient's age.
There is mild mucosal thickening of the ethmoid air cells with small mucous
retention cysts in the right maxillary sinus. Small mucous retention cyst in
the right sphenoid sinus is also noted. The orbits are unremarkable. The
mastoid air cells and middle ears are well pneumatized and clear.
CTA HEAD:
Minimal atherosclerotic calcification of the internal carotid arteries is
identified. There is abrupt termination of the distal left M2 superior
division branch (series 4, image 279; series 557, image 4). In addition,
there is overall paucity of vessels in the left inferior division, suggesting
an additional site of occlusion, not definitively visualized. The right MCA,
bilateral ACA and their major branches are unremarkable. There is fetal type
origin of the left posterior cerebral artery. An apparent linear filling
defect in the mid right vertebral artery (series 4, image 218) is felt to
likely be artifactual otherwise, the remainder of the posterior circulation is
unremarkable. No evidence of aneurysm. The dural venous sinuses are patent.
CTA NECK:
The right left common carotid artery arises from the right brachiocephalic, a
normal anatomic variant. The bilateral common carotid arteries are
unremarkable. The subclavian arteries are unremarkable. The right vertebral
artery is dominant otherwise, the vertebral arteries are unremarkable. There
is no stenosis of the cervical internal carotid arteries by NASCET criteria.
Very minimal atherosclerotic disease is noted at the carotid bifurcations.
CT PERFUSION: Automated CT profusion software demonstrates large region of
elevated T-max, predominantly involving the left posterior frontal and
parietal lobes with total volume of 145 mL. No evidence of CBF less than 30%.
Given lack of CT findings of acute infarct, this would suggest a large
penumbra.
OTHER: The visualized lungs are clear allowing for respiratory motion
artifact. No acute osseous abnormality. Multiple periapical lucencies with
dehiscence of the buccal alveolar ridge and dental caries, predominantly
involving ___ teeth number 2 through 4 is noted. The thyroid is unremarkable.
There is no cervical lymphadenopathy by size criteria. The visualized
aerodigestive tract is unremarkable. The major salivary glands are within
expected limits.
IMPRESSION:
1. Findings compatible with occlusion of the left distal M2 superior division.
There is also overall paucity of enhancement in the inferior division
territory, although site of occlusions not definitively visualized.
2. No evidence of acute large territory infarct or intracranial hemorrhage on
noncontrast head CT.
3. Allowing for left MCA findings, the remainder of the CTA head is
unremarkable without aneurysm or other sites of large vessel occlusion.
Unremarkable CTA neck.
4. CT perfusion suggest large ischemic penumbra involving the left posterior
frontal and parietal lobes with total volume of 145ml.
5. Additional findings as described above including scattered dental caries
and periapical lucencies. Dental exam when feasible is recommended.
|
19982539-RR-19 | 19,982,539 | 23,136,520 | RR | 19 | 2175-04-23 09:06:00 | 2175-04-24 09:59:00 | EXAMINATION: Left common carotid artery angiogram.
Right common femoral artery angiogram.
INDICATION: ___ year old man with L MCA// thrombectomy
TECHNIQUE: anesthesia: Conscious sedation with local analgesia provided by
anesthesia team, please see separate sheets for medications and dosing.
Patient was brought into the angio suite, ID was confirmed via wrist band.The
patient was placed supine on fluoroscopy table and bilateral groins were
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. The location of the right mid femoral
head was located using anatomic and radiographic landmarks. 10 +10 cc of
subcutaneous lidocaine was infused into the tissue. Micropuncture kit was
used to gain access to the right femoral artery, serial dilation was
undertaken until a long 8 ___ groin sheath connected to a continuous
heparinized saline flush could be inserted. Next, a VTK catheter was connected
to the power injector and also to a continuous heparinized saline flush. This
was advanced over the 0.038 glidewire brought up the aorta used to select the
left common carotid artery. AP and lateral views of the anterior cerebral
circulation were obtained .
Under direct road map guidance and after multiple attempts using different
types of wires the diagnostic catheter was removed utilizing an exchange wire
and 6 ___ cook shuttle was advanced until it was parked in a satisfactory
position the common carotid artery.
New AP and lateral road maps were obtained, ___ ___ intermediate
catheter was advanced over synchro 2 wire and Trevo ProVue microcatheter.
Synchro 2 wire in the microcatheter were advanced slowly and carefully until
positioned beyond the clot in M1 M2 junction, then the ___ was advanced
slowly and carefully until proximal M1, synchro wire was removed then 4MM X
30MM stent was deployed, and the ___ was connected to suction.
Few min later, the stent and the microcatheter were withdrawn as a single unit
into the ___, then it was removed under direct and constant manual
suction. New AP and lateral angio run were obtained from the ___ shuttle
which showed partial revascularization of the inferior division but persistent
clot in the distal superior division and M3.
Due to that we decided to attempt another pass utilizing the same technique
the same instruments which was unsuccessful to restore the superior division
MCA territory.
Third pass was attempted with 3 mm by 20 mm stent with focus on
revascularizing the inferior division, utilizing the same technique and the
same instruments and a micro injection was done to verify position. Which was
successful in restoring flow in proximal superior division but not distal M3.
At this point we decided to stop.
Magnified and de magnified AP and lateral views of the anterior circulation
were obtained after.
The catheter was then pulled back in the aorta fully removed from the body. A
common femoral arteriogram was performed prior to use of a closure device,
subsequently 8 Angio-Seal was put in. At the conclusion of the procedure,
there is no evidence of thromboembolic complication.
Devices inventory:
.038" 150cm Angled Glidewire
035 x 150cm ___ Wire
___ x 25cm Terumo Sheath Set
___ ___ 2 Cath. 100cm $25.00 X2
___ Micropuncture Set $25.00
Synchro2 Standard 14 200cm Wire
___ x 90cm Shuttle Sheath Set
___ PLUS Distal Access Catheter
038 Angled Glidewire Exchange
High Flow Tubing
___ Angio Seal Evolution Closure Device ___ x 260cm Amplatz Straight Exchange
018 x 300cm V-18 Control Wire X2
___ VTK .038/100cm Cath.
StrokeFastPack Trevo XP 4x30 3/PK ___
___ 131CM ___ ACCESS CATHETER
High Flow Tubing
Trevo Retriever 3 x 20 kit ___
COMPARISON: None
FINDINGS:
Bovine configuration of the aortic arch with significant tortuosity at left
common carotid.
Left common carotid artery: Carotid bifurcations well-visualized. There is
no significant atherosclerosis or carotid stenosis but significant tortuosity.
Left internal carotid artery: Distal left ICA, proximal and distal ACA
branches are well-visualized with a robust PCOM. 2 occlusion spots were
identified in the MCA territory, the first 1 is at the proximal inferior
division and the second is at the distal superior division obstructing one of
the M3 branches completely after its takeoff. Post mechanical thrombectomy (3
passes) successful partial recannulization of the MCA territory compatible
with TICI 2b.
Right common femoral artery: Well-visualized with a good caliber size for
closure device.
I, Abdulrahman ___, participated in the procedure. I, ___,
was present for the entirety of the procedure and supervised all critical
steps.
I, ___, have reviewed the report and agree with the fellow's
findings.
IMPRESSION:
2 occlusion spots were identified in the left MCA territory, the first 1 is at
the proximal inferior division and the second is at the distal superior
division obstructing one of the M3 branches completely after its takeoff. Post
mechanical thrombectomy (3 passes) successful partial recannulization of the
MCA territory compatible with TICI 2b.
RECOMMENDATION(S): Management as per Stroke Neurology recommendations.
|
19982539-RR-21 | 19,982,539 | 23,136,520 | RR | 21 | 2175-04-23 14:06:00 | 2175-04-23 15:25:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with L MCA stroke, s/p thrombectomy// Evaluate
for new changes intracranially
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.4 mGy-cm.
2) Sequenced Acquisition 2.0 s, 8.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
373.8 mGy-cm.
Total DLP (Head) = 1,308 mGy-cm.
COMPARISON: CTA head and neck ___
FINDINGS:
The patient is status post conventional cerebral angiogram and thrombectomy.
There is suggestion of subtle loss of gray-white differentiation of the left
inferior parietal lobule, corresponding to region of increased mean transit
time on prior CT perfusion. No other regions of acute large territory infarct
is identified. No evidence of hemorrhagic transformation. There is increased
density of a proximal left superior M 2 division (series 2, image 21), felt
likely to represent residual thrombus. The sulci, ventricles and cisterns are
otherwise within expected limits for the patient's age. No acute osseous
abnormality. Mild mucosal thickening of the right maxillary sinus is noted.
The orbits are unremarkable. The mastoid air cells middle ears are well
pneumatized and clear.
IMPRESSION:
1. Suggestion of subtle loss of gray-white differentiation of the left
inferior parietal lobule corresponding to region of increased mean transit
time on prior CT perfusion.
2. No evidence of hemorrhagic transformation.
3. Hyperdensity of the left MCA bifurcation of a superior M2 division is
compatible with residual thrombus.
4. Additional findings as described above.
|
19982539-RR-22 | 19,982,539 | 23,136,520 | RR | 22 | 2175-04-23 15:46:00 | 2175-04-23 17:55:00 | INDICATION: ___ year old man with hx of HTN presenting w/ suspected L MCA
stroke s/p thrombectomy// Evaluate for cardiopulmonary status
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
IMPRESSION:
The tip of a nasogastric tube projects over the distal esophagus and
advancement by at least 10 cm is recommended to ensure that the side port lies
beyond the GE junction.
There are low bilateral lung volumes. Mild pulmonary edema is present. There
is no pleural effusion or pneumothorax identified. The size of the cardiac
silhouette is enlarged however is likely magnified by low lung volumes and AP
technique.
|
19982539-RR-23 | 19,982,539 | 23,136,520 | RR | 23 | 2175-04-23 18:06:00 | 2175-04-23 18:51:00 | INDICATION: ___ year old man with stroke// dobhoff placement
TECHNIQUE: 2 chest radiographs were obtained
COMPARISON: Chest radiograph from earlier today
IMPRESSION:
2 sequential images demonstrate advancement of a Dobhoff tube from the
esophagus into the stomach. Unchanged cardiopulmonary findings. There are no
dilated loops of bowel projecting over the upper abdomen.
|
19982539-RR-25 | 19,982,539 | 23,136,520 | RR | 25 | 2175-04-24 21:29:00 | 2175-04-24 22:25:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with L MCA infarct, R pupil > L pupil// eval for
uncal herniation
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head dated ___
FINDINGS:
There is a large geographic hypodense area within the left cerebral hemisphere
consistent with the known left MCA infarct. There is associated sulcal
effacement and effacement of the left lateral ventricle. There is 4 mm of
rightward midline shift. Mild uncal herniation is however noted with
mass-effect on the left side of the suprasellar cistern. There is no evidence
of hemorrhagic transformation..
No osseous abnormalities seen. Several right maxillary periapical lucencies
are noted and consistent with periodontal disease. There is mild mucosal
thickening in the right maxillary sinus. Otherwise the remain paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The orbits are
unremarkable.
IMPRESSION:
Evolving large left MCA territory infarct without hemorrhagic transformation.
There is increased mass effect as described above including new mild uncal
herniation.
NOTIFICATION: The findings were discussed with the ___ care NP by
___, M.D. on the telephone on ___ at 10:22 pm, 2 minutes
after discovery of the findings.
|
19982539-RR-26 | 19,982,539 | 23,136,520 | RR | 26 | 2175-04-24 23:14:00 | 2175-04-25 09:41:00 | INDICATION: ___ year old man with L MCA infarct// hypoxic, eval for pulm edema
v pna
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
The Dobhoff tube has been further advanced and the tip projects over the
stomach. Lungs are low volume with stable cardiomediastinal silhouette.
There is subsegmental atelectasis in the right lung base. There is no pleural
effusion. No pneumothorax is seen
|
19982539-RR-28 | 19,982,539 | 23,136,520 | RR | 28 | 2175-04-25 10:15:00 | 2175-04-25 11:14:00 | INDICATION: ___ year old man with new picc// R picc 50 cm Contact name:
___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
There is stable near complete atelectasis of the right middle and right lower
lobe. Right-sided PICC line projects to the cavoatrial junction. Lungs are
low volume. Mild interstitial edema has slightly worsened. Cardiomediastinal
silhouette is stable. No pneumothorax is seen. Right pleural effusion is
unchanged.
|
19982539-RR-29 | 19,982,539 | 23,136,520 | RR | 29 | 2175-04-26 02:26:00 | 2175-04-26 10:22:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with stroke// Patient has increased O2
requirements, assess for aspiration/PNA
TECHNIQUE: Frontal chest radiograph, AP portable technique
COMPARISON: Chest radiograph dated ___, as well as multiple other
prior radiographs dating back to ___.
FINDINGS:
The lung volumes remain low, with unchanged near complete atelectasis of the
right lower lobe, as well as likely a component of the right middle lobe
atelectasis. In addition, there is likely a small to moderate right pleural
effusion. Left lung remains clear. A right-sided PICC line terminates at the
cavoatrial junction. Enteric feeding tube is seen coursing below the
gastroesophageal junction before disappearing from view. No focal
consolidation. There is mild interstitial edema. Cardiomediastinal
silhouette is stable. No evidence of pneumothorax.
IMPRESSION:
In comparison to ___, there is unchanged right lower lobe and
likely right middle lobe atelectasis. In addition, there is likely a small to
moderate right pleural effusion. No evidence of pneumonia.
|
19982539-RR-30 | 19,982,539 | 23,136,520 | RR | 30 | 2175-04-27 03:23:00 | 2175-04-27 10:18:00 | INDICATION: ___ year old man with Left MCA infarct// Please evaluate lung
fields
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Right-sided PICC line projects to the cavoatrial junction. The NG tube is
unchanged. Cardiomediastinal silhouette is stable. There is bibasilar
atelectasis. There is mild interstitial edema. No pneumothorax is seen
|
19982539-RR-31 | 19,982,539 | 23,136,520 | RR | 31 | 2175-04-28 13:03:00 | 2175-04-28 14:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with Right M2 cutoff// Dobhoff placement. please
evaluate
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are unchanged. Continued low lung volumes that accentuate the transverse
diameter of the enlarged cardiac silhouette. Indistinctness of engorged
pulmonary vessels is consistent with elevated pulmonary venous pressure. The
hemidiaphragms are not well seen, suggesting small pleural effusions with
underlying compressive atelectasis at the bases.
|
19982539-RR-32 | 19,982,539 | 23,136,520 | RR | 32 | 2175-04-29 03:21:00 | 2175-04-29 09:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA infarct// eval dobhoff, eval pulm
edema v pna eval dobhoff, eval pulm edema v pna
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lung volumes are still quite low but previous right basal atelectasis has
improved. Moderate to severe cardiac enlargement persists and mediastinal
venous engorgement, exaggerated by supine positioning, suggests elevated
central venous pressure or volume. There is no pulmonary edema or focal
consolidation and no pleural effusion or pneumothorax.
Right PIC line ends in the right heart close to the tricuspid valve.
|
19982539-RR-33 | 19,982,539 | 23,136,520 | RR | 33 | 2175-04-29 09:29:00 | 2175-04-29 10:57:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD
INDICATION: ___ year old man with Pt is a ___ yr M w/ hx of HTN who developed
acute onset of language difficulties and R sided weakness, now s/p
thrombectomy for L M2 cutoff.// decreased mental status, unarousable- stat
scan
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
COMPARISON: CT head without contrast ___
FINDINGS:
Large subacute left MCA distribution infarct is stable compared with ___. Additional small infarcts seen in the left caudate head, and
left ACA distribution, stable.
Rightward midline shift by 11 mm is increased from 4 mm on ___. Mild
crowding at foramen magnum. Left uncal herniation is worsened, partial
effacement of the superior cerebellar cistern is worsened, effacement of the
perimesencephalic cisterns and mass effect on the upper midbrain is worsened.
Completely effaced suprasellar cistern, completely effaced prepontine cistern,
worsened.
Iation. There is no evidence of hemorrhage. Worsened dilatation of the right
lateral ventricle, consistent with developing hydrocephalus and right
ventricular trapping.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Small amount
of fluid is noted in the right maxillary sinus.
IMPRESSION:
Stable distribution of extensive left MCA distribution infarct. Smaller
stable infarcts left caudate nucleus, left ACA distribution.
Increased rightward midline shift, completely efface suprasellar, pre pontine
cisterns, worsened uncal herniation, mild right lateral ventricular trapping,
and mild crowding of the cerebellar tonsils at foramen magnum.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 10:30 am, 2 minutes after discovery
of the findings.
|
19982539-RR-34 | 19,982,539 | 23,136,520 | RR | 34 | 2175-04-29 14:31:00 | 2175-04-29 16:17:00 | INDICATION: Pt is a ___ yr M w/ hx of HTN who developed acute onset of
language difficulties and R sided weakness, now s/p thrombectomy for L M2
cutoff.// confirm placement of NGT
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
An ET tube has been placed in the interim the ET tube projects approximately 7
cm from the carina. The NG tube projects below the left hemidiaphragm.
Cardiomediastinal silhouette is stable. Right-sided PICC line projects to the
cavoatrial junction. There is no pleural effusion. No pneumothorax is seen
|
19982539-RR-35 | 19,982,539 | 23,136,520 | RR | 35 | 2175-04-30 04:57:00 | 2175-04-30 08:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p left hemicraniectomy// assess for PNA
assess for PNA
IMPRESSION:
Comparison to ___. The monitoring and support devices are in
stable position. The tip of the endotracheal tube projects 6 cm above the
carinal on today's image, the device could be advanced by 1-2 cm. Lung volumes
are low. Mild fluid overload but no overt pulmonary edema. Moderate
cardiomegaly. No pneumothorax, no pneumonia, no pleural effusions.
|
19982539-RR-36 | 19,982,539 | 23,136,520 | RR | 36 | 2175-04-30 03:43:00 | 2175-04-30 04:54:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with left MCA stroke s/p left hemicraniectomy for
decompression// follow stroke and postop hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
Compared with ___, patient has undergone interval left craniectomy
for decompression with a small amount of expected pneumocephalus, and a
left-sided surgical drain in place. Again seen is a large infarct in the left
MCA distribution, now with herniation through the craniectomy defect. There is
a new small focus of hyperdense hemorrhage along the inferior aspect of the
infarct territory measuring up to 17 mm (601:71). There is improved mass
effect, with decreased effacement of the left lateral ventricle, and rightward
midline shift currently measuring up to 4 mm, compared with 11 mm previously.
Effacement of the basal cisterns is improved. Entrapment of the right lateral
ventricle is improved. Additional small infarcts in the distribution of the
left ACA and in the left caudate head are unchanged.
Surgical staples overlie the left craniectomy site. There is no evidence of
fracture. There is mucosal thickening in the right maxillary sinus, bilateral
sphenoid sinuses, and ethmoid air cells. The visualized portion of the
remainder of the paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are unremarkable. An
endotracheal tube is partially visualized.
IMPRESSION:
1. Status post interval left craniectomy for decompression, with interval
improvement in mass effect, with decreased effacement of the left lateral
ventricle and basal cisterns, and rightward midline shift currently measuring
up to 4 mm, compared with 11 mm previously.
2. New small focus of acute hemorrhage along the inferior aspect of the
infarct territory measures up to 17 mm.
NOTIFICATION: The findings were discussed by Dr. ___ with ___
___ on the telephone on ___ at 4:40 am, 1 minutes after discovery
of the findings.
|
19982539-RR-38 | 19,982,539 | 23,136,520 | RR | 38 | 2175-04-30 10:32:00 | 2175-04-30 11:52:00 | EXAMINATION: MR HEAD W/O CONTRAST PORT ___ MR HEAD
INDICATION: ___ year old man with assess stroke// please perform by 11 am
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Prior CTA done ___ at 04:04
FINDINGS:
The patient is status post left frontoparietal decompression craniectomy. The
cutaneous surgical clips overlying the left scalp results in susceptibility
artifact. The frontal and parietal lobes is seen herniating through the
defect.
Large left MCA infarct is again visualized involving the left frontal and
parietal lobes as well as the left basal ganglia and extending into the
corticospinal tracts into the left cerebral peduncle. There is also slow
diffusion involving the splenium of the corpus callosum. Punctate areas of
slow diffusion also seen in the left superior frontal gyrus as well as in the
high posterior aspect of the right frontal lobe and left occipital lobe. Mild
mass effect with midline shift to the left by 4 mm.
No posterior fossa infarcts.
Multiple punctate areas of susceptibility artifact within the infarct in
keeping with hemorrhagic transformation. Loss of the left M2 vessels flow
void in keeping with occlusion.
Susceptibility artifact in the right basal ganglia most likely represents
idiopathic mineralization.
Mild moderate opacification of the paranasal sinuses. Retained fluid present
in the nasopharynx is most likely secondary to nasopharyngeal instrumentation.
The orbits appear normal. The craniocervical junction appears normal. The
pituitary appears normal.
IMPRESSION:
The patient is status post left frontoparietal decompression craniectomy.
Large left MCA infarct as well as scattered infarcts in other vascular
distributions. Punctate areas of hemorrhagic transformation of the left MCA
infarct. Mild mass effect with midline shift to the left by 4 mm.
|
19982539-RR-39 | 19,982,539 | 23,136,520 | RR | 39 | 2175-04-30 09:49:00 | 2175-04-30 15:08:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with Pt is a ___ yr M w/ hx of HTN who developed
acute onset of language difficulties and R sided weakness, now s/p
thrombectomy for L M2 cutoff.// assess ETT placement
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 05:11
IMPRESSION:
Compared to the earlier same day examination, the endotracheal tube has been
slightly advanced 4 cm cranial to the carina, satisfactory. Upper enteric
tube and right-sided PICC are unchanged, satisfactory. Lung volumes otherwise
remain low without new consolidation, effusion, or pneumothorax. No other
change.
|
19982539-RR-40 | 19,982,539 | 23,136,520 | RR | 40 | 2175-05-02 07:52:00 | 2175-05-02 10:29:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST Q151 CT HEAD
INDICATION: ___ year old man with L MCA stroke pod 3 left hemicraniectomy//
24hr post drain pull
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 1343.9 mGy cm
COMPARISON: MR head without contrast ___
FINDINGS:
Patient is status post left frontoparietal decompression craniectomy.
Herniation of left parietal and temporal lobes through the craniectomy defect
appears similar to 2 days ago. Small amount of subdural hematoma is noted at
the surgical bed. Large area of hypodensity associated with vasogenic edema
in the left parietal temporal lobe is consistent with history of recent left
MCA infarct. Ventricles and sulci appear similar in configuration as before,
including effacement of left lateral ventricle. Small areas of hyperdensity
within the area of infarct (02:18, 17) correspond to areas of hemorrhagic
transformation, better seen on prior MRI. Mild rightward midline shift by 3
mm is similar to before.
Mucosal thickening is noted in the right maxillary, bilateral ethmoid, and
sphenoid sinuses. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Patient is status post left frontoparietal decompression craniectomy for
large territory left MCA infarct. Mass effect and small subdural hematoma at
the surgical bed appear similar to before. Small areas hemorrhagic
transformation were better evaluated on prior MRI and appear grossly similar.
|
19982539-RR-41 | 19,982,539 | 23,136,520 | RR | 41 | 2175-05-03 02:25:00 | 2175-05-03 08:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA infarct// eval ETT, eval for pna
eval ETT, eval for pna
IMPRESSION:
Comparison to ___. No relevant change is noted. The endotracheal
tube is no longer visualized. The feeding tube and the right PICC line are in
stable position. Low lung volumes. Mild fluid overload but no overt
pulmonary edema. Moderate cardiomegaly. No pleural effusions.
|
19982539-RR-42 | 19,982,539 | 23,136,520 | RR | 42 | 2175-05-02 10:00:00 | 2175-05-02 12:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA stroke// intubated, secretions, eval
ETT and for pulm edema intubated, secretions, eval ETT and for pulm edema
IMPRESSION:
Compared to chest radiographs ___ through ___.
ET tube in standard placement. Lung volumes are lower, exaggerating moderate
cardiac enlargement. New abnormality in the right lung marginates the major
fissure, could be pneumonia. There is no pulmonary edema. No focal pulmonary
abnormality on the left.
Transesophageal drainage tube can be traced as far as the low esophagus but
the tip is indistinct. Right PIC line ends in the right atrium.
|
19982539-RR-43 | 19,982,539 | 23,136,520 | RR | 43 | 2175-05-04 15:50:00 | 2175-05-04 17:16:00 | EXAMINATION: CT abdomen pelvis
INDICATION: ___ year old man with L MCA stroke.// Evaluate for evidence of
malignancy iso of possible hypercoagulation.
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) Spiral Acquisition 5.7 s, 75.2 cm; CTDIvol = 24.1 mGy (Body) DLP =
1,808.7 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 7.2 s, 0.5 cm; CTDIvol = 40.2 mGy (Body) DLP =
20.1 mGy-cm.
Total DLP (Body) = 1,831 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Subtle 2.5 cm ill-defined hypodensity in the hepatic dome is indeterminate and
not completely characterized (2; 37). 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 is mildly enlarged measuring 13.8 cm with normal
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: Partially visualized enteric tube terminates within the
proximal stomach, gastric fundus. The stomach is unremarkable. Fatty
infiltration of the wall of the terminal ileum is consistent with chronic
inflammation. The remaining small bowel loops demonstrate normal caliber,
wall thickness, and enhancement throughout. There is possible wall thickening
of the sigmoid/rectum, difficult to differentiate from adherent stool (2;
117). The appendix is normal.
PELVIS: The urinary bladder contains a foci of air, correlate with recent
instrumentation. The distal ureters are unremarkable. There is no 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. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: An umbilical hernia containing fat is noted.
IMPRESSION:
1. 2.5 cm ill-defined hypodensity in the hepatic dome is indeterminate, while
this may represent an atypical hemangioma other etiologies cannot be excluded,
consider further evaluation with MRI liver.
2. Possible focal wall thickening of the sigmoid/rectum, difficult to
differentiate from adherent stool, consider proctoscopy or sigmoidoscopy for
further evaluation.
3. Mild splenomegaly.
4. Enteric tube terminates in the gastric fundus and should be advanced
further.
RECOMMENDATION(S):
1. MRI liver
2. Advanced enteric tube
3. Consider proctoscopy or sigmoidoscopy
|
19982539-RR-44 | 19,982,539 | 23,136,520 | RR | 44 | 2175-05-04 16:28:00 | 2175-05-04 17:12:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Evaluate for evidence of malignancy. ___ man with left
MCA stroke.
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 75.2 cm; CTDIvol = 24.1 mGy (Body) DLP =
1,808.7 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 7.2 s, 0.5 cm; CTDIvol = 40.2 mGy (Body) DLP =
20.1 mGy-cm.
Total DLP (Body) = 1,831 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: No prior studies are available for comparison.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.
There is no supraclavicular and no axillary lymphadenopathy.
CHEST CAGE: No evidence of osteo destructive lesions at the level of the
vertebra, ribs or sternum.
UPPER ABDOMEN: Reported separately in the same day CT abdomen and pelvis.
MEDIASTINUM: Scattered mediastinal lymph nodes measure up to 0.6 cm in the
right lower paratracheal station. Posterior mediastinum is unremarkable.
There is no hilar lymphadenopathy. NG tube through collapsed esophagus
terminates in the stomach.
HEART and PERICARDIUM: Heart is normal in size. Right PICC terminates in the
right atrium. There is no pericardial effusion. No appreciable
atherosclerotic calcifications in the coronaries or along normal caliber
thoracic aorta and main branches. Main pulmonary artery is top normal
diameter, measuring 3.1 cm. The study is not dedicated for the evaluation of
pulmonary emboli.
PLEURA: There are no pleural space abnormalities.
LUNG: Respiratory motion artifacts limit evaluation of fine detail such as
millimetric pulmonary nodules. No lung nodules identified. No lung masses.
Mild dependent bibasilar atelectasis.
IMPRESSION:
No evidence of intrathoracic malignancy.
|
19982539-RR-46 | 19,982,539 | 23,136,520 | RR | 46 | 2175-05-05 14:39:00 | 2175-05-05 15:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA stroke with Doboff in place.//
Evaluate position of Doboff
IMPRESSION:
In comparison with the study of ___, there again are low lung volumes.
Continued enlargement of the cardiac silhouette with mild vascular congestion.
No evidence of acute pneumonia or pleural effusion.
The tip of the Dobhoff tube is in the upper stomach. Right subclavian PICC
line has been advanced and appears to extend into the right atrium. A the
tube could be pulled back approximately 4 cm if the desired position is to
have the tip in the region of the cavoatrial junction.
|
19982539-RR-47 | 19,982,539 | 23,136,520 | RR | 47 | 2175-05-09 16:54:00 | 2175-05-09 18:12:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with L MCA stroke s/p left hemi craniectomy
presents after fall this morning.// Evaluate for intracranial hemorrage s/p
fall.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: HEAD CT ___
FINDINGS:
Again noted is left frontoparietal decompression craniectomy with herniation
of the left parietal and temporal lobes through the defect. The subdural
collection is increased since the prior study measuring up to 2.2 cm in
greatest axial thickness. Extensive vasogenic edema predominantly in the left
parietal and temporal lobes compatible with history of recent left MCA infarct
decreased since the prior study from ___. Small areas of
hemorrhagic transformation within the evolving infarct are less well
visualized, likely reflecting evolving blood products. There is no
significant midline shift. Mild effacement of the left lateral ventricle is
improved. Mild right maxillary sinus mucosal thickening is noted. The
remaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear
cavities are well aerated.
IMPRESSION:
1. No evidence of acute hemorrhage.
2. Extensive vasogenic edema in the evolving left MCA infarct is decreased
since the prior study.
3. Post craniectomy changes as detailed above.
|
19982539-RR-48 | 19,982,539 | 23,136,520 | RR | 48 | 2175-05-15 17:48:00 | 2175-05-15 18:18:00 | INDICATION: ___ year old man who is pre-op for VP shunt// Pre-op scan Surg:
___ (VP shunt)
TECHNIQUE: Portable chest x-ray
COMPARISON: Chest x-ray ___
FINDINGS:
Low lung volumes are re-demonstrated. The heart is enlarged as seen
previously. There is mild pulmonary venous congestion. There is no
consolidation.
The right PICC is stable in position with tip of the right PICC overlying the
right atrium. A previously seen NG tube has been removed.
IMPRESSION:
As above
RECOMMENDATION(S): If the desired location the right PICC is at the
cavoatrial junction, consider repositioning by pulling back approximately 4
cm.
|
19982539-RR-49 | 19,982,539 | 23,136,520 | RR | 49 | 2175-05-16 10:32:00 | 2175-05-16 20:45:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with L MCA stroke s/p craniectomy. unwitnessed
fall today// interval change. had unwitnessed fall
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Comparison head CT without contrast dated ___.
FINDINGS:
The patient is status post frontoparietal decompression craniectomy. Again
seen is evolution of left middle cerebral artery infarction (2: 18). There is
no new hemorrhage or midline shift. There is no interval change in the
extra-axial collection that extends into the craniectomy site. Slight
interval increase in compression of the anterior horn of the lateral
ventricles.
The left mastoid air cells are partially opacified. Otherwise the right
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
IMPRESSION:
1. Patient is status post frontoparietal decompression craniectomy.
2. Large evolving subacute infarct extending along the left parietal and
temporal lobes with decreasing vasogenic edema.
3. Slight interval increase of compression on the anterior horn of the
lateral ventricles.
4. There is no new hemorrhage or midline shift.
|
19982539-RR-50 | 19,982,539 | 23,136,520 | RR | 50 | 2175-05-17 10:34:00 | 2175-05-17 12:47:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man s/p thrombectomy for L MCA stroke c/b uncal
herniation s/p hemicraniectomy.// Worsening compression of lateral ventricle?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.1 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head without contrast of ___.
FINDINGS:
The patient is status post left frontal parietal craniectomy, with unchanged
herniation of the left cerebral hemisphere through the craniectomy defect.
Evolving sequela of left middle cerebral artery subacute infarct is identified
without evidence of interval new hemorrhage. Mild gyriform hyperdensity
within the infarct is compatible with petechial hemorrhage, unchanged. No
evidence of new acute large territorial infarct. Minimal 2 mm rightward
midline shift is unchanged. There remains mild mass effect on the right
lateral ventricle. The visualized paranasal sinuses are essentially clear.
The orbits are unremarkable fluid in the left mastoid air cells is overall
similar to prior exam. The right mastoid air cells are clear.
IMPRESSION:
1. Unchanged appearance of frontoparietal decompressive craniectomy.
2. Evolving sequela of left MCA subacute infarct, also unchanged from prior
exam. Unchanged appearance of the lateral ventricles from prior exam.
3. No interval change from prior exam.
|
19982539-RR-51 | 19,982,539 | 23,136,520 | RR | 51 | 2175-05-19 08:09:00 | 2175-05-19 09:13:00 | INDICATION: ___ year old man with leukocytosis// Eval for PNA
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Right-sided PICC line projects to the right atrium. Cardiomediastinal
silhouette is stable. Interstitial abnormality is more prominent. There is a
small right pleural effusion. No pneumothorax is seen.
|
19982539-RR-52 | 19,982,539 | 23,136,520 | RR | 52 | 2175-05-19 09:41:00 | 2175-05-19 15:38:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man s/p thrombectomy for L MCA stroke c/b uncal
herniation s/p hemicraniectomy.// ? interval change of CSF accumulation and
Worsening compression of lateral ventricle?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: Comparison includes CT head dated ___..
FINDINGS:
The patient is status left frontal parietal craniectomy with no interval
change of left cerebral herniation through craniectomy site, (302:29).
Re-demonstrated, is a large evolving left parietal hypodensity due to recent
left MCA infarct, (302: 24). There is no new hemorrhage. There is no new
infarct. Interval decrease of subgaleal fluid collection at the left,
(302:34).
Re-demonstrated, partial opacification of the left mastoid air cells,
(302:14). Otherwise, the maxillary, frontal, sphenoid and ethmoid sinuses are
well aerated. The right mastoid air cells and middle ear canals are clear.
IMPRESSION:
1. Again seen is a large evolving left parietal subacute infarct.
2. No interval change in leftward midline shift.
3. No interval change of left cerebral herniation through the craniectomy
site.
4. Interval decrease of subgaleal fluid collection.
|
19982539-RR-53 | 19,982,539 | 23,136,520 | RR | 53 | 2175-05-19 16:35:00 | 2175-05-19 18:58:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with left MCA stroke and hydrocephalus now S/P
placement of right EVD; please complete at 1630// evaluate EVD placement;
please complete at 1630
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CT head without contrast from ___
FINDINGS:
Postsurgical changes are again seen following left frontoparietal craniectomy.
There is persistent cerebral herniation through the craniectomy site. There
is redemonstration of an evolving left frontoparietal infarct. As previously
mentioned, mild gyriform hyperintensity within the known infarct likely
represents petechial hemorrhage. No new intracranial hemorrhage or large acute
infarct. There is no midline shift.
There is interval placement of a right frontal approach ventriculostomy
catheter which terminates near the left foramen of ___. Small amount
pneumocephalus is seen in the right frontal convexity (02:19). The ventricles
and sulci are stable compared to the same-day prior study. There is interval
increase in a subgaleal collection measuring up to 1.5 cm in maximal thickness
(02:17) since the earlier same day study.
There is no new osseous abnormality. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Interval increase in a left-sided subgaleal collection measuring up to 1.5
cm in maximal thickness as compared to the earlier same-day study.
2. Interval placement of a right frontal approach ventriculostomy catheter
which terminates near the left foramen of ___.
3. Again seen is an evolving left frontoparietal infarct. No new large acute
infarct or intracranial hemorrhage.
4. Stable postsurgical changes following left frontoparietal craniectomy.
|
19982539-RR-54 | 19,982,539 | 23,136,520 | RR | 54 | 2175-05-23 03:41:00 | 2175-05-23 08:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA stroke and now wound dehiscence who
vomited tube feeds// rule out aspiration
IMPRESSION:
In comparison with study of ___, there again are very low lung volumes.
Right subclavian PICC line again extends to the right atrium. Continued
enlargement of the cardiac silhouette with little if any vascular congestion.
No acute focal pneumonia.
|
Subsets and Splits