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19986341-RR-41 | 19,986,341 | 25,942,220 | RR | 41 | 2169-10-15 07:29:00 | 2169-10-15 10:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent CABG w/ AVR, now s/p
pericardiocentesis w/ drain.// ICU evaluation, pericardiocentesis drain
IMPRESSION:
In comparison with the study of ___, following pericardiocentesis the
cardiac silhouette is now essentially within normal limits. Pericardial drain
is in place. Blunting of the left costophrenic angle is consistent with
pleural fluid. No evidence of appreciable vascular congestion or acute focal
pneumonia.
|
19986341-RR-42 | 19,986,341 | 25,942,220 | RR | 42 | 2169-10-16 14:15:00 | 2169-10-16 16:37:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man s/p pericardial drain now with rising AST/ALT.
Rule out obstruction// obstruction; cause of transaminase elevation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound ___
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 4 mm
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreatic head appears within normal
limits, without masses or pancreatic ductal dilation, with portions of the
pancreatic body and tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 15.5 cm
KIDNEYS: Limited assessment of the right kidney shows no evidence of
hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease and
more advanced liver disease including steatohepatitis or significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
2. Mild splenomegaly.
3. Cholelithiasis.
RECOMMENDATION(S): Radiological evidence of fatty liver does not exclude
cirrhosis or significant liver fibrosis which could be further evaluated by
___. This can be requested via the ___ (FibroScan) or the
Radiology Department with either MR ___ or US ___, in
conjunction with a GI/Hepatology consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
19986341-RR-43 | 19,986,341 | 25,942,220 | RR | 43 | 2169-10-17 11:57:00 | 2169-10-20 15:42:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ man with pericardial effusion and cough
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent and reconstructed as contiguous 5 mm and 1.25 mm
thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.7 s, 33.6 cm; CTDIvol = 8.9 mGy (Body) DLP = 283.3
mGy-cm.
Total DLP (Body) = 293 mGy-cm.
COMPARISON: None
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is extensive coronary arterial
calcification. There are also severe calcifications in the aortic valve. An
anterior approach pericardial drain is in place. There is a trace residual
pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
There are moderate atherosclerotic calcifications in the thoracic aorta and at
the origins of the great vessels. The main, right, and left pulmonary arteries
are normal caliber.
PULMONARY PARENCHYMA: There is biapical pleuroparenchymal scarring with
nodular components. There are scattered 2 mm nodules in right lower lobe
(5:180, 97, 123). There is no focal consolidation.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is no pleural effusion.
CHEST WALL AND BONES: There is a healing fracture in the right first rib (5:
25). There are additional healing fractures in the right second, third and
fourth ribs. There is no worrisome lytic or sclerotic lesion. Multilevel
degenerative changes are mild.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is notable for
punctate calcifications in the right hepatic lobe.
IMPRESSION:
1. Punctate, subpleural nodules in the right lower lobe are nonspecific, but
likely infectious versus inflammatory in etiology.
2. Trace residual pericardial effusion with a pericardial drain in situ.
3. Incidentally noted are multiple healing right-sided rib fractures.
|
19986341-RR-44 | 19,986,341 | 25,942,220 | RR | 44 | 2169-10-18 07:14:00 | 2169-10-18 11:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CABG, s/p pericardial drain removal.// CCU
evaluation CCU evaluation
COMPARISON: Chest x-ray ___, CT chest ___
FINDINGS:
There has been interval removal of pericardial drain. There is stable
blunting of the left costophrenic angle consistent with small pleural
effusion. No pulmonary edema, pneumothorax or focal consolidation.
IMPRESSION:
Status post interval removal of pericardial drain.
|
19986341-RR-45 | 19,986,341 | 25,942,220 | RR | 45 | 2169-10-19 08:26:00 | 2169-10-19 14:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p CABG c/b cardiac effusion; s/p
pericardial drain.// Worsening cough. Worsening cough.
COMPARISON: Chest x-ray ___
FINDINGS:
Stable left pleural effusion. No pneumothorax. No focal consolidation. No
other significant change.
IMPRESSION:
Stable left pleural effusion.
|
19986341-RR-47 | 19,986,341 | 25,942,220 | RR | 47 | 2169-10-20 10:06:00 | 2169-10-20 11:16:00 | EXAMINATION: Fluoro sniff test.
INDICATION: ___ year old man with CAD s/p CABG now with L hemidiaphragm
elevation concerning for phrenic nerve damage// phrenic nerve damage
TECHNIQUE: Fluoroscopic sniff test.
COMPARISON: Multiple prior chest radiographs, most recently ___
FINDINGS:
Scout fluoroscopic images demonstrate symmetric hemidiaphragms with a small
amount of left pleural fluid. 5 intact median sternotomy wires are
demonstrated in this field-of-view. Multiple surgical clips are visualized.
On deep breathing (series 2) and sniffing (series 3 and 4), there is normal
movement of the bilateral hemidiaphragms.
IMPRESSION:
Normal movement of the bilateral hemidiaphragms.
|
19986589-RR-83 | 19,986,589 | 27,690,011 | RR | 83 | 2192-02-19 18:26:00 | 2192-02-19 19:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with CP// pna
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Evaluation is slightly limited by patient rotation and low lung volumes.
Patient is status post median sternotomy and CABG. Heart size appears within
normal limits. Mediastinal and hilar contours are similar. Crowding of
bronchovascular structures is present without frank pulmonary edema. Patchy
atelectasis is seen in the lung bases with continued eventration of the right
hemidiaphragm. No pleural effusion or pneumothorax. No acute osseous
abnormality.
IMPRESSION:
Mild bibasilar atelectasis in the setting of low lung volumes. No focal
consolidation to suggest pneumonia.
|
19986589-RR-85 | 19,986,589 | 20,368,763 | RR | 85 | 2192-03-16 04:45:00 | 2192-03-16 05:59:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with chest pain// ? pneumothorax
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Median sternotomy wires and mediastinal clips are unchanged in appearance.
There is no focal consolidation. Cardiomediastinal and hilar silhouettes are
within normal limits. There is no pulmonary edema. There is persistent
elevation of the right hemidiaphragm. No pleural effusions. No pneumothorax.
IMPRESSION:
No focal consolidations. No pneumothorax.
|
19986589-RR-94 | 19,986,589 | 21,321,609 | RR | 94 | 2192-05-20 00:57:00 | 2192-05-20 02:00:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain// eval pna
COMPARISON: Chest radiograph ___
FINDINGS:
AP and lateral views of the chest.
Mid sternotomy wires are again seen and appear similarly positioned. Low lung
volumes bilaterally, particularly on the right where there is unstable right
hemidiaphragm elevation. No areas of focal consolidation, pulmonary edema,
pneumothorax or pericardial effusion. Cardiac size is normal.
IMPRESSION:
No acute intrathoracic process.
|
19986589-RR-95 | 19,986,589 | 21,321,609 | RR | 95 | 2192-05-28 20:04:00 | 2192-05-28 20:45:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old man with pain with deep breath, immobility and chest
pain// Pe?
TECHNIQUE: Multidetector helical scanning of the chest was performed with
intravenous contrast and reconstructed as axial, coronal, parasagittal,
and,MIPs axial images.
DOSAGE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 14.9 mGy (Body) DLP = 3.0
mGy-cm.
2) Stationary Acquisition 5.5 s, 0.2 cm; CTDIvol = 150.2 mGy (Body) DLP =
30.0 mGy-cm.
3) Spiral Acquisition 5.6 s, 36.3 cm; CTDIvol = 14.8 mGy (Body) DLP = 525.8
mGy-cm.
Total DLP (Body) = 559 mGy-cm.
COMPARISON: CT ___ and multiple priors dating back to ___.
FINDINGS:
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is grossly unremarkable.
No supraclavicular or axillary lymphadenopathy.
UPPER ABDOMEN: Small hiatal hernia noted. 3.5 cm hypodensity arising from the
upper pole of the right kidney, compatible with a simple cyst. Limited
assessment the abdomen is otherwise grossly unremarkable.
MEDIASTINUM: No mediastinal lymphadenopathy.
HILA: No hilar lymphadenopathy.
HEART and PERICARDIUM: Pericardial effusion. Coronary calcification.
PLEURA: Pleural effusion.
LUNG:
1. PARENCHYMA: No suspicious pulmonary nodules. There is mild atelectasis at
the right lung base.
2. AIRWAYS: There is a small amount of debris in the dependent portion of the
mid trachea (series 6, image 65). Airways are otherwise patent the
subsegmental level.
3. VESSELS: Aorta and main pulmonary artery are normal in size. No pulmonary
embolus.
CHEST CAGE: Patient is status post median sternotomy. Bridging anterior
vertebral body osteophytes are noted throughout midthoracic spine. An 11 mm
lucent lesion within posterolateral aspect of right seventh rib (series 6,
image 165), is unchanged from ___ and of doubtful clinical significance.
IMPRESSION:
No evidence of pulmonary embolus. No acute intrathoracic abnormality.
|
19986589-RR-96 | 19,986,589 | 26,187,373 | RR | 96 | 2192-06-05 13:15:00 | 2192-06-05 13:38:00 | EXAMINATION: CTA HEAD AND NECK WITH PERFUSION PQ149.
INDICATION: Suspected stroke with acute neurological deficit.*** WARNING ***
Multiple patients with same last name!// Please exclude ICH, signs of early
ischemic stroke, large vessel occlusion, or other vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of Omnipaque 350 intravenous contrast material. Three-dimensional
angiographic volume rendered, curved reformatted and segmented images were
generated on a dedicated workstation. This report is based on interpretation
of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 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 8.0 s, 0.5 cm; CTDIvol = 87.1 mGy (Head) DLP =
43.6 mGy-cm.
4) Spiral Acquisition 5.5 s, 42.9 cm; CTDIvol = 32.0 mGy (Head) DLP =
1,375.6 mGy-cm.
Total DLP (Head) = 4,836 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute territorial infarction,intracranial
hemorrhage,edema,ormass. Mild subcortical, deep, and periventricular white
matter hypodensities are nonspecific, but likely represent the sequela of
chronic microvascular ischemia. The ventricles and sulci are normal in size
and configuration.
Minimal mucosal thickening within the inferior maxillary sinuses. Otherwise,
the visualized portion of the paranasal sinuses, mastoid air cells,and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
Mild atherosclerotic calcifications of the cavernous carotid arteries
bilaterally. The vessels of the circle of ___ and their principal
intracranial branches appear normal without stenosis, occlusion, or aneurysm
formation. The dural venous sinuses are patent.
CT PERFUSION: Nondiagnostic due to poor bolus timing.
CTA NECK:
Mild atherosclerotic calcifications at the carotid bifurcations bilaterally.
The carotidandvertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria. Sternotomy wires appear intact. Mild multilevel degenerative
changes are visualized throughout the cervical spine, slightly more pronounced
at C5-C6 level.
IMPRESSION:
1. No evidence of acute territorial infarction or intracranial hemorrhage.
2. CT perfusion is nondiagnostic due to poor bolus timing.
3. No evidence of large vessel occlusion, stenosis, aneurysm, or dissection.
|
19986589-RR-97 | 19,986,589 | 26,187,373 | RR | 97 | 2192-06-08 00:36:00 | 2192-06-08 07:11:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ male with PMH of CAD on dual anti-platelet therapy as
well as T2DM presenting with a discrete brief episode of speech difficulty
with preserved comprehension as well as R hemibody weakness 2 days ago. TIA,
embolic stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head without contrast dated ___. Brain MR ___
FINDINGS:
There is no evidence of hemorrhage, edema, mass, or infarction. The ventricles
and sulci are age-appropriate. There is no mass effect or midline shift.
Scattered T2 and FLAIR hyperintense foci in the periventricular and
subcortical white matter are nonspecific, but likely reflect chronic small
vessel ischemic changes.
There is mild mucosal thickening of the paranasal sinuses. There is mild
fluid signal in the left mastoid air cells. The intraorbital contents are
unremarkable.
IMPRESSION:
1. No evidence of mass, hemorrhage or infarction.
|
19986589-RR-98 | 19,986,589 | 21,882,677 | RR | 98 | 2192-06-14 03:14:00 | 2192-06-14 03:34:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: Suspected stroke with acute neurological deficit. // Please
exclude ICH, signs of early ischemic stroke, large vessel occlusion, or other
vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 34.9 mGy (Body) DLP =
17.4 mGy-cm.
3) Spiral Acquisition 5.6 s, 44.2 cm; CTDIvol = 15.3 mGy (Body) DLP = 675.3
mGy-cm.
Total DLP (Body) = 693 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: MRI head without contrast ___
CTA head neck ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction,hemorrhage,edema,ormass. The ventricles
and sulci are prominent, consistent global cerebral volume loss.
There is mild mucosal thickening of the maxillary sinuses. Multiple maxillary
mandibular periapical cysts are seen. The mastoid air cells,and middle ear
cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
Atherosclerotic changes of the cavernous and supraclinoid segments of the
bilateral internal carotid arteries are seen without stenosis.
Otherwise, the vessels of the circle of ___ and their principal
intracranial branches appear normal without stenosis, occlusion, or aneurysm
formation. The dural venous sinuses are patent.
CTA NECK:
Atherosclerotic changes of the carotid bifurcations are seen without
narrowing of the internal carotid arteries, by NASCET criteria. The vertebral
arteries appear normal with no evidence of stenosis or occlusion.
OTHER:
Sternotomy wires are seen. The visualized portion of the lungs are clear.
The visualized portion of the thyroid gland is within normal limits. There is
no lymphadenopathy by CT size criteria.
IMPRESSION:
1. Normal head CTA.
2. Calcified atheromatous plaque at the proximal internal carotid arteries
bilaterally without stenosis by NASCET criteria.
3. Otherwise normal neck CTA.
|
19986589-RR-99 | 19,986,589 | 21,882,677 | RR | 99 | 2192-06-14 06:42:00 | 2192-06-14 06:59:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain. Evaluation for pna, pnx.
TECHNIQUE: Chest AP upright and lateral
COMPARISON: Comparison to multiple prior chest radiographs, most recently
from ___.
FINDINGS:
Median sternotomy wires are intact and well aligned. Cardiomediastinal
silhouette is within normal limits. Mild tortuosity of the descending
thoracic aorta. Slightly diminished lung volumes contribute to crowding of
bronchovascular markings. Chronic elevation of the right hemidiaphragm is
unchanged. Lungs are clear without focal consolidation. Mild bibasilar
atelectasis is noted. No pleural effusion or pneumothorax is seen.
IMPRESSION:
1. No acute cardiopulmonary abnormality.
2. Persistent low lung volumes with mild bibasilar atelectasis.
|
19986715-RR-37 | 19,986,715 | 21,254,631 | RR | 37 | 2153-07-22 22:00:00 | 2153-07-22 22:49:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with ? myasthenic crisis, eval for acute infection//pls eval
for acute intrathoracic process
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.
|
19986715-RR-38 | 19,986,715 | 21,254,631 | RR | 38 | 2153-07-22 20:54:00 | 2153-07-22 21:41:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with myasthenia ___ left proptosis by exam// Please
evaluate for any acute intracranial process. Please obtain the scan through
the level of the orbits to evaluate for evidence of proptosis
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) = 1,104 mGy-cm.
COMPARISON: Brain MRI dated ___
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 a persistent cavum septum pellucidum et vergae.
Otherwise, ventricles appear unremarkable. Basal cisterns are patent. A
small fluid level is noted within the left maxillary sinus. Minimal
opacification of the left ethmoidal air cells. Mastoid air cells middle ear
cavities are well aerated. Bony calvarium is intact. The orbits appear
unremarkable. The imaged portions of the globes and retrobulbar space is
normal. Superior ophthalmic veins appear symmetric and normal.
IMPRESSION:
No acute intracranial process.
|
19986744-RR-30 | 19,986,744 | 29,239,682 | RR | 30 | 2132-04-03 11:22:00 | 2132-04-03 13:42:00 | INDICATION: Left shoulder and arm pain after fall.
TECHNIQUE: Two views of the chest and four additional radiographs of the left
hemithorax in a rib series.
COMPARISON: Radiographs of the chest dated ___.
FINDINGS: No focal opacity to suggest pneumonia is seen. No pleural
effusion, pulmonary edema or pneumothorax is present. The heart size is top
normal. There is tortuosity of the aorta and calcification at the aortic
arch.
Adjacent to the marker along the left lower hemithorax, there is a possible
minimally displaced fracture along the left lateral seventh rib.
|
19986744-RR-31 | 19,986,744 | 29,239,682 | RR | 31 | 2132-04-03 11:22:00 | 2132-04-03 13:57:00 | INDICATION: Fall onto left shoulder and arm. Pain.
TECHNIQUE: Three views of the left shoulder and two additional views of the
left forearm.
COMPARISON: Correlation with radiographs dated ___.
FINDINGS: No acute fracture or dislocation is seen. There are degenerative
changes at the acromioclavicular joint as well as spur formation at the
glenoid and in the region of the supraspinatus tendon.
IMPRESSION: No acute fracture or dislocation.
|
19986744-RR-32 | 19,986,744 | 29,239,682 | RR | 32 | 2132-04-03 10:37:00 | 2132-04-03 11:41:00 | INDICATION: ___ with fall and head injury.
TECHNIQUE: Axial CT images of the head were obtained. Coronal and sagittal
reformations were acquired.
COMPARISON: No comparison studies available.
FINDINGS:
There is no acute intracranial hemorrhage, edema, mass effect, or large acute
territorial infarction. The ventricles and sulci are normal in size and
configuration. There is moderate confluent hypodensity in the centra
semiovale and periventricular white matter, consistent with sequelae of
chronic small vessel ischemic disease. There are mild atherosclerotic
calcifications of the cavernous ICAs.
There is no calvarial or skull base fracture. The paranasal sinuses and
mastoid air cells are clear.
IMPRESSION: No acute intracranial process.
|
19987152-RR-39 | 19,987,152 | 21,958,012 | RR | 39 | 2147-03-25 08:46:00 | 2147-03-25 11:29:00 | HISTORY: Peritoneal inclusion cyst, treated with percutaneous drainage,
presenting for sclerotherapy.
COMPARISON: CT from ___.
FINDINGS:
After risks, benefits, alternatives and procedure were explained to the
patient and written informed consent was obtained. From the patient was
brought to the angiography suite and placed supine on the angiography table.
General anesthesia was induced. Time out was performed per hospital protocol.
Initial scout image demonstrated percutaneous drain in the pelvis and
appropriate position. Slow injection of 20 cc of the diluted contrast
material showed opacification of fluid in the cul-de-sac and contrast flowing
along the left colic gutter, consistent with communication of peritoneal
inclusion cyst with peritoneum. Therefore a decision was made not to perform
sclerotherapy. The injected fluid was aspirated. The percutaneous drainage
catheter was cut and removed. Sterile dressings were applied at the site.
Patient tolerated procedure well. No immediate complications were noted.
IMPRESSION:
Communication of peritoneal inclusion cyst with peritoneum. Sclerotherapy was
not performed. Percutaneous drainage catheter was removed.
|
19987152-RR-40 | 19,987,152 | 24,973,631 | RR | 40 | 2147-04-01 18:01:00 | 2147-04-02 08:28:00 | HISTORY: Abdominal pain. Evaluate for improvement of pelvic fluid
collection. Patient has history of total colectomy with ileoanal pouch
formation.
TECHNIQUE: Multiplanar T1- and T2-weighted images were performed on a 1.5
Tesla magnet per MRE protocol. Imaging was performed before and after
uneventful administration of 7 cc of Gadavist IV contrast material. The
patient received intramuscular injection of glucagon prior to the procedure
and drank 900 cc of VoLumen prior to the procedure as well.
COMPARISON: CT abdomen and pelvis from ___. MRE from ___.
MR ABDOMEN:
Patient is post proctocolectomy. There is no wall thickening or abnormal
enhancement within the loops of small bowel, which are normal in caliber. A
right lower quadrant ileostomy has the expected appearance. There is normal
enhancement of the liver, adrenal glands, pancreas, spleen, and kidneys.
MR PELVIS:
Within the pelvis is a rim-enhancing T2 dark T1 bright circumscribed area
measuring 1.8 x 3.4 cm, smaller than on prior CT and is consistent with a
right ovarian hemorrhagic follicle. In the pre-sacral space is a small amount
of fluid with septations but not a circumferential defined wall, slightly
increased in amount from prior CT when drain was in place. There is no
abnormal enhancement associated with this fluid. Uterus is normal in
appearance as is the left ovary. Urinary bladder is normal.
IMPRESSION:
1. Decreased size of lesion in the deep right pelvis, compatible with a
hemorrhagic ovarian cyst.
2. Small adjacent fluid in the pre-sacral space with septations, slightly
larger than on prior CT when the drainage catheter was in place.
3. Normal small bowel and ileostomy post proctocolectomy.
|
19987152-RR-48 | 19,987,152 | 26,069,092 | RR | 48 | 2147-10-13 14:43:00 | 2147-10-13 16:50:00 | HISTORY: ___ female with peritoneal inclusion cyst. Repeat
sclerotherapy requested.
COMPARISON: MRI of the pelvis ___, ultrasound of the pelvis ___, and prior sclerotherapy ___
CLINICIANS: Dr. ___ (attending physician) and Dr. ___
(fellow). The attending was present throughtout the entirety of the
procedure.
Anesthesia: General anesthesia was provided for the duration of the
procedure. 1% lidocaine was used for local anesthesia. Bupivacaine was also
injected into the peritoneal inclusion cyst for local anesthesia.
Radiation: 15mGy
Fluoro: 9min
Contrast: 65cc Optiray
PROCEDURE:
1. Wire disruption of peritoneal inclusion cyst loculations.
2. Sclerotherapy of peritoneal inclusion cyst using 30 mg of ETOH.
FINDINGS:
The procedure was discussed in detail with the patient and risks and benefits
emphasized. Informed written consent was obtained.
When the patient arrived in the angiography suite, they were placed prone on
the procedure table and anesthesia was induced. The right lower back /buttock
was prepped and draped in usual sterile fashion. A preprocedural time out was
performed per ___ protocol.
The existing drain was cracked and removed under fluoroscopic guidance using a
___ wire. A new 10 ___ multi side hole pigtail drain was inserted into
the peritoneal inclusion cyst, crossing midline. Approximately 120 cc of
saline containing 25% Optiray was injected into the peritoneal inclusion cyst.
Several focal regions of pooled contrast was visualized. The peritoneal cyst
appeared larger in size than previous sclerotherapy session and also has
multiple pockets.
At this time the saline/ contrast mixture was aspirated and the ___ wire
was used for disruption of the peritoneal inclusion cyst loculations. This
was followed with injection of 30 cc bupivacaine which was aspirated out after
approximately 5 min. At this time 30 ml of 100% ETOH was injected into the
peritoneal inclusion cyst. The drain was capped with plans for uncapping in
approximately 2 hr.
A flexitrack was used to attach the drain to the skin. A sterile dressing was
applied. The patient left the department in stable condition. No
complications. Sign-out was given to the accepting team.
IMPRESSION:
Wire disruption of a peritoneal inclusion cyst loculations followed-by
sclerotherapy using ETOH.
|
19987152-RR-50 | 19,987,152 | 26,069,092 | RR | 50 | 2147-10-06 14:01:00 | 2147-10-06 15:24:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with ulcerative colitis s/p total colectomy,
ileostomy,failed J-pouch s/p take-down, recurrent pelvic seromas with JP drain
in placevia R buttock. Awaits ___ sclerotherapy today. // Seroma size?
TECHNIQUE: Transvesical and endovaginal grayscale sonographic images of the
pelvis were obtained with color Doppler imaging.
COMPARISON: CT ___
FINDINGS:
Sonographic assessment of the pelvis was performed with transvesical and
endovaginal images obtained. The right trans gluteal drain is seen in the
posterior cul-de-sac. There is a small residual fluid collection measuring
3.7 x 0.4 cm, with some wall thickening around the collection. The drain is
positioned within the collection.
The uterus is anteverted. 1.8 cm dominant follicle is incidentally noted in
the left ovary. The right ovary is unremarkable.
IMPRESSION:
Small residual fluid collection in the posterior cul-de-sac measuring 3.7 x
0.4 cm, with drainage catheter in situ
|
19987152-RR-51 | 19,987,152 | 26,069,092 | RR | 51 | 2147-10-07 11:29:00 | 2147-10-07 17:19:00 | INDICATION: Recurrent peritoneal inclusion cyst, presenting for sclerotherapy.
OPERATORS: Dr ___ and Dr ___ (attending radiologists).
ANESTHESIA: MAC anesthesia was provided by anesthesiology department.
PROCEDURE: After risks, benefits, alternatives and procedure were explained to
the patient a written informed consent was obtained. Patient was brought to
angiography suite. Anesthesia was induced. The right buttock was prepped and
draped in the usual fashion. Time out was performed per ___ protocol.
50cc of diluted contrast was instilled within the peritoneal inclusion cyst
through the existent catheter. No free spill of contrast was seen. It was
noted that the catheter hub was cracked, therefore prior to proceeding further
the catheter was exchanged to a new ___ ___ catheter over ___ wire. The
contrast was then aspirated and 40cc of 100% alcohol with 5cc of Omnipaque
were introduced through the catheter into the cyst. Patient experienced mild
discomfort despite MAC anesthesia. The catheter was capped.
The patient was transferred to PACU in stable condition.
IMPRESSION: Technically successful sclerotherapy of the peritoneal inclusion
cyst with 40cc of alcohol. The fluid will be aspirated in 2 hours and then the
drain will be connected to drain under gravity. The drain should remain in
place for 2 weeks at which time we will reevaluate need for additional
sclerotherapy vs. removal of the drain.
|
19987152-RR-52 | 19,987,152 | 26,069,092 | RR | 52 | 2147-10-11 15:50:00 | 2147-10-11 17:07:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: History of ulcerative colitis, s/p colectomy, with recurrent
pelvic seromas, now with increased pain and serosanguinous drainage from
transgluteal drain. Evaluate for interval change.
TECHNIQUE: Grayscale and Doppler ultrasound images of the pelvis were
obtained with a transabdominal approach followed by a transvaginal approach.
COMPARISON: Pelvic ultrasound from ___. CT abdomen and pelvis from
___.
FINDINGS:
The fluid and debris containing collection within the cul de sac is increased
in size compared to the prior ultrasound from ___, measuring up to
8.0 x 4.7 x 8.4 cm on today's exam. The quantity of clot within this
collection appears to have increased. A segment of the transgluteal drainage
catheter courses through the collection, although the tip of the catheter is
not definitively visible. Limited assessment of the uterus is unremarkable.
IMPRESSION:
Increased size of 8.4 cm fluid and debris containing collection in the cul de
sac. The transgluteal drainage catheter courses within the collection,
although the position of its tip is difficult to evaluate sonographically.
Precise localization of the tip position would require evaluation with CT.
|
19987152-RR-53 | 19,987,152 | 26,069,092 | RR | 53 | 2147-10-12 21:59:00 | 2147-10-13 10:46:00 | INDICATION: ___ woman with history of ulcerative colitis, status post
proctocolectomy, removal of the J-pouch with ileostomy, bilateral ovarian
cystectomies complicated by peritoneal inclusion cyst, status post
percutaneous drainage catheter placement and sclerotherapy on ___, is
here for followup evaluation.
COMPARISON: Multiple prior studies including MRI pelvis, ___, CT abdomen
and pelvis, ___, pelvic ultrasound, ___, sclerotherapy
procedure, ___.
TECHNIQUE: Multiplanar T1- and T2-weighted MR images of the pelvis were
performed in a 1.5 Tesla magnet including dynamic 3D imaging obtained prior
to, during, and after uneventful intravenous administration of 7 mL of
Gadavist.
FINDINGS: Multiloculated T2 hyperintense, T1 hypointense cystic lesion in the
cul-de-sac, extending to the left hemipelvis, encasing the left ovary, now
measures 4.1 (CC) x 5.4 (AP) x 3.8 (TR) cm and has enlarged since ___.
Comparable measurements in prior studies are as follows: 8.3 x 8.9 x 6.9 cm
on ___ MRI; 4.9 x 2.1 x 3.8 cm on ___ CT study. This collection
now appears slightly more complex, containing a few thin non-enhancing
internal pseudoseptations/fibrous bands. Small locules of air are seen within
the non-dependent portion of this collection. Right transgluteal approach
percutaneous drainage catheter terminates in the collection, as before. There
is increased enhancement of the thickened walls lining the collection,
reflecting reactive changes from recent sclerotherapy procedure and presence
of drainage catheter. A new 3.1-cm cyst with hemorrhage is seen in the left
ovary (12:20). The right ovary is normal. The uterus is anteverted and
anteflexed, measuring 8.0 x 4.9 x 5.2 cm. Lower uterine segment C-section scar
is noted. The endometrium is normal, measuring 8 mm. The patient is status
post proctocolectomy with right lower quadrant ileostomy. The remainder of
the bowel loops are unremarkable. Small amount of fluid is seen within the
vagina, without evidence for a fistula. Again seen is somewhat heterogeneous
marrow signal throughout the imaged pelvic bones, without focal lesions. The
pelvic vasculature is patent.
IMPRESSION:
Multiloculated pelvic peritoneal inclusion cyst larger since ___, now has
hyperenhancing walls, likely reflecting changes of recent intervention and
presence of a drainage catheter.
|
19987152-RR-54 | 19,987,152 | 26,069,092 | RR | 54 | 2147-10-13 22:20:00 | 2147-10-14 00:09:00 | INDICATION: Peritoneal inclusion cyst status post ___ sclerotherapy on
___, now with vaginal discharge. Evaluate for fluid collection within
the vagina and uterus.
COMPARISON: Ultrasound ___, MRI ___.
LMP: Three weeks ago.
FINDINGS: Transabdominal and transvaginal ultrasounds were performed, the
latter for further evaluation of the endometrium and adnexa.
The uterus is 9.9 x 4.4 x 5.9 cm. A cesarean section scar is seen anteriorly.
No other uterine wall defect is seen. The endometrium is normal measuring 7
mm. Trace fluid is seen within the endometrial canal. There is no fluid
within the cervical canal.
The right ovary is normal, measuring 2.7 x 1.4 x 3.1 cm. The left ovary is
possibly visualized and measures 3.3 x 1.7 cm (image 23). There is no
hydrosalpinx. No free fluid is seen in the pelvis.
A 6.4 x 3.7 cm complex fluid collection posterior to the uterus (image 27) is
smaller (previously 8.0 x 4.7cm) and more organized with a decreased fluid
component compared to ___.
IMPRESSION:
1. No large intrauterine fluid collection; small amount of fluid in
endometrial cavity is nonspecific. No hydrosalpinx.
2. No uterine defect is sonographically evident other than the cesarean
section scar.
3. Interval decrease in size of complex collection posterior to the uterus.
The findings were discussed with the patient upon study completion.
Additionally, Dr. ___ the findings with Dr. ___ by phone
at 11:55 p.m. on ___.
|
19987152-RR-55 | 19,987,152 | 26,069,092 | RR | 55 | 2147-10-21 10:29:00 | 2147-10-21 16:30:00 | EXAMINATION: Pelvic MRI.
INDICATION: ___ year old woman with peritoneal inclusion cysts s/p transluteal
drain andsclerotherapy x2 // Cyst size? Location? Interval change?
COMPARISON: MR and CT examinations available from ___ through ___.
TECHNIQUE: T1 and T2 weighted multiplanar images of the pelvis were acquired
within a 1.5 Tesla magnet, including 3D dynamic sequences performed prior to,
during, and following the administration of 6 mL of Gadavist intravenous
contrast.
FINDINGS:
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
A right transgluteal catheter terminates within a multiloculated presacral
collection, currently measuring up to 3.9 x 2.1 cm axially (series 4 image
21), overall markedly smaller since the MR examination from ___.
Mild rim enhancement is minimally changed (series 11 image 37). A small
amount of gas within the collection is increased, denoted by blooming
susceptibility artifacts (series 6 image 49).
Trace left adnexal free fluid is present (series 4 image 18). The ovaries and
uterus are normal. There is no intrapelvic lymphadenopathy.
Hemosiderin deposits scattered throughout the anterior pelvic wall denotes
prior laparotomy (series 6 image 42). The patient is post proctocolectomy
with a right lower quadrant ileostomy (series 4 image 6). Intrapelvic loops
of small bowel are within normal limits.
There are no bony lesions concerning for malignancy or infection.
IMPRESSION:
Marked decrease in size of a peritoneal inclusion cyst since the ___
MRI reflecting reponse from recent sclerotherapy. A 3.9 x 2.1 cm presacral
multi-loculated collection remains, with a portion communicating with a right
transgluteal drain. A small amount of gas within the collection has increased
since the prior examination.
|
19987152-RR-56 | 19,987,152 | 26,069,092 | RR | 56 | 2147-10-23 18:39:00 | 2147-10-23 23:21:00 | HISTORY: Pelvic fluid collection with fistulization to fallopian tube now
status post removal of ___ drain.
COMPARISON: ___ pelvis MRI.
FINDINGS:
Transabdominal and transvaginal ultrasound examinations were performed, the
latter to further assess the endometrium, adnexa, and previously seen fluid
collection.
The uterus is normal, measuring 8.4 x 4.4 x 5.3 cm. The endometrium contains
a small amount of fluid and measures 5 mm. The ovaries are normal with normal
vascular waveforms. A 1.5 cm anechoic physiologic cyst is seen in the left
ovary. Complex fluid is present in the vaginal canal.
Small loculated fluid is present posterior to the cervix. The total
___ of the previously seen pelvic fluid collection is difficult to
measure due to overlying bowel gas but appear smaller compared to ___.
IMPRESSION:
1. Small pelvic fluid collection has decreased since ___.
2. Complex fluid in the vaginal canal.
3. Tiny amount of fluid within the endometrium. Otherwise, normal uterus and
ovaries.
|
19987152-RR-57 | 19,987,152 | 26,069,092 | RR | 57 | 2147-10-27 13:25:00 | 2147-10-27 15:12:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with peritoneal inclusion cyst. Evaluate for
change.
TECHNIQUE: Grayscale and Doppler ultrasound images of the pelvis were
obtained with transabdominal approach followed by transvaginal approach for
further delineation of uterine anatomy.
COMPARISON: MR ___ dated ___ as well as Ultrasound dated ___.
FINDINGS:
Posterior to the cervix is again identified complex partially solid and
partially cystic fluid collection which measures approximately 4.3 x 2.1 cm,
largely unchanged since most recent ultrasound dated ___. No new
fluid collection is identified.
The uterus is unremarkable measuring 8.9 x 4.7 x 5.5 cm. The ovaries are
normal in size with a 1.5 cm anechoic physiologic cyst within the left ovary
unchanged since prior examination. Complex fluid is present in the vaginal
canal with an unremarkable cervix.
IMPRESSION:
1. Unchanged complex fluid collection posterior to the cervix, stable in size
since ___, allowing for differences in imaging modalities. No new
fluid collection is detected.
2. Normal appearing uterus and ovaries with small physiologic cyst
redemonstrated within the left ovary.
NOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___
telephone at 15:00 on ___ at the time the study was reviewed.
|
19987482-RR-13 | 19,987,482 | 25,440,790 | RR | 13 | 2147-12-15 00:48:00 | 2147-12-15 01:16:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with fever// infection
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided.
No focal consolidation. No pleural effusion or pneumothorax.
Cardiomediastinal silhouette is within normal limits.
IMPRESSION:
No acute intrathoracic process.
|
19987482-RR-14 | 19,987,482 | 25,440,790 | RR | 14 | 2147-12-15 14:06:00 | 2147-12-15 16:45:00 | EXAMINATION: MRI of the Pelvis
INDICATION: ___ year old woman with 3 weeks of vaginal bleeding and abdominal
pain, c/f dilated tubular structure within the left adnexa, suggesting
possible hemosalpinx vs hydrosalpinx on imaging, need MRI to further
evaluate// Please evaluate for hemosalpinx vs hydrosalpinx
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: 5 mL Gadavist.
COMPARISON: Pelvic ultrasound from ___
FINDINGS:
UTERUS AND ADNEXA:
The uterus has an unicornuate morphology with a left rudimentary non
communicating horn.
The right lateral horn is unremarkable with normal appearing endometrium and
cervix.
The left rudimentary horn contains a 2.3 x 3.5 cm non enhancing fluid
collection in the endometrial cavity demonstrating isointense T2 signal,
mildly hyperintense T1 signal suggestive of hemorrhagic component.
There is a large tubular serpiginous structure in the pelvis measuring up to
8.7 x 7.4 cm containing hyperintense T1 nonenhancing signal suggestive of a
hematosalpinx.
There are also bilateral subcentimeter endometriomas in the adnexa which are
otherwise unremarkable.
Multiple punctate hyperintense T1 foci are seen throughout the pelvic located
around the anterior and posterior horns of the uterus as well as posteriorly
in the cul-de-sac suggestive of endometrial implants. There is also thickened
of the posterior ligament of the uterus suggestive of deep endometriosis.
LYMPH NODES: No adenopathy.
BLADDER: Unremarkable. The left kidney is not visualized.
RECTUM AND INTRAPELVIC BOWEL: Unremarkable.
VASCULATURE: Unremarkable.
OSSEOUS STRUCTURES AND SOFT TISSUES: Unremarkable.
IMPRESSION:
1. The uterus has an unicornuate morphology with a left rudimentary
noncommunicating horn containing blood products.
2. Pelvic endometriosis with a large hematosalpinx.
3. The left kidney is not visualized on this evaluation. It's presence could
be confirmed by abdominal ultrasound.
|
19987482-RR-16 | 19,987,482 | 25,440,790 | RR | 16 | 2147-12-17 12:00:00 | 2147-12-17 13:32:00 | EXAMINATION: US INTRA-OP ___ MINS
INDICATION: ___ year old woman with hematometra// Intraoperative US guidance
TECHNIQUE: Laparoscopic intraoperative ultrasound
FINDINGS:
Intraoperative ultrasound was to enter the uterine horn on the right. Again
seen is a noncommunicating left uterine horn with fluid debris level
compatible with hematometra. The large a hematosalpinx is again visualized
but not assessed on today's study..
IMPRESSION:
OR guidance allowed entry into the uterine horn on the right but not into the
noncommunicating uterine horn on the left.
|
19987702-RR-19 | 19,987,702 | 27,149,559 | RR | 19 | 2131-06-02 10:30:00 | 2131-06-02 13:41:00 | EXAMINATION:
ULTRASOUND GUIDED ABSCESS DRAINAGE
INDICATION: ___ yo s/p open cholecystectomy for choledocolithiasis ___ p/w
ED dehydrated and with ??abd wall abscess// ___ year old man with likely
infected hematoma of abdominal wall at site of open cholecystectomy incision
(surgery ___
COMPARISON: CT abdomen and pelvis from ___.
PROCEDURE: Ultrasound-guided drainage of superficial right abdominal
collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection in the right
abdominal wall. Based on the ultrasound findings an appropriate skin entry
site for the drain placement was chosen. The site was marked. Local
anesthesia was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, ___ Exodus drainage catheter was
advanced via trocar technique into the collection. A sample of fluid was
aspirated, confirming catheter position within the collection. The pigtail
was deployed. The position of the pigtail was confirmed within the collection
via ultrasound.
Approximately 75 cc of pus was drained with a sample sent for microbiology
evaluation. The catheter was secured by a StatLock. The catheter was attached
to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 8
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
A loculated fluid collection is seen in the right anterior abdominal wall, the
largest component measures approximately 6.1 x 3.5 cm. This pocket was
localized for drain placement.
IMPRESSION:
Successful US-guided placement of ___ pigtail catheter into the right
abdominal wall collection. Sample was sent for microbiology evaluation.
|
19988077-RR-13 | 19,988,077 | 28,414,691 | RR | 13 | 2140-05-03 13:29:00 | 2140-05-03 16:30:00 | REASON FOR EXAMINATION: Progressive dysphagia, suspected laryngeal cancer ,
attempted esophageal dilatation, please evaluate for pneumomediastinum.
AP radiograph of the chest was reviewed with no prior studies available for
comparison.
Heart size is normal. Mediastinum is normal. There is no evidence of
pneumomediastinum or pneumothorax within the limitations of the study
technique. Bibasal opacities are present and unclear if represent atelectasis
or aspiration. Some contribution to this appearance is done by the low lung
volumes, although they cannot explain the entire extent of bibasal
opacifications. There is no appreciable pleural effusion noted.
|
19988077-RR-15 | 19,988,077 | 28,414,691 | RR | 15 | 2140-05-06 15:44:00 | 2140-05-06 17:44:00 | EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old man with dysphagia // Is this dysphagia or
aspiration?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. Aspiration with swallowing thin liquids, nectar thick liquids,
and honey thick liquids was demonstrated. There was a penetration with puree.
IMPRESSION:
There was aspiration with liquids, nectar thick liquids, and honey thick
liquids. Penetration with puree was demonstrated.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19988077-RR-16 | 19,988,077 | 28,414,691 | RR | 16 | 2140-05-03 15:30:00 | 2140-05-03 18:23:00 | CT CHEST
REASON FOR EXAM: Progressive dysphagia and known pharyngeal tumor.
There are no prior studies available for comparison.
The neck portion is evaluated by a concurrent neck CT.
TECHNIQUE: Multidetector CT through the chest was acquired after
administration of IV contrast. Images were displayed in axial, coronal and
sagittal reformations.
FINDINGS: Secretions are present in the right side of the lower trachea.
Mediastinal lymph nodes measure 10 mm right upper paratracheal station, 5 mm
prevascular station, 10 mm lower paratracheal station, 8 mm in the left hilum,
9 mm subcarinal station. There is no pericardial effusion. Moderate
calcifications are present in all coronary arteries. Main pulmonary artery is
minimally enlarged, measuring 32 mm, could represent pulmonary hypertension.
Lung nodules are as follows: In the right upper lobe 2 mm (4, 54), 6 mm (4,
65), several more medial nodules right upper lobe (4, 66), spiculated 9 mm (4,
79), 1 mm (4, 86), 3 mm (4, 90, 95, 98), in the right lower lobe (4:143, 179).
Peribronchial ground glass and centrilobular soft tissue nodular opacities in
the right middle lobe more extensive than in the lingula or the left lower
lobe are most likely infectious in etiology. They could also represent
aspiration. There is a large area of peribronchial consolidation in the left
lower lobe medially, also infectious in etiology. Multifocal areas of
atelectasis are seen throughout the lower lobes bilaterally and right middle
lobe.
This examination is not tailored for subdiaphragmatic evaluation. Stranding
of the mesenteric fat, mild ascites. Splenomegaly measuring at least 21 mm.
Incompletely imaged hypodense cortical lesion in the upper pole of the right
kidney. There are multiple subcentimeter periceliac lymph nodes. These
findings are incompletely evaluated by the non-dedicated incomplete upper
abdomen.
There are no bone findings of malignancy.
IMPRESSION: Multifocal peribronchial, centrilobular and ___ opacities
in the right middle lobe, lingula and larger consolidation in the left lower
lobe are multifocal pneumonia, could be due to aspiration. Followup is
recommended.
Other more focal irregular soft tissue nodules described are of unclear
etiology, could be infectious, but metastases cannot be excluded.
Coronary calcification.
Enlarged main pulmonary artery suggests pulmonary hypertension.
Findings in the abdomen in keeping with patient known cirrhosis.
Findings were discussed by Dr ___ on the phone with Dr. ___ at 5:10
p.m. ___. 15 min after discovery of the finding
|
19988077-RR-17 | 19,988,077 | 28,414,691 | RR | 17 | 2140-05-03 15:30:00 | 2140-05-03 18:36:00 | EXAMINATION: CT neck with contrast
INDICATION: ___ year old man with progressive dysphagia with documented
posterior pharyngeal tumor. // How advanced is the lesion in the posterior
pharynx?
TECHNIQUE: Non contrast CT axial images of the cervical spine were obtained.
Sagittal and coronal reconstructions were performed.
DOSE: DLP: 412.83 mGy-cm; CTDI: 12 mGy
COMPARISON: None
FINDINGS:
There is a circumferential mass there is supraglottic, glottic and subglottic
of consistent with known laryngeal cancer. There are no prior images for
comparison. The esophagus looks normal there is no evidence of rupture. There
is no evidence of malignant adenopathy. The tumor erodes the hyoid bone.
There is bilateral pulmonary atelectasis which may be due to aspiration.
There is pleural thickening versus fluid collection on the left.
IMPRESSION:
Supraglottic glottic and subglottic circumferential mass consistent with known
laryngeal cancer.
|
19988077-RR-18 | 19,988,077 | 28,414,691 | RR | 18 | 2140-05-07 12:00:00 | 2140-05-07 13:25:00 | HISTORY: Pre-operative.
FINDINGS: In comparison with the study of ___, there are better lung
volumes. No evidence of vascular congestion or pleural effusion. Dense
streak of atelectasis is seen in the left mid zone. No evidence of acute
focal pneumonia.
|
19988077-RR-19 | 19,988,077 | 28,414,691 | RR | 19 | 2140-05-07 13:30:00 | 2140-05-07 16:54:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ gentleman with cirrhosis; evaluate for ascites.
TECHNIQUE: Grey scale and color ultrasound images of the abdomen were
obtained.
COMPARISON: CT chest with contrast performed on ___.
FINDINGS:
LIVER: The liver is nodular with heterogeneous echotexture consistent with
known history of cirrhosis. There is no focal liver mass. The main portal
vein is patent with hepatopetal flow. There is trace ascites, mostly
perihepatic, perisplenic, and in the right lower quadran. There is no obvious
pleural fluid.
BILE DUCTS: There is no intrahepatic or extrahepatic biliary dilation. The CBD
measures 0.6 cm.
GALLBLADDER: Biliary sludge is visualized in the lumen of the gallbladder.
There is no gallbladder distention or wall-thickening. There is no
pericholecystic fluid. No shadowing gallstones are visualized, although some
echogenic foci that could represent gravel are seen.
PANCREAS: Overlying bowel gas limits visualization of the pancreas. The
visualized portions of the head, body, and tail of the pancreas are within
normal limits.
SPLEEN: The spleen is enlarged, measuring 18.3 cm, slightly smaller than on
prior CT chest on ___.
KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 11.3 cm.
No hydronephrosis is seen in either kidney.
RETROPERITONEUM: The visualized portions of the abdominal aorta are of normal
caliber, and the visualized portion of the IVC is within normal limits.
IMPRESSION:
1. Nodular, heterogeneous echotexture liver that is consistent with known
cirrhosis. No concerning liver lesions identified.
2. Trace ascites.
3. Stable splenomegaly.
4. Gallbladder sludge and/or gravel without evidence of cholecystitis.
|
19988077-RR-21 | 19,988,077 | 28,414,691 | RR | 21 | 2140-05-10 16:29:00 | 2140-05-10 20:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p tracheostomy, direct laryngoscopy //
rule out pneumothorax, pneumediastinum rule out pneumothorax,
pneumediastinum
IMPRESSION:
In comparison with the study of ___, there has been placement of a
tracheostomy that appears well seated with no evidence of complication. The
atelectatic streaks in the left mid zone is less prominent on the current
study.
|
19988077-RR-22 | 19,988,077 | 28,414,691 | RR | 22 | 2140-05-12 10:19:00 | 2140-05-12 11:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with elevated WBC, productive cough //
pneumonia? pneumonia?
IMPRESSION:
In comparison with the study of ___, there is little overall change. Again
there is some increased opacification at the left base. This is most likely
representing atelectasis. However, in the appropriate clinical setting,
superimposed pneumonia would have to be considered.
|
19988077-RR-23 | 19,988,077 | 28,414,691 | RR | 23 | 2140-05-13 08:52:00 | 2140-05-13 09:31:00 | PORTABLE CHEST, ___.
COMPARISON: ___.
FINDINGS: Lung volumes remain low. Cardiomediastinal contours are stable.
Interval improvement in extent of bibasilar atelectasis. Persistent small
left pleural effusion. Questionable ascites accounting for diffuse haziness
of imaged upper abdomen.
|
19988077-RR-24 | 19,988,077 | 28,414,691 | RR | 24 | 2140-05-13 11:22:00 | 2140-05-13 17:11:00 | INDICATION:
___ year old man with fever,s high WBC // perforation?
COMPARISON: None available.
FINDINGS:
Enteric contrast is visible in the nondilated colon throughout. Bowel gas
pattern is nonobstructive. Contrast outlines diverticula of the distal colon.
There is no pneumoperitoneum.
IMPRESSION:
No evidence of pneumoperitoneum.
|
19988077-RR-25 | 19,988,077 | 28,414,691 | RR | 25 | 2140-05-13 22:43:00 | 2140-05-13 23:47:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with new septic shock after PEG placement on ___
and abdominal pain. // ?leak from PEG, intra-abdominal abscess or explanation
for abdominal pain.
TECHNIQUE: Multiple contiguous slices were obtained from the lung bases to
pubic symphysis after the adminstration of 130 cc of Omnipaque contrast via
power injection. Oral contrast was also administered.
COMPARISON: Ultrasound of the abdomen from ___.
FINDINGS:
Lower Thorax: There is a focus of atelectasis in the left lower lobe.There is
no cardiomegaly.
Peritoneal Cavity: There is a small amount of pneumoperitoneum likely related
to recent procedure. There is a mild to moderate amount of ascites with no
focal rim enhancing collection to suggest intra-abdominal abscess.
Liver: The liver is mildly nodular in contour in keeping with known cirrhosis.
Gallbladder and Biliary System: There is mild pericholecystic fluid or
gallbladder wall thickening with no gallbladder wall distention, likely
related to known chronic liver disease.There is no significant intra or
extrahepatic biliary ductal dilatation.
Pancreas: The pancreas is normal in size with no focal lesion, ductal
dilatation or calcifications.
Spleen: There is splenomegaly up to 18.4 cm with no focal splenic lesion.
Kidneys and Adrenals: There is a 10 mm hypodensity in the upper pole of the
right kidney that is too small to characterize but may represent a small
cyst.The kidneys and adrenal glands are otherwise normal bilaterally.
Bowel: There is a gastrostomy tube in the antrum of the stomach with small
adjacent foci of air and no contrast leakage. In the left lower quadrant there
is a fistulous tract extending from small bowel towards a skin communication
in the left lateral abdominal wall representing the known enterocutaneous
fistula. There is colonic diverticulosis and no evidence of bowel obstruction.
Lymph Nodes: There is no significant mesenteric or retroperitoneal
lymphadenopathy.
Vessels: There are splenic varices and recanalization of the paraumbilical
vein in keeping with known cirrhosis and portal hypertension.
Bones: The osseous structures are unremarkable and there is no suspicious bone
lesion.
IMPRESSION:
1. Status post PEG tube insertion with expected minimal pneumoperitoneum and
no focal collection or contrast leak.
2. Cirrhotic liver with splenomegaly and varices related to portal
hypertension.
3. Known enterocutaneous fistula in the left lower quadrant.
4. Atelectasis in the left lower lobe.
|
19988077-RR-27 | 19,988,077 | 28,414,691 | RR | 27 | 2140-05-15 17:00:00 | 2140-05-16 09:23:00 | REASON FOR EXAMINATION: Esophageal stricture, right PICC line placed.
AP radiograph of the chest was reviewed in comparison to ___.
The right PICC line tip is at the level of low SVC. Heart size and
mediastinum are stable. Bibasal areas of atelectasis are re-demonstrated,
overall unchanged since the prior study. There is no evidence of pulmonary
edema. Tracheostomy is in place.
|
19988077-RR-28 | 19,988,077 | 28,414,691 | RR | 28 | 2140-05-20 09:10:00 | 2140-05-20 10:28:00 | INDICATION: Cirrhosis and peritonitis, requiring diagnostic paracentesis for
further evaluation.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: None.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
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 was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant. Diagnostic samples were requested by the clinician and sent to
the lab as per request. An additional 1 L of straw-colored fluid was removed
to reduce the chance of post-procedural leakage.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___, the attending radiologist, was present throughout the critical
portions of the procedure.
IMPRESSION:
Uneventful ultrasound guided diagnostic and therapeutic paracentesis with
extraction of 1 L of fluid.
|
19988632-RR-15 | 19,988,632 | 21,153,934 | RR | 15 | 2182-05-21 05:25:00 | 2182-05-21 07:02:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ with gsw to hand // foreign body
TECHNIQUE: Three views the right hand.
COMPARISON: None.
FINDINGS:
There is a comminuted fracture the base of the first metacarpal with adjacent
soft tissue defect consistent with gunshot wound tract. Comminuted fractures
of the small and ring finger metacarpal heads are also noted. Multiple bony
fragments are seen adjacent to the base of the thumb and metacarpal head
fractures as well as along the dorsum of the hand. No radiopaque metallic
density foreign body present. Subcutaneous emphysema and soft tissue edema is
most prominent at the radial aspect of the hand.
IMPRESSION:
1. Comminuted fractures of the base of the first metacarpal and small and ring
finger metacarpal heads with numerous bony fragments and soft tissue gas/edema
in keeping with gunshot wound.
2. No metallic density radiopaque foreign objects.
|
19988669-RR-10 | 19,988,669 | 28,672,431 | RR | 10 | 2156-07-25 06:42:00 | 2156-07-25 07:18:00 | INDICATION: History of bicycle accident, deep puncture to the left anterior
shin. Please evaluate for fracture.
COMPARISONS: None.
TECHNIQUE: Left tib-fib two views, left ankle two views.
FINDINGS: There is a linear ossific density overlying the posterior margin of
the fibula. Note is also made of mild periosteal reaction along the lateral
margin of the distal tibia. There is extensive soft tissue swelling overlying
the proximal tibia with no evidence of soft tissue air. No focal lytic or
sclerotic lesions are seen. No soft tissue calcification or radiopaque
foreign bodies are identified.
IMPRESSION:
1. Linear density along the posterior margin of the tibia may be secondary to
an old trauma. No definite acute fracture is identified.
2. Irregularity along the lateral cortex of the distal tibia is incompletely
evaluated on this exam, however also likely secondary to an old trauma.
|
19988669-RR-12 | 19,988,669 | 28,672,431 | RR | 12 | 2156-07-26 11:21:00 | 2156-07-26 12:16:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with CT to WS at 7 AM // Please eval for Fox,
interval change at 11 AM
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Small right apical pneumothorax is unchanged. Right chest tube is in unchanged
position. Cardiomediastinal contours are normal. Bibasilar opacities have
increased consistent with worsening atelectasis or aspiration there is no
pleural effusion.
IMPRESSION:
Stable small right pneumothorax
Increased bibasilar opacities could be due to atelectasis and or aspiration
|
19988669-RR-13 | 19,988,669 | 28,672,431 | RR | 13 | 2156-07-27 10:36:00 | 2156-07-27 14:02:00 | EXAMINATION: CHEST (SINGLE VIEW) IN O.R.CHEST (SINGLE VIEW) IN O.R.i
INDICATION: ___ year old male bicycle vs MVC, +EtOH, unknown LOC, unknown
helmet p/w R PTX, L ortbital wall fx, L zygomatic fx, b/l nasal bone fx,
maxillary sinus fx // interval change PTX. please get 1 view PA ___ AM
COMPARISON: Chest radiograph ___
IMPRESSION:
Small right apical pneumothorax is smaller, right pleural drain in place.
Subcutaneous emphysema persists in the right chest wall traversed by the tube.
No appreciable pleural effusion. Lungs grossly clear. Normal cardiomediastinal
silhouette.
|
19988669-RR-14 | 19,988,669 | 28,672,431 | RR | 14 | 2156-07-27 17:22:00 | 2156-07-28 09:33:00 | REASON FOR EXAMINATION: Right chest tube placed on the waterseal.
PA and lateral radiographs of the chest were reviewed in comparison to ___.
The right chest tube is in place. The right apical pneumothorax is small.
Heart size and mediastinum are stable. The left costophrenic angle linear
opacity is unchanged. Heart size and mediastinum are stable.
|
19988669-RR-15 | 19,988,669 | 28,672,431 | RR | 15 | 2156-07-28 10:55:00 | 2156-07-28 13:41:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with CT to WS // Please eval interval change
COMPARISON: ___, 05:39
IMPRESSION:
As compared to the previous radiograph, the extent of the pre-existing
millimetric right apical pneumothorax is not substantially changed. There is
no evidence of tension. The right chest tube is in unchanged position.
Moderate cardiomegaly persists. No pulmonary edema.
|
19988669-RR-16 | 19,988,669 | 28,672,431 | RR | 16 | 2156-07-29 09:00:00 | 2156-07-29 09:36:00 | INDICATION: Right pneumothorax, status post chest tube, evaluate if stable.
COMPARISON: Chest radiograph on ___.
FINDINGS: PA and lateral views of the chest. The small right apical
pneumothorax is unchanged. There is a possible small left apical
pneumothorax, difficult to appreciate on prior studies. Lungs are otherwise
clear. No pleural effusion. The cardiomediastinal and hilar contours are
normal.
IMPRESSION: Small right apical pneumothorax is unchanged compared to ___ at 11:12 a.m. Possible small left apical pneumothorax, difficult to
appreciate on prior studies, attention on follow up.
These findings were discussed with Dr. ___ by Dr. ___ at 1013am on
___ by phone at time of discovery.
|
19988669-RR-18 | 19,988,669 | 28,672,431 | RR | 18 | 2156-07-29 13:31:00 | 2156-07-29 14:31:00 | INDICATION: Status post MVC, known right pneumothorax, question of new left
pneumothorax.
COMPARISON: ___ at 9:18 a.m.
FINDINGS: PA and lateral views of the chest. Again seen is a small right
apical pneumothorax, unchanged. There is no evidence of pneumothorax on the
left. No focal consolidation or pleural effusion. Cardiomediastinal and
hilar contours are normal.
IMPRESSION: Unchanged small right apical pneumothorax. No evidence of
pneumothorax on the left.
|
19988669-RR-9 | 19,988,669 | 28,672,431 | RR | 9 | 2156-07-25 06:22:00 | 2156-07-25 07:25:00 | INDICATION: History of bike accident. Please evaluate chest tube.
COMPARISONS: Radiograph from ___ and chest CT from ___.
TECHNIQUE: Portable supine radiograph of the chest.
FINDINGS: There is a small right-sided pneumothorax with a chest tube
traversing medially and terminating along the right mediastinal border. The
heart size is mildly enlarged. There is mild pulmonary vascular congestion.
Note is made of subcutaneous emphysema along the right lateral chest wall.
Increased opacities at the mid right lung, is likely secondary to aspiration.
No acute fracture is identified. The left lung aside from mild pulmonary
vascular congestion is otherwise clear. There is no large pleural effusion.
IMPRESSION:
1. Chest tube in appropriate position with small right-sided pneumothorax.
2. Increased opacities at the mid right lung is likely secondary to
aspiration. Continued close interval follow up is recommended.
|
19988951-RR-32 | 19,988,951 | 28,202,516 | RR | 32 | 2168-06-06 12:23:00 | 2168-06-06 12:58:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with Jaw and arm pain, hx of 14 stents // Edema
TECHNIQUE: Chest PA and lateral
COMPARISON: None
IMPRESSION:
Lungs are clear. Heart size is normal. There is no pleural effusion. No
pneumothorax is seen. No evidence of pneumonia. Coronary stents are seen
|
19988997-RR-15 | 19,988,997 | 29,807,937 | RR | 15 | 2174-06-27 16:36:00 | 2174-06-27 18:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NSTEMI// pulmonary edema
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ outside hospital chest radiograph
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
No evidence of pulmonary edema. The size of the cardiac silhouette is mildly
enlarged when compared to prior.
IMPRESSION:
No evidence of pulmonary edema. Mildly enlarged cardiac silhouette when
compared to prior.
|
19989126-RR-13 | 19,989,126 | 22,853,928 | RR | 13 | 2149-08-05 19:15:00 | 2149-08-05 19:58:00 | HISTORY: Subarachnoid hemorrhage, intubated.
TECHNIQUE: Supine AP view of the chest.
COMPARISON: None.
FINDINGS:
Endotracheal tube tip terminates approximately 4 cm from the carina.
Orogastric tube tip courses below the diaphragm, off the inferior borders of
the film. The heart size is normal. The mediastinal and hilar contours are
unremarkable. The lungs are clear and the pulmonary vascularity is normal.
No pleural effusion or pneumothorax is present. No acute osseous abnormality
seen.
IMPRESSION:
Endotracheal tube and orogastric tube in standard positions. No acute
cardiopulmonary abnormality.
|
19989126-RR-15 | 19,989,126 | 22,853,928 | RR | 15 | 2149-08-05 20:16:00 | 2149-08-06 14:24:00 | ANGIO REPORT
DIAGNOSIS: Intraventricular hemorrhage from ___ disease status post
right ___ bypass.
ATTENDING: ___.
ANESTHESIA: General.
INDICATIONS: The patient had presented with a hemorrhage and had distal
aneurysms on a previous angiogram, therefore I elected to do the
above-mentioned procedure.
PROCEDURES PERFORMED: Left vertebral artery arteriogram, right common carotid
artery arteriogram, left common carotid artery arteriogram, right common
femoral artery arteriogram.
DETAILS OF PROCEDURE: The patient was brought to the angiography suite.
Anesthesia was induced in the supine position. Following this, both groins
were prepped and draped in a sterile fashion. Right common femoral artery
access was gained using Seldinger technique with some difficulty. Following
this, the above-mentioned vessels were catheterized and AP and lateral filming
done. This revealed that there were no aneurysms or definite cause for the
hemorrhage other than dilated collateral vessels. We therefore decided that
no further intervention was required.
Left vertebral artery arteriogram shows filling of the left vertebral artery
with both PCAs filling. There are multiple collaterals to the left hemisphere
supplying the anterior circulation. The two aneurysms seen on the arteriogram
from ___ are no longer apparent. There is also a posterior meningeal artery
which also richly collateralizes the posterior circulation.
Right common carotid artery arteriogram shows that the right internal carotid
artery is occluded in the supraclinoid segment. There is a superficial
temporal artery bypass into the middle cerebral artery which has maintained
its patency and has formed rich collaterals and supplies the right hemisphere.
Left common carotid artery arteriogram shows filling of the left external
carotid artery and its branches. The left internal carotid artery fills well
along the cervical, petrous, cavernous portion. The supraclinoid portion is
seen to be stenotic. The posterior communicating artery is patent and the
middle cerebral artery is patent, but there is stenosis and multiple
___-like vessels.
Right common femoral artery arteriogram shows a very diminutive right common
femoral artery.
IMPRESSION:
___ underwent cerebral angiography. This revealed occlusion of the
right internal carotid artery and significant stenosis of the left middle
cerebral artery and supraclinoid internal carotid artery. However, the bypass
which has been done previously supplies the right hemisphere. The distal
aneurysms seen on the previous right vertebral artery injections are now no
longer apparent,
|
19989126-RR-16 | 19,989,126 | 22,853,928 | RR | 16 | 2149-08-05 20:17:00 | 2149-08-05 23:32:00 | INDICATION: ___ female with subarachnoid hemorrhage status post drain
placement, evaluate for progression or bleed.
COMPARISON: CT of the head from ___ dated ___
at 17:23.
TECHNIQUE: Contiguous axial sections are obtained through the brain without
administration of IV contrast. Coronal and sagittal reformations were
provided and reviewed.
FINDINGS: There is a large amount of intraventricular blood, which appears to
be unchanged in quantity from prior. Blood is seen within all ventricles and
exiting via the foramen of Luschka. The patient is status post bilateral
ventricular drain placements via frontal approaches. The right drain
terminates within the left frontal horn of the lateral ventricle near the
foramen of ___. The left drain terminates within the right frontal horn of
the lateral ventricle. There is diffuse subarachnoid hemorrhage, with the
amount seen in the frontal sulci bilaterally slightly increased from prior.
Subarachnoid blood is seen along the path of the ventricular drains, as well
as adjacent pneumocephalus. A new focus of subarachnoid hemorrhage is seen
within the left parietal lobe (2:20). A small amount of air, as expected, is
seen within the right frontal horn of the lateral ventricle. The size of the
ventricles appears unchanged from prior study. There is no shift of midline
structures. Slight effacement of the sulci of the occipital lobes as well as
effacement of the basal cisterns is present. Low lying cerebellar tonsils is
concerning for herniation. The ___ appears to be hypodense, possibly
secondary to edema. The imaged paranasal sinuses and mastoid air cells are
well aerated. A craniotomy is seen within the right parietal bone.
IMPRESSION:
1. No change in extensive intraventricular blood, status post bilateral
ventricular drain placements.
2. Effacement of the basal cisterns and sulci of the occipital lobe. Low
lying cerebellar tonsils is concerning for herniation, unchanged from prior
study.
3. Diffuse subarachnoid hemorrhage, slightly increased from prior.
4. Expected pneumocephalus.
5. Hypodense ___ be reflective of edema.
|
19989126-RR-17 | 19,989,126 | 22,853,928 | RR | 17 | 2149-08-06 00:11:00 | 2149-08-06 13:21:00 | PORTABLE AP CHEST FILM, ___ AT 12:26 A.M.
CLINICAL INDICATION: Placement of orogastric tube, evaluate location.
Comparison is made to the patient's previous study dated ___ at 19:20.
A portable supine chest film, ___ at 12:26 is submitted.
IMPRESSION:
1. Nasogastric tube courses below the diaphragm with its tip coiled likely
within the stomach. An endotracheal tube remains in place in satisfactory
position. The lungs are well inflated without evidence of focal airspace
consolidation, pleural effusions, or pneumothorax. Overall, cardiac and
mediastinal contours are within normal limits.
|
19989126-RR-18 | 19,989,126 | 22,853,928 | RR | 18 | 2149-08-08 07:54:00 | 2149-08-08 10:43:00 | CLINICAL HISTORY: ___ year old woman with ___ status post bypass surgery
with worsening headache.
COMPARISON: CT head ___ from ___ ___ from
___ CT head ___ MRI ___
TECHNIQUE: Non-contrast MDCT axial images were acquired through the head
portable. The portion of the study was reported due to motion artifact.
FINDINGS: The study is limited by patient motion. Since ___, there has
been interval decrease in ventricular size. Intraventricular blood is also
decreased, particularly in the right lateral and fourth ventricles. The
basilar cisterns are no longer effaced. Bifrontal approach ventriculostomy
catheters are unchanged in position with the left catheter ending in the body
of the right lateral ventricle and the right frontal approach catheter ending
in the superior third ventricle. No new hemorrhage is identified.
Subarachnoid hemorrhage is no longer seen, compatible with evolution of blood
products. Pneumocephalus has resolved. No new hemorrhage is seen. The
patient is status post right temporal craniotomy for bypass surgery. There is
no shift of normally midline structures. Gray-white matter differentiation is
preserved. The visualized paranasal sinuses and mastoid air cells are clear.
IMPRESSION:
1. Interval improvement in hydrocephalus and intraventricular hemorrhage. No
new hemorrhage.
2. Unchanged position of bifrontal approach EVDs.
3. Subarachnoid hemorrhage is no longer visualized, compatible with evolution
of blood products. Pneumocephalus resolved.
|
19989126-RR-19 | 19,989,126 | 22,853,928 | RR | 19 | 2149-08-10 12:59:00 | 2149-08-10 15:24:00 | STUDY: AP chest, ___.
CLINICAL HISTORY: ___ woman with new PICC line placement.
FINDINGS: Comparison is made to the previous study from ___.
There has been removal of the chest tube since the previous study. There is a
new right-sided PICC line with distal lead tip at the distal SVC. The lungs
are clear. Heart size is within normal limits. There are no pneumothoraces.
Bony structures are intact.
|
19989126-RR-20 | 19,989,126 | 22,853,928 | RR | 20 | 2149-08-11 17:20:00 | 2149-08-12 09:37:00 | CHEST RADIOGRAPH
INDICATION: Intraventricular bleed, right PICC line, assessment for
pneumothorax.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the right PICC line is
completely removed. There is no evidence of pneumothorax. Otherwise, normal
chest radiograph.
|
19989126-RR-21 | 19,989,126 | 22,853,928 | RR | 21 | 2149-08-12 10:28:00 | 2149-08-12 13:53:00 | INDICATION: ___ woman with bilateral EVDs, left clamped, evaluate for
hydrocephalus.
COMPARISON: CT head without contrast ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
the administration of IV contrast.
FINDINGS: The study is limited by patient motion with some images repeated.
The bifrontal approach ventriculostomy catheters are unchanged in position
with the left catheter ending in the body of the right ventricle and the right
catheter appearing to terminate within the superior third ventricle. No new
foci of hemorrhage are identified. The ventricular blood is decreased since
most recent prior examination with layering blood noted within the left atria
as well as within the right occipital horn. Subarachnoid hemorrhage is no
longer visualized compatible with evolution of blood products. There is no
evidence of pneumocephalus. The patient is status post right temporal
craniotomy for bypass surgery. There is no shift of normally midline
structures. There is no evidence of acute major vascular territory infarction
within limitations of severely motion-degraded study. Bilateral mastoid air
cells and visualized paranasal sinuses are clear.
IMPRESSION:
1. Interval evolution of blood products with improvement in intraventricular
hemorrhage and no significant change in size of ventricles.
2. Unchanged position of bifrontal approach EVDs.
|
19989126-RR-22 | 19,989,126 | 22,853,928 | RR | 22 | 2149-08-14 09:52:00 | 2149-08-14 11:28:00 | INDICATION: ___ woman with intraventricular hemorrhage, please
evaluate for hydrocephalus.
TECHNIQUE:
Images of the head were obtained.
COMPARISON: CT head from ___.
FINDINGS:
In the interval, the left frontal approach EVD has been removed. The right
EVD unchanged with the tip at the foramen of ___. There is new small amount
of air in the frontal horn of the right lateral ventricle and moderate amount
of new air in the temporal horn of the right lateral ventricle. Allowing for
the air distended right temporal horn, the ventricular size is unchanged.
There is no shift of midline structures. The amount of intraventricular
hemorrhage continues to decrease with especially decreased hemorrhage in the
right occipital horn. No new intracranial hemorrhage. Redemonstrated a right
temporoparietal craniotomy defect.
There is a small amount of subarachnoid hemorrhage in the posterior right
frontal lobe and the right parietal lobe (series 2, image 24, 225, 222). This
is more conspicuous on the prior exam and was likely present on the most
recent study from ___ (retrospectively on series 2B, image 45).
There is no acute fracture and there are no suspicious lytic or sclerotic bony
lesions. The paranasal sinuses and mastoids are clear.
IMPRESSION:
Interval removal of a left frontal approach EVD with post-procedural small
amount of air in the right frontal horn and moderate amount of air in the
right temporal horn.
1. Allowing for the new air in the ventricular system, the right lateral
ventricle is unchanged and there is no evidence of hydrocephalus or new mass
effect.
2. Right frontoparietal subarachnoid hemorrhage is stable-more conspicuous on
prior exam from ___- attention on f/u.
|
19989126-RR-23 | 19,989,126 | 22,853,928 | RR | 23 | 2149-08-15 00:48:00 | 2149-08-15 10:17:00 | HISTORY: Fever.
FINDINGS: In comparison with the study of ___, there is no change or evidence
of acute cardiopulmonary disease. Specifically, no pneumonia, vascular
congestion, or pleural effusion.
|
19989126-RR-24 | 19,989,126 | 22,853,928 | RR | 24 | 2149-08-15 08:56:00 | 2149-08-15 12:37:00 | REASON FOR EXAMINATION: PICC line placement.
AP radiograph of the chest was reviewed with comparison to ___
obtained at 00:54 a.m.
Right PICC line has been inserted with the tip at the level of mid SVC. Heart
size and mediastinum are unremarkable. Lungs are essentially clear.
|
19989126-RR-25 | 19,989,126 | 22,853,928 | RR | 25 | 2149-08-15 12:48:00 | 2149-08-16 13:55:00 | INDICATION: ___ woman with intraventricular bleed and right-sided
extraventricular drain, presenting with acute onset abdominal pain.
TECHNIQUE: A single portable supine abdominal radiograph was obtained.
COMPARISONS: None.
FINDINGS: Air is seen throughout non-distended loops of small and large
bowel. There is moderate amount of dense stool throughout colon, particularly
at the cecum. No evidence of pneumoperitoneum on this single supine film.
Osseous structures are unremarkable.
IMPRESSION: Non-obstructive bowel gas pattern.
|
19989126-RR-26 | 19,989,126 | 22,853,928 | RR | 26 | 2149-08-17 15:15:00 | 2149-08-18 12:11:00 | HEAD CT
INDICATION: Status post revision of EVD, evaluation of EVD placement.
TECHNIQUE: Contiguous CT images obtained through the brain without
administration of IV contrast.
COMPARISON: CT head performed ___, and CT head performed ___.
FINDINGS: There is an EVD seen passing through a right frontal burr hole
coursing into the right frontal lobe through the anterior horn of the right
lateral ventricle, crossing the midline and ending near the genu of the left
internal capsule and anteromedial portion of the thalamus. There is
hemorrhage seen bilaterally in the occipital horns of the lateral ventricles.
The amount of blood in the lateral ventricles is unchanged compared to prior
study. There is air in the right anterior temporal horn, most likely related
to the recent procedure.
There is a burr hole in the left frontal bone most likely from previous
procedure.
There is no evidence of infarction. There is no shift of normally midline
structures. The basal cisterns appear patent and there is no evidence of
hydrocephalus. Compared to prior study, there is decreased air in the
temporal horn of the right lateral ventricle. The visualized paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The globes are
unremarkable.
CONCLUSION: Status post revision of EVD. Increased air in frontal horn of
the lateral ventricle. Decreased air in the temporal horn of the right
lateral ventricle. Small amount of blood seen in the bilateral occipital
horns of the lateral ventricle is unchanged compared to prior study. No
evidence of hydrocephalus. No evidence of new hemorrhage.
|
19989126-RR-27 | 19,989,126 | 22,853,928 | RR | 27 | 2149-08-21 04:49:00 | 2149-08-21 05:43:00 | INDICATION: Post-clamping of ___.
COMPARISON: CT available from ___.
TECHNIQUE: MDCT-acquired 5-mm axial images of the head were obtained without
the use of IV contrast.
FINDINGS:
The patient is post right middle craniotomy. A right frontal approach
ventriculostomy catheter terminates at the level of the third ventricle, with
the tip to the left side in the parenchyma, unchanged. In comparison to the
___ examination, there has been interval decrease in the amount of
gas within the right lateral ventricle (2:12). Trace blood is again seen
within the occipital horn of the left lateral ventricle. Previously seen
blood products within the occipital horn of the right lateral ventricle have
resolved. No superimposed acute hemorrhage, mass effect, or large vascular
territorial infarction is seen. The middle ear cavities, mastoid air cells,
included views of the paranasal sinuses remain clear.
IMPRESSION: Decrease in right lateral ventricular gas and decreased
intraventricular blood. Unchanged position of a right frontal approach
ventriculostomy catheter in the parenchyma adjacent to the left side of third
ventricle. Correlate clinically if this is the desired position. No new
acute hemorrhage is detected.
|
19989126-RR-28 | 19,989,126 | 22,853,928 | RR | 28 | 2149-08-21 17:18:00 | 2149-08-22 09:17:00 | PORTABLE AP CHEST X-RAY
INDICATION: Patient with new fever. Assess for pulmonary pathology.
COMPARISON: ___.
FINDINGS:
The lungs are clear. There is no evidence of pneumonia. The right-sided PICC
line is in adequate position in the upper portion of the SVC. The mediastinal
and cardiac contours are within normal limits. There is no pneumothorax and
no pleural effusion.
CONCLUSION:
There is no significant change since the previous exam. There is no evidence
of pneumonia.
|
19989126-RR-29 | 19,989,126 | 22,853,928 | RR | 29 | 2149-08-21 20:56:00 | 2149-08-22 02:44:00 | INDICATION: ___ woman with intraventricular hemorrhage, evaluate for
DVT.
COMPARISON: No relevant comparisons available.
FINDINGS:
The examination was limited due to patient cooperation. Gray-scale and
Doppler images of the bilateral common femoral, superficial femoral, popliteal
and proximal calf veins were obtained. Assessment of the peroneal calf veins
was limited. There is wall-to-wall flow with normal response to compression
and augmentation otherwise noted in all visible veins.
IMPRESSION:
Limited assessment of the peroneal calf veins bilaterally. Otherwise, no DVT
in either lower extremity.
|
19989126-RR-30 | 19,989,126 | 22,853,928 | RR | 30 | 2149-08-23 16:18:00 | 2149-08-24 09:35:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Assess line.
Right PICC tip is in the mid SVC. There is no pneumothorax.
Cardiomediastinal contours are normal. The lungs are clear. There is no
pleural effusion.
|
19989126-RR-31 | 19,989,126 | 22,853,928 | RR | 31 | 2149-08-25 07:09:00 | 2149-08-25 09:21:00 | CHEST RADIOGRAPH
INDICATION: Fever, rule out acute process.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. Normal size of the cardiac silhouette. No acute changes such as
pneumonia or pulmonary edema. No pleural effusions.
|
19989126-RR-32 | 19,989,126 | 22,853,928 | RR | 32 | 2149-08-25 13:33:00 | 2149-08-25 17:03:00 | CT HEAD WITHOUT IV CONTRAST
INDICATION: Evaluation for interval change of hydrocephalus after removal of
EVD.
TECHNIQUE: MDCT axial images were obtained through the brain at a slice
thickness of 5 mm without administration of IV contrast.
COMPARISON: NECT head performed on ___.
FINDINGS: The patient is status post removal of VP shunt located in the in
the parenchyma adjacent to the left side of the third ventricle. The shunt is
no longer visualized. Normal postsurgical changes are seen including
pneumocephalus in the temporal horn of the left lateral ventricle and the
frontal horn of the right lateral ventricle. There is no evidence of
transependymal migration of CSF to suggest hydrocephalus. The ventricles are
unchanged in size compared to prior studies.
There is no evidence of hemorrhage, edema, mass effect, or infarction. No
fracture is identified. The visualized paranasal sinuses exhibit slight
mucosal thickening. The mastoid air cells and middle ear cavities are clear.
The globes are unremarkable.
IMPRESSION: Status post removal of VP shunt. Normal postsurgical change. No
evidence of acute hemorrhage or findings to suggest hydrocephalus.
|
19989126-RR-34 | 19,989,126 | 21,824,927 | RR | 34 | 2155-01-31 01:37:00 | 2155-01-31 03:24:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD ___
INDICATION: ___ with ___, left IPH. Evaluate change in ICH.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion 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.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 73.5 mGy (Head) DLP =
36.8 mGy-cm.
3) Spiral Acquisition 2.8 s, 22.2 cm; CTDIvol = 30.2 mGy (Head) DLP = 672.3
mGy-cm.
Total DLP (Head) = 1,512 mGy-cm.
COMPARISON: CT head ___.
___ outside noncontrast head CT.
FINDINGS:
CT HEAD:
Craniotomy changes are seen along the right temporoparietal cortex. There is
an acute 1.2 cm intraparenchymal hemorrhage in the left medial temporal lobe
with surrounding vasogenic edema (02:13). Additionally, there is
intraventricular decompression with blood seen layering in the occipital horns
of the lateral ventricles, left greater than right (02:15). There is no
midline shift. Grossly stable left basal ganglia probable calcification is
again noted (see 02:13 on current study and 02:12 on prior exam).
There is mild prominence of the ventricles and sulci, grossly unchanged
compared to ___ prior exam. Chronic hypodensities noted along the right
frontal lobe white matter in the vicinity of a prior external ventricular
drain placement. There is no evidence for large vascular territorial
infarction.
The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.
The orbits are grossly unremarkable bilaterally.
CTA HEAD:
The patient is status post a superior temporal-middle cerebral artery bypass
on the right, better assessed on recent cerebral angiogram.
There is narrowing of the petrous, supraclinoid, and paraclinoid portions of
the right internal carotid artery. The terminal portion of the right ICA is
not discretely visualized.
There is extensive narrowing of multiple vessels involving the circle of
___ including bilateral M1 segments, A1 segments, and right PCOM arteries.
The left PCOM artery remains patent. Multiple collateral lenticulostriate
vessels are noted, with a "puff of smoke" appearance, all of which are
compatible with the patient's known diagnosis of moyamoya. The posterior
circulation appears patent and, overall, less affected. Bilateral visualized
portion of V3 segments are patent. Bilateral V4 segments are patent. The
basilar artery is patent. Bilateral SCA is are visualized. Bilateral P1
segments are visualized. Infundibulum is noted at the right P1-P2 junction.
Focal nonocclusive narrowing of the right distal P2 segment is noted.
Bilateral P2 and P3 segments are otherwise grossly patent.
IMPRESSION:
1. Postsurgical changes following prior right temporoparietal craniotomy with
right STA-MCA bypass.
2. Grossly stable acute, intraparenchymal hemorrhage within the left medial
temporal lobe with associated intraventricular decompression and mild local
vasogenic edema, without definite midline shift.
3. Intraventricular hemorrhage as described. Allowing for difference
technique, slightly increased compared to recent prior outside exam.
4. No additional site of hemorrhage.
5. No evidence for vascular territorial infarction. Please note MRI of the
brain is more sensitive for the detection of acute infarct.
6. Diffusely irregular and narrowed intra cerebral vasculature, as detailed
above, most prominently affecting the bilateral M1 and A1 segments with
associated lenticulostriate collateral formation, compatible with patient's
provided history of moyamoya.
7. Moderate narrowing of the right petrous, paraclinoid, and supraclinoid ICA,
with near complete occlusion of the terminal right ICA.
8. Right distal P2 segment nonocclusive stenosis.
|
19989126-RR-35 | 19,989,126 | 21,824,927 | RR | 35 | 2155-01-31 08:00:00 | 2155-01-31 10:09:00 | EXAMINATION: Right common carotid artery angiogram.
Left common carotid artery angiogram.
Left vertebral angiogram.
Right common femoral are them.
INDICATION: ___ year old woman with known ___ s/p right EDAS and
previous 3mm right vert aneurysm x 2 that was resolved on f/u. presents for
left occipital IPH/IVH// eval of collateral circulation/stenosis and eval for
aneurysm
ANESTHESIA: No sedation was provided. The total intra service time of 40
minutes during which the patient's hemodynamic parameters were continuously
monitored by an independent nurse.
TECHNIQUE: 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. Under ultrasound
guidance, Micropuncture kit was used to gain access to the right femoral
artery, serial dilation was undertaken until a short 5 ___ groin sheath
connected to a continuous heparinized saline flush could be inserted. Next, a
___ 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 right common carotid artery.
AP, oblique and lateral views of the anterior cerebral circulation were
obtained .
Catheter was then pulled back in the aorta and used to select the left common
carotid artery. AP, oblique and lateral views of the anterior cerebral
circulation were obtained. The catheter was then pulled back in the aorta and
the left subclavian artery was selected. AP and lateral road map imaging was
undertaken. Next, the left vertebral artery was selected. AP and lateral
views were taken from this vessel for the posterior cerebral circulation. 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 5 ___ Mynx was put in. At the conclusion of the procedure,
there is no evidence of thromboembolic complication and the patient was at his
neurologic baseline.
All angio runs were medically necessary for baseline assessment and for future
comparison.
COMPARISON: None.
PROCEDURE: Diagnostic cerebral angiogram.
FINDINGS:
Right common carotid artery: Carotid bifurcations well-visualized. There is
no significant atherosclerosis or carotid stenosis.
Right internal carotid artery: Occlusion of the intracranial ICA pass the
ophthalmic segment with ___ vessels. Compatible with ___ stage 5.
Robust STA to MCA bypass with filling of the MCA territory and some
collateralization to the ACA territory with leptomeningeal collaterals
supporting the MCA territory.
Left common carotid artery: Carotid bifurcations well-visualized. There is
no significant atherosclerosis or carotid stenosis.
Left internal carotid artery: Intensified moyamoya changes can battle with
___ stage III, with leptomeningeal anastomosis from bilateral middle
meningeal arteries and falx arteries. No aneurysms were observed.
Left vertebral artery , left ___, basilar artery, bilateral AICA, bilateral
SCA and bilateral PCAs are well-visualized. The right ___ is not well
visualized as there was no cross-filling to the right vertebral artery.
Contribution to the anterior circulation was observed via collaterals from
posterior choroidals, posterior callosal, posterior temporal and posterior
cerebral arteries. This is more pronounced on the left hemisphere. Corkscrew
appearance of some of the anastomotic junctions mainly at the posterior
choroidal and posterior callosal arteries. No aneurysms were observed.
Right common femoral artery: Well-visualized with a good caliber size for
closure device.
I, ___, 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:
Bilateral ___ disease, ___ stage III on the left side and stage 5 on
the right side.
Mature direct STA to MCA bypass on the right side with multiple left meningeal
and posterior circulation to anterior circulation anastomoses.
No aneurysms were identified.
RECOMMENDATION(S):
1. Management as per usual protocol.
|
19989126-RR-36 | 19,989,126 | 21,824,927 | RR | 36 | 2155-02-01 16:01:00 | 2155-02-01 16:45:00 | EXAMINATION: ART DUP EXT UP UNI OR LMTD RIGHT
INDICATION: ___ year old woman with Moyamoya disease s/p cerebral angiography
___ with induration at groin access site.// Assess for groin catheterization
site pseudoaneurysm
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right groin.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right groin. There is no pseudoaneurysm, arteriovenous malformation or
hematoma within the right groin on this targeted exam. The palpable nodule
within the right groin corresponds to a normal sized, normal appearing lymph
node with a fatty hilum.
IMPRESSION:
No pseudoaneurysm or hematoma within the right groin the site of palpable
swelling. Palpable nodule in the right groin corresponds to a normal sized,
normal appearing lymph node.
|
19989126-RR-37 | 19,989,126 | 21,824,927 | RR | 37 | 2155-02-03 10:50:00 | 2155-02-03 13:57:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with ___, left IPH/IVH, please eval for interval
change// Evaluate IVH/IPH
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 =
747.5 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: Noncontrast CT head ___.
FINDINGS:
The patient is status post right temporoparietal craniotomy. A 9 mm focus of
intraparenchymal hemorrhage is seen with in the left temporal lobe, slightly
decreased in size compared to prior, with mild surrounding edema. A small
amount of hemorrhage is seen layering within the left occipital horn of the
lateral ventricle, decreased compared to prior study. No significant midline
shift. A chronic infarct is seen in the right frontal lobe. There is no
evidence of acute infarctionor mass. The ventricles are stable in size
without evidence of hydrocephalus.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells. The visualized portion of the remaining paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
IMPRESSION:
1. Interval decrease in left intraparenchymal hemorrhage with mild
surrounding edema and interventricular extension. No definite midline shift.
Interval decrease in interventricular hemorrhage.
2. Chronic right frontal lobe infarct.
|
19989783-RR-12 | 19,989,783 | 22,784,678 | RR | 12 | 2128-06-18 09:34:00 | 2128-06-18 09:51:00 | INDICATION: History: ___ with weakness, ekg changes // eval for
consolidation
TECHNIQUE: Single portable upright chest radiograph
COMPARISON: Chest radiograph dated ___
FINDINGS:
Single portable AP upright chest radiograph demonstrate cardiomegaly, the size
of the heart which appears decreased in size relative to prior study performed
___. There is no evidence of pulmonary edema. There is no pleural
effusion or pneumothorax. Lungs are clear without a focal consolidation
convincing for pneumonia.
IMPRESSION:
Cardiomegaly without evidence of pulmonary edema. No evidence of pneumonia.
|
19989783-RR-13 | 19,989,783 | 22,784,678 | RR | 13 | 2128-06-21 08:44:00 | 2128-06-21 09:53:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with thrombocytopenia // please assess liver
parenchyma and spleen size
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT OF THE ABDOMEN PELVIS DATED ___
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened. The contour of the liver is
nodular. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 7 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 12.1 cm.
KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 10.9 cm.
2 parapelvic cysts are noted in the upper pole of the right kidney. Several
cysts are that are identified in the left kidney. The largest measures 3.6
cm. A 2.0 cm cyst is seen in the interpolar region on the left. A 4 cm cyst
is seen in the lower pole a 2.8 cm cyst is seen in the upper pole. Normal
cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Coarsened liver echotexture and nodular contour of the liver are
concerning for cirrhosis.
2. Multiple bilateral renal cysts
3. Normal size of spleen
|
19989783-RR-48 | 19,989,783 | 24,282,820 | RR | 48 | 2130-08-02 13:29:00 | 2130-08-02 13:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with dyspnea, c diff colitis, fever, cough// ?
pneumonia
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Tracheostomy and enteric tubes remain in standard positions. Right internal
jugular central venous tip terminates in the proximal right atrium. Cardiac
silhouette size is severely enlarged, a component of which reflects the
presence of a pericardial effusion as seen on the prior CT. The aorta is
tortuous. Central mediastinal venous distension and mild pulmonary vascular
engorgement is present. There are small to moderate-sized bilateral pleural
effusions, not substantially changed in the interval. Airspace opacities
within both lung bases may reflect compressive atelectasis. No pneumothorax
is detected. There are multilevel moderate to severe degenerative changes
seen in the thoracic spine.
IMPRESSION:
1. Cardiac silhouette size remains severely enlarged, likely reflecting a
combination of moderate cardiomegaly and moderate size pericardial effusion,
as seen on the prior CT.
2. Mild pulmonary vascular congestion with similar small to moderate-sized
bilateral pleural effusions.
3. Bibasilar airspace opacities likely reflect compressive atelectasis, with
pneumonia or aspiration not excluded in the correct clinical setting.
|
19989783-RR-49 | 19,989,783 | 24,282,820 | RR | 49 | 2130-08-02 22:07:00 | 2130-08-02 22:50:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old man with recent abdominal surgery, altered mental
status, elevated WBC, fever// eval for abscess or other infectious source
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 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 9.5 s, 1.0 cm; CTDIvol = 22.0 mGy (Body) DLP =
22.0 mGy-cm.
3) Spiral Acquisition 15.0 s, 51.5 cm; CTDIvol = 17.9 mGy (Body) DLP =
893.7 mGy-cm.
Total DLP (Body) = 930 mGy-cm.
COMPARISON: CT U from ___.
FINDINGS:
LOWER CHEST: Visualized lung fields demonstrate subsegmental atelectasis in
both lower lobes and the lingula and bilateral pleural effusions. There is
marked cardiomegaly. Partially imaged central catheter with its tip in the
right atrium..
ABDOMEN:
HEPATOBILIARY: The liver demonstrates heterogeneous parenchymal enhancement
throughout. There is mild periportal edema. There is no evidence of focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits. There is a moderate
amount of ascites.
PANCREAS: The pancreas has normal attenuation throughout, with mild prominence
of the pancreatic duct (measuring 5 mm) in the pancreatic head all the way to
the confluence with the CBD, not significantly changed compared to the prior
CT from ___.
SPLEEN: Surgically absent. There is a focal small fluid collection in the
operative bed measuring 3.2 x 2.3 cm showing internal intermediate to
hyperdense contents (39 ___ (series 5, image 40).
ADRENALS: The right and left adrenal glands are normal in size and shape.
KIDNEYS: Both kidneys are atrophic in appearance with cortical thinning and
show multiple cortical cysts. There is no hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable, distal end of a feeding tube is
seen in the proximal jejunum.. the small and large bowel loops are normal in
caliber. There is no evidence of bowel obstruction.
PELVIS: The urinary bladder is decompressed with thick walls, not
significantly changed compared to prior study from ___. There is a small
amount of free fluid in the pelvis. The visualized reproductive organs are
unremarkable. Again seen is an intermediate attenuation lesion above the
urinary bladder measuring approximately 3.0 x 2.0 cm, minimally larger
compared to the prior CT (series 5, image 74).
LYMPH NODES: There is a prominent left para-aortic lymph node measuring 1.1
cm, stable compared to prior.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. The portal vein and SMV are patent. The splenic vein is not seen.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Significant degenerative disc disease involving the entire lumbar spine and
the visualized portions of the thoracic spine.
SOFT TISSUES: There is evidence of bilateral gynecomastia. Diffuse
generalized anasarca.
IMPRESSION:
1. Status post splenectomy. Small intermediate attenuation area in the
operative bed measuring 3.2 cm may represent evolving postsurgical
changes/hematoma.
2. Moderate ascites. Bilateral pleural effusions and subsegmental
atelectasis. Generalized anasarca.
|
19989783-RR-50 | 19,989,783 | 24,282,820 | RR | 50 | 2130-08-02 23:13:00 | 2130-08-03 11:57:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cough// eval for pulmonary edema after IV
contrast load
TECHNIQUE: 2 frontal views of the chest
COMPARISON: 428
FINDINGS:
Support devices remain in place. Diffuse opacity at the left lung base which
may reflect moderate effusion is stable. Underlying infiltrate or atelectasis
at the left lung base is difficult to exclude due to presence of the left
effusion. Mild vascular congestion and mild edema, slightly increased. Right
costophrenic angle cut off the film, otherwise no pneumothorax in the
visualized areas.
Prominent cardiomegaly again noted.
IMPRESSION:
Mild edema now noted. Moderate left effusion stable. Underlying atelectasis
or infiltrate at the left lung base is difficult to exclude.
|
19989783-RR-51 | 19,989,783 | 24,282,820 | RR | 51 | 2130-08-04 09:51:00 | 2130-08-04 17:42:00 | INDICATION: ___ with NICM (EF 25% ___, CKD Stage III-IV (baseline Cr
3, eGFR 22), alcoholic cirrhosis who was found down at home 4 weeks ago,
hypotensive, +FAST s/p splenectomy scalp lac repair, postop course c/b
persistent vent dependence, renal failure on HD. Discharged to ___ two days
ago, readmitted yesterday with increased WBC and altered mental status. CT
abdomen/pelvis noted fluid in the splenectomy bed as well as ascites, concern
for SBP.// Obtain ascites sample prior to drain placement in splenectomy bed
TECHNIQUE: Ultrasound guided diagnostic paracentesis
COMPARISON: ___ abdominal CT
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: Consent was obtained through the ICU.
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 was instilled
for local anesthesia.
A 22 gauge needle was advanced into the largest fluid pocket in the left lower
quadrant under direct ultrasound guidance and 5 cc of clear yellow fluid were
removed. This was sent to the lab for requested analysis.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Successful ultrasound-guided diagnostic paracentesis with removal of 5 cc
clear yellow fluid which was sent for requested analysis.
|
19989918-RR-69 | 19,989,918 | 26,554,786 | RR | 69 | 2179-09-14 16:56:00 | 2179-09-14 18:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with seizure, pls r/o pna as cause for infection.
COMPARISON: ___.
FINDINGS:
AP portable supine view of the chest. Vagal nerve stimulator projects over
the left chest wall with catheter extending to the left neck soft tissues,
unchanged. Heart size is mildly enlarged. Lung volumes are low. No overt signs
of pneumonia or edema. No large effusion or pneumothorax. The mediastinal
contour is stable. No acute osseous injuries.
IMPRESSION:
No acute intrathoracic process
|
19990072-RR-6 | 19,990,072 | 22,632,312 | RR | 6 | 2180-07-20 15:12:00 | 2180-07-20 15:53:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with fever, headache, meningismus, b/l lateral
nystgmus. Evaluate for space occupying lesion or bleeding.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 891 mGy-cm
CTDI: 55 mGy
COMPARISON: None.
FINDINGS:
There is no evidence of acute major vascular territorial infarction,
hemorrhage, edema, or large mass. The ventricles and sulci are normal in size
and configuration. The basal cisterns appear patent and there is preservation
of gray-white matter differentiation.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial process. Please note that MRI would be more sensitive
for subtle intracranial lesions.
|
19990072-RR-8 | 19,990,072 | 22,632,312 | RR | 8 | 2180-07-25 12:50:00 | 2180-07-25 14:26:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with aseptic meningitis, high fevers continue,
with ruq pain yesterday, now rlq pain today, ongoing high fevers. Please
perform pelvic ultrasound to assess for ovarian torsion or other pathology to
explain fevers, eval appendix if able also please (pt relatively thin).
Assess for pathology to explain fevers
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy. Spectral arterial and venous
Doppler was performed on the ovaries.
COMPARISON: None
FINDINGS:
The uterus is anteverted and measures 5.4 x 2.7 x 2.9 cm. The endometrium is
homogenous and measures 5 mm. The ovaries are normal. Normal spectral
arterial and venous waveforms are seen within the ovaries. There is a small
amount of free fluid.
IMPRESSION:
1. Normal uterus and ovaries. No evidence of ovarian torsion.
2. Small amount of free pelvic fluid is likely physiologic.
|
19990072-RR-9 | 19,990,072 | 22,632,312 | RR | 9 | 2180-07-25 12:50:00 | 2180-07-25 14:33:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with asceptic meningitis, high fevers continue,
with ruq pain yesterday, now rlq pain today, ongoing high fevers. Please
perform pelvic ultrasound r.o ovarian torsion, other pathology to explain
fevers, eval appendix if able also please (pt relatively thin). Assess
appendix, or gallstones.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
Punctate echogenic focus along the gastric fundus demonstrates ring down
artifact and is consistent with focal adenomyomatosis.
PANCREAS: Head, body and tail of the pancreas are within normal limits,
without masses or pancreatic ductal dilatation.
SPLEEN: Normal echogenicity, measuring 9.9 cm. A 1.2 x 1.0 1.1 cm accessory
spleen is present.
KIDNEYS: The kidneys are grossly unremarkable. No hydronephrosis or
obstructing stone.
RETROPERITONEUM: Visualized portions of the IVC are within normal limits.
OTHER: Targeted right lower quadrant ultrasound was unremarkable. The
appendix is not visualized. No focal fluid collection. A normal-appearing
lymph node was seen.
IMPRESSION:
1. Normal abdominal ultrasound.
2. Appendix not visualized.
|
19990106-RR-16 | 19,990,106 | 20,746,590 | RR | 16 | 2161-06-02 13:07:00 | 2161-06-02 15:28:00 | INDICATION: History: ___ with chest pain // acute process?
TECHNIQUE: Frontal and lateral chest radiographs were obtained with the
patient in the upright position.
COMPARISON: Chest radiographs from ___.
FINDINGS:
The lungs are clear of focal consolidation, pleural effusion or pneumothorax.
The heart size is normal. The mediastinal contours are normal.
IMPRESSION:
No acute cardiopulmonary process.
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19990106-RR-18 | 19,990,106 | 20,746,590 | RR | 18 | 2161-06-04 12:37:00 | 2161-06-04 17:41:00 | EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ year old man post PCI via right radial access.Short term
memory loss. no other neurological deficits. // intracranial hemorrhage
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast. Subsequently, rapid axial imaging was performed from the aortic arch
through the brain during infusion of Omnipaque intravenous contrast material.
Three dimensional images were generated on a separate workstation.
DOSE: DLP: 2405mGy-cm; CTDI: 135 mGy
COMPARISON: None available
FINDINGS:
Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or
infarction. The ventricles and sulci are normal in caliber and configuration.
No fractures are identified. There is mucosal thickening within the right
maxillary sinus and a small mucous retention cyst within the left maxillary
sinus. The remainder of the paranasal sinuses are clear. The mastoid air cells
are clear.
Head CTA: There is a severe stenosis of the superior division of the left MCA
just distal to the bifurcation. The remainder of the vessels are patent
without evidence of stenosis or occlusion. No aneurysms are detected. A right
fetal type PCA is noted.
Neck CTA: Imaging of the neck reveals no evidence of arterial stenosis or
occlusion. There is no evidence of internal carotid artery stenosis by NASCET
criteria. The distal right internal carotid artery measures 4.8 mm in
diameter. The distal left internal carotid artery measures 4.8 mm in diameter.
IMPRESSION:
1. Unremarkable noncontrast CT scan of the head.
2. Severe stenosis of the superior division of the left MCA
3. Unremarkable CTA of the neck
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19990141-RR-30 | 19,990,141 | 24,852,269 | RR | 30 | 2133-03-04 10:32:00 | 2133-03-04 11:27:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with to follow up on superficial clot seen at
outside hospital. Pt. will have report. // ___ year old man with to follow up
on superficial clot seen at outside hospital. Pt. will have report.
Known clot in the greater saphenous vein
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is noncompressibility and abnormal echogenic signal within the majority
of the greater saphenous vein imaged from its proximal origin off of the
common femoral vein to the level of the distal calf. A small amount of
thrombus is seen extending into the distal most aspect of the common femoral
vein at the greater saphenous vein origin. The common femoral vein is also
incompletely compressible at this level.
There is normal compressibility, flow, and augmentation of the right 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:
There is thrombosis of the majority of the greater saphenous vein from its
origin to the level of the distal calf with extension into the common femoral
vein at the greater saphenous vein origin, compatible with superficial and
deep venous thrombosis.
NOTIFICATION: The findings were discussed with ___, medical
assistant for the ordering physician ___, M.D. by ___,
M.D. on the telephone on ___ at 11:22 AM, 10 minutes after discovery of
the findings.
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19990141-RR-31 | 19,990,141 | 24,852,269 | RR | 31 | 2133-03-04 16:24:00 | 2133-03-04 16:53:00 | INDICATION: ___ w/pleuritic CP, DVT please eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 351 mGy-cm.
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
The thoracic aorta is patent and normal in caliber. There is mild
atherosclerotic plaque along the medial wall of the mid thoracic aorta. There
is no evidence of penetrating atherosclerotic ulcer or aortic arch atheroma
present.
There are multiple subsegmental filling defects involving the left lower lobe
(2:68 - 76). Within the left lower lobe, there is focal airspace opacity
concerning for early pulmonary infarct. Additionally, there filling defects
within pulmonary veins the right lower lobe (2:76) and left lower lobe (2:73).
The main pulmonary arteries are normal caliber, with no evidence of central
thrombus.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is a small intermediate
density left pleural effusion.
The major airways are patent. There is mild compressive atelectasis adjacent
to the left lung base pleural effusion. Mild dependent atelectasis is noted
along the posterior aspect of the right lung. There is no evidence of
pneumonia.
Limited images of the upper abdomen demonstrate hypodensities within the
liver, the largest measuring 1.3 cm, unchanged from a prior CT from ___,
likely cysts and/or biliary hamartomas.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Subsegmental pulmonary emboli involving the left lower lobe with probable
left lower lobe infarct.
2. Filling defects within subsegmental pulmonary veins in the right and left
lower lobes.
3. Intermediate density small left pleural effusion.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 4:52 ___, 3 minutes after
discovery of the findings.
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19990366-RR-10 | 19,990,366 | 24,092,667 | RR | 10 | 2133-08-08 05:52:00 | 2133-08-08 08:38:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with hypoxia evaluation// Evaluate for hypoxia
TECHNIQUE: Semi upright AP view of the chest
COMPARISON: No relevant comparison identified.
FINDINGS:
Consolidation in the left lower lung field, with meniscal shaped, is
consistent with moderate pleural effusion alongside associated atelectasis.
Remaining left lung is clear. Right lung is clear of focal consolidation.
There is no right pleural effusion. There is mild pulmonary vascular
congestion without frank pulmonary edema. No pneumothorax is seen.
Cardiomediastinal silhouette is enlarged.
Density projecting just above the aortic arch, toward the left glenoid is of
unknown etiology and may be external to the patient in the absence of a
lateral view.
IMPRESSION:
1. Mild pulmonary vascular congestion without frank pulmonary edema.
2. Consolidation in the left lower lung field, consistent with moderate left
pleural effusion alongside associated atelectasis. Remaining left lung is
clear. Right lung is free of consolidation
3. Density projecting above the aortic arch is of unknown etiology. Recommend
clinical correlation.
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19990366-RR-11 | 19,990,366 | 24,092,667 | RR | 11 | 2133-08-09 08:10:00 | 2133-08-09 11:12:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: DMII, hypertension, and remote colon cancer who presented with
atraumatic back pain and found to have T-spine fracture, incidentally found to
have a new pleural effusion in her left lung not visualized on prior records.
Concern for Parapneumonic effusion vs. CHF. Trial of diuresis on 7.31//
interval change in pleural effusion
TECHNIQUE: Portable frontal plain film radiograph of the chest.
COMPARISON: Frontal plain-film radiograph the chest dated ___.
FINDINGS:
Lungs are well expanded. The cardiac silhouette is enlarged, but unchanged
since prior radiograph. The mediastinum is notable for significant vascular
calcifications of the aorta. There has been improvement of pulmonary vascular
congestion and resolution of the left-sided pleural effusion. There is no
focal consolidation or pneumothorax. There are unchanged severe degenerative
changes of the bilateral shoulders and deformity of the right humeral head.
IMPRESSION:
Interval improvement of pulmonary vascular congestion and resolution of the
left-sided pleural effusion.
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19990545-RR-20 | 19,990,545 | 23,106,222 | RR | 20 | 2139-10-05 08:17:00 | 2139-10-05 09:22:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ w/ epigastric pain, transaminitis, RUQ U/S c/w acute
cholecystitis // ?acute cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None available on our PACS system for review
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. Geographic areas of relative hypo echogenicity
are seen within the hepatic parenchyma, in subcapsular location about the
porta hepatis, consistent with sparing from steatosis. The main portal vein
is patent with hepatopetal flow. There is no ascites. Trace right pleural
effusion.
BILE DUCTS: There is no intrahepatic biliary dilation. However, a stone is
seen within the common bile duct. The periampullary portion of the duct is
suboptimally visualized. The CBD measures 4 mm.
GALLBLADDER: The gallbladder contains multiple mobile stones and a small
amount of sludge. It is moderately distended. There is no wall edema and no
pericholecystic fluid
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 8 cm.
KIDNEYS: The right kidney measures 10.0 cm. The left kidney measures 10.4 cm.
Survey views of the kidneys show no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Mobile gallstones and sludge within a moderately distended gallbladder.
No gallbladder wall edema or pericholecystic fluid is seen at the present
time, although findings may represent early acute cholecystitis. In addition
there is note of choledocholithiasis, with at least 1 shadowing stone seen in
the common bile duct.
2. Echogenic liver consistent with steatosis. Other forms of liver disease
and more advanced liver disease including steatohepatitis or significant
hepatic fibrosis/cirrhosis cannot be excluded on this study. Relative areas
of hypo echogenicity within the liver parenchyma are consistent with
geographic sparing from steatosis.
3. Trace right pleural effusion.
NOTIFICATION: The findings were discussed with Dr ___. by ___
___, M.D. on the telephone on ___ at 9:20 AM, 5 minutes after discovery
of the findings.
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19990545-RR-21 | 19,990,545 | 23,106,222 | RR | 21 | 2139-10-06 15:58:00 | 2139-10-06 16:35:00 | INDICATION: ___ w/ epigastric pain, transaminitis, RUQ U/S c/w acute
cholecystitis s/p ERCP c/b pancreatitis // ? free air
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No evidence of free intraperitoneal air.
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19990545-RR-24 | 19,990,545 | 23,106,222 | RR | 24 | 2139-10-11 10:14:00 | 2139-10-11 14:28:00 | INDICATION: ___ year old woman with gallstone pancreatitis s/p ERCP now with
resolving lipase but persistent epigastric pain // PO/IV contrast
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen 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 3.2 s, 35.5 cm; CTDIvol =
13.4 mGy (Body) DLP = 475.0 mGy-cm. 2) Stationary Acquisition 4.0 s, 0.5 cm;
CTDIvol = 19.3 mGy (Body) DLP = 9.6 mGy-cm. 3) Spiral Acquisition 3.3 s, 35.9
cm; CTDIvol = 13.2 mGy (Body) DLP = 473.8 mGy-cm. Total DLP (Body) = 958
mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Bilateral pleural effusions are small. Bibasilar atelectasis is
mild.
ABDOMEN:
HEPATOBILIARY: Small area of hypodensity adjacent to the falciform ligament is
likely perfusional. Intra and extrahepatic bile ducts are not dilated. Hyper
enhancement of extrahepatic bile duct wall and gallbladder mucosa is noted.
Gallbladder contains gallstones and demonstrates wall thickening. Gallbladder
is not distended.
PANCREAS: Pancreas is homogeneous in attenuation throughout. There is no
pancreatic duct dilation.
SPLEEN: Spleen is not enlarged.
ADRENALS: Bilateral adrenal glands are unremarkable.
URINARY: Bilateral nephrograms are symmetric. No focal lesion is identified.
There is no hydronephrosis.
GASTROINTESTINAL: Stomach is unremarkable.
Extra luminal retroperitonial air is identified posterior to the second
portion of the duodenum. There is fluid extending from the posterior aspect of
the duodenum and to the right perinephric space. Findings are concerning for
recent duodenal perforation. No extravasation of oral contrast is identified.
There is wall thickening at the second portion of the duodenum. No discrete
defect is identified in the duodenal wall.
Small and large bowel loops are normal caliber. Wall thickening of the right
colon is noted. Partially visualized appendix is unremarkable.
LYMPH NODES: No pathologically enlarged lymph node is identified.
VASCULAR: There is no abdominal aortic aneurysm. No Atherosclerotic disease is
noted.
BONES: No suspicious bone lesion is identified.
SOFT TISSUES: Abdominal wall is intact. Small amount of subcutaneous fat
stranding and air is likely related to possible subcutaneous injections.
IMPRESSION:
1. Extraluminal retroperitoneal air is identified posterior to the second
portion of duodenum. There is fluid extending from the duodenum and to right
perinephric space. Duodenal wall is thickened. Findings are suspicious for
duodenal perforation although no oral contrast extravasation or discrete
duodenal wall defect is identified.
2. Cholelithiasis with gallbladder wall thickening. Hyperenhancement of
gallbladder mucosa and extrahepatic bile ducts may be inflammatory.
3. Peritoneal enhancement is consistent with peritonitis. Omental nodularity
may reflect edema.
4. Right colonic wall thickening may reflect secondary inflammation.
5. Small to moderate ascites.
6. Bilateral pleural effusions are small.
NOTIFICATION: The impression 1. was discussed with Dr. ___. by
___, M.D. on the telephone on ___ at 1:30 ___, 5 minutes after
discovery of the findings.
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Subsets and Splits