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19990545-RR-25 | 19,990,545 | 23,106,222 | RR | 25 | 2139-10-12 12:03:00 | 2139-10-12 17:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fevers and n/v/abdominal pain // r/o
infection r/o infection
IMPRESSION:
There are no prior chest radiographs available. Study is read in conjunction
with images of the lower chest on an abdomen CT ___.
The heart is mildly enlarged. Worsened consolidation left lower lobe could be
new pneumonia or atelectasis. Previous small pleural effusions are probably
still present. Upper lungs are clear.
|
19990545-RR-26 | 19,990,545 | 23,106,222 | RR | 26 | 2139-10-14 13:03:00 | 2139-10-14 16:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fevers and increased wbc count // r/o
pneumonia r/o pneumonia
IMPRESSION:
Heart size and mediastinum are stable. New right middle lobe opacity mA also
potentially represent focus of infection. Left basal consolidation on the
other hand has improved. There is minimal amount of left pleural effusion
suspected. There is no pneumothorax.
|
19990545-RR-27 | 19,990,545 | 23,106,222 | RR | 27 | 2139-10-15 18:03:00 | 2139-10-15 21:55:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with know acute cholecystitis s/p ERCP induced
pancreatitis and ? perforation. Now with low grade fevers and rising WBC.
Thank you // please evaluate for interval change in know peritonitis,
retroperitoneal fluid collection, air and inflammation, ascites. Please
evaluate for possible right PNA.
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: Total DLP (Body) = 808 mGy-cm.
COMPARISON: CT abdomen ___. Abdominal ultrasound ___.
FINDINGS:
LOWER CHEST: Small bilateral pleural effusions, further evaluated on the
concurrently performed although separately dictated CT chest.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder contains gallstones
without significant pericholecystic fat stranding or gallbladder wall
thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. There is redemonstration of
retroperitoneal, extraluminal fluid and air, centered posterior to the second
portion the duodenum, and extending inferiorly along the right perirenal space
These are again most consistent with perforation of the duodenum, without
defect identified. There are multiple, likely communicating organizing fluid
collections throughout the abdomen, most pronounced in the right hemi abdomen
with new rim enhancement. The largest pocket measures approximately 5.8 x 2.6
cm in the right lower abdomen (2:80). Additionally, there is enhancement of
the peritoneum, likely reflecting a degree of peritonitis.
Multiple small hyperdensities are identified within the ascending colon, which
may reflect intraluminal gallstones, potentially related to gallstone ileus.
There is mild gaseous and fluid distention of multiple small bowel loops up to
2.4 cm, with multiple air-fluid levels, further suggestive of ileus.
Mildly prominent fluid-filled loops of small bowel may reflect a reactive
ileus. Persistent thickening of the partially decompressed ascending and
descending colon may reflect inflammatory change. The appendix is not
visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
moderate free fluid within the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Unchanged extraluminal retroperitoneal air and fluid posterior to the
second portion of the duodenum and extending throughout the right perirenal
space, remaining suggestive of duodenum perforation.
2. Moderate free fluid throughout the abdomen pelvis is slightly increased
from prior with new rim enhancement suggestive of organizing fluid
collections/ early abscess formation. New peritoneal enhancement,
particularly in the pelvis, suggestive of peritonitis.
3. Mildly prominent small bowel loops with air-fluid levels are suggestive of
reactive ileus.
4. Probable reactive colonic mucosal thickening.
5. No definite CT evidence of acute cholecystitis.
|
19990545-RR-28 | 19,990,545 | 23,106,222 | RR | 28 | 2139-10-15 18:23:00 | 2139-10-15 21:21:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Fevers, evaluation for pneumonia.
TECHNIQUE: MD CT axial imaging of the chest following intravenous
administration of contrast using split bolus technique a conjunction with a CT
of the abdomen and pelvis. Multiplanar reformatted images are provided.
DOSE: Total DLP (Body) = 808 mGy-cm.
COMPARISON: CT abdomen and pelvis ___. Abdominal ultrasound ___.
FINDINGS:
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid appears unremarkable.
Multiple nonenlarged axillary lymph nodes are seen bilaterally. Punctate
macrocalcification within the right breast is noted.
UPPER ABDOMEN: Please refer to the report from the concurrent CT scan of the
abdomen and pelvis for intra-abdominal findings.
MEDIASTINUM: No lymphadenopathy or hemorrhage.
HILA: No lymphadenopathy.
HEART and PERICARDIUM: Trace pericardial fluid. Heart size is within normal
limits.
PLEURA: Small bilateral pleural effusions, decreased from prior.
LUNG:
-PARENCHYMA: Mild right lower lobe enhancing atelectasis may reflect
relaxation atelectasis. Superimposed infection is not definitively excluded
although is felt to be less likely.
-AIRWAYS: The airways are patent to the subsegmental bronchi bilaterally.
-VESSELS: Aorta and great vessel origins appear normal. Pulmonary arteries
appear unremarkable.
CHEST CAGE: Normal. No evidence of osseous abnormality.
IMPRESSION:
Small bilateral pleural effusions, decreased from prior, with improving mild
right lower lobe atelectasis. Superimposed pneumonia is felt to be less
likely.
|
19990545-RR-29 | 19,990,545 | 23,106,222 | RR | 29 | 2139-10-16 09:23:00 | 2139-10-16 20:50:00 | EXAMINATION: CT-guided drainage
INDICATION: ___ s/p ERCP c/b duodenal perforation n/w RP abscess // RIGHT
retroperitoneum
COMPARISON: CT from ___
PROCEDURE: CT-guided drainage of a retroperitoneal and pelvic collections.
OPERATORS: Dr. ___, radiology fellow 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 left lateral position on the CT scan table.
Limited preprocedure CT scan was performed to localize the retroperitoneal
collection. Based on the CT findings an appropriate skin entry site for the
drain placement was chosen. The site was marked.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the retroperitoneal collection below the level of the right
kidney. A 0.038 ___ wire was placed through the needle. Attempts were
made to manipulate the wire superiorly into the retro duodenum aspect of the
collection, which was not successful. The needle was removed in the ___
wire was left in place and secured to the skin with a Tegaderm. Manipulation
of the wire will be continued under fluoroscopic guidance.
Additionally, the patient was placed supine and under CT fluoroscopic
guidance, an 18 gauge ___ needle was inserted into the the pelvic
collection from an anterior approach. A ___ wire was placed through the
needle and the needle was exchanged for a 6 ___ catheter. 20 cc of dark
red/yellow fluid was aspirated and sent for microbiology. The catheter was
secured in place with sutures and a stat lock device.
DOSE: Acquisition sequence:
1) Spiral Acquisition 14.1 s, 43.0 cm; CTDIvol = 11.8 mGy (Body) DLP =
491.9 mGy-cm.
2) Stationary Acquisition 5.1 s, 1.4 cm; CTDIvol = 52.7 mGy (Body) DLP =
75.9 mGy-cm.
3) Spiral Acquisition 14.1 s, 43.0 cm; CTDIvol = 14.9 mGy (Body) DLP =
622.5 mGy-cm.
4) Stationary Acquisition 3.3 s, 1.4 cm; CTDIvol = 33.9 mGy (Body) DLP =
48.8 mGy-cm.
5) Spiral Acquisition 5.6 s, 17.1 cm; CTDIvol = 18.1 mGy (Body) DLP = 284.6
mGy-cm.
Total DLP (Body) = 1,548 mGy-cm.
SEDATION: General anesthesia was provided by anesthesiology.
FINDINGS:
Limited intraoperative fluoroscopic CT demonstrated the ___ wire coiled
within the inferior aspect of the right retroperitoneal collection.
Additional intra procedural fluoroscopic CT demonstrated the 6 ___ catheter
in appropriate position within the pelvis.
IMPRESSION:
Successful CT-guided placement of a 6 ___ catheter within the pelvic fluid
collection.
___ wire was placed within the inferior aspect of the
right retroperitoneal fluid collection. The patient will be moved into the
angiography suite for further manipulation and placement of a retroduodenal
drain.
|
19990545-RR-31 | 19,990,545 | 23,106,222 | RR | 31 | 2139-10-16 12:45:00 | 2139-10-16 16:41:00 | INDICATION: ___ year old woman with wire in place into abscess. request into
duodenal perf area. continuation of CT procedure // ___ year old woman with
wire in place into abscess. request into duodenal perf area. continuation of
CT procedure ; ___ s/p ERCP c/b duodenal perforation n/w RP abscess // ?
superinfected pelvic ascites
COMPARISON: CT of the abdomen from ___
TECHNIQUE: OPERATORS: Dr. ___,
performed the procedure.
ANESTHESIA: General
MEDICATIONS: None
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 9.5 min, 54 mGy
PROCEDURE:
1. Repositioning of wire placed under CT guidance from the retroperitoneal
abscess into the retro duodenum region
2. Placement of 8 ___ biliary drain over wire with pigtail formed in the
retro duodenum region
3. Upper GI series through NG tube to evaluate for persistent duodenum
perforation
PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography ___ from the CT scanner and placed
left side down on the table. A pre-procedure time-out was performed per ___
protocol.
The patient's existing wire which was placed under CT guidance was prepped
and draped in the usual sterile fashion. Then a Kumpe the catheter was
introduced over the wire. The ___ wire was removed and a Glidewire were
utilized to navigate slowly up the abcesses tract into the retro duodenual
area. At this point, the copy was placed over the Glidewire the Glidewire
removed. A small contrast injection was performed which delineated the
abscess tract, but the decision was made to utilize a cone beam CT to assure
positioning as this catheter was to be use for surgical guidance.
Rotational cone-beam CT was performed to help delineate the anatomy.
Multiplanar CT images were reconstructed and 3D volume-rendered images of the
abscess anatomy required post-processing on an independent workstation under
direct physician ___. These images were used in the interpretation,
decision making for intervention and reporting of this procedure.
Once confirmed in appropriate position, an Amplatz wire was placed through the
Kumpe the catheter. The copy was removed and an 8 ___ biliary catheter was
placed. The pigtail was formed and locked. The catheter was secured to the
skin with 0 silk sutures and placed to drainage bag.
Then, attention was turned to the requested upper GI fluoroscopic examination
for leak. Contrast is administered through the existing NG tube, and the
patient was turned right-side-down order to assist drainage. Despite this,
contrast with only passed to the first portion the duodenum. No contrast was
seen passing into the retroperitoneal space nor into the third or fourth
portions of the duodenum. The lack of passage of contrast was likely due to
edema around the area. No definitive leak was identified.
The patient tolerated the procedure well and was returned to the PACU for
ongoing care.
FINDINGS:
1. The existing CT-guided wire placement in a retroperitoneal abscess
collection
2. Successful navigation of the catheter up the retroperitoneal abscess
collection into the retroduodenal area
3. Placement of a 8 ___ biliary drain in the retroduodenal area
4. No definitive visualization of a duodenal leak from the upper GI series
however limited overall evaluation given that contrast would not passed
through the second portion of the duodenum, likely secondary to edema in this
area.
IMPRESSION:
Successful placement of 8 ___ biliary drain into the retro duodenal area
for source control as well as for operative guidance as requested by the
surgical team
|
19990545-RR-32 | 19,990,545 | 23,106,222 | RR | 32 | 2139-10-16 12:46:00 | 2139-10-16 16:41:00 | INDICATION: ___ year old woman with wire in place into abscess. request into
duodenal perf area. continuation of CT procedure // ___ year old woman with
wire in place into abscess. request into duodenal perf area. continuation of
CT procedure ; ___ s/p ERCP c/b duodenal perforation n/w RP abscess // ?
superinfected pelvic ascites
COMPARISON: CT of the abdomen from ___
TECHNIQUE: OPERATORS: Dr. ___,
performed the procedure.
ANESTHESIA: General
MEDICATIONS: None
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 9.5 min, 54 mGy
PROCEDURE:
1. Repositioning of wire placed under CT guidance from the retroperitoneal
abscess into the retro duodenum region
2. Placement of 8 ___ biliary drain over wire with pigtail formed in the
retro duodenum region
3. Upper GI series through NG tube to evaluate for persistent duodenum
perforation
PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography ___ from the CT scanner and placed
left side down on the table. A pre-procedure time-out was performed per ___
protocol.
The patient's existing wire which was placed under CT guidance was prepped
and draped in the usual sterile fashion. Then a Kumpe the catheter was
introduced over the wire. The ___ wire was removed and a Glidewire were
utilized to navigate slowly up the abcesses tract into the retro duodenual
area. At this point, the copy was placed over the Glidewire the Glidewire
removed. A small contrast injection was performed which delineated the
abscess tract, but the decision was made to utilize a cone beam CT to assure
positioning as this catheter was to be use for surgical guidance.
Rotational cone-beam CT was performed to help delineate the anatomy.
Multiplanar CT images were reconstructed and 3D volume-rendered images of the
abscess anatomy required post-processing on an independent workstation under
direct physician ___. These images were used in the interpretation,
decision making for intervention and reporting of this procedure.
Once confirmed in appropriate position, an Amplatz wire was placed through the
Kumpe the catheter. The copy was removed and an 8 ___ biliary catheter was
placed. The pigtail was formed and locked. The catheter was secured to the
skin with 0 silk sutures and placed to drainage bag.
Then, attention was turned to the requested upper GI fluoroscopic examination
for leak. Contrast is administered through the existing NG tube, and the
patient was turned right-side-down order to assist drainage. Despite this,
contrast with only passed to the first portion the duodenum. No contrast was
seen passing into the retroperitoneal space nor into the third or fourth
portions of the duodenum. The lack of passage of contrast was likely due to
edema around the area. No definitive leak was identified.
The patient tolerated the procedure well and was returned to the PACU for
ongoing care.
FINDINGS:
1. The existing CT-guided wire placement in a retroperitoneal abscess
collection
2. Successful navigation of the catheter up the retroperitoneal abscess
collection into the retroduodenal area
3. Placement of a 8 ___ biliary drain in the retroduodenal area
4. No definitive visualization of a duodenal leak from the upper GI series
however limited overall evaluation given that contrast would not passed
through the second portion of the duodenum, likely secondary to edema in this
area.
IMPRESSION:
Successful placement of 8 ___ biliary drain into the retro duodenal area
for source control as well as for operative guidance as requested by the
surgical team
|
19990545-RR-33 | 19,990,545 | 23,106,222 | RR | 33 | 2139-10-17 15:38:00 | 2139-10-17 15:59:00 | INDICATION: ___ year old woman with picc // s/p r 40cm ___ ___
Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
There has been interval placement of a right PICC line whose tip projects over
the right atrium. Retraction by approximately 1.6 cm would place the tip in
the region of the cavoatrial junction.
Low bilateral lung volumes. Mild left basilar atelectasis, unchanged. No
large pleural effusion or pneumothorax is identified. The size of the cardiac
silhouette is enlarged but unchanged.
A catheter projects over the lower mid abdomen.
IMPRESSION:
Interval placement of a right PICC line whose tip projects over the right
atrium and retraction by approximately 1.6 cm would place the tip in the
region of cavoatrial junction.
Mild left basilar atelectasis.
|
19990545-RR-34 | 19,990,545 | 23,106,222 | RR | 34 | 2139-10-22 05:51:00 | 2139-10-22 10:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman w/ continued fever episdoes // ? infectious
processes, ? PNA ? infectious processes, ? PNA
IMPRESSION:
In comparison with the study of ___, the patient has taken a better
inspiration. The right subclavian PICC line is been pulled back so that the
tip is at the midportion of the SVC.
No evidence of acute pneumonia or vascular congestion.
Of incidental note is a
|
19990545-RR-35 | 19,990,545 | 23,106,222 | RR | 35 | 2139-10-24 11:39:00 | 2139-10-24 14:39:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman post ERCP pancreatitis c/b duodo perforation
and RP fluid collection pod ___ s/p ___ drain placement // RP fluid collection
?progression
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following administration of 130 cc of Omnipaque
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.0 s, 0.5 cm; CTDIvol = 4.8 mGy (Body) DLP = 2.4
mGy-cm.
2) Spiral Acquisition 5.0 s, 54.9 cm; CTDIvol = 12.4 mGy (Body) DLP = 677.9
mGy-cm.
Total DLP (Body) = 680 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: There is mild bibasilar dependent atelectasis. No pleural
effusions. Mild cardiomegaly. Partially imaged small pericardial effusion
appears grossly similar to ___.
ABDOMEN:
HEPATOBILIARY: The liver is diffusely hypoattenuating relative to the spleen,
suggestive of fatty infiltration (2:21). There is no evidence of focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. There is cholelithiasis. Air within the gallbladder and CBD are
likely a result of recent sphincterotomy. Portal venous system is patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
No hydronephrosis. Tiny hypodensity in the interpolar region of the right
kidney is too small to characterize, but statistically likely represents a
cyst (2:41). No parenchymal lesions are identified on the left.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Apparent wall
thickening of the descending and sigmoid colon are likely due to under
distention (2:46,77). Colon and rectum are otherwise unremarkable. The
appendix is not visualized.
Since the prior study performed on ___, there has been interval
placement of a pigtail catheter into a retroperitoneal fluid collection. The
superior aspect of the fluid collection located adjacent to the pancreatic
head/second part of the duodenum has decreased in size from 4.0 x 2.3 cm to
3.4 x 2.1 cm on the current study (2:36). More inferiorly shortly after the
catheter enters the peritoneal cavity, the collection has also decreased from
5.8 x 2.6 cm to 4.3 x 1.4 cm (2:54).
However, remainder of the multiloculated fluid collections in the right
perirenal space are not significantly changed in size. For instance, the
fluid measures approximately 6.3 x 1.2 cm TV x AP anterior to the right kidney
(2:40), and 3.8 x 1.9 cm posteriorly (2:42), which are similar to prior.
Degree of surrounding rim enhancement is unchanged.
Free fluid in the abdomen and pelvis that was noted on the prior study has
essentially resolved. There is a fluid collection adjacent to the left adnexa
that now appears newly organized, measuring 3.7 x 1.9 cm (2:73), may represent
walled-off ascites. A crescent-shaped fluid collection abutting the posterior
uterine wall is slightly smaller (2:74).
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: Uterus is unremarkable in appearance. Hypodensity in the
region of the endometrial canal is nonspecific in a premenopausal woman, and
may represent hemorrhagic products.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Subcutaneous soft tissue nodule in the right gluteal region may
represent an injection granuloma (2:86). Abdominal and pelvic wall is
otherwise within normal limits.
IMPRESSION:
1. Interval placement of a pigtail catheter, with resulting decrease in size
of the retroperitoneal fluid collection along its course.
2. However, remainder of the small multiloculated perirenal fluid collections
on the right are unchanged in size.
3. Within the pelvis, a new 3.7 x 1.9 cm organized collection in the region of
the left adnexa could represent walled-off ascites. Fluid collection along
the posterior uterine wall has decreased.
4. Fatty infiltration of the liver.
5. Trace pericardial effusion, grossly unchanged.
|
19990545-RR-36 | 19,990,545 | 23,106,222 | RR | 36 | 2139-10-25 15:18:00 | 2139-10-25 16:53:00 | EXAMINATION:
CT-guided right perinephric collection drainage/pigtail catheter placement.
INDICATION: ___ year old woman with post ERCP pancreatitis c/b RP fluid
collection s/p drain placement now with growing and increasingly organized
pelvic fluid collection. // Growing and organizing fluid collection in pelvis
COMPARISON:
CT of the abdomen and pelvis ___
PROCEDURE: CT-guided drainage of right perinephric collection.
OPERATORS: Dr. ___ trainee and Dr. ___
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 prone position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the CT
findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A 1cc sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 1 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. AN additional 5cc was aspirated from the collection.
The catheter was secured by a StatLock. The catheter was attached to suction
bulb. 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
Versed and fentanyl throughout the total intra-service time of 15 minutes
during which patient's hemodynamic parameters were continuously monitored by
an independent trained radiology nurse.
FINDINGS:
Preprocedure CT re- demonstrates a perinephric collection. Intra procedure CT
demonstrates appropriate positioning of the needle. Postprocedure CT
demonstrates appropriate positioning of the pigtail catheter.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
|
19990545-RR-41 | 19,990,545 | 28,670,614 | RR | 41 | 2140-03-03 12:35:00 | 2140-03-03 13:58:00 | INDICATION: ___ year old woman with hx CBD stones, post-ERCP pancreatitis,
duodenal rupture with subsequent RP abscess p/w increased abdominal pain//
Eval for evidence perforation (free air)
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: ___
FINDINGS:
There is a nonobstructive bowel gas pattern. No large air-fluid levels are
seen. There is no evidence of free air. Right upper quadrant surgical clips
are from presumed cholecystectomy. The lung bases are grossly clear.
IMPRESSION:
No bowel obstruction or free air.
|
19990545-RR-44 | 19,990,545 | 28,670,614 | RR | 44 | 2140-03-04 08:16:00 | 2140-03-04 18:50:00 | EXAMINATION: MRCP
INDICATION: ___ year old woman s/p ERCP with microperf of duodenum ___ s/p
CCY ___ episodic spasms of severe pain// rule out biliary anatomy
abnormality
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT abdomen pelvis dated ___. And ___.
FINDINGS:
Lower Thorax: No pleural effusion or focal consolidation.
Liver: The liver is normal in size and signal intensity. There is no
enhancing focal liver lesion identified.
Biliary: Patient is post prior the ERCP with history of micro perforation of
the duodenum. There is no intrahepatic or extrahepatic biliary ductal
dilatation. Pneumobilia is noted.
Pancreas: Pancreas is normal in bulk and signal intensity. The pancreatic
duct is normal in caliber. There is no peripancreatic stranding to suggest
acute pancreatitis. No evidence of contrast extravasation to suggest bile
leak.
Spleen: Spleen is normal in size and signal intensity.
Adrenal Glands: These renal glands are normal.
Kidneys: The left and right kidneys are normal in size. There is no
hydronephrosis or focal enhancing renal lesion identified.
Gastrointestinal Tract: Visualized loops of bowel are normal in caliber.
There is no evidence of bowel obstruction.
Lymph Nodes: No lymphadenopathy
Vasculature: Visualized vessels are patent. No abdominal aortic aneurysm.
Osseous and Soft Tissue Structures: No suspicious bone lesion is identified.
IMPRESSION:
1. Post prior ERCP with history of microperforation of the duodenum. No
intrahepatic or extrahepatic biliary ductal dilatation. Pneumobilia is
present.
2. No evidence of biliary leak.
|
19990786-RR-81 | 19,990,786 | 20,124,902 | RR | 81 | 2154-11-02 11:40:00 | 2154-11-02 12:40:00 | EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION: History: ___ with chest pain, eval for PE // eval for PE or
aortic dissection
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: 495.72 mGy-cm
COMPARISON: None available.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no evidence
of penetrating atherosclerotic ulcer or aortic arch atheroma present. Note is
made of a bovine aortic arch.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
The heart is not enlarged. Note is made of coronary artery calcifications.
Debris is seen within the upper trachea. There is mild dependent atelectasis
bilaterally. No pneumothorax or pleural effusion. No concerning pulmonary
nodules are identified.
There is a small hiatal hernia. Few small gallstones are present. Limited
images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Small hiatal hernia.
3. Cholelithiasis.
|
19991085-RR-17 | 19,991,085 | 28,178,930 | RR | 17 | 2125-01-02 09:22:00 | 2125-01-02 12:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new lymphoma diagnosis. // Patient has a
pacemaker and will need a spinal MRI. We need to check where there is any
other hardward besides the pacemaker in her chest prior to the MRI
TECHNIQUE: Portable chest
COMPARISON: ___
FINDINGS:
Compared to the prior study there is no significant interval change. There is
a dual lead pacemaker with the leads projecting over the expected location.
No other radiopaque foreign bodies are visualized.The cardiac and mediastinal
silhouettes are normal and are unchanged compared to prior.
|
19991085-RR-18 | 19,991,085 | 28,178,930 | RR | 18 | 2125-01-02 16:36:00 | 2125-01-03 08:37:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with newly diagnosed lymphoma chronic
neurological finding suggesting possible brain involvement, and PET finding
suggesting cord impingement. // Concern for spread of lymphoma to brain
(based on exam findings) and cord and for cord compression (based on exam and
PET findings).
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 10 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ whole-body PET-CT.
FINDINGS:
There is motion artifact which degrades image quality particularly on the pre
and postcontrast axial T1, postcontrast MP rage, and axial T2 sequences.
There is diffuse leptomeningeal pachymeningeal nodular enhancing disease
consistent with lymphoma, as follows:
There is nodular extra-axial enhancing disease at the anterior left frontal
operculum (30 01:15), anterior parafalcine left frontal cortex (___),
suprasellar cistern, ambient cistern, cerebellopontine angles, fourth
ventricle, and posterior cranial fossa base. There is diffuse nodular
enhancement coating the posterior fossa structures including the midbrain,
pons, medulla, and visualized upper cervical spine. There is enhancing
disease involving the expected course of multiple cranial nerve courses,
foramen of Luschka and Magendie, however the fine detail is obscured by motion
artifact. There is enhancing disease within the right internal auditory
canal, indicated leptomeningeal disease. There is mass like enhancing disease
within the spinal canal at the C3 level which extends across the near entirety
of the spinal canal either infiltrating or compressing the traversing cervical
cord and producing spinal cord edema. This measures 1.0 cm x 1.7 by 1.1 cm
(101:20).
There is no acute hemorrhage, territorial infarct, or shifting of the normally
midline structures. The ventricles are unremarkable. The orbits and soft
tissues are unremarkable. The paranasal sinuses and mastoid air cells are
clear. There is diffuse T1 hypointensity of the calvarial marrow.
IMPRESSION:
1. Study is limited by motion artifact, as described, limiting the spatial
resolution.
2. Diffuse nodular enhancing disease involving the leptomeningeal and
pachymeningeal extra-axial spaces, as described, predominantly within the
basal cisterns consistent with intracranial lymphoma.
3. Mass like enhancing disease within the visualized upper cervical canal from
C1 through C3 levels, which may be compressing or infiltrating the adjacent
cervical cord.
4. Low signal within the cranial marrow which is nonspecific and may be seen
with hematopoetic marrow or infiltration.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 9:18 AM, 10 minutes after discovery of the findings.
|
19991085-RR-19 | 19,991,085 | 28,178,930 | RR | 19 | 2125-01-02 16:37:00 | 2125-01-03 09:18:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ female with newly diagnosed lymphoma experiencing
chronic neurological deficits. Prior PET-CT suspicious for cord impingement.
TECHNIQUE: Patient with a cardiac device therefore is seen in consultation by
electrophysiology cardiology and radiology. Patient was explained the risks
and benefits of MR imaging in the setting of a cardiac device and signed
informed consent. A limited cardiac device protocol was utilized with low
SAR, with sagittal T2, stir, T1, and postcontrast T1 imaging. Axial
postcontrast T1 imaging was performed. Postcontrast imaging was obtained
following the uneventful intravenous administration of Gadavist, gadolinium
base contrast.
COMPARISON: ___ whole-body PET-CT.
FINDINGS:
CERVICAL:
There is motion artifact which limits spatial resolution.
There is normal cervical alignment. The vertebral body heights and marrow
signal are preserved. The intervertebral disc spaces demonstrate normal
signal height. There are mild degenerative changes without significant neural
foraminal stenosis. There is diffuse thin leptomeningeal postcontrast
enhancement consistent with carcinomatosis. There is more nodular enhancing
disease as follows: There is a 0.8 AP by 1.1 TV by 1.1 SI cm enhancing mass
at the left lateral aspect of the nodule cervical junction at the foramen
magnum which mildly deforms the traversing cord.
There is a large 2.0 TV by 1.1 AP by 1.1 SI cm enhancing mass centered at the
left lateral aspect of the spinal canal at the C3 level which severely narrows
the spinal canal compressing and displacing the traversing cord to the right
with associated underlying cord T2 signal hyperintensity extending from C1-C2
to the C4 levels (15:19).
THORACIC:
There is a normal thoracic alignment the vertebral body heights and marrow
signal are preserved. The intervertebral disc spaces demonstrate preserved
height. There are mild degenerative changes without significant neural
foraminal stenosis. There is nodular enhancing intradural extramedullary
disease at the right lateral aspect of the thoracic spinal canal centered at
the T8 level measuring 1.0 AP by 0.5 T the by 2.1 SI cm which mildly deforms
and leftward displaces the traversing cord. There is no definitive intrinsic
cord signal T2 hyperintensity on sagittal T2 and STIR sequences. There is
diffuse trace leptomeningeal enhancement throughout the remainder of the
thoracic spinal canal.
LUMBAR:
There is normal lumbar alignment. The vertebral body heights are preserved.
There is a T1 hypointense, T2 hyperintense, enhancing circumscribed lesion
within the anterior aspect of the S2 vertebral body measuring 8 mm (12:13).
There is there is low signal within the T12-L1, L4-L5, and L5-S1
intervertebral disc spaces. The conus terminates appropriately at the L1
level. There is diffuse nodular enhancing leptomeningeal disease throughout
the visualized conus and cauda equina without definitive cord or nerve root
compression.
There are mild degenerative changes without significant neural foraminal
stenosis. There are prominent bilateral iliac chain lymph nodes measuring up
to 7 mm in short axis on the right (17:34) and 9 mm in short axis on the left
(17:41).
IMPRESSION:
1. Motion artifact which limits space resolution of this study.
2. Diffuse total spine leptomeningeal carcinomatosis consistent with lymphoma.
3. More focal areas of nodular masslike enhancing disease, as described, with
large 2 cm lesion at the C3 level severely compressing the traversing cervical
cord causing intrinsic cord edema.
4. Enhancing lesion within the S2 vertebral body which may represent
metastatic osseous disease.
5. Prominent bilateral iliac chain lymph nodes, as described.
NOTIFICATION: Results discussed with Dr. ___ by Dr. ___ at ___ on ___ via telephone 5 minute after discovery.
|
19991085-RR-22 | 19,991,085 | 28,178,930 | RR | 22 | 2125-01-02 22:55:00 | 2125-01-02 23:48:00 | EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old woman with likely new lymphoma diagnosis. She has no
tissue diagnosis yet, but she has brain and spinal cord involvement that may
require emergent steroid treatment which would obliterate any path diagnosis.
Thus, she requires an emergent excisional lymph node biopsy to preserve the
chance of accurate diagnosis. Patient needs excisional lymph node biopsy, and
surgery is asking that the right lymph node be marked by ultrasound.
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right groin.
COMPARISON: FDG PET dated ___.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right groin demonstrates multiple normal-appearing lymph nodes, largest
measures 0.8 in short axis with a normal central fatty hilum and normal
cortex. No enlarged abnormal appearing lymph node identified.
IMPRESSION:
1. No abnormal right groin lymph node identified for marking.
2. Few normal-appearing right groin lymph nodes.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 11:46 ___, 5 minutes after discovery of the
findings.
|
19991085-RR-23 | 19,991,085 | 28,178,930 | RR | 23 | 2125-01-03 21:15:00 | 2125-01-04 08:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with lymphadenopathy s/p mediastinoscopy with
biopsy // postop; any pneumo?
TECHNIQUE: Portable chest
___.
FINDINGS:
There is subsegmental atelectasis in both lower lungs. There is no
pneumothorax. The appearance of the dual lead pacemaker is unchanged. The
upper lungs are clear
|
19991085-RR-24 | 19,991,085 | 28,178,930 | RR | 24 | 2125-01-07 13:01:00 | 2125-01-11 10:53:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) BILATERAL
INDICATION: ___ year old woman with probable sarcoid vs lymphoma // Eval for
cystic changes in the phalynx in a patient with likely Sarcoidosis
COMPARISON: None.
FINDINGS:
Right hand: No definite focal lytic lesion to confirm the presence of sarcoid
is identified. Subtle lucencies seen in the proximal phalanges of the middle
and ring fingers remain relatively non-specific. Possible minimal narrowing
and spurring at the first CMC joint consistent with osteoarthritis. Mild
narrowing of multiple IP joints is also likely present. There is normal
variant ulnar positive variance and accentuated angulation of the distal
radial articular surface in the coronal plane (approximately 26 degrees).
Mild degenerative spurring at the articulation of the radial styloid with the
distal scaphoid and some bony ridging along the lateral aspect of the distal
radius are noted.
Left hand: No definite focal lytic lesion to confirm the presence of sarcoid
is identified. Subtle lucencies seen in the proximal phalanges of the middle
and ring fingers and middle phalanges of the ring and small fingers remain
relatively non-specific. There is mild osteoarthritis of the first CMC joint
and mild degenerative changes at the radioscaphoid articulation and multiple
IP joints. Similar to the contralateral side, there is ulnar positive
variance with accentuated angulation of the distal radial articular surface.
IMPRESSION:
Mild degenerative changes in both hands, worst at the left first CMC joint.
No definite focal lytic lesion identified in either hand to confirm the
presence of sarcoid. Subtle lucencies seen in the proximal phalanges of the
middle and ring fingers in both hands and in the proximal phalanx of the index
finger and middle phalanges of the ring and small fingers in the left hand
remain relatively non-specific and could lie within the range of normal.
|
19991085-RR-25 | 19,991,085 | 28,178,930 | RR | 25 | 2125-01-08 09:12:00 | 2125-01-08 13:03:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ year old woman with diffuse lymphadenopathy seen on PET, CT
and MRI of spine concerning for sarcoidosis based on biopsy however with
ongoing concern for underlying malignancy, evaluate foci of uptake in the
vagina and cervix seen on PET scan concerning for malignant foci.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: PET CT ___.
FINDINGS:
The uterus is anteverted and measures 8.4 x 4.1 x 4.2 cm cm. The endometrium
is homogenous and measures 3 mm.
The ovaries are normal. No cervical abnormality is seen. The vaginal canal
is not well evaluated. There is no free fluid.
IMPRESSION:
No abnormality identified in the cervix. Vaginal canal not well evaluated.
RECOMMENDATION(S): Pelvic MRI can be considered to better evaluate the
vaginal canal.
|
19991135-RR-153 | 19,991,135 | 29,872,770 | RR | 153 | 2133-07-04 05:15:00 | 2133-07-04 06:41:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with hypoxia, tachycardia, concern for PE// Pulmonary
Embolism
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
2) Spiral Acquisition 4.8 s, 38.1 cm; CTDIvol = 11.7 mGy (Body) DLP = 445.6
mGy-cm.
Total DLP (Body) = 453 mGy-cm.
COMPARISON: CT chest ___. Chest radiograph ___
FINDINGS:
HEART AND VASCULATURE: There are numerous filling defects, some of which are
occlusive within the pulmonary vascular tree compatible with pulmonary emboli
involving both segmental and subsegmental segments predominantly in the right
lower, middle and upper lobes as well as the left lingular and lower lobes.
Clot is seen as proximally as the right interlobar pulmonary artery. There is
no definite bowing of the interventricular septum. However, the right
ventricle does appear somewhat prominent, and clinical correlation is
recommended for right heart strain. There is no pericardial effusion. Main
pulmonary artery is dilated to 3.7 cm. There is also dilatation of the right
and left main pulmonary arteries suggesting pulmonary arterial hypertension.
The heart, pericardium and great vessels are otherwise within normal limits.
Atrial appendage exclusion device.
AXILLA, HILA, AND MEDIASTINUM: There is no axillary lymphadenopathy. There
are prominent mediastinal lymph nodes, for example in the distal right
paratracheal lymph node station measuring 10 mm (02:43). There is no
mediastinal mass.
PLEURAL SPACES: Trace left pleural effusion. Right apical pleuroparenchymal
thickening/scarring.
LUNGS/AIRWAYS: There are severe emphysematous changes, predominantly involving
the upper lobes, which appear to have progressed in comparison to ___. Postsurgical changes noted in the right upper lung. There is a
wedge-shaped region of heterogeneously enhancing soft tissue through the
superior left lower lobe. Differential considerations include infection.
Pulmonary infarction or atelectasis related to PEs felt to be less likely as
no occlusive thrombi are seen to supply this region. There is diffuse
bronchial wall thickening. This is seen on a background of diffuse
ground-glass opacification which raises the interstitial pneumonitis. There
is diffuse bronchial wall thickening and some mucous plugging.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
Thyroid gland is grossly normal.
ABDOMEN: Included portion of the upper abdomen is unremarkable. Gallbladder
is somewhat distended without evidence of fat stranding or wall edema.
Partially visualized left renal cyst.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Incidental note is made of a chronic healed rib fracture in the posterior
right fifth rib.
IMPRESSION:
1. Extensive filling defects in the pulmonary vascular tree compatible with
pulmonary emboli. These are seen as proximal as the right intralobar artery.
Emboli are seen at both the segmental and subsegmental level involving nearly
every lobe, but predominantly in the lower lobes.
2. There is mild prominence of the right ventricle. Clinical correlation for
right heart strain is recommended.
3. Dilation of the main pulmonary and right and left pulmonary arteries
compatible with pulmonary hypertension.
4. Severe emphysematous changes. Ground-glass opacification is seen
bilaterally which suggests interstitial pneumonitis. However, in the superior
left upper lobe there is a more consolidative appearance favored to represent
infection with atelectasis and infarction also considerations.
5. Trace left pleural effusion.
|
19991135-RR-154 | 19,991,135 | 29,872,770 | RR | 154 | 2133-07-04 21:21:00 | 2133-07-04 22:03:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with submassive PE.// evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: CTA chest ___ 05:24
FINDINGS:
There is normal respiratory variation in the common femoral veins bilaterally.
RIGHT LEG: There is normal compressibility, flow and augmentation of the
common femoral, femoral and popliteal veins. There is lack of compressibility
and flow in the calf veins. The gastrocnemius veins are involved as well.
LEFT LEG: There is normal compressibility and flow in the common femoral vein.
There is lack of compressibility of the superficial femoral vein. A subtle
amount of flow is seen within this vessel. The left popliteal vein
demonstrates normal flow and compressibility. There is lack of
compressibility and flow in the calf veins.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Nonocclusive deep venous thrombus in the left superficial femoral vein. In
addition, there is lack of compressibility and flow in the bilateral calf
veins compatible with occlusive deep venous thrombi. On the right, the
gastrocnemius veins are involved as well.
|
19991135-RR-155 | 19,991,135 | 29,872,770 | RR | 155 | 2133-07-07 00:52:00 | 2133-07-07 10:36:00 | INDICATION: ___ yo F with a sig PMHX of atrial fibrillation (on Coumadin),
COPD on O2 (2L at rest, up to ___ with ambulation), frequent falls here w/
shortness of breath, dizziness, found to have submassive PE. Now with
escalating O2 requirement.// Evidence of edema, consolidation or other
etiology of worsening hypoxia?
IMPRESSION:
Left atrial appendage metallic clip is again seen. There is coarsening of
bronchovascular markings, stable. No definite consolidation is seen.
Thoracotomy changes on the upper right is again present. There are no
pneumothoraces.
|
19991135-RR-156 | 19,991,135 | 29,872,770 | RR | 156 | 2133-07-07 08:49:00 | 2133-07-07 11:24:00 | INDICATION: ___ year old woman with PE and worsening hypoxia// Pulm edema, PNA
COMPARISON: CT scan from ___ and radiographs from 7 hours
earlier.
IMPRESSION:
Metallic atrial appendage clip is again seen and projects over the left
infrahilar region. Heart size is enlarged but stable. There are baseline
coarse bronchovascular markings bilaterally related to patient's emphysema and
scarring. There are areas of increased density within the left mid and lower
lung fields which may represent superimposed pneumonia as suggested on the
prior CT scan.
|
19991135-RR-157 | 19,991,135 | 29,872,770 | RR | 157 | 2133-07-08 08:01:00 | 2133-07-08 09:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with PE and history of emphysema and ?pneumonia
with acute dyspnea// acute dyspnea acute dyspnea
IMPRESSION:
Compared to chest radiographs ___.
Moderate pulmonary edema, more pronounced in the left lung, developed between
___ and ___, worsened slightly by at ___, is subsequently
stable. Small bilateral pleural effusions have accumulated. No pneumothorax.
Heart size normal. Atrial appendage clamp in place. Large lung volumes
reflect emphysema. Healed posterior displaced right rib fracture, an
incidental finding.
|
19991135-RR-158 | 19,991,135 | 29,872,770 | RR | 158 | 2133-07-08 09:44:00 | 2133-07-08 11:39:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with Right PICC// Right PICC 45cm, ___ ___
Contact name: ___: ___ Right PICC 45cm, ___ ___
IMPRESSION:
Compared to chest radiographs ___ through ___ at 08:00.
Mild pulmonary edema has improved, still more pronounced in the left lung,
where there may be new consolidation in the left upper lobe sitting on the
major fissure or there may be a small fissural fluid collection. Follow-up
advised.. Diaphragmatic pleural surfaces are excluded from 58 of previous
small dependent pleural effusions cannot be assessed. There is no
pneumothorax. Heart size is normal and unchanged.
New right PIC line ends at the origin of the SVC.
|
19991135-RR-159 | 19,991,135 | 29,872,770 | RR | 159 | 2133-07-11 10:56:00 | 2133-07-11 13:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hx PEs and COPD here with higher O2
requirement and wheezing.// Look for pneumonia or other acute abnormalities
IMPRESSION:
In comparison with the study of ___, the area of focal opacification
in the mid and lower lung zones on the left has substantially cleared.
Cardiomediastinal silhouette and hyperexpansion of the lungs are stable. Some
elevation of pulmonary venous pressure is again present, and the rib
abnormality on the right is again noted.
|
19991805-RR-25 | 19,991,805 | 23,646,288 | RR | 25 | 2143-01-26 17:56:00 | 2143-01-26 23:59:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: Worsening oxygen requirement and hypernatremia. History of
dementia and recent pneumonia.
TECHNIQUE: Chest, portable AP upright.
COMPARISON: ___.
FINDINGS:
Patient is status post coronary artery bypass graft surgery. The cardiac,
mediastinal and hilar contours appear unchanged including moderate
cardiomegaly. What is new is bilateral opacification of each lung base, which
is especially confluent in the retrocardiac region on the left. Particularly
on the right, small coinciding pleural effusion is suspected. Indistinct
pulmonary vasculature appears mildly distended suggesting coinciding vascular
congestion.
IMPRESSION:
Substantial opacities at both lung bases, raising concern for pneumonia.
Findings also suggest mild coinciding vascular congestion and possibly small
pleural effusions.
|
19991805-RR-26 | 19,991,805 | 23,646,288 | RR | 26 | 2143-01-31 18:33:00 | 2143-01-31 21:27:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with coronary artery disease s/p CABG and PCI,
congestive heart failure, and COPD/asthma who admitted with hypoxia and
hypernatremia now with increased work of breathing. Growing MRSA in sputum but
clinically without cough or fever to suggest PNA. Also has had diuretics held
// evaluate for pulmonary edema or PNA evaluate for pulmonary edema or PNA
IMPRESSION:
In comparison with the study of ___, there has been increase in the
bilateral pulmonary opacifications, consistent with moderate pulmonary edema.
In the appropriate clinical setting, superimposed pneumonia cannot be
excluded.
Basilar opacifications are again consistent with small pleural effusions and
atelectatic changes in this patient with stable enlargement of the cardiac
silhouette.
|
19992202-RR-68 | 19,992,202 | 20,329,411 | RR | 68 | 2153-02-26 16:58:00 | 2153-02-26 19:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: Ms. ___ is a ___ w/ hx of CAD, stroke w/ residual cognitive
deficits, bipolar disorder w/ psychotic features, HTN, asthma, hypothyroidism,
multiple falls and other issues who presents from ___ with altered
mental status, fever, leukocytosis, and an unwitnessed fall, with positive UA
and GNR bacteremia. // Please assess for pulmonary edema/acute process
COMPARISON: ___
IMPRESSION:
The patient is substantially rotated. No evidence of larger pleural
effusions. No pneumonia, no pulmonary edema. Moderate cardiomegaly.
|
19992365-RR-42 | 19,992,365 | 20,220,175 | RR | 42 | 2167-10-21 00:03:00 | 2167-10-21 01:18:00 | INDICATION: ___ male with acute onset dyspnea and elevated D-dimer.
TECHNIQUE: Axial multidetector CT scan from the upper chest to the diaphragm
was performed following the administration of intravenous contrast.
Multiplanar reformatted images in coronal and sagittal axis were generated.
Oblique maximum intensity projection images were prepared and reviewed.
Dose 379 mGy-cm
COMPARISON: CT chest dated ___.
FINDINGS:
CT Thorax: The thyroid gland is within normal limits. The airways are patent
to the subsegmental level. There is no mediastinal, hilar, or axillary lymph
node enlargement by CT size criteria. The heart, pericardium and great
vessels are within normal limits. No esophageal abnormality is identified.
There is a small hiatal hernia noted. Moderate amount of coronary artery
calcifications are noted in the aortic arch.
Lung windows demonstrate centrilobular emphysema with multiple bilateral
pulmonary nodules recently described on a dedicated CT dated ___.
Ground-glass opacities along bilateral major fissures may reflect aspiration
though deep dependent atelectasis is probable more likely. There is no pleural
effusion.
CTA Thorax: The aorta and main thoracic vessels are well opacified. The
aorta demonstrates normal caliber throughout the thorax without evidence of
dissection or aneurysmal dilatation. The pulmonary arteries are opacified to
the subsegmental level. There is no filling defect to suggest pulmonary
embolism.
Osseous structures: No suspicious lytic or blastic lesions are identified.
Although this study is not designed for assessment of the intra-abdominal
visceral, the hepatic dome hypodensities are identified (2:87), stable since
prior examination.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Centrilobular emphysema with multiple bilateral pulmonary nodules better
described on recent dedicated CT dated ___. Recommend imaging
followup in ___ months time.
3. Again identified are hepatic dome hypodensities incompletely characterized
on this single phase examination.
|
19992365-RR-43 | 19,992,365 | 20,220,175 | RR | 43 | 2167-10-21 02:09:00 | 2167-10-21 02:24:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with AMS, unable to stand. Able to stand previously
// ICH, stroke
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 1003 mGy-cm
CTDI: 55 mGy
COMPARISON: None.
FINDINGS:
In the left cerebellar hemisphere, there is a 2.4 x 2.8 cm intraparenchymal
hemorrhage with surrounding edema. Mild mass effect is noted with effacement
of the fourth ventricle. Note should be made that patient received
intravenous contrast for a CTA chest on the same day approximately 2 hr
previously accounting for enhanced vasculature. No additional hemorrhage is
identified. There is no shift of normally midline structures. Ventricles and
sulci are normal in size and configuration for patient's age. Basal cisterns
are patent. Gray-white matter differentiation is preserved.
Bilateral mucous retention cysts are noted in the maxillary sinuses. Partial
opacification and mucosal thickening within the anterior ethmoidal cells as
well as left frontal sinus is additionally seen. Extensive atherosclerotic
calcifications are noted in the carotid siphon. Bilateral mastoid air cells
and middle ear cavities are clear. No acute fracture is identified.
IMPRESSION:
2.4 x 2.8 cm left cerebellar acute intraparenchymal hemorrhage with mild mass
effect and effacement of the fourth ventricle.
Correlate clinically for etiology and further workup.
NOTIFICATION: Findings communicated immediately to the ordering physician ___.
___ by Dr. ___ telephone at 2:21 am on ___.
|
19992365-RR-44 | 19,992,365 | 20,220,175 | RR | 44 | 2167-10-21 10:13:00 | 2167-10-21 11:23:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: Ataxia of the left arm, gait and intermittent nystagmus on
leftward gaze found to have left cerebellar hyperdensity.
TECHNIQUE: Multiplanar, multi sequence MR images of the head were acquired on
a 1.5 Tesla magnet prior to and after the uneventful intravenous
administration of 7 cc Gadovist per routine protocol.
COMPARISON: CTA head ___, noncontrast head CT ___.
FINDINGS:
There is re- demonstration of a 26 x 24 mm acute left cerebellar
intraparenchymal hematoma with associated T2 prolongation and signal void on
gradient echo. This hemorrhage is unchanged in size compared with earlier same
day examination. Trace peripheral enhancement is likely related to the bleed.
There is no definite underlying mass. Associated surrounding mass effect
appears similar to the prior study with effacement of the fourth ventricle.
Overall configuration of the ventricles and sulci is unchanged compared to the
prior examination remaining prominent, likely secondary to age related
involutional change. There is no hydrocephalus. There is mild surrounding
vasogenic edema. Other scattered punctate foci of subcortical and deep white
matter and T2 prolongation are nonspecific. There is no abnormal focus of
diffusion restriction. T2 "dark through" effect is seen in the region of
intraparenchymal hemorrhage on diffusion-weighted images. There is otherwise
no definite focus of abnormal post gadolinium enhancement. There is no
abnormality of the skull base or calvarium. The orbits, periorbital and
paracavernous spaces are unremarkable. The major intracranial vascular flow
voids are preserved. Mucosal wall thickening is noted in the bilateral
frontal sinuses, bilateral ethmoid air cells, bilateral sphenoid air cells and
bilateral maxillary sinuses.
IMPRESSION:
1. No significant interval change of a 26 x 24 mm acute left cerebellar
intraparenchymal hematoma with associated mass effect and effacement of the
fourth ventricle. No definite underlying mass with trace peripheral post
gadolinium enhancement likely secondary to bleed.
|
19992365-RR-46 | 19,992,365 | 20,220,175 | RR | 46 | 2167-10-21 10:03:00 | 2167-10-21 13:37:00 | INDICATION: ___ year old man with cerebellar hemorrhage // eval for
progression of bleed
TECHNIQUE: CT without IV contrast; CT angiogram of the head with IV contrast
COMPARISON: CT head ___
FINDINGS:
CT HEAD WITHOUT IV CONTRAST:
Stable left cerebellar acute hematoma, 2.8 x 3.3cm, with mild surrounding
edema and mass effect on the left side of ___ ventricle, similar to the prior
study done 8 hr earlier.
Slightly increased density of the transverse sinuses on both sides and the
tentorial leaflets similar to the prior study. No filling defect on CTA study
to suggest thrombosis No hydrocephalus are low lying cerebellar tonsils.
No new hemorrhage.
Vascular calcifications the cavernous carotid segments.
Small retention cyst/mild mucosal thickening in the anterior aspect of the
right maxillary sinus, left side of the frontal and the right side of the
sphenoid sinus.
Mild to moderate ethmoidal mucosal thickening. The mastoid air cells are
clear.
No suspicious osseous lesions are noted.
Incidental note of long styloid processes, left longer than right extending
towards the parapharyngeal space.
A few calcifications in the right palatine tonsil, likely from prior
inflammation.
Mildly prominent tonsils and adenoids.
Evaluation of the level of the maxilla and mandible limited due to dental
artifacts.
CT ANGIOGRAM OF THE HEAD WITH IV CONTRAST
The major intracranial arteries of the anterior and the posterior circulation
are patent. No focal flow-limiting stenosis or occlusion or aneurysm more
than 2 mm noted within the resolution of the study.
A few nondilated vascular structures are noted in proximity to the left
cerebellar hematoma and mildly displaced; these can relate to venous
structures.
The right posterior inferior cerebellar artery and left superior cerebellar
artery are not well seen-? diminutive.
The tip of the basilar artery is slightly tortuous in course as also the P1
segment of the right posterior cerebral artery.
The posterior communicating arteries are faintly seen.
The anterior communicating artery is not well seen.
Vascular calcifications are noted in the distal vertebral arteries right more
than left and in the cavernous carotid segments on both sides.
IMPRESSION:
1. Stable 2.8x3.3cm left cerebellar acute hematoma, 2.8x3.3cm, with mild
surrounding edema and mass effect on the left side of ___ ventricle, similar
to the prior study done 8 hr earlier.
2. No obvious aneurysm or AV malformation in the vicinity of the left
cerebellar hematoma. Minimally displaced nondilated vascular structures
adjacent.
Correlate clinically for risk factors. INR/NS consult to decide on further
workup/mngt.
3. Atherosclerotic calcifications in the distal vertebral and cavernous
carotid segments with contour irregularity on both sides.
Patent major intracranial arteries as described above.
Right posterior inferior cerebellar and Left superior cerebellar artery not
well seen.
Other details as above.
|
19992365-RR-47 | 19,992,365 | 20,220,175 | RR | 47 | 2167-10-22 09:14:00 | 2167-10-22 17:53:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: ___ year old man with cerebellar bleed // eval bleed
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal and
thin-section bone algorithm-reconstructed images were acquired.
DOSE: DLP: 1000 mGy-cm
CTDI: 70 mGy
COMPARISON: CT head ___
FINDINGS:
The left cerebellar hematoma measures 2.5 x 2.0 cm (AP x TV), previously 2.4 x
2.8 cm on ___. The surrounding edema and mass effect on the left side of
the ___ ventricle and rightward shift are not significantly changed from the
prior study.
There are no new foci of hemorrhage formation. No evidence of midline shift.
The lateral ventricles and sulci are within normal limits. Basal cisterns are
patent. Gray-white matter differentiation is preserved. No fracture is
identified. The paranasal sinuses, mastoid air cells and middle ear cavities
clear. Bilateral orbits are unremarkable.
IMPRESSION:
Stable left cerebellar hematoma with mass effect on the left side of the ___
ventricle; slightly increased mass effect on ___ ventricle.
Limited assessment of position of cerebellar tonsils, due to dental artifacts
and lack of sagittal and coronal reformations is performed as a portable
study.
Consider standard CT head study as needed and feasible.
|
19992418-RR-5 | 19,992,418 | 20,262,597 | RR | 5 | 2145-01-10 14:05:00 | 2145-01-10 15:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ post-partum 4 days with chest pain and hypertension.
Pneumonia? Widened mediastinum? Pulmonary edema?
TECHNIQUE: Single AP upright portable view of the chest
COMPARISON: None
FINDINGS:
No focal consolidation is seen. There is no large pleural effusion or
pneumothorax. Cardiac silhouette is borderline to mildly enlarged in size
given AP technique. There may be mild central pulmonary vascular engorgement.
IMPRESSION:
Borderline to mildly enlarged cardiac silhouette size. Mild central pulmonary
vascular engorgement.
|
19992418-RR-7 | 19,992,418 | 20,262,597 | RR | 7 | 2145-01-10 13:14:00 | 2145-01-10 14:38:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with bilateral lower extremity swelling. DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19992418-RR-8 | 19,992,418 | 20,262,597 | RR | 8 | 2145-01-10 14:42:00 | 2145-01-10 15:15:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ recently post-partum with shortness of breath and chest
pain. Pulmonary embolism?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
2) Spiral Acquisition 2.6 s, 20.6 cm; CTDIvol = 23.6 mGy (Body) DLP = 485.3
mGy-cm.
Total DLP (Body) = 491 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma.. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pneumothorax is seen. There may be very trace pleural
effusions.
LUNGS/AIRWAYS: Ground-glass opacities in the dependent areas of the lung may
represent fluid overload. The airways are patent to the level of the
segmental bronchi bilaterally.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Ground-glass opacities in the dependent areas of the lung may represent
fluid overload.
3. Possible very trace pleural effusions.
|
19992418-RR-9 | 19,992,418 | 20,262,597 | RR | 9 | 2145-01-11 18:04:00 | 2145-01-12 07:49:00 | EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD.
INDICATION: ___ year old woman with persistent HA, severe pre-eclampsia//
PRES.
TECHNIQUE: 3D time-of-flight MRA was performed through the brain. Sagittal
and axial T1 weighted imaging were performed along with diffusion imaging.
Axial imaging was performed with gradient echo, FLAIR, T2, and T1 technique.
The T1 weighted images were repeated after the intravenous administration of 9
mL of Gadavist contrast agent. Sagittal MPRAGE imaging was performed and
re-formatted in axial and coronal orientations.
3D maximum intensity projection and segmented images were generated. This
report is based on interpretation of all of these images.
COMPARISON: None available.
FINDINGS:
MR BRAIN:
There is no evidence of intracranial hemorrhage,edema,masses,mass effect,
midline shift or infarction. The ventricles and sulci are normal in caliber
and configuration. No diffusion abnormalities are detected.
Both orbits and globes are unremarkable. Paranasal sinuses and mastoid air
cells are unremarkable.
MRA brain: The intracranial vertebral and internal carotid arteries and their
major branches appear normal without evidence of stenosis, occlusion, or
aneurysm formation.
IMPRESSION:
1. Unremarkable MRI and MRA of the brain. There is no evidence of acute
intracranial process or hemorrhage
2. There is no evidence of abnormal enhancement after contrast administration
|
19992507-RR-158 | 19,992,507 | 28,877,211 | RR | 158 | 2175-06-18 09:53:00 | 2175-06-18 10:09:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with h/o SBO, vomiting, no flatus// assess for SBO
COMPARISON: CT of the chest from ___
FINDINGS:
PA and lateral views of the chest provided. Port-A-Cath resides over the
right chest wall with catheter tip in the mid SVC region. The lungs are clear
bilaterally. There is no focal consolidation, large effusion, pneumothorax or
signs of edema. Cardiomediastinal silhouette appears stable. Bony structures
are intact. No free air below the right hemidiaphragm.
IMPRESSION:
No acute findings.
|
19992507-RR-159 | 19,992,507 | 28,877,211 | RR | 159 | 2175-06-18 12:24:00 | 2175-06-18 13:05:00 | EXAMINATION: CT of the abdomen and pelvis
INDICATION: ___ with h/o SBO, vomiting, no flatus//assess for SBO
TECHNIQUE: Multidetector CT through the abdomen pelvis performed following IV
contrast administration with multiplanar reformations provided.
DOSE Total DLP (Body) = 1,532 mGy-cm.
COMPARISON: Prior CT abdomen pelvis dated ___
FINDINGS:
LUNG BASES: The tip of the Port-A-Cath is seen within the low SVC. There is
slight narrowing of the SVC near the cavoatrial junction. The heart is normal
in size though there is mitral annular and aortic valvular calcifications.
The imaged lung bases are clear aside from minimal right basal atelectasis.
ABDOMEN: The liver parenchyma appears normal and there is no concerning liver
lesion. Trace perihepatic ascites is noted. Main portal vein is patent. No
biliary ductal dilation. The gallbladder is normal. The spleen is normal in
size. Adrenals are normal bilaterally. The pancreas appears slightly
atrophic though without signs of inflammation or focal abnormality. The
kidneys enhance symmetrically. No hydronephrosis or worrisome renal lesion.
The abdominal aorta is mildly calcified and normal in caliber. The stomach
and duodenum appear normal.
PELVIS: There are dilated, fluid-filled loops of small bowel, measuring up to
4 cm. There is a left paraumbilical hernia containing small bowel loops. A
dilated loop enters and exits this hernia sac and can be traced to a second
entry point of small-bowel into this hernia sac, seen best on series 2 image
59, likely representing the point of bowel obstruction as there is complete
decompression of small bowel distal to this point. Decompressed small bowel
exits the hernia on series 2 image 59 through 64, and can be traced directly
to the terminal ileum. Appendix is not definitively visualized though there
are no secondary signs of appendicitis. The colon is unremarkable containing
a mild fecal load. The uterus is grossly unchanged with slight prominence of
the endometrium, as stated on prior, measuring up to 2.8 cm, series 2, image
82 which can be further evaluated by a nonemergent pelvic ultrasound. There
is a right adnexal cystic lesion measuring 8.0 x 5.4 x 8.8 cm, previously
characterized as a hydrosalpinx. No left adnexal abnormality. No pelvic free
fluid. The urinary bladder is mostly decompressed. No pelvic sidewall or
inguinal adenopathy.
Bones: No worrisome lytic or blastic osseous lesion.
Soft tissues: In addition to the small bowel containing large left
periumbilical hernia, there are multiple defect in the anterior body wall,
containing fat, series 2, image 36 series 2, image 45, series 2, image 48,
series 2, image 51, and series 2, image 63.
IMPRESSION:
1. Small-bowel obstruction due to a left periumbilical small bowel containing
hernia. Please correlate for reducibility. No free fluid, free air or bowel
wall thickening.
2. Multiple additional fat containing abdominal wall hernias.
3. Right adnexal cystic lesion, previously characterized as hydrosalpinx.
4. Thickened endometrium, measuring up to 2.8 cm, consider nonemergent pelvic
ultrasound to further assess.
RECOMMENDATION(S): Nonemergent pelvic ultrasound to further assess
endometrium.
|
19992507-RR-160 | 19,992,507 | 28,877,211 | RR | 160 | 2175-06-18 16:30:00 | 2175-06-18 17:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with NG tube placement// Eval for NG tube placement
COMPARISON: ___
FINDINGS:
AP portable upright view of the chest. Port-A-Cath resides over the right
chest wall with catheter tip in the region of the mid SVC. The NG tube
terminates in the mid upper abdomen. The imaged portions of the lungs appear
clear. Cardiomediastinal silhouette is stable. No free air seen below the
right hemidiaphragm.
IMPRESSION:
NG tube terminates in the mid upper abdomen.
|
19992507-RR-161 | 19,992,507 | 28,877,211 | RR | 161 | 2175-06-21 15:29:00 | 2175-06-21 16:19:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ y/o F with leukocytosis, hx lymphoma s/p alloSCTx2,
pneumonitis// eval for PNA, atelectasis
COMPARISON: Chest radiograph ___
FINDINGS:
PA and lateral views of the chest provided.
The enteric tube projects over the proximal stomach, with the side port
projecting in the distal esophagus. A right chest wall Port-A-Cath terminates
in the upper SVC.
Lung volumes are low. No consolidation. Small right pleural effusion. No
pneumothorax. Cardiomediastinal silhouette is normal.
IMPRESSION:
1. No pneumonia. Small right pleural effusion.
2. Enteric tube projects over proximal stomach, with the side port projecting
in the distal esophagus. Consider advancement for optimal positioning.
|
19992507-RR-162 | 19,992,507 | 28,877,211 | RR | 162 | 2175-06-25 05:18:00 | 2175-06-25 12:07:00 | INDICATION: ___ w hx marginal zone lymphoma s/p alloSCTx2, remote colon ca
s/p resection w incisional hernia, p/w recurrent SBO// SBO vs ileus
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis dated ___
FINDINGS:
There are multiple air-filled, mildly dilated loops of small and large bowel,
compatible with ileus.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Multiple air-filled, mildly dilated loops of small and large bowel, compatible
with ileus.
|
19992507-RR-165 | 19,992,507 | 28,877,211 | RR | 165 | 2175-06-28 13:59:00 | 2175-06-28 15:56:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ M p/w recurrent SBO now WBC up// r/o aspiration/Pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs ___ through ___, chest CT ___
FINDINGS:
Redemonstration of a dual lumen right sided Port-A-Cath and an enteric tube.
No new focal consolidations. Small right pleural effusion. There is been
interval improvement in right lower lobe atelectasis. No pneumothorax.
Cardiomediastinal silhouette is unchanged.
IMPRESSION:
No new focal consolidations. Improved right lower lobe atelectasis. Small
right pleural effusion.
|
19992507-RR-166 | 19,992,507 | 28,877,211 | RR | 166 | 2175-06-28 13:59:00 | 2175-06-28 16:45:00 | INDICATION: ___ M presenting with recurrent small-bowel obstruction now WBC
elevated. Evaluate for obstruction.
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Abdominal radiograph dated ___
FINDINGS:
There is interval improvement in the mildly dilated loops of small and large
bowel compared to prior study dated ___.
There is no for free intraperitoneal air.
Osseous structures are unremarkable.
Enteric tube is seen with tip region the gastric antrum.
IMPRESSION:
Interval decrease in mildly dilated loops of small and large bowel, compatible
with improving ileus.
|
19992507-RR-168 | 19,992,507 | 28,877,211 | RR | 168 | 2175-06-28 22:31:00 | 2175-06-28 23:24:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ w hx marginal zone lymphoma s/p alloSCTx2, remote colon ca
s/p resection w incisional hernia, p/w recurrent SBO. Please perform with IV
and PO contrast. Please give PO contrast via NGT.// Please perform with IV and
PO contrast to assess obstruction. Please give PO contrast via NGT.
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 70.2 cm; CTDIvol = 23.0 mGy (Body) DLP =
1,615.3 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 33.5 mGy (Body) DLP =
16.8 mGy-cm.
Total DLP (Body) = 1,634 mGy-cm.
COMPARISON: Multiple prior CT abdomen and pelvis examinations most recent
dated ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout
suggestive of hepatic steatosis.. There is no evidence of focal lesions.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There is a nasogastric tube in place. Again seen is left
periumbilical incisional hernia with a 4.2 cm neck (series 2, image 85)
containing multiple loops of small bowel with upstream small bowel dilatation
measuring up to 3.4 cm slightly improved from prior exam. The oral contrast
material has passed through the trapped loops of small-bowel extending to the
transverse colon. There is no evidence of strangulation or ischemia. There
is no pneumoperitoneum.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The endometrium is thickhead measuring 0.9 cm as noted on
pelvic ultrasound dated ___. There is right hydrosalpinx as seen
on prior pelvic ultrasound..
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes are seen in the spine.
SOFT TISSUES: In addition to aforementioned left periumbilical incisional
hernia there is a smaller right ventral abdominal wall hernia containing
mesenteric fat with aperture measuring 15 mm (series 2, image 73) similar to
prior exam.
IMPRESSION:
1. Left periumbilical incisional hernia with a 4.2 cm neck containing loops of
small bowel with interval slight improvement of upstream small bowel
dilatation. The oral contrast material has passed through the trapped loops
of small-bowel in the incisional hernia, however, given the continued upstream
dilation, there appears to be an element of persisting partial obstruction.
2. Thickened endometrium measures 0.9 cm as noted on pelvic ultrasound dated ___. Please correlate with prior endometrial biopsy.
3. Unchanged right hydrosalpinx.
4. Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
|
19992507-RR-169 | 19,992,507 | 28,877,211 | RR | 169 | 2175-06-28 22:32:00 | 2175-06-28 23:20:00 | EXAMINATION: CT CHEST W/CONTRAST ___
INDICATION: ___ w hx marginal zone lymphoma s/p alloSCTx2, remote colon ca
s/p resection w incisional hernia, p/w recurrent SBO. Please perform with IV
and PO contrast. Please give PO contrast via NGT.// Please perform with IV and
PO contrast to assess obstruction. Please give PO contrast via NGT.
TECHNIQUE: Multi-detector helical scanning of the chest, coordinated with
intravenous infusion of nonionic, iodinated contrast agent, following oral
administration of contrast agent for selected abdominal studies, and/or
followed by scanning of the neck, was reconstructed as contiguous 5 mm and 1.0
or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and parasagittal, and 8 mm
MIP axial images. Concurrent scanning of the abdomen and pelvis and/or neck
will be reported separately. All images of the chest were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 70.2 cm; CTDIvol = 23.0 mGy (Body) DLP =
1,615.3 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 33.5 mGy (Body) DLP =
16.8 mGy-cm.
Total DLP (Body) = 1,634 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest CT scans ___ and ___.
FINDINGS:
CHEST PERIMETER: No thyroid findings need any further imaging.
Supraclavicular and axillary lymph nodes are not enlarged. Breast evaluation
is reserved exclusively for mammography. No soft tissue abnormalities
elsewhere in the chest wall. Findings below the diaphragm will be reported
separately.
CARDIO-MEDIASTINUM: Drainage tube traverses normal caliber esophagus.
Atherosclerotic calcification is not apparent in head and neck vessels or
coronary arteries. Moderate calcification of the aortic valve, unchanged
since ___ is sufficient to be hemodynamically significant and should be
evaluated with echocardiography, if not already performed.
Aorta and pulmonary arteries and cardiac chambers are normal size and
pericardium is physiologic.
THORACIC LYMPH NODES: As follows:
Left lower paratracheal mediastinum, 10 mm, previously 8 mm, probably with no
clinical significance. No lymph nodes elsewhere in the chest are either
pathologically enlarged or growing.
LUNGS, AIRWAYS, PLEURAE: Mild bronchial wall thickening and inflammatory micro
nodules in the upper lobes chronic, usually seen in cigarette smokers.
Segmental atelectasis right lower lobe reflects elevated hemidiaphragm. No
bronchial obstruction. Mild peribronchial ground-glass opacification left
lower lobe probably due to aspiration. No pneumonia or measurable pulmonary
nodules.
Tracheobronchial tree is normal to subsegmental levels
CHEST CAGE: Although there are no bone lesions in the imaged chest cage
suspicious for malignancy or infection, it should be noted that radionuclide
bone and FDG PET scanning are more sensitive in detecting early osseous
pathology than chest CT scanning.
IMPRESSION:
No evidence of intrathoracic malignancy or infection.
Right lower lobe segmental atelectasis is a reflection of elevated right
hemidiaphragm. Mild aspiration changes, left lower lobe.
Chronic calcification, aortic valve could be hemodynamically significant,
should be evaluated with echocardiography if not already performed.
|
19992581-RR-6 | 19,992,581 | 22,115,219 | RR | 6 | 2197-03-09 13:58:00 | 2197-03-09 15:25:00 | INDICATION: ___ man with right lower quadrant pain, tenderness,
guarding. Evaluate for appendicitis.
COMPARISON: None.
TECHNIQUE: Contiguous axial imaging was obtained from the lung bases to the
pubic symphysis following the administration of intravenous contrast material.
Coronal and sagittal reformats were completed.
FINDINGS:
CT ABDOMEN WITH CONTRAST: There is no pericardial effusion. The visualized
lung bases are clear.
The liver enhances homogenously without any focal lesions. The portal vein is
patent. There is no intra- or extra-hepatic biliary ductal dilatation. The
gallbladder, pancreas, spleen and adrenal glands are unremarkable. The
kidneys enhance and excrete contrast symmetrically without any focal lesions
or hydronephrosis. The small intra-abdominal and large bowel are
unremarkable. There is no free air or free fluid within the abdomen.
CT PELVIS: The appendix is dilated up to 8 mm, hyperenhancing and
fluid-filled, consistent with acute appendicitis. There is associated
stranding in the right lower quadrant. There is no abscess, drainable fluid
collection or extraluminal air. There is a trace amount of free fluid in the
pelvis posterior to the bladder. The bladder, prostate, rectum and sigmoid
colon are unremarkable. There is no pelvic lymphadenopathy.
OSSEOUS STRUCTURES: There are no suspicious lytic or sclerotic lesions.
IMPRESSION:
1. Dilated fluid-filled appendix consistent with acute appendicitis. No
abscess, drainable fluid collection or extraluminal air.
2. Trace amount of free fluid in the pelvis.
|
19992875-RR-100 | 19,992,875 | 26,793,370 | RR | 100 | 2163-12-23 10:31:00 | 2163-12-23 11:18:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ with transplant liver, needs us to eval transplant. please
___
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Abdominal Doppler ultrasound from ___
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation. The common hepatic duct measures 0.8 cm. There is no
ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen measures 15.6 cm and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 24. Appropriate arterial
waveforms are seen in the right hepatic artery and the left hepatic artery
with resistive indices of 0.74, and 0.79, respectively. The main portal vein
and the right and left portal veins are patent with hepatopetal flow and
normal waveform. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
1. Patent hepatic vasculature with appropriate waveforms.
2. Stable splenomegaly.
|
19992875-RR-131 | 19,992,875 | 24,912,961 | RR | 131 | 2166-04-21 00:20:00 | 2166-04-21 00:35:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with SOB in setting of immunosuppression// r/o PNA
COMPARISON: Multiple chest radiographs dating back to ___ through ___ and CT chest ___.
FINDINGS:
PA and lateral views of the chest
Posterior fusion hardware in the midthoracic spine stable since multiple
priors.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
IMPRESSION:
No acute intrathoracic process.
|
19992875-RR-132 | 19,992,875 | 24,912,961 | RR | 132 | 2166-04-21 01:33:00 | 2166-04-21 02:37:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: History: ___ with liver transplant ___ presenting with
generalized weakness// assess for portal vein thrombosis
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Transplant Doppler ultrasound ___
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation.
CHD: 4 mm
There is no ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen has normal echotexture.
Spleen length: 16.4 cm, previously 15.6 cm.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 70.7 cm/second, previously 24
cm/second. Appropriate arterial waveforms are seen in the right hepatic
artery with resistive indices of 0.49, previously 0.74. The left hepatic
artery was not able to be visualized secondary to poor acoustic windows and
patient breathing. The main portal vein and the right and left portal veins
are patent with hepatopetal flow and normal waveform. Appropriate flow is
seen in the hepatic veins and the IVC.
IMPRESSION:
1. Patent hepatic vasculature with appropriate waveforms. Please note that
the left hepatic artery was not able to be visualized secondary to poor
acoustic windows and patient breathing.
2. Splenomegaly.
|
19992875-RR-133 | 19,992,875 | 21,570,862 | RR | 133 | 2166-07-15 01:03:00 | 2166-07-15 01:19:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with liver transplant weakness// Pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
There is no focal consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette is unchanged. Posterior midthoracic spinal
fusion hardware is again noted. There is no acute osseous abnormality.
IMPRESSION:
No acute cardiopulmonary process.
|
19992875-RR-134 | 19,992,875 | 21,570,862 | RR | 134 | 2166-07-15 01:12:00 | 2166-07-15 02:01:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ with liver transplant with RUQ pain weakness// chole? PVT?
pls get doppler thnx
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation.
CHD: 6 mm
There is no ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen has normal echotexture.
Spleen length: 13.9 cm
DOPPLER: The main hepatic artery shows a high resistance pattern, with sharp
systolic upstrokes with diminished antegrade diastolic flow. Peak systolic
velocity in the main hepatic artery is 31.3 cm/s, previously 70.7 cm/s. The
right and left hepatic arteries were not visualized. The main portal vein and
the right and left portal veins are patent with hepatopetal flow and normal
waveform. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
1. High resistance waveform in the main hepatic artery with diminished
antegrade diastolic flow as well as interval decrease in peak systolic
velocity (31.3 cm/s), represents a change from ultrasound of ___
and is concerning for possible occlusion. Recommend clinical correlation with
LFTs and CT angiogram.
2. Patent portal veins.
3. Splenomegaly.
RECOMMENDATION(S): Recommend clinical correlation with LFTs and CT angiogram.
NOTIFICATION: The recommendations were discussed with Dr. ___. by
___, M.D. on the telephone on ___ at 11:56 am.
|
19992875-RR-135 | 19,992,875 | 21,570,862 | RR | 135 | 2166-07-15 01:45:00 | 2166-07-15 03:03:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with IBS versus Crohn's with unknown onset abdominal pain and
weaknessNO_PO contrast// Colitis abscess?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 7.4 s, 58.1 cm; CTDIvol = 12.0 mGy (Body) DLP = 695.3
mGy-cm.
Total DLP (Body) = 707 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: Bibasilar atelectasis. There is no evidence of pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The patient is status post hepatic transplant. The liver
demonstrates homogenous attenuation throughout. There is no evidence of focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas is mildly atrophic, without evidence of focal lesions
or pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen is enlarged measuring 14 cm and shows attenuation
throughout, without evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is right upper pole. A subcentimeter hypodensity arising from the right
lower pole is too small to characterize, but is likely simple cyst. There is
no evidence of focal renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Submucosal fat is
seen in the sigmoid colon, consistent with the patient's diagnosis of Crohn's
disease. There is lipomatosis of the ileocecal valve. The appendix is
normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. There is suboptimal evaluation of the hepatic arterial vasculature
on this non angiogram study. The transplant main hepatic artery appears to
arise from the SMA and is patent to level of the hilum.
BONES: Bones are osteopenic. There is no evidence of worrisome osseous
lesions or acute fracture. Schmorl's nodes are seen along the superior
endplates T12 and L1. There is a chronic/healed right L2 transverse process
fracture.
SOFT TISSUES: An umbilical hernia containing fat is noted.
IMPRESSION:
1. No acute intra-abdominal process.
2. Unremarkable appearance of the liver transplant. The transplant main
hepatic artery appears patent to level of the liver hilum. Suboptimal
evaluation of the hepatic arterial vasculature on this non dedicated study.
3. Splenomegaly.
|
19992875-RR-136 | 19,992,875 | 21,570,862 | RR | 136 | 2166-07-17 19:57:00 | 2166-07-17 21:13:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with hx of PBC s/p liver transplant (___),
hemorrhagic pericarditis s/p window, CAD c/b MI x 2 (___), IBSvs Crohn's
disease, OA, and pancytopenia who presents with generalized weakness; on RUQ
U/S found to have ?decreased hepatic artery flow// main hepatic artery with
diminished antegrade diastolic flow. Occlusion? Stenosis?
TECHNIQUE: Abdomen CTA: Non-contrast and multiphasic post-contrast images
were acquired through the abdomen.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.3 s, 35.7 cm; CTDIvol = 3.4 mGy (Body) DLP = 121.3
mGy-cm.
2) Spiral Acquisition 1.5 s, 19.7 cm; CTDIvol = 12.0 mGy (Body) DLP = 234.9
mGy-cm.
3) Spiral Acquisition 2.5 s, 33.7 cm; CTDIvol = 11.4 mGy (Body) DLP = 383.8
mGy-cm.
4) Spiral Acquisition 1.5 s, 19.7 cm; CTDIvol = 11.9 mGy (Body) DLP = 233.1
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.3
mGy-cm.
6) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 16.0 mGy (Body) DLP =
8.0 mGy-cm.
Total DLP (Body) = 982 mGy-cm.
COMPARISON: Comparison to previous CT ___.
FINDINGS:
VASCULAR:
The main hepatic artery arises from the SMA and is widely patent. The left
and right hepatic arteries are relatively small caliber but appear similar to
prior CTA chest from ___. There is no evidence of focal stenosis.
There is stable postsurgical change along the course of the main hepatic
artery.
Major portal and hepatic veins are patent. The celiac and SMA are widely
patent. There is mild atherosclerotic plaque in the visualized abdominal
aorta.
LOWER CHEST: There is mild scarring at the left lung base. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout and
shows normal enhancement on all phases. There is no evidence of focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas demonstrates normal attenuation throughout. A 13 x 8
mm cystic lesion in the pancreatic head (303:55) is unchanged from MRCP ___ and likely represents a side-branch IPMN. There is no main duct
dilation.
SPLEEN: This plane is mildly enlarged at 14.8 cm in the sagittal plane. The
parenchyma enhances homogeneously.
ADRENALS: The bilateral adrenals are unremarkable.
URINARY: There is mild cortical scarring in the right kidney. Adjacent
punctate calcifications could represent stones or parenchymal calcifications.
There are multiple small cortical hypodensities in the right kidney,
incompletely characterized but likely cysts. There is no hydronephrosis.
GASTROINTESTINAL: Visualized bowel is grossly unremarkable. No ascites in the
field of view.
LYMPH NODES: A 1 cm upper abdominal node is stable from ___ (303:28). No new
enlarged nodes.
BONES: There is stable mild anterior wedge compression deformity of T12 and
L1. Nonacute right L1-L3 transverse process fractures are again noted. No
aggressive bone lesions.
SOFT TISSUES: The abdominal wall is within normal limits aside from a tiny fat
containing periumbilical hernia.
IMPRESSION:
1. Main, left and right hepatic arteries are patent and appear similar to CTA
from ___ with no evidence of focal stenosis.
2. Stable pancreatic cystic lesion is likely a side-branch IPMN and can be
re-evaluated at next follow-up.
|
19992875-RR-32 | 19,992,875 | 20,870,047 | RR | 32 | 2160-04-13 15:14:00 | 2160-04-13 16:50:00 | TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient status post left anterior thoracotomy
with pericardial window and chest tube placement. Postoperative evaluation.
FINDINGS: AP single view of the chest has been obtained with patient in
semi-upright position. Comparison is made to the next preceding PA and
lateral chest examination of ___. The patient has undergone
left-sided anterior thoracotomy and pericardial window creation. A transverse
running row of cutaneous surgical clips overlying the left upper abdominal
quadrant indicating the entrance for the left-sided thoracotomy. One chest
tube in this area terminates in the lower left-sided pleural space. The
second tube has a course which suggests its placement within the pericardial
space. There is no evidence of pneumothorax in the apical area. In the right
hemithorax, a diffuse hazy density has developed obliterating the right-sided
diaphragmatic contours and reaching along the lateral chest wall. This is
compatible with pleural effusion layering in the posterior depending portions
of the right-sided pleural space. A circular translucency overlying the right
lung base compatible with a loculated air bubble top of the thorax as the
patient in steep recumbent, almost supine position. Referring physician, ___.
___, was paged at 4:30 p.m. Situation was discussed with Dr.
___ confirmed that pericardium was evacuated from bloody content
and that pleural effusions were present at the time of the operation.
Confirmed that the patient was in practically supine position at the time of
the radiograph.
|
19992875-RR-33 | 19,992,875 | 20,870,047 | RR | 33 | 2160-04-14 02:32:00 | 2160-04-14 08:31:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Pericardial window
Comparison is made with prior study performed a day earlier.
Moderate enlargement of the cardiomediastinal silhouette has minimally
improved. There is no evident pneumothorax. Left chest tube and a second
tube projecting over the heart are in unchanged position. Enlarged right
pleural effusion is grossly unchanged allowing the difference in positioning
of the patient associated with adjacent atelectasis. A rounded radiolucency
projecting in the right lower hemithorax is again noted, this could be due to
air in the pleural space or aerated lung surrounding by atelectasis.
|
19992875-RR-35 | 19,992,875 | 20,870,047 | RR | 35 | 2160-04-15 03:21:00 | 2160-04-15 05:18:00 | INDICATION: Patient with history of pericardial effusion, cardiac tamponade,
status post pericardial window.
COMPARISON: Multiple chest radiographs dating back to ___.
TECHNIQUE: MDCT-acquired contiguous images through the chest were obtained at
5-mm slice thickness. Coronally and sagittally reformatted images are
provided.
FINDINGS:
Heart is mildly enlarged. There is a thickened pericardium and a 2moderately
large heterogeneous pericardial effusion, which measures up to 40 Hounsfield
units in attenuation, compatible with hemorrhagic effusion. No prior CTs are
available for direct comparison. Small locules of gas are seen adjacent to
the cardiac silhouette within the pericardium, which likely relate to recent
procedure. Post-surgical changes related to left-sided thoracotomy are noted.
Multiple surgical staples project over lower left chest. Left-sided chest
tube is seen terminating at the left lung base. The pericardial drain has
been removed since ___ radiograph. There is a small left-sided
pneumothorax.
There is a nonhemorrhagic moderately large right pleural effusion and small
left pleural effusion. Adjacent areas of consolidations most likely represent
atelectasis. Paraseptal emphysema is evident at the lung apices. Small amount
of fluid is seen layering along the major fissures bilaterally. No suspicious
pulmonary mass or nodule is detected. The pulmonary artery is well opacified
without apparent perfusion defects. The intrathoracic aorta is normal in
caliber without evidence of dissection. The great vessels are unremarkable.
There are scattered mediastinal lymph nodes, which do not meet CT criteria for
pathologic enlargement. There is no hilar lymphadenopathy. No pathologically
enlarged axillary lymph nodes are seen.
This study is not tailored for subdiaphragmatic evaluation. The spleen is
enlarged measuring 15 cm.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is seen. Mild
anterior wedge deformity and Schmorl's node involving lower thoracic vertebral
bodies are noted.
IMPRESSION:
1. Moderately large intermediate density pericardial effusion, which is
likely hemorrhagic. Adjacent small locules of gas, likely relate to recent
procedure.
2. Small left pneumothorax. Left-sided chest tube is in place terminating at
the left lung base.
3. Moderate non-hemorrhagic right and small left pleural effusions. Adjacent
areas of consolidations most likely represent atelectasis.
4. Splenomegaly.
The findings discussed with Dr. ___ at 4:50 a.m. ___ by phone at the
time of the discovery.
|
19992875-RR-36 | 19,992,875 | 20,870,047 | RR | 36 | 2160-04-15 12:10:00 | 2160-04-15 13:50:00 | PORTABLE CHEST FILM ___ AT 1219
CLINICAL INDICATION: ___ post chest tube removal, question
pneumothorax.
Comparison to prior study of ___ at 242.
A portable upright chest film ___ at 1219 is submitted.
IMPRESSION:
Stable cardiac enlargement. There is right basilar and lateral pleural
thickening with associated patchy basilar airspace disease which could reflect
atelectasis. There has been interval removal of the left chest tubes with
residual patchy basilar opacity likely representing areas of atelectasis.
Possible tiny left apical pneumothorax given the presence of an area of focal
lucency at the apex. Follow up imaging is advised. No evidence of pulmonary
edema.
|
19992875-RR-37 | 19,992,875 | 20,870,047 | RR | 37 | 2160-04-16 07:14:00 | 2160-04-16 11:13:00 | PORTABLE AP CHEST FILM ___ AT 722
CLINICAL INDICATION: ___ with loculated pericardial effusion and
pleural effusions, status post pericardiocentesis, left thoracotomy and
pericardial window, question interval change.
Comparison is made to the patient's prior study dated ___ at 1219.
AP portable upright chest film ___ at 722 is submitted.
IMPRESSION:
1. Stable cardiac enlargement and stable mediastinal contours. There
continue to be bilateral pleural effusions with associated patchy and linear
opacities at the right base and more focal airspace consolidation at the left
base. These findings may represent atelectasis, although superimposed
infection cannot be entirely excluded. No evidence of pulmonary edema.
Previously seen lucency at the left apex is no longer seen. No pneumothorax
is appreciated. There are some bullous cystic changes at both apices
consistent with known paraseptal emphysema seen on recent CT study of
___.
|
19992875-RR-39 | 19,992,875 | 28,963,342 | RR | 39 | 2160-05-20 09:04:00 | 2160-05-20 09:55:00 | HISTORY: ___ male with cirrhosis and acutely worsening liver
functions.
TECHNIQUE: Transabdominal grayscale and duplex Doppler ultrasound examination
of the upper abdomen was performed.
COMPARISON: ___ and ___.
FINDINGS:
The liver demonstrates coarsened nodular echotexture, consistent with
cirrhosis. No focal liver lesions are detected. There is no intra or
extrahepatic biliary ductal dilation. The gallbladder is collapsed and
therefore incompletely evaluated. The spleen is enlarged measuring 19.4 cm.
The pancreas is not well seen on this study due to overlying bowel gas. The
right kidney measures 11.6 cm. A 1 cm non-obstructing calculus is seen in the
right renal upper pole. The left kidney measures 10.1 cm. Neither kidney
demonstrates hydronephrosis or large masses. No ascites is detected.
The main, right anterior, right posterior, and left portal veins are patent;
flattened waveform in the portal vein is consistent with known cirrhosis. The
left, middle, and right hepatic veins are patent with normal waveforms. The
main, right, and left hepatic arteries are patent with normal waveforms. The
inferior vena cava, superior mesenteric vein, and splenic vein demonstrate
normal waveforms. A prominent splenic artery appears unchanged compared to
chest CT dated ___.
IMPRESSION:
1. No sonographic evidence for portal vein thrombosis.
2. Cirrhosis with splenomegaly. No liver lesions or ascites detected.
3. Non-obstructing 1 cm right renal calculus.
|
19992875-RR-40 | 19,992,875 | 28,963,342 | RR | 40 | 2160-05-21 11:09:00 | 2160-05-21 12:49:00 | ABDOMINAL RADIOGRAPH SERIES, DATED ___
COMPARISON: Scout images of the abdomen from an abdominal CT dated ___.
FINDINGS: A large amount of stool is present throughout the colon extending
into the rectosigmoid region. Scattered air-fluid levels are also present
within non-distended loops of small bowel. There is no evidence of free
intraperitoneal air. Prominent soft tissue in left upper quadrant of the
abdomen probably relates to known splenic enlargement reported on prior CT
scan. Within the imaged portion of the chest, note is made of interstitial
opacities in the mid and lower lungs suggestive of interstitial edema, as well
as a more focal opacity at the left lung base, which may reflect atelectasis
and less likely a focal pneumonia or area of infarction. Small left pleural
effusion is also demonstrated.
|
19992875-RR-41 | 19,992,875 | 27,668,708 | RR | 41 | 2160-06-19 22:32:00 | 2160-06-20 13:25:00 | HISTORY: Evaluation for fecal load and free air in a man with a history of
primary biliary cirrhosis and acute abdominal pain.
COMPARISON: Abdominal radiograph ___.
FINDINGS: Frontal upright and supine radiographs demonstrate a moderate
amount of stool throughout the colon extending to the rectosigmoid junction.
There are air-filled loops of small bowel that are mildly distended. There is
no abnormal air-fluid levels or evidence of free intraperitoneal air.
Prominent soft tissues in the left upper quadrant of the abdomen is due to
splenic enlargement. There is a small left pleural effusion.
IMPRESSION: Moderate fecal load throughout the colon. No free air
identified. Small left pleural effusion.
|
19992875-RR-42 | 19,992,875 | 27,668,708 | RR | 42 | 2160-06-19 22:31:00 | 2160-06-19 23:24:00 | HISTORY: Primary biliary cirrhosis presenting with abdominal pain, assess for
a portal vein thrombosis.
TECHNIQUE: Grayscale and Doppler examination was performed of the liver.
COMPARISON: Abdominal ultrasound of ___.
FINDINGS:
Again, the liver demonstrates a coarsened and nodular echotexture consistent
with cirrhosis. There are no focal liver lesions identified. The spleen
remains enlarged, measuring 20.1 cm. There is no ascites.
The gallbladder is collapsed. There is no intrahepatic biliary ductal
dilation of the common bile duct is not dilated. To the extent visualized,
the pancreas is unremarkable. A 0.6 cm nonobstructing stone is incidentally
noted in the right kidney.
The main, right anterior, right posterior and left portal veins are patent
with normal hepatopetal flow. A flattened wave form in the main portal vein
is consistent with known cirrhosis. The main, left and right hepatic veins
are patent and demonstrate normal respiratory phasicity. The main hepatic
artery demonstrates a normal waveform. The inferior vena cava is patent.
IMPRESSION:
1. No sonographic evidence for a portal venous thrombosis. Patent portal
vein with hepatopetal flow.
2. Cirrhosis with unchanged splenomegaly, no ascites.
3. Incidental, nonobstructing 0.6 cm right renal stone.
|
19992875-RR-44 | 19,992,875 | 21,441,737 | RR | 44 | 2160-08-29 21:25:00 | 2160-08-29 22:24:00 | ABDOMINAL RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior MRI of the abdomen from ___ and abdominal radiograph
from ___.
CLINICAL HISTORY: Abdominal pain, assess stool burden.
FINDINGS: Supine and upright views of the abdomen and pelvis were provided.
There is a large amount of fecal loading within the colon, increased from
prior exam. There is no free air below the right hemidiaphragm. No signs of
bowel obstruction. Bony structures are intact.
IMPRESSION: Large fecal load.No bowel obstruction.
|
19992875-RR-45 | 19,992,875 | 21,441,737 | RR | 45 | 2160-08-31 09:33:00 | 2160-08-31 10:00:00 | HISTORY: Constipation, to assess for obstruction.
FINDINGS: There are mildly dilated loops of both large and small bowel,
presenting a nonspecific pattern. General haziness of the abdominal contents
with central position of the bowel loops raises the possibility of ascites.
There appears to be substantial soft tissues to the left lateral aspect of the
mid and upper abdomen, suggesting substantial enlargement of the spleen.
If there is serious clinical concern for possible obstruction, CT would be the
next imaging procedure.
|
19992875-RR-46 | 19,992,875 | 21,441,737 | RR | 46 | 2160-08-31 21:58:00 | 2160-08-31 22:43:00 | INDICATION: History of primary biliary cirrhosis with increased bilirubin.
COMPARISON: MR abdomen, ___.
FINDINGS: The liver is coarse and echogenic, consistent with known cirrhosis.
The main portal vein is patent and displays hepatopetal flow. There is no
intra- or extra-hepatic biliary ductal dilatation and the common bile duct
measures 3 mm. The gallbladder is contracted as seen on prior MR. ___
pancreas is not visualized. The spleen is markedly enlarged, measuring 23.1
cm. There is no ascites.
IMPRESSION:
1. Coarsened liver echotexture. No biliary dilatation.
2. Splenomegaly.
|
19992875-RR-47 | 19,992,875 | 21,441,737 | RR | 47 | 2160-09-02 02:04:00 | 2160-09-02 09:26:00 | HISTORY: Preoperative.
FINDINGS: In comparison with study of ___, there is no evidence of acute
cardiopulmonary disease. No pneumonia or vascular congestion or pleural
effusion. Streaks of opacification at both bases are consistent with
atelectatic change.
|
19992875-RR-48 | 19,992,875 | 21,441,737 | RR | 48 | 2160-09-02 13:06:00 | 2160-09-02 13:50:00 | HISTORY: Swan-Ganz placement.
FINDINGS: In comparison with the earlier study of this date, there has been
placement of a Swan-Ganz catheter with the tip in the right pulmonary artery.
Endotracheal tube tip lies well above the clavicles, approximately 9 cm above
the carina. It could be pushed forward several cm to be better seated. There
are lower lung volumes, but no evidence of acute pneumonia or vascular
congestion. Mild atelectatic changes at the bases.
|
19992875-RR-49 | 19,992,875 | 21,441,737 | RR | 49 | 2160-09-02 15:08:00 | 2160-09-02 16:40:00 | HISTORY: Tubes advanced, to assess for position.
FINDINGS: In comparison with the earlier study of this date, the tip of the
endotracheal tube has been advanced to the clavicular level, approximately 4.5
cm above the carina. Nasogastric tube has been advanced so that the side hole
lies below the level of the esophagogastric junction.
Little change in the appearance of the heart and lungs.
|
19992875-RR-50 | 19,992,875 | 21,441,737 | RR | 50 | 2160-09-03 08:28:00 | 2160-09-03 14:09:00 | INDICATION: Status post liver transplant. Evaluate flow.
COMPARISONS: Liver ultrasound from ___, pretransplant.
TECHNIQUE: Gray-scale, Doppler, and spectral ultrasound images were acquired
through the right upper quadrant.
FINDINGS: The transplanted liver is normal in shape and contour. There is
normal echogenicity. No focal hepatic lesions are identified. There is no
intra- or extra-hepatic biliary duct dilation. The common bile duct measures
5 mm.
The left, middle, and right hepatic veins are patent with normal venous flow.
The main, right posterior, right anterior, and left portal veins are patent
with normal direction of flow and appropriate velocities. The main hepatic
artery is patent with a normal arterial waveform. The resistive index is
0.79. The right hepatic artery is patent with a normal arterial waveform.
The resistive index is 0.6. The left hepatic artery is patent with normal
arterial waveform. The resistive index is 0.77.
There are no fluid collections surrounding the liver. The spleen remains
enlarged, measuring 19.4 cm, which is not significantly changed from the prior
exam. Limited views of the right kidney are normal.
IMPRESSION:
1. Normal appearance of post-transplant liver with normal arterial waveforms
in the right, main, and left hepatic arteries, and patent portal and hepatic
veins.
2. Unchanged splenomegaly.
|
19992875-RR-51 | 19,992,875 | 21,441,737 | RR | 51 | 2160-09-03 11:34:00 | 2160-09-03 15:36:00 | HISTORY: Status post line change.
___.
FINDINGS:
There has been interval replacement of the right IJ Swan-Ganz catheter with a
right IJ line. The tip is in the right atrium, just below the cavoatrial
junction. The ET tube has been removed. The NG tube tip is in the stomach.
2 right-sided chest tubes are again visualized. Skin staples are again seen.
As on the prior study, the colon is slightly prominent measuring up to 5.5 cm.
There are bilateral pleural effusions, pulmonary vascular redistribution and
alveolar infiltrates compatible with fluid overload. This is worsened
compared to the study from the prior day.
|
19992875-RR-52 | 19,992,875 | 21,441,737 | RR | 52 | 2160-09-11 09:22:00 | 2160-09-11 10:15:00 | HISTORY: ___ male with PSC status post liver transplant postop day 9
with right leg swelling. Evaluate for DVT.
COMPARISON: None.
FINDINGS:
Gray scale and color Doppler ultrasound was performed of the right common
femoral, superficial femoral, popliteal, posterior tibial and peroneal veins.
There is normal flow, augmentation and compressibility.
IMPRESSION:
No evidence of DVT in the right lower extremity.
|
19992875-RR-60 | 19,992,875 | 27,965,926 | RR | 60 | 2160-12-27 02:56:00 | 2160-12-27 03:33:00 | HISTORY: Fever and abdominal pain.
TECHNIQUE: CT of the abdomen and pelvis with IV contrast. Coronal and
sagittal reformations were reviewed. Oral contrast was administered.
COMPARISON: ___
FINDINGS:
LOWER CHEST: Scattered bibasilar atelectasis is once again present. .
Cardiac apex is unremarkable.
ABDOMEN: The transplanted liver enhances homogeneously. There are no focal
liver lesions. The main portal vein is patent. Postsurgical changes are
around the biliary did jejunal anastomosis are again noted.
The gallbladder contains no evidence of stones and there is no pericholecystic
fluid or gallbladder wall edema. The pancreas and bilateral adrenal glands
are normal. Spleen is enlarged at 18 cm
Bilateral kidneys enhance and excrete contrast symmetrically without evidence
of hydronephrosis or suspicious renal masses. A right lower pole hypodensity
is too small to accurately characterize, but statistically is most likely a
simple renal cyst.
The abdominal aorta is normal in course and caliber. Mural thrombus is once
again noted just prior to the bifurcation.
There is trace abdominal free fluid
The stomach, small, and large bowel are normal in caliber. Scattered sigmoid
diverticulosis is present without evidence of acute diverticulitis. The cecum
is near the inferior tip of the liver. The appendix is normal.
PELVIS: The bladder, prostate, and rectum are unremarkable. There is no
pelvic free fluid or lymphadenopathy.
BONES: There are no suspicious bony lesions.
IMPRESSION:
No evidence of acute intra-abdominal process.
|
19992875-RR-62 | 19,992,875 | 22,729,360 | RR | 62 | 2161-05-09 21:32:00 | 2161-05-09 22:49:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior chest radiograph from ___.
CLINICAL HISTORY: Neutropenia and toxic symptoms, question pneumonia.
FINDINGS: PA and lateral views of the chest were provided demonstrating no
focal consolidation, effusion or pneumothorax. The cardiomediastinal
silhouette appears normal. Subtle opacities projecting over the lower lungs
are most compatible with subsegmental atelectasis. No effusion or
pneumothorax is seen. Biapical pleural parenchymal scarring is noted.
IMPRESSION: No acute osseous abnormality.
|
19992875-RR-63 | 19,992,875 | 22,729,360 | RR | 63 | 2161-05-09 23:04:00 | 2161-05-10 00:13:00 | INDICATION: Status post liver transplant with fevers and chills. Evaluate
for portal vein thrombosis.
COMPARISON: Ultrasound ___, CT ___.
FINDINGS: The transplated liver is mildly heterogeneous in echotexture. No
focal liver lesion is identified. There is no intrahepatic bile duct
dilation. The common duct is mildly dilated to 7 mm, which can be seen after
cholecystectomy. The pancreas is not seen due to overlying bowel gas. The
spleen is enlarged measuring 18.7 cm, previously 21 cm, smaller. There is no
ascites.
DOPPLER: Color Doppler sonogram with spectral analysis of the hepatic
vasculature was performed. The main portal vein is patent with normal
hepatopetal flow. The left portal, right anterior and right posterior portal
veins are patent with normal forward flow. The left, middle and right hepatic
veins are patent with normal waveforms. The main hepatic artery has brisk
systolic upstroke and forward flow in diastole with RI 0.82, previously 0.63.
The right and left hepatic arteries have brisk systolic upstroke with forward
flow in diastole with RIs 0.68 and 0.70, respectively, previously 0.62 and
0.56, respectively. The IVC has normal color flow and normal waveform.
IMPRESSION: Normal liver Doppler. No focal liver lesion.
|
19992875-RR-64 | 19,992,875 | 22,729,360 | RR | 64 | 2161-05-13 16:28:00 | 2161-05-13 17:34:00 | CLINICAL HISTORY: Neutropenic fever, evaluate for pneumonia.
CHEST, PA AND LATERAL
Heart and mediastinum are normal. No evidence of pneumonia is present. The
lung fields are essentially clear.
|
19992875-RR-77 | 19,992,875 | 29,454,637 | RR | 77 | 2162-09-12 00:15:00 | 2162-09-12 01:24:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with fatigue elevated LFTs, ___ s/p liver xplant
// signs liver rejection, PVT?
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Liver ultrasound from ___.
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation. There is no ascites, right pleural effusion or sub- or
___ fluid collections/hematomas.
Evaluation of the pancreas is limited by overlying bowel gas.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 46.4 cm/sec. Appropriate
arterial waveforms are seen in the right hepatic artery and the left hepatic
artery with resistive indices of 0.64, and 0.54, respectively. The main
portal vein, right and left portal veins are patent with hepatopetal flow with
normal waveform. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
Patent hepatic vasculature with appropriate waveforms.
|
19992875-RR-78 | 19,992,875 | 29,454,637 | RR | 78 | 2162-09-12 00:23:00 | 2162-09-12 06:34:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: History: ___ with fatigue, immunocompromised // PNA? PNA?
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest CT from ___ and outside chest radiograph from ___.
FINDINGS:
Aside from mediastinal and extrapleural fat deposition, often seen with
chronic steroid use, cardiomediastinal and hilar contours are within normal
limits. There is mild atelectasis at the lingula. Lungs are otherwise well
expanded and clear. There is no focal consolidation, pleural effusion or
pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
19992875-RR-79 | 19,992,875 | 29,454,637 | RR | 79 | 2162-09-13 16:21:00 | 2162-09-13 18:00:00 | INDICATION: ___ year old man with possible liver transplant failure on high
dose aspirin // transjugular liver biopsy
COMPARISON: CHEST CT WITHOUT CONTRAST ___
TECHNIQUE: OPERATORS: Dr. ___, Interventional Radiology Fellow and Dr.
___, attending radiologist performed the procedure. Dr. ___
personally supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
75mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 35 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, midazolam
CONTRAST: 20 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 9.1 min, 53 mGy
PROCEDURE: 1. Right internal jugular venous access using ultrasound.
2. Right atrial and hepatic venous and balloon-occluded portal pressure
measurements.
3. Transjugular hepatic core biopsy with 5 passes.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Hard copy
ultrasound images were obtained before and after intravenous access.
Subsequently a Nitinol wire was passed into the right atrium using
fluoroscopic guidance. A small incision was made at the needle entry site. The
needle was exchanged for a micropuncture sheath. The Nitinol wire was removed
and a short ___ wire was advanced distally into the IVC.
A 9 ___ sheath was advanced over the wire into the inferior vena cava.
Using a Cobra catheter and ___ wire, access was obtained in the right
hepatic vein. Appropriate position was confirmed with contrast injection and
fluoroscopy. The ___ wire was exchanged for Glide wire and the sheath was
advanced into the right hepatic vein.
The biopsy needle was advanced through the liver access sheath and 5 x 18
gauge core biopsies were acquired while pointing the biopsy sheath anteriorly.
The core biopsies were placed in formalin and labeled for pathology.
The wire, catheters and core biopsy needle were then removed, pressure held
until hemostasis was achieved and sterile dressings were applied. The patient
tolerated the procedure well and there were no immediate post-procedure
complications.
FINDINGS:
1. Patent right internal jugular vein.
2. Five 18G core biopsies of the liver acquired through transjugular access
(because the initial samples were considered less than optimal)..
IMPRESSION:
Successful transjugular liver biopsy, as above.
|
19992875-RR-80 | 19,992,875 | 29,454,637 | RR | 80 | 2162-09-16 11:25:00 | 2162-09-16 18:17:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with hx PBC s/p liver transplant from ___+ donor
(___) c/b CMV viremia and rejection ___ yr ago now on tacro and steroids p/w
one week of progressive malaise found to have elevated LFTs concerning for
rejection vs infection (hx CMV viremia). // biliary pathology
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: Gadavist 8 cc.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Abdominal ultrasound from ___, abdominal/pelvic CT from
___, abdominal MRI from ___ and abdominal/pelvic CT from ___.
FINDINGS:
Lower Thorax: There is persistent increased opacity and increased signal
intensity at the left lung base, as seen on prior CT examination from ___. In addition, mild to moderate bibasilar atelectasis is
present. Visualized portions of the heart are within normal limits.
Liver: Patient is status post orthotopic liver transplant for primary biliary
cirrhosis. The transplanted liver is of normal signal intensity. There is no
focal hepatic lesion, abscess or biliary collection.
Biliary: There is mild intrahepatic biliary ductal dilatation, with a
transition point identified between the native and transplant bile ducts.
There is a notable transition with a difference in caliber between the native
and transplant bile ducts, measuring 10 mm above the transition point and 4 mm
below (series 6, image 40).
There are no filling defects within the ducts to suggest choledocholithiasis.
Pancreas: The pancreas is of normal signal intensity. There are no
pancreatic masses or peripancreatic fluid collections. There is focal
dilation of the distal pancreatic duct, at the level of the communication with
the common bile duct (series 6, image 40).
Spleen: The spleen has normal signal intensity and is enlarged, measuring up
to 16.4 cm.
Adrenal Glands: The adrenal glands are normal.
Kidneys: There is cortical scarring in the upper pole of the right kidney.
The kidneys otherwise enhance symmetrically with no hydronephrosis or renal
masses.
Gastrointestinal Tract: The stomach as well as visualized loops of small and
large bowel are within normal limits.
Lymph Nodes: There are no pathologically enlarged lymph nodes.
Vasculature: The portal vein is patent. Visualized portions of the
intraabdominal aorta are normal in caliber. The celiac axis, SMA and bilateral
renal arteries are patent.
Osseous and Soft Tissue Structures: Schmorl's nodes are noted at the superior
endplates of the lower thoracic spine, consistent with degenerative changes.
IMPRESSION:
1. Status post orthotopic liver transplant with mild intrahepatic biliary
ductal dilatation and a transition point identified between the native and
transplant bile ducts. It is unclear whether these findings are chronic in
nature or could reflect a stricture at the surgical anastomosis.
2. Transplanted liver parenchyma is normal with no focal mass, abscess or
biliary collection.
3. Splenomegaly.
4. Persistent increased opacity in the left lower lobe, as seen on CT
examination from ___.
RECOMMENDATION(S): Consider ERCP for direct assessment of biliary anastomotic
caliber if there is clinical suspicion for biliary stricture.
NOTIFICATION: Finding #1 was discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 6:15 ___, 15 minutes after discovery of the
findings.
|
19992875-RR-81 | 19,992,875 | 25,002,205 | RR | 81 | 2162-11-12 02:16:00 | 2162-11-12 06:01:00 | INDICATION: History: ___ with cp // eval for cp
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Normal heart size, mediastinal and hilar contours. No focal consolidation,
pleural effusion or pneumothorax. Multiple healed right-sided rib fractures
are noted which appear new from ___.
IMPRESSION:
No acute process. Multiple healing right-sided rib fractures.
|
19992875-RR-88 | 19,992,875 | 29,951,097 | RR | 88 | 2163-04-01 21:35:00 | 2163-04-01 22:22:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: History: ___ with PBC s/p liver transplant p/w BRBPR and
abdominal pain // graft eval
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: ___ liver Doppler ultrasound
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation. There is no ascites, right pleural effusion or sub- or
___ fluid collections/hematomas.
The spleen measures 17 cm and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 54 cm/sec. Appropriate
arterial waveforms are seen in the right hepatic artery and the left hepatic
artery with resistive indices of 0.64, and 0.58, respectively. The main
portal vein, right and left portal veins are patent with hepatopetal flow with
normal waveform. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
1. Unremarkable liver transplant with patent hepatic vasculature and normal
waveforms.
2. Splenomegaly.
|
19992875-RR-89 | 19,992,875 | 29,951,097 | RR | 89 | 2163-04-02 18:50:00 | 2163-04-02 19:19:00 | EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old man with h/o liver transplant presents with BRBPR and
___ described trouble urinating and suprapubic pain
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys and
bladder were obtained.
COMPARISON: CT A/P dated ___
FINDINGS:
The right kidney measures 9.3 cm and contains a simple appearing 1.1 cm lower
pole cyst. The left kidney measures 9.7 cm. There is no hydronephrosis,
stones, or masses bilaterally. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally.
The bladder is normal in appearance. Postvoid images of the bladder were not
obtained secondary to the patient's inability to void. Calculated prostate
volume is 22 cc.
IMPRESSION:
Normal appearance of the bilateral kidneys.
|
19992875-RR-96 | 19,992,875 | 29,765,419 | RR | 96 | 2163-11-10 14:17:00 | 2163-11-10 16:23:00 | INDICATION: ___ year old man with abdominal pain, diarrhea found to have C.
difficile, complaining of increased abdominal pain/bloating. Evaluate for
developing ___.
TECHNIQUE: 2 portable supine abdominal radiographs were obtained.
COMPARISON: ___ CT abdomen and pelvis with contrast
FINDINGS:
There is gas distending the colon. The colon does not exceed 4.5-5 cm in
caliber. There is gas in scattered nondilated small bowel loops. Supine
assessment limits detection for free air; there is no gross pneumoperitoneum.
A surgical clip is seen in the right upper quadrant.
There are degenerative changes in the femoroacetabular joints.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No radiographic evidence of toxic megacolon.
|
19992875-RR-98 | 19,992,875 | 26,793,370 | RR | 98 | 2163-12-23 09:08:00 | 2163-12-23 10:07:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with abd pain, n/v, cp hx of pericarditis // acute process
COMPARISON: ___ and CT chest from ___
FINDINGS:
PA and lateral views of the chest provided. Faint linear densities in the
lower lungs likely reflect platelike atelectasis. The lungs are otherwise
clear. There is stable prominence of the mediastinal silhouette, which has
been previously assessed by CT chest from ___. The heart size is
normal. Bony structures are intact. No free air below the right
hemidiaphragm.
IMPRESSION:
No acute findings.
|
19992875-RR-99 | 19,992,875 | 26,793,370 | RR | 99 | 2163-12-23 09:20:00 | 2163-12-23 10:05:00 | INDICATION: ___ with c diff
COMPARISON: Prior exam dated ___
FINDINGS:
Supine and upright views of the abdomen pelvis were provided. Bowel gas
pattern is unremarkable without signs of ileus or obstruction. No free air is
seen below the right hemidiaphragm. No worrisome calcifications. The imaged
osseous structures appear intact. There is a mild dextroscoliosis of the
thoracolumbar spine, apex at L1. A clip again noted in the right upper
quadrant.
IMPRESSION:
Unremarkable exam.
|
19994233-RR-16 | 19,994,233 | 29,338,696 | RR | 16 | 2184-02-10 19:47:00 | 2184-02-10 21:16:00 | INDICATION: Altered mental status.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images through the head were obtained
without intravenous contrast at 5-mm slice thickness. Coronally and
sagittally reformatted images are provided.
FINDINGS:
Evaluation is limited due to suboptimal patient positioning. There is a large
intraparenchymal hemorrhage centered in the left frontoparietal region
measuring 4.2 x 3.3 cm. Adjacent linear areas of hyperattenuation likely
reflect subarachnoid extension of hemorrhage (2:18). There is an adjacent 3-mm
left subdural hematoma. There is surrounding vasogenic edema and effacement
of overlying sulci. The hemorrhage displays mild mass effect with 3 mm
righward shift of normally midline structures. No definite intraventricular
hemorrhage is seen. Basal cisterns are not well visualized but appear patent.
The sulci and ventricles are prominent, likely age-related involutional
changes. Confluent hypodensities are seen in subcortical, deep and
periventricular white matter distribution, likely small vessel ischemic
disease. No acute fracture is noted.
IMPRESSION:
Limited evaluation due to patient's positioning. Large intraparenchymal
hemorrhage centered in the left frontoparietal region with associated
vasogenic edema, and adjacent subarachnoid and subdural hemorrhage. There is
mild associated mass effect with 3 mm rightward shift of normally midline
structures. ___ consider MRI for further charaterizaion to exclude underlying
mass, if clinically indicated.
|
19994233-RR-17 | 19,994,233 | 29,338,696 | RR | 17 | 2184-02-10 19:56:00 | 2184-02-10 20:57:00 | INDICATION: Altered mental status.
COMPARISONS: None available.
TECHNIQUE: 2.5-mm axial slices through the cervical spine were obtained
without intravenous contrast. Coronally and sagittally reformatted images are
provided.
FINDINGS:
No evidence of acute fracture or malalignment. There is exaggeration of the
cervical spine lordosis. Multilevel degenerative disc changes are
demonstrated, most pronounced at C4-C5, C5-C6 and C6-C7 with the
intervertebral disc space narrowing, subchondral sclerosis and subchondral
cyst formations. Disc osteophyte complexes are seen at these corresponding
levels which mildly to moderately narrow the thecal sac. Multilevel bilateral
neural foraminal narrowing is moderate at these levels as well. Prevertebral
soft tissues are unremarkable. The airway is patent. No pneumothorax is
seen. Thyroid gland is heterogeneous and enlarged.
IMPRESSION:
1. No evidence of acute fracture or malalignment. Multilevel degenerative
disc disease.
2. Heterogeneous, enlarged thyroid gland likely reflective of multinodular
goiter. Clinical correlation recommended.
|
19994233-RR-18 | 19,994,233 | 29,338,696 | RR | 18 | 2184-02-11 00:29:00 | 2184-02-11 11:45:00 | HISTORY: Breast cancer with large left frontoparietal intraparenchymal
hemorrhage, history of atrial fibrillation. Evaluate for amyloid angiopathy
or underlying lesion.
TECHNIQUE: Multisequence MRI of the brain was obtained before and after the
administration of IV gadolinium as per department protocol.
COMPARISON: CT of ___.
FINDINGS:
There is a 5.4 cm AP x 4.9 cm TR left parietal intraparenchymal hematoma
causing mass effect upon the adjacent brain parenchyma with associated edema.
There are subdural blood products along the left convexity as well as
subarachnoid blood products. There is effacement of the occipital horn of the
left lateral ventricle. No other areas of acute hemorrhage is noted. There is
3 mm right-sided midline shift. There is mild prominence of the lateral
ventricles.
There are foci of low signal in the susceptibility sequence along the right
frontal lobe and along the left occipital horn, consistent with old
hemorrhagic foci. Old blood products along the right occipital sulci is also
noted. There is no definite evidence of enhancing mass.
Otherwise, there are moderate T2/FLAIR hyperintensities in the subcortical and
periventricular white matter which are nonspecific but likely the sequelae of
chronic microangiopathy.
There is mucosal thickening of the ethmoid air cells.
IMPRESSION:
Large left parietal intraparenchymal hematoma with subarachnoid and subdural
blood products, without evidence of definite underlying mass. At least 2 foci
of chronic intraparenchymal hemorrhagic products and old subarachnoid blood
products. The presence of these findings suggest amyloid angiopathy, however
other etiologies such as hypertensive hemorrhage is also possible. Follow-up
after resolution of the blood products is advised to exclude an underlying
lesion.
|
19994233-RR-20 | 19,994,233 | 29,338,696 | RR | 20 | 2184-02-11 08:34:00 | 2184-02-11 11:05:00 | HISTORY: Left parietal hemorrhage.
TECHNIQUE: Portable frontal chest radiograph, 2 views.
COMPARISON: None available.
FINDINGS:
Heart size is top-normal. The thoracic aorta is mildly tortuous with
atherosclerotic mural calcifications. Lungs are clear. There is no pleural
effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
19994233-RR-21 | 19,994,233 | 29,338,696 | RR | 21 | 2184-02-11 13:07:00 | 2184-02-11 17:16:00 | HISTORY: Hemorrhagic stroke and frontoparietal intraparenchymal hemorrhage.
NG tube placed.
COMPARISON: ___, 8:35 a.m.
TECHNIQUE: Portable frontal chest radiograph.
FINDINGS: There has been interval placement of an upper enteric drainage tube
which terminates in the mid portion of a non-distended stomach. There is
otherwise no short-term interval change from earlier study five hours prior.
|
19994233-RR-22 | 19,994,233 | 29,338,696 | RR | 22 | 2184-02-11 23:47:00 | 2184-02-12 10:46:00 | INDICATION: CHF, admitted with intracranial hemorrhage, now with
desaturations and fever.
COMPARISON: ___.
TECHNIQUE: Portable frontal chest radiograph.
FINDINGS: Cardiomediastinal silhouette and hilar contours are stable. Left
base atelectasis is noted. The lungs are otherwise clear. There is no
pleural effusion or pneumothorax.
IMPRESSION:
Little change compared to ___ with streaks of atelectasis at the left lung
base.
|
19994233-RR-23 | 19,994,233 | 29,338,696 | RR | 23 | 2184-02-12 14:10:00 | 2184-02-12 16:31:00 | HISTORY: ___ with left parenchymal hematoma, as well as subarachnoid
and subdural hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast.
COMPARISON: Comparison is made to non-contrast CT of the head from ___ and MR of the head with and without contrast from ___, 14 hours
prior.
FINDINGS:
Allowing for differences in the plane of imaging and inter-modality
differences, there is no change in size of previously seen left parietal
intraparenchymal hematoma (2a: 20), with surrounding vasogenic edema causing
persistent effacement of the posterior horn of the left lateral ventricle.
There is unchanged 3 mm rightward shift of normally midline structures. The
small adjacent left subdural hematoma again measures 3 mm, unchanged from
initial noncontrast CT of the head from ___.
There has been interval redistribution of a small amount of subarachnoid
hemorrhage, now with intraventricular extension (2a: 15) to the posterior left
lateral ventricle. The basal cisterns appear patent. The prominent
ventricles and sulci are again noted, consistent with age-related involutional
of changes or atrophy. Periventricular white matter hypodensities are again
seen, representing the sequelae of chronic small vessel ischemic disease.
There is no evidence of obstructive hydrocephalus. No fracture is identified.
IMPRESSION:
1. Since the previous MRI from 14 hours prior, there has been no significant
change in size of left parietal parenchymal hematoma (allowing for different
imaging modalities and planes of scanning). Surrounding vasogenic edema
which effaces the occipital horn of the left lateral ventricle is also not
signiifcantly changed, with stable 3 mm rightward shift of normally midline
structures.
2. Interval redistribution of small amount of subarachnoid hemorrhage, now
with intraventricular extension.
3. Stable 3 mm left subdural hematoma. No new focus of hemorrhage is
identified.
|
19994233-RR-24 | 19,994,233 | 29,338,696 | RR | 24 | 2184-02-12 14:37:00 | 2184-02-12 15:08:00 | REASON FOR EXAMINATION: Evaluation of the patient with history of heart
failure, desaturations and pulmonary edema. Also suspected aspiration.
AP radiograph of the chest was compared to ___.
Heart size is enlarged. Mediastinum is stable. Left retrocardiac opacity is
noted, more pronounced than on the prior study and might reflect interval
aspiration. There is no pleural effusion or pneumothorax. The NG tube tip is
in the stomach.
|
19994233-RR-25 | 19,994,233 | 29,338,696 | RR | 25 | 2184-02-14 07:52:00 | 2184-02-14 11:40:00 | HISTORY: New NG tube below.
COMPARISON: ___.
FINDINGS:
NG tube tip is in the stomach. The appearance of the lungs is unchanged.
IMPRESSION:
NG tube in the stomach.
|
19994379-RR-16 | 19,994,379 | 27,052,619 | RR | 16 | 2131-05-05 00:57:00 | 2131-05-05 04:47:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ with question L1-L2 epidural abscess on outside hospital CT.
Evaluate for epidural abscess
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of 10 mL of Gadavist contrast
agent, additional axial and sagittal T1 images were obtained.
COMPARISON: ___ MR lumbar spine with without contrast
___ MR thoracic and lumbar spine without contrast
FINDINGS:
Study is degraded by motion and by lumbar spinal fusion hardware artifact.
Within these confines:
CERVICAL:
There is 2 mm spondylolisthesis of C7 on T1, likely degenerative.
Mild loss of cervical vertebral body height without definite associated
increased STIR signal are likely degenerative. Low signal intensity within
the right lamina of the C3-C6 vertebral bodies on T1 and T2 weighted images
likely reflects postoperative change.
The visualized portion of the spinal cord is grossly preserved in signal and
caliber. There is no definite abnormal enhancement.
At C2-3, uncovertebral and facet joint hypertrophy result in mild left neural
foraminal narrowing. There is no spinal canal or right neural foraminal
narrowing.
At C3-4, a disc osteophyte complex, uncovertebral and facet joint hypertrophy
result in mild spinal canal narrowing. There is moderate left and severe
right neural foraminal narrowing.
At C4-5, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy
result in mild spinal canal narrowing. There is severe bilateral neural
foraminal narrowing.
At C5-6, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy
result in mild-to-moderate spinal canal narrowing. There is severe bilateral
neural foraminal narrowing.
At C6-7, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy
result in mild spinal canal narrowing. There is severe bilateral neural
foraminal narrowing.
At C7-T1 a disc osteophyte complex, uncovertebral, and facet joint hypertrophy
result in mild spinal canal narrowing. There is mild-to-moderate bilateral
neural foraminal narrowing.
THORACIC:
Vertebral body alignment is preserved. Vertebral body heights are preserved.
T8 vertebral body probable hemangioma is noted.
The visualized portion of the spinal cord is preserved in signal and caliber.
There is no abnormal enhancement.
There is mild degenerative disc disease, without moderate or severe spinal
canal or neural foraminal narrowing.
LUMBAR:
There postoperative changes for posterior instrumented fusion with
transpedicular screws at the L4-S1 level and anterior fixation screws at right
L4 and S1. There is solid osseous fusion of the L2-3, partial osseous fusion
of L3-4, L4-5, and L5-S1. Laminectomy changes are detailed below.
There is an oblique fracture of the superior endplate of L2 with lateral
extension through the lateral margin of the vertebral body. This is likely
subacute to chronic, however is a new finding from the ___ MRI.
Vertebral body height is otherwise preserved without evidence of an acute
fracture. Vertebral body alignment is preserved.
The conus medullaris terminates at the L1 level. There is no definite signal
abnormality within the conus or cauda equina. There is no abnormal
enhancement.
At T12-L1 there is no spinal canal or neural foraminal narrowing.
At L1-2, there is advanced degenerative endplate change with bone marrow
reactive change and associated vacuum disc phenomenon. There is a disc bulge
with superimposed central disc extrusion with superior migration, ligamentum
flavum thickening, and facet hypertrophy with bilateral synovial cysts that
result in severe spinal canal narrowing. There is probable impingement on the
traversing bilateral L2 and possibly other nerve roots. There is there is
moderate left and severe right neural foraminal narrowing. There is a right
facet joint effusion.
At L2-3, there is ossification of a residual L2-3 intervertebral disc versus
endplate spurs. There are bilateral laminectomy changes with decompression of
the spinal canal narrowing. Facet hypertrophy results in severe bilateral
neural foraminal narrowing, left worse than right.
At L3-4, there is a small disc bulge. There are bilateral laminectomy changes
with decompression of the spinal canal. Facet hypertrophy results in moderate
bilateral neural foraminal narrowing.
At L4-5, facet hypertrophy results in mild bilateral neural foraminal
narrowing. There are bilateral laminectomy changes with decompression of the
spinal canal.
At L5-S1, there are bilateral laminectomy changes with decompression of the
spinal canal. Facet hypertrophy results in and moderate left neural foraminal
narrowing.
OTHER:
There is a 5 mm nodule within the left lobe of the thyroid.
There is a moderate size loculated right pleural effusion. Signal abnormality
within the basilar right lower lobe could reflect atelectasis and/or
pneumonia.
There is a gastric fundal diverticulum (series 18, image 22).
IMPRESSION:
1. Study is degraded by motion and by lumbar spinal fusion hardware artifact.
2. Cervical degenerative disc disease as detailed above, without high-grade
spinal canal narrowing or cord signal abnormality. There is severe neural
foraminal narrowing at multiple levels.
3. Mild thoracic degenerative disc disease, without high-grade spinal canal or
neural foraminal narrowing.
4. Loculated right pleural effusion basilar right lower lobe could reflect
atelectasis, however pneumonia cannot be excluded. Chest CT is suggested.
5. Instrumented lumbar fusion at L4-S1, interbody fusion graft at L3-4 with
partial osseous fusion, and solid osseous fusion of the L2-3 level as detailed
above.
6. L1-2 disc extrusion with superior migration results in severe spinal canal
narrowing. There is probable impingement of the traversing L2 and possibly
other nerve roots. Allowing for difference technique, finding may be slightly
progressed compared to ___ prior exam.
7. Within limits of study, no definite evidence of discitis-osteomyelitis, or
epidural abscess.
8. Probable subacute to chronic oblique fracture of the superior endplate of
L2 with lateral extension through the lateral vertebral body.
9. Right L1-2 and bilateral L2-3 Severe neural foraminal narrowing.
|
19994379-RR-17 | 19,994,379 | 27,052,619 | RR | 17 | 2131-05-06 11:27:00 | 2131-05-06 13:11:00 | EXAMINATION: Chest radiograph PA and lateral
INDICATION: ___ year old man with spinal stenosis, CHF, pleural effusion noted
on MRI spine// ?evidence of pleural effusion, volume overload, infection
TECHNIQUE: Chest PA and lateral
COMPARISON: Compressed includes semi-upright portable chest x-ray done on ___ 14.
FINDINGS:
Increased opacification of the right hemithorax. There is stable
cardiomegaly. Hilar and mediastinal contours are normal. There is a mild to
moderate layering right pleural effusion. Otherwise the left lung is clear.
There is enlargement of the gastric bubble. There are dilation of colon at
the splenic flexure.
IMPRESSION:
There is a mild to moderate layering right pleural effusion.
There is dilation of colon at the splenic fracture.
|
Subsets and Splits