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19999987-RR-18 | 19,999,987 | 23,865,745 | RR | 18 | 2145-11-03 04:35:00 | 2145-11-03 10:46:00 | INDICATION: ___ female intubated for head bleed, who presents for
evaluation of pneumonia.
COMPARISONS: Chest radiographs from ___.
TECHNIQUE: Single AP portable exam on the chest.
FINDINGS: The ET tube terminates approximately 2.9 cm from the carina. The
NG tube courses below the diaphragm with the tip out of the field of view of
the film. There has been interval worsening of the right linear opacification
likely secondary to atelectasis. No pneumothorax or definite pleural effusion
is seen. The hilar and mediastinal contours are normal. There is mild
cardiomegaly, stable compared to the preior exam.
IMPRESSION:
Slight interval worsening of right lower lung atelectasis.
|
19999987-RR-19 | 19,999,987 | 23,865,745 | RR | 19 | 2145-11-03 16:40:00 | 2145-11-04 08:36:00 | HISTORY: ___ woman with left occipital hemorrhage of unclear
etiology. Assess for infarct or underlying mass lesion.
COMPARISON: CTA head and CTA neck on ___.
TECHNIQUE: Multiplanar, multisequence T1- and T2-weighted images were
acquired through the head before and after administration of IV gadolinium
contrast. Diffusion-weighted images and ADC maps were also obtained for
evaluation.
FINDINGS: Again noted is a large intraparenchymal hemorrhage centered at the
left occipital lobe. There is ___ edema with moderate mass
effect on to the adjacent parenchyma. No shift of normally midline structures
is noted. There is no definite evidence of intraventricular hemorrhagic
extension. There is evidence of a developmental venous anomaly (DVA)
traversing in the vicinity (image 10:16).
An additional focus of susceptibility artifact is noted in the left temporal
lobe (image 6:10).
The ventricles remain normal in size and symmetric in configuration. The
gray-white matter differentiation is well preserved in the remaining
parenchyma. There is mild superimposed periventricular T2/FLAIR
hyperintensity, nonspecific but could represent mild chronic microvascular
ischemic disease.
Allowing for the obscuration of the intrinsic T1 hyperintensity from the
hemorrhage, there is no abnormal post-contrast enhancement. Major vascular
flow voids are present. There is no slow diffusion to suggest acute
infarction.
There is moderate amount of retained fluid in the right mastoid air cells.
The remaining visualized paranasal sinuses and left mastoid air cells are
clear. The globes are symmetric.
IMPRESSION:
1. Large left occipital intraparenchymal hemorrhage, unchanged and with
persistent mass effect on to the adjacent parenchyma. No midline shift or
intraventricular hemorrhagic extension. No acute infarcts or definite
postcontrast enhancement.
2. A small DVA traversing in the vicinity of the left occipital
intraparenchymal hemorrhage. The presence of a nearby DVA favors the
differential of cavernous malformation (hemangioma cavernoma) which
hemorrhaged.
3. A punctate susceptibility artifact in the left temporal lobe, could
represent either a second cavernoma or an old microhemorrhage.
Consider short-term follow-up after resolution of acute hemorrhage to better
assess the underlying pathology.
|
19999987-RR-20 | 19,999,987 | 23,865,745 | RR | 20 | 2145-11-04 05:10:00 | 2145-11-04 08:58:00 | PORTABLE CHEST OF ___
COMPARISON: ___ radiograph.
FINDINGS: There has been interval extubation and improved lung volumes
compared to the recent radiograph. Bibasilar atelectasis has nearly resolved
with residual patchy atelectasis remaining in the right lower lobe and only
minimal residual linear atelectasis in the left lower lobe. Apparent
rightward deviation of the trachea is likely due to mild patient rotation and
curvature of the spine, as there is no evidence of a discrete paratracheal
mass on recent neck CTA of ___. Cardiac silhouette is stable in
size. No pleural effusion or pneumothorax.
|
19999987-RR-21 | 19,999,987 | 23,865,745 | RR | 21 | 2145-11-07 15:18:00 | 2145-11-08 16:44:00 | DATE OF SERVICE: ___.
PRE-OPERATIVE DIAGNOSIS: Left occipital hemorrhage.
INDICATION: Rule out vascular malformation.
ATTENDING PHYSICIAN: ___, M.D.
ASSISTANT: ___, N.P.
ANESTHESIA: Moderate sedation was provided by administering divided doses of
fentanyl and Versed throughout the total intraservice time of 45 minutes,
during which the patient's hemodynamic parameters were continuously monitored.
PROCEDURES PERFORMED: Right internal carotid artery arteriogram, right
external carotid artery arteriogram, left internal carotid artery arteriogram,
left external carotid artery arteriogram, left vertebral artery arteriogram,
right common femoral artery arteriogram and Angio-Seal closure of right common
femoral artery puncture site.
DETAILS OF THE PROCEDURE: The patient was brought to the angiography suite.
IV sedation was given. Following this, both groins were prepped and draped in
a sterile fashion. Access was gained to the right common femoral artery and a
5 ___ vascular sheath was placed in the right common femoral artery. We
now catheterized the above-mentioned vessels and AP, lateral filming was done.
This did not show evidence of brain aneurysm. At this point, the right common
femoral artery arteriogram was done and a 6 ___ Angio-Seal was used for
closure of the right common femoral artery puncture site.
FINDINGS: Right internal carotid artery arteriogram shows filling of the
right internal carotid artery along the cervical, petrous, cavernous, and
supraclinoid portion. The anterior and middle cerebral arteries fill well.
The PCA is seen to be fetal in origin. There is a vascular blush in the
lateral aspect of the orbit; however, there is no evidence of a dural AV
fistula. The ophthalmic artery is also seen to give rise to a large branch
which seems to course superiorly through the superior orbital fissure most
likely anastomosing with the middle meningeal artery.
Right external carotid artery arteriogram shows no evidence of dural AV
fistula.
Left internal carotid artery arteriogram shows filling of the left internal
carotid artery along the cervical, petrous, cavernous, and supraclinoid
portion. The anterior and middle middle cerebral arteries are seen normally
with no evidence of arteriovenous malformation or dural AV fistula. There is
a prominent posterior communicating artery; however, this is not fetal in
nature.
Left external carotid artery arteriogram shows no evidence of dural AV
fistula.
Left vertebral artery arteriogram shows filling of the left vertebral artery
with reflux into the right vertebral artery. The left PCA is seen; however,
the right PCA is not seen because of the hypoplastic nature of the right P1.
The superior cerebellar arteries are seen well. There is mass effect on the
distal branches of the left PCA; however, there is no definite evidence of an
arteriovenous malformation. One cortical vein draining into the superior
sagittal sinus is seen early, but there is no definite evidence of a nidus.
Right common femoral artery arteriogram shows widely patent right common
femoral artery.
IMPRESSION: ___ underwent cerebral angiography which failed to
reveal a source of hemorrhage in the left occipital lobe. There was a vein
which appeared slightly early in the left vertebral artery injection draining
into the left superior sagittal sinus; however, this was not consistent with
an AVM and angiogram should be repeated in a month's time after the mass
effect from the hematoma has resolved.
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