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10110363-RR-13 | 10,110,363 | 21,842,992 | RR | 13 | 2167-06-14 15:05:00 | 2167-06-14 17:25:00 | HISTORY: ___ male with altered mental status.
COMPARISON: None.
FINDINGS: There is mild bilateral interstitial pulmonary edema. The heart is
top-normal in size. There is no pneumothorax or pleural effusion. The
glenohumeral joints demonstrate mild degenerative changes bilaterally.
IMPRESSION:
1. Mild bilateral interstitial pulmonary edema.
2. Mild degenerative changes in the glenohumeral joints bilaterally.
|
10110363-RR-14 | 10,110,363 | 21,842,992 | RR | 14 | 2167-06-14 14:23:00 | 2167-06-14 16:46:00 | INDICATION: Altered mental status, here to evaluate for acute intracranial
process.
COMPARISON: No prior studies available.
TECHNIQUE: MDCT-acquired axial images were obtained through the head without
intravenous contrast. Coronally and sagittally reformatted images as well as
thin section images in a bone window algorithm were generated and reviewed.
The examination was partially repeated due to motion degradation.
CT HEAD: There is no evidence of intra-axial or extra-axial hemorrhage,
edema, mass effect, or shift of normally midline structures. There is
hypodensity in the left occipital lobe extending to the cortex compatible with
left PCA stroke, which is likely subacute given the hypodensity or chronic,
although no prior study is available for comparison. The gray-white matter
interface is otherwise preserved without evidence of acute major vascular
territorial infarct. Periventricular white matter hypodensities in the left
posterior temporal/occipital region is consistent with sequela of chronic
microvascular ischemic disease. The ventricles and sulci are prominent but
proportional compatible with age-related parenchymal volume loss.
Atherosclerotic calcification of the bilateral carotid siphons and basilar
artery is noted. There is central high density in the basilar artery, which
most likely represents calcific atherosclerotic disease, but acute clot cannot
be excluded. There is mild opacification of the ethmoid air cells. The
remainder of the visualized paranasal sinuses, middle ear cavities, and right
mastoid air cells are clear. There is mild opacification of the left mastoid
air cells inferiorly, which may represent inflammation. The bony calvaria
appear intact.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Hypodensity of the left occipital lobe suggests subacute left PCA stroke.
3. Luminal hyperdensity of the basilar artery may represent atherosclerotic
disease though acute clot is not excluded. Further evaluation with CTA or MRA
could be considered if there is high clinical concern.
4. Mild opacification of the inferior left mastoid air cells may represent
inflammation.
Findings were discussed by Dr. ___ with ___ telephone at 16:20
on ___.
|
10110363-RR-15 | 10,110,363 | 21,842,992 | RR | 15 | 2167-06-14 16:29:00 | 2167-06-14 17:55:00 | HISTORY: History of pancreatic cancer now with chest tightness, elevated
D-dimer and atrial fibrillation with rapid ventricular response, here to
evaluate for pulmonary embolism. The patient has recently stopped his
Coumadin for an upcoming liver biopsy.
COMPARISON: Chest radiograph performed earlier the same day. Otherwise, no
prior studies are available for comparison.
TECHNIQUE: Multi detector CT imaging of the chest was obtained using the CTA
protocol following the uneventful administration of 100 cc Omnipaque nonionic
intravenous contrast. Sagittal and coronal reformatted images as well as
bilateral oblique maximum intensity projections were generated and reviewed.
FINDINGS:
The visualized portion of the thyroid gland is within normal limits. Numerous
small supraclavicular and mediastinal lymph nodes are present, many of which
do not meet CT size criteria for lymphadenopathy. However, there is
lymphadenopathy in the subcarinal and paraesophageal stations measuring up to
22 x 21 mm in the paraesophageal region (2: 67). No axillary lymphadenopathy
is detected. A small sliding hiatal hernia is incidentally noted.
The thoracic aorta is normal in caliber without evidence of acute aortic
syndrome. There is scant calcification at the aortic arch. An aberrant right
subclavian artery is noted arising as a ___ vessels from the aortic arch. The
pulmonary arterial trunk is normal in caliber. The heart is enlarged with a
moderate sized filling defect in the left atrial appendage compatible with
clot. There is no evidence of acute right heart strain. Calcification of the
coronary arteries is noted. No pericardial effusion is present. A small
filling defect is present in a subsegmental pulmonary artery in the periphery
of the right lower lobe, best appreciated on series 603, image 19. Another
filling defect is present in a subsegmental pulmonary artery in the right
middle lobe (2: 72). No centralized pulmonary emboli are identified.
There are multiple pulmonary nodules predominantly within the lower lobes (for
example, 2: 26, 52, 62, 66, 69, 89, 97, 105, 113, 116) with the largest
nodules measuring 7 mm in the right lower lobe (2: 97) and 6 mm in the left
lower lobe (2: 62). Within the pulmonary parenchyma, there is septal
thickening and ___ bronchovascular edema. No pleural effusion, focal
consolidation or pneumothorax is present.
Although this study is not tailored for the evaluation of subdiaphragmatic
contents, the visualized upper abdomen demonstrates a hypodense lesion
replacing the pancreatic tail measuring approximately 42 x 36 mm (2: 136)
compatible with primary pancreatic malignancy. The liver is replaced with
innumerable hypodense lesions throughout both lobes compatible with extensive
hepatic metastases.
IMPRESSION:
1. Filling defect in the left atrial appendage compatible with clot.
2. Small subsegmental pulmonary emboli in the right middle and lower lobes
without evidence of acute right heart strain.
3. Septal thickening and peribronchovascular interstitial edema.
4. Multiple subpleural and parenchymal pulmonary nodules measuring up to 7 mm
in the right lower lobe and 6 mm in the left lower lobe along with enlarged
paraesophageal and subcarinal lymph nodes compatible with intra thoracic
metastatic disease.
5. Pancreatic tail mass compatible with primary malignancy and innumerable
hepatic hypodensities compatible with extensive hepatic metastases.
NOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___
emergency ___ via telephone at 17:20 on ___.
|
10110363-RR-16 | 10,110,363 | 21,842,992 | RR | 16 | 2167-06-19 09:31:00 | 2167-06-19 20:50:00 | ABDOMINAL RADIOGRAPH SERIES DATED ___
No prior abdominal radiographs for comparison.
FINDINGS: A non-obstructive bowel gas pattern is visualized. No free
intraperitoneal air is evident. Residual oral contrast is present within
numerous diverticula in the abdomen and pelvis. Lumbar scoliosis is present
with accompanying degenerative changes. Widespread vascular calcifications
are also noted throughout the abdomen. Within the imaged portion of the lower
chest, note is made of cardiomegaly.
|
10110584-RR-25 | 10,110,584 | 20,222,612 | RR | 25 | 2121-12-15 00:25:00 | 2121-12-15 01:25:00 | EXAMINATION: CTU without contrast.
INDICATION: History: ___ with ___ (can NOT get contrast), w/ severe R groin
pain, ? stone vs. local infx. // ? stone on R or infection in R groin visible
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Coronal and sagittal reformations were performed and reviewed on PACS.
No oral contrast was administered.
DOSE: DLP: 846 mGy-cm (abdomen and pelvis).
COMPARISON: None available.
FINDINGS:
LOWER CHEST: Lung bases are clear. There is no pleural or pericardial
effusion. Visualized portions of the heart are within normal limits.
ABDOMEN:
Evaluation of solid abdominal viscera is limited by lack of IV contrast.
HEPATOBILIARY: Scattered calcifications are seen throughout the liver. The
nonenhanced liver otherwise demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening
PANCREAS: Scattered calcifications are seen throughout the pancreas. There is
no evidence of pancreatic ductal dilatation. No peripancreatic fluid
collections or pancreatic masses are identified.
SPLEEN: Scattered calcified granuloma are seen within the spleen. The spleen
is otherwise normal in size and demonstrates homogeneous attenuation.
ADRENALS: The right adrenal gland is normal. The left of adrenal gland has
been surgically removed.
URINARY: Patient is status post left nephrectomy. Multiple hypodensities are
seen in the right kidney, the largest measuring 2.6 x 2.3 cm, and measure low
attenuation, however not fully characterized in this examination. The right
kidney is otherwise grossly unremarkable, with no evidence of hydronephrosis,
nephrolithiasis or surrounding perinephric fluid collections.
GASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops
demonstrate normal caliber and wall thickness throughout. Colon and rectum are
within normal limits. The appendix is not clearly visualized, however there is
no evidence of acute appendicitis. There is no evidence of mesenteric
lymphadenopathy. There is no free fluid. There is no free air. There is a
small umbilicus hernia.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is severe calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Multiple calcified fibroids are seen in the uterus.
There is a Lippes Loop intrauterine device..
BONES AND SOFT TISSUES: Patient is status post posterior fusion of L4 through
L5 fusion. Transpedicular screws and surgical rods appear grossly intact.
There is grade 1 anterolisthesis of L4 on L5. There is multilevel mild to
moderate degenerative disc disease. There is mild compression of the T11
vertebral body. Within the subcutaneous tissues of the posterior back, there
is a small fluid collection, which is felt to reflect an expected postsurgical
fluid collection. There is no foci of gas within the collection to suggest an
active infection. Soft tissue stranding is noted posterior to the spinal
canal at the L5 level, may also be postsurgical in nature. No worrisome
osseous lesions identified.
IMPRESSION:
1. No acute intra-abdominal findings, specifically no right renal calculus or
hydronephrosis.
2. Status post posterior fusion of L4 - L5 with expected postsurgical changes.
Intact surgical hardware.
3. Status post left nephrectomy, no evidence of local recurrence in this
limited noncontrast examination.
4. Multiple scattered calcifications in the liver, spleen and pancreas, could
reflect prior granulomatous exposure.
|
10110584-RR-26 | 10,110,584 | 20,222,612 | RR | 26 | 2121-12-15 17:22:00 | 2121-12-15 18:39:00 | EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: Evaluate for DVT in a patient with new onset right groin pain.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins. The right common
femoral artery is grossly unremarkable.
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 lower extremity veins.
|
10110584-RR-27 | 10,110,584 | 20,222,612 | RR | 27 | 2121-12-16 19:45:00 | 2121-12-17 10:04:00 | EXAMINATION: MRI MSK PELVIS W/O CONTRAST
INDICATION: ___ year old woman with worsening R groin pain // Please evaluate
for bony lesion
TECHNIQUE: Imaging performed at 1.5 Tesla using the body coil. Sequences
include coronal T1 and STIR, axial T1 and T2 fat sat weighted sequences.
COMPARISON: CT urogram ___
FINDINGS:
Images are directed towards evaluation of the hip joints. Visualized bone
marrow is predominately fatty. No concerning lesions are identified. No
fracture seen. Trace fluid in the bilateral hip joints is within normal
physiologic limits. There are mild degenerative changes in the bilateral hip
joints (08:15) with minimal subchondral cystic change.
There is diffuse fatty atrophy of the pelvic girdle muscles. The visualized
muscle the pelvic girdle are otherwise unremarkable in appearance. The
piriformis muscles are symmetric.
No edema is identified about the greater trochanter to suggest trochanteric
bursitis.
Evaluation of the pelvic parenchymal structures is limited. There is colonic
diverticulosis without evidence of diverticulitis. There are multiple hypo
attenuating lesions in the uterus consistent with fibroids. Small perineural
cysts noted in the sacrum. There has been prior surgery with posterior
decompression and stabilization in the lower lumbar spine, incompletely
visualized on this study.
IMPRESSION:
No bony lesion to explain the patient's groin pain seen. Mild degenerative
changes in the bilateral hip joints.
Diverticulosis without evidence of diverticulitis.
Fibroid uterus.
|
10110584-RR-28 | 10,110,584 | 24,580,984 | RR | 28 | 2125-12-07 01:20:00 | 2125-12-07 05:36:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough, dyspnea// eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
The cardiomediastinal silhouettes are normal. New streaky parenchymal
opacification projecting over the right lower lung likely represents
atelectasis or scarring. No focal consolidations are seen. There is no
pulmonary edema or pleural abnormality.
This examination neither suggests nor excludes the diagnosis of acute
pulmonary embolism.
Healed left upper rib fractures are long-standing.
IMPRESSION:
No pneumonia or evidence of cardiac decompensation.
New right lower lobe atelectasis or scarring. This examination neither
suggests nor excludes the diagnosis of acute pulmonary embolism.
|
10110584-RR-29 | 10,110,584 | 24,580,984 | RR | 29 | 2125-12-07 02:19:00 | 2125-12-07 03:47:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: NO_PO contrast; History: ___ with abd pn, N.VNO_PO contrast//
eval for SBO, nephrolithiasis, diverticulitis
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.0 s, 55.1 cm; CTDIvol = 22.5 mGy (Body) DLP =
1,239.3 mGy-cm.
Total DLP (Body) = 1,239 mGy-cm.
COMPARISON: MRI pelvis from ___. CT U abdomen pelvis from ___.
FINDINGS:
LOWER CHEST: There is a trace dependent right pleural effusion and mild
atelectasis in the imaged lung bases. No pericardial effusion is seen.
Coronary artery calcifications are moderate to severe.
ABDOMEN:
HEPATOBILIARY: There are multiple hypoattenuating lesions scattered throughout
the liver, new from ___. The largest in the right lobe measures up to
5.5 cm (02:21). Several areas of moderate intrahepatic biliary ductal
dilatation are noted, predominantly in the right lobe, likely secondary to
obstructive compression from the aforementioned lesions. There is no
extrahepatic biliary ductal dilatation. Scattered calcified granulomas are
again seen throughout the liver. The gallbladder is not visualized.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. Numerous coarse calcifications are again seen
throughout the pancreas, likely secondary to prior inflammation.
SPLEEN: Calcified granulomas are again seen in the spleen, which is otherwise
unremarkable.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The left kidney is absent. Several simple cysts are seen in the
right kidney. There is no evidence of focal renal lesions within the
limitations of an unenhanced scan. There is no hydronephrosis. There is no
nephrolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening and fat stranding. The
appendix is surgically absent.
PELVIS: A vesicourachal diverticulum is present. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Several calcified fibroids are noted within the uterus.
No adnexal abnormality is seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is focal fusiform aneurysmal dilatation the abdominal aorta
proximal to the iliac bifurcation (601:28), unchanged. Extensive
atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Patient is post L4-5 posterior fusion.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Multiple new hypodense lesions scattered throughout the liver measure up to
5.5 cm and cause several areas of moderate intrahepatic biliary ductal
dilatation, likely secondary to obstructive compression. This is highly
suspicious for a metastatic process given history of clear cell renal
carcinoma.
2. No acute findings in the abdomen or pelvis.
3. Additional chronic findings are not significantly changed from ___.
|
10110584-RR-30 | 10,110,584 | 24,580,984 | RR | 30 | 2125-12-08 11:54:00 | 2125-12-08 15:52:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with history of clear cell renal cell
carcinoma, presenting with AMS, fevers, elevated ALK and new liver lesions.
Patient has new liver lesions seen on CT, want to look for potential other
targets for biopsy.
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: No prior chest CT. Pelvic CT from ___ was reviewed.
FINDINGS:
HEART AND VASCULATURE: Moderate atherosclerotic calcifications are seen in the
aorta and coronary arteries. The thoracic aorta is normal in caliber. The
heart, pericardium, and great vessels are within normal limits based on an
unenhanced scan. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Partially calcified non pathologically enlarged
paracardiac node (4:208). No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma.
PLEURAL SPACES: Small right pleural effusion. No pneumothorax.
LUNGS/AIRWAYS: Mild upper lobe dominant centrilobular emphysema. Scarring is
noted in the right middle and lower lobes.. Several subcentimeter pulmonary
nodules are noted. For example, 2 mm nodules in the right upper lobe (4: 78,
and 6, 123). 4 mm in the right upper lobe (4:68), and 2 mm nodules in the
right middle and lower lobes (4: 100, 136).
Also 2 mm and 5 mm Doppler nodules in the left upper lobe (4:83, 92). 1
The airways are patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Please refer to report of dedicated abdominopelvic CT for detailed
findings in the abdomen and pelvis.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Several subcentimeter pulmonary nodules, may be concerning for metastatic
disease. Three-month follow-up chest CT is recommended.
2. Small right pleural effusion.
3. No suspicious mediastinal mass or lymphadenopathy.
|
10110584-RR-31 | 10,110,584 | 24,580,984 | RR | 31 | 2125-12-08 15:06:00 | 2125-12-08 16:41:00 | EXAMINATION: ULTRASOUND-GUIDED TARGETED LIVER BIOPSY
INDICATION: ___ year old woman with fevers, AMS, elevated ALK, now with new
liver lesions concerning for mets seen on recent CT. Request for
ultrasound-guided liver biopsy.
COMPARISON: Comparison to prior CT abdomen/pelvis from ___.
PROCEDURE: Ultrasound-guided targeted liver biopsy.
OPERATORS: Dr. ___, radiology resident and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee during
the key components of the procedure and reviewed and agrees with the trainee's
findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was
performed. The lesion for biopsy was identified in the right hepatic lobe. A
suitable approach for targeted liver biopsy was determined.
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.
Based on the preprocedure imaging, an appropriate skin entry site for the
biopsy was chosen. The site was marked. The skin was then prepped and draped
in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 10 mL 1% lidocaine.
Under real-time ultrasound guidance, two 18-gauge core biopsy passes were
made. The samples were placed in formalin.
The skin was then cleaned and a dry sterile dressing was applied. There were
no immediate complications.
SEDATION: Moderate sedation was provided by administering divided doses of
0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of
19 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
IMPRESSION:
Uncomplicated 18-gauge targeted liver biopsy x 2, with specimens sent to
pathology.
|
10110724-RR-22 | 10,110,724 | 29,881,025 | RR | 22 | 2179-02-20 19:38:00 | 2179-02-20 20:26:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with syncopal episode and head strike with new a fib
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. The heart is mildly enlarged.
The hila appear slightly engorged. There is no convincing evidence for edema
or pneumonia. No large effusion or pneumothorax. The mediastinal contour is
unchanged. Bony structures appear intact.
IMPRESSION:
Cardiomegaly with pulmonary vascular congestion.
|
10110724-RR-23 | 10,110,724 | 29,881,025 | RR | 23 | 2179-02-20 19:28:00 | 2179-02-20 20:13:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ man with syncopal episode and fall with head strike
on right side, evaluate for intracranial hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformatted images were acquired.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no evidence of acute major infarction, hemorrhage, edema, or large
mass. The ventricles and sulci are mildly enlarged in size and configuration,
consistent with age related involution. There is no acute fracture. There
patient has had prior sinus surgery. There is mucosal thickening in the
ethmoid air cells and frontal sinus. There is also opacification of the right
mastoid air cells. The remainder of the paranasal sinuses are clear. The
orbits are unremarkable.
IMPRESSION:
No acute intracranial process.
|
10110724-RR-24 | 10,110,724 | 29,881,025 | RR | 24 | 2179-02-20 19:29:00 | 2179-02-20 20:17:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with syncopal episode and fall with head strike.
TECHNIQUE: Non-contrast helical multidetector CT was performed.Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 891 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of cervical spine fracture. There are mild multilevel
degenerative changes. There is no evidence of critical canal or
neuroforaminal narrowing. The bones are demineralized. There is no gross
evidence of infection. A 6 mm hypodense left thyroid nodule requires no
specific followup. Lung apices are clear.
IMPRESSION:
No cervical spine fracture or malalignment.
|
10110742-RR-6 | 10,110,742 | 25,989,257 | RR | 6 | 2137-12-06 06:38:00 | 2137-12-06 07:14:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with right femoral neck fracture, preop CXR //
Preoperative examination Surg: ___ (R THA )
TECHNIQUE: Portable AP
COMPARISON: None available
FINDINGS:
Ill-defined opacity overlying the right lower lobe compatible with pneumonia
in the right clinical setting. There is no pleural effusion or pneumothorax.
Cardiomediastinal silhouette is normal. Visualized upper abdomen is normal.
IMPRESSION:
Right lower lobe opacity likely represents a lobar pneumonia.
|
10110742-RR-7 | 10,110,742 | 25,989,257 | RR | 7 | 2137-12-08 14:50:00 | 2137-12-08 16:14:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS IN O.R. RIGHT
INDICATION: Right hip arthroplasty.
TECHNIQUE: 15 spot fluoroscopic images obtained in the OR without radiologist
present.
Fluoroscopy time: 12.8 seconds
COMPARISON: Pelvic radiographs ___.
FINDINGS:
The available images show the steps related to placement of a right hip
arthroplasty. Alignment appears appropriate. No periprosthetic fracture
seen. Please see the operative report for further details.
|
10110843-RR-14 | 10,110,843 | 23,376,934 | RR | 14 | 2163-02-17 23:20:00 | 2163-02-18 01:32:00 | INDICATION: ___ with recurrent pancreatitis s/p lap chole ___ presenting
with abdominal pain, leukocytosis, elevated lipase ___. Evaluate for
pancreatitis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
IV Contrast: 130 mL Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
4) Spiral Acquisition 5.0 s, 54.0 cm; CTDIvol = 15.4 mGy (Body) DLP = 828.7
mGy-cm.
Total DLP (Body) = 847 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bibasilar dependent atelectasis. Mild atherosclerotic
calcifications of the coronary arteries are noted. There is no pericardial or
pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Hypodensities are noted in segments 4A and 2, incompletely characterized but
likely represents. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is surgically absent and the portal vein
is patent.
PANCREAS: There is extensive peripancreatic stranding surrounding an edematous
pancreas compatible with acute pancreatitis. There is fluid layering along
the bilateral Gerota's fascia and tracking inferiorly into the pelvis. The
body of the pancreas appears atrophic. No abscess or other organized fluid
collection is identified at this time. Stranding extends into the periportal
space as well as the mesentery and retroperitoneum.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid within the pelvis.
REPRODUCTIVE ORGANS: The uterus is not clearly identified. No adnexal mass is
seen.
LYMPH NODES: There are scattered enlarged periportal and periperipancreatic
lymph nodes. 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 throughout the thoracic and lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Edematous pancreas with extensive peripancreatic stranding and fluid
compatible with acute pancreatitis. No definite CT evidence of necrosis or
organized collection is identified at this time.
|
10110843-RR-16 | 10,110,843 | 23,376,934 | RR | 16 | 2163-02-18 14:29:00 | 2163-02-18 15:57:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cough post-surgery // r/o PNA r/o
PNA
COMPARISON: ___
IMPRESSION:
Heart size and mediastinum are stable. There is new right upper lung linear
opacity in left basal linear opacity consistent most likely with interval
development of atelectasis. Infectious process would be less likely2 such as
pneumonia and aspiration is another possibility to consider. No appreciable
pleural effusion demonstrated.
|
10111112-RR-102 | 10,111,112 | 26,631,649 | RR | 102 | 2151-05-02 15:50:00 | 2151-05-02 19:17:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: History: ___ with calf pain, hx dvt // calf pain, hx dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Evaluation of the calf veins limited
due to edema.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Subcutaneous edema is seen.
IMPRESSION:
Suboptimal evaluation of the calf veins due to subcutaneous edema. Otherwise,
no evidence of deep venous thrombosis in the left lower extremity veins.
|
10111112-RR-103 | 10,111,112 | 26,631,649 | RR | 103 | 2151-05-02 22:02:00 | 2151-05-03 00:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cirrhosis, SBP, leukocytosis >40 // r/o
PNA, edema, pleural effusion
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Mild left pleural effusion has worsened. Left basilar consolidation, likely
represents atelectasis, consider pneumonitis in the appropriate clinical
setting. Right basilar opacity has improved. Mildly increased pulmonary
vascularity has worsened. Stable heart size. No pneumothorax.
IMPRESSION:
Left pleural effusion has worsened. Left basilar consolidation, likely
atelectasis, consider pneumonitis in the appropriate clinical setting.
Increased pulmonary vascularity.
|
10111112-RR-104 | 10,111,112 | 26,631,649 | RR | 104 | 2151-05-04 20:40:00 | 2151-05-04 21:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with essential thrombocythemia/myelofibrosis,
cirrhosis and renal failure (HD in the past), prior PE, mild COPD who
presented to ED from liver clinic w/LLE pain and swelling, found to have SBP.
Now called out from the MICU s/p flash pulmonary edema. Now with new SOB and
O2 requirement. // Please evaluate for fluid overload vs. consolidation given
new O2 requirement.
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Shallow inspiration accentuates heart size, pulmonary vascularity. Stable
bilateral perihilar opacities, likely edema. Mildly worsened right apical
opacity, edema likely, consider pneumonitis. Stable left pleural effusion,
with left basilar consolidation.
IMPRESSION:
Mildly worsened right apical opacity, likely edema, consider pneumonitis
|
10111112-RR-105 | 10,111,112 | 26,631,649 | RR | 105 | 2151-05-12 14:16:00 | 2151-05-12 17:21:00 | INDICATION: ___ year old woman with cirrhosis, recurrent ascites // please
place drain
COMPARISON: Paracentesis dated ___
TECHNIQUE: OPERATORS: Dr. ___, attending radiologist performed
the procedure. ANESTHESIA: Moderate sedation was provided by administrating
divided doses of 25 mcg of fentanyl and 0.5 mg of midazolam throughout the
total intra-service time of 20 minutes during which the patient's hemodynamic
parameters were continuously monitored by an independent trained radiology
nurse.
MEDICATIONS: Fentanyl, Versed, Clindamycin, 1% lidocaine, lidocaine with
epinephrine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.3 min, 4 mGy
PROCEDURE:
1. Limited abdominal ultrasound
2. Peritoneal PleurX catheter placement
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained. The abdomen was cleaned
and draped in standard sterile fashion. A pre-procedure time-out was performed
as per ___ protocol.
Under ultrasound guidance, an entrance site was selected in the . 1% lidocaine
was instilled for local anesthesia. Under direct ultrasound guidance, a A 5
___ catheter was advanced into the ascitic fluid. A ___ wire was
passed through the catheter and crossed to the left side of the abdominal
cavity. A location for the subcutaneous tunnel was chosen and 1% lidocaine was
administered at the skin entry site and along the tunnel tract. A skin
incision was made and the catheter was tunneled to the peritonotomy site. The
___ catheter site was dilated and a peel-away sheath was inserted. The wire
and inner cannula were removed and the PleurX catheter was passed through the
peel-away sheath. Final position of the catheter was confirmed with
fluoroscopy. The catheter was secured to the skin with 0 silk suture. The ___
catheter site was closed with ___ Vicryl subcuticular suture and Steri-Strips.
The patient tolerated the procedure well without any immediate postprocedure
complications. 2 L of amber ascites were drained. A dressing was applied.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated
pelvicascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for PleurX catheter placement.
IMPRESSION:
Successful peritoneal PleurX catheter placement
|
10111112-RR-39 | 10,111,112 | 23,834,763 | RR | 39 | 2146-07-17 09:10:00 | 2146-07-17 09:59:00 | PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Bronchiolitis, hypoxia, pulmonary hypertension; for V/Q
scan.
Cardiac size is top normal. There is mild interstitial edema. There is no
pneumothorax. There is mild biapical pleural thickening. There is no pleural
effusion. Moderate degenerative changes are in the thoracic spine.
|
10111112-RR-40 | 10,111,112 | 23,834,763 | RR | 40 | 2146-07-17 18:15:00 | 2146-07-17 18:57:00 | CLINICAL HISTORY: ___ woman with bilateral PEs. Evaluate for DVT.
FINDINGS: Grayscale and color Doppler sonograms with spectral analysis of the
bilateral common femoral veins, superficial femoral veins, popliteal veins,
peroneal veins, and posterior tibial veins was performed. There is normal
compressibility, flow and augmentation. One peroneal vein on the right and
one posterior tibial vein on the left were not visualized.
IMPRESSION: No DVT bilaterally. One right peroneal vein and one left posterior
tibial vein were not visualized.
|
10111112-RR-48 | 10,111,112 | 29,481,082 | RR | 48 | 2149-04-27 23:06:00 | 2149-04-27 23:28:00 | EXAMINATION: Chest radiograph.
INDICATION: ___ with fever, immunosuppression. Assess for infectious source.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
The lungs are mildly hypoinflated. Right lung is clear. New small left pleural
effusion. No focal opacity. Top normal heart size. Mediastinal contour and
hila are otherwise unremarkable.
Limited assessment of upper abdomen is unremarkable.
IMPRESSION:
New small left pleural effusion. No evidence of pneumonia. Of note subtle
infection may only be seen on CT scan.
NOTIFICATION: The findings were discussed by Dr. ___ with
___ on the telephone on ___ at 8:53 AM, 5 minutes after discovery
of the updated findings.
|
10111112-RR-49 | 10,111,112 | 29,481,082 | RR | 49 | 2149-04-28 09:09:00 | 2149-04-28 09:41:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with UTI and left flank pain // please evaluate
for pyelonephritis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen pelvis on ___ and hand abdominal ultrasound
on ___
FINDINGS:
The right kidney measures 10.3 Cm. The left kidney measures 11 cm. There are
no stones, or masses bilaterally. The right kidney shows normal cortical
echogenicity and corticomedullary differentiation. The left kidney shows a
thin cortex and a minimally dilated collecting system, similar in appearance
to the CT scan on ___. There is no evidence of perinephric abscess
or perinephric fluid collection in either kidney.
The bladder is moderately well distended and normal in appearance.
Note is made of an enlarged spleen measuring 20 cm.
IMPRESSION:
Atrophic left kidney with minimally dilated left collecting system similar in
appearance to the prior CT done in ___. No evidence of perinephric fluid
collection or abscess in either kidney.
Splenomegaly measuring 20 cm.
|
10111112-RR-50 | 10,111,112 | 29,481,082 | RR | 50 | 2149-04-30 17:38:00 | 2149-04-30 17:52:00 | EXAMINATION: SPLEEN ULTRASOUND
INDICATION: ___ year old woman with essential thrombocythemia myelofibrosis
presenting with fevers and RUQ abdominal pain with palpable spleen. Please
evalute spleen size and inflammation around capsule
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Renal ultrasound from ___
FINDINGS:
The spleen is enlarged measuring 20.3 cm in length, previously 19.5 cm. The
echotexture is homogeneous.
IMPRESSION:
Moderate splenomegaly.
|
10111112-RR-51 | 10,111,112 | 29,481,082 | RR | 51 | 2149-05-01 13:22:00 | 2149-05-01 14:18:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with fevers on ctx/azithro, and previous LLL
effusion. // Evaluate for worsening effusion vs consolidation concerning for
pna Evaluate for worsening effusion vs consolidation concerning
IMPRESSION:
In comparison with the study of 11 7, there is little change in the small left
pleural effusion with mild basilar atelectasis. Otherwise little change.
|
10111112-RR-52 | 10,111,112 | 29,481,082 | RR | 52 | 2149-05-02 15:27:00 | 2149-05-02 17:06:00 | INDICATION: ___ year old woman with post-essential thrombocythemia
myelofibrosis presenting with fevers up to 102 with no clear source. Please
evaluate for any source of infection.
TECHNIQUE: Axial helical MDCT scan of the abdomen and pelvis without the
administration of IV contrast. Oral contrast was given. Coronal and sagittal
reformatted images were also generated for review.
DOSE: 982 mGy-cm
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
Evaluation of intra-abdominal organs and soft tissues somewhat limited without
the administration of IV contrast.
CT CHEST: Please see separate report from CT chest performed on the same day
for discussion of findings within the thorax. Note is made of a small right
pleural effusion.
LIVER: The liver demonstrates normal attenuation without focal liver lesion on
this limited non-contrast enhanced study. The gallbladder is surgically
absent. There is no intra or extrahepatic biliary ductal dilatation.
PANCREAS: The pancreas does not demonstrate focal lesions or peripancreatic
stranding or fluid collection.
SPLEEN The spleen is massively enlarged and measures 18 cm. There are some
areas in the inferolateral region that demonstrate lower attenuation and
likely represent focal infarcts.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys do not show solid or cystic lesions and demonstrate
symmetric nephrograms and excretion of contrast. No pelvicaliceal dilatation
or perinephric abnormalities are present.
GI TRACT: The stomach, duodenum, and small bowel are within normal limits,
without evidence of wall thickening or obstruction. The colon is non-dilated
without obstructive lesions. The appendix is visualized and normal.
VASCULAR: The aorta is normal in caliber without aneurysmal dilatation.
Vessel patency cannot be assessed on this non-contrast enhanced study.
RETROPERITONEUM AND ABDOMEN: There is no retroperitoneal or mesenteric lymph
node enlargement. No ascites, free air, or abdominal wall hernias are noted.
PELVIC CT: The urinary bladder and distal ureters are unremarkable. No
pelvic wall or inguinal lymph node enlargement is seen. There is a small
amount non-specific pelvic free fluid.
OSSEOUS STRUCTURES: No blastic or lytic lesions suspicious for malignancy is
present. Bones are diffusely sclerotic consistent with known diagnosis of
myelofibrosis.
IMPRESSION:
1. Limited evaluation without IV contrast but no evidence of pathology within
the abdomen or pelvis to explain patient's persistent fevers.
2. Splenomegaly with areas of infarction in the inferolateral tip.
|
10111112-RR-53 | 10,111,112 | 29,481,082 | RR | 53 | 2149-05-02 15:31:00 | 2149-05-02 16:53:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with post-essential thrombocythemia
myelofibrosis presenting with fevers up to 102 with no clear source. // Please
evaluate for any source of infection in pt with fever of unknown origin
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images .
DOSE: DLP: REPORTED IN THE CONCURRENT ABDOMEN CT
COMPARISON: ___.
FINDINGS:
The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph
nodes are not enlarged. Aorta is normal size. The main pulmonary artery is
enlarged as before measuring 36 mm. Cardiac configuration is normal and there
is severe calcification of the LAD. Small pericardial effusion is
physiologic. Left layering non hemorrhagic pleural effusion is new and
associated with adjacent atelectasis.
Multiple scattered lung nodules including the largest located in the right
lower lobe measuring 6 mm (4, 222) are stable. Right apical scarring is
unchanged. New peribronchial ground-glass and small consolidations in the
anterior right lower lobe is consistent with an infectious process
There is mosaic pattern throughout the lungs, more conspicuous than before
this could be due to small airways disease, less likely infection or
hypersensitivity pneumonitis
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings
There is increase heterogeneous density of a imaged bones related to his
primary malignancy
IMPRESSION:
New right lower lobe peribronchial opacities consistent with infection.
Stable lung nodules
Enlargement of the pulmonary artery suggesting pulmonary hypertension coronary
calcification
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 4:50 ___, 5 minutes after discovery of the
findings.
|
10111112-RR-58 | 10,111,112 | 23,643,056 | RR | 58 | 2150-02-14 17:02:00 | 2150-02-15 12:06:00 | EXAMINATION: MR ANKLE ___ CONTRAST LEFT
INDICATION: ___ year old woman with worsening thrombocytopenia after trauma to
left foot few weeks ago with progressive ankle foot edema, ecchymosis, limited
ankle ROM and severe pain
TECHNIQUE: Imaging performed at 1.5 using the ankle coil. Sequenced include
axial T1, axial STIR, sagittal T1, sagittal STIR, coronal T1, and coronal
STIR.
COMPARISON: Comparison is made to left ankle radiograph ___.
FINDINGS:
This study is performed as per the mass/infection protocol, consequently
evaluation of ligamentous structures about the ankle is somewhat limited.
Tibiotalar Joint Effusion: None
Subtalar Joint Effusion:None
Talar Dome OCL:None
Bone Marrow:There is no subchondral marrow edema.
Bones: There is a well corticated osseous fragment inferior to the medial
malleolus without associated marrow edema consistent with a remote avulsion
injury.
Posterior tibial Tendon:There is a small amount of fluid in the tendon sheath
(Series 4, image 12).
Flexor Digitorum Tendon: Normal
Flexor Hallucis Tendon:Normal
Peroneus Brevis Tendon:There is trace fluid within the tendon sheath.
Peroneus Longus Tendon:Normal
Peroneus Quadrtus Tendon:Normal
Anterior Tibialis Tendon:Normal
Extensor Digitorum tendon:Normal
Achilles tendon:The Achilles tendon appears unremarkable. There is mild edema
in ___ fat pad and a small amount of fluid in the retrocalcaneal bursa
(series 6, image 10).
Lateral Collateral Ligaments:
Anterior tibiofibular Ligament: Normal
Posterior tibiofibular ligament:Normal
Calcaneofibular ligament:Normal
Anterior talofibular ligament: Normal
Posterior talofibular ligament:Normal
Deltoid Ligaments: There is mild thickening of the deep fibers of the deltoid
ligament, likely from prior injury.
Tibiotalar ligament:Normal
Tibiocalcaneal ligament:Normal
Spring ligament:Normal
Sinus tarsi fat: Preserved
Sinus tarsi ligaments - cervical:Normal
Sinus tarsi ligaments - interosseous talocalcaneal:Normal not well seen
Plantar fascia: The central cord of the plantar fascia is in the upper limits
of normal measuring 4 mm.
Inferior calcaneal enthesophyte: None
There is circumferential edema surrounding the ankle, most pronounced
posteriorly.
There is mild fatty atrophy of the muscles in the tibial tunnel, within the
range of normal for the patient's age.
IMPRESSION:
1. No MR evidence of osteomyelitis.
2. No joint effusion.
3. Circumferential subcutaneous edema.
4. No evidence of acute fracture, old injury of the medial malleolus.
5. Mild tenosynovitis of the posterior tibial and peroneus brevis tendons.
6. Paratenonitis of the Achilles tendon.
|
10111112-RR-59 | 10,111,112 | 23,643,056 | RR | 59 | 2150-02-15 09:22:00 | 2150-02-15 13:10:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with known splenomegaly, worsening
thrombocytopenia and hemolysis of undetermined etiology // assess
splenomegaly
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Prior ultrasound from ___. Prior CT from ___.
FINDINGS:
LIVER: Increased periportal echoes within the hepatic parenchyma compared to
previous. The contour of the liver is smooth. There is no focal liver mass.
The main portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures up to
9 mm, but tapers towards the duodenum.
GALLBLADDER: Removed.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, enlarged, measuring 25.4 cm.
KIDNEYS: The right kidney measures 10.2 cm. The left kidney is atrophic
measures 8.9 cm with cortical thinning. Normal cortical echogenicity and
corticomedullary differentiation is seen bilaterally. There is no evidence of
masses, stones, or hydronephrosis in the kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Marked splenomegaly, unchanged.
2. Mildly increased periportal echoes within the liver, which may indicate
mild periportal edema.
|
10111112-RR-60 | 10,111,112 | 23,643,056 | RR | 60 | 2150-02-15 04:40:00 | 2150-02-15 10:33:00 | INDICATION: ___ year old woman with SOB, hypoxia // edema, PNA, effusion
COMPARISON: ___
FINDINGS:
Mild to moderate interstitial pulmonary edema with associated asymmetric right
upper lobe opacity. A small left pleural effusion with adjacent basal
atelectasis. No pneumothorax. The heart size is top-normal.
IMPRESSION:
Moderate interstitial edema with asymmetric right upper lobe airspace disease
can be asymmetric edema in the setting of mitral valve disease, acute
papillary muscle injury in the setting of myocardial infarction or edema with
concurrent right upper lobe pneumonia.
|
10111112-RR-61 | 10,111,112 | 23,643,056 | RR | 61 | 2150-02-15 21:52:00 | 2150-02-16 00:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p intubation // please evaluate for tube
placement
FINDINGS:
Compared to the chest x-ray from ___ at 05:12, there has been
increase in degree of confluent opacity in the right upper and mid/perihilar
zones and in left perihilar region. Patchy retrocardiac opacity is also
present behind the right an left cardiac silhouettes. Minimal blunting of
left costophrenic angle is again noted. Mild vascular plethora is likely
present. The right costophrenic angle is clear. No pneumothorax detected.
Compared to the prior film, an ET tube is now in place, tip approximately 4.6
cm above the carina, at the level of the upper clavicular heads.
IMPRESSION:
1. Worsening opacities in both lungs with prominent confluent opacity in the
right upper and mid zones and left perihilar region as well as in the
retrocardiac region. The differential remains similar and includes asymmetric
CHF related to or independent of mitral valve or papillary muscle
abnormalities or edema with concurrent right upper lobe pneumonia.
2. ET tube tip 4.6 cm above the carina, at the level of the upper clavicular
heads.
|
10111112-RR-62 | 10,111,112 | 23,643,056 | RR | 62 | 2150-02-15 23:24:00 | 2150-02-16 11:30:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new central line // Please evaluate for
left IJ line placement Contact name: ___: ___
FINDINGS:
Compared to ___ at 21:57 p.m., a new left IJ central line is in
place. The tip overlies the cavoatrial junction. No pneumothorax is
detected. Extensive bilateral opacities are similar to the prior film. No
gross effusions identified.
ETT and NG tube extending off film again noted. The tip of the ET tube lies
just above the medial clavicular heads.
IMPRESSION:
As above.
|
10111112-RR-63 | 10,111,112 | 23,643,056 | RR | 63 | 2150-02-16 04:59:00 | 2150-02-16 13:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with septic shock, pna, intubated // ETT was
moved back--please evaluate for placement
COMPARISON: None.
FINDINGS:
The ET tube lies approximately 5.8 cm above the carina, slightly above the
clavicular heads. An NG tube is present, tip extending beneath diaphragm, off
film. Left IJ central line tip overlies the distal SVC near the SVC/RA
junction. No pneumothorax is detected.
Again seen is extensive parenchymal opacity in both lungs, worse on the right.
Patchy opacity at the right base is probably slightly worse. Opacity at the
left base may also be slightly worse, as left hemidiaphragm is now less
distinct.
IMPRESSION:
As above.
|
10111112-RR-64 | 10,111,112 | 23,643,056 | RR | 64 | 2150-02-17 05:34:00 | 2150-02-17 10:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman ventilated for shock of unknown etiology with
pulmonary infiltrates. // interval change
COMPARISON: Chest x-ray from ___ at ___
FINDINGS:
The left IJ line projects slightly more distal, near the cavoatrial junction.
Lines and tubes are otherwise grossly unchanged. No pneumothorax detected.
Again seen are extensive patchy opacities in both lungs, most pronounced in
the right upper and mid zones but also seen at the right and left bases and
left perihilar region. The overall distribution is similar. Changes in the
right upper and suprahilar zones may be slightly less dense. No gross
effusion. Cardiomediastinal silhouette unchanged. Prominence of the main
pulmonary artery is again noted.
IMPRESSION:
Extensive multiple bilateral opacities, non-specific, but compatible with
multifocal pneumonia. These are overall similar to the study from 1 day
earlier. There has been possible minimal improvement in the right upper/
suprahilar zones.
|
10111112-RR-65 | 10,111,112 | 23,643,056 | RR | 65 | 2150-02-16 14:39:00 | 2150-02-16 16:45:00 | INDICATION: ___ year old woman with essential thrombocytosis, myelofibrosis,
here with hypoxemic respiratory failure, acute renal failure likely ___ ATN,
with severe lactic acidosis, hemolytic anemia, thrombocytopenia and worsening
leukocytosis // With PO contrast only. No IV contrast. eval for colitis. eval
for etiology of respiratory failure.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis with split bolus technique. Coronal and
sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 466 mGy cm
COMPARISON: CT torso ___
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
Small amount of intraperitoneal simple fluid is noted.
HEPATOBILIARY: The liver is unremarkable.
There is no intrahepatic or extrahepatic biliary dilatation.
The gallbladder is surgically absent.
PANCREAS: Unremarkable.
SPLEEN: Massive splenomegaly measures 22 cm, increased compared to prior
(previously 18 cm) . A 1.7 cm hypodense focus is again noted at the inferior
margin of the spleen previously noted to be an infarct.
ADRENALS: Unremarkable.
URINARY: The kidneys are unremarkable. There is a vascular calcification
within the left kidney. There is no hydronephrosis.
GASTROINTESTINAL: Small bowel loops are normal caliber. Colon is normal
caliber.
PELVIS: Bladder is decompressed around a Foley catheter.
REPRODUCTIVE ORGANS: Unremarkable.
VASCULAR: Abdominal aorta is within normal size.
LYMPH NODES: Evaluation of lymph nodes are limited due to lack of IV contrast,
however no obvious lymphadenopathy is identified. .
BONES AND SOFT TISSUES: Diffuse sclerotic changes of the bones are appear
increased compared to ___ and probably related to patient's history of
myelofibrosis. Diffuse subcutaneous tissue edema is noted.
IMPRESSION:
1. Massive splenomegaly, and diffuse sclerotic changes of the bones have
progressed since ___ and likely related to patient's history of hematologic
disease.
2. Small ascites, anasarca.
NOTIFICATION: Findings were discussed with ___ at 16:40 ___
|
10111112-RR-66 | 10,111,112 | 23,643,056 | RR | 66 | 2150-02-16 12:23:00 | 2150-02-16 19:58:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with ___, placement of right IJ HD catheter //
___ yo female with ___, placement of right IJ HD catheter Contact name:
___: ___
COMPARISON: ___ AT 05:09
FINDINGS:
The right IJ catheter has been placed. The tip overlies the distal SVC. No
pneumothorax is detected. Otherwise, doubt significant interval change.
IMPRESSION:
As above.
|
10111112-RR-67 | 10,111,112 | 23,643,056 | RR | 67 | 2150-02-16 14:40:00 | 2150-02-16 20:14:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ female with essential thrombocytosis, myelofibrosis,
here with hypoxic respiratory failure, acute renal failure likely secondary to
ATN, severe lactic acidosis, hemolytic anemia, thrombocytopenia and worsening
leukocytosis.
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
DOSE: Please refer to the report for CT abdomen pelvis obtained at the same
time.
COMPARISON: CT chest without contrast ___
FINDINGS:
Thyroid gland is unremarkable. There is no pericardial effusion. Thoracic
aorta is within normal size limits. Main pulmonary artery is enlarged with
4.1 cm in diameter, similar as before. Moderate coronary artery calcification
is noted. Evaluation of lymph nodes are limited without IV contrast.
Axillary lymph nodes appear within normal size.
Airways are patent to subsegmental levels. Secretions are noted layering in
the trachea. Endotracheal tube is in appropriate position. Right internal
jugular venous catheter terminates in mid SVC. Left internal jugular venous
catheter terminates in low SVC.
Small bilateral pleural effusions are composed of simple fluid.
Multifocal areas of consolidation is identified in bilateral lungs involving
all lung lobes, most prominently in the posterior distribution. Bilateral
ground-glass opacities are upper lobe predominant.
Diffuse sclerotic changes of the bones may reflect patient's history of
hematologic disease. Please see report for CT abdomen and pelvis obtained at
the same time for details of abdominal findings.
IMPRESSION:
1. Multiple areas of consolidation and ground-glass opacities involving
bilateral lungs are consistent with multifocal pneumonia.
2. Enlarged main pulmonary artery is similar as before and may reflect
underlying pulmonary hypertension.
NOTIFICATION: Findings regarding multi focal pneumonia was discussed with
___ at 16:40 on ___
|
10111112-RR-69 | 10,111,112 | 23,643,056 | RR | 69 | 2150-02-18 04:57:00 | 2150-02-18 11:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure // eval for worsening
consolidation eval for worsening consolidation
IMPRESSION:
Multi focal pneumonia continues to clear, particularly in the right upper
lobe. Both lower lobes are still substantially consolidated. Pleural
effusion is small if any. Heart size top-normal.
Tip of the endotracheal tube is above the upper margin of the clavicles, no
less than 8 cm from the carina. The chin is in neutral or elevation, and
therefore the tube should be advanced no more than 3 cm.
Right jugular line ends at the origin of the SVC, left jugular line in the low
SVC. Nasogastric drainage tube passes into a nondistended stomach and out of
view. No pneumothorax.
|
10111112-RR-70 | 10,111,112 | 23,643,056 | RR | 70 | 2150-02-19 05:04:00 | 2150-02-19 08:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated for hypoxia, severe metabolic
acidosis and elevated lactate. // interval change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the right upper lobe pneumonia has
decreased in extent and severity but the patient has developed small bilateral
pleural effusions. Mild basal areas of atelectasis persist. Mild fluid
overload is unchanged. Unchanged appearance of the cardiac silhouette and of
the monitoring and support devices.
|
10111112-RR-71 | 10,111,112 | 23,643,056 | RR | 71 | 2150-02-20 02:35:00 | 2150-02-20 08:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated in shock-like picture with
myelofibrosis. // interval change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, a pre-existing small left pleural
effusion is unchanged and a previous right pleural effusion. Has resolved.
Parenchymal opacities are present. In the perihilar regions both on the left
than on the right, suggesting a combination of centralized pulmonary edema and
infection. Moderate cardiomegaly. No pneumothorax. The monitoring and
support devices are constant.
|
10111112-RR-72 | 10,111,112 | 23,643,056 | RR | 72 | 2150-02-19 12:01:00 | 2150-02-19 14:37:00 | INDICATION: ___ year old woman with essential thrombocythemia and
myelofibrosis on ruxolitinib, h/o PE (on warfarin), and PAD who initially
presented on ___ with left foot pain, swelling and ecchymosis x1 month,
now transferred to ICU for lactic acidosis and presumed septic shock. // rule
out ileus
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT abdomen/pelvis without contrast dated ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Bowel gas
pattern is nonspecific, but no evidence of ileus or obstruction. There is
residual contrast from CT abdomen/pelvis 3 days prior within the sigmoid
colon. There is no evidence of pneumatosis or pneumoperitoneum.
An NG tube terminates within the stomach. Both right and left IJ catheters
terminate near the junction of the SVC and right atrium. Surgical clips
project over the right mid abdomen.
Osseous structures are unremarkable.
IMPRESSION:
No evidence of ileus or obstruction.
|
10111112-RR-73 | 10,111,112 | 23,643,056 | RR | 73 | 2150-02-21 05:05:00 | 2150-02-21 09:15:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated, with septic shock-like picture. //
interval change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the signs indicative of centralized
pulmonary edema have increased in severity. In addition, minimal blunting of
the left costophrenic sinus has newly appeared, suggesting the presence of a
small pleural effusion. Mild cardiomegaly persists. No pneumothorax. The
monitoring and support devices are constant.
|
10111112-RR-74 | 10,111,112 | 23,643,056 | RR | 74 | 2150-02-26 02:19:00 | 2150-02-26 10:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ET and myelofibrosis on Ruxolitinib c/o of
new cough and congestion. // Please evaluate for infiltrate.
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Right internal jugular line tip is at the level of mid to lower SVC. Heart
size and mediastinum are stable. There is interval progression of widespread
parenchymal opacities concerning for interval development of are drug toxicity
within the lungs or diffuse infectious process.
Left pleural effusion is small to moderate, unchanged as well as left
retrocardiac consolidation
Further assessment with chest CT would be beneficial in that specific case.
|
10111112-RR-82 | 10,111,112 | 27,068,188 | RR | 82 | 2150-12-14 12:00:00 | 2150-12-14 12:13:00 | EXAMINATION: Chest radiograph
INDICATION: ___ man with cough, evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
In comparison to prior study there is new multifocal opacity in the right
hemithorax. A moderate left pleural effusion with associated compressive
atelectasis is unchanged. Cardiomediastinal silhouette is stable. There is no
pneumothorax.
IMPRESSION:
1. New multifocal opacity in the right hemithorax concerning for pneumonia.
2. Stable moderate left pleural effusion.
|
10111112-RR-83 | 10,111,112 | 27,068,188 | RR | 83 | 2150-12-14 19:36:00 | 2150-12-14 21:16:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with essential thrombocythemia/myelofibrosis
admitted with shortness of breath (PNA on CXR) and worsening ascites, evaluate
for pneumonia or pleural effusion.
TECHNIQUE: MDCT axial images were obtained through the chest without IV
contrast. Coronal sagittal, and axial map images were also acquired.
DOSE: Total DLP (Body) = 215 mGy-cm.
COMPARISON: Chest CT ___ and same-day chest radiograph.
FINDINGS:
Optimal evaluation of organ pathology and vasculature is limited without the
benefit of intravenous contrast.
The thyroid is unremarkable. There is no axillary or supraclavicular
adenopathy. There is no mediastinal adenopathy.
Coronary artery calcifications are severe. There is no thoracic aortic
aneurysm. There are moderate atherosclerotic calcifications of the aortic
arch and descending aorta. The pulmonary artery is significantly dilated
measuring up to 37 mm, raising concern for pulmonary arterial hypertension.
There is no pericardial effusion.
The airways are patent to the segmental level bilaterally. Multifocal areas
of consolidative and ground-glass throughout the right lung with an upper lobe
predominance are present, as demonstrated on same-day chest radiograph. Few
lower and smaller areas of ground-glass are noted in the lingula and left
upper lobe respectively. There is a small to moderate left pleural effusion
with associated atelectasis. Calcified granulomas are unchanged, as expected.
The esophagus is patulous. Views of the upper abdomen demonstrate a markedly
enlarged spleen and intra-abdominal ascites. The gallbladder surgically
absent.
Diffuse sclerotic bony changes are consistent with patient's known history of
myelofibrosis.
IMPRESSION:
1. Multifocal opacities throughout the right lung, and fewer foci of
ground-glass in the left upper lobe and lingula consistent with multifocal
pneumonia.
2. Small to moderate left pleural effusion with associated atelectasis.
3. Enlarged pulmonary artery, raising suspicion for pulmonary artery
hypertension.
4. Massive splenomegaly and ascites.
5. Diffuse sclerotic bony changes reflective of known history of
myelofibrosis. No pathologic fracture identified.
|
10111112-RR-84 | 10,111,112 | 27,068,188 | RR | 84 | 2150-12-14 19:35:00 | 2150-12-14 20:25:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ woman with myelofibrosis presenting with shortness of
breath and worsening ascites hepatobiliary pathology, PVT, and evaluate for
ascites
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Limited abdominal ultrasound ___, chest radiograph ___ and CT abdomen and pelvis ___.
FINDINGS:
Liver: The hepatic parenchyma is coarsened. No focal liver lesions are
identified. There is moderate to large volume ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 6 mm.
Gallbladder: The gallbladder is surgically absent.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic body and tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 20.9 cm.
There is a left pleural effusion.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 30 cm/sec.
Right and left portal veins are patent, with antegrade flow.
Visualization of the main hepatic artery is limited, but the artery is patent,
with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
1. Patent hepatic vasculature.
2. Coarsened liver with moderate to large volume ascites.
3. Massive splenomegaly.
|
10111112-RR-85 | 10,111,112 | 27,068,188 | RR | 85 | 2150-12-16 11:24:00 | 2150-12-16 14:25:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new L (Dominant arm) PICC // 44cm L
basilic DL PICC - ___ ___ Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Previously seen multifocal opacities in the right hemithorax appear more
confluent. Small to moderate left pleural effusion is likely unchanged.
Cardiomediastinal silhouette is stable. Left-sided PICC terminates in the
upper right atrium. No evidence of pneumothorax.
IMPRESSION:
Persistent multifocal opacities in the right hemithorax.
Left PICC terminates in the upper right atrium. No pneumothorax.
|
10111112-RR-89 | 10,111,112 | 29,341,294 | RR | 89 | 2151-03-01 18:55:00 | 2151-03-01 19:13:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with myelofibrosis and cirrhosis of the liver,
assess for patency of the portal vein, for focal liver lesions.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Liver Doppler ultrasound ___.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is a small amount of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 23 cm.
KIDNEYS: Limited sagittal views of the right kidney demonstrate no evidence
of hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic hepatic morphology. No concerning focal liver lesions seen.
Patent portal vein with normal direction of flow.
2. Massive splenomegaly is unchanged. Small amount of ascites.
|
10111112-RR-90 | 10,111,112 | 29,341,294 | RR | 90 | 2151-03-04 11:18:00 | 2151-03-04 13:22:00 | EXAMINATION: Ultrasound-guided paracentesis
INDICATION: ___ year old woman with cirrhosis and ascites. Large volume
paracentesis for diuretic intolerant ascites.
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: Liver ultrasound ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right upper quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
upper quadrant and 3.4 L of clear orange fluid was removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Uncomplicated therapeutic paracentesis yielding 3.4 L of ascitic fluid.
|
10111112-RR-91 | 10,111,112 | 29,341,294 | RR | 91 | 2151-03-07 09:49:00 | 2151-03-07 10:57:00 | EXAMINATION: Ultrasound-guided paracentesis
INDICATION: ___ year old woman with cirrhosis w/ diuretic intolerant ascites.
Therapeutic paracentesis up to 3L.
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: None
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 3 L of serosanguinous fluid was removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Uncomplicated ultrasound-guided paracentesis yielding 3 L of serosanguineous
fluid.
|
10111112-RR-99 | 10,111,112 | 26,631,649 | RR | 99 | 2151-05-02 10:43:00 | 2151-05-02 13:07:00 | INDICATION: ___ year old woman with cirrhosis and ascites // for LVP
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Paracentesis from ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower quadrant and 1.8 L of serosanguinous fluid were removed. Fluid samples
were submitted to the laboratory for cell count, differential, and culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 1.8 L of fluid were removed.
|
10111136-RR-69 | 10,111,136 | 29,438,205 | RR | 69 | 2172-03-04 17:21:00 | 2172-03-04 17:39:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with acute shortness of breath, hypoxia// ? acute
process
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___, chest radiograph ___
FINDINGS:
Heart size is normal. The aorta is tortuous and the ascending aorta remains
prominent. Prominent hila bilaterally may suggest underlying pulmonary
arterial hypertension, as seen on prior CT. Pulmonary vasculature is
attenuated and there is no evidence for pulmonary edema. Severe panlobular
emphysema is re-demonstrated. Patchy ill-defined opacity in the left lung
base is concerning for an area of infection. Additional interstitial
opacities in lung bases may reflect areas of atelectasis and scarring. No
pleural effusion or pneumothorax is demonstrated. Aortic stent graft repair
is partially visualized within the upper abdomen. No acute osseous
abnormalities detected.
IMPRESSION:
Patchy ill-defined opacity in the left lung base may reflect an area of
infection. Severe panlobular emphysema. Prominent hila suggestive of
underlying pulmonary arterial hypertension, as suggested on the prior CT.
|
10111614-RR-38 | 10,111,614 | 22,951,202 | RR | 38 | 2172-05-01 21:36:00 | 2172-05-02 10:22:00 | CHEST PORTABLE ___ AT 2139
INDICATION: ___ with pleuritic chest pain, question focal
consolidation.
Comparison is made to the patient's previous study dated ___.
An AP upright portable chest film ___ at 2139 is submitted.
IMPRESSION:
1. There continues to be a patchy streaky opacity in the left mid lung in a
known area of interstitial fibrosis. Overall, it appears to be slightly
worse, although this could be related to differences in technique. A
superimposed infection cannot be entirely excluded. The remaining lungs are
otherwise grossly clear. No evidence of pulmonary edema. Overall cardiac and
mediastinal contours are stable. No pleural effusions. No pulmonary edema.
No evidence of pneumothorax. Clinical correlation is advised and further
imaging evaluation with CT at this time should be based on the clinical
assessment.
|
10112163-RR-15 | 10,112,163 | 29,734,486 | RR | 15 | 2121-08-22 13:24:00 | 2121-08-22 14:07:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with CHF// ?pulm edema
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is moderate to severely enlarged. The mediastinal and hilar
contours are normal. The pulmonary vasculature is mildly engorged with mild
interstitial pulmonary edema and small bilateral pleural effusions noted.
Streaky retrocardiac opacity likely reflects atelectasis. No pneumothorax is
seen. There are no acute osseous abnormalities.
IMPRESSION:
Moderate to severe cardiac enlargement with mild interstitial pulmonary edema
and small bilateral pleural effusions. Streaky retrocardiac opacity, likely
atelectasis.
|
10112392-RR-20 | 10,112,392 | 26,396,613 | RR | 20 | 2156-11-30 00:08:00 | 2156-11-30 08:24:00 | INDICATION: History: ___ with AMS// ?cpd
TECHNIQUE: AP frontal chest radiograph
COMPARISON: None
FINDINGS:
Lung volumes are slightly low. There is no focal consolidation. Mildly
prominent cardia silhouette is likely due to AP technique. No pneumothorax or
pleural effusion.
IMPRESSION:
No focal consoldation.
|
10112984-RR-21 | 10,112,984 | 28,460,904 | RR | 21 | 2160-08-06 16:20:00 | 2160-08-06 18:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo man w/ HTN, IDDM, ESRD on HD ___, severe PVD s/p BKA, CAD
of unclear extent), renal carcinoma s/p local radiofrequency ablation of tumor
without nephrectomy who presented to ___ w/ severe SOB and hypoxia,
transferred to ___ w/ c/f NSTEMI on heparin.// pulmonary edema?
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Shallow inspiration. Heart size is increased, similar to prior. Pulmonary
vascular congestion is mildly improved. Bilateral perihilar, basilar
opacities have improved, consistent with improving edema or improving
infection. Left axillary stent in place. No pneumothorax. No sizable
effusion.
IMPRESSION:
Mild improvement since prior.
|
10112984-RR-22 | 10,112,984 | 28,460,904 | RR | 22 | 2160-08-07 22:03:00 | 2160-08-07 22:29:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ yo man w/ HTN, IDDM, ESRD on HD ___, severe PVD s/p BKA, CAD
of unclear extent), renal carcinoma s/p local radiofrequency ablation of tumor
without nephrectomy who presented to ___ w/ severe SOB and hypoxia,
transferred to ___ w/ c/f NSTEMI on heparin.// calcifications in the aorta?
evaluation before potential cardiac surgery
TECHNIQUE: Multidetector helical scanning of the chest was reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.2 s, 35.2 cm; CTDIvol = 20.3 mGy (Body) DLP = 712.2
mGy-cm.
2) Spiral Acquisition 1.1 s, 16.7 cm; CTDIvol = 20.4 mGy (Body) DLP = 340.0
mGy-cm.
Total DLP (Body) = 1,052 mGy-cm.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The imaged thyroid is normal. Supraclavicular
and axillary lymph nodes are not enlarged by CT size criteria. There is small
area of calcification in between origin of RCA and left main coronary
arteries, extensive involving aortic wall closer to the RC origin. Small
focus of aortic wall calcification wall vein posterior-lateral left margin of
mid ascending aorta series 302, image 92. Otherwise, in the ascending aorta,
there is no aortic wall calcifications involving anterior, right lateral or
left lateral walls. Extensive arterial calcifications are seen in the
visualized upper abdomen.
MEDIASTINUM: Mildly prominent mediastinal lymph nodes, largest 1.2 cm short
axis, likely reactive.
HILA: Hilar lymph nodes are not pathologically enlarged.
HEART and PERICARDIUM: Mildly prominent main pulmonary artery, suggest
pulmonary artery hypertension.. Moderate cardiomegaly. Coronary artery
calcifications.
PLEURA: There is no pleural effusion or pneumothorax.
LUNGS/AIRWAYS: The airways are patent to the subsegmental level. There are
moderate ___ and ground-glass predominantly centrilobular and
peribronchial opacities throughout both lungs, greatest at the left lung base.
No new suspicious pulmonary nodule detected. Left lower lobe 4 mm calcified
granuloma.
UPPER ABDOMEN: This study is not tailored to evaluate subdiaphragmatic
structures. Allowing for this, no significant abnormalities identified.
Bilateral gynecomastia.
CHEST CAGE/BONES: No focal lytic or sclerotic lesion concerning for
malignancy. Moderate multilevel degenerative changes of the thoracic spine are
unchanged. Findings in the vast spine are suggestive of DISH. Resection of
the medial margin of the right clavicle. There few chronic rib fractures.
IMPRESSION:
1. Bilateral ___, centrilobular, ground-glass opacities, greatest at
the left lower lobe, are most likely infectious. Mildly prominent mediastinal
lymph nodes, likely reactive.
2. Cardiomegaly with moderate to severe coronary artery calcifications, and
minimal ascending aortic calcification..
3. Suggestion of pulmonary artery hypertension.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 12:04 am, 10 minutes
after discovery of the findings.
|
10112984-RR-23 | 10,112,984 | 28,460,904 | RR | 23 | 2160-08-08 10:51:00 | 2160-08-08 19:27:00 | EXAMINATION: VEIN MAPPING-Lower extremities
INDICATION: ___ yo man w/ HTN, IDDM, ESRD on HD ___, severe PVD s/p BKA, CAD
of unclear extent), renal carcinoma s/p local radiofrequency ablation of tumor
without nephrectomy who presented to ___ w/ severe// vein mapping
for cabg
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of bilateral
lower extremity veins.
COMPARISON: None.
FINDINGS:
RIGHT: The great saphenous vein is patent in the thigh only with diameters
ranging from 0.36 to 0.41 cm. RT GSV is absent below the knee. The right
small saphenous vein is not seen.
LEFT: The great saphenous vein is patent with diameters ranging from 0.29 to
0.4 cm. The left small saphenous vein is patent with thick walls.
IMPRESSION:
The RT great saphenous vein is patent in the thigh; the left GSV is patent.
Please see digitized image on PACS for formal sequential measurements.
|
10113036-RR-10 | 10,113,036 | 21,335,145 | RR | 10 | 2111-01-20 04:30:00 | 2111-01-20 06:41:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: History: ___ with R-foot clelulit,s R-knee pain// osteo, septic
arthritis osteo, septic arthritis
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of
COMPARISON: None.
FINDINGS:
No fracture or dislocation is seen. There is joint space narrowing in the
tibiofemoral joint space compartments, more severe in the lateral compartment.
There is tricompartmental osteophytosis. There is a small knee effusion.
There is mild distortion of ___ fat pad. Incidental note is made of a
fabella. No lytic or sclerotic lesions are identified. Bone mineral density
is within normal limits.
IMPRESSION:
No acute fracture or dislocation. Extensive degenerative changes as described
above.
|
10113036-RR-12 | 10,113,036 | 21,335,145 | RR | 12 | 2111-01-20 09:52:00 | 2111-01-20 17:32:00 | EXAMINATION: MR FOOT ___ CONTRAST RIGHT
INDICATION: ___ with R-foot cellulitis and R-knee pain// eval severe diabetic
foot infection
TECHNIQUE: Imaging performed at 1.5 tesla using the foot/ankle coil.
Sequences include coronal T1 and STIR, sagittal T1 and STIR, coronal T1 fat
sat pre and post-contrast and sagittal T1 fat sat post contrast weighted
sequences. The patient received 16 mL of Gadavist for intravenous contrast.
COMPARISON: Right foot radiographs ___
FINDINGS:
The patient has a Charcot arthropathy with resultant disorganization
fragmentation and sclerosis of the midfoot. There is plate of the Lisfranc
joint, association of the intercuneiform and tarsometatarsal joints. There is
extensive bone marrow replacement on T1 weighted sequences involving the
distal cuboid, the navicular bone, the intermediate, medial and lateral
cuneiform and the base of the second through fifth metatarsals. There is
edema a more fluid sensitive sequences in a similar distribution with slightly
more extensive involvement of the metatarsals. There is expected
hyperenhancement of these bony structures following contrast administration.
Given the extent of involvement, a Charcot arthropathy is favored over acute
osteomyelitis however there is an area of devitalized tissue overlying the
fifth metatarsal with nonenhancement on the post-contrast images (10:25).
Multiple areas of markedly low signal intensity on all sequences are
consistent with air given the appearances on the prior radiographs (10:29).
This area of devitalized tissue partially surrounds the fifth metatarsal
distally, however the bone marrow in the fifth metatarsal at this level is
actually preserved (04:29).
More proximally in the midfoot there is a presumed skin ulcer with devitalized
tissue in the presumed sinus tract extending along the plantar aspect of the
lateral foot (10:21). On postcontrast images a sinus tract appears to extend
to the plantar surface of the cuboid (10:20) where there is marrow signal
replacement and associated edema (4:20, 6:14). This area is more suspicious
for acute osteomyelitis.
Nonspecific marrow edema in the distal fibula, talus, calcaneus is seen
without replacement of the normal T1 marrow signal, likely reactive. There is
a small tibiotalar joint effusion and a small subtalar joint effusion.
At the first metatarsophalangeal joint there are multiple erosions of the head
of the first metatarsal (04:34, 33). There is a small associated joint
effusion. Although difficult to evaluate bone marrow edema in the setting of
a Charcot arthropathy, there is relative sparing of the first metatarsal head
(6:3, 7:3) so an infective process is considered less likely. This may
reflect gout, correlate clinically.
There is severe fatty atrophy of the tarsal tunnel muscles. There is
thickening and heterogeneity of the plantar fascia consistent with plantar
fasciitis. This study is tailored to evaluate the foot rather than the ankle,
nonetheless there is tenosynovitis of the peroneus longus and brevis tendons
with an apparent longitudinal split tear of peroneus brevis.
Diffuse soft tissue edema and hyper enhancement is nonspecific but may reflect
cellulitis.
IMPRESSION:
1. Devitalized tissue and ulceration involving the lateral and plantar aspect
of the midfoot. A sinus track along the plantar aspect of the midfoot extends
to the plantar surface of the cuboid bone with underlying bone marrow edema,
abnormal T1 signal and hyper enhancement suspicious for acute osteomyelitis at
this site.
2. Extensive marrow signal abnormalities in the navicular, medial, lateral and
intermediate cuneiform and second through fifth metatarsals as described in
detail above. Given the multiple bones involved, the chronic fragmentation
and displacement, Charcot arthropathy is favored over an infectious process.
Difficult to exclude superimposed infection in the setting of a Charcot
arthropathy.
3. Apparent erosive arthropathy at the first metatarsophalangeal joint, the
lack of adjacent bone marrow edema makes an infectious process and likely,
correlate with any symptoms or signs of chronic gout.
4. Peroneus longus and brevis tenosynovitis, tendinosis and a longitudinal
split tear peroneus brevis.
5. Severe fatty atrophy of the muscles of the tarsal tunnel.
6. Marrow edema without corresponding loss of the T1 signal intensity in the
tibia talus and calcaneus likely reactive.
7. Diffuse soft tissue edema and hyper enhancement may reflect cellulitis.
|
10113036-RR-13 | 10,113,036 | 21,335,145 | RR | 13 | 2111-01-25 14:59:00 | 2111-01-25 17:21:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with PICC// Pt had a R PICC,55cm ___ ___
Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Prior chest radiograph dated ___.
FINDINGS:
Right PICC line with tip overlying cavoatrial junction.
Moderate cardiomegaly, larger than in ___.
Cardiomediastinal silhouette is unremarkable.
Low lung volumes bilaterally.
Mild pulmonary edema.
No pleural effusions. No pneumothorax.
IMPRESSION:
New right PICC line overlying cavoatrial junction.
Moderate cardiomegaly with mild pulmonary edema and low lung volumes.
|
10113036-RR-14 | 10,113,036 | 21,335,145 | RR | 14 | 2111-01-28 19:43:00 | 2111-01-28 20:53:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ M w/ PMHx of A flutter, gout, HFpEF,HTN, recent metatarsal
fracture with Lisfranc injury, andinsulin-dependent type 2 DM with right-sided
charcot neuropathy who presents in setting of progressive soft tissue
infection of right foot, s/p x2 I D with resulting complex wound that requires
coverage.// rule out DVT, lower extremity swelling
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial vein. The bilateral
peroneal veins were not seen. Subcutaneous edema was noted in the bilateral
calf.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
The bilateral peroneal veins were not seen. Otherwise, no evidence of deep
venous thrombosis elsewhere in the right or left lower extremity veins.
Bilateral calf subcutaneous edema.
|
10113036-RR-15 | 10,113,036 | 21,335,145 | RR | 15 | 2111-01-28 23:57:00 | 2111-01-29 09:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ man with atrial flutter on apixaban, HFpEF, gout,HTN,
and DM2 with charcot foot, recent metatarsal fracture withLisfranc injury,
presenting with R foot infection, now s/p I D x2 (___) pending I D and
wound VAC ___// Evaluate for pulmonary edema Evaluate for pulmonary edema
IMPRESSION:
Compared to chest radiographs ___.
Moderate cardiomegaly and mediastinal venous engorgement persist. Lung
volumes have improved. Mild edema persists in the lung bases. Pleural
effusions small if any. No pneumothorax.
Right PIC line can be traced as far as the superior cavoatrial junction, but
the tip is not distinct.
|
10113036-RR-16 | 10,113,036 | 21,335,145 | RR | 16 | 2111-01-29 13:22:00 | 2111-01-29 19:24:00 | EXAMINATION: VENOUS DUP UPPER EXT BILATERAL
INDICATION: ___ M w/ PMHx of A flutter, gout, HFpEF,HTN, recent metatarsal
fracture with Lisfranc injury, and insulin-dependent type 2 DM with
right-sided charcot neuropathy who presents in setting of progressive soft
tissue infection of right foot, s/p x2 I D with resulting complex wound that
requires coverage.// please perform vein mapping of upper extremities (look at
suitability and caliber of cephalic veins as vein grafts
TECHNIQUE: Grey scale and Doppler evaluation was performed on the bilateral
upper extremity veins.
COMPARISON: None.
FINDINGS:
The right cephalic vein appears patent and measures 0.18 cm near the shoulder,
0.13 cm in the upper arm, 0.14 cm in the mid upper arm and 0.2 cm near the
elbow. The right cephalic vein measures 0.45 cm in the upper forearm, 0.43 cm
in the mid forearm and 0.35 cm near the wrist. There is a PICC line in the
right basilic vein which precludes evaluation.
The left cephalic vein is patent and measures 0.24 cm near the shoulder, 0.22
cm in the mid upper arm, 0.33 cm in the distal upper arm and 0.30 cm above the
elbow. In the forearm, the left cephalic vein measures 0.55 cm in the
proximal forearm, 0.36 cm in the mid forearm and 0.38 cm in the distal
forearm. The basilic vein is patent measuring 0.62 cm in the proximal upper
arm, 0.67 cm in the mid upper arm and 0.52 cm above the elbow.
IMPRESSION:
Patent veins in both upper extremities with measurements as noted above.
|
10113036-RR-25 | 10,113,036 | 21,746,949 | RR | 25 | 2111-06-24 02:46:00 | 2111-06-24 03:32:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: History: ___ with hx RLE infection c/b osteo here with recurrent
sx. Evaluation for changes concerning for osteomyelitis.
TECHNIQUE: AP, oblique, and lateral views of the right foot.
COMPARISON: Comparison to multiple prior radiographs, most recently from ___. Comparison to MRI right foot from ___.
FINDINGS:
Severe neuropathic changes of the midfoot remain similar in appearance to
prior study, with inferior subluxation/dislocation of the cuneiforms and
navicular in relation to the metatarsal bases. Dislocation of the Lisfranc
interval also remains unchanged. Postsurgical changes related to prior
excision of the right fifth metatarsophalangeal joint and multiple
debridements of the right foot. Fragmentation is seen at the base of the
metatarsals and cuneiforms. An inferior calcaneal spur is noted. Vascular
calcifications are again seen. No definite evidence of new erosions to suggest
osteomyelitis.
IMPRESSION:
1. No definite evidence of new erosions to suggest osteomyelitis.
2. Overall similar radiographic appearance of the right foot, including severe
neuropathic changes of the midfoot and postsurgical changes related to prior
excision of the right fifth MTP joint and multiple debridements of the right
foot.
|
10113036-RR-26 | 10,113,036 | 24,053,360 | RR | 26 | 2111-07-20 16:33:00 | 2111-07-20 17:19:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ male with hx of charcot foot, osteo, chronic R foot
wound with new swelling/erythema. Evaluate for interval changes or evidence
of osteomyelitis.
TECHNIQUE: AP, lateral, and oblique views of the right foot were obtained.
COMPARISON: Right foot radiograph dated ___.
FINDINGS:
Again demonstrated are postsurgical changes related to a excision of the right
fifth metatarsophalangeal joint, similar to most recent prior examination.
Neuropathic changes of the midfoot including inferior subluxation of the
cuneiform and navicular in relation to the metatarsal bases are stable. There
is persistent dislocation of the Lisfranc interval. Osseous fragmentation at
the base of the medial cuneiform is unchanged. Stable appearance of a
calcaneal spur. No evidence of osseous erosions or periostitis. There is
redemonstration of multiple vascular calcifications.
IMPRESSION:
1. Overall unchanged radiographic appearance of the right foot including
severe neuropathic changes of the midfoot and postsurgical changes of the
fifth metatarsophalangeal joint.
2. No evidence of osseous erosions to suggest osteomyelitis. Soft tissue
structures are unremarkable aside from a multiple vascular calcifications.
|
10113036-RR-27 | 10,113,036 | 24,053,360 | RR | 27 | 2111-07-23 18:31:00 | 2111-07-23 22:01:00 | EXAMINATION: MR FOOT ___ CONTRAST RIGHT
INDICATION: ___ male with diabetes and a right plantar nonhealing
ulcer status post graft and right lower extremity cellulitis. Examination is
been requested to evaluate for abscess or osteomyelitis.
Per the ___ medical record:
___: Excision of the right fifth metatarsophalangeal joint.
Debridement of a right foot wound.
___: Irrigation debridement of a right dorsal foot wound.
___: Debridement of the right foot wound and split-thickness
skin graft from the right thigh measuring 14 x 9 cm.
TECHNIQUE: Multiplanar multisequence imaging of the right foot using a
foot/ankle coil. The patient received 15 mL of Gadavist for intravenous
contrast.
COMPARISON: Right foot radiographs dated ___.
Right foot MRI performed ___.
FINDINGS:
Patient is status post excision of the right fifth metatarsophalangeal joint,
unchanged compared to prior exam.
As compared to exam dated ___, again demonstrated are findings
compatible with neuropathic joint. Includes disruption of the Lisfranc
interval and severe degenerative changes of the midfoot. There is persistent
inferior tilting of the talus, cuneiform, and navicular towards the plantar
aspect of the foot.
Previously seen extensive bone marrow STIR signal abnormality in the midfoot
appears similar to slightly improved compared to ___. There is
persistent increased STIR signal hyperintensity within the proximal shaft of
the fifth metatarsal, unchanged compared to ___ (08:24). There is
no evidence of cortical erosion or other imaging evidence to suggest
osteomyelitis. Soft tissue edema seen within the right fifth MTP excision bed
appears similar. There is no evidence of deep ulceration at the site.
Induration of the soft tissues at the lateral plantar aspect of the foot
appear similar to improved compared prior exam. No organized fluid collection
is demonstrated to suggest abscess. Cystic changes of the first MTP joint and
navicular bone are similar to prior.
There is diffuse muscle atrophy, compatible with diabetic neuropathy.
IMPRESSION:
1. Imaging findings are most compatible with neuropathic joint rather than
osteomyelitis. Bone marrow signal appears similar to slightly improved
compared to ___ with persistent increased STIR signal hyperintensity
within the proximal shaft of the fifth metatarsal.
2. Postsurgical changes related to a fifth MTP joint excision without evidence
of a focal fluid collection or ulceration.
3. Induration of the soft tissues of the lateral and plantar aspect of the
foot appears similar to slightly improved compared to most recent prior exam.
|
10113036-RR-30 | 10,113,036 | 20,558,872 | RR | 30 | 2111-09-15 13:08:00 | 2111-09-15 18:59:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with RLE cellulitis. Erythema and swelling have
been slow to resolve.// Assess for DVT. Please also check great saphenous vein
for superficial thromboplebitis.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
The right greater saphenous vein is also patent.
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 lower extremity veins.
|
10113036-RR-9 | 10,113,036 | 21,335,145 | RR | 9 | 2111-01-20 04:24:00 | 2111-01-20 07:17:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: History: ___ with T2DM, w/ R-foot cellulitis// osteomyelitis
TECHNIQUE: Three views of the right foot.
COMPARISON: None.
FINDINGS:
In the area of clinical concern over the head of the fifth metatarsal there is
apparent loss of cortex along the tibial aspect of the bone raising concern
for osteomyelitis. In addition, over this region there is an apparent soft
tissue defect with associated soft tissue gas.
There is no evidence of acute fracture. There is collapse of the midfoot as
well as extensive dorsal spurring. There is a plantar calcaneal spur. There
is extensive vascular calcifications.
IMPRESSION:
Findings concerning for osteomyelitis of the head of the fifth metatarsal.
There is extensive soft tissue gas within the foot with swelling. Surgical
consultation and further evaluation with MRI is recommended as clinically
indicated.
NOTIFICATION: The findings were discussed with ___ MD by ___
___, M.D. 5 minutes after discovery of the findings.
|
10113224-RR-5 | 10,113,224 | 29,363,512 | RR | 5 | 2135-10-05 02:03:00 | 2135-10-05 05:26:00 | EXAMINATION: DX HAND AND WRIST
INDICATION: History: ___ with left hand swelling, infection// foreign body,
soft tissue, osteo foreign body, soft tissue, osteo
foreign body, soft tissue, osteo
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left hand
and wrist
COMPARISON: None.
FINDINGS:
There is diffuse soft tissue swelling about the hand. No fracture or
dislocation is seen. There are no significant degenerative changes. No bone
erosion or periostitis is identified. No suspicious lytic or sclerotic lesion
is identified. No soft tissue calcification or radio-opaque foreign bodies are
detected.
IMPRESSION:
Diffuse soft tissue swelling about the hand. No radiopaque foreign body is
identified.
|
10113381-RR-100 | 10,113,381 | 24,304,543 | RR | 100 | 2173-04-04 08:03:00 | 2173-04-04 10:58:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT
IMPRESSION:
Images from the operating suite show placement of an extensive fixation device
about comminuted fracture of the distal femur. Total knee arthroplasty is in
place. Further information can be gathered from the operative report.
|
10113381-RR-88 | 10,113,381 | 20,850,207 | RR | 88 | 2168-10-10 17:49:00 | 2168-10-10 19:27:00 | INDICATION: +PO contrast; History: ___ with ab pain. s/p recent TAH/BSO,
ileocecectomy +PO contrast // rule out abscess
TECHNIQUE: MDCT imaging of the abdomen and pelvis with intravenous contrast
performed. Multiplanar reformats were prepared and reviewed.
DOSE: DLP: 765.76 mGy-cm
COMPARISON: None.
FINDINGS:
The visualized lung bases are clear.
ABDOMEN: LIVER: The liver is homogeneous in texture with no focal lesions.
There is no biliary ductal dilatation.
GALLBLADDER: The gallbladder his normal in appearance.
PANCREAS: The pancreas is atrophic but is otherwise unremarkable.
SPLEEN: The spleen demonstrates multiple calcifications consistent with
granulomatous disease.
ADRENALS: The adrenal glands are unremarkable bilaterally.
KIDNEYS: The left kidney demonstrates multiple hypodensities too small to
characterize though likely represent renal cysts. Kidneys otherwise
unremarkable.
GI: Sigmoid diverticulosis without evidence of diverticulitis is seen.
RETROPERITONEUM: Scattered small mesenteric and periaortic lymph nodes are
noted.
VASCULAR: The abdominal aorta is normal in appearance.
There is a rim enhancing fluid collection measuring 4.0 x 1.6 cm in the
midline anterior abdominal wall at the level of the bladder. There is fat
stranding adjacent to the fluid collection and extending along the anterior
abdominal midline up to the level of the umbilicus. Trace fluid and fat
stranding is seen in the abdominal cavity. No drainable collection is seen
intraabdominally.
PELVIS: The sigmoid colon and rectum are normal in appearance. The distal
ureters and bladder are normal. There is no pelvic or inguinal
lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES: No focal lytic or sclerotic osseous lesions
suspicious for infection or malignancy are seen. Multilevel degenerative
changes in the spine.
IMPRESSION:
1. Rim enhancing fluid collection with surrounding fat stranding in the
midline anterior abdominal wall at the level bladder, about 10 cm inferior to
the umbilicus. Findings consistent with an abscess versus possible
postsurgical changes.
2. Trace ascites and intra-abdominal fat stranding, while findings may be
postsurgical cannot rule out an infectious process in the right clinical
setting. No drainable collection is seen intra-abdominally.
|
10113381-RR-98 | 10,113,381 | 24,304,543 | RR | 98 | 2173-04-03 17:34:00 | 2173-04-03 18:35:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall on eliquis// cva?
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: DLP 846 mGy cm
COMPARISON: Noncontrast head CT ___
FINDINGS:
There is no evidence of acute large territorial infarction, intracranial
hemorrhage, edema, or discrete mass.Age related involutional changes noted
with prominence of ventricles and sulci appearing unchanged. Periventricular
and subcortical white matter hypodensities are nonspecific, though likely
sequelae of chronic small vessel ischemic disease. Basal ganglia and
cerebellar senescent calcifications again noted.
No acute osseous abnormalities seen. There are chronic deformities of the
nasal bone. Again demonstrated, is a leftward nasal septal deviation with a
small spur. The partially imaged paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The left external ear cavity contains mild
soft tissue which is likely impacted cerumen. The orbits demonstrate no acute
abnormalities.
Partially visualized right parotid mass better assessed on same-day CT
C-spine.
IMPRESSION:
1. No acute intracranial process.
2. Partially imaged enlarging right parotid mass better assessed on same day
C-spine CT.
|
10113381-RR-99 | 10,113,381 | 24,304,543 | RR | 99 | 2173-04-03 17:34:00 | 2173-04-03 18:30:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall// eval c spine fracture
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: DLP 496 mGy-cm
COMPARISON: CT C-spine ___
FINDINGS:
Alignment is unchanged with mild anterolisthesis of C4 on C5. No acute
fracture seen. M degenerative disc disease is most pronounced at C5-6 and
C6-7 with disc space narrowing and small endplate osteophytes. Facet
arthropathy is extensive in the mid to upper cervical spine without severe
neural foraminal stenosis. No critical central canal stenosis. There is no
prevertebral edema. The thyroid and included lung apices are unremarkable.
There is interval enlargement of a previously reported right parotid mass,
currently measuring 2.2 x 1.7 cm, previously measuring 1.2 x 1.2 cm. Findings
best seen on series 3 image 19
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Degenerative changes as stated.
3. Increased size of a right parotid mass. Recommend biopsy.
RECOMMENDATION(S): Right parotid mass biopsy.
|
10113512-RR-15 | 10,113,512 | 24,931,866 | RR | 15 | 2121-11-28 13:18:00 | 2121-11-28 14:05:00 | INDICATION: ___ with right flank pain, know hx of kidney stones // please
eval for kidney stones
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection. The patient was scanned in prone position.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP (Body) = 718 mGy-cm.
COMPARISON: None available.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is a 4 mm proximal right ureteral stone with mild to moderate
right hydronephrosis. Mildly right perinephric stranding is seen. There are
4 mm and 2 mm right lower pole renal stones. On the left, there is an 8 mm
left lower pole nonobstructing stone and a 11 mm nonobstructing left renal
pelvis stone. No left hydronephrosis.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall
thickness throughout. Diverticulosis of the descending colon is noted,
without evidence of wall thickening and fat stranding. The appendix is normal
and located slightly left of midline.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are not well assessed, but the
uterus appears bulbous and may contain fibroids.
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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 4 mm proximal right ureteral stone with mild to moderate right
hydronephrosis. Mild right perinephric stranding.
2. Bilateral nephrolithiasis, as above.
|
10113512-RR-16 | 10,113,512 | 24,931,866 | RR | 16 | 2121-11-29 08:53:00 | 2121-11-29 10:49:00 | INDICATION: Patient with G negative bacteremia and hemodynamically unstable
with right-sided hydronephrosis due to ureterolithiasis. Please perform
percutaneous right nephrostomy tube placement urgently.
COMPARISON: CTU from ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 35 min 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: See above
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.44 min, 361 cGycm2
PROCEDURE: 1. Right ultrasound guided renal collecting system access.
2. Right nephrostogram.
3. ___ F nephrostomy tube placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right flank was prepped and draped in the usual sterile fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the right renal collecting system was accessed through a posterior lower pole
calyx under ultrasound guidance using a 21 gauge Cook needle. Ultrasound
images of the access were stored on PACS. Prompt return of urine confirmed
appropriate positioning. Injection of a small amount of contrast outlined a
dilated renal collecting system.
Under fluoroscopic guidance, a Nitinol wire was advanced into the renal
collecting system. After a skin ___, the needle was exchanged for an
Accustick sheath. Once the tip of the sheath was in the collecting system; the
sheath was advanced over the wire, inner dilator and metallic stiffener. The
wire and inner dilator were then removed and diluted contrast was injected
into the collecting system to confirm position. A ___ wire was advanced
through the sheath and coiled in the collecting system. The sheath was then
removed and an 8 ___ nephrostomy tube was advanced into the renal
collecting system. The wire was then removed and the pigtail was formed in the
collecting system. Contrast injection confirmed appropriate positioning. The
catheter was then flushed, 0 silk stay sutures applied and the catheter was
secured with a Stat Lock device and sterile dressings. The catheter was
attached to a bag.
The patient tolerated the procedure well. There were no immediate
complications or significant blood loss. However the patient's heart rate at
the beginning of the procedure was in the 100-130's with a blood pressure in
the 90-100/ ___, which remain stable throughout the intra service time.
FINDINGS:
1. Mild right-sided hydronephrosis. Obstructive stone in the proximal right
ureter.
2. Right-sided percutaneous nephrostomy tube placement with the tube entering
the kidney in the lower pole calyx and the pigtail in the renal pelvis
IMPRESSION:
Successful placement of an 8 ___ nephrostomy on the right.
|
10113512-RR-17 | 10,113,512 | 24,931,866 | RR | 17 | 2121-11-29 20:50:00 | 2121-11-30 08:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with GNR in blood with SOB // ? development of
PNA
COMPARISON: No comparison
IMPRESSION:
Low lung volumes. Moderate cardiomegaly. Bilateral parenchymal opacities at
the lung bases, right more than left, with air bronchograms, that could
reflect pneumonia in the appropriate clinical setting. No pulmonary edema.
No pneumothorax. No larger pleural effusions.
|
10113512-RR-18 | 10,113,512 | 24,931,866 | RR | 18 | 2121-11-30 04:42:00 | 2121-11-30 08:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with urosepsis s/p nephrostomy tube now with
increasing SOB // interval change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, there is unchanged evidence of
bilateral parenchymal opacities with air bronchograms, likely reflecting
pneumonia in the appropriate clinical setting. Pre-existing signs of mild
pulmonary edema have decreased but fluid overload is still present. No larger
pleural effusions.
|
10113857-RR-19 | 10,113,857 | 27,855,685 | RR | 19 | 2123-12-01 00:43:00 | 2123-12-01 05:38:00 | INDICATION: ___ man with fever status post hospitalization. Evaluate
for infiltrate.
COMPARISONS: None.
FINDINGS: PA and lateral chest radiographs were provided. There is no focal
consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette
is normal. The bones are intact.
IMPRESSION: No acute cardiopulmonary process.
|
10113857-RR-20 | 10,113,857 | 27,855,685 | RR | 20 | 2123-12-03 11:42:00 | 2123-12-03 14:56:00 | HISTORY: New right PICC line, eval for placement.
COMPARISON: ___.
FINDINGS:
Portable single frontal chest radiograph was obtained with the patient in
upright position.
A right PICC line terminates in the upper SVC. There is no evidence of
complication or pneumothorax. No focal consolidation, pleural effusion, or
pulmonary edema is seen. Her size is normal. Mediastinal contours are
normal.
IMPRESSION:
Right PICC line terminating in the upper SVC.
Findings were communicated with ___ by ___ telephone at the
time of the observation at 12:20 on ___.
|
10113857-RR-23 | 10,113,857 | 27,005,154 | RR | 23 | 2124-01-27 19:51:00 | 2124-01-27 20:32:00 | HISTORY: ___ y/o M with history of peripheral vascular disease, with a cold
and painful right foot.
TECHNIQUE: Grayscale, color Doppler, and spectral analysis of the venous
system of the right lower extremity was performed.
COMPARISON: None available.
FINDINGS:
There is normal compression, color flow, and augmentation of the common
femoral vein; proximal, mid and distal superficial femoral vein as well as the
popliteal vein. The peroneal and posterior tibial veins were not seen. There
is normal phasicity of the common femoral veins bilaterally.
IMPRESSION:
No evidence of right lower extremity DVT. Peroneal and posterior tibial veins
were not seen.
|
10113898-RR-17 | 10,113,898 | 27,529,166 | RR | 17 | 2112-11-19 23:12:00 | 2112-11-20 10:48:00 | AP CHEST, 11:17 P.M., ___
HISTORY: Tracheal stent for mediastinal mass.
IMPRESSION: AP chest compared to ___:
An 8 mm region of tracheal stenting is centered on the thoracic inlet,
terminates approximately 2.5 cm above the carina. Diameter of the stent
combination is approximately 18 mm. There is no interval widening of the
mediastinum harboring a very large right paratracheal mass. Extent of
leftward tracheal displacement is unchanged. The stents are not deformed, as
far as one can tell from a single projection. There is no pneumothorax or
pleural effusion. Heart is top normal size. Lungs grossly clear.
Dr. ___ was paged to discuss these findings.
|
10113898-RR-18 | 10,113,898 | 27,529,166 | RR | 18 | 2112-11-20 04:13:00 | 2112-11-20 11:08:00 | PATIENT HISTORY: ___ years old woman with mediastinal mass with tracheal
compression status post biopsy and bare-metal stents by two to the trachea 2
cm below the vocal cords.
INDICATION: Pneumothorax, interval change in stent.
TECHNIQUE: Portable AP single view chest x-ray in erect position.
COMPARISON: Exam is compared to ___.
FINDINGS: As compared to prior chest x-ray, there are no interval changes.
The stent project in the same position without changes in caliber or
confirmation. The right upper parahilar mass is redemonstrated. There is no
pneumothorax or new consolidations. Cardiomediastinal silhouette is
unchanged. There is moderate air gastric distension
IMPRESSION: Status quo.
|
10114694-RR-18 | 10,114,694 | 22,418,467 | RR | 18 | 2163-03-27 14:47:00 | 2163-03-27 15:22:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with concern for endotracheal tube placement***
WARNING *** Multiple patients with same last name!// tube placement
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: None.
IMPRESSION:
Endotracheal tube tip terminates 4.5 cm cranial to the carina, satisfactory.
Upper enteric tube tip lies just proximal to the GE junction and should be
advanced by roughly 7 cm. Heart size is normal. Cardiomediastinal silhouette
and hilar contours are grossly preserved. There is no focal consolidation.
There is no large effusion or pneumothorax.
|
10114694-RR-19 | 10,114,694 | 22,418,467 | RR | 19 | 2163-03-27 17:29:00 | 2163-03-27 19:26:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with altered mental status*** WARNING *** Multiple
patients with same last name!// Stroke or bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.8 cm; CTDIvol = 48.0 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is no evidence of fracture. There is a tiny mucous retention cyst in
the right maxillary sinus. The remainder of the visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable. Upper enteric tube is
partially visualized with associated fluid within the posterior nasopharynx.
IMPRESSION:
No acute intracranial abnormality.
|
10114694-RR-20 | 10,114,694 | 22,418,467 | RR | 20 | 2163-03-28 07:51:00 | 2163-03-28 13:35:00 | INDICATION: ___ year old man with history of IVDU, Hep C, HIV, ERCP s/p Stent,
bipolar w/ multiple prior psych hospitalizations presenting with concern for
overdose with suicidal intent now intubated for airway protection// ETT
position
COMPARISON: Radiographs from ___
IMPRESSION:
The endotracheal tube and enteric tube are unchanged in position. The side
port of the nasogastric tube is again at the GE junction. Cardiomediastinal
silhouette is within normal limits. There are no focal consolidations,
pleural effusion, or pulmonary edema. There are no pneumothoraces.
|
10114694-RR-21 | 10,114,694 | 22,418,467 | RR | 21 | 2163-03-29 04:42:00 | 2163-03-29 09:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ male w/ history of IVDU, Hep C, HIV, ERCP s/p Stent, bipolar
w/ multiple prior psych hospitalizations presenting with concern for overdose
with suicidal intent now intubated// ETT placement ETT placement
IMPRESSION:
Compared to chest radiographs ___ and ___ one.
Lungs clear. Heart size top-normal. No pleural abnormality. ET tube in
standard placement. Nasogastric drainage tube passes into the stomach and out
of view.
|
10114694-RR-22 | 10,114,694 | 22,418,467 | RR | 22 | 2163-03-30 15:29:00 | 2163-03-30 16:17:00 | INDICATION: ___ year old man with fever,,just extubated// any e/o pna?
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
The NG tube has been removed. Lungs are low volume with bibasilar
atelectasis. Heart size is normal. No pneumothorax is seen
|
10114736-RR-10 | 10,114,736 | 21,428,253 | RR | 10 | 2166-05-10 17:46:00 | 2166-05-10 20:48:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ female right-sided facial numbness and left frontal
linear hyperdensity concerning for hemorrhage. Evaluate for aneurysm, AVM,
or acute intracranial hemorrhage.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 32.7 mGy (Head) DLP =
16.3 mGy-cm.
3) Spiral Acquisition 5.0 s, 39.6 cm; CTDIvol = 32.1 mGy (Head) DLP =
1,270.3 mGy-cm.
Total DLP (Head) = 2,184 mGy-cm.
COMPARISON: ___ outside unenhanced head CT
FINDINGS:
CT HEAD WITHOUT CONTRAST:
The focal left parietal hyperdensity is again seen on image 4:20, less
conspicuous compared to the prior head CT. This is indeterminate, could be a
focal hemorrhage versus a focus of mineralization. On the subsequent head
MRI, no corresponding susceptibility post seen on gradient echo imaging to
suggest blood products. This is hence favored to be secondary to
mineralization.
There is no evidence of no evidence of infarction, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There are postsurgical changes related to prior right canal wall down
mastoidectomy. The visualized portion of the paranasal sinuses,left mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
Incidentally seen is fetal origin of left posterior cerebral artery with
hypoplastic left P1 segment. Incidentally seen is a developmental venous
anomaly in the left cerebellum.
Precontrast imaging again demonstrates a approximately 4 mm linear left corona
radiata hyperdensity that is of decreased intensity relative to the outside
prior exam (see 04:20 on current exam and 02:20 on prior outside exam). On
CTA imaging there is increased intensity corresponding to this linear
structure suggestive of vessel (see 5:293, 601b:36, 602b:46, 603b:38).
CTA NECK:
The carotid and vertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria.
IMPRESSION:
1. Interval decrease of hyperintensity of linear left coronal radiata
structure on precontrast imaging relative to prior outside imaging with
subsequent linear enhancement on CTA portion of examination. Question if
linear structure represent small capillary telangiectasia or DVA.
Additionally, question if outside precontrast study was performed while
intravascular contrast from prior examination was present and circulation.
Recommend correlation with patient's imaging history. Finding less likely
tumors are present focal hemorrhage. However, if clinically indicated,
consider brain MRI for further evaluation.
2. Postsurgical changes related to prior right canal wall down mastoidectomy.
3. No definite evidence of acute intracranial hemorrhage.
4. No evidence ofaneurysm greater than 3 mm, dissection or significant
luminal narrowing.
RECOMMENDATION(S): Recommend correlation with patient's recent imaging
history prior to outside noncontrast head CT study.
|
10114736-RR-11 | 10,114,736 | 21,428,253 | RR | 11 | 2166-05-11 01:54:00 | 2166-05-11 09:10:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with transient right face paraesthesias and
left frontal lobe hyperdensity. Evaluate for intracranial mass or lesion.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ head and neck CTA.
___ 12:41 outside noncontrast head CT.
FINDINGS:
Study is mildly degraded by motion.
Corresponding to the left corona radiata linear hyperdensity on prior CT
imaging, nonenhancing T2 and FLAIR signal hyperintensity as seen on image 8,
9:16. There is no corresponding susceptibility on gradient echo images or
slow diffusion.
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. A left cerebellar developmental venous anomaly is present.
The orbits are unremarkable. Intracranial flow voids are maintained. There
is a mucous retention cyst in the floor of right maxillary sinus. Also seen
is mild mucosal thickening in bilateral anterior ethmoid air cells. The
remaining visualized paranasal sinuses are clear. There is evidence of prior
right canal wall down mastoidectomy. The left mastoid air cells are clear.
IMPRESSION:
1. Study is mildly degraded by motion.
2. Nonspecific faint left coronal radiata white matter nonenhancing lesion as
described, corresponding to linear hyperdensity seen on recent noncontrast
head CT studies. Of note, intensity of linear hyperdensity on outside
noncontrast head CT at ___ 12:41 is of increased intensity relative
to appearance on subsequent noncontrast portion of head and neck CTA of ___ 18:25, with increased intensity on subsequent postcontrast imaging
of head and neck CTA (see 4:20, 5:293). Question presence of intravascular
contrast during prior head CT examinations pooling at site of prior trauma or
infection. Alternatively, finding may represent capillary telangectasia or
DVA that id not well visualized on this motion degraded examination.
Recommend correlation with imaging history and attention on followup imaging.
3. Postsurgical changes related to prior right canal wall down mastoidectomy.
4. Left cerebellar DVA.
RECOMMENDATION(S): Question presence of intravascular contrast during prior
head CT examinations pooling at site of prior trauma or infection. Recommend
correlation with imaging history and attention on followup imaging.
|
10114825-RR-17 | 10,114,825 | 24,797,756 | RR | 17 | 2179-07-07 00:31:00 | 2179-07-07 02:04:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ year old woman with R trimal// post reduction post
reduction
TECHNIQUE: Three views of the right ankle
COMPARISON: Same day radiograph ___ at 22:30 p.m.
FINDINGS:
Status post interval casting, cast material somewhat obscures fine osseous
detail.
Interval reduction with minimal displacement of a oblique right distal fibular
fracture. There is mild displacement of a oblique fracture through the
posterior malleolus as on prior. The ankle mortise appears intact. No
additional fractures are demonstrated within limits of technique.
IMPRESSION:
Status post casting of acute fractures of the distal fibula and posterior
malleolus, now minimally to mildly displaced. The ankle mortise appears
intact.
|
10114825-RR-18 | 10,114,825 | 24,797,756 | RR | 18 | 2179-07-07 00:45:00 | 2179-07-07 03:18:00 | EXAMINATION: Right ankle CT
INDICATION: ___ year old woman with R trimal ankle fx, preop CT// Fx pattern
___ woman with a right trimalleolar fracture.
TECHNIQUE: Axial images of the right ankle with coronal and sagittal
reformations.
COMPARISON: Right ankle radiographs dated ___ and ___.
FINDINGS:
There is a comminuted posterior malleolus fracture with intra-articular
extension and minimal posterior displacement of the dominant posterior
fragment. The fracture lines involve the tibial attachment of the posterior
tibiofibular ligament.
There are small tibiotalar ligament avulsion fractures along the medial aspect
of the distal medial malleolus (series 401, images 63-69; series 2, images
101-103). There is hematoma along the expected location of the tibiospring
ligament.
There is a comminuted, predominantly obliquely oriented distal fibular
diaphysis fracture above the level of the mortise with approximately 3 mm of
posterior displacement. A small posterior butterfly fragment measures up to
1.2 cm.
There is mild widening of the medial clear space, improved compared to the
initial radiographs obtained 2 hours prior. Posterior dislocation of the
talus has been reduced.
The posterior tibial and flexor digitorum tendons are located in close
proximity to the posterior malleolus fractures without evidence of obvious
entrapment. The peroneal tendons are located within close proximity to distal
fibula fractures without evidence of obvious entrapment. There is substantial
soft tissue edema adjacent to the above-described fractures. There is a small
amount of soft tissue emphysema along the dorsal aspect of the talus.
Small posterior and plantar calcaneal spurs.
IMPRESSION:
1. Trimalleolar fractures as described above with mild persistent widening of
the medial clear space, but improved tibiotalar joint alignment compared to
the initial right ankle radiographs.
2. Probable injuries to the posterior tibiofibular, tibiotalar, and
tibiospring ligaments.
|
10114825-RR-19 | 10,114,825 | 24,797,756 | RR | 19 | 2179-07-07 14:14:00 | 2179-07-07 16:04:00 | EXAMINATION: Intraoperative fluoroscopy, right ankle.
INDICATION: ORIF of right ankle fracture.
TECHNIQUE: 3 intraoperative fluoroscopic spot views of the right ankle were
obtained in the operating room during and immediately following open reduction
internal fixation of distal fibula and tibia fractures without presence of
radiologist.
DOSE: Fluoroscopy time 83.9 seconds, cumulative dose 3.89 mGy.
COMPARISON: Radiographs and CT dated ___, earlier on the same day.
FINDINGS:
Final two views depict interval open reduction internal fixation of
trimalleolar ankle fractures with a lateral fixation plate spanning a fracture
through the distal fibular shaft, a posterior plate along the distal tibia and
a syndesmotic screw. Ankle mortise appears congruent.
IMPRESSION:
ORIF of trimalleolar ankle fractures.
|
10115044-RR-79 | 10,115,044 | 25,373,695 | RR | 79 | 2186-12-08 08:57:00 | 2186-12-08 11:05:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with w/ abdominal pain and nausea c/f
choledocholithiasis.// Does pt have evidence of choledocholithiasis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT from ___, MRI from ___
FINDINGS:
LIVER: The liver is heterogeneous. Multiple ill-defined masses are
re-demonstrated. The dominant mass seen spanning the left and right lobes of
the liver is better appreciated on the prior MRI and CT. Smaller satellite
masses include a 2.5 x 2.3 x 1.9 cm heterogeneous, mildly hypoechoic mass in
the left lobe of the liver and a 2.8 x 2.4 x 1.5 cm heterogeneous, hypoechoic
mass in the left lobe of liver. The main portal vein is patent with
hepatopetal flow. There is a small amount of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 6 mm
GALLBLADDER: The gallbladder is distended with cholelithiasis and gallbladder
sludge. No gallbladder wall edema.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
SPLEEN: Normal echogenicity.
Spleen length: 13.7 cm
KIDNEYS: Limited views of the right kidney shows no hydronephrosis.
Right kidney: 9.7 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Heterogeneous liver with multiple masses, better appreciated on the prior
MRI and CT.
2. Distended gallbladder with cholelithiasis and gallbladder sludge as seen on
prior MRI. No specific sonographic findings for acute cholecystitis.
3. No biliary dilatation or choledocholithiasis identified.
4. Splenomegaly. Small amount of ascites.
|
10115044-RR-80 | 10,115,044 | 25,373,695 | RR | 80 | 2186-12-09 12:52:00 | 2186-12-09 15:47:00 | EXAMINATION: Ultrasound-guided liver biopsy
INDICATION: ___ year old woman with abd pain and multiple liver masses
concerning for metastatic cancer unknown primary// bx liver mass for cancer dx
COMPARISON: Previous ultrasound from ___.
PROCEDURE: Ultrasound-guided targeted liver biopsy.
OPERATORS: Dr. ___, radiology 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 supine position on the US scan table. Limited
preprocedure ultrasound of the liver was performed. Based on the ultrasound
findings an appropriate position for the biopsy was chosen. The site was
marked.
The site was prepped and draped in the usual sterile fashion. 10 cc of 1%
lidocaine were administered to the subcutaneous and deep tissues for local
anesthetic effect. Under continuous ultrasound guidance, an 18 gauge core
biopsy device with a 22 mm throw was used to obtain 2 core biopsy specimens,
which were sent for pathology and cytology.
The procedure was tolerated well and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of
16 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Corresponding with prior ultrasound and CT findings, there is a large
heterogeneously hypoechoic dominant mass in the right hepatic lobe. Multiple
additional masses are identified, though less well-defined than on CT. The
dominant mass was selected for biopsy. Obtained cores were dense white
tissue, causing bending of the needle.
IMPRESSION:
Technically successful ultrasound-guided biopsy of the dominant right liver
mass.
|
10115044-RR-81 | 10,115,044 | 25,373,695 | RR | 81 | 2186-12-09 12:51:00 | 2186-12-09 17:05:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with malignancy and new lower extremity
swelling// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
Evaluation is somewhat limited of the bilateral proximal femoral veins due to
extensive calcifications of the adjacent arteries.
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow is
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:
Slightly limited study due to shadowing of the bilateral proximal femoral
veins due to extensive calcifications of the adjacent arteries. Within this
limitation, no evidence of deep venous thrombosis in the right or left lower
extremity veins.
|
10115044-RR-82 | 10,115,044 | 25,373,695 | RR | 82 | 2186-12-12 15:06:00 | 2186-12-12 17:57:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with HTN, DM, and newly-diagnosed metastatic
CA, preliminary liver biopsy results suggest cholangiocarcinoma, staging newly
diagnosed metastatic CA
TECHNIQUE: Axial CT images of the chest were obtained with intravenous
contrast. Coronal, sagittal, and axial MIP images were provided for further
review.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.5 s, 28.9 cm; CTDIvol = 10.2 mGy (Body) DLP = 287.1
mGy-cm.
Total DLP (Body) = 287 mGy-cm.
COMPARISON:
-MRI liver ___
-CTA chest ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized thyroid is
unremarkable. No supraclavicular or axillary lymphadenopathy. No suspicious
chest wall mass.
UPPER ABDOMEN: Known heterogeneous mass at the hepatic dome is better assessed
on the recent MR of ___, but appears grossly similar. Trace
ascites has slightly increased.
MEDIASTINUM: There is an enlarged 2.3 x 1.7 x 2.8 cm subcarinal lymph node.
Peripheral coarse calcification (4:100) is unchanged since ___.
Mediastinal lymph nodes measure up to 1.1 cm at the left lower paratracheal
station (4:87).
HILA: Right hilar lymphadenopathy measures up to 2.1 cm at the inferior right
hilum (4:122).
HEART and PERICARDIUM: Heart size is normal. There are dense atherosclerotic
coronary artery calcifications. Hyperdensity about the mitral annulus may be
due to calcifications or valve replacement. The thoracic aorta is normal in
caliber and course.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: There are multiple new solid pulmonary nodules throughout all
lobes measuring up to 8 mm in the left apicoposterior segment (4:83),
concerning for metastases. Focal consolidation at the anterior base of the
right middle lobe appears to enhance and likely represents atelectasis. There
is otherwise minimal bilateral dependent atelectasis.
2. AIRWAYS: Airways are patent to the subsegmental level bilaterally.
3. VESSELS: The central pulmonary arteries are normal in caliber.
CHEST CAGE: There are severe degenerative changes about the bilateral
sternoclavicular joints. Multilevel ossification of the anterior longitudinal
ligament with preservation of the disc spaces likely represents DISH. No
acute fracture.
IMPRESSION:
1. Multiple new pulmonary nodules throughout all lobes, as well as right hilar
and mediastinal lymphadenopathy, are concerning for metastatic disease.
2. Slight increase in small volume ascites.
3. Known liver mass better assessed on the recent MR of ___.
|
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