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10115156-RR-20 | 10,115,156 | 22,801,147 | RR | 20 | 2141-10-10 13:24:00 | 2141-10-11 14:21:00 | EXAMINATION: L-SPINE (AP AND LAT)
INDICATION: C-arm in OR for L2/L4 XLIF
TECHNIQUE: Fluoroscopic assistance provided to the clinician in the OR
without the radiologist present. 1 spot views obtained. Fluoro time recorded
as not recorded on the available paper and electronic requisitions.
COMPARISON: None
FINDINGS:
Spot view shows the lower lumbar spine, with discogenic and facet degenerative
changes. Assessment of fine bony detail is limited by fluoroscopic technique.
No radiopaque hardware identified on this view.
IMPRESSION:
Correlation with real-time findings and, when appropriate, conventional
radiographs is recommended for further assessment.
|
10115156-RR-21 | 10,115,156 | 22,801,147 | RR | 21 | 2141-10-11 06:02:00 | 2141-10-11 09:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with tachypnea // POD0 w/ tachypnea POD0
w/ tachypnea
IMPRESSION:
There are no prior chest radiographs available for review.
Lung volumes are extremely low. Right basal opacification is almost certainly
atelectasis. Less clearly seen consolidation in the left lower lobe and in
the lingula, obscuring the left heart border, could be atelectasis or
pneumonia. Vascular congestion in the left lung is probably positional.
Pleural effusions are likely, but not large. No pneumothorax.
|
10115156-RR-22 | 10,115,156 | 22,801,147 | RR | 22 | 2141-10-11 18:57:00 | 2141-10-11 20:36:00 | EXAMINATION: CT chest
INDICATION: ___ year old woman with tacyhypnea and increase SOB, s/p lumbar
fusion// eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 1.8 s, 27.9 cm; CTDIvol = 12.7 mGy (Body) DLP = 353.3
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.5 cm; CTDIvol = 1.7 mGy (Body) DLP = 0.9
mGy-cm.
3) Stationary Acquisition 5.1 s, 0.5 cm; CTDIvol = 17.2 mGy (Body) DLP =
8.6 mGy-cm.
Total DLP (Body) = 363 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
There is a filling defect within the distal right main pulmonary artery
extending to lobar and proximal segmental branches of the right upper lobe and
right lower lobe. Left pulmonary artery branches are patent. The main and
right pulmonary arteries remain normal in caliber, and there is no evidence of
right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
Assessment of the lung parenchyma is limited by motion artifact.
There are areas of subsegmental atelectasis in the right middle lobe and
dependent portions of the lower lobes bilaterally. There is no focal
consolidation. There is no evidence of pulmonary hemorrhage/infarction. No
evidence of interstitial pulmonary edema.
The airways are patent to the subsegmental level.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Acute PE involving the distal right main pulmonary artery extending to the
lobar and proximal segmental branches of the right upper and lower lobes.
2. No evidence of right ventricular strain.
3. No evidence of pulmonary hemorrhage/infarction.
RECOMMENDATION(S): The findings were discussed with ___, M.D.
by ___, M.D. on the telephone on ___ at 8:30 pm, 5 minutes
after discovery of the findings.
|
10115156-RR-23 | 10,115,156 | 22,801,147 | RR | 23 | 2141-10-12 08:30:00 | 2141-10-12 13:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with tachypnea// eval for pnuemonia eval
for pnuemonia
IMPRESSION:
Comparison to ___. Stable low lung volumes. Stable elevation
of the bilateral hemidiaphragms with formation of relatively extensive areas
of basilar atelectasis. Moderate cardiomegaly persists. Mild to moderate
pulmonary edema is visualized.
|
10115156-RR-24 | 10,115,156 | 22,801,147 | RR | 24 | 2141-10-12 09:19:00 | 2141-10-12 09:46:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with AMS while on heparin. concerning for a new
head bleed// excluding a ICH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: MRI brain ___
FINDINGS:
There are postsurgical changes once again demonstrated status post right
frontal craniotomy for prior meningioma resection, including underlying
encephalomalacia. Areas of dural thickening or calcification at the surgical
bed, residual meningioma cannot be excluded, MRI would be better evaluated
surgical bed.
Otherwise, there is no evidence of acute infarction,hemorrhage. There is
prominence of the ventricles and sulci suggestive of age-related cerebral
volume loss. Atherosclerotic vascular calcifications are noted of bilateral
cavernous portions of internal carotid arteries. There are severe chronic
small vessel ischemic changes, similar to mildly worsened since prior.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Postsurgical changes, encephalomalacia anterior frontal lobe the surgical
bed. Presumed dural thickening deep to the craniotomy, residual or recurrent
meningioma cannot be excluded on this scan.
2. No evidence of acute intracranial process. Severe chronic small vessel
ischemic changes
|
10115513-RR-44 | 10,115,513 | 24,907,785 | RR | 44 | 2164-09-03 13:34:00 | 2164-09-03 16:37:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: ___ year old man with chronic LBP, now with acute L thigh pain,
r/o fracture and evidence of muscle injury if able to visualize. // ___ year
old man with chronic LBP, now with acute L thigh pain, r/o fracture and
evidence of muscle injury if able to visualize. ___ year old man with
chronic LBP, now with acute L thigh pain, r/o fracture and evidence of muscle
injury if able to visualize.
TECHNIQUE: AP and lateral views of the left femur.
COMPARISON: None
FINDINGS:
There is a transitional anatomy at L5 which partially articulates with the
sacrum. No fracture or dislocation. No other evidence of degenerative change
of the left hip joint. No soft tissue injury. Surgical clips overlying the
pelvis. Presumed spinal stimulator generator is visualized overlying the left
iliac bone.
IMPRESSION:
1. No fracture seen.
|
10115513-RR-45 | 10,115,513 | 24,907,785 | RR | 45 | 2164-09-05 17:48:00 | 2164-09-05 18:19:00 | EXAMINATION: CT L-SPINE W/O CONTRAST Q331 CT SPINE
INDICATION: ___ year old man with acute on chronic LBP, r/o herniated disc,
evidence of foraminal narrowing causing lumbar plexopathy or root compression,
evidence of radiculitis if able to visualize. Per discussion with CT MSK
radiologist, please addd on pelvis to see femoral nerve anatomy . // ___ year
old man with acute on chronic LBP, r/o herniated disc, evidence of foraminal
narrowing causing lumbar plexopathy or root compression, evidence of
radiculitis if able to visualize. Per discussion with CT MSK radiologist,
please addd on pelvis to see femoral nerve anatomy . ___ year old man with
acute on chronic LBP, r/o herniated disc, evidence of foraminal narrowing
causing lumbar plexopathy or root compression, evidence of radiculitis if able
to visualize. Per discussion with CT MSK radiologist, please addd on pelvis to
see femoral nerve anatomy .
TECHNIQUE: Non-contrast helical multidetector CT of the lumbar spine was
performed. Soft tissue and bone algorithm images were generated. Coronal and
sagittal reformations were then constructed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 7.2 s, 28.3 cm; CTDIvol = 30.9 mGy (Body) DLP = 874.6
mGy-cm.
Total DLP (Body) = 875 mGy-cm.
COMPARISON: MRI of the lumbar spine dated ___, plain films of
the lumbar spine dated ___. MRI of the lumbar spine dated ___. CT of the pelvis performed concurrently.
FINDINGS:
The patient is status post bilateral laminectomies at L4/L5 level. Two
spinal cord stimulators are visualized entering posterior to T11/T12
interspinous process space (image 36, series 602b). The lumbar spine
alignment appears maintained. No lumbar spine fractures are identified.
From T12/L1 through L2/L3 levels, there is no evidence of neural foraminal
narrowing or spinal canal stenosis.
At L2/L3 level, there is diffuse disc bulge, causing anterior thecal sac
deformity and moderate bilateral neural foraminal narrowing (images 41, 42,
series 2).
At L3/L4 level, there is diffuse disc bulge, causing anterior thecal sac
deformity and bilateral neural foraminal narrowing, apparently unchanged since
the prior MRI of the lumbar spine.
At L4/L5 level, there is a focal disc protrusion, causing anterior thecal sac
deformity (image 66, series 3), bilateral articular joint facet hypertrophy is
present.
At L5/S1 level there is a prominent articulated transverse process on the
left. The visualized paravertebral structures are grossly unremarkable.
IMPRESSION:
1. Postsurgical changes identified at L4/L5 level, consistent with bilateral
laminectomies, spinal cord stimulator appears in place, entering posterior to
T11/T12 level interspinous process. No fractures of the lumbar spine are
identified.
2. Degenerative changes throughout the lumbar spine remain relatively stable
since the prior MRI of the lumbar spine, with persistent focal protrusion at
L4/L5 level.
|
10115513-RR-46 | 10,115,513 | 24,907,785 | RR | 46 | 2164-09-05 17:48:00 | 2164-09-05 18:14:00 | EXAMINATION: CT pelvis without contrast
INDICATION: Lower back pain with evidence of radiculitis. Evaluate femoral
nerve.
TECHNIQUE: Axial helical multi detector CT images were acquired of the pelvis
without contrast. Multiplanar reformats were generated in the coronal and
sagittal planes.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 6.3 s, 30.9 cm; CTDIvol = 24.8 mGy (Body) DLP = 766.0
mGy-cm.
Total DLP (Body) = 766 mGy-cm.
COMPARISON: Same-day lumbar spine CT.
FINDINGS:
There is no fracture or dislocation. Pelvic girdle is intact. There is
normal morphology of the femoral heads and acetabula bilaterally. There are
mild degenerative changes of bilateral hip joints. There is no hip joint
effusion bilaterally. There are mild degenerative changes of the pubic
symphysis. SI joints are intact with mild degenerative change. There is no
suspicious focal bone lesion. Sub cm bone island is noted in the right iliac
bone. Stimulator pack is partially visualized in the posterior soft tissues.
Transitional anatomy of the presumed L5 vertebral body with left-sided
anomalous articulation of L5 left transverse process with sacral ala. No
gross abnormality is seen along the expected course of the femoral nerve
bilaterally.
Limited evaluation of the intrapelvic structures demonstrates mild enlargement
of the prostate, small fat containing bilateral inguinal hernias, and small
fat containing umbilical hernia. Visualized intrapelvic structures are
otherwise grossly unremarkable.
IMPRESSION:
1. No fracture or dislocation.
2. Mild degenerative changes of bilateral hips, SI joints and pubic symphysis.
3. No obvious abnormality along the expected course of the femoral nerves
bilaterally. Note that direct evaluation of the femoral nerve on CT is
limited.
|
10115513-RR-48 | 10,115,513 | 24,907,785 | RR | 48 | 2164-09-10 13:01:00 | 2164-09-10 14:52:00 | EXAMINATION: MYELOGRAM LUMBAR W/INJECTION ___ XA SPINE
INDICATION: ___ year old male status post L4-5 laminectomy, with spinal
stimulator placement and suspected repeat L4/L5 disc herniation, now
presenting for fluoroscopic guided lumbar spine contrast injection for CT
myelogram.
TECHNIQUE: Fluoroscopy time: 33 seconds.
Skin dose: 14 mGy
Total DAP: 184.4 uGym2
After informed consent was obtained from the patient explaining the risks,
benefits, and alternatives to the procedure, the patient was laid in prone
position on the fluoroscopic table. A pre-procedure time-out was performed
confirming the patient's identity, relevant history, procedure to be performed
and labs.
Puncture was performed at L5-S1 and L4-5.
Approximately 10 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 20 gauge, 8.9 cm spinal needle was inserted
into the thecal sac. There was good return of clear CSF.
10 mls of Isovue 200 M contrast was administered intrathecally. Myelographic
images were obtained.
Following performance of the myelogram, the patient was transported to CT. CT
images of the lumbar spine were then obtained.
COMPARISON: ___ noncontrast lumbar spine CT.
FINDINGS:
Lumbar puncture was initially attempted at L5-S1 with no return of CSF.
Lumbar puncture was then attempted at L4-L5 with good return of clear CSF.
Contrast was administered, demonstrating contrast within the subarachnoid
space of the thecal sac. No extraluminal contrast was identified.
The leads of a spinal stimulator are partially visualized as they course into
the spinal canal at L2-L3.
IMPRESSION:
1. Successful lumbar myelogram performed at L4-L5.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
|
10115513-RR-49 | 10,115,513 | 24,907,785 | RR | 49 | 2164-09-10 14:28:00 | 2164-09-10 16:00:00 | EXAMINATION: CT L-SPINE W/O CONTRAST Q331 CT SPINE
INDICATION: ___ year old man with L4/L5 herniated disc.
TECHNIQUE: Non-contrast helical multidetector CT was performed following the
intrathecal administration of contrast. Soft tissue and bone algorithm images
were generated. Coronal and sagittal reformations were then constructed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 6.8 s, 26.8 cm; CTDIvol = 30.9 mGy (Body) DLP = 826.1
mGy-cm.
Total DLP (Body) = 826 mGy-cm.
COMPARISON: ___ noncontrast lumbar spine CT
___ contrast lumbar spine MRI
___ contrast lumbar spine fluoroscopic myelogram
FINDINGS:
There is transitional anatomy with pseudoarticulation of the left L5
transverse process with the sacrum, unchanged from the prior examination. The
mild levoscoliosis of the lower lumbar spine is unchanged. The bone is normal
in density. Intrathecally administered contrast from a fluoroscopic lumbar
myelogram opacifies the subarachnoid space of the thecal sac in the lower
thoracic and lumbar spine. No extraluminal contrast is identified. The conus
medullaris terminates at T12 and L1. The height of the vertebral bodies are
maintained. The intervertebral disc spaces of L2-L3 and L4-L5 are mildly
narrowed. There is a Schmorl's node at the inferior endplate of L4. Small
anterior endplate osteophytes are scattered throughout the lumbar spine.
Stranding in the subcutaneous fat and small locules of subcutaneous gas at
L4-L5 are related to the recent procedure.
At T12-L1, there is no spinal canal or neural foraminal stenosis, unchanged
from the prior examination.
At L1-L2, there is no spinal canal or neural foraminal stenosis, unchanged
from the prior examination.
At L2-L3, there is disc bulge without spinal canal or neural foraminal
stenosis, unchanged from the prior examination.
At L3-L4, disc bulge and bilateral facet arthropathy cause mild bilateral
neural foraminal stenosis, unchanged from the prior examination. There is no
spinal canal stenosis.
At L4-L5, there are postsurgical changes related to laminectomy, bilateral
facet arthropathy and disc bulge with interval increase in the size of a
superimposed left paracentral disc protrusion, resulting in increased
impingement of the traversing left L5 nerve root in comparison to the MRI ___. The mild-to-moderate right neural foraminal, moderate left neural
foraminal, and mild spinal canal stenosis have also progressed from the prior
examination.
At L5-S1, there is disc bulge and bilateral facet arthropathy without spinal
canal or neural foraminal stenosis, unchanged from the prior examination.
The battery pack of the spinal stimulator is partially visualized within the
subcutaneous fat of the left buttock. The leads of the spinal stimulator
course into the spinal canal at T11-T12.
There are mild atherosclerotic calcifications of the bilateral common iliac
arteries and abdominal aorta.
IMPRESSION:
1. Multilevel degenerative changes of the lumbar spine as described, including
interval increase in the size of a left paracentral disc protrusion at L4-L5
in comparison to ___ lumbar spine MRI, which results in increased
impingement of the traversing left L5 nerve root and progressive
mild-to-moderate right neural foraminal, moderate left neural foraminal, and
mild spinal canal stenosis.
2. Postsurgical changes related to prior L4-5 laminectomy.
3. Transitional anatomy with pseudoarticulation of left L5 transverse process
with the sacrum.
4. Spinal stimulator as described.
|
10115513-RR-51 | 10,115,513 | 24,907,785 | RR | 51 | 2164-09-12 20:15:00 | 2164-09-13 10:42:00 | EXAMINATION: L-SPINE (AP AND LAT) IN O.R.
INDICATION: REMOVAL SPINAL CORD STIMULATOR
TECHNIQUE: 3 fluoroscopic views were obtained in the operating room without a
radiologist present. Total fluoroscopic time is 5.0 seconds.
COMPARISON: CT the lumbar spine on ___.
FINDINGS:
3 fluoroscopic views demonstrate spinal cord stimulator removal. Please see
operative note for further details.
IMPRESSION:
Please see operative note for further details.
|
10115513-RR-52 | 10,115,513 | 24,907,785 | RR | 52 | 2164-09-13 21:53:00 | 2164-09-14 10:25:00 | EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: ___ y/o M w/ history of chronic lower back pain and L4/L5 disc
herniation, eval anatomy, eval for far lateral herniation and root compression
// ___ y/o M w/ history of chronic lower back pain and L4/L5 disc herniation,
eval anatomy, eval for far lateral herniation and root compression ___ y/o M
w/ history of chronic lower back pain and L4/L5 disc herniation, eval anatomy,
eval for far lateral herniation and root compression // ___ y/o M w/ history
of chronic lower back pain and L4/L5 disc herniation, eval anatomy, eval for
far lateral herniation and root compression ___ y/o M w/ history of chronic
lower back pain and L4/L5 disc herniation, eval anatomy, eval for far lateral
herniation and root compression
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of mL of
Gadavist contrast agent.
COMPARISON: Lumbar myelogram and postmyelographic CT ___.
FINDINGS:
Alignment is normal. There are changes of degenerative disc disease with loss
of height of the intervertebral discs at multi levels and loss of signal of
the discs on the long TR images. There are ___ type 2 signal intensity
changes of the vertebral endplates at L4-5.
Axial images from T12-L2 demonstrate clumping of the nerve roots similar to
the observation on the myelogram and postmyelographic CT. These imply
arachnoiditis, perhaps related to the prior spinal stimulator placement.
There is subcutaneous soft tissue in the midline along the prior location of
the stimulator site, likely scar tissue.
There is bulging of the disc into and lateral to the left L2-3 neural foramen
with contact with the exiting nerve root.
At L3-4, the spinal canal and right neural foramen appear normal. There is
bulging of the disc into the left neural foramen and a small protrusion
contacting the dorsal root ganglion and exiting nerve root.
At L4-5, there are postoperative changes after diskectomy. There is soft
tissue encroaching on the spinal canal in the midline and extending to the
left. This largely enhances after contrast administration, implying that much
of it reflects postoperative scar. However, there is a central nonenhancing
component that appears to be a disc fragment. The combination of scarring and
disc material compresses the traversing left L5 nerve root which is also
investigated in scar.
At L5-S1, findings of arachnoiditis are again seen with the nerve root
straight dura on the periphery of the thecal sac. There is no evidence of
spinal canal or neural foraminal compromise.
The distal spinal cord appears normal in caliber and configuration. There is
no evidence of infection or neoplasm.
IMPRESSION:
1. Findings of arachnoiditis unchanged since the CT myelogram of ___.
2. Left lateral disc bulges and protrusions at L2-3 and L3-4 compromising the
exiting nerve roots.
3. Disc protrusion with surrounding scar encroaching on the thecal sac and the
left L5 nerve root at L4-5.
4. Subcutaneous soft tissue likely scarring in the midline and T12 and L1.
This is presumably related to the spinal stimulator placement.
|
10115513-RR-53 | 10,115,513 | 24,907,785 | RR | 53 | 2164-09-14 15:05:00 | 2164-09-14 15:57:00 | EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ year old man with L3-L5 disc herniation, pre-op eval // ___
year old man with L3-L5 disc herniation, pre-op eval Surg: ___ (L3-L5
discectomy) INTRACTABLE PAIN
IMPRESSION:
Compared to prior chest radiographs ___.
Heart size top-normal. Lungs clear. Mild bilateral hilar fullness is stable
since ___, probably due to mildly enlarged central pulmonary arteries, rather
than lymph node enlargement. There is no pleural effusion.
|
10115593-RR-10 | 10,115,593 | 20,387,556 | RR | 10 | 2115-09-18 22:20:00 | 2115-09-19 08:40:00 | PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Assess atelectasis versus pneumonia postop.
Cardiomediastinal contours are normal. Increased opacity projecting over the
spine in the lateral view is worrisome for an infectious process in one of the
lower lobes. There is mild right apical pleural thickening of unknown
chronicity. There is no pneumothorax or pleural effusion.
Findings were discussed with Dr ___ by phone on ___ at 11.30
am
|
10115593-RR-7 | 10,115,593 | 20,387,556 | RR | 7 | 2115-09-13 04:52:00 | 2115-09-13 09:58:00 | HISTORY: ___ woman, with headache for two days, status post L5-S1
discectomy. Assess for CSF leak.
COMPARISON: Preoperative MRI lumbar spine on ___.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired through the
lumbar spine before and after administration of IV contrast.
FINDINGS: Transitional anatomy is again noted. The lumbar vertebral bodies
are labeled according to image 2:9, in order to be consistent to with previous
imaging study and the surgical procedure.
There is a small T1- and T2 hyperintense focus in the L2 vertebral body,
compatible with an intraosseous hemangioma, unchanged. The remaining bone
marrow signal is unremarkable. The vertebral body heights are preserved.
There is normal lumbar lordosis.
There are no significant degenerative changes from L1-L2 to L4-L5.
At L5/S1, there is partial right L5 laminectomy, with a tiny amount of
curvilinear fluid tracking posteriorly to a larger pocket of amorphous fluid
in the posterior subcutaneous soft tissues (image 6:19). A right eccentric
disc protrusion is noted, indenting the right ventral thecal sac, and
moderately narrowing the right lateral recess and impinging on the traversing
right S1 nerve roots. The exiting right L5 nerve roots are unaffected. There
is no significant neural foraminal narrowing bilaterally.
IMPRESSION:
1. Right eccentric L5-S1 disc protrusion, resulting in moderate right lateral
recess narrowing and impinging on the traversing right S1 nerve root.
Compared to the preoperative MR lumbar spine, there is significant interval
reduction of disc herniation.
2. Tiny amount curvilinear fluid tracking posteriorly to the posterior
subcutaneous soft tissues at the level of L5/S1. While this could just
represent non-specific post-surgical fluid, CSF leak cannot be excluded.
Recommend clinical correlation with the location of suspected leak.
|
10115923-RR-21 | 10,115,923 | 28,388,616 | RR | 21 | 2186-07-24 11:36:00 | 2186-07-25 09:17:00 | CT INTERVENTIONAL PROCEDURE
___ man with right lower quadrant fluid collection, assess for
drainage.
PHYSICIANS: Dr. ___, abdominal imaging fellow and Dr. ___,
___ radiologist.
PROCEDURE:
The procedure, risks, benefits, and alternatives were discussed with the
patient and written informed consent was obtained. A preprocedure timeout was
performed, discussing the planned procedure, confirming the patient's identity
with three unique patient identifiers and reviewing a checklist per ___
protocol.
Preprocedure limited examination of the mid abdomen was performed to localize
the fluid collection just underneath the abdominal wall in the right lower
quadrant using a non-contrast CT. An entrance site was selected and the skin
was prepped and draped in the usual sterile fashion. 1% lidocaine was
instilled for local anesthetic.
An 18-gauge x15-cm ___ needle was advanced into the fluid collection and a
wire was placed within the fluid collection. Subsequently, this needle was
exchanged for an 8 ___ catheter without complication.
Subsequently, about 110 cc of mixed tan and partly bloody fluid was aspirated
until the collection was collapsed on post-procedure imaging. A few cc's of
fluid was sent for microbiology.
Moderate sedation was provided by administering divided doses of Versed and
fentanyl. The total intraservice time of 25 minutes, during which the
patient's hemodynamic parameters were continuously monitored by radiology
nursing personal. A total of 50 mcg of fentanyl and 2 mg of Versed was
administered.
The patient tolerated the procedure well with no immediate complication.
Estimated blood loss was less than 5 cc.
Dr. ___ attending radiologist, was present throughout the entire
procedure.
IMPRESSION:
CT-guided aspiration with drainage catheter placement of the right lower
quadrant fluid collection. Microbiology is pending.
|
10115962-RR-67 | 10,115,962 | 24,064,363 | RR | 67 | 2125-10-13 10:09:00 | 2125-10-13 10:25:00 | HISTORY: Left knee patellar rupture.
TECHNIQUE: 3 views of the left knee.
COMPARISON: Bilateral knees, ___.
FINDINGS:
There is no acute fracture or dislocation. Mild tricompartmental degenerative
changes are noted with osteophytic spurring. Focal soft tissue swelling is
noted in the region of the quadriceps tendon. Position of the patella is
unchanged from prior. There is likely a small joint effusion. Moderate size
superior patellar enthesophyte is re- demonstrated. There are no concerning
lytic or sclerotic osseous abnormalities.
IMPRESSION:
No acute fracture or dislocation. Soft tissue prominence in the region of the
quadriceps tendon.
|
10115962-RR-68 | 10,115,962 | 24,064,363 | RR | 68 | 2125-10-14 13:59:00 | 2125-10-14 15:14:00 | HISTORY: ___ year old male with left quadriceps injury.
COMPARISON: Knee radiograph dated ___.
FINDINGS:
Fluoroscopic assistance was provided to the surgeon in the absence of a
radiologist. Two spot images were obtained which show a lateral view of the
left knee with two metall screws traversing the proximal tibia. Total
fluoroscopic time was 11.7 seconds. For details, please refer to ___
medical record for complete operative report.
|
10115962-RR-69 | 10,115,962 | 28,601,092 | RR | 69 | 2125-11-01 15:06:00 | 2125-11-01 15:43:00 | LEFT FEMUR
INDICATION: Cellulitis and drainage, evaluation for fracture.
COMPARISON: ___. ___.
A known varus positioning of the femoral head, documented on a radiograph from
___. Currently, external fixation are seen at the level of the
distal femur and the tibia. Expected postoperative appearance. Clips in the
skin. No evidence of complications.
|
10116054-RR-29 | 10,116,054 | 28,557,795 | RR | 29 | 2168-08-07 10:00:00 | 2168-08-07 12:01:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with LLE swelling and calf pain.// rule out LLE
DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
A 3 x 1.6 x 2.3 cm fluid collection is seen in the posterior popliteal fossa.
IMPRESSION:
1. No evidence of deep venous thrombosis in the left lower extremity veins.
2. 3 ___ cyst within the left politeal fossa.
|
10116085-RR-14 | 10,116,085 | 24,145,114 | RR | 14 | 2190-04-17 14:56:00 | 2190-04-17 17:09:00 | EXAMINATION: Portable AP chest radiograph
INDICATION: ___ s/p crush injury // please eval for traumatic injury
TECHNIQUE: Portable AP chest
COMPARISON: None.
FINDINGS:
Lung volumes are slightly low. There is linear atelectasis the left lung
base. Lungs are otherwise clear. No pleural effusion or pneumothorax. There
is apparent widening of the right paratracheal stripe. Otherwise,
cardiomediastinal hilar silhouettes are unremarkable. Heart size is normal.
No displaced fracture seen. Right-sided rib fractures seen on subsequent CT
are not well appreciated on this less sensitive study.
IMPRESSION:
Apparent widening of the right paratracheal stripe. CT pending. Otherwise,
no visible traumatic abnormalities.
|
10116085-RR-16 | 10,116,085 | 24,145,114 | RR | 16 | 2190-04-17 15:07:00 | 2190-04-17 16:08:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with trauma, crush injury // eval for fx
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, 20.2 cm; CTDIvol = 44.7 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Same day maxillofacial CT and cervical spine CT
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass effect. There
is prominence of the ventricles and sulci suggestive of involutional changes.
Patient is status-post right maxillary sinus surgery. There is near complete
opacification of the right maxillary sinus extending into the ipsilateral
ethmoids air cells. There is mucosal thickening of the left ethmoid air
cells, bilateral frontal sinuses, and bilateral sphenoid sinuses. There is a
large laceration extending from the left ear to the lateral orbital rim with
underlying fat stranding, hematoma, and subcutaneous emphysema. There are tiny
fractures with tiny displaced fragments of cortex from left frontal bone
(03:47, 03:51). Material filling the left external auditory canal is likely
blood related to the adjacent laceration.
IMPRESSION:
1. No acute intracranial abnormality.
2. Large left facial laceration with underlying subcutaneous emphysema and
hematoma.
3. Tiny fractures with a tiny displaced fragments of cortex from left frontal
bone.
4. Status-post right maxillary sinus surgery with pansinus disease worst in
the right maxillary sinus.
|
10116085-RR-17 | 10,116,085 | 24,145,114 | RR | 17 | 2190-04-17 15:08:00 | 2190-04-17 16:05:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ with trauma, crush injury // eval for fx
TECHNIQUE: Helical axial images were acquired through the facial bones. Bone
and soft tissue reconstructed images were generated. Coronal and sagittal
reformatted images were also obtained.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.2 s, 25.0 cm; CTDIvol = 26.0 mGy (Head) DLP = 651.2
mGy-cm.
Total DLP (Head) = 651 mGy-cm.
COMPARISON: Same day head CT and C-spine CT
FINDINGS:
There is no facial bone fracture. Pterygoid plates are intact. There is no
mandibular fracture and the temporomandibular joints are anatomically aligned.
The orbits are intact. The globes and extra-ocular muscles are unremarkable.
There is no orbital hematoma.
Patient is status-post right maxillary sinus surgery. There is near complete
opacification of the right maxillary sinus extending into the ipsilateral
ethmoids air cells. There is mucosal thickening of the left ethmoid air
cells, bilateral frontal sinuses, and bilateral sphenoid sinuses. There is a
large laceration extending from the left left ear to the lateral orbital rim
with underlying fat stranding, hematoma, and subcutaneous emphysema. There
are tiny fractures with tiny displaced fragments of cortex from left frontal
bone (601b:103, 601b:109). Material filling the left external auditory canal
may be blood related to an adjacent laceration.
IMPRESSION:
1. No facial fracture.
2. Large left facial laceration with underlying subcutaneous emphysema and
hematoma.
3. Tiny fractures with tiny displaced fragments of cortex from left frontal
bone.
4. Status-post right maxillary sinus surgery with pansinus disease worst in
the right maxillary sinus.
5. Material filling the left external auditory canal may be blood related to
an adjacent laceration.
|
10116085-RR-18 | 10,116,085 | 24,145,114 | RR | 18 | 2190-04-17 15:09:00 | 2190-04-17 16:48:00 | EXAMINATION: CT chest/abdomen/pelvis
INDICATION: History: ___ with trauma, crush injury // eval for fx
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.1 s, 71.4 cm; CTDIvol = 23.7 mGy (Body) DLP =
1,694.5 mGy-cm.
Total DLP (Body) = 1,694 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: There is a 2.3 x 1.6 cm right thyroid nodule (02:10). More
inferiorly and posteriorly, there is a 0.9 x 0.8 cm partially calcified nodule
(02:15).
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a 2.9 x 1.6 cm simple cyst arising from the interpolar left kidney.
An additional simple cyst arising from the lower pole the left kidney measures
1.6 x 1.2 cm. There is no evidence of worrisome renal lesions or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: High-density material in the dependent gastric fundus is
likely related to ingested contents. Small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. There is extensive
sigmoid diverticulosis without focal wall thickening or adjacent fat
stranding. The appendix is normal. There is no evidence of mesenteric
injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. Numerous
surgical clips are seen in the pelvis. There is no free fluid in the pelvis.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted. A small amount of gas in left common
femoral vein may be related to lower extremity trauma or vascular access.
Incidental note is made of a unique origins of the splenic and common hepatic
arteries.
BONES: There is buckling of the anterior right third rib (02:54) days, a
minimally displaced anterior right fourth rib fracture (2:70), nondisplaced
anterior right fifth rib fracture (2:80), a nondisplaced anterior right sixth
rib fracture (2:97), and buckling of the anterior right seventh rib (2:107).
There are scattered tiny locules of gas overlying these fractures in the
anterior right chest wall. No underlying pneumothorax. There is cortical
irregularity of the posterior sternum (605b:103) without a retrosternal
hematoma. No additional fractures are identified. No focal suspicious
osseous abnormality.
SOFT TISSUES: There are multiple right chest wall subcutaneous contusions
(02:21, 02:58, 2:74, 2:83). There is a small fat containing left inguinal
hernia.
IMPRESSION:
1. Anterior right third through seventh rib fractures. Only the fourth rib
fracture is minimally displaced. No pneumothorax.
2. Possible nondisplaced sternum fracture involving the posterior cortex.
Alternatively, this could be caused by a vascular channel or nutrient foramen.
3. Multiple small right chest wall subcutaneous contusions.
4. Right-sided thyroid nodules measuring up to 2.3 cm. Recommend nonurgent
outpatient ultrasound if not previously performed.
5. Extensive sigmoid diverticulosis without diverticulitis.
RECOMMENDATION(S): Right-sided thyroid nodules measuring up to 2.3 cm.
Recommend nonurgent outpatient ultrasound if not previously performed.
NOTIFICATION: The findings related to a possible nondisplaced sternum
fracture were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 5:15 ___, approximately 15 minutes after
discovery of the findings.
|
10116085-RR-19 | 10,116,085 | 24,145,114 | RR | 19 | 2190-04-17 15:10:00 | 2190-04-17 15:59:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with trauma, crush injury // eval for fx eval
for fx
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.5 s, 25.3 cm; CTDIvol = 37.4 mGy (Body) DLP = 946.9
mGy-cm.
Total DLP (Body) = 947 mGy-cm.
COMPARISON: Same day head CT and maxillofacial CT.
FINDINGS:
Alignment is normal. No fractures are identified. There is mild to moderate
multilevel disc space narrowing, anterior, posterior, and uncovertebral
osteophytosis, and facet arthropathy. Posterior osteophytosis is worst at
C5-C6 causing mild to moderate vertebral canal narrowing. Osteophytosis also
causes mild neural foraminal narrowing on the right at C3-C4 and on the left
at C4-C5. There is no prevertebral soft tissue swelling. There is no evidence
of infection or neoplasm.
Incidental note is made of a right thyroid nodule measuring 2.3 x 1.6 cm
(3:65). More inferiorly and posteriorly, there is a peripherally calcified
0.6 x 0.6 cm thyroid nodule.
A left-sided facial laceration with underlying fat stranding and hematoma is
better evaluated on the head CT and maxillofacial CT. Patient and can appears
to be status-post right maxillary sinus surgery with near complete
opacification of the maxillary sinus and ipsilateral ethmoid air cells. There
is mild mucosal thickening of the bilateral sphenoid sinuses.
IMPRESSION:
1. No acute cervical spine abnormality. Degenerative changes include
posterior osteophytosis causing mild to moderate vertebral canal narrowing at
C5-C6.
2. Incidental note made of right-sided thyroid nodules measuring up to 2.3 cm.
Recommend correlation with prior imaging, if available, or dedicated
ultrasound in the outpatient setting.
3. A left facial laceration is better evaluated on a same day a maxillofacial
CT.
RECOMMENDATION(S): Incidental note made of right-sided thyroid nodules
measuring up to 2.3 cm. Recommend correlation with prior imaging, if
available, or dedicated ultrasound in the outpatient setting.
|
10116085-RR-20 | 10,116,085 | 24,145,114 | RR | 20 | 2190-04-17 15:50:00 | 2190-04-17 17:16:00 | INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Bilateral elbows, three views of each
COMPARISON: None.
FINDINGS:
Right elbow: No dislocation is seen. No definite acute fracture is seen.
There are numerous punctate radiodensities projecting over the soft tissue
lateral and anterior to the distal lateral humerus, nonspecific but concerning
for retained foreign bodies. No posterior elbow joint effusion is seen.
Left elbow: On the lateral view, there are two calcific structures measuring
2 mm projecting over the soft tissue posterior to the olecranon on the lateral
view ; findings could represent avulsed fragments versus retained foreign
bodies. No acute fracture is seen elsewhere. Posterior elbow soft tissue
swelling is seen and there are couple foci of soft tissue gas which may relate
to laceration. No dislocation is seen.
IMPRESSION:
Right elbow: No definite acute fracture. Numerous punctate radiodensities
projecting over the soft tissue lateral and anterior to the distal lateral
humerus, nonspecific but concerning for retained foreign bodies.
Left elbow: Two calcific structures measuring 2 mm projecting over the soft
tissue posterior to the olecranon on the lateral view ; findings could
represent avulsed fragments versus retained foreign bodies. No acute
fracture seen elsewhere. Posterior elbow soft tissue swelling with couple
foci of soft tissue gas, which may relate to laceration.
|
10116085-RR-21 | 10,116,085 | 24,145,114 | RR | 21 | 2190-04-17 15:50:00 | 2190-04-17 17:18:00 | INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Bilateral clavicles, two views each
COMPARISON: None.
FINDINGS:
No clavicular fracture is identified. The acromioclavicular joints are
intact.
IMPRESSION:
No acute clavicular fracture.
|
10116085-RR-22 | 10,116,085 | 24,145,114 | RR | 22 | 2190-04-17 15:51:00 | 2190-04-17 17:31:00 | INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Four views of the left wrist and AP and lateral views of the left
forearm
COMPARISON: None.
FINDINGS:
No acute fracture or dislocation is seen. There are severe osteoarthritic
changes at the left first carpometacarpal joint, with joint space narrowing,
marginal sclerosis, proliferative change, and subchondral cysts.
IMPRESSION:
No acute fracture or dislocation of the left wrist or left forearm.
|
10116085-RR-23 | 10,116,085 | 24,145,114 | RR | 23 | 2190-04-17 15:51:00 | 2190-04-17 17:23:00 | INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Four views of the right wrist and AP view of the right forearm
COMPARISON: None.
FINDINGS:
No acute fracture or dislocation is seen. There is ulnar minus variance with
degenerative change at the radial ulnar joint. There are severe
osteoarthritic changes at the first carpometacarpal joint. As also seen on
the right elbow radiographs, there are numerous punctate radiodensities
projecting over the soft tissue of the anterior lateral right elbow,
concerning for retained foreign bodies. Correlate clinically.
IMPRESSION:
No acute fracture.
Numerous radiodensities projecting over the soft tissue at the anterolateral
right elbow, worrisome for foreign bodies.
|
10116085-RR-24 | 10,116,085 | 24,145,114 | RR | 24 | 2190-04-17 15:51:00 | 2190-04-17 17:26:00 | EXAMINATION: DX SHOULDER AND HUMERUS
INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Four views of the left shoulder and AP and lateral views of the
left humerus
COMPARISON: None
FINDINGS:
No acute fracture is seen. There is no frank dislocation, although the Y-view
the left shoulder it is limited due to underpenetration. The left
acromioclavicular joint is intact with mild degenerative change seen.
IMPRESSION:
No acute fracture. Limited Y-view of the left shoulder due to
underpenetration, but no frank dislocation seen.
|
10116085-RR-25 | 10,116,085 | 24,145,114 | RR | 25 | 2190-04-17 15:51:00 | 2190-04-17 17:20:00 | EXAMINATION: DX SHOULDER AND HUMERUS
INDICATION: History: ___ with trauma // trauma
TECHNIQUE: Three views of the right shoulder and two views of the right
humerus
COMPARISON: None
FINDINGS:
The Y-view of the right shoulder is suboptimal due to underpenetration, but no
frank dislocation is identified. No acute fracture is seen. The right
acromioclavicular joint is intact.
IMPRESSION:
No acute fracture of the right shoulder or right humerus.
|
10116085-RR-26 | 10,116,085 | 24,145,114 | RR | 26 | 2190-04-17 19:51:00 | 2190-04-17 20:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with intermittent hypotension. rib fxs // eval for
ptx
COMPARISON: CT torso from earlier today.
FINDINGS:
AP portable upright view of the chest. Mild basal atelectasis. No large
consolidation, effusion or pneumothorax is seen. The cardiomediastinal
silhouette appears within normal limits. Right-sided rib fractures are better
assessed on the same day CT torso.
IMPRESSION:
No pneumothorax. Rib fractures better assessed on same-day CT exam.
|
10116085-RR-27 | 10,116,085 | 24,145,114 | RR | 27 | 2190-04-18 11:53:00 | 2190-04-18 12:48:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT
INDICATION: ___ year old man s/p crush injury with 3-ton roller with L ankle
tenderness // please eval for traumatic injury
TECHNIQUE: Three views left ankle.
COMPARISON: None available.
FINDINGS:
No fracture, dislocation or degenerative change seen. No destructive lytic or
sclerotic bone lesions. No radiopaque foreign body or soft tissue
calcification. There is diffuse soft tissue swelling around the ankle. There
is preservation of ___ fat pad.
IMPRESSION:
No acute bony injury seen. Diffuse soft tissue swelling.
|
10116085-RR-28 | 10,116,085 | 24,145,114 | RR | 28 | 2190-04-18 11:54:00 | 2190-04-18 12:48:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: ___ year old man s/p crush injury with 3-ton roller with L thigh
tenderness // please eval for traumatic injury
TECHNIQUE: Two views left femur
COMPARISON: None available.
FINDINGS:
No fracture, dislocation or degenerative change seen. No destructive lytic or
sclerotic bone lesions. A Foley catheter is in-situ. Numerous surgical clips
in the pelvis suggest a prior prostatectomy.
IMPRESSION:
No acute bony injury seen.
|
10116085-RR-29 | 10,116,085 | 24,145,114 | RR | 29 | 2190-04-23 11:08:00 | 2190-04-23 11:26:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ y/o M ___ s/p crush injury, R rib fxs, persistent expiratory
wheezing // Interval change Interval change
IMPRESSION:
The cardiac silhouette is within normal limits and there is no evidence of
vascular congestion, pleural effusion, or acute focal pneumonia. Dense
streaks of opacification is seen at the right base, most likely representing
atelectasis. Less prominent changes are seen at the left base.
|
10116085-RR-30 | 10,116,085 | 24,145,114 | RR | 30 | 2190-04-25 10:39:00 | 2190-04-25 13:21:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man s/p crush injury resulting in right sided rib
fractures, sternal fx., left ear avulsion. Now with swelling, pain left leg
// assess for vascular occlusion/ bleed
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10116129-RR-18 | 10,116,129 | 20,698,381 | RR | 18 | 2164-11-27 18:16:00 | 2164-11-27 20:54:00 | EXAMINATION: Abdominal radiograph, supine AP portable.
INDICATION: Contrast present in the colon? Status post mesh repair with
recent small bowel obstruction.
COMPARISON: CT from ___.
FINDINGS:
Nasogastric tube terminates in the stomach, which is nondistended. This study
shows persistent dilatation of small bowel which measures up to 55 mm in
diameter, similar to the prior study allowing for differences in technique,
but there is now enteric contrast throughout much of the colon suggesting that
small bowel obstruction is at least to some extent partial. No evidence of
free air.
IMPRESSION:
Persistent small bowel dilatation in distension suggesting small-bowel
obstruction, but contrast within the colon, suggesting that obstruction may be
partial.
|
10116310-RR-174 | 10,116,310 | 27,906,419 | RR | 174 | 2186-04-30 14:38:00 | 2186-04-30 17:09:00 | INDICATION: ___ female with recurrent cellulitis over fourth and
fifth metatarsals. Rule out osteomyelitis.
COMPARISON: Foot radiographs ___.
FINDINGS: Three views of the right foot were obtained. There is no evidence
of fracture or dislocation. Moderate degenerative changes are present with
joint space narrowing and subchondral sclerosis of the first MTP joint. There
is diffuse demineralization. No subcutaneous gas or bony erosion is seen over
the fourth or fifth metatarsals. There is mild dorsal soft tissue swelling.
Vascular calcifications are present. No focal lytic or sclerotic lesion.
IMPRESSION: Mild dorsal soft tissue swelling. No subcutaneous gas or erosive
lesion. No fracture or dislocation.
|
10116310-RR-175 | 10,116,310 | 27,906,419 | RR | 175 | 2186-05-02 11:24:00 | 2186-05-02 12:44:00 | CHEST RADIOGRAPH
INDICATION: Shortness of breath, wheezes, evaluation for fluid overload.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is newly appeared
bilateral evidence of pleural effusions. The effusions are mild-to-moderate
in extent. There also is a part of loculated pleural effusion in the region
of the right lateral chest wall. The size of the cardiac silhouette is
slightly enlarged as compared to the previous examination. Finally, there is
an increase in pulmonary fluid content, as documented by the slightly
increased diameters of the pulmonary vessels. Overall, the changes are
consistent with mild-to-moderate pulmonary edema. At the time of observation
and dictation, 11:54 a.m., on ___, the referring physician, ___.
___, was paged for notification and the findings were subsequently
discussed over the telephone.
|
10116310-RR-197 | 10,116,310 | 22,838,844 | RR | 197 | 2187-09-26 13:55:00 | 2187-09-26 14:28:00 | HISTORY: History of metastatic breast cancer status post XRT, now with
dyspnea on exertion.
TECHNIQUE: Frontal and lateral chest radiographs were obtained.
COMPARISON: Comparison is made to chest radiographs dated ___,
and PET-CT dated ___.
FINDINGS:
There has been interval placement of a left Port-A-Cath which terminates in
the mid SVC. Redemonstrated are stable postradiation changes in the right
lung. There is no focal consolidation suggestive of an acute infectious
process. No pleural effusion, pneumothorax, or pulmonary edema is identified.
The heart size is top normal. Mediastinal and hilar contours are unchanged.
IMPRESSION:
No radiographic evidence for acute cardiopulmonary process.
Findings were conveyed by Dr. ___ to Dr. ___ telephone at 3:11pm on
___, 5 min after discovery.
|
10116310-RR-198 | 10,116,310 | 22,838,844 | RR | 198 | 2187-09-27 17:36:00 | 2187-09-27 21:06:00 | HISTORY: Evaluate for adrenal metastasis in a patient with metastatic breast
cancer presenting with recurrent unexplained hyperkalemia.
COMPARISON: PET-CT from ___.
TECHNIQUE: MDCT acquired axial images were obtained from the lung bases to
the pubic symphysis without intravenous or enteric contrast. Coronal and
sagittal reformats prepared and reviewed.
DLP: 387.03 mGy-cm.
FINDINGS:
The lower chest is unremarkable.
ABDOMEN: Multiple hypodense liver metastases are present. The gallbladder is
not well seen. There is no bile duct dilation. The spleen is unremarkable.
The pancreas contains coarse calcifications, which can be seen in patients
with chronic pancreatitis. The kidneys contain multiple large simple cysts
and several higher density cysts which are not fully characterized on this non
contrast study. There is no hydronephrosis. There is no adrenal nodule.
The stomach, small bowel, and large bowel are normal in caliber, without wall
thickening. There is no ascites, fluid collection, pneumoperitoneum, or focal
mesenteric fat stranding. There is no lymphadenopathy. The abdominal aorta
is normal in caliber.
PELVIS: The urinary bladder and rectum are unremarkable. There are no stones
within either ureter or within the bladder. The there is no pelvic free
fluid, lymphadenopathy, or mass. The uterus and ovaries are not seen.
MUSCULOSKELETAL: Diffuse skeletal metastatic disease is still present.
IMPRESSION:
No adrenal nodules are present. Incompletely characterized diffuse metastatic
disease.
|
10116409-RR-36 | 10,116,409 | 20,541,656 | RR | 36 | 2156-06-26 16:24:00 | 2156-06-27 08:31:00 | EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE
INDICATION: ___ PMH locally advanced pancreatic cancer (s/p 5C FOLFOX + SRS,
recently admitted for pancreatitis ___ who presents on this admission
with acute abdominal and back pain.// Rule out back lesions
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of Gadavist contrast agent,
additional axial and sagittal T1 images were obtained.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
Posterior disc bulging at C6-7 is partially imaged, and results in moderate
canal narrowing with mild bilateral neural foraminal narrowing.
THORACIC:
Sagittal spinal alignment is maintained. There is no suspicious bone marrow
signal identified.
Mild posterior disc bulges are seen in thoracic spine, most notably at T10-11
and T11-12, without evidence for significant central canal stenosis or neural
foraminal narrowing.
LUMBAR:
Vertebral body heights are maintained. Vertebral body alignment is within
normal limits, without evidence for subluxation.
There is no concerning focal bone marrow signal abnormality. The conus
medullaris terminates at the level of L1. There is lipomatous infiltration of
the filum terminal. Multilevel degenerative changes. Diffuse disc bulges.
Lower lumbar facet arthritis, with multilevel facet joint effusions.
There is multilevel loss of intervertebral disc height and intrinsic T2
signal.
At T12-L1 level, central canal, foramina are patent.
At L1-L2 level there is tiny left paramedian shallow broad-based disc
protrusion. Mild central canal narrowing. Mild left foraminal narrowing.
Patent right foramen.
At L2-L3 level there is mild central canal narrowing. Mild bilateral
foraminal narrowing.
At L3-L4 level there is mild central canal narrowing. Moderate bilateral
foraminal narrowing, worse on the left.
At L4-5 level there is mild-to-moderate central canal narrowing. Severe left,
moderate right foraminal narrowing.
At L5-S1 level there is mild central canal narrowing. Minimal effacement
right at S1 traversing perineural fat, no mass effect on the nerve. Annular
disc tear. Mild right foraminal narrowing. Patent left foramen. L5 segment
is transitional.
There is no evidence for abnormal intramedullary, leptomeningeal, or epidural
enhancement.
A known pancreatic head lesion is suboptimally visualized on MRI. There is
tumor infiltration at the celiac trunk and SMA, as seen on prior. Cystic
dilatation of the pancreatic duct to the level of pancreatic tail. Atrophic
spleen.
The visualized portion of the extrahepatic common biliary duct appears
prominent. Indeterminate right hepatic lobe lesion, suboptimally evaluated on
this scan. Bilateral patchy lung opacities, likely represent atelectasis
and/or edema in the absence of infectious symptoms. Splenosis is also better
seen on prior CT examination. Small volume pleural fluid.
IMPRESSION:
1. No evidence for spine metastasis.
2. Changes related to known pancreatic cancer better seen on prior CT.
3. Degenerative changes spine.
4. Mild-to-moderate central canal narrowing L4-L5 level.
5. Severe left L4-5 foraminal narrowing.
6. Small volume pleural fluid. Patchy lung opacities, likely atelectasis
and/or edema. Consider infection, chest PA lateral, if clinically
appropriate.
|
10116621-RR-79 | 10,116,621 | 28,927,488 | RR | 79 | 2130-08-22 16:32:00 | 2130-08-22 17:20:00 | INDICATION: ___ with sob and cp s/p stents,, // r/o chf
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal
limits. No acute osseous abnormalities identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10116621-RR-81 | 10,116,621 | 28,927,488 | RR | 81 | 2130-08-24 00:01:00 | 2130-08-24 06:23:00 | EXAMINATION: CTA chest with contrast
INDICATION: ___ year old man with known CAD p/w refractopry chest pain of
unclear etiology. // Please eval for e/o PE or aortic dissection.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 717 mGy-cm.
COMPARISON: CTA chest ___
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no evidence
of penetrating atherosclerotic ulcer or aortic arch atheroma present. Coronary
artery calcifications noted. Scattered calcifications of the thoracic aorta
and great vessels. There is common origin of the brachiocephalic and left
common carotid arteries.
Right upper lobe subsegmental pulmonary embolus (03:85). The main and right
pulmonary arteries are normal in caliber, and there is no evidence of right
heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
Bilateral dependent hypoventilatory/atelectatic changes. The airways are
otherwise patent to the subsegmental level.
Limited images of the upper abdomen demonstrates an exophytic cyst in the
upper pole the left kidney, seen best on coronal imaging. The liver
demonstrates decreased attenuation, likely secondary to fatty liver. Replaced
left hepatic artery.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Right upper lobe subsegmental pulmonary embolus. No imaging evidence of
right heart strain.
2. Hepatic Steatosis.
|
10116898-RR-13 | 10,116,898 | 22,177,826 | RR | 13 | 2171-04-16 17:48:00 | 2171-04-16 18:37:00 | INDICATION: ___ with cough, SOB // ?cpd
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear without consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10116898-RR-14 | 10,116,898 | 22,177,826 | RR | 14 | 2171-04-16 17:41:00 | 2171-04-16 18:34:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with right leg erythema/pain // ?dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Lower extremity ultrasound dated ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right 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:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10116898-RR-15 | 10,116,898 | 22,177,826 | RR | 15 | 2171-04-16 18:46:00 | 2171-04-16 20:16:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with +dimer // ?PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 517 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: There is an apparent filling defect within a single
subsegmental right lower lobe pulmonary artery (series 3, image 140), however
this is due to motion artifact. Otherwise, pulmonary vasculature is well
opacified to the subsegmental level without filling defect to indicate a
pulmonary embolus. Minimal atherosclerotic calcification of the aortic arch.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Multiple subcentimeter mediastinal lymph nodes
are nonspecific. No pathologically enlarged axillary, mediastinal, or hilar
lymph nodes. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Minimal atelectasis. Multiple calcified granulomas
bilaterally. Tiny triangular 2 mm triangular ground-glass opacity within the
right upper lobe (series 3, image 62) of questionable significance. The
airways are patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: A 5 mm hypodense nodule within the right lobe of the thyroid
(series 2, image 8), which does not require ultrasound follow-up according to
the ACR guidelines.
ABDOMEN: A 2.0 x 1.3 cm lesion within the posterior right lobe of the liver
appears to demonstrate peripheral puddling (series 2, image 100), likely
representing a hemangioma. Small hiatal hernia. Colonic diverticuli are
visualized. No other abnormalities within the partially visualized upper
abdomen.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Low attenuation of the liver suggesting steatosis.
3. A 2.0 cm lesion within the right lobe of the liver appears to demonstrate
peripheral puddling, likely a hemangioma.
RECOMMENDATION(S): Probable hepatic hemangioma to be confirmed by nonurgent
ultrasound.
|
10117130-RR-32 | 10,117,130 | 24,247,140 | RR | 32 | 2200-07-23 19:22:00 | 2200-07-23 19:35:00 | INDICATION: ___ with chest pain // Chest pain
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: CT from ___.
FINDINGS:
The lungs are clear. There is no consolidation, effusion, or pneumothorax.
The cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10117130-RR-33 | 10,117,130 | 24,247,140 | RR | 33 | 2200-07-30 19:03:00 | 2200-07-31 00:15:00 | EXAMINATION: AP chest radiograph
INDICATION: ___ year old man with s/p CABG // cardiac surgery fast track.
eval for ptx, effusions. call ___ house officer at ___ if there is any
concern with findings Contact name: ___ house officer, ___: ___
TECHNIQUE: AP chest radiograph
COMPARISON: Chest x-ray from ___.
FINDINGS:
Right IJ line has its tip projecting over the SVC. Endotracheal tube is in
good position. Enteric tube has its tip projecting over the stomach.
Bilateral chest tubes are noted. There is no evidence of pneumothorax or
consolidation.
IMPRESSION:
Tubes and lines are in appropriate position.
Findings were discussed with ___.
|
10117130-RR-34 | 10,117,130 | 24,247,140 | RR | 34 | 2200-07-31 10:48:00 | 2200-07-31 13:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p cabg and ct removal // r/o ptx r/o ptx
IMPRESSION:
In comparison with the study of ___, the endotracheal tube, and
nasogastric tube have been removed. Following chest tube removal, there is no
evidence of pneumothorax. Mild atelectatic changes are seen the in the left
mid and lower zone.
|
10117130-RR-35 | 10,117,130 | 24,247,140 | RR | 35 | 2200-08-02 13:47:00 | 2200-08-02 14:09:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p CABG // interval chnage interval chnage
IMPRESSION:
Compared to chest radiographs, since ___, most recently ___.
Moderately severe bibasilar atelectasis has progressed. Small bilateral
pleural effusions are larger. No pneumothorax. No pulmonary edema. Normal
postoperative cardiomediastinal silhouette.
|
10117273-RR-41 | 10,117,273 | 25,087,476 | RR | 41 | 2188-04-15 17:22:00 | 2188-04-15 17:58:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with c/f GI bleed, dizzy/lightheaded// eval pna
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
A retrocardiac opacity may reflect atelectasis or pneumonia. There is no
pleural effusion or pneumothorax. No consolidations are seen on the right.
The size the cardiomediastinal silhouette is within normal limits.
IMPRESSION:
Possible retrocardiac opacity may reflect atelectasis or pneumonia.
|
10117273-RR-42 | 10,117,273 | 25,087,476 | RR | 42 | 2188-04-15 17:33:00 | 2188-04-15 18:53:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with cirrhosis and known rectal varices p/w melena// eval
active bleeding
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
2) Spiral Acquisition 6.4 s, 50.6 cm; CTDIvol = 25.5 mGy (Body) DLP =
1,289.2 mGy-cm.
Total DLP (Body) = 1,307 mGy-cm.
COMPARISON: CT abdomen pelvis from ___. Abdominal ultrasound from
___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion. Aortic root calcifications are
noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of new focal lesion. Persistent hypodense 10 mm
structure in segment six is unchanged, potentially a cyst. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is notable for intraluminal gallstones but otherwise unremarkable.
There is partially calcified thrombus in the SMV as seen previously on remote
prior CT. Thrombus had also been present within the portal venous confluence
and proximal portal vein in ___ though not in the distal main portal vein and
left portal vein as is seen on today's exam. Of note, interval ultrasound did
not imaged the left portal vein to evaluate for interval change since ___.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Spleen is enlarged measuring 15.6 cm cc. Parenchymal calcification is
likely from prior granulomatous disease.
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 suspicious renal lesions or hydronephrosis.
Nonobstructing right lower pole 6 mm calculus is larger than on prior.
Exophytic hypodensity off the upper pole the left kidney is likely a cyst.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Colon is
unremarkable.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate is not visualized.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes noted at the lumbosacral junction.
SOFT TISSUES: Fat and fluid containing ventral hernia is noted.
IMPRESSION:
1. Nonocclusive portal venous thrombus involving the left portal vein, main
portal vein, SMV, distal splenic vein and portosplenic confluence. Of note,
this has progressed since ___ when the distal main portal and left
portal veins were not involved.
2. Findings of cirrhosis with portal hypertension including splenomegaly and
increased degree of ascites.
|
10117273-RR-43 | 10,117,273 | 25,087,476 | RR | 43 | 2188-04-19 10:31:00 | 2188-04-19 15:54:00 | INDICATION: ___ year old man with progressive portal thrombus and varices// ___
year old man with progressive portal thrombus and varices
COMPARISON: CT abdomen and pelvis dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and Dr.
___ and ___, Interventional Radiology fellow performed the
procedure. Dr. ___ supervised the trainee during any key components
of the procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: General sedation was provided by anesthesiology
MEDICATIONS: Ceftriaxone 1 g IV
CONTRAST: 105 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 41.0 min, 484 mGy
PROCEDURE: 1. Right internal jugular central venous catheter placement.
2. Right internal jugular venous access using ultrasound.
3. Paracentesis.
4. Pre-procedure right atrial and portal vein pressure measurements.
5. Superior mesenteric venogram.
6. Splenic venogram.
7. Inferior mesenteric venogram.
8. Portal venogram.
9. Lysis catheter placements.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck/abdomen was prepped and draped in the usual sterile
fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible in accessed using micropuncture needle. Images of ultrasound
access were stored on PACs. Subsequently, a Nitinol wire was passed into the
IVC using fluoroscopic guidance. A small incision was made at the needle
entry site. The needle was exchanged for a micropuncture sheath. The Nitinol
wire was exchanged for ___ wire. The sheath was removed and a
triple-lumen central venous catheter was placed over the wire with the tip in
the distal SVC. The wire was removed. All 3 ports were flushed. Sterile
sutures were applied.
Under continuous ultrasound guidance, a 19 gauge single wall needle was
advanced into a pocket of ascites in the right upper quadrant. ___
wire was advanced and exchange was made for an Omni Flush catheter. The flush
catheter was attached to suction.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a advantage glide wire was advanced distally
into the IVC.
The micropuncture sheath was then removed and a 10 ___ sheath was advanced
over the wire into the inferior vena cava, after pausing for pressure
measurement in the right atrium. After initial attempts with an MPA, using a
modified C2 catheter and a Glidewire, access was obtained in the right hepatic
vein. Appropriate position was confirmed with contrast injection and
fluoroscopy in AP and lateral views. The sheath was advanced over the wire
into the right hepatic vein.
Once the sheath was placed in an appropriate position, the cannula device was
inserted, followed by ___ needle. The angled sheath was turned
anteriorly. The needle was then advanced through liver parenchyma and the
needle was withdrawn over its sheath. The sheath was withdrawn while gentle
suction was applied. Upon blood return, a advantage glidewire was introduced
into the catheter to pass into the portal vein and subsequently into the
superior mesenteric vein. The sheath was advanced over the wire into the main
portal vein. A straight flush catheter was advanced over the wire and a
superior mesenteric venogram was performed which demonstrated hepatofugal flow
with obstruction of the proximal superior mesenteric vein and opacification of
paraumbilical veins. An Amplatz wire was advanced through the catheter. An
MPA and Advantage Glidewire were advanced side-by-side with the Amplatz Wire
and the splenic vein was accessed. The MPA was exchanged for a straight flush
catheter. Splenic venogram was performed which demonstrated hepatofugal flow
with opacification of perisplenic varices as well as hepatofugal flow into the
inferior mesenteric vein with thrombosis of the proximal splenic vein.
Next the inferior mesenteric vein was selected using the straight flush
catheter and Advantage Glidewire. Inferior mesenteric venogram demonstrated
hepatofugal flow with large rectal varices. Next main portal pressure
measurements were obtained. The inferior mesenteric catheter was removed.
Main portal venogram was performed through the sheath which demonstrated
nonocclusive thrombus within the central superior mesenteric vein and main
portal vein.
A 10 cm infusion length ___ lysis catheter was advanced over the
Amplatz wire into the superior mesenteric vein. Contrast was injected into
the sheath and the lysis catheter to confirm positioning within the thrombus.
The Amplatz wire was readvanced through the lysis catheter, while the catheter
and sheath were sutured to the neck. The wire was removed. The lysis
catheter was connected to tPA a rate of 1 mg/hour. The 10 ___ sheath site
arm was connected to heparinized saline. Sterile dressing was applied to the
central venous catheter and sheath.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Pre TIPS portosystemic gradient of 24 mm Hg.
2. Superior mesenteric, splenic, inferior mesenteric, and portal venograms
demonstrated thrombus extending from the SMV at approximately the level of L3
to the main portal vein and into the left portal vein; hepatofugal through the
superior mesenteric vein into paraumbilical vein; and splenic/inferior
mesenteric vein hepatofugal flow opacifying perisplenic varices and large
rectal varices.
3. 10 cm infusion length lysis catheter was placed extending from L3 to the
main portal vein.
4. Paracentesis with drainage of 6.3 L serous fluid.
5. Central venous catheter tip in the distal SVC.
IMPRESSION:
Right internal jugular access TIPS approach lysis catheter placement into the
SMV-PV for overnight lysis of SMV-PV thrombus.
Triple-lumen central venous catheter placed the right IJ access. Catheter can
be used immediately.
|
10117273-RR-44 | 10,117,273 | 25,087,476 | RR | 44 | 2188-04-20 09:47:00 | 2188-04-20 14:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ male past medical history of alcoholic cirrhosis
(complicated by ascites, SBP, esophageal varices s/p banding, rectal varices
s/p GI bleed), prostate cancer s/p prostectomy, T2DM and ETOH use disorder
(currently drinking) who originally presented from liver clinic with chief
complaint of melena, now with fever// Please assess for edema, effusion,
infiltrate
TECHNIQUE: Chest AP
COMPARISON: Low lung volumes. There is pulmonary vascular congestion. No
evidence of focal solid lesion, pneumothorax or pleural effusion. Cardiac
silhouette is top-normal. No evidence bony abnormality. Right IJ lines
terminate in the cavoatrial junction.
FINDINGS:
Pulmonary vascular congestion. No evidence of focal consolidation.
|
10117273-RR-45 | 10,117,273 | 25,087,476 | RR | 45 | 2188-04-20 14:46:00 | 2188-04-21 21:07:00 | INDICATION: ___ year old man with TIPS approach lysis catheter in the portal
vein.// Needs further thrombectomy, TIPS placement and rectal varix
embolization.
COMPARISON: ___. CT of the abdomen pelvis dated ___.
TECHNIQUE: OPERATORS: Drs. ___, attending Interventional
Radiologists and Dr. ___, Interventional Radiology fellow performed
the procedure. Dr. ___ supervised the trainee during any key
components of the procedure where applicable and reviewed and agrees with the
findings as reported below.
ANESTHESIA: General endotracheal anesthesia
MEDICATIONS: Please refer to anesthesia flow sheets.
CONTRAST: 300 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 83 minutes and 20 seconds, 2836 mGy
PROCEDURE:
1. Paracentesis with aspiration of 2.3 L of ascitic fluid.
2. Portal venogram.
3. Preprocedural right atrial and portal venous pressure measurements.
4. SMV mechanical thrombectomy using balloon venoplasty (10 mm balloon),
Angiojet and cleaner.
5. Post thrombectomy venogram.
6. Placement of a 10 mm x 7 cm x 2 cm Viatorr covered stent.
7. TIPS balloon angioplasty with a 10 mm balloon followed by post angioplasty
portal venogram.
8. Post TIPS placement right atrial and portal venous pressure measurements.
9. IMV mechanical thrombectomy using balloon venoplasty (10 mm balloon),
Angiojet and cleaner.
10. SMV/paraumbilical varices plug embolization using a 16 mm Amplatz plug.
11. Post plug embolization SMV venogram.
12. IMV/rectal varices plug embolization using a 12 mm Amplatz plug.
13. Post plug embolization IMV venogram.
14. IMV/splenic vein confluence mechanical thrombectomy using balloon
venoplasty (10 mm, 12 mm and 14 mm balloon), Angiojet and cleaner.
15. TIPS balloon sweep.
16. TIPS extension with a 10 mm x 6 cm x 2 cm Viatorr covered stent.
17. Post TIPS extension right atrial and portal venous pressures.
18. Portal vein thrombectomy using cleaner.
19. Final venograms through the SMV, IMV and splenic vein.
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. General endotracheal anesthesia was induced. The neck and abdomen
were prepped and draped in the usual sterile fashion.
Limited examination of the abdomen with ultrasound was performed. Once a
pocket of ascitic fluid was identified common the skin was marked. Under
ultrasound guidance a 7 ___ needle was used to access the right peritoneal
cavity. Upon return of ascitic fluid, the inner cannula was removed. ___
wire was advanced through the sheath. The sheath was removed and an Omni
Flush catheter was advanced over the wire under fluoroscopy. The wire was
removed and of the Omni Flush catheter was connected to a vacuum suction
system. Approximately 2.3 L of serous fluid were aspirated.
Attention was then diverted to the right neck. A scout image of the abdomen
was obtained. An Amplatz wire was advanced through the indwelling catheter
into the SMV. The flush catheter was exchanged for an Omni Flush catheter.
The catheter was retracted the portal vein. Portal venogram was performed.
A wire was advanced in tandem to the catheter in the left as safety. A 7
___ 55 centimeter sheath was telescoped into the portal vein. The 10
___ sheath was retracted into the right atrium. Right atrial and portal
vein pressures were obtained. The 10 ___ sheath was then readvanced.
A Glidewire preloaded in a glide catheter was advanced into the superior
mesenteric vein. Superior mesenteric venogram was performed. The decision
was made to perform mechanical thrombectomy in the proximal SMV. Balloon
venoplasty using 10 millimeter balloon was performed, followed by Angiojet
thrombectomy. Post thrombectomy venogram showed an irregular channel of flow
in the SMV.
The sheath was retracted the confluence. The Glidewire and Glide catheter
were used to select the splenic vein. The Glidewire was exchanged for an
Amplatz wire. A marking catheter was advanced over the Amplatz wire. A
portal venogram from the splenic vein was performed. The 10 ___ sheath was
then retracted to the level of the hepatic vein and coordinated splenic and
hepatic vein venograms were performed to outline the hepatic parenchymal
tract.
The 10 ___ sheath was advanced into the portal vein. The catheter and 7
___ sheath were removed. A 10 millimeter x 7 centimeter x 2 centimeter
covered Viatorr stent was advanced over the Amplatz wire. The stent was
deployed under continuous fluoroscopic evaluation. Following deployment a 10
millimeter high-pressure balloon was advanced over the wire and balloon
angioplasty of the TIPS was performed.
The Omni Flush catheter was advanced over the wire into the portal vein. The
wire was removed. Portal vein and right atrial pressures were performed. A
portal venogram was performed. Additional SMV thrombectomy was performed with
a ___ Cleaner XT thrombectomy device and additional balloon maceration. After
demonstrating flow towards the TIPS, a decision was made to embolize the
competing paraumbilic varix. The 7 ___ sheath was advanced distally just
proximal to the take-off of the paraumbilical varix. A 16 mm plug was advanced
through the sheath and deployed under fluoroscopic guidance. Post plug
embolization venogram was performed.
Attention was then diverted to the IMV. The 7 ___ sheath was advanced to
the mesenteric confluence. The Glidewire preloaded in the glide catheter was
used to negotiate the wire into the IMV. An IMV venogram was performed. The
decision was made to perform mechanical thrombectomy in the proximal IMV.
Balloon venoplasty using 10 millimeter balloon was performed, followed by
Angiojet thrombectomy followed by a 7 ___ cleaner device. After ensuring
flow in the IMV, a decision was made to embolize the rectal varices. The 7
___ sheath was advanced distally just proximal to the bifurcation of the
rectal varices. A 12 millimeter plug was advanced through the sheath and
deployed under fluoroscopic guidance. Post plug embolization venogram was
performed.
The sheath was then retracted to the confluence to the level of the
IMV/splenic vein confluence. Venogram was performed. Focal area of stenosis
and residual thrombus was suspected. Mechanical thrombectomy using 10
millimeter, 12 millimeter and 14 millimeter balloon venoplasty was performed
followed by Angiojet and the 7 ___ cleaner. Post venoplasty venogram was
performed.
Attention was then diverted to the TIPS which was noted to have significantly
decreased flow of contrast suggesting thrombosis. Over the wire a 5.5 ___
___ balloon was inflated and used to sweep the shunt. During sweeping it
was noted that the stent slightly migrated towards the right atrium. The
balloon was deflated. A decision was made to extend the TIPS into the portal
vein. Marking catheter was advanced. Measurements were taken. The catheter
was removed and a 10 millimeter x 6 centimeter x 2 centimeter covered Viatorr
stent was advanced over the Amplatz wire. The stent was successfully deployed
under fluoroscopic guidance. A 10 millimeter balloon was used to angioplasty
the TIPS extension.
The 7 ___ sheath was readvanced over the wire into the portal vein. The 10
___ sheath was retracted into the right atrium. Right atrial and portal
venous pressures were obtained. A filling defect close to the TIPS was noted.
Thrombectomy was done using a cleaner.
Final venograms through the SMV, IMV and portal vein were performed. The
patient tolerated the procedure without any complications. The right IJ
sheaths and wires were removed and a pursestring suture was placed. The
Omniflush catheter was removed and the paracentesis skin sites were closed
with nonabsorbable sutures. Sterile dressing was applied. The patient
tolerated the procedure without any complications. The patient was returned
to the ICU intubated for close monitoring.
FINDINGS:
1. Pre-TIPS right atrial pressure of 8 mm Hg and balloon-occluded portal
pressure measurement of 32 mm Hg resulting in portosystemic gradient of 24
mmHg.
2. Preprocedure portal venogram demonstrates significantly improved flow
towards the liver with decreased clot burden in the proximal splenic vein, SMV
and portal vein.
3. SMV venogram demonstrates hepatofugal flow of contrast distal to the clot
towards paraumbilical varices. IMV venogram demonstrates hepatofugal flow of
contrast distal to the clot towards the rectal varices.
4. Post thrombectomy and initial TIPS placement venograms demonstrate
significantly improved flow towards the liver was reduced flow of contrast in
the hepatofugal direction. Post initial TIPS placement in pressure
measurements the right atrium are 9 mm Hg and 20 mm Hg of the portal vein with
a gradient of 11 millimeter Hg. 5. post embolization SMV and IMV venograms
demonstrates significantly reduced flow towards the varices.
6. Post-TIPS extension / shunt embolization right atrial pressure of 12
millimeter Hg and portal pressure of 28 millimeter Hg resulting in
portosystemic gradient of 16 mmHg.
6. 2.3 liters of serous fluid removed through paracentesis drain.
IMPRESSION:
1. Technically successful right internal jugular vein approach portal vein,
SMV, IMV and proximal splenic vein thrombectomy as described above with
significantly improved flow towards the liver.
2. Technically successful right internal jugular vein approach TIPS placement
with reduction of the gradient from 24 millimeter Hg to 16 mm Hg. Post-TIPS
PSG gradient was 11 mm Hg and increased after embolization of competing SMV
and IMV shunts.
3. Technically successful SMV/paraumbilical varices and IMV/rectal varices
embolization.
4. Ultrasound-guided paracentesis of 2.3 liters serous fluid.
|
10117273-RR-46 | 10,117,273 | 25,087,476 | RR | 46 | 2188-04-21 04:52:00 | 2188-04-21 11:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis, respiratory failure// eval for
volume eval for volume
IMPRESSION:
Compared to chest radiographs since ___ most recently ___ and ___.
Pulmonary vascular congestion is new. No focal consolidation. Heart size
normal. No appreciable pleural effusion or pneumothorax.
Tip of the endotracheal tube at the sternal notch is no less than 6 cm from
the carina. It could be advanced 15 mm for more secure and effective
positioning. Right jugular line ends in the mid SVC.
|
10117273-RR-47 | 10,117,273 | 25,087,476 | RR | 47 | 2188-04-23 09:22:00 | 2188-04-23 12:03:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ male past medical history of alcoholic
cirrhosis(complicated by ascites, SBP, esophageal varices s/p banding,rectal
varices s/p GI bleed), prostate cancer s/p prostectomy,T2DM and ETOH use
disorder (currently drinking) who originallypresented from liver clinic with
melena now s/p placement ofthrombolysis catheter for PVT and TIPs procedure
with persistent hypotension and pain around paracenteses site. Eval for
evidence of bleed.
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 15.2 s, 52.3 cm; CTDIvol = 14.9 mGy (Body) DLP =
755.0 mGy-cm.
Total DLP (Body) = 768 mGy-cm.
COMPARISON: CT abdomen pelvis performed ___.
FINDINGS:
LOWER CHEST: Bibasilar atelectasis. Trace bilateral pleural effusions, right
greater than left are new compared to prior exam. No pericardial effusion.
Coronary artery calcifications are severe.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation with nodular
contour compatible with cirrhotic morphology. Subtle hypodensity in segment
VI is poorly characterized but unchanged (03:32). Otherwise, 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 contains gallstones without wall thickening or evidence of
inflammation. Patient is status post right hepatic vein to main portal vein
TIPS placement, which is limited in its evaluation on this nonenhanced exam.
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. There is no peripancreatic stranding.
SPLEEN: The spleen is enlarged up to 14.3 cm. Stable coarse calcification in
the spleen likely reflect sequelae of prior granulomatous infection.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. Previously seen
exophytic cystic lesion off the left kidney is not well evaluated on current
exam. No concerning renal lesions are seen within the limits of an unenhanced
scan. Stable 7 mm nonobstructing right lower pole renal stone is unchanged
(04:43). No hydronephrosis.
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 normal (03:54). Small volume ascites.
PELVIS: The urinary bladder is moderately distended with intravesicular air.
Trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is not visualized.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
Embolization material related to rectal variceal and SMV vein embolization
appear unchanged compared to recent interventional images performed ___ (04:28, 39).
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Moderate degenerative changes are noted at the lumbosacral junction,
unchanged.
SOFT TISSUES: There is an approximately 4.2 x 3.4 cm hematoma centered within
the right external oblique muscle with hematocrit level, likely related to
recent procedure (03:44). This is associated with moderate surrounding soft
tissue stranding, new compared to prior exam. A small fat and fluid
containing ventral hernia is unchanged.
IMPRESSION:
1. Small hematoma within the right external oblique muscle is likely related
to recent intervention and is associated with moderate subcutaneous soft
tissue stranding.
2. Status post TIPS and rectal variceal and SMV vein embolizations.
3. Cirrhotic liver morphology with splenomegaly and small volume ascites.
4. Moderately distended urinary bladder with air. Recommend correlation for
recent Foley catheter placement.
|
10117273-RR-48 | 10,117,273 | 25,087,476 | RR | 48 | 2188-04-25 11:05:00 | 2188-04-25 14:46:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old man with alcohol cirrhosis (decompensated by
esophageal varices s/p banding, ascites, SBP, rectal varices, non-occlusive
portal vein thrombosis) who was admitted from clinic with melena and found to
have PVT. He is s/p TIPS and catheter-directed lysis ___ of SMV-PV thrombus +
___ SMV-IMV-proximal splenic vein thrombectomy; TIPS placement (24mmHg >
16mmHg), embolization of SMV + IMV shunts; SMV/paraumbilical + IMV/rectal
varices embolization.// with Doppler to assess velocities. s/p TIPS ___.
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Abdominal ultrasound ___ and CT abdomen and pelvis ___
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. There is mild ascites.
There is stable splenomegaly, with the spleen measuring 17.6 cm. There is no
intrahepatic biliary dilation. The CHD measures 6 mm. Cholelithiasis and
sludge without gallbladder wall thickening.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 87 cm/sec
Proximal TIPS: 277 cm/sec
Mid TIPS: 134 cm/sec
Distal TIPS: 122 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
PANCREAS: The 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.
IMPRESSION:
1. Patent TIPS with elevated velocities proximally, but more normal in the mid
and distal portions, with velocities as reported above.
2. Mild ascites.
3. Splenomegaly.
4. Cholelithiasis and sludge.
|
10117273-RR-50 | 10,117,273 | 25,864,134 | RR | 50 | 2188-06-05 00:28:00 | 2188-06-05 02:46:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ abd pn// eval for ascites, PVT.
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___ 19.
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. There is trace ascites.
There is stable splenomegaly, with the spleen measuring 16.6 cm. There is no
intrahepatic biliary dilation. The CHD measures 17 mm. Cholelithiasis without
gallbladder wall thickening.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 63 cm/sec, previously 87 cm/sec
Proximal TIPS: 140 cm/sec, previously 227cm/sec
Mid TIPS: 205 cm/sec, previously 134 cm/sec
Distal TIPS: 191 cm/sec, previously 122 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
PANCREAS: The 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: The spleen measures 16.6 cm in length.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Patent TIPS.
2. Cholelithiasis without gallbladder wall thickening.
|
10117273-RR-51 | 10,117,273 | 25,864,134 | RR | 51 | 2188-06-06 02:34:00 | 2188-06-06 04:04:00 | EXAMINATION: Evaluate for clot burden in ___ (same protocol as ___ Single
phase contrast: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration. Oral contrast not administered.
INDICATION: ___ year old man with cirrhosis with prior rectal variceal bleed,
PVT s/p tPA on AC presents with melena.// Evaluate for clot burden in ___
(same protocol as ___ Single phase contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration. Oral contrast not administered.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
without and with intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
COMPARISON: CT abdomen and pelvis from ___
FINDINGS:
Lungs: The visualized lung bases are within normal limits, except for
subsegmental atelectasis.
Liver: Cirrhotic morphology of the liver, with no suspicious liver lesion. A
long-term stable hypodensity seen in segment 5 measuring 1.0 cm. A few
calcified granulomas are seen in the liver.
Biliary: There is no intrahepatic or extrahepatic bile duct dilatation. The
gallbladder contains a small gallstone, without wall thickening.
Spleen: The spleen is enlarged measuring 16.4 cm in AP dimension. A calcified
granuloma is again seen. Stable wedge-shaped linear structure at the upper
aspect of the spleen, possibly representing a small infarct.
Pancreas: Unremarkable. There is no pancreatic duct dilatation.
Adrenal glands: Unremarkable.
Urinary: A 7 mm nonobstructing caliceal stone is seen in the lower pole of the
right kidney. Bilateral hypodensities are seen in the kidneys, likely
representing cortical cysts. There is no hydronephrosis.
Pelvis: The urinary bladder is unremarkable. The distal ureters are
unremarkable. A small amount of fluid is seen surrounding the liver, unchanged
compared to previously
The prostate is not visualized. A nodule is seen at the expected location of
the left seminal vesicle, unchanged compared to ___ CT.
Gastrointestinal: The bowel is within normal limits, except for colonic
diverticulosis. There is no evidence of bowel dilatation or obstruction.
Vascular: There are severe atherosclerotic calcifications of the abdominal
aorta.
A TIPS is seen and is patent.
Stable nonocclusive thrombus in the left portal vein (series 303, image 42)
and right portal vein (series 303, image 44).
Stable nonocclusive thrombus in the main portal vein extending to the splenic
confluence and SMV.
Multiple embolization devices are seen throughout mesenteric and perirectal
vessels consistent with prior embolization. Mild perigastric, perisplenic and
aortocaval varices are again noted.
Lymph nodes: A borderline 1.0 cm left external iliac lymph node is seen.
Small retroperitoneal lymph nodes not meeting criteria for pathologic
enlargement are seen. There is nonspecific mild fat stranding surrounding the
abdominal aorta..
Bone and soft tissues: There is no suspicious bone lesion. Degenerative disc
disease is seen at L5-S1. An umbilical hernia containing fat is seen.
Right abdominal wall intramuscular lesion measuring 2.2 cm x 1.3 cm,
previously 2.6 cm x 1.7 cm, slightly decreased, and likely representing a
resolving hematoma.
IMPRESSION:
1. Stable nonocclusive thrombus in the left portal vein (series 303, image 42)
and right portal vein (series 303, image 44). Stable nonocclusive thrombus in
the main portal vein extending to the splenic confluence and SMV. Patent TIPS.
No additional thrombus seen in the visualized veins.
2. Right abdominal wall intramuscular lesion measuring 2.2 cm x 1.3 cm,
previously 2.6 cm x 1.7 cm, slightly decreased, and likely representing a
resolving hematoma.
3. Cirrhotic morphology of the liver, with no suspicious liver lesion.
Splenomegaly. Small amount of perihepatic fluid.
4. 7 mm nonobstructing caliceal stone in the right kidney. No hydronephrosis.
5. Uncomplicated cholelithiasis.
|
10117273-RR-54 | 10,117,273 | 27,763,784 | RR | 54 | 2188-07-06 18:10:00 | 2188-07-06 19:37:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ with hx of ETOH cirrhosis c/b portal HTN with esopahgeal
varices, ascites, hx nonocclusive PVT s/p thrombectomy + TIPS p/w melena.//
PVT, TIPS patency?
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Prior ultrasound ___
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified.
There is small volume ascites.
There is stable splenomegaly, with the spleen measuring 14.9 cm.
There is no intrahepatic biliary dilation. The CHD measures 3 mm.
There is no evidence of stones or gallbladder wall thickening. There is a 6
mm non-mobile round echogenic focus within the gallbladder which may represent
a polyp versus nonmobile gallstone.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 32.4 cm/sec, previously 87 cm/sec
Proximal TIPS: 141 cm/sec, previously 277 cm/sec
Mid TIPS: 187 cm/sec, previously 134 cm/sec
Distal TIPS: 158 cm/sec, previously 122 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
PANCREAS: The 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.
IMPRESSION:
1. Patent TIPS with lower and improved velocities proximally, normal
velocities throughout the TIPS.
2. 6 mm round echogenic focus in the gallbladder may represent a polyp versus
nonmobile gallstone. Attention on follow up.
|
10117273-RR-55 | 10,117,273 | 27,763,784 | RR | 55 | 2188-07-07 08:44:00 | 2188-07-07 10:20:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis, melena, L sided crackles on exam.
Evaluation for pulmonary edema, PNA.
TECHNIQUE: Chest AP portable upright
COMPARISON: Comparison to multiple prior chest radiographs, most recently
from ___.
FINDINGS:
Cardiomediastinal silhouette is top-normal in size. The pulmonary vasculature
is normal. Mild bibasilar atelectasis. Lungs are otherwise clear without
focal consolidation. No pleural effusion or pneumothorax is seen. There are
no acute osseous abnormalities. Right upper quadrant stent is again noted.
IMPRESSION:
No evidence of focal consolidation or pulmonary edema.
|
10117273-RR-56 | 10,117,273 | 27,763,784 | RR | 56 | 2188-07-08 18:49:00 | 2188-07-08 21:09:00 | INDICATION: ___ year old man with cirrhosis, recurrent melena, hx of prior
TIPS// consult for venography, evaluation of TIPS
COMPARISON: Duplex of the abdomen dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
performed the procedure.
ANESTHESIA: Divided doses of 125mcg of fentanyl was administered during which
the patient's hemodynamic parameters were continuously monitored by an
independent trained radiology nurse. 1% lidocaine was injected in the skin and
subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, 1% lidocaine
CONTRAST: 60 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 28.7, 177 mGy
PROCEDURE:
1. Right internal jugular venous access using ultrasound.
2. Pre intervention right atrial and portal vein pressure measurements.
3. Contrast portal venogram from the splenic vein.
4. Contrast enhanced portal venogram from the SMV
5. Mechanical thrombectomy of the main portal vein using the cleaner device
with post portal venogram.
TIPS stent angioplasty with 12 mm balloon
6. Post-stenting portal venogram and pressure measurements.
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 neck was prepped and draped in the usual sterile fashion.
Under real-time ultrasound guidance, the patent right internal jugular vein
was accessed. Sonographic images of the access were obtained and stored. A
micropuncture wire was passed down into the right atrium over which a
micropuncture sheath was placed. An Amplatz wire was advanced down into the
IVC over which a 7 ___ sheath was placed.
Several catheters and a Glidewire were tried to get access to the TIPS.
Ultimately, Kumpe catheter and Glidewire were negotiated down into the portal
vein. Through the sheath, a pre-procedure right atrial pressure was measured.
Through the Kumpe catheter, a portal venous pressure was measured. A
Glidewire was negotiated into the splenic vein. Position was confirmed with
contrast injection. The Kumpe catheter was exchanged over an Amplatz wire for
a straight flush catheter. A portal venogram was performed. Due to some
irregularity in the main portal vein this was further investigated with a
portal venogram from the ___. The flush catheter was removed over an Amplatz
wire and a 7 ___ cleaner device was advanced down into the portal vein and
used to attempt to clear some potential thrombus. Post portal venogram was
performed which did not demonstrate any definitive residual portal venous
thrombus. An Amplatz wire was passed into the ___. Over the wire, a 12 x 4
balloon was used to plasty the TIPS. A post portal venogram was performed.
Right atrial and repeat portal venous pressures were measured. The catheters
and wires and sheath were removed and manual pressure was held for hemostasis.
A hemostatic dressing was placed. The patient tolerated the procedure well
without any immediate complications.
FINDINGS:
1. Pre intervention right atrial pressure of 3 mmHg and portal venous pressure
of 16 mmHg for a gradient of 13 mm Hg
2. Portal venogram showing patent portal vein with some irregularity in the
main portal vein which was felt to potentially represent thrombus. The TIPS
was noted to be widely patent and there were no varices identified..
3. Post mechanical portal thrombectomy with mild improvement in the appearance
of the portal vein which was again noted to be widely patent.
4. Post TIPS plasty portal venogram demonstrating rapid flow through the TIPS
which was widely patent.
5. Post intervention right atrial pressure of 6 mmHg and portal pressure of 16
mmHg resulting in portosystemic gradient of 10 mmHg.
IMPRESSION:
Successful right internal jugular access with transjugular intrahepatic
portosystemic shunt interrogation with decrease in the portosystemic gradient
after plasty. No definitive varices were identified.
RECOMMENDATION(S): Continued ultrasound follow-up to evaluate the TIPS for
stenosis or dysfunction.
|
10117508-RR-20 | 10,117,508 | 20,560,939 | RR | 20 | 2140-01-15 18:12:00 | 2140-01-15 19:34:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SIRS physiology, eval for infectious process
// Evidence of infectious process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal
contours are unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10117508-RR-21 | 10,117,508 | 20,560,939 | RR | 21 | 2140-01-15 17:27:00 | 2140-01-15 18:26:00 | EXAMINATION: LEFT BREAST ULTRASOUND
INDICATION: ___ female status post left mastectomy with
reconstruction 2 months ago, now with cellulitis. Evaluate for fluid
collection.
COMPARISON: None available.
TECHNIQUE: Targeted breast ultrasound was performed. Selected images were
obtained.
FINDINGS:
The left-sided implant appears grossly intact. There is a complex fluid
collection spanning for approximately 6 o'clock to 9 o'clock with associated
hyperemia. Given its shape and extent, this collection is difficult to
measure exactly, but appears approximately 1.7 cm in width, certainly longer
in length. Edema is seen within the overlying soft tissues.
IMPRESSION:
1. Grossly intact left breast implant.
2. Complex fluid collection spanning from approximately 6 o'clock to 9
o'clock adjacent to the left implant. Differential diagnosis includes
infection vs complex postoperative seroma. Recommend close followup in the
dedicated breast clinic.
RECOMMENDATION: Recommend close interval followup of left breast ___
complex fluid collection for further evaluation with evaluation in the
dedicated breast imaging clinic.
NOTIFICATION: Findings reviewed with the patient at the completion of the
study.
BI-RADS: 0 Incomplete - Need Additional Imaging
Evaluation.
|
10117734-RR-20 | 10,117,734 | 24,389,181 | RR | 20 | 2112-12-09 12:42:00 | 2112-12-09 13:36:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with tachycardia hypoxia and significant dyspnea.
Eval for PE.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.5 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
2) Spiral Acquisition 4.3 s, 33.8 cm; CTDIvol = 7.6 mGy (Body) DLP = 255.3
mGy-cm.
Total DLP (Body) = 258 mGy-cm.
COMPARISON: Same-day chest radiograph
FINDINGS:
HEART AND VASCULATURE:Motion artifact and suboptimal contrast bolus limits
assessment of the pulmonary arterial vasculature. Pulmonary vasculature is
opacified to the proximal segmental level without filling defect to indicate a
pulmonary embolus. The distal segmental and subsegmental branches cannot be
adequately assessed. The thoracic aorta is normal in caliber without evidence
of dissection or intramural hematoma. The heart, pericardium, and great
vessels are within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Several prominent but not pathologically
enlarged paratracheal and bilateral hilar nodes are likely reactive. No
axillary lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Bilateral ground-glass opacities in the medial lung apices and
lingula. There is diffuse airway wall thickening with scattered mucous
plugging. Mild lower lobe cylindrical bronchiectasis.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Diffusely hypoattenuation of the liver may be suggestive of hepatic
steatosis. Otherwise, included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Limited assessment of the distal segmental and subsegmental pulmonary
arterial branches due to suboptimal timing of the contrast bolus and
respiratory motion. Within this limitation, no evidence of pulmonary embolism
to the proximal segmental level or aortic abnormality.
2. Bilateral upper lobe and lingular ground-glass opacities may reflect early
infection.
3. Diffuse airway wall thickening with scattered mucous plugging suggestive of
bronchitis.
4. Possible hepatic steatosis.
|
10117812-RR-27 | 10,117,812 | 29,475,932 | RR | 27 | 2117-02-21 13:11:00 | 2117-02-21 13:49:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with abdominal pain, elevated total bilirubin//
Evaluate for biliary ductal dilatation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound ___
FINDINGS:
LIVER: There is a coarsened and echogenic hepatic echotexture with nodular
contour consistent with known cirrhosis. No focal lesions are identified.
The main portal vein is patent with hepatofugal (reversed) flow. There is a
small amount of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The common bile duct
is not visualized.
GALLBLADDER: Sludge is seen within the gallbladder which demonstrates wall
thickening/edema, overall similar compared to the prior study and likely
consistent with cirrhosis.
PANCREAS: The 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.
Spleen length: 13.6 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
IMPRESSION:
1. Cirrhotic liver with trace ascites. There is mild splenomegaly.
2. No visualized portal vein thrombosis. There is new reversal of portal
venous directional flow, likely sequela of portal hypertension.
3. Redemonstration of a gallbladder containing intraluminal sludge with wall
thickening, which is likely due to third-spacing.
4. No findings to suggest biliary obstruction.
|
10117812-RR-30 | 10,117,812 | 26,571,680 | RR | 30 | 2117-04-14 15:07:00 | 2117-04-14 15:34:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with worsening anasarca // Rule out pneumonia peer
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is mildly enlarged, unchanged. The mediastinal and hilar contours
are normal. The pulmonary vasculature is normal. Mild patchy atelectasis is
seen in the lung bases without focal consolidation. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
Mild atelectasis in the bases.
|
10117812-RR-31 | 10,117,812 | 26,571,680 | RR | 31 | 2117-04-14 15:31:00 | 2117-04-14 16:05:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with worsening anasarca. // Rule out portal vein
thrombosis,
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound ___
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. A 1.1 cm cyst is again seen
within the right hepatic lobe. There is no suspicious focal liver mass. The
main portal vein is patent with hepatopetal flow. There is moderate ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 2 mm
GALLBLADDER: Sludge is again seen throughout a nondistended gallbladder.
There is persistent wall thickening/edema, overall similar to the prior study
and likely related to cirrhosis.
PANCREAS: The 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.
Spleen length: 14.0 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver, without evidence of focal lesion.
2. Patent portal vein with hepatopetal flow, previously hepatofugal.
3. Gallbladder sludge with wall thickening likely secondary to third spacing.
No evidence of acute cholecystitis.
|
10117812-RR-33 | 10,117,812 | 26,571,680 | RR | 33 | 2117-04-17 01:54:00 | 2117-04-17 10:54:00 | INDICATION: ___ year old woman with alcoholic cirrhosis fever to 102 and cough
// rule out PNA
COMPARISON: Radiographs from ___
IMPRESSION:
Heart size is enlarged but stable. There has been development of moderate
pulmonary edema and patchy opacity at the right base. Follow-up to resolution
is recommended. There are no pneumothoraces.
|
10117812-RR-34 | 10,117,812 | 26,571,680 | RR | 34 | 2117-04-18 15:33:00 | 2117-04-18 16:11:00 | INDICATION: ___ year old woman with abdominal and left shoulder pain following
paracentesis // Assess for free air
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None
FINDINGS:
There are 2 radiopaque structures, likely pills seen within the area of the
stomach.
There is a distended large bowel loop within the right hemiabdomen with
prominent but nondistended small-bowel loops. There are multiple air-fluid
levels in the upright position, without a transition point. No air seen
within the rectum. There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Single distended large bowel loop within the right hemiabdomen without
evidence of free intraperitoneal air
|
10117812-RR-35 | 10,117,812 | 26,571,680 | RR | 35 | 2117-04-19 01:05:00 | 2117-04-19 08:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cirrhosis, volume overload, ? pneumonia
// hypoxia hypoxia
IMPRESSION:
Comparison to ___. Lung volumes remain low. The patient is
rotated. Moderate cardiomegaly persists. Today's image shows evidence of
mild pulmonary edema. No pneumothorax. No pneumonia.
|
10117812-RR-37 | 10,117,812 | 26,571,680 | RR | 37 | 2117-04-19 14:22:00 | 2117-04-19 17:07:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman with cirrhosis presenting with volume overload,
___, and now fevers, abdominal pain, and hypoxia. // With PO contrast. Assess
chest for PNA, abdomen for colitis or other causes of fever and abdominal pain
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 8.2 s, 64.5 cm; CTDIvol = 22.7 mGy (Body) DLP =
1,462.3 mGy-cm.
Total DLP (Body) = 1,462 mGy-cm.
COMPARISON: US liver ___.
FINDINGS:
LOWER CHEST: There are bilateral pleural effusions with associated
atelectasis. Please refer to separate report of CT chest performed on the
same day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver has a nodular contour consistent with cirrhosis. The
liver demonstrates homogeneous attenuation throughout. There is a
subcentimeter hypodense lesion within the right lobe of the liver which is not
well characterized without contrast, but likely corresponds with a cyst seen
on ultrasound. No concerning lesions are appreciated within limitations of an
unenhanced scan.
The gallbladder has layering sludge. The common bile duct is distended,
measuring 7 mm in diameter. There is no evidence of an obstructing mass or
lesion on this noncontrast study.
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. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is a punctate
stone in the midpole of the left kidney. There is no suspicious renal lesions
within the limitations of an unenhanced scan. There is no hydronephrosis.
There is no nephrolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. There is reflux into the
esophagus. The stomach is unremarkable. There is diffuse distention of the
small bowel with air fluid levels. There is no transition point. Oral
contrast does not enter the large bowel. This is suggestive of an ileus. The
colon and rectum are within normal limits.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
large volume ascites diffusely within the abdomen.
REPRODUCTIVE ORGANS: The uterus is in mid position, and normal in size. No
concerning adnexal lesions are detected.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There are multiple gastric, perisplenic and paraesophageal varices.
There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is diffuse stranding of the subcutaneous fat consistent
with third spacing. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Dilated loops of small bowel, with air fluid levels and without a
transition point, are suggestive of an ileus. Evaluation of the large bowel
is limited.
2. Large volume ascites diffusely within the abdomen and anasarca is
consistent with third spacing.
3. The liver has a nodular contour consistent with cirrhosis. There are
multiple serpiginous vessel consistent with varices. Evaluation for focal
masses or lesions is limited in this noncontrast enhanced study.
4. Please refer to dedicated CT chest for further characterization.
|
10117812-RR-38 | 10,117,812 | 26,571,680 | RR | 38 | 2117-04-19 14:23:00 | 2117-04-19 15:38:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with cirrhosis presenting with volume overload,
___, and now fevers, abdominal pain, and hypoxia. // With PO contrast. Assess
chest for PNA, abdomen for colitis or other causes of fever and abdominal pain
With PO contrast. Assess chest for PNA, abdomen for colitis
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
no administration of intravenous contrast material, multiplanar
reconstructions. Axial sagittal and coronal images were acquired.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.2 s, 64.5 cm; CTDIvol = 22.7 mGy (Body) DLP =
1,462.3 mGy-cm.
Total DLP (Body) = 1,462 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W/O CONTRAST)
COMPARISON: No prior CT chest is available for comparison.
FINDINGS:
THORACIC INLET: Thyroid is unremarkable. There are no enlarged
supraclavicular lymph nodes
BREAST AND AXILLA : There are no enlarged axillary lymph nodes.
MEDIASTINUM: There are small mediastinal lymph nodes. A right paratracheal
lymph node measures 8 mm. A subcarinal lymph node measures 10 mm. There is
no pericardial effusion. There is a small right pericardial lymph node
measuring 6 mm. There is no pericardial effusion.
PLEURA: There are small bilateral pleural effusions left greater than right.
LUNG: There is diffuse bilateral ground-glass opacification which most likely
represents interstitial edema. Consolidative opacity in the left lower lobe
and right lung base most likely represents atelectasis. No evidence of
pneumonia.
BONES AND CHEST WALL : Review of bones shows mild osteopenia. Bones are
otherwise unremarkable. There is evidence of anasarca
UPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of
ascites.
IMPRESSION:
Small bilateral pleural effusions with bibasilar atelectasis left greater than
right. Mild diffuse interstitial edema with subsegmental atelectasis in the
left lower lobe. No evidence of pneumonia.
Evidence of anasarca.
Ascites.
Small mediastinal lymph nodes are most likely reactive.
|
10118190-RR-11 | 10,118,190 | 20,393,246 | RR | 11 | 2140-12-17 12:37:00 | 2140-12-17 13:23:00 | HISTORY: Low back and coccygeal pain for 2 days.
COMPARISON: Radiographs of the lumbosacral spine from ___.
FINDINGS:
Frontal and lateral radiographs of the lumbosacral spine demonstrate multiple
severe compression fractures. There is severe loss of height of L3-5. There
has been further loss of height at L2 when compared to the prior study.
Multilevel degenerative changes with loss of intervertebral disc height,
vacuum disc phenomenon, and osteophyte formation are seen throughout the
lumbar spine.
IMPRESSION:
Multiple severe compression fractures of the lumbar spine with further
progression of the L2 fracture when compared to the ___ study. If
there is clinical concern, consider CT.
|
10118190-RR-12 | 10,118,190 | 20,393,246 | RR | 12 | 2140-12-17 13:36:00 | 2140-12-17 15:03:00 | INDICATION: History of spinal stenosis with bilateral lower extremity
weakness. Evaluate for worsening compression fractures.
COMPARISONS: Lumbar spine radiographs from ___ from ___
___. Lumbar spine radiographs from ___ done here.
TECHNIQUE: Helical axial MDCT images were obtained through the lumbar spine
without the administration of IV contrast. Sagittal, coronal, and thin
section bone reformatted images were obtained and reviewed.
FINDINGS:
There are 5 lumbar type vertebrae; L5 is partially sacralized.
The bones are demineralized. There is mild diffuse loss of height in the L3,
L4 and L5 vertebral bodies, unchanged. There is anterior wedging of the L2
vertebral body, slightly increased since ___ radiographs. There is a
fracture line parallel to the superior endplate (501b:45, 500b:22), with
minimal sclerosis along the fracture line compatible with either remodeling in
response to a subacute fracture, or acute impaction of fracture fragments.
There is no retropulsion.
There is unchanged mild retrolisthesis at L2-3, L3-4, and L4-5, a
dextroscoliosis centered at L1-2, and a kyphotic curvature centered at L2-3.
There is multilevel disc space narrowing and vacuum phenomenon, not
significantly changed from the prior radiograph.
At T12-L1, there is no significant spinal canal or neural foraminal narrowing.
At L1-L2, a small disc bulge causes minimal spinal canal narrowing.
At L2-3, there is a small disc bulge, facet arthropathy, and mild
retrolisthesis causing mild central canal narrowing, and mild left neural
foraminal narrowing.
At L3-4, there is mild spinal canal narrowing due to a disc bulge, facet
arthropathy and mild retrolisthesis. There is mild right and mild to moderate
left neural foraminal narrowing.
At L4-5, there is severe spinal canal narrowing due to posterior epidural
lipomatosis, a disc bulge, facet arthropathy, and mild retrolisthesis. There
is also severe right and moderate-to-severe left neural foraminal narrowing.
At L5-S1, there is a large disc bulge with endplate osteophytes, and facet
arthropathy, with moderate spinal canal narrowing and severe bilateral neural
foraminal narrowing.
Psoas muscles appear asymmetric due to scoliosis. The imaged portions of the
liver demonstrate fatty infiltration. Punctate right renal hilus
calcifications could be vascular or could represent nonobstructing stones. The
imaged abdominal aorta and iliac arteries are extensively calcified.
IMPRESSION:
1. Acute-on-chronic or subacute compression fracture of L2 vertebral body
without retropulsion, which demonstrates increased anterior loss of height
since ___. The preliminary report stated that there was no acute fracture;
the final interpretation was discussed by Dr. ___ with Dr. ___ at
5:44 pm on ___ via telephone.
2. Unchanged mild diffuse loss of height in the L3 through L5 vertebral
bodies.
3. Multilevel degenerative disease with severe spinal stenosis at L4-5.
4. Partially sacralized L5.
5. Hepatosteatosis.
6. Non-obstructing right renal stones versus arterial calcifications.
|
10118201-RR-16 | 10,118,201 | 28,761,568 | RR | 16 | 2156-03-01 03:50:00 | 2156-03-01 06:09:00 | INDICATION: ___ female status post recent pancreatectomy/splenectomy
transferred with increasing abdominal pain from ___. Evaluate for fluid
collection or obstruction.
COMPARISON: Preoperative abdomen CTA from ___.
TECHNIQUE: Axial helical MDCT images were obtained from the lung bases to the
pubic symphysis after administration of IV and oral contrast. Coronal and
sagittal reformats were generated.
DLP: 445.61 mGy-cm.
FINDINGS: The lung bases are clear and the visualized heart and pericardium
are unremarkable.
The patient is status post distal pancreatectomy/splenectomy. The head and
body of the pancreas are within normal limits. A 2.9 x 1.8 cm fluid
collection is seen in the distal portion of the remaining pancreas in the area
of the resection of prior cystic lesion. Hyperdense surgical material is seen
in this area as well. There is no gas within the fluid collection to suggest
gas-forming bacteria or fistula with adjacent viscera. The portion of the
stomach adjacent to the surgical bed shows mild wall thickening. There is
significant stranding of the mesentery in the upper left and mid abdomen also
anticipated after recent surgical procedure.
The liver enhances homogeneously, without evidence of intrahepatic biliary
duct dilatation. A sub-5-mm hypodensity in segment V of the liver (2:24) is
unchanged from prior exam and likely benign such as a biliary hamartoma. The
portal vein is patent. There is a small calcified gallstone within the
gallbladder which is otherwise unremarkable. The adrenal glands are
unremarkable. The kidneys demonstrate symmetric nephrograms and excretion of
contrast. A pelvic diverticulum is noted in the interpolar region of the left
kidney (2:26). Otherwise, the kidneys demonstrate symmetric nephrograms and
excretion of contrast and there is no hydronephrosis or nephrolithiasis
bilaterally.
The small and large bowel are unremarkable, without dilatation to suggest
obstruction. The appendix is visualized and is not inflamed. The aorta is
normal in caliber throughout. The main intra-abdominal vessels are grossly
patent. There is no retroperitoneal or mesenteric lymphadenopathy. No
ascites, abdominal free air, or abdominal wall hernia is present.
PELVIC CT: The urinary bladder is underdistended but unremarkable. The
uterus and adnexa are within normal limits. There is no pelvic wall or
inguinal lymphadenopathy. No pelvic free fluid is identified.
OSSEOUS STRUCTURES: There is bilateral pars defect at the level of L5
resulting in spondylolysis with grade 1 anterolisthesis of L5 on S1 and
degenerative changes of this joint. Otherwise, the remaining visualized spine
is unremarkable. There are no lytic or blastic lesions concerning for
malignancy.
IMPRESSION:
1. Small fluid collection in the distal pancreas in the resection bed is
likely post-surgical. Associated mesenteric stranding in the upper left and
mid abdomen is anticipated after recent surgical procedure but postsurgical
pancreatitis and/or superimposed infection cannot be excluded with this
appearance.
2. Bilateral pars articularis defect of L5 resulting in grade 1
anterolisthesis of L5 on S1.
3. Punctate calcified gallstone. Normal gallbladder.
|
10119094-RR-42 | 10,119,094 | 24,446,921 | RR | 42 | 2146-12-02 16:52:00 | 2146-12-02 17:06:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain // acute process?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Heart size is top normal. Mediastinal and hilar contours are unremarkable.
Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. No acute osseous abnormalities demonstrated. Minimal
degenerative changes are noted in the thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10119094-RR-45 | 10,119,094 | 29,995,182 | RR | 45 | 2150-12-06 14:18:00 | 2150-12-06 15:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with nstemi, no active cp// cardiomegaly?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
No focal consolidation is seen peer there is no pleural effusion or
pneumothorax. The cardiac silhouette size is borderline to mildly enlarged.
Mediastinal contours unremarkable. No pulmonary edema is seen.
IMPRESSION:
Borderline to mildly enlarged cardiac silhouette size. No pulmonary edema.
No focal consolidation.
|
10119234-RR-19 | 10,119,234 | 22,784,276 | RR | 19 | 2133-08-23 15:09:00 | 2133-08-23 17:19:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ with PNA, c/f vaping-related lung injury; also is due for
annual lung-cancer screening // ?e/o vaping-related injury
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: Acquisition sequence:
1) Spiral Acquisition 6.0 s, 38.9 cm; CTDIvol = 8.2 mGy (Body) DLP = 312.4
mGy-cm.
Total DLP (Body) = 312 mGy-cm.
COMPARISON: Outside CT chest ___ and ___. Outside
chest radiograph ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid appears
unremarkable. There is no axillary or supraclavicular lymphadenopathy.
Evaluation of the base of the neck and right shoulder is limited by right
shoulder hemiarthroplasty.
UPPER ABDOMEN: Visualized portion of the abdomen appears unremarkable.
MEDIASTINUM: A 0.9 cm subcarinal lymph node may be reactive. Prominent 0.9 cm
AP window lymph nodes are also likely reactive.
HILA: Evaluation for hilar lymphadenopathy is limited on this noncontrast
scan.
HEART and PERICARDIUM: The heart is not enlarged. Trace pericardial fluid is
likely physiologic. Moderate coronary artery and mild aortic valve
calcifications are seen.
PLEURA: There is a trace left pleural effusion. No right pleural effusion.
No pneumothorax.
LUNG:
1. PARENCHYMA: There are severe bilateral centrilobular emphysema most
notable in the upper lobes. There is dense consolidation of the left upper
lobe concerning for lobar pneumonia. There are also opacities in the apical
left lower lobe concerning for infection (2; 27).
2. AIRWAYS: The airways are patent to the subsegmental level bilaterally.
3. VESSELS: The aorta and pulmonary arteries are normal in caliber. There is
moderate atherosclerotic calcification in the aortic arch.
CHEST CAGE: Patient is status post right shoulder hemiarthroplasty.No
suspicious osseous lesion is identified.
IMPRESSION:
1. Interval left upper lobe consolidation and opacities in the apical segment
of the left lower lobe, concerning for infection given localized appearance
rather than vaping related lung injury which typically demonstrates a diffuse
pattern. Follow up chest CT 8 weeks after treatment for pneumonia is
recommended.
2. Severe bilateral upper lobe centrilobular emphysema.
RECOMMENDATION(S): Follow-up chest CT in 8 weeks after treatment.
|
10119391-RR-108 | 10,119,391 | 28,577,408 | RR | 108 | 2196-12-08 21:10:00 | 2196-12-08 21:22:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with fall/AMS// PNA?
COMPARISON: Prior chest radiograph from ___
FINDINGS:
AP upright and lateral views of the chest provided.
Elevated right hemidiaphragm is noted. There is a retrocardiac opacity likely
reflecting a hiatal hernia. Mild right basal atelectasis noted. No focal
consolidation concerning for pneumonia. No large effusion or pneumothorax.
The heart remains mildly enlarged. The aorta is unfolded. Bony structures
appear intact. Chronic degenerative disease at both shoulders again noted
with resorptive changes at the humeral heads.
IMPRESSION:
As above.
|
10119391-RR-109 | 10,119,391 | 28,577,408 | RR | 109 | 2196-12-08 21:11:00 | 2196-12-08 21:45:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with dementia p/w fall and headstrike// eval for bleed eval
for fracture
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: DLP (Head) = 803 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of acute major infarction,hemorrhage,edema, or mass
effect. There is prominence of the ventricles and sulci suggestive of
involutional changes. Nonspecific periventricular subcortical white matter
hypodensities suggest chronic small vessel ischemic changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits demonstrate bilateral lens replacement.
Dense calcifications are noted in bilateral cavernous internal carotid
arteries.
IMPRESSION:
No acute intracranial process. Small vessel disease.
|
10119391-RR-110 | 10,119,391 | 28,577,408 | RR | 110 | 2196-12-08 21:11:00 | 2196-12-08 21:57:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with dementia p/w fall and headstrike// eval for bleed eval
for fracture
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) = 458 mGy-cm.
COMPARISON: CT C-spine ___.
FINDINGS:
There is grade 2 anterolisthesis of C7 on T1, unchanged from prior. Again,
there is re-demonstration of chronic nonunited fracture of the anterior and
left posterior arch of C1, unchanged since prior. There is re-demonstration
of mild subluxation of the right lateral mass of C1 on C2 as well as rotation
of C1 on C2, unchanged from prior exam. There is multilevel degenerative
changes similar to prior with fusion of C3-C4 through C5-C6.
There is no prevertebral soft tissue swelling.
IMPRESSION:
1. No acute fracture.
2. Severe multilevel degenerative changes, similar to prior.
|
10119391-RR-146 | 10,119,391 | 24,883,591 | RR | 146 | 2198-03-24 10:29:00 | 2198-03-24 11:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with altered mental status, has tardive dyskinesia and thus
aspiration risk// new fever, aspiration pneumonitis vs. pneumonia?
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are low volume. There is persistent subsegmental atelectasis in the
left lung base the retrocardiac a opacity in the left paraspinal region
corresponds to the hiatus hernia. Lungs are clear. There are extensive
degenerative changes involving the left shoulder joint with near complete
resorption of the left humeral head. There also extensive degenerative
changes involving the right shoulder joint. Cardiomediastinal silhouette is
stable. No pneumothorax is seen
|
10119391-RR-148 | 10,119,391 | 24,883,591 | RR | 148 | 2198-03-27 20:55:00 | 2198-03-27 21:25:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with unwitnessed fall and head down when
found// eval for intracranial injury
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.6 mGy-cm.
2) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.6 mGy-cm.
Total DLP (Head) = 1,495 mGy-cm.
COMPARISON: None.
FINDINGS:
Severely limited study with significant patient motion despite repeat attempts
at imaging. Within this limitation, there is no large intracranial
hemorrhage, however cannot exclude small peripheral intracranial hemorrhage.
Due to limitations in imaging, difficult to assess for a large vascular
territory infarction or edema. No midline shift. There is prominence of the
ventricles and sulci suggestive of involutional changes.
There is no definite large displaced fracture.. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities appear grossly
clear. The visualized portion of the orbits demonstrate bilateral lens
replacement.
IMPRESSION:
Severely limited study with significant patient motion despite repeat attempts
at imaging. Within this limitation, there is no large intracranial
hemorrhage. However cannot exclude small peripheral intracranial hemorrhage
based on the limitations.
|
10119391-RR-150 | 10,119,391 | 26,812,710 | RR | 150 | 2198-04-12 06:46:00 | 2198-04-12 09:11:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with unequal pupils concern for intracranial
process, stroke// unequal pupils concern for intracranial process, stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.6 s, 22.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
1,166.0 mGy-cm.
2) Sequenced Acquisition 6.6 s, 22.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
1,166.0 mGy-cm.
Total DLP (Head) = 2,332 mGy-cm.
COMPARISON: CT head ___
FINDINGS:
Examination is significantly limited by patient positioning, motion and beam
hardening artifact. Evaluation of the skull brain interfaces particularly
suboptimal. Within these confines: There is an approximately 3.2 cm
hypodensity in the left cerebellum demonstrating mass effect, not previously
seen on CT head ___, consistent with an late acute to subacute
infarct. There is no large hemorrhage, however, small hemorrhage cannot be
excluded on this limited study. There is no midline shift. The ventricles
and sulci are prominent, consistent with age related atrophy.
The known bilateral C1 anterior and posterior arch fractures are partially
imaged. There is mild mucosal thickening of the sphenoid and ethmoid sinuses.
Patient is status post bilateral lens replacement; the visualized portion of
the orbits are otherwise unremarkable.
IMPRESSION:
1. Findings compatible with late acute to subacute left cerebellar infarct.
2. No large hemorrhage or midline shift. Examination is significantly limited
by patient positioning, motion and beam hardening artifact.
3. Additional findings described above.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:06 am, 5 minutes after
discovery of the findings.
|
10119391-RR-151 | 10,119,391 | 26,812,710 | RR | 151 | 2198-04-15 13:47:00 | 2198-04-15 15:32:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with history of dementia,
bipolardisorder/schizoaffective disorder, tardive dyskinesia (thoughtto be
due to olanzapine, stelazine) that presented to the hospital for change in
mental status found to have late acute to subacute cerebellar stroke//
evaluate for stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head without contrast from ___
FINDINGS:
Please note that the study is suboptimal due to extensive motion artifact
which limits evaluation of intracranial structures. Within these limitations,
there are several areas of high signal on the diffusion-weighted images in the
left cerebellar hemisphere corresponding to the abnormalities seen on the CT
head study from ___. However, the apparent diffusion coefficient
images are so degraded by motion artifact that it is not clear whether there
are corresponding regions of slow diffusion. Prominence of ventricles and
sulci are compatible with age related involutional changes. Ill-defined
T2/FLAIR hyperintensities are nonspecific but likely due to chronic sequela of
small-vessel ischemic disease.
The paranasal sinuses are grossly clear without obvious opacification. The
orbits are unremarkable.
IMPRESSION:
1. Please note the study is suboptimal due to extensive motion artifact which
limits evaluation of intracranial structures.
2. Within these limitations, several areas of high signal on the diffusion
weighted images are seen in the left cerebral hemisphere are seen without
definite correlate on the ADC sequences. While these lesions could represent
subacute infarcts, other lesions are not excluded given degree of motion and a
repeat study may be helpful for further characterization.
RECOMMENDATION(S): A repeat study when patient is more cooperative would be
helpful to better characterize the left cerebellar lesions.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:21 pm, 1 minutes after discovery
of the findings.
|
10119514-RR-63 | 10,119,514 | 20,157,432 | RR | 63 | 2192-05-22 20:40:00 | 2192-05-22 21:46:00 | HISTORY: ___ man with fever cough and dyspnea for 24 hours.
COMPARISON: ___
FINDINGS:
PA and lateral chest radiographs were obtained. No focal consolidation,
effusion or pneumothorax is present. Moderate cardiomegaly is unchanged.
There is no evidence of pulmonary edema.
IMPRESSION:
No acute cardiopulmonary process.
|
10119514-RR-64 | 10,119,514 | 20,157,432 | RR | 64 | 2192-05-22 21:12:00 | 2192-05-22 22:08:00 | HISTORY: ___ man with fever and left lower quadrant pain.
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after the
administration of intravenous contrast. Images were displayed in multiple
planes. DLP: 671 mGy-cm.
COMPARISON: CT ___.
FINDINGS:
ABDOMEN: Stable diffuse ground-glass opacity at the lung bases is
attributable to air trapping/atelectasis. No effusion.
There are no focal liver lesions. The hepatic and portal veins are patent.
The spleen and adrenal glands are unremarkable. The kidneys enhance
symmetrically and excrete contrast promptly. A stable 9 mm hypodensity in the
lower pole of the right kidney is too small to characterize but is most likely
a cyst. There is no ascites. There is no mesenteric or retroperitoneal
adenopathy. The stomach and small and large bowel are unremarkable.
PELVIS: The remainder of the bowel is normal caliber and appearance. No
appendix is visualized but there is no secondary signs of appendicitis. There
is moderate to severe sigmoid diverticulosis without evidence of
diverticulitis. There is there is no bowel wall thickening or abnormal
dilation. No free pelvic fluid is present. The prostate and seminal vesicles
are unremarkable. There is no inguinal or pelvic adenopathy. Bilateral fat
containing inguinal hernias are present. Moderate partially calficied
atherosclerotic plaque seen in the abdominal aorta which is normal in caliber.
No lytic or sclerotic lesions are concerning for malignancy.
IMPRESSION:
1. No acute intra-abdominal process.
2. Moderate sigmoid diverticulosis without evidence of diverticulitis.
|
10119514-RR-65 | 10,119,514 | 20,157,432 | RR | 65 | 2192-05-23 20:49:00 | 2192-05-24 09:15:00 | LEFT SHOULDER RADIOGRAPHS DATED ___
CLINICAL INDICATION: ___ man with left shoulder pain status post fall
several weeks ago and deformity of the joint, assess for fracture and
dislocation.
COMPARISON: Left shoulder radiographs from ___.
FINDINGS:
Internal rotation, external rotation, and scapular Y views of the left
shoulder demonstrate no acute fracture or dislocation. The partially
visualized left lung and ribs are within normal limits. Mild osteopenia.
Unchanged appearance of sessile osteochondroma involving the lateral
metadiaphysis of the proximal left humerus. Unchanged remote posttraumatic
deformity involving the surgical neck of the humerus. Again demonstrated is a
stable calcific density adjacent to the proximal humerus diaphysis, which may
represent calcification within the biceps tendon sheath. Minimal
osteoarthritic changes of the acromioclavicular joint.
IMPRESSION:
1. No definite acute fracture.
2. Stable probable calcific tendinitis/bursitis within the bicipital tendon
sheath.
3. Stable-appearing sessile osteochondroma at proximal left humerus
metadiaphysis.
|
10119514-RR-66 | 10,119,514 | 20,157,432 | RR | 66 | 2192-05-24 09:01:00 | 2192-05-24 10:41:00 | PA AND LATERAL CHEST ON ___
HISTORY: ___ man with shortness of breath, cough and new crackles on
exam.
IMPRESSION: PA and lateral chest compared to ___ and ___:
Moderate cardiomegaly is longstanding. Mediastinal venous engorgement is
slightly larger today than it was on ___, and larger than on ___, but
there is no particular pulmonary vascular engorgement and no edema. Mild
heterogeneous opacification at the base of the right lung is more likely
atelectasis than pneumonia. Pleural effusion is minimal on the left if any.
|
10119514-RR-77 | 10,119,514 | 24,542,641 | RR | 77 | 2193-01-12 18:34:00 | 2193-01-12 21:10:00 | CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Dementia, chronic headache, question infection.
FINDINGS: Frontal and lateral views of the chest provided demonstrate
persistent mild cardiomegaly, though no definite signs of pneumonia, effusion
or pneumothorax. Low lung volume limits the evaluation. ___ be mild
interstitial edema.
|
10119514-RR-78 | 10,119,514 | 24,542,641 | RR | 78 | 2193-01-12 17:40:00 | 2193-01-12 19:32:00 | INDICATION: Dementia, now with acute worsening of chronic headache and
altered mental status, here to evaluate for acute intracranial hemorrhage.
COMPARISON: Non-contrast head CT dated ___.
TECHNIQUE: Multidetector CT imaging was performed 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.
CT HEAD: There is no evidence of intra-axial or extra-axial hemorrhage,
edema, mass effect or shift of normally midline structures. Confluent
periventricular and subcortical white matter hypodensities are consistent with
sequela of chronic microvascular ischemic disease. The gray-white matter
interface is otherwise preserved without evidence of acute major vascular
territorial infarct. The ventricles and sulci are enlarged, predominantly in
the bifrontal regions consistent with age-related parenchymal volume loss.
Atherosclerotic calcification of the bilateral carotid siphons and bilateral
vertebral arteries is noted. The orbits and globes are unremarkable. The
visualized paranasal sinuses demonstrate mucosal thickening in the left
maxillary sinus and bilateral ethmoid air cells. Small mucus retention cysts
are noted in the left sphenoid sinus and right maxillary sinus. The middle
ear cavities and mastoid air cells are clear bilaterally. The bony calvaria
appear intact. A metallic density is seen in the left sphenoid bone, which is
unchanged and likely represents an embedded foreign body. There is a small
right parieto-occipital subcutaneous density without underlying skull
fracture, unchanged from ___.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Metallic foreign body in left sphenoid bone is unchanged.
|
10119554-RR-15 | 10,119,554 | 20,303,886 | RR | 15 | 2115-11-10 03:25:00 | 2115-11-10 05:31:00 | EXAMINATION: MR CODE CORD COMPRESSION PT27 MR SPINE
INDICATION: ___ year old man with metz Ca, urostomy/colostomy, enlarging
sacral mass. new to system with bilateral leg weakness// r/o cord involvement
r/o cord involvement
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: None.
FINDINGS:
The study is mildly degraded by motion artifact.
There is grade 1 anterolisthesis at L4-L5, likely degenerative. The spinal
cord appears normal in caliber and configuration. There are incidental
hemangiomas at the T11, L1, and L5 inferior endplates. There is T2 and T1
hyperintense signal within the sacrum, compatible with post radiation changes.
Otherwise, vertebral body and intervertebral disc signal intensity appear
normal. There is central disc protrusion at L4-L5 and L5-S1 causing moderate
spinal canal stenosis and severe bilateral neural foraminal stenosis at L4-L5.
There is no definite evidence of infection.
There is a lobulated, heterogeneous low signal mass with peripheral
enhancement centered in the distal left sacrum involving the left greater than
right S3 foramina measuring approximately 7.7 x 5.2 x 4.9 cm (05:44).
Intrinsic signal of the mass suggests hemorrhage and necrosis. There is
intraspinal extension of the mass through the sacral spinal canal with
extension superiorly to the L4-5 level with compression of the posterior
thecal sac. The intraspinal component of the mass appears similar with
peripheral enhancement and likely central necrosis and hemorrhage. There is
partial visualization of the bladder mass with possible posterior extension to
the seminal vesicles (08:44). This is not fully evaluated.
There is severe left hydroureteronephrosis to level of the bladder.
IMPRESSION:
1. Lobulated, heterogeneous 7.7 cm left sacral mass involving the left greater
than right S3 foramina and with extension into the adjacent left piriformis
muscle. There is additional extension into the sacral spinal canal superiorly
to the L4-5 level with posterior compression of the thecal sac. The mass
enhances peripherally with intrinsic signal suggestive of hemorrhage and
necrosis.
2. Partial visualization of the bladder mass with possible extension
posteriorly . Pelvic MRI or comparison to prior imaging can be performed for
better characterization of the mass, if clinically indicated.
3. No evidence of abnormal cord signal or cord compression.
4. No suspicious bony abnormalities of the lumbar and upper sacral spine
5. Central disc protrusion at L4-L5 with moderate spinal canal stenosis and
severe bilateral neural foraminal stenosis.
6. Severe left hydroureteronephrosis.
RECOMMENDATION(S): Pelvic MRI or comparison to prior imaging for better
characterization of the bladder and sacral mass.
|
10119554-RR-16 | 10,119,554 | 20,303,886 | RR | 16 | 2115-11-10 20:47:00 | 2115-11-10 22:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with metastatic rectal adenocarcinoma, with port
in place. Xray to confirm placement.// port placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
FINDINGS:
The tip of a left subclavian Port-A-Cath projects over the distal SVC. There
are low bilateral lung volumes with no focal consolidation, pleural effusion
or pneumothorax identified. The size of the cardiac silhouette is borderline
enlarged.
IMPRESSION:
The tip of the left subclavian Port-A-Cath projects over the distal SVC. No
pneumothorax.
|
10119692-RR-16 | 10,119,692 | 29,109,151 | RR | 16 | 2142-06-08 14:02:00 | 2142-06-08 16:17:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC. Evaluate right PICC placement.
TECHNIQUE: Single portable AP view of the chest.
COMPARISON: Chest radiograph from ___.
FINDINGS:
The new right PICC line ends in the right atrium and should be withdrawn 4-5
cm to be positioned in the lower SVC, if desired. Lung volumes are low with a
new area of platelike atelectasis in the left lung. No effusions or
pneumothorax. Heart size, mediastinum, and hilar contours are normal.
IMPRESSION:
The knee right PICC line ends in the right atrium and should be withdrawn 4-5
cm to be positioned in the lower SVC, if desired.
NOTIFICATION: The above finding was communicated via telephone by Dr. ___
to ___ (IV RN) at 15:13 on ___, 2 min after discovery.
|
10119692-RR-17 | 10,119,692 | 29,109,151 | RR | 17 | 2142-06-08 15:23:00 | 2142-06-08 17:46:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with abdominal hernia repair. Evaluate line
placement.
TECHNIQUE: Single portable AP view of the chest.
COMPARISON: Chest radiograph from earlier on the same date and ___.
FINDINGS:
The right PICC line has been retracted approximately 3 cm, but its tip is
still within the right atrium and would need to be retracted approximately 2
cm to be positioned in the lower SVC, if desired. No other significant changes
since the radiograph from 1 hr prior. Left lung atelectasis is unchanged.
IMPRESSION:
The right PICC line tip is still in the right atrium and would need to be
retracted approximately 2 cm to be positioned in the lower SVC, if desired.
NOTIFICATION: The above findings were communicated via telephone by Dr.
___ to ___ (IV RN) at 16:13 on ___, 2 min after
discovery.
|
10119692-RR-18 | 10,119,692 | 29,109,151 | RR | 18 | 2142-06-08 16:59:00 | 2142-06-08 17:35:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman s/p hernia repair now s/p PICC line placement.
TECHNIQUE: Chest PA and lateral
COMPARISON: Two prior chest radiographs from the same date.
FINDINGS:
The right PICC line now terminates in the lower SVC. No relevant change since
the prior radiograph from 1 hr earlier.
IMPRESSION:
The right PICC line now terminates in the lower SVC.
|
10119692-RR-19 | 10,119,692 | 23,775,644 | RR | 19 | 2142-06-13 09:31:00 | 2142-06-13 11:40:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p hernia repair then s/p ischemic breakdown
of incision with subsequent repair and d/c to rehab now readmitted with
incisional cellulitis. Had R PICC placed here on ___. Please check PICC
placement s/p readmission from rehab.
TECHNIQUE: Single portable AP view of the chest.
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
The right PICC line terminates in the mid to lower SVC, unchanged since the
most recent radiograph on ___. No other relevant changes.
Platelike atelectasis at the left base is unchanged. Lungs are otherwise clear
without new focal consolidation, large pleural effusions, or pneumothorax.
Heart size, mediastinal, and hilar contours are stable.
IMPRESSION:
The right PICC line terminates in the mid to lower SVC, unchanged since the
most recent radiograph.
|
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