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10119692-RR-21 | 10,119,692 | 23,775,644 | RR | 21 | 2142-06-17 11:22:00 | 2142-06-17 12:18:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with Urostomy and foley in place // assess for
hydronephrosis.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.3 cm. The left kidney measures 9.2 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder was not assessed on this exam.
IMPRESSION:
Normal renal ultrasound. No evidence of hydronephrosis.
|
10119863-RR-57 | 10,119,863 | 26,756,106 | RR | 57 | 2131-02-28 13:11:00 | 2131-02-28 17:14:00 | EXAMINATION: MRCP WITH CONTRAST
INDICATION: ___ year old man with acute pancreatitis, biliary sludge, high
bili.// Biliary sludge and pancreatitis, eval for stones and ?need for ERCP
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 9 mL Gadavist.
Oral contrast: None.
COMPARISON: Correlation with CT abdomen and pelvis from ___.
FINDINGS:
The majority of the images are degraded by motion artifact.
Lower Thorax: A 1 cm left lower lobe pulmonary nodule can be followed up with
CT in 3 months as recommended in the CT report. There is no evidence of
pleural effusion or airspace consolidation at the lung bases.
Liver: The hepatic parenchyma appears within normal limits. The postcontrast
images are severely degraded by artifact, but there is no obvious focal liver
lesion.
Biliary: MRCP images are technically suboptimal. There are a few small
subcentimeter gallstones lying near the gallbladder neck. No choledochal
stones are identified. There is no biliary dilation.
Pancreas: There are mild inflammatory changes surrounding the pancreatic head
as demonstrated on CT. The pancreatic duct is not dilated and there are no
focal lesions demonstrated. No evidence of pancreatic necrosis.
Spleen: The spleen is normal in size in appearance.
Adrenal Glands: Both adrenals are unremarkable.
Kidneys: There are multiple bilateral renal cysts as demonstrated on CT. The
largest cortical cyst on the left measures 8.4 x 6.1 x 8.8 cm. There is no
hydronephrosis.
Gastrointestinal Tract: There is extensive colonic diverticulosis. The bowel
is otherwise grossly unremarkable.
Lymph Nodes: No enlarged lymph nodes identified.
Vasculature: Unremarkable aside from atherosclerotic disease.
Osseous and Soft Tissue Structures: No aggressive bone lesions are
demonstrated.
IMPRESSION:
1. Technically suboptimal study due to motion artifact.
2. Cholelithiasis with no evidence of choledocholithiasis.
3. Findings of interstitial edematous pancreatitis again noted.
|
10119910-RR-30 | 10,119,910 | 21,317,576 | RR | 30 | 2192-02-03 14:23:00 | 2192-02-03 15:52:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ m hypotension eval for intra abd bleeding, on cxr eval for ett
position s/p intubation
TECHNIQUE: Single frontal view of the chest
COMPARISON: None.
FINDINGS:
The ET tube terminates 8.1 cm above the carina and should be advanced further.
The tip of the NG tube terminates in the proximal stomach with the side port
in the distal esophagus or gastroesophageal junction and should also be
advanced further so that it terminates in the stomach.
Cardiac size is normal. The lungs are clear. There is no pneumothorax or
pleural effusion.
IMPRESSION:
1. ET tube terminates 8.1 cm above the carina and should be advanced further.
2. Tip of NG tube terminates in the proximal stomach with side port in the
distal esophagus or gastroesophageal junction and should also be advanced
further.
|
10119910-RR-31 | 10,119,910 | 21,317,576 | RR | 31 | 2192-02-03 14:29:00 | 2192-02-03 15:15:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with AMS, hypoxia eval for bleed, PE
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 16.0 s, 16.7 cm; CTDIvol = 48.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is a large left frontal intraparenchymal hemorrhage measuring 3.9 x 5.4
cm with adjacent edema and mass effect on the sulci as well as on the frontal
horn of the left lateral ventricle. Given less well-defined margins in degree
of surrounding edema, this is likely acute/subacute. There is no midline
shift. Basal cisterns are patent.
No evidence of large vascular territory infarction. Otherwise, there is
prominence of the ventricles and sulci suggestive of involutional changes.
Severe bilateral cavernous carotid artery calcifications are noted.
There appears to be a burr hole along the left frontal region (3; 50). No
evidence of acute fracture. There is some stranding in the left suboccipital
subcutaneous soft tissue, which is nonspecific (3; 7). There is moderate
mucosal thickening of the sphenoid sinus and ethmoid sinuses. Mild mucosal
thickening of the left maxillary sinus is noted. The visualized portion of
the remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Large acute/subacute left frontal intraparenchymal hemorrhage with adjacent
mass effect on the frontal horn of the left lateral ventricle. No midline
shift.
2. Possible burr hole in the left frontal region, correlate with history of
prior surgery.
NOTIFICATION: The findings were discussed with Dr. ___. by ___,
M.D. on the telephone on ___ at 3:40 pm, 15 minutes after discovery of
the findings.
|
10119910-RR-32 | 10,119,910 | 21,317,576 | RR | 32 | 2192-02-03 14:30:00 | 2192-02-03 15:41:00 | EXAMINATION: CT torso
INDICATION: ___ with AMS, hypoxia eval for bleed, PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
2) Spiral Acquisition 4.4 s, 34.6 cm; CTDIvol = 7.0 mGy (Body) DLP = 241.4
mGy-cm.
3) Spiral Acquisition 5.9 s, 46.6 cm; CTDIvol = 8.7 mGy (Body) DLP = 406.7
mGy-cm.
Total DLP (Body) = 651 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: There is a filling defect within the right lower lobar
pulmonary artery (3; 149) consistent with pulmonary embolism. The thoracic
aorta is normal in caliber without evidence of dissection or intramural
hematoma. There is mild to moderate atherosclerotic calcifications of the
thoracic arch and descending aorta. Moderate coronary calcifications are
noted. The heart, pericardium, and great vessels are within normal limits. No
pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy.
There are bilateral prominent hilar lymph nodes measuring up to 1.1 cm in
short axis (3; 17). There are partially calcified lymph nodes, for example
measuring 0.6 x 0.6 cm (3; 95). No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is severe bilateral paraseptal and moderate centrilobular
emphysema. There is biapical scarring. Peribronchovascular opacities in the
left lower lobe is concerning for aspiration or pneumonia. The airways are
patent to the level of the segmental bronchi bilaterally with regions of
bronchiolectasis.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ET tube is partially visualized.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: NG tube terminates in the stomach. The stomach is
decompressed. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. There is extensive colonic diverticulosis without
evidence diverticulitis. There is a redundant sigmoid colon. The appendix is
normal. There is no free intraperitoneal fluid or free air.
PELVIS:
The urinary bladder is decompressed with a Foley catheter. Nondependent air
within the bladder is consistent with recent instrumentation. The distal
ureters are unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is not visualized. Well clips are noted in
the pelvis suggestive of prior prostatectomy. Seminal vesicles appear
unremarkable.
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. Mild to moderate atherosclerotic calcifications are noted
in the origin of the celiac axis and along the mid SMA. Moderate to severe
atherosclerotic calcifications are noted at the origin of bilateral renal
arteries.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. A 2 mm sclerotic focus in the left third rib is likely a bone
island in a patient without history of malignancy (3; 78). Mild to moderate
atherosclerotic calcifications are noted in the lower lumbar spine, most
notable at L4-L5. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. There is an acute pulmonary embolism in the right lower lobar artery.
2. Prominent hilar nodes likely reactive.
3. Left lower lobe opacities concerning for aspiration or pneumonia.
4. No evidence of hemoperitoneum or acute intra-abdominal pathology.
5. Diverticulosis without evidence of diverticulitis.
NOTIFICATION: The findings were discussed with Dr. ___. by ___,
M.D. on the telephone on ___ at 3:40 pm, 5 minutes after discovery of the
findings.
|
10119910-RR-33 | 10,119,910 | 21,317,576 | RR | 33 | 2192-02-03 17:53:00 | 2192-02-03 18:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with line placement, valuate for line placement
COMPARISON: CT of the chest from ___
FINDINGS:
AP portable semi upright view of the chest. A right IJ central venous
catheter has been placed with its tip located in the region of the mid SVC.
The patient is intubated with the tip of the endotracheal tube located 4.7 cm
above the carina. The OG tube extends below the left hemidiaphragm, tip
excluded from view. The lungs are clear without effusion or pneumothorax.
IMPRESSION:
As above.
|
10119910-RR-34 | 10,119,910 | 21,317,576 | RR | 34 | 2192-02-04 01:36:00 | 2192-02-04 03:05:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with PE// DVT. History notable for recent SFA DP
bypass of unclear lower extremity per OMR note.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
In the thigh of the left lower extremity, there is a complex fluid collection
measuring 5.8 x 3.5 x 13.4 cm (AP x TV x CC)
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins.
2. Large complex fluid collection in the thigh of the left lower extremity
which measures 5.8 x 3.5 x 13.4 cm (AP x TV x CC) likely representing
hematoma.
|
10119910-RR-35 | 10,119,910 | 21,317,576 | RR | 35 | 2192-02-04 11:37:00 | 2192-02-04 12:26:00 | EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ year old man with new left sided IPH// eval interval change
TECHNIQUE: Axial images of the head were obtained without contrast .
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: ___.
FINDINGS:
There is unchanged appearance of the left frontal intracerebral hemorrhage
with surrounding edema and mild mass effect. There is no midline shift. No
acute hemorrhage is identified. No hydrocephalus.
IMPRESSION:
Unchanged appearance of the left frontal intracerebral and hematoma and
surrounding edema as well as the mild mass effect. No acute hemorrhage.
Otherwise unchanged.
|
10119910-RR-36 | 10,119,910 | 21,317,576 | RR | 36 | 2192-02-04 15:36:00 | 2192-02-04 17:10:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with IPH// Eval of IPH seen on CT
TECHNIQUE: T1 sagittal and axial and FLAIR, T2, susceptibility and diffusion
axial images of the brain were acquired. Following gadolinium administration,
T1 axial and MPRAGE sagittal images were acquired with axial and coronal
reformats. 3D time-of-flight MRA of the circle of ___ was obtained.
Gadolinium enhanced MRA of the neck was acquired.
COMPARISON: HEAD CT OF ___.
FINDINGS:
Left frontal intraparenchymal hematoma is identified with peripheral area of
high T1 signal indicative of subacute blood products with central areas of low
T2 and T1 signal indicative of acute blood products. Surrounding edema is
identified as seen on the previous CT. The postcontrast images demonstrate
and no areas of enhancement in addition to the pre gadolinium hyper
intensities indicating blood products. No remote areas of abnormal
enhancement are identified. There is linear hypointensity on susceptibility
images within the right temporal lobe and adjacent to the right temporal horn
(___) indicative of chronic blood products likely from prior hemorrhage.
Mild-to-moderate changes of small vessel disease are identified. No other
areas of microhemorrhage are seen. No acute infarct is identified.
Restricted diffusion within the area of hematoma is due to blood products.
MRA of the neck demonstrates no evidence of carotid stenosis. However, there
is absence of flow within the left vertebral artery indicating occlusion.
There are focal areas of stenosis within the mid portion of the right cervical
vertebral artery (___). Focal areas of narrowing are also visualized
within distal cervical internal carotid arteries and in the pre cavernous
portion of the right carotid artery (___).
MRA of the head demonstrates absence of A1 segment of the right anterior
cerebral artery which could be a normal variation. Mild atherosclerotic
disease is identified in the anterior and posterior circulation including
atherosclerotic disease with narrowing of bilateral cavernous and proximal
supraclinoid internal carotid arteries.
IMPRESSION:
1. Left frontal intraparenchymal hematoma demonstrates acute and subacute
blood products. There is no distinct area of enhancement seen in addition to
the blood products to suggest an underlying lesion. However, in the presence
of hematoma evaluation is limited and a follow-up examination should be
obtained for further confirmation.
2. Findings suggesting chronic hemorrhage in the right temporal region.
3. No other areas of abnormal enhancement. No acute infarcts.
4. MRA neck demonstrates areas of stenosis in the right cervical internal
carotid artery and absence of flow in the left cervical internal carotid
artery which is visualized distally in the V3 segment demonstrating
atherosclerotic disease.
5. Intracranial atherosclerotic disease as described predominantly involving
the precavernous, cavernous and supraclinoid internal carotid arteries right
greater than left side with moderate stenosis on the right.
|
10119910-RR-38 | 10,119,910 | 21,317,576 | RR | 38 | 2192-02-05 11:53:00 | 2192-02-05 12:27:00 | EXAMINATION: Chest radiograph.
INDICATION: ___ year old man with respiratory failure. Assess NGT.
TECHNIQUE: Portable chest AP.
COMPARISON: Chest radiograph from ___.
FINDINGS:
The tip of the nasogastric tube projects over the body of the stomach
approximately 5 cm below the diaphragm. Redemonstration of a right internal
jugular central venous line with the tip projecting at the level of the mid
superior vena cava. The endotracheal tube is similarly positioned. The lungs
are fully expanded without evidence of consolidation. There is no
pneumothorax or effusion. The cardiomediastinal silhouette is stable.
IMPRESSION:
Nasogastric tube is within the body of the stomach, approximately 5 cm below
the diaphragm. Additional 5-7 cm advancement is recommended.
|
10119910-RR-40 | 10,119,910 | 21,317,576 | RR | 40 | 2192-02-05 19:55:00 | 2192-02-05 20:07:00 | EXAMINATION: Chest x-ray
INDICATION: ___ year old man with new NG tube// eval NG tube placement
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___ approximately 8 hours previous
FINDINGS:
The right IJ catheter is in similar position. The endotracheal tube is in
good position. The tip of the NG tube is in the proximal stomach with the
side port just distal to the GE junction. The heart is not enlarged. The
aorta is atherosclerotic. There is no consolidation.
IMPRESSION:
As above
RECOMMENDATION(S): Consider advancing the NG tube approximately 7 cm for more
secure positioning.
|
10119910-RR-41 | 10,119,910 | 21,317,576 | RR | 41 | 2192-02-08 13:52:00 | 2192-02-08 14:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NGT placement 2 step// 2 step 2 step
IMPRESSION:
2 frontal radiographs of the chest show repositioning of the transesophageal
feeding tube with the wire stylet in place from the upper mediastinum to the
gastroesophageal junction. It needs to be advanced several cm to move all the
side ports into the stomach. Mild left lower lobe atelectasis has increased.
Lungs otherwise clear. There may be a very small right pleural effusion. No
pneumothorax. Heart size normal.
Right jugular line ends in the upper SVC.
|
10119910-RR-42 | 10,119,910 | 21,317,576 | RR | 42 | 2192-02-09 10:08:00 | 2192-02-09 16:41:00 | EXAMINATION: Duplex arterial ultrasound
INDICATION: ___ year old man with PAD with recent SFA-DP bypass.// Maintenance
graft duplex
TECHNIQUE: Grayscale ultrasound, color Doppler, and spectral Doppler
waveforms of the right lower extremity were obtained.
COMPARISON: None
FINDINGS:
Left:
Peak systolic velocities are as follows:
Superficial femoral artery: Waveform is triphasic. Peak systolic velocity is
159 cm/sec.
Proximal arterial anastomosis: Waveform is triphasic. Peak systolic velocity
is 90 cm/sec.
Proximal graft: Waveform is triphasic. Peak systolic velocity is 57 cm/sec.
Proximal/mid graft: Waveform is triphasic. Peak systolic velocity is 50
cm/sec.
Mid graft: Waveform is triphasic. Peak systolic velocity is 28 cm/sec.
Mid/distal graft: Waveform is triphasic. Peak systolic velocity is 44 cm/sec.
Distal graft: Waveform is triphasic. Peak systolic velocity is 61 cm/sec.
Distal arterial anastomosis: Waveform is triphasic. Peak systolic velocity is
82 cm/sec.
Dorsalis pedis artery: Waveform is triphasic. Peak systolic velocity is 126
cm/sec.
Of note, there is a complex fluid collection within the distal thigh, anterior
to the bypass graft measuring 4.1 x 4.3 x 15 cm. There is no color flow
demonstrated within the fluid collection.
IMPRESSION:
Patent SFA-DP bypass graft with waveforms and velocities as described above.
15 cm heterogeneous fluid collection within the distal thigh, anterior to the
bypass graft without internal vascularity.
|
10119910-RR-43 | 10,119,910 | 21,317,576 | RR | 43 | 2192-02-10 15:56:00 | 2192-02-10 16:20:00 | EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man with prolonged hospitalization now with
increasing left foot edema, decreased movement// Eval for fracture
TECHNIQUE: Three views, 4 radiographs
COMPARISON: None
FINDINGS:
There is extensive soft tissue swelling involving the foot most marked at the
dorsum of the forefoot. There is cortical contour interruption along the
distal tuft of distal phalanx of the second toe with ill definition of the
subjacent trabecula. No evidence of dislocation. Patchy demineralization in
the forefoot is seen. This could be due to disuse. There is vascular
calcification. Surgical clip projects over the anterior aspect of the ankle.
IMPRESSION:
Cortical discontinuity involving the distal tuft of distal phalanx of the
second toe with some apparent destruction of subjacent trabecula. Although
this could reflect a subacute fracture, osteomyelitis could have this
appearance in the appropriate clinical setting. Recommend clinical
correlation.
|
10119910-RR-45 | 10,119,910 | 21,317,576 | RR | 45 | 2192-02-12 13:36:00 | 2192-02-12 17:46:00 | EXAMINATION: MR FOOT ___ CONTRAST LEFT
INDICATION: ___ year old man with new L foot swelling and XR concerning for
osteo.// SHOULD ALSO BE DONE WITH CONTRAST. Evaluate for osteomyelitis.
TECHNIQUE: Multiplanar images of the foot were performed with and without the
administration of intravenous contrast using a mass/infection MR protocol. A
total of 7 cc of Gadavist was administered.
COMPARISON: Left foot radiographs performed on ___
FINDINGS:
In the second distal phalanx, there is marrow edema at the with corresponding
T1 hypointense signal. There is soft tissue enhancement in this region
postcontrast. This corresponds to the area of concern seen on the prior
radiograph performed on ___, and is concerning for osteomyelitis.
Notably, no adjacent ulcer is noted.
In the first distal phalanx, there is also suggestion of increased marrow
edema,, without corresponding T1 hypointense signal (series 6, image 15).
In the first metatarsal head, there is also hypointense T1 signal at the first
metatarsal head, without increased T2 signal or enhancement post-contrast.
This is of uncertain etiology or significance, but signal intensity and
pattern could reflect an unusual instance of osteonecrosis in this location.
There is patchy and somewhat serpiginous marrow signal in the visualized bones
of the midfoot, not fully evaluated on this examination. No frank bone
erosion or well-defined fracture line is identified. No dislocation.
Evaluation of the soft tissues is notable for diffuse intramuscular and
subcutaneous soft tissue enhancement throughout the imaged foot, which can be
seen in the setting of myositis and cellulitis. No focal fluid collection is
identified.
The imaged tendons are grossly unremarkable in appearance.
IMPRESSION:
1. T1 hypointense signal in the second distal phalanx with associated marrow
edema and enhancement, findings which can be seen in the setting osteomyelitis
if there is an associated ulcer. However, in the absence of a skin ulcer,
more likely differential considerations would include changes related to
gangrene, Raynaud's phenomenon, or trauma.
2. Of note, similar signal is seen in the distal phalanx of the first toe.
Multifocality makes osteomyelitis somewhat less likely unless it is
hematogenous spread.
3. Nonenhancing T1 hypointense marrow signal at the first metatarsal head.
This is of uncertain etiology or significance, but may reflect the unusual
instance of subchondral osteonecrosis in this location. No articular surface
collapse at the first metatarsal head is identified.
4. Unusual pattern of patchy and somewhat serpiginous marrow signal in the
visualized bones of the midfoot, not fully characterized. This is also of
uncertain etiology, question osteonecrosis or contusions. It is possible that
more complete MR imaging through the foot could help in further
characterization. No definite correlate on the radiographs is identified.
5. Pronounced intramuscular and soft tissue edema and enhancement, a
nonspecific finding. In the appropriate clinical setting, this can that can
be seen with myositis and cellulitis, but other etiologies are not excluded.
NOTIFICATION: The forefoot and soft tissue findings were discussed with
___, M.D. by ___, M.D. on the telephone on ___ at
5:35 pm, 5 minutes after discovery of the findings.
|
10119992-RR-62 | 10,119,992 | 21,252,040 | RR | 62 | 2151-08-12 02:48:00 | 2151-08-12 06:35:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with dyspnea. Evaluation for pneumonia,
pneumothorax or other acute abnormalities.
TECHNIQUE: Chest AP upright and lateral
COMPARISON: Comparison to multiple prior chest radiographs, most recently
from ___.
FINDINGS:
Median sternotomy wires remain intact and well aligned. Few surgical clips
are again seen in the mediastinum. Mildly enlarged cardiac silhouette is
unchanged. Low lung volumes contribute to crowding of bronchovascular
markings. Retrocardiac opacification most likely represents atelectasis,
however infection cannot be excluded in the appropriate clinical setting.
Likely small left pleural effusion. No pneumothorax is seen. Chronic
fractures along the lateral aspects of the right upper and middle ribs,
unchanged in appearance.
IMPRESSION:
1. Left lower lobe opacification most likely consistent with combination of
atelectasis and small effusion, however infection cannot be excluded in the
appropriate clinical setting.
2. Slightly diminished lung volumes with bibasilar atelectasis.
3. Chronic right-sided rib fractures.
|
10119992-RR-63 | 10,119,992 | 21,252,040 | RR | 63 | 2151-08-12 22:54:00 | 2151-08-13 10:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old patient of Dr. ___ with history of HFpEF, CAD s/p
CABG with LIMA-LAD, SVG-OM1, SVG-RPDA-PLV), AS s/p 23mm ___ AVR,
HTN, HIV on ART, CKD3, DM2, NASH cirrhosis here with mechanical fall c/b rib
fractures but reporting weeks of progressive dyspnea on exertion, fatigue, and
increased lower extremity edema found to have weight gain and elevated pro-BNP
all consistent with HF exacerbation.// evaluate for pulmonary edema
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
There remains median sternotomy, with 7 intact sternotomy wires, and CABG.
Cardiothoracic ratio remains enlarged.
There is progressed left retrocardiac/LLL opacity, with a moderate pleural
effusion. No superimposed pulmonary edema.
There remains multiple defects within the right upper to mid posterior ribs,
either representing sequela prior trauma/fractures, or thoracotomy changes.
IMPRESSION:
Progressed left lower lobe consolidation/atelectasis, with a moderate pleural
effusion. No superimposed pulmonary edema.
|
10119992-RR-64 | 10,119,992 | 21,252,040 | RR | 64 | 2151-08-12 23:34:00 | 2151-08-13 00:26:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with chf exacerbation, b/l ___ edema, now with
acute worsening of SOB, has bilateral calf tenderness. Evaluation for dvt.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Comparison to bilateral lower extremity ultrasound from ___.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10119992-RR-65 | 10,119,992 | 25,316,635 | RR | 65 | 2151-08-19 12:07:00 | 2151-08-19 14:21:00 | EXAMINATION: US RENAL ARTERY DOPPLER
INDICATION: ___ with new ___ artery stenosis, obstructive process
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON: Renal ultrasound dated ___ and abdominal ultrasound dated
___.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. The kidneys are
echogenic bilaterally with cortical thinning, compatible with chronic medical
renal disease.
Right kidney: 12.6 cm
Left kidney: 8.1 cm
Renal Doppler:
Limited renal Doppler evaluation. Intrarenal arteries show abnormal waveforms
with loss of diastolic flow bilaterally. The resistive indices are elevated
measuring up to 1.0 bilaterally. The peak systolic velocity on the right is
55.3 centimeters/second. The peak systolic velocity on the left is 23.4
centimeters/second. Main renal veins are patent bilaterally with normal
waveforms.
The bladder is moderately well distended. There is an echogenic structure
along the posterior aspect of the bladder, which may represent a bladder fold.
IMPRESSION:
1. Diffusely echogenic kidneys with cortical thinning and absence of diastolic
flow bilaterally, compatible with chronic medical renal disease.
2. No evidence of hydronephrosis.
3. Echogenic structure along the posterior aspect of the bladder, which may
represent a bladder fold. If macro or microhematuria is present, urology
consultation is recommended.
|
10119992-RR-66 | 10,119,992 | 25,316,635 | RR | 66 | 2151-08-19 18:25:00 | 2151-08-19 19:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ PMH of HFpEF (LVEF 62%), CAD s/p CABG ___ with
LIMA-LAD, SVG-OM1, SVG-RPDA-PLV), AS s/p 23mm ___ AVR (___), HIV
on HAART therapy (CD4 ___, CKD3 (baseline creatinine 2 to 2.5), DM type
II, NASH and HTN presents due to abnormal labs. Patient had recent admission
___ after a fall and found to have 3 rib fractures, found to be in HFpEF
exacerbation, presenting now due to elevated creatinine.// Pleural effusion,
vascular congestion, pulmonary edema
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Multiple right sided rib fractures are visualized. The size of the cardiac
silhouette is enlarged but unchanged. There is rightward deviation of the
upper trachea, unchanged, and could be secondary to patient positioning or
displacement by vascular structures. Retrocardiac opacities are again
visualized, somewhat decreased in density when compared to prior. There is no
pneumothorax or large pleural effusion however pulmonary vascular congestion
is new.
IMPRESSION:
New pulmonary vascular congestion. Retrocardiac opacities are re-demonstrated
but decreased in density. No large pleural effusion.
|
10119992-RR-67 | 10,119,992 | 25,316,635 | RR | 67 | 2151-08-21 22:03:00 | 2151-08-21 22:42:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ with dyspnea// Eval for volume overload or PNA
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 2.2 s, 35.2 cm; CTDIvol = 8.2 mGy (Body) DLP = 286.9
mGy-cm.
Total DLP (Body) = 287 mGy-cm.
COMPARISON: Chest radiographs ___, CT chest without contrast ___
FINDINGS:
Thyroid is unremarkable. Supraclavicular, axillary, and mediastinal lymph
nodes are not pathologically enlarged. Thoracic aorta and main pulmonary
artery are normal caliber. Prosthetic aortic valve is noted. Heart is
moderately enlarged. There is no pericardial effusion.
Bilateral pleural effusions are small to medium in size. Bilateral lower lobe
subsegmental airways are intermittently occluded. Moderate bilateral lower
lobe atelectasis is present. Mild ground-glass opacities in bilateral lungs
likely reflect mild pulmonary edema.
Limited evaluation upper abdomen notable for bilateral atrophic kidneys and
dysmorphic liver suggestive of hepatic fibrosis/cirrhosis. Subcentimeter
hypodensity in the upper pole right kidney is likely a hemorrhagic cyst.
No suspicious bone or soft tissue lesion is identified. Sternotomy wires are
intact. Bones are probably demineralized. Nondisplaced but a cute appearing
fractures involve the left seventh, eighth and ninth ribs. Right-sided rib
deformities are old.
IMPRESSION:
1. Mild bilateral ground-glass opacities likely reflect mild pulmonary edema.
Moderate bilateral lower lobe atelectasis and small to medium-sized bilateral
pleural effusions.
2. Severe acute appearing nondisplaced left lateral rib fractures.
3. Morphological abnormality of the liver suggesting fibrosis/cirrhosis.
|
10119992-RR-68 | 10,119,992 | 25,316,635 | RR | 68 | 2151-08-27 23:48:00 | 2151-08-28 09:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with shortness of breath.// Please evaluate for
pulmonary edema. Please evaluate for pulmonary edema.
IMPRESSION:
Heart size and mediastinum are stable. Cardiomegaly is unchanged. There is
interval progression of perihilar opacities consistent with progression of
pulmonary edema. Multiple right rib fractures are re-demonstrated. No
appreciable pneumothorax. Small bilateral pleural effusion.
|
10119992-RR-69 | 10,119,992 | 25,316,635 | RR | 69 | 2151-08-28 06:39:00 | 2151-08-28 10:58:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with ___ on CKD, hyperkalemia, CAD s/p CABG,
HFpEF// new dialysis line placement Contact name: ___: ___
new dialysis line placement
IMPRESSION:
Left internal jugular line tip is at the level of lower SVC. Heart size and
mediastinum are enlarged but stable. Left pleural effusion is large. There
is pulmonary edema, moderate.
|
10119992-RR-70 | 10,119,992 | 25,316,635 | RR | 70 | 2151-08-29 04:30:00 | 2151-08-29 09:58:00 | INDICATION: ___ year old man with CKD, HFpEF, now w/ bradycardia and
cardiogenic shock// evaluate hypoxemia
COMPARISON: Radiographs from ___
IMPRESSION:
Left-sided central venous catheter and mediastinal wires are unchanged. There
is evidence of prior thoracotomy with ununited rib deformities. There is
unchanged cardiomegaly. There is a left retrocardiac opacity. There is a
moderate left-sided pleural effusion. There has been improvement of the
pulmonary edema which is now mild. There are no pneumothoraces.
|
10119992-RR-71 | 10,119,992 | 20,137,492 | RR | 71 | 2151-09-12 02:03:00 | 2151-09-12 02:43:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with right lower extremity edema worse than left. Recent
hospitalization// Rule out DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
Atherosclerotic calcifications are seen along the left femoral artery
A complex 2.8 x 4.4 x 1.4 cm posterior popliteal cyst is seen.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. Complex 4.4 cm popliteal cyst.
|
10119992-RR-72 | 10,119,992 | 20,137,492 | RR | 72 | 2151-09-12 02:43:00 | 2151-09-12 03:53:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough, hypoxia// ?pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
Compared to the prior exam mild pulmonary edema has decreased. The moderate
left pleural effusion has similarly decreased. Retrocardiac atelectasis has
improved. No pneumothorax.
The cardiomediastinal silhouette is moderately enlarged, similar to prior.
Aortic knob calcifications are noted. The patient is status post median
sternotomy and CABG. There is evidence of prior right-sided rib fractures
There has been interval removal of a left internal jugular central line.
IMPRESSION:
Interval improvement in mild pulmonary edema and interval decrease in the left
pleural effusion, which is now small.
|
10119992-RR-73 | 10,119,992 | 20,137,492 | RR | 73 | 2151-09-12 03:36:00 | 2151-09-12 04:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with dyspnea// worsening resp status
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from 1 hour prior
FINDINGS:
Similar to the prior radiograph there is mild pulmonary edema and a small left
pleural effusion. Right basilar atelectasis has minimally increased. No
pneumothorax. The cardiomediastinal silhouette is unchanged. Midline
sternotomy wires appear intact. Aortic knob calcifications in mediastinal
surgical clips are again noted. Right-sided thoracotomy changes are seen.
IMPRESSION:
Mild pulmonary edema and small left pleural effusion, similar to prior.
Slight interval increase in right basilar atelectasis.
Multiple displaced right-sided rib fractures.
|
10120109-RR-20 | 10,120,109 | 22,197,111 | RR | 20 | 2171-04-25 16:57:00 | 2171-04-25 17:37:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with PE on CT // r/o dvts
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal respiratory variation in the common femoral veins bilaterally.
Within the left lower extremity, there is lack of compressibility of the
femoral vein just distal to the bifurcation which is extends to the popliteal
vein. Color Doppler interrogation demonstrates flow indicating a nonocclusive
thrombus. While of the peroneal veins are not definitely visualized, color
Doppler evaluation of the posterior tibial veins demonstrate occlusion.
Within the right lower extremity, the common, proximal femoral, mid and distal
femoral vein demonstrates normal compressibility and flow. There is a filling
defect within the popliteal vein as well as noncompressibility of the
popliteal vein most compatible with thrombus, nonocclusive. Color Doppler
interrogation demonstrates patent peroneal and posterior tibial veins.
IMPRESSION:
1. Left deep venous thrombus within the proximal femoral vein extending to
the popliteal vein, nonocclusive. Posterior tibial occlusive thrombus
identified.
2. Right popliteal deep venous non occlusive thrombus.
|
10120109-RR-34 | 10,120,109 | 27,687,066 | RR | 34 | 2174-10-13 13:05:00 | 2174-10-13 14:24:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with extensive smoking history and
hypercoagulability, weight loss// please assess for malignancy
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
Patient is status post median sternotomy. Heart size is normal. Mediastinal
and hilar contours are unremarkable. Pulmonary vasculature is not engorged.
Blunting of the right costophrenic angle may reflect chronic pleural
thickening or pleural fluid, similar to the prior exam. Lungs are clear
without focal consolidation. No pneumothorax is detect present ed. Lungs are
hyperinflated. No acute osseous abnormalities detected.
IMPRESSION:
Chronic blunting of the right costophrenic angle which could reflect chronic
pleural thickening or small pleural effusion. No evidence of intrathoracic
malignancy detected on chest radiograph, but please note that CT would be more
sensitive.
|
10120109-RR-35 | 10,120,109 | 27,687,066 | RR | 35 | 2174-10-14 10:34:00 | 2174-10-18 12:54:00 | Study arterial duplex lower extremity.
Reason prior graft
Findings. Duplex evaluations for left lower extremity arterial system the
common femoral and proximal superficial femoral arteries are patent. The
graft is occluded.
Impression occluded left superficial femoral artery to posterior tibial artery
bypass graft
|
10120330-RR-46 | 10,120,330 | 21,812,195 | RR | 46 | 2173-03-11 21:00:00 | 2173-03-11 23:09:00 | INDICATION: Right-sided pelvic pain. Evaluation for cyst or torsion.
TECHNIQUE: Pelvic ultrasound (non-obstetric).
COMPARISON: Pelvic ultrasound, ___.
FINDINGS: Transabdominal ultrasound demonstrates an enlarged uterus measuring
11.8 x 6.5 x 4.4 cm. Transvaginal ultrasound was performed for better
visualization of the ovaries and adnexa. The endometrial stripe is normal,
measuring 15 mm. 2.1 x 2.0 x 1.8 cm left-sided fibroid is noted. Scar from
prior C-section is noted. The right ovary is normal. The left ovary is not
visualized, but there is no abnormality seen in the adnexa. Again seen is a
prominent vessel in the right adnexa likely representing a slow flowing
vessel. There is trace free fluid.
IMPRESSION:
1. Left ovary not visualized. Normal right ovary.
2. Fibroid uterus.
|
10120372-RR-21 | 10,120,372 | 20,656,547 | RR | 21 | 2183-12-29 04:24:00 | 2183-12-29 05:24:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111
INDICATION: History: ___ with trauma// ?RP bleed ?rib fx ?pneumothorax ?c
spine fx ?head bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.8 cm; CTDIvol = 47.7 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass effect. There is prominence of the ventricles and sulci suggestive of
involutional changes.
There is no evidence of fracture. Mucous retention cyst within the left
maxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable. Degenerative changes are noted within the
right temporomandibular joint.
IMPRESSION:
1. No evidence of fracture or intracranial hemorrhage. No acute intracranial
abnormality on noncontrast head CT.
2. Age-related involutional changes.
|
10120372-RR-22 | 10,120,372 | 20,656,547 | RR | 22 | 2183-12-29 04:25:00 | 2183-12-29 05:34:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with trauma// ?RP bleed ?rib fx ?pneumothorax ?c
spine fx ?head bleed ?RP bleed ?rib fx ?pneumothorax ?c spine fx ?head
bleed
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 4.8 s, 19.0 cm; CTDIvol = 22.5 mGy (Body) DLP = 427.3
mGy-cm.
Total DLP (Body) = 427 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is anatomic.No acute fractures are identified.There is no
prevertebral soft tissue swelling.
Severe degenerative disc disease is seen at C7-T1. Milder degenerative disc
changes are seen at other cervical levels. Small posterior intervertebral
osteophytes cause mild narrowing of the spinal canal at multiple levels, most
prominent at C5-6. There is also mild-to-moderate multilevel neural foraminal
stenosis due to a combination of uncovertebral and facet osteophytes, most
prominent at C5-6 and C6-7 bilaterally, where it is moderate.
Pleuroparenchymal scarring within the bilateral lung apices. No cervical
lymphadenopathy. The thyroid is atrophic.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. Multilevel multifactorial degenerative changes, as described above.
3. Additional findings described above.
|
10120372-RR-23 | 10,120,372 | 20,656,547 | RR | 23 | 2183-12-29 04:26:00 | 2183-12-29 05:56:00 | EXAMINATION: CT chest, abdomen, and pelvis with IV contrast.
INDICATION: History: ___ with trauma// ?RP bleed ?rib fx ?pneumothorax ?c
spine fx ?head bleed
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: Total DLP (Body) = 1,478 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Minimal atherosclerotic calcifications of the thoracic
aorta. The thoracic aorta is normal in caliber without evidence of acute
injury. Note is made of a bovine arch, a normal variant. The main pulmonary
artery is enlarged measuring up to 3.4 cm, suggesting pulmonary arterial
hypertension. Otherwise, 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. There is a
large hiatal hernia containing the entirety of the stomach, the majority of
the pancreas, and portion of the splenic artery and vein.
PLEURAL SPACES: There is a small nonhemorrhagic left pleural effusion. No
right pleural effusion. No pneumothorax.
LUNGS/AIRWAYS: Mild atelectasis along the margins of the posterior mediastinum
bilaterally. Mild pleuroparenchymal scarring at the bilateral lung apices,
left greater right. No focal consolidations. Calcified granulomas within the
right lower lobe. No suspicious lung nodules requiring follow-up. The
airways are patent to the level of the segmental bronchi bilaterally. There
is a fat containing Bochdalek's hernia on the right.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: Geographic hypodensity adjacent to the falciform ligament
likely represents focal fatty deposition. Otherwise, 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 contains gallstones without wall thickening or
surrounding inflammation.
PANCREAS: The body and tail of the pancreas is contained within the large
hiatal hernia. Otherwise, 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 no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS:
Bladder is distended with fluid, but otherwise unremarkable in appearance.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable in appearance. There is a
small focus of air within the lower uterine segment. No adnexal masses are
visualized.
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.
Moderate atherosclerotic disease is noted. There is moderate stenosis at the
origin of the celiac and SMA.
BONES: Acute mildly displaced fracture of the left posterolateral seventh rib
(series 3, image 45). There are moderate compression deformities involving T6
through T8 and T11, which are indeterminate in age, but do not appear to be
acute. No suspicious osseous lesions.
SOFT TISSUES: Bilateral breast implants are visualized, which appear rim
calcified. There is a small fat containing umbilical hernia.
IMPRESSION:
1. Acute mildly displaced fracture of the left posterolateral seventh rib.
Moderate compression deformities of T6 through T8 and T11, which are
indeterminate in age, but do not appear acute. No other acute traumatic
abnormalities within the chest, abdomen, or pelvis.
2. Small nonhemorrhagic left pleural effusion.
3. Large hiatal hernia containing the stomach, the majority of the pancreas,
the splenic artery, and the splenic vein.
4. Cholelithiasis.
5. Moderate stenosis at origin of the celiac and SMA.
|
10120826-RR-22 | 10,120,826 | 27,121,829 | RR | 22 | 2185-02-20 01:51:00 | 2185-02-20 02:47:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with abdominal pain periumbilical
and RLQNO_PO contrast // Eval for appendicitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 5.0 s, 55.0 cm; CTDIvol = 15.5 mGy (Body) DLP = 850.4
mGy-cm.
Total DLP (Body) = 862 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver is homogeneously hypodense, consistent with hepatic
steatosis. There is no evidence of focal lesions. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The multiple perisplenic varices are noted, with evidence of a
splenorenal shunt. Spleen shows normal size and attenuation throughout,
without evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Multiple hypodense cysts are seen in the bilateral kidneys. The largest cyst
in the upper pole of the right kidney measures 6.2 x 5.6 cm. A smaller cyst
in the interpolar region of the right kidney measures 4.4 x 3.3 cm, and may
contain an enhancing internal septation, though evaluation is limited on this
examination (02:40). Multiple simple cysts are seen on the left as well. A
likely complex cyst is seen in the interpolar region of the left kidney as
well, measuring 4.7 x 3.8 cm, with a possibly enhancing internal septation as
well (02:35). There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable aside from a tiny hiatal hernia.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. The colon and rectum are within normal limits. The appendix is
prominent, measuring up to 9 mm in diameter, with possible, minimal hyperemia
of the wall. There is no surrounding fat stranding or fluid.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Multiple pretty therapy seeds are seen within the
prostate. The seminal vesicles are normal.
LYMPH NODES: A prominent portacaval lymph node is noted, measuring up to 1 cm
in short axis. There is no other definite retroperitoneal or mesenteric
lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: Multilevel degenerative changes are seen throughout the thoracolumbar
spine without vertebral body height loss or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Prominent appendix with possible hyperemic wall, without surrounding fat
stranding or fluid. These findings are worrisome for early appendicitis.
2. Complex bilateral renal cysts incompletely evaluated on this examination.
Further evaluation with dedicated ultrasound is recommended for better
evaluation.
|
10120826-RR-31 | 10,120,826 | 22,684,899 | RR | 31 | 2186-07-23 09:35:00 | 2186-07-23 12:04:00 | EXAMINATION: CT scan of the abdomen pelvis without and with intravenous
contrast
INDICATION: ___ year old man with gross hematuria// assess for upper tract
lesion/filling defect on delayed images
TECHNIQUE: CTU: Multidetector CT of the abdomen and pelvis were acquired
prior to and after intravenous contrast administration with the patient in
supine position. The non-contrast scan was done with low radiation dose
technique. The contrast scan was performed 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 9.3 s, 49.2 cm; CTDIvol = 4.1 mGy (Body) DLP = 202.2
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.6 mGy (Body) DLP = 1.9
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.2 cm; CTDIvol = 103.8 mGy (Body) DLP =
20.8 mGy-cm.
4) Spiral Acquisition 9.3 s, 49.5 cm; CTDIvol = 15.0 mGy (Body) DLP = 746.1
mGy-cm.
5) Spiral Acquisition 8.0 s, 42.3 cm; CTDIvol = 4.1 mGy (Body) DLP = 174.0
mGy-cm.
Total DLP (Body) = 1,145 mGy-cm.
COMPARISON: CT scan of the abdomen pelvis dated ___.
FINDINGS:
LOWER THORAX: The lung bases are clear. No pleural or pericardial effusion.
HEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.
Unremarkable gallbladder.
PANCREAS: Unremarkable.
SPLEEN: Unremarkable. No splenomegaly.
ADRENALS: Nonspecific thickening of the left adrenal gland without discrete
nodule. The right adrenal gland is unremarkable.
URINARY: There bilateral renal cortical cysts, largest measuring 66 mm arising
from the upper pole of the right kidney with one cyst containing a single hair
thin calcified septation (Bosniak 2). Additional subcentimeter hypodense
lesions are too small to characterize but also likely represent small cysts.
There is no hydronephrosis. There is suboptimal opacification of the distal
right ureter. However, no filling defect is identified to suggest a site of
upper tract urothelial carcinoma. The bladder is collapsed with a Foley
catheter in situ. High-density material is noted within the bladder lumen to
the left of the Foley catheter balloon (coronal series 12, image 64) which may
be in keeping with blood products given the history of gross hematuria. Gas
within the bladder lumen is likely post catheterization.
GASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are
normal in caliber. Scattered colonic diverticula. The appendix is prominent
in caliber measuring up to 9 mm without evidence of surrounding inflammatory
change.
REPRODUCTIVE ORGANS: Brachytherapy seeds are noted within the prostate.
LYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or
inguinal adenopathy.
PERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.
VASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic
calcification.
BONES: There is sclerosis and expansion involving the right eleventh rib
posteriorly (axial series 10, image 19), which is new from ___. There is
also sclerosis involving the right twelfth rib (axial series 10, image 48),
also new from previous. There is a sclerotic lesion within the left iliac
bone (axial series 10, image 114) which is also new from ___, though there
may be a vague lucent lesion in this region on the prior study. Additional
sclerotic lesions are noted within the T11 vertebral body and along the
posterior aspect of the L5 vertebral body. Intramedullary nail is noted
transfixing the left proximal femur.
SOFT TISSUES: Nonspecific stranding is noted within the subcutaneous tissues
of the lower anterior abdominal wall, left greater than right (axial series
10, image 81).
IMPRESSION:
1. Multiple new sclerotic osseous lesions are worrisome for metastatic
disease, particularly given history of prostatic carcinoma
2. No CT evidence of upper tract filling defect.
3. High-density nonenhancing material within the bladder lumen likely
represents blood products given the history of gross hematuria.
|
10120826-RR-34 | 10,120,826 | 23,274,807 | RR | 34 | 2188-03-23 20:16:00 | 2188-03-23 22:21:00 | EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE.
INDICATION: ** CODE CORD ** History: ___ with grad worsening back pain x 2
weeks, ___ days of BLE weakness, decreased rectal tone IV contrast to be given
at radiologist discretion as clinically needed // ? cord impingement?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: Chest CT dated ___, CT abdomen and pelvis dated ___.
FINDINGS:
CERVICAL:
Limited imaging of the cervical spine demonstrates numerous T1 hypointense
lesions which are incompletely characterized, including lesions in C2 and C4
(3:6).
THORACIC:
There is a levoconvex curvature of the thoracic spine and kyphosis centered at
T6. There is no spondylolisthesis. There is extensive bone marrow signal
abnormality throughout the thoracic spine, with T1 hypointense, water IDEAL
hyperintense lesion in nearly every single thoracic vertebral body. The T5,
T6, and T11 vertebral bodies demonstrate near complete marrow infiltration.
At the T6 level, an expansile lesion extends into the spinal canal and focally
compresses the spinal cord (7:27, 4:12). Tumor also extends into the T6-7
right greater than left neural foramina. Overall, this has progressed since
the CT chest from ___, given differences in imaging technique.
There is central T2/STIR hyperintensity at this level, as well as mild central
cord water IDEAL hyperintensity extending to approximately the T10 level. The
osseous lesions otherwise do not encroach on the spinal canal. With the
exception of T6-7, there is no neural foraminal narrowing.
LUMBAR:
Alignment is normal. Numerous T1 hypointense, water IDEAL hyperintense
lesions are demonstrated throughout the lumbar spine, with the largest lesions
in the right lateral L1 vertebral body and pedicle, L3 spinous process, near
complete infiltration of the L4 vertebral body, and numerous lesions
throughout the L5 vertebral body and imaged sacrum. These lesions appear new
compared to ___. None of these osseous lesions encroach on the
spinal canal.
The terminal spinal cord is normal in caliber and configuration, encourage
medullaris terminates at L1.
At T12-L1, there is facet degenerative change and ligamentum flavum thickening
without spinal canal or neural foraminal narrowing.
At L1-2, there is diffuse disc bulge, ligamentum flavum thickening and facet
degenerative change contributing to mild spinal canal narrowing. No neural
foraminal narrowing.
At L2-3, there is diffuse disc bulge, ligamentum flavum thickening and facet
degenerative change contributing to mild spinal canal narrowing. Both lateral
recesses are narrowed with probable contact of the traversing nerve roots.
There is mild bilateral neural foraminal narrowing.
At L3-4, there is diffuse disc bulge, ligamentum flavum thickening, facet
degenerative change and prominent epidural fat contributing to moderate spinal
canal narrowing. The lateral recesses are narrowed with contact of the
traversing nerve roots. There is mild bilateral neural foraminal narrowing.
At L4-5, there is diffuse disc bulge, ligamentum flavum thickening, facet
degenerative change and prominent epidural fat contributing to moderate to
severe spinal canal narrowing. There is also moderate bilateral neural
foraminal narrowing.
At L5-S1, prominent epidural fat and facet degenerative change contributes to
moderate spinal canal narrowing. There is severe right and moderate to severe
left neural foraminal narrowing.
OTHER: Numerous rib lesions are also noted. There are numerous bilateral T2
hyperintense renal cysts.
IMPRESSION:
1. Expansile osseous lesion involving the anterior and posterior T6 vertebral
body extends into the spinal canal and focally compresses the spinal cord with
central T2/water IDEAL hyperintensity which extends in the central cord to the
T10 level.
2. Metastatic lesions in the lumbar spine and sacrum appear new compared ___. None of these lesions encroach on the spinal canal.
3. There are multilevel degenerative changes of the lumbar spine, with
moderate to severe spinal canal narrowing at L4-5.
4. Limited imaging of the cervical spine demonstrates T1 hypointense lesions
in the C2 and C4 vertebral bodies, suspicious for metastases.
5. Numerous bilateral rib lesions, compatible with metastases.
PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects
without low back pain:
Overall evidence of disk degeneration 91% (decreased T2 signal, height loss,
bulge)
T2 signal loss 83%
Disk height loss 58%
Disk protrusion 32%
Annular fissure 38%
Jarvik, et all. Spine ___ 26(10):1158-1166
Lumbar spinal stenosis prevalence- present in approximately 20% of
asymptomatic adults over ___ years old
___, et al, Spine Journal ___ 9 (7):545-550
These findings are so common in asymptomatic persons that they must be
interpreted with caution and in context of the clinical situation.
NOTIFICATION: The neuro surgical team (Brown, ___, PA. ___,
___, MD.), was aware of the findings at the time of this interpretation.
|
10121003-RR-22 | 10,121,003 | 23,255,269 | RR | 22 | 2155-10-23 16:39:00 | 2155-10-23 16:58:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with cough, elevated lactate // evidence of pneumonia
COMPARISON: ___.
FINDINGS:
AP upright and lateral views of the chest provided. A calcified granuloma is
again seen projecting over the right mid lung. There is no focal
consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. Chronic left ribcage deformities are unchanged. Severe right
glenohumeral joint disease is noted. No free air below the right
hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10121003-RR-23 | 10,121,003 | 23,255,269 | RR | 23 | 2155-10-24 11:29:00 | 2155-10-24 14:20:00 | INDICATION: Cough and diarrhea with a history of C diff colitis now with
elevated lactate. Rule out megacolon.
TECHNIQUE: Frontal and left lateral decubitus views of the abdomen.
COMPARISON: CT pelvis ___.
FINDINGS:
There is a normal-appearing bowel gas pattern. There are no dilated loops of
small bowel or air-fluid levels. The colon appears normal caliber. There is
air within the rectum. There is no free air.
Bilateral hip prostheses are grossly unremarkable and there are moderate
degenerative changes of the lower lumbar spine. Chronic appearing left-sided
rib fractures are present. Intra-abdominal clips are noted. The included lung
bases are grossly unremarkable.
IMPRESSION:
No evidence of megacolon.
|
10121003-RR-24 | 10,121,003 | 23,255,269 | RR | 24 | 2155-10-24 11:29:00 | 2155-10-24 16:40:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with cough and diarrhea // eval for infiltrate
after IVF
TECHNIQUE: PA and lateral view radiographs of the chest.
COMPARISON: Prior chest radiographs dating back ___.
FINDINGS:
There is a 6 mm granuloma in the right midlung zone, which is unchanged dating
back as far as ___. The aorta is tortuous, and the heart size is top-normal.
There are chronic well healed rib fractures of posterior ribs 5 through 7.
There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary
edema.
IMPRESSION:
1. No evidence of acute cardiopulmonary process.
2. Top-normal heart size.
|
10121003-RR-25 | 10,121,003 | 23,255,269 | RR | 25 | 2155-10-25 09:52:00 | 2155-10-25 12:06:00 | EXAMINATION: Video oropharyngeal swallow study.
INDICATION: A ___ inpatient, clinical concern for ongoing aspiration.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: No prior examinations available for comparison.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was marked difficulty in initiating oropharyngeal swallow.
There was laryngeal penetration seen with honey-thick liquids. There was
aspiration of nectar-thick and thin liquids. There was increased residual
contrast material seen in the valleculae after attempted swallows, indicative
of some degree of pharyngeal stasis.
IMPRESSION:
1. Laryngeal penetration with honey-thick liquids.
2. Aspiration of nectar-thick and thin liquids.
3. Pharyngeal stasis.
4. Difficulty initiating swallow.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10121003-RR-26 | 10,121,003 | 23,255,269 | RR | 26 | 2155-10-27 16:58:00 | 2155-10-27 19:23:00 | INDICATION: ___ year old man with ESBL UTI // PICC placed by ___ nurse short
and couldn't be advanced, please advance to proper position; discharge is
pending PICC placement!!!
COMPARISON: Comparison is made to chest radiograph performed ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed the procedure. Dr.
___ radiologist, personally supervised the trainee during the
key components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 5 min 7 sec, 7 mGy
PROCEDURE:
1. Failed attempted repositioning of left arm PICC.
2. Single lumen PICC placement through the basilic vein on the right.
PROCEDURE DETAILS:
Using sterile technique, a Nitinol wire was advanced through the indwelling
left arm approach PICC, but could not be advanced centrally. The wire was
withdrawn, and an injection to contrast demonstrated opacification cof
ollaterals veins but no opacification of the subclavian vein. The access point
was abandoned, and attention was turned to the right arm.
Using sterile technique and local anesthesia, the basilic vein on the right
was punctured under direct ultrasound guidance using a micropuncture set.
Permanent ultrasound images were obtained before and after intravenous access,
which confirmed vein patency. A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava using
fluoroscopic guidance. A single lumen PIC line measuring cm in length was
then placed through the peel-away sheath with its tip positioned in the distal
SVC under fluoroscopic guidance. Position of the catheter was confirmed by a
fluoroscopic spot film of the chest. The peel-away sheath and guidewire were
then removed. The catheter was secured to the skin, flushed, and a sterile
dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Left central stenosis, unable to advance a left PICC
2. The accessed vein was patent and compressible.
3. Basilicvein approach single lumen right PICC with tip in the distal SVC.
IMPRESSION:
Successful placement of a right 46 cm basilic approach single lumen PowerPICC
with tip in the distal SVC. The line is ready to use.
|
10121316-RR-26 | 10,121,316 | 20,600,733 | RR | 26 | 2156-09-26 06:55:00 | 2156-09-26 07:38:00 | EXAMINATION: Chest radiograph
INDICATION: ___ woman with fever
TECHNIQUE: AP and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Cardiomediastinal silhouette grossly unchanged. Lung volumes are low with
increased bibasilar lung opacity. There is no pneumothorax or large pleural
effusion.
IMPRESSION:
Bibasilar lung opacity, concerning for pneumonia in the correct clinical
setting.
|
10121316-RR-27 | 10,121,316 | 20,600,733 | RR | 27 | 2156-09-26 07:12:00 | 2156-09-26 07:46:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ woman with swelling, erythema of the left leg,
evaluate for deep vein thrombosis
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.
|
10121316-RR-28 | 10,121,316 | 20,600,733 | RR | 28 | 2156-09-26 09:35:00 | 2156-09-27 22:32:00 | EXAMINATION: ART DUP EXT LO UNI;F/U LEFT
INDICATION: ___ year old woman with LLE edema and pain, s/p LLE bypass graft
// Eval for arterial graft occlusion/function
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the -.
COMPARISON: None
FINDINGS:
Grayscale and color Doppler images of the left lower extremity were obtained.
The right iliac to profunda artery bypass graft is patent. There is no flow
in the proximal and mid native superficial femoral artery and posterior tibial
artery. Peroneal artery is and dorsalis pedis arteries are patent with low
amplitude flow. There is monophasic flow throughout the remainder of the
arterial vasculature. Focally increased velocities are noted at the proximal
anastomosis from 77 cm/sec up to 294 cm/sec.
IMPRESSION:
Patent left iliac to profunda artery bypass graft.
|
10121316-RR-30 | 10,121,316 | 20,600,733 | RR | 30 | 2156-09-26 22:38:00 | 2156-09-27 00:40:00 | EXAMINATION: CT left lower extremity with contrast
INDICATION: ___ year old woman with LLE swelling and severe tenderness, s/p
recent external iliac to profunda bypass, iliac stenting. // Is there e/o
free air or abscess?
TECHNIQUE: ___ MD CT imaging was performed from the diaphragm to the toes
following intravenous contrast. Coronal and sagittal reformats were produced
and reviewed. Please note, this study was not performed as a CT angiogram
DOSE: Radiation: 2774.36 mGy-cm
Contrast: 100 cc Omnipaque
COMPARISON: Arterial Doppler performed on the same date
FINDINGS:
This study was not performed as a CT angiogram and evaluation of the
vasculature is therefore limited. There is extensive atherosclerotic
calcification in the abdominal aorta. There is a left external iliac stent
in-situ. This appears to be patent. The surgical anastomosis from the
external iliac artery to the profunda femoris is not well visualized on the
current study but appears patent with distal runoff. Patency of both the
iliac stent and arterial anastomosis in better demonstrated on the concurrent
ultrasound. There is moderately extensive atherosclerotic calcification in
the (superficial) femoral artery. Portions of the femoral artery are
non-opacified consistent with occlusion. The popliteal artery appears to be
reconstituted via the deep femoral artery. There is at least 2 vessel runoff
at the ankle.
There is atelectasis at the visualized portions of the bilateral lung bases.
The spleen is not enlarged. Visualized portions of the liver are unremarkable
in appearance. The portal vein is patent. A small focus of calcification
within the pancreas appears to be vascular (03:25). Visualized portions of
the pancreas are otherwise unremarkable in appearance. There is a large
periampullary diverticulum (301b:7). The bilateral adrenal glands are
unremarkable in appearance. The left kidney is not enlarged. No
hydronephrosis. There are multiple hypo enhancing lesions in the left kidney.
The largest is a 1.5 cm lesion in the lower pole with Hounsfield units
consistent with a cyst. A 1.4 cm lesion in the interpolar region has
indeterminate ___ unit measurements. This could be further evaluated
with a non urgent ultrasound. There is extensive colonic diverticulosis
without evidence of diverticulitis. No free fluid in the visualized portions
of the abdomen or pelvis. The uterus is enlarged and heterogenous appearance
with areas of coarse calcification consistent with a fibroid uterus. The
urinary bladder is decompressed with a Foley catheter in-situ.
There are small left external iliac nodes measuring up to 7 mm in short axis
(03:11 4). Small retroperitoneal nodes measure up to 7 mm (03:58). No lymph
nodes meet the CT size criteria for pathologic enlargement. There is abnormal
stranding and soft tissue attenuation material seen adjacent to the surgical
anastomosis in the left inguinal region. This is nonspecific in appearance
and may be related to the prior surgery. Superimposed infection cannot be
excluded. There is no rim enhancing fluid collection seen. There is diffuse
subcutaneous edema in the left lower extremity. Trace left knee effusion.
Mild fatty atrophy of the calf muscles.
There are dystrophic calcifications along the plantar aspect of the left foot,
unchanged in appearance when compared to the prior radiographs. Degenerative
changes in the lumbar spine. No subcutaneous air seen.
IMPRESSION:
1. Evaluation of the vasculature is somewhat limited on this non angiographic
study. The external iliac stent appears to be patent. The external iliac to
profunda femoral is anastomosis appears patent. These structures are better
evaluated on the concurrent ultrasound.
2. Extensive atherosclerotic calcification in all visualized vessels with
probable occlusion of the femoral artery (superficial femoral).
3. Abnormal soft tissue attenuation material at the level of the surgical
anastomosis and extending more inferiorly. This is nonspecific in appearance
and may be related to prior surgery. Superimposed infection cannot be
excluded. No rim enhancing fluid collection seen. No subcutaneous air seen.
4. Indeterminate left renal lesion measuring 1.4 cm, recommend further
evaluation with non urgent ultrasound.
5. Colonic diverticulosis without evidence of diverticulitis.
6. Fibroid uterus
7. Small retroperitoneal and left external iliac nodes do not meet the CT size
criteria for pathologic enlargement.
8. Small left knee effusion
9. Dystrophic calcifications in the plantar aspect of the left foot.
|
10121316-RR-31 | 10,121,316 | 20,600,733 | RR | 31 | 2156-09-27 13:03:00 | 2156-09-27 22:26:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old woman with LLE erythema, PAD, leg pain, fever //
Please measure PVR and ABI
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with Doppler signal recordings, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: Arterial duplex ___
FINDINGS:
On the right side, triphasic Doppler waveforms were seen at the right femoral
and popliteal arteries with more biphasic waveforms in the posterior tibial
and dorsalis pedis arteries. The right ABI is 1.13 at rest.
On the left side, triphasic Doppler waveforms were seen in the femoral artery
however more monophasic waveforms are identified in the femoral, popliteal,
posterior tibial and dorsalis pedis. The left ABI is 0.44 at rest.
Pulse volume recordings showed decreased amplitude in the left ankle and
metatarsal.
IMPRESSION:
Normal right resting ankle brachial index with moderate severely decreased
left resting ankle brachial index. Given the appearance of the waveforms,
there may be a high-grade stenosis or occlusion at the level of the SFA.
|
10121316-RR-32 | 10,121,316 | 20,600,733 | RR | 32 | 2156-09-28 15:03:00 | 2156-09-28 16:06:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ w/PMHx PVD, HTN, DM and CLL transfer from ___ who presents
with fever, erythematous, painful, swollen LLE concerning for cellulitis.
Patient with facial droop // Please evaluate for stroke.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.2 s, 14.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
742.0 mGy-cm.
Total DLP (Head) = 742 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass.
Periventricular hypodensities are nonspecific but likely represent sequela of
chronic small vessel ischemic disease. The ventricles and sulci are normal in
size and configuration.
There is no evidence of fracture. Moderate mucosal thickening is noted in the
visualized paranasal sinuses. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
|
10121316-RR-33 | 10,121,316 | 20,600,733 | RR | 33 | 2156-09-30 18:48:00 | 2156-09-30 22:23:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with PVD, HTN, CLL p/w sepsis and erythematous,
painful LLE concerning for cellulitis // Previous xray with bibasilar
opacity. Please reevaluate for interval changes. Atelectasis vs pna
Previous xray with bibasilar opacity. Please reevaluate for interval changes.
Atelectasis vs pna
IMPRESSION:
Comparison to ___. Mild increase in extent and severity of the
bilateral basal parenchymal opacities, accompanied by a minimal pleural
effusions. Mild fluid overload is stable. Moderate cardiomegaly is
unchanged.
|
10121316-RR-35 | 10,121,316 | 20,600,733 | RR | 35 | 2156-09-30 23:32:00 | 2156-10-01 08:09:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with PVD, CLL, cellulitis and persistent fevers
// R IJ line placement Contact name: ___: ___ R IJ line
placement
IMPRESSION:
Comparison to ___. The patient has received a right internal jugular
vein catheter. The tip projects over the cavoatrial junction. No
complications, notably no pneumothorax. Decrease in extent of the
pre-existing parenchymal opacities. Minimal bilateral pleural effusions might
be present.
|
10121316-RR-36 | 10,121,316 | 20,600,733 | RR | 36 | 2156-10-01 07:02:00 | 2156-10-01 11:51:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with CLL, persistent fevers to 102 despite
broad spectrum antibiotics // pneumonia, effusion with tappable pocket
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
administration of intravenous contrast material, multiplanar reconstructions.
DOSE: DLP: 562 mGy-cm
COMPARISON: No comparison.
FINDINGS:
No incidental thyroid findings. Borderline diameter and mild enlargement of
right axillary lymph nodes (2, 13). Borderline sized mediastinal lymph nodes.
Moderate aortic wall calcifications, moderate to severe coronary
calcifications, moderate cardiomegaly, moderate bilateral pleural effusions.
No pericardial effusions. No osteolytic lesions at the level of the ribs, the
sternum or the vertebral bodies. Mild degenerative vertebral disease. No
vertebral compression fractures. The lung parenchyma shows motion. In
addition, predominantly perihilar ground-glass opacities are noted. In the
lower lobes, peribronchial vascular areas of consolidations are seen. Very
enhancement pattern is suggestive of atelectasis rather than pneumonia. No
suspicious lung nodules or masses. Mild apical centrilobular pulmonary
emphysema.
IMPRESSION:
Areas of mild atelectasis bilaterally, small bilateral pleural effusions
without specific predominance an without radiologic need for tapping. Diffuse
ground-glass opacities, although partly caused by motion, could also reflect
developing pneumonia. Aortic wall and coronary calcifications.
|
10121316-RR-37 | 10,121,316 | 20,600,733 | RR | 37 | 2156-10-01 19:36:00 | 2156-10-01 21:46:00 | INDICATION: ___ year old woman with falling H/H. Large right thigh, thought to
be due to infection. Concern for RP bleed, sheath bleed. // Please extend
windows through the lower thigh, as looking for thigh bleed in addition to
RP/sheath/back bleeding.
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 6.3 s, 69.0 cm; CTDIvol = 14.1 mGy (Body) DLP = 972.1
mGy-cm.
2) Spiral Acquisition 1.0 s, 11.0 cm; CTDIvol = 5.1 mGy (Body) DLP = 56.2
mGy-cm.
3) Spiral Acquisition 1.0 s, 11.0 cm; CTDIvol = 4.9 mGy (Body) DLP = 54.0
mGy-cm.
Total DLP (Body) = 1,082 mGy-cm.
COMPARISON: CT of lower extremity dated ___
FINDINGS:
LOWER CHEST: There are small bilateral low-density pleural effusions, and
adjacent bibasilar atelectasis. Imaged portion of heart and pericardium ir
notable for coronary artery calcifications. A central venous access catheter
terminates in right atrium.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains a couple of punctate hyperdense foci
most compatible with stones without evidence of wall edema or surrounding
stranding.
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: Borderline enlarged, measuring 13.5 cm.
ADRENALS: A 1 cm nodule in the right adrenal gland is of intermediate,
indeterminate density. No left adrenal nodule identified although the adrenal
gland appears mildly thickened.
URINARY: The kidneys are of normal and symmetric size. A small amount of
excreted contrast is seen within the collecting systems bilaterally consistent
with residua of prior administration. Multiple hypo attenuating renal lesions
contain internal fluid density most suggestive of cysts though not fully
characterized on a noncontrast CT. There is no hydronephrosis. There is no
nephrolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: Small axial hiatal hernia. Stomach appears otherwise
unremarkable. Small bowel loops demonstrate normal caliber and wall thickness
throughout. There is colonic diverticulosis without evidence of inflammatory
change. Rectum appears unremarkable. The appendix is normal.
PELVIS: Bladder contains air, suggestive of recent Foley catheter placement,
as well as excreted contrast from prior administration. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is enlarged with multiple calcified fibroids.
No adnexal masses are appreciated.
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. There is no retroperitoneal or evidence of intraperitoneal
hematoma. Stranding in the left groin surrounding the access site might
represent interspersed hematoma, but no organized collection is identified in
the left groin or proximal left thigh. There is additional stranding deep to
a surgical incision in the left thigh medially. Diffuse subcutaneous
edema/stranding is seen in the imaged portion of the proximal left thigh
circumferentially. The left external iliac artery contains a stent.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Marked multilevel degenerate changes of the thoracic and lumbar spine.
SOFT TISSUES: There are 2 fat containing hernias just inferior to the
umbilicus.
IMPRESSION:
1. No evidence of retroperitoneal, or intraperitoneal hematoma.
2. Diffuse subcutaneous stranding throughout the proximal left thigh as well
as stranding at the left inguinal region, presumably representing the vascular
access site. These findings may represent a combination of interspersed
hematoma and/or edema. However, no organized hematoma is identified. Please
note, the clinical indication for this study indicates that swelling of the
right thigh is present, although by CT the left thigh appears to be larger in
caliber and shows postprocedural changes at the groin. No hematoma is
visualized in the proximal right thigh.
3. Indeterminate 1 cm right adrenal nodule.
4. Additional incidental findings include small bilateral pleural effusions,
cholelithiasis without evidence of cholecystitis, bilateral hypodense renal
lesions containing fluid density, most likely representing cysts, and multiple
calcified fibroids.
|
10121316-RR-38 | 10,121,316 | 20,600,733 | RR | 38 | 2156-10-02 15:09:00 | 2156-10-02 16:06:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC R IJCCL // 42 cm R brachial
DL PICC - ___ ___ Contact name: ___: ___ cm R brachial
DL PICC - ___ ___
IMPRESSION:
Heart size and mediastinum appear to be mildly enlarged, unchanged since the
prior study. Small bilateral pleural effusion is better demonstrated on the
recent chest CT. Bibasal opacities are stable.
Right PICC line tip is at the cavoatrial junction. Right internal jugular
line tip is at the cavoatrial junction.
|
10121316-RR-39 | 10,121,316 | 20,600,733 | RR | 39 | 2156-10-06 14:30:00 | 2156-10-06 15:44:00 | EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) SOFT TISSUE LEFT
INDICATION: ___ w/PMHx PVD, HTN, DM and CLL transfer from ___ who presents
with fever, erythematous, painful, swollen LLE concerning for LLE cellulitis,
on cefepime // L shoulder/arm pain x1 day. Please evaluate for fracture,
dislocation L shoulder/arm pain x1 day. Please evaluate for fracture,
dislocation
IMPRESSION:
The AC joint is well maintained, though there are substantial degenerative
changes in the glenohumeral joint. No evidence of acute fracture or
dislocation, though if this is a serious clinical concern cross-sectional
imaging could be obtained. Some irregularity of the superolateral aspect of
the humeral head could be a reflection of previous episodes of dislocation.
|
10121316-RR-40 | 10,121,316 | 20,600,733 | RR | 40 | 2156-10-06 14:30:00 | 2156-10-06 15:34:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with pvd, CLL. P/w LLE cellulitis on cefepime,
now w/ new fever after being afebrile >48 hr // new fever. Please evaluate
for pna. Please take with shoulder X-ray new fever. Please evaluate for
pna. Please take with shoulder X-ray
IMPRESSION:
In comparison with the study of ___, there again are low lung volumes that
accentuate the transverse diameter of the heart. There has been the
development of moderate pulmonary edema with bilateral basilar opacifications
consistent with layering effusions and compressive atelectasis. The given the
extensive pulmonary changes, in the appropriate clinical setting it would be
difficult to exclude a superimposed infection, especially in the absence of a
lateral view.
The right jugular catheter has been removed. The remaining right PICC line
now has its tip within the right atrium.
|
10121316-RR-41 | 10,121,316 | 20,600,733 | RR | 41 | 2156-10-07 01:13:00 | 2156-10-07 01:51:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with CLL, LLE cellulitis, therapeutic INR on
warfarin now with altered mental status, responding to commands. // Brain
hemorrhage/stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations were generated and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 7.0 s, 14.5 cm; CTDIvol = 48.6 mGy (Head) DLP =
702.4 mGy-cm.
Total DLP (Head) = 702 mGy-cm.
COMPARISON: CT head dated ___
FINDINGS:
There is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci
likely relate to age related volume loss. Periventricular and deep white
matter hypodensities are nonspecific, probably sequela of chronic small vessel
ischemic disease. Gray-white matter differentiation is preserved. Basal
cisterns are patent. There is no shift of normally midline structures.
The orbits are unremarkable. Imaged paranasal sinuses demonstrate moderate
mucosal thickening within the left sphenoid sinus and posterior left ethmoidal
air cells. There are no air-fluid levels. Partial opacification of bilateral
mastoid air cells may reflect long-standing supine position. Middle ear
cavities are clear. Note is made of heavily calcified bilateral carotid
siphons.
IMPRESSION:
No acute intracranial abnormality. Chronic changes as described above.
|
10121316-RR-42 | 10,121,316 | 20,600,733 | RR | 42 | 2156-10-13 07:04:00 | 2156-10-13 09:47:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypogammaglobulinemia, CLL, fever // r/o
pulm infectious source
IMPRESSION:
In comparison to ___, lung volumes have improved, and previously
reported pulmonary edema has resolved. Nonspecific bibasilar opacities have
also substantially improved. No localized new or worsening opacities are
identified to suggest a new source of infection.
|
10121316-RR-45 | 10,121,316 | 20,600,733 | RR | 45 | 2156-10-14 01:50:00 | 2156-10-14 02:37:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ year old woman with CLL, UTI, supratherapeutic INR now with
left facial droop and decreased responsiveness.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.6 s, 14.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
785.0 mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 32.7 mGy (Head) DLP =
16.3 mGy-cm.
3) Spiral Acquisition 4.3 s, 33.9 cm; CTDIvol = 31.8 mGy (Head) DLP =
1,078.2 mGy-cm.
Total DLP (Head) = 1,880 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute intracranial hemorrhage, mass, mass effect or
large territorial infarction. Prominence of the ventricles and sulci is
likely related to age related involutional changes. Periventricular deep
subcortical white matter hypodensities are likely related to chronic small
vessel ischemic disease. The basilar cisterns are patent, there is otherwise
good preservation gray-white matter differentiation.
No acute fracture is identified. Mild mucosal thickening is seen involving
the left maxillary sinus. The mastoid air cells, and middle ear cavities are
clear. The orbits are notable for bilateral lens replacement.
CTA HEAD:
Extensive calcifications are seen along the cavernous portion of the carotids
bilaterally. Irregularity of the M1 segments of the MCAs bilaterally likely
secondary to intracranial sclerotic disease. There is a left fetal type PCA.
The right posterior communicating artery is visualized. The anterior
communicating artery is visualized. The left vertebral artery terminates in a
left height. The right vertebral artery is dominant. No evidence aneurysm.
The dural venous sinuses are patent.
CTA NECK:
The carotid and vertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria. Extensive atherosclerotic disease is seen along
the aortic arch.
OTHER:
Aside from mild centrilobular emphysema, the visualized apices of lungs are
clear. Incidental 4 mm hypodense nodule seen within left thyroid gland. There
is no lymphadenopathy by CT size criteria. Multilevel, multifactorial
degenerative changes are visualized throughout the cervical spine, consistent
with anterior and posterior spondylosis, more severe from C3/C4 through C6/C7
levels.
IMPRESSION:
1. No acute intracranial abnormalities identified. Chronic microangiopathy.
2. Extensive intracranial atherosclerotic disease. No evidence of an
aneurysm.
3. Patent vessels of the head neck.
4. Incidental thyroid nodules measuring up to 5 mm.
|
10121316-RR-46 | 10,121,316 | 20,600,733 | RR | 46 | 2156-10-14 12:31:00 | 2156-10-14 18:15:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with CLL, supratherapeutic INR, new mental
status changes and previous seizure-like episode // Question of seizure like
activity and possible stroke
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 5 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ noncontrast head CT.
FINDINGS:
Study is moderately degraded by motion. There is no evidence of hemorrhage,
edema, masses, mass effect, midline shift or infarction. Confluent
periventricular and scattered subcortical white matter T2 and FLAIR
hyperintensities are nonspecific, but most likely represent sequelae of
chronic small vessel ischemic disease. There is prominence of the ventricles
and sulci suggestive involutional changes. There is no abnormal enhancement
after contrast administration. Mild bilateral maxillary sinus mucosal
thickening. Otherwise the visualized portions of the paranasal sinuses,
middle ear cavities and mastoid air cells appear clear.
IMPRESSION:
1. Study is moderately degraded by motion.
2. No evidence of infarction, hemorrhage, mass or edema.
3. Mild global cerebral atrophy and evidence of chronic small vessel ischemic
disease.
4. Mild bilateral maxillary sinus mucosal thickening.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 5:50 ___.
|
10121316-RR-49 | 10,121,316 | 20,600,733 | RR | 49 | 2156-10-14 14:20:00 | 2156-10-14 17:05:00 | EXAMINATION: CTA runoff of aorta, iliacs, and bifem
INDICATION: ___ year old woman with hx left external iliac artery to profunda
femoral artery bypass graft with iliac stenting, now w new fevers and severe L
foot pain // evaluate for graft patency (LLE)
TECHNIQUE: Run off CTA: Non-contrast images and arterial phase images were
acquired from base of neck through toes. Delayed images were obtained from the
knees to the toes.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS
DOSE: Acquisition sequence:
1) Spiral Acquisition 13.3 s, 146.0 cm; CTDIvol = 3.1 mGy (Body) DLP =
445.3 mGy-cm.
2) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
3) Spiral Acquisition 18.6 s, 146.7 cm; CTDIvol = 13.1 mGy (Body) DLP =
1,923.3 mGy-cm.
4) Spiral Acquisition 8.7 s, 68.6 cm; CTDIvol = 6.3 mGy (Body) DLP = 428.6
mGy-cm.
Total DLP (Body) = 2,803 mGy-cm.
COMPARISON: CTA head and neck ___ CT abdomen pelvis without
contrast ___
FINDINGS:
VASCULATURE:
There is complete occlusion of the left superficial femoral artery
reconstitution of the popliteal artery and several collaterals as well as
multifocal occlusive disease in the bilateral anterior tibial arteries with
reconstituted dorsalis pedis arteries bilaterally. There is mild to moderate
narrowing at the branching of the profunda femoris, at the distal tip of the
external iliac to profunda bypass graft.
There is asymmetric subcutaneous fat stranding and edema in the left lower
extremity throughout.
Abdominal aorta:Patent
-Celiac axis: Patent
-SMA: Patent
-___: Patent
-Renal arteries: Left, Patent; right, Patent
-Left common iliac: Patent
-Right common iliac: Patent
-Left external iliac: Patent with stent
-Right external iliac: Patent
-Left internal iliac: Patent
-Right internal iliac: Patent
CTA run-off RLE:
-Common femoral artery: Extensive non occlusive disease and is patent
-Superficial femoral artery: Patent
-Deep femoral artery: Patent
-Popliteal artery: Patent
-Anterior tibial artery: occlusive disease throughout
-Posterior tibial artery: Multifocal disease mostly proximal that is
nonocclusive
-Peroneal artery: Patent
-Dorsalis pedis: Reconstituted and Patent
CTA run-off LLE:
-Common femoral artery: Extensive nonocclusive disease
-Superficial femoral artery: Occluded
-Deep femoral artery: Patent with multiple collaterals
-Popliteal artery: Moderate nonocclusive disease
-Anterior tibial artery: Occluded, multifocal with good reconstitution of
dorsalis pedis
-Posterior tibial artery: Multifocal severe stenosis to occlusive disease
-Peroneal artery: Patent
-Dorsalis pedis: Patent
Atherosclerotic plaques: Diffuse and severe involving .
CHEST:
HEART AND VASCULATURE: The pulmonary vasculature appears well opacified to
the subsegmental level without filling defects, with no evidence of pulmonary
embolism. The thoracic aorta is normal in caliber without evidence of
dissection or intramural hematoma. The heart is enlarged. There is extensive
coronary artery calcifications as well as of the thoracic aorta. No
pericardial effusion is seen. The tip of the right PICC is seen with right
atrium.
AXILLA, HILA, AND MEDIASTINUM: Multiple bilateral subcentimeter axillary
lymph nodes. No mediastinal or hilar lymphadenopathy is present. No
mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Mild biapical centrilobular emphysema. No suspicious lung
nodules or mass. Bilateral mild ground glass opacities. There is engorged
pulmonary vasculature inferiorly consistent with pulmonary vascular
congestion.The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Bilateral thyroid hypoenhancing lesions, the largest measuring
4 mm in the left thyroid, as noted in CTA neck from yesterday.
ABDOMEN:
HEPATOBILIARY: The liver seen in arterial phase shows no focal lesions. There
is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder contains dependent gallstones without wall thickening or
surrounding inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right adrenal gland medial limb contains a 1 cm hypoenhancing
nodule with Hounsfield units of 25 with a noncontrast scan and Hounsfield
units as ___ with contrast in the arterial phase (3A;78). The left adrenal
gland is normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a 1.1 x 1.1 x 1.0 cm hypo enhancing lesion in the right upper pole
with Hounsfield units of 31 (3a, 81). There is another hypo enhancing lesion
in the lateral upper pole of the right kidney measuring 0.8 x 0.6 cm (3A; 88)
and another lesion in the in the right interpolar region which measures 0.6 x
0.5 cm with which are too small to characterize but likely represents renal
cyst.) the left kidney contains a hypodense lesion in the lower pole measuring
1.5 x 1.3 cm with Hounsfield units of 7.2 representing a simple renal cyst.
There is another hypodense lesion in the posterior segment of the left renal
interpolar region measuring 1.5 x 0.9 cm with Hounsfield units of 20 also
likely representing simple cysts. Enhancing lesions in the kidneys too small
to characterize There is no evidence of hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Extensive colonic
diverticulosis without diverticulitis. . The appendix is normal. There is
no free intraperitoneal fluid or free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus contains multiple calcified fibroids, the
largest measuring 4.8 x 4.6 cm in the fundus of the uterus (3A ; 162). .
There is no evidence of adnexal abnormality bilaterally.
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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. Extensive degenerative changes throughout the thoracic and
lumbar spine particularly with osteophyte formation in the right lateral
thoracic vertebral bodies. Small hiatal hernia. Small area umbilical hernia
containing fat.
IMPRESSION:
1. Mild-to-moderate narrowing of the branching of the femoral profunda at
distal end of the external iliac to profunda bypass graft. Complete occlusion
of the left superficial femoral artery with reconstitution of the popliteal
artery as well as several collaterals from the level of the profunda.
2. Bilateral anterior tibial artery occlusion with reconstitution of dorsalis
pedis bilaterally
3. Severe to occlusive disease of posterior tibial artery
4. cardiomegaly
5. Pulmonary vascular congestion
6. Bilateral thyroid subcentimeter hypodense lesions, largest measuring 4mm
in the left thyroid lobe
7. 1.0 cm right adrenal nodule again demonstrated
8. Bilateral renal hypodense lesions likely representing cysts
9. Multiple calcified fibroids
10. Diverticulosis without evidence of diverticulitis
11. Extensive degenerative changes of the thoracolumbar spine
|
10121634-RR-15 | 10,121,634 | 28,264,080 | RR | 15 | 2155-10-23 18:15:00 | 2155-10-23 19:22:00 | EXAMINATION: Q62R
INDICATION: ___ year old woman with diabetes, fall with wounds to the right
shin about 1 week ago, presenting with cellulitis and swelling of the right
lower extremity, bedside ultrasound in urgent care concerning for drainable
fluid collection.// Please evaluate for evidence of drainable fluid
collection. Please scan from the mid thigh through the distal extremity.
TECHNIQUE: Axial CT images were obtained from the right midthigh extending
through the right toes after intravenous contrast. Coronal and sagittal
reformats were performed and reviewed at the workstation.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.8 s, 77.1 cm; CTDIvol = 22.8 mGy (Body) DLP =
1,754.9 mGy-cm.
Total DLP (Body) = 1,755 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is extensive subcutaneous edema and skin thickening extending from the
knee throughout the right lower extremity and into the right foot. There is a
thin oblong collection of intermediate density fluid within the subcutaneous
tissues superficial to the anterior tibia, just below the knee measuring 1.2 x
3.3 x 7.1 cm, compatible with a hematoma. There are no other focal fluid
collections. There is no evidence of subcutaneous emphysema. There are
extensive subcutaneous calcifications throughout the right lower extremity.
There is a small nonhemorrhagic right knee joint effusion. Right lower
extremity vessels appear patent. Surrounding musculature is unremarkable in
appearance.
There is no evidence of acute fracture. Note is made of an irregular os
navicular. Mineralization is within normal limits. No suspicious osseous
lesions. Mild tricompartmental degenerative changes are seen within the knee,
most severe within the patellofemoral compartment.
IMPRESSION:
1. Thin oblong collection of intermediate density fluid along the proximal
anterior tibia measuring 7.1 cm in craniocaudal ___, compatible with a
hematoma. No other focal fluid collections.
2. Extensive subcutaneous edema throughout the right lower extremity extending
into the right foot. No subcutaneous emphysema.
3. Small nonhemorrhagic right knee joint effusion.
|
10121836-RR-35 | 10,121,836 | 24,419,339 | RR | 35 | 2185-07-20 16:38:00 | 2185-07-20 21:15:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT IN O.R.
INDICATION: ORIF fracture.
TECHNIQUE: FLUOROSCOPIC ASSISTANCE PROVIDED TO THE CLINICIAN IN THE OR
WITHOUT THE RADIOLOGIST PRESENT. 6 SPOT VIEWS OBTAINED. FLUORO TIME RECORDED
AS 80.5 SECONDS.
COMPARISON: Right femur radiographs from ___
FINDINGS:
VIEWS DEMONSTRATE STATUS RELATED TO fixation of a femur fracture.
IMPRESSION:
Correlation with real-time findings and, when appropriate, conventional
radiographs is recommended for further assessment.
|
10121836-RR-44 | 10,121,836 | 20,311,493 | RR | 44 | 2186-12-29 17:41:00 | 2186-12-29 18:25:00 | INDICATION: ___ with left pelvis and hip pain, possible pre-op // acute
process?
TECHNIQUE: Multiple supine views of the chest.
COMPARISON: ___.
FINDINGS:
Lungs are clear without consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. Mitral annular
calcifications are noted. No acute osseous abnormalities. Mid thoracic back
is again noted.
IMPRESSION:
No acute cardiopulmonary process.
|
10121836-RR-45 | 10,121,836 | 20,311,493 | RR | 45 | 2186-12-29 17:41:00 | 2186-12-29 18:20:00 | INDICATION: ___ with left pelvis and hip pain // fx?
TECHNIQUE: AP view of the pelvis. AP and lateral views of the proximal and
distal left femur.
COMPARISON: Prior right hip films from ___.
FINDINGS:
Orthopedic hardware again seen in the proximal right femur. There is an acute
intertrochanteric fracture through the proximal left femur. No other acute
fractures identified. Distally, the femur is unremarkable. Pubic symphysis
and SI joints are preserved. Clips project over the pelvis. Atherosclerotic
calcifications noted in the abdominal aorta and iliac vessels.
IMPRESSION:
Acute intertrochanteric left femoral fracture.
|
10121836-RR-46 | 10,121,836 | 20,311,493 | RR | 46 | 2186-12-30 09:42:00 | 2186-12-30 11:11:00 | INDICATION: LEFT HIP FX.ORFI
IMPRESSION:
Fluoroscopic images from the operating suite shows placement of a fixation
device about a previous fracture of the proximal left femur. Further
information can be gathered from the operative report.
|
10122126-RR-16 | 10,122,126 | 21,265,562 | RR | 16 | 2171-03-18 03:49:00 | 2171-03-18 06:20:00 | EXAMINATION: MR ___ SPINE WITH CONTRAST
INDICATION: History: ___ with left lower back pain radiating down the left
leg, severe pain. Weakness of foot/toe, but may be due to pain. Assess for
disc herniation, nerve root impingement, other acute pathology.
TECHNIQUE: Sagittal T1 weighted, T2 weighted, and fat-suppressed T2 weighted
images of the lumbar spine with axial T2 weighted images.
COMPARISON: None available.
FINDINGS:
The most caudal rib-bearing vertebra is not included on the axial images. 5
lumbar-type vertebrae are visualized, labeled L1 through L5. The numbering is
documented on image 2:10.
No concerning bone marrow signal abnormalities seen. Vertebral body heights
are preserved. There is straightening of lumbar lordosis without subluxation.
The distal spinal cord demonstrates normal morphology and signal intensity,
with the conus medullaris terminating at L1-L2.
From T12-L1 through L3-L4, there is no disk abnormality, facet arthropathy ,
spinal canal narrowing, or neural foraminal narrowing.
At L4-L5, there is a minimal disc bulge without disc desiccation. There is no
spinal canal or neural foraminal narrowing.
At L5-S1, there is disc desiccation with a bulge and a left paracentral disc
herniation extending inferiorly, which measures 12 mm transverse, 7 mm AP, 12
mm craniocaudad. It displaces and deforms the traversing left S1 nerve root
in the subarticular zone. The left ventral thecal sac is mildly indented, but
the intrathecal nerve roots are not crowded. The disc bulge and mild facet
arthropathy cause mild left neural foraminal narrowing without nerve root
impingement.
IMPRESSION:
Left paracentral disc herniation L5-S1 displaces and deforms the traversing
left S1 nerve root in the subarticular zone. The left ventral thecal sac is
mildly indented without crowding of the intrathecal nerve roots.
NOTIFICATION: The following preliminary report was provided by Dr. ___:
"Disc extrusion at L5-S1 which causes moderate spinal canal stenosis and
moderate to severe left neural foraminal stenosis at that level. No abnormal
cord signal. No osseous abnormality." Please see the WET READ section for the
time of the preliminary report.
|
10122126-RR-17 | 10,122,126 | 21,265,562 | RR | 17 | 2171-03-18 14:50:00 | 2171-03-19 09:20:00 | EXAMINATION: L-SPINE (AP AND LAT)
INDICATION: L5-S1 MICRODISCECTOMY
IMPRESSION:
Images from the operating suite show a posterior probe a what appears to be
the L5-S1 level. Further information can be gathered from the operative
report.
|
10122182-RR-20 | 10,122,182 | 20,031,947 | RR | 20 | 2143-07-18 17:48:00 | 2143-07-18 18:11:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with fever// eval for PNA
COMPARISON: Chest x-ray from ___
FINDINGS:
PA and lateral views of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10122182-RR-21 | 10,122,182 | 20,031,947 | RR | 21 | 2143-07-18 20:13:00 | 2143-07-18 22:39:00 | EXAMINATION: CT of the abdomen and pelvis
INDICATION: +PO contrast; History: ___ with s/p duodenal surgery+PO
contrast// Evaluate for fever, abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
2) Spiral Acquisition 5.0 s, 55.4 cm; CTDIvol = 16.6 mGy (Body) DLP = 921.8
mGy-cm.
3) Spiral Acquisition 1.1 s, 12.0 cm; CTDIvol = 14.9 mGy (Body) DLP = 178.9
mGy-cm.
4) Spiral Acquisition 0.8 s, 9.0 cm; CTDIvol = 14.3 mGy (Body) DLP = 128.1
mGy-cm.
Total DLP (Body) = 1,242 mGy-cm.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. The patient is status post biliary
jejunal ostomy with a biliary stent in place. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent.
PANCREAS: The patient is status post pancreaticojejunostomy. Note is made of
a stent within the proximal aspect of the pancreatic duct with its tip
terminating in the jejunum. Otherwise, the pancreas has normal attenuation
throughout, without evidence of focal lesions or pancreatic ductal dilatation.
There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. An accessory spleen is noted anteriorly.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The patient is status post pancreas sparing total
duodenectomy with distal gastrectomy. The patient is status post subtotal
colectomy with a short segment of remaining rectosigmoid colon. Note is made
of diffusely dilated loops of small bowel measuring up to 5.4 cm, with
transition to normal caliber very distal small bowel in the right abdomen,
approximately 12 cm above ileocolonic anastomosis series 1, image 52, coronal
image ___, in an area where there are fluid collections and stranding.
There is an organizing complex collection about the duodenectomy site, with
the largest component measuring 10.3 x 3.8 cm (L x T) showing a rim
enhancing wall located along the medial aspect of the liver (601:38). An
additional 5.3 x 3.2 cm peripancreatic component (02:27) is also noted. There
is also fluid tracking along the falciform ligament.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
LYMPH NODES: Mildly prominent mesenteric lymph nodes are likely reactive.
There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: There is no evidence of worrisome osseous lesion or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Surgical
staples are noted along the anterior abdominal wall.
IMPRESSION:
1. Status post pancreas sparing total duodenectomy with distal gastrectomy
with an organizing complex collection about the duodenectomy site, with the
largest component measuring 10.3 x 3.8 cm (L x T) showing a rim enhancing
wall, concerning for abscess, located along the medial aspect of the liver.
Additional smaller components are also noted, measuring up to additional 5.3 x
3.2 cm in the peripancreatic region, however it is unclear if these components
are communicating with each other.
2. The patient is status post subtotal colectomy. Diffusely significantly
dilated loops of small bowel, transition point is in the right upper quadrant
adjacent to the fluid collections, where there is significant bowel caliber
change, favoring obstruction over ileus. Follow-up radiographs recommended.
3. Mildly enlarged mesenteric lymph nodes are likely reactive.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:20 pm, 5
minutes after discovery of the findings.
|
10122182-RR-22 | 10,122,182 | 20,031,947 | RR | 22 | 2143-07-19 17:35:00 | 2143-07-19 19:33:00 | EXAMINATION: CT-guided peripancreatic fluid collection drainage
INDICATION: ___ year old man with FAP s/p pancreas sparing duodenectomy ___,
now with fever found to have intraabdominal abscess.// please drain known
duodenectomy site abscess. Please send fluid for micro, gram stain and
amylase. Thank you
COMPARISON: CT abdomen and pelvis ___
PROCEDURE: CT-guided drainage of peripancreatic collection.
OPERATORS: Dr. ___ trainee and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 20 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to suction bulb. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.5 s, 29.2 cm; CTDIvol = 12.3 mGy (Body) DLP = 344.1
mGy-cm.
2) Stationary Acquisition 6.1 s, 1.4 cm; CTDIvol = 64.0 mGy (Body) DLP =
92.1 mGy-cm.
3) Spiral Acquisition 9.5 s, 29.2 cm; CTDIvol = 12.4 mGy (Body) DLP = 346.5
mGy-cm.
Total DLP (Body) = 792 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 3
mg Versed and 150 mcg fentanyl throughout the total intra-service time of 25
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Preprocedure CT re-demonstrates a peripancreatic fluid collection, within
accessible component along the anterior margin the pancreas. Pancreatic and
biliary stents again noted. Postsurgical changes noted along the anterior
abdominal wall.
Intraprocedural CT fluoroscopy demonstrates appropriate positioning of the
___ needle, wire, and catheter.
Postprocedure CT demonstrates appropriate positioning of the pigtail catheter.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
|
10122182-RR-23 | 10,122,182 | 20,031,947 | RR | 23 | 2143-07-20 12:33:00 | 2143-07-20 13:41:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with picc// r picc 51cm iv ping ___ Contact
name: ping, ___: ___
IMPRESSION:
In comparison with the study ___, there is an placement of a right
subclavian PICC line it extends to the upper right atrium. It could be pulled
back approximately 3 cm if the desired position is at or above the cavoatrial
junction.
Otherwise, the examination is within normal limits.
NOTIFICATION: Ping, a venous access nurse.
|
10122182-RR-30 | 10,122,182 | 22,489,381 | RR | 30 | 2145-06-20 11:25:00 | 2145-06-20 14:08:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with CTA ab/pel, recent surgery, positive fast// CTA ab/pel,
recent surgery, positive fast
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.8 s, 61.1 cm; CTDIvol = 7.8 mGy (Body) DLP = 476.8
mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 18.2 mGy (Body) DLP =
9.1 mGy-cm.
3) Spiral Acquisition 7.8 s, 61.3 cm; CTDIvol = 17.6 mGy (Body) DLP =
1,076.4 mGy-cm.
4) Spiral Acquisition 7.8 s, 61.3 cm; CTDIvol = 17.5 mGy (Body) DLP =
1,075.6 mGy-cm.
Total DLP (Body) = 2,638 mGy-cm.
COMPARISON: MRCP ___
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is no calcium burden in the
abdominal aorta and great abdominal arteries. There is mild narrowing of the
upper superior mesenteric vein and main portal vein adjacent to the
collection. The veins remain patent with no evidence of thrombosis. No
extravasation of contrast identified.
LOWER CHEST: The lungs are well aerated. There is no pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: There is a linear hypodensity in the inferior aspect of segment
6 which could be postsurgical (series 5: image 113). The liver demonstrates
homogenous attenuation throughout. There is no evidence of focal lesions.
There is expected pneumobilia. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is resected.
PANCREAS: Patient is status post completion Whipple; the remaining pancreatic
body and tail is unremarkable with homogeneous enhancement throughout. There
is some peripancreatic stranding.
GASTROINTESTINAL: The esophagus and stomach is distended. The patient is
status post interval completion Whipple. Within the postoperative bed at the
presumed site of the pancreaticojejunostomy there is a 11 cm x 5 cm x 8 cm
irregular collection with debris and gas (series 5: Image 70). Adjacent to
this collection, the medial wall of the jejunostomy is not definitively
visualized (series 5: Image 84). The medial drainage catheter traverses this
collection and tracks inferiorly along the course of the catheter which
terminates in the right mid abdomen posteriorly. Free-fluid that is
peripherally enhancing is visualized tracking down the right paracolic gutter
and into the pelvis. Additional, lateral drainage catheter seen with tip
along the course of this collection in the right paracolic gutter. Prominent
fluid-filled small bowel loops are demonstrated throughout the abdomen, most
dilated proximal to the collection at the level of the gastrojejunostomy,
measuring up to 5.5 cm (series 601: Image 86). There are small bowel loops
within the pelvis which demonstrate mild bowel wall edema, but to be secondary
to surrounding free-fluid. Though there are couple loops of bowel which are
relatively decompressed, overall the entirety of the bowel is distended. The
patient is status post colectomy.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands demonstrates scattered
calcifications. They are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. The
mesenteric lymph nodes appear more numerous and larger compared to
preoperative exam.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly
unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. A 11 cm x 5 cm x 8 cm irregular collection with debris and gas adjacent to
the presumed site of the pancreaticojejunostomy. Adjacent to this collection,
the medial wall of the jejunum is not definitively visualized raising concern
for anastomotic leak. The medial drainage catheter seen to traverse this
collection though the tip extends inferiorly and terminates in the right mid
abdomen, inferior to the dominant component of the collection.
2. Fluid seen tracking along the right paracolic gutter extending into the
pelvis with enhancement of the peritoneum. Second, lateral drainage catheter
seen in association with the right paracolic component.
3. Dilated small bowel loops throughout the abdomen and pelvis, some with
apparent wall edema in the pelvis without evidence of obstruction, potentially
reactive.
4. Multiple mesenteric lymph nodes that are increased from prior exam.
|
10122182-RR-31 | 10,122,182 | 22,489,381 | RR | 31 | 2145-06-20 12:49:00 | 2145-06-20 14:52:00 | INDICATION: ___ with ng placement// ng placement
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Lung volumes are relatively low. The lungs are clear without consolidation or
obvious effusion. Enteric tube seen coiled in the left upper quadrant. No
acute osseous abnormalities.
IMPRESSION:
Enteric tube within the stomach.
|
10122182-RR-32 | 10,122,182 | 22,489,381 | RR | 32 | 2145-06-20 14:32:00 | 2145-06-20 17:45:00 | INDICATION: ___ hx FAP s/p panc-sparing duodenectomy, part gastrectomy, CCY
___ s/p panc head rsxn, PJ HJ for recurrent adenoma in CBD p/w abd pain and
sepsis, collection on CTA concerning for leak poorly controlled by surgical
___ drain// drain placement for improved control of likely leak
PROCEDURE: CT-guided drainage of peripancreatic collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a right lateral position on the CT scan table.
Limited preprocedure CT scan was performed to localize the collection. Based
on the CT findings an appropriate skin entry site for the drain placement was
chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The inner stiffener and the wire
were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 10 cc of dark serosanguineous fluid was aspirated with a sample
sent for microbiology evaluation. The catheter was secured by a StatLock. The
catheter was attached to suction bulb. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.6 s, 26.5 cm; CTDIvol = 14.4 mGy (Body) DLP = 362.3
mGy-cm.
2) Spiral Acquisition 7.9 s, 24.2 cm; CTDIvol = 20.6 mGy (Body) DLP = 471.9
mGy-cm.
3) Stationary Acquisition 13.0 s, 1.4 cm; CTDIvol = 135.5 mGy (Body) DLP =
195.1 mGy-cm.
Total DLP (Body) = 1,052 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 0
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 30
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. An anterior peripancreatic air gas collection is again noted measuring
approximately 10.9 x 5.4 cm. This collection was targeted for drainage.
2. Post drainage placement, this collection appears slightly smaller.
IMPRESSION:
Successful CT-guided placement of ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
|
10122182-RR-33 | 10,122,182 | 22,489,381 | RR | 33 | 2145-06-23 14:21:00 | 2145-06-23 14:55:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new picc// R picc 50 cm Contact name: sal,
___: ___
IMPRESSION:
In comparison with the study of ___, there has been placement of a right
subclavian PICC line that extends to the lower SVC. Nasogastric tube again
loops in the fundus of the stomach before heading further into the body of the
stomach.
Low lung volumes but no evidence of acute pneumonia, vascular congestion, or
pleural effusion.
|
10122182-RR-34 | 10,122,182 | 22,489,381 | RR | 34 | 2145-06-24 16:14:00 | 2145-06-24 18:24:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with FAP s/p partial colectomy ___, s/p pancreas
preserving dudenectomy, distal gastrectomy,and cholecystectomy, and s/p
pancreaticojejunectomywith end to side pancreaticojejunostomy and
hepaticojejunostomy on ___ who presentedwith sepsis likely secondary to
leak at pancreatic anastomosis s/p ___ drainage. Sepsis has since resolved but
he continues to have high NGT and surgical drain output, likely leak at the PJ
or HJ anastomosis.// PO and IV Contrast please. Please eval for progression of
known collection and
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 64.1 cm; CTDIvol = 23.6 mGy (Body) DLP =
1,514.1 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 7.8 s, 0.5 cm; CTDIvol = 43.6 mGy (Body) DLP =
21.8 mGy-cm.
Total DLP (Body) = 1,538 mGy-cm.
COMPARISON: Previous CT from ___.
FINDINGS:
LOWER CHEST: There is a small left pleural effusion with associated basal
atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver is homogeneously hypoattenuating in keeping with
steatosis. There is no evidence of focal lesions. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent.
PANCREAS: The pancreas demonstrates preserved enhancement but appears mildly
edematous, likely related to postsurgical changes.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis.
GASTROINTESTINAL:
The NG tube passes through the gastrojejunostomy with the tip in the proximal
jejunum. Pancreaticojejunostomy and hepatojejunostomy are noted. The patient
is status post subtotal colectomy. There has been oral contrast passage
beyond the ileocolic anastomosis with no obstruction.
The upper abdominal collection containing a pigtail drain has decreased in
size, measuring 8.3 x 3.2 x 6.5 cm, previously 11.5 x 5.9 x 9.2 cm. A 4.4 x
2.6 cm fluid collection containing a gas locule at the posterior aspect of the
pancreaticojejunostomy (02:39) is stable. Another rim enhancing fluid
collection with a small gas locule medial to the hepatic caudate lobe measures
7.4 x 3.0 x 7.6 cm, previously 4.4 x 1.2 x 6.7 cm. These could be
communicating.
There is increased fluid surrounding bowel loops in the anterior abdomen
demonstrating more extensive rim enhancement, increased in volume and
organization compared with prior CT. The largest discrete pocket in the right
upper quadrant measures 15.4 x 4.3 x 6.5 cm (2:38, 602:42) but this appears to
be communicating with numerous additional pockets. There are 2 surgical
drains passing through portions of this rim enhancing fluid. There is
scattered interloop fluid, as well as more confluent rim enhancing fluid in
the pelvis, also showing rim enhancement. There is increased fluid in the
left subdiaphragmatic space with milder incomplete rim enhancement.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly
unremarkable.
LYMPH NODES: There are numerous mildly prominent lymph nodes in the small
bowel mesentery and retroperitoneum, likely reactive. These are overall
similar to previous studies.
VASCULAR: There is no abdominal aortic aneurysm. The main portal vein is
narrowed around the level of the pancreaticojejunostomy but there is good
contrast opacification beyond this segment. The hepatic veins are patent.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Unremarkable aside from postsurgical changes and subcutaneous
injection sites.
IMPRESSION:
1. Significant decrease in the peripancreatic collection containing the
pigtail drain.
2. Increase in smaller rim enhancing collection adjacent to the hepatic
caudate lobe.
3. Significant increase in extensive rim enhancing fluid associated with
anterior small-bowel loops just deep to the abdominal wall, much of which
appears to be communicating. It is uncertain if this is secondary to
pancreatic or biliary anastomotic leak but there are pockets of fluid tracking
near to the anastomoses. Additional percutaneous drainage would be
technically feasible if indicated though it may not be definitive.
4. As previously mentioned, an anastomotic leak at the pancreaticojejunostomy
should be considered
NOTIFICATION: The findings were discussed with ___, M.D.
by ___, M.D. on the telephone on ___ at 6:19 pm, 15 minutes
after discovery of the findings.
|
10122182-RR-35 | 10,122,182 | 22,489,381 | RR | 35 | 2145-06-25 19:08:00 | 2145-06-26 13:35:00 | EXAMINATION: ULTRASOUND CT-GUIDED ABDOMEN DRAINAGE
INDICATION: ___ year old man with w/ pacreaticojejunosotmy,
hepaticojejunostomy found to have multiple intrabdominal collections post-op//
Drain collections
COMPARISON: CT ___ and multiple priors
PROCEDURE: CT-guided drainage of abdominal collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Based on
the ultrasound findings an appropriate skin entry site for the drain placement
was chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using intermittent ultrasound guidance, the right upper quadrant component of
the collection was targeted and an 18-G needle was inserted into the
collection. A sample of fluid was aspirated, confirming needle position within
the collection. 0.038 ___ wire was placed through the needle and needle
was removed. This was followed by placement of ___ Exodus pigtail
catheter into the collection. The plastic stiffener and the wire were removed.
The pigtail was deployed. The position of the pigtail was confirmed within the
collection via CT fluoroscopy.
Approximately 150 cc of peach-colored fluid was aspirated with a sample sent
for microbiology evaluation. The catheter was secured with a suture. The
catheter was attached to bag. Sterile dressing was applied.
The patient was placed in a supine position on the CT scan table. Based on the
ultrasound findings an appropriate skin entry site for the drain placement was
chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using intermittent ultrasound guidance, the right lower quadrant component of
the collection was targeted and an 18-G needle was inserted into the
collection. A sample of fluid was aspirated, confirming needle position within
the collection. 0.038 ___ wire was placed through the needle and needle
was removed. This was followed by placement of ___ Exodus pigtail
catheter into the collection. The plastic stiffener and the wire were removed.
The pigtail was deployed. The position of the pigtail was confirmed within the
collection via CT fluoroscopy.
Approximately 20 cc of serosanguineous fluid was aspirated with a sample sent
for microbiology evaluation. The catheter was secured with a StatLock. The
catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence: 1) Spiral Acquisition 14.0 s, 42.7 cm; CTDIvol =
21.3 mGy (Body) DLP = 881.5 mGy-cm. 2) Spiral Acquisition 14.0 s, 42.7 cm;
CTDIvol = 21.2 mGy (Body) DLP = 879.3 mGy-cm. 3) Spiral Acquisition 14.0 s,
42.7 cm; CTDIvol = 21.3 mGy (Body) DLP = 884.5 mGy-cm. Total DLP (Body) =
2,659 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 4
mg Versed and 200 mcg fentanyl throughout the total intra-service time of 60
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Small left pleural effusion, unchanged.
Following placement of the right upper quadrant, near midline drain, the upper
abdominal component of the collection was significantly decreased in size.
While difficult to discretely measure, the fluid component of the right lower
quadrant collection was mildly decreased in comparison to prior following
drainage. For example, a 3.2 x 2.0 cm component anterior to the right lower
quadrant drain (series 5, image 156) previously measured approximately 5.0 x
7.6 cm.
The collection at the posterior aspect of the intrahepatic IVC (series 3,
image 45) measured 6.5 x 2.8 cm (previously 7.4 x 3.0 cm), slightly decreased.
The fluid and gas containing collection along the anterior aspect of the
pancreatic body appears mildly decreased, measuring 7.7 x 2.6 cm (previously
8.3 x 3.2 cm). The collection again contains a pigtail catheter.
A small fluid collection along the posterior aspect of the uncinate process of
the pancreas measures 3.8 x 2.5 cm (previously 4.4 x 2.6 cm).
A right lower quadrant JP drain again terminates along the anterior aspect of
the infrahepatic IVC (series 5, image 80). A second right lower quadrant JP
drain terminates within the aforementioned collection at the anterior aspect
of the pancreatic body.
There is borderline splenomegaly with the spleen measuring 13.6 cm, unchanged.
Moderate peripancreatic stranding is also unchanged. Prominent peripancreatic
and mesenteric lymph nodes again measure at the upper limits of normal or R
mildly enlarged (series 5, image 142). Right adrenal calcifications without a
discrete underlying lesion, appears similar to prior. The patient is status
post subtotal colectomy pancreaticojejunostomy and hepaticojejunostomy.
Prominent bowel loops in the anterior abdomen are similar in comparison to ___.
IMPRESSION:
1. Successful CT-guided placement of right upper quadrant and right lower
quadrant an 8 and ___ pigtail catheters, respectively, into the anterior
abdominal collection. Samples were sent for microbiology evaluation.
2. Interval decrease in the anterior abdominal collection following
drainage.
3. Mild interval decrease in the size of the peripancreatic collections and
the posterior aspect of the intrahepatic IVC.
4. The patient is status post subtotal colectomy, hepaticojejunostomy and
pancreaticojejunostomy. Borderline or mildly enlarged peripancreatic and
mesenteric lymph nodes are unchanged.
|
10122182-RR-36 | 10,122,182 | 22,489,381 | RR | 36 | 2145-07-01 13:39:00 | 2145-07-01 15:01:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ hx FAP s/p panc-sparing duodenectomy, part gastrectomy, CCY
___ s/p panc head rsxn, PJ HJ for recurrent adenoma c/b pancreatic leak//
interval assessment of collections s/p drainage, please give IV and PO
contrast
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 64.1 cm; CTDIvol = 23.0 mGy (Body) DLP =
1,474.6 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 20.1 mGy (Body) DLP =
10.1 mGy-cm.
Total DLP (Body) = 1,486 mGy-cm.
COMPARISON: CT examinations from ___ and ___. MRCP
from ___.
FINDINGS:
The lung bases are clear. There is no pericardial or pleural effusion. The
heart size is top-normal.
The liver density appears slightly decreased, suggestive of steatosis. No
focal hepatic lesion is detected. There is no intra or extrahepatic bile duct
dilation.
The patient is post duodenectomy. There are 5 drainage catheters present:
1. Again seen is an anterior peripancreatic collection adjacent to the head,
with a left approach percutaneous pigtail catheter terminating within the left
aspect. The collection now measures 5.7 x 1.7 cm, previously 8.3 x 3.2 cm on
the ___ examination (series 2, image 33).
2. A right-approach surgical drain traverses the superior aspect of the
peripancreatic collection, terminating inferiorly at the right pararenal
space, where there is minimal residual fluid (series 2, image 53).
3. A lateral right surgical drain terminates along the posterior aspect of the
porta hepatis, near the hepaticojejunostomy, with only minimal fluid adjacent
to the tip (series 2, image 39).
4. A right parasagittal percutaneous pigtail catheter terminates within an
anterior collection just beneath the left hepatic lobe, where there is only a
small amount of fluid remaining, spanning approximately 4.5 x 1.3 cm,
previously 15.4 x 4.3 cm (series 2, image 34).
5. A right lower quadrant percutaneous pigtail catheter terminates within the
inferior aspect of the anterior collection (series 2, image 60), where there
is only a 2.6 x 1.3 cm pocket, previously measuring 7.6 x 5.0 cm (series 2,
image 60).
A central collection abutting the caudate lobe measures 3.7 x 1.8 cm. This is
decreased from 7.4 x 3.0 cm on the ___ examination (series 2, image
24).
No new abdominopelvic collection is detected.
Mild peripancreatic stranding, particularly near the tail, is minimally
changed since ___ (series 2, image 33). No focal pancreatic lesion is
detected. There is no pancreatic ductal dilation.
The spleen size is within normal limits. A subcentimeter accessory spleen is
unchanged. No focal splenic lesion is detected.
The adrenal glands are normal in size and shape.
The kidneys are normal in size and enhance symmetrically, without
hydronephrosis.
The stomach appears normal. There is moderate distention of multiple loops of
small bowel, without transition point, likely reflecting mild ileus (series 2,
image 52).
The bladder is mildly distended, and appears normal.
The prostate is normal in size.
Prominent mesenteric and retroperitoneal lymph nodes are unchanged from prior
recent examinations, none demonstrating interval enlargement or meeting strict
size criteria for adenopathy. There is no inguinal or intrapelvic
lymphadenopathy.
There are no osseous lesions concerning for malignancy or infection.
IMPRESSION:
1. Interval decrease in size of an anterior peripancreatic collection adjacent
to the pancreatic head, with a left pigtail drain remaining in situ.
2. Near resolution of and anterior abdominal collection since ___,
following placement of 2 percutaneous pigtail catheters.
3. A collection abutting the caudate lobe has decreased in size, currently 3.7
x 1.8 cm, previously 7.4 x 3.0 cm.
4. Two right-sided surgical drains are unchanged in position, with only
minimal fluid at the tips.
5. No new abdominopelvic collection.
6. Unchanged peripancreatic stranding along the pancreatic body and tail.
7. Moderate distention of multiple loops of small bowel, without transition
point, likely reflecting mild ileus.
8. Mild hepatic steatosis.
|
10122297-RR-28 | 10,122,297 | 20,383,912 | RR | 28 | 2175-11-01 19:28:00 | 2175-11-01 20:46:00 | INDICATION: ___ with NSLC with mets on chemo p/w hypotension// eval for new
mass or abscess
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.
Multidetector helical scanning of the chest was coordinated with intravenous
infusion of nonionic iodinated contrast agent and reconstructed as contiguous
5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm
MIP axial images.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 9.1 s, 71.6 cm; CTDIvol = 13.4 mGy (Body) DLP = 960.7
mGy-cm.
Total DLP (Body) = 972 mGy-cm.
COMPARISON: Prior CT torso from ___.
PET-CT ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta and great vessels are unremarkable.
The heart, pericardium, and great vessels are within normal limits. No
pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: There is no axillary or supraclavicular
lymphadenopathy. A lower right paratracheal node currently measures 1.1 cm
(02:20), previously 0.8 cm. Again seen is a large right hilar mass measuring
3.0 x 3.4 x 3.5 cm (02:27), previously 3.7 x 3.7 x 4.1 cm. Mass appears to
invade the right upper lobe pulmonary arteries to the segmental level, similar
to the prior study.
PLEURAL SPACES: No pleural effusion or pneumothorax. A right azygos fissure is
again noted.
LUNGS/AIRWAYS: Again seen is a spiculated mass in the right upper lobe
measuring 3.1 x 1.9 x 2.5 cm (02:16), previously 3.4 x 2.5 x 3.0 cm.
Previously seen pleural based triangular opacities in the right upper lobe
(02:25) and along the right major fissure (02:20) have significantly decreased
in size and likely represent atelectasis. A 2 mm nodule in the left upper
lobe is unchanged (02:32). The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Calcified granuloma is noted along the liver dome. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
decompressed and contains a punctate hyperdensity which may represent a stone.
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: A 1.2 cm right adrenal nodule, previously 9 mm, and a 1.8 cm left
adrenal nodule, previously 2.0 cm, are incompletely characterized, however did
not demonstrate FDG uptake on recent PET-CT from ___.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality. Areas of cortical thinning suggesting of scarring
seen at the upper pole the left kidney.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal..
There is no free fluid or free air in the abdomen.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles unremarkable.
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.
Moderate atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
Chronic right posterior fourth rib fracture is noted. Severe compression
deformity of the T5 vertebral body is again noted, similar in appearance to
the prior study from ___.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Previously seen right hilar mass and spiculated right upper lobe mass are
slightly decreased in size compared to the prior study. No evidence of new
masses or fluid collections. Slight interval enlargement of a right lower
paratracheal lymph node in the interval.
2. Bilateral adrenal nodules incompletely characterized, however did not
demonstrate FDG uptake on PET-CT from ___.
|
10122428-RR-11 | 10,122,428 | 20,966,529 | RR | 11 | 2154-09-26 16:36:00 | 2154-09-26 17:49:00 | EXAMINATION: CT ___ W/O CONTRAST Q331 CT SPINE
INDICATION: ___ year old woman s/p I D with ortho with downtrending hgb //
eval for blood collection eval for blood collection
eval for blood collection
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 5.3 s, 41.9 cm; CTDIvol = 27.2 mGy (Body) DLP =
1,138.4 mGy-cm.
Total DLP (Body) = 1,138 mGy-cm.
COMPARISON: MR ___
FINDINGS:
The patient is status post L3-4 hemilaminectomy. Posterior to the spine
within the right paravertebral muscles extending from L1 to the sacrum there
is simple fluid, which is likely postsurgical. Edema is seen within the soft
tissues overlying the lumbar spine deep to the incision. A small amount of
hyperdensity posterior to the L2 and L3 spinous processes may represent
minimal blood products (301:87, 92). There is no evidence of large hematoma.
There is mild dextroconvex scoliosis of the lumbar spine with partial fusion
of the L2-3 vertebral bodies. Degenerative disc disease is present, worst
around the curvature extending from L1 to L4. No fractures are identified.
There is no evidence of severe spinal canal or neural foraminal stenosis.
There is no prevertebral soft tissue swelling.
There are trace bilateral pleural effusions. Cholelithiasis is noted. A
simple cyst is seen arising from the left kidney. There is diverticulosis of
the colon without evidence of acute diverticulitis.
IMPRESSION:
1. Status post L3-4 hemilaminectomy with postsurgical changes including fluid
within the right paravertebral muscles and overlying subcutaneous edema. No
large hematoma.
2. Cholelithiasis without evidence of acute cholecystitis.
3. Trace bilateral pleural effusions.
PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects
without low back pain:
Overall evidence of disk degeneration 91% (decreased T2 signal, height loss,
bulge)
T2 signal loss 83%
Disk height loss 58%
Disk protrusion 32%
Annular fissure 38%
Jarvik, et all. Spine ___ 26(10):1158-1166
Lumbar spinal stenosis prevalence- present in approximately 20% of
asymptomatic adults over ___ years old
___, et al, Spine Journal ___ 9 (7):545-550
These findings are so common in asymptomatic persons that they must be
interpreted with caution and in context of the clinical situation.
|
10122428-RR-14 | 10,122,428 | 28,752,926 | RR | 14 | 2154-12-27 16:33:00 | 2154-12-27 20:10:00 | INDICATION: ___ with fever // PNA?
TECHNIQUE: AP and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
There is persistent pulmonary edema though improved since prior exam. There
are small to moderate pleural effusions, larger on the left. Cardiac
silhouette is enlarged, similar to prior. Azygos fissure again noted. No
acute osseous abnormalities.
IMPRESSION:
Cardiomegaly with pulmonary edema though improved since prior and persistent
bilateral pleural effusions.
|
10122428-RR-15 | 10,122,428 | 28,752,926 | RR | 15 | 2154-12-27 20:33:00 | 2154-12-27 21:04:00 | EXAMINATION: CT L-SPINE W/ CONTRAST
INDICATION: ___ with recent JP drainNO_PO contrast // sacral region for
abscess? sacral region for abscess?
TECHNIQUE: Non-contrast helical multidetector CT was performed after the
intravenous administration of mL of Omnipaque contrast agent. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 15.8 s, 30.3 cm; CTDIvol = 30.3 mGy (Body) DLP =
868.0 mGy-cm.
Total DLP (Body) = 882 mGy-cm.
COMPARISON: CT L-spine ___
FINDINGS:
Status post L3-4 and L4-5 hemilaminectomies and foraminotomies as well as
recent local paraspinous muscle flap repair of dehisced lumbar surgical wound.
Expected postsurgical changes are seen within the midline soft tissues
superficial to the spinous processes extending from the L1-L5 levels. At the
L1-L2 level, there is a 2.9 x 1.0 cm region of air which may be postsurgical.
Ill-defined enhancement throughout the surgical bed is likely postsurgical,
although early developing phlegmon can not be excluded.
Mild right lateral listhesis of L3 on L4 is unchanged. Alignment of the
lumbar spine is otherwise preserved. No acute fractures.
There is moderate sigmoid diverticulosis. Small amount of pelvic free fluid
is nonspecific. Bilateral pleural effusions are partially visualized.
IMPRESSION:
1. Status post L3-4 and L4-5 hemilaminectomies as well as recent paraspinous
muscle flap repair of dehisced lumbar surgical wound. Expected postsurgical
changes are seen within the midline soft tissues extending from the L1-L5
levels. Specifically, ill-defined enhancement throughout the surgical bed may
be postsurgical, but early developing phlegmon would be difficult to exclude.
Additionally, a 2.9 cm region of air within the midline wound at the L1-2
level may also be postsurgical, although abscess formation would be difficult
to exclude.
2. Sigmoid diverticulosis. Small volume pelvic free fluid surrounding the
sigmoid colon is nonspecific but limits evaluation for acute diverticulitis.
3. Bilateral pleural effusions.
|
10122428-RR-7 | 10,122,428 | 20,966,529 | RR | 7 | 2154-09-17 16:32:00 | 2154-09-17 16:47:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with wound dehiscence. preop cxr// preop cxr
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: None.
FINDINGS:
Heart size is mildly enlarged with dense mitral annular calcifications.
Thoracic aorta is unfolded with diffuse atherosclerotic calcifications. Hilar
contours are unremarkable. The pulmonary vasculature is normal. Lungs are
clear. No pleural effusion or pneumothorax is seen. There are no acute
osseous abnormalities. Bridging anterior osteophytes are seen in the thoracic
spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10122428-RR-9 | 10,122,428 | 20,966,529 | RR | 9 | 2154-09-24 08:50:00 | 2154-09-24 12:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new post op fever to 101 // eval for PNA
TECHNIQUE: Portable chest x-ray AP view.
COMPARISON: Chest x-ray dated ___.
FINDINGS:
The heart is mildly enlarged. There is atherosclerotic calcification
involving the aortic arch and mitral annular. There is prominent
peribronchial wall thickening consistent with inflammatory/infectious process.
There is an azygous lobe, which is interval denser from previous study.
Pneumonia cannot be excluded. There is no focal consolidation. There is no
pleural effusion or pneumothorax.
There are moderate multilevel degenerative changes of the thoracic spine.
IMPRESSION:
1. Peribronchial wall thickening consistent with inflammatory/infectious
process.
2. Interval denser of the azygos lobe compared to previous study. Pneumonia
of the azygos lobe cannot be excluded.
|
10122838-RR-18 | 10,122,838 | 26,886,831 | RR | 18 | 2175-10-13 23:37:00 | 2175-10-14 02:21:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ male with intracranial hemorrhage. Evaluate for
acute vascular abnormality and/or aneurysm.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 4.9 s, 38.6 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,234.0 mGy-cm.
Total DLP (Head) = 2,153 mGy-cm.
COMPARISON: ___ outside head CT.
FINDINGS:
CT head: There is a 1.0 x 1.3 cm parenchymal hyperdensity within the right
corona radiata with mild adjacent hypodense vasogenic edema (03:21), which is
relatively unchanged comparison to prior study. There is a subacute to
chronic appearing lacune within the right thalamus (03:16). Otherwise the
gray-white matter differentiation is intact without acute territorial infarct
or mass effect. There is mild prominence of the ventricles and cortical sulci
consistent with volume loss. The extra-axial spaces are unremarkable.
The bilateral native lenses are absent. There senile calcifications at the
extraocular muscle tendon insertions. The soft tissues are unremarkable.
There is a heterogeneous a sclerotic appearance of the skullbase. The mastoid
air cells and middle ears are clear. There is soft tissue opacity completely
occluding the mid to inner right external auditory canal (5:220. There is
soft tissue debris within the left external auditory canal, likely
representing cerumen.
CTA: There is calcification of the bilateral intracranial internal carotid
arteries, which are patent. The bilateral posterior communicating arteries
are visualized. The anterior communicating artery is not definitively seen.
There are bilateral fetal origin posterior cerebral arteries. The posterior
circulation is diminutive and demonstrates right dominance with the left
vertebral artery ending in the posterior inferior cerebellar artery. There is
a short segment stenosis within the right V3 V4 segment vertebral artery,
likely at the site of the dural reflection (5:200). There is no evidence of
arterial occlusion, dissection, or aneurysm. There is no evidence of vascular
malformation. There is thin asymmetrically diminutive left transverse sinus
with absent contrast enhancement within the left sigmoid sinus and internal
jugular vein, likely secondary to phase of contrast.
CTA neck: There is a 3 vessel aortic arch. There is calcification at the
right carotid bifurcation and bulb, causing 20% stenosis at the bulb by NASCET
criteria ___: 19). There is calcification at the left carotid bifurcation
bulb without significant stenosis by NASCET criteria. There is calcification
of the right vertebral artery origin with moderate stenosis. The vertebral
arteries are patent and demonstrate right dominance.
There is a heterogeneous sclerotic appearance of the entirety of the
visualized spine and thoracic osseous structures. There is a dental ___ and
periapical lucency at the patient's a right maxillary molar tooth (5:191).
There are periapical lucencies and dental caries at the mandibular canine
teeth. There is a heterogeneous sclerotic appearance of the mandible and
alveolar maxillary bone. There is aerosolized secretions at the distal
trachea extending into the right mainstem bronchus, likely representing mucus.
There is mild bronchiectasis and bronchial wall thickening within the
visualized lungs. There is scattered opacities within the right upper lobe
bronchi with scattered small ground-glass opacities. There is a 2 mm nodule
in the right thyroid lobe. There is a diminutive appearance of the salivary
glands. There are no suspicious lymph nodes by size or morphology. The
masticator parapharyngeal spaces are unremarkable.
IMPRESSION:
1. 1.0 x 1.3 cm parenchymal hyperdensity within the right mid corona radiata
with mild adjacent vasogenic edema, likely representing an unchanged
parenchymal hemorrhage
2. Small subacute to chronic lacune within the right thalamus.
3. Patent intracranial vasculature. Short-segment stenosis at the right V3/V4
segment vertebral artery, likely at the dural reflection. No evidence of
aneurysm.
4. Diminutive left transverse sinus with absent filling of the left sigmoid
sinus and internal jugular vein, likely due to phase of contrast.
5. Patent neck vasculature with 20% stenosis at the right carotid bulb by
NASCET criteria. Moderate stenosis at the right vertebral artery origin.
6. Heterogeneous sclerotic appearance the skullbase, mandible, facial bones,
visualized spine, and thoracic osseous structures likely due to diffuse
blastic neoplasm, likely prostate given history of prostate cancer. Recommend
clinical correlation.
7. Dental caries and periapical lucencies within the remaining mandibular and
maxillary teeth.
8. Aerosolized secretions within the distal trachea extending of the mainstem
bronchus consistent with mucus or aspiration.
9. Mild bronchial wall thickening and bronchiectasis within the upper lobes
likely secondary to chronic aspiration.
10. Scattered opacities within the right upper lobe bronchi and scattered
small ground-glass opacities, likely representing aspiration and/or developing
pneumonia.
11. 2 mm hypodense nodule within the right thyroid lobe. Per the ___
College of Radiology, thyroid nodules measuring less than 1.5 cm in patient's
greater than ___ years of age do not require imaging follow up, in the absence
of clinical risk factors.
12. Complete opacification of the right external auditory canal, likely due to
cerumen. Recommend correlation with direct visualization, to exclude a mass.
RECOMMENDATION(S): 1. Recommend visualization of the right external auditory
canal.
2. 2 mm hypodense nodule within the right thyroid lobe. Per the ___
College of Radiology, thyroid nodules measuring less than 1.5 cm in patient's
greater than ___ years of age do not require imaging follow up, in the absence
of clinical risk factors.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:39 AM, 15 minutes after
discovery of the findings.
|
10122838-RR-19 | 10,122,838 | 26,886,831 | RR | 19 | 2175-10-16 11:52:00 | 2175-10-16 14:34:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old man with R parietal IPH, evaluate for mass.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, T2 and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Head and neck CTA dated ___.
FINDINGS:
The known right basal gangliar intraparenchymal hemorrhage is similar to the
prior study with a moderate amount of surrounding vasogenic edema and no
associated midline shift (3:17, 9:17). No other foci of hemorrhage are
identified. There is no evidence of acute infarction. There is mild
prominence of the ventricles and sulci suggesting age related involutional
changes. A chronic right thalamic infarction is unchanged. Mild T2 and FLAIR
periventricular hyperintensities are consistent with chronic small vessel
ischemic change.
Uniform low signal intensity of the visualized osseous structures,
particularly the proximal cervical spine, which demonstrates enhancement
following contrast administration, is consistent with metastatic prostate
cancer, better evaluated by CT.
IMPRESSION:
1. No interval hemorrhage or evidence of acute infarction.
2. Unchanged right basal gangliar intraparenchymal hemorrhage with mild
associated vasogenic edema and no midline shift. There is no definite
enhancement seen surrounding or within the hemorrhage. Follow-up examination
after resolution of hemorrhage should be obtained to exclude any underlying
abnormality.
RECOMMENDATION(S): Follow-up examination after resolution of hemorrhage
should be obtained to exclude any underlying abnormality about the hemorrhage.
|
10122838-RR-20 | 10,122,838 | 26,886,831 | RR | 20 | 2175-10-14 13:51:00 | 2175-10-14 17:22:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old man with stroke now s/p DHT // please eval tube
placement. Please page ___ when on floor so I can look at film for
advancement per protocol.
TECHNIQUE: Single AP radiograph of the chest.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
A dobhoff tube is seen coursing below the diaphragm, with the tip in the
stomach. The lungs are hyperinflated suggesting COPD. There are ill-defined
opacities within the right mid and lower lung, possibly representing
multifocal pneumonia. The pulmonary vasculature is normal. The
cardiomediastinal silhouette is stable. There are no pleural effusions.
There is no visualized pneumothorax.
There is a diffuse increase in the density of the bones of the thoracic spine,
raising concern for bony metastatic disease. There is high-density material
within the right upper abdominal quadrant, which may represent retained
contrast within the renal collecting system.
IMPRESSION:
1. Dobhoff tube with tip in the stomach.
2. Ill-defined opacities within the right mid and lower lung, possibly
representing multifocal pneumonia.
3. Hyperinflation suggesting COPD.
4. Diffuse increase in the thoracic spine density, raising concern for bony
metastatic disease.
5. High-density material within the right upper quadrant, which may represent
retained contrast within the renal collecting system.
|
10122838-RR-21 | 10,122,838 | 26,886,831 | RR | 21 | 2175-10-15 14:04:00 | 2175-10-15 18:17:00 | INDICATION: ___ year old man with hx prostate ca, colon ca presented with
intraparenchymal hemorrhage, noted to have sclerotic lesions on head ct and
cxr concerning for widespread cancer // please eval for signs of metastatic
disease, particularly bony involvement.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 637 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is moderate periportal edema. There is no evidence of focal lesions.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: A 7 mm cystic lesion in the pancreatic head is noted (2:69). There
is no evidence of pancreatic ductal dilatation or peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. An accessory splenule measuring 1.7 cm (2:61) is
noted.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is moderate hydroureteronephrosis of the right kidney with an
abrupt cut off of the right distal ureter (2:90, 91). There is an irregular
conglomerate of soft tissue nodules (2:92) adjacent to this cut off, which is
suspicious for extrinsic compression secondary to recurrent or metastatic
disease. Contrast is seen throughout the right renal collecting system up to
this abrupt cut off, which is compatible with an nonobstructive
hydroureteronephrosis. There is a 2.0 cm exophytic simple cyst off the lower
pole of the left kidney. There is no evidence hydronephrosis or perinephric
abnormality in the left kidney.
GASTROINTESTINAL: The stomach appears edematous. An enteric tube terminates
within the stomach. Small bowel loops demonstrate normal caliber, wall
thickness, and enhancement throughout. There is colonic diverticulosis
without evidence of diverticulitis. The appendix is not visualized. Surgical
clips are noted in the right mid abdomen.
PELVIS: The bladder is filled with intravenous contrast. The left distal
ureter is unremarkable. Please refer to urinary section above for discussion
of the right distal ureter. Patient is status post pelvic lymph node
dissection with surgical clips noted in the bilateral pelvic sidewalls.
REPRODUCTIVE ORGANS: The prostate is surgically absent. Scrotal pearls are
noted.
LYMPH NODES: There are a cluster of ill-defined soft tissue in nodules
adjacent to the right common iliac artery and adjacent to the broke off of the
right distal ureter (2:92, 93, and 94) which are concerning for recurrent or
metastatic disease.
VASCULAR: There is moderate to significant atherosclerotic disease. There is
no abdominal aortic aneurysm.
BONES: There are diffuse sclerotic lesions in the spine, pelvis, and ribs
concerning for metastatic disease.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Diffuse sclerotic lesions in the spine, pelvis, and ribs concerning for
malignant disease, likely metastatic prostate cancer.
2. Moderate right partially obstructive hydroureteronephrosis either secondary
to urothelial lesion or extrinsic compression by adjacent soft tissue.
Ureteroscopy is recommended.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ on the telephone on ___ at 5:30 ___, 15 minutes after discovery
of the findings.
|
10122838-RR-22 | 10,122,838 | 26,886,831 | RR | 22 | 2175-10-15 14:26:00 | 2175-10-15 17:22:00 | INDICATION: ___ male with prostate cancer.
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) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 6.5 s, 71.9 cm; CTDIvol = 8.7 mGy (Body) DLP = 627.4
mGy-cm.
Total DLP (Body) = 637 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest radiograph dated ___.
FINDINGS:
There are 2 hypodensities within the right lobe of the thyroid, neither of
which meets the ACR size threshold for ultrasound follow-up of incidental
thyroid nodules. There are no enlarged axillary, supraclavicular,
mediastinal, or hilar lymph nodes. A nasogastric tube is seen coursing into
the stomach.
There is moderate cardiomegaly. There is no pericardial effusion. There are
extensive coronary calcifications. There are moderate calcifications within
the head and neck vessels. There is no thoracic aortic aneurysm. The main
pulmonary artery is not enlarged. Although limited by bolus timing, there are
no large central pulmonary emboli.
The large airways are normal. There are small to moderate bilateral pleural
effusions, non serous, but non hemorrhagic. There is a combination of
pneumonia within the superior segments of the right lower lobe, and
atelectasis within the basal segments of the right lower lobe. There are
additional ___ and ground-glass opacities with bronchial wall
thickening within the right upper and middle lobe. The left lung is
essentially clear. There is no pneumothorax.
The bones are diffusely sclerotic due to widespread prostatic metastatic
disease. There are no pathologic or compression fractures. Please refer to
the abdominal CT with the same date for evaluation of the abdominal organs.
IMPRESSION:
1. Extensive metastatic involvement of the bones, but no pathologic fractures.
2. Right lower lobe pneumonia and atelectasis.
3. Small to moderate nonhemorrhagic pleural effusions.
4. Extensive coronary calcifications.
5. Please refer to the abdominal CT with the same date for evaluation of
intra-abdominal organs.
|
10123220-RR-13 | 10,123,220 | 26,589,699 | RR | 13 | 2111-09-28 17:22:00 | 2111-09-28 18:45:00 | HISTORY: Neck pain, right hand weakness.
TECHNIQUE: Multiplanar multisequence noncontrast MR images of the cervical
spine were obtained.
COMPARISON: None.
FINDINGS:
The visualized osseous structures exhibit normal alignment and marrow signal.
C2-C3: Mild central disc protrusion partially effacing the ventral thecal sac
without significant spinal canal or neural foraminal narrowing.
C3-C4: Central disc protrusion with posterior osteophytosis efface the
ventral thecal sac and contacts the ventral aspect of the cord with mild
spinal canal narrowing. Uncovertebral joint hypertrophy and facet arthrosis
cause mild left greater than right neural foraminal narrowing.
C4-C5: Broad-based central left paracentral disc protrusion effaces the
ventral thecal sac and deforms the ventral aspect of the cord causing
/mildmoderate spinal canal narrowing in conjunction with thickened ligamentum
flavum effacing the dorsal thecal sac. Disc protrusion, uncovertebral joint
hypertrophy, and facet arthrosis cause moderate right and severe left neural
foraminal narrowing.
C5-C6: Near-complete loss of disk space height with disc desiccation. Large
disc protrusion and posterior osteophytosis, as well as ligamentum flavum
thickening, cause severe spinal canal narrowing with impingement of the spinal
cord with associated cord signal abnormality reflecting myelomalacia.
Uncovertebral joint hypertrophy and facet arthrosis cause moderate right and
severe left neural foraminal narrowing.
C6-C7: Near complete loss of disc space height and disc desiccation. Central
disc protrusion deforms the ventral aspect of the cord causing moderate spinal
canal narrowing. Uncovertebral hypertrophy and facet arthrosis cause moderate
right and moderate/severe left neural foraminal narrowing.
C7-T1: Loss of disc space height with disc desiccation. Mild disc protrusion
partially effacing the ventral thecal sac with mild spinal canal narrowing.
Uncovertebral hypertrophy and facet arthrosis cause moderate left greater than
right neural foraminal narrowing.
Small disc protrusion is noted at T2-T3 without significant spinal canal
narrowing.
The visualized portions of the posterior fossa, superior mediastinum, and lung
apices are unremarkable.
IMPRESSION:
Large C5-C6 disc protrusion with posterior osteophytosis and ligamentum flavum
thickening causing severe spinal canal narrowing with impingement of the
spinal cord and associated cord signal abnormality reflecting myelomalacia.
Moderate right and severe left C5-C6 neural foraminal narrowing.
Moderate C6-C7 spinal canal, and moderate right and moderate/severe left
neural foraminal narrowing
Severe C4-C5 left neural foraminal narrowing. Moderate C7-T1 bilateral neural
foraminal narrowing.
|
10123220-RR-14 | 10,123,220 | 26,589,699 | RR | 14 | 2111-09-29 18:39:00 | 2111-09-30 09:41:00 | HISTORY: Fusion.
FINDINGS: Images from the operating suite show anterior fusion with interbody
spacers spanning C4 through C7. Further information can be gathered from the
operative report.
|
10123220-RR-15 | 10,123,220 | 26,589,699 | RR | 15 | 2111-09-30 13:23:00 | 2111-09-30 16:31:00 | HISTORY: Posterior cervical laminectomy.
FINDINGS: Images from the operating suite show posterior fusion spanning C4
through C7 in addition to the anterior fusion with interbody spacers at this
level. Some prevertebral soft tissue prominence is consistent with recent
surgery.
|
10123421-RR-15 | 10,123,421 | 29,885,856 | RR | 15 | 2152-05-28 20:30:00 | 2152-05-28 20:45:00 | INDICATION: Exertional chest pain.
COMPARISON: None.
PA AND LATERAL VIEWS OF THE CHEST: The heart size is moderately enlarged.
The aorta is slightly unfolded. Hilar contours are normal. Elevation of left
hemidiaphragm is noted, with adjacent streaky opacity in left lung base,
likely reflective of atelectasis. No pleural effusion, pulmonary edema, or
pneumothorax is present. Multiple clips are demonstrated within the left
axilla, and the patient appears to be status post left mastectomy. Multiple
clips are also seen within the upper abdomen, only on the lateral view. There
are no acute osseous abnormalities.
IMPRESSION: Moderate cardiomegaly, but no evidence for pulmonary edema.
|
10123924-RR-21 | 10,123,924 | 24,269,221 | RR | 21 | 2139-11-12 08:15:00 | 2139-11-12 11:53:00 | EXAMINATION: FEMUR (AP AND LAT) RIGHT
IMPRESSION:
Images from the operating suite show extensive fixation device since about
periprosthetic fracture the right femur. Further information can be gathered
the operative report.
|
10123949-RR-115 | 10,123,949 | 28,859,520 | RR | 115 | 2181-10-09 15:41:00 | 2181-10-09 16:04:00 | HISTORY: ___ male with incident dependent diabetes, on home
peritoneal dialysis presents with chest pain.
COMPARISON: ___.
FINDINGS:
PA and lateral views of the chest. Streaky left midlung opacity is most
compatible with atelectasis. The lungs are otherwise clear. The
cardiomediastinal silhouette is normal. Free intraperitoneal air seen below
the hemidiaphragms. Soft tissues and osseous structures are otherwise
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
Free intraperitoneal air compatible with patient's history of peritoneal
dialysis.
|
10123949-RR-116 | 10,123,949 | 28,859,520 | RR | 116 | 2181-10-10 12:35:00 | 2181-10-10 16:38:00 | HISTORY: ___ man with PICC, evaluate placement.
TECHNIQUE: Portable AP frontal chest radiograph was obtained.
COMPARISON: Chest radiograph from ___.
FINDINGS:
New left-sided PICC line ends at the cavoatrial junction with no complications
including pneumothorax seen. Low lung volumes and atelectasis continues to be
seen. No consolidation, pleural effusion or pulmonary edema is seen, and the
cardiac and mediastinal contours are normal. Previous free intraperitoneal
air associated with peritoneal dialysis is no longer seen.
IMPRESSION:
New left-sided PICC line ends at the cavoatrial junction with no
complications.
|
10123949-RR-119 | 10,123,949 | 23,813,195 | RR | 119 | 2182-01-19 21:11:00 | 2182-01-19 22:26:00 | CHEST TWO VIEWS, ___
HISTORY: ___ male with diabetes, end-stage renal disease on
peritoneal dialysis with hypoglycemia. Question pneumonia.
COMPARISON: ___.
FINDINGS: PA and lateral views of the chest. Left PICC is no longer
visualized. The lungs are clear of focal consolidation or effusion. The
cardiomediastinal silhouette is normal. No acute osseous abnormality is
detected.
IMPRESSION: No acute cardiopulmonary process.
|
10123949-RR-120 | 10,123,949 | 24,460,648 | RR | 120 | 2182-03-27 07:08:00 | 2182-03-27 07:41:00 | HISTORY: Chest pain.
COMPARISON: Multiple prior chest radiographs, most recently of ___.
FINDINGS:
Frontal and lateral views of the chest. Heart size and cardiomediastinal
contours are normal. Mild interstitial abnormality is not accompanied by any
ancillary findings of heart failure, but could be edema nevertheless. Lungs
are clear of focal consolidation, pleural effusion, or pneumothorax.
IMPRESSION:
Mild interstitial edema.
|
10123949-RR-121 | 10,123,949 | 24,460,648 | RR | 121 | 2182-03-27 09:20:00 | 2182-03-27 09:44:00 | HISTORY: Patient with new right IJ central venous catheter, evaluate for
placement.
COMPARISON: PA and lateral chest x-ray from ___.
FINDINGS: Portable single frontal chest radiograph was obtained.
A right sided internal jugular central venous catheter is malpositioned with
the tip terminating in the region of the right axillary vein. There is no
pneumothorax. Lungs are clear. The cardiomediastinal silhouette, hilar
contours, and pleural surfaces are normal. There is no pleural effusion.
IMPRESSION: Malpositioned right IJ central venous catheter with the tip
terminating in the region of the right axillary vein.
Findings were flagged on the ED dashboard by Dr. ___ at 09:44 on ___.
|
10123949-RR-123 | 10,123,949 | 24,460,648 | RR | 123 | 2182-03-28 12:45:00 | 2182-03-28 16:04:00 | HISTORY: ___ male in need of right-sided temporary catheter.
COMPARISON: Chest x-ray ___ and chest CT ___
CLINICIANS: Dr. ___ (attending physician) and Dr. ___
(fellow). The attending was present throughtout the entirety of the
procedure.
Anesthesia: Moderate sedation was provided by administering divided doses of
Versed throughout the total intra-service time of 1 hour. The patient's
hemodynamic parameters were continuously monitored by an independently trained
radiology nurse. A total dose of 1 mg versed was used. 1% lidocaine was used
for local anesthesia.
Radiation: 86 mGy
Pleural: 2.56 min
No contrast used for today's procedure
PROCEDURE:
1. Right internal jugular venous access.
2. Placement of a triple -lumen temporary non-tunneled line via the right
IJV.
FINDINGS:
The procedure was discussed in detail with the patient and risks and benefits
emphasized. Informed written consent was obtained.
When the patient arrived in the procedure suite, they were placed supine on
the procedure table. The right upper chest was prepped and draped in usual
sterile fashion. A preprocedural time out was performed per ___ protocoll.
Under continuous ultrasound guidance, the right internal jugular vein, which
was patent and compressible, was accessed using a micropuncture needle. A
Nitinol wire was then advanced through the micropuncture sheath, however,
continued to coil within the subclavian vein. At this time the wire was
removed and a new puncture of the right internal jugular vein more cranial and
medial was performed. The Nitinol wire was directed down the SVC, passed into
the right side of the heart and the needle exchanged for a micropuncture
sheath. The inner dilator and Nitinol wire were removed and ___ wire was
advanced through the heart into the IVC.
Several dilators were attempted, however, all buckled within the subcutaneous
tissue. At this time the ___ wire was exchanged for an Amplatz wire and the
tract was dilated with a 6, 7 and 8 ___ dilator. The catheter was inserted
over the wire and fluoroscopy verified positioning of the tip at the
cavoatrial junction. The tip was slightly withdrawn, however, due to severe
patient discomfort manipulation of the tip was aborted. The lumens were
flushed according to protocol. The catheter was sutured to the skin and a
bandage per protocol.
The patient left the department in stable condition. No complications.
IMPRESSION:
Successful placement of a right-sided triple lumen temporary catheter via the
right IJ.
The tip is at the cavoatrial junction and the catheter ready to use at this
time.
|
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