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10123949-RR-124 | 10,123,949 | 24,460,648 | RR | 124 | 2182-03-31 10:14:00 | 2182-03-31 12:13:00 | HISTORY: Right upper extremity swelling, right internal jugular, rule out
deep vein thrombosis.
FINDINGS:
Soft tissue edema is noted in the right upper extremity. The right
subclavian, internal jugular, axillary, brachial and basilic veins are patent
with normal flow and compression and no findings to suggest deep vein
thrombosis. A right fistula graft is noted. There is atherosclerosis of the
right common carotid artery.
IMPRESSION:
No findings to suggest right upper extremity deep vein thrombosis.
Findings were discussed with Dr. ___ at 11:55 a.m. on ___, five minutes after discovery of findings.
|
10123949-RR-134 | 10,123,949 | 25,762,958 | RR | 134 | 2182-10-14 13:57:00 | 2182-10-14 14:19:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new picc // L picc 42cm ___ ___ Contact
name: ___: ___ L picc 42cm ___ ___
IMPRESSION:
In comparison with the study of ___, there is increased opacification at the
left base with poor definition of the hemidiaphragm, consistent with layering
effusion and volume loss in the left lower lobe. The left subclavian PICC line
loops upon itself in the axillary region. Hemodialysis catheter extends to the
right atrium. The right lung is clear.
The misplaced catheter was telephoned to Carmel, the venous access nurse.
|
10123949-RR-135 | 10,123,949 | 25,762,958 | RR | 135 | 2182-10-20 17:32:00 | 2182-10-20 19:43:00 | INDICATION: ___ year old man with ESRD on HD, PVD, infected HD line.
COMPARISON: Chest radiograph ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
150mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 30 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl and midazolam.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1.4 min, 7 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right neck and upper chest were prepped and
draped in the usual sterile fashion
A fluoroscopic image was obtained and showed a left tunneled subclavian
catheter with tip in the right atrium. A stiff glidewire was passed through
the existing catheter. The skin over the venotomy site was anesthetized using
lidocaine. A dermatotomy was performed were the catheter was visualized which
was clamped. The stiff glidewire was advanced into the IVC and the catheter
was pulled back over the wire. The wire was pulled through the tunnel to the
venotomy site and a new 24 cm temporary dialysis catheter was inserted. The
tip was placed in the distal SVC using fluoroscopy.
Both access ports were aspirated, flushed and capped. The catheter was
secured to the skin with a 0 silk suture and sterile dressings were applied.
Final spot fluoroscopic image demonstrating good alignment of the catheter and
no kinking. The patient tolerated the procedure well without immediate
complications.
FINDINGS:
Final fluoroscopic image showing dual lumen central venous catheter with
catheter tip terminating in the distal SVC.
IMPRESSION:
Exchange of a left tunneled subclavian dialysis catheter with a non-tunneled
temporary dialysis catheter. The catheter is ready for use.
|
10123949-RR-137 | 10,123,949 | 25,762,958 | RR | 137 | 2182-10-19 11:10:00 | 2182-10-19 20:12:00 | STUDY: Bilateral upper extremity venous duplex.
REASON: Preop dialysis access.
FINDINGS: Duplex was performed of bilateral upper extremity veins and limited
views of the brachial and radial arteries were also obtained. Phasic flow was
seen in the subclavian veins bilaterally. The brachial and radial arteries
are heavily calcified bilaterally. Waveforms are triphasic throughout the
brachial and radial arteries. The right brachial is duplicated, measures 3.5
mm and 2.1 mm. The radial measures 2.2 mm. The left brachial measures 3.9
mm, the left radial measures 1.6 mm.
The right cephalic vein is noncompressible in the upper arm, diameters above
and below this are less than 2 mm. The right basilic vein is patent with
diameters of 2.2 mm or less. The left cephalic was not visualized in the
forearm. An IV is in place in the upper arm and there is thrombus in the left
basilic near the axilla.
IMPRESSION: No suitable venous conduit for AV fistula noted in bilateral
upper extremities.
|
10123949-RR-138 | 10,123,949 | 25,762,958 | RR | 138 | 2182-10-22 13:09:00 | 2182-10-22 13:58:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: New right upper extremity swelling.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Upper extremity ultrasound from ___.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins. A hemodialysis catheter is seen in the left subclavian vein.
The right internal jugular and axillary veins are patent and compressible with
transducer pressure.
The right brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
There are several cervical lymph nodes with borderline size seen in the right
neck.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10123949-RR-139 | 10,123,949 | 25,762,958 | RR | 139 | 2182-10-25 13:25:00 | 2182-10-25 15:26:00 | INDICATION: ___ year old man requiring exchange of a non-tunneled temporary
dialysis catheter done on ___. Now converting temporary non-tunnled line to
tunneled line.
COMPARISON: Prior conversion of left-sided tunneled line to temporary
dialysis catheter from ___.
TECHNIQUE: OPERATORS: Dr. ___ ( radiology resident) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 15 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. Local
anesthesia was provided by 1% lidocaine into the dermis and 1% lidocaine with
epinephrine into the subcutaneous tissues.
MEDICATIONS: No additional medications were provided.
CONTRAST: No contrast was used.
FLUOROSCOPY TIME AND DOSE: 2 min, 12 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The left upper chest was prepped and draped in
the usual sterile fashion.
A 0.035 ___ wire was initially advanced into the right atrium through the
existing temporary dialysis catheter. Subsequently, a stiff Glidewire was
advanced into the right atrium through the existing temporary dialysis
catheter in the left subclavian vein. The wire was advanced into the IVC under
fluoroscopic guidance. Appropriate measurements were made for skin incision,
approximately 7 cm below the venotomy site. After anesthetizing the skin and
subcutaneous tissues, attention was turned to the creation of the subcutaneous
tunnel. After additional local anesthesia, a small skin incision was made at
the tunnel entry site. A 15.5 ___ tunnel catheter was passed from the
incision to the venotomy site with aid of a metal tunneling device. The
existing dialysis catheter was removed. The venotomy tract was dilated using
the introducer of the peel-away sheath supplied. The peel-away sheath was
passed over the wire. The wire and the inner cannula were removed and the
catheter was passed through the peel-away sheath into the right atrium. This
was confirmed with fluoroscopy demonstrating the catheter tip in the right
atrium. Both lumens withdrew blood and flushed easily. The catheter was
secured with 0 silk sutures. The venotomy site was closed with Steri-Strips.
Dry sterile dressings were applied. No immediate post-procedure complications
were noted. The patient tolerated the procedure well.
FINDINGS:
Existing left-sided temporary dialysis catheter with tip terminating in the
right atrium.
IMPRESSION:
Successful exchange of existing left subclavian vein temporary dialysis
catheter for a tunneled access catheter through the left subclavian vein
approach. The tip is located in the right atrium and the catheter is ready for
use.
|
10123949-RR-140 | 10,123,949 | 23,147,995 | RR | 140 | 2182-10-29 08:15:00 | 2182-10-29 09:20:00 | INDICATION: Right-sided weakness, in a patient on heparin. Evaluate for
hemorrhage.
TECHNIQUE: Helical axial MDCT images were obtained through the brain without
the administration of IV contrast. Reformatted images in coronal and sagittal
axes were generated.
DOSE: DLP: 891.9 mGy-cm
COMPARISON: Noncontrast CT head from ___ second ___.
FINDINGS:
There is no acute large territorial infarct, hemorrhage, edema, or mass
effect. The ventricles and sulci are normal in size and configuration. The
basal cisterns are patent and there is preservation of gray-white matter
differentiation.
There is no acute fracture. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
IMPRESSION:
No acute intracranial abnormality.
|
10123949-RR-141 | 10,123,949 | 23,147,995 | RR | 141 | 2182-10-29 19:59:00 | 2182-10-29 21:30:00 | EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: History: ___ with new onset right sided weakness // eval for
thrombus
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of intravenous contrast
material. Images were processed on a separate workstation with display of
curved reformats, 3D volume rendered images, and maximum intensity projection
images.
DOSE: DLP: 2539.83 mGy-cm; CTDI: 123.91 mGy
COMPARISON: CT head ___.
FINDINGS:
There is no evidence acute intracranial hemorrhage or mass effect. The
ventricles and basilar cisterns appear normal. There is mild brain parenchymal
volume loss.
There is no evidence of intracranial aneurysm, vascular malformation, or
hemodynamically significant stenosis within the intracranial vasculature.
There is scattered atheromatous narrowing throughout the vertebral arteries,
greatest within the distal vertebral arteries, at the origins of the great
vessels, and carotid bifurcations although there is no evidence of
hemodynamically significant stenosis or pathologic large vessel occlusion
within the neck. The right vertebral artery is dominant.
There is a large left pleural effusion with associated atelectasis. The
remaining paraspinal soft tissues are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial hemorrhage or mass effect.
2. No evidence of hemodynamically significant stenosis or pathologic large
vessel occlusion within the head or neck.
|
10123949-RR-142 | 10,123,949 | 23,147,995 | RR | 142 | 2182-10-29 16:10:00 | 2182-10-29 17:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SSTI on IV antibiotics, heparin drip PICC in
place.
COMPARISON: Chest radiograph from ___.
FINDINGS:
AP portable upright view of the chest.
A left approach tunneled central line terminates at the right atrium. Multiple
intact sternal wires are again seen. A large left pleural effusion has
enlarged since ___. The right lung appears clear. There is no
pneumothorax.
A left PICC remains within the left axillary vein.
IMPRESSION:
1. Left PICC terminating within the left axillary vein.
2. Large left pleural effusion has enlarged since ___.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 5:17 ___, 2 minutes after discovery of the
findings.
|
10123949-RR-144 | 10,123,949 | 23,147,995 | RR | 144 | 2182-10-30 16:39:00 | 2182-10-31 08:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHEST TUBE PLACEMENT for loculated pleural
effusion // eval for chest tube placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Since the previous examination a pigtail catheter is seen in the left lower
pole region. The large left pleural effusion has substantially resolved. There
is a small left pneumothorax presumably due to trapped or hypoinflated lung.
The right lung is clear. Monitor leads overlie the chest. 80 double lumen
large bore catheter terminates in the right atrium. The patient has median
sternotomy closures and mediastinal clips consistent with coronary artery
bypass graft.
IMPRESSION:
Evidence for interval placement of a pigtail catheter in the left pleural
space with and substantial reduced affection of the large pleural effusion.
Small pneumothorax is present
The right lung is clear.
|
10123949-RR-145 | 10,123,949 | 23,147,995 | RR | 145 | 2182-10-31 07:14:00 | 2182-10-31 08:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest tube placement // eval CT placement,
ptx/pleural effusion
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. The small
left basal pneumothorax, seen at the level of the costophrenic sinus, is
constant in appearance. Unchanged position of the left pigtail catheter.
Minimal re-expansion edema on the left. Normal size of the cardiac silhouette.
Unchanged alignment of the sternal wires. Unremarkable and unchanged
appearance of the right lung.
|
10123949-RR-146 | 10,123,949 | 23,147,995 | RR | 146 | 2182-11-01 12:19:00 | 2182-11-01 14:33:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with ESRD and vascular risk factors, now
hemiplegia, suspected stroke, now worsening symptoms // R/o hemorrhage
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 1003 mGy-cm
COMPARISON: CT angiography ___.
FINDINGS:
There is no significant interval change since the previous CT head ___. Hemorrhage mass effect midline shift or hydrocephalus is seen. Mild to
moderate brain atrophy is identified.
There is a subtle hypodensity in the left posterior frontal region. This is
better appreciated on the current study. Extensive vascular calcifications
are seen
IMPRESSION:
Subtle hyperdensity in the left posterior frontal lobe best visualized on
image on series 2, image ___. MRI can help for further assessment. No acute
hemorrhage.
|
10123949-RR-147 | 10,123,949 | 23,147,995 | RR | 147 | 2182-11-03 09:59:00 | 2182-11-03 16:00:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old man with R weakness, evaluate for infarct.
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T1-weighted, axial fast spin echo T2-weighted,axial flair,
axial diffusion weighted and axial gradient echo images .
COMPARISON: Head CT ___ T8 and CTA head and neck ___.
FINDINGS:
Very limited exam secondary to patient position. There is slow diffusion
involving the posterior frontal lobe extending from the cortical white matter
to the gray matter. Additional punctate foci of restricted diffusion are seen
superiorly/anteriorly within the frontal lobe. There does appear to be
corresponding high signal on FLAIR in the regions of slow diffusion.
Evaluation of hemorrhage is limited.
IMPRESSION:
Subacute infarct involving the posterior frontal lobe with additional punctate
areas of slow diffusion in the more anterior/superior frontal lobe, suggesting
a thromboembolic source.
NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ the
telephone on ___ at 12:20, 20 min after they were made.
|
10123949-RR-148 | 10,123,949 | 23,147,995 | RR | 148 | 2182-11-07 10:37:00 | 2182-11-07 13:40:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ year old man with prior chest tube for pulm effusion, removed
early per pt request // eval for effusion, ptx on L side
TECHNIQUE: Portable chest radiograph
COMPARISON: Portable chest radiograph ___
FINDINGS:
Since the prior radiograph, the left sided chest tube has been removed and the
left pleural effusion has increased in size. The superior portion of the left
hemithorax is also diffusely opacified, which is due to layering pleural
effusion. Oval shaped lucency abutting left heart border is likely a basilar
pneumothorax and has remained stable since ___. The right lung
essentially clear. Cardiomediastinal silhouette is stable. No acute osseous
abnormalities.
Median sternotomy wires and left subclavian catheter are unchanged in
position. Left midline catheter terminates in the axillary or left
brachiocephalic vein, unchanged.
IMPRESSION:
1. Interval removal of the left pigtail catheter, with worsening layering left
pleural effusion.
2. Stable small left basilar pneumothorax.
|
10123949-RR-149 | 10,123,949 | 28,284,803 | RR | 149 | 2182-12-05 02:04:00 | 2182-12-05 02:47:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with worsened right sided weakness // eval for
bleed
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891 mGy-cm; CTDI: 55 mGy
COMPARISON: MR from ___
FINDINGS:
There is no acute intracranial hemorrhage,acute infarction or midline shift.
There is no hydrocephalus. There is no edema. Focal hypodensity spanning the
posterior frontal lobe on the left is compatible with chronic infarct as seen
on the MR from ___.
There is no fracture. There is extensive atherosclerotic calcification of the
distal vertebral arteries and the carotid siphons, as well as the scalp
vessels, diffusely, . Visualized paranasal sinuses and mastoid air cells are
clear.
IMPRESSION:
1. No acute intracranial abnormality, with evolving focal encephalomalacia
involving the posterior left frontal lobe.
2. Dense calcifications of the intra-and extracranial vessels,, likely related
to the underlying ESRD on dialysis.
|
10123949-RR-152 | 10,123,949 | 28,284,803 | RR | 152 | 2182-12-05 05:11:00 | 2182-12-05 05:35:00 | INDICATION: History: ___ with R arm pain // evidence of infection
//History: ___ with R arm pain
TECHNIQUE: Single portable view of the chest
COMPARISON: ___
FINDINGS:
The lungs are clear. The previous left pleural effusion has mostly resolved.
Dialysis subclavian line remains in place. Median sternotomy wires are noted.
No pneumothorax. Normal cardiac size.
IMPRESSION:
No evidence of acute cardiopulmonary process. Nearly completely resolved left
pleural effusion.
|
10123949-RR-153 | 10,123,949 | 28,284,803 | RR | 153 | 2182-12-05 09:21:00 | 2182-12-05 10:29:00 | EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ man presenting with right elbow swelling and
tenderness.
COMPARISON: None available.
FINDINGS:
There is no acute fracture or dislocation. There is diffuse subcutaneous
swelling in the posterior upper arm. There are minimal degenerative changes.
There are no focal lesions or osseous erosions. There is extensive vascular
calcification and a vascular stent present in the upper arm.
IMPRESSION:
No fracture or dislocation.
|
10123949-RR-154 | 10,123,949 | 28,284,803 | RR | 154 | 2182-12-05 16:03:00 | 2182-12-05 17:04:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ male with prior stroke and right hemiparesis. Right
arm swelling, question DVT.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: ___ right upper extremity venous ultrasound.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular and axillary veins are patent and compressible with
transducer pressure.
The right axillary, brachial, and basilic veins are patent with normal flow
and compression with no sonographic findings of thrombosis. The cephalic vein
is not visualized. In the region of the cephalic vein, there is a abandoned
graft, as seen on prior ultrasound.
IMPRESSION:
No evidence of deep venous thrombosis in the right upper extremity. The
cephalic vein is not visualized. Again demonstrated is a right sided abandoned
dialysis graft.
|
10123949-RR-167 | 10,123,949 | 20,216,545 | RR | 167 | 2183-07-23 14:49:00 | 2183-07-23 15:38:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with fever, cough // eval for pneumonia
COMPARISON: ___ and ___.
FINDINGS:
AP upright and lateral views of the chest provided. Midline sternotomy wires
and prosthetic cardiac valve are again noted. There is a left subclavian
dialysis catheter with its tip in the low SVC in the region of the cavoatrial
junction. Patient is rotated to the right limiting assessment. There is mild
pulmonary edema noted with hilar engorgement. No large effusion is seen.
Please note lateral view limited due to motion artifact. No large
pneumothorax. The imaged osseous structures appear grossly intact.
IMPRESSION:
Mild pulmonary edema. No definite signs of pneumonia though post diuresis
chest radiograph may be obtained to further assess.
|
10123949-RR-168 | 10,123,949 | 20,216,545 | RR | 168 | 2183-07-24 16:22:00 | 2183-07-24 17:10:00 | EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: ___ M w/ESRD on HD, DM1, CAD s/p AVR and CABG, PAD, and CVA
presenting w/shortness of breath, RUE, RLE edema. // Please evaluate for DVT
in the Right lower extremity
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow is demonstrated in
the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10123949-RR-169 | 10,123,949 | 20,216,545 | RR | 169 | 2183-07-24 13:02:00 | 2183-07-25 17:19:00 | INDICATION: ___ year old man with ESRD on HD, with swollen right upper
extremity, concern for possible central stenosis // please perform fistulagram
for possible central stenosis
COMPARISON: Comparison is made to venous a cannulation procedure 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: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 1 hr 20 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: fentanyl, Versed, lidocaine.
CONTRAST: 54 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 13.8 min, 30 mGy
PROCEDURE:
1. Right upper extremity venogram.
2. Right subclavian/ brachiocephalic/ superior vena cava venoplasty with 8 mm
cutting balloon.
3. Right subclavian/brachiocephalic/superior vena cava venoplasty with 12 mm
conventional balloon
4. Post venoplasty right subclavian/ brachiocephalic/superior vena cava
venogram
PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the right
upper extremity abducted and stabilized.
Clinical examination demonstrated a significantly small in right upper
extremity, particularly distally. Right Upper extremity was prepped and draped
in the usual sterile fashion. A preprocedure timeout and huddle was performed
as per ___ protocol.
Using ultrasound and fluoroscopy, the right basilic vein was accessed under
continuous ultrasound guidance using a 21G micropuncture needle (of note,
patient has an brachiobasilic straight AV graft). Permanent ultrasound images
were saved. A 018wire was then advanced easily into the basilic vein under
fluoroscopic guidance. A 4.5F micropuncture sheath was advanced and used to
exchange for an 0.035 Glidewire. The glide wire was advance to the level of
the superior vena cava. Given expectation of brachiocephalic stenosis, the
decision was made to perform venogram through indwelling micropuncture sheath
before upsizing to a 6 ___ sheath. A right upper extremity venogram was
performed demonstrating mild stenosis at the junction of the brachiocephalic
and superior vena cava. The micropuncture sheath was exchanged for a short 6
___ sheath over the wire. The glidewire was exchanged for ___ wire
which was advanced into the inferior vena cava. The ___ wire was then
exchanged for an Amplatz wire via a Kumpe catheter. The Kumpe catheter was
withdrawn. An 8 mm cutting balloon was advanced along the wire and inflated
throughout the subclavian vein, brachiocephalic vein, and vena cava. A slight
waist was noted at the junction of the brachiocephalic and superior vena cava.
The cutting balloon was then exchanged for a 12 mm conventional balloon which
was again dilated through the same vessels. Two areas of stenosis were
identified, at the junction of the subclavian and brachiocephalic and again
slightly more in the distal in the brachiocephalic. Both waists effaced
easily before meeting rated burst pressure of 14 atm. The balloon catheter
was withdrawn and a repeat right upper extremity venogram was performed
through the sheath demonstrating improved stenosis and brisk flow into the
superior vena cava. The sheaths were removed and hemostasis was achieved with
manual pressure. There were no immediate complications.
FINDINGS:
1. Patent basilic and axillary vein. Stenosis of the brachiocephalic vein and
at the junction of the brachiocephalic vein and super vena cava.
2. Improved stenosis following venoplasty with 8 mm cutting balloon followed
by 12 mm conventional balloon.
IMPRESSION:
Uncomplicated venoplasty of right upper extremity central stenosis as
described above.
RECOMMENDATION: Lesion continues to be high risk. Have ordered an outpatient
procedure with interventional radiology in 2 weeks for venogram with possible
venoplasty and possible stent placement.
|
10123949-RR-170 | 10,123,949 | 20,216,545 | RR | 170 | 2183-07-25 14:53:00 | 2183-07-25 16:00:00 | EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old man with esrd on HD with left tunneled SC CVC, needs
left upper extremity vein mapping // LUE vein mapping
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of left
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
COMPARISON: None.
FINDINGS:
The left subclavian vein shows normal respiratory variation.
LEFT: The left cephalic vein is not visualized secondary to history of
harvest. The left basilic vein is partially thrombosed.
The radial artery measures 0.21 cm. The brachial artery is duplicated with
vessels measuring 0.37 cm and 0.16 cm. There are significant calcifications
within the left radial artery. Mild calcifications are seen in the duplicated
brachial arteries.
IMPRESSION:
1. Partial thrombosis of the left basilic vein.
2. Prior harvest of the left cephalic vein.
3. Patent radial and duplicated brachial arteries.
|
10123949-RR-178 | 10,123,949 | 23,761,871 | RR | 178 | 2183-10-04 12:49:00 | 2183-10-04 14:17:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with fever, new central line
TECHNIQUE: Single AP semi supine view of the chest.
COMPARISON: Chest radiograph from ___ and CT chest from ___.
FINDINGS:
A new right internal jugular central venous line terminates at the cavoatrial
junction. Previously described left subclavian dialysis catheter with tip in
the right atrium is unchanged in position. Lung volumes are low, and there is
continued mild interstitial pulmonary edema. No new focal consolidation or
pleural effusions. No pneumothorax identified.
IMPRESSION:
New right internal jugular central venous line terminates at the cavoatrial
junction. Low lung volumes, with continued mild interstitial pulmonary edema.
No new focal consolidation or pneumothorax.
|
10123949-RR-181 | 10,123,949 | 20,015,523 | RR | 181 | 2184-01-30 19:27:00 | 2184-01-30 20:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with poor access, s/p CVL placement
COMPARISON: ___.
FINDINGS:
AP portable upright view of the chest. Midline sternotomy wires and left
subclavian access dialysis catheter again noted. There is a new right IJ
central venous catheter with its tip in the mid SVC. Rightward rotation
limits assessment. Mild basal atelectasis. No large effusion or
pneumothorax.
IMPRESSION:
Right IJ central venous catheter positioned appropriately.
|
10123949-RR-182 | 10,123,949 | 20,015,523 | RR | 182 | 2184-01-31 13:23:00 | 2184-01-31 17:52:00 | EXAMINATION: ART DUP EXT LOW/BILAT COMP
INDICATION: ___ year old man with significant PVD and infected foot ulcer //
Please evaluate vasculature for patency
TECHNIQUE: Direct examination of the arterial system of both lower
extremities is performed with measurements of flow velocity once to the feet.
COMPARISON: Prior arterial study ___
FINDINGS:
Right leg: The common femoral artery to anterior tibial artery bypass could
not be identified and likely occluded. The common femoral and SFA
significantly calcified with flow velocities in the common femoral artery 73
cm/sec and in the SFA ___ centimeters/second. In the popliteal artery the
flow is 34 D 38 cm/sec with flows in the anterior tibial artery 34-41 cm
second and the knee a the 2 cm/sec. The posterior to it artery is occluded.
Left leg: The left SFA to peroneal bypass graft is not seen and suspected to
be occluded. The vessels are diffusely calcified with flow velocities in the
common femoral artery 76 cm/sec profunda 37 cm/sec, SFA ___
centimeters/second, popliteal ___ centimeters/seconds peroneal 21-40 cm/sec
and posterior tibial artery 14 cm/sec. Flow velocity the dorsalis pedis is 21
cm/sec.
IMPRESSION:
1. The right 1 femoral to anterior tibial artery bypass graft is not
visualized and suspected to be occluded. The right the vessels are
significantly calcified with flow velocities throughout and an occluded
posterior tibial artery below the knee.
2. The left SFA to peroneal bypass graft is not seen and suspected occluded.
This was on this side are also diffusely calcified with continuous flow and at
least 2 vessel runoff but generally slow velocities.
|
10123949-RR-183 | 10,123,949 | 20,015,523 | RR | 183 | 2184-01-31 13:24:00 | 2184-01-31 17:26:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old man with significant PVD and infected foot ulcer //
Please evaluate vascular patency
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 dated ___
FINDINGS:
On the right side, monophasic Doppler waveforms are seen within the right
femoral, popliteal, posterior tibial, and dorsalis pedis arteries. There is
artifactually high a systolic blood pressures of the right calf, consistent
with noncompressible vessels. There is dampening of the pulse volume
waveforms in the right ankle and right metatarsal.
On the left side, monophasic Doppler waveforms are seen within the left
femoral, popliteal, posterior tibial, and dorsalis pedis arteries.
Noncompressible vessels are again seen in the left calf. Dampening of the
pulse volume recordings in the ankle and metatarsal.
ABI is not of value given patient's noncompressible arteries.
IMPRESSION:
1. Moderate bilateral aortoiliac disease
2. Associated bilateral tibial disease.
|
10123949-RR-184 | 10,123,949 | 20,015,523 | RR | 184 | 2184-02-01 12:45:00 | 2184-02-01 16:55:00 | EXAMINATION: Bilateral superficial venous mapping duplex ultrasound
INDICATION: ___ year old man with occluded graft // vein mapping
TECHNIQUE: Grayscale ultrasound was performed of the lower extremities for
mapping the superficial venous system.
COMPARISON: Right lower extremity venous ultrasound dated ___
FINDINGS:
Ultrasound of the right and left lower extremity did not identify the
saphenous veins which may have been previously harvested or ablated.
IMPRESSION:
The saphenous veins could not be identified bilaterally which may be related
to prior surgery or intervention.
|
10123949-RR-185 | 10,123,949 | 20,015,523 | RR | 185 | 2184-02-01 12:46:00 | 2184-02-01 18:24:00 | EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old man with occluded graft. Please perform vein mapping
in both upper extremities.
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of the venous
system of both upper extremities was performed.
COMPARISON: Right upper extremity veins ultrasound from ___ and left
upper extremity venous ultrasound from ___.
FINDINGS:
RIGHT:
The cephalic vein is patent throughout its course and measures 0.04-0.08 cm of
caliber.
The basilic vein is patent throughout its course and measures 0.04 - 0.34 cm
of caliber.
LEFT:
The cephalic vein is patent in the forearm on measures 0.06-0.07 cm of
caliber. The cephalic vein was not seen at the level of the arm.
The basilic vein is patent throughout its course and measures 0.06-0.20 cm of
caliber.
IMPRESSION:
Patent basilic and cephalic veins in the right and patent basilic vein in the
left. The cephalic vein was not seen at the level of the left arm. For
detailed measurements please refer to sonographer report in PACs.
|
10123949-RR-186 | 10,123,949 | 20,015,523 | RR | 186 | 2184-02-06 13:44:00 | 2184-02-10 06:17:00 | EXAMINATION: ART EXT (REST ONLY)
CLINICAL HISTORY ___ year old man with PVD,CAD s/p R AT angioplasty // w/ toe
pressures. ?success w/ revascularization w/ toe pressures. ?success w/
revascularization
FINDINGS:
BE doppler waveforms and PVRs were performed at rest.
ABIs were not possible due to calcified vessels
RIGHT great toe pressure 46mm Hg
Left great toe pressure was not measured to to presence of TMA.
Doppler waveforms are monophasic bilaterally, with dampened PVRs consistent
with multilevel occlusive disease in the oderately servere range.
IMPRESSION:
Mulitlevel, moderately severe PVD.
The right forefoot perfusion is significantly improved compared to the prior
study.
|
10123949-RR-187 | 10,123,949 | 20,015,523 | RR | 187 | 2184-02-07 14:23:00 | 2184-02-07 16:46:00 | EXAMINATION: FOOT 2 VIEWS RIGHT
INDICATION: ___ year old man s/p ___ met head and ___ phalanx base resection
TECHNIQUE: Right foot, two views.
COMPARISON: Right foot radiograph dated ___.
FINDINGS:
Status post resection of the fifth metatarsal head and fifth proximal
phalangeal base with adjacent wound VAC device in place. The bones are
diffusely osteopenic. There is no acute fracture or dislocation.
Postsurgical changes again noted at the PIP joint of the second ray. Vascular
calcification noted.
IMPRESSION:
Postoperative changes detailed above.
|
10123949-RR-220 | 10,123,949 | 20,875,376 | RR | 220 | 2185-11-13 07:40:00 | 2185-11-13 10:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain, shortness of breath, history
AVR.//Pulm edema? Pneumonia?
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Patient is status post median sternotomy and aortic valve replacement.
Left-sided subclavian dual lumen central venous catheter tip terminates at the
SVC/right atrial junction. A right sided internal jugular central venous
catheter tip terminates in the low SVC. Cardiac silhouette size is top
normal. The mediastinal and hilar contours are unremarkable. The pulmonary
vasculature is not engorged. Lung volumes are low linear atelectasis noted in
the lung bases. No pleural effusion or pneumothorax is present. No acute
osseous abnormality is demonstrated.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10123949-RR-227 | 10,123,949 | 25,322,219 | RR | 227 | 2186-02-14 17:09:00 | 2186-02-14 17:56:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with R subclavian CVL// confirm R subclavian CVL
TECHNIQUE: Portable frontal views of the chest.
COMPARISON: ___.
IMPRESSION:
Left subclavian central line is unchanged. There has been placement of a
right subclavian central line, which likely terminates in the right atrium.
There is otherwise little change with persistent complete opacification of the
right hemithorax. There are apparent changes from CABG and aortic valve
replacement. Heart size cannot be reliably assessed given the complete
opacification of the right hemithorax. The left lung volume is low, though
appears essentially clear. There is no pneumothorax.
|
10123949-RR-228 | 10,123,949 | 25,322,219 | RR | 228 | 2186-02-14 17:57:00 | 2186-02-14 18:35:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: History: ___ with ESRD on dialysis, no urine output here w/
complete whiteout of right lung, on NRB// Etiology of large right sided
complex pulmonary finding
TECHNIQUE: MD CT axial images of the chest were obtained after administration
of intravenous contrast. Multiplanar reformats, including coronal, sagittal
and axial maximal intensity projection images were obtained and reviewed on
PACs.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 37.5 cm; CTDIvol = 21.5 mGy (Body) DLP = 807.3
mGy-cm.
Total DLP (Body) = 807 mGy-cm.
COMPARISON: CT abdomen and pelvis from ___ obtained at an
outside hospital. Chest CT from ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable
and homogeneous in attenuation. There is no supraclavicular or axillary
lymphadenopathy by CT size criteria. There is moderate symmetric
gynecomastia. Otherwise, the imaged chest wall demonstrate diffuse anasarca.
UPPER ABDOMEN: The imaged portion of the upper abdomen is grossly
unremarkable, aside from diffuse atherosclerotic disease and atrophic left
kidney.
MEDIASTINUM: Scattered mediastinal lymph nodes are stable from prior exam from
___ and are not pathologically enlarged by CT size criteria.
HILA: There is no hilar lymphadenopathy by CT size criteria.
HEART and PERICARDIUM: The heart size is within normal limits. The right
internal jugular vein and left subclavian vein approach central venous
catheter tips terminates in the right atrium.
PLEURA: There is a large nonhemorrhagic pleural effusion, which appears to
have increased from ___ at 12:57, as seen on the partially imaged
portion of the lower lung, which demonstrate partially aerated right middle
lobe. The degree of right middle lobe aeration has substantially decreased,
with miniscule amount remaining (4:146).
LUNG:
1. PARENCHYMA: There is complete collapse of the right lung, though
parenchymal enhancement remains mostly homogeneous. There is minimal
atelectasis of the left lower lobe. No concerning pulmonary nodule is seen in
the aerated left lung.
2. AIRWAYS: The airways are patent to the subsegmental levels on the left.
The right mainstem bronchus is mildly narrowed with air columns visualized in
the right upper and bronchus intermedius, leading to the large segmental
branches. No bronchial airway mass is appreciated.
3. VESSELS: There is minimal atherosclerotic disease at the aortic arch.
Ascending and descending aorta are normal in caliber. The main pulmonary
artery is unremarkable in caliber. While this exam is not tailored for
evaluation of pulmonary embolism, the visualized portion of the pulmonary
arteries appear well opacified.
CHEST CAGE: Patient is status post median sternotomy. No suspicious osseous
lesion is seen concerning for acute fracture or metastatic disease. Multiple
Schmorl nodes are seen at T10 through T12.
IMPRESSION:
1. Interval increase in the large nonhemorrhagic right pleural effusion, with
essentially collapsed right lung since CT abdomen obtained at 12:57 on ___. The lung parenchyma enhances homogeneously. No evidence of
obstructive airway mass.
2. Mild anasarca.
RECOMMENDATION(S): Thoracentesis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 6:33 pm, 10 minutes after
discovery of the findings.
|
10123949-RR-229 | 10,123,949 | 25,322,219 | RR | 229 | 2186-02-14 19:38:00 | 2186-02-14 20:02:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with effusion s/p R chest tube.// Confirm R chest
tube
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: Same-day chest radiograph and CT.
IMPRESSION:
Compared to the earlier same day examination, there has been placement of a
right-sided chest tube, with decrease of a still large right-sided pleural
effusion, with improved aeration of the right lung, which remains mostly
collapsed. The remainder of the support devices are unchanged. The left
hemithorax remains essentially clear. There is no pneumothorax.
|
10123949-RR-230 | 10,123,949 | 25,322,219 | RR | 230 | 2186-02-14 21:10:00 | 2186-02-14 21:18:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with chest tube reposition// Chest Tube Position
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 19:35.
IMPRESSION:
Compared to the examination from 0.5 hours prior, the chest tube has been
slightly repositioned, with the side port at the upper lateral chest wall and
the tip in the medial right hemithorax. The still large right-sided pleural
effusion continues to decrease in volume, with further increase of right lung
aeration. No other changes seen. There is no pneumothorax.
|
10123949-RR-231 | 10,123,949 | 25,322,219 | RR | 231 | 2186-02-15 04:08:00 | 2186-02-15 10:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax s/p chest tube// eval for
interval of R sided pleural effusion eval for interval of R sided pleural
effusion
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Small to moderate right pleural effusion continues to improve. Small right
pneumothorax is new. Most proximal side port could be extrathoracic. Clinical
correlation advised. No subcutaneous emphysema in the right chest wall. Left
lung is clear. No definite right lung abnormality is seen.
Heart size normal. Right subclavian line ends in the mid SVC. Dual channel
left subclavian line ends in the upper right atrium. Right thoracostomy tube
has been repositioned.
|
10123949-RR-232 | 10,123,949 | 25,322,219 | RR | 232 | 2186-02-15 09:52:00 | 2186-02-15 11:30:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with hemorrhagic pleural effusion and collapse of
right lung.// Pt. complaining of new pain, worse with inspiration... interval
changes, chest tube placement, progression of effusion?
TECHNIQUE: Chest AP
COMPARISON: Chest radiograph dated: ___. CT
chest dated ___.
FINDINGS:
Persistent small right pneumothorax and small residual right pleural effusion
without evidence of subcutaneous emphysema. Right chest tube with most
proximal side-port may potentially be extrathoracic in location, however
unchanged from the most recent chest radiograph. From the orientation of the
chest tube, fissural placement cannot be ascertained. Dual-chamber left
subclavian line terminates in the right atrium. Right subclavian line ends in
the lower SVC.
IMPRESSION:
1. Persistent small right pneumothorax and small residual right pleural
effusion.
2. Right chest tube with its most proximal side port possibly extrathoracic in
location, however grossly unchanged compared to most recent chest radiograph.
Fissural placement of the right chest tube cannot be ascertained.
3. Dual-chamber left subclavian line terminates in the right atrium. Right
subclavian line ends in the lower SVC.
|
10123949-RR-233 | 10,123,949 | 25,322,219 | RR | 233 | 2186-02-17 08:20:00 | 2186-02-17 12:24:00 | INDICATION: ___ year old man with DMI and supratherapeutic INR with
hemothorax// ?regression of hemothorax
TECHNIQUE: AP portable radiograph of the chest.
COMPARISON: Radiograph of the chest performed ___.
FINDINGS:
There has been no significant interval change in the persistent right small
pneumothorax and small right pleural effusion. Right-sided chest tube
overlying the mid right lung is also unchanged compared to prior exam.
Left-sided central line terminates within the right atrium unchanged in
position compared to the prior exam. The left lung is relatively clear. The
visualized osseous structures are unremarkable. Sternal wires are seen
intact.
IMPRESSION:
Overall, no significant interval change in appearance of the small right
effusion and pneumothorax compared to the exam performed 1 day prior.
|
10123949-RR-234 | 10,123,949 | 25,322,219 | RR | 234 | 2186-02-18 16:15:00 | 2186-02-18 16:47:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with DM1 and supratherapeutic INR with
hemothorax// eval of hemothorax eval of hemothorax
IMPRESSION:
Central venous line tip is in the proximal right atrium. Right PICC line tip
is at the level of mid SVC. Pleural effusion on the right and linear
opacities in the right lower lobe are similar to previous examination. No
pneumothorax.
|
10123949-RR-237 | 10,123,949 | 25,322,219 | RR | 237 | 2186-02-20 11:46:00 | 2186-02-20 12:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax// ?hemothorax ?hemothorax
IMPRESSION:
Compared to chest radiographs ___ through ___.
Left lung is clear. Heart size is normal. Moderate right pleural effusion
unchanged. No pneumothorax. Right central venous catheter ends in the upper
SVC. Dual channel left subclavian line ends in the upper right atrium.
|
10123949-RR-238 | 10,123,949 | 25,322,219 | RR | 238 | 2186-02-22 08:31:00 | 2186-02-22 13:42:00 | INDICATION: ___ year old man with hemothorax on warfarin s/p chest tube
removal// hemothorax
TECHNIQUE: Portable upright AP chest radiograph
COMPARISON: Chest radiograph ___
FINDINGS:
The left lung remains slightly underinflated but clear. The right moderate
pleural effusion is unchanged. A lucency projecting over the right hilum is
similar in attenuation to the contralateral lung, and is either air loculated
within the oblique fissure or more likely absence of fissural fluid because of
incomplete or adherent pleura within the fissure. No pneumothorax.
Right central venous catheter ends in the upper SVC. The dual channel left
subclavian line ends in the right atrium. Median sternotomy wires remain
intact in similar configuration.
IMPRESSION:
-Unchanged right moderate pleural effusion. No pneumothorax.
-Lucency projecting over the right hilum is not a cavity, but likely
represents air loculated within the oblique fissure or absence of fissural
fluid because of incomplete or adherent pleura within the fissure. This is
not a cavity.
|
10123949-RR-239 | 10,123,949 | 24,524,130 | RR | 239 | 2186-03-27 07:50:00 | 2186-03-27 08:43:00 | INDICATION: History: ___ with fever and cough on dialysis// ?pna, pulm edema
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph dated ___ and ___.
FINDINGS:
Left subclavian dialysis catheter terminates in the right atrium. The right
PICC line terminates in the lower SVC. Right lower lobe could represent
pneumonia in appropriate clinical setting. No pulmonary edema. Small right
pleural effusion has improved. Lucency projecting over the right mid lung is
stable since at least ___. No left pleural effusion. No
pneumothorax. The cardiomediastinal silhouette is unchanged. No acute
osseous abnormalities.
IMPRESSION:
Right lower lobe hazy opacity could represent pneumonia in appropriate
clinical setting. No pulmonary edema.
|
10123949-RR-241 | 10,123,949 | 24,524,130 | RR | 241 | 2186-03-27 14:53:00 | 2186-03-27 16:35:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: History: ___ with RUE swelling// ?DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial and basilic veins are patent,
compressible and show normal color flow and augmentation.
The right cephalic vein is not visualized, likely utilized for a prior AV
fistula for which the imaged aspect appears thrombosed.
IMPRESSION:
1. No evidence of deep vein thrombosis in the right upper extremity.
2. Nonvisualized right cephalic vein, likely utilized for a prior AV fistula
which appears thrombosed.
|
10123949-RR-243 | 10,123,949 | 24,524,130 | RR | 243 | 2186-03-28 12:32:00 | 2186-03-28 16:19:00 | EXAMINATION: MRI SACRUM/SI JOINTS W/O CONTRAST
INDICATION: ___ year old man with DMI, ESRD on HD, p/w GPCs in blood, septic
shock, has a sacral ulcer overlying his coccyx// eval bone, soft tissues in
relation to sacral ulcer, ? osteomyelitis
TECHNIQUE: Multiplanar images of the sacrum were performed without the
administration of intravenous contrast using a routine MR protocol.
COMPARISON: There are no prior studies for comparison.
FINDINGS:
There is a focal area of increased signal intensity in the subcutaneous
tissues adjacent to the coccyx on fluid sensitive images predominately to the
right of midline (series 7, image 5, series 6, image 10). Corresponding low
signal intensity seen on T1. This is soft tissue signal change extends to the
level of the coccyx however there is preservation of T1 high-signal of the
adjacent coccyx. There is no overt bone marrow edema involving the adjacent
coccyx.
The background bone marrow appears diffusely mildly heterogeneous which may
reflect red marrow reconversion.
There is some irregularity of the articular cortices of the sacroiliac joints
bilaterally, with paucity of surrounding edema. This may reflect sequela of
prior sacroiliitis, or, in the setting of chronic renal disease
hyperparathyroidism.
There is diffuse patchy muscle edema most marked in the adductor compartment.
Trace hip joint fluid bilaterally appears symmetric.
No pelvic sidewall lymphadenopathy is identified.
IMPRESSION:
-Increased fluid signal in the subcutaneous fat overlying the coccyx
predominantly to the right of midline may be inflammatory/reactive to
underlying ulcer. No evidence of osteomyelitis however.
-Sacroiliac articular cortical irregularity may be sequela of prior
sacroiliitis or hyperparathyroidism. No subchondral edema to suggest active
sacroiliitis or septic arthritis.
-Diffuse nonspecific soft tissue edema.
|
10123949-RR-244 | 10,123,949 | 24,524,130 | RR | 244 | 2186-03-28 18:41:00 | 2186-03-28 19:11:00 | INDICATION: ___ year old man with new R IJ HD line.// Line placement- R IJ HD
line Contact name: R ___: ___
TECHNIQUE: Portable chest x-ray
COMPARISON: Chest x-ray ___
FINDINGS:
The left subclavian dialysis catheter terminates in the right atrium. The
right PICC is not well seen but is grossly stable in position. The right IJ
catheter terminates in the mid to lower SVC.
The heart is normal in size. The trachea is midline. The patient is status
post valve replacement. Sternal wires appear intact.
There is likely a small right pleural effusion.
IMPRESSION:
Likely small right pleural effusion. Right IJ line terminates in the mid to
lower SVC.
|
10123949-RR-245 | 10,123,949 | 24,524,130 | RR | 245 | 2186-03-29 09:00:00 | 2186-03-29 13:37:00 | INDICATION: ___ year old man with tunneled HD line for ESRD, p/w GPC
bacteremia, needs line removed// remove tunneled HD line
COMPARISON: Chest radiograph on ___
TECHNIQUE: OPERATORS: Dr. ___ (interventional radiology fellow) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: None
PROCEDURE: 1. Left chest tunneled dialysis catheter removal.
PROCEDURE DETAILS: The patient was brought to the angiography holding area
and positioned with his head upright on a stretcher. The Left chest tunneled
line site was cleaned and draped in standard sterile fashion. 1% lidocaine was
administered around the tube track. The cuff was loosened with a bent forceps.
The catheter was removed with gentle traction while manual pressure was held
at the venotomy site. Hemostasis was achieved after 5 min of manual pressure.
A clean sterile dressing was applied. The patient tolerated the procedure
well. There were no immediate postprocedural complications.
FINDINGS:
Expected appearance after tunneled line removal.
IMPRESSION:
Successful removal of a left chest tunneled line.
|
10123949-RR-246 | 10,123,949 | 24,524,130 | RR | 246 | 2186-04-01 14:59:00 | 2186-04-01 17:08:00 | INDICATION: ___ year old man with ESRD on HD presenting with MRSA bacteremia
___ line infection, line has been removed, currently has ___ placed
temporary trialysis line in place
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 29 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: 2.2 min, 4 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 19 cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. ___ subcuticular Vicryl sutures and Steri-strips were also used to
close the venotomy incision site. Final spot fluoroscopic image demonstrating
good alignment of the catheter and no kinking. The tip is in the right atrium.
The catheter was flushed and both lumens were capped. Sterile dressings were
applied. The patient tolerated the procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing tunneled
dialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 19cm tip-to-cuff length tunneled dialysis line. The
tip of the catheter terminates in the right atrium. The catheter is ready for
use.
|
10123949-RR-257 | 10,123,949 | 26,796,872 | RR | 257 | 2186-05-26 23:16:00 | 2186-05-26 23:55:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with R>L upper extremity swelling.// Please
evaluate RUE for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
Right upper extremity AV fistula is occluded, unchanged from right upper
extremity ultrasound ___.
There is mild subcutaneous edema along the medial aspect of the forearm.
IMPRESSION:
1. No evidence of deep vein thrombosis in the right upper extremity.
2. Chronic occluded AV fistula.
3. Mild subcutaneous edema in the medial aspect of the right forearm.
|
10123949-RR-258 | 10,123,949 | 26,796,872 | RR | 258 | 2186-06-02 17:05:00 | 2186-06-02 20:22:00 | INDICATION: ___ year old man with DM, ESRD on HD, and mAVR on warfarin without
access, requiring a port catheter for frequent blood draws and medication
administration. Spoke with ___ and ___.
COMPARISON: Right venous ultrasound ___
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___
radiologist performed the procedure. Dr. ___ supervised the
trainee during the key components of the procedure and has reviewed and agrees
with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 40 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, midazolam, lidocaine
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: 8.4 min, 48 mGy
PROCEDURE
1. Left subclavian approach chest single lumen Port-a-cath placement
PROCEDURE DETAILS: Following the explanation of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. Prior to time-out, ultrasound was performed
demonstrating no suitable veins in the left neck. A pre-procedure time-out
was performed per ___ protocol. The upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent left subclavian vein was
identified using color and spectral Doppler and accessed using a micropuncture
needle. Permanent ultrasound images were obtained before and after intravenous
access, which confirmed vein patency. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. The needle was exchanged
for a micropuncture sheath. The Nitinol wire was removed and a short ___
wire was advanced to make appropriate measurements for catheter length.
Initially, the ___ was unable to be passed into the IVC. Therefore, the
micropuncture sheath was removed and a short Kumpe catheter was advanced over
the wire into the superior vena cava. The ___ wire was removed and an
Amplatz was placed. Using the Kumpe catheter and the Amplatz wire, the
Amplatz wire was then passed distally into the IVC.
Next, attention was turned towards creation of a subcutaneous pocket over the
upper anterior chest wall immediately adjacent to the access site. After
instilling superficial and deeper local anesthesia using lidocaine, a 2.5 cm
transverse incision was made and a subcutaneous pocket was created by using
blunt dissection. The single lumen port was then connected to the catheter.
The port was then connected to the catheter and checks were made for any
leakage by accessing the diaphragm using a non-coring ___ needle. No leaks
were found.
The port was then placed in the subcutaneous pocket. The venotomy tract was
dilated using the introducer of the peel-away sheath supplied. Following this,
the peel-away sheath was placed over the ___ wire through which the port was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away.
The subcutaneous pocket was closed in layers with ___ interrupted and ___
subcuticular continuous Vicryl sutures. Steri-Strips were applied over the
sutures. Final spot fluoroscopic image demonstrating good alignment of the
catheter and no kinking. The tip is in the right atrium.
The port was accessed using a non coring ___ needle and could be aspirated
and flushed easily. Sterile dressings were applied. The patient tolerated the
procedure well without immediate complication. The port was left accessed as
requested.
FINDINGS:
Patent left subclavian vein. Final fluoroscopic image showing port with
catheter tip terminating in the right atrium.
IMPRESSION:
Successful placement of a single lumen chest power Port-a-cath via the left
subclavian venous approach. The tip of the catheter terminates in the right
atrium. The catheter is ready for use.
|
10123949-RR-259 | 10,123,949 | 26,796,872 | RR | 259 | 2186-06-05 16:38:00 | 2186-06-05 17:47:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with afib and hx of stroke with R sided deficit,
on anticoagulation, now with increased edema in R arm// ? DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
A chronically occluded AV graft is seen within the medial right upper forearm.
Mild subcutaneous edema throughout the right upper arm is unchanged.
IMPRESSION:
1. No evidence of deep vein thrombosis in the right upper extremity.
2. Unchanged chronically occluded AV graft and subcutaneous edema within the
medial right upper arm.
|
10123949-RR-262 | 10,123,949 | 27,537,146 | RR | 262 | 2186-07-23 02:24:00 | 2186-07-23 04:20:00 | EXAMINATION: CTA LOWER EXT W/ANDW/O C AND RECONS BILATERAL
INDICATION: ___ year old man with acute onset of LLE pain h/o vasculopathy//
with 3 vessel runnof of LLE.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis into the bilateral lower
extremities 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 19.7 s, 155.1 cm; CTDIvol = 3.6 mGy (Body) DLP =
559.3 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 24.3 mGy (Body) DLP =
12.1 mGy-cm.
3) Spiral Acquisition 20.3 s, 159.7 cm; CTDIvol = 10.0 mGy (Body) DLP =
1,600.5 mGy-cm.
4) Spiral Acquisition 10.8 s, 84.6 cm; CTDIvol = 5.4 mGy (Body) DLP = 454.0
mGy-cm.
Total DLP (Body) = 2,626 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
VASCULAR:
No abdominal aortic aneurysm or dissection. There is mild calcium burden in
the abdominal aorta and great abdominal arteries. The celiac trunk and
branches are patent. The SMA is patent. The ___ is attenuated. There is
mild narrowing at the origin of the ___ but it is patent. There is mild
narrowing of the bilateral renal ostium from atherosclerotic disease.
Bilateral internal iliac artery calcifications are mild.
RIGHT:
Right common femoral artery is patent but slightly dilated to 1 cm (series 4,
image 198), unchanged. The SFA is patent with severe atherosclerotic
calcifications causing narrowing distally. The popliteal artery has severe
atherosclerotic calcifications eventrally resulting complete occlusion
distally (Series 4, image 387). Collaterals are seen to provide the
three-vessel runoff to the calf and dorsal and plantar surfaces of the feet.
LEFT:
The left common femoral artery is patent with moderate atherosclerotic
calcification resulting in 50% luminal narrowing (series 4, image 193). The
SFA is patent with areas of moderate focal atherosclerosis resulting in
moderate to severe narrowing distally. Contrast however is seen within the
lumen indicating patency. The native popliteal artery appears occluded. The
presumed SFA graft to the posterior tibial artery appears patent (series 4,
image 337). The peroneal artery is markedly attenuated but appears to have
contrast on delayed images. Similarly, the anterior tibial artery is markedly
attenuated with marked atherosclerotic calcifications but also appears to have
contrast on delayed images. Intravenous contrast in the dorsal and plantar
surfaces of the foot is visualized.
Evaluation of the lower chest and abdomen is limited by streak artifact from
the patient's arms being down and over the abdominal wall. Within this
limitation:
LOWER CHEST: Bilateral trace pleural effusions are nonhemorrhagic. Mild
bilateral lower lobe parenchymal opacities are consistent with relaxation
atelectasis, improved from prior. Mild bibasilar bronchiectasis in the lower
lobes is unchanged. Aortic valve replacement is noted. Coronary artery
calcifications are extensive. No pericardial effusion. Patient has had prior
median sternotomy. Hypoattenuation of the cardiac blood pool on this
unenhanced exam suggests anemia.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No
evidence of focal lesions. No evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is distended with layering hyperdense
biliary sludge. No gallbladder wall thickening or pericholecystic fluid
collection.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. 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 markedly atrophic, similar to prior. No
hydronephrosis, nephrolithiasis, or perinephric abnormality. Bilateral renal
cortical hypodensities are too small to accurately characterize on CT.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. The colon is unremarkable. The rectum is
moderately distended with wall thickening and mild fat stranding, which can be
seen with stercoral colitis (series 4, image 179).
RETROPERITONEUM: No evidence of retroperitoneal lymphadenopathy. No
retroperitoneal hematoma.
PELVIS: The urinary bladder is underdistended, limiting evaluation. The
distal ureters are unremarkable. No evidence of pelvic or inguinal
lymphadenopathy. No free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate gland is not enlarged.
BONES: No evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small soft tissue nodule posterior to the left proximal thigh is
of doubtful clinical significance (series 4, image 239). A fat containing
paraumbilical hernia is small. Gynecomastia is noted.
IMPRESSION:
1. Patent left lower extremity femoral arteries and graft. Markedly
attenuated and atherosclerotic left anterior tibial and peroneal arteries with
slow flow as above but appear patent. Patent left posterior tibial artery.
2. Three-vessel runoff in the right lower extremity as above. Ectatic right
common femoral artery, unchanged. Occlusion of the popliteal artery with
reconstitution to provide three-vessel runoff in the right lower extremity as
above.
3. Bilateral, trace nonhemorrhagic pleural effusions with minimal relaxation
atelectasis in the lower lobes, improved from prior.
NOTIFICATION: The findings and impression were discussed with Dr. ___,
___. by ___, M.D. on the telephone on ___ at 3:59 am, minutes
after discovery of the findings.
|
10123949-RR-263 | 10,123,949 | 27,537,146 | RR | 263 | 2186-07-23 04:57:00 | 2186-07-23 10:49:00 | EXAMINATION: ART DUP EXT LO UNI;F/U
INDICATION: ___ year old man with acute LLE pain// eval graft patency
TECHNIQUE: Grayscale, color, and spectral doppler ultrasound images were
obtained of the superficial tissues of the left lower extremity in the
expected region of the graft.
COMPARISON: None
FINDINGS:
The left distal SFA demonstrates wall-to-wall color flow and normal arterial
waveforms. The distal SFA graft appears patent with wall to wall color flow
and arterial waveforms. Distal to the graft, the calf artery is also patent
with color flow and arterial waveform.
IMPRESSION:
Limited assessment of the left lower extremity in the expected area of the SFA
graft which appears patent.
|
10123949-RR-264 | 10,123,949 | 27,537,146 | RR | 264 | 2186-08-04 20:43:00 | 2186-08-04 21:18:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with hypotension necessitating MICU transfer//
eval for PNA
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___.
IMPRESSION:
Right IJ central venous catheter tip is in the high right atrium. Left
subclavian Port-A-Cath tip is in the mid to low SVC. Heart size is normal.
Mediastinal wires are intact. There is borderline vascular congestion without
frank interstitial edema. Linear scarring in the right midlung field is
unchanged. There is no focal consolidation. There is no large effusion or
pneumothorax.
|
10123949-RR-79 | 10,123,949 | 22,466,207 | RR | 79 | 2180-04-08 13:56:00 | 2180-04-08 15:11:00 | CLINICAL HISTORY: ___ man with recent URI, now with chest tightness.
Please evaluate for infection.
COMPARISON: ___.
PA AND LATERAL VIEWS OF THE CHEST: The lungs are clear. The
cardiomediastinal silhouette and hilar contours are unremarkable. There are
no pleural effusions or pneumothoraces. The bones are intact.
IMPRESSION: No acute cardiopulmonary process.
|
10123997-RR-57 | 10,123,997 | 22,701,140 | RR | 57 | 2196-11-18 16:06:00 | 2196-11-18 18:22:00 | INDICATION: ___ with lung cancer p/w dyspnea // eval infiltrate, effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison is made to chest CT from ___.
FINDINGS:
A spiculated retrocardiac mass appears increased in size with a small left
pleural effusion. Increased interstitial opacities in the right lung raise
concern for lymphangitic carcinomatosis. Heart size appears grossly stable.
Mediastinal contour is unremarkable. Bony structures appear intact. No free
air below the right hemidiaphragm.
IMPRESSION:
Interval progression in size of left retrocardiac mass with increased right
lung interstitial opacities concerning for lymphangitic carcinomatosis.
|
10123997-RR-59 | 10,123,997 | 22,701,140 | RR | 59 | 2196-11-19 11:55:00 | 2196-11-19 17:42:00 | INDICATION: ___ year old woman with lung cancer and increased dyspnea // eval
for progression. also with hx of tumor invasion of left pulm artery, assess
extent and for evidence of clot
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen during the early arterial phase scanning after the
administration of Omnipaque contrast material. Multiplanar reformatted images
in coronal,sagittal and oblique axes were generated.
COMPARISON: CT from ___ and ___.
FINDINGS:
The thyroid is unremarkable. There is no axillary lymph node enlargement by CT
size criteria. Prominent prevascular and paratracheal lymph nodes are again
noted, stable in size from ___ (4: 57,49). The airways are patent to
the segmental level.
A left hilar mass appears stable from ___, currently measuring 2.7 x
1.4 cm compared to 3.0 x 1.6 cm (6:158). The mass continues to slightly narrow
the left upper lobe bronchus and invade the left pulmonary artery (06:58).
Moderate peripheral fibrosis and moderate centrilobular emphysema are again
noted. Bilateral small nonhemorrhagic pleural effusions with associated
atelectasis is present.
Left lower lobe consolidation and collapse has worsened since ___, and
extension of the hilar mass into the posterior left lower lobe cannot be
excluded. Multifocal consolidation and a 1.1 x 0.9 cm nodule in the right
upper lobe could represent infection versus aspiration (4:81), though
malignancy progression is also possible.
The heart, pericardium, and great vessels are within normal limits. No hiatal
hernia or any other esophageal abnormality is present.
CTA: The aorta and main thoracic vessels are well opacified. The aorta
demonstrates normal caliber throughout the thorax without intramural hematoma
or dissection. The left hilar mass continues to invade the left pulmonary
artery, stable since the prior exam. No other filling defect is seen in the
main, right, lobar or segmental pulmonary arteries.
BONES: No focal osseous lesion concerning for malignancy.
Although this study is not designed for assessment of intra-abdominal
structures, the visualized organs are unremarkable. A calcified granuloma is
seen in the right hepatic lobe, and a replaced left hepatic artery arises from
the left gastric artery.
IMPRESSION:
1. 2.7 x 1.4 cm left hilar mass with irregular encroachment of the left
pulmonary artery appearing stable since the prior CT from ___. Stable
prominent prevascular and paratracheal lymph nodules.
2. Worsening left lower lobe collapse, which may be obscuring increased
posterior extension of the left hilar mass.
3. Worsened small bilateral non-hemorrhagic pleural effusions.
4. Increased multifocal bilateral densities, including a new 1.1 cm right
upper lobe nodule favors infection given short-interval development, however,
aggressive neoplastic spread cannot be excluded. Recommend short-term follow
CT following resolution of acute symptoms.
5. Background moderate centrilobular emphysema and peripheral pulmonary
fibrosis.
|
10123997-RR-60 | 10,123,997 | 22,701,140 | RR | 60 | 2196-11-26 14:09:00 | 2196-11-26 17:27:00 | INDICATION: ___ year old woman with lung cancer, PNA, COPD. // interval
change from ___ - progression of cancer? lymphangetic spread? PNA improved?
TECHNIQUE: MDCT imaging of the chest was performed with administration of
intravenous contrast. Multiplanar reformats were prepared and reviewed. MIP
images were generated and reviewed.
DOSE: DLP: 359.30 mGy-cm
COMPARISON: Comparison is made with CT chest from ___, and ___.
FINDINGS:
Emphysematous changes are noted in the lungs bilaterally with multiple small
bullae seen. The right lung demonstrates widespread septal wall thickening and
multiple scattered consolidative but predominantly ground glass opacities,
which have worsened since prior exam one week prior in the right lung. A left
hilar mass is unchanged from prior exam and it is again noted to partially
invade the left pulmonary artery. Consolidation likely representing
postobstructive atelectasis is again seen in the left lower lobe, improving
from prior exam. Patchy opacities in the left upper lobe are for the most
part similar to improved.
There is a small to moderate right pleural effusion, increased from prior
exam. There is a small left pleural effusion, similar to prior exam. The
heart is normal in size.
This study is not tailored for subdiaphragmatic evaluation, but the visualized
intra-abdominal organs are unremarkable.
BONE WINDOWS: No focal lytic or sclerotic osseous lesion suspicious for
infection or malignancy is seen. The bones are noted to be generally
demineralized. Kyphosis is seen in the thoracic spine
IMPRESSION:
1. Heterogeneous opacification of the right lung with ground glass and septal
thickening, but areas of spared lung and with patchy consolidative opacities,
which have worsened since prior exam one week prior, suggesting an acute
process such as pneumonia. Asymmetric edema, inflammatory pneumonitis or
sequelae of drug toxicity are less common etiologies which can be otherwise
considered if infection is not likely on clinical grounds. Carcinomatosis is
difficult to exclude but rapid on-site in the acute setting makes other
etiologies perhaps more likely.
2. Treated left hilar mass is unchanged from prior exam.
3. Consolidation likely representing postobstructive atelectasis is again seen
in the left lower lobe, improved from prior exam.
4. Small moderate right pleural effusion, increased from prior exam. Stable
small left pleural effusion.
|
10123997-RR-61 | 10,123,997 | 22,701,140 | RR | 61 | 2196-11-28 06:00:00 | 2196-11-28 10:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with lung cancer, PNA, COPD // eval for
worsening infiltrates, hyperinflation, edema
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the opacity on the left as well as the
small left pleural effusion have decreased. However, at decreasing lung
volumes, the reticular opacities on the right have substantially increased.
No larger pleural effusions. A small pleural effusion on the left is
unchanged.
|
10123997-RR-62 | 10,123,997 | 22,701,140 | RR | 62 | 2196-12-01 06:17:00 | 2196-12-01 10:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with metastatic lung cancer, multifocal
pneumonia and worsening hypoxemia. // ? worsening infiltrates ? worsening
infiltrates
IMPRESSION:
In comparison with the study of ___, there is again diffuse opacification
involving the entire right hemithorax, consistent with the clinical diagnosis
of widespread pneumonia. Areas of opacification are also seen at the left
base. Volume loss is noted in the lower lobe on the left.
|
10124346-RR-50 | 10,124,346 | 21,387,191 | RR | 50 | 2131-07-01 12:04:00 | 2131-07-01 14:11:00 | EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: Chest pain.
___.
FINDINGS: There are relatively low lung volumes, which accentuate the
bronchovascular markings. However, given this, patchy left basilar opacity is
seen and an infectious process is not excluded. There is mild elevation of
the anterior right hemidiaphragm. Retrocardiac density, best seen on the
lateral view, also seen on the prior study, may be due to a hiatal hernia. No
large pleural effusion or pneumothorax is seen. The cardiac silhouette is top
normal to mildly enlarged. The mediastinal contours are unremarkable.
IMPRESSION: Low lung volumes which accentuate the bronchovascular markings.
Patchy opacity projecting over the lateral left lung base on the frontal view,
not well substantiated on the lateral view, may be due to atelectasis versus
infection.
|
10124346-RR-52 | 10,124,346 | 20,904,650 | RR | 52 | 2132-07-20 12:00:00 | 2132-07-20 12:27:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: History: ___ with fall // r/o infection, ICH, fracture
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Cardiac silhouette is top-normal to mildly enlarged. There is no pulmonary
edema. There is mild elevation of the right hemidiaphragm. No definite focal
consolidation is seen. There is no pleural effusion or pneumothorax.
Mediastinal contours are stable.
IMPRESSION:
No acute cardiopulmonary process.
|
10124346-RR-53 | 10,124,346 | 20,904,650 | RR | 53 | 2132-07-20 12:11:00 | 2132-07-20 13:31:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: A ___ woman with a fall, rule out infection intracranial
hemorrhage or fracture.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 1560.87 mGy-cm
CTDI: 54.90 mGy
COMPARISON: None..
FINDINGS:
There is no hemorrhage, acute large vascular territorial infarction, or brain
edema. The basal cisterns are patent. There is no shift of normally midline
structures. Mild prominence of the ventricles and sulci is compatible with age
related involutional change. Mild periventricular white matter hypodensities
are likely the sequelae of chronic small vessel ischemic change. There is
minimal mucosal thickening of the right maxillary sinus and ethmoid air cells,
otherwise the imaged paranasal sinuses and mastoid air cells are clear. The
patient is status post bilateral lens removal, otherwise the globes and bony
orbits are unremarkable. There is no acute fracture.
IMPRESSION:
No acute intracranial process.
|
10124346-RR-54 | 10,124,346 | 20,904,650 | RR | 54 | 2132-07-20 12:12:00 | 2132-07-20 13:43:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: A ___ woman with a fall, evaluate for fracture.
TECHNIQUE: Contiguous axial images were obtained and reviewed. Sagittal and
coronal reformatted images were generated. No contrast was administered.
CTDIvol: 36.96 mGy.
DLP: 840.91 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no acute fracture. There is no prevertebral soft tissue swelling or
hematoma. There are moderate degenerative joint changes of the cervical spine,
with multilevel intervertebral disc height loss. There is minimal C5-6
retrolisthesis, which appears degenerative in nature; this, and a prominent
C6-7 posterior intervertebral osteophyte results in moderate central spinal
canal narrowing at these levels. Multilevel uncovertebral osteophytes and
facet joint hypertrophy result in moderate neural foraminal narrowing worst at
C5-6.
IMPRESSION:
1. No acute fracture. Mild C5-6 retrolisthesis is likely degenerative in
nature. No prevertebral soft tissue swelling or hematoma.
2. Multilevel degenerative changes, as above.
|
10124346-RR-55 | 10,124,346 | 20,904,650 | RR | 55 | 2132-07-20 12:12:00 | 2132-07-20 14:04:00 | EXAMINATION: CT T-SPINE W/O CONTRAST
INDICATION: A ___ woman with a fall, evaluate for fracture.
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
DLP: 1523.29 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture or subluxation. There is no evidence of
critical central spinal canal narrowing. There is no paraspinal soft tissue
swelling or hematoma.
The partially-imaged unopacified mediastinal great vessels are unremarkable.
There is no significant mediastinal lymphadenopathy by CT size criteria. The
major airways and central branches are patent. Motion artifact obscures much
of the lower lobe lung parenchyma however, within this limitation, the lungs
appear clear without focal consolidation. There is no pleural effusion.
Incidentally noted is a large hiatus hernia. The partially imaged upper
abdominal solid and hollow viscous organs are otherwise unremarkable.
IMPRESSION:
1. No acute fracture or subluxation.
2. Incidentally noted large hiatus hernia.
|
10124346-RR-56 | 10,124,346 | 20,904,650 | RR | 56 | 2132-07-20 12:13:00 | 2132-07-20 14:10:00 | EXAMINATION: CT L-SPINE W/O CONTRAST
INDICATION: A ___ woman with a fall, pain, evaluate for fracture.
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 1100.85 mGy.
DLP: 32.29 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute fracture. There is mild degenerative change of
the lumbar spine. There is grade 1 L4-5 anterolisthesis, which appears
degenerative in nature, with resultant mild-to-moderate central spinal canal
narrowing at that level. There is no paraspinal hematoma or edema. There is no
evidence of infection or neoplasm.
Incidentally noted is marked rectosigmoid colonic diverticulosis without
evidence of diverticulitis. Otherwise, the partially-imaged solid and hollow
viscous organs of the abdomen and pelvis are unremarkable.
IMPRESSION:
1. No acute fracture. No paraspinal hematoma or edema.
2. Lumbar spine degenerative changes, including grade 1 L4-5 anterolisthesis
resulting in mild to moderate central spinal canal narrowing at that level.
3. Rectosigmoid diverticulosis.
|
10124367-RR-15 | 10,124,367 | 27,078,967 | RR | 15 | 2170-01-09 16:28:00 | 2170-01-09 18:34:00 | EXAM: Chest, frontal and lateral views.
CLINICAL INFORMATION: Chest pain.
___.
FINDINGS: Patient is status post median sternotomy and CABG. The cardiac
silhouette is mildly enlarged. The aorta is tortuous. No focal consolidation
is seen. There is no pleural effusion or pneumothorax. Evidence of DISH is
seen along the thoracic spine.
IMPRESSION: No acute cardiopulmonary process.
|
10124428-RR-14 | 10,124,428 | 25,968,315 | RR | 14 | 2137-03-06 19:53:00 | 2137-03-06 22:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with hypoxemia, transfer for urosepsis// pna? chf?
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Lung volumes are low. There are bibasilar patchy opacities which may reflect
atelectasis or aspiration in the proper clinical setting. Obscuration of the
left hemidiaphragm and costophrenic angle is likely due to atelectasis . No
pneumothorax. Heart is moderately enlarged. Mediastinal contours are
unremarkable. No aggressive osseous lesion.
IMPRESSION:
Bibasilar patchy opacities may reflect atelectasis or aspiration proper
clinical setting.
|
10124428-RR-15 | 10,124,428 | 25,968,315 | RR | 15 | 2137-03-06 21:00:00 | 2137-03-06 22:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with post intubation. confirm central line placement.// post
intubation. central line placement.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Patient is status post intubation with endotracheal tube tip a bit low,
approximately 2.2 cm from the carina. There has been interval placement of a
right IJ venous catheter with its tip in the proximal right atrium.
Additionally, an enteric tube descends into the stomach and out of view.
Lung volumes are low. There are bibasilar opacities, left greater right. No
pneumothorax. Apparent moderate enlargement of the cardiac silhouette may be
accentuated by low lung volumes the mediastinal contours are unremarkable. No
aggressive osseous lesion.
IMPRESSION:
Status post intubation with low position. Retraction by approximately 2 cm is
recommended. No significant change in lung findings compared to the prior
study. Other support devices as above.
Of note, endotracheal tube has been appropriately repositioned on subsequent
imaging.
|
10124428-RR-16 | 10,124,428 | 25,968,315 | RR | 16 | 2137-03-06 21:19:00 | 2137-03-06 23:02:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with urosepsis, s/p ETT and line// ETT has been pulled back,
pls re-eval
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs ___ at 19:51 and 20:59
FINDINGS:
There has been interval repositioning of the endotracheal tube, with its tip
now 3.4 cm above the carina in appropriate position. Tip of right IJ venous
catheter remains in the proximal right atrium. Enteric tube again descends
into the stomach and out of view.
Compared to the prior study, there has been no significant interval change in
lung findings, including low lung volumes, bibasilar patchy opacities.
IMPRESSION:
1. Interval repositioning of endotracheal tube, now in appropriate position.
2. No significant interval change in lung findings, including bibasilar patchy
opacities which may reflect atelectasis or aspiration in the proper clinical
setting.
|
10124428-RR-17 | 10,124,428 | 25,968,315 | RR | 17 | 2137-03-06 21:30:00 | 2137-03-06 22:15:00 | EXAMINATION: CT ABDOMEN PELVIS W O CONTRAST
INDICATION: ___ with urosepsis+PO contrast// eval for obstructing renal stone
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 6.1 s, 47.8 cm; CTDIvol = 7.7 mGy (Body) DLP = 365.7
mGy-cm.
Total DLP (Body) = 366 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bilateral dependent atelectasis. There is no evidence
of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas is atrophic, without evidence of focal lesions within
the limitations of an unenhanced scan. There is no pancreatic ductal
dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are symmetrically thickened.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
mild to moderate right hydroureteronephrosis proximal to a 1.0 cm stone in the
proximal right ureter, at the ureteropelvic junction. There is no left
hydronephrosis. There is bilateral symmetric perinephric stranding, which is
nonspecific.
GASTROINTESTINAL: The stomach is unremarkable. An enteric tube terminates at
the pylorus. Small bowel loops demonstrate normal caliber and wall thickness
throughout. Colonic diverticulosis is noted without diverticulitis. The
appendix is normal.
PELVIS: The urinary bladder is collapsed around a Foley catheter. Air within
the lumen is consistent with recent intervention. The distal ureters are
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus contains a large exophytic fundal fibroid.
Bilateral adnexae are within normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are mild multilevel degenerative changes of the spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
There is a 1.0 cm calculus at the right ureteropelvic junction with upstream
mild to moderate hydroureteronephrosis. Bilateral perinephric stranding.
|
10124428-RR-18 | 10,124,428 | 25,968,315 | RR | 18 | 2137-03-06 23:30:00 | 2137-03-08 18:23:00 | INDICATION: ___ year old woman with urosepsis, RT 1 cm stone distal rt
ureter// Rt 1 cm stone
COMPARISON: CT of the abdomen pelvis dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and
Dr. ___, Interventional Radiology fellow performed the procedure.
Dr. ___ supervised the trainee during any key components of
the procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: General endotracheal anesthesia
MEDICATIONS: Please check anesthesia flow sheets
CONTRAST: 10 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 8 minutes, 82 mGy
PROCEDURE: 1. Right ultrasound guided renal collecting system access.
2. Right nephrostogram.
3. 8 ___ nephrostomy tube placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
health care proxy. The patient was then brought to the angiography suite and
placed left lateral decubitus on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right flank was prepped and draped in the
usual sterile fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the right renal collecting system was accessed through a posterior lower pole
calyx under ultrasound guidance using a 21 gauge Cook needle. Ultrasound
images of the access were stored on PACS. Prompt return of urine confirmed
appropriate positioning. Injection of a small amount of contrast outlined a
dilated renal collecting system. Under fluoroscopic guidance, a Nitinol wire
was advanced into the renal collecting system. After a skin ___, the needle
was exchanged for an Accustick sheath. Once the tip of the sheath was in the
collecting system; the sheath was advanced over the wire, inner dilator and
metallic stiffener. The wire and inner dilator were then removed and diluted
contrast was injected into the collecting system to confirm position. A ___
wire was advanced through the sheath and coiled in the collecting system. The
sheath was then removed and a 8 ___ nephrostomy tube was advanced into the
renal collecting system. The wire was then removed and the pigtail was formed
in the collecting system. Contrast injection confirmed appropriate
positioning. The catheter was then flushed, 0 silk stay sutures applied and
the catheter was secured with a Stat Lock device and sterile dressings. The
catheter was attached to a bag. The patient tolerated the procedure without
any complications. Patient was transferred to the ICU for further
resuscitation.
FINDINGS:
1. Ultrasound images demonstrate hyperechoic needle tip within the dilated
inferior posterior calyx.
2. Nephrostogram demonstrated dilated renal collecting system with abrupt cut
off of contrast in the proximal ureter consistent with known obstructive
stone.
3. Final image demonstrates 8 ___ nephrostomy tube in appropriate
positioning.
IMPRESSION:
Successful placement of 8 ___ nephrostomy on the right.
|
10124428-RR-19 | 10,124,428 | 25,968,315 | RR | 19 | 2137-03-07 10:17:00 | 2137-03-07 14:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated// interval change, pulm edema?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs ___.
FINDINGS:
Patient has taken a better inspiration from prior. There is bibasilar
atelectasis. No pulmonary edema or pneumothorax. Stable small left pleural
effusion. Right IJ catheter terminates at the cavoatrial junction.
Endotracheal tube is satisfactorily positioned.
IMPRESSION:
Increased lung volumes with improved bibasilar atelectasis. Stable small left
pleural effusion.
|
10124428-RR-20 | 10,124,428 | 25,968,315 | RR | 20 | 2137-03-08 09:37:00 | 2137-03-08 13:26:00 | INDICATION: ___ year old woman with new R perc nephrosotomy tube// R perc
nephrosotomy tube position
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
Pigtail catheter is seen projecting over the lower pole of the right kidney.
An NG tube is seen projecting over the left upper quadrant.
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air.
Osseous structures are notable for
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Well coiled pigtail catheter projecting over the lower pole of the right
kidney.
|
10124428-RR-21 | 10,124,428 | 25,968,315 | RR | 21 | 2137-03-08 11:38:00 | 2137-03-08 16:54:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with urosepsis s/p PCN// evaluation of right
flank/ kidney for hematoma as well as liver/gallbladder for causes of
transaminitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained. There is decreased penetration of sonographic waves which may be
due to patient's body habitus.
COMPARISON: CT dated ___ .
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is no ascites.
There is a trace right pleural effusion.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 3 mm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 11.0 cm
KIDNEYS: Normal cortical echogenicity and corticomedullary differentiation is
seen bilaterally. There is no evidence of masses, stones, or hydronephrosis
in the kidneys.
The nephrostomy tube is demonstrated traversing toward the right kidney.
Right kidney: 12.7 cm
Left kidney: 12.0 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Liver parenchyma is within normal limits, without evidence of focal hepatic
lesions.
2. No evidence of hydronephrosis or nephrolithiasis bilaterally.
3. Trace right pleural effusion.
|
10124428-RR-22 | 10,124,428 | 25,968,315 | RR | 22 | 2137-03-09 20:30:00 | 2137-03-09 20:54:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old woman, intubated, with hypoxia// interval change
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
The endotracheal tube terminates 2.8 cm above the carina. The right internal
jugular central venous catheter terminates in the superior vena cava. A
nasogastric tube crosses the diaphragm and terminates outside of the field of
view.
Hazy bibasilar opacities most likely represent trace pleural effusions and
subsegmental atelectasis. There is no focal consolidation or pneumothorax.
The cardiomediastinal silhouette is stable in appearance. There is no
pulmonary edema. No acute osseous abnormalities are identified.
IMPRESSION:
1. Trace bilateral pleural effusions and subsegmental atelectasis.
2. No focal consolidation, pneumothorax or pulmonary edema.
|
10124428-RR-23 | 10,124,428 | 25,968,315 | RR | 23 | 2137-03-10 15:06:00 | 2137-03-10 17:07:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman intubated, AMS, septic shock from UTI, now with
persisitent fevers and tachycardia// evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: No relevant comparison identified.
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.
|
10124428-RR-24 | 10,124,428 | 25,968,315 | RR | 24 | 2137-03-11 01:28:00 | 2137-03-11 10:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with septic shock from UTI, since with
persistent fevers, now tachypnea/tachycardia// evaluate for infection,
interval change evaluate for infection, interval change
IMPRESSION:
ET tube tip is 3.5 cm above the carina. Right internal jugular line tip is at
the level of mid SVC. Heart size and mediastinum are stable. Left perihilar
consolidation is unchanged but right upper lobe opacity is progressing
concerning for like right upper lobe pneumonia.
|
10124428-RR-25 | 10,124,428 | 25,968,315 | RR | 25 | 2137-03-11 11:46:00 | 2137-03-11 13:04:00 | INDICATION: ___ year old woman with urosepsis// ?intraabdoninal process or
perinephric abscess, location/movement of stone
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 4.0 s, 52.7 cm; CTDIvol = 23.2 mGy (Body) DLP =
1,220.5 mGy-cm.
Total DLP (Body) = 1,220 mGy-cm.
COMPARISON: Prior noncontrast CT abdomen done ___
FINDINGS:
LOWER CHEST: Bibasal atelectasis appears slightly improved compared to prior.
Nondependent ground-glass opacities in the right middle lobe and lingula is
nonspecific, but may represent aspiration if the patient was in the prone
position for a prolonged time period or may reflect infection. Trace
pericardial fluid.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal 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: Previously noted 7 mm right proximal ureteric calculi is essentially
unchanged in position. There has been interval placement of a right
percutaneous nephrostomy tube with resultant decompression of the right renal
collecting system. No right para or perirenal collection. No left renal
calculi. Foley's catheter in situ in the bladder with air present in the
bladder.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is an exophytic fibroid arising from the uterus.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Previously noted 7 mm right proximal ureteric calculi is essentially
unchanged in position.
2. There has been interval placement of a right percutaneous nephrostomy tube
with resultant decompression of the right renal collecting system.
3. No right para or perirenal collections.
4. Non dependent ground-glass opacities in the right middle lobe and lingula
is nonspecific, but may represent aspiration if the patient was in the prone
position for a prolonged time period. Consider atypical infection in the
differential diagnosis.
5. Presumed exophytic fibroid from the uterus for which pelvic ultrasound can
be performed for confirmation.
|
10124428-RR-26 | 10,124,428 | 25,968,315 | RR | 26 | 2137-03-11 11:46:00 | 2137-03-11 13:18:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ year old woman with now resolved thrombocytopenia and altered
mental status. Evaluate for intracranial bleed.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no evidence of acute, large territorial infarction,intracranial
hemorrhage,edema,or mass. The ventricles and sulci are normal in size and
configuration.
There is no evidence of fracture. Partial opacification of the right mastoid
air cells. Partial opacification of the ethmoid air cells. 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.
IMPRESSION:
There is no evidence of acute intracranial process or hemorrhage.
|
10124428-RR-27 | 10,124,428 | 25,968,315 | RR | 27 | 2137-03-12 03:42:00 | 2137-03-12 10:11:00 | INDICATION: Fevers.
TECHNIQUE: Frontal chest radiograph.
COMPARISON: Chest radiographs from chest ___ through ___.
FINDINGS:
An endotracheal tube terminates 3.1 cm above the carinal. A right IJ catheter
terminates at the mid SVC. The heart size is normal. The hilar and
mediastinal contours are unchanged. There is no pneumothorax or focal
consolidation. A small left pleural effusion appears increased since the ___ study. There is central pulmonary vascular congestion, without
overt edema.
IMPRESSION:
-Slightly increased small left pleural effusion.
-Central pulmonary vascular congestion.
|
10124428-RR-29 | 10,124,428 | 25,968,315 | RR | 29 | 2137-03-12 16:09:00 | 2137-03-12 19:06:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new picc// Right basilic 39cm picc placed,
? picc tip position. Contact name: ___: ___
TECHNIQUE: Portable semi-upright portable supine frontal chest radiograph
COMPARISON: ___ 03:49 chest x-ray.
FINDINGS:
There is a new right PICC with the tip ending in the 1 cm below the cavoatrial
junction, within the right atrium. The right IJ, endotracheal tube and enteric
tube are in appropriate position.
Lung volumes are low-normal. There are patchy opacities in the right lung
base, which may represent atelectasis or aspiration. Linear opacities in the
left lung base most likely represent subsegmental atelectasis. The small left
pleural effusion is unchanged. The cardiomediastinal silhouette is stable in
appearance. There are no acute osseous abnormalities.
IMPRESSION:
1. Tip of the new right PICC terminates 1 cm below the cavoatrial junction.
All other lines and tubes in unchanged position.
2. Patchy opacities in the right lung base which may represent atelectasis or
aspiration.
3. Unchanged small left pleural effusion.
NOTIFICATION: The findings were discussed with ___, R.N. by ___
___, M.D. on the telephone on ___ at 7:05 pm, 0 minutes after
discovery of the findings.
|
10124428-RR-31 | 10,124,428 | 25,968,315 | RR | 31 | 2137-03-14 15:46:00 | 2137-03-14 16:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sepsis, increasing tachypnea// r/o
interval change r/o interval change
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Heart size and mediastinum
are stable. Mild vascular congestion is unchanged. There is no appreciable
pleural effusion or pneumothorax peer
|
10124428-RR-32 | 10,124,428 | 25,968,315 | RR | 32 | 2137-03-15 00:57:00 | 2137-03-15 03:45:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old woman with sepsis, increasing tachypnea/O2
requirements// r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.4 s, 31.2 cm; CTDIvol = 13.8 mGy (Body) DLP = 430.8
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
4) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
Total DLP (Body) = 436 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
The heart is enlarged. A central venous access line terminates at the
cavoatrial junction. There is no evidence of pericardial effusion. There is
a trace left pleural effusion.
Motion artifact limits evaluation of the lung parenchyma. Within limitations
of the study, bilateral ground-glass opacities with peripheral interlobular
septal thickening suggest volume overload. There is minimal dependent
atelectasis of the bilateral lung bases. The airways are patent to the
segmental level.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Mild volume overload with trace left pleural effusion.
3. Cardiomegaly.
|
10124428-RR-33 | 10,124,428 | 25,968,315 | RR | 33 | 2137-03-20 11:47:00 | 2137-03-20 13:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with urinary tract infection and atelectasis.//
evaluate for pneumonia/atelectasis
IMPRESSION:
In comparison with the study of ___, the patient has taken a better
inspiration. Cardiac silhouette is within normal limits. Mild indistinctness
of pulmonary vessels suggests some elevated pulmonary venous pressure.
Atelectatic streaks are seen at the left base, but there is no evidence of
acute focal pneumonia or definite pleural effusion.
Right subclavian catheter extends to the lower SVC.
|
10124428-RR-35 | 10,124,428 | 25,968,315 | RR | 35 | 2137-03-22 18:03:00 | 2137-03-22 18:57:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old woman with tachycardia// pulmonary embolism
TECHNIQUE: MDCT imaging was performed through the chest following the
administration of contrast in the arterial phase.
DOSAGE: Acquisition sequence:
1) Spiral Acquisition 2.4 s, 32.2 cm; CTDIvol = 10.3 mGy (Body) DLP = 332.1
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
Total DLP (Body) = 335 mGy-cm.
COMPARISON: CT chest ___
FINDINGS:
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Visualized thyroid is unremarkable.
No supraclavicular or axillary lymphadenopathy.
UPPER ABDOMEN: Small hiatal hernia. Limited assessment of the abdomen is
otherwise unremarkable.
MEDIASTINUM: No mediastinal lymphadenopathy.
HILA: No hilar lymphadenopathy.
HEART and PERICARDIUM: Small pericardial effusion, increased from ___.
PLEURA: Previously seen small left pleural effusion is essentially resolved.
LUNG:
1. PARENCHYMA: Previously seen mosaic attenuation is improved. There is
still mild ground-glass opacity at periphery of the left upper lobe and trace
scattered foci of ground-glass in the right upper lobe (series 301, image 84,
83). Right lung base and right middle lobe (series 301, image 140, 54)
___ opacities which may have been obscured by respiratory motion of
the right lung base on the prior examination appear more prominent. There is
mild bronchial thickening and mucous plugging (series 301, image 51), which
appears similar to prior allowing for technical differences. A more discrete
3 mm right upper lobe pulmonary nodule (series 301, image 40).
2. AIRWAYS: Trace secretions the dependent portion of the trachea (series 2,
image 15).
3. VESSELS: Ascending aorta is mildly enlarged measuring up to 4.1 cm,
unchanged.
CHEST CAGE: No osseous malignancy or infection.
IMPRESSION:
1. No pulmonary embolism
2. Fluid overload appears moderately improved. ___ opacities at the
right lung base and right middle lobe as well as ground-glass opacities in the
periphery of the left upper lobe may be infectious or inflammatory. These
were likely present on the prior examination, but obscured by respiratory
motion. Trace bronchial thickening and mucous plugging also appears similar
to prior.
3. Small pericardial effusion appears increased from ___.
4. Mild enlargement of the ascending aorta measuring up to 4.1 cm, unchanged
from ___.
|
10124428-RR-36 | 10,124,428 | 25,968,315 | RR | 36 | 2137-03-23 09:41:00 | 2137-03-23 17:03:00 | EXAMINATION: Video swallow study
INDICATION: ___ year old woman with difficulty swallowing and nutritional need
to advance diet// evaluation of oropharyngeal
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 4.19 min. Skin does: 33 mGy. DAP: 780.7 uGym2
COMPARISON: None
FINDINGS:
Trace penetration with thin liquids. No other penetration no other
penetration and no aspiration risk. Slow mastication due to edentulous upper
teeth and dry mouth.
IMPRESSION:
Trace aspiration with thin liquids. No other evidence of penetration. Low
risk for aspiration
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
10124500-RR-20 | 10,124,500 | 28,359,046 | RR | 20 | 2163-07-10 00:48:00 | 2163-07-10 01:58:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: NO_PO contrast; History: ___ with recent abnormal CT scan and
known ____PO contrast// ?RUQ mass
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) = 412 mGy-cm.
COMPARISON: Same-day CT chest; MRI abdomen ___
FINDINGS:
LOWER CHEST: Bibasilar atelectasis. Otherwise, visualized lung fields are
within normal limits. There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Compared to ___, again seen is a 3.3 x 2.2 cm segment
VI/VII lesion, previously characterized as an OPTN 5b hepatocellular carcinoma
with new central hypodensity concerning for fat. This lesion is likely
post-TACE, though no records are available at the time of dictation to confirm
this suspicion. There is a subcentimeter segment VII hypodensity,
characterized on recent MR as ___ simple cyst (___). There is mild CBD
enhancement without evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreatic head has a large area of necrosis. There is an
adjacent large multiloculated acute necrotic collection measuring 9.1 x 6.1 cm
on axial images. The pancreatic duct is non-dilated and is visualized to the
level of the pancreatic neck. The duct likely drains into the acute necrotic
collection. No evidence of extra-luminal gas. There is extensive stranding
surrounding the ascending colon and Gerota's fascia.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There is diffuse thickening of the descending duodenal wall.
The stomach is unremarkable. Small bowel loops demonstrate normal caliber,
wall thickness, and enhancement throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Again seen are multiple paraesophageal and gastric varices. The
origin of the common hepatic artery is normal. The distal hepatic arteries
are not well evaluated on this non-arterial phase study. The portal, superior
mesenteric and splenic veins are patent.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is fat stranding in the subcutaneous tissues of the right
flank. Otherwise, the abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. The pancreatic head has necrosis with adjacent multiloculated acute
necrotic collection. The pancreatic duct is non-dilated and is visualized to
the level of the pancreatic neck. The duct likely drains into the acute
necrotic collection. No evidence of extra-luminal gas.
2. Compared to ___, again seen is a 3.3 x 2.2 cm segment VI/VII
lesion, previously characterized as an OPTN 5b hepatocellular carcinoma with
new central fat. This lesion is likely post-TACE, though no records are
available at the time of dictation to confirm this suspicion.
NOTIFICATION: The updated findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 11:19 am, 10 minutes after
discovery of the findings.
|
10124500-RR-21 | 10,124,500 | 28,359,046 | RR | 21 | 2163-07-13 18:03:00 | 2163-07-13 19:03:00 | INDICATION: ___ year old woman with pancreatic necrosis s/p TACE procedure,
now with likely duodenal ischemia// ? duodenal ischemiaPLEASE PERFORM SCAN
WITH PO CONTRAST
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 administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.5 s, 55.2 cm; CTDIvol = 10.0 mGy (Body) DLP = 554.2
mGy-cm.
Total DLP (Body) = 554 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___ and MRI abdomen dated ___.
FINDINGS:
LOWER CHEST: There is bilateral small pleural effusion, more on the right.
There is associated right compressive atelectasis. The lungs are otherwise
clear. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates a nodular contour consistent with
cirrhosis. Again seen is a 3.2 x 2.6 cm lesion in hepatic segment VI/VII with
central fatty component, unchanged compared to ___. Additional
subcentimeter hypoattenuating lesion consistent with cysts on MRI in the right
lobe of the liver is unchanged. There is no evidence of new focal lesions
within the limitations of an unenhanced scan. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent. No portal venous gas.
PANCREAS: The head of the pancreas appears edematous and heterogeneous with
central hypoattenuating areas in keeping with known pancreatic head necrosis,
which is better evaluated on contrast enhanced CT from ___. The
remaining pancreas demonstrate normal morphology and attenuation throughout.
Evaluation of the acute necrotic collection is limited due to lack of IV
contrast but measures approximately 9.0 x 3.4 cm (series 2, image 30),
slightly smaller dated ___. There is no pancreatic ductal
dilatation.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is distended and contrast filled. Again seen is
diffuse wall thickening of the descending duodenal wall. Contrast is seen
passing through the duodenum into the small bowel loops. There is no
extraluminal air or contrast extravasation. The small and large bowel
demonstrate no obstruction. Soft tissue stranding surrounding the hepatic
flexure is most likely secondary to adjacent peripancreatic necrotic
collection. The colon and rectum are within normal limits. The appendix is
normal. No free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal masses.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Again seen is soft tissue stranding in the right flank, similar
to ___. There is a small fat containing umbilical hernia.
IMPRESSION:
1. Evaluation of the pancreatic head necrosis and acute peripancreatic
necrotic collection is limited by noncontrast study. Given the limitation,
pancreatic head necrosis is stable. Acute necrotic collection has decreased
in size.
2. Circumferential wall thickening of the descending duodenal wall without
extraluminal air or contrast extravasation. No free air or portal venous gas.
3. Cirrhotic liver with a unchanged hypoattenuating lesion in segment VI/VII
with central fatty component.
4. Small bilateral pleural effusion, more on the right.
|
10124500-RR-23 | 10,124,500 | 28,359,046 | RR | 23 | 2163-07-14 12:45:00 | 2163-07-14 13:49:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new line // new right PICC 43 cm ___
___ Contact name: ___: ___ new right PICC 43 cm ___ ___
IMPRESSION:
Compared to chest radiograph on ___.
New right PIC line heads into the neck and out of view. Mild right basilar
atelectasis has increased. Pleural effusions small if any. Upper lungs
clear. Heart size normal.
|
10124500-RR-24 | 10,124,500 | 28,359,046 | RR | 24 | 2163-07-14 13:54:00 | 2163-07-14 21:22:00 | INDICATION: ___ year old woman with severe necrotic pancreas and duodenal
ulcer, needs TPN// please place ___ IV nurses unable to place. CXR pending
COMPARISON: Chest x-ray dated ___
TECHNIQUE: OPERATORS: Dr. ___, attending radiologist, performed
the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: Lidocaine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.6 min, 3 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
double lumen PIC line measuring 35 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. Existing right arm approach PICC with tip coiled in the SVC replaced with a
new double lumen PIC line with tip in the distal SVC.
IMPRESSION:
Successful placement of a 35 cm right arm approach double lumen PowerPICC with
tip in the distal SVC. The line is ready to use.
|
10124807-RR-23 | 10,124,807 | 28,379,577 | RR | 23 | 2114-07-27 16:54:00 | 2114-07-27 18:57:00 | INDICATION: ___ year old man with J tube clogged // Please exchange.
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___, Interventional Radiology Fellow and Dr.
___, attending radiologist performed the procedure. Dr. ___
___ Dr. ___ supervised the trainee during the key components of
the procedure and have reviewed and agree with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 32 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed
CONTRAST: 20 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1.1 min, 4 mGy
PROCEDURE: 1. Exchange of a jejunostomy tube.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The upper abdomen and tube site was prepped and draped in the usual
sterile fashion.
The existing tube was injected with contrast and showed opacification of the
small bowel. The stay sutures were cut. A ___ wire was advanced through
the tube into the small bowel. The existing tube was then removed using gentle
traction. A new 14 ___ ___ catheter was modified by shortening and
making several new sideholes. The new 14 ___ Tube was advanced over the
wire into the jejunum and the loop was formed. Contrast injection confirmed
appropriate position. The tube was secured in place using 0 silk sutures.
Sterile dressing was applied. Patient tolerated the procedure well and there
were no immediate post-procedure complications.
FINDINGS:
1. Existing 14 ___ surgically placed jejunostomy within the small bowel
2. Replacement of jejunostomy tube with a new 14 ___ modified ___ with
tip in the small bowel.
IMPRESSION:
Successful exchange of a jejunostomy tube for a new ___ Fr modified ___
tube. The tube is ready to use.
|
10124825-RR-20 | 10,124,825 | 27,890,366 | RR | 20 | 2123-03-06 01:05:00 | 2123-03-06 03:12:00 | INDICATION: Stroke, please evaluate for infection.
COMPARISON: No prior studies available for comparison.
FINDINGS: Chest PA and lateral radiograph demonstrates bilateral low lung
volumes. Mediastinal and main pulmonary artery engorgement with dense air
space opacification noted throughout both lungs as well as hazy pulmonary
vasculature likely representing edema. Hear size is minimally enlarged.
Retrocardiac opacity is likely atelectasis.
IMPRESSION: Diffuse bilateral opacities with hazy pulmonary vasculature
likely represents pulmonary edema; however, concurrent pneumonia cannot be
excluded. Recommend repeat conventional radiographs when feasible.
|
10124825-RR-21 | 10,124,825 | 27,890,366 | RR | 21 | 2123-03-06 10:36:00 | 2123-03-07 09:41:00 | INDICATION: ___ man with new right vertebral artery dissection and
dysarthria. Evaluate for stroke.
COMPARISON: CTA from ___.
TECHNIQUE: Multiplanar, multisequence MRI imaging of the brain was obtained
without the administration of contrast.
FINDINGS: There is an area of slow diffusion in the right ___ territory
involving the right cerebellum. This area also demonstrates a few regions of
susceptibility artifact and corresponding increased T2 FLAIR signal and mild
mass effect. T2 sequences demonstrate a possible segmental absence of flow
voids in the right V4 segment. The remaining flow voids are unremarkable.
The ventricles, cistern and sulci are age appropriate. There is no evidence
of midline shift, herniation or hydrocephalus. The orbits are within normal
limits. There is near-complete opacification of the left maxillary sinus with
heterogeneous material, which may represent inspissated secretions.
IMPRESSION:
Early acute infarction in the right cerebellum, involving the right ___
territory with few regions of susceptibility artifact, likely representing
hemorrhagic transformation. There appears to be a segmental occlusion of the
right V4 segment.
These findings were communicated via phone to Dr. ___ at 1pm -
___ by Dr. ___
|
10124825-RR-22 | 10,124,825 | 27,890,366 | RR | 22 | 2123-03-06 19:30:00 | 2123-03-07 09:06:00 | CHEST RADIOGRAPH
INDICATION: Known lung disease, status post stroke, new line.
COMPARISON: ___.
FINDINGS: left IJ line with the tip likely to project over the
caval-brachiocephalic junction. There is no pneumothorax. Minimally improved
ventilation of the lung parenchyma.
|
10124825-RR-24 | 10,124,825 | 27,890,366 | RR | 24 | 2123-03-07 08:43:00 | 2123-03-07 15:20:00 | INDICATION: ___ man with right cerebellar or brainstem stroke.
Evaluate for worsening swelling around the fourth ventricle.
COMPARISON: Prior head MR of ___ and prior head CTA of ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast.
FINDINGS: The known right cerebellar infarction is more pronounced than on
the prior CT, with slightly increased leftward shift of midline structures.
Mass effect and distortion of the fourth ventricle is present, not appreciably
changed since the prior exam. The third and lateral ventricles remain
enlarged, stable since the prior exam. No new area of infarct or hemorrhage.
The basal cisterns appear patent.
Vascular calcifications are noted. The left maxillary sinus is opacified
diffusely, unchanged since the prior CT.
IMPRESSION: Appearance of right cerebellar infarct is more pronounced with
slightly increased leftward shift of midline. Mass effect and distortion of
the fourth ventricle persistent though not appreciably changed from the prior
exam. No hemorrhage or new area of infarct.
|
10124825-RR-25 | 10,124,825 | 27,890,366 | RR | 25 | 2123-03-07 17:49:00 | 2123-03-07 19:26:00 | INDICATION: ___ male status post posterior fossa craniectomy and
cerebellar resection for stroke. Question postoperative change.
COMPARISON: CT dated ___ and MR dated ___.
TECHNIQUE: Contiguous non-contrast axial images were acquired through the
brain.
FINDINGS: Patient is immediately status post right suboccipital craniotomy
with small amount of fluid and air within the surgical bed. There is focal
hyperdensity within the right cerebellum, consistent with hemorrhage likely
due to a combination of hemorrhagic conversion and postoperative change.
There is also a small amount of bifrontal extra-axial pneumocephalus. There
is mild improvement of fourth ventricular effacement, as compared to preceding
CT. There is no new major vascular territorial infarct. Ventricles and sulci
are stable in size and contour. Suprasellar and basilar cisterns are patent.
Hypoattenuation within the right cerebellar hemisphere, extending into the
vermis appears unchanged, consistent with known ischemic infarct.
Complete opacification of the left maxillary sinus is unchanged. There is
also mucosal thickening in the ethmoidal air cells. Mastoid air cells are
well aerated. Vascular calcifications are seen in the cavernous carotid
arteries. Globes and orbits appear intact.
IMPRESSION:
1. Status post suboccipital craniotomy with post-operative air and fluid
within the surgical bed with associated subcutaneous emphysema. Hyperdensity
within the right cerebellum may represent a combination of hemorrhagic
conversion and postoperative change.
2. Mild improvement in the degree of fourth ventricular effacement.
3. No definite new major vascular territorial infarct.
|
10124825-RR-26 | 10,124,825 | 27,890,366 | RR | 26 | 2123-03-08 09:44:00 | 2123-03-08 11:34:00 | CHEST RADIOGRAPH
INDICATION: Cranial bleeding, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has been
intubated. The tip of the endotracheal tube projects 3 cm above the carina.
There is no nasogastric tube. Left central venous access line is unchanged.
Unchanged mild-to-moderate pulmonary edema and mild cardiomegaly.
|
10124825-RR-27 | 10,124,825 | 27,890,366 | RR | 27 | 2123-03-08 14:07:00 | 2123-03-08 15:39:00 | HISTORY: Ischemic CVA, for NG tube placement.
FINDINGS: In comparison with the earlier study of this date, there has been
placement of a nasogastric tube that extends well into the stomach beyond the
lower margin of the image. Otherwise, little change.
|
10124825-RR-28 | 10,124,825 | 27,890,366 | RR | 28 | 2123-03-09 07:22:00 | 2123-03-09 13:20:00 | INDICATION: ___ man with right vertebral thrombus and large right
cerebellar stroke, now status post occipital craniectomy. Reassess swelling,
mass effect, hemorrhagic conversion, and hydrocephalus.
COMPARISONS: Multiple prior head NECTs, most recently of ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast.
FINDINGS: The patient is status post right suboccipital craniectomy.
Postoperative pneumocephalus has resolved. Hypoattenuation of the right
cerebellar hemisphere is again seen, compatible with known infarction. The
previously noted central dense foci are less prominent, compatible with
expected evolution of blood products. Mild leftward shift of normally midline
posterior fossa structures is not significantly changed, allowing for
differences in position and technique. Slight effacement of the fourth
ventricle and quadrigeminal plate cistern are not appreciably changed since
the prior exam. Size and configuration of third ventricle and lateral
ventricles are similar to prior. No new areas of hemorrhage or mass effect.
The left maxillary sinus remains completely opacified. Slight thickening of
the mucosal ethmoid air cells is stable. Mastoid air cells and middle ear
cavities are clear. The globes are intact.
IMPRESSION: Status post right suboccipital craniectomy for right cerebellar
infarct. Dense central foci have decreased in conspicuity, compatible with
expected evolution of infarction. Otherwise, no significant changes. Stable
effacement of the fourth ventricle. No new hemorrhage or mass effect.
|
10124825-RR-29 | 10,124,825 | 27,890,366 | RR | 29 | 2123-03-10 04:09:00 | 2123-03-10 10:17:00 | REASON FOR EXAMINATION: Evaluation of the patient with aphasia and left
hemiparesis.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The ET tube tip is 4.5 cm above the carina. The NG tube tip is in the
stomach. The left internal jugular line tip is at the level of mid portion of
left brachiocephalic vein. Heart size and mediastinum are unchanged including
cardiomegaly. Bilateral opacities in the lung bases appear to be slightly
progressed since the prior studies and might reflect developing infectious
process or atelectasis. Minimal vascular engorgement is noted.
|
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