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10124825-RR-31 | 10,124,825 | 27,890,366 | RR | 31 | 2123-03-10 08:35:00 | 2123-03-10 12:21:00 | INDICATION: ___ man with right cerebellar stroke with increased
intracranial pressure and compression of fourth ventricle status post
occipital craniectomy. Evaluate for 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 administration of IV contrast.
FINDINGS: The posterior fossa is incompletely imaged and the only the
superior-most aspect of the right suboccipital craniectomy is visualized.
Hypoattenuation of the visualized right cerebellar hemisphere is similar to
prior, compatible with right cerebellar infarct. Blood products are more
prominent in the cerebellum and now subdural blood is seen to track around the
tentorium and along the posterior falx. Mild leftward shift of normally
midline posterior fossa structures is similar to prior. Effacement of the
fourth ventricle remains. The size and configuration of the third ventricle
and lateral ventricles are similar to prior. No new areas of mass effect.
Stable area of encephalomalacia in the left occipital lobe is compatible with
a chronic infarct. The left maxillary sinus is opacified. The paranasal
sinuses, mastoid air cells, and middle ear cavities are otherwise clear. The
globes are intact.
IMPRESSION: The posterior fossa is incompletely imaged. The visualized
cerebellum demonstrates stable edema and infarct and blood products. Subdural
blood now tracks around the tentorium and along the posterior falx. The
fourth ventricle remains effaced. No new mass effect.
Findings were communicated via phone call by ___ to Dr. ___ on
___ at 1353.
|
10124825-RR-32 | 10,124,825 | 27,890,366 | RR | 32 | 2123-03-11 04:19:00 | 2123-03-11 10:47:00 | REASON FOR EXAMINATION: Aphasia and left hemiparalysis.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The ET tube tip is 5.5 cm above the carina. Left internal jugular line tip is
in the left brachiocephalic vein most likely. The NG tube tip cannot be
clearly seen on the current examination, passing below the diaphragm, most
likely in the stomach. Cardiac silhouette is unchanged including mild
cardiomegaly. Left more than right basal opacities are most likely reflecting
atelectasis. No appreciable pulmonary edema is noted. No pneumothorax or
substantial pleural effusion is seen.
|
10124825-RR-33 | 10,124,825 | 27,890,366 | RR | 33 | 2123-03-12 01:56:00 | 2123-03-12 09:03:00 | HISTORY: Stroke.
FINDINGS: In comparison with study of ___, the monitoring and support
devices remain in place, though the left IJ catheter has been pushed forward
to almost reach the superior vena cava. Relatively low lung volumes persist
with little change in the cardiac silhouette. Mild bilateral atelectatic
changes with some indistinctness of pulmonary vessels suggestive of elevated
pulmonary venous pressure.
|
10124825-RR-34 | 10,124,825 | 27,890,366 | RR | 34 | 2123-03-13 03:30:00 | 2123-03-13 08:53:00 | HISTORY: Diuresis.
FINDINGS: In comparison with the study of ___, the monitoring and support
devices remain in place. Continued relative low lung volumes with little
change in the enlarged cardiac silhouette. Pulmonary vascular congestion is
essentially unchanged and there are again mild atelectatic changes at the
bases.
|
10124825-RR-35 | 10,124,825 | 27,890,366 | RR | 35 | 2123-03-14 03:41:00 | 2123-03-14 10:38:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Stroke, anticoagulation, and STEMI; intubated.
Comparison is made with prior study, ___.
Moderate-to-severe cardiomegaly and widened mediastinum are unchanged. Left
IJ catheter tip is in the upper SVC. There is no pneumothorax. Bibasilar
opacities, larger on the right side, are a combination of pleural effusions
and atelectases. The atelectases have worsened on the right. Pulmonary edema
has almost resolved. NG tube tip is out of view below the diaphragm. There
is no evident pneumothorax.
|
10124825-RR-36 | 10,124,825 | 27,890,366 | RR | 36 | 2123-03-15 08:58:00 | 2123-03-15 09:54:00 | CHEST RADIOGRAPH
INDICATION: Hyperosmolar therapy, worsening swelling. Evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. The monitoring and support devices are constant. Unchanged moderate
cardiomegaly. Mild bilateral pleural effusions. No focal parenchymal opacity
suggesting pneumonia. No relevant fluid overload.
|
10124825-RR-37 | 10,124,825 | 27,890,366 | RR | 37 | 2123-03-16 08:46:00 | 2123-03-16 13:09:00 | INDICATION: ___ man with followup for stroke.
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. Blood
products appear slightly more dense in the right cerebellar hemisphere with
increased conspicuity of subdural blood tracking along the tentorium into the
falx. This is concerning for ongoing hemorrhage. Effacement of the right
frontal lobe sulci is similar to before.
A new, small hypodense focus is present in the left internal capsule and there
are one or two left parasagittal parietal hypodensities that are more
conspicuous than on the prior exam. ( se 2, im 17, 18 and 19). These may
represent an evolving infarcts, although not seen on the prior MR of ___. Stable area of encephalomalacia in the left parietal/occipital lobe is
compatible with a prior infarct. Size and configuration of the third and
lateral ventricles are similar to prior. The fourth ventricle remains
effaced. No evidence of new mass effect. Left maxillary sinus is opacified,
as before. There has been increase in mucosal thickening of the right
maxillary sinus and paranasal sinuses. The mastoid air cells and middle ear
cavities are clear.
IMPRESSION:
1. Increased density of blood products within right cerebellar hemisphere
infarct and increased conspicuity of subdural blood tracking along the
tentorium and falx is concerning for ongoing hemorrhage.
2. Two or three hypodense foci at the left internal capsule and left
parasagittal parietal region likely represent evolving infarcts, as not seen
on earlier imaging. Attention on close f/u.
Findings were communicated via phone call by ___ to ___
on ___ at 12:15 p.m.
|
10124825-RR-38 | 10,124,825 | 27,890,366 | RR | 38 | 2123-03-17 11:44:00 | 2123-03-18 11:49:00 | STUDY: CT of the head and CTA of the neck.
CLINICAL INDICATION: Right cerebellar infarction with hemorrhage, evaluate
for interval changes.
COMPARISON: Prior head CT dated ___ and prior MRI of the brain
dated ___, CTA of the head dated ___.
TECHNIQUE: MDCT helical images were obtained through the head without
contrast. Subsequently, rapid axial imaging was performed through the brain
during the infusion of 70 cc of Optiray intravenous contrast. Curved
reformats, 3D volume-rendered images, and maximum intensity projection images
process were generated in a separate workstation and reviewed.
FINDINGS:
HEAD CT WITHOUT CONTRAST: The patient is status post right suboccipital
craniotomy, again blood products are visualized along the tentorium and the
posterior falx, consistent with subdural collection, unchanged area of low
attenuation in the left thalamic region, measuring approximately 10 x 15 mm in
transverse dimension (image #23, series #2), likely consistent with an
evolving infarct, there is no evidence of hemorrhagic transformation in this
region. The orbits are unremarkable, persistent mucosal thickening identified
at the maxillary sinuses, now with mucosal thickening on the right maxillary
sinus with patchy ethmoidal mucosal thickening. There is also bilateral
mucosal thickening in the posterior aspect of the sphenoid sinus.
CTA OF THE HEAD:
In comparison with the prior examination, now restored flow is identified
throughout the right vertebral artery, otherwise, no significant changes are
seen and the major arterial branches are patent.
Mild multilevel degenerative changes are visualized throughout the cervical
spine. New band of atelectasis is noted at the right lung with a small amount
of bilateral pleural effusion, unchanged hypodense nodule is identified in the
left thyroid lobe.
IMPRESSION:
1. Unchanged right cerebellar hemisphere infarct with associated hemorrhagic
focus and unchanged subdural blood along the tentorium and falx. Focal area
of low attenuation noted on the left thalamus, likely consistent with an
evolving infarct with no evidence of hemorrhagic transformation.
2. The CTA of the neck demonstrates restored flow throughout the right
vertebral artery with reconstitution of the different segments, otherwise, no
significant change, all major arteries are patent.
|
10124825-RR-39 | 10,124,825 | 27,890,366 | RR | 39 | 2123-03-17 18:04:00 | 2123-03-18 08:38:00 | HISTORY: Possible cerebellar stroke, to assess for pneumonia.
FINDINGS: In comparison with study of ___, the left IJ catheter is at the
junction of the brachiocephalic vein and SVC. There is continued enlargement
of the cardiac silhouette with possible mild elevation of pulmonary venous
pressure. No evidence of acute focal pneumonia.
|
10124825-RR-40 | 10,124,825 | 27,890,366 | RR | 40 | 2123-03-18 18:38:00 | 2123-03-19 08:17:00 | HISTORY: Stroke with possible lung collapse.
FINDINGS: In comparison with the study of ___, there is little overall
change. Enlargement of the cardiac silhouette with some elevation of
pulmonary venous pressure and opacification at the left base consistent with
substantial atelectasis in the left lower lung and small pleural effusion are
again seen. Nasogastric tube is in the distal esophagus.
|
10124825-RR-41 | 10,124,825 | 27,890,366 | RR | 41 | 2123-03-22 11:23:00 | 2123-03-22 18:14:00 | INDICATION: ___ man with right cerebellar stroke and long-term NG
tube placement. Now with persistent fevers and leukocytosis; evaluate for
sinusitis.
COMPARISONS: Multiple prior head NECTs, most recently of ___.
TECHNIQUE: Helical axial MDCT images were acquired through the paranasal
sinuses. Coronal reformatted images were prepared.
SINUS CT: Lobulated and somewhat polypoid mucosal thickening of the nasal
mucosa and bilateral maxillary and ethmoid sinuses is similar in appearance to
the admission CTA of ___, at which time, no enteric or endotracheal
tube was present. There are now superimposed layering fluid and aerosolized
secretions in the right maxillary sinus and bilateral sphenoid air cells. Both
spheno-ethmoidal recesses are occluded by lobulated mucosal thickening. While
loculated fluid is seen immediately adjacent to the nasogastric tube in the
___- and oropharynx, no dependent fluid is seen within the nasopharynx or
nasal cavity. There is mucosal thickening along the maxillary infundibula,
but the ostiomeatal units remain patent.
The anterior clinoid processes are not pneumatized. The laminae papyracea are
intact. The nasal septum is midline. The orbits are grossly unremarkable.
Evaluation of the brain is limited by helical acquisition, reconstruction
algorithm, and section thickness. The patient is status post occipital
craniectomy. The right cerebellar infarct has undergone expected evolution
with resolution of small central hemorrhage and developing encephalomalacia
with prominence of the extra-axial spaces. Mass effect on the fourth
ventricle appears to have improved. Allowing for limitations of this study's
technique, no evidence of new hemorrhage or infarction is present.
IMPRESSION:
1. New layering fluid in the right maxillary antrum and bilateral sphenoid
air cells is non-specific. However, given other evidence of inflammatory
sinus disease and the relative paucity of layering fluid in the nasopharynx
and nasal cavity, the findings favor acute inflammation, superimposed on
pre-existent sinus disease.
2. Expected evolution of right cerebellar infarct with early encephalomalacia
and resolution of small central hemorrhage. No new hemorrhage or infarction.
COMMENT: Findings were communicated to Dr. ___ (Neurology
service), by Dr. ___ via phone call, at 1606H on ___.
|
10124825-RR-42 | 10,124,825 | 27,890,366 | RR | 42 | 2123-03-23 10:33:00 | 2123-03-23 11:04:00 | INDICATION: Right PICC placement.
COMPARISONS: ___.
Findings portable AP chest radiograph demonstrates new right PICC terminating
in the lower SVC. Moderate cardiomegaly and pulmonary vascular congestion are
unchanged from ___. The nasogastric tube has been removed.
IMPRESSION:
1. Right PICC terminates in the lower SVC.
2. Unchanged mild pulmonary edema.
|
10124885-RR-13 | 10,124,885 | 20,490,662 | RR | 13 | 2146-05-17 17:47:00 | 2146-05-17 18:02:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with chest pain at rest// eval for PNA, PTX,
effusion
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable. No pulmonary edema is seen. Anterior bridging osteophyte is
seen at at least 1 level at the mid to lower thoracic spine.
IMPRESSION:
No acute cardiopulmonary process.
|
10124890-RR-14 | 10,124,890 | 23,933,770 | RR | 14 | 2170-01-30 22:05:00 | 2170-01-30 23:35:00 | EXAMINATION: CT enterography
INDICATION: ___ year old woman with Celiac disease, severe malabsorption, and
abnormal LFTs.// CT enterography. Assess extent of bowel involvement. Look for
any unexpected intrabdominal pathology that would change differential
diagnosis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 1.4
mGy-cm.
2) Stationary Acquisition 21.7 s, 0.2 cm; CTDIvol = 366.6 mGy (Body) DLP =
73.3 mGy-cm.
3) Spiral Acquisition 8.2 s, 53.5 cm; CTDIvol = 9.5 mGy (Body) DLP = 504.0
mGy-cm.
Total DLP (Body) = 579 mGy-cm.
COMPARISON: No relevant comparison.
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions with compressive
subsegmental atelectasis..
ABDOMEN:
HEPATOBILIARY: There is diffuse hepatic steatosis evidenced by regions of
sparing. The presence of fat limits the evaluation for focal lesions. The
gallbladder is within normal limits. There is small to moderate ascites
throughout the abdomen.
PANCREAS: Unremarkable.
SPLEEN: Unremarkable.
ADRENALS: Unremarkable.
URINARY: Bilateral kidneys are unremarkable. No hydronephrosis.
GASTROINTESTINAL: There is moderate gastric distension and mild distal
esophageal dilatation, the latter could represent reflux or delayed emptying
from gastric distension. There is no small bowel obstruction. There is
jejunization of the ileum and hyperenhancement of the bowel wall, reflective
of celiac disease. The jejunal loops demonstrate mild loss of the folds and
multiple segments resemble the ileum.
There are prominent mesenteric lymph nodes measuring up to 1.0 cm (series 5;
image 73), which are most likely reactive. There is no free intraperitoneal
air.
PELVIS: There is a small amount of simple free fluid in the pelvis. The
uterus and adnexa are unremarkable for age.
LYMPH NODES: No enlarged retroperitoneal or inguinal lymph nodes are seen
VASCULAR: There is no abdominal aortic aneurysm. The mesenteric vasculature
is patent
BONES: There is no evidence of worrisome osseous lesions .
SOFT TISSUES: Severe subcutaneous soft tissue edema is noted. There is also
deep and intermuscular soft tissue edema.
IMPRESSION:
1. Marked dilatation of the stomach could be correlated with gastroparesis.
There is mild dilatation of the distal esophagus which could be due to reflux
or secondary to gastric distension.
2. "Jejunization'' of the ileum likely reflecting known celiac disease.
Numerous nonenlarged mesenteric lymph nodes, likely reactive.
3. Small pleural effusions, small amount of ascites and extensive subcutaneous
soft tissue edema most likely secondary to third spacing.
4. Hepatic steatosis.
|
10124890-RR-15 | 10,124,890 | 23,933,770 | RR | 15 | 2170-01-30 18:16:00 | 2170-01-30 18:52:00 | INDICATION: ___ year old woman with picc// r dl picc 43cm iv ping ___
Contact name: ping, ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
FINDINGS:
The tip of the right PICC line projects approximately 1 cm beyond the
cavoatrial junction.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is within normal limits.
IMPRESSION:
The tip of the right PICC line projects approximately 1 cm beyond the
cavoatrial junction.
|
10124890-RR-16 | 10,124,890 | 23,933,770 | RR | 16 | 2170-02-04 08:17:00 | 2170-02-04 10:53:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ woman with elevated LFTs; RUQ US with Doppler.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis from ___. No prior ultrasound is
available on PACS at the time this dictation.
FINDINGS:
Liver: The hepatic parenchyma is mildly coarsened and echogenic. No focal
liver lesions are identified. There is trace ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 3 mm.
Gallbladder: The gallbladder is contracted. The gallbladder appears within
normal limits, without stones, abnormal wall thickening, or edema.
Pancreas: The pancreas is not well visualized, obscured by overlying bowel
gas.
Spleen: The spleen demonstrates normal echotexture, and measures 10.1 cm.
Kidneys: Limited views of the kidneys show no hydronephrosis.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 35.1 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
IMPRESSION:
1. Echogenic liver consistent with steatosis as seen on prior CT. Other
forms of liver disease and more advanced liver disease including
steatohepatitis or significant hepatic fibrosis/cirrhosis cannot be excluded
on this study.
2. Patent hepatic vasculature.
|
10124890-RR-17 | 10,124,890 | 23,933,770 | RR | 17 | 2170-02-05 10:24:00 | 2170-02-05 12:00:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with acute onset LLE pain// DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: No prior imaging available for comparison at the time of
dictation.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
There is prominent soft tissue edema in the left calf at the site of the
patient's pain.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
There is prominent soft tissue edema in the left calf at the site of the
patient's pain.
|
10124890-RR-18 | 10,124,890 | 23,933,770 | RR | 18 | 2170-02-07 12:33:00 | 2170-02-07 14:30:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with R sided PICC// RUE edema, worsening, rule
out DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
A right PICC line is visualized with nonocclusive adherent thrombus along the
line within the basilic vein.
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 cephalic veins are patent,
compressible and show normal color flow and augmentation.
IMPRESSION:
1. Adherent nonocclusive basilic vein thrombus along the right upper extremity
PICC line.
2. No evidence of deep vein thrombosis in the right upper extremity.
|
10125252-RR-7 | 10,125,252 | 28,943,109 | RR | 7 | 2115-08-30 16:00:00 | 2115-08-30 17:24:00 | INDICATION: ___ with chest pain // ? pna
TECHNIQUE: Frontal and lateral chest radiographs were obtained with the
patient in the upright position.
COMPARISON: None available.
FINDINGS:
The lungs are clear of focal consolidation, pleural effusion or pneumothorax.
The heart size is normal. The mediastinal contours are normal. Surgical clips
are noted within the right chest.
IMPRESSION:
No acute cardiopulmonary process.
|
10125734-RR-10 | 10,125,734 | 27,298,072 | RR | 10 | 2171-09-08 14:18:00 | 2171-09-08 20:11:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with a dilated tubular structure on CT,
pyosalpinx vs. hydrosalpinx. please page ___ with results.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: Ultrasound and CT scans dated ___
FINDINGS:
The uterus is anteverted and measures 7.6 x 3.1 x 4.1 cm.
Re- demonstrated is a left adnexal dilated tubular structure containing
internal debris measuring up to 1.9 cm in diameter and at least 9 cm in
length. A small amount of free fluid is noted throughout the pelvis.
The ovaries are normal.
IMPRESSION:
Left adnexal dilated tubular structure containing internal debris which may
reflect a pyosalpinx versus hematosalpinx.
|
10126501-RR-20 | 10,126,501 | 20,777,622 | RR | 20 | 2110-03-03 03:42:00 | 2110-03-03 05:09:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with new focal neuro deficits (r face droop, tongue
left)// eval for emboli, stenosis, bleed
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 9.5 s, 0.5 cm; CTDIvol = 103.5 mGy (Head) DLP =
51.7 mGy-cm.
3) Spiral Acquisition 5.0 s, 39.6 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,263.9 mGy-cm.
Total DLP (Head) = 2,213 mGy-cm.
COMPARISON: CT head from ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute intracranial hemorrhage, mass, mass effect or
large territorial infarction. Postoperative changes are seen status post left
frontal craniotomy. Subtle periventricular and deep subcortical white matter
hypodensities are likely sequelae of chronic microangiopathy. Note is made of
bilateral basal ganglia calcifications.
No acute fracture is identified. The patient is status post right lens
replacement surgery. Right maxillary sinus appears hypoplastic, with mild
mucosal sinus thickening. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
CTA HEAD:
The basilar artery is normal. The right posterior cerebral artery is normal.
The left posterior cerebral artery is normal. The left internal carotid
artery demonstrates a 2 mm inferiorly oriented outpouching, arising from the
supraclinoid segment, series 5, image 252. Moderate atherosclerotic disease
is seen along the cavernous segment of the left internal carotid artery. The
left middle cerebral artery is normal. There is normal arborization of the
distal left MCA vessels. The right internal carotid artery demonstrates
moderate atherosclerotic disease. The right MCA is normal. There is normal
arborization of the distal right MCA vessels. The anterior cerebral arteries
are normal. The dural venous sinuses are patent.
Incidental note is made of a prominent vessel extending from the left internal
carotid artery and connecting to the mid basilar artery, which may be a
congenital anatomic variant on the spectrum of a persistent trigeminal artery.
CTA NECK:
The right common carotid, and internal carotid artery are normal. Note is
made of a tortuous, retropharyngeal course of the right internal carotid
artery. Mild atherosclerotic disease is seen along the bulb of the right
internal carotid artery, however there is no evidence of internal carotid
artery stenosis by NASCET criteria. The left common carotid, and internal
carotid artery appear to be normal. Moderate atherosclerotic disease is seen
at the left common carotid bifurcation, with at least 45% stenosis of the left
internal carotid artery by NASCET criteria. The left vertebral artery is
dominant, with ___ termination of the right vertebral artery. The V4 segment
of the right vertebral artery is diminutive. Flow is seen within the cervical
segments of the bilateral vertebral arteries.
OTHER:
Incidental note is made of a 0.4 cm ground-glass nodule within the right lung
apex. The left lung apex is unremarkable. Note is made of a dilated and
patulous esophagus. The thyroid is heterogeneous, with multiple hypodensities
measuring up to 0.4 cm. There is no cervical lymphadenopathy. The
submandibular glands are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality identified.
2. Incidental 2 mm inferiorly oriented outpouching is seen arising from the
supraclinoid left internal carotid artery, series 5, image 252, potentially
representing an infundibular origin versus a small aneurysm. Otherwise,
unremarkable CTA of the head without evidence of significant stenosis.
3. 45% stenosis of the left internal carotid artery by NASCET criteria. No
evidence of right cervical internal carotid artery stenosis by NASCET
criteria.
4. 0.4 cm ground-glass nodule incidentally noted within the right lung apex,
unchanged compared to the prior CTA of the chest from ___.
NOTIFICATION: Updated findings were discussed with Dr. ___, M.D. by
___, M.D. on the telephone on ___ at 2:53 pm, 10 minutes after
discovery of the findings.
|
10126501-RR-21 | 10,126,501 | 23,167,022 | RR | 21 | 2110-03-21 22:23:00 | 2110-03-22 09:25:00 | EXAMINATION: FEMUR (AP AND LAT) LEFT IN O.R.
INDICATION: ___ year old woman with IT fracture.// Preop film for long
intramedullary nail. r/o lesion in femur that would contraindicate a long
nail. Preop film for long intramedullary nail. r/o lesion in femur that
would contraindicate a long nail.
TECHNIQUE: Frontal and lateral radiographs of the left femur
COMPARISON: X-rays dated ___.
FINDINGS:
Re-demonstration of a comminuted intertrochanteric fracture with slight medial
displacement of the lesser tuberosity. Left hip joint is in anatomic
location. No other fractures of the distal femur. Mild osteoarthritis at the
medial tibiofemoral compartment.
IMPRESSION:
Comminuted left intratrochanteric fracture.
|
10126501-RR-22 | 10,126,501 | 23,167,022 | RR | 22 | 2110-03-22 11:00:00 | 2110-03-22 13:22:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO LEFT IN O.R.
INDICATION: LEFT HIP FX ORIF WITH TFN IN O.R. ROOM 9
IMPRESSION:
Images from the operating suite show placement of a fixation device about
previous fracture of the proximal fifth left femur. Further information can
be gathered from the operative report.
|
10126501-RR-23 | 10,126,501 | 23,167,022 | RR | 23 | 2110-03-24 16:25:00 | 2110-03-24 16:41:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with chest pain, dyspnea// Edema, infiltrate,
effusion
TECHNIQUE: Chest two views
COMPARISON: ___
FINDINGS:
Marked cardiomegaly, similar to prior. Pre seen mediastinal congestion is
mildly improved. Resolved pulmonary edema. Right infrahilar opacity is
improved. Trace pleural effusions, better seen compared to prior.
Sternotomy, valve replacement. Surgical clips right axilla. No pneumothorax.
IMPRESSION:
Interval mild improvement.
Trace pleural effusions.
|
10127469-RR-27 | 10,127,469 | 21,405,846 | RR | 27 | 2162-10-15 01:36:00 | 2162-10-15 03:38:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with sepsis; line comfirmation // L CVL placement;
infiltrate?
TECHNIQUE: Portable AP upright radiograph view of the chest.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
A left sided Port-A-Cath tip projects just to the right of midline a over the
expected region of the mid to upper SVC. Left lower lobe dense consolidation
is perhaps slightly more conspicuous particularly in the perihilar region
compared to the prior exam - this likely reflects a combination of infection
in the setting of sepsis, atelectasis, as well as a small pleural effusion.
New heterogeneous right lower lobe consolidation is likely pneumonia. Mild
interstitial edema is improved since ___. Probable mild cardiomegaly
is overall similar. No pneumothorax.
IMPRESSION:
1. Catheter tip projects over the expected region of the mid to upper SVC.
2. Bibasilar pneumonia increased since ___.
3. Persistent small left pleural effusion and atelectasis.
4. Mild interstitial edema, improved.
|
10127469-RR-28 | 10,127,469 | 21,405,846 | RR | 28 | 2162-10-15 05:58:00 | 2162-10-15 10:02:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ female with rectosigmoid resection p/w fevers,
tachycardia, peritonitis. Evaluate for intraabdominal perforation? abscess?
leak?
Per OMR, patient has a history of rectal cancer, status-post chemoradiation.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
IV Contrast: 150 mL Omnipaque.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
4) Spiral Acquisition 4.8 s, 52.0 cm; CTDIvol = 14.3 mGy (Body) DLP = 743.3
mGy-cm.
Total DLP (Body) = 751 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: Bilateral, nonhemorrhagic small pleural effusions are overall
similar prior exam. Adjacent region of homogeneously enhancing lung
parenchyma bilaterally in the lower lobes is consistent with compressive
atelectasis, similar to the prior exam. Adjacent to these regions of
atelectasis are consolidative opacities with air bronchograms that do not
appreciably enhance and could reflect pneumonitis or sequelae of pulmonary
embolus in the appropriate clinical situation - this is difficult to assess
since the chest is incompletely visualized. The visualized pulmonary
vasculature on this non-dedicated exam appear patent. No evidence of
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
There is a small amount of low-attenuation fluid along the inferior tip of the
right hepatic lobe with slight along the right pericolic gutter into the
pelvis (series 2, image 41).
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 of normal and symmetric size with normal nephrograms.
Small bilateral renal cortical hypodensities are too small to accurately
characterize on CT but are statistically likely cysts, unchanged. Left
parapelvic cysts are unchanged. No evidence of concerning focal focal renal
lesions or hydronephrosis. No perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. The patient is status-post
terminal ileum resection with end ileostomy with mucous fistula in the right
lower quadrant. The patient is also status-post proctosigmoidectomy with end
colostomy in the left lower quadrant. Contrast is seen throughout the small
bowel through the ileostomy. The end colostomy and residual colon are largely
decompressed. A short segment of small bowel in the right abdomen adjacent to
the ileostomy is slightly edematous (e.g. Series 2, image 55) but is not
dilated and has oral contrast. Remaining small bowel loops are distended with
oral contrast but are not abnormally dilated and have normal wall thickness
and enhancement. No drainable fluid collection, pneumoperitoneum, or evidence
of pneumatosis or bowel obstruction. No evidence of extraluminal leak of oral
contrast.
PELVIS: The urinary bladder is decompressed and contains a Foley catheter with
the balloon inflated is small focus of intraluminal air and contrast. The
distal ureters are unremarkable. There is a small amount of free fluid in the
pelvis presacral space. No drainable fluid collection.
REPRODUCTIVE ORGANS: The uterus is absent.
LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or
inguinal lymphadenopathy.
VASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is
noted.
BONES: No evidence of worrisome osseous lesions or acute fracture.
Degenerative changes are most prominent at L5-S1 with loss of intervertebral
disc height and vacuum phenomenon. There is suggestion of disc protrusion
into the spinal canal at this level (series 602b, image 48).
SOFT TISSUES: Post-surgical skin closure material is demonstrated. A region
of soft tissue fluid, edema, and emphysema directly under the skin staples is
demonstrated at midline, measuring up to 7.6 cm in the craniocaudal direction
(series 602b, image 45). Small amounts of soft tissue emphysema and swelling
is also noted inferiorly. No drainable fluid collection in the soft tissues.
There is general diffuse soft tissue edema.
IMPRESSION:
1. No evidence of pneumoperitoneum or drainable fluid collection in the
abdomen or pelvis. Small amount of free fluid in the presacral space and
right upper abdomen.
2. No bowel obstruction or evidence of oral contrast leak.
3. Soft tissue emphysema, fluid, and edema involving the mid abdomen directly
under the skin staples with a small component also seen superiorly.
4. Persistent small bilateral nonhemorrhagic pleural effusions with
compressive atelectasis. New non-enhancing bilateral airspace consolidation
which could reflect pneumonitis or sequelae of pulmonary embolus, incompletely
imaged on this abdomen/pelvis exam. If concern of pulmonary embolus, a
dedicated Chest CT for PE can be performed.
5. Degenerative changes at L5-S1 with disc protrusion.
RECOMMENDATION(S): Dedicated pulmonary embolus CT if there is clinical
concern.
NOTIFICATION: The findings were discussed by Dr. ___ with the ACS
team on the telephoneon ___ at 7:51 AM, 5 minutes after discovery of the
findings.
|
10127469-RR-29 | 10,127,469 | 21,405,846 | RR | 29 | 2162-10-17 05:23:00 | 2162-10-17 08:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ hx of rectal cancer s/p perf with exlap and sigmoid resection
readmitted with sepsis from presumed urinary tract infection and afib rvr //
interval change PNA vs pulm edema interval change PNA vs pulm edema
IMPRESSION:
Comparison to ___. Moderate bilateral pulmonary edema has
decreased in extent and severity. A small pleural effusion on the left is
also more extensive than on the previous image. Moderate retrocardiac
atelectasis persists. Unchanged position of the left Port-A-Cath.
|
10127469-RR-31 | 10,127,469 | 21,405,846 | RR | 31 | 2162-10-17 15:47:00 | 2162-10-17 16:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with dobhoff tube // assess tube placement
assess tube placement
COMPARISON: Prior chest radiographs since ___, most recently
___ one through ___.
IMPRESSION:
Feeding tube with the wire stylet in place passes into the stomach and out of
view. Left subclavian infusion port ends in the upper SVC.
Severe bilateral pulmonary consolidation has remained stable since earlier in
the day, substantially worsened since ___. Whether it is pneumonia or
pulmonary hemorrhage or pulmonary edema is radiographically indeterminate.
Moderate bilateral pleural effusions have increased during the day. Heart
shadow is now entirely obscured. There is no pneumothorax.
|
10127469-RR-32 | 10,127,469 | 21,405,846 | RR | 32 | 2162-10-18 11:18:00 | 2162-10-18 13:58:00 | EXAMINATION: CHEST PORT LINE/TUBE PLCT 1 EXAM
INDICATION: ___ ___ only) PMHx for rectal cancer s/p neoadjuvant
chemoXRT c/b SB perf w/fecal peritonitis s/p exlap, TI resection, end
ileostomy/mucus fistula ___ w/radiation induced necrosis s/p open
proctosigmoid resection with end colostomy ___ who returned from rehab
with fever, abdominal pain, hyperglycemia, and Afib with RVR, now transferred
out of the ICU w/worsening leukocytosis w/dobhoff placement // evaluate
dobhoff location as out ___ inches evaluate dobhoff location as out ___ inches
IMPRESSION:
In comparison with the study of ___, the opaque tip of the Dobhoff
tube is in the mid to lower stomach. There has been some decrease in the
diffuse bilateral pulmonary opacifications, which are still quite evident.
The appearance could well represent improving pulmonary edema, possibly with
some element of multifocal pneumonia or pulmonary hemorrhage.
|
10127469-RR-33 | 10,127,469 | 21,405,846 | RR | 33 | 2162-10-18 18:36:00 | 2162-10-18 19:17:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ ___ only) PMHx for rectal cancer and CT findings
suggestive of prior PE. Evaluate for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: CT abdomen and pelvis from ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst. There is extensive
bilateral subcutaneous soft tissue edema. On the left, there is edema
tracking into the fascial layers.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins.
2. Extensive bilateral subcutaneous soft tissue edema. On the left, there is
fluid tracking into the deeper fascia layers.
|
10127469-RR-34 | 10,127,469 | 21,405,846 | RR | 34 | 2162-10-20 11:52:00 | 2162-10-20 13:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with dobhoff pulledback accidentally //
dobhoff position
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are unchanged compared to the prior study with bibasal, layering
pleural effusions. In addition, bile airspace opacities are noted, similar
when compared to the prior study and likely reflecting pulmonary edema. A
left-sided PICC terminates in the proximal SVC. A Dobhoff tube terminates in
the distal stomach. No pneumothorax seen.
IMPRESSION:
The Dobhoff tube terminates in the distal stomach.
|
10127469-RR-36 | 10,127,469 | 21,405,846 | RR | 36 | 2162-10-23 14:11:00 | 2162-10-23 15:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p thortacentesis // pneumo pneumo
IMPRESSION:
In comparison with study of ___, there has been a substantial decrease
in opacification bilaterally no evidence of post thoracentesis pneumothorax.
Cardiac silhouette is within upper limits of normal in size. There is some
indistinctness of pulmonary vessels suggesting some elevated pulmonary venous
pressure. Although there appears to have been significant decrease in the
pleural effusions bilaterally, some of this could reflect a more upright
position of the patient.
|
10127469-RR-37 | 10,127,469 | 21,405,846 | RR | 37 | 2162-10-23 17:44:00 | 2162-10-24 00:49:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman with new dobhoff // stage dobhoff placement.
Contact name: ___: ___ stage dobhoff placement.
IMPRESSION:
The second of 2 films documents position of the top of catheter in the
stomach. No complications, notably no pneumothorax. Unchanged appearance of
the heart and the lung parenchyma.
|
10127469-RR-39 | 10,127,469 | 21,405,846 | RR | 39 | 2162-10-28 08:22:00 | 2162-10-28 09:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with NG tube pulled back 10cm. // NG tube
position NG tube position
COMPARISON: ___
IMPRESSION:
Port-A-Cath catheter tip terminates at the level of mid SVC. The cough tube
tip is in the stomach. Heart size and mediastinum are stable. Left pleural
effusion is noted. Pulmonary edema appears to be extensive, minimally
decreased since the prior study.
|
10127469-RR-42 | 10,127,469 | 21,405,846 | RR | 42 | 2162-10-29 08:21:00 | 2162-10-29 09:00:00 | EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old woman with ___ // hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT ABDOMEN PELVIS DATED ___
FINDINGS:
The right kidney measures 11.5 cm. The left kidney measures 10.6 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance. Ureteral
jets were not able to be visualized. Patient was unable to cooperate with
voiding and postvoid measurements due to confusion.
IMPRESSION:
No evidence of hydronephrosis.
|
10127469-RR-43 | 10,127,469 | 21,405,846 | RR | 43 | 2162-10-29 19:06:00 | 2162-10-30 11:34:00 | EXAMINATION: MRI of the Pelvis
INDICATION: History of rectal cancer, status post chemotherapy and XRT.
Complicated by bowel perforation, status post ileostomy and colostomy. Now
with severe rectal pain. Please evaluate.
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: None, given the patient's acute kidney injury.
COMPARISON: CT of the abdomen and pelvis from ___. MRI of the
pelvis from ___.
FINDINGS:
The patient is status post a partial colectomy. There is a remaining rectal
pouch. The wall of the pouch is significantly thickened. The thickening is
circumferential. No obvious residual tumor is identified, though the exam is
slightly limited by the lack of intravenous contrast. Along the superior
aspect of the pouch on the left, the mucosa is slightly irregular, though no
obvious discrete dehiscence is identified (4, 17). There is a pocket of
ill-defined fluid which sits between the pouch and the sigmoid colon in the
presacral space (4, 14), which is not significantly changed from the prior CT.
There is no air in the fluid to suggest a leak, though one cannot be
completely excluded. The fat around this ill-defined fluid demonstrate
significant stranding and inflammatory changes. There is no well-defined rim
around this fluid to suggest that it is an abscess.
The patient is status post a hysterectomy. The vaginal mucosa is thickened
and edematous, likely from radiation changes. There is no focal mass. No
evidence of a fistula is identified between the rectal pouch and the vaginal
canal.
A Foley catheter is present within the bladder. Air within the bladder is
likely from this recent instrumentation. The bladder is not well distended,
which limits evaluation. Within the limitations, there does appear to be
diffuse circumferential wall thickening, somewhat worse along the superior
aspect of the bladder. There is no evidence of mass. This is likely related
to radiation changes. No fistula to the bladder is identified.
There is diffuse significant edema in the presacral space. Additionally,
there is significant edema in the musculature of the pelvis, bilaterally.
Finally, there is significant edema in the subcutaneous fat, particularly
anteriorly. This is again likely radiation changes.
The pelvic vasculature is not well evaluated on this noncontrast study.
There is no pelvic or inguinal lymphadenopathy.
There are no concerning osseous lesions. Surgical changes are noted in the
anterior pelvis from a vertical midline incision. There is no evidence of a
fluid collection or hernia.
IMPRESSION:
1. Significant thickening of the wall of the rectal pouch, likely due to post
radiation changes. No evidence of recurrent tumor in the pouch.
2. The mucosa along the superior aspect of the pouch is irregular, and there
is a moderate amount of ill-defined fluid in the presacral space superior to
the pouch, which is similar in amount to the prior CT from ___.
While no discrete dehiscence is identified, given this persistent fluid, one
cannot be excluded with certainty. If desired, this could be further
evaluated with a pouch-o-gram.
3. Significant thickening of the vaginal wall and bladder wall, likely due to
post radiation changes. No fistula is identified.
4. Significant edema in the musculature and soft tissues of the pelvis,
likely from postradiation changes. No well-defined fluid collection to
suggest an abscess.
|
10127469-RR-45 | 10,127,469 | 21,405,846 | RR | 45 | 2162-10-30 10:19:00 | 2162-10-30 11:37:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with pneumonia and effusions previously
resolving // recurrence of pna or effusion
TECHNIQUE: Portable, AP radiograph view of the chest.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Lung volumes are low. Progressive, gradual increase in bilateral parenchymal
opacities with air bronchograms, which may reflect edema, although concurrent
pneumonia cannot be excluded. Retrocardiac opacity likely reflects
combination of small persistent left pleural effusion and atelectasis, which
is overall unchanged. No pneumothorax. The cardiomediastinal silhouette is
unchanged. Left Port-A-Cath tip is unchanged. Enteric tube coiled enters
into the left upper abdomen its tip is not seen.
IMPRESSION:
New moderate edema. Persistent small left pleural effusion and atelectasis.
|
10127469-RR-47 | 10,127,469 | 21,405,846 | RR | 47 | 2162-11-02 14:06:00 | 2162-11-02 20:26:00 | EXAMINATION: CT urogram
INDICATION: ___ year old woman with ___, severe radiation inflammation of
bladder and rectum. // ? recto-vesicular fistula, ureteral obstruction?
TECHNIQUE: CT urogram: Multidetector CT axial images were acquired through
the pelvis without the administration of intravenous contrast. Subsequently,
400 cc of water soluble contrast was instilled into the urinary bladder the
via gravity and additional axial images were acquired through the pelvis.
Post void axial images were also obtained through the pelvis.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 4.8 s, 35.4 cm; CTDIvol = 7.9 mGy (Body) DLP = 242.8
mGy-cm.
4) Spiral Acquisition 4.8 s, 35.4 cm; CTDIvol = 7.9 mGy (Body) DLP = 242.8
mGy-cm.
5) Spiral Acquisition 4.8 s, 35.4 cm; CTDIvol = 7.9 mGy (Body) DLP = 242.8
mGy-cm.
6) Spiral Acquisition 4.8 s, 35.4 cm; CTDIvol = 7.9 mGy (Body) DLP = 242.8
mGy-cm.
Total DLP (Body) = 971 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
The patient is status-post terminal ileum resection with end ileostomy and
mucous fistula in the right lower quadrant as well as post-proctosigmoidetomy
with an end colostomy in the left lower quadrant. Overall appearance is
unchanged. A short segment of small bowel in the right abdomen adjacent to the
ileostomy again may be slightly edematous and there appears to be some
residual oral contrast within the lumen. No bowel obstruction in visualized
loops of bowel in the pelvis. No drainable fluid collection. There is mild
fat-stranding in the mesentery and peritoneum.
The urinary bladder after installation of 400 cc of contrast distends nicely
with small amount of air in the lumen, consistent with Foley catheter
placement. No evidence of extraluminal contrast to suggest a leak. No
evidence of oral contrast within the rectum to suggest a fistula. The urinary
bladder wall is grossly uniform in thickness. No evidence of a bladder mass
lesion. No evidence of contrast within the distal ureters. No obstructing
calcified distal ureteral or bladder stone on the non-contrast images.
The uterus is absent. No pelvic or inguinal lymphadenopathy by CT size
criteria. There is moderate anasarca diffusely.
Degenerative changes at L5-S1 are mild and similar to the prior exam. No
suspicious lytic or sclerotic osseous lesion. No evidence of an acute
fracture.
Mild atherosclerotic calcifications are similar to the prior exam.
IMPRESSION:
1. No evidence of extraluminal contrast from the bladder to suggest a leak or
fistula.
2. Post-surgical changes in the bowel without evidence of obstruction or
drainable fluid collection.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephoneon ___ at 4:08 ___, 1 minutes after
discovery of the findings.
|
10127469-RR-48 | 10,127,469 | 21,405,846 | RR | 48 | 2162-11-02 15:14:00 | 2162-11-02 15:45:00 | EXAMINATION: RENAL U.S. PORT
INDICATION: ___ year old woman with ___, severe radiation induced hemorrhagic
cystitis // Hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound dated ___.
FINDINGS:
The right kidney measures 11.4 cm. The left kidney measures 10.4 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is decompressed with Foley in place.
IMPRESSION:
No hydronephrosis.
|
10127469-RR-49 | 10,127,469 | 21,405,846 | RR | 49 | 2162-11-05 10:31:00 | 2162-11-05 12:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with diffuse crackles // Pneumonia vs.
pulmonary edema? Pneumonia vs. pulmonary edema?
COMPARISON: Chest radiographs since ___, most recently ___
through ___.
IMPRESSION:
Moderate pulmonary edema worsened on ___, subsequently improved
slightly. Moderate right and small left pleural effusions and left lower lobe
collapse are still present. Mild cardiomegaly unchanged. No pneumothorax.
Left subclavian infusion port ends in the upper SVC, as before.
|
10127469-RR-50 | 10,127,469 | 21,405,846 | RR | 50 | 2162-11-07 20:52:00 | 2162-11-08 08:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new hypoxia // r/o pulm edema, pleural
effusions worsening, or pneumonia r/o pulm edema, pleural effusions
worsening, or pneumonia
COMPARISON: Comparison to ___ at 10:42
FINDINGS:
Portable AP semi-upright chest radiograph ___ at 21:18 is
submitted.
IMPRESSION:
There are increasing perihilar and parenchymal opacities consistent with
worsening moderate pulmonary edema. There are likely layering bilateral
effusions, left greater than right, with persistent retrocardiac consolidation
likely reflecting partial lower lobe collapse. Overall cardiac mediastinal
contours are stable. Left-sided Port-A-Cath unchanged in position. No large
pneumothorax is appreciated.
|
10127469-RR-51 | 10,127,469 | 21,405,846 | RR | 51 | 2162-11-08 02:56:00 | 2162-11-08 03:34:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with rectal cancer and pneumonia and renal
failure now with severe lethargy virtually unarousable // eval for bleeding
intracranially, pt on heparin
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 752 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture, infarction, hemorrhage, edema, or mass
effect. Prominent ventricles and sulci likely reflect age related
involutional changes. Periventricular and scattered subcortical white matter
hypodensities are nonspecific though likely sequela of chronic small vessel
ischemia. There is no shift of normally midline structures. The basal
cisterns are patent. Orbits are unremarkable. Mastoid air cells are
partially opacified, left greater than right. Remaining paranasal sinuses
demonstrate minimal mucosal thickening within bilateral maxillary sinuses.
IMPRESSION:
No acute intracranial abnormality. Age related volume loss and likely sequela
of chronic small vessel ischemia.
Partially opacified mastoid air cells, left greater than right, may reflect
prolonged supine position.
|
10127469-RR-52 | 10,127,469 | 21,405,846 | RR | 52 | 2162-11-12 17:41:00 | 2162-11-12 18:14:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new dobhoff placement // placement of
dobhoff Contact name: ___: ___ placement of dobhoff
IMPRESSION:
In comparison with the study of ___, the Dobhoff tube extends at
least to the lower body of the stomach. Port-A-Cath is unchanged.
The degree of pulmonary edema has decreased. There is still enlargement of
cardiac silhouette with layering pleural effusion on the left with compressive
basilar atelectasis. The right hemidiaphragm is more sharply seen, though a
small effusion in may well also be present on this side.
|
10127469-RR-53 | 10,127,469 | 21,405,846 | RR | 53 | 2162-11-19 09:25:00 | 2162-11-19 10:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with loose dobhoff // dobhoff placement in
stomach dobhoff placement in stomach
IMPRESSION:
The Dobhoff tube extends to the distal stomach. In comparison with the study
of ___, there is again enlargement of the cardiac silhouette though the
pulmonary edema has cleared. Retrocardiac opacification is consistent with
substantial volume loss in left lower lobe and possible small effusion.
|
10127469-RR-54 | 10,127,469 | 21,405,846 | RR | 54 | 2162-11-21 10:23:00 | 2162-11-21 12:19:00 | INDICATION: ___ year old woman with rectal cancer s/p resection + chemo/xrt
// evaluate for fistula
TECHNIQUE: Cystogram
DOSE: Acc air kerma: 73 mGy; Accum DAP: 792 uGym2; Fluoro time: 2 min 6
second
COMPARISON: CT cystogram without contrast ___
FINDINGS:
Initial AP, and lateral scout images prior to administration of contrast show
a Foley catheter within the bladder.
Study was suboptimal due to limitation in patient's mobility.
Intermittent fluoroscopy was performed while approximately 120 cc of
Cysto-Conray water soluble contrast was instilled through the patient's
catheter into the bladder. Filling of the bladder was terminated when the
patient began to experience discomfort. With a distended bladder, imaging was
performed in AP, oblique, and lateral projections. The bladder was evacuated
through the catheter. Post-evacuation images were then obtained.
There is no evidence of contrast extravasation from the bladder. No ureteral
contrast reflux was seen.
IMPRESSION:
No evidence of bladder leak of fistula.
|
10127469-RR-55 | 10,127,469 | 21,405,846 | RR | 55 | 2162-11-21 14:40:00 | 2162-11-21 15:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new dobhoff // check dobhoff placement
check dobhoff placement
IMPRESSION:
In comparison with the study of ___, there has been placement of a new
Dobhoff tube that extends to the antrum. Continued opacification at the left
base consistent with a combination of pleural fluid and volume loss in the
left lower lobe. No evidence of vascular congestion or acute focal pneumonia.
The left subclavian PICC line extends to the mid portion of the SVC.
|
10127469-RR-57 | 10,127,469 | 21,405,846 | RR | 57 | 2162-11-22 15:28:00 | 2162-11-26 08:28:00 | EXAMINATION: MRI of the Pelvis.
INDICATION: Status -post terminal ileum resection with end ileostomy and
mucous fistula in the right lower quadrant as well as post-proctosigmoidetomy
with an end colostomy in the left lower quadrant, and de functioning rectal
pouch. Status post hysterectomy as well. There is ongoing clinical concern for
a fistulous tract between the rectal pouch and bladder anteriorly. This has
been investigated with a CT cystogram and cystogram under fluoroscopy, both of
which have not demonstrated a fistulous tract.
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: 12 mL Prohance.
COMPARISON: MR pelvis ___.
FINDINGS:
No fluid collections or abscesses are noted within the pelvis.
No fistula or sinus tract is noted between the rectal pouch, vaginal cuff, and
bladder.
Bladder is moderately distended with a Foley catheter. Vaginal cuff is within
normal limits.
As seen on the prior study, along the superior aspect of the rectal pouch,
there is a moderate amount of nonenhancing, heterogeneously T2-hyperintense
mucosa. Along the superior aspect of the rectal pouch, a small amount of
intraluminal nonenhancing fluid is again noted, unchanged from the prior
study. No external fluid collection is detected.
Status post hysterectomy. The vaginal mucosa remains thickened and edematous,
likely post therapy changes. The degree of edema within the presacral space
and subcutaneous soft tissue has markedly improved since the ___
study.
No pelvic sidewall or inguinal lymphadenopathy. Visualized vasculature is
patent.
No acute or aggressive osseous lesions.
IMPRESSION:
1. No rectovaginal or rectovesical fistula. No focal fluid collection.
2. Posttreatment changes at the proctectomy site with interval improvement of
presacral and subcutaneous edema.
|
10127469-RR-58 | 10,127,469 | 21,405,846 | RR | 58 | 2162-11-28 09:03:00 | 2162-11-28 10:17:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman with resected rectal cancer now in recovery but
with poor PO intake requiring repeat dobhoff placement // please assess for
dobhoff placement please assess for dobhoff placement
IMPRESSION:
The second of 2 images shows the feeding tube having a normal course. The tip
is not included on the image. No complications, notably no pneumothorax.
|
10127469-RR-59 | 10,127,469 | 21,405,846 | RR | 59 | 2162-11-30 13:16:00 | 2162-11-30 14:39:00 | INDICATION: Renal failure and ureteral stents. Confirmed stent position.
TECHNIQUE: Single supine frontal view of the abdomen.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
Bilateral ureteral stents are present. They appear to be in satisfactory
position with the superior pigtails in the expected location of the renal
collecting systems and the inferior pigtails in the expected location of the
bladder. The tip of the Dobhoff tube is present within the distal aspect of
the stomach. The bowel gas pattern is nonobstructive. There is no free
intraperitoneal air on this limited supine exam. There are no concerning
osseous lesions.
IMPRESSION:
Satisfactory position of the bilateral ureteral stents.
|
10127469-RR-60 | 10,127,469 | 21,405,846 | RR | 60 | 2162-11-30 14:07:00 | 2162-11-30 14:55:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with worsening renal failure // please
evaluate for hydronephrosis or other sign of obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound dated ___.
FINDINGS:
The right kidney measures 10.5 cm. The left kidney measures 10.5 cm. There is
no hydronephrosis, stones, or masses bilaterally. Increased cortical
echogenicity is noted bilaterally, similar to the prior examination. Normal
corticomedullary differentiation are seen bilaterally.
The bladder is only minimally distended and can not be fully assessed on the
current study.
IMPRESSION:
No evidence of hydronephrosis. Mildly increased bilateral renal cortical
echogenicity is suggestive of underlying medical renal disease.
|
10127469-RR-62 | 10,127,469 | 21,405,846 | RR | 62 | 2162-12-05 15:19:00 | 2162-12-06 13:08:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: ___ year old woman with h/o rectal cancer, presenting with sepsis
(unclear source) and worsening renal dysfunction. WBC scan shows area
concerning for possible infection of L mandible. // r/o dental infection
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: Total DLP (Head) = 835 mGy-cm.
COMPARISON: None available.
FINDINGS:
SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other
soft tissue abnormality.
MAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.
The zygomatico-maxillary complex is intact. The lateral pterygoid plates are
intact.
MANDIBLE: The mandible is without fracture or temporomandibular joint
dislocation. The temporomandibular joints are symmetric, without significant
degenerative change.
DENTITION: Evaluation of the dentition is severely limited due to streak
artifact. Within these limitations, there are no dental fractures.There is an
area of periapical lucency surrounding the left mandibular canine,
representing bony erosion, possibly due to the infection. There is no
evidence of abscess. There is an impacted tooth within the left mandibular
ramus. There is no evidence of malignancy.
SINUSES: There is mild mucosal thickening within the maxillary sinuses
bilaterally. Otherwise, the paranasal sinuses are intact and clear. The
ostiomeatal units are patent.There is partial opacification of the mastoid air
cells bilaterally. The middle ear cavities are clear.
NOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are
unremarkable. There is no nasal septal hematoma.
ORBITS: The orbits, including the laminae papyracea, are intact. The globes
are intact with non-displaced lenses and no intraocular hematoma. There is no
preseptal soft tissue edema. There is no retrobulbar hematoma or fat
stranding.
There is prominence of the ventricles and sulci which likely reflect
age-related atrophy. Allowing for imaging technique optimized for the face,
the limited included portion of the brain stress prominence of the ventricles
and sulci, which likely reflects age-related atrophy, but no other
abnormalities.
IMPRESSION:
1. Evaluation of the dentition is severely limited due to streak artifact.
2. Periapical lucency surrounding the left mandibular canine, representing
bony erosion, possibly due to infection, which likely corresponds with the
area of increased radiotracer uptake on the nuclear medicine exam.
3. No evidence of abscess or mandibular mass.
4. Impacted tooth within the left mandibular ramus.
|
10127469-RR-64 | 10,127,469 | 21,405,846 | RR | 64 | 2162-12-09 16:46:00 | 2162-12-09 21:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rectal cancer s/p neoadjuvantchemoXRT c/b
SB perf w/fecal peritonitis s/p exlap, TI resection,end ileostomy/mucus
fistula, radiation induced necrosis s/p open proctosigmoid resection with end
colostomy // new NG tube placement new NG tube placement
IMPRESSION:
Enteric tube terminates within the stomach. Left-sided Port-A-Cath is
unchanged in position. Left basal opacity is unchanged. No pneumothorax.
Left retrocardiac opacity is unchanged. It might represent atelectasis with
pleural effusion but infectious process in this location is a possibility.
|
10127469-RR-65 | 10,127,469 | 26,610,237 | RR | 65 | 2162-12-18 19:01:00 | 2162-12-18 19:58:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with elevated wbc // ?pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Left-sided Port-A-Cath distal tip is similar position as compared to prior
studies. Enteric tube courses below the level the diaphragm, at terminating
in the expected location of the stomach. Patchy left base opacity is re-
demonstrated. No pleural effusion or pneumothorax is seen. The cardiac and
mediastinal silhouettes are stable.
IMPRESSION:
Patchy left base opacity may be chronic.
|
10127469-RR-66 | 10,127,469 | 26,610,237 | RR | 66 | 2162-12-20 09:08:00 | 2162-12-20 10:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rectal ca s/p end ileostomy p/w ___ and
anemia // evaluate placement of NGT evaluate placement of NGT
IMPRESSION:
In comparison with the study of ___, the tip of the nasogastric tube
is in the mid portion of the stomach, with the side port distal to the
esophagogastric junction. Otherwise, little change in the appearance of the
heart and lungs except for mild increase in the degree atelectasis at the left
base.
|
10127469-RR-67 | 10,127,469 | 26,610,237 | RR | 67 | 2162-12-21 08:19:00 | 2162-12-21 11:05:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman with NGT placed, now appears to have been
pulled distally by patient // evaluate placement of NGT
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
NG tube tip in probably the first study is in the proximal esophagus, in the
second film the tip of the NG tube is in the stomach. No other interval
change from prior study.
|
10127469-RR-68 | 10,127,469 | 26,610,237 | RR | 68 | 2162-12-25 20:01:00 | 2162-12-26 09:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rectal CA s/p colostomy with discomfort at
NG // eval for clogging, migration, aspiration eval for clogging,
migration, aspiration
IMPRESSION:
Compared to prior chest radiographs since ___, most recently ___.
Mild cardiomegaly and small left pleural effusion persist. Previous
borderline edema is resolved. Lungs are now clear.
Left subclavian infusion port ends in the upper SVC. Esophageal drainage tube
passes into the stomach and out of view
|
10127469-RR-69 | 10,127,469 | 26,610,237 | RR | 69 | 2162-12-29 13:38:00 | 2162-12-29 16:18:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with NGT partially withdrawn then replaced //
eval placement of NGT eval placement of NGT
IMPRESSION:
. Compared to prior chest radiographs, ___ through ___.
Left subclavian infusion port ends in the upper SVC. Esophageal drainage tube
ends in nondistended stomach. Ureteral pelvic urinary catheters noted in the
upper abdomen.
Borderline cardiomegaly increased slightly since ___ with no pulmonary
vascular congestion or edema. Lungs clear. Pleural effusion small if any.
No pneumothorax.
|
10127469-RR-70 | 10,127,469 | 26,610,237 | RR | 70 | 2162-12-31 08:05:00 | 2162-12-31 10:44:00 | INDICATION: ___ year old woman with rectal cancer s/p radiation and chemo c/b
injury with persistent hematuria and recent DVT/PE // Please place IVC
filter.
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___, Interventional Radiology Fellow and Dr.
___, attending radiologist performed the procedure. Dr. ___
___ personally 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
25mcg of fentanyl and 0 mg of midazolam throughout the total intra-service
time of 25 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.
CONTRAST: 0 ml of Optiray contrast. CO2 was used for IVC venogram.
FLUOROSCOPY TIME AND DOSE: 2.2 min, 29 mGy
PROCEDURE:
1. IVC venogram.
2. Infrarenal Denali IVC filter deployment.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck was prepped and draped in the usual sterile fashion.
Under ultrasound and fluoroscopic guidance, the patent and compressible right
internal jugular vein was punctured using a 21G micropuncture needle.
Ultrasound images of the access was stored on PACS. A ___ wire was advanced
through the micropuncture sheath into the inferior vena cava. The IVC filter
sheath was then advanced over the ___ wire into the infrarenal IVC. A CO2
IVC venogram was performed through the IVC filter sheath with details below.
A decision was made to place a infrarenal filter. An Denali vena cava filter
was advanced over the wire until the cranial tip was at the level of the
inferior margin of the lower renal vein. The sheath was then withdrawn until
the filter was deployed. The wire and loading device were then removed through
the sheath. The final image was stored on PACS.
The sheath was removed and pressure was held for 10 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with single bilateral renal veins
and no evidence of a clot.
2. Successful deployment of an infra-renal Denali IVC filter.
IMPRESSION:
Successful deployment of infrarenal Denali IVC filter.
RECOMMENDATION(S): Patient should be seen and interventional radiology in
clinic in ___ weeks, at which time evaluation for potential IVC filter removal
can be discussed with the patient and family.
|
10127469-RR-71 | 10,127,469 | 26,610,237 | RR | 71 | 2162-12-31 16:36:00 | 2162-12-31 20:27:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with new dobhoff placed // eval dobhoff
eval dobhoff
IMPRESSION:
Compared to prior chest radiographs, ___ through ___.
Feeding tube with the wire stylet in place ends in moderately distended
stomach.
Moderate cardiomegaly has increased since ___. Small left pleural
effusion is new. Lungs grossly clear. Left subclavian infusion port ends in
the SVC. No pneumothorax.
|
10127469-RR-72 | 10,127,469 | 26,610,237 | RR | 72 | 2163-01-01 18:33:00 | 2163-01-01 21:02:00 | INDICATION: ___ year old woman with rectal CA s/p resection now with high
residuals via dobhoff, still with output from ostomy. Concern for obstruction
vs. partial obstruction // evaluate for obstruction
TECHNIQUE: Portable AP supine and cross-table left lateral decubitus
radiographs of the abdomen
COMPARISON: Radiographs of the abdomen ___
FINDINGS:
Bilateral double-J ureteral stents are in similar position to the prior study.
In the interval there has been placement of an IVC filter which projects to
the right of the spine at the L3-L4 level. A Dobbhoff tube terminates in the
stomach.
There are multiple loops of air-filled dilated small bowel measuring up to 5.2
cm and a few scattered air-fluid levels. There is no evidence of pneumatosis
or free air.
IMPRESSION:
Several dilated loops of air-filled small bowel worrisome for small bowel
obstruction.
|
10127469-RR-73 | 10,127,469 | 26,610,237 | RR | 73 | 2163-01-01 21:54:00 | 2163-01-02 08:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SBO // eval placement of NGT eval
placement of NGT
IMPRESSION:
Comparison to ___. The feeding tube was changed. The course of
the new tube is unremarkable, the tip projects over the middle parts of the
stomach. A left Port-A-Cath is in unchanged position. Bilateral ureter
stents as well as a vena cava filter are visualized. Mild cardiomegaly with
minimal retrocardiac atelectasis is stable.
|
10127469-RR-74 | 10,127,469 | 26,610,237 | RR | 74 | 2163-01-02 16:40:00 | 2163-01-02 17:28:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: Rectal cancer status post resection and right lower quadrant
ostomy with small bowel obstruction now having increased abdominal pain.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 52.4 cm; CTDIvol = 9.7 mGy (Body) DLP = 506.0
mGy-cm.
Total DLP (Body) = 506 mGy-cm.
COMPARISON: At are radiograph ___. MR pelvis ___.
CT cystogram ___. CT abdomen pelvis ___
FINDINGS:
Heart size is top-normal without significant pericardial fluid. There is mild
bibasilar atelectasis with trace pleural effusion. Imaged lung bases are
otherwise clear.
CT abdomen without contrast: A punctate calcified granuloma is noted in
hepatic segment II. Liver is grossly unremarkable. Gallbladder is distended
but otherwise unremarkable. Spleen, pancreas and adrenal glands are
unremarkable.
Bilateral double-J ureteral stents are in place with persistent bilateral mild
hydroureteronephrosis.
Upper enteric tube tip terminates in the gastric body. Stomach is grossly
unremarkable. Jejunal loops are distended to a maximal diameter of 3.9 cm
with transition to decompressed loops in the lower left pelvis. No abrupt
point of transition is seen. Right lower quadrant ostomy is seen.
Decompressed large bowel to a left lower quadrant ostomy site is grossly
unremarkable.
There are moderate atherosclerotic calcifications along a normal caliber
abdominal aorta. Scattered mesenteric and retroperitoneal lymph nodes are not
pathologically enlarged. Infrarenal IVC filter is noted. There is no
pneumoperitoneum or ventral abdominal hernia.
CT pelvis without contrast: Bladder is grossly unremarkable. There is a
small amount of free pelvic fluid. Postsurgical changes from
proctosigmoidectomy with areas of surrounding and soft tissue stranding, not
well evaluated on this noncontrast study. There is no free pelvic air. There
is no inguinal or pelvic sidewall lymphadenopathy by CT size criteria.
Bones and soft tissues: There is no suspicious focal bone lesion.
IMPRESSION:
1. Multiple dilated small bowel loops up to 3.9 cm with transition in the left
hemipelvis, compatible with small bowel obstruction. No evidence of
perforation.
2. Postsurgical changes from end ileostomy and proctosigmoidectomy.
Perirectal fat stranding and small amount of free fluid is again visualized
which may be postsurgical, difficult to evaluate on this noncontrast study.
3. Bilateral double-J ureteral stents in place with persistent mild collecting
system dilatation.
4. Trace bilateral pleural effusion.
|
10127552-RR-16 | 10,127,552 | 25,186,732 | RR | 16 | 2110-11-20 17:06:00 | 2110-11-20 19:48:00 | INDICATION: ___ year old man with spinal tumor, plan for OR tomorrow. // ___
year old man with spinal tumor, plan for OR tomorrow. Surg: ___ (C8 tumor
resection )
TECHNIQUE: Chest PA and lateral
COMPARISON: No priors
FINDINGS:
Heart size within normal limits. No features of decompensation. Unfolding of
the aorta. The left paraspinal opacity in the lower chest is thought to be
represented by the descending thoracic aorta. No confluent airspace
consolidation. No pulmonary edema. Small pulmonary nodule in the lateral
aspect of the left upper lobe. No suspicious bony lesions.
IMPRESSION:
No cardiomegaly or features of decompensation. No pneumonia.
Indeterminate small 3 mm probable pulmonary nodule in the lateral aspect of
the left upper lobe for which dedicated CT chest is advised.
RECOMMENDATION(S): Dedicated CT chest.
|
10127552-RR-18 | 10,127,552 | 25,186,732 | RR | 18 | 2110-11-21 15:12:00 | 2110-11-21 16:40:00 | EXAMINATION: Q313CT CERVICAL WANDW/O CONTRAST SPINECT
INDICATION: ___ yo male with worsening right foot drop since ___.
Cervical MRI shows likely right C8 Schwannoma with cord compression // Thin
cuts please. Pre-op planning for OR today for tumor RSX, please include T4 as
patient will likely need multi-level laminectomy and fusion
TECHNIQUE: Helical CT of the cervical spine both before and after contrast
with sagittal and coronal reconstructions then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 16.9 s, 25.8 cm; CTDIvol = 29.0 mGy (Body) DLP =
710.1 mGy-cm.
2) Spiral Acquisition 17.8 s, 27.2 cm; CTDIvol = 29.0 mGy (Body) DLP =
750.5 mGy-cm.
Total DLP (Body) = 1,470 mGy-cm.
COMPARISON: ___ outside noncontrast cervical spine MRI.
FINDINGS:
Dental amalgam streak artifact limits study.
There is mild anterolisthesis of C4 on C5.
There is no exophytic mucosal mass. There is no pathologic adenopathy by
imaging criteria.
The thyroid gland is unremarkable.
The salivary glands are unremarkable.
Neck vessels are patent.
Upper lung fields are clear.
Patient's known right C7-T1 epidural enhancing soft tissue mass are not
well-visualized on the current exam (see 3, 8:72, 7b:34, 12b:44, 14: 96 on
current study and 301:10 and 901:18 on prior MRI). Right C7 ventral vertebral
body bony remodeling again noted.
Moderate multilevel degenerative changes are noted in the cervical spine and
upper thoracic spine (including loss of vertebral body height, intervertebral
disc space narrowing, endplate sclerosis, subchondral cysts, anterior and
posterior osteophytes) without evidence of vertebral canal nor neural
foraminal stenosis.
At C3-C4 there is moderate narrowing of the right neural foramina by
uncovertebral hypertrophy.
At C5-C6 there is severe narrowing of the right neural foramina by
uncovertebral hypertrophy.
IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Moderate multilevel degenerative changes are noted in the cervical spine,
as described above.
3. Patient's known C7-T1 right epidural enhancing soft tissue mass not
visualized on current examination, with C7 right ventral vertebral body
remodeling.
|
10127552-RR-19 | 10,127,552 | 25,186,732 | RR | 19 | 2110-11-25 16:40:00 | 2110-11-26 08:44:00 | EXAMINATION: CERVICAL SINGLE VIEW IN OR
INDICATION: POST. C7-T1 LAMI
IMPRESSION:
Fluoroscopic images show early steps in a posterior C7-T1 laminectomy.
Further information can be gathered from the operative report.
|
10127552-RR-20 | 10,127,552 | 25,186,732 | RR | 20 | 2110-11-26 09:34:00 | 2110-11-26 13:36:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: ___ man with history of schwannoma and fusion status post
cervical laminectomy.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.2 s, 24.3 cm; CTDIvol = 37.3 mGy (Body) DLP = 907.0
mGy-cm.
2) Spiral Acquisition 1.4 s, 5.6 cm; CTDIvol = 30.1 mGy (Body) DLP = 168.3
mGy-cm.
Total DLP (Body) = 1,075 mGy-cm.
COMPARISON: CT C-spine from ___.
FINDINGS:
Patient is status post C7-T2 laminectomy and placement of spine stabilization
hardware from C5-T2, without evidence of complication. There are associated
postsurgical changes, including bone grafting, adjacent soft tissue edema and
subcutaneous air as well as narrowing of spinal canal.
Moderate multilevel degenerative changes are again noted in the cervical spine
and upper thoracic spine, including loss of vertebral body height,
intervertebral disc space narrowing, endplate sclerosis, subchondral cysts,
and osteophytosis. No fractures are identified. There is no evidence of spinal
canal stenosis. There is no prevertebral soft tissue swelling. The thyroid
and upper lung fields are unremarkable. Coronary artery calcifications are
noted.
IMPRESSION:
1. Status post C7-T2 laminectomy and placement of spine stabilization hardware
from C5-T2, without evidence of complication. Postsurgical changes, as
described above.
2. Moderate multilevel degenerative changes in the cervical spine and upper
thoracic spine, as described above.
|
10127552-RR-21 | 10,127,552 | 25,186,732 | RR | 21 | 2110-11-27 11:03:00 | 2110-11-27 14:56:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with C8 Schwannoma, post-operative evaluate for
residual tumor // post-operative, s/p cervical neck schwannoma
post-operative, s/p cervical neck schwannoma
TECHNIQUE: Sequences obtained include sagittal T2, sagittal STIR, and axial
T2. Patient was unable to finish exam with complain of neck pain.
COMPARISON: MR dated ___
FINDINGS:
Sagittal T2 and STIR as well as axial T2 images were obtained.
Patient is status post C7 and T1 laminectomies with posterior spinal fusion
hardware spanning the C5 through T2 levels. Since prior examination, there is
been removal of a C8 schwannoma. There is a mixed density predominantly T2
hyperintense presumably fluid collection abutting the posterior thecal sac
which measures at most 7 mm (3:9) in the anterior posterior dimension but
extends inferiorly approximately 10 cm to the T4 vertebral body. This abuts
the spinal cor with. There is focal increased cord signal at the C7-T1 level
(3:9, 2:9), although the cord does demonstrate increased signal secondary to
mass effect from schwannoma on outside hospital MRI of ___. There
remaining cord signal is within normal limits. Edema within the posterior
spinal tissues is present with a 3.2 x 0.9 cm fluid collection within the
subcutaneous tissues at this level. Trace minimal prevertebral fluid at C4-C5
is identified without associated ligamentous injury.
At the right aspect of the C7 level, is a 6 x 7 mm nodule (series 4, image 30)
lateral to the cord. This may represent residual lesion, however not
definitively established given the lack of IV contrast.
Cervical spine demonstrates multilevel degenerative changes most pronounced at
the C5-C6 and C6-C7 levels with posterior disc bulges which efface the thecal
sac but do not encroach upon the spinal cord. Alignment is anatomic. Soft
tissue to edema in the bilateral axilla, extending along the paraspinal
muscles is identified, presumably postoperative in nature.
IMPRESSION:
Examination incomplete in this patient unable to tolerate image acquisition.
Evaluation for residual tumor is suboptimal in the absence of contrast.
1. Postsurgical changes secondary to removal of C8 schwannoma include C7 and
T1 laminectomies and posterior spinal fusion spanning levels C5 through T2
with resultant edema in the paraspinal soft tissues. Mixed density fluid
collection at the surgical site posteriorly deforms the thecal sac and abuts
the spinal cord extending from the C6-T4 levels.
2. There is focal increased T2 signal within the spinal cord at the C7-T1
level,, which can be seen on outside hospital examination of ___
secondary to mass effect from the schwannoma. The spinal cord is now
decompressed and it is uncertain whether there is any interval change in the
degree of cord signal.
3. A 6 x 7 mm nodule lateral to the C7 cord within the spinal canal (series 4,
image 30), presumably representing residual lesion along the nerve roots.
|
10127712-RR-7 | 10,127,712 | 28,323,151 | RR | 7 | 2188-10-11 18:48:00 | 2188-10-11 19:44:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with epigastric/ruq pain // ? gall stones,
cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
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.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 6 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 13 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cholelithiasis without evidence of acute cholecystitis.
2. Top normal spleen size.
|
10127712-RR-8 | 10,127,712 | 28,323,151 | RR | 8 | 2188-10-12 14:14:00 | 2188-10-12 19:56:00 | EXAMINATION: MRCP.
INDICATION: ___ year old man with several episodes of biliary colic with LFT
abnormalities. Evaluation of biliary tree.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 14 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Ultrasound from ___.
FINDINGS:
Lower Thorax: The lung bases are clear. There is no pleural or pericardial
effusion.
Liver: The liver parenchyma demonstrates normal signal intensity without
evidence of focal lesions. The portal vein is patent. Hepatic artery anatomy
is conventional.
Biliary: There is no intra or extrahepatic biliary ductal dilatation. The CBD
measures 4 mm. There are no filling defects within the CBD. Multiple small
stones are seen within the gallbladder. The gallbladder is not distended.
There is mild edema, thickening and enhancement of the GB wall (series 1502,
image 77).
Pancreas: The pancreatic parenchyma demonstrates normal signal intensity
without suspicious focal lesions. There is no ductal dilatation.
Spleen: The spleen is normal in size without evidence of focal lesions.
Adrenal Glands: The adrenals are normal in size and shape.
Kidneys: The visualized portions of the kidneys appear unremarkable, without
evidence of focal lesions or hydronephrosis. Cortical scarring is seen in the
right kidney.
Gastrointestinal Tract: The stomach appears unremarkable. The visualized
large and small bowel demonstrate normal caliber without wall thickening or
abnormal enhancement.
Lymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.
Vasculature: Abdominal aorta is normal in caliber.
Osseous and Soft Tissue Structures: An incidental vertebral body hemangioma is
seen in the lumbar spine.
IMPRESSION:
1. No intra or extrahepatic bile duct dilation. No obstructing ductal stone
or mass.
2. Small stones are seen within the gallbladder. Mild gallbladder wall edema
and enhancement are present, however, the gallbladder is not distended. The
findings could reflect mild chronic cholecystitis.
This preliminary report was reviewed with Dr. ___ radiologist.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 7:49 ___, 30 minutes after
discovery of the findings.
|
10128191-RR-13 | 10,128,191 | 24,307,094 | RR | 13 | 2175-01-10 15:46:00 | 2175-01-10 16:26:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old man with R foot ulcer. Assess blood supply // ?
healing potential, chronic non healing ulcers
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: None
FINDINGS:
Triphasic Doppler waveforms were seen in the femoral, superficial femoral,
popliteal, posterior tibial and dorsalis pedis arteries bilaterally.
The right ABI is 1.3 and the left ABI is 1.23.
Pulse volume recordings showed symmetric amplitudes bilaterally, at all
levels.
IMPRESSION:
No evidence of arterial insufficiency to the lower extremities bilaterally at
rest.
|
10128191-RR-14 | 10,128,191 | 24,307,094 | RR | 14 | 2175-01-11 18:43:00 | 2175-01-12 14:16:00 | INDICATION: ___ year old man with RLE cellulitis, now with worsening lactic
acidosis, fever, hypotension; please assess for involvement of bone // Please
eval for osteomyelitis
TECHNIQUE: Multiplanar multi sequence MR of the right foot was obtained
before after administration of 7 cc of Gadovist IV contrast on a 1.5 Tesla
magnet.
COMPARISON: Radiographs of the right ankle and foot ___.
FINDINGS:
Patient is status post partial resection of the fifth metatarsal.
IMPRESSION:
Patient is status post partial resection of the distal fifth metatarsal.There
is extensive edema throughout the forefoot at the level of the metatarsal
heads. In the fourth metatarsal head there is abnormally low T1 bone marrow
signal, associated edema and enhancement (9:8). There may be a small plantar
ulceration near the fourth metatarsal head (10:8). There is a 1.3 x 0.7 cm
subcutaneous fluid collection at the fourth web space at the dorsal lateral
aspect of the fourth metatarsal head.
There is a phlegmon versus early fluid collection tracking between the first
intermetatarsal space with the largest component dorsally measuring 3.2x5.4x2
cm TRV x AP x CC. This tracks between the first and second metatarsal heads
which are slightly splayed with a smaller plantar component tracking
posteriorly to at least the level of the first tarsometatarsal joint and
beyond the field of view (12:24). The plantar abscess component maximally
measures 1.3 x 1.2 cm (12:24) at the level of the mid metatarsal shaft.
There is no acute fracture or dislocation. There is mild-to-moderate
degenerative change of the first metatarsophalangeal joint and interphalangeal
joint. The included portions of the flexor and extensor tendons are grossly
intact. Partially imaged plantar fascia is not thickened.
RECOMMENDATION(S):
1. Marrow changes in the fourth metatarsal head most worrisome for
osteomyelitis/septic arthritis with adjacent 1.3 x 0.7 cm superficial
subcutaneous fluid collection at the fourth web space.
2. Prominent phlegmon/early fluid collection between the first and second
metatarsals as detailed above.
NOTIFICATION: The findings were telephoned to ___ by ___
___ at 11:45, ___, 15 min after discovery.
|
10128191-RR-16 | 10,128,191 | 24,307,094 | RR | 16 | 2175-01-14 11:52:00 | 2175-01-14 15:23:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old man s/p R foot debridement // s/p R foot debridement
TECHNIQUE: Three portable views of the right foot.
COMPARISON: MRI right forefoot ___. Right foot radiographs ___.
FINDINGS:
New irregularity of the fourth metatarsal head is consistent with
osteomyelitis-related resection.
Mild subcutaneous emphysema and packing material is seen at the first
intermetatarsal space. No osseous erosion is seen.
Resection of the distal fifth metatarsal appears similar to prior.
IMPRESSION:
Status post partial resection of the fourth metatarsal head related to known
septic arthritis/ osteomyelitis.
Postoperative change and packing at the first intermetatarsal space without
evidence of erosion.
|
10128191-RR-17 | 10,128,191 | 24,307,094 | RR | 17 | 2175-01-16 17:18:00 | 2175-01-17 08:52:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new L PICC // L 45cm DL PPICC, thanks, ___
___ Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Left PICC tip is in themid SVC. Cardiac size is top normal. The aorta is
tortuous. The lungs are clear. There is no pneumothorax or pleural effusion.
NOTIFICATION:
The findings were discussed with ___, IV nurse, requesting a wetread by
___, M.D. on the telephone on ___ at 6:30 ___, 1 minutes after
discovery of the findings.
|
10128874-RR-2 | 10,128,874 | 23,063,778 | RR | 2 | 2158-06-11 08:19:00 | 2158-06-11 10:07:00 | EXAMINATION: CT HEAD WITHOUT CONTRAST
INDICATION: ___ year old man with closed head injury, right parietal contusion
// ___ year old man with closed head injury, right parietal contusion
TECHNIQUE: Axial images of the head were obtained without contrast with
sagittal and coronal reformats.
DOSE: DLP:891 MGy-cm
COMPARISON: ___.
FINDINGS:
Small right parietal subdural hematoma and/or associated contusion are
unchanged compared to the prior study. No new hemorrhage is identified. Brain
atrophy seen. Small vessel disease noted. A right temporal pole incidental
arachnoid cyst is again seen.
The visualized paranasal sinuses are clear. No skull fracture is seen.
IMPRESSION:
Unchanged appearance of the right parietal small subdural hematoma and/ or
associated contusion. No new abnormalities are seen.
|
10128874-RR-3 | 10,128,874 | 23,063,778 | RR | 3 | 2158-06-13 18:34:00 | 2158-06-13 19:38:00 | EXAMINATION: NON-CONTRAST CT OF THE ABDOMEN AND PELVIS
INDICATION: ___ year old man s/p fall with small stable SDH with dropping H/H
and abdominal ecchymosis. // Please evaluate for any evidence of
retroperitoneal or intraabdominal bleed. Please evaluate below the hip due to
left lower leg swelling to evaluate for hematoma.
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis. No
intravenous contrast was administered. Images were displayed in multiple
planes.
DOSE: DLP: 851 mGy-cm
COMPARISON: Hip and leg radiographs dated ___. Otherwise, no prior
studies available for comparison.
FINDINGS:
The descending thoracic aorta appears aneurysmally dilated, measuring 4.2 x
3.9 cm (3:1). There are trace bilateral pleural effusions. The lung bases are
otherwise clear. Limited imaging of the heart reveals no pericardial effusion
or cardiomegaly. Relative hypodensity of the chambers compared to the
myocardium suggests underlying anemia.
CT ABDOMEN: The lack of intravenous contrast limits evaluation of the solid
organs. The liver, gallbladder, pancreas, spleen and adrenal glands are
normal. The patient is status post right nephrectomy. There is no left
hydronephrosis or renal calculi. There are multiple exophytic or partially
exophytic lesions arising from the left kidney, the largest of which can't be
accurately characterized as simple renal cysts. A 2.0 x 1.5 cm hyperdense
partially exophytic lesion (3:28) may represent a cyst with
proteinaceous/hemorrhagic contents.
There is no retroperitoneal or abdominal adenopathy. No free air or free fluid
is present. There is fusiform dilation of the abdominal aorta measuring up to
3.6 x 3.3 cm (03:36) in the infrarenal abdominal aorta. There is arteriomegaly
of the iliac arteries. The stomach and intra-abdominal loops of bowel are
normal caliber.
CT PELVIS: The remainder of the bowel is normal. The prostate is mildly
enlarged. The bladder is normal. There is no free pelvic fluid. There is no
inguinal or pelvic adenopathy. There is a left inguinal hernia containing
loops of large bowel without apparent bowel wall thickening, edema or
surrounding fluid/stranding.
OSSEOUS STRUCTURES AND SOFT TISSUES: No concerning osteoblastic or osteolytic
lesion identified. There is a fracture of the left transverse process of the
L1 vertebra.
There is a large predominantly hyperdense fluid collection in the soft tissues
of the left buttock consistent with hematoma measuring 220.5 x 9.4 x 3.9 cm
(602a: 38) with fluid tracking into the lateral/anterior aspect of the left
thigh.
IMPRESSION:
1. Large 20.5 x 9.4 x 3.9 cm hematoma in the soft tissues of the left buttock
with fluid tracking into the lateral aspect of the left thigh.
2. Acute or subacute fracture of the left transverse process of L1.
3. No evidence of solid organ injury in the abdomen or pelvis as best can be
assessed on this nonenhanced study.
4. Aneurysmal dilation of the descending thoracic aorta and infrarenal
abdominal aorta with arteriomegaly of the iliac arteries.
5. Left inguinal hernia containing loops of large bowel without evidence of
complication.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ telephone on ___ at 7:11 ___, immediately after discovery of the
findings.
|
10129052-RR-103 | 10,129,052 | 26,352,938 | RR | 103 | 2179-02-05 08:05:00 | 2179-02-05 09:48:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT
INDICATION: RT HIP FX.ORIF
IMPRESSION:
Fluoroscopic image shows placement of a fixation device about a comminuted
fracture of the intertrochanteric region of the right femur. Further
information can be gathered from the operative report.
|
10129052-RR-104 | 10,129,052 | 26,352,938 | RR | 104 | 2179-02-09 10:17:00 | 2179-02-09 12:17:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with R IT fx now s/p R intermediate TFN ___, K-Rod) PMH:
RA, sarcoid, HLD, hypothyroid, temporal arteritis, L internal iliac stent,
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: Comparisons to prior study dated ___.
FINDINGS:
There is normal compressibility and color flow of the right common femoral,
femoral, and popliteal veins. Normal color flow and compressibility are
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10129052-RR-71 | 10,129,052 | 20,235,284 | RR | 71 | 2174-02-14 08:58:00 | 2174-02-14 10:24:00 | INDICATION: Suspicion for left hand infection. Recent swelling beginning in
the ulnar aspect. Additional review of medical record shows that the
patient's history of severe rheumatoid arthritis.
TECHNIQUE: Left hand, three views.
COMPARISON: None.
FINDINGS: The bones are diffusely demineralized. Mild soft tissue swelling
overlies the metacarpals. However, there is no periosteal reaction, cortical
lucency or any other evidence of osteomyelitis. Mild degenerative changes of
the first CMC and triscaphe joint are again noted. Similarly, there are mild
degenerative changes of the PIP and DIP joints. The radiocarpal joints are
noteworthy only for subchondral cystic changes but there are no marginal
erosions.
IMPRESSION:
1. No radiographic evidence of osteomyelitis.
2. Mild DJD as described above.
3. Diffuse demineralization without specific signs of rheumatoid arthritis.
|
10129052-RR-83 | 10,129,052 | 26,848,471 | RR | 83 | 2176-08-10 08:25:00 | 2176-08-10 11:13:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with lightheadedness // evaluate for ACS
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Minimal right base atelectasis is seen. There is no focal consolidation. No
pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are stable. The aorta is calcified and tortuous. No pulmonary
edema is seen. Degenerative changes are seen along the thoracic spine,
although not well assessed.
IMPRESSION:
No acute cardiopulmonary process.
|
10129052-RR-84 | 10,129,052 | 26,848,471 | RR | 84 | 2176-08-10 11:27:00 | 2176-08-10 12:54:00 | EXAMINATION: CT abdomen and pelvis with contrast.
INDICATION: ___ woman with left lower quadrant pain, vomiting, and
elevated lactate.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
2) Spiral Acquisition 4.2 s, 46.0 cm; CTDIvol = 15.6 mGy (Body) DLP = 718.5
mGy-cm.
3) Spiral Acquisition 0.9 s, 9.5 cm; CTDIvol = 13.2 mGy (Body) DLP = 125.1
mGy-cm.
Total DLP (Body) = 852 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural
or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
A small amount of simple, perihepatic fluid is nonspecific and is not
contiguous with the large amount of hemoperitoneum, but may reflect older
blood products from a previous aneurysmal bleed that have not been resorbed.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal concerning renal lesions or hydronephrosis.
There is a 1.4 cm simple cyst in the lower pole of the right kidney. There
are multiple left renal peripelvic cysts, the largest of which measures 1.6
cm. There is no perinephric abnormality.
GASTROINTESTINAL: There is an ingested pill within a small hiatal hernia.
There are additional ingested pills within the fundus of the stomach and in
the small bowel. There are numerous diverticula in the transverse colon.
Patient is status post appendectomy. The distal bowel is relatively
decompressed and apparent hyperdense material within the distal colon could
reflect ingested hyperdense material, intramural blood, or simply be
artifactual from interposition of the collapsed bowel walls.
PELVIS: The urinary bladder has been displaced anterosuperiorly by the
ruptured left internal iliac artery aneurysm and surrounding blood. There is
a moderate amount of blood within the pelvis.
REPRODUCTIVE ORGANS: Patient is status post hysterectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is extensive atherosclerotic disease throughout. There is a
3.0 x 2.7 x 2.4 cm left common iliac artery aneurysm just proximal to the
bifurcation. There is a 6.9 x 6.8 x 7.3 cm, ruptured, left internal iliac
artery aneurysm with a large volume of blood in the pelvis. A crescentic
hypodense component likely reflects mural thrombus.
BONES: There are extensive degenerative changes. There is no evidence of
worrisome osseous lesions or acute fracture.
SOFT TISSUES: Surgical material is noted in the midline, lower abdominal
wall. Otherwise, the abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Ruptured, 7.3 cm, left internal iliac artery aneurysm with a large volume
hemorrhage in the pelvis.
2. 3.0 cm left common iliac artery aneurysm just proximal to the bifurcation.
3. Hyperdense material within the distal colon could reflect ingested
hyperdense material or reflect interposition of the collapsed bowel walls;
however, intramural bleeding is not excluded.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:50 ___, 2 minutes after
discovery of the findings.
Wet read was updated at 14:06.
|
10129052-RR-85 | 10,129,052 | 26,848,471 | RR | 85 | 2176-08-10 16:44:00 | 2176-08-10 18:07:00 | EXAMINATION: CHEST RADIOGRAPHS
INDICATION: ___ year old woman with Central line
TECHNIQUE: Supine portable AP image of the chest.
COMPARISON: Comparison is made with chest radiographs from earlier the same
day, ___, and ___.
FINDINGS:
There has been interval intubation with the tip of the endotracheal tube
residing 2.4 cm above the carina. A right IJ central venous catheter is also
new from prior with its tip in the mid SVC region. Excreted contrast noted in
the bilateral renal collecting systems. There is platelike right basal
atelectasis, increased from prior. Otherwise lungs appear clear.
Cardiomediastinal silhouette is unchanged allowing for differences in imaging
technique.
IMPRESSION:
Interval placement of endotracheal tube and right IJ central venous catheter
with appropriate position. Increased right basal atelectasis.
|
10129052-RR-86 | 10,129,052 | 26,848,471 | RR | 86 | 2176-08-11 19:27:00 | 2176-08-12 14:19:00 | INDICATION: ___ year old woman with ruptured internal iliac artery aneurysm
s/p endograft coverage now with abdominal pain // colonic distention
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for degenerative changes of the thoracolumbar
spine.
A left common iliac artery endo graft is in place. Embolization coil material
is present in the left hemipelvis. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
10129052-RR-90 | 10,129,052 | 21,463,945 | RR | 90 | 2177-09-14 11:16:00 | 2177-09-14 11:44:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with weakness, eval for pna// weakness, eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___, ___
FINDINGS:
The lungs appear grossly clear without focal consolidation. There is no
pulmonary edema, pneumothorax, or pleural effusion. The cardiomediastinal
silhouette and hilar contours are grossly unremarkable. The aorta is mildly
torturous. Calcifications are seen at the aortic knob. Degenerative changes
are seen in the thoracic spine.
IMPRESSION:
No acute cardiopulmonary process
|
10129052-RR-91 | 10,129,052 | 21,463,945 | RR | 91 | 2177-09-14 12:10:00 | 2177-09-14 13:54:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: History: ___ with Right knee pain after fall, evaluate for
fracture// Right knee pain after fall, evaluate for fracture Right knee
pain after fall, evaluate for fracture
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the right knee.
COMPARISON: Right knee radiographs from ___
FINDINGS:
No fracture or dislocation is seen. There is interval progression of
degenerative changes in the right knee, particularly involving the
patellofemoral and medial compartments with increased osteophyte formation.
There is no knee joint effusion. There is normal osseous mineralization. No
suspicious lytic or sclerotic lesions are identified. Vascular calcifications
are incidentally identified.
IMPRESSION:
Interval progression of degenerative changes in the right knee since prior
exam in ___. No definite fracture or dislocation is identified.
|
10129052-RR-94 | 10,129,052 | 21,463,945 | RR | 94 | 2177-09-14 21:37:00 | 2177-09-14 22:18:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Head and neck pain after fall, evaluate for fracture or
hemorrhage// eval for hemorrhage
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are prominent in size and configuration however age-appropriate.
Mild scattered subcortical and deep white matter hypodensities are nonspecific
but likely reflect chronic microvascular ischemic change.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
|
10129052-RR-95 | 10,129,052 | 21,463,945 | RR | 95 | 2177-09-14 21:37:00 | 2177-09-14 22:31:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: Head and neck pain after fall, evaluate for fracture or
hemorrhage// Pt has midline cervical tenderness, please eval for fracture
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.2 s, 20.2 cm; CTDIvol = 32.0 mGy (Body) DLP = 622.8
mGy-cm.
Total DLP (Body) = 623 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified.Multilevel degenerative
changes are present most pronounced at C4-5, C5-6 and C6-7. There is no
evidence of a spinal canal stenosis. Multilevel bilateral neural foraminal
narrowing is mild.There is no prevertebral soft tissue swelling. There is no
evidence of infection or neoplasm. The lung apices are clear.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
|
10129052-RR-96 | 10,129,052 | 21,463,945 | RR | 96 | 2177-09-15 11:01:00 | 2177-09-15 15:28:00 | EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA LEFT
INDICATION: ___ year old woman with shoulder pain after a fall, limited ROM//
is there fracture or dislocation is there fracture or dislocation
IMPRESSION:
Three views of the left shoulder show no fracture or dislocation on 2 of the
projections, the the AP and Y-views. Third view is nonstandard and difficult
to interpret.
|
10129119-RR-18 | 10,129,119 | 22,141,961 | RR | 18 | 2178-12-15 12:29:00 | 2178-12-15 13:39:00 | INDICATION: ___ with ptx // eval ptx
TECHNIQUE: Portable view of the chest.
COMPARISON: None.
FINDINGS:
There is subcutaneous gas overlying the right chest wall. There is a small
right apical pneumothorax identified. Multiple right-sided rib fractures are
seen, specifically involving the posterior right seventh, eighth and
potentially ninth ribs. Increased hazy opacity projecting over the right lung
base could represent an effusion or hemothorax. The left lung is clear. The
cardiomediastinal silhouette is within normal limits.
IMPRESSION:
Right rib fractures with subcutaneous gas and a small right apical
pneumothorax. Right basilar opacity could represent an effusion or
hemothorax.
|
10129119-RR-20 | 10,129,119 | 22,141,961 | RR | 20 | 2178-12-15 13:39:00 | 2178-12-15 15:03:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: Fall while intoxicated.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm; CTDI: 53.59 mGy
COMPARISON: None.
FINDINGS:
There is no acute hemorrhage, edema or shift of the normally midline
structures. Prominence of the ventricles and sulci is consistent with global
involutional changes, slightly advanced for age. The gray-white matter
differentiation is preserved and there is no evidence for a large vascular
territorial infarction. The basal cisterns are patent.
Nasal bone fractures are identified and could be old. There is no definite
acute fracture. There is mild mucosal thickening within the right sphenoid
sinus and ethmoid air cells. Otherwise, the included paranasal sinuses and
mastoid air cells are well-aerated. The lenses and globes are normal.
IMPRESSION:
1. No acute intracranial process.
2. Global involutional changes, slightly advanced for age.
3. Nasal bone fractures could be old, clinical correlation suggested.
|
10129119-RR-21 | 10,129,119 | 22,141,961 | RR | 21 | 2178-12-16 01:12:00 | 2178-12-16 09:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R hemopneumothorax, rib fx // pls eval for
interval changes
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, there is unchanged evidence of
displaced right rib fractures and a right hema toe thorax. The extent of the
fluid component of the MR toe thorax, however, has substantially increased.
The soft tissue air collection on the right is constant in appearance.
Unchanged appearance of the cardiac silhouette and of the left lung.
|
10129119-RR-22 | 10,129,119 | 22,141,961 | RR | 22 | 2178-12-16 15:44:00 | 2178-12-16 17:14:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with h/o afib (on warfarin) s/p fall with multiple R sided
rib fractures, hemopneumothorax being managed conservatively // eval right
pleural effusiosn. interval changes?
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Substantial subcutaneous air collection is unchanged/minimally decreased.
Right pleural effusion is substantial but layers out differently since the
current study is obtained in upright position. There is suspicion for small
pneumothorax. Multiple rib fractures are re- demonstrated.
|
10129119-RR-23 | 10,129,119 | 22,141,961 | RR | 23 | 2178-12-17 08:03:00 | 2178-12-17 10:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumothorax and rib fractures // please
follow up pneumothorax
COMPARISON: ___
IMPRESSION:
No relevant change as compared to the previous examination. Known multiple rib
fractures. Known soft tissue air collections on the right. The right lung
apex Re confirms the presence of a millimetric pneumothorax without evidence
of tension. The extent of the right pleural effusion has minimally increased.
Unchanged appearance of the cardiac silhouette and of the left lung.
|
10129119-RR-24 | 10,129,119 | 22,141,961 | RR | 24 | 2178-12-19 15:23:00 | 2178-12-19 16:49:00 | EXAMINATION:
CHEST (PA AND LAT)
INDICATION:
___ year old man with hemopneumothorax on R, Hct drop since yesterday //
?increase in hemo/PTX, Hct drop since yesterday
TECHNIQUE: Chest two views.
___
IMPRESSION:
There is small bilateral pleural effusions right greater than left and a small
right lateral pneumothorax there is a moderate amount of right-sided
subcutaneous emphysema there is volume loss in the right lower lobes.
Compared to the prior study the right-sided pneumothorax is slightly larger
|
10129119-RR-25 | 10,129,119 | 22,141,961 | RR | 25 | 2178-12-20 08:42:00 | 2178-12-20 09:17:00 | EXAMINATION:
CHEST (PA AND LAT)
INDICATION:
___ year old man with recent traumatic hemopneumothorax, resolved, now with
slight worsening of pneumothorax // Evaluate for worsening right-sided
pneumothorax
TECHNIQUE: Chest two-view
___
IMPRESSION:
Multiple right-sided rib fractures are again visualized. There is a moderate
right-sided effusion. And a small right pneumothorax there is also small left
effusion compared to the study from the prior day, the effusions have slightly
increased
|
10129119-RR-26 | 10,129,119 | 22,141,961 | RR | 26 | 2178-12-21 10:18:00 | 2178-12-21 10:52:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with recent traumatic hemopneumothorax, resolved,
now with slightly worsensing pneumothorax // ? interval enlargement of
right-sided pneumothorax
TECHNIQUE: Portable chest
___
FINDINGS:
Compared to the prior study there is no significant interval change
IMPRESSION:
No change
|
10129124-RR-6 | 10,129,124 | 25,476,866 | RR | 6 | 2121-07-08 22:22:00 | 2121-07-08 23:21:00 | INDICATION: ___ with cough // acute process?
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal limits.
No acute osseous abnormalities identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10129124-RR-7 | 10,129,124 | 25,476,866 | RR | 7 | 2121-07-09 15:47:00 | 2121-07-09 16:28:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Head strike on anticoagulation. Evaluate for hemorrhage.
TECHNIQUE: Contiguous axial images MDCT images of the brain were obtained
without intravenous contrast. Coronal and sagittal as well as thin
bone-algorithm reconstructed images were obtained.
DLP: 891 mGy-cm
COMPARISON: Outside hospital head CT from ___.
FINDINGS:
There is no acute hemorrhage, edema, mass effect, midline shift. The
ventricles and sulci are normal in size and configuration for the age. The
basal cisterns are patent and there is normal gray-white matter
differentiation. No acute fracture on the routine images provided
Repaired left frontal scalp laceration. Imaged paranasal sinuses are clear.
IMPRESSION:
No acute intracranial hemorrhage or mass effect .
|
10129167-RR-8 | 10,129,167 | 28,940,207 | RR | 8 | 2139-02-21 03:25:00 | 2139-02-21 06:39:00 | INDICATION: Right upper quadrant pain, postop day 3 from cholecystectomy and
outside hospital, tender in right upper quadrant, evaluate for fluid
collection in the surgical site.
COMPARISONS: None.
TECHNIQUE: MDCT axial imaging was obtained from the lung base to the pubic
symphysis following the administration of intravenous contrast material.
Coronal and sagittal reformats were completed.
FINDINGS:
CT ABDOMEN WITH CONTRAST: The lung bases are clear. Visualized heart and
pericardium are unremarkable. The liver enhances homogenously without any
focal lesions. The patient is status post cholecystectomy with clips seen in
the right upper quadrant. There is mild central intrahepatic biliary
dilatation and extra-hepatic biliary dilatation with stranding around the
common bile duct which is likely due to recent surgery. The common bile duct
measures approximately 9 mm in maximal dimension. There is no evidence of a
radiolucent stone. No fluid collection at the surgical site. The pancreas is
unremarkable without any ductal dilatation. The spleen and adrenal glands are
unremarkable. The kidneys enhance and excrete contrast as expected without
any focal lesions or hydronephrosis. The stomach, small and intra-abdominal
large bowels are unremarkable. The aorta is of normal caliber and its major
branches are patent. There is no free fluid or lymphadenopathy or free air
within the abdomen.
CT PELVIS: There is a moderate amount of simple free fluid tracking in the
right paracolic gutter into the pelvis. The bladder is unremarkable. The
uterus and adnexa are unremarkable. There is no lymphadenopathy or free air
within the pelvis.
OSSEOUS STRUCTURES: There are no concerning lytic or sclerotic lesions.
IMPRESSION:
1. Status post cholecystectomy with mild intra- and extra-hepatic biliary
dilatation and ___ stranding which is likely post-operative.
2. Moderate amount of simple free fluid in the pelvis and in the right
paracolic gutter which may be due to recent surgery.
|
10129197-RR-5 | 10,129,197 | 22,654,366 | RR | 5 | 2151-07-01 17:51:00 | 2151-07-01 22:04:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with elevated alk phos and RUQ u/s showing
dilated CBD of 1.4cm. // Cause of bile duct obstruction?
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: None available
FINDINGS:
The exam is somewhat limited by motion.
Lower Thorax: The bases of the lungs are clear. There is no pleural or
pericardial effusion
Liver: The liver is normal in signal and morphology. There is a 1.9 cm T2
hyperintense lesion in the left lobe of the liver which demonstrates
restricted diffusion and peripheral enhancement concerning for a small
abscess.
Biliary: The common bile duct is dilated measuring up to 14 mm with a 13 x 7
mm filling defect in the distal common bile duct compatible with a stone.
Small stones are seen in the gallbladder. There is mild intrahepatic biliary
dilatation.
Pancreas: The pancreas is normal in signal with no focal lesions or pancreatic
duct dilatation.
Spleen: The spleen is top-normal in size measuring 12.9 cm.
Adrenal Glands: The adrenal glands are unremarkable.
Kidneys: The kidneys enhance and excrete normally with no hydronephrosis or
masses. Bilateral punctate nonenhancing T2 hyperintensities are compatible
with simple cysts.
Gastrointestinal Tract: Visualized loops of small and large bowel are normal
in caliber with no evidence of obstruction
Lymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy
Vasculature: The abdominal aorta is normal in caliber.
Osseous and Soft Tissue Structures: Normal bone marrow signal
IMPRESSION:
1. Choledocholithiasis with a 13 mm stone in the distal common bile duct
causing moderate extrahepatic and mild intrahepatic biliary dilatation.
2. 1.9 cm hepatic abscess in the left lobe
3. Cholelithiasis
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 10:03 ___, 1 minute after discovery of the findings.
Change from initial wet read regarding hepatic abscess was communicated to Dr.
___ by Dr ___ at 8:40 on ___.
|
10129197-RR-7 | 10,129,197 | 22,654,366 | RR | 7 | 2151-07-04 12:35:00 | 2151-07-04 14:26:00 | EXAMINATION: Ultrasound-guided liver aspiration and biopsy.
INDICATION: ___ year old man with choledocholithiasis s/p ERCP, found to have
1.9cm hepatic abscess. // Please perform aspiration of hepatic abscess.
COMPARISON: MRI abdomen ___
PROCEDURE: Ultrasound-guided targeted liver aspiration and biopsy.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was
performed. The lesion for biopsy was identified in left hepatic lobe, . A
suitable approach for targeted liver aspiration and possible biopsy was
determined.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
Based on the preprocedure imaging, an appropriate skin entry site for the
procedure was chosen. The site was marked. The skin was then prepped and
draped in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 10 mL 1% lidocaine.
Under real-time ultrasound guidance, the lesion was aspirated with an 18 gauge
needle. A small amount of bloody fluid was aspirated.
Since no frankly purulent material was aspirated, biopsy of the lesion was
then undertaken. A single 18-gauge single core biopsy sample was obtained.
The aspirated fluid and a piece of the core biopsy was sent for
microbiology/cultures. The other piece of core biopsy was placed in formalin
for pathology.
The skin was then cleaned and a dry sterile dressing was applied. There were
no immediate complications.
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of
16 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
IMPRESSION:
Uncomplicated 18-gauge targeted liver aspiration and biopsy x 1, with specimen
sent for microbiology and pathology.
|
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