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10129197-RR-8 | 10,129,197 | 22,654,366 | RR | 8 | 2151-07-05 11:25:00 | 2151-07-05 13:26:00 | INDICATION: ___ year old man with chronic cough, polyarthropathy due to
pseudogout and sepsis, now on abx. // Evidence of infectious etiology?
TECHNIQUE: Chest portable
COMPARISON: No prior
FINDINGS:
Low lung volumes. No acute focal consolidation. The cardiac silhouette is
within normal limits. No significant effusions or pneumothorax.
IMPRESSION:
No acute focal consolidation.
|
10129197-RR-9 | 10,129,197 | 22,654,366 | RR | 9 | 2151-07-07 09:26:00 | 2151-07-07 09:51:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with PICC // Pt had a left ___
___ Contact name: ___: ___
IMPRESSION:
As compared to ___, a left PICC has been placed, terminating in the
mid superior vena cava. Lung volumes are lower with associated crowding of
bronchovascular structures at the lung bases. No other relevant changes.
|
10129254-RR-35 | 10,129,254 | 24,703,145 | RR | 35 | 2189-03-06 15:35:00 | 2189-03-06 17:08:00 | HISTORY: ___ male with sepsis induced bowel ischemia status post
resection. Worsening abdominal pain. Evaluate for recurrent ischemia.
COMPARISON: CT scan from ___
TECHNIQUE: The patient was administered oral volumen as well as 130 cc of
intravenous Optiray. Helical scans were performed through the abdomen and
pelvis. Images were reformatted in the coronal, sagittal and axial planes.
Dose report: The patient was administered a total dose of 1281 mGy/cm.
FINDINGS:
Abdomen with contrast: Stable linear atelectasis in lung bases. Unremarkable
lower visualized pericardium. No focal solid mass lesions in liver.
Gallbladder has previously been removed. Spleen is not enlarged and unchanged
splenules are seen. Head body and tail of pancreas are normal. Left and
right adrenal glands are normal. No solid mass lesions in the kidneys. No
hydronephrosis. Prior bowel resection with anastomotic sutures noted in left
mid abdomen. No free fluid or nodes are seen in the upper abdomen.
Incidental note made of replaced right hepatic artery.
The extent of abnormal pathology in the terminal ileum has increased. An
approximately 25 cm length of ileum now demonstrates progressive wall
thickening with edema and ___ enteric stranding and fluid. No intramural gas
or venous gas is seen. Multiple enlarged lymph nodes are again seen arising
from this area tracking up the root of the mesentry. The remaining bowel is
unremarkable.
Pelvis with contrast: Loops of bowel in the pelvis are unremarkable. Pelvic
solid organs unremarkable the bladder wall is normal. No free fluid is seen
in the deep pelvis. No inguinal adenopathy is seen. No concerning lytic or
blastic abnormalities are seen in the skeleton. An incidental lipoma is seen
in the mid ascending colon. The major vessels arising from the aorta are all
widely patent. No intraluminal filling defects are seen in any of the major
vessels. The superior mesenteric vein is widely patent throughout its course.
IMPRESSION:
Likely progression ischemic change involving the terminal ileum 1 with
increase in the extent length of involvement, increase in the ___ enteric
inflammation and free fluid and increase in the extent of wall thickening. As
clearly described in the wet read, these findings were communicated with Dr.
___ (by Dr ___ approximately 10 min of the discovery of the
initial findings.
|
10129815-RR-97 | 10,129,815 | 29,313,907 | RR | 97 | 2138-04-03 01:33:00 | 2138-04-03 08:48:00 | PA AND LATERAL CHEST OF ___
COMPARISON: Radiograph of ___, CTA of the chest of ___
and prior chest radiographs dating back to ___.
FINDINGS: The patient is status post right upper lobe resection. The right
hilum appears enlarged and abnormally dense compared to the left, but is
without change. Immediately lateral to the right hilum is a new area of
poorly defined opacity approximately at right eighth posterior rib level.
Lungs are otherwise remarkable for a persistent area of poorly defined opacity
anteriorly in the right middle lobe projecting in the retrosternal area on the
lateral view, and corresponding to an area of apparent scarring on ___ chest CTA. Cardiomediastinal contours are unchanged. Small pleural
effusions have resolved since the prior study.
IMPRESSION:
New poorly defined right juxta-hilar opacity, possibly due to an early/focal
pneumonia given clinical suspicion for pneumonia. However, recurrent
malignancy is an additional consideration, particularly considering adjacent
persistent enlargement and increased density of the right hilum.
Management recommendation for this finding is treatment for pneumonia with
short-term followup radiographs. However, as there is reportedly also a
potential clinical concern for aortic dissection, an immediate chest CTA
should be considered as a CXR is not sufficiently sensitive or specific for
detecting or excluding this diagnosis.
|
10129815-RR-98 | 10,129,815 | 29,313,907 | RR | 98 | 2138-04-03 11:46:00 | 2138-04-03 18:11:00 | INDICATION: ___ female with complicated medical history including
lung cancer and melanoma, now presents with intermittent chest pain. Question
aortic dissection.
COMPARISON: CTA chest dated ___.
TECHNIQUE: CTA of the chest was performed with multiplanar reformations.
FINDINGS: The aorta is normal in caliber throughout, without dissection or
other acute process. The pulmonary arterial tree is opacified to the
subsegmental level without filling defects to suggest pulmonary embolism. The
heart is top normal in size. There is a small pericardial effusion which has
increased in size as compared to ___. Multivessel coronary arterial
calcifications are present. Moderate atherosclerotic disease involves the
aortic arch, extending into arch vessels. There is no mediastinal or hilar
lymphadenopathy. Note is made of asymmetric aeration in the lung, status post
right upper lobectomy. Post-surgical changes are noted in the right
cardiophrenic angle, associated with calcification, but no new mass. There is
also mosaic attenuation in bilateral lungs, suggestive of small vessel or
airway disease. Scattered subpleural sub-4-mm pulmonary nodules are overall
unchanged as compared to preceding exam.
BONE WINDOWS: There is healed posterior right eighth rib fracture. There is
wedge compression deformity involving the superior endplate of T6 and inferior
endplate of T5, both with less than 30% loss of height, increased since ___.
IMPRESSION:
1. No aortic dissection or pulmonary embolism.
2. Stable post-surgical appearance of right upper lobectomy with associated
asymmetric aeration.
3. Likely underlying small vessel and/or airway disease.
4. Unchanged scattered subpleural pulmonary nodules under 4 mm.
5. Slight increase of a small pericardial effusion.
6. Interval increase in severity of wedge deformities involving the superior
endplate of T6 and inferior endplate of T5 as compared to ___.
|
10130010-RR-11 | 10,130,010 | 24,810,808 | RR | 11 | 2170-09-21 19:41:00 | 2170-09-21 22:34:00 | EXAMINATION: TRAUMA #3 (PORT CHEST ONLY)
INDICATION: ___ man with fall from roof
COMPARISON: None
FINDINGS:
Single portable view of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. No displaced fractures are seen. No
free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10130010-RR-12 | 10,130,010 | 24,810,808 | RR | 12 | 2170-09-21 20:14:00 | 2170-09-21 20:42:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fal from roof// trauma, fall off roof 12
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 21.0 cm; CTDIvol = 22.6 mGy (Body) DLP = 475.9
mGy-cm.
Total DLP (Body) = 476 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified.There is no significant
canal or foraminal narrowing.There is no prevertebral edema.
The thyroid and included lung apices are unremarkable.
IMPRESSION:
No cervical spine fracture or malalignment.
|
10130010-RR-13 | 10,130,010 | 24,810,808 | RR | 13 | 2170-09-21 20:14:00 | 2170-09-21 20:54:00 | EXAMINATION: CT abdomen pelvis with contrast
INDICATION: ___ with fal from roofNO_PO contrast// trauma, fall off roof 12
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.3 s, 49.3 cm; CTDIvol = 10.0 mGy (Body) DLP = 492.6
mGy-cm.
Total DLP (Body) = 493 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST: The visualized lung bases demonstrate mild bibasilar dependent
atelectasis. Otherwise, the lung bases are clear there is no pleural effusion
or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Subcentimeter hypodensity in segment three (02:37) is too small to
characterize but may represent a hemangioma or cyst. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
No evidence of traumatic injury in the abdomen or pelvis. No fracture.
|
10130010-RR-14 | 10,130,010 | 24,810,808 | RR | 14 | 2170-09-21 22:24:00 | 2170-09-21 22:42:00 | EXAMINATION: Right ankle radiographs, three views.
INDICATION: Status post reduction.
COMPARISON: Earlier on the same day.
FINDINGS:
Alignment of distal tibial and fibular fractures is much closer to anatomic
following reduction. Ankle mortise appears congruent.
IMPRESSION:
Marked improvement in alignment.
|
10130010-RR-15 | 10,130,010 | 24,810,808 | RR | 15 | 2170-09-21 22:42:00 | 2170-09-21 23:34:00 | EXAMINATION: CT LOWER EXTREMITY WITHOUT CONTRAST (RIGHT)Q61R
INDICATION: ___ year old man with ankle fracture// tib/fib distal, go to knee
TECHNIQUE: MDCT axial images were acquired through the right lower extremity
without the administration of intravenous contrast. Coronal, sagittal, and
bone algorithm reformations were performed and reviewed on PACS.
DOSE: DLP: 667.3 mGy-cm
COMPARISON: Radiograph from 1 hour prior
FINDINGS:
There is a comminuted fracture of the distal tibia with mild posterior apex
angulation and intra-articular extension. There is a comminuted fracture of
the distal fibula with mild posterior apex angulation and intra-articular
extension. There is a comminuted nondisplaced fracture of the anterior
process of the calcaneus involving the calcaneocuboid joint. There is
irregularity along the dorsal surface of the base of the third metatarsal
which is suspicious for additional fracture (8; 41, 42). The posterior
tibialis tendon is seen between 2 fracture fragments of the tibia at risk for
entrapment (4; 218). There is moderate overlying soft tissue swelling.
There are age-advanced degenerative changes at the posterior subtalar joint
which may be the sequelae of prior injury. Additionally ossicles are seen
along the lateral margin of the posterior subtalar joint and within the
expected location of the Lisfranc ligament. Muscle bulk is grossly
maintained. Limited view of the right knee is unremarkable.
IMPRESSION:
1. Comminuted intra-articular fractures of the distal tibia and distal fibula
with mild posterior apex angulation.
2. Nondisplaced comminuted intra-articular calcaneal fracture.
3. The posterior tibialis tendon is seen between 2 fracture fragments at-risk
for entrapment.
4. Irregularity of the dorsal surface of the base of the third metatarsal,
suspicious for additional fracture.
|
10130010-RR-16 | 10,130,010 | 24,810,808 | RR | 16 | 2170-09-22 09:24:00 | 2170-09-22 12:21:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: RT ANKLE FX.ORIF
COMPARISON: Preoperative radiograph and CT right ankle ___.
FINDINGS:
7 intraoperative fluoroscopic images, demonstrating placement of the external
fixation device for distal tibial and fibular fracture. Total fluoroscopic
time 33.4 seconds. No radiologist present.
IMPRESSION:
Please refer to operative report.
|
10130111-RR-18 | 10,130,111 | 27,485,248 | RR | 18 | 2157-08-02 04:22:00 | 2157-08-02 13:11:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with right IJ cvl placement // catheter tip
location Contact name: ___: ___
COMPARISON: None
FINDINGS:
A right IJ central line is present, tip overlying the cavoatrial junction. No
pneumothorax is detected .
There is mild cardiomegaly, with mild overall prominence of mediastinal and
hilar silhouettes. There is upper zone redistribution. There are increased
interstitial markings in both lungs. No definite alveolar opacities and no
effusions. The azygos vein is dilated measuring 16.3 mm.
IMPRESSION:
1. Right IJ central line tip over cavoatrial junction. No pneumothorax
detected.
2. Cardiomegaly and upper zone redistribution.
3. Diffuse increased interstitial markings. This may reflect interstitial
edema. However, in the appropriate clinical setting, the differential
diagnosis could include an interstitial infectious or inflammatory infiltrate.
4. Dilated azygos vein on an upright film. This suggests an element of right
heart failure.
|
10130111-RR-20 | 10,130,111 | 27,485,248 | RR | 20 | 2157-08-02 11:16:00 | 2157-08-02 11:48:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old male with history of acute cerebellar infarct.
Evaluate extent of edema and mass effect.
TECHNIQUE: ___ MDCT images were obtained through the head without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axis were generated and reviewed.
DOSE: DLP: 935 mGy per cm
CTDI: 54.79 mGy
COMPARISON: CT from ___
FINDINGS:
There is redemonstration of a left cerebellar hemisphere hypodensity, again
concerning for acute infarction. There is no evidence of hemorrhagic
conversion, however there appears to be slight interval increase in mass
effect on the adjacent brainstem and fourth ventricle. There is stable left
internal capsule chronic infarction, with associated ex vacuo dilatation of
the frontal horn of the left lateral ventricle. The basilar cisterns are
patent.
The visualized paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. No acute fractures identified. The globes are unremarkable.
IMPRESSION:
1. Slight interval increase in edema in the left cerebellum consistent with
patient's known stroke, with slight interval increase in mass effect on the
adjacent brainstem.
2. No definite evidence of hemorrhagic conversion.
3. Stable chronic left internal capsule infarct with associated ex vacuo
dilatation of the frontal horn of left lateral ventricle.
NOTIFICATION: ___ were d/w Dr. ___ at 11:35A on the day of the exam,
immediately after discovery of the findings by Dr. ___ by phone.
|
10130111-RR-21 | 10,130,111 | 27,485,248 | RR | 21 | 2157-08-03 04:10:00 | 2157-08-03 06:10:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with ___ infarct and mass effect //
?hydrocephalus, ?worsening mass effectplease perform at approx 0600 ___
TECHNIQUE: Multi detector CT images were obtained of the head without the
administration of intravenous contrast material. Multiplanar reformatted
images in coronal and sagittal planes are provided.
DOSE: DLP: 1114.91 mGy-cm
CTDI: 52.04 mGy
COMPARISON: CT of the head dated ___ and ___, and CTA
of the head and neck dated ___.
FINDINGS:
There is re- demonstration of a left cerebellar hemisphere hypodensity,
consistent with known acute infarction. There is no evidence of hemorrhagic
conversion. The degree of mass effect on the adjacent brainstem and fourth
ventricle is grossly unchanged from the most recent prior study.
There is a stable hypodensity in the left internal capsule, consistent with
chronic infarction. Unchanged ex vacuo dilatation of the frontal horn left
lateral ventricle is seen.
The basal cisterns appear patent.
No fracture is identified. The mastoid air cells, middle ear cavities, and
visualized paranasal sinuses are clear. The globes are unremarkable.
IMPRESSION:
1. Stable appearance of the acute infarct of the left cerebellum, with
unchanged degree of mass effect on the adjacent brainstem.
2. No evidence of hemorrhagic conversion.
3. Stable size and configuration of the ventricles, with persistent ex vacuo
dilatation of the frontal horn of the left lateral ventricle.
|
10130111-RR-22 | 10,130,111 | 27,485,248 | RR | 22 | 2157-08-03 15:09:00 | 2157-08-03 17:08:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ man with a known left ___ infarct involving the left
cerebellum and brainstem, with associated mass effect; evaluate for signs of
obstruction.
TECHNIQUE: Contiguous axial images of the brain were obtained without the
administration of intravenous contrast.
DOSE: DLP: 936 mGy-cm;
CTDIvol: 53 mGy
COMPARISON: Non-contrast head CT dated ___.
FINDINGS:
A large hypodensity involving most of the left cerebellar hemisphere is
compatible with known acute infarct and overall not significantly changed in
size since ___. There is no evidence of hemorrhage. The appearance of
the fourth ventricle is stable. There is no evidence of obstruction.
Persistent ex vacuo dilatation of the left lateral ventricular horn is
unchanged.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. No significant interval change in the known left cerebellar infarct since
___.
2. No evidence of obstruction.
|
10130111-RR-23 | 10,130,111 | 27,485,248 | RR | 23 | 2157-08-04 02:35:00 | 2157-08-04 03:48:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with worsening dysmetria and anisocoria. Assess
for interval change.
TECHNIQUE: Multi detector CT images were obtained of the head without the
administration of intravenous contrast material. Some of the images were
repeated due to motion artifact. Multiplanar reformatted images in coronal and
sagittal planes are provided.
DOSE: DLP: 1560.87 mGy-cm
CTDI: 54.32 mGy
COMPARISON: CT of the head dated ___, and ___.
FINDINGS:
The large left cerebellar infarct is again seen, with stable mass effect and
stable partial effacement of the fourth ventricle. Due to artifacts through
the posterior fossa, which persist despite repetition of some of the images on
the present exam, and which were also present on prior exams, it is difficult
to exclude punctate hyperdensities in infarcted territory. There has been no
significant interval change in the mass effect on the brainstem and in the
effacement of the left greater than right quadrigeminal plate cistern.
There is a stable hypodensity in the left internal capsule and caudate,
consistent with chronic infarction. Unchanged ex vacuo dilatation of the
frontal horn left lateral ventricle is again seen. Lateral and third
ventricles are overall stable in size.
There is mild mucosal thickening in the partially visualized maxillary
sinuses.
IMPRESSION:
1. Stable appearance of the large left cerebellar infarct with stable mass
effect on the fourth ventricle, brainstem, and quadrigeminal plate cistern.
2. Stable size of the supratentorial ventricles.
3. Due to artifacts through the posterior fossa on the current and prior
studies, punctate microhemorrhages in the left cerebellar infarcts are
difficult to exclude.
|
10130111-RR-24 | 10,130,111 | 27,485,248 | RR | 24 | 2157-08-05 08:22:00 | 2157-08-05 11:37:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ man with a cerebelar infarct; compare to prior exam.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Thin bone-algorithm reconstructed images were obtained.
DOSE: DLP: 936 mGy-cm
CTDI: 53 mGy
COMPARISON: Non-contrast head CT dated ___.
FINDINGS:
No overall significant interval change in the large left cerebellar hypodense
area corresponding to ischemic infarct. Associated minimal compression of the
___ ventricle and left greater than right quadrigeminal plate cistern persists
and is unchanged. The focal hypodensity in the region of the left caudate
nucleus and anterior limb of the internal capsule with associated ex vacuo
dilatation of the anterior horn of the left lateral ventricle is compatible
with chronic infarct and is also unchanged. Multiple, small focal
hypodensities in the periventricular region are compatible with probable
chronic small vessels disease and are also unchanged. There is no new area of
ischemia. There is no evidence of hemorrhage. The appearance of the
ventricles and sulci are otherwise unchanged, with slight prominence of the
sulci that are likely age-related.
There is no acute osseous abnormality. Other than mild ethmoid mucosal
thickening, the paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The orbits are unremarkable on this non-contrast exam.
IMPRESSION:
1. No significant interval change in the large left cerebellar ischemic
infarct and compression of ___ ventricle.
2. No change in chronic left caudate and anterior limb of internal capsule
infarct.
3. No new ischemia. No hemorrhage.
|
10130111-RR-25 | 10,130,111 | 27,485,248 | RR | 25 | 2157-08-06 11:04:00 | 2157-08-06 13:32:00 | EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old man with head bleed. Evaluate swallow.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 4 min 41 seconds.
COMPARISON: None available.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There is aspiration of nectar thick consistencies with trace
aspiration of honey consistency. Asymmetry of the swallow is noted on the AP
view, however both sides demonstrate coordinated movement.
IMPRESSION:
Aspiration of nectar thick consistency with trace aspiration of honey
consistency.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10130111-RR-27 | 10,130,111 | 27,485,248 | RR | 27 | 2157-08-07 17:53:00 | 2157-08-07 20:23:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with large cerebellar brainstem infarct, NG tube
placement // ev NG placement Contact name: ___: ___ ev NG
placement
IMPRESSION:
With the earlier study of ___, there has been placement of a Dobbhoff tube
that extends only to the gastroesophageal junction. It should be pushed
forward at least 5 cm to definitely be within the stomach. Continued
enlargement of the cardiac silhouette with mild elevation of pulmonary venous
pressure.
|
10130111-RR-28 | 10,130,111 | 27,485,248 | RR | 28 | 2157-08-10 14:14:00 | 2157-08-10 18:23:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with large cerebellar and brainstem stroke //
eval stroke, PATIENT IN BLOOD GLUCOSE STUDY, PLEASE REMOVE BLOOD GLUCOSE
MONITOR ATTACHED TO BODY PRIOR TO SCAN!
TECHNIQUE: Brain imaging was performed with sagittal T1, axial FLAIR, axial
T2, axial gradient echo and axial diffusion weighted images.
MRA of the head. 3D time-of-flight arteriography of the head was obtained,
axial source images and multiplanar reformations were obtained and reviewed.
Dynamic MRA of the neck was performed during administration of 15cc of
Multihance intravenous contrast. This report is based on interpretation of
all of these images.
COMPARISON: Multiple prior head CT examination and CTA of the head dated ___, the most recent head CT dated ___.
FINDINGS:
MRI BRAIN: Extensive area of subacute ischemia is re- demonstrated on the
left cerebellar hemisphere, involving the left middle cerebellar peduncles,
with no evidence of hemorrhagic transformation or significant shifting of the
normally midline structures. Supratentorially chronic areas of ischemia are
identified in the left caudate nucleus, causing ex vacuo dilatation of the
left frontal ventricular horn with susceptibility changes suggesting chronic
hemorrhagic changes. Scattered foci of high signal intensity are demonstrated
in the subcortical white matter bilaterally, which are nonspecific, likely
consistent with chronic microvascular ischemic changes. The orbits are
unremarkable. The paranasal sinuses and the mastoid air cells are clear.
MRA BRAIN: There is severe segmental narrowing of the basilar artery with
almost complete occlusion. There is also diffuse narrowing with areas of
stenosis and post stenotic dilatation throughout the circle of ___, likely
consistent with severe arteriosclerotic disease, both posterior communicating
arteries are patent, the middle cerebral arteries demonstrate bilateral
narrowing as well as the posterior cerebral arteries, no aneurysms are
identified.
MRA NECK: The aortic arch appears unremarkable with 3 branching pattern. The
origin of the supraaortic vessels appears patent. Both common carotid arteries
are patent.
On the left cervical carotid bifurcation, there is severe stenosis at the
origin of the left external carotid artery and moderate narrowing of the
origin of the left internal carotid artery, correlation with carotid
ultrasound is recommended if clinically warranted.
On the right cervical carotid bifurcation, there is moderate narrowing at the
origin of the right external carotid artery and mild narrowing at the proximal
segment of the internal carotid artery.
Both vertebral arteries are patent, however there is decreased vascular signal
at both V3 segments, with minimal signal of the basilar artery, consistent
with critical stenosis.
IMPRESSION:
1. Extensive area of subacute ischemia is re- demonstrated on the left
cerebellar hemisphere, involving the left middle cerebellar peduncles, with no
evidence of hemorrhagic transformation.
2. Chronic areas of ischemia are identified in the area of the left caudate
nucleus, causing ex vacuo dilatation of the left frontal ventricular horn,
with susceptibility changes suggesting chronic hemorrhagic changes.
3. Severe segmental narrowing of the basilar artery with almost complete
occlusion. There is also diffuse narrowing with areas of stenosis and post
stenotic dilatation throughout the circle of ___, likely consistent with
severe arteriosclerotic disease.
4. Arteriosclerotic disease is identified at the cervical carotid
bifurcations, more severe on the left, causing significant stenosis at the
origin of the left external carotid artery and moderate narrowing at the
origin of the left internal carotid artery.
|
10130111-RR-29 | 10,130,111 | 27,485,248 | RR | 29 | 2157-08-07 20:47:00 | 2157-08-07 21:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with stroke, eval NG tube (thanks) // eval NG
tube eval NG tube
IMPRESSION:
In comparison with the earlier study of this date, according to the
technologist report the patient pulled the nasogastric tube out during the
examination. The right IJ catheter has also been removed. Lower lung volumes
accentuate the transverse diameter of the heart. Otherwise little change.
|
10130111-RR-30 | 10,130,111 | 27,485,248 | RR | 30 | 2157-08-08 02:04:00 | 2157-08-08 04:05:00 | EXAMINATION: CT HEAD W/ CONTRAST
INDICATION: ___ year old man with stroke. fell face first now complaining of
vision changes. // concern for intracranial bleed or orbital injury
TECHNIQUE: Multi detector CT images were obtained of the head without the
administration of intravenous contrast material. Multiplanar reformatted
images in coronal and sagittal planes are provided.
DOSE: DLP: 891.93 mGy-cm
CTDI: 55.2 mGy
COMPARISON: CT of the head dated ___ and ___.
FINDINGS:
There is no significant interval change in the large left cerebellar hypodense
area, corresponding to the known ischemic infarct. There has been no
significant interval change in the mass effect on the brainstem in effacement
the left greater than right quadrigeminal plate cistern.
There is a stable hypodensity in the left internal capsule and caudate,
consistent with chronic infarction. Unchanged ex vacuo dilatation of the
frontal horn left lateral ventricle is again seen. The lateral and third
ventricles are overall stable in size.
No fracture is identified. The globes are unremarkable. There is fluid
layering in a few left-sided ethmoid air cells. The frontal sinus is absent.
IMPRESSION:
1. No acute intracranial process.
2. Stable appearance of large left cerebellar ischemic infarct.
NOTIFICATION: These findings were discussed with ___ by Dr. ___
___ telephone at 4am on ___, 5 minutes after discovery.
|
10130111-RR-31 | 10,130,111 | 27,485,248 | RR | 31 | 2157-08-08 14:08:00 | 2157-08-08 15:04:00 | EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT
INDICATION: ___ year old man with fall, R shoulder pain // ?injury
?injury
IMPRESSION:
There is mild degenerative change involving the AC joint. Minimal spurring is
seen at the inferior aspect of the glenoid. There appears to be some soft
tissue calcification in the region, although not in the area of the tendons of
the rotator cuff.
|
10130111-RR-32 | 10,130,111 | 27,485,248 | RR | 32 | 2157-08-09 14:03:00 | 2157-08-09 15:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with left brainstem cerebellum stroke // confirm
NG Tube placement.
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
NG tube tip isin the stomach. The side port is at the level of the EG
junction are should be advanced 10 cm for more standard position.
Moderate cardiomegaly, mild pulmonary edema, bilateral effusions are stable.
There is no evident pneumothorax. There is residual contrast in the colon
|
10130111-RR-33 | 10,130,111 | 27,485,248 | RR | 33 | 2157-08-10 10:19:00 | 2157-08-10 13:21:00 | INDICATION: Evaluate nasogastric tube placement, in a patient with CAD, CHF,
and cerebellar stroke requiring repeated nasogastric tube placement.
COMPARISON: Chest radiographs from ___, and ___.
FINDINGS:
A portable frontal upright chest radiograph demonstrates interval
repositioning or replacement of the nasogastric tube, which now terminates
within the stomach. Lung volumes are slightly lower. Allowing for this,
moderate cardiomegaly and mild pulmonary edema are unchanged. Previously noted
bilateral pleural effusions are likely unchanged, although the left
costophrenic angle is incompletely imaged and cannot be fully evaluated.
Residual contrast is again seen within the colon.
IMPRESSION:
1. Nasogastric tube terminating within the stomach.
2. Slightly lower lung volumes with unchanged moderate cardiomegaly and mild
pulmonary edema.
|
10130111-RR-34 | 10,130,111 | 27,485,248 | RR | 34 | 2157-08-16 16:57:00 | 2157-08-17 08:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cough // concern for infiltrate
concern for infiltrate
IMPRESSION:
In comparison with the study of ___, the patient has taken a deeper
inspiration. The cardiac silhouette is at the upper limits of normal in size.
No definite vascular congestion or pleural effusion. Mild asymmetry of
opacification with increased density at the left base. This could reflect
developing consolidation in the appropriate clinical setting.
|
10130111-RR-35 | 10,130,111 | 27,485,248 | RR | 35 | 2157-08-20 15:15:00 | 2157-08-20 16:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man admitted for stroke found to have intracardiac
thrombus. Has increasing WBC to 17.6 today with new onset cough. Afebrile. //
assess for PNA assess for PNA
IMPRESSION:
In comparison with the study of ___, there again is mild asymmetry of
opacification at the right base. Again, this most likely represents
atelectatic change, though in the appropriate clinical setting superimposed
pneumonia could be considered. No evidence of vascular congestion or pleural
effusion.
|
10130348-RR-62 | 10,130,348 | 24,286,651 | RR | 62 | 2197-05-27 07:43:00 | 2197-05-27 10:00:00 | INDICATION: Chest pain. Evaluate for acute process.
COMPARISON: Chest radiograph ___.
FINDINGS: The lungs are clear without consolidation or edema. There is no
pneumothorax of pleural effusion. The previously seen lingular pneumonia has
resolved. The cardiomediastinal silhouette is normal. The osseous structures
are unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10130573-RR-10 | 10,130,573 | 25,964,565 | RR | 10 | 2138-02-25 04:42:00 | 2138-02-25 09:09:00 | CHEST RADIOGRAPH
INDICATION: Evaluation for airway protection, rule out pneumonia.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the endotracheal tube and
the nasogastric tube are in unchanged position. There is unchanged mild
elevation of the right hemidiaphragm. The pre-existing right basal
atelectasis is improved. Retrocardiac atelectasis is unchanged.
Unchanged size of the cardiac silhouette. No newly appeared focal parenchymal
opacities.
|
10130573-RR-11 | 10,130,573 | 25,964,565 | RR | 11 | 2138-02-27 08:54:00 | 2138-02-27 11:43:00 | STUDY: Supine abdomen, ___.
HISTORY: ___ woman with seizures with PEG in place.
FINDINGS: There is a tubular catheter seen projecting over the abdomen.
However, it appears to end over the hepatic flexure. It is unclear if this is
the PEG tube. Please correlate clinically. There is contrast material and
stool seen throughout the colon. There are no dilated loops of small bowel to
indicate bowel obstruction. Surgical clips are seen within the upper abdomen.
There is a right hip hemiarthroplasty. No free abdominal gas is identified.
Degenerative changes of the lumbar spine are seen.
|
10130573-RR-14 | 10,130,573 | 25,964,565 | RR | 14 | 2138-03-01 15:26:00 | 2138-03-01 17:43:00 | INDICATION: ___ woman with seizures and new fever, assess for
pneumonia.
COMPARISONS: ___.
FINDINGS: Portable semi-upright radiograph is obtained. Endotracheal tube
and nasogastric tube have been removed. New pulmonary opacities are seen in
the bases bilaterally with accompanying small right pleural effusion. In the
setting of a seizure history, these findings could reflect aspiration, though
pneumonia in the appropriate setting is an alternative explanation. Heart is
normal. No pneumothorax is seen.
IMPRESSION: New bibasilar opacities could reflect aspiration given the
seizure history, though in the appropriate clinical setting could also reflect
developing multifocal pneumonia
Findings discussed with Dr. ___ by Dr. ___ by phone at ___ on
___.
|
10130573-RR-15 | 10,130,573 | 25,964,565 | RR | 15 | 2138-03-03 08:27:00 | 2138-03-03 17:55:00 | INDICATION: ___ woman with leukodystrophy and seizures, with chronic
gastrostomy tube placement, now presents for G-tube replacement. The patient
currently has a Foley catheter in place of gastrostomy tube.
After the risks, benefits, and alternatives of procedure were explained to the
patient's healthcare proxy, written informed consent was obtained. The
patient was placed on the angiography table in supine position. The skin of
the anterior abdominal wall around the gastrostomy tube insertion site was
prepped and draped in a sterile fashion. A preprocedure timeout was performed
using ___ protocol.
RADIOLOGISTS: ___ (fellow), ___ (resident) and Dr.
___ (attending). ___ the entire procedure.
ANESTHESIA: Topical, 2% lidocaine gel.
PROCEDURE: The existing Foley catheter tip was located in the proximal
duodenum. A 0.035 ___ guide wire was advanced through the Foley catheter,
and Foley catheter was then replaced with a 10 ___ MIC gastrostomy tube.
After injecting contrast and confirming the position within the stomach, the
gastrostomy tube was secured in place. Sterile dressings were applied. There
were no immediate post-procedure complications.
IMPRESSION: Percutaneous gastrostomy tube in place. Placement of a 10 ___
MIC gastrostomy tube over a guide wire. The tube is ready to use.
|
10130573-RR-16 | 10,130,573 | 25,964,565 | RR | 16 | 2138-03-03 11:35:00 | 2138-03-03 13:41:00 | REASON FOR EXAMINATION: PICC line placement.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The right PICC line tip is at the level of cavoatrial junction. Heart size
and mediastinum are stable. Bibasilar atelectases are demonstrated with no
change on the right and improvement at the left lung base. The patient
continues to be in mild interstitial pulmonary edema. Underlying infectious
process cannot be entirely excluded.
|
10130573-RR-8 | 10,130,573 | 25,964,565 | RR | 8 | 2138-02-24 18:34:00 | 2138-02-24 19:40:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Seizure disorder, intubated, assess for ET tube position.
FINDINGS: AP portable supine chest radiograph obtained. The endotracheal
tube is seen with its tip residing approximately 3.4 cm above the carina. The
NG tube courses into the left upper abdomen. Contrast is seen within large
bowel loops in the right upper quadrant. Linear areas of plate-like
atelectasis in the right and left lower lungs are noted. There is no large
consolidation or signs of CHF. No definite pneumothorax is present. The
heart and mediastinal contours appear grossly unremarkable aside from
atherosclerotic calcifications of the aortic knob. No definite displaced rib
fractures are seen.
IMPRESSION: Appropriately positioned endotracheal and nasogastric tubes.
|
10130573-RR-9 | 10,130,573 | 25,964,565 | RR | 9 | 2138-02-24 19:31:00 | 2138-02-24 20:13:00 | INDICATION: ___ woman status epilepticus, intubated at outside
hospital. Second opinion read.
COMPARISONS: MRI of the head from ___.
TECHNIQUE: Axial, coronal and sagittal images were obtained from Mount Auburn
Hospital and submitted for a second read.
FINDINGS: There is no acute hemorrhage, edema, mass effect or territorial
infarction. The ventricles and sulci are prominent consistent with atrophy.
There is hypodensity of the periventricular white matter consistent with
chronic small vessel disease. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. There are no acute skeletal
abnormalities.
IMPRESSION: No acute intracranial process. Severe chronic small vessel
disease and atrophy.
|
10130585-RR-10 | 10,130,585 | 27,470,349 | RR | 10 | 2150-12-31 21:39:00 | 2150-12-31 22:44:00 | HISTORY: Shortness of breath, dyspnea.
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: None.
FINDINGS:
There is a mild elevation of the right hemidiaphragm. No focal consolidation
is seen. There is slight blunting of the bilateral costophrenic angles on the
frontal view of the no large pleural effusion is seen on the lateral view.
There is no pneumothorax. The cardiac and mediastinal silhouettes are
unremarkable. No pulmonary edema is seen.
IMPRESSION:
Mild elevation of the right hemidiaphragm without focal consolidation or large
pleural effusion seen.
|
10130585-RR-11 | 10,130,585 | 27,470,349 | RR | 11 | 2151-01-01 10:56:00 | 2151-01-01 16:06:00 | INDICATION: Enlarged liver.
No comparison studies available.
TECHNIQUE: MDCT-acquired axial images of the chest, abdomen, and pelvis were
obtained following the uneventful administration of oral contrast and 130 cc
of Omnipaque intravenous contrast. Coronal and sagittal reformations were
performed.
EXAMINATION DLP: 2423 mGy-cm.
CT OF THE CHEST WITH IV CONTRAST:
The thyroid is normal. There is no axillary, mediastinal, or hilar
lymphadenopathy. The heart size is normal, and there is no pericardial
effusion. The great vessels are patent and normal in caliber. No pulmonary
embolus is detected to the proximal segmental levels. There is no pulmonary
nodule, mass, or pleural effusion.
The liver is markedly enlarged, containing numerous lobulated enhancing masses
(3:66, 401B:26). The gallbladder is collapsed and appears normal. The
pancreas, spleen, adrenal glands, kidneys, stomach, and intra-abdominal loops
of small bowel are normal. There is no mesenteric or retroperitoneal
lymphadenopathy, and no free air. A small amount of fluid tracks along the
right paracolic gutter (3:102).
CT OF THE PELVIS WITH IV CONTRAST:
There is a moderate amount of intrapelvic free fluid (3:113). A small
fluid-containing right inguinal hernia is present (3:122). The bladder,
rectum, and prostate are normal. There is moderate colonic diverticulosis
with no evidence of diverticulitis. Along the distal third of the descending
colon is a 6 cm narrowed segment which may represent underdistension or
peristalsis, although stricture cannot be excluded (401B:36, 400B:55). No
bowel mass is seen. There is no bowel obstruction.
OSSEOUS STRUCTURES:
There is no acute fracture. There are no bony lesions concerning for
malignancy or infection.
IMPRESSION:
1. Marked hepatomegaly secondary to multiple enhancing masses. In the setting
of apparent focal narrowing of the distal third of the descending colon,
metastatic colon cancer could be a consideration in addition to other
metastases or HCC. A liver biopsy is recommended for more definitive
diagnosis, and colonoscopy could be considered pending initial pathology
results.
2. Moderate pelvic ascites. Trace intra-abdominal ascites.
3. No intrathoracic metastases detected.
|
10130585-RR-12 | 10,130,585 | 27,470,349 | RR | 12 | 2151-01-02 12:50:00 | 2151-01-03 08:47:00 | TYPE OF THE PROCEDURE: Ultrasound-guided liver biopsy.
REASON FOR THE PROCEDURE AND MEDICAL HISTORY: Massive hepatomegaly. Liver
biopsy requested for tissue pathology, HCC, lymphoma, melanoma or metastatic
disease to be ruled out.
COMPARISON EXAM: CT of the abdomen and pelvis, dated ___.
PREPROCEDURE SCANNING.
The entire liver is nearly replaced by multiple iso- to hypoechoic masses. A
right lobe mass was selected for biopsy.
PROCEDURE:
The procedure, risk, benefits and alternatives were discussed with the patient
and written informed consent was obtained. A preprocedure timeout was
performed discussing the planned procedure, confirming the patient's identity
with three identifiers, and reviewing a checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 10 mL of 1% lidocaine was
instilled for local anesthesia. An 18-gauge biopsy needle was advanced into
the large mass within the right hepatic lobe via a subcostal approach and a
single core biopsy was obtained.
The specimen was sent over to the cytopathology team on site, which deemed the
specimen accurate.
Moderate sedation was provided by administering divided doses of Versed and
fentanyl (1 mg of Versed and 50 mcg of fentanyl) throughout the total
intraservice time of 15 minutes, during which the patient's hemodynamic
parameters were continuously monitored by radiology nursing personnel. The
patient tolerated the procedure well with no immediate complication.
Estimated blood loss was less than 5 mL.
Dr. ___ attending radiologist, was present throughout the entire
procedure. Post-procedure instructions were written in the ___ medical
record.
IMPRESSION:
Ultrasound-guided targeted liver biopsy of a right lobe large mass. Pathology
pending.
|
10130751-RR-36 | 10,130,751 | 20,254,619 | RR | 36 | 2156-04-24 02:17:00 | 2156-04-24 05:16:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with fever, cough // ?PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
The heart size is normal. The mediastinal and hilar contours are
unremarkable. A patchy opacity projecting over the right lower lung appears
new from the prior study from ___, and could reflect aspiration or
pneumonia. Within this opacity is an apparent lucent focus with a sclerotic
rim, which could reflect overlapping rib shadows and vascular structures. No
pleural effusions or pneumothorax. Cervical fusion hardware is partially
imaged.
IMPRESSION:
Patchy opacity projecting over the right lower lung, which could reflect
aspiration or pneumonia in the appropriate clinical setting.
|
10130751-RR-37 | 10,130,751 | 20,254,619 | RR | 37 | 2156-04-24 03:19:00 | 2156-04-24 03:49:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with fevers, nausea, vomiting, ttp epigastric and
RUS. // ?cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: No relevant prior studies available for comparison.
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.
CHD: 3 mm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 9.4 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
No evidence of cholelithiasis or acute cholecystitis.
|
10131237-RR-24 | 10,131,237 | 23,193,728 | RR | 24 | 2123-04-30 08:37:00 | 2123-04-30 10:15:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old man with angiolymphoblastic T-cell lymphoma and new
PE with R groin pain // r/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Comparison is made with CT abdomen and pelvis from ___.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, superficial femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
Prominent lymph nodes are seen in the right inguinal area at the site of the
patient's pain, consistent with known lymphoma and enlarged lymph nodes in
this area seen on prior CT. No soft tissue edema is seen adjacent to these
nodes.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. Prominent lymph nodes in the right inguinal area at the site of the
patient's pain, consistent with known lymphoma and prior imaging.
|
10131445-RR-18 | 10,131,445 | 25,666,320 | RR | 18 | 2139-02-19 12:36:00 | 2139-02-19 13:03:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ with left flank pain, dysuria, history of kidney stone//
?nephrolithiasis, hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.2 cm. The left kidney measures 10.7 cm. There is
mild hydronephrosis on the left. Two echogenic foci are seen within the
midpole of left kidney measuring up to 4 mm consistent with renal calculi.
The proximal ureter is not visualized.
There is no evidence of hydronephrosis or stones on the right. There is a
anechoic cystic structure in the interpolar right kidney measuring 1.2 x 1.9
cm, consistent with a simple renal cyst.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
The bladder is decompressed.
IMPRESSION:
1. Mild left-sided hydronephrosis.
2. Two nonobstructing renal calculi in the interpolar left kidney measuring
up to 4 mm.
2. Simple renal cyst in the interpolar right kidney measuring up to 1.9 cm.
|
10131445-RR-19 | 10,131,445 | 25,666,320 | RR | 19 | 2139-02-19 15:10:00 | 2139-02-19 15:47:00 | EXAMINATION: CT abdomen pelvis without contrast
INDICATION: ___ year old woman with left hydronephrosis, urology requests low
dose radiation renal protocol without contrast// ?kidney stone
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast in prone positioning. 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: Total DLP: 1198.1 mGy-cm
COMPARISON: None.
FINDINGS:
LOWER CHEST: Aside from mild dependent atelectasis, visualized lung fields are
within normal limits. There is no evidence of pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal suspicious renal lesions within the limitations of an unenhanced
scan. There is mild-to-moderate hydronephrosis of the left kidney. At least
2 stones are seen within the lower calices of the left kidney, the largest
measuring 4 mm (2:36, 601:36). The left ureter is mildly dilated throughout
its course. In addition, there is mild stranding around the left kidney.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal (2:67).
PELVIS: The urinary bladder is unremarkable. At the left ureterovesicular
junction, there is a 3 mm stone (2:81, 601:39, 602: 55), presumably resulting
in a least partial obstruction evidence by mild left ureteral dilation and
moderate left hydronephrosis. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: Scattered mesenteric lymph nodes are probably reactive. There is
no retroperitoneal lymph node enlargement by CT size criteria. There is no
pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. A 3 mm stone in the left ureteral vesicular junction, resulting in mild
left ureteral dilation and moderate left hydronephrosis.
2. Additional nonobstructing stones in the lower left calices, measuring up to
4 mm.
|
10131647-RR-19 | 10,131,647 | 23,709,958 | RR | 19 | 2147-05-03 03:06:00 | 2147-05-03 04:09:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old woman with new O2 requirement now with persistent
sinus tachycardia despite volume resuscitation for presumed septic shock// PE?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 1.6 s, 0.2 cm; CTDIvol = 26.4 mGy (Body) DLP =
5.3 mGy-cm.
3) Spiral Acquisition 4.9 s, 32.1 cm; CTDIvol = 5.4 mGy (Body) DLP = 170.7
mGy-cm.
Total DLP (Body) = 178 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level. There
are multiple nonocclusive, linear filling defects in the segmental and
subsegmental pulmonary arteries. For example there is are nonocclusive
thrombus in the right apical and posterior subsegmental, (series 5, image
139), right lateral basilar subsegmental pulmonary artery, (series 5, image
180) and the left apicoposterior segmental pulmonary artery, (series 5, image
104). The main pulmonary artery measures up to 37 mm which is enlarged and
suggests pulmonary hypertension. There is no evidence of right heart strain.
There is no supraclavicular, axillary, lymphadenopathy. Multiple small
mediastinal lymph nodes that do not meet CT criteria for lymphadenopathy are
demonstrated for example a 9 mm left prevascular lymph node, (series 5, image
93) are likely reactive. The right hilum demonstrates a 14 mm lymph node that
does not meet CT criteria for lymphadenopathy, (series 5, image 113). The
thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. Trace bilateral pleural
effusions with adjacent compressive atelectasis.
There are multiple millimetric centrilobular nodules, and regional
ground-glass opacification most pronounced at the lingula segment of the left
upper lobe, (series 5, image 152) concerning for infectious process. The
airways are patent to the subsegmental level but demonstrate bronchial wall
thickening which may also represent an infectious process. No evidence of
pulmonary infarction in the setting of pulmonary embolism.
Limited images of the upper abdomen demonstrates a diffusely hypoattenuating
liver which suggest moderate hepatic steatosis. No other gross abnormalities
demonstrated in the apparent.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
There is a nondisplaced fracture of the mid midsternum with surrounding
hyperdense material likely represents a subacute fracture.
IMPRESSION:
1. Pulmonary embolism in a few subsegmental and segmental branches of the
right pulmonary artery without evidence of right heart strain.
2. Enlarged main pulmonary artery measuring 37 mm suggesting pulmonary
hypertension.
3. Diffuse centrilobular pulmonary nodules and scattered ground-glass
opacification in bilateral lungs likely represent an infectious process such
as multifocal pneumonia. However, respiratory bronchiolitis cannot be
excluded.
4. Moderate hepatic steatosis.
RECOMMENDATION(S): 1.A follow up chest CT is recommended in ___ weeks after
treatment of acute pulmonary process taken for resolution.
2. Radiological evidence of fatty liver does not exclude cirrhosis or
significant liver fibrosis which could be further evaluated by ___.
This can be requested via the ___ (FibroScan) or the Radiology
Department with either MR ___ or US ___, in conjunction with
a GI/Hepatology consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
10131647-RR-20 | 10,131,647 | 23,709,958 | RR | 20 | 2147-05-04 13:30:00 | 2147-05-04 14:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo w/ etoh withdrawl, hypoxia// r/o pulmonary edema r/o
pulmonary edema
IMPRESSION:
Heart size and mediastinum are stable. Multifocal consolidations are similar
to previous chest CT from ___. There is no appreciable pleural
effusion. There is no pneumothorax.
|
10131647-RR-21 | 10,131,647 | 23,709,958 | RR | 21 | 2147-05-05 16:11:00 | 2147-05-05 17:02:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with PE I/s/o strep bacteremia, unclear whether
thromboembolic vs septic; r/o DVT// presence of DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility and flow of the bilateral common femoral,
femoral, and popliteal veins. There is lack of compressibility of 1 of the
left posterior tibial veins. There is normal color flow and compressibility
of the left peroneal vein. Normal color flow and compressibility are
demonstrated in the right posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Deep venous thrombosis of 1 of the 2 left posterior tibial veins. No evidence
of deep venous thrombosis in the rightlower extremity veins.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:49 pm, 2 minutes after
discovery of the findings.
|
10131707-RR-20 | 10,131,707 | 25,176,043 | RR | 20 | 2167-07-12 20:38:00 | 2167-07-12 22:18:00 | PORTABLE CHEST: ___
HISTORY: ___ female with dyspnea, status post intubation.
FINDINGS: Single portable view of the chest. No prior. Endotracheal tube is
seen with tip approximately 5 cm from the carina. Nasogastric tube is also
seen with side port in the region of the GE junction. Left-sided central
venous catheter is seen with tip in the right atrium. Right-sided subclavian
line is seen with tip in the mid SVC. Lungs are grossly clear, given
significant rotation and portable supine technique. Median sternotomy wires
again seen. Cardiac silhouette is enlarged but likely accentuated due to
technique and positioning. Osseous and soft tissue structures are
unremarkable.
IMPRESSION: Endotracheal tube tip approximately 5 cm from the carina.
|
10131707-RR-21 | 10,131,707 | 25,176,043 | RR | 21 | 2167-07-13 02:26:00 | 2167-07-13 09:46:00 | HISTORY: ___ woman with chest pain radiating to the back with
shortness of breath and history of PEs, allergic to IV contrast, please
evaluate for aortic dissection and PE.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired on a 1.5
Tesla magnet. Intravenous gadolinium was not administered in view of the
patient's severe chronic renal failure, eGFR 7. Imaging was performed from
the thoracic inlet to the aortic bifurcation.
MR CHEST:
No enlarged mediastinal or axillary lymph nodes are seen on this non-dedicated
study. There is a left-sided subclavian line in situ with its tip terminating
in the right atrium, it is not clear whether this extends into the IVC (per
clinical report a groin catheter is also in place and may result in this
appearance), and a chest radiograph should be obtained to confirm line
positioning. A right-sided Port-A-Cath is in situ with its tip in the distal
SVC. No pericardial effusion. The great vessel with branching pattern is
normal. No aortic dissection. Very limited images were obtained of the
pulmonary arteries, and there is no thrombus in the main pulmonary artery,
main right or main left pulmonary arteries. The lobar and smaller-order
branches cannot be assessed on this study. There is right lower lobe presumed
atelectasis, consolidation cannot be excluded on this non-contrast MRI. There
is a trace right pleural effusion.
MR ABDOMEN:
The evaluation of the solid abdominal viscera is limited by the lack of
intravenous contrast. The liver is not nodular in contour. No focal liver
lesions are seen. No biliary duct dilatation. The gallbladder is
unremarkable in appearance. The spleen is not enlarged measuring 11.7 cm.
The pancreas is normal in signal intensity and morphology. Both adrenal
glands are unremarkable. Both kidneys are small and contain multiple cysts
consistent with the patient's known chronic renal disease. An NG tube is in
situ with the tip in the distal stomach. No upper abdominal lymphadenopathy.
No free fluid in the abdomen.
The visualized osseous structures are unremarkable.
IMPRESSION:
1. No MR evidence for aortic dissection.
2. No central pulmonary embolism in the main, right or left pulmonary
arteries, the lobar and smaller order pulmonary arteries cannot be assessed on
this non-contrast study.
3. Right lower lobe atelectasis or consolidation.
4. Multiple renal cysts with small shrunken kidneys consistent with the
patient's chronic renal disease.
5. Positioning of the central venous catheters is not clear, at least one
catheter appears to terminate in the right atrium or extend into the IVC.
Recommend a chest radiograph to confirm catheter tip placement.
|
10131707-RR-22 | 10,131,707 | 25,176,043 | RR | 22 | 2167-07-13 08:45:00 | 2167-07-13 09:40:00 | INDICATION: Evaluate right Port-A-Cath and central venous catheter locations
due to positioning within the right atrium noted prior MRI of the chest.
COMPARISON: Chest radiogram from ___ and MRA of the torso from ___.
FINDINGS: A bedside AP radiograph of the chest demonstrates that the
double-lumen catheter terminates well within the right atrium, approximately 7
cm below the expected location of the cavoatrial junction. It is unchanged in
position from the prior study. The right subclavian line terminates in the
mid SVC, also unchanged. The patient has been extubated. The lungs are
clear. There continues to be enlargement of the right atrium. There is no
pneumothorax or pleural effusion. Pulmonary vascularity is normal.
Sternotomy cerclage wires are intact.
IMPRESSION: The double-lumen Port-A-Cath should be retracted approximately 7
cm to ensure proper positioning in the lower one-third of the SVC.
|
10131707-RR-23 | 10,131,707 | 25,176,043 | RR | 23 | 2167-07-15 11:27:00 | 2167-07-15 16:51:00 | RIGHT CHEST PORT CATHETER FIBRIN SHEATH STRIPPING AND REMOVAL OF RIGHT GROIN
CVL
INDICATION: ___ woman with right chest port, suspected fibrin sheath.
The patient has contrast allergy.
OPERATORS: Dr. ___ (fellow), ___ (resident),
and ___ (attending physician). Dr. ___ was present throughout the
procedure.
CONTRAST: None.
SEDATION/ANESTHESIA: General endotracheal anesthesia provided by the
anesthesiologist.
PROCEDURE AND FINDINGS: Consent was obtained from the patient after
explaining the benefits, risks, and alternatives. Patient was placed supine
on the imaging table in the interventional suite. Timeout was performed as
per ___ protocol.
Under aseptic conditions and sonographic guidance, a micropuncture needle was
placed in the patent left common femoral vein at the level of mid femoral
head. A 0.018 wire was advanced through the needle and into the iliac vein.
After making incision with the access point, needle was exchanged for a 4.5
___ microsheath. After removing the inner cannula and wire, 0.035 ___
wire was advanced through the microsheath and into the upper IVC, while
carefully visualizing the wire traversing the IVC filter. After removing the
microsheath, a 6 ___ 90-cm ___ sheath was advanced over the wire,
again visualizing while traversing the IVC filter. After removing the inner
cannula, the sidearm was aspirated and flushed. A 12-20 mm EN Snare system
was placed within the sheath and advanced system to the lower SVC to the level
of the tip of right port catheter. After unsheathing appropriately, the EN
Snare loops wire placed around the catheter and stripping was performed twice
from the level of upper SVC through to the catheter tip and beyond. While
flushing the catheter and cleaning the tube, fibrin sheath material was noted.
Both the lumens of the chest port were accessed with ___ needles to
successfully aspirate and flush freely. CO2 was injected into one of the
lumens to perform a DSA run and confirm the successful fibrin sheath
stripping. Both ___ needles were left in place and site dressed in a
sterile fashion. The left groin sheath and the right groin central venous
catheter (placed by the team) were removed. Firm pressure was applied to the
venotomy sites for about 5 minutes to achieve complete hemostasis. These
sites were also dressed in a sterile fashion. No immediate post-procedure
complication was seen.
IMPRESSION: Uncomplicated fibrin sheath stripping of the right chest port
catheter utilizing EN Snare system. Both lumens of the right chest port were
accessed and successfully aspirated and flushed, followed by CO2 injection
through one of the ports to confirm successful stripping.
Results were discussed over the phone with Dr. ___ at 3:45 p.m. on
___.
|
10131707-RR-24 | 10,131,707 | 25,176,043 | RR | 24 | 2167-07-16 14:46:00 | 2167-07-16 16:57:00 | INDICATION: ___ woman with left flank pain.
COMPARISONS: Torso MRI ___.
FINDINGS: The right kidney measures 9 cm. The left kidney measures 9.5 cm.
Several cysts are seen in both kidneys. A 1.9 cm left upper pole cyst has a
single septation. The bladder is clear. There is no stone, mass or
hydronephrosis in either kidney.
IMPRESSION: No hydronephrosis, stone or perinephric fluid collection.
|
10131707-RR-25 | 10,131,707 | 25,176,043 | RR | 25 | 2167-07-17 15:25:00 | 2167-07-17 16:15:00 | INDICATION: ___ woman with end-stage renal disease and new oxygen
requirement. Assess for pneumonia.
___
Two views of the chest were obtained. The lungs are well expanded and clear
without pleural effusion or pneumothorax. The heart is normal in size with
normal cardiomediastinal contours. Right-sided Port-A-Cath and left-sided
hemodialysis catheter are in unchanged position. Cardiac size is stably
enlarged.
|
10131707-RR-26 | 10,131,707 | 25,176,043 | RR | 26 | 2167-07-19 16:16:00 | 2167-07-19 18:37:00 | CT OF THE ABDOMEN AND PELVIS WITHOUT CONTRAST
INDICATION: ___ woman with end-stage renal disease presenting with
flank pain and worsening anemia. Assessment for retroperitoneal bleeding and
etiology of the flank pain.
TECHNIQUE: Axial images of the abdomen and pelvis were acquired without oral
or IV contrast. Coronal and sagittal reformations were also performed.
FINDINGS: Visualized lung bases are within normal limits apart from minimal
linear subpleural atelectasis. The dialysis catheter is seen to terminate
seen in the IVC. The liver on this non-contrast study appears to be
homogeneous without evidence of focal lesions or ductal dilatation. The
spleen is within normal limits. The pancreas is mildly atrophic but without
evidence of focal lesions throughout. The adrenals are within normal limits.
Kidneys are of small size, with hypodense lesions which were previously
identified as cysts on the MRI from ___. There is no evidence of
hydronperosis or urinary stones. Small and large bowel loops are within normal
limits. There is no evidence of retroperitoneal hematoma. IVC filter is seen
in the IVC in the appropriate infrarenal position.
PELVIS: Urinary bladder, uterus, and large bowel are within normal limits.
There is no evidence of pelvic or inguinal lymphadenopathy.
MUSCULOSKELETAL: Status post sternotomy. There is no evidence of focal bone
lesions throughout.
IMPRESSION:
1. No evidence of retroperitoneal hematoma or other cause of flank pain.
2. Tip of the dialysis catheter appears to be in the IVC. This finding was
discussed on the phone by Dr. ___ with Dr. ___ on ___ at 6:00
p.m.
3. Renal hypodensities, better visualized on the prior MRI study and
characterized as cysts.
|
10131707-RR-27 | 10,131,707 | 25,176,043 | RR | 27 | 2167-07-19 17:09:00 | 2167-07-20 08:17:00 | AP CHEST, 5:19 P.M., ___
HISTORY: ___ woman with end-stage renal disease, chest and flank
pain.
IMPRESSION: AP chest compared to ___:
Earlier mediastinal and pulmonary venous engorgement on ___ have resolved.
Right infrahilar atelectasis is slightly more pronounced today than it was on
___. Mild cardiomegaly, particularly involving the right heart is
longstanding. Left lung is clear. Dual-channel right supraclavicular central
venous dialysis catheter unchanged in position in the right heart. Right
subclavian line ends in the SVC.
|
10132365-RR-24 | 10,132,365 | 24,668,665 | RR | 24 | 2180-02-19 12:27:00 | 2180-02-19 13:29:00 | EXAMINATION: PA AND LATERAL CHEST RADIOGRAPHS
INDICATION: ___ male with shortness of breath.
TECHNIQUE: PA and lateral chest radiographs
COMPARISON: Multiple prior chest radiographs, most recent on ___.
FINDINGS:
The lungs are well expanded. Patchy opacities are seen in the right lower
lobe, which also shows mild bronchiectasis with peribronchial thickening. A
small pleural effusion and consolidation in the right cardiophrenic angle is
better seen in the lateral view. The left lung is clear. Cardiomediastinal and
hilar contours are unremarkable. There is no pneumothorax.
IMPRESSION:
Findings consistent with right lower lobe pneumonia on the setting of right
lower lobe bronchiectasis and peribronchial thickening suggestive of
bronchitis.
|
10132365-RR-25 | 10,132,365 | 24,668,665 | RR | 25 | 2180-02-19 18:01:00 | 2180-02-19 18:39:00 | INDICATION: ___ with new ataxia. Assess for intracranial hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal, and
thin section bone algorithm reconstructed images were generated.
DOSE: DLP: 1226.4 mGy-cm
CTDI: 55.71 mGy
COMPARISON: None available
FINDINGS:
No evidence of hemorrhage, edema, mass effect, or acute large territorial
infarction.Mild prominence of the ventricles and sulci are consistent with
age-related cortical volume loss. Periventricular, subcortical, and deep white
matter hypodensities are likely sequelae of chronic small vessel ischemic
disease. The basal cisterns are patent and there is preservation of gray-white
matter differentiation.
No fracture identified. The right mastoids are poorly pneumatized and
completely opacified. Opacification also seen in the aditus ad antrum. There
is complete opacification of the left maxillary sinus which is small.
High-density internal components may be from chronic inspissated secretions
although fungal colonization is also possible. Other paranasal notable for a
hypoplastic frontal sinuses and mild mucosal thickening in the ethmoid air
cells and sphenoid sinus. The globes are notable for a right lens replacement.
Left lens (which may be replaced) is more ventrally located than expected.
IMPRESSION:
1. White matter changes suggestive of chronic small vessel disease without
acute intracranial process.
2. Complete opacification of left maxillary sinus which is small suggesting
silent sinus syndrome. High-density internal components could be due to
chronic inspissated secretions although fungal colonization is possible.
|
10132419-RR-16 | 10,132,419 | 23,821,029 | RR | 16 | 2148-12-31 10:34:00 | 2148-12-31 11:32:00 | INDICATION: Chest pain.
COMPARISON: None.
TECHNIQUE: Upright AP and lateral views of the chest.
FINDINGS: The heart size is mildly enlarged. The aorta is slightly tortuous
and calcified. There is no pulmonary vascular congestion. Hilar contours are
unremarkable. There is minimal streaky atelectasis in the lung bases. No
focal consolidation, pleural effusion or pneumothorax is seen. Degenerative
changes are noted involving both acromioclavicular and glenohumeral joints,
which are moderate in degree. Mild-to-moderate multilevel degenerative
changes are also seen within the thoracic spine.
IMPRESSION: Mild bibasilar atelectasis. No acute cardiopulmonary abnormality
otherwise demonstrated.
|
10132419-RR-17 | 10,132,419 | 23,821,029 | RR | 17 | 2149-01-06 08:55:00 | 2149-01-06 09:33:00 | HISTORY: ___ man with new pacemaker.
COMPARISON: ___.
FINDINGS:
New left chest subclavian atrial ventricular defibrillator leads follow their
expected courses. There is no pneumothorax, pleural effusion or mediastinal
widening. Lungs are clear. Moderate to severe cardiomegaly is unchanged.
There is no pulmonary edema or pulmonary vascular congestion.
IMPRESSION:
Normal post insertion appearance, atrioventricular pacemaker lead. No
complications.
|
10132489-RR-38 | 10,132,489 | 20,721,274 | RR | 38 | 2163-11-27 16:35:00 | 2163-11-27 17:08:00 | EXAMINATION: Left lower extremity venous ultrasound
INDICATION: Left ankle pain, erythema, edema and hyperthermia.
TECHNIQUE: Grayscale and Doppler sonograms of the left common femoral,
superficial femoral and popliteal veins were performed including color and
spectral Doppler imaging studies.
COMPARISON: ___.
FINDINGS:
Grayscale and Doppler sonograms the left common femoral, superficial femoral
and popliteal veins show normal compressibility and Doppler flow and
waveforms. No intraluminal thrombus is found. Paired patent left posterior
tibial and peroneal veins are identified. No ___ cyst
IMPRESSION:
No evidence of deep vein thrombosis in the left lower extremity.
|
10132628-RR-91 | 10,132,628 | 25,596,068 | RR | 91 | 2135-08-15 20:45:00 | 2135-08-15 23:34:00 | INDICATION: ___ with ___ toe cellulitis and ulcer. Immunosuppresed // r/o
osteo
COMPARISON: ___.
FINDINGS:
Four views of the right second toe provided. Since the prior exam, the
appearance of the mid phalanx of the second ray appears somewhat truncated
along the proximal and mid aspect. While loss of bone in the setting of
osteomyelitis is a potential concern, findings are indeterminate.
IMPRESSION:
As above. Would recommend MRI to further assess.
|
10132628-RR-92 | 10,132,628 | 25,596,068 | RR | 92 | 2135-08-16 16:01:00 | 2135-08-17 09:22:00 | EXAMINATION: MR FOOT ___ CONTRAST RIGHT
INDICATION: ___ woman with rheumatoid arthritis presenting with 8 months of
a poorly healing wound on her R second toe, s/p horse stepping on her, with
X-ray indeterminate for osteomyelitis. Evaluate for osteomyelitis.
TECHNIQUE: Imaging performed at 3 tesla using the foot coil. Sequences
include coronal and sagittal T1 and STIR a, coronal fat saturated precontrast
T1, and coronal and sagittal postcontrast T1 weighted sequences, with and
without fat saturation. 5 cc Gadavist was administered uneventfully.
COMPARISON: Toe radiographs from ___
FINDINGS:
There is significant soft tissue edema and enhancement surrounding the second
ray, from the level of the metatarsal head through the tip of the foot. There
is abnormally low bone marrow signal on T1 weighted sequence of the second
proximal and middle phalanges, and irregularity of the cortical outline of the
proximal phalanx, and relative preservation of the cortex of the middle
phalanx. The second distal phalanx is normal in signal. Similarly, the
second metatarsal head demonstrates normal bone marrow signal. There is a
trace amount of fluid in the second MTP joint, which may be reactive or
infected. There is no rim enhancing fluid collection to suggest abscess.
There is no bone marrow signal abnormality of the first, third, fourth, or
fifth rays. Tarsal bone marrow signal is normal.
The tibial sesamoid of the first MTP demonstrates low T1 signal, and high T2
signal, with mild postcontrast enhancement, although this is likely secondary
to stress related changes seen with sesamoiditis rather than osteomyelitis.
No surrounding soft tissue edema.
Incidentally noted is an erosion at the medial aspect of the first metatarsal
head, and given the hallux valgus deformity, is likely mechanical or related
to prior episode of gout. Given its juxta articular location, this is not
compatible with a rheumatoid erosion.
IMPRESSION:
1. Osteomyelitis of the second proximal and middle phalanges, with
preservation of bone marrow signal of the distal phalanx and of the metatarsal
head. Trace fluid in the second MTP joint may be reactive or infected.
2. Bone marrow signal changes of the tibial sesamoid likely due to stress
related changes, seen with sesamoiditis. These are not reflective of
osteomyelitis.
3. Juxta articular erosion at the medial first metatarsal head, either
related to mechanical stress from hallux valgus, or prior episode of gout.
This is not compatible with a rheumatoid erosion. This does not appear to be
an active process.
NOTIFICATION: The findings were discussed by Dr. ___ with Neir ___ on
the telephone on ___ at 9:20 AM, 5 minutes after discovery of the
findings.
|
10132628-RR-94 | 10,132,628 | 25,596,068 | RR | 94 | 2135-08-16 21:52:00 | 2135-08-16 23:07:00 | EXAMINATION: AORTA AND BRANCHES
INDICATION: ___ year old woman with significant smoking history and palpable
abdominal aorta. // Please assess for AAA.
TECHNIQUE: Grayscale and color Doppler ultrasound of the abdominal aorta was
performed.
COMPARISON: ___ CT abdomen pelvis.
FINDINGS:
The aorta measures 2.2 cm in the proximal portion, 1.6 cm in mid portion and
1.4 cm in the distal abdominal aorta. There is significant calcified
atherosclerotic plaque.
Wall-to-wall color flow is seen within the aorta with appropriate arterial
waveforms.
The right common iliac artery measures 0.7 cm and the left common iliac artery
measures 0.8 cm.
IMPRESSION:
Significant atherosclerotic calcifications in the abdominal aorta without
evidence of aneurysm.
|
10132628-RR-95 | 10,132,628 | 25,596,068 | RR | 95 | 2135-08-17 16:38:00 | 2135-08-17 18:51:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with infection // location of right 42 cm picc
tip Contact name: ___: ___
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph. ___
FINDINGS:
A right-sided PICC is in-situ, this terminates very distally in the SVC,
possibly in the right atrium. This could be safely withdrawn by 2.5 cm to be
well seated in the SVC. Lung volumes are within normal limits. The trachea
is central. The cardiomediastinal contour is normal. The heart is not
enlarged. No consolidation, pneumothorax or pleural effusion seen. Moderate
atherosclerotic calcification in the aortic arch. There has been interval
resolution of the previously demonstrated atelectasis at the bilateral lung
bases.
|
10132759-RR-33 | 10,132,759 | 24,406,934 | RR | 33 | 2178-06-02 09:53:00 | 2178-06-02 11:14:00 | HISTORY: Syncope and hypotension. Evaluate widened mediastinum.
COMPARISON: Chest radiographs ___ and ___.
FINDINGS: Frontal and lateral views of the chest. The appearance of the
mediastinum is unchanged, accounting for differences in technique. There is
no pleural effusion, pneumothorax or focal airspace consolidation. Bibasilar
atelectasis is present. The heart size is normal. The hilar structures are
unremarkable.
IMPRESSION: Unchanged, normal-appearing mediastinum.
|
10132759-RR-34 | 10,132,759 | 24,406,934 | RR | 34 | 2178-06-02 13:55:00 | 2178-06-02 14:30:00 | HISTORY: Syncope with new hypoxia. Evaluate for a pulmonary embolus.
TECHNIQUE: MDCT axial images were acquired through the chest during the
pulmonary arterial phase of enhancement with 100 mL of Omnipaque. Coronal and
sagittal reformations were provided and reviewed. Maximum intensity
projection images were created and reviewed as well.
DLP: 560.20 mGy/cm.
COMPARISON: None.
FINDINGS:
Contrast is seen opacifying the segmental and subsegmental branches of the
pulmonary vascular tree, without filling defect to indicate a pulmonary
embolus. The aorta and main pulmonary artery are normal in caliber. There is
no evidence for aortic injury or dissection. The heart is normal in size.
There is no pericardial effusion. Focal coronary artery calcifications are
present.
There is no axillary, hilar or mediastinal lymphadenopathy. The esophagus is
unremarkable. Small hiatal hernia is noted. The trachea is normal in
caliber. The airways are patent the subsegmental level. There is no pleural
effusion or pneumothorax. There is no focal consolidation worrisome for
pneumonia. Bibasilar atelectasis is noted. A focus of ground-glass opacity
within the lingula is new from ___ bones probably atelectasis (601 b:
27).
The included images of the arterially enhanced liver, spleen, stomach and
adrenal glands are normal.
There are no concerning lytic or blastic osseous lesions. Calcification of
the anterior longitudinal ligament is unchanged.
IMPRESSION:
No pulmonary embolus or other findings to explain symptoms.
|
10132833-RR-31 | 10,132,833 | 24,015,490 | RR | 31 | 2137-10-28 10:56:00 | 2137-10-28 11:25:00 | CHEST RADIOGRAPH PERFORMED ON ___.
COMPARISON: None.
CLINICAL HISTORY: Diabetes, hyperlipidemia, hypertension with chest pain,
assess for edema or volume overload.
FINDINGS: PA and lateral views of the chest were obtained. The heart is
mildly enlarged. There is no sign of pulmonary edema or heart failure. No
pleural effusion. No pneumothorax. Mediastinal contour is unremarkable.
Bony structures are intact. No free air below the right hemidiaphragm.
IMPRESSION: Mild cardiomegaly without signs of acute decompensation.
|
10133075-RR-24 | 10,133,075 | 24,506,507 | RR | 24 | 2180-08-20 13:27:00 | 2180-08-20 14:51:00 | HISTORY: Pituitary adenoma status post CyberKnife now presenting with left
cheek pain and swelling. Rule out abscess.
TECHNIQUE: MDCT axial images were acquired through the facial bones after the
uneventful administration of 90 mL of Omnipaque. Coronal sagittal
reformations are provided and reviewed.
DLP: 740.1-mGy/cm.
CTDIvol 36.09 mGy.
COMPARISON: Pituitary MRI ___.
FINDINGS:
There is stranding seen within the soft tissues overlying the left anterior
masseter muscle. Although there is some artifact from the presence of the
dental amalgam, there is no fluid collection. There is no definite skin
thickening. The salivary glands appear normal. There is no cortical
disruption seen within the maxilla or mandible to suggest osteomyelitis.
However, there is circumferential mucosal thickening in the left maxillary
sinus, occluding its infundibulum. The roots ___ #16 extend into the left
maxillary sinus. Otherwise, no periapical lucencies are seen. There are no
enlarged lymph nodes.
There is a large nasal septal defect, and postsurgical changes in the sphenoid
and posterior ethmoid sinuses. Soft tissue contents of the sella are
suboptimally assessed.
Intracranial contents are grossly unremarkable, but this study is not
technically optimized for their evaluation.
IMPRESSION:
1. Soft tissue fat stranding overlying the left anterior masseter without a
fluid collection to indicate an abscess. This is compatible with cellulitis.
2. Mild left maxillary sinus mucosal thickening, without fluid to suggest
acute infection. The roots ___ #16 extend into the left maxillary sinus.
3. Postsurgical changes in the nasal cavity and sphenoid/ethmoid sinuses.
Soft tissue contents of the sella would be better assessed by MRI, if
indicated.
|
10133363-RR-10 | 10,133,363 | 24,023,873 | RR | 10 | 2113-01-08 13:44:00 | 2113-01-08 14:21:00 | EXAMINATION: Chest radiographs, AP and lateral views.
INDICATION: Shortness of breath and dyspnea on exertion.
COMPARISON: None.
FINDINGS:
Lung volumes are low. Heart is mild-to-moderately enlarged. Possible hiatal
hernia. Mediastinal contours are otherwise unremarkable, but noting very
limited technique. Pulmonary vasculature shows cephalization in addition to a
diffuse mild interstitial process suggesting pulmonary edema. Congestive
changes at each hilum. In addition, flat focal opacity along the posterior
mid chest, probably in the superior segment of the left lower lobe, could be
seen with atelectasis or potentially pneumonia. Nonspecific patchy opacities
at each lung base; particularly with low lung volumes, these are typical for
atelectasis although an infectious cause cannot be excluded.
IMPRESSION:
1. Findings consistent with mild interstitial pulmonary edema.
2. Patchy opacities at each lung base which are probably due to atelectasis
although an infectious cause cannot be excluded.
3. Focal posterior midlung opacity, compatible with atelectasis although
infection cannot be excluded.
|
10133363-RR-11 | 10,133,363 | 24,023,873 | RR | 11 | 2113-01-10 09:09:00 | 2113-01-10 11:12:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with worsening respiratory status, acute on
chronic CHF// Assess pulmonary edema, worsening respiratory status Assess
pulmonary edema, worsening respiratory status
IMPRESSION:
Comparison to ___. New right basal parenchymal opacity and new
opacity at the bases of the right upper lobe, highly suggestive for pneumonia.
This changes come in addition to underlying mild pulmonary edema, that has
slightly increased in severity. Mild interval increase of the pre-existing
retrocardiac atelectasis.
|
10133363-RR-12 | 10,133,363 | 24,023,873 | RR | 12 | 2113-01-11 09:38:00 | 2113-01-11 11:34:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure// clinical improvement
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Pulmonary edema has improved. Bilateral effusions right greater than left are
also unchanged. Cardiomediastinal silhouette is unchanged. No pneumothorax.
|
10133363-RR-13 | 10,133,363 | 24,023,873 | RR | 13 | 2113-01-11 12:40:00 | 2113-01-11 15:40:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with CHF exacerbation, hypox resp failure,
subacute right arm swelling.// ? DVT in RIGHT upper extremity
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The right basilic,
and cephalic veins are patent, compressible and show normal color flow.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10133363-RR-14 | 10,133,363 | 24,023,873 | RR | 14 | 2113-01-14 13:01:00 | 2113-01-14 14:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HFpEF exacerbation// eval for pulmonary
edema vs infection eval for pulmonary edema vs infection
IMPRESSION:
Comparison to ___. The current radiograph shows evidence of mild to
moderate pulmonary edema, accompanied by small bilateral pleural effusions
with subsequent areas of basal atelectasis. No pneumonia, no pneumothorax.
|
10133363-RR-15 | 10,133,363 | 24,023,873 | RR | 15 | 2113-01-26 13:26:00 | 2113-01-26 18:46:00 | EXAMINATION: Intraoperative ultrasound.
INDICATION: ___ year old woman with post-menopausal bleeding. Unable to
perform bedside EMB. Proceeding to OR for hysteroscopy and D C.//
intra-operative monitoring for hysteroscopy/D C
TECHNIQUE: Intraoperative ultrasound guidance within the pelvis.
COMPARISON: None.
FINDINGS:
Intraoperative ultrasound guidance was provided to Dr. ___
dilation and curettage.
25 images were obtained. Please see the operative notes for further details.
IMPRESSION:
Intraoperative ultrasound examination of the pelvis. Please see the operative
note for further details.
|
10133478-RR-73 | 10,133,478 | 20,755,810 | RR | 73 | 2181-04-07 08:43:00 | 2181-04-07 10:38:00 | INDICATION: Nausea, vomiting, and abdominal pain with elevated lipase.
Evaluate for gallstone pancreatitis.
COMPARISONS: CT of the abdomen from ___.
TECHNIQUE: Grayscale and Doppler ultrasound images were acquired through the
right upper quadrant.
FINDINGS: The liver is normal in shape and contour. The echogenicity is
normal. In the right lobe of the liver, there is an unchanged 2 cm simple
cyst. There may be a few poorly characterized isoechoic nodules within the
liver, though the sonographic technique and the available acoustic windows
limit their characterization. The previously identified metastases in the CT
from ___ are not definitely visualized, though this may be due to technique
rather than true resolution. The main portal vein is patent. There is no
intra- or extra-hepatic biliary duct dilation. The common bile duct measures
4 mm.
The gallbladder is normal without stones or sludge. There is no gallbladder
wall thickening or pericholecystic fluid. The imaged portions of the pancreas
are normal. The distal body and the tail are obscured by overlying bowel gas.
No fluid collection is identified. Limited views of the right kidney are
normal without hydronephrosis. There is no ascites on this limited right
upper quadrant ultrasound.
IMPRESSION:
1. No cholelithiasis or cholecystitis.
2. Evaluation of the hepatic parenchyma for suspected metastases is limited
by technique. The possibility of isoechoic nodules is difficult to exclude.
If evaluation of the patient's known hepatic metastases is clinicallly
indicated, a multiphase CT of the liver is recommended.
|
10133631-RR-21 | 10,133,631 | 20,514,903 | RR | 21 | 2148-05-06 01:26:00 | 2148-05-06 08:37:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with chest pain // eval for pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph on ___
FINDINGS:
Patient is status post CABG, with intact median sternotomy wires.There is an
opacity at the left lung base. There is mild vascular congestion. No pleural
effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
1. Left lower lobe pneumonia.
2. Mild pulmonary vascular congestion, with no overt pulmonary edema.
|
10133751-RR-10 | 10,133,751 | 22,697,228 | RR | 10 | 2111-12-30 01:29:00 | 2111-12-30 03:49:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: History: ___ with metatarsal fx, talus fx// Foot fracture
TECHNIQUE: Three views of the right foot.
COMPARISON: Right ankle radiographs dated ___.
FINDINGS:
Cast material obscures fine bony detail. There is acute transversely oriented
minimally displaced fracture at the base of the fifth metatarsal, which
extends to the intermetatarsal joint, compatible with ___ fracture with
overlying swelling. There is an additional 11 mm ossific fragment medial to
the talus, likely a deltoid ligament avulsion. No other fractures or
dislocations are visualized. Moderate Achilles enthesophyte. Tiny plantar
calcaneal enthesophyte. Mineralization is normal. There are no erosions.
IMPRESSION:
1. Minimally displaced fracture at the base of the fifth metatarsal extending
into the intertarsal joint, compatible with ___ fracture.
2. 11 mm ossified fragment medial to the talus, likely deltoid ligament
avulsion.
|
10133751-RR-11 | 10,133,751 | 22,697,228 | RR | 11 | 2111-12-30 03:18:00 | 2111-12-30 03:57:00 | EXAMINATION: Q61R
INDICATION: ___ year old man with open fx. please include the entire foot up
to mid shin thanks// fx
TECHNIQUE: ___ MD CT imaging was performed through the right ankle without
intravenous contrast. Coronal and sagittal reformats were produced and
reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 18.7 s, 39.8 cm; CTDIvol = 14.4 mGy (Body) DLP =
572.4 mGy-cm.
Total DLP (Body) = 572 mGy-cm.
COMPARISON: Right foot and right ankle radiographs obtained on the same date
FINDINGS:
There is a soft tissue defect seen overlying the lateral malleolus with
subcutaneous air tracking into the tibiotalar joint and the subtalar joint,
the sinus tarsus I and diffusely into the subcutaneous tissues about the
ankle.
There are multiple small ossific densities adjacent to the medial malleolus
consistent with a deltoid ligament avulsion injury. 2 larger bony fragments
are seen along the medial talus (2:187, 188).
There is mature ossification seen along the anterior aspect of distal fibula
at the expected site of attachment of the anterior tibiofibular ligament
consistent with remote injury.
The ankle mortise is congruent on these nonstress views.
No fracture of the talus or calcaneus. Incidental note is made of an os
trigonum and Achilles enthesophytes (2:212).
No fracture of the cuboid, navicular or cuneiform bones.
There is a mildly displaced transverse fracture the base of the fifth
metatarsal (400:38). No additional fracture seen.
There is a small bone island at the head of first metatarsal (2:270) and mild
degenerative changes at the first metatarsophalangeal joint.
Diffuse soft tissue edema around the ankle.
IMPRESSION:
1. Laceration overlying the lateral malleolus with the air extending through
the subcutaneous tissues and into the tibiotalar and subtalar joints.
2. Findings consistent with acute avulsion injury of the deltoid ligament with
multiple small bony fragments adjacent to the medial malleolus.
3. Minimally displaced fracture at the base of the fifth metatarsal.
|
10134173-RR-41 | 10,134,173 | 25,844,372 | RR | 41 | 2185-06-05 16:53:00 | 2185-06-05 20:56:00 | INDICATION: Possible fracture.
Three views of the left wrist are partially obscured by overlying cast. No
fracture is identified. There are severe degenerative changes of the first
CMC joint. No compariosn exams available
|
10134173-RR-42 | 10,134,173 | 25,844,372 | RR | 42 | 2185-06-05 20:01:00 | 2185-06-06 10:04:00 | INDICATION: Pain.
COMPARISON: Left hand radiographs on ___.
Four views of the scaphoid demonstrate severe degenerative changes of the
first CMC joint. The exam is otherwise normal. There is no fracture,
dislocation, or bone destruction.
|
10134485-RR-2 | 10,134,485 | 26,177,897 | RR | 2 | 2166-09-07 01:02:00 | 2166-09-07 02:53:00 | EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old woman with hx of L vertebral artery dissection now
with R vertebral dissection// Brain changes due to vertebral dissections
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Outside hospital CTA head of ___
FINDINGS:
There is no intra or extra-axial mass, acute infarct or intracranial
hemorrhage. The sulci, ventricles and cisterns are within expected limits for
the patient's age. There are 2 punctate FLAIR hyperintensities of the right
frontal lobe (series 10, image 13 and right postcentral gyrus (series 10,
image 18), nonspecific.
The major intracranial flow voids are preserved. There is mild mucosal
thickening of the ethmoid air cells. The orbits are unremarkable. Trace
fluid signal is seen the mastoid tips. There is no suspicious marrow signal.
IMPRESSION:
1. No acute infarct or intracranial hemorrhage.
2. There are 2 punctate FLAIR hyperintensities of the right frontal lobe and
right postcentral gyrus, nonspecific. These could represent slow flow through
venous vessels and likely artifactual. Differential consideration of sequela
of prior trauma, infectious/inflammatory etiology, chronic headache, or small
vessel ischemic disease are considered less likely. These are not in a
distribution compatible with demyelinating process.
3. Additional findings described above.
|
10134507-RR-55 | 10,134,507 | 22,862,516 | RR | 55 | 2149-04-08 10:28:00 | 2149-04-08 12:00:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with HCV cirrhosis // eval for ascites, portal
vein thrombosis, assess w/ dopplers for portal vein thrombosis
TECHNIQUE: Grey scale ultrasound images of the abdomen were obtained.
COMPARISON: Abdomen MRI ___
FINDINGS:
Note is made that this ultrasound study is somewhat limited due to the limited
sonographic window.
LIVER: The hepatic architecture is diffusely echogenic consistent with fatty
infiltration. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD is again noted
to be dilated measuring 1.3 cm.
GALLBLADDER: No gallstones are visualized.
PANCREAS: The pancreas and midline structures are obscured from view by
overlying bowel gas.
SPLEEN: The spleen is mildly enlarged measuring 12.9 cm.
KIDNEYS: No hydronephrosis is seen in the right kidney. The left kidney could
not be visualized..
RETROPERITONEUM: The aorta is obscured from view by bowel gas. The visualized
portion of the IVC is within normal limits.
IMPRESSION:
1. Echogenic liver consistent with fatty infiltration.
2. Mild splenomegaly
3. Patent portal vein.
4. No intrahepatic biliary dilatation. The extrahepatic common bile duct is
again noted to be enlarged measuring up to 1.3 cm.
|
10134507-RR-56 | 10,134,507 | 22,862,516 | RR | 56 | 2149-04-09 20:31:00 | 2149-04-10 09:36:00 | EXAMINATION: MRI of the abdomen.
INDICATION: ___ year old woman with HCV cirrhosis found to have a concerning
liver lesion on US // evaluate for HCC
TECHNIQUE: T1 and T2 weighted multiplanar images of the abdomen were acquired
within a 1.5 T magnet, including 3D dynamic sequences obtained prior to,
during, and following the administration of 12 cc of Gadavistintravenous
contrast.
COMPARISON: Ultrasound from ___ and MRI examination from ___.
FINDINGS:
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Included views of the lung bases are clear. There is no pericardial or pleural
effusion. The heart size is normal.
The hepatic parenchyma demonstrates normal signal intensity on T1 and T2
weighted sequences. Arising from segment VII and VIII are 5 mm and 4 mm
hepatic cyst or biliary hamartoma, denoted by very high internal signal
intensity on T2 weighted sequences without appreciable internal contrast
enhancement (series 5, image 10, 15). No concerning hepatic mass is detected.
Conventional hepatic arterial anatomy is demonstrated. The portal and hepatic
veins are patent.
There is no intra or extrahepatic bile duct dilation. The gallbladder is
normal. No ductal stones are detected. Prominence of the CBD is again noted,
measuring up to 8 mm (series 3, image 22), tapering smoothly to the ampulla,
without obstructing stone or mass.
The abdominal aorta, celiac trunk, SMA, and renal arteries are patent and
normal in caliber. A replaced right hepatic artery arises from the SMA (series
11, image 60).
The spleen, adrenal glands, kidneys, pancreas, stomach, and intra-abdominal
loops of small and large bowel are within normal limits. There is no
mesenteric or retroperitoneal lymphadenopathy, and no ascites.
There are no bony lesions concerning for malignancy or infection
IMPRESSION:
1. No concerning hepatic mass. Replaced right hepatic artery arising from the
SMA.
2. Unchanged, mildly prominent CBD, without obstructing stone or mass.
|
10134648-RR-10 | 10,134,648 | 25,921,585 | RR | 10 | 2181-11-26 15:22:00 | 2181-11-26 16:50:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with early stroke with PFO. Lower extremity DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: No priors.
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 tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10134648-RR-7 | 10,134,648 | 25,921,585 | RR | 7 | 2181-11-25 04:26:00 | 2181-11-25 11:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with L parietal infarct, eval for PNA// eval for PNA
eval for PNA
IMPRESSION:
Heart size and mediastinum are stable. Lungs are clear. There is no pleural
effusion. There is no pneumothorax.
|
10134648-RR-8 | 10,134,648 | 25,921,585 | RR | 8 | 2181-11-25 05:40:00 | 2181-11-25 07:04:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ year old man with left parietal infarct, concern for
dissection. Evaluate for dissection.
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 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 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 8.5 s, 0.5 cm; CTDIvol = 185.1 mGy (Head) DLP =
92.6 mGy-cm.
3) Spiral Acquisition 5.6 s, 44.2 cm; CTDIvol = 31.1 mGy (Head) DLP =
1,376.7 mGy-cm.
Total DLP (Head) = 2,272 mGy-cm.
COMPARISON: ___ head CT.
___ brain MRI.
___ brain MRA.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is an approximately 2.5 x 1.8 cm area of cytotoxic edema in the left
parietal lobe, corresponding to the acute infarction seen on the MRI from 1
day earlier. No evidence for ventricular effacement or shift of midline
structures. No acute hemorrhage.
There is a large mucous retention cyst in the left sphenoid sinus. There is a
large mucous retention cyst in the right maxillary sinus separated by a
septation, as well as foci of mucosal thickening plus/minus small mucous
retention cysts in the remaining right maxillary sinus. There is mild mucosal
thickening in the left maxillary sinus. There is a mucous retention cyst in
the right posterior ethmoid and opacification of a right posterior ethmoid air
cell. Mastoid air cells appear well-aerated.
CTA NECK:
There is a 3 vessel aortic arch. Bilateral common carotid, cervical internal
carotid, and vertebral arteries are widely patent without evidence for
dissection, atherosclerosis, or other abnormalities. Specifically, there is
no internal carotid stenosis by NASCET criteria.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear patent without evidence for flow-limiting stenosis or aneurysm. The
dural venous sinuses are patent.
OTHER:
No pathologically enlarged lymph nodes. The thyroid is unremarkable.
Included upper lungs are clear allowing for respiratory motion artifact. No
suspicious bone lesion is seen.
IMPRESSION:
1. Early subacute infarction in the left parietal lobe, similar to the MRI
from 1 day earlier. No acute hemorrhage. No significant mass effect.
2. Normal CTA of the head and neck without evidence for dissection.
3. Paranasal sinus disease.
|
10134648-RR-9 | 10,134,648 | 25,921,585 | RR | 9 | 2181-11-26 16:08:00 | 2181-11-26 19:11:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with stroke with PFO.// Please perform CTV pelvis
to rule out pelvic DVT
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.3 s, 51.7 cm; CTDIvol = 2.7 mGy (Body) DLP = 137.3
mGy-cm.
2) Spiral Acquisition 3.9 s, 51.7 cm; CTDIvol = 9.9 mGy (Body) DLP = 509.2
mGy-cm.
Total DLP (Body) = 647 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
Common femoral is patent. Bilateral external and internal, common iliac veins
are patent. IVC and renal veins, with no filling defects.
There is no abdominal aortic aneurysm. There is no calcium burden in the
abdominal aorta and great abdominal arteries.
LOWER CHEST: Unremarkable, without 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.
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 stones, focal renal lesions, or hydronephrosis. There
is no perinephric abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber and enhancement
throughout. Colon and rectum are within normal limits. Appendix is not
visualized. There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
No abnormal findings, specifically no evidence of deep vein thrombosis.
|
10134664-RR-44 | 10,134,664 | 28,886,120 | RR | 44 | 2163-01-14 10:00:00 | 2163-01-14 11:48:00 | EXAMINATION: CT of the abdomen and pelvis
INDICATION: ___ with abdominal pain, RUQ/LLQ ttp, and n/v/d.
TECHNIQUE: Multidetector CT through the abdomen pelvis performed following IV
contrast with multiplanar reformations. Dose: Total DLP (Body) = 841 mGy-cm.
COMPARISON: Prior CT from ___
FINDINGS:
LUNG BASES: Imaged lung bases are clear. The imaged portion of the heart is
unremarkable.
ABDOMEN: The liver enhances normally without concerning focal lesion. No
intrahepatic or extrahepatic biliary ductal dilation. The main portal vein is
patent. The gallbladder is normal. The pancreas enhances normally. The
spleen is normal in size. Adrenals are normal bilaterally. The kidneys
enhance symmetrically and there is no hydronephrosis or worrisome renal
lesion. The abdominal aorta is normal in course and caliber without
appreciable atherosclerotic calcification. No retroperitoneal adenopathy. No
free air or free fluid. The stomach and duodenum are normal.
PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The
appendix is dilated measuring up to 14 mm, containing mid luminal
appendicoliths, and there is mild periappendiceal fat stranding and trace free
fluid. No free air or drainable collection. The colon is unremarkable.
Findings are concerning for acute uncomplicated appendicitis. Fibroid uterus
noted. No adnexal mass. Urinary bladder is partially distended and appears
normal. No pelvic sidewall or inguinal adenopathy.
BONES: Unremarkable.
IMPRESSION:
1. Acute uncomplicated appendicitis.
2. Fibroid uterus.
|
10135398-RR-13 | 10,135,398 | 28,054,572 | RR | 13 | 2153-09-25 19:31:00 | 2153-09-25 20:03:00 | EXAMINATION: CT CHEST, ABDOMEN, AND PELVIS
INDICATION: Pedestrian struck by car.
TECHNIQUE: Multidetector CT through the chest, abdomen, and pelvis was
performed following IV contrast administration with multiplanar reformations
provided. Dose:
Total DLP (Body) = 1,670 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST: The thoracic aorta is tortuous though normal in caliber without
evidence of focal injury, dissection, or aneurysm. There is no mediastinal
hematoma. The airways centrally patent. The main pulmonary artery and
central branches appear patent. The heart is top normal in size. No pleural
or pericardial effusion is seen.
No worrisome nodule, mass, or consolidation. There is bibasilar atelectasis,
left greater than right. No signs of lung injury.
ABDOMEN: The liver is intact though appears mildly steatotic. The spleen is
intact and normal in size. Gallbladder, pancreas and adrenals are normal.
The kidneys enhance symmetrically without focal injury, hydronephrosis or
perinephric fluid. The abdominal aorta is normal in course and caliber with
widely patent major branches. There is no retroperitoneal hematoma or
lymphadenopathy. No free air or free fluid is seen.
The stomach and duodenum are normal.
PELVIS: Loops of small and large bowel demonstrate no signs of ileus or
obstruction. There is no evidence of mesenteric injury. The appendix is
normal. No free pelvic fluid. Mesh along the anterior pelvic wall noted.
BONES: No osseous injury. No worrisome bony lesions.
IMPRESSION:
No acute sequelae of trauma.
|
10135398-RR-14 | 10,135,398 | 28,054,572 | RR | 14 | 2153-09-25 23:20:00 | 2153-09-26 01:25:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: History: ___ ped struck, intoxicated // Trauma?
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right knee.
COMPARISON: None.
FINDINGS:
There is a moderate lipohemarthrosis. There is increased sclerosis in the
medial tibial plateau with slight contour deformity of the medial tibial
cortex most consistent with an impacted tibial plateau fracture. . There is
no suspicious lytic or sclerotic osseous lesion. No soft tissue calcification
or radiopaque foreign body is seen.
IMPRESSION:
Lipohemarthrosis with findings suspicious for an impacted medial tibial
plateau fracture.
|
10135398-RR-15 | 10,135,398 | 28,054,572 | RR | 15 | 2153-09-26 05:26:00 | 2153-09-26 06:11:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man s/p struck by car, + TBI. // ___ year old man s/p
struck by car, + TBI.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.7 cm; CTDIvol = 48.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 7.0 s, 14.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
702.4 mGy-cm.
3) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 1,706 mGy-cm.
COMPARISON: Noncontrast CT head from ___.
FINDINGS:
There is been interval increase in the subdural collection along the left
lateral convexity, with hypodense components concerning for acute interval
hemorrhage. The subdural collection measures 15 in maximum thickness
(previously 5 mm) and again extends along the left aspect of the falx and
likely along the left tentorium. There is mass effect upon the underlying
brain parenchyma with effacement of sulci and new rightward shift of normally
midline structures measuring 6 mm. Additionally, there is been interval
development of parenchymal hemorrhage in the bilateral frontal lobes. A small
amount of subarachnoid blood within the right marginal sulcus (05:22) is new.
Subdural blood previously seen only overlying the right temporal lobe now
extends superiorly along the right frontal and parietal lobes. There is no
evidence of infarct.
No fracture is identified. There is fluid layering within the bilateral
maxillary sinuses. Mucosal thickening is noted in anterior ethmoid air cells
in the frontoethmoidal recesses. The other visualized paranasal sinuses are
clear. There is a small amount of fluid layering in a posterior right mastoid
air cell. The other mastoid air cells and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Interval increase in the left subdural hematoma, now measuring 15 mm in
maximum thickness, previously 5 mm. Hypodense components are concerning for
active hemorrhage. New rightward shift of normally midline structures
measures 6 mm.
2. Interval development of parenchymal hemorrhage in the bilateral frontal
lobes.
3. New small amount of subarachnoid blood in the right marginal sulcus likely
due to redistribution.
4. Subdural blood previously seen only overlying the right temporal lobe now
extends superiorly along the right frontal and parietal lobes.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 6:03 AM, 5 minutes
after discovery of the findings.
|
10135398-RR-16 | 10,135,398 | 28,054,572 | RR | 16 | 2153-09-26 17:49:00 | 2153-09-26 18:53:00 | EXAMINATION: CT Knee
INDICATION: ___ year old man struck by vehicle, R knee swelling and pain, xray
with lipoma hemarthrosis is concerning for occult tibial plateau fracture,
although no discrete fracture line for defect is visualized. // Evaluate for
fracture
TECHNIQUE: Axial CT images of the right knee were obtained. Sagittal and
coronal images were reconstructed reviewed. Contrast is not administered.
DOSE: Acquisition sequence:
1) Spiral Acquisition 11.5 s, 24.5 cm; CTDIvol = 20.3 mGy (Body) DLP =
498.2 mGy-cm.
Total DLP (Body) = 498 mGy-cm.
COMPARISON: None
FINDINGS:
There is a knee joint effusion with layering blood products and fat within
knee joint.
There is complex fracture of the proximal tibia. There is horizontal fracture
of the medial tibial metaphysis, with hairline vertical component extending
into the articular surface sagittal image 52, axial image 95. Transverse
metaphyseal component of the fracture travels laterally across metaphysis, and
at the level of the lateral tibia there is vertical, mildly displaced fracture
that extends into the articular surface of the lateral tibial plateau, with
0.3 cm diastases at the level of the articular surface, and 0.2 cm of
depression, coronal image 40. Micro fracture planes extend into the anterior
tibial plateau.
Soft tissue swelling about the knee. No soft tissue mass.
Patella and femur show no fracture. Suprapatellar, infrapatellar tendon are
intact.
No lytic or blastic osseous lesion.
IMPRESSION:
1. Complex fracture of the proximal tibia, with involvement of the
metaphysis, and intraarticular extension in the medial, lateral tibial
plateau.
2. Lipohemarthrosis.
|
10135398-RR-17 | 10,135,398 | 28,054,572 | RR | 17 | 2153-09-26 17:48:00 | 2153-09-26 18:46:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man s/p Left craniotomy for evacuation of hematoma.
Post-operative head CT to rule out post-operative hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.5 cm; CTDIvol = 51.5 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: CT head with the same date.
FINDINGS:
The patient is status post left hemispheric craniotomy and evacuation of a
left subdural hematoma. There is a surgical drain with the tip overlying the
left temporal lobe. Expected postoperative changes include subcutaneous
emphysema and pneumocephalus overlying the left frontal and parietal lobes.
There is a hypodense left subdural fluid collection layering dependently and
measuring up to 7 mm in maximal dimension. There is also a small amount of
residual acute blood products within the left subdural space and layering
along the left falx. Small amount of acute subdural hemorrhage on the right,
also stable. Stable small areas of subarachnoid hemorrhage. Small
parenchymal hematoma along the inferior margin of the right mid temporal lobe
measures 0.6 cm, stable, with more prominent surrounding edema. Bifrontal
hemorrhagic contusions are similar. No evidence of new hemorrhage.
There is persistent mass effect on adjacent sulci, the frontal horn of the
left lateral ventricle, and left-to-right midline shift, which has improved,
currently measuring 4 mm. Left lateral ventricle is partially re-expanded. .
The basal cisterns are patent without evidence of herniation. No evidence of
acute infarction.
There is no evidence of fracture. Air-fluid levels are seen within the
maxillary sinuses bilaterally. There is complete opacification of the ___
and oropharynx, likely due to intubation. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. Status post left hemispheric craniotomy and evacuation of a left subdural
hematoma. Improved left-to-right midline shift.
2. Stable subarachnoid hemorrhage.
3. Hemorrhage contusion ends involving bilateral frontal lobes, and right
temporal lobe, 1 small focus is mildly more prominent since prior.
|
10135398-RR-19 | 10,135,398 | 28,054,572 | RR | 19 | 2153-09-26 21:00:00 | 2153-09-26 23:15:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with SDH // New OGT placement, please assess
placement
TECHNIQUE: Chest single view
COMPARISON: ___ 18:15
FINDINGS:
Endotracheal tube tip is 5 cm above carina. Enteric tube is seen to
gastroesophageal junction which is the extent of the film. Mild cardiac
enlargement, decreased since prior. No pulmonary edema. No pneumothorax.
Lungs are clear. Stable widening of right AC joint.
IMPRESSION:
Enteric tube is seen to the level of gastroesophageal junction, which is
inferior extent of the film.
|
10135398-RR-20 | 10,135,398 | 28,054,572 | RR | 20 | 2153-09-27 11:20:00 | 2153-09-27 12:09:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with L subdural hematoma from motor vehicle
accident, s/p emergent craniotomy for L subdural hematoma evacuation with
drain in place, evaluate for interval change // interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE:
Total DLP (Head) = 848 mGy-cm.
COMPARISON: CT head dated ___ and ___.
FINDINGS:
Patient is status post left hemispheric craniotomy and evacuation of left
subdural hematoma, with expected postoperative changes, including
pneumocephalus, which has decreased from prior. A surgical drain is in situ
overlying the left cerebral convexity. A heterogeneous, predominately
hyperdense, extra-axial collection remains overlying the left cerebral
convexity, measuring 9 mm in maximal thickness. There is persistent crowding
of subjacent sulci, without evidence of rightward shift of the midline
structures. The left lateral ventricle appears re-expanded. The basal
cisterns appear patent. There is a stable appearing small subdural hematoma
overlying the right frontal lobe, as well as stable extensive subarachnoid
hemorrhage and expected evolution of bifrontal and right temporal hemorrhagic
contusions. Redistribution of blood products is seen within the occipital
horns of the bilateral lateral ventricles. No new foci of hemorrhage are
identified. No evidence of acute infarct.
There is no evidence of fracture. Air-fluid levels are again seen within the
bilateral maxillary sinuses. Remaining visualized paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. Status post left hemispheric craniotomy and evacuation of left subdural
hematoma, with interval evolution of expected postoperative changes.
2. A heterogeneous, predominately hyperdense extra-axial collection remains
overlying the left cerebral convexity, with interval resolution of previously
seen midline shift and mass effect on the left lateral ventricle.
3. Stable small right frontal subdural hematoma, extensive subarachnoid
hemorrhage, and expected evolution of bifrontal and right temporal hemorrhagic
contusions.
4. No new foci of hemorrhage or evidence of acute infarct.
|
10135398-RR-21 | 10,135,398 | 28,054,572 | RR | 21 | 2153-09-28 08:09:00 | 2153-09-28 10:09:00 | EXAMINATION: DX SHOULDER AND HUMERUS
INDICATION: ___ year old man with SDH after being hit by a car as a pedestrian
with erythema and tenderness to RUE // assess for fracture
TECHNIQUE: Three views right shoulder, two views right humerus, images
obtained at the patient's bedside
COMPARISON: CT torso ___
FINDINGS:
There is widening of the acromioclavicular distance which may reflect
disruption of the acromioclavicular ligament. This could be clarified with
bilateral AC joint views with without weight-bearing. The coracoclavicular
distance is not increased. No fracture or dislocation seen. There are mild
degenerative changes of the glenohumeral joint. An IV cannula is noted in the
right antecubital fossa. Visualized portions of the right lung are grossly
clear.
IMPRESSION:
Widening of the right acromioclavicular joint may be an artifact related to
projection but could reflect disruption of the acromioclavicular ligament.
This could be clarified with bilateral AC joint views with and without
weight-bearing when the patient's clinical condition improves.
|
10135398-RR-22 | 10,135,398 | 28,054,572 | RR | 22 | 2153-09-28 08:09:00 | 2153-09-28 10:21:00 | EXAMINATION: ELBOW, AP AND LAT VIEWS RIGHT
INDICATION: ___ year old man with SDH after being hit by a car as a pedestrian
with erythema and tenderness to RUE // assess for fracture
TECHNIQUE: Two views right elbow obtained at the patient's bedside.
COMPARISON: None available.
FINDINGS:
No fracture, dislocation or degenerative change seen. No destructive lytic or
sclerotic bone lesions. No soft tissue calcification. 2 intravenous cannulas
are seen in the antecubital fossa. No joint effusion seen.
IMPRESSION:
Unremarkable right elbow radiographs.
|
10135398-RR-23 | 10,135,398 | 28,054,572 | RR | 23 | 2153-09-28 17:16:00 | 2153-09-28 17:57:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with ___ s/p crani and now subdural drain
removal. Evaluate for oval change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.5 cm; CTDIvol = 47.4 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 842 mGy-cm.
COMPARISON: CT head of ___.
FINDINGS:
Patient is post left craniotomy and evacuation of the previous subdural
hematoma, with expected postoperative changes. The amount of pneumocephalus
has slightly decreased. A previous surgical drain in situ overlying the left
cerebral convexity has been removed. There is a persistent hyperdense
extra-axial collection along the left cerebral convexity measuring up to 8 mm
in thickness, grossly unchanged however, there has been mild increase in the
amount of acute blood products along the posterior margin of subdural
hemorrhage overlying left parietal lobe,, possibly from redistribution. .
There is persisting crowding of the subjacent sulci, without evidence of
rightward shift of normally midline structures. The left lateral ventricle is
unchanged in configuration in appearance. Basal cisterns remain patent.
There is a stable small subdural acute hematoma overlying the right frontal,
parietal, temporal lobe, with stable subarachnoid hemorrhage. There are
stable bifrontal hemorrhage contusions. Right temporal hemorrhagic contusion
has mildly increased, measuring 0.9 cm, compared with 0.6 cm on prior. Small
amount of layering blood products in the occipital horns of both lateral
ventricles. No evidence of acute infarction.
There few punctate hyperdense foci in the upper pons, midbrain, may represent
foci of hemorrhage, not definitely seen on prior exams.
There is no evidence of fracture. Air-fluid levels are again seen in the
bilateral maxillary sinuses. There is mild thickening of the anterior
ethmoidal air cells. The visualized portion of the remaining paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Suggestion of few punctate hemorrhages in the upper brainstem, not
definitely seen on prior exams. Mildly enlarged right temporal lobe
parenchymal hemorrhage. Slightly more prominent subdural hematoma overlying
left frontal, parietal lobes, likely from redistribution.
2. Otherwise, there is no significant change in other areas of intracranial
hemorrhage. There is no hydrocephalus.
|
10135398-RR-24 | 10,135,398 | 28,054,572 | RR | 24 | 2153-10-01 01:28:00 | 2153-10-01 11:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SDH // assess placement of new NGT
assess placement of new NGT
IMPRESSION:
Compared to chest radiographs ___ and ___.
New Esophageal drainage tube ends in the mid stomach. Moderate cardiomegaly
has increased, and pulmonary vasculature is now engorged due to volume
overload or cardiac decompensation but there is no pulmonary edema. No
consolidation to suggest pneumonia. No pleural abnormality.
|
10135398-RR-25 | 10,135,398 | 28,054,572 | RR | 25 | 2153-10-01 02:37:00 | 2153-10-01 09:07:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with SDH with worsening neuro exam, not following
commands // assess for expanding hematoma or edema
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.5 cm; CTDIvol = 48.6 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 4.0 s, 4.1 cm; CTDIvol = 48.6 mGy (Head) DLP =
200.7 mGy-cm.
3) Sequenced Acquisition 4.0 s, 4.1 cm; CTDIvol = 48.6 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: Head CT ___.
FINDINGS:
Study is moderately degraded by motion. Patient is status post left
craniotomy with evacuation of a subdural hematoma with expected postoperative
changes.
Soft tissue swelling and air overlying the craniotomy site is unchanged
compared to the prior study.
There is a grossly stable hyperdense extra-axial collection along left
cerebral convexity measuring up to 7 mm.
There is no midline shift or effacement of the ventricles. The ventricles are
stable in size and configuration. The basal cisterns remain patent. The
amount of pneumocephalus has decreased.
Evolving bifrontal hemorrhagic contusions are again noted.
Right temporal hemorrhagic contusion is also unchanged.
Small right parietal probable subarachnoid hemorrhage versus hemorrhagic
contusion (02:22, 602b:41) is also unchanged.
Punctate hyperdense foci in the pons seen on the prior study is not
well-visualized on the current study. No definite new hemorrhage is noted.
There is mild mucosal thickening of bilateral maxillary sinuses and anterior
ethmoid air cells. The mastoid air cells and middle ear cavities are well
aerated.
IMPRESSION:
1. Study is moderately degraded by motion.
2. Status post left craniotomy and evacuation of a subdural hematoma with
expected postoperative changes.
3. Grossly stable left cerebral convexity 7 mm subdural hemorrhage.
4. Evolving bifrontal hemorrhagic contusions.
5. Grossly stable right parietal and temporal hemorrhages.
|
10135398-RR-26 | 10,135,398 | 28,054,572 | RR | 26 | 2153-10-02 04:45:00 | 2153-10-02 11:57:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SDH with tachypnea // tachypnic, febrile
r/o PNA tachypnic, febrile r/o PNA
IMPRESSION:
Compared to chest radiographs since ___ most recently ___ one.
Right PIC line ends in the upper right atrium within 2 cm of the estimated
location of the superior cavoatrial junction. Esophageal drainage tube passes
into the stomach and out of view.
Mild to moderate cardiomegaly and upper mediastinal widening due to tortuous
vessels and venous engorgement are stable but there is no pulmonary vascular
congestion or edema or appreciable pleural effusion. No pneumothorax.
|
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