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|---|---|---|---|---|---|---|---|
10135398-RR-27
| 10,135,398 | 28,054,572 |
RR
| 27 |
2153-10-01 15:56:00
|
2153-10-01 17:06:00
|
INDICATION: ___ year old man with SDH new PICC R arm // R arm PICC placed,
42cm; assess for correct placement Contact name: ___:
___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The tip of a new right PICC line projects over the cavoatrial junction. A
gastric tube projects below the level the diaphragms but beyond the field of
view of this radiograph.
Unchanged appearance of the cardiomediastinal silhouette and central pulmonary
vascular congestion. No pleural effusion or pneumothorax identified.
IMPRESSION:
The tip of the right PICC line projects over the cavoatrial junction. No
other significant interval change since the prior radiograph.
|
10135398-RR-28
| 10,135,398 | 28,054,572 |
RR
| 28 |
2153-10-05 08:44:00
|
2153-10-05 09:55:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new R PICC,recently patient removed R PICC
// 41 cm R brachial DL PICC - ___ ___ Contact name: ___:
___ cm R brachial DL PICC - ___ ___
IMPRESSION:
Right PICC line tip terminates at the level of lower SVC. Heart size and
mediastinum are stable. Lungs are clear. Cardiomegaly is most likely present
at the sequela to assess on this portable semi-erect radiograph.
|
10135398-RR-29
| 10,135,398 | 28,054,572 |
RR
| 29 |
2153-10-11 17:11:00
|
2153-10-11 17:56:00
|
EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old man with tib plateau fx // ___ w/ tib plateau fx
TECHNIQUE: Right knee two views
COMPARISON: CT ___
FINDINGS:
Healing transverse fracture through the tibial metaphysis, extending into the
lateral tibial plateau. There has been some sclerosis along the medial margin
of the tibial metaphysis since prior scan. More subtle fracture of the medial
corner femoral condyle, not extending into the articular surface. Small knee
joint effusion, decreased.
IMPRESSION:
Fractures of the distal femur, proximal tibia
Small knee effusion.
|
10135557-RR-16
| 10,135,557 | 26,612,112 |
RR
| 16 |
2141-03-25 17:20:00
|
2141-03-25 19:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with resp failure // eval for tube placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Distal aspect of the endotracheal tube is distal occult to assess, but likely
terminates approximately 4.3 cm above the carina. Enteric tube courses into
the lower chest, but is not well seen distally. Suggest repeat with the image
centered along the lower chest tp better assess position of enteric tube.
Patient is status post median sternotomy and CABG. Cardiac silhouette is
mildly enlarged. Mediastinum is slightly prominent which may relate to
pulmonary hypertension. There is moderate pulmonary edema. No large pleural
effusion is seen. There is no evidence of pneumothorax.
IMPRESSION:
Distal aspect of endotracheal tube difficult to accurately assess but likely
terminates approximately 4.3 cm above the carina.
Enteric tube courses into the lower chest is not well seen distally; suggest
repeat with image centered along the lower chest to better assess position of
the distal enteric tube.
Moderate pulmonary edema.
Slightly prominent mediastinum may relate to pulmonary hypertension.
|
10135557-RR-17
| 10,135,557 | 26,612,112 |
RR
| 17 |
2141-03-25 18:17:00
|
2141-03-25 19:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with new CVL in R IJ // IJ placement?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___ at 17:49
FINDINGS:
Interval placement of a right IJ central venous catheter terminates in the mid
to lower SVC without evidence of pneumothorax. Endotracheal tube terminates 5
cm above the carina. Enteric tube is not well seen beyond the midchest.
There is moderate pulmonary edema. The cardiac silhouette is mild to
moderately enlarged. Left base opacity may be due to atelectasis although
underlying consolidation is not excluded. No large pleural effusion is seen.
IMPRESSION:
Interval placement of right IJ central venous catheter terminates the mid to
lower SVC without evidence of pneumothorax.
Again, enteric tube not well seen be on the mid chest. Suggest repeat
centered more inferior to attempted better assess the distal aspect of the
enteric tube.
Left base opacity may be due to atelectasis although underlying consolidation
not excluded.
|
10135557-RR-18
| 10,135,557 | 26,612,112 |
RR
| 18 |
2141-03-26 04:58:00
|
2141-03-26 13:06:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxemic respiratory failure, septic shock
___ cholangitis, intubated. // Eval for interval change. Eval for
interval change.
COMPARISON: Comparison to ___ at 18:30
FINDINGS:
Portable supine chest radiograph ___ at 05:04 is submitted.
IMPRESSION:
Endotracheal tube and right internal jugular central line are unchanged. A
nasogastric tube is seen coursing below the diaphragm with the tip not
identified. Status post median sternotomy for CABG with stable cardiac and
mediastinal contours. Perihilar vascular congestion with resolution of
superimposed pulmonary edema. No pneumothorax, although the sensitivity to
detect pneumothorax is diminished given supine technique. No large effusions.
|
10135557-RR-21
| 10,135,557 | 26,612,112 |
RR
| 21 |
2141-03-26 09:29:00
|
2141-03-26 13:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cholangitis, intubated // eval et and og
placement eval et and og placement
COMPARISON: Comparison to ___ at 05:03
FINDINGS:
Portable chest radiograph centered at the epigastric region dated ___
at 09:33 is submitted.
IMPRESSION:
This demonstrates a nasogastric tube with the tip projecting over the proximal
stomach but the side port still remains within the distal esophagus.
Advancement of the tube 6-8 cm is recommended. Right internal jugular central
line and endotracheal tube unchanged in position. Status post median
sternotomy for CABG with stable cardiac mediastinal contours. Perihilar
vascular congestion with no overt pulmonary edema.
NOTIFICATION: Results were communicated to the patient's nurse, ___, by
phone on ___ at 13:07 at the time of discovery.
|
10135557-RR-22
| 10,135,557 | 26,612,112 |
RR
| 22 |
2141-03-27 12:39:00
|
2141-03-27 14:02:00
|
INDICATION: History of Cipro PD, admitted for cholangitis, with sepsis and
hypoxia poor breath sounds.
TECHNIQUE: Frontal chest radiograph.
COMPARISON: Radiograph from ___.
IMPRESSION:
The patient is post CABG. A right IJ central venous catheter terminates at
the mid SVC. The heart size is normal. The hilar and mediastinal contours
are within normal limits. There is no pneumothorax, focal consolidation, or
pleural effusion. The central pulmonary vessels are prominent, however, there
is no pulmonary edema.
|
10135907-RR-20
| 10,135,907 | 25,335,150 |
RR
| 20 |
2124-10-10 10:05:00
|
2124-10-10 10:49:00
|
INDICATION: ___ year old man with bil penetrating injuries// Foreign body
COMPARISON: None
FINDINGS:
AP and lateral views of both elbows.
Right elbow: An IV is noted in the antecubital fossa. No fracture or
dislocation. No signs of joint effusion. No radiopaque foreign body.
Left elbow: No fracture or dislocation. No signs of joint effusion. No
radiopaque foreign body.
IMPRESSION:
No radiopaque foreign body, fracture or signs of joint effusion at the elbows.
|
10135907-RR-21
| 10,135,907 | 25,335,150 |
RR
| 21 |
2124-10-10 10:06:00
|
2124-10-10 10:50:00
|
INDICATION: ___ year old man with bil penetrating injuries// Foreign body
COMPARISON: None
FINDINGS:
AP and lateral views of both wrists.
Right wrist: No fracture, dislocation, or radiopaque foreign body. Soft
tissue disruption is noted along the radial aspect of the distal forearm on
the AP view.
Left wrist: No fracture, dislocation, or radiopaque foreign body.
IMPRESSION:
No radiopaque foreign body within the bilateral wrists.
|
10135907-RR-22
| 10,135,907 | 25,335,150 |
RR
| 22 |
2124-10-11 10:05:00
|
2124-10-11 10:22:00
|
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA LEFT
INDICATION: ___ yo M s/p window/trauma to the ___ forearms, also with shoulder
pain, Left side.// r/o fracture to the left shoulder.
IMPRESSION:
No previous images. No evidence of fracture or dislocation. The AC and
glenohumeral joints are essentially within normal limits with no abnormal
calcification in soft tissues. No abnormal calcification in soft tissues.
There is a round opacification on one view, projected over the femoral head
and adjacent to the coracoid process, most likely of no clinical significance.
|
10136083-RR-14
| 10,136,083 | 22,928,285 |
RR
| 14 |
2161-01-14 21:13:00
|
2161-01-14 22:19:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: ___ year old woman with history of colostomy and osteomyelitis who
underwent biopsy/joint aspiration on ___ with reported collapse of the bone,
please evaluate C7-T1 facet joint, neural foramen after collapse during
biopsy/joint aspiration.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.0 s, 23.8 cm; CTDIvol = 32.5 mGy (Body) DLP = 773.1
mGy-cm.
Total DLP (Body) = 773 mGy-cm.
COMPARISON: CT cervical spine for outside facility dated ___.
FINDINGS:
The imaged cervical vertebral bodies are normally aligned. Vertebral body
heights are preserved. There is no evidence of fracture. There is no
prevertebral fluid. Irregularity and osteolysis is seen involving the right
C7-T1 facet joint (see series 2, image 46), not appreciably changed in
comparison to the outside hospital cervical spine CT from ___,
and consistent with stated history of osteomyelitis. The remaining portions
of the T1 and C7 vertebral bodies are intact and within normal limits. There
is mild surrounding inflammatory change including fat stranding centered on
this facet joint, minimally protruding into the right lateral aspect of the
spinal at this level, probably minimally displacing the thecal sac to the left
although this is not well seen, not appreciably changed from prior. No bony
neural foraminal narrowing is seen at this level.
There is no critical spinal canal or neural foraminal narrowing elsewhere.
Bilateral carotid bulb calcifications are mild-to-moderate. The thyroid gland
is without acute focal abnormality. There is no cervical or supraclavicular
lymphadenopathy. A right IJ central line is partially visualized to the level
of the SVC. The imaged aerodigestive tract is within normal limits. Aside
from moderate to severe emphysematous changes, the visualized portions of the
lung apices are grossly clear. Evidence of prior median sternotomy is noted.
IMPRESSION:
1. Irregularity and osteolysis centered on the right C7-T1 facet joint with
surrounding mild inflammatory change, minimally protruding into the right
lateral aspect of the spinal canal, stable in appearance in comparison to
prior outside hospital CT cervical spine dated ___, and
consistent with stated history. No bony neural foraminal narrowing. Note, CT
is not sensitive to detect and/or grade non-bony causes of neural foraminal
narrowing.
2. Moderate to severe biapical centrilobular emphysematous changes.
|
10136619-RR-54
| 10,136,619 | 29,900,232 |
RR
| 54 |
2140-11-10 09:52:00
|
2140-11-10 11:15:00
|
EXAMINATION: LUMBO-SACRAL SPINE (AP AND LAT)
INDICATION: Worsening back pain while on steroids. Evaluate for a compression
fracture.
TECHNIQUE: Frontal and lateral views of the lumbar spine.
COMPARISON: Lumbar spine MRI ___ and pelvic radiograph ___.
FINDINGS:
There are 5 non-rib-bearing lumbar type vertebra. The lumbosacral junction is
not well assessed due to overlying tissues. There is apparent mild loss in
the vertebral body height of L5 from ___. Retropulsion is difficult
to assess. The overall lumbar spine alignment is maintained. Moderate
multilevel degenerative changes are evidenced by endplate sclerosis,
osteophytosis and facet arthropathy.
Bilateral hip prostheses are incompletely evaluated. There is a calcified
aorta
IMPRESSION:
Mild loss in L5 vertebral body height from ___. Clinically correlate
regarding need for additional imaging.
|
10136619-RR-55
| 10,136,619 | 29,900,232 |
RR
| 55 |
2140-11-10 13:22:00
|
2140-11-10 15:31:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST
INDICATION: History: ___ with ___ day of L > R leg weakness and low back pain
// epidural abscess, unstable Lspine fx or other process
TECHNIQUE: Sagittal T1, T2 and sagittal STIR sequences were obtained through
the lumbar spine, axial T2 weighted images were also obtained.
COMPARISON: Prior MRI of the lumbar spine dated ___.
FINDINGS:
The alignment and configuration of the lumbar vertebral bodies appears
maintained and unchanged since the prior examination, the conus medullaris
terminates at the level of T12/L1 and is unremarkable.
At T12/L1 level, again there is disc desiccation with no evidence of neural
foraminal narrowing or spinal canal stenosis, mild unchanged articular joint
facet hypertrophy is present.
At L1/L2 level, there is disc desiccation and unchanged disc bulging, causing
mild bilateral neural foraminal narrowing, apparently contacting the
traversing nerve roots, moderate articular joint facet hypertrophy appears
unchanged. In comparison with the prior examination, there is crowding and
clumping of the nerve roots within the thecal sac (image 10, series 12).
At L2/L3 level, again there is disc desiccation and disc bulging, causing
bilateral neural foraminal narrowing and anterior thecal sac deformity,
bilateral articular joint facet hypertrophy and ligamentum flavum thickening
are unchanged, the degree of spinal canal narrowing appears relatively stable
with crowding of the nerve roots within the thecal sac.
At L3/L4 level, disc degenerative changes are seen, consistent with disc
desiccation and disc bulging, causing bilateral neural foraminal narrowing and
spinal canal narrowing, which appears slightly more severe in comparison with
the prior study. Unchanged bilateral articular joint facet hypertrophy.
At L4/L5 level, unchanged disc degenerative changes are present, consistent
with disc desiccation and disc bulging, causing bilateral neural foraminal
narrowing, more severe towards the left, associated articular joint facet
hypertrophy ligamentum flavum thickening remain unchanged.
At L5/S1 level, again shows a disc degenerative changes, disc bulging and
bilateral neural foraminal narrowing, contacting the traversing nerve roots,
unchanged articular joint facet hypertrophy and ligamentum flavum thickening.
The sacroiliac joints are unremarkable. Again there is atrophy of the psoas
muscles bilaterally, slightly more significant on the left. Note is made of
areas of T2 low signal in the expected location of the gallbladder, suggesting
gallstones (image 6, series 6, and image 5 series 6).
IMPRESSION:
1. Multilevel degenerative changes throughout the lumbar spine appear
relatively stable, however there is more crowding and clumping of the nerve
roots at L2 level, suggesting increased in the spinal canal narrowing at this
level.
2. Note is made of areas of T2 low signal in the expected location of the
gallbladder, suggesting gallstones (image 6, series 6, and image 5 series 6),
correlation with abdominal ultrasound is recommended if clinically warranted.
|
10136619-RR-57
| 10,136,619 | 29,900,232 |
RR
| 57 |
2140-11-11 11:11:00
|
2140-11-11 12:13:00
|
EXAMINATION: BILAT HIPS (AP,LAT AND AP PELVIS)
INDICATION: ___ year old woman with b/l hip groin pain s/p hip replacements
and revision // ? hip fracture, dislocation
TECHNIQUE: AP pelvis and two views of each hip.
COMPARISON: ___
FINDINGS:
There is a right hip arthroplasty which appears similar to previous, with
superior positioning of the acetabular prosthesis, unchanged. Small amount of
periprosthetic lucency at the acetabular cement osseous interface appears
stable from previous. The right femoral stem appears well-seated. Fragmented
cerclage wires at the right proximal femur are noted. These appear unchanged.
Left hip arthroplasty with cerclage wires at the femoral shaft stable in
appearance from previous. There may be slight contour deformity of the femoral
shaft just distal to the tip of the femoral stem.
Degenerative change in lower lumbar spine.
IMPRESSION:
1. Essentially unchanged appearance of bilateral hip arthroplasties.
2. Lateral projection of the left hip suggests slight contour deformity of the
proximal shaft at the tip of the femoral stem. Recommend repeat lateral view
to include the distal stem and remaining femoral shaft.
NOTIFICATION: #2 of the impression above was entered by Dr. ___ on
___ at 12:10 into the Department of Radiology critical communications
system for direct communication to the referring provider.
|
10136619-RR-58
| 10,136,619 | 29,900,232 |
RR
| 58 |
2140-11-11 18:21:00
|
2140-11-12 09:29:00
|
INDICATION: ___ year old woman with L groin pain s/p old hip replacement and
repair with question of slight contour deformity of the proximal shaft at the
tip of the femoral stem and recommended repeat lateral view to include the
distal stem and remaining femoral shaft. //
TECHNIQUE: Left femur, two views. Pelvis/hip radiographs from ___.
COMPARISON: Femur radiographs from ___.
FINDINGS:
There is slight irregularity along the anterior femoral cortex, just beyond
the distal tip of the prosthetic femoral stem, similar in appearance compared
to the radiograph performed earlier today, not significantly changed in
appearance dating back through ___. There is no acute fracture or
dislocation. The patient is status post total left hip arthroplasty, without
evidence of hardware complication. There is generalized osteopenia. There is
no left knee joint effusion.
IMPRESSION:
1. No acute fracture or dislocation. Mild deformity along the anterior mid
femoral cortex is long-standing, possibly related to remote trauma.
|
10136711-RR-17
| 10,136,711 | 27,096,616 |
RR
| 17 |
2157-12-14 08:04:00
|
2157-12-14 11:30:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old man with erysipelas vs. cellulitis b/l of lower
extremities, now ? septic joint in L knee // ? septic L knee joint
TECHNIQUE: Portable films.
COMPARISON: None.
FINDINGS:
There is a probable small joint effusion . No fracture or discrete lytic
lesion is identified. No gross degenerative changes.
IMPRESSION:
As above.
|
10136711-RR-18
| 10,136,711 | 20,017,382 |
RR
| 18 |
2160-11-19 00:42:00
|
2160-11-19 05:53:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: History: ___ with right foot pain// Evaluate for fracture
TECHNIQUE: Three views of the right foot.
COMPARISON: ___
FINDINGS:
No acute fractures or dislocation are seen. Degenerative changes at the first
MTP and IP joints are progressed from prior. Plantar calcaneal spur is noted.
Mineralization is decreased. Vascular calcifications are noted.
IMPRESSION:
No acute fracture. Progress severe degenerative change of the great toe MTP
joint and moderate degenerative change of the great toe IP joint.
|
10136711-RR-20
| 10,136,711 | 29,236,046 |
RR
| 20 |
2161-12-22 10:12:00
|
2161-12-22 11:28:00
|
EXAMINATION: VENOUS DUP UPPER EXT BILATERAL
INDICATION: ___ year old man with CKD needing mapping for future dialysis
access.// Pt. in need of future HD fistula. Please do bilat. upper extremity
vein mapping of both forearms and upper arms to assess vein patency for future
AV fistula. Please also assess central veins to r/o any central stenosis. We
need the depth of the veins measured as well. If possible, please also check
radial and brachial arteries for the presence of any calcifications. Please
comment on this. Pt. is coming to see the surgeon post mapping so kindly give
pt. a written report to bring to the surgeon.
FINDINGS:
RIGHT UPPER EXTREMITY:
Right Subclavian Vein: patient with normal venous waveform
Right Cephalic Vein
Location: Diameter / Depth /Patency
----------------------------------------------------------
Proximal upper arm 0.35 cm/.64Patent
Mid upper arm 0.31 cm/ .44/Patent
Distal upper arm .31/.46/Patent
Antecubital fossa 0.34 cm/ 0.46 cm/Patent
Proximal forearm 0.21 cm/ 0.48 cm/Patent
Mid forearm 0.17 cm/.48/Patent
Distal forearm 0.15 cm/0.36 cm/Patent
Right Basilic Vein
Location: Diameter / Depth / Patency
----------------------------------------------------------
Proximal upper arm 0.37 cm/1.54 cm/Patent
Mid upper arm 0.34 cm/0.72 cm/Patent
Distal upper arm 0.29 cm/0.58 cm/Patent
Antecubital fossa 0.28 cm/.40/Patent
Proximal forearm .___ cm/Patent
Mid forearm .___ cm/Patent
Right Brachial Artery
Diameter: 0.49 cm
Atherosclerotic Plaque/calcifications: None
Peak systolic velocity: 93 cm/sec
Waveform: triphasic
Right Radial Artery
Diameter: 0.28 cm
Atherosclerotic Plaque/Calcifications: Severe
Peak systolic velocity: 119 cm/sec
Waveform: triphasic
----------------------------------------------------------------------
LEFT UPPER EXTREMITY:
Left Subclavian Vein: patient with normal venous waveform
Left Cephalic Vein
Location: Diameter / Depth /Patency
----------------------------------------------------------
Proximal upper arm 0.35 cm/1.3/Patent
Mid upper arm 0.35 cm/.81/Patent
Distal upper arm 0.33 cm/0.49 cm/Patent
Antecubital fossa 0.45 cm/0.37 cm/Patent
Proximal forearm 0.17 cm/1.29 cm/Patent
Mid forearm 0.18 cm/0.54 cm/Patent
Distal forearm 0.17 cm/0.35 cm/Patent
Left Basilic Vein
Location: Diameter / Depth /Patency
----------------------------------------------------------
Proximal upper arm 0.25 cm/0.17 cm/Patent
Mid upper arm .___
Distal upper arm 0.3 cm/0.12 cm/Thickened walls
Antecubital fossa 0.27 cm/1.08 cm/Patent
Proximal forearm 0.13 cm/.17/Patent
Mid forearm 0.11 cm/0.22 cm/Patent
Left Brachial Artery
Diameter: 0.46 cm
Atherosclerotic Plaque/Calcifications: None
Peak systolic velocity: 123 cm/sec
Waveform: triphasic
Left Radial Artery
Diameter: 0.26 cm
Atherosclerotic Plaque/Calcifications: Severe
Peak systolic velocity: 90 cm/sec
Waveform: triphasic
IMPRESSION:
Mapping as above patent vasculature
|
10136711-RR-21
| 10,136,711 | 29,236,046 |
RR
| 21 |
2161-12-22 20:00:00
|
2161-12-22 20:32:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ with worsening renal failure// eval for obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Memory kidney dated ___. CT abdomen and pelvis dated ___. Liver gallbladder ultrasound dated ___.
FINDINGS:
There is no hydronephrosis, definite stones, or worrisome masses bilaterally.
Echogenic appearance of the renal cortex is concerning for chronic medical
renal disease. The right kidney measures 9.7 cm and the left kidney measures
12.3 cm.
The bladder is mostly decompressed.
IMPRESSION:
Echogenic appearance of the kidneys concerning for medical renal disease. No
hydronephrosis. Limited evaluation of the bladder given decompressed state.
|
10136711-RR-22
| 10,136,711 | 29,236,046 |
RR
| 22 |
2161-12-22 22:14:00
|
2161-12-22 22:41:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with infections workup// Eval for PNA
COMPARISON: Prior exam is dated ___
FINDINGS:
PA and lateral views of the chest provided. Low lung volumes. Lungs are
clear. There is no focal consolidation, effusion, or pneumothorax. There are
no signs of congestion or edema. The cardiomediastinal silhouette is normal.
Imaged osseous structures are intact. No free air below the right
hemidiaphragm is seen. Clips in the right upper quadrant noted.
IMPRESSION:
No acute intrathoracic process.
|
10136781-RR-10
| 10,136,781 | 26,967,395 |
RR
| 10 |
2162-09-26 09:14:00
|
2162-09-26 12:56:00
|
HISTORY: ___ man, with facial bone fracture. Assess for the
fractures.
COMPARISON: Limited comparison from CT head and CT C-spine on ___.
TECHNIQUE: Non-contrast MDCT images were acquired through the facial bones
per CT sinus/mandible/maxillofacial protocol. Multiplanar reformatted images
were obtained for evaluation.
FINDINGS: There is a minimally comminuted, transverse fracture of the right
mandibular ramus, with the superior fragment medially angulated toward to the
right TMJ. There is a corresponding minimally-displaced, oblique symphyseal
oblique fracture (image 2:111-114). The mandibular condyle remains in the
glenoid fossa, without gross TMJ dislocation; however, there are subtle
vertical lines along the articulation surface of the temporal bone (image
400B:17), could represent subtle temporal bone fractures. The right temporal
styloid process is fractured and minimally displaced (image 401B:22). There
is moderate soft tissue swelling and hemorrhage around the right mandibular
rami fracture.
The remaining facial bones are intact. In particular, the lamina papyracea,
cribriform plates, zygomatic arches are intact. There is no suspicious
air-fluid in the visualized paranasal sinuses. The mastoid air cells are
clear.
IMPRESSION:
1. Minimally-comminuted, transverse fracture at the right mandibular ramus.
The right mandibular condyle remains in the glenoid fossa. Equivocal right
temporal bone fractures at the right TMJ articulation surface. Moderate
adjacent soft tissue hematoma/swelling around the mandibular rami fracture
site.
2. Minimally-displaced, oblique mandibular symphyseal fracture.
3. Minimally displaced right temporal styloid process fracture.
|
10136781-RR-11
| 10,136,781 | 26,967,395 |
RR
| 11 |
2162-09-26 14:03:00
|
2162-09-26 16:23:00
|
INDICATION: Status post MVC. Evaluate for fracture.
COMPARISON: None.
THREE VIEWS RIGHT HAND: There is an obliquely oriented fracture through the
fourth metacarpal without intra-articular extension. An obliquely oriented
fracture also extends to the base of the second metacarpal, extending to the
carpometacarpal joint. The alignment is near anatomic. No additional
fractures are identified.
IMPRESSION: Essentially non-displaced fractures of the second and fourth
metacarpals.
Findings discussed with Dr. ___ on ___ at 3:50 p.m.
|
10136781-RR-12
| 10,136,781 | 26,967,395 |
RR
| 12 |
2162-09-26 16:12:00
|
2162-09-26 17:28:00
|
CHEST RADIOGRAPH.
INDICATION: Hemothorax, evaluation for chest tube position.
COMPARISON: ___, 6:20.
FINDINGS: As compared to the previous radiograph, the patient has received a
left-sided chest tube. The tube appears to be in correct position. At the
apex of the left hemithorax, a 3-4 cm apical pneumothorax is seen. The
pre-existing basal fluid collection has decreased in extent and the left basal
lung is better expanded than before.
No change in appearance of the right lung. Unchanged size of the cardiac
silhouette.
The referring physician, ___, was paged for notification at the time
of dictation, 4:54 p.m., on ___.
|
10136781-RR-13
| 10,136,781 | 26,967,395 |
RR
| 13 |
2162-09-26 17:02:00
|
2162-09-27 08:07:00
|
CHEST RADIOGRAPH
INDICATION: Status post chest tube re-adjustment, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the left-sided chest tube
has been slightly pulled back. The dimension of the known left pneumothorax
has minimally decreased. However, parenchymal opacities, likely to be
atelectatic, at the left lung base have slightly increased in severity. No
change in appearance of the right-sided lung.
|
10136781-RR-14
| 10,136,781 | 26,967,395 |
RR
| 14 |
2162-09-27 07:48:00
|
2162-09-27 08:33:00
|
AP CHEST, 7:45 A.M., ___
HISTORY: Question pneumothorax or hemothorax.
IMPRESSION: AP chest compared to ___, previous mild pulmonary edema
has resolved. The extent of consolidation in the left lung, presumably
pulmonary hemorrhage and atelectasis, has decreased slightly. There is no
appreciable left pleural effusion layering dependently. Mild thickening of
the left apical pleural margin is stable. The small apical component of
pneumothorax is decreasing. Right lung is grossly clear. Normal
cardiomediastinal silhouette except for leftward shift. Severe gaseous
distention of the stomach has improved. Left pleural tube ends deep in the
posterior sulcus medially.
|
10136781-RR-15
| 10,136,781 | 26,967,395 |
RR
| 15 |
2162-09-27 11:01:00
|
2162-09-27 12:42:00
|
STUDY: MANDIBLE SERIES INCLUDING ___.
CLINICAL HISTORY: Comparison is made to the CT mandible series from ___.
Compared to CT scan from ___.
There is again seen a fracture involving the mandibular symphysis extending
from the right to the left side going inferiorly. There is also a fracture
involving the mandibular condyle on the right, which is minimally displaced.
No dislocation of the temporomandibular joints. Overall, the findings are
similar to the CT scan performed yesterday.
|
10136781-RR-16
| 10,136,781 | 26,967,395 |
RR
| 16 |
2162-09-27 11:01:00
|
2162-09-27 12:30:00
|
LEFT SHOULDER, ___
CLINICAL HISTORY: A ___ man with trauma. Assess for injury.
FINDINGS: There is mild irregularity at the lateral aspect of the distal
clavicle on the external rotation view. However, there is no AC joint
widening. The CC interval is also preserved. No acute fractures or
dislocations are seen. The glenohumeral joint is within normal limits. The
visualized left lung apex is clear.
IMPRESSION: No fracture
|
10136781-RR-17
| 10,136,781 | 26,967,395 |
RR
| 17 |
2162-09-27 19:16:00
|
2162-09-28 08:58:00
|
CHEST RADIOGRAPH
INDICATION: Multiple left rib fractures with pulmonary contusion,
hemopneumothorax, status post chest tube. Evaluation for interval change.
COMPARISON: ___, 7:45 a.m.
FINDINGS: As compared to the previous radiograph, the position of the
left-sided chest tube is unchanged. Unchanged size of the cardiac silhouette.
Unchanged retrocardiac opacity, presumably atelectatic in genesis. On today's
image, the dimension of the pre-existing small left apical pneumothorax is
unchanged. Unchanged size of the cardiac silhouette. No newly appeared
parenchymal opacities.
|
10136781-RR-18
| 10,136,781 | 26,967,395 |
RR
| 18 |
2162-09-28 11:46:00
|
2162-09-28 15:36:00
|
HISTORY: Left hemopneumothorax and chest tube on waterseal.
FINDINGS: In comparison with the study of ___, with the chest tube on
waterseal, there appears to be some increase in the degree of pneumothorax on
the left. The distance from the apex of the lung to the lower margin of the
posterior first rib measures approximately 1.6 cm.
The degree of pulmonary vascular congestion has decreased since the prior
study. Atelectatic changes are again seen at the left base.
|
10136781-RR-19
| 10,136,781 | 26,967,395 |
RR
| 19 |
2162-09-29 11:48:00
|
2162-09-29 16:47:00
|
INDICATION: ___ male with hemothorax and left rib fractures status
post MVC.
COMPARISON: Semi-erect portable chest radiograph ___.
TECHNIQUE: AP supine radiograph portable.
FINDINGS: There is a left apical pneumothorax which is unchanged, remaining
1.6 cm in maximal span. There is stable left lower lobe atelectasis. Left
chest tube is seen in place. There is no pleural effusion. The
cardiomediastinal silhouette is stable and within normal limits.
IMPRESSION: Stable pneumothorax. Study essentially unchanged from prior.
|
10136781-RR-20
| 10,136,781 | 26,967,395 |
RR
| 20 |
2162-09-29 14:48:00
|
2162-09-30 09:01:00
|
AP CHEST 2:38 P.M. ON ___
HISTORY: ___ man after motor vehicle accident and left pneumothorax.
Left chest tube to waterseal.
IMPRESSION: AP chest compared to ___ through ___ at 11:56 a.m.:
Small left apical pneumothorax unchanged in size since ___ a.m., and no
appreciable left pleural effusion, basal pleural tubes still in place and
reportedly on waterseal. Greater coalescence of consolidation in both the
right mid and lower lung zones could be progressive atelectasis but is more
concerning for pneumonia. Consolidation in the left lower lobe, however, has
improved since ___ through ___. There is no right pleural
effusion or definite right pneumothorax. Cardiomediastinal silhouette is
normal. Distention of large and small bowel seen in the imaged portion of the
upper abdomen is unchanged.
|
10136781-RR-21
| 10,136,781 | 26,967,395 |
RR
| 21 |
2162-09-30 02:53:00
|
2162-09-30 09:02:00
|
AP CHEST 4:56 A.M. ___.
HISTORY: Hemopneumothorax. Chest tube to waterseal.
IMPRESSION: AP chest compared to ___, 2:38 p.m.:
Mild pulmonary edema has developed, partially obscuring areas of likely
pneumonia in the right mid and lower lung zones. Small left apical
pneumothorax is unchanged and pleural fluid accumulation on the left is
minimal if any, basal pleural tube still in place. Leftward mediastinal shift
reflects worsening of left lower lobe atelectasis. No definite right pleural
effusion or pneumothorax. Normal cardiomediastinal silhouette.
|
10136781-RR-22
| 10,136,781 | 26,967,395 |
RR
| 22 |
2162-10-01 15:59:00
|
2162-10-01 21:42:00
|
SINGLE FRONTAL VIEW OF THE CHEST.
REASON FOR EXAM: Assess for pneumothorax after chest tube removal.
Comparison is made with prior study ___.
A small-to-moderate left pneumothorax has increased. Cardiomediastinal
contours are stable. Left lower lobe atelectasis has improved. Mild
pulmonary edema is unchanged. Right perihilar consolidations are stable
consistent with pneumonia. If any, there is small left pleural effusion.
Finding of increasing pneumothorax was discussed with Dr. ___ by phone
on ___ at 5:30 p.m.
|
10136781-RR-24
| 10,136,781 | 26,967,395 |
RR
| 24 |
2162-10-01 20:44:00
|
2162-10-02 10:41:00
|
ABDOMEN ON ___
HISTORY: ___ man with nausea, evaluate for ileus.
IMPRESSION: Three frontal views of the abdomen and pelvis are submitted.
There is no notation as to patient position.
A loop of bowel traversing the upper abdomen just inferior to the mildly
distended stomach is probably the splenic flexure, and therefore only mildly
dilated. However, if, instead, it is a loop of small bowel it is
significantly distended. Since there is gas distributed throughout the
gastrointestinal tract, this would represent a region of local inflammation
rather than obstruction. There is no intra-abdominal mass effect or
indication of either substantial ascites or appreciable pneumoperitoneum.
|
10136781-RR-25
| 10,136,781 | 26,967,395 |
RR
| 25 |
2162-10-01 20:44:00
|
2162-10-02 09:56:00
|
AP CHEST, 8:34 P.M., ___
HISTORY: ___ man with pneumothorax.
IMPRESSION: AP chest compared to ___:
Small left apical pneumothorax, mild pulmonary edema, and right perihilar
pneumonia are all stable since earlier in the day. Heart size is normal.
|
10136781-RR-26
| 10,136,781 | 26,967,395 |
RR
| 26 |
2162-10-02 13:42:00
|
2162-10-02 17:47:00
|
RENAL ANGIOGRAM AND EMBOLIZATION
INDICATION: ___ man with left renal laceration and hematuria.
OPERATORS: Drs. ___ (fellow) and ___ (attending
physician). Dr. ___ was present throughout the procedure.
CONTRAST: Sterile 62 mL Omnipaque 350.
SEDATION: None given during the procedure. Patient received Dilaudid while
on the floor before the procedure.
PROCEDURE: Consent was obtained from the patient and his mom 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 palpatory and fluoroscopic guidance, a 19-gauge
needle was placed in the right common femoral artery at the level of mid
femoral head. A 0.035 ___ wire was advanced through the needle and into
the upper abdominal aorta. The needle was exchanged for a 5 ___ ___
sheath. After removing the inner cannula, the sidearm was aspirated and
flushed, and connected to a continuous heparinized saline flush. A 5 ___
C2 catheter was placed over the wire and within the sheath and advanced into
the upper abdominal aorta. After removing the wire, the catheter was placed
in the left main renal artery to perform an angiogram. A Renegade STC
catheter was then placed within the C2 catheter and over a Transcend
microwire, and advanced more selectively into the interlobar branch and
subsequently into smaller branches to perform multiple angiograms.
Micro-catheter tip was then placed appropriately to perform coil embolization
with two 2 mm x 1 cm coils sequentially. Post-embolization angiograms were
performed from interlobar artery via the microcatheter, and subsequently from
the left main renal artery via the C2 catheter (after removing the
microcatheter). The C2 catheter and subsequently right groin sheath were
removed. Firm pressure was applied at the arteriotomy site for about 20
minutes to achieve complete hemostasis. Site was appropriately dressed.
Patient tolerated the procedure well, and no immediate post-procedure
complication was seen.
FINDINGS:
1. Left main renal arteriogram demonstrated a large pseudoaneurysm arising
from a branch of interlobar branch.
2. More selective angiograms confirmed the pseudoaneurysm. In addition, the
most selective angiogram demonstrated a small amount of contrast flow, which
may represent an active extravasation or early draining vein related to AV
fistula formation.
3. Post-embolization arteriograms did not demonstrate the pseudoaneurysm. A
small wedge- shaped focus of renal perfusion defect was, however, seen in the
embolized territory.
IMPRESSION: Uncomplicated left renal angiogram and coil embolization from a
branch of intralobar artery with good angiographic results.
|
10136781-RR-27
| 10,136,781 | 26,967,395 |
RR
| 27 |
2162-10-07 10:41:00
|
2162-10-07 11:17:00
|
HISTORY: Fractures.
FINDINGS: In comparison with the study of ___, overlying cast obscures the
appearance of the nondisplaced fractures of the second and fourth metacarpals.
|
10136781-RR-6
| 10,136,781 | 26,967,395 |
RR
| 6 |
2162-09-26 00:04:00
|
2162-09-26 07:53:00
|
INDICATION: Evaluation of patient status post motor vehicle trauma.
COMPARISON: CT cervical spine and head from the same day at the same time.
TECHNIQUE: MDCT-acquired axial images were obtained from the thoracic inlet
to the pubic symphysis after uneventful administration of 130 mL of Omnipaque
nonionic intravenous contrast. Delayed images were obtained through the
abdomen and pelvis. Multiplanar reformatted images were prepared and
reviewed.
FINDINGS:
CT CHEST WITH IV CONTRAST: There is a moderate left pneumothorax, but no
right pneumothorax is visualized. Multiple parenchymal opacities are
visualized throughout the left lung and suggestive of hemorrhagic lung
contusions. Additionally, there is a small hemorrhagic left pleural effusion,
likely due to trauma from multiple adjacent rib fractures including left
third, fourth, sixth, seventh, eighth, ninth, tenth, and eleventh rib
fractures. Additionally, the hyperdense foci in the pleural effusion are
noted to change in morphology on delayed imaging and likely representative of
active extravasation.
The heart is normal in size and without pericardial effusion. There is no
hemo or pneumomediastinum. Opacification of the pulmonary vasculature
demonstrates no large central filling defect to suggest the large central PE.
Foci of air visualized surrounding the distal aorta (2:43, 46, 48, 53) and may
be representative of air tracking along the pleural surface though an
esophageal or duodenal etiology cannot be excluded. No hilar, mediastinal, or
axillary lymphadenopathy by CT size criteria.
CT OF THE ABDOMEN WITH IV CONTRAST:
A focal hypodensity is visualized extending from the left renal hilum all the
way to the left renal capsule and consistent with a Grade III left renal
laceration. There is no evidence of active extravasation, but a small left
perirenal hematoma is visualized. There is no evidence of definite vascular
injury at the renal hilum. However, a focal clot is visualized in the proximal
left ureter. The right kidney appears within normal limits.
Hypodensities are visualized throughout the spleen (2:45) and suggestive of
hemorrhagic contusions. Furthermore, there is relative ___ of the
small bowel (2:79) in the left lower quadrant which raises suspicion for
trauma to the bowel. Otherwise, the visualized portions of the liver,
gallbladder, and stomach are normal. There is a small amount of
hemoperitoneum noted in the pelvis (2:106). Additionally, there is tiny focus
of free air adjacent to the left kidney (2:61) which is likely from adjacent
rib fractures. No other foci of free air in the abdomen. The abdominal aorta
is normal in caliber. No mesenteric or retroperitoneal lymphadenopathy.
CT OF THE PELVIS WITH IV CONTRAST: A small amount of hemoperitoneum is noted.
Foley catheter is visualized and otherwise normal-appearing bladder. The
prostate and sigmoid colon appear normal. No pelvic or inguinal
lymphadenopathy. No free air throughout the pelvis.
OSSEOUS STRUCTURES: Multiple left-sided rib fractures are noted as described
above including left third, fourth, sixth, seventh, eighth, ninth, tenth, and
eleventh rib fractures. Additionally, there is a left sacral ala fracture
(2:94, 95), a left anterior acetabular wall fracture (2:108, 109), a left
superior pubic ramus fracture (2:116), and a left inferior pubic ramus
fracture (2:121).
IMPRESSION:
1. Extensive trauma to the chest includes multiple left-sided rib fractures,
small to moderate left pneumothorax, left lung contusions and possible
lacerations, and hemorrhagic left pleural effusion with evidence of active
extravasation.
2. Small foci of air surround the aorta and the subdiaphragmatic region and
are suggestive of either free air tracking along the pleural surface or injury
to the duodenum or esophagus. Continued followup is recommended.
3. Grade 3 left renal laceration. There is also evidence of a clot in the
left renal collecting system. Continued followup is recommended.
4. Hypodense foci throughout the spleen representative of grade 1 or 2
injuries consistent with contusions. Continued followup is recommended.
5. There is evidence of bowel wall thickening involving the small bowel in
the left lower quadrant along with a small amount of hemoperitoneum, which
raise suspicion for small bowel. Continued followup is recommended.
6. Multiple fractures including left third, fourth, sixth, seventh, eighth,
ninth, tenth, and eleventh ribs, left sacral ala, left anterior acetabular
wall, and left superior and inferior pubic rami fractures.
|
10136781-RR-7
| 10,136,781 | 26,967,395 |
RR
| 7 |
2162-09-26 00:05:00
|
2162-09-26 05:51:00
|
INDICATION: Evaluation of patient with history of motor vehicle collision.
COMPARISON: None available.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Multiplanar reformations were prepared.
FINDINGS:
Laceration involving the left ear is noted. There is however no large focus of
hemorrhage, large vessel territorial infarction, or shift of the normally
midline structures. No acute fractures are visualized.
Hyperdense foci along the right tentorium (2:18) are likely representative of
beam hardening artifact. However, a subtle subdural hematoma layering along
the right tetorium cannot be fully excluded. The visualized mastoid air cells
and paranasal sinuses are clear.
IMPRESSION:
1. Laceration involving the left ear is noted. There is, however, no
evidence of large intracranial hemorrhage or shift of the normally midline
structures.
2. Hyperdense foci along the right tentorium are likely representative of
beam hardening artifact. However, continued followup is recommended.
|
10136781-RR-8
| 10,136,781 | 26,967,395 |
RR
| 8 |
2162-09-26 00:05:00
|
2162-09-26 05:51:00
|
INDICATION: Evaluation of patient post motor vehicle trauma.
COMPARISON: CT head from the same day at 12:18 a.m.
TECHNIQUE: Contiguous axial images were obtained through the cervical spine
without intravenous contrast. Multiplanar reformatted images were prepared.
FINDINGS: There is no evidence of acute cervical spine fractures. Normal
alignment is maintained. No prevertebral soft tissue swelling. CT is not
able to provide intrathecal detail compared to MRI but the visualized outline
of the thecal sac is unremarkable. Left ear laceration is again noted. Partial
evaluation af a comminuted transverse fracture of the right mandibular ramus,
with the superior segment medially angulated, better depicted in the dedicated
maxillofacial CT.
IMPRESSION: No acute cervical spine fractures or abnormal alignment.
Comminuted transverse fracture of the right mandibular ramus, with the
superior segment medially angulated.
|
10136781-RR-9
| 10,136,781 | 26,967,395 |
RR
| 9 |
2162-09-26 06:30:00
|
2162-09-26 12:41:00
|
AP CHEST, 6:20 A.M., ___
HISTORY: ___ man motor vehicle accident. Assess hemopneumothorax.
IMPRESSION: AP chest compared to ___ at 11:48 p.m.
Cardiomediastinal silhouette has not changed in appearance over seven hours.
Mild edema has developed in the right lung. Consolidation in the left lung is
much more pronounced accompanied by at least a small if not larger left
pleural effusion, but no appreciable pneumothorax. Bleeding in the lung and
pleural space is likely. Multiple displaced left rib fractures, most marked
in the lower hemithorax in the proximal few centimeters of at least seven ribs
meaning that the patient is at risk for a posterior flail chest although that
is less often a problem than an anterior or lateral flail.
Dr ___ I discussed the findings and their clinical significance by
telephone at the time of dictation.
|
10136839-RR-18
| 10,136,839 | 29,401,107 |
RR
| 18 |
2175-05-06 20:07:00
|
2175-05-06 21:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever // eval for pneumonia
TECHNIQUE: AP upright portable views of the chest
COMPARISON: ___
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac and mediastinal silhouettes are unremarkable. Anterior left
costochondral calcification is seen in the mid to lower left hemi thorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10136839-RR-19
| 10,136,839 | 29,401,107 |
RR
| 19 |
2175-05-07 11:19:00
|
2175-05-07 16:59:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with acute leukemia with transaminitis // eval
for acute process
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
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. The CHD measures 0.2 cm
.
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, measuring 14.8 cm.
KIDNEYS: Right kidney measures 12.1 cm. Left kidney measures 13.5 cm. No
nephrolithiasis or hydronephrosis. Normal corticomedullary differentiation.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal abdominal ultrasound.
|
10136839-RR-20
| 10,136,839 | 29,401,107 |
RR
| 20 |
2175-05-07 19:29:00
|
2175-05-07 23:07:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with AML // s/p c v line ???position
?pneumo???Please call ___ with wet read. Thanks Contact name: ___,
___: ___ s/p c v line ???position ?pneumo???Please call ___ with
wet read. Thanks
IMPRESSION:
Right subclavian line tip is at the level of mid SVC. Heart size and
mediastinum are stable. Lungs are overall clear. There is no pleural
effusion or pneumothorax.
|
10136839-RR-21
| 10,136,839 | 29,401,107 |
RR
| 21 |
2175-05-16 16:08:00
|
2175-05-16 16:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new diagnosis of AML s/p induction
chemotherapy with new fever and neutropenia // eval for acute process
eval for acute process
IMPRESSION:
In comparison with the study ___, there is no change or evidence of
acute cardiopulmonary disease. No pneumonia, vascular congestion, or pleural
effusion. Right subclavian catheter tip again extends to the mid portion of
the SVC.
|
10136839-RR-22
| 10,136,839 | 29,401,107 |
RR
| 22 |
2175-05-18 09:55:00
|
2175-05-18 14:16:00
|
INDICATION: ___ year old man with new diagnosis of AML s/p induction chemo w/
febrile neutropenia despite broad spectrum abx, evaluate for acute process
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 6.9 s, 0.2 cm; CTDIvol = 117.7 mGy (Body) DLP =
23.5 mGy-cm.
3) Spiral Acquisition 7.4 s, 81.6 cm; CTDIvol = 7.0 mGy (Body) DLP = 566.4
mGy-cm.
Total DLP (Body) = 592 mGy-cm.
COMPARISON: None.
FINDINGS:
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: Spleen shows normal size and attenuation throughout. A focal
hypodensity laterally may represent a small splenic hemangioma, incompletely
characterized on the present study (4:68).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Multiple small hypodensities in the left kidney are too small to fully
characterize but likely represent simple cysts. There is no hydronephrosis.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Mild apparent
wall thickening of the distal descending and sigmoid colon is likely due to
underdistention. There is no surrounding fat stranding. The appendix is
normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild multilevel degenerative changes include grade 1 retrolisthesis of L5 on
S1.
SOFT TISSUES: There is a small fat containing umbilical hernia (4:85).
IMPRESSION:
No acute intra-abdominal process.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:00 ___, 25 minutes
after discovery of the findings.
|
10136839-RR-23
| 10,136,839 | 29,401,107 |
RR
| 23 |
2175-05-18 09:56:00
|
2175-05-18 14:21:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ male with new diagnosis of AML status post induction
chemotherapy with febrile neutropenia despite broad spectrum antibiotics,
evaluate for acute process.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
contiguous 5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and
parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 6.9 s, 0.2 cm; CTDIvol = 117.7 mGy (Body) DLP =
23.5 mGy-cm.
3) Spiral Acquisition 7.4 s, 81.6 cm; CTDIvol = 7.0 mGy (Body) DLP = 566.4
mGy-cm.
Total DLP (Body) = 592 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest radiographs dated ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber. A tunneled
right subclavian central line terminates in the low SVC.
PULMONARY PARENCHYMA: ___ airspace opacities in the right upper lobe
may represent aspiration or early infection (04:17). There is a 6 mm left
lower lobe pulmonary nodule (5:161). There is no emphysema.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is no pleural effusion. Left lower lobe rounded atelectasis is
noted (5:267).
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild.
IMPRESSION:
1. Right upper lobe ___ airspace opacities may represent aspiration or
early pneumonia.
2. 6 mm left lower lobe pulmonary nodule.
RECOMMENDATION(S): The ___ society pulmonary nodule recommendations
are intended as guidelines for follow-up and management of newly incidentally
detected pulmonary nodules smaller than 8 mm, in patients ___ years of age or
older. Low risk patients have minimal or absent history of smoking or other
known risk factors for primary lung neoplasm. High risk patients have a
history of smoking or other known risk factors for primary lung neoplasm.
In the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12
months and if no change, no further imaging needed. For high risk patients,
initial follow-up CT at ___ months and then at ___ months if no change.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:00 ___, 25 minutes
after discovery of the findings.
|
10136839-RR-24
| 10,136,839 | 29,401,107 |
RR
| 24 |
2175-05-18 10:28:00
|
2175-05-18 14:29:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man with AML, with left leg pain to rule out DVT,
evaluate for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
The left gastrocnemius vein is partially compressible with intraluminal
echogenic material and slow intermittent flow. There is normal augmentation
of this vein.
IMPRESSION:
Probable nonocclusive DVT in the left gastrocnemius vein. No other acute or
occlusive DVT identified.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:00 ___, 25 minutes
after discovery of the findings.
|
10136839-RR-25
| 10,136,839 | 29,401,107 |
RR
| 25 |
2175-05-22 12:55:00
|
2175-05-22 16:50:00
|
EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) LEFT
INDICATION: ___ year old man with recent diagnosis of AML s/p induction
chemotherapy w/ LLE pain and swelling found to have nonocclusive DVT on recent
US // eval for interval change in LLE DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: US from ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
The left gastrocnemius vein is compressible with evidence of slow intermittent
flow. No definite thrombus is seen.
IMPRESSION:
The left gastrocnemius vein is compressible with evidence of slow intermittent
flow. No definite thrombus is seen.
|
10137137-RR-13
| 10,137,137 | 20,750,480 |
RR
| 13 |
2191-02-13 12:52:00
|
2191-02-13 14:20:00
|
INDICATION: Hypoxia. Evaluate for pneumonia.
COMPARISONS: None.
FINDINGS: There is minor streaky opacification of the lung bases suggesting
minor atelectasis. No definite consolidation is present. There is no
pulmonary edema, pleural effusion or pneumothorax. A rounded dense 2.9 cm
lesion projects over the right mediastinal border and is consistent with a
relatively large but highly calcified mediastinal lymph node. The
cardiomediastinal silhouette is otherwise normal.
IMPRESSION:
1. Calcified mediastinal lymph node suggesting a prior granulomatous process.
2. Streaky right basilar opacity suggesting minor atelectasis.
|
10137137-RR-14
| 10,137,137 | 20,750,480 |
RR
| 14 |
2191-02-13 13:42:00
|
2191-02-13 16:05:00
|
INDICATION: ___ female with chest pain and hypoxia. Rule out PE.
COMPARISON: None.
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. Chest pain protocol was followed. 100 cc of Omnipaque IV contrast
was administered. Axial images were interpreted in conjunction with coronal
and sagittal reformats.
DLP: 249 mGy-cm:
CHEST: The thyroid is normal. Several mediastinal and hilar calcified lymph
nodes are present, measuring up to 1.7 cm in the right paratracheal station.
Otherwise, no axillary, supraclavicular, mediastinal, or hilar enlarged lymph
nodes.
Filling defects are present in the bilateral pulmonary arteries, compatible
with bilateral pulmonary emboli. Thrombus is seen in the right main pulmonary
artery extending into all right segmental branches. Thrombus is also seen in
the left upper and lower segmental branches. There is relative enlargement of
the right ventricle, indicating right heart strain. The main pulmonary artery
measures 3.3 cm, indicating mild pulmonary hypertension. Scattered aortic
vascular calcifications are present. There is no evidence of acute aortic
injury. The great vessels are otherwise unremarkable. The pericardium is
intact without effusion.
Bilateral peripheral parenchymal opacities are seen at the dependent portion
of the lung bases, most compatible with dependent atelectasis. A 1.4-cm right
middle lobe pulmonary nodule (3:40) is present, without prior studies for
comparison. No pleural effusion is present.
The liver contains a calcified 3-mm granuloma. The visualized upper abdominal
organs are otherwise unremarkable.
OSSEOUS STRUCTURES: Multilevel thoracic spine degenerative changes are
present with anterior osteophytosis and vacuum phenomenon in the lower
intravertebral thoracic space.
IMPRESSION:
1. Bilateral pulmonary emboli involving all pulmonary lobes with evidence of
right heart strain and mild pulmonary artery hypertension.
2. 1.4-cm right middle lobe pulmonary nodule or node. Further evaluation
with prior examinations or additional modalities may be obtained after
resolution of acute issues. Alternatively, follow-up CT in 3 months with IV
contrast may be obtained.
3. Peripheral parenchymal opacities at bilateral dependent lung bases, most
compatible with atelectasis.
4. Several calcified medistinal and hilar lymph nodes, likely prior
granulomatous disease.
Findings of pulmonary emboli were discussed by ___ via phone call with
Dr. ___ on ___ at 14:14 at the time of discovery of the
findings and regarding right heart strain and right middle lobe nodule via
phone with ___ at 1819.
|
10137146-RR-21
| 10,137,146 | 29,831,158 |
RR
| 21 |
2145-04-10 14:56:00
|
2145-04-10 20:08:00
|
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ PMH of Anxiety, Recently Diagnosed breast cancer (presumed
T3N0), admitted for severe hypercalcemia (likely hypercalcemia of malignancy),
assess for metastatic disease// ___ PMH of Anxiety, Recently Diagnosed breast
cancer (presumed T3N0), admitted for severe hypercalcemia (likely
hypercalcemia of malignancy), assess for metastatic disease
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 31.4 cm; CTDIvol = 8.9 mGy (Body) DLP = 273.7
mGy-cm.
2) Spiral Acquisition 3.2 s, 20.9 cm; CTDIvol = 11.7 mGy (Body) DLP = 237.4
mGy-cm.
3) Spiral Acquisition 1.8 s, 11.4 cm; CTDIvol = 12.6 mGy (Body) DLP = 135.7
mGy-cm.
4) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
5) Stationary Acquisition 15.6 s, 0.2 cm; CTDIvol = 265.6 mGy (Body) DLP =
53.1 mGy-cm.
6) Spiral Acquisition 9.7 s, 62.9 cm; CTDIvol = 11.0 mGy (Body) DLP = 686.4
mGy-cm.
7) Spiral Acquisition 5.1 s, 33.4 cm; CTDIvol = 11.4 mGy (Body) DLP = 372.3
mGy-cm.
Total DLP (Body) = 1,761 mGy-cm.
COMPARISON: Concurrently performed CT chest.
FINDINGS:
LOWER CHEST: Please refer to the separately dictated CT chest for full
description of the supradiaphragmatic findings.
ABDOMEN:
HEPATOBILIARY: There are innumerable conglomerate heterogeneous masses
throughout the entirety of the hepatic parenchyma concerning for metastatic
disease. The largest conglomerate hypodensity is located in the right hepatic
lobe measuring 11.1 x 12.0 cm in axial diameter (07:34). The main portal vein
and the anterior and posterior branches of the right portal vein are patent.
The left portal vein is not well visualized. The hepatic veins are not well
visualized. The intrahepatic IVC is attenuated but remains patent superiorly
and inferiorly (07:38). No definite evidence of intrahepatic biliary ductal
dilatation. There is mild gallbladder wall thickening, likely related to
underlying liver dysfunction. Perihepatic ascites is presumably malignant
(7:65).
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. A 7 mm
hypodensity in the right aspect of the spleen is too small to characterize
(07:38).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: A 15 mm indeterminate hypodensity is noted in the left upper pole
measuring 32 Hounsfield units and a 12 mm hypodensity in the left upper pole
measures 37 Hounsfield units (10:34, 37). A wedge-shaped opacity in the
interpolar region of the left kidney may represent risen sequelae of scarring
or a focus of infection (10:32). The right kidney is normal in appearance.
No hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. No small bowel obstruction.
The colon and rectum are unremarkable. The appendix is normal.
PELVIS: There is suggestion of circumferential wall thickening of the anterior
aspect of the bladder although a component of this may related to
underdistention. The distal ureters are normal. Small volume free fluid is
noted lying dependently within the pelvis.
REPRODUCTIVE ORGANS: There is a somewhat heterogeneous appearance of the
uterus. No adnexal abnormality identified.
LYMPH NODES: No intra-abdominal lymphadenopathy. There is a conspicuous 7 mm
periaortic node (7:61).
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There are numerous lytic osseous lesions throughout the abdomen and
pelvis. The largest of these is located in the posterior L5 vertebral body
measuring up to 15 mm in axial diameter (7:73). 15 mm lesion is also noted in
the posterior L2 vertebral body (07:57). Lytic lesions are noted in the
pelvic bones for example in the left iliac wing measuring 14 mm (7:78).
SOFT TISSUES: Small fat containing umbilical hernia.
IMPRESSION:
1. Extensive and confluent, peripherally enhancing hypodensities throughout
the liver are highly suspicious for metastatic disease. There is trace
perihepatic ascites.
2. The main portal vein and right portal vein branches are patent, however the
left portal vein is not definitively visualized. The hepatic veins are not
well seen. The intrahepatic IVC is markedly attenuated although it remains
patent superiorly and inferiorly.
3. Numerous lytic lesions throughout the lumbar spine and pelvic bones as
described above, highly suspicious for metastatic disease.
4. Indeterminate lesions in the upper pole of the left kidney as described
above. A wedge-shaped opacity in the interpolar region of the left kidney may
reflect sequelae of prior vascular insult or infection.
5. Small volume pelvic ascites may be physiologic in a patient of this age.
6. Gallbladder wall thickening likely related to underlying liver dysfunction.
7. Please refer to the separately dictated CT chest for full description of
the supradiaphragmatic findings.
|
10137146-RR-22
| 10,137,146 | 29,831,158 |
RR
| 22 |
2145-04-10 17:31:00
|
2145-04-10 19:36:00
|
EXAMINATION: CT CHEST WITH CONTRAST
INDICATION: ___ PMH of Anxiety, Recently Diagnosed breast cancer (presumed
T3N0), admitted for severe hypercalcemia (likely hypercalcemia of malignancy),
assess for metastatic disease// ___ PMH of Anxiety, Recently Diagnosed breast
cancer (presumed T3N0), admitted for severe hypercalcemia (likely
hypercalcemia of malignancy), assess for metastatic disease
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 axial maximal intensity
projection images were submitted to ___ and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 31.4 cm; CTDIvol = 8.9 mGy (Body) DLP = 273.7
mGy-cm.
2) Spiral Acquisition 3.2 s, 20.9 cm; CTDIvol = 11.7 mGy (Body) DLP = 237.4
mGy-cm.
3) Spiral Acquisition 1.8 s, 11.4 cm; CTDIvol = 12.6 mGy (Body) DLP = 135.7
mGy-cm.
4) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
5) Stationary Acquisition 15.6 s, 0.2 cm; CTDIvol = 265.6 mGy (Body) DLP =
53.1 mGy-cm.
6) Spiral Acquisition 9.7 s, 62.9 cm; CTDIvol = 11.0 mGy (Body) DLP = 686.4
mGy-cm.
7) Spiral Acquisition 5.1 s, 33.4 cm; CTDIvol = 11.4 mGy (Body) DLP = 372.3
mGy-cm.
Total DLP (Body) = 1,761 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W AND W/O CONTRAST, ADDL SECTIONS)
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: While the current exam is not tailored for such
evaluation the central pulmonary vasculature appears patent without evidence
of central pulmonary filling defect. The thoracic aorta is normal in caliber.
Heart, pericardium and great vessels are within normal limits. No pericardial
effusion.
AXILLA, HILA, AND MEDIASTINUM: No definite right axillary lymphadenopathy. A
largely fatty replaced right axillary node measures 9 mm in short axis (7:9).
A slightly rounded appearing left axillary lymph node measures 10 mm in short
axis (7:8). Right lower paratracheal lymph node measures 8 mm in short axis
(07:13). There is no mediastinal mass. No internal mammary nodes are
identified within limitation of the study.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is a 4 mm soft tissue pulmonary nodule in the left lower
lobe (08:139). Bibasilar atelectasis is noted. The central airways are
patent.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Please refer to the separately dictated report for the CT
abdomen/pelvis.
BONES: 10 mm lucent lesion in the posterior T3 vertebral body is worrisome for
metastatic disease in the provided clinical setting (07:10). A 5 mm lucent
lesion in the T8 vertebral body may also represent metastatic lesion (07:31).
A lucency in the left humeral head is present (7:2). There is cortical breach
along the right scapula in the region of the glenoid. There is cortical
destruction of the right posterior fourth rib and to a lesser extent multiple
additional ribs bilaterally.
OTHER: A larger irregular soft tissue mass is located in the right breast with
associated biopsy clips and soft tissue inflammatory change. This lesion is
seen to tether the right pectoralis major muscle (07:20).
IMPRESSION:
1. 4 mm pulmonary nodule in the left lower lobe.
2. Multiple lytic lesions seen throughout the thoracic skeleton are highly
suspicious for osseous metastases.
3. Large irregular soft tissue mass in the right breast with associated biopsy
clips and soft tissue inflammatory change. This mass is seen to tether the
right pectoralis major muscle.
4. Please refer to the separately dictated report for the CT abdomen/pelvis
for full description of the subdiaphragmatic findings.
|
10137553-RR-22
| 10,137,553 | 24,893,925 |
RR
| 22 |
2136-11-21 11:32:00
|
2136-11-21 13:09:00
|
HISTORY: COPD and acute anaphylactic reaction.
COMPARISON: Multiple prior chest radiographs, most recently ___.
FINDINGS:
Single frontal view of the chest. Heart size and cardiomediastinal contours
are stable. There is increased lucency of the upper right hemithorax, likely
representing severe panlobular emphysema. Retrocardiac atelectasis is similar
to prior. No new focal consolidation or pleural effusion.
IMPRESSION:
Upper right hemithorax hyperlucency consistent with severe panlobular
emphysema. Stable retrocardiac atelectasis.
|
10137890-RR-20
| 10,137,890 | 28,533,013 |
RR
| 20 |
2143-08-28 10:57:00
|
2143-08-28 14:40:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: ___ of MS, DM and ___ transferred from ___ s/p syncopal episode,
with history c/f vasovagal episode. No back pain, however new urinary
retention, poor rectal tone. Full ___ ___ strength b/l, ? spinal
mass/compression as cause// ___ of MS, DM and ___ transferred from ___ s/p
syncopal episode, with history c/f vasovagal episode. No back pain, however
new urinary retention, poor rectal tone. Full ___ ___ strength b/l, ? spinal
mass/compression as cause ___ of MS, DM and ___ transferred from ___ s/p
syncopal episode, with history c/f vasovagal episode. No back pain, however
new urinary retention, poor rectal tone. Full ___ ___ strength b/l, ? spinal
mass/compression as cause
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 8 mL of
Gadavist contrast agent.
COMPARISON: None.
FINDINGS:
Alignment is normal. Vertebral body and intervertebral disc signal intensity
appear normal. There is mild loss of height of the T12 through L3 vertebral
bodies, which appear chronic. The spinal cord appears normal in caliber and
configuration. There are mild multilevel degenerative changes of the lumbar
spine.
Mild disc bulge at the L3-4 level causes mild spinal canal narrowing and
narrowing of the neural foramina bilaterally.
Moderate disc bulge at the L4-5 level with associated ligamentum flavum
hypertrophy and facet osteophytes causes severe spinal canal narrowing. Facet
hypertrophy and disc bulge causes mild left and moderate right neural
foraminal narrowing.
At L5-S1, there are bilateral facet osteophytes but no spinal canal or neural
foraminal narrowing. There is no evidence of infection or neoplasm.
IMPRESSION:
1. Disc bulge and ligamentum flavum hypertrophy causing severe canal narrowing
at L4-L5.
2. Degenerative changes causing mild bilateral neural foraminal narrowing at
the L3-L4 and L4-L5 levels, which is severe at the right L4-L5 level.
|
10137916-RR-6
| 10,137,916 | 28,412,159 |
RR
| 6 |
2119-11-05 16:00:00
|
2119-11-05 18:12:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: History: ___ with tachycardia, prior DVT// eval DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10137916-RR-7
| 10,137,916 | 28,412,159 |
RR
| 7 |
2119-11-05 17:38:00
|
2119-11-05 18:25:00
|
INDICATION: ___ with tachycardia// eval for fluid overloard
TECHNIQUE: PA and lateral views the chest.
COMPARISON: None.
FINDINGS:
Lungs are clear. There is no consolidation, effusion, or edema.
Cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process. No edema.
|
10138440-RR-22
| 10,138,440 | 29,282,662 |
RR
| 22 |
2161-09-30 01:55:00
|
2161-09-30 02:11:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Status post fall with head strike and known T12 burst fracture.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm
CTDI: 54.21 mGy
COMPARISON: Noncontrast head CT ___, MR head ___.
FINDINGS:
Tiny chronic lacune in the left subinsular white matter. Previously
identified tiny left parietal meningioma is unchanged and is calcified. There
is no acute intracranial hemorrhage, acute infarction, new or large mass or
midline shift. There is no hydrocephalus. The ventricles and sulci are
prominent suggesting age-related involution, there is an unchanged left
temporal fossa arachnoid cyst (image 5, series 2). Confluent periventricular,
subcortical and deep white matter hypodensity is in a configuration most
suggestive of chronic small vessel ischemia. The basal cisterns are patent and
there is preservation of gray-white matter differentiation. The orbits are
unremarkable. Vertebrobasilar and carotid siphon calcifications are prominent.
Mucosal wall thickening in the right maxillary sinus is trace. The visualized
paranasal sinuses, middle ear cavities and mastoid air cells are otherwise
clear. There is no fracture.
IMPRESSION:
1. No acute intracranial abnormality.
2. Stable calcified tiny left parietal meningioma.
3. Chronic left subinsular white matter lacune.
|
10138440-RR-23
| 10,138,440 | 29,282,662 |
RR
| 23 |
2161-09-30 01:55:00
|
2161-09-30 02:16:00
|
EXAMINATION: Cervical spine CT without contrast
INDICATION: Status post fall with head strike and known T12 burst fracture.
TECHNIQUE: Axial helical multi detector CT images were acquired of the
cervical spine without contrast. Multiplanar reformats were generated in the
coronal and sagittal planes.
DOSE: DLP: 748.96 mGy-cm
CTDI vol: 36.81 mGy
COMPARISON: None.
FINDINGS:
Cervical vertebral body heights and alignment are well maintained without
evidence of fracture or malalignment. The prevertebral soft tissue is
unremarkable. Multilevel, multifactorial degenerative changes are focally
moderate at C5/C6 with small eccentric posterior osteophytes along with
suggestion of a large posterior disc bulge causing at least moderate canal
stenosis. The neural foramina are mildly narrowed at multiple levels secondary
to a combination of uncovertebral and facet arthropathy. Though CT resolution
of the thecal sac is limited, the contours appear preserved. The imaged lung
apices are clear. The thyroid is unremarkable.
IMPRESSION:
1. No cervical spine fracture or malalignment.
2. Focally moderate cervical degenerative changes at the level of C5-C6 with a
combination of small eccentric osteophytes and a large posterior disc bulge
causing at least moderate canal stenosis. If neurological symptoms are
present, further evaluation with MR can be considered, if amenable.
|
10138440-RR-24
| 10,138,440 | 29,282,662 |
RR
| 24 |
2161-09-30 15:43:00
|
2161-09-30 18:15:00
|
EXAMINATION: MR cervical, thoracic, lumbar spine.
INDICATION: ___ year old man with ___ weakness, found to have T12 burst
fracture, now urinary retention/decreased rectal tone. // Evaluate for cord
impingement
TECHNIQUE: MRI of the thoracic, and lumbar spine were obtained without
administration of intravenous contrast
COMPARISON: Prior CT scan of the thoracic and lumbar spine dated ___. Prior MRI of the lumbar spine dated ___.
FINDINGS:
Thoracic Spine: There is a fracture again noted through the superior endplate
of T12 with 3 mm retropulsion of posterior fracture fragment. This retropulsed
fracture fragment minimally narrows the spinal canal without causing cord
compression or abnormal cord signal. There is bone marrow edema within the
superior aspect of the T12 vertebral body. The thoracic spine has normal
curvature vertebral body height, bone marrow signal and alignment. There are
hemangiomas noted in the T9 and T8 vertebral bodies. The intervertebral disc
have normal height and signal intensities. There is a small central disc
protrusion at T7-T9 which is effacing the ventral CSF and slightly flattening
the ventral aspect of the cord. There is no neural foraminal narrowing. The
thoracic spinal cord and conus medullaris have normal morphology and signal
intensities. The posterior elements and paraspinal soft tissues are normal.
There are T2 hyperintense lesions in the kidneys bilaterally which most likely
represent renal cysts.
Lumbar spine: There is a fracture of the superior endplate of the T12
vertebral body as described above. The bone marrow signal is heterogeneous
likely due to focal fat. There is mild loss of normal intervertebral disc
signal from L2-L3 through L5-S1 without significant loss of intervertebral
disc height.
L1-L2: There is no disc herniation spinal canal stenosis or neural foraminal
narrowing. There is mild bilateral facet arthropathy.
L2-L3: There is no disc herniation or spinal canal stenosis or neural
foraminal narrowing. There is more mild facet arthropathy bilaterally with
fluid in the facet joints right greater than left.
L3-L4: There is a new central disc herniation which is migrating superiorly
posterior to the L3 vertebral body. Disc material combined with bilateral
facet arthropathy results in narrowing of the bilateral subarticular zones
with possible compression of the bilateral traversing L4 nerve roots. There is
also thickening of the ligamentum flavum at this level. There is mild spinal
canal narrowing and mild right greater than left neural foraminal narrowing.
L4-L5: There is disc bulge with an annular fissure. There is bilateral facet
arthropathy and ligamentum flavum infolding. There is resulting mild spinal
canal narrowing and narrowing of the bilateral subarticular zones. There is
severe left and moderate to severe right neural foraminal stenosis.
L5-S1: There is disc bulge and bilateral facet arthropathy. There is no
significant spinal canal narrowing. There is mild bilateral neural foraminal
stenosis.
The conus medullaris and cauda equina have normal signal intensity. The conus
medullaris terminates at L1-L2 level. There is a rounded 3.5 mm lesion seen
in the thecal sac at the level of the L3 vertebral body (image 10, series 9).
This finding is unchanged compared to prior study dated ___.
The posterior elements and paraspinal soft tissues are normal.
IMPRESSION:
1. Acute fracture through superior endplate of the T12 vertebral body with 3
mm of retropulsion of a posterior fracture fragment. There is minimal spinal
canal narrowing without cord compression or abnormal cord signal.
2. Multilevel degenerative changes in the lumbar spine as detailed above.
There is a new small disc herniation at L3-L4. Other findings have not
significantly changed compared to prior study.
3. 3.5 mm rounded lesion within the thecal sac at the level of the L3
vertebral body. This finding is stable dated back to ___. Followup
MRI with intravenous contrast could be performed if clinically indicated.
|
10138440-RR-25
| 10,138,440 | 29,282,662 |
RR
| 25 |
2161-10-01 19:00:00
|
2161-10-01 19:39:00
|
EXAMINATION: Renal ultrasound.
INDICATION: Acute on chronic kidney injury and urinary retention. Rule out
hydro.
TECHNIQUE: Grey scale and Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None available.
FINDINGS:
The right kidney measures 14.6 cm.
The left kidney measures 12.6 cm.
There is no hydronephrosis, stones or masses bilaterally. Renal echogenicity
and corticomedullary architecture is within normal limits. There is a 2.8 x
1.8 x 1.6 cm simple renal cyst in the upper pole of the right kidney.
The urinary bladder is well distended and normal. The prostate is not clearly
visualized, seen only on sagittal view.
IMPRESSION:
1. No hydronephrosis.
2. 2.8 cm right upper pole renal cyst.
|
10138440-RR-28
| 10,138,440 | 24,744,029 |
RR
| 28 |
2162-11-16 20:05:00
|
2162-11-16 21:07:00
|
INDICATION: ___ with right foot ___ need OR. Pre-op. // acute
process?
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Right PICC tip projects over the mid SVC. Low lung volumes are noted. The
lungs are clear without focal consolidation or large effusion.
Cardiomediastinal silhouette is enlarged, stable. Degenerative changes are
seen at the shoulders. Surgical clips are in the right upper quadrant.
IMPRESSION:
No acute cardiopulmonary process.
|
10138440-RR-29
| 10,138,440 | 24,744,029 |
RR
| 29 |
2162-11-16 20:05:00
|
2162-11-16 23:09:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ with right foot ulceration // osteo?
TECHNIQUE: Three views right foot
COMPARISON: Multiple views of the right foot dated ___, MRI right
foot dated ___
FINDINGS:
Soft tissue swelling is seen surrounding the first cuneiform. Again noted is
progressive deformity of the midfoot. The cortical margins of the first
cuneiform and the first metatarsal base have become progressively more
indistinct since the prior examination. Again noted is diffuse
demineralization of the bones and moderate plantar calcaneal spur. Small
vessel atherosclerotic calcifications are also noted.
IMPRESSION:
Progressive deformity of the first cuneiform bone, with prior MRI findings
consistent with septic arthritis and osteomyelitis.
|
10138440-RR-30
| 10,138,440 | 24,744,029 |
RR
| 30 |
2162-11-17 14:43:00
|
2162-11-17 15:21:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old man s/p R foot debridement // s/p R foot debridement
s/p R foot debridement
IMPRESSION:
As compared to the previous study there is decrease E soft tissue swelling
surrounding the first 44. Hardware is in expected position. Cortical margins
of the first cuneiform and the first metatarsal are indistinct unchanged since
previous examination. Demineralization is unchanged.
|
10138440-RR-31
| 10,138,440 | 24,744,029 |
RR
| 31 |
2162-11-19 10:28:00
|
2162-11-19 13:00:00
|
INDICATION: ___ year old man with worsening ulceration to R foot // please
include toe pressures
TECHNIQUE: Non-invasive evaluation of the arterial system in the lower
extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
COMPARISON: ___, vascular ultrasound.
FINDINGS:
On the right side, a triphasic Doppler waveform is seen in the right
superficial femoral artery. Monophasic waveforms are seen in the popliteal,
posterior tibial and dorsalis pedis arteries.
The right Toe brachial index was 0.14.
On the left side, a triphasic Doppler waveform is seen in the left superficial
femoral artery. Monophasic waveforms are seen in the popliteal, posterior
tibial and dorsalis pedis arteries.
The left Toe brachial index was 0.41.
Pulse volume recordings demonstrate mild dampening at the left calf and left
ankle, and severed dampening at the right forefoot.
IMPRESSION:
Severe bilateral SFA and tibial disease.
|
10138440-RR-32
| 10,138,440 | 24,744,029 |
RR
| 32 |
2162-11-19 09:45:00
|
2162-11-19 12:48:00
|
EXAMINATION: UPPER EXTREMITY VENOUS MAPPING
INDICATION: ___ year old man with PAD and potential need for bypass // Pls
perform b/l upper and lower extremity vein mapping for bypass planning
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, basilic veins and subclavian veins was performed.
COMPARISON: None available.
FINDINGS:
The bilateral subclavian veins demonstrate normal phasicity.
RIGHT:
The cephalic vein measures 0.4 cm at the wrist, 0.43 cm at the distal forearm,
0.46 cm at the mid forearm, 0.42 cm at the proximal forearm, 0.39 cm at the
distal arm, 0.52 cm at the mid arm and 0.51 cm at the proximal arm. The
basilic vein measures 0.16 cm at the forearm, 0.12 cm at the antecubital
fossa, 0.61 cm at its mid portion, and 0.51 cm at the proximal portion. The
right radial artery measures 0.24 cm with normal waveform.
LEFT:
The cephalic vein measures 0.41 cm at the wrist, 0.41 cm at the distal
forearm, 0.33 cm at the mid forearm, 0.37 cm at the proximal forearm, 0.41 cm
at the distal arm, 0.55 cm at the mid arm and 0.59 cm at the upper arm. The
basilic vein measures 0.39 cm at the forearm, 0.6 cm at its mid portion, and
0.79 cm at the proximal portion.
Additional measurements are available on PACs.
IMPRESSION:
Patent basilic and cephalic veins bilaterally, with measurements as above.
|
10138440-RR-33
| 10,138,440 | 24,744,029 |
RR
| 33 |
2162-11-19 09:45:00
|
2162-11-19 12:41:00
|
INDICATION: ___ year old man with PAD and potential need for bypass // Pls
perform b/l upper and lower extremity vein mapping for bypass planning
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of bilateral
saphenous veins was performed.
COMPARISON: None available.
FINDINGS:
RIGHT:
The great saphenous vein is patent. Vein diameters are as follows:
Proximal: 9.6 mm
Mid thigh: 5.1 mm
Distal thigh: 4.9 mm
Popliteal fossa: 4.3 mm
Mid calf: 3.8 mm
Distal calf: 4 mm
The small saphenous vein is patent. Vein diameters are as follows:
Proximal: 2.6 mm
Mid: 2.2 mm
Distal: 1.6 mm
Subcutaneous edema is noted in the calf and ankle.
LEFT:
The great saphenous vein is patent. Vein diameters are as follows:
Proximal: 8.8 mm
Mid thigh: 4.6 mm report
Distal thigh: 5.2 mm
Proximal calf: 4.6 mm
Mid calf: 3.0 mm
Distal calf: 2.7 mm
The small saphenous vein is patent. Vein diameters are as follows:
Proximal: 3.5 mm
Mid: 2.2 mm
Distal: 1.9 mm
Subcutaneous edema is noted in the calf.
IMPRESSION:
Patent bilateral great and small saphenous veins
Bilateral calf edema.
|
10138762-RR-31
| 10,138,762 | 24,312,685 |
RR
| 31 |
2138-05-20 11:37:00
|
2138-05-20 14:46:00
|
EXAMINATION:
DX ANKLE AND FOOT
INDICATION:
___ w/twisting injury to ankle with significant swelling and pain, please eval
for fracture // ___ w/twisting injury to ankle with significant swelling and
pain, please eval for fracture
TECHNIQUE: Ankle three views
COMPARISON: None
IMPRESSION:
There is a comminuted distal tibial fracture that involves the ankle mortise.
The distal tibia it is anteriorly displaced off the talus. There is a
fracture of the medial malleolus as well. There is associated soft tissue
swelling.
NOTIFICATION: This finding was immediately called to the emergency room at
the time of dictating the report by Dr. ___ and was discussed with
Dr. ___ who already knew of the finding
|
10138762-RR-32
| 10,138,762 | 24,312,685 |
RR
| 32 |
2138-05-20 14:40:00
|
2138-05-20 15:54:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ w/trimalleolar fracture, s/p reduction, please eval for
adequacy of reduction
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right ankle.
COMPARISON: Radiograph from ___ at 11:45.
FINDINGS:
Patient is status post closed reduction of the known trimalleolar ankle
fracture. Fine detail is obscured by overlying cast material. However, there
is persistent posterior dislocation of the talus with respect to the distal
tibia.
IMPRESSION:
Status post close reduction and cast placement of trimalleolar ankle fracture.
Persistent posterior dislocation of the talus.
|
10138762-RR-33
| 10,138,762 | 24,312,685 |
RR
| 33 |
2138-05-20 16:45:00
|
2138-05-20 17:24:00
|
INDICATION: ___ w/trimalleolar fracture, s/p reduction, please eval for
adequacy of reduction (for second time)
COMPARISON: Prior study performed earlier today.
FINDINGS:
AP, lateral, obliques views of the right ankle provided post reduction. There
is improved alignment of the tibiotalar joint post reduction. Otherwise no
change.
IMPRESSION:
As above.
|
10138762-RR-34
| 10,138,762 | 24,312,685 |
RR
| 34 |
2138-05-21 00:49:00
|
2138-05-21 10:20:00
|
EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ year old woman with R ankle fx going for OR // Pre-op
evaluation Surg: ___ (ORIF R ankle)
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
the heart is upper limits in size but is similar compared to the prior study.
there is a subtle area of increased opacity adjacent to the left heart the
could be a fat pad or could be an early infiltrate. attention should be paid
to this area on follow-up. the aorta is mildly unfolded.
IMPRESSION:
QUESTIONED SMALL LEFT LOWER LOBE INFILTRATE. RECOMMEND FOLLOW-UP.
|
10138762-RR-35
| 10,138,762 | 24,312,685 |
RR
| 35 |
2138-05-21 11:18:00
|
2138-05-22 15:51:00
|
INDICATION: ___ year old woman with trimal fx // Further characterization of
fracture for surgical planning
TECHNIQUE: Multi detector CT axial images were acquired from distal tibia to
forefoot without contrast. Bone and soft tissue algorithm and multi planar
reformations were obtained and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.7 s, 20.5 cm; CTDIvol = 14.3 mGy (Body) DLP = 292.8
mGy-cm.
Total DLP (Body) = 293 mGy-cm.
COMPARISON: Radiographs from ___ and ___.
FINDINGS:
There is comminuted, mildly displaced trimalleolar fracture. There is a
slightly oblique, minimally displaced fracture of the medial malleolus. There
a is comminuted fracture of the posterior malleolus with 4 mm superior
displacement of the fracture fragment. There is an oblique fracture with 5 mm
posterior superior overriding of the distal fibula. There is mild posterior
translation of the talus with respect to the distal tibia. The displacement
of the fracture fragment and translation of the talus result in mild
disruption of the mortise.
There is no fracture of the talar dome. There are no loose bodies within the
ankle joint.
Limited assessment of soft tissues shows soft tissue edema in the lateral
ankle along the dorsum of the foot.
IMPRESSION:
Comminuted and displaced trimalleolar fracture with 4 mm superior displacement
of the posterior malleolus and slight posterior translation of the talus with
respect to the distal tibia.
s
|
10138762-RR-36
| 10,138,762 | 24,312,685 |
RR
| 36 |
2138-05-21 13:50:00
|
2138-05-22 08:23:00
|
INDICATION: ORIF
TECHNIQUE: Fluoroscopic spot views of the right ankle.
COMPARISON: ___.
FINDINGS:
Fluoroscopic spot views of the right ankle demonstrate plate and screw
fixation of the distal fibular and distal tibial fractures. The images are
obtained without the radiologist present and for guidance purposes. For
further details please see the intraoperative note.
|
10138762-RR-38
| 10,138,762 | 24,312,685 |
RR
| 38 |
2138-05-22 08:34:00
|
2138-05-22 08:53:00
|
INDICATION: Right trimalleolar fracture.
TECHNIQUE: Three views right ankle.
COMPARISON: ___.
FINDINGS:
An overlying cast is noted. There is plate and screw fixation of the lateral
and posterior malleolar fracture fragments. The medial fracture fragments are
in good overall alignment. The mortise appears congruent. No new fracture is
noted.
|
10138917-RR-37
| 10,138,917 | 26,772,323 |
RR
| 37 |
2157-07-13 15:35:00
|
2157-07-13 16:26:00
|
INDICATION: ___ status post left lower lobectomy and shortness of
breath, please evaluate for pneumonia.
TECHNIQUE:
Frontal and lateral radiographs of the chest were obtained.
COMPARISON: Chest radiograph from ___ and CT of the chest from
___.
FINDINGS:
Numerous large bilateral pulmonary metastases are seen from patient's known
history of lung cancer, significantly progressed since ___. There is
no definite evidence of pneumonia. No pneumothorax. Surgical clips are seen
at the site of the left lower lobectomy.
IMPRESSION: Extensive metastatic disease to the lungs.
|
10138917-RR-38
| 10,138,917 | 26,772,323 |
RR
| 38 |
2157-07-15 17:14:00
|
2157-07-16 07:56:00
|
CHEST
HISTORY: NG tube placement.
FINDINGS: Again seen are numerous bilateral pulmonary metastases from
patient's known lung cancer. The NG tube terminates at the GE junction. This
would need to be advanced prior to using. This was discussed with Dr.
___ at 5:40 p.m. by Dr. ___.
|
10138979-RR-5
| 10,138,979 | 20,742,047 |
RR
| 5 |
2170-05-09 03:56:00
|
2170-05-09 05:11:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with MCC accident// trauma
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 18.0 s, 18.8 cm; CTDIvol = 48.1 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
Minimal paranasal sinus mucosal thickening. 0.5 cm well-circumscribed focus
of sclerosis left supraorbital rim, likely benign in the absence of history of
malignancy. The imaged paranasal sinuses are clear. Mastoid air cells and
middle ear cavities are well aerated. No acute fractures.. Chronic fracture
left medial orbital wall, possibly medial right orbital wall. Mild left scalp
soft tissue swelling.
IMPRESSION:
No acute hemorrhage or fracture.
0.5 cm focus of osseous sclerosis, likely benign in the absence of history of
malignancy.
|
10138979-RR-6
| 10,138,979 | 20,742,047 |
RR
| 6 |
2170-05-09 03:57:00
|
2170-05-09 05:37:00
|
EXAMINATION:
CT torso
INDICATION: ___ year old man with MCC accident// trauma
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 10.1 s, 79.3 cm; CTDIvol = 21.4 mGy (Body) DLP =
1,695.8 mGy-cm.
Total DLP (Body) = 1,696 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma. Prominent
anterior mediastinal stranded soft tissue could represent thymic remnant
versus mild edema/minimal hemorrhage.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a 2.4 x 1.7 cm lesion along the anterior aspect of segment 4A of the
liver (series 2, image 98). This is intermediate in density, and demonstrates
dependent hyperdense material posteriorly. 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.
Multiple subcentimeter hypodensities are seen in bilateral kidneys, too small
to characterize, likely simple cysts. There is no evidence of hydronephrosis.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. 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: An L2 burst fracture is noted. The retropulsed fragment severely
narrows the spinal cord. The L2 left lamina is also fractured. Hemorrhage
surrounds the L2 vertebral body in the region of bilateral psoas muscles.
There is a focal area of heterogeneous attenuation along the left psoas
muscle. A 1.0 cm osseous excrescence projecting within the spinal canal
(2:122) at the T11 vertebral level likely represents an atypical osteophyte.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. L2 burst fracture with retropulsed fragment severely narrowing the spinal
canal. The L2 left lamina is also fractured.
2. Hemorrhage surrounds the L2 vertebral body and bilateral psoas muscles. A
focal area of heterogeneous attenuation along the left psoas muscle is noted.
Cannot exclude mild contrast extravasation.
3. Anterior mediastinal soft tissue stranding may reflect residual thymic
tissue, although mild edema and/or minimal hemorrhage cannot be totally
excluded.
4. Indeterminate lesion in segment 4 A of the liver with dependent
hyperdensity. This could reflect a partly calcified hemangioma. It is
difficult to completely exclude traumatic lesion although the appearance is
atypical for this. Consider multiphase liver CT including noncontrast to
further evaluate.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. in person on ___ at 4:41 am, 1 minutes after
discovery of the findings. Recommendation contained in impression point 4
discussed over the telephone by Dr. ___ with ___ at 12:50 on
___.
|
10138979-RR-7
| 10,138,979 | 20,742,047 |
RR
| 7 |
2170-05-09 04:02:00
|
2170-05-09 05:18:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ year old man s/p MVC at 100mph with back pain// eval for
traumatic injury
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.9 s, 23.3 cm; CTDIvol = 22.7 mGy (Body) DLP = 529.5
mGy-cm.
Total DLP (Body) = 530 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal.There is loss of vertebral body height of C6 with mild
rounded deformity of the upper endplate, likely Schmorl's node, there is no
adjacent paravertebral edema, acute fracture is unlikely. Tiny flecks of
calcifications along the posterior margins of C3-C4, C5-C6 disc spaces likely
represent calcifications of the discs.
Degenerative changes cervical spine, multilevel mild disc osteophyte
complexes, narrowed disc spaces, mild posterior element hypertrophic changes.
Congenital narrowing cervical spinal canal. Broad-based small shallow disc
protrusions at C2-C3, C4-C5 levels. Multilevel moderate central canal
narrowing most prominent at C4-C5, C5-C6, C6-C7 level. Multilevel foraminal
narrowing, most prominent and probably moderate at C6-7 levels.
There is no prevertebral soft tissue swelling. There is no evidence of
infection or neoplasm.
IMPRESSION:
1. Mild loss of height C6 with probable Schmorl's node, acute fracture is
unlikely..
2. No definite acute fractures.
3. Multilevel degenerative changes, congenital narrowing spinal canal.
4. Multilevel moderate central canal narrowing.
|
10139117-RR-79
| 10,139,117 | 22,598,112 |
RR
| 79 |
2156-02-15 16:53:00
|
2156-02-15 20:39:00
|
CHEST TWO VIEWS: ___.
HISTORY: ___ male with syncopal episode, history of lung cancer with
recent lobectomy.
FINDINGS: PA and lateral view of the chest compared to prior chest x-ray from
___ and chest CT from ___. Postoperative changes of
left upper lobectomy are seen with left hemithorax volume loss and elevation
of the hemidiaphragm as well as surgical chain sutures in the suprahilar
region. There is increased nodular opacity in the postoperative bed, which
was more clearly delineated by recent CT as suspicious for recurrent disease.
The lungs are otherwise clear. Cardiomediastinal silhouette is unchanged.
Osseous and soft tissue structures are unremarkable.
IMPRESSION: No acute cardiopulmonary process. Findings again suspicious for
recurrent disease abutting the surgical chain sutures of the left upper
lobectomy.
|
10139117-RR-80
| 10,139,117 | 22,598,112 |
RR
| 80 |
2156-02-15 17:15:00
|
2156-02-15 18:52:00
|
INDICATION: Syncope. Patient with history of lung cancer. Assess for
metastases or other acute process.
COMPARISONS: MRI brain of ___.
TECHNIQUE: MDCT-acquired contiguous images through the head were obtained
without intravenous contrast at 5-mm slice thickness. Coronally and
sagittally reformatted images are provided.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, mass effect, or shift
of normally midline structures. There is no cerebral edema or loss of
gray-white matter differentiation to suggest an acute ischemic event.
Scattered hypodensities in periventricular white matter distribution likely
reflect sequela of small vessel ischemic disease. There is no hydrocephalus.
Basal cisterns are patent. No large intracranial mass is detected. There is
mild mucosal thickening of maxillary sinuses. Otherwise, imaged paranasal
sinuses appear well aerated. The orbits are normal in appearance. No acute
fracture. No suspicious lytic or sclerotic bony lesion seen.
IMPRESSION:
No evidence of acute intracranial process. Specifically, no intracranial mass
is detected; however, MRI is more sensitive for detection for small metastatic
lesions.
|
10139117-RR-84
| 10,139,117 | 22,598,112 |
RR
| 84 |
2156-02-18 13:38:00
|
2156-02-18 14:12:00
|
HISTORY: Acute on chronic kidney disease, evaluate for hydronephrosis.
TECHNIQUE: Gray scale and Doppler examination was performed of the kidneys
and bladder.
COMPARISON: PET-CT ___.
FINDINGS:
The kidney are slightly echogenic comparged to liver.
The right kidney measures 7.9 cm. A 1.8 x 1.7 x 1.4 cm and 0.7 x 0.7 cm
simple appearing cysts are again seen. There is no hydronephrosis,
nephrolithiasis or mass.
The left kidney measures 7.8 cm. 8 2.5 x 2.4 x 2.4 and 0.6 x 0.5 cm simple
appearing cysts are seen within the left kidney. There is no hydronephrosis,
nephrolithiasis or solid mass.
Limited views of the bladder demonstrate a small diverticulum arising from the
superior aspect.
IMPRESSION: No hydronephrosis. Slightly echogenic kidneys is compatible with
medical renal disease.
|
10139228-RR-31
| 10,139,228 | 20,586,108 |
RR
| 31 |
2128-10-19 15:14:00
|
2128-10-19 16:43:00
|
EXAMINATION: CTA CHEST ABDOMEN AND PELVIS.
INDICATION: ___ with abd pain // evidence of dissection, AAA or cause of abd
pain
TECHNIQUE: Multi detector CT images were obtained through the chest, abdomen,
and pelvis in arterial phase after administration of 100 cc of IV Omnipaque
contrast. Axial images were interpreted in conjunction with coronal, sagittal,
right oblique MIP and left oblique MIP reformats.
DLP: 912 mGy-cm.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
CHEST CTA:
The thoracic aorta is normal caliber without evidence of aneurysm or
dissection. The main, lobar, segmental, and subsegmental pulmonary arteries
are well opacified without filling defect. The remainder of the great vessels
have a normal appearance.
ABDOMEN AND PELVIC CTA: The abdominal aorta and its major branches are patent.
The portal venous system is patent. There is no abdominal aortic aneurysm.
There is no significant atherosclerotic disease.
CHEST:
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph
nodes are not pathologically enlarged. The heart and mediastinum are normal.
The pericardium is intact without effusion. Airways are patent to the
subsegmental levels.
There is minimal bibasilar atelectasis. The lungs are otherwise clear. The
pleura is intact without effusion. No pneumothorax or pneumomediastinum.
There is fluid within a mildly dilated intrathoracic esophagus.
ABDOMEN AND PELVIS: The liver enhances homogeneously and is without focal
lesions. The gallbladder is normal without radiopaque gallstones. There is no
intra or extrahepatic biliary duct dilation. The spleen, adrenal glands, and
pancreas are unremarkable.
Sub cm hypodensities within the kidneys bilaterally were present in ___ and
are too small to characterize but likely represent simple cysts. There is no
hydronephrosis. Renal enhancement is symmetric.
The stomach is distended. There is mild edema involving the duodenum. There is
extensive free intraperitoneal air most pronounced in the right pelvis
(2:191). Adjacent to this region is a edematous loops of distal sigmoid colon
(2:190). Additional edema is noted within the rectum. There is a large amount
of intra-abdominal and pelvic free fluid. Additionally, there are multiple
mildly dilated loops of small bowel with a fecalized loop in the right mid
pelvis with gradual tapering distally (2:188). The ascending, transverse, and
descending colon is unremarkable.
There is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.
There are no abdominal wall hernias.
The bladder is distended and unremarkable. There is no pelvic sidewall or
inguinal lymphadenopathy. Moderate pelvic free fluid is noted.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. No evidence of aortic dissection.
2. Large intra-abdominal free air centered in the right pelvis adjacent to an
edematous loops of distal sigmoid colon, findings are concerning for a sigmoid
perforation.
3. Multiple dilated loops of small bowel with a fecalized loop in the right
mid pelvis and gradually tapering, findings are likely reactive however, a
partial/ early small bowel obstruction cannot be excluded.
4. Edema within the duodenum and rectum.
5. Moderate abdominal and pelvic free fluid.
6. Fluid within the distal intrathoracic esophagus may increase risk of
aspiration.
|
10139228-RR-32
| 10,139,228 | 20,586,108 |
RR
| 32 |
2128-10-25 12:25:00
|
2128-10-25 18:20:00
|
EXAMINATION: CONTRAST ENHANCED CT ABDOMEN AND PELVIS
INDICATION: Sigmoid resection, ___ pouch, with prolonged ileus postop
and uptrending white count. Evaluate postoperative changes.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the uneventful administration of IV and oral contrast. Sagittal and
coronal reformats were generated.
TOTAL EXAM DLP: 962 mGy-cm.
COMPARISON: CT torso from ___.
FINDINGS:
There are small bilateral pleural effusions with associated compressive
atelectasis. Visualized portions of the heart and pericardium are normal.
CT of the abdomen: The liver enhances homogeneously with no evidence of focal
hepatic lesions. There is no intra or extrahepatic biliary ductal dilatation.
The gallbladder is distended, however there is no gallbladder wall hyper
enhancement, pericholecystic fluid or gallstones to suggest acute
cholecystitis. The adrenal glands and pancreas are normal. The spleen is
enlarged measuring up to 14.4 cm. There is a small amount of perisplenic
ascites. 7 mm hypodensity in the lower pole of the right kidney and an 8 mm
hypodensity in the upper pole of the right kidney are too small to further
characterize. Small hypodensities in the left kidney are also too small to
further characterize. The kidneys otherwise enhance symmetrically with no
evidence of hydronephrosis or abnormal renal mass.
An NG tube is seen terminating within the gastric fundus. Oral contrast is
seen within the stomach. Again seen are multiple dilated fluid-filled loops of
small bowel, measuring up to 3.4 cm in widest dimension. As compared to prior
examination, there is a new focal area of bowel wall thickening in the mid to
distal jejunum (series 2, image 55). There is no additional discrete
thickening of bowel. A colostomy is seen in the left lower quadrant, with
descending colon extending through the stoma. There are expected small
pockets of air seen within the subcutaneous tissues at this level.
Significant amount of stool and air is seen within the right colon. Small
amount of intraabdominal ascites surrounds multiple loops of bowel. No
organized fluid collection identified.
The intra-abdominal aorta is of normal diameter. The celiac axis, SMA,
bilateral renal arteries and ___ are patent. The portal vein is patent. There
is no large amount of free air. There are scattered small mediastinal and
retroperitoneal lymph nodes none of which meet CT size criteria for
lymphadenopathy. There is persistent thickening of the peritoneum. There is
mild generalized body wall edema.
CT of the pelvis: The urinary bladder contains small pockets of air, likely
related to recent instrumentation. ___ pouch is seen in the pelvis in
addition to surgical sutures. There is a small amount of pelvic free fluid.
No pelvic or inguinal lymphadenopathy by CT size criteria.
Osseous structures: No blastic or lytic lesion concerning for malignancy. Old
rib deformity is noted on the right, at the level of T11.
IMPRESSION:
1. Persistent ileus with mid jejunal bowel wall thickening which is new as
compared to prior. No organized fluid collection identified.
2. Small volume intra-abdominal ascites.
3. Thickened peritoneum, likely ongoing peritoneal inflammation given ongoing
ileus and ascites.
4. No large free air or extravasation of contrast.
5. Small bilateral pleural effusions with associated atelectasis.
6. Mild splenomegaly.
7. Air in the urinary bladder is likely secondary to recent instrumentation.
Correlation recommended.
|
10139228-RR-33
| 10,139,228 | 20,586,108 |
RR
| 33 |
2128-10-25 22:05:00
|
2128-10-26 11:33:00
|
INDICATION: ___ year old man s/p ex-lap, sigmoid rsection, and ___ //
Eval for contrast follow-through in large bowel
COMPARISON:
Scout image from CT abdomen ___
IMPRESSION:
Distended, air-filled loops of large and small bowel appear similar to the
prior CT exam performed earlier the same date, which suggested these findings
were due to ileus. A moderate amount of stool persists in the ascending and
proximal transverse colon. Intravenous contrast within the bladder is likely
related to the recent CT injection.
|
10139228-RR-34
| 10,139,228 | 20,586,108 |
RR
| 34 |
2128-10-27 12:26:00
|
2128-10-27 18:24:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)ABDOMEN (SUPINE AND ERECT)i
INDICATION: ___ year old man s/p sigmoid resection, known ileus on CT // eval
for interval improvement of obstruction
COMPARISON: Abdominal radiographs ___.
IMPRESSION:
Frontal views of the abdomen, 2 supine and 1 upright are submitted.
The horizontally oriented loop of bowel crossing the abdomen just inferior to
transverse colon is considerably more distended today with air and fluid,
diameter 66 mm, compared to 50 mm on ___. Possibility of developing
small bowel obstruction needs to be considered.
NOTIFICATION: Dr. ___ paged ___ J., MD 3 times on ___
at between 3:30 and 5:30PM, starting 5 minutes after discovery of the
findings.
Dr. ___ reported the findings to ___ ___ by telephone on
___ at 6:15 ___, 2.75 hours after discovery of the findings.
|
10139228-RR-50
| 10,139,228 | 25,617,386 |
RR
| 50 |
2133-03-14 07:28:00
|
2133-03-14 09:42:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with RIJ CVL placement, intubated// Please eval
for line positions Contact name: ___: ___ Please eval for
line positions
IMPRESSION:
Compared to most recent prior chest radiograph ___.
Right IJ line ends in the upper SVC. ET tube in standard placement.
Esophageal drainage tube is looped in the stomach and passes out of view.
Borderline cardiomegaly and early pulmonary vascular engorgement are
exaggerated by low lung volumes. No focal pulmonary abnormality. Normal
mediastinal and hilar contours and pleural surfaces.
|
10139228-RR-51
| 10,139,228 | 25,617,386 |
RR
| 51 |
2133-03-17 17:30:00
|
2133-03-17 17:48:00
|
INDICATION: ___ year old man with w/ sigmoid perforation now s/p sigmoid
resection with primary anastomosis//please eval for ileus/SBO
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Abdominal radiographs ___. CT abdomen and pelvis ___.
FINDINGS:
There are surgical skin staples along the anterior abdominal wall and surgical
anastomotic sutures in the pelvis.
There are several dilated loops of small bowel measuring up to 6.1 cm with
air-fluid levels, which may represent postoperative ileus or small bowel
obstruction. There is no free intraperitoneal air.
There is mild levoscoliosis of the lumbar spine. No acute osseous
abnormalities are identified.
IMPRESSION:
Several dilated loops of small bowel, which may represent postoperative ileus
or small bowel obstruction.
|
10139228-RR-52
| 10,139,228 | 25,617,386 |
RR
| 52 |
2133-03-19 09:41:00
|
2133-03-19 11:13:00
|
INDICATION: ___ year old man status post exploratory laparotomy with resection
of the sigmoid colon and primary anastomosis with postop ileus and NGT// Eval
NGT placement
TECHNIQUE: Portable AP supine abdominal radiograph.
COMPARISON: Abdominal radiograph dated ___ and ___.
FINDINGS:
The enteric tube terminates in the stomach. Dilated small bowel loops and
colon up to splenic flexure have improved since ___. Air is seen
all the way to the rectum.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for mild degenerative changes of the lower
lumbar spine.
Midline skin staples are noted..
IMPRESSION:
Enteric tube terminates in the stomach. Interval improvement of ileus.
|
10139228-RR-53
| 10,139,228 | 25,617,386 |
RR
| 53 |
2133-03-20 07:38:00
|
2133-03-20 10:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ sigmoid perforation ___ foreign body s/p sigmoid
resection w/primary anastomosis, now with ileus and febrile to 101.3.//
?pneumonia/consolidation, effusion ?pneumonia/consolidation, effusion
IMPRESSION:
Comparison to ___. Lung volumes have decreased. The patient is
extubated. The feeding tube is in stable position. Mild cardiomegaly. Mild
retrocardiac atelectasis. Minimal left pleural effusion. No pneumonia.
|
10139228-RR-54
| 10,139,228 | 25,617,386 |
RR
| 54 |
2133-03-20 11:34:00
|
2133-03-20 15:42:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ w/ sigmoid perforation ___ foreign body s/p sigmoid
resection w/primary anastomosis, now with ileus and fever.// PO, IV, and
Rectal contrast please. ?abscess
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral and rectal contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP: 612 mGy-cm
COMPARISON: CT of the abdomen and pelvis from ___
FINDINGS:
LOWER CHEST: New small bilateral pleural effusions with moderate bibasilar
atelectasis. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Stable subcentimeter right hepatic hypodensity suggestive of a cyst but too
small to characterize. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder distended without wall thickening or
surrounding inflammation, likely due to limited oral intake.
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.
Bilateral renal cysts redemonstrated. No hydronephrosis or perinephric
abnormality.
GASTROINTESTINAL: An enteric tube terminates in the stomach. Dilated loops of
jejunum gradually taper to normal caliber and oral contrast diffusing into the
ileum suggestive of ileus. Mild focal jejunal wall thickening is likely
reactive. The cecum, ascending, transverse, and descending colons are
essentially normal. Stranding remains in the pelvis adjacent to the rectum. A
rectal tube is present. The colorectal anastomosis in the pelvis is intact.
No evidence of extraluminal contrast to suggest leak. Trace pneumoperitoneum
is in keeping with postoperative status.
PELVIS: Unremarkable bladder. The previously seen pelvic hematoma has
resolved. Trace free fluid in the pelvis remains.
REPRODUCTIVE ORGANS: The prostate is normal.
LYMPH NODES: No abdominopelvic lymphadenopathy by CT size criteria.
VASCULAR: The visualized abdominopelvic vasculature is patent. Patent portal
vein.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Postsurgical changes with lower abdominal wound extending to the
fascia. Edema in the left rectus muscle which appears swollen and edematous
(5:68; 07:37). No drainable fluid collection.
IMPRESSION:
1. No evidence of anastomotic leak or organized abscess.
2. Essentially resolved right pelvic hematoma. Trace residual free-fluid.
3. Postsurgical ileus.
4. New small bilateral pleural effusions with moderate bibasilar atelectasis.
|
10139228-RR-55
| 10,139,228 | 25,617,386 |
RR
| 55 |
2133-03-24 13:12:00
|
2133-03-24 16:04:00
|
EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ y/o sigmoid perforation ___ foreign body ___ s/p sigmoid
resection w/primary anastomosis now with profuse diarrhea c diff neg// Pt is
refusing CT scan, please do abdominal/pelvic US to look for fluid collection
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
Four-quadrant ultrasound demonstrates small volume simple appearing free fluid
in the abdomen and pelvis.
Additionally there is a minimally complex fluid collection in the right lower
quadrant measuring approximately 6.0 x 2.5 cm in size with no vascularity
within it.
IMPRESSION:
Minimally complex fluid collection in the right lower quadrant measuring up to
6 cm in size, likely resolving hematoma.
Additionally 4 quadrant ultrasound demonstrates trace free fluid which appears
simple.
|
10139461-RR-23
| 10,139,461 | 22,000,499 |
RR
| 23 |
2153-01-06 08:32:00
|
2153-01-06 10:22:00
|
INDICATION: Fever and elevated white blood cell count and right upper
quadrant pain, non-contrast CT showing cholelithiasis, but no evidence of
cholecystitis on ___. Hematuria and right CVA tenderness. Exophytic
1.3-cm lesion of left kidney seen on CT.
COMPARISON: Abdominal CT of ___.
TECHNIQUE: Abdomen ultrasound.
FINDINGS: The liver shows borderline increase in echogenicity, consistent
with fatty infiltration with areas of relative sparing adjacent to the
fissures and some patchy areas of relative ___. Within the left
lateral segment, there is a 9-mm cyst, and an additional hypoechoic lesion
seen high within segment II measuring 8 mm that might represent an additional
cyst, although its features are less well defined. Along the right lobe of
the liver involving segments VI and VII, is a multilobulated chain of fluid
collections with internal debris, which were not evident on the CT of ___, suggestive of subcapsular abscesses. Cystic subcapsular neoplastic
deposits are unlikely given the short interval appearance of this finding.
The gallbladder is nondistended and contains multiple shadowing gallstones.
The wall is thickened and edematous with some echogenic foci, which could
indicate foci of adenomyomatosis. There is no pericholecystic fluid
collection directly seen. No biliary ductal dilation. Common hepatic duct
measures 2 mm. The imaged portions of pancreas appear within normal limits
without evidence of pancreatic ductal dilation. The pancreatic tail and a
portion of the head is obscured by overlying bowel gas. The imaged portions
of the abdominal aorta and IVC are normal in caliber. The larger of the
subcapsular collections measures 5.5 x 2.3 cm. The spleen measures 9.4 cm.
Left kidney measures 9.8 cm and contains a 1.4-cm cyst which corresponds to
the exophytic lesion seen on the prior CT, representing a hemorrhagic or
proteinaceous cyst. The right kidney measures 10.2 cm. There is no evidence
of hydronephrosis or stone within the right kidney. No free fluid is
identified elsewhere in the abdomen.
IMPRESSION:
1. Since the CT of ___, there is a new finding of subcapsular,
debris- containing fluid collections along the right lobe of the liver, a
finding that is concerning for subcapsular abscesses given the rapid interval
appearance. The source is not clearly defined and could relate to the
abnormal gallbladder (see #2) or bowel pathology (diverticulosis known from
prior CT). Suggest further evaluation with CT.
2. Cholelithiasis and thickened and edematous gallbladder wall suggestive of
cholecystitis, possibly chronic: the gallbladder is not distended to suggest
acute cholecystitis although could have decompressed to the subhepatic space.
No pericholecystic fluid is directly seen.
3. 1.4-cm left renal cyst in conjunction with the prior CT is consistent with
a proteinaceous cyst and shows no suspicious features.
4. No evidence of hydronephrosis or stone within the right kidney as
questioned.
The results were telephoned to Dr. ___ office by Dr. ___ at 10:00 a.m.
on ___, and the patient is being scheduled to undergo CT on the
same day.
|
10139461-RR-24
| 10,139,461 | 22,000,499 |
RR
| 24 |
2153-01-06 10:05:00
|
2153-01-06 13:15:00
|
INDICATION: ___ female with fevers, leukocytosis and right upper
quadrant pain with non-contrast CT on ___ showing cholelithiasis but no
evidence of cholecystitis, now with hematuria and right CVA tenderness.
COMPARISON: Same day abdominal sonogram and non-contrast CT of the abdomen
and pelvis performed on ___.
TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases to
the pubic symphysis after the uneventful administration of 100 cc Omnipaque
intravenous contrast and oral contrast. Coronally and sagittally reformatted
images were generated and reviewed.
FINDINGS:
CT OF THE ABDOMEN WITH ORAL AND INTRAVENOUS CONTRAST:
Limited supradiaphragmatic evaluation shows bibasilar atelectasis. No
pulmonary nodules, opacities or focal consolidations are present in the lung
bases. Limited evaluation of the heart shows normal size without pericardial
effusion.
The liver enhances homogeneously without perfusion defects. There are several
subcentimeter hypodensities scattered throughout the liver (for example 2A:8,
9, ___, 15) which are contained within the parenchyma and likely represent
benign hepatic cysts or hemangiomas but are too small to fully characterize by
CT. There is a new hypodense lesion in segment V/VI (2a:20) measuring 1.9 x
1.3 cm which is adjacent to the neck of the gallbladder and may demonstrate
direct communication. A separate, larger hypodense lesion which is also new
from ___ posterior to the right lobe of the liver appears subcapsular with
a thin wall that extends the length of segment VI (601b:39) measuring 8.9 x
5.4 x 2.5 cm. No extra-hepatic biliary ductal dilation is seen. The
gallbladder is contracted with pericholecystic fluid or edema within the
gallbladder wall. Multiple calcified gallstones are present within the
gallbladder measuring up to 1.7 cm in diameter. The spleen and bilateral
adrenal glands are unremarkable. The pancreas contains a 1.5 cm cystic lesion
in the uncinate process which is too small to fully characterize by
single-phase CT. The pancreas is otherwise unremarkable. Both kidneys
enhance symmetrically and excrete contrast normally without evidence of
hydronephrosis or solid renal masses. A 1.5 cm exophytic renal cyst of the
left kidney is unchanged.
The intra-abdominal loops of small and large bowel are unremarkable without
evidence of wall thickening or obstruction. There is no free air or ascites.
No pathologically enlarged lymph nodes are identified in the retroperitoneal
or mesenteric region. There are several small aortocaval and para-aortic
lymph nodes but none are pathologically enlarged by CT size criteria.
CT OF THE PELVIS WITH ORAL AND INTRAVENOUS CONTRAST: The rectum, sigmoid
colon, urinary bladder and uterus are unremarkable. There is no free pelvic
fluid or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesions are identified.
There is a well-circumscribed lesion with a sclerotic border involving the
vertebral body of L2.
IMPRESSION:
1. New subcapsular complex fluid collection posterior to the right lobe of
the liver is concerning for subcapsular abscess given the clinical history of
fevers and the rapid appearance since ___. It may also represent a biloma
or hematoma. There is an apparent communication between one of the fluid
collections and the contracted gallbladder which suggests a gallbladder
source.
2. Cholelithiasis with contraction and edema of the gallbladder wall may
represent cholecystitis favoring a chronic rather than acute etiology or,
alternatively, perforation of the gallbladder. No intra-abdominal fluid
collections are present.
3. 1.5 cm cystic lesion in the uncinate process of the pancreas is
incompletely characterized. Consider eventual MRCP for further evaluation.
Findings of #1 and #2 were communicated by Dr. ___ to Dr. ___
___ by phone at 12:15 p.m. on ___.
|
10139461-RR-25
| 10,139,461 | 22,000,499 |
RR
| 25 |
2153-01-06 16:15:00
|
2153-01-06 18:59:00
|
PROCEDURE: CT-guided drainage procedure.
INDICATION: ___ female with possible perforated gallbladder and
subcapsular fluid collection. Request drainage.
COMPARISON: CT of the abdomen and pelvis dated ___.
OPERATORS: Dr. ___ Dr. ___. Dr. ___ was present
for the entire duration of the procedure.
PROCEDURE: After explaining the risks, benefits and alternatives to the
procedure, written informed consent was obtained. The patient was laid in a
left lateral decubitus position on the CT table. A preprocedure timeout was
performed using three unique patient identifiers as per standard ___
protocol.
Limited preprocedure CT images of the upper abdomen were performed for the
purposes of skin entry site localization. An entry site within the right
flank was chosen. The skin over the right flank was prepped and draped in the
usual sterile fashion. 1% lidocaine was used to anesthetize the skin and
subcutaneous soft tissues. Under CT fluoroscopy guidance an 18-gauge ___
needle was advanced through the retroperitoneum into the subcapsular hepatic
fluid collection. There was return of bilious-appearing fluid. Through the
___ needle ___ wire was advanced into the fluid collection. The
___ needle was then exchanged for an 8 ___ ___ pigtail drainage
catheter. The wire was then removed and the pigtail loop was formed within
the fluid collection and was secured to patient's posterior abdominal wall.
The catheter was attached to a suction bulb. The obtained sample was sent for
microbiological analysis.
The patient tolerated the procedure well without any immediate periprocedural
complications.
Moderate sedation was provided by administering divided doses of Versed (2 mg)
and Fentanyl (50 mcg) throughout the total intraservice time of 15 minutes
during which the patient's hemodynamic parameters were continuously monitored.
IMPRESSION: Successful CT-guided drainage catheter placement into the
subcapsular hepatic fluid collection. White bile obtained. Microbiological
results pending at this time.
|
10139461-RR-26
| 10,139,461 | 25,057,350 |
RR
| 26 |
2153-03-07 01:27:00
|
2153-03-07 04:08:00
|
INDICATION: Abdominal pain.
COMPARISON: CTs available from ___ and ___.
TECHNIQUE: MDCT-acquired 5 mm axial images of the abdomen and pelvis were
obtained following the uneventful administration of 130 cc of Omnipaque
intravenous contrast. Coronal and sagittal reformations were performed at 5
mm slice thickness.
CT OF THE ABDOMEN WITH IV CONTRAST:
Included views of the lung bases demonstrate mild atelectasis. There is no
pericardial or pleural effusion. The heart size is normal.
A right posterior approach pigtail catheter terminates medial to the right
hepatic lobe. Previously seen fluid collections in this region from ___ have resolved. No new intrahepatic fluid collections are detected.
Subcentimeter hypodensities within segments VIII (2a:7) and the left lobe
(2a:11) are unchanged since ___, most compatible with a small cyst
or biliary hamartomas. There is no intra- or extra-hepatic bile duct
dilation. Again seen are numerous large gallstones and a thickened, edematous
gallbladder wall (2a:20), with no active neighboring fat stranding or
pericholecystic fluid. The pancreas, adrenal glands, spleen, stomach, and
intra-abdominal loops of small and large bowel are normal. An 15 mm exophytic
left renal cyst is unchanged. The kidneys are otherwise normal. There is no
mesenteric or retroperitoneal lymphadenopathy, and no free air or free fluid.
The abdominal aorta, celiac trunk, SMA, and ___ are patent and normal in
caliber.
CT OF THE PELVIS WITH IV CONTRAST:
The urinary bladder, uterus, adnexa, rectum, sigmoid colon, and intrapelvic
loops of small and large bowel are normal. Mild ascending colonic
diverticulosis is unchanged, with no evidence of diverticulitis (2a:47). The
appendix is normal (2a:60). There is no intrapelvic free fluid or
lymphadenopathy.
OSSEOUS STRUCTURES:
There is no acute fracture. There is no bony lesion concerning for infectious
or malignancy. Moderate multilevel degenerative changes are again seen, worst
at L5/S1, where there is mild vacuum phenomenon and posterior osteophytosis
with mild thecal sac narrowing.
IMPRESSION:
1. Interval resolution of right hepatic fluid collections. A right posterior
pigtail catheter is unchanged in position, however, no neighboring fluid
collections are present anymore.
2. No superimposed acute intra-abdominal or intrapelvic process.
3. Extensive cholelithiasis in a gallbladder with a chronically thickened
edematous wall. No superimposed acute cholecystitis.
|
10139461-RR-27
| 10,139,461 | 25,057,350 |
RR
| 27 |
2153-03-07 22:50:00
|
2153-03-08 06:07:00
|
INDICATION: Preoperative chest radiograph.
COMPARISON: Radiograph available from ___.
FRONTAL AND LATERAL CHEST RADIOGRAPHS: The heart size is top normal. The
hilar and mediastinal contours are within normal limits. A linear left
retrocardiac opacity is most compatible with atelectasis, also seen on the
___ radiograph. There is no pneumothorax or pleural effusion.
IMPRESSION: No acute intrathoracic process.
|
10139461-RR-28
| 10,139,461 | 25,057,350 |
RR
| 28 |
2153-03-08 18:29:00
|
2153-03-09 08:40:00
|
CHEST RADIOGRAPH
INDICATION: Evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. Small lung volumes with areas of atelectasis at the left lung bases.
No acute change, notably no pneumonia or pulmonary edema. Borderline size of
the cardiac silhouette.
|
10139461-RR-29
| 10,139,461 | 25,057,350 |
RR
| 29 |
2153-03-11 03:11:00
|
2153-03-11 12:56:00
|
INDICATION: Postop new onset Afib with RVR, with rapid ventricular rate with
new O2 requirement, please assess for pulmonary embolism.
TECHNIQUE: Non-contrast axial images were obtained through the chest.
Subsequently, intravenous contrast was administered and arterial phase imaging
was performed.
FINDINGS:
CHEST CTA: Pulmonary vasculature is well opacified without filling defect to
suggest pulmonary emboli. Minimal arthrosclerotic calcifications identified
within the aorta which is of normal caliber throughout. There is normal
three-vessel takeoff identified. Heart size is mildly enlarged with a small
pericardial effusion, likely physiologic.
CHEST CT: The thyroid gland is incompletely visualized, though demonstrated
portions are unremarkable. There is no supraclavicular, axillary, mediastinal
or hilar lymphadenopathy evident. There is minimal generalized thickening of
the peribronchial tissues, a nonspecific finding. Areas of atelectasis are
identified in the bilateral lower lung as well as within the lingula. No
focal opacifications concerning for pneumonia identified. Small bilateral
pleural effusions identified.
Though this exam is not tailored for subdiaphragmatic evaluation, a small
hypodensity is noted within the right hepatic lobe, stable since ___, too small to fully characterize though likely represents a simple
hepatic cyst.
Area of sclerosis identified within the right pedicle of the T4 vertebra
(2:16, 602b:29).
FINDINGS:
1. No pulmonary embolism or aortic pathology identified.
2. Small bilateral pleural effusions with adjacent and dependent atelectasis.
3. Sclerotic focus in the T4 right pedicle. Attention on follow-up.
|
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