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10139504-RR-30
| 10,139,504 | 29,112,725 |
RR
| 30 |
2195-02-06 15:57:00
|
2195-02-07 13:54:00
|
EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old man with chronic venous stasis changes and recurrent
cellulitis of LLE // ? evidence of PVD
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with Doppler signal recordings, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: None
FINDINGS:
On the right side, triphasic Doppler waveforms is seen at the femoral,
superficial femoral and popliteal arteries. However, monophasic Doppler
waveforms is seen in the right posterior tibial and dorsalis pedis arteries.
On the left side, triphasic Doppler waveforms is seen at the left femoral,
superficial femoral and popliteal arteries. However, monophasic Doppler
waveforms is seen at the left posterior tibial and dorsalis pedis arteries.
The right ABI is 0.97 and the left ABI is 1.53 at rest. ABIs are likely
artificially elevated due to noncompressible vessels.
Pulse volume recordings showed symmetric amplitudes bilaterally.
IMPRESSION:
Significant tibial arterial insufficiency to the lower extremities
bilaterally.
|
10139504-RR-31
| 10,139,504 | 29,112,725 |
RR
| 31 |
2195-02-07 13:57:00
|
2195-02-07 15:38:00
|
EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old man with persistent cellulitis of LLE, re-presenting
after fall. LLE edematous and tender. // ?LLE DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow demonstrated
in the right posterior tibial and peroneal veins. The left peroneal veins
were not well visualized. One of the posterior tibial veins on the left mid
calf is noncompressible, and only demonstrates trace flow on color and
spectral Doppler imaging, consistent with a nonocclusive deep vein thrombosis.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Nonocclusive deep vein thrombosis of one of the left posterior tibial veins
within the mid calf.
2. No evidence of deep venous thrombosis in the rightlower extremity veins.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, on the telephone on ___ at 3:34 ___, 30 minutes after discovery
of the findings.
|
10139504-RR-41
| 10,139,504 | 27,059,994 |
RR
| 41 |
2195-06-14 18:03:00
|
2195-06-14 19:07:00
|
EXAMINATION: EMERG BILAT LOWER EXT VEINS
INDICATION: ___ w/ BLE erythema, evaluate for DVT in either lower extremity.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None available
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the right posterior tibial and peroneal
veins.
There is expansion of 1 of the left posterior tibial veins without
compressibility or dopplerable pulse compatible with deep vein thrombosis.
The left peroneal veins were not seen.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst. There is severe bilateral
subcutaneous soft tissue edema in the calves.
IMPRESSION:
1. Deep vein thrombosis in one of the left posterior tibial veins.
2. No DVT in the right lower extremity.
3. Severe bilateral calf edema.
|
10139504-RR-49
| 10,139,504 | 23,099,959 |
RR
| 49 |
2195-09-06 16:50:00
|
2195-09-06 17:36:00
|
INDICATION: History: ___ with weakness, fall// ? pneumonia
TECHNIQUE: Supine AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Cardiac silhouette size remains mildly enlarged. The aorta is calcified.
Mediastinal and hilar contours are otherwise unremarkable. Pulmonary
vasculature is not engorged. Minimal patchy right basilar opacity may reflect
atelectasis. Blunting of the left costophrenic sulcus suggests a small
pleural effusion. No large right-sided pleural effusion or pneumothorax is
detected. No acute osseous abnormality is visualized. Remote right-sided rib
fractures are again seen.
IMPRESSION:
Minimal patchy right basilar opacity could reflect atelectasis. Small
left-sided pleural effusion.
|
10139504-RR-50
| 10,139,504 | 23,099,959 |
RR
| 50 |
2195-09-06 19:53:00
|
2195-09-06 20:46:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111
INDICATION: History: ___ with weakness, fall// ?ICH? fx
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
There is no evidence of acute territorial infarction,hemorrhage,edema, or
mass. Periventricular and subcortical white matter hypodensities are
nonspecific, but likely represent the sequela of chronic microvascular
ischemic disease. Chronic encephalomalacia within the left cerebellum is
compatible with a remote fracture. Chronic appearing lacunar infarcts within
the bilateral basal ganglia. There is prominence of the ventricles and sulci
suggestive of involutional changes. Mild atherosclerotic calcifications of
the cavernous carotid arteries are noted.
There is no evidence of fracture. Mild mucosal thickening within the right
frontal and left maxillary sinuses. Minimal opacification of the right
mastoid air cells. Otherwise, the visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Extensive dental caries and
periapical lucencies are re-demonstrated.
IMPRESSION:
No evidence of fracture or intracranial hemorrhage.
|
10139504-RR-51
| 10,139,504 | 23,099,959 |
RR
| 51 |
2195-09-06 19:53:00
|
2195-09-06 20:56:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311
INDICATION: History: ___ with weakness, fall// ? fracture
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 431 mGy-cm.
COMPARISON: CT C-spine dated ___.
FINDINGS:
Accentuation of normal cervical lordosis. Otherwise, alignment is normal. No
fractures are identified.There is no prevertebral soft tissue swelling. There
is no evidence of infection or neoplasm.
Multilevel mild to moderate degenerative disc disease, most severe at C6-7.
No high-grade spinal canal stenosis. Multilevel mild-to-moderate neural
foraminal stenosis due to a combination of uncovertebral and facet
osteophytes.
Pleuroparenchymal scarring at the lung apices bilaterally. 9 mm hypodense
nodule within the left lobe of the thyroid is unchanged (series 2, image 57).
A 3.9 x 3.1 cm fat containing lesion adjacent to the left mandible likely
represents a lipoma (series 2, image 27), unchanged, however a low-grade
liposarcoma cannot be excluded. There is diffuse subcutaneous edema.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. 3.9 cm fat containing lesion adjacent to the left minimal, unchanged,
either a lipoma or low grade liposarcoma.
3. Diffuse subcutaneous edema.
|
10139504-RR-52
| 10,139,504 | 23,099,959 |
RR
| 52 |
2195-09-06 19:54:00
|
2195-09-06 21:37:00
|
EXAMINATION: CT abdomen pelvis with IV contrast.
INDICATION: ___ with abdominal distension, pain.
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 not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 923 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
LOWER CHEST: Moderate right and small left pleural effusions, slightly
increased in the interval, with associated atelectasis. The heart is
moderately enlarged. Small, if any, pericardial effusion. Moderate aortic
annular calcifications are visualized.
ABDOMEN:
Small volume ascites throughout the abdomen and pelvis appears new.
HEPATOBILIARY: Calcified granuloma within the right lobe. Otherwise, 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 appears atrophic but has a 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: Numerous large simple cysts are seen within the kidneys bilaterally.
The largest is exophytic arising from the lower pole the right kidney
measuring 10.5 x 9.0 cm in maximum axial ___. There is moderate left
hydroureteronephrosis which extends to the pelvis, unchanged, definite
obstructing lesion seen. There also appears to be urothelial thickening
affecting the proximal left ureter (series 2, image 33), which should be
correlated with urinalysis. There is no evidence of hydronephrosis on the
right.
GASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. There is large stool burden. Otherwise, the colon and rectum are
within normal limits. The appendix is not visualized.
PELVIS: The bladder is distended with fluid. Bladder wall thickening and
trabeculation is likely due to chronic bladder outlet obstruction.
REPRODUCTIVE ORGANS: Although incompletely evaluated due to streak artifact
from the left total hip arthroplasty, the prostate appears massively enlarged
measuring approximately 6.2 x 7.2 cm in maximum axial ___. There is
protrusion of the median lobe into the bladder base.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic lymphadenopathy. Prominent inguinal lymph nodes bilaterally are
unchanged compared to prior.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted. Partially thrombosed left common iliac artery aneurysm is
unchanged (series 2, image 47).
BONES: Patient is status post total hip arthroplasty on left without evidence
of hardware complication. Streak artifacts arising from the hardware limit
evaluation of the pelvis. Numerous compression deformities throughout the
lumbar spine are overall unchanged compared to prior. There is no evidence of
acute fracture. No suspicious osseous lesions are visualized.
SOFT TISSUES: There is diffuse anasarca.
IMPRESSION:
1. No acute abnormalities within the abdomen or pelvis.
2. Diffuse anasarca with moderate right and small left pleural effusions,
which have increased in size compared to prior. Small volume ascites
throughout the abdomen and pelvis is new.
3. Massive prostatomegaly with bladder wall thickening and trabeculation,
likely due to chronic bladder outlet obstruction.
4. Moderate left hydroureteronephrosis, unchanged compared to prior, without
obstructing lesion identified. Urothelial thickening affecting the proximal
left ureter should be correlated with urinalysis to exclude infection.
5. Unchanged partially thrombosed left common iliac artery aneurysm.
6. Unchanged numerous compression deformities throughout the lumbar spine. No
evidence of acute fracture.
7. Large stool burden.
|
10139824-RR-6
| 10,139,824 | 24,791,154 |
RR
| 6 |
2152-01-02 15:18:00
|
2152-01-05 15:32:00
|
INDICATION: ___ man, status post fall from roof on to the left side,
with known pelvic fractures.
COMPARISON: A reference pelvis radiograph from outside hospital. ___.
TECHNIQUE: MDCT helical images were acquired through the pelvis without
intravenous contrast. Sagittal and coronal reformats were generated and
reviewed. Additional volume-rendered images of the pelvis were obtained.
FINDINGS: There is a nondisplaced fracture involving the left sacral ala
extending from S1 to S3 level (2:35). The fracture does not extend into the
sacral neural foramina. Also seen is nondisplaced fracture through the
superior pubic ramus (2:72) posteriorly and at the pubic body (2:78) adjacent
to the pubic symphysis. Also seen are nondisplaced fractures through the
inferior pubic ramus (2:87, 2:90). There is a comminuted fracture involving
the anterior acetabular wall, without significant displacement. There is
extension of the acetabular fracture into the articular surface. No
right-sided pelvic fractures are seen.
No pelvic hematoma is seen. A Foley catheter is in place with residual
intravenous contrast from a prior study filling the bladder. The distal
ureters are normal. Surgical sutures are seen in the rectum. The imaged
small and large bowel loops are unremarkable. No pelvic free fluid or
adenopathy is seen. Small fat-containing inguinal hernias are present.
IMPRESSION:
1. Non-displaced comminuted fracture involving the left anterior acetabulum
extending to the left hip joint.
2. Non-displaced left superior and inferior pubic rami fractures. Left pubic
body fracture.
3. Nondisplaced left sacral ala fracture extending from S1 to S3. No neural
foraminal involvement.
|
10139824-RR-7
| 10,139,824 | 24,791,154 |
RR
| 7 |
2152-01-02 15:29:00
|
2152-01-02 17:01:00
|
INDICATION: ___ after fall.
TECHNIQUE: Four views of the left shoulder were obtained.
COMPARISON: There are no comparison studies available.
FINDINGS:
There are no fractures at the proximal humerus, scapula, clavicle, or upper
ribs. Mild degenerative changes are noted along the acromioclavicular joint.
No evidence of shoulder dislocation.
IMPRESSION: No fracture, no dislocation.
|
10139983-RR-10
| 10,139,983 | 26,537,804 |
RR
| 10 |
2122-11-27 16:20:00
|
2122-11-27 16:56:00
|
INDICATION: ___ with constipation and abdominal pain, evaluate for small
bowel obstruction.
TECHNIQUE: Supine and left lateral decubitus views of the abdomen and pelvis
were obtained.
COMPARISON: None available
FINDINGS:
There is severe colonic fecal loading. There are no dilated loops of small
bowel. There is intraperitoneal free air. No large air-fluid levels are
seen. Severe degenerative changes are noted at the bilateral hip joints.
Included lung bases are grossly clear.
IMPRESSION:
Severe colonic fecal loading. No radiographic evidence for small bowel
obstruction.
|
10139983-RR-11
| 10,139,983 | 26,537,804 |
RR
| 11 |
2122-11-27 17:35:00
|
2122-11-27 18:14:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with abdominal pain and elevated LFT's
COMPARISON: None
FINDINGS:
AP upright and lateral views of the chest provided. Lung volumes are low with
bibasilar atelectasis noted. No convincing evidence for pneumonia or edema.
No large effusion or pneumothorax. The heart appears relatively normal in
size. Mediastinal contour is unremarkable. The imaged bony structures are
intact. No free air below the right hemidiaphragm is seen.
IMPRESSION:
Basilar atelectasis without acute abnormalities.
|
10139983-RR-12
| 10,139,983 | 26,537,804 |
RR
| 12 |
2122-11-27 17:44:00
|
2122-11-27 19:22:00
|
INDICATION: ___ with diffuse abdominal pain and elevated LFTs. Evaluate for
biliary disease a liver abnormalities.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
IV Contrast: 130 mL Omnipaque. Please note patient had initial infiltration
of IV contrast and repeat study was done following new IV insertion.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 694 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis. There is a small pericardial
effusion. No pleural effusion is present.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation with the
exception of a 2.1 cm hypodense structure in segment 5, likely a cyst. There
is moderate intra and extrahepatic biliary ductal dilatation with enhancing
common bile duct measuring up to 2.1 cm. Stones are seen within the distal
common bile duct compatible with choledocholithiasis. The gallbladder is
massively distended and contains numerous gallstones. The gallbladder wall
appears mildly thickened with surrounding fat stranding. There is also
pericholecystic fluid. The cystic duct is also markedly dilated. The portal
vein is patent.
PANCREAS: The pancreas demonstrates homogeneous attenuation. The main
pancreatic duct is slightly prominent but not frankly dilated. There is no
peripancreatic stranding or fluid collection.
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.
Scattered cortically based hypodensities are noted, which are too small to
fully characterize, but likely represent cysts. There is no hydronephrosis or
perinephric abnormality.
GASTROINTESTINAL: There is a large hiatal hernia containing fluid. The
stomach is otherwise unremarkable. Small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. There is severe colonic
fecal loading extending into the rectum. The appendix is not visualized but
there are no secondary signs of the appendicitis.
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. Moderate atherosclerotic
disease is noted.
BONES: There is moderate loss of height with superior endplate compression
deformity of the T12 vertebral body of unknown chronicity. No suspicious
lytic or sclerotic osseous lesion is identified.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Acute cholangitis secondary to choledocholithiasis with stones seen within
the distal CBD with moderate upstream intra and extrahepatic biliary ductal
dilatation.
2. Massively distended gallbladder and dilated cystic duct, possibly due to
the downstream obstruction, although somewhat unusual. Presence of
pericholecystic fluid and gallbladder wall thickening raise concern for acute
cholecystitis.
3. Large hiatal hernia.
4. Severe fecal loading extending into the rectum.
|
10139983-RR-13
| 10,139,983 | 26,537,804 |
RR
| 13 |
2122-12-02 08:47:00
|
2122-12-02 10:23:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with ___ disease, admitted with biliary
sepsis and choledocholithiasis, abd CT ___ showed massively distended GB and
dilated cystic duct, s/p ERCP ___ with sphincterotomy stent placement but
unable to remove stone from cystic duct, now clinically doing well //
re-assess GB ducts post ERCP with stent placement
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis dated ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. An anechoic 2.1 cm simple cyst is seen in segment 5. There
is no focal liver mass. The main portal vein is patent with hepatopetal flow.
There is a small amount of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation and pneumobilia is now
os seen. A stent is visualized in the common bile duct. The CBD measures 7 mm
and contains a stent.
GALLBLADDER: Stones and sludge are again seen within the gallbladder which is
less distended though still thick-walled. Sonographic ___ sign was
negative.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 8.8 cm.
IMPRESSION:
Interval decrease in intrahepatic and extrahepatic biliary dilation with
expected pneumobilia post stenting. Stent seen within the gallbladder, which
is less distended though still thick walled. Cholelithiasis.
|
10139983-RR-16
| 10,139,983 | 20,140,325 |
RR
| 16 |
2123-01-29 05:41:00
|
2123-01-29 06:14:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ female status post fall. Evaluate for injury.
TECHNIQUE: Frontal, lateral and oblique radiographs of the right knee were
obtained.
COMPARISON: None.
FINDINGS:
There is a contour abnormality and slight cortical ill definition of the
lateral tibial plateau concerning for a tibial plateau fracture. Background
mild degenerative changes. No significant joint effusion is seen. Small
corticated density adjacent to the medial femoral condyle suggests old injury.
IMPRESSION:
It is difficult to exclude a tibial plateau fracture on this exam. I note
that CT was subsequently performed to further evaluate.
|
10139983-RR-17
| 10,139,983 | 20,140,325 |
RR
| 17 |
2123-01-29 07:12:00
|
2123-01-29 10:11:00
|
EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
INDICATION: ___ with fall R hip pain
TECHNIQUE: Right hip, two views
COMPARISON: None available
FINDINGS:
There is an acute fracture of the right femoral neck. The fracture is
displaced with apparent overlap of proximal and distal fragments. The
fracture resides at a mid-cervical level. No additional fracture.
IMPRESSION:
Right femoral neck fx, mid-cervical level.
|
10139983-RR-18
| 10,139,983 | 20,140,325 |
RR
| 18 |
2123-01-29 07:31:00
|
2123-01-29 09:57:00
|
EXAMINATION: DX FEMUR AND TIB/FIB
INDICATION: ___ with s/p fall R hip pain, also with possible tibial plateau
fracture
TECHNIQUE: Right distal femur, one view. Right distal femur, to these Right
mid tibia and fibula, one views. Right distal tibia and fibula, two views.
COMPARISON: Right knee radiograph ___ 05:37
FINDINGS:
Right femur and knee: There is no fracture or dislocation. No joint
effusion. There are mild tricompartmental degenerative changes. No soft
tissue calcification or radiopaque foreign body. No suspicious lytic or
sclerotic osseous lesion.
Right tibia and fibula and ankle: No fracture or dislocation. Ankle mortise
is congruent on these nonstress views. No soft tissue calcification or
radiopaque foreign body. No suspicious lytic or sclerotic osseous lesion.
IMPRESSION:
No fracture or dislocation.
|
10139983-RR-19
| 10,139,983 | 20,140,325 |
RR
| 19 |
2123-01-29 07:48:00
|
2123-01-29 08:45:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with s/p fall // acute process
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 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 prominent likely secondary to
age-related involutional change. The imaged paranasal sinuses are clear.
Mastoid air cells and middle ear cavities are well aerated. The bony calvarium
is intact.
IMPRESSION:
No acute intracranial process.
|
10139983-RR-20
| 10,139,983 | 20,140,325 |
RR
| 20 |
2123-01-29 07:48:00
|
2123-01-29 08:52:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with s/p fall
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 743 mGy-cm.
COMPARISON: None available
FINDINGS:
Alignment is normal. There is no acute fracture. There is a chronic
deformity of the C2 vertebral body (603b:17) which is likely secondary to a
old healed hangman type fracture. There is multilevel hypertrophic spurring
and intervertebral disc space narrowing which is most prominent at C3-C4.
There is no significant spinal canal or neural foraminal stenosis. There is no
prevertebral soft tissue swelling.Thyroid and lung apices are unremarkable.
IMPRESSION:
1. No acute fracture or malalignment.
2. Chronic C2 deformity, suggestive of a old hangman type fracture.
|
10139983-RR-21
| 10,139,983 | 20,140,325 |
RR
| 21 |
2123-01-29 07:48:00
|
2123-01-29 09:24:00
|
EXAMINATION: CT of the right lower extremity
INDICATION: ___ year old woman with R femoral neck fracture, possible tibial
plateau fracture, s/p fall.
TECHNIQUE: MDCT through the right knee without contrast with multiplanar
reformations.
DOSE: Total DLP (Body) = 399 mGy-cm.
COMPARISON: Right knee radiograph ___
FINDINGS:
Bones are demineralized. There is no acute fracture or dislocation. There is
a small suprapatellar joint effusion. There is mild degenerative disease with
tricompartmental osteophytosis. There is loss of medial tibiofemoral joint
space, moderate. No radiopaque foreign body or suspicious lytic or sclerotic
osseous lesion.
IMPRESSION:
1. No acute fracture or dislocation.
2. Small suprapatellar joint effusion.
3. Mild tricompartmental degenerative changes of the right knee.
|
10139983-RR-22
| 10,139,983 | 20,140,325 |
RR
| 22 |
2123-01-29 07:53:00
|
2123-01-29 10:03:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with R femoral neck fx s/p fall // pre-op
TECHNIQUE: AP supine
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low. There is hilar congestion with mild interstitial edema.
Scattered atelectasis noted. There is no supine evidence for effusion or
pneumothorax. Cardiomediastinal silhouette is stable. Imaged osseous
structures are intact. There is a CBD stent projecting over the RUQ.
IMPRESSION:
Mild interstitial edema.
|
10139983-RR-23
| 10,139,983 | 20,140,325 |
RR
| 23 |
2123-01-29 15:26:00
|
2123-01-29 16:14:00
|
EXAMINATION: HIP 1 VIEW
INDICATION: Status post Right hip hemiarthroplasty.
TECHNIQUE: AP view of the right hip obtained at the patient's bedside.
COMPARISON: Right hip radiographs ___
FINDINGS:
There has been interval placement of a right hip hemiarthroplasty. Alignment
appears appropriate. No periprosthetic fracture seen. Subcutaneous air
consistent with recent surgery.
IMPRESSION:
Expected appearances fall Right hip hemiarthroplasty.
|
10139992-RR-56
| 10,139,992 | 22,906,379 |
RR
| 56 |
2123-09-26 15:18:00
|
2123-09-26 15:48:00
|
INDICATION: ___ with dyspnea// plz evaluate for infectious process/acute
intrathoracic process
TECHNIQUE: PA and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
The lungs are well inflated and clear without consolidation, effusion, or
edema. The cardiomediastinal silhouette is within normal limits. No acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10139992-RR-57
| 10,139,992 | 22,821,243 |
RR
| 57 |
2123-10-01 12:04:00
|
2123-10-01 13:52:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ with dyspnea// eval PNA, pneumothorax; eval PE
TECHNIQUE: Portable AP chest
COMPARISON: Comparison is made to ___.
FINDINGS:
Bilateral lungs are clear without evidence of consolidation or effusion. The
cardiomediastinal silhouette is unremarkable.
IMPRESSION:
No acute intrathoracic abnormality.
|
10139992-RR-58
| 10,139,992 | 22,821,243 |
RR
| 58 |
2123-10-01 15:59:00
|
2123-10-01 17:04:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ history of cirrhosis status post liver transplant with
history of hepatopulmonary syndrome with dyspnea// eval PNA, pneumothorax;
eval PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 18.2 mGy (Body) DLP =
9.1 mGy-cm.
2) Spiral Acquisition 5.1 s, 40.1 cm; CTDIvol = 9.2 mGy (Body) DLP = 370.1
mGy-cm.
Total DLP (Body) = 379 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. Trace pericardial fluid likely physiologic.
AXILLA, HILA, AND MEDIASTINUM: No supraclavicular or axillary
lymphadenopathy., no mediastinal or hilar lymphadenopathy is present. No
mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Mild ground-glass opacities are noted in the left upper lobe
(2; 38) and right upper lobe (2; 27), are nonspecific and unchanged from last
week's exam. Otherwise, lungs are clear without masses or areas of
parenchymal opacification. There is minimal bronchial wall thickening
bilaterally. 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: Cholecystectomy clips are noted. Surgical clips are also noted from
history of prior liver transplant. There are prominent varices noted in the
upper mid abdomen and adjacent to the distal esophagus. Common bile duct
stent is again noted.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
No evidence of pulmonary embolism or aortic abnormality.
|
10139992-RR-67
| 10,139,992 | 23,325,882 |
RR
| 67 |
2124-02-07 09:34:00
|
2124-02-07 17:41:00
|
EXAMINATION: Ultrasound-guided non targeted liver biopsy.
INDICATION: ___ year old man with rising LFTs with a recent rejection s/p
liver transplant on ___// please perform a non-targeted liver bx to r/o
rejection. This is URGENT. Please RUSH PATH
COMPARISON: Abdominal ultrasound dated ___.
PROCEDURE: Ultrasound-guided non-targeted liver biopsy.
OPERATORS: Dr. ___, radiology resident and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee during the
key components of the procedure and reviewed and agrees with the trainee's
findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the right
hepatic lobe was performed and a suitable approach for non targeted liver
biopsy was determined. No other abnormalities were identified on the limited
imaging.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
Based on the preprocedure imaging, an appropriate skin entry site for the
biopsy was chosen. The site was marked. The skin was then prepped and draped
in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound
guidance, an 18 gauge core biopsy needle was then advanced into the liver and
a single core biopsy sample was obtained and placed in formalin. The skin was
then cleaned and a dry sterile dressing was applied. There was no immediate
complications.
SEDATION: Analgesia was provided by administering divided doses of 50 mcg
fentanyl throughout the total intra-service time of 10 minutes during which
patient's hemodynamic parameters were continuously monitored by an independent
trained radiology nurse.
IMPRESSION:
Uncomplicated non-targeted liver biopsy.
|
10139992-RR-68
| 10,139,992 | 23,325,882 |
RR
| 68 |
2124-02-07 06:37:00
|
2124-02-07 07:14:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: History: ___ with liver tx on immunosuppression w/
fevers/chills// evaluate for pneumonia or acute process
TECHNIQUE: Chest PA and lateral
COMPARISON: CTA chest from ___. Chest radiographs from ___.
FINDINGS:
The cardiomediastinal and hilar contours are normal. No focal consolidations
are seen. There is no pulmonary edema or pleural abnormality. Surgical clips
project over the mid upper abdomen
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10139992-RR-69
| 10,139,992 | 23,325,882 |
RR
| 69 |
2124-02-07 08:01:00
|
2124-02-07 09:27:00
|
EXAMINATION: DUPLEX DOP ABD/PEL LIMITED
INDICATION: History: ___ with liver tx w/ N/V// evaluate for liver and
vasculature
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Abdominal ultrasound from ___.
FINDINGS:
Patient is post living donor transplant.
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation. The common hepatic duct measures 2 mm. There is no
ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen measures 14.0 cm, borderline size, and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 180 cm/s. Appropriate
arterial waveforms are seen in the right hepatic artery, which has a resistive
index of 0.47. The main portal vein and the right and left portal veins are
patent with hepatopetal flow and normal waveform. Appropriate flow is seen in
the hepatic veins and the IVC.
IMPRESSION:
Patent hepatic vasculature with appropriate waveforms, overall similar to
prior.
|
10139992-RR-70
| 10,139,992 | 23,325,882 |
RR
| 70 |
2124-02-10 20:51:00
|
2124-02-10 22:42:00
|
EXAMINATION: MRCP
INDICATION: ___ year old man with EtOH cirrhosis s/p transplant c/b mild
rejection, now w/acute cholangitis s/p ERCP w/R anterior biliary stenting,
unable to cannulate R posterior branch, evaluate biliary system s/p ERCP w/R
anterior biliary stenting, unable to cannulate R posterior branch.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 5 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MRCP dated ___.
FINDINGS:
Lower Thorax: The lung bases are grossly clear. There is no pleural or
pericardial effusion. There is no cardiomegaly.
Liver: Patient is status post liver transplant with expected postsurgical
changes. The transplanted liver is normal in signal intensity and morphology.
There is no steatosis or worrisome lesion. The portal and hepatic veins are
patent.
Biliary: There is minimal intrahepatic biliary ductal dilatation. There is
no high-grade stenosis. Areas of mild narrowing near the anastomosis are
noted in the region of the biliary stent. There is minimal heterogeneous
right hepatic enhancement, which is nonspecific but may reflect known
cholangitis. No focal lesion is detected. No drainable fluid collection or
significant peribiliary enhancement. The gallbladder is surgically absent.
Pancreas: The pancreas is moderately atrophic without focal lesion or ductal
dilatation.
Spleen: The spleen is top normal in size measuring up to 13 cm without focal
lesion.
Adrenal Glands: Bilateral adrenal glands are normal.
Kidneys: Simple cysts and small hemorrhagic or proteinaceous cysts are seen
bilaterally. Bilateral kidneys are otherwise normal without suspicious focal
lesion or hydronephrosis.
Gastrointestinal Tract: No focal abnormality.
Lymph Nodes: No lymphadenopathy by imaging criteria.
Vasculature: Arterial, portal venous, and hepatic venous anastomoses appear
widely patent without focal stenosis. There is no focal abnormality.
Osseous and Soft Tissue Structures: No suspicious osseous lesion. No focal
abnormality.
IMPRESSION:
1. Status post liver transplant with mild narrowing of the biliary system near
the anastomosis and minimal intrahepatic biliary ductal dilatation. No
high-grade stenosis. Biliary stent in situ. No focal lesion.
2. Mildly heterogeneous right hepatic enhancement may reflect known mild
cholangitis. No focal fluid collection.
|
10139992-RR-71
| 10,139,992 | 23,325,882 |
RR
| 71 |
2124-02-11 17:42:00
|
2124-02-11 19:07:00
|
INDICATION: ___ year old man with new left 48cm PICC// PICC tip location
Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of a left PICC line projects over the distal SVC.
The lungs are hyperexpanded. There is no focal consolidation, pleural
effusion or pneumothorax identified. The size of the cardiac silhouette is
within normal limits.
IMPRESSION:
The tip of the left PICC line projects over the distal SVC. No pneumothorax.
|
10140454-RR-5
| 10,140,454 | 27,352,547 |
RR
| 5 |
2173-09-18 08:32:00
|
2173-09-18 10:55:00
|
INDICATION: ___ man with fever, leukocytosis, productive cough.
Assess for pneumonia.
COMPARISONS: None.
FINDINGS: There are multiple bilateral pulmonary nodules consistent with
metastatic disease. There is no evidence of focal consolidation, pleural
effusion, or pneumothorax. The cardiac silhouette is mildly enlarged and
aorta is slightly tortuous. Osseous structures are unremarkable.
IMPRESSION: Multiple bilateral pulmonary nodules most consistent with
metastatic disease.
|
10140454-RR-6
| 10,140,454 | 27,352,547 |
RR
| 6 |
2173-09-23 15:29:00
|
2173-09-23 16:23:00
|
CLINICAL HISTORY: ___ man with persistent leukocytosis and leg
swelling. Evaluate for DVT.
FINDINGS: Grayscale and color Doppler sonograms with spectral analysis of the
bilateral common femoral, superficial femoral, popliteal, and posterior tibial
veins were performed. There is normal compressibility, flow, and
augmentation.
The left peroneal veins demonstrate normal compressibility. The right peroneal
veins were not visualized.
IMPRESSION: No bilateral lower extremity DVT. Right peroneal veins not
visualized.
|
10140532-RR-2
| 10,140,532 | 28,085,231 |
RR
| 2 |
2144-07-07 16:17:00
|
2144-07-07 16:48:00
|
EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: History: ___ with polycystic kidney disease. Evaluate for
obstructing renal stone
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.1 s, 56.0 cm; CTDIvol = 7.5 mGy (Body) DLP = 418.8
mGy-cm.
Total DLP (Body) = 419 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
Lack of contrast limits evaluation.
HEPATOBILIARY: There is a subcentimeter hypodensity in segment VIII (___),
too small to characterize, but likely a cyst. The liver otherwise
demonstrates homogeneous attenuation throughout. There is no evidence of
focal lesions within the limitations of an unenhanced scan. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Multicystic and enlarged appearance of both kidneys is present with
limited visualization of the renal parenchyma. There are a few scattered
higher density cysts, likely hemorrhagic cysts, more so on the right kidney.
There are a few punctate 1-2 mm non-obstructive calculi in the right kidney
(for example, ___, 31, 40) and in the left kidney (for example, ___, 42, 37,
30). There is no hydronephrosis. there is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is not visualized.
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. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of obstructing urolithiasis, as clinically questioned.
2. Enlarged polycystic kidneys bilaterally with multiple punctate
nonobstructive renal calculi bilaterally.
3. Some of the renal cysts bilaterally appear hyperdense likely reflective of
hemorrhagic cysts.
4. Sub cm hepatic hypodensity in segment VIII, likely a cyst.
|
10140907-RR-10
| 10,140,907 | 23,984,083 |
RR
| 10 |
2133-04-17 15:36:00
|
2133-04-17 16:01:00
|
HISTORY: Patient with old infarct, now with worsening symptoms. Evaluate for
CVA.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast. Subsequently helical acquired axial images were obtained through
the head and neck using a CTA protocol after the uneventful administration of
70 cc of Omnipaque intravenous contrast. Curved reformats, volume rendered
reformations and CTA maximum intensity projection images were generated on an
independent work station. In addition, CT perfusion was performed and blood
flow, blood volume and mean transit time maps created on an independent work
station.
COMPARISON: MR head from ___ and CTA head from ___.
FINDINGS:
Head CT: There is a hypodensity within the right caudate head and putamen
consistent with evolution of infarction. There are additional new
hypodensities in the right temporal lobe and right frontal lobe. Within the
prior infarct in the right caudate head, there is a small hyperdensity which
could possibly represent a small area of hemorrhage. There is associated mass
effect from the edema of the infarct with effacement of the frontal horn of
the right lateral ventricle. No hydrocephalus is present. No fracture is
identified.
CT perfusion: There is a matched perfusion deficit in the entire right MCA
territory. This deficit is larger in size compared to the prior MR diffusion
weighted imaging which demonstrated restricted diffusion in the right basal
ganglia.
Head and neck CTA: Again seen is a filling defect in the mid aspect of the
right M1 segment, unchanged in appearance from the prior CTA. There is normal
appearance of the rest of the MI and M2 branches. There are no intraluminal
caliber irregularity to suggest dissection or aneurysm. The cervical carotid
and vertebral arteries are patent with no evidence of stenosis. Imaged
portions of the lung apices are clear.
IMPRESSION:
1. Perfusion deficit consistent with right MCA territory infarct which is
increased in size compared to the prior diffusion weighted imaging. Unchanged
intraluminal filling defect in the right MCA.
2. Small hyperdensity in the right caudate head in the region of prior infarct
could possibly represent a small area of hemorrhage.
NOTIFICATION: Telephone notification to Dr. ___ by Dr. ___ Dr.
___ at 16:15 on ___ at time of review of study.
|
10140907-RR-11
| 10,140,907 | 23,984,083 |
RR
| 11 |
2133-04-18 01:46:00
|
2133-04-18 11:00:00
|
HISTORY: Recent stroke.
COMPARISON: MR from ___, and CTAs from ___ and ___.
TECHNIQUE: Multiplanar MR images are acquired through the head without
intravenous contrast.
FINDINGS: There are numerous punctate foci of abnormal slow diffusion
scattered throughout the right middle cerebral artery distribution, the
majority of which are new since ___. In addition, more confluent
abnormally slow diffusion in the right basal ganglia and periventricular white
matter has also increased in size. Susceptibility artifact is noted within
the head of the caudate nucleus on the right, anterior limb of the right
internal capsule and right lentiform nucleus, consistent with interval
hemorrhage. There is increased mass effect and region of the right basal
ganglia, with partial effacement of the right lateral ventricle, which is
increased from the comparison examination.
IMPRESSION: Interval increase in the extent of right middle cerebral arterial
distribution embolic infarction as above, as well as interval development of
right basal ganglionic hemorrhagic transformation.
COMMENT: Results discussed with Dr. ___ (Neurology service) by Dr.
___ telephone, at 10:58 AM on ___, the time of initial
interpretation.
|
10140907-RR-12
| 10,140,907 | 23,984,083 |
RR
| 12 |
2133-04-18 12:32:00
|
2133-04-18 15:39:00
|
NON-CONTRAST HEAD CT, ___
INDICATION: Recent right basal ganglia infarction complicated by further
ischemic injury in the right middle cerebral artery distribution. Assess
interval change.
COMPARISON: CT scans from ___ and ___, and brain MRIs from ___ and ___.
TECHNIQUE: Non-contrast head CT.
FINDINGS: Again seen is a subacute infarction involving the right lentiform
and caudate nuclei, as well as the surrounding white matter. Within the
hypodense area of infarction, there are now two foci of isodensity to the
brain parenchyma, located in the right caudate head and in the right anterior
internal capsule. These correspond to low signal on gradient echo images of
the ___ MRI, but are new compared to ___ and ___, indicating
subacute hemorrhagic transformation. There are also multiple small foci of
low density in the right frontal and parietal lobes, slightly better seen than
on ___, corresponding to acute infarction seen on the ___ MRI, but new
since ___ MRI. Effacement of the frontal horn and anterior body of the
right lateral ventricle is similar to one day earlier. The third ventricle is
not compressed, and there is no significant shift of midline structures. No
new abnormalities are seen.
Mucosal thickening and fluid are seen in bilateral ethmoidal air cells, likely
related to prolonged supine positioning.
IMPRESSION: Subacute infarct centered in the right basal ganglia with
subacute hemorrhagic transformation. More recent acute to early subacute
infarcts in the right frontal and parietal lobes. No significant change
compared to one day earlier.
|
10140907-RR-13
| 10,140,907 | 23,984,083 |
RR
| 13 |
2133-04-20 11:41:00
|
2133-04-20 15:07:00
|
HISTORY: Right MCA stroke now with worsening weakness, evaluate for interval
changes.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast.
COMPARISON: Nonenhanced head CT from ___.
FINDINGS:
Compared to the prior study ___, there is no significant change. Again
seen is a subacute infarction involving the deep right basal ganglia. Within
the hypodense areas of infarction there are foci of isodensity to the to the
brain consistent with subacute hemorrhage which continues to evolve. Multiple
small foci of hypodensity in the right frontal and parietal lobes continue to
evolve. Effacement to the frontal horn and anterior body of the right lateral
ventricle similar to the prior study. The ___ ventricle and basal cisterns
remain patent. There is no significant shift of midline structures. No new
hemorrhage or infarction is appreciated.
No fractures identified. Mucosal thickening and fluid are again seen in the
bilateral ethmoid air cells.
IMPRESSION:
Expected evolution of the subacute infarct centered in the right basal ganglia
with subacute hemorrhagic transformation. More recent subacute infarcts in
the right frontal and parietal lobes also continue to evolve. No significant
change compared to the most recent prior study.
|
10140907-RR-14
| 10,140,907 | 23,984,083 |
RR
| 14 |
2133-04-21 01:49:00
|
2133-04-21 10:43:00
|
HISTORY: Interval clinical worsening in patient with known right middle
cerebral arterial distribution stroke.
COMPARISON: MRI from ___ and ___.
TECHNIQUE: Multiplanar MR images are acquired through the head without
intravenous contrast.
FINDINGS: There is extensive abnormally slow diffusion throughout the right
middle cerebral arterial vascular distribution, which appears worse since ___, though unchanged since ___. A small focus of abnormally
slow diffusion is noted in the right cerebral peduncle (series 4, image 11).
This area is faintly hyperintense on the FLAIR images, and has increased in
conspicuity the MR examination of ___. Susceptibility artifact
indicating blood products in the basal ganglia on the right is also unchanged
since ___. There is no interval intracranial hemorrhage. Mass
effect upon the right lateral ventricle is stable.
IMPRESSION: Redemonstration of right middle cerebral arterial distribution
infarctions, including hemorrhage in the right basal ganglia, all of which
appears unchanged since ___. A new focus of slow diffusion in the
right cerebral peduncle has evolved since ___ and may be related to
Wallerian-type degeneration.
|
10140907-RR-8
| 10,140,907 | 20,057,418 |
RR
| 8 |
2133-04-12 08:18:00
|
2133-04-12 08:42:00
|
HISTORY: Stroke symptoms.
COMPARISON: CT from ___.
TECHNIQUE: Axial CT images were acquired through the head without intravenous
contrast. Thereafter, images were acquired through the head and neck
following the uneventful intravenous administration of iodine based contrast.
Multiplanar reformatted images including maximum intensity projection images
and dedicated 3 dimensional angiographic reconstructions were created.
CT HEAD: There is abnormal, asymmetric hypodensity involving the right
caudate and putamen nuclei. There is no evidence of hemorrhage or mass
effect. Ventricles and sulci are normal in size and configuration.
CT ANGIOGRAM NECK: The aorta demonstrates a normal 3 vessel branching pattern.
The origins and courses of the vertebral arteries, common carotid arteries and
internal carotid arteries are normal. Overall there are no luminal caliber
irregularities to suggest thromboembolic filling defects, dissection or
pseudoaneurysm.
Imaged portions of the lung apices are clear as are image soft tissue
structures of the neck. Bony structures reveal no suspicious sclerotic or
lytic lesion.
CT ANGIOGRAM HEAD: Primary intracranial arterial structures demonstrate
appropriate contrast opacification. There is a focal, abrupt, severe filling
defect in the middle aspect of the right M1 segment, with normal appearance of
the distal M1 as well as M2 branches. Anatomy is conventional in orientation.
There are no luminal caliber irregularity to suggest dissection or aneurysm.
IMPRESSION: Abnormal hypodensity, consistent with infarction involving the
right caudate and lentiform nuclei. Note is made of a corresponding severe
focal filling defect, presumably an embolus, in the mid portion of the right
M1 segment.
|
10140907-RR-9
| 10,140,907 | 20,057,418 |
RR
| 9 |
2133-04-13 00:07:00
|
2133-04-13 09:19:00
|
HISTORY: Patient with left arm and face paralysis
TECHNIQUE: Routine brain imaging without contrast.
COMPARISON: Comparison was made to the CT angiography of ___.
FINDINGS:
There is an acute infarcts seen in the right basal ganglia involving the
predominant in the head of the caudate nucleus as well as the anterior limb of
the internal capsule and putamen. There is no hemorrhage identified. Minimal
mass effect is seen on the right lateral ventricle. There is no midline shift
or hydrocephalus. No other acute infarcts are seen.
IMPRESSION:
Acute infarct in the right basal ganglia region. No hemorrhage.
|
10141031-RR-7
| 10,141,031 | 25,541,845 |
RR
| 7 |
2148-05-07 09:02:00
|
2148-05-07 10:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with syncope, hypotension // eval ? edema,
cardiomegaly
TECHNIQUE: Portable chest radiograph
COMPARISON: None.
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax. No
evidence of pulmonary edema. Heart size appears mildly enlarged, although
this may be exaggerated by portable technique. No acute osseous abnormalities
are identified.
IMPRESSION:
Clear lungs. Heart size appears mildly enlarged, although this may be
exaggerated by portable technique.
|
10141031-RR-8
| 10,141,031 | 25,541,845 |
RR
| 8 |
2148-05-07 11:14:00
|
2148-05-07 12:40:00
|
EXAMINATION: CTA CHEST AND CT ABDOMEN AND PELVIS.
INDICATION: History: ___ with chest -> abdominal pain this AM, syncope this
AM with BP ___, pale, improving w/ fluids // eval ? aortic abnormalities,
AAA, dissection.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 1,852 mGy-cm.
COMPARISON: Chest radiograph ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the proximal
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: There is a single prominent lower paratracheal
node measuring 14 mm (3:60), a nonspecific finding. Other mediastinal nodes
are not pathologically enlarged by size criteria. No axillary or hilar
adenopathy. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is no focal consolidation. There is a 4 mm pulmonary
nodule in the right lower lobe (3:143). There may be an additional 3 mm
nodule in the posterior right upper lobe (3:75). 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 no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
Portal venous system is patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Spleen is normal in size and attenuation throughout. No focal lesions
are identified.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Moderately-sized hiatal hernia. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. The
colon and rectum are within normal limits. Normal appendix. There is no free
intraperitoneal fluid or free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate gland and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. There is grade 1 anterolisthesis of L5 on S1 with bilateral
pars defects. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Nonspecific prominent left lower paratracheal node measuring 14 mm,
possibly reactive.
3. 4 mm right lower lobe pulmonary nodule, with a possible second 3 mm right
upper lobe nodule. Per ___ criteria, no follow-up needed in low-risk
patients. For high risk patients, recommend follow-up at 12 months and if no
change, no further imaging needed.
4. Moderate hiatal hernia.
RECOMMENDATION(S): In the case of nodule size <= 4 mm: No follow-up needed in
low-risk patients. For high risk patients, recommend follow-up at 12 months
and if no change, no further imaging needed.
|
10141035-RR-10
| 10,141,035 | 24,588,863 |
RR
| 10 |
2144-12-11 09:38:00
|
2144-12-11 16:13:00
|
INDICATION: Cough.
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal and lateral chest radiographs.
FINDINGS:
A small right and moderate left pleural effusions are new since ___. There is moderate left lower lobe atelectasis. Underlying
consolidation cannot be entirely excluded. There is no pneumothorax. The
cardiac and mediastinal contours remain within normal limits.
IMPRESSION:
1. New small right and a moderate left pleural effusions.
2. Moderate left lower lobe atelectasis. Underlying consolidation cannot be
excluded.
|
10141035-RR-11
| 10,141,035 | 24,588,863 |
RR
| 11 |
2144-12-13 12:38:00
|
2144-12-13 18:09:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with bladder tumor and right nephrostomy tube.
// ?LEFT Renal hydronephrosis? Postop day 1 following trans urethral partial
resection of bladder tumor.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: ___ MRI of the abdomen and pelvis.
FINDINGS:
The right kidney is normal in size, measuring 9.2 cm in length, without
hydronephrosis. A nephrostomy tube is visualized within the renal pelvis.
Moderate left hydronephrosis is not significantly changed from prior MRI. Both
kidneys demonstrate normal cortical thickness with normal corticomedullary
differentiation.
The bladder is partially decompressed around the Foley catheter. Diffuse
bladder wall thickening appears somewhat decreased compared with the MRI
study, although accurate comparison is difficult between modalities.
Mild perihepatic and perisplenic ascites is new in the interval.
IMPRESSION:
1. Moderate left hydronephrosis unchanged from ___ MRI.
2. Previous right-sided hydronephrosis now decompressed by percutaneous
nephrostomy tube.
3. Mild ascites .
|
10141035-RR-4
| 10,141,035 | 24,374,681 |
RR
| 4 |
2144-11-16 23:48:00
|
2144-11-17 09:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with expiratory wheezes // r/o pulmonary edema
COMPARISON: No comparison
IMPRESSION:
The lung volumes are high an show evidence of overinflation. Bilateral apical
symmetrical thickening. No evidence of lung nodules or masses. No pneumonia,
no pulmonary edema. Normal size of the cardiac silhouette.
|
10141035-RR-5
| 10,141,035 | 24,374,681 |
RR
| 5 |
2144-11-17 07:59:00
|
2144-11-17 14:15:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with acute renal failure // r/o obstruction
TECHNIQUE: Grey scale ultrasound images of the kidneys were obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 9.5 cm. The left kidney measures 9.9 cm. There is no
hydronephrosis. No cyst or stone or suspicious solid mass is seen in either
kidney. Normal cortical echogenicity and corticomedullary differentiation are
seen bilaterally. No perinephric fluid collection is identified.
The bladder is entirely filled with a large echogenic mass which measures 6.8
x 8.3 x 5.6 cm. Arterial and venous flow is identified within this mass on
color and spectral waveform Doppler. The appearance is consistent with
urothelial carcinoma. A Foley catheter balloon is also noted within the
bladder adjacent to the mass.
IMPRESSION:
1. Large vascularized mass filling the urinary bladder most consistent with a
urothelial carcinoma.
2. Unremarkable appearance of the kidneys.
NOTIFICATION: These findings were discovered at 11:45 on ___
and were conveyed by telephone to Dr. ___ at 14:14 on the same day.
|
10141035-RR-7
| 10,141,035 | 24,588,863 |
RR
| 7 |
2144-12-07 16:07:00
|
2144-12-08 13:23:00
|
EXAMINATION: MRI of the abdomen and pelvis with and without contrast.
INDICATION: ___ w/ recently diagnosed urothelial carcinoma, recurrent UTI,
h/o breast cancer, htn/hl, presented from her assisted living facility w/
sepsis. // eval urothelial carcinoma
TECHNIQUE: Multiplanar MRI of the abdomen and pelvis is obtained at 1.5 Tesla
per the MR urogram protocol. T1 and T2 weighted sequences are acquired both
pre and post administration of 15 mL of ProHance.
COMPARISON: Renal ultrasound dating ___
FINDINGS:
A foley catheter enters are moderately distended urinary bladder, traversing a
6.3 x 7.2 x 7.3 cm mass arising from the posterior wall/bladder base (22:72).
This mass is heterogeneously T2 iso- to hyperintense, T1 hypointense,
demonstrates restricted diffusion, and is avidly enhancing. The configuration
is frondlike, extending into the lumen of the bladder. There is surrounding
layering nonenhancing debris, likely representing blood products. Along the
posterior bladder wall, there are focal areas of loss of the retrovesical fat
plane with the adjacent upper uterine segment, concerning for local invasion
(22:75 and 21:58).
Bilateral distal ureters are dilated as they approach the trigone (22:82). No
enhancing tumor is seen within the ureters. Mild prominence of the upper
collecting systems bilaterally, left greater than right, and lack of contrast
excretion into the collecting systems is indicative of obstruction.
There are bilateral renal cysts. Layering hemorrhagic or proteinaceous
material is seen within a single cyst along the superior pole of the right
kidney.
There is a moderate amount of free pelvic fluid within the cul de sac. No
pelvic, retroperitoneal or inguinal lymphadenopathy is identified.
Scattered hepatic cysts are noted. No concerning hepatic lesion is seen.
Pancreas, spleen and adrenal glands are unremarkable.
There are small bilateral pleural effusions as well as diffuse muscular edema.
The osseous structures are notable for mild dextroscoliosis with apex at L2-3
and associated mild degenerative changes. No concerning lesion for osseous
metastases is noted.
IMPRESSION:
Large bladder mass, consistent with a primary urothelial neoplasm, most likely
urothelial carcinoma. While the majority appears contained within the
bladder, there is concern for local invasion posteriorly with loss of fat
plane between the bladder and uterus. No distal metastases are identified.
Bilateral renal collecting systems are obstructed at the UV junctions, without
extension of tumor into the ureters.
|
10141035-RR-8
| 10,141,035 | 24,588,863 |
RR
| 8 |
2144-12-09 13:15:00
|
2144-12-09 19:02:00
|
INDICATION: ___ year old woman with urothelial carcinoma s/p partial
cystectomy. Requires b/l PCN. // Concern for obstructive uropathy which may
occur following surgery and induction chemo/radiation
COMPARISON: MRI ___, ultrasound ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
125mcg of fentanyl and 2.5 mg of midazolam throughout the total intra-service
time of 100 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, midazolam, lidocaine
CONTRAST: 40 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 22 min, 61 mGy
PROCEDURE: 1. Right ultrasound guided renal collecting system access.
2. Right nephrostogram.
3. 8 ___ right nephrostomy tube placement.
4. Limited left renal ultrasound.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right and left flanks were prepped and draped in the usual
sterile fashion.
Preliminary ultrasound of both kidneys was performed.
The left kidney appeared non dilated on ultrasound. The right kidney showed
mildly dilated calyces. given findings a decision was made to perform right
renal collecting system access.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the right renal collecting system was accessed through a posterior lower pole
calyx under ultrasound guidance using a 21 gauge Cook needle. Ultrasound
images of the access were stored on PACS. Prompt return of urine confirmed
appropriate positioning. Injection of a small amount of contrast outlined a
small renal collecting system. Under fluoroscopic guidance, a Nitinol wire was
advanced into the renal collecting system. After a skin ___, the needle was
exchanged for an Accustick sheath. Once the tip of the sheath was in the
collecting system; the sheath was advanced over the wire, inner dilator and
metallic stiffener. The wire and inner dilator were then removed and diluted
contrast was injected into the collecting system to confirm position.
Due to the small capacity of the right renal pelvis, a wire could not be
easily coiled in the collecting system. A C2 catheter was now advanced within
the Accustick sheath and used to guide a glidewire down the ureter. The
glidewire was now exchanged for an Amplatz wire and the catheter and sheath
were removed. The tract was dilated with 6 and 8 ___ dilators. The 8 ___
nephrostomy tube was now advanced over the wire. Due to the small opacity at
the right renal collecting system the pigtail could not be fully formed.
Position of the pigtail was optimized in the collecting system and the pigtail
was secured after ensuring that no sideholes were outside the collecting
system. Contrast injection was performed to confirm position. The drain was
flushed, attached to bag, and secured to the skin with a 0 silk suture and a
Stat Lock device. A dry sterile dressing was applied. The patient tolerated
the procedure well. There were no immediate postprocedure complications.
FINDINGS:
1. Mild right sided hydronephrosis.
2. Appropriate position of the right percutaneous nephrostomy tube. The
pigtail is not fully formed the to the small capacity of the right renal
pelvis.
IMPRESSION:
Successful placement of an 8 ___ right nephrostomy tube. Due to the
difficulty placing a nephrostomy in a minimally dilated collecting system,
placement of a left percutaneous nephrostomy catheter was deferred at this
time. Left sided drainage may be revisited if the patient develops more
pronounced left hydronephrosis. Ultrasound follow up is advised.
|
10141035-RR-9
| 10,141,035 | 24,588,863 |
RR
| 9 |
2144-12-10 12:41:00
|
2144-12-10 13:42:00
|
EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old woman with bladder tumor with edematous hands //
?clot in Left Upper extremity
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left internal jugular and axillary veins are patent and compressible with
transducer pressure.
The left brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity.
|
10141487-RR-20
| 10,141,487 | 24,889,188 |
RR
| 20 |
2119-08-10 02:59:00
|
2119-08-10 04:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with intubation, etoh// eval post intubation
COMPARISON: None
FINDINGS:
Portable semi-upright view of the chest provided.
Patient is status post placement of ETT which terminates approximately 3.6 cm
superior to the carina. An enteric tube is also seen coursing below the
diaphragm terminating within the stomach. Low lung volumes explain
bronchovascular crowding and exaggerate size of the cardiac silhouette, which
could be normal. Retrocardiac opacification likely represents atelectasis.
The right lung is clear. No pleural effusion or pneumothorax present.
IMPRESSION:
1. ETT terminates approximately 3.6 cm the carina.
2. Probable retrocardiac atelectasis with no definite focal consolidations
identified.
|
10141487-RR-21
| 10,141,487 | 24,889,188 |
RR
| 21 |
2119-08-10 03:26:00
|
2119-08-10 03:45:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111
INDICATION: History: ___ with obtunded, deviated eyes// eval bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute large territory infarction,hemorrhage,edema, or
mass effect. The ventricles and sulci are normal in size and configuration.
There is no evidence of fracture. Mild bilateral ethmoidal air cell mucosal
thickening is demonstrated otherwise the visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Dysconjugate
gaze. Otherwise, the orbits are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality on noncontrast head CT.
2. Dysconjugate gaze. Otherwise orbits are unremarkable.
|
10141505-RR-100
| 10,141,505 | 24,681,640 |
RR
| 100 |
2204-06-02 22:39:00
|
2204-06-03 09:03:00
|
PA AND LATERAL CHEST, ___
COMPARISON: Radiograph ___.
FINDINGS: Heart size and mediastinal contours are normal. The right hilum is
asymmetrically enlarged compared to the left hilum but has a similar size and
configuration compared to a baseline radiograph ___. A chest CT
performed in ___ demonstrated no evidence of a right hilar mass, and
the observed asymmetry is probably due to a combination of a slight rotation
related to mild scoliosis and a prominent pulmonary vascularity.
Lungs are slightly hyperexpanded but grossly clear. There are no pleural
effusions or pneumothoraces.
IMPRESSION: No radiographic evidence of pneumonia.
|
10141505-RR-99
| 10,141,505 | 24,681,640 |
RR
| 99 |
2204-06-02 11:14:00
|
2204-06-02 12:17:00
|
INDICATION: Perirectal abscess, status post I&D 10 days ago.
COMPARISON: CT pelvis, ___.
TECHNIQUE: Axial MDCT images were taken through the pelvis without the
administration of oral contrast. IV contrast was administered. Coronal and
sagittal reformats were also examined.
DLP: 628.96 mGy-cm.
FINDINGS: Diverticulosis is present without diverticulitis. The visualized
small and large bowel are otherwise unremarkable. There is no mesenteric or
retroperitoneal lymphadenopathy. Atherosclerotic calcifications are again
noted. There are no abdominal wall hernias. Diastasis of the anterior
abdomina wall is noted. There is no ascites.
The bladder is well distended and is otherwise unremarkable. The prostate and
seminal vesicles are normal. There is no pelvic free fluid. There is no
pelvic sidewall or inguinal lymphadenopathy.
Again noted is a small infralevator perianal abscess at the 6:00 location,
measuring 1.9 x 2.3 x 1.9 cm, slightly smaller compared to the prior study.
No suspicious lesion is seen in the visualized osseous structures. Multilevel
degenerative changes are again noted.
IMPRESSION:
Small perianal abscess, slightly smaller in size compared to the recent prior
study.
|
10141577-RR-12
| 10,141,577 | 28,822,575 |
RR
| 12 |
2169-08-07 02:45:00
|
2169-08-07 04:10:00
|
HISTORY: Cough and low-grade temperatures.
COMPARISON: ___ and ___.
FINDINGS: 2 views were obtained of the chest. Large retrocardiac opacity is
unchanged from the recent comparison from ___ but
progressed from ___. On review of imaging in the ___ system, the
left lower lung has not been clear since surgery. The remainder of the lung
is clear. Moderate cardiomegaly and mitral valve prosthesis are unchanged.
Sternal wires are intact. There is no pneumothorax or right pleural effusion.
IMPRESSION: Increased retrocardiac opacity. Diagnostic considerations include
pneumonia with pleural effusion, post-pericardiotomy syndrome, airway
obstruction and diaphragmatic paralysis, though this is less likely given the
normal position of the colonic and gastric air bubbles.
Findings were discussed by phone with S. ___, PA for cardiac surgery,
by Dr. ___ by phone at ___.
|
10141577-RR-13
| 10,141,577 | 28,822,575 |
RR
| 13 |
2169-08-08 16:46:00
|
2169-08-09 08:26:00
|
CHEST RADIOGRAPH
INDICATION: Evaluation for pleural effusions and consolidations.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the effusion on the left
has minimally increased. Also increased are the subsequent atelectasis at the
left lung bases. The right lung and the overall shape of the cardiac
silhouette are constant in appearance.
|
10141695-RR-11
| 10,141,695 | 29,073,061 |
RR
| 11 |
2131-03-15 01:07:00
|
2131-03-15 08:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with tachycardia, perforated appendicitis. Eval for
CHF/pneumonia.
TECHNIQUE: Single portable AP view of the chest.
COMPARISON: Chest radiograph of ___.
FINDINGS:
Lower lung volumes cause bronchovascular crowding. Bibasilar atelectasis is
identified. However no focal consolidation concerning for pneumonia. No
pneumothorax. The heart size, mediastinal, and hilar contours are normal.
IMPRESSION:
No acute cardiopulmonary process.
|
10141695-RR-12
| 10,141,695 | 29,073,061 |
RR
| 12 |
2131-03-18 11:26:00
|
2131-03-18 14:58:00
|
EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with perforated appendicitis and failure to
improve on antibiotics // Please eval for abscess formation or leak. Please
give PO and IV contrast.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
4) Spiral Acquisition 4.9 s, 53.4 cm; CTDIvol = 12.0 mGy (Body) DLP = 641.6
mGy-cm.
Total DLP (Body) = 654 mGy-cm.
COMPARISON: ___
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions and atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. The small bowel is distended
up to 4 cm with multiple air-fluid levels and a transition point in the right
lower quadrant secondary to a previously seen fluid collection with adjacent
bowel wall edema and thickening at site of prior perforated appendicitis
(2:59). There has been interval increase in the size of previously seen fluid
collection containing air adjacent to the cecum (2:62), which tracks along the
cul-de-sac and anterior to the uterus (602b: 21), measuring approximately 2.4
x 8.5 cm (601b:26).
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: There are fibroids within the uterus.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Interval increase in fluid collection containing air in the right lower
quadrant at site of prior perforated appendix, which extends along the
cul-de-sac and anterior to the uterus, with adjacent bowel inflammation
causing small bowel obstruction.
2. Small Bilateral pleural effusions and atelectasis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 2:26 ___, 5 minutes after discovery of the
findings.
|
10141695-RR-13
| 10,141,695 | 29,073,061 |
RR
| 13 |
2131-03-19 14:29:00
|
2131-03-19 16:38:00
|
EXAMINATION: CT-guided drainage
INDICATION: ___ year old woman with ruptured appendicitis now has
intraabdominal abscess // ___ abscess drainage
COMPARISON: CT abdomen and pelvis ___
PROCEDURE: CT-guided drainage of right lower quadrant collection.
OPERATORS: Dr. ___ radiology fellow and Dr. ___,
___ radiologist. Dr. ___ supervised the trainee during the
key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 10 cc of serosanguineous fluid was aspirated with a sample sent
for microbiology evaluation. The catheter was secured by a StatLock. The
catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 6.1 s, 18.7 cm; CTDIvol = 14.6 mGy (Body) DLP = 253.0
mGy-cm.
4) Stationary Acquisition 5.1 s, 1.4 cm; CTDIvol = 52.3 mGy (Body) DLP =
75.3 mGy-cm.
Total DLP (Body) = 338 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 3
mg Versed and 150 mcg fentanyl throughout the total intra-service time of 25
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Right lower quadrant fluid collection re- demonstrated, difficult to
measure without contrast.
2. Persistent dilation of left hemi abdominal small bowel loops, partially
visualized.
3. Sigmoid diverticulosis.
4. Trace free fluid in the pelvis.
5. Uterine fundus hypodensity consistent with previously characterized
fibroid.
6. Mild soft tissue edema.
7. Appropriately placed drainage catheter within the collection.
IMPRESSION:
CT-guided placement of an ___ pigtail catheter into the collection with
aspiration of 10 cc serosanguineous fluid. Samples was sent for microbiology
evaluation.
|
10141695-RR-14
| 10,141,695 | 29,073,061 |
RR
| 14 |
2131-03-21 14:10:00
|
2131-03-21 16:39:00
|
INDICATION: ___ year old woman s/p ruptured appendix, s/p ___ drainge // rising
WBC, concern for abscess formation
TECHNIQUE: Multidetector CT images through the abdomen and pelvis were
obtained after the uneventful administration of intravenous and oral contrast.
Water-soluble contrast was administered. Coronal and sagittal reformations
were generated and reviewed.
DOSE: Total DLP (Body) = 619 mGy-cm.
COMPARISON: CT abdomen and pelvis performed ___.
FINDINGS:
Chest: Relative to prior examination, bilateral layering and nonhemorrhagic
pleural effusions are smaller. Bibasilar atelectasis is mild. A small
pericardial effusion is noted.
Abdomen: The liver appears homogeneous in attenuation without a focal lesion
identified. There is no intrahepatic biliary duct dilation. The gallbladder
is without radiopaque cholelithiasis. The portal veins are patent. The
pancreas, spleen, and bilateral adrenal glands are normal in appearance.
The kidneys present symmetric nephrograms and excretion of contrast. There is
no focal lesion, hydronephrosis, or perinephric fluid collection.
Loops of small bowel are dilated with air-fluid levels not significantly
changed in appearance relative to prior study dated ___. There is
been interval placement of a pigtail catheter through the subcutaneous tissues
of the right lower anterior abdominal wall. A multiloculated right lower
quadrant fluid collection is is not changed in size or extent. On sagittal
images, this extends around the anterior aspect of the uterus measuring
approximately a 4.7 x 1 1.9 cm (7b:47). This communicates with laterally and
superiorly located fluid collection which measures approximate 3.7 x 5.3 cm in
size (5:67). This continues superiorly along the anterior and lateral right
abdominal wall, which measures approximately 4.2 x 3.2 cm as seen on the
sagittal images (7b:24). Locules of air are identified within the fluid
collection which may be iatrogenic in etiology though infection cannot be
entirely excluded. A fluid collection within the cul-de-sac measures
approximately 2.0 x 3.1 cm (5:78) now with apparent rim enhancement.
The bladder is moderately well distended and grossly unremarkable. A fibroid
uterus is again identified. Scattered pelvic sidewall nodes are not
pathologically enlarged and likely reactive in etiology. There is no inguinal
adenopathy.
Osseous structures: No suspicious lytic or blastic lesion is identified.
IMPRESSION:
1. Interval placement of pigtail catheter within a previously described right
lower quadrant multiloculated fluid collection with no significant change in
size and persistent locules of air. A fluid collection within the cul-de-sac
as well as anterior to the uterus persist, the former which demonstrates new
rim enhancement. Edematous adjacent bowel results in statis/early small bowel
obstruction which is unchanged in appearance.
2. Interval decrease in size of small bilateral pleural effusions. A
pericardial effusion is small.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 4:34 ___, 15 minutes after discovery of the
findings.
|
10141695-RR-15
| 10,141,695 | 29,073,061 |
RR
| 15 |
2131-03-23 11:16:00
|
2131-03-24 09:44:00
|
EXAMINATION: CT-guided right lower quadrant abscess drainage and catheter
upsize
INDICATION: ___ year old woman with pelvic abscess.
COMPARISON: ___
PROCEDURE: CT-guided drainage of right lower quadrant collection with
catheter up sizing.
OPERATORS: Dr. ___, radiology trainee and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection and drain
location. Based on the CT findings upsizing the drain was deemed appropriate.
Local anesthesia was administered with 1% Lidocaine solution.
Using intermittent CT fluoroscopic guidance, the current catheter was cut, and
a 0.035 wire was placed through the drain to maintain access. A ___ F
dilatator was used to expand the dermis, followed by placement of a ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 5 cc of purulent fluid was initially aspirated. The catheter was
secured by a StatLock. The catheter was attached to a bag to gravity. Sterile
dressing was applied.
DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer
Radiograph 3) Spiral Acquisition 5.9 s, 18.0 cm; CTDIvol = 16.0 mGy (Body)
DLP = 267.5 mGy-cm. 4) Stationary Acquisition 2.5 s, 1.4 cm; CTDIvol = 26.3
mGy (Body) DLP = 37.9 mGy-cm. Total DLP (Body) = 316 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of
3.5 mg Versed and 175 mcg fentanyl throughout the total intra-service time of
25 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Preliminary CT scan showed residual abscess slightly smaller compared to the
previous CT with the drain in good position. 5 cc of thick pus was aspirated.
IMPRESSION:
Successful CT-guided up-sizing of a pigtail catheter into the RLQ collection,
now with a ___ catheter.
|
10141911-RR-3
| 10,141,911 | 23,690,373 |
RR
| 3 |
2169-12-14 16:09:00
|
2169-12-14 17:04:00
|
EXAMINATION: CTA TORSO
INDICATION: ___ with AAA// Further characterize AAA on OSH CT. Please
perform CTA chest/abd/pelvis
TECHNIQUE: Chest, abdomen, and pelvis CTA: Non-contrast and multiphasic
post-contrast images were acquired through chest, abdomen, and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.4 s, 66.1 cm; CTDIvol = 7.9 mGy (Body) DLP = 520.9
mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP =
10.6 mGy-cm.
3) Spiral Acquisition 8.3 s, 65.3 cm; CTDIvol = 17.6 mGy (Body) DLP =
1,147.9 mGy-cm.
Total DLP (Body) = 1,679 mGy-cm.
COMPARISON: CT abdomen and pelvis from 5 hours prior
FINDINGS:
VASCULAR:
The abdominal aorta is tortuous with a 7.9 x 7.7 cm infrarenal abdominal
aortic aneurysm which is partially thrombosed and extends to the iliac
bifurcation. Shape is mixeed fusiform and saccular. The aorta is tortuous.
The superior mesenteric artery, and bilateral renal arteries are patent.
Celiac trunk is occluded. There is moderate calcium burden in the abdominal
aorta and great abdominal arteries.
CHEST: There is no axillary, mediastinal, or hilar adenopathy. Heart size is
mildly enlarged. No pericardial effusion. Moderate coronary artery
calcifications are noted. The main pulmonary artery is enlarged measuring up
to 3.7 cm. The thoracic aorta is of normal caliber.
There is no focal consolidation. Mild interstitial lung disease is
characterized by reticular opacities in the periphery of each lung with
minimal ground-glass, although not optimally characterized with this
technique, particularly since coinciding minor atelectasis obscures the
posterior basilar lower lobes.. Motion artifact limits evaluation for small
pulmonary nodules. The airways are patent to the subsegmental level
bilaterally.
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 decompressed and contains
small calcified stones.
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: There is mild thickening of the right adrenal gland. The left
adrenal gland is normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, solid renal lesions, or hydronephrosis. A 1.5
cm cyst is seen arising from the interpolar region of the left kidney. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening or fat
stranding. The appendix is not visualized.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The prostate is moderate to severely enlarged with
central hypertrophy. Corpora ambulation calcification.
BONES: Degenerative changes are seen in the thoracolumbar spine.
SOFT TISSUES: Bilateral inguinal hernias containing fat are noted, Left
greater than right.
IMPRESSION:
1. 7.9 partially thrombosed abdominal aortic aneurysm. No evidence of
rupture. Occlusion of the celiac trunk.
2. Enlarged main pulmonary artery, a finding which can be seen in pulmonary
arterial hypertension. This may be secondary to interstitial lung disease but
is nonspecific.
3. Cholelithiasis.
4. Mild incompletely characterized interstitial lung disease. If needed
clinically dedicated CT protocol could be used to characterize further if
needed clinically.
|
10141955-RR-39
| 10,141,955 | 24,201,243 |
RR
| 39 |
2148-03-06 04:45:00
|
2148-03-06 05:22:00
|
INDICATION: Fever and cough.
___.
FRONTAL SEMI-UPRIGHT CHEST RADIOGRAPH: There is no focal consolidation,
pleural effusion or pneumothorax. Moderate cardiomegaly has increased since
___. Mediastinal silhouette and hilar contours are normal. The patient is
status post median sternotomy. Hiatal hernia is present.
IMPRESSION: No pneumonia, edema or pleural effusion.
|
10141955-RR-40
| 10,141,955 | 24,201,243 |
RR
| 40 |
2148-03-06 04:51:00
|
2148-03-06 05:27:00
|
INDICATION: Abdominal pain and no bowel movement for several days.
COMPARISON: Upper GI ___, L-spine radiographs ___.
FINDINGS: Supine frontal views of the abdomen were obtained. There is
gaseous distention of large bowel up to descending colon. Small amount of air
is seen in the rectum. No small bowel dilation is seen. A small amount of
stool is seen within the cecum. There is no large pneumoperitoneum or
secondary signs of free air on the supine radiographs.
A catheter projects over the left hemi-abdomen. Skin staples from recent
lumbar surgery are noted.
IMPRESSION:
No obstruction. Findings may represent ileus. Further evaluation on subsequent
CT.
|
10141955-RR-41
| 10,141,955 | 24,201,243 |
RR
| 41 |
2148-03-06 05:59:00
|
2148-03-06 07:35:00
|
INDICATION: Fever, abdominal pain, constipation and large bowel distention.
COMPARISON: AXR ___.
TECHNIQUE: MDCT axial images acquired from the lung bases to the pubic
symphysis were displayed with 5-mm slice thickness with intravenous contrast.
Coronal and sagittal reformations were displayed with 5-mm slice thickness.
DLP: 853.34 mGy-cm.
CT ABDOMEN: Visualized lung bases demonstrate trace bilateral pleural
effusions. There is a small-to-moderate-sized hiatal hernia.
The liver is unremarkable without focal liver lesion identified. The
gallbladder is unremarkable. The spleen, pancreas and bilateral adrenal glands
are normal. The kidneys enhance symmetrically without hydronephrosis.
Subcentimeter hypodensity in the left renal lower pole is too small to
characterize, but most likely a cyst.
The small and large bowel are normal in course and caliber without
obstruction. There is gaseous distention of large bowel. The appendix is
visualized and is normal. Small ascites in the abdomen is nonspecific and of
unknown significance. There is no free intra-abdominal air. The abdominal
aorta is of normal caliber throughout. The main portal vein, splenic vein and
SMV are patent. No pathologically enlarged mesenteric or retroperitoneal
lymph nodes are identified.
CT PELVIS: The rectum is normal. Scattered diverticula are seen in the
sigmoid colon without inflammatory changes. The bladder is decompressed with
a Foley catheter. The uterus is absent. There is no pelvic or inguinal
lymphadenopathy.
BONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.
Small stranding and air in the posterior subcutaneous tissues with posterior
skin staples is related to recent discectomy and laminectomy.
IMPRESSION:
1. No acute intra-abdominal process. Gaseous distention of large bowel without
obstruction.
2. Small ascites is nonspecific and of unknown significance.
3. Small-moderate hiatal hernia.
|
10142207-RR-15
| 10,142,207 | 23,369,630 |
RR
| 15 |
2131-07-12 00:31:00
|
2131-07-12 03:13:00
|
INDICATION: ___ male with seizures, question of subdural hemorrhage
on outside head CT with poor study, evaluate for subdural hemorrhage or
intracranial process.
COMPARISON: Outside hospital head CT, ___ obtained at 1840.
TECHNIQUE: Contiguous axial images were obtained through the brain without
the administration of IV contrast. Multiplanar reformats were generated and
reviewed.
FINDINGS: There is no evidence of infarction, hemorrhage, discrete masses,
mass effect or shift of normally midline structures. The ventricles and sulci
are normal in size and configuration.
Bilateral mastoid air cells are clear. There are mucosal secretions within
the sphenoid sinus as well the nasal cavity, likely representing intubation.
There is mucosal thickening involving bilateral maxillary sinuses. The globes
are intact.
IMPRESSION:
1. No evidence of hemorrhage or infarction.
2. Mucosal thickening involving the sphenoid and maxillary sinuses as well as
secretions within the nasal cavity likely representing intubation.
|
10142207-RR-16
| 10,142,207 | 23,369,630 |
RR
| 16 |
2131-07-12 05:58:00
|
2131-07-12 11:49:00
|
INDICATION: ___ male status post central line placement.
COMPARISON: Comparison is made with chest radiographs from ___.
FINDINGS: Two frontal images of the chest demonstrate interval placement of a
right subclavian central line which terminates with the tip in the right
atrium near the cavoatrial junction. There is no pneumothorax or other
complication seen. Lung volumes are low likely secondary to poor inspiration.
There is no pulmonary opacity or pleural effusion seen. Cardiomediastinal
silhouette is unchanged from prior imaging. Again seen is an ET tube in
position and an NG tube in appropriate position.
IMPRESSION: Right subclavian line with the tip in the right atrium near the
cavoatrial junction. Otherwise, unchanged chest radiograph.
|
10142207-RR-17
| 10,142,207 | 23,369,630 |
RR
| 17 |
2131-07-13 04:16:00
|
2131-07-13 09:53:00
|
HISTORY: Endotracheal tube with possible pneumonia.
FINDINGS: In comparison with the study of ___, the patient has taken a much
better inspiration. Cardiac silhouette is at the upper limits of normal in
size. No evidence of vascular congestion. No definite pleural effusion or
substantial volume loss.
The endotracheal tube has been removed. The right subclavian catheter extends
to lower portion of the SVC.
|
10142207-RR-19
| 10,142,207 | 27,739,425 |
RR
| 19 |
2136-03-31 15:29:00
|
2136-03-31 17:00:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with seizure d/o p/w seizure cluster// PNA?
COMPARISON: Chest x-ray from ___
FINDINGS:
PA and lateral views of the chest provided.
No definite focal consolidation is seen. There is no pleural effusion or
pneumothorax. The aorta is slightly tortuous. The cardiac silhouette is
top-normal. No pulmonary edema is seen.
IMPRESSION:
No definite focal consolidation.
|
10142213-RR-15
| 10,142,213 | 25,711,897 |
RR
| 15 |
2163-11-09 16:11:00
|
2163-11-09 17:00:00
|
INDICATION: History: ___ with left great toe infection// assess for
osteomyelitis
TECHNIQUE: Three views of the left foot
COMPARISON: None.
FINDINGS:
There is cortical destruction of the first digit distal phalanx worrisome for
acute osteomyelitis. Associated soft tissue gas is seen in the big toe.
Posterior calcaneal enthesophyte is noted.
IMPRESSION:
Cortical destruction of the first digit distal phalanx worrisome for acute
osteomyelitis. Associated soft tissue gas in the big toe.
|
10142213-RR-16
| 10,142,213 | 25,711,897 |
RR
| 16 |
2163-11-09 20:04:00
|
2163-11-09 20:23:00
|
EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ year old man with foot infection pre op//
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Cervical fusion hardware
partially visualized in the neck. A surgical anchor is seen imbedded over the
right humeral head.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10142213-RR-18
| 10,142,213 | 25,711,897 |
RR
| 18 |
2163-11-10 09:11:00
|
2163-11-10 11:49:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man s/p L hallux amputation// postop. History
notable for presentation with acute osteomyelitis of the big toe.
TECHNIQUE: Non-weightbearing frontal, oblique, and lateral view radiographs
of the left foot.
COMPARISON: Left foot radiograph ___
FINDINGS:
There has been interval amputation of the great toe at the level of the
proximal base of the proximal phalanx. Wound VAC projects over the surgical
site. There is a large posterior calcaneal spur.
IMPRESSION:
Expected postoperative appearance.
|
10142213-RR-19
| 10,142,213 | 25,711,897 |
RR
| 19 |
2163-11-11 08:56:00
|
2163-11-11 15:03:00
|
EXAMINATION: NON-INVASIVE PERIPHERAL ARTERIAL STUDY
INDICATION: ___ year old man with L foot infection. patient recently
recommended he obtain vascular studies.// ___
TECHNIQUE: Doppler ultrasound and pulse volume recordings were obtained at
multiple levels in both lower extremities
COMPARISON: None.
FINDINGS:
On the right side, triphasic Doppler waveforms are seen in the femoral,
superficial femoral, popliteal, posterior tibial and dorsalis pedis arteries.
No monophasicwaveforms are seen.
On the left side, triphasic Doppler waveforms are seen in the femoral,
superficial femoral, popliteal, posterior tibial arteries. No
monophasicwaveforms are seen. Imaging of the dorsalis pedis artery could not
be performed due to overlying wound vac and bandaging.
The right ABI is 1.19 and the left ABI is 0.98. Pulse volume recordings
demonstrate symmetric amplitudes at the levels studied noting non imaging of
the left dorsalis pedis artery.
IMPRESSION:
No evidence of flow-limiting stenosis in either lower extremity noting non
interrogation of the left dorsalis pedis artery due to wound vac and
bandaging.
|
10142213-RR-26
| 10,142,213 | 27,416,132 |
RR
| 26 |
2164-03-19 17:24:00
|
2164-03-19 23:05:00
|
EXAMINATION: DX FOOT AND HEEL
INDICATION: History: ___ with progression of gangrene in ___ digit + swelling
in foot. s/p L hallux amp// gas? gas?
gas?
TECHNIQUE: Three-view of the left ankle.
COMPARISON: Left foot radiograph dated ___, and ___.
FINDINGS:
Patient status post amputation of the left first toe. There is equivocal
irregularity of the tip of the second digit. Lucency over the tip of the
second toe seen on oblique view could be related to the nail or soft tissue
ulceration. Underlying osteomyelitis is difficult to exclude. No acute
fracture or dislocations are seen. Well corticated bony fragment in the
medial malleolus appears old. There are mild degenerative changes of the
midfoot. Retrocalcaneal enthesophyte is noted. The mortise is congruent.
The tibial talar joint space is preserved and no talar dome osteochondral
lesion is identified. No suspicious lytic or sclerotic lesion is identified.
IMPRESSION:
1. Equivocal irregularity of the tip of the second digit. Lucency over the
tip of the second digit could be related to the nail or soft tissue
ulceration. Underlying osteomyelitis is difficult to exclude.
2. No acute fracture or dislocation.
|
10142213-RR-27
| 10,142,213 | 27,416,132 |
RR
| 27 |
2164-03-21 12:40:00
|
2164-03-23 17:20:00
|
INDICATION: ___ year old man with___ with DM and current tobacco use who is 8
weeks s/p angiogram and PTA who presents with gangrenous left ___ toe and
spreading erythema, c/f cellulitis s/p toe amp// ABI/PVRs bilateral
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.
FINDINGS:
On the right side, triphasic Doppler waveforms are seen in the common and
superficial femoral, popliteal, posterior tibial and dorsalis pedis arteries.
The right ABI was 0.99 ___ 1.04 DP. The right great toe pressure is 145 mm
Hg.
Pulse volume recordings are within normal limits..
On the left side, triphasic Doppler waveforms are seen at the common,
superficial femoral, and popliteal arteries. The posterior tibial and
dorsalis pedis arteries are monophasic.
The left ABI was 0.86 ___ 0.62 DP. Toe pressures were not obtained due to the
presence of amputation..
Left PVRs show drop-off below the knee consistent with tibial occlusive
disease.
IMPRESSION:
No evidence of arterial insufficiency to right lower extremity. Moderate left
tibial occlusive disease.
|
10142213-RR-32
| 10,142,213 | 20,154,856 |
RR
| 32 |
2164-09-06 12:47:00
|
2164-09-07 09:00:00
|
Study venous duplex lower extremity
Reason the for bypass
Findings duplex evaluation was performed of both lower extremity superficial
veins. Neither small saphenous vein is suitable conduit. Left greater
saphenous vein is patent but multiple areas where the wall is thick consistent
with phlebitis.
Right greater saphenous vein is patent with diameters ranging from 0.21 -.49.
Venous mapping study as above only suitable conduit is the right greater
saphenous vein the specially in the upper portion
|
10142213-RR-33
| 10,142,213 | 20,154,856 |
RR
| 33 |
2164-09-06 12:48:00
|
2164-09-07 08:51:00
|
Study venous duplex upper extremity
Reason bypass
Findings Doppler evaluation was performed of both upper extremity superficial
venous system. The right cephalic vein is patent in the upper arm, it is
thick walled proximally. Basilic vein has a similar pattern on the right. On
the left there is thrombus in the cephalic vein. Basilic vein is patent.
Impression venous mapping of superficial veins as above. Evaluate scanned
worksheet
|
10142213-RR-34
| 10,142,213 | 20,154,856 |
RR
| 34 |
2164-09-07 13:38:00
|
2164-09-07 16:25:00
|
EXAMINATION: KNEE (2 VIEWS) LEFT
INDICATION: Left fem-pop stent.
TECHNIQUE: Screening provided knee operating room without a radiologist
present, with apparent popliteal artery angiogram.
COMPARISON: CT angiogram ___.
FINDINGS:
Multifocal popliteal arterial stenosis is demonstrated. For details of the
procedure, please consult the procedure report.
|
10142213-RR-35
| 10,142,213 | 20,154,856 |
RR
| 35 |
2164-09-13 12:28:00
|
2164-09-13 14:10:00
|
EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old man with SFA stent thrombosis with distal
embolization sp thrombectomy with ischemic appear left forefoot// ? forefoot
ischemia
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with Doppler signal recordings, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: Arterial extremity Doppler ___
FINDINGS:
On the right side, triphasic Doppler waveforms were seen at the right femoral,
popliteal, posterior tibial and dorsalis pedis arteries. The right ABI is
1.15 at rest.
On the left side, triphasic Doppler waveforms were seen at the left femoral
and popliteal arteries. There are monophasic waveforms within the posterior
tibial and dorsalis pedis arteries. Left toe pressures were not obtained due
to prior great toe amputation. The left ABI is 0.72 at rest.
Pressure volume recordings were not obtained of the left calf or thigh due to
staples. Amplitudes were otherwise within normal limits.
IMPRESSION:
Moderate tibial and distal arterial insufficiency of the left lower extremity
as demonstrated by monophasic waveform within the posterior tibial and
dorsalis pedis arteries and a diminished ankle brachial index of 0.72.
No evidence of significant arterial insufficiency within the right lower
extremity.
|
10142404-RR-22
| 10,142,404 | 22,811,313 |
RR
| 22 |
2157-02-07 11:42:00
|
2157-02-07 12:15:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with cellulitis, right lower extremity swelling
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10142413-RR-13
| 10,142,413 | 24,004,865 |
RR
| 13 |
2153-09-04 01:31:00
|
2153-09-04 03:34:00
|
HISTORY: History of IVF with embryo transfer on ___, now with right
lower quadrant pain.
COMPARISON: None.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
FINDINGS:
IVF with embryo transfer on ___.
The uterus demonstrates a posterior fibroid measuring 1.7 x 1.0 x 1.5 cm but
is otherwise is normal in appearance. The endometrium is homogeneous and
measures 3 mm. No clear gestational sac is seen. There is a cyst on within
the right adnexa measuring 2.2 x 2.0 x 2.7 cm with internal debris. Excluding
the cyst, the right ovary measures approximately 2.4 x 0.6 x 2.6 cm. The left
ovary measures 3.4 x 1.7 x 3.2 cm. Normal arterial and venous blood flow is
demonstrated in the right and left ovaries. A tubular structure within the
right adnexa represents a hydrosalpinx or bowel loop. There is no free fluid.
IMPRESSION:
1. 2.7 cm cyst within the right adnexa may represent a hemorrhagic cyst.
Follow-up ultrasound is recommended.
2. No evidence of torsion.
3. No intra-gestational sac is seen. The differential includes early IUP
with ectopic pregnancy not excluded on this exam. Serial b-hCG and ultrasound
is recommended.
4. Tubular right adnexal structure represents a bowel loops or hydrosalpinx.
|
10142413-RR-14
| 10,142,413 | 24,004,865 |
RR
| 14 |
2153-09-04 04:25:00
|
2153-09-04 08:39:00
|
EXAMINATION: MR ___
INDICATION: ___ year old woman with right sided abdominal pain and elevated
WBC count // Bowel wall edema? Crohns? Other cause of abdominal pain and
elevated WBC count. Patient is ___ weeks pregnancy via IVF. Additional history
includes partial bowel resection, appendectomy, cystectomy, and
cholecystectomy.
TECHNIQUE: T1 and T2-weighted multiplanar images of the abdomen and pelvis
were acquired the MRI. Post-contrast imaging was not performed due to
pregnancy.
COMPARISON: Pelvic ultrasound from ___
FINDINGS:
MR ENTEROGRAPHY:
There is a single dilated loop of distal ileum measuring approximately 7 cm in
diameter. The ileal loops entering into this loop are normal in caliber,
suggesting that this may represent postsurgical anatomy. There is, however a
distal loop of thickened mid ileum with adjacent inflammatory changes and
edema. Differential for this finding includes adhesions versus a component of
some acute Crohn's flare. Differentiation is difficult due to lack of IV
contrast. There is no definite evidence of obstruction however.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Visualized portions of the liver have homogeneous signal and enhancement.
There is no intra or extra-hepatic biliary dilatation. The gallbladder is
absent.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
The bladder is normal. The uterus is normal in appearance. Intrauterine
gestation is no yet seen. There is a 2.6 cm right ovarian cyst and a probable
hemorrhagic corpus luteal cysts. No obvious hydrosalpinx is visualized within
the limitations of this examination.
IMPRESSION:
1. Inflammatory changes and edema adjacent to a thickened loop of ileum in the
right mid to lower abdomen. Findings may be secondary to adhesions or a
component of a subacute Crohn's flare. Further differentiation is difficult
due to lack of IV contrast and if there is clinically change or worsening,
repeat exam can be performed.
2. Isolated, dilated loop of distal ileum may be related to postsurgical
anatomy. There is no definite evidence of upstream obstruction as the
remainder of the small bowel is normal in caliber.
NOTIFICATION: Final read discussed with Dr. ___ at 11:55am.
|
10142413-RR-15
| 10,142,413 | 24,004,865 |
RR
| 15 |
2153-09-04 10:22:00
|
2153-09-04 11:25:00
|
INDICATION: ___ female with small bowel obstruction status post NG
tube placement. Evaluate position of the tube.
COMPARISON: None available.
TECHNIQUE: Frontal upright chest radiograph.
FINDINGS: The lungs are well expanded and clear. Cardiomediastinal and hilar
contours are unremarkable. There is no pleural effusion or pneumothorax. An
NG tube is seen with the tip and side port beyond the gastroesophageal
junction. No subdiaphragmatic free air is identified.
IMPRESSION: Appropriate position the NG tube. No evidence of
subdiaphragmatic free air.
|
10142447-RR-22
| 10,142,447 | 26,010,176 |
RR
| 22 |
2168-09-14 10:35:00
|
2168-09-14 12:23:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ with r/o DKA and AMI // Eval for acute process
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
Midline sternotomy wires are present with fracture through the most superior
sternotomy wire, new since ___. Multiple surgical clips overlie the
mediastinum. The lungs are clear without focal consolidation. No pleural
effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10142844-RR-37
| 10,142,844 | 25,227,088 |
RR
| 37 |
2177-08-20 20:54:00
|
2177-08-20 22:17:00
|
CHEST RADIOGRAPHS
HISTORY: Chest pain.
COMPARISON: ___.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The lung volumes are low. There is persistent mild relative
elevation of the right hemidiaphragm compared to the left side. The cardiac,
mediastinal and hilar contours appear stable. There is no pleural effusion or
pneumothorax. New streaky opacities involve each lung base as well as the
left mid lung, the latter probably associated with the lingula. This
appearance is very suggestive of minor atelectasis. Elsewhere, the lungs
appear clear.
IMPRESSION: New basilar opacities, most likely due to atelectasis.
|
10142844-RR-38
| 10,142,844 | 25,227,088 |
RR
| 38 |
2177-08-20 20:06:00
|
2177-08-20 21:14:00
|
CLINICAL INDICATION: Left flank pain, abdominal pain and vomiting. Evaluate
for renal stones, pyelonephritis and diverticulitis.
TECHNIQUE: Multidetector CT scan of the abdomen and pelvis was performed with
the patient in the prone position without the administration of intravenous
contrast. Subsequently, Omnipaque intravenous contrast was administered and
repeat scan through the abdomen and pelvis was performed.
DLP: 1339.47 mGy-cm.
COMPARISON: None.
FINDINGS: Linear opacity at the lung bases most likely represents atelectasis
or scarring. A nodule in the right lung base measures 2 mm. There is no
pleural or pericardial effusion.
Diffuse hypodensity of the liver parenchyma indicates hepatic steatosis. There
are no focal liver lesions. The gallbladder appears normal. Fat stranding
adjacent to the tail of the pancreas may represent focal pancreatitis. The
left renal fascia is thickening and there is adjacent fat stranding. The
spleen and adrenal glands appear normal. The kidneys enhance symmetrically
and promptly excrete contrast. No renal stones or concerning renal lesions
are identified. The bladder is partially filled and appears normal. The
prostate is unremarkable.
The stomach is decompressed. The small bowel appears normal without evidence
of wall thickening or obstruction. There is colonic diverticulosis without
evidence of diverticulitis. The appendix is visualized in the right lower
quadrant and appears normal. There is no free fluid, free air or pathologic
lymphadenopathy by CT size criteria. There are calcifications within a normal
caliber aorta.
OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesions
identified.
IMPRESSION:
1. Fat stranding adjacent to the tail of the pancreas and thickening of the
left pararenal fascia is most consistent with acute pancreatitis. There is no
decreased pancreatic parenchymal enhancement, peripancreatic free fluid or
fluid collections. No biliary dilation or gallstones identified.
2. The kidneys appear normal without evidence of stones, hydronephrosis or
masses.
3. Hepatic steatosis.
4. Diverticulosis without evidence of diverticulosis.
5. A nodule in the right lung base measures 2 mm. Follow-up CT in ___ year is
recommended if the patient has risk factors for lung cancer or known prior
malignancy.
COMMENT: Updated recommendations were emailed to Dr. ___ by Dr. ___
at 0108 ___.
|
10142844-RR-40
| 10,142,844 | 25,227,088 |
RR
| 40 |
2177-08-20 22:41:00
|
2177-08-21 03:24:00
|
INDICATION: History of pancreatitis. Please evaluate for cholelithiasis or
dilated CBD.
COMPARISONS: CT from ___.
TECHNIQUE: Grayscale and color Doppler evaluation of the right upper
quadrant.
FINDINGS: The liver is mildly echogenic, consistent with fatty deposition.
No focal lesions or intrahepatic biliary ductal dilatation is seen. The
common bile duct is normal measuring 0.4 cm. The pancreas is not assessed on
this exam. The gallbladder is normal without evidence of cholelithiasis or
cholecystitis. Doppler assessment of the main portal vein demonstrates normal
hepatopetal flow. There is no evidence of ascites. Limited assessment of the
right kidney is unremarkable.
IMPRESSION:
1. No evidence of cholelithiasis or cholecystitis.
2. Echogenic liver is consistent with fatty deposition. More advanced forms
of liver disease such as cirrhosis or hepatic fibrosis cannot be excluded by
this study, however.
|
10142844-RR-49
| 10,142,844 | 22,340,248 |
RR
| 49 |
2181-01-04 21:21:00
|
2181-01-04 21:46:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with syncope, hypoxia// eval for PNA
COMPARISON: Prior exam is dated ___
FINDINGS:
AP upright and lateral views of the chest provided. Mild left basal
atelectasis is noted. There is no focal consolidation, effusion, or
pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous
structures are intact. No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10142844-RR-50
| 10,142,844 | 22,340,248 |
RR
| 50 |
2181-01-04 21:57:00
|
2181-01-04 22:35:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with syncope, head trauma// eval for bleeding
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: ___ noncontrast head CT.
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
large mass. Bilateral inferior frontal lobe encephalomalacia is not
significantly changed since prior. Periventricular and subcortical white
matter hypodensities are nonspecific, but likely represent chronic small
vessel ischemic disease. The ventricles and sulci are normal in size and
configuration.
There is no evidence of fracture. There are few opacified right anterior
ethmoid air cells. The visualized portion of the remainder of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The orbits are
unremarkable.
IMPRESSION:
No acute intracranial process.
|
10142844-RR-51
| 10,142,844 | 22,340,248 |
RR
| 51 |
2181-01-04 21:57:00
|
2181-01-04 22:57:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with syncope, hypoxia, tachycardia// eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 420 mGy-cm.
COMPARISON: CT abdomen ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Heart size is top normal. The heart, pericardium, and
great vessels are otherwise within normal limits. No pericardial effusion is
seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild emphysema. There is a calcified granuloma in the
mid right lung. Focus of nodular scarring at the inferior lingula is similar
to ___. Lungs are otherwise clear without masses or areas of
parenchymal opacification. There is mild bronchial wall thickening. 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: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Mild bronchial wall thickening suggestive of airway inflammation.
|
10142844-RR-52
| 10,142,844 | 22,340,248 |
RR
| 52 |
2181-01-05 01:51:00
|
2181-01-05 08:42:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: History: ___ with intubated// ETT in place?
COMPARISON: Chest radiographs ___
FINDINGS:
On the second image taken at 01:54, the ET tube tip is approximately 1.4 cm
above the carina. Side port and tip of the NG tube are in the stomach. There
is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal
silhouette is within normal limits.
IMPRESSION:
On the second image taken at 01:54, the ET tube tip is approximately 1.4 cm
above the carina.
|
10143711-RR-37
| 10,143,711 | 27,783,888 |
RR
| 37 |
2161-02-11 20:33:00
|
2161-02-12 08:51:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: ___ year old man with tib/fib fracture // Post-splint films to
f/u fracture Post-splint films to f/u fracture
TECHNIQUE: Frontal and lateral view radiographs of the right tibia and
fibula.
COMPARISON: ___ at 10:18 and.
FINDINGS:
Overlying cast material limits evaluation of fine detail. Again seen is the
comminuted distal tibia fracture with mild posterior and lateral displacement
of the distal fracture fragment. No significant change alignment. There is
also a a mildly displaced oblique fracture of the proximal fibula with mild
apex anterior angulation, unchanged.
IMPRESSION:
No significant change in tibia and fibula fractures as described above.
|
10143896-RR-14
| 10,143,896 | 20,308,860 |
RR
| 14 |
2134-07-22 14:04:00
|
2134-07-22 17:41:00
|
INDICATION: Left breast abscess.
ULTRASOUND-GUIDED ABSCESS ASPIRATION LEFT BREAST: The patient was referred
for aspiration of an abscess in her left breast seen on diagnostic ultrasound
from ___. The procedure, risks and benefits were explained to the
patient including risk of milk fistula. Written, informed consent was
obtained. A preprocedure timeout was performed using two patient identifiers
and laterality was confirmed.
Preprocedure scanning today redemonstrates an irregular mixed echogenic mass
corresponding to the palpable area in the left breast. This was too large to
measure and is at least 6 cm in greatest dimension. Using standard aseptic
technique and 1% lidocaine for local anesthesia, a 16-gauge needle was
advanced into the lateral aspect of the mass. A total of 15 cc was aspirated.
During the aspiration, the patient spontaneously ruptured on the medial aspect
of the mass and at that point, the procedure was terminated. Gentle pressure
was applied to the abscess which continued to drain to near resolution from
the site of spontaneous rupture. The drainage was soaked in gauze and
therefore we were unable to measure the exact amount, but one syringe was sent
to microbiology for Gram stain, culture and sensitivity, and MRSA screen. The
patient tolerated the procedure well without complications. She was returned
to the OB ward with a dressing in place and in good condition without
complications. The procedure was performed by ___, NP, and
___, MD.
IMPRESSION: Aspiration of a large abscess with spontaneous rupture of abscess
during the procedure. The patient's microbiology specimen is pending. She
was transferred to the OB ward in good condition.
|
10144359-RR-26
| 10,144,359 | 27,402,483 |
RR
| 26 |
2151-02-28 14:23:00
|
2151-02-28 17:35:00
|
EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: ___ year old man with HIV/AIDS and IVDU. Needle retained where
patient is having pain?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the superficial calf veins.
COMPARISON: None.
FINDINGS:
Grayscale ultrasound and Doppler imaging was performed over a region of
patient reported pain in the right medial calf.
A superficial vein in the area of pain contains thrombus and is
noncompressible. There is no foreign body or fluid collection identified.
IMPRESSION:
1. No evidence of retained needle.
2. Superficial noncompressible vein with thrombus deep to the area of pain
consistent with superficial thrombophlebitis.
|
10144359-RR-27
| 10,144,359 | 27,402,483 |
RR
| 27 |
2151-03-02 08:10:00
|
2151-03-02 10:45:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with elevated alkaline phosphatase. // Please
evaluate for biliary obstruction and gallstones.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 1 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
The gallbladder is somewhat contracted.
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 9.4 cm.
KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 10.0 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys. A tiny simple cyst is seen arising from the lower pole of the right
kidney measuring 0.5 x 0.5 x 0.5 cm.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal abdominal ultrasound. Simple right renal cyst.
|
10144359-RR-28
| 10,144,359 | 27,402,483 |
RR
| 28 |
2151-03-05 13:39:00
|
2151-03-05 15:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HIV, new cough // any e/o infection?
TECHNIQUE: Portable chest
COMPARISON: ___.
FINDINGS:
Compared to the prior study there is no significant interval change.
IMPRESSION:
No change.
|
10144359-RR-29
| 10,144,359 | 27,402,483 |
RR
| 29 |
2151-03-08 02:23:00
|
2151-03-08 08:30:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: History of HIV/AIDS and IV drug use with point tenderness of the
lumbar spine. Evaluate for osteomyelitis or abscess.
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 6 mL of
Gadavist contrast agent.
COMPARISON: None.
FINDINGS:
For the purposes of numbering, the lowest rib bearing vertebral body was
designated the T12 level.
Vertebral body alignment is preserved. Vertebral body heights are preserved.
There are type ___ ___ endplate degenerative changes seen in the superior
endplate of the T12 vertebral body, with minimal postcontrast enhancement.
There is no other marrow signal abnormality. The visualized portion of the
spinal cord is preserved in signal and caliber. The conus medullaris
terminates at the L1 level.
There is loss of T2 signal multiple intervertebral discs, a manifestation of
degenerative disc disease. There is mild loss of disc height at L2-L3 and
L3-L4.
There is no paravertebral or paraspinal mass identified and there is no
evidence of infection or neoplasm. The visualized portion of the sacroiliac
joints are preserved.
Spinal canal is congenitally narrowed from the L1-L2 through L4-L5 levels.
Limited sagittal view of the T11-T12 and T12-L1 levels demonstrate no
significant spinal canal or neural foraminal narrowing
At L1-2 there is mild disc bulge and ligamentum flavum thickening producing
mild spinal canal narrowing. The neural foramina are patent.
At L2-3 there is mild disc bulge and ligamentum flavum thickening producing
mild spinal canal narrowing. The neural foramina are patent..
At L3-4 there is mild disc bulge and ligamentum flavum thickening producing
mild spinal canal narrowing. Additionally, there is what appears to be a
small disc fragment extending inferiorly along the posterior margin of the L4
vertebral body to the left, displacing the traversing left L4 nerve root, with
enhancement of this portion of this fragment and minimal surrounding epidural
space (10:11, 11:21). However, there is no edema or enhancement of the
adjacent vertebral body or L3-L4 intervertebral disc. The neural foramina are
patent.
At L4-5 there is mild disc bulge and ligamentum flavum thickening are present
without significant spinal canal narrowing. There is small foraminal
component of the disc bulge on the right, producing mild right neural
foraminal narrowing with contact of the exiting right L4 nerve root. The left
neural foramen is patent. There are prominent degenerative changes of the
left facet joint with osteophyte formation, small amount of fluid within the
joint space, and a periarticular cyst (05:17).
At L5-S1 there is no significant spinal canal or neural foraminal narrowing.
The visualized retroperitoneum is grossly unremarkable.
IMPRESSION:
1. Small left paracentral disc fragment protruding inferiorly at the level of
L3-L4 displacing the traversing left L4 nerve root. There is associated
epidural enhancement in this area, which is likely inflammatory. Infection is
highly unlikely given lack of edema or enhancement of the adjacent
intervertebral disc or vertebral body, though not entirely excluded.
2. Multilevel lumbar spondylosis, as described, with congenital narrowing,
disc bulges and ligamentum flavum thickening contributing to mild spinal canal
narrowing from the L1-L2 through L3-L4 levels.
3. Foraminal component of disc bulge at the right L4-L5 level contacts the
exiting L4 nerve root with production of mild neural foraminal narrowing. The
remainder of the neural foramina are patent.
4. No terminal cord signal abnormality.
5. Focally prominent degenerative changes at the left L4-L5 facet
articulation, which may explain focal point tenderness. Correlate with area
of point tenderness on physical exam.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:26 AM, 15 minutes after
discovery of the findings.
|
10144359-RR-30
| 10,144,359 | 27,987,310 |
RR
| 30 |
2151-03-12 04:30:00
|
2151-03-12 05:12:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with leg pain, redness // r/o dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow is demonstrated in
the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10144359-RR-31
| 10,144,359 | 27,987,310 |
RR
| 31 |
2151-03-12 06:11:00
|
2151-03-12 06:52:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: History: ___ with PMH of HIV and IVDU presents with atraumatic
right leg pain, swelling, fevers // question of necrotizing fasciitis
question of necrotizing fasciitis
TECHNIQUE: Frontal and lateral view radiographs of the right tibia and
fibula.
COMPARISON: None.
FINDINGS:
No fracture. No subcutaneous gas or radiopaque foreign body. Multiple
exophytic osteochondromas are identified, involving the distal femur, proximal
tibia, and distal tibia/fibula.
IMPRESSION:
No subcutaneous gas identified. Multiple osteochondromas involving the distal
femur and proximal as well as distal tibia/ fibula. No knee joint effusion.
|
10144359-RR-32
| 10,144,359 | 27,987,310 |
RR
| 32 |
2151-03-13 16:46:00
|
2151-03-13 18:23:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with HIV/AIDs, low grade fever, sweats, worsening
low back pain especially on Left side with recent abnormal MRI with notable
changes including disc fragments L4, and other changes) and now with possible
new cardiac murmur. // presence and extent of any new interval development
of signs of local spine infection
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 6 mL of
Ga___ contrast agent.
COMPARISON: MRI lumbar spine with without contrast of ___.
FINDINGS:
When compared to examination ___, there is interval increase
conspicuity of a peripherally enhancing fluid collection arising from the left
L4-L5 facet joint, with associated surrounding enhancing soft tissue and
increased enhancing facet marrow edema pattern, not seen on prior examination.
In addition, increased enhancing edema pattern of the adjacent paraspinal
muscles extending up to the L1 level is concerning for either reactive or
infectious myositis. No evidence for intramuscular abscess at this time. No
epidural rim enhancing collection to suggest epidural abscess.
Lumbar alignment is anatomic. Vertebral body heights are preserved. T12
superior endplate Schmorl's node with adjacent marrow edema pattern is similar
in appearance to examination of ___ without evidence of adjacent
disc signal abnormality, almost certainly degenerative in nature. No abnormal
enhancing T2 hyperintense signal of the discs to suggest discitis. The
remainder of the marrow signal is within expected limits. The conus
medullaris terminates at the L1 level, within expected limits. There is no
abnormal signal or enhancement of the terminal cord, conus medullaris or cauda
equina. Chronic fracture of the left L2 transverse process is noted.
L1-L2 and L2-L3: Small disc bulges do not significantly narrow the spinal
canal or result in significant neural foraminal narrowing.
L3-L4: A disc bulge with minimally inferiorly migrating left disc fragment,
similar appearance to prior examination, which crowds the left subarticular
zone without significant spinal canal narrowing. There is associated
unchanged epidural enhancement without rim enhancement, presumably
inflammatory in nature. In combination with facet arthropathy, there is mild
left and no significant right neural foraminal narrowing.
L4-L5: A small disc bulge does not significantly narrow the spinal canal.
There is no significant neural foraminal narrowing. The no evidence for
epidural fluid collection or definitive phlegmon.
L5-S1: No significant spinal canal or neural foraminal narrowing.
The visualized prevertebral soft soft tissues are unremarkable.
IMPRESSION:
1. When compared to examination 5 days prior, there is increased conspicuity
of peripherally enhancing fluid collection arising from the left L4-L5 facet
joint with worsening associated surrounding enhancing soft tissue and
increasing enhancing facet marrow edema, highly concerning for septic joint.
2. Associated enhancing paraspinal soft tissue edema extending to the L1
level, may represent reactive versus infectious myositis.
3. No evidence for epidural abscess or definitive evidence for epidural
phlegmon at this time.
4. There is STIR hyperintense signal of the T12 superior endplate, presumably
degenerative secondary to a endplate Schmorl's node, however close attention
on followup is recommended. No evidence of discitis.
5. Additional findings described above.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:08 AM, 2 minutes after
discovery of the findings.
|
10144359-RR-34
| 10,144,359 | 27,987,310 |
RR
| 34 |
2151-03-14 19:36:00
|
2151-03-14 22:26:00
|
EXAMINATION: MRI CERVICAL AND THORACIC PT21 MR SPINE
INDICATION: ___ year old man with aids and gpc bacteremia and ivdu with
possible lr/l5 facet septic arthritis with pain throughout back // assess for
possible osteo, discitis or other sites of septic arthritis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of 6 mL of Gadavist contrast
agent, additional axial and sagittal T1 images were obtained.
COMPARISON: None.
FINDINGS:
The images are severely degraded by motion.
CERVICAL:
Alignment is normal.Vertebral body heights are preserved. There is no bone
marrow signal abnormality. There is diffuse loss of disc height and normal T2
signal in the cervical spine.
There is no high-grade spinal canal or neural foraminal narrowing at C2-3 and
C3-4.
At C4-5, there is a posterior disc protrusion and uncovertebral osteophytes
resulting in mild spinal canal and mild bilateral neural foraminal narrowing.
At C5-6, there is a posterior disc protrusion and uncovertebral osteophytes,
resulting in moderate spinal canal and moderate bilateral neural foraminal
narrowing.
At C6-7, there is a posterior disc protrusion and uncovertebral osteophytes,
resulting in mild spinal canal and mild bilateral neural foraminal narrowing.
The spinal cord appears normal and signal intensity. The postcontrast axial
images are nondiagnostic as a result of motion artifact. The postcontrast
sagittal images are also motion degraded. Within this limitation, there is no
obvious abnormal enhancement. The paraspinal soft tissues are within normal
limits. There is no epidural or paraspinal fluid collection
THORACIC:
Alignment is normal.Vertebral body heights are preserved. There is a mildly
enhancing T2 hypointense, mildly T2 hyperintense lesion in the T12 vertebral
body (12:10) that likely reflects ___ type 1 change. There is no disc
herniation. There is no spinal canal or neural foraminal narrowing.
Evaluation of the spinal cord is limited by motion artifact on the sagittal
and axial T2 weighted images. The spinal cord appears normal in
caliber.Postcontrast images are degraded by artifact. There is no paraspinal
soft tissue abnormality.
IMPRESSION:
1. The study is at least moderately degraded by motion, limiting assessment of
the spinal cord and detection of enhancing lesions.
2. A mildly enhancing T1 hypointense lesion in the T12 vertebral body is
likely ___ type 1 signal intensity change related to degenerative disc
disease.
3. Multilevel degenerative changes as described above.
4. No evidence of discitis or osteomyelitis in the cervical and thoracic
spine.
|
10144359-RR-35
| 10,144,359 | 27,987,310 |
RR
| 35 |
2151-03-15 13:07:00
|
2151-03-15 15:44:00
|
EXAMINATION: CT INTERVENTIONAL PROCEDURE
INDICATION: ___ year old man with aids and increased conspicuity of
peripherally enhancing fluid collection arising from the left L4-L5 facet
joint with worsening associated surrounding enhancing soft tissue and
increasing enhancing facet marrow edema, highly concerning for septic joint
with GPC bacteremia // aspirate fluid collection and send for gram stain and
culture
COMPARISON: MRI lumbar spine dated ___
PROCEDURE: CT-guided left L4-L5 facet joint aspiration.
OPERATORS: Dr. ___, radiology resident and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee during the
key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a prone position on the CT scan table. Limited
preprocedure CTscan of the lumbar spine was performed. Based on the CT
findings an appropriate position for the aspiration was chosen. The site was
marked.
The site was prepped and draped in the usual sterile fashion. 1% lidocaine
were administered to the subcutaneous and deep tissues for local anesthetic
effect. Under CT guidance, a 18 guage needle was introduced into the left
L4/5 facet joint. Attempt was made at aspiration (less than 1 cc of fluid
was obtained). A small amount of saline was subsequently injected and
aspirated and also sent for cell count and culture. Contrast was administered
to confirm position within the joint space.
The needle was removed and the insertion site was covered with a sterile
dressing.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: Total DLP (Body) = 919 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 4
mg Versed and 200 mcg fentanyl throughout the total intra-service time of 40
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Extensive bony destruction is seen at the left L4/5 facet joint compatible
with septic arthritis. Less than 1 cc of blood tinged fluid was aspirated.
IMPRESSION:
Uncomplicated CT-guided left L3-L4 facet joint aspiration, but minimal fluid
aspirated.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 3:30 ___, 15 minutes after
discovery of the findings.
|
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