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10144359-RR-36
| 10,144,359 | 27,987,310 |
RR
| 36 |
2151-03-18 14:41:00
|
2151-03-18 19:49:00
|
INDICATION: ___ year old man with HIV/AIDS and active IVDU w severe back pain
w descructive lesion in L4 facet joint concerning for septic arhtirits with
unrevealing joint aspiration // perform bone biopsy of affected spine L4
facet to send for gram stain/culture, fungal culture, mycobacterial culture,
afb and SAVE EXTRA SAMPLE FOR UNIVERSAL PCR
COMPARISON: CT-guided interventional procedure from ___ and MR
of the L-spine from ___
PROCEDURE: CT-guided L4-L5 facet biopsy.
OPERATORS: Dr. ___, performed the
procedure.
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 CTscan of the intended biopsy area was performed. Based on the
CT findings an appropriate position for the biopsy 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 11 gauge coaxial needle using Arrow Oncontrol
bone drill system (was introduced into the L4-L5 facet space). An 13 gauge
core biopsy device with a was advanced to obtain 2 core biopsy specimens,
which were sent for microbiology.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: Total DLP (Body) = 352 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of
200 mg Versed and 3 mcg fentanyl throughout the total intra-service time of 17
min minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Destruction of the L4-L5 facet compatible with septic arthritis
2. Appropriate positioning of biopsy device within the joint for sampling
IMPRESSION:
Successful bone biopsy of the L4-L5 facet region. Sample sent for
microbiology analysis
NOTIFICATION: Procedure and findings were discussed in detail with Dr.
___ completion by Dr. ___
|
10144359-RR-37
| 10,144,359 | 27,987,310 |
RR
| 37 |
2151-03-20 13:22:00
|
2151-03-20 15:35:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with right PICC // Right 41cm PICC ___ ___
Contact name: ___: ___
IMPRESSION:
In comparison to ___ chest radiograph, a right PICC has been
placed, terminating in the lower superior vena cava. Cardiomediastinal
contours are stable, and lungs are grossly clear except for minor atelectasis
at the lung bases.
|
10144359-RR-42
| 10,144,359 | 22,065,166 |
RR
| 42 |
2152-01-13 13:21:00
|
2152-01-13 14:11:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with cough, borderline fever, hx of HIV// r/o PNA
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Mild right base atelectasis is seen without definite focal consolidation. No
pleural effusion or pneumothorax is seen. Enlargement of the main pulmonary
artery suggest component of underlying pulmonary hypertension. Cardiac
silhouette is mildly enlarged.
IMPRESSION:
Enlargement the pulmonary artery suggests underlying pulmonary hypertension.
No focal consolidation to suggest pneumonia.
|
10144359-RR-43
| 10,144,359 | 22,065,166 |
RR
| 43 |
2152-01-13 15:00:00
|
2152-01-13 15:40:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with AIDS, AMS// please eval for bleed, intracranial
lesions
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast in standard and soft tissue thins. Coronal and sagittal reformations
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.2 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CT head ___ stable.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or midline shift.
There is a stable 0.8 x 0.8 cm hypodense right occipital lesion, previously
characterized and meningioma and unchanged in size. There is persistent
prominence of the ventricles and sulci more than expected for given age.
Nonspecific periventricular subcortical white matter hypodensities suggest
chronic small vessel ischemic changes.
There is no evidence of acute fracture. There is moderate mucosal thickening
of the bilateral maxillary, ethmoid, and sphenoid sinuses. The visualized
portion of the remaining paranasal sinuses, mastoid air cells, and middle ear
cavities are clear.
IMPRESSION:
1. No evidence of acute intracranial process such as hemorrhage or infarction.
2. Stable 0.8 cm right occipital meningioma.
|
10144359-RR-44
| 10,144,359 | 22,065,166 |
RR
| 44 |
2152-01-14 16:06:00
|
2152-01-14 16:57:00
|
EXAMINATION: CT ABDOMEN/PELVIS WITHOUT CONTRAST
INDICATION: ___ year old man with AIDS, known recent L4-L5 septic arthritis
with MAC, presents with L flank pain, fever to 102// Fever with L flank pain
in immunocompromised patient, eval for intrabdominal infectious process
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 7.6 s, 49.4 cm; CTDIvol = 5.8 mGy (Body) DLP = 280.7
mGy-cm.
Total DLP (Body) = 281 mGy-cm.
COMPARISON: MR lumbar spine ___.
FINDINGS:
Lack of IV contrast limits evaluation of solid organs and vascular structures.
Lack of oral contrast and paucity of intra-abdominal fat limits assessment of
bowel pathology.
LOWER CHEST: Minimal dependent atelectasis.
HEPATOBILIARY: Unenhanced liver is unremarkable. Gall bladder is not
visualized.
PANCREAS: Unremarkable pancreas.
SPLEEN: Measures 12.5 cm.
ADRENALS: Unremarkable.
URINARY:No hydronephrosis. No nephrolithiasis. Urinary bladder is
unremarkable.
GASTROINTESTINAL: Stomach filled with food debris, unremarkable. Status post
bowel resection and anastomosis. No bowel obstruction. Colonic
diverticulosis.
PERITONEUM: No free air. No free-fluid. No peritoneal stranding.
LYMPH NODES: No adenopathy.
VASCULAR: Normal caliber abdominal aorta.
PELVIS: Rectum is unremarkable. Unremarkable seminal vesicles.
BONES:No appreciable acute osseus abnormality. The vertebral body endplates
are maintained.
SOFT TISSUES: Metallic superficial density along the right medial gluteal
region. Soft tissues are otherwise unremarkable.
IMPRESSION:
No acute intra-abdominal process. Note that evaluation is somewhat limited
with lack of contrast and paucity of intra-abdominal fat.
|
10144359-RR-45
| 10,144,359 | 29,787,205 |
RR
| 45 |
2152-02-14 10:06:00
|
2152-02-14 11:02:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ man with AIDS and fever. Evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Lung volumes are slightly low. The cardiomediastinal measure are
unremarkable. No consolidation is identified. Right basilar atelectasis is
noted. No sizable pleural effusion or pneumothorax is breast
IMPRESSION:
No definite acute intrathoracic abnormality.
|
10144359-RR-46
| 10,144,359 | 29,787,205 |
RR
| 46 |
2152-02-14 11:20:00
|
2152-02-14 11:49:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with possible fall, intoxication. Evaluate for
acute intracranial abnormality.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 14.0 s, 14.3 cm; CTDIvol = 49.1 mGy (Head) DLP =
702.4 mGy-cm.
Total DLP (Head) = 702 mGy-cm.
COMPARISON: Head CTs from ___ and ___, MRI brain dated ___
FINDINGS:
There is no evidence of large territorial infarction,hemorrhage,or edema.
There is a stable extra-axial right occipital lesion measuring up to 8 mm,
previously characterized as a meningioma, unchanged. There is prominence of
the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The polypoid bilateral maxillary sinus
mucosal thickening as well as mild mucosal thickening of the anterior ethmoid
air cells is noted. The mastoid air cells and middle ear cavities are clear.
The visualized portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
Stable right occipital extra-axial lesion compatible with meningioma.
|
10144359-RR-48
| 10,144,359 | 23,696,555 |
RR
| 48 |
2154-01-24 13:28:00
|
2154-01-24 15:09:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with epidural abscess/discitis/osteomyelitis, IV
drug user with HIV/AIDS and hepatitis C// evaluate for progression of epidural
abscess/discitis/osteomyelitis evaluate for progression of epidural
abscess/discitis/osteomyelitis
TECHNIQUE: Sagittal imaging was performed with T2, and IDEAL technique,
followed by axial T2 imaging.
COMPARISON: ___ outside contrast lumbar spine MRI.
FINDINGS:
Study is moderately degraded by motion. Additionally, study is limited due to
lack of administration of intravenous contrast and presence of T1 imaging.
Within these confines:
For the purposes of numbering, the lowest rib bearing vertebral body was
designated the T12 level.
There is levoscoliosis lumbar spine. Vertebral body heights are preserved.
T12 vertebral body superior anterior marrow signal abnormality is again seen.
T2 and water ideal hyperintensity of the L3 vertebral body is again seen. The
L4 vertebral body again demonstrates a mid to superior endplate T2 and water
ideal hyperintense structure, grossly similar in size and signal compared to
prior outside exam. Additionally, along the dorsal and ventral margins of the
L3-4 intervertebral disc space T2 and water ideal heterogeneous collections
with extension along the ventral and dorsal L3 and L4 vertebral bodies is
again grossly similar in size and signal heterogeneity compared to ___
prior outside exam. Fluid collection again completely includes L3-4
intervertebral disc space. Additionally, fluid collections are again noted to
extend into bilateral psoas muscles above and below the L3-4 level.
The visualized portion of the spinal cord is grossly preserved in signal and
caliber.
There is loss of intervertebral disc height throughout the lumbar spine.
There is loss of intervertebral disc signal at T11-12, L1-2 and L2-3.
Nonspecific facet joint fluid is noted at multiple levels of the lumbar spine.
At T12-L1 there is disc bulge, facet hypertrophy, ligamentum flavum
thickening, epidural fat, with no vertebral canal and mild bilateral neural
foraminal narrowing.
At L1-2 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,
pro fat, with mild-to-moderatevertebral canal and mild bilateral neural
foraminal narrowing.
At L2-3 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,
epidural fat, with mild-to-moderatevertebral canal and mild bilateral neural
foraminal narrowing.
At L3-4 there is epidural collection, facet hypertrophy, epidural fat, with
moderate to severevertebral canal, mild right and severe leftneural foraminal
narrowing.
At L4-5 there is disc bulge, facet hypertrophy, ligament flavum thickening,
epidural fat, with mild vertebral canal and moderate bilateral neural
foraminal narrowing.
At L5-S1 there is disc bulge, facet hypertrophy, with no vertebral canal and
mild bilateral neural foraminal narrowing.
OTHER:
Limited imaging of the kidneys demonstrate right at least partially T2
hyperintense structure, incompletely characterized.
IMPRESSION:
1. Study is moderately degraded by motion. Additionally, please note study is
limited due to lack of sagittal T1 and postcontrast imaging, which was not
obtained due to patient inability to further tolerate examination.
2. Allowing for difference in technique, grossly stable L3-4 level findings
concerning for discitis osteomyelitis, with probable psoas muscle abscesses
above and below the L3-4 level as described.
3. L3-4 moderate to severe vertebral canal, mild right and severe left neural
foraminal narrowing secondary to a epidural collection better demonstrated on
2 months prior outside contrast lumbar spine MRI.
4. Additional multilevel lumbar spondylosis and epidural fat as described.
5. Limited imaging of the kidneys demonstrate right at least partially cystic
structure, incompletely characterized.
|
10144359-RR-49
| 10,144,359 | 23,696,555 |
RR
| 49 |
2154-01-24 17:28:00
|
2154-01-25 15:12:00
|
EXAMINATION: SECOND OPINION MR NEURO PSO4 MR
INDICATION: ___ year old man with HIV/AIDS, substance use disorder who
presents with known L3-L4 epidural abscess with central canal stenosis,
previously being treated at ___. Now with +MAC culture, concern for
progressive resistance and/or extension of abscess.// OSH imaging read (MR
___ performed ___, #___) Characterization of spinal abscess
OSH imaging read (MR ___ performed ___, #___) Characterization
of spinal abscess
TECHNIQUE: Second read request performed and interpreted at ___
___.
COMPARISON: MR lumbar spine ___.
FINDINGS:
There has been an increase in the size of the prevertebral and epidural
peripherally enhancing collections at L3-L4. The prevertebral collection
measures 5.6 cm (SI) x 1.6 cm (AP), and the epidural collection measures 3.4
cm (SI) x 1.1 cm (AP). There is also increase in the peripherally enhancing
fluid collection within the superior aspect of the L4 vertebral body, which
communicated the L3-L4 disc space, now measuring 2 cm (AP) x 1.7 cm (SI).
There are also bilateral small paravertebral enhancing fluid collections at
L3-L4, abutting and possibly involving of the medial aspect of the psoas
muscles bilaterally
The epidural collection causes severe spinal canal narrowing. There is also a
diffuse disc bulge at L3-L4, causing mild bilateral neural foraminal
narrowing.
Within the anterosuperior aspect of T12 vertebral body, there is STIR
hyperintensity and T1 hypointensity, which was also demonstrated on the prior
MR and is unchanged.
There is a broad-based disc bulge at L4-L5, with mild bilateral neural
foraminal narrowing and no significant spinal canal narrowing.
Alignment is normal. There is reduced intervertebral disc height from L1-L4
levels and at T11-T12, with disc desiccation, and disc height is at L3-L4
level. Vertebral body and intervertebral disc signal intensity appear
otherwise normal. The spinal cord appears normal in caliber and
configuration. The conus ends at T12-L1 level. There is no evidence of
infection.
IMPRESSION:
1. Second read request for a study performed and interpreted at ___ and
___.
2. Progressive diskitis and osteomyelitis at L3-L4 level, with an increase in
the size of the prevertebral and epidural collections, and the collection in
the superior aspect of L4 vertebral body.
3. Severe spinal canal stenosis at L3-L4 secondary to the epidural
collection.
|
10144359-RR-50
| 10,144,359 | 23,696,555 |
RR
| 50 |
2154-01-24 18:20:00
|
2154-01-25 10:09:00
|
EXAMINATION: SECOND OPINION CT ABD/PELVIS
INDICATION: ___ year old man with HIV/AIDS, substance use disorder who
presents with known L3-L4 epidural abscess with central canal stenosis,
previously being treated at ___. Now with +MAC culture, concern for
progressive resistance and/or extension of abscess.// OSH imaging read
request: #REF___, CT MISCELLANEOUSCharacterization of spinal abscess
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was not administered.
IV contrast: 130ml Omnipaque
DOSE: CT DLP Dose: 7.66
COMPARISON: Noncontrast CT abdomen performed subsequently dated ___
FINDINGS:
LOWER CHEST:
There is bibasilar dependent atelectasis. No pleural or pericardial
effusions.
ABDOMEN:
GENERAL: There is no intra-abdominal free air or free fluid.
HEPATOBILIARY: The liver is unremarkable.
The gallbladder is incompletely distended with no radiopaque calculi within
it.
PANCREAS: The pancreatic parenchyma enhances homogeneously without focal
lesions or main duct dilation.
SPLEEN: The spleen is top normal with no focal lesions..
ADRENALS: No adrenal nodules..
URINARY: The kidneys are unremarkable.
GASTROINTESTINAL: Stomach and duodenum are unremarkable.
Colon and small bowel loops demonstrate no wall thickening. Bowel sutures are
noted in the mid abdomen.
LYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis.
Numerous prominent but subcentimeter short axis bilateral inguinal lymph nodes
noted. Similarly prominent but less than 1 cm short axis left para-aortic
lymph nodes also noted..
VASCULAR: Abdominal aorta is normal in caliber.
PELVIS:
The bladder is minimally distended and unremarkable. The prostate and seminal
vesicles are unremarkable..
BONES AND SOFT TISSUES:
There is discitis involving the L3-4 intervertebral disc space associated with
a focal prevertebral abscess at this level measuring 4.5 x 1.5 cm (series 7,
image 60) and an epidural abscess measuring 3.2 by 1.0 cm.
Similar anterior endplate sclerosis and cystic changes are noted at those
superior endplate of T12 vertebra. A focal sclerotic lesion measuring
approximately 1.2 cm also noted within the left pedicle of the T12 vertebra
(5:74).
There is bony fusion of the pubic symphysis. Old healed fractures of the left
inferior pubic ramus noted.
IMPRESSION:
1. Diskitis involving the L3-4 intervertebral disc space associated with a
prevertebral abscess and an epidural abscess at this level, as described in
detail above.
2. No abdominal or pelvic lymphadenopathy or solid organ abnormality
identified.
3. Likely degenerative endplate changes seen at the anterosuperior endplate of
the T12 vertebra.
|
10144359-RR-51
| 10,144,359 | 23,696,555 |
RR
| 51 |
2154-01-25 17:48:00
|
2154-01-25 20:59:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with Left PICC// Left PICC 45cm, ___ ___
Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
The tip of the left PICC projects over the right atrium, approximately 2 cm
beyond the cavoatrial junction. There is no focal consolidation, pleural
effusion or pneumothorax. The size of the cardiac silhouette is unchanged.
|
10144359-RR-52
| 10,144,359 | 23,696,555 |
RR
| 52 |
2154-01-30 13:05:00
|
2154-01-30 16:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HIV/AIDS and known spinal epidural abscess
who has new onset SOB after prolonged hospitalization, concerning for PE vs
pneumonia.// Any evidence of pulmonary embolism, consolidation, or pleural
fluid.
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: Multiple plain film radiographs of the chest, most recent dated
___.
FINDINGS:
Compared to the prior chest radiograph, the bilateral lungs are well inflated.
The cardiac silhouette is decreased in size, and the mediastinal contours are
unchanged. There is no focal consolidation, pleural effusion or pneumothorax.
A left-sided PICC line is seen with its tip in unchanged position. There is a
small rounded opacity overlying the right lower lobe which likely represents a
nipple shadow.
IMPRESSION:
No evidence of pulmonary infection or pleural effusion.
|
10144359-RR-53
| 10,144,359 | 23,696,555 |
RR
| 53 |
2154-02-01 17:40:00
|
2154-02-01 23:04:00
|
EXAMINATION: Intraoperative fluoroscopy, lumbar spine.
INDICATION: XL IF of right L3-L4.
TECHNIQUE: Two intraoperative fluoroscopic spot images of the lumbar spine
were obtained in the operating room without presence of radiologist.
DOSE: Fluoroscopy time 64.0 seconds, cumulative dose 7.26 mGy.
COMPARISON: MR is available from ___.
FINDINGS:
The study shows ongoing fusions spacer placement at the L3-L4 interspace.
IMPRESSION:
XL IF of L3-L4.
|
10144359-RR-55
| 10,144,359 | 23,696,555 |
RR
| 55 |
2154-02-03 18:34:00
|
2154-02-03 19:42:00
|
EXAMINATION: Lumbar spine radiographs, 2 lateral intraoperative views.
INDICATION: L4-L5 posterior fusion and laminectomy.
COMPARISON: Prior studies from ___.
FINDINGS:
These views of the lumbar spine, obtained in the operating room, depict
ongoing posterior L3-L4 fusion with pedicle screws. Fusions spacer is noted
at across the anterior aspect of the interspace.
IMPRESSION:
Ongoing posterior L3-L4 fusion.
|
10144359-RR-56
| 10,144,359 | 23,696,555 |
RR
| 56 |
2154-02-04 17:52:00
|
2154-02-04 22:49:00
|
EXAMINATION: Chest radiograph, AP view.
INDICATION: PICC line no longer working. HIV, polysubstance abuse and
epidural abscess.
COMPARISON: Prior study from ___.
FINDINGS:
PICC line terminates in the mid to lower right atrium. It would probably lie
in the distal superior vena cava for attractive by 4 cm. Allowing for
rotation, cardiac, mediastinal and hilar contours appear stable. Minimal
suspected left basilar atelectasis. No definite pleural effusion or
pneumothorax.
IMPRESSION:
PICC line terminating in the right atrium.
|
10144359-RR-57
| 10,144,359 | 23,696,555 |
RR
| 57 |
2154-02-05 12:49:00
|
2154-02-05 16:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with left picc repo// left picc pulled back 4cm,
___ ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___ and 20, ___.
FINDINGS:
Left-sided PICC line ending at the right atrium. Even though it was pulled
back, in order for it to be in the distal SVC it will need to be pulled back
an additional 2 cm. Lung parenchyma and cardiomediastinal silhouette are
stable in appearance. No pleural effusion or pneumothorax.
IMPRESSION:
Left-sided PICC line reposition, in order for it to be positioned in SVC, it
should be pulled back another 2 cm.
|
10144359-RR-58
| 10,144,359 | 23,696,555 |
RR
| 58 |
2154-02-05 15:56:00
|
2154-02-05 16:45:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man w HIV who p/w epidural abscesses s/p multiple
spine procedures, with ongoing fevers// RLE DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Ultrasound right lower extremity ___.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10144359-RR-59
| 10,144,359 | 23,696,555 |
RR
| 59 |
2154-03-12 13:05:00
|
2154-03-12 14:39:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: PICC inadvertently displaced. // PICC position.
IMPRESSION:
In comparison with the study of ___, there has been placement of a left
subclavian PICC line extends to the mid SVC. Cardiac silhouette is within
normal limits and there is no vascular congestion, pleural effusion, or acute
focal pneumonia.
Uppermost portion of a spinal fusion device is seen.
|
10144406-RR-26
| 10,144,406 | 29,118,181 |
RR
| 26 |
2149-11-03 06:10:00
|
2149-11-03 07:45:00
|
EXAMINATION:
DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION:
___ year old man with NGT // ?NGT placement
IMPRESSION:
There is a new NG tube with tip in the stomach. There bilateral pleural
effusions and pulmonary vascular redistribution compatible fluid overload.
There is some hazy alveolar infiltrates lower lobe greater than upper lobe.
Multiple mildly distended loops of large and small bowel are visualized with
the transverse colon measuring up to 6.4 cm and small bowel loops measuring up
to 3.2 cm compatible with an ileus. Skin staples are seen in the abdomen.
|
10144406-RR-27
| 10,144,406 | 29,118,181 |
RR
| 27 |
2149-11-07 15:00:00
|
2149-11-07 17:18:00
|
EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old man with increasing lipase with decreased LFTs //
s/p open CCY ?necrosis ?pancreatitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP =
15.6 mGy-cm.
2) Spiral Acquisition 5.4 s, 59.4 cm; CTDIvol = 17.0 mGy (Body) DLP =
1,008.3 mGy-cm.
Total DLP (Body) = 1,024 mGy-cm.
COMPARISON: ___, ultrasound ___.
FINDINGS:
LOWER CHEST: Right lung base atelectasis with homogeneous enhancement of the
atelectatic lung parenchyma. Air bronchogram is also visualized which raises
the concern of pneumonia in the appropriate clinical settings. Left lung base
atelectasis. Small bilateral pleural effusions. Small right subpulmonic
fluid.
ABDOMEN:
HEPATOBILIARY: No suspicious lesion or ductal dilation.
Status post cholecystectomy. Fat stranding of the gallbladder fossa and
inferior to the liver, postsurgical. Foci of air in the gallbladder fossa
from surgical material (Surgicel). Right upper quadrant surgical drain tip in
the gallbladder fossa and inferior to segment 4 B of the liver. No fluid
collection.
Linear hyperdensities along the muscles and subcutaneous soft tissues of the
right hemi abdomen near the surgical incision consistent with fluid and blood.
No hematoma or loculation. No signs of active extravasation.
PANCREAS: No discrete lesion or ductal dilation.
SPLEEN: No splenomegaly.
ADRENALS: Unremarkable.
URINARY: Simple right renal cyst. Multiple left peripelvic cysts. No
nephrolithiasis or hydronephrosis.No suspicious lesion.
GASTROINTESTINAL: No intestinal obstruction. Unremarkable appendix. No fluid
collection.
PELVIS: Unremarkable rectum, and seminal vesicles. A focus of air in the
nondependent portion of the bladder, likely from catheterization. Prostate
hypertrophy.
LYMPH NODES: No adenopathy.
VASCULAR: Patent aorta and major branches. Mild arteriosclerosis.
BONES AND SOFT TISSUES: Right upper quadrant and umbilical surgical clips.
Diffuse anterior thoracic spine hyperostoses.
IMPRESSION:
1. Status post open cholecystectomy with postsurgical changes. No acute
abdominal abnormality.
2. Bibasilar atelectasis and small bilateral pleural effusions. Small right
subpulmonic fluid. Consider superimposed infection in the right lung base in
the appropriate clinical settings.
|
10144406-RR-28
| 10,144,406 | 29,118,181 |
RR
| 28 |
2149-11-08 14:35:00
|
2149-11-08 17:26:00
|
EXAMINATION: MRCP
INDICATION: ___ y/o M POD6 lap ccy, elevated LFTs and increasing lipase w/o
pancreatitis on CT abd/pel // r/o pancreatitis
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 9 mL Gadavist
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
Lower Thorax: Right lower lobe consolidation or atelectasis and small pleural
effusion. Trace left pleural effusion is present.
Postsurgical changes from recent open cholecystectomy with a small amount of
fluid in the resection bed.
A surgical drain is seen coursing through the cholecystectomy surgical bed.
Possible trace fluid around the tail of the pancreas, and in the bilateral
pararenal spaces, likely post-surgical. No drainable collection.
Liver: The liver is homogeneous in signal characteristics. There is no
chemical shift on the in or out of phase sequences to suggest the presence of
hepatic steatosis or iron deposition. The liver contours are smooth. No solid
or cystic lesions. Minimal periportal edema is present.
Biliary: No intra- or extra-hepatic duct dilatation. The common bile duct is
within normal limits. No choledocholithiasis or dropped stones are
identified.
Pancreas: The pancreatic parenchyma maintains normal bulk but with mildly low
T1 signal particularly in the tail (5b:42). No focal lesion or ductal
abnormality is seen. The pancreas grossly enhances normally, although limited
due to patient breathing motion and oral contrast from CT exam.
Spleen: The spleen is normal in size and signal characteristics. There are no
focal lesions.
Adrenal Glands: 9 mm left adrenal nodule which does not appear to drop out on
in and out of phase imaging. Normal right adrenal gland.
Kidneys: 3.7 cm cyst in the mid right kidney. There are left sided
parapelvic cysts. No focal lesion or hydronephrosis is present.
Gastrointestinal Tract: The GI tract is of normal caliber throughout.
Lymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis
lymphadenopathy by size criteria.
Vasculature: The visualized abdominal aorta and proximal mesenteric vessels
appear patent without any significant areas of narrowing or dilatation.
Osseous and Soft Tissue Structures: L1 vertebral body T2 bright hemangioma.
Postsurgical changes and edema are seen in the right body wall.
IMPRESSION:
There is artifact from difficulty in breath hold and oral contrast limiting
the evaluation.
Postsurgical changes from recent cholecystectomy. No choledocholithiasis. No
biliary or pancreatic duct dilation. No drainable fluid collection.
No imaging evidence of acute pancreatitis. Possible mild chronic
pancreatitis.
Right lower lobe disease more has the appearance of atelectasis than
pneumonia. Small left pleural effusion.
9 mm left adrenal nodule, too small to characterize definitively, but
unchanged in size since ___, most likely representing an adenoma.
Endocrine lab correlation may be obtained.
NOTIFICATION: The findings were discussed by Dr. ___ with ___
on the telephoneon ___ at 5:21 ___, 2 minutes after discovery of the
findings.
|
10144424-RR-30
| 10,144,424 | 26,254,341 |
RR
| 30 |
2176-11-21 13:28:00
|
2176-11-21 15:49:00
|
INDICATION: Feculent emesis, from nursing home. Diffuse abdominal pain.
Evaluate for acute intrathoracic process.
COMPARISON: Chest radiograph from ___.
FINDINGS: The lung volumes are slightly low. The lungs are clear. The heart
size is normal. The descending thoracic aorta is slightly tortuous. Aortic
calcifications are noted. The mediastinal contours are otherwise
unremarkable. There are no pleural effusions. No pneumothorax is seen.
There has been interval removal of the right IJ catheter and right PICC.
IMPRESSION: No acute cardiac or pulmonary process.
|
10144424-RR-31
| 10,144,424 | 26,254,341 |
RR
| 31 |
2176-11-21 14:13:00
|
2176-11-21 17:24:00
|
INDICATION: Apparent feculent emesis, acute renal insufficiency,
leukocytosis, and diffuse abdominal pain in patient with chronic indwelling
Foley catheter as of ___ for chronic urinary retention.
COMPARISONS: CT abdomen from ___.
TECHNIQUE: MDCT-acquired axial images from the lung bases to the pubic
symphysis were acquired after administration of IV contrast. P.o. contrast
was not administered. Multiplanar reformations were performed to generate
coronal and sagittal image series.
FINDINGS: The Foley catheter balloon is inflated within the urethra (2A:84).
Proximally, there is distention of the urinary bladder with concentric bladder
wall thickening and enhancement of the urothelium. There is marked bilateral
hydroureter, leading to bilateral renal pelvicalyceal dilation as well as
blunting of the calices (601B:26). There is enhancement of the urothelium
within the bilateral ureters as well. There are subcentimeter hypodensities
in the kidneys which are too small to characterize, but statistically likely
represents simple cysts. There is a 2-mm stone in the left renal collecting
system (2A:26).
There is bilateral atelectasis as well as coronary arterial calcifications.
The imaged lung bases are otherwise unremarkable.
The liver enhances normally, with several subcentimeter well-circumscribed
hypodensities, which are too small to characterize, but statistically likely
represent cysts. The pancreas, adrenals, and spleen are normal. There is a
gallstone within the lumen of the gallbladder, unchanged from prior
examination, without gallbladder dilation or pericholecystic fluid.
There is marked gastric dilation without finding to suggest mechanical
obstruction. The duodenum, jejunum and small bowel are normal in caliber and
are without wall thickening. The large bowel is mostly decompressed and
features diverticulosis without evidence of diverticulitis. The normal
appendix is seen. The prostate is stably enlarged and contains coarse
calcifications. There is stool within the rectal vault. There is minimal
rectal wall thickening and hyperenhancement of the mucosa.
There is no retroperitoneal or mesenteric lymphadenopathy. There is no free
air or fluid within the abdomen. A fat-containing left inguinal hernia is
stable. The aorta is normal in caliber with patent main branches. There are
extensive atherosclerotic calcifications.
Bone windows demonstrate diffuse osteopenia as well as degenerative changes of
the thoracolumbar and sacral spine.
IMPRESSION:
1. Findings suggestive of urinary outlet obstruction with bilateral
hydroureteronephrosis and urothelial hyperemia concerning for cystitis and
ureteritis or other infectious process, in this patient with positive
urinalysis and elevated serum WBC with possible acute on chronic process.
Suggest urology consultation. Foley catheter balloon inflated within the
penile urethra. Repositioning/removal and repositioning so that it is within
the bladder recommended.
3. Stomach distended with fluid without finding to suggest mechanical
obstrucion.
4. Possible mild proctitis, similar in appearance to prior studies from
___.
|
10144424-RR-32
| 10,144,424 | 26,254,341 |
RR
| 32 |
2176-11-22 14:37:00
|
2176-11-22 17:22:00
|
INDICATION: ___ man with bilateral hydronephrosis on CT yesterday,
evaluate hydronephrosis.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS: The left kidney measures 8.7 cm. The right kidney measures 9.9 cm.
There is no hydronephrosis, stone, mass. The bladder is minimally distended
and cannot be fully assessed. A Foley catheter is in place.
IMPRESSION: No hydronephrosis.
|
10144424-RR-33
| 10,144,424 | 26,254,341 |
RR
| 33 |
2176-11-24 15:27:00
|
2176-11-24 19:20:00
|
BARIUM SWALLOW DATED ___
INDICATION: ___ man presented with hematemesis noted of tight pylorus
in EGD. Evaluate for obstruction.
COMPARISON: Comparison is made to previous barium swallow dated ___.
SINGLE CONTRAST UPPER GI: Severely limited study due to patient's immobility
and clinical condition. The table was tilted to 20 degrees and examination
was performed. There is holdup of contrast within the esophagus which is
patulous. The findings are consistent with presbyesophagus. Barium flows
through to gastro-esophageal junction without evidence of stricture.
Barium flows through to the stomach. The patient was turned to the right side
and contrast flows through the pylorus, duodenum and jejunum. No evidence of
holdup or obstruction within the jejunum. The pylorus, duodenum and proximal
jejunum are normal in appearance on limited images.
IMPRESSION: Limited study.
1. Presbyesophagus with patulous esophagus with holdup of contrast. The
patient is at risk of aspiration.
2. The remainder of the study is normal.
Findings were discussed by phone with the referring physician on pager number
___ at 4:14 p.m.
|
10144859-RR-6
| 10,144,859 | 21,500,757 |
RR
| 6 |
2129-12-12 08:54:00
|
2129-12-12 09:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with abd pain, shoulder pain// eval free air
eval free air
IMPRESSION:
No comparison. Free intraperitoneal air under both the left and the right
hemidiaphragm. Normal lung volumes. Minimal atelectasis at the lung bases.
Normal size of the heart. No pneumonia or pulmonary edema. No pleural
effusions.
NOTIFICATION: At the time of dictation and observation, on ___,
09:10, the referring physician ___ was paged for notification and the
findings were discussed on the telephone 1 minutes later.
|
10144859-RR-7
| 10,144,859 | 21,500,757 |
RR
| 7 |
2129-12-12 09:52:00
|
2129-12-12 11:16:00
|
EXAMINATION: CT abdomen and pelvis with and without contrast
INDICATION: ___ yaer old woman ___ fibroids s/p hysterectomy, HIV presents
with abdominal pain, hematuria// urogram protocol, ?stone, if cannot visualize
stone without contrast, can add contast
TECHNIQUE: Pre and post contrast with split bolus: MDCT axial images were
acquired through the abdomen and pelvis prior to and following intravenous
contrast administration with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 51.9 cm; CTDIvol = 4.5 mGy (Body) DLP = 233.4
mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
3) Spiral Acquisition 4.7 s, 51.9 cm; CTDIvol = 5.9 mGy (Body) DLP = 304.7
mGy-cm.
Total DLP (Body) = 548 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. There is some calcification along the
gallbladder fundal wall. There is a significant amount of free
intra-abdominal air seen adjacent to the liver as well as scattered throughout
the abdomen.
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.
A duplicated collecting system is noted in the left which joins along the mid
ureteral course. There is no evidence of focal renal lesions or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is collapse. Small bowel loops and large bowel
loops appear largely decompressed. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
large amount of pocket of free intrapelvic air (series 9: Image 29) which
extends superiorly.
REPRODUCTIVE ORGANS: The patient is status post hysterectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild degenerative changes are seen in the lumbosacral spine, particularly at
the L5-S1 level.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Large amount of free intraperitoneal air with a dominant pocket of free air
seen in the deep pelvis. While the source is not definitively identified, it
is most likely pelvic in origin.
2. Calcifications noted along the gallbladder fundal wall could reflect early
porcelain gallbladder. Outpatient followup with general surgery could be
considered.
|
10144972-RR-16
| 10,144,972 | 22,630,457 |
RR
| 16 |
2185-12-27 11:57:00
|
2185-12-27 12:30:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with CP// intrathoracic process
COMPARISON: Prior chest radiograph from ___ and CT of the chest
from ___
FINDINGS:
PA and lateral views of the chest provided. The lungs are clear bilaterally.
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.
|
10144972-RR-17
| 10,144,972 | 22,630,457 |
RR
| 17 |
2185-12-27 13:01:00
|
2185-12-27 14:54:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with pancreatitis// gall stones
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound from ___
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 2 mm
GALLBLADDER: There is a mobile, avascular echogenic focus within the
gallbladder measuring 0.7 cm, previously felt to represent a polyp, but given
its mobility is consistent with a stone. There is no gallbladder wall
thickening or pericholecystic fluid.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 9.0 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 11.7 cm
Left kidney: 12.4 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cholelithiasis without other findings of acute cholecystitis.
2. Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
|
10144972-RR-22
| 10,144,972 | 20,914,059 |
RR
| 22 |
2186-07-28 09:50:00
|
2186-07-28 10:30:00
|
EXAMINATION: CT TORSO WITH CONTRAST
INDICATION: History: ___ with chest and abdominal pain// **fyi pt had CTA at
BIN on ___ see ___ record for amount of contrast. evaluate for aortic
dissection, pancreatitis, cholecystitis or other acute intra-abdominal process
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.
Oral contrast was not administered.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.9 s, 38.2 cm; CTDIvol = 15.2 mGy (Body) DLP = 578.4
mGy-cm.
2) Spiral Acquisition 4.4 s, 58.2 cm; CTDIvol = 15.2 mGy (Body) DLP = 882.8
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
4) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.2 mGy (Body) DLP =
6.6 mGy-cm.
Total DLP (Body) = 1,470 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
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. 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: Please note that evaluation for small long nodules is limited
due to respiratory motion. Otherwise, lungs are clear without masses or areas
of parenchymal opacification. The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is surgically absent.
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. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal. There is no free intraperitoneal fluid or
free air.
PELVIS:
The urinary bladder is unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate 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. Moderate atherosclerotic
disease is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of pulmonary emboli no acute aortic syndrome.
2. No CT evidence of pancreatitis or other acute intra-abdominal process.
|
10145540-RR-57
| 10,145,540 | 25,306,247 |
RR
| 57 |
2165-10-09 13:30:00
|
2165-10-09 14:58:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with cirrhosis, portal hypertension, RUQ pain
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound dated ___
FINDINGS:
LIVER: The liver is coarsened and markedly nodular in echotexture. The contour
of the liver is additionally nodular. No distinct nodule, however, can be
identified in the setting of heterogeneous hepatic parenchyma. There is small
volume ascites. Stigmata of portal hypertension with several enlarged
collaterals is again noted.
BILE DUCTS: There is no intrahepatic biliary dilation.
GALLBLADDER: The gallbladder is contracted limiting assessment though no
stone or wall thickening is appreciated.
PANCREAS: The pancreas is not well visualized.
SPLEEN: The spleen is enlarged measuring 18cm.
KIDNEYS:Limited views of the right kidney are unremarkable without
hydronephrosis. The left kidney is not well visualized.
Doppler interrogation of the hepatic vasculature demonstrates a patent portal
vein though with reversal of flow, as previously described. The main and
right hepatic veins are patent, the left hepatic vein not clearly visualized.
The main hepatic artery is patent with normal waveform.
IMPRESSION:
1. Nodular, shrunken liver. No focal mass however can be distinguished in
the setting of background heterogeneity. Further assessment is best made with
a contrast enhanced study.
2. Stigmata of portal hypertension with small volume ascites, splenomegaly,
and multiple large portosystemic collateral vessels.
3. Patent portal vein with redemonstrated hepatofugal flow.
|
10145540-RR-58
| 10,145,540 | 25,306,247 |
RR
| 58 |
2165-10-10 13:17:00
|
2165-10-10 17:24:00
|
EXAMINATION: MR ___
INDICATION: ___ year old man with cirrhosis, Crohn's right-sided abdominal
pain and diarrhea // ?active Crohn's
TECHNIQUE: T1 and T2-weighted multiplanar images of the abdomen and pelvis
were acquired within a 1.5 T magnet, including 3D dynamic sequences performed
prior to, during, and following the administration of 0.1 mmol/kg of Gadavist
intravenous contrast (7 cc). Oral contrast consisted of 900 mL of VoLumen. 1.0
mg of Glucagon was administered IM to reduce bowel peristalsis.
COMPARISON: MRI of the abdomen from ___
FINDINGS:
MR ENTEROGRAPHY:
The small bowel demonstrates normal signal intensity and morphology with no
abnormal bowel wall thickening, abnormal mucosal enhancement, obstruction or
mass lesion. There is no focal fluid collection to suggest abscess. There is
no perienteric inflammatory change. There is no fistula or sinus tract.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
The liver is cirrhotic with areas of fibrosis and massive splenomegaly with
numerous portosystemic collaterals including large esophageal varices. There
are very large right-sided varices of drain into the inferior vena cava.
The pancreas, stomach, adrenal glands, kidneys are unremarkable.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
The urinary bladder and rectum are unremarkable.
There is no suspicious lymphadenopathy. There is no suspicious bone lesion.
IMPRESSION:
1. No evidence of inflammatory bowel disease.
2. Cirrhotic liver with massive splenomegaly and large varices.
|
10145540-RR-59
| 10,145,540 | 26,540,270 |
RR
| 59 |
2165-12-24 01:43:00
|
2165-12-24 02:18:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ pain, liver disease
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. Contour or of the
liver is nodular. A definite mass is identified in the setting of a
heterogeneous hepatic parenchyma. There is no ascites. Several enlarged
collaterals are again noted. Doppler interrogation of the portal vein
demonstrates patency though with reversal of flow as previously noted. The
main hepatic artery is patent with normal waveform.
BILE DUCTS: There is no intrahepatic biliary dilation.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: 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: The spleen is enlarged measuring 16.4 cm. .
KIDNEYS: Limited views of the right kidney demonstrate no hydronephrosis.
IMPRESSION:
1. Nodular shrunken liver with heterogeneous hepatic parenchyma in keeping
with cirrhosis. Numerous portosystemic walls and reversal of flow within a
patent portal vein reflects portal hypertension, similar to examination dated
___. No ascites.
2. Splenomegaly.
|
10145540-RR-60
| 10,145,540 | 26,540,270 |
RR
| 60 |
2165-12-24 02:14:00
|
2165-12-24 02:42:00
|
INDICATION: ___ male with fever.
TECHNIQUE: Chest PA and lateral
COMPARISON: Radiograph dated ___.
FINDINGS:
PA and lateral chest radiograph is compared to multiple prior radiographs
including ___. Relative to prior examinations, subtle opacities
within the bilateral lower lung zones likely overlying soft tissue.
Cardiomediastinal and hilar contours are within normal limits. There is no
pleural effusion or pneumothorax. Visualized osseous structures are
unremarkable.
IMPRESSION:
Subtle opacities project over bilateral lower lung zones are due to overlying
soft tissue.
NOTIFICATION: Updated read after readout were communicated to the ED QA
nurses after patient had left the department.
|
10145540-RR-62
| 10,145,540 | 26,540,270 |
RR
| 62 |
2165-12-24 11:41:00
|
2165-12-24 15:11:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with Crohn's disease, cirrhosis, and fevers,
evaluate for source of infection.
TECHNIQUE: Helical axial MDCT images were obtained from the bases of the
lungs through the lesser trochanters, following the administration of IV
contrast. Reformatted images in coronal and sagittal axes were generated.
DLP: 644.57mGy-cm.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: The partially assessed lung bases are clear. There is no pleural
or pericardial effusion.
LIVER: The liver is shrunken and nodular compatible with history of cirrhosis
due to sclerosing cholangitis. Sequelae of portal hypertension are present
including marked splenomegaly, esophageal, paraesophageal, gastric, and
pronounced retroperitoneal varices. Overall appearance is very similar to the
prior study ___. The portal vein demonstrates marked cavernous
transformation. The nondistended gallbladder is within normal limits, without
wall thickening or pericholecystic fluid.
SPLEEN: Spleen is enlarged measuring up to 21.8 cm (02:23).
PANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or
fluid collection.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast
promptly. There is no focal lesion or hydronephrosis. Massive splenomegaly
causes mild anterior displacement of the left kidney.
GI: The stomach is moderately distended without obvious intraluminal mass or
wall thickening. The small and large bowel are within normal limits, without
wall thickening or evidence of obstruction. The appendix is not definitively
visualized, but there is no fat stranding or free fluid in the right lower
quadrant to suggest acute appendicitis. There is colonic diverticulosis
without evidence of diverticulitis.
RETROPERITONEUM: The aorta is normal in caliber, with no atherosclerotic
calcifications. There is no retroperitoneal or mesenteric lymph node
enlargement by CT size criteria.
CT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal
lymph node enlargement by CT size criteria is seen. There is no pelvic free
fluid.
SOFT TISSUES: The soft tissues are unremarkable.
OSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.
IMPRESSION:
1. No evidence of acute infectious process within the abdomen or pelvis.
2. Cirrhosis with sequelae of severe portal hypertension, unchanged from
___.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 2:37 ___, 5 minutes after the
discovery of the findings.
|
10145540-RR-65
| 10,145,540 | 21,436,784 |
RR
| 65 |
2167-02-22 22:38:00
|
2167-02-22 23:59:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with cough // acute process?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
No definite focal consolidation is seen. No pleural effusion or pneumothorax
is seen. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
No definite focal consolidation to suggest pneumonia. No acute
cardiopulmonary process.
|
10145540-RR-66
| 10,145,540 | 21,436,784 |
RR
| 66 |
2167-02-22 21:59:00
|
2167-02-22 22:57:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with headache, blood from left ear, assess for
temporal bone fracture and intracranial hemorrhage // hemorrhage?
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head: ___.
FINDINGS:
There is no evidence of infarction, acute intracranial hemorrhage, edema, or
mass. The ventricles and sulci are normal in size and configuration.
No acute fracture is seen. There is mucosal thickening within the sphenoid
sinuses, ethmoid air cells, and left frontal sinus. The mastoid air cells,
and middle ear cavities are clear. There is opacification of the left
external auditory canal (3:7). The orbits are unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Left external auditory canal opacification, with no evidence of acute
fracture on this head CT. .
3. Mild paranasal sinus inflammation.
|
10145540-RR-67
| 10,145,540 | 21,436,784 |
RR
| 67 |
2167-02-22 22:31:00
|
2167-02-22 23:00:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ pain, cirrhosis // portal vein thrombosis?
TECHNIQUE: Grey scale ultrasound images of the abdomen were obtained.
COMPARISON: CT abdomen pelvis: ___.
FINDINGS:
Limited grayscale images of the upper abdomen demonstrate an unremarkable
gallbladder, with no evidence of gallstones, wall thickening, or
pericholecystic fluid.
The exam was terminated secondary to patient discomfort and continuing emesis
during image acquisition.
IMPRESSION:
1. Incomplete exam was terminated early due to patient discomfort and ongoing
emesis during image acquisition. No Doppler images could be acquired.
2. Unremarkable gallbladder.
|
10145540-RR-71
| 10,145,540 | 28,792,447 |
RR
| 71 |
2168-08-02 12:53:00
|
2168-08-02 17:22:00
|
EXAMINATION: CT ABDOMEN PELVIS WITH CONTRAST
INDICATION: ___ with PMHx cirrhosis (from PSC, complicated by
HE/ascites/bleeding varices), Crohn's disease, and polysubstance abuse who
presents with abdominal pain and N/V/D. Found to have RLL pneumonia.// any
evidence of crohns flare or PSC flare?
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 VoLumen was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 63.2 cm; CTDIvol = 10.7 mGy (Body) DLP = 675.1
mGy-cm.
2) Stationary Acquisition 7.3 s, 0.5 cm; CTDIvol = 39.7 mGy (Body) DLP =
19.9 mGy-cm.
Total DLP (Body) = 695 mGy-cm.
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
LOWER CHEST: There is a large right pleural effusion associated with almost
complete collapse of the imaged portion of the right lower lobe. The
collapsed lung demonstrates appropriate enhancement, favoring atelectasis over
infection. The left lung base is clear. There is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken and nodular in contour, consistent with
known cirrhosis. There is no evidence of focal lesions. There is no
intrahepatic or extrahepatic biliary ductal dilatation. There is no
hyperenhancement of the biliary ducts or periductal edema to suggest acute
inflammation. The gallbladder is collapsed.
A diminutive portal vein is again seen. Sequela of severe portal hypertension
with marked splenomegaly, large abdominal ascites and prominent mesenteric and
upper abdominal varices are similar to prior.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation.
SPLEEN: The spleen is markedly enlarged at 20.2 cm, previously 21.9 cm. 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: The stomach is distended with fluid and ingested material.
Small and large bowel loops demonstrate normal caliber. No areas of focal
thickening of small or large bowel wall are seen to suggest active Crohn's
flare. The colon is fluid-filled. The appendix is normal (601:55).
PELVIS: The urinary bladder is 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. Gastric distension and fluid-filled colon suggests gastroenteritis of an
infectious/inflammatory etiology. No bowel obstruction. No evidence of active
Crohn's flare.
2. No CT evidence of acute inflammation involving the biliary tree.
3. Large right pleural effusion with near collapse of the imaged right lower
lobe. Appropriate enhancement of the collapsed portion of lung favors
atelectasis over infection.
4. Re-demonstration of cirrhosis with sequela of severe portal hypertension,
similar to ___.
|
10145540-RR-72
| 10,145,540 | 28,792,447 |
RR
| 72 |
2168-08-03 10:49:00
|
2168-08-03 15:26:00
|
INDICATION: ___ year old man with history of cirrhosis, PSC, Crohn's disease,
and polysubstance abuse, who presented with abdominal pain and found to have
right lower lobe pneumonia, now with gastric distention and worsening
abdominal pain. Gastric distention and fluid filled colon seen on recent CT.
Please evaluate for signs of obstruction or perforation.
TECHNIQUE: Supine and upright abdominal radiograph.
COMPARISON: CT abdomen and pelvis from ___.
FINDINGS:
Centralized gas pattern with scattered air noted in small and large bowel
loops, and the rectosigmoid. Central distribution of bowel loops may be due
to ascites.
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Contrast material is seen within the urinary bladder from the most recent CT.
There is a right pleural effusion.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonspecific gas pattern without clear evidence of free air or obstruction. If
there is concern for obstruction or pneumoperitoneum, may consider CT for
further characterization.
|
10145540-RR-74
| 10,145,540 | 28,792,447 |
RR
| 74 |
2168-08-04 15:25:00
|
2168-08-04 16:37:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleural effusion.// Please evaluate for
interval change of R pleural effusion. Please evaluate for interval
change of R pleural effusion.
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Moderate right pleural effusion is larger, obscuring the right lower lobe.
Interstitial abnormality in the left lung has a nodular quality. Findings are
concerning for atypical pneumonia, including possible miliary tuberculosis.
Heart size top-normal, increased since ___.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 4:35 pm, 1 minutes after discovery of
the findings.
|
10145540-RR-75
| 10,145,540 | 28,792,447 |
RR
| 75 |
2168-08-05 10:38:00
|
2168-08-05 16:31:00
|
INDICATION: ___ year old man with R pleural effusion, interstitial
abnormality.// Please evaluate for interval change of pleural effusion and
interstitial abnormality.
TECHNIQUE: Single frontal radiograph of the chest.
COMPARISON: ___.
IMPRESSION:
Improvement in right pleural effusion, now small. Patchy opacity at the right
lung base may represent resolving atelectasis versus pneumonia. Previously
described faint nodular interstitial abnormality of the left lung appears
slightly less conspicuous. Attention on follow-up.
Cardiomediastinal silhouette appears unchanged. No pneumothorax.
|
10145540-RR-77
| 10,145,540 | 28,792,447 |
RR
| 77 |
2168-08-07 19:05:00
|
2168-08-07 20:21:00
|
INDICATION: ___ year old man with abdominal distention and pain.// Please
evaluate for ileus, free air under diaphragm/perforation, SBO, recurrent
gastric distention.
TECHNIQUE: Supine and upright portable abdominal radiographs were obtained.
COMPARISON: ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonspecific, nonobstructive bowel gas pattern.
|
10145540-RR-79
| 10,145,540 | 28,792,447 |
RR
| 79 |
2168-08-12 10:30:00
|
2168-08-12 11:54:00
|
EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with hand strike vs. wall, now with R hand pain
and swelling.// Please evaluate for bony fracture. Please evaluate for
bony fracture.
IMPRESSION:
No comparison. Three views of the right hand are provided. No periarticular
soft tissue swelling. No cortical disruptions indicative of fracture. No
articular erosions, no substantial degenerative disease.
|
10145540-RR-80
| 10,145,540 | 28,792,447 |
RR
| 80 |
2168-08-12 23:04:00
|
2168-08-13 11:57:00
|
INDICATION: ___ year old man with worsening abdominal pain. asses for perf.//
young man with cirrhosis
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph ___. Dominant CT ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Assessment for free intraperitoneal air is limited on supine radiographs,
however there is no gross pneumoperitoneum. If there is clinical concern for
pneumoperitoneum, advise upright or left lateral decubitus radiograph, or
cross-sectional imaging.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
1. Nonspecific, nonobstructive bowel gas pattern.
2. Assessment pneumoperitoneum is limited on supine imaging, however there is
no gross pneumoperitoneum. If there is clinical concern for pneumoperitoneum,
advise upright or left lateral decubitus radiograph, or cross-sectional
imaging.
|
10145750-RR-10
| 10,145,750 | 27,421,018 |
RR
| 10 |
2176-05-13 19:09:00
|
2176-05-13 23:26:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: A ___ woman with a new malignancy diagnosis, unclear
primary, now with leg pain, evaluate for metastases other pathology.
TECHNIQUE: Two views of the left tibia and fibula.
COMPARISON: None.
FINDINGS:
There is mild marginal spurring of the left knee, consistent with mild
osteoarthritis. The joint space appears well preserved. There is no evidence
of knee effusion. There is no evidence of fracture of the tibia or fibula.
Small ossific densities inferior to the lateral malleolus likely represent
sequelae of prior trauma. There is no definite concerning lytic or sclerotic
lesion identified. There is no periostitis or focal bony erosion. No soft
tissue calcification or radiopaque foreign body is seen.
IMPRESSION:
1. No definite lytic or sclerotic lesion identified. MRI should be considered
for further evaluation if there is clinical concern for malignancy.
2. Mild left knee osteoarthritis.
|
10145750-RR-11
| 10,145,750 | 27,421,018 |
RR
| 11 |
2176-05-14 13:31:00
|
2176-05-14 17:50:00
|
EXAMINATION: BX-NEEDLE LIVER BY RADIOLOGIST
INDICATION: ___ year old woman with new malignancy of unclear primary, please
do bx of liver lesion for diagnosis // Please eval liver lesions
COMPARISON: Outside CT ___
PROCEDURE: Ultrasound-guided targeted liver biopsy.
OPERATORS: Dr. ___ trainee and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
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 US scan table. Limited
preprocedure ultrasound of the liver was performed. Based on the ultrasound
findings an appropriate position for the biopsy was chosen, with a segment ___
hypoechoic lesion targeted. The site was marked.
The site was prepped and draped in the usual sterile fashion. 10 cc of 1%
lidocaine were administered to the subcutaneous and deep tissues for local
anesthetic effect. Under continuous ultrasound guidance, an 18 gauge core
biopsy device with a 22 mm throw was used to obtain 1 core biopsy specimens,
which were sent for pathology.
The specimen was evaluated by onsite cytologist, and deemed adequate for
diagnosis.
The procedure was tolerated well and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of 1
mg Versed and 50 mcg fentanyl throughout the total intra-service time of 22
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Multiple hypoechoic liver lesions, as demonstrated on prior CT, are
demonstrated.
IMPRESSION:
Successful 18 gauge core biopsy of focal liver lesion.
|
10145750-RR-8
| 10,145,750 | 27,421,018 |
RR
| 8 |
2176-05-13 06:01:00
|
2176-05-13 06:43:00
|
EXAMINATION: SECOND OPINION MR TORSO
INDICATION: ___ year old woman with vaginal bleeding, pelvic mass, perineal
numbness // eval mass
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen were
obtained on a 1.5 Tesla magnet before and after the administration of
gadolinium intravenous contrast. The amount and type of contrast administered
is not provided with the images, but upon referring to the ___ report
in the ___ medical record, 10 cc of Gadavist was administered
intravenously.
COMPARISON: No relevant comparisons available.
FINDINGS:
This is a second opinion read of a pelvic MRI performed at ___
___ on ___, time stamped 1:18 AM.
MRI PELVIS: The uterus is 16.5 x 7.2 x 6.7 cm. A multi-lobulated enhancing
mass, which is isointense to myometrium on the T2 weighted images, measures to
15.1 x 5.6 cm in aggregate and involves the endometrium, portions of the
myometrium, and cervix. The fundal endometrium demonstrates additional sites
of nodularity (4:18, 19). The cervical fibromuscular stroma is obliterated
with posterior bulging of the cervix (07:23). Nabothian cysts are noted.
Nodular abnormal enhancement involves at least the anterior upper vagina
(1003:47) and possibly the anterior lower vagina (11:30, 1003:43). The fat
plane between the mass and the posterior bladder wall is obliterated. Invasion
of the at least the outer wall of the bladder cannot be excluded. No
intraluminal bladder mass is identified. The bladder is decompressed with a
Foley catheter with air, likely related to instrumentation. The rectum is
normal without evidence of involvement.
There is bilateral hydrosalpinx. The ovaries are normal.
Enlarged lymph nodes in the pelvis are concerning for metastatic disease. For
example, a right internal iliac/presacral lymph node is 2.5 cm (11:12) and a
right external iliac lymph node is 2.0 cm (11:18). Left external iliac lymph
nodes are 2.5 x 1.7 cm (11:19) and 1.9 cm (11:15).
There is osseous metastatic disease with a 1.7 cm enhancing lesion in the S1
vertebral body. Vague enhancement in the right iliac wing with adjacent
muscular enhancement (11:15), heterogeneous enhancement in the left sacral ala
(11:10), and a lesion in the L5 vertebral body are concerning for additional
sites of metastatic disease. At the inferior aspect of the thecal sac, within
the spinal canal posterior to the S1-S3 vertebral bodies, there is T2
hypointensity spanning 6 cm (4:16), with enhancement (better seen on the
concurrent MRI L-spine), suspicious for tumor involvement. The enhancement
extends into the S2 nerve roots.
IMPRESSION:
1. Multilobulated enhancing mass involving the endometrium extensively,
several areas of the myometrium, and cervix as detailed above, more likely
representing endometrial carcinoma. The tumor involves the upper vagina and
possibly the lower vagina. Invasion of the outer bladder wall cannot be
excluded though the muscular bladder wall appears intact. No evidence of
rectal involvement.
2. Metastatic disease with pelvic lymphadenopathy and multiple osseous
metastases. Tumor involvement at the inferior aspect of the thecal sac,
likely extending into the S2 nerve roots.
3. Bilateral hydrosalpinx. Normal ovaries.
|
10145750-RR-9
| 10,145,750 | 27,421,018 |
RR
| 9 |
2176-05-13 06:07:00
|
2176-05-13 06:31:00
|
EXAMINATION: MRI lumbar spine from outside hospital uploaded for second read
INDICATION: ___ year old woman with pelvic mass // eval Lumbar spine for
metastatic lesion
TECHNIQUE: Localizer, sagittal T1 post-contrast, and axial T1 post-contrast
sequences of the lumbar spine were performed at ___. Images
were uploaded and PACS for a second read.
COMPARISON: MRI lumbar spine ___, CT abdomen and pelvis ___.
FINDINGS:
For the purposes of numbering, the lowest well formed intervertebral disc
space was designated the L5-S1 level. Please note that this method is
inappropriate for surgical planning and that prior to any intervention
appropriate levels must be established.
Comparison was made with noncontrast lumbar spine MRI from with ___
performed at ___. There is a 0.9 cm T1 hypointense, T2
hyperintense, enhancing lesion in the left-sided aspect of the L5 vertebral
body (series 3, image 7). This lesion is suspicious for an osseous metastasis.
The cortex of the vertebral body is intact. There is a 1.2 cm heterogeneously
T1 hyperintense, T2 hyperintense, enhancing lesion in the S1 vertebral body
(series 3, image 6). Correlation was made CT from ___, which
demonstrates a target ovoid appearance. Vertebral bodies are normal in height.
There are degenerative endplate changes at a few levels. There is no
pathologic fracture. Intervertebral discs are preserved in height except for
mild disc space narrowing at L5-S1. The distal thoracic spinal cord is normal.
The conus is normal in appearance and position, terminating at L1. There is no
pathologic enhancement of the nerve roots of the cauda equina.
There is degenerative disc disease at T12-L1, L4-5, and L5-S1 and facet
arthropathy throughout the lumbar spine but no significant spinal canal or
neural foraminal stenosis.
There is a 2.2 x 2.2 cm heterogeneously enhancing mass near the right internal
iliac artery, incompletely imaged but suspicious for an abnormal lymph node
(series 4, image 31). The uterus is enlarged and markedly lobular and
irregular, corresponding to a similar appearance on CT from ___.
IMPRESSION:
1. Enhancing lesion within the L5 vertebral body consistent with an osseous
metastasis. There is a similar lesion within the S1 vertebral body, although
the S1 lesion demonstrates intrinsic T1 hyperintensity which is somewhat
unusual for a metastasis. It is uncertain whether the S1 vertebral body lesion
is a metastasis or a hemangioma. Comparison with the available CT from ___ is also indeterminate at S1, demonstrating a lesion that is mixed lucent
and sclerotic and not clearly typical of either a metastasis or a hemangioma.
2. Enlarged markedly and markedly irregular uterus. Correlation with dedicated
MRI of the pelvis is recommended. Right internal iliac lymphadenopathy.
|
10146033-RR-25
| 10,146,033 | 22,111,490 |
RR
| 25 |
2164-03-13 17:48:00
|
2164-03-13 18:24:00
|
CHEST RADIOGRAPHS
HISTORY: Question pneumonia.
COMPARISONS: ___.
TECHNIQUE: Chest, AP and lateral.
FINDINGS: Allowing for AP technique, the cardiac, mediastinal and hilar
contours appear unchanged including mild unfolding of the thoracic aorta. The
heart is normal in size. The lungs appear clear. There are no pleural
effusions or pneumothorax. The lateral view is somewhat limited, particularly
with respect to visualization of more anterior structures, because the arms
are down. The osseous structures are unremarkable.
IMPRESSION: No evidence of acute disease.
|
10146186-RR-21
| 10,146,186 | 27,138,521 |
RR
| 21 |
2120-04-16 09:46:00
|
2120-04-16 14:26:00
|
HISTORY: History of rhabdomyolysis now with acute diffuse abdominal pain and
no bowel movement for several days.
COMPARISON: None available.
FINDINGS:
One frontal and one left lateral decubitus view of the abdomen shows gaseous
distention of the transverse colon in the region of the splenic flexure.
There are no dilated loops of small bowel to suggest obstruction. There is no
free air on left lateral decubitus view or pneumatosis. There is hardware in
place in the lumbar spine.
IMPRESSION:
Gaseous distention of the transverse colon. No dilated loops of small bowel to
suggest obstruction or ileus. No evidence of free air.
|
10146186-RR-22
| 10,146,186 | 27,138,521 |
RR
| 22 |
2120-04-19 15:32:00
|
2120-04-19 16:08:00
|
HISTORY: Hypertension and chronic back pain coming in rhabdomyolysis.
Worsening renal function
COMPARISON: None
TECHNIQUE: Grayscale and Doppler and spectral imaging of the kidneys
FINDINGS:
The right kidney measures 10.2 cm and the left kidney measures 10.8 cm.
Neither shows evidence of hydronephrosis, renal stones or solid renal masses.
The bladder is unremarkable.
DOPPLER ULTRASONOGRAPHY: The main and intrarenal arteries are patent
bilaterally. The resistive indices on the right in the upper, mid and lower
poles are 0.66, 0.69 and 0.69 respectively. On the left, the resistive
indices in the upper, mid, lower polar 0.63, 0.65 and 0.69. Note is made of
delayed acceleration times in bilateral main renal arteries.
IMPRESSION:
1) No hydronephrosis.
2) Delayed arterial acceleration bilaterally in a symmetric fashion. If
further evaluation is desired, can consider CTA or MRA to evaluate for
stenosis.
|
10146602-RR-100
| 10,146,602 | 27,939,683 |
RR
| 100 |
2185-01-14 09:08:00
|
2185-01-14 10:09:00
|
EXAMINATION: US, OTHER SOFT TISSUE AREA PORT
INDICATION: ___ year old man s/p CABG readmitted with fevers and dehydration
// r/o infection at SVG site on L calf
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left calf in the region of swelling and discomfort indicated by
the patient, at the site of recent saphenous vein harvest.
COMPARISON: A bilateral lower extremity venous study was performed in the
same session.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left calf. There is confluent subcutaneous edema about the surgical incision
but no organized fluid collection is identified..
IMPRESSION:
Subcutaneous edema surrounding the surgical incision in the left calf, which
could be seen in the setting of cellulitis, but no organized fluid collection
identified to suggest abscess.
|
10146602-RR-96
| 10,146,602 | 27,939,683 |
RR
| 96 |
2185-01-13 01:17:00
|
2185-01-13 01:49:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ man with recent CABG presenting with sudde onset left
hand numbness
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 65.3 mGy (Head) DLP =
32.7 mGy-cm.
3) Spiral Acquisition 5.6 s, 43.7 cm; CTDIvol = 32.0 mGy (Head) DLP =
1,400.6 mGy-cm.
Total DLP (Head) = 2,330 mGy-cm.
COMPARISON: ___ CTA chest.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of hemorrhage, edema, mass effect, or
acute vascular territorial infarction. The ventricles and sulci are normal in
size and configuration.
There is mild mucosal thickening of the inferior bilateral frontal sinuses and
ethmoid air cells. Otherwise, the remainder the visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
There is a three vessel aortic arch. The origin of the common carotid and
vertebral arteries is patent. There is mixed plaque in the carotid bulbs
bilaterally extending into the proximal internal and external carotid
arteries. This results in approximately 25% narrowing of the proximal right
internal carotid artery by NASCET criteria. There is no narrowing of the left
internal carotid artery by NASCET criteria.
There is a 8 mm saccular outpouching arising from the posteromedial aspect of
the left proximal cervical internal carotid artery near the carotid
bifurcation (series 5, image 213 ; series ___, image 26), which in
retrospect may be seen on CT neck of ___, potentially slightly
increased in size allowing for technical differences, compatible with a pseudo
aneurysm.
The vertebral arteries are within normal limits.
OTHER:
Lung parenchymal distortion representing postsurgical changes in the right
upper lobe are similar to the prior study. Mediastinal fat stranding,
retrosternal fluid and gas and moderate left pleural effusion are in keeping
with reported history of recent CABG. A 2 mm nodule at the right apex is
stable (5:91). The lungs are clear. A broad pleural based extrapulmonary
soft tissue nodule in the left upper chest measures 9 x 25 mm was not clearly
present on the prior study of ___ (5:47), potentially secondary to a
loculated effusion. The adjacent rib is intact. The visualized portion of
the thyroid gland is within normal limits. There is no lymphadenopathy by CT
size criteria. Multiple prominent venous collaterals are noted along the
anterior chest wall.
IMPRESSION:
1. No evidence of hemorrhage, edema, mass effect or acute vascular territorial
infarction. No acute intracranial abnormality on noncontrast head CT.
2. Unremarkable head CTA.
3. There is a 8 mm saccular outpouching of the proximal left cervical internal
carotid artery near the carotid bifurcation, concerning for a pseudo aneurysm.
This appears slightly increased in size since neck CT of ___ allowing
for technical differences. In addition, CTA neck is notable for mixed
atherosclerotic disease in the carotid bulbs extending into the proximal
internal carotid arteries with approximately 25% narrowing of the proximal
right internal carotid artery by NASCET criteria.
4. Postsurgical changes of recent CABG, including sternotomy, mediastinal fat
stranding and small retrosternal fluid collection with locules of gas.
5. Moderate left pleural effusion.
6. A pleural-based extrapulmonary soft tissue mass in the left upper chest was
not present on the most recent examination of ___ mA related to
postoperative changes however, such as loculated pleural fusion, short-term
follow-up with dedicated chest CT is recommended to assess for stability or
resolution.
NOTIFICATION: A new finding not reported on preliminary wet read regarding 8
mm saccular outpouching of the proximal left cervical internal carotid artery
concerning for a pseudo aneurysm were discussed with Dr. ___, M.D. by
___, M.D. on the telephone on ___ at 4:06 ___, 10 minutes
after discovery of the findings.
|
10146602-RR-97
| 10,146,602 | 27,939,683 |
RR
| 97 |
2185-01-13 01:19:00
|
2185-01-13 07:48:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with L arm numbness, fever, SOB // eval for
pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
There has been interval resolution of the right-sided pleural effusion. The
left-sided pleural effusion persistent. The cardiomediastinal silhouette is
similar to the prior examination in this patient status post recent CABG and
more remote partial resection of the right lung. Midline sternal wires are
well aligned and intact. Mediastinal clips are noted. No definite focal
consolidation is identified. Multifocal subsegmental atelectasis has slightly
decreased in the interval.
IMPRESSION:
No definite focal consolidation identified.
|
10146602-RR-98
| 10,146,602 | 27,939,683 |
RR
| 98 |
2185-01-14 14:03:00
|
2185-01-14 15:29:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man s/p cabg returns with fever and L ulnar nerve
distribution numbness // eval post stroke code. Request for ___ as pt
already received dye today
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck of ___
FINDINGS:
There is no intra or extra-axial mass, acute hemorrhage or infarct. The sulci,
ventricles and cisterns are within expected limits for the patient's age. The
major intracranial flow voids are preserved. There is mild mucosal thickening
of the ethmoid air cells. The remainder the paranasal sinuses are clear. The
orbits are unremarkable. The mastoid air cells appear clear.
IMPRESSION:
1. No acute infarct or intracranial hemorrhage.
|
10146602-RR-99
| 10,146,602 | 27,939,683 |
RR
| 99 |
2185-01-14 09:07:00
|
2185-01-14 10:04:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old man s/p cabg readmit with fever // follow up
superficial DVT from last week.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: ___
FINDINGS:
On the left, noncompressible, nonocclusive thrombus is re- demonstrated in the
distal superficial femoral vein, located along a valve. Its distribution and
appearance is unchanged from ___.
Otherwise, there is normal compressibility, and flow, of the bilateral common
femoral, femoral, and popliteal veins. Normal augmentation is present on the
right and was not performed on the left. 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.
There is atherosclerotic calcification in portions of the visualized arteries.
No evidence of medial popliteal fossa (___) cyst. There is calf edema in
the right lower extremity.
IMPRESSION:
1. Stable appearance of a nonocclusive thrombus in the left distal superficial
femoral vein. No evidence of propagation or new DVT bilaterally.
2. Calf edema of the right lower extremity. Please refer to separately
dictated report of same date for ultrasound of the venous harvest site.
|
10146735-RR-143
| 10,146,735 | 26,221,231 |
RR
| 143 |
2136-12-23 12:06:00
|
2136-12-23 13:14:00
|
EXAMINATION: Chest single view
INDICATION: ___ year old man with ETOH cirrhosis, admitted with hematemesis,
intubated for EGD/TIPS// ET tube placement
TECHNIQUE: Chest portable AP
COMPARISON: .
FINDINGS:
NG tube has been placed the cold in the stomach. An ET tube has also been
placed with its tip just above the carina, 1.5 cm. The heart is not enlarged.
The aorta is tortuous. Patchy opacities in the left lower lung field noted.
No pleural effusion or pneumothorax
IMPRESSION:
NG-tube an ET tube in position.
RECOMMENDATION(S): ET tube may be too close to carina. Suggest pull back a
cm
|
10146735-RR-144
| 10,146,735 | 26,221,231 |
RR
| 144 |
2136-12-23 14:29:00
|
2136-12-24 07:33:00
|
INDICATION: ___ year old man with hematemesis and history of frequent large
volume paracenteses.
COMPARISON: CTA abdomen dated ___
TECHNIQUE: OPERATORS: Dr. ___ and Drs.
___, attending radiologists performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: General anesthesia was administered by the anesthesiology
department. Please refer to anesthesiology notes for details.
MEDICATIONS: Please refer to the general anesthesia medical record.
CONTRAST: 50 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 21.5 min, 76.0 mGy
PROCEDURE: 1. Paracenesis
2. Right internal jugular venous access using ultrasound
3. Pre-procedure right atrial pressure measurement
4. Right hepatic venogram
5. CO2 portal venogram
6. Contrast enhanced splenic and portal venogram
7. Placement of a 10 mm x 6 cm x 2 cm Viatorr covered stent
8. Post-stenting balloon angioplasty of the TIPS shunt with a 10 mm balloon
9. Post TIPS 10 mm balloon angioplasty right atrial and portal vein pressure
measurements
10. Post TIPS contrast-enhanced splenic and portal venogram
11. Balloon angioplasty of the TIPS with a 12 mm balloon
12. Post 12 mm balloon angioplasty right atrial and portal vein pressure
measurements
13. Final contrast-enhanced portal venogram
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient's wife. The patient was then brought to the angiography suite and
placed supine on the exam table. A pre-procedure time-out was performed per
___ protocol. The right neck and right abdomen were prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, ___ catheter was advanced through the
skin of the right abdomen into a pocket of intraperitoneal ascites. Pre and
post ultrasound-guided access images were saved to PACS. The catheter was
advanced over the needle, the needle was removed and ___ wire was
advanced into the abdomen. The ___ catheter was exchanged for ___
pigtail catheter. The catheter was then connected to tubing for bottle
drainage.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a ___ wire was advanced distally into
the IVC.
The micropuncture sheath was then removed and a 10 ___ TIPS sheath was
advanced over the wire into the inferior vena cava. A ___ wire was
advanced in the sheath next to the ___ wire and passed into the IVC for
stability. Using a MPA catheter and angled Glidewire, access was obtained in
the right hepatic vein. Appropriate position was confirmed with a right
hepatic venogram and fluoroscopy in lateral view. The safety ___ wire was
removed. The ___ F sheath was advanced over the catheter into the right
hepatic vein. The MPA catheter was exchanged for a balloon occlusion catheter
which was advanced into the distal right hepatic vein. A CO2 portal venogram
was performed in AP and ___ projections.
Following procedural planning, the occlusion balloon was removed. The cannula
device was inserted over the ___ wire and the wire was exchanged for ___
___ needle. The angled sheath was turned anteromedial. The needle was then
advanced through liver parenchyma and the needle was withdrawn over its
sheath. Blood return was immediately identified through the sheath. A small
hand contrast injection opacified the location of the portal vein. Due to
adequate blood return, an angled Glidewire was advanced carefully through the
catheter to pass into the portal vein and eventually into the proximal splenic
vein. The needle sheath was exchanged for a ___ angled glide catheter. The
glide catheter was advanced over the wire into the splenic vein. The wire was
removed and a small hand contrast injection confirmed placement within the
splenic vein. An Amplatz wire was advanced through the catheter into the
proximal splenic vein. The ___ TIPS sheath were advanced into the portal
vein. The catheter and cannula device were removed. A marking pigtail flush
catheter was advanced over the wire into the splenic vein. A portal vein
pressure measurement was then obtained. A contrast-enhanced splenic and portal
venogram was then performed.
The catheter was removed and a 10 mm x 6 cm x 2 cm Viatorr covered covered
stent was advanced into appropriate position and deployed. Following stent
deployment, the stent was dilated using a 10 mm balloon. The flush catheter
was advanced over the wire into the splenic vein. Repeat right atrial and
portal vein pressure measurements were obtained. At this time, 12 mm balloon
angioplasty of the TIPS was performed. The flush catheter was advanced over
the wire into the splenic vein. Repeat portal vein and right atrial pressure
measurements were obtained. A contrast-enhanced proximal splenic and portal
venogram were performed.
All wires, catheters and sheaths were removed from the patient. Manual
pressure over the right neck and right abdomen was held for 10 minutes to
ensure hemostasis. Sterile dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Abdominal ultrasound identified a large volume of ascites. Roughly 3 L of
ascites was removed.
2. Initial portosystemic gradient of 15 mm per Hg.
3. Small caliber gastroesophageal varices are identified on initial splenic
and portal venogram.
4. Technically successful placement of 10 mm x 6 cm x 2 cm TIPS connecting
the right hepatic vein to the right portal vein.
5. 10 mm balloon angioplasty of the TIPS resulted in a reduction of the
portosystemic gradient from 15 mm per Hg to 7 mm per Hg.
6. 12 mm balloon angioplasty of the TIPS resulted in a reduction of the
portosystemic gradient from 7 mm per Hg to 5 mm per Hg.
7. Final proximal splenic and portal venogram showed no evidence of varices
or thrombus within the portal and splenic vein.
IMPRESSION:
Successful right internal jugular access with transjugular intrahepatic
portosystemic shunt placement with decrease in porto-systemic pressure
gradient from 15 mm per Hg to 5 mm per Hg. 3 liters of large pleural effusion
were drained.
|
10146735-RR-146
| 10,146,735 | 26,221,231 |
RR
| 146 |
2136-12-24 03:03:00
|
2136-12-24 12:24:00
|
INDICATION: ___ year old man with ETOH cirrhosis, upper GI bleed// L CVL
placement, ET tube placement Contact name: MICU BLUE, ___: ___
TECHNIQUE: Single supine portable radiograph of the chest
COMPARISON: Chest radiograph dated ___
FINDINGS:
The lungs are moderately well inflated. Mild interstitial edema has improved
compared to the prior radiograph. Unchanged cardiomegaly and a unfolding of
the thoracic aorta. No large pleural effusions.
Endotracheal tube terminates 5.2 cm above the carina; enteric tube courses
below the diaphragm, tip not visualized; left internal jugular catheter tip
terminates in the SVC, EKG leads overlie the chest wall.
IMPRESSION:
Interval improvement in mild pulmonary edema.
Lines and tubes as above, in unchanged position compared to the prior
radiograph. The newly placed left internal jugular venous catheter tip
terminates in the SVC.
|
10146735-RR-158
| 10,146,735 | 21,502,169 |
RR
| 158 |
2137-05-02 07:19:00
|
2137-05-02 08:05:00
|
EXAMINATION: CT abdomen/pelvis
INDICATION: ___ with repaired umbilical hernia, with abd painNO_PO contrast//
plz evaluate for intrabdominal process
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP 605.16mGy-cm.
COMPARISON: CT abd/pel ___.
FINDINGS:
LOWER CHEST: Mild bibasilar dependent atelectasis. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver is nodular consistent with cirrhosis. There is no
evidence of focal lesions. There is a patent TIPS stent. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits.
There is a small amount of perihepatic and perisplenic ascites with ___ of 20,
minimally complex.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is enlarged measuring 13.8 cm with normal 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 hydronephrosis. Subcentimeter hypodense lesion is too
small to characterize but likely represents renal cysts. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. There are dilated fluid-filled
loops of small bowel with relative decompression of the terminal ileum and the
colon concerning for at least partial small bowel obstruction. There is a loop
of small bowel which is within the umbilical hernia with relative mild
decrease in caliber of the more distal loops of small bowel compared with the
proximal loops which are dilated. The colon and rectum are decompressed. The
appendix is normal.
PELVIS: A portion of the left urinary bladder wall is within in left inguinal
hernia. Otherwise, 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. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There is mild grade 1 retrolisthesis of L2 on L3, likely degenerative.
SOFT TISSUES: The left inguinal hernia contains a portion of the left aspect
of the bladder wall. The right inguinal hernia contains ascitic fluid. There
is an umbilical hernia containing a loop of small bowel.
IMPRESSION:
1. Dilated fluid-filled loops of small bowel with relative decompression of
the terminal ileum and colon concerning for at least partial small bowel
obstruction with likely transition point in the umbilical hernia.
2. Cirrhotic liver with splenomegaly and ascites. Patent TIPS stent.
3. Bilateral inguinal hernias, the left inguinal hernia containing a portion
of the bladder wall.
|
10146735-RR-76
| 10,146,735 | 27,669,890 |
RR
| 76 |
2136-07-18 16:08:00
|
2136-07-18 16:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis childs class c, nausea, elevated
WBC, ruling out infectious causes // ___ year old man with cirrhosis childs
class c, nausea, elevated WBC, ruling out infectious causes
TECHNIQUE: Chest single view
COMPARISON: ___ 10:55
FINDINGS:
Normal heart size, pulmonary vascularity. Lungs are clear. No pleural
effusion. Chronic posttraumatic change right posterior fifth rib is stable.
IMPRESSION:
No acute findings.
|
10146735-RR-77
| 10,146,735 | 27,669,890 |
RR
| 77 |
2136-07-18 18:14:00
|
2136-07-18 19:33:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with cirrhosis child class C, nausea, abdominal
pain, decreased BMs, concern for possible small bowel obstruction. // ___ year
old man with cirrhosis child class C, nausea, abdominal pain, decreased BMs,
concern for possible small bowel obstruction.
TECHNIQUE: Abdomen two views
COMPARISON: Chest radiograph ___
FINDINGS:
There are multiple dilated small bowel loops in the central abdomen, few with
air-fluid levels, suggesting small bowel obstruction. Colon is decompressed.
Suggestion of ascites. Degenerative changes lumbar spine. No free air.
Chronic right rib fractures.
IMPRESSION:
Multiple dilated small bowel loops in the central abdomen, suggesting small
bowel obstruction.
|
10146735-RR-78
| 10,146,735 | 27,669,890 |
RR
| 78 |
2136-07-18 23:03:00
|
2136-07-18 23:59:00
|
INDICATION: ___ year old man with cirrhosis, presenting with 3 day of nausea
and no BMs, concern for small bowel obstruction; WOULD LIKE ORAL CONTRAST BUT
NOT IV //
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 52.0 cm; CTDIvol = 9.3 mGy (Body) DLP = 485.0
mGy-cm.
Total DLP (Body) = 485 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild ___ opacities are noted in right middle lobe.
ABDOMEN:
Moderate ascites is noted.
HEPATOBILIARY: Liver contour is nodular, consistent with known cirrhosis. No
focal lesion is identified within the limits station of unenhanced scan.
There is no intra or extrahepatic bile duct dilation.
Gallbladder wall edema is likely related to liver disease.
PANCREAS: Pancreas is homogeneous in attenuation throughout. There is no
pancreatic duct dilation.
SPLEEN: Spleen is borderline enlarged, measuring 12.4 cm.
ADRENALS: Bilateral adrenal glands are mildly thickened without discrete
nodules.
URINARY: Bilateral kidneys are symmetric in size. There is no stone or
hydronephrosis.
GASTROINTESTINAL: Stomach is distended. Proximal small bowel loops are
dilated. Transition point (02:54, 601b:17, 602b:40) is identified at the
umbilical hernia which contain decompressed small bowel loops. Small bowel
loops distal to the umbilical hernia are also decompressed. Colon is also
relatively decompressed. Colonic diverticulosis is noted. Appendix is not
visualized.
PELVIS: Bladder is unremarkable.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable. Large
left hydrocele is noted.
LYMPH NODES: No pathologically enlarged lymph node is identified.
VASCULAR: There is no abdominal aortic aneurysm. Moderate Atherosclerotic
disease is noted.
BONES: Subcentimeter sclerotic lesion in the right iliac bone is likely a bone
island. Multiple old fractures are noted in bilateral ribs.
SOFT TISSUES: No suspicious soft tissue lesion is identified. Left inguinal
hernia contains small portion of anterior bladder wall.
IMPRESSION:
1. Small bowel containing umbilical hernia and findings consistent with small
bowel obstruction, with transition point at the hernia neck. Findings are
concerning for entrapped small bowel in the umbilical hernia, causing small
bowel obstruction.
2. Liver cirrhosis with small to moderate ascites.
3. Large left hydrocele.
4. Left inguinal hernia contains a small portion of anterior bladder wall.
5. Colonic diverticulosis.
|
10146735-RR-79
| 10,146,735 | 27,669,890 |
RR
| 79 |
2136-07-20 13:32:00
|
2136-07-20 14:23:00
|
INDICATION: ___ M hx Child C cirrhosis, MELD 29 w/ refractory acites, variceal
bleed, hepatic encephalopathy s/p primary repair of leaking umbilical hernia
___. would like paracentesis to decompress and prevent leaking via incision,
please perform paracentesis
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: None
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
During procedure setup, patient experienced a generalized tonic-clonic seizure
lasting approximately 45 seconds with proximally 10 min of postictal
confusion. The procedure was terminated, clinical team was contacted and the
patient was transferred to the ICU.
IMPRESSION:
Procedure canceled due to generalized tonic-clonic seizure.
NOTIFICATION: The events were discussed with ___, M.D. by ___
___, M.D. in person on ___ at 2:01 ___, 5 minutes after discovery of
the findings.
|
10146735-RR-80
| 10,146,735 | 27,669,890 |
RR
| 80 |
2136-07-20 17:39:00
|
2136-07-20 19:05:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ w/ seizure , evaluate for intracranial change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 925 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass. There is parenchymal atrophy, more prominent in the frontal,
temporal lobes, more apparent compared with prior.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial process.
|
10146735-RR-81
| 10,146,735 | 27,669,890 |
RR
| 81 |
2136-07-21 13:43:00
|
2136-07-21 15:32:00
|
INDICATION: ___ w cirrhosis in need of ___ paracentesis
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: None.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower quadrant and 3 L of serosanguinous fluid were removed. Fluid samples
were submitted to the laboratory for cell count, differential, and culture.
Ultrasound was performed when drainage ceased, confirming complete resolution
of ascites.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 3 L of fluid were removed and no residual ascites is present.
|
10146735-RR-82
| 10,146,735 | 27,669,890 |
RR
| 82 |
2136-07-23 17:24:00
|
2136-07-23 20:01:00
|
EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: ___ year old man with new sz's. Please do MRI brain with and
without contrast // new seizures, eval for structural lesion.
TECHNIQUE: Sagittal 3D FLAIR, axial GRE, coronal FSTIR, axial DTI, images
were obtained. After administration of 14 mL of ProHance intravenous contrast,
Coronal MPRAGE images were obtained. Additional sagittal and axial
reformatted images of the MPRAGE images were then produced. All images were
reviewed in the production of this report. The examination was performed using
a 3.0T MRI scanner.
An additional MRA of the brain was performed, with additional 3D reformats
generated and reviewed.
COMPARISON: CT head from ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. Mild prominence of the ventricles and sulci is likely related
to age related involutional changes. Periventricular and deep subcortical
FLAIR white matter hyperintensities are likely sequelae of chronic small
vessel ischemic disease. There is no abnormal enhancement after contrast
administration. Prominence of extra-axial spaces in the frontal region appear
to be due to brain atrophy.
Bilateral hippocampal formations and mammillary bodies are preserved in signal
and configuration. There is no disproportionate medial temporal atrophy. There
is no focal lobar encephalomalacia. There are no focal cortical dysplasias or
gray matter heterotopia noted.
MRA head: The circle of ___ is patent without evidence of aneurysm, or
stenosis. Note is made of a triplicated anterior cerebral artery, a normal
congenital variant. Appropriate flow is seen within the distal aspects of the
anterior cerebral arteries.
IMPRESSION:
1. No acute intracranial abnormalities identified. No concerning enhancing
lesions seen. Chronic microangiopathy. Brain atrophy predominantly in the
frontal lobes.
2. Unremarkable MRA of the brain, without evidence of stenosis or aneurysm.
|
10146735-RR-83
| 10,146,735 | 27,669,890 |
RR
| 83 |
2136-07-22 16:21:00
|
2136-07-22 16:44:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with acute renal failure, please assess for
hydronephrosis or other cause. // r/o hydro or other cause of renal failure
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen pelvis on ___.
FINDINGS:
The right kidney measures 10.6 cm. The left kidney measures 11.6 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally. There
is moderate ascites, similar to recent CT.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. Normal renal ultrasound. No hydronephrosis.
2. Ascites, similar to recent CT.
|
10146735-RR-84
| 10,146,735 | 27,669,890 |
RR
| 84 |
2136-07-24 21:53:00
|
2136-07-28 13:37:00
|
EXAMINATION: MANDIBLE (PANOREX ONLY)
INDICATION: ___ year old man with etoh cirrhosis (Childs class c), anxiety
here w/ SBO and leakage of ascites from umbilical hernia now s/p hernia repair
c/b seizure, hyponatremia, ATN, malnutrition. Also noted recent partial tooth
extraction with retained piece of tooth // please evaluate for retained root
after partial tooth extraction please evaluate for retained root after
partial tooth extraction
TECHNIQUE: Panorex
COMPARISON: Radiographs of the C-spine ___
FINDINGS:
___ tooth number 19 is absent. The crown ___ tooth number 30 is missing
with a remnant tooth within the mandible. There are multiple lucencies at the
crowns of the mandibular teeth most evident at teeth numbers 29, 22, and 21,
compatible with dental caries. There is a subtle periapical lucency involving
___ tooth number 20.
IMPRESSION:
Partially extracted ___ tooth number 30 with remnant tooth in the mandible.
Dental caries of the teeth 29, 22, and 21 and periapical lucency involving
tooth 20.
|
10146735-RR-85
| 10,146,735 | 27,669,890 |
RR
| 85 |
2136-07-25 12:29:00
|
2136-07-25 15:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with decompensated cirrhosis, SBO s/p repair, now
w/ hyponatremia, ___, seizures. // evaluate for pleural effusion evaluate
for pleural effusion
IMPRESSION:
Comparison to ___. New bilateral basal parenchymal opacities.
With air bronchograms, likely reflecting pneumonia. In addition, signs of
mild fluid overload have developed. No pleural effusions. Moderate
cardiomegaly. Mild elongation of the descending aorta.
|
10146735-RR-86
| 10,146,735 | 27,669,890 |
RR
| 86 |
2136-07-26 13:46:00
|
2136-07-26 16:39:00
|
INDICATION: ___ year old man with alcoholic cirrhosis, decompensated. //
please perform therapeutic paracentesis. Please only remove 3L as patient has
HRS.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Paracentesis from ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 2 L of serosanguinous fluid were removed. Fluid samples
were submitted to the laboratory for chemistry, cell count, differential, and
culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 2 L of fluid were removed.
|
10146735-RR-88
| 10,146,735 | 27,669,890 |
RR
| 88 |
2136-08-01 09:49:00
|
2136-08-01 12:55:00
|
INDICATION: ___ year old man with EtOH cirrhosis here after SBO s/p hernia
repair, with HRS, SBP, requiring frequent paracentesis // diagnostic and
therapeutic paracentesis. please drain no more than ___.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: None
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 3.4 L of serosanguinous fluid were removed. Fluid samples
were submitted to the laboratory for cell count, differential, and culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 3.4 L of fluid were removed.
|
10146735-RR-89
| 10,146,735 | 27,669,890 |
RR
| 89 |
2136-08-01 10:50:00
|
2136-08-01 13:01:00
|
EXAMINATION: SCROTAL U.S.
INDICATION: ___ year old man with enlarged scrotum // ?hernia vs ascites
TECHNIQUE: Grayscale with color and spectral Doppler ultrasound of the
scrotum was performed with a linear transducer.
COMPARISON: Abdomen CT ___
FINDINGS:
The right testicle measures: 2.4 x 3.1 x 3.5 cm.
The left testicle measures: 2.1 x 2.7 x cm.
The testicular echogenicity is normal, without focal abnormalities.
Arterial vascularity is normal and symmetric in the testes.
No epididymal abnormality is identified however note is made that the
epididymis is difficult to visualize bilaterally due to the presence of a
large cystic area.
As was seen on prior CT there is a large fluid filled hernia arising in the
left groin extending into the left scrotal sac. This hernia displaces the
testes.
IMPRESSION:
1. Large fluid filled hernia in the left groin extending into the left scrotal
sac displacing the testis. The hernia is filled with ascites fluid.
2. No testicular abnormality identified.
|
10146735-RR-90
| 10,146,735 | 27,669,890 |
RR
| 90 |
2136-08-01 16:06:00
|
2136-08-01 17:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ etoh cirrhosis here for hernia repair c/b cirrhosis
decompensation w/ HRS, worsening ascites and HE. Now w/ new leukocytosis //
evaluate for pna
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Enteric tube tip well below diaphragm, not included on the radiograph. Trace
free air suggested underneath left hemidiaphragm, may be related to
paracentesis performed earlier this morning, clinically correlate. Pulmonary
vascularity has improved. Bibasilar opacities have improved. Small right
pleural effusion is more apparent. Shallow inspiration accentuates heart
size, which has improved. No pneumothorax. Stable right rib fractures,
likely chronic on
IMPRESSION:
Small volume free peritoneal air suggested, may be from earlier today
paracentesis, clinically correlate. Improved cardiopulmonary findings.
NOTIFICATION: The findings were discussed with ___ , M.D. by ___
___, M.D. on the telephone on ___ at 5:41 ___, 5 minutes after
discovery of the findings.
|
10146782-RR-164
| 10,146,782 | 22,283,133 |
RR
| 164 |
2163-11-22 20:54:00
|
2163-11-22 21:50:00
|
CHEST TWO VIEWS, ___
HISTORY: ___ male with trouble breathing and productive cough.
FINDINGS: Frontal and lateral views of the chest were compared to previous
exam from ___. The lungs are clear of confluent consolidation.
There is, however, evidence of bronchial wall thickening centrally. There is
no effusion. The cardiomediastinal silhouette is normal. Osseous and soft
tissue structures are unremarkable.
IMPRESSION: No focal consolidation. Suggestion of bronchial wall thickening
which can be seen in the setting of bronchitis. Clinical correlation
recommended.
|
10146782-RR-170
| 10,146,782 | 27,318,446 |
RR
| 170 |
2164-03-04 13:08:00
|
2164-03-04 13:39:00
|
INDICATION: ___ male with shortness of breath and asthma flare with
cough for one week. Rule out and evaluate for acute process.
COMPARISON: Multiple prior chest radiographs, most recently of ___.
CT trachea of ___.
FINDINGS: Frontal and lateral views of the chest were obtained. The heart is
of normal size with normal cardiomediastinal contours. Bilateral streaky
linear perihilar opacities are compatible with reactive airway disease,
progressed since ___ and similar to ___. The lungs are otherwise
clear. No lobar consolidation, pleural effusion, or pneumothorax. The
osseous structures are unremarkable. No radiopaque foreign bodies.
IMPRESSION: Bilateral streaky perihilar opacities, compatible with reactive
airway disease, similar to ___ though progressed since ___.
|
10146782-RR-173
| 10,146,782 | 25,573,030 |
RR
| 173 |
2164-05-08 18:41:00
|
2164-05-08 20:43:00
|
INDICATION: ___ male with dyspnea.
COMPARISON: Chest radiograph ___.
PORTABLE AP CHEST RADIOGRAPH: The cardiomediastinal and hilar contours are
normal. The lungs are well expanded and clear, without consolidation, pleural
effusion or pneumothorax.
IMPRESSION: No acute cardiopulmonary pathology.
|
10146806-RR-28
| 10,146,806 | 27,994,357 |
RR
| 28 |
2131-12-17 14:28:00
|
2131-12-17 15:07:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old man with bilateral PE. Assess for deep venous
thrombosis.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Left lower extremity ultrasound ___.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and left peroneal
veins. Normal color flow within the right 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 bilateral lower extremity veins.
|
10146806-RR-37
| 10,146,806 | 20,658,951 |
RR
| 37 |
2134-11-27 04:24:00
|
2134-11-27 05:51:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: ___ with chest pain// eval PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CTA ___
FINDINGS:
Lung volumes are normal. There is no focal consolidation, pleural effusion,
or pneumothorax. Incidentally noted is an azygos fissure. No pulmonary
edema. No acute osseous abnormalities are identified.
IMPRESSION:
No acute cardiopulmonary process identified.
|
10146904-RR-197
| 10,146,904 | 23,206,692 |
RR
| 197 |
2137-07-30 16:35:00
|
2137-07-30 18:00:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ female with fall downstairs. Question fracture.
COMPARISON:
FINDINGS: The lungs are clear. There is no effusion or pneumothorax.
Cardiomediastinal silhouette is within normal limits given lower inspiratory
effort on the current exam. There is no displaced fracture. Right shoulder
arthroplasty is again noted.
IMPRESSION: No acute cardiopulmonary process.
|
10146904-RR-198
| 10,146,904 | 23,206,692 |
RR
| 198 |
2137-07-30 16:35:00
|
2137-07-30 19:20:00
|
LEFT SHOULDER, THREE VIEWS; ___
HISTORY: ___ female with fall downstairs. Question fracture.
COMPARISON: ___.
FINDINGS: Three views of the left shoulder. Again seen is markedly abnormal
left glenohumeral articulation with lack of a clear humeral head or normal
appearing glenoid. There is no evidence of acute fracture. There is no focal
osteolysis. Acromioclavicular joint is unremarkable. Included left ribs and
soft tissues are unremarkable.
IMPRESSION: Markedly abnormal left glenohumeral joint without evidence of
acute fracture or new osseous abnormality.
|
10146904-RR-199
| 10,146,904 | 23,206,692 |
RR
| 199 |
2137-07-30 16:38:00
|
2137-07-30 17:02:00
|
HISTORY: Fall, confusion. Evaluate for ICH, fracture.
TECHNIQUE: Axial MDCT images were obtained through the brain without IV
contrast. Multiplanar coronal, sagittal and thin section bone algorithm
reconstructed images were acquired.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or large territorial
infarction. The ventricles and sulci are prominent suggesting age-related
atrophy. Periventricular white matter hypodensities are nonspecific but may
be seen in the setting of chronic small vessel ischemic disease. The basal
cisterns are patent and there is preservation of gray-white differentiation.
There is no fracture. Diastasis of the lambdoid and coronal sutures is
similar to prior. Aerosolized secretions in the left sphenoid sinus are
noted. The remaining partially visualized paranasal sinuses, mastoid air
cells and middle ear middle ear cavities are clear. There are atherosclerotic
calcifications of the internal carotid arteries. The globes are unremarkable.
IMPRESSION:
1. No acute abnormality.
2. Aerosolized secretions in the left sphenoid sinus may suggest sinusitis.
Please correlate clinically.
|
10146904-RR-201
| 10,146,904 | 22,169,828 |
RR
| 201 |
2138-06-05 06:50:00
|
2138-06-05 07:47:00
|
INDICATION: Shortness of breath. Evaluate for infiltrate.
COMPARISON: Chest radiographs, ___, and ___.
TECHNIQUE: Portable semi-upright AP radiograph of the chest.
FINDINGS: The lungs are normally expanded and clear. There is no focal
airspace opacity, large pleural effusion or pneumothorax. The heart is not
enlarged. The mediastinal and hilar contours are normal. The aortic knob is
calcified. A right humeral prosthesis is partially imaged.
IMPRESSION: No acute cardiopulmonary abnormality.
|
10146904-RR-202
| 10,146,904 | 22,169,828 |
RR
| 202 |
2138-06-05 11:28:00
|
2138-06-05 12:50:00
|
HISTORY: Pleuritic chest pain and right lower quadrant pain.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen following the administration of 100 cc of
Omnipaque. Subsequently, MDCT images were acquired through the abdomen and
pelvis in the portal venous phase. Multiplanar reformatted images in coronal
and sagittal axes were generated. Oblique MIPS were prepared in an
independent work station.
DLP: ___
COMPARISON: Comparison is made to CT abdomen pelvis dated ___, CT
abdomen pelvis dated ___ dated ___, and CTA chest dated
___.
FINDINGS:
CTA THORAX: The aorta and main thoracic vessels are well opacified. The aorta
demonstrates normal caliber throughout the thorax without intramural hematoma
or dissection. The pulmonary arteries are opacified to the segmental level.
There is no filling defect to suggest pulmonary embolism.
CT THORAX: The airways are patent to the subsegmental level. There is no
mediastinal, hilar, or axillary lymph node enlargement by CT size criteria.
Heart, pericardium, and great vessels are within normal limits. No hiatal
hernia or any other esophageal abnormality is present.
Lung windows demonstrate multiple, bilateral pulmonary nodules measuring less
than 4 mm (series 3, images: 22, 26, 62, 69-70, 74, 78, 113-114), largely
unchanged as compared to a prior CTA chest dated ___, although a few
may be new. These are generally centilobular and suggest sequelae of airway
inflammation. Bibasilar atelectasis is present.
There is mild centrilobular emphysema. No pleural effusion or pneumothorax is
present. A right anterior pericardial cyst measures up to 29 x 14 mm in axial
___, somewhat increased, but simple, compared to the prior CT torso.
ABDOMEN: The liver enhances homogeneously without focal lesions. The portal
venous system is patent. No intrahepatic or extrahepatic biliary dilatation
is seen. The gallbladder, pancreas, spleen, and bilateral adrenal glands are
within normal limits. Both kidneys enhance symmetrically and excrete contrast
normally without evidence of hydronephrosis or solid renal mass.
The stomach and duodenum are grossly unremarkable. The remainder of the small
and large bowel is predominantly fluid-filled and demonstrates a mildly
hyperenhancing wall, compatible with a diffuse mild inflammatory process of
the bowel. There is no evidence of focal bowel wall thickening or bowel
dilation to suggest obstruction. The appendix is not definitively visualized,
but there are no secondary signs of appendicitis. No free air or ascites is
present.
There is marked distasis of the right puborectalis muscle with subsequent
prolapse of the rectum into an inferior bulging defect although probably the
muscle is thinned rather than torn. The defect was present before.
There are no pathologically enlarged retroperitoneal lymph nodes seen. The
abdominal aorta contains diffuse calcifications and is normal in caliber
throughout. The celiac artery and SMA are patent. The urinary bladder is
within normal limits, and there is no free pelvic fluid.
BONES: Moderate, multilevel degenerative changes are seen within the lower
lumbar spine. No osseous destructive lesions concerning for malignancy are
detected.
IMPRESSION:
1. No evidence of pulmonary embolism or other acute cardiopulmonary process.
2. Fluid-filled bowel with minimally hyperenhancing wall, suggestive of an
inflammatory condition such as diffuse mild enterocolitis.
3. Marked thinning and bulging of the right puborectalis muscle with partial
prolapse of the loewr rectum into the region of diastasis, although
non-obstructing. This appearance is not new and is unlikely to relate to the
current presentation although it may be a possible source of symptoms related
to the pelvic floor.
|
10147499-RR-25
| 10,147,499 | 22,326,041 |
RR
| 25 |
2110-07-05 07:02:00
|
2110-07-05 09:45:00
|
HISTORY: ___ female, with aphasia and tingling in the left arm.
Assess for acute ischemia.
COMPARISON: None.
TECHNIQUE: Non-contrast MDCT images were acquired through the head initially.
Following IV administration of iodinated contrast, MDCT images were acquired
from the aortic arch to the vertex per standard CTA head and neck protocol.
Dedicated 3D rendering was performed to better assess the underlying
vasculature.
DOSE REPORT: DLP 2387 mGy-cm.
FINDINGS:
NON-CONTRAST CT HEAD: There is no acute intracranial hemorrhage, edema, mass
effect or major vascular territorial infarct. The ventricles and sulci are
prominent, but remain symmetric, compatible with age-related global atrophy.
There are mild-to-moderate periventricular white matter hypodensities,
nonspecific but likely represent chronic microvascular ischemic disease. The
gray-white matter differentiation is well preserved.
There is no acute calvarial fracture. The visualized paranasal sinuses and
mastoid air cells are clear. There are moderate calcifications along the
cavernous portion of the ICAs bilaterally. The globes are symmetric and
unremarkable.
CTA NECK: There is a normal three-vessel aortic arch. Moderate vascular
calcifications are noted scattered along the aortic arch, but there is no
significant stenosis at the origins of the great mediastinal vessels or the
vertebral arteries. The vertebral arteries are codominant.
There are significant vascular calcifications at the carotid bifurcation.
There is medialization of the right common carotid artery. The cervical
vessels remained patent.
The Dmin of the proximal and distal right ICA measures 1.0 mm and 4.0 mm,
respectively.
The Dmin of the proximal and distal left ICA measures 4.0 mm and 5.0 mm,
respectively.
Major cervical vessels remain patent. There is no evidence of dissection,
aneurysm, pseudoaneurysm, vascular malformation or occlusion.
In the visualized lung apices, there are significant centrilobular
emphysematous changes. Tiny hypodense thyroid nodules are noted.
In the visualized cervicothoracic spine, there is a chronic-appearing odontoid
fracture with significant 11-mm anterior dislocation of the fractured odontoid
process, incompletely assessed in the current study. This could represent a
chronic nonunion, and potentially unstable fracture. The spinal canal at
craniocervical junction is significantly narrowed. Multilevel atherosclerotic
changes are noted diffuse decrease in bone mineral density.
CTA HEAD: Major intracranial vessels are patent. There are mild-to-moderate
vascular calcifications along the cavernous portion of the internal carotid
arteries, but the parent vessels are patent. There is a left PCA of fetal
origin. There is a hypoplastic but patent right A1 segment. The anterior
communicating artery complex is patent. The right vertebral artery dominant.
There is no aneurysm, dissection, vascular malformation or distal occlusion.
IMPRESSION:
1. Significant 11-mm anterior subluxation of the chronic-appearing fractured
C2 odontoid, resulting severe spinal canal narrowing and possible cord
compression. Recommend urgent MR ___ to further assess.
2. No acute intracranial abnormalities. Age-related global atrophy with
baseline chronic microvascular ischemic disease.
3. Significant atherosclerotic disease at the carotid bifurcations and
mild-to-moderate atherosclerotic disease at the cavernous portions of ICA.
75% right proximal ICA stenosis by NASCET criteria. 20% left proximal ICA
stenosis by NASCET criteria.
4. Major intracranial and cervical vessels remain patent, without evidence of
dissection, aneurysm, pseudoaneurysm, vascular malformation or occlusion.
5. Significant centrilobular emphysematous changes in the visualized upper
lungs.
Dr. ___ discussed the urgent finding #1 with the ED team Dr. ___
___ at 7:45 am on ___ shortly after the preliminary review of the
study.
|
10147499-RR-26
| 10,147,499 | 22,326,041 |
RR
| 26 |
2110-07-05 09:21:00
|
2110-07-05 11:24:00
|
STUDY: MRI of the cervical spine.
CLINICAL INDICATION: ___ woman with what appears to be an unstable
C-spine fracture on CT scan and neck, evaluate for cord compression.
COMPARISON: CTA of the neck dated ___.
TECHNIQUE: Sagittal T1, T2 and sagittal STIR sequences were obtained
throughout the cervical spine, axial T2 and gradient echo sequences were also
obtained.
FINDINGS: In the craniocervical junction at the level of C1, there is severe
spinal canal stenosis with high signal intensity within the cervical spinal
cord, suggesting myelomalacia, associated with fracture of the odontoid
process with no significant pre-vertebral edema, therefore the chronicity is
uncertain, additionally the possibility of an os odontoideum is a
consideration. The spinal cord is flattened and the spinal canal is
considerably narrowed at the level of C1 (image #9, series #2, series #3 and
series #9). The spinal cord measures approximately 2.1 mm in
anterior-posterior dimension (image #13, series #6).
At C2/C3 level, there is mild posterior central disc bulge, causing anterior
thecal sac deformity with no evidence of significant spinal canal stenosis or
neural foraminal narrowing.
At C3/C4 level, there is a prominent posterior osteophytic disc bulge complex
formation, causing anterior thecal sac deformity and causing narrowing of both
neural foramina, no focal lesions are noted within the cervical spinal cord at
this level.
At C4/C5 level, there is mild posterior disc bulge with no evidence of spinal
canal stenosis or neural foraminal narrowing.
At C5/C6 level, there is a posterior disc bulge, causing anterior thecal sac
deformity, slightly more pronounced on the left (image #30, series #5),
additionally there is mild bilateral neural foraminal narrowing.
At C6/C7 level, there is a posterior disc bulge, causing anterior thecal sac
deformity and mild bilateral neural foraminal narrowing. The visualized
aspect of the upper thoracic spine is unremarkable.
IMPRESSION: Severe stenosis of the spinal canal at the level of C1, with
possible odontoid fracture versus os odontoideum, the chronicity is uncertain.
There is evidence of high signal intensity in the spinal cord at the level of
C1, raising the possibility of acute on chronic changes, please correlate
clinically. Multilevel degenerative changes throughout the cervical spine as
described in detail above, more significant at C3/C4 and C5/C6 levels.
These findings were discovered at 10:02 a.m. and communicated at 10:08 hours,
to Dr. ___, via phone call by Dr. ___ on ___.
|
10147499-RR-27
| 10,147,499 | 22,326,041 |
RR
| 27 |
2110-07-05 12:01:00
|
2110-07-05 13:14:00
|
HISTORY: Possible stroke.
TECHNIQUE: Single frontal view of the chest.
COMPARISON: None.
FINDINGS:
Subtle opacity at the left costophrenic angle felt to most likely be due to
atelectasis. No definite focal consolidation is seen. There is no large
pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are
unremarkable. There may be a hiatal hernia. Aortic knob calcification is
seen. The lungs are relatively hyperinflated with flattening of the
diaphragms, suggesting chronic obstructive pulmonary disease.
IMPRESSION:
Likely mild left base atelectasis. No acute cardiopulmonary process.
|
10147499-RR-28
| 10,147,499 | 22,326,041 |
RR
| 28 |
2110-07-05 12:00:00
|
2110-07-05 13:29:00
|
EXAM: Flexion and extension views of the cervical spine.
CLINICAL INFORMATION: Cervical spine fracture.
COMPARISON: No prior radiographs or CT available for comparison. Reference
made to MR cervical spine performed earlier the same date, ___.
FINDINGS: MRI performed earlier the same date. Flexion and extension views
were obtained. C1 through C7 are included. Evaluation of C1 and C2 is
suboptimal on this study, however, there appears to be anterior subluxation of
proximal fracture of C2 on body of C2 which increases upon flexion, well as
the relation of C1 and C2. Additionally, upon extension, there is 2-3 mm of
retrolisthesis of C3 over C4 which is not seen on the flexion view. Very
minimal anterolisthesis of C2 over C3 is seen on the flexion view. Multilevel
degenerative changes. No prevertebral soft tissue swelling.
|
10147499-RR-29
| 10,147,499 | 22,326,041 |
RR
| 29 |
2110-07-06 12:32:00
|
2110-07-09 09:24:00
|
HISTORY: Fusion.
Fluoroscopic assistance provided to the surgeon in the OR without the
radiologist present. Two spot views obtained. These demonstrate fusion
hardware extending between the occiput and cervical spine. Fluoro time
recorded as 47.8 seconds. Correlation with real-time findings and when
appropriate, conventional radiographs is recommended for full assessment.
|
10147499-RR-30
| 10,147,499 | 22,326,041 |
RR
| 30 |
2110-07-08 14:38:00
|
2110-07-09 09:30:00
|
HISTORY: Remote odontoid fracture nonunion. Followup evaluation.
TECHNIQUE: Three views of the cervical spine.
COMPARISON: ___. Radiographs performed ___.
FINDINGS:
Two posterior cervical surgical fixation rods are in place. There is a
suboccipital surgical plate that appears intact. Surgical screws extend
across the posterior elements of C2 and C3. The patient is status post C1
laminectomy. The surgical hardware appears intact. There is no evidence for
hardware failure and / or loosening.
There is marked bone demineralization. There is reversal of normal cervical
lordosis centered at the C3 level. There are decreased intervertebral disc
space heights throughout the cervical spine with facet joint arthropathy.
The prevertebral soft tissues are normal in thickness. The epiglottis is
normal.
IMPRESSION:
1. Status post open reduction internal fixation of a known non united
odontoid fracture.
2. Surgical hardware is intact with no evidence of hardware failure.
|
10147499-RR-33
| 10,147,499 | 23,722,759 |
RR
| 33 |
2110-07-28 16:18:00
|
2110-07-28 18:51:00
|
HISTORY: ___ female with bilateral lower extremity weakness after C2
laminectomy, evaluate for cord compression or epidural abscess.
TECHNIQUE: MRI of the cervical, thoracic, and lumbar spine were obtained with
IV contrast.
COMPARISON: MRI cervical spine of ___.
FINDINGS:
There is no evidence of abnormal bone marrow signal in the total spine.
Cervical spine: Artifact related to recent surgery is noted in the
craniocervical junction. There is improvement in the previously noted spinal
canal stenosis at this level.
There is mild increased STIR signal in the posterior paraspinal soft tissues
of the cervical spine with likely postsurgical. There is a 1 x 2 cm fluid
collection in the surgical bed at C2 level particularly on the left likely
representing a postsurgical collection. There is mild enhancement of the
adjacent soft tissues without definite epidural or intradural enhancement. The
signal within the cord demonstrates persistent T2 hyperintensity in keeping
with myelomalacia, stable.
At C2-C3, lateral mass screws are noted. There is no definite abnormal signal
within the cord.
At C3-C4, there is a disc osteophyte complex resulting in moderate narrowing
of the spinal canal. There is moderate neural foraminal narrowing.
At C4-C5, there is no significant spinal canal or neural foraminal narrowing.
At C5-C6, there is a disc osteophyte complex and facet joint arthropathy
resulting in moderate spinal canal and neural foraminal narrowing.
At C6-C7, there is a disc osteophyte complex with mild spinal canal narrowing.
There is no significant neural foraminal narrowing.
At C7-T1, there is no spinal canal or neural foraminal narrowing.
Thoracic spine: The alignment appears maintained. The vertebral body heights
are within normal limits. There are minimal disc bulges in the upper thoracic
spine without significant spinal canal or neural foraminal narrowing. There
is no definite abnormal signal in the cord.
The conus medullaris terminates at L1 and has normal signal and configuration.
There is no evidence of abnormal enhancement in the thoracic spine.
Lumbar spine: There is mild levoscoliosis of the thoracolumbar ___
at L1-L2 level. There is mild retrolisthesis of L1 on L2 likely degenerative
in nature.
At L1-L2, there is a diffuse disc bulge, ligamentum flavum thickening, and
facet joint arthropathy resulting in mild spinal canal narrowing with
deformity of the nerve roots and moderate left and severe right neural
foraminal narrowing.
At L2-L3, there are posterior endplate osteophytes with high signal within the
disc likely degenerative, however infection cannot be excluded. There is a
diffuse disc bulge which in combination with ligamentum flavum thickening and
facet joint arthropathy results in moderate spinal canal stenosis with
crowding of the traversing nerve roots and in severe right and moderate left
neural foraminal narrowing.
At L3-L4, there is a mild diffuse disc bulge with an annular tear which in
combination with ligamentum flavum thickening, and facet joint arthropathy
results in moderate bilateral neural foraminal narrowing.
At L4-L5, there is a diffuse disc bulge, ligamentum flavum thickening, and
facet joint arthropathy resulting in severe spinal canal and moderate right,
and severe left neural foraminal narrowing.
At L5-S1, there is disc degeneration, diffuse disc bulge and annular tear as
well as facet joint arthropathy resulting in moderate left and mild right
neural foraminal narrowing. The spinal canal is preserved.
In the scout images, there is a T2 hypointense lesion superior to the upper
pole of the right kidney which may represent an adrenal lesion versus an
exophytic renal lesion.
There is no evidence of abnormal enhancement in the lumbar spine.
IMPRESSION:
1. Postsurgical changes in the upper cervical spine as described with a small
fluid collection likely postsurgical. No evidence of epidural abscess.
2. Multilevel degenerative changes of the cervical spine, stable since the
prior examination.
3. High signal within the L2-L3 disc likely degenerative, however infection
cannot be excluded and recommend clinical correlation.
4. Multilevel degenerative changes of the lumbar spine as described resulting
in severe L4-L5 spinal canal narrowing and multilevel neural foraminal
stenosis as described.
5. T2 hypointense lesion superior to the upper pole of the right kidney which
may represent an adrenal lesion versus an exophytic renal lesion. Clinical
correlation with prior imaging or ultrasound could be obtained.
|
10147499-RR-34
| 10,147,499 | 23,722,759 |
RR
| 34 |
2110-07-28 19:57:00
|
2110-07-28 20:59:00
|
HISTORY: C2 decompression and fusion new lower extremity weakness. Evaluate
interval change.
TECHNIQUE: MDCT axial images were acquired of the cervical spine without
administration intravenous contrast. Coronal and sagittal reformations were
provided and reviewed.
DLP: 727.23 mGy/cm.
CTDIvol: 32.54 mGy.
COMPARISON: Same date MRI. Cervical spine radiographs ___.
FINDINGS: The posterior arch of C1 has been resected. Fusion hardware is seen
extending from the base of the skull to C3. There is no perihardware
lucencies to suggest loosening. The right pillar screw at C3 traverses the
lateral aspect of the right vertebral foramen. A chronic nondisplaced
fracture of the dens is noted. There is no acute fracture identified. Mild
anterolisthesis of C2 on C3 is noted and unchanged. There is no prevertebral
soft tissue swelling. There is no fluid collection within the operative bed.
Soft tissues of the neck are unremarkable. Lung apices notable for
centrilobular emphysema. The salivary glands are symmetric. Dense
calcifications are seen within the carotid bulbs and siphons. The thyroid is
normal. The spinal canal contents are better evaluated on the same day MRI.
IMPRESSION:
1. Right pillar screw at C3 tranverses the lateral aspect of the right
vertebral foramen.
2. Uncomplicated appearance of hardware.
|
10147499-RR-35
| 10,147,499 | 23,722,759 |
RR
| 35 |
2110-07-29 15:22:00
|
2110-07-30 08:08:00
|
HISTORY: ___ woman with numbness, tingling, and lower extremity
weakness, recent history of occipital cervical fusion. Evaluate for spinal
cord compression and abnormal signal within the cord.
TECHNIQUE: Multiplanar multisequence MRI of the cervical and lumbar spine
were obtained. The MRI of the cervical spine was obtained before and after
the administration of IV contrast. The MRI of the lumbar spine was obtained
without IV contrast.
COMPARISON: Flow spine MRI of ___ and cervical spine MRI of ___.
FINDINGS:
Cervical spine: The patient is status post occipitocervical fusion from the
occiput to C3 level with C1 laminectomies and posterior hardware placement.
There has been decompression of the severe stenosis at the C1 level. Similar
to the prior examination, there is persistent thinning of the cord with high
T2 signal at this level consistent with myelomalacia. There is high T2 signal
involving the posterior paraspinal soft tissues from the occiput through C3-C4
level likely postsurgical in nature. A 2.1 cm TR x 2.3 cm SI x 0.7 cm AP
peripherally enhancing fluid collection at the level of C1-C2, from the
midline to the left, in the expected area of the surgical bed, is noted most
likely representing a postsurgical collection. There is minimal epidural
enhancement along the posterior aspect of the thecal sac without evidence of
abnormal enhancement within the cord.
There is persistent deformity of the odontoid process in keeping with old
fracture. No other areas of abnormal signal within the cord are identified.
There is loss of the cervical lordosis.
At C1-C2, the spinal canal is capacious due to the decompressive
laminectomies.
At C2-C3, there is no significant spinal canal or neural foraminal narrowing.
At C3-C4, there are posterior endplate osteophytes and a left paracentral
disc protrusion contacting and deforming the anterior aspect of the cord
without abnormal signal. There is resulting mild spinal canal and mild right
and moderate left neural foraminal narrowing.
At C4-C5, there is no significant spinal canal or neural foraminal narrowing.
At C5-C6, there are posterior endplate osteophytes and a diffuse disc bulge
flattening the anterior aspect of the thecal sac resulting in mild spinal
canal narrowing in combination with ligamentum flavum thickening. There are
uncovertebral and facet joint osteophytes resulting in moderate bilateral
neural foraminal narrowing.
At C6-C7, there is a diffuse disc bulge, uncovertebral and facet joint
osteophytes without significant spinal canal narrowing. There is mild right
and moderate left neural foraminal narrowing.
At C7-T1, there is no significant spinal canal or neural foraminal narrowing.
The visualized airways are patent. The nasopharynx is unremarkable.
Lumbar spine: There is levoscoliosis of the lumbar ___ at L2 -L3
level with associated endplate changes. There is mild retrolisthesis at of L1
on L2 likely degenerative in nature. The bone marrow signal is heterogeneous
without focal masses. There are degenerative endplate changes at L2-L3 and
L5-S1 with disc desiccation at L1-L2, L2-L3, and L5-S1 levels.
The conus medullaris terminates at L1 level and has normal signal and
configuration.
The posterior paraspinal soft tissues are unremarkable.
At T12-L1, there is a diffuse disc bulge, with a superimposed right
paracentral and foraminal disc protrusion as well as ligamentum flavum
thickening and facet joint arthropathy which in combination with levoscoliosis
results in mild right neural foraminal narrowing. The spinal canal is not
narrowed.
At L1-L2, there is a diffuse disc bulge with a superimposed right paracentral
and foraminal disc protrusion which in conjunction with facet joint
arthropathy and levoscoliosis results in mild narrowing of the spinal canal
and severe narrowing of the right subarticular zone as well as severe right
neural foraminal narrowing.
At L2-L3, there are posterior endplate osteophytes, diffuse disc bulge,
ligamentum flavum thickening, and facet joint arthropathy, which in
conjunction with levoscoliosis results in severe right and mild left neural
foraminal narrowing. The spinal canal is moderately narrowed with narrowing
of the bilateral subarticular zones.
At L3-L4, there is a diffuse disc bulge with a small annular tear, ligamentum
flavum thickening, and facet joint arthropathy resulting in moderate to severe
narrowing of the spinal canal and moderate bilateral neural foraminal
narrowing. There is narrowing of the bilateral subarticular zones.
At L4-L5, there is a diffuse disc bulge, significant ligamentum flavum
thickening, and facet joint arthropathy which results in moderate to severe
left neural foraminal narrowing. There is severe narrowing of the spinal
canal with further narrowing of the left side due to synovial cyst and
asymmetric thickening of the ligamentum flavum.
At L5-S1, there is a diffuse disc bulge, more pronounced in the left foramen,
which in combination with ligamentum flavum thickening and facet joint
arthropathy results in mild narrowing of the subarticular zones and severe
narrowing of the left neural foramen.
Gallstones are visualized. A 2.5 cm x 1.7 cm right adrenal lesion is noted. A
tiny cyst in the right kidney is also noted.
IMPRESSION:
1. Stable myelomalacia at C1 level, otherwise no other areas of abnormal
signal or abnormal enhancement in the cervical spine.
2. Rim enhancing fluid collection within the surgical bed likely representing
postsurgical collection, however clinical correlation with patient's symptoms
is advised to exclude infected fluid.
3. Multilevel degenerative changes of the cervical and lumbar spine as
described.
4. Incidentally noted gallstones.
5. Right adrenal lesion, possibly an adenoma, however correlation with
patient's history and prior imaging is recommended.
|
10147499-RR-37
| 10,147,499 | 27,547,361 |
RR
| 37 |
2110-08-01 09:47:00
|
2110-08-01 10:17:00
|
HISTORY: Altered mental status.
TECHNIQUE: AP view of the chest.
COMPARISON: ___.
FINDINGS:
The heart size is normal. The aortic knob is calcified. Mediastinal and
hilar contours are unremarkable. The pulmonary vascularity is normal.
Minimal patchy left basilar opacity likely reflects atelectasis. There is no
focal consolidation. No pleural effusion or pneumothorax is seen. Cervical
spinal fusion hardware is partially imaged.
IMPRESSION:
Minimal left basilar atelectasis.
|
10147499-RR-38
| 10,147,499 | 27,547,361 |
RR
| 38 |
2110-08-01 10:02:00
|
2110-08-01 11:33:00
|
INDICATION: Altered mental status, found altered at 6 a.m.; last normal, last
night; evaluate for bleed or stroke.
COMPARISON: ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Coronal and sagittal reformatted
images were generated.
DLP: 897 mGy-cm.
FINDINGS:
Streak artifact from occipitocervical fusion hardware limits assessment of the
posterior fossa. There is no evidence of hemorrhage, edema, mass effect, or
acute large vascular territorial infarction. Prominent ventricles and sulci
likely reflect age-related involutional changes. Periventricular white matter
hypodensities are compatible with chronic small vessel ischemic disease.
Basal cisterns are patent and there is preservation of gray-white matter
differentiation. No acute fracture is identified. Mild mucosal thickening is
seen within the ethmoid air cells. Mastoid air cells and middle ear cavities
are clear. Orbits are unremarkable.
IMPRESSION:
No evidence of acute intracranial abnormality. MRI is more sensitive in the
detection of acute stroke.
|
10147525-RR-17
| 10,147,525 | 26,112,986 |
RR
| 17 |
2148-01-01 04:55:00
|
2148-01-01 05:38:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with AMS, sepsis from ?pneumonia ?cholangitis,
with encephalopathy.// eval for AMS
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass.
Periventricular and subcortical white matter hypodensities are nonspecific but
likely sequelae of chronic small vessel ischemic disease. There is
prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. There is a left sphenoid sinus mucous
retention cyst. The visualized portion of the remaining paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. There is rightward
nasal septum deviation. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
No evidence of an acute intracranial abnormality.
|
10147525-RR-18
| 10,147,525 | 26,112,986 |
RR
| 18 |
2148-01-02 08:40:00
|
2148-01-02 13:20:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with wheezing, tachypnea// eval for pulmonary
edema, other acute process, change v prior eval for pulmonary edema,
other acute process, change v prior
IMPRESSION:
Heart size and mediastinum are stable. There is mild vascular congestion but
no overt pulmonary edema. There is no appreciable consolidation. There is
minimal amount of small bilateral pleural effusion. S/p thoracic vertebral
surgery.
|
10147525-RR-19
| 10,147,525 | 26,112,986 |
RR
| 19 |
2148-01-02 08:13:00
|
2148-01-02 09:19:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ year old woman with cholangitis/sepsis with new left facial
droop and left pronator drift. Code stroke. Neurology recommends: stat CTA
head and neck, CT head without contrast, and brain perfusion study (will order
all)- eval for stroke// ___ year old woman with cholangitis/sepsis with new
left facial droop and left pronator drift. Code stroke. Neurology
recommends: stat CTA head and neck, CT head without contrast, and brain
perfusion study (will order all)- eval for stroke
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: DLP 2305.10 mGy cm
COMPARISON: CT head without contrast of ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute large territorial infarction, hemorrhage, edema
or mass or mass effect. The ventricles and sulci are age-appropriate. There is
calcified atherosclerosis in the bilateral carotid siphons. There is mild
mucosal thickening of the bilateral ethmoid air cells and bilateral maxillary
sinuses. A mucous retention cyst is demonstrated in the left sphenoid sinus.
The other paranasal sinuses, middle ear and mastoid air cells are pneumatized.
Bilateral orbits are unremarkable.
CTA evaluation is suboptimal secondary to timing of contrast bolus, which
results in prominent venous contamination and poor arterial enhancement.
Within this confine:
CTA HEAD:
The intracranial ICA, ACA, MCA and their major branches are unremarkable
without evidence of high-grade stenosis, occlusion or aneurysm. A 5 mm
basilar tip aneurysm is identified. The right SCA may arise from the neck of
the aneurysm. The distal PCAs are poorly visualized secondary to contrast
bolus timing, otherwise the bilateral P1 and P2 segments appear patent. The
remainder of the posterior circulation is within expected limits. The dural
venous sinuses are patent.
CTA NECK:
Mild atherosclerotic calcification of the aortic arch is identified. There is
a 3 vessel arch. The bilateral common carotid, subclavian, vertebral and
internal carotid arteries are unremarkable. There is no stenosis of the
cervical internal carotid arteries by NASCET criteria.
OTHER:
Diffuse centrilobular emphysematous changes of the visualized lungs with right
apical pleuroparenchymal scarring is identified. No definite suspicious
pulmonary nodule, although examination is suboptimal secondary to respiratory
motion artifact. The visualized thyroid is unremarkable. There is no
cervical lymphadenopathy by size criteria. The visualized aerodigestive tract
is within expected limits. No suspicious osseous lesions, noting findings
compatible with diffuse idiopathic skeletal hyperostosis and additional
superimposed multilevel degenerative findings.
IMPRESSION:
1. No acute intracranial abnormality on noncontrast head CT. Specifically no
acute large territory infarct or intracranial hemorrhage.
2. 5 mm basilar tip aneurysm. The left SCA appears to arise from the neck of
the aneurysm. The remainder of the CTA head is unremarkable allowing for
suboptimal contrast bolus timing.
3. Allowing for mild atherosclerotic disease, unremarkable CTA of the neck
allowing for suboptimal contrast bolus timing. There is no stenosis of the
internal carotid arteries by NASCET criteria.
4. Additional findings as described above.
|
10147525-RR-21
| 10,147,525 | 26,112,986 |
RR
| 21 |
2148-01-05 09:52:00
|
2148-01-05 12:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cholangitis now with worsening hypoxemia
and cough.// interval study to eval for worsening pulm edema vs. development
of focal consolidation within limits of portable AP study. interval study
to eval for worsening pulm edema vs. development of focal consolidation within
limits of portable AP study.
IMPRESSION:
Compared to chest radiographs ___.
Small right pleural effusion and mild bibasilar atelectasis worsened slightly
since ___. Upper lungs clear. Heart size normal. No pneumothorax.
|
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