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10147525-RR-22
| 10,147,525 | 26,112,986 |
RR
| 22 |
2148-01-08 18:34:00
|
2148-01-08 19:03:00
|
EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old woman with LUE swelling. Evaluate for DVT.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity.
|
10147617-RR-16
| 10,147,617 | 22,981,794 |
RR
| 16 |
2131-12-06 12:56:00
|
2131-12-06 14:31:00
|
INDICATION: ___ with fall, sob // ? ptx
TECHNIQUE: Single supine view of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear of consolidation, effusion, or pneumothorax based on this
supine film. The cardiomediastinal silhouette is within normal limits. No
displaced acute fractures seen. Deformity of the right lateral rim appears
chronic.
IMPRESSION:
No acute cardiopulmonary process.
|
10147617-RR-17
| 10,147,617 | 22,981,794 |
RR
| 17 |
2131-12-06 13:59:00
|
2131-12-06 15:14:00
|
INDICATION: ___ with 8 foot fall and right back pain. Assess for intracranial
hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal, and
thin section bone algorithm reconstructed images were generated.
DOSE: DLP: 1003.42 mGy-cm
COMPARISON: None
FINDINGS:
No evidence of hemorrhage, edema, mass effect, or acute large territorial
infarction.The ventricles and sulci are normal in size and configuration.
The basal cisterns are patent and there is preservation of gray-white matter
differentiation.
No fracture identified. The visualized paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The globes are unremarkable.
IMPRESSION:
Normal head CT, specifically no hemorrhage.
|
10147617-RR-18
| 10,147,617 | 22,981,794 |
RR
| 18 |
2131-12-06 13:59:00
|
2131-12-06 15:21:00
|
EXAMINATION: CT cervical spine.
INDICATION: ___ with 8 foot fall and right back pain. Assess for intracranial
hemorrhage or fracture.
TECHNIQUE: Axial helical MDCT images were obtained from the skull base
through the cervical spine without intravenous contrast. Sagittal, coronal,
soft tissue and thin section bone algorithm reconstructed images were
acquired.
DOSE: DLP: 788.94 mGy-cm
CTDIvol: 36.96 mGy
COMPARISON: None.
FINDINGS:
No cervical spine fracture or acute malalignment. Vertebral body and disc
height are preserved. Multilevel degenerative changes are noted atC5-C6. Pre
and paravertebral soft tissues are normal. Visualized portions of the
skullbase show no abnormalities.
Limited assessment of the spinal canal is notable for mild canal narrowing at
T2 by ligamentum flavum hypertrophy and calcification. Visualized portions of
the aerodigestive tract are patent. Limited assessment of the lung apices is
notable for a lucency along the right lung apices consistent with a small
apical pneumothorax.
IMPRESSION:
1. Small right apical pneumothorax.
2. No cervical spine fracture or malalignment
|
10147617-RR-19
| 10,147,617 | 22,981,794 |
RR
| 19 |
2131-12-06 13:59:00
|
2131-12-06 15:46:00
|
EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST
INDICATION: ___ with 8 foot fall and right back pain. Assess for ICH, splenic
liver injuiry, retroperitoneal bleed
TECHNIQUE: TECHNIQUE: MDCT images were obtained from the thoracic inlet to
the pubic symphysis following the administration of intravenous contrast.
Axial images were interpreted in conjunction with sagittal and coronal
reformats.
DLP: 1141.78 mGy-cm
COMPARISON: Chest radiograph from ___.
FINDINGS:
CHEST:
The thyroid is normal. No axillary, supraclavicular, mediastinal, or hilar
lymph node enlargement by CT size criteria. The great vessels are
unremarkable. The heart and mediastinum are normal. No pericardial effusion.
The airways are patent to the subsegmental level.An air-fluid level is noted
within the mid esophagus increasing risk for aspiration. A small right
pneumothorax is present. No mediastinal shift. Bilateral lower lobe
atelectasis is present. Ground-glass opacities within the right lower lobe
along its dependent portion is most consistent with atelectasis however
differential includes pneumonia and aspiration. A small right pleural effusion
is of higher density worrisome for small hemorrhagic pleural effusion. No
obvious extravasation of IV contrast.
ABDOMEN:
The liver is homogeneous. A 1.4 x 1.8 cm (02:56) hypodensity is seen adjacent
to the gallbladder fossa and is incompletely characterize, potentially a
hemangioma. No intra or extrahepatic biliary duct dilatation. The portal vein,
SMV, and splenic vein are patent. The gallbladder, pancreas, spleen, and
bilateral adrenal glands are normal. The kidneys enhance symmetrically and are
without suspicious solid mass. No perinephric fluid collection.
The stomach is normal. The small and large bowel are unremarkable without
dilation or wall thickening. The appendix is normal without evidence of acute
appendicitis. The aorta is normal in caliber without aneurysmal dilatation.
No retroperitoneal hematoma. The celiac axis, SMA,and ___ are patent. No
retroperitoneal or mesenteric lymph node enlargement. No free abdominal fluid,
abdominal wall hernia or pneumoperitoneum. An approximately 11 x 2.7 cm
(2:85) right sided hematoma is seen superior to the gluteal muscles along the
right paraspinal muscles with associated fat stranding. An additional 5.9 x 3
cm (2:117) hematoma is seen adjacent to the right greater trochanter.
PELVIS:
The bladder is well distended and unremarkable. No pelvic side-wall or
inguinal lymph node enlargement. No free pelvic fluid seen. Small amount of
fat is seen along the left spermatic cord.
OSSEOUS STRUCTURES: Right rib fractures spanning third through 11th ribs
posterorlaterally with displacement of the ___ and 9 rib fractures. Fractures
at the medial aspect of the fifth through tenth ribs adjacent to the
costovertebral junction are noted. Small amount of subcutaneous emphysema is
seen posterior to the eleventh and tenth ribs. Spinal fusion device spanning
L4 through S1 is present. Multilevel degenerate changes throughout the
thoracolumbar spine most notable at T9-10 and L1-L2. No focal lytic or
sclerotic lesion concerning for malignancy.
IMPRESSION:
1. Small right pneumothorax without mediastinal shift.
2. Ground-glass opacity in the right lower lobe is most consistent
atelectasis however differential includes pneumonia and aspiration in the
appropriate clinical setting.
3. Small right hemorrhagic pleural effusion. No definite evidence of active
extravasation.
4. Multiple right-sided displaced and nondisplaced rib fractures spanning
third through eleventh ribs as described above. Fifth through tenth
right-sided rib fractures are segmental.
5. 11 cm right-sided hematoma superior to right gluteal muscles along the
right paraspinal muscles as well as 5.9 cm hematoma adjacent to right greater
trochanter.
6. Fluid-filled esophagus increasing risk for aspiration.
|
10147617-RR-20
| 10,147,617 | 22,981,794 |
RR
| 20 |
2131-12-06 18:26:00
|
2131-12-06 21:20:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with rib fractures R3-11 with tiny R sided
pneumothorax // compare to prior compare to prior
IMPRESSION:
In comparison with the earlier study of this date, there is no evidence of
pneumothorax on the right. Although this was seen on the recent chest CT, it
may not be appreciated radiographically due to its anterior position. Multiple
rib fractures are again seen on the right.
|
10147617-RR-22
| 10,147,617 | 22,981,794 |
RR
| 22 |
2131-12-07 09:38:00
|
2131-12-07 11:42:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ year old man s/p fall w small apical pneumo right. // Eval
interval change
COMPARISON: Chest radiograph ___
FINDINGS:
Single AP view of the chest provided.
Right moderate apical pneumothorax.
No pleural effusion.
Hilar and cardiomediastinal contours are normal. Right rib fractures are
unchanged.
IMPRESSION:
1. Right rib fractures are stable.
2. There is a moderate right apical pneumothorax, which is new from ___.
|
10147617-RR-24
| 10,147,617 | 22,981,794 |
RR
| 24 |
2131-12-07 17:51:00
|
2131-12-07 21:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old s/p fall from roof, now w worsening pneumo. // eval
pneumo - interval change - Please complete test at 6pm eval pneumo -
interval change - Please complete test at 6pm
IMPRESSION:
In comparison with the earlier study of this day, there is little change in
the degree of right apical pneumothorax. Remainder the study is unchanged.
|
10147617-RR-25
| 10,147,617 | 22,981,794 |
RR
| 25 |
2131-12-08 04:38:00
|
2131-12-08 12:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ fall 10ft from roof, panscanned, R ___ rib ___ apical
R ptx, R gluteal hematoma, 8mm R elbow laceration // Evaluate pneumothorax -
interval change - Please complete test at 5.30 am on ___
COMPARISON: Chest radiograph ___
FINDINGS:
AP and lateral views of the chest provided.
An opacity projecting over the lung bases on the lateral view likely
represents basilar atelectasis.
Moderate right apical pneumothorax is mildly increased.
Hilar and cardiomediastinal contours are normal. Rib fractures are unchanged.
IMPRESSION:
1. Moderate right apical pneumothorax is mildly increased in size from ___.
2. Rib fractures are stable.
|
10147617-RR-26
| 10,147,617 | 22,981,794 |
RR
| 26 |
2131-12-08 18:30:00
|
2131-12-08 20:16:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man fall from roof with right rib fx ___
apical PTX // evaluate for changes in PTX ( standing, end-expiratory film)
please do x-ray at 2pm
COMPARISON: Chest radiograph ___
FINDINGS:
Multiple AP views of the chest provided.
Mild atelectasis at the right lung base is improved.
No pleural effusion. Small right apical pneumothorax is unchanged.
Hilar and cardiomediastinal contours are normal. Minimally displaced rib
fractures are unchanged. The aorta is mildly tortuous.
IMPRESSION:
Small to moderate, right apical pneumothorax and rib fractures are unchanged
from ___.
|
10147617-RR-27
| 10,147,617 | 22,981,794 |
RR
| 27 |
2131-12-09 09:36:00
|
2131-12-09 12:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with R pneumothorax // compare to prior
compare to prior
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
Small right apical pneumothorax is minimally larger than it was on ___
at 6:32 p.m. There is no hematoma associated with the displaced right
posterior rib fractures. Small right pleural effusion seen on the lateral view
only is unchanged.Mediastinum has a normal appearance. Lungs are clear.
|
10147617-RR-28
| 10,147,617 | 22,981,794 |
RR
| 28 |
2131-12-10 07:24:00
|
2131-12-10 13:42:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man w R pneumothorax. Eval interval change // eval
interval change. Please complete exam at 6:00am prior to surgical rounds
eval interval change. Please complete exam at 6:00am prior t
COMPARISON: Chest radiographs ___.
IMPRESSION:
Right basal atelectasis unchanged since ___, is actually more severe
than previously suspected, could be nearly lower lobe collapse. There is no
hematoma or layering pleural effusion associated with the right middle rib
fractures of right upper or middle ribs, and the small right apical
pneumothorax is smaller. Left lung is entirely clear. Normal
cardiomediastinal silhouette.
|
10147782-RR-34
| 10,147,782 | 26,174,094 |
RR
| 34 |
2183-01-14 01:51:00
|
2183-01-14 04:43:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with RLQ abdominal pain and productive cough// CT:
hematoma? hernia?/ PNA on CXR
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
The lungs are well inflated but clear. No focal consolidations. No pulmonary
edema. Normal cardiomediastinal silhouette. No pleural effusion. No
pneumothorax.
IMPRESSION:
Hyperinflated but clear lungs.
|
10147782-RR-35
| 10,147,782 | 26,174,094 |
RR
| 35 |
2183-01-14 02:08:00
|
2183-01-14 03:33:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with RLQ abdominal pain and
productive coughNO_PO contrast// CT: hematoma? hernia?/ PNA on CXR
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen 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) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 5.3 s, 41.6 cm; CTDIvol = 9.6 mGy (Body) DLP = 400.3
mGy-cm.
3) Spiral Acquisition 1.1 s, 8.6 cm; CTDIvol = 6.9 mGy (Body) DLP = 59.5
mGy-cm.
4) Spiral Acquisition 1.2 s, 9.1 cm; CTDIvol = 6.9 mGy (Body) DLP = 63.2
mGy-cm.
Total DLP (Body) = 533 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: 2.2 x 1.6 cm hyperenhancing lesion within the right lobe of the
liver, likely a hemangioma. Additional subcentimeter hypodensities within the
liver too small to characterize, likely represent cysts or biliary hamartomas.
Otherwise, the liver demonstrates homogenous attenuation throughout. There is
no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There are multiple dilated loops of small bowel with
air-fluid levels, compatible with small bowel obstruction. The transition
point is a right femoral hernia with compression of the right common femoral
vein. There is no bowel wall thickening. There is no pneumatosis. There is
no free air or fluid. The stomach is unremarkable. The colon and rectum are
within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted, particularly within the proximal SMA with moderate to severe
stenosis (series 602, image 37).
BONES: Degenerative changes throughout the lumbar spine with moderate
dextroconvex scoliosis. Mild retrolisthesis of L3 on L4. There is no
evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is a right femoral hernia containing obstructed loops of
small bowel. There is a small fat containing left inguinal hernia.
IMPRESSION:
1. Small-bowel obstruction due to a right femoral hernia with compression of
the right common femoral vein. No bowel wall thickening, pneumatosis, or
pneumoperitoneum.
2. Moderate atherosclerosis with moderate to severe stenosis of the proximal
SMA.
3. 2.2 cm liver hemangioma.
|
10147992-RR-59
| 10,147,992 | 26,054,842 |
RR
| 59 |
2149-07-14 00:09:00
|
2149-07-14 01:02:00
|
EXAMINATION: Chest radiographs
INDICATION: ___ woman with recurrent presyncope, question
cardiomegaly.
TECHNIQUE: Frontal and lateral views
COMPARISON: Chest radiographs between ___ and ___
FINDINGS:
The lungs are well expanded. Mild right apical scarring. No focal
consolidation. No pleural effusion or pneumothorax. Heart size is normal.
Calcified mediastinal lymph nodes are unchanged. Aortic arch calcifications
are mild. The mediastinal silhouette is otherwise unremarkable.
IMPRESSION:
No evidence of an acute cardiopulmonary abnormality. Heart size is normal.
|
10148145-RR-40
| 10,148,145 | 21,346,827 |
RR
| 40 |
2162-11-02 14:29:00
|
2162-11-02 15:39:00
|
EXAMINATION: CT L-SPINE W/O CONTRAST Q331 CT SPINE
INDICATION:
___ year old man s/p L1-L4 laminectomy with L2-3 bilateral discectomy who
presents with increased drainage from wound site. Evaluate for hematoma
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.7 s, 37.8 cm; CTDIvol = 46.3 mGy (Body) DLP =
1,753.6 mGy-cm.
Total DLP (Body) = 1,754 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
As before, the patient is status post L2-L3 laminectomy and L2-L3 discectomy.
Compared to ___, there has been interval evacuation of a large
hematoma overlying the midline posterior subcutaneous tissues. There is
subcutaneous gas in the region of the hematoma. Please correlate with recent
evacuation. There is indistinctness of the posterior spinal musculature,
which could represent a persistent, though decreased, hematoma. Alignment is
normal.Linear lucency through the right L2 inferior facet may represent a
minimally displaced pars defect or artifact ___ B/35).
Incidentally noted IVC filter and Foley catheter.
IMPRESSION:
1. Compared to ___, there has been interval evacuation of the
previously seen large posterior subcutaneous hematoma. There is subcutaneous
gas in the region of the hematoma. Recommend correlation with recent
evacuation.
2. There is indistinctness of the posterior spinal musculature, which could
represent a persistent, though decreased, hematoma.
3. Linear lucency through the right L2 inferior facet may represent a
minimally displaced pars defect or artifact
|
10148145-RR-41
| 10,148,145 | 21,346,827 |
RR
| 41 |
2162-11-15 12:01:00
|
2162-11-15 18:24:00
|
INDICATION: ___ year old man with picc // s/p left 47cm picc ___ ___
Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Left PICC line in situ with the tip projecting over the midline. Normal
cardiomediastinal shadow. No airspace consolidation. No pleural effusion.
No pneumothorax. No pulmonary edema.
IMPRESSION:
Left-sided PICC line in situ with the tip more medial than would be expected,
but in discussion with the referring NP I was assured that the PICC line is
not intra-arterial or extra-luminal.
The tip projects 2 cm inferior to the carina, then placing it in the low SVC.
|
10148533-RR-13
| 10,148,533 | 26,200,962 |
RR
| 13 |
2113-02-28 17:24:00
|
2113-02-28 20:25:00
|
PORTABLE CHEST: ___
HISTORY: Trauma post-intubation.
COMPARISON: None.
FINDINGS: Single portable view of the chest. Endotracheal tube is seen with
tip in the right mainstem bronchus and should be retracted at least 3 to 4 cm
for optimal positioning. Enteric tube seen with tip projecting over the
gastric antrum. The lungs demonstrate relatively low lung volumes but are
grossly clear. The cardiomediastinal silhouette is within normal limits. No
acute osseous abnormality is identified.
IMPRESSION: Endotracheal tube tip in the right mainstem bronchus and should
be retracted 3 to 4 cm. These findings were known by the ordering clinician
at time of dictation.
|
10148533-RR-14
| 10,148,533 | 26,200,962 |
RR
| 14 |
2113-02-28 17:47:00
|
2113-02-28 19:19:00
|
INDICATION: Fall, seizure in ED. Evaluate for intracranial
hemorrhage/trauma.
COMPARISON: None.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without IV contrast. Multiplanar coronal, sagittal and thin section bone
algorithm reconstructed images were generated.
TOTAL BODY DLP: 1783.85 mGy-cm.
FINDINGS: There is no evidence of acute intracranial hemorrhage, edema, mass
effect or large territorial infarction. The ventricles and sulci are normal
in size and configuration. The basal cisterns are patent, and there is
preservation of gray-white differentiation.
There is no fracture detected. There is a tiny scalp hematoma over the right
forehead. The visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The globes are grossly intact.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Tiny right scalp, forehead hematoma.
|
10148533-RR-15
| 10,148,533 | 26,200,962 |
RR
| 15 |
2113-02-28 17:48:00
|
2113-02-28 19:07:00
|
HISTORY: ___ male with fall and seizure in emergency department.
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
COMPARISON: None.
FINDINGS:
Cervical vertebral bodies are maintained in height and alignment. There is no
acute fracture. There is mild straightening of the normal cervical lordosis.
Intervertebral disc spaces are preserved. There is no definite prevertebral
soft tissue abnormality. Endotracheal and orogastric tubes are identified are
partially visualized. Thyroid and lung apices are unremarkable.
IMPRESSION:
No cervical spine fracture or malalignment.
|
10148533-RR-16
| 10,148,533 | 26,200,962 |
RR
| 16 |
2113-02-28 23:29:00
|
2113-03-01 10:16:00
|
REASON FOR EXAMINATION: Evaluation of the patient with history of ethanol
abuse, recent episodes of hematemesis and fall.
Portable AP radiograph of the chest was reviewed.
The ET tube tip is at the carina and should be pulled back. Heart size and
mediastinum are grossly stable. The NG tube tip is in the stomach. Lungs are
essentially clear. No pneumothorax is seen.
|
10148533-RR-17
| 10,148,533 | 26,200,962 |
RR
| 17 |
2113-03-01 01:06:00
|
2113-03-01 03:04:00
|
INDICATION: History of asymmetric pupils, presents with seizure. Question
edema or herniation.
COMPARISONS: CT head without contrast from ___.
TECHNIQUE: MDCT axial imaging was obtained through the brain without the
administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
FINDINGS: There is no acute hemorrhage, edema, mass effect or large
territorial infarction. Ventricles and sulci are normal in size and
configuration. The basilar cisterns are preserved. There is mucosal
thickening of the ethmoid air cells and the sphenoid sinuses. The remainder
of the paranasal sinuses, mastoid air cells and middle ear cavities are clear.
There are no acute fractures.
IMPRESSION: No acute intracranial process.
|
10148533-RR-18
| 10,148,533 | 26,200,962 |
RR
| 18 |
2113-03-01 04:30:00
|
2113-03-01 10:28:00
|
REASON FOR EXAMINATION: Altered mental status, assessment of the ET tube.
AP radiograph of the chest was reviewed in comparison to prior study obtained
on ___ at 23:20 p.m.
The ET tube tip is currently better positioned, but still too low, 13 mm above
the carina and should be pulled back additional centimeter. Heart size and
mediastinum are stable. Left retrocardiac opacity is new and might reflect
area of atelectasis that developed in interim or potentially aspiration.
|
10148533-RR-19
| 10,148,533 | 26,200,962 |
RR
| 19 |
2113-03-01 10:21:00
|
2113-03-01 13:21:00
|
HISTORY: Past medical history of ETOH abuse, recent episodes of hematemesis
status post unwitnessed fall in driveway and seizure in ED follow by agitation
requiring intubation and elevated AST/ALT. ?Evidence of cirrhosis.
COMPARISON: None relevant.
TECHNIQUE: Grayscale and Doppler ultrasound images of the abdomen were
obtained. The study was performed as a portable study in the ICU.
FINDINGS:
The liver is mildly echogenic, consistent with mild hepatic steatosis. No
focal liver lesions are identified. No intra or extrahepatic duct dilatation.
The common bile duct measures 3 mm in diameter. Doppler examination of the
main portal vein demonstrates patency with normal hepatopetal flow. The
gallbladder is normal without evidence of stones or gallbladder wall
thickening.
The pancreas is unremarkable. Limited views of the right kidney are
unremarkable. The visualized portions of the aorta and inferior vena cava
appear normal.
It was not possible to obtain images of the left kidney and spleen as the
patient was not cooperative.
IMPRESSION:
Mildly echogenic liver consistent with mild hepatic steatosis. Other forms of
liver disease and more advanced liver disease including significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
|
10148710-RR-107
| 10,148,710 | 22,361,808 |
RR
| 107 |
2140-10-14 15:06:00
|
2140-10-14 15:47:00
|
INDICATION: History of Crohn's with SOB with abdominal discomfort.
COMPARISON: Radiograph available from ___ and abdominal CT from
___.
UPRIGHT AND SUPINE FRONTAL ABDOMINAL RADIOGRAPHS: No free air is detected.
Multiple loops of dilated small bowel are noted in the right hemiabdomen which
contain fluid levels on Upright projection. There is a large amount of gas in
the colon. Moderate-to-severe multilevel degenerative changes are seen
throughout the lower lumbar spine.
IMPRESSION: Findings concerning for early or partial SBO.
|
10148710-RR-108
| 10,148,710 | 22,361,808 |
RR
| 108 |
2140-10-14 18:02:00
|
2140-10-14 20:59:00
|
CT SCAN OF THE ABDOMEN AND PELVIS PERFORMED ON ___
Comparison is made with a prior CT abdomen and pelvis dated ___.
CLINICAL HISTORY: ___ with abdominal pain, history of multiple SBO,
multiple surgeries for lysis of adhesions, assess for bowel obstruction.
TECHNIQUE: Multidetector CT through the abdomen and pelvis was performed
following oral and IV contrast administration. Multiplanar reformations were
provided.
FINDINGS:
LUNG BASES: There is mild dependent atelectasis in the lower lungs. The
imaged portion of the heart is unremarkable.
ABDOMEN: The liver enhances normally without focal lesions. The gallbladder
is not clearly visualized and may be collapsed or surgically absent. The
spleen is normal. The adrenal glands, pancreas appear unremarkable. The
kidneys enhance symmetrically and excrete contrast promptly. Bilateral renal
cysts appear unchanged. No hydronephrosis or worrisome renal lesion is seen.
The abdominal aorta is normal in course and caliber with scattered mild
atherosclerotic calcifications. The major aortic branch vessels appear widely
patent. There is no retroperitoneal or mesenteric lymphadenopathy.
The stomach is distended with orally administered contrast. The duodenum
appears normal.
PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.
There is an unchanged Richter's hernia at the level of an incisional defect in
the right abdominal wall which is unchanged. The large bowel contains
liquified stable. Extensive colonic diverticulosis is noted. There is
incomplete colonic distention at the proximal sigmoid colon seen on series 2,
image 73 with the possibility of mild acute diverticulitis at this level,
given the associated fat stranding in the region. There is no perforation or
evidence of complication. No free air. The urinary bladder is decompressed.
BONES: No worrisome lytic or blastic osseous lesion is seen. Degenerative
facet arthropathy in the lower lumbar spine is noted.
IMPRESSION:
1. Equivocal findings suggestive of mild acute diverticulitis in the proximal
sigmoid colon. Dindings conveyed to Dr. ___ at approximately 9:15pm on
date of exam.
2. Liquid stool throughout the colon could be related to diarrhea.
3. Stable Richter's hernia through an incisional defect in the right mid
abdominal wall.
|
10148710-RR-114
| 10,148,710 | 26,517,626 |
RR
| 114 |
2141-09-21 17:33:00
|
2141-09-21 18:22:00
|
HISTORY: Diffuse abdominal pain and vomiting.
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after
administration of oral and intravenous contrast. Images were displayed in
multiple planes.
COMPARISON: CT ___.
FINDINGS:
Abdomen: Subsegmental bibasilar atelectasis is mild. There is no nodule,
consolidation, or effusion at the lung bases.
There is no focal liver lesion. The portal and hepatic veins are patent.
There is no intra or extrahepatic biliary dilatation. Small cystic structure
in the gallbladder fossa may represent prominnent cystic duct stump given
history of prior cholecystectomy, and is unchanged. The pancreas and spleen
enhance homogeneously. The adrenal glands have normal attenuation and
morphology. The kidneys enhance symmetrically and excrete contrast promptly.
Several renal hypodensities are present bilaterally. The largest 2.5 cm
hypodensity in the lower pole of the left kidney has attenuation compatible
with a simple cyst. Other hypodensities are too small to characterize but
also likely cysts. There is no ascites. No left mesenteric or
retroperitoneal adenopathy is present. A nonenhancing 1.3 cm soft tissue
density adjacent to the left diaphragmatic crura is unchanged from at least
___.
There is diffuse dilation of a segmental region of small bowel up to 4 cm in
diameter. The change in caliber from a nondilated proximal jejunum to
distended bowel occurs in the mid jejunum (2: 44). There is no transition
point distally. There is air and fluid throughout the bowel. Ther eis no
wall thickening or pneumatosis. Air and fluid course following into the
stomach into the colon. There is mild diverticulosis without evidence of
diverticulitis.
Scattered areas of atherosclerotic calcifications are seen in the abdmoninal
aorta which is normal in caliber. Origin of the SMA, celiac axis and ___ are
widely patent.
Right anterior abdominal wall small bowel ___ type hernia is again
noted. No secondary obstruction noted.
Pelvis: The bladder and prostate are unremarkable. There is no pelvic or
inguinal adenopathy. Bone windows no concerning lytic or sclerotic bone
lesions. Multilevel degenerative disease of the thoracolumbar spine is
moderate, most severe at L5-S1. Impression
IMPRESSION:
1. Diffuse dilation, up to 4 cm of the mid jejunum through ileum. There is
air and fluid throughout the bowel without evidence of transition point.
Findings could represent a jejunitis/ileitis. There is no evidence of high
obstruction at this time although continued clinical followup suggested.
2. Stable 1.3 cm soft tissue density next to the left diaphragmatic crura.
3. Diverticulosis without evidence of diverticulitis.
|
10148710-RR-118
| 10,148,710 | 20,807,610 |
RR
| 118 |
2143-12-10 02:02:00
|
2143-12-10 07:20:00
|
EXAMINATION: Abdomen radiographs, supine and upright.
INDICATION: History: ___ with abd distension, obstipation // Eval for SBO
TECHNIQUE: Supine and upright radiographs of the abdomen were obtained.
COMPARISON: Comparison is made to CT of the abdomen pelvis from ___.
FINDINGS:
Multiple distended loops of small bowel are noted in the right lower quadrant,
with air-fluid levels seen on the upright film, measuring up to 3.9 cm in
diameter. The colon is air-filled throughout, to the level of the sigmoid.
There is no pneumatosis or free gas.
IMPRESSION:
Nonspecific bowel gas pattern, compatible with ileus or early obstruction. If
clinical concern remains for small bowel obstruction, a CT is recommended.
|
10148710-RR-119
| 10,148,710 | 20,807,610 |
RR
| 119 |
2143-12-10 06:32:00
|
2143-12-10 08:08:00
|
EXAMINATION: CT abdomen pelvis with contrast.
INDICATION: +PO contrast; History: ___ with abd pain vomiting +PO contrast
// EvAl obstruction
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 reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 873.2 mGy-cm (abdomen and pelvis.
COMPARISON: ___.
FINDINGS:
LOWER CHEST:
The bibasilar dependent atelectasis is noted. There is no pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous low attenuation throughout,
compatible with hepatic steatosis. There is no evidence of focal lesions.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is small, but otherwise unremarkable.
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: Multiple left renal cysts and bilateral subcentimeter renal
hypodensities, which are too small to characterize, unchanged. There is no
evidence of hydronephrosis or renal stones bilaterally.
GASTROINTESTINAL: Dilated loops of mid abdominal small bowel, measuring up to
3.8 cm in diameter, are seen, with distal small bowel decompression. Zone of
transition is identified in the midline lower abdomen (2:66). There is
fecalization of small bowel content proximal to the zone of transition. No
evidence of extraluminal enteric contrast extravasation. Colonic anastomosis
appears intact. There are diverticula in the descending and sigmoid colon, no
evidence of diverticulitis. There is gas and fluid in the colon. There is a
small right anterior abdominal wall hernia, possibly incisional, containing
some small bowel which does not appear obstructed. This is similar to
previous.
RETROPERITONEUM: A prominent gastrohepatic ligament node is unchanged
(02:19). Otherwise, there is no retroperitoneal or mesenteric lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is mild vascular
calcification.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES:
No osseous lesion worrisome for malignancy is identified. Multilevel,
multifactorial degenerative changes are again noted throughout the lumbar
spine.
IMPRESSION:
1. Findings compatible with small bowel obstruction, with transition point in
the low anterior mid abdomen, as described above. Etiology may be due to a
stricture or adhesion. Fecalalized small bowel content proximal to zone of
transition suggests a subacute or chronic obstruction, and preserved gas and
fluid in the colon may reflect early or incomplete obstruction.
2. No evidence of abdominal abscess or free fluid.
3. Hepatic steatosis.
|
10148710-RR-120
| 10,148,710 | 20,807,610 |
RR
| 120 |
2143-12-11 09:37:00
|
2143-12-11 16:15:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with Crohn's p/w SBO // Assess for SBO
Assess for SBO
COMPARISON: Abdominal radiographs ___, 1:41.
IMPRESSION:
2 frontal supine and 2 frontal erect views of the upper and lower abdomen are
submitted. Dilute contrast agent is present in normal caliber large bowel. The
supine views best show distended small bowel loops clustered in the mid
abdomen, 33-58 mm in diameter. Since the stomach and small bowel proximal to
these loops are not distended, these may be dilated due to local inflammation.
There is no evidence of intestinal perforation Careful followup is advised.
NOTIFICATION: Dr. ___ reported the findings to Dr ___ by telephone
on ___ at 16:10 ___, 70 min minutes after the initial page when the
findings were discovered.
|
10148993-RR-12
| 10,148,993 | 28,081,253 |
RR
| 12 |
2140-06-04 12:00:00
|
2140-06-04 12:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with ICH (unclear prior imaging from ___) //
evaluate for acute process
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
A subacute right sided subdural hemorrhage is 8 mm in maximal diameter. This
is associated with adjacent sulcal effacement and 5 mm leftward midline shift.
There is no hydrocephalus. The imaged paranasal sinuses are clear. Mastoid air
cells and middle ear cavities are well aerated. The bony calvarium is intact.
IMPRESSION:
Subacute right subdural hemorrhage 8 mm in maximal diameter with mild sulcal
effacement and 5 mm midline shift. No priors available for comparison to
assess for interval change.
NOTIFICATION: The updated findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 3:54 ___, 5 minutes
after discovery of the findings.
|
10148993-RR-18
| 10,148,993 | 25,023,703 |
RR
| 18 |
2143-08-08 13:17:00
|
2143-08-08 13:57:00
|
EXAMINATION: CTU (ABD/PEL) W/CONTRAST
INDICATION: ___ with LLQ Pain// ?kidney stone, diverticulitis
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered. Coronal and sagittal reformations were
performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,101 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis. Otherwise, visualized lung fields
are within normal limits. There is no evidence of pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Multiple subcentimeter hypodense lesions, too small to further characterize.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Colonic
diverticulosis is noted. There is inflammatory fat stranding along the
proximal sigmoid colon in the region of multiple diverticulae in the left
lower quadrant, consistent with acute diverticulitis. Mild thickening along
this segment of colon is also present. There is a locule of free air
suggesting micro perforation. No drainable collection. The appendix is
normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
BONES: Degenerative changes are seen in the lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Acute sigmoid diverticulitis with trace associated free air suggesting micro
perforation. No drainable collection.
|
10149067-RR-18
| 10,149,067 | 27,304,639 |
RR
| 18 |
2183-06-29 08:39:00
|
2183-06-29 12:48:00
|
EXAMINATION: CERVICAL SINGLE VIEW IN OR
INDICATION:
Fusion C3-C5.
COMPARISON:
Preoperative cervical spine MRI ___.
FINDINGS:
Multiple intraoperative lateral images were acquired without a radiologist
present.
Images show zero profile ACDF between C3 and C4, and multilevel degenerative
changes..
IMPRESSION:
Please refer to the operative note for details of the procedure.
|
10149067-RR-20
| 10,149,067 | 27,304,639 |
RR
| 20 |
2183-06-30 02:53:00
|
2183-06-30 10:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with difficulty swallowing s/p anterior
cervical corpectomy and fusion// eval for tracheal deviation
TECHNIQUE: AP portable chest radiograph.
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low accentuating the pulmonary vasculature. There is no
focal consolidation, significant pulmonary edema or pleural effusion. No
pneumothorax. There is new widening of the right paratracheal stripe with
leftward tracheal deviation. Cardiomediastinal silhouette is unremarkable
IMPRESSION:
New widening of the right paratracheal stripe with leftward tracheal
deviation.
|
10149067-RR-21
| 10,149,067 | 27,304,639 |
RR
| 21 |
2183-06-30 03:48:00
|
2183-06-30 05:19:00
|
EXAMINATION: CT NECK W/O CONTRAST (EG: PAROTIDS) Q21 CT NECK.
INDICATION: ___ year old woman with C4 corpectomy and anterior C3-5 fusion
with difficulty swallowing and anterior neck edema, concern for tracheal
deviation, evaluate for postop hematoma.
TECHNIQUE: MDCT acquired helical axial images were obtained from the thoracic
inlet through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.9 s, 22.7 cm; CTDIvol = 7.2 mGy (Body) DLP = 162.9
mGy-cm.
Total DLP (Body) = 163 mGy-cm.
COMPARISON: None.
FINDINGS:
The patient is status post C4 corpectomy and anterior fusion of C3 through 5.
There is simple fluid and foci of air in the prevertebral space, measuring up
to 2.2 cm in maximal AP thickness, tracking into the superior mediastinum and
along the right chest wall. The supraglottic airway is moderately narrowed,
though patent. Postsurgical locules of subcutaneous air are visualized in the
anterior neck, and also anterior to the thecal sac from C2 through C4 levels.
Multilevel degenerative changes throughout the cervical spine from C4-C5
through C6-C7 levels appears unchanged.
The salivary glands are grossly without mass or adjacent fat stranding. The
thyroid gland appears normal. There is no lymphadenopathy by CT criteria.
The imaged portion of the lung apices are clear and there are no concerning
pulmonary nodules. There are no osseous lesions.
IMPRESSION:
Status post C3 through 5 anterior fusion, with prevertebral edema and air
resulting in moderate narrowing of the supraglottic airway, and tracking into
the superior mediastinum and along the right chest wall.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 5:15 am, 2 minutes after
discovery of the findings.
|
10149316-RR-35
| 10,149,316 | 20,642,594 |
RR
| 35 |
2201-09-09 18:24:00
|
2201-09-09 20:09:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: History: ___ with diplopia, ptosis // stroke?
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head ___ and ___
MRI head ___
FINDINGS:
There is encephalomalacia of the left basal ganglia, particularly of the left
caudate, with associated ex vacuo dilatation of the frontal horn of the left
lateral ventricle, new from the CT head ___. Within this area of
encephalomalacia, there is linear restricted diffusion on 302:16 and 302:15.
There is no evidence of hemorrhage, masses, mass effect, or midline shift.
T2/FLAIR hyperintensities in the periventricular, subcortical, and deep white
matter are nonspecific, but may represent the sequela of chronic small vessel
ischemic disease.
Patchy T1 hypointense and diffusion hyperintense signal within the visualized
upper cervical spine, clivus, and throughout the calvarium are new from the
prior examination.
There is moderate, circumferential mucosal thickening of the left maxillary
sinus and mild mucosal thickening in the left anterior ethmoid and left
frontal sinuses. Several of the bilateral mastoid air cells are opacified.
The patient is status post bilateral cataract surgery.
The major intracranial flow voids are preserved.
The ventricles are enlarged with prominence of temporal horns. The convexity
sulci are small.
IMPRESSION:
1. Acute on chronic infarction of the left basal ganglia.
2. New, diffuse osseous metastases in the clivus, visualized upper cervical
spine, and calvarium.
3. The large ventricles with prominent temporal horns and small convexity
sulci can be due to communicating hydrocephalus in proper clinical setting.
4. Paranasal sinus disease.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the ___ ___ at 9:29 AM, 10 minutes after discovery of the
findings.
|
10149316-RR-36
| 10,149,316 | 20,642,594 |
RR
| 36 |
2201-09-10 18:44:00
|
2201-09-11 08:24:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with acute on chronic in the basal ganglia with
also likely bone mets in the cervical spine. Requested per neurology attending
with contrast. // Please eval for possible mets
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 8 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI head ___ and ___
CT head ___
FINDINGS:
Patchy, T1 hypointense, enhancing lesions are scattered throughout the
calvarium and clivus. An ill-defined, enhancing mass in the left Meckel's
cave encases the left cavernous internal carotid artery and is new from the
MRI head ___.
Ex vacuo dilatation of the frontal horn of the left lateral ventricle and left
putamen and caudate head encephalomalacia are unchanged. The area of
encephalomalacia contains linear T1 hyperintense signal.
There is no evidence of mass effect, midline shift or extra-axial fluid
collection. The ventricles and sulci are unchanged in size.
The moderate mucosal thickening in the left maxillary sinus and mild mucosal
thickening in the left anterior ethmoid and left frontal sinuses are
unchanged. The patient is status post bilateral cataract surgery.
IMPRESSION:
1. Enhancing mass in the left Meckel's cave, encasing the left cavernous
internal carotid artery, most likely representing metastases.
2. Diffuse osseous metastases in the clivus and calvarium.
3. Unchanged chronic infarction in the left putaminal and caudate head.
|
10149316-RR-37
| 10,149,316 | 20,642,594 |
RR
| 37 |
2201-09-10 18:44:00
|
2201-09-11 08:32:00
|
EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with acute on chronic in the basal ganglia with
also likely bone mets in the cervical spine. Requested per neurology attending
with contrast. // Please eval mets
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique.
Axial T2 and gradient echo imaging were next performed. After administration
of 8 mL of Gadavist intravenous contrast, sagittal and axial T1 weighted
imaging was performed.
COMPARISON: MRI head ___ and ___
FINDINGS:
There is a 3 mm retrolisthesis of C4 on C5, 3 mm retrolisthesis of C5 on C6
and 2 mm anterolisthesis of C6 on C7. The bone marrow is diffusely T1
hypointense with patchy areas of enhancement. Patchy T1/T2 hyperintense and
IDEAL hypointense signal within the C4, C5, and C6 vertebral bodies represent
degenerative type ___ ___ changes. The height of the vertebral bodies are
maintained. The intervertebral disc spaces of C4-C5 and C5-C6 are severely
narrowed. The intervertebral discs are diffusely desiccated. The spinal cord
is normal in signal. There is no enhancement within the spinal cord. No
epidural masses or fluid collections are identified. The prevertebral and
paraspinal soft tissues are normal.
At C2-C3, there is no spinal canal or neural foraminal stenosis.
At C3-C4, left central disc bulge and bilateral facet osteophytes cause mild
spinal canal and moderate bilateral neural foraminal stenosis.
At C4-C5, right central disc bulge and bilateral facet osteophytes cause
severe bilateral neural foraminal and moderate spinal canal stenosis.
At C5-C6, right central disc bulge and bilateral facet osteophytes cause
severe spinal canal, severe right neural foraminal, moderate left neural
foraminal stenosis.
At C6-C7, minimal disc bulging and bilateral facet osteophytes cause moderate
left neural foraminal and mild right neural foraminal stenosis. There is no
spinal canal stenosis.
At C7-T1, bilateral facet osteophytes cause mild bilateral neural foraminal
stenosis. There is no spinal canal stenosis.
IMPRESSION:
1. Diffuse osseous metastases throughout the cervical spine.
2. Multilevel degenerative changes of the cervical spine, most advanced at
C5-C6, where there is severe spinal canal, severe right neural foraminal, and
moderate left neural foraminal stenosis.
|
10149316-RR-38
| 10,149,316 | 20,642,594 |
RR
| 38 |
2201-09-11 19:08:00
|
2201-09-12 09:49:00
|
EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE
INDICATION: ___ year old male with acute on chronic in the basal ganglia with
also likely bone mets in the cervical spine. Evaluate for metastatic disease.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of mL of Gadavist contrast
agent, additional axial and sagittal T1 images were obtained.
COMPARISON: CT from ___
FINDINGS:
Partially visualized degenerative changes are noted throughout the cervical
spine, fully characterized on the previously performed MRI of the C-spine.
THORACIC:
There is dextroscoliosis of the mid/ lower thoracic spine.Multilevel disc
space height loss and decreased signal is seen. Diffuse T1 hypo intense
signal is noted throughout the thoracic spine with scattered areas of STIR
hyperintense signal and heterogeneous contrast enhancement, particularly in
the T6 vertebral body. The spinal cord appears normal in caliber and
configuration.
There is diffuse dorsal and lateral lipomatosis throughout the mid to lower
thoracic spine resulting in mild narrowing of the spinal canal. There is
moderate right T3-4 neural foraminal narrowing secondary to the spinal
curvature. There is a central disc protrusion at T5-6 effacing the ventral
thecal sac and mildly remodeling the ventral spinal cord, resulting in mild
spinal canal stenosis and mild left neural foraminal stenosis. Mild
multilevel neural foraminal stenosis is noted throughout the remainder of the
thoracic spine, secondary to facet arthropathy and spinal curvature.
LUMBAR:
There is levoscoliosis of the lumbar spine.Diffuse T1 hypo intense signal is
noted throughout the lumbar spine and visualized sacrum. Heterogeneous
contrast enhancement is noted throughout the lumbar spine. ___ type 1
changes are seen at L4-5. There is multilevel disc space height loss and
decreased signal. The spinal cord appears normal in caliber and
configuration. There is linear dural or intradural enhancement along the
dorsal aspect of the spinal canal at the level of T12 - L3.
There is severe right neural foraminal stenosis at L3-4 and moderate right
neural foraminal stenosis at L ___ secondary to facet arthropathy and
scoliosis. There is a disc bulge a L3-4 with facet arthropathy resulting in
mild spinal canal stenosis.
T2/STIR hyperintense signal is noted in the presacral space.
OTHER: Patchy left basilar airspace disease is seen. There is partially
visualized retroperitoneal lymphadenopathy.
IMPRESSION:
1. Diffusely abnormal bone marrow signal throughout the thoracic and lumbar
spine and the visualized sacrum consistent with diffuse bony metastatic
disease.
2. Mild multilevel spinal canal stenosis and mild-to-moderate neural foraminal
stenosis, as described above.
3. Abnormal dural versus intradural enhancement at the level of T12-L3, of
uncertain etiology and may represent malignant involvement. Correlation with
lumbar puncture can be performed if clinically indicated.
4. Presacral edema of uncertain etiology with no definite fracture seen,
although pathologic fracture cannot be excluded. Recommend CT of the sacrum
for further evaluation.
5. Partially visualized retroperitoneal lymphadenopathy.
6. Partially visualized patchy left basilar airspace disease.
|
10149316-RR-39
| 10,149,316 | 20,642,594 |
RR
| 39 |
2201-09-13 11:51:00
|
2201-09-14 08:25:00
|
EXAMINATION: MR PITUITARY ___ CONTRAST T___ MR ___
INDICATION: ___ year old man with CLL, metastatic prostate cancer, now with
left sided ptosis, diplopia // please eval with MRI pituitary with FIESA
sequence
TECHNIQUE: Sagittal and coronal T1 weighted imaging were performed along with
coronal T2 imaging. Sagittal and coronal T1 weighted imaging were repeated
after the uneventful intravenous administration of 5 mL of Gadavist contrast.
COMPARISON MRI from ___.
FINDINGS:
Images of the pituitary appear normal. The pituitary signal intensity appears
normal before and after contrast administration. The suprasellar cistern
appears normal.
There is persistent loss of normal CSF signal in the left Meckel's cave with
associated expansion and heterogeneous contrast enhancement with no definite
mass effect on the internal carotid artery is seen. There is mild enhancement
and dural invasion along the anterior/medial left temporal lobe, series 8,
image 9. In addition, there is a heterogeneously enhancing 2.1 cm SI oblong
lesion in the anterior right cavernous sinus, extending into and expanding the
right foramen rotundum. No mass effect on the internal carotid artery is
seen.
Partially visualized patchy T1 hypointense signal throughout the calvarium
including the clivus with associated heterogeneous contrast enhancement.
There is partially visualized T2 hyperintense signal in the left putamen and
caudate head with intrinsic T1 hyperintense signal and mild associated
contrast enhancement.
Tornwaldt or retention cysts are noted in the posterior nasopharynx.
Degenerative changes are noted in the bilateral temporomandibular joints.
IMPRESSION:
1. Partially visualized subacute infarction of the left putamen and caudate
head.
2. Re- demonstration of the expansile heterogeneously contrast enhancing
lesion in the left Meckel's cave with associated dural invasion along the
anterior medial left temporal lobe.
3. Additional lesion in the anterior right cavernous sinus extending into and
expanding the right foramen rotundum.
4. Partially visual calvarial metastatic disease.
5. Normal appearance the pituitary gland.
|
10149334-RR-22
| 10,149,334 | 21,389,939 |
RR
| 22 |
2165-04-28 08:53:00
|
2165-04-28 10:09:00
|
EXAMINATION: CT LOW EXT W/O C RIGHT Q61R
INDICATION: ___ year old woman with fracture of right leg, right leg pain//
concern for periprosthetic fracture? please image from hip to past the knee
TECHNIQUE: Axial acquisition without contrast through the right knee with
coronal and sagittal reconstructions.
DOSE: Acquisition sequence:
1) Spiral Acquisition 12.7 s, 27.0 cm; CTDIvol = 29.2 mGy (Body) DLP =
788.5 mGy-cm.
Total DLP (Body) = 789 mGy-cm.
COMPARISON: Right knee radiograph from ___ from outside institution
___.
FINDINGS:
Patient is status post right knee arthroplasty. Streak artifact does limit
the examination. Vertically-oriented minimally displaced periprosthetic
fracture through the medial femoral condyle with intra-articular extension
remains in similar alignment. A horizontally oriented fracture line extends
into the lateral femoral condyle as well. Moderate lipohemarthrosis is
appreciated. No radiolucency surrounding the prosthesis to suggest loosening.
No additional fractures noted.
Extensive vascular calcifications are noted. Subcutaneous fat stranding is
noted. Muscle atrophy noted diffusely. Overall bone demineralization.
IMPRESSION:
1. Complex fracture with vertically oriented component extending through the
medial femoral condyle to the articular surface. Horizontal component
extending into the lateral femoral condyle.
2. Lipohemarthrosis.
|
10149334-RR-23
| 10,149,334 | 21,389,939 |
RR
| 23 |
2165-04-29 14:42:00
|
2165-04-29 15:58:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ with history of NIDDM, CAD, CHF (unclear EF), CKD, chronic
b/l neuropathic ulcers, HLD, HTN, presenting as a transfer for fall and R
distal femur fracture// Please eval R plantar ulcer for evidence of osteo
COMPARISON: None.
FINDINGS:
There is background demineralization, severe degenerative changes of the first
MTP and TMT joints, and hammertoe deformities of the ___ to ___ toes, and
probable pes planus. There are mild-to-moderate degenerative changes of the
hindfoot, with enthesopathic changes in assess re-ossicles subjacent to the
cuboid. There also plantar and dorsal calcaneal spurs.
There is a mottled appearance of the hindfoot, and distal tibia, with several
ill-defined lucencies, may represent a pseudo permeative appearance of
demineralization. No aggressive or erosive changes of osteomyelitis.
Diffuse soft tissue edema, without definite emphysema or ulceration.
IMPRESSION:
Limited assessment, due to severe demineralization, and overlying soft tissue
edema. Mottled appearance of the hindfoot and tibia, likely related to
demineralization, and no radiographic Findings of osteomyelitis otherwise. If
there is remains high clinical concern for the diagnosis, may further assess
with MRI.
|
10149334-RR-24
| 10,149,334 | 21,389,939 |
RR
| 24 |
2165-05-07 14:40:00
|
2165-05-07 16:08:00
|
EXAMINATION: KNEE (2 VIEWS) RIGHT PORT
INDICATION: ___ year old woman with medial femoral condyle fx, non displaced//
please evaluate for displacement of fx
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the right knee.
COMPARISON: Right knee CT ___
FINDINGS:
Patient is status post total right knee arthroplasty. Again seen is a
vertically-oriented, minimally displaced periprosthetic fracture through the
medial femoral condyle with intra-articular extension, unchanged in position
compared to prior. There is a small suprapatellar knee effusion. Vascular
calcifications within the soft tissues of the posterior knee.
IMPRESSION:
Unchanged vertically-oriented, minimally displaced periprosthetic fracture
through the medial femoral condyle with intra-articular extension. The
fracture fragment is unchanged in position compared to prior CT.
|
10149485-RR-10
| 10,149,485 | 21,087,785 |
RR
| 10 |
2150-05-11 04:40:00
|
2150-05-11 05:39:00
|
EXAMINATION: CT abdomen pelvis
INDICATION: History: ___ with hx inflammatory breast cancer on Taxol p/w
fever, chills, and right labial/inguinal abscess on ultrasound w/ one
collection and ?loculations// extent of abscess, any loculations/tracking, for
possible surgical planning
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 705 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is mild dependent atelectasis in the bilateral lower lobes.
There is no evidence of pleural or pericardial effusion. Trace pericardiaaenla
fluid
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
There is a simple cyst posterior to ___ pouch (03:25) measuring 2.4 x
1.9 cm which may represent a peritoneal or exophytic renal simple cyst.
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. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. The bilateral ovaries are
unremarkable. An intrauterine device appears well positioned.
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: There is subcutaneous stranding in the region of the right labia
and groin. There is no evidence of a fluid collection.
IMPRESSION:
Stranding in the region of the right labia and groin likely compatible with
cellulitis or inflammation. No evidence of fluid collection.
|
10149485-RR-11
| 10,149,485 | 21,087,785 |
RR
| 11 |
2150-05-11 10:43:00
|
2150-05-11 13:52:00
|
EXAMINATION: Chest single view
INDICATION: ___ year old woman with h/o breast cancer on chemo with port in
place// confirm port placement from outside hospital
TECHNIQUE: Chest portable AP upright
COMPARISON: None
FINDINGS:
The heart and great vessels are normal. The lungs are clear. Port-A-Cath in
the left axilla with its tip projecting over the mid to distal SVC.
IMPRESSION:
Port-A-Cath with tip in mid to distal SVC.
|
10149485-RR-21
| 10,149,485 | 25,049,331 |
RR
| 21 |
2151-10-06 06:11:00
|
2151-10-06 06:25:00
|
INDICATION: History: ___ with PMH metastatic breast cancer here with
pancytopenia and a fever last week as well as cough and congestion.// R/o
Infection, metastatic disease
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Left chest port tip terminates in the distal SVC. The lungs are well inflated
and clear. No pleural effusion or pneumothorax. Heart size is normal. The
mediastinal and hilar contours are unremarkable. Status post right
mastectomy.
IMPRESSION:
No focal findings of pneumonia.
|
10149485-RR-22
| 10,149,485 | 25,049,331 |
RR
| 22 |
2151-10-06 19:00:00
|
2151-10-07 10:01:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with breast cancer admitted with progressive
right sided neck and right arm paresthesias// Eval etiology of parasthesias,
suspect metastatic cause
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: Outside MRI head on ___
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. Scattered subcortical and periventricular white matter
T2/FLAIR signal hyperintensities are nonspecific however are not significantly
changed compared with outside brain MRI ___, and do not demonstrate
abnormal diffusion or enhancement. The ventricles and sulci are normal in
caliber and configuration. The major intracranial flow voids are preserved.
The dural venous sinuses are patent.
There is trace mucosal thickening in the ethmoid air cells. There is no
abnormal fluid signal in the remainder of the visualized paranasal sinuses or
mastoid air cells. The orbits are grossly unremarkable.
There is diffuse marrow signal abnormality. Marrow signal abnormality
previously seen in the clivus appears different compared with prior, with
decreased T1/FLAIR/T2 signal, however there is diffuse marrow signal
abnormality and enhancement, compatible with diffuse metastatic disease.
IMPRESSION:
1. No evidence of intraparenchymal metastatic disease.
2. Diffuse marrow signal abnormality in the calvarium and clivus, compatible
with osseous metastatic disease.
|
10149485-RR-23
| 10,149,485 | 25,049,331 |
RR
| 23 |
2151-10-06 19:00:00
|
2151-10-07 10:22:00
|
EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old woman with breast cancer admitted with progressive
right sided neck and right arm paresthesias// eval etiology of neck pain and
paresthesias
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique.
Axial T2 and gradient echo imaging were next performed. After administration
of 7 mL of Gadavist intravenous contrast, sagittal and axial T1 weighted
imaging was performed.
COMPARISON: Outside cervical spine MRI on on ___
FINDINGS:
Exam is degraded by motion, particularly the post-contrast images.
Alignment is normal. Vertebral body heights are preserved. There is diffuse
loss of normal T1 marrow signal in the cervical and visualized upper thoracic,
unchanged, however there is increased loss of normal T2 signal diffusely in
the vertebral body marrow. Several previously seen focal T2 hyperintense/T1
hypointense enhancing lesions in the C2, C3, C4 and C7 are not well seen,
however there is now diffuse abnormal enhancement within the vertebral bodies,
compatible with diffuse metastatic disease.
The visualized portion of the spinal cord appears normal. There is no
definite abnormal leptomeningeal enhancement postcontrast.
At C5-C6, a small posterior disc bulge causes mild canal narrowing without
significant neural foraminal narrowing, stable. There is otherwise no
significant spinal canal or neural foraminal narrowing throughout the cervical
spine.
IMPRESSION:
Diffuse osseous metastatic disease in the spine. The appearance is changed
since ___, and the study is limited by motion, however there is extensive
signal abnormality and enhancement.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 1:28 pm, 5 minutes after discovery of the
findings.
|
10149485-RR-25
| 10,149,485 | 25,049,331 |
RR
| 25 |
2151-10-06 18:55:00
|
2151-10-06 19:22:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with metastatic breast cancer. Admitted with
right arm, chest, and neck pain.// Eval RUE DVT. Please do on ___, as patient
has twins who are going back to school tomorrow, and if possible would like to
expedite discharge home.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial, basilic, and cephalic veins are
patent, compressible, and show normal color flow and augmentation.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10149485-RR-26
| 10,149,485 | 25,049,331 |
RR
| 26 |
2151-10-07 00:03:00
|
2151-10-07 01:59:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with metastatic breast cancer admitted with
right upper extremity, neck, and anterior chest pain.// Eval right chest pain.
? DVT. ? progressive metastatic disease.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 1.4
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 10.6 mGy (Body) DLP =
2.1 mGy-cm.
3) Spiral Acquisition 4.4 s, 28.7 cm; CTDIvol = 5.4 mGy (Body) DLP = 151.8
mGy-cm.
Total DLP (Body) = 155 mGy-cm.
COMPARISON: Chest CT dated ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen. A left internal jugular
Port-A-Cath terminates near the superior cavoatrial junction.
AXILLA, HILA, AND MEDIASTINUM: The patient is status post right axillary lymph
node dissection. Left axillary lymph nodes are not enlarged. No mediastinal,
or hilar lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: There is a trace right pleural effusion.
LUNGS/AIRWAYS: Passive atelectasis is present at the right base. There is
subsegmental left basilar dependent atelectasis.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: There is diffuse sclerosis of the vertebral bodies, sternum and
sclerotic lesions in several bilateral ribs similar to the prior study in
keeping with breast cancer metastasis. Healing left posterior fifth rib
fracture is re-demonstrated.
SOFT TISSUES: The patient is staus-post right mastectomy.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Trace right pleural effusion with subjacent passive atelectasis.
3. Diffuse sclerotic osseous metastatic disease as before.
|
10149485-RR-27
| 10,149,485 | 25,049,331 |
RR
| 27 |
2151-10-08 10:07:00
|
2151-10-08 13:09:00
|
EXAMINATION: MR ___ ANDW/O CONTRAST ___ MR SPINE
INDICATION: ___ year old woman with metastatic breast cancer. Admitted with
right arm and neck pain. Now localizing to upper back radiating around into
right chest.// Eval for thoracic lesion causing band like pain radiating
around her ribs. Eval for thoracic lesion causing band like pain
radiating around her ribs.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 7 mL of
Ga___ contrast agent.
COMPARISON:
1. CTA chest ___.
2. CT chest ___.
3. MRI thoracic spine ___.
FINDINGS:
There is a slight levocurvature of the upper thoracic spine which is
unchanged. Otherwise, thoracic spine alignment is normal without anterior or
posterior spondylolisthesis. Thoracic spine vertebral bodies demonstrate
preserved height. As seen on prior exams, there is diffuse abnormal signal in
the thoracic spine marrow. Specifically, there is primarily diffuse,
multisequence hypointense signal throughout the imaged thoracic vertebral
bodies, with multifocal areas of T1 hypointense, T2/STIR hyperintense focal
lesions, some demonstrate enhancement, the largest which are seen within the
T12 and L1 vertebral bodies, as previously, compatible with known
diffuse/multifocal skeletal metastatic disease..
Compared with the prior MRI of ___, several of these more focal
T2/STIR hyperintense lesions (for example within T4, T6, and T9) are
significantly less conspicuous or are no longer identified, now replaced with
hypointense marrow signal likely reflecting post-treatment sclerosis. There
is no evidence of new pathologic fracture. There is no epidural collection.
No epidural tumor. The thoracic spinal cord is normal in caliber and signal
intensity. The imaged right proximal cauda equina nerve roots are
unremarkable.
8 mm circumscribed T2 hyperintense lesion within the left posterior fifth rib
(6: 19) is unchanged in size, now more homogeneously T2 hyperintense compared
with prior exam of ___. Similar lesions in the right posterior seventh
rib (06:26) are unchanged. Nondisplaced fracture through the left posterior
fifth rib is again noted, as seen on prior studies.
There is mild multilevel disc signal and height loss in the thoracic spine,
compatible with mild degenerative changes. There is no significant thoracic
spinal canal or neural foraminal stenosis.
The imaged prevertebral and paraspinal soft tissues are grossly unremarkable
on limited evaluation. There is medium-sized layering right pleural effusion,
unchanged or possibly slightly larger compared with the prior CTA of ___. Right basilar consolidation, likely atelectasis. Trace right
retroperitoneal fluid.
IMPRESSION:
1. Extensive bone metastatic disease. Several more focal T2/STIR hyperintense
lesions previously seen in T4, T6, and T9 are significantly less conspicuous
compared to prior study, now replaced with post-treatment sclerosis. No new
focal bone, paraspinal or epidural mass.
2. No significant spinal canal or foraminal narrowing. No new pathologic
fracture.
3. Right pleural effusion is unchanged or minimally larger since study from ___. Right basilar consolidation, likely atelectasis.
|
10149485-RR-28
| 10,149,485 | 25,049,331 |
RR
| 28 |
2151-10-08 09:59:00
|
2151-10-08 11:47:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with metastatic breast cancer and
thrombocytopenia. Progressive right thorax pain. Small new effusion on CT
yesterday.// Eval progression of right effusion. ? hemothorax. This was
ordered on ___ at 1pm and has not yet been done. Chaning order to urgent.
Eval progression of right effusion. ? hemothorax. This was ordered on ___ at
1pm and has not yet been done. Chaning order to urgent.
IMPRESSION:
Compared to chest radiographs since ___ most recently ___
read in conjunction with chest CTA on ___..
Cardiac silhouette is substantially larger today than on ___. Small
right pleural effusion has increased progressively compared to ___ and
___ and there is more consolidation at the base of the right lung
compared to the chest CTA on ___ which showed new atelectasis. Since
there is no vascular engorgement in the lungs, the larger cardiac silhouette
could be due to pericardial effusion. No pneumothorax.
Generalized skeletal sclerosis is presumably due to treated metastasis.
Left transjugular central venous infusion catheter ends in the low SVC.
NOTIFICATION: The findings were discussed with ___. by ___
___, M.D. on the telephone on ___ at 11:37 am, 1 minutes after
discovery of the findings.
|
10149485-RR-29
| 10,149,485 | 25,049,331 |
RR
| 29 |
2151-10-08 14:38:00
|
2151-10-08 17:07:00
|
INDICATION: Pain question rib fracture
TECHNIQUE: Four views right ribs
COMPARISON: None
FINDINGS:
A left-sided port is visualized. There is a small right-sided pleural
effusion. Clips are noted in the right axilla. There is increased sclerosis
of the vertebral bodies consistent with known osseous metastatic disease.
Markers are seen adjacent to the right lower ribs. No definitive rib fracture
is appreciated.
IMPRESSION:
No definitive rib fracture identified.
|
10149485-RR-30
| 10,149,485 | 25,049,331 |
RR
| 30 |
2151-10-10 10:06:00
|
2151-10-10 11:55:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with worsening cough// evaluate for worsening
pleural effusion or consolidation evaluate for worsening pleural effusion
or consolidation
IMPRESSION:
Compared to chest radiographs ___ through ___.
Moderate right pleural effusion that developed between ___ and
___ is increasing and consolidation at the right lung base largely if
not exclusively atelectasis is worsening. Enlargement of the cardiac
silhouette is progressing. Since there is no indication of left heart
decompensation, pericardial effusion needs to be considered.
No pneumothorax.
Left central venous infusion catheter ends in the low SVC.
|
10149624-RR-30
| 10,149,624 | 28,655,127 |
RR
| 30 |
2136-01-05 15:57:00
|
2136-01-05 16:44:00
|
HISTORY: Ulcerative colitis with worsening abdominal pain and diarrhea.
TECHNIQUE: Upright and supine AP views of the abdomen.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
The bowel gas pattern is normal. No evidence of small bowel obstruction,
differential air-fluid levels, or free intraperitoneal air. No soft tissue
calcifications are noted. There are no acute osseous abnormalities.
IMPRESSION:
Normal bowel gas pattern. No free intraperitoneal air.
|
10149624-RR-31
| 10,149,624 | 28,655,127 |
RR
| 31 |
2136-01-06 16:58:00
|
2136-01-07 10:20:00
|
PA AND LATERAL CHEST X-RAY
INDICATION: Patient with UC flare not improving, may need to start Remicade.
Please evaluate for infectious process.
COMPARISON: Multiple chest x-rays from ___ to ___.
FINDINGS:
The lungs are clear. Mediastinal and cardiac contours are normal. There is
no pleural effusion or pneumothorax.
CONCLUSION:
There are no acute cardiopulmonary findings. There is no evidence of
infectious process.
|
10149722-RR-59
| 10,149,722 | 23,479,434 |
RR
| 59 |
2203-03-08 00:29:00
|
2203-03-08 01:24:00
|
HISTORY: ___ female with diffuse lower abdominal pain. Evaluate for
colitis.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after administration 130 cc of IV Omnipaque contrast. Axial images
were interpreted in conjunction with coronal and sagittal reformats.
COMPARISON: Multiple prior CTs, most recently CT abdomen of ___
and CT abdomen pelvis of ___.
FINDINGS:
The visualized portion of the heart is unremarkable. No pericardial effusion.
Bibasilar atelectasis is present. There is a trace left pleural effusion.
ABDOMEN:
The liver, intra and extrahepatic bile ducts, pancreas, spleen, and adrenal
glands are normal. The gallbladder is absent. Hypodense renal lesions
measuring up to 3.1 centimeters in the right lower pole are compatible with
simple renal cysts. Other renal hypodensities are too small to further
characterize. The kidneys otherwise enhance symmetrically and excrete
contrast promptly. The ureters are normal in course and caliber.
A small hiatal hernia is present. The stomach is otherwise unremarkable. The
small and large bowel enhance homogeneously. The small bowel has a normal
course and caliber. The large bowel has a normal course. There is colonic
mild wall thickening with surrounding mesenteric fat stranding and adjacent
vascular engorgement extending from the mid descending colon to the rectum.
Several diverticula are noted within this region of colitis, but no single
offending diverticulum is identified to suggest diverticulitis. No
pneumatosis, extraluminal air, or adjacent collection.
The portal vasculature is unremarkable. Dense atherosclerotic calcifications
are present along the descending aorta. A large atherosclerotic calcification
is present at the trifurcation of the celiac axis with poststenotic
dilatation. The base of the SMA is narrowed by an atherosclerotic plaque and
the SMA appears diminutive but well opacified. The ___ is opacified. There
is aneurysmal dilatation of left common iliac artery, measuring up to 2.1
centimeters (601b:43), which contains containing small thrombus, similar to
prior.
No retroperitoneal or mesenteric lymphadenopathy. No free pelvic fluid or
pneumoperitoneum. A small paraumbilical hernia is similar to prior.
PELVIS: The bladder contains a Foley catheter and is decompressed. The
uterus is not visualized. No pelvic sidewall or inguinal lymphadenopathy. No
inguinal hernia or free pelvic fluid.
OSSEOUS STRUCTURES: Severe multilevel thoracolumbar degenerative changes are
present. Multilevel compression deformities, worst at T12, are similar to
prior.
IMPRESSION:
1. Mild colitis extending from the mid descending colon to the rectum. No
pneumatosis, extraluminal air, or adjacent fluid collection. The distribution
of colitis favors ischemia as the etiology, though no arterial or portal
venous occlusion is visualized.
2. The SMA is diminutive but opacifies normally. A large atherosclerotic
calcification is present along the celiac axis with poststenotic dilatation.
3. Aneurysmal dilatation of left common iliac artery, similar to prior.
|
10149722-RR-73
| 10,149,722 | 23,451,705 |
RR
| 73 |
2206-01-18 14:05:00
|
2206-01-18 15:47:00
|
EXAMINATION: Portable chest radiograph.
INDICATION: History: ___ with left lower rib pain ax region after fall //
r/o fx's
TECHNIQUE: Single semi-upright portable chest radiograph is obtained.
COMPARISON: ___.
FINDINGS:
Lung volumes are low. Patchy opacity at the left lung base may reflect
atelectasis although aspiration and pneumonia should also be considered.
Portable technique and body habitus limits assessment of the rib cage,
particularly along the left chest wall; however, no obvious displaced
fractures are identified. Heart size is normal. There is no pneumothorax,
pulmonary edema, or large pleural effusion.
IMPRESSION:
Low lung volumes and left basilar opacity, possiby atelectasis, aspiration, or
pneumonia. Clinical correlation is recommended. Limited assessment of the
ribs reveals no obvious displaced fracture. If clinical suspicion is high,
non-contrast chest CT or dedicated rib series could be performed.
|
10149722-RR-74
| 10,149,722 | 23,451,705 |
RR
| 74 |
2206-01-18 14:56:00
|
2206-01-18 17:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall // eval for bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 53.5 mGy (Head) DLP =
891.9 mGy-cm.
Total DLP (Head) = 892 mGy-cm.
COMPARISON: MRI/MRA ___
FINDINGS:
There is no acute intracranial hemorrhage or major vascular territorial
infarction. No edema or mass effect. Again noted is left ACA and MCA
territory encephalomalacia with adjacent ex-vacuo dilation, as noted on the
prior MRI performed in ___. Periventricular and subcortical white matter
hypodensities are non-specific but likely represent chronic small vessel
ischemic changes. Ventricles and sulci are prominent, suggestive of age
related involutional changes.
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. Atherosclerotic calcifications are
noted in the bilateral carotid siphons.
IMPRESSION:
1. No acute intracranial process.
2. Unchanged extensive left ACA and MCA territory encephalomalacia with
secondary extensive ex-vacuo dilation of the left ventricle.
|
10149722-RR-75
| 10,149,722 | 23,451,705 |
RR
| 75 |
2206-01-18 14:57:00
|
2206-01-18 17:43:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall // eval for bleed eval for bleed
TECHNIQUE: Non-contrast helical multidetector CT was performed. Axial image
data was collimated to display separate 2.5 mm soft tissue and bone algorithm
axial images. Coronal and sagittal reformations were then constructed.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 5.9 s, 23.1 cm; CTDIvol = 36.9 mGy (Body) DLP = 853.1
mGy-cm.
Total DLP (Body) = 853 mGy-cm.
COMPARISON: MRI/MRA neck ___
FINDINGS:
There is subluxation of C1 on C2 on the left (602b:41), which appears
unchanged in appearance from the prior MRI dated ___ (2:16, prior
study). Minimal anterolisthesis of C4 on C5 and C7 on T1 is most likely
degenerative in nature, although no prior studies are available to compare for
stability. No acute fractures. Multilevel multifactorial degenerative
changes are noted throughout the cervical spine including anterior/posterior
osteophytes, uncovertebral hypertrophy, and facet joint arthropathy that
results in up to mild/moderate spinal canal narrowing at C5-C6 and C6-C7.
The thyroid gland is heterogeneous in appearance, containing coarse
calcifications on the right at multiple bilateral nodules. Nonspecific
ground-glass opacities of partially visualized in the right lung apex, further
characterized on the CT chest performed on the same date.
IMPRESSION:
1. No acute fracture.
2. Subluxation of C1 on C2 on the left, unchanged from the prior MRI in ___.
There is also minimal anterolisthesis of C4 on C5 and C7 on T1, which are most
likely degenerative in nature although no prior studies are available to
compare for stability. No prevertebral soft tissue edema.
3. Heterogeneous thyroid gland with coarse calcifications on the right and
multiple bilateral nodules.
RECOMMENDATION(S): Nonurgent thyroid ultrasound for further characterization
of the thyroid nodules described above.
|
10149722-RR-76
| 10,149,722 | 23,451,705 |
RR
| 76 |
2206-01-18 14:57:00
|
2206-01-18 18:16:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: History: ___ with fall onto left chest wall. hypoxic // eval for
rib fxs, lung inj
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
without intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 3.9 s, 30.6 cm; CTDIvol = 18.5 mGy (Body) DLP = 567.7
mGy-cm.
Total DLP (Body) = 568 mGy-cm. mGy-cm
COMPARISON: Chest radiograph ___. CT abdomen and pelvis ___.
FINDINGS:
Partially visualized thyroid gland is heterogeneous in appearance, containing
coarse calcifications on the right. Again noted are several hypodense nodules
in the left, the largest measuring approximately 10 x 13 mm.
No evidence of supraclavicular, axillary, mediastinal, or hilar
lymphadenopathy.
Heart size is normal, and there is no pericardial effusion. Calcifications
are noted within the aortic valve and coronary arteries.
The thoracic aorta is normal in caliber, also containing atherosclerotic
calcification throughout. The non-opacified appearance of the pulmonary
arteries is unremarkable.
Airways are patent to the subsegmental levels. There are diffuse bilateral
ground-glass opacities, which may be related to expiration or air trapping.
There is bibasilar dependent atelectasis. More focal high density region in
the left lung base (4:144) may represent additional focus of atelectasis.
There is a small pleural effusion on the left. No pneumothorax, contusions or
lacerations.
Limited images of the upper abdomen demonstrate a moderately-sized hiatal
hernia. Pancreas is atrophic. Diverticulosis is noted within the partially
visualized portions of the splenic flexure. There is focal dilation of the
celiac artery with calcified walls, measuring up to 1.3 cm in diameter (2:51)
; this could represent either post stenotic or aneurysmal dilation, stable
from ___.
Old right humeral neck fracture (___:66). Acute minimally is display
fractures of the left eighth, ninth, tenth and eleventh ribs (602b:107, 108,
110). There is loss of height at the T6 vertebral body, which appears old,
although no prior studies are available to compare for stability. T12
compression fracture is unchanged from the ___ CT abd/pelvis. There is
a 3.0 x 4.6 cm fluid collection with an air-fluid level in the left breast
tissue (3:36) without significant surrounding stranding. Lateral to this,
there is a soft tissue density containing small locules of air that measures
approximately 3.5 x 2.2 cm; this could represent a fluid collection/hematoma
or possibly underlying lesion.
IMPRESSION:
1. Acute nondisplaced fractures of the left ___ - 11th ribs.
2. Diffuse bilateral ground-glass opacities, which may be related to
expiration or air trapping. High-density consolidation in the left lung base
may represent atelectasis. No pneumothorax.
3. Heterogeneous thyroid gland, as described on the separate cervical spine
CT.
4. 4.6 x 3.0 cm fluid collection in the medial left breast tissue that may
represent post-surgical seroma but infection could be present. Correlate
clinically. Additional 3.5 x 2.2 cm soft tissue density with locules of air
along lateral left breast, which may be a combination of fluid/hematoma and
underlying soft tissue lesion. Recommend correlation with surgical history and
patient symptoms.
7. Re-demonstrated post-stenotic dilation vs focal aneurysm of the celiac
artery.
8. Chronic T12 compression fracture, and probably chronic T6 compression
deformity. Please correlate clinically for focal tenderness.
|
10149722-RR-77
| 10,149,722 | 23,451,705 |
RR
| 77 |
2206-01-19 07:23:00
|
2206-01-19 10:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall and left ___ rib fx, non-displaced
// Eval for PTX Eval for PTX
COMPARISON: Comparison to ___ at 14:03
FINDINGS:
Portable upright chest radiograph ___ at 07:34 is submitted.
IMPRESSION:
There is improved inspiration with increasing aeration at the left base but
residual bibasilar atelectasis, less likely aspiration or pneumonia. The
right hemidiaphragm remains elevated of uncertain etiology. Fractures
involving the left ninth and tenth posterolateral ribs can now be visualized.
There is a layering left effusion. No pneumothorax is seen. Overall cardiac
and mediastinal contours are likely stable given patient rotation on the
current study. Clips in the right upper quadrant are consistent with prior
cholecystectomy. Severe degenerative change of the left glenohumeral joint
which is incompletely visualized. Remote fracture of the right humeral head
with remodeling and associated degenerative change.
|
10149722-RR-78
| 10,149,722 | 23,451,705 |
RR
| 78 |
2206-01-20 14:02:00
|
2206-01-20 15:11:00
|
INDICATION: ___ y/o F s/p fall- pt c/o L hip pain to palpation // r/o fx and
dislocation
COMPARISON: Radiographs from ___.
IMPRESSION:
Study is somewhat limited due to the overlying bowel-gas pattern. However, no
displaced fractures or hip dislocations are identified. There are moderate
degenerative changes of both hips with joint space narrowing and spurring
which has progressed since the prior study. Severe degenerative changes of
the lower lumbar spine are seen. There is prominent air-filled loops of bowel
which obscures evaluation of the pelvis including the sacrum.Proliferative
changes of the pubic symphysis are present.
|
10149765-RR-21
| 10,149,765 | 26,535,625 |
RR
| 21 |
2131-02-21 00:04:00
|
2131-02-21 02:03:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with concern for inflammatory breast cancer, found
to have new oxygen requirement. // Rule out pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Ill-defined densities are present in the right middle and lower lobes, and
left lower lobe. Bilateral small pleural effusions, greater on the right with
likely atelectasis. No pneumothorax. Cardiomediastinal silhouette is within
normal limits.
IMPRESSION:
1. Bilateral ill-defined densities in the mid and lower lung zones, greater
on the right, concerning for multifocal pneumonia.
2. Small bilateral pleural effusions, greater on the right.
|
10149765-RR-22
| 10,149,765 | 26,535,625 |
RR
| 22 |
2131-02-21 01:21:00
|
2131-02-21 03:01:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with new o2 requirement, c/f malignancy. // rule
out PE.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.5 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
2) Spiral Acquisition 4.4 s, 34.6 cm; CTDIvol = 7.3 mGy (Body) DLP = 253.8
mGy-cm.
Total DLP (Body) = 257 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No substantial pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: There are numerous pathologically enlarged
lymph nodes. In the axillae, the largest node on the right measures 2.7 cm in
short axis (2:29), on the left, 1.5 cm (2:33). In the mediastinum, a
prevascular node measures up to 1.1 cm short axis (2:46). A subcarinal node
measures up to 1.0 cm (2:52). Conglomerate of bilateral pathologically
enlarged hilar nodes measure up to 1.2 cm. A pericardial node measuring 1.1
cm is also present (2:101).
PLEURAL SPACES: Regions of mild nodular enhancement are demonstrated in the
right anterior pleural, as seen on series 2, image 57 and series 602, image
30). Bilateral pleural effusions, moderate on the right, small on the left.
LUNGS/AIRWAYS: Ground-glass and irregular opacities are present bilaterally in
all lobes, greater on the right compared to left.
There is also bibasilar and lingular atelectasis.
There are also several subpleural nodules, measuring 1.4 cm in the right upper
lobe (3:133), and 1.7 cm in the left lower lobe (3:141). Additional
subcentimeter ground-glass and solid nodules are present (3:86, 90, 110, 132).
There is mild peribronchial thickening with scattered mucous plugging.
Lungs are clear without masses or areas of parenchymal opacification. The
central airways are patent.
BASE OF NECK: Visualized portions of the base of the neck show 1.6 cm right
supraclavicular nodes with associated mass effect in the right jugular vein
(21:8).1
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: There are nonspecific cortical irregularities of the posterior ___
through 6th ribs bilaterally. Otherwise no suspicious osseous abnormality.?
There is no acute fracture.
SOFT TISSUES: A multilobular heterogeneous enhancing mass in the right breast
measures approximately 8.2 x 4.5 cm. There is associated diffuse thickening
of the overlying skin.
IMPRESSION:
1. 8 x 4.5 cm enhancing multilobular right breast mass with associated skin
thickening, highly suspicious for primary malignancy.
2. Pulmonary nodules and extensive supraclavicular, axillary, mediastinal, and
hilar lymphadenopathy, concerning for metastatic disease.
3. Scattered bilateral ground-glass and irregular opacities, concerning for
multifocal pneumonia, possibly superimposed on metastatic disease.
4. No pulmonary embolism to the subsegmental level.
5. Bilateral moderate-sized pleural effusions, right greater than left.
|
10150056-RR-85
| 10,150,056 | 28,370,219 |
RR
| 85 |
2153-05-22 21:23:00
|
2153-05-22 21:53:00
|
HISTORY: Hip pain after fall.
TECHNIQUE: AP view of the pelvis, 2 views of the left hip.
COMPARISON: None.
FINDINGS:
Diffuse demineralization of the osseous structures limits the detection of
subtle fractures. A subtle area of cortical irregularity is seen involving
the superior left pubic ramus suspicious for a nondisplaced fracture. There
is no diastasis of the pubic symphysis or sacroiliac joints, with degenerative
changes noted in these joints. Mild to moderate degenerative changes with
joint space narrowing are also noted involving both hips. No focal lytic or
sclerotic osseous abnormalities are identified. There are scattered vascular
calcifications.
IMPRESSION:
Possible nondisplaced fracture of the left superior pubic ramus.
|
10150056-RR-86
| 10,150,056 | 28,370,219 |
RR
| 86 |
2153-05-22 21:58:00
|
2153-05-22 22:19:00
|
HISTORY: Diastolic congestive heart failure with chronic pleural effusions,
recent weight gain weakness.
TECHNIQUE: Upright AP and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Moderate to severe cardiomegaly is unchanged. The mediastinal and hilar
contours are stable. There is no pulmonary vascular engorgement. Moderate
size right pleural effusion is relatively unchanged compared to the prior
study with a trace left pleural effusion also again noted. There is worsening
opacification in the right lung base, which could reflect atelectasis though
infection cannot be excluded. Retrocardiac atelectasis is also be
demonstrated. No pneumothorax is identified.
IMPRESSION:
Moderate size right and small left pleural effusions. Worsening opacification
in the right lung base could reflect compressive atelectasis though infection
is difficult to exclude. Retrocardiac atelectasis.
|
10150136-RR-11
| 10,150,136 | 21,205,678 |
RR
| 11 |
2126-08-20 11:49:00
|
2126-08-20 12:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with cp, sob// chf?
COMPARISON: None
FINDINGS:
AP portable upright view of the chest. Low lung volumes. No definite signs
of pneumonia or edema. No large effusion or pneumothorax. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
IMPRESSION:
Limited, negative.
|
10150136-RR-12
| 10,150,136 | 21,205,678 |
RR
| 12 |
2126-08-20 14:30:00
|
2126-08-20 15:44:00
|
EXAMINATION: CTA CHEST AND CT ABDOMEN AND PELVIS
INDICATION: ___ with chest pain, SOB, hypotension, and epigastric abdominal
apin // eval for PE. eval for acute 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.
DOSE: Total DLP (Body) = 1,882 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: There is mild bibasilar atelectasis. 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: The thyroid gland appears mildly heterogeneous without evidence
of a discrete nodule. Otherwise, visualized portions of the base of the neck
show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
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 a subcentimeter hypodense cortical lesion in the interpolar region of
the left kidney, too small to characterize (05:41). There is mild bilateral
nonspecific perinephric stranding.
GASTROINTESTINAL: The stomach is unremarkable. The small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. There
is colonic diverticulosis without evidence of wall thickening or pericolonic
stranding. Otherwise, the colon and rectum are within normal limits. The
appendix is not visualized. There is no free intraperitoneal fluid or free
air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is a fibroid uterus. The bilateral adnexae are
unremarkable..
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There are moderate multilevel degenerative changes of
the thoracic and lumbar spine, most prominent at L1-L 2. There is mild
anterolisthesis at L4-L5, likely degenerative. There is no evidence of
worrisome osseous lesions or acute fracture. The abdominal and pelvic wall is
within normal limits.
IMPRESSION:
1. No acute intra-abdominal or intrapelvic process.
2. No evidence of pulmonary embolism.
3. Fibroid uterus.
4. Diverticulosis without evidence of diverticulitis.
NOTIFICATION: Updated wet read was discussed with ___ MD by ___
MD on ___ at 17:25.
|
10150136-RR-13
| 10,150,136 | 21,205,678 |
RR
| 13 |
2126-08-20 17:49:00
|
2126-08-20 18:53:00
|
INDICATION: ___ with SOB, ? Flash// SOB
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest CT from ___. Chest x-ray from earlier the same
day at 11:52.
FINDINGS:
Lung volumes remain low. There is no consolidation. No effusion or edema.
The cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities, degenerative changes noted at the right shoulder.
IMPRESSION:
No acute cardiopulmonary process, no change since exam from earlier the same
day.
|
10150136-RR-14
| 10,150,136 | 21,205,678 |
RR
| 14 |
2126-08-21 00:05:00
|
2126-08-21 08:17:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with hypothyroidism presenting w/ septic shock
s/p R IJ placement// evaluate R IJ placement Contact name: ___,
___: ___ evaluate R IJ placement
COMPARISON: Chest x-ray ___
FINDINGS:
Single portable frontal view of the chest shows the costophrenic angles to be
sharp. The heart is mildly enlarged. The distal tip of the right IJ central
venous catheter overlies the SVC. No focal consolidation or pneumothorax.
IMPRESSION:
Mild cardiomegaly.
|
10150136-RR-15
| 10,150,136 | 21,205,678 |
RR
| 15 |
2126-08-22 18:35:00
|
2126-08-22 19:20:00
|
EXAMINATION: Abdominal radiographs, three views.
INDICATION: Abdominal pain, nausea and possible obstruction.
COMPARISON: CT is available from ___.
FINDINGS:
Stomach is nondistended. There are no dilated loops of large or small bowel.
Transverse descending sigmoid and sigmoid portions of the large bowel show
slight distension without dilatation, comparable to the prior CT. Distension
of the transverse colon is decreased. This is probably in association with
colitis with suggestion of mild fold thickening. No evidence of toxic
megacolon. No free air.
IMPRESSION:
Mild colonic distension, perhaps slight ileus that seems to be improving
common association with suspected recent colitis at the splenic flexure,
possibly ischemic colitis, based on review of the CT. No evidence of
obstruction.
|
10150136-RR-16
| 10,150,136 | 21,205,678 |
RR
| 16 |
2126-08-23 05:53:00
|
2126-08-23 07:54:00
|
EXAMINATION: CT ABDOMEN W/CONTRAST
INDICATION: ___ year old woman with recently dx duodenal ulcer based off EGD
at OSH with unremitting, severe epigastric pain, ttp with involuntary guarding
in epigastrium, persistent hypotension// ?perforation, bleed
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
2) Spiral Acquisition 4.0 s, 31.1 cm; CTDIvol = 27.3 mGy (Body) DLP = 846.7
mGy-cm.
Total DLP (Body) = 860 mGy-cm.
COMPARISON: Abdominal CT scan from ___.
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. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of solid focal renal lesions or hydronephrosis. A small
simple cyst is noted along the lateral aspect of the mid left kidney. There
is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Thickening of the wall of the
second portion the duodenum is noted consistent with the given history of a
duodenal ulcer. No extravasation of air or contrast or any other fluid is
noted along the portions of the duodenum. Several small lymph nodes are noted
medial to the second portion of the duodenum in the space between the neck of
the pancreas and the descending duodenum..
LYMPH NODES: There is no retroperitoneal or mesenteric 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.
SOFT TISSUES: The abdominal wall is within normal limits.
IMPRESSION:
In this patient with known duodenal ulcer disease, there is no CT evidence for
perforation or extravasation of fluid or contrast.
|
10150167-RR-14
| 10,150,167 | 25,951,281 |
RR
| 14 |
2128-01-29 12:13:00
|
2128-01-29 13:18:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with Right PICC// Right PICC 44cm, ___ ___
Contact name: ___: ___
IMPRESSION:
No previous images. Right subclavian PICC line extends into the jugular
system.
There are very low lung volumes. The cardiac silhouette is at the upper
limits of normal in size or mildly enlarged and there is evidence central
pulmonary vascular congestion. Bibasilar atelectatic changes are seen and
there may be a small left effusion.
Prosthetic device is seen in the left shoulder.
NOTIFICATION: ___, a venous access nurse.
|
10150167-RR-15
| 10,150,167 | 25,951,281 |
RR
| 15 |
2128-01-29 13:41:00
|
2128-01-29 14:52:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with right PICC MAlpositioned// Right PICC
Malpositioned Power FLUSHED Contact name: ___: ___
IMPRESSION:
In Ca with the earlier study of this date, the right subclavian PICC line has
been pulled back, though it still lies within the internal jugular system,
approximately 3.5 cm above the superior aspect of the clavicle.
Otherwise little change.
|
10150167-RR-16
| 10,150,167 | 25,951,281 |
RR
| 16 |
2128-01-29 16:11:00
|
2128-01-29 16:43:00
|
INDICATION: ___ year old woman with Right PICC line// picc tip location after
power flush Contact name: ___: ___
TECHNIQUE: Single AP view of the chest.
COMPARISON: ___ at 14:14.
FINDINGS:
Right PICC line tip terminates at the brachiocephalic/caval confluence. NG
tube traverses stomach tissue in the inferior margin of the film. The
cardiomediastinal silhouette is enlarged but unchanged. There is persistent
low lung volumes. There is pulmonary vascular congestion which is unchanged.
Bibasilar atelectasis is unchanged. No pleural effusions are decreased small
pneumothorax.
IMPRESSION:
Right PICC line terminates at the brachiocephalic/caval confluence.
Otherwise, no significant interval change.
|
10150167-RR-17
| 10,150,167 | 25,951,281 |
RR
| 17 |
2128-01-31 12:16:00
|
2128-01-31 13:34:00
|
EXAMINATION: Single-contrast upper GI leak check
INDICATION: ___ year old woman with perforated marginal ulcer, now s/p repair
and ___ patch// leak
TECHNIQUE: Single contrast upper GI.
DOSE: Acc air kerma: 59 mGy; Accum DAP: 1226 uGym2; Fluoro time: 1.16
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
Water-soluble contrast (Optiray) was administered followed by thin consistency
barium with the patient upright.
Barium passed freely through the esophagus into the stomach and then into the
proximal small bowel. Narrowing is visualized at the distal esophagus likely
secondary to edema. Small-bowel diverticular visualized. There is no
evidence of leak or obstruction.
IMPRESSION:
No evidence of leak or obstruction.
|
10150167-RR-18
| 10,150,167 | 25,951,281 |
RR
| 18 |
2128-01-30 10:06:00
|
2128-01-30 10:49:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// R DL Power PICC 50cm ___
___ Contact name: ___: ___ R DL Power PICC 50cm ___ ___
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Heart size and mediastinum
are stable. Bibasal areas of atelectasis are present. There is mild vascular
congestion, unchanged since previous examination.
|
10150167-RR-19
| 10,150,167 | 25,951,281 |
RR
| 19 |
2128-01-31 17:55:00
|
2128-01-31 18:23:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ with h/o RYGB now with sudden onset severe abd pain and CT
showing intraabd free air now s/p ex. lap, ___ patch and venting G-tube in
remnant stomach.// Now with R picc, R hand edema. Please eval for thrombus
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility.
The right brachial and cephalic veins are patent, compressible and show normal
color flow and augmentation.
There is a nonocclusive thrombus in the mid right basilic vein along the
visualized PICC.
IMPRESSION:
Nonocclusive thrombus in mid right basilic vein along the visualized PICC. No
right upper extremity deep venous thrombosis.
|
10150279-RR-17
| 10,150,279 | 29,054,774 |
RR
| 17 |
2143-09-18 15:28:00
|
2143-09-18 16:58:00
|
HISTORY: ___ female with likely small bowel obstruction. History of
metastatic colorectal cancer with liver metastases, status post colostomy and
liver resection.
COMPARISON: Multiple prior examinations, most recently of ___.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after administration of 150 cc of IV Omnipaque contrast. Oral
contrast was administered. Axial images were interpreted in conjunction with
coronal and sagittal reformats.
FINDINGS:
A central catheter terminates in the right atrium. The visualized heart is
otherwise normal. There is right lung base atelectasis. The left lung base
is clear. The pericardium and pleura are intact without effusion.
ABDOMEN:
The patient is status post segment V wedge resection on ___. A new
11.8 x 7.9 cm complex right hepatic lobe collection is present and contains
heterogeneous contents and several foci of air. The gallbladder is absent.
The intra- and extra-hepatic bile ducts, pancreas, spleen, and adrenal glands
are normal. The kidneys enhance symmetrically and excrete contrast promptly.
The ureters are normal in course and caliber.
The stomach is normal. The patient is status post left lower quadrant
colostomy. The distal colon and distal small bowel are collapsed and there is
dilatation of the proximal small bowel, measuring up to 3.3 cm. A discrete
transition point is not definitely identified but there are several points of
relative narrowing in the pelvis along the ileum. Mild edema may be present
at the location of relative transition in the distal small bowel (601b:44).
No oral contrast is seen beyond the stomach. The appendix is not definitely
identified. 3.3 x 2.0 x 8.4 cm subcutaneous seroma in the anterior abdominal
wall adjacent to the colostomy has decreased in size since ___.
Right abdominal wall surgical staples are present.
No retroperitoneal or mesenteric lymphadenopathy. The portal and
intra-abdominal systemic vasculature are normal. No abdominal wall hernia or
pneumoperitoneum. There is a small amount of low-density free fluid that
tracks along the right pericolic gutter.
PELVIS: The bladder and terminal ureters are normal. The uterus is
unremarkable. No pelvic side-wall or inguinal lymphadenopathy. No inguinal
hernia. Small amount of low-density free pelvic fluid. A perineal
low-density fluid collection is slightly decreased since the prior exam and
consistent with a postoperative seroma.
OSSEOUS STRUCTURES: Unchanged bilateral osteitis condensans ilii and and
multilevel lower lumbar spine degenerative changes. No focal lytic or
sclerotic lesion concerning for malignancy.
IMPRESSION:
1. Dilated proximal small bowel that tapers distally with relative transition
in the left lower quadrant with collapsed distal bowel, compatible with small
bowel obstruction. Mild edema may be present at the location of relative
transition in the distal small bowel.
2. 11.8 x 7.9 cm complex right hepatic lobe heterogeneous collection, which
may be normal in the setting of recent segment V wedge resection, but please
correlate for infection, especially given amount of fluid and foci of air
within this collection. This collection would be amenable to drainage.
3. Status post left lower quadrant colostomy with decreased size of anterior
abdominal wall subcutaneous postoperative seroma. Perineal postoperative
seroma has also decreased in size.
|
10150299-RR-24
| 10,150,299 | 25,312,997 |
RR
| 24 |
2139-05-02 18:43:00
|
2139-05-04 15:48:00
|
EXAM: MRA of the neck.
CLINICAL INFORMATION: Patient with dizziness and previous MRA and MRI of the
brain which showed question of dissection, recommend dedicated MRA of the neck
with axial T1 fat-sat images.
TECHNIQUE: Gadolinium-enhanced MRA of the neck was acquired. Fat-suppressed
axial images of the neck were obtained. Correlation was made with the brain
MRA examination of ___.
FINDINGS: As seen on the previous MRI but better demonstrated on the current
study is a small outpouching of the distal cervical left internal carotid
artery with a small linear adjacent filling defect. There is no evidence of
blood products adjacent to the area seen. These findings suggest an area of
chronic dissection with a small pseudoaneurysm with fibromuscular dysplasia
also a consideration, but less likely. There is no evidence of blood products
seen adjacent artery to indicate an acute dissection.
Otherwise, both carotid arteries and vertebral arteries are patent and there
is no evidence of stenosis or occlusion. The visualized great vessels are
also normal in appearance.
IMPRESSION: The focal outpouching and a linear defect within the distal left
cervical internal carotid artery are again demonstrated but better visualized
on the current study and could be due to a chronic dissection with tiny
pseudoaneurysm. Less likely other alternative would be focal fibromuscular
dysplasia. No evidence of acute blood products seen adjacent to the area of
abnormality to suggest an acute dissection or thrombus within the arterial
wall. No other abnormalities are seen on MRA of the neck.
|
10150423-RR-10
| 10,150,423 | 29,203,506 |
RR
| 10 |
2138-10-02 04:46:00
|
2138-10-02 05:07:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with vomiting, cough, fever. Evaluation for PNA,
aspiration
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to prior radiograph from ___.
FINDINGS:
New focal consolidation within the right lower lobe is likely compatible with
pneumonia. Cardiomediastinal silhouette is within normal limits. The
pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen.
IMPRESSION:
New focal consolidation within the right lower lobe is likely compatible with
right lower lobe pneumonia. Follow-up to complete resolution after course of
antibiotics is ___ weeks is recommended
|
10150423-RR-11
| 10,150,423 | 29,203,506 |
RR
| 11 |
2138-10-02 05:12:00
|
2138-10-02 06:21:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with fever, pain, lft abnormality. Evaluation for
stone, obstruction.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is a small focal echogenic area of calcification in
the left hepatic lobe measuring 4 mm, possibly compatible with calcified
granuloma. There is an echogenic lesion within the right hepatic lobe
measuring 1.8 x 1.8 x 1.2 cm, likely compatible with hemangioma. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 5 mm
GALLBLADDER: The patient is status post cholecystectomy.
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: 13.1 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.There is a
simple appearing cyst within the right midpole measuring 2.6 x 2.3 x 2.4 cm.
There is a simple appearing cyst within the left upper pole measuring 1.7 x
1.9 x 1.8 cm.
Right kidney: 12.2 cm
Left kidney: 11.9 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Status post cholecystectomy without evidence of biliary ductal dilatation.
2. Mild splenomegaly, measuring up to 13.1 cm.
3. Probable hemangioma in the right lobe of the liver.
|
10150423-RR-7
| 10,150,423 | 24,100,930 |
RR
| 7 |
2138-02-10 07:59:00
|
2138-02-10 08:55:00
|
INDICATION: ___ year old man with NSTEMI.// r/o pneumonia, evaluate for
cardiomegaly
TECHNIQUE: Chest AP
COMPARISON: None
IMPRESSION:
Lungs are low volume with bibasilar atelectasis. Heart size is normal. There
is no pleural effusion. No pneumothorax is seen.there is no evidence of
pneumonia
|
10150423-RR-8
| 10,150,423 | 24,100,930 |
RR
| 8 |
2138-02-10 18:23:00
|
2138-02-10 19:55:00
|
INDICATION: ___ year old man s/p code in cardiac cath lab// ?Rib fractures,
PTX
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
The tip of the endotracheal tube projects 1.5 cm from the carina and should be
retracted by approximately 1 cm. An Impella device is present with the tip
projecting over the right ventricle. A feeding tube extends to the stomach.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiac silhouette is within normal limits.
|
10150423-RR-9
| 10,150,423 | 24,100,930 |
RR
| 9 |
2138-02-12 09:37:00
|
2138-02-12 10:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CAD s/p NSTEMI with PCI, remains intubated,
s/p impella (now out).// assess for interval change
IMPRESSION:
In comparison with the study of ___, the Impella has been removed. The
monitoring and support devices are essentially unchanged. Cardiomediastinal
silhouette is stable. Mild bibasilar opacifications most likely represent
atelectasis. No definite vascular congestion or acute focal pneumonia.
|
10150465-RR-51
| 10,150,465 | 23,902,861 |
RR
| 51 |
2152-06-21 09:18:00
|
2152-06-21 12:06:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with pancreatitis, evaluate for pseudocyst,
biliary dilation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRI abdomen from ___.
FINDINGS:
LIVER: The hepatic parenchyma appears diffusely echogenic, consistent with
hepatic steatosis. . No focal suspicious nodules or masses are identified
within the liver. There is no intra or extrahepatic biliary ductal dilation.
The CBD measures 0.4 cm. The portal vein is patent with flow in the
appropriate direction. There is no ascites.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, with
portions of the pancreatic head and tail obscured by overlying bowel gas. The
pancreatic duct size is top normal, measuring 0.3 cm.
SPLEEN: Normal echogenicity, measuring 9.6 cm. A 0.8 cm round hypoechoic
lesion just inferior to the spleen most likely correspond to the splenule that
was previously seen on MR study.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal limits
IMPRESSION:
1. Limited pancreas view. Within limitations, no pancreatic pseudocyst or
pancreatic ductal dilatation.
2. Echogenic liver consistent with steatosis. Other forms of liver disease and
more advanced liver disease cannot be excluded on this study.
|
10150465-RR-52
| 10,150,465 | 25,699,609 |
RR
| 52 |
2152-08-12 18:10:00
|
2152-08-12 18:42:00
|
INDICATION: ___ with fatigue, sob s/p admission for pancreatitis // eval
for pneumonia
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is normal. No acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10150465-RR-53
| 10,150,465 | 25,699,609 |
RR
| 53 |
2152-08-13 21:15:00
|
2152-08-14 16:19:00
|
EXAMINATION: MRCP
INDICATION: ___ year old woman with weight loss / malnutrition, recent
hospitalization for pancreatitis, report of pancreatic mass on OSH MRI
presenting with leukocytosis and reports of fevers. // ? pancreatic
malignancy
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: Prohance 11 cc.
COMPARISON: CT abdomen pelvis dating ___. Outside MRI dating ___. Abdominal ultrasound dating ___.
FINDINGS:
Liver: The liver is normal in size and contour without morphologic features of
significant fibrosis or cirrhosis. There is diffuse hepatic steatosis with fat
fraction percentage calculated up to 28%. No focal hepatic lesion is
appreciated.
Biliary: Intra and extrahepatic bile ducts are normal in caliber and contour.
There is no cholelithiasis or choledocholithiasis. Cystic change at the
gallbladder fundus is consistent with focal adenomyomatosis.
Pancreas: The pancreatic parenchyma is mildly atrophied but maintains
relatively normal parenchymal signal and enhancement. No peripancreatic
inflammatory change is present. The main pancreatic duct is notable for
divisum configuration. It is mildly prominent throughout, measuring up to 3 mm
within the head. A normal smooth contour is, however, maintained.
Within the pancreatic head just below the ampulla is 1.5 cm structure which is
partially filled with fluid, but also contains oral contrast, confirming that
this is a duodenum diverticulum rather than a cystic lesion within the
pancreas. No additional focal abnormality within the pancreas is identified.
Spleen: Normal.
Adrenal Glands: Normal
Kidneys: There are innumerable tiny subcentimeter renal cysts seen
bilaterally, with random distribution throughout the renal parenchyma. In the
right clinical setting, this appearance is compatible with lithium
nephropathy.
Gastrointestinal Tract: Aside from the juxta papillary duodenum diverticulum
no bowel abnormality is identified.
Lymph Nodes: None pathologically enlarged.
Vasculature: Arterial vascular anatomy is conventional. Venous structures are
widely patent.
Other: There is no ascites or pleural effusion. Mild degenerative changes
noted at the lower lumbar spine.
IMPRESSION:
1. Moderate hepatic steatosis.
2. No pancreatic mass. There is pancreas divisum and a juxta papillary
duodenum diverticulum.
3. Innumerable randomly distributed renal microcysts. This appearance is
typically seen in the setting of lithium nephropathy.
|
10150465-RR-79
| 10,150,465 | 27,771,661 |
RR
| 79 |
2155-07-30 18:10:00
|
2155-07-30 18:45:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with increasing shortness of breath// Pneumonia,
edema?
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___
FINDINGS:
Right-sided Port-A-Cath tip terminates at the SVC/right atrial junction.
Heart size is normal. Mediastinal and hilar contours are unchanged.
Pulmonary vasculature is not engorged. Previously demonstrated patchy
ill-defined opacities throughout the lungs on prior CT are not as evident on
the current chest radiograph suggesting improving pneumonia. No new focal
consolidation, pleural effusion, or pneumothorax is seen. No acute osseous
abnormalities present.
IMPRESSION:
Previously noted patchy ill-defined opacities within the lungs seen on prior
chest CT are not clearly visualized on the current radiograph suggesting
interval improvement in pneumonia. No new focal consolidation identified. No
pulmonary edema.
|
10150465-RR-81
| 10,150,465 | 27,771,661 |
RR
| 81 |
2155-07-31 07:55:00
|
2155-07-31 11:45:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with breast cacner admitted with dyspnea and
tachycardia. CKD precludes contrast injection, evaluate for DVT given concern
for PE.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10150465-RR-83
| 10,150,465 | 27,771,661 |
RR
| 83 |
2155-07-31 09:34:00
|
2155-07-31 11:45:00
|
EXAMINATION: BILAT UP EXT VEINS US
INDICATION: ___ year old woman with breast cancer and ESRD, dyspnea, evaluate
for DVT.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the bilateral
upper extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The bilateral internal jugular and axillary veins are patent, show normal
color flow and compressibility.
The bilateral brachial and basilic veins are patent, compressible and show
normal color flow and augmentation.
The midportion of the right cephalic vein is noncompressible with echogenic
intraluminal material and no demonstrable color flow consistent superficial
thrombophlebitis. The left cephalic vein is not identified, although
thrombosed vessel is seen.
IMPRESSION:
1. No evidence of deep vein thrombosis in the bilateral upper extremity veins.
2. Right cephalic superficial thrombophlebitis.
3. Nonvisualization of the left cephalic vein.
NOTIFICATION: The findings were discussed with ___,
M.D. by ___, M.D. on the telephone on ___ at 11:12 am, 40
minutes after discovery of the findings.
|
10150465-RR-84
| 10,150,465 | 27,771,661 |
RR
| 84 |
2155-08-01 11:30:00
|
2155-08-01 14:31:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with CKD V, COPD and recent PNA presenting with
worsening DOE, no clear explanation// Evaluate for interval change in
opacities, evaluate for signs of taxol pneumonitis.
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
no administration of intravenous contrast material, multiplanar
reconstructions.
DOSE: DLP: 199 mGy-cm
COMPARISON: ___.
FINDINGS:
Minimal left thyroid calcification (3, 4). Right pectoral Port-A-Cath. No
supraclavicular, infraclavicular or axillary lymphadenopathy. No enlarged
lymph nodes in the hilar or mediastinal compartments. The visible mediastinal
lymph nodes are all normal to borderline in size and unchanged since the
previous examination (___, ___). Mild to moderate aortic wall calcifications.
Moderate coronary calcifications. No pericardial effusion. Stable appearance
of the posterior mediastinum and of the upper abdomen. Moderate degenerative
vertebral disease. No vertebral compression fractures. No osteolytic lesions
at the level of the ribs, the sternum, or the vertebral bodies. There is
stable moderate pulmonary emphysema the. The pre-existing and previously
relatively widespread parenchymal opacities have almost completely resolved.
Only minimal peribronchial ground-glass opacities remain visualized. The
consolidation in the left lower lobe (5, 144) is also smaller than on the
previous examination. Stable evidence of moderate chronic airways disease,
with multisegmental subtle mucous retention. No pleural thickening or pleural
effusions. The 6 mm subpleural pulmonary nodule in the left lower lobe (5,
174) is completely unchanged as compared to the previous examination, the
morphology of the nodules suggests an intrapulmonary lymph node.
IMPRESSION:
Near complete resolution of the pre-existing ground-glass opacities. Only
minimal remnant ground-glass opacities as well as a decreasing consolidation
in the left lower lobe persist. Signs of mild to moderate pulmonary emphysema
and moderate chronic airways disease. Stable left lower lobe pulmonary
nodule, likely reflecting an intrapulmonary lymph node.
|
10150503-RR-20
| 10,150,503 | 29,926,898 |
RR
| 20 |
2117-04-01 10:33:00
|
2117-04-01 11:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with bradycardia s/p pacemaker// lead position,
ptx
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
A left-sided pacemaker has been placed with leads projecting to the right
atrium and right ventricle. Lungs are low volume. Heart size is normal.
There is no pleural effusion. No pneumothorax is seen
|
10150503-RR-21
| 10,150,503 | 29,926,898 |
RR
| 21 |
2117-04-01 10:33:00
|
2117-04-01 11:25:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ year old woman with bradycardia episode now s/p PPM placement.
Ankle pain this AM. No trauma that we know of.// Ankle fracture?
IMPRESSION:
No previous images. The bony structures and joint spaces are essentially
within normal limits and the ankle mortise is intact. No evidence of
calcaneal spurring.
Substantial vascular calcification is seen about the ankle.
|
10150563-RR-33
| 10,150,563 | 24,925,572 |
RR
| 33 |
2204-03-26 19:30:00
|
2204-03-26 20:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with previous independent living, rapid mental
status change 5 days ago
TECHNIQUE: Contiguous axial images were obtained through the head without the
administration of intravenous contrast. Coronal and sagittal reformatted
images as well as thin section images in a bone window algorithm were
generated and reviewed.
DOSE: DLP: 891.93 mGy-cm; CTDI: 54.09 mGy
COMPARISON: NECT the head, ___.
FINDINGS:
There is no acute intracranial hemorrhage, edema, mass effect or shift of
normally midline structures. The ventricles and sulci are prominent,
consistent with global atrophy. The basal cisterns appear patent and
gray-white matter differentiation is preserved. Subcortical and
periventricular white matter hypodensities are in keeping with chronic small
vessel ischemic disease. The orbits and globes are unremarkable. The imaged
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
calvaria appear intact.
IMPRESSION:
No acute intracranial abnormality. Atrophy and chronic small vessel ischemic
disease.
|
10150563-RR-34
| 10,150,563 | 24,925,572 |
RR
| 34 |
2204-03-26 19:46:00
|
2204-03-26 20:00:00
|
EXAMINATION: CHEST (AP AND LATERAL)
INDICATION: History: ___ with previous independent living, rapid mental
status change 5 days ago
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: ___
FINDINGS:
Heart size is normal. There is likely a small hiatal hernia accounting for
prominence of the right lower mediastinal contour. Mediastinal and hilar
contours are otherwise unremarkable. Scarring within the apices is re-
demonstrated. Lungs are clear. No pleural effusion or pneumothorax is seen.
Osseous structures are diffusely demineralized without an acute abnormality.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10150567-RR-53
| 10,150,567 | 24,904,661 |
RR
| 53 |
2156-04-09 08:17:00
|
2156-04-09 13:20:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with severe MR and chronic consitpation with
distended ABD and concern for obstruction // obstruction r/o
TECHNIQUE: Supine, upright, and left lateral decubitus radiographs of the
abdomen.
COMPARISON: Abdominal radiographs dated ___, and CT
of the abdomen and pelvis dated ___.
FINDINGS:
There is a nonspecific bowel gas pattern, with air seen in multiple loops of
large and small bowel. Again noted is moderately distended colon at the
hepatic flexure. Multiple air-fluid levels are present in loops of large
bowel, with few additional air-fluid levels within the small bowel, consistent
with chronic colonic dilation possibly contributed to by history of recent
administration of laxative medications. No pneumatosis or evidence of free
air. There is mild S-shaped thoracolumbar scoliosis, with degenerative changes
noted in the lower lumbar spine.
IMPRESSION:
Nonspecific bowel gas pattern, with air seen in multiple loops of large and
small bowel, and both colonic and small-bowel air-fluid levels, consistent
with chronic colonic dilation related to chronic constipation and possibly
contributed to by recent administration of laxative medications.
|
10150767-RR-154
| 10,150,767 | 24,421,797 |
RR
| 154 |
2135-01-29 17:27:00
|
2135-01-29 18:26:00
|
HISTORY: Chest pain and syncope.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest radiograph ___. CTA chest ___.
FINDINGS:
The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity
is normal. Lungs are clear. No pleural effusion or pneumothorax is
identified. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10150842-RR-18
| 10,150,842 | 25,200,625 |
RR
| 18 |
2126-12-05 00:04:00
|
2126-12-05 09:12:00
|
EXAM: MRI cervical spine.
CLINICAL INFORMATION: Patient with C6 fracture, for further evaluation.
TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 and gradient echo
axial images of cervical spine acquired. Correlation was made with the
cervical spine CT from ___.
FINDINGS: At the site of bony ossicle seen on the CT, subtle increased signal
identified which is too small to characterize. No evidence of ligamentous
disruption of the anterior longitudinal ligament seen or evidence of
prevertebral hematoma identified. There is no intraspinal hematoma seen. No
facet joint malalignment seen or evidence of abnormal signal within the
vertebral bodies.
At the craniocervical junction and C2-3, no abnormalities are seen. At C3-4,
C4-5 and C5-6, mild disc bulging and degenerative change seen. At C6-7, mild
bulging identified.
At C7-T1 to T3-4, mild degenerative change seen.
The spinal cord shows normal intrinsic signal. There is subtle increased
signal in the posterior soft tissues of the neck which could be related to
trauma. No abnormal signal seen within the spinal cord.
IMPRESSION:
1. Although there is subtle signal seen at the anterior margin of C6 at the
site of ossicle seen on CT, it is too small to characterize. No definite
ligamentous disruption identified or facet joint malalignment seen. No
prevertebral hematoma seen.
2. Mild degenerative changes in the cervical region.
|
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