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10150882-RR-11
| 10,150,882 | 29,448,542 |
RR
| 11 |
2127-12-04 07:09:00
|
2127-12-04 07:31:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with right sided weakness. Evaluate for ischemia or
hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 780 mGy-cm
CTDI: 62 mGy
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is mild
ex vacuo dilatation of the frontal horn of the right lateral ventricle, with
adjacent hypodensity in keeping with a prior infarct. Other less severe
periventricular hypodensities are likely sequela of chronic small vessel
ischemia.
No osseous abnormalities seen. There is a mucous retention cysts in the right
frontal ethmoidal recess and mild scattered mucosal thickening of the anterior
ethmoid air cells. Mastoid air cells and middle ear cavities are clear. There
is a small midline scalp lipoma overlying the forehead
IMPRESSION:
Sequela of chronic small vessel ischemic disease and prior infarction in the
right frontal periventricular white matter, however no evidence of acute
infarction or hemorrhage.
|
10150882-RR-12
| 10,150,882 | 29,448,542 |
RR
| 12 |
2127-12-04 08:44:00
|
2127-12-04 09:50:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: History: ___ man with left-sided MCA infarct.
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
brain during infusion of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated. This report is based on interpretation of all
of these images.
DOSE: DLP: 1427.25 mGy-cm; CTDI: 79.02 mGy
COMPARISON: CT head of ___.
FINDINGS:
Head CTA: There are no intracranial vascular abnormalities. There is no
evidence of aneurysm, stenosis or vascular occlusion.
Neck CTA: There is a 2 vessel arch, a very common anatomic variant. Trace
atherosclerotic calcification of the right carotid bifurcation is noted. The
left vertebral artery is dominant. The carotid and vertebral arteries and
their major branches are patent with no evidence of stenoses. There is no
evidence of internal carotid stenosis by NASCET criteria.
Other: Sequela of chronic small vessel disease and prior infarction in the
right frontal periventricular white matter are better depicted in the prior
noncontrast head CT. In the maxilla there are dental caries and periapical
lucencies. A mucous retention cyst in the right frontal ethmoidal recess is
noted. The remainder the paranasal sinuses are clear. The patient is status
post bilateral lens replacements otherwise orbits are unremarkable. The
mastoid air cells and middle ear cavities are well pneumatized and clear. The
mastoid air cells are clear. There are biapical paraseptal emphysematous
changes. Otherwise, allowing for mild pleural-parenchymal scarring, the lung
apices are clear. The thyroid gland is unremarkable. There is no cervical
lymphadenopathy by CT size criteria. The visualized aerodigestive tract is
unremarkable. There is cervical spondylosis without suspicious blastic or
lytic osseous lesions.
IMPRESSION:
Allowing for anatomic variation, unremarkable CTA of the head and neck without
evidence of occlusion, dissection or aneurysm. Sequela of chronic small
vessel disease and prior infarction in the right frontal periventricular white
matter are better depicted in the prior noncontrast head CT.
|
10150882-RR-13
| 10,150,882 | 29,448,542 |
RR
| 13 |
2127-12-04 22:01:00
|
2127-12-05 10:04:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old man with L MCA syndrome // eval for stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique.
COMPARISON: CTA head of ___ and CTA head and neck of ___.
FINDINGS:
Left lateral lenticulostriate distribution slow diffusion of the left
posterior putamen extending along the coronal radiata with associated FLAIR
hyperintense signal is noted compatible with late acute to subacute infarct.
There are superimposed periventricular, subcortical and pontine T2/FLAIR white
matter hyperintensities, which are nonspecific, but commonly seen in setting
of chronic microangiopathy. Right encephalomalacia in the lateral
lenticulostriate distribution corresponds to hypodensity seen on prior CT
examination. There is no intracranial hemorrhage or intra-axial mass effect.
Mild ex vacuo dilatation of the anterior body of the right lateral ventricle.
Otherwise, sulci, ventricles and cisterns are within expected limits for the
patient's age. The major intracranial flow voids are preserved. The paranasal
sinuses are clear. The orbits are unremarkable. The mastoid air cells are
clear.
IMPRESSION:
1. Late acute to subacute infarct of the left posterior putamen extending
along the coronal radiata.
2. Periventricular, subcortical and pontine T2/FLAIR white matter
hyperintensities, which are nonspecific, but commonly seen in setting of
chronic microangiopathy.
3. Right frontal encephalomalacia unchanged from prior CT examination.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 9:57 AM, at the time of
discovery of the findings.
|
10150882-RR-14
| 10,150,882 | 29,448,542 |
RR
| 14 |
2127-12-04 12:23:00
|
2127-12-04 13:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L MCA stroke // eval for infiltrate
IMPRESSION:
The lung volumes are low. Borderline size of the cardiac silhouette with mild
fluid overload but no overt pulmonary edema. Moderate tortuosity of the
descending aorta. No pleural effusions. No pneumonia.
|
10150980-RR-23
| 10,150,980 | 26,326,661 |
RR
| 23 |
2140-09-30 17:24:00
|
2140-09-30 17:40:00
|
HISTORY: Fever, cough, likely aspiration.
TECHNIQUE: Upright AP view of the chest.
COMPARISON: ___.
FINDINGS:
Heart size is top normal and unchanged. Mediastinal contours are relatively
stable. Pulmonary vascularity is normal, and the hilar contours are
unremarkable. Low lung volumes are present. Minimal streaky bibasilar
airspace opacities likely reflect mild atelectasis. Prominent left epicardial
fat pad is noted. No pleural effusion or pneumothorax is identified. No
acute osseous abnormalities are seen.
IMPRESSION:
Minimal patchy bibasilar airspace opacities likely reflect atelectasis. No
focal consolidation noted.
|
10150980-RR-24
| 10,150,980 | 26,326,661 |
RR
| 24 |
2140-10-01 13:22:00
|
2140-10-01 16:51:00
|
Indication: concern for aspiration
Swallowing video fluoroscopy: Oropharyngeal swallowing video fluoroscopy was
performed in conjunction with the speech and swallow division. Multiple
consistencies of barium were administered. Barium passed freely through the
oropharynx without evidence of obstruction. Deep penetration was seen with
nectar thick liquids, and aspiration was seen with thin liquids.
Impression: Penetration with nectar thick liquids and aspiration with thin
liquids. For details, please refer to speech and swallow note in OMR.
|
10150980-RR-33
| 10,150,980 | 24,160,142 |
RR
| 33 |
2141-05-08 17:54:00
|
2141-05-08 18:00:00
|
HISTORY: Altered mental status, agitation.
TECHNIQUE: Portable AP view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is
normal. Minimal linear opacities are demonstrated within the lung bases
compatible with atelectasis. No focal consolidation, pleural effusion or
pneumothorax is seen. There are multilevel mild degenerative changes within
the thoracic spine.
IMPRESSION:
Bibasilar atelectasis.
|
10150980-RR-34
| 10,150,980 | 24,160,142 |
RR
| 34 |
2141-05-08 18:43:00
|
2141-05-08 19:44:00
|
HISTORY: Increasing confusion
COMPARISON: CT head from ___
TECHNIQUE: Axial contiguous MDCT images were obtained through the head
without administration of IV contrast. Coronal, sagittal, and thin slice bone
reformations were generated.
DLP: 1681.72 mGy-cm
FINDINGS:
Assessment is limited due to motion artifact. Allowing for this limitation,
there is no intracranial hemorrhage, edema, mass, mass effect, large
territorial infarction. The sulci and ventricles are prominent suggesting age
related atrophy. Periventricular white matter changes are consistent with
chronic small vessel ischemic disease. There is preservation of gray-white
matter differentiation and the basal cisterns appear patent.
There is no fracture. The right globe is deformed and contains dense material
likely from prior ophtalmologic procedure. The paranasal sinuses, mastoid air
cells and middle ear cavities are clear. Atherosclerotic calcification of the
carotid siphons is present.
IMPRESSION:
Limited exam due to motion artifact. No evidence of acute intracranial
process. Chronic changes as described above.
|
10151282-RR-5
| 10,151,282 | 22,754,987 |
RR
| 5 |
2168-03-27 14:40:00
|
2168-03-27 15:11:00
|
INDICATION: ___ with right leg pain for acute injury
TECHNIQUE: Frontal and lateral
COMPARISON: None.
FINDINGS:
Patient status post cemented total right knee arthroplasty with evidence of
remote prior periprosthetic diaphyseal fracture and subsequent lateral
stabilizing plate and screw fixation. There has been fracture of the superior
most 3 screws approximately 2.2 cm of lateral displacement of the proximal end
of the stabilizing plate. The second most superior screw is noted to be
dislocated from the whole of the lateral plate. The mid and distal screws
appear intact and well seated. There is minimal irregularity along the tibial
aspect of the knee arthroplasty hardware of uncertain etiology. Multiple
linear lucencies through the mid femoral diaphysis may represent acute or
subacute fracture lines. Heterotopic ossification is noted, presumed chronic.
There is otherwise diffuse demineralization. Vascular calcifications are
noted. There is no suspicious lytic or sclerotic lesion. Limited evaluation
of the left hip is unremarkable.
IMPRESSION:
1. Patient is status post cemented total knee arthroplasty and lateral plate
and screw fixation with subsequent hardware fracture of the top 3 stabilizing
plate screws and multiple mid femoral lucencies, which may represent acute
fractures of sequelae of prior fracture.
2. Irregularity along the lateral proximal tibia may be postsurgical in
etiology or a new fracture near the tibial arthroplasty stem.
3. Comparison with prior studies, if they can be obtained, would be useful to
evaluate for chronicity of these findings.
RECOMMENDATION(S): Comparison with prior studies, if they can be obtained,
would be useful to evaluate for chronicity of these findings.
|
10151282-RR-7
| 10,151,282 | 22,754,987 |
RR
| 7 |
2168-03-30 22:28:00
|
2168-03-31 12:08:00
|
INDICATION: ___ year old woman s/p right distal femoral replacement.
AP/Lateral of femur and knee in PACU please.// prosthesis placement
COMPARISON: Radiographs from ___
IMPRESSION:
There has been revision of the hardware within the right femur. There has
been resection of the distal femoral shaft and placement of a modular long
stem femoral component. There is a constrained total knee arthroplasty.
There has been removal of the fracture plate within the femur as well as the
broken screws in the femoral shaft.Cerclage wire seen at the midportion of the
femur. There is soft tissue swelling and drains consistent with the recent
surgery.
|
10151282-RR-8
| 10,151,282 | 22,754,987 |
RR
| 8 |
2168-03-31 14:46:00
|
2168-03-31 16:25:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with hx bilateral DVTs now POD ___ s/p R knee
revision, distal femoral replacement with R calf pain and decreased LLE
sensation// r/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None
FINDINGS:
RIGHT: There is normal compressibility, flow, and augmentation of the right
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the right posterior tibial and peroneal veins.
LEFT: The left mid and distal femoral vein and popliteal vein are only
partially compressible, but demonstrate wall-to-wall color flow. There is no
intraluminal echogenic thrombus on grayscale images to suggest acute DVT.
There is normal augmentation response. There is normal compressibility, flow,
and augmentation of the left common femoral and proximal femoral veins. Normal
color flow is demonstrated in the left posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
1. Partial compressibility of the left mid and distal femoral vein and
popliteal vein, suggesting partial chronic DVT. No evidence of acute DVT.
2. No evidence of deep venous thrombosis in the right lower extremity veins.
|
10151713-RR-250
| 10,151,713 | 29,275,958 |
RR
| 250 |
2163-07-18 14:46:00
|
2163-07-18 16:19:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: ___ woman with left lower extremity pain. Evaluate for
fracture.
TECHNIQUE: Frontal and lateral view radiographs of the left tibia and fibula.
COMPARISON: Bilateral knee radiographs of ___ and bilateral foot
radiographs of ___.
FINDINGS:
There is a horizontally oriented sclerotic band with central lucency
suggestive of fracture at the medial proximal tibial metaphysis. This may be
due to a stress fracture. There is no intra-articular extension. Mild
degenerative changes in the left knee, denoted by joint space narrowing in the
medial compartment. There is also likely a small left knee joint effusion.
There is re-demonstration of the known chronic collapse and severe subluxation
of the talonavicular joint, similar in appearance since ___. The
bones are diffusely demineralized. Calcaneocuboid degenerative changes have
progressed. Mild joint space narrowing noted at the imaged TMT joint, with
associated marginal osteophytes.
IMPRESSION:
1. Nondisplaced fracture of the medial proximal left tibia, without
intra-articular extension. The appearance is suggestive of an insufficiency
fracture.
2. Re-demonstration of known chronic collapse and severe subluxation of the
left talonavicular joint, similar in appearance since ___.
|
10151713-RR-251
| 10,151,713 | 29,275,958 |
RR
| 251 |
2163-07-18 17:42:00
|
2163-07-18 18:06:00
|
EXAMINATION: Noncontrast CT of the left knee
INDICATION: ___ year old woman with left tibia fracture// eval fracture
TECHNIQUE: Noncontrast CT of the left knee. Multiplanar reformations were
carried out.
DOSE: Acquisition sequence:
1) Spiral Acquisition 13.5 s, 28.6 cm; CTDIvol = 20.3 mGy (Body) DLP =
582.2 mGy-cm.
Total DLP (Body) = 582 mGy-cm.
COMPARISON: ___ radiographs
FINDINGS:
Patella: Intact.
Distal femur: Appears demineralized, limiting assessment for nondisplaced
fractures. Minimal heterogeneous sclerosis along the distal medial femoral
metaphysis could reflect sequela of insufficiency injury of indeterminate age.
No associated discrete fracture line is identified (series 304, image 61).
Proximal tibia: There is a transversely orientated fracture of the proximal
medial tibial metaphysis with minimal impaction. There is some associated gas
locules within the fracture line most likely reflecting vacuum phenomenon.
There is no gross extension to the articular surface.
Cruciate ligaments appear grossly intact. Collateral ligaments appear grossly
intact. No joint effusion is identified.
IMPRESSION:
Mildly impacted transverse likely insufficiency fracture of the proximal
medial tibial metaphysis. Some gas along the fracture line may reflect vacuum
phenomenon.
There is subtle curvilinear sclerosis along the distal medial femoral
metaphysis which may also represent an insufficiency injury of indeterminate
age however no discrete fracture line is associated with the femoral finding.
|
10151713-RR-252
| 10,151,713 | 29,275,958 |
RR
| 252 |
2163-07-18 23:37:00
|
2163-07-19 00:01:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with cognitive difficulty.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: ___ and ___ noncontrast head CTs
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Subcortical
white matter hypodensities are nonspecific but likely sequelae of chronic
small vessel ischemic disease. A right parafalcine dense calcification is
unchanged since at least ___, either a benign calcification or densely
calcified meningioma. The ventricles and sulci are normal in size and
configuration.
There is no evidence of fracture. There is leftward nasal septum deviation
and a large leftward pointing bony nasal spur. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable. Incidental congenital
nonunion of the C1 posterior arch.
IMPRESSION:
No evidence of an acute intracranial abnormality.
|
10151713-RR-253
| 10,151,713 | 29,275,958 |
RR
| 253 |
2163-07-23 12:03:00
|
2163-07-23 12:21:00
|
INDICATION: ___ year old woman with bruising and pain in R foot in setting of
recent falls at home// ? fracture
TECHNIQUE: AP, lateral, and oblique views of the right foot.
COMPARISON: Right foot radiographs from ___. right foot films from ___.
FINDINGS:
There are chronic changes identified at the proximal first through fifth
metatarsals. Chronic healed fracture deformities involving at least the
proximal third, fourth and fifth metatarsals is noted. Hypertrophic changes
centered at the first and second metatarsophalangeal joints have progressed
over the past few years.. There is no acute fracture. No focal erosion.
IMPRESSION:
Chronic posttraumatic and degenerative changes centered at the first and
second tarsal metatarsal joints and proximal third through fifth metatarsals.
Though changes have progressed over time since ___. No superimposed acute
fracture.
|
10152017-RR-34
| 10,152,017 | 21,303,195 |
RR
| 34 |
2140-05-29 04:32:00
|
2140-05-29 07:06:00
|
HISTORY: ___ male with chest pain
COMPARISON: Chest radiograph from ___
FRONTAL AND LATERAL CHEST RADIOGRAPHS: Increased AP diameter of the chest
with flattened hemidiaphragms suggest COPD, unchanged from prior.
Bronchiectasis and peribronchial opacities have progressed in the left lower
lobe and may reflect aspiration or inflammation. No confluent consolidation
is identified. There is no pulmonary edema or pleural effusion.
Cardiomediastinal and hilar contours are within normal limits.
IMPRESSION: Hyperexpanded lungs with increased left lower lobe peribronchial
opacities, possible interval aspiration.
|
10152086-RR-10
| 10,152,086 | 24,825,843 |
RR
| 10 |
2159-06-12 16:27:00
|
2159-06-12 17:18:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with history of subarachnoid hemorrhage status post
ventriculostomy catheter placement. Evaluate for ventriculostomy catheter
position.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 1114.91 mGy-cm CTDI: 53.02 mGy
COMPARISON: CTA head with and without contrast of ___.
FINDINGS:
Stable subarachnoid and intraventricular hemorrhages. There has been interval
placement of a right frontal approach ventriculostomy catheter, with its tip
terminating at the superior aspect of the anterior body of the right lateral
ventricle. The ventricles are stable in size and configuration. There is no
evidence of uncal herniation.
There is mild mucosal thickening of the maxillary, frontal and sphenoid
sinuses are noted. Partial opacification of the anterior ethmoid air cells are
noted. The orbits are unremarkable. The mastoid air cells and rare cavities
are well pneumatized and clear.
IMPRESSION:
1. Interval placement of a ventriculostomy catheter via a right frontal burr
hole. The catheter terminates at the superior aspect of the anterior body of
the right lateral ventricle.
2. Unchanged appearance in distribution of extensive subarachnoid and
intraventricular hemorrhages
3. The ventricles are unchanged in configuration from prior examination.
4. No acute infarct.
|
10152086-RR-11
| 10,152,086 | 24,825,843 |
RR
| 11 |
2159-06-12 16:42:00
|
2159-06-13 00:54:00
|
CLINICAL HISTORY: Patient is a ___ gentleman who presented with
sudden onset of headaches and CT scan showed diffuse subarachnoid hemorrhage.
His CT angiography was unsuccessful to delineate an aneurysm. He is here for
his first diagnostic cerebral angiography.
ATTENDING PHYSICIAN: Dr. ___.
ASSISTANT: Dr. ___.
PROCEDURE PERFORMED: Diagnostic cerebral angiography by catheterization and
injection into the right internal carotid artery, right common carotid artery,
right ICA spin angiography and post-processing of the data in a separate
workstation under concurrent physician supervision and utilizing data for
further interpretation and treatment purposes, left common carotid artery
angiography, left ICA angiography, left ICA spin angiography and
post-processing of data in a separate workstation under concurrent physician
supervision and utilizing data for further interpretation and treatment
purposes, left vertebral angiography, right common femoral artery roadmap
angiography and closure of the vascular puncture site using a 6 ___
Angio-Seal vascular closure device.
ANESTHESIA: General anesthesia.
DESCRIPTION OF PROCEDURE: After describing the procedure, rationale, risks,
and benefits, the patient happily signed a consent form.
Subsequently, the patient was sedated and intubated and EVD was left in place
and subsequently was transferred to the radiology unit and angiography table.
Under general anesthesia in supine position, after prepping and draping
bilateral groin, access to the right common femoral artery was obtained using
a modified Seldinger technique and a micropuncture set. A long 6 ___
sheath was inserted to the right common femoral artery and was connected to a
continuous heparinized saline. Using a 4 ___ Berenstein catheter over a
0.038-inch Terumo wire, access to the right common carotid artery and
subsequently right internal carotid artery was performed and Diagnostic
cerebral angiography in AP, lateral and oblique projections were performed
separately. While In right ICA, a spin angiography was also performed and the
data was post-processed in a separate workstation under concurrent physician
supervision and the 3D reconstruction data was utilized for further
interpretation. After obtaining adequate images in the right side, we
catheterized the left internal carotid artery, an AP, lateral and oblique
projections were performed. Then, a spin angiography was performed and the
data was post-processed in a separate workstation under supervision of
concurrent physician and utilized for further interpretation, then a left
common carotid artery angiography was performed in AP and lateral projections.
After obtaining adequate images in the left common carotid artery, we
catheterized the left vertebral artery, which comes off directly from the
aortic arch. AP, lateral and oblique projections from the vertebrobasilar
system was performed and finally, after obtaining adequate images, we removed
the catheter and after obtaining a right common femoral artery roadmap
angiography, hemostasis of the groin was achieved using a 6 ___ Angio-Seal
vascular closure device.
FINDINGS:
Right common carotid artery roadmap angiography showed carotid bifurcation
unremarkable. The selective right ICA angiography shows very well
opacification of its upper cervical, petrous, cavernous and supraclinoid
segments along with a fetal-type PCA and finally a dominant ACA, which filling
bilateral ACAs through the patent anterior communicating artery. The M1
segment is well sized; however, both superior and inferior M2s have
mild-to-moderate vasospasm. Regardless, there is unusual hypervascularity in
the MCA territory. Looking at AP, lateral and oblique projections and also 3D
spin angiography and reconstructions, we were not able to find any aneurysm,
AVM or other vascular abnormality compatible with vasculitis/vasculopathy.
The right common carotid artery angiography also confirmed that the external
carotid artery branches are all patent with no contribution into any dural AV
fistula or other vascular abnormalities.
Left common carotid artery roadmap angiography showed carotid bifurcation
unremarkable. There is a very good antegrade flow, filling of the cervical
branches of both left ICA and ECA branches. Selective left ICA angiography
shows very well opacification of its upper cervical, petrous, cavernous and
supraclinoid ICA along with a sizeable middle cerebral artery on the left
side. The left A1 is nondominant and hardly filling into the lateral ACA,
which is fed mainly filling from the right ACA. There is a sizeable posterior
communicating artery. The ophthalmic and anterior choroidal arteries are also
filling. Looking at AP, lateral and oblique projections and also 3D
reconstruction data images, we were not able to find any aneurysm, AVM or
other vascular abnormalities compatible with dural AV fistula or other
vascular abnormalities. There is only very mild vasospasm in the M2 segment
on the right side.
Selective left vertebral artery angiography, which originates directly from
the arch, not from the left subclavian artery, shows very well opacification
of its V1-V4 segments along with both ipsilateral and contralateral ___,
AICA, superior cerebellar arteries and small PCAs. The PCAs are mostly PCom
predominant in the left side and fetal-type in the right side. Looking at the
AP, lateral and oblique projections, we did not see any aneurysm, AVM or other
vascular abnormalities. The only abnormal feature in this territory was
sudden narrowing of the right vertebral artery at about 1-2 cm before joining
to the other vertebral artery and forming the basilar artery. There is about
50% narrowing at this region, however, it is not flow-limiting and there is
very good antegrade flow and filling of the basilar system. The left
vertebral artery is completely dominant and the right vertebral artery is very
small. However, by injection into the left vertebral artery, we see
retrograde filling of the distal right vertebral artery, including its ___
branch. Again, there is no aneurysm, AVM or other vascular abnormalities in
this territory.
Overall, there is no thromboembolic complication in the cerebral angiography.
Finally, right common femoral artery roadmap angiography shows sizeable common
femoral artery without any evidence of dissection, vascular injury or other
vascular abnormalities. The puncture site is before the bifurcation and
opposite to the head of the femur.
CONCLUSION: This diagnostic cerebral angiography did not show any evidence of
aneurysm, AVM, dural AV fistula or any other vascular abnormalities compatible
with vasculitis/vasculopathy. The left vertebral artery originates directly
from the aortic arch. There is vasospasm at the left vertebral artery
termination before joining to the basilar artery. This is not flow-limiting
and there is very good antegrade filling of the basilar system. There is no
aneurysm in both anterior and posterior circulation. The M2 segment of the
right MCA has mild-to-moderate vasospasm and M2 of the left MCA has mild
vasospasm. The right ACA is dominant. This M2 vasospasm is not flow-limiting
and actually there is a very high hypervascularity in the MCA territory.
Considering this unusual hypervascularity in the distal MCA territory and
those narrowing of the M2, this may indicate a chronic obstructive process
like moyamoya disease as an underlying problem in this patient presented with
hemorrhagic stroke.
No procedure-related thromboembolic complication was noted and the patient
remained neurologically intact afterward.
___, M.D.
Clinical Fellow for Dr. ___.
I, ___, personally attended and performed this procedure with my
fellow, ___, during the entire stages of this procedure.
I also read and reviewed all images in this exam and confirmed all key
elements of this dictation and corrected all errors.
|
10152086-RR-12
| 10,152,086 | 24,825,843 |
RR
| 12 |
2159-06-13 00:12:00
|
2159-06-13 08:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sah // gastric tube placement, ett
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the course of the nasogastric tube is
unchanged. The device, however, must have been advanced in the interval,
given that the tip is no longer included on the image.
Simultaneously, however, the endotracheal tube was also advanced. The tip of
the tube is now within 1 cm of the orifice of the right main bronchus and the
device should be pulled back by approximately 1-2 cm, to avoid accidental
right bronchial intubation.
Unchanged bilateral areas of basilar atelectasis. Low lung volumes. Moderate
cardiomegaly. No larger pleural effusions.
|
10152086-RR-13
| 10,152,086 | 24,825,843 |
RR
| 13 |
2159-06-13 07:09:00
|
2159-06-13 11:51:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: ___ year old man with non-aneurysmal SAH. Assessment for interval
change.
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast.
CTDIvol: 71 mGy
DLP: 1061 mGy-cm
COMPARISON: Head CT from ___
FINDINGS:
Stable subarachnoid and intraventricular hemorrhages. A right frontal approach
ventriculostomy catheter is stable in position, with its tip terminating at
the superior aspect of the anterior body of the right lateral ventricle.
Compared with the previous exam there has been decrease in caliber of the
lateral ventricles. There is no effacement of the basal cisterns. The foramen
magnum cannot be assessed as it was not included in the imaging frame.
Mild mucosal thickening of the maxillary, frontal and sphenoid sinuses is
unchanged. Partial opacification of the anterior ethmoid air cells are noted.
The orbits are unremarkable. The mastoid air cells and rare cavities are well
pneumatized and clear.
IMPRESSION:
1. Stable subarachnoid and intraventricular hemorrhage. No new hemorrhage.
2. Interval decrease in caliber of the lateral ventricles.
3. Unchanged position of right frontal approach ventriculostomy catheter
terminating at the superior aspect of the anterior body of the right lateral
ventricle.
|
10152086-RR-14
| 10,152,086 | 24,825,843 |
RR
| 14 |
2159-06-13 20:28:00
|
2159-06-13 22:55:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old male with history significant ___ ___ disease and
recent non aneurysmal subarachnoid hemorrhage now with severe headache and
nausea. Evaluate for worsening subarachnoid hemorrhage.
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: 55.39 mGy
COMPARISON: ___ head CT studies, and cerebral
angiogram dated ___.
FINDINGS:
Diffuse subarachnoid hemorrhage within the basal cisterns is overall stable
from most recent NECT. Subarachnoid hemorrhage within the cerebral convexities
has begun to layer dependently.
Right frontal ventriculostomy catheter is again demonstrated, with its tip
terminating near the right foramen of ___.
Small amount of intraventricular hemorrhage within both frontal horns,
occipital horns, third ventricle, and fourth ventricle are stable. The
ventricles are stable in size and there is no new area of hemorrhage.
Gray-white matter differentiation is preserved. The globes are intact.
Aerosolized secretions are noted in the left maxillary sinus along with fluid
mucosal thickening in the posterior ethmoid air cells and sphenoid sinuses.
The mastoid air cells and middle ear cavities are clear.
IMPRESSION:
1. Stable subarachnoid and intraventricular hemorrhage.
2. No new focus of hemorrhage.
3. Stable ventricular size.
4. Stable right frontal approach ventriculostomy catheter.
5. Paranasal sinus disease as described.
|
10152086-RR-15
| 10,152,086 | 24,825,843 |
RR
| 15 |
2159-06-15 15:56:00
|
2159-06-15 17:23:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: ___ year old man with SAH with vasospasm of the M2 braches and
distal left V4. Assess for worsening vasopspasm // Assess for vasospasm
TECHNIQUE: Contiguous axial imaging was performed through the head before
contrast administration. Subsequently CTA of the head was performed during
rapid infusion of Omnipaque 350 intravenous contrast. Three-dimensional
re-formatted images were generated. This report is based on interpretation of
all of these images.
DOSE: DLP: 1574 mGy-cm
CTDI: 200 mGy
COMPARISON: Prior CTA dated ___, prior CT head dated ___.
FINDINGS:
Head CT: There is a right frontal ventriculostomy catheter with tip
unchanged. There has been interval increase in intraventricular hemorrhage
compared to prior study and the ventricles are now dilated. Subarachnoid
hemorrhage appear similar to prior study. There is no evidence of acute
infarction. The orbits are unremarkable. There are aerosolized secretions in
the left maxillary sinus. There is mucosal thickening within the sphenoid
sinuses and ethmoid air cells. The mastoid air cells are clear. There is no
evidence of fracture.
Head CTA: The left vertebral artery is dominant. There is persistent
vasospasm of the distal left vertebral artery before the junction with the
basilar again noted. Vasospasm of the MCAs has slightly improved compared to
prior study. The left A1 artery is hypoplastic. There is a fetal type right
PCA incidentally noted. There are no aneurysms or vascular malformations.
IMPRESSION:
1. Interval increase in intraventricular hemorrhage with new ventricular
dilatation.
2. Subarachnoid hemorrhage unchanged.
3. Vasospasm of the distal left vertebral artery unchanged.
4. Slight interval improvement in the vasospasm of the bilateral MCAs.
|
10152086-RR-16
| 10,152,086 | 24,825,843 |
RR
| 16 |
2159-06-16 11:37:00
|
2159-06-16 12:05:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old male with history of non-aneurysmal subarachnoid
hemorrhage and external ventricular drain placement. Evaluate ventricular
size and stability of intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Axial images were repeated secondary to artifact from patient
motion.
DOSE: DLP: 1397 mGy-cm
CTDI: 54 mGy
COMPARISON: ___ head CTA and ___ head CT.
FINDINGS:
There continues to be bilateral subarachnoid hemorrhage. The amount of
intraventricular hemorrhage appears increased from ___ at 16:45.
The right frontal EVD is in stable position with stable the ventricles. There
is no new hemorrhage or infarction. No osseous abnormalities seen. There size
secretions are again noted in the left maxillary sinus, and mucosal thickening
is noted within the sphenoid sinuses and ethmoid air cells. The orbits are
unremarkable.
IMPRESSION:
1. 1. Stable appearance of the right frontal ventriculostomy catheter with
stable ventricles compared to ___ CTA head. Ventricles are again noted to
be enlarged relative to the ___ prior CT examination.
2. Stable subarachnoid hemorrhage with slight increase in intraventricular
hemorrhage.
3. No new focus of hemorrhage.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 12:03 ___, 5 minutes after discovery of the
findings.
|
10152086-RR-17
| 10,152,086 | 24,825,843 |
RR
| 17 |
2159-06-16 15:08:00
|
2159-06-16 19:17:00
|
INDICATION: ___ with diffuse SAH, s/p angio which showed no evidence of
aneurysm, EVD placed ___ // febrile - PNA?
COMPARISON: Radiographs from ___.
IMPRESSION:
The endotracheal tube and feeding tube have been removed. Heart size is upper
limits of normal. There is prominence of the pulmonary interstitial markings
without overt pulmonary edema or definite consolidation. This may be partially
due to low lung volumes. There is atelectasis at the lung bases. No
pneumothoraces are seen.
|
10152086-RR-18
| 10,152,086 | 24,825,843 |
RR
| 18 |
2159-06-16 19:32:00
|
2159-06-16 21:49:00
|
INDICATION: ___ with diffuse SAH, s/p angio which showed no evidence of
aneurysm, EVD placed ___. now intubated and CVL placed // eval ETT placement
and left subclavian line placement. r/o pneumothorax Contact name: ___,
___: ___
COMPARISON: Radiographs from ___.
FINDINGS:
The endotracheal tube tip is 4.3 cm from the carina. The left-sided central
venous line has the distal tip in the proximal right atrium. The feeding tube
tip and side port are within the distal stomach. There is cardiomegaly. There
is mild prominence of the pulmonary interstitial markings without overt
pulmonary edema. No pneumothoraces or focal consolidations are seen.
IMPRESSION:
As above.
|
10152086-RR-19
| 10,152,086 | 24,825,843 |
RR
| 19 |
2159-06-16 22:32:00
|
2159-06-17 08:53:00
|
INDICATION: ___ year old man with L SCL line // CVL pulled back 3-4 cm - eval
placement
COMPARISON: Radiographs from ___.
IMPRESSION:
Endotracheal tube and feeding tube are unchanged in position. The left-sided
central venous line has been retracted and the distal tip is now within the
distal SVC. Heart size is upper limits of normal and stable. There is
atelectasis at the left lung base. There is a patchy opacity at the right
infrahilar region. No pneumothoraces are seen.
|
10152086-RR-20
| 10,152,086 | 24,825,843 |
RR
| 20 |
2159-06-17 10:48:00
|
2159-06-17 11:35:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: ___ year old male with history of subarachnoid hemorrhage noted on
___, now with Clinical findings concerning for basilar artery vasospasm.
Evaluate circle of ___ for basilar artery basal spasm.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed through the
brain during infusion of 70 cc of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered and segmented images were
generated. This report is based on interpretation of all of these images.
DOSE: DLP: 1658.09 mGy-cm; CTDI: 150.64 mGy
COMPARISON: CTA head with without contrast ___.
FINDINGS:
Head CT: A right frontal approach ventriculostomy catheter, its tip
terminating at the frontal horn of the right lateral ventricle, is stable when
compared to prior exam. The configuration of the ventricles are unchanged.
Increased dependent hemorrhage within the occipital horns of the lateral
ventricles is noted, potentially secondary to redistribution. Again noted is
bilateral posterior frontal subarachnoid hemorrhage as well as hemorrhage in
the third ventricle, similar in appearance from prior exam.
There is no acute infarct. Dependent mucus within the maxillary sinuses as
well as partial opacification of the ethmoid air cells and right sphenoid
sinus is noted. The orbits are unremarkable. Right greater than left fluid
opacification of the mastoid tips are noted.
There has been interval placement of endotracheal and enteric tubes.
Head CTA: The appearance of the MCAs are unchanged from prior exam. The left
A1 segment is hypoplastic.
There is new focal narrowing of the distal left posterior communicating
artery, (series 753, image 8), compatible with vasospasm. Of note, there is
fetal origin of the left PCA.
Unchanged vasospasm of the distal left vertebral artery just prior to the
junction with the basilar artery. The left vertebral artery is dominant.
The basilar artery is unchanged from prior exam.
IMPRESSION:
1. New vasospasm of the distal left posterior communicating artery just prior
to the junction with the P2 segment.
2. Fetal origin of the left PCA.
3. Unchanged appearance of left distal vertebral artery vasospasm.
4. Unchanged appearance of dependent subarachnoid hemorrhage. Interval
increase extent of hemorrhage within the occipital horns of lateral
ventricles, potentially from the distribution.
5. No evidence of acute infarct.
6. Additional findings described above.
|
10152086-RR-22
| 10,152,086 | 24,825,843 |
RR
| 22 |
2159-06-20 11:58:00
|
2159-06-20 13:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SAH // eval pnuemonia
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has been extubated and the
nasogastric tube was removed. The left subclavian line remains in situ. As
expected, the lung volumes have decreased, causing areas of atelectasis at
both the left and the right lung base. No pleural effusions. No pneumonia,
no pulmonary edema.
|
10152086-RR-23
| 10,152,086 | 24,825,843 |
RR
| 23 |
2159-06-25 10:42:00
|
2159-06-25 17:17:00
|
CLINICAL HISTORY: The patient is a ___ made who presented with sudden
onset of headaches 11 days ago. His CT scan showed diffuse subarachnoid
hemorrhage. His initial diagnostic cerebral angiography did not show any
aneurysm, AVM or other vascular abnormalities. He is here for a second
diagnostic angiography.
ATTENDING PHYSICIAN: ___, M.D.
ASSISTANT: Dr. ___ and ___, NP.
PROCEDURE PERFORMED: Diagnostic cerebral angiography by catheterization and
injection into the right common carotid artery, left internal carotid artery,
left vertebral artery.
ANESTHESIA: Moderate conscious sedation was administered by providing divided
doses of Versed and fentanyl during the entire intraservice time of about 60
minutes, during which the patient's hemodynamic parameters were continuously
monitored by radiology nurse.
DESCRIPTION OF PROCEDURE: After describing the procedure, risks, and benefits
to the family, finally a consent was signed by the family of this patient.
The patient was brought to the radiology unit and was transferred to the
radiology table. Under moderate conscious sedation, after prepping and
draping bilateral groins, access to the left common femoral artery was
obtained using a modified Seldinger technique and a micropuncture set. A
___ sheath was inserted into the left common femoral artery.
Subsequently, using SIM2 soft, access into the right common carotid artery was
obtained in AP, lateral and oblique projections from the right common carotid
artery was obtained.
Subsequently, we got access into the left internal carotid artery in AP and
lateral and oblique projections were performed. Then, we got access into the
left vertebral artery, which was originating directly from the aortic arch and
the upper cervical and cranial angiography in AP and lateral projections.
After obtaining adequate images, it shows modified vasospasm in the A1 and A2
in the right side, which are the only AC arteries in this patient. Therefore,
we readvanced the Be___ catheter into the right common carotid artery and
we injected about 10 mg of verapamil, hopefully to resolve vasospasm.
Subsequently, the catheter was removed and left common femoral artery sheath
was removed and the hemostasis of the groin was achieved using 20 minutes
manual compression.
This procedure was accomplished uncomplicated and the patient remained
neurologically stable afterwards.
Dr. ___ personally attended and performed this procedure with me,
___, M.D.
FINDINGS: Right common carotid artery angiography showed carotid bifurcation
unremarkable. There is very good antegrade flowing of the right ECA and ICA
branches including ICAs, upper cervical, petrous and cavernous and
supraclinoid segments along with final MCA and ACA branches. The right ACA is
the dominant ACA and filling both A2s via a patent anterior communicating
artery. However, we found a moderate vasospasm of the A1 and both A2 and
maybe that is the cause of his recent confusion.
Again, no aneurysm, AVM or other vascular abnormality was seen in this
patient. No other evidence compatible with vasculopathy or vasculitis in this
territory.
Left internal carotid artery angiography shows very well opacification of its
upper cervical, petrous and cavernous and supraclinoid segments. The
posterior communicating artery, again, becomes the fetal-type PCA and anterior
choroidal artery and ophthalmic arteries are also seen very well. Again, no
aneurysm, AVM or other vascular abnormality is seen in this territory. Again,
the anterior cerebral artery is not seen in this angiography, which is exactly
the same as first angiography and found that A1 is atretic in this side. No
aneurysm, AVM or other vascular abnormalities seen. There is no vasospasm in
the supraclinoid ICA or MCA branches.
Again, there is no aneurysm, AVM or other vascular abnormalities compatible
with vasculitis/vasculopathy.
The left vertebral artery angiography showed very well opacification of its
V1-V4 segments. The previously narrowed V4 segment before joining into the
basilar artery is well patent and filling basilar artery and all of its
branches including AICA, superior cerebellar artery and PCA branches. No
vasospasm, aneurysm, AVM or other vascular abnormalities is seen in this
territory. No obvious evidence of dissection at this point.
Overall, again, we could not find any aneurysm or other vascular abnormality
in this case.
CONCLUSION: This diagnostic cerebral angiography did not show any evidence of
aneurysm, AVM, dural AV fistula or other vascular abnormalities compatible
with the vasculopathy/vasculitis. We found a moderate vasospasm in the right
A1 and A2 branches. The right ACA is the dominant and only ACAs in this
patient which fills bilateral A2 via a patent anterior communicating artery.
In comparison to previous angiography, we have a moderate ACA vasospasm. We
injected 10 mg of verapamil to treat this vasospasm.
The left vertebral artery is coming off directly from the aortic arch. The
left PCA is the fetal-type PCAs. The previously suspected area of the left V4
segment to that dissection is well open and there is no flow limitation in the
posterior circulation. The patient has remained neurologically fine. No
procedure-related thromboembolic complication was seen in this patient and the
patient remained neurologically stable afterwards.
___, M.D.
Clinical Fellow for ___, M.D.
I, ___, personally attended, performed this procedure with my fellow,
___, M.D. during the entire stages of this angiography.
I also read and reviewed all images in this exam and agree with all key
elements of this dictation and corrected all errors.
|
10152086-RR-27
| 10,152,086 | 24,825,843 |
RR
| 27 |
2159-06-23 18:00:00
|
2159-06-23 21:01:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with subarachnoid hemorrhage, altered mental
status. Please evaluate for new hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the head
without IV contrast.
DOSE: DLP: 931 mGy-cm
CTDI: 54 mGy
COMPARISON: Head CTA from ___.
FINDINGS:
No new hemorrhage is seen. Subarachnoid and intraventricular hemorrhage has
decreased compared to 6 days earlier. Specifically, there is less blood in the
occipital horns of the lateral ventricles, and slightly less blood in the
third ventricle, with decreased density of blood. Enlargement of the lateral
and third ventricles is stable. Right frontal approach ventriculostomy
catheter terminates in the frontal horn of the right lateral ventricle,
unchanged. There is no evidence of an acute major vascular territorial
infarction. Basal cisterns are not compressed.
Mucosal thickening, fluid and secretions are seen in the right frontal sinus,
right frontoethmoidal recess, right anterior ethmoid air cells, and right
maxillary sinus. Aeration of the left maxillary sinus has improved. There is
partial opacification of the mastoid air cells, right worse than left. These
findings may be secondary to prolonged supine positioning in the inpatient
setting.
IMPRESSION:
1. Decreasing subarachnoid and intraventricular hemorrhage. No new hemorrhage.
2. Stable enlargement of the lateral and third ventricles. Stable position of
the ventriculostomy catheter.
|
10152086-RR-28
| 10,152,086 | 24,825,843 |
RR
| 28 |
2159-06-25 10:15:00
|
2159-06-25 11:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SAH // assess for pulmonary edema, PNA
IMPRESSION:
Compared to ___ radiograph, cardiac silhouette is stable in size.
Pulmonary vascular congestion is new. Patchy right infrahilar opacity may
reflect atelectasis, aspiration, and less likely developing pneumonia.
Short-term followup radiographs may be helpful in this regard.
|
10152086-RR-29
| 10,152,086 | 24,825,843 |
RR
| 29 |
2159-06-26 07:53:00
|
2159-06-26 08:52:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with SAH, self DC'd left femoral artery angio
catheter, downtrending HCT, concern for retroperitoneal hematoma, active bleed
// eval for retroperitoneal hematoma and active extravasation
TECHNIQUE: MDCT images were obtained through the abdomen and pelvis,
initially without contrast, and subsequently in the arterial phase after
administration of IV Omnipaque contrast. Axial images were interpreted in
conjunction with coronal, sagittal, and MIP reformats.
DLP: 2690 MGy-cm
COMPARISON: None
FINDINGS:
CTA ABDOMEN AND PELVIS:
There is soft tissue stranding in the left inguinal region at site of recent
vascular access. There is a small amount of acute thrombus within the left
common femoral and external iliac artery, likely related to sheath removal,
with no evidence of pseudoaneurysm, hematoma or active extravasation. The
abdominal aorta is normal in caliber and without evidence of aneurysmal
dilation or dissection. The celiac axis, SMA, bilateral renal arteries, and
___ are grossly patent. Atherosclerotic mural calcifications are seen
throughout the aorta and its major branches. The hepatic arterial anatomy is
traditional. Assessment of the venous vasculature is limited by the timing of
contrast.
ABDOMEN:
The visualized lung bases demonstrate bibasilar atelectasis. There is no
evidence of pericardial effusion.
The liver is normal in appearance and without focal abnormality. There is a
subcentimetric hypo enhancing lesion in segment V that is too small to
characterize but likely a benign cyst or hemangioma (3:295). The portal venous
system is patent. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder, pancreas, spleen, and bilateral adrenal glands
are normal. The kidneys enhance symmetrically and are without suspicious solid
mass.
The stomach is grossly unremarkable in appearance. The small and large bowel
are normal in caliber and without evidence of wall thickening. The appendix is
normal. There is no retroperitoneal lymphadenopathy by CT size criteria. There
is no free abdominal fluid or pneumoperitoneum. There is evidence of prior
ventral hernia repair.
PELVIS:
There is a Foley catheter within the bladder. The sigmoid colon, and rectum
are grossly unremarkable. There is no pelvic side-wall or inguinal
lymphadenopathy by CT size criteria. No free pelvic fluid is identified.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. No evidence of retroperitoneal hematoma, active extravasation or other
active bleeding.
2. Small amount of acute thrombus in the left distal external iliac and
common femoral artery, likely related to sheath removal.
|
10152086-RR-30
| 10,152,086 | 24,825,843 |
RR
| 30 |
2159-06-26 12:11:00
|
2159-06-26 16:01:00
|
INDICATION: ___ year old man with Subarachnoid hemorrhage, groin sheath that
was traumatically removed by patient // evaluate left groin s/p cerebral
angiogram and sheath traumatically removed by patient
TECHNIQUE: Limited ultrasound evaluation of the left groin was performed.
COMPARISON: None.
FINDINGS:
Limited ultrasound evaluation of the left groin demonstrates no hematoma or
pseudoaneurysm. The visualized femoral artery is patent.
IMPRESSION:
No evidence of left groin pseudoaneurysm or hematoma.
|
10152086-RR-31
| 10,152,086 | 24,825,843 |
RR
| 31 |
2159-06-28 08:47:00
|
2159-06-28 10:25:00
|
EXAMINATION:
PORTABLE HEAD CT W/O CONTRAST
INDICATION: ___ year old man with worsening neuro exam, unstable for
transport. // r/o stroke
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows.
DOSE: DLP: 1130 mGy-cm; CTDI: 70 mGy
___
FINDINGS:
Since the previous CT examination, the hyperdense material in the occipital
horn appears less apparent. There remains some dilatation of the temporal
bones. Right frontal ventricular drain tip is in the right lateral ventricle
unchanged in position. The gray-white matter differentiation is maintained.
Small amount of subarachnoid blood is identified in the right parietal
convexity sulcus. No acute hemorrhage is identified.
IMPRESSION:
Slight decrease in hyperdense material in the occipital horns of the lateral
ventricles since the previous study. Unchanged ventricular size. Ventricular
catheter. No acute hemorrhage.
|
10152086-RR-32
| 10,152,086 | 24,825,843 |
RR
| 32 |
2159-06-28 15:02:00
|
2159-06-28 16:32:00
|
EXAMINATION: MRA BRAIN AND NECK
INDICATION: ___ year old man with SAH, please evaluate for other causes // ___
year old man with SAH, please evaluate for other causes
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
with rotational reconstructions. Gadolinium enhanced MRA of the neck was
acquired.
COMPARISON: Prior conventional angiography and CT angiographic studies.
FINDINGS:
MR ___ of the neck shows normal appearance of the carotid and
vertebral arteries without stenosis or occlusion or abnormal vascular
structures.
MR angiography of the head shows focal dilatation of the V4 segment of the
left vertebral artery which is unchanged from the previous studies. No
vascular occlusion or stenosis is identified. Evaluation for vasospasm is
limited.
IMPRESSION:
No significant abnormalities on MR angiography of the neck.
MRA of the head again demonstrates focal dilatation of the V4 segment of the
left vertebral artery adjacent to the origin of posterior inferior cerebellar
artery. No aneurysm greater than 3 mm in size seen.
|
10152086-RR-33
| 10,152,086 | 24,825,843 |
RR
| 33 |
2159-06-30 11:32:00
|
2159-06-30 14:51:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with angio negative SAH. Please perform with T2
sequencing. // bleed etiolgoy.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 9cc 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: MRA brain and neck of ___, CT head without contrast
of ___ through ___, CTA head with without contrast of
___, shaver angiogram of ___ and ___.
FINDINGS:
This study is motion degraded.
Right trans frontal ventriculostomy catheter terminating in the body of the
right lateral ventricle is stable from prior exam. The configuration of the
ventricles are also unchanged, noting mild enlargement of the lateral and
third ventricles. Superficial siderosis/residual subarachnoid hemorrhage
predominant along the posterior parietal occipital sulci is noted. There is no
acute infarct or new hemorrhage. Allowing for the limits of motion artifact,
there is no intra or extra-axial mass or findings to suggest occult vascular
malformation. The major intracranial flow voids are preserved. Mucous
retention cyst in the left maxillary sinus and mucosal thickening of the
ethmoid air cells and sphenoid sinuses are noted. The orbits are grossly
unremarkable. Fluid signal is seen in the bilateral mastoid air cells.
IMPRESSION:
1. The study is motion degraded.
2. Allowing for the limitations, there is no evidence of intra or extra-axial
mass or evidence of occult vascular malformation.
3. Residual in bilateral occipital parietal predominant superficial
siderosis/subarachnoid hemorrhage is noted.
4. Stable enlargement of the lateral and third ventricles.
5. No acute infarct or new hemorrhage.
|
10152086-RR-34
| 10,152,086 | 24,825,843 |
RR
| 34 |
2159-07-03 10:24:00
|
2159-07-03 11:03:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with subarachnoid hemorrhage following clamping
of the EVD, evaluate for hydrocephalus.
TECHNIQUE: Contiguous dual energy axial images images of the brain were
obtained without contrast.
DOSE: DLP: 1009.26 mGy-cm
CTDI: 111.2 mGy
COMPARISON: Prior head CT dated ___ and prior head MR dated ___.
FINDINGS:
Mild ventriculomegaly is unchanged following clamping of the EVD. There has
been interval resolution of previously seen intraventricular and subarachnoid
hemorrhage. No new foci of hemorrhage are identified. There is no evidence of
infarction, edema, or mass.
No osseous abnormalities seen. Mild mucosal thickening or possible mucous
retention cyst is noted in the right maxillary sinus. The orbits are
unremarkable.
IMPRESSION:
Unchanged mild ventriculomegaly following clamping of the EVD.
|
10152086-RR-35
| 10,152,086 | 29,640,006 |
RR
| 35 |
2159-07-09 11:33:00
|
2159-07-09 16:02:00
|
CLINICAL HISTORY ___ year old man with known concern for vertebral artery
dissection// Please evaluate for known aneurysm*Dr. ___ Please start at
12:30pm, RCU
EXAMINATION: The following vessels were selectively catheterized and
injected:
Left vertebral artery: ___ and lateral, magnified biplane oblique, Three
dimensional rotational angiography and postprocessing on separate work station
with concurrent physician supervision with images being used for final
interpretation.
Right subclavian artery: AP
ANESTHESIA: ANESTHESIA: Moderate sedation was provided by administrating
divided doses of 50 mcg of fentanyl and 1 mg of midazolam throughout the total
intra-service time of 30 min during which the patient's hemodynamic parameters
were continuously monitored by an independent trained radiology nurse. 1%
lidocaine was injected in the skin and subcutaneous tissues overlying the
access site
TECHNIQUE: OPERATORS: Dr. ___ and Dr. ___
physician performed the procedure. Dr. ___ supervised the
trainee during the key components of the procedure and has reviewed and agrees
with the trainee's findings.
PROCEDURE: Patient was brought to the angiography suite common ID was
confirmed via wrist band. The patient was laid supine on the fluoroscopy
table. Next the patient has bilateral groins were prepped and draped in the
usual sterile manner. A institutional time-out procedure was performed per
guidelines. A separate radiology nurse provided moderate sedation for the
entirety of the procedure monitor the patient's hemodynamic status throughout.
Next using radiographic an anatomic landmarks, the location the right mid
femoral head was located. 20 cc of 1% lidocaine was infused in the
subcutaneous tissue. Using a micropuncture kit, access of the right femoral
artery was obtained after serial dilation, a short 5 ___ groin sheath was
placed. This is connected to a continuous heparinized saline flush. Next a
___ catheter was connected to a continuous heparinized saline flush
and also to the power injector. This catheter was advanced over the 0.038
glidewire brought up the aorta. At the patient's left vertebral artery has an
origin off the aorta itself and the catheter was placed in the proximal
segment of this given tortuosity. This was confirmed under will live
fluoroscopy with gentle puffs of contrast. Next a ___ and lateral,
magnified biplane oblique, an 3 division rotational angiography and post
processing on a separate workstation with contra physician supervision of the
images being used for final interpretation was undertaken. Next the catheter
was pulled back into the aorta used to select the right innominate artery.
Multiple attempts were made to access the right subclavian artery for road
mapping to see the right vertebral artery however given significant tortuosity
of this vessel, vessel takeoff continue to occur. The patient is also very
uncomfortable at this juncture and the angiogram was concluded. Subsequently
the catheter was pulled back and the aorta removed from the body. Next under
manual pressure, the groin sheath was removed and hemostasis was achieved with
manual compression. This results in excellent hemostasis without evidence of
groin hematoma formation. At the conclusion of the procedure, the patient was
under be is neurologic baseline moving all extremities. There is no evidence
of thromboembolic complication.
FINDINGS:
In the left vertebral artery injections: A origin directly off the aorta is
again visualized, there is mild tortuosity at the takeoff of this vessel.
Distally the left vertebral artery, left ___, basilar artery, bilateral PCA
and SCA vessels are well-visualized. At the vertebral basilar junction there
is a dissection in C2 aneurysm identified. When compared to the prior
angiograms dated ___ and ___, this dissection with
pseudoaneurysm is much more prominent today. Note is likely the source of the
patient's subarachnoid hemorrhage 1 also compared to the pattern of blood seen
as initial head CT angiogram dated ___. The base of this
pseudoaneurysm measures approximately 5.4 mm, maximum height 2.9 mm. There is
no abnormal arteriovenous shunting, or early venous drainage identified. There
is no other areas of dissection noted on this projection.
The right subclavian artery injection: Significant tortuosity of the vessels
is noted. There is a very short segment of right innominate artery. The
vertebral artery origin off the low right subclavian is not well visualized.
IMPRESSION:
1. Focal vertebral artery dissection at the vertebral basilar junction with
pseudo aneurysm formation, given the patient's recent subarachnoid hemorrhage
in pattern of bleed this likely represents the source of this hemorrhage.
Given the clinical history ___ is at a higher risk for hemorrhagic Re rupture
in this will elected treat the patient with flowed over stent in the near
future.
Dr. ___ was personally present supervised the entirety of the procedure, ___
is also review the above films agrees with above interpretation.
|
10152086-RR-36
| 10,152,086 | 29,640,006 |
RR
| 36 |
2159-07-08 19:54:00
|
2159-07-08 21:00:00
|
INDICATION: Worsening headache in a patient with a history of subarachnoid
hemorrhage.
TECHNIQUE: Helical axial MDCT images were obtained through the brain without
the administration of IV contrast. Reformatted images in coronal and sagittal
axes were generated.
DOSE: DLP: 891.9 mGy-cm; CTDIvol: 52.2 mGy.
COMPARISON: Noncontrast CT head from ___.
FINDINGS:
There has been interval removal of a right frontal approach ventricular drain,
with the expected postsurgical changes. The ventricles remain mildly dilated
but unchanged in size. There is no acute large territorial infarct,
hemorrhage, edema, or mass effect. The basal cisterns are patent and there is
preservation of gray-white matter differentiation.
There is no acute fracture. Mucous retention cysts are seen within the right
maxillary and sphenoid sinuses. There is opacification of the right inferior
mastoid air cells. The other visualized paranasal sinuses, mastoid air cells,
and middle ear cavities are clear.
IMPRESSION:
Unchanged mild ventriculomegaly. No acute intracranial abnormality otherwise
demonstrated.
|
10152086-RR-37
| 10,152,086 | 29,640,006 |
RR
| 37 |
2159-07-11 16:18:00
|
2159-07-13 13:26:00
|
CLINICAL HISTORY: The patient is a ___ gentleman with a history of
subarachnoid hemorrhage from a dissecting left vertebral artery, which
happened three weeks ago. ___ is here for diagnostic cerebral angiography and
pipeline stenting of this dissection.
ATTENDING PHYSICIAN: Dr. ___.
ASSISTANT: Dr. ___ and ___.
PROCEDURE PERFORMED: Diagnostic cerebral angiography by catheterization and
injection into the left vertebral artery, failed attempted left vertebral
artery stenting across the pseudoaneurysm, right common femoral artery roadmap
angiography and closure of the vascular puncture site using an 8 ___
Angio-Seal vascular closure device and spin angiography of the left vertebral
artery and post-processing of the data in a separate workstation under
concurrent physician supervision, we utilized the 3D reconstruction data for
further interpretation and treatment purposes.
ANESTHESIA: General anesthesia.
DESCRIPTION OF PROCEDURE: After describing the procedure, risks and benefits,
rationale, the patient signed a consent form. The patient was brought to the
radiology unit and was transferred to the radiology table. Under general
anesthesia at supine position, after prepping and draping bilateral groin,
access to the right common femoral artery was obtained using a modified
Seldinger technique and a micropuncture set. A long 8 ___ sheath was
inserted into the right common femoral artery. Subsequently, we utilized a 4
___ Berenstein 2 catheter for catheterization into the left vertebral
artery over a 0.038 inch Terumo angled Glidewire. Subsequently, after
performing an AP, lateral and spin angiography of the left vertebral artery,
the data was post-processed in a separate workstation under concurrent
physician supervision and we utilized this 3D reconstruction data for
determining the best working projection and measurements.
Subsequently, we exchanged the Berenstein 2 catheter with a 5 ___ ___
058, 115 intracranial support catheter inside the 6 ___ shuttle sheath, as
an assembly coaxially over the exchange length Terumo wire and finally we
parked the tip of the shuttle sheath at the proximal left vertebral artery and
we advanced the ___ to the distal left V2 segment. Subsequent check
angiography confirmed patency of the left vertebral artery. Subsequently, we
advanced a Marksman catheter over a Synchro 2 standard microwire and we parked
the tip of this Marksman catheter at the proximal basilar artery.
Subsequently, we tried to deploy a 3.0 mm x 12 mm pipeline embolization device
from the distal left vertebral artery just proximal to the origin of the
anterior spinal artery all the way down across the neck of the aneurysm in the
vertebral artery; however, the stent moved back with half of the neck of the
aneurysm uncovered by stent. Therefore, we did not proceed with deploying
the Pipeline device. When we removed this stent and we found that two pieces
of the clot had formed inside the stent. Therefore, we found that regardless
of being preloaded with dual antiplatelet agents and also injecting 5000
units of heparin, the patient was still forming thrombus in the Pipeline and
we consulted with Dr. ___, in terms of risks and benefits of the
thromboembolic versus hemorrhagic complication of this vascular dissection.
We finally decided to not proceed with another pipeline device, primarily
because we could not protect the anterior spinal artery. We removed the
___ and the shuttle sheath down and after obtaining another check
angiography and making sure about the patency of the vertebral artery and also
integrity of the small aneurysm, the shuttle sheath was finally removed and
after obtaining right common femoral artery roadmap angiography, the femoral
sheath was also removed and hemostasis of the right groin was achieved using
an 8 ___ Angio-Seal vascular closure device.
This procedure was accomplished without complication and the patient remained
neurologically intact afterwards. No procedure-related thromboembolic
complication was noted.
Dr. ___ attended and performed this procedure with his fellow
during the entire stages of this procedure.
FINDINGS: The left vertebral artery angiography showed very well antegrade
filling of the V1, V2 and V3 segments. There is a previously known dissection
of the V4 segments with proximal pseudoaneurysm formation, and measured about
2.5 mm height and 3 mm base. Although the vertebral artery at the V4 segment
is fully patent; however, the diameter is about 25% less than normal as it
used to be in comparison to its proximal part. The anterior spinal artery
origin is very close to the distal neck of the pseudoaneurysm.
No other aneurysm or other vascular abnormality was seen. There is a very
good antegrade flow along the basilar artery, including its AICA, superior
cerebellar and PCA branches.
The 3D reconstruction data also confirmed the presence of narrowing as a
result of previous dissection and small pseudoaneurysm at the V4 segment just
proximal to the origin of the anterior spinal artery.
The left ___ remained unchanged after the procedure.
No procedure-related thromboembolic complication was noted.
The right common femoral artery roadmap angiography also showed a sizeable
artery and the puncture site proximal to the bifurcation site without evidence
of dissection or vascular injury.
CONCLUSION:
Mr. ___ was taken to the angiography today for potential treatment of his
pseudoaneurysm in the left V4 segment, however, the attempt for deployment of
a 3 mm x 12 mm pipeline embolization device in a way to cover the neck of the
aneurysm and leave the origin of the left anterior spinal artery uncovered by
the stent to protect the spinal cord perfusion failed and the stent was not
deployed. No procedure related thromboembolic or hemorrhage complication was
noted. We will follow this patient with further angiography in future.
No procedure-related thromboembolic complication was noted.
The patient remained neurologically intact afterwards.
Dr. ___, Clinical Fellow for Dr. ___.
I, Dr. ___, personally attended and performed this procedure with my
fellow during the entire stages of this procedure.
I also read and reviewed all images in this exam and confirm and approve all
key elements of this dictation and corrected all errors.
|
10152086-RR-38
| 10,152,086 | 29,640,006 |
RR
| 38 |
2159-07-10 07:27:00
|
2159-07-10 08:43:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with subarachnoid hemorrhage in late ___,
found to have distal left vertebral dissection with pseudoaneurysm, now
worsening HA, persistent dizziness. Evaluate hemorrhage.
TECHNIQUE: Noncontrast head CT. DLP 897 mGy cm.
COMPARISON: Noncontrast head CT ___. Conventional cerebral
angiogram ___ at 23:55.
FINDINGS:
There is motion artifact through the skullbase.There is no acute intracranial
hemorrhage, edema, loss of gray/ white matter differentiation or pathologic
extra-axial collection. Mild to moderate diffuse ventriculomegaly is stable.
A track from a prior right frontal ventriculostomy is again seen with
associated coarse calcifications.
The bones are unremarkable. Mucous retention cysts are again seen in the right
maxillary and right sphenoid sinuses. The mastoid air cells are grossly well
aerated.
IMPRESSION:
Stable appearance of the intracranial compartment without evidence for acute
hemorrhage or other acute abnormalities.
|
10152086-RR-8
| 10,152,086 | 24,825,843 |
RR
| 8 |
2159-06-12 12:54:00
|
2159-06-12 14:24:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: History: ___ with extensive SAH on ___. Currently awaiting
labs. // Eval for aneurysm
TECHNIQUE: Contiguous axial imaging was performed through the head before
contrast administration. Subsequently CTA of the head was performed during
rapid infusion of Omnipaque 350 intravenous contrast. Three-dimensional
re-formatted images were generated. This report is based on interpretation of
all of these images.
DOSE: DLP: 2580 mGy-cm
CTDI: 160 mGy
COMPARISON: Outside hospital CT head dated ___.
FINDINGS:
Head CT: There is diffuse acute subarachnoid hemorrhage, with blood noted
throughout all basal cisterns. Intraventricular extension of hemorrhage is
also noted. There is no acute infarction, edema, mass or shift of midline
structures. There is no hydrocephalus. Visualized paranasal sinuses and
mastoid air cells are clear. There is no evidence of fracture.
Head CTA: The study is slightly limited by suboptimal timing of contrast
administration. The bilateral ICA's, ACA's, and MCA's are patent. There is
fetal origin of the left PCA. Right PCA is unremarkable. The distal
intracranial left vertebral artery is dilated distal to the origin of the left
___ (5:259), raising the possibility of dissection. Right vertebral
artery and the basilar artery are patent. No evidence of aneurysm formation.
Neck CTA: Normal 3-vessel aortic arch. There is no internal carotid artery
stenosis by NASCET criteria. Atherosclerotic calcifications are noted at
bilateral carotid bifurcations. Subclavian arteries are patent.
Thyroid gland enhances homogeneously. No nodules are seen in the visualized
portions of bilateral lung apices.
IMPRESSION:
1. Diffuse acute subarachnoid hemorrhage with intraventricular extension. No
hydrocephalus.
2. Dilation of distal intracranial left vertebral artery after left ___
___, raising the possibility of dissection.
NOTIFICATION: Findings telephoned to Dr. ___ by Dr. ___ on ___
2:08PM, time of discovery.
|
10152086-RR-9
| 10,152,086 | 24,825,843 |
RR
| 9 |
2159-06-12 15:24:00
|
2159-06-12 15:49:00
|
EXAMINATION: CHEST RADIOGRAPH ___
INDICATION: History: ___ with intubation for NSurg procedure // ETT
placement
TECHNIQUE: Chest PA and lateral
COMPARISON: NONE.
FINDINGS:
The lung volumes are low, and the heart is mildly enlarged. An endotracheal
tube terminates 3.7 cm above the level the carina. An enteric tube courses
through the esophagus, and terminates in the stomach. There is bibasilar
atelectasis, greater on the left, with a possible small left pleural effusion.
There is no pneumothorax or focal consolidation worrisome for pneumonia.
IMPRESSION:
Monitoring and support devices in appropriate position. Left greater than
right basilar atelectasis and possible small left pleural effusion.
|
10152121-RR-38
| 10,152,121 | 24,401,913 |
RR
| 38 |
2185-09-10 17:23:00
|
2185-09-10 17:38:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ status post endoscopic esophageal stent removal
today now with fever and rigors
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CTA ___ and chest radiograph ___
FINDINGS:
Heart size is normal. Aortic knob is calcified. Patient is status post
esophagectomy and gastric pull-through with unchanged appearance of the
mediastinum compared to the previous radiograph. Worsening patchy opacities
are noted in both lung bases, findings which could reflect aspiration. Small
right pleural effusion is also noted. Lungs are hyperinflated with
emphysematous changes re- demonstrated. No pulmonary edema is seen. No
pneumothorax is present. There are no acute osseous abnormalities visualized.
IMPRESSION:
Patchy opacities within the lung bases concerning for aspiration. Small right
pleural effusion.
|
10152275-RR-10
| 10,152,275 | 27,295,862 |
RR
| 10 |
2172-01-30 05:31:00
|
2172-01-30 08:51:00
|
HISTORY: Patient with brain tumor for surgical planning.
TECHNIQUE: T1 axial and and MPRAGE axial postcontrast images of the brain
were acquired. Surface markers placed for surgical planning.
COMPARISON: Comparison was made with the previous MRI examination of ___.
FINDINGS:
Findings inhomogeneously enhancing mass identified at the left frontoparietal
region near the midline adjacent to the superior sagittal sinus. The mass is
lobulated and demonstrates and and intense enhancement. There is minimal
surrounding dural enhancement seen. There is indentation on the brain. No
significant brain edema is identified. The enhancement of the superior
sagittal sinus is maintained as described previously.
IMPRESSION:
Lobulated intensely enhancing left frontoparietal mass again identified. The
examination was performed for surgical planning. There is no significant
change in size and appearance of the brain otherwise compared to the previous
MRI.
|
10152275-RR-11
| 10,152,275 | 27,295,862 |
RR
| 11 |
2172-01-31 17:56:00
|
2172-02-01 14:26:00
|
STUDY: MRI of the head with and without contrast.
CLINICAL INDICATION: ___ woman with left-sided brain lesion, status
post resection, evaluate for interval change.
COMPARISON: Prior MRI of the brain dated ___ and prior head CT
dated ___.
TECHNIQUE: Pre-contrast axial and sagittal T1-weighted images were obtained,
axial FLAIR, axial T2, axial magnetic susceptibility and axial
diffusion-weighted sequences. The T1-weighted images were repeated after the
administration of gadolinium contrast in axial T1, sagittal MP-RAGE and
multiplanar reconstructions were reviewed.
FINDINGS: The patient is status post resection of left vertex meningioma,
again post-surgical changes are seen, consistent with left parietal
craniotomy, residual blood products and soft tissue edema are noted at the
surgical site and also bifrontal pneumocephalus. Blood products are noted in
the surgical bed at the left parietal convexity, there is a punctate focus of
restricted diffusion in the left frontal subcortical white matter (image #25,
series 502), possibly related with edema versus an area of slow diffusion,
close attention in this area in the followup examination is advised. Minimal
residual subdural blood is identified and expected after the surgical
procedure. Minimal degree of rightward midline shift is essentially unchanged
with approximately 4 mm of shifting (image 16, series 7). The major vascular
flow voids are patent and demonstrate normal distribution. The paranasal
sinuses are clear, there is minimal patchy mucosal thickening in the mastoid
air cells, new since the prior MRI.
IMPRESSION: Status post left vertex meningioma resection with expected
post-surgical changes. There are small amount of blood products in the
surgical bed and a small focus of slow diffusion in the subcortical white
matter of the left frontal lobe, but close attention in this area in the
followup examinations is advised. There is no evidence of abnormal
enhancement to suggest residual mass lesion. Unchanged minimal shifting of
midline towards the right, residual pneumocephalus identified in the frontal
regions.
|
10152275-RR-12
| 10,152,275 | 27,295,862 |
RR
| 12 |
2172-01-30 20:53:00
|
2172-01-30 22:33:00
|
COMPARISON: Comparison is made to CT of the head with contrast from ___ as well as MRI from ___ and ___.
TECHNIQUE: MDCT images were obtained through the brain without the
administration of intravenous contrast. Reformatted coronal, sagittal and
thin slice bone images were reviewed.
FINDINGS: Since the prior study, there has been interval resection of a left
frontal vertex mass, with associated postoperative changes including overlying
left vertex craniotomy, as well as pneumocephalus underlying the craniotomy
site, along the falx (2:27), as well as surrounding the bilateral frontal
lobes (2:18). There is no evidence of similar degree of rightward shift of
normally midline structures since the preoperative contrast-enhanced CT of the
head from ___, again measuring approximately 3 mm. There is no
evidence of hydrocephalus or obstruction. The basal cisterns remain patent.
There is preservation of the gray-white matter differentiation. No evidence
of acute vascular territorial infarction is seen. A small high density
collection of blood is seen adjacent to the superior sagittal sinus (60___:60),
within the resection bed, and associated with postoperative changes. A left
scalp hematoma with subcutaneous air is also noted overlying the craniotomy
site. The visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear.
IMPRESSION:
1. Expected postoperative changes status post resection of left vertex mass,
with persistent 3 mm rightward shift of normally midline structures, not
significantly changed since preoperative CT from ___. There is
no evidence of herniation or obstruction.
The above findings were communicated to Dr. ___ by Dr. ___ telephone
at 10:15 p.m., five minutes after the findings were discovered.
|
10152275-RR-13
| 10,152,275 | 27,295,862 |
RR
| 13 |
2172-01-31 12:50:00
|
2172-01-31 13:30:00
|
HISTORY: ___ woman status post craniotomy and resection of left
vertex meningioma now with worsening mental status and right-sided weakness.
COMPARISON: ___ 20. ___, MR ___ ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm reconstructed images were acquired.
Total Exam DLP: 1154mGy-cm
CTDIvol: 62mGy
FINDINGS:
The patient is status post resection of left vertex meningioma with
postoperative changes. There is a similar amount of postoperative
pneumocephalus. The degree of rightward midline shift is essentially
unchanged measuring 4 mm. There is an area of hypodensity at the resection
bed which is more conspicuous on today's CT but appears to be extra-axial and
likely represents fluid in the resection bed (2:28); (400b:65). Again seen,
is a small high-density collection of blood adjacent to the superior sagittal
sinus which is unchanged. A left scalp hematoma with subcutaneous air is also
unchanged. There is no evidence of large vascular territory infarction.
There are no new areas of hemorrhage. The basal cisterns appear patent and
there is preservation of gray-white matter differentiation. The paranasal
sinuses, mastoid air cells, middle ear cavities are clear the globes are
unremarkable.
IMPRESSION:
1. No significant interval change following craniotomy and resection of left
vertex meningioma. There is no evidence of large vascular territory
infarction. There is a more conspicuous hypodensity in the left vertex which
is extra-axial and likely represents a postoperative fluid collection. If
high clinical concern for acute stroke recommend MRI.
2. No new areas of hemorrhage. No change in minimal shift of midline
structures to the right. Similar degree of pneumocephalus compared to
yesterday's CT.
|
10152275-RR-6
| 10,152,275 | 27,295,862 |
RR
| 6 |
2172-01-25 00:35:00
|
2172-01-25 02:02:00
|
HISTORY: ___ female with brain tumor seen on outside CT from ___
___ (images not available for comparison at this time).
COMPARISON: None available.
TECHNIQUE: MDCT images were obtained through the brain without contrast
initially, followed by the administration of 90 cc of Omnipaque intravenous
contrast and rescanning through the brain. Reformatted coronal, sagittal and
thin slice bone images were reviewed.
FINDINGS: Within the left vertex, there is a well-circumscribed ovoid
homogeneously enhancing mass which abuts the falciform ligament and measures
3.9 x 2.6 x 2.2 cm (AP x TV x CC). There is local mass effect on the adjacent
brain parenchyma, with minimal surrounding edema. There is 3 mm of rightward
shift of normally midline structures. Otherwise, the ventricles and sulci are
normal in size and configuration. There is no sign of ventricular entrapment
or obstruction. No other enhancing foci are identified within the brain. The
gray-white matter differentiation is preserved. The intracranial vessels are
well opacified and normal in appearance. There is no evidence of vascular
territorial infarction. No fracture is identified. The visualized paranasal
sinuses, mastoid air cells and middle ear cavities are clear. The globes are
intact bilaterally.
IMPRESSION:
1. Well-circumscribed heterogeneously enhancing mass in the left vertex, with
local mass effect and 3 mm of rightward shift of normally midline structures,
but no evidence of herniation or obstruction. These findings are most
consistent with a meningioma. Recommend MRI to confirm.
2. No other enhancing foci are identified within the brain.
|
10152275-RR-7
| 10,152,275 | 27,295,862 |
RR
| 7 |
2172-01-25 11:50:00
|
2172-01-25 12:49:00
|
INDICATION: History of mass and confusion. Please evaluate for interval
change.
COMPARISON: CT from ___ performed at 12:45 a.m.
TECHNIQUE: ___ MDCT images were obtained through the brain without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axis were generated and reviewed.
FINDINGS:
Again seen is the well-circumscribed ovoid mass abutting the falciform
ligament in the left vertex, measuring 4.5 cm x 2.2 cm evaluated on the prior
contrast-enhanced CT. There is stable minimal surrounding edema. Again noted
is 3 mm rightward midline shift. There is no evidence of herniation. There is
no intracranial hemorrhage. The ventricles and sulci are otherwise normal in
size and configuration. The basilar cisterns are patent and there is
otherwise preservation of the gray-white matter differentiation.
No fracture is identified. Visualized paranasal sinuses are clear. No
cranial or facial soft tissue abnormalities are identified.
IMPRESSION:
No significant change in the well-circumscribed mass at the left vertex,
better evaluated on the prior contrast-enhanced CT. There is stable 3 mm
rightward shift of the normally midline structures; however, no evidence of
herniation or obstruction.
Findings are consistent with a meningioma, however an MRI is recommended for
further evaluation.
|
10152275-RR-8
| 10,152,275 | 27,295,862 |
RR
| 8 |
2172-01-26 15:48:00
|
2172-01-27 13:08:00
|
HISTORY: ___ year old woman with newly-diagnosed L vertex brain tumor.
TECHNIQUE: Multiplanar multi sequence MR images of the brain were obtained
before and after the administration of intravenous contrast.
COMPARISON: CT head ___
FINDINGS:
There is an approximately 4.6 x 2.7 x 3.1 cm low T1, high T2, avidly enhancing
mass at the left posterior frontal vertex. There appear to be flow voids
within the mass lesion. The mass is dural based and abutting the falx. The
mass is adjacent to the superior sagittal sinus without evidence of
obstruction. There no significant surrounding high FLAIR abnormality. There
is grossly stable approximately 3 mm of left-to-right midline shift.
There is no evidence of acute intracranial hemorrhage or infarct. Mild
ventricular, cisternal, and sulcal prominence may be a function of age-related
parenchymal volume loss. Ventricles are midline. Cisterns appear patent.
The major intracranial vessels exhibit the expected signal void related to
vascular flow.
The paranasal sinuses and mastoid air cells demonstrate normal signal. The
sella turcica, craniocervical junction, and orbits are grossly unremarkable.
IMPRESSION:
Avidly enhancing 4.6 cm left frontal vertex mass adjacent to the falx abutting
the superior sagittal sinus without evidence of obstruction. A few flow voids
are identified within this mass lesion. Findings are suggestive of a
meningioma; a hemangiopericytoma can have a similar appearance.
|
10152275-RR-9
| 10,152,275 | 27,295,862 |
RR
| 9 |
2172-01-27 16:08:00
|
2172-01-28 08:43:00
|
REASON FOR EXAMINATION: Preoperative assessment in a patient with meningioma.
Portable AP radiograph of the chest was reviewed with no prior studies
available for comparison.
Heart size is top normal. Mediastinum is grossly unremarkable. Lungs are
essentially clear except for right basal opacity which unclear if represents a
true lesion or summation of shadows. Repeated radiograph preferably with full
inspiration is required. If finding is persistent, assessment with chest CT
would be necessary.
|
10152346-RR-31
| 10,152,346 | 24,720,735 |
RR
| 31 |
2128-07-07 11:13:00
|
2128-07-07 11:34:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with hypoxia.// Pneumonia? effusion?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
Compared to ___, the lung volumes are lower, accentuating
bronchovascular markings. Compared to prior exam, there is persistent
elevation of the left hemidiaphragm with new dependent pleural effusion and
increased left base atelectasis/consolidation. Small right pleural effusion
is likely. There is no pneumothorax. Evaluation of the cardiac silhouette is
mildly limited due to new right lower lobe opacification, though likely
stable.
IMPRESSION:
Low lung volumes. New left moderate left pleural effusion and left lower lobe
atelectasis or consolidation. New small right pleural effusion.
|
10152346-RR-32
| 10,152,346 | 24,720,735 |
RR
| 32 |
2128-07-08 13:39:00
|
2128-07-08 15:33:00
|
INDICATION: ___ year old man with L>R pleural effusions, perform diagnostic
thoracentesis
TECHNIQUE: Ultrasound guided diagnostic thoracentesis
COMPARISON: None.
FINDINGS:
Limited grayscale ultrasound imaging of the left hemithorax demonstrated a
small amount of pleural fluid, and limited gray scale ultrasound imaging of
the right hemithorax demonstrated a small to moderate amount of pleural fluid.
A suitable target in the deepest pocket in the right posterior mid scapular
line was selected for thoracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine buffered with
sodium bicarbonate was instilled for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
posterior mid scapular line and 0.415 L of clear, straw-colored fluid was
removed. Fluid samples were submitted to the laboratory for cell count,
differential, culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound-guided diagnostic thoracentesis.
|
10152346-RR-33
| 10,152,346 | 24,720,735 |
RR
| 33 |
2128-07-10 10:45:00
|
2128-07-10 12:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with pleural effusions// assess interval change
COMPARISON: ___, ___
FINDINGS:
AP and lateral views of the chest provided.
Low lung volumes accentuate bronchovascular markings. There is small right
pleural effusion, not significantly changed. There is a interval increase in
size of moderate-sized left pleural effusion. Adjacent atelectasis is
increased. New patchy opacities throughout the left upper lobe concerning for
pneumonia. Cardiomediastinal silhouette is incompletely evaluated due to
adjacent effusion, but is likely stable.
IMPRESSION:
Interval increase in size of moderate left pleural effusion with increased
adjacent atelectasis. New opacification left upper lobe concerning for
pneumonia in appropriate clinical setting.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:07 pm, 10 minutes after
discovery of the findings.
|
10152346-RR-34
| 10,152,346 | 24,720,735 |
RR
| 34 |
2128-07-10 16:06:00
|
2128-07-10 17:01:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with ambulatory desaturation, pleural effusions//
assess for consolidation, edema, mass
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen. Axial images were reviewed in conjunction with coronal and sagittal
reformats
COMPARISON: Chest radiograph from ___
FINDINGS:
Aorta and pulmonary arteries are normal in diameter. There is large amount of
left pleural effusion and small amount of right pleural effusion. There is
evidence of mediastinal lymphadenopathy. Evidence of anemia is demonstrated
as high density of the myocardium.
The image portion of the upper abdomen demonstrate ascites and partially
assessed giving the lack of IV contrast. There is potentially loculated fluid
levels within the abdomen.
Airways are patent to the subsegmental level bilaterally except for collapse
of left lower lobe.
There are no lytic or sclerotic lesions worrisome for infection or neoplasm.
Left lower lobe extensive consolidation and partial collapse in combination
with multifocal opacities in the left upper lobe are consistent with
multifocal infection. Smaller areas of ___ opacities in the right
lung are most likely infectious as well. No pulmonary masses to suggest
neoplasm demonstrated
IMPRESSION:
Multifocal infection as described primarily involving left lung
Bilateral pleural effusion
Atelectasis of the left lower lobe
Anemia
Coronary calcifications
No definitive evidence of intrathoracic neoplasm but assessment is limited
giving the lack of IV contrast
Ascites
Liver hypodensity partially characterized and mesenteric stranding
|
10152346-RR-35
| 10,152,346 | 24,720,735 |
RR
| 35 |
2128-07-11 13:20:00
|
2128-07-11 14:30:00
|
INDICATION: ___ year old man with enlarging left pleural effusion and
multifocal left-sided infection// please perform diagnostic/therapeutic
thoracentesis of the left pleural effusion
TECHNIQUE: Ultrasound guided diagnostic and therapeutic thoracentesis
COMPARISON: CT chest ___
FINDINGS:
Limited grayscale ultrasound imaging of the left hemithorax demonstrated a
small to moderate amount of pleural fluid. A suitable target in the deepest
pocket in the left posterior mid scapular line was selected for thoracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine buffered with
sodium bicarbonate was instilled for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
posterior mid scapular line and 0.4 L of serosanguinous fluid was removed.
Fluid samples were submitted to the laboratory forchemistry, cell count,
differential, culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Successful ultrasound-guided diagnostic and therapeutic left thoracentesis.
|
10152346-RR-36
| 10,152,346 | 24,720,735 |
RR
| 36 |
2128-07-12 10:46:00
|
2128-07-12 13:58:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with multifocal pna and b/l pleural effusions s/p
thoracentesis x2// interval change in effusions
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ and ___ chest x-rays. ___ chest CT
FINDINGS:
Cardiomediastinal contours are stable. Small to moderate left pleural
effusion has decreased. Small right pleural effusion has decreased. There is
no pneumothorax. Multifocal consolidations largest in the left upper lobe
have improved.
IMPRESSION:
Improved multifocal pneumonia. Decrease in bilateral pleural effusions. No
evident pneumothorax
|
10152346-RR-37
| 10,152,346 | 28,245,979 |
RR
| 37 |
2128-07-23 01:20:00
|
2128-07-23 02:33:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB// eval for pleural effusion, pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiographs from ___
FINDINGS:
Small to moderate left pleural effusion and left basal consolidation are
persistent since ___. Severe elevation of the left hemidiaphragm has
been present since at least ___. There is no pneumothorax. Previous
left upper lobe consolidation has resolved. No new or residual focus of
consolidation is seen. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
Upper lobe pneumonia resolved since ___. Small to moderate left pleural
effusion and left lower lobe atelectasis, less likely pneumonia, unchanged
since ___. Chronic elevation and presumed dysfunction of the left
hemidiaphragm may contribute to both chronic atelectasis and persistent left
pleural effusion.
|
10152346-RR-38
| 10,152,346 | 28,245,979 |
RR
| 38 |
2128-07-23 18:20:00
|
2128-07-23 19:00:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with cirrhosis presenting with nausea/vomiting
and leukocytosis also with renal failure. Exam with LUQ
abnormality/mass/spleen?// Please eval for GB pathology causing infection,
please eval for PVT, please evaluate the spleen, also please r/o
hydronephrosis given new ___
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound ___.
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened. The contour of the liver is
nodular, consistent with cirrhosis. There is a lobulated hyperechoic 2.6 x
1.9 x 2.6 cm lesion in the left lobe of the liver, stable from prior. An
anechoic lesion in the right lobe of the liver measuring up to 1.9 cm likely
represents a simple cyst. The main portal vein is patent with hepatopetal
flow. There is perihepatic ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 7 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 12.2 cm. There is perisplenic ascites.
KIDNEYS: The right kidney measures 8.3 cm. The left kidney measures 9.9 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
Bladder is moderately well distended and unremarkable.
RETROPERITONEUM: The aorta is not well visualized.
Left and right pleural effusions are noted.
IMPRESSION:
1. Cirrhosis with ascites. Patent main portal vein with hepatopetal flow.
2. Hyperechoic focus in the left lobe of the liver is seen on prior ultrasound
from ___ and was not fully characterized on prior limited MRI. Consider
nonurgent multiphasic CT as previously recommended.
3. Cholelithiasis without evidence of cholecystitis.
4. No hydronephrosis.
5. No splenomegaly.
6. Right and left pleural effusions noted.
|
10152346-RR-39
| 10,152,346 | 28,245,979 |
RR
| 39 |
2128-07-24 09:07:00
|
2128-07-24 10:34:00
|
EXAMINATION: Ultrasound-guided paracentesis
TECHNIQUE: Ultrasound guided diagnostic paracentesis
COMPARISON: None.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated trace
ascites. A suitable target in the deepest pocket in the left upper quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
An 18 gauge spinal needle was advanced under real-time US visualization, into
the largest fluid pocket in the left upper quadrant and 20 cc of clear,
straw-colored fluid were removed. Fluid samples were submitted to the
laboratory for cell count, differential, and culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound guided diagnostic paracentesis.
|
10152950-RR-69
| 10,152,950 | 24,564,462 |
RR
| 69 |
2177-08-31 00:01:00
|
2177-08-31 02:01:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: History: ___ with episodes of unresponsiveness and persistent
headache// mass? csvt?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 16 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: Most recent MR done ___
FINDINGS:
The patient is status post resection of a large olfactory groove meningioma.
Extensive post therapeutic encephalomalacia within the bilateral frontal lobes
are unchanged. Unchanged residual meningioma within the anterior left
paramedian surgical bed measuring 1.5 x 1.0 cm (series 100, image 45). Soft
tissue within the olfactory groove extending into the ethmoid air cells is
also unchanged, measuring 3.9 x 1.6 x 2.5 cm. Small cranial meningocele
herniating ting into the right frontal bone (series 12, image 13) appear
similar compared to prior.
The apparent cortical high signal intensity in the right frontal and temporal
areas on the diffusion-weighted imaging does not have any correlate on ADC, T2
or FLAIR sequences and is most likely secondary to susceptibility artifact.
No evidence of acute territorial infarction. The major intracranial vessels
appear normal. No dural venous thrombosis.
IMPRESSION:
1. No acute interval change/acute pathology compared to most recent prior MRI
done ___.
2. The apparent cortical high signal intensity in the right frontal and
temporal areas on the diffusion-weighted imaging does not have any correlate
on ADC, T2 or FLAIR sequences and is most likely secondary to susceptibility
artifact. Follow-up imaging may be performed if clinically warranted.
3. Residual/recurrent disease appears very similar compared to most recent
comparison, but mild progression is more evident when compared to older
studies.
|
10153623-RR-14
| 10,153,623 | 29,622,693 |
RR
| 14 |
2114-05-02 15:34:00
|
2114-05-02 16:31:00
|
INDICATION: ___ with EtOH, tachycardia, hypoxia // Eval for acute process
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
Low lung volumes are noted with secondary crowding of the bronchovascular
markings. There is no focal consolidation or large effusion. The
cardiomediastinal silhouette is grossly unchanged. Chronic, presumably
posttraumatic changes seen at the right shoulder with widening of the
acromioclavicular joint and adjacent heterotopic calcifications.
IMPRESSION:
No acute cardiopulmonary process.
|
10153623-RR-15
| 10,153,623 | 29,622,693 |
RR
| 15 |
2114-05-03 02:01:00
|
2114-05-03 03:37:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with right sided facial droop, headache // eval
for stroke
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 18.0 s, 18.0 cm; CTDIvol = 55.8 mGy (Head) DLP =
1,003.4 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
There is no evidence of fracture. Left maxillary sinus mucosal thickening.
Remaining visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. Globes are unremarkable.
Again seen is scalp thickening overlying the left convexity. The underlying
bone appears normal. This was present on the studies of ___
but is more extensive on the current examination. Correlation with physical
examination is likely to be the most useful next step. Deep gradual
progression makes this unlikely to be an acute scalp hematoma or other
consequence of a single episode of trauma. The possibility of a neoplasm
should be considered.
IMPRESSION:
1. Normal brain CT.
2. Convexity scalp thickening of uncertain etiology. Correlation with
physical examination is recommended to exclude the possibility of a neoplasm.
NOTIFICATION: The scalp thickeing was noted in the Radiology Department
Critical Results system.
|
10153623-RR-16
| 10,153,623 | 29,622,693 |
RR
| 16 |
2114-05-03 16:39:00
|
2114-05-03 17:18:00
|
EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: Evaluate for alcoholic hepatitis or cirrhosis in a patient with
alcohol abuse, hypertension, and right upper quadrant tenderness on exam.
TECHNIQUE: Gray scale, color and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: None.
FINDINGS:
Liver: The hepatic parenchyma is within normal limits. Nofocal liver lesions
are identified. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 3 mm.
Gallbladder: The gallbladder appears within normal limits, without stones or
abnormal wall thickening or edema.
Pancreas: Imaged portion of the pancreas appears within normal limits, with
portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 10.4 cm.
Kidneys: Limited images of the right kidney demonstrate no stone, mass, or
hydronephrosis.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 15.9 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
Normal abdominal ultrasound, with patent hepatic vasculature.
|
10153623-RR-17
| 10,153,623 | 29,622,693 |
RR
| 17 |
2114-05-05 14:22:00
|
2114-05-05 14:49:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with PMH of alcohol abuse, presenting for detox,
with new cough and rising WBCs. // ahy consolidation suggestive of pneumonia?
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Heart size and mediastinum are stable. Lungs are clear. No pleural effusion
or pneumothorax is seen.
Increased densities projecting over the right acromioclavicular joint,
unchanged in the prior study in might represent evidence of prior trauma.
|
10153623-RR-22
| 10,153,623 | 29,406,708 |
RR
| 22 |
2115-05-31 17:47:00
|
2115-05-31 19:10:00
|
INDICATION: History: ___ with ams, biba, found down*** WARNING *** Multiple
patients with same last name! // ams
TECHNIQUE: Single AP supine portable view of the chest
COMPARISON: None.
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac and mediastinal silhouettes are unremarkable. Deformity at the
distal right clavicle appears chronic.
IMPRESSION:
Clear lungs. Partially imaged deformity at the distal right clavicle appears
chronic, but not well assessed on this study.
|
10153623-RR-23
| 10,153,623 | 29,406,708 |
RR
| 23 |
2115-05-31 17:09:00
|
2115-05-31 17:49:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with AMS, BIBA found down on the street*** WARNING
*** Multiple patients with same last name! // bleed? neck fracture?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 49.0 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 4.0 s, 8.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
401.4 mGy-cm.
Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass effect. The ventricles and sulci are slightly or prominent than expected
given patient age.
There is no evidence of acute fracture. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
No acute intracranial process.
|
10153623-RR-24
| 10,153,623 | 29,406,708 |
RR
| 24 |
2115-05-31 17:10:00
|
2115-05-31 17:47:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with AMS, BIBA found down on the street*** WARNING
*** Multiple patients with same last name! // bleed? neck fracture?
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 22.3 cm; CTDIvol = 37.1 mGy (Body) DLP = 828.3
mGy-cm.
Total DLP (Body) = 828 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified. There is no critical spinal
canal stenosis. There is no prevertebral soft tissue swelling.
IMPRESSION:
No acute fracture or traumatic malalignment.
|
10153623-RR-25
| 10,153,623 | 29,406,708 |
RR
| 25 |
2115-05-31 19:32:00
|
2115-05-31 22:48:00
|
INDICATION: History: ___ with r shoulder pain // fracture? dislocation?
TECHNIQUE: Three views of the right shoulder
COMPARISON: None.
FINDINGS:
Chronic appearing deformity of the distal right clavicle is seen likely due to
prior displaced fracture with 4.3 cm of bony overriding. An acute component
is difficult to exclude, but none is definitely seen. The right
acromioclavicular joint is grossly intact. The right glenohumeral joint is
intact. No evidence of right shoulder fracture is seen. The right upper
outer chest is otherwise grossly unremarkable.
IMPRESSION:
Chronic appearing deformity the distal right clavicle likely due to a the
prior displaced fracture with 4.3 cm of bony overriding; an acute component is
difficult to exclude, although none is definitely seen.
No evidence of acute fracture or dislocation of the right glenohumeral joint.
|
10153623-RR-26
| 10,153,623 | 29,406,708 |
RR
| 26 |
2115-06-02 08:24:00
|
2115-06-02 11:18:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with elevated LFTs, hx of EtOH, low plts //
signs of cirrhosis, splenomegaly
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Doppler ultrasound ___
FINDINGS:
LIVER: The hepatic parenchyma appears coarse. The contour of the liver is
smooth. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is unremarkable but is only minimally visualized due to
overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 11.0 cm.
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
IMPRESSION:
Coarse hepatic architecture however no concerning liver lesion identified.
|
10153623-RR-27
| 10,153,623 | 29,406,708 |
RR
| 27 |
2115-06-02 14:05:00
|
2115-06-02 18:01:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man with pleuritic CP new onset, tachycardia, concern
for PE // PE?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 409 mGy-cm.
COMPARISON: Chest radiographs dated ___.
FINDINGS:
This examination is moderately limited due to motion artifact.
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. There is minimal atherosclerotic calcification at the
origin of the head and neck vessels and of the coronary arteries. Otherwise,
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: Mild dependent atelectasis bilaterally. No focal
consolidations. No suspicious lung nodules. The airways are patent to the
level of the segmental bronchi bilaterally.
ABDOMEN: A 1.8 cm right adrenal nodule is partially visualized (series 2,
image 97).
BONES: A chronic appearing right clavicular fracture is partially imaged. No
suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. 1.8 cm right adrenal nodule is partially visualized. Although this nodule
is indeterminate on this examination, this statistically most likely
represents an adrenal adenoma.
3. Chronic appearing right clavicular fracture is partially imaged.
|
10153623-RR-28
| 10,153,623 | 29,406,708 |
RR
| 28 |
2115-06-06 15:40:00
|
2115-06-06 16:45:00
|
INDICATION: ___ year old man with hx cdiff unclear if fully treated w/
diarrhea ongoing, crampy unimproving abdominal pain worst in LLQ // ?colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 46.9 mGy (Body) DLP =
23.5 mGy-cm.
2) Spiral Acquisition 4.5 s, 49.9 cm; CTDIvol = 11.3 mGy (Body) DLP = 561.3
mGy-cm.
Total DLP (Body) = 585 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. 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.
Bilateral renal hypodense lesions measuring up to 1 cm in the left renal
midpole, too small to characterize but likely represent cysts. No
hydronephrosis or perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is bowel
wall thickening with pericolonic inflammatory changes involving the transverse
colon through the rectum, most likely in keeping with infectious colitis given
the provided clinical history. No pneumoperitoneum or free fluid. The
appendix is prominent up to 9 mm in dimension, likely reactive secondary to
the adjacent inflammatory changes involving the sigmoid colon. No
appendicolith is visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Multiple old right lateral rib fractures.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Bowel wall thickening and pericolonic inflammatory changes involving the
transverse colon through the rectum, likely in keeping with infectious colitis
given the provided clinical history. No pneumoperitoneum or free fluid.
2. Bilateral renal hypodensities, too small to characterize, however likely
reflecting cysts.
|
10153740-RR-19
| 10,153,740 | 21,432,113 |
RR
| 19 |
2144-04-29 15:36:00
|
2144-04-30 12:41:00
|
EXAMINATION: MRI of the pelvis with and without contrast
INDICATION: ___ year old woman with unusual Hx of perirectal fistula to Right
labia and significant sepsis -> s/p LIFT procedure -> resolution seen in
Clinic 6 days ago no mass/swelling but d/c ulceration in anal canal ->
improved. now w/ recurrent labia mass/swelling, I D last night in ED = no pus,
cavity // please evaluate for undrained perianal/rectal/labial abscess,
evaluate for fistula, Crohn's Dz
TECHNIQUE: Multiplanar MRI of the pelvis is obtained at 1.5 Tesla per the
perianal fistula protocol. T1 and T2 weighted sequences are acquired both pre
and post administration of 6 mL of gadavist.
COMPARISON: None
FINDINGS:
The uterus is anteverted and with approximate ___ of 9.3 x 4.5 x 5.2
cm. Slight nodularity is of signal noted at the level of the fundus, not
evaluated in its entirety on this examination but likely on the basis of
multiple intramural small fibroids. There is thinning of the anterior lower
uterine segment with associated susceptibility artifact and cystic change,
consistent with prior C-section.
Aside from several small nabothian cysts the cervix is unremarkable.
There are tiny follicular type cysts associated with each ovary. On the right
note is made of a small hydrosalpinx (___). There is also a 2 cm cystic
structure within undulating peripherally hyperenhancing contour, most
suggestive of a corpus luteum cyst. No solid lesion of concern is noted within
the pelvis. There is no hemorrhage or evidence of endometriosis.
The rectum the maintains normal wall thickness and enhancement pattern. There
is no perirectal edema or fluid. Several small mesorectal lymph nodes are
noted just above the pelvic sling (901:70), as well as more superiorly at the
level of the mid rectum (901:82). Several bilateral subcentimeter obturator
nodes are also noted (901:88).
The majority of the anal sphincter complex is intact, demonstrating normal
bulk and signal. There is hyperenhancement and loss of the normal
intersphincteric architecture along the anterior and right aspect of the lower
anus with mild T2 hyperintensity and hyperenhancement and multiple foci of
susceptibility artifact likely reflecting prior LIFT. Stranding and hyperemia
extends towards the ischioanal fossa, right greater than left, and towards the
skin surface of the right gluteal fold (902:24) . Abutting anteriorly at the
anal verge, just right of midline, and against the posterior lateral aspect of
the inferior vagina/introitus, is a 11 mm pocket of T2 hyperintense, T1
hypointense and nonenhancing fluid. This is surrounded by a thick rind of T2
hypointense and hyperenhancing soft tissue. This appears to communicate with a
a fairly wide tract extending inferiorly towards the skin surface of the right
perineum (04:24 and 902:24). The contents of this tract are nonenhancing.
However, within the very distalmost aspect of the tract is focal T2
hypointense filling defect with mild susceptibility artifact (04:24 and
06:28). Correlation with prior instrumentalization or intervention at this
location is recommended. Skin thickening and subcutaneous inflammation extends
throughout this area and across the right labia (05:35).
Osseous structures are unremarkable.
IMPRESSION:
Post-LIFT changes along the right lower intersphincteric space with
inflammatory changes extending inferiorly and anteriorly as described above,
worse on the right, and abutting a right anterior 1.1 cm abscess. The abscess
communicates with a tract extending towards the skin surface of the right
perineum without obvious exit. A distal defect distally could represent
debris. Adjacent soft tissue swelling and hyperemia extends along the right
anterior perineum and throughout the right labia.
|
10154074-RR-25
| 10,154,074 | 28,722,607 |
RR
| 25 |
2162-07-04 18:51:00
|
2162-07-04 19:12:00
|
INDICATION: ___ with s/p knee replacmenet now with increasing redness,
warmth, swelling.// eval hardware with c/f post op infection
TECHNIQUE: AP, lateral, and oblique views of the left knee.
COMPARISON: Postoperative films from ___.
FINDINGS:
Postoperative changes of left total knee arthroplasty are again noted. There
is no evidence of periaortic hardware lucency nor fracture. Significant soft
tissue swelling seen overlying and inferior to the patella. There is no
unexpected radiopaque foreign body or subcutaneous edema. Prior drains have
been removed. Evaluation for presence of effusion is limited.
IMPRESSION:
Significant soft tissue swelling. No evidence of hardware related
complication.
|
10154074-RR-26
| 10,154,074 | 28,722,607 |
RR
| 26 |
2162-07-04 18:17:00
|
2162-07-04 18:49:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with history of knee replacement 1 week ago now with swelling
of left lower extremity and pain.// eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10154074-RR-27
| 10,154,074 | 28,722,607 |
RR
| 27 |
2162-07-04 20:54:00
|
2162-07-04 21:25:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old man with left total knee replacement with c/f joint
aspiration. Needs feasibility study to eval for joint tap.// Feasibility
Ultrasound for eventual joint aspiration
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left knee.
COMPARISON: Left knee radiographs from ___
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left knee.
IMPRESSION:
In the superficial soft tissues overlying the left knee, there is a 7 x 2.5 x
13 cm complex fluid collection with internal echoes but no internal
vascularity, which is most compatible with a hematoma. No appreciable joint
effusion is seen.
RECOMMENDATION(S): Complex fluid collection in the soft tissues overlying the
left knee is most compatible with a hematoma, however superimposed infection
cannot be excluded. No suprapatellar joint effusion.
|
10154074-RR-28
| 10,154,074 | 28,722,607 |
RR
| 28 |
2162-07-05 10:43:00
|
2162-07-05 17:17:00
|
EXAMINATION: Ultrasound-guided knee aspiration.)
INDICATION: ___ year old man with ?knee infection// L knee joint aspiration
TECHNIQUE: The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under ultrasound guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
2 cc of 1% Lidocaine was used to achieve local anesthesia. Under intermittent
ultrasound guidance, a 20-gauge spinal needle was advanced into the left knee
via the lateral anterior compartment. Then, approximately 10 cc of dark
brown, hemorrhagic fluid was aspirated.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in good
condition. There were no immediate complications.
COMPARISON: Left knee radiographs ___.
FINDINGS:
1. Large heterogeneous prepatellar collection which is not definitely
communicate with the intra-articular space.
2. A small intra-articular fluid collection along the anterolateral
compartment of the knee.
IMPRESSION:
1. Imaging Findings - as above.
2. Procedure - Uneventful ultrasound-guided aspiration of 10 cc dark brown
hemorrhagic fluid from the anterolateral compartment of the left knee, which
was sent for Gram stain/culture as well as cell count and differential as
requested.
I Dr. ___ personally supervised the Resident/Fellow during the key
components of the above procedure and I have reviewed and agree with the
Resident/Fellow findings/dictation.
|
10154074-RR-29
| 10,154,074 | 28,722,607 |
RR
| 29 |
2162-07-05 20:42:00
|
2162-07-05 22:26:00
|
EXAMINATION: KNEE (2 VIEWS) LEFT
INDICATION: ___ year old man s/p left knee liner exchange// eval of prosthesis
TECHNIQUE: Left knee two views
COMPARISON: ___
FINDINGS:
Left knee arthroplasty. Postoperative changes in the soft tissues, surgical
drain.
IMPRESSION:
Left knee arthroplasty
|
10154074-RR-30
| 10,154,074 | 28,722,607 |
RR
| 30 |
2162-07-08 09:49:00
|
2162-07-08 15:53:00
|
INDICATION: ___ year old man with two drains in, one pulled, concerned for
piece left in knee// retained object
TECHNIQUE: AP and lateral views of the left knee.
COMPARISON: Left knee films from ___.
FINDINGS:
Postoperative changes of left total knee arthroplasty are again noted without
evidence of hardware related complication. Since prior, one of the two drains
has been removed. One remains in place. There is no discontinuity of the
drain nor evidence of retained drain fragment. Extensive swelling and some
associated subcutaneous gas is noted.
IMPRESSION:
One of two drains remains in place without discontinuity or unexpected
retained catheter fragment.
|
10154271-RR-82
| 10,154,271 | 25,314,369 |
RR
| 82 |
2149-11-16 10:49:00
|
2149-11-16 11:41:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with ruq abd pain// ? gall stones, cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MR abdomen from ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no suspicious liver mass. Again seen is a 1.6 x 1.8
x 1.8 cm echogenic lesion at the dome liver, consistent with previously
described hemangioma on prior MR study. The main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 3 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 11.6 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No evidence of gallbladder pathology.
2. Stable appearance of hemangioma at the hepatic dome.
|
10154271-RR-83
| 10,154,271 | 25,314,369 |
RR
| 83 |
2149-11-16 12:22:00
|
2149-11-16 13:36:00
|
EXAMINATION: CT chest, abdomen, and pelvis
INDICATION: ___ with R sided chest, abdominal, and back pain// Concern for PE
vs abdominal process
TECHNIQUE: CTA through the chest performed with axial, coronal, sagittal, and
oblique reformations. A CT portal venous space of the abdomen pelvis
performed utilizing a split bolus technique with multiplanar reformations also
provided. No oral contrast was administered.
DOSE: Total DLP (Body) = 1,258 mGy-cm.
COMPARISON: Prior MRI of the abdomen from ___, prior chest
radiograph from ___.
FINDINGS:
Chest CTA: The base of neck, there is marked enlargement of the left thyroid
lobe containing innumerable small nodules likely a goiter, only partially
visualized. Please correlate with prior workup and in the absence of prior
work-up a nonemergent thyroid ultrasound may be performed to further assess.
Thoracic aorta enhances normally without signs of dissection, aneurysm or
significant atherosclerosis. The heart is mildly enlarged with biatrial
chamber enlargement. No pericardial effusion. The main pulmonary artery is
enlarged measuring 4.2 cm in diameter. Please correlate for pulmonary
arterial hypertension. There is no filling defect within the pulmonary
arterial tree to suggest the presence of a pulmonary embolism. There is no
lymphadenopathy. The airways centrally patent. No pleural or pericardial
effusion is seen.
Hypoventilatory changes within the lungs without worrisome nodule, mass, or
consolidation.
ABDOMEN: A hepatic hypodensity consistent with previously characterized
hemangioma. Slight heterogeneity of the enhancement of the liver may reflect
mild passive congestion. Main portal vein is patent. No biliary ductal
dilation. The gallbladder, pancreas and spleen appear normal. Adrenal glands
are normal bilaterally. Simple appearing renal cysts are noted. No
hydronephrosis or worrisome renal lesion. No signs of pyelonephritis. The
abdominal aorta contains mild atherosclerotic calcification and is normal in
caliber. No lymphadenopathy, free air or free fluid.
The stomach is decompressed as is the duodenum.
PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The
appendix is normal. The colon is mostly decompressed containing a mild fecal
load. Calcified uterine fibroids are noted. No adnexal mass. Urinary
bladder is partially distended appearing normal. No pelvic sidewall or
inguinal adenopathy.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Grade 1 anterolisthesis of L4 on L5 noted without pars defects. Significant
posterior facet arthropathy in the lower lumbar spine with at least moderate
degenerative disc disease at L5-S1.
IMPRESSION:
1. No pulmonary embolism or acute aortic process.
2. Dilated main pulmonary artery, correlate for pulmonary arterial
hypertension.
3. Mild to moderate cardiomegaly with biatrial chamber enlargement.
4. Nodular thyroid enlargement, likely goiter, correlate clinically and with
ultrasound in the absence of prior work-up.
5. Slightly heterogeneous enhancement of the liver, possibly due to passive
congestion, correlate clinically.
6. Calcified uterine fibroids.
|
10154473-RR-100
| 10,154,473 | 27,559,862 |
RR
| 100 |
2190-07-26 10:58:00
|
2190-07-26 12:26:00
|
EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old man with ongoing LUE area of firmness; excluding DVT
to determine ?need for AC // ?progress of thrombosis
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: ___
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
Note is made of blunted phases City in the right subclavian vein with respect
to the left.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, and basilic veins are patent,
compressible and show normal color flow. The left cephalic vein remains
thrombosed and noncompressible, in unchanged distribution compared to the
prior study.
IMPRESSION:
1. No change in thrombosis of the left cephalic vein with no evidence of deep
vein thrombosis in the left upper extremity.
2. Asymmetry of phasicity within the right subclavian vein waveform compared
to the left, a finding that is of uncertain significance but could indicate a
more proximal relative impedance to blood flow on the right, and could be
further evaluated with chest CT if clinically indicated.
RECOMMENDATION(S): Chest CTV could be performed for assessment of asymmetric
phasicity of the subclavian vein waveforms (i.e. to exclude more central
venous stenosis, compression or thrombosis) if clinically relevant.
NOTIFICATION: The findings were discussed with Dr ___. by
___, M.D. on the telephone on ___ at 12:25 ___, 5 minutes after
discovery of the findings.
|
10154473-RR-102
| 10,154,473 | 27,559,862 |
RR
| 102 |
2190-07-28 13:39:00
|
2190-07-28 17:56:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with osteo // please obtain CTV to r/o stenosis
TECHNIQUE: Contiguous axial images were obtained through the chest with
intravenous contrast. Coronal and sagittal reformats were obtained.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.3 s, 37.1 cm; CTDIvol = 4.5 mGy (Body) DLP = 163.3
mGy-cm.
2) Spiral Acquisition 5.4 s, 35.1 cm; CTDIvol = 17.3 mGy (Body) DLP = 594.8
mGy-cm.
Total DLP (Body) = 758 mGy-cm.
COMPARISON: CT torso ___, CT abdomen ___, MRCP ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: There are multiple bilateral
hypodense millimetric nodules in an enlarged thyroid. No supraclavicular or
axillary lymphadenopathy.
UPPER ABDOMEN: Hiatal hernia is small. Innumerable cystic lesions throughout
the pancreas, bilateral adrenal adenomas, and bilateral renal cysts are
similar to and better evaluated on prior MRI.
MEDIASTINUM: No mediastinal mass or lymphadenopathy. There is an 8 mm lower
right paratracheal lymph node.
HILA: No hilar lymphadenopathy.
HEART and PERICARDIUM: Heart size is normal. There is coronary artery
calcification. No pericardial effusion.
PLEURA: Trace right pleural effusion with mild associated atelectasis. No
left effusion or pneumothorax.
LUNG:
1. PARENCHYMA: There is a 2 mm ground-glass nodule in the right upper lobe
(04:49) and a 3 mm fissural nodule on the left (4:78), of doubtful clinical
significance. No focal consolidation.
2. AIRWAYS: The airways are patent to subsegmental levels.
VESSELS: The main pulmonary artery measures up to 3.3 cm, similar to prior.
The great vessels are otherwise normal caliber. Severe compression of the
right subclavian vein near the junction with the internal jugular vein, is due
to a narrow thoracic inlet. There is no mass or thrombus. Otherwise no
significant stenosis of the imaged portions of the axillary, subclavian,
internal jugular, and brachiocephalic veins or SVC.
CHEST CAGE: No suspicious lytic or sclerotic lesion. No acute fracture. Old
posterior right rib fractures are seen. Spinal hardware is partially imaged.
IMPRESSION:
1. Severe compression of the right subclavian vein near the junction with the
internal jugular vein, likely due to a narrow thoracic inlet. No mass or
thrombus. Other major veins intact.
2. Mild enlargement of the main pulmonary artery raises the question of
possible pulmonary hypertension.
|
10154473-RR-103
| 10,154,473 | 27,559,862 |
RR
| 103 |
2190-08-01 13:11:00
|
2190-08-01 15:44:00
|
INDICATION: ___ year old man with osteomyelitis, R sided thoracic INLET
syndrome, L sided extensive superficial thrombophlebitis. Needs 6 weeks and
FX. Please place tunneled single lumen non-power access line.
COMPARISON: CT chest of ___.
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___,
attending radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
75 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 32 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
FLUOROSCOPY TIME AND DOSE: 2 min, 37 seconds, 26 mGy
Medications: In addition to fentanyl and midazolam, 10 mg of hydralazine was
administered.
PROCEDURE:
1. Tunneled non-dialysis line placement
PROCEDURE DETAILS: Following the explanation of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The access site was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A ___ single lumen ___ catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. Final spot fluoroscopic image demonstrating
good alignment of the catheter and no kinking. The tip is in the right atrium.
The catheter was flushed and each lumen was capped. The catheter was sutured
in place with 0 silk sutures. ___ subcuticular Vicryl sutures and
Steri-strips were used to close the venotomy incision site. Steri-Strips were
applied. Sterile dressings were applied. The patient tolerated the procedure
well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing ___ single
lumen ___ catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a ___ single lumen ___ tunneled line via the right
internal jugular venous approach. The tip of the catheter terminates in the
right atrium. The catheter is ready for use.
|
10154473-RR-82
| 10,154,473 | 24,152,652 |
RR
| 82 |
2189-02-26 20:50:00
|
2189-02-27 12:03:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with episode of slurred speech // ?evidence of
stroke
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions. Dynamic
MRA of the neck was performed during administration of 20 T0 cc of Multihance
intravenous contrast. Brain imaging was performed with sagittal T1 and axial
FLAIR, T2, gradient echo and diffusion technique. Postcontrast imaging of the
brain was additionally performed. Three dimensional maximum intensity
projection and segmented images were generated. This report is based on
interpretation of all of these images.
COMPARISON: Noncontrast CT head ___.
FINDINGS:
MRI Brain:
There is no evidence of hemorrhage, edema, masses or infarction. There is no
pathologic enhancement. There is mild generalized prominence of the cerebral
sulci and cisterns. The ventricles are normal in size.
Prominent cisterna magna.
Major intravascular flow voids are preserved. There is normal enhancement of
the major intracranial arteries and dural venous sinuses following contrast
administration.
There is mild ethmoid and moderate maxillary sinus mucosal thickening. The
paranasal sinuses otherwise appear clear. There is fluid in the mastoid air
cells, left greater than right, as seen on recent CT.
Status post left lens replacement.
MRA brain:
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis, occlusion, or aneurysm
more than 3 mm within the resolution of the study.
There is likely fenestration of the proximal basilar artery.
The anterior inferior cerebellar arteries are not well seen.
Mild contour irregularity of the cavernous carotid segments on both sides.
MRA neck:
The common, internal and external carotid arteries appear patent without focal
flow-limiting stenosis or occlusion.
3 vessel arch pattern.
There is no evidence of internal carotid artery stenosis by NASCET criteria.
The origins of the great vessels, subclavian and vertebral arteries appear
normal bilaterally. There is 3 vessel aortic arch anatomy. The visualized
aortic arch is normal.
Degenerative changes in the cervical spine, not adequately assessed.
IMPRESSION:
1. No hemorrhage or acute infarct. No evidence of chronic small vessel
ischemic disease.
2. No focal flow-limiting stenosis or occlusion on MRA head.
3. Normal MRA neck with no internal carotid artery stenosis by NASCET
criteria and no vertebral artery stenosis.
Other details as above.
|
10154473-RR-98
| 10,154,473 | 27,559,862 |
RR
| 98 |
2190-07-19 17:37:00
|
2190-07-19 18:11:00
|
INDICATION: ___ with severely swollen R middle finger // gas?
COMPARISON: ___
FINDINGS:
AP, lateral, oblique views of the right long finger. There has been prior
amputation at the index finger at the level of the mid phalanx. Flexion at
the DIP joint of the right long finger is unchanged from prior. There is
severe degenerative disease at the DIP joint of the long finger. There is
significant soft tissue swelling at the long finger without soft tissue gas or
osseous destruction to suggest the presence of osteomyelitis. Subtle cortical
irregularity at the dorsal aspect of the distal phalangeal tuft on the lateral
view raises potential concern for early osteomyelitis versus periosteal
reaction.
IMPRESSION:
Soft tissue swelling at the long finger without soft tissue gas. Subtle
cortical regularity tuft of the terminal phalanx of the long finger raises
potential concern for very early osteomyelitis versus periostitis.
|
10154473-RR-99
| 10,154,473 | 27,559,862 |
RR
| 99 |
2190-07-24 13:02:00
|
2190-07-24 15:27:00
|
EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old man with firm area of prior IV in LUE // ?LUE DVT;
pls also assess soft tissue in antecubitum for ?phlegmon
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 and basilic veins are patent,
compressible and show normal color flow and augmentation.
There is thrombus within the left cephalic vein from the antecubital fossa
extending proximally, near the junction with the axillary vein.
IMPRESSION:
1. Left cephalic vein thrombus originating at the antecubital fossa and
extending proximally, near the junction with the axillary vein.
2. No deep vein thrombus.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 3:25 ___, 30 minutes
after discovery of the findings.
|
10154479-RR-23
| 10,154,479 | 29,648,489 |
RR
| 23 |
2138-03-26 02:39:00
|
2138-03-26 03:46:00
|
INDICATION: ___ woman with productive cough, to rule out infection.
COMPARISON: None available.
PA AND LATERAL CHEST RADIOGRAPHS: The cardiomediastinal and hilar contours
are normal. The lungs are hyperinflated. No consolidation, pleural effusion
or pneumothorax is seen. A large hiatal hernia is present.
IMPRESSION: Hyperinflated lungs suggestive of COPD. No acute abnormality.
|
10154479-RR-24
| 10,154,479 | 29,648,489 |
RR
| 24 |
2138-03-26 04:13:00
|
2138-03-26 05:07:00
|
INDICATION: ___ woman with sore throat for one day, to rule out
retropharyngeal abscess.
COMPARISON: None available.
TECHNIQUE: MDCT helical images were acquired through the neck after
administration of 70 mL of Omnipaque intravenous contrast. Sagittal and
coronal reformats were generated and reviewed.
FINDINGS: The nasopharynx, oropharynx and hypopharyngeal spaces are normal,
without evidence of deep cervical infection. There is no evidence of a
retropharyngeal abscess. The larynx and airway are normal in the imaged
portion. No significant cervical adenopathy is seen. The parotid and
submandibular salivary glands are normal. The thyroid gland is normal.
The imaged portion of the brain appears unremarkable. The cervical vessels
are normal. Moderate atherosclerotic calcification is seen in the aortic
arch. The imaged lung apices demonstrate mild centrilobular emphysema and
minimal bi-apical pleural parenchymal scarring.
The imaged paranasal sinuses and mastoid air cells are clear. No periapical
lucency is identified. Extensive dental implants with streak artifacts are
noted. There is reversal of normal cervical lordosis with moderate
degenerative changes at C4-C5, C5-C6 and C6-C7 levels. Mild anterolisthesis
of C3 on C4 is noted.
IMPRESSION:
No acute abnormality identified in the neck, especially no retropharyngeal
abscess.
NOTE ADDED AT ATTENDING REVIEW: There is diffuse supraglottic and to lesser
extent glottic swelling. The epiglottis appears normal, there is no evidence
of adenopathy, and no abscess is identified. This does not appear focal enough
to suggest a neoplasm and appears more likely to be due to inflammation. The
airway is somewhat narrowed, most markedly at the level of the true cords,
series 2 image 56. Given this appearance, we suggest the patient return for
evaluation by ENT. This revised interpretation was discussed by telephone with
the ED QA nurse, ___, at 11 am on ___ by Dr. ___.
|
10154578-RR-19
| 10,154,578 | 29,824,487 |
RR
| 19 |
2153-08-14 00:10:00
|
2153-08-14 05:33:00
|
INDICATION: Status post fall, recent necrosis of right hip, pain of the right
hip with decreased movement. Please evaluate for fracture.
COMPARISON: Comparison is made to right hip radiographs performed ___ and MR hip performed ___.
Single AP view of pelvis. Right hip, two views.
FINDINGS: Exam appears largely unchanged with bone-on-bone contact of the
right femoral head and acetabulum. Right femoral head is flattened and
laterally subluxed in regards to the acetabulum. There is stable patchy
sclerosis within the femoral head. No new fracture lines are identified. The
remainder of the pelvis and left hip are unremarkable.
IMPRESSION: Largely unchanged exam with a markedly abnormal right
femoroacetabular joint with flattening, sclerosis and a lateral superior
subluxation of the femoral head. As before the differential diagnosis
includes septic arthritis versus AVN.
|
10154578-RR-20
| 10,154,578 | 29,824,487 |
RR
| 20 |
2153-08-14 01:19:00
|
2153-08-14 05:45:00
|
INDICATION: Pneumonia.
COMPARISON: Comparison is made to chest radiograph performed ___.
FINDINGS: Chest PA and lateral radiograph demonstrates a tortuous aorta with
questionable prominence of the ascending aortic contour. Heart size is normal.
Th previously noted right lower lung opacity has largely resolved with minimal
residual linear opacities evident on the lateral view, likely
post-inflammatory. There has been interval resolution of the previously
identified right lower lung opacity. Multiple calcified nodules identified,
the largest located in the left upper lung. No pleural effusion or
pneumothorax evident.
IMPRESSION: Tortuous aorta with prominence of ascending aortic contour. If
clinical conern, could be further evaluated with chest CT. Multiple calcified
granulomas.
|
10155329-RR-3
| 10,155,329 | 21,745,132 |
RR
| 3 |
2128-05-31 01:10:00
|
2128-05-31 03:51:00
|
EXAMINATION: TRAUMA #2 (AP CXR AND PELVIS PORT)
INDICATION: History: ___ with trauma, eval chest and pevlis*** WARNING ***
Multiple patients with same last name!// trauma, eval chest and pevlis
TECHNIQUE: Single frontal view of the chest
COMPARISON: None.
FINDINGS:
Chest radiograph: Cardiac size is normal. The lungs are clear. There is no
pneumothorax or pleural effusion.
Abdominal radiograph: No dilated loops of small or large bowel. Bullet
fragment is noted projecting over the right buttocks measuring 1.7 cm with
adjacent soft tissue stranding.
IMPRESSION:
Chest radiograph: Normal chest radiograph.
Abdominal radiograph: Bullet fragment noted projecting over the right buttocks
measuring 1.7 cm
|
10155329-RR-4
| 10,155,329 | 21,745,132 |
RR
| 4 |
2128-05-31 01:18:00
|
2128-05-31 02:37:00
|
EXAMINATION: CT abdomen pelvis
INDICATION: +PO contrast; History: ___ with please perform with RECTAL
contrast, NO PO CONTRAST, to eval for rectal perforation due to GSW+PO
contrast*** WARNING *** Multiple patients with same last name!// please
perform with RECTAL contrast, NO PO CONTRAST, to eval for rectal perforation
due to GSW
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Rectal contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.3 s, 57.8 cm; CTDIvol = 13.7 mGy (Body) DLP = 790.6
mGy-cm.
Total DLP (Body) = 791 mGy-cm.
COMPARISON: CT torso ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: Patient status post splenectomy.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is agenesis of the right kidney. Left kidney is visualized.
There is no evidence of focal renal lesions within the limitations of an
unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis.
There is no perinephric abnormality. Again, a well-circumscribed multicystic
structure with calcification noted lateral to the IVC and adjacent to the
appendix, incompletely characterized on this study (601; 46) and may represent
a mucocele, mesenteric axis, carcinoid, or lymphangioma should be further
assessed with a contrast enhanced study.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are
distended with contrast without evidence of extraluminal contrast
extravasation. The appendix is normal.
No pneumoperitoneum. No free intraperitoneal fluid.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is a comminuted minimally displaced fracture through bilateral
aspects of S5, potentially involving the S4-S5 level as well (2; 162).
SOFT TISSUES:Hyperdense fluid collection compatible with presacral hematoma
are noted posterior to the rectum (2; 65). Again, multiple scattered foci of
soft tissue air are noted extending transversely from the left lateral buttock
across the midline through the presacral region and into the right buttock
with associated subcutaneous fat stranding consistent with a bullet tract.
There is a bullet fragment measuring up to 1.7 cm noted in the subcutaneous
tissues projecting over the right buttock with adjacent 3.2 x 6.2 cm fluid
collection ___ 52 consistent with hematoma (2; 183).
IMPRESSION:
1. No extraluminal contrast extravasation of the rectum.
2. Presacral hematoma noted with comminuted minimally displaced fracture of S5
with possible extension to S4-S5.
3. Stable scattered foci of soft tissue air is noted in the bullet tract with
a 1.7 cm bullet fragment the right buttock subcutaneous tissues within
adjacent subcutaneous hematoma.
4. Well-circumscribed multi-cystic structure lateral to the right of the IVC
with calcifications incompletely characterized on this noncontrast scan.
Differential includes mesenteric cyst, carcinoid, or lymphangioma. Recommend
further evaluation with contrast-enhanced study.
NOTIFICATION: Updated findings text-paged to Dr. ___ at 9:16am on
___.
|
10155336-RR-16
| 10,155,336 | 22,060,295 |
RR
| 16 |
2187-05-26 10:26:00
|
2187-05-26 19:20:00
|
MRI AND MRA BRAIN AND MRA NECK WITHOUT AND WITH CONTRAST, ___
HISTORY: Recurrent episodes of sudden right hemisensory loss and
hemiparaplegia. Is there evidence of infarction?
Axial T1-weighted fat-saturated images were obtained through the neck. Brain
imaging was performed with sagittal short TR, short TE spin echo, and axial
three-dimensional time-of-flight MRA, FLAIR, long TR, long TE fast spin echo,
gradient echo, and diffusion technique. Contrast-enhanced MRA of the neck was
performed. Comparison to a head CT of ___.
FINDINGS: There is no evidence of hemorrhage, edema, masses, mass effect, or
infarction. The ventricles and sulci are normal in caliber and configuration.
Incidentally noted are mucus retention cysts containing inspissated mucus in
the maxillary sinuses bilaterally. The FLAIR images demonstrate several
scattered subcortical and periventricular white matter hyperintensities on
FLAIR. These are usually of no clinical significance.
The brain MRA examination demonstrates no evidence of vascular stenosis,
occlusion, or aneurysm formation. The left vertebral artery is dominant.
The neck MRA demonstrates a normal appearance of the origins of the great
vessels, the carotid and vertebral artery origins, and the carotid
bifurcations bilaterally. There are no stenoses by NASCET criteria.
These findings were discussed with Dr. ___ by Dr. ___, in person at 6
p.m. on ___.
CONCLUSION: No evidence of hemorrhage or infarction. No vascular
abnormalities are detected. Scattered white matter hyperintensities on FLAIR,
unlikely to be of clinical significance.
|
10155734-RR-46
| 10,155,734 | 20,692,891 |
RR
| 46 |
2133-04-09 16:10:00
|
2133-04-09 18:06:00
|
EXAMINATION: Chest radiograph, portable AP upright view.
INDICATION: Recent alcohol use. New fever.
COMPARISON: Prior study from ___.
FINDINGS:
Heart is mildly enlarged, somewhat increased. There are small suspected
pleural effusions with atelectasis at each lung base. Slight suspected
vascular congestion. Metallic fragments again project over the right
supraclavicular region and axilla.
IMPRESSION:
Mild new cardiomegaly. Suspected small pleural effusions with opacities very
likely due to minor basilar atelectasis. Pneumonia seems less likely to
explain these. Slight vascular congestion.
|
10155734-RR-47
| 10,155,734 | 20,692,891 |
RR
| 47 |
2133-04-11 09:24:00
|
2133-04-11 12:11:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with ETOH use, fevers, c/f aspiration// please
evaluate for pneumonia please evaluate for pneumonia
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Mild interstitial edema is new. Loss of volume in the left lower lobe has
improved, but there is still dense consolidation there and there is more
consolidation at the right lung base, both concerning for pneumonia. Small
pleural effusions are stable. Heart not enlarged.
Shrapnel fragments project over the right shoulder and lower neck.
Right PIC line ends in the low SVC.
|
10155734-RR-48
| 10,155,734 | 20,692,891 |
RR
| 48 |
2133-04-11 15:36:00
|
2133-04-11 16:59:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with new onset hemoptysis and history of prior
clots// r/o DVTs
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
Right:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Left:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
A simple appearing fluid collection within the posteromedial left thigh, along
the joint line, at the level of the popliteal fossa, measures approximately
1.8 x 1.0 x 1.2 cm. No definite evidence of medial popliteal fossa (___)
cyst.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins.
2. 1.8 cm simple fluid collection within the posteromedial left thigh
subcutaneous tissues, not in the expected location for ___ cyst, possibly
reflecting synovial fluid.
|
10155734-RR-50
| 10,155,734 | 20,692,891 |
RR
| 50 |
2133-04-15 04:15:00
|
2133-04-15 09:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man prior gastric bypass with gastric ulcer bleeding,
now s/p L VATS vagotomy// r/o htx, ptx, effusion-- POD#1 ___- 0600
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 11 hours prior.
FINDINGS:
A right-sided PICC line terminates at the cavoatrial junction. Chest tube
projects over the mid left chest similar in position compared to prior exam.
Cardiomediastinal and hilar contours are grossly stable. Small right pleural
effusion is unchanged. No evidence of pneumothorax. There has been no
significant interval change in the mild interstitial process suggestive of
edema. Bibasilar atelectasis is persistent. Metallic densities project over
the right upper chest and axillary regions. Slight interval increase in left
subcutaneous emphysema.
IMPRESSION:
-No significant interval change in the extent of the mild interstitial edema
compared to the prior exam.
-Slight interval increase in left subcutaneous emphysema.
-No evidence of pneumothorax.
|
10155734-RR-51
| 10,155,734 | 20,692,891 |
RR
| 51 |
2133-04-14 16:40:00
|
2133-04-14 17:47:00
|
EXAMINATION: Chest radiograph, portable AP upright.
INDICATION: Prior gastric bypass with bleeding gastric ulcer, now status post
VATS vagotomy.
COMPARISON: Prior study from ___.
FINDINGS:
PICC line terminates at the cavoatrial junction. Chest tube projects over the
left mid chest. Cardiac, mediastinal and hilar contours appear stable. Small
right-sided pleural effusion is probably unchanged, no definite one on the
left. No pneumothorax. There is very similar mild interstitial process
suggesting edema. Basilar opacities suggesting atelectasis of shown some
improvement. Metallic densities against project over the right upper chest
and axillary regions.
IMPRESSION:
Decreased atelectasis at each lung base. Findings consistent with persistent
mild interstitial edema.
|
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