note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
10155734-RR-53
| 10,155,734 | 20,692,891 |
RR
| 53 |
2133-04-15 12:25:00
|
2133-04-15 15:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man w/ reduced EF and melena, now s/p vagotomy w/
left chest tube removal// evaluate for pulmonary edema, hemorrhage/hemothorax
evaluate for pulmonary edema, hemorrhage/hemothorax
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Cardiomegaly is severe.
Interstitial pulmonary edema is moderate, unchanged. No interval increase in
bilateral currently small pleural effusion is seen. Left chest tube has been
discontinued.
|
10155734-RR-54
| 10,155,734 | 20,692,891 |
RR
| 54 |
2133-04-16 01:20:00
|
2133-04-16 10:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ is a ___ year old man with PMH notable for pAF, stroke
on Eliquis, gastric bypass ___ years ago, alcohol abuse who presents with >1
week melena, worsening lightheadedness with no source of bleed seen on EGD,
colonoscopy with capsule study demonstrating diffuse gastric ulceration with
bleeding now s/p ulcer cauterization with thoracic surgery on board and risk
assessment work up significant for new decreased EF/wall motion abnormality.//
interval change s/p chest tube removal. Hgb drop
TECHNIQUE: Portable chest x-ray
COMPARISON: Distal tip of the right upper extremity PICC line is at the caval
atrial junction. Metal fragments overlie the right upper thorax consistent
with prior gunshot 1.
The heart is mildly enlarged. There is blunting of both costophrenic angles
suggesting small bilateral pleural effusions. Bilateral platelike
atelectasis. Stable interstitial pulmonary edema. No focal consolidation or
pneumothorax.
FINDINGS:
Stable interstitial pulmonary edema. Small bilateral pleural effusions.
|
10155734-RR-55
| 10,155,734 | 20,692,891 |
RR
| 55 |
2133-04-16 12:32:00
|
2133-04-16 17:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new hypotension, recent intrathoracic
procedure// r/o infection/complication from procedure
TECHNIQUE: Portable chest x-ray
COMPARISON: Chest x-ray 11 hours prior
FINDINGS:
Distal tip of the right upper extremity PICC line is at the caval atrial
junction. There is slight interval worsening of the interstitial pulmonary
edema. No pneumothorax or focal consolidation. Small bilateral pleural
effusions and bibasilar atelectasis.
IMPRESSION:
Slight interval worsening of interstitial pulmonary edema. Stable small
bilateral pleural effusions and bibasilar atelectasis.
|
10155734-RR-56
| 10,155,734 | 20,692,891 |
RR
| 56 |
2133-04-18 02:31:00
|
2133-04-18 08:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PMH notable for pAF, strokeon Eliquis,
gastric bypass ___ years ago, alcohol abuse who presents with >1 week melena,
worsening lightheadedness with no source of bleed seen on EGD, colonoscopy
with capsule study demonstrating diffuse gastric ulceration with bleeding now
s/p ulcer cauterization with thoracic surgery on board and risk assessment
work up significant for new decreased EF/wall motion abnormality.// fever,
interval change fever, interval change
IMPRESSION:
Compared to chest radiographs since ___ most recently ___
through ___.
Mild pulmonary edema, small pleural effusions, and poor aeration, left lower
lobe has fluctuated since ___, but has not the improved since ___. Cardiomegaly is mild.
Right PIC line ends in the low SVC. Shrapnel has been present in the soft
tissues of the right chest since at least ___..
|
10155734-RR-57
| 10,155,734 | 20,692,891 |
RR
| 57 |
2133-04-18 15:33:00
|
2133-04-18 16:37:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with fever overnight, recent VATS surgery// ?
retrocardiac pneumonia ? retrocardiac pneumonia
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Pulmonary edema has substantially improved since ___. Consolidation
persists in the infrahilar left lower lobe, could be pneumonia or atelectasis.
Emphysema and interstitial fibrosis are chronic. Small right pleural effusion
has decreased. Mild cardiomegaly is long-standing.
Shrapnel noted in soft tissues of the right upper chest and lower neck.
Right PIC line ends close to the superior cavoatrial junction.
|
10155734-RR-71
| 10,155,734 | 20,778,459 |
RR
| 71 |
2133-12-23 16:37:00
|
2133-12-23 17:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with SOB*** WARNING *** Multiple patients with same
last name!// ?pulm edema
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Shrapnel again projects over the right upper chest. There has been interval
removal of a previously seen left-sided PICC. Cardiac silhouette size is
mildly enlarged. Mediastinal contours are grossly stable. There is
persistent blunting of the right costophrenic angle. Bibasilar fibrotic
changes are re-demonstrated. There is central pulmonary vascular engorgement
without overt pulmonary edema.
IMPRESSION:
Central pulmonary vascular engorgement without overt pulmonary edema.
Chronic blunting of the right costophrenic angle. Re-demonstrated bibasilar
chronic fibrotic changes.
|
10155734-RR-72
| 10,155,734 | 20,778,459 |
RR
| 72 |
2133-12-25 13:41:00
|
2133-12-25 14:54:00
|
EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old man with DVT in LUE with persistent swelling despite
apixaban. // Please evaluate for DVT.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: Multiple prior left upper extremity ultrasound, most recently ___.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
There is redemonstration of occlusive thrombus within the left subclavian vein
which is noncompressible and demonstrates minimal internal color Doppler flow.
The left axillary vein demonstrates occlusive thrombus with minimal internal
color Doppler flow and noncompressibility, similar to the prior exam. The
left internal jugular vein is patent. There is now normal color flow,
spectral Doppler, and compressibility of the brachial veins, as compared to ___.
The basilic vein is largely patent and compressible. There is new occlusive
thrombus in the distal half of the cephalic vein, with the proximal portion
patent demonstrating normal spectral Doppler flow.
IMPRESSION:
1. Redemonstration of occlusive thrombus in the left subclavian and axillary
veins, not appreciably changed compared to ___.
2. New patency of the brachial and basilic veins as compared to the prior
examination.
3. New occlusive thrombus in the distal half of the cephalic vein.
|
10155766-RR-21
| 10,155,766 | 29,723,268 |
RR
| 21 |
2143-05-21 16:43:00
|
2143-05-21 18:55:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with no significant PMH with biliary colic found to have
cholelithiasis at OSH. // r/o cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. Main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: There is substantial cholelithiasis but no gallbladder wall
thickening or pericholecystic fluid. The gallbladder is noted to be only
partially distended. A focal area of hyperechogenicity in the non-dependent
position of the wall may reflect adenomyomatosis versus less likely an
adherent stone.
IMPRESSION:
Substantial cholelithiasis without evidence of cholecystitis. Possible focal
area of wall adenomyomatosis.
Increased echogenicity of the liver parenchyma likely due to fatty liver.
|
10155766-RR-25
| 10,155,766 | 23,391,823 |
RR
| 25 |
2144-08-27 00:37:00
|
2144-08-27 08:01:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p exlap, washout, now with fever // interval
change/consolidation? interval change/consolidation?
IMPRESSION:
No comparison. The lung volumes are low. Mild cardiomegaly without pulmonary
edema. Bilaterally at the lung bases parenchymal opacities with air
bronchograms are visualized. In the appropriate clinical setting these
opacities reflect pneumonia. No pleural effusions. No pneumothorax. Normal
hilar and mediastinal contours.
|
10155766-RR-26
| 10,155,766 | 23,391,823 |
RR
| 26 |
2144-08-29 12:32:00
|
2144-08-29 16:10:00
|
INDICATION: ___ year old man s/p exp. lap, washout abscesses, febrile //
evaluate for abdominal/pelvic collection with IV contrast
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 5.2 s, 57.4 cm; CTDIvol = 16.9 mGy (Body) DLP = 967.6
mGy-cm.
Total DLP (Body) = 980 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast ___
FINDINGS:
LOWER CHEST: Small areas of consolidations are identified in bilateral lung
bases posteriorly. Consolidation on the right is larger than left. Small
bilateral pleural effusions are increased than before.
ABDOMEN:
Small amount of ascites is noted. 2 abdominal drains are noted entering
through the right lateral abdominal wall. The drain that enters lower at the
abdominal wall terminates just anterior to the right posterior abdominal wall
fluid collection. The other drain that enters superiorly at the abdominal
wall terminates at the right anterior abdomen.
The fluid collection in the right posterior abdominal wall measures 8.4 x 7.3
x 1.9 cm, smaller than before (previously 10.3 x 9.2 x 3.9 cm).
Small 1.2 cm fluid collection at the anterior bladder dome is smaller than
before (previously 1.5 cm). Focus of air is noted in the fluid collection.
There is small focus of intraluminal air in the bladder. Immediately superior
to this fluid collection in the bladder dome, there is another elongated fluid
collection tracking superiorly to the level of umbilicus and to the midline
incision, measuring approximately 9.2 x 3.6 x 1.5 cm (2:74, 602b:42). Several
foci of air is noted in anti-dependent portion of the fluid collection.
Compared to ___, this fluid collection is slightly larger and assumes more
elongated shape (previously 4.4 x 4.3 x 3.0 cm).
A 4.1 x 2.3 cm pocket of fluid is identified in the right aspect of mesentery
(02:56). A separate 7.7 x 2.5 cm pocket of fluid is identified in the right
anterior pelvis (2:81). These 2 pockets of fluid are new since ___.
HEPATOBILIARY: A 1.4 cm ill-defined area of hypodensity in the posterior
margin of the liver (02:23) is stable or slightly smaller than before. This
finding may reflect phlegmon. There is no evidence of focal lesions. There
is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: A 4.2 cm well-circumscribed hypodense lesion in the left kidney lower
pole is consistent with a simple renal cyst. There is no hydronephrosis.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: Bladder as described above.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: Enlarged epiphrenic lymph node measures 1.3 cm in short axis
(02:16), similar to before. Prominent retroperitoneal lymph nodes are likely
reactive and are not pathologically enlarged.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is diffuse subcutaneous tissue edema.
IMPRESSION:
1. The fluid collection deep to the midline anterior abdominal wall incision
is larger than before. There are 2 new small pockets of fluid in the right
abdomen since ___.
2. Fluid collections in the right posterior abdominal wall and anterior
bladder dome are smaller than before. Two abdominal drains are not in the
fluid collections.
3. New focal consolidations in the posterior bilateral lower lobes may
represent aspiration, pneumonia, or atelectasis. Small bilateral pleural
effusions are larger compared to ___.
NOTIFICATION: The impression 2 and 3 were discussed with ___, N.P. by
___, M.D. on the telephone on ___ at 3:00 ___, 10 minutes after
discovery of the findings.
The impression 1 was discussed with ___, N.P. by ___, M.D. on
the telephone on ___ at 3:59 ___, 5 minutes after discovery of the
findings.
|
10155766-RR-27
| 10,155,766 | 23,391,823 |
RR
| 27 |
2144-08-30 14:48:00
|
2144-08-30 16:45:00
|
EXAMINATION: Ultrasound-guided drainage of a right lower quadrant fluid
collection.
INDICATION: ___ year old man with intra-abdominal abscess, s/p exp lap,
washout of abscesses, with recurrent fever, sweat, cat scan with multiple
abdominal collections // aspiration and drainage of abd. fluid collections
COMPARISON: CT from ___
PROCEDURE: Ultrasound-guided drainage of right lower quadrant collection.
OPERATORS: Dr. ___ fellow and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agree with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection. Based on
the ultrasound findings an appropriate skin entry site for the needle was
chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using continuous sonographic guidance, an 18 gauge spinal needle was advanced
into the RLQ collection. A sample of fluid was aspirated, confirming position
within the collection.
Approximately 6 cc of serous fluid was drained with a sample sent for
microbiology evaluation. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
0.5 mg Versed and 50 mcg fentanyl throughout the total intra-service time of
11 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Revisualization of the patient's right lower quadrant fluid collection, today
measuring 4.3 x 2.1 x 5.1 cm. This appeared septated and slightly
heterogeneous. This fluid collection was targeted for aspiration.
The patient's retrohepatic/right flank collection was re- visualized,
measuring 8.9 x 5.1 x 2.8 cm. For the most part, it was solid, with only a
small amount of fluid noted centrally. There were 2 hyperechoic foci noted
within this collection, measuring up to 1.3 cm. These are concerning for
dropped gallstones.
The patient's midline collection was not well visualized, likely due to
overlying bowel gas and dressings.
IMPRESSION:
Successful US-guided aspiration of a right lower quadrant collection as
detailed above.
Persistent retrohepatic/right flank collection measuring 8.9 x 5.1 x 2.8 cm
which was for the most part solid, with only small amounts of fluid noted
centrally. There were 2 hyperechoic foci noted within this collection
measuring up to 1.3 cm, concerning for dropped gallstones.
|
10155766-RR-28
| 10,155,766 | 23,391,823 |
RR
| 28 |
2144-09-01 07:01:00
|
2144-09-01 14:25:00
|
EXAMINATION: INTRAOPERATIVE ULTRASOUND
INDICATION: ___ year old man with intra-abdominal abscesses ___ dropped
gallstones from laparoscopic cholecystectomy ___ // Assistance with
localization of dropped gallstones
TECHNIQUE: Scans of the right flank at the site of chronic abscess and drop
stones.
COMPARISON: Ultrasound ___.
FINDINGS:
Initial scans were performed from within the abdomen using and end-fire IOUS
probe. Subsequently scans were performed on the skin surface of the right
flank using a standard abdominal imaging probe. Neither approach was
successful at identifying any retained stones within the site of the chronic
abscess.
Twos tiny stone fragments were identified visually and removed by a the
surgeons.
IMPRESSION:
No retained stones could be identified sonographically.
|
10155766-RR-29
| 10,155,766 | 23,391,823 |
RR
| 29 |
2144-09-01 20:45:00
|
2144-09-02 07:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p exlap/washout, dyspnea/hypoxia // interval
change
IMPRESSION:
In comparison to ___ radiograph, lung volumes are extremely low,
accentuating the cardiac silhouette and bronchovascular structures. Allowing
for this factor, bibasilar atelectasis is probably relatively similar to the
prior study. Probable small bilateral pleural effusions.
|
10155766-RR-30
| 10,155,766 | 23,391,823 |
RR
| 30 |
2144-09-04 14:35:00
|
2144-09-04 17:30:00
|
INDICATION: ___ year old man s/p exp. lap, washout of abscesses, re-do
washout, stone retrival, now with vomitting // compare to prior studies,
obstruction vs ileus
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
There are loops of dilated small bowel measuring up to 5.6 cm in the left
upper quadrant with air-fluid level, new since ___. There are
string of foci of air in the mid abdomen, likely from dilated small bowel
loops. There is air in the distal colon. There are no abnormally dilated
loops of large bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable. Surgical clips are seen in the right
upper quadrant and 2 right-sided drains are in place.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Dilated small bowel loops with air-fluid level measuring up to 5.6 cm in the
left upper quadrant, concerning for partial or early complete small bowel
obstruction.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 5:26 ___, 10 minutes after
discovery of the findings.
|
10155766-RR-31
| 10,155,766 | 23,391,823 |
RR
| 31 |
2144-09-06 13:16:00
|
2144-09-06 13:56:00
|
INDICATION: ___ year old man with new picc.
TECHNIQUE: Frontal view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
A new right PICC ends at the cavoatrial junction. No pneumothorax identified.
The lung volumes are low which causes crowding of the bronchovascular
structures and bibasilar atelectasis. No pleural effusion identified. The
cardiac and mediastinal silhouettes are stable.
IMPRESSION:
New right PICC ends at the cavoatrial junction.
|
10155841-RR-21
| 10,155,841 | 22,166,204 |
RR
| 21 |
2161-10-17 01:54:00
|
2161-10-17 09:15:00
|
EXAMINATION: MR HIP ___ CONRAST LEFT
INDICATION: ___ year old woman with L hip pain after fall// hip fracture
TECHNIQUE: Multiplanar images of the left hip were performed without the
administration of intravenous contrast. Obtained sequences include coronal
T1, coronal STIR, axial T1, and axial T2 fat-sat of the pelvis and sagittal
STIR, axial PD fat sat and sagittal PD fat-sat of the left hip.
COMPARISON: Same day x-ray and CT.
FINDINGS:
Pelvis: Alignment appears preserved. Bloom artifact from right total hip
prosthesis is seen. Mild right and moderate left proximal hamstrings
tendinosis with possible partial tearing of the left proximal hamstrings
tendons. Mild degenerative changes pubic symphysis. Exam is not optimized
for evaluation of intrapelvic structures.
Left hip: There is a vertically oriented fracture which extends from the
superior femoral head neck junction inferiorly toward the intratrochanteric
region. There does not appear to be a definite cortical break/exit
inferiorly.
Reticular STIR hyperintense and T1 hypointense signal inferior to the fracture
line within the intramedullary canal of the proximal femur likely represents a
combination of posttraumatic edema and hemorrhage.
Multilobular collection of T1 and STIR hypointense signal interposed between
the gluteus maximus and medius at the level of the greater trochanter
corresponds with CT hyperintensity, most consistent with a hematoma. This
area measures 5.0 x 3.3 by 2.5 cm.
Fluid signal at the gluteus minimus insertion with apparent heterogeneity and
thinning of the tendon may represent a partial tear.
Left femoroacetabular joint appears well aligned. Mild cartilage space
narrowing of the left femoroacetabular joint. Anterior superior labral tear.
Small amount of subchondral cystic change of the superolateral acetabulum.
Trace joint effusion.
IMPRESSION:
1. Nondisplaced, likely impaction type fracture involves the superior left
femoral head neck junction and extends inferiorly to the intratrochanteric
region without definite inferior cortical involvement/exit.
2. Moderate-sized hematoma interposed between the left gluteus medius and
maximus muscles posterior to the greater trochanter.
3. Possible partial tear of the distal gluteus minimus tendon on the left.
4. Moderate tendinosis of the proximal left hamstrings with likely partial
tearing.
NOTIFICATION: The findings were discussed with ___ M.D. by ___
___, M.D. on the telephone on ___ at 8:23 am, 15 minutes after
discovery of the findings.
|
10155841-RR-22
| 10,155,841 | 22,166,204 |
RR
| 22 |
2161-10-17 13:54:00
|
2161-10-17 15:35:00
|
INDICATION: Left hip fracture. ORIF.
COMPARISON: MRI from ___
IMPRESSION:
Intraoperative images demonstrate a dynamic compression screw and plate within
the proximal left femur stabilizing a femoral neck fracture. No hardware
related complications are seen. The total intraservice fluoroscopic time was
124.5 seconds. Please refer to the operative note for additional details.
|
10155841-RR-23
| 10,155,841 | 22,166,204 |
RR
| 23 |
2161-10-18 10:18:00
|
2161-10-18 11:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p Left hip fixation with emesis x2 overnight,
wanting to rule out evolving aspiration PNA// ? aspiration PNA ?
aspiration PNA
IMPRESSION:
Comparison to ___. The known parenchymal opacity in the right
upper lobe has not substantially changed. Minimal peribronchial thickening at
the bases of the right lung. Borderline size of the heart. No pulmonary
edema, no pleural effusions.
|
10155841-RR-26
| 10,155,841 | 21,958,750 |
RR
| 26 |
2163-07-21 16:06:00
|
2163-07-21 17:02:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with r sided hemiplegia Cr today osh 1.0 // ?stroke
?LVO ?pna
TECHNIQUE: AP and lateral chest radiographs
COMPARISON: Multiple prior radiographs, most recently dated ___
FINDINGS:
Right apical opacities may reflect sequela of prior cavitary pneumonia
(___). Mild interstitial prominence is seen bilaterally. No
pneumothorax or pleural effusion. The size of the cardiac silhouette is
borderline enlarged.
IMPRESSION:
Mild pulmonary vascular congestion. No focal consolidation. Right apical
opacities may reflect scarring following the history of prior cavitary right
upper lobe pneumonia.
|
10155841-RR-27
| 10,155,841 | 21,958,750 |
RR
| 27 |
2163-07-21 13:24:00
|
2163-07-21 13:43:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: History: ___ with stroke // stroke protocol.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
intravenous administration of 55 mL of Omnipaque 350 nonionic contrast agent.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 65.3 mGy (Head) DLP =
32.7 mGy-cm.
3) Spiral Acquisition 4.8 s, 38.0 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,212.1 mGy-cm.
Total DLP (Head) = 2,148 mGy-cm.
COMPARISON: None available.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction,hemorrhage,edema,ormass. Punctate
hyperdensity in the right middle cerebral artery region is seen. There is a
small area of hypoattenuation in the area of the basal ganglia, likely
representing lacunar ischemic changes. Periventricular and subcortical white
matter hypoattenuation is related to microvascular atherosclerotic disease.
The ventricles and sulci are normal in size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells,and middle
ear cavities are clear. The visualized portion of the orbits are normal.
CTA HEAD:
A 4 mm saccular aneurysm (measured in the transverse dimension) is seen at the
bifurcation of the M1-M2 segment of the right MCA (3; 230). Otherwise the
intracranial internal cerebral arteries are unremarkable. The left MCA and
the ACA is are widely patent. The basilar artery, and the bilateral vertebral
arteries and the posterior cerebral arteries are unremarkable. The dural
venous sinuses are patent.
CTA NECK: Mild calcification of the thoracic aorta, otherwise nonaneurysmal.
The bilateral common carotid arteries are widely patent. There is moderate
calcification involving the left carotid bifurcation with associated 50%
narrowing by NASCET criteria. There is minimal calcification at the right
carotid bifurcation without significant narrowing by NASCET criteria. The
bilateral vertebral arteries are widely patent.
OTHER:
In the lungs, there are mosaic changes, pleural scarring, and bullous
emphysema in the apices with a small left pleural effusion. There are also
areas of pleural thickening, retraction, and fibrous changes in the right
lung. Moderate degenerative changes are seen along the cervical spine,
including mild anterolisthesis of C2-3 and retrolisthesis of C4-5.
IMPRESSION:
1. No acute intracranial abnormality. No evidence of an acute stroke,
hemorrhage, or intracranial mass.
2. 4 mm saccular aneurysm of the M1/M2 junction of the right MCA. Otherwise
unremarkable CT of the head.
3. Moderate calcification at the left carotid bifurcation with at least 50%
ICA narrowing by NASCET criteria
|
10155841-RR-30
| 10,155,841 | 21,958,750 |
RR
| 30 |
2163-07-21 18:43:00
|
2163-07-21 19:37:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old woman POD s/p knee replacement // Eval
effusion/hemarthrosis
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right knee
COMPARISON: None
FINDINGS:
A right knee prosthesis is present, overall in near anatomic alignment. There
is no evidence of hardware related complications or periprostatic fracture.
Soft tissue swelling is present around the knee as well as a small joint
effusion.
IMPRESSION:
Right knee prosthesis, overall in near anatomic alignment.
|
10155841-RR-31
| 10,155,841 | 21,958,750 |
RR
| 31 |
2163-07-22 10:54:00
|
2163-07-22 13:53:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: History: ___ with stroke // Assess for stroke stroke
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CTA head and neck from ___.
FINDINGS:
Multiple foci of slow diffusion within the left frontal lobe with correlating
FLAIR hyperintensity consistent with a subacute infarcts (series 6, image 14,
19, 15 and 21). In addition, in the left temporal lobe, there is increased
DWI signal with no decreased ADC correlate, associated FLAIR hyperintensity,
punctate T1 shortening, susceptibility, and gyriform enhancement consistent
with a subacute infarct, with probable associated detail hemorrhage. Upon
retrospective review of the previous head CT, there is a high density
correlate with this finding which is unchanged in size, reflecting blood
products or cortical laminar necrosis.. No evidence of intracranial, mass or
midline shift. There are several areas of similar increased DWI signal
without ADC correlate with associated T2 prolongation also seen in the white
matter of the right frontal lobe, for example image 20 series 6 and image 15
series 6. Known 4 mm right MCA aneurysm is better assessed on previous CTA
head. There is no evidence of abnormal enhancement.
Metallic artifact from intra calvarial BB markers obscures detail from
adjacent structures. The ventricles and sulci are prominent consistent with
age-related involutional change. The orbits are unremarkable.
IMPRESSION:
1. Multiple foci of diffusion abnormality with correlating FLAIR
hyperintensity is concerning for subacute infarcts due to a embolic source.
2. Focus of enhancement and susceptibility in the left temporal lobe
consistent with late subacute infarction, with potential petechial hemorrhage
and/or in combination with cortical laminar necrosis. No significant change
compared to the prior head CT.
3. 4 mm right MCA aneurysm better assessed on prior CTA.
|
10155841-RR-33
| 10,155,841 | 27,706,701 |
RR
| 33 |
2163-08-02 13:24:00
|
2163-08-02 14:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with dyspnea, atrial fibrillation // r/o pneumonia,
pulmonary edema, effusion or other acute cardiopulmonary abnormality
COMPARISON: ___, CT of the chest from ___
FINDINGS:
AP portable upright view of the chest. Overlying EKG leads are present.
Chronic linear densities in the right upper lung may reflect fibrotic changes
which appear unchanged dating back to a chest radiograph from ___.
Elsewhere, lungs are clear without consolidation, effusion, pneumothorax. The
heart appears mildly enlarged though unchanged. Mediastinal contour stable.
Bony structures are intact.
IMPRESSION:
Chronic appearing fibrosis in the right upper lung. Mild cardiac enlargement.
Otherwise unremarkable. No signs of edema or pneumonia.
|
10155841-RR-34
| 10,155,841 | 27,706,701 |
RR
| 34 |
2163-08-02 14:38:00
|
2163-08-02 15:26:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with shortness of breath and fever as well as dysuria, recent
knee replacement on ___ // Rule out pneumonia, pulmonary edema or other
acute abnormalities.
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) = 378 mGy-cm.
COMPARISON: CT chest ___, chest radiograph ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
segmental 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 a common origin of the right brachiocephalic
and the left common carotid artery. There is mild cardiomegaly. Otherwise,
the heart, pericardium, and great vessels are within normal limits.
Atherosclerotic calcifications are seen along the aortic valve annulus. 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: Redemonstration of severe bilateral emphysematous changes.
There is bibasilar atelectasis, as well as a region of parenchymal scarring in
the right upper lobe extending to the pleura, which may reflect sequela of
prior infection as seen on ___ CT. No focal consolidation is seen. The
airways are patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Small hiatal hernia. There is a 2.2 cm rounded hypodense structure
within the liver (2:93), which may represent a hepatic cyst.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Mild degenerative changes are seen within the thoracic spine.
IMPRESSION:
1. No evidence of pulmonary embolism to the segmental level.
2. Severe emphysema with chronic scarring of the right upper lobe.
3. Mild cardiomegaly.
|
10155841-RR-35
| 10,155,841 | 27,706,701 |
RR
| 35 |
2163-08-03 07:15:00
|
2163-08-03 10:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new O2 requirement and afib with RVR //
evidence of pulmonary edema or other etiology of sob evidence of
pulmonary edema or other etiology of sob
IMPRESSION:
Interval development of moderate to severe interstitial pulmonary edema is
demonstrated, bilateral symmetric new as compared to yesterday. No
appreciable pleural effusion is currently seen. No pneumothorax is seen
Heart size is normal. There is distended azygos vein, consistent with volume
overload/pulmonary edema.
NOTIFICATION: The findings were discussed with ___ , m.D. by ___
___, M.D. on the telephone on ___ at 10:12 am, 5 minutes after
discovery of the findings.
|
10155915-RR-10
| 10,155,915 | 20,393,363 |
RR
| 10 |
2126-05-22 18:43:00
|
2126-05-22 19:29:00
|
HISTORY: TTP now with headaches. Evaluate for bleed.
TECHNIQUE: Continuous axial sections were acquired through the brain without
the administration of IV contrast.
DLP: 891.93 mGy/cm.
CTDIvol: 54.63 mGy.
COMPARISON: Head MRI on ___.
FINDINGS: Although limited by recent IV contrast administration, there is no
acute hemorrhage, edema or shift of the midline structures. The ventricles
and sulci are of normal size and configuration. The gray-white matter
differentiation is preserved, without evidence for an acute infarction. The
basal cisterns remain patent. There is no fracture. The imaged paranasal
sinuses and mastoid air cells are well aerated. The imaged lenses and globes
are normal.
IMPRESSION: No acute intracranial process.
|
10155915-RR-11
| 10,155,915 | 20,393,363 |
RR
| 11 |
2126-05-22 18:51:00
|
2126-05-23 08:10:00
|
CHEST RADIOGRAPH
INDICATION: Cough, leukocytosis, rule out pneumonia.
COMPARISON: No comparison available at the time of dictation.
FINDINGS: The lung volumes are normal. In the left upper lobe, a relatively
diffuse parenchymal opacity with air bronchograms is seen. The opacities
consistent with pneumonia. There is no pneumothorax or pleural effusion.
Mild tortuosity of the ascending aorta, leading to blunting of the right
paratracheal stripe. Size of the cardiac silhouette is at the upper range of
normal. There is evidence of minimal pleural effusions.
The findings were communicated by telephone at the time of discovery by wet
read.
|
10155915-RR-12
| 10,155,915 | 20,393,363 |
RR
| 12 |
2126-05-23 11:29:00
|
2126-05-23 18:38:00
|
HISTORY: ___ woman with TTP, triple-lumen pheresis line requested.
COMPARISON: Chest x-ray ___. . No prior central venous access
studies available.
RADIOLOGISTS: Dr. ___, supervising and present throughout
the procedure, Dr. ___ fellow).
PROCEDURE: Temporary dialysis catheter placement.
ANESTHESIA: 100 mcg of fentanyl was administered in two doses throughout the
total interest service time of 25 min during which the patients hemodynamic
parameters were continuously monitored. Local anesthesia with 1% lidocaine
was given over the right jugular access site.
PROCEDURE IN DETAIL :
An informed written consent was obtained after explaining the procedure,
benefits, alternatives and risks involved. The patient was brought to the
angiography suite and placed supine on the imaging table. The right neck was
prepped and draped in the usual sterile fashion. A preprocedural time out was
performed per ___ protocol.
Using ultrasound guidance, the patent and compressible right internal jugular
vein was accessed using standard micropuncture technique. Pre- and post
venous access digital ultrasound images were stored on PACS. A ___ wire was
advanced through the micropuncture sheath into the inferior vena cava for
stability. The micropuncture sheath was then removed and a soft tissue tract
was dilated using 10 and 12 ___ dilators. A 14 ___ 15 cm pheresis
catheter with VIP port (trialysis) was then advanced over the ___ wire. The
tip of the catheter was positioned in the right cavoatrial junction. The
guidewire was removed. All 3 ports aspirated and flushed easily. Each was
flushed with saline and capped. The catheter was secured to the skin using
___ silk sutures and a sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
Patent and compressible right internal jugular vein.
IMPRESSION:
Uncomplicated placement of a temporary pheresis catheter with VIP port via the
right internal jugular vein (14 ___, 15 cm). The tip terminates at the
cavoatrial junction and is ready for use.
|
10155915-RR-8
| 10,155,915 | 20,393,363 |
RR
| 8 |
2126-05-19 08:40:00
|
2126-05-19 09:49:00
|
INDICATION: Chronic diarrhea with acute worsening status post flexible
sigmoidoscopy concerning for ulcerative colitis. A second opinion of imaging
performed at ___ on ___ at 5:27 p.m.
prior to transfer to ___ is requested.
TECHNIQUE: MDCT axial images were acquired from the lung bases to the pubic
symphysis with oral and 100 mL Isovue intravenous contrast. Delayed images of
the abdomen were obtained. Coronal reformatted images were provided for
review.
FINDINGS: The visualized lung bases are clear. There is no pleural or
pericardial effusion.
Within the left hepatic lobe, there is a lobulated 1.9-cm hypodensity with the
attenuation of a simple cyst. No prior imaging is available from ___ to
assess for stability. The remainder of the liver is normal and no focal
concerning liver lesion is identified. There is no intra- or extra-hepatic
bile duct dilation. The gallbladder, spleen, pancreas and bilateral adrenal
glands are normal. The kidneys enhance symmetrically and excrete contrast
promptly without hydronephrosis.
There is no bowel obstruction. The appendix is visualized and is normal
(3:98). There is no free fluid and no free air. The abdominal aorta is of
normal caliber throughout. The main portal vein, splenic vein and SMV are
patent. Para-aortic and aortocaval lymph nodes are not enlarged by CT size
criteria, measuring up to 9 mm in the left paraaortic (602:34, 3:81) and
aortocaval stations (3:71).
CT PELVIS: The rectum is normal. Bowel wall thickening with mild adjacent
stranding in the sigmoid is noted. The bladder and uterus are normal. The
right ovary is normal. Within the left adnexa, there is a 3.1 x 3.7 cm simple
cyst, within the physiologic range if the patient is premenopausal. There is
no free fluid. A left iliac node (3:108) is borderline enlarged to 10 mm and a
9mm node is seen at the right pelvic side wall. There is a small
fat-containing left inguinal hernia.
BONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.
IMPRESSION:
1. Mild sigmoid colitis, which may be infectious or inflammatory. Borderline
pelvic and retroperitoneal lymph nodes are likely reactive. Repeat CT with
rectal volumen or MRI may be helpful if further imaging is going to be
performed.
2. Left adnexal 3.7-cm cyst. If the patient is premenopausal, this is within
the physiologic range. If the patient is postmenopausal, followup with
dedicated pelvic ultrasound is recommended in one year.
3. 1.9-cm left hepatic lobe simple cyst. No prior imaging is available from
___ to compare, but it does not have concerning features on this study and no
specific follow up is required.
|
10155915-RR-9
| 10,155,915 | 20,393,363 |
RR
| 9 |
2126-05-21 12:25:00
|
2126-05-21 15:16:00
|
EXAM: CT of the abdomen and pelvis with oral and IV contrast.
INDICATION: ___ year-old patient with lupus and chronic diarrhea and worsening
pain. Previous CT on ___ suggested of mild colitis. Follow up because of
worsening symptoms.
TECHNIQUE: 64-row MDCT of the abdomen and pelvis was done with oral and IV
contrast. 130 cc of Omnipaque injected with split bolus technique.
Multiplanar image displays.
DLP: 56 mGy-cm.
COMPARISON: ___.
FINDINGS:
Images through the lower chest show no abnormality.
LIVER: Normal in size with no focal solid mass. A slightly lobular cyst at
the dome is seen with no interval change. No other focal lesions. There is
no bile duct dilatation and the gallbladder is normal.
PANCREAS: Normal in size with no focal mass or diffuse enlargement. There is
no peripancreatic stranding.
SPLEEN: Normal in size and homogeneous.
ADRENAL GLANDS: Normal in size and shape.
KIDNEYS: Normal in size with no focal solid or cystic mass. There is no
hydronephrosis. Symmetric nephrograms and excretion of contrast.
ABDOMEN: There is no retroperitoneal or mesenteric lymph node enlargement or
other mass. No abnormal fluid collections.
GI TRACT: The stomach and duodenum show no abnormalities. There is no small
bowel dilatation or other obstructing lesion. The GI is normal. The colon is
well filled with oral contrast throughout with no signs of wall thickening
down to the level of the sigmoid. In the distal sigmoid, there is mild fold
thickening. No mesenteric or other mesenteric fat stranding or vascular
engorgement. The appearance of the sigmoid appears better than on the
previous exam of ___.
In the pelvis, there is no free fluid. The uterus is normal. A cyst in the
left ovary persists and measures 2.4 x 3.1 cm (compared to 3.1 x 3.7 cm on the
previous study).
VASCULAR: No abdominal aortic aneurysm and the distal abdominal aorta
measures 1.73 cm. No occlusive aneurysmal disease in the other great vessels
of the abdomen.
There is no free fluid in the abdomen or pelvis.
SKELETAL: There is mild scoliosis of the spine. No blastic or lytic lesions.
IMPRESSION: Persistent thickening of folds in the mid and distal sigmoid
colon with no signs of fat stranding or pericolonic phlegmon.
|
10156068-RR-2
| 10,156,068 | 24,238,743 |
RR
| 2 |
2114-11-13 09:21:00
|
2114-11-13 11:04:00
|
INDICATION: ___ man with nausea, vomiting, and periumbilical pain,
now with right lower quadrant tenderness on exam, question appendicitis.
COMPARISONS: None.
TECHNIQUE: MDCT axial imaging was obtained from the lung bases through the
pubic symphysis following the administration of intravenous contrast material.
Coronal and sagittal reformats were completed.
FINDINGS:
CT ABDOMEN WITH CONTRAST: The visualized heart and pericardium are
unremarkable. The lung bases are clear. There is no pericardial or pleural
effusion. The liver enhances homogeneously without any focal lesions. Portal
vein is patent. The gallbladder, pancreas, and spleen are unremarkable. The
kidneys enhance and excrete contrast symmetrically without any hydronephrosis.
In the upper pole of the right kidney is a small sub-cm hypodense lesion that
is too small to characterize and most likely represents a cyst. The adrenal
glands are unremarkable. The stomach, small and intra-abdominal large bowel
are unremarkable. There is no free fluid or free air or lymphadenopathy
within the abdomen. The intra-abdominal vasculature is unremarkable.
CT PELVIS: The appendix is dilated to 8 mm and fluid filled with a
hyperenhancing wall consistent with acute appendicitis. Also seen is a
proximal obstructing appendicolith, image 601B:17. Distally is a small amount
of trapped air, image 601B:11. There is no evidence of perforation or abscess
formation. There is a small amount of free fluid layering dependently within
the pelvis. The rectum and sigmoid colon are unremarkable. The bladder and
prostate gland are unremarkable. There is no pelvic lymphadenopathy.
OSSEOUS STRUCTURES: There are no suspicious lytic or sclerotic lesions.
IMPRESSION:
1. Dilated fluid-filled appendix with a proximal obstructing appendicolith
consistent with acute appendicitis.
2. Small hypodense lesion in the right kidney, too small to characterize but
most likely a cyst.
|
10156269-RR-82
| 10,156,269 | 22,026,410 |
RR
| 82 |
2191-07-14 11:52:00
|
2191-07-14 12:45:00
|
HISTORY: Productive cough with sputum, chills.
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Patchy bilateral lower lobe opacities are seen, worrisome for multifocal
pneumonia. No pleural effusion is seen. The cardiac and mediastinal
silhouettes are unremarkable. No evidence of pneumothorax is seen.
IMPRESSION:
Patchy bilateral lower lobe opacities worrisome for multifocal pneumonia.
|
10156886-RR-20
| 10,156,886 | 24,201,568 |
RR
| 20 |
2129-08-04 14:35:00
|
2129-08-04 16:21:00
|
INDICATION: ___ male with history of renal cancer with altered mental
status. Rule out renal mets.
COMPARISON: None.
TECHNIQUE: Contiguous axial images were obtained through the brain with and
without the administration of IV contrast. Multiplanar reformats were
generated and reviewed.
FINDINGS: There is no evidence of acute intracranial hemorrhage, discrete
masses, mass effect or shift of normally midline structures. There is no
evidence of vasogenic edema. The ventricles and sulci are normal in size and
configuration. Bilateral mastoid air cells and visualized paranasal sinuses
are clear.
Following the administration of IV contrast after three-minute delay no
enhancing lesions were identified.
IMPRESSION: No definite enhancing lesions identified. No acute intracranial
hemorrhage.
|
10156886-RR-21
| 10,156,886 | 24,201,568 |
RR
| 21 |
2129-08-04 14:35:00
|
2129-08-04 16:46:00
|
INDICATION: ___ male with renal cancer, new abdominal pain, evaluate
for abdominal acute pathology.
COMPARISON: Outside hospital CT of the abdomen ___.
TECHNIQUE: MDCT axial images were obtained through the abdomen and pelvis
with the administration of IV contrast. Multiplanar reformats were generated
and reviewed.
FINDINGS: At the right lung base (2:3) is a 7-mm pulmonary nodule, unchanged
from the prior examination. Additional tiny nodule at the left lung base
(2:4) and at the right lung base (2:5) measuring up to 4 mm are unchanged from
the prior examination. There is bilateral tiny pleural effusion with mild
dependent atelectasis.
ABDOMEN: Diffuse hypodensities within both lobes of the liver appear
consistent with metastases with interval progression compared to the prior
examination. There is now near total involvement of the left lobe of the liver
by hepatic metastases. The liver appears enlarged measuring 29cm in CC
dimension, previously 23cm. The spleen is increased in size compared to the
prior exam, now 19cm, previously 13cm. Patient is status post left nephrectomy
with no lesions within the nephrectomy bed to suggest recurrence. The right
kidney appears unremarkable. The pancreas appears unremarkable.
Retroperitoneal and mesenteric lymph nodes do not meet CT size criteria for
pathology. The intra-abdominal loops of large and small bowel are
unremarkable. There is small volume ascites. There is haziness to the
mesentery which may represent mesenteric edema related to hepatic dysfunction
in the setting of diffuse hepatic metastases. The main portal vein is patent.
The splenic vein appears prominent. The intra-abdominal vasculature appears
unremarkable.
PELVIS: The bladder, distal ureters, rectum and sigmoid colon appear
unremarkable. There is some trace free pelvic fluid. Pelvic lymph nodes do
not meet size criteria for pathology.
BONES: Visualized osseous structures show no focal lytic or sclerotic lesions
suspicious for malignancy. Thre is mild anasarca.
IMPRESSION:
1. Stable pulmonary nodules at bilateral lung bases. Bilateral pleural
effusions.
2. Interval progression of extensive hepatic metastases.
3. Anasarca, mild ascites, and mesenteric edema likely secondary to hepatic
dysfunction in the setting of diffuse hepatic metastases.
4. Splenomegaly likely secondary to increasing portal hypertension in the
setting of widespread hepatic metastasis.
Findings discussed with Dr. ___ at 1:40am on ___ via telephone.
|
10156886-RR-22
| 10,156,886 | 24,201,568 |
RR
| 22 |
2129-08-07 00:43:00
|
2129-08-07 09:54:00
|
HISTORY: ___ man, with history of stage IV clear cell renal cell
carcinoma, now complaining with increasing fatigue, neck pain, confusion and
leukocytosis. The patient is afebrile. Assess for acute intracranial
process.
COMPARISON: CT head with and without contrast on ___.
TECHNIQUE:
MRI head: Multiplanar T1- and T2-weighted images were acquired through the
head before and after administration of IV contrast. Diffusion-weighted
images and ADC maps were also obtained.
MRA HEAD: 3D time-of-flight images were obtained through the brain. 3D
rendering was performed to facilitate evaluation of the intracranial
vasculature.
FINDINGS:
MRI HEAD: There is no abnormal intracranial enhancement to suggest
metastasis. There is no intracranial hemorrhage or edema. No acute
infarction is noted. The gray-white matter differentiation is preserved. The
ventricles and sulci are normal in size for age. There is no shift of
normally midline structures. Major vascular flow voids are present. There is
mild ethmoidal mucosal thickening, but the remaining paranasal sinuses are
clear. Bone marrow signal is grossly unremarkable.
MRA HEAD: Major intracranial vessels are patent. There is no aneurysm
greater than 3 mm. No vascular malformation or flow-limiting stenosis is
noted.
IMPRESSION:
1. No acute intracranial process or acute infarction.
2. No evidence of intracranial metastasis.
3. Normal MRA head.
|
10156886-RR-23
| 10,156,886 | 24,201,568 |
RR
| 23 |
2129-08-08 16:22:00
|
2129-08-08 18:18:00
|
INDICATION: ___ man with new left PICC.
COMPARISON: No prior exams available.
FINDINGS: Portable AP chest radiograph is obtained with patient in the
upright position. Left PICC terminates at the level of the carina in the mid
SVC. Heart is normal size and cardiomediastinal contours are unremarkable.
Lungs are clear. No pleural effusions and no pneumothorax.
IMPRESSION: Left PICC terminates in the mid SVC.
|
10156886-RR-24
| 10,156,886 | 24,201,568 |
RR
| 24 |
2129-08-08 17:59:00
|
2129-08-09 10:38:00
|
HISTORY: Metastatic renal CA, hypercalcemia. Show oblique film to verify
line placement.
CHEST, THREE VIEWS.
A left PICC line is present, the tip overlies the mid SVC. No pneumothorax is
detected.
The heart is not enlarged. The aorta is slightly unfolded. No CHF, focal
infiltrate or effusion is identified. Mild degenerative changes of the
thoracic spine are suggested. No obvious lytic or sclerotic lesion is
detected on these lung-technique films.
|
10157167-RR-11
| 10,157,167 | 29,327,446 |
RR
| 11 |
2158-05-30 06:32:00
|
2158-05-30 07:19:00
|
HISTORY: ___ male with tachycardia and dyspnea.
COMPARISON: None available in the ___ system.
PORTABLE FRONTAL CHEST RADIOGRAPH: The lungs are clear. There is no focal
consolidation or pneumothorax. There is no vascular congestion or pleural
effusions. Cardiomediastinal and hilar contours are within normal limits.
IMPRESSION: No acute cardiopulmonary process.
|
10157362-RR-82
| 10,157,362 | 29,651,209 |
RR
| 82 |
2187-05-29 18:31:00
|
2187-05-29 20:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with dyspnea// pna
COMPARISON: ___
FINDINGS:
AP portable upright view of the chest. Overlying EKG leads are present. Lung
volumes are low. Allowing for this, the lungs are clear. There is no focal
consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. Imaged osseous structures are intact.
IMPRESSION:
No signs of pneumonia.
|
10157454-RR-10
| 10,157,454 | 23,978,280 |
RR
| 10 |
2181-12-03 19:44:00
|
2181-12-03 21:12:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with AMS on warfarin. Evaluation for ICH.
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, 16.2 cm; CTDIvol = 49.4 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.4 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 1,605 mGy-cm.
COMPARISON: Comparison to prior head CT from ___.
FINDINGS:
Evaluation is slightly limited by motion. There is no evidence of acute
infarction,hemorrhage,edema, or mass. There is prominence of the ventricles
and sulci suggestive of involutional changes. Periventricular, subcortical,
and deep white matter hypodensities are nonspecific but compatible with the
sequela of chronic small vessel ischemic disease. A focal hypodensity within
the left basal ganglia is likely compatible with prior lacunar infarct.
There is no evidence of fracture. There is moderate mucosal thickening of the
left maxillary sinus. The remaining paranasal sinuses are clear. The
visualized portion of the mastoid air cells and middle ear cavities are clear.
The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial abnormality.
2. Focal hypodensity within the left basal ganglia, likely compatible with
prior lacunar infarct.
3. Moderate mucosal thickening of the left maxillary sinus suggests ongoing
inflammation.
|
10157454-RR-11
| 10,157,454 | 23,978,280 |
RR
| 11 |
2181-12-03 19:58:00
|
2181-12-03 21:01:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ with Hct drop in 2 weeks and AMS with increased white blood
cell count. Evaluate for intra-abdominal pathology.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.8 s, 53.6 cm; CTDIvol = 25.6 mGy (Body) DLP =
1,372.6 mGy-cm.
Total DLP (Body) = 1,373 mGy-cm.
COMPARISON: Outside hospital chest CT from ___.
FINDINGS:
LOWER CHEST: There is a new moderate nonhemorrhagic right pleural effusion
with adjacent compressive atelectasis. Right basilar consolidation and
opacification is also new, and superimposed infection is considered in the
appropriate clinical setting. The left pleural effusion is small and grossly
unchanged from the prior study, along with adjacent atelectasis. Cardiac size
is mildly enlarged with coronary artery calcifications noted.
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: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: A 3.8 cm nodule is identified in the right adrenal gland, with
internal attenuation of 7.8 ___, compatible with an adenoma. The left adrenal
gland is unremarkable.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis.
GASTROINTESTINAL: The stomach is unremarkable. Portions of the left-sided
small and large bowel loops were excluded from the scan. Imaged small bowel
loops are normal caliber without evidence of dilatation. The colon and rectum
are within normal limits. The appendix is not directly visualized. There is
a small amount of free abdominal fluid.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: A left para-aortic lymph node is enlarged, measuring 1.5 cm in
short axis (2:34). There is no mesenteric lymphadenopathy. There is no
pelvic or inguinal lymphadenopathy.
Several surgical clips are identified in the retroperitoneum at the level of
the aortic bifurcation, possibly due to prior vascular surgery.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: Notably, compared with the prior outside hospital chest CT from ___, there has been progression of the T12 vertebral body compression
deformity, now with increased lucency and cortical destruction, as well as
increased lucency extending from the inferior endplate of the T11 vertebral
body, which has expanded in size (602:48 compared with prior study 605:81).
There is associated paravertebral soft tissue (02:20). Findings are
concerning for infection, such as osteomyelitis discitis. Subacute right
sided rib fractures are again noted with developing callus formation. Chronic
left-sided rib fractures are also seen.
SOFT TISSUES: Heterogeneous hyperdense asymmetric enlargement of the left
psoas muscle (series 2, image 41) is compatible with a hematoma, in the
setting of known anticoagulation. Incidental note is made of diffuse
anasarca.
IMPRESSION:
1. Compared with the outside hospital chest CT from ___,
progression of the T12 vertebral body compression deformity, now with
increased lucency, cortical destruction, paravertebral soft tissue, and
enlarged lucency within the inferior T11 vertebral body. Findings are
concerning for infection resulting in osteomyelitis and discitis, given the
rapid progression. Further assessment with MRI is recommended.
2. Heterogeneous hyperdense asymmetric enlargement of the left psoas muscle
at the level of the inferior left kidney, compatible with a hematoma in the
setting of known anticoagulation.
3. New moderate right pleural effusion with adjacent right lung base
consolidation and atelectasis. Superimposed infection is considered in the
appropriate clinical setting. Small left pleural effusion is relatively
unchanged.
RECOMMENDATION(S): MRI of the thoracic spine is recommended, preferably with
contrast, for further characterization of the new cortical destruction and
lucency in the T11 and T12 vertebral bodies.
NOTIFICATION: The above findings and recommendations were communicated via
telephone by Dr. ___ to Dr. ___ at 20:50 on ___, 2 minutes
after discovery.
|
10157454-RR-12
| 10,157,454 | 23,978,280 |
RR
| 12 |
2181-12-04 23:12:00
|
2181-12-05 14:51:00
|
EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE
INDICATION: ___ year old man with h/o bacteremia now with more + GPCs and
osteo on CT// ___ out abscess, characterize osteomyelitis ___ out
abscess, characterize osteomyelitis ___
out abscess, characterize osteomyelitis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: Prior CT abdomen done ___
FINDINGS:
The study is degraded by motion artifact.
THORACIC:
The thoracic cord appears normal in volume, morphology and signal intensity.
No compromise of the thoracic cord in the spinal canal. No high-grade neural
foraminal stenosis.
There is increased signal intensity with an associated pathological fracture
of the T12 vertebral body. The central aspect of the vertebral body does not
enhance. There is relative preservation of the anterior and posterior
vertebral body heights. There is increased signal intensity in the adjacent
disc, but no focal fluid collections or disc destruction. There is also
disruption of the inferior endplate of the T11 vertebral body with extension
of abnormal T2 and STIR signal intensity into the inferior aspect of this
vertebral body. Edema is also noted in the right and left pedicles of the T12
vertebral body. There is enhancement of the paraspinal soft tissues. There
is an associated T2 mixed hyper and hypointense collection with hypointense
margins in the left psoas muscle 24 x 24 mm in the axial plane and 117 mm in
the craniocaudal plane. This collection is T1 centrally Iso to hypointense
and peripherally hyperintense.
At the T11-12 level there is a small anterior epidural fluid collection
measuring 4 mm in AP diameter which partially effaces the CSF space anterior
to the cord, but there is no cord compromise in the spinal canal.
LUMBAR:
The conus terminates at the L1 level.
There is multilevel degenerative changes of the lumbar spine in the form of
disc desiccation, broad-based disc bulge and protrusions, facet joint
osteophytosis and ligamentum flavum hypertrophy as described below:
L1-2: Disc protrusions with associated facet joint osteophytosis and
ligamentum flavum hypertrophy results in moderate left and right subarticular
zone narrowing. No compromise of the nerve roots in the central aspect of
spinal canal. Moderate left and mild right neural foraminal narrowing.
L2-3: No nerve root compromise in the spinal canal. Mild neural foraminal
narrowing bilateral.
L3-4: Broad-based disc bulge with superimposed left paracentral and proximal
foraminal disc protrusion with associated facet joint osteophytosis and
ligamentum flavum hypertrophy results in moderate severe spinal canal stenosis
with moderate crowding of the nerve roots and almost complete effacement of
the CSF outlining the nerve roots. Moderate severe left and mild moderate
right neural foraminal narrowing.
L4-5: Partial fusion of the vertebral bodies. Mild narrowing of the
subarticular zones, but no nerve root compromise. Mild narrowing of the left
an mild moderate narrowing of the right neural foramina.
L5-S1: No compromise of the nerve roots in the spinal canal. Mild narrowing
of the neural foramina bilateral.
EXTRA-SPINAL: Moderate sized right-sided pleural effusion, small left-sided
pleural effusion. Atelectasis in the left lower lobe. Simple appearing left
renal cortical cysts.
IMPRESSION:
1. The study is degraded by motion artifact.
2. Pathological fracture of the T12 vertebral body with relative preservation
of the anterior and posterior vertebral body heights. The central aspect of
the vertebral body does not enhance in keeping with a pathological fracture
most likely secondary to infection. There is enhancement of the adjacent
paravertebral soft tissue and there is involvement of the inferior aspect of
the T11 vertebral body. These findings are most consistent with a
pathological fracture secondary to/destruction of the T12 vertebral body by
osteomyelitis.
3. There is and associated mixed intensity collection the left psoas muscle
most likely representing a psoas abscess. The signal intensity of the
collection is slightly atypical for an abscess being T2 mixed Iso and
hyperintense with a surrounding T2 hypointense rim and a psoas hematoma
secondary to a pathological fracture should be considered in the differential
diagnosis.
4. Moderate severe spinal canal stenosis at the L3-4 level as well as moderate
severe left L3-4 neural foraminal narrowing described above.
5. No compromise of the thoracic cord in the thoracic spinal canal.
6. Small epidural collection at T11-12.
|
10157454-RR-13
| 10,157,454 | 23,978,280 |
RR
| 13 |
2181-12-06 10:10:00
|
2181-12-06 14:15:00
|
EXAMINATION: MR SHOULDER ___ CONTRAST LEFT
INDICATION: ___ yo man with bacteremia and new shoulder pain.
TECHNIQUE: Multisequence, multiplanar of the left shoulder was performed
without the IV administration of contrast material.
COMPARISON: None
FINDINGS:
Images degraded by motion artifact. Susceptibility artifact anterior to the
shoulder may relate to reported EKG leads found on patient's sheets.
Supraspinatus tendon: Full thickness tear of the leading edge of the distal
supraspinatus tendon. Moderate to high grade articular surface tear of the
remainder of the tendon with differential retraction. Cystic changes of the
greater tuberosity underlie the supraspinatus tendon insertion.
Infraspinatus tendon: Moderate tendinosis with interstitial tearing. A 7 mm
focus of T1 and T2 hypointensity in the distal posterior infraspinatus tendon,
near its insertion, probably reflects hydroxyapatite deposition consistent
with calcific tendinitis. Cystic changes underlie the infraspinatus tendon
insertion.
Teres minor tendon: Unremarkable.
Subscapularis tendon: Moderate tendinosis.
Muscles: There is mild diffuse rotator cuff muscle atrophy with mild
nonspecific edema in the inferior aspect of the supraspinatus musculature.
Acromio-clavicular joint: Moderate degenerative changes including joint space
narrowing, osteophytosis, mild bone marrow edema, and subchondral cystic
change.
Subacromial-subdeltoid bursa: Mild fluid.
Glenohumeral joint: Mild degenerative changes including joint space narrowing,
cartilaginous thinning.
Joint effusion: Trace to small glenohumeral joint effusion.
Hyaline cartilage: Mild cartilaginous thinning along the glenoid and humeral
head.
Glenoid labrum: Amorphous morphology and intermediate signal in the
anterior-inferior glenoid labrum may represent degenerative changes or changes
from prior injury.
Biceps tendon: Intraarticular and intertubercular portions not well seen,
likely due to tear and retraction.
Bone marrow: Degenerative appearing changes as previously described. No focal
lesions. Diffuse red marrow changes.
Axilla: Unremarkable.
IMPRESSION:
1. No findings specific for septic arthritis of the glenohumeral joint. Trace
to small glenohumeral joint effusion, could be related to rotator cuff
pathology and biceps tendon tear, superimposed infection cannot be excluded.
If clinical concern for septic arthritis, joint fluid sampling could be
obtained.
2. Moderate to high-grade articular surface tearing of the supraspinatus
tendon with additional full-thickness tear along the leading edge.
3. Moderate tendinosis and interstitial tearing of the infraspinatus tendon
with probable calcific tendinitis near its insertion. Recommend correlation
with left shoulder radiographs.
4. Likely complete tear of the intra-articular portion of the biceps tendon
with retraction.
5. Small amount of subacromial subdeltoid bursal fluid.
6. Moderate degenerative type changes of the acromioclavicular joint. No
findings specific for septic arthritis.
7. Diffuse red marrow changes.
RECOMMENDATION(S): Left shoulder radiographs.
|
10157454-RR-14
| 10,157,454 | 23,978,280 |
RR
| 14 |
2181-12-05 14:03:00
|
2181-12-05 14:54:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with possible aspiration vs PNA, new oxygen req x
several days// evaluate intervalchange
IMPRESSION:
In comparison with study of ___, the there is further increase in
opacification in the right mid and lower zones. This is consistent with the
clinical suggestion of developing consolidation with increasing pleural
effusion. The pattern along the right lateral chest wall raises the
possibility of the loculated component of fluid. Less prominent effusion on
the left.
Continued enlargement of the cardiac silhouette with increasing pulmonary
vascular congestion.
|
10157454-RR-15
| 10,157,454 | 23,978,280 |
RR
| 15 |
2181-12-06 15:17:00
|
2181-12-06 15:44:00
|
EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) LEFT
INDICATION: ___ year old man with MSSA bacteremia and left shoulder pain// per
ortho request, eval for fracture or joint disease
TECHNIQUE: Three views of the left shoulder
COMPARISON: None
FINDINGS:
There are mild-to-moderate degenerative changes at the acromioclavicular joint
with joint space narrowing marginal spurring. Minimal degenerative spurring
seen at the humeral head compatible with osteoarthritis also. No acute
fracture dislocation is seen. No concerning bone lesion. The acromiohumeral
interval appears somewhat narrowed raising possibility of rotator cuff tear.
IMPRESSION:
Degenerative changes. No acute fracture is seen. Some narrowing of the
acromial humeral interval raises possibility of rotator cuff tear.
|
10157454-RR-16
| 10,157,454 | 23,978,280 |
RR
| 16 |
2181-12-07 09:21:00
|
2181-12-07 09:55:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with Right PICC// Right PICC 45cm, ___ ___
Contact name: ___: ___ Right PICC 45cm, ___ ___
IMPRESSION:
Right PICC line tip most likely terminates in the proximal right atrium and
should be pulled back 4 cm. Patient is in pulmonary edema. Right pleural
effusion is moderate. Left pleural effusion is small. No pneumothorax.
Cardiomegaly.
|
10157454-RR-17
| 10,157,454 | 23,978,280 |
RR
| 17 |
2181-12-10 15:06:00
|
2181-12-10 15:26:00
|
INDICATION: ___ year old man with rib fractures and inc WOB// Please assess
for pleural effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
The loculated right pleural effusion associated with pleural thickening and
nodularity is unchanged. Cardiomediastinal silhouette is stable. Right-sided
PICC line projects to the cavoatrial junction. Pulmonary edema has improved.
No pneumothorax is seen. Patchy parenchymal opacity in the left perihilar
region is unchanged. There are healing right-sided rib fractures and old
healed left-sided rib fractures.
|
10157454-RR-18
| 10,157,454 | 23,978,280 |
RR
| 18 |
2181-12-11 13:01:00
|
2181-12-11 14:17:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old man with recent multifocal pneumonia, now with b/l
pleural effusion// r/o pneumothorax s/p b/l chest tube placement
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Compared to the prior radiograph lung volumes have decreased. There has been
interval placement of bilateral pigtail catheters. A moderate, loculated
right and small left pleural effusion appear grossly stable. No pneumothorax.
Mild pulmonary vascular congestion appears unchanged. Left perihilar opacity
is stable. Healing right-sided rib fractures are again seen. The
cardiomediastinal silhouette is enlarged and appears grossly stable. A right
PICC is seen in unchanged position.
IMPRESSION:
Status post bilateral chest tube placement. No pneumothorax. Stable moderate
and small left pleural effusions.
|
10157454-RR-19
| 10,157,454 | 23,978,280 |
RR
| 19 |
2181-12-12 08:03:00
|
2181-12-12 10:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with b/l PEFF s/p b/l CT// PEFF Evolution
PEFF Evolution
IMPRESSION:
Compared to chest radiographs ___ through ___.
Fracture through the lateral aspect of a right lower rib was probably
responsible for the well-circumscribed pleural or extra pleural abnormality it
developed in along the right chest cage laterally between ___ and ___. It has not cleared. Instead moderate right pleural effusion developed on
___. Pigtail pleural drainage catheters were subsequently placed on ___. The well-circumscribed pleural abnormality is still present either a
loculation of pleural fluid or are hematoma or pseudoaneurysm. Small
loculations of right pleural effusion remain although there has been some
improvement since ___. There is no appreciable pneumothorax. Pulmonary
vascular engorgement and moderate cardiomegaly have also decreased.
Right PIC line ends in the right atrium. Both pigtail pleural drainage
catheters are unchanged in their respective positions.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 10:06 am, 1 minutes after discovery of
the findings.
|
10157454-RR-22
| 10,157,454 | 23,978,280 |
RR
| 22 |
2181-12-14 15:43:00
|
2181-12-14 18:40:00
|
EXAMINATION: MR ___ ANDW/O CONTRAST ___ MR SPINE
INDICATION: Scratch
___ year old man with known vertebral osteomyelitis, with rising WBC count on
appropriate antibiotics. Please assess for other foci of infection within the
spine.
TECHNIQUE: Sagittal imaging of the thoracic and lumbar was performed with T2,
T1, and IDEAL technique, followed by axial T2 imaging. Axial T1 weighted
images of the lumbar spine were also obtained. This was followed by sagittal
and axial T1 images of the thoracic and lumbar spine obtained after the
uneventful intravenous administration of 10 mL of Gadavist contrast agent.
COMPARISON: ___ thoracic and lumbar spine MRI
___ abdominal/pelvic CT
___ chest CT
___ lumbar spine radiographs
FINDINGS:
12 rib-bearing and 5 lumbar-type vertebrae are again demonstrated.
THORACIC:
Motion artifact limits evaluation.
T12 vertebral body is collapsed with severe loss of height centrally,
demonstrate central nonenhancement with anterior and posterior contrast
enhancement, not significantly changed compared to ___. There is
edema throughout the T11 vertebral body, with contrast enhancement along the
inferior endplate, and minimal loss of height, also not significantly changed.
Contrast enhancement within the posterior aspect of the T11-T12 disc has
slightly progressed. Right anterior epidural phlegmon T11-T12 does not appear
significantly changed on sagittal postcontrast images, but may be slightly
larger based on axial postcontrast images. Associated mild spinal canal
narrowing at T11-T12 also appear slightly increased on axial T1 weighted
images, the slightly displacing the spinal cord posteriorly, without cord
compression.
No evidence for diskitis or osteomyelitis at other thoracic levels. No change
in other thoracic vertebral body heights. No evidence for cord signal
abnormalities. Small left paracentral disc protrusion at T2-T3, and minimal
disc bulges in the lower thoracic spine, do not cause significant spinal canal
stenosis.
LUMBAR:
There is T2 hyperintensity in the T12-L1 disc without contrast enhancement,
unchanged. Mild edema and contrast enhanced in the superior endplate of L1
are new. Mild anterior wedging of L1 is unchanged.
There is edema and contrast enhancement of the left psoas from T12 through S1,
with peripherally enhancing complex fluid pockets between L3 and L5. These are
stable in size, with maximal axial cross-section of 2.6 x 1.4 cm on axial
images 13:38-40 at the level of L3-L4, and 2.1 x 1.5 cm on axial image 16:32
at L4-L5. These collections demonstrate a rim of low signal on T2 weighted
images, as before, with partial hyperdensity on the ___
abdominal/pelvic CT, suggesting hematoma. However, superimposed infection
cannot be excluded.
There is also bilateral posterior paravertebral edema and contrast enhancement
from L2 through L5.
Fusion of L4 and L5 vertebral bodies is again noted. No subluxation.
Multilevel degenerative disease was described in detail in the ___
report. Moderate to severe spinal canal stenosis and moderate left neural
foraminal narrowing with mass effect on the exiting left L3 nerve root are
again seen at L3-L4. Mild spinal canal narrowing is again seen at L1-L2.
OTHER:
Bilateral pleural effusions and bibasilar atelectasis are again partially
visualized. Left upper pole renal cyst is again noted.
IMPRESSION:
1. Discitis and osteomyelitis are again demonstrated T11-T12. Severe collapse
of T12 vertebral body and minimal T11 vertebral body loss of height are
unchanged. Contrast enhancement in the posterior aspect of the T11-T12 disc
has increased. Small right anterior epidural phlegmon has slightly increased,
displacing the spinal cord without compression.
2. Unchanged T12-L1 disc edema without enhancement, a nonspecific finding
which may be reactive. New mild edema and contrast enhancement in the
superior endplate of L1 may be reactive, though spread of infection cannot be
excluded definitively.
3. Persistent edema and contrast enhancement of the left psoas from T12
through S1, with stable peripherally enhancing fluid pockets between L3 and L5
which may in part be related to hematomas. However, superimposed infection
and abscess formation cannot be excluded.
4. Stable mild bilateral posterior paravertebral edema from L2 through L5.
5. Multilevel degenerative changes in the lumbar spine, with moderate to
severe spinal canal stenosis at L3-L4, are again demonstrated.
6. Bilateral pleural effusions and bibasilar atelectasis are again partially
visualized.
NOTIFICATION: The following preliminary report in PACS was provided on ___ at 18:39 by Dr. ___: "Compared to ___. Worsening
pathologic compression of the T12 vertebral body with increasing irregularity
of the T11-T12 endplates, with areas of bony enhancement which involve the
disc. This is consistent with worsening at T11-T12 osteomyelitis discitis.
There is also slight worsening of a 4 mm area of enhancing epidural phlegmon
in this area. There is also irregular enhancement and edema within the left
psoas musculature as seen on the prior study in this region compatible with
psoas abscess, though there is no large fluid component seen that would be
amenable to aspiration. There is a moderate right-sided pleural effusion. No
other levels of involvement in the thoracic spine. There is no infectious
involvement of the lumbar spine. Partial fusion of L4 on L5 is again seen.
There is moderate disc space narrowing at L1-L2. There remains moderate
spinal canal narrowing at L3-L4."
|
10157454-RR-6
| 10,157,454 | 25,401,199 |
RR
| 6 |
2181-11-11 16:47:00
|
2181-11-11 17:11:00
|
INDICATION: ___ year old man with T12 compression fx on CT// Eval fracture
COMPARISON: CT chest from earlier today performed at outside hospital.
FINDINGS:
AP and lateral views of the lumbar spine were provided. There are neutral,
flexion and extension lateral views. Patient has a known compression
deformity at T12. There is no additional fracture seen. There is no abnormal
motion with flexion or extension. No malalignment.
IMPRESSION:
As above.
|
10157454-RR-7
| 10,157,454 | 25,401,199 |
RR
| 7 |
2181-11-11 19:16:00
|
2181-11-11 23:13:00
|
EXAMINATION: Chest portable PICC line placement
INDICATION: History: ___ with PICC// Confirm PICC
TECHNIQUE: Single supine view of the chest was obtained.
COMPARISON: CT chest dated ___
FINDINGS:
Supine view of the chest limits evaluation. The cardiac silhouette is
borderline enlarged, likely exaggerated by technique. Known small left
pleural effusion is not well demonstrated on this study. Extensive, bilateral
opacities are re-demonstrated, most prominent in the right base, right apex,
and left midlung, as seen on recent CT, and most compatible with an infectious
process. A PICC line is not demonstrated. There is likely bibasilar
atelectasis.
IMPRESSION:
1. PICC is not seen.
2. Multifocal opacities are compatible with multifocal pneumonia as seen on
recent CT chest.
|
10157454-RR-9
| 10,157,454 | 23,978,280 |
RR
| 9 |
2181-12-03 20:05:00
|
2181-12-03 20:18:00
|
INDICATION: History: ___ with dyspnea, oxygen requirement, increased WBC and
AMS// eval for pneumonia
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
The heart size remains moderately enlarged. The mediastinal and hilar
contours are similar with mild pulmonary vascular congestion noted. Hazy
opacification of the right lung base is compatible with a moderate right
pleural effusion, new from the prior exam. A small left pleural effusion is
not substantially changed. New opacification of the right lateral mid and
lower lung fields is concerning for pneumonia. No pneumothorax. Chronic
left-sided rib fractures and subacute right rib fractures are re-demonstrated.
IMPRESSION:
1. New opacification along the periphery of the right mid and lower lung field
concerning for pneumonia.
2. New moderate right pleural effusion and similar left pleural effusion.
3. Mild pulmonary vascular congestion.
|
10157674-RR-12
| 10,157,674 | 23,215,474 |
RR
| 12 |
2166-06-16 14:12:00
|
2166-06-16 14:44:00
|
HISTORY: ___ female with history of recurrent lymphoma with cough and
congestion.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Frontal and lateral chest radiograph demonstrates an opacification of the
right middle lobe concerning for pneumonia. The left lung is clear with no
focal consolidation. There is no pleural effusion or pneumothorax. The
cardiomediastinal and hilar silhouettes are within normal limits. A left
sided Port-A-Cath extends to the lower superior vena cava.
IMPRESSION:
Right middle lobe pneumonia.
These findings were communicated to the ordering physician, ___, by
Dr. ___ telephone upon review of the films on ___.
|
10157674-RR-45
| 10,157,674 | 22,623,459 |
RR
| 45 |
2168-09-24 22:10:00
|
2168-09-24 22:49:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with fever/immunosuppressed. // pneumonia?
COMPARISON: Chest CT from ___.
FINDINGS:
PA and lateral views of the chest provided. Port-A-Cath resides over the
left chest wall with catheter tip in the region of the lower SVC. Lungs are
clear. Clips are noted in the right axilla with absence of the right breast
shadow. Lungs are clear. There is no focal consolidation, effusion, or
pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous
structures are intact. No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process. Port-A-Cath positioned appropriately.
|
10157674-RR-46
| 10,157,674 | 22,623,459 |
RR
| 46 |
2168-09-25 18:01:00
|
2168-09-25 19:46:00
|
EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with lymphoma and new fevers of unclear source.
// eval for infectious source
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 6.9 s, 0.2 cm; CTDIvol = 117.1 mGy (Body) DLP =
23.4 mGy-cm.
3) Spiral Acquisition 5.9 s, 65.6 cm; CTDIvol = 4.4 mGy (Body) DLP = 285.0
mGy-cm.
Total DLP (Body) = 310 mGy-cm.
COMPARISON: ___.
FINDINGS:
LOWER CHEST: Linear atelectasis in the lingula, middle lobe, bilateral lung
bases. No pleural effusions. Please review same day dedicated chest CT
report. Small hiatal hernia with mildly patulous esophagus.
ABDOMEN:
HEPATOBILIARY: No suspicious lesion or ductal dilation. Contracted
gallbladder.
PANCREAS: No discrete lesion or ductal dilation.
SPLEEN: No splenomegaly.
ADRENALS: Unremarkable.
URINARY: No nephrolithiasis or hydronephrosis.No discrete lesion.
GASTROINTESTINAL: Unremarkable stomach and duodenum. Multiple jejunal
submucosal lipomas. The largest measures 15 mm. No obstruction.
Unremarkable appendix. No fluid collection.
PELVIS: Unremarkable rectum, bladder,and ovaries. Retroverted uterus.
LYMPH NODES: Diffuse retroperitoneal and mesenteric adenopathy, slightly
decreased in size. For example, conglomerate left para-aortic lymph nodes
measure 2.8 x 4.7 cm (previously 4.5 x 5.6 cm) (05:26). Pre caval lymph node
measures 1.6 x 2.7 cm (previously 1.9 x 2.9 cm) (05:28).
Scattered paraesophageal, epicardial, and inguinal lymph nodes.
VASCULAR: Patent aorta and major branches. Mild arteriosclerosis. Replaced
left hepatic from left gastric artery.
BONES AND SOFT TISSUES: Grade 1 anterolisthesis L5 on S1. No suspicious
osseous lesion. No soft tissue mass.
IMPRESSION:
1. No acute intra-abdominal pathology.
2. Slightly decreased size of diffuse mesenteric and retroperitoneal
lymphadenopathy consistent with known lymphoma.
3. Incidental nonobstructive jejunal lipomas.
|
10157674-RR-47
| 10,157,674 | 22,623,459 |
RR
| 47 |
2168-09-25 18:02:00
|
2168-09-25 19:46:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with lymphoma and new fevers of unclear
source.// eval for infectious source
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent reconstructed as
axial, coronal , parasagittal, and ,MIPs axial images.
DOSE: DLP: Reported in the concurrent abdomen CT
COMPARISON: ___
FINDINGS:
The thyroid is normal. Increasing number of bilateral axillary lymph nodes
are stable measuring up to 9 mm. There is an increasing number of mediastinal
lymph nodes measuring up to 11 mm in the right upper paratracheal station,
posterior to the left main bronchus an enlarged lymph node measures 15 mm was
13 mm (05:27), there are other multiple enlarged lymph nodes surrounding the
descending distal aorta grossly unchanged from prior study. There is a small
hiatal hernia. Subcarinal lymph node measures only 6 mm. Left hilar lymph
nodes are grossly unchanged measuring up to 5 mm
Aorta and pulmonary arteries are normal size. Cardiac configuration is normal
and there is no appreciable coronary calcification. Increasing subpleural
opacities in the lower lobes bilaterally and ground-glass opacities in the
left lower lobe are likely atelectasis. Right lower lobe lung nodule
measuring 8 x 4 mm is unchanged from prior study (6:191. There are no new
lung nodules. . There is no pleural or pericardial effusion.
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings.
There are no bone findings of malignancy
Central catheter tip is in the cavoatrial junction
IMPRESSION:
No evidence of active intrathoracic infection
Stable right lower lobe lung nodule
Diffuse lymphadenopathy with minimally increased in size of periaortic lymph
node as described above
.
|
10157940-RR-20
| 10,157,940 | 21,734,583 |
RR
| 20 |
2163-10-19 17:53:00
|
2163-10-19 18:06:00
|
HISTORY: "Stroke symptoms" (sic).
COMPARISON: None available.
TECHNIQUE: Axial CT images were acquired through the head without intravenous
contrast. Thereafter, images were acquired through the head and neck
following the uneventful intravenous administration of iodine based contrast.
Multiplanar reformatted images including maximum intensity projection images
and dedicated 3 dimensional angiographic reconstructions were created. CT
perfusion imaging is also performed.
CT HEAD: There is no intracranial hemorrhage, edema, mass effect or vascular
territorial infarction. Ventricles and sulci are normal in size and
configuration. Mucous retention cysts are noted in the maxillary sinuses
bilaterally.
CT ANGIOGRAM NECK: The aorta demonstrates a normal three-vessel branching
pattern. The origins of the right vertebral artery, both common carotid
arteries and both internal carotid arteries are normal. The small amount of
atherosclerotic plaque is visualized carotid bifurcations bilaterally, without
evidence of hemodynamically significant stenosis by NASCET criteria. The V1
segment of the left vertebral artery is notably tortuous, and note is made of
a moderate focal stenosis is at the origin of the left vertebral artery. The
vertebral arterial system is left dominant. Overall there are no luminal
caliber irregularities to suggest dissection or pseudoaneurysm.
Imaged portions of the lung apices are clear as are image soft tissue
structures of the neck. Bony structures reveal no suspicious sclerotic or
lytic lesion.
CT ANGIOGRAM HEAD: Primary intracranial arterial structures demonstrate
appropriate contrast opacification. Anatomy is notable for a hypoplastic
right A1 segment. There is a small right posterior communicating artery
infundibulum. There are no luminal caliber irregularities to suggest
occlusive thromboembolic filling defect, dissection or aneurysm.
CT PERFUSION HEAD: Relative cerebral blood flow, relative cerebral blood
volume and mean transit time maps demonstrate no focal vascular territorial
perfusion abnormalities.
IMPRESSION: No acute intracranial abnormality, no occlusive thrombo-embolic
arterial filling defect and no focal CT perfusion abnormality.
If concern persists for ischemia/infarction, MRI is the more sensitive
modality for evaluation.
|
10157940-RR-21
| 10,157,940 | 21,734,583 |
RR
| 21 |
2163-10-19 20:50:00
|
2163-10-20 08:26:00
|
HISTORY: Chest pain.
FINDINGS: In comparison with the study of ___, there is little change and
no evidence of acute cardiopulmonary disease. The cardiac silhouette is
within normal limits and there is again blunting of one of the costophrenic
angles posteriorly, with chronic change. Tiny granuloma is again seen at the
left base.
No acute pneumonia or vascular congestion.
|
10157940-RR-22
| 10,157,940 | 21,734,583 |
RR
| 22 |
2163-10-20 18:18:00
|
2163-10-20 18:43:00
|
HISTORY: TIA with widely patent PFO. Evaluate for DVT.
TECHNIQUE: Duplex Doppler examination was performed on the lower extremities.
COMPARISON: Left lower extremity ultrasound ___.
FINDINGS: There is normal compression and augmentation of the common femoral,
superficial femoral and popliteal veins bilaterally. Normal flow is seen
within the calf veins. Normal respiratory phasicity was appreciated within
the common femoral veins bilaterally.
IMPRESSION: No deep vein thrombosis within the right or left lower extremity.
|
10157940-RR-34
| 10,157,940 | 21,051,857 |
RR
| 34 |
2169-10-04 10:16:00
|
2169-10-04 10:32:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough// ? pna
COMPARISON: Prior exam dated ___
FINDINGS:
PA and lateral views of the chest provided. Lungs are clear. There is no
focal consolidation, effusion, or pneumothorax. There are no signs of
congestion or edema. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. No free air below the right hemidiaphragm is
seen.
IMPRESSION:
No acute intrathoracic process.
|
10158230-RR-21
| 10,158,230 | 28,089,795 |
RR
| 21 |
2149-09-23 13:00:00
|
2149-09-23 17:35:00
|
EXAMINATION: CT of the abdomen pelvis
INDICATION: Abdominal pain, nausea, dry heaving, question SBO.
TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed with IV
and oral contrast. Multiplanar reformations were provided.
DOSE: Total DLP (Body) = 688 mGy-cm.
COMPARISON: Prior liver gallbladder ultrasound from ___
FINDINGS:
Lung Bases: The imaged lung bases are clear aside from subsegmental right
basal atelectasis. The imaged portion of the heart is unremarkable. There is
a small hiatal hernia.
Abdomen: The liver enhances normally without focal concerning lesion. There
is a tiny hypodensity at the hepatic dome which is too small to characterize.
There is likely mild steatosis. Main portal vein is patent. No intrahepatic
or extrahepatic biliary ductal dilation is seen. The gallbladder is mostly
collapsed. Adrenal glands appear normal bilaterally. The spleen and pancreas
appear normal. The kidneys enhance symmetrically and excretion of contrast is
prompt. A tiny cortical hypodensity on the left may represent a simple renal
cyst. The abdominal aorta is normal in course and caliber without appreciable
atherosclerosis. No retroperitoneal or mesenteric adenopathy.
The stomach and duodenum contain ingested contrast. There is progressive
dilation of small bowel loops which can be traced to the point of a caliber
transition at the anterior low abdominal wall inferior to the umbilicus, best
seen on series 601b, image 15. There appears to be tethering of small bowel
to the anterior body wall, likely reflecting the presence of adhesions.
Distal to this point, small bowel is decompressed. The colon contains fluid
and a small amount of fecal material. No bowel wall thickening. No ascites
or free air. The appendix is surgically absent.
Pelvis: Uterus and bilateral ovaries have been surgically removed. The
urinary bladder is only partially distended appearing normal. No pelvic
sidewall or inguinal adenopathy.
Bones: No worrisome bony lesion. Degenerative changes in lumbar spine most
pronounced at L5-S1. Facet arthropathy is also most pronounced in the lower
lumbar spine. Grade 1 anterolisthesis of L4 on L5 noted.
IMPRESSION:
Findings concerning for small bowel obstruction with transition point at the
low anterior abdominal wall. No ascites or bowel wall thickening.
NOTIFICATION: Findings were discussed with Dr. ___ at the time of initial
review and patient was brought to the ___ ___ ___ ED
for further assessment.
|
10158488-RR-25
| 10,158,488 | 29,409,510 |
RR
| 25 |
2156-06-02 13:52:00
|
2156-06-02 15:57:00
|
EXAMINATION: CT-guided drainage
INDICATION: ___ year old woman with perforated appendicitis with 3x3 fluid
collection// Please aspirate and leave drain
COMPARISON: CT abdomen and pelvis ___
PROCEDURE: CT-guided drainage of right lower quadrant collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 5 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to suction bulb. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.3 s, 25.4 cm; CTDIvol = 8.9 mGy (Body) DLP = 213.7
mGy-cm.
2) Spiral Acquisition 8.3 s, 25.4 cm; CTDIvol = 8.9 mGy (Body) DLP = 215.2
mGy-cm.
3) Stationary Acquisition 8.3 s, 1.4 cm; CTDIvol = 86.6 mGy (Body) DLP =
124.6 mGy-cm.
Total DLP (Body) = 566 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 1
mg Versed and 50 mcg fentanyl throughout the total intra-service time of 20
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
CT scan of the pelvis with and without contrast demonstrates a air and
fluid-filled collection in the right lower quadrant measuring 3.9 x 2.4 cm
(4:74) adjacent to a dilated and hyperemic appendix..
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into collection
in right lower quadrant. Samples were sent for microbiology evaluation.
|
10158991-RR-15
| 10,158,991 | 23,796,890 |
RR
| 15 |
2131-09-21 05:42:00
|
2131-09-21 08:33:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with hypertension, hyper presenting with
left-sided weakness, numbness, and word-finding difficulty. Assess for
infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck, CT head from ___
FINDINGS:
There is no acute infarction, edema, mass effect, or evidence for blood
products. Mild T2 hyperintensity along the lateral ventricles, most prominent
along the frontal horns, and scattered small foci of T2 hyperintensity in the
subcortical white matter of the right frontal lobe (12:19, 12:16) and insula
(12:15), nonspecific but likely sequela of mild chronic small vessel ischemic
disease in this age group. Ventricles and sulci are age-appropriate in size.
Major vascular flow voids are grossly preserved; the intracranial blood
vessels are better assessed on the preceding CTA.
There is mild mucosal thickening in the ethmoid air cells and mastoid air
cells. Left mastoid is underpneumatized.
IMPRESSION:
1. No acute infarction.
2. Minimal T2 signal abnormalities in the supratentorial white matter are
nonspecific but likely sequela of mild chronic small vessel ischemic disease
in this age group.
|
10159772-RR-10
| 10,159,772 | 22,350,855 |
RR
| 10 |
2136-12-04 12:40:00
|
2136-12-04 13:54:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: Fall with right hip pain, evaluate for fracture.
TECHNIQUE: Frontal and lateral views of the right hip.
COMPARISON: None.
FINDINGS:
There are minimal degenerative changes involving the right femoral acetabular
joint with osteophytes. The joint space is preserved and the femoral head is
normal in morphology. There is no fracture or dislocation. Mild degenerative
changes involve the lower lumbar spine. The pubic symphysis, left
femoroacetabular joint and sacroiliac joints are unremarkable.
Phleboliths are noted in the pelvis. A metallic, spring shaped device projects
over the left iliac wing and is presumably external to the patient.
IMPRESSION:
No fracture.
|
10159772-RR-11
| 10,159,772 | 22,350,855 |
RR
| 11 |
2136-12-04 16:58:00
|
2136-12-04 21:06:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ with fall to face x 4 feet // further characterization of
fractures
TECHNIQUE: Helical axial images were acquired through the paranasal sinuses.
Coronal reformatted images were also obtained
DOSE: DLP: 535 mGy-cm; CTDI: 25 mGy
COMPARISON: CT head on ___
FINDINGS:
Multiple facial fractures are identified on the left including a fracture of
the medial and lateral walls of the left maxillary sinus. There is
high-density material within the left maxillary sinus which may represent
blood. Additionally, there is a small fracture involving the left lateral
orbital wall as well as a possible nondisplaced fracture through the left
orbital floor. There is no evidence of extraocular muscle herniation or
herniation of intraorbital fat through the orbital floor fracture. The
remainder of the paranasal sinuses are clear. The globes are intact. Finally,
there is soft tissue swelling in the left periorbital area.
IMPRESSION:
Multiple left-sided facial fractures including a fracture through the medial
and lateral walls of the left maxillary sinus, the lateral left orbital wall
as well as a possible nondisplaced fracture through the left orbital floor
without extraocular muscle entrapment. High-density material in the left
maxillary sinus may represent blood.
|
10159772-RR-12
| 10,159,772 | 22,350,855 |
RR
| 12 |
2136-12-05 09:08:00
|
2136-12-05 10:33:00
|
EXAMINATION: CT pelvis without contrast.
INDICATION: Right hip pain difficulty ambulating after fall.
TECHNIQUE: MDCT axial images were acquired through pelvis without intravenous
contrast. Coronal and sagittal reformations are provided and reviewed. Images
were reviewed in soft tissue and bone windows.
DOSE: DLP: 714.58 mGy-cm
COMPARISON: Hip radiographs ___
FINDINGS:
The bones are diffusely demineralized. There is no fracture or dislocation.
The femoral heads are normal in morphology and well-positioned. The joint
spaces are preserved. There is no joint effusion. There is soft tissue
stranding seen over the left greater trochanter, compatible with recent
injury. There is no associated large hematoma or fluid collection.
Mild degenerative changes of the hips are evidenced by osteophytosis.
Moderate degenerative changes are seen in the lower lumbar spine with loss in
the disc space and vacuum phenomenon. There are mild degenerative changes of
the sacroiliac joints.
There is extensive diverticulosis without diverticulitis. The appendix is
normal. The remaining loops of included small bowel are normal. There is no
free pelvic fluid. There is no inguinal or pelvic sidewall lymphadenopathy.
The bladder is moderately distended. Calcifications are seen within an
atrophic uterus.
IMPRESSION:
1. No fracture.
2. Soft tissue stranding over the left greater trochanter, compatible with
recent injury.
3. Diverticulosis.
|
10159772-RR-13
| 10,159,772 | 22,350,855 |
RR
| 13 |
2136-12-05 17:18:00
|
2136-12-05 18:18:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ with fall with chest pain // eval rib fx
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. IV contrast was not administered. Axial images were interpreted in
conjunction with sagittal and coronal reformats.
DLP: 688 mGy-cm
COMPARISON: Chest radiograph on ___.
FINDINGS:
The thyroid is grossly unremarkable. Axillary, supraclavicular, and
mediastinal lymph nodes are not pathologically enlarged.
The great vessels are normal caliber. There is no evidence of aortic
intramural hematoma. Scattered atherosclerotic calcifications along the
thoracic aorta noted. The heart size is normal. No pericardial effusion. The
airways are patent to subsegmental levels.
There is minimal atelectasis at the left lung base. No focal consolidation,
pleural effusion, or pneumothorax. There are two calcified granulomas in the
lingula and in the left upper lobe.
In the absence of IV or oral contrast, the esophagus and visualized upper
abdominal organs are unremarkable.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy. No fracture is identified.
IMPRESSION:
No acute intrathoracic process. No fractures.
|
10159772-RR-8
| 10,159,772 | 22,350,855 |
RR
| 8 |
2136-12-04 12:13:00
|
2136-12-04 13:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Neck pain, fall. Evaluate for an acute intracranial process.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm; CTDI: 53.31 mGy
COMPARISON: None.
FINDINGS:
There is no acute hemorrhage, edema or shift of the normally midline
structures. Changes of encephalomalacia involve the left occipital lobe from
a prior left PCA infarction are noted. These changes result in ex vacuo
dilatation of the occipital horn of the left lateral ventricle. Otherwise, the
ventricles and sulci are of normal size and configuration for age. Scattered
periventricular white matter hypodensities, while nonspecific, are presumably
sequela chronic small vessel ischemic disease. The gray-white matter
differentiation is preserved there is no evidence for acute territorial
vascular infarction. The basal cisterns are patent.
There are fractures involving the medial and lateral walls of the left
maxillary sinus which contains high-density material, presumably blood. A
small fracture also involves the left lateral orbital wall. The mastoid air
cells are well-aerated.
IMPRESSION:
1. Minimally displaced fractures involving the medial and lateral walls of the
left maxillary sinus and lateral wall of the left orbit.
2. No acute intracranial process.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
telephone on ___ at 2:28 ___, 15 minutes after discovery of the findings.
|
10159772-RR-9
| 10,159,772 | 22,350,855 |
RR
| 9 |
2136-12-04 12:13:00
|
2136-12-04 13:51:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with neck pain, fall.
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations.
Dose: 789.2 mGy-cm.
COMPARISON: None
FINDINGS:
There is no acute fracture or malalignment in the cervical spine. There is a
minimal anterolisthesis of C4 relative to C5 with disc disease at C5-6 and
C6-7 with loss of disc space as well as endplate sclerosis. No prevertebral
edema. The visualized outline of the thecal sac is gross unremarkable. Mild
septal thickening at the lung apices may represent a component of edema. Tiny
calcified granulomas in the left lung apex noted. Thyroid gland is
unremarkable.
Partially imaged in the left facial bones, is a mildly displaced fracture
involving the lateral wall of the left maxillary sinus. There is a small
amount of blood layering in the left maxillary sinus along with a retention
cyst.
IMPRESSION:
1. No fracture. Degenerative disease, with mild anterolisthesis of C4 on C5.
2. Minimally displaced fracture of the left maxillary sinus along the lateral
wall.
|
10159832-RR-28
| 10,159,832 | 28,812,774 |
RR
| 28 |
2118-06-09 14:57:00
|
2118-06-09 15:22:00
|
EXAMINATION: Chest radiographs
INDICATION: ___ with fever.
TECHNIQUE: Frontal and lateral views of the chest
COMPARISON: Chest radiographs between ___ and ___
___ chest CT
FINDINGS:
Lungs are fully expanded and clear. No pleural abnormalities. Heart size is
normal. Cardiomediastinal and hilar silhouettes are normal.
IMPRESSION:
No evidence of an acute cardiopulmonary abnormality.
|
10159832-RR-29
| 10,159,832 | 28,812,774 |
RR
| 29 |
2118-06-11 08:34:00
|
2118-06-11 10:54:00
|
INDICATION: ___ year old woman with nephrotic range proteinuria// etiology
TECHNIQUE: Real-time grayscale ultrasound imaging for biopsy guidance.
OPERATORS: Dr. ___ provided sonographic guidance for biopsy that
was performed by the Nephrology team.
FINDINGS:
This procedure was performed by the Nephrology team; please see Nephrology
procedure note for further details.
Real-time ultrasound guidance for percutaneous renal biopsy was provided by
radiologist. The lower pole of the left kidney was targeted and 2 biopsy
passes performed.
SEDATION: Moderate sedation was provided by administering divided doses of
Fentanyl and Versed throughout the total intra-service time of 11 minutes
during which the patient's hemodynamic parameters were continuously monitored
by an independent, trained radiology nurse.
IMPRESSION:
Ultrasound guidance for percutaneous left kidney biopsy.
|
10160202-RR-29
| 10,160,202 | 27,812,768 |
RR
| 29 |
2153-10-16 18:19:00
|
2153-10-16 19:46:00
|
CHEST RADIOGRAPH PERFORMED ON ___
Comparison is made with a prior study from ___.
CLINICAL HISTORY: Low O2 saturation at PCP's office, assess for acute process
in the chest.
FINDINGS: PA and lateral views of the chest were obtained. Elevated left
hemidiaphragm is unchanged. Thoracic kyphotic angulation somewhat limits the
evaluation to the apices. However, allowing for this, there is no focal
consolidation, effusion, pneumothorax. Heart size is difficult to assess but
appears grossly stable. Mediastinal contour appears normal. Bony structures
are intact. No free air below the right hemidiaphragm is seen. Clips are
noted in the upper abdomen.
IMPRESSION: No acute intrathoracic process.
|
10160202-RR-30
| 10,160,202 | 24,455,932 |
RR
| 30 |
2154-10-31 20:48:00
|
2154-11-01 02:06:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ male with increased confusion.
FINDINGS: AP and lateral views of the chest are compared to previous exam
from ___. Again seen is elevation of the left hemidiaphragm with
eventration posteriorly as previously seen. Streaky right basilar opacity
suggestive of atelectasis versus scarring. Elsewhere, the lungs are clear.
The cardiomediastinal silhouette is unchanged. Extensive degenerative and
potentially post-traumatic changes seen at the left humerus.
IMPRESSION: No definite acute cardiopulmonary process.
|
10160202-RR-31
| 10,160,202 | 24,455,932 |
RR
| 31 |
2154-11-01 09:47:00
|
2154-11-01 10:13:00
|
HISTORY: Fever and cough.
FINDINGS: In comparison with the study of ___, there is probably little
change. Again, there is elevation of the left hemidiaphragm related to
posterior eventration. Bibasilar atelectatic changes are seen. The cardiac
silhouette is at the upper limits of normal in size. No definite vascular
congestion.
|
10160202-RR-32
| 10,160,202 | 24,455,932 |
RR
| 32 |
2154-11-02 15:43:00
|
2154-11-02 17:01:00
|
REASON FOR EXAMINATION: Dementia, hypertension.
Portable AP radiograph of the chest was reviewed with comparison to ___.
There is mild interval progression of pulmonary edema, mild to moderate.
There is redemonstration of elevation of left hemidiaphragm, chronicity
undetermined. It was present at least back to ___. Small amount of
bilateral pleural effusion is most likely present.
|
10160202-RR-33
| 10,160,202 | 24,455,932 |
RR
| 33 |
2154-11-03 04:17:00
|
2154-11-03 08:34:00
|
PORTABLE CHEST ___
COMPARISON: ___ radiograph.
FINDINGS: Persistent cardiomegaly accompanied by pulmonary vascular
congestion and worsening pulmonary edema. Rapidly developing areas of
consolidation in the left perihilar and right basilar region, probably
represent asymmetrical pulmonary edema but developing infection is also an
important consideration for the right lower lobe opacity. With this in mind,
short-term followup radiographs after diuresis may be helpful. Left lower
lobe atelectasis is new. Small bilateral pleural effusions have slightly
increased.
|
10160202-RR-34
| 10,160,202 | 24,455,932 |
RR
| 34 |
2154-11-03 11:01:00
|
2154-11-03 13:23:00
|
INDICATION: ___ man with hypoxemia, now intubated and with OG tube
placement.
COMPARISON: Prior chest radiographs from ___, 4:32 through ___.
TECHNIQUE: Frontal chest radiograph.
FINDINGS: As compared to prior chest radiograph from ___, there has
been interval placement of an ET and OG tube. Endotracheal tube terminates
5.9 cm above the carina. The orogastric tube is difficult to visualize,
however the tip is likely in the proximal stomach. There has been interval
improvement of bilateral consolidations, likely related to resolving pulmonary
edema. There are small bilateral pleural effusions. There is atelectasis at
the left lung base. There is redemonstration of elevation of the left
hemidiaphragm, which appears chronic in nature. Cardiomegaly is unchanged.
IMPRESSION:
1. ET tube terminates 5.9 cm above the carina. Orogastric tube is difficult
to visualize, with tip likely within the proximal stomach and sideport above
this level; further advancement of the tube is recommended.
2. Interval improvement of bilateral consolidations, likely related to
improving pulmonary edema.
|
10160202-RR-35
| 10,160,202 | 24,455,932 |
RR
| 35 |
2154-11-03 17:56:00
|
2154-11-04 08:38:00
|
HISTORY: OG placement.
FINDINGS: In comparison with the study of earlier in this date, there is
substantial widening of the superior mediastinum. Although possibly
positional, the possibility of a mediastinal hemorrhage or aortic dissection
would have to be considered. If these are serious clinical concerns, CT would
be strongly recommended. This information was telephoned to the student on
call in the CCU immediately upon discovery by the resident on call.
There is some hazy opacification of the left hemithorax that could represent
layering effusion. Nasogastric tube extends to the stomach, though the side
hole lies above the cardioesophageal junction. Endotracheal tube is in good
position.
|
10160202-RR-36
| 10,160,202 | 24,455,932 |
RR
| 36 |
2154-11-03 20:20:00
|
2154-11-04 08:29:00
|
HISTORY: Widened mediastinum on previous study.
FINDINGS: In comparison with the earlier study of this date, with the patient
in a less oblique position, the mediastinum is less widened. Nevertheless, if
there are clinical symptoms suggesting hematoma or dissection, CT would be the
next imaging procedure. This information was discussed with Dr. ___ by
Dr. ___ resident on call.
|
10160202-RR-37
| 10,160,202 | 24,455,932 |
RR
| 37 |
2154-11-03 22:15:00
|
2154-11-04 10:37:00
|
CHEST CT WITHOUT CONTRAST
INDICATION: Patient with newly widened mediastinum.
COMPARISON: No prior chest CT. Chest ___ from ___ to ___.
TECHNIQUE:
Axial helical MDCT images were obtained from the suprasternal notch to the
upper abdomen without administration of IV contrast. Multiplanar reformatted
images in coronal and sagittal axis were generated.
FINDINGS:
LUNGS AND AIRWAYS:
Left lower lobe consolidation is mainly explained by the atelectasis; however,
superimposed infection or aspiration cannot be excluded in appropriate
clinical setting. There is bibasilar small atelectatic bands. A 4 mm left
upper lobe perifissural nodule is probably benign, series 4, image 101. The
airways are patent until subsegmental level. The ET tube is in adequate
position.
MEDIASTINUM:
There is no explanation for the widening of the mediastinum on the chest
___. The aorta is tortuous, but not dilated. There is severe aortic valve
and mitral annulus calcification in this patient with known moderate-to-severe
aortic stenosis, coronary arteries are severely calcified. Bilateral pleural
effusions are small. Hypodensity of the ventricular content relative to
myocardium is due to anemia.
UPPER ABDOMEN: This study is not tailored for assessment for intra-abdominal
organs. NG tube ends in the stomach. Right kidney cyst measures 15 mm.
There is stigmata of calcified chronic pancreatitis.
Prior cholecystectomy was done.
OSSEOUS STRUCTURES: There is no bony lesion concerning for malignancy.
Degenerative change of the shoulders are seen.
CONCLUSION:
1. There is no explanation for the widening of the mediastinum. There is no
dilation of the aorta.
2. Small bilateral pleural effusions.
3. Left lower lobe opacification is mainly due to atelectasis, which is
relatively unchanged since the chest ___ superimposed
infection or aspiration can be considered in appropriate clinical settings.
4. Stigmata of chronic calcified pancreatitis.
5. Severe aortic valve and coronary artery calcification.
|
10160202-RR-38
| 10,160,202 | 24,455,932 |
RR
| 38 |
2154-11-05 07:11:00
|
2154-11-05 12:49:00
|
AP CHEST, 7:46 A.M., ___
HISTORY: ___ man with hypoxia, respiratory failure.
IMPRESSION: AP chest compared to ___:
Lung volumes are lower, exaggerating moderate cardiomegaly, but there appears
to be increased caliber to mediastinal veins suggesting elevated central
venous pressure. Opacification in the left lower lobe persists, probably
atelectasis since the hemidiaphragm appears to be elevated. Small bilateral
pleural effusions are stable. ET tube is in standard placement. Nasogastric
drainage tube can be traced only as far as the lower esophagus and may need
substantial repositioning to put it into the stomach. Right PIC line ends in
the right atrium. No pneumothorax. Healed fracture of left humerus may be
responsible for both distortion and degeneration.
|
10160202-RR-39
| 10,160,202 | 24,455,932 |
RR
| 39 |
2154-11-04 11:14:00
|
2154-11-04 16:01:00
|
INDICATION: ___ man with new right PICC line.
COMPARISON: Prior chest radiographs and chest CT from ___.
TECHNIQUE: Portable frontal chest radiograph.
FINDINGS: As compared to prior chest radiograph from ___, there has
been interval placement of a right-sided PICC line with its tip terminating in
the lower SVC. There is no pneumothorax. Endotracheal tube terminates 5.4 cm
above the carina. Enteric tube tip is not clearly visualized. There are
small bilateral pleural effusions. Left lower lobe opacification is again
noted and may be related to atelectasis, however, in the appropriate clinical
setting, early pneumonia should also be considered.
IMPRESSION: Right-sided PICC line terminates in low SVC. No pneumothorax.
These findings were discussed with ___, IV team nurse by Dr. ___
via telephone on ___ at 12:20 p.m., at time of discovery.
|
10160202-RR-40
| 10,160,202 | 24,455,932 |
RR
| 40 |
2154-11-09 09:52:00
|
2154-11-09 12:42:00
|
PORTABLE CHEST, ___
COMPARISON: ___ radiograph.
FINDINGS: Right PICC has been withdrawn substantially since the prior
radiograph, now terminating in the right axilla. Interval removal of
endotracheal tube and nasogastric tube. Cardiomediastinal contours are within
normal limits for technique. Bibasilar atelectasis is present, with interval
improvement in the left lower lobe and worsening on the right. Small left
pleural effusion is noted. There is no evidence of pneumothorax.
|
10160202-RR-41
| 10,160,202 | 24,494,866 |
RR
| 41 |
2155-04-14 03:07:00
|
2155-04-14 06:23:00
|
HISTORY: Hematemesis and fever.
COMPARISON: Chest radiograph from ___ and chest CT from ___
FINDINGS:
Frontal radiographs of the chest demonstrate normal heart size. The left
hemidiaphragm remains elevated with however the contour is obsured which could
reflect left lower lobe collapse. Chronic atelectasis with more prominent
atelectasis in the left mid and lower lung.
IMPRESSION:
Chronic atelectasis with more pronounced left lower lobe volume loss likely
reflecting collapse. This could be further evaluated with chest CT.
Telephone notification to Dr ___ by Dr ___ at 9:15 on ___.
|
10160202-RR-42
| 10,160,202 | 24,494,866 |
RR
| 42 |
2155-04-14 03:13:00
|
2155-04-14 05:30:00
|
HISTORY: Altered mental status, on Coumadin; evaluate for intracranial
hemorrhage.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Multiplanar reformatted images in
coronal and sagittal planes and thin-section bone algorithm reconstructed
images were acquired.
DLP: 1282 mGy-cm
CTDIvol: 63 mGy
COMPARISON: Non-enhanced MR brain, ___
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect or acute large vascular
territory infarction. Prominent ventricles and sulci suggest age-related
global atrophy. Periventricular white matter hypodensities are consistent
with sequelae of chronic small vessel ischemic disease. The basal cisterns
appear patent and the gray-white matter differentiation is otherwise
preserved. Atherosclerotic mural calcification of the internal carotid
arteries is noted.
No fracture is identified. There is mild mucosal thickening in the right
maxillary sinus, bilateral ethmoid air cells and right frontal sinus. There
aerosolized secretions in the left maxillary sinus as well as the posterior
oropharynx. The remaining visualized paranasal sinuses, mastoid air cells and
middle ear cavities are clear. The globes are unremarkable.
IMPRESSION:
1. No evidence of hemorrhage or other acute intracranial process.
2. Global atrophy and sequelae of chronic small vessel ischemic disease.
3. Acute-on-chronic inflammatory disease in the paranasal sinuses; correlate
clinically.
|
10160202-RR-43
| 10,160,202 | 24,494,866 |
RR
| 43 |
2155-04-14 04:35:00
|
2155-04-14 06:38:00
|
HISTORY: Status post intubation. Confirm ETT placement
COMPARISON: Chest radiograph performed 1 hr prior
FINDINGS:
Frontal radiograph of the chest demonstrates ET tube ending at 5.4 cm above
the carina. An enteric tube is seen passing below the diaphragm with the tip
out of view. The side hole is at the level of the diaphragm. There is
increased volume loss in the left lung and new mild pulmonary edema.
|
10160202-RR-44
| 10,160,202 | 24,494,866 |
RR
| 44 |
2155-04-14 05:11:00
|
2155-04-14 06:42:00
|
HISTORY: Central line placement.
COMPARISON: Chest radiograph done 30 min prior.
FINDINGS:
Frontal radiograph of the chest demonstrate placement of the right
supraclavicular central venous line with the tip at the level of the upper
right atrium. No pneumothorax. Persistent moderate left effusion and left
lung atelectasis. ETT ends 6.6 cm above the carina. Enteric tube with the tip
below the diaphragm but side hole at the level of the GE junction.
|
10160202-RR-45
| 10,160,202 | 24,494,866 |
RR
| 45 |
2155-04-14 05:29:00
|
2155-04-14 07:11:00
|
HISTORY: Unexplained transaminitis with elevation of alkaline phosphatase and
fever to 104. Evaluate for intra-abdominal abscess, colitis, diverticulitis
or cholecystitis.
TECHNIQUE: Axial helical MDCT images were obtained through the abdomen and
pelvis after administration of Omnipaque intravenous contrast. Multiplanar
reformatted images in coronal and sagittal axes were generated.
DLP: 697 mGy-cm
COMPARISON: None available
FINDINGS:
There is a is moderate left pleural effusion measuring simple fluid density
with associated compressive atelectasis. There are coronary artery
calcifications and calcifications of the mitral annulus. No pericardial
effusion.
CT abdomen: The liver enhances homogeneously without focal lesions or
intrahepatic biliary dilatation. There is mild periportal edema. The portal
vein is patent. The patient is status post cholecystectomy. Calcifications
are noted in the atrophic pancreas consistent with chronic pancreatitis. The
spleen and adrenal glands are unremarkable. There is a 17 mm simple cyst in
the upper pole of the right kidney. The kidneys otherwise present symmetric
nephrograms and excretion of contrast with no pelvicaliceal dilation or
perinephric abnormalities.
An enteric tube with the tip in the stomach with the side hole at the level of
the GE junction is noted. The stomach, duodenum and small bowel are
unremarkable. There is sigmoid diverticulosis without evidence of
diverticulitis. The appendix is visualized and there is no evidence of
appendicitis. The intraabdominal vasculature demonstrates extensive
atherosclerotic calcifications. There is no mesenteric or retroperitoneal
lymph node enlargement by CT size criteria. No ascites, free air or abdominal
wall hernia is noted.
CT pelvis: The urinary bladder is decompressed with a Foley. There is
massive prostatomegaly. There is no pelvic free fluid. There is no inguinal
or pelvic wall lymphadenopathy.
Osseous structures: No lytic or sclerotic lesions suspicious for malignancy
is present. Multilevel degenerative changes of the thoracic and lumbar spine
are noted.
IMPRESSION:
1. No evidence of intra-abdominal abscess, colitis, diverticulitis or
cholecystitis.
2. Small left pleural effusion.
3. Enteric tube with tip in the stomach but the side hole of the level of the
GE junction.
4. Chronic pancreatitis
5. Extensive atherosclerotic calcifications.
6. Prostatomegaly
|
10160202-RR-46
| 10,160,202 | 24,494,866 |
RR
| 46 |
2155-04-15 02:47:00
|
2155-04-15 15:37:00
|
AP CHEST, 3:14 A.M., ___
HISTORY: ___ man with gram-negative rod sepsis. Check ET tube
placement and interval change.
IMPRESSION: AP chest compared to ___ through ___:
Lung volumes are lower, and mild interstitial edema may have recurred,
accompanied by increasing small right pleural effusion. Left lower lobe
atelectasis; however, is unchanged. Stomach is newly distended with air,
suggesting the drainage tube may not reach the upper stomach. ET tube in
standard placement. Right subclavian line ends low in the SVC. No
pneumothorax.
Moderate enlargement of the cardiac silhouette unchanged.
|
10160202-RR-47
| 10,160,202 | 24,494,866 |
RR
| 47 |
2155-04-15 11:27:00
|
2155-04-15 14:22:00
|
HISTORY: ___ man with GNR bacteremia and elevated LFTs.
COMPARISON: The report of the abdomen CT ___.
FINDINGS:
The liver is normal in size. The hepatic architecture is normal in
appearance. No focal liver lesion is identified. No biliary dilatation is
seen and the common duct measures 0.5 cm. The patient is status post
cholecystectomy. The pancreas and midline structures including the aorta are
obscured from view by overlying bowel gas. The spleen is normal measuring 7.8
cm. No hydronephrosis is seen on limited views of the kidneys. No ascites is
seen in the abdomen.
DOPPLER EXAMINATION: Color Doppler and spectral waveform analysis was
performed. The main, right and left portal veins are patent with hepatopetal
flow. The hepatic veins and IVC are patent. Appropriate arterial waveforms
are seen in the main hepatic artery.
IMPRESSION:
1. No biliary dilatation identified.
2. Patent hepatic vasculature.
|
10160202-RR-48
| 10,160,202 | 24,494,866 |
RR
| 48 |
2155-04-16 03:07:00
|
2155-04-16 10:15:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Intubated patient with sepsis.
Comparison is made with prior study ___.
ET tube tip is 6.4 cm above the carina in a standard position. Cardiomegaly
and tortuous aorta are unchanged. Increasing opacities in the retrocardiac
region are consistent with increasing large area of atelectasis, almost
collapse of the left lower lobe. Mild interstitial edema is unchanged. NG
tube tip is coiled in the stomach. The left hemidiaphragm is elevated. Small
right effusion has minimally increased.
|
10160202-RR-49
| 10,160,202 | 24,494,866 |
RR
| 49 |
2155-04-17 02:50:00
|
2155-04-17 08:44:00
|
CHEST RADIOGRAPH
INDICATION: Sepsis, endotracheal tube placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, a nasogastric tube has been
pulled back. The sidehole is now at the level of the gastroesophageal
junction, the tube should be advanced by approximately 5 cm. The position of
the endotracheal tube is unchanged. Also unchanged is the right subclavian
access line. Moderate cardiomegaly, right perihilar atelectasis and left
pleural effusion with retrocardiac atelectasis are unchanged. On the right,
at the lung bases, the radiolucency has increased, likely caused by improved
right lower lung ventilation.
|
10160202-RR-50
| 10,160,202 | 24,494,866 |
RR
| 50 |
2155-04-19 08:15:00
|
2155-04-19 11:49:00
|
PORTABLE CHEST FILM ___ AT 829
CLINICAL INDICATION: ___ with Alzheimer's, urinary sepsis, now with
increasing oxygen requirements, question edema or consolidation.
Comparison is made to the patient's previous study dated ___.
A portable semi-erect chest film ___ at 829 is submitted.
IMPRESSION:
The patient is markedly rotated, limiting evaluation of the cardiac and
mediastinal contours. However, the heart still remains enlarged. There has
been interval appearance of mild pulmonary edema. There are likely layering
effusions with patchy bibasilar opacities, left greater than the right, likely
reflecting compressive lower lobe atelectasis. Pneumonia cannot be excluded.
No pneumothorax. Calcification of the aorta consistent with atherosclerosis.
Interval extubation and removal of the nasogastric tube. Right subclavian
central line is unchanged in position with the tip in the distal SVC.
|
10160622-RR-135
| 10,160,622 | 28,663,041 |
RR
| 135 |
2180-05-19 15:41:00
|
2180-05-19 16:44:00
|
INDICATION: ___ with sob// r/o PNA
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
There is right basilar opacity is seen on prior suggesting moderate to large
pleural effusion with adjacent atelectasis. Degree of parenchymal opacity in
the left mid to upper appears to have slightly progressed. Cardiac silhouette
is slightly enlarged but similar compared to prior. No acute osseous
abnormalities.
IMPRESSION:
Probable moderate to large right pleural effusion. With superimposed mild
pulmonary edema. More dense opacity in the left lung which could also
represent edema though infection would be possible.
|
10160622-RR-136
| 10,160,622 | 28,663,041 |
RR
| 136 |
2180-05-21 04:28:00
|
2180-05-21 08:37:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HF, known pleurla effusion who presents
with dyspnea, requiring hi flow// eval for pulm edema, interval change,
IMPRESSION:
In comparison with the study of ___, there has been some decrease in
the opacification at the right base with the hemidiaphragm slightly better
seen. Although this could represent improvement in the pleural effusion, it
may merely be a manifestation of a more upright position of the patient.
The remainder the study is essentially unchanged.
|
10160622-RR-138
| 10,160,622 | 28,663,041 |
RR
| 138 |
2180-05-23 04:58:00
|
2180-05-23 13:28:00
|
INDICATION: ___ year old woman with hypoxia// ?eval for pulmonary edema,
infection
TECHNIQUE: Chest portable AP
COMPARISON: ___
FINDINGS:
Larger right pleural effusion again is unchanged or slightly increased. Left
lung appears clear.
IMPRESSION:
Large right effusion.
|
10160622-RR-139
| 10,160,622 | 28,663,041 |
RR
| 139 |
2180-05-23 12:00:00
|
2180-05-23 14:04:00
|
INDICATION: ___ year old woman with new L PICC// L DL Power PICC 46cm ___
___ Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: To 11 18, 05:07 (8 hours prior)
FINDINGS:
Left PICC line has been placed with its tip projecting at the sinoatrial
juncture. Large right effusion as previously. Increased pulmonary vascular
congestion in the left lung is now seen not as apparent on the previous
radiograph
IMPRESSION:
Tip of PICC line in the right the cavoatrial juncture. No pneumothorax.
Increased vascular congestion in the left lung. Large right effusion as
previously.
|
10160622-RR-140
| 10,160,622 | 28,663,041 |
RR
| 140 |
2180-05-24 12:52:00
|
2180-05-24 15:20:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent chest tube// post chest tube
placement
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-rays ___ through ___.
FINDINGS:
Compared to the most recent prior study, the right pleural effusion has
improved, and is now moderate in size. A right apical pneumothorax is new.
Right lung atelectasis appears mildly increased from prior. Pulmonary
vascular congestion is similar to prior. The heart size is normal. No left
pleural effusion. A pleural catheter projects over the right hemithorax. The
left PICC terminates near the cavoatrial junction.
IMPRESSION:
1. New right apical pneumothorax.
2. Interval improvement in right pleural effusion, which is now moderate in
size.
3. Mild increase in right mid and upper lung atelectasis.
4. Unchanged pulmonary vascular congestion.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 3:15 pm, 5 minutes after discovery of
the findings.
|
10160622-RR-141
| 10,160,622 | 28,663,041 |
RR
| 141 |
2180-05-25 07:05:00
|
2180-05-25 11:06:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right side chest tube and apical PTX//
apical PTX and pleural effusion with chest tube. Evaluate apical pneumothorax
and pleural effusion.
TECHNIQUE: Frontal views of the chest.
COMPARISON: Chest x-rays ___ through ___.
FINDINGS:
Compared to the most recent prior study the right pleural effusion has
improved, and is now small in size. The right apical pneumothorax is
unchanged. Mild pulmonary edema, in a perihilar distribution, is similar to
prior. No left pleural effusion. The heart size is normal. The pleural
catheter projects over the right hemithorax. The left PICC terminates near
the cavoatrial junction.
IMPRESSION:
1. Unchanged right apical pneumothorax.
2. Interval improvement in the right pleural effusion, which is now small.
3. Unchanged mild pulmonary edema.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.