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10160622-RR-142
| 10,160,622 | 28,663,041 |
RR
| 142 |
2180-05-25 10:55:00
|
2180-05-25 12:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with chest tube in place.// Please evaluate for
chest tube positioning. Please evaluate for chest tube positioning.
IMPRESSION:
Compared to chest radiographs ___ through ___ at 07:56.
Right pigtail pleural drainage catheter has several more loops as it projects
over the right lower chest. I cannot say whether these are external or
internal. There is no pneumothorax. Pleural effusion is small if any. Right
lower lobe consolidation has worsened appreciably, and there may be more
rightward mediastinal shift. In any case the changes probably due to
worsening atelectasis. Mild pulmonary edema is unchanged. Heart size
top-normal.
Left PIC line ends in the mid SVC.
|
10160622-RR-143
| 10,160,622 | 28,663,041 |
RR
| 143 |
2180-05-25 21:58:00
|
2180-05-25 22:47:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with afib, holding apixaban, now with acute
respiratory failure// PE?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 468 mGy-cm.
COMPARISON: Bilateral lower extremity venous ultrasound dated ___.
Chest x-ray dated ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, supraclavicular, or hilar
adenopathy is identified. Borderline enlarged mediastinal lymph nodes measure
up to 9 mm in short axis in the right lower paratracheal station.
PLEURAL SPACES: A right-sided pigtail pleural drainage catheter is present.
There is a small hydropneumothorax on the right. Pleural effusion on the left
is small to moderate in volume.
LUNGS/AIRWAYS: An endotracheal tube is present, the tip ending just above the
carina. The airways are patent centrally. Dense consolidation and extensive
ground-glass are seen involving the right upper and lower lobes. Ground-glass
opacities are seen to a lesser degree involving the left upper and lower lobes
as well. Linear atelectasis versus scarring is noted at the left lower lobe.
Numerous scattered ground-glass nodules are noted bilaterally, likely
infectious in etiology
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen are notable for clips in the
gallbladder fossa, compatible with prior cholecystectomy. There is bilateral
adrenal thickening, without focal nodule.
BONES AND SOFT TISSUES: No suspicious osseous abnormality is seen.? There is
no acute fracture. There is extensive anasarca.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Extensive multifocal ground-glass opacities and dense pulmonary
consolidation involving the right lower lobe are consistent with multifocal
pneumonia.
3. Status post right pigtail pleural drainage catheter, with small right
hydropneumothorax.
4. Small left pleural effusion.
5. Diffuse anasarca.
|
10160622-RR-145
| 10,160,622 | 28,663,041 |
RR
| 145 |
2180-05-25 13:46:00
|
2180-05-25 15:34:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with history of afib on warfarin now with acute
hypoxic respiratory failure, concern for DVT/PE// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. The right calf veins are not
well evaluated secondary to leg circumference. The patient is s/p left BKA.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins extending from the common femoral veins to the popliteal veins.
|
10160622-RR-146
| 10,160,622 | 28,663,041 |
RR
| 146 |
2180-05-26 04:56:00
|
2180-05-26 10:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with acute hypoxic respiratory failure//
Interval change? Interval change?
IMPRESSION:
Compared to chest radiographs ___ through ___ at 00:46.
Mild to moderate pulmonary edema most pronounced at the lung bases is
increased slightly. Right basal atelectasis is still considerable. Hard to
assess the volume of right pleural effusion, could be small or moderate and
sub pulmonic. No pneumothorax. Heart is still mildly enlarged, particularly
the right heart and mediastinal veins still mildly distended.
ET tube and left jugular line and left PIC line are in standard placements.
Nasogastric drainage tube passes into the stomach and out of view.
|
10160622-RR-147
| 10,160,622 | 28,663,041 |
RR
| 147 |
2180-05-25 20:35:00
|
2180-05-25 21:56:00
|
INDICATION: ___ year old woman with new OG tube placement.// Please evaluate
OG tube placement.
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT chest dated ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for degenerative changes of the spine as well
as a mild levoconvex scoliosis. The tip of the feeding tube extends below the
level the diaphragm projecting rightward presumably within the stomach. A
pigtail catheter projects over the right lung base and there is persisting
rightward mediastinal shift.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
The tip of the feeding tube projects over the stomach.
|
10160622-RR-148
| 10,160,622 | 28,663,041 |
RR
| 148 |
2180-05-26 00:38:00
|
2180-05-26 09:17:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman s/p left central line placement// line
placement Contact name: ___: ___ line placement
IMPRESSION:
Compared to chest radiographs ___ through ___.
Severe atelectasis of the right lung base has improved minimally. There is no
pneumothorax on the right. Subpulmonic effusion would be difficult to
distinguish from atelectasis in the elevated right hemidiaphragm. Mild
pulmonary edema has improved. Rightward shift of the lower mediastinum has
improved but the right heart border is still partially obscured. I doubt
substantial cardiomegaly. Previous mediastinal venous engorgement has
decreased.
Lines and tubes including right lower pigtail pleural drainage catheter,
unchanged in standard positions.
|
10160622-RR-149
| 10,160,622 | 28,663,041 |
RR
| 149 |
2180-05-27 04:26:00
|
2180-05-27 09:28:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxemic respiratory failure; pulmonary
edema// Please evaluate for interval change Please evaluate for interval
change
IMPRESSION:
ET tube tip is 4.5 cm above the carinal. Heart size and mediastinum are
stable. Left PICC line tip is at the level of superior SVC. Right internal
jugular line tip is at the level of lower SVC. Right pigtail catheter is in
place. Right mediastinal shift is unchanged. Left basal opacity is
unchanged. There is mild interstitial pulmonary edema, similar to previous
examinations.
|
10160622-RR-150
| 10,160,622 | 28,663,041 |
RR
| 150 |
2180-05-28 04:30:00
|
2180-05-28 08:45:00
|
INDICATION: ___ year old woman with chest tube// daily CXR to monitor pleural
effusion
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Support lines and tubes unchanged. Right-sided pigtail catheter is also
unchanged. Right pleural effusion has slightly decreased in volume.
Interstitial abnormality is stable. Cardiomediastinal silhouette is
unchanged. No pneumothorax is seen
|
10160622-RR-151
| 10,160,622 | 28,663,041 |
RR
| 151 |
2180-05-29 04:46:00
|
2180-05-29 10:58:00
|
INDICATION: ___ year old woman with hypoxemic respiratory failure; intubated//
Please evaluate for interval change
COMPARISON: Radiographs ___
IMPRESSION:
Support lines and tubes are unchanged in position. Heart size is grossly
within normal limits. The patient is rotated on the study. There is patchy
opacity at the left base, stable. There are no pneumothoraces.
|
10160622-RR-152
| 10,160,622 | 28,663,041 |
RR
| 152 |
2180-05-28 23:17:00
|
2180-05-29 03:54:00
|
EXAMINATION: CT scan of the abdomen and pelvis without intravenous contrast
INDICATION: ___ year old woman with fevers and concern for worsening
infection// Please evaluate for intra-abdominal infectious foci
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 14.7 s, 50.4 cm; CTDIvol = 21.9 mGy (Body) DLP =
1,070.5 mGy-cm.
Total DLP (Body) = 1,084 mGy-cm.
COMPARISON: CT scan of the thorax dated ___. CT abdomen and
pelvis ___.
FINDINGS:
LOWER CHEST: There is bibasal airspace consolidation. The degree of
consolidation within the right lung base appears improved in comparison to the
prior examination. However, the left basal consolidation is new. There are
small bilateral pleural effusions. There is a right-sided pigtail pleural
drainage catheter.
ABDOMEN:
HEPATOBILIARY: Assessment on noncontrast exam is limited. There is a small
hypodensity measuring 8 mm in segment 8 (series 3, image 18, series 4, image
26), less likely unenhanced vessel, not clearly visible on prior CT. The
gallbladder is surgically absent. No intra or extrahepatic biliary ductal
dilatation.
PANCREAS: Pancreas appears grossly unremarkable. No focal pancreatic mass is
identified.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Mild nonspecific thickening of the adrenal glands without focal
mass.
URINARY: Atypical orientation of the right kidney with transverse lie. No
focal renal lesion is identified. No hydronephrosis.
GASTROINTESTINAL: There is an enteric tube with its tip in the distal stomach.
The small bowel is normal in caliber. Scattered colonic diverticula. The
appendix is not visualized.
PELVIS: The bladder is collapsed with a Foley catheter in situ. Gas within
the bladder lumen is likely post catheterization. Small volume pelvic
ascites.
REPRODUCTIVE ORGANS: The uterus is diminutive in size. Coarse calcification
along the left lateral aspect of the uterine body likely represents a
calcified fibroid. The left ovary is enlarged measuring 4.2 x 5.4 cm with a
multiloculated cystic mass which appears present dating back to ___. The
right ovary measures 2.8 x 4.0 cm and contains a bilobed low-attenuation
structure, which may also be present dating back to ___ but appears to have
increased in size in the interval, previously measuring 1.9 x 2.5 cm on
transvaginal ultrasound from ___.
LYMPH NODES: Multiple prominent retroperitoneal lymph nodes, none of which are
enlarged by CT size criteria. Prominent bilateral inguinal lymph.
VASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic
disease is noted, with extensive calcification of the splenic artery, celiac
trunk and its branches, SMA, ___, and renal arteries.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes are seen in the spine addition to postsurgical change.
Anterolisthesis of L5 with respect to S1, grade 2 appears similar to prior
study also. Irregular contour of the left lateral iliac bone is likely
postsurgical in nature.
SOFT TISSUES: Diffuse subcutaneous edema suggestive of fluid third-spacing.
IMPRESSION:
1. Bibasal atelectasis/consolidation with small bilateral pleural effusions.
An infectious etiology, such as aspiration pneumonitis/pneumonia could be
considered in the appropriate clinical context.
2. Bilateral cystic ovarian/adnexal masses, present dating back to ___ but
increased in size on the right.
3. Severe atherosclerotic calcification involving the abdominal aorta and
major branch vessels including the celiac trunk, SMA, ___, and renal arteries.
Evaluation is limited by lack of intravenous contrast.
4. Diffuse subcutaneous edema suggestive of fluid third-spacing.
5. Small hepatic hypodensity measuring 8 mm in segment 8 not clearly visible
on prior CT.
RECOMMENDATION(S): Dedicated pelvic ultrasound for evaluation of cystic
ovarian/adnexal masses.
Targeted liver ultrasound to assess for right hepatic lesion given limited
assessment on current noncontrast CT, and apparent interval development of 8
mm hypodensity in segment 8 since prior CT.
|
10160622-RR-153
| 10,160,622 | 28,663,041 |
RR
| 153 |
2180-05-30 04:44:00
|
2180-05-30 09:56:00
|
INDICATION: ___ year old woman with ET tube placement, multifocal PNA//
Evaluate for ET tube position, progression of pulmonary infiltrates
IMPRESSION:
Support lines and tubes are unchanged in position. Patient is rotated on the
study. There is cardiomegaly. There is moderate pulmonary edema, stable.
There are small bilateral pleural effusions. There are no pneumothoraces.
|
10160622-RR-154
| 10,160,622 | 28,663,041 |
RR
| 154 |
2180-05-29 17:47:00
|
2180-05-29 19:06:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with desats// ?edema
TECHNIQUE: Portable frontal views of the chest.
COMPARISON: ___ 04:51.
IMPRESSION:
Compared to the earlier same day examination, endotracheal tube, left PICC,
and upper enteric tube are unchanged in position, satisfactory.
Cardiomediastinal silhouette is unchanged. There remains central pulmonary
vascular congestion with trace interstitial edema. Right lung base pigtail
pleural catheter is unchanged. There is no large pleural effusion. There is
no pneumothorax. There is no new consolidation.
|
10160622-RR-155
| 10,160,622 | 28,663,041 |
RR
| 155 |
2180-05-31 04:03:00
|
2180-05-31 10:18:00
|
INDICATION: ___ year old woman with hypoxemic respiratory failure, pleural
effusion s/p chest tube placement// Please evaluate for interval change
IMPRESSION:
Support lines and tubes are unchanged in position. There is unchanged
cardiomegaly and low lung volumes. There are bilateral effusions and
increased opacity of the left lung since prior, possibly due to layering
pleural fluid and/or consolidation. There are no pneumothoraces.
|
10160622-RR-156
| 10,160,622 | 28,663,041 |
RR
| 156 |
2180-05-30 15:59:00
|
2180-05-30 16:39:00
|
EXAMINATION: Right ankle radiograph
INDICATION: Right foot amputation with fevers. Concern for osteomyelitis.
TECHNIQUE: Right ankle, three views.
COMPARISON: Right foot ___.
IMPRESSION:
There are changes from right foot amputation at the level of the metatarsal
bases. The bones are demineralized. Surgical clips are seen medially.
Vascular stent is partially seen. There is no acute fracture or subluxation.
The ankle mortise appears preserved. There are mild residual hindfoot
degenerative changes. There is a small inferior calcaneal enthesophyte.
There is no gross bony destruction or periosteal reaction. There is no
explain radiopaque foreign body. No radiographic evidence for osteomyelitis,
though gadolinium-enhanced MR would be more sensitive, if there is high
concern.
|
10160622-RR-157
| 10,160,622 | 28,663,041 |
RR
| 157 |
2180-05-31 11:43:00
|
2180-05-31 12:46:00
|
INDICATION: ___ year old woman with intubation// ?worsening opacity
COMPARISON: ___
IMPRESSION:
Patient is rotated. The endotracheal tube, left-sided central venous
catheters, enteric tube, and right basilar pleural pigtail catheter appear
unchanged in position. There is unchanged cardiomegaly. There has been
slight decrease in the right-sided pleural effusion. There is a persistent
left retrocardiac opacity. There is mild to moderate pulmonary edema, stable.
There are no pneumothoraces.
|
10160622-RR-158
| 10,160,622 | 28,663,041 |
RR
| 158 |
2180-06-01 04:15:00
|
2180-06-01 08:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxic respiratory failure and fevers//
PNA, fluid
IMPRESSION:
In comparison with study of ___, the monitoring and support devices
are unchanged. With the right chest tube in place, there is no evidence of
pneumothorax. Slightly lower lung volumes with continued enlargement of the
cardiac silhouette and mild to moderate pulmonary vascular congestion.
Bilateral pleural effusions with volume loss in the left lower lobe.
|
10160622-RR-159
| 10,160,622 | 28,663,041 |
RR
| 159 |
2180-06-02 04:01:00
|
2180-06-02 08:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxemic respiratory failure, pleural
effusion// Please evaluate for interval change
IMPRESSION:
The right chest tube remains in place, though there is an increase in the
amount of pleural fluid. Small pneumothorax is appreciated in the apical
region extending part way down the lateral aspect of the right lung.
Continued enlargement of the cardiac silhouette with pulmonary edema and small
effusion on the left.
|
10160622-RR-160
| 10,160,622 | 28,663,041 |
RR
| 160 |
2180-06-02 11:29:00
|
2180-06-02 13:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new intubation.// Please assess for ET
tube position.
IMPRESSION:
In comparison with the earlier study of this date, there has been placement of
an endotracheal tube with its tip approximately 3 cm above the carina.
Allowing for differences in obliquity, there is little change except for some
improvement in the degree of pulmonary vascular congestion.
|
10160622-RR-161
| 10,160,622 | 28,663,041 |
RR
| 161 |
2180-06-03 04:20:00
|
2180-06-03 08:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary edema, SOB// ?pulmonary edema
IMPRESSION:
In comparison with the study of ___, the monitoring support devices
remain in place. No evidence of pneumothorax. The increased opacification at
the right base has essentially cleared. Opacification at the left base with
obscuration of the hemidiaphragm suggests layering pleural effusion with
compressive atelectasis.
Cardiac silhouette is within overall normal limits. Mild indistinctness of
pulmonary vessels is consistent with mild elevation of pulmonary venous
pressure.
|
10160622-RR-162
| 10,160,622 | 28,663,041 |
RR
| 162 |
2180-06-03 15:07:00
|
2180-06-03 16:33:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman with renal failure, fevers. Evaluate for
infectious source.
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 administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 65.2 cm; CTDIvol = 20.6 mGy (Body) DLP =
1,342.2 mGy-cm.
Total DLP (Body) = 1,342 mGy-cm.
COMPARISON: CT abdomen pelvis of ___ and CT abdomen pelvis of ___..
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: An 8 mm hypodensity in hepatic segment VIII is too small to
characterize by CT. The unenhanced liver is otherwise unremarkable. The
gallbladder is surgically absent.
PANCREAS: Unenhanced pancreas is unremarkable.
SPLEEN: The unenhanced spleen is unremarkable.
ADRENALS: Unremarkable.
URINARY: Unenhanced kidneys are unremarkable, aside from vascular
calcifications.
GASTROINTESTINAL: Enteric tube tip is in the distal stomach. No bowel
obstruction. A rectal tube is in place. There is slightly increased trace
perihepatic ascites. The appendix is not visualized.
PELVIS: Foley catheter is identified in the urinary bladder. There is trace
free pelvic fluid.
REPRODUCTIVE ORGANS: Coarse calcification along the left aspect of the uterus,
likely a fibroid. No change in the appearance of the right ovary and 4.3 cm
left adnexal mass.
LYMPH NODES: No enlarged abdominal or pelvic lymph nodes are seen
VASCULAR: Extensive atherosclerotic disease is again noted.
BONES: Unchanged presacral soft tissue and irregular contour of the left
lateral iliac bone since ___, presumably postsurgical.
SOFT TISSUES: Diffuse edema, suggestive of fluid third-spacing, has increased
since the prior study.
IMPRESSION:
1. No CT evidence of intra-abdominal or intrapelvic infection.
2. Bilateral adnexal masses again noted, as reported recently on CT.
3. Please refer to dedicated CT chest report of same date for the
intrathoracic findings.
|
10160622-RR-163
| 10,160,622 | 28,663,041 |
RR
| 163 |
2180-06-03 15:08:00
|
2180-06-03 16:57:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ woman with renal failure, fevers. Infectious
source?.
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.0 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. No contrast agent was administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 65.2 cm; CTDIvol = 20.6 mGy (Body) DLP =
1,342.2 mGy-cm.
Total DLP (Body) = 1,342 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W/O CONTRAST)
COMPARISON: CTA ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid is unremarkable.
Left supraclavicular 1 cm lymph nodes are borderline (302:17) stable.
Bilateral borderline axillary lymph nodes are few and unchanged, likely
reactive.
Extensive subcutaneous edema in the chest wall unchanged.
CHEST CAGE: Multilevel mild-to-moderate degenerative changes with no evidence
of osteo destructive lesions at the level of the sternum, ribs or vertebral.
UPPER ABDOMEN: Patient is status post sternotomy. Extensive atherosclerotic
calcifications in the imaged subdiaphragmatic arteries. Small quantity of
ascites. Please see separately dictated CT of the abdomen and pelvis for
complete description of subdiaphragmatic findings.
MEDIASTINUM: Small hiatal hernia, the esophagus is collapsed, NG tube extends
through it into the stomach and out of view. Small quantity of ascites
extends alongside the hernia. Multiple borderline mediastinal lymph nodes
measure up to 0.9 cm (302:69) unchanged likely reactive. There is no gross
hilar lymphadenopathy.
HEART and PERICARDIUM: Heart is normal in size. Hypodensity of cardiac
chambers suggest mild anemia. Severe calcification of the coronaries
predominantly LAD and RCA. Moderate along the normal caliber thoracic aorta.
Left internal jugular line and PICC terminates in upper SVC and mid SVC
respectively. No pericardial effusion. Pulmonary artery is normal in
caliber.
PLEURA: Right pigtail catheter through ___ intercostal space terminates in the
pleural space. Small right hydro pneumothorax is essentially unchanged.
Small bilateral layering pleural effusions, left greater than right
essentially unchanged.
LUNG: Endotracheal tube terminates in the trachea in good position,
approximately 3 cm from carina. Previous extensive consolidation in the right
lower and dependent upper lobe, possibly aspiration pneumonia, has almost
completely resolved.
Respiratory motion artifacts limit evaluation of fine details. Bilateral
centrilobular nodulation is more evidenced in the left upper and lower lobes
(302: 102), new since prior, reflecting new bronchopneumonia. Mild pulmonary
edema is unchanged.
IMPRESSION:
-Right pigtail catheter unchanged in position, small right hydropneumothorax
is unchanged and left small layering pleural effusion is stable.
-Almost complete resolution of right lung possibly aspiration pneumonia.
-New bronchopneumonia in the left lung.
-Anasarca.
|
10160622-RR-164
| 10,160,622 | 28,663,041 |
RR
| 164 |
2180-06-04 03:56:00
|
2180-06-04 10:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxic respiratory failure, PNA, edema
and right effusion with chest tube// interval change
IMPRESSION:
In comparison with the study ___, the monitoring support devices are
unchanged. With the right chest tube in place, there is no evidence of
pneumothorax. Otherwise, little overall change and except for the left
hemidiaphragmatic contour being more sharply seen.
|
10160622-RR-166
| 10,160,622 | 28,663,041 |
RR
| 166 |
2180-06-04 15:47:00
|
2180-06-04 17:46:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ year old woman s/p movement of ETT tube and Dobhoff placement.
Evaluate ETT placement? Dobhoff position?.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___ at 04:30.
FINDINGS:
In comparison with a study from ___ at 04:30 there is
demonstration of an appropriately positioned endotracheal tube. The tip of a
Dobhoff projects over the cardiac silhouette and should be advanced at least
15 cm. Bilateral opacities consistent with pulmonary congestion are again
noted. There is in new electronic device of unknown origin projecting over
the left hemithorax and probably external to the patient. Other supportive
tubes and lines are similarly position.
IMPRESSION:
Interval placement of a Dobhoff tube with the tip projecting over the mid
cardiac silhouette. If placement within the body of the stomach is desired, a
15 cm advancement is recommended.
|
10160622-RR-167
| 10,160,622 | 28,663,041 |
RR
| 167 |
2180-06-05 03:09:00
|
2180-06-05 08:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxic respiratory failure// interval
change
IMPRESSION:
In comparison with the study of ___, the monitoring and support
devices are unchanged. Continued enlargement of the cardiac silhouette with
pulmonary vascular congestion. Right pleural effusion and compressive
atelectasis is unchanged. Pigtail catheter again overlies the right lung
base.
|
10160622-RR-168
| 10,160,622 | 28,663,041 |
RR
| 168 |
2180-06-04 16:54:00
|
2180-06-04 19:55:00
|
INDICATION: ___ year old woman with Dobhoff placement// Confirm tube placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Please note that the images are flipped horizontally. 2 images demonstrate
advancement of a Dobhoff into the stomach. A gastric tube is also present
within the stomach. A pigtail catheter overlies the right lung base. The
tips of 2 central venous catheters project over the mid SVC.
IMPRESSION:
2 sequential images demonstrate advancement of a Dobhoff into the stomach.
|
10160622-RR-169
| 10,160,622 | 28,663,041 |
RR
| 169 |
2180-06-06 04:04:00
|
2180-06-06 08:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxemic respiratory failure, intubated//
Please evaluate for interval change
IMPRESSION:
In comparison with the study of ___, the monitoring and support
devices are unchanged. Cardiomediastinal silhouette is stable and there is no
evidence of pneumothorax. The right hemidiaphragmatic contour is much better
seen on the current study. Bibasilar atelectatic changes are seen, especially
on the right above the elevated hemidiaphragmatic contour.
|
10160622-RR-170
| 10,160,622 | 28,663,041 |
RR
| 170 |
2180-06-07 04:59:00
|
2180-06-07 08:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxemic respiratory failure, pleural
effusions// Please evaluate for interval change
IMPRESSION:
In comparison with study of ___, the monitoring and support devices
are essentially unchanged. Cardiomediastinal silhouette is stable and there
is indistinctness of engorged pulmonary vessels consistent with elevated
pulmonary venous pressure. Hazy opacification with obscuration of the
hemidiaphragm and retrocardiac opacification is consistent with layering
pleural effusion and volume loss in the left lower lobe. The right
hemidiaphragm is quite well seen.
Pigtail catheter is again projected over the right lung and there is no
evidence of pneumothorax.
|
10160622-RR-171
| 10,160,622 | 28,663,041 |
RR
| 171 |
2180-06-08 04:20:00
|
2180-06-08 18:09:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ year old woman with ET tube and persisten respiratory
failure.// Please evaluate for ET position, intrapulmonary pathology.
TECHNIQUE: Portable chest AP.
COMPARISON: Chest radiograph from ___.
FINDINGS:
In comparison with the study of ___ the patient is grossly
rotated to the right, resulting in distortion of the cardiomediastinal
silhouette and suboptimal visualization and comparison of the lung zones.
Within this limitation, there is prominence of the pulmonary vessels
associated with hazy densities resulting in partial obscuration of the left
hemidiaphragm, consistent with pulmonary edema. The right hemidiaphragm is not
visualized as the cardiac silhouette projects over it. There is
redemonstration of the endotracheal tube and partial visualization of the
nasogastric tube. The right pigtail drain is also noted.
IMPRESSION:
Limited study due to gross patient rotation with redemonstration of pulmonary
edema which is better demonstrated on the left lung, probably similar to the
prior exam. Visualization of the right hemithorax is suboptimal.
|
10160622-RR-173
| 10,160,622 | 28,663,041 |
RR
| 173 |
2180-06-09 04:01:00
|
2180-06-09 10:13:00
|
INDICATION: ___ year old woman with ET tube and persistent respiratory
failure.// Please evaluate for ET tube position, intrapulmonary process
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Chest radiograph from ___.
FINDINGS:
ET tube terminates 3.9 cm above the carina. A right pigtail drain is
unchanged in position. Enteric tube extends below the diaphragm with the tip
out of view of this film. Small right pleural effusion is unchanged. Opacity
at the right lung base appears slightly increased compared to the prior exam.
Left lung base opacities unchanged. There is no evidence of pneumothorax.
IMPRESSION:
ET tube terminates approximately 3.9 cm above the carina. Slight interval
increase in the opacity at the right lung base compared to the prior exam
performed 23 hours prior.
|
10160622-RR-174
| 10,160,622 | 28,663,041 |
RR
| 174 |
2180-06-10 04:30:00
|
2180-06-10 09:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure undergoing active
diuresis// interval change interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Patient is rotated severely to the right distorting anatomic relationships.
Left lung is clear and there is no appreciable left pleural abnormality.
Right middle and lower lobe atelectasis is substantial, and obliteration of
the bronchial lumen below the bronchus intermedius suggests bronchial
impaction may be largely responsible. The right pigtail pleural drainage
catheter is sharply folded as it enters the chest which may compromise
drainage. There is no pneumothorax. Heart size is hard to assess but
probably not greatly enlarged.
ET tube in standard placement. Feeding tube passes into the stomach and out
of view.
|
10160622-RR-175
| 10,160,622 | 28,663,041 |
RR
| 175 |
2180-06-11 04:18:00
|
2180-06-11 10:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxemic respiratory failure, pleural
effusions, intubated// Please evaluate for interval change
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are stable. The left lung remains clear. However, there again is
opacification in the right mid and lower zone, consistent with atelectatic
changes. The pigtail pleural catheter show some apparent kinking, but there
is no evidence of pneumothorax.
|
10160622-RR-177
| 10,160,622 | 28,663,041 |
RR
| 177 |
2180-06-12 05:03:00
|
2180-06-12 09:51:00
|
INDICATION: ___ year old woman with hypoxemic respiratory failure with kinked
chest tube// Please evaluate for interval change
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Endotracheal, enteric, left IJ, and left PICC are again seen, in stable
position. Right-sided chest tube is again noted. Elevation of the right
hemidiaphragm is again seen. Left lung remains grossly clear. Overall
appearance of the lungs and cardiomediastinal silhouette is unchanged.
IMPRESSION:
No significant interval change.
|
10160622-RR-178
| 10,160,622 | 28,663,041 |
RR
| 178 |
2180-06-13 05:28:00
|
2180-06-13 09:47:00
|
INDICATION: ___ year old woman with R sided chest tube, respiratory failure,
pulm edema// evaluate lines/tubes placement and for pleural effusions
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-rays over the past few days with most recent from ___.
FINDINGS:
ET, left PICC, left IJ, enteric tube and right pleural pigtail catheter are
unchanged. There is focal kinking of a portion of the right pigtail catheter
as seen on priors, the kink is likely at the chest entry site. There is no
significant effusion. No pneumothorax. Besides right base atelectasis, the
lungs are essentially clear
IMPRESSION:
No significant interval change.
|
10160622-RR-179
| 10,160,622 | 28,663,041 |
RR
| 179 |
2180-06-14 04:37:00
|
2180-06-14 09:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ETT// interval change
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are unchanged. Again there are low lung volumes with the cardiac silhouette
within normal limits and probable mild vascular congestion.
Increased opacification is again seen at the right base medially with poor
definition of the right heart border. In the appropriate clinical setting,
this would be worrisome for superimposed aspiration/pneumonia.
Right pigtail catheter remains in place with kinking probably at the chest
entry site.
|
10160622-RR-180
| 10,160,622 | 28,663,041 |
RR
| 180 |
2180-06-15 04:26:00
|
2180-06-15 08:19:00
|
INDICATION: ___ year old woman with hypodermic respiratory failure// ET tube,
congestion/edema?
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume with bibasilar atelectasis. Support lines and tubes
unchanged. Right-sided pigtail catheter remains in place. There is a trace
right apical pneumothorax. Small right pleural effusions also seen.
Cardiomediastinal silhouette is unchanged.
|
10160622-RR-182
| 10,160,622 | 28,663,041 |
RR
| 182 |
2180-06-17 10:53:00
|
2180-06-17 11:29:00
|
INDICATION: ___ w/ CAD (s/p DES), T1DM, Afib, HFpEF, PVD (s/p L BKA,
Rtransmetatarsal amputation and chronic RLE ulcers), HTN, reactiveairway
disease admitted with respiratory failure (initiallysecondary to pneumonia and
later due to volume overload,extubated ___, with course complicated by MRSA
bacteremia(possibly secondary to pneumonia, on linezolid) and ___ to
ATN in setting of sepsis).// ?pneumothorax resolution, ?r-sided effusion
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume with stable position of the right basilar pigtail
catheter. Left-sided PICC line projects to the SVC. The ET and NG tube have
been removed. Lungs are low volume. Subsegmental atelectasis in the right
lower lobe has slightly worsened. Cardiomediastinal silhouette is stable. No
pneumothorax is seen
|
10160622-RR-183
| 10,160,622 | 28,663,041 |
RR
| 183 |
2180-06-19 11:10:00
|
2180-06-19 13:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman T1DM, Afib, HFpEF, PVD, respiratory failure,
MRSA bacteremia, now with hypoxia and crackles// ?effusion ?effusion
IMPRESSION:
Compared to chest radiographs ___ through ___.
Right pigtail pleural drainage catheter is been removed. No increase in small
residual right pleural effusion. No pneumothorax. Right basal atelectasis
stable. Left lung grossly clear. Heart size normal. Left PIC line ends at
their origin of the SVC.
|
10160622-RR-185
| 10,160,622 | 28,663,041 |
RR
| 185 |
2180-06-21 15:27:00
|
2180-06-21 16:21:00
|
INDICATION: ___ year old woman with PNA, pulm edema// Eval for acute change
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Multiple priors from ___ dating back to ___
FINDINGS:
There is stable low right lung volume and basilar opacities. Small right
pleural effusions unchanged. No left pleural effusion. No pneumothorax.
Heart size is normal, unchanged. Mediastinal contour is unremarkable. Left
PICC terminates at the origin of the SVC.
IMPRESSION:
No significant change compared to the prior study on ___. Stable
small right pleural effusion and right lower lobe atelectasis.
|
10160622-RR-186
| 10,160,622 | 28,663,041 |
RR
| 186 |
2180-06-22 16:45:00
|
2180-06-22 17:19:00
|
INDICATION: ___ year old woman with MRSA bacteremia now with hypoxia//
?cardiopulmonary process
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the left PICC line projects over the upper SVC. The right
hemidiaphragm is again elevated with an overlying small pleural effusion and
atelectasis. The left lung demonstrates no focal consolidation, pleural
effusion or pneumothorax. Mild pulmonary edema is unchanged. The size of the
cardiac silhouette is within normal limits.
IMPRESSION:
No significant interval change since the prior chest radiograph.
|
10160622-RR-187
| 10,160,622 | 28,663,041 |
RR
| 187 |
2180-06-23 22:44:00
|
2180-06-24 10:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure, thought secondary to
PNA as well as volume overload, now with increasing O2 requirement// ? volume
overload vs worsening infection ? volume overload vs worsening infection
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Mild pulmonary edema in the left lung has worsened and mediastinal venous
engorgement has progressed.. More confluent opacification in the right lung
has also progressed and although this could be asymmetric edema aspiration
pneumonia should be considered.
Left PIC line ends in the upper SVC. Heart size top-normal. Hiatus hernia is
chronic.
|
10160622-RR-188
| 10,160,622 | 28,663,041 |
RR
| 188 |
2180-06-25 10:51:00
|
2180-06-25 15:16:00
|
INDICATION: ___ year old woman with HFrEF, MRSA PNA s/p abx course, with
hypoxia// ?pulmonary edema, ?consolidation
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Pulmonary edema has improved. Left-sided PICC line projects to the SVC.
Cardiomediastinal silhouette is stable. There is moderate pulmonary edema.
Small right pleural effusions unchanged. No pneumothorax is seen
|
10160622-RR-189
| 10,160,622 | 28,663,041 |
RR
| 189 |
2180-06-25 23:39:00
|
2180-06-26 08:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with reactive airway disease admitted with
respiratory failure ___ PNA and vol overload, now with worsening hypoxia//
pulmonary edema interval change
IMPRESSION:
In comparison with study of ___, there is difference in the degree of
obliquity of the patient. Continued enlargement of the cardiac silhouette
with moderate pulmonary edema. The right pleural effusion is more prominent
with obscuration of the cardiophrenic angle. Increased opacification at the
right base could merely reflect atelectatic changes, though in the appropriate
clinical setting superimposed pneumonia would have to be seriously considered.
|
10160622-RR-190
| 10,160,622 | 28,663,041 |
RR
| 190 |
2180-06-30 22:43:00
|
2180-06-30 23:27:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with hypoxia//pna? pnx?
COMPARISON: Prior exam from ___
FINDINGS:
AP upright and lateral views of the chest provided. There is complete
opacification of the right hemithorax, concerning for large pleural effusion.
Congestion and mild edema is suspected. No left effusion. Heart size cannot
be assessed. Bony structures grossly intact.
IMPRESSION:
Complete opacification of the right hemithorax is likely due to a large
effusion. Congestion and mild edema.
|
10160622-RR-200
| 10,160,622 | 20,002,800 |
RR
| 200 |
2180-07-18 14:19:00
|
2180-07-18 16:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with sob// worsening PTX
COMPARISON: Prior from ___
FINDINGS:
AP portable upright view of the chest. There is a right apical pneumothorax
without evidence of tension. Mild basal atelectasis. No large effusion.
Cardiomediastinal silhouette appears grossly unremarkable. Bony structures
are intact.
IMPRESSION:
Small right apical pneumothorax without evidence of tension.
|
10160622-RR-201
| 10,160,622 | 20,002,800 |
RR
| 201 |
2180-07-18 16:13:00
|
2180-07-18 16:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with PTX// evaluate for change in PTX
COMPARISON: Prior from 1 hour earlier.
FINDINGS:
AP portable upright view of the chest. A right pneumothorax is again seen,
without significant change, small in overall size and without evidence of
tension.
IMPRESSION:
Unchanged small right apical pneumothorax, no tension
|
10160622-RR-202
| 10,160,622 | 20,002,800 |
RR
| 202 |
2180-07-19 08:38:00
|
2180-07-19 12:51:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with small apical PTX// ? change in PTX ?
change in PTX
IMPRESSION:
Compared to chest radiographs ___.
Heart is now normal size. Rightward mediastinal shift is exaggerated by
patient rotation, but there is probably still atelectasis at the base the
right lung. There is no longer pulmonary edema and pleural effusion is small
if any
|
10160622-RR-203
| 10,160,622 | 20,002,800 |
RR
| 203 |
2180-07-19 07:24:00
|
2180-07-19 12:11:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with sob found to have R Pnemothorax//
Pneumothorax evolution
TECHNIQUE: Portable chest
COMPARISON: Chest radiograph ___
FINDINGS:
Compared to the prior study the moderate right pneumothorax appears stable.
Interval increase in right lung base atelectasis and small right pleural
effusion is noted. The left lung demonstrates mild pulmonary vascular
congestion. The cardiac silhouette is within normal limits.
IMPRESSION:
1. Stable moderate right pneumothorax. Increasing right lung base atelectasis
and small right pleural effusion.
2. Mild left pulmonary vascular congestion.
|
10160990-RR-11
| 10,160,990 | 27,707,315 |
RR
| 11 |
2121-09-02 16:27:00
|
2121-09-02 17:02:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough and chest pain. Evaluate for PNA.
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Large right pneumothorax with mild leftward mediastinal shift. No
consolidation or pleural effusion noted. Cardiomediastinal silhouette is
within normal limits.
IMPRESSION:
Large right pneumothorax with mild leftward mediastinal shift.
|
10160990-RR-12
| 10,160,990 | 27,707,315 |
RR
| 12 |
2121-09-02 18:04:00
|
2121-09-02 18:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with PNX W/ PIGTAL // ?chest tube placement
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest radiograph ___ at 16:42
FINDINGS:
Interval placement of right apical chest tube with pigtail projecting over the
medial right apex. Previously noted large right-sided pneumothorax has
substantially decreased in size with only a small residual apical pneumothorax
remaining. There has been substantial re-expansion of the right lung. Linear
atelectasis is seen in the right lung base. Left lung is clear. Cardiac and
mediastinal contours are normal with previously noted leftward shift of
mediastinal structures no longer visualized. No acute osseous abnormality.
IMPRESSION:
Interval placement of right apical chest tube with substantial decrease in
size of the right pneumothorax, with only a residual small apical pneumothorax
now seen. Interval re-expansion of the right lung and resolution of
previously noted leftward mediastinal shift.
|
10160990-RR-13
| 10,160,990 | 27,707,315 |
RR
| 13 |
2121-09-03 08:02:00
|
2121-09-03 08:31:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with spontaneous R pneumothorax s/p right pigtail
placement in ED // Please perform chest xray PA/LAT at 8am ___ to
evaluate right pneumothorax and pigtail position
IMPRESSION:
In comparison with the study of ___, the right apical pigtail catheter
remains in place and there is no change in the degree of apical pneumothorax.
Cardiomediastinal silhouette is stable without appreciable vascular
congestion, pleural effusion, or acute focal pneumonia.
|
10160990-RR-15
| 10,160,990 | 27,707,315 |
RR
| 15 |
2121-09-05 08:00:00
|
2121-09-05 09:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R PTX // check interval change with suction
at -20 cm check interval change with suction at -20 cm
IMPRESSION:
Comparison to ___. On today's radiograph, the patient has a right
apical pneumothorax with the diameter of approximately 3 cm, close to double
the diameter than on the previous image. There is no evidence of tension.
Stable position of the right pigtail catheter.
|
10160990-RR-16
| 10,160,990 | 27,707,315 |
RR
| 16 |
2121-09-05 13:45:00
|
2121-09-05 15:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/significant smoking hx presents with 1 day of cough,
spontaneous R pneumothorax s/p pigtail placement in the ED // interval change
with CT to watersealplease complete at 1400 interval change with CT to
watersealplease complete at 1400
IMPRESSION:
Heart size and mediastinum are stable. Right pneumothorax is small to
moderate, minimally increased since previous radiograph obtained the same the
earlier at 08:38. Right pigtail catheter is in place. Lungs overall clear.
No appreciable pleural effusion.
|
10160990-RR-17
| 10,160,990 | 27,707,315 |
RR
| 17 |
2121-09-06 07:25:00
|
2121-09-06 15:52:00
|
INDICATION: ___ w/significant smoking hx presents with 1 day of cough,
spontaneous R pneumothorax s/p pigtail placement in the ED with small residual
air leak. // interval change on waterseal
COMPARISON: Radiographs dated ___
IMPRESSION:
Emphysematous changes bilaterally. Percutaneous pigtail catheter tip
projecting over the right apex medially. Unchanged right apical pneumothorax.
Cardiomediastinal silhouette is within normal limits. There are no focal
consolidations, pleural effusion, or pulmonary edema. There are no
pneumothoraces.
|
10160990-RR-18
| 10,160,990 | 27,707,315 |
RR
| 18 |
2121-09-05 18:51:00
|
2121-09-05 19:55:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with a history of smoking and spontaneous right
pneumothorax status post pigtail placement. Persistent pnx // Location of
pigtail- ? intraparenchymal
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent and reconstructed as contiguous 5 mm and 1.25 mm
thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images.
DOSE: Total DLP (Body) = 268 mGy-cm.
COMPARISON: No prior chest CTs are available.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
PULMONARY PARENCHYMA: There is moderate emphysema predominantly at the lung
bases. Patchy linear ground-glass opacity extending predominantly along the
paravertebral left lower lobe (7:130, 5:165) is of unclear significance.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: A percutaneous pigtail catheter inserted along the anterolateral
upper chest terminates in a small right apical pneumothorax.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are absent. Mild subcutaneous emphysema is
noted along the anterolateral chest wall secondary to percutaneous pigtail
catheter insertion.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is unremarkable.
IMPRESSION:
1. A percutaneous pigtail catheter tip terminates in a small right apical
pneumothorax.
2. Moderate emphysema, severe however at the lung bases.
3. Geographic linear ground-glass opacity along the paravertebral aspect of
the left lower lobe is nonspecific. Finding may represent small airways
disease.
|
10160990-RR-19
| 10,160,990 | 27,707,315 |
RR
| 19 |
2121-09-07 08:16:00
|
2121-09-07 14:26:00
|
INDICATION: ___ w/significant smoking hx presents with 1 day of cough,
spontaneous R pneumothorax s/p pigtail placement in the ED with small residual
air leak // interval changes
COMPARISON: Radiographs ___
IMPRESSION:
Right-sided chest tube, unchanged in position. No significant change in right
apical pneumothorax. Emphysema. Cardiomediastinal silhouette is within
normal limits. There are no focal consolidations, pleural effusion, or
pulmonary edema.
|
10160990-RR-21
| 10,160,990 | 27,707,315 |
RR
| 21 |
2121-09-09 08:11:00
|
2121-09-09 11:16:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with persistent air leak s/p bleb resection and
pleurodesis // Interval change
TECHNIQUE: AP chest radiograph
COMPARISON: Multiple prior chest radiographs most recently ___
also ___
FINDINGS:
The cardiomediastinal silhouette is within normal limits. There is increased
subcutaneous emphysema the right now tracking up to the right neck.
Right-sided chest tube is unchanged in position. No definite pneumothorax at
this time. No evidence of pleural effusion. No evidence of pulmonary edema.
IMPRESSION:
Unchanged position of right-sided chest tube. No pneumothorax.
|
10160990-RR-22
| 10,160,990 | 27,707,315 |
RR
| 22 |
2121-09-08 12:09:00
|
2121-09-08 13:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with persistent air leak s/p bleb resection and
pleurodesis // S/P bleb resection and pleurodesis
IMPRESSION:
In comparison with the study of 10 20, following interventional procedure, a
new right chest tube is now in place and the pigtail catheter is been removed.
No definite pneumothorax at this time.
No vascular congestion or pleural effusion.
|
10160990-RR-25
| 10,160,990 | 27,707,315 |
RR
| 25 |
2121-09-10 11:45:00
|
2121-09-10 13:02:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p R VATS blebectomy // R/O PTX post CT
removal, please do around 11AM
IMPRESSION:
In comparison with the study of ___, the right chest tube has been
removed and there is a small apical pneumothorax. Otherwise, little change in
the appearance of the heart and lungs.
|
10161042-RR-123
| 10,161,042 | 27,538,146 |
RR
| 123 |
2176-07-27 19:36:00
|
2176-07-27 21:28:00
|
INDICATION: ___ female with hypertension and headache, evaluate for
bleed.
COMPARISONS: None.
TECHNIQUE: Contiguous axial sections were obtained through the brain without
the administration of IV contrast. Coronal and sagittal reformations were
provided and reviewed.
FINDINGS: Complete evaluation of the posterior fossa is slightly limited by
artifact from the shoulders, despite attempted angulation of the gantry.
Within this limitation, there is no acute hemorrhage, edema, or shift of the
normally midline structures. The ventricles and sulci are of normal size and
configuration. The gray-white matter differentiation is preserved, and the
basal cisterns are patent. A hypodensity within the left basal ganglia may be
a prominent perivascular space versus an old lacunar infarct. Lenses and
globes are normal. The mastoid air cells and visualized paranasal sinuses are
well aerated. There are no suspicious osseous lesions.
IMPRESSION: No evidence of acute intracranial process. Small hypodensity in
the left basal ganglia, for which a prior small lacunar infarct or normal
perivascular space could be considered.
|
10161042-RR-124
| 10,161,042 | 27,538,146 |
RR
| 124 |
2176-07-28 12:29:00
|
2176-07-28 17:51:00
|
INDICATION: Hypoxia in a patient with a history of COPD.
COMPARISON: Most recent chest radiograph from ___.
FINDINGS: A bedside AP radiograph of the chest demonstrates clear lungs aside
from minimal bibasilar atelectasis. The heart size is stably minimally
enlarged, and there is slight widening of the upper mediastinal silhouette
suggestive of central venous engorgement. There is no pneumothorax or pleural
effusion. The pulmonary vascularity is normal and there is no edema.
IMPRESSION:
1. Mild central venous engorgement suggestive of hypervolemia.
2. No evidence of decompensated congestive heart failure or pneumonia.
|
10161042-RR-144
| 10,161,042 | 23,203,523 |
RR
| 144 |
2178-06-09 10:45:00
|
2178-06-09 14:53:00
|
INDICATION: History: ___ with shortness of breath // Eval for pneumonia
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___
FINDINGS:
Compared to the prior chest radiograph there is little change in, left greater
than right, lower lobe opacities which may represent atelectasis or pneumonia.
There is no pulmonary edema, pleural effusion or pneumothorax. The cardiac
silhouette is top normal in size. The mediastinal and pulmonary vascular are
not dilated. There is no free air beneath the right hemidiaphragm.
IMPRESSION:
Left greater than right, lower lobe opacities are unchanged since ___
and may represent atelectasis or pneumonia.
|
10161042-RR-145
| 10,161,042 | 23,203,523 |
RR
| 145 |
2178-06-09 09:19:00
|
2178-06-09 11:01:00
|
HISTORY: ___ female with shortness of breath and right lower
extremity swelling. Evaluation for DVT.
COMPARISON: Comparison is made to left lower extremity venous ultrasound from
___.
TECHNIQUE: Grayscale and color Doppler ultrasound images were obtained of the
right lower extremity veins.
FINDINGS: There is normal color flow, compressibility, and augmentation of
the right common femoral, superficial femoral, popliteal, posterior tibial,
and peroneal veins where appropriate. Normal respiratory variation is
demonstrated in the bilateral common femoral veins.
IMPRESSION: No evidence of DVT in the right lower extremity veins.
|
10161042-RR-146
| 10,161,042 | 23,203,523 |
RR
| 146 |
2178-06-09 12:55:00
|
2178-06-09 14:56:00
|
INDICATION: History: ___ with hypercarbic respiratory failure // Eval ETT
placement
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: Chest radiograph performed 2 hours prior.
FINDINGS:
A new endotracheal tube ends at the right mainstem bronchus. A nasogastric
tube terminates off of the radiograph. The right lung is clear. Near complete
opacification of the left lung represents a combination of atelectasis and a
small amount of pleural fluid. No pneumothorax is identified. There is no free
air beneath the right hemidiaphragm. Assessment of the cardiac and mediastinal
borders is limited due to the partial left lung collapse.
IMPRESSION:
1. The endotracheal tube ends at the right mainstem bronchus. Retraction of
the endotracheal tube is recommended.
2. Near complete opacification of the left lung likely represent atelectasis
and a small pleural effusion.
NOTIFICATION: ___ discussed with ___ at 1301 ___, the time of
discovery.
|
10161042-RR-147
| 10,161,042 | 23,203,523 |
RR
| 147 |
2178-06-09 17:26:00
|
2178-06-10 08:39:00
|
REASON FOR EXAMINATION: Right mainstem intubation after bronchoscopy with ET
tube pulled back.
Portable AP radiograph of the chest was reviewed in comparison to a prior
study obtained on ___.
The ET tube tip is currently 4.5 cm above the carina. The NG tube tip passes
below the diaphragm, not clearly seen. Although there is improvement of the
left upper lobe aeration, there is still presence of left lower lobe
atelectasis as well as right basal atelectasis. Small amount of pleural
effusion cannot be excluded. No pneumothorax is seen.
|
10161112-RR-40
| 10,161,112 | 20,020,549 |
RR
| 40 |
2184-11-18 17:16:00
|
2184-11-18 17:41:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough
TECHNIQUE: PA and lateral views of the chest
COMPARISON: Chest CT ___, chest radiograph ___
FINDINGS:
The patient is status post left upper lobectomy with clips noted in the left
hilar region. There is unchanged leftward shift of the mediastinal structures
with left sided volume loss. There is focal opacification within the left mid
lung field, which could reflect an area of pneumonia though recurrent
malignancy is not excluded. Blunting of the left costophrenic sulcus is
unchanged compatible with a small pleural effusion, similar to prior. There
is no pulmonary vascular congestion. The right lung is clear. Cardiac and
mediastinal contours are unchanged with a small hiatal hernia re-
demonstrated. No acute osseous abnormalities seen.
IMPRESSION:
Focal opacification within the left mid lung field concerning for pneumonia,
but recurrent malignancy is not excluded. Recommend followup radiographs after
treatment to assess for interval resolution.
|
10161112-RR-41
| 10,161,112 | 20,020,549 |
RR
| 41 |
2184-11-18 19:53:00
|
2184-11-18 20:47:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: History: ___ with recent lung cancer now with cough and change on
chest radiograph
TECHNIQUE: Volumetric, multidetector CT of the chest was performed with
intravenous contrast administration. Images are presented for display in the
axial plane at 5 mm and 1.25 mm collimation. A series of multiplanar
reformation images are also submitted for review.
Total exam DLP: 449 mGy-cm.
COMPARISON: Chest CT from ___.
FINDINGS:
The thyroid gland is unremarkable. No significant axillary, mediastinal or
hilar lymphadenopathy is detected. There is a small hiatal hernia. The
thoracic aorta is normal in caliber with a typical 3 vessel takeoff from the
arch. Moderate atherosclerotic calcifications are seen diffusely within the
aorta. The pulmonary arterial trunk is normal in caliber. There is a small
pericardial effusion. The heart is normal in size. Diffuse coronary artery
calcifications are re- demonstrated.
Patient is status post left upper lobectomy with loculated pleural fluid
anteriorly re- demonstrated. The bronchial stump appears unremarkable. The
tracheobronchial tree is otherwise patent to the subsegmental levels. Diffuse
ground-glass opacities occupying the left lower lobe are new since the prior
CT examination from ___. There is a small left-sided pleural
effusion, not changed from the previous study. Small area of rounded
atelectasis in the left lung base is unchanged. No pneumothorax present. There
is moderate emphysema, not significantly changed since prior examination.
Right lung is clear except for a mild peripheral interstitial abnormality in
the right lower lobe, unchanged, and likely reflective of mild fibrosis.
Although this study is not designed for evaluation of subdiaphragmatic
structures, there is redemonstration of cortical cysts in the right kidney and
left peripelvic renal cysts. There is redemonstration of a fusiform infrarenal
abdominal aneurysm, not fully imaged but measuring approximately 49 x 44 mm,
not significantly changed since prior examination. Multiple pancreatic cysts
are seen within visualized portions of the pancreatic head and neck.
No blastic or lytic lesion suspicious for malignancy is present. Postsurgical
changes are seen within the left rib cage.
IMPRESSION:
1. Diffuse ground-glass opacities within the left lower lobe are new since
prior examination, and likely reflect infection in the correct clinical
setting. Followup chest radiograph recommended following treatment to document
resolution.
2. Status post left upper lobectomy with similar appearance of the bronchial
stump and loculated pleural fluid anteriorly. Small left-sided basilar pleural
effusion unchanged.
3. Moderate emphysema.
4. Large infrarenal aortic aneurysm, incompletely evaluated although
relatively unchanged as compared to prior examination.
|
10161112-RR-42
| 10,161,112 | 20,020,549 |
RR
| 42 |
2184-11-21 16:38:00
|
2184-11-21 17:08:00
|
INDICATION: Squamous cell lung cancer, post left thoracotomy with left upper
lobe sleeve lobectomy in ___, followed by radiotherapy ___.
COMPARISON: Chest CT ___ and chest radiograph ___.
TECHNIQUE: Frontal and lateral chest radiographs.
FINDINGS:
Again seen is a rounded opacity overlying the left hilum, demonstrating an
internal reticular pattern, less discrete on the lateral view. There is
slight leftward shift of the mediastinum and left volume loss, relating to
prior left upper lobectomy. Surgical clips are again seen. The right lung is
clear. There is no pneumothorax or pleural effusion. The findings are
unchanged since the ___ examination.
IMPRESSION:
Rounded reticular opacity at the left perihilar region, unchanged since ___, likely reflecting radiation pneumonitis given history of
radiotherapy in ___. Underlying consolidation and residual tumor
cannot be excluded.
|
10161112-RR-52
| 10,161,112 | 24,848,241 |
RR
| 52 |
2188-02-16 14:03:00
|
2188-02-16 14:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hx COPD and SCC s/p lung resection p/w
cough and wheezing// Evaluate for intrapulmonary process
TECHNIQUE: Frontal chest radiograph
COMPARISON: Multiple chest radiographs, most recently dated ___
and CT torso from ___.
FINDINGS:
Compared to ___, there is improved aeration of the left lung.
There is persistent opacity in the left upper lung and diffuse opacity
throughout the left hemithorax, likely representing a combination of
atelectasis, pleural thickening and possibly small pleural effusion. The
right lung is demonstrate interval improvement of the basal opacity.
Evaluation of the heart size is limited due to overlying opacity. The right
mediastinal contour is unremarkable.
IMPRESSION:
-Interval improved aeration of the remaining left lung and right base compared
to ___.
-Persistent left upper lung opacity and small pleural effusion.
|
10161112-RR-54
| 10,161,112 | 24,848,241 |
RR
| 54 |
2188-02-16 16:45:00
|
2188-02-16 17:53:00
|
EXAMINATION: CTA torso
INDICATION: ___ year old woman with recent AAA repair presents with nausea,
abdominal pain, and constipation// Evaluate for bowel ischemia and impaction
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.1 s, 64.1 cm; CTDIvol = 4.0 mGy (Body) DLP = 255.7
mGy-cm.
2) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 33.4 mGy (Body) DLP =
16.7 mGy-cm.
3) Spiral Acquisition 8.2 s, 64.3 cm; CTDIvol = 14.1 mGy (Body) DLP = 909.2
mGy-cm.
Total DLP (Body) = 1,182 mGy-cm.
COMPARISON: CTA torso from ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
segmental level without filling defect, though evaluation for pulmonary
embolism is limited on the current study due to the phase of contrast. The
main pulmonary artery is mildly dilated, measuring up to 3.1 cm, suggestive of
pulmonary arterial hypertension. The thoracic aorta is normal in caliber
without evidence of dissection or intramural hematoma. There is trace amount
of pericardial effusion. The heart size is within normal limits. Coronary
artery and aortic valvular calcifications are moderate. Patient is status
post ligation of the left upper lobar pulmonary artery with unremarkable
appearance of the suture line.
AXILLA, HILA, AND MEDIASTINUM: Patient is status post upper lobectomy with
shift of the mediastinal structures to the left due to volume loss. No
axillary, mediastinal, or hilar lymphadenopathy is present.
PLEURAL SPACES: Diffuse thickening of the left pleura is likely related to
prior treatment and is unchanged from prior exam. There is no pleural
effusion.
LUNGS/AIRWAYS: There is postsurgical changes from left upper lobectomy. There
is diffuse narrowing of the left mainstem bronchus, not substantially changed
from prior exam. There is persistent opacification of the superior segment of
the remaining left lower lobe with air bronchogram, unchanged from prior exam,
likely related to post treatment changes. However, there is a 13 mm nodular
area in the periphery of the remaining left lower lobe, which may represent of
focus of subsegmental atelectasis (03:49). Moreover, there is increased
reticulation in the aerated portion of the left lung with stable scarring at
the base. The right lung is grossly unremarkable, aside from mild periphery
chronic interstitial abnormality and atelectasis in the dependent portion of
the right lower lobe.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas is diffusely atrophic with possible 8 mm cystic lesion
at the tail of the pancreas and 2.0 cm cystic lesion at the head uncinate
process (3:126 and 110), unchanged from prior exam. There is diffuse dilation
of the main pancreatic duct to 4-5 mm, unchanged however, no focal stenosis is
seen. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are multiple intrinsically hyperdense and hypodense renal lesions in
bilateral kidneys, overall unchanged from prior exam and likely representing
hemorrhagic and nonhemorrhagic renal cysts. There is no hydronephrosis.
There is no perinephric abnormality.
GASTROINTESTINAL: Moderate hiatal hernia is stable. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout.
Diverticulosis of the sigmoid colon is noted, without evidence of wall
thickening and fat stranding. The appendix is normal (3:62). There is no
free intraperitoneal fluid or free air.
PELVIS:
The urinary bladder is mildly thickened with a trace amount of fat stranding,
suggestive of cystitis. The distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are
within normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Patient is status post stenting of the descending thoracic aorta
through the bilateral common iliac arteries with aorto bi-iliac stent.
Additional stents are seen at the celiac artery, SMA and bilateral renal
arteries, which appear patent. There is no evidence of endoleak. The largest
dimension of the sac measures 5.7 x 5.8 cm, previously 5.8 x 6.0 cm. Moderate
atherosclerotic disease is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mild fat stranding around the bladder with mild wall thickening, suggestive
of cystitis in the right clinical setting. Correlation with urinalysis is
suggested.
2. Status post aorto bi-iliac stenting from the descending aorta with
additional stents in the celiac, superior mesenteric and bilateral renal
arteries, which all remain patent. No evidence of endoleak. Stable aneurysm
sac size.
3. Stable pancreatic cystic lesions measuring up to 2.0 cm, likely side branch
IPMN. Mild pancreatic duct dilatation is also unchanged.
4. Moderate hiatal hernia.
5. Overall stable appearance of the left hemithorax with postoperative and
post radiation changes re-demonstrated in the remaining left lower lobe. 13
mm nodular area in the periphery of the remaining left lower lobe is
nonspecific and may represent focal atelectasis, however, close attention on
follow-up is recommended with follow-up chest CT in ___ months.
RECOMMENDATION(S): Follow-up chest CT in 3 months
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. in person on ___ at 6:37 pm, 5 minutes after discovery
of the findings.
|
10161682-RR-15
| 10,161,682 | 24,238,867 |
RR
| 15 |
2167-12-17 16:30:00
|
2167-12-17 17:16:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ male with shortness of breath, evaluate for CHF or
infection.
TECHNIQUE: PA and lateral view radiographs of the chest.
COMPARISON: Prior chest radiographs from ___.
FINDINGS:
Focal consolidations are seen in the right lower lobe and the right upper
lobe, with a small associated right pleural effusion. Underlying pulmonary
vascular congestion and pulmonary edema is mild. There is no pneumothorax.
The cardiomediastinal silhouette is within normal limits.
IMPRESSION:
1. Multifocal pneumonia in the right lung. Followup radiographs are
recommended following treatment to ensure complete resolution.
2. Underlying mild pulmonary vascular congestion and pulmonary edema.
|
10161682-RR-16
| 10,161,682 | 24,238,867 |
RR
| 16 |
2167-12-17 19:32:00
|
2167-12-17 20:38:00
|
EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with fall 1 week ago with intermittent headaches //
eval for bleed eval for bleed
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DLP: 892 mGy/cm
COMPARISON: None.
FINDINGS:
Artifact through a few images, including the level of the third ventricle, may
be due to patient motion. Given this, there is no evidence of acute
intracranial hemorrhage, midline shift, mass effect, or acute large vascular
territory infarct. Bilateral periventricular and subcortical white matter
hypodensities suggest sequela of chronic small vessel disease. Slightly
asymmetric focus of hypodensity in the white matter in the left frontal region
most likely related to prior small vessel disease. Mild prominence of the
ventricles and sulci is consistent with cortical volume loss. There is no
hydrocephalus. The visualized paranasal sinuses demonstrate partially imaged
opacification in the left maxillary sinus may relate to mucous retention cyst.
The remainder of the partially imaged paranasal sinuses and mastoid air cells
are clear. The mastoid air cells are clear. No acute fracture is seen.
IMPRESSION:
Some artifact through a few images, including approximately the level of the
third ventricle. Given this, no acute intracranial process seen, including no
acute intracranial hemorrhage.
Evidence of chronic small vessel ischemic change.
|
10161682-RR-17
| 10,161,682 | 24,238,867 |
RR
| 17 |
2167-12-18 15:38:00
|
2167-12-18 17:10:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man who p/w Dyspnea who also has RUQ abdominal pain
// r/o acute hepatic process
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Renal ultrasound on ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is a hyperechoic nonvascular mass in the right hepatic
lobe measuring 0.5 x 0.5 x 0.7 cm, consistent with a hemangioma. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is not well seen due to overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 10.2 cm.
KIDNEYS: The right kidney measures 14.1 cm. The left kidney measures 18.0 cm.
There are multiple renal cysts bilaterally, the largest on the right measuring
6.8 cm in the upper pole, and the largest on the left measuring 6.1 cm in the
upper pole. No worrisome features are identified.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
There is a right pleural effusion.
IMPRESSION:
0.7 cm lesion in the liver most consistent with a hemangioma.
Right pleural effusion.
Multiple bilateral renal cysts.
|
10161682-RR-18
| 10,161,682 | 24,238,867 |
RR
| 18 |
2167-12-19 17:08:00
|
2167-12-19 23:46:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with COPD who p/w dyspnea found to have a right
sided pnuemonia and pulmonary edema // asses for interval improvement
COMPARISON: ___.
IMPRESSION:
As compared to the previous image, there is unchanged evidence of a moderate
right pleural effusion and extensive right lung apex opacities. There is no
substantial change in extent and severity. Constant appearance of the cardiac
silhouette and of the left lung.
|
10161682-RR-20
| 10,161,682 | 24,238,867 |
RR
| 20 |
2167-12-19 22:28:00
|
2167-12-20 08:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with increasing oxygen requirement, dCHF //
?eval of hypoxia, volume overload
COMPARISON: ___, 17:32
IMPRESSION:
As compared to the previous radiograph, taking into account a different
patient position, no relevant change has occurred. Moderate right pleural
effusion and right apical parenchymal opacity. Borderline size of the cardiac
silhouette. Mild fluid overload but no overt pulmonary edema. No
pneumothorax.
|
10161682-RR-21
| 10,161,682 | 24,238,867 |
RR
| 21 |
2167-12-20 20:04:00
|
2167-12-20 22:54:00
|
INDICATION: ___ year old man with COPD, OSA with 3 months of dyspnea.
Evaluation for malignancy.
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.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 1263.48 mGy-cm (chest, abdomen, and pelvis).
COMPARISON: Abdominal ultrasound, ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: Evaluation of the liver is limited in the absence of
intravenous contrast. However, the only focal lesion is a 9 mm hypodensity in
the peripheral right lobe that is too small to characterize (3:61). The
gallbladder is within normal limits, without stones or gallbladder wall
thickening
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: There are numerous simple cysts in both kidneys, better characterized
on recent abdominal ultrasound. There is no hydronephrosis or
nephrolithiasis. Hyperdense focus in the lower pole of the left kidney likely
represents a hemorrhagic or proteinaceous cyst (3:80).
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall
thickness throughout. Diverticulosis of the sigmoid colon is noted, without
evidence of wall thickening and fat stranding. Appendix is not visualized.
There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The prostate is moderately enlarged. The urinary bladder and seminal
vesicles are unremarkable. There is no pelvic or inguinal lymphadenopathy.
There is no free fluid in the pelvis.
BONES AND SOFT TISSUES: There is no osseous lytic or blastic lesion worrisome
for malignancy. Note is made of a lipoma interposed between the right gluteus
medius and minimus muscles (3:108).
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of malignancy in the abdomen or pelvis. Please refer to the
chest CT dictation regarding intrathoracic findings.
2. Multiple benign-appearing bilateral renal cysts, better characterized on
prior abdominal ultrasound.
3. Diverticulosis without evidence of diverticulitis.
4. Moderate BPH.
|
10161682-RR-22
| 10,161,682 | 24,238,867 |
RR
| 22 |
2167-12-20 20:27:00
|
2167-12-20 22:56:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: COPD. Dyspnea.
TECHNIQUE: MULTI DETECTOR HELICAL SCANNING OF THE CHEST WAS PERFORMED WITHOUT
INTRAVENOUS CONTRAST AGENT, RECONSTRUCTED AS CONTIGUOUS 5 AND 1.25 MM THICK
AXIAL, 5 MM THICK CORONAL AND PARASAGITTAL, AND 8 MM MIP AXIAL IMAGES.
SUBSEQUENT SCANNING OF THE ABDOMEN AND PELVIS WILL BE REPORTED SEPARATELY, AND
WILL PROVIDE THE TOTAL DOSAGE OF SCANNING THE ENTIRE TORSO.
DOSAGE: TOTAL DLP reported separatelymGy-cm
COMPARISON: Chest radiograph of ___
FINDINGS:
Thyroid gland is mildly enlarged and heterogeneous with a dominant low density
region in the right lobe measuring 1.3 cm, not fully characterize by CT.
A large partially loculated right pleural effusion is present with a dominant
dependent lead distributed component and demonstrating simple fluid
attenuation. Within the right lung apex there is an apparent lobulated and
mass adjacent to the loculated component of the pleural effusion, measuring
5.2 by 4.1 cm approximately. It abuts the mediastinal pleural surface
medially with possible infiltration adjacent mediastinal fat. Precise
measurement and differentiation of margins from adjacent pleural fluid is
extremely difficult in the absence of intravenous contrast. Enlarged lymph
nodes are present in the right peritracheal region measuring up to 1.2 cm and
within the right hilar region, difficult to measure due to absence of
intravenous contrast.
Lungs are otherwise remarkable for clustered nodular opacities along the minor
fissure and subpleural nodularity in the right upper lobe adjacent to the
partially loculated right pleural effusion. Moderate emphysema is present,
and note is also made of a unilateral septal thickening in the right upper
lobe, which may represent localized lymphangitic carcinomatosis or lymphatic
obstruction.
Skeletal structures are remarkable for a focal area of sclerosis in the right
third posterior lateral rib (51, 5).
IMPRESSION:
Apparent large right apical lung mass is difficult to differentiate from
adjacent loculated component of large right pleural effusion. In conjunction
with right paratracheal and right hilar lymph node enlargement as well as
pleural nodularity, the constellation of findings is concerning for primary
lung cancer with potential malignant pleural effusion and lymph node
involvement. Considering the limitations of this unenhanced scan, further
evaluation could be performed either with initial contrast-enhanced CT or,
alternatively, a PET-CT, which could simultaneously evaluate the mass and
assist with staging.
Small sclerotic focus in right third rib is potentially due to bone island but
could be correlated with PET-CT.
Please see separately dictated CT of the abdomen and pelvis for complete
description of subdiaphragmatic findings.
|
10161682-RR-23
| 10,161,682 | 24,238,867 |
RR
| 23 |
2167-12-23 22:00:00
|
2167-12-24 10:39:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with progressive dyspnea with 30 pack year
history with CT chest concerning for malignancy. Would like to r/o metastases
with MRI however patient has ___ on CKD. // r/o metastases
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of Gadavist intravenous contrast, axial imaging was performed
with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE
imaging was performed and re-formatted in axial and coronal orientations.
COMPARISON: No prior MRI available for comparison. Prior head CT dated ___
FINDINGS:
Image quality is degraded by motion artifact.
There is no evidence of hemorrhage, edema, masses, mass effect, or infarction.
The ventricles and sulci are normal in caliber and configuration. There is no
definite abnormal enhancement after contrast administration. There is
extensive T2/FLAIR hyperintensity in the periventricular, subcortical, and
deep white matter which is nonspecific but likely on the basis of chronic
small vessel ischemic disease. On gradient echo images, there are a few
scattered foci of susceptibility artifact in the left-greater-than-right
temporal lobes likely reflecting hemosiderin deposition from prior
microhemorrhage. The orbits are unremarkable. Major vascular flow voids are
preserved. The paranasal sinuses and mastoid air cells are grossly clear.
IMPRESSION:
1. Image quality is degraded by motion artifact. No definite evidence of
acute infarction, acute hemorrhage, or enhancing mass lesion
2. Extensive T2/FLAIR signal hyperintensity in the periventricular,
subcortical, and deep white matter which is nonspecific but likely on the
basis of chronic small vessel ischemic disease.
|
10161682-RR-24
| 10,161,682 | 24,238,867 |
RR
| 24 |
2167-12-22 01:04:00
|
2167-12-22 11:16:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with OSA, lung mass, dCHF with worsening hypoxia
// evaluation of worsening hypoxia
COMPARISON: ___ at 17 32
FINDINGS:
Compared with ___, the effusion at the right base is larger and
underlying collapse and/or consolidation is increased.
Otherwise, allowing for technical differences, I doubt significant interval
change. Again seen is somewhat confluent opacity at the right lung apex and
patchy opacity at the left lung base, similar to the prior study. No gross
left effusion. Doubt CHF. Cardiomediastinal silhouette unchanged.
IMPRESSION:
Increase in size of right effusion and underlying collapse and/or
consolidation.
|
10161682-RR-25
| 10,161,682 | 24,238,867 |
RR
| 25 |
2167-12-22 16:07:00
|
2167-12-22 21:34:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with pleural effusion // chest tube Contact
name: ___, ___: ___
COMPARISON: Chest x-ray from ___ at 01:16
FINDINGS:
Lordotic positioning. Compared with the prior film, a right pigtail type
catheter is been placed at the base of the right lung. There has been
considerable interval improvement in the right pleural effusion, now with
minimal residual fluid at the right lung base. No significant atelectasis or
consolidation is seen at the right lung base at this time. No pneumothorax is
detected.
Minimal patchy opacity at the left lung base is similar to the prior film.
There is upper zone redistribution, without overt CHF.
Hazy opacity in the right lung apex which apparently corresponds to a findings
on the ___ chest CT concerning for a pulmonary mass, is unchanged.
Based on the CT, there may also be loculated pleural fluid in this location.
IMPRESSION:
1. Interval placement of pigtail all catheter, with marked decrease in size of
the previous seen right pleural effusion. Small amount of residual pleural
fluid remains present, but there is negligible underlying collapse and/or
consolidation.
2. Right apical opacity unchanged.
|
10161682-RR-26
| 10,161,682 | 24,238,867 |
RR
| 26 |
2167-12-23 07:15:00
|
2167-12-23 12:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p chest tube placement // Please eval for
pneumothorax
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Heart size and mediastinum are stable in appearance. Right apical opacity is
unchanged consistent with known right upper lobe tumor. . Right basal
consolidation appears to be minimally increased since the prior study despite
the presence of pleural catheter. Nodularity of the pleura is better
appreciated on the previous chest CT from ___
|
10161682-RR-27
| 10,161,682 | 24,238,867 |
RR
| 27 |
2167-12-24 04:13:00
|
2167-12-24 08:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ y/o man that reports progressive dysnpea on exertion, syncope,
and pleuritic chest pain, most concerning for lung malignancy v. infectious
process, s/p chest tube placement and patient removal of chest tube //
?complication of patient initiated chest tube removal
IMPRESSION:
Right pigtail pleural catheter remains in place, with slight increase in size
of moderate right pleural effusion is compared to previous radiograph of ___. Heterogeneous opacities in the right lung are persistent finding,
but focal atelectasis in the left lower lobe has substantially improved. No
other relevant changes.
|
10161682-RR-30
| 10,161,682 | 24,238,867 |
RR
| 30 |
2167-12-28 20:45:00
|
2167-12-29 07:35:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with R pleural effusion s/p R pleuroscopy and
chest tube placement. // ptx Contact name: ___: ___
COMPARISON: ___.
IMPRESSION:
The right pigtail catheter has been removed. The right chest tube could have
been introduced, but is poorly visualized on the current image. Minimal soft
tissue air inclusions. Unchanged appearance of the thickened pleura on the
right. On the left, there is a small to moderate new pleural effusion, with
the subsequent atelectasis. Lung volumes remain low. Moderate cardiomegaly
without overt pulmonary edema.
|
10161682-RR-31
| 10,161,682 | 24,238,867 |
RR
| 31 |
2167-12-29 10:15:00
|
2167-12-29 10:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleurx in place // please eval size of
effusion
COMPARISON: ___, 20:53
IMPRESSION:
No relevant change in extent of the moderate right and small left pleural
effusion. Unchanged low lung volumes and mild cardiomegaly.
|
10161682-RR-32
| 10,161,682 | 24,238,867 |
RR
| 32 |
2167-12-31 08:38:00
|
2167-12-31 10:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest tube in place // please eval effusion
please eval effusion
IMPRESSION:
In comparison with the study ___, there is some continued improvement
in ventilation at the right base, though evidence of atelectasis and effusion
processed. No evidence of pneumothorax, though the lordotic position of the
patient makes it difficult to assess the right apex.
The left lung is clear.
|
10161682-RR-34
| 10,161,682 | 24,238,867 |
RR
| 34 |
2167-12-29 16:41:00
|
2167-12-29 17:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sob // Please eval for edema
COMPARISON: ___, 10:21
IMPRESSION:
NO RELEVANT CHANGE AS COMPARED TO THE PREVIOUS IMAGE.
|
10161682-RR-35
| 10,161,682 | 24,238,867 |
RR
| 35 |
2167-12-30 03:53:00
|
2167-12-30 08:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with likely RUL lung cancer of new diagnosis s/p
___ and ___ pleurX now with worsening hypoxia // evaluate for interval
change
COMPARISON: ___.
IMPRESSION:
As compared to the previous image, the ventilation of the right lung base has
improved. Otherwise no relevant change is seen. Low lung volumes. Moderate
cardiomegaly. Known right apical and pleural changes.
|
10161682-RR-36
| 10,161,682 | 24,238,867 |
RR
| 36 |
2167-12-29 23:44:00
|
2167-12-30 01:14:00
|
EXAMINATION: RENAL U.S.
INDICATION:
___ year old man with likely lung cancer, now with acute renal failure,
evaluate for hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Comparison is made to renal ultrasound from ___ and
abdominal CT ___.
FINDINGS:
The right kidney measures 13.8 cm. The left kidney measures 12.3 cm. There is
no evidence of hydronephrosis. There are bilateral renal cysts as seen on
prior CTs with the largest in the right upper pole measuring 6.4 x 7.5 x 5.8
cm containing a thin septation. The largest left renal cyst measures 6.5 x
6.0 x 6.5 cm in the upper pole. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally.
The bladder is decompressed with a Foley catheter.
IMPRESSION:
1. No evidence of hydronephrosis.
2. Multicystic kidneys including a minimally complex right upper pole cyst
with a thin septation, not largely changed from ___, and requiring no
specific followup.
|
10161682-RR-37
| 10,161,682 | 24,238,867 |
RR
| 37 |
2167-12-29 23:44:00
|
2167-12-30 01:08:00
|
EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ year old man with likely lung cancer, now with acute renal
failure and worsening abdominal distension, evaluate for ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Comparison is made to abdominal ultrasound ___ and
abdominal CT ___.
FINDINGS:
Limited abdominal ultrasound demonstrates no ascites. A limited view of the
right kidney and liver are unremarkable.
IMPRESSION:
No intra-abdominal ascites.
|
10161682-RR-39
| 10,161,682 | 24,238,867 |
RR
| 39 |
2167-12-30 22:46:00
|
2167-12-31 11:32:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old man with stage IV lung ca, abd pain and distention
// Assess for bowel obstruction and fecal load
TECHNIQUE: Two views of the abdomen
COMPARISON: CT abdomen ___
FINDINGS:
There is gaseous distention of several loops of small bowel measuring up to
4.5 cm. There is no evidence of free air. Osseous structures are grossly
unremarkable. The fecal load is moderate.
IMPRESSION:
Dilated small bowel; differential considerations are ileus or small bowel
obstruction.
|
10161682-RR-40
| 10,161,682 | 24,238,867 |
RR
| 40 |
2167-12-31 11:49:00
|
2167-12-31 13:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with evidence of ileus/SBO but symptoms improving
// Evidence of ileus, SBO? Is as chest tube and pleural effusion
TECHNIQUE: Portable chest radiograph
IMPRESSION:
As compared to prior study from earlier the same date, lung volumes are
slightly low or. Allowing for this factor, there has been no relevant change
in the appearance of the chest since the recent study from approximately 2.5
Hr earlier.
Note that the provided history it suggests that a primary indication was for
assessment of the ileus or small-bowel obstruction. Dedicated radiographs of
the abdomen with the necessary to evaluate this process.
|
10161682-RR-41
| 10,161,682 | 24,238,867 |
RR
| 41 |
2167-12-31 15:24:00
|
2167-12-31 17:17:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old man with worsning abdominal pain. Please evaluate for
obstruction as noted as possible on KUB. // Evidence of obstruction, please
give oral contrast
TECHNIQUE: MDCT axial images were core through the abdomen pelvis without the
administration of intravenous contrast. Reformatted coronal and sagittal
images were also reviewed. Oral contrast was also administered.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 15.9 s, 54.8 cm; CTDIvol = 17.7 mGy (Body) DLP =
943.7 mGy-cm.
Total DLP (Body) = 958 mGy-cm.
COMPARISON: Comparison is made to prior abdomen and pelvis CT from ___.
FINDINGS:
LOWER CHEST:
Bilateral pleural effusions, are again noted. The right pleural effusion is
smaller following interval placement of a right pleural drainage catheter,
which courses along the anterior right lower lobe (3:6). The left pleural
effusion has minimally increased. Adjacent atelectasis is present
bilaterally. A small amount of subcutaneous of gas along the right lateral
chest wall is related to tube placement (03:15).
ABDOMEN:
GENERAL: The lack of intravenous contrast somewhat limits assessment. There
is no intra-abdominal free air. There is a tiny amount of fluid tracking along
the right paracolic gutter (03:43).
HEPATOBILIARY: The liver has a normal noncontrast appearance, with no focal
lesions identified. There is no intrahepatic biliary ductal dilation. The
gallbladder is slightly distended, but otherwise unremarkable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Multiple bilateral simple cysts are again noted in the bilateral
kidneys. There is no evidence of hydronephrosis or stones. No perinephric
abnormalities are detected.
GASTROINTESTINAL: The stomach is distended, with an air-fluid level, and
dependent location of oral contrast material. The duodenum and proximal small
bowel are dilated and fluid-filled, and a transition point in the right lower
quadrant (03:59, 4B:45). Scattered colonic diverticula are present, with no
evidence of diverticulitis.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is mild calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. Findings compatible with small bowel obstruction, with transition point in
the right lower quadrant.
2. Bilateral simple renal cysts.
3. Bilateral pleural effusions, decreased on the right following interval
pleural catheter placement, and minimally increased on the left.
NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr.
___ ___ intern) on ___ at 4:14 ___, 5 minutes after discovery
of the findings.
|
10161682-RR-42
| 10,161,682 | 24,238,867 |
RR
| 42 |
2167-12-31 19:51:00
|
2168-01-01 00:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new NG tube // confirm placement in stomach
COMPARISON: ___, 11:54
IMPRESSION:
As compared to the previous radiograph, the patient has received a nasogastric
tube. The tip projects over the lower esophagus. The line needs to be
advanced by about 15 cm.
|
10161682-RR-43
| 10,161,682 | 24,238,867 |
RR
| 43 |
2168-01-01 10:14:00
|
2168-01-01 15:29:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old man with SBO // e/o of air fluid levels and ongoing
SBO?
TECHNIQUE: Two views of the abdomen
COMPARISON: CT abdomen ___
FINDINGS:
There is persistent dilatation of multiple loops of small bowel within the mid
abdomen with multiple loops of colon decompressed distally. There is no
evidence of pneumatosis or pneumoperitoneum. The visualized osseous structures
are unremarkable.A density in the right lower quadrant likely represents a
colonoscopy clip.
IMPRESSION:
Gaseous distention of multiple loops of small bowel with colon decompressed
distally, grossly unchanged from CT ___.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
___ at 3:27 ___, 10 minutes after discovery of the findings.
|
10161682-RR-44
| 10,161,682 | 24,238,867 |
RR
| 44 |
2168-01-01 10:17:00
|
2168-01-01 11:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleural effusion // change in pleural
effusion (patient now has no pleurx drainage)
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, all monitoring and support devices
have been removed. The lung volumes continue to be low and the known right
lung parenchymal and pleural changes show no substantial dynamic. Unchanged
appearance of the cardiac silhouette and of the left lung.
|
10161682-RR-45
| 10,161,682 | 24,238,867 |
RR
| 45 |
2168-01-01 18:46:00
|
2168-01-02 00:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SBO // please evaluate placement of NG tube
IMPRESSION:
Radiograph obtained for purposes of assessing a nasogastric to demonstrates
placement of the distal tip within the proximal stomach. There is otherwise
no relevant change the appearance of the chest since the recent study
performed earlier the same date.
|
10161682-RR-46
| 10,161,682 | 24,238,867 |
RR
| 46 |
2168-01-02 11:05:00
|
2168-01-02 17:38:00
|
EXAMINATION: ABD SUPINE AND LAT DECUB
INDICATION: ___ year old man with hx primary lung cancer presenting with
abdominal distension and pain secondary to small bowel obstruction.
TECHNIQUE: Multiple portable supine and decubitus radiographs of the abdomen.
COMPARISON:
1. Abdominal radiograph from ___.
2. CT abdomen and pelvis ___.
FINDINGS:
An enteric tube is seen in grossly appropriate position with distal tip
projecting over the expected location of the stomach, with side-port distal to
the GE junction. Again seen are multiple gas-filled and dilated loops of
small bowel measuring up to 5 cm, with relatively decompressed colon distally,
mildly progressed in severity since most recent prior abdominal radiographs.
Multiple small bowel air-fluid levels are demonstrated on decubitus views.
There is no large pocket of free intraperitoneal air evident on supine and
decubitus views. There is no evidence of concerning soft tissue calcification
or radiopaque foreign body. Mild blunting of the left lateral CP angle on
right lateral decubitus radiograph likely reflects a small loculated left
pleural effusion.
IMPRESSION:
1. Marked dilation of multiple loops of small bowel with air-fluid levels and
relative decompression of the distal colon, compatible with persistent
small-bowel obstruction. The degree of dilation is mildly worsened in
comparison to most recent abdominal radiograph.
2. Appropriately placed enteric tube with distal tip and side port in the
expected location of the stomach.
3. Probable small loculated left pleural effusion.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 4:25 ___, at the time review.
|
10161682-RR-47
| 10,161,682 | 24,238,867 |
RR
| 47 |
2168-01-03 03:12:00
|
2168-01-03 10:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with replaced NGT // confirm NGT placement
COMPARISON: ___.
IMPRESSION:
As compared to the previous image, the nasogastric tube has been replaced.
The course of the tube is unremarkable, the tip of the tube projects over the
middle parts of the stomach. No complications, notably no pneumothorax.
Unchanged appearance of the left and right lung as well as of the cardiac
silhouette.
|
10161682-RR-48
| 10,161,682 | 24,238,867 |
RR
| 48 |
2168-01-03 11:29:00
|
2168-01-03 14:30:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old man with stage 4 nonsmall cell carcinoma, here for
SBO. // KUB supine and upright to evaluate SBO
TECHNIQUE: Two views of the abdomen
COMPARISON: Abdomen ___
FINDINGS:
There are several loops of gas-filled small bowel within the mid abdomen
measuring up to 4.2 cm. There is a relative paucity of gas within the large
bowel. There is no evidence of pneumatosis or pneumoperitoneum. The
visualized osseous structures are unremarkable.A tube projects over the
midline thorax. This may represent the patient's nasogastric tube which has
been pulled back and now sits within the mid esophagus.
IMPRESSION:
1. Improved distention of the small bowel is consistent with mildly improved
small bowel obstruction.
2. A tube projecting over the midline thorax likely represents the patient's
nasogastric tube, which has been pulled back and now terminates in the mid
esophagus.
|
10161682-RR-49
| 10,161,682 | 24,238,867 |
RR
| 49 |
2168-01-08 11:01:00
|
2168-01-08 16:10:00
|
INDICATION: ___ year old man with stage 4 NSCLC, pleural effusion, pleurx in
place // presence of pleural effusion
TECHNIQUE: Portable AP upright view of the chest
COMPARISON: Multiple prior radiographs, most recently ___
FINDINGS:
In comparison to the most recent study, lung volumes have slightly increased
although they remain low. Cardiomediastinal silhouette is stable. Right
upper lobe opacity corresponds to known mass. Heterogeneous opacities at the
right base are largely stable and likely represent a combination of
atelectasis pleural effusion and pleural thickening. Superimposed
consolidation be difficult to exclude. No pneumothorax.
IMPRESSION:
The lung volumes slightly increased. Increased opacification of the right
base likely represents a combination of atelectasis, pleural effusion, and
pleural thickening. Superimposed consolidation cannot be excluded.
|
10161722-RR-28
| 10,161,722 | 29,288,854 |
RR
| 28 |
2181-05-05 17:19:00
|
2181-05-05 17:49:00
|
EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: ___ year old man with chronic lower extremity edema with R lower
extremity wound noted to have RLE measuring greater than left raising concern
for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial. The right peroneal
veins are not visualized.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins; the
right peroneal veins, however, are not visualized.
|
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