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10161722-RR-29
| 10,161,722 | 24,926,366 |
RR
| 29 |
2182-03-02 20:37:00
|
2182-03-02 22:35:00
|
INDICATION: ___ with morbid obesity, venous stasis with right great toe
infection.*** osteo?
TECHNIQUE: Three views of the right toe.
COMPARISON: None.
FINDINGS:
There is no fracture. There is no focal osseous abnormality or focal erosion.
Irregularity of the soft tissues overlying the distal aspect of the right
great toe is noted. There is no subcutaneous gas or radiopaque foreign body.
IMPRESSION:
No radiographic evidence of osteomyelitis.
|
10161722-RR-30
| 10,161,722 | 24,926,366 |
RR
| 30 |
2182-03-02 21:22:00
|
2182-03-02 22:14:00
|
INDICATION: ___ with DOE, cough, SOB, pedal edema // pneumonia/pulm edema?
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal
limits. Slight tortuosity of the descending thoracic aorta is noted. No
acute osseous abnormalities. Hypertrophic changes are seen in the spine.
IMPRESSION:
No acute cardiopulmonary process.
|
10161722-RR-31
| 10,161,722 | 24,926,366 |
RR
| 31 |
2182-03-03 16:27:00
|
2182-03-03 16:56:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with significant alcohol history, pancytopenic on
admission // e/o cirrhosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis on ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 9 cm.
KIDNEYS: Limited views of the right kidney show no evidence of
hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
|
10161722-RR-37
| 10,161,722 | 27,424,829 |
RR
| 37 |
2183-10-31 11:51:00
|
2183-10-31 13:07:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with shortness of breath and cough// ?pna, pulm edema,
effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: Portable chest radiograph ___
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax. No
pulmonary edema. Mild cardiomegaly is stable. No mediastinal widening. No
acute osseous abnormalities are identified.
IMPRESSION:
No acute cardiopulmonary process identified.
|
10161722-RR-38
| 10,161,722 | 27,424,829 |
RR
| 38 |
2183-10-31 11:51:00
|
2183-10-31 13:04:00
|
EXAMINATION: DX HAND AND WRIST
INDICATION: ___ with left hand pain, redness and swelling.?fracture,
osteomyelitis
TECHNIQUE: Frontal, lateral, and oblique images of the left hand and wrist
were obtained for a total of 6 images
COMPARISON: None relevant
FINDINGS:
There is no acute fracture or dislocation. Mild degenerative changes are
noted throughout the interphalangeal joints, first CMC and triscaphe joints.
No bony erosion or periostitis is identified. No suspicious lytic or
sclerotic lesion is identified. There is no radiopaque foreign body.
Generalized soft tissue swelling is most notable about the wrist, without
evidence of subcutaneous emphysema.
IMPRESSION:
Non-specific soft tissue swelling, without radiographic evidence of
osteomyelitis.
|
10161722-RR-39
| 10,161,722 | 27,424,829 |
RR
| 39 |
2183-10-31 21:20:00
|
2183-10-31 22:29:00
|
EXAMINATION: ELBOW (AP AND LAT) SOFT TISSUE LEFT
INDICATION: ___ year old man with left hand pain/swelling/erythema now also
with left elbow pain// e/o osteo, nec fasc, fracture, joint effusion e/o
osteo, nec fasc, fracture, joint effusion
TECHNIQUE: Two portable views of the left elbow were obtained
COMPARISON: None available
FINDINGS:
No acute fractures or dislocations are seen. Joint spaces are preserved
without significant degenerative changes. No joint effusion is seen, although
the lateral view is suboptimal. No soft tissue calcifications or radiopaque
foreign bodies are detected.
IMPRESSION:
No evidence of an osseous abnormality of the left elbow.
|
10161722-RR-40
| 10,161,722 | 27,424,829 |
RR
| 40 |
2183-10-31 21:19:00
|
2183-10-31 22:38:00
|
EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with left hand pain/swelling/erythema now also
with right ___ and ___ digit pain// e/o osteo, nec fasc, fracture, joint
effusion e/o osteo, nec fasc, fracture, joint effusion
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right hand
COMPARISON: ___ wrist radiographs and ___
FINDINGS:
No fracture or dislocation is seen. There are mild degenerative changes
around the first carpal/metacarpal joint, as well as the proximal and distal
interphalangeal joints. No evidence of erosions or abnormal periosteal
reaction.. Soft tissue swelling is noted around the hand but most pronounced
around the third and fourth digits.
IMPRESSION:
Soft tissue swelling around the hand but most pronounced over the third and
fourth digits without radiographic evidence of osteomyelitis.
|
10161764-RR-75
| 10,161,764 | 26,863,664 |
RR
| 75 |
2118-12-22 17:51:00
|
2118-12-22 18:57:00
|
EXAMINATION: CHEST (AP upright AND LAT)
INDICATION: ___ with recent ureter stenting for ureteral stone w/ stent
removal today p/w 2d fatigue, fevers, elevated WBC, elevated lactate,
concerning for sepsis// CXR- ?PNAUS- hydronephrosis
COMPARISON: Prior chest CT from ___
FINDINGS:
AP upright and lateral views of the chest provided. Lung volumes are low and
there is stable elevation of the right hemidiaphragm. No focal consolidation,
large effusion, or pneumothorax is seen. There is mild right basal
atelectasis. No signs of congestion or edema. Heart size is normal.
Mediastinal contour is normal. Bony structures are intact. No free air below
the right hemidiaphragm.
IMPRESSION:
No acute findings in the chest. Stable right hemidiaphragmatic elevation with
mild subjacent atelectasis.
|
10161764-RR-76
| 10,161,764 | 26,863,664 |
RR
| 76 |
2118-12-22 17:23:00
|
2118-12-22 18:03:00
|
EXAMINATION: RENAL U.S. PORT
INDICATION: ___ with recent ureter stenting for ureteral stone w/ stent
removal today p/w 2d fatigue, fevers, elevated WBC, elevated lactate,
concerning for sepsis// CXR- ?PNAUS- hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CTU from ___, abdominal ultrasound from ___
FINDINGS:
There is no hydronephrosis, definite stones, or worrisome masses bilaterally.
Bilateral parapelvic cysts are again noted. A 1.3 cm simple cortical cyst is
seen arising from the lower pole of the right kidney. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally. The
left kidney has a lobulated contour. A small amount of fluid is seen adjacent
to the lower pole the left kidney likely related to recent stent removal.
Right kidney: 11.3 cm
Left kidney: 14.7
The bladder is poorly distended though grossly normal in appearance.
IMPRESSION:
1. No hydronephrosis.
2. Bilateral parapelvic cysts, similar to prior.
3. Small amount of fluid adjacent to the lower pole of the left kidney is
likely related to recent stent removal.
|
10161801-RR-2
| 10,161,801 | 23,990,616 |
RR
| 2 |
2196-10-24 00:03:00
|
2196-10-24 01:37:00
|
EXAMINATION: Chest radiographs.
INDICATION: History: ___ with s/p fall righ communited humerus fracture //
pre-op clerance
TECHNIQUE: AP views of the chest.
COMPARISON: None available.
FINDINGS:
Lung volumes are low leading to crowding of the bronchovascular structures.
Streaky bibasilar and perihilar airspace opacities are noted, left greater the
right. There is asymmetric elevation of the right hemidiaphragm. The upper
lungs are grossly clear. There is no evidence pneumothorax. Allowing for AP
projection, the heart is grossly normal in size.
IMPRESSION:
Low lung volumes and bibasilar airspace opacities, likely reflecting
atelectasis although superimposed infection is difficult to exclude.
|
10161801-RR-3
| 10,161,801 | 23,990,616 |
RR
| 3 |
2196-10-24 01:21:00
|
2196-10-24 01:56:00
|
EXAMINATION: DX SHOULDER AND HUMERUS
INDICATION: History: ___ with s/p right communited fracture // eval for
right ap lateral of the humerus and right shoulder eval for right ap
lateral of the humerus and right shoulder
TECHNIQUE: AP and lateral views of the right shoulder and humerus.
COMPARISON: Right humerus radiographs dated ___.
FINDINGS:
Redemonstrated is a displaced comminuted fracture through the midshaft of the
right humerus, with lateral displacement of the distal fracture fragment. The
right humeral head appears well seated within the glenoid fossa. There is no
evidence of glenohumeral or acromioclavicular joint dislocation.
IMPRESSION:
Displaced, comminuted right humeral diaphyseal fracture without evidence for
associated right shoulder dislocation.
|
10161801-RR-4
| 10,161,801 | 23,990,616 |
RR
| 4 |
2196-10-24 03:41:00
|
2196-10-24 04:05:00
|
EXAMINATION: HUMERUS (AP AND LAT) RIGHT
INDICATION: History: ___ with post reduction*** WARNING *** Multiple patients
with same last name! // post reduction post reduction
TECHNIQUE: Right humerus AP and lateral views.
COMPARISON: Right humerus radiographs dated ___.
FINDINGS:
There has been interval attempted reduction of an oblique fracture through the
mid diaphysis of the right humerus. The distal fracture fragment remains
medially angulated, with interval increased posterior displacement relative to
the proximal humerus.
IMPRESSION:
Oblique right humeral fracture status post attempted reduction with
increasingly posterior displacement of the distal fracture fragment.
|
10161801-RR-5
| 10,161,801 | 23,990,616 |
RR
| 5 |
2196-10-24 15:17:00
|
2196-10-25 09:39:00
|
EXAMINATION: HUMERUS (AP AND LAT) RIGHT
INDICATION: ORIF R HUMERUS
TECHNIQUE: Screening provided in the operating room without a radiologist
present.
COMPARISON: ___
FINDINGS:
Total fluoroscopy time 58.9 seconds. Images demonstrate fixation of spiral
humeral fracture with plate and screw hardware. For details of procedure,
please consult the procedure report.
IMPRESSION:
Images for operative guidance. Please see procedure report for details.
|
10161986-RR-48
| 10,161,986 | 29,944,305 |
RR
| 48 |
2138-04-22 01:05:00
|
2138-04-22 01:54:00
|
INDICATION: ___ female with dizziness. Please evaluate for
intracranial hemorrhage.
COMPARISON: No relevant comparisons available.
TECHNIQUE: MDCT images were acquired through the head without contrast.
Multiplanar reformations were obtained and reviewed.
FINDINGS:
There is no evidence of hemorrhage, infarction, shift of midline structures or
mass effect. The ventricles and sulci are normal in size and configuration.
The visible paranasal sinuses and mastoid air cells are well aerated.
IMPRESSION:
Normal study.
|
10161986-RR-50
| 10,161,986 | 29,944,305 |
RR
| 50 |
2138-04-23 10:39:00
|
2138-04-23 12:09:00
|
PA AND LATERAL CHEST X-RAY
INDICATION: Patient with malaise, newly spiked fever, rule out pneumonia.
COMPARISON: ___.
FINDINGS:
The lungs are clear. Mediastinal and cardiac contours are unchanged. There
is no pneumothorax or pleural effusion.
CONCLUSION:
There is no pneumonia.
|
10162137-RR-2
| 10,162,137 | 20,936,550 |
RR
| 2 |
2172-08-21 19:08:00
|
2172-08-21 20:21:00
|
HISTORY: Altered mental status. Rule out ICH, territorial infarct.
COMPARISON: None available.
TECHNIQUE: Axial MDCT images were obtained through the brain without IV
contrast. Sagittal and coronal reconstructions were generated.
FINDINGS: Evaluation is extremely limited by motion artifact. There is no
definite hemorrhage, major vascular territory infarction, edema, mass or shift
of normally midline structures. Prominence of ventricles and sulci is
consistent with age related involutional changes. Periventricular white
matter hypodensities are likely the sequelae of chronic small vessel ischemic
disease. The basal cisterns appear grossly patent and there is gross
preservation of gray-white matter differentiation.
Within the limitations of the study, no definite fracture is identified. The
visualized paranasal sinuses and visualized portions of mastoid air cells are
clear. Extremely limited examination of middle ear cavities.
IMPRESSION: Extremely limited study by motion artifact. However, no definite
acute intracranial findings.
|
10162137-RR-3
| 10,162,137 | 20,936,550 |
RR
| 3 |
2172-08-21 19:08:00
|
2172-08-21 20:53:00
|
CHEST RADIOGRAPH PERFORMED ON ___.
COMPARISON: None.
CLINICAL HISTORY: Altered mental status, question aspiration.
FINDINGS: AP upright portable chest radiograph provided. No large
consolidation, effusion, or pneumothorax is seen. The heart appears normal in
size. The mediastinal contour appears normal. There is a dextroscoliosis of
the T-spine. Bony structures are demineralized, though appear intact.
IMPRESSION: No evidence of aspiration or pneumonia.
|
10162137-RR-4
| 10,162,137 | 20,936,550 |
RR
| 4 |
2172-08-22 11:49:00
|
2172-08-22 12:13:00
|
HISTORY: Acute mental status change.
COMPARISON: Head CT ___.
TECHNIQUE: Axial MDCT images were obtained through the brain without the
administration of IV contrast. Axial bone algorithm reconstructed images were
acquired.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
acute large vascular territory infarction. The ventricles and sulci are
normal in size and configuration for age. Periventricular and subcortical
white matter hypodensities are nonspecific but likely sequela of chronic small
vessel ischemic disease. Left basal ganglia and corona radiata hypodensities
are consistent with prior infarcts. The basal cisterns appear patent.
There is no fracture. Left frontal 12 mm ossified extra-axial mass may
represent a meningioma, without mass effect on the brain. The visualized
paranasal sinuses and mastoid air cells are clear.
IMPRESSION:
1. No evidence of an acute intracranial abnormality.
2. Left frontal 12 mm ossified extra-axial mass, likely a meningioma, without
mass effect on the brain.
|
10162137-RR-5
| 10,162,137 | 20,936,550 |
RR
| 5 |
2172-08-22 21:26:00
|
2172-08-23 10:46:00
|
HISTORY: New seizures.
TECHNIQUE: Sagittal T1 weighted imaging was performed through the brain.
After administration of 5 cc of Gadavist intravenous contrast, axial imaging
was performed with diffusion, gradient echo, FLAIR, T2, and T1 technique.
Sagittal MP rage imaging was performed in re-formatted in axial and coronal
orientations.
COMPARISON: Head CT ___.
FINDINGS:
Again seen is a left frontal mass adjacent to the inner table. This appears
to be dural based and enhances after contrast administration. This likely
represents a meningioma. A second small mass arises from the falx anteriorly,
best seen on MIP image 14 of series 13 and image 20 of series 101. This also
appears to represent a small meningioma. Images of the remainder of the brain
demonstrate no other masses. The ventricles and sulci are normal in caliber
and configuration for a patient of this age. There is extensive
periventricular and to a lesser extent subcortical white matter hyperintensity
on FLAIR. This finding is usually attributed to chronic small vessel
ischemia. There is no evidence of hemorrhage or infarction. Except for the
dural based lesions noted above, and there are no other areas of abnormal
enhancement.
IMPRESSION:
Left frontal enhancing mass along the inner table and right frontal enhancing
mass arising from the falx. These likely represent small meningiomas.
Changes suggesting white matter chronic small vessel ischemia.
|
10162137-RR-6
| 10,162,137 | 20,936,550 |
RR
| 6 |
2172-08-23 10:38:00
|
2172-08-23 12:55:00
|
RIGHT KNEE SERIES ___ AT 10:44
CLINICAL INDICATION: ___ with meningioma seizures, assess for joint
inflammation.
AP, lateral and skyline views of the right knee are submitted. There are no
comparison studies.
IMPRESSION:
The bony mineralization is diminished consistent with osteoporosis. There are
mild degenerative changes. No suprapatellar joint effusion. No evidence of
displaced fracture or dislocation. Prominent arterial calcifications
consistent with atherosclerosis.
|
10162298-RR-10
| 10,162,298 | 29,210,265 |
RR
| 10 |
2190-11-02 14:36:00
|
2190-11-02 18:25:00
|
INDICATION: Shortness of breath and sarcoidosis. Evaluate for pneumonia.
COMPARISONS: CT of the chest from ___. CT of the chest from
___. CT of the chest from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the chest
without the administration of IV contrast. Sagittal and coronal reformatted
images were obtained and reviewed.
TOTAL DLP: 176.37 mGy-cm.
FINDINGS: The imaged portions of the thyroid gland are normal. There is no
axillary lymphadenopathy. Numerous small mediastinal lymph nodes are present
and not significantly changed from the prior exam. The largest is in the
lower right paratracheal region and measures 6 mm in the short axis (2, 22).
There is no new mediastinal or hilar lymphadenopathy. The heart is normal in
size. There are no significant atherosclerotic calcifications. There is a
small pericardial effusion, similar to the prior exam from ___. The thoracic
aorta is normal in course and caliber with minimal atherosclerotic
calcifications.
The airways are patent to the subsegmental levels. There are extensive
partially calcified bilateral perihilar consolidations and fibrosis, which are
not changed significantly from ___. These are in keeping with a history of
sarcoidosis. No new consolidation is identified to suggest a superimposed
infection.
There is a background of compensatory emphysema, similar to the prior exam.
The bronchiectasis and architectural distortion in the bilateral lungs is also
similar to the prior exam and likely related to these consolidations and
fibrosis. No new discrete solid nodule is identified. There is no pulmonary
edema or pleural effusion. There is no pneumothorax.
This exam is not tailored to evaluate the subdiaphragmatic structures. The
imaged portions of the liver, spleen, pancreas, adrenal glands, and kidneys
are normal.
There are no concerning lytic or sclerotic osseous lesions. No fracture is
identified. Mild degenerative changes are noted in the spine.
IMPRESSION:
1. Extensive perihilar consolidations with bronchiectasis and architectural
distortion is not significantly changed from the prior exams in ___ and ___.
This is in keeping with sarcoidosis.
2. Scattered prominent mediastinal lymph nodes are stable from the prior
exam, and also in keeping with sarcoidosis.
3. Compensatory emphysema and hyperinflation is stable.
4. No new opacities to suggest a superimposed infection.
|
10162298-RR-11
| 10,162,298 | 29,455,384 |
RR
| 11 |
2190-11-17 14:15:00
|
2190-11-17 15:48:00
|
CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Chest CT from ___ and chest radiograph from ___.
CLINICAL HISTORY: Sarcoidosis with COPD and worsening shortness of breath.
FINDINGS: PA and lateral views of the chest were provided. Extensive
scarring in the mid lungs again noted without significant change in overall
appearance from prior exam. There is no new consolidation. There is blunting
of the left CP angle which could indicate a small effusion versus pleural
thickening. The heart size appears grossly stable. The mediastinal contour
is unchanged. No acute bony abnormalities are seen.
IMPRESSION: Extensive bilateral scarring in the lungs, overall stable from
prior exam, compatible with sarcoidosis. No new consolidation is seen.
Possible tiny left pleural effusion.
|
10162298-RR-12
| 10,162,298 | 29,455,384 |
RR
| 12 |
2190-11-18 14:14:00
|
2190-11-18 16:20:00
|
INDICATION: Longstanding history of pulmonary sarcoid, who presents for
evaluation of worsening dyspnea on exertion, please evaluate infection versus
worsening sarcoid.
COMPARISONS: CT from ___.
TECHNIQUE: ___ MDCT images were obtained through the chest without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes were generated and reviewed.
FINDINGS: The visualized thyroid gland is unremarkable. There is no
axillary, hilar, or mediastinal lymphadenopathy. The heart is normal in size
with a possible trace pericardial effusion. There are no significant
atherosclerotic calcifications. The thoracic aorta is normal in course and
caliber with minimal atherosclerotic calcifications.
The airways are overall patent to the subsegmental levels. There are
extensive partially calcified bilateral perihilar consolidations and fibrosis,
overall not significantly changed compared to the prior exam from ___ in keeping with patient's history of sarcoidosis.
There is worsening consolidation at the left lung base, series 5, image 50,
compared to the prior exam from ___.
There is a background of compensatory emphysema, similar to the prior exam.
Bronchiectasis and architectural distortion in the bilateral lungs otherwise
is unremarkable.
This study is not tailored for the evaluation of subdiaphragmatic structures;
however, no acute intra-abdominal abnormalities are identified.
OSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy are
identified.
IMPRESSION:
1. New consolidation at the left lower lobe which may be secondary to
pneumonia. Redemonstrated are extensive perihilar consolidations with
bronchiectasis and architectural distortion in keeping with patient's known
history of sarcoidosis.
2. Scattered stable mediastinal lymph nodes.
3. Stable compensatory emphysema and hyperinflation.
|
10162298-RR-7
| 10,162,298 | 26,554,971 |
RR
| 7 |
2188-07-13 16:31:00
|
2188-07-13 16:58:00
|
EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: ___ female with history of sarcoid and new
cough/sputum.
COMPARISON: Outside hospital chest radiograph from ___ and chest CT
performed at ___ from ___.
FINDINGS: Frontal and lateral views of the chest were obtained. In
comparison with scout radiograph from CT from ___, there does not appear
to be significant interval change, nor from chest radiograph from ___.
Findings again include massive perihilar fibrosis/consolidation in this
patient with history of sarcoidosis. No definite new areas of consolidations
are seen. There is persistent tenting of the left diaphragm. No pleural
effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are
stable.
IMPRESSION:
No significant interval change in bilateral perihilar consolidation/fibrosis
in this patient with history of sarcoidosis. No definite new focal
consolidation seen.
|
10162298-RR-8
| 10,162,298 | 26,554,971 |
RR
| 8 |
2188-07-13 21:20:00
|
2188-07-13 23:34:00
|
INDICATION: ___ woman with sarcoidosis presenting with shortness of
breath, hypoxia.
COMPARISON: CT ___, outside hospital CT, ___.
TECHNIQUE: MDCT data were acquired through the chest without intravenous
contrast. Images were reconstructed using soft tissue and lung algorithms and
displayed at 5- and 1.25-mm slice thicknesses. Images were displayed in
multiple planes.
FINDINGS: Pulmonary parenchymal changes are stable since ___
and ___. Extensive bilateral partially calcified perihilar
consolidations are seen on a background of diffuse pan-lobar compensatory
emphysema. Extensive bronchiectasis and architectural distortion is
associated with these bilateral consolidations. Scattered irregular opacities
in the periphery are also stable. These changes and their stability are
compatible with chronic sarcoidosis. The heart and great vessels have normal
caliber. Trace pericardial effusion is visualized. Pretracheal lymph nodes
have decreased in size since ___. No axillary lymphadenopathy is
present. No pleural effusion or pneumothorax is identified. Visualized
portions of the upper abdomen are unremarkable. Minimal abdominal aortic and
splenic artery calcifications are present.
BONE WINDOWS: There are no concerning lytic or sclerotic lesions.
IMPRESSION:
1. Extensive perihilar consolidations, bronchiectasis and architectural
distortion compatible with sarcoidosis and show gross stability compared with
___ and ___.
2. Pan-lobar compensatory emphysema/hyperinflation of normal lung.
|
10162298-RR-9
| 10,162,298 | 29,210,265 |
RR
| 9 |
2190-11-02 10:38:00
|
2190-11-02 12:33:00
|
INDICATION: Shortness of breath and pneumonia. Question pneumonia.
COMPARISON: ___.
FINDINGS: AP view of the chest. Again seen are findings consistent with
perihilar fibrosis/consolidation in this patient with history of sarcoidosis.
Unchanged tenting of the diaphragms. No new consolidations are identified.
No pleural effusion or pneumothorax. Heart size is normal.
IMPRESSION: No significant change compared to ___ of findings
consistent with massive perihilar fibrosis/consolidation in this patient with
known history of sarcoidosis. No new consolidation.
|
10162540-RR-12
| 10,162,540 | 22,309,712 |
RR
| 12 |
2138-02-10 10:34:00
|
2138-02-10 13:22:00
|
INDICATION: Right femur fracture. ORIF.
COMPARISON: ___.
IMPRESSION:
Several fluoroscopic images of the right femur from the operating room
demonstrate placement of a lateral fracture plate and screws fixating a
periprosthetic fracture round the right total hip arthroplasty. Total
intraservice fluoroscopic time was 30.1 seconds. Please refer to the
operative note for additional details.
|
10162540-RR-13
| 10,162,540 | 22,309,712 |
RR
| 13 |
2138-02-11 16:42:00
|
2138-02-11 18:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypotension s/p surgery // ? fluid overload
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Bilateral shoulder arthroplasties. Stable heart size. Tortuous thoracic
aorta. No pulmonary edema. Pulmonary vascularity has improved. Small focus
of calcification right chest, similar. No pneumothorax.
IMPRESSION:
Decreased pulmonary vascularity.
No pulmonary edema.
|
10162540-RR-14
| 10,162,540 | 22,309,712 |
RR
| 14 |
2138-02-11 21:00:00
|
2138-02-11 21:36:00
|
EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ year old man with flank ecchymosis // ? eval for RP bleed
given flank ecchymosis
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 13.6 s, 46.6 cm; CTDIvol = 17.8 mGy (Body) DLP =
803.6 mGy-cm.
Total DLP (Body) = 817 mGy-cm.
COMPARISON: None available
FINDINGS:
LOWER CHEST: Trace dependent atelectasis noted at the lung bases. Coronary
artery atherosclerotic calcifications noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. Suggestion of cholelithiasis, without gallbladder wall thickening
or fluid.
PANCREAS: Atrophic pancreas. .
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. 12 mm cyst noted in
the midpole of the right kidney. There is no hydronephrosis. Punctate
calcification in the lower pole of the left kidney may represent a small
nonobstructing stone. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. Appendix is not identified
PELVIS: Foley catheter in the bladder. Mild bladder wall thickening, may be
reactive or inflammatory, with minimal adjacent stranding. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate is not seen secondary to beam hardening artifact
from the patient's hip prostheses.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: Right hip arthroplasty. Postoperative change left proximal femur
across intertrochanteric fracture. Degenerative change left hip. No
concerning osseous lesions. Bone graft donor site posterior left iliac bone.
Postoperative changes lumbar spine, advanced degenerative changes lumbar spine
most prominent at L1-L2 level. Implanted electronic device noted in the
subcutaneous tissues overlying the thoracic spine, with leads terminating in
the paraspinal musculature.
SOFT TISSUES: Extensive Subcutaneous stranding is seen along the right flank,
consistent with the given history of right flank ecchymoses. No organized
hematoma.
IMPRESSION:
1. No evidence for retroperitoneal hematoma. Subcutaneous stranding along the
right flank, posttraumatic. No organized hematoma.
2. Mild circumferential bladder thickening, may be reactive or inflammatory.
|
10162540-RR-17
| 10,162,540 | 27,114,590 |
RR
| 17 |
2138-03-23 14:50:00
|
2138-03-23 16:27:00
|
EXAMINATION: FEMUR (AP AND LAT) RIGHT
INDICATION: ___ year old man with femur fracture// ? interval change
TECHNIQUE: Right femur two views
COMPARISON: ___
FINDINGS:
Right total hip arthroplasty. Side plate, screws, cerclage wires across
periprosthetic proximal femoral fracture. Fracture is not well seen. Small
ossification along the medial margin middle third femoral diaphysis is
stable.. Degenerative changes right knee. Arterial calcifications. Surgical
staples have been removed.
IMPRESSION:
No significant change.
|
10162540-RR-18
| 10,162,540 | 27,114,590 |
RR
| 18 |
2138-03-24 11:18:00
|
2138-03-24 13:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with flu and PNA, had been holding Lasix,
reporting continued SOB, c/f pulm edema// ? Pulm edema/vascular congestion
? Pulm edema/vascular congestion
IMPRESSION:
Heart size and mediastinum are unchanged. Lungs are well inflated. No focal
consolidations to suggest infectious process demonstrated. No pneumothorax or
pleural effusion is noted.
Minimal interstitial prominence is noted and might be consistent with some
degree of pulmonary edema. Pulmonary nodule projecting over the right mid
lung most likely represents pleural plaque, 8 mm in diameter, but correlation
with chest CT is to be considered for it is precise characterization.
|
10162861-RR-10
| 10,162,861 | 26,205,742 |
RR
| 10 |
2170-03-09 00:07:00
|
2170-03-09 01:06:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ abdominal pain// ?cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 5 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: A 0.3 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 10.0 cm
Left kidney: 10.8 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Cholelithiasis without gallbladder-wall thickening.
|
10162861-RR-11
| 10,162,861 | 26,205,742 |
RR
| 11 |
2170-03-09 21:33:00
|
2170-03-10 02:33:00
|
EXAMINATION: MRCP.
INDICATION: Abdominal pain. CT showed stone in the common bile duct and
common bile duct dilatation to 10 12 mm. Normal liver function tests query
passed stone.
TECHNIQUE: Multiplanar T1- and T2-weighted images of the abdomen were
obtained on a 1.5 Tesla magnet including sequences obtained prior to and
following intravenous gadolinium administration. 6 cc of gadolinium a
Gadavist was administered intravenously. 1 mL of Magnevist mixed with 50 mL
water was also administered orally before the study. Study includes dedicated
MRCP sequences.
COMPARISON: CT is available from ___ and more recent ultrasound
from earlier on the same day.
FINDINGS:
There are small bilateral pleural effusions with minimal atelectasis at each
lung base. Heart appears mildly enlarged.
There are many small stones within the gallbladder which otherwise appears
normal. No focal liver lesions are identified. The common hepatic duct is
mildly dilated, measuring up to 9 mm in diameter although essentially normal
for age without short term change since the prior CT. There is no
intrahepatic biliary dilatation.
Motion artifact substantially affects most of the sequences limiting
assessment for biliary stones and for other potential pathology. However,
fast spin echo sequences suggest that there may be a persistent dependent
filling defect (04:31) layering in the distal common bile duct. At least the
possibility cannot be excluded.
Pancreas is unremarkable. Spleen is normal in size. Adrenals appear normal.
Kidneys are mildly atrophic but otherwise unremarkable.
Stomach and small and visualized bowel appear normal. Small quantity of free
fluid is found in the pelvic cul de sac. There is wall thickening of the
lower sigmoid and rectum that may indicate active colitis but not optimally
assessed with this technique including ill-defined surrounding edema in
adjacent fat. Small bowel abnormality has perhaps improved.
Major vascular structures appear widely patent. Mild ectasia of the abdominal
aorta up to 25 mm including moderate to severe mixed type atherosclerotic
change.
An enlarged aortocaval lymph node measures up to 21 x 18 mm in axial
___ (04:38) without short-term change. Left periaortic lymph node
measures up to 13 x 9 mm in axial ___.
A left lower pelvic cyst measures 22 mm in diameter, not seen on most
sequences although likely benign. Bladder wall thickening appears reduced.
Bone marrow signal intensities appear normal.
IMPRESSION:
1. Limited examination due to motion artifact. The previous CT showed a very
small calcified stone or group of stones layering in the distal common bile
duct, but not necessarily obstructing. Persistent filling defects such as
these cannot be excluded by this examination. No biliary dilatation given
patient age, however.
2. Cholelithiasis.
3. Limited imaging suggesting wall thickening of the lower sigmoid which may
indicate colitis. Clinical correlation is suggested. This is not fully
evaluated with this technique.
4. Retroperitoneal lymphadenopathy. The largest node, an aortocaval node,
measures up to 18 mm in shortest dimension which is suspicious. Evaluation
with PET-CT or short-term reimaging may be appropriate for followup versus
consideration of biopsy. This may be related to a suspicious medial right
lower lobe nodule (02:14) with spiculations measuring up to 12 x 12 mm, not
well visualized on this study but depicted on the recent CT. This is
concerning for primary malignancy. This could also perhaps benefit from PET
evaluation as a first step.
5. Left adnexal cyst. Evaluation with follow-up ultrasound is recommended
when clinically appropriate.
|
10162861-RR-12
| 10,162,861 | 26,205,742 |
RR
| 12 |
2170-03-10 10:21:00
|
2170-03-10 16:40:00
|
EXAMINATION: SECOND OPINION CT ABD/PELVIS
INDICATION: History: ___ with abd pain// please eval ___ read of OSH CT scan
to look for rectal intramural abscess.
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Not available.
COMPARISON: MRCP ___.
FINDINGS:
LOWER CHEST: There is a large nodule measuring 13 mm in the posterior basal
segment of the right lower lobe (series 2, image 14). There appears to be a
second flatter nodule over the right hemidiaphragm, measuring approximately 14
mm in diameter (series 2, image 9). Small hiatal hernia is seen.
ABDOMEN:
HEPATOBILIARY: Liver is normal in contour and attenuation. No focal
parenchymal lesions identified. Cholelithiasis. The CBD is dilated up to 13
mm in diameter. There are multiple stones in the common bile duct. No
intrahepatic bile duct dilatation.
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 (8 cm). And attenuation throughout,
without evidence of focal lesions.
ADRENALS: Mild nodular thickening of the left adrenal gland. Right adrenal
gland normal.
URINARY: There are small bilateral renal cortical cysts. The right kidney is
small in comparison to the left kidney.
GASTROINTESTINAL: The stomach is normal. There is abnormal mural thickening
and mucosal hyperenhancement in the rectal wall, continuing along the entire
length of the sigmoid colon, and into the descending and distal transverse
colon. There is sigmoid diverticular disease. No evidence of rectal wall
abscess. There is perirectal edema and fat stranding. There remainder of the
large bowel is distended with fluid, but demonstrates no mural thickening or
mucosal hyperenhancement. There is a long segment of mid to distal small
bowel which demonstrates mural thickening and mucosal hyperenhancement.
Proximal small bowel is unremarkable.
PERITONEUM: No evidence of free intra-abdominal air.
PELVIS: Urinary bladder is collapsed.
REPRODUCTIVE ORGANS: The uterus is not identified. There is no obvious adnexal
mass.
LYMPH NODES: No inguinal or pelvic lymphadenopathy. Bulky aortocaval lymph
node which measures up to 16 mm in short axis (series 3, image 39). Bulky
left common iliac lymph node which measures 11 mm in short axis (series 2,
image 52).
VASCULAR: There is heavy atheromatous calcification of the aortoiliac
vasculature. Although there is atherosclerotic plaque at the origin of the
SMA, it remains patent. ___ is similarly patent. Portal vein, portal
confluence, and SMV are patent. Splenic vein is diminutive but patent.
BONES: No acute or focal destructive osseous lesions. Multilevel degenerative
disc disease and facet arthropathy in the visualized spine.
SOFT TISSUES: Abdominal and pelvic wall unremarkable.
IMPRESSION:
1. Abnormal mural thickening and mucosal hyperenhancement extending from the
rectum to the splenic flexure. Additional mural thickening and mucosal
hyperemia within a long segment of the mid to distal small bowel. Findings
are non-specific and suggest an enterocolitis. Etiology is indeterminate.
Although there is atherosclerotic disease, origins of the SMA and ___ are
patent. SMV is patent. No gross perforation is noted.
2. There is no evidence of rectal wall abscess.
3. Bulky retroperitoneal lymph nodes are seen, measuring up to 1.6 cm in
short axis. These could be reactive in nature.
4. CBD is dilated. There are multiple stones within the CBD. Note that the
MRCP performed ___ confirmed presence of stones.
5. Large nodule measuring 13 mm in the posterior basal segment of the right
lower lobe. Second flatter nodule over the right hemidiaphragm. Due to the
Size of these nodules, are dedicated CT of the chest is recommended for
further characterization.
RECOMMENDATION(S): CT chest for further characterization of the findings in
the right lung.
|
10162861-RR-13
| 10,162,861 | 26,205,742 |
RR
| 13 |
2170-03-13 14:38:00
|
2170-03-13 16:55:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ hx HTN, stroke (on plavix), p/w choledocholithiasis with
normal LFT's, sigmoid colitis vs diverticulitis now s/p ERCP with stent and
increased abdominal pain.// ? abscess. PO and IV contrast please.
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.8 s, 50.7 cm; CTDIvol = 11.9 mGy (Body) DLP = 601.5
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 26.7 mGy (Body) DLP =
13.4 mGy-cm.
Total DLP (Body) = 617 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: There are left greater than right pleural effusions with
associated atelectasis. A right lower lobe nodular opacity is partially
visualized, similar from the CT dated ___.
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. Patient is status post placement of biliary
drain within the CBD. A new stent is also noted extending along the main
pancreatic duct coiling in the duodenum. There is mild expected pneumobilia.
High-density material is noted within the gallbladder lumen possibly
representing vicarious excretion. The gallbladder wall is noted to be
thickened, and a stone is seen within the gallbladder neck (02:25).
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. A pancreatic duct stent is
noted. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: There is non-specific thickening of the left adrenal gland,
unchanged. The right adrenal gland is unremarkable.
URINARY: The kidneys are somewhat atrophic bilaterally. No focal renal lesions
are identified. No hydronephrosis. No perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. There has been interval
progression of colitis, now involving the right colon (although a component of
this may be related to relative under-distention in comparison to prior).
Extensive wall thickening, pericolonic fat stranding and fluid surrounding the
sigmoid and distal descending colon is progressed in comparison to the prior
study. No discrete abscess is identified. No focal fluid collection. No bowel
obstruction.
PELVIS: Urinary bladder is only minimally distended and not well evaluated.
Punctate foci of gas within the bladder lumen may be secondary to prior
instrumentation.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable for
patient age.
LYMPH NODES: Several enlarged retroperitoneal and mesenteric nodes are similar
in comparison to the prior study measuring up to 15 mm in short axis, possibly
reactive attention on follow-up is recommended (02:40).
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Postsurgical changes noted in the anterior abdominal wall. Mild
anasarca is noted.
IMPRESSION:
1. Interval progression in diffuse colitis. No fluid collection.
2. Thickening of the gallbladder wall, new from prior with a stone again seen
in the gallbladder neck. Further evaluation with gallbladder ultrasound is
recommended.
3. Status post placement of a common bile stent and a pancreatic duct stent.
No evidence of procedural complication.
4. New small bilateral pleural effusions and mild anasarca, suggestive fluid
balance shift.
RECOMMENDATION(S): Right upper quadrant ultrasound.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:52 pm, 5 minutes
after discovery of the findings.
|
10163609-RR-13
| 10,163,609 | 21,722,804 |
RR
| 13 |
2125-10-01 06:41:00
|
2125-10-01 08:19:00
|
INDICATION: Evaluation of patient with left lower quadrant pain.
COMPARISON: Abdominal ultrasound from ___.
FINDINGS: There is a nonspecific bowel gas pattern with no evidence of
high-grade obstruction. Visualized lung bases are clear. There are no soft
tissue calcifications or radiopaque foreign bodies. The patient is status post
cholecystectomy.
IMPRESSION: Nonspecific bowel gas pattern.
|
10163609-RR-14
| 10,163,609 | 21,722,804 |
RR
| 14 |
2125-10-01 08:08:00
|
2125-10-01 09:47:00
|
INDICATION: Evaluation of the patient with history of left flank pain and
left renal stones.
COMPARISON: Abdominal ultrasound from ___.
FINDINGS:
The right kidney measures 10.9 cm.
The left kidney measures 12.4 cm.
There is mild left hydronephrosis. Left ureteral jet not visualized.
However, no distinct stones are visualized. The right kidney is within normal
limits.
IMPRESSION: Mild left hydronephrosis along with absence of the left ureteral
jet is suggestive of a stone in the left collecting system. However, no
distinct stones are noted in the visualized portions of the left collecting
system.
|
10163609-RR-15
| 10,163,609 | 21,722,804 |
RR
| 15 |
2125-10-01 10:02:00
|
2125-10-01 12:35:00
|
INDICATION: ___ female with left hydronephrosis and no ureteral jet,
consistent with stone.
COMPARISON: Renal ultrasound ___ and abdominal ultrasound ___.
TECHNIQUE: MDCT images were obtained through the abdomen and pelvis without
the administration of IV contrast. Coronal and sagittal reformations were
performed.
FINDINGS: The visualized lung bases are clear. The visualized heart and
pericardium are unremarkable.
ABDOMEN: Examination of the intra-abdominal viscera is slightly limited due
to lack of IV contrast. The liver appears unremarkable and no focal lesions
are identified. Patient is status post cholecystectomy. The spleen,
pancreas, and adrenal glands are unremarkable. The patient is status post
gastric bypass surgery and there are no abnormalities seen within the stomach,
small bowel, colon, appendix, and rectum.
There is mild hydronephrosis of the left kidney and a 3 mm obstructing stone
in the left ureteropelvic junction. There is a 3 mm non-obstructing stone in
a lower pole calix of the left kidney. There is no perinephric
stranding/fluid. The right kidney is unremarkable and no stones are
identified. The bladder is unremarkable.
PELVIS: The uterus is unremarkable and an IUD is in appropriate position.
There is no free air. There are no hernias identified. There is no free
fluid in the pelvis. There is no lymphadenopathy. There is evidence of prior
laparoscopic port sites in the anterior subcutaneous tissues.
BONES: The bones demonstrate no osseous or lytic lesions.
IMPRESSION: Mild left hydronephrosis secondary to 3mm stone in the left
ureteropelvic junction. Additional 3 mm non-obstructing stone in the left
kidney.
|
10163774-RR-16
| 10,163,774 | 25,837,438 |
RR
| 16 |
2127-10-11 16:36:00
|
2127-10-11 16:57:00
|
INDICATION: ___ with L sided chest pain, fever, s/p Epicardial left
ventricular lead placement via left thoracotomy ___
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___.
FINDINGS:
There is new retrocardiac opacity silhouetting the descending thoracic aorta.
Elsewhere, lungs are clear. Cardiac silhouette is moderately enlarged as on
prior. Left chest wall dual lead pacing device is well as epicardial leads
are again noted. Median sternotomy hardware again noted.
IMPRESSION:
New left lower lobe opacity which could be due to pneumonia in the proper
clinical setting.
|
10163793-RR-10
| 10,163,793 | 24,579,886 |
RR
| 10 |
2194-08-01 16:53:00
|
2194-08-01 17:27:00
|
ABDOMINAL RADIOGRAPH PERFORMED ON ___
COMPARISON: Renal ultrasound from earlier today.
CLINICAL HISTORY: ___ female with 7-mm stone at the left distal
ureter/UVJ, question visibility on KUB.
FINDINGS: Single KUB supine image of the abdomen was provided. Gaseous
distention of the stomach noted. There are multiple pelvic phleboliths which
are rounded in appearance. In addition, there is an irregular calcified
density in the left hemipelvis measuring approximately 3 mm, which could
represent the reported stone in the left distal ureter. Additional tiny
calcific densities are seen overlying the renal shadows likely representing
non-obstructing stones. Bony structures appear intact. Bowel gas pattern is
unremarkable.
IMPRESSION: Irregular calcified 4-mm density in the left hemipelvis
represents reported left distal ureteral/UVJ stone. Additional small stones
are identified within the kidneys.
|
10163793-RR-11
| 10,163,793 | 24,579,886 |
RR
| 11 |
2194-08-02 16:00:00
|
2194-08-02 16:47:00
|
SUPINE AND UPRIGHT ABDOMINAL PLAIN FILM, ___ AT 16:07
CLINICAL INDICATION: ___ with nephrolithiasis who passed stone, check
location.
Comparison to prior study dated ___ at 16:54.
Supine and upright imaging of the abdomen and pelvis ___ at 16:07 is
submitted.
There continue to be three rounded calcifications in the left hemipelvis
consistent with phleboliths. The fourth more irregular calcification is no
longer apparent, consistent with the passed stone which used to be at the left
ureterovesical junction. A prominent amount of gas is seen in non-distended
loops of bowel. There continues to be a 2-mm calcification overlying the left
renal shadow and a fainter one overlying the right renal shadow suggestive of
nonobstructive stones. No free air. Visualized lung bases are unremarkable.
IMPRESSION:
1. Interval passing of a left distal ureteral/ureterovesical junction stone.
Faint calcifications overlying both kidneys consistent with nephrolithiasis.
Nonspecific bowel gas pattern. No free air.
|
10163793-RR-9
| 10,163,793 | 24,579,886 |
RR
| 9 |
2194-08-01 13:30:00
|
2194-08-01 14:37:00
|
INDICATION: History of nephrolithiasis with left flank pain.
COMPARISONS: Renal ultrasound from ___.
TECHNIQUE: Gray-scale and Doppler ultrasound images were acquired through the
kidneys and bladder.
FINDINGS: The right kidney measures 10.7 cm. There is a 3-mm stone in the
mid pole. The left kidney measures 11.2 cm. There is a 7-mm stone in the mid
pole. There are no other stones are identified within the kidneys. There is
no hydronephrosis. There is no renal mass or perinephric fluid collection.
The right ureter is not well visualized. There is a normal right ureteral
jet.
There is mild left hydroureter. In the distal ureter, at or just before the
UVJ, there is a 7-mm stone. No left ureteral jet is identified.
The bladder is only moderately distended, which limits this evaluation. No
gross bladder wall abnormalities are identified.
IMPRESSION:
1. 7-mm stone at or just proximal to the left UVJ, with associated mild left
hydroureter. The left ureteral jet is not identified. There is no left
hydronephrosis.
2. 7-mm stone in the mid pole of the left kidney.
3. 3-mm stone in the mid pole of the right kidney.
|
10164104-RR-49
| 10,164,104 | 21,297,346 |
RR
| 49 |
2142-02-15 16:16:00
|
2142-02-15 20:19:00
|
RIGHT FOOT RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior exam from ___.
CLINICAL HISTORY: Diabetes with foot ulcer and concern for osteo.
FINDINGS: AP, lateral, oblique views of the right foot were provided. Since
the prior exam, there is increasing loss of bone, centered at the first MTP
joint which is concerning for osteomyelitis. There is chronic degenerative
disease at the MTP joint of the third toe, which appears stable. Vascular
calcifications are present. Also noted, is loss of bone along the head of the
fifth metatarsal, laterally which is concerning also for osteomyelitis. There
is an adjacent soft tissue ulcer. A small plantar calcaneal spur is present.
IMPRESSION: Findings concerning for osteomyelitis at the head of the fifth
metatarsal adjacent to a soft tissue ulcer. Loss of bone density centered at
the first MTP joint is new from prior and raises concern for osteomyelitis at
this level as well.
|
10164104-RR-50
| 10,164,104 | 21,297,346 |
RR
| 50 |
2142-02-16 15:52:00
|
2142-02-18 08:51:00
|
VASCULAR LAB STUDY
MEDICAL HISTORY: This is a ___ man with right metatarsal head ulcer.
Please evaluate for blood flow to right leg.
FINDINGS: Metatarsal pulsed volume recordings were obtained of both feet.
The waveforms were biphasic suggesting adequate perfusion.
|
10164104-RR-51
| 10,164,104 | 21,297,346 |
RR
| 51 |
2142-02-17 12:05:00
|
2142-02-17 14:27:00
|
HISTORY: Status post partial resection of the distal right fifth metatarsal.
Postoperative evaluation.
TECHNIQUE: Three views of the right foot.
COMPARISON: Radiographs of the right foot performed ___.
FINDINGS:
There has been interval resection of the distal aspect of the right fifth
metatarsal. There has also been resection of the base of the proximal phalanx
of the right fifth toe.
Prominent marginal erosions are present along the medial and lateral aspects
of the distal head of the right first metatarsal. A prominent marginal
erosion is again present along the medial aspect of the proximal phalanx of
the right great toe. There is an overlying post operative soft tissue defect.
There is joint space narrowing with subchondral sclerosis and osseous spurring
of the third metatarsophalangeal joint.
Incidental note is made of a type 3 os naviculare measuring approximately 1.3
cm in AP dimension. There is a small plantar calcaneal spur. Prominent
atherosclerotic calcifications are present within the right foot.
IMPRESSION:
1. Status post surgical resection of the distal aspect of the right fifth
metatarsal and base of the proximal phalanx of the right fifth toe.
2. Prominent marginal erosions again present within the proximal phalanx of
the right great toe as well as the distal head of the first metatarsal.
Findings are suggestive of gouty arthritis, recommend clinical correlation.
3. Severe degenerative changes of the third metatarsophalangeal joint again
present and unchanged.
|
10164104-RR-52
| 10,164,104 | 21,297,346 |
RR
| 52 |
2142-02-18 16:42:00
|
2142-02-19 10:13:00
|
HISTORY: PICC placement.
FINDINGS: In comparison with the study of ___, there is a right subclavian
PICC line that extends to the upper to mid portion of the SVC. No evidence of
acute cardiopulmonary disease.
|
10164104-RR-53
| 10,164,104 | 27,075,752 |
RR
| 53 |
2142-02-27 18:01:00
|
2142-02-27 18:37:00
|
HISTORY: Fever, assess PICC position.
TECHNIQUE: Upright AP view of the chest.
COMPARISON: ___.
FINDINGS:
Right PICC tip terminates within the upper SVC. The cardiac, mediastinal and
hilar contours are unchanged with the heart size within normal limits. There
is no evidence of pulmonary vascular congestion. No focal consolidation,
pleural effusion or pneumothorax is identified. No acute osseous
abnormalities demonstrated.
IMPRESSION:
Right PICC tip within the upper SVC. No acute cardiopulmonary process.
|
10164104-RR-54
| 10,164,104 | 27,075,752 |
RR
| 54 |
2142-02-27 18:01:00
|
2142-02-27 19:02:00
|
HISTORY: Fever, recent foot debridement.
TECHNIQUE: Right foot, 3 views.
COMPARISON: ___.
FINDINGS:
There has been resection of the distal aspect of the ___ metatarsal bone and
base of the proximal phalanx of the right ___ toe with a large area of soft
tissue loss again noted. No new areas of cortical destruction are identified.
Marginal erosions are again demonstrated involving the head of the ___
metatarsal bone and base of the proximal phalanx of the great toe, unchanged.
Degenerative changes of the ___ MTP joint appear similar. There are vascular
calcifications. No new fracture or dislocation is identified. There is a
small plantar calcaneal spur. No soft tissue gas is present.
IMPRESSION:
No significant interval change in the appearance of the foot compared to the
previous exam. No new areas of cortical destruction to suggest osteomyelitis.
|
10164104-RR-66
| 10,164,104 | 21,111,081 |
RR
| 66 |
2147-09-01 18:24:00
|
2147-09-01 20:51:00
|
INDICATION: History: ___ with foot ulcer and pain// fx? osteo?
TECHNIQUE: Three views of the right foot
COMPARISON: ___
FINDINGS:
Again, there has been partial resection of the fourth and fifth digits.
Severe degenerative changes are seen at the third MTP joint. Degenerative
changes are also again seen at the first MTP and interphalangeal joints as
well as at the second MTP joint.
There is lucency involving the base of the second digit middle phalanx,
possibly due to fracture and/or osteomyelitis. A plantar calcaneal spur is
small. Vascular calcifications are seen.
IMPRESSION:
Lucency involving the base of the second digit middle phalanx may be due to
fracture and/or osteomyelitis.
Re-demonstrated chronic findings in the foot.
|
10164104-RR-67
| 10,164,104 | 21,111,081 |
RR
| 67 |
2147-09-09 15:52:00
|
2147-09-09 17:16:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old man now s/p debridement and primary closure// Post op
eval
TECHNIQUE: AP, lateral and oblique view radiographs of the right foot.
COMPARISON: Right foot radiographs ___.
IMPRESSION:
There are postsurgical changes from amputation of the second toe. New erosive
changes in the second metatarsal head may represent postsurgical debridement.
There are postsurgical changes from previous partial resection of the fourth
and fifth digits. No acute fracture or dislocation is identified.
Arthropathic changes of the midfoot and forefoot are unchanged from prior
study. There is a small plantar calcaneal spur. Atherosclerotic
calcifications are noted.
|
10164104-RR-68
| 10,164,104 | 21,111,081 |
RR
| 68 |
2147-09-14 16:45:00
|
2147-09-14 18:11:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with 46cm left arm SL power PICC. ___ ___//
New 46cm left PICC Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the left PICC line projects over the distal SVC.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size and appearance of the cardiomediastinal silhouette is unchanged.
IMPRESSION:
The tip of the left PICC line projects over the distal SVC. No pneumothorax.
|
10164309-RR-25
| 10,164,309 | 25,927,595 |
RR
| 25 |
2134-11-14 01:14:00
|
2134-11-14 01:48:00
|
EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: History: ___ with RLQ abdominal pain/tenderness // Eval for
torsion
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach.
COMPARISON: Reference pelvic ultrasound dated ___.
FINDINGS:
The patient is status post hysterectomy in ___. The right ovary is enlarged,
measuring 5.9 x 6.2 x 5.1 cm, and demonstrates only subtle, peripheral on
Doppler ultrasound examination; on the reference study performed ___,
no definite internal flow is seen. . The left ovary measures 3.4 x 3.1 x 2.8
cm and is normal in appearance with expected arterial and venous waveforms.
There is a mild amount of free fluid.
IMPRESSION:
Enlarged right ovary with decreased intrinsic vascularity, similar in
morphology as compared to the recent to reference examination, suspicious for
right ovarian torsion, possibly intermittent given reported history of
intermittent pain. Minimal free fluid.
NOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___
telephone at 01:45 on ___.
|
10164309-RR-26
| 10,164,309 | 25,927,595 |
RR
| 26 |
2134-11-14 09:17:00
|
2134-11-14 10:37:00
|
EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman admitted with intermittent ? right ovarian
torsion. Previous US this admission with ? torsion.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: Abdomen and pelvis MR from ___ and a pelvic ultrasound
from ___ and ___, the latter performed 8 hr prior to this exam.
.
FINDINGS:
The patient is status posthysterectomy. The right ovary is not clearly seen.
In the right hemipelvis there is a heterogeneously isoechoic mass measuring
6.0 x 5.3 x 5.4 cm, with no demonstrable internal flow and minimal
demonstrable peripheral flow. The flow pattern as well as the size and
appearance of the mass is unchanged compared with prior exam.
The left adnexa is unremarkable. There is moderate amount of free fluid in the
pelvis with trace amount of free fluid in the right upper and right lower
quadrant compatible with ascites, slightly increased compared with recent
exam.
The patient did not report pain during the examination.
IMPRESSION:
1. Right pelvic mass with only peripheral flow and no demonstrable internal
flow, unchanged in size or appearance compared with recent exam may represent
a right adnexal neoplasm versus a residual broad ligament fibroid partially
seen in pre-hysterectomy MRI from ___. Further assessment with a pelvic
MRI with contrast is recommended for complete evaluation.
2. Ascites slightly increased compared with recent exam.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 10:35 AM, immediately after discovery of the
findings.
|
10164309-RR-28
| 10,164,309 | 25,927,595 |
RR
| 28 |
2134-11-14 12:14:00
|
2134-11-14 15:00:00
|
EXAMINATION: MRI PELVIS W/O CONTRAST
INDICATION: ___ year old woman with intermittent right lower quadrant pain s/p
hysterectomy // Please evaluate for torsed right ovarian mass versus broad
ligament fibroid. No contrast
TECHNIQUE: Multiplanar, multi sequence imaging at 1.5 Tesla. No IV
gadolinium was administered.
COMPARISON: Ultrasound ___, renal MRA ___
FINDINGS:
Post hysterectomy. A small to moderate amount of free pelvic fluid is
demonstrated. The left ovary measures 3.5 x 2.3 x 3.3 cm and demonstrates
multiple small follicles. A rounded heterogenous mass is demonstrated within
the right adnexa, measuring 5.7 x 5.2 x 5.6 cm and demonstrates nondependent
T2 hyperintense signal, approaching that of fluid, and heterogenous T2
hypointense/isointense, T1 hyperintense signal, possibly internal hemorrhage
or debris. This was not well visualized on the prior renal MRI, with limited
evaluation of the pelvis. A separate right ovary is not identified.
Decompressed bladder. No pelvic adenopathy. 6 mm left and 5 mm right small
___'s gland cysts are demonstrated. Normal appearance of the urethra.
Vagina demonstrates a trace amount of fluid.
No suspicious osseous lesions.
IMPRESSION:
-Heterogenous 5.7 cm right adnexal mass with layering hemorrhage/ debris.
This was not visualized on the prior renal MRA, with limited evaluation of the
pelvis. Considerations include a degenerated or torsed broad ligament fibroid
or degenerated ovarian neoplasm. Ovarian torsion, however, cannot be excluded,
especially since the right ovary is not identified.
-Small to moderate amount of free pelvic fluid, which may be secondary to the
patient's peritoneal dialysis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 2:20 ___.
|
10164309-RR-29
| 10,164,309 | 25,927,595 |
RR
| 29 |
2134-11-15 10:08:00
|
2134-11-15 13:14:00
|
INDICATION: ___ year old woman with ESRD currently on PD, needs to switch to
HD for urgent GYn surgery // Place line for HD
COMPARISON: Tunnel line placement ___.
TECHNIQUE: OPERATORS: Dr. ___ resident) and Dr. ___
___ radiology attending) performed the procedure. The attending,
Dr. ___ was present and supervising throughout the procedure. Dr.
___ radiologist, personally supervised the trainee during the
key components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 20 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1 min, 33 cGy-cm2
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right/left, upper chest/groin was prepped
and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent internal jugular vein on the
right was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 19cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. At the request of the patient, a single suture was used. Steri-strips
were also used to close the venotomy incision site. Final spot fluoroscopic
image demonstrating good alignment of the catheter and no kinking. The tip is
in the right atrium. The catheter was flushed and both lumens were capped.
Sterile dressings were applied. The patient tolerated the procedure well.
FINDINGS:
Patent internal jugular vein on the right. Final fluoroscopic image showing
the hemodialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 19cm tip-to-cuff length tunneled dialysis line. The
tip of the catheter terminates in the right atrium. The catheter is ready for
use.
|
10164613-RR-29
| 10,164,613 | 27,642,370 |
RR
| 29 |
2172-03-17 01:26:00
|
2172-03-17 03:43:00
|
INDICATION: +PO contrast; History: ___ with recent complex surgical hx now w/
intermittent ___ pain, N/V/D, has G-tube for contrast+PO contrast // ? acute
intraabdo process, ? abnormality or colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 871 mGy-cm.
COMPARISON: None.
FINDINGS:
There is mild bibasilar atelectasis. New nodular opacities within the right
lung base may be secondary to aspiration/infection. There is a small hiatal
hernia.
The liver is normal without evidence of focal lesions, or intrahepatic biliary
ductal dilatation. Previously noted pneumobilia within the left lobe of the
liver, has improved. The spleen, is homogeneous and normal in size. The
pancreas is normal without evidence of focal lesions, or pancreatic ductal
dilatation. The adrenal glands bilaterally are normal. The kidneys
bilaterally demonstrate multiple hypodensities, too small to characterize by
CT but likely secondary to renal cysts. There is no evidence of
hydronephrosis.
Inflammatory changes involving the pylorus and duodenum around the site of the
prior surgical repair has not significantly changed compared to the prior
exam. Inflammatory tissue is seen extending from the duodenum laterally to
the skin surface with multiple foci of air, slightly increased compared to the
prior exam, consistent with a fistula between the duodenum in the skin. There
is contact between the tract and the bile ducts as well as the colon, however
there is no definite evidence of a fistulous tract to the colon. No definite
drainable collection is identified. There is diverticulosis throughout the
colon.
CT pelvis: The urinary bladder is unremarkable. There is no pelvic wall, or
inguinal lymphadenopathy.
Osseous structures: No lytic or blastic lesions concerning for malignancy are
identified.
IMPRESSION:
1. Inflammatory changes involving the pylorus and duodenum at the site of the
prior surgical repair remains extensive and persistent with a fistula from the
duodenum laterally to the skin surface contacting the bile ducts and colon
with increased gas compared to prior. There is no definite open fistula
involving the colon. No definite underlying drainable collection identified.
2. New nodular opacities within the right lung base, may be secondary to
aspiration/infection.
|
10164613-RR-30
| 10,164,613 | 27,642,370 |
RR
| 30 |
2172-03-17 06:15:00
|
2172-03-17 06:47:00
|
INDICATION: History: ___ with abdominal pain- 02% 93 // ? pleural effusion
TECHNIQUE: AP upright radiograph of the chest.
COMPARISON: Abdominal CT from ___, chest radiograph from ___.
FINDINGS:
Mild cardiomegaly has been stable compared to prior exams dated back to at
least ___. There is mild pulmonary vascular congestion as well as
mild pulmonary edema. Small bilateral pleural effusions are new. There is no
pneumothorax. The visualized osseous structures are unremarkable.
IMPRESSION:
Mild pulmonary edema. New small bilateral pleural effusions.
|
10164613-RR-31
| 10,164,613 | 27,642,370 |
RR
| 31 |
2172-03-21 15:21:00
|
2172-03-21 16:31:00
|
INDICATION: ___ year old woman with new picc // R picc 44cm sal ___
Contact name: sal, ___: ___
TECHNIQUE: AP upright portable chest radiograph.
COMPARISON: Chest radiographs from ___, and ___.
FINDINGS:
Patient is severely rotated. Right-sided PICC projects over the mid
clavicular line, medial to the anterior first rib, likely in right
brachiocephalic vein, if it is in a major vessel. The lungs are grossly
clear, improved from prior exam. All heart is mildly enlarged. The hilar
contour is likely within normal limits. There is no evidence for pulmonary
edema, pleural effusion or pneumothorax.
IMPRESSION:
Right-sided PICC possibly in right brachiocephalic vein, at least 9 cm
proximal to estimated position of cavoatrial junction. No complications.
|
10164613-RR-32
| 10,164,613 | 27,642,370 |
RR
| 32 |
2172-03-22 15:26:00
|
2172-03-22 17:00:00
|
INDICATION: ___ year old woman with gallstone ileus s/p ex-lap for duodenal
gallstone, duodenotomy, pyloric exclusion, and loop gastrojejunostomy, with
abdominal wound infection, with ileus and high tube feed residuals from G Tube
// eval for ileus or evidence of obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen pelvis with contrast ___
FINDINGS:
The sigmoid colon is significantly dilated to 8.4 cm however appears stable
compared to CT abdomen and pelvis from ___. The remaining colon is
air-filled and nondilated.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable. A gastrostomy tube is noted. Phleboliths
are noted in the pelvis.
IMPRESSION:
Dilated sigmoid colon appears stable and likely secondary to ileus. This
finding is somewhat similar to multiple prior abdominal films making the
diagnosis of a sigmoid volvulus unlikely however if there is clinical concern,
CT abdomen and pelvis is recommended.
RECOMMENDATION(S): CT abdomen and pelvis if clinical concern for volvulus.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephoneon ___ at 4:45 ___, 5 minutes after discovery
of the findings.
|
10164665-RR-16
| 10,164,665 | 26,362,325 |
RR
| 16 |
2136-08-30 06:34:00
|
2136-08-30 07:51:00
|
HISTORY: Shortness of breath status post CABG.
COMPARISON: Multiple prior chest radiographs with the most recent from ___.
FINDINGS:
The lungs are clear with no evidence of a consolidation, effusion, or
pneumothorax. Cardiac and mediastinal silhouettes are stable with post CABG
changes. Median sternotomy wires appear aligned and intact. No acute
fractures are identified.
IMPRESSION:
No acute cardiopulmonary process with post-CABG changes.
|
10164665-RR-17
| 10,164,665 | 26,362,325 |
RR
| 17 |
2136-08-30 09:55:00
|
2136-08-30 11:41:00
|
INDICATION: ___ man with pleuritic chest pain, dyspnea, evaluate for
pulmonary embolism.
COMPARISON: None.
TECHNIQUE: Axial multidetector CT images were obtained through the chest
during rapid administration of intravenous contrast with coronal, sagittal,
and oblique maximum intensity projection reformations.
DLP: 653 mGy-cm.
FINDINGS:
CTA CHEST: Pulmonary arteries are well opacified to the segmental level.
There is no filling defect to suggest pulmonary embolism. Thoracic aorta is
of normal caliber without aneurysm or dissection.
CT CHEST: Thyroid enhances homogeneously. There is no axillary, mediastinal,
or hilar lymphadenopathy by CT criteria. A small amount of fluid tracking
along the pericardium and in the anterior mediastinum between the heart and
the sternum likely represents post-surgical changes related to recent CABG.
Heart is top normal in size.
Trachea is midline and airways are patent to subsegmental level. Lungs do not
show focal consolidation or concerning pulmonary nodules. Trace right and
small-to-moderate left nonhemorrhagic pleural effusions and adjacent
compressive atelectasis are noted. There is no pneumothorax.
Several locules of gas are present superficial to the left pectoralis major
muscle and are probably post surgical in etiology; however, infection cannot
be excluded.
This study is not optimized for evaluation of subdiaphragmatic structures;
however, limited view of the upper abdomen is unremarkable.
Bone window is notable for sternotomy wires, but no concerning osteolytic or
osteosclerotic lesion.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Small amount of fluid tracking along the pericardium and in the anterior
mediastinum likely represents post-surgical changes related to recent CABG.
Trace right and small-to-moderate left non-hemorrhagic pleural effusions.
3. Several locules of gas are present superficial to the left pectoralis
major muscle and are probably post surgical in etiology; however, infection
cannot be excluded and should be correlated with clinical examination.
|
10164996-RR-44
| 10,164,996 | 26,794,754 |
RR
| 44 |
2136-09-07 14:20:00
|
2136-09-07 15:41:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with 1 month hx of hernia. R. Had previous b/l hernia
repair. Evaluate for inguinal hernia.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS. Oral
contrast was administered.
DOSE: Total DLP (Body) = 892 mGy-cm.
COMPARISON: CT abdomen pelvis from ___ and ___.
FINDINGS:
LOWER CHEST: A punctate left lower lobe nodule is unchanged since ___ (2:4). Lung bases are otherwise clear, without pleural effusion or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. Multiple hyperdense gallstones are
identified, but the gallbladder is nondistended, without evidence of
cholecystitis.
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: Right renal interpolar cyst measuring 1.0 cm is grossly unchanged
since ___. Left lower pole subcentimeter hypodensity is too small
to characterize, but likely a cyst (601b:42). The kidneys are otherwise of
normal and symmetric size with normal nephrogram. No hydronephrosis or
perinephric abnormality.
GASTROINTESTINAL: The cecum and appendix are located within a right inguinal
hernia sac (2:78, 79). The appendix appears normal, but there is ascites and
fat stranding adjacent to the cecum (2:76, 83, 601b:31). The terminal
ileum/ileocecal valve is intra-abdominal. Remaining small bowel loops
demonstrate normal caliber without evidence of obstruction. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal 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.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine.
IMPRESSION:
1. The cecum and appendix are located within a right inguinal hernia, with
ascites and fat stranding adjacent to the cecum. The appendix appears normal.
2. Cholelithiasis without evidence of cholecystitis.
|
10164996-RR-45
| 10,164,996 | 26,794,754 |
RR
| 45 |
2136-09-07 17:33:00
|
2136-09-07 18:37:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with surg, pre op cxr
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. There is no focal consolidation,
effusion, or pneumothorax. The cardiomediastinal silhouette is stable with
unfolded thoracic aorta again noted. Imaged osseous structures are intact. No
free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10165018-RR-14
| 10,165,018 | 23,251,005 |
RR
| 14 |
2132-06-27 20:38:00
|
2132-06-27 23:51:00
|
INDICATION: ___ woman with fever.
COMPARISON: Chest radiograph, ___.
PA AND LATERAL CHEST RADIOGRAPHS: The cardiomediastinal and hilar contours
are normal. There are subtle opacities in the anterior basal segment of the
right lower lobe obscuring the medial right hemidiaphragm, concerning for
pneumonia. No pleural effusion or pneumothorax is seen.
IMPRESSION: Findings suggestive of right lower lobe pneumonia.
|
10165018-RR-16
| 10,165,018 | 23,251,005 |
RR
| 16 |
2132-06-28 15:20:00
|
2132-06-29 18:35:00
|
INDICATION: ___ woman with possible fibrosing mediastinitis with D/T,
histoplasmosis, hemarthrosis. Please evaluate for infiltrate, effusion,
lymphadenopathy or extravasation of blood.
COMPARISON: Comparison is made to previous CT chest dated ___.
TECHNIQUE: Axial MDCT images were acquired from the thoracic inlet to the
pubic symphysis following the administration of oral and uneventful Omnipaque
administration. Coronal and sagittal reformats were obtained. DLP: 1300.13
mGy-cm.
FINDINGS: The visualized thyroid gland is normal in appearance. There are
bilateral subcentimeter axillary lymph nodes, none of which meet size criteria
for pathology. There is no supraclavicular adenopathy. Increase in size of
upper right paratracheal lymph node which now measures 10 mm, previously 7 mm
(2A:22). There has been slight increase in size of subcarinal partially
calcified lymph node mass (2A:48), which now measures 4.5 x 4.2 cm, previously
3.9 x 4.3 cm. The right lower lobe bronchus appears attenuated measuring 2.6
mm in diameter (2A:51), previously 4 mm in diameter at the same level. There
is a new right hilar partially calcified mass, which measures 3.1 x 3.1 cm
(2A:61). This encases bronchi to the lower lobes resulting consolidation and
atelectasis within the anterior basal segment of the right lower lobe (2A:68).
New infrahilar lymph node (2A:56) measuring 2.6 x 1.9 cm.
There are multiple areas of ___ opacification throughout the right
lung (2A:40), which were not present previously. There are also multiple
areas of ground-glass opacity (2A:50) for example, within the medial basal
segment of the right lower lobe and 2A:68 within the medial segment of the
right middle lobe. The left lung is clear.
The pulmonary vessels opacify normally. No evidence of pulmonary embolus.
The pulmonary vessels are patent to the subsegmental level. The right main
pulmonary artery is deviated slightly anteriorly due to the large subcarinal
mass.
Decrease in size of right pleural effusion. There is a small pericardial
effusion. Calcified stable left lower lobe granuloma (2A:54 measuring 4 mm).
CT ABDOMEN WITH ORAL AND IV CONTRAST: The liver is normal in attenuation. No
focal liver lesions are identified. There is no intra- or extra-hepatic duct
dilation. There is a tiny hypodensity within segment IVb adjacent to the
falciform ligament which may represent partial voluming and is too small to
characterize (2B:103), measuring 1.6 mm. The spleen is normal in size and
appearance. The pancreas, both adrenal glands are normal. Both kidneys
enhance and excrete contrast symmetrically without evidence of hydronephrosis
or suspicious renal lesions. The aorta is normal in caliber throughout.
There is no significant mesenteric or retroperitoneal adenopathy. The
visualized small and large bowel are normal. There is no evidence of free
fluid or free air.
CT PELVIS: There is an adnexa 4.8 x 4.4 cm hypodense lesion most likely
representing a right follicular cyst. This is slightly hyperdense with
Hounsfield measurement of 27 Hounsfield units. The uterus, urinary bladder,
rectum and sigmoid are normal in appearance. There is no free fluid or free
air. There is no significant inguinal or pelvic sidewall adenopathy.
OSSEOUS STRUCTURES: No suspicious osseous, sclerotic or lucent lesions
identified.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Increase in size of partly calcified subcarinal lymph node, new partly
calcified right hilar lymph node and right infrahilar lymph node.
3. New consolidation involving the anterior basal segment of the right lower
lobe.
4. Multiple peribronchial opacities and multiple ___ opacities
throughout the right lobe which is a nonspecific finding which has a wide
differential including infection.
5. Multiple areas of ground-glass opacity diffusely throughout the right
lung.
6. Interval decrease in size of right pleural effusion.
WET READ by ___ on ___ ___ 8:06 ___
|
10165018-RR-17
| 10,165,018 | 23,251,005 |
RR
| 17 |
2132-07-03 15:42:00
|
2132-07-03 17:27:00
|
TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ female patient with bronchoscopy, bronchial mass
debridement, evaluate for pneumothorax.
FINDINGS: AP single view of the chest has been obtained with patient in
upright position. Comparison is made with the next preceding PA and lateral
chest examination of ___. During the examination interval, the
patient has undergone bronchoscopy and debridement of the mediastinal mass,
which has been identified by chest CT examination of ___. There is
no pneumothorax and no new acute pulmonary parenchymal infiltrates are seen.
Diaphragmatic contours and lateral pleural sinuses are free. On CT,
identified mediastinal mass with calcifications cannot be identified
conclusively on this portable single view chest examination.
|
10165018-RR-18
| 10,165,018 | 23,251,005 |
RR
| 18 |
2132-07-06 12:06:00
|
2132-07-06 16:10:00
|
INDICATION: ___ female admitted with hemoptysis, found to have
mediastinal granuloma likely secondary to histoplasmosis, with chronic frontal
headache for two months unrelieved by pain medications. Evaluate for
infection or mass.
COMPARISONS: None.
TECHNIQUE: Routine ___ MR examination including sequences of
sagittal T1, axial T1 pre, axial FLAIR, axial T2, sagittal MP-RAGE,
susceptibility axial images, ADC, DWI, and axial T1 post were obtained.
FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or
infarction. The ventricles and sulci are normal in size and configuration. A
septum vergae is incidentally noted. No diffusion abnormalities are detected.
There is no abnormal enhancement after contrast administration. The paranasal
sinuses are unremarkable. The major intracranial vessel flow voids are
preserved.
IMPRESSION: Normal brain MRI. No evidence of infection or mass.
|
10165220-RR-108
| 10,165,220 | 22,079,223 |
RR
| 108 |
2150-11-10 02:34:00
|
2150-11-10 04:00:00
|
INDICATION: ___ female with abdominal pain. Elevated lipase.
TECHNIQUE: Multi detector CT images through the abdomen and pelvis were
obtained in the absence of oral contrast. Intravenous contrast was
administered. Coronal and sagittal reformations were generated and reviewed.
DOSE: 914 mGy-cm.
COMPARISON: CT torso dated ___
FINDINGS:
Chest: The bases of the lungs are clear. Visualized heart and pericardium
are unremarkable. There is no pericardial effusion.
Abdomen: The liver appears homogeneous, though low in attenuation, in keeping
with known hepatic steatosis. There is no intrahepatic biliary dilatation.
Within segment VI of the liver, there is a 1.6 x 0.8 cm ill-defined
hypodensity, not definitely visualized on prior MR dated ___.
Additional note is made of nonocclusive thrombus within the posterior branch
of the right portal vein and subsegmental branch of the right anterior portal
vein, additionally demonstrated on MR dated ___ patient is status post
cholecystectomy with surgical clips within the gallbladder fossa noted.
Within the pancreatic tail, there is a 6.3 x 3.3 cm lobulated cystic lesion
with calcifications. This is been previously characterized on MR dated ___ bowel most compatible with a serous microcystic pancreatic adenoma. This
appears stable in size. There is no pancreatic duct dilatation. There is no
peripancreatic fluid collection or surrounding inflammatory changes.
The spleen is unremarkable. Bilateral adrenal glands are without nodularity.
The kidneys present symmetric nephrograms and excretion of contrast. There is
no hydronephrosis or perinephric stranding. The distal right ureter is
dilated, though no obstructing stone is seen.
The stomach, duodenum, and loops of small bowel are unremarkable. The appendix
is air-filled and unremarkable. Moderate fecal load and within the colon is
identified appear the distal descending colon and sigmoid colon demonstrates
mildly thickened wall and hyperemic mucosa. Adjacent fat stranding is
additionally seen. Distal rectum is unremarkable.
The abdominal aorta is normal in caliber without aneurysmal dilatation.
Scattered retroperitoneal nodes are identified none of which meet CT size
criteria for pathology be for pathology. Several perirenal and left
para-aortic collaterals appear to have been present on prior examinations.
Additional note is made of paraaortic stranding.
There is trace abdominal free fluid adjacent to the sigmoid colon (2:72).
Pelvis: The bladder is unremarkable, moderately distended. There is no
inguinal or pelvic sidewall adenopathy. There is no pelvic free fluid.
Osseous structures: No suspicious lytic or blastic lesion is identified.
Multilevel degenerative changes are noted in the prerectal lumbar spine with
anterior osteophytosis.
IMPRESSION:
1. Thickened bowel wall of the distal descending and sigmoid colon with
surrounding inflammatory changes consistent with colitis. This is a
nonspecific finding which includes infectious, ischemic and inflammatory
etiologies. Recommend follow up to resolution to exclude underlying
malignancy.
2. Pancreatic cystic lesion previously characterized on MR to most likely
represent serous microcytic pancreatic adenoma, stable in size. No pancreatic
ductal dilation or surrounding inflammatory changes.
3. Stable nonocclusive thrombus within the right posterior and anterior portal
veins.
4. Hepatic segment VI focal 1.5cm ill defined hypodensity not fully
characterized on current examination and not definitely appreciated on prior
MR dated ___. Nonemergent ultrasound is recommended as a first step
for further evaluation.
5. Hepatic steatosis.
6. Several collateral vessels along the left aorta and left kidney
incidentally noted as well as retroperitoneal stranding. Retroperitoneal
fibrosis should be considered and if symptoms persist, follow up CT in 6
months time is recommended.
NOTIFICATION: Findings discussed
|
10165220-RR-90
| 10,165,220 | 23,060,728 |
RR
| 90 |
2148-05-24 14:26:00
|
2148-05-24 15:07:00
|
INDICATION: ___ female with diabetes mellitus, status post two
incision and drainages of the right index finger.
COMPARISON: ___.
TECHNIQUE: Three views of the right second digit were obtained.
FINDINGS: There is increased lucency at the second proximal interphalangeal
joint with worsening joint space narrowing, cortical irregularity of the
distal aspect of the proximal phalanx and base of the middle phalanx, and
increased surrounding soft tissue swelling. No acute fracture or dislocation
is detected, but there may be increased ulnar subluxation of the joint.
Degenerative changes of the PIP and DIP joints are noted with osteophyte
formation and joint space narrowing.
IMPRESSION: Findings highly concerning for osteomyelitis and septic joint of
the second PIP joint.
Findings discussed with ___ by Dr. ___ by telephone at 2:55 p.m. on
___ at the time of review of the study.
|
10165220-RR-91
| 10,165,220 | 23,060,728 |
RR
| 91 |
2148-05-26 09:23:00
|
2148-05-26 10:45:00
|
INDICATION: ___ woman with left-sided PICC line placement.
COMPARISONS: ___ -- ___.
FINDINGS: A single portable AP chest radiograph is obtained. A left-sided
PICC line has been inserted with the tip projecting over the mid SVC. The
lungs are clear. No effusion, consolidation, or pneumothorax is present. The
heart and mediastinal contours are normal.
IMPRESSION: Left-sided PICC line tip at the mid SVC.
|
10165494-RR-76
| 10,165,494 | 21,439,323 |
RR
| 76 |
2198-11-11 13:30:00
|
2198-11-11 13:52:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with a fib, increased dyspnea on exertion, leukocytosis
COMPARISON: ___ and ___
FINDINGS:
PA and lateral views of the chest provided. Lung volumes are low. Mild
elevation of left hemidiaphragm is unchanged. There is no focal consolidation,
effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. No free air below the right hemidiaphragm is
seen.
IMPRESSION:
No acute intrathoracic process.
|
10165494-RR-77
| 10,165,494 | 21,439,323 |
RR
| 77 |
2198-11-11 14:16:00
|
2198-11-11 14:41:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with persistent vomiting of unclear cause //
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 780.4 mGy-cm
CTDI: 51.5 mGy
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
Moderate periventricular white matter hypodensities compatible with chronic
microvascular ischemic disease. The imaged paranasal sinuses are clear.
Mastoid air cells and middle ear cavities are well aerated. The bony calvarium
is intact.
IMPRESSION:
1. No acute intracranial process.
2. Moderate small vessel disease.
|
10165522-RR-60
| 10,165,522 | 20,042,475 |
RR
| 60 |
2154-04-23 00:54:00
|
2154-04-23 05:26:00
|
EXAMINATION: Chest PA and lateral
INDICATION: History: ___ with CHF w/ DOE// evaluate for volume overload
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___
FINDINGS:
A cardiac pacing device projects over the left hemithorax, with leads
projecting over the right atrium and right ventricle. The heart is enlarged
and there is mild pulmonary edema seen as ___ B-lines as well as upper zone
redistribution of the vasculature. No pleural effusions. No pneumothorax.
IMPRESSION:
Cardiomegaly with moderate pulmonary edema.
|
10165522-RR-61
| 10,165,522 | 20,042,475 |
RR
| 61 |
2154-04-27 17:34:00
|
2154-04-27 17:53:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with low urine output.// Any hydronephrosis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal ultrasound dated ___.
FINDINGS:
The right kidney measures 12.3 cm cm. The left kidney measures 10.8 cm cm.
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is mildly distended without wall thickening.
Partially visualized liver is diffusely echogenic.
IMPRESSION:
1. Normal renal ultrasound. No hydronephrosis or nephrolithiasis.
2. Echogenic liver consistent with steatosis. Other forms of liver disease
and more advanced liver disease including steatohepatitis or significant
hepatic fibrosis/cirrhosis cannot be excluded on this study.
RECOMMENDATION(S): Radiological evidence of fatty liver does not exclude
cirrhosis or significant liver fibrosis which could be further evaluated by
___. This can be requested via the ___ (FibroScan) or the
Radiology Department with either MR ___ or US ___, in
conjunction with a GI/Hepatology consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
10165522-RR-64
| 10,165,522 | 26,098,931 |
RR
| 64 |
2154-05-21 15:13:00
|
2154-05-21 15:49:00
|
INDICATION: ___ year old man with HFrEF, s/p swan placement.// confirm swan
placement Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left-sided pacemaker is unchanged. Right-sided Swan-Ganz catheter projects in
the right main pulmonary artery. Cardiomediastinal silhouette is stable.
There is no pleural effusion. No pneumothorax is seen
|
10165522-RR-65
| 10,165,522 | 26,098,931 |
RR
| 65 |
2154-05-24 08:02:00
|
2154-05-24 08:41:00
|
INDICATION: ___ year old man with HFrEF, now with swan in place, variable
waveforms from catheter at rest// confirm swan position
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are clear. Left-sided pacemaker and right-sided Swan-Ganz catheter are
unchanged. Cardiomediastinal silhouette is stable. There is no pleural
effusion. No pneumothorax is seen
|
10165522-RR-67
| 10,165,522 | 26,098,931 |
RR
| 67 |
2154-05-26 22:11:00
|
2154-05-26 22:56:00
|
INDICATION: ___ year old male with non ischemic cardiomyopathy, HFrEF (EF 17%)
s/p ICD ___, afib on apixaban, s/p VT ablation x 2, celiac disease, chronic
abdominal pain, presenting with post-prandial abdominal pain, concerning for
low-flow state through abdominal vasculature in the setting of advanced heart
failure. However also found to have antral erosions and superficial ulcers on
EGD which are also likely contributing to acute on chronic abd pain.// CT A/P
this admission with some ?hemangiomas vs. hypoperfusion; being considered for
possible heart transplant, needs further evaluation of these
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 1.9 s, 30.7 cm; CTDIvol = 4.1 mGy (Body) DLP = 124.7
mGy-cm.
2) Spiral Acquisition 2.3 s, 30.7 cm; CTDIvol = 22.1 mGy (Body) DLP = 677.7
mGy-cm.
3) Spiral Acquisition 2.3 s, 30.7 cm; CTDIvol = 22.1 mGy (Body) DLP = 676.1
mGy-cm.
4) Spiral Acquisition 2.3 s, 30.7 cm; CTDIvol = 22.0 mGy (Body) DLP = 674.9
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
6) Stationary Acquisition 8.4 s, 0.5 cm; CTDIvol = 47.0 mGy (Body) DLP =
23.5 mGy-cm.
Total DLP (Body) = 2,179 mGy-cm.
COMPARISON: A CT of the abdomen pelvis dated ___ and MRCP dated ___.
FINDINGS:
LOWER CHEST: The previously seen right pleural effusion has resolved. There
is no left-sided pleural effusion. There is no pericardial effusion. A 2 mm
right lower lobe pulmonary nodule requires no further follow-up according to
current ___ guidelines (2:5).
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneously decreased attenuation
throughout consistent with hepatic steatosis. Similar to the prior study,
there very small foci of arterial enhancement within the liver without
correlate on portal venous or delayed phase imaging, likely representing
transient hepatic attenuation differences (301: 13, 22, 41, 52). There is no
suspicious liver lesion. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
,
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Exophytic simple cyst arises from the right upper pole (303:41). There is no
evidence of suspicious focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Nonspecific enhancing nodularity arising from the greater
curvature of the stomach is unchanged from multiple prior studies, of
uncertain etiology but doubtful clinical significance given the long-term
stability (02: 17,19). The visualized large and small bowel loops are
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Metallic densities along the abdominal wall suggest prior
herniorrhaphy. There is focal rectus diastasis (02:42).
IMPRESSION:
1. Previously seen foci of hyperenhancement within the liver are
re-demonstrated without correlate on more delayed imaging series likely
representing transient hepatic attenuation differences. No suspicious liver
lesion is present.
2. Hepatic steatosis.
3. Nodularity along the greater curvature of the stomach is stable from at
least ___.
|
10165522-RR-69
| 10,165,522 | 24,549,025 |
RR
| 69 |
2154-06-06 11:12:00
|
2154-06-06 13:40:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new line// new right PICC 48 cm ___
___ Contact name: ___: ___
IMPRESSION:
In comparison with the study of ___, there is been insertion of a right
subclavian PICC line that extends to the level of the carina. However, there
is suggestion of a slight upward position of the tip, which could imply that
it lies within the orifice of the azygos vein. The overlying pacer lead
somewhat obscures detail.
NOTIFICATION: This information has been conveyed to ___, a venous access
nurse. She will attempt to do a power flush that would cause the tip of the
tube to be positioned in the SVC.
|
10165522-RR-70
| 10,165,522 | 24,549,025 |
RR
| 70 |
2154-06-06 14:05:00
|
2154-06-06 15:24:00
|
EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with new line// PICC tip loop seen flushed
recheck tip ___ ___ Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___
FINDINGS:
The right upper extremity PICC now terminates at the cavoatrial junction.
Otherwise, no significant interval change compared to the study from earlier
today.
IMPRESSION:
The right upper extremity PICC now terminates at the cavoatrial junction.
Otherwise, no significant interval change.
|
10165672-RR-45
| 10,165,672 | 27,153,626 |
RR
| 45 |
2157-03-04 15:02:00
|
2157-03-04 15:22:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ male with fever and cough.
COMPARISON: ___.
FINDINGS: Frontal and lateral views of the chest. There is new bilateral
increased interstitial markings throughout the lungs. More dense region of
consolidation identified in the right lower lobe. There is no pleural
effusion. The cardiac silhouette is moderately enlarged, but unchanged.
Tortuosity of the descending thoracic aorta is noted. No acute osseous
abnormality is identified.
IMPRESSION: Increased interstitial markings throughout the lungs with more
confluent consolidation at the right lung base. Findings could be seen in the
setting of pulmonary edema with possible superimposed right base infection or
an atypical infection is possible.
|
10165672-RR-46
| 10,165,672 | 27,153,626 |
RR
| 46 |
2157-03-06 13:22:00
|
2157-03-06 14:41:00
|
EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old man with bilateral lower extremity swelling L>R. //
rule out DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: Right leg ultrasound ___
FINDINGS:
There is normal compressibility, flow and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10165672-RR-51
| 10,165,672 | 23,785,684 |
RR
| 51 |
2158-10-28 04:38:00
|
2158-10-28 08:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain // evaluate for pneumonia,
pulmonary edema, acute process
COMPARISON: ___
FINDINGS:
Upright views of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. Heart size is
top-normal. Imaged osseous structures are intact.
IMPRESSION:
No acute intrathoracic process.
|
10165672-RR-53
| 10,165,672 | 26,115,205 |
RR
| 53 |
2159-06-08 08:28:00
|
2159-06-08 11:16:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ w/ chest pain
TECHNIQUE: PA and lateral views of the chest provided.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Lung volumes are normal. There is pulmonary vascular engorgement with ___
B-lines, consistent with mild interstitial pulmonary edema. There is no focal
consolidation, large pleural effusion or pneumothorax. Mediastinal contour is
normal. Cardiomegaly is mild. Mild mediastinal widening is unchanged.
IMPRESSION:
Mild cardiomegaly, pulmonary vascular congestion and mild interstitial
pulmonary edema.
|
10165672-RR-54
| 10,165,672 | 26,115,205 |
RR
| 54 |
2159-06-08 15:25:00
|
2159-06-08 16:12:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with epigastric pain and RUQ tenderness // eval
for cholecystitis, biliar colic
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CTU of ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with the pancreatic body and tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 12.4 cm.
KIDNEYS: The kidneys are markedly echogenic bilaterally, rendering their
visualization typical with ultrasound. A simple cyst on the right measures
1.9 cm. Right kidney measures 6.1 cm. Left kidney measures 5.6 cm. No
hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No evidence of gallstones, biliary obstruction, or cholecystitis.
2. Atrophic native kidneys bilaterally, with right-sided simple renal cyst.
|
10165672-RR-55
| 10,165,672 | 26,115,205 |
RR
| 55 |
2159-06-08 22:55:00
|
2159-06-09 02:01:00
|
EXAMINATION: CT chest with contrast
INDICATION: ___ year old man with w/ ESRD on HD here w/ atypical cp c/f PE.
Patient Cr elevated but will get dialysis tomorrow, contrast OK. // r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence: 1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol
= 8.1 mGy (Body) DLP = 4.1 mGy-cm. 2) Spiral Acquisition 4.4 s, 34.4 cm;
CTDIvol = 7.9 mGy (Body) DLP = 270.8 mGy-cm. Total DLP (Body) = 275 mGy-cm.
COMPARISON: ___ CT chest without contrast
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection. The ascending thoracic aorta measures up to
4.5 cm. There are atherosclerotic calcifications within the coronary arteries
and thoracic aorta as well as the major branches. There is no evidence of
penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main pulmonary artery is dilated
measuring up to 4.3 cm. There is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There are trace bilateral
pleural effusions and mild associated compressive atelectasis in the lung
bases posteriorly. There is moderate cardiomegaly.
There is no evidence of pulmonary parenchymal abnormality. The airways are
patent to the subsegmental level.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
There is a stable 0.5 cm sclerotic focus in the right sixth rib laterally.
IMPRESSION:
No evidence of pulmonary embolism.
The main pulmonary artery and the ascending thoracic aorta measured dilated at
4.3 cm and 4.5 cm respectively, similar compared to ___.
Moderate cardiomegaly.
|
10165875-RR-7
| 10,165,875 | 22,545,966 |
RR
| 7 |
2116-09-08 10:38:00
|
2116-09-08 11:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ angeioedema eval for lower respiratory infection// ___
angeioedema eval for lower respiratory infection
TECHNIQUE: Single frontal view of the chest
COMPARISON: None
FINDINGS:
No focal consolidation is seen. There is no large pleural effusion or
pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No
pulmonary edema is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10165902-RR-23
| 10,165,902 | 25,888,675 |
RR
| 23 |
2152-09-23 22:06:00
|
2152-09-24 10:07:00
|
HISTORY: ___ year old woman with h/o MCI and hypothyroidism presents with
worsening word-finding difficulties and paranoia concerning for acute stroke
vs. neoplasm.
TECHNIQUE: Multiplanar multi sequence pre- and post contrast MR images of the
brain were obtained.
COMPARISON: Non contrast CT head ___.
FINDINGS:
There is no acute infarct or intracranial hemorrhage. There are nonspecific
small scattered T2/FLAIR high signal foci throughout the brain which may be
sequela of chronic microvascular changes. Gray white matter differentiation
is maintained. Ventricular, cisternal, sulcal prominence may be a function of
age-related parenchymal volume loss. The major intracranial vessels exhibit
the expected signal void related to vascular flow.
No abnormal enhancement is appreciated. The paranasal sinuses demonstrate
scattered areas of mucosal thickening. The mastoid air cells demonstrate
normal signal. The sella turcica, craniocervical junction, and orbits are
unremarkable.
IMPRESSION:
Age-related involutional and chronic microvascular angiopathic changes without
acute infarct, hemorrhage, mass effect, or abnormal enhancement appreciated.
|
10165902-RR-29
| 10,165,902 | 28,082,290 |
RR
| 29 |
2154-09-30 07:52:00
|
2154-09-30 12:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with AMS, laid flat and now 90% RA and gurgling
sound // aspiration or other acute process aspiration or other acute
process
IMPRESSION:
Compared to prior chest radiographs since ___, most recently ___ and
___.
Lung volumes have not improved. There are no findings to suggest either
cardiac decompensation or pneumonia. There is most likely a small right
pleural effusion. Heart size is normal. No pneumothorax.
|
10165902-RR-30
| 10,165,902 | 28,082,290 |
RR
| 30 |
2154-09-30 13:20:00
|
2154-09-30 14:35:00
|
EXAMINATION: CTA thorax.
INDICATION: ___ year old woman with tachypnea and AMS who desatted to ___ on
RA, but may have aspirated; want to r/o PE // r/o PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 3.2 mGy (Body) DLP = 1.6
mGy-cm.
2) Spiral Acquisition 3.4 s, 27.1 cm; CTDIvol = 6.5 mGy (Body) DLP = 176.0
mGy-cm.
Total DLP (Body) = 178 mGy-cm.
COMPARISON: Same day chest radiograph.
FINDINGS:
No pulmonary embolism or aortic dissection.
Coronary calcifications. Mitral valve calcifications. No cardiomegaly or
pericardial effusion. Patent aorta and arch branches. Mild arteriosclerosis.
Patent central airways. Mild biapical pleural thickening, right greater than
left. Accessory right lower lobe fissure. Trace dependent atelectasis and
mild right pleural thickening. No focal consolidation or pleural effusions.
Unremarkable visualized thyroid. No adenopathy. Small hiatal hernia.
Unremarkable visualized upper abdominal viscera.
Kyphosis. No acute fracture or soft tissue mass.
IMPRESSION:
No evidence of pulmonary embolism or aortic dissection. No signs of
aspiration or pneumonia.
|
10165902-RR-31
| 10,165,902 | 28,082,290 |
RR
| 31 |
2154-10-02 21:12:00
|
2154-10-03 09:58:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old female with baseline word-finding difficulties but
got acutely worse. Evaluate for etiology of mental status change.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 4 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT from ___ and MRI from ___.
FINDINGS:
Some of the images are limited by motion.
There is no evidence of an intra-axial or extra-axial enhancing mass, and no
pathologic leptomeningeal or pachymeningeal contrast enhancement. There is no
evidence for edema, abnormal diffusion, or blood products. There is unchanged
moderate prominence of the ventricles and sulci consistent with age-related
involutional changes.
Periventricular, deep, and subcortical T2 and FLAIR hyperintensities are in
the supratentorial white matter grossly unchanged compared to ___.
T2 hyperintense foci in the pons were probably present on the ___
exam but a better seen now with due to motion artifact through the pons on the
prior exam. These findings are nonspecific but likely secondary to chronic
small vessel ischemic disease in this age group.
The major arterial flow voids are preserved. Major dural venous sinuses are
patent on postcontrast MP RAGE images.
IMPRESSION:
1. Parenchymal involutional changes, as well as signal abnormalities in the
supratentorial white matter and pons which are likely secondary to chronic
small vessel ischemic disease in this age group, are similar to ___.
2. No evidence for acute infarction, other acute intracranial abnormalities,
or intracranial mass.
|
10165902-RR-32
| 10,165,902 | 21,807,075 |
RR
| 32 |
2155-04-02 08:35:00
|
2155-04-02 11:03:00
|
INDICATION: ___ with s/p fall. RLE short and externally rotated //
Hemorrhage/fracture?
COMPARISON: ___.
FINDINGS:
AP pelvis and AP and lateral views of the right femur provided. There is an
acute inter trochanteric fracture of the right femoral neck with mild
comminution. The lesser trochanter is medially avulsed. No additional
fracture seen involving the imaged left hip, bony pelvis, or mid to distal
right femur. Limited views of the right knee are unremarkable. There is only
minimal bilateral hip osteoarthritis with minimal loss of joint space and mild
subchondral sclerosis. The SI joints appear mildly sclerotic bilaterally.
IMPRESSION:
Acute, intratrochanteric fracture of the right femoral neck.
|
10165902-RR-33
| 10,165,902 | 21,807,075 |
RR
| 33 |
2155-04-02 08:40:00
|
2155-04-02 09:35:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with s/p fall.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
There is no evidence of acute major infarction, hemorrhage, edema, or large
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Subcortical, periventricular, and deep white matter
hypodensities are nonspecific, however likely represent sequela of chronic
small vessel ischemic disease. There are vascular calcifications of bilateral
cavernous carotids.
There is no evidence of fracture. There is mild mucosal thickening in the
right sigmoid sinus. The visualized portion of the remainder of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No fracture or acute intracranial process.
|
10165902-RR-34
| 10,165,902 | 21,807,075 |
RR
| 34 |
2155-04-02 08:41:00
|
2155-04-02 09:42:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with s/p fall. RLE short and externally rotated
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Total DLP (Body) = 699 mGy-cm.
COMPARISON: CTA chest on ___
FINDINGS:
Alignment is normal. No fractures are identified. There is mild multilevel
degenerative disc disease resulting in mild loss of disc space height most
pronounced at C4-5 level. There is no critical central canal or neural
foraminal narrowing.There is no prevertebral edema. Cervical lordosis is
slightly exaggerated.
The thyroid is unremarkable. Scarring at the right lung apex is similar to
prior.
IMPRESSION:
No fracture or malalignment in the C-spine. Degenerative changes as detailed
above.
|
10165902-RR-35
| 10,165,902 | 21,807,075 |
RR
| 35 |
2155-04-02 09:55:00
|
2155-04-02 10:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with R femur fracture. Pre-op CXR
COMPARISON: Prior exam dated ___
FINDINGS:
AP portable supine view of the chest.
Lungs appear clear. No large consolidation, supine evidence for effusion or
pneumothorax. The heart size is normal. Mediastinal contour is unremarkable.
No acute bony injuries seen.
IMPRESSION:
No acute intrathoracic process
|
10165902-RR-36
| 10,165,902 | 21,807,075 |
RR
| 36 |
2155-04-03 10:09:00
|
2155-04-03 15:46:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: ORIF RIGHT HIP
IMPRESSION:
Fluoroscopic images show placement of a fixation device about fracture of the
femur. Further information can be gathered from the operative report.
|
10165963-RR-40
| 10,165,963 | 28,362,771 |
RR
| 40 |
2157-04-04 15:28:00
|
2157-04-04 15:52:00
|
INDICATION: ___ that is post transplant here with fever chills
hypotension.// Intrahepatic infection.
TECHNIQUE: AP and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Small persistent right-sided pleural effusion with adjacent atelectasis. Mild
retrocardiac atelectasis. Elsewhere, lungs are clear. Cardiomediastinal
silhouette is within normal limits.
IMPRESSION:
Small right pleural effusion and probable bibasilar atelectasis.
|
10165963-RR-41
| 10,165,963 | 28,362,771 |
RR
| 41 |
2157-04-04 14:46:00
|
2157-04-04 15:50:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ that is post transplant here with fever chills hypotension.//
Intrahepatic infection.
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___.
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation.
CHD: 3 mm
There is no ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen has normal echotexture.
Spleen length: 16.3 cm.
DOPPLER: The main hepatic artery shows a high resistance pattern, with sharp
systolic upstrokes with decreased antegrade diastolic flow. Peak systolic
velocity in the main hepatic artery is 108 cm/sec. Appropriate arterial
waveforms are seen in the right hepatic artery and the left hepatic artery
with resistive indices of 0.83, and 0.7, respectively. The main portal vein
and the right and left portal veins are patent with hepatopetal flow, however
flow within the main portal vein is pulsatile. Appropriate flow is seen in
the hepatic veins and the IVC.
IMPRESSION:
1. High resistance pattern in the main hepatic artery, which may be technical
given normal appearance on ___, recommend short-term interval
follow-up.
2. Pulsatile flow in the main portal vein which may be secondary to venous
congestion.
3. No focal hepatic lesion identified.
4. Stable splenomegaly. No ascites.
RECOMMENDATION(S): Recommend short-term interval liver transplant ultrasound
|
10165963-RR-42
| 10,165,963 | 28,362,771 |
RR
| 42 |
2157-04-04 20:46:00
|
2157-04-04 21:41:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: NO_PO contrast; History: ___ with liver transplant, concern for
intra-abdominal infectionNO_PO contrast// Intra-abdominal infection
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.1 s, 55.6 cm; CTDIvol = 26.2 mGy (Body) DLP =
1,457.7 mGy-cm.
Total DLP (Body) = 1,458 mGy-cm.
COMPARISON: CTA abdomen and pelvis ___, MRCP ___
FINDINGS:
LOWER CHEST: Redemonstration of a moderate, low-density right pleural
effusion, similar in extent to the prior study. There is overlying relaxation
atelectasis in the right lower lobe, as seen previously. The left lung is
clear at the visualized base. Heart is normal size with atherosclerotic
calcification of the coronary arteries and aortic valve. No large pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: Transplant liver is re-demonstrated with a streak of apparent
hypoattenuation along the right hepatic dome, previously described as a likely
a focal hepatic infarct, grossly unchanged compared to the prior study (series
2, image 12). There is similar appearance of periportal edema throughout the
liver. A plastic biliary stent is demonstrated traversing the hepatic hilum
and passing the ampulla, terminating within the third portion the duodenum,
stable in position compared to the prior study.
The gallbladder has been removed.
Surgical material is again demonstrated near the hepatic hilum (series 2,
image 33), with an ill-defined hypoattenuating fluid collection measuring
approximately 3.2 x 2.1 cm, slightly decreased in size compared to the prior
study when it measured 3.7 x 2.5 cm on ___. There are new foci of air
within and about this collection which were not seen previously as well as
tracking along the porta hepatis (02:30, 31, 32). An additional ill-defined
hypoattenuating fluid collection slightly superior to the duodenum measures
approximately 1.6 x 1.4 cm (02:34), and is smaller compared to the prior
study, also containing new foci of gas within and about it.
There is moderate periportal stranding, which appears somewhat more pronounced
compared to the prior study.
Additionally, there is new under organized fluid and stranding along the
hepatic flexure of the colon which extends inferiorly along the right lateral
conal fascia, which was not demonstrated previously (series 2, image 53).
PANCREAS: The unenhanced pancreas appears within normal limits without
pancreatic ductal dilatation or focal lesion.
SPLEEN: The spleen is enlarged, measuring 18.6 cm in the anterior-posterior
diameter. No focal splenic lesions. There are perisplenic varices.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no suspicious
renal lesions within the limitations of an unenhanced scan. Subcentimeter
hypodensity in the inferior pole of the right kidney likely reflects a cyst
(02:51). There is no hydronephrosis. There is no nephrolithiasis. There is
no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening or fat stranding.
PELVIS: The urinary bladder is decompressed about a Foley catheter. Distal
ureters are unremarkable. There is trace pelvic ascites.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Severe height loss with kyphoplasty changes at the L3 vertebral body
with 6 mm of posterior retropulsion resulting in moderate canal narrowing,
unchanged.
SOFT TISSUES: Umbilical hernia containing a portion of a small bowel loop as
well as small amount of fluid is noted, without complication. Skin staples
have been removed from the right anterior upper abdominal wall with expected
postsurgical changes.
IMPRESSION:
1. Interval decrease in size of two ill-defined fluid collections about the
hepatic hilum, one of which previously was noted to contain contrast from
prior ERCP. New foci of extraluminal gas in and about these fluid collections
however are present, likely secondary to a continued bile duct leak in the
setting of a biliary stent and prior sphincterotomy. Additional etiologies
such as perforated viscus from a duodenal ulcer would be less likely based on
clinical history however cannot be completely excluded.
2. Small amount of new un-organized fluid tracking along the right lateral
conal fascia, with persistent stranding in the perihepatic space.
3. Redemonstration of streak like hypodensity along the right hepatic dome,
incompletely characterized on the current CT but consistent with known hepatic
infarct. Transplant liver otherwise grossly stable but not well evaluated by
noncontrast CT. Trace perihepatic and pelvic ascites.
4. Stable positioning of the common bile duct stent which terminates in the
duodenum.
5. Moderate volume right-sided pleural effusion is stable compared to the
prior study.
|
10165963-RR-43
| 10,165,963 | 28,362,771 |
RR
| 43 |
2157-04-04 23:01:00
|
2157-04-05 10:49:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p
DDLT7/24 p/w biliary stricture s/p ERCP, fluid collection surroundinghepatic
duct now w chills and hypotension c/f cholangitis.// Eval RIJ central line
placement Contact name: ___: ___
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: Prior chest radiographs, most recent dated ___.
FINDINGS:
Compared to the prior chest study from ___, the cardiomediastinal
silhouette is unchanged. There has been interval decrease in the right lower
lung opacification with increased atelectatic component. There is no
right-sided pleural effusion, the left costophrenic angle is not included on
this study. There is no new focal opacity. There has been interval placement
of a right IJ catheter with its tip in the mid/lower SVC.
IMPRESSION:
1. Right IJ catheter has its tip projecting over the mid/lower SVC.
2. Interval improvement of the right lower lobe opacity with an increase in
the atelectatic component.
|
10165963-RR-44
| 10,165,963 | 28,362,771 |
RR
| 44 |
2157-04-05 16:51:00
|
2157-04-05 18:31:00
|
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p
DDLT7/24 p/w biliary stricture s/p ERCP, fluid collection surroundinghepatic
duct now w chills and hypotension c/f cholangitis// LIVER PROTOCOL
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen and pelvis in the portal venous phase, followed by a scan of the
abdomen in equilibrium phase (3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 31.2 cm; CTDIvol = 4.8 mGy (Body) DLP = 150.4
mGy-cm.
2) Spiral Acquisition 2.1 s, 28.2 cm; CTDIvol = 23.7 mGy (Body) DLP = 665.8
mGy-cm.
3) Spiral Acquisition 4.1 s, 54.4 cm; CTDIvol = 23.3 mGy (Body) DLP =
1,266.2 mGy-cm.
4) Spiral Acquisition 2.1 s, 28.2 cm; CTDIvol = 23.7 mGy (Body) DLP = 665.7
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
6) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.4 mGy (Body) DLP =
6.7 mGy-cm.
Total DLP (Body) = 2,756 mGy-cm.
COMPARISON: Multiple prior imaging, most recent CT dated ___.
FINDINGS:
LOWER CHEST: There is a stable moderate right pleural effusion with adjacent
compressive atelectasis. There is very trace left fluid with mild dependent
atelectasis.
ABDOMEN:
HEPATOBILIARY: The gall bladder is surgically absent. Postsurgical changes
from prior liver transplant are noted. Previously described irregular area of
hypoattenuation in segment 8 seen on pre contrast, arterial phase, and portal
venous phase images are stable compatible with hepatic infarction. This has
not developed into a discrete collection. No suspicious focal hepatic lesions
are identified. Biliary stent is again identified and is stable in position.
Periportal edema and mild intrahepatic ductal dilation are stable findings.
Right intrahepatic ducts are again more dilated than the left. The right main
hepatic duct shows mild wall thickening and hyperenhancement although this is
not very specific in the setting of stent placement.
Trace ill-defined fluid, fat stranding, and scattered foci of free air at the
porta hepatis have decreased since ___. However, although air has
decreased since ___ there is somewhat greater Fluid in the hepatic hilum
although quite limited (303:47 compared to 2:31 on the prior study). Status
not seem highly organized. It measures about 53 by 33 mm in axial ___
by 13 mm in height.
Small amount of free fluid is along the right pericolic gutter is stable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is enlarged measuring up to 19 cm AP ___. No
discrete focal splenic lesions are identified. There are perisplenic varices.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is stable too small to characterize hypodensity involving the inferior
pole of the right kidney, likely a cyst. There is no evidence of solid renal
lesions or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Visualized small and large
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. There is sigmoid diverticulosis without evidence of
diverticulitis.
PELVIS: The urinary bladder is decompressed with Foley catheterization with
nondependent air. There is trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. The major proximal portal venous vasculature and hepatic arterial
and venous vasculature appear patent
BONES: There are degenerative changes of the spine. Kyphoplasty changes of L3
with compression and retropulsion causing moderate spinal canal stenosis is
stable..
SOFT TISSUES: Tiny umbilical hernia containing a portion of small bowel and
fluid is stable.
IMPRESSION:
1. Small quantity of poorly organized be it somewhat increased fluid since the
prior day in the hepatic hilum. Although the quantity is not very striking
possibility of persistent biliary leakage could be considered.
2. Unchanged mild intrahepatic biliary dilatation, right lobe greater than
left. No specific evidence for cholangitis. In the setting of stent
placement mild wall thickening and hyperenhancement along intrahepatic biliary
ducts is not very specific.
3. Status post liver transplant which appears grossly stable from ___. Stable streak like hyperdensity along the right hepatic lobe compatible
with known hepatic infarct.
4. Small amount intrapelvic free fluid.
5. Stable moderate right pleural effusion with compressive atelectasis.
6. Stable small quantity of ill-defined fluid tracking along the right
pericolic gutter.
NOTIFICATION: Findings discussed with Dr. ___ at 12:25 am by
telephone on ___.
|
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