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10165963-RR-45
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2157-04-09 16:53:00
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2157-04-09 23:54:00
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EXAMINATION: MRCP
INDICATION: ___ with PMH of type ___ DM, ITP, NASH cirrhosis and HCC s/p DDLT
___ p/w biliary stricture s/p ERCP, fluid collection surrounding hepatic duct
admitted w chills and hypotension c/f sepsis.// Patient is s/p ERCP w/stent
placement ___ showing no stricture, +extrav @ level of mid CBC. Now with
persistently rising LFTs s/p ERCP. Please assess CBD, anastomosis
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT abdomen pelvis ___. MRCP ___.
FINDINGS:
Lower Thorax: Visualized portions of the bilateral lower lungs demonstrate
compressive atelectasis of the right lower lobe. There is a small to moderate
right pleural effusion, similar to prior. No left pleural effusion. No
pericardial effusion.
Liver: Patient is status post deceased donor liver transplant. There is no
significant loss of signal on out of phase imaging to suggest hepatic
steatosis. A stable punctate T2 hyperintense nonenhancing focus in segment
___ is consistent with biliary hamartoma or cyst (1303; 49).
In the hepatic dome in segment VIII, there is a rim enhancing 1.0 cm T2
hyperintense lesion concerning for a microabscess with thickening and
enhancement of a mildly dilated bile duct leading up to this area (1303; 52).
In segment VI, there is a similar appearing 1.0 cm rim enhancing T2
hyperintense lesion also concerning for a microabscess (1303; 64).
Perfusional abnormalities are noted adjacent to these suspected microabscesses
(1303; 47). Additional punctate 1-2 mm nonenhancing T2 hyperintense foci with
peripheral rim enhancement in segment ___ and segment ___ are also suspicious
for tinier developing micro abscesses, not clearly seen on prior CT exams
(1303; 50, 52). A punctate nonenhancing T2 hyperintense focus in segment III
(1303; 72) is equivocal for a microabscess, and not clear if seen on prior
exam.
Nonenhancing irregular areas in segment VIII in the hepatic dome are
consistent with areas of infarction, similar in extent compared to prior CT
___ 25)
No suspicious hepatic lesions meeting OPTN 5 criteria for ___ is identified.
There is redemonstration of the rim enhancing irregular T2 hyperintense fluid
collection in the periportal area with foci of susceptibility consistent with
air near the site of anastomosis, similar to prior allowing for differences in
technique, measuring approximately 5.6 x 2.6 cm (4; 26), previously measuring
6.5 x 2.3 cm. Trace fluid near the hepatic hilum and biliary anastomosis
measuring 1.2 x 1.6 cm has decreased in size compared to prior MRCP when it
measured 1.9 x 2.7 cm (4; 27).
There is trace perihepatic ascites.
Biliary: Status post interval biliary stent exchange which appears
appropriately positioned. There is persistent mild intrahepatic biliary
dilatation, right greater than left, with mild wall thickening and enhancement
of segment VIII bile duct concerning for cholangitis. Gallbladder is
surgically resected.
Pancreas: There is mild loss of intrinsic T1 signal of the pancreatic
parenchyma likely related to recent surgery. There is no main pancreatic
ductal dilatation or focal lesion.
Spleen: The spleen is enlarged measuring 14.4 cm, previously measuring 15.1
cm. There is no focal lesion.
Adrenal Glands: The adrenal glands appear unremarkable bilaterally.
Kidneys: The kidneys are symmetric in size and nephrogram. There is no
hydronephrosis. Bilateral subcentimeter T2 hyperintense nonenhancing lesions
are consistent with renal cysts 3; 31).
Gastrointestinal Tract: The visualized small and large bowel appear normal in
caliber without evidence of obstruction. Trace fluid along the right
pericolic gutter has decreased from prior.
Lymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.
Vasculature: The hepatic veins are patent. The portal vasculature, portal
anastomosis, main portal vein, splenic vein, and SMV are patent. The hepatic
arterial anastomosis arising directly from the celiac axis is patent. The
intra-abdominal aorta is normal in caliber.
Osseous and Soft Tissue Structures: Chronic compression fracture of the L3
vertebral body status post vertebroplasty is similar to prior. Mild
subcutaneous edema is noted in the bilateral lateral abdominal walls and in
the posterior subcutaneous tissues. Susceptibility artifact from the right
upper quadrant abdominal wall is consistent with prior surgery.
IMPRESSION:
1. New 1.0 cm rim enhancing fluid collections in segment VIII and segment VI
with biliary duct wall thickening leading up to them are concerning for
microabscesses in setting of cholangitis.
2. Additional punctate foci in segment ___ and ___ may also represent
additional microabscesses, attention on follow-up.
3. Stable periportal fluid collection containing foci of air, similar to prior
CT. Trace fluid is also noted at the hepatic hilum, decreased compared to
prior MRI dated ___.
4. Irregular areas of non-enhancement in segment VIII are consistent with
hepatic infarction.
5. Status post biliary stenting with stable mild intrahepatic biliary ductal
dilatation.
6. Stable small to moderate right pleural effusion with compressive
atelectasis of the right lower lobe.
NOTIFICATION: The updated findings were discussed with Dr. ___, M.D.
by ___, M.D. on the telephone on ___ at 9:51 am, 10 minutes after
discovery of the findings.
|
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2157-04-09 13:09:00
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2157-04-09 14:09:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p DDLT
___ p/w biliary stricture s/p ERCP, fluid collection surrounding hepatic duct
now w chills and hypotension c/f sepsis- rising LFTs s/p ERCP ___.
Evaluation for hepatic vasculature.
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Comparison to prior ultrasound from ___. Comparison
to CT abdomen/pelvis from ___.
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation.
CHD: 4 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 arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 65 cm/sec. Appropriate
arterial waveforms are seen in the right hepatic artery and the left hepatic
artery with resistive indices of 0.67, and 0.59, respectively. The main
portal vein and the right and left portal veins are patent with hepatopetal
flow and normal waveform, however flow within the main portal vein remains
pulsatile. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
1. Patent hepatic vasculature with appropriate waveforms. Previously seen
high resistance pattern within the main hepatic artery is no longer
appreciated on the current study.
2. Pulsatile flow within the main portal vein is similar to prior study,
likely secondary to venous congestion.
3. No focal hepatic lesions identified.
4. Stable moderate splenomegaly, measuring up to 16.3 cm.
|
10165963-RR-48
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2157-04-11 17:55:00
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2157-04-11 22:33:00
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INDICATION: ___ year old man with increased LFTs and concerns for
cholangitis// please place PTBD
COMPARISON: CT ___ MRCP, ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
performed the procedure.
ANESTHESIA: General
MEDICATIONS:
CONTRAST: 40 ml of OPTIRAY contrast
FLUOROSCOPY TIME AND DOSE: 38 min, 628 mGy
PROCEDURE:
1. Transabdominal ultrasound.
2. Ultrasound and Fluoroscopic guided right percutaneous transhepatic bile
duct access.
3. Right cholangiogram
4. ___ right biliary drain.
PROCEDURE DETAILS:
Following the discussion 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 abdomen
was prepped and draped in the usual sterile fashion.
Preliminary ultrasound did not show any intrahepatic biliary dilatation.
Under Ultrasound guidance, a 21G Cook needle was advanced toward a visible
hilar bile duct. The needle was withdrawn while injecting contrast,
ultimately opacifying a central right bile duct. Under fluoroscopic guidance,
a second 21 gauge cook needle was advanced towards a right anterior bile duct.
A headliner wire was advanced into the duct to confirm intraluminal position.
The wire was removed and contrast was injected. Injected contrast from the
second access needle opacified tiny peripheral bile ducts. A third 21 gauge
cook needle was advanced under fluoroscopic guidance towards a peripheral
right posterior bile duct. A headliner wire was advanced through the needle.
The inner portion of an Accustick sheath was advanced over the wire into the
bile duct. Contrast injection confirmed intraluminal position. A stiff
Glidewire was advanced through the inner Accustick sheath. Outer Accustick
sheath was advanced over the wire and a wire was advanced into duodenum. A 6
___ sheath was advanced over the wire. The wire was exchanged for an
Amplatz and a pull-back cholangiogram was performed. A ___ internal external
biliary catheter was advanced, the wire and inner stiffener were removed and
the pigtail was formed. Contrast injection confirmed appropriate position.
The catheter was flushed with saline, secured with stay sutures to the skin
and sterile dressings were applied. The catheter was attached to a bag.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. No biliary dilatation on ultrasound
2. Mild prominence of central bile ducts
3. Patent CBD stent
4. Brisk bile leak from the upper portion of the CBD
IMPRESSION:
1. Successful placement of the right ___ internal-external biliary drain.
2. Redemonstration of bile leak in upper CBD
|
10165963-RR-49
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| 49 |
2157-04-19 09:29:00
|
2157-04-19 14:42:00
|
EXAMINATION: MRCP
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p DDLT
___ p/w biliary stricture s/p ERCP, fluid collection surrounding hepatic duct
p/w sepsis now s/p ___ PTBD placement, s/p ex lap abscess drainage with
persistently elevated LFTs likely requiring another ___ PTBD// assess for
undrained collection
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 16 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Prior MRCP dated ___. CT
abdomen/pelvis dated ___.
FINDINGS:
Lower thorax: Moderate right pleural effusion again seen. No left pleural
effusion. Mild bibasilar atelectasis.
Liver: Patient is status post deceased donor liver transplant. The transplant
liver demonstrates normal morphology and signal intensity. No suspicious
hepatic lesions meeting OPTN 5 criteria for hepatocellular carcinoma.
However, in segment VIII, there is a new 0.7 x 0.8 cm rim enhancing T2
hyperintense lesion (series 18, image 20; series 2, image 27), likely a
microabscess with surrounding with thickening and enhancement of adjacent
mildly dilated intrahepatic biliary ducts.
Inferior to this, within segment VIII, there is redemonstration of two
additional microabscesses measuring 0.8 x 0.4 cm (series 18, image 39) and 0.3
x 0.3 cm (series 18, image 37), similar in appearance compared to prior exam.
In segment VI, there is an additional 0.3 x 0.3 cm rim enhancing microabscess
(series 18, image 37), which is smaller compared to prior exam, previously
measuring up to 1.0 cm. There are other punctate foci with rim enhancement
noted in segments II and ___, unchanged compared to prior exam.
An additional 2.6 x 0.8 x 2.0 cm rim enhancing irregular periportal fluid
collection is again seen (series 6, image 29; series 4, image 23). Inferior
to this, there are new ill-defined patchy fluid pockets with air-fluid levels,
likely postoperative.
In segment III, there is redemonstration of a nonenhancing irregular area,
compatible with prior infarction.
There is persistent mild perihepatic ascites.
Biliary: The gallbladder is surgically absent. Redemonstration of a PTBD and
a plastic biliary stent. There is persistent mild intrahepatic biliary
dilatation with enhancement, compatible with acute cholangitis. Additionally,
there is mild extrahepatic biliary dilatation, with the common bile duct
measuring up to 9 mm, likely due to prior cholecystectomy.
Pancreas: Pancreas demonstrates normal signal intensity on T1 weighted images
and enhances homogeneously. Pancreatic duct is normal in caliber.
Spleen: The spleen is enlarged measuring up to 14.0 cm (series 2, image 39).
Adrenals: Adrenal glands are normal.
Kidneys: The kidneys enhance and excrete symmetrically without suspicious
lesions or hydronephrosis. Bilateral subcentimeter T2 hyperintense
nonenhancing foci are seen and compatible with renal cysts.
Bowel: Partially imaged loops of small and large bowel are unremarkable.
There is no wall thickening, adjacent inflammatory change, or abnormal
enhancement. There is no evidence of stricture or obstruction.
Vasculature: Abdominal aorta is normal in caliber and major branch vessels are
patent. The portal vein, splenic vein and SMV are patent.
Lymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.
Osseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious
osseous lesion.
IMPRESSION:
1. New segment VIII 0.7 x 0.8 cm microabscess with thickened and enhancing
adjacent biliary ducts, compatible with acute cholangitis.
2. Interval decrease in the size of the now 0.3 cm segment VI microabscess.
The remaining hepatic microabscesses are stable in size and appearance
compared to prior MRCP dated ___.
3. Similar-appearing 2.0 cm periportal fluid collection is again seen.
4. New subhepatic fluid pockets with multiple air-fluid levels likely
represents postsurgical change.
5. Irregular nonenhancing area in segment III is unchanged compared to prior
exam and compatible with a hepatic infarction.
6. Moderate right pleural effusion.
7. Cholecystectomy.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:37 pm, 20 minutes after discovery
of the findings.
|
10165963-RR-50
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| 50 |
2157-04-20 18:13:00
|
2157-04-20 19:38:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with Left PICC// left PICC 48cm, ___ ___
Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
IMPRESSION:
Study is limited by patient positioning with the left costophrenic angle not
included in the field of view. There has been interval placement of a left
upper extremity PICC, which terminates in the cavoatrial junction. The right
internal jugular central venous catheter terminates in the lower superior vena
cava.
There is a layering right pleural effusion. Bibasilar atelectasis is noted.
There is no new consolidation or pneumothorax. The cardiomediastinal
silhouette is within normal limits. There is no pulmonary edema. No acute
osseous abnormalities are identified.
|
10165963-RR-52
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| 52 |
2157-04-22 11:36:00
|
2157-04-22 12:56:00
|
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p DDLT
___ p/w biliary stricture s/p ERCP, fluid collection surrounding hepatic duct
p/w sepsis now s/p ___ PTBD placement, s/p ex lap abscess drainage// Please
interrogate PTBD and see if it is clogged, LFT's consistently rising.
COMPARISON: PTBD ___
TECHNIQUE: OPERATOR: Dr. ___ radiology attending)
performed the procedure.
PROCEDURE:
1. Cholangiogram through existing right percutaneous transhepatic biliary
drainage access.
2. Exchange of the existing ___ percutaneous transhepatic biliary drainage
catheter with a new ___ ___ PTBD catheter.
PROCEDURE DETAILS:
Following the discussion 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.
Existing right PTBD was injected which showed complete occlusion of the drain
with brisk leak from proximal CBD. The drain was cut and removed over the
wire. A new ___ internal external biliary drain was placed. Wire and
stiffener removed. The drain connected to the bag.
Patient tolerated procedure well.
FINDINGS:
1. Complete occlusion of the existing right PTBD.
2. Brisk leak from proximal CBD.
IMPRESSION:
Successful exchange of the existing right ___ internal external PTBD for a ___
internal external PTBD.
|
10165963-RR-53
| 10,165,963 | 28,362,771 |
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| 53 |
2157-04-24 17:34:00
|
2157-04-24 19:19:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ with PMH of type II DM, ITP, NASH cirrhosis and HCC s/p DDLT
___ p/w biliary stricture s/p ERCP, fluid collection surrounding hepatic duct
p/w sepsis now s/p ___ PTBD placement, s/p ex lap abscess drainage // Please
assess for evidence of remaining fluid collection at the JP drain
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 14.8 s, 50.8 cm; CTDIvol = 15.3 mGy (Body) DLP =
755.9 mGy-cm.
2) Spiral Acquisition 14.8 s, 50.8 cm; CTDIvol = 15.3 mGy (Body) DLP =
755.9 mGy-cm.
Total DLP (Body) = 1,540 mGy-cm.
COMPARISON: MRCP ___. CT abdomen
and pelvis ___ and ___.
FINDINGS:
LOWER CHEST: Small hiatal hernia. There remains small right pleural effusion
with passive atelectasis. Mild atelectasis is also demonstrated at the left
lung base. Lung bases, visualized pleural spaces, and lower mediastinal
structures otherwise unremarkable.
ABDOMEN:
HEPATOBILIARY: Patient is status-post deceased donor liver transplant.
Transplant liver is normal in contour. A low-attenuation lesion at the liver
dome is re-demonstrated (series 3, image 11). It measures up to 10 mm in
diameter, previously 8 mm. As this is a non-enhanced study, details with
regards to pattern of enhancement cannot be appreciated on today's scan.
Similarly, associated ductal enhancement and mild intrahepatic surrounding
ductal dilatation are best assessed on the recent MRI of the liver performed ___. Tiny scattered liver cysts are best seen on MR. ___ new focal
parenchymal lesions identified.
Patient is status-post cholecystectomy. Right and left internal external
biliary drain remains in-situ. Both drains terminate within the second
portion of the duodenum.
There remains an air and fluid containing collection adjacent to the
gallbladder fossa measuring approximately 3.0 x 4.6 cm in AP and transverse
dimension (series 3, image 28). Allowing for the differences in modality and
techniques, this is likely unchanged from the MR performed ___.
The second air and fluid containing collection is seen more medially, adjacent
to the cholecystectomy clips, and measures approximately 1.3 x 3.2 cm, again
largely unchanged from the MR performed ___ (series 3, image 25).
Is unclear whether these two collections are in communication with each other.
A percutaneous surgical drain is seen coursing along the right paracolic
gutter. Tip is localized to ___ pouch (series 3, image 31). This drain
is located away from the above described collections. ___ residual fluid at
the tip of the drain.
___ new organized fluid collections are identified in the abdomen or pelvis,
and specifically in the right upper quadrant.
Small pockets of loculated fluid in the right upper quadrant are stable.
PANCREAS: Pancreatic parenchyma is atrophic. ___ focal parenchymal lesions
identified. ___ main duct dilatation.
SPLEEN: The spleen is enlarged (14 cm). ___ focal parenchymal lesions
identified.
ADRENALS: Normal adrenal glands.
URINARY: Mild bilateral perinephric fat stranding, nonspecific. Stable cyst
lower pole right kidney. ___ nephrolithiasis. ___ hydronephrosis.
GASTROINTESTINAL: Uncomplicated colonic diverticulosis, centered primarily on
the sigmoid colon, and to a lesser extent in the descending colon. Along
segment of the sigmoid: Demonstrates mural thickening, likely and a background
of muscularis propria hypertrophy. Large bowel otherwise unremarkable.
Appendix in the right lower quadrant normal. Mild thickening within the
second portion of the duodenum, likely reactive in nature. Normal small bowel
otherwise.
PELVIS: Underdistended and otherwise unremarkable urinary bladder.
REPRODUCTIVE ORGANS: Mildly bulky prostate gland. Normal seminal vesicles.
LYMPH NODES: ___ inguinal, pelvic, retroperitoneal, periportal, or mesenteric
lymphadenopathy.
VASCULAR: Mild atheromatous calcification of the abdominal aorta and iliac
vasculature. ___ aneurysmal dilatation.
BONES: ___ acute or focal destructive osseous lesions. Multilevel degenerative
disc disease throughout the visualized spine. Kyphoplasty changes for severe
L3 compression fracture, with moderate retropulsion of the posterior column
into the spinal canal, with associated thecal sac and cord mass effect.
Appearance is unchanged from ___. There are ___ new compression
fractures. ___ acute or focal destructive osseous lesions.
SOFT TISSUES: There are subcutaneous soft tissue changes related to recent
laparotomy. Surgical skin staples remain in situ in the right hemiabdomen.
IMPRESSION:
1. ___ adverse interval change from the MRCP performed ___.
2. Re-demonstrated post-surgical changes in the right upper quadrant. Right
and left internal external biliary drains in situ. There remain two small air
and fluid containing collections adjacent to the gallbladder fossa. Allowing
for the differences in modality in technique, these are unchanged from the MR
performed ___. ___ new organized fluid collections in the abdomen
or pelvis.
3. The tip of the right-sided percutaneous catheters localized to ___
pouch. ___ residual fluid is noted at the tip of this catheter.
4. Low-attenuation lesion at the dome of the liver, suspected to represent is
small intrahepatic abscess, as best assessed on MRI. It demonstrates marginal
enlargement on today's study, which may be related to measurement technique
(10 mm versus 8 mm). ___ new focal parenchymal lesions are identified.
5. The small right pleural effusion is unchanged from prior. Associated
passive atelectasis is noted.
|
10166010-RR-14
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RR
| 14 |
2186-02-13 01:45:00
|
2186-02-13 05:04:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man with posterior diaphragmatic hernia,
hx/unprovoked DVT (not on AC) p/w pleuritic pain found to have elevated
d-dimer.// 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) Spiral Acquisition 2.2 s, 29.2 cm; CTDIvol = 15.0 mGy (Body) DLP = 437.5
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 19.9 mGy (Body) DLP =
9.9 mGy-cm.
Total DLP (Body) = 449 mGy-cm.
COMPARISON: There is no prior imaging available for comparison.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level with evidence of filling defects seen in 2 subsegmental
pulmonary arteries of the posterior right upper lobe consistent with pulmonary
embolus (series 301, image 53). The thoracic aorta is normal in caliber
without evidence of dissection or intramural hematoma. The heart,
pericardium, and great vessels are within normal limits. No pericardial
effusion is seen. There is no right heart strain.
AXILLA, HILA, AND MEDIASTINUM: No axillary or hilar lymphadenopathy is
present. There is a mediastinal lymph node inferiorly to the right mainstem
bronchus measuring up to 11 mm. There is no mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. There is bibasilar mild atelectasis. The airways are patent
to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen demonstrates a small hiatal
hernia measuring 6.2 cm and large Bochdalek hernia in the right lung base
measuring 9.7 x 5.5 x 12 cm (TR by AP by CC).
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
Right upper lobe subsegmental pulmonary emboli.
|
10166010-RR-15
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RR
| 15 |
2186-02-13 09:47:00
|
2186-02-13 10:31:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man with newly diagnosed PE, LLE swelling// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is thin nonocclusive thrombus within the proximal left common femoral
vein, proximal left deep femoral vein, and more extensive partially occlusive
thrombus within the distal femoral vein and popliteal vein. There is normal
compressibility, color flow, and spectral doppler of the right common femoral,
femoral, and popliteal veins. Normal color flow and compressibility are
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Minimal nonocclusive DVT within the proximal left common femoral and deep
femoral veins, and more extensive partially occlusive acute DVT within the
left distal femoral and popliteal veins. No evidence of DVT in the right
lower extremity.
|
10166010-RR-16
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RR
| 16 |
2186-02-13 17:25:00
|
2186-02-13 18:18:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with acute onset abdominal pain, found to have
unprovoked PE, concern for hypercoagulable state and mesenteric clot as
etiology of pain// Evidence of thrombosis in mesenteric vasculature?
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.6 s, 57.7 cm; CTDIvol = 3.6 mGy (Body) DLP = 209.5
mGy-cm.
2) Spiral Acquisition 4.4 s, 57.7 cm; CTDIvol = 17.6 mGy (Body) DLP =
1,012.8 mGy-cm.
Total DLP (Body) = 1,222 mGy-cm.
COMPARISON: CT abdomen and pelvis performed at outside hospital ___
FINDINGS:
VASCULAR:
The abdominal aorta and major mesenteric branch vessels are normal in caliber
and patent. No high-grade occlusion, dissection or thrombus.
There is no abdominal aortic aneurysm. There is no substantial calcium burden
in the abdominal aorta and great abdominal arteries.
The portal venous vasculature is patent. The splenic vein and superior
mesenteric veins are patent. The opacified IVC is within normal limits.
LOWER CHEST: Please see same day CT chest for full description of
intrathoracic findings. A right posterior diaphragmatic hernia is again
demonstrated.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is empty. Gallbladder wall
prominence is likely secondary to hydration or third-spacing.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops
demonstrate normal caliber, wall thickness and enhancement throughout. Colon
and rectum are within normal limits. There is no evidence of mesenteric
lymphadenopathy.
RETROPERITONEUM: There is no retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
pelvic or inguinal lymphadenopathy. There is no ascites.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly
unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No obstruction, thrombus or dissection within the intra-abdominal arterial,
venous or portal venous vessels.
2. No acute process within the abdomen or pelvis. No substantial interval
change from the prior CT from the outside hospital from ___.
3. Moderate hiatal hernia and right-sided posterior diaphragmatic hernia are
unchanged.
|
10166356-RR-10
| 10,166,356 | 22,421,715 |
RR
| 10 |
2170-10-16 13:47:00
|
2170-10-16 14:40:00
|
HISTORY: ___ female on scooter collided with truck. Evaluation for
fractures or acute process.
TECHNIQUE: Helical axial images were acquired through the paranasal sinuses.
Coronal and sagittal re-formatted images were prepared.
COMPARISON: Comparison is made to concurrent noncontrast CT of the head, CT
of the cervical spine, and CT of the torso.
FINDINGS:
Multiple left-sided facial fractures are present, including a slightly
displaced fracture of the left orbital floor with no evidence of extraocular
muscle entrapment (400:67). Additionally, fractures seen through the medial,
anterior, and posterolateral walls of the left maxillary sinus, which is
filled with blood and small locules of air (400b:75). A small locule of air
is seen adjacent to a linear fracture through the antral floor of the left
maxillary sinus (400b:71). Additionally there are fractures extending into
the maxillary alveolar ridge, at the level of the ___ molar on the left and
more anteriorly between the central incisors (400b:60, 400b:40 respectively).
The bilateral zygomatic arches are intact. There is overlying soft tissue
swelling and hematoma are noted along the left maxilla (3:111, 3:90). The
globes are intact bilaterally. The left ostiomeatal unit is opacified, as is
the the left maxillary sinus. The right ostiomeatal unit is patent. The
cribriform plates are intact. The right maxillary sinus, frontal sinuses, and
the sphenoid sinuses are clear. The nasal bones are intact. There is at mild
thickening within the ethmoid air cells. The left nasal cavity is filled with
fluid. The nasal septum is intact. There are aerosolized secretions within
the ___- and oropharynx, likely secondary to endotracheal tube placement.
For detail on intracranial structures, please refer to non contrast head CT
report, dictated separately.
IMPRESSION:
1. Multiple left-sided facial fractures including the left orbital floor with
no evidence of extraocular muscle entrapment. Multiple fractures of the left
maxillary sinus and left maxillary alveolar ridge as described above.
The above findings were discussed with Dr. ___ by Dr. ___ in person at the
time of discovery.
|
10166356-RR-11
| 10,166,356 | 22,421,715 |
RR
| 11 |
2170-10-16 13:48:00
|
2170-10-16 14:41:00
|
HISTORY: ___ female on scooter collided with truck. Assessment for
acute process and fractures.
TECHNIQUE: Helical axial MDCT sections were obtained from the skullbase
through the T3 level. Reformatted images in sagittal and coronal axes were
obtained.
COMPARISON: Comparison is made to concurrent CT of the head, CT of the
sinuses and CT of the torso.
FINDINGS:
The cervical lordosis is preserved. There is no sign of acute fracture or
abnormal alignment in the cervical spine. No prevertebral soft tissue
swelling is present. There are aerosolized secretions seen within the ___-
and oropharynx, likely secondary to intubation. No lymphadenopathy is present
by CT size criteria. There is an ill-defined hypodensity within the right
lobe of the thyroid which measures approximately 1.1 cm (2:55).
For details on intracranial structures, please refer to head CT report,
dictated separately.
IMPRESSION:
1. No fracture or malalignment within the cervical spine. For facial
fractures, please see CT face.
2. 1.1 cm ill-defined hypodensity within the right lobe of the thyroid for
which follow up ultrasound is recommended.
The above findings were communicated to Dr. ___ by Dr. ___ in person, at the
time discovery immediately after image acquisition.
|
10166356-RR-12
| 10,166,356 | 22,421,715 |
RR
| 12 |
2170-10-16 13:48:00
|
2170-10-16 14:43:00
|
HISTORY: ___ female on scooter collided with truck. Evaluataion for
acute process or fractures.
TECHNIQUE: MDCT images were obtained from the suprasternal notch to the pubic
symphysis after the administration of intravenous contrast. No oral contrast
was given. Reformatted coronal and sagittal images were also reviewed.
COMPARISON: Comparison is made to concurrent non-contrast CT of the head, CT
of the cervical spine and CT of the sinuses.
FINDINGS:
CT OF THE THORAX WITH IV CONTRAST: There is a partially visualized hypodense
area within the right lobe of the thyroid, which is better evaluated on CT of
the cervical spine. There is no supraclavicular or axillary lymphadenopathy.
The airways are patent to the subsegmental level. There is an endotracheal
tube in appropriate position, which has been repositioned since the previous
chest radiograph. The aorta and great vessels, and mediastinum are
unremarkable. The lung windows demonstrate no focal opacity bilaterally.
There is no hilar or mediastinal lymph node enlargement. No pleural effusion
or pneumothorax is present. The aorta is of normal caliber throughout the
thorax without intramural hematoma or dissection. Pulmonary arteries
demonstrate no filling defect in the main, right, left, lobar, and segmental
pulmonary arteries.
An esophageal tube is seen coursing below the diaphragm and into the stomach,
terminating just below the gastroesophageal junction (620:26), and could be
advanced several centimeters so that it is well within the stomach.
CT ABDOMEN WITH IV CONTRAST: The liver enhances homogeneously with no
evidence of focal lesions. There is no intra or extrahepatic biliary ductal
dilatation and the gallbladder is normal. The portal vein is patent. The
pancreas, bilateral adrenal glands, bilateral kidneys and spleen are normal in
appearance. The stomach, duodenum and small bowel are normal with no evidence
of wall thickening or obstruction. There is no retroperitoneal or mesenteric
lymphadenopathy. The large bowel is unremarkable with no evidence of wall
thickening or obstruction. There is no intra-abdominal free air or free
fluid.
CT PELVIS WITH IV CONTRAST: The uterus has an apparent septated, or possibly
arcuate morphology (2:102, 620:28), and can be further evaluated with
follow-up 3D Ultrasound or MRI. CT is not the best imaging modality to
evaluate the uterus. The pelvic loops of large and small bowel are
unremarkable. The bladder is decompressed and unremarkable in appearance.
There is a small amount of pelvic free fluid, likely physiologic. No adnexal
masses are seen. There is no pelvic sidewall or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: No fracture or dislocation is seen. No suspicious lytic
or blastic osseous lesion is present.
IMPRESSION:
1. No acute pathology is identified within the torso.
2. Nasogastric tube terminates just below the level of the gastroesophageal
junction and should be advanced several centimeters.
3. Possible septate or arcuate uterus. Follow up three-dimensional ultrasound
or MRI is recommended for further characterization.
Findings under #1 and #2 above were discussed with ___ by Dr. ___ at the
time discovery immediately after image acquisition.
The above findings under #3 regarding possible septate or arcuate uterus were
communicated to ___ by Dr. ___ telephone, 5 minutes after the
discovery was made on ___ at approximately 3:45pm.
|
10166356-RR-8
| 10,166,356 | 22,421,715 |
RR
| 8 |
2170-10-16 13:28:00
|
2170-10-16 14:44:00
|
HISTORY: Injury, trauma.
TECHNIQUE: Single supine AP portable view of the chest.
COMPARISON: None.
FINDINGS:
Endotracheal tube is seen terminating at the level of the carina, low lying.
This was subsequently withdrawn by and seen to be in appropriate position on
subsequent CT torso and in discussion with Dr. ___ surgery resident.
Nasogastric tube is seen coursing below the diaphragm, with side port at the
gastric fundus. The lungs are clear without focal consolidation. No pleural
effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable. No displaced fracture is seen.
IMPRESSION:
1. Low lying endotracheal tube which was subsequently withdrawn to appropriate
position by the clinical team as seen on subsequent CT torso and discussed
with Dr. ___. Otherwise, no acute intrathoracic process.
|
10166356-RR-9
| 10,166,356 | 22,421,715 |
RR
| 9 |
2170-10-16 13:47:00
|
2170-10-16 14:34:00
|
HISTORY: ___ female on scooter collided with truck. Evaluation for
fractures or acute process.
TECHNIQUE: Contiguous axial MDCT images were obtained of the brain without
administration of intravenous contrast. Reformatted coronal, sagittal and
thin slice bone images were reviewed.
COMPARISON: Comparison is made to concurrent CT of the cervical spine, CT of
the sinuses and CT of the torso.
FINDINGS:
There is no evidence of intracranial hemorrhage, edema, mass, mass effect or
infarction. The ventricles and sulci are normal in size and configuration.
The basal cisterns appear patent and there is preservation of gray-white
matter differentiation.
Multiple left-sided facial fractures are identified, better characterized on
the current maxillofacial CT; see that report. The visualized mastoid air
cells and middle ear cavities are clear.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Multiple left-sided facial fractures, described in detail on the concurrent
CT of the face.
The above findings were communicated to Dr. ___ by Dr. ___ in person, at the
time discovery, immediately after image acquisition.
|
10166498-RR-34
| 10,166,498 | 23,259,648 |
RR
| 34 |
2118-03-23 13:21:00
|
2118-03-23 14:06:00
|
INDICATION: History: ___ with R knee pain, bike fall/injury// eval for
fx/injury
TECHNIQUE: Three views of the right knee
COMPARISON: None.
FINDINGS:
There is comminuted, depressed intra-articular fracture of the lateral tibial
metaphysis, with extension to the articular surface/lateral tibial plateau.
No dislocation is seen. No suprapatellar joint effusion is identified.
IMPRESSION:
Comminuted, depressed, intra-articular fracture of the lateral tibial
metaphysis with extension to the articular surface/lateral tibial plateau.
|
10166498-RR-35
| 10,166,498 | 23,259,648 |
RR
| 35 |
2118-03-23 12:55:00
|
2118-03-23 14:18:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall over bike, knee deformity// eval for
bleed, neck fx
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is nodes acute intracranial midline shift, mass effect, or acute large
vascular territorial infarct. The ventricles and sulci are normal in size and
configuration.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. No acute intracranial process.
|
10166498-RR-36
| 10,166,498 | 23,259,648 |
RR
| 36 |
2118-03-23 12:55:00
|
2118-03-23 15:08:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall over bike, knee deformity// eval for
bleed, neck fx eval for bleed, neck fx
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.9 s, 23.0 cm; CTDIvol = 22.7 mGy (Body) DLP = 523.7
mGy-cm.
2) Sequenced Acquisition 0.5 s, 2.0 cm; CTDIvol = 30.3 mGy (Head) DLP =
60.5 mGy-cm.
3) Sequenced Acquisition 0.5 s, 2.0 cm; CTDIvol = 30.3 mGy (Head) DLP =
60.5 mGy-cm.
Total DLP (Body) = 524 mGy-cm.
Total DLP (Head) = 121 mGy-cm.
COMPARISON: Cervical CT of ___.
FINDINGS:
No acute fracture or traumatic malalignment. Multilevel degenerative changes
most notably at C5-C6 associated with mild central canal narrowing. There is
also bilateral moderate foraminal narrowing at C6-7.
There is no prevertebral soft tissue swelling.
IMPRESSION:
Degenerative changes without acute fracture or traumatic malalignment.
|
10166498-RR-37
| 10,166,498 | 23,259,648 |
RR
| 37 |
2118-03-23 16:48:00
|
2118-03-23 17:57:00
|
INDICATION: ___ year old man with right tibial plateau fx.// Characterization
of tibial plateau fx
TECHNIQUE: ___ MD CT imaging was performed through the right lower
extremity from the proximal femur to the ankle. Intravenous contrast was not
administered. Coronal and sagittal reformats were produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.9 s, 77.9 cm; CTDIvol = 22.7 mGy (Body) DLP =
1,767.2 mGy-cm.
Total DLP (Body) = 1,767 mGy-cm.
COMPARISON: Right knee radiographs ___
FINDINGS:
There is a split and depressed fracture of the lateral tibial plateau with
depression of the articular surface measuring approximately 13 mm and
involving an area measuring 2.8 x 2.9 cm (404:32). There is a moderate
lipohemarthrosis. No additional fractures are seen. An apparent fracture
through the proximal fibular neck (404:21) appears to be an artifact related
to motion at this level.
Incidental note is made of ossification of the soleal attachment.
There is moderate vascular calcification.. Limited assessment of the thigh
and calf musculature is grossly unremarkable. I joint incidental note is made
of an os peroneum.
IMPRESSION:
Schatzker type 2 fracture of the lateral tibial plateau as outlined above.
|
10166498-RR-38
| 10,166,498 | 23,259,648 |
RR
| 38 |
2118-03-23 16:52:00
|
2118-03-23 18:16:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with R tibial plateau fx, admitting to orthopedics for OR//
eval for structural process
COMPARISON: None
FINDINGS:
AP upright and lateral views of the chest provided. The lungs appear clear
though upper lung lucency raises concern for COPD. No focal consolidation,
large effusion or pneumothorax is seen. Linear densities projecting over the
right lower lung is likely external artifact. Cardiomediastinal silhouette
appears grossly unremarkable. The imaged bony structures are intact.
IMPRESSION:
As above.
|
10166498-RR-39
| 10,166,498 | 23,259,648 |
RR
| 39 |
2118-03-23 16:52:00
|
2118-03-23 19:37:00
|
INDICATION: ___ with R wrist pain, fall// eval for fx/injury
COMPARISON: Prior exam from ___
FINDINGS:
AP, lateral, oblique views of the right wrist and a dedicated navicular view
provided. No acute fracture or dislocation. The distal radius and ulna
appear intact. Carpals align normally. Significant DJD. No worrisome
calcifications. Bone mineralization is normal.
IMPRESSION:
No acute fracture or dislocation.
|
10166498-RR-40
| 10,166,498 | 23,259,648 |
RR
| 40 |
2118-03-24 11:09:00
|
2118-03-24 13:12:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
IMPRESSION:
Fluoroscopic images show placement of fixation devices about the depressed
fracture of the lateral tibial plateau. Further information can be gathered
from the operative report.
|
10166682-RR-16
| 10,166,682 | 28,100,196 |
RR
| 16 |
2112-04-13 00:35:00
|
2112-04-13 07:44:00
|
EXAMINATION: Chest radiographs.
INDICATION: History: ___ with cough // acute process
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___.
FINDINGS:
There is mild cardiomegaly. There is prominence of the vascularity in the
upper lobes bilaterally, suggestive of mild to moderate pulmonary edema.
There is no focal consolidation, pleural effusion or pneumothorax.
IMPRESSION:
Mild to moderate pulmonary edema.
|
10166688-RR-16
| 10,166,688 | 21,606,055 |
RR
| 16 |
2151-01-11 12:45:00
|
2151-01-11 17:03:00
|
INDICATION: Eight days of headache with new ptosis, pedal visual changes.
Please evaluate for mass.
TECHNIQUE: Contiguous axial images were obtained through the brain. Coronal
and sagittal reformations were obtained. No contrast was administered.
COMPARISON: None.
FINDINGS: There is no evidence of hemorrhage, edema, shift of midline
structures, or major vascular territorial infarction. The ventricles and
sulci are normal in size and configuration. No suspicious osseous lesions are
identified. The visualized paranasal sinuses, mastoid air cells, and middle
ear cavities are clear.
IMPRESSION: No acute hemorrhage or mass effect.
|
10166688-RR-17
| 10,166,688 | 21,606,055 |
RR
| 17 |
2151-01-11 17:14:00
|
2151-01-11 17:51:00
|
CLINICAL HISTORY: ___ woman with headache and ptosis.
STUDY: CTA head and neck.
COMPARISON STUDY: CT head dated ___.
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
brain during intravenous administration of contrast. The images were
processed on a separate workstation with display of curved reformats, 3D
volume-rendered images, and maximum intensity projection images.
FINDINGS:
CTA NECK: The left common carotid artery has a common origin with right
brachiocephalic artery. The origins of the great vessels appear normal.
Bilateral common carotid, internal and external carotid arteries appear
normal. Bilateral vertebral arteries appear normal. There is no evidence of
focal flow-limiting stenosis, occlusion, or aneurysm greater than 3 mm.
The proximal left internal carotid artery measures 7.3 mm, and distally, it
measures 4.4 mm. The proximal right internal carotid artery measures 6.6 mm,
and distally, it measures 4.4 mm.
CTA HEAD: The arteries of the anterior circulation including bilateral
intracranial internal carotid arteries, anterior and middle cerebral arteries
appear normal. The arteries of the posterior circulation including bilateral
vertebral arteries, basilar artery, and posterior cerebral arteries appear
normal. There is no evidence of focal flow-limiting stenosis, occlusion, or
aneurysm greater than 3 mm.
IMPRESSION: No evidence of focal flow-limiting stenosis, occlusion, or
aneurysm greater than 3 mm in arteries of head and neck.
|
10166688-RR-18
| 10,166,688 | 21,606,055 |
RR
| 18 |
2151-01-11 19:53:00
|
2151-01-12 10:34:00
|
CLINICAL HISTORY: ___ woman with rheumatoid arthritis, polymyositis,
left retroorbital headache associated with left ptosis. To evaluate for
compressive lesion, orbital myositis, or other contributory abnormalities.
STUDY: MRI brain and orbit without and with contrast.
COMPARISON STUDY: CT and CTA head dated ___.
TECHNIQUE: Sagittal T1, axial FLAIR and diffusion-weighted images were
obtained of the brain prior to administration of contrast. Axial and coronal
T1 and coronal STIR images were obtained of the orbits prior to administration
of contrast. Axial and coronal T1-weighted images were obtained of the orbits
after administration of contrast and axial T1-weighted images were obtained of
the brain after administration of contrast.
FINDINGS:
MRI ORBITS: Bilateral globes appear normal. The extraocular muscles are
normal in size and show normal enhancement. Bilateral optic nerves are normal
in size and signal intensity. The retroorbital fat appears normal. There is
no abnormal enhancing mass noted.
MRI BRAIN: There is no evidence of acute infarct or intracranial hemorrhage.
There is no abnormal leptomeningeal or parenchymal enhancement. The
ventricles, extra-axial CSF spaces, and cortical sulci appear normal.
Brainstem and cerebellum appear normal.
The visualized paranasal sinuses and mastoid air cells are clear. Osseous
structures are unremarkable.
IMPRESSION:
1. No evidence of abnormal enhancing mass in the orbits.
2. No evidence of acute intracranial abnormality.
3. No abnormal leptomeningeal or parenchymal enhancement in the brain.
|
10167784-RR-44
| 10,167,784 | 26,706,672 |
RR
| 44 |
2165-10-20 19:25:00
|
2165-10-20 19:50:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: ___ with left weakness // stroke?
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 1,009 mGy-cm.
COMPARISON: None provided.
FINDINGS:
Study is degraded by significant motion artifact. Within this limitation:
There is a large intraparenchymal hemorrhage centered in the right parietal
lobe measuring approximately 7.5 x 4.1 cm with surrounding edema. There is
secondary effacement of posterior body, atrium and occipital horn of the right
lateral ventricle and approximately 9 mm leftward midline shift.
There is no evidence of hydrocephalus. Interventricular hemorrhage seen
within the atrium of the left lateral ventricle. Evaluation of the basilar
cisterns is limited secondary to motion but there is no visualized frank
herniation.
No osseous abnormalities are identified. Imaged paranasal sinuses are clear.
Mastoid air cells and middle ear cavities are well aerated. Visualized
portions of the orbits are unremarkable.
IMPRESSION:
1. Motion degraded study.
2. A 7.5 x 4.1 cm parenchymal hemorrhage centered in the right parietal lobe
with associated edema, mass effect on the right lateral ventricle and
approximately 9 mm leftward midline shift. Small amount of intraventricular
hemorrhage.
3. Basilar cisterns are not particularly well assessed but there is no
evidence of frank herniation and there is no evidence of obstructive
hydrocephalus.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 7:42 ___, 1 minute after
discovery of the findings.
|
10167784-RR-45
| 10,167,784 | 26,706,672 |
RR
| 45 |
2165-10-20 21:51:00
|
2165-10-20 23:17:00
|
INDICATION: ___ with ett
TECHNIQUE: Single portable view of the chest.
COMPARISON: None.
FINDINGS:
Endotracheal tube tip is 3.4 cm from the carina. Enteric tube passes below
the inferior field of view with side-port in the gastric body. The lungs are
clear without consolidation, large effusion or edema. The cardiomediastinal
silhouette is within normal limits. No displaced fractures.
IMPRESSION:
ET and enteric tubes in appropriate position.
|
10167784-RR-46
| 10,167,784 | 26,706,672 |
RR
| 46 |
2165-10-20 22:13:00
|
2165-10-21 15:28:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD
INDICATION: ___ year old woman with R IPH // evaluate for intracranial
vascular anomaly
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
1,009.3 mGy-cm.
2) Stationary Acquisition 8.4 s, 0.5 cm; CTDIvol = 127.7 mGy (Head) DLP =
63.9 mGy-cm.
3) Spiral Acquisition 6.3 s, 20.3 cm; CTDIvol = 30.7 mGy (Head) DLP = 623.1
mGy-cm.
Total DLP (Head) = 1,696 mGy-cm.
COMPARISON: CT head from ___ performed at 19:25.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Compared to the prior exam performed on the same day at 19:25, there has been
no significant interval change in the large intraparenchymal hemorrhage
centered within the right parietal lobe, measuring approximately 7.2 cm x 5
cm, given differences in acquisition technique. Again demonstrated is
redistribution of intraventricular hemorrhage also not significantly changed
compared to the prior exam. The intraparenchymal hemorrhage results and
secondary effacement of the body, atrium and occipital horn of the right
lateral ventricle as well as midline shift to the left of approximately 4 mm.
Subarachnoid hemorrhage along the left frontoparietal convexities, series 3,
image 29 appears new compared to the prior exam.
No acute fracture is identified. The visualized paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The globes are unremarkable.
CTA HEAD:
The posterior circulation appears to be well preserved. The bilateral PCAs
are intact. The MCAs bilaterally are unremarkable. The anterior cerebral and
anterior communicating arteries are also well preserved. No aneurysm or
stenosis is identified.
IMPRESSION:
1. No significant interval change in the extent of the large right parietal
intraparenchymal hemorrhage measuring up to 7.2 cm and midline shift to the
left of approximately 4 mm. Stable intraventricular hemorrhage.
2. New left subarachnoid hemorrhage along the left frontoparietal convexities
near the vertex, series 3, image 29.
3. No aneurysms or vascular abnormalities identified. Intracranial
atherosclerotic disease.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 4:32 ___, 120 minutes after
discovery of the findings.
|
10167784-RR-47
| 10,167,784 | 26,706,672 |
RR
| 47 |
2165-10-21 00:17:00
|
2165-10-21 01:08:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ year old woman with IPH, s/p R hemicraniectomy // evaluate
for post-op change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT ___.
FINDINGS:
Interval right frontal craniotomy. Due to technical factors direct comparison
of the size of the hemorrhage is difficult but grossly the right frontal
hemorrhage appears unchanged in size. Overall right frontal vasogenic edema
is grossly unchanged. There is decreased mass effect on the right lateral
ventricle. 4 mm of leftward midline shift is unchanged.
A large amount of layering hemorrhage in the occipital horns of the lateral
ventricles is moderately increased. Layering hemorrhage in the fourth
ventricle is new. Interval increase in the size of the lateral ventricles and
third ventricle may be partially due to decreased mass effect but underlying
hydrocephalus cannot be excluded.
Moderate left frontoparietal subarachnoid hemorrhage is unchanged.
IMPRESSION:
1. Interval right frontal craniotomy. Due to technical factors direct
comparison of the size of the right frontal hemorrhage is difficult but
grossly unchanged. Mass effect on the right lateral ventricle is mildly
decreased, but leftward midline shift is unchanged. No large territorial
infarction.
2. Re- demonstrated intraventricular extension, now with new hemorrhage
layering in the fourth ventricle. Interval increase in the size of the lateral
ventricles and third ventricle may be partially due to decreased mass effect
but given the increase in size of the left lateral ventricle hydrocephalus
should be considered.
3. Unchanged left frontoparietal subarachnoid hemorrhage.
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RR
| 48 |
2165-10-21 04:56:00
|
2165-10-22 09:50:00
|
EXAMINATION: Chest single view
INDICATION: On ventilator with the ET tube
TECHNIQUE: Chest single view
___
FINDINGS:
The right mainstem bronchus has been intubated. This finding was immediately
called to the ICU at the time of dictating this report by Dr. ___ on 9/ 17
at 14:25 at the time of initial dictation of this study. . The nurse caring
for the patient had already known of this finding and the ET tube had been
pulled back earlier in the morning. The lungs are clear without infiltrate.
The NG tube is off the film, at least in the stomach.
IMPRESSION:
Right endotracheal tube intubation
NOTIFICATION: ICU notified, but they already knew of the problem
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RR
| 49 |
2165-10-22 05:24:00
|
2165-10-22 10:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH // interval change
TECHNIQUE: Portable chest
___
FINDINGS:
The ET tube has been pulled back and is now 2.5 cm above the carina. There is
increased opacity in the left lower lobe compatible with volume
loss/infiltrate/effusion. The remainder of the chest is unchanged.
|
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| 10,167,784 | 26,706,672 |
RR
| 51 |
2165-10-22 20:17:00
|
2165-10-23 10:15:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: Intraparenchymal hemorrhage post hemi craniectomy. Evaluate for
micro bleeds/amyloid angiopathy.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, DTI, and T1 technique. Sagittal MPRAGE
imaging was performed and re-formatted in axial and coronal orientations.
Please note, B 1000 diffusion-weighted images were not obtained secondary to
technical factors.
COMPARISON: Noncontrast head CT ___ and ___. CTA
head ___.
FINDINGS:
There are postsurgical changes from right frontoparietal craniectomy for
decompression of a large right frontoparietal temporal intraparenchymal
hemorrhage. Large right frontotemporoparietal intraparenchymal hemorrhage
appears overall unchanged in size compared to the prior CT examination given
difference of modality. There is a surrounding rim of vasogenic edema, with
associated mass effect, which is decompressed by the craniectomy. There is no
significant associated midline shift. There is no definite enhancement within
the area of hemorrhage.
Areas of sulcal FLAIR hyperintensity and susceptibility artifact are noted in
the bilateral frontal and left parietal lobes consistent with subarachnoid
hemorrhage, as previously noted on the CT examination. Intraventricular
hemorrhage layering within the occipital horns of the lateral ventricles is
again seen. Small amount of hemorrhage within the fourth ventricle is better
seen on the prior CT examination.
There is no evidence of new hemorrhage, definite masses, midline shift or
infarction. The ventricles remain mildly prominent, unchanged compared to the
prior examination. There is no definite abnormal enhancement after contrast
administration. Background areas of scattered periventricular, subcortical
and deep white matter T2/FLAIR hyperintensity likely represent the sequela of
chronic small vessel ischemic disease. Apart from the large area of
intraparenchymal hemorrhage, and subarachnoid hemorrhage, there are only a few
areas of punctate susceptibility artifact at the gray-white matter junction in
the right parietal lobe and a single focus in the left parietal lobe. The
dural venous sinuses are patent on MPRAGE images. The principal intracranial
vascular flow voids are preserved.
There is minimal mucosal wall thickening in the left maxillary sinus and mild
mucosal wall thickening in the bilateral sphenoid air cells and ethmoid air
cells. The orbits are grossly unremarkable.
IMPRESSION:
1. Grossly unchanged large right frontoparietotemporal intraparenchymal
hemorrhage with surrounding vasogenic edema, decompressed by a right-sided
craniectomy. No definite underlying enhancing mass.
2. Unchanged areas of subarachnoid hemorrhage and intraventricular extension
of hemorrhage. Please note, due to technical factors, assessment for
ischemia/infarct cannot be assessed.
3. Few scattered, punctate areas of microhemorrhage, though no definite
evidence for amyloid angiopathy.
4. Unchanged mild prominence of the ventricles which may relate to background
atrophy, though hydrocephalus remains a possibility.
RECOMMENDATION(S): Continued surveillance MRI is recommended until resolution
of hemorrhage, to exclude an underlying mass.
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| 10,167,784 | 26,706,672 |
RR
| 52 |
2165-10-23 12:41:00
|
2165-10-23 17:05:00
|
EXAMINATION: RIGHT INTERNAL CAROTID ARTERY ANGIOGRAM.
RIGHT COMMON CAROTID ARTERY ANGIOGRAM.
LEFT COMMON CAROTID ARTERY ANGIOGRAM.
LEFT VERTEBRAL ARTERY ANGIOGRAM.
INDICATION: ___ yo F found down 5pm, with lethargy, left hemiparesis, last
seen well at 0830, with large Right parietal IPH (7.5. x4.1cm), IVH with mass
effect on right ventricle and 9mm s/p crani // source of hemorrhage- request
of Dr ___
___: General endotracheal anesthesia was maintained by
separate anesthesia provider throughout the entirety of the case. The
anesthesia provider also monitored the patient's hemodynamic and respiratory
parameters.
TECHNIQUE: OPERATORS: Dr. ___ Dr. ___ physician performed
the procedure. Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings.
COMPARISON: MRI of the brain from ___.
PROCEDURE: The patient was brought to the angio suite. The right groin was
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. Location of the right mid femoral
head was located using anatomic and radiographic landmarks. Micropuncture kit
was used to gain access to the right femoral artery in serial dilation was
undertaken until a long 8 ___ groin sheath to be placed connected to a
continuous heparinized saline flush. Next the ___ catheter was
connected to a continuous heparinized saline flush and also the power
injector. It was advanced over the 0.038 glidewire, which was used to select
the right innominate followed by the right common carotid and right internal
carotid artery. Cervical biplane imaging was undertaken. Next, from the same
vessel, intracranial biplane and magnified biplane oblique views were
undertaken. The catheter was then pulled back into the aorta used to select
the left common carotid artery. Cervical biplane imaging was undertaken.
Next, from the same left common carotid artery, intracranial biplane along
with 3 dimensional rotational angiography was separate processing a 3D
workstation for attending physician final interpretation images was
undertaken. The catheter was then pulled back in the aorta used to select the
vertebral artery. AP and lateral road map imaging was undertaken. At this
time juncture, 3000 units of IV heparin were given.
An Angio-Seal was used at the end of the procedure. The patient was kept
intubated, and transferred back to her ICU bed and brought back up to the ICU
for further convalescence. At the conclusion seizure, there is no evidence of
thromboembolic complication.
FINDINGS:
Right common carotid and internal carotid artery: There is no significant
vessel tortuosity of the proximal and mid cervical ICA. The intracranial
views, the distal right ICA, proximal distal MCA andACA branches are
well-visualized. Vessel caliber smooth and tapering,. There is no evidence
of early venous drainage or adenoma or abnormal intracranial to extracranial
anastomoses orarteriovenous shunting.
Left common carotid artery: Just past the carotid bulb, there is was no flow
limitation. There is no significant tortuosity of the proximal or mid
cervical left ICA. Of the intracranial vessels visualized, the distal left
ICA, proximal distal MCA and ACA branches are well-visualized. No aneurysms
are identified.
Left vertebral artery: The left vertebral artery, left ___, left basilar
artery, bilateral AICA, SCA,andPCAs are well-visualized.
IMPRESSION:
1. No evidence of dural AV fistula, arteriovenous malformation or aneurysm,
underlying the patient's large right fronto-parietal intraparenchymal
hemorrhage.
I,Dr. ___ , was personally present and participated in the entirety of the
procedure; I have reviewed the above images and agree with the findings as
stated above.
NOTIFICATION: Findings were discussed with Dr. ___ by telephone by Dr. ___.
___ by phone at 5:08p on the day of the exam.
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RR
| 53 |
2165-10-23 17:05:00
|
2165-10-23 17:40:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with right arm DL power PICC. ___ ___ //
Right arm DL power PICC. ___ ___ Contact name: ___: ___
TECHNIQUE: Chest single view
COMPARISON: ___ 05:31
FINDINGS:
There is a right PICC line which courses into the right neck, tip not included
on the radiograph, should be repositioned. Endotracheal tube tip in good
position. Enteric tube tip in the proximal stomach. Stable left lower lobe
consolidation, small left pleural effusion. Possible trace right pleural
effusion. There is increased right basilar opacity, likely atelectasis.
There is no pneumothorax.
IMPRESSION:
Right PICC line tip in the right neck, should be repositioned.
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RR
| 54 |
2165-10-23 18:19:00
|
2165-10-23 19:06:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with right arm PICC repositioned/power flushed.
___ ___ // Right arm PICC repositioned. ___ ___ Contact name:
___: ___
TECHNIQUE: Chest single view
COMPARISON: ___ at 17:12
FINDINGS:
Right PICC line is still positioned over right neck, stable. Endotracheal
tube tip in good position. Enteric tube tip in the mid stomach. Unchanged
cardiopulmonary findings.
IMPRESSION:
Stable exam. Right PICC line tip in the right neck, should be repositioned
|
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RR
| 55 |
2165-10-24 13:08:00
|
2165-10-24 15:24:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ yo F found down 5pm, with lethargy, left hemiparesis, last
seen well at 0830, with large Right parietal IPH (7.5. x4.1cm), IVH with mass
effect on right ventricle and 9mm s/p crani // piccline placement piccline
placement
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Right PIC line still heads up into the neck and out of view. ETT tip is 2 cm
from the carina with the chin flexed, standard placement. Nasogastric
drainage tube ends in the upper stomach.
Dense consolidation that developed in the left lower lobe on ___ is
unchanged, either atelectasis or pneumonia, but likely related to aspiration.
Small bilateral pleural effusions are unchanged. There is more atelectasis at
the right lung base today and early interstitial edema at both lung bases has
worsened. No pneumothorax
|
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RR
| 56 |
2165-10-24 15:38:00
|
2165-10-25 14:21:00
|
INDICATION: ___ year old woman with mal-positioned PICC, please reposition //
please reposition
COMPARISON: Chest x-ray dated ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: 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: 0.1 min, 0 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: The pre-existing PICC line access site was prepped and
draped in the usual sterile fashion. Prior to attempting replacement, the
PICC line was flushed with a 10 cc saline filled syringe. The PICC line
unchanged position post flushing; the tip terminated in the right atrium.
Position of the catheter was confirmed by a fluoroscopic spot film of the
chest. The catheter was therefore secured to the skin, flushed, and a sterile
dressing was applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach PICC with tip in the right internal jugular
vein. The tip unchanged position and terminated in the right atrium post
flushing.
IMPRESSION:
Successful repositioning of a right arm approach double lumen PowerPICC with
tip currently terminating in the SVC/right atrium junction. The line is
ready to use.
|
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RR
| 57 |
2165-10-25 05:26:00
|
2165-10-25 08:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with vent and RLL pna // interval scan, RLL
PNA interval scan, RLL PNA
IMPRESSION:
Compared to chest radiographs ___ through ___.
Previous mild pulmonary edema has resolved. Combination of bibasilar
atelectasis and moderate pleural effusions is probably unchanged. Heart size
is normal. No pneumothorax.
ET tube, nasogastric drainage tube in standard placements.
Right PIC line has been repositioned, now ends in the region of the superior
cavoatrial junction.
|
10167784-RR-58
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RR
| 58 |
2165-10-26 05:34:00
|
2165-10-26 09:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with VAP, right IPH // ? pneumonia ?
pneumonia
IMPRESSION:
Compared to chest radiographs ___ through ___.
ET tube, right PIC line are in standard placements. Nasogastric tube ends in
the upper stomach.
Small left pleural effusion decreased. Moderate right pleural effusion
stable. Severe bibasilar atelectasis, stable on the left, increased on the
right. No pneumothorax.
|
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RR
| 59 |
2165-10-26 11:18:00
|
2165-10-26 11:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pna, hypoxic // acutely hypoxic, interval
exam acutely hypoxic, interval exam
IMPRESSION:
Compared to chest radiographs ___ through ___.
Persistent severe consolidation in the left lower lobe could be pneumonia but
collapse is more likely. Moderate right lower lobe atelectasis and moderate
bilateral pleural effusions are stable. Upper lungs clear. No pneumothorax.
Heart size normal.
ET tube in standard placement. Right PIC line ends just beyond the cavoatrial
junction. Is transesophageal drainage tube ends in the upper stomach.
|
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RR
| 60 |
2165-10-26 14:02:00
|
2165-10-26 15:43:00
|
INDICATION: Evaluate for pulmonary embolism in a ___ woman with
intraparenchymal hemorrhage, known Pseudomonas pneumonia, with acute
desaturation.
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 = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
2) Spiral Acquisition 3.7 s, 29.1 cm; CTDIvol = 10.5 mGy (Body) DLP = 305.2
mGy-cm.
Total DLP (Body) = 308 mGy-cm.
COMPARISON: CT abdomen/pelvis from ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma
present.The pulmonary arteries are well opacified to the subsegmental level,
without filling defect to suggest acute pulmonary embolism.
The patient is intubated, with the endotracheal tube terminating approximately
2.3 cm above the carina. Airways are patent. There are bilateral lower lobe
consolidations compatible with known pneumonia. Small simple pleural
effusions are noted bilaterally. A 5 mm nodule in the superior segment of the
right lower lobe (03:109) is noted. Ground-glass opacity is noted in the
lateral base of the left upper lobe (3:147).
The visualized thyroid gland is unremarkable. No for supraclavicular
lymphadenopathy is identified. Mediastinal CT lymph nodes in the right upper
and lower paratracheal stations as well as the AP window are prominent but not
pathologically enlarged by CT size criteria, as are right hilar lymph nodes.
These are likely reactive. The heart is normal in size. There is no
pericardial fluid. A right PICC terminates at the cavoatrial junction. An
enteric tube extends into the stomach and off the the field of view.
This exam is not optimized for evaluation of subdiaphragmatic structures.
Allowing for this, the visualized upper abdomen is remarkable only for an
incompletely imaged cystic structure which likely corresponds to a simple
renal cyst seen on a CT abdomen/pelvis from ___.
There is no focal lytic or sclerotic osseous lesion to suggest neoplasm or
infection.
IMPRESSION:
1. No evidence of acute pulmonary embolism.
2. Bilateral lower lobe consolidations, compatible with known pneumonia.
3. A 5 mm nodule in the superior segment of the right lower lobe is likely
inflammatory, but attention on followup is advised.
4. Small bilateral pleural effusions.
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10167784-RR-61
| 10,167,784 | 26,706,672 |
RR
| 61 |
2165-10-26 14:02:00
|
2165-10-26 15:49:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with right frontal intraparenchymal hemorrhage
status post craniectomy, now acutely desaturating. Evaluate for acute
intracranial hemorrhage or large territorial infarct.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: ___ noncontrast head CT.
___ contrast brain MRI.
FINDINGS:
Patient is post right frontal craniectomy. Large right frontal
intraparenchymal hemorrhage is again noted. Surrounding vasogenic edema and
associated brain herniation through the craniectomy is increased compared to
___. Bilateral subdural and subarachnoid hemorrhages appear similar
to before. Intraventricular hemorrhage in bilateral posterior horns of
lateral ventricles are less. The ventricles are generally larger compared to
___, likely due to redistribution of brain parenchyma in setting of
parenchymal edema. There has been interval resolution of pneumocephalus.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. Orbits are unremarkable.
IMPRESSION:
1. Large right frontal intraparenchymal hemorrhage grossly stable, however
associated edema and brain herniation through right frontal craniectomy is
increased compared to ___.
2. Interval increase of ventricular size, with continued intraventricular
hemorrhage.
3. No definite new hemorrhage is identified.
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RR
| 62 |
2165-10-26 13:49:00
|
2165-10-26 17:41:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with right IPH s/p hemicraniectomy, acutely
desaturated, concern for PE/DVT // ? DVT in lower extremities, Pt. in ICU,
PORTABLE needed
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10167784-RR-63
| 10,167,784 | 26,706,672 |
RR
| 63 |
2165-10-27 02:11:00
|
2165-10-27 11:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right ICH complicated by RLL pneumonia,
intubated // ? ETT, evaluate pneumnia
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Bilateral low lung volumes. No significant change in bilateral lower lobe
opacities. Upper lungs are clear. Moderate pleural effusions bilaterally
stable. No pneumothorax. Cardiac size mildly enlarged likely exaggerated by
low lung volumes. ET tube 3.5 cm above the carina. NG tube terminates in the
stomach. Right PICC tip terminates in the upper right atrium and can be
pulled back 3 cm for standard positioning at the cavoatrial junction.
IMPRESSION:
ET tube 3.5 cm above the carina. Right PICC tip terminates in the right
atrium and may be pulled back 3 cm for standard sectioning of the cavoatrial
junction. Otherwise no interval change compared to ___
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:03 AM, 30 minutes after
discovery of the findings.
|
10167784-RR-64
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RR
| 64 |
2165-10-28 05:25:00
|
2165-10-28 11:24:00
|
INDICATION: ___ year old woman with IPH // interval changes
TECHNIQUE: Semi supine AP portable radiograph of the chest
COMPARISON: ___
FINDINGS:
Moderately well inflated lungs with improvement in patchy opacities noted in
the left lower lobe with new linear and patchy opacities in the right lower
lobe likely subsegmental atelectasis.
Improvement in bilateral layering pleural effusions.
Cardiomediastinal silhouette appears normal.
Right PICC terminates slightly beyond the cavoatrial junction, as before.
ET tube tip terminates 5 cm above the carina in the midtrachea. EKG leads
overlie the chest wall. Enteric tube traverses below the diaphragm, distal
tip not visualized. Visualized bones are unremarkable.
IMPRESSION:
1. Moderately well inflated lungs with bibasilar, likely subsegmental
atelectasis and slight improvement in bilateral layering pleural effusions.
2. Lines and tubes as above.
|
10167784-RR-65
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RR
| 65 |
2165-10-29 05:08:00
|
2165-10-29 09:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH, intubated, PNA // serial exam
serial exam
IMPRESSION:
Right PICC line tip is in the proximal right atrium and should be pulled back
1 cm to secure it position at the cavoatrial junction or above.
ET tube tip is 4 cm above the carinal. NG tube tip is in the stomach.
Heart size and mediastinum are stable. Left basal consolidation appears to be
similar since the prior study concerning for infection. Right basal opacity
is overall unchanged as well. No pneumothorax. Small pleural effusion.
|
10167784-RR-66
| 10,167,784 | 26,706,672 |
RR
| 66 |
2165-10-28 09:25:00
|
2165-10-28 10:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ yo F found down with lethargy, left hemiparesis, with right
parietal IPH s/p decompressive hemicraniectomy, rhabodmyolysis, troponin leak
and pseudomonas VAP. Eval for interval change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 848 mGy-cm.
COMPARISON: Head CT of ___.
FINDINGS:
Again, patient is post right frontal craniectomy. The large known right
frontal intraparenchymal hemorrhages again noted with surrounding vasogenic
edema and associated brain herniation through the craniectomy. Compared with
the study of 2 days prior, this has not significantly changed. Bilateral
subdural and subarachnoid hemorrhages are also similar to before.
Intraventricular hemorrhage in the bilateral posterior horns of the lateral
ventricles is greater on the left than the right, but grossly unchanged to
slightly smaller. Ventricular diameter has not significantly changed
(comparing series 3, image 15 for both studies). No pneumocephalus detected.
A region of hypodensity in the right cerebellar hemisphere is unchanged.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
Compared with the study of ___, no significant change in the
large right frontal intraparenchymal hemorrhage with associated edema and
brain herniation through the right frontal craniectomy. Ventricular size is
grossly unchanged.
|
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RR
| 67 |
2165-10-30 02:57:00
|
2165-10-30 08:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with PNA, vent dependent // serial exam
serial exam
IMPRESSION:
Right PICC line tip is deep in the right atrium and should be pulled back 5
cm. NG tube tip is in the stomach. Heart size and mediastinum are stable.
Left more than right basal consolidations appear to be improved as
|
10167784-RR-68
| 10,167,784 | 26,706,672 |
RR
| 68 |
2165-10-31 03:02:00
|
2165-10-31 09:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right IPH // interval changes, pneumonia
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
Worsening opacities in the right mid and right lower lungs are concerning for
aspiration. ET tube is in standard position. Retrocardiac opacities have
minimally improved. Bilateral effusions are small. . There is no
pneumothorax. NG tube tip is in the stomach. Right PICC tip is in the right
atrium. Mild cardiomegaly is stable
|
10167784-RR-70
| 10,167,784 | 26,706,672 |
RR
| 70 |
2165-10-31 03:01:00
|
2165-10-31 16:01:00
|
INDICATION: ___ year old woman with IPH // abdomen distended, r/o obstructive
pattern
TECHNIQUE: Portable supine abdominal radiograph
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. An enteric
tube terminates in the body of the stomach.
Assessment for free intraperitoneal air is limited on supine radiographs. If
there is clinical concern for pneumoperitoneum, advise upright or left lateral
decubitus radiograph, or cross-sectional imaging.
There are mild degenerative changes at the femoroacetabular joints
bilaterally.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Non-obstructive bowel gas pattern.
|
10167784-RR-72
| 10,167,784 | 26,706,672 |
RR
| 72 |
2165-10-31 10:39:00
|
2165-10-31 13:05:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: ___ year old woman with intracranial hemorrhage status post
decompressive hemicraniectomy, rhabdomyolysis, Pseudomonas, now with changing
neurologic exam.
TECHNIQUE: Portable head CT. DLP 1061 mGy cm.
COMPARISON: CT head from ___.
FINDINGS:
Right posterior frontal/parietal parenchymal hematoma demonstrates decreased
extent of hyperdense blood products compared to ___, now 3.7 x 3.7 cm
on image 2:16, and previously 4.1 x 4.0 cm, consistent with expected
evolution. Surrounding edema persists, but the extent of parenchymal
herniation through the right hemi craniectomy defect has decreased since ___. There is no shift of midline structures.
Dependent blood in the occipital horns of the lateral ventricles is unchanged.
There may be trace blood in the fourth ventricle, not well seen previously.
The lateral and third ventricles are enlarged, unchanged. The fourth
ventricle is normal in size, also stable.
Left greater than right subarachnoid hemorrhage is again noted, not
significantly changed.
Previously noted small extra-axial hematoma along the anterior aspect of the
right hemi craniectomy defect has decreased.
Hypodensities along the occipital horns of the lateral ventricles are again
seen, nonspecific. There is no evidence for a new major vascular territorial
infarction.
Visualized paranasal sinuses and mastoid air cells are grossly well-aerated.
IMPRESSION:
1. Decreased size of right frontal/parietal parenchymal hematoma compared to
___. Surrounding edema persists, but the extent of parenchymal
herniation through the right hemi craniectomy defect has decreased.
2. Stable intraventricular hemorrhage and stable enlargement of the lateral
and third ventricles.
3. Stable left greater than right subarachnoid hemorrhage.
4. Decreased small extra-axial hematoma along the right hemi craniectomy
defect.
5. No CT evidence for new intracranial abnormalities.
|
10167784-RR-73
| 10,167,784 | 26,706,672 |
RR
| 73 |
2165-10-31 22:20:00
|
2165-10-31 23:12:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with IPH // febrile, pseudomonas PNA, not
improving in setting of increased WBC's to 26.1, r/o empyema?
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) Spiral Acquisition 3.8 s, 29.6 cm; CTDIvol = 12.0 mGy (Body) DLP = 354.9
mGy-cm.
Total DLP (Body) = 355 mGy-cm.
COMPARISON: CTA chest from ___ and CT chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM there are multiple prominent mediastinal lymph
nodes, which are likely reactive. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: An ET tube is identified with the tip at the level of the
carina. There is a right PICC line with the tip terminating within the distal
SVC. There are bilateral lower lobe consolidations with associated
compressive atelectasis. The airways are patent to the level of the segmental
bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable. An enteric
tube is present.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence empyema or pulmonary embolism.
2. Bilateral lower lobe consolidations with associated compressive
atelectasis are unchanged.
3. Small bilateral pleural effusions are improved
\ This preliminary report was reviewed with Dr. ___
radiologist.
|
10167784-RR-74
| 10,167,784 | 26,706,672 |
RR
| 74 |
2165-10-31 22:20:00
|
2165-10-31 23:25:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with IPH // Interval changes, change in neuro
exam
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
Total DLP (Head) = 897 mGy-cm.
COMPARISON: ___ from earlier today
FINDINGS:
Re- demonstrated is a right posterior frontal parietal parenchymal hematoma
measuring approximately 3.7 x 3.6 cm, unchanged. There is persisting
surrounding edema without mass effect on the adjacent right lateral ventricle
or resulting in any midline shift. There is no significant change in the
degree of herniation through the right hemi craniectomy defect.
Overall unchanged blood layering in the occipital horns of both lateral
ventricles. Scattered subarachnoid blood is noted throughout the left greater
than right cerebral hemispheres. The ventricular size is unchanged. No
evidence of an acute territorial infarct.
The paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
The orbits are unremarkable.
IMPRESSION:
1. No significant interval change in the size of the right frontal parietal
parenchymal hematoma with surrounding edema. The extent of the herniation
through the right hemi craniectomy defect is also stable. No midline shift.
2. Stable intraventricular and subarachnoid hemorrhage.
|
10167784-RR-75
| 10,167,784 | 26,706,672 |
RR
| 75 |
2165-11-01 00:14:00
|
2165-11-01 08:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH // ETT position, interval changes
IMPRESSION:
In comparison to previous radiograph of 1 day earlier, endotracheal tube
terminates 2.4 cm above the carina. Cardiomediastinal contours are stable.
Bibasilar atelectasis has improved in the interval, but a new area of
opacification has developed in the right juxta hilar region, likely in the
superior segment of the right lower lobe. This could reflect focal
atelectasis, aspiration, or developing pneumonia.
|
10167784-RR-76
| 10,167,784 | 26,706,672 |
RR
| 76 |
2165-11-02 05:14:00
|
2165-11-02 08:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with failure to wean from ventilator //
infiltrate assessment, PNA infiltrate assessment, PNA
IMPRESSION:
Comparison to ___. No relevant change is noted. Minimal
decrease in extent and severity of a platelike atelectasis on the right. No
pulmonary edema. No pleural effusions. No pneumothorax.
|
10167784-RR-77
| 10,167,784 | 26,706,672 |
RR
| 77 |
2165-11-03 05:44:00
|
2165-11-03 09:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with vent dependence // interval scan
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
Mild cardiomegaly is stable. Bibasilar consolidations have markedly improved.
ET tube is in standard position. Right PICC tip is in the mid SVC. There is
no evident pneumothorax or enlarging pleural effusions. NG tube tip is out of
view below the diaphragm
|
10167784-RR-78
| 10,167,784 | 26,706,672 |
RR
| 78 |
2165-11-04 06:01:00
|
2165-11-04 10:25:00
|
INDICATION: ___ year old woman with ___ yo F found down with large Right
parietal IPH (7.5. x4.1cm), IVH with mass effect on right ventricle and 9mm
s/p crani // interval change
TECHNIQUE: Semi supine portable radiograph of the chest
COMPARISON: ___ at 05:54
FINDINGS:
The lungs are moderately well inflated. There is mild prominence of
interstitial markings with linear atelectasis in the right lower lobe,
unchanged compared to the prior exam.
No pleural effusions.
Cardiomediastinal silhouette is normal. Aortic knuckle calcification is
present.
Unchanged position of endotracheal tube, enteric tube, temperature probe and a
right PICC.
IMPRESSION:
1. Unchanged right lower lobe linear atelectasis with no pulmonary edema or
new consolidations.
2. Lines and tubes as above.
|
10167784-RR-79
| 10,167,784 | 26,706,672 |
RR
| 79 |
2165-11-05 04:45:00
|
2165-11-05 08:37:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right IPH and pneumonia // Interval
changes
IMPRESSION:
In comparison to previous radiograph of 1 day earlier, a right infrahilar
opacity has nearly resolved. No new or worsening areas of opacification are
identified, in the remainder of the exam is unchanged.
|
10167784-RR-80
| 10,167,784 | 26,706,672 |
RR
| 80 |
2165-11-04 08:56:00
|
2165-11-04 09:53:00
|
EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL RIGHT
INDICATION: ___ year old woman with ___ yo F found down with large Right
parietal IPH (7.5. x4.1cm), IVH with mass effect on right ventricle and 9mm
s/p crani // assymetric pitting edema RUE
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
Limited study as the mid and distal portions of the axillary vein were not
visualized, due to patient cooperation on exam.
There is normal flow with respiratory variation in the right subclavian vein.
A right PICC line is visualized within the right subclavian and axillary
veins.
The right internal jugular vein is patent, show normal color flow and
compressibility. The proximal portion of the axillary vein is visualized,
demonstrating flow with normal compressibility. The mid and distal segments
of the axillary vein were not visualized and compression was not performed.
The right brachial, basilic, and cephalic veins not visualized.
IMPRESSION:
Limited study due to lack of patient cooperation exam. No DVT visualized
within the right internal jugular, subclavian and proximal portion of the
axillary vein. The mid and distal portions of the right axillary vein, as
well as the brachial, basilic and cephalic veins, were not visualized.
Recommend repeat study in ___ hours.
|
10167784-RR-81
| 10,167,784 | 26,706,672 |
RR
| 81 |
2165-11-04 15:33:00
|
2165-11-04 22:13:00
|
EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL RIGHT
INDICATION: ___ year old woman with right IPH // Right arm/forearm swelling,
evaluate for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Same-day right upper extremity ultrasound.
FINDINGS:
There is an eccentric area of lack of color flow adjacent to the central line
within the right subclavian vein, raising the possibility of small,
nonocclusive eccentric thrombus. As this area is not accessible to
compression, no compression was performed. In addition, there is echogenic
material around the central line within the basilic vein with lack of
compressibility and absence of wall-to-wall flow, consistent with superficial
thrombophlebitis. The axillary, brachial and cephalic veins are patent,
compressible and show normal color flow and augmentation.
IMPRESSION:
1. Possible small eccentric thrombus in the right subclavian vein adjacent to
the indwelling central line as demonstrated by echogenicity with lack of wall
to wall color flow.
2. Superficial thrombosis of the right basilic vein surrounding the venous
catheter.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 8:45 ___, 3 minutes after
discovery of the findings.
|
10167784-RR-82
| 10,167,784 | 26,706,672 |
RR
| 82 |
2165-11-06 04:47:00
|
2165-11-06 08:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right IPH and pneumonia // interval
changes
IMPRESSION:
In comparison with ___ chest radiograph, a right subclavian
catheter has been removed, with no visible pneumothorax. No other relevant
change.
|
10167784-RR-83
| 10,167,784 | 26,706,672 |
RR
| 83 |
2165-11-07 04:12:00
|
2165-11-07 09:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH // interval changes interval
changes
IMPRESSION:
Compared to chest radiographs ___ through ___.
New tracheostomy tube midline. No evidence of complications.
Moderate atelectasis left lower lobe worsened slightly. No pneumothorax or
pleural effusion. ___ lungs otherwise clear. Heart size normal.
|
10167784-RR-84
| 10,167,784 | 26,706,672 |
RR
| 84 |
2165-11-10 00:50:00
|
2165-11-10 08:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxia // eval for acute pulmonary
process eval for acute pulmonary process
IMPRESSION:
Compared to chest radiographs ___ through ___.
Lungs are substantially lower in volume today, exaggerating new mild pulmonary
edema, and reflected in worsening severe left lower lobe atelectasis. Small
bilateral pleural effusions are presumed. No pneumothorax. Tracheostomy tube
midline.
|
10167784-RR-85
| 10,167,784 | 26,706,672 |
RR
| 85 |
2165-11-10 08:51:00
|
2165-11-10 13:52:00
|
INDICATION: ___ year old woman with hypoxia, tachycardia, EKG changes // eval
for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 220 mGy-cm.
COMPARISON: CT chest dated ___
FINDINGS:
There is no supraclavicular or axillary adenopathy. Several mediastinal nodes
are present which are not pathologically enlarged. A right lower paratracheal
station node measures 8 mm (02:43). A left lower paratracheal station node
measures 7 mm. An aortopulmonary window node measures 7 mm (02:35). A small
left hilar node measures 5 mm (02:54). These nodes appear to been present on
examination dated ___, unchanged, presumably reactive.
The ascending aorta is non aneurysmal. The main pulmonary artery is within
normal limits in caliber. The main pulmonary artery is opacified to the
subsegmental level.
There is a filling defect within the sub segmental pulmonary artery supplying
the lateral right middle lobe (3:94). Additional defects are present in the
right upper lobe subsegmental pulmonary arteries (3:79). No filling defect is
identified within the pulmonary arteries in the left lung. There is no
evidence to suggest right heart strain.
Endotracheal tube is present and terminates approximately 4 cm above the level
of the carina in appropriate position. Large airways are clear. Diffuse
small airway thickening suggest chronic small airways disease. Biapical
pleural parenchymal scarring is symmetric. There is no pneumothorax. A 1.6
cm opacity subpleural in location in the right upper lobe (03:45) appears to
been present on prior study dated ___ and may be atelectatic in
etiology. There are scattered centrilobular opacities within the right upper
lobe posteriorly as well as in the lower lobes bilaterally possibly sequela of
aspiration although infectious process is difficult to exclude. Bibasilar
atelectasis is moderate and symmetric. Ill defined area of nonenhancing lung
parenchyma at the right lung base (3:153) is worrisome for infectious process
in the absence of a filling defect in the arteries supplying the lower lobes
which would suggest infarction. Bilateral nonhemorrhagic and layering pleural
effusions are small, right greater than left.
There are no lesions within the chest cage worrisome for malignancy or
infection.
Study is not tailored for subdiaphragmatic evaluation. Allowing for this,
note is made of a partially imaged left renal upper pole cortical cyst which
measures 4.3 x 4.5 cm.
IMPRESSION:
1. Pulmonary emboli within the segmental pulmonary arteries supplying the
lateral right middle lobe and filling subsegmental pulmonary arteries
supplying the right upper lobe.
2. Centrilobular opacities within the right upper lobe and bilateral lower
lobes dependently may reflect sequelae of aspiration or pneumonia. Right
basilar wedge-shaped hypoattenuation admidst atelectasis suggests
consolidation and is concerning for underlying pneumonia.
3. Bilateral nonhemorrhagic and layering pleural effusions are small, right
greater than left, and increased since prior examination dated ___.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 10:44 AM, 1 minutes after
discovery of the findings.
|
10167784-RR-86
| 10,167,784 | 26,706,672 |
RR
| 86 |
2165-11-10 09:16:00
|
2165-11-10 14:13:00
|
INDICATION: ___ year old woman with distended abdomen. Please do ***KUB*** //
Please do KUB to look for ileus.
TECHNIQUE: Portable supine radiograph
COMPARISON: Radiograph dated ___
FINDINGS:
Motion artifact is noted. The right hemidiaphragm is incompletely imaged.
Gas filled loops of small bowel are dilated, a loop in the left lower quadrant
measuring up to 4.4 cm. Gas fills transverse and descending colon, normal in
caliber. Air is present in the rectum. No evidence of free intra abdominal
air although supine technique is suboptimal in its detection.
IMPRESSION:
Air distended loops of small bowel and gas filled large bowel not definitely
obstructive in pattern, may reflect ileus.
|
10167784-RR-87
| 10,167,784 | 26,706,672 |
RR
| 87 |
2165-11-10 11:05:00
|
2165-11-10 13:48:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with tachypnea, tachycardia, hypoxia. //
Evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
However, in the right calf there are several a clotted deep gastrocnemius vein
seen. These clots do not extend to the popliteal vein however.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Acute DVT in the right lower extremity involving several gastrocnemius veins
but nothing more proximally. Femoral and popliteal veins are fully patent.
No thrombosis is seen in the left leg.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 1:10 ___, 10 minutes after discovery of
the findings.
|
10167784-RR-88
| 10,167,784 | 26,706,672 |
RR
| 88 |
2165-11-10 11:06:00
|
2165-11-10 13:19:00
|
EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old woman with tachypnea, tachycardia, hypoxia. RUE
swelling. // Evaluate for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: ___.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
The right internal jugular and axillary veins are patent, show normal color
flow and compressibility. The right brachial, basilic, and cephalic veins are
patent in the proximal arm, compressible and show normal color flow and
augmentation. However, more distally near the antecubital fossa, the cephalic
and basilic veins are thrombosed and occluded and some nonocclusive clot
extends to the mid right arm in the basilic vein. .
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity. Basilic and
cephalic vein thrombosis noted as described above.
NOTIFICATION: Findings were conveyed to ___ by telephone at 13:10.
|
10167784-RR-89
| 10,167,784 | 26,706,672 |
RR
| 89 |
2165-11-10 14:31:00
|
2165-11-10 16:37:00
|
INDICATION: ___ year old woman with IPH and new PE // Needs IVC filter
placement
COMPARISON: CTA chest on ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was not provided. The patient was on a propofol
drip. 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine.
CONTRAST: 30 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 4.4 min, 39 mGy
PROCEDURE:
1. IVC venogram.
2. Infrarenal Denali IVC filter deployment.
3. Post-filter placement venogram.
PROCEDURE DETAILS: Following the discussion 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. Both groins were prepped and draped in the usual sterile fashion.
Under ultrasound and fluoroscopic guidance, the patent and compressible Right
common femoral vein was punctured using a 21G micropuncture needle. Ultrasound
images of the access was stored on PACS. A ___ wire was advanced through
the micropuncture sheath into the inferior vena cava. A 5 ___ sheath was
exchanged for the micropuncture sheath. After the inner dilator was removed,
an Omniflush catheter was advanced over the wire into the IVC. An inferior
vena cava venogram was performed. Based on the results of the venogram,
detailed below, a decision was made to place a Denali filter. The catheter and
sheath were removed over the wire and the sheath of the filter was advanced
over the wire into the IVC inferior to the take-off of the renal vessels. A
Denali vena cava filter was advanced over the wire until the cranial tip was
at the level of the inferior margin of the lower renal vein. The sheath was
then withdrawn until the filter was deployed. The wire and loading device were
then removed through the sheath and a repeat contrast injection was performed,
confirming appropriate filter positioning. The final image was stored on PACS.
The sheath was removed and pressure was held for 10 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with single bilateral renal veins
and no evidence of a clot.
2. Successful deployment of an infra-renal Denali IVC filter.
IMPRESSION:
Successful deployment of a Dnali IVC filter via right common femoral vein
access.
|
10167784-RR-90
| 10,167,784 | 26,706,672 |
RR
| 90 |
2165-11-10 19:47:00
|
2165-11-10 21:14:00
|
INDICATION: ___ year old woman with PE and PNA // ?pulmonary edema
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
A tracheostomy tube is present.
Mild pulmonary edema is again noted. There are small layering pleural
effusions as well as bibasilar opacities reflecting atelectasis and/or
consolidation. No pneumothorax identified. The size of the cardiac
silhouette is at the upper limits of normal.
IMPRESSION:
Mild pulmonary edema.
Small bilateral pleural effusions with overlying opacities likely reflecting
atelectasis and/or consolidation.
|
10167784-RR-91
| 10,167,784 | 26,706,672 |
RR
| 91 |
2165-11-12 12:18:00
|
2165-11-12 13:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with trach // interval scan interval scan
IMPRESSION:
Tracheostomy is in place. Heart size and mediastinum are stable. Bibasal
consolidations and bilateral pleural effusion is unchanged. Mild vascular
congestion.
|
10167837-RR-14
| 10,167,837 | 20,665,754 |
RR
| 14 |
2169-11-10 02:19:00
|
2169-11-10 03:19:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with 4days of abdominal painNO_PO
contrast // acute process?
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) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
2) Spiral Acquisition 6.9 s, 54.1 cm; CTDIvol = 24.3 mGy (Body) DLP =
1,313.3 mGy-cm.
Total DLP (Body) = 1,321 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is minimal bibasilar atelectasis. The heart is mildly
enlarged. Moderate coronary artery calcifications. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: There is hepatic steatosis. The liver demonstrates homogenous
attenuation throughout. There is no evidence of focal lesions. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. Small accessory spleen is seen.
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.
A 3.0 cm exophytic hypodensity arising from the lower pole of the left kidney
(2:53) demonstrates apparent asymmetric wall thickening (2:54). 2.4 cm cyst
of indeterminate density in the interpolar region of the right kidney ___ 31).
Few subcentimeter hypodensities throughout the bilateral kidneys are too small
to characterize but statistically likely represent cysts. There is no
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is markedly distended with air and ingested
material. Small bowel is dilated up to 3.3 cm (2:36) but tapers slowly to
mildly underdistended loops of small bowel distally. No transition point.
There is normal wall thickness and enhancement throughout the small bowel.
The large bowel is largely filled with air. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening or fat stranding. The
appendix is not visualized, although no secondary signs of appendicitis are
seen. There are minimal inflammatory changes within the mesentery of the left
lower quadrant in the region of multiple diverticula which could suggest early
findings of acute diverticulitis.
PELVIS: The bladder wall is mildly thickened and irregular, likely
trabeculated in the setting of chronic urinary outflow obstruction. A 2.0 cm
diverticulum is seen along the left aspect of the bladder. A 3 mm stone is
seen within the right UVJ (2:76, 601:47). The distal ureters are
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is mildly enlarged. The seminal vesicles
are grossly unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small fat containing left inguinal hernia.
IMPRESSION:
1. Minimal mesenteric inflammatory changes about diverticula of the distal
descending colon may represent early findings of uncomplicated diverticulitis.
2. Fluid distension of small bowel and ascending colon are consistent with
diarrhea. No evidence of bowel obstruction.
3. 4 mm nonobstructing stone within the right ureterovesicular junction.
4. Indeterminate 3.0 cm cyst with irregular wall thickening within the lower
pole of the left kidney. Nonemergent MRI is recommended for further
evaluation.
5. Hepatic steatosis.
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 MR ___, 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
NOTIFICATION: Updated findings discussed with ___, NP by ___
___, MD via telephone at 09:48 on ___.
|
10167837-RR-15
| 10,167,837 | 20,665,754 |
RR
| 15 |
2169-11-10 05:25:00
|
2169-11-10 06:20:00
|
INDICATION: History: ___ with SBO. new NG tube placement // NG tube in
place?
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None
FINDINGS:
There has been interval placement of an enteric tube with its tip projecting
over the distal stomach. Diffusely dilated loops of small bowel were better
assessed on the CT performed 2 hours prior.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Appropriate positioning of enteric tube within the distal stomach.
|
10168247-RR-43
| 10,168,247 | 29,293,693 |
RR
| 43 |
2173-03-25 16:25:00
|
2173-03-25 17:11:00
|
EXAMINATION: TRAUMA #3 (PORT CHEST ONLY)
INDICATION: ___ with fall, R apical ptx// eval ptx
TECHNIQUE: Portable AP view of the chest
COMPARISON: Chest CT performed at an outside hospital.
FINDINGS:
There is an acute mildly displaced midclavicular fracture. No definite
evidence of acromioclavicular separation. Subtle opacity at the right apex
corresponds with subtle contusion on outside hospital CT exam. Known
pneumothorax is not definitively visualized. No large effusion is seen. The
cardiomediastinal silhouette and hilar contours are unchanged. A displaced
fracture involving the right anterior first rib is also noted.
IMPRESSION:
Acute mildly displaced midclavicular fracture. Right anterior first rib
fracture. Subtle opacity at the right lung apex corresponds with known
contusion on outside hospital CT chest. Please refer to outside hospital CT
chest for further details.
|
10168247-RR-44
| 10,168,247 | 29,293,693 |
RR
| 44 |
2173-03-26 07:49:00
|
2173-03-26 08:49:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ w fall found to have R clavicle and R ___ rib fx and small
apical ptx// ? ptx, please do at 7AM
IMPRESSION:
In comparison with the study of ___, the previously described o'clock E
question fee do know how to. Any residual pneumothorax would be very small.
Cardiomediastinal silhouette is stable and there is no evidence of vascular
congestion or acute focal pneumonia. Generalized dilatation of gas-filled
loops of bowel is consistent with an adynamic ileus pattern.
|
10168247-RR-45
| 10,168,247 | 29,293,693 |
RR
| 45 |
2173-03-26 11:55:00
|
2173-03-26 16:29:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ woman status post fall. Study performed evaluate for
traumatic bowel injury.
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 4.0 s, 53.2 cm; CTDIvol =
7.8 mGy (Body) DLP = 412.4 mGy-cm. 2) Stationary Acquisition 0.6 s, 0.5 cm;
CTDIvol = 3.3 mGy (Body) DLP = 1.7 mGy-cm. 3) Stationary Acquisition 1.8 s,
0.5 cm; CTDIvol = 10.0 mGy (Body) DLP = 5.0 mGy-cm. Total DLP (Body) = 419
mGy-cm.
COMPARISON: Chest radiograph ___
FINDINGS:
LOWER CHEST: Atelectasis is seen in the right lung base. There is trace right
pleural fluid. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
sub-centimeter hypodensity in hepatic segment II is too small to characterize
but statistically represents a simple hepatic cyst or biliary hamartoma
(02:17). There is no evidence of intrahepatic or extrahepatic biliary
dilatation. Main portal vein is patent. There is no perihepatic ascites.
There is vicarious excretion of contrast within the gallbladder.
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. There is no perisplenic fluid.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality. Bilateral sub-centimeter hypodensities are too small
to characterize.
GASTROINTESTINAL: The stomach is well distended by oral contrast media. The
small bowel is well opacified by oral contrast to the level of the ileum.
Probable intra duodenal lipoma measuring 7 mm (02:32). There is no evidence
of small-bowel obstruction. There is a large amount of gas and stool within a
highly redundant large bowel, without evidence of obstruction. There is no
mesenteric free fluid or stranding. No free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Buckle deformity of the posterior right ninth rib is likely chronic.
There are multilevel degenerative changes about the thoracolumbar spine most
prominent at L3 through S1.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Punctate
calcifications are noted within the right breast, correlation with prior
mammography is recommended.
IMPRESSION:
1. No evidence of traumatic bowel injury. There is no bowel obstruction.
Large amount of gas and stool within a highly redundant large colon.
2. Right basilar atelectasis with trace pleural fluid. Buckle deformity of a
posterior right ninth rib is likely chronic.
|
10168247-RR-46
| 10,168,247 | 29,293,693 |
RR
| 46 |
2173-03-27 17:57:00
|
2173-03-27 19:04:00
|
EXAMINATION: Right shoulder radiographs, four views.
INDICATION: Status post fall. Subarachnoid hemorrhage in right clavicle
fracture.
COMPARISON: Earlier studies from the same day.
FINDINGS:
Some mildly angulated fracture of the mid to distal right clavicular shaft
with a small comminution fragment. Right shoulder itself is unremarkable.
IMPRESSION:
Mid to distal right clavicle fracture.
|
10168247-RR-47
| 10,168,247 | 29,293,693 |
RR
| 47 |
2173-03-28 15:06:00
|
2173-03-28 16:38:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with history of left ophthalmic segment
aneurysm status post stent assisted embolization, now fall, hit left side of
head on floor// hematoma? injury after 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: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
Dental amalgam and left internal carotid artery ophthalmic segment stent
assisted embolization surgical material streak artifact limits study.
Grossly stable subarachnoid hemorrhage in the bilateral medial frontoparietal
lobes. There is no evidence of new intracranial hemorrhage. There is no
evidence of acute large territorial infarction,edema,or mass. The ventricles
and sulci are stable in size and configuration.
There is no evidence of fracture. The visualized portion of the mastoid air
cells, and middle ear cavities are clear. The visualized portion of the
orbits are preserved. Left ethmoid air cell mucosal thickening is present.
IMPRESSION:
1. Dental amalgam and left internal carotid artery ophthalmic segment stent
assisted embolization surgical material streak artifact limits study.
2. Grossly stable bilateral frontoparietal subarachnoid hemorrhage.
3. Within limits of study, no evidence of new intracranial hemorrhage or
acute fracture.
|
10168400-RR-5
| 10,168,400 | 23,945,347 |
RR
| 5 |
2133-01-21 00:17:00
|
2133-01-21 01:05:00
|
INDICATION: History: ___ with hypoxemia and tachycardia above baseline, CTA
at OSH negative for PE*** WARNING *** Multiple patients with same last name!//
evidence of pulmonary edema?
TECHNIQUE: Chest PA and lateral
COMPARISON: Outside hospital chest CT performed 5 hours prior.
FINDINGS:
The lung volume is small, exaggerating bronchovascular markings. There is
bibasilar atelectasis. Otherwise, no focal consolidation. No pulmonary
edema. There is small left pleural effusion. No right pleural effusion. No
pneumothorax. Cardiomegaly is moderate to severe. No acute osseous
abnormalities.
IMPRESSION:
Bibasilar atelectasis and small left pleural effusion. Otherwise no focal
consolidation or pulmonary edema.
|
10168400-RR-6
| 10,168,400 | 23,945,347 |
RR
| 6 |
2133-01-21 13:17:00
|
2133-01-21 17:10:00
|
EXAMINATION: CT ABDOMEN PELVIS WITH CONTRAST
INDICATION: ___ year old woman with history of breast cancer, presenting with
shortness of breath, afib with RVR, with CTA chest on ___ at ___ with
possible pancreatic mass.// eval of pancreatic mass
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Spiral Acquisition 7.8 s, 50.4 cm; CTDIvol = 24.7 mGy (Body) DLP =
1,229.7 mGy-cm.
Total DLP (Body) = 1,232 mGy-cm.
COMPARISON: Outside reference CT chest from ___.
FINDINGS:
LOWER CHEST: There are small left and trace right dependent pleural effusions.
No pericardial effusion is seen. There is mild dependent bibasilar
atelectasis.
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. Calcification of the gallbladder wall is
again noted. The gallbladder is not distended and there is no abnormal wall
thickening.
PANCREAS: There is an ill-defined hypoattenuating area in the uncinate process
measuring approximately 1.2 cm (05:30). There is no main pancreatic ductal
dilatation or peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal (5:63).
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is thickening of the endometrium up to 1.0 cm
(08:49). No adnexal abnormality is seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Ill-defined 1.2 cm hypoattenuating area in the pancreas uncinate process is
incompletely characterized. Recommend further evaluation with MRCP with and
without contrast.
2. Endometrial thickening up to 1.0 cm is abnormal in a postmenopausal woman.
Recommend pelvic ultrasound and consultation with Gynecology.
3. Similar appearance of the calcifications within the wall of the
gallbladder.
RECOMMENDATION(S):
1. MRCP with and without contrast for impression point 1 can be done on an
outpatient basis.
2. Pelvic ultrasound and consultation with gynecology for impression point 2.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 17:09 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
10168835-RR-10
| 10,168,835 | 26,590,592 |
RR
| 10 |
2185-06-13 13:34:00
|
2185-06-14 18:32:00
|
EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old man with CKD, vein mapping today before pacemaker
placement tomorrow.// Vein mapping
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
FINDINGS:
The subclavian veins have normal respirophasicity.
RIGHT:
The cephalic vein measures 0.17 cm at the wrist, cm at the distal forearm,
0.2 cm at the mid forearm, 0.22 cm at the proximal forearm, 0.4 cm at the
antecubital fossa, 0.1 cm at the proximal arm, 0.18 cm at the mid arm and cm
at the distal arm. The basilic vein measures 0.13 cm at the forearm, 0.09 cm
at the antecubital fossa, 0.26 cm at its mid portion, and 0.28 cm at the
proximal portion.
The radial artery measures 0.35 cm. The brachial artery measures 0.36 cm.
Moderate arterial calcifications are present in the radial arteries but the
brachial artery is free of calcium.
LEFT:
The cephalic vein measures 0.28 cm at the wrist, 0.14 cm at the distal
forearm, 0.07 cm at the mid forearm, absent in the upper arm. The basilic
vein measures 0.11 cm at the forearm, 0.07 cm at the antecubital fossa, 0.24
cm at its mid portion, and 0.32 cm at the proximal portion.
The radial artery measures 0.23 cm. The brachial artery measures 0.65 cm.
Moderate arterial calcifications are present in the radial arteries but the
brachial artery is free of calcium.
IMPRESSION:
Patent central veins. Small diameter right upper extremity veins. The left
cephalic vein is small in the forearm and is not seen in the upper arm.
Moderately calcified radial arteries. Please see technologist worksheet for
detailed measurements.
|
10168835-RR-11
| 10,168,835 | 26,590,592 |
RR
| 11 |
2185-06-15 10:13:00
|
2185-06-15 15:11:00
|
INDICATION: ___ year old man with dual chamber PPM via R-cephalic. Assess for
PTX/effusion and lead position.// ___ year old man with dual chamber PPM via
R-cephalic. Assess for PTX/effusion and lead position.
TECHNIQUE: Frontal and lateral radiographs of the chest.
COMPARISON: ___.
IMPRESSION:
Status post right sided dual lead pacemaker. 1 lead projects over the right
atrium the other lead projects over the right ventricle. No pneumothorax is
identified. No pleural effusion. Cardiac silhouette appears unchanged.
Aortic vascular calcifications. Degenerative changes of the thoracic spine.
Possible pulmonary nodule of the left upper lung measuring 8 mm is again seen.
This nodule as well as likely pleural calcifications can be more fully
characterized on CT as recommended of prior exam.
|
10168835-RR-9
| 10,168,835 | 26,590,592 |
RR
| 9 |
2185-06-12 08:02:00
|
2185-06-12 09:13:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with ___ on CKD4, evaluate for hydronephrosis.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal aortic aneurysm screening dated ___.
FINDINGS:
The right kidney measures 11.3 cm. The left kidney measures 11.6 cm. There is
no hydronephrosis or masses bilaterally. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally.
A right interpolar peripelvic renal cyst is similar to the prior study of
___. Large shadowing stones are seen in the right lower pole measuring up to
1.8 cm and 1.5 cm, respectively.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. No hydronephrosis or suspicious renal lesion.
2. New nonobstructing stones in the right lower pole measuring up to 1.8 cm.
|
10168921-RR-11
| 10,168,921 | 20,241,674 |
RR
| 11 |
2173-06-20 05:27:00
|
2173-06-20 09:51:00
|
INDICATION: ___ year old woman with acute stroke, found down, concern for
aspiration// concern for aspiration pna
COMPARISON: Compared to the chest radiograph from ___
IMPRESSION:
Cardiomediastinal silhouette is within normal limits. There is again seen
calcifications projecting over the right mediastinum and over the left lower
heart. This may represent pleural plaques or less likely calcified lymph
nodes. There is no focal consolidation. There is a small left-sided pleural
effusion. There are no pneumothoraces. Degenerative changes of bilateral
glenohumeral joints are seen.
|
10169160-RR-17
| 10,169,160 | 22,053,865 |
RR
| 17 |
2184-04-17 13:59:00
|
2184-04-17 15:11:00
|
INDICATION: NO_PO contrast; History: ___ with abd pain and distentionNO_PO
contrast// r/o obstruction
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 23.5 mGy (Body) DLP =
11.7 mGy-cm.
2) Spiral Acquisition 5.1 s, 55.5 cm; CTDIvol = 11.9 mGy (Body) DLP = 659.1
mGy-cm.
Total DLP (Body) = 671 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is streaky density at the lung bases consistent with
subsegmental atelectasis and, or scarring. There is a 4 mm subpleural nodule
posterolateral aspect of the right lower lobe (2:3).
ABDOMEN:
There is a large amount ascites in the abdomen. It that there is
heterogeneous infiltration the omental by soft tissue density material.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There is a small axial hiatal hernia. The gastric antrum is
not fully distended. Its wall appears thick. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There are
multiple diverticula in the colon. The colon is not well distended. The
appendix is not identified.
PELVIS: There is a large amount of free fluid in the pelvis. The urinary
bladder is unremarkable.
REPRODUCTIVE ORGANS: The uterus and pelvic adnexa are unremarkable.
LYMPH NODES: There are prominent lymph nodes at the mesenteric root and there
are enlarged portacaval and retroperitoneal nodes. There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is extensive atherosclerotic calcification. There is no
abdominal aortic aneurysm.
BONES: Degenerative changes are present in spine and hips. No concerning
osteolytic or osteoblastic lesion
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Omental thickening or caking concerning neoplastic disease, particularly
metastatic disease. The wall of the gastric antrum appears thickened and
gastric carcinoma should be considered.
2. Massive abdominal and pelvic ascites
3. Portacaval, mesenteric and retroperitoneal lymphadenopathy.
4. 4 mm, indeterminate subpleural nodule along the posterolateral aspect of
the right lung base.
5. Colonic diverticulosis without evidence of acute diverticulitis.
|
10169160-RR-19
| 10,169,160 | 22,053,865 |
RR
| 19 |
2184-04-18 13:03:00
|
2184-04-18 15:46:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with likely new gastric cancer CT A/P with
subpleural nodule. Evaluate for metastatic disease.
TECHNIQUE: ___ MD CT images were obtained through the chest without the
administration of IV contrast. Coronal and sagittal reformatted images were
also generated.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.2 s, 32.9 cm; CTDIvol = 6.9 mGy (Body) DLP = 230.0
mGy-cm.
Total DLP (Body) = 230 mGy-cm.
COMPARISON: CT abdomen ___
FINDINGS:
There is asymmetric enlargement the right thyroid gland with areas of nodular
hypodensity. There is no supraclavicular, mediastinal, or hilar
lymphadenopathy. 8 mm right upper mediastinal lymph node is identified
(03:10). The heart is normal in size. Atherosclerotic calcifications of the
aortic arch and coronary arteries are severe. There is no pericardial
effusion. The main pulmonary artery is normal in caliber.
There is an enlarged axillary node on the right measuring up to 1.4 x 1.8 cm.
In addition common intend are male ___ node on the right anteriorly is also
enlarged measuring 1.2 x 0 point 9 cm.
The central airways are patent. There is bronchial wall thickening consistent
with at least mild bronchitis and mild bronchiectasis. Bandlike regions of
parenchymal scarring are seen within both lower lung zones. There are
multiple millimetric pulmonary nodules measuring up to 5 mm, some of which are
perifissural while others are intraparenchymal and subpleural (5:62, 93, 105,
120, 132, 144, 147, 151). There also areas of atelectasis bilaterally. Ovoid
regions of atelectasis and/or airspace disease at the left lung base and to a
lesser extent within the lingula may represent sequelae of scarring however
the possibility of tumor infiltration or pneumonia particularly at the left
lung base is not excluded. There is no pleural effusion.
The study is not designed for evaluation of subdiaphragmatic structures but
the limited included views demonstrate large volume ascites as well as omental
metastatic disease as well as a small hiatal hernia. These are better
assessed on the CT from 1 day prior.
No suspicious lytic or sclerotic osseous lesion is identified. Degenerative
changes are seen throughout the thoracic spine. The bones are moderately to
severely diffusely demineralized. There is moderate multilevel degenerative
disc disease throughout the thoracic spine.
IMPRESSION:
1. Scattered bilateral pulmonary nodules measuring up to 5 mm. Clinical and
imaging follow-up recommended.
2. Heterogeneous right thyroid with a prominent right upper mediastinal lymph
node. Thyroid ultrasound is recommended. Right axillary and right internal
mammary adenopathy worrisome for metastatic disease.
3. Extensive intra-abdominal ascites well as omental caking compatible with
metastatic disease, better assessed on CT abdomen from 1 day prior.
4. Heavy atherosclerotic calcifications in the coronary arteries.
5. Small hiatal hernia.
6. Atelectasis and airspace disease left lung base which could be related to
pneumonia or possible tumor infiltration of the lung.
RECOMMENDATION(S): Thyroid ultrasound.
NOTIFICATION: Findings reported to referring clinician via the internal
departmental notification system.
|
10169160-RR-21
| 10,169,160 | 22,053,865 |
RR
| 21 |
2184-04-20 12:55:00
|
2184-04-20 15:57:00
|
EXAMINATION: Ultrasound-guided paracentesis
INDICATION: ___ year old woman with new ascites, concern for malignancy//
diagnostic/therapeutic para
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 4 L of clear, straw-colored fluid were removed. Fluid
samples were submitted to the laboratory for cell count, differential,
culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 4 L of fluid were removed.
|
10169160-RR-22
| 10,169,160 | 22,053,865 |
RR
| 22 |
2184-04-21 12:54:00
|
2184-04-21 16:07:00
|
EXAMINATION: CT-guided biopsy and paracentesis.
INDICATION: ___ year old woman with new ascites, omental caking concerning for
malignancy// Please perform diagnosis/therapeutic paracentesis and omental
sampling to assist with diagnosis
COMPARISON: CT of the abdomen and pelvis from ___.
PROCEDURE: CT-guided omental biopsy and paracentesis.
OPERATORS: Dr. ___, radiology fellow and Dr. ___,
attending radiologist. Dr. ___ personally supervised the trainee during
the key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CTscan of the intended paracentesis area was performed. Based on
the CT findings an appropriate position for the initial paracentesis was
chosen. The site was marked. The site was prepped and draped in the usual
sterile fashion. 1% lidocaine were administered to the subcutaneous and deep
tissues for local anesthetic effect. Under CT guidance, a 6 ___ ___
drain was placed via trochar technique in the right flank. 4.25 L of fluid
were removed, initially clear straw-colored and expectedly blood-tinted after
biopsy passes.
After aspiration of the initial 3 L of fluid, limited preprocedure CT scan of
the intended biopsy area was performed. Based on the CT findings an
appropriate position for the omental biopsy was chosen. The site was marked.
1% lidocaine were administered to the subcutaneous and deep tissues for local
anesthetic effect. Under CT guidance 17 gauge coaxial needle was introduced
into the lesion. An 18 gauge core biopsy device with a 22 mm throw was used
to obtain three core biopsy specimens from just left of midline, which were
sent for pathology. The pigtail catheter paracentesis catheter was
subsequently removed.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: DLP: 687.10 mGy-cm
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of
60 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Limited preprocedure images show decreased large volume ascites since prior
study. Multiple omental nodules are redemonstrated suggesting omental
caking. Enlarged upper abdominal and retroperitoneal lymph nodes are again
seen. Limited scan after paracentesis demonstrates significant interval
decrease in the amount of ascites.
IMPRESSION:
1. Technically successful CT-guided therapeutic paracentesis and omental
biopsy. Pathology is pending.
2. 4.5 L of fluid were removed.
|
10169389-RR-15
| 10,169,389 | 22,067,161 |
RR
| 15 |
2181-03-22 14:07:00
|
2181-03-22 16:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p fall on stairs. // Eval rib fxs/ PTX?
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: None
IMPRESSION:
Heart size is normal. Mediastinum is normal. NG tube tip is in the stomach.
Lungs are essentially clear. There is no pleural effusion or pneumothorax.
|
10169389-RR-16
| 10,169,389 | 22,067,161 |
RR
| 16 |
2181-03-24 08:45:00
|
2181-03-24 11:01:00
|
INDICATION: ___ with mono who fell on stairs ___, presents ___ w/ abdominal
pain, hypotension ___ splenic rupture now s/p ex-lap, splenectomy // fever,
tachycardia post-op
EXAMINATION: CHEST (PORTABLE AP)
TECHNIQUE: Portable Chest radiograph, frontal view
COMPARISON: Chest radiograph ___
FINDINGS:
Transesophageal tube courses below the diaphragm but the tip is not well
visualized. Epidural catheter is noted projecting over the left hemi thorax.
There is no consolidation, pleural effusion, or pneumothorax. There is mild
pulmonary vessel congestion, increased compared to ___. Cardiomediastinal
silhouette is within normal size.
IMPRESSION:
Mild pulmonary vessel congestion, increased from ___.
|
10169389-RR-17
| 10,169,389 | 22,067,161 |
RR
| 17 |
2181-03-24 08:45:00
|
2181-03-24 16:01:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ with mono who fell on stairs ___, presents ___ w/ abdominal
pain, hypotension ___ splenic rupture now s/p ex-lap, splenectomy. Retained
foreign body?
TECHNIQUE: Single supine portable view of the abdomen.
COMPARISON: Chest x-ray from ___ 0 ___.
FINDINGS:
Air fills multiple loops of nondilated bowel in a nonobstructive pattern.
Midline surgical staples are noted. A radiodense line overlying the left upper
quadrant, then coiling over the midline at the T12-L1 interspace corresponds
with the patient's epidural catheter for recent anesthesia. Another radiodense
curvilinear structure in the left upper quadrant perhaps corresponds to the
transesophageal tube described on the chest x-ray from earlier on the same
date. However, this is not fully imaged.
IMPRESSION:
No evidence of retained foreign body.
|
10169726-RR-10
| 10,169,726 | 22,012,406 |
RR
| 10 |
2160-08-20 18:49:00
|
2160-08-20 20:48:00
|
INDICATION: ___ year old man with s/p CABG// s/p MT removal
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The mediastinal drains have been removed as has the Swan-Ganz catheter. The
left chest tube remains. There are small bilateral pleural effusions with
subjacent atelectasis, decreased since prior. A small moderate left apical
and lateral pneumothorax is present. The size of the cardiac silhouette is
enlarged but unchanged.
IMPRESSION:
Small to moderate left pneumothorax.
Interval decrease in extent of the bilateral pleural effusions and
atelectasis.
NOTIFICATION: The findings were discussed with ___. ___, M.D. by ___
___, M.D. on the telephone on ___ at 8:15 pm, 15 minutes after
discovery of the findings.
|
10169726-RR-11
| 10,169,726 | 22,012,406 |
RR
| 11 |
2160-08-21 09:36:00
|
2160-08-21 11:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p cabg// eval for ptx chest tube on
suction eval for ptx chest tube on suction
IMPRESSION:
Comparison to ___. With the left chest tube in unchanged position, the
size of the known left pneumothorax has slightly increased. The upper aspect
of the pneumothorax has now a dimension of approximately 18 mm. No evidence
of tension. No change in appearance of the cardiac silhouette and of the
right lung, with a small right pleural effusion.
|
10169726-RR-12
| 10,169,726 | 22,012,406 |
RR
| 12 |
2160-08-21 13:19:00
|
2160-08-22 12:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p cabg. Evaluation for left ptx, chest tube on
suction.
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiographs from ___ through ___.
FINDINGS:
Left-sided chest tube remains in unchanged position, with stable appearance of
the known moderate-sized left apical pneumothorax. Median sternotomy wires
are intact and well aligned. Multiple surgical clips are again noted in the
mediastinum. Moderate cardiomegaly is unchanged. Low lung volumes contribute
to crowding of bronchovascular markings and exaggeration of heart size. Small
right pleural effusion with right basilar atelectasis, similar in appearance
to prior study.
IMPRESSION:
1. Moderate sized left apical pneumothorax, grossly unchanged in size compared
to prior study.
2. Stable appearance of small right pleural effusion with right basilar
atelectasis.
|
10169726-RR-13
| 10,169,726 | 22,012,406 |
RR
| 13 |
2160-08-22 07:01:00
|
2160-08-22 12:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CABG. Evaluation for left ptx, interval
change.
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiographs spanning from ___ through ___.
FINDINGS:
Left-sided chest tube remains in unchanged position, with stable appearance of
moderate sized left apical pneumothorax. Median sternotomy wires remain
intact and well aligned. Multiple surgical clips are again noted in the
mediastinum. Moderate cardiomegaly is unchanged. Small right pleural
effusion with adjacent right basilar atelectasis, unchanged.
IMPRESSION:
1. Stable appearance of moderate sized left apical pneumothorax.
2. Small right pleural effusion with right basilar atelectasis, unchanged.
|
10169726-RR-14
| 10,169,726 | 22,012,406 |
RR
| 14 |
2160-08-22 13:40:00
|
2160-08-22 15:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p CABG// chest tube increased suction-
eval left ptx chest tube increased suction- eval left ptx
IMPRESSION:
Left chest tube is in place. There is small left apical pneumothorax, similar
to previous examination. There is interval improvement in the right lung base
aeration. No pulmonary edema. No new consolidations.
|
10169726-RR-15
| 10,169,726 | 22,012,406 |
RR
| 15 |
2160-08-23 08:04:00
|
2160-08-23 09:11:00
|
INDICATION: ___ year old man with s/p CABG// chest tube on suction evaluate
left ptx
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume. There is subsegmental atelectasis in the left lower
lobe. Small left apical pneumothorax is slightly more prominent. Left-sided
chest tube remains in place. With stable mild pulmonary vascular congestion.
Cardiomediastinal silhouette is stable.
|
10169726-RR-16
| 10,169,726 | 22,012,406 |
RR
| 16 |
2160-08-24 08:01:00
|
2160-08-24 10:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ptx, AM of ___, still on suction// ___ year
old man with ptx, AM of ___, still on suction ___ year old man with ptx,
AM of ___, still on suction
IMPRESSION:
Comparison to ___. Stable left chest tube. No pneumothorax. No
larger pleural effusions. Moderate cardiomegaly persists. No change in
appearance of the normal right lung.
|
10169726-RR-17
| 10,169,726 | 22,012,406 |
RR
| 17 |
2160-08-24 16:57:00
|
2160-08-24 17:33:00
|
INDICATION: ___ year old man s/p CABG// CT clamp trial- eval ptx ***at 5pm
please***
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The left chest tube is unchanged. A small to moderate left pneumothorax is
unchanged. Bibasilar atelectasis is also present and unchanged. No large
pleural effusion. The size of the cardiac silhouette is enlarged but
unchanged.
IMPRESSION:
Unchanged small to moderate left pneumothorax.
|
10169726-RR-18
| 10,169,726 | 22,012,406 |
RR
| 18 |
2160-08-25 11:27:00
|
2160-08-25 12:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest tube clamped, perform CXR at 1145
please// ___ year old man with chest tube clamped, perform CXR at 1145 please
___ year old man with chest tube clamped, perform CXR at 1145 please
IMPRESSION:
Comparison to ___. Stable position of the left chest tube. 1 cm
pleural cap at the level of the known left apical pneumothorax. No evidence
of tension.
|
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