note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
10169726-RR-19
| 10,169,726 | 22,012,406 |
RR
| 19 |
2160-08-25 13:20:00
|
2160-08-25 15:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p chest tube removal. Evaluation for
pneumothorax.
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiograph spanning from ___ through ___.
FINDINGS:
Interval removal of the left-sided chest tube. There is stable appearance of
the small to moderate left apical pneumothorax. Median sternotomy wires
remain intact and well aligned. Multiple surgical clips are again seen in the
mediastinum. Moderate cardiomegaly is unchanged. Stable appearance of left
basilar atelectasis.
IMPRESSION:
Interval removal of the left-sided chest tube with stable appearance of the
small to moderate-sized left apical pneumothorax.
|
10169726-RR-20
| 10,169,726 | 22,012,406 |
RR
| 20 |
2160-08-26 10:07:00
|
2160-08-26 10:55:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man eval ptx// ___ year old man eval ptx ___ year
old man eval ptx
IMPRESSION:
Left pneumothorax is apical, small to moderate, unchanged.
Pleural effusion present, creating hydropneumothorax.
Cardiomediastinal size is normal.
|
10169726-RR-21
| 10,169,726 | 24,468,740 |
RR
| 21 |
2160-09-08 10:16:00
|
2160-09-08 11:21:00
|
INDICATION: ___ year old man with cabg// r/o inf, eff
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
The left apical pneumothorax has resolved. Cardiomediastinal silhouette is
stable. Left pleural effusions unchanged. There is stable subsegmental
atelectasis in the left lung base. The right lung remains clear.
|
10169726-RR-7
| 10,169,726 | 22,012,406 |
RR
| 7 |
2160-08-13 15:05:00
|
2160-08-13 15:23:00
|
EXAMINATION: Chest x-ray
INDICATION: History: ___ with chest pain. Evaluate for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
There is cephalization of the pulmonary vasculature suggestive of pulmonary
vascular congestion. There are no pleural effusions. The heart is at the
upper limits of normal in size. The trachea is midline. Degenerative changes
are evident in the spine.
IMPRESSION:
Cephalization of the pulmonary vasculature suggestive pulmonary vascular
congestion.
|
10169726-RR-8
| 10,169,726 | 22,012,406 |
RR
| 8 |
2160-08-14 16:39:00
|
2160-08-14 17:44:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with worsening hypertensionPlease do Renal US
with Doppler// renal Doppler for workup of hypertension Please do Renal US
with Doppler
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.5 cm. The left kidney measures 11.2 cm. There is
no hydronephrosis, stones, or masses bilaterally. There is mild cortical
thinning bilaterally consistent with normal corticomedullary differentiation.
Renal Doppler: Intrarenal arteries show normal waveforms with sharp systolic
peaks and continuous antegrade diastolic flow. The resistive indices of the
right intra renal arteries range from 0.76 - 0.80. The resistive indices on
the left range from 0.75 - 0.84. Bilaterally, the main renal arteries are
patent with normal waveforms. The peak systolic velocity on the right is 61
centimeters/second. The peak systolic velocity on the left is 33
centimeters/second. Main renal veins are patent bilaterally with normal
waveforms.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. No evidence of significant renal artery stenosis.
2. Cortical thinning of the renal parenchyma bilaterally compatible with mild
atrophy. No hydronephrosis or renal masses.
|
10169726-RR-9
| 10,169,726 | 22,012,406 |
RR
| 9 |
2160-08-18 15:08:00
|
2160-08-19 09:03:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with CAD s/p CABG. Please ___ at
___ with abnormalities.// FAST TRACK EXTUBATION CARDIAC SURGERY, ?line
placement, r/o PTX/Effusion Contact name: ___: ___ FAST
TRACK EXTUBATION CARDIAC SURGERY, ?line placement, r/o PTX/Effusion
IMPRESSION:
Swan-Ganz catheter is in place. ET tube tip is 3.5 cm above the carina.
Mediastinal drains and left chest tube are in appropriate locations. No
pneumothorax. Bilateral pleural effusion and bibasal atelectasis. No
pulmonary edema. Sternotomy wires are unremarkable.
|
10169796-RR-16
| 10,169,796 | 29,617,004 |
RR
| 16 |
2151-06-04 19:30:00
|
2151-06-04 20:06:00
|
CHEST RADIOGRAPH PERFORMED ON ___
Comparison with a prior chest radiograph from ___ as well as a reference CT
abdomen and pelvis performed earlier today from an outside hospital.
CLINICAL HISTORY: Question pneumonia in the lung bases on today's CT.
FINDINGS: PA and lateral views of the chest were obtained. Subtle left
basilar opacity corresponds to a subtle opacity on today's CT, possibly
representing atelectasis or a very early pneumonia. Otherwise lungs are
clear. No pleural effusion or pneumothorax. Cardiomediastinal silhouette
normal. Bony structures are intact. Residual contrast is noted in bowel
loops in the upper abdomen.
IMPRESSION: Subtle opacity in the left lung base may represent atelectasis or
a very early pneumonia.
|
10169796-RR-17
| 10,169,796 | 29,617,004 |
RR
| 17 |
2151-06-05 16:26:00
|
2151-06-06 09:44:00
|
CLINICAL HISTORY: ___ man with history of seizures. Status post
anterior left temporal lobe resection. To evaluate for evolutional of
changes.
STUDY: MRI head without and with contrast, chronic seizure protocol.
TECHNIQUE: Sagittal T1, coronal T2, coronal STIR, axial FLAIR, T2, gradient
echo, and diffusion-weighted images were obtained of the brain prior to
administration of contrast. Coronal T2-weighted images were obtained of the
hippocampus. Coronal MP-RAGE images were obtained after administration of
contrast with axial and sagittal reconstructions.
FINDINGS:
Postoperative changes are noted in the form of left temporal craniotomy with
resection cavity noted in the left anterior temporal lobe. There is minimal
enhancement along the periphery of the resection cavity on the post-contrast
images. This represents postoperative changes. There is mild dural
enhancement noted underlying the craniotomy site.
There is decrease in size of the left hippocampus with increased FLAIR signal
as compared to the MRI study of ___, this may represent changes of
retrograde degeneration. No signal abnormality is noted in the right
hippocapus. However, the right hippocampus is slightly small in size with
prominent right temporal horn.
There is no evidence of acute infarct or intracranial hemorrhage or mass
effect. The ventricles, extra-axial CSF spaces and cortical sulci appear
normal.
Developmental venous anomalies are noted in the right frontal lobe and the
left superior cerebellar hemisphere which are unchanged as compared to the
prior study.
Mild mucosal thickening is noted in bilateral ethmoid air cells. Rest of the
paranasal sinuses appear normal. T2 hyperintensity is noted in the left
inferior mastoid air cells, which likely represents fluid/mucosal thickening.
IMPRESSION:
1. Postoperative changes in the form of left temporal craniotomy and
resection cavity in the left temporal lobe. Postoperative mild dural
enhancement underlying the craniotomy site and along the resection cavity.
2. Decrease in size of the left hippocampus with increased FLAIR signal as
compared to the MRI study of ___, this may represent changes of retrograde
degeneration. No signal abnormality is noted in the right hippocapus; however
small in size. Correlate with EEG and followup.
3. No evidence of acute infarct or intracranial hemorrhage.
4. Stable developmental venous anomalies in the right frontal lobe and left
cerebellum.
|
10169796-RR-18
| 10,169,796 | 29,617,004 |
RR
| 18 |
2151-06-06 01:34:00
|
2151-06-06 10:31:00
|
REASON FOR EXAMINATION: Fever, meningitis, uncertain etiology.
Desaturations.
PA and lateral upright chest radiographs were reviewed in comparison to
___.
Heart size and mediastinum are stable. Lungs are essentially clear. No
pleural effusion or pneumothorax noted.
|
10170435-RR-41
| 10,170,435 | 22,423,777 |
RR
| 41 |
2175-08-29 10:00:00
|
2175-08-29 13:55:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with small bowel obstruction related to hernia,
NGT in place.
TECHNIQUE: Portable abdominal film.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
Nasogastric tube side port is within the stomach. No free air. Evaluation of
the abdomen is limited due to body habitus.
IMPRESSION:
Nasogastric side-port is in the stomach.
|
10170435-RR-42
| 10,170,435 | 22,423,777 |
RR
| 42 |
2175-08-30 11:14:00
|
2175-08-30 13:39:00
|
EXAMINATION:
CT ABDOMEN AND PELVIS WITH CONTRAST.
INDICATION: ___ year old woman w SBO secondary to ventral hernia, evaluate for
obstruction.
TECHNIQUE: 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: DLP: 1134 mGy-cm (abdomen and pelvis).
IV Contrast: 130 mL Omnipaque
COMPARISON: Comparison is made to abdominal CT from ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
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. There is cholelithiasis without evidence of
acute cholecystitis. The portal vein is patent.
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: A nasoenteric tube is present within the stomach. Oral
contrast remains in the stomach and proximal duodenum. Again seen are
multiple dilated loops of small bowel measuring up to 3.6 cm with a transition
point within a large and complex ventral hernia defect (series 2, image 88).
Distal to the transition point terminal ileum is completely decompressed. The
large bowel is also decompressed. The appendix is not visualized but there
are no secondary signs of appendicitis within the right lower quadrant. There
is mild mesenteric edema, increased from prior. There is no evidence of free
air or pneumatosis. There is no portal venous gas. There is no abdominal
free fluid.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Persistent high-grade small bowel obstruction with a transition point in a
large complex ventral hernia (series 2, image 88). No evidence of free air or
pneumatosis although mild mesenteric edema has increased since ___.
2. Cholelithiasis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 12:00, 5 minutes after discovery of the
findings.
|
10170435-RR-43
| 10,170,435 | 22,423,777 |
RR
| 43 |
2175-08-30 15:03:00
|
2175-08-30 16:30:00
|
INDICATION: ___ year old woman with new R PICC // 44cm R basilic DL ___ -
___ ___ Contact name: ___: ___
COMPARISON: Chest x-ray from ___
FINDINGS:
A right subclavian PICC line is present. The tip of the PICC line is not well
visualized and its level cannot be confidently determined. The PICC line can
be traced through the level of the mid/lower SVC, but, beyond that, it is not
well delineated. No pneumothorax is detected.
In addition, there is tubing overlying the upper mediastinum. This also
cannot be traced below the level of the mid chest.
There is cardiomegaly, similar to ___. There is CHF, with
vascular plethora and mild vascular blurring. Probable bibasilar atelectasis.
No gross effusions. However, the left costophrenic angle is excluded from the
film. With left lower lobe collapse
IMPRESSION:
1. Right subclavian PICC line tip not well delineated. If clinically
indicated, a repeat chest x-ray could be attempted for better visualization.
2. Tubing overlying the mediastinum. Clinical correlation is required. If
this is an NG tube, it is not traced beyond the mid chest. If it is an ET
tube, it lies too low, seen immediately above the carina.
3. Cardiomegaly and mild CHF, with bibasilar atelectasis.
|
10170435-RR-44
| 10,170,435 | 22,423,777 |
RR
| 44 |
2175-08-31 15:32:00
|
2175-08-31 16:14:00
|
EXAMINATION:
CHEST PORT. LINE PLACEMENT
INDICATION:
___ s/p RIJ CVL placement; assess position, r/o PTX. // ___ s/p RIJ CVL
placement; assess position, r/o PTX. Contact name: Park, ___: ___
TECHNIQUE: Chest single view
___
IMPRESSION:
There is a new right IJ line with tip in the distal SVC. The right-sided PICC
line is unchanged, with the tip difficult to identify, at least in the mid
SVC. There is volume loss in both lower lobes. There continues to be a
mildly elevated right hemidiaphragm.
|
10170435-RR-45
| 10,170,435 | 22,423,777 |
RR
| 45 |
2175-09-02 19:37:00
|
2175-09-02 23:39:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old obese woman with swollen left foot warm to touch.
Evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
The study is somewhat limited due to patient body habitus. There is normal
compressibility, flow and augmentation of the left common femoral, superficial
femoral, and popliteal veins. Normal color flow and compressibility are
demonstrated in the posterior tibial veins. The peroneal veins were not
visualized.
There is normal respiratory variation in the common femoral veins bilaterally.
Note is made of a 3.8 x 2.6 x 1.2 cm left ___ cyst.
IMPRESSION:
1. Limited evaluation of the left peroneal veins. No evidence of deep venous
thrombosis in the remaining visualized left lower extremity veins.
2. 3.8 cm ___ cyst.
|
10170435-RR-46
| 10,170,435 | 22,423,777 |
RR
| 46 |
2175-09-07 20:16:00
|
2175-09-07 21:40:00
|
EXAMINATION: CT abdomen/pelvis without contrast.
INDICATION: ___ year old with SBO secondary to ventral hernia with persistent
SBO on CT scan now s/p ex-lap/LOA/reduction hernia, primary repair, overlay
with ventralight mesh on ___ with infected midline abdominal surgical
incision w/ erythema and some fluctulance. Assess for abdominal wall fluid
collection.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: DLP: 1432.9 mGy-cm (abdomen and pelvis).
COMPARISON: CT abdomen/ pelvis ___.
FINDINGS:
Somewhat limited evaluation due to artifact related to patient body habitus.
LOWER CHEST: Visualized lung fields demonstrate left lower lobe platelike
atelectasis as well as a 1 x 0.6 cm (2:5) left lower lobe opacity most
consistent with atelectasis. There is no evidence of pleural or pericardial
effusion.
ABDOMEN:
Assessment of the solid visceral structures of the abdomen and pelvis is quite
limited without IV contrast.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions within the limits of a noncontrast
examination. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is notable for few calcified gallstones measuring
7 mm. No pericholecystic free fluid or fat stranding.
PANCREAS: The pancreas has normal attenuation throughout with fatty atrophy,
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. There is no evidence of
focal renal lesions or hydronephrosis; limited assessment contrast. There is
no nephrolithiasis. There is no perinephric abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall
thickness throughout. Colon and rectum are within normal limits. Appendix is
not visualized. There is no evidence of mesenteric lymphadenopathy. No free
intraperitoneal air. Small amount of mesenteric fat stranding within the
lower abdomen/upper pelvis is most consistent with postsurgical change from
recent surgery.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Reproductive organs are within normal limits.
BONES AND SOFT TISSUES: A chronic healed right lateral twelfth rib fracture
is noted. There is no evidence of worrisome lesions.
Patient is status post ventral hernia repair with associated postsurgical
changes and radiopaque midline sutures. A 5.6 cm fat containing left
paramidline ventral hernia which is adjacent some drainage catheters is
unchanged in appearance from previous examination with a 2.6 cm peritoneal
defect/neck in the abdominal wall (2: 74)
Moderate amount of fat stranding is seen at the midline surgical site without
definite fluid collection. Mild 4 mm skin thickening at surgical site is
present. (2:85) Locules of air at the surgical site anterior to the
abdominal wall are seen surrounding the suture material as well as a few
locules of gas which are anterior to the right lateral abdominal wall (2:66)
with an underlying 3.8 x 2.9 cm heterogeneous focus (2:66, 68) which appears
to be extending and expanded the abdominal wall. There is possible
intra-abdominal extension although study is severely limited due to body
habitus. Locules of gas are slightly out of proportion for 1 week post
operative at the site of collection and worrisome for infection, although
there is no drainable fluid collection this time.
IMPRESSION:
Limited evaluation due to motion and patient body habitus.
1. Status post ventral hernia repair with associated post surgical changes
including intra-abdominal fat stranding, suture material and locules of gas in
the subcutaneous tissue.
2. 3.8 x 2.9 cm focus expanding the right anterolateral abdominal wall with
possible intra-abdominal extension unclear whether this is a thickened rectus
abdominus muscle versus a small locular all of fluid. Differential includes
postoperative seroma, resolving hematoma with postoperative change, or
prominence of the rectus abdominis muscle. Clinical correlation is
recommended. Consider dedicated evaluation with ultrasound if this the region
of erythema/fluctuance.
3. Anterior abdominal wall skin thickening worrisome for cellulitis.
4. Left lower lobe atelectasis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 9:28 ___, 5 minutes after discovery of the
findings.
|
10170562-RR-16
| 10,170,562 | 25,879,071 |
RR
| 16 |
2181-10-02 04:29:00
|
2181-10-02 05:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with trauma*** WARNING *** Multiple patients with
same last name!// trauma
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
Dental amalgam streak artifact limits study.
There are punctate foci of hyperintensity within the bilateral frontal,
(series 2 image 29) right posterior parietal, (series 2, image 19) and left
temporal regions, (series 2, image 16) which may represent small
intraparenchymal hemorrhages in the setting of trauma. There is no evidence
of infarction edema,or mass. No midline shift. The basal cisterns are widely
patent. The ventricles and sulci are grossly preserved in size and
configuration.
Limited imaging of facial bones suggests bilateral age-indeterminate nasal
bone fractures. There is no evidence of acute calvarial fracture. The
visualized portion of the mastoid air cells, and middle ear cavities are
clear. The visualized portion of the orbits are preserved. Nonspecific
bilateral ethmoid air cell and maxillary sinus mucosal thickening and
nasopharyngeal fluid is present, which may be related intubation status.
IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Multifocal probable hemorrhagic contusions as described.
3. No midline shift.
4. No definite evidence of acute calvarial fracture.
5. Bilateral age-indeterminate nasal bone fractures.
|
10170562-RR-17
| 10,170,562 | 25,879,071 |
RR
| 17 |
2181-10-02 04:30:00
|
2181-10-02 05:02:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with trauma*** WARNING *** Multiple patients with
same last name!// trauma trauma
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 6.2 s, 24.5 cm; CTDIvol = 23.1 mGy (Body) DLP = 566.5
mGy-cm.
Total DLP (Body) = 566 mGy-cm.
COMPARISON: None at time of interpretation.
FINDINGS:
Dental amalgam streak artifact limits study. Patient body habitus limits
examination, especially of C7 inferior levels.
There is straightening of cervical lordosis. Vertebral body heights are
preserved. Intubation status limits evaluation for prevertebral soft tissue
swelling. Within limits of study, no definite acute cervical spine fractures
are identified.
There is no evidence of bony spinal canal or neural foraminal narrowing.
The visualized right lung apex demonstrates dense opacification which in the
setting of trauma may represent contusions. A small partially visualized
pneumothorax is demonstrated which is better characterized on concurrently
obtained CT torso. Soft tissue emphysema along the upper chest may be related
to possible fractures.
Limited imaging the teeth demonstrate right mandibular molar with periapical
lucency and absent crown (see 602:11) an impacted left mandibular molar (see
602:37), and a left maxillary tooth with periapical lucency and absent crown
(see 602:33).
IMPRESSION:
1. Patient body habitus and dental amalgam streak artifact limits study as
described.
2. Within limits of study, no definite evidence of acute cervical spine
fracture.
3. Nondisplaced fracture of first right posterior rib.
4. Multifocal dental disease as described.
5. Biapical pneumothoraces, better demonstrated on concurrently obtained torso
CT.
6. Dense opacification of right upper lobe concerning for pulmonary
contusion, with aspiration not excluded on the basis of this examination.
Please see concurrently obtained torso CT for further evaluation of thoracic
findings.
7. Soft tissue emphysema along the upper chest, better demonstrated on same
day torso CT.
|
10170562-RR-18
| 10,170,562 | 25,879,071 |
RR
| 18 |
2181-10-02 04:31:00
|
2181-10-02 05:47:00
|
INDICATION: History: ___ with trauma*** WARNING *** Multiple patients with
same last name!// trauma
TECHNIQUE: MDCT axial images were acquired through the chest, 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) Spiral Acquisition 9.9 s, 78.1 cm; CTDIvol = 20.3 mGy (Body) DLP =
1,583.4 mGy-cm.
Total DLP (Body) = 1,583 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: Small medial pneumothorax is demonstrated within the right
lower lobe, (series 2, image 87) and right upper lobe, (series 2, image 29).
No evidence of tension. Trace pneumothorax in the right lung apex. Small
left hemothorax with adjacent compressive atelectasis is likely secondary to
splenic laceration.
LUNGS/AIRWAYS: Multiple dense opacifications involving the right upper, middle
and lower lobes likely represent pulmonary contusion in the setting of trauma.
A couple of pulmonary laceration/traumatic cyst filled with hemorrhage are
noted for example in the right upper lobe 1.2 x 0.9 cm, (series 2, image 40).
Aspiration could also account for some degree of pulmonary opacification. 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:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Within the hepatic dome is a vague linear 6 mm hypodense area which likely
represents hepatic contusion. 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: There is a splenic laceration of the inferior spleen which measures
4.3 cm in greatest dimension on the axial plane with adjacent perisplenic
hematoma concerning for a grade 3 splenic laceration. Within the central
spleen is an area of hyperdensity (series 2, image 96) which is suboptimally
characterized on a single phase contrast study
ADRENALS: There is high-density material intimately associated with the right
adrenal gland which is concerning for right adrenal gland hemorrhage (series
2, image 107). The left adrenal is normal in morphology and size.
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. However the small
bowel demonstrates numerous regions of intussusceptions, (series 2, image 145)
without proximal bowel dilation/obstruction. Colon and rectum are within
normal limits. The appendix is normal. There is no evidence of mesenteric
injury. Moderate stool burden in the colon.
PELVIS:
The urinary bladder is unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles 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 or retroperitoneal hematoma.
Mild atherosclerotic disease is noted.
BONES: There is a comminuted displaced fracture of the left femur with a 2.1
cm butterfly fragment, incompletely characterized. A minimally displaced
fracture of the mid right clavicle is demonstrated, (series 3, image 15 and
14). Multiple nondisplaced rib fractures include the right posterior first
and fourth ribs, right anterolateral second and third ribs. There are
multiple moderately displaced right transverse process fractures of L5-L2.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. A 4 cm splenic laceration with perisplenic hemorrhage as described above.
The main splenic artery and vein are intact. Within the central spleen is a
small area of hyperdensity which is not well characterized on single contrast
phase examination. This may represent arterial or venous hemorrhage. If
there is concern for active arterial extravasation a arterial phase CT scan is
recommended.
2. A 3.0 x 1.9 hyperdensity intimately associated with the right adrenal gland
is concerning for adrenal hemorrhage
3. Small medial right pneumothorax with apical and basilar components. No
evidence of tension. Trace left apical pneumothorax.
4. Multiple areas of dense opacifications throughout the right lung are
concerning for pulmonary contusion in the setting of trauma. A couple of
small pulmonary lacerations/traumatic cysts are noted, filled with hemorrhage.
5. Within the hepatic dome is a 7 mm area of hypodensity which may represent
hepatic contusion.
6. Small left hemothorax is likely secondary to splenic laceration.
7. Comminuted fracture of the left femur (incompletely imaged).
8. Minimally displaced fracture of the mid right clavicular shaft.
9. Multiple nondisplaced rib fractures including the right posterior first and
fourth ribs, and right anterolateral second and third ribs.
10. Multiple moderately displaced right transverse process fractures of L5-L2.
11. At least three areas of short-segment intussusception are demonstrated
throughout the small bowel in the upper abdomen without obstruction.
RECOMMENDATION(S): If there is continued clinical concern for active arterial
extravasation of contrast within the spleen a multiphase abdominal CT with a
delayed phase is recommended.
Orthopedic referral for left femoral fracture.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:41 am, 5 minutes after
discovery of the findings.
|
10170562-RR-19
| 10,170,562 | 25,879,071 |
RR
| 19 |
2181-10-02 04:35:00
|
2181-10-02 05:52:00
|
EXAMINATION: TRAUMA #3 (PORT CHEST ONLY)
INDICATION: History: ___ with trauma*** WARNING *** Multiple patients with
same last name!// ?pneumo
TECHNIQUE: AP chest radiographs.
COMPARISON: None
FINDINGS:
An endotracheal tube projects 3.3 cm above the carina.
Low lung volumes. There are patchy opacifications seen throughout the right
hemithorax is consistent with pulmonary contusion better demonstrated on same
day CT torso. No evidence of pulmonary edema. The small pneumothorax right
apical and right basilar pneumothoraces are better demonstrated on same day CT
torso. The left pleural effusion is better demonstrated on the CT torso.
A comminuted displaced fracture of the mid clavicular shaft is demonstrated.
IMPRESSION:
1. Patchy opacifications seen to the right hemithorax are consistent with
pulmonary contusion.
2. The comminuted displaced fracture of the midclavicular shaft is
demonstrated.
3. An endotracheal tube projects 3.3 cm above the carina.
|
10170562-RR-20
| 10,170,562 | 25,879,071 |
RR
| 20 |
2181-10-02 04:54:00
|
2181-10-02 05:57:00
|
EXAMINATION: DX PELVIS AND FEMUR
INDICATION: History: ___ with trauma*** WARNING *** Multiple patients with
same last name!// trauma
TECHNIQUE: AP pelvis, left hip, knee joint and lateral knee joint.
COMPARISON: Seen the CT torso.
FINDINGS:
Comminuted fracture of the left mid femur with a 15 cm butterfly fragment.
The distal femoral fracture fragment demonstrates complete posterolateral
displacement and 13 mm of overlap with the more proximal fracture fragment.
There are no gross degenerative changes. There is no suspicious lytic or
sclerotic lesion. A metallic frame projects over the proximal through mid
left fibular. Nondisplaced right transverse process fractures better depicted
on prior cross-sectional imaging.
IMPRESSION:
1. Comminuted fracture of the shaft of the mid femur demonstrated 15 cm
butterfly fragment.
2. The distal femoral fracture fragment demonstrates complete posterolateral
displacement and 13 mm of overlap with the more proximal fracture fragment.
|
10170562-RR-21
| 10,170,562 | 25,879,071 |
RR
| 21 |
2181-10-02 08:12:00
|
2181-10-02 10:10:00
|
INDICATION: ORIF left hip fracture.
COMPARISON: Radiographs from ___, 3 hours earlier
IMPRESSION:
Intraoperative images demonstrate placement of an intramedullary rod with
distal and proximal interlocking screws fixating a fracture of the proximal
left femoral shaft. There is good anatomic alignment. There are no signs for
hardware related complications. Total intraservice fluoroscopic time was
244.7 seconds. Please refer to the operative note for additional details.
|
10170562-RR-22
| 10,170,562 | 25,879,071 |
RR
| 22 |
2181-10-02 12:43:00
|
2181-10-02 13:59:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man s/p MCC no helmet; significant trauma burden. No
PMHx no medication hx// assessment of IPH per NSGY.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.3 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
Please note evaluation for intracranial hemorrhage is limited due to
circulating intravascular contrast from same day contrast torso CT. Within
these confines:
There is redemonstration of multiple punctate foci of hyperdensity within the
bilateral frontal and parietal lobes (2:29, 2:28, 2:26, 2:23, 2:19), not
substantially changed compared to prior study from 8 hours prior and
compatible with small intraparenchymal hemorrhage/contusion. There is no
evidence of acute infarction,or mass, mass effect, or midline shift. The
ventricles and sulci are grossly stable in size and configuration.
An endotracheal 2 is partially visualized. Nonspecific nasopharyngeal sinus
and paranasal sinus mucosal thickening is noted, which may be related
intubation status.
IMPRESSION:
1. Please note evaluation for intracranial hemorrhage is limited due to
circulating intravascular contrast from same day contrast torso CT.
2. Multiple punctate foci of intraparenchymal hemorrhage/contusion within the
bilateral frontal and parietal lobes, grossly stable compared to study from 8
hours
3. Within limits of study, no definite evidence of new acute intracranial
hemorrhage.
|
10170562-RR-23
| 10,170,562 | 25,879,071 |
RR
| 23 |
2181-10-02 12:57:00
|
2181-10-02 17:23:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with no PMHx or medications, s/p MCC// further
eval splenic blush seen on previous scan; eval for other ___ pathology
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 3.4 s, 53.7 cm; CTDIvol = 3.4 mGy (Body) DLP = 183.3
mGy-cm.
2) Spiral Acquisition 4.1 s, 53.7 cm; CTDIvol = 11.2 mGy (Body) DLP = 602.9
mGy-cm.
3) Spiral Acquisition 4.1 s, 53.7 cm; CTDIvol = 11.2 mGy (Body) DLP = 602.2
mGy-cm.
4) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
5) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.3 mGy (Body) DLP =
6.6 mGy-cm.
Total DLP (Body) = 1,397 mGy-cm.
COMPARISON: Comparisons made with the CT scan performed on the same day, 8
hours earlier.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is no calcium burden in the
abdominal aorta and great abdominal arteries. No traumatic vascular injury
has been demonstrated.
LOWER CHEST: Redemonstration of small hyperattenuating pleural effusions
consistent with hemothoraces.
ABDOMEN:
HEPATOBILIARY: A subtle area of linear hypoattenuation identified in the dome
of the liver on the previous study is no longer seen and may have been
artifactual. A few very subtle focal hypoattenuating lesions measuring less
than 5 mm in the right lobe of the liver are unchanged (series 303 image 25)
likely biliary hamartomas. The remainder of the liver demonstrates homogenous
attenuation throughout. No hepatic laceration or hematoma is seen. There is
no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits, without stones or gallbladder wall
thickening.
ADRENALS: A 1.6 x 4.3 cm hypoattenuating fluid density lesion closely related
right adrenal gland, likely to represent adrenal hemorrhage is stable in
appearances. The left adrenal gland appears normal.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions, laceration or pancreatic ductal dilatation. There is no
peripancreatic stranding.
SPLEEN: There is re-demonstration of a laceration involving the inferomedial
aspect of the spleen. No evidence of active extravasation of arterial blood.
The splenic artery appears intact. No significant change in the size of the
perisplenic hematoma.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
No renal laceration is seen. There is no evidence of stones, solid renal
lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or
ureters. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Previously
demonstrated multiple transient small bowel intussusceptions have resolved.
The colon and rectum are within normal limits. Interval internal fixation of a
left femoral neck fracture.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
BONES: Moderately displaced fractures of the right L2-L5 transverse process is
again demonstrated.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Stable appearances of left splenic laceration. No active extravasation of
arterial blood. Stable perisplenic hematoma.
2. Stable right adrenal hematoma.
3. A subtle area of linear hypoattenuation identified in the dome of the
liver on the previous study is no longer seen and may have been artifactual.
4. Interval resolution of multiple transient intussusceptions demonstrated on
previous study.
5. Interval internal fixation of left femoral neck fracture is noted.
|
10170562-RR-24
| 10,170,562 | 25,879,071 |
RR
| 24 |
2181-10-03 06:04:00
|
2181-10-03 09:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with mvc// pulmo contusion, monitor pulm sx
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are low volume with improving bilateral parenchymal opacification which
most likely represents improving contusions. Cardiomediastinal silhouette is
stable. No pneumothorax. No effusions.
|
10170781-RR-4
| 10,170,781 | 22,569,220 |
RR
| 4 |
2143-12-04 00:46:00
|
2143-12-04 05:37:00
|
EXAMINATION: TRAUMA #2 (AP CXR AND PELVIS PORT)
INDICATION: History: ___ with trauma. // trauma
TECHNIQUE: Portable AP views of the chest, pelvis
COMPARISON: CT abdomen pelvis from outside hospital
FINDINGS:
Lung volumes are low. There is mild peribronchial cuffing particularly in the
right. No focal areas of consolidation. Cardiomediastinal silhouette is
normal. No pleural effusions or pneumothorax.
Single view of the pelvis shows dense contrast within the bladder. No
fractures. Limited evaluation of the left pubic ramus due to a device
presumably overlying the patient.
IMPRESSION:
Mild peribronchial cuffing on the right could be secondary to vascular
congestion.
No pelvic fractures.
|
10170781-RR-5
| 10,170,781 | 22,569,220 |
RR
| 5 |
2143-12-04 13:03:00
|
2143-12-04 13:50:00
|
INDICATION: History: ___ with injury // A/P standing to assess for fx.
TECHNIQUE: Standing AP view of the pelvis
COMPARISON: CT abdomen and pelvis from outside hospital obtained ___ at 20:20, pelvis radiograph ___ at 1:04
FINDINGS:
There is diastasis of the pubic symphysis to 10 mm, not apparent on prior
nonweightbearing exams. No widening of the sacroiliac joints. No acute
fracture or dislocation. Hips are preserved with no significant degenerative
changes. No concerning lytic or sclerotic osseous abnormality.
IMPRESSION:
Pubic symphysis diastasis without sacroiliac joint widening. No acute
fracture.
|
10170781-RR-6
| 10,170,781 | 22,569,220 |
RR
| 6 |
2143-12-04 14:54:00
|
2143-12-04 15:15:00
|
INDICATION: ___ year old man with pubic symphasis widening // Please perform
this exam with the patient standing. He was able to stand at bedside despite
pain. Please call ___ if unable to have patient stand. ___
TECHNIQUE: Standing AP view of the pelvis
COMPARISON: Pelvic radiographs ___
FINDINGS:
Redemonstration of diastasis of the pubic symphysis to 10 mm. Sacroiliac
joints are preserved without diastasis. No acute fracture or dislocation.
Hips are preserved. No concerning lytic or sclerotic osseous abnormalities.
Visualized bowel gas pattern is unremarkable.
IMPRESSION:
Redemonstration of pubic symphysis diastasis to 10 mm on standing view.
|
10171405-RR-59
| 10,171,405 | 26,373,120 |
RR
| 59 |
2131-07-22 12:38:00
|
2131-07-22 17:35:00
|
INDICATION: Known large left renal cell carcinoma. Recently discharged on
Lovenox for left IJ thrombus. Now presenting with recurrent hematuria.
Concern for IVC thrombosis.
TECHNIQUE: Multiplanar T1- and T2-weighted sequences were obtained on a 1.5
Tesla magnet including dynamic 3D imaging performed prior to and after the
uneventful administration of 6 cc of Gadavist. 10 mg of IV Lasix was also
given.
COMPARISON: Multiple prior CT torsos, most recent on ___.
MR UROGRAM: Again seen is a 10.6 x 9.5 cm mass replacing much of the left
kidney with central T1 hyperintensity that represents either hemorrhage or
proteinaceous material. The mass remains highly vascular with considerable
peripheral enhancement and overall is slightly increased in size from ___ when it measured 13.7 x 8.5 cm. However, there is no
hydronephrosis or filling defect within the collecting system. The bladder is
collapsed and contains a Foley catheter. Allowing for this limitation, there
is no mucosal irregularity or mass. The right kidney and ureter are normal.
The IVC, left renal and right renal veins are patent. There is a small
accessory left renal artery arising from the left common iliac artery
(1301:35).
MR ABDOMEN: Extrahepatic biliary ductal dilatation is unchanged and the CBD
measures 14 mm in diameter. There is suggestion of a filling defect in the
distal CBD. However, this is most likely due to either volume averaging from
the adjacent pancreatic tissue or patulous morphology (6:14). There is no
focal liver lesion to suggest metastasis. The hepatic and portal veins are
patent. The gallbladder, spleen, and adrenals are normal. The stomach, small
bowel, and colon are normal. There is no mesenteric or retroperitoneal
lymphadenopathy. Incidental note is made of a pulmonary nodule in the right
lower lobe (4:33) not visible on CT-Chest of ___.
MR PELVIS: The uterus is absent. The adnexa are unremarkable. There is no
pelvic lymphadenopathy or free fluid. No bone marrow signal abnormality is
detected.
IMPRESSION:
1. No IVC thrombosis. Patent renal veins.
2. Slight interval increase in size of large left renal mass since ___. However, no pseudoaneurysm, hydronephrosis, or filling defect
within the collecting system to provide a specific explanation for hematuria
other than the presence of this mass.
3. Limited assessment of the bladder with a Foley catheter in place.
However, no bladder abnormality identified to suggest an additional possible
source of patient's hematuria.
4. Right lower lobe pulmonary nodule can be better assessed at the time of
restaging on a chest CT. This is most likely metastatic disease given the
patient's history.
|
10171405-RR-60
| 10,171,405 | 26,373,120 |
RR
| 60 |
2131-07-23 00:07:00
|
2131-07-23 06:20:00
|
INDICATION: Renal cell carcinoma. Preoperative evaluation.
TECHNIQUE: Multidetector CT scan through the chest was performed after the
administration of Omnipaque intravenous contrast. Coronal and sagittal
reformatted images were obtained.
DLP: 553.80 mGy-cm.
COMPARISON: CT chest ___.
FINDINGS: The thyroid appears normal. Intrathoracic aorta is of normal
caliber throughout and without evidence of dissection. The heart size is
normal. There is no pericardial effusion. Compared to the prior study, the
previously seen mediastinal lymphadenopathy has slightly worsened. For
example, the previously measured prevascular lymph nodes measuring 10 mm
(2:18), now measure 11 and 12 mm (2:17) and the number of visible lymph nodes
within the prevascular space has increased. Additionally, paratracheal and
precarinal lymph nodes have also increased since the prior study. For
example, the precarinal lymph node now measures up to 3.4 cm (2:26) and
previously measured 2.7 cm (2:25). A left cervical chain lymph node has also
increased in size, currently measuring 1.7 x 1.8 mm and previously measuring
16 x 16 mm. There is no significant axillary lymphadenopathy. Multiple left
hilar lymph nodes have increased in size, the largest now measuring up to 1.4
cm (2:30).
Lung windows demonstrate interval increase in the size and number of multiple
bilateral pulmonary nodules. The largest pulmonary nodule is located in the
right upper lobe (4:110) and currently measures 1.2 x 1.4 cm and previously
measured 0.9 x 1 cm (4:93). Also, of note, the pulmonary hila adjacent to
this nodule shows new now marked lymphadenopathy or possible metastatic
involvement that was not previously present. Multiple nodules within the
right upper lobe are new (4:20, 43, 66). There are also new nodules in the
right middle lobe (4:74 and 99). There are also new nodules within the left
upper lobe (4:26, 46, 83 and 146). There are also new nodules within the
lower lobe (4:147 and 187). Also, of note, there is new nodular thickening of
the right oblique fissure (4:139).
The visualized portions of the liver, spleen and stomach are unremarkable.
The known left renal cell cancer is also seen.
OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesions are
seen.
IMPRESSION: Compared to the most recent prior study of ___, there
has been interval disease progression with increased mediastinal and hilar
adenopathy as well as interval increase in the number and size of multiple
bilateral pulmonary nodules.
|
10171405-RR-73
| 10,171,405 | 27,306,920 |
RR
| 73 |
2131-10-10 08:58:00
|
2131-10-10 12:18:00
|
HISTORY: Atrial fibrillation.
COMPARISON: ___.
FINDINGS:
The patient has known metastatic disease. Again visualized are multiple small
pulmonary nodules and hilar adenopathy. the pleural effusion on the left has
decreased compared to prior. NG tube tip is in the proximal stomach. heart
size is upper limits normal.
|
10171405-RR-74
| 10,171,405 | 27,306,920 |
RR
| 74 |
2131-10-12 12:00:00
|
2131-10-12 13:40:00
|
HISTORY: NG placement.
FINDINGS: In comparison with study of ___, the tip of the nasogastric tube
is in the upper-to-mid body of the stomach. The side port is probably just
below the level of the esophagogastric junction.
Non-specific bowel gas pattern. If there is serious clinical concern for
obstruction, CT would be the next imaging procedure.
|
10171405-RR-75
| 10,171,405 | 27,306,920 |
RR
| 75 |
2131-10-12 14:00:00
|
2131-10-12 15:03:00
|
HISTORY: History renal cell carcinoma now with prolonged immobilization and
new atrial fibrillation, concerning for pulmonary embolism, here to evaluate
for deep venous thrombosis.
COMPARISON: No prior studies available.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed on
the bilateral lower extremity veins.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, proximal femoral, mid femoral, distal femoral and popliteal veins.
Normal color flow is demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity.
|
10171525-RR-14
| 10,171,525 | 21,263,495 |
RR
| 14 |
2115-12-03 20:24:00
|
2115-12-03 20:39:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with endotracheal tube placement
TECHNIQUE: Supine AP view of the chest
COMPARISON: None.
FINDINGS:
Endotracheal tube tip terminates approximately 4.6 cm from the carina. Heart
size is borderline enlarged. Mediastinal and hilar contours are grossly
unremarkable. Low lung volumes are present which results in crowding of
bronchovascular structures, but no pulmonary edema is seen. Patchy opacities
in the lung bases may reflect areas of atelectasis. No focal consolidation,
pleural effusion or pneumothorax is present. There are no acute osseous
abnormalities detected.
IMPRESSION:
1. Endotracheal tube in standard position.
2. Low lung volumes. Patchy opacities within the lung bases may reflect areas
of atelectasis. Aspiration or infection, however, cannot be completely
excluded in the correct clinical setting.
|
10171525-RR-15
| 10,171,525 | 21,263,495 |
RR
| 15 |
2115-12-03 23:43:00
|
2115-12-04 08:27:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman, intubated, with new OG tube // eval OG tube
eval OG tube
IMPRESSION:
In comparison with the earlier study of this date, there is an placement of an
orogastric tube that extends to the distal stomach. Otherwise little change.
|
10172206-RR-10
| 10,172,206 | 26,783,176 |
RR
| 10 |
2185-05-14 07:38:00
|
2185-05-14 10:17:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: VT arrest.
Comparison is made with prior study, ___.
Moderate-to-severe cardiomegaly is stable. Pacer leads are in a standard
position. Right IJ catheter tip is in the upper right atrium. There is no
pneumothorax. There is mild vascular congestion. There are no large pleural
effusions. Sternal wires are aligned.
|
10172206-RR-11
| 10,172,206 | 26,783,176 |
RR
| 11 |
2185-05-17 09:02:00
|
2185-05-17 10:02:00
|
CHEST RADIOGRAPH
INDICATION: Nasogastric tube placement. Evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has received a
nasogastric tube. The tip of the tube projects over the middle parts of the
stomach, the course of the tube is unremarkable. No evidence of
complications. Otherwise, unchanged appearance of the chest radiograph.
|
10172206-RR-12
| 10,172,206 | 26,783,176 |
RR
| 12 |
2185-05-18 18:40:00
|
2185-05-18 20:48:00
|
HISTORY: ___ year old man with VT arrest c/b left sided posterior watershed
stroke.
TECHNIQUE: Noncontrast CT head was performed. CTA of the head and neck
performed. MIP reconstructions were performed on a separate workstation.
DLP: ___.33 mGy-cm
COMPARISON: Non contrast CT head ___.
FINDINGS:
Noncontrast CT head: Once again identified are hypodensities within the left
parieto-occipital lobe likely related to subacute or remote infarct. Other
periventricular and patchy bihemispheric deep white matter hypodensity is
nonspecific; in light of the patient's age, this may represent sequela of
chronic microangiopathic change. Ventricular, cisternal, and sulcal prominence
may be a function of age-related parenchymal volume loss. No mass effect,
midline shift, or herniation is identified. No intra-axial or extra-axial
hemorrhage or fluid collection is seen. No significant bony abnormalities are
seen. The paranasal sinuses demonstrate scattered areas of mucosal
thickening. The mastoid air cells are clear.
CTA head: There is moderate narrowing of the proximal left cavernous ICA just
beyond it's exit of the petrous segment. Calcifications are noted within the
carotid siphons bilaterally. The petrous, cavernous, and supraclinoid
portions of the internal carotid arteries otherwise demonstrate normal
enhancement. The anterior and middle cerebral arteries are unremarkable. The
anterior communicating artery region is normal. The bilateral posterior
communicating, bilateral posterior cerebral, basilar, bilateral superior
cerebellar, and bilateral intradural segments to both vertebral arteries
appear unremarkable. No other arterial stenosis, saccular aneurysm, or AVM is
identified.
CTA neck: There is normal opacification of the next vessels. The origins of
the innominate, left common carotid, and left subclavian arteries are normal
with conventional arch anatomy. Calcified atheromatous plaque about the right
carotid bifurcation causes mild narrowing of the right ICA without significant
stenosis, as well as mild-to-moderate stenosis of the right external carotid
artery origin. Calcified atheromatous plaque at the left carotid bulb causes
no significant stenosis. The common, internal, and external carotid arteries,
as well as the vertebral arteries, otherwise demonstrate normal enhancement.
The vertebral artery origins are unremarkable. No other significant stenosis,
dissection, aneurysm, or pseudoaneurysm is identified.
The thyroid gland is normal in size and contour without evidence of mass or
cyst. The salivary glands as visualized are unremarkable. No significant
lymphadenopathy is appreciated. Scattered mildly prominent subcentimeter
cervical lymph nodes are non specific. The aerodigestive tract is patent.
There is asymmetric soft tissue fullness about the right piriform sinus to
above the true vocal cords. The superficial soft tissues of the neck show no
swelling or abnormality. No abnormal area of contrast enhancement is seen.
The included bones appear intact with degenerative changes. The included
lungs demonstrate hypoventilatory dependent changes more otherwise limited
secondary to respiratory motion artifact. The main pulmonary trunk is
enlarged reflecting pulmonary hypertension.
IMPRESSION:
Sequela from old left parietal occipital infarcts and age-related involutional
with chronic microangiopathic changes without acute hemorrhage or mass effect.
Moderate narrowing of the proximal left cavernous ICA just beyond it's exit of
the petrous segment. Otherwise unremarkable CTA of the head and neck without
evidence of significant stenosis, aneurysm, pseudoaneurysm, or dissection.
Enlarged main pulmonary artery which may reflect pulmonary hypertension.
Asymmetric soft tissue fullness about the right piriform sinus to above the
true vocal cords; further evaluation as clinically warranted.
|
10172206-RR-2
| 10,172,206 | 26,783,176 |
RR
| 2 |
2185-05-07 03:46:00
|
2185-05-07 04:39:00
|
INDICATION: Status post arrest, question pneumothorax.
COMPARISON: None available.
FINDINGS: AP view of the chest. Sternotomy wires and mediastinal clips are
seen. Endotracheal tube ends at the thoracic inlet. Left-sided pacemaker
with wires is seen. NG tube ends in the stomach. Enteric tube ends in the
stomach. There is at least moderate cardiomegaly. No pleural effusions or
pneumothorax is identified. No focal consolidation.
IMPRESSION: Moderate to severe cardiomegaly.
|
10172206-RR-3
| 10,172,206 | 26,783,176 |
RR
| 3 |
2185-05-07 06:07:00
|
2185-05-07 07:36:00
|
INDICATION: Status post arrest, evaluate for hemorrhage.
COMPARISON: None available.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered. Coronal and sagittal reformations were performed.
Bone algorithm was obtained.
Total DLP is 891 mGy-cm. CTDIvol is 52 mGy.
FINDINGS: There is no evidence of acute hemorrhage, edema, mass, mass effect,
or acute territorial infarction. Gray-white differentiation is preserved.
The ventricles and sulci are mildly prominent, consistent with age-related
atrophy. There are minimal periventricular white matter hypodensities
consistent with a sequela of chronic small vessel ischemic disease.
There is moderate mucosal thickening in the maxillary sinuses bilaterally,
there is partial opacification of the left mastoid air cells.No acute
fracture.
IMPRESSION: No acute intracranial process.
|
10172206-RR-4
| 10,172,206 | 26,783,176 |
RR
| 4 |
2185-05-07 09:41:00
|
2185-05-07 13:52:00
|
HISTORY: Cardiac arrest with tube placement.
FINDINGS: In comparison with the earlier study of this date, the tip of the
endotracheal tube is somewhat difficult to see, though it appears to be about
3.5 cm above the carina. Nasogastric tube extends at least to the distal
esophagus, where it crosses the lower margin of the image. There is
suggestion of some increased opacification at the right base, which could
reflect aspiration or atelectasis. Otherwise, little change.
|
10172206-RR-6
| 10,172,206 | 26,783,176 |
RR
| 6 |
2185-05-09 00:58:00
|
2185-05-09 09:38:00
|
HISTORY: Cardiomyopathy with pacer and cardiac arrest.
FINDINGS: In comparison with study of ___, there is increased opacification
at the right base. This is consistent with some combination of pleural fluid,
volume loss, and possible supervening pneumonia. Right IJ catheter tip is
difficult to see but appears to extend to lower SVC. Otherwise, little
overall change in the appearance of the heart and lungs.
|
10172206-RR-7
| 10,172,206 | 26,783,176 |
RR
| 7 |
2185-05-10 16:17:00
|
2185-05-10 19:12:00
|
INDICATION: Status post cardiac arrest. Evaluate for edema and stroke.
COMPARISON: ___.
TECHNIQUE: Continuous axial MDCT images of the brain were obtained without
intravenous contrast. Coronal and sagittal as well as bone algorithm
reformatted images were obtained.
FINDINGS: Compared to the prior CT from ___, there are hypodense areas
in the left occipital and parietal lobes in a watershed distribution,
concerning for infarction. Additionally, there is surrounding cytotoxic
edema. In the left medial temporal lobe (series 3, image 18), there are
hypodensities which may represent infarction or partial volume averaging with
the adjacent choroidal fissure. If these indeed are infarcted areas of brain
tissue, they would be unusual for a watershed distribution. There is no
evidence of hemorrhage. There is no midline shift. The basal cisterns are
patent. The ventricles and sulci are normal in size and configuration for the
patient's age.
No fracture is identified. Fluid in the posterior nasopharynx and posterior
ethmoid air cells as well as the sphenoid sinus is likely a sequela of
intubation. Mastoid air cells are clear.
IMPRESSION:
1. Interval development of hypodensities in the left occipital and parietal
lobes in a watershed distribution, concerning for infarction.
2. Hypodensities in the left medial temporal lobe may represent partial
volume averaging with the choroidal fissure, or areas of infarction. If they
are areas of infarction, they would be usual for a watershed distribution.
3. No hemorrhage is identified.
|
10172206-RR-9
| 10,172,206 | 26,783,176 |
RR
| 9 |
2185-05-13 07:36:00
|
2185-05-13 12:27:00
|
CHEST RADIOGRAPH
INDICATION: Status post cardiac arrest and cooling, evaluation for
endotracheal tube placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the tip of the endotracheal
tube now projects 5.3 cm above the carina. No change in appearance of the
other monitoring and support devices. The lung bases, notably on the right,
have substantially cleared. No larger pleural effusions. Unchanged size of
the cardiac silhouette. No pneumothorax.
|
10172240-RR-46
| 10,172,240 | 29,600,520 |
RR
| 46 |
2126-06-28 15:56:00
|
2126-06-28 16:26:00
|
HISTORY:
Shortness of breath status post lung biopsy.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest CT ___ and ___ chest radiograph.
FINDINGS:
Compared to the previous exam, there is increasing amount of pleural fluid
loculated along the lateral aspect of the left hemithorax, now small to
moderate in size. Wedge-shaped opacity within the left mid lung field is
relatively unchanged compatible with post biopsy changes. Left basilar
opacification may reflect atelectasis. The right lung demonstrates minimal
atelectasis in the right lung base. Multiple nodules are again seen within
both lungs, better appreciated on the previous CT. Elevation of the right
hemidiaphragm is unchanged. No pneumothorax is identified, and no pulmonary
vascular congestion is seen. Cardiac, mediastinal and hilar contours are
stable.
IMPRESSION:
Interval increase in amount of left pleural effusion which is loculated
laterally. Post wedge resection changes again seen in the left mid lung
field. Bibasilar atelectasis.
|
10172240-RR-47
| 10,172,240 | 29,600,520 |
RR
| 47 |
2126-06-29 11:36:00
|
2126-06-29 14:45:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ woman status post left-sided chest tube
placement.
FINDINGS: Comparison is made to previous study from ___.
There has been placement of a left-sided pigtail pleural catheter. There are
again seen opacities at the left base and left mid lung field, stable. The
heart size is within normal limits. There are low lung volumes. There are no
pneumothoraces. The right lung is clear.
|
10172240-RR-48
| 10,172,240 | 29,600,520 |
RR
| 48 |
2126-06-30 09:04:00
|
2126-06-30 10:53:00
|
STUDY: AP chest, ___.
CLINICAL HISTORY: ___ woman with left pleural effusion.
FINDINGS: Comparison is made to previous study from ___.
There is a left-sided pigtail catheter at the base. This is unchanged in
position. Again seen are opacities in the left mid and lower lung zones.
There is some atelectasis at the right base. There are no pneumothoraces.
Heart size is within normal limits.
|
10172240-RR-49
| 10,172,240 | 29,600,520 |
RR
| 49 |
2126-06-30 13:23:00
|
2126-06-30 17:03:00
|
STUDY: PA and lateral chest, ___.
CLINICAL HISTORY: ___ woman with left-sided pleural effusion status
post pigtail removal.
FINDINGS: Comparison is made to previous study from ___ at 9:09
a.m.
There has been removal of the left-sided pigtail pleural catheter. There is
some atelectasis at the lung bases. There is an area of confluent opacity in
the left mid lung field, which appears stable. Heart size is within normal
limits. There are no pneumothoraces identified.
|
10172264-RR-27
| 10,172,264 | 25,992,198 |
RR
| 27 |
2117-05-28 16:07:00
|
2117-05-28 17:02:00
|
INDICATION: ___ female with question of compartment syndrome.
COMPARISON: MR of the calf from ___ and tibial radiographs from
___.
TWO VIEWS OF THE RIGHT CALF:
There is mild prominence of the medial head of the gastrocnemius/soleus which
is unchanged compared to the radiograph from ___ and could be
related to underlying edema. No new areas of subcutaneous gas are noted.
IMPRESSION:
Prominence of the medial gastrocnemius/scoliosis is unchanged from ___, and could be related to underlying edema. Please note that
compartment syndrome is a clinical diagnosis.
|
10172264-RR-28
| 10,172,264 | 25,992,198 |
RR
| 28 |
2117-05-28 18:38:00
|
2117-05-28 20:11:00
|
INDICATION: ___ female with right leg swelling, question DVT or soft
tissue mass.
COMPARISON: Venous extremity ultrasound from ___ and MR of the
calf from ___.
FINDINGS: Gray-scale and Doppler images of the right and left common femoral,
right superficial femoral, popliteal, and proximal calf veins were obtained.
There is wall-to-wall flow with normal response to compression and
augmentation in all visible veins. Significant edema is noted within the
right medial calf muscles.
IMPRESSION: No DVT in right lower extremity. Significant edema within the
right medial calf muscles as noted on the previous MRI and ultrasound
examination.
|
10172264-RR-29
| 10,172,264 | 25,992,198 |
RR
| 29 |
2117-05-28 21:25:00
|
2117-05-29 10:29:00
|
CLINICAL HISTORY: Calf swelling.
COMPARISON: MRIs from ___ and ___.
TECHNIQUE: Multiplanar T1- and T2-weighted sequences of the right calf were
obtained.
FINDINGS: Again seen is marked edema in the right soleus muscle as well as
edema of the right gastrocnemius muscle medial head. The distribution is the
same as on the ___ MRI. The findings were not present on the
___ MRI. No discrete fluid collection is seen. Fluid is seen
tracking along the superficial fascial covering the gastrocnemius muscles as
well as the anterior compartment. Fluid is also seen along the superficial
fascia of the lateral compartment tracking over the lateral head of the
gastroc. No substantial skin or subcutaneous edema is seen. Bone marrow
signal is normal.
Left calf appears normal.
IMPRESSION: Marked edema involving the right soleus muscle and medial head of
the right gastrocnemius muscle with edema along the fascial planes. These are
similar to the findings from ___. On the ___ MRI,
these findings had resolved. The appearances are again nonspecific and could
result from muscles strain, infection, or other causes of myositis. Given the
patient's operating room findings of increased compartment pressures, the
edema could also be seen in the setting of compartment syndrome.
Findings were discussed with Dr. ___ by Dr. ___ at 10:10
a.m. on the day of the study via telephone. The patient had been taken for a
muscle biopsy and fasciotomy by the orthopedic service at that time.
|
10172358-RR-14
| 10,172,358 | 22,629,909 |
RR
| 14 |
2129-12-20 14:34:00
|
2129-12-20 15:52:00
|
HISTORY: Right upper quadrant pain and nausea.
COMPARISON: None available.
TECHNIQUE: Grayscale and color Doppler ultrasound images were obtained of the
abdomen.
FINDINGS: Increased echogenicity of the liver is suggestive of hepatic
steatosis. The liver is otherwise unremarkable without focal lesion. There
is no intra- or extra-hepatic biliary duct dilatation and the common bile duct
measures 3 mm in diameter. The gallbladder is thin-walled and unremarkable
without stones. The portal vein is patent and there is hepatopetal flow. The
pancreatic tail is not well visualized due to overlying bowel gas. The
visualized portion of the pancreatic head and body is unremarkable. The
spleen is homogeneous in echotexture and measures 11.5 cm.
IMPRESSION:
1. Echogenic liver suggestive of hepatic steatosis. More advanced forms of
liver disease including cirrhosis cannot be excluded on the basis of
ultrasound.
2. Otherwise, unremarkable examination without evidence of cholecystitis or
cholelithiasis.
|
10172358-RR-15
| 10,172,358 | 22,629,909 |
RR
| 15 |
2129-12-20 15:48:00
|
2129-12-20 18:57:00
|
HISTORY: Right upper quadrant abdominal pain, nausea and diarrhea and weight
loss.
COMPARISON: None available.
TECHNIQUE: Axial helical MDCT images were obtained of the abdomen and pelvis
after the administration of IV contrast. Multiplanar reformatted images were
generated into the coronal and sagittal planes.
DLP: 652.29 mGy-cm.
FINDINGS: There is mild bibasilar atelectasis in the imaged lung bases as
well as nonspecific patchy areas of ground glass density in the left lung
base. The heart size is normal.
CT ABDOMEN: There are large geographic areas of hypodensity within the liver
compatible with fatty infiltration. The gallbladder is distended but
thin-walled and unremarkable without stones or pericholecystic fluid or
stranding. The spleen, pancreas, and adrenal glands are unremarkable in
appearance. Note is made of pancreatic divisum. No peripancreatic
inflammation noted. The kidneys present symmetric nephrograms without focal
solid or cystic lesions, pelvicaliceal dilatation or perinephric abnormality.
The stomach, duodenum and remainder of the small bowel is unremarkable in
appearance without evidence of obstruction. The large bowel is unremarkable
in appearance. A normal appendix is visualized in the right mid abdomen
(2:41).
The abdominal aorta is of normal caliber with patent celiac axis, SMA,
bilateral renal arteries and ___. There are no enlarged mesenteric or
retroperitoneal lymph nodes by CT size criteria. There is no ascites,
pneumoperitoneum or hernia.
CT PELVIS: The bladder, rectum, and ovaries are unremarkable in appearance.
There is mild thickening of the endometrium to 1 cm. There is no free pelvic
fluid or air. There are no enlarged pelvic wall or inguinal lymph nodes by CT
size criteria.
OSSEOUS STRUCTURES: There are no focal blastic or lytic lesions in the
visualized osseous structures concerning for malignancy.
IMPRESSION:
1. Areas of focal fatty infiltration in the liver.
2. Nonspecific ground glass densities in the left lung base could be
infectious or inflammatory.
3. Pancreatic divisum without CT evidence of pancreatitis.
4. Mildly thickened endometrium at 1 cm could be normal if the patient is
premenopausal. Correlate clinically.
|
10172388-RR-19
| 10,172,388 | 26,694,448 |
RR
| 19 |
2180-02-13 01:24:00
|
2180-02-13 02:13:00
|
INDICATION: ___ female with six weeks' pregnancy, acute left lower
quadrant pain and hypertension, concerning for ruptured ectopic.
No prior examinations for comparison.
___: ___.
PELVIC ULTRASOUND: Limited transabdominal images were acquired. Transvaginal
imaging could not be performed, and transabdominal imaging was limited, due to
excessive patient pain.
There is a small amount of fluid in the endometrial cavity. No intrauterine
gestation is identified. Complex free fluid is present, suggestive of
hemorrhage. Heterogeneous 8 x 5 cm structure is present in the left adnexa.
IMPRESSION: Very limited exam including transabdominal images only. No
intrauterine gestation identified. Heterogeneous echogenicity in left adnexa
suggestive of an adnexal mass or collection and complex free fluid. Cannot
exclude ruptured ectopic pregnancy.
Recommend short interval repeat ultrasound and correlation with serial
beta-HCG measurements as clinically indicated for better evaluation of the
present findings, and since differential diagnosis includes early pregnancy
and missed abortion.
|
10172388-RR-20
| 10,172,388 | 26,694,448 |
RR
| 20 |
2180-02-13 03:07:00
|
2180-02-13 04:02:00
|
INDICATION: ___ female with emergency exploratory laparotomy,
incomplete surgical counts.
No prior examinations for comparison.
ABDOMEN, SUPINE PORTABLE: Equipment radiographs demonstrate ___ clamp,
curved needle, 4 x 4 pad, and two gauze strips. No corresponding radiopaque
foreign bodies are identified in the abdomen. Bowel gas pattern is
unremarkable. Temperature probe is noted in the esophagus. There is right
lower lobe atelectasis.
IMPRESSION: No radiopaque foreign bodies identified. This was called to Dr.
___ on ___ at 3:39 a.m.
|
10172505-RR-25
| 10,172,505 | 26,509,910 |
RR
| 25 |
2142-09-07 00:47:00
|
2142-09-07 05:47:00
|
HISTORY: Right foot fracture
COMPARISON: Earlier today
FINDINGS:
3 views of the right foot were obtained. Cast material obscures fine bony
detail. A spiral fracture of the right ___ metatarsal remains offset by
approximately 2 mm in the superior inferior dimension. ___ metatarsal base
fracture is unchanged in alignment. No radiopaque foreign body is seen.
IMPRESSION:
Status post casting of minimally displaced right ___ and ___ metatarsal
fractures as described above.
|
10172505-RR-26
| 10,172,505 | 26,509,910 |
RR
| 26 |
2142-09-07 00:47:00
|
2142-09-07 05:49:00
|
HISTORY: Left ankle fracture
COMPARISON: Earlier today
FINDINGS:
3 views of the left ankle were obtained. Cast material obscures fine bony
detail. Alignment of the left medial malleolar fracture has slightly improved
after splinting. There are no radiopaque foreign bodies.
IMPRESSION:
Slightly improved alignment of left medial malleolar fracture after splinting.
|
10172505-RR-27
| 10,172,505 | 26,509,910 |
RR
| 27 |
2142-09-07 14:49:00
|
2142-09-08 08:35:00
|
INTRAOPERATIVE RADIOGRAPHS OF THE LEFT ANKLE
CLINICAL INDICATION: ___ female status post ORIF of the left ankle.
TECHNIQUE: Multiple intraoperative radiographs of the left ankle were
obtained.
COMPARISON: Left ankle radiography dated ___.
FINDINGS:
There has been interval placement of two cancellous screws through the medial
malleolus fixating the left medial malleolar fracture. No hardware
complication is seen. Ankle mortise is congruent. Please refer to the
intraoperative report for further details.
IMPRESSION: Interval placement of two cancellous screws through the medial
malleolus without hardware complications. Please refer to the intraoperative
report for further details.
|
10172505-RR-28
| 10,172,505 | 26,509,910 |
RR
| 28 |
2142-09-09 10:19:00
|
2142-09-09 11:52:00
|
INDICATION: L3 compression fracture. Please further assess.
COMPARISON: MR ___ from ___.
LUMBAR SPINE, TWO VIEWS: There are five non-rib-bearing lumbar-type vertebral
bodies. A compression deformity of the superior endplate of L3 is similar in
appearance compared to the recent MRI from ___. Minimal
retropulsion of the dorsal cortex of the L3 superior endplate is unchanged.
There is also unchanged mild cavity of the superior and inferior endplates of
L5, likely degenerative in nature. There is no new loss of vertebral body
height. The disc spaces are preserved throughout. Alignment is unchanged.
IMPRESSION: No significant change in appearance of the known L3 vertebral
compression fracture compared to the MRI from ___. No new
fracture identified.
|
10173480-RR-57
| 10,173,480 | 21,165,338 |
RR
| 57 |
2200-09-23 13:29:00
|
2200-09-23 13:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ woman with chest pain. Evaluate for pneumonia.
COMPARISON: Chest radiograph from ___.
FINDINGS:
The lungs are clear. The hilar and cardiomediastinal contours are normal.
There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity
is normal.
IMPRESSION:
Normal radiographs of the chest.
|
10173672-RR-137
| 10,173,672 | 21,851,308 |
RR
| 137 |
2151-10-09 12:10:00
|
2151-10-09 12:56:00
|
INDICATION: ___ with hypertension, dyspnea on exertion // ? pulmonary edema
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___ chest x-ray. Thyroid ultrasound from ___.
FINDINGS:
Lungs are clear without consolidation, effusion, or edema. Moderate
cardiomegaly is again noted as well as tortuosity of the thoracic aorta.
Increased density at the right aspect of the upper mediastinum with associated
leftward deviation of the trachea at the thoracic inlet is compatible with
known right greater than left thyroid enlargement.
IMPRESSION:
No acute cardiopulmonary process.
|
10173851-RR-2
| 10,173,851 | 24,747,618 |
RR
| 2 |
2174-07-09 13:12:00
|
2174-07-09 13:33:00
|
INDICATION: History: ___ with cough// Pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: None
IMPRESSION:
Lungs are clear. Heart size is normal. There is no pleural effusion. No
pneumothorax is seen
|
10173851-RR-3
| 10,173,851 | 24,747,618 |
RR
| 3 |
2174-07-09 16:02:00
|
2174-07-09 16:32:00
|
EXAMINATION: CT abdomen pelvis with contrast
INDICATION: ___ with abdominal pain, tendernessNO_PO contrast// eval colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 898 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of hydronephrosis. A 1.8 cm renal cyst is visualized in
the mid-polar region left kidney. 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 not visualized though no secondary signs of
appendicitis are seen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: Multiple nonenlarged lymph nodes are visualized throughout the
upper abdomen and right lower quadrant. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No focal abnormalities identified within the abdomen or pelvis to correlate
with patient's symptoms.
2. Diverticulosis without diverticulitis.
|
10173851-RR-4
| 10,173,851 | 24,747,618 |
RR
| 4 |
2174-07-10 18:20:00
|
2174-07-10 20:19:00
|
EXAMINATION: Chest CT.
INDICATION: ___ year old man with fevers, arthralgias, and rash, suspected
Still's disease, cough// Please assess for any evidence of malignancy,
infection or other intrathoracic process
TECHNIQUE: Multidetector CT images of the chest were obtained with
intravenous contrast. Sagittal and coronal reformations were also performed.
DOSE: Acquisition sequence: 1) Spiral Acquisition 5.8 s, 37.9 cm; CTDIvol =
9.3 mGy (Body) DLP = 347.3 mGy-cm. Total DLP (Body) = 347 mGy-cm.
COMPARISON: CT abdomen and pelvis is available from the prior day.
FINDINGS:
Heart is normal in size. Great vessels are unremarkable. Aorta is normal in
caliber.
There is no intrathoracic lymphadenopathy, but there are mildly prominent
bilateral axillary lymph nodes with normal morphology on each side. The
largest of these is on the left and measures up to 20 x 15 mm in axial
___ (3:13), which is borderline in size. There is no pleural or
pericardial effusion.
Lungs appear clear.
Again noted is a small simple cyst in the upper pole of the left kidney.
There are no suspicious bone lesions. Vertebral body heights and interspaces
are preserved in height.
IMPRESSION:
Mildly prominent bilateral axillary lymph nodes, likely reactive; otherwise
unremarkable study of the chest.
|
10173851-RR-5
| 10,173,851 | 24,747,618 |
RR
| 5 |
2174-07-13 14:19:00
|
2174-07-13 16:14:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with babesiosis. clinical course improving except
for worsening LFTs// please assess for hepatobiliary pathology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 3 mm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity
Spleen length: 11.5 cm
KIDNEYS: Again demonstrated, is a 1.8 cm simple cyst in the lower pole the
left kidney. Otherwise, no suspicious renal lesions, hydronephrosis or
stones.
Right kidney: 11.8 cm
Left kidney: 10.2 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
No acute sonographic findings. Stable left simple renal cyst.
Echogenic liver consistent with steatosis. Other forms of liver disease and
more advanced liver disease including steatohepatitis or significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
RECOMMENDATION(S):
Radiological evidence of fatty liver does not exclude cirrhosis or
significant liver fibrosis which could be further evaluated by ___.
This can be requested via the ___ (FibroScan) or the Radiology
Department with either MR ___ or US ___, in conjunction with
a GI/Hepatology consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
10174363-RR-11
| 10,174,363 | 20,224,039 |
RR
| 11 |
2120-02-25 15:23:00
|
2120-02-26 11:10:00
|
EXAMINATION: CAROTID DOPPLER ULTRASOUND
INDICATION: ___ year old woman with h.o carotid disease. Several episodes of
syncope recently. // eval for carotid disease
TECHNIQUE: Duplex and color Doppler of both carotid systems was performed.
COMPARISON: ___.
FINDINGS:
THERE IS SLOW RETROGRADE FLOW IN THE RIGHT COMMON CAROTID ARTERY, CONSISTENT
WITH KNOWN PROXIMAL OCCLUSION. THERE IS LOSS, APPROPRIATE TARDUS PRIOR VARUS
WAVEFORMS. INVOLVING THE ICA. . IN ADDITION, THERE IS RETROGRADE FLOW FROM THE
EXTERNAL CAROTID ARTERY ON THE RIGHT, FEEDING THE INTERNAL CAROTID ARTERY AND
THE COMMON CAROTID ARTERY.
THERE IS SOME CALCIFIC PLAQUE AT THE ORIGIN OF THE ICA AND ECA ON THE LEFT.
THE PEAK SYSTOLIC VELOCITIES ON THE LEFT ARE 109, 226, 128, 84 AND 257 CM/SEC
FOR THE PROXIMAL MID AND DISTAL ICA AND CCA AND ECA RESPECTIVELY. THE ICA TO
CCA RATIO IS 2.7 ON THE LEFT.
IMPRESSION:
1. CENTRAL OCCLUSION OF THE RIGHT COMMON CAROTID ARTERIES.
2 APPROXIMATELY 60% STENOSIS OF THE LEFT ICA. ELEVATED LEFT ICA VELOCITIES ARE
DUE IN PART TO COMPENSATION FOR THE OCCLUDED RIGHT COMMON CAROTID ARTERY.
|
10174481-RR-21
| 10,174,481 | 28,378,496 |
RR
| 21 |
2186-06-01 03:51:00
|
2186-06-01 05:22:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: History: ___ with s/p fall. small amount of bruising around right
orbit // eval for acute traumatic pathology
TECHNIQUE: Chest AP
COMPARISON: Chest radiograph from ___.
FINDINGS:
Mild enlargement of the cardiac silhouette is unchanged. No focal
consolidations, pulmonary edema or pleural abnormality. Mild biapical
scarring is noted. No acute osseous abnormality. Compression deformities of
2 lower thoracic vertebral bodies are unchanged.
IMPRESSION:
No acute intrathoracic or osseous abnormality.
|
10174481-RR-22
| 10,174,481 | 28,378,496 |
RR
| 22 |
2186-06-01 04:42:00
|
2186-06-01 04:53:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with s/p fall. small amount of bruising around right
orbit // eval for acute traumatic pathology
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, 16.8 cm; CTDIvol = 47.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head from ___.
FINDINGS:
There is no evidence of fracture, acute large territory
infarction,hemorrhage,edema,or mass effect. There is prominence of the
ventricles and sulci suggestive of involutional changes. Confluent and severe
subcortical and periventricular white-matter hypodensities are similar and
likely represent sequela of chronic microangiopathic disease.
There is moderate mucosal thickening in the ethmoid air cells and right
sphenoid sinus. The visualized portion of the mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are normal.
IMPRESSION:
No acute intracranial abnormality on noncontrast CT head. No acute displaced
calvarial fracture.
|
10174481-RR-23
| 10,174,481 | 28,378,496 |
RR
| 23 |
2186-06-01 04:42:00
|
2186-06-01 05:01:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with s/p fall. small amount of bruising around right
orbit // eval for acute traumatic pathology
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 19.5 cm; CTDIvol = 22.8 mGy (Body) DLP = 445.1
mGy-cm.
Total DLP (Body) = 445 mGy-cm.
COMPARISON: CT C-spine from ___.
FINDINGS:
Alignment is anatomic. The bones are diffusely demineralized which may
decrease sensitivity for acute nondisplaced fractures. Within this confine:
No fractures are identified.
Multilevel degenerative changes are seen, most extensive at C5-6 and notable
for moderate to severe left neural foraminal stenosis.
There is no prevertebral edema.
Hypoattenuating thyroid nodules in the right lobe measuring up to 1.8 cm
appear unchanged. Scarring is present in the imaged lung apices.
IMPRESSION:
1. The bones are diffusely demineralized which may decrease sensitivity for
acute nondisplaced fractures. Within this confine: No fracture or traumatic
malalignment.
2. Unchanged thyroid nodules measuring up to 1.8 cm in the right lobe.
NOTIFICATION: Thyroid nodule. Ultrasound follow up recommended.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or older, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
10174481-RR-24
| 10,174,481 | 28,378,496 |
RR
| 24 |
2186-06-02 18:03:00
|
2186-06-03 08:49:00
|
EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: ___ with history of HTN, osteoporosis c/b prior hip fracture, and
TIA who presents as a referral from ___ ___ after a fall, with
evidence of MCA stroke on exam, with progressively worsening deficits in MCA
territory // evaluate MCA stroke
TECHNIQUE: Axial imaging was performed with gradient echo, FLAIR, T2, and T1
technique. Postcontrast imaging was performed with T1 spin echo and MPRAGE
technique.
3 dimensional time-of-flight MRA was performed through the brain. Sagittal and
axial T1 weighted imaging were performed along with diffusion imaging. Three
dimensional maximum intensity projection and segmented images were generated.
This report is based on interpretation of all of these images.
COMPARISON: Head CT dated ___
FINDINGS:
MR BRAIN:
There is an acute stroke involving the left corona radiata with extension
inferiorly to involve the region of the posterior putamen. There is no
evidence of acute intracranial hemorrhage. There is no evidence of mass,
significant mass effect or midline shift.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Periventricular and subcortical T2 and FLAIR hyperintensities are
nonspecific but compatible with moderate small vessel ischemic changes.
Several small chronic lacunar infarcts are noted bilaterally, the largest of
which is in the left thalamus. There is no evidence of abnormal enhancement
MRA BRAIN:
Irregular contour of the bilateral carotid siphons without significant luminal
narrowing correlates with prominent calcifications seen on the prior CT,
compatible with prominent nonocclusive atherosclerotic calcifications.
Within the right cavernous ICA, there is a saccular medially oriented
outpouching measuring 5 mm at its base and 3 mm in height, compatible with
aneurysm (4:76). There is an additional saccular outpouching of the
supraclinoid right internal carotid artery measuring 3 mm at its base and 3 mm
in height (4:61, 400:17), compatible with additional aneurysm.
The bilateral MCAs and left greater than right ACA A2 segments demonstrate
multifocal irregular luminal narrowing, most prominent at the left distal M1
segment and right inferior M2 segment. Additional irregular multifocal
luminal narrowing is seen within the right greater than left posterior
cerebral arteries. Findings are compatible with prominent atherosclerotic
changes.
There is fetal type anatomy of the left posterior cerebral artery, a normal
variant. There is fenestration of the proximal basilar artery, an anatomical
variant. The patient is left vertebral artery dominant.
IMPRESSION:
MRI HEAD:
1. Acute infarct of the left basal ganglia/corona radiata. No evidence of
intracranial hemorrhage or significant mass effect.
2. There are moderate involutional changes as well as periventricular FLAIR
hyperintensities compatible with moderate chronic small vessel ischemic
changes.
MRA HEAD:
1. There are 2 aneurysms of the right internal carotid artery measuring 5 x 3
mm and 3 x 3 mm in width and height within the right cavernous and
supraclinoid ICA, respectively.
2. Multifocal irregular luminal narrowing involving the bilateral internal
carotid arteries, MCAs, PCAs and left greater than right ACAs suggestive
prominent atherosclerotic disease.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 8:42 am, 10 minutes after
discovery of the findings.
|
10174481-RR-25
| 10,174,481 | 28,378,496 |
RR
| 25 |
2186-06-02 13:18:00
|
2186-06-02 13:44:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with fall from home, MCA stroke symptoms with
some worsening in last several hours // evaluate for hemorrhage
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 11.0 s, 18.7 cm; CTDIvol = 48.8 mGy (Head) DLP =
911.9 mGy-cm.
Total DLP (Head) = 924 mGy-cm.
COMPARISON: CT head ___
FINDINGS:
There is no evidence of fracture, acute infarction,hemorrhage,edema,or mass.
Confluent and severe subcortical and periventricular white matter
hypodensities are nonspecific, likely the sequelae of chronic small vessel
ischemic disease and appear similar in extent compared to the study from
___. There also multiple hypodensities in the basal ganglia and
thalami bilaterally which may reflect chronic lacunar infarcts. There is
prominence of the ventricles and sulci suggestive of involutional changes.
Trace mucosal secretions are seen in the right maxillary sinus. There is
moderate opacification of the ethmoid air cells and the right sphenoid sinus.
The visualized portion of the remaining paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The visualized portion of the orbits show
evidence bilateral lens implants.
IMPRESSION:
1. No acute intracranial abnormality, specifically no evidence of intracranial
hemorrhage.
|
10174481-RR-26
| 10,174,481 | 28,378,496 |
RR
| 26 |
2186-06-04 08:43:00
|
2186-06-04 11:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent CVA // Evaluate for pneumonia
TECHNIQUE: Portable chest AP
COMPARISON: Chest radiograph dated ___
FINDINGS:
In comparison to the radiograph from ___, there is interval increase
in degree of opacification at the right lower lung base adjacent to the right
heart border, concerning for a right middle lobe pneumonia in the appropriate
clinical setting. No large pleural effusions. No pneumothorax. The cardiac
silhouette is enlarged, but unchanged.
IMPRESSION:
Interval increase in the degree of opacification at the right lower lung base
adjacent to the right heart border, concerning for a right middle lobe
pneumonia in the appropriate clinical setting.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 10:57 am, 5 minutes after
discovery of the findings.
|
10174481-RR-27
| 10,174,481 | 28,378,496 |
RR
| 27 |
2186-06-07 10:46:00
|
2186-06-07 16:53:00
|
INDICATION: ___ year old woman with recent CVA, hemiparesis, dysarthria.
Recommended for video swallow by SLP // Evaluate for dysphagia
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 3 minutes 52 seconds min.
COMPARISON: None.
FINDINGS:
Penetration with honey thick and nectar thick liquids. Trace aspiration with
honey thick and nectar thick liquids.
IMPRESSION:
Penetration and trace aspiration with honey thick and nectar thick liquids.
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
10174481-RR-28
| 10,174,481 | 28,378,496 |
RR
| 28 |
2186-06-06 09:01:00
|
2186-06-06 11:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent acute CVA and R-sided hemiparesis,
aspiration pneumonitis (___), ongoing hypoxia // Evaluate for interval
change
TECHNIQUE: Portable chest AP
COMPARISON: Multiple prior chest radiographs, most recent radiograph dated ___
FINDINGS:
In comparison with the radiograph from ___, the previously noted
opacification at the right lower lung base adjacent to the right heart border
is less defined on today's study. Mild biapical scarring is noted, unchanged.
No new focal consolidations or large pleural effusions. No pneumothorax. No
pulmonary edema. Cardiomediastinal silhouette is unchanged.
IMPRESSION:
1. Previously noted opacification at the right lower lung base adjacent to the
right heart border is less defined on today's study. No new focal
consolidations.
2. Mild biapical scarring is noted, unchanged.
|
10174481-RR-29
| 10,174,481 | 28,378,496 |
RR
| 29 |
2186-06-07 10:46:00
|
2186-06-07 12:11:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with recent CVA, aspiration pneumonitis. Now
with increased cough, chest congestion on exam // Interval change
TECHNIQUE: Portable chest AP with lateral
COMPARISON: Multiple prior chest radiographs, most recent radiograph dated ___
FINDINGS:
In comparison to the radiograph from ___, the right lower lung base
opacity is unchanged since ___ but improved since ___. This
finding is consistent with improving aspiration/pneumonia in the appropriate
clinical setting. Mild biapical scarring is again noted. The interstitial
lung markings are more prominent, concerning for new pulmonary edema. No
large pleural effusions. No pneumothorax. Cardiac silhouette is enlarged,
but unchanged.
IMPRESSION:
1. Interstitial lung markings are more prominent since ___, concerning
for new mild pulmonary edema.
2. The right lower lung base opacity is unchanged since ___ but
improved since ___, consistent with improving aspiration/pneumonia.
|
10174935-RR-21
| 10,174,935 | 23,150,740 |
RR
| 21 |
2151-07-31 00:00:00
|
2151-08-01 09:01:00
|
INDICATION: ___ year old woman with impella, and swan placed// interval
changes
IMPRESSION:
Fluoroscopic images demonstrate placement of a Swan-Ganz catheter. Please
note that the superior portion of the catheter tip is not included on the
field of view. Please refer to the operative note for additional
details.There is gaseous distention of the stomach.
|
10174935-RR-23
| 10,174,935 | 23,150,740 |
RR
| 23 |
2151-08-01 01:02:00
|
2151-08-01 10:11:00
|
INDICATION: ___ year old woman with impella and Swan// need stat CXR to
confirm impella placement
COMPARISON: Intra procedural study from 1 hour earlier.
IMPRESSION:
There is a Swan-Ganz catheter with the distal tip projecting over the main
pulmonary artery in good position. Impella catheter is seen within the aorta.
Heart size is within normal limits. There is no focal consolidation, large
pleural effusions, pulmonary edema, or pneumothoraces.
|
10174935-RR-24
| 10,174,935 | 23,150,740 |
RR
| 24 |
2151-08-01 03:58:00
|
2151-08-01 09:08:00
|
INDICATION: Adjustment of Impella catheter.
COMPARISON: Compared to radiographs from ___
IMPRESSION:
Fluoroscopic images demonstrate placement of a Swan-Ganz catheter. On the
last image, the distal tip appears to terminate within a distal right main
pulmonary arterial branch. This could be pulled back 4-5 cm for more optimal
placement. Please refer to the procedure note for additional details.
|
10174935-RR-25
| 10,174,935 | 23,150,740 |
RR
| 25 |
2151-08-01 11:30:00
|
2151-08-01 13:30:00
|
INDICATION: ___ year old woman with Impella removal; CABG// eval tube position
COMPARISON: Radiographs from ___
IMPRESSION:
The Impella device has been removed. There is a Swan-Ganz catheter,
endotracheal tube, feeding tube, and chest tubes which are in standard
position. Heart size is upper limits of normal. There remains some
prominence of the upper left mediastinum, unchanged. There is minimal
blunting of the right CP angle. Lungs are relatively clear. There is no
pneumothoraces.
|
10174935-RR-26
| 10,174,935 | 23,150,740 |
RR
| 26 |
2151-08-02 13:58:00
|
2151-08-02 18:30:00
|
EXAMINATION: Lower extremity arterial duplex US.
INDICATION: ___ year old woman s/p cabg/impella pre-op, right side
cannulation// assess flow right leg
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the right lower extremity arteries was obtained.
FINDINGS:
On the right, the common femoral artery is patent with a peak velocity of 0
with impella device in place.
The SFA is patent with velocities of 37, 18, and 17 cm/sec. There is no
velocity elevation to suggest stenosis.
The popliteal artery is patent with a velocity of 11 cm/sec.
The and anterior tibial artery is patent with a velocity of 15 cm/sec but the
peronal, poterior tibial and dorsalis pedis arteries do not have flow.
IMPRPRESSION: Patent right femoral and popliteal arteries with severely
decreased flows. No flow seen in distal tibial arteries.
|
10174935-RR-27
| 10,174,935 | 23,150,740 |
RR
| 27 |
2151-08-02 14:21:00
|
2151-08-03 19:42:00
|
INDICATION: ___ year old woman s/p CABG-had Impella pre-op with in right side
cannulation// assess right ___
TECHNIQUE: Non-invasive evaluation of the arterial system in the lower
extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
FINDINGS:
On the right side, no Doppler waveforms are seen at the ankle. The toe PPG
waveform is flat.
On the left side, triphasic Doppler waveforms are seen at the posterior tibial
and dorsalis pedis arteries.
The left ABI was 1.19. The digit PPG waveform is barely pulsatile.
Pulse volume recordings are severely dampened on the right. They are normally
pulsatile at the left calf, ankle, and metatarsal levels.
IMPRESSION:
Evidence of severe right lower extremity ischemia. No evidence ischemia on
the left.
|
10174935-RR-28
| 10,174,935 | 23,150,740 |
RR
| 28 |
2151-08-02 21:09:00
|
2151-08-02 21:45:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old woman with knee pain/after impella removal// assess
for mass/trauma/ assess for mass/trauma/
TECHNIQUE: Right knee, three views.
COMPARISON: None.
FINDINGS:
Right total knee arthroplasty hardware is in place without periprosthetic
fracture, or hardware complication. Alignment is preserved. There is a
moderate joint effusion. There is no fracture or dislocation.
IMPRESSION:
Moderate joint effusion. Right TKR without fracture or dislocation.
|
10174935-RR-29
| 10,174,935 | 23,150,740 |
RR
| 29 |
2151-08-03 16:04:00
|
2151-08-03 17:20:00
|
EXAMINATION: Portable chest
INDICATION: ___ year old woman with POD 2 from Impella removal and CABGx1.//
Post chest tube removal
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiograph ___
FINDINGS:
There is a large right-sided pneumothorax. There is increased opacification
of the right lower lung which is likely due to layering pleural effusion. In
the left midlung there is a focal area of opacification which may be due to
central pulmonary vascular congestion or aspiration/pneumonia in the
appropriate clinical setting. The cardiomediastinal silhouette is mildly
enlarged and appears stable. There are medial sternotomy wires which appear
intact and aligned. There has been interval removal of a left-sided chest
tube, a Swan-Ganz catheter, endotracheal tube, and nasogastric tube. A right
central venous catheter is seen with its tip in the mid SVC.
IMPRESSION:
There is a new large right-sided pneumothorax and right-sided pleural
effusion. New area of focal opacification in the left midlung which may be
due to pulmonary vascular congestion or aspiration/pneumonia in the
appropriate clinical setting.
NOTIFICATION: The findings were discussed with Dr. ___. by
___, M.D. on the telephone on ___ at 5:10 pm, 5
minutes after discovery of the findings.
|
10174935-RR-30
| 10,174,935 | 23,150,740 |
RR
| 30 |
2151-08-03 18:03:00
|
2151-08-03 18:27:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman post pigtail placement.// Expansion of right
lung.
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 16:09
IMPRESSION:
Compared to the examination from 2 hours prior, a right upper pleural pigtail
catheter has been placed, with decrease of the right apical lateral
pneumothorax, though with small residual apical component and residual partial
collapse of the right upper lobe. No other interval changes seen.
|
10174935-RR-31
| 10,174,935 | 23,150,740 |
RR
| 31 |
2151-08-04 07:13:00
|
2151-08-04 09:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with PTX// ___ year old woman with PTX ___
year old woman with PTX
IMPRESSION:
Comparison to ___. The right internal jugular vein catheter and
the right chest tube are in stable position. On the current radiograph, there
is no evidence of pneumothorax. Moderate cardiomegaly. Mild retrocardiac
atelectasis. No larger pleural effusions.
|
10174935-RR-32
| 10,174,935 | 23,150,740 |
RR
| 32 |
2151-08-04 11:34:00
|
2151-08-04 13:28:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p cabg// chest tube on water seal-
please do xray around 1200 thank you
IMPRESSION:
In comparison with the earlier study of this date, with the right chest tube
on water seal, there is no evidence of appreciable pneumothorax.
Otherwise no change.
|
10174935-RR-33
| 10,174,935 | 23,150,740 |
RR
| 33 |
2151-08-04 18:02:00
|
2151-08-04 18:38:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman s/p Line exchange// ___ year old woman s/p Line
exchange Contact name: ___: ___
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: ___ 12:06
IMPRESSION:
Compared to the earlier same day examination, there has been exchange of the
right internal jugular central venous catheter with the tip now terminating at
the cavoatrial junction, satisfactory. There is no associated pneumothorax.
There is otherwise no significant change compared to the earlier same day
examination. The right pigtail pleural catheter remains in place and there is
no gross pneumothorax. There are likely small bilateral pleural effusions
with bibasilar atelectasis and linear lingular atelectasis. There is no
worsening or new consolidation.
|
10174935-RR-34
| 10,174,935 | 23,150,740 |
RR
| 34 |
2151-08-05 11:26:00
|
2151-08-05 12:15:00
|
EXAMINATION: Chest AP view.
INDICATION: ___ year old woman s/p clamp trial, perform at 1130// ___ year old
woman s/p clamp trial, perform at 1130
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
Chest AP view is compared to a prior done ___. Right-sided pigtail
catheter and right IJ line are unchanged in position. Small bilateral
effusions right greater than left have slightly increased in volume.
Cardiomediastinal silhouette is stable. No pneumothorax is seen. Lungs are
low volume.
|
10174935-RR-35
| 10,174,935 | 23,150,740 |
RR
| 35 |
2151-08-05 14:51:00
|
2151-08-05 15:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p chest tube removal// ___ year old woman s/p
chest tube removal ___ year old woman s/p chest tube removal
IMPRESSION:
Compared to chest radiographs ___, through 11:33.
Small right pleural effusion stable, no detectable right pneumothorax,
following removal of the right pigtail pleural drainage catheter. Previous
mild cardiomegaly has resolved and small pleural effusions are smaller.
Moderate left lower lobe atelectasis unchanged. No pulmonary edema.
Right jugular line ends in the low SVC.
|
10174935-RR-36
| 10,174,935 | 23,150,740 |
RR
| 36 |
2151-08-06 13:59:00
|
2151-08-06 15:10:00
|
EXAMINATION: Chest radiograph PA and lateral
INDICATION: ___ year old woman s/p CABG// ___ year old woman s/p CABG
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
Small bilateral pleural effusions. There is left basilar atelectasis. There
is no focal consolidation or definite evidence of pneumothorax. The cardiac
silhouette is mildly enlarged. There has been interval removal of right-sided
chest tube and a right central venous catheter. There are medial sternotomy
wires which appear aligned and intact.
IMPRESSION:
No definite evidence of pneumothorax. Stable small pleural effusions.
|
10174994-RR-25
| 10,174,994 | 20,229,162 |
RR
| 25 |
2118-06-29 19:18:00
|
2118-06-29 19:59:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: Suspected stroke with acute neurological deficit.// Please
exclude ICH, signs of early ischemic stroke, large vessel occlusion, or other
vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 32.7 mGy (Head) DLP =
16.3 mGy-cm.
3) Spiral Acquisition 5.4 s, 42.2 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,346.9 mGy-cm.
Total DLP (Head) = 2,266 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction, hemorrhage, edema, or mass. A 6 mm round
hyperdense lesion in relation to the right foramina ___ (02:19) is
compatible with a colloid cysts. There is no evidence of hydrocephalus. The
ventricles and sulci are normal in size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
Mild atherosclerotic changes at the proximal ICAs, but no ICA stenosis by
NASCET criteria. The vertebral arteries are patent. Dominant left vertebral
artery.
OTHER:
Paraseptal emphysema in the upper lobes with bullous formation in the
anteromedial aspect of the left upper lobe. 10 x 11 x 16 mm hypodense nodule
in the left parotid. The visualized portion of the thyroid gland is within
normal limits. There is no lymphadenopathy by CT size criteria.
IMPRESSION:
6 mm hyperdense lesion consistent with a colloid cyst in relation to the right
foramen of ___. No findings to suggest hydrocephalus.
No acute intracranial infarct or hemorrhage.
No intracranial arterial aneurysm or occlusion.
No ICA stenosis by NASCET criteria.
Hyperdense left parotid nodule for which correlation with ultrasound is
advised.
Paraseptal emphysematous changes with bullous formation in the anteromedial
aspect of the left upper lobe.
RECOMMENDATION(S): Ultrasound evaluation of a left parotid nodule
|
10174994-RR-26
| 10,174,994 | 20,229,162 |
RR
| 26 |
2118-06-30 23:59:00
|
2118-07-06 11:46:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with left hand and face numbness// assess for CVa
TECHNIQUE: Scout views of the head only.
COMPARISON None.
FINDINGS:
Incomplete study as the patient was unable to complete the study. Only scout
views were obtained. No gross abnormality is identified on the scout views.
IMPRESSION:
1. Incomplete study with only scout views obtained.
2. No gross abnormality identified on the scout views. Recommend patient
return for a complete study when amenable.
|
10175097-RR-12
| 10,175,097 | 29,552,546 |
RR
| 12 |
2182-02-19 00:59:00
|
2182-02-19 01:41:00
|
EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: Right-sided weakness and aphasia after t-PA.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 38.1 mGy (Head) DLP =
19.1 mGy-cm.
3) Spiral Acquisition 4.8 s, 37.9 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,172.1 mGy-cm.
Total DLP (Head) = 1,994 mGy-cm.
COMPARISON: Noncontrast head CT ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of infarction, hemorrhage, edema, or mass.
There is mild prominence of the ventricles and sulci suggestive of
involutional changes.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
The carotid and vertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized lung apices demonstrate mosaic attenuation likely due to
submaximal inspiration. The visualized portion of the thyroid gland is within
normal limits. There is no lymphadenopathy by CT size criteria.
IMPRESSION:
1. No acute intracranial abnormality.
2. Patent intracranial vasculature. No aneurysm.
3. Patent cervical vasculature without dissection.
|
10175097-RR-14
| 10,175,097 | 29,552,546 |
RR
| 14 |
2182-02-19 10:38:00
|
2182-02-19 12:41:00
|
EXAMINATION:
MRI OF THE CERVICAL SPINE
INDICATION: ___ year old woman with post tpa // stenosis? explanation for
difficulty swallowing and dysphasia
TECHNIQUE: T1, T2 and inversion recovery sagittal and gradient sequence T2
axial images of cervical spine obtained.
COMPARISON: No prior similar examinations.
FINDINGS:
Inversion recovery images are limited by motion for evaluation of spinal cord
signal which was adequately evaluated on T2 sagittal and axial images.
At the craniocervical junction and C2-3 level mild degenerative change seen.
At C3-4 level disc bulging and thickening of the ligaments result in mild
spinal stenosis with mild narrowing of the left foramen.
At C4-5 posterior disc osteophyte is seen indenting the thecal sac and
deforming the spinal cord resulting in moderate spinal stenosis with moderate
left foraminal narrowing and mild right foraminal narrowing.
At C5-6 posterior disc osteophyte and facet degenerative changes resulting in
mild-to-moderate spinal stenosis with moderate bilateral foraminal narrowing.
At C6-7 mild disc bulging identified without spinal stenosis or foraminal
narrowing.
From C7-T1 to T3-4 degenerative changes are seen on the sagittal images.
Disc bulging contacts the spinal cord from C3-4 to C5-6 level with deformity
at C4-5 level. No definite abnormal signal is seen within the spinal cord.
IMPRESSION:
Changes of cervical spondylosis with mild spinal stenosis at C3-4 moderate
spinal stenosis at C4-5 and mild to moderate spinal stenosis at C5-6 level.
Deformity of the spinal cord by disc bulging at C4-5 level with spinal cord
contact by disc bulging at C3-4 and C5-6 levels. No abnormal signal within
the spinal cord. Foraminal changes as described above.
|
10175097-RR-15
| 10,175,097 | 29,552,546 |
RR
| 15 |
2182-02-19 10:38:00
|
2182-02-19 12:53:00
|
EXAMINATION: MRI AND MRA BRAIN
INDICATION: ___ year old woman with HTN, HLD p/w aphasia and R sided weakness
s/p tPA at OSH // ?stroke
TECHNIQUE: T1 sagittal and FLAIR, T2, susceptibility and diffusion axial
images of the brain were acquired. 3D time-of-flight MRA of the circle of
___ was obtained.
COMPARISON: CT angiography ___.
FINDINGS:
Infarct identified on diffusion images. Few scattered foci of FLAIR
hyperintensity indicate early changes of small vessel disease. There is no
mass effect midline shift or hydrocephalus. There are no chronic micro
hemorrhages. Subtle signal abnormality within the left frontal bone on
diffusion images (09:25) does not have correlate on the previous head CT and
appears to be due to venous channels.
MRA of the head shows normal signal in the arteries of the anterior and
posterior circulation. No evidence of vascular occlusion stenosis or an
aneurysm greater than 3 mm in size seen.
IMPRESSION:
No acute infarcts or other significant abnormalities on MRI brain without
gadolinium. . No significant abnormalities are seen on MRA of the head.
|
10175301-RR-4
| 10,175,301 | 21,582,456 |
RR
| 4 |
2127-02-01 09:28:00
|
2127-02-01 11:38:00
|
INDICATION: ___ year old man with pelvic masses on OSH CT abdomen/pelvis
(images uploaded). Need biopsy for tissue diagnosis of likely malignancy. //
Please biopsy pelvic mass.
COMPARISON: Comparison made to CT from ___.
PROCEDURE: CT-guided pelvic mass biopsy.
OPERATORS: Dr. ___ trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure pre and postcontrast CTscan of the intended biopsy area was
performed. Based on the CT findings an appropriate position for the biopsy
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 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, which were sent for pathology.
The specimen was evaluated by onsite cytologist, deemed adequate.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: Found no primary dose record and no dose record stored with the
sibling of a split exam.
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
40 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Enhancing pelvic mass extending along the left lateral aspect of the
bladder wall, with involvement of the seminal vesicles and prostate,
superiorly extending in the retroperitoneum, abutting the left common iliac
artery and vein. The left common iliac vein appears obstructed. Distal left
ureteric obstruction.
2. Ascites.
3. Multiple sclerotic osseous lesions concerning for metastases.
IMPRESSION:
Uneventful left pelvic mass core needle biopsy.
|
10175457-RR-9
| 10,175,457 | 20,436,733 |
RR
| 9 |
2127-07-11 06:09:00
|
2127-07-11 07:12:00
|
HISTORY: ___ with headache. Rule out mass or CVT.
COMPARISON: None.
TECHNIQUE: Sagittal T1-weighted sequence, axial FLAIR, axial T2, magnetic
susceptibility and diffusion-weighted images were obtained. Subsequently, 2D
time-of-flight MRV was performed.
FINDINGS:
There is mild cerebral and cerebellar volume loss. Normal ventricular size. No
mass, edema or infarct is demonstrated. No diffusion abnormality is present.
Normal flow related enhancement in the dural venous sinuses and internal
cerebral veins.
Minor foci of increased FLAIR-signal are noted involving the periventricular
white matter, and subcortical white matter in the left frontal and parietal
lobe that are non-specific.
The orbits are unremarkable. There is minor mucosal thickening involving the
ethmoid air cells. Normal bone marrow signal is demonstrated.
IMPRESSION:
No mass or cerebral venous sinus thrombosis.
|
10175944-RR-32
| 10,175,944 | 28,061,875 |
RR
| 32 |
2155-08-20 20:28:00
|
2155-08-20 21:05:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with EtOH p/w anemia // RUQ u/s w/ dopplers
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. There is no focal liver mass. The
main, right, and left portal veins are patent with hepatofugal flow. There is
a large amount of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: The gallbladder is surgically absent.
PANCREAS: The pancreas is not well visualized.
SPLEEN: Normal echogenicity, measuring 13.4 cm.
KIDNEYS: The right kidney measures 10.7 cm. The left kidney measures 10.7 cm.
Limited views demonstrate no stone, mass, or hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Patent portal veins with reversed flow.
2. Cirrhotic liver with sequela of portal hypertension, including splenomegaly
and massive ascites.
|
10175944-RR-33
| 10,175,944 | 28,061,875 |
RR
| 33 |
2155-08-21 09:58:00
|
2155-08-21 12:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with intubation. // pls eval ET tube
placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: Prior radiographs of ___
FINDINGS:
Compared with prior radiographs of ___, there has been interval
placement of an ET tube which is located at the origin of the right mainstem
bronchus and should be pulled back 4 cm for more standard positioning. A left
perihilar consolidation is increased from prior. There is no pneumothorax.
There is no large pleural effusion. Overall lung volumes are low, with
atelectasis at the left lung base. Heart size is normal.
IMPRESSION:
1. ET tube is located the origin of the right mainstem bronchus, and should
be pulled back 4 cm for more standard positioning.
2. Worsening left upper lobe pneumonia.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephoneon ___ at 12:09 ___, 10 minutes after
discovery of the findings.
|
10175944-RR-34
| 10,175,944 | 28,061,875 |
RR
| 34 |
2155-08-24 00:52:00
|
2155-08-24 13:47:00
|
INDICATION: ___ year old woman with a history of duodenitis and vomiting
evaluate for evidence of ileus.
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: ___ CT of the abdomen and pelvis with contrast.
FINDINGS:
The stomach is air-filled, dilated, and contains radiopaque tablets. There
are no abnormally dilated loops of large or small bowel. Supine assessment
limits detection for free air; there is no gross pneumoperitoneum. Clips in
the right upper quadrant are consistent with prior cholecystectomy. Osseous
structures are unremarkable. Featureless abdomen suggests the presence of
ascites.
IMPRESSION:
Air-filled dilated stomach. No evidence of obstruction or ileus.
|
10175944-RR-35
| 10,175,944 | 28,061,875 |
RR
| 35 |
2155-08-24 01:48:00
|
2155-08-24 08:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SOB // pls eval pulm edema, evidence of
ASN
IMPRESSION:
As compared to prior radiograph of ___, the patient has been
extubated. Cardiomediastinal contours are stable. Worsening pulmonary
vascular congestion is accompanied by worsening bilateral airspace opacities
which are most severe in the lung apices. Differential diagnosis includes
asymmetrical edema, including neurogenic edema, as well as edema with
secondary superimposed process such as multifocal aspiration, hemorrhage, or
infectious pneumonia PA.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.