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
|
|---|---|---|---|---|---|---|---|
10175944-RR-36
| 10,175,944 | 28,061,875 |
RR
| 36 |
2155-08-24 20:56:00
|
2155-08-25 08:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cirrhosis, hypoxemia, and new NGT //
evaluate for NGT placement and aspiration pneumonitis evaluate for NGT
placement and aspiration pneumonitis
IMPRESSION:
Comparison to ___, 01:59. The patient has received the new
nasogastric tube. The tip of the tube projects over the middle parts of the
stomach. No complications. The low lung volumes and the diffuse bilateral
parenchymal opacities have not changed in extent and severity.
|
10176087-RR-10
| 10,176,087 | 21,498,645 |
RR
| 10 |
2116-07-11 18:01:00
|
2116-07-11 18:34:00
|
EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION: ___ with DOE, d-dimer 6000 // assess for PE
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. IV contrast was administered. Axial images were interpreted in
conjunction with sagittal and coronal reformats.
DLP: 399 mGy-cm
COMPARISON: None
FINDINGS:
There is a saddle embolus in the main pulmonary artery extending into the
right and left branches. Extensive filling defects are noted within the right
and left pulmonary arteries extending into the lobar and segmental branches
most notably in the right lower lobe. There is no definite evidence of right
heart strain.
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph
nodes are not pathologically enlarged. The great vessels are normal caliber.
The heart size is normal. No pericardial effusion.
The airways are patent to subsegmental levels.
There is developing consolidation in the right lower lobe which is concerning
for infarction. Additionally, subtle areas of hypodensity in the left lower
lobe appear more consistent with atelectasis versus infarction. No pleural
effusion.
There is a small hiatal hernia. The visualized upper abdominal organs are
unremarkable.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
Extensive bilateral pulmonary emboli including saddle embolism with greatest
clot burden in the right lower lobe. Probable early infarction in the right
lower lobe, possibly also in the left lower lobe. No definite evidence of
right heart strain.
NOTIFICATION: Findings communicated to Dr. ___ telephone at 18:32 at
the time of discovery by Dr. ___.
|
10176087-RR-11
| 10,176,087 | 21,498,645 |
RR
| 11 |
2116-07-12 09:42:00
|
2116-07-12 11:40:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old man with saddle pulmonary embolus.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal compressibility flow and augmentation of the left common
femoral and proximal femoral artery. From the mid femoral through the
popliteal vein, there is nonocclusive thrombus as demonstrated by
noncompressibility. Normal color flow and compressibility is demonstrated
within the posterior tibial veins. Lack of compressibility of the anterior
peroneal vein indicates additional thrombus which appears nonocclusive.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
Nonocclusive thrombus extending from the mid femoral vein through the
popliteal vein and involving the anterior peroneal vein within the left lower
extremity.
These findings were communicated to the house staff, Dr. ___, by Dr. ___
___ telephone at 10:30 on ___ immediately upon completion of the
study.
|
10176494-RR-49
| 10,176,494 | 21,768,537 |
RR
| 49 |
2149-03-16 06:31:00
|
2149-03-16 10:11:00
|
INDICATION: Acute mental status change.
COMPARISON: Chest radiograph ___.
FINDINGS: Accounting for differences in technique compared to the prior
study, the cardiomediastinal and hilar contours are stable with unfolding the
thoracic aorta. There is no pleural effusion or pneumothorax. Lungs are
mildly underinflated but clear. Pulmonary vasculature is within normal
limits.
IMPRESSION: No acute cardiopulmonary process.
|
10176494-RR-50
| 10,176,494 | 21,768,537 |
RR
| 50 |
2149-03-16 06:35:00
|
2149-03-16 08:01:00
|
HISTORY: Altered mental status, history of falls in the past. Unclear if hit
head at this time.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Multiplanar reformatted images in
coronal and sagittal axes and thin-section bone algorithm reconstructed images
were acquired.
DLP: 898 mGy-cm
CTDIvol: 64 mGy.
COMPARISON: None available
FINDINGS:
There is no evidence of acute hemorrhage, edema, mass effect or acute major
vascular infarction. Moderate prominence of the ventricles and sylvian
fissures, and milder prominence of the sulci, indicate parenchymal atrophy.
The left lateral ventricle is larger than the right, likely a congenital or
developmental finding. The basal cisterns appear patent.
No fracture is identified. The visualized paranasal sinuses and mastoid air
cells are clear.
IMPRESSION:
No evidence of acute intracranial process.
|
10176494-RR-53
| 10,176,494 | 21,768,537 |
RR
| 53 |
2149-03-16 20:13:00
|
2149-03-17 10:07:00
|
HISTORY: Possible seizure with nystagmus and wide based DLP.
TECHNIQUE: Sagittal T1 imaging was performed followed by axial diffusion,
FLAIR, T2, gradient echo, and 3 dimensional time-of-flight MRA. Neck MRA was
performed during infusion of 13 cc of MultiHance intravenous contrast.
COMPARISON: Head CT ___.
FINDINGS:
Images of the brain demonstrate no evidence of hemorrhage, edema, masses, mass
effect, or infarction. The ventricles and sulci are mildly prominent in an
atrophic pattern.
The brain MRA is of somewhat limited technical quality due to motion artifact.
Within this limitation, no definite abnormalities are demonstrated. The left
vertebral artery is hypoplastic and appears to terminate in the posterior
inferior cerebellar artery. There is no evidence of aneurysm or stenosis.
The MRA of the neck appears normal. The origins of the great vessels,
subclavian, carotid, and cervical vertebral arteries appear normal. The right
vertebral artery is dominant. There is no evidence of internal carotid artery
stenosis by NASCET criteria.
IMPRESSION:
Hypoplastic left vertebral artery. No other abnormalities detected.
|
10176494-RR-58
| 10,176,494 | 28,734,584 |
RR
| 58 |
2151-01-09 20:56:00
|
2151-01-09 21:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ intubated in field // ? tube placement
COMPARISON: None
FINDINGS:
AP portable supine view of the chest. Endotracheal tube is seen entering the
right mainstem bronchus. Retraction by at least 3-4 cm is recommended.
Endogastric tube descends just beyond the GE junction. Mild left basal
atelectasis. Otherwise lungs appear clear. No supine evidence for effusion
or pneumothorax. Cardiomediastinal silhouette appears grossly within normal
limits. No acute bony abnormalities.
IMPRESSION:
1. Right mainstem bronchus intubation. Retraction by 3-4 cm is recommended.
2. Advancement of the OG tube by at least 8-10 cm would result in more optimal
positioning.
3. Mild left basal atelectasis
|
10176494-RR-59
| 10,176,494 | 28,734,584 |
RR
| 59 |
2151-01-09 21:32:00
|
2151-01-09 21:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with altered mental status, pinpoint pupils, ? acute
intracranial process.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 780 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Diffuse sulcal prominence reflect age related involutional
changes. Ventricles appear within normal limits. Basilar cisterns are
patent. Minimal mucosal thickening within the imaged paranasal sinuses noted.
The mastoid air cells and middle ear cavities appear well aerated. Mastoid
air cells and middle ear cavities are well aerated. The bony calvarium is
intact.
IMPRESSION:
No acute intracranial process.
|
10176494-RR-60
| 10,176,494 | 28,734,584 |
RR
| 60 |
2151-01-09 22:13:00
|
2151-01-09 22:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with R mainstem intubation, interval repositioning.
TECHNIQUE: Portable upright chest radiograph
COMPARISON: 1 hr prior
FINDINGS:
The endotracheal tube has been retracted, now terminating approximately 2 cm
from the carina. The enteric tube terminates in the left upper quadrant with
the proximal side port at the gastroesophageal junction to. Heart size and
mediastinal contours are normal. Lungs are clear aside from basilar
atelectasis. No pneumothorax.
IMPRESSION:
1. Interval retraction of endotracheal tube with tip now terminating 2 cm from
the carina.
2. Proximal side port of the enteric tube is at the gastroesophageal junction.
|
10176643-RR-24
| 10,176,643 | 25,918,580 |
RR
| 24 |
2143-11-10 20:26:00
|
2143-11-10 20:56:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with leg swelling, hx of DVT, evaluate for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10176643-RR-25
| 10,176,643 | 25,918,580 |
RR
| 25 |
2143-11-10 23:25:00
|
2143-11-11 00:34:00
|
EXAMINATION: CT lower extremity
INDICATION: ___ year old woman with rapidly progressive cellulitis of the
right ___. // Please eval for signs of nec fasc in the right lower extremity.
TECHNIQUE: MDCT images were obtained from the distal femur through the toes
without IV contrast
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 7.4 s, 57.9 cm; CTDIvol = 17.0 mGy (Body) DLP = 983.3
mGy-cm.
Total DLP (Body) = 983 mGy-cm.
COMPARISON: None.
FINDINGS:
There is a 3.9 x 1.2 x 2.8 cm fluid collection within the subcutaneous fat
overlying the anteromedial aspect of the right tibia with a large amount of
surrounding fat stranding, concerning for an abscess. The remainder of the
lower extremity is diffusely edematous. No additional fluid collections are
appreciated. No lytic or blastic lesions are suspicious for infection or
malignancy. The patient is status post right knee replacement without
complication. Soft tissue calcifications are noted throughout lower
extremity.
No soft tissue gas is seen.
Partial fatty atrophy of the medial gastrocnemius head. Scattered dystrophic
calcifications the soleus muscle.
IMPRESSION:
3.9 x 1.2 x 2.8 cm fluid collection within the subcutaneous fat overlying the
anteromedial aspect of the right tibia is consistent with an abscess.
|
10176833-RR-19
| 10,176,833 | 20,607,200 |
RR
| 19 |
2122-07-31 22:01:00
|
2122-07-31 23:10:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: History: ___ with s/p ATV accident, proximal tib fib fracture //
Evaluate fracture and for neighboring injuries Evaluate fracture and
for neighboring injuries
TECHNIQUE: Frontal and lateral view radiographs of right tibia and fibula
COMPARISON: None available.
FINDINGS:
In the metadiaphysis of the right proximal tibia, there is a comminuted
fracture with inferior and posterior displacement of distal fracture fragment.
There is a oblique lucent fracture line that extends superiorly towards the
tibial plateau, but there is no cortical irregularity of the tibial plateau.
Another lucent line which overlies the lateral articular surface of the tibia
is nonspecific. There is significant soft tissue swelling. There is no
evidence of fracture of the fibula.
IMPRESSION:
1. Comminuted and displaced fracture of the right proximal tibia with the
fracture line extending superiorly towards the tibial plateau, but no definite
evidence of intra-articular extension
2. An oblique lucent line overlying the lateral articular surface of the
tibia is nonspecific. However, a second fracture involving the articular
surface cannot be ruled out.
|
10176833-RR-20
| 10,176,833 | 20,607,200 |
RR
| 20 |
2122-08-01 00:47:00
|
2122-08-01 01:56:00
|
EXAMINATION: CT right lower extremity.
INDICATION: ___ year old man with proximal tib fib fracture // Evaluate
fracture and knee
TECHNIQUE: Noncontrast multidetector CT images were acquired through the
right lower extremity.
COMPARISON: Right lower extremity radiographs dated ___.
FINDINGS:
There are comminuted fractures noted involving the proximal right tibia, with
extension into the lateral and medial tibial plateaus. There is diastasis of
the two largest fracture fragments, which measures up to 6 mm on the axial
view (2:74). There is angulation with anterior displacement of the largest
proximal fracture fragment, which measures up to 2.5 cm (401b:92).
Additionally, there is intra-articular extension of the fracture line into the
medial tibial plateau, the lateral total plateau, and the tibial spine. No
discrete depression of the articular surface of the tibia is identified.
Extensive soft tissue tissue swelling is noted. The anterior cruciate
ligament is noted insert on one of the more proximal fracture fragments. A
large joint effusion is present, and contains both a fat fluid level and
several small left foci of air. Additionally, there is a small focus of air
seen in the soft tissues immediately adjacent to the medial femoral condyle.
IMPRESSION:
1. Comminuted fracture of the proximal right tibia involving the lateral and
medial tibial plateaus with intra-articular extension.
2. Significant associated soft tissue edema and stranding, in addition to a
large joint effusion demonstrating a lipohemarthrosis.
|
10176833-RR-21
| 10,176,833 | 20,607,200 |
RR
| 21 |
2122-08-01 07:48:00
|
2122-08-01 09:49:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: RT TIB FX.ORIF
IMPRESSION:
Fluoroscopic images show placement of a fixation device about the fracture of
the proximal tibia. Further information can be gathered from the operative
report.
|
10176871-RR-5
| 10,176,871 | 28,364,588 |
RR
| 5 |
2162-05-12 08:51:00
|
2162-05-12 13:48:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with pituitary hemorrhage, ___ head pain.
Neurologically intact. Evaluate intracranial 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 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: MR head ___.
CT head ___
FINDINGS:
Hemorrhage in the sella is not significantly changed in extent from prior head
CT on ___, without suprasellar or other extrasellar extension. No
new hemorrhage is seen. No parenchymal edema, mass effect, or loss of
gray/white matter differentiation. Ventricles, sulci, and basal cisterns are
normal in size. Cerebellar tonsils are normally positioned.
No suspicious osseous abnormality is seen. Marked enlargement of the adenoids
for the patient's age is again noted. Since the prior CT, there has been new
opacification of the left nasal cavity and new trace fluid in the left
sphenoid sinus, likely secondary to prolonged supine positioning in the
inpatient setting. Mild partial bilateral mastoid air cell opacification is
unchanged.
IMPRESSION:
1. No significant change in the sellar hemorrhage, without suprasellar or
other extrasellar extension. No new hemorrhage.
2. Unchanged marked enlargement of the adenoids. Please correlate clinically
whether there has been upper respiratory infection or inflammation to explain
this finding.
|
10176871-RR-6
| 10,176,871 | 28,364,588 |
RR
| 6 |
2162-05-13 14:28:00
|
2162-05-13 16:20:00
|
INDICATION: ___ year old woman with multiple DVT/PE on Coumadin, presenting
with stable pituitary bleed.// Patient will be off Coumadin until follow up in
___ clinic; need IVC filter placed to prevent PE.
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100mcg of fentanyl and 2 mg of midazolam throughout the total intra-service
time of 45 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 5 cc 1% buffered lidocaine subcutaneous injection at the access
site
CONTRAST: 60 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 9.2 min, 296 mGy
PROCEDURE:
1. Left iliac vein and IVC venogram.
2. Infrarenal retrievable IVC filter deployment.
3. Post-filter placement venogram.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck was prepped and draped in the usual sterile fashion.
Under ultrasound and fluoroscopic guidance, the patent and compressible right
internal jugular vein was punctured using a 21G micropuncture needle.
Ultrasound images of the access was stored on PACS. A ___ wire was advanced
through the micropuncture sheath into the inferior vena cava. The
micropuncture sheath was then removed over the wire and serial dilatation up
to 9 ___ was performed at the venotomy. Next, the 8.4F Denali sheath was
then inserted over the wire into the inferior vena cava. The inner dilator
was removed and a 5 ___ Omniflush catheter was advanced over the wire into
the left common iliac vein.
A left common iliac and inferior vena cava venogram was performed. Based on
the results of the venogram, detailed below, a decision was made to place a
retrievable filter. The catheter and sheath were removed over the wire and the
sheath of an retrievable (Denali) filter was advanced over the wire into the
IVC past the take-off of the renal vessels. A retrievable vena cava filter
was advanced over the wire until the cranial tip was at the level just
inferior to the margin of the lower renal veins. The sheath was then
withdrawn until the filter was deployed. The wire and loading device were then
removed through the sheath and a repeat contrast injection was performed,
confirming appropriate filter positioning. The final image was stored on PACS.
The sheath was removed and pressure was held for 10 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with single bilateral renal veins
and no evidence of a clot.
2. Successful deployment of an infra-renal retrievable (Denali) IVC filter.
IMPRESSION:
Successful deployment of retrievable (Denali) IVC filter.
|
10177053-RR-26
| 10,177,053 | 25,406,284 |
RR
| 26 |
2175-02-03 08:19:00
|
2175-02-03 09:23:00
|
INDICATION: ___ status post fall.
TECHNIQUE: Single AP chest radiograph.
COMPARISON: None available.
FINDINGS:
Single portable AP chest radiograph demonstrates low lung volumes. There is no
focal consolidation. No pleural effusion or pneumothorax is identified.
Cardiomediastinal and hilar contours are within normal limits. Several right
rib fractures identified including the lateral third, posterior fourth, and
lateral sixth.
IMPRESSION:
Several right-sided rib fractures including the third fourth and sixth ribs.
No evidence of a pneumothorax.
|
10177053-RR-27
| 10,177,053 | 25,406,284 |
RR
| 27 |
2175-02-03 08:23:00
|
2175-02-03 13:45:00
|
INDICATION: Patient is status post trauma after fall with abrasions to the
head and ecchymosis in the abdomen. Evaluate for bleed
COMPARISON: None available.
TECHNIQUE: Contiguous axial MDCT images were obtained through the head
without administration of IV contrast. Coronal, sagittal, and thin slice bone
reformats were generated.
DLP: 1114.91 mGy-cm.
CTDI: 55.75 mGy.
FINDINGS: There is no hemorrhage, edema, mass, mass effect, or acute
infarction. The ventricles and sulci are slightly prominent, noteworthy in a
patient in this age group. There is preservation of gray-white matter
differentiation, and the basal cisterns are patent.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. A scalp laceration is identified in
the left aspect of the superior frontal region.
IMPRESSION: No evidence of acute intracranial process. Laceration in the
scalp overlying the left superior frontal region.
|
10177053-RR-28
| 10,177,053 | 25,406,284 |
RR
| 28 |
2175-02-03 08:23:00
|
2175-02-03 09:42:00
|
INDICATION: ___ male status post fall with abrasion to the head and
ecchymosis in the abdomen. Evaluate for cervical spine trauma.
COMPARISON: None available.
TECHNIQUE: Axial helical MDCT images were obtained from the skull base to the
level of T1 without administration of IV contrast. Coronal, sagittal, and
thin slice bone reformats were generated.
DLP: 828.1 mGy-cm.
CTDIvol: 36.85 mGy.
FINDINGS: The cervical lordosis is preserved. There is no fracture or
malalignment. Moderate degenerative changes of the cervical spine are
identified, more prominent at the level of C5-C6, C6-C7, and C7-T1.
Degenerative changes are characterized by loss of disc height, anterior and
posterior spondylophytes, and facet joint arthropathy. Spondylophytes are
seen impinging upon the thecal sac, more prominently at the level of C6-C7,
resulting in mild-to-moderate narrowing of the spinal canal. There is no
prevertebral soft tissue swelling. The aerodigestive tract is unremarkable.
The imaged lung apices are clear.
IMPRESSION: No evidence of fracture or malalignment. Degenerative changes of
the cervical spine as described above.
Final Attending comment: There is a large central disc protrusion at C4-5
which impinges the thecal sac and there is severe canal stenosis at C5-6 and
C6-7. These findings would be better assessed on MRI.
|
10177053-RR-29
| 10,177,053 | 25,406,284 |
RR
| 29 |
2175-02-03 08:24:00
|
2175-02-03 10:09:00
|
INDICATION: Patient status post trauma after fall with abrasions to the head
and ecchymosis in the abdomen. Evaluate.
COMPARISON: None available.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the pubic symphysis after the uneventful administration of IV
contrast. Coronal and sagittal reformations were generated.
DLP: 676.07 mGy-cm.
FINDINGS:
CT CHEST:
MEDIASTINUM: The thyroid gland is unremarkable. There is no central or
axillary lymphadenopathy. The heart and great vessels are within normal
limits. There is no pericardial effusion. There is no esophageal wall
thickening or hiatal hernia. Multiple periesophageal varices will be further
described in the abdomen section of the report.
LUNGS AND AIRWAYS: The airways are patent to the subsegmental level. No
intraluminal lesion is identified. There is no evidence of consolidation
within the lungs. There is no pleural effusion. Minimal bibasilar
atelectasis is present. No pneumothorax.
CT ABDOMEN: The liver has a nodular contour in keeping with known history of
hepatitis C-related cirrhosis. The caudate lobe is slightly hypertrophied,
also compatible with cirrhosis. However, there are no focal lesions or
intrahepatic biliary duct dilatation. The gallbladder is unremarkable. The
portal vein is patent. A 2.2 cm lipoma is present in the uncinate process
ofthe pancreas. Otherwise, the pancrea and adrenal glands are within normal
limits. Mild splenomegaly is present with the spleen measuring 13.4 cm of
craniocaudal dimension. The kidneys demonstrate symmetric nephrograms and
excretion of contrast. There are no focal renal lesions, hydronephrosis.
The aorta is normal in caliber throughout. The main intra-abdominal vessels
are patent. There are numerous perigastric, periesophageal, and perisplenic
varices, as well as recanalization of the paraumbilical veins with multiple
varicose veins seen in the anterior abdomen, sequelae of chronic portal
hypertension. Of note, there is mild stranding in the mesentery adjacent to
the origin of the SMA and celiac trunk (2:52). This may represent a
mesenteric contusion, although mesenteric venous congestion is also possible
in the setting of portal hypertension. There is no abdominal free air or
abdominal wall hernia. The small and large bowel are unremarkable.
PELVIC CT: The urinary bladder is unremarkable. There is no pelvic free
fluid. There is no pelvic wall or inguinal lymphadenopathy. Bilateral
fat-containing inguinal hernias are identified.
OSSEOUS STRUCTURES: There are displaced and comminuted fractures of the
posterolateral right third, fourth, and fifth ribs. There are old
non-displaced fractures of the posterior left eleventh and tenth ribs. The
right glenohumeral joint is incompletely imaged, but there is complete
obliteration of the joint space, raising concern for subluxation of the right
shoulder. In the left shoulder, there is a linear lucency in the humeral
head, only appreciated in the first image (series 2, image 1), which may
represent a fracture, but is incompletely evaluated. There is no thoracic or
lumbar spine fracture. Minimal retrolisthesis of L2 on L3 and L3 on L4 is
identified with loss of disc height and vacuum phenomenon at the same level,
suggestive of degenerative changes. No pelvic or hip fractures are
identified. There are no lytic or blastic lesions concerning for malignancy.
IMPRESSION:
1. Multiple comminuted and displaced fractures of the right posterolateral
ribs ___. No other acute fractures identified. Old fractures of the
posterior left ribs 10 and 11 are present.
2. Minimal retrolisthesis of L2 on L3 and L3 on L4 are likely secondary to
degenerative changes. There is no evidence of acute fracture or malalignment
in the thoracic or lumbar spine.
3. The appearance of the liver is compatible with liver cirrhosis. Sequelae
of portal hypertension include periesophageal, perigastric, and perisplenic
varices as well as recanalization of the paraumbilical veins. Mild
splenomegaly is also present.
4. No evidence of solid or hollow organ injury within the abdomen. Mild
stranding of the mesentery adjacent to the origin of the celiac trunk and
superior mesenteric artery may represent mild congestion from portal
hypertension.
5. Uncinate process lipoma incidentally noted.
These findings were communicated to Dr. ___ by Dr. ___ on ___ at
9:30 a.m. in person immediately after discovery of the findings.
|
10177053-RR-30
| 10,177,053 | 25,406,284 |
RR
| 30 |
2175-02-03 09:01:00
|
2175-02-03 09:29:00
|
EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) LEFT
INDICATION: History: ___ with fall down stairs // r/o fx
TECHNIQUE:
Three views of the left shoulder.
COMPARISON: .
FINDINGS:
Three views of the left shoulder were obtained. These demonstrate no fracture
or dislocation. Degenerative changes about the acromioclavicular joint are
seen. The humeral head appears well seated in the glenoid fossa. Limited
views of the left chest wall are unremarkable.
IMPRESSION:
No fracture or dislocation identified.
|
10177094-RR-3
| 10,177,094 | 28,906,835 |
RR
| 3 |
2175-11-25 12:47:00
|
2175-11-25 14:06:00
|
INDICATION: ___ year old woman status post with cervical ectopic hemorrhaging
GUIDANCE, INTERVENTIONAL PROCEDURE:
Ultrasonic guidance was provided by the radiology department assisted by Dr
___, Dr. ___ Dr. ___ the successful guidance of an
intraoperative dilatation and curettage performed by the maternal fetal
medicine physicians. The procedure took approximately 30 minutes.
|
10177158-RR-12
| 10,177,158 | 23,456,006 |
RR
| 12 |
2177-07-22 16:07:00
|
2177-07-22 17:49:00
|
INDICATION: ___ year old man with hx of kidney stone with stent placement//
r/o stone, pyelo
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 390 mGy-cm.
COMPARISON: Outside hospital CT torso from ___.
FINDINGS:
LOWER CHEST: The visualized lung bases are clear. There is no pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver is homogeneous in background attenuation. Multiple
hypodensities, the largest measuring 1.1 cm in segment 7, are too small to
characterize but likely represent simple hepatic cysts or biliary hamartomas
and were seen on prior. No obvious focal lesion is identified, within the
limits of a noncontrast exam. There is no intra or extrahepatic biliary duct
dilation. The gallbladder is decompressed.
PANCREAS: The pancreas is normal in attenuation, without mass, ductal
dilation, or peripancreatic stranding or fluid collection. Punctate
calcifications and suggest a history of chronic pancreatitis. There is no
peripancreatic stranding.
SPLEEN: The spleen is homogeneous and normal in size.
ADRENALS: The adrenal glands are normal in caliber and configuration
bilaterally.
URINARY: The kidneys are symmetric and normal in size. Again seen is a
staghorn calculus involving the entire right kidney, similar in appearance
compared to ___. There is a left percutaneous nephrostomy, as well
as a left nephroureteral stent. There is been interval left lithotripsy, with
removal of several large upper and lower pole stones. Residual calculi are
noted predominantly in the lower pole. There is mild left hydronephrosis.
There is no evidence of focal renal lesions within the limitations of an
unenhanced scan. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is distended with ingested material. Small
bowel loops demonstrate normal caliber and wall thickness throughout. The
colon and rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: Left periaortic lymph nodes are mildly enlarged, measuring up to
1.2 cm (02:25). This is increased compared to ___, when it measured
9 mm. There is no mesenteric lymphadenopathy. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Transitional anatomy noted at the lumbosacral junction. Unilateral
right-sided spondylolysis of the fifth non rib-bearing lumbar type vertebral
body is noted.
SOFT TISSUES: Other than the left percutaneous nephrostomy, the abdominopelvic
walls are unremarkable.
IMPRESSION:
1. Status post interval left lithotripsy, with few nonobstructing residual
calcifications/stones. Mild left hydronephrosis. No perinephric stranding.
2. Left nephroureteral stent and percutaneous nephrostomy in what appears to
be appropriate position.
3. Unchanged right staghorn calculus.
4. Left periaortic lymphadenopathy, slightly increased in size compared to
___.
|
10177415-RR-10
| 10,177,415 | 24,337,996 |
RR
| 10 |
2157-03-10 16:28:00
|
2157-03-10 18:27:00
|
INDICATION: ___ year old woman with untreated lung adenocarcinoma for about
six months.// ?metastases
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.4 s, 54.2 cm; CTDIvol = 18.8 mGy (Body) DLP =
1,016.5 mGy-cm.
2) Stationary Acquisition 6.1 s, 0.5 cm; CTDIvol = 33.5 mGy (Body) DLP =
16.8 mGy-cm.
Total DLP (Body) = 1,033 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
LOWER CHEST: Left-sided segmental pulmonary emboli again seen (2:8, 2:3). In
the partially visualized right lung, diffuse hyperenhancing pleural
rind/thickening, moderate sized loculated right pleural effusion, and
atelectasis involving the right lower and middle lobes are redemonstrated.
The previously described obstructing right lung mass is better assessed on
dedicated CT chest performed the day prior. Other than a 5 mm left lower lobe
nodular opacity which is partially visualized (2:1), the visualized left lung
is essentially clear. No pericardial or left pleural effusion.
A soft tissue nodule anterior to the distal esophagus measures 10 mm in short
axis suggestive of a lymph node (02:14). Linear soft tissue enhancing nodules
in the right posterior chest wall, one of which demonstrates central
hypodensity and possible connection to the right pleura measures 2.3 x 1.4 cm
(303:9).
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Multiple ill-defined hypodense lesions are present in the hepatic dome
measuring approximately 2.0 x 1.5 cm (02:21) and 1.1 x 1.1 cm (02:18) with
density of 68 ___ in close proximity to the posteroinferior pleura.
Hyperenhancing lesion in segment 4A measures 1.5 cm (303:19) which could
represent a flash filling hemangioma or due to transient hepatic attenuation
difference. Trace perihepatic ascites. 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 left interpolar region is cyst
contains multiple septations measures 2.9 x 2.1 x 2.5 cm (2:37, 601:46).
Multiple subcentimeter right renal hypodensities are too small to characterize
but suggestive of cysts. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus is enlarged and lobulated containing multiple
masses some of which contain calcifications, suggestive of fibroids. No
adnexal abnormality appreciated.
LYMPH NODES: There is no retroperitoneal, pelvic, or inguinal lymphadenopathy.
An 8 mm soft tissue density nodule in the right lower quadrant likely
represents a mildly prominent mesenteric lymph node (2:65).
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: A right gluteal soft tissue nodule measures 0.4 x 1.6 cm,
possibly sequela of prior trauma (2:79). The abdominal and pelvic wall is
otherwise within normal limits.
IMPRESSION:
1. Ill-defined hepatic dome hypodensities measure up to 2.0 cm most concerning
for metastases although infection or infiltrative tumor from adjacent pleura
could possibly have this appearance.
2. Linear soft tissue enhancing nodules in the right posterior chest wall may
represent track metastasis from prior biopsy or possibly
infection/inflammatory change.
3. Left-sided segmental pulmonary emboli, diffuse hyperenhancing right pleural
rind/thickening, moderate sized loculated right pleural effusion, right lower
and middle lobe atelectasis redemonstrated. Previously described right lung
mass is better assessed on dedicated CT chest performed the day prior.
4. Left renal cyst with septations could be further assessed with dedicated
renal ultrasound if clinically indicated. No definite renal mass.
5. Enlarged multi-fibroid uterus.
|
10177415-RR-11
| 10,177,415 | 24,337,996 |
RR
| 11 |
2157-03-10 20:38:00
|
2157-03-10 21:25:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD.
INDICATION: ___ year old woman with untreated lung adenocarcinoma for about
six months.//?metastases.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of Gadavist intravenous contrast, axial imaging was performed
with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE
imaging was performed and re-formatted in axial and coronal orientations.
COMPARISON: None.
FINDINGS:
There are numerous supratentorial and infratentorial T2 hyperintense enhancing
lesions seen throughout the brain, compatible with diffuse metastatic disease.
Some of the larger, more dominant metastases demonstrate mild surrounding
vasogenic edema.
A dominant right frontal cortically based metastatic lesion contacts the dura
and measures 1.4 x 1.1 cm (100:64). A lower left cerebellar
hemisphere/cerebellar peduncle lesion measures 1.3 x 1.0 cm (100:35). A
dominant right cerebellar hemisphere lesion measures 1.0 x 0.9 cm (100:21).
Multiple metastatic lesions also involve the midbrain and pons.
There is no evidence for intracranial hemorrhage or hemorrhagic conversion.
No vascular territorial infarction.
The ventricles and sulci are normal, without evidence of hydrocephalus. The
basal cisterns are patent. There is gross preservation of the principal
intracranial vascular flow voids.
The dural venous sinuses appear patent on MP-RAGE imagine sequences.
The visualized paranasal sinuses, middle ear cavities, and mastoid air cells
are well aerated and clear. The patient is status post bilateral lens
resections.
IMPRESSION:
1. Extensive intracranial metastatic disease involving the supratentorial and
infratentorial brain, pons, and midbrain. Mild associated vasogenic edema is
seen surrounding several dominant lesions.
2. No evidence for mass effect or hemorrhagic transformation.
3. No vascular territorial ischemia or infarction.
|
10177415-RR-8
| 10,177,415 | 24,337,996 |
RR
| 8 |
2157-03-09 11:28:00
|
2157-03-09 11:39:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with upper back pain and dyspnea// r/o acute process
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Tiny clips in the base of neck
likely reflect a prior thyroidectomy. Opacity in the right mid and lower lung
with collapse of the right mid middle and lower lobes noted. Findings are
concerning for underlying malignancy and CT is recommended to further assess.
There is right apical cap which could represent pleural thickening or fluid.
Left lung is clear. Heart size is grossly unremarkable the right heart border
is obscured. Imaged bony structures appear intact.
IMPRESSION:
Significant opacification in the right middle lower lung with collapsed right
middle and lower lobes. Recommend CT to further assess as findings are
concerning for malignancy.
|
10177415-RR-9
| 10,177,415 | 24,337,996 |
RR
| 9 |
2157-03-09 15:11:00
|
2157-03-09 16:25:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ with right back mass, CXR with possible mass.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
contiguous 5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and
parasagittal, and 8 mm MIP axial images.
DOSE: Total DLP (Body) = 559 mGy-cm.
COMPARISON: Chest radiographs dated ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The patient is status post thyroidectomy.
Right supraclavicular lymph nodes are increased in number but not
pathologically enlarged by CT size criteria.
MEDIASTINUM: There are multiple enlarged mediastinal lymph nodes including a
1 cm precarinal lymph node (4:81), and a 1 cm subcarinal lymph node (4:92). A
left lower paratracheal lymph node measures 9 mm in short axis (4:75).
Multiple small prevascular lymph nodes are noted as well (4:66).
HILA: A right hilar lymph node measures up to 1.5 cm (4:98). Left hilar
lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
Segmental pulmonary emboli are seen in the left upper lobe (4: 59, 65, 75),
and in the left lower lobe segmental branches (4:112, 135). There is mild
flattening of the interventricular septum, possibly representing right heart
strain.
PULMONARY PARENCHYMA: A right pleural rind is consistent with metastatic
disease. Heterogeneous mass in the right lower lung is noted, likely
representing primary malignancy, with associated collapse of the right middle
and lower lobes. This mass is difficult to accurately measures at least 10.9
x 7.7 x 5.8 cm and is inseparable from the pleural rind. There is a cystic
collection noted posteriorly in the right lung base measuring 5.8 x 6.8 by 6.9
cm which could reflect a necrotic int of tumor versus loculated pleural fluid.
There is tumor encasing the bronchus intermedius with resultant. In addition,
there are numerous small pulmonary parenchymal nodules bilaterally measuring
up to 4 mm (4:69, 103). There is no emphysema.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild. Hemangiomas noted in the T4
vertebral body. Soft tissue density extending from the subcutaneous tissues
to the posterior pleural surface may represent scar tissue from prior
thoracentesis, but seeding of malignancy along the tract is not excluded
(4:131). Indistinct areas of soft tissue density in the subcutaneous fat and
musculature of the posterior right chest wall may represent soft tissue
metastases, difficult to measure accurately (4: 118, 142).
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is notable for an
indistinct 2.8 x 2.9 cm soft tissue density mass in segment VII (4:178).
IMPRESSION:
1. Left upper and lower lobe segmental pulmonary emboli with mild flattening
of the interventricular septum, which may represent mild right heart strain.
2. Large mass in the right lower lung concerning for primary lung cancer with
diffuse right pleural thickening consistent with metastatic disease and
scattered pulmonary nodules. Prominent mediastinal lymph nodes also noted as
well as sites of potential metastatic disease within the right posterior chest
wall and liver.
RECOMMENDATION(S): Biopsy.
NOTIFICATION: The findings were discussed with ___, Medical
Student by ___, M.D. on the telephone on ___ at 4:09 pm, 2
minutes after discovery of the findings.
|
10177799-RR-42
| 10,177,799 | 28,993,766 |
RR
| 42 |
2172-02-05 16:29:00
|
2172-02-05 16:37:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with R visual field cut ? CRAO by OSH
ophthalmologist // ? CRAO
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low. Heart size is top-normal. Loop recorder device noted
in the left anterior chest wall.. The mediastinal and hilar contours are
normal. The pulmonary vasculature is normal. Low lung volumes. Lungs are
clear. No pleural effusion or pneumothorax is seen. There are no acute
osseous abnormalities. Bridging anterior osteophytes are noted in the
thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10177799-RR-43
| 10,177,799 | 28,993,766 |
RR
| 43 |
2172-02-05 17:33:00
|
2172-02-05 18:12:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with R visual field cut ? CRAO by OSH
ophthalmologist // ? CRAO
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 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 27.4 mGy (Body) DLP =
13.7 mGy-cm.
3) Spiral Acquisition 4.9 s, 38.9 cm; CTDIvol = 15.2 mGy (Body) DLP = 590.0
mGy-cm.
Total DLP (Body) = 604 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CTA head and neck dated ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction,hemorrhage,edema,ormass. The ventricles
and sulci are normal in size and configuration.
There is mucosal thickening of bilateral maxillary sinuses and fluid layering
in the sphenoid sinuses. The visualized portion of the remaining paranasal
sinuses,mastoid air cells,and middle ear cavities are clear. The visualized
portion of the orbits are normal.
CTA HEAD:
Mild calcified and noncalcified atherosclerotic plaque is seen along the left
internal carotid artery siphon without stenosis. The vessels of the circle of
___ and their principal intracranial branches otherwise appear patent
without stenosis, occlusion, or aneurysm. The dural venous sinuses are
patent.
CTA NECK:
There are atherosclerotic calcifications along the aortic arch and origins of
the major vessels with mild atherosclerotic stenosis at the origin of the left
common carotid and left subclavian arteries. There is atheromatous luminal
narrowing at the origin of the left vertebral artery with approximately 50%
stenosis.
Bilateral carotid and vertebral artery origins are otherwise patent.
There is mixed calcified and noncalcified plaque at the bilateral common
carotid artery bifurcations and proximal internal carotid arteries resulting
in approximately 30% stenosis of the internal carotid arteries bilaterally by
NASCET criteria.
The carotidandvertebral arteries and their major branches otherwise appear
patent with no evidence of stenosis or occlusion.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria.
IMPRESSION:
1. No acute intracranial process or mass.
2. Patent circle of ___ without evidence of stenosis,occlusion,or
aneurysm.
3. Mild atheromatous 30% stenosis of the bilateral proximal internal carotid
arteries by NASCET criteria and moderate stenosis at the origin of the left
vertebral artery.
4. Otherwise patent bilateral cervical carotid and vertebral arteries without
evidence of stenosis, occlusion, or dissection.
5. Paranasal sinus mucosal thickening.
|
10177799-RR-44
| 10,177,799 | 28,993,766 |
RR
| 44 |
2172-02-07 20:14:00
|
2172-02-08 10:00:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with retinal artery occlusion, eval for stroke
// stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON MR head dated ___ and CTA head dated ___
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. There are mild periventricular and subcortical white matter
foci of T2/FLAIR signal hyperintensity.
There is diffuse mucosal thickening within the frontal sinus, ethmoid air
cells, right sphenoid and bilateral maxillary sinuses.
IMPRESSION:
1. No infarction, hemorrhage or other acute intracranial abnormality.
2. Mild periventricular and subcortical white matter signal changes,
nonspecific but likely sequelae of chronic small vessel disease.
3. Diffuse paranasal sinus mucosal thickening.
|
10177799-RR-45
| 10,177,799 | 28,993,766 |
RR
| 45 |
2172-02-06 09:41:00
|
2172-02-06 10:36:00
|
EXAMINATION: Carotid Artery ultrasound
INDICATION: ___ year old man with retinal artery occlusion, eval for carotid
stenosis // carotid stenosis
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: None
FINDINGS:
RIGHT:
There is mild heterogenous atherosclerotic plaque in the right carotid artery.
Segment: PSV (cm/s) / EDV (cm/s)
----------------------------------------------
CCA ___: 114 cm/s / 21.7 cm/s
CCA Distal: 88.5 cm/s / 20.5 cm/s
ICA ___: 60.4 cm/s / 17.6 cm/s
ICA Mid: 83.3 cm/s / 29.3 cm/s
ICA Distal: 99.7 cm/s / 29.9 cm/s
ECA: 115 cm/s
Vertebral: 54.5 cm/s
ICA/CCA Ratio: 1.13
The right vertebral artery flow is antegrade with a normal spectral waveform.
LEFT:
There is mild heterogenous atherosclerotic plaque in the left carotid artery.
Segment: PSV (cm/s) / EDV (cm/s)
----------------------------------------------
CCA ___: 112 cm/s / 18.8 cm/s
CCA Distal: 79.2 cm/s / 19.3 cm/s
ICA ___: 94.4 cm/s / 28.7 cm/s
ICA Mid: 104 cm/s / 36.9 cm/s
ICA Distal: 110 cm/s / 40.5 cm/s
ECA: 113 cm/s
Vertebral: 67.4 cm/s
ICA/CCA Ratio: 1.39
The left vertebral artery flow is antegrade with a normal spectral waveform.
IMPRESSION:
Right ICA <40% stenosis.
Left ICA <40% stenosis.
|
10178145-RR-20
| 10,178,145 | 25,544,280 |
RR
| 20 |
2198-10-26 21:47:00
|
2198-10-27 00:32:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ female with altered mental status.
COMPARISON: None.
FINDINGS: AP and lateral views of the chest. Linear opacities identified at
the lung bases, right greater than left, most suggestive of atelectasis.
There is no confluent consolidation worrisome for infection.
Cardiomediastinal silhouette is within normal limits. Atherosclerotic
calcifications are noted at the aortic arch. No acute osseous abnormality is
identified.
IMPRESSION: Linear opacities at the lung bases, left greater than right, most
suggestive of atelectasis without definite acute cardiopulmonary process.
|
10178145-RR-21
| 10,178,145 | 25,544,280 |
RR
| 21 |
2198-10-26 21:43:00
|
2198-10-26 22:39:00
|
HISTORY: ___ female with altered mental status.
TECHNIQUE: Contiguous axial images obtained from skullbase to vertex without
intravenous contrast. Coronal and sagittal reformats were reviewed. DLP:
891 mGy-cm.
COMPARISON: ___.
FINDINGS:
There is no acute intra-axial or extra-axial hemorrhage, mass, midline shift,
or territorial infarct. The ventricles and sulci are prominent compatible
with global volume loss. Periventricular white matter hypodensities are
likely sequelae of chronic small vessel disease. Basilar cisterns are patent.
Gray-white matter differentiation is preserved.
Mucosal thickening seen within the ethmoid air cells. Other included
paranasal sinuses and mastoids are clear. Skull and extracranial soft tissues
are unremarkable.
IMPRESSION:
No acute intracranial process.
|
10178145-RR-22
| 10,178,145 | 25,544,280 |
RR
| 22 |
2198-10-28 00:52:00
|
2198-10-28 15:18:00
|
EXAMINATION: MR HEAD W/O CONTRASTMRI of the head with and without contrast.MR
HEAD W/O CONTRAST
INDICATION: ___ year old woman with dementia, hypertension, found to be
unresponsive at nursing home, now at baseline mental status // TIA? stroke?
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T1-weighted, axial fast spin echo T2-weighted,axial FLAIR,
axial diffusion weighted and axial gradient echo images.
COMPARISON: Prior head CT dated ___.
FINDINGS:
There is no evidence of intracranial hemorrhage, mass, mass effect or shifting
of the normally midline structures. The ventricles and sulci are prominent,
suggesting cortical volume loss, probably age related and involutional in
nature. Multiple scattered foci of high signal intensity are identified on T2
and FLAIR sequences, distributed in the subcortical and periventricular white
matter, which are nonspecific and may reflect changes due to small vessel
disease, similar findings are demonstrated in the posterior fossa and a small
chronic right-sided cerebellar infarct (7:11). No diffusion abnormalities are
detected to suggest acute or subacute ischemic changes. The major vascular
flow voids are present and demonstrate normal distribution. The orbits are
unremarkable, the paranasal sinuses are clear, minimal mucosal thickening is
noted at the tip of the mastoid air cells bilaterally.
IMPRESSION:
There is no evidence of acute intracranial process. Scattered foci of high
signal intensity detected on FLAIR and T2 weighted images, distributed in the
subcortical and periventricular white matter, are nonspecific and may reflect
changes due to small vessel disease.
NOTIFICATION: These findings were communicated via phone call to Dr. ___
___, by Dr. ___, on ___ at 15:10 hrs.
|
10178145-RR-23
| 10,178,145 | 29,414,887 |
RR
| 23 |
2199-04-19 13:00:00
|
2199-04-19 14:31:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with ams // stroke
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: DLP: 1223 mGy-cm
COMPARISON: MRI head ___
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction. Prominent ventricles and sulci suggest
age-related involutional changes or atrophy. Subcortical and periventricular
white matter hypodensities are consistent with chronic small vessel ischemic
disease, most notable on the left frontal region and unchanged from prior. The
basal cisterns appear patent and there is preservation of gray-white matter
differentiation.
The visualized bony structures are grossly unremarkable. There is mild mucosal
thickening of the right sphenoid sinus which also contains aerosolized debris.
The remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear.
Atherosclerotic mural calcification of the internal carotid arteries is noted.
The globes are unremarkable.
IMPRESSION:
No evidence of acute intracranial process. If there is clinical concern for
stroke, consider obtaining MRI which is more sensitive.
|
10178145-RR-24
| 10,178,145 | 29,414,887 |
RR
| 24 |
2199-04-19 20:09:00
|
2199-04-20 09:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with dementia, HTN p/w alterned mental status
undergoing infectious work-up // ?acute intrapulmonary process,
?consolidation, ?atelectasis ?acute intrapulmonary process,
?consolidation, ?atelectasis
IMPRESSION:
In comparison with the study ___, the cardiac silhouette remains at the
upper limits of normal in size and there is again tortuosity of the descending
thoracic aorta. No evidence of pneumonia, vascular congestion, or pleural
effusion. Basilar atelectatic changes are again suggested on the left.
|
10178145-RR-25
| 10,178,145 | 29,414,887 |
RR
| 25 |
2199-04-20 13:14:00
|
2199-04-20 15:04:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with ___ with histoy of dementia, depression
who had an episode of unresponsiveness, suspected hypoactive delirum in
setting of possible infection. // R/o acute process R/o acute process
IMPRESSION:
Patient motion somewhat obscures detail. The bowel gas pattern is essentially
within normal limits. Pneumoperitoneum cannot be assessed in the absence an
upright view.
Of incidental note is severe degenerative change in the lumbar spine.
|
10178145-RR-26
| 10,178,145 | 29,414,887 |
RR
| 26 |
2199-04-20 13:15:00
|
2199-04-20 14:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ___ with histoy of dementia, depression
who had an episode of unresponsiveness, suspected hypoactive delirum in
setting of possible infection. // Ro acute process Ro acute process
IMPRESSION:
In comparison with the study of ___, the cardiac silhouette remains
mildly enlarged and there is substantial tortuosity of the aorta. Atelectatic
streaks are again
|
10178217-RR-42
| 10,178,217 | 23,446,429 |
RR
| 42 |
2182-09-15 20:08:00
|
2182-09-15 21:00:00
|
HISTORY: Intermittent substernal chest pain.
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
No focal consolidation, pleural effusion, or evidence of pneumothorax is seen.
The cardiac and mediastinal silhouettes are stable. Prominent osteophytes are
seen extending anteriorly along the thoracic spine and also extending to the
right. A prominent right-sided osteophyte is seen at the level of the aortic
arch. No displaced fracture is seen.
IMPRESSION:
No acute cardiopulmonary process. Prominent anterior osteophytes along the
thoracic spine with increase in prominence as compared to the prior chest
radiographs.
|
10178472-RR-12
| 10,178,472 | 24,177,409 |
RR
| 12 |
2168-11-05 21:48:00
|
2168-11-06 08:16:00
|
INDICATION: ___ year old woman with TBI, now with new Dobhoff tube // Please
check dobhoff tube placement
NOTIFICATION:
The findings were discussed by Dr. ___ with Dr. ___ on the telephone on
___ at 8:14 AM, 2 minutes after discovery of the findings.
FINDINGS:
Dobbhoff tube is malpositioned, coursing in the airway and terminating in the
right infrahilar region, terminating in a segmental branch of the right middle
lobe or right lower lobe bronchus. Worsening atelectasis involving the right
middle and both lower lobes, possibly accompanied by aspiration. Small right
pleural effusion is present, but there is no visible pneumothorax.
|
10178472-RR-13
| 10,178,472 | 24,177,409 |
RR
| 13 |
2168-11-06 17:52:00
|
2168-11-07 10:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with seizures // eval retrocardiac opacity
seen on portable CXR on admission
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
Mild position Dobbhoff tube has been removed. Heart size and mediastinum are
stable. Bibasal consolidations and mild interstitial pulmonary edema are
noted, mildly progressed as compared to previous study. There is no
pneumothorax.
|
10178472-RR-14
| 10,178,472 | 24,177,409 |
RR
| 14 |
2168-11-09 14:15:00
|
2168-11-09 16:04:00
|
EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old woman with seizure d/o // c/f asp
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: None available.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There is penetration with thin and nectar thick barium
preparations. Laryngeal aspiration is noted upon the administration of thin
barium alone.
IMPRESSION:
Penetration with thin and nectar barium, and aspiration with thin barium.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10178472-RR-15
| 10,178,472 | 24,177,409 |
RR
| 15 |
2168-11-10 17:55:00
|
2168-11-10 22:19:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with history of TBI and seizures who presented
with a breakthrough seizures. // evaluate for infiltrate
COMPARISON: ___
IMPRESSION:
Substantial improvement but no complete resolution of the pre-existing
bilateral basal parenchymal opacities. Low lung volumes and mild elevation of
the right hemidiaphragm persist. No pulmonary edema. No pleural effusions.
Unchanged borderline size of the cardiac silhouette.
|
10178472-RR-16
| 10,178,472 | 24,177,409 |
RR
| 16 |
2168-11-13 08:36:00
|
2168-11-13 15:54:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with breakthrough seizures // new LFT elevation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
Note is made that this is a limited study due to the patient's limited ability
to hold her breath and move.
LIVER: There is no focal liver mass identified. The main portal vein is
patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 0.2
cm.
GALLBLADDER: No gallstones are visualized.
PANCREAS: The pancreas is unremarkable but is only minimally visualized due to
overlying bowel gas.
SPLEEN: The spleen is normal measuring 9.8 cm.
KIDNEYS: No hydronephrosis is seen in either kidney. The right kidney measures
8.5 cm and the left kidney measures 9.5 cm.
RETROPERITONEUM: The aorta is obscured from view by overlying bowel gas. The
visualized portion of the IVC is within normal limits.
IMPRESSION:
Unremarkable appearance of the liver, bile ducts and gallbladder. Note is made
that this is a limited study.
|
10178472-RR-6
| 10,178,472 | 24,177,409 |
RR
| 6 |
2168-11-02 04:58:00
|
2168-11-02 05:20:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with intubation. Evaluate endotracheal tube position.
TECHNIQUE: Portable chest radiograph
COMPARISON: Outside hospital chest radiograph from the same day.
FINDINGS:
The endotracheal tube tip terminates at the carina. Enteric tube terminates in
the stomach with the proximal side hole likely at the gastroesophageal
junction. Retrocardiac opacity may represent aspiration or atelectasis. The
lungs are otherwise clear with no pleural effusion or pneumothorax.
IMPRESSION:
1. Endotracheal tube tip at the carina.
2. Enteric tube tip in the stomach with the proximal side hole at the
gastroesophageal junction.
3. Retrocardiac opacity may represent atelectasis or aspiration.
NOTIFICATION: Findings relayed to Dr. ___ by Dr. ___ page at 05:20
on ___.
|
10178472-RR-7
| 10,178,472 | 24,177,409 |
RR
| 7 |
2168-11-02 20:37:00
|
2168-11-03 12:59:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with seizures since traumatic brain injury in
___, recent craniotomy for subdural hematoma 2 weeks ago, presenting with
seizure lasting 30 minutes. Evaluate for seizure focus, metastasis, stroke,
hemorrhage.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 5cc of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations
COMPARISON: Noncontrast CT head ___
FINDINGS:
There is a left convexity subdural hematoma that measures 7 mm in maximum
thickness, unchanged from CT on ___. There is flattening of the
underlying cerebral hemisphere. There is approximately 2 mm rightward shift of
the septum pellucidum, not significantly changed compared to the prior CT.
There is no acute infarct.
There is extensive encephalomalacia and gliosis in bilateral frontal lobes and
right temporal lobe, as well as a small area of gliosis in the left temporal
lobe, with foci of hemosiderin deposition in bilateral frontal lobes,
compatible with sequela of traumatic brain injury. There is ex vacuo
dilatation of the right frontal and right temporal horn due to adjacent
encephalomalacia. The ventricles are also overall large in size for age,
without associated sulcal enlargement. This suggests that the ventricular
enlargement may be due to prior intraventricular hemorrhage or other sequela
of traumatic injury, rather than parenchymal atrophy. There is mild
cerebellar atrophy, which may be related to anticonvulsive medications, given
the clinical history.
The right frontal sinus is hypoplastic and opacified. There is mild mucosal
thickening of the ethmoid and sphenoid sinuses. There is scattered fluid in
the right mastoid air cells.
IMPRESSION:
1. Left subdural hematoma measuring 7 mm in maximum thickness, unchanged from
CT earlier the same day. There is flattening of the underlying left cerebral
hemisphere and 2 mm rightward shift of midline structures.
2. Extensive encephalomalacia and gliosis of the bilateral frontal and right
temporal lobes, as well as small area of gliosis in left temporal lobe, with
hemosiderin deposition in the frontal lobes, compatible with sequela of
traumatic injury.
3. Global enlargement of the ventricles, without associated sulcal
enlargement, which may be related to sequela of prior traumatic injury, such
as intraventricular hemorrhage, rather than cerebral atrophy.
4. Mild cerebellar atrophy, which may be related to anticonvulsive
medications, given the clinical history.
|
10178557-RR-4
| 10,178,557 | 20,990,620 |
RR
| 4 |
2184-12-19 13:47:00
|
2184-12-19 14:38:00
|
INDICATION: NO_PO contrast; History: ___ with hx of possibly crohn's, worst
pain ever, diffuse abdominal pain and tender with guardingNO_PO contrast //
eval for abscess, diverticulitis
TECHNIQUE: Contiguous helical MDCT images were obtained through the abdomen
and pelvis after administration of 150 cc of Omnipaque IV contrast and barium
oral contrast. Multiplanar axial, coronal and sagittal images were generated.
DOSE: Total body DLP: 944 mGy-cm.
COMPARISON: MR pelvis ___
FINDINGS:
LOWER CHEST: The included lung bases are clear. The heart is not enlarged and
there is no pericardial effusion.
CT ABDOMEN WITH CONTRAST:
HEPATOBILIARY: The liver enhances normally without focal lesions. There is
mild intrahepatic biliary duct dilation. The CBD is normal in caliber. The
gallbladder is surgically absent. The portal vein is patent.
PANCREAS: The pancreas has normal attenuation without focal lesions, duct
dilation or peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation without focal lesions.
A 17 mm accessory spleen is incidentally noted (series 2, image 29).
ADRENALS: Bilateral adrenal glands are normal in size and shape.
URINARY: The kidneys excrete contrast promptly and symmetrically and are
without hydronephrosis, mass or perinephric abnormality.
GASTROINTESTINAL: The stomach, small and large bowel are normal in caliber.
Oral contrast opacifies to the level of the mid small bowel. The remaining
small bowel is not well distended and difficult to fully evaluate. However,
there is no adjacent vascular engorgement or fat stranding to suggest active
inflammation. The appendix is normal. There is no free air or free fluid.
RETROPERITONEUM: There is no mesenteric or retroperitoneal lymphadenopathy.
VASCULAR: The abdominal aorta and iliac arteries are normal in caliber.
There is a circumaortic left renal vein.
CT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. The
uterus and ovaries are normal. There is no pelvic wall or inguinal
lymphadenopathy and no free fluid.
BONES AND SOFT TISSUES: There are no worrisome blastic or lytic lesions. The
abdominal and pelvic wall is within normal limits. A ___ is in place within
a partially visualized left perianal fistula. No obvious fluid collection is
seen.
IMPRESSION:
1. No acute intra-abdominal or intrapelvic process.
2. There is no CT evidence for active Crohn's disease. Examination limited by
underdistention of the small bowel.
3. Mild intrahepatic biliary duct dilation likely relates to prior
cholecystectomy, given normal LFTs at the time of presentation.
4. ___ within a partially visualized left perianal fistula. No obvious
fluid collection detected.
|
10178639-RR-17
| 10,178,639 | 22,455,006 |
RR
| 17 |
2179-10-30 19:54:00
|
2179-10-30 21:27:00
|
EXAM: Chest single frontal view.
CLINICAL INFORMATION: New V-tach.
COMPARISON: None.
FINDINGS: Single AP upright portable view of the chest was obtained. No
focal consolidation, pleural effusion, evidence of pneumothorax is seen. The
cardiac silhouette is top normal, likely accentuated by AP technique.
Mediastinal contours are unremarkable. No overt pulmonary edema is seen.
IMPRESSION: No pulmonary edema.
|
10178639-RR-18
| 10,178,639 | 22,455,006 |
RR
| 18 |
2179-11-01 11:47:00
|
2179-11-03 10:24:00
|
Patient Name: ___ Date of Study: ___
MRN: ___
Date of Birth: ___ Requesting Physician: ___, MD
___: ___ Cardiology Staff: ___, MD
Gender: Male Radiology Staff: ___, MD
Technologist: ___, RT
Status: Inpatient Nursing Support: ___, RN
Height (in): 71
Weight (lbs): 208 Injection Site: right antecubical vein
Body Surface Area (m2): 2.17 Contrast Type: Gd-BOPTA (Multihance)
Blood Pressure (mmHg): 151/81 Contrast Dose (mmol/kg): 0.1
Heart Rate(bpm): 47 Contrast Amount (ml): 19
Rhythm: Sinus rhythm Creatinine (mg/dl): 1.3
Complications: None Creatinine Date: ___
Image Quality: Adequate eGFR (ml/min/1.73m2): 65
Indication: Ventricular tachycardia. Please evaluate for scar or infiltrative
disease.
CMR MEASUREMENTS:
Measurement ___ Normal Range
Left Ventricle
LV End-Diastolic Dimension (mm) 58 <62
LV End-Diastolic Dimension Index (mm/m2) 27 <32
LV End-Systolic Dimension (mm) 40
LV End-Diastolic Volume (ml) 187 <196
LV End-Diastolic Volume Index (ml/m2) 86 <95
LV End-Systolic Volume (ml) 98
LV Stroke Volume (ml) 89
LV Stroke Volume Index (ml/m2) 41
LV Ejection Fraction (%) *48 >=54
LV Mass (g) 115
LV Mass Index (g/m2) 53 <80
Basal ___ wall thickness (mm) 11 <12
Basal infero-lateral wall thickness (mm) 8 <11
Q-Flow Aortic Net Forward Stroke Volume (ml) 81
Q-Flow Aortic Total Stroke Volume (ml) 84
Q-Flow Aortic Cardiac Output (l/min) 3.8
Q-Flow Aortic Cardiac Index (l/min/m2) 1.8
LV Effective Forward Ejection Fraction (%) *45 >=54
Right Ventricle
RV End-Diastolic Volume (ml) 178
RV End-Diastolic Volume Index (ml/m2) 82 58-114
RV End-Systolic Volume (ml) 84
RV Stroke Volume (ml) 94
RV Stroke Volume Index (ml/m2) 43
RV Ejection Fraction (%) 53 >=46
Q-Flow Pulmonary Net Forward Stroke Volume (ml) 91
Q-Flow Pulmonary Total Stroke Volume (ml) 93
Qp/Qs 1.12 0.8-1.2
Atria
Left Atrial Dimension (Axial) (mm) **51 <40
Left Atrial Length (4-Chamber) (mm) ***85 <52
Left Atrial Length (2-Chamber) (mm) 73
Left Atrial Area (4-Chamber) (mm) 36
Left Atrial Area (2-Chamber) (mm) 36
Right Atrial Dimension (4-Chamber) (mm) **64 <50
Coronary Sinus Diameter (mm) 11 <15
Great Vessels
Ascending Aorta Diameter (mm) 29 <39
Ascending Aorta Diameter Index (mm/m2) 13 <20
Transverse Aorta Diameter (mm) 33
Transverse Aorta Diameter Index (mm/m2) 15
Descending Aorta Diameter (mm) 27 <28
Descending Aorta Index (mm/m2) 12 <14
Abdominal Aorta Diameter (mm) 24
Abdominal Aorta Diameter Index (mm/m2) 11
Main Pulmonary Artery Diameter (mm) *29 <29
Main Pulmonary Artery Diameter Index (mm/m2) 13 <15
Right Pulmonary Artery Diameter (mm) 27
Left Pulmonary Artery Diameter (mm) 28
Valves
Aortic Valve Morphology Trileaflet
Aortic Valve Excursion Normal
Aortic Valve Area (cm2) 3.6 >=2
Aortic Valve Area Index (cm2/m2) 1.7
Aortic Valve Regurgitation (Visual) None present
Aortic Valve Regurgitant Volume (ml) 3
Aortic Valve Regurgitant Fraction (%) 4 <5
Mitral Valve Regurgitation (Visual) Present
Mitral Valve Regurgitant Volume (ml) 5
Mitral Valve Regurgitant Fraction (%) *6 <5
Pulmonary Valve Regurgitant Volume (ml) 2
Pulmonary Valve Regurgitant Fraction (%) 2 <5
Tricuspid Valve Regurgitation (Visual) Present
Tricuspid Valve Regurgitant Volume (ml) 1
Tricuspid Valve Regurgitant Fraction (%) 1 <5
Pericardium
Pericardial Effusion Trace
* Mildly abnormal | ** Moderately abnormal | *** Severely abnormal
CMR TECHNICAL INFORMATION:
Structure
" T1-Weighted (Black Blood): Dual-inversion T1-weighted fast spin echo images
were acquired in 5-mm contiguous axial slices to evaluate cardiac and vascular
anatomy.
Function
" Cine SSFP: Breath-hold SSFP cine images were acquired in 8-mm slices in the
4-chamber, 3-chamber, 2-chamber, and short axis orientations.
" Cine SSFP (Additional Aortic Valve Views): A short-axis series was acquired
at the level of the aortic valve.
" Tagged Cine: Breath-hold tagged cine images were acquired to evaluate
myocardial function and/or sliding motion of the pericardium.
Flow
" Aortic Valve Flow: Phase-contrast cine images were acquired transverse to
the proximal ascending aorta to quantify through-plane flow.
" Pulmonary Valve Flow: Phase-contrast cine images were acquired transverse
to the main pulmonary artery to quantify through-plane flow.
Viability
" LGE (3D PSIR): Late gadolinium enhancement (LGE) images were acquired using
a navigator-gated 3D phase sensitive inversion-recovery (PSIR) sequence with
spectral fat saturation pre-pulses 15 minutes after injection of a total of
0.1 mmol/kg (19 mL) Gd-BOPTA (Multihance).
" EGE: Early gadolinium enhancement (EGE) images were acquired using an
ultrafast gradient echo inversion-recovery sequence with spectral fat
saturation pre-pulses 5 minutes after injection of a total of 0.1 mmol/kg (19
mL) Gd-BOPTA (Multihance).
CMR FINDINGS:
Left Ventricle
" LV cavity size: Normal
" LV ejection fraction: Mildly depressed
" LV mass: Normal
Right Ventricle
" RV cavity size: Normal
" RV ejection fraction: Normal
" Intra-cardiac shunt: None present
Atria
" LA size: Severely enlarged
" RA size: Moderately enlarged
Great Vessels
" Ascending aortic diameter: Normal
" Main pulmonary artery diameter: Normal
Valves
" Aortic valve morphology: Trileaflet
" Aortic stenosis: No
" Aortic regurgitation jet: None present
" Mitral regurgitation jet: Present
" Mitral regurgitation: Mild
" Tricuspid regurgitation jet: Present
Pericardium
" Pericardial effusion: Trace
ADDITIONAL INFORMATION/FINDINGS:
None.
NON-CARDIAC FINDINGS:
1.9 cm left adrenal nodule and possible right adrenal nodule although obscured
by artifact. Statistically most likely adenoma. Recommend further evaluation
with CT with adrenal protocol (3 phase).
IMPRESSION:
Severe left atrial enlargement. Moderate right atrial enlargement. Normal left
ventricular cavity size, wall thickness, and mass. Mild global left
ventricular hypokinesis with relatively greater hypokinesis of the mid-distal
lateral wall. Normal right ventricular cavity size and systolic function. No
obvious late gadolinium enhancement of the left or right ventricle consistent
with the absence of fibrosis/scar in the setting of suboptimal image quality.
Normal ascending aorta, descending aorta and main pulmonary artery diameters.
Mild dilation of the right and left pulmonary artery branches. No aortic
stenosis or aortic regurgitation. Mild mitral regurgitation. Trace pericardial
effusion.
Interpreted by Drs.: ___, and ___
___.
|
10178639-RR-19
| 10,178,639 | 29,170,797 |
RR
| 19 |
2180-06-04 14:37:00
|
2180-06-04 15:39:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with AF, SSS s/p dual-chamber pacemaker // lead
position, pneumothorax
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has received the new left
pectoral pacemaker system. 1 lead projects over the right atrium and 1 over
the right ventricle. No evidence of complications, notably no pneumothorax.
Minimal bilateral areas of atelectasis. No pulmonary edema. No pneumonia.
|
10179119-RR-7
| 10,179,119 | 26,992,464 |
RR
| 7 |
2164-05-25 11:38:00
|
2164-05-25 12:04:00
|
INDICATION: ___ with fever // Pneumonia
TECHNIQUE: AP views of the chest.
COMPARISON: None.
FINDINGS:
Exam is limited secondary to degree of the thoracic scoliosis with posterior
fixation hardware and rotation to the left. There is no visualized
consolidation noting that a significant portion of the lungs is obscured. The
cardiomediastinal silhouette is unremarkable. No acute osseous abnormalities
identified.
IMPRESSION:
Limited exam especially without priors without definite acute cardiopulmonary
process.
|
10179119-RR-8
| 10,179,119 | 26,992,464 |
RR
| 8 |
2164-05-26 08:12:00
|
2164-05-26 09:26:00
|
EXAMINATION: BILATERAL LOWER EXTREMITY ULTRASOUND
INDICATION: Chest pain, shortness of breath and right heart strain. Evaluate
for DVT.
TECHNIQUE: Bilateral lower extremity venous ultrasound
COMPARISON: none
FINDINGS:
Grayscale, color, and spectral doppler imaging was obtained of the right and
left common femoral, femoral, and popliteal veins. Normal flow,
compressibility, augmentation, and waveforms are demonstrated. No intraluminal
thrombus is identified. Normal color flow is demonstrated in the posterior
tibial and peroneal veins. There is normal respiratory variation in both
common femoral veins. No ___ cyst is seen.
IMPRESSION:
No evidence of deep vein thrombosis in right or left lower extremity.
|
10179438-RR-12
| 10,179,438 | 26,517,964 |
RR
| 12 |
2136-03-15 10:19:00
|
2136-03-15 10:54:00
|
INDICATION: ___ year old woman s/p fall from standing height with facial
fractures and right humorous fracture.// ?fracture or dislocation
COMPARISON: None
IMPRESSION:
No acute fractures or dislocations are seen. There is mild medial and lateral
joint space narrowing and small spurs in the three compartments. There is
faint chondrocalcinosis which is nonspecific but can be seen with CPPD
arthropathy and/or osteoarthritis.There is mild demineralization. There are
vascular calcifications. There is a small joint effusion.
|
10179438-RR-13
| 10,179,438 | 26,517,964 |
RR
| 13 |
2136-03-15 10:20:00
|
2136-03-15 12:56:00
|
INDICATION: ___ year old woman s/p fall from standing height with facial
fractures and right humorous fracture.// ?fracture or dislocation
COMPARISON: None
IMPRESSION:
There is demineralization which limits evaluation for subtle fractures. No
displaced fractures are seen of the distal humerus or elbow. There are
degenerative changes of the radiocapitellar joint with joint space narrowing,
spurring, and subchondral cystic changes. There is spurring along the lateral
epicondyle. Evaluation for elbow joint effusion is limited due to the
overlying soft tissue swelling and projection.
|
10179438-RR-14
| 10,179,438 | 26,517,964 |
RR
| 14 |
2136-03-15 18:27:00
|
2136-03-15 19:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with chest pain// Assess for cause of chest
pain
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT torso dated ___
FINDINGS:
A right central line projects over the low right atrium. There is no focal
consolidation, pleural effusion or pneumothorax identified. The size of the
cardiac silhouette is enlarged, partially impart 2 AP portable technique and
low lung volumes. Re-demonstrated is a acute impacted fracture of the
proximal right humerus.
IMPRESSION:
No acute cardiopulmonary abnormality.
Known impacted fracture of the right proximal humerus.
|
10179438-RR-15
| 10,179,438 | 26,517,964 |
RR
| 15 |
2136-03-15 21:45:00
|
2136-03-15 22:52:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ s/p mechanical fall with pain in L hallux// eval for fx
TECHNIQUE: Three views of the left foot were obtained
COMPARISON: None
FINDINGS:
The bones are diffusely osteopenic. There is no acute displaced fracture
identified. Mild degenerative changes are noted within the midfoot. A
plantar calcaneal spur is noted. Vascular calcification is present.
IMPRESSION:
Diffusely demineralized bones. No acute displaced fracture identified.
|
10180139-RR-16
| 10,180,139 | 29,190,188 |
RR
| 16 |
2116-08-27 07:26:00
|
2116-08-27 08:09:00
|
CLINICAL HISTORY: ___ woman with lethargy. Evaluate for pneumonia.
___ and ___.
FINDINGS: A frontal view of the chest was obtained portably. Low lung
volumes result in bronchovascular crowding. There is no focal consolidation
or pneumothorax. Blunting at the left costophrenic sulcus is unchanged and
may be due to a small effusion or pleural thickening. Moderate cardiomegaly
is unchanged. The mediastinal silhouette with an enlarged aorta is stable. A
left humeral head fracture is unchanged.
IMPRESSION: No pneumonia or edema.
|
10180139-RR-17
| 10,180,139 | 29,190,188 |
RR
| 17 |
2116-08-27 10:28:00
|
2116-08-27 13:13:00
|
INDICATION: ___ female with subdural hematoma. Reevaluate for
evidence of new bleeding.
COMPARISONS: CT head, ___ at 3:40 a.m. CT head, ___. CT head, ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast.
FINDINGS: In comparison to the prior CT at 3:40 a.m., there has been little
change. The left temporoparietal extra-axial hypodense collection is stable
in size and measures approximately 15 mm in width. This is consistent with a
subdural hematoma. There are no areas of hyperdensity to suggest new bleeding
within the subdural hematoma. There is stable mass effect with compression of
the adjacent sulci and the occipital horn of the right lateral ventricle.
There is no intraventricular hemorrhage or hydrocephalus. There is no shift
of the normal midline structures. The basal cisterns are patent without
evidence of herniation.
Again redemonstrated are multiple areas of high attenuation in the right
frontal lobe (2:18), as well as the left frontal lobe (2:26). These are most
consistent with subarachnoid hemorrhage, and possibly cortical contusion. No
new foci of hemorrhage are noted.
Prominent sulci on the left suggest age-related atrophy. There is no evidence
of infarction or mass. Confluent hypodensities in the periventricular white
matter are consistent with mild small vessel ischemic disease.
No fracture is identified. The visualized paranasal sinuses are clear.
Opacification of the right mastoid air cells is noted. The left mastoid air
cells are well aerated. The middle ear cavities are clear. The soft tissues
are unremarkable.
IMPRESSION:
1. Stable right subdural hematoma with stable mass effect on the adjacent
sulci, but no shift of midline structures or uncal herniation.
2. Stable areas of subarachnoid hemorrhage and possible cortical contusions
in the bilateral frontal lobes.
3. No new foci of hemorrhage.
|
10180407-RR-68
| 10,180,407 | 25,091,963 |
RR
| 68 |
2173-01-27 10:52:00
|
2173-01-27 11:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: please eval for bleed, acute intracranial process History:
___ with h/o sz and R meningioma s/p surgery with fall, not anticoagulated //
please eval for bleed, acute intracranial process
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
CTDIvol: 54.9 mGy
DLP: 891.93 mGy-cm
COMPARISON: Multiple prior head CTs, the most recent of ___.
FINDINGS:
There is no evidence of acute large vascular territorial infarction,
hemorrhage, edema, mass effect, midline shift, or mass. The ventricles and
sulci are prominent consistent with age-related atrophy. Confluent
periventricular and subcortical white matter hypodensities likely represent
the sequela of chronic small vessel ischemic disease. Hypodensity in the
right frontal lobe is related to encephalomalacic changes from prior surgical
excision of a meningioma. Other densities in the left basal ganglia are stable
and likely represent lacunar infarctions. Left frontal and parietal sulci and
more prominent than right, as before,.
The basal cisterns are patent and there is preservation of gray-white matter
differentiation.
There is evidence of prior right craniotomy. The paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial hemorrhage or mass effect or significant change since
___ study.
Correlate clinically to decide on the need for further workup or followup.
Other details as above.
|
10180407-RR-69
| 10,180,407 | 25,091,963 |
RR
| 69 |
2173-01-27 11:19:00
|
2173-01-27 12:26:00
|
INDICATION: ___ male status post fall and healing on balanced.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
AP and lateral chest radiographs were obtained. Comparison is made to prior
radiograph dated ___. Cardiomediastinal and hilar contours are stable.
No focal opacity is identified concerning for infection. No overt pulmonary
edema. There is no pleural effusion. No acute osseous abnormality is
identified.
IMPRESSION:
No acute intra thoracic abnormality.
|
10180796-RR-10
| 10,180,796 | 22,296,135 |
RR
| 10 |
2181-11-25 00:38:00
|
2181-11-25 11:14:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ FTM transgender (on testosterone) w/ PMHx depression, PTSD,
question of fibromyalgia, ?"reportedly" ___, and migraines, admitted
with persistent headache (likely ___ medication overuse, possibly low pressure
headache ___ CSF leak). // evaluate for signs of intracranial hypotension
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T-weighted, axial fast spin echo T2-weighted, axial FLAIR,
axial diffusion weighted and axial gradient echo images. The T1 weighted
images were repeated after the administration of 4 mL intravenous gadolinium
(___) contrast material.
COMPARISON: Prior head CT dated ___.
FINDINGS:
On the left temporal lobe, the axial images with FLAIR technique, and the
axial T1 weighted images postcontrast demonstrates a punctate area of high
signal intensity with enhancement, measuring approximately 4 x 4 mm in
transverse dimension (image 10, series 11, and image 10, series 14), with no
significant mass effect or shifting of the adjacent structures. This lesion
is adjacent to venous vascular structures, therefore the possibility of
subcortical prominent vein with slow flow is a consideration versus small
venous thrombosis, in comparison with the prior head CT apparently there is an
tiny punctate calcification in this area, therefore the possibility of a small
granuloma is also a consideration. No other areas with abnormal signal are
seen throughout the brain, no diffusion abnormalities are detected, there is
no evidence of hemorrhage or magnetic susceptibility abnormalities. The major
arterial vascular flow voids are present and demonstrate normal distribution.
The orbits are unremarkable, the paranasal sinuses and the mastoid air cells
are clear.
IMPRESSION:
Small area of high signal intensity demonstrated on FLAIR and T1 postcontrast
is images, localized in the left temporal lobe, measuring approximately 4 x 4
mm in transverse dimension, with no evidence of mass effect or edema, this
lesion apparently is adjacent to cortical venous vascular structures, and
apparently there is a punctate calcification demonstrated by prior head CT.
The possibility of small venous thrombus on a cortical vein, versus a small
granuloma are considerations, follow-up MRI in 2 weeks or as clinically
warranted is recommended to demonstrate stability or any further change.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephoneon ___ at 11:04 AM, 5 minutes after
discovery of the findings.
RECOMMENDATION(S): Punctate area of enhancement identified in the left
temporal lobe as described detail above, with no evidence of mass effect or
edema, follow-up MRI with and without contrast in two weeks, or as clinically
warranted is recommended to demonstrate stability or any further change.
|
10180796-RR-11
| 10,180,796 | 22,296,135 |
RR
| 11 |
2181-11-25 00:38:00
|
2181-11-25 11:40:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR
INDICATION: ___ FTM transgender (on testosterone) w/ PMHx depression, PTSD,
question of fibromyalgia, ?"reportedly" ___, and migraines, admitted
with persistent headache (likely ___ medication overuse, possibly low pressure
headache ___ CSF leak). // evaluate for signs of intracranial hypotension.
TECHNIQUE: Sagittal T1, T2 and sagittal STIR sequences were obtained through
the cervical thoracic and lumbar spine, axial T2 weighted images were also
obtained.
COMPARISON: No prior examinations of the spine are available.
FINDINGS:
MRI of the cervical spine. The visualized elements of the posterior fossa are
unremarkable, the alignment of the cervical vertebral bodies appears
maintained. The signal intensity throughout the cervical spinal cord is
normal with no evidence of focal or diffuse lesions. From C2/C3 through C5/C6
levels, there is no evidence of neural foraminal narrowing or spinal canal
stenosis.
At C6/C7 level, there is a small central disc bulge, causing minimal anterior
thecal sac deformity, there is no evidence of spinal canal stenosis or neural
foraminal narrowing. The visualized paravertebral structures are
unremarkable.
MRI of the thoracic spine. The alignment and configuration of the thoracic
vertebral bodies appears normal, the signal intensity throughout the thoracic
spine appears unremarkable with no evidence of focal or diffuse lesions, the
conus medullaris terminates at the level of T12/L1 and is unremarkable. Note
is made of rounded focal low signal area in the expected location of the
gallbladder, suggestive of gallstone (image 2, series 11).
MRI of the lumbar spine. Anatomical variation consistent with transitional
segment is identified, for reading purposes six lumbar vertebral bodies are
labeled on the image 11, series 8. The alignment of the lumbar vertebral
bodies is normal as well as the signal in the intervertebral disc spaces.
There is no evidence of neural foraminal narrowing or spinal canal stenosis.
Mild articular joint facet hypertrophy is identified at L5/L6 with no evidence
of nerve compression or spinal canal stenosis, the sacroiliac joints are
unremarkable, again a gallstone is visible on the axial images on T2 weighted
sequence.
IMPRESSION:
1. Minimal degenerative changes identified at C6/C7 level, consistent with
disc bulge, there is no evidence of neural foraminal narrowing or spinal canal
stenosis.
2. The MRI of the thoracic spine appears normal with no evidence of neural
foraminal narrowing or spinal canal stenosis, no signal abnormalities are seen
throughout the thoracic spinal cord.
3. Anatomical variation identified in the lumbar spine, consistent with
transitional segment. There is no evidence of spinal canal stenosis or neural
foraminal narrowing, mild articular joint facet hypertrophy is noted at L5/L6
level.
4. Area of low signal is identified in the expected location of the
gallbladder, suggestive of gallstone, correlation with abdominal ultrasound is
recommended for further characterization.
RECOMMENDATION(S): Area of low signal is identified in the expected location
of the gallbladder, suggestive of gallstone, correlation with abdominal
ultrasound is recommended for further characterization.
|
10180971-RR-16
| 10,180,971 | 21,774,892 |
RR
| 16 |
2181-01-05 11:19:00
|
2181-01-05 16:12:00
|
INDICATION: ___ woman with left lower quadrant pain with history of
cysts, evaluate for cyst versus torsion.
COMPARISONS: Multiple prior pelvic ultrasounds from ___
from ___, ___.
LMP: ___.
FINDINGS: Transabdominally, the uterus measures 7.4 x 3.6 x 4.7 cm. The
endometrial stripe measures 6 mm. Transvaginal exam was completed for better
visualization of the uterus and adnexa. The right ovary measures 3.6 x 1.3 x
3 cm and is normal. There is a large complex left ovarian cystic structure
measuring 6.4 x 4 x 6.6 cm, largely unchanged from prior study. Some
ring-down artifact is seen, which was also seen in ___ and is of unclear
significance, but air or crystals cannot be excluded. Arterial and venous
flow is demonstrated in both ovaries. There is trace pelvic free fluid.
IMPRESSION:
1. Large complex left ovarian cystic structure, largely unchanged from prior
studies. Consider further evaluation with MRI if not already performed. GYN
follow-up.
2. Arterial and venous flow demonstrated in both ovaries.
3. Trace amount of pelvic free fluid.
|
10180971-RR-24
| 10,180,971 | 21,438,695 |
RR
| 24 |
2187-06-30 10:48:00
|
2187-06-30 11:35:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ abd pain// ? cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the liver and
gallbladder.
COMPARISON: ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. No focal liver mass. The main portal vein is patent with
hepatopetal flow. No ascites.
BILE DUCTS: No intrahepatic biliary dilation. The CHD measures up to 6 mm but
tapers both upstream in downstream.
GALLBLADDER: Again seen are 2 small sludge balls within the gallbladder which
are mobile. No gallbladder wall thickening, gallbladder distention, or
pericholecystic abnormality. The patient was tender over the region of the
gallbladder.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail and inferior head obscured by overlying bowel gas.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Persistent mobile sludge balls within the gallbladder within otherwise normal
appearing gallbladder. No bile duct dilation.
|
10180971-RR-25
| 10,180,971 | 21,438,695 |
RR
| 25 |
2187-07-01 08:41:00
|
2187-07-04 16:43:00
|
EXAMINATION: Acute cholecystitis with possible choledocholithiasis
INDICATION: Intraoperative cholangiogram
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Ultrasound gallbladder ___
FINDINGS:
38 intraoperative images were acquired without a radiologist present.
Images show injection of the contrast into the cystic duct and opacification
of the intra and extrahepatic biliary tree and drainage into the small bowel.
NG tube projects over the left upper quadrant of the image. Percutaneous tube
seen in the ___ the image.
IMPRESSION:
Intraoperative images were obtained during cholecystectomy. Please refer to
the operative note for details of the procedure.
|
10181023-RR-91
| 10,181,023 | 25,467,628 |
RR
| 91 |
2146-04-23 18:22:00
|
2146-04-23 19:29:00
|
CLINICAL HISTORY: ___ man with chest pain, cough, and history of
multiple myeloma status post bone marrow transplant.
COMPARISON: CT chest ___.
TECHNIQUE: Volumetric multidetector CT acquisition of the chest was
performed. Images are presented for display in the axial plane at 5-mm and
1.25-mm collimation. A series of multiplanar reformation images is submitted
for review.
CT CHEST WITHOUT INTRAVENOUS CONTRAST: The thoracic aorta and pulmonary
artery are of normal caliber. Axillary and mediastinal lymph nodes are not
enlarged by CT size criteria. Evaluation for hilar lymphadenopathy is limited
without intravenous contrast. The heart, pericardium and great vessels are
within normal limits. There is no pleural or pericardial effusion. No
nodules are seen in the imaged unenhanced thyroid gland. There is a small
hiatal hernia.
Lung window images demonstrate a 4mm nodule in the left upper lobe (4:89),
unchanged from ___. The previously seen left lower lobe ___
opacities have nearly completely resolved. A calcified granuloma at the
right lung base (4:204) suggests prior exposure to granulomatous disease.
Linear atelectasis or scarring involving the lateral right middle and lower
lobes is unchanged. No new areas of opacification are noted. Mild diffuse
bronchiolar thickening is similar to the prior study. Airways are otherwise
patent to the level of the segmental bronchi.
This study is not tailored for subdiaphragmatic evaluation. The liver is
diffusely hypodense, compatible with fatty deposition. Small hiatal hernia is
present.
BONE WINDOWS: Again seen are several expansile lytic lesions in the left
posterior first and fifth ribs, right lateral fourth rib, left glenoid and
coracoid process and inferior right scapula. Vertebral plana of T3 is
unchanged.
IMPRESSION:
1. Interval near resolution of left lower lobe ___ opacities. No new
opacity.
2. 4mm left upper lobe nodule and mild bronchiolar wall thickening are
unchanged from ___.
3. Diffuse osseous lesions, similar to ___.
4. Fatty liver.
|
10181023-RR-93
| 10,181,023 | 25,467,628 |
RR
| 93 |
2146-04-25 09:49:00
|
2146-04-25 15:51:00
|
MR EXAMINATION OF THE BRAIN WITHOUT AND WITH CONTRAST, ___
HISTORY: ___ male, status post allogeneic stem cell transplant for
multiple myeloma, with episodes of inattentiveness and possible seizure;
evaluate for intracranial mass.
TECHNIQUE: Routine ___ enhanced MR examination, including T1-weighted axial
SE and sagittal MP-RAGE sequences, post-contrast administration, the latter
with axial and coronal reformations.
FINDINGS: The study is compared with the recent MDCT of the paranasal
sinuses, dated ___, and the NECT of the head dated ___.
The axial FLAIR sequence is notable only for fluid-opacification of the
mastoid air cells, bilaterally, as on the more remote CT. There is no intra-
or extra-axial hemorrhage and the midline structures are in the midline.
There is mild-moderate asymmetric prominence of all components of the right
lateral ventricle, unchanged on studies dating to ___, and likely
congenital/developmental. There is no focus of slow diffusion to suggest an
acute ischemic event and the principal intracranial vascular flow-voids,
including those of the dural venous sinuses, are preserved and these
structures enhance normally. There is no pathologic parenchymal,
leptomeningeal or dural focus of enhancement. There is no space-occupying
lesion, and the sella, parasellar region and remainder of the skull base and
orbits are unremarkable.
In addition to the mastoid opacification, there are small mucus-retention
cysts along both maxillary antral floors with relatively mild mucosal
thickening involving anterior ethmoidal air cells, as on the recent sinus CT.
The included upper cervical vertebral, clival and calvarial bone marrow signal
is unremarkable, with no bone destructive lesion.
IMPRESSION:
1. No acute intracranial abnormality.
2. No pathologic focus of enhancement, space-occupying lesion or other
anatomic substrate for seizure. N.B. Dedicated high-resolution T2-weighted and
fast STIR sequences were neither protocoled or performed.
3. Extensive fluid-opacification of the mastoid air cells; though this is
unchanged on studies dating to ___, it was not present on the study of
___ and should be correlated clinically.
|
10181426-RR-15
| 10,181,426 | 29,167,589 |
RR
| 15 |
2121-10-25 04:55:00
|
2121-10-25 11:26:00
|
HISTORY: ___ year old left handed man with transient left hemiplegia and
aphasia.
TECHNIQUE: Multiplanar multisequence noncontrast MR images are obtained of
the brain. Noncontrast has MRA of the head and neck were performed.
COMPARISON: No prior examinations for comparison at this institution.
FINDINGS:
MR head:
There is no evidence of acute intracranial hemorrhage or infarct. There is a
small focus of high T2/FLAIR signal within the left frontal lobe which is
nonspecific. Gray-white matter differentiation is otherwise preserved. There
is a posterior fossa arachnoid cyst ___ cisterna magna. Ventricles and
extra-axial spaces are otherwise within normal limits for age.
The paranasal sinuses demonstrate scattered allergic inflammatory changes with
a large mucous retention cyst within the left maxillary sinus. The mastoid
air cells demonstrate normal signal. The sella turcica, craniocervical
junction, and orbits are grossly unremarkable.
MRA head:
Normal flow signal is noted in the petrous, cavernous, and supraclinoid
portions of the internal carotid arteries. The anterior cerebral, middle
cerebral, and anterior communicating arteries are unremarkable.
The posterior cerebral, basilar, superior cerebellar arteries are
unremarkable. The intradural segments to the vertebral arteries are
unremarkable. There is ___ termination of the left vertebral artery. The
right vertebral artery is dominant. Both posterior communicating arteries are
seen.
MRA neck:
The origins of the innominate, left common carotid, and left subclavian
arteries appear unremarkable. The common, internal, and external carotid
arteries demonstrate normal flow signal. The vertebral artery origins appear
unremarkable. The right vertebral artery is dominant; the left vertebral
artery origin is hypoplastic.
IMPRESSION :
No evidence of acute hemorrhage or infarct.
Unremarkable MRA of the head and neck.
|
10181426-RR-16
| 10,181,426 | 29,167,589 |
RR
| 16 |
2121-10-25 16:56:00
|
2121-10-26 08:15:00
|
HISTORY: TIA versus stroke, rule out infection.
CHEST, SINGLE AP PORTABLE VIEW. No previous chest x-rays on PACS record for
comparison.
There are low inspiratory volumes. Allowing for this, no definite
cardiomegaly. No CHF, focal infiltrate, or effusion is detected. A
dual-lumen catheter is present, with tip over SVC/RA junction/uppermost right
atrium.
IMPRESSION: No acute pulmonary infiltrate identified.
|
10181426-RR-17
| 10,181,426 | 29,167,589 |
RR
| 17 |
2121-10-26 16:01:00
|
2121-10-26 17:55:00
|
INDICATION: TIA symptoms.
COMPARISON: MRI of the head on ___.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered.
FINDINGS: There is no evidence of acute hemorrhage, edema, mass, mass effect,
or acute territorial infarction. The ventricles and sulci are normal in size
and configuration for patient's age. There is a left-sided either arachnoid
cyst ___ cisterna magna in the posterior fossa measuring approximately 1.9
x 2.0 cm. Visualized paranasal sinuses and mastoid air cells are well
aerated. The orbits and globes are partially visualized and unremarkable.
Bones are normal.
IMPRESSION: No acute intracranial process.
|
10181426-RR-20
| 10,181,426 | 23,798,578 |
RR
| 20 |
2123-01-21 17:11:00
|
2123-01-21 18:12:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ man with cough.
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:
No acute cardiopulmonary process.
|
10181426-RR-21
| 10,181,426 | 23,798,578 |
RR
| 21 |
2123-01-22 01:00:00
|
2123-01-22 11:59:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ with autosomal dominant polycystic kidney disease and
hypertension who has had multiple events (almost weekly) of left sided
numbness and weakness, now with new event of prolonged left sided numbness,
weakness and speech arrest at noon today. Evaluate for seizure focus and
stroke please.
TECHNIQUE: 3D sagittal FLAIR images with multiplanar reformations, coronal
FSTIR images, and axial gradient echo and diffusion-weighted images were
obtained. Following intravenous gadolinium administration, coronal MP RAGE
images with multiplanar reformations were obtained. 2D time-of-flight MRA of
the neck was obtained with multiplanar maximal intensity projection
angiographic reformatted images. 3D coronal T1 weighted gradient echo imaging
of the neck was obtained before, during, and after intravenous gadolinium
administration with multiplanar maximum intensity projection angiographic
reformatted images.
COMPARISON: Prior MRI of the head and MRI of the brain and neck dated ___.
FINDINGS:
Images are limited by motion artifact.
MRI BRAIN:
There is no acute infarction. There are unchanged scattered foci of high T2
signal in the periventricular, subcortical, and deep white matter which are
nonspecific but likely secondary to chronic small vessel disease given the
history of hypertension. There is an unchanged small arachnoid cyst medial to
the left cerebellar hemisphere. There is no evidence for abnormal contrast
enhancement, parenchymal edema, or blood products.
Coronal FSTIR images are limited by motion artifact. The temporal horn of the
right lateral ventricle is larger than the left, as are all components of the
right lateral ventricle, suggesting congenital or developmental etiology.
There is no definite evidence of right hippocampal atrophy. There is no change
from the prior MRI.
There is a mucous retention cyst in the left maxillary sinus.
MRA NECK:
There is normal three-vessel takeoff of the great vessels from the thoracic
aortic arch. The origins of the great vessels, subclavian and vertebral
arteries appear normal bilaterally. The common, internal and external carotid
arteries appear normal. There is no evidence of stenosis by NASCET criteria.
The right vertebral artery is dominant.
MRA BRAIN:
The MRA of the brain is significantly limited by motion artifact. The
intracranial vertebral and internal carotid arteries and their major branches
appear patent, allowing for unchanged ___ termination of the left vertebral
artery. Evaluation for an aneurysm is markedly limited, though no large
aneurysm is seen.
IMPRESSION:
1. No acute infarction. No intracranial mass.
2. Coronal FSTIR images are limited by motion artifact. The right temporal
horn is larger than the left, as are all components of the right lateral
ventricle. There is no definite evidence of right hippocampal atrophy. These
findings suggest congenital or developmental etiology. Correlation with EEG
findings could be helpful, given the clinical concern for a seizure focus.
3. MRA of the brain is significantly degraded by motion artifact, and
evaluation for aneurysms is limited. No large aneurysm is seen. Major
intracranial arteries appear patent.
4. Unremarkable MRA of the neck.
|
10181426-RR-22
| 10,181,426 | 27,814,694 |
RR
| 22 |
2123-12-24 19:55:00
|
2123-12-24 20:18:00
|
EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ with hx PCKD s/p kidney transplant, here with pyelo. //
evidence of hydronephrosis, stranding?
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: None.
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.6 to 0.69, within the
normal range. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 78.4 cm/second. Vascularity is symmetric throughout transplant.
The transplant renal vein is patent and shows normal waveform.
IMPRESSION:
Normal renal transplant ultrasound.
|
10181426-RR-25
| 10,181,426 | 29,600,070 |
RR
| 25 |
2124-05-01 11:25:00
|
2124-05-01 12:15:00
|
INDICATION: ___ year old man autosomal dominant polycystic kidney disease
status post renal transplant. The patient presents with right flank pain,
gross hematuria, pyuria and note history or fever. Evaluate for
nephrolithiasis, cyst rupture or other structural abnormality.
TECHNIQUE: CTU: Multidetector CT of the abdomen and pelvis were acquired
without intravenous contrast administration with the patient in the prone
position. The non-contrast scan was done with low radiation dose technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 54.9 cm; CTDIvol = 3.5 mGy (Body) DLP = 194.4
mGy-cm.
Total DLP (Body) = 194 mGy-cm.
COMPARISON: Ultrasound from ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
Evaluation of the abdominal pelvic organs are within limited without
intravenous contrast material.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Multiple hypodensities are seen throughout the liver including a 2.2 cm cyst
in segment ___. Most of these hypodense lesions are subcentimeter in size and
too small to characterize but statistically likely to reflect cysts given
clinical history of autosomal dominant polycystic kidney disease. 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: There are numerous cysts with enlargement of the kidneys bilaterally,
compatible with known history of autosomal dominant polycystic kidney disease.
There is no evidence of hydronephrosis or stones seen. A right lower quadrant
renal transplant appears normal without evidence of stone, hydronephrosis or
focal lesion. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is collapsed and not well evaluated. Small
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. The colon and rectum are within normal limits. The appendix is
not visualized, though there are no secondary findings to suggest
appendicitis.
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 unremarkable,
within limits of CT.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Mild degenerative changes are seen in the lumbar spine.
SOFT TISSUES: There is a fat containing left inguinal hernia.
IMPRESSION:
1. No evidence of stone or CT findings to explain the patient's right flank
pain or hematuria within the limitations of a non-enhanced CT.
2. Enlarged bilateral native kidneys with innumerable cysts compatible with
known history of autosomal dominant polycystic kidney disease. Multiple
hypodense lesions in the liver likely reflective of cysts given clinical
history.
|
10182104-RR-2
| 10,182,104 | 25,194,454 |
RR
| 2 |
2123-06-06 16:37:00
|
2123-06-06 19:04:00
|
EXAMINATION: MRCP
INDICATION: ___ year old man with abd pain. Assess for choledocholithiasis
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Outside CT abdomen ___.
Outside gallbladder ultrasound ___.
FINDINGS:
Lower Thorax: Limited evaluation of the lung bases are clear. No pleural
effusion.
Liver: There is T2 hyperintense signal around the gallbladder fossa with
subtle parenchymal hyperemia. The liver is otherwise homogeneous in signal
intensity without suspicious mass. Moderate signal drop on out of phase
imaging is consistent with hepatic steatosis (fat fraction 17%). No ascites
noted.
Biliary: No intrahepatic or extrahepatic biliary duct dilatation. No
choledocholithiasis. No peribiliary enhancement. There is aberrant biliary
anatomy with posterior right biliary duct draining into the left biliary duct.
The gallbladder is notable for cholelithiasis and sludge. The gallbladder is
mildly dilated heterogeneous enhancement and mild pericholecystic free fluid
with gallbladder wall edema similar in appearance to CT from ___
worrisome for acute cholecystitis.
Pancreas: Pancreas is homogeneous in signal intensity without suspicious mass.
No pancreatic duct dilatation or peripancreatic fat stranding. Pancreatic
divisum or dominant dorsal duct noted.
Spleen: Spleen is normal in size without suspicious mass.
Adrenal Glands: Unremarkable.
Kidneys: Bilateral T2 hyperintense nonenhancing renal cysts are noted largest
measuring 2.4 cm right upper pole (03:37). Kidneys are otherwise homogeneous
in signal intensity without suspicious mass. No hydronephrosis or perinephric
fat stranding.
Gastrointestinal Tract: Distal esophagus, stomach, visualized small and large
bowel are otherwise unremarkable. No obstruction.
Lymph Nodes: Few top normal peripancreatic nodes are likely reactive, largest
measuring up to 0.9 cm (15:59). Mesenteric lymph nodes are nonenlarged.
Vasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal
arteries are patent. Hepatic anatomy is conventional. Hepatic veins, main
portal vein, SMV, and splenic vein are patent.
Osseous and Soft Tissue Structures: No suspicious osseous lesions. Soft
tissues are unremarkable. Multilevel degenerative changes of the lower lumbar
spine are noted.
IMPRESSION:
1. Acute cholecystitis with gallstones and biliary sludge.
2. No choledocholithiasis or evidence of cholangitis.
3. Incidentally noted aberrant biliary anatomy with posterior right biliary
duct draining into the left biliary duct.
4. Moderate hepatic steatosis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 6:55 pm, 5 minutes after
discovery of the findings.
|
10182665-RR-25
| 10,182,665 | 29,411,152 |
RR
| 25 |
2126-01-15 14:36:00
|
2126-01-15 18:00:00
|
STUDY: MRI head without and with contrast.
CLINICAL HISTORY: ___ woman on cediranib and Olaparib for recurrent
platinum sensitive papillary serous ovarian cancer with hypertension and
headache.
COMPARISON STUDY: MRI head dated ___.
TECHNIQUE: Sagittal T1, axial T1, T2, FLAIR, gradient echo and
diffusion-weighted images were obtained of the brain prior to administration
of contrast. Axial T1 and sagittal MP-RAGE images were obtained after
administration of contrast with coronal and axial reconstructions. The post
contrast images are degraded by motion artefact.
FINDINGS: The brain parenchyma appears normal. There is no evidence of acute
infarct, intracranial hemorrhage or space-occupying lesion. The ventricles,
extra-axial CSF spaces and cortical sulci appear normal. There is no abnormal
leptomeningeal or parenchymal enhancement. Brainstem and cerebellum appear
normal.
Few scattered FLAIR hyperintense foci are noted in bilateral frontal white
matter, which are unchanged since the prior study and are non specific.
The normal major intracranial flow voids are patent. There is opacification of
scattered ethmoid air cells. Rest of the visualized paranasal sinuses and
mastoid air cells are clear. The orbits are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
2. No abnormal enhancement.
3. Few scattered FLAIR hyperintense foci in bilateral frontal white matter,
which are unchanged since the prior study and are non specific.
|
10182930-RR-5
| 10,182,930 | 25,621,352 |
RR
| 5 |
2118-09-18 18:58:00
|
2118-09-18 22:42:00
|
CHEST RADIOGRAPH
HISTORY: Preoperative for C6-C7 disc herniation surgery.
COMPARISONS: None.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The heart is normal in size. The mediastinal and hilar contours
appear within normal limits. There is no pleural effusion or pneumothorax.
Streaky opacity in the lingula suggests minor atelectasis or scarring.
Otherwise, the lungs appear clear. The osseous structures are unremarkable
aside from small osteophytes along the mid-to-lower thoracic spine.
IMPRESSION: No evidence of acute disease.
|
10182930-RR-6
| 10,182,930 | 25,621,352 |
RR
| 6 |
2118-09-19 16:26:00
|
2118-09-23 08:16:00
|
CERVICAL SPINE OPERATIVE RADIOGRAPHS
CLINICAL INDICATION: ACDF of C6- C7.
FINDINGS:
Changes of an ACDF at C6-C7. Mild degenerative changes at C4-C5 with anterior
osteophyte formation. An endotracheal tube is in place. Remaining osseous
structures and soft tissue structures are unable to be evaluated.
IMPRESSION:
Operative changes of C6-C7 ACDF without orthopedic immediate hardware
complications. Please refer to operative report for further details.
|
10183012-RR-33
| 10,183,012 | 28,787,562 |
RR
| 33 |
2125-03-02 09:11:00
|
2125-03-02 12:06:00
|
EXAM: CT of the head and neck.
CLINICAL INFORMATION: Patient with left hand numbness and weakness, question
of stroke.
TECHNIQUE: Axial images of the head were obtained without contrast.
Following this, using departmental protocol, CT angiography of the head and
neck acquired.
FINDINGS: There is a small area of hyperdensity in the right frontal
subcortical white matter which could be due to small vessel disease. No
hemorrhage, mass effect or midline shift seen.
CT ANGIOGRAPHY NECK: The CT angiography of the neck demonstrates patent
vascular structures with patent carotid and vertebral arteries. Vascular
calcifications are seen at the bifurcation without stenosis.
CT ANGIOGRAPHY HEAD: The CT angiography of the head demonstrates normal
vascular structures in the anterior and posterior circulation without stenosis
or occlusion.
IMPRESSION:
1. No evidence of hemorrhage on CT. Hypodensity in the right frontal
subcortical white matter could be due to small vessel disease. MRI can help
for further assessment to exclude subcortical infarct if clinically indicated.
2. CT angiography of the neck demonstrates patent vascular structures without
stenosis, occlusion or dissection.
3. CT angiography of the head demonstrates patent vascular structures in the
anterior and posterior circulation without stenosis or occlusion.
Degenerative changes in the cervical spine and increased fat in the
mediastinum indicative of mediastinal lipomatosis.
COMMENT: This report is provided without the availability of 3D reformatted
images. When these images are available and if additional information is
obtained, an addendum will be given to this report.
|
10183012-RR-34
| 10,183,012 | 28,787,562 |
RR
| 34 |
2125-03-02 16:15:00
|
2125-03-02 17:51:00
|
PA AND LATERAL CHEST of ___.
COMPARISON: ___, chest x-ray.
FINDINGS: Cardiac silhouette is enlarged but stable in size. Pulmonary
vascularity is within normal limits. Focal patchy opacity is present in the
left retrocardiac region with otherwise clear lungs. No pleural effusion.
Scoliosis is noted.
IMPRESSION:
1. Cardiomegaly without evidence of congestive heart failure.
2. Patchy left lower lobe opacity, which may reflect patchy atelectasis,
focal aspiration, and less likely an early infectious pneumonia. Followup
radiographs would be helpful to assess for resolution.
|
10183012-RR-35
| 10,183,012 | 28,787,562 |
RR
| 35 |
2125-03-03 13:09:00
|
2125-03-03 15:49:00
|
CLINICAL HISTORY: ___ man with new bilateral leg pitting edema.
Evaluate for DVT.
FINDINGS: Grayscale and color Doppler sonograms with spectral analysis of the
bilateral common femoral, superficial femoral, popliteal, posterior tibial,
and peroneal veins was performed. There is normal compressibility, flow, and
augmentation.
IMPRESSION: No bilateral lower extremity DVT.
|
10183012-RR-36
| 10,183,012 | 28,787,562 |
RR
| 36 |
2125-03-03 21:31:00
|
2125-03-04 10:53:00
|
INDICATION: ___ man with atrial fibrillation, complaining of left
hand weakness and numbness. Evaluate for stroke.
TECHNIQUE: Multiplanar, multisequence images of the head were performed
without contrast.
COMPARISON: CTA from ___.
FINDINGS:
There is no evidence of acute infarct or hemorrhage. There is a T2 FLAIR
hyperintensity in the right inferior subcortical white matter likely
representing an old lacunar infarction or an area of stenosis due to prior
injury. There is mild volume loss. No evidence of mass effect or midline
shift. The major intracranial flow voids are preserved. There is fluid in
the bilateral mastoid air cells, worse on the left and a mucus retention cyst
in the left maxillary sinus. The orbits are unremarkable.
IMPRESSION:
1. No evidence of acute infarct or hemorrhage.
2. Focal area of increased T2 FLAIR signal in the right inferior frontal
subcortical white matter likely representing an old lacunar infarction.
3. No specific fluid in the bilateral mastoid air cells, worse on the left.
Mucosal thickening/mucus retention cyst in the left maxillary sinus.
|
10183012-RR-64
| 10,183,012 | 20,897,479 |
RR
| 64 |
2127-01-31 17:45:00
|
2127-01-31 18:56:00
|
CLINICAL INDICATION: History of neutropenia. Febrile. Evaluate for
pneumonia.
COMPARISON: Multiple prior chest radiographs, the most recent of ___.
FRONTAL AND LATERAL VIEWS OF THE CHEST: The lungs are clear without focal
opacity, pleural effusion or pneumothorax. The heart size is mildly enlarged.
The mediastinal contours are normal. A right Port-A-Cath ends in the mid
superior vena cava. There is no free air beneath the right hemidiaphragm.
IMPRESSION: No acute intrathoracic process. Mild cardiomegaly.
|
10183012-RR-65
| 10,183,012 | 20,897,479 |
RR
| 65 |
2127-02-02 15:52:00
|
2127-02-03 11:20:00
|
EXAMINATION: MR thoracic spine with and without contrast
INDICATION: ___ year old man with T4 spinal met on prior CT.
TECHNIQUE: Multiplanar, multi sequence MR images of the thoracic spine were
obtained before and after the administration of intravenous contrast.
COMPARISON: Chest CT ___.
FINDINGS:
Thoracic spine alignment is maintained. Vertebral body heights and disc spaces
are preserved. The
The thoracic cord demonstrates normal morphology and signal intensity and.
Within the posterior right aspect of the T5 vertebral body, there is a 14 mm
STIR and T2 hyperintense, T1 hypo a 10 this enhancing lesion which corresponds
to the lytic lesion seen on the CT examination. Bone marrow signal is
otherwise normal. There is no extension of the lesion into the spinal canal.
Scattered mild degenerative changes are present without significant spinal
canal or neural foraminal narrowing.
A disc bulge is present at C7-T1.
Small bilateral pleural effusions are noted. A large T2 hyperintense lesion is
seen within the right hepatic lobe, better characterized on the recent
abdominal CT.
IMPRESSION:
T5 vertebral body lesion corresponds to the lytic lesion seen on chest CT and
is consistent with metastatic disease. There is no extraosseous extension of
this lesion. No other lesion is identified.
|
10183551-RR-118
| 10,183,551 | 23,839,683 |
RR
| 118 |
2145-05-23 09:51:00
|
2145-05-23 11:46:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ female with dyspnea.
COMPARISON: ___.
FINDINGS: Frontal and lateral views of the chest. The lungs are clear. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormality is identified.
IMPRESSION: No acute cardiopulmonary process.
|
10183775-RR-11
| 10,183,775 | 23,475,081 |
RR
| 11 |
2155-07-28 19:51:00
|
2155-07-28 22:25:00
|
INDICATION: ___ man with supratherapeutic INR and head trauma.
Evaluate for hemorrhage.
___.
TECHNIQUE: MDCT data were acquired through the head without intravenous
contrast. Images were displayed in multiple planes after reconstruction with
bone and soft tissue algorithms.
FINDINGS: A small amount of intraventricular hemorrhage layers posteriorly in
the occipital horn of the left lateral ventricle. No additional intra- or
extra-axial hemorrhage is identified. Ventricular dilatation is unchanged
since ___, with prominence of the sulci, likely due to atrophy. Focal
hypodensities in the right thalamus and left lentiform nucleus are unchanged
since ___, and likely reflect lacunes. Confluent periventricular and
subcortical white matter hypoattenuation is compatible with the sequela of
chronic microvascular infarction. A large posterior parietal subgaleal
hematoma is present. No fractures are seen. Visualized paranasal sinuses and
mastoid air cells are well aerated. Calcification of the cavernous carotid
arteries is present.
IMPRESSION: Small amount of intraventricular hemorrhage in the occipital horn
of left lateral ventricle. Large posterior parietal subgaleal hematoma.
|
10183775-RR-12
| 10,183,775 | 23,475,081 |
RR
| 12 |
2155-07-29 10:36:00
|
2155-07-29 14:05:00
|
PORTABLE AP CHEST
CLINICAL INDICATION: An ___ with end-stage renal disease with
nocturnal hypoxia, rule out acute pulmonary process.
Comparison is made to prior study of ___.
Portable AP chest film of ___ at 1038 hours is submitted.
IMPRESSION:
1. Status post median sternotomy for CABG with stable cardiac enlargement and
calcification of the aorta consistent with atherosclerosis. Relatively lower
lung volumes with no focal airspace consolidation appreciated. Crowding of
the pulmonary vasculature with possible minimal perihilar edema, but no overt
pulmonary edema. No pleural effusions or pneumothoraces.
|
10184005-RR-6
| 10,184,005 | 21,449,438 |
RR
| 6 |
2144-03-08 22:28:00
|
2144-03-08 23:11:00
|
HISTORY: Concern for perforation with diverticulitis. Evaluate for
perforation. Second read requested due to no read on the outside hospital
study.
TECHNIQUE: CT of the abdomen and pelvis from ___ provided for ___
reading.
COMPARISON: Reference CT abdomen and pelvis from ___
FINDINGS: There is fibrosis at the bases of the bilateral lungs concerning for
interstitial lung disease. The visualized heart and pericardium are
unremarkable.
CT abdomen: There are locules of perihepatic free air. The liver enhances
homogeneously without focal lesions or intrahepatic biliary dilatation. The
gallbladder is unremarkable and the portal vein is patent. The pancreas,
spleen and adrenal glands are unremarkable. The kidneys present symmetric
nephrograms and excretion of contrast with no pelvicaliceal dilation or
perinephric abnormalities.
The stomach, duodenum and small bowel are unremarkable. There is a segment of
colonic wall thickening in the transverse colon. There is thickening of the
sigmoid colon with surrounding fat stranding and a perisigmoid fluid
collection measuring 4.3 x 2.3 x 2.7 cm, likely representing an abscess from a
contained perforation. The fat plane is visualized between the fluid
collection in the bladder, so there is no obvious fistula at this time. The
appendix is visualized and there is no evidence of appendicitis. The
intraabdominal vasculature is unremarkable with no evidence of
thrombophlebitis. There is no mesenteric or retroperitoneal lymph node
enlargement by CT size criteria. There is a small fat containing umbilical
hernia.
CT pelvis: The urinary bladder is unremarkable. There are locules of free
air within the pelvis. The prostate is normal in size. There is no inguinal
or pelvic wall lymphadenopathy.
Osseous structures: No lytic or sclerotic lesions suspicious for malignancy
is present.
IMPRESSION:
1. Complicated diverticulitis with perisigmoid fluid collection and free air
within the pelvis and upper abdomen.
2. Focal thickening of the transverse colon. Colonoscopy is recommended
following treatment to rule out underlying mass.
2. Bibasilar pulmonary fibrosis is concerning for interstitial lung disease.
Recommend non-emergent dedicated high-resolution CT scan of the chest for
further evaluation if not already done elsewhere.
|
10184327-RR-100
| 10,184,327 | 21,280,059 |
RR
| 100 |
2137-01-03 12:17:00
|
2137-01-03 17:46:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with bacteremia and lead extraction with
leukocytosis and low grade fever // evaluation for pneumonia
COMPARISON: None.
FINDINGS:
Compared with ___ at 09:14, the degree of consolidation/
retrocardiac opacity at the left lung base has improved. There is some
residual retrocardiac opacity as well as a residual small left effusion. Mild
upper zone redistribution, but no overt CHF. Aside from minimal basilar
atelectasis, the right lung is grossly clear. No right effusion.
Cardiomediastinal silhouette is grossly unchanged. Right IJ the seen lead
overlies the right ventricle, as before.
On the current study, the tracheal air column is not well visualized between
the clavicles and aortic knob. It is well seen on the most recent prior study.
IMPRESSION:
1. Partial interval clearing of retrocardiac density. No new focal infiltrate
identified.
2. Poor visualization of a portion of the tracheal air column. Question
artifact. Clinical correlation requested.
|
10184327-RR-101
| 10,184,327 | 21,280,059 |
RR
| 101 |
2137-01-03 11:50:00
|
2137-01-03 12:51:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with ESRD, on hemodialysis, with suspected
thrombus in the right upper extremity AV fistula during dialysis
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity AV fistula.
COMPARISON: None.
FINDINGS:
The right upper extremity AV fistula is widely patent with normal wall-to-wall
color flow. Vascular waveforms are normal. There is no soft tissue edema or
fluid collection.
IMPRESSION:
Widely patent right upper extremity AV fistula without evidence of thrombus.
|
10184327-RR-102
| 10,184,327 | 21,280,059 |
RR
| 102 |
2137-01-05 13:42:00
|
2137-01-07 19:02:00
|
INDICATION: ___ year old male with PMH notable for HCM s/p septal ablation and
ICD, ESRD on HD recurrent enterococcus feacalis pacemaker endocarditis. //
fistulagram for RUE AVF, weak thrill, high venous pressure during dialysis
COMPARISON: Right upper extremity fistula ultrasound from ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow), Dr. ___
___ radiology attending), and Dr. ___
radiology attending) performed the procedure. The attendings, Drs. ___
___ were present and supervising throughout the procedure. Drs. ___
___, attending radiologists, personally supervised the trainee during
the key components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100mcg of fentanyl and 1.5 mg of midazolam throughout the total intra-service
time of 330 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, midazolam, 5000 units heparin, 8 mg of intra radial
tPA.
CONTRAST: 150 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 71.3 minutes, 28 mGy
PROCEDURE:
1. Right upper extremity AV fistulogram.
2. Axillary and subclavian venography.
3. Angioplasty of inflow (radial) artery and outflow (cephalic) vein.
4. Chemical and mechanical thrombolysis of radial artery and outflow cephalic
vein.
5. ___ balloon pull through of the arterial inflow.
6. Stent graft placement along the area of focal rupture of the radial artery
using 6 mm x 5 cm Viabahn stent.
7. Coil embolization of muscular/epicondylar branch.
PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the right
upper extremity abducted and stabilized.
Clinical examination demonstrated palpable thrill/pulsatility near the
arterial anastomosis. Further evaluation by targeted ultrasound demonstrated
stenosis in the juxta anastomotic region. The right upper extremity was
prepped and draped in the usual sterile fashion. A pre-procedure timeout and
huddle was performed as per ___ protocol.
Using ultrasound and fluoroscopy, the arterial anastomosis level was
identified and the skin was marked with a skin marker. Following
administration of lidocaine for local anesthesia, retrograde access (directed
towards the arterial inflow) was obtained under continuous ultrasound guidance
using a 21 gauge micropuncture needle. Ultrasound images were saved. An 0.018
wire was then advanced easily into the cephalic vein under fluoroscopic
guidance. A 4.5 ___ micropuncture sheath was advanced and used to exchange
for a Glidewire. The Glidewire had difficulty in cannulating the inflow
brachial artery/arterial anastomosis. The micropuncture sheath was exchanged
for a short 6 ___ sheath. A Kumpe catheter was directed into the sheath and
positioned in the juxta-anastomotic region and contrast injection was
performed.
The Kumpe catheter and Glidewire were then directed into the inflow brachial
artery. Fistulogram was repeated with findings detailed below.
The arterial highly stenotic anastomosis was angioplastied with 4 mm balloon,
as well as angioplasty of the outflow vein using 4 mm, 5 mm, and 6 mm
balloons. Following this, a 5.5 ___ ___ balloon was advanced beyond the
arterial anastomosis, partially inflated and pullback was performed through
the arterial anastomosis into the fistula. This resulted in improvement in
flow and improved palpable thrill in the fistula.
The decision was then made to obtain antegrade access and further evaluate the
abnormal venous outflow. Following administration of a lidocaine as local
anesthesia, antegrade (directed towards the venous outflow) access was
obtained under continuous ultrasound guidance using a 21G micropuncture
needle. An 0.018 wire was then advanced into the outflow vein under
fluoroscopic guidance. A 4.5F micropuncture sheath was advanced and used to
exchange for an 0.035 Glidewire. The Glidewire was advance to the level mid
cephalic vein, where it was noted to bifurcate. The Glidewire was then
directed towards the dominant branch and axillary and limited subclavian
venography was performed and noted to be patent centrally.
Despite intervention, flow was noted to be relatively sluggish. An additional
attempt to improve in flow was performed with ___ pull through, after
which sluggish flow was noted in the radial artery concerning for radial
artery thrombosis. Additional intravenous heparin was administered as well as
lacing of TPA in the area of thrombosis. The Angiojet pulse spray device was
also utilized.
Continued attempt to restore patency of the distal radial artery led to focal
rupture in the mid portion of the aretry with extravasation noted. The
decision was made to place a 6 mm x 5 cm Viabahn stent graft. This was
performed using a 20 cm ___ sheath .Extravasation resolved following stent
graft placement. An additional small focus of extravasation was noted in a
recurrent radial /epicondylar branch, possibly related to wire manipulation
during procedure. This area was treated with embolization utilizing 2 mm Hilal
coils, with resolution of extravasation.
Right upper extremity arteriography was then performed to evaluate the ulnar
artery with presence of an intact palmar arch and retrograde filling of the
distal radial artery. Clinical examination demonstrated symmetric profusion of
the fingers bilaterally. The decision was made to terminate the procedure at
this point.
The sheaths were removed and hemostasis was achieved with two 0-silk
pursestring sutures.
FINDINGS:
1. Very small proximal outflow vein with findings of poor maturation. The
outflow vein was also noted to bifurcate at its midportion.
2. Focal thrombosis and extravasation of the distal radial artery.
Extravasation controlled with stent graft placement.
3. Preservation of flow to the right hand demonstrated by filling of the
palmar arch via the ulnar artery.
IMPRESSION:
Non-usable right upper extremity AV fistula despite aggressive attempts to
establish good flow. The procedure was complicated by distal radial artery
thrombosis and rupture requiring stent graft placement. Hand perfusion was
maintained via an intact ulnar artery.
RECOMMENDATION: Patient will require a left sided HD catheter and possible
new RUE fistula/graft.
|
10184327-RR-103
| 10,184,327 | 21,280,059 |
RR
| 103 |
2137-01-06 13:58:00
|
2137-01-06 17:53:00
|
EXAMINATION: VENOUS MAPPING FOR DIALYSIS ACCESS
INDICATION: ___ year old man with failed AV fistula. Please perform vein
mapping for fistul eval // please perform vein mapping for fistula
placemenrt.
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of both
cephalic veins, radial artery, brachial artery, basilic vein and subclavian
veins was performed.
FINDINGS:
RIGHT:
The cephalic vein measures 0.3 cm at the proximal arm. Intraluminal thrombus
is noted distally in the right cephalic vein. The basilic vein measures 0.25
cm at the antecubital fossa, 0.24 cm at its mid portion, and 0.26 cm at the
proximal portion.
No flow was noted in the right radial artery. The brachial artery measures 0.6
cm.
LEFT:
The cephalic vein measures 0.12 cm at the distal forearm, 0.13 cm at the mid
forearm, 0.2 cm at the proximal forearm, 0.2 cm at the antecubital fossa, 0.11
cm at the proximal arm, 0.2 cm at the mid arm and 0.12 cm at the distal arm.
The basilic vein measures 0.21 cm at its mid portion, and 0.29 cm at the
proximal portion. Intraluminal thrombus is noted in the left subclavian vein.
The radial artery measures 0.25 cm. The brachial artery measures 0.56 cm. Mild
arterial calcifications are present in the left radial artery.
IMPRESSION:
Intraluminal thrombus was noted in the left subclavian vein and distal
segments of the right cephalic vein. Diameters of the cephalic and basilic
veins as described above.
Occlusion of the right radial artery.
|
10184327-RR-104
| 10,184,327 | 21,280,059 |
RR
| 104 |
2137-01-06 15:15:00
|
2137-01-06 16:53:00
|
INDICATION: ___ year old man with RUE fistula complications. R neck external
pacemaker. Need for HD line // Place L IJ temp line vs. groin line
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr.
___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure. Dr.
___ radiologist, personally supervised the trainee during the key
components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine.
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: 3 minutes, 4 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient's wife, who is the healthcare proxy. The patient was
then brought to the angiography suite and placed supine on the exam table. A
pre-procedure time-out was performed per ___ protocol. The left neck was
prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent left internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced into the IVC.
A triple-lumen dialysis catheter with VIP port was advanced over the wire into
the superior vena cava with the tip at the cavoatrial junction. All 3 access
ports were aspirated, flushed and capped. The catheter was secured to the skin
with a 0 silk suture and sterile dressings were applied.
Final spot fluoroscopic image demonstrating good alignment of the catheter and
no kinking. The patient tolerated the procedure well. The patient was noted
to be hypotensive on arrival, but the decision was made to proceed with the
procedure as the patient had no IV access. Following the procedure, the
primary team was made aware in came to evaluate the patient. The patient will
be transferred to the ICU for monitoring.
FINDINGS:
Patent left internal jugular vein. Final fluoroscopic image showing triple
lumen central venous catheter with catheter tip terminating in the distal
superior vena cava.
IMPRESSION:
Successful placement of a temporary triple lumen dialysis catheter with VIP
port via the left internal jugular venous approach. The tip of the catheter
terminates in the distal superior vena cava. The catheter is ready for use.
|
10184327-RR-105
| 10,184,327 | 21,280,059 |
RR
| 105 |
2137-01-06 17:49:00
|
2137-01-06 19:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with parkinsons, ESRD on HD, infected pacemaker,
s/p removal on abx with temp pacemaker in place. Acutely hypotensive with SBPs
___ in ___ suite with L IJ line placement. // evidence of pneumothorax?
post procedure complication? evidence of pneumothorax? post procedure
complication?
COMPARISON: Chest radiographs since ___, most recently one ___.
IMPRESSION:
New opacification at the left lung base obscures the left hemidiaphragm, may
be accompanied by mild leftward mediastinal shift indicating a component of
atelectasis, but pneumonia particularly due to aspiration is of great concern,
since there is a also a new smaller region of consolidation at the medial
aspect of the right lower lobe. Small bilateral pleural effusions are
presumed. The heart is not enlarged and there is no pulmonary edema.
New left supraclavicular dual channel hemodialysis catheter ends in the low
SVC. There is no associated mediastinal widening, pleural effusion, or
pneumothorax.
|
10184327-RR-108
| 10,184,327 | 21,280,059 |
RR
| 108 |
2137-01-12 07:47:00
|
2137-01-12 10:54:00
|
INDICATION: ___ year old man with ESRD, HCM, pacemaker infection and
bacteremia, lost R AV fistula, needs tunneled HD access. // please remove
temporary HD line in L IJ, place tunneled HD line in L IJ, thank you.
COMPARISON: Temporary dialysis line placement ___, fistulogram ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure. The
attending, Dr. ___ was present and supervising throughout the procedure.
Dr. ___ radiologist, personally supervised the trainee during
the key components of the procedure and reviewed and agreed with the trainee's
findings.
ANESTHESIA: Sedation was provided by administrating divided doses of 25 mcg
of fentanyl while the patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. 1% lidocaine was injected
in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, lidocaine with and without epinephrine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.4 min, 2 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient's healthcare proxy. The patient was then brought to
the angiography suite and placed supine on the exam table. A pre-procedure
time-out was performed per ___ protocol. The left chest was prepped and
draped in the usual sterile fashion.
Preliminary spot fluoroscopy confirmed position of the left IJ temporary
dialysis catheter tip in the low SVC. A J wire was advanced through the
catheter to measure length for the tunneled line. The wire was advanced into
the IVC under fluoroscopy. The tunnel site was anesthetized with 1% lidocaine.
The tunnel tract was anesthetized with 1% lidocaine with epinephrine. A 27 cm
tip to cuff length tunneled dialysis catheter was tunneled from the skin entry
site to the existing venotomy site. The temporary dialysis catheter was
removed over the wire and a peel-away sheath was advanced into the SVC under
fluoroscopy. The catheter was threaded into the right side of the heart with
the tip in the right atrium. The sheath was then peeled away. The catheter was
sutured in place with 0 silk sutures. ___ subcuticular Vicryl sutures were
also used to close the venotomy incision site. Final spot fluoroscopic image
demonstrating good alignment of the catheter and no kinking. The tip is in the
right atrium. The catheter was flushed and both lumens were capped. Sterile
dressings were applied. The patient tolerated the procedure well.
FINDINGS:
Final fluoroscopic image showing left IJ approach tunneled dialysis catheter
with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 27cm tip-to-cuff length tunneled dialysis line via
left IJ access. The tip of the catheter terminates in the right atrium. The
catheter is ready for use.
|
10184327-RR-111
| 10,184,327 | 21,280,059 |
RR
| 111 |
2137-01-14 07:51:00
|
2137-01-14 13:12:00
|
INDICATION: New R-sided ppm via cephalic vein. Eval lead position.
___ year old man with new R sided ppm. // New R-sided ppm via cephalic vein.
Eval lead position.
EXAMINATION: CHEST (PORTABLE AP)
TECHNIQUE: Portable Chest radiograph, frontal view
COMPARISON: Chest radiograph ___
FINDINGS:
There is new right pectoral pacemaker with its leads terminating at the right
atrium and right ventricle. Left subclavian catheter terminates in right
atrium. There is no pneumothorax. There is slightly increased mild left lung
base atelectasis and pleural effusion compared to ___.
IMPRESSION:
New right pectoral pacemaker has leads terminating at right atrium and right
ventricle. No pneumothorax.
|
10184327-RR-112
| 10,184,327 | 21,280,059 |
RR
| 112 |
2137-01-14 09:54:00
|
2137-01-14 11:43:00
|
EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old man with bacteremia/infected pacemaker, bedside
speech and swallow evaluation on ___ recommended video study, please evaluate
for aspiration.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 04:19 min.
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There is no gross aspiration. There is penetration with thin and
nectar thick liquids which resolved with chin tuck technique. Mild
degenerative changes including grade 1 anterolisthesis of C2 on C3 are noted.
IMPRESSION:
Penetration with thin and nectar thick liquids which resolved with chin-tuck
technique. No gross aspiration.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10184327-RR-120
| 10,184,327 | 22,570,171 |
RR
| 120 |
2138-09-10 17:25:00
|
2138-09-10 17:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with hypotension // Evaluate for infection
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest CT ___, chest radiograph ___
FINDINGS:
Right-sided pacer is noted with leads terminating in the right atrium and
right ventricle, unchanged. Left-sided central venous catheter tip terminates
in the proximal right atrium. Mild enlargement of the cardiac silhouette is
present. Aortic knob calcifications are noted. The mediastinal and hilar
contours are unremarkable. A small left pleural effusion is substantially
decreased in size compared to the previous study. Subsegmental atelectasis or
scarring accounts for the linear opacity within the left mid lung field.
There is minimal left basilar atelectasis. Right lung is clear. No pulmonary
edema or pneumothorax is present.
IMPRESSION:
Small left pleural effusion with minimal left basilar atelectasis and
subsegmental atelectasis or scarring in the left mid lung field.
|
10184327-RR-121
| 10,184,327 | 22,570,171 |
RR
| 121 |
2138-09-11 03:33:00
|
2138-09-11 10:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sepsis likely ___ PNA // e/o PNA?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
Left lower lobe opacities are unchanged, a combination of moderate effusion
and adjacent atelectasis. The right lung is clear. linear opacity in the left
upper lobe is fluid in the fissure an adjacent atelectasis. There is no
evident pneumothorax. Pacer leads and HD catheter are in standard position.
Cardiomegaly is unchanged
|
10184327-RR-122
| 10,184,327 | 22,570,171 |
RR
| 122 |
2138-09-13 14:26:00
|
2138-09-13 15:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PNA, with acute hypotension/hypoxia post-HD
// eval for pulmonary abnormality eval for pulmonary abnormality
IMPRESSION:
Comparison to ___. Moderate increase in retrocardiac atelectasis.
The presence of a small pleural effusion cannot be excluded. No pulmonary
edema. Moderate cardiomegaly persists. Stable position of the pacemaker
leads and of the left central venous access line.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.