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10184327-RR-92
| 10,184,327 | 21,280,059 |
RR
| 92 |
2136-12-20 01:00:00
|
2136-12-20 05:02:00
|
INDICATION:
___ with fever, evaluate for pneumonia..
COMPARISON: None Available.
TECHNIQUE
AP and lateral view of the chest.
FINDINGS:
Transvenous pacing leads ending in the right atrium and right ventricle. Mild
cardiomegaly is unchanged. There is no pleural effusion or pneumothorax.
There is increased opacification posteriorly on the lateral view corresponding
to the left basilar opacity. Additionally, interstitial markings are mildly
increased from prior.
IMPRESSION:
Left lower lobe pneumonia.
NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ in person
on ___ at 02:00, 1 after they were made.
|
10184327-RR-93
| 10,184,327 | 21,280,059 |
RR
| 93 |
2136-12-20 00:49:00
|
2136-12-20 01:58:00
|
EXAMINATION: CT LEFT LOWER EXTREMITY WITHOUT CONTRAST.
INDICATION: ___ year old man with left leg pain, evaluate for abscess
TECHNIQUE: MDCT images were obtained through the left thigh with IV contrast.
Axial images were interpreted in conjunction with sagittal and coronal
reformats.
DLP: 2256 mGy-cm
COMPARISON: Left hip radiograph ___. CT abdomen and pelvis ___.
FINDINGS:
There is no evidence of fracture. Diffuse demineralization noted. There are
mild degenerative changes of the left hip. Mild degenerative changes are also
noted about the knee with subchondral cystic changes and medial joint space
narrowing. There is a small knee joint effusion.
A lytic lesion within the anterior femoral head is unchanged from ___ as is a
mildly sclerotic lesion within the posterior acetabulum.
There is no evidence of abscess. There is mild nonspecific soft tissue
stranding involving the medial and lateral thigh. Limited views of the vessels
demonstrate atherosclerotic disease with both calcified and noncalcified
thrombus within the popliteal artery. The muscles are within normal limits for
the patient's age.
IMPRESSION:
1. No drainable fluid collection.
2. No evidence of fracture.
3. Atherosclerotic disease within the left lower extremity arterial vessels.
|
10184327-RR-94
| 10,184,327 | 21,280,059 |
RR
| 94 |
2136-12-22 19:17:00
|
2136-12-22 20:49:00
|
EXAMINATION: CT L-SPINE W/ CONTRAST
INDICATION: ___ year old man with h/o ESRD on HD, HCM s/p ICD, and several
bouts of serious bacteremia psoas abscess, here with G+cocci bacteremia and
pneumonia and new low back pain // Evidence of abscess or diskitis or other
infectious source or sequelae causing low back pain Evidence of abscess or
diskitis or other infectious source o
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated.
No contrast was administered.
CTDIvol: 31 mGy
DLP: 743 mGy-cm
COMPARISON: Lumbar spine radiographs on ___. Chest CT on ___. CT abdomen pelvis on ___.
FINDINGS:
NUMBERING USED IS SHOWN ON SE 602B, IM 38
Scoliosis and straightening of lumbar spine.
There is scoliosis of the lumbar spine convex to the right at L3-4.
Again seen are multilevel, multifactorial degenerative changes of the lumbar
spine with partial fusion of L3-4 and severe disc space narrowing at L2-3 and
L4-5. Large osteophytes are seen throughout the lumbar spine. There is
cortical irregularity at the endplates L4-5 and at L5-S1.
Multilevel, multifactorial degenerative changes are noted, with disk bulge,
posterior osteophytes, facet degenerative changes and mild ligamentum flavum
thickening causing mild canal and mild to moderate foraminal and lateral
recess narrowing from L2-3 to L5-S1 levels.
Limited assessment of intra canalicular/intrathecal details on CT.
No acute fractures or suspicious osseous lesions.
No surrounding fluid collections. There is no evidence of psoas abscess.
Partially visualized left pleural effusion.
Renal cysts and marked vascular calcifications.
IMPRESSION:
Multilevel, multifactorial degenerative changes of the lumbar spine,
significantly worsened compared to ___ with mild canal, mild to
moderate foraminal and lateral recess narrowing.
Irregularity of the endplates of L4-5 and L5-S1 with surrounding fat
stranding, this is likely the result of severe degenerative changes however
cannot entirely rule out discitis/osteomyelitis at these levels though less
likely. No fluid collection or suggestion of abscess on non-contrast study.
Correlate clinically to decide on the need for further workup or followup.
Partially visualized left pleural effusion.
Renal cysts and marked vascular calcifications.
|
10184327-RR-95
| 10,184,327 | 21,280,059 |
RR
| 95 |
2136-12-28 16:35:00
|
2136-12-28 17:51:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: ___ year old man with multiple comorbidities including ESRD on HD,
here for recurrent enterococcal pacemaker associated endocarditis c/b
suspected L spine osteo/diskitis now with new right hip pain with standing.
// Please evaluate for evidence of septic arthritis
TECHNIQUE: AP pelvis and two views of right hip.
COMPARISON: ___.
FINDINGS:
There is severe right hip joint degenerative change, with joint space
narrowing, subchondral sclerosis, subchondral cyst formation. No acute
fracture is seen. No obvious bone destruction. Bones appear generally
demineralized. There is mild left hip joint degenerative change. There is
vascular calcification. There is degenerative change in the lower lumbar
spine which is partly visualized.
IMPRESSION:
Severe right hip joint degenerative change, but no evidence of bone
destruction. Septic arthritis is not excluded by this study.
|
10184327-RR-96
| 10,184,327 | 21,280,059 |
RR
| 96 |
2136-12-31 11:17:00
|
2136-12-31 13:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: s/p left sided ICD extraction and R IJ temporary pacemaker. Eval
for PTX // s/p left sided ICD extraction and R IJ temporary pacemaker. Eval
for PTX s/p left sided ICD extraction and R IJ temporary pacemaker.
IMPRESSION:
In comparison with the study of ___, the dual-channel pacer device is
been removed and replaced with a right IJ single-lead device that extends to
the region of the apex of the right ventricle. There is increasing
opacification at the left base with poor definition of the hemidiaphragm. This
could well reflect volume loss in the lower lobe and pleural effusion, though
in the appropriate clinical setting superimposed pneumonia would have to be
considered.
|
10184327-RR-98
| 10,184,327 | 21,280,059 |
RR
| 98 |
2137-01-01 16:32:00
|
2137-01-01 20:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with lead extraction // s/p lead extraction
COMPARISON: Chest x-ray from ___ at 11:39 a.m.
FINDINGS:
Again seen is the right IJ single pacing lead with tip over right ventricle.
Inspiratory volumes are considerably lower. Again seen is left lower lobe
collapse and/or consolidation. A small left effusion would be difficult to
exclude. The vascular markings are prominent, more so than on the previous
film, but likely accentuated by low lung volumes. Minimal atelectasis at the
right base.
Heart borders are obscured by left base opacity, but grossly unchanged.
IMPRESSION:
1. Left lower lobe collapse and/or consolidation, probably slightly worse.
2. Vascular plethora, suggestive of CHF, but likely accentuated by low lung
volumes.
|
10184327-RR-99
| 10,184,327 | 21,280,059 |
RR
| 99 |
2137-01-02 09:06:00
|
2137-01-02 13:16:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with bacteremia and lead extraction, with fever
// evaluation
COMPARISON: Chest x-ray from ___ at 16:48
FINDINGS:
Compared with ___ at 16 48, the degree of vascular plethora/CHF
findings have improved, with only mild residual CHF. Again seen is left lower
lobe collapse and/or consolidation. A small left effusion would be difficult
to exclude. Aside from right base atelectasis and residual vascular plethora,
the right lung is grossly clear. Right IJ pacing lead again noted.
IMPRESSION:
1. Left lower lobe collapse and/or consolidation, essentially unchanged.
2. Interval improvement CHF findings. Mild residual vascular plethora present.
|
10185295-RR-25
| 10,185,295 | 22,821,991 |
RR
| 25 |
2183-04-11 03:13:00
|
2183-04-11 05:23:00
|
INDICATION: Chest pain. Evaluate for evidence of congestive heart failure
versus pneumothorax.
COMPARISON: Chest radiograph from ___.
FINDINGS: Frontal and lateral radiographs of the chest were acquired.
Elevation of the right hemidiaphragm is not significantly changed compared to
the prior study from ___. There is minimal atelectasis/scarring in
the right mid to upper lung. The lungs are otherwise clear. The heart is
normal in size. The mediastinal contours are normal. There are no pleural
effusions. No pneumothorax is seen.
IMPRESSION:
1. No acute cardiac or pulmonary process.
2. Unchanged elevation of the right hemidiaphragm.
|
10185295-RR-33
| 10,185,295 | 25,419,883 |
RR
| 33 |
2186-04-18 17:41:00
|
2186-04-18 18:39:00
|
INDICATION: ___ with CP // r/o cardiopulm process
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___.
FINDINGS:
Right basilar atelectasis is noted.The lungs are otherwise clear without
consolidation, effusion, or edema. Relative elevation the right hemidiaphragm
is unchanged. The cardiomediastinal silhouette is within normal limits.
Atherosclerotic calcifications seen at the aortic arch. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10185295-RR-34
| 10,185,295 | 25,419,883 |
RR
| 34 |
2186-04-19 19:28:00
|
2186-04-19 20:08:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: ___ year old woman presents with not following commands during a
coronary angiogram // stroke.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque350 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 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 4.9 s, 38.1 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,215.8 mGy-cm.
Total DLP (Head) = 2,135 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of hemorrhage, edema, mass effect, or
acute vascular territorial infarction. Periventricular and subcortical white
matter hypodensities are nonspecific but likely sequelae of chronic small
vessel ischemic disease. The ventricles and sulci are age-appropriate.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
There is multifocal calcified plaque in the cavernous and paraclinoid internal
carotid arteries bilaterally without high-grade luminal narrowing. The
vessels of the circle of ___ and their principal intracranial branches
otherwise appear normal without stenosis, occlusion, or aneurysm formation.
The dural venous sinuses are patent.
CTA NECK:
There is a four vessel aortic arch with the left vertebral artery originating
directly from the arch between the left common carotid and left subclavian
arteries. The origin of branch vessels, common carotid, and vertebral
arteries are patent. There is calcified plaque in carotid bulbs bilaterally,
left greater than right, resulting in moderate narrowing of the origin of the
left external carotid artery. There is no internal carotid artery stenosis by
NASCET criteria. The vertebral arteries are within normal limits.
OTHER:
The visualized portion of the lungs are clear. There is probably moderate
centrilobular emphysema. The thyroid gland is difficult to evaluate as a
result of extensive streak artifact in this region. There is no
lymphadenopathy by CT size criteria. Note is made of diffuse circumferential
wall thickening of the esophagus.
IMPRESSION:
1. No evidence of hemorrhage, edema, mass effect, or acute vascular
territorial infarction.
2. Unremarkable head and neck CTA except for scattered atherosclerotic
disease as described above.
3. Diffuse circumferential wall thickening of the esophagus may be related to
esophagitis or reflux and should be clinically correlated.
|
10185323-RR-24
| 10,185,323 | 24,626,364 |
RR
| 24 |
2121-06-22 08:15:00
|
2121-06-22 13:21:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with chronic thromboembolic PH and emphysema,
with new lingula scarring on last CT chest at OSH ___, eval for change//
change in lingula scarring
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.6 s, 36.4 cm; CTDIvol = 8.1 mGy (Body) DLP = 291.0
mGy-cm.
Total DLP (Body) = 291 mGy-cm.
COMPARISON: CT chest without IV contrast ___ from outside
hospital.
FINDINGS:
Thyroid is unremarkable. Multiple prominent mediastinal lymph nodes are not
pathologically enlarged and are likely reactive. Thoracic aorta is normal
size. Main pulmonary artery is enlarged, measuring 40 mm in diameter,
increased from 38 mm in ___. Right atrium is enlarged. Distal
pulmonary artery branches are diffusely enlarged. Segmental and subsegmental
pulmonary veins in bilateral posterior lower lobes, right greater than left,
are also larger compared to ___. There is no pericardial effusion.
Mild diffuse bronchial wall thickening is noted. Small area of consolidation
in the posterior right lower lobe with new small right pleural effusion is
suspicious for pneumonia. Trace left pleural effusion is also new.
Diffuse predominantly central ground-glass opacities in bilateral lungs are
similar to ___. Multiple areas of focal peripheral scarring in
the left upper and lower lobes are unchanged. Pulmonary emphysema is mild.
Hiatal hernia is small to moderate size. Limited evaluation of the upper
abdomen is unremarkable. Sequela of old fractures are noted in the lower left
ribs. Congenital bridging of lateral right seventh and eighth ribs is noted.
IMPRESSION:
1. Small area of consolidation in the posterior right lower lobe with new
small right pleural effusion is suspicious for pneumonia.
2. Enlarged pulmonary arteries and veins are consistent with history of
pulmonary artery hypertension.
3. Mild pulmonary emphysema.
4. Bilateral pulmonary ground-glass opacities and peripheral parenchymal
scarring appear stable from before.
|
10185323-RR-25
| 10,185,323 | 24,626,364 |
RR
| 25 |
2121-06-22 12:20:00
|
2121-06-22 12:57:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with lt calf swelling// evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow is demonstrated in
the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Superficial subcutaneous edema noted in the left calf.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10185405-RR-19
| 10,185,405 | 21,571,821 |
RR
| 19 |
2184-03-02 04:42:00
|
2184-03-02 06:01:00
|
EXAMINATION: CTA NECK WANDW/OC AND RECONS Q25 CT NECK
INDICATION: ___ year old man with know carotid pseudoaneurysm. Please assess
for wosrening rupture/interval change // Please obtain at 5am. Assess
bilateral carotid aneurysms
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
skull base during infusion of 70 mL of Omnipaque intravenous contrast
material. Three-dimensional angiographic volume rendered, curved reformatted
and segmented images were generated. This report is based on interpretation of
all of these images.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 65.3 mGy (Head) DLP =
32.7 mGy-cm.
2) Spiral Acquisition 4.1 s, 32.3 cm; CTDIvol = 35.2 mGy (Head) DLP =
1,137.9 mGy-cm.
Total DLP (Head) = 1,171 mGy-cm.
COMPARISON: Outside CT angiography ___.
FINDINGS:
A partially imaged stent is present within the distal aspect of the aortic
arch extending inferiorly. There is adjacent hematoma about the aorta which
anteriorly displaces the esophagus. No extravasation is seen extending beyond
the lumen.
Extensive calcifications are present at the origin of the right common carotid
artery. Again identified at the level of the carotid bifurcation there is a
dilatation of the artery with lobulated appearance which when measured at the
same level, the same way relative to CT performed ___, measures 23 x
19 mm, previously 23 x ___ m. A focal saccular dilation, probably a
pseudoaneurysm laterally and inferiorly, however is increased in ___,
previously 6 x 7 mm, currently 7 x 10 mm (2:174). Superiorly and medially, an
additional saccular mildly lobulated probably pseudoaneurysm measures
approximately 5.8 x 7.4 cm, not significantly changed previously 6.2 x 6.1 cm.
This is surrounded blood products which fills the carotid sheath. There is no
evidence to suggest active extravasation. Distal right internal carotid
demonstrates atherosclerotic calcifications about the carotid siphon, although
remains patent. No evidence of dissection.
Atherosclerotic disease is seen at the left carotid bifurcation and at both
vertebral origins and at the aortic arch. No evidence of high-grade stenosis
occlusion or dissection seen
IMPRESSION:
1. The inferior outpouching indicating pseudoaneurysm at the right carotid
bifurcation is slightly increased in size compared with the prior CT
angiography. However, of the second outpouching superiorly medially has not
significantly changed.
2. Stent is visualized and partially seen descending thoracic aorta since the
previous study. No obvious contrast extravasation is seen at the visualized
levels.
|
10185405-RR-20
| 10,185,405 | 21,571,821 |
RR
| 20 |
2184-03-04 10:11:00
|
2184-03-05 14:23:00
|
EXAMINATION: ART DUP EXT LOW/BILAT COMP
INDICATION: ___ year old man with R carotid pseudoaneurysm s/p TEVAR POD2,
now being screened for possible popliteal aneurysm // Popliteal aneurysm.
Please go up to the groin area as well.
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with grayscale, color Doppler and pulse Doppler of
the common femoral artery and popliteal arteries bilaterally.
COMPARISON: None
FINDINGS:
On the right side, the CFA measures 0.9 x 1.1 x 0.78 cm with heterogeneous
plaque and a triphasic waveform. The right popliteal artery measures 0.8 x
0.8 x 0.76 cm with a triphasic waveform. No aneurysm or pseudoaneurysm was
identified.
On the left side, the left common femoral artery measures 1.1 x 1.2 x 0.8 cm
and contains heterogeneous plaque with a triphasic waveform. The left
popliteal artery measures 0.71 x 0.76 x 0.65 cm and contains heterogeneous
plaque with a triphasic waveform. No aneurysm is identified.
IMPRESSION:
Bilateral heterogeneous plaque in the common femoral arteries and popliteal
arteries bilaterally. No aneurysm was identified.
|
10185405-RR-22
| 10,185,405 | 21,571,821 |
RR
| 22 |
2184-03-06 11:47:00
|
2184-03-06 14:48:00
|
EXAMINATION: CTA chest
INDICATION: ___ year old man s/p TVAR, eval for endoleak with CTA. Also eval
for infectious process w delayed phase. ___ to discuss // Endoleak?
Infectious process in the chest? ___ to discuss
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.1 s, 34.5 cm; CTDIvol = 4.0 mGy (Body) DLP = 137.2
mGy-cm.
2) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
3) Spiral Acquisition 4.2 s, 32.8 cm; CTDIvol = 15.7 mGy (Body) DLP = 515.0
mGy-cm.
Total DLP (Body) = 670 mGy-cm.
COMPARISON: CTA neck ___, CT chest ___.
FINDINGS:
The patient is status post EVAR of the descending thoracic aorta immediately
distal to the aortic arch. The aneurysm sac measures approximately 7.3 x 7.0
cm in its greatest axial dimension, not significantly changed in size from the
preprocedural CT chest from ___. The sac is again filled with
heterogeneous intermediate density material concerning for clotted blood
products. A small outpouching of the posterior aspect of the graft at its
midportion with adjacent blush of contrast into the aneurysm sac (series 3,
image 55, series 602 B, image 44) is concerning for a Type III endoleak.
Atherosclerotic disease throughout the aorta and its major branches is
moderate.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no supraclavicular, axillary, or hilar lymphadenopathy. Prominent
mediastinal lymph nodes are likely reactive. The thyroid gland appears
unremarkable.
There is no evidence of pericardial effusion. There is a trace left pleural
effusion. Coronary calcifications are dense.
Secretions in the dependent portion of the trachea are associated with
impacted bronchi at the lung bases, new from prior. Peripheral ground-glass
opacities in the left upper lobe (series 3, image 60) are new from prior.
Right upper lobe ground-glass opacities (series 3, image 77) are slightly
improved from prior. Subpleural ground-glass opacities at the lung bases
likely represent dependent edema, new from prior.
Gastrohepatic lymph nodes are prominent, but not enlarged by CT size criteria
and likely reactive. Otherwise, limited images of the upper abdomen are
unremarkable.
Severe degenerative change is noted at the first costosternal joint. No lytic
or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Small type III endoleak, currently contained, based on absence of any
increase in size of the aneurysm sac compared to preoperative study on ___.
2. New ground-glass opacities in the left upper lobe likely represent sequela
of aspiration or infection.
3. Secretions in the trachea with impacted bronchi at the lung bases are new.
4. Ground-glass in the right upper lobe is mildly improved from prior and
likely represents resolving inflammation.
|
10185405-RR-23
| 10,185,405 | 21,571,821 |
RR
| 23 |
2184-03-06 15:29:00
|
2184-03-06 16:44:00
|
INDICATION: ___ year old man month ago had his lt ankle sprain and than a few
days later another strike by hard objectno complaining on pain around the
ankle patient is also evaluate for IE or hematogenic cause for multui site
infection // Fx of ankle ? other bony pathology?
IMPRESSION:
Ankle mortise is preserved. There are mild degenerative changes of the
tibiotalar joint, best seen on the lateral view. Vascular calcifications are
seen. Prominent spurs about the calcaneus are present. Ankle mortise is
preserved without osteochondral lesions. Mineralization is normal.
|
10185405-RR-24
| 10,185,405 | 21,571,821 |
RR
| 24 |
2184-03-06 16:01:00
|
2184-03-06 16:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with infected aneurysm of the carotid artery and
aneurysm of the thoracic aorta in a workup of blood born infection. Evaluate
for brain abscess.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.8 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 844 mGy-cm.
COMPARISON: Same day CTA chest; CTA neck ___.
FINDINGS:
There is no evidence of intra or extra-axial mass, abnormal fluid collection,
hemorrhage, edema, or acute large territory infarct. The ventricles are
symmetric. The ventricles and sulci are prominent, consistent with mild
cortical atrophy. Known calcification of the bilateral carotid siphons is
redemonstrated, but better visualized on CTA neck from ___.
There is no evidence of fracture. Incidentally noted bilateral concha
bullosae. The visualized portion of the paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The visualized portion of the orbits are
unremarkable. There are right neck surgical skin clips, visualized on the
scout radiograph only.
IMPRESSION:
1. No acute intracranial abnormality. Specifically, no evidence of brain
abscess, as clinically questioned.
2. Mild cortical atrophy.
|
10185405-RR-25
| 10,185,405 | 21,571,821 |
RR
| 25 |
2184-03-07 12:46:00
|
2184-03-12 18:35:00
|
EXAMINATION: Video Swallow
INDICATION: ___ year old man with signs concerning for aspiration with all
consistencies tested (thin liquids > nectar thick liquids and soft solids >
puree solids) as well as poor secretions management suggesting pharyngeal
weakness // aspiration?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 2 min.
COMPARISON: none
FINDINGS:
Barium passes freely through the oropharynx without evidence of obstruction.
There was both penetration and silent aspiration with thin liquids, nectar
thick liquids, pureed and ground solids. Retention of the nectar thick
liquids in the right vallecula.
IMPRESSION:
Penetration and silent aspiration with thin liquids, nectar thick liquids,
pureed, and ground solids.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10185405-RR-27
| 10,185,405 | 21,571,821 |
RR
| 27 |
2184-03-10 21:05:00
|
2184-03-11 10:35:00
|
EXAMINATION: MR ANKLE ___ CONTRAST LEFT
INDICATION: ___ year old man with infected pseudoaneurysm of Rt carotid artery
with endovascular stent in a descending thoracic aortic aneurism. Suspicion
for systemic source of infection.
TECHNIQUE: Multiplanar, multi sequence MR imaging of the left ankle before
and after intravenous administration of 7 cc Gadavist. Sequences include:
Axial T1 non fat saturated, axial STIR, sagittal T1, sagittal STIR, axial T1
pre and post fat saturated, and sagittal T1 postcontrast fat saturated.
COMPARISON: Left ankle radiographs ___.
FINDINGS:
Tibiotalar Joint Effusion: None
Subtalar Joint Effusion: None
Talar Dome OCL: There is a 13 mm AP x 9 mm TV nondisplaced osteochondral
lesion along the medial talar dome. Mild adjacent subchondral marrow edema
and enhancement is identified.
Bone Marrow: Mild degenerative subchondral cyst formation along the anterior
tibial plafond. Otherwise normal without evidence of abnormal marrow edema or
enhancement.
Posterior tibial Tendon: Trace fluid within the tendon sheath.
Flexor Digitorum Tendon: Normal
Flexor Hallucis Tendon: Normal
Peroneus Brevis Tendon: Normal
Peroneus Longus Tendon: Normal
Anterior Tibialis Tendon: Normal
Extensor Digitorum tendon: Normal
Achilles tendon: Moderately thickened with increased internal STIR
hyperintensity and enhancement, consistent with posterior partial-thickness
tear, extending to an intrasubstance component. There is moderate surrounding
soft tissue edema and enhancement. No well-formed abscess collection is
identified. A small amount of fluid be difficult distinguish from dense edema
posterior to the flexor hallucis muscle (8:7, 4: 9)
There is also generalized soft tissue edema about the ankle, which may reflect
reactive change, cellulitis,or dependent edema.
The lateral collateral ligaments are grossly preserved. The deltoid ligaments
are suboptimally evaluated due to study technique.
Plantar fascia: Mild thickened. No associated marrow edema.
Inferior calcaneal enthesophyte: Moderate-size.
IMPRESSION:
1. Partial-thickness tear through the posterior Achilles tendon extending into
an intrasubstance component. Moderate surrounding edema and soft tissue
enhancement is present. The differential diagnosis includes infection or
reactive change.
2. No evidence of osteomyelitis.
3. No well-formed abscess collection. No definite fluid collection. Small
amount of fluid may be difficult to distinguish from dense edema posterior to
the flexor hallucis muscle at the level of the distal tibia. If clinically
indicated, ultrasound may help further to assess for focal fluid.
4. Nondisplaced 13 mm medial talar dome osteochondral lesion.
5. Generalized soft tissue edema surrounding the ankle which may represent
dependent edema.
|
10185405-RR-29
| 10,185,405 | 21,571,821 |
RR
| 29 |
2184-03-08 18:57:00
|
2184-03-09 09:29:00
|
INDICATION: ___ year old man with new dobhoff // dobhoff placement
COMPARISON: Compared to the chest CT from ___
IMPRESSION:
Descending thoracic aortic stent is seen. There is a Dobbhoff tube whose
distal tip is just 3 cm beyond the GE junction. This could be advanced a few
more cm. Cardiomediastinal silhouette is within normal limits. There are no
focal consolidations, pleural effusion, or pulmonary edema. There are no
pneumothoraces.
|
10185405-RR-30
| 10,185,405 | 21,571,821 |
RR
| 30 |
2184-03-08 22:32:00
|
2184-03-09 09:58:00
|
INDICATION: ___ year old man with dobhoff tube advanced // dobhoff tube
placement
COMPARISON: Radiographs from ___ at 19:25.
IMPRESSION:
The Dobbhoff tube has been advanced and the tip is now within the body of the
stomach. Thoracic aortic stent is again seen. Visualized lung fields are
grossly clear. There are no pneumothoraces. Contrast material within the
colon is seen.
|
10185405-RR-33
| 10,185,405 | 21,571,821 |
RR
| 33 |
2184-03-11 10:54:00
|
2184-03-11 12:55:00
|
EXAMINATION: SECOND OPINION CT NEURO PSO1 CT
INDICATION: ___ year old man with infected pseudo aneurism of rt carotid
artery and aneurism of thoracic aorta a/p interpose. veiwn to carotid and
intravascular aortic stenting // look for a soft tissue infection or process
in the neck pharynx/arynx carotid sheeth
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
skull base during infusion of 80 cc Omnipaque 350. Three-dimensional
angiographic volume rendered, curved reformatted and segmented images were
generated. This report is based on interpretation of all of these images.
DOSE: CTDIvol 30.13 mGy; DLP 975.61 mGycm.
COMPARISON: CT head without contrast of ___ any 16, CTA neck with
without contrast of ___.
FINDINGS:
Interval removal of previously described stent in the distal aortic arch and
descending thoracic aorta from examination of ___. There is a
partially imaged descending thoracic pseudoaneurysm (series 3, image 1; 3.5 x
1.7 cm (AP, TRV)), not visualized on prior examination. Large surrounding
high density fatty stranding is identified.
Atherosclerotic calcification of the aortic arch, origins of the right
brachiocephalic, bilateral common carotid and subclavian arteries is
identified without high-grade stenosis, although there is at moderate stenosis
at the origin of the bilateral subclavian arteries. Prominent atherosclerotic
calcification of the bilateral carotid bifurcations is noted. Multi lobulated
pseudo aneurysms of the right internal carotid artery is similar in appearance
to examination of ___, measuring approximately 2.3 x 1.9 cm in
greatest dimension (series 3, image 78 ; AP, TRV). Diffuse surrounding
inflammatory stranding of the right carotid space. Approximately 50% stenosis
of the right cervical internal carotid artery by NASCET criteria. There is no
stenosis of the left cervical internal carotid artery by NASCET criteria.
Atherosclerotic calcification of the intracranial internal carotid arteries is
identified without high-grade stenosis. Otherwise, the visualized
intracranial circulation is grossly unremarkable.
There is no cervical lymphadenopathy by size criteria. The thyroid gland is
unremarkable. Aerosolized adherent mucus along the anterior aspect of the
carina is identified. Otherwise, the visualized aerodigestive tract is
unremarkable. No suspicious pulmonary nodules is noted. No suspicious
blastic or lytic osseous lesions. The visualized orbits are remarkable.
Prominent periapical lucency ___ tooth 8 is noted.
IMPRESSION:
1. Interval removal of a descending thoracic aorta stent from examination of
___.
2. There is diffuse inflammatory stranding and a new descending thoracic aorta
pseudo-aneurysm with aortitis measuring approximately 3.5 cm partially
visualized, at high risk for rupture.
3. Re-identified is are lobulated pseudo aneurysms of the right cervical
internal carotid artery near the bifurcation. Diffuse inflammatory stranding
and mural thickening is unchanged from ___.
4. No focal enhancing collection or contrast extravasation is identified.
5. The inflammatory stranding of the descending thoracic aorta and right
cervical internal carotid artery is most compatible with inflammatory aortitis
and arteritis. The clinical scenario and similar appearance of the right
cervical internal carotid artery pseudo aneurysms since examination of ___ makes infectious process less likely.
|
10185405-RR-34
| 10,185,405 | 21,571,821 |
RR
| 34 |
2184-03-14 08:49:00
|
2184-03-14 10:04:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with picc // r picc 50cm iv ping ___ Contact
name: ping, ___: ___ r picc 50cm iv ping ___
IMPRESSION:
Comparison to ___. The patient has received a right-sided PICC line.
The tip of the line projects over the lower SVC. No complications, notably no
pneumothorax. Stable appearance of the lungs and of the cardiac silhouette,
the aortic stent graft is in unchanged position.
|
10185405-RR-37
| 10,185,405 | 21,571,821 |
RR
| 37 |
2184-03-15 12:47:00
|
2184-03-15 13:51:00
|
EXAMINATION: Scrotal and right renal ultrasound
INDICATION: ___ year old man with groin bulge ?hernia - discussed with
radiologist // ? hernia
TECHNIQUE: Grayscale with color and spectral Doppler ultrasound of the
scrotum was performed with a linear transducer.
COMPARISON: None.
FINDINGS:
The right testicle measures: 2.9 x 3.4 x 4.2 cm.
The left testicle measures: 2.9 x 2.8 x 4.7 cm.
The testicular echogenicity is normal, without focal abnormalities.
There are multiple, large, confluent anechoic structures in the bilateral
epididymides.
Vascularity is normal and symmetric in the testes and epididymides.
Grayscale and color Doppler images of the right groin with Valsalve maneuver
revealed a tubular, echogenic, somewhat mobile structure descending along the
route of the spermatic cord and terminating near the right epididymis.
IMPRESSION:
1. Predominantly fat containing right inguinal hernia, possibly also
containing a small amount of bowel.
2. Bilateral confluent epididymal head cysts.
3. Right hydrocele.
|
10185405-RR-38
| 10,185,405 | 21,571,821 |
RR
| 38 |
2184-03-17 12:54:00
|
2184-03-17 16:22:00
|
EXAMINATION: G-tube check
INDICATION: ___ s/p PEG w severe abd pain now // verify placement of PEG
TECHNIQUE: 3 supine portable AP radiographs of the abdomen were obtained
before and after the administration of oral contrast through an existing
gastric tube.
COMPARISON: Chest x-ray ___
FINDINGS:
Pre-injection images demonstrate a nonobstructive nonspecific bowel gas
pattern. There is retained oral contrast within numerous colonic diverticula
in both the right and left colon. Contrast also projects over the rectum.
Evaluation for free air is limited on these supine AP radiographs. If there
is concern for free air, upright or decubitus imaging is recommended.
The balloon of a percutaneous gastric tube projects over the left upper
quadrant just to the left of midline over the twelfth rib. After the
injection of contrast, contrast is seen opacifying the gastric lumen with
normal appearing gastric folds. A third image obtained demonstrates contrast
progressing through the antrum of the stomach into the first and second
portions of the duodenum. There is no evidence of extraluminal contrast
extravasation to suggest leak.
IMPRESSION:
Contrast opacifies the gastric lumen and progresses into the first and second
portions of the duodenum. There is no evidence of extraluminal contrast
extravasation to suggest leak.
|
10185405-RR-39
| 10,185,405 | 21,571,821 |
RR
| 39 |
2184-03-17 15:08:00
|
2184-03-17 15:41:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ s/p PEG with severe abd pain s/p tube study // ? movement of
contrast, please do at 3:30pm
TECHNIQUE: Abdomen single view
COMPARISON: ___ 13:00
FINDINGS:
Percutaneous gastrostomy tube. Residual contrast throughout bowel loops. No
bowel dilatation. Degenerative changes spine. Arterial calcifications.
Surgical staples left groin. Additional metallic densities left groin.
IMPRESSION:
Residual contrast in the bowel loops
|
10185454-RR-22
| 10,185,454 | 28,615,334 |
RR
| 22 |
2196-06-01 09:14:00
|
2196-06-01 12:14:00
|
INDICATION: ___ male patient with new right PICC line placement.
COMPARISON: None available.
TECHNIQUE: Upright AP chest radiograph.
FINDINGS: A right-sided PICC line tip terminates in the low SVC. The PICC
line demonstrates a normal course with no complications, particularly no
pneumothorax. There are low lung volumes which accentuate the cardiac
silhouette and bronchovascular structures. Atelectasis in the setting of low
lung volumes could be a component of bronchovascular crowding. There are no
focal consolidations or pleural effusions.
IMPRESSION: Right PICC line tip in low SVC.
These findings were discussed with ___ by Dr. ___ via
telephone on ___ at 10:30 a.m., at the time of discovery.
|
10185829-RR-17
| 10,185,829 | 24,391,963 |
RR
| 17 |
2165-01-01 16:58:00
|
2165-01-01 19:10:00
|
EXAMINATION: CTA TORSO
INDICATION: ___ with chronic type B dissection s/p ascending aorta repair for
type A dissection here with ?SMA clot, chronic type B dissection, and acute
diverticulitis// ? progression of disease
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 64.9 cm; CTDIvol = 11.3 mGy (Body) DLP = 731.6
mGy-cm.
2) Stationary Acquisition 5.1 s, 0.5 cm; CTDIvol = 22.3 mGy (Body) DLP =
11.2 mGy-cm.
Total DLP (Body) = 743 mGy-cm.
COMPARISON: CTA from ___ and ___.
FINDINGS:
VASCULAR:
The patient is status post repair of ___ dissection, with 2
rings placed at the sino-tubular junction and another at the proximal aortic
arch. Postsurgical changes are seen along the ascending aorta, decreased in
comparisons to the previous study from ___. Calcification of the
coronary arteries are again noted, appearing similar to previous..
Re-demonstration of a type B dissection extending from just beyond the takeoff
of the left subclavian artery, extending caudally into the left common iliac
artery. There is extension of the dissection into the proximal celiac artery,
stable to the previous study. There is also extension of the dissection into
the SMA, beyond the origin of the proximal branches, with thrombosis of the
false lumen distally, stable to previous. The distal branches of the SMA
remain supplied by the true lumen, and are patent.
The single right renal artery is supplied by the true lumen and is patent.
There is extension of the dissection into the left renal artery, stable to
previous.
Stability of a saccular aneurysm of the proximal right common iliac artery,
measuring up to 2.3 cm.
CHEST: Extensive centrilobular emphysematous changes, with scarring in the
right lower lobe. No focal lung lesions of visualized, however the lung
apices are not included in the study.
There are no pleural or pericardial effusions.
There is no size significant mediastinal or hilar lymphadenopathy.
The pulmonary arteries are patent down to the subsegmental branches.
Previous median sternotomy.
ABDOMEN:
HEPATOBILIARY: Interval stability of scattered hypodense liver lesions, the
largest in segment 7 measuring up to 2.7 cm, likely cysts. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. Uncomplicated
gallbladder stones, with vicarious contrast excretion.
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: Scarring is noted at the upper pole of the left kidney, sequelae of
prior infarction. Bilateral cortical cysts, the largest measuring up to 4.6
cm in the upper pole of the left kidney. There is no hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is small-bowel dilatation measuring up to 4 cm. There
is gradual tapering of the small bowel loops within the right lower quadrant,
with few areas of more abrupt transition seen on series 2 images 170 and 179.
The distal small bowel is decompressed up to the ileocecal valve.
There is a focally thickened portion of proximal ileum seen within the pelvis
(series 2, image 178) without surrounding inflammatory changes. There is
normal mucosal enhancement of the small bowel loops, without evidence of
pneumatosis or portal venous gas. Contrast is seen in the colon, from the
previous study.
There is thickening of the proximal-mid sigmoid colon which contains numerous
diverticula, with adjacent fat stranding, compatible with diverticulitis.
There is no free air, or extraluminal collection.
There is persistent thickening of the distal sigmoid colon, stable to
previous.
There is increased ascites in comparisons to the previous exam, small in
volume.
Small subcentimeter mesenteric and pelvic lymph nodes, likely reactive..
PELVIS: A Foley catheter is present in the bladder. The urinary bladder and
distal ureters are unremarkable. There is no evidence of pelvic or inguinal
lymphadenopathy.
REPRODUCTIVE ORGANS: The prostate is prominently enlarged.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Stable extension of the type B aortic dissection, with involvement of the
celiac, SMA, left renal and left common iliac arteries. The distal branches
of the SMA are supplied by the true lumen and remain patent.
2. Acute uncomplicated sigmoid diverticulitis, without evidence of perforation
or abscess.
3. New small bowel dilatation, with gradual tapering up to the level of the
distal ileum, where there are few focal more abrupt changes in bowel caliber.
Overall, this likely represents an ileus secondary to the sigmoid
diverticulitis.
4. Focally thickened segment of proximal ileum in the pelvis, without adjacent
inflammatory changes, likely reactive. There is no pneumatosis or portal
venous gas. No signs of bowel ischemia on the present study.
5. Small volume of ascites which has increased since the previous study.
6. Uncomplicated cholelithiasis.
7. Prominent prostatic enlargement. Correlate with PSA.
8. Severe emphysema.
|
10186442-RR-29
| 10,186,442 | 27,911,046 |
RR
| 29 |
2168-01-13 11:33:00
|
2168-01-13 21:23:00
|
INDICATION: ___ year old woman with HF and respiratory distress. Pulmonary
edema?
TECHNIQUE: Portable frontal supine chest radiograph
COMPARISON: Multiple prior chest radiographs, most recent on ___
FINDINGS:
There has been significant interval worsening of the left sided pleural
effusion with associated left lower lobe collapse. A right lower lung opacity
is a combination of a layering effusion and atelectasis. Vascular congestion
and interstitial edema is also unchanged. Assessment of cardiac size is
limited due to technique but there appears to be moderate cardiomegaly. There
is no pneumothorax. Left-sided PICC line ends in the mid SVC. Severe
degenerative changes of the right glenohumeral joint are reidentified.
IMPRESSION:
Significant worsening of the left pleural effusion with associated severe left
lower lobe atelectasis. Vascular congestion and interstitial pulmonary edema
not significantly worsened from the previous exam.
|
10186442-RR-30
| 10,186,442 | 27,911,046 |
RR
| 30 |
2168-01-18 13:13:00
|
2168-01-18 16:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with w/o R MCA stroke p/w encephalopathy ___
UTI, course complicated by CHF exacerbation and now uptrending leukocyosis
with increasing O2 requirement // ? pneumonia or aspiration event OR
pulmonary edema
TECHNIQUE: Plain film
COMPARISON: ___.
FINDINGS:
Combination of left pleural fluid and consolidation at the left base
completely obscure the left hemidiaphragm but the opacity appears to be more
related to lung consolidation or edema than to fluid currently. Cardiomegaly
appears unchanged. Hemidiaphragm on the right is obscured as well though there
is better aeration of the right lung compared to the previous film.
Right-sided PICC line is in unchanged position.
IMPRESSION:
Slightly worsened opacity at the right left lung base and left upper lobe
appears more related to consolidation or edema than to pleural effusion which
appeared larger on ___
|
10186442-RR-31
| 10,186,442 | 21,537,662 |
RR
| 31 |
2168-01-27 00:59:00
|
2168-01-27 03:16:00
|
INDICATION: History: ___ with et tube // eval tube placement
TECHNIQUE: AP portable view of the chest
COMPARISON: ___ chest radiograph
FINDINGS:
ET tube ends 4.6 cm from the carina. Enteric tube is off the inferior portion
of the image. There is left lower lobe collapse. There are small bilateral
pleural effusions, with a significant decrease in the size of the left pleural
effusion. There is mild pulmonary edema. No pneumothorax.
IMPRESSION:
ET tube in appropriate position.
Left lower lobe collapse. Mild pulmonary edema.
Small bilateral pleural effusions, the left pleural effusion has decreased.
|
10186442-RR-32
| 10,186,442 | 21,537,662 |
RR
| 32 |
2168-01-27 01:10:00
|
2168-01-27 02:42:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with ams // ICH
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891 mGy-cm; CTDI: 54 mGy
COMPARISON:
CT head ___.
FINDINGS:
Encephalomalacia from the patient's right MCA infarction is increased from
prior study. Again seen is the cortical gyriform hyperattenuating areas, most
consistent with dystrophic mineralization at sites of pseudolaminar necrosis.
No evidence of a hemorrhage or new infarction. There is no hydrocephalus.
Again seen is opacification of the mastoid air cells bilaterally. There is no
fracture.
IMPRESSION:
Progression of encephalomalacia in the patient's right MCA infarction. The
cortical gyriform hyperattenuating areas are most consistent with dystrophic
mineralization at sites of pseudolaminar necrosis. No evidence of hemorrhage
or new infarction.
NOTIFICATION: These findings were discussed with Dr. ___ by Dr.
___ at 02:39 on ___ by telephone at time of
discovery.
|
10186442-RR-33
| 10,186,442 | 21,537,662 |
RR
| 33 |
2168-01-28 06:00:00
|
2168-01-29 11:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ female with respiratory failure. Evaluate for
worsening edema.
TECHNIQUE: Portable AP radiograph of the chest from ___.
COMPARISON: ___.
FINDINGS:
ET and enteric tubes remain in satisfactory position. Moderate to severe
pulmonary edema is unchanged. Moderate bilateral layering pleural effusions
appear slightly larger on today's exam. There is no pneumothorax. The heart
and mediastinum cannot be accurately assessed due to projection and
significant airspace disease. Regional bones and soft tissues are
unremarkable.
IMPRESSION:
Stable moderate to severe pulmonary edema.
Slight interval increase in moderate layering bilateral pleural effusions.
|
10186442-RR-34
| 10,186,442 | 21,537,662 |
RR
| 34 |
2168-01-28 11:42:00
|
2168-01-28 14:32:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with distended belly // ?obstruction
TECHNIQUE: Portable radiographs of the abdomen.
COMPARISON: Abdominal radiographs obtained ___.
FINDINGS:
There is a nasoenteric tube seen coursing vertically down the midline of the
abdomen, with distal tip projecting over the approximate location of the
duodenum. There is a G-tube in the left upper quadrant in unchanged position
as compared to prior abdominal radiograph. The visualized portions of the
lower thorax demonstrates cardiomegaly. Blunting of left CP angle is
consistent with a small left pleural effusion.
There are no abnormally dilated loops of small or large bowel. The bowel gas
pattern is unremarkable. There is no evidence of pneumoperitoneum or
pneumatosis.
IMPRESSION:
1. No evidence of obstruction.
2. Cardiomegaly and small left pleural effusion.
|
10186442-RR-35
| 10,186,442 | 21,537,662 |
RR
| 35 |
2168-01-29 04:38:00
|
2168-01-29 10:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated for hypoxemic respiratory failure //
eval for interval change
TECHNIQUE: Portable semi-erect
COMPARISON: Chest films dating back to ___
FINDINGS:
ET tube is 3.5 cm above the carinal. NG tube is seen in the stomach and goes
out of view. Left chest pigtail catheter is seen terminating in the basal left
lung. Right moderate pleural effusion is smaller since prior. Pulmonary
vascular congestion is unchanged as compared to prior. There is moderate
cardiomegaly.
IMPRESSION:
Smaller moderate right pleural effusion, moderate cardiomegaly which is
unchanged, and vascular congestion which is stable.
|
10186442-RR-36
| 10,186,442 | 21,537,662 |
RR
| 36 |
2168-01-28 17:35:00
|
2168-01-28 18:34:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with pleural effusion // chest tube patient
COMPARISON: Chest radiographs ___ through ___ at 06:10.
IMPRESSION:
Since ___ following insertion of a pigtail pleural drainage catheter at the
base of the left chest chest, the previous moderate to large left pleural
effusion has been substantially drained and there is no pneumothorax. Moderate
right pleural effusion persists. Pulmonary vasculature is congested, but I
doubt that pulmonary edema is present. Mild cardiomegaly is improved. ET tube
is in standard placement. Nasogastric tube passes into the duodenum and out of
view.
|
10186442-RR-37
| 10,186,442 | 21,537,662 |
RR
| 37 |
2168-01-28 17:59:00
|
2168-01-28 18:50:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with septic shock likely ___ to UTI, now with
distended, firm abdomen PLEASE DO STUDY BEDSIDE AS ___ IN MICU ON PRESSORS //
Abdominal process to explain abdominal distension, RUQ pathology?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None available.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. No focal
suspicious nodules or masses are identified within the liver. There is no
intra or extrahepatic biliary ductal dilation. The CBD measures 4mm. The
portal vein is patent with flow in the appropriate direction. There is
significant ascites. Incidentally, a right pleural effusion is noted.
GALLBLADDER: Sludge is noted within the gallbladder, however, the gallbladder
itself is not distended.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilatation, with portions of the pancreatic head
and tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 8.7 cm.
BLADDER: The urinary bladder is seen to be collapsed around a Foley catheter.
IMPRESSION:
Moderate ascites and a right pleural effusion.
|
10186442-RR-38
| 10,186,442 | 21,537,662 |
RR
| 38 |
2168-01-29 10:53:00
|
2168-01-29 13:18:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new picc
TECHNIQUE: Semi supine portable
COMPARISON: ___ 04:57
FINDINGS:
Right PICC line terminates in the right atrium 8 cm below the Carina, the
nurse was discharged to pull back the PICC line by approximately 4 cm. Left
pigtail catheter is seen terminating in the left lung base. The ET tube is 5
cm above the carina. Mild pulmonary edema. Cardiomegaly. Small left pleural
effusion.
IMPRESSION:
Right PICC line terminating in the right atrium 8 cm below the carina. Mild
pulmonary edema.
|
10186442-RR-39
| 10,186,442 | 21,537,662 |
RR
| 39 |
2168-01-31 04:15:00
|
2168-01-31 08:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxic respiratory failure // ?interval
worsening
COMPARISON: ___
IMPRESSION:
As compared to the previous image, the nasogastric tube has been removed. The
endotracheal tube, the left pleural pigtail catheter as well as the right PICC
line are still visualized, the PICC line has been pulled back by several cm
and the tip now projects over the mid to lower SVC.
Improvement in the extent of bilateral pleural effusions, with subsequent
improvement of pulmonary ventilation. However, mild pulmonary edema and areas
of atelectasis, predominantly at the lung bases, are still visualized.
Unchanged borderline size of the cardiac silhouette.
|
10186442-RR-40
| 10,186,442 | 21,537,662 |
RR
| 40 |
2168-02-01 18:27:00
|
2168-02-02 00:34:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with sepsis ___ UTI, CHF, hypoxemic respiratory
failure ___ pulmonary edema, pleural effusion, s/p thoracentesis and chest
tube, now with hypotension of unclear etiology // s/p paracentesis on ___,
eval for free air
TECHNIQUE: Portable radiographs of the abdomen
COMPARISON: Abdominal radiograph obtained ___.
FINDINGS:
Evaluation for free air is limited by supine positioning and exclusion of
diaphragm on multiple frontal abdominal images. No definite large collection
of free intraperitoneal air is seen. However, if further concern for free
intraperitoneal air exists, it is recommended to obtain upright chest
radiograph.
A G-tube is seen projecting over the left upper quadrant. There is a pigtail
catheter seen at the left upper limit of the film, overlying the left lung
base. Colonic and rectal stool and air is seen. There is are no abnormally
dilated loops of small or large bowel, nor any other evidence of obstruction.
IMPRESSION:
1. No large collection of free intraperitoneal air; however, current study
limited by supine positioning and incomplete visualization of diaphragm.
Recommend upright chest radiograph for further evaluation if clinically
indicated.
2. Otherwise, unremarkable bowel gas pattern.
|
10186442-RR-41
| 10,186,442 | 21,537,662 |
RR
| 41 |
2168-02-01 18:27:00
|
2168-02-02 00:36:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with sepsis ___ UTI, CHF, hypoxemic respiratory
failure ___ pulmonary edema, pleural effusion, s/p thoracentesis and chest
tube, now with hypotension of unclear etiology // eval for pneumothorax,
pleural effusion
COMPARISON: Chest radiographs ___ through ___
IMPRESSION:
Pulmonary edema present on ___ has nearly resolved. Small right
pleural effusion is smaller. No pneumothorax. Mild cardiomegaly unchanged.
ET tube and right PIC line in standard placements. Left pigtail pleural
drainage catheter unchanged in position, narrowed as it enters the chest could
be respectively occluded. Clinical evaluation advised.
|
10186442-RR-42
| 10,186,442 | 21,537,662 |
RR
| 42 |
2168-02-03 01:56:00
|
2168-02-03 08:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent extubation // ?interval worsening
of effusions
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has been extubated. The
right PICC line remains in unchanged position. The pigtail catheter on the
left has been removed. Mild cardiomegaly. Mild pulmonary edema and bilateral
pleural effusions are visualized on today's image.
|
10186442-RR-43
| 10,186,442 | 21,537,662 |
RR
| 43 |
2168-02-04 02:08:00
|
2168-02-04 08:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with afib and some volume overload // eval for
interval change in pulmonary edeam and pleural effusions
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, there is increasing evidence of
pulmonary edema with increasing bilateral pleural effusions and appearance of
multiple air bronchograms, predominantly in the right perihilar lung zones.
The size of the cardiac silhouette is unchanged. Unchanged position of the
right PICC line.
|
10186442-RR-44
| 10,186,442 | 21,537,662 |
RR
| 44 |
2168-02-07 16:15:00
|
2168-02-07 17:36:00
|
EXAMINATION: RENAL U.S. PORT
INDICATION: ___ year old woman with amyloid CHF, nephrotic range proteinuria,
anasarca // eval for hydro, amyloid kidney
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: ___.
FINDINGS:
The right kidney measures 9.2 cm. The left kidney measures 10.0 cm. There is
no hydronephrosis, stones, or masses bilaterally. The kidneys are echogenic
bilaterally consistent with chronic medical renal disease. Note is made of
sludge seen within the gallbladder. There is moderate ascites seen in the
right and left lower quadrants. The spleen measures 7.91 cm. The bladder is
decompressed with a Foley catheter in place.
IMPRESSION:
1. No hydronephrosis, large stones or worrisome masses in either kidney.
2. Echogenic kidneys consistent with chronic medical renal disease.
3. Gallbladder sludge without signs of acute cholecystitis.
|
10186442-RR-45
| 10,186,442 | 21,537,662 |
RR
| 45 |
2168-02-08 09:54:00
|
2168-02-08 11:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with shortness of breath // ?interval
worsening of pulmonary edema
COMPARISON: ___.
IMPRESSION:
Stable cardiomegaly accompanied by marked asymmetry pulmonary edema. This was
previously more severe in the right lung than the left, and is now worse on
the left than the right. Moderate bilateral pleural effusions are present,
with apparent interval increase on the left since the prior study.
|
10186442-RR-46
| 10,186,442 | 21,537,662 |
RR
| 46 |
2168-02-08 09:54:00
|
2168-02-08 16:49:00
|
INDICATION: ___ year old woman with shortness of breath // ?dilated loops of
bowel
TECHNIQUE: Abdomen supine
COMPARISON: ___
FINDINGS:
Air is identified in the transverse colon as well as several small bowel loops
and the rectum. There is a gastrostomy tube. No dilated loops of bowel are
seen.
IMPRESSION:
Nonspecific bowel gas pattern. No evidence for obstruction or ileus.
|
10186442-RR-47
| 10,186,442 | 21,537,662 |
RR
| 47 |
2168-02-09 03:59:00
|
2168-02-09 08:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ascites and HF // ?interval worsening
?interval worsening
IMPRESSION:
IN COMPARISON WITH THE STUDY OF ___, THERE IS AGAIN STABLE
CARDIOMEGALY WITH LOW LUNG VOLUMES AND SUBSTANTIAL BILATERAL LAYERING PLEURAL
EFFUSIONS, WORSE ON THE LEFT. CONTINUED ASYMMETRIC PULMONARY EDEMA. CENTRAL
CATHETER IS UNCHANGED.
|
10186442-RR-8
| 10,186,442 | 25,331,778 |
RR
| 8 |
2167-11-21 18:30:00
|
2167-11-21 19:31:00
|
CHEST RADIOGRAPHS
HISTORY: Shortness of breath. History of congestive heart failure.
COMPARISONS: None.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The lung volumes are low. There is opacification along the base of
each hemithorax suggesting moderate-sized pleural effusions with parenchymal
opacities, most commonly due to atelectasis. The cardiac contours are partly
obscured, but the heart is probably at least mildly enlarged. There is no
evidence for parenchymal edema. Mild degenerative changes affect lower
thoracic levels. The thoracic spine curves to the left side to a
mild-to-moderate degree.
IMPRESSION: Bilateral pleural effusions with opacities that can probably be
attributed to atelectasis, although not entirely specific, as well as
suspected mild cardiomegaly; however, no parenchymal edema identified.
|
10186513-RR-6
| 10,186,513 | 24,621,624 |
RR
| 6 |
2133-02-22 23:10:00
|
2133-02-23 01:45:00
|
INDICATION: Evaluation of patient for possible CBD obstruction.
COMPARISON: Outside hospital CT from ___.
FINDINGS:
A 9 x 9 mm echogenic focus consistent with a stone is visualized in the distal
common bile duct with proximal dilatation of the common bile duct up to 11 mm
consistent with an obstructing stone. The gallbladder is distended and
contains cholelithiasis and sludge. However, there is no pericholecystic
fluid, gallbladder wall edema, or positive ___ sign at this time. The
liver is normal in echotexture with no focal liver lesions identified. The
main portal vein is patent with hepatopetal flow.
IMPRESSION:
1. 9 mm obstructing stone in the distal common bile duct with dilatation of
the proximal common bile duct up to 11 mm consistent with an obstructing
stone.
2. The gallbladder is distended with stones and sludge. However, there is no
pericholecystic fluid, gallbladder wall thickening, or positive ___ sign at
this time.
|
10186925-RR-121
| 10,186,925 | 22,558,971 |
RR
| 121 |
2193-03-27 00:10:00
|
2193-03-27 02:04:00
|
INDICATION: History of right flank pain and tender mass. Please evaluate.
COMPARISONS: CT from ___.
TECHNIQUE: ___ MDCT images were obtained through the abdomen and pelvis after
the administration of IV contrast. Multiplanar reformatted images in coronal
and sagittal axes were generated and reviewed.
FINDINGS: The base of the right lung demonstrates a small pleural effusion
with adjacent compressive atelectasis. Otherwise, the bases of the lungs are
unremarkable.
The liver is normal without evidence of focal lesions or intrahepatic biliary
ductal dilatation. There is mild periportal edema. The portal vein is
patent. The splenic vein is patent. The SMV is patent. The adrenal glands
bilaterally are normal. The kidneys are markedly atrophic without evidence of
stones or hydronephrosis. The pancreas is normal, although mildly atrophic
without evidence of focal lesions.
The stomach, duodenum and small bowel are normal without evidence of wall
thickening or obstruction. There is no retroperitoneal or mesenteric
lymphadenopathy. A transplanted right kidney is seen in the right iliac
fossa, which appears homogenous. There is no intra-abdominal free air.
Multiple sutures are seen throughout the colon from multiple prior bowel
surgeries without evidence of leak, obstruction, or active inflammation.
CT PELVIS: The urinary bladder is unremarkable. Streak artifact from
surgical clips and left femoral hardware limits evaluation of the pelvis;
however, there is no pelvic or inguinal lymphadenopathy.
Mild diffuse mesenteric and subcutaneous edema are present, likely reflecting
volume overload. Multiple surgical clips are present from a prior ventral
hernia repair with associated fascial thickening, most prominent around the
umbilicus. Multiple injection granulomas are also seen along the anterior
abdominal wall.
There is a right flank extraperitoneal collection measuring approximately 13.3
cm x 6.3 cm x 9.2 cm with internal septations concerning for an abscess.
There does not seem to be intraperitoneal extension of this.
OSSEOUS STRUCTURES: Diffuse skeletal demineralization is present with mild
multilevel degenerative changes in thoracolumbar spine. Gamma nail and
intramedullary rods are seen transfixing an old fracture of the left femoral
neck. Mild degenerative disease is seen involving the bilateral sacroiliac
and hip joints.
IMPRESSION:
1. Large right flank abscess measuring 13.3 cm x 6.3 cm x 9.2 cm.
2. Severe native renal atrophy with transplant kidney in the right iliac
fossa.
3. Mild mesenteric and subcutaneous edema likely from volume overload.
These findings were discussed with Dr. ___ by phone approximately 5
minutes after discovery.
|
10186925-RR-122
| 10,186,925 | 22,558,971 |
RR
| 122 |
2193-03-27 11:11:00
|
2193-03-27 12:34:00
|
EXAM: Chest, single AP upright portable view.
CLINICAL INFORMATION: End-stage renal disease, coronary artery disease
presenting with flank abscess.
___.
FINDINGS: The patient is status post median sternotomy and CABG. There has
been interval removal of right-sided hemodialysis catheter. The cardiac and
mediastinal silhouettes are grossly stable. There is mild-to-moderate
pulmonary edema. No large pleural effusion is seen, although trace right
pleural effusion would be difficult to exclude. No definite focal
consolidation. No evidence of pneumothorax.
IMPRESSION: Moderate pulmonary edema.
|
10186925-RR-123
| 10,186,925 | 22,558,971 |
RR
| 123 |
2193-03-27 15:39:00
|
2193-03-27 17:20:00
|
INDICATION: ___ year old woman with large right flank abscess // please drain
13.3-cm x 6.3-cm x 9-cm abscess and send culture
COMPARISON: CT dated ___.
PROCEDURE: Ultrasound-guided drainage of right flank abscess.
OPERATORS: Dr. ___, abdominal radiology fellow and Dr. ___,
attending radiologist, who was present and supervising throughout the total
procedure time.
TECHNIQUE: This was a portable procedure performed in the MICU.
The risks, benefits, and alternatives of the procedure were explained to the
patient. After a detailed discussion, informed written consent was obtained.
A pre-procedure timeout using three patient identifiers was performed per
___ protocol.
The patient was placed in a left lateral decubitus position. Limited
preprocedure ultrasound was performed to localize the right flank collection.
Based on the ultrasound findings an appropriate skin entry site for the right
flank abscess drainage was chosen in the right flank. The site was marked.
Local anesthesia was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, an 8 ___ ___ catheter was
advanced into the right flank collection. A sample of fluid was aspirated,
confirming catheter position within the collection. The pigtail was deployed.
The position of the pigtail was confirmed within the collection via
ultrasound.
Approximately 180 cc of thick purulent tan colored fluid was drained with a
sample sent for microbiology evaluation. The catheter was secured by a
StatLock. The catheter was attached to a suction bulb. A sterile dressing was
applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
ANALGESIA: Analgesia was provided by administering divided doses of 2 mg
Dilaudid intravenously during which the patient's hemodynamic parameters were
continuously monitored by a MICU nurse.
FINDINGS:
Limited preprocedure ultrasound was performed to localize the right flank
collection. This measured approximately 10.6 x 6.3 x 6 7 cm. The collection
contains hyperechoic foci within it, suggestive of calculi.
IMPRESSION:
1. Technically successful ultrasound-guided drainage of right flank abscess
with placement of an 8 ___ ___ catheter. A sample was sent for
microbiology analysis.
2. Hyperechoic foci within the collection, which are suggestive of calculi.
This raises the possibility that this represents an abscess secondary to
dropped gallstones.
|
10186925-RR-124
| 10,186,925 | 22,558,971 |
RR
| 124 |
2193-03-28 03:58:00
|
2193-03-28 09:30:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with R flank abscess, ESRD on HD // evaluate
pulm edema
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, there is unchanged evidence of mild
cardiomegaly as well as mild fluid overload. No new parenchymal opacities. No
larger pleural effusions. No pneumonia, no pneumothorax.
|
10186925-RR-125
| 10,186,925 | 22,558,971 |
RR
| 125 |
2193-03-30 14:52:00
|
2193-03-30 16:45:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with right flank abscess. Evaluate right flank
abscess for resolution prior to removing drain.
TECHNIQUE: Axial CT images of the abdomen and pelvis were obtained with
intravenous and oral contrast . Sagittal and coronal reformats were prepared.
DLP: 1045 mGy-cm
COMPARISON: Recent CT abdomen and pelvis from ___.
FINDINGS:
ABDOMEN:
Trace bilateral pleural effusions are identified. There is minor bibasilar
atelectasis. Marked mitral annular calcifications are identified. No
pericardial effusions.
The liver demonstrates homogeneous enhancement. Slight prominence of the right
lobe of the liver likely pertains to ___ lobe. No focal hepatic lesions
are identified. No intrahepatic or extrahepatic biliary ductal dilatation.
The pancreas is atrophic, however no focal masses or ductal dilatation is
noted. The adrenal glands are unremarkable. Spleen is within normal limits.
Both kidneys are atrophic. A simple cyst identified in the upper pole of the
right kidney (6b:35), unchanged. A tiny hypodense lesion is identified in the
lower pole of left kidney (6b:40), too small to characterize, however likely
related to simple cyst. No hydronephrosis. A few prominent retroperitoneal
left periaortic lymph nodes are identified (05:34, 37), largest measuring up
to 1.1 cm. Moderate to severe atherosclerotic calcification of abdominal aorta
and its branches is identified. Caliber of small and large bowel is within
normal limits. Multiple sutures are again identified throughout the colon from
multiple prior bowel surgeries. Previously identified right flank subcutaneous
abscess collection demonstrates significant interval improvement, with
slightly dense residual collection remaining measuring 6.6 x 2.0 cm (05:35).
The stomach is unremarkable. The portal vein is patent. Mild bilateral flank
edema persists. Subcutaneous anterior abdominal wall venous collaterals again
identified.
PELVIS:
A right lower quadrant transplanted kidney is again identified. Partially
distended urinary bladder is unremarkable. Arcuate calcifications of the
uterus are noted. Adnexal structures are unremarkable. Stool-filled rectum is
within normal limits. High-density metallic clips are identified in midline
pelvis and left adnexa. Mild presacral edema is evident. No inguinal or pelvic
lymphadenopathy.
OSSEOUS STRUCTURES:
Bones are grossly osteopenic. No suspicious focal osteolytic or osteoblastic
lesions are identified. An intra medullary rod and gamma nail is identified at
the left femur, unchanged in configuration. Mild degenerative changes of the
bilateral sacroiliac and hip joints are noted.
IMPRESSION:
1. Significant interval decrease in size of the large right flank abscess
collection, with small residual dense collection remaining, measuring 6.6 x
2.0 cm.
2. Renal cortical atrophy with a transplant kidney in the right iliac fossa.
3. Trace bilateral pleural effusions.
4. Few prominent retroperitoneal lymph nodes, dominant in left para-aortic
region, nonspecific in etiology. Short-term CT followup of these lymph nodes
is recommended.
|
10186925-RR-126
| 10,186,925 | 22,558,971 |
RR
| 126 |
2193-04-01 17:19:00
|
2193-04-02 09:32:00
|
FOOT, LEFT
HISTORY: swelling, assess for osteomyelitis.
FINDINGS: AP and oblique views. A lateral view is not submitted. Comparison
with a previous study done ___. Patient is status post amputation of the
first ray at the level of the mid shaft of the first metatarsal, as before.
Irregularity of the contour at the site of amputation and deformity and
irregularity of the distal second metatarsal is redemonstrated. There are
degenerative changes in the digits as before. Soft tissue swelling overlies
the site of amputation and forefoot. There is extensive atherosclerotic
calcification. Bones appear osteopenic. There is no definite bony erosion or
periosteal reaction.
IMPRESSION: Soft tissue swelling. No definite evidence of osteomyelitis.
MRI may be helpful for further evaluation. Limited study as described.
|
10186925-RR-127
| 10,186,925 | 22,558,971 |
RR
| 127 |
2193-04-01 17:19:00
|
2193-04-02 09:06:00
|
HIP, BILATERAL
HISTORY:
Bilateral hip pain. Assess for fracture.
Six views. Intramedullary rod and gamma nail are in place in the proximal
left femur. Visualized cortical margins are intact. Bones appear osteopenic.
There is no evidence of dislocation. The hip joint spaces are narrow and
surrounded by tiny osteophytes. There is slight irregularity of the right
inferior pubic ramus without an apparent fracture line. Extensive
atherosclerotic calcification and scattered surgical clips are noted.
IMPRESSION: Bones appear osteopenic. There is no definite evidence of acute
fracture. Slight irregularity of the right inferior pubic ramus may be due to
an old healed fracture. Clinical correlation is recommended.
|
10186925-RR-128
| 10,186,925 | 22,558,971 |
RR
| 128 |
2193-04-02 10:45:00
|
2193-04-02 13:45:00
|
HISTORY: Non-healing heel ulcer.
FINDINGS: In comparison with study of ___, single view shows what appears
to be an ulceration posteriorly in a patient with generalized osteopenia and a
large inferior calcaneal spur. It is difficult to see the posterior cortical
margin of the calcaneus. If there is serious clinical concern for
osteomyelitis, MRI would be helpful.
|
10186925-RR-129
| 10,186,925 | 22,558,971 |
RR
| 129 |
2193-04-02 10:46:00
|
2193-04-02 11:51:00
|
INDICATION: ___ year old woman with ESRD on dialysis with dyspnea and
crackles, evaluate for pulmonary edema.
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiographs from ___ through ___.
FINDINGS:
Frontal and lateral views of the chest demonstrate peribronchial cuffing,
cardiomegaly, and upper zone vascular redistribution consistent with mild to
moderate pulmonary edema. There are no new parenchymal opacities. There is
no large pleural effusion or pneumothorax.
IMPRESSION:
Mild to moderate pulmonary edema.
|
10186925-RR-130
| 10,186,925 | 22,558,971 |
RR
| 130 |
2193-04-04 19:23:00
|
2193-04-05 10:48:00
|
INDICATION: VRE flank abscess, concerning for seeding from distant site, Left
lower extremity with chronic nonhealing ulcer, rule out osteomyelitis.
TECHNIQUE: Imaging was acquired on a 3 Tesla magnet without intravenous
gadolinium. Intravenous gadolinium was withheld in view of the patient's
renal failure. Sequences acquired include coronal T1 and STIR, axial T2 and
STIR, sagittal T1 and STIR-weighted sequences.
COMPARISON: Left foot radiographs, ___.
FINDINGS:
There is mild diffuse subcutaneous edema without a discrete fluid collection
seen. There has been prior resection at the first ray at the level of the
mid-metatarsal. There is an old fracture of the second metatarsal with
extensive callus formation. There is edema seen within the distal portions of
the third, fourth, and fifth metatarsals (7:12). There are linear areas of
low signal at the metatarsal necks in all three bones (8:16, 10, 5). The
appearances suggest subacute fractures. Degenerative change is noted in the
midfoot, for example at the first tarsometatarsal joint (8:26). The
visualized intrinsic muscles of the foot are normal in signal intensity.
IMPRESSION:
1. No convincing evidence of osteomyelitis.
2. Edema of the third, fourth, and fifth metatarsals is most consistent with
subacute fractures given the linear low signal seen at the metatarsal necks.
3. Moderate subcutaneous edema.
4. Degenerative change in the midfoot.
Findings paged to Dr. ___ on ___ @ 10:28 am.
|
10186925-RR-131
| 10,186,925 | 22,558,971 |
RR
| 131 |
2193-04-02 20:15:00
|
2193-04-02 21:57:00
|
INDICATION: Acute onset myoclonus and possible seizure. Evaluate for mass
lesion.
COMPARISON: No relevant comparisons available.
TECHNIQUE: Non-contrast MDCT axial images were acquired through the head.
Bone reconstructions and coronal and sagittal reformations were provided for
review. Portions of the study were repeated due to patient motion.
CT HEAD WITHOUT CONTRAST: The study is somewhat limited by patient motion.
There is no acute intracranial hemorrhage, edema, mass effect or major
vascular territorial infarct. Prominent ventricles and sulci are compatible
with mild global age-related volume loss. Basal cisterns are preserved.
There is no shift of normally midline structures. Dense atherosclerotic
calcifications are seen in the intracranial internal carotid and intracranial
vertebral arteries. A focus of hypoattenuation in the left periventricular
white matter (2a:19) is nonspecific but appears chronic and may be sequelae of
prior infarct. Elsewhere, gray-white matter differentiation is preserved. No
osseous abnormality is identified. The visualized paranasal sinuses, mastoid
air cells and middle ear cavities are clear.
IMPRESSION: No acute intracranial abnormality. If clinical concern for
intracranial mass is high, MRI is more sensitive.
|
10186925-RR-132
| 10,186,925 | 22,558,971 |
RR
| 132 |
2193-04-08 15:40:00
|
2193-04-08 16:40:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with ESRD s/p failed kidney transplant and DM,
presented with back pain, found to have RP abscess drained by ___, JP drain
still in place. Evaluate for interval change in right retroperitoneal abscess
TECHNIQUE: MDCT axial images from the lung bases to the pubic symphysis were
displayed with 5 mm slice thickness with intravenous contrast. Coronal and
sagittal reformations are displayed with 5 mm slice thickness.
DLP: 991 mGy cm
COMPARISON: CTs ___
FINDINGS:
CT ABDOMEN: The visualized lung bases demonstrate tiny bilateral pleural
effusions with adjacent atelectasis, left more than right. Dense mitral
annular calcifications are seen.
The liver is unremarkable without focal liver lesion identified. The
gallbladder is absent. The spleen is unremarkable. The pancreas is atrophic
but otherwise unremarkable. Bilateral adrenal glands are normal. The native
kidneys are atrophic.
Small and large bowel are normal in course and caliber without obstruction. A
dilated bowel loop is seen adjacent to an anastomosis in the left lower
quadrant, similar to prior studies. There is large colonic fecal loading. No
free fluid and no free air. Dense atherosclerotic calcifications are noted
throughout the mesenteric and renal vasculature as well as the normal caliber
abdominal aorta. The main portal vein, splenic vein and SMV are patent.
Prominent retroperitoneal lymph nodes, predominantly in the left para-aortic
region, are unchanged from ___ and nonspecific.
The right retroperitoneal fluid collection in the right flank subcutaneous
tissues and muscle has nearly completely resolved with minimal residual fluid
collection (5:32). The catheter is in place.
CT PELVIS: The rectum, sigmoid colon, and bladder are unremarkable. The
transplanted kidney is seen in the right lower hemipelvis similar to prior
studies. Numerous clips are noted in the pelvis. There is no free fluid and
no pelvic or inguinal lymphadenopathy.
BONE WINDOWS: Bones are diffusely demineralized. No bone finding suspicious
for infection or malignancy is seen. Loss of height of the L5 vertebral body
is unchanged. Fixation hardware is noted within the left femur.
IMPRESSION:
1. Near complete resolution of right retroperitoneal abscess with minimal
residual fluid collection.
2. Small bilateral pleural effusions, left larger than right ,with bibasilar
atelectasis.
3. Nonspecific prominent retroperitoneal lymph nodes, predominantly in the
left para-aortic region, are unchanged from ___. As suggested on the
prior study, short-term CT followup of these lymph nodes could be performed.
|
10186925-RR-134
| 10,186,925 | 22,558,971 |
RR
| 134 |
2193-04-12 16:45:00
|
2193-04-12 18:24:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with ESRD, COPD, DM, RP abscess now with
increased abdominal distention, severe n/v, and abdominal discomfort. //
?obstruction
COMPARISON: ___.
IMPRESSION:
Large dilated bowel loop in the central abdomen. Otherwise nonspecific bowel
gas patterns. No free area. The quality of the exam, however, is limited.
Therefore, if the clinical concerns for obstruction persist, CT should be
obtained. Multiple clips and postsurgical material is visible. Status post
sternotomy. No abnormalities at the lung bases.
|
10186925-RR-135
| 10,186,925 | 22,558,971 |
RR
| 135 |
2193-04-12 19:10:00
|
2193-04-12 21:36:00
|
INDICATION: ___ female with end-stage renal disease and
retroperitoneal abscess, with concern for small bowel obstruction.
COMPARISON: CT abdomen and pelvis ___.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the administration of 130 cc of Omnipaque intravenous contrast material.
Oral contrast was not administered. Coronal and sagittal reformats were also
examined.
DLP: 932.47 mGy-cm.
CTDIvol: 16.90 mGy.
FINDINGS: Bibasilar atelectasis is present, worse on the left. Heavy mitral
annular calcifications are noted.
The liver enhances homogeneously without focal lesions or intrahepatic biliary
ductal dilatation. The patient is status post cholecystectomy. The spleen is
homogeneous and normal in size. The pancreas is atrophic but otherwise
unremarkable. The adrenal glands are normal in appearance. The native
kidneys are atrophic. A kidney transplant is noted in the right lower
quadrant.
An enteric tube is present with distal tip in the stomach. The stomach and
duodenum are newly mildly dilated. The proximal jejunum beyond the ligament
of Treitz is more dilated, with a maximum diameter of 16 cm in transverse
dimension with an unusual configuration, new since the prior study. The
distal small bowel loops are collapsed, and a transition point is seen in the
left lower quadrant (series 2, image 55). The colon is stool filled and
otherwise unremarkable. There is no abdominal free air or free fluid. There
is no evidence of bowel wall thickening, pneumatosis, mesenteric edema or
other findings concerning for bowel wall ischemia. There is no significant
mesenteric lymphadenopathy. Small retroperitoneal lymph nodes are again seen,
similar to prior, including a left para-aortic lymph node with a maximum
diameter of 1.0 cm in the short axis.
The bladder is collapsed and otherwise unremarkable. There is no pelvic free
fluid. There is no pelvic sidewall or inguinal lymphadenopathy. Dense
atherosclerotic calcifications are present in the abdominal aorta and
branches.
No suspicious lesion is seen in the visualized osseous structURE
The drain from the right flank abscess has been pulled and a 7 x 3.3 cm fluid
collection is now seen there
IMPRESSION: Small-bowel obstruction involving the proximal jejunum with a
transition point in the left lower quadrant. No sign of bowel ischemia or
pneumoperitoneum.
The drain from the right flank abscess has been pulled and a 7 x 3.3 cm fluid
collection is now seen there
Dr. ___ these results with Dr. ___ at 8:08 p.m. on ___ via
telephone.
Dr ___ the flank ___ with Dr ___ @1.19 pm on
___
|
10186925-RR-136
| 10,186,925 | 22,558,971 |
RR
| 136 |
2193-04-13 09:33:00
|
2193-04-13 10:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxia // ? Interval change
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has received a nasogastric
tube. The tip of the tube is difficult to visualize but appears to be
projecting over the proximal to middle parts of the stomach. There is a
status post CABG. As on the previous radiograph there is mild pulmonary edema
and mild cardiomegaly. No pleural effusions. No pneumonia.
|
10186925-RR-137
| 10,186,925 | 22,558,971 |
RR
| 137 |
2193-04-13 09:33:00
|
2193-04-13 12:21:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old woman with hypotension with known SBO with distended
abdomen // ? Interval change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. Known
large dilated bowel loop in the central abdomen. No free intra-abdominal air.
Normal to borderline diameter of the other visible of a lobes. Unchanged
multiple postsurgical material projecting over the abdomen.
|
10186925-RR-138
| 10,186,925 | 22,558,971 |
RR
| 138 |
2193-04-15 14:19:00
|
2193-04-15 16:03:00
|
EXAMINATION: Soft tissue ultrasound of the right flank.
INDICATION: ___ year old woman with CABG, ESRD with flank abscess s/p drainage
with increased size on CT // Reassess known flank abscess
TECHNIQUE: Portable, limited grayscale and color Doppler ultrasounds were
acquired over the right flank.
COMPARISON: Comparison is made to ultrasound dated ___.
FINDINGS:
Limited, portable ultrasound examination over the patient's posterior right
flank demonstrates a hypoechoic fluid collection measuring 10.1 x 2.6 x 7.1
cm, previously measuring 10.6 x 6.3 x 6.7 cm.
IMPRESSION:
10.1 x 2.6 x 7.1 cm hypoechoic right flank fluid collection.
|
10186925-RR-140
| 10,186,925 | 22,558,971 |
RR
| 140 |
2193-04-16 15:42:00
|
2193-04-16 17:13:00
|
INDICATION: Patient w/ known R flank abscess. For ultrasound-guided drainage.
COMPARISON: Abdomen ultrasound from ___ and CT abdomen and pelvis from
___.
PROCEDURE: Ultrasound-guided drainage of right flank subcutaneous collection.
OPERATORS: Dr. ___, radiology fellow and Dr. ___
radiologist, who was present and supervising throughout the total procedure
time.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a left lateral decubitus position on the US scan
table. Limited preprocedure ultrasound was performed to localize the
collection. Based on the ultrasound findings an appropriate skin entry site
for the drain placement was chosen at the right flank. The site was marked.
Local anesthesia was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, ___ drainage catheter was
advanced via trocar technique into the collection. A sample of fluid was
aspirated, confirming catheter position within the collection. The pigtail
was deployed. The position of the pigtail was confirmed within the collection
via ultrasound.
Approximately 42 cc of purulent fluid was drained with a sample sent for
microbiology evaluation. The right flank collection was irrigated with
approximately 200 cc of sterile saline. The catheter was secured by a
StatLock. The catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 15
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. Patient was also
administered 1 amp of IV D50 related to hypoglycemia prior to procedure.
FINDINGS:
A right flank subcutaneous collection is again identified, similar in size
compared to recent ultrasound abdomen from ___. The collection
demonstrates some internal echoes.
IMPRESSION:
Successful US-guided placement of ___ pigtail catheter into the right
flank subcutaneous complex fluid collection. 42 cc of purulent fluid
aspirated. Samples was sent for microbiology evaluation.
|
10186925-RR-141
| 10,186,925 | 22,558,971 |
RR
| 141 |
2193-04-16 17:06:00
|
2193-04-16 21:39:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old woman with VRE RP abscess and recent SBO now with
increased abdominal pain. . Please evaluate for worsening SBO or perforation.
TECHNIQUE: Supine and left lateral decubitus radiographs.
COMPARISON: ___
FINDINGS:
A pigtail on the right upper quadrant is new since the prior study. There are
no abnormally dilated loops of large or small bowel. A few air-fluid levels
are seen on left lateral decubitus radiograph, which could represent ongoing
partial obstruction or ileus. Air and stool are seen within the rectum. There
is no definite evidence of free air. Multiple surgical clips are seen and left
hip hardware is partially imaged. The paper clip overlying the pelvis is
likely external to the patient.
IMPRESSION:
Air-fluid levels on the left lateral decubitus film could represent ongoing
partial obstruction or ileus. No definite free air.
|
10186925-RR-143
| 10,186,925 | 22,558,971 |
RR
| 143 |
2193-04-22 14:34:00
|
2193-04-22 15:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with ESRD on HD, CAD, and VRE abscess with
prolonged hospital course now with hypotension and crackles on exam. //
Please eval for pneumonia vs. pulm edema.
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple chest radiographs most recent on ___
FINDINGS:
The patient is status post CABG with sternotomy wires unchanged from the prior
examination.
There is mild stable cardiomegaly. There is minimal interstitial edema and
mild peripheral edema as well as peribronchial cuffing. There is a subtle
focal opacity at the right infrahilar region which may represent asymmetric
edema or an early focus of pneumonia. There is no large pleural effusion or
pneumothorax identified.
IMPRESSION:
1. Subtle, focal opacity at the right infrahilar region, which may represent
asymmetric edema or an early focus of pneumonia.
2. Mild pulmonary edema.
|
10186925-RR-144
| 10,186,925 | 22,558,971 |
RR
| 144 |
2193-04-22 14:34:00
|
2193-04-22 16:14:00
|
INDICATION: ESRD on hemodialysis, CAD, and VRE abscess with prolonged
hospital course, now with worsening abdominal exam concerning for recurrent
SBO. Evaluate for small bowel obstruction.
COMPARISON: Abdominal radiographs from ___, and ___.
FINDINGS:
Frontal and left lateral decubitus abdominal radiographs demonstrate multiple
loops of dilated small and large bowel, without air-fluid levels. A small
bowel obstruction cannot be excluded. There is no pneumatosis or
intraperitoneal free air. Also noted are sternotomy wires, multiple surgical
clips within the abdomen and pelvis, a pigtail drainage catheter in the right
upper quadrant, and left femoral hardware.
IMPRESSION:
Dilated bowel loops without air-fluid levels. A small bowel obstruction
cannot be excluded, and CT is recommended for further evaluation.
|
10186925-RR-145
| 10,186,925 | 22,558,971 |
RR
| 145 |
2193-04-23 08:51:00
|
2193-04-23 16:10:00
|
INDICATION: Right flank abscess and previous small bowel obstruction, now
with increased abdominal distention. Evaluate for interval change.
COMPARISON: Abdominal radiographs from ___, and ___.
FINDINGS:
Frontal abdominal radiographs again demonstrate multiple loops of dilated
small a large bowel, without air-fluid levels. These appear to be minimally
decreased in caliber compared to prior radiograph. There is no evidence of
intraperitoneal free air or pneumatosis. The remainder of the exam is grossly
unchanged, including multiple sternotomy wires, a right upper quadrant pigtail
catheter, and pelvic and abdominal surgical clips.
IMPRESSION:
Minimally decreased caliber of dilated small and large bowel.
|
10187053-RR-26
| 10,187,053 | 25,403,067 |
RR
| 26 |
2142-07-28 10:26:00
|
2142-07-28 16:29:00
|
INDICATION: Anterior C3-C6 fusion
COMPARISON: MRI from ___
IMPRESSION:
Intraoperative images demonstrate placement of an anterior fusion plate
extending from C3 to C6 with interbody disc prostheses. Please refer to the
operative note for additional details. No hardware related complications are
identified.
|
10187053-RR-27
| 10,187,053 | 25,403,067 |
RR
| 27 |
2142-07-29 08:34:00
|
2142-07-29 18:18:00
|
EXAMINATION: Cervical spine radiographs, two intraoperative lateral views.
INDICATION: Posterior C3 through C6 fusion.
COMPARISON: Prior study from ___.
FINDINGS:
Patient is status post recent C3 through C5 anterior cervical fusion including
interbody spacers. This study depicts ongoing additional C3 through C C6
fusion surgery.
IMPRESSION:
Ongoing posterior C3 through C6 fusion surgery.
|
10187053-RR-28
| 10,187,053 | 25,403,067 |
RR
| 28 |
2142-08-02 12:49:00
|
2142-08-02 14:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with newly place doboff ? placement // tube
placement
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
Enteric tube terminates in the inferior right bronchus. The lungs are fully
expanded and clear. Cardiomediastinal, hilar and pleural surfaces are normal.
No evidence of pulmonary vascular congestion. No pneumothorax or pleural
effusion. Minimal bibasilar atelectasis. Previously visualized focal lucency
over the right lung apex is no longer seen.
IMPRESSION:
Enteric tube terminates in the inferior right bronchus, retraction is advised.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 1:54 pm, 10 minutes after discovery
of the findings.
|
10187053-RR-29
| 10,187,053 | 25,403,067 |
RR
| 29 |
2142-08-05 11:28:00
|
2142-08-05 16:07:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with cough and decreased lung sounds //
pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray dated ___.
FINDINGS:
There is interval adjustment of the previous described Dobbhoff tube now with
tip below the GE junction but out of the view of this study.
The heart is normal in size. The mediastinum is grossly unremarkable. There
is opacification in the right lower lobe interval more prominent from previous
study. Given the history of mal position Dobbhoff tube, this is likely
secondary to aspiration pneumonia. There is left lung base linear
atelectasis. There is no evidence of pleural effusion or pneumothorax.
There is no acute displaced fracture visualized.
IMPRESSION:
Interval increased opacification in the right lower lobe concerning for
aspiration pneumonia.
|
10187053-RR-30
| 10,187,053 | 25,403,067 |
RR
| 30 |
2142-08-07 14:09:00
|
2142-08-07 15:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ y/o male s/p cervical fusion c/b dysphagia requiring dobhoff
tube placement and tube feeds for alternative means of nutrition, pt now
coughing up tube feeds. // Confirm dobhoff tube location
IMPRESSION:
In comparison with the study of ___, no Dobbhoff tube is identified.
The increased opacification at the right base is no longer appreciated.
RECOMMENDATION(S): This information was telephoned to ___, the nurse
taking care of the patient in the hospital. There has been no new placement
of a Dobhoff tube, indicating that the tube is now presumably coiled within
the neck or back of the throat. She will order a study of the neck and back
of the throat to assess for the position of the tube.
|
10187053-RR-32
| 10,187,053 | 25,403,067 |
RR
| 32 |
2142-08-09 17:40:00
|
2142-08-09 18:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p NJ tube placement; confirm placement of NJ
tube. // confirm placement of NJ tube.
TECHNIQUE: AP radiograph of the lower chest and upper abdomen.
COMPARISON: Chest radiograph ___.
IMPRESSION:
There has been interval placement of a nasojejunal tube which terminates in
the proximal jejunum. The lung bases are clear. There are no abnormally
dilated loops of small or large bowel. No suspicious radiopaque calculi or
acute osseous abnormalities are identified.
|
10187092-RR-10
| 10,187,092 | 20,968,686 |
RR
| 10 |
2182-11-02 10:02:00
|
2182-11-02 14:45:00
|
INDICATION: ___ female with advanced dementia, who had a urine
culture growing Staph aureus, who now presents for evaluation.
TECHNIQUE: Grayscale ultrasound images of the kidneys were obtained and
reviewed.
FINDINGS:
The right kidney measures 9.4 cm.
The left kidney measures 10.1 cm.
There is no evidence of hydronephrosis, stones, or masses in either kidney.
Although the image quality of the right kidney is suboptimal, renal
echogenicity and corticomedullary architecture is within normal limits
bilaterally.
The bladder is only minimally distended and cannot be assessed.
IMPRESSION:
1. No evidence of hydronephrosis, stones, or masses in the kidneys
bilaterally.
2. Incomplete assessment of bladder secondary to minimal distention.
|
10187092-RR-5
| 10,187,092 | 20,968,686 |
RR
| 5 |
2182-10-26 20:42:00
|
2182-10-26 21:29:00
|
HISTORY: Intubated for hypercarbic respiratory arrest status post transfer
from outside hospital.
TECHNIQUE: Semi-upright AP view of the chest.
COMPARISON: None.
FINDINGS:
Endotracheal tube tip is slightly low lying and terminates approximately 2.8
cm from the carina. Low lung volumes are noted. The heart size is mildly
enlarged. Aortic knob is calcified. There is crowding of the bronchovascular
structures. Mild pulmonary vascular congestion appears to be present.
Opacity within the retrocardiac region could reflect atelectasis though
infection or aspiration cannot be excluded. A possible trace left pleural
effusion is noted. The right lung is free of consolidation. No right-sided
pleural effusion is present. There is no pneumothorax. S-shaped scoliosis of
the thoracolumbar spine is present.
IMPRESSION:
1. Low lung volumes. Left basilar opacity may reflect atelectasis though
aspiration or infection is not excluded.
2. Mild pulmonary vascular congestion.
3. Endotracheal tube is slightly low lying, terminating 2.8 cm from the
carina.
|
10187092-RR-6
| 10,187,092 | 20,968,686 |
RR
| 6 |
2182-10-28 03:48:00
|
2182-10-28 10:29:00
|
CHEST RADIOGRAPH
INDICATION: Pneumonia, effusions, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is a slight increase
in size of the cardiac silhouette and a newly appeared plate-like atelectasis
on the right. Moderate retrocardiac atelectasis. The presence of a small
left pleural effusion cannot be excluded. Unchanged position of the
endotracheal tube.
|
10187092-RR-7
| 10,187,092 | 20,968,686 |
RR
| 7 |
2182-10-29 03:15:00
|
2182-10-29 10:26:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Restrictive lung disease, COPD, severe dementia, respiratory
failure and aspiration pneumonia, transfer from outside hospital.
Comparison is made with prior study ___.
ET tube is low tip 1.7 cm above the carina. Right PICC tip is in the upper
right atrium/cavoatrial junction, has been withdrawn from prior study. There
are persistent low lung volumes. Mild cardiomegaly and widened mediastinum
are stable. Right upper lobe atelectasis and right lower lobe perihilar
consolidations are stable. There is no pneumothorax. If any, there is a
small left pleural effusion.
|
10187092-RR-8
| 10,187,092 | 20,968,686 |
RR
| 8 |
2182-10-28 12:21:00
|
2182-10-28 14:45:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Assess line.
Right PICC tip is in the right atrium, can be withdrawn 4 cm for more standard
position. ET tube is low, the tip is 1.4 cm above the carina, can be
withdrawn a couple of centimeters for more standard position. The balloon
(cuff) appears to be overinflated. Compared to prior study performed eight
hours earlier, there is no change in the cardiomediastinal silhouette, right
upper lobe and left lower lobe atelectasis and moderate vascular congestion.
There is no pneumothorax. If any, there is a small left pleural effusion.
|
10187092-RR-9
| 10,187,092 | 20,968,686 |
RR
| 9 |
2182-11-01 01:23:00
|
2182-11-01 12:20:00
|
PORTABLE AP CHEST X-RAY
INDICATION: Patient with past medical history of restrictive lung disease,
COPD, PEG in place, respiratory failure.
COMPARISON: Multiple chest x-rays from ___ to ___.
FINDINGS:
The lung volumes are very low and unchanged; left lower lobe is poorly
aerated. Right lower lung atelectatic band has improved. The patient has
been extubated since the previous exam. Right-sided PICC line is either in
lower SVC or at cavoatrial junction. There is no pneumothorax or pleural
effusion. Mediastinal and cardiac contours are top normal. Curvilinear
increased density overlying left heart is possibly a calcified mitral annulus.
CONCLUSION:
There is no significant change since previous exam.
1. The patient has been extubated.
2. The lung volumes are very low.
|
10187254-RR-26
| 10,187,254 | 23,049,675 |
RR
| 26 |
2183-09-09 03:03:00
|
2183-09-09 06:03:00
|
INDICATION: ___ male with cough, fever, recent surgery, rule out
pneumonia.
COMPARISON: ___.
FINDINGS: AP upright and lateral chest radiographs were obtained. Lung
volumes are low. A retrocardiac opacity projects over the spine on the
lateral view. No effusion or pneumothorax is present. The heart and
mediastinal contours are normal. The lower edge of cervical pedicular screws
is present.
IMPRESSION: Left lower lobe pneumonia.
|
10187254-RR-27
| 10,187,254 | 23,049,675 |
RR
| 27 |
2183-09-10 17:12:00
|
2183-09-11 14:11:00
|
INDICATION: ___ man status post cervical spine laminectomy and
fusion, presenting with swelling at the surgical site.
COMPARISON: MRI of the cervical spine ___.
TECHNIQUE: MRI of the cervical spine was obtained before and after
administration of contrast per departmental protocol.
FINDINGS: The cervical vertebrae appear normal in height, marrow signal
intensity and alignment. There are expected susceptibility artifacts from the
surgical hardware. The patient is status post C3-C7 laminectomies and fusion
surgery with expected postoperative changes. Fluid collection is seen in the
posterior paraspinal soft tissues at the level of previous surgery extending
from C3-C7 levels. There is no definite communication with the spinal canal
to suggest a CSF leak. There is diffuse abnormal enhancement along the
surgical site which is likely reflects postoperative changes. The
craniocervical junction is normal. The cervical spinal cord shows normal
morphology and signal intensity.
Pre- and para-vertebral soft tissues otherwise appear unremarkable.
IMPRESSION: Post-surgical changes from prior laminectomy and fusion surgery.
A fluid collection is seen in the posterior paraspinal soft tissues, which
would not be unexpected in the postoperative phase. No definite communication
is seen within the spinal canal to suggest a CSF leak.
|
10187254-RR-28
| 10,187,254 | 23,049,675 |
RR
| 28 |
2183-09-11 14:36:00
|
2183-09-11 16:44:00
|
CLINICAL BACKGROUND: ___ man status post multilevel cervical spine
laminectomy, presenting with paraspinal fluid collection.
REASON FOR THE PROCEDURE: Drainage of paraspinal fluid collection.
TECHNIQUE AND FINDINGS: Written informed consent was obtained from the
patient after explaining the risks, benefits and alternatives to the
procedure. The patient was brought into the fluoroscopic suite and laid prone
on the fluoroscopic table. A preprocedure timeout was performed confirming
the patient's identity and the procedure to be performed.
The procedure was planned according to the MR ___ dated ___. Using
ultrasound, the paraspinal or subcutaneous fluid collection was redemonstrated
at the C6-C7 level. Following local anesthesia of the overlying skin using 1%
lidocaine, a 20-gauge 1-inch needle was advanced into the septated fluid
collection under ultrasound guidance. 14 cc of bloody, non-cloudy and
non-smelling fluid was aspirated. The patient tolerated the procedure well
without complications. The aspirated fluid was sent for microbiology and
chemistry for further assessment.
Dr ___ attending radiologist was present and supervised the entire
procedure.
IMPRESSION: Uncomplicated ultrasound-guided aspiration of bloody, non-cloudy
fluid from paraspinal fluid collection at the C6-C7 level.
|
10187254-RR-29
| 10,187,254 | 23,049,675 |
RR
| 29 |
2183-09-13 08:50:00
|
2183-09-13 11:07:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: Patient with PICC line placement.
FINDINGS: Comparison is made to prior study from ___.
There has been placement of a left-sided PICC line with distal lead tip at the
cavoatrial junction. Heart size is normal. Lungs are grossly clear.
|
10187254-RR-30
| 10,187,254 | 23,049,675 |
RR
| 30 |
2183-09-13 11:49:00
|
2183-09-13 15:51:00
|
HISTORY: Questionable meningitis
OPERATORS: Dr. ___, Dr. ___
___: Written informed consent was obtained from the patient
after explaining the risks, benefits and alternatives to the procedure. The
patient was brought into the fluoroscopic suite and laid prone on the
fluoroscopic table. A preprocedure timeout was performed confirming the
patient's identity and the procedure to be performed. Under fluoroscopic
guidance, and after the administration of 1% lidocaine for local anesthesia,
access to the thecal sac was obtained at the L2-L3 level. Four vials
containing a total of 12 cc of CSF were sent for requested laboratory
analysis. The patient tolerated the procedure well. There were no immediate
complications.
IMPRESSION: Successful fluoroscopic-guided lumbar puncture. 12 cc of clear
CSF divided into four vials and sent for laboratory evaluation.
|
10187422-RR-20
| 10,187,422 | 22,024,813 |
RR
| 20 |
2188-07-28 14:26:00
|
2188-07-28 15:47:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with history of RUQ pain worsened with meals// eval for
cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: There is a distended gallbladder with a large and mobile
gallstone within the neck. There is also a sludge ball measuring 3.5 x 1.6
cm. Positive sonographic ___ sign.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 15.2 cm.
KIDNEYS: Right kidney measures 11.3 cm. Limited views of the right kidney
show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Distended gallbladder with lodged gallstone in the neck with positive
sonographic ___ sign consistent with acute cholecystitis.
2. Splenomegaly measuring 15.2 cm.
|
10187935-RR-20
| 10,187,935 | 26,149,070 |
RR
| 20 |
2158-01-24 19:55:00
|
2158-01-24 21:32:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST
INDICATION: History of neck pain, please evaluate.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: None.
FINDINGS:
Exam is motion degraded, most extensively involving sagittal T1 weighted and
STIR sequences.
Anterolisthesis is seen involving C2 on C3 and C4 on C5. Focal increased STIR
signal abnormality is seen within the vertebral body at the level of C6,
series 4, image 8, difficult to evaluate secondary to extensive motion
artifact however may be secondary to a hemangioma. The marrow is diffusely T1
hypointense. No cord signal abnormalities identified. Diffuse loss of normal
T2 signal seen within the intervertebral discs of the cervical spine.
A focal area of increased STIR signal abnormality is seen anterior to the C3
vertebral body (4;7), as well as the left side of C1-C2 articulation (3;11).
Extensive anterior osteophytosis is seen.
C2-C3: Disc bulge is seen resulting in moderate spinal canal narrowing. Facet
joint and uncovertebral arthropathy results in mild right and moderate left
neural foraminal narrowing.
C3-C4: Mild disc bulge is seen resulting in mild spinal canal narrowing.
Central disc protrusion appears to contact the ventral aspect of the cord.
Facet joint and uncovertebral arthropathy results in severe left and moderate
right neural foraminal narrowing.
C4-C5: Disc osteophyte complex with a focal central disc protrusion is seen
resulting in moderate spinal canal narrowing. Facet joint and uncovertebral
arthropathy results in mild bilateral neural foraminal narrowing, right
greater than left.
C5-C6: Disc osteophyte complex eccentric to the left is seen resulting in
moderate spinal canal narrowing. Facet joint and uncovertebral arthropathy
results in moderate to severe right and moderate left neural foraminal
narrowing.
C6-C7: Disc osteophyte complex is seen resulting in severe spinal canal
stenosis and slight remodeling of the ventral aspect of the cord. Facet joint
and uncovertebral arthropathy results in severe bilateral neural foraminal
narrowing.
C7-T1: There is right facet joint hypertrophy without canal or foraminal
narrowing.
The visualized posterior fossa is unremarkable. No other paraspinal or
paravertebral soft tissue abnormalities are identified.
IMPRESSION:
1. Study is limited secondary to moderate motion artifact.
2. Focal T2/STIR hyperintense signal is seen anterior to the C3 and C4
vertebral body, which may be secondary to ligamentous injury, however no
definite disruption is seen.
3. Subtle increased signal within the left aspect of the C1/C2 articulation
(3;11) may be sequelae of degenerative changes vs traumatic injury.
4. Diffusely hypointense bone marrow may be sequelae of chronic systemic
changes such as anemia, however a diffusely infiltrative neoplastic process
cannot be excluded. Please correlate clinically.
5. No cord signal abnormalities identified.
6. Cervical spondylosis, with moderate to severe spinal canal stenosis is seen
at C2-C3, C4-C5, C5-C6, and C6-C7.
NOTIFICATION: Updated findings were discussed with Dr. ___. by
___, M.D. on the telephone on ___ at 9:52 am, 5 minutes after
discovery of the findings.
|
10187935-RR-21
| 10,187,935 | 26,149,070 |
RR
| 21 |
2158-01-24 23:33:00
|
2158-01-25 08:32:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with dizziness, htn, r/o pulm edema// r/o pulm
edema
IMPRESSION:
No previous images. There is enlargement of the cardiac silhouette without
appreciable vascular congestion. Moderate pleural effusion on the left with
underlying compressive atelectasis. No evidence of acute focal pneumonia.
|
10187935-RR-22
| 10,187,935 | 26,149,070 |
RR
| 22 |
2158-01-25 09:19:00
|
2158-01-25 12:31:00
|
EXAMINATION: Carotid Doppler Ultrasound
INDICATION: ___ year old man with cartodi stenosis, new dizziness, r/o sever
carotid stenosis// r/o sever carotid stenosis
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: None available
FINDINGS:
RIGHT:
The right carotid vasculature has severe atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 68 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 546, 207, and 126 cm/sec, respectively. The peak end
diastolic velocity in the right internal carotid artery is 132 cm/sec.
The ICA/CCA ratio is 8.0.
The external carotid artery has peak systolic velocity of 133 cm/sec.
The vertebral artery is patent with antegrade flow.
LEFT:
The left carotid vasculature has moderate atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 143 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 122, 131, and 81 cm/sec, respectively. The peak end
diastolic velocity in the left internal carotid artery is 23 cm/sec.
The ICA/CCA ratio is 0.91.
The external carotid artery has peak systolic velocity of 82 cm/sec.
The vertebral artery is patent with antegrade flow.
IMPRESSION:
80-99% stenosis of the right ICA.
40-59% stenosis of the left ICA.
|
10188275-RR-43
| 10,188,275 | 29,197,045 |
RR
| 43 |
2144-12-02 10:44:00
|
2144-12-02 12:28:00
|
CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior chest radiograph from ___.
CLINICAL HISTORY: Short of breath, cough, hemoptysis, question pneumonia.
FINDINGS: PA and lateral views of the chest were provided. There is a small
right pleural effusion again noted. Scattered areas of plate-like atelectasis
are noted. Lung volumes are low. A chronic right fifth rib resection is
again seen. Cardiomediastinal silhouette is stable. No acute bony
abnormalities are detected.
IMPRESSION: Scattered subsegmental atelectasis, small right pleural effusion.
Please refer to subsequent CTA chest for further details.
|
10188275-RR-45
| 10,188,275 | 29,197,045 |
RR
| 45 |
2144-12-02 21:02:00
|
2144-12-03 12:40:00
|
CHEST CTA WITH CONTRAST
INDICATION: Patient with hemoptysis, tracheobronchomalacia, source of
bleeding?
COMPARISON: Chest CT of ___.
TECHNIQUE:
Axial helical MDCT images were obtained from the suprasternal notch to the
upper abdomen with administration of IV contrast following the CTA protocol.
Multiplanar reformatted images in coronal and sagittal axes were generated.
FINDINGS:
HEART AND GREAT VESSELS:
The opacification of pulmonary artery is adequate. There is no pulmonary
embolism until subsegmental level. The main pulmonary artery is not dilated.
The heart and aorta are unremarkable. There is no pericardial effusion.
MEDIASTINUM:
Moderate non-hemorrhagic loculated right pleural effusion is also tracking
along the fissure. Less than 1 cm central lymph nodes are probably reactive.
The esophagus is unremarkable.
LUNGS AND AIRWAYS:
Multiple atelectatic bands are seen. The exam was acquired mainly during
expiration, explaining the anterior bowing of the posterior wall of the
trachea. The thickening of the posterior wall of the trachea up to 4 mm is
probably related to recent surgery, but there is also minimal lower lobe
bronchial wall thickening. Subtle bilateral ground-glass opacities with
minimal intralobular septal thickening could be explained by pulmonary edema.
Part of the ground-glass opacities could also be due to expiration aquisition.
The airways remain patent until subsegmental level.
UPPER ABDOMEN: This study is not tailored for assessment for intra-abdominal
organs. The upper abdomen appears unremarkable.
OSSEOUS STRUCTURES: There is no bony lesion concerning for malignancy.
CONCLUSION:
1. There is no pulmonary embolism and no acute aortic syndrome.
2. Minimal pulmonary edema.
3. Moderate right loculated pleural effusion.
4. Mild thickening of posterior wall of the trachea could be related to
recent tracheoplasty.
|
10188275-RR-46
| 10,188,275 | 29,197,045 |
RR
| 46 |
2144-12-03 10:48:00
|
2144-12-03 13:20:00
|
AP CHEST, 10:58 A.M., ___
HISTORY: ___ man with right pleural effusion. Rule out pneumothorax
after thoracentesis.
IMPRESSION: AP chest compared to ___:
There is neither appreciable pleural effusion nor pneumothorax. Moderate
cardiomegaly is stable. Right infrahilar opacification is most likely
atelectasis, but is barely visible on the frontal radiograph. Lateral view
would be helpful in assessment.
|
10188275-RR-47
| 10,188,275 | 29,197,045 |
RR
| 47 |
2144-12-03 15:40:00
|
2144-12-03 16:55:00
|
INDICATION: ___ man with abdominal pain, distention, and
constipation, ? obstruction.
COMPARISON: None available.
FINDINGS: Single frontal supine abdominal radiograph demonstrates gas within
the colon. No dilated loops are seen. Surgical hardware projects over the
spine.
IMPRESSION:
Non-obstructive bowel gas pattern.
|
10188275-RR-48
| 10,188,275 | 29,197,045 |
RR
| 48 |
2144-12-03 18:37:00
|
2144-12-04 10:27:00
|
TYPE OF THE EXAM: CT of the abdomen and pelvis.
REASON FOR THE EXAM: ___ gentleman with abdominal pain and
distention; guarding on the exam.
COMPARISON EXAMS: CTA of the chest performed on ___.
TECHNIQUE: Multiple axial MDCT images through the abdomen and pelvis were
obtained post-administration of intravenous contrast and ingestion of oral
contrast.
Coronal and sagittal reconstructions are available for interpretation.
FINDINGS:
Lung bases demonstrate presence of small bilateral effusions, right greater
than left with associated atelectasis and some areas of scarring.
ABDOMEN:
The liver enhances homogeneously without evidence of focal masses. There is
no intrahepatic biliary dilatation. Gallbladder demonstrates presence of
contrast secondary to the vicarious excretion.
The pancreas, kidneys, adrenal glands are unremarkable in appearance. Spleen
is enlarged measuring 15 cm. There is no lymphadenopathy in the abdomen. The
visualized small and colonic loops of bowel are normal in caliber without
evidence of abnormal dilatation. There is no free fluid.
PELVIS: Prostate gland is normal in size. Urinary bladder is well distended
without evidence of mural masses. There is no lymphadenopathy. Rectum,
sigmoid and remaining colon including the appendix is unremarkable.
There is no fluid in the pelvis. There are scattered tiny inguinal lymph
nodes.
VASCULAR STRUCTURES: There is a normal opacification of the arterial
structures. There is a circumaortic left renal vein.
OSSEOUS STRUCTURES: There is evidence of L4-L5 posterior fusion with some
degenerative changes at the L5-S1 level with endplate changes. No destructive
lytic lesion or acute fractures are seen.
IMPRESSION:
Splenomegaly, measuring 15 cm.
No evidence of intra-abdominal or pelvic collections.
Small bilateral pleural effusions, right greater than left with associated
atelectasis.
|
10188275-RR-49
| 10,188,275 | 29,197,045 |
RR
| 49 |
2144-12-04 12:55:00
|
2144-12-04 14:34:00
|
HISTORY: ___ male with tracheobronchomalacia and back pain in
association with abdominal pain, question gallstones.
COMPARISON: CT of the abdomen and pelvis performed ___.
FINDINGS:
Transabdominal sonographic images were obtained. The liver is echogenic
consistent with fatty liver; there is focal fatty sparing near the hepatic
hilum. There are no concerning focal liver lesions. There is no intra or
extrahepatic biliary duct dilatation. The common bile duct measures 4 mm.
The gallbladder is normal in appearance without wall thickening or stones.
Hepatopetal flow seen within the main portal vein. The visualized head and
body of the pancreas are normal in appearance. The spleen is mildly enlarged
measuring 15 cm. Limited images of the kidneys demonstrate no masses,
hydronephrosis, or stone. The visualized portions of aorta and IVC are
unremarkable. There is no abdominal ascites.
IMPRESSION:
1. No gallstones or biliary obstruction.
2. Echogenic liver consistent with fatty liver. Other forms of liver disease
including cirrhosis/fibrosis cannot be excluded on this study. Focal
hypogenicity near hepatic hilum is consistent in appearance with focal
sparing.
|
10188275-RR-60
| 10,188,275 | 25,433,697 |
RR
| 60 |
2145-04-09 15:02:00
|
2145-04-09 17:02:00
|
HISTORY: Shortness of breath.
COMPARISON: Comparison is made with chest radiographs from ___ on
___.
FINDINGS: There are low lung volumes with crowding of the bronchovascular
structures. There is a hazy opacity in the right lung base, unchanged from
prior exam, which likely represents atelectasis with probable pleural
effusion. The cardiomediastinal silhouette is mildly enlarged, stable from
prior exam. There is no pneumothorax or large pleural effusion.
IMPRESSION: No acute cardiopulmonary process. Persistent right base
atelectasis with probable right pleural effusion.
|
10188275-RR-61
| 10,188,275 | 25,433,697 |
RR
| 61 |
2145-04-12 10:56:00
|
2145-04-12 13:53:00
|
PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Patient with tracheobronchomalacia and COPD. Assess for
acute changes.
Comparison is made with prior study ___.
Cardiomegaly and elongated aorta are unchanged. Moderate right pleural
effusion has probably increased allowing the difference in positioning of the
patient. Bibasilar atelectases have increased on the left. Left perihilar
plate-like atelectases are new. There is no pneumothorax.
|
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