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10188275-RR-62
| 10,188,275 | 25,433,697 |
RR
| 62 |
2145-04-12 12:50:00
|
2145-04-12 13:50:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Status post thoracentesis for pneumothorax.
There is no pneumothorax. Small right effusion has decreased compared to
prior study performed two hours earlier. Bibasilar atelectases have improved.
|
10188275-RR-87
| 10,188,275 | 25,261,717 |
RR
| 87 |
2148-02-08 23:01:00
|
2148-02-08 23:52:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ w/confusion, recent head strike // signs of bleed, infarct
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.3 cm; CTDIvol = 49.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Head CT from ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is no evidence of fracture. Air-fluid levels with aerosolized
secretions are present in the bilateral maxillary sinuses. Otherwise, the
remaining visualized portion of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
2. Inflammatory sinus disease as described.
|
10188275-RR-88
| 10,188,275 | 25,261,717 |
RR
| 88 |
2148-02-09 14:02:00
|
2148-02-09 14:37:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with dCHF, COPD, OSA presenting with volume
overload and confusion. // Evaluate for infiltrate, effusion or edema
Evaluate for infiltrate, effusion or edema
IMPRESSION:
Comparison to ___. Stable borderline size of the cardiac
silhouette. No pulmonary edema, no pneumonia, no pleural effusions. Known
right middle lung parenchymal scarring, associated with an area of pleural
thickening. Stable position of the spinal catheter.
|
10188275-RR-90
| 10,188,275 | 25,261,717 |
RR
| 90 |
2148-02-10 16:18:00
|
2148-02-10 17:01:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ w/dCHF, COPD w/worsening ___ and ___, increasing abd
distention and ttp // signs of cirrhosis, ascites, renal obstruction. please
evaluate IVC flows
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___
FINDINGS:
LIVER: The liver is markedly hyperechoic and attenuating. 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 3 mm.
GALLBLADDER: The gallbladder is normal in size and contains minimal gravel but
there are no signs of cholecystitis.
PANCREAS: The pancreas is obscured by bowel gas.
SPLEEN: Normal echogenicity, measuring 14.4 cm.
KIDNEYS: The right kidney measures 11.7 cm. The left kidney measures 13.6 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: Very limited views of the inferior vena cava show patency of
the level of the hepatic veins. More distal IVC an aortic cannot be imaged
due to overlying bowel gas.
IMPRESSION:
Diffuse hepatic steatosis and splenomegaly, relatively unchanged since the
prior scan. Minimal gravel in an otherwise normal-appearing gallbladder.
|
10188275-RR-91
| 10,188,275 | 25,261,717 |
RR
| 91 |
2148-02-10 18:42:00
|
2148-02-10 21:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/confusion, increasing abdominal distention, abd pain //
signs of perforation signs of perforation
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Pulmonary vasculature is slightly more distended but there is no pulmonary
edema. Bands of subsegmental atelectasis have increased. Heart is normal
size, obscured by right mediastinal fat collection. No appreciable pleural
effusion. No pneumothorax. No pneumoperitoneum.
|
10188275-RR-92
| 10,188,275 | 25,261,717 |
RR
| 92 |
2148-02-10 18:42:00
|
2148-02-10 21:33:00
|
INDICATION: ___ w/confusion, increasing abdominal distention, abd pain //
signs of SBO, perf
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen pelvis on ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for fusion hardware in the lumbar spine.
A stimulator generator projects over the left pelvis. There are no
unexplained soft tissue calcifications or radiopaque foreign bodies.
IMPRESSION:
1. Nonobstructive bowel gas pattern.
2. Assessment for free intraperitoneal air is limited on supine radiographs,
however there is no gross pneumoperitoneum. If there is clinical concern for
pneumoperitoneum, advise upright or left lateral decubitus radiograph.
|
10188374-RR-10
| 10,188,374 | 25,651,180 |
RR
| 10 |
2164-04-09 06:10:00
|
2164-04-09 15:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with dementia, presenting with paraesophageal
hernia. NG tube recently advanced// please assess location of NG tube
COMPARISON: Chest x-ray from ___ at 01:41
FINDINGS:
Rotated positioning.
NG tube tip lies approximately 7.3 cm above the left cardiophrenic
angle/medial diaphragm. The NG tube tip may lie near the GE junction with the
hiatal hernia, but this is difficult to confirm on these views. If clinically
indicated, a lateral view may help for further assessment.
Otherwise, doubt significant interval change.
|
10188374-RR-11
| 10,188,374 | 25,651,180 |
RR
| 11 |
2164-04-09 09:19:00
|
2164-04-09 10:32:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with hiatal hernia now s/p NGT replacement// Is
the NGT in the correct location? Contact name: ___: ___
COMPARISON: None.
FINDINGS:
Rotated positioning.
An NG tube is present. It has been advanced distal to the position seen on
the on the chest x-ray from 01:40 on ___. The tip now lies
immediately below the level of the hemidiaphragm. It likely lies within the
hiatal hernia, given relative lucency in this area on the edge enhanced image.
If clinically indicated, a lateral view could help to confirm this. Given
complex anatomy, a CT scan could also help for more complete evaluation.
Cardiomediastinal silhouette and parenchymal findings are similar to prior.
|
10188374-RR-12
| 10,188,374 | 25,651,180 |
RR
| 12 |
2164-04-09 15:47:00
|
2164-04-09 19:18:00
|
INDICATION: ___ year old man with new hypoxemia// Is there e/o new
intrapulmonary process?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
Unchanged positioning of the gastric tube, projecting over the level of the
left hemidiaphragm, likely within a hiatal hernia. Unchanged cardiopulmonary
findings.
IMPRESSION:
No significant interval change since the prior chest radiograph.
|
10188374-RR-14
| 10,188,374 | 25,651,180 |
RR
| 14 |
2164-04-10 15:26:00
|
2164-04-10 17:22:00
|
EXAMINATION: CT of the abdomen and pelvis.
INDICATION: ___ year old man with hiatal hernia and possible gastric outlet
obstruction// Please obtain with PO contrast to look for gastric outlet
obstruction
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence: 1) Spiral Acquisition 12.0 s, 41.3 cm; CTDIvol =
12.4 mGy (Body) DLP = 495.6 mGy-cm. Total DLP (Body) = 509 mGy-cm.
COMPARISON: Outside CT of the abdomen and pelvis from ___.
FINDINGS:
LOWER CHEST: There is consolidative opacities in both lower lobes that could
represent atelectasis or aspiration. There are new trace bilateral pleural
effusion. There is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Multiple calcified granulomas are noted throughout the spleen.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: A large paraesophageal hiatal hernia is redemonstrated. An
enteric tube has its tip terminating in the stomach which is located above
the diaphragm. There has been interval resolution of previously seen gastric
distension. Small bowel loops demonstrate normal caliber, wall thickness, and
enhancement throughout. There is large amount of stool impacted within the
rectum, increased from prior.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: Again noted is exansion of the bones of the left hemipelvis along with
coarsened trabeculae concerning for Paget's disease.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Large paraesophageal hernia is redemonstrated with enteric tube terminating
within the stomach which is located above the diaphragm. Interval resolution
of the gastric distension.
2. Increased amount of stool impacted within the rectum.
3. Consolidative opacities in both lower lobes could be related to aspiration.
4. Appearances of the left hemipelvis raises concern for Paget disease.
|
10188374-RR-15
| 10,188,374 | 25,651,180 |
RR
| 15 |
2164-04-10 18:54:00
|
2164-04-10 20:21:00
|
INDICATION: ___ year old man with productive cough, rhonchi// Eval for PNA
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of an enteric tube projects over the cardiac silhouette, likely within
a hiatal hernia. There are increasing infrahilar opacities bilaterally likely
reflective of developing pneumonia. Small bilateral pleural effusions are
also present. There is no pneumothorax. The size of the cardiac silhouette
is unchanged.
IMPRESSION:
Increasing infrahilar opacities bilaterally, likely reflecting developing
infection. Small bilateral pleural effusions.
|
10188374-RR-9
| 10,188,374 | 25,651,180 |
RR
| 9 |
2164-04-09 01:46:00
|
2164-04-09 08:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with ngt// ngt placement
COMPARISON: Targeted review of outside chest radiograph and CT abdomen exams
___
FINDINGS:
2 AP views of the chest were obtained, 1 labeled # 1 the other labeled # 2.
On # 1, the tip of the NG tube lies just be low the carina. On # 2, the tip
lies slightly distal to that, but is still approximately a 7.3 cm above the
traditional site of the GE junction.
Of note, targeted review of the outside CT from ___ suggests the
presence of a relatively large hiatal hernia, also suggested on this AP
radiograph, and the tip of the NG tube therefore probably lies in close
proximity to the herniated GE junction. If clinically indicated, a lateral
view may be helpful in better demonstrating that.
Rotated positioning. Probable mild cardiomegaly. Aorta calcified and
unfolded. Upper zone redistribution, but doubt overt CHF. Bibasilar
atelectasis. Part of the retrocardiac density is probably accounted for by
the hiatal hernia, but there is also mild indistinctness of left
hemidiaphragm. No definite pneumonic infiltrate. No gross pleural effusion.
IMPRESSION:
On the later image taken at 01:45 (image # 2), the tip of the NG tube is
approximately 7.3 cm above the hemidiaphragm (costovertebral angle). However,
there is likely also a relatively large hiatal hernia, with the GE junction
resultantly lying in the lower chest. If clinically indicated, a lateral view
may be helpful in better demonstrating that. Please see comment above. The
nature of hiatal hernia is not fully characterized on the basis of this
radiograph.
Probable mild cardiomegaly. Mild bibasilar atelectasis. Given slight
indistinctness of the left hemidiaphragm, continued attention to the left base
is recommended to exclude changes related to aspiration pneumonitis.
NOTIFICATION: Critical results were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:40 am, 10 minutes after
discovery of the findings.
Review ___ am)of thoracic surgery consult note on OMR on ___
indicates that the clinical team is aware of the presence of a large hiatal
hernia.
|
10188463-RR-7
| 10,188,463 | 21,111,707 |
RR
| 7 |
2166-08-16 15:14:00
|
2166-08-16 18:05:00
|
HISTORY: ___ male with question of choledocholithiasis at outside
hospital. Patient had right upper quadrant pain two days ago though pain has
now improved.
COMPARISON: None available
RIGHT UPPER QUADRANT ULTRASOUND: The liver is homogeneous in echogenicity
without focal lesion. The main portal vein is patent with hepatopetal flow.
The gallbladder is filled with stones. There is no gallbladder distention,
and the sonographic ___ sign was negative. However, gallbladder wall
thickening, edema and minimal pericholecystic fluid may be present.
Additionally, there is an echogenic band crossing the mid portion of the
gallbladder which is of uncertain etiology. It may represent a prominent
fold, though focal mass lesion cannot be excluded. The gallbladder wall is
hypervascular. No intrahepatic biliary ductal dilatation is identified. The
common bile duct is dilated up to 8 mm. No ductal stone is identified. The
spleen is normal measuring 10.9 cm. The pancreatic head, neck, and body
appear normal in echogenicity. Evaluation of the tail is limited by overlying
bowel gas.
IMPRESSION:
1. Non-distended stone-filled gallbladder with wall thickening, hyperemia and
possible pericholecystic fluid. Echogenic band crossing the mid gallbladder,
query thick septation/fold or other soft tissue.
2. Dilated common bile duct up to 8 mm
Recommend MRCP for further assessment of the biliary tree and for evaluation
of the echogenic band seen crossing the mid gallbladder. Sonographic findings
are equivocal for acute cholecystitis.
|
10188463-RR-8
| 10,188,463 | 21,111,707 |
RR
| 8 |
2166-08-19 15:49:00
|
2166-08-21 10:32:00
|
INDICATION: ___ male with abdominal pain, elevated liver enzymes and
bilirubin, and status post ERCP with sphincterotomy and incomplete gallbladder
filling. Question malignancy.
COMPARISON: Ultrasound dated ___.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired at 1.5 Tesla,
including dynamic 3D imaging obtained prior to, during, and following
uneventful intravenous administration of 8 mL of Gadovist. In addition, 2 mL
of Gadovist and 75 mL of water were administered orally.
FINDINGS: Corresponding to previously seen echogenic band across the mid
gallbladder on ultrasound dated ___, there is "hourglass" appearance to
the gallbladder, with a triangular 1.9 x 1.3 cm band of avidly enhancing
tissue across the waist of the gallbladder (1003, 61), with internal foci of
T2 hyperintensity (for example, 3, 12), morphology highly suggestive of focal
adenomyomatosis, much less likely carcinoma. There is no gallbladder wall
thickening away from the enhancing tissue. There are stones within the fundal
gallbladder. There are no surrounding inflammatory changes to suggest
cholecystitis.
The liver appears unremarkable. There is no evidence of biliary dilatation,
with common duct measuring 7 mm. The adrenal glands, spleen, and kidneys are
normal in appearance. There are bilateral tiny renal cysts, measuring up to 8
mm on the right. Bowel loops appear unremarkable.
Bone marrow signal is normal with the exception of a small T2 hyperintense
probable hemangioma within L5 vertebral body. The lung bases are clear.
IMPRESSION: Findings most consistent with focal adenomyomatosis of the
gallbladder, much less likely carcinoma, to be correlated with pathology.
|
10188463-RR-9
| 10,188,463 | 21,111,707 |
RR
| 9 |
2166-08-19 16:48:00
|
2166-08-20 09:01:00
|
HISTORY: To assess for metallic density near the orbit.
FINDINGS: Two views show no evidence of metallic foreign body in the region
of the orbits.
|
10188472-RR-48
| 10,188,472 | 28,041,885 |
RR
| 48 |
2185-07-26 01:06:00
|
2185-07-26 03:20:00
|
INDICATION: History: ___ with fever cough // eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest from ___.
FINDINGS:
Frontal and lateral chest radiographs demonstrate mild to moderate
cardiomegaly. Obscuration of the lateral right hemidiaphragm likely
represents atelectasis, less likely early pneumonia. There is no definite
focal consolidation. No appreciable pleural effusion or pneumothorax is seen.
Cardiomegaly is mild to moderate.
IMPRESSION:
Lungs clear. Moderate cardiomegaly.
|
10188472-RR-49
| 10,188,472 | 28,041,885 |
RR
| 49 |
2185-07-26 11:03:00
|
2185-07-26 16:57:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ woman with a right arm lump, eval for abscess vs.
lipoma. ?etiology of R arm lump
Per discussion with the patient, she first noticed the "lump" yesterday
morning. She denies any trauma. She reports focal pain in the area of the
lump on palpation. On my exam, she says it is tender to palpation. There is
mild soft tissue prominence over the right ventral lateral forearm where she
reports the lump. The skin overlying this area is slightly erythematous. The
temperature is normal.
TECHNIQUE: Targeted transverse and sagittal greyscale and color Doppler
images were obtained of the superficial tissues of the right ventral forearm
correspond to the area of palpable concern reported by the patient.
COMPARISON: No prior relevant imaging is available on PACS at the time of
this dictation.
FINDINGS:
There is a tubular, hypoechoic structure with echogenic internal debris and no
demonstrable internal vascularity. This is not compressible. The patient is
tender to compression. These findings are most consistent with superficial
thrombophlebitis. There is associated moderate soft tissue edema. No
organized fluid collections. No evidence of a soft tissue mass.
IMPRESSION:
Superficial thrombophlebitis and moderate soft tissue edema corresponding to
the area of palpable concern and tenderness on exam reported by the patient in
the right ventral lateral forearm. No evidence for abscess.
|
10188582-RR-34
| 10,188,582 | 29,645,280 |
RR
| 34 |
2170-07-25 15:43:00
|
2170-07-25 16:13:00
|
EXAMINATION: RENAL U.S.
INDICATION: History: ___ with recurrent UTIs // eval hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: GU ultrasound ___
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Right kidney: 11.1 cm
Left kidney: 11.1 cm
The bladder is only minimally distended and can not be fully assessed on the
current study.
IMPRESSION:
Normal renal ultrasound.
|
10188935-RR-10
| 10,188,935 | 22,289,170 |
RR
| 10 |
2164-05-02 07:09:00
|
2164-05-02 12:24:00
|
INDICATION: ___ male status post arrest who presents for evaluation
of altered mental status.
COMPARISON: Chest radiographs from ___,
___.
TECHNIQUE: Single AP portable exam of the chest.
FINDINGS: There is mild enlargement of the heart, stable compared to multiple
prior exams dating back to at least ___. The hilar and
mediastinal contours are stable. There has been interval improvement of the
right lower lobe opacity compared to the prior exam. There is a small right
pleural effusion. No new consolidations are seen. There is no pneumothorax.
IMPRESSION:
Interval improvement of the right lower lobe pneumonia.
|
10188935-RR-11
| 10,188,935 | 22,289,170 |
RR
| 11 |
2164-05-04 09:11:00
|
2164-05-04 10:06:00
|
PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Assess pacemaker leads.
Left transvenous pacemaker leads terminate in standard position, in the right
atrium and right ventricle. There is no evident pneumothorax. If any, there
is a small left effusion. There is mild cardiomegaly. Compared to ___, mild interstitial edema has almost completely resolved.
|
10188935-RR-4
| 10,188,935 | 22,289,170 |
RR
| 4 |
2164-04-28 13:32:00
|
2164-04-28 14:18:00
|
HISTORY: ___ male status post arrest. Question congestive heart
failure.
COMPARISON: ___ from ___
FINDINGS:
Mild cardiomegaly again persists as do basilar streaky opacities consistent
with atelectasis. The vessels are somewhat indistinct compatible with mild
vascular engorgement. There is no overt edema. No pleural effusion or
pneumothorax.
IMPRESSION:
Mild vascular congestion and bibasilar atelectasis.
|
10188935-RR-5
| 10,188,935 | 22,289,170 |
RR
| 5 |
2164-04-28 17:11:00
|
2164-04-29 09:13:00
|
CLINICAL HISTORY: CHF, recent V-tach arrest.
CHEST
Cardiomegaly is present and perihilar prominence is seen and some ___ B
lines are present suggesting some mild interstitial failure.
IMPRESSION: Early interstitial failure.
|
10188935-RR-6
| 10,188,935 | 22,289,170 |
RR
| 6 |
2164-04-29 14:34:00
|
2164-04-29 16:27:00
|
INDICATION: PE, evaluate for DVT.
COMPARISON: None available.
FINDINGS: There is normal phasicity in the common femoral veins bilaterally.
There is normal compression, augmentation and flow in the common femoral,
superficial femoral, and popliteal veins of the legs bilaterally. There is
normal compression and flow in the peroneal and posterior tibial veins of the
legs bilaterally. Incidental note of duplicated proximal to mid superficial
femoral veins bilaterally.
IMPRESSION: No evidence of DVT in the right or left leg.
|
10188935-RR-7
| 10,188,935 | 22,289,170 |
RR
| 7 |
2164-04-30 14:59:00
|
2164-04-30 17:50:00
|
INDICATION: ___ male with altered mental status who presents for
evaluation of interval change.
COMPARISON: Chest radiographs from ___ and ___.
TECHNIQUE: Single AP portable exam of the exam.
FINDINGS: Again seen is mild cardiomegaly, stable since the exam from
___. There has been an interval increase in bilateral pulmonary
vascular engorgement and pulmonary edema. There has also been an increase in
bibasilar opacities with silhouetting of the left hemidiaphragm, likely
secondary to pulmonary edema; however, a superimposed aspiration or pneumonia
is also likely in the acute clinical setting. There is no pneumothorax.
IMPRESSION:
1. Interval worsening of bilateral pulmonary edema and vascular engorgement.
2. Interval increase in bibasilar opacities. This may be secondary to
worsening atelectasis or superimposed aspiration/pneumonia.
Findings were discussed with Dr. ___, by Dr. ___, by telephone on the
day of the exam at 5:30pm.
|
10188935-RR-9
| 10,188,935 | 22,289,170 |
RR
| 9 |
2164-05-01 07:26:00
|
2164-05-01 08:50:00
|
HISTORY: Cardiac cath with possible pulmonary edema or aspiration pneumonia.
FINDINGS: In comparison with study of ___, mild enlargement of the cardiac
silhouette persists, though there has been substantial decrease in the degree
of pulmonary edema. Asymmetric opacification at the right base could be a
manifestation of asymmetric edema, though in the appropriate clinical setting,
supervening pneumonia would have to be considered.
|
10189149-RR-24
| 10,189,149 | 24,478,128 |
RR
| 24 |
2159-05-13 02:37:00
|
2159-05-13 05:11:00
|
INDICATION: ___ female with constipation, abdominal tenderness, and
fever.
___ and ___.
TECHNIQUE: Axial CT images through the abdomen and pelvis were acquired after
administration of intravenous contrast. Coronal and sagittal reformatted
images were reviewed.
FINDINGS: There is a small left pleural effusion with adjacent atelectasis.
A hypodense rim around a contrast opacified descending aorta is concerning for
dissection. The celiac axis and origin of the superior mesenteric artery are
patent and arise from the true lumen. The dissection appears to extend to
just above the origin of the left renal artery and in the region of the right
renal artery, although evaluation is difficult on this study due to contrast
timing. The kidneys enhance and excrete contrast symmetrically.
ABDOMEN: Right calcified pleural plaque is again noted. The liver, spleen,
gallbladder, pancreas, adrenal glands, stomach, small bowel, and colon are
within normal limits. There is no free intraperitoneal air or ascites. No
mesenteric or retroperitoneal lymphadenopathy is detected. Bilateral renal
hypodensities likely represent cysts but are incompletely evaluated and on the
left are too small to characterize.
PELVIS: The bladder, uterus, and rectum are unremarkable. There is mild
fecal loading. No intrapelvic or inguinal lymphadenopathy is detected.
Degenerative changes are seen in the spine.
IMPRESSION:
1. Aortic dissection with small left pleural effusion, incompletely imaged.
2. Mild fecal loading.
At the time this study was performed, Dr. ___ was contacted immediately
by Dr. ___ at which time a chest CTA was ordered and performed.
These findings were subsequently discussed in person with Dr. ___
Dr. ___ by Dr. ___ at 3:35 a.m. on ___. Findings were
discussed in person with ___ by Dr. ___ in person at 3:50
a.m. on ___. Findings were also discussed in person with Dr. ___ at
4:00 a.m. on ___.
|
10189149-RR-25
| 10,189,149 | 24,478,128 |
RR
| 25 |
2159-05-13 03:26:00
|
2159-05-13 04:45:00
|
INDICATION: ___ female with aortic dissection, partially imaged on CT
abdomen.
COMPARISON: No chest CT available for comparison. CT abdomen dated ___
just prior to this study.
TECHNIQUE: Axial CT images through the chest were acquired before and after
administration of intravenous contrast. Of note, the patient received
intravenous contrast for the CT abdomen preceding this study. Coronal,
sagittal, and bilateral oblique reformatted images were reviewed.
FINDINGS: There is a Type A dissection extending from the origin of the
innominate artery into the proximal left subclavian artery to the abdominal
aorta just below the diaphragmatic crura with an associated large
pseudoaneurysm measuring 2.9 x 2.2 x 3.6 at the aortic arch. The
pseudoaneurysm lies 1.7 cm from left subclavian artery. The mouth measures
1.2 x 1.7 cm (TV x AP). The ascending aorta measures 3.5 x 3.4 cm. The
dissection does not involve the aortic valve. There is no pericardial
effusion. A small left pleural effusion measures predominantly simple fluid
attenuation, however, there are a few areas of intermediate attenuation.
Ground-glass opacity in the left lower lobe may be secondary to mild volume
loss. Cardiomegaly is seen with left ventricular hypertrophy. The
visualized portions of the pulmonary arteries appear patent. The main
pulmonary artery is mildly enlarged measuring 3.6 cm. Right pleural
calcifications are again noted. There is a coarse right breast calcification.
Visualized subdiaphragmatic structures demonstrate no acute abnormalities.
Degenerative changes are seen in the spine.
IMPRESSION: Type A aortic dissection with 3 cm pseudoaneurysm arising from
the distal aortic arch. Small left sided pleural effusion.
Preliminary findings were discussed with Dr. ___ in person by Dr. ___ at 3:35
a.m. on ___. Findings were also discussed with Dr. ___ at 3:50
a.m. in person by Dr. ___ on ___. Findings were also discussed with Dr.
___ by Dr. ___ in person at 4 a.m. on ___.
|
10189149-RR-26
| 10,189,149 | 24,478,128 |
RR
| 26 |
2159-05-13 09:49:00
|
2159-05-13 20:15:00
|
REASON FOR EXAMINATION: New right internal jugular line placement.
AP radiograph of the chest was reviewed in comparison to chest CT from ___.
The ET tube tip is 6.2 cm above the carina. The right Swan-Ganz catheter tip
is at the level of the right ventricular outflow tract. The NG tube tip is at
the distal esophagus that should be further advanced. The patient is after
stenting of the ascending aorta due to type B aortic dissection. Left pleural
effusion is noted, grossly unchanged since the prior study. Small amount of
right pleural effusion is present as well. Note is made that the ET tube cuff
is hyperextended and should be readjusted.
The findings were communicated to Dr. ___ the phone by Dr. ___
at 11 a.m. on ___.
|
10189149-RR-27
| 10,189,149 | 24,478,128 |
RR
| 27 |
2159-05-15 16:26:00
|
2159-05-15 18:23:00
|
INDICATION: ___ with type A dissection, contained rupture just distal
to the left subclavian artery, status post TEVAR and right femoral patch,
assess for distal third of the right foot because of asymmetric examination.
COMPARISON: CTA chest, ___.
TECHNIQUE: MDCT axial images were obtained extending just proximal to the
aortic bifurcation with bilateral runoff with the administration of IV
contrast. Multiplanar reformats were generated and reviewed.
FINDINGS: Intra-abdominal loops of large and small bowel appear unremarkable.
Calcification is noted within the right adnexa. There is a small amount of
ascites. The uterus appears unremarkable. The bladder demonstrates presence
of Foley and air within the bladder. Visualized osseous structures show no
focal lytic or sclerotic lesions suspicious for malignancy.
CTA RUNOFF: On the right, plaque is noted within the right common femoral
artery; however, the right common femoral artery, superficial femoral artery
appear patent. There is complete occlusion of the popliteal artery on the
right, which is reconstituted below the knee with patency of right anterior
tibial, peroneal and posterior tibial arteries, which are followed to the mid
calf, where they taper off likely due to slow perfusion.
On the left, the left common femoral, superficial femoral and popliteal
arteries appear patent. The anterior tibial, posterior tibial and peroneal
arteries on the left appear patent; however, they taper off at the level of
the mid calf, similar to the right side, likely due to slow perfusion.
IMPRESSION:
1. Right popliteal artery occluded with reconstitution below knee.Findings may
represent embolus as the vessels otherwise appear without significant
thrombus.
2. Bilateral anterior tibial, posterior tibial and peroneal arteries traced to
the level of the midcalf where they taper off, likely due to slow perfusion.
3. Calcification in right adnexa.
4. Ascites.
|
10189149-RR-30
| 10,189,149 | 28,231,983 |
RR
| 30 |
2159-11-21 11:41:00
|
2159-11-21 12:50:00
|
HISTORY: ___ female with chest pain.
COMPARISON: ___.
FINDINGS: There is a descending aortic stent graft in place. The lungs are
clear. Cardiomediastinal silhouette is enlarged. Hilar contours appear
unremarkable. A right-sided line is actually external to the patient.
IMPRESSION: No acute intrathoracic process.
|
10189149-RR-31
| 10,189,149 | 28,231,983 |
RR
| 31 |
2159-11-21 11:56:00
|
2159-11-21 12:43:00
|
___ female with chest pain and history of type A dissection in
___, question acute thoracic process.
COMPARISON: Multiple priors, most recently ___.
TECHNIQUE: ___ MDCT-acquired axial images from the thoracic inlet to the pubic
symphysis were displayed with 2.5-mm and 5-mm slice thickness. Axial images
of the chest were initially acquired in a non-contrast phase, followed by
arterial phase imaging through the chest, abdomen and pelvis. Curved
reformats and volume-rendered images were prepared on a separate workstation
and reviewed on the PACS.
FINDINGS: There is no pulmonary arterial filling defect to the subsegmental
level. The patient is status post descending thoracic aortic stent graft.
Notably since ___, there is interval increase in the diameter of the
descending thoracic aorta along the segment covered by the stent. Approximate
proximal diameter is 4.1 compared to 3.2 cm on the prior study, mid portion
4.3 compared to 3.6, lower portion 3.9 compared to 3.5 cm and just inferior to
the stent it measures 2.4, stable to the last study. There is heterogeneity of
the luminal contrast in the descending aorta, most likely due to mixing
artifact. There is an enlarged heart, particularly the right atrium.
Tracheobronchial tree appears patent to the subsegmental level. No pleural or
pericardial effusion. No axillary, mediastinal lymphadenopathy by CT
criteria. There is compressive atelectasis adjacent to the ectatic aorta.
Although this exam was not tailored for subdiaphragmatic evaluation, the
non-contrast appearance of the subdiaphragmatic organs appears unremarkable. A
fat containing diaphragmatic hernia is present.
IMPRESSION:
1) Interval dilation of the descending thoracic aorta involving the segment
covered by the stent, now up to 4.3 cm. Recommend vascular surgical consult.
2) No pulmonary embolism.
|
10189149-RR-43
| 10,189,149 | 20,717,975 |
RR
| 43 |
2166-02-03 11:04:00
|
2166-02-03 14:24:00
|
EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: ___ year old woman with intraparenchymal hemorrhage// underlying
lesion
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
Sagittal and axial T1 weighted imaging were performed along with diffusion
imaging.
Axial imaging was performed with gradient echo, FLAIR, T2, and T1 technique.
Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images.
COMPARISON: CTA of the head and neck dated ___.
FINDINGS:
MR BRAIN:
5.4 cm x 3.6 cm subacute right temporal lobe intraparenchymal hematoma is
re-demonstrated, similar compared with CTA ___ allowing for
differences in technique. Moderate surrounding edema, expected finding.
Intraventricular hemorrhage is seen with blood products layering within the
bilateral occipital horns, right greater than left.
Abnormal signal the sulci overlying posterior left temporal, occipital lobes,
cerebellum likely represents subarachnoid hemorrhage, with possible mild
enhancement seen on FLAIR images. Follow-up brain MRI without contrast
recommended to document resolution. Post gadolinium images, gradient images
are moderately compromised by motion.
Chronic infarct left PCA distribution, left temporal, left parietal, left
occipital lobes, right inferior parietal lobule, similar.. Findings
consistent with moderate to severe chronic small vessel ischemic changes.
Small chronic right cerebellar infarct. Focus of chronic microhemorrhage left
basal ganglia related to chronic lacunar infarct.
The paranasal sinuses, mastoid air cells and middle ear cavities are clear.
The intraorbital contents are normal.
MRA brain:
Moderately motion compromised exam.
Appearance of high cervical bilateral ICA suggestive of fibromuscular
dysplasia.
2 mm infundibulum versus aneurysm lateral aspect cavernous segment right ICA.
Posterior digested 2 infundibula right supraclinoid ICA.
Otherwise, the intracranial vertebral and internal carotid arteries and their
major branches appear normal without evidence of stenosis, occlusion, or
aneurysm formation.
IMPRESSION:
1. 5 cm right temporal lobe subacute parenchymal hematoma, similar. No
evidence of mass or vascular malformation.
2. Stable small volume intraventricular hemorrhage, no hydrocephalus.
3. Probable subarachnoid hemorrhage.
4. Possible mild leptomeningeal or surface enhancement at the cerebellum, post
gadolinium images are motion degraded, follow-up brain MRI without contrast
recommended to document resolution.
5. Extensive chronic infarcts, as above.
6. 2 mm infundibulum versus aneurysm lateral wall cavernous segment right ICA.
7. Findings consistent with high cervical ICA bilateral fibromuscular
dysplasia.
|
10189377-RR-24
| 10,189,377 | 20,333,459 |
RR
| 24 |
2142-12-31 11:21:00
|
2142-12-31 11:42:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with multiple R rib fx and small hemothorax//
interval change, please take exam in AM
IMPRESSION:
In comparison with the chest radiograph and CT scan dated ___, the
anterolateral rib fractures on the right are difficult to see. Opacification
at the right base is consistent with pleural fluid and atelectatic changes at
the right base. There is no evidence of pneumothorax.
The left lung remains essentially clear.
|
10189377-RR-38
| 10,189,377 | 26,604,060 |
RR
| 38 |
2144-08-06 00:18:00
|
2144-08-06 04:36:00
|
EXAMINATION: FEMUR (AP AND LAT) RIGHT
INDICATION: History: ___ with fall and pain// further detail on Rt
intertrochanteric fracture
TECHNIQUE: Frontal and lateral views of the right femur
COMPARISON: Right hip and pelvis radiographs from 4 hours prior
FINDINGS:
Right proximal femur intertrochanteric fracture redemonstrated although
overlying skin fold makes it less conspicuous than on prior dedicated hip
radiograph. No additional fractures in the right femur. Limited views of the
right knee are unremarkable other than mild spurring in the patellofemoral
compartment and chondrocalcinosis.
IMPRESSION:
No additional fractures. The right proximal femur intertrochanteric fracture
is better assessed on prior dedicated right hip radiograph.
|
10189377-RR-39
| 10,189,377 | 26,604,060 |
RR
| 39 |
2144-08-06 08:11:00
|
2144-08-06 10:22:00
|
EXAMINATION: INTRAOPERATIVE FEMUR RADIOGRAPHS
INDICATION: ___ man with right intertrochanteric femur fracture
TECHNIQUE: Intraoperative images of the right femur were obtained during open
reduction internal fixation
COMPARISON: Right femur x-rays ___ from 7 hours prior, pelvic
x-rays ___
FINDINGS:
2 intraoperative images were acquired without a radiologist present.
Images show femoral fixation device with femoral head nail..
IMPRESSION:
Intraoperative images were obtained during right femur open reduction internal
fixation. Please refer to the operative note for details of the procedure.
|
10189427-RR-10
| 10,189,427 | 28,497,058 |
RR
| 10 |
2125-04-16 16:58:00
|
2125-04-17 08:51:00
|
REASON FOR EXAMINATION: Evaluation of the patient after stabbing to chest and
thoracotomy with removal of the right-sided chest tube.
Portable AP radiograph of the chest was reviewed in comparison to ___.
Left chest tube is in place. The inferior left chest tube has been
disconnected. Mediastinal drain is in place. Cardiomediastinal silhouette is
stable. No definitive pneumothorax is seen. Improved aeration of the right
lung is noted. Left basal atelectasis is unchanged.
|
10189427-RR-11
| 10,189,427 | 28,497,058 |
RR
| 11 |
2125-04-17 01:46:00
|
2125-04-17 08:30:00
|
REASON FOR EXAMINATION: Evaluation of the patient after stab wound to the
chest and left arm after thoracotomy and repair of left ventricle, currently
chest tube has been removed.
Portable AP radiograph of the chest was compared to prior study obtained on
___.
The left chest tube is in place. Compared to the prior study there is slight
interval increase in the left apical pneumothorax, small. Heart size and
mediastinum are stable. Right basal opacity is new and might reflect interval
development of atelectasis versus aspiration.
Findings again of small apical pneumothorax were discussed with Dr.
___ the phone by Dr. ___ at 8:45 a.m. Findings were made
approximately at 8:15 a.m. on ___.
|
10189427-RR-13
| 10,189,427 | 28,497,058 |
RR
| 13 |
2125-04-18 13:19:00
|
2125-04-18 15:21:00
|
PA SINGLE VIEW OF THE CHEST
INDICATION: ___ man with stab wound repair via thoracotomy,
discontinuation of chest tube.
COMPARISON: ___.
FINDINGS:
Left chest tube has been removed. Residual apical left pneumothorax is
unchanged measuring 8 mm. Mild left lung base atelectasis is stable. Right
basal atelectasis is improved. Mediastinal and cardiac contours are within
normal limits. There is no significant pleural effusion.
CONCLUSION:
Left residual pneumothorax is small and unchanged.
|
10189427-RR-3
| 10,189,427 | 28,497,058 |
RR
| 3 |
2125-04-13 09:17:00
|
2125-04-13 10:32:00
|
PORTABLE SUPINE CHEST FILM ___ AT 9:25
CLINICAL INDICATION: Evaluate for traumatic injury status post stab wound to
chest.
Comparison is made to a chest film from ___ dated ___, 8:12 a.m.
A portable supine chest film ___ at 9:25 is submitted.
IMPRESSION:
Endotracheal tube has its tip approximately 6 cm above the carina. There is a
nasogastric tube seen coursing below the diaphragm with the tip projecting
over the stomach. A left chest tube is in place. Skin staples overlying the
left upper abdomen in this patient status post recent surgery. There is a
tiny left apical pneumothorax. There is retrocardiac patchy opacity which may
represent an area of contusion or atelectasis. No pleural effusions are
appreciated. No acute bony abnormality is appreciated.
|
10189427-RR-5
| 10,189,427 | 28,497,058 |
RR
| 5 |
2125-04-13 12:25:00
|
2125-04-13 14:02:00
|
CHEST PORT LINE PLACEMENT ___ AT 12:52
CLINICAL INDICATION: ___ with thoracotomy, check endotracheal tube
placement and chest tube placement.
Comparison is made to the patient's previous study dated ___ at 9:25
a.m.
A portable supine chest film ___ at 12:52 is submitted.
IMPRESSION:
1. Endotracheal tube has its tip 4 cm above the carina. A left chest tube is
in place. There is also a second chest tube now in position. A third
catheter is also seen projecting over the left lower lung and upper abdomen.
Clinical correlation is advised. There is persistent retrocardiac opacity
which may reflect partial lower lobe atelectasis or contusion. The tiny left
apical pneumothorax is difficult to appreciate on the current examination.
Right lung remains well inflated and clear. Overall, cardiac size and
mediastinal contours are stable. Skin staples are seen overlying the left
upper abdomen. Interval removal of the nasogastric tube.
|
10189427-RR-6
| 10,189,427 | 28,497,058 |
RR
| 6 |
2125-04-14 05:21:00
|
2125-04-14 08:49:00
|
HISTORY: Thoracotomy, to assess for change.
FINDINGS: In comparison with the study of ___, the endotracheal tube and
nasogastric tubes have been removed. Left chest tubes remain in place and
there is no pneumothorax. Retrocardiac opacification is again consistent with
atelectasis and effusion, though supervening pneumonia would have to be
considered in the appropriate clinical setting. Hazy opacification at the
right base is consistent with pleural effusion and atelectasis on this side as
well.
There is striking dilatation of the gas-filled stomach since removal of the
nasogastric tube.
|
10189427-RR-7
| 10,189,427 | 28,497,058 |
RR
| 7 |
2125-04-13 14:40:00
|
2125-04-13 16:04:00
|
PORTABLE AP CHEST FILM, ___ AT 14:48
CLINICAL INDICATION: ___ intubated and nasogastric tube placement,
check position.
Comparison to prior study of ___ at 12:52.
Single portable semi-erect chest film ___ at 14:48 is submitted.
IMPRESSION:
The endotracheal tube continues to have its tip approximately 4 cm above the
carina. A nasogastric tube is seen coursing below the diaphragm with the tip
not identified. Two left chest tubes and a third catheter are seen overlying
the left hemithorax. There continues to be retrocardiac consolidation with
probable associated effusion likely reflecting partial lower lobe atelectasis,
although pneumonia or aspiration cannot be entirely excluded. The right lung
is grossly clear, although the right costophrenic angle is not entirely
included on the study. A left subclavian central line has its tip in the
proximal SVC. No pneumothorax is seen. The cardiac and mediastinal contours
are stable.
|
10189427-RR-9
| 10,189,427 | 28,497,058 |
RR
| 9 |
2125-04-15 04:44:00
|
2125-04-15 09:53:00
|
INDICATION: ___ man with polytrauma, evaluate for interval changes.
COMPARISONS: Chest radiograph from ___.
FINDINGS: Single portable chest radiograph was provided. Left PICC has been
removed. Retrocardiac opacification is consistent with atelectasis and
possible effusion. Hazy opacification at the right base is likely
atelectasis. Left chest tube and left mediastinal drain are unchanged in
position. There is no pneumothorax or pneumomediastinum. The
cardiomediastinal silhouette is unchanged. Bony structures are intact.
Stomach is much less distended than the prior exam.
IMPRESSION:
1. Retrocardiac opacity and right basilar opacity, likely atelectases.
2. No pneumothorax.
|
10189661-RR-10
| 10,189,661 | 28,061,726 |
RR
| 10 |
2197-07-07 14:03:00
|
2197-07-07 17:53:00
|
EXAMINATION: LUMBAR SPINE MRI WITH AND WITHOUT CONTRAST
INDICATION: History: ___ s/p microdiscectomy 5d ago presenting with recurrent
LBP and sciatica // eval herniation
TECHNIQUE: Multiplanar, multi sequence MRI data were acquired through the
lumbar spine before and after the administration of intravenous contrast.
COMPARISON: Lumbar spine MRI ___
FINDINGS:
Postsurgical changes reflect the recent right L5 hemilaminotomy. There is a 2
x 2.5 cm ill-defined, heterogeneous fluid collection at the surgical site
without evidence of rim enhancement or continuity with the CSF space. There is
no mass effect on the dura.
There is a substantial amount of residual disc material at the L4-L5 level
which occupies approximately 75% of the spinal canal at this level. The
increase in T2 signal within the disc is compatible with postoperative change.
There is minimal annular enhancement compatible with postoperative granulation
tissue. ___ type 2 degenerative endplate changes are stable.
Elsewhere in the lumbar spine the mild degenerative changes have not changed
since ___.
L2-L3: Loss of disc height and L2 inferior endplate Schmorl's node. No neural
foraminal or central canal stenosis.
L3-L4: Mild disc space narrowing, mild left paracentral disc bulge and a small
enhancing annular fissure.
L5-S1: There is a mild central disc protrusion.
The visualized intra-abdominal structures are unremarkable.
IMPRESSION:
1. Postsurgical changes after right-sided L4-L5 hemilaminotomy. The fluid
collection at the laminal defect most likely represents a seroma. There is no
rim enhancement or evidence of CSF leak.
2. Substantial amount of residual disc material at L4-L5 that continues to
cause severe spinal stenosis, not significantly changed in degree since the
pre-operative study.
3. No epidural fluid collection.
|
10189661-RR-11
| 10,189,661 | 28,061,726 |
RR
| 11 |
2197-07-07 18:17:00
|
2197-07-08 15:00:00
|
HISTORY: Microdiscectomy.
FINDINGS: Images from the operating suite show posterior probe at what
appears to be L4-L5. Further information can be gathered from the operative
report.
|
10189774-RR-5
| 10,189,774 | 25,424,241 |
RR
| 5 |
2133-09-20 00:14:00
|
2133-09-20 13:49:00
|
STUDY: CTA of the head with and without contrast.
CLINICAL INDICATION: ___ female patient with worst headache of life,
sudden onset, lumbar puncture with 213 RBC, rule out aneurysm, intracranial
bleed.
COMPARISON: No prior examinations of the head are available.
TECHNIQUE: Axial MDCT images were obtained initially without contrast. After
the administration of nonionic intravenous contrast material, axial images
were obtained through the brain, sagittal, coronal and axial reformations were
provided. Curved multiplanar reformats and volume-rendered reconstructions of
the intracranial circulation was also generated at a separate workstation by
the advanced imaging lab.
FINDINGS:
NON-CONTRAST HEAD CT: There is no evidence of intracranial hemorrhage, mass,
mass effect or shifting of the normally midline structures. The ventricles
and sulci are normal in size and configuration for the patient's age. The
examination is partially limited due to patient motion, the soft tissues and
bony structures are unremarkable. The orbits are normal. The paranasal
sinuses and mastoid air cells are clear.
IMPRESSION: There is no evidence of acute intracranial process or hemorrhage.
CTA OF THE HEAD: There is evidence of normal pattern of enhancement in the
major arterial vascular structures, the anterior, middle and posterior
cerebral arteries are patent, no aneurysms larger than 3 mm in size are seen.
The basilar artery is patent, the major dural venous sinuses are patent with
no evidence of venous sinus thrombosis.
IMPRESSION: Essentially normal CTA of the head with no evidence of flow
stenotic lesions or aneurysms larger than 3 mm in size.
A preliminary report was provided by Dr. ___ on ___.
|
10189889-RR-27
| 10,189,889 | 24,397,884 |
RR
| 27 |
2146-05-01 16:59:00
|
2146-05-01 18:05:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with asthma, OSA, recent lightheadedness // ?cpd
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Costophrenic angles are partially obscured due to overlying soft tissue/
patient body habitus. Given this, no focal consolidation is seen. No large
pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are stable.
IMPRESSION:
Costophrenic angles partially obscured due to overlying soft tissue/ patient
body habitus. Given this, no acute cardiopulmonary process seen.
|
10189889-RR-31
| 10,189,889 | 28,110,950 |
RR
| 31 |
2146-12-03 19:35:00
|
2146-12-03 19:58:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with asthma here with shortness of breath and
productive cough // evaluate for infiltrate
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low which accentuates the size of the cardiac silhouette
which appears mildly enlarged. Mediastinal and hilar contours are within
normal limits. The pulmonary vasculature is not engorged. Focal
consolidation in the right middle lobe is concerning for pneumonia. The left
lung is clear. No pleural effusion or pneumothorax is identified. Anterior
bridging osteophytes are again noted in the thoracic spine.
IMPRESSION:
Right middle lobe pneumonia. Followup radiographs are recommended after
treatment to ensure resolution of this finding.
|
10189889-RR-37
| 10,189,889 | 20,136,408 |
RR
| 37 |
2147-05-11 14:25:00
|
2147-05-11 14:53:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with shortness of breath for 24 hour duration with
one week URI symptoms.// pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities. Anterior
bridging osteophytes are noted within the thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10189939-RR-24
| 10,189,939 | 22,003,018 |
RR
| 24 |
2180-08-18 04:55:00
|
2180-08-18 09:45:00
|
HISTORY: Epigastric pain and elevated white blood cell count.
COMPARISON: CT from ___, CT from ___ and MR from
___.
TECHNIQUE: CT of the abdomen and pelvis was performed with IV contrast. No
oral contrast was administered. Coronal and sagittal reformats were reviewed.
FINDINGS: LUNG BASES: The lung bases demonstrate bilateral dependent
atelectasis. Cardiac apex is unremarkable. An expansile artery in the right
lower lobe has been present on prior CTs in ___ as well as in ___,
but the appearance if very worrisome for a pulmonary embolism.
ABDOMEN: Multiple hypodense lesions of the liver corresponding to hemangioma
and simple cysts are better characterized on the MRs ___ this patient has
previously had. There is focal intrahepatic dilatation in the left lobe of
the liver (2, 17) which are all stable from the prior exams. Multiple
hypodense lesions within the pancreatic body and tail are qualitatively
similar in size to the MR from ___ representing the side branch
IPMNs. The spleen is normal. Bilateral kidneys are unremarkable. Bilateral
adrenal glands are normal. Gallbladder is distended but otherwise normal and
there is no pericholecystic fluid. The main portal vein is patent.
The abdominal aorta is normal in course and caliber demonstrating moderate
atherosclerotic disease. There is no abdominal free fluid. There is no
abdominal lymphadenopathy.
Patient is status post subtotal colectomy. The exact area of small bowel to
colonic anastomosis is difficult to identify, but mild thickening of one loop
in the right lower quadrant may be it. There are several area of chronic
changes related to Crohn's disease such as the mucosal hyperenhancement
involving the rectosigmoid junction (2, 71) and fatty infiltration of the
bowel wall. However, there is no stranding to suggest acute inflammation.
Multiple areas of adhesions are noted throughout the abdomen with tethered
small bowel loops, but no obstruction.
PELVIS: There is no pelvic free fluid. The prostate is unremarkable. The
bladder is unremarkable containing left inguinal hernia. There is no pelvic
lymphadenopathy.
BONES: There are no suspicious lytic or sclerotic lesions. Diffuse
degenerative changes involving L5 and S1 again demonstrated.
IMPRESSION:
1) No evidence of acute intrabdominal process. Chronic changes related to
Crohn's as above.
2) Expansile artery in the right lower lobe with apparent filling defect
concernig for pulmonary embolism. The size of the vessel seems larger than it
should, but this has been that way since ___ and ___ have been similar to a
prior CT in ___ though the presence of thrombus on these is unclear because
of lack of opacification. A CTA of the Chest is recommended for evaluation for
pulmonary embolism.
3) Chronic unchanged findings including pancreatic IPMN, multiple hepatic
hypodensities, persistent dilatation of the left intrahepatic biliary tree.
Findings discussed with Dr ___ at 10 AM via telephone.
|
10189939-RR-25
| 10,189,939 | 24,110,862 |
RR
| 25 |
2180-10-01 19:49:00
|
2180-10-01 22:37:00
|
INDICATION: History of primary sclerosing cholangitis and Crohn's disease as
well as prior small-bowel obstruction now with right upper quadrant pain and
diarrhea, here to evaluate for small-bowel obstruction or other acute
intra-abdominal process.
COMPARISON: CT of the abdomen and pelvis with contrast dated ___.
TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases
through the pubic symphysis following the uneventful administration of 130 cc
Omnipaque intravenous contrast and enteric contrast. Coronal and sagittal
reformatted images were generated and reviewed.
FINDINGS:
LUNG BASES: Mild posterior dependent positional changes are noted in the
imaged lung bases. Limited imaging of the heart demonstrates no pericardial
effusion.
ABDOMEN/PELVIS: There are multiple stable hypodense lesions throughout the
liver corresponding to hemangiomata and simple cysts, which are better
characterized on prior MRI. Focal intrahepatic dilatation in the left lobe of
the liver (___) is unchanged in comparison to the prior examinations. No
new or worrisome hepatic lesion is detected. The gallbladder is distended
without gallbladder wall thickening, edema or pericholecystic fluid, somewhat
similar to prior. No extra-hepatic biliary ductal dilation is seen. Multiple
hypodense lesions within the pancreatic body and tail are not significantly
changed in comparison to the prior CT or MR and likely represent side branch
IPMN. The largest in the proximal body measures 14 x 7 mm (2:26). There is
no pancreatic ductal dilatation, peripancreatic stranding or peripancreatic
fluid collections. The spleen is small in size. The bilateral adrenal glands
and kidneys are within normal limits. The ureters are normal in course and
caliber bilaterally.
The abdominal aorta is normal in caliber throughout. There is no free air.
No abdominal lymphadenopathy is seen.
The patient is status post subtotal colectomy with ileorectal anastomosis.
The location of the colonic anastomosis is difficult to identify. There are
chronic changes related to Crohn's disease such as fatty infiltration of the
bowel wall in the residual rectum. There is no significant mucosal
hyperenhancement or pericolonic stranding to suggest acute inflammation. No
new bowel wall thickening is seen. There is no free air. There are multiple
loops of diffusely dilated small bowel in the right abdomen, increased in
caliber from ___, extending to the level of a focal narrowing along the
bowel in the right lower quadrant (601B:24). Very trace free fluid is seen
along the lateral right mid abdomen. The stomach is moderately distended with
enteric contrast. The duodenum is unremarkable. The proximal small bowel,
predominantly jejunum, is collapsed.
The urinary bladder is underdistended. The prostate and seminal vesicles are
within normal limits.
OSSEOUS STRUCTURES: Degenerative changes are most pronounced at the L5-S1
level. There are no osseous destructive lesions concerning for malignancy.
IMPRESSION:
1. Findings concerning for early partial small bowel obstruction extending to
the level of focal narrowing along the bowel in the right lower quadrant
(601B:24) with increased caliber of the small bowel from ___. Fluid seen
in the small bowel distal to this level.
2. Chronic findings including multiple pancreatic IPMN, multiple hepatic
hypodensities and persistent dilatation of the left intrahepatic biliary tree
stable in comparison to the most recent prior CT of ___ and MRI
of ___.
|
10189939-RR-26
| 10,189,939 | 24,110,862 |
RR
| 26 |
2180-10-02 09:54:00
|
2180-10-02 10:42:00
|
HISTORY: Primary sclerosing cholangitis. Evaluate for biliary dilatation.
TECHNIQUE: Gray scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT of the abdomen from ___ and an ultrasound of the
abdomen from ___.
FINDINGS:
The liver displays heterogeneous architecture with numerous cysts,
predominantly in the left lobe. The largest measures up to 2.2 cm. The left
lateral segment is atrophic and difficult to visualize. Mild biliary
dilatation is noted in the right lobe. Doppler assessment of the main portal
vein demonstrates hepatopetal flow. The gallbladder is normal with no stones
or wall thickening. The common bile duct measures 5 mm. The pancreas is
largely obscured by overlying bowel gas. The spleen is normal appearing,
measuring 8 cm. No ascites seen. The IVC is unremarkable.
IMPRESSION:
1. Multiple hepatic cystic areas in left lateral segments of the liver,
similar to the prior study. Mild intrahepatic biliary dilatation in the right
lobe. Similar findings were seen on the prior CT.
2. Normal gallbladder with no stones.
|
10189939-RR-27
| 10,189,939 | 24,110,862 |
RR
| 27 |
2180-10-08 11:36:00
|
2180-10-08 16:25:00
|
HISTORY: Increasing nausea, vomiting and abdominal distention.
COMPARISON: CT ___.
FINDINGS: Frontal supine and upright views of the abdomen were obtained.
Surgical clips are noted throughout the abdomen. Small bowel loops are
dilated to 6.1 cm with multiple air-fluid levels, compatible with small bowel
obstruction. This appears worse than on ___. There is no free
air. Mild degenerative change is seen in the hip joints bilaterally.
IMPRESSION: Findings suggest small bowel obstruction, worse than on ___.
|
10189939-RR-28
| 10,189,939 | 24,110,862 |
RR
| 28 |
2180-10-08 13:14:00
|
2180-10-08 16:27:00
|
HISTORY: New NG tube placement.
COMPARISON: Abdominal radiograph ___ at 11:51 a.m. and CT ___.
FINDINGS: A frontal supine view of the abdomen was obtained portably. The tip
of the nasogastric tube projects over the left upper quadrant at the expected
location of the stomach. Distended loops of small bowel are similar to 11:51
a.m. allowing for differences in technique. Surgical clips are noted
throughout the abdomen. Degenerative change is seen in the lumbar spine and
hip joints bilaterally. Phleboliths are noted in the pelvis.
IMPRESSION: Nasogastric tube projects over the left upper quadrant at the
expected location of the stomach.
|
10189939-RR-29
| 10,189,939 | 24,110,862 |
RR
| 29 |
2180-10-10 11:22:00
|
2180-10-10 12:46:00
|
CHEST RADIOGRAPH.
INDICATION: PICC line placement.
COMPARISON: ___.
FINDINGS: As compared to the previous examination, the patient has received a
right-sided PICC line. The course of the line is unremarkable, the tip of the
line projects over the mid-to-lower SVC. There is no evidence of
complication, notably no pneumothorax. No change in appearance of the heart
and the cardiac silhouette.
|
10189939-RR-30
| 10,189,939 | 24,110,862 |
RR
| 30 |
2180-10-14 14:04:00
|
2180-10-14 16:32:00
|
ABDOMEN ___ AT 2:14 P.M.
HISTORY: ___ man with a history of partial small-bowel obstruction,
now more distended.
IMPRESSION: One frontal upright and two frontal supine views of the abdomen
are compared to ___:
Nasogastric tube has been removed. Although there is moderate distention of
bowel loops in the upper abdomen that are probably colon, the majority of
distended loops are small bowel containing air and fluid, usually indicating
stasis. There has been a slight increase in the number of these distended
small bowel loops, but the distension of these loops is not nearly as severe
as it was on ___. For example, in the left upper quadrant, 36 mm
today and 48 mm on ___, in the left flank, 51 mm today and 65 mm on
___. The most reasonable explanation is that there is continued
partial small-bowel obstruction. There is no free subdiaphragmatic gas, and
no mass effect in the upper or mid abdomen.
These findings were discussed by telephone with Dr. ___ at the time
of dictation.
|
10189939-RR-31
| 10,189,939 | 24,110,862 |
RR
| 31 |
2180-10-15 15:05:00
|
2180-10-15 18:54:00
|
HISTORY: ___ man with Crohn's disease, status post remote subtotal
colectomy, now with fevers leukocytosis and inability to tolerate oral feeds.
COMPARISON: CT abdomen and pelvis ___, MRCP ___ and ___.
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen and pelvis
was performed prior to and after uneventful intravenous administration of 8 mL
of Gadavist. 670 mL of volumen was administered as intraluminal oral contrast
via the nasogastric tube. 1 mg of intramuscular glucagon was administered
reduced bowel motion.
FINDINGS:
Numerous T2 hyperintense lesions throughout the liver, predominant in the left
hepatic lobe, consistent with hepatic cysts are stable. Asymmetric small
dilation and irregularity of the left intrahepatic bile ducts, associated with
mild left hepatic lobe atrophy, secondary to PSC is again noted, but better
evaluated in the prior MRCP study. The gallbladder is normal. The adrenal
glands, kidneys and spleen are normal. Multiple cystic pancreatic lesions
consistent with IPMN are again seen. There is minimal increase in size of a
few of these lesions including a dominant multilobulated lesion with thin
internal pseudoseptation in the pancreatic body now measuring 26 x 18 mm
(06:18), previously (___) 20 x 12 mm. A 13 x 11 mm cyst in the
pancreatic tail (06:19) is also larger since the prior study of ___,
9 x 10 mm. The main pancreatic duct is not dilated. The abdominal aorta is
normal in caliber. No pathologic retroperitoneal or mesenteric
lymphadenopathy is seen.
The patient is status post subtotal colectomy. The ileo colonic anastomosis,
likely in the right lower quadrant (6:62) has less prominent wall thickening
compared to the prior CT study. The stomach and small bowel loops are
distended from the administered oral contrast. The bowel loops are distended
all the way to the rectum, without a focal transition point. A focal area of
wall thickening and intramural fatty infiltration in the rectum (5:26),
without hyperenhancement or edema, represent changes of chronic Crohn's
disease. Mild tethering and angulation of the central small bowel loops are
likely due to adhesions (05:20, 21).
The urinary bladder and prostate are normal. There is no pelvic
lymphadenopathy or free fluid. No focal bone lesion is identified.
IMPRESSION:
1. No evidence of current bowel obstruction. Chronic changes related to
Crohn's disease, without active inflammation evident. Widely patent
ileosigmoid anastomosis Mild tethering and angulation of central small bowel
loops from adhesions.
2. Numerous pancreatic cysts, likely side-branch IPMN, with mild interval
enlargement of the dominant cysts since ___. Follow up MRCP in ___
year is recommended.
3. Numerous simple hepatic cysts. Known changes of primary sclerosing
cholangitis, predominant in the left hepatic lobe are better assessed on the
prior MRCP studies.
|
10189939-RR-32
| 10,189,939 | 24,110,862 |
RR
| 32 |
2180-10-19 12:29:00
|
2180-10-19 13:25:00
|
REASON FOR EXAMINATION: Right PICC line placement.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The right PICC line tip is at the level of low SVC. The NG tube tip is too
proximal in the entrance of the stomach and the side hole is still in the
distal esophagus and should be further advanced. Heart size and mediastinum
are stable. Lungs are essentially clear.
Findings were discussed with Dr. ___ the phone by Dr. ___ at
approximately 1:15 p.m. on ___
|
10189939-RR-33
| 10,189,939 | 24,110,862 |
RR
| 33 |
2180-10-23 15:39:00
|
2180-10-23 16:43:00
|
HISTORY: Leukocytosis.
FINDINGS: In comparison with study of ___, there is little change and no
evidence of acute pneumonia, vascular congestion, or pleural effusion.
Nasogastric tube has been removed.
|
10189939-RR-38
| 10,189,939 | 27,145,991 |
RR
| 38 |
2181-08-10 19:03:00
|
2181-08-10 19:39:00
|
INDICATION: ___ with PSC, Crohn's, 1x day fever to 102, nonproductive cough x
several wks // r/o infiltrate
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___ chest x-ray and chest CT from ___. .
FINDINGS:
The lungs remain clear. Cardiomediastinal silhouette is within normal limits.
No acute osseous abnormality is identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10189939-RR-39
| 10,189,939 | 27,145,991 |
RR
| 39 |
2181-08-10 18:04:00
|
2181-08-10 19:32:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with PSC, Crohn's disease w/ recent discharge for e.coli
sepsis related to recurrent cholangitis, recent ABX change. Negative ___,
no TTP // evaluate for recurrent cholangitis, cholecystitis, gallstone burden
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRI abdomen ___. Abdominal ultrasound ___.
FINDINGS:
The liver is normal in echogenicity. There are multiple irregular dilated
ducts throughout the liver most severe in the left lobe with prominent cystic
areas. Diameter of the CBD is stable at 10 mm. The gallbladder is prominent
with layering sludge but no wall thickening or pericholecystic fluid. The
portal vein is patent with hepatopetal flow. There is no ascites. Visualized
portions of the pancreatic head and body are normal without focal lesions.
Portions of the tail are obscured by overlying bowel gas. The spleen is
homogeneous and measures 8.7 cm. Visualized portions of the IVC are normal.
IMPRESSION:
1. Irregular dilated bile ducts throughout the liver compatible with known
primary sclerosing cholangitis.
2. Prominent gallbladder with sludge similar to prior studies without other
evidence of cholecystitis.
|
10189939-RR-40
| 10,189,939 | 27,145,991 |
RR
| 40 |
2181-08-11 09:15:00
|
2181-08-11 13:41:00
|
EXAMINATION: MRCP
INDICATION: ___ year old man with primary sclerosing cholangitis and recent
admission for cholangitis coming with fever // eval for evidence of
cholangitis or CBD dilatation
TECHNIQUE: T1 and T2 weighted multiplanar images of the abdomen were acquired
within a 1.5 T magnet, including 3D dynamic sequences obtained prior to,
during, and following the administration of 9 cc of Gadavist intravenous
contrast. The patient also received oral contrast of 1 cc of Gadavist diluted
in 50 cc of water.
COMPARISON: Numerous prior abdominal ultrasounds, CTs and MRIs ranging ___ to ___.
FINDINGS:
Compared to ___, there has been mild improvement of multifocal
cholangitis. Chronic moderate intrahepatic bile duct dilation with
irregularity is unchanged, involving the left lobe more than the right. The
common bile duct remains irregular in contour and dilated proximally to 11-mm
with an unchanged narrowing in the mid portion of the duct. No new or
progressive ductal dilation or choledocholithiasis is seen.
Heterogeneous arterial enhancement with hyperintensity on T2-weighted imaging
remains within the right lobe, more parenchymally based rather than in a
peribiliary distribution. This is most apparent on the arterial phase, with a
lesser degree of persistent hyperenhancement on the more delayed phases.
___ hyperenhancement in segment II has improved since ___
compatible with resolving cholangitis. No parenchymal abscess or phlegmon is
identified. Multiple left lobe hepatic cysts and/or biliary hamartomas are
unchanged.
The pancreatic parenchyma maintains relatively normal bulk and signal. There
are innumerable pancreatic cystic lesions. These are unchanged in
distribution and size as compared to the recent prior examination. Mild
gradual increase in size of these lesions is noted when compared to more
remote examinations. Complexity is difficult to assess given the quantity and
small size of these lesions, but no enhancing nodularity is definitely
identified within these pancreatic cysts.
The spleen, adrenal glands and kidneys are unremarkable. There is no ascites
or lymphadenopathy. The patient is status post subtotal colectomy. The
osseous structures are within normal limits. Venous structures are patent.
IMPRESSION:
Interval improvement in previous areas of cholangitis within the right lobe
and segment II of the left lobe of the liver. No hepatic abscess. Unchanged
irregularity and moderate intrahepatic and common bile duct dilation, without
new areas of biliary obstruction or inflammation.
Innumerable pancreatic cystic structures, most consistent with multifocal side
branch IPMNs. These are unchanged from recent prior examinations.
|
10189939-RR-41
| 10,189,939 | 27,145,991 |
RR
| 41 |
2181-08-15 11:27:00
|
2181-08-15 13:05:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new picc // 41cm right picc
TECHNIQUE: Single portable AP view radiograph of the chest.
COMPARISON: Prior chest radiographs ___.
FINDINGS:
A new right-sided PICC line ends in the upper SVC. There is no pneumothorax.
There is mild cardiomegaly. There is no focal consolidation, pleural effusion,
pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within
normal limits.
IMPRESSION:
1. New right-sided PICC line ends in the upper SVC.
2. No evidence of acute cardiopulmonary process.
|
10189939-RR-43
| 10,189,939 | 27,334,098 |
RR
| 43 |
2181-09-03 22:16:00
|
2181-09-03 22:40:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with positive blood cultures, Crohn's disease,
history of cholangitis,
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Right PICC tip terminates in the low SVC. Heart size is normal with a left
ventricular predominance. The aorta is unfolded. Pulmonary vasculature is
normal. Hilar contours are unremarkable. Patchy opacity within the right
lower lobe likely reflects atelectasis. Left lung is clear. No pleural
effusion or pneumothorax is present. No acute osseous abnormality is
visualized.
IMPRESSION:
Patchy opacity in the right lower lobe, likely atelectasis.
|
10189939-RR-44
| 10,189,939 | 27,334,098 |
RR
| 44 |
2181-09-03 22:33:00
|
2181-09-03 23:45:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: History: ___ with history of Crohn disease, PSC, DVT and
pulmonary emboli, positive blood cultures for multidrug resistant E. coli,
presenting with abdominal pain, nausea, vomiting, spiking fever of 100.4,
TECHNIQUE: MDCT images were obtained from the lung bases to the lesser
trochanters . IV contrast was administered. Coronal and sagittal reformations
were prepared.
DOSE: DLP: 805.89 mGy-cm
COMPARISON: CT abdomen pelvis dated ___, MRCP dated ___.
FINDINGS:
THORAX: The visualized lung bases demonstrate bibasilar dependent atelectasis.
The heart size is normal. There is no evidence of pericardial effusion. The
distal esophagus is distended and fluid-filled, which may be secondary to
reflux.
LIVER: There is a persistent degree of moderate irregular intrahepatic
biliary ductal dilatation, seen bilaterally but more pronounced on the left
and measuring up to 8 mm in diameter (2:19), similar in extent as compared to
the recent MRCP. The proximal extrahepatic CBD measures approximately 1.0 cm
in diameter, also similar to the prior MRCP, with a stricture again identified
in the mid portion of the duct. Numerous hypodensities within the liver likely
reflecting hepatic cysts versus biliary hamartomas are re- demonstrated, more
prominent on the left, and minimally changed from the prior examination. The
left hepatic lobe remains mildly atrophic relative to the right. No new
hepatic mass is identified. No Subtle areas of peripheral hyperenhancement are
seen within the right hepatic lobe, not as well visualized as on the prior
MRCP. The main portal vein and superior mesenteric vein are patent. Tiny foci
of air are noted within the intrahepatic and extrahepatic portal system and
SMV (2:29), new from the prior exam.
GALLBLADDER: The gallbladder is grossly unremarkable appearance.
SPLEEN: The spleen is homogeneous in attenuation and somewhat atrophic.
PANCREAS: The pancreas is mildly atrophic and contains numerous large cystic
lesions, better characterized on the recent MRCP and likely reflect side
branch IPMNs. These are essentially unchanged in size and configuration as
compared to the recent MRCP. No solid suspicious mass is identified. There is
no main pancreatic ductal dilatation.
ADRENALS: The adrenal glands are normal bilaterally, without evidence of mass.
KIDNEYS: The kidneys enhance symmetrically and excrete contrast promptly.
There is no evidence of hydronephrosis or solid renal masses.
BOWEL: The patient is status post subtotal colectomy with an anastomosis of
the iliosigmoid, likely in the right lower quadrant. The majority of the small
bowel, sigmoid, and rectum are fluid-filled and distended, most compatible
with gastroenteritis given the patient's history of nausea, vomiting, and
diarrhea. 2 focal areas of apparent bowel wall thickening are noted in the
right lower quadrant, 1 of which is in the ileum, and the other of which is
likely at the ileosigmoid anastomosis (2:62, 65) and may be secondary to
underdistention as there is no adjacent fat stranding, but inflammation is
difficult to exclude. Areas of small bowel angulation within the mid abdomen
are again noted, similar to prior examinations and likely secondary to
adhesions. A focal region of rectal wall thickening is again seen, unchanged,
and likely secondary to chronic Crohn's disease. No evidence of small bowel
obstruction is clearly demonstrated. There is no evidence of pneumatosis. No
free air or free fluid is demonstrated.
VESSELS: The aorta and its major branches contains mild atherosclerotic
calcifications but are widely patent.
LYMPH NODES: There is no evidence of pathologic retroperitoneal or mesenteric
lymphadenopathy by CT size criteria.
PELVIS: The urinary bladder is grossly unremarkable. There is no sidewall or
inguinal lymphadenopathy. A small, fat containing left inguinal hernia is
present. There is no free fluid within the pelvis.
OSSEOUS STRUCTURES: There are no suspicious sclerotic or blastic osseous
lesions identified.
IMPRESSION:
1. Foci of gas within the portal and superior mesenteric veins, new from the
prior examination. There is no definite evidence of bowel ischemia or
pneumatosis. Findings could potentially be related to history of inflammatory
bowel disease or bacteremia/ongoing infection. Clinical correlation is
recommended and close imaging followup is suggested.
2. Intrahepatic biliary ductal irregularity and dilatation, and proximal
common bile duct dilatation with stricturing in its mid portion, largely
unchanged from prior examination and secondary to the patient's primary
sclerosing cholangitis. No hepatic abscess is identified.
3. Diffusely fluid-filled and distended small bowel, colon, and rectum, likely
reflective of gastroenteritis given the patient's clinical presentation. No
transition point or bowel obstruction is identified.
4. 2 focal areas of apparent bowel wall thickening in the right lower
quadrant, 1 presumably at the anastomosis of the ileum with the sigmoid colon,
and another within the ileum, without adjacent inflammatory changes. These
findings may be secondary to bowel underdistension, although mild bowel
inflammation is difficult to exclude. If clinically warranted, MRI
enterography could be performed for further evaluation.
5. Numerous hepatic cysts/ biliary hamartomas and pancreatic cystic lesions,
likely side branch IPMNs, unchanged and better evaluated on the recent MRCP.
NOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___
telephone at 23:10 on ___.
|
10189939-RR-45
| 10,189,939 | 27,334,098 |
RR
| 45 |
2181-09-06 08:36:00
|
2181-09-06 13:46:00
|
EXAMINATION: MR ___
INDICATION: ___ year old man with history of Crohn's s/p subtotal colectomy
with PSC and recurrent cholangitis, admitted with diarrhea and fever to 102.7
concerning for recurrent cholangitis vs. Cdiff vs. Crohn's flare // eval for
Crohn's flare, any signs of active inflammation, perforation, abscess
TECHNIQUE: T1 and T2-weighted multiplanar images of the abdomen and pelvis
were acquired on a 1.5 T magnet, including 3D dynamic sequences performed
prior to, during, and following the intravenous administration of 0.1 mmol/kg
(8 cc) of Gadavist. 900 cc of oral Volumen was administered, and 1.0 mg of
Glucagon was administered IM to reduce bowel peristalsis.
COMPARISON: CT performed on ___. MRI of the abdomen performed on
___. MR enterography performed on ___.
FINDINGS:
MR ENTEROGRAPHY: The patient is status post colectomy. The small bowel is
diffusely dilated and fluid filled. In the distal small bowel (series 902,
image 51) there is a short-segment stricture measuring 3.6 cm in length and
demonstrating wall thickening and mucosal hyper enhancement. Distal to this
stricture, there is a second stricture which measures approximately 6 cm in
length and also demonstrates wall thickening and mucosal hyperenhancement. In
the anterior abdomen, there is a short segment stricture (series 11, image
136) also demonstrating mild wall thickening and mucosal hyper enhancement.
MR ABDOMEN: Diffuse intrahepatic and extrahepatic bile duct dilation and
beading worse in the left lobe is again compatible with primary sclerosing
cholangitis (PSC), better visualized on the MRCP in ___. The degree of
biliary dilation is stable when compared to the most recent MRI allowing for
differences in technique. There are multiple T2 hyperintense cystic pancreatic
lesions as seen on prior MRCP.
The visualized portions of the liver, spleen, bilateral adrenal glands, and
kidneys are normal. There is sludge in the gallbladder. The abdominal aorta
is of normal caliber throughout. Note is made of an accessory right renal
artery. No enlarged mesenteric or retroperitoneal lymph nodes are seen. There
are enhancing nodules along the anterior abdomen, likely representing
injection granulomas.
MR PELVIS: The bladder is unremarkable. There is no free fluid or
lymphadenopathy.
No bone marrow signal abnormality is identified.
IMPRESSION:
1. Three new inflammatory strictures are identified in the small bowel as
described above compatible with active, probably on chronic, Crohn's disease.
2. Dilated small bowel containing fluid compatible with history of diarrhea.
3. No evidence of perforation or abscess.
4. Intrahepatic and extrahepatic bile duct dilation with beading compatible
with primary sclerosing cholangitis. The overall appearance is grossly stable
from the prior exam last month; however, contribution of cholangitis to the
patient's symptoms cannot be excluded.
|
10189939-RR-58
| 10,189,939 | 21,069,641 |
RR
| 58 |
2186-07-27 21:16:00
|
2186-07-27 23:38:00
|
EXAMINATION: MRCP.
INDICATION: Crohn's disease and primary sclerosing cholangitis. History of
cholangitis with multiple ERCP since stent placements, presenting with fever
and right upper quadrant pain.
TECHNIQUE: Multiplanar T1- and T2-weighted images of the abdomen were
obtained on a 1.5 Tesla magnet including sequences obtained prior to and
following intravenous gadolinium administration. 9 cc of Gadavist was
administered intravenously.
COMPARISON: MRCP is available from ___ and more recent MR
___ from ___.
FINDINGS:
Dilatation with multifocal strictures of intrahepatic biliary ducts, most
striking in the left lobe, appear very similar to the recent prior study.
There are no severely dilated ducts and the pattern is very similar.
Extensive biliary wall thickening and early persistent hyperenhancement is
again striking among ducts in the left lateral segments with more patchy
involvement of ducts in the right lobe, including in segment V. The main
change is new ill-defined early hyperenhancement in segment V accompanied by
increased signal on T2-weighted imaging and suggestion of relative restricted
diffusion compared to the background liver. Increased background signal of
liver parenchyma in the left lobe on T2 weighted images appears very similar
to the prior study. No fluid collection is found. Several cysts of varying
sizes, mostly located in the left lateral segments, appear unchanged.
Extrahepatic biliary ducts show similar diffuse mild wall thickening without
focal mass.
Gallbladder is only partly full without stones. Numerous pancreatic cysts,
most confluent in the body and tail, appear unchanged, the largest again
measuring up to 35 mm. The spleen is normal in size and appearance. Adrenals
are unremarkable. Kidneys also appear within normal limits.
The stomach and visible bowel appear normal.
Major vascular structures appear widely patent. There is no lymphadenopathy
or ascites.
Bone marrow signal intensities are unremarkable.
IMPRESSION:
Very little short-term change aside from an area of increased enhancement and
edema in the fifth segment of the liver in addition to pre-existing finding
suggesting active cholangitis.
|
10190445-RR-12
| 10,190,445 | 27,005,502 |
RR
| 12 |
2174-08-13 21:42:00
|
2174-08-13 22:54:00
|
INDICATION: ___ male with mandibular dislocation after endotracheal
intubation for status epilepticus.
COMPARISON: Outside hospital head CT dated ___.
TECHNIQUE: Axial CT images through the facial bones were acquired without
intravenous contrast. Coronal and sagittal reformatted images were reviewed.
FINDINGS: There is anterior dislocation of the right mandibular condyle and
anterior subluxation of the left mandibular condyle, which appears partially
reduced compared to yesterday's outside hospital head CT. There is no
evidence of fracture.
Aerosolized secretions are seen in the left frontal sinus and left ethmoid air
cells. Mucosal thickening is seen in the ethmoid air cells bilaterally and
maxillary sinuses bilaterally. Air-fluid levels and mucosal thickening are
seen in the sphenoid sinuses bilaterally. The ostiomeatal complexes are
occluded bilaterally. Soft tissue thickening of the uvula and posterior
pharynx is noted.
This study is not optimized for evaluation of intracranial structures; within
this limitation, no large abnormalities are detected.
IMPRESSION:
1. Anterior dislocation of the right mandibular condyle and anterior
subluxation of the left mandibular condyle without evidence for acute
fracture.
2. Aerosolized secretions in the left frontal sinus and left ethmoid air
cells with air-fluid levels in the sphenoid sinuses bilaterally, which are
likely secondary to retained secretions from recent intubation. However,
acute sinusitis cannot be excluded.
3. Soft tissue thickening of the uvula and posterior pharynx, which likely
represents edema secondary to recent intubation.
These findings were discussed with Dr. ___ by Dr. ___ by
telephone at 10:35 p.m. on ___.
|
10190445-RR-13
| 10,190,445 | 27,005,502 |
RR
| 13 |
2174-08-14 15:40:00
|
2174-08-14 16:16:00
|
INDICATION: ___ with ARF. Please assess for hydronephrosis.
TECHNIQUE: Grayscale and color ultrasound images of both kidneys were
obtained.
COMPARISON: No comparison studies available.
FINDINGS:
The right kidney measures 12.1 cm, the left kidney measures 10.6 cm without
evidence of hydronephrosis, stones, or masses. The urinary bladder is normal.
IMPRESSION: No hydronephrosis.
|
10190445-RR-14
| 10,190,445 | 27,005,502 |
RR
| 14 |
2174-08-15 10:48:00
|
2174-08-15 11:36:00
|
INDICATION: Altered mental status, respiratory failure, status post
extubation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has been
extubated. The lung volumes are still low, with bilateral symmetrical areas
of atelectasis at the lung bases. These atelectasis are slightly more
extensive than on the previous image.
No pleural effusions. No focal parenchymal opacity suggesting pneumonia.
Borderline size of the cardiac silhouette. No evidence of hilar or
mediastinal abnormalities.
|
10190445-RR-15
| 10,190,445 | 27,005,502 |
RR
| 15 |
2174-08-15 19:57:00
|
2174-08-16 09:54:00
|
INDICATION: A ___ man with newly diagnosed IDDM presents with new
onset seizures.
COMPARISON: None.
TECHNIQUE: Multiplanar, multisequence MRI of the brain was obtained without
contrast per department protocol. The study was requested without contrast in
view of the high serum creatinine values.
FINDINGS: There is no acute intracranial hemorrhage or infarction, edema,
mass or mass effect seen. No diffusion abnormalities are seen. No foci of
abnormal susceptibility are seen. Ventricles and sulci appear age
appropriate. Structural abnormalities identified. Major intracranial flow
voids are preserved. There are few scattered T2/FLAIR hyperintensities seen
in bilateral periventricular, subcortical and deep white matter which are
___ be related to the seizures, or result from prior infectious/
inflammatory process.
There is mucosal thickening involving bilateral maxillary sinuses, ethmoidal
air cells and sphenoid sinuses. There is mild diffuse opacification of right
mastoid air cells.
IMPRESSION:
1. No acute intracranial abnormality. No abnormality identified on the MRI
to explain the patient's seizures.
2. Bilateral maxillary, ethmoid and sphenoid sinus disease.
|
10190445-RR-7
| 10,190,445 | 27,005,502 |
RR
| 7 |
2174-08-13 01:56:00
|
2174-08-13 10:29:00
|
AP CHEST 1:49 A.M. ___
HISTORY: Status epilepticus. Evaluate ET tube position.
IMPRESSION: Endotracheal tube is in standard position at the thoracic inlet.
Nasogastric tube passes into the stomach and out of view. Very low lung
volumes exaggerate mild enlargement of the heart and borderline interstitial
edema. Left infrahilar consolidation could be acute aspiration, atelectasis
or even pneumonia. No pleural abnormality is present.
|
10190445-RR-8
| 10,190,445 | 27,005,502 |
RR
| 8 |
2174-08-13 07:23:00
|
2174-08-13 11:21:00
|
AP CHEST 7:49 A.M. ON ___
HISTORY: New onset of seizures and fevers.
IMPRESSION: AP chest compared to ___ at 1:49 a.m.:
Previous mild pulmonary edema has cleared. Lungs are low in volume, but
caliber of the pulmonary vasculature and cardiac silhouette is probably
normal. Left infrahilar consolidation could be pneumonia or atelectasis and
should be followed. ET tube is in standard placement. Nasogastric tube
passes into the stomach and out of view. No pneumothorax or pleural effusion.
|
10190580-RR-17
| 10,190,580 | 24,021,799 |
RR
| 17 |
2121-05-20 14:13:00
|
2121-05-20 15:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with cough// Pneumonia
COMPARISON: None
FINDINGS:
AP portable upright view of the chest. There is no focal consolidation,
effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. Dextroscoliotic curvature of the thoracic
spine noted.
IMPRESSION:
No acute intrathoracic process
|
10190580-RR-18
| 10,190,580 | 24,021,799 |
RR
| 18 |
2121-05-21 00:00:00
|
2121-05-21 01:51:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with R facial droop, aphasia, R arm weakness.//
eval for stroke, seizure focus
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: Prior CT brain done ___
FINDINGS:
The study is degraded by motion artifact: Especially the MP rage postcontrast
imaging.
There is a 7 x 5 mm acute infarct in the left ventral medial thalamus. No
hemorrhagic transformation.
The rest of the brain is normal in volume, signal intensity and morphology.
No intracranial mass or hemorrhage. The intracranial arteries demonstrate
normal T2 flow void. The orbits appear normal. Mild mucosal thickening
involving the paranasal sinuses. The pituitary appears normal. The
craniocervical junction appears normal.
IMPRESSION:
Small acute infarct in the left ventral medial thalamus. No hemorrhagic
transformation.
The rest of the brain is normal in volume, signal intensity and morphology.
Mild mucosal thickening involving the paranasal sinuses.
|
10190580-RR-20
| 10,190,580 | 24,021,799 |
RR
| 20 |
2121-05-22 18:38:00
|
2121-05-22 19:06:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with stroke and PFO// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10190580-RR-21
| 10,190,580 | 24,021,799 |
RR
| 21 |
2121-05-23 09:10:00
|
2121-05-23 10:25:00
|
EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old woman with stroke, PFO now with ?phlebitis of LEFT
arm// DVT left arm
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
There is an occlusive thrombus in a superficial branch of the basilic vein.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity. Superficial
thrombophlebitis in a branch of the basilic vein.
|
10190580-RR-22
| 10,190,580 | 24,021,799 |
RR
| 22 |
2121-05-24 12:12:00
|
2121-05-24 15:14:00
|
EXAMINATION: MRI of the Pelvis
INDICATION: ___ year old woman with stroke, PFO and negative LENIs. C/f
hypercoag process.// DVT in pelvis?
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: 12 mL MultiHance.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
UTERUS AND ADNEXA:
The uterus is unremarkable. The left ovary is notable for a 2.1 cm follicular
cysts which is within normal limits for a premenopausal patient. The right
ovary is unremarkable. There is trace free fluid in the pelvis which is
physiologic.
LYMPH NODES: There are no enlarged retroperitoneal, pelvic sidewall, or
inguinal lymph nodes.
BLADDER AND DISTAL URETERS: The bladder is decompressed. Distal ureters are
unremarkable.
RECTUM AND INTRAPELVIC BOWEL: The rectum and intrapelvic bowel loops are
unremarkable.
VASCULATURE: There is no abdominal aortic aneurysm. There is a single renal
artery bilaterally. There is a replaced right hepatic artery arising from the
SMA. The venous system is widely patent.
UPPER ABDOMEN: Limited views of the liver, kidneys, gallbladder, and biliary
tree are unremarkable.
OSSEOUS STRUCTURES AND SOFT TISSUES: There is no worrisome bony lesion. There
is no superficial soft tissue abnormality.
IMPRESSION:
No evidence of proximal deep venous thrombosis in the abdomen and pelvis.
|
10190580-RR-23
| 10,190,580 | 24,021,799 |
RR
| 23 |
2121-05-24 09:14:00
|
2121-05-24 10:26:00
|
EXAMINATION: CT ABDOMEN PELVIS WITH CONTRAST
INDICATION: ___ year old woman with stroke and thrombus on valve// Malignancy?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 65.7 cm; CTDIvol = 5.2 mGy (Body) DLP = 344.2
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 9.6 s, 0.5 cm; CTDIvol = 48.8 mGy (Body) DLP =
24.4 mGy-cm.
Total DLP (Body) = 370 mGy-cm.
COMPARISON: CTU abdomen pelvis from ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver and gallbladder are unremarkable.
PANCREAS: The pancreas is unremarkable.
SPLEEN: The spleen is unremarkable.
ADRENALS: The adrenal glands are unremarkable.
URINARY: The kidneys are unremarkable. No hydronephrosis.
GASTROINTESTINAL: There is no gastrointestinal obstruction or free
intraperitoneal fluid. The appendix is normal.
PELVIS: There is no free fluid in the pelvis. Again seen is a coarse
calcification within subcutaneous fat posterior to the pubic symphysis
(2:112), which is nonspecific and may be related to prior injury. Bilateral
tubal ligation is noted. The uterus and bilateral adnexae are otherwise
unremarkable.
LYMPH NODES: There is no abdominal or pelvic lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: There is no evidence of aggressive appearing osseous lesions.
SOFT TISSUES: Mild fat stranding and small locules of subcutaneous gas in the
lower anterior abdominal wall likely reflect sequela of injections.
IMPRESSION:
1. No evidence of malignancy in the abdomen or pelvis.
2. Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
|
10190580-RR-24
| 10,190,580 | 24,021,799 |
RR
| 24 |
2121-05-24 09:16:00
|
2121-05-24 10:33:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION:
___ woman with stroke on thrombus on valve, rule out malignancy.
TECHNIQUE: Multi detector CT of the chest was performed after the
administration of intravenous contrast. Axial coronal and sagittal
reconstructions were acquired. Maximum intensity projections were also
acquired
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 65.7 cm; CTDIvol = 5.2 mGy (Body) DLP = 344.2
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 9.6 s, 0.5 cm; CTDIvol = 48.8 mGy (Body) DLP =
24.4 mGy-cm.
Total DLP (Body) = 370 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON:
No prior CT chest is available for comparisons
FINDINGS:
THORACIC INLET: There is punctate calcification in the left lobe of thyroid
(2, 1). There are no enlarged supraclavicular lymph nodes.
BREAST AND AXILLA : There are no enlarged axillary lymph nodes.
MEDIASTINUM: There are no enlarged mediastinal hilar lymph nodes. There is
mild cardiomegaly. There is no pericardial effusion. There is no coronary
artery calcification. The aorta and pulmonary arteries normal in caliber.
The airways are patent up to the subsegmental level
PLEURA: There is no pleural effusion
LUNG: There is a 3 mm nodule along the fissure on the left (302, 107 which
could represent an intraparenchymal lymph node. No other nodules or
consolidations.
BONES AND CHEST WALL : Review of bones is unremarkable.
UPPER ABDOMEN: Limited sections through the upper abdomen shows no focal liver
lesions. Please refer to dedicated report on abdomen which has been dictated
separately.
IMPRESSION:
Punctate calcification in the left lobe of thyroid.
3 mm nodule in the left lung along the fissure could represent an
intraparenchymal lymph node.
|
10190580-RR-25
| 10,190,580 | 24,021,799 |
RR
| 25 |
2121-05-27 11:22:00
|
2121-05-27 12:19:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with chest pain// Consolidation
Consolidation
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
pleural effusion. There is no pneumothorax. Severe dextroscoliosis is
unchanged.
|
10191175-RR-14
| 10,191,175 | 20,771,137 |
RR
| 14 |
2185-07-11 00:19:00
|
2185-07-12 12:07:00
|
INDICATION: Concern for posterior CVA.
COMPARISON: CT head without contrast, ___.
TECHNIQUE: MDCT images of the head were obtained in the axial plane after
intravenous administration of contrast. MIPs, volume-rendered images, and
curved reformats were generated.
FINDINGS: Bilateral intracranial internal carotid arteries, vertebral
arteries, basilar artery and their major branches are patent with no evidence
of stenosis, occlusion, dissection, or aneurysm formation.
Visualized aortic arch appears normal. There is direct origin of the left
vertebral artery from the aortic arch. Bilateral carotid arteries and
vertebral arteries in the neck otherwise appear normal with no evidence of
stenosis, occlusion, dissection, or pseudoaneurysm formation. Soft tissue
structures of the neck and visualized upper lung fields appear unremarkable.
IMPRESSION: Unremarkable CTA of the head and neck.
|
10191175-RR-15
| 10,191,175 | 20,771,137 |
RR
| 15 |
2185-07-11 08:46:00
|
2185-07-11 11:20:00
|
REASON FOR EXAMINATION: Vertigo.
PA and lateral upright chest radiographs were reviewed with no prior studies
available for comparison.
Heart size is normal/minimally enlarged. Tortuous aorta is demonstrated. The
mediastinum is not widened. Hila are unremarkable. Lungs are clear with no
pleural effusion or pneumothorax.
|
10191175-RR-16
| 10,191,175 | 20,771,137 |
RR
| 16 |
2185-07-11 09:04:00
|
2185-07-11 13:18:00
|
TECHNIQUE: MRI of the brain without gad.
HISTORY: Vertigo and nystagmus, assess for posterior stroke.
COMPARISON: CTA from the same day.
FINDINGS: There is no evidence for acute ischemia or hydrocephalus. There is
no midline shift or mass effect. Intracranial flow voids are maintained.
There is left mastoid mild opacification. There is mild bilateral maxillary
sinus mucosal thickening.
IMPRESSION:
No acute abnormality is seen. No evidence for acute infarction in the
posterior circulation.
|
10191316-RR-22
| 10,191,316 | 22,285,904 |
RR
| 22 |
2188-12-19 08:14:00
|
2188-12-19 17:51:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with known renal cyst and hematuria here for eval
of new 19cm mediastinal mass, reported liver involvement on OSH imaging// eval
liver for lesions/concerning features
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRI abdomen dated ___.
FINDINGS:
Small right pleural effusion.
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is a 2.3 x 1.7 x 1.7 cm heterogeneous lesion within
segment III, which was visualized on the MR dated ___, but appears
to have increased in size. No new liver lesions are visualized. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 3 mm.
GALLBLADDER: There is no evidence of stones or acute cholecystitis. Note is
made of diffuse gallbladder adenomyomatosis. There also multiple gallbladder
wall polyps measuring up to 6 mm.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 7.5 cm.
KIDNEYS: Normal cortical echogenicity and corticomedullary differentiation is
seen bilaterally. There is no evidence of masses, stones, or hydronephrosis in
the kidneys.
Right kidney: 10.4 cm
Left kidney: 10.8 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. 2.3 cm heterogeneous lesion within segment III of the liver, present on the
MR dated ___, but appears to have increased in size. This does
not have the classic appearance of a metastatic lesion and may represent an
atypical hemangioma, however dedicated liver MR with contrast should be
obtained for further characterization.
2. Diffuse gallbladder adenomyomatosis with multiple gallbladder wall polyps
measuring up to 6 mm.
3. Small right pleural effusion.
RECOMMENDATION(S): Dedicated liver MR with contrast should be obtained for
further characterization of the liver lesion.
|
10191316-RR-23
| 10,191,316 | 22,285,904 |
RR
| 23 |
2188-12-19 10:56:00
|
2188-12-19 15:14:00
|
INDICATION: ___ year old man with large anterior mediastinal mass// Core
needle biopsy of anterior mediastinal mass for work up
COMPARISON: Chest CT with contrast from ___ performed at an outside
institution
PROCEDURE: CT-guided anterior mediastinal biopsy biopsy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CTscan of the intended biopsy area was performed. Based on the
CT findings an appropriate position for the biopsy was chosen. The site was
marked.
The site was prepped and draped in the usual sterile fashion. 1% lidocaine
were administered to the subcutaneous and deep tissues for local anesthetic
effect. Under CT guidance, a 17 gauge coaxial needle was introduced into the
lesion. An 18 gauge core biopsy device with a 20 mm throw was used to obtain
10 core biopsy specimens, which were sent for pathology, cytogenetics, and
histopathology for departmental lymphoma protocol.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 16.4 cm; CTDIvol = 14.6 mGy (Body) DLP = 230.3
mGy-cm.
2) Stationary Acquisition 7.0 s, 1.4 cm; CTDIvol = 53.3 mGy (Body) DLP =
76.7 mGy-cm.
Total DLP (Body) = 315 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 3
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 25
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Redemonstrated right anterior mediastinal mass which appears slightly
heterogeneous and contains few calcifications, causes very mild mass effect on
the SVC, and measures approximately 12.7 x 7.8 cm (03:26).
2. Small pericardial and right pleural effusions have grown slightly since
___.
3. Subsegmental dependent atelectasis in both lung bases and the right middle
lobe is mild. Otherwise the partially visualized lung parenchyma, bronchi,
osseous structures, upper abdomen, and chest soft tissues are unremarkable.
4. During the procedure, images demonstrate the needle tip within the soft
tissue mass. Post procedure images demonstrate no significant hematoma,
pneumothorax, or evidence complication.
IMPRESSION:
1. Technically successful CT-guided biopsy of the anterior mediastinal mass.
2. No immediate postprocedure complications.
3. Pathology (lymphoma protocol) is pending.
|
10191404-RR-15
| 10,191,404 | 24,966,201 |
RR
| 15 |
2163-08-10 17:45:00
|
2163-08-10 19:11:00
|
EXAM: Single supine AP portable view of the chest.
CLINICAL INFORMATION: Injury.
COMPARISON: None.
FINDINGS: Single supine AP portable view of the chest was obtained.
Underlying trauma board and other external artifact partially obscure the
view. There are relatively low lung volumes. No focal consolidation. No
pleural effusion or evidence of pneumothorax is seen. Cardiac and mediastinal
silhouettes are unremarkable. No displaced fracture is seen.
IMPRESSION: No acute intrathoracic process.
|
10191404-RR-16
| 10,191,404 | 24,966,201 |
RR
| 16 |
2163-08-10 17:50:00
|
2163-08-10 19:16:00
|
INDICATION: Patient is status post fall.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images through the head were obtained
without intravenous contrast at 5 mm slice thickness. Coronally and
sagittally reformatted images are provided.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, mass effect or shift of
normally midline structures. There is no cerebral edema or loss of gray-white
matter differentiation to suggest an acute ischemic event. The sulci and
ventricles are prominent, likely age-related involutional changes. There is
no hydrocephalus. Basal cisterns are patent. Moderate amount of secretions
are seen at the level of the nasopharynx. There is mild mucosal thickening of
ethmoid air cells, right maxillary sinus. Otherwise, imaged paranasal sinuses
and mastoid air cells are well aerated. No acute fracture is seen. Soft
tissue edema and induration is seen overlying the right frontal region and the
vertex. Bilateral minimally displaced nasal bone fractures are noted, age
indeterminate, likely chronic.
IMPRESSION:
No evidence of acute intracranial process.
Bilateral minimally displaced nasal bone fractures are noted, age
indeterminate, likely chronic.
|
10191404-RR-17
| 10,191,404 | 24,966,201 |
RR
| 17 |
2163-08-10 17:51:00
|
2163-08-10 19:18:00
|
INDICATION: Patient is status post fall.
COMPARISONS: None available.
TECHNIQUE: 2.5 mm axial slices through the cervical spine were obtained
without intravenous contrast. Coronally and sagittally reformatted images are
provided.
FINDINGS:
There is no evidence of acute fracture or malalignment. Multilevel
degenerative disc changes are seen, most pronounced at C4-C5 and C5-C6 with
intervertebral disc space narrowing. Anterior disc osteophyte complex is seen
at C3-C4 level. There is no critical central canal stenosis. Evaluation of
prevertebral soft tissues is limited due to presence of endotracheal and
nasogastric tubes. Secretions are seen in the ___- and oro-pharynx likely
from intubation. These is a well corticated subcentimeter ossification
anterior to the dens, which likely represents a ligamentous ossification.
Imaged lung apices are clear without pneumothorax.
IMPRESSION:
No evidence of acute fracture or malalignment.
|
10191404-RR-18
| 10,191,404 | 24,966,201 |
RR
| 18 |
2163-08-10 17:51:00
|
2163-08-10 20:33:00
|
INDICATION: Patient status post fall.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images from the thoracic inlet to pubic
symphysis was obtained with intravenous contrast at 5 mm slice thickness.
Coronally and sagittally reformatted images are provided.
FINDINGS:
CT OF THE CHEST:
The thyroid gland is unremarkable. Intrathoracic aorta is normal in caliber
without evidence of dissection. Vessels are unremarkable. The pulmonary
arteries are well opacified. The heart is normal in size without pericardial
effusion. There is no mediastinal hematoma. There are scattered mediastinal
lymph nodes, which do not appear pathologically enlarged. There is no hilar
lymphadenopathy. No pathologically enlarged axillary lymph nodes are seen.
The nasogastric tube terminates at the gastroesophageal junction. A linear
opacity at the lung bases likely represents atelectasis. Small bibasal
consolidations are also noted. Otherwise, lungs are clear without
pneumothorax. Endotracheal tube is in place, which is appropriately
positioned.
CT OF THE ABDOMEN: The liver enhances homogeneously without focal lesions.
There is no evidence of intrahepatic biliary ductal dilatation. The hepatic
vasculature is patent. The gallbladder is incompletely distended. There is
no gallbladder wall edema or pericholecystic fluid collection to suggest acute
inflammation. Gallstone is seen within its lumen. The spleen is
unremarkable. The pancreas enhances homogeneously without ductal dilatation
or peripancreatic fluid collection. The adrenal glands are normal. The
kidneys enhance and excrete contrast symmetrically without evidence of
hydronephrosis or renal masses.
Small and large bowel loops are normal in caliber without evidence of bowel
wall thickening or obstruction. There is no free air or free fluid within the
abdomen. The intra-abdominal aorta and its branches are normal in caliber and
appear patent.
CT OF THE PELVIS: The bladder, distal ureters, rectum and sigmoid colon are
unremarkable. The prostate gland appears slightly enlarged with associated
coarse calcifications. There is no free air or free fluid within the pelvis.
There is no pelvic or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is seen. Old
remote bilateral rib fractures are noted. There are mild compression
deformities of T10 and T11 superior endplates of indeterminate age. No
paraspinal hematoma is seen. There is no retropulsion.
IMPRESSION:
1. No evidence of acute visceral injury in the chest, abdomen, or pelvis.
2. Small bibasilar posterior/dependent consolidations, most likely aspiration
in the setting of intubation.
3. Nasogastric tube terminates at the level of the gastroesophageal junction
and should be advanced so that it is well within the stomach.
4. Mild compression deformities of T10 and T11 superior endplates of
indeterminate age.
Findings discussed with Dr. ___ at 11:30pm ___ by phone.
|
10191404-RR-20
| 10,191,404 | 24,966,201 |
RR
| 20 |
2163-08-11 11:17:00
|
2163-08-11 12:50:00
|
HISTORY: Injuries post fall within digit deformity.
COMPARISON: None.
FINDINGS:
There is an oblique fracture of the of the proximal ___ fracture with minimal
overriding of the fragments and lateral angulation of the distal fragment.
This finding was called to the trauma SICU at the time of interpretation of
this film at 12:50 ___ and was discussed with nurse ___, who already
was aware of the fracture.
IMPRESSION:
Oblique fracture of proximal phalanx of the ___ digit.
|
10191971-RR-10
| 10,191,971 | 29,690,819 |
RR
| 10 |
2133-09-28 12:49:00
|
2133-09-28 17:26:00
|
HISTORY: ___ years old man with new diagnosis of T-cell lymphoma status post
one cycle of chemotherapy, now with increased shortness of breath. Please
evaluate for progression of disease or other etiology for shortness of breath.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen in supine position after administration of Omnipaque nonionic
intravenous contrast material agent. Axial images were reviewed in
conjunction with coronal and sagittal reformats.
COMPARISON: Exam is compared to chest CT of ___ and ___.
FINDINGS: Thyroid gland is unremarkable. Multiple peripheral and central
lymphadenopathies have decreased since ___, for example, right
axillary mass (4:10) is 3.5 x 5.1 cm, was 3.2 x 4.1 cm. Right axillary node
is 1.1 x 1.1 cm, was 1.3 x 1 cm. Left axillary node (4:21) is 1.3 x 1.6 cm,
was 2.1 x 2.2 cm. Right lower paratracheal node (4:21) is 1.2 x 1.3 cm, was
1.9 x 1.3 cm. Right hilar node (4:26) is 1.9 x 1.4 cm, was 2.6 x 1.8 cm.
Left hilar lymph node (4:32) is 1 x 1.7 cm, was 2.4 x 1.6 cm. Subcarinal node
(4:33) is 1.5 x 2.2 cm, was 2.1 x 2.5 cm. Heart size is normal without
pericardial effusion. Great vessels are normal sized. Ascending aorta is top
normal, measuring 3.7 cm (5:137).
The bilateral pleural effusions described in ___ have resolved along
with compression atelectasis described in the right lower lobe, now minimal in
the posterobasal segment of the right lower lobe (5:216).
Abdominal finding will be described in concurrent CT abdomen and pelvis, clip
# ___.
BONES: There are no bone lesions suspicious for malignancy or infection.
LUNGS AND AIRWAYS: Airways are patent to the subsegmental level bilaterally.
Severe and diffuse bronchial wall thickening is new since ___, more
severe to the right, especially in the right lower lobe, with severe airways
narrowing (S5:___,179). Especially in the right lower lobe, the airways
appear almost encased by soft tissue, raising concern of airway infiltration
by primary lymphoproliferative disorder (S5:___). In the most distal portion
of the airways, downstream to this soft tissue obstruction, there is mucus
impaction (5:221). There are multiple bilateral lung nodules, like in the
right upper lobe (S5:I66, 84, 90, 107); the latter is the largest with
dimension of 7 x 7 mm. These nodules were not visible in prior chest CT
because previously obscured by pleural effusion. 1.2 x 1.7 cm lingular nodule
has enlarged since ___, when it was 0.8 x 1.4 cm. This nodule is
surrounding and obstructing the bronchus for the inferior segment of the
lingula with downstream atelectasis (5:209). Left lower lobe nodule (5:226)
is also larger since ___, measuring 8 mm, was 4 mm. Right upper lobe
punctate pericardial nodule is new since ___ (5:126). Parafissural
nodule in the major fissure (5:124) between the superior segment of the right
lower lobe and right upper lobe was not visible in prior chest CT due to the
pleural effusion.
IMPRESSION:
1. New extensive air wall thickening is concerning for diffuse metastatic
disease involving the airways; also with post-obstructive atelectasis, as in
the lingula.
2. There are also multiple bilateral lung nodules, some larger since ___ which are likely metastasis.
3. Interval response of peripheral and central lymphadenopathy, which is
smaller since ___.
4. No signs of PE or bone involvement.
Findings were discussed with Dr. ___ at 4:12 p.m. by Dr. ___.
|
10191971-RR-11
| 10,191,971 | 29,690,819 |
RR
| 11 |
2133-09-28 17:44:00
|
2133-09-28 18:09:00
|
HISTORY: ___ male with respiratory failure.
COMPARISON: Chest CT and two-view chest x-ray performed earlier the same day
on ___.
FINDINGS:
Single portable view of the chest. When compared to CT performed hours prior,
there has been no significant interval change. There is slight motion on this
exam limiting evaluation. Bibasilar opacities most suggestive of atelectasis.
There is no new confluent consolidation. Bilateral hilar adenopathy,
pulmonary nodules, bronchial wall thickening and mucous plugging are also
better seen on prior chest x-ray CT. The cardiomediastinal silhouette is
within normal limits. No acute osseous abnormality is identified.
IMPRESSION:
No change since CT performed 3 hours prior. For additional details see prior
CT report.
|
10191971-RR-12
| 10,191,971 | 29,690,819 |
RR
| 12 |
2133-09-29 05:02:00
|
2133-09-29 09:29:00
|
INDICATION: History of peripheral T-cell lymphoma, possible pneumonia.
Interval worsening on chest x-ray.
COMPARISON: Chest radiographs from ___.
FINDINGS: A single portable chest radiograph was provided. There has been
improvement in the left and right hilar opacities, likely representing
combination of pneumonia and lymphadenopathy. There is left basilar
atelectasis. Cardiomediastinal silhouette is unchanged. No pneumothorax or
pleural effusions are present.
IMPRESSION: Improvement in right perihilar opacity consistent with improving
infection.
|
10191971-RR-13
| 10,191,971 | 29,690,819 |
RR
| 13 |
2133-10-02 15:02:00
|
2133-10-02 15:55:00
|
HISTORY: PICC line placement.
TECHNIQUE: Single, AP, portable view of the chest with the patient in an
upright position.
COMPARISON: Comparison is made to radiographs dated ___.
FINDINGS:
Interval placement of a right-sided PICC line is seen extending into the
proximal left brachiocephalic vein. There is no associated pneumothorax
identified. The remainder of examination is essentially unchanged as compared
to ___. Redemonstrated is left basilar atelectasis. There is no
focal consolidation, pleural effusion, or pulmonary edema identified. The
cardiomediastinal silhouette is stable.
IMPRESSION:
Right PICC line seen extending into the proximal left brachiocephalic vein.
Findings were conveyed by Dr. ___ to Sal via telephone at 15:53 on ___, 5 min after discovery.
|
10191971-RR-14
| 10,191,971 | 29,690,819 |
RR
| 14 |
2133-10-02 16:39:00
|
2133-10-03 09:18:00
|
CHEST RADIOGRAPH
INDICATION: PICC positioning.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has received a
right-sided PICC line. The line needs to be pulled back given that it crosses
the midline and projects over the brachiocephalic vein.
No pneumothorax or other complications. No other relevant changes.
|
10191971-RR-15
| 10,191,971 | 29,690,819 |
RR
| 15 |
2133-10-02 17:55:00
|
2133-10-03 08:50:00
|
CHEST RADIOGRAPH
INDICATION: PICC line reposition.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the right PICC line has now
been re-positioned. The tip of the line is correctly projecting over the mid
SVC. There is no evidence of complications. Minimal atelectasis at the lung
bases persist. Unchanged normal size of the cardiac silhouette.
|
10191971-RR-8
| 10,191,971 | 29,690,819 |
RR
| 8 |
2133-09-28 11:01:00
|
2133-09-28 11:35:00
|
HISTORY: T-cell lymphoma, now with dyspnea, cough, and hoarseness.
TECHNIQUE: Frontal and lateral chest radiographs were obtained.
COMPARISON: Comparison is made to radiographs dated ___.
FINDINGS:
Interval removal of a previous left PICC line. A zone of minimally increased
density is seen in the ight lower lobe, concerning for a possible
consolidation. Bilateral, perihilar lymphadenopathy is noted, unchanged in
appearance from prior examination. There is no pleural effusion, pneumothorax,
or pulmonary edema. The heart size is normal. Mediastinal contours are
stable.
IMPRESSION:
Right lower lobe consolidation, concerning for early pneumonia.
Findings were entered into the radiology dashboard by Dr. ___ at 1:22pm on
___, 5 minutes after discovery.
|
10191971-RR-9
| 10,191,971 | 29,690,819 |
RR
| 9 |
2133-09-28 12:44:00
|
2133-09-28 15:58:00
|
EXAM: CT abdomen pelvis.
INDICATION: Patient new diagnosis of T-cell lymphoma status post 1 cycle of
chemotherapy now with increased shortness of breath, evaluate for progression
of disease.
COMPARISON: Images from CT Abd/pelvis from ___.
TECHNIQUE: Axial helical MDCT scan of the torso was done after the
administration of split bolus of IV contrast and oral contrast. Multiplanar
reformatted images in coronal and sagittal axes were generated.
DLP: 677.20 mGy-cm
FINDINGS:
CT THORAX: Please refer to separate report on CT chest performed on the same
date for discussion of findings within the thorax.
LIVER: The liver enhances homogeneously, without focal lesions or intrahepatic
biliary duct dilatation. The gallbladder is unremarkable and the portal vein
is patent.
PANCREAS: The pancreas does not demonstrate focal lesions, peripancreatic
stranding or fluid collection.
SPLEEN: The spleen is enlarged and measures 16 cm in its largest dimension.
A hypodense wedge-shaped region is seen in the lateral aspect of the spleen,
likely an old infarct.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys do not show solid or cystic lesions and demonstrate
symmetric nephrograms and excretion of contrast. No pelvicaliceal dilatation
or perinephric abnormalities are present.
GI TRACT: The stomach, duodenum and small bowel are within normal limits,
without evidence of wall thickening or obstruction. The colon is non-dilated
without evidence of obstructive lesions. The appendix is not well visualized
but there is no evidence of appendicitis.
VASCULAR: The aorta is of normal caliber without aneurysmal dilatation. The
IVC and major abdominal vessels are patent.
RETROPERITONEUM AND ABDOMEN: Diffuse lymphadenopathy is seen in all nodal
stations within the abdomen and pelvis, most of which are stable or smaller in
size compared to study from ___. These include: para-esophageal,
gastrohepatic, portahepatic, splenic hilum, retrocrural, retroperitoneal,
mesenteric, common iliac, external iliac, obturator, and inguinal stations.
The largest nodes are located in the external iliac and inguinal stations.
For example, the largest external iliac node now measures 3.4 x 4.5 cm,
previously 5.8 x 5.3cm, decreased in size. The largest right inguinal node
now measures 3.8 x 2.3cm, previously 3.7 x 2.1cm, unchanged in size. No
ascites, free air or abdominal wall hernias are noted.
PELVIC CT: The urinary bladder and terminal ureters are normal. There is no
pelvic free fluid.
OSSEOUS STRUCTURES: No blastic or lytic lesion suspicious for malignancy is
present.
IMPRESSION:
1. Diffuse widespread lymphadenopathy in the abdomen and pelvis, most of which
are stable or smaller in size compared to scan from ___.
2. Splenomegaly with old splenic infarct.
Findings were discussed with ___ by ___ at 5:30pm via telephone on
___, 20 minutes after discovery.
|
10192095-RR-13
| 10,192,095 | 26,617,869 |
RR
| 13 |
2196-12-18 12:42:00
|
2196-12-18 13:20:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with DOE // cough
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Lungs are hyperinflated with
coarsened reticular markings suggesting emphysema or fibrosis. There is a
bandlike left perihilar opacity which could represent scarring versus an
atypical infection. No large effusion is seen. There is no pneumothorax.
Biapical pleural parenchymal scarring noted. The heart is not enlarged. The
mediastinal contour is grossly unremarkable. Bony structures are intact.
IMPRESSION:
Coarsened lung markings suggesting emphysema/ fibrosis. Left perihilar band
like opacity may represent scarring versus atypical infection. Please
correlate clinically. Followup to resolution advised.
|
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