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10192095-RR-14
| 10,192,095 | 26,617,869 |
RR
| 14 |
2196-12-18 14:14:00
|
2196-12-18 15:06:00
|
EXAMINATION: CTA CHEST
INDICATION: ___ with dypsnea, back pain, and elevated d-dimer
TECHNIQUE: Multidetector CT through the chest performed with IV contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
Dose: Total DLP (Body) = 390 mGy-cm.
COMPARISON: Same day chest radiograph
FINDINGS:
There is a massive left hilar and perihilar mass measuring at least 8.8 x 7.9
x 10.0 cm. This mass encases the left hilar bronchovasculature with
attenuation of the left pulmonary artery and central branches as well as the
left mainstem bronchus and central branches. Subcarinal adenopathy is noted.
There is no definite central pulmonary embolism. The aorta is normal in
caliber with mild calcification. The heart is normal in size. Tumor is seen
invading the left pulmonary vein inferiorly with extension into the left
atrium as seen on series 2, image 68. Invasion of the pericardium is also
suspected given the presence of a small pericardial effusion. There is also a
small pleural effusion. Lymph nodes in the mediastinum are confluent in a
region of the left hilum. Additional smaller, several calcified nodes are
present within the mediastinum.
Severe emphysema and fibrosis is noted. In the left upper lobe there is a
peripheral mass with a bandlike configuration best seen on series 604b image
fall or measuring approximately 9.5 cm in maximal dimension. This finding is
highly concerning for malignancy.
In the imaged portion of the upper abdomen, there is a nodular structure
abutting the tail of the pancreas best seen on series 3, image 210 measuring
19 x 25 mm, indeterminate. Otherwise the imaged portion of the upper abdomen
is unrevealing.
Bones: No worrisome lytic or blastic osseous lesion is seen. No fracture.
IMPRESSION:
1. Severe emphysema with large left hilar mass concerning for primary lung
malignancy with peripheral band like opacity in the left upper lobe. Apparent
invasion of the pericardium with tumor thrombus extending into the left
atrium. Significant mass effect and tumor encasement of the left hilar
bronchovasculature.
2. No central pulmonary embolism or acute aortic process.
3. Left pleural effusion.
4. Indeterminate nodular opacity adjacent to the pancreatic tail for which
MRCP is recommended to further evaluate.
|
10192095-RR-15
| 10,192,095 | 26,617,869 |
RR
| 15 |
2196-12-19 15:22:00
|
2196-12-19 17:17:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old man with new found massive hilar mass that is locally
aggressive with 1 month history of right preauricular mass that is
non-painful, non-inflamed. // ?Characterize preauricular mass
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right temporal region.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right temporal region. Corresponding to the area palpable abnormality is a
solid, heterogeneous 3.2 x 1.3 x 3.4 cm vascular lesion.
IMPRESSION:
A 3.4 cm heterogeneous vascular lesion corresponds the area of palpable
abnormality in the right temporal region. Recommend ultrasound-guided fine
needle aspiration for further evaluation.
RECOMMENDATION(S): A 3.4 cm heterogeneous vascular lesion corresponds the
area of palpable abnormality in the right temporal region. Recommend
ultrasound-guided fine needle aspiration for further evaluation.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 17:15 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
10192095-RR-17
| 10,192,095 | 26,617,869 |
RR
| 17 |
2196-12-20 14:01:00
|
2196-12-20 14:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p LUL biopsy // r/u left PTX r/u left PTX
COMPARISON: Chest radiographs ___.
IMPRESSION:
New heterogeneous opacification in the left lower lung could be due to
atelectasis or small amount of pulmonary hemorrhage. The left hilar mass and
contiguous tubular left upper lobe mass are unchanged. Pulmonary fibrosis is
predominantly basilar. No acute abnormality in the right lung. No
pneumothorax or appreciable pleural effusion. Stable moderate enlargement of
the cardiomediastinal silhouette, largely due to adenopathy and pericardial
effusion, respectively.
|
10192095-RR-18
| 10,192,095 | 26,617,869 |
RR
| 18 |
2196-12-21 15:13:00
|
2196-12-22 09:47:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with new hilar mass which is likely malignancy.
Evaluate for brain metastasis?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: None.
FINDINGS:
There are 3 intraparenchymal enhancing lesions with slow diffusion and
surrounding FLAIR signal abnormality, most likely in keeping with intracranial
metastasis. The lesions are as follows:
- An 8 mm lesion in the right occipital lobe on image 14:13.
- An 8 mm lesion in the left occipital lobe on image 14:15.
- A 4 mm lesion in the left parieto-occipital lobe on image 100b:59.
There is no evidence of hemorrhage, midline shift or infarction. The
ventricles and sulci are patent and prominent in keeping with age-related
volume loss. There are scattered areas of T2/FLAIR hyperintensity in the
subcortical and periventricular white matter, nonspecific, likely secondary to
small vessel ischemic disease.
The orbits are unremarkable noting prior bilateral cataract surgeries. There
is mild mucosal thickening in bilateral ethmoid air cells and bilateral
frontal sinuses. The remaining visualized paranasal sinuses are clear.
Bilateral mastoid air cells are clear. Intracranial flow voids are
maintained.
IMPRESSION:
1. Three enhancing lesions with slow diffusion and surrounding FLAIR signal
abnormality, most likely in keeping with intracranial metastasis.
|
10192095-RR-19
| 10,192,095 | 26,617,869 |
RR
| 19 |
2196-12-22 09:58:00
|
2196-12-22 13:52:00
|
INDICATION: ___ year old man with new hilar mass. Staging study //
?metastatic disease
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
IV Contrast: 130 mL Omnipaque.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 10.7 mGy (Body) DLP = 303.5
mGy-cm.
4) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP =
15.6 mGy-cm.
5) Spiral Acquisition 4.7 s, 51.4 cm; CTDIvol = 9.5 mGy (Body) DLP = 487.3
mGy-cm.
6) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 259.1
mGy-cm.
Total DLP (Body) = 1,066 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
LOWER CHEST: Multifocal areas of interlobular septal thickening with bibasal
fibrosis and reticulation. Mild interval increase in the left pleural
effusion. Moderate pericardial effusion, mildly increased compared to
previous.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a small focus of likely focal fat adjacent the falciform ligament.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: There is slight nodular appearance of the left medial adrenal limb,
measuring up to 1.0 cm. Normal appearance of the right adrenal gland.
URINARY: There are multiple tiny 1 mm nonobstructing calculi in the left
kidney. Additionally, there is an exophytic left renal cyst measuring 1.5 cm.
No evidence of hydronephrosis. The bladder is unremarkable in appearance.
Prostatic enlargement. The seminal vesicles are grossly unremarkable.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Colonic
diverticulosis. Multiple intraperitoneal and retroperitoneal nodal and
abnormal soft tissue metastatic implants are identified. These include:
- Left paraesophageal lymph nodes, larger measuring 1.1 x 1.0 cm (3:8)
- Soft tissue deposit adjacent the pancreatic tail at the splenic hilum
measuring 2.0 x 2.7 x 1.3 cm (03:17)
- Small 0.7 cm soft tissue nodule in the left extraperitoneal fat (03:25)
- Large deposit along the serosal aspect of the descending colon measuring 3.9
x 4.3 x 4.0 cm (03:28)
- Left para renal space soft tissue implant measuring 2.6 x 3.2 x 3.9 cm
(03:30)
- 1.7 x 1.4 cm soft tissue nodule along the lesser curvature of the stomach
(03:30)
- Left periaortic retroperitoneal soft tissue implant, possibly nodal,
measuring 1.6 x 1.8 x 3.0 cm (03:32)
- Small left pericolic gutter nodular soft tissue measuring 0.9 cm (03:41)
- 2.9 x 3.7 x 4.3 cm implant along the mesenteric aspect of the sigmoid colon
(3:68)
- left psoas muscle implant measuring 1.5 x 1.8 cm (03:31)
- posterior subcutaneous soft tissue implant measuring 1.0 cm overlying the L5
spinous process (03:44)
No significant free fluid in the abdomen or pelvis is noted. No evidence of
bowel obstruction.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted. Conventional anatomy of the visceral arteries.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
IMPRESSION:
1. Multiple intraperitoneal, serosal, retroperitoneal, and intramuscular
metastatic implants described above. No evidence of bowel obstruction. No
hydronephrosis. No ascites.
2. Nodular medial limb of the left adrenal gland, indeterminate.
3. Nonobstructing left renal calculi.
4. Interval increase in the left pleural effusion as well as pericardial
effusion.
|
10192095-RR-20
| 10,192,095 | 26,617,869 |
RR
| 20 |
2196-12-22 14:37:00
|
2196-12-22 16:10:00
|
INDICATION: ___ year old man with massive hilar mass and new preauricular
lesion that was imaged on ___ // FNA of right preauricular mass for
cytology. Is this SCC?
COMPARISON: CT abdomen and pelvis ___, MRI a brain ___.
TECHNIQUE: Ultrasound-guided Fine-needle aspiration of a right pre-auricular
mass.
OPERATORS: Dr. ___ radiology fellow and Dr. ___
radiologist, who personally supervised the trainee during the key components
of the procedure and reviewed and agrees with the trainee's findings.
FINDINGS:
Limited scanning of the right pre-auricular mass was performed. To determine
the best accessible and safe mass to biopsy, limited scanning of the left
retroperitoneum was performed. This demonstrated a left retroperitoneal mass
posterior to the kidney as identified by CT, measuring 3.2 x 4.6 cm posterior
to the left kidney.
The decision was made to biopsy the pre auricular mass.
PROCEDURE: The risks and benefits of the procedure were explained to the
patient, and written informed consent was obtained. The preprocedure time out
was performed per ___ protocol. An entrance site for the FNA was determine.
The patient was prepped and draped in usual sterile fashion. 1% lidocaine was
injected subcutaneously for local anesthesia.
Using ultrasound guidance, 1 fine needle aspirate was obtained from from the
right pre-auricular mass using a 25 gauge needle. A portion of the sample was
given to the on-site cytologist and the remainder was submitted in Cytolyt.
The sample was deemed adequate for diagnosis by the on-site cytologist. No
periprocedural complications were encountered. The patient tolerated the
procedure well and was discharged in stable condition.
IMPRESSION:
Fine-needle aspiration of a right pre-auricular mass.
|
10192095-RR-21
| 10,192,095 | 26,617,869 |
RR
| 21 |
2196-12-29 08:34:00
|
2196-12-29 11:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with metastatic lung cancer, started
chemotherapy, rec'd fluid resuscitation and now has increased SOB // please
eval for pulm edema vs effusion vs infection please eval for pulm edema vs
effusion vs infection
COMPARISON: Chest radiographs ___.
IMPRESSION:
Central adenopathy may have worsened since ___, particularly in the
aortopulmonic window of the mediastinum and left hilus. Heart size is
top-normal, unchanged, but is more interstitial abnormality in the lungs,
probably edema in addition to preexisting pulmonary fibrosis, primarily basal.
Small left pleural effusion is new. The cluster of unusually shaped left
upper lobe lung masses is unchanged extending from the large hilus to the
costal pleura at the level of the third anterior rib.
|
10192095-RR-28
| 10,192,095 | 29,836,985 |
RR
| 28 |
2197-03-18 16:58:00
|
2197-03-18 18:03:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with advanced small cell lung CA, now w/vertigo //
eval for pna, mass
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___ and chest CT performed ___
FINDINGS:
Large left hilar mass was better assessed on CT 1 day prior. Peripheral left
upper lobe 2 cm pulmonary nodule/ mass is re- demonstrated and also better
assessed on pre seeding CT. Additional pulmonary nodules are better assessed
on CT. Subtle reticular opacities bilaterally with a basal predominance are
consistent with chronic interstitial lung disease. Mild biapical pleural
thickening is re- demonstrated. There is likely a small left pleural
effusion. No pneumothorax is seen. The cardiac and mediastinal silhouettes
are stable.
IMPRESSION:
Large left hilar mass and peripheral left upper lobe pulmonary nodule/mass
seen on CT 1 day prior were better assessed on CT. Chronic interstitial lung
disease. No new opacity identified.
|
10192095-RR-29
| 10,192,095 | 29,836,985 |
RR
| 29 |
2197-03-18 17:33:00
|
2197-03-18 18:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with small cell lung CA, h/o brain mets, now
w/vertigo x 3d, currently undergoing chemo // evaluate for intracranial
bleed, mass
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.8 cm; CTDIvol = 47.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Known brain metastatic lesions are not visualized in this study. There is no
evidence of infarction, hemorrhage, or edema. There is prominence of the
ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Evidence of
prior maxillary sinus sugery is noted. The visualized portion of the orbits
are unremarkable.
IMPRESSION:
No acute intracranial process. MRI is more sensitive in detecting small
intracranial lesions.
|
10192095-RR-30
| 10,192,095 | 29,836,985 |
RR
| 30 |
2197-03-19 11:42:00
|
2197-03-19 13:49:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with hx extensive stage small cell lung cancer
with brain mets, new vertigo // f/u brain metastases, eval for CVA
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6cc of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Brain MR examinations of ___ and ___
FINDINGS:
There have been no significant changes since the prior study. The 3 foci of
parenchymal enhancement noted in ___ are no longer detectable. No new
lesions are identified. Again seen, and unchanged, are scattered areas of
white matter hyperintensity on FLAIR with no abnormal contrast enhancement.
There is no evidence of hemorrhage, edema, masses, mass effect, or infarction.
The ventricles and sulci are normal in caliber and configuration. The
enhancing right temporal scalp mass appears unchanged. Otherwise, there is no
abnormal enhancement after contrast administration.
IMPRESSION:
No evidence of tumor progression or recurrence. The intraparenchymal
enhancing masses noted on ___ are no longer detected. The
right scalp mass appears unchanged.
|
10192358-RR-10
| 10,192,358 | 24,835,138 |
RR
| 10 |
2155-05-25 11:23:00
|
2155-05-25 11:52:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB x1.5 weeks// evaluate for PNA vs pleural
effusion or edema
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Re-demonstrated is marked elevation of the left hemidiaphragm and bowel
contents into the left hemithorax, stable appearance. Associated rightward
mediastinal shift is stable. The cardiac and mediastinal silhouettes are
stable. Mild bibasilar atelectasis is seen without focal consolidation. No
pleural effusion or pneumothorax is seen.
IMPRESSION:
No significant interval change from ___. Re-demonstrated marked
elevation of the left hemidiaphragm.
|
10192358-RR-11
| 10,192,358 | 24,835,138 |
RR
| 11 |
2155-05-25 12:57:00
|
2155-05-25 13:51:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with dyspnea, positive D dimer// assess for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 12.1 mGy (Body) DLP =
6.1 mGy-cm.
2) Spiral Acquisition 4.6 s, 36.3 cm; CTDIvol = 12.2 mGy (Body) DLP = 444.2
mGy-cm.
Total DLP (Body) = 450 mGy-cm.
COMPARISON: Chest radiograph ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. There are extensive coronary artery calcifications.
There is expected rightward mediastinal shift due to elevation of the left
hemidiaphragm. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild centrilobular emphysema. A lobulated opacity
abutting the pleura in the medial right upper lobe measuring up to 1.3 cm
(02:24, 602:26). The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: The left hemidiaphragm is severely elevated, similar to prior. An
ovoid corticated calcific density at the liver dome (2:94) appears
subdiaphragmatic and is nonspecific, possibly a calcified granuloma or dropped
gallstone if the gallbladder has been previously removed. The bilateral
adrenal glands are mildly thickened but without focal nodularity.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. 1.3 cm nodular pulmonary opacity abutting the pleura in the medial right
upper lobe is of indeterminate clinical significance with regard to the
current complaints, but could represent a pulmonary nodule. However,
follow-up chest CT in 3 months is recommended for further evaluation per
___ criteria.
3. Mild centrilobular emphysema.
|
10192402-RR-18
| 10,192,402 | 26,455,078 |
RR
| 18 |
2184-04-05 09:58:00
|
2184-04-05 10:25:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with intracranial hemorrhage// Evaluate for interval change
in subdural hematoma
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, 16.0 cm; CTDIvol = 23.4 mGy (Body) DLP =
375.0 mGy-cm.
2) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Body) = 375 mGy-cm.
Total DLP (Head) = 100 mGy-cm.
COMPARISON: CT from ___ at 02:36, ___
FINDINGS:
Along the right convexity, there is a heterogeneous extra-axial fluid
collection which is predominantly hypoattenuating with smaller more peripheral
areas of high-density, measuring 2.5 cm in maximum thickness, consistent with
a subacute on chronic subdural hematoma, which appears similar to the prior
from ___ and unchanged compared to the prior from the same day. A focus
of pneumocephalus is again seen within the extra-axial collection. There is 7
mm of leftward shift of normally midline structures with mild effacement of
the right lateral ventricle, similar to most recent prior, but increased
compared to ___ when it measured approximately 3-4 mm. The basal
cisterns are patent. A right parietal burr hole is noted. A chronic right
thalamic infarct is noted. There is no evidence of acute vascular territorial
infarction,edema, or mass. The sulci are prominent suggestive of global
involutional changes. Dense carotid siphon calcifications are noted.
Lucency at the site of prior right parietal drain is re-demonstrated. There
is no evidence of fracture. The visualized portion of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits show bilateral lens replacement.
IMPRESSION:
1. 2.5 cm wide subacute on chronic right subdural hematoma, unchanged compared
to most recent prior from earlier in the day and similar to the prior
examination from ___.
2. 7 mm of leftward shift of normally midline structures and mild effacement
of the right lateral ventricle is unchanged compared to the most recent prior
from the same day, but slightly increased compared to ___.
|
10192644-RR-49
| 10,192,644 | 20,872,956 |
RR
| 49 |
2127-12-10 14:14:00
|
2127-12-10 14:55:00
|
HISTORY: Right leg swelling and edema.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed on
the right lower extremity veins.
COMPARISON: Comparison is made to left lower extremity venous ultrasound from
___.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, proximal femoral, mid femoral, distal femoral and popliteal veins.
Normal color flow is demonstrated in the posterior tibial veins. The right
peroneal veins are not well visualized on this study. There is normal
respiratory variation of the common femoral veins bilaterally. Note is made
of subcutaneous edema and calcifications within the common femoral arteries.
IMPRESSION:
Right peroneal veins are not well seen, otherwise no evidence of deep vein
thrombosis in the right lower extremity veins.
|
10192644-RR-50
| 10,192,644 | 20,872,956 |
RR
| 50 |
2127-12-10 19:43:00
|
2127-12-11 08:43:00
|
REASON FOR EXAMINATION: Congestive heart failure.
Portable AP radiograph of the chest was compared to ___.
Cardiomegaly is severe and unchanged. Left basal consolidation is most likely
reflecting atelectasis due to elevated left hemidiaphragm. As compared to the
prior study, there is slight interval worsening of upper zone vascular
redistribution as well as interstitial opacities consistent with
mild-to-moderate interstitial edema. No definitive pleural effusion is
demonstrated.
|
10192644-RR-58
| 10,192,644 | 28,208,401 |
RR
| 58 |
2129-06-03 22:33:00
|
2129-06-03 23:55:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ male with increased headache.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 1115 mGy-cm
CTDI: 54 mGy
COMPARISON: CT dated ___.
FINDINGS:
No acute intracranial hemorrhage, edema, or mass effect is identified. Re-
demonstration of encephalomalacia within the right MCA territory better
depicted on MR dated ___.
No evidence of new infarction. Chronic right basal ganglia lacune is again
seen. Ventricles and sulci are stable in configuration, the right lateral
ventricle asymmetrically dilated likely ex vacuo phenomena. Basal cisterns are
patent. There is preservation of gray-white matter differentiation. There is
no shift of normally midline structures.
The bony calvarium is intact. Mild mucosal thickening within the ethmoidal air
cells is noted. The remainder the visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. Calcifications within the carotid
siphon are noted.
IMPRESSION:
No acute intracranial hemorrhage or mass effect or obvious new major acute
infarct. Encephalomalacia of the right MCA territory is again noted and
unchanged.
Correlate clinically
|
10192644-RR-59
| 10,192,644 | 28,053,646 |
RR
| 59 |
2129-06-21 09:40:00
|
2129-06-21 11:24:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with Fall, on coumadin, right sided body strike with
elbow and hip pain // Eval for injury
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: CTDIvol: 52 mGy
DLP: 892 mGy-cm
COMPARISON: CT head without contrast ___
FINDINGS:
Again seen is a encephalomalacia involving right frontoparietal region,
unchanged from prior. There is no evidence of acute intracranial hemorrhage or
edema.
Prominent ventricles and sulci suggest age-related involutional changes or
atrophy. Subcortical and periventricular white matter hypodensities are
consistent with chronic small vessel ischemic disease.
The basal cisterns appear patent and there is preservation of gray-white
matter differentiation.
The visualized bony structures are grossly unremarkable. The paranasal
sinuses, mastoid air cells, and middle ear cavities are clear.
Atherosclerotic mural calcification of the internal carotid arteries is noted.
The globes are unremarkable.
IMPRESSION:
Unchanged encephalomalacia of the right frontoparietal region. No evidence of
acute intracranial process.
|
10192644-RR-60
| 10,192,644 | 28,053,646 |
RR
| 60 |
2129-06-21 09:40:00
|
2129-06-21 11:23:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall // Eval for injury
TECHNIQUE: helical axial MDCT sections were obtained from the skull base
through the cervical spine. Axial images were interpreted in conjunction with
coronal and sagittal reformats.
DLP: 690 mGy-cm
CTDIvol: 37 mGy
COMPARISON: CT head without contrast ___, C-spine radiograph ___, CT cervical spine ___
FINDINGS:
There are complete fractures of the C1 ring seen anteriorly with displacement
of fractures and along the left lamina, the latter not displaced. These
fractures were also present in the head CT from ___ and show no
increase in displacement. Otherwise the chronicity is not certain. In
current study, there is associated posterior subluxation of C1 over C2 which
has increased however since the remote prior CT of the cervical spine in
association with these fractures, which may be subacute or older. Anterior
subluxations of C3 over C4 and C5 over C6 appear chronic and likely related to
degenerative disease. Compared to the CT of the cervical spine from ___, the subluxation of C3 over C4 has been increased, and the C5 over C6 has
remained the same. There is no prevertebral soft tissue abnormality. The
thyroid is grossly unremarkable in appearance. No lymphadenopathy is present
by CT size criteria. The visualized lung apices are clear.
IMPRESSION:
1. C1 fractures, present before and subacute or older in age, but substantial
C1-C2 subluxations.
2. Otherwise unchanged degenerative changes including associated alignment
abnormalities.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 11:05 ___, 5 minutes after discovery of the
findings.
|
10192644-RR-61
| 10,192,644 | 28,053,646 |
RR
| 61 |
2129-06-21 10:54:00
|
2129-06-21 11:36:00
|
EXAMINATION: RADIOGRAPHS OF THE RIGHT HIP AND PELVIS
INDICATION: Right-sided trauma and hip pain.
COMPARISON: CT from ___.
TECHNIQUE: Right hip, two views, and AP pelvis.
FINDINGS:
There is a displaced discontinuity of the cortex along the medial acetabulum
and lateral superior pubic ramus suggesting fracture that is otherwise
difficult to assess the extent. The patient is status post right hip
hemiarthroplasty. A remodeled appearance to the right greater trochanter
suggests a prior healed fracture. The left hip joint space appears preserved.
Degenerative changes are incompletely characterized along the lower lumbar
spine. The bones appear demineralized. Vascular calcifications are
widespread.
IMPRESSION:
Displaced fracture of the right lateral superior pubic ramus and probably
acetabulum. The extent of the fracture is difficult to assess given its
location and the presence of a right hip arthroplasty.
|
10192644-RR-62
| 10,192,644 | 28,053,646 |
RR
| 62 |
2129-06-21 10:53:00
|
2129-06-21 11:43:00
|
EXAMINATION: CHEST RADIOGRAPHS
INDICATION: Status post fall on Coumadin with right-sided body strike.
COMPARISON: ___.
TECHNIQUE: Chest, 2 AP supine views.
FINDINGS:
There is again striking elevation of the left hemidiaphragm. The heart again
appears moderately enlarged. The aorta is calcified. The mediastinal and
hilar contours appear stable. Aside from streaky opacities suggesting minor
atelectasis at the left lung base, the lungs remain clear. There is no
definite pleural effusion or pneumothorax. No fracture is identified.
IMPRESSION:
No evidence of acute cardiopulmonary disease or injury.
|
10192644-RR-63
| 10,192,644 | 28,053,646 |
RR
| 63 |
2129-06-21 10:54:00
|
2129-06-21 11:31:00
|
EXAMINATION: RIGHT ELBOW RADIOGRAPHS
INDICATION: Status post fall with right elbow pain.
COMPARISON: ___.
TECHNIQUE: Right elbow, three views.
FINDINGS:
There is a non-displaced supracondylar fracture associated with a faint
lucency. Moderate degenerative changes affect both the ulnar trochlear and
radial capitellar joints including moderate osteophytes about the radial head.
Overlying soft tissues are prominent. It is difficult to assess for an
effusion due bony spurs and background soft tissue attenuation.
IMPRESSION:
Non-displaced supracondylar fracture of the distal humerus.
|
10192644-RR-64
| 10,192,644 | 28,053,646 |
RR
| 64 |
2129-06-21 13:10:00
|
2129-06-21 15:19:00
|
EXAMINATION: CT PELVIS W/O CONTRAST
INDICATION: History: ___ with right hip fx // Eval for right hip fx
TECHNIQUE: MDCT axial images were acquired through pelvis. Coronal and
sagittal reformations were performed and submitted to PACS for review.
DOSE: DLP: 1242 mGy-cm .
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
BONES AND SOFT TISSUES:
There is extensive right acetabulum fracture with comminution and distraction
of fragments propagating through the right iliac wing and superior pubic
ramus. The medial wall is displaced medially, and the fracture involves both
anterior and posterior columns as well as the acetabular roof, but potentially
also anterior and posterior walls (the latter partly obscured by streak
artifact from metallic implant). There are also, separately, fractures of the
right superior and inferior pubic rami. There is heterotopic bone along the
right proximal femur but no evidence of acute femur fracture. The bone is
generally demineralized. Patient is status post right hip hemiarthroplasty.
PELVIS:
There is a very large 9.3 x 3.5 x 6.7 cm acute retroperitoneal hematoma in the
pelvis along the right pelvic wall. The hematoma also has extravesicular
space component and courses along the course of right the iliac vessels, which
are not well delineated. Active bleeding cannot be excluded given that
contrast was not administered for this study. There is hematoma immediately
posterior to the right rectus muscle although possibly within the rectus
sheath; this seems to be recurrent acute hemorrhage rather than sequela of the
prior one. The right ileopsoas is hyperdense and expansile near the site of
right iliac wing hemorrhage in association with recent infiltrative
intramuscular bleeding.
The bladder is unremarkable. Atherosclerotic mural calcification of the aorta,
the lateral common iliac arteries and their major branches.
IMPRESSION:
1. Extensive right acetabulum fracture propagating through the right iliac
wing. There is fracture of superior and inferior pubic ramus. Patient is
status post right hip replacement.
2. There is a large retroperitoneal hematoma along the right pelvic wall and
course of the right iliac vessels, as well as a hematoma in the right rectus
sheath. Active bleeding cannot be excluded.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 2:30 ___, 5 minutes after discovery of the findings.
|
10192644-RR-65
| 10,192,644 | 28,053,646 |
RR
| 65 |
2129-06-21 15:39:00
|
2129-06-21 17:48:00
|
EXAMINATION: RADIOGRAPHS OF THE PELVIS
INDICATION: Judet views of the pelvis requested.
COMPARISON: Earlier on the same day.
TECHNIQUE: Pelvis, four views, including bilateral oblique views.
FINDINGS:
Due to bony demineralization and soft tissue attenuation, bony structures are
difficult to visualize on this study, and in particular right acetabular and
superior pubic ramus fractures are not well assessed but are again detectable
without clear change. The patient is status best right hip replacement.
Vascular calcifications are widespread.
IMPRESSION:
Right superior pubic ramus and acetabular fractures, better assessed on recent
CT.
|
10192644-RR-66
| 10,192,644 | 28,053,646 |
RR
| 66 |
2129-06-23 10:57:00
|
2129-06-23 13:01:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with painless hematuria // Perirenal hematoma
TECHNIQUE: Grey scale ultrasound images of the kidneys were obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 10.5 cm. The left kidney measures 9.3 cm. There is
no hydronephrosis. Note is made of somewhat limited visualization of the
kidneys due to the patient's body habitus. No stone or suspicious solid mass
is seen in either kidney. A minimally complex cyst is seen at the lower pole
of the right kidney measuring 1.5 x 2.1 x 1.9 cm. No suspicious vascularity is
seen within this cyst. No perinephric fluid collection is identified.
The bladder is collapsed on a Foley catheter.
IMPRESSION:
Minimally complex cyst without worrisome features is incidentally noted in the
right kidney. No findings to suggest a cause of hematuria.
|
10192644-RR-67
| 10,192,644 | 28,053,646 |
RR
| 67 |
2129-06-26 20:52:00
|
2129-06-27 10:12:00
|
EXAMINATION: PELVIS (AP, INLET AND OUTLET) IN O.R.
INDICATION: RT ACETAB. FX.ORFI
IMPRESSION:
Images from the operating suite show placement of fixation device about the
right acetabulum. Further information can be gathered
|
10192644-RR-68
| 10,192,644 | 28,053,646 |
RR
| 68 |
2129-06-26 08:14:00
|
2129-06-26 15:25:00
|
INDICATION: ___ male with pelvis fracture.
TECHNIQUE: 3D reconstructions of the pelvis were performed from the knee
pelvic CT performed on ___.
COMPARISON: CT performed on ___. This previous CT is the source
examination for current reconstructions.
FINDINGS:
3D volumetric reconstructions of the pelvis were performed from the CT
performed on ___. Again seen is a right hip hemiarthroplasty.
There is a fracture of the right acetabulum which extends into the right iliac
wing. In addition, there are fractures of the inferior pubic ramus and at the
junction of the superior pubic ramus and acetabulum.
IMPRESSION:
3D volumetric reconstructions of the pelvis were performed. Redemonstrated is
a complex fracture of the right acetabulum and iliac wing as described above.
Please see report of source CT ___.
|
10192644-RR-69
| 10,192,644 | 28,053,646 |
RR
| 69 |
2129-06-26 23:18:00
|
2129-06-27 11:58:00
|
INDICATION: ___ year old man with knee effusion // r/o fx, other causes of
effusion r/o fx, other causes of effusion
TECHNIQUE: Frontal and cross-table lateral projections of the right knee for
a total of 2 projections on 4 images.
COMPARISON: Radiographs of the right knee ___.
FINDINGS:
The bones are demineralized. There is no fracture. There is no periosteal
reaction or erosive change.
There is no dislocation. There are severe tricompartmental degenerative
changes with marked joint space narrowing and marginal osteophyte formation,
worsened from the prior exam. There is a moderate joint effusion. No definite
intra-articular loose body is seen.
There are vascular calcifications. Nonspecific coarse calcification projects
lateral to the distal femur.
IMPRESSION:
Interval worsening of severe tricompartmental osteoarthritis.
|
10192644-RR-70
| 10,192,644 | 28,053,646 |
RR
| 70 |
2129-06-30 11:40:00
|
2129-06-30 18:38:00
|
EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old man with acetabulum fracture having difficulty
swallowing // able to swallow?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was aspiration with thin liquids and penetration with
nectar thick liquids.
IMPRESSION:
Aspiration with thin liquids and penetration with nectar thick liquids.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10192644-RR-72
| 10,192,644 | 28,053,646 |
RR
| 72 |
2129-06-30 12:00:00
|
2129-06-30 13:20:00
|
INDICATION: ___ year old man with percutaneous screws for R acetabulum fx //
hardware
COMPARISON: Radiographs from ___.
IMPRESSION:
There is a right hip hemiarthroplasty which is intact. There are screws within
the right hemipelvis without complications. Fractures of the right iliac wing
extending into the medial acetabulum are again seen. Contrast material is seen
in the small bowel. There are degenerative changes of the lower lumbar spine
and bilateral sacroiliac joints.
|
10192748-RR-105
| 10,192,748 | 28,500,595 |
RR
| 105 |
2139-11-12 18:22:00
|
2139-11-12 19:50:00
|
CHEST, TWO VIEWS: ___
HISTORY: ___ female with lymphoma and shortness of breath. Decreased
left breath sounds.
FINDINGS: AP and lateral views of the chest are compared to previous exam
from ___. When compared to prior, there is interval improvement in
the appearance of the left hemithorax now with aerated left upper lobe. There
is, however, a large left-sided pleural effusion. There is also no
significant aeration of the left lower lobe suggesting underlying atelectasis,
possible consolidation. The right-sided pleural effusion has also likely
decreased in size since prior. Right basilar infection is not excluded.
Cardiomediastinal silhouette is difficult to assess given dense opacity in the
left lung. Left subclavian line and NG tubes are no longer seen.
IMPRESSION: Large left-sided pleural effusion with increased aeration of the
left upper lobe when compared to prior. Decrease in size of right-sided
pleural effusion. Presumed left lower lobe and right base atelectasis with
infection not excluded.
|
10192748-RR-106
| 10,192,748 | 28,500,595 |
RR
| 106 |
2139-11-14 13:25:00
|
2139-11-14 15:19:00
|
INDICATION: Evaluate pleural effusion following placement of left-sided
Pleurx catheter.
COMPARISON: Chest radiograph from ___.
FINDINGS: In addition to chronic dextroscoliosis of the thoracic spine, the
patient is markedly leftwardly rotated and in a reverse lordotic
configuration, making assessment difficult. There has been marked reduction
in size of the left-sided pleural effusion since placement of the catheter;
however, there is a new right-sided moderate pleural effusion. A horizontal
line underlying the left main stem bronchus is likely the diaphragmatic
contour, although the presence of an air-fluid level cannot be excluded on
these limited views. There is no pneumothorax, and the visualized lung fields
are clear. Cardiomegaly is stable.
IMPRESSION:
1. Interval reduction in size of left-sided pleural effusion with possible
new moderate-sized right pleural effusion.
2. Given the limitations of this current study, a repeat chest radiograph
with more careful positioning to avoid rotation should be considered.
|
10192748-RR-108
| 10,192,748 | 28,500,595 |
RR
| 108 |
2139-11-14 18:00:00
|
2139-11-15 08:49:00
|
CHEST RADIOGRAPH
INDICATION: Status post thoracocentesis, low saturation, questionable
pneumothorax.
COMPARISON: ___, 1:52 p.m.
FINDINGS: As compared to the previous radiograph, there is a substantial
increase in extent of the left pleural effusion, despite the identical
position of the left pleural pigtail catheter. In addition, the pleural
effusion, there is a zone of increased parenchymal density in the lateral
aspects of the left hemithorax, suggesting the presence of coexisting
atelectasis. However, a more acute event such as parenchymal bleeding should
not be excluded. Close monitoring is strongly suggested.
There is no evidence of left pneumothorax. The right lung appears unchanged.
A wet read and phone contact was established at the time of the initial
observation, 6:58 p.m., on ___, by Dr. ___ contacted the
referring physician, ___.
|
10192748-RR-109
| 10,192,748 | 28,500,595 |
RR
| 109 |
2139-11-18 16:10:00
|
2139-11-18 17:29:00
|
PORTABLE CHEST FILM, ___ AT 16:39
CLINICAL INDICATION: ___ with lymphoma and recurrent pleural effusion
status post pigtail placement thoracentesis.
Comparison is made to the patient's prior study of ___.
Portable AP upright chest film, ___ at 16:39 is submitted.
IMPRESSION:
1. Interval placement of a left pigtail catheter with decrease in size of a
left pleural effusion. There continues to be a right pleural effusion. There
is a loculated medial left apical pneumothorax. Bibasilar patchy opacities
likely reflect compressive atelectasis. There is also suggestion of a hiatal
hernia. There is a marked thoracolumbar curvature with diffuse osteopenia and
degenerative changes. Calcifications of the aortic knob. Overall cardiac and
mediastinal contours are likely stable given differences in positioning. No
evidence of pulmonary edema.
|
10192748-RR-110
| 10,192,748 | 28,500,595 |
RR
| 110 |
2139-11-21 11:21:00
|
2139-11-21 14:11:00
|
INDCATION: Chylous pleural effusion with left-sided pigtail pleural catheter
actively draining. The patient has a history of AML and bladder cancer.
COMPARISON: Most recent radiograph from ___ and series of older
studies dating back to ___.
FINDINGS: PA and lateral radiographs of the chest depict the left-sided
pigtail pleural drainage catheter in unchanged position. There is a
persistent small left-sided pleural effusion which appears to be loculated
into two components, anteriorly and posteriorly. The drainage catheter is
within the anterior component. The size of the effusion on the left has
decreased from the prior study and the right-sided effusion has almost
completely resolved. There is no pneumothorax and the lungs are otherwise
clear. Severe cardiomegaly and scoliosis is unchanged.
IMPRESSION:
1. Loculated small left pleural effusion has decreased in size, and a
drainage catheter is within the anterior component of the effusion.
2. Right-sided effusion has decreased considerably in size.
3. Pneumothorax is no longer apparent.
|
10192748-RR-111
| 10,192,748 | 28,500,595 |
RR
| 111 |
2139-11-23 16:26:00
|
2139-11-24 11:21:00
|
PROCEDURE: CT torso with contrast.
REASON FOR EXAM: Staging scans for interval improvement.
COMMENTS: ___ woman with history of chronic lymphocytic leukemia (in
remission) now with bladder cancer, LPL versus marginal zone lymphoma; status
post rituximab with recent initiation of chemotherapy; staging scans for
interval improvement.
COMPARISONS: Multiple prior studies, the most recent one ___ and a
comparison also was made with a prior study dated ___.
TECHNIQUE: Multidetector CT of the chest, abdomen and pelvis was obtained
post-intravenous contrast administration of contrast in the portal vein phase.
Additional images at three minutes delay were obtained through the kidneys and
the abdomen.
FINDINGS:
CHEST: There are bilateral small-to-moderate pleural effusions with
associated atelectasis, slightly smaller compared with the prior study. Small
area of consolidation within the lingula is noted, which may represent an area
of focal atelectasis versus infection. The visualized pulmonary arteries
centrally demonstrate no evidence of embolism. There is heavy atherosclerotic
calcification of the mediastinal vessels, coronary arteries and cardiac
valves. There is no evidence of pericardial effusion. No evidence of
supraclavicular lymphadenopathy. There are prominent left axillary
axillaryenhancing lymph nodes and left neck nodes, stable from the prior
study.
ABDOMEN: The previously described liver hypodensities which were consistent
with post-traumatic laceration and hematomas are resolved in the interim.
There is a tiny subcentimeter hypodensity within the right posterior inferior
hepatic lobe, unchanged from the prior studies, likely representing a cyst.
No evidence of other hepatic focal masses. The liver enhances homogeneously.
Layering multiple stones within the gallbladder are noted, without evidence of
wall thickening to suggest cholecystitis. Spleen is not enlarged and
demonstrates no focal lesions. There is again seen a large retroperitoneal
mass encasing the mid abdominal aorta, smaller compared to the most recent
study and esepcially smaller compared with the study of ___, now
measuring 9.5 x 4 cm (2;72) compared with 11.1 x 3.4 cm. The left perirenal
mass is slightly smaller measuring 5.5 x 3.7 cm ,compared with 6.2 x 5 cm.
The IVC is displaced anteriorly secondary to mass effect and slightly
flattened. Bilateral renal veins are also displaced anteriorly secondary to
mass effect, unchanged significantly from the prior studies. Pancreas
enhances homogeneously and demonstrates no evidence of focal mass or
pancreatic duct dilatation. Left kidney enhances and excretes normally.
Right kidney demonstrates presence of moderate hydronephrosis and hydroureter
throughout its course to the level of the ureterovesical junction where an
enhancing bladder mass at the right hemitrigone is noted, measuring 4 x 1.1 cm
(2:109), slightly more prominent than on other studies. There is some nodular
enhancement of the distal right ureter, highly suggesting neoblastic
involvement at that region. The bladder mass extends posteriorly with
obscuration of the bladder-rectal fat plane, suggesting transmural invasion.
There is a small amount of subhepatic low-attenuation fluid. There is a small
collection in the left retroperitoneal space, measuring approximately 3 cm in
the largest dimension (2:73) with a slightly calcified rim, significantly
smaller from the prior study, most likely representing resolving hematoma.
VASCULAR STRUCTURES: There is heavy atherosclerotic calcification of the
aortoiliac vessels, unchanged from the prior study.
Small and colonic loops of bowels within the abdomen demonstrate no evidence
of abnormal dilatation or obstruction.
PELVIS: Status post hysterectomy. Please refer to abdomen for description of
the bladder mass, which appears slightly enlarged compared to the prior study.
Colonic and small-bowel loops within the pelvis demonstrate no evidence of
abnormal dilatation or obstruction.
SUBCUTANEOUS TISSUES AND OSSEOUS STRUCTURES: There is diffuse soft tissue
edema/anasarca. There is a severe S-shaped scoliosis with degenerative
changes throughout the spine, not significantly changed from the prior study.
Mixed sclerotic appearacne of the left acetubulu, unclear is represents
lymphomatous involvement.
IMPRESSION:
1. Smaller size of retroperitoneal mass encasing the aorta and displacing
anteriorly the IVC, consistent with treatment response.
2. Interval resolution of previously seen hepatic hypodensities consistent
with laceration and hematomas. No focal liver masses are seen at this time.
3. Smaller left retroperitoneal calcified collection compared with prior
studies, likely representing resolving hematoma.
4. Right-sided hydronephrosis and hydroureter throughout its course with no
evidence of excretion from the right kidney on the delayed images secondary to
a slightly enlarged obstructing bladder mass at the level of the right
trigone, which extends transmurally posteriorly.
5. Bilateral small-to-moderate pleural effusion with associated atelectasis.
6. Irregular appearance of the left acetabulum and ilium with mixed sclerotic
and lytic component, not significantly changed from prior study. Cannot rule
out lymphomatous involvement.
|
10192748-RR-125
| 10,192,748 | 28,902,887 |
RR
| 125 |
2140-03-22 18:27:00
|
2140-03-22 18:44:00
|
HISTORY: Hypoxia and cough.
TECHNIQUE: Upright AP and lateral views of the chest. FINDINGS
COMPARISON: Chest radiograph ___. CT torso ___.
FINDINGS:
Severe dextroscoliosis of the thoracolumbar spine is present. Large bilateral
pleural effusions are relatively unchanged compared to the prior exam, with
associated bibasilar atelectasis. Assessment of the cardiac silhouette size
is limited, as is evaluation of the mediastinal and hilar contours. Mild
pulmonary vascular congestion appears present. Calcification of the thoracic
aorta is noted. No pneumothorax is identified.
IMPRESSION:
Large bilateral pleural effusions, similar compared to the prior study with
associated bibasilar atelectasis. Mild pulmonary vascular congestion.
|
10192748-RR-126
| 10,192,748 | 28,902,887 |
RR
| 126 |
2140-03-23 02:33:00
|
2140-03-23 11:20:00
|
AP CHEST, 2:39 A.M., ___
HISTORY: This is an ___ woman with lymphoma and bilateral pleural
effusions after thoracentesis.
IMPRESSION: AP chest compared to ___:
Small left pleural effusion has decreased substantially and there is no
pneumothorax. Left lower lobe still remains largely atelectatic.
Moderate-to-large right pleural effusion may have increased. The heart size
is indeterminate obscured by adjacent pleural and parenchymal abnormalities.
Upper lobe vasculature is engorged, but I cannot assess whether mild edema is
present.
|
10192748-RR-128
| 10,192,748 | 28,902,887 |
RR
| 128 |
2140-03-23 10:31:00
|
2140-03-23 11:35:00
|
AP CHEST, 10:39 AM, ___
HISTORY: New intubation.
IMPRESSION: AP chest compared to 2:39 a.m.:
ET tube is at the level of the sternal notch, no less than 4 cm from the
carina, but the tip abuts the left wall of the trachea due to severe
scoliosis. Lower lobe atelectasis, small-to-moderate left and
moderate-to-large right pleural effusion are unchanged. I do not think there
is no pneumothorax but skin folds and anatomic distortion make that
determination difficult. Heart size cannot be assessed. Nasogastric tube
ends in the stomach.
|
10192748-RR-129
| 10,192,748 | 28,902,887 |
RR
| 129 |
2140-03-23 13:47:00
|
2140-03-23 15:13:00
|
CHEST ON ___
HISTORY: Right chest tube placement.
FINDINGS: There has been interval placement of a right pigtail catheter with
decreased size of the right pleural effusion. Again seen is the severe
scoliosis with the ET tube at the sternal notch, abutting the left wall of the
trachea, left lower lobe atelectasis, small left effusion, moderate
cardiomegaly, and NG tube in the stomach.
|
10192748-RR-130
| 10,192,748 | 28,902,887 |
RR
| 130 |
2140-03-23 18:29:00
|
2140-03-24 08:11:00
|
CHEST ON ___
HISTORY: Right-sided PICC line.
FINDINGS: The right PICC line tip is just above the cavoatrial junction.
There is a new dense right lower lobe infiltrate. Pulmonary vascular
re-distribution is slightly increased. There continues to be dense
retrocardiac opacity, severe scoliosis. The position of the ET tube is
unchanged with the tip adjacent to the left tracheal wall just above the
aortic knob. Right-sided pigtail chest catheter is again seen.
|
10192748-RR-131
| 10,192,748 | 28,902,887 |
RR
| 131 |
2140-03-25 04:24:00
|
2140-03-25 08:52:00
|
HISTORY: Respiratory failure with intubation.
FINDINGS: In comparison with the study of ___, there has been decrease in
the opacification at the right base. Retrocardiac opacification persists.
Monitoring and support devices remain in place in this patient with severe
thoracic scoliosis convex to the right.
|
10192748-RR-132
| 10,192,748 | 28,902,887 |
RR
| 132 |
2140-03-24 13:46:00
|
2140-03-24 16:05:00
|
INDICATION: ___ woman with multiple cancers, hypoxia. Assess for
pulmonary embolism and progression of intra-abdominal malignancy.
COMPARISONS: CT abdomen and pelvis ___ and CT torso ___.
TECHNIQUE: MDCT-acquired axial images were obtained through the chest in
arterial phase after the uneventful administration of 130 cc of Omnipaque
contrast medium. Subsequently, in the portal venous phase, images were
obtained from the lung bases to the pubic symphysis. The patient was also
given oral contrast. Coronal and sagittal reformations were prepared along
with oblique maximum intensity projection images of the pulmonary arteries.
CT OF THE CHEST WITH CONTRAST: Endotracheal tube terminates in the mid
trachea. Right PICC terminates in the distal SVC. Nasogastric tube courses
into the stomach. The aorta and major branches are patent with note made of a
bovine aortic arch, a normal variant. Pulmonary arterial tree is well
opacified without evidence of filling defect to suggest pulmonary embolus.
The trachea and central airways are patent to the segmental level aside from
the left lower lobe airways, which are somewhat attenuated due to a large
nonhemorrhagic pleural effusion. There is near total collapse of the left
lower lobe and otherwise compressive atelectasis in the posterior left upper
lobe. Trace right pleural effuion results in mild atelectasis in the right
lower lobe. Ground-glass and consolidative nodular opacities are seen in the
right lower and middle lobe and to a lesser degree in the lingula. These
could reflect infectious or inflammatory process or sequelae of aspiration.
Peribronchial thickening is also noted in the bilateral lower lobe airways. A
small pneumothorax is seen in the right hemithorax which likely was introduced
by the right basal chest tube which is noted in position.
The esophagus is normal. There is no axillary or mediastinal lymphadenopathy,
though assessment of the mediastinum is somewhat limited due to phase of
contrast. Heart and pericardium are normal with physiologic quantity of
pericardial fluid. An 11 mm right hilar lymph node is noted (2A:43). A
second right lower lobe hilar lymph node is seen measuring 9 mm (2A:53).
CT OF THE ABDOMEN WITH CONTRAST: The liver is heterogeneous in attenuation,
which is likely related to the phase of contrast. Hypodensity in segment VI
(2B:124) is unchanged. No other focal hepatic lesions are seen in this study
with periportal edema noted. There is no intra- or extra-hepatic biliary
ductal dilatation. The layering hyperdensity in the gallbladder is unchanged
compatible with stones or sludge. The portal vein is patent. The pancreas,
spleen and bilateral adrenal glands are unremarkable. The kidneys enhance and
excrete contrast symmetrically, with decrease in right-sided hydronephrosis.
Hypodensities in both kidneys are too small to fully characterize but likely
simple cyst. Parapelvic left renal cysts are again noted. The soft tissue
attenuation mass surrounding the aorta and IVC in the retroperitoneum is
smaller than on the previous examination where it measured 8.9 x 2.9 cm. It
is not nearly as well seen, nor as confluent but measures at most 7.8 x 2.8
cm. Hyperdense lesion inferior into the left kidney is also smaller,
currently measuring 4.8 x 2.2 cm, having measured 7 x 4 cm on the previous
examination. Superficial to this is the unchanged rim calcified chronic
hematoma in the left flank.
The stomach, small and large bowel are in total unremarkable with a moderate
volume of stool. Small volume ascites is nted without free intraperitoneal
air. There is no demonstrable mesenteric adenopathy.
CT OF THE PELVIS WITH CONTRAST: The bladder is decompressed by Foley
catheter, limiting assessment of the previously described bladder lesion. The
rectum is unremarkable. The uterus appears to be surgically absent. There is
dense atherosclerotic disease of the aorta and major branches without evidence
of discrete stenosis on this nonarteriographic study.
OSSEOUS STRUCTURES: There is multilevel degenerative disease with marked
scoliosis involving the thoracic and lumbar spine. Mixed lytic or sclerotic
appearance of the left acetabulum and pubis is unchanged and of uncertain
significance. Extensive degenerative changes are noted.
IMPRESSION:
1. No pulmonary embolism or acute aortic pathology.
2. Large left pleural effusion causing near complete collapse of the left
lower lobe.
3. Right lower and middle lobe and to a lesser degree lingular ground-glass
opacities could reflect aspiration or infectious process. Trace right
pneumothorax likely due to right basal chest tube.
4. Decreased size of retroperitoneal nodal conglomeration encasing the aorta
as well as infrarenal lesion in the left retroperitoneum.
5. Bladder lesion is not as well assessed as on the previous study.
Preliminary findings were discussed with Dr. ___ by Dr. ___ at 13:40 on
___ by phone.
|
10192748-RR-133
| 10,192,748 | 28,902,887 |
RR
| 133 |
2140-03-25 09:56:00
|
2140-03-25 10:49:00
|
CHEST RADIOGRAPH
INDICATION: Hypoxia, status post left chest tube placement.
COMPARISON: ___, 4:41 a.m.
FINDINGS: As compared to the previous radiograph, the patient has received a
left chest tube. The extent of the pleural effusion has decreased. However,
there is an approximately 1-cm left basal and left apical lateral
pneumothorax. No evidence of tension is seen. The right lung is unchanged.
Unchanged monitoring and support devices, unchanged shape of the cardiac
silhouette.
At the time of observation and dictation, 10:30 a.m., on ___, the
referring physician, ___, was paged for notification.
|
10192748-RR-134
| 10,192,748 | 28,902,887 |
RR
| 134 |
2140-03-26 05:07:00
|
2140-03-26 09:25:00
|
HISTORY: Respiratory failure with intubation.
FINDINGS: In comparison with study of ___, the left apical portion of the
pneumothorax has decreased in size. Small amount of possibly loculated gas is
seen in the region of the left costophrenic sulcus.
Otherwise, there is continued volume loss in the left lower lobe with
relatively clear lungs in this patient with severe scoliosis of the thoracic
spine convex to the right.
|
10192748-RR-135
| 10,192,748 | 28,902,887 |
RR
| 135 |
2140-03-25 14:30:00
|
2140-03-25 16:12:00
|
CHEST RADIOGRAPH
INDICATION: Status post pneumothorax. Evaluation for interval change.
COMPARISON: ___, 10:05 a.m.
FINDINGS: As compared to the previous radiograph, the apical component of the
known left pneumothorax has increased in size. At the bases of the left
hemithorax, the pneumothorax is less apparent.
Otherwise, unchanged radiograph. Currently, there are no signs for tension.
Positions of the bilateral pleural drains are constant.
|
10192748-RR-136
| 10,192,748 | 28,902,887 |
RR
| 136 |
2140-03-27 05:10:00
|
2140-03-27 13:45:00
|
AP CHEST, 5:36 A.M., ___
HISTORY: Acute respiratory failure, hypoxia and hypercarbia. Chest tube
drainage of bilateral pleural effusions.
IMPRESSION: AP chest compared to ___:
Small-to-moderate bilateral pleural effusions remain despite pigtail pleural
drainage catheter in each hemithorax. No pneumothorax. Moderately severe
left lower lobe atelectasis unchanged. Heart size normal. ET tube in
standard placement, right PIC line ends in the mid-to-low SVC and a
nasogastric tube passes below the diaphragm and out of view.
|
10192748-RR-138
| 10,192,748 | 28,902,887 |
RR
| 138 |
2140-03-26 14:28:00
|
2140-03-26 15:48:00
|
REASON FOR EXAMINATION: Hypoxia and hypercarbia after self pulling of NG tube
and attempted self extubation.
AP radiograph of the chest was compared to ___ obtained at 05:22
a.m.
The ET tube tip is 4.7 cm above the carina. NG tube tip is in the stomach.
Left pigtail catheter is in place. Right PICC line tip is at the level of
superior SVC. NG tube tip is in the stomach. No substantial change in the
cardiomediastinal appearance and appearance of the lungs demonstrated.
|
10192748-RR-141
| 10,192,748 | 28,902,887 |
RR
| 141 |
2140-03-27 18:24:00
|
2140-03-28 08:47:00
|
CHEST RADIOGRAPH
INDICATION: Intubation, bilateral chest tubes, evaluation.
COMPARISON: ___, 5:36 a.m.
FINDINGS: As compared to the previous radiograph, the monitoring and support
devices are in standard position. As dictated, is in unchanged position.
Small left pleural effusion is unchanged, no relevant change as compared to
the previous examination.
|
10192748-RR-143
| 10,192,748 | 28,902,887 |
RR
| 143 |
2140-03-29 05:11:00
|
2140-03-29 10:22:00
|
REASON FOR EXAM: Evaluate effusions.
Comparison is made with prior study, ___.
Moderate-to-large left pleural effusion and small-to-moderate right pleural
effusion have markedly increased from prior study. Cardiomediastinal contours
are partially obscured by the pleuroparenchymal abnormalities. Bibasilar
atelectases have increased. Bilateral basal pigtail catheters are in
unchanged position. Right PICC tip is in the lower SVC.
|
10192748-RR-144
| 10,192,748 | 28,902,887 |
RR
| 144 |
2140-03-28 13:22:00
|
2140-03-28 14:49:00
|
INDICATION: ___ man with left arm swelling, to rule out DVT.
COMPARISON: Left upper extremity venous Doppler study ___.
FINDINGS: Grayscale and Doppler sonogram of the left internal jugular,
subclavian, axillary, brachial veins were performed. The left basilic vein is
normal. The left cephalic vein is not visualized.
IMPRESSION: No DVT in the left upper extremity.
|
10192748-RR-145
| 10,192,748 | 28,902,887 |
RR
| 145 |
2140-03-28 15:47:00
|
2140-03-28 20:36:00
|
INDICATION: ___ year old female patient with possible HIT. Study requested for
evaluation of possible slow intracranial bleed over the past few months.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast.
Total exam DLP: 910.19 mGy-cm.
CTDIvol: 59.39 mGy.
COMPARISON: NECT of the head from ___.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect, or acute
infarction. The ventricles and sulci are normal in size and configuration for
patient's age. Mild periventricular white matter hypodensities are consistent
with chronic small vessel ischemic disease. The basal cisterns appear patent
and there is preservation of gray-white matter differentiation.
No fracture is identified. Fluid is noted in the sphenoid sinus. The remaining
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
Atherosclerotic mural calcification of the vertebral and internal carotid
arteries is noted.
CONCLUSION: No evidence of hemorrhage or mass effect.
|
10192748-RR-146
| 10,192,748 | 28,902,887 |
RR
| 146 |
2140-03-30 07:42:00
|
2140-03-30 09:12:00
|
CHEST RADIOGRAPH
INDICATION: Pleural effusions, chest tubes, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is a decrease in
extent of the right pleural effusion with subsequent improved ventilation of
the right lung bases. On the left, effusion has fairly decreased. Unchanged
position of the chest tubes, unchanged course of the PICC line. No evidence
of pneumothorax.
|
10192748-RR-147
| 10,192,748 | 28,902,887 |
RR
| 147 |
2140-03-31 04:54:00
|
2140-03-31 09:29:00
|
CHEST RADIOGRAPH
INDICATION: Evaluation for interval change.
COMPARISON: ___.
FINDINGS: The technical information states the following. The requested
decubitus films were attempted on the floor but was unable to obtain
diagnostic radiographs, due to patient's body habitus and various other
limitations.
The bilateral chest tubes are in unchanged position. There is no evidence of
current pneumothorax. Scoliosis with subsequent asymmetry of the rib cage is
unchanged. Unchanged size of the cardiac silhouette. The extent of the
bilateral pleural effusions has not substantially changed. The right PICC
line is constant.
|
10192748-RR-148
| 10,192,748 | 28,902,887 |
RR
| 148 |
2140-03-30 16:18:00
|
2140-03-30 16:52:00
|
CHEST RADIOGRAPH
INDICATION: Bilateral pleural effusions, chest tube placement.
COMPARISON: ___, 8:08 a.m.
FINDINGS: As compared to the previous radiograph, there is no substantial
change. The bilateral pigtail catheters are in unchanged position. The
parenchymal opacity in the left perihilar area is minimally smaller. The
minimal effusion at the right lung base and a mild effusion on the left are
constant in extent. There is no evidence of pneumothorax. Unchanged massive
scoliosis with displacement of the heart towards the left and rib cage
asymmetry.
|
10192748-RR-149
| 10,192,748 | 28,902,887 |
RR
| 149 |
2140-03-31 21:59:00
|
2140-04-01 12:44:00
|
AP CHEST 10:19 P.M., ___
HISTORY: An ___ woman with decreased breath sounds on the left.
Evaluate for possible collapse.
IMPRESSION: AP chest compared to ___ through ___ at 5:17 p.m.:
Left lower lobe collapse is longstanding. Moderate left pleural effusion is
larger now than it was 15 hours earlier despite the left pleural pigtail
catheter. There is no pneumothorax. The heart is moderately enlarged. Right
pleural drainage catheter also in place and a small right pleural effusion is
smaller. There is no right pneumothorax. Right PIC line ends in the mid SVC.
|
10192748-RR-150
| 10,192,748 | 28,902,887 |
RR
| 150 |
2140-04-01 11:54:00
|
2140-04-01 13:10:00
|
PORTABLE CHEST, ___
COMPARISON: ___ radiograph.
FINDINGS: Bilateral pleural catheters remain in place as well as a right
PICC. Since the prior chest radiograph, there has been dramatic increase in
extent of opacification of the left hemithorax, which is nearly completely
opacified with the exception of portions of the left upper lobe. This is
likely due primarly to an enlarging left pleural effusion in the setting of
recent clamping of pleural tube by history; near complete collapse of the left
lung is likely secondary to the effusion with or without a component of
bronchial obstruction from mucous plugging. This finding has been
communicated by telephone to Dr. ___ at 1:00 p.m. on ___ at
the time of discovery. On the right, a small pleural effusion and adjacent
atelectasis are not appreciably changed.
|
10192748-RR-151
| 10,192,748 | 28,902,887 |
RR
| 151 |
2140-04-02 09:40:00
|
2140-04-02 12:45:00
|
CHEST RADIOGRAPH
INDICATION: Retroperitoneal lymphoma, new chronic heart failure. Evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. The monitoring and support devices are in constant position.
Constant extent of the left pleural effusion. A pre-existing minimal left
upper ventilated lung area is now consolidated.
No relevant changes in the right lung, except for slightly decreased extent of
the pre-existing basal opacity. The left and right chest tubes are in
unchanged position.
|
10192748-RR-152
| 10,192,748 | 28,902,887 |
RR
| 152 |
2140-04-03 10:47:00
|
2140-04-03 13:25:00
|
EXAMINATION: AP chest, 11:01 a.m., on ___.
HISTORY: ___ woman with retroperitoneal lymphoma, new CHF and
hypercarbic respiratory failure. Mucus plugging with atelectasis. Bilateral
chest tubes in place.
IMPRESSION: AP chest compared to ___, 9:51 a.m.:
Left upper lobe has largely re-expanded. Moderate right pleural effusion is
larger. Small to moderate left pleural effusion is unchanged since ___ when the left upper lobe was still aerated. Left lower lobe is collapsed.
There is no pneumothorax. Heart is moderately enlarged but unchanged.
|
10192748-RR-153
| 10,192,748 | 28,902,887 |
RR
| 153 |
2140-04-04 11:26:00
|
2140-04-04 12:13:00
|
CHEST RADIOGRAPH
INDICATION: Lymphoma, chronic heart failure, chest tubes put to waterseal.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the right chest tube has
been removed. The extent of the right pleural effusion has slightly
increased. On the left, the position of the chest tube is constant. Constant
appearance of the heart and of the right-sided PICC line.
|
10192748-RR-154
| 10,192,748 | 28,902,887 |
RR
| 154 |
2140-04-04 21:41:00
|
2140-04-05 15:21:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Respiratory failure and bilateral pleural effusions.
Comparison is made with prior study, ___.
Large right and small-to-moderate left pleural effusions are stable associated
with adjacent opacities. There is no pneumothorax. Cardiomediastinal
contours are unchanged. There is severe S-shaped scoliosis. Right PICC is in
unchanged position. Left basal PICC catheter is in unchanged position.
|
10192748-RR-156
| 10,192,748 | 28,902,887 |
RR
| 156 |
2140-04-06 16:18:00
|
2140-04-06 17:37:00
|
PA AND LATERAL VIEWS OF THE CHEST.
REASON FOR EXAM: Respiratory failure, lymphoma, followup of pleural
effusions.
Comparison is made with prior study, ___.
Large bilateral effusions have increased on the left. Bibasilar atelectases
have also increased. There is no pneumothorax. There is severe S-shaped
scoliosis. Right PICC tip is in the upper SVC. Perihilar opacities have
improved, likely improving edema.
|
10192748-RR-157
| 10,192,748 | 28,902,887 |
RR
| 157 |
2140-04-08 09:01:00
|
2140-04-08 12:51:00
|
AP CHEST, 9:23 A.M. ON ___
HISTORY: ___ woman with lymphoma and recent hypercapnic respiratory
failure with bilateral pleural effusions and chest tubes.
IMPRESSION: AP chest compared to ___:
Moderate bilateral pleural effusions have grown. Left lower lobe remains
airless. Heart is severely enlarged, but the upper lobes show there is no
edema. Right PIC line ends in the uppermost SVC. No pneumothorax.
|
10192748-RR-158
| 10,192,748 | 28,902,887 |
RR
| 158 |
2140-04-09 09:54:00
|
2140-04-09 12:43:00
|
PA AND LATERAL CHEST, ___
HISTORY: ___ woman with a retroperitoneal lymphoma and bilateral
pleural effusion. Previous chest tubes have been removed.
IMPRESSION: AP chest compared to ___:
Moderate-to-large left pleural effusion continues to increase, both
posteriorly and in the fissure and over the apex of the left lung. Left lower
lobe is still collapsed. Small right pleural effusion is probably unchanged.
Cardiomediastinal silhouette is enlarged but stable. Right PIC line ends at
the origin of the SVC. There is no pneumothorax. Dr. ___ was paged.
|
10192748-RR-160
| 10,192,748 | 28,902,887 |
RR
| 160 |
2140-04-10 15:09:00
|
2140-04-10 16:28:00
|
HISTORY: ___ female with right pleural effusion status post PleurX
catheter placement.
STUDY: Portable AP upright chest radiograph.
COMPARISON: ___.
FINDINGS: There has been interval placement of a pleural pigtail catheter at
the right costophrenic angle with improvement in the previously described
right-sided pleural effusion. The right lung is well aerated. There is
complete opacification of the left hemithorax likely reflecting components of
left lung collapse and pleural fluid. This hemithoracic opacification
obscures the heart and mediastinal contours. Again, there is marked
dextroscoliosis of thoracic spine.
IMPRESSION:
1. Right pleural pigtail catheter placement without evidence of pneumothorax
and improvement in right pleural effusion.
2. Left hemithoracic opacification reflecting components of pleural effusion
and left lung collapse.
|
10192748-RR-161
| 10,192,748 | 28,902,887 |
RR
| 161 |
2140-04-11 14:47:00
|
2140-04-11 16:00:00
|
REASON FOR EXAMINATION: Evaluation of the patient with bilateral effusions
after right pleural catheter placement.
Portable AP radiograph of the chest was reviewed in comparison to ___.
The right pleural effusion appears to be increased since the prior study
despite the presence of the Pleurx catheter. There is no evidence of
pneumothorax. There is complete opacification of the left hemithorax with
left mediastinal shift, most likely due to a combination of atelectasis and
pleural effusion. Right PICC line tip is at the level of superior mid SVC.
Note is made that the atelectasis is newly appeared back on ___.
|
10192748-RR-162
| 10,192,748 | 28,902,887 |
RR
| 162 |
2140-04-12 08:13:00
|
2140-04-12 13:35:00
|
HISTORY: Recent respiratory failure, effusions, now with right Pleurx in
place, whiteout of the left lung likely from mucous plugging. Please evaluate
left lung atelectasis/mucous plugging and right lung effusion with Pleurx in
place.
TECHNIQUE: Portable AP chest.
COMPARISON: Multiple prior radiographs of the chest, most recent ___.
FINDINGS:
Complete opacification of the left hemithorax persists without appreciable
change. The moderate right pleural effusion is slightly larger since
yesterday despite reported good drainage from the Pleurx catheter. Of note,
the intrathoracic component of the catheter appears to be sharply kinked. The
cardiomediastinal silhouette is nearly completely obscured by the bilateral
opacities. There is no evidence of apical pneumothorax. A right PICC line
terminates in the mid SVC.
IMPRESSION:
1. Complete opacification of the left hemithorax is unchanged and while there
may be a component of pleural effusion, lung collapse is highly suspected,
perhaps secondary to mucous plugging as suggested.
2. The moderate right pleural effusion is slightly larger and the
intrathoracic portion of the Pleurx catheter appears kinked.
The above results were communicated via telephone by Dr. ___ to Dr. ___ at
13:20 on ___.
|
10192748-RR-163
| 10,192,748 | 28,902,887 |
RR
| 163 |
2140-04-13 07:59:00
|
2140-04-13 08:53:00
|
HISTORY: Left atelectasis from mucus plugging and right effusion with Pleurx
catheter in place.
FINDINGS: In comparison with the study of ___, there is little change in
the complete opacification of the left hemithorax. The right effusion may be
slightly smaller. PICC line remains in place and there is no evidence of
apical pneumothorax.
|
10192748-RR-164
| 10,192,748 | 28,902,887 |
RR
| 164 |
2140-04-14 09:17:00
|
2140-04-14 11:33:00
|
AP CHEST, 9:41 A.M. ON ___
HISTORY: An ___ man with a right pleural effusion and pleural
drainage catheter, with a recurrent left lung atelectasis due to mucus
plugging, recently intubated for respiratory failure, now with bilateral
pleural tubes.
IMPRESSION: AP chest compared to ___ at 8:06 a.m.:
Left lung is still collapsed. Small-to-moderate right pleural effusion is
present in the right lower chest despite the pleural drainage catheter. I see
no pneumothorax. Cardiac and mediastinal contours are obscured by the
collapsed left lung, and volume of pleural fluid in the left hemithorax is
also indeterminate. Right PIC line ends at the junction of brachiocephalic
veins.
|
10192748-RR-165
| 10,192,748 | 28,902,887 |
RR
| 165 |
2140-04-15 07:40:00
|
2140-04-15 08:44:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: The patient with respiratory failure, left lung collapse and
followup.
Comparison is made with prior study, ___.
There has been only minimally improvement of a small area of aerated lung in
the mid left hemithorax , ther rest of thr hemithorax is opacified, a
combination of large areas of atelectasis and unknown amount of effusion.
There is no evident pneumothorax. Cardiac and mediastinal contours are
obscured by the left lung opacities. Right PICC tip is at the confluence of
the brachiocephalic vein as before. Right lower lobe opacity is a combination
of small effusion and adjacent atelectasis, unchanged from prior. There is a
PleurX catheter in the right base, unchanged. Severe scoliosis is again noted.
|
10192748-RR-166
| 10,192,748 | 28,902,887 |
RR
| 166 |
2140-04-16 07:13:00
|
2140-04-16 09:33:00
|
STUDY: Chest radiograph.
INDICATION: Patient with PICC line. To assess position.
TECHNIQUE: Single portable AP radiograph was obtained.
COMPARISON: ___.
REPORT: The tip of the right-sided PICC line has been retracted and probably
lies at the brachiocephalic/caval junction.
There is an unchanged background change within the left hemithorax. In the
right lung, the chest tube remains unchanged, and probably slightly kinked
shortly after entry through the chest wall. No right-sided pneumothorax
though fluid persists in the right base. Profound scoliosis.
CONCLUSION: Slight retraction of PICC line. Unchanged chronic changes.
|
10192748-RR-169
| 10,192,748 | 28,902,887 |
RR
| 169 |
2140-04-16 10:22:00
|
2140-04-16 12:54:00
|
HISTORY: New right PICC via catheter exchange.
COMPARISON: ___ at 7:25.
FINDINGS:
Right PICC with tip ending at cavoatrial junction. No improvement in collapse
of the left lung and moderate right pleural effusion despite chest tube. No
pneumothorax.
IMPRESSION:
Right PICC tip ends cavoatrial junction. No pneumothorax.
Telephone notification of Dr. ___ by Dr. ___ at 11:30 on ___.
|
10192748-RR-170
| 10,192,748 | 28,902,887 |
RR
| 170 |
2140-04-17 08:54:00
|
2140-04-17 09:25:00
|
HISTORY: ___ female with lymphoma, chronic effusions on the right and
atelectatic lung on the left. Question interval change.
COMPARISON: ___.
FINDINGS:
Single portable view of the chest. Right PICC appears slightly withdrawn,
likely in the mid SVC. There is persistent complete opacification of left
hemithorax. Overall appearance of the right pleural effusion has not
significantly changed. Right-sided chest tube projects in similar location.
There is no definite pneumothorax. Osseous structures are unchanged noting a
mid thoracic dextroscoliosis.
IMPRESSION:
Mild interval retraction of the right PICC. Otherwise no change in the
appearance of the lungs including complete opacification of left hemithorax
and moderate right effusion.
|
10192748-RR-171
| 10,192,748 | 28,902,887 |
RR
| 171 |
2140-04-19 11:51:00
|
2140-04-19 14:14:00
|
HISTORY: Lymphoma with right effusion and left lung atelectasis.
FINDINGS: In comparison with the study of ___, the central catheter is in
the mid to low SVC. Again there is complete opacification of the left
hemithorax with little change in the right pleural effusion in this patient
with severe scoliosis convexed to the right. No definite pneumothorax.
IMPRESSION: Little change.
|
10192748-RR-172
| 10,192,748 | 28,902,887 |
RR
| 172 |
2140-04-21 08:55:00
|
2140-04-21 21:41:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Patient with right effusion, retroperitoneal lymphoma and
left atelectasis.
Comparison is made with prior study ___.
Complete whiteout of the left hemithorax is unchanged, is a combination of
large areas of atelectasis and unknown amount of pleural effusion. Right PICC
tip is in the low SVC. Cardiac size cannot be evaluated. Cardiomediastinum
is obscured by the left lung opacities, is deviated towards the left. Large
right effusion is unchanged. Severe right scoliosis is again noted. Right
chest tube is in place.
|
10192748-RR-173
| 10,192,748 | 28,902,887 |
RR
| 173 |
2140-04-27 15:08:00
|
2140-04-28 08:07:00
|
STUDY: PA and lateral chest, ___.
CLINICAL HISTORY: ___ woman with known right-sided pleural effusion
and PleurX catheter. Left lung collapse.
FINDINGS: Comparison is made to previous study from ___.
Since the prior study, there has been improved aeration of left upper lung
with moderate left-sided pleural effusion. There is slight interval decrease
in the right-sided pleural effusion which persists. There remains volume loss
in the left side. The cardiac silhouette is enlarged. There is severe
scoliosis. There is a right-sided PICC line with the distal lead tip in the
distal SVC, stable. No pneumothoraces are identified.
|
10192912-RR-10
| 10,192,912 | 25,917,825 |
RR
| 10 |
2120-03-20 22:22:00
|
2120-03-20 22:48:00
|
INDICATION: History: ___ with hip dislocation with plan for OR. // evaluate
for pulmonary edema
TECHNIQUE: Supine AP view of the chest
COMPARISON: None.
FINDINGS:
Heart size is normal. The aorta is diffusely calcified and mildly tortuous.
The mediastinal and hilar contours are otherwise unremarkable. The pulmonary
vasculature is not engorged. Streaky atelectasis is seen in the retrocardiac
region without focal consolidation. No pleural effusion or pneumothorax is
detected. No acute osseous abnormalities seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10192912-RR-11
| 10,192,912 | 25,917,825 |
RR
| 11 |
2120-03-21 11:36:00
|
2120-03-21 14:26:00
|
EXAMINATION: Intraoperative fluoroscopic images
INDICATION: ___ female with left hip dislocation.
TECHNIQUE: 3 fluoroscopic images of the pelvis were obtained intraoperatively
without the presence of a radiologist.
COMPARISON: Left hip radiographs from ___
FINDINGS:
3 intraoperative images were acquired during left hip closed reduction without
a radiologist present for total fluoro time of 11.8 seconds.
Images show total bilateral hip arthroplasty with reduction of the left hip
now in anatomic alignment.
IMPRESSION:
Intraoperative images were obtained during left hip reduction. Please refer
to the operative note for details of the procedure.
|
10192912-RR-12
| 10,192,912 | 25,917,825 |
RR
| 12 |
2120-03-22 13:00:00
|
2120-03-22 13:48:00
|
EXAMINATION: PELVIS (AP ONLY)
INDICATION: ___ year old woman with recurrent left hip dislocations s/p THA
// ?dislocation ?dislocation
IMPRESSION:
No previous images. There are bilateral total hip arthroplasties that appear
well seated without evidence of hardware-related complication. Of incidental
note is calcified fibroid in the pelvis.
|
10192912-RR-13
| 10,192,912 | 25,917,825 |
RR
| 13 |
2120-03-22 20:39:00
|
2120-03-22 22:06:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old woman s/p b/l total hip replacments with left L3
weakness. // evaluate for Left L3 foraminal stenosis evaluate for Left
L3 foraminal stenosis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: None.
FINDINGS:
Alignment is normal. There are degenerative changes in the lumbar spine with
multilevel disc space narrowing at L1-L2, L2-L3, L5-S1 levels. Multilevel
endplate hypertrophic changes, diffuse disc bulges and advanced facet
arthritis is seen. There is diffusion at the left L4-5 facet joint, with
adjacent posterior element mild edema, likely reactive. There is small facet
joint effusions elsewhere.
There is abnormal increased T2 signal involving L2-L3 disc, with mild adjacent
endplate edema, mild left paravertebral edema which extends to the level of
L4. There are mild adjacent endplate irregularities, which may be
degenerative. Findings can be seen secondary to degenerative changes. Early
disc space infection could have this appearance, clinically correlate. There
is no epidural fluid collection, no prevertebral edema or fluid collection.
The spinal cord appears normal in caliber and configuration.
There is mild central canal narrowing at L1-L2 level secondary to diffuse disc
bulge.
At L1-L2 level central canal is patent. Left foramen is patent. There is
mild right foraminal narrowing.
At L2-L3 level there is mild central canal narrowing. Mild encroachment on
bilateral traversing L3 nerves in the lateral recess from diffuse disc bulges.
Left foramen is patent. There is moderate right foraminal narrowing.
At L3-L4 level there is moderate central canal narrowing, with incomplete
effacement of the thecal sac. There is mild bilateral foraminal narrowing,
more prominent on the right.
L4-5 level: There is mild central canal narrowing, with narrowing of the
lateral recess bilaterally from disc bulge and facet arthritis. There is
moderate left foraminal narrowing. Left foraminal, far lateral diffuse disc
bulge contacts exited left L4 nerve. There is mild-to-moderate right
foraminal narrowing.
At L5-S1 level central canal is patent. There is mild-to-moderate bilateral
foraminal narrowing.
Other: There is small benign simple left renal cyst
IMPRESSION:
1. There are multilevel degenerative changes in the lumbar spine.
2. There is moderate central canal narrowing at L3-L4 level.
3. There is multilevel moderate foraminal narrowing, most prominent at left
L4-5 foramen.
4. Abnormal disc signal at L2-L3 level, mild paravertebral edema, may be
degenerative, early disc space infection could have this appearance,
clinically correlate.
|
10192912-RR-9
| 10,192,912 | 25,917,825 |
RR
| 9 |
2120-03-20 22:22:00
|
2120-03-20 22:44:00
|
INDICATION: History: ___ with left prosthetic hip dislocation // evaluate
post hip reduction attempt
TECHNIQUE: AP view of the pelvis, two views of the left hip
COMPARISON: ___ 15:29 from outside hospital
FINDINGS:
Osseous structures are diffusely demineralized. Patient is status post
bilateral hip arthroplasties. The left femoral component is superiorly and
anteriorly dislocated relative to the acetabular component. No hardware
loosening is identified however the inferior aspect of the right femoral stem
is incompletely imaged. No fracture is identified. No diastases of the pubic
symphysis or sacroiliac joints is seen. Heterogeneous coarse calcification in
the pelvis likely reflects calcified fibroids. Mild degenerative changes are
noted in the lower lumbar spine.
IMPRESSION:
Status post bilateral hip arthroplasties. Left femoral component is
superiorly and anteriorly dislocated relative to the acetabular component. No
fracture.
|
10193065-RR-21
| 10,193,065 | 23,797,594 |
RR
| 21 |
2128-10-08 20:16:00
|
2128-10-08 20:52:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with chest pain and dyspnea this afternoon, evidence of
volume overload on exam. Assess for volume overload, infiltrate, effusion.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
Compared with the prior radiograph, mild cardiomegaly is unchanged. Unfolded
aorta is unchanged. There is new pulmonary vascular congestion with mild
pulmonary edema. The previously described nodular opacity projecting in the
left mid to lower lung is obscured by the edema. No pneumothorax.
IMPRESSION:
1. New pulmonary vascular congestion and mild pulmonary edema.
2. Previously noted nodular opacity projecting over left heart border is
obscured on current exam. However, agree with the prior recommendation of ___ for nonemergent chest CT for further evaluation, once the acute
symptoms resolve.
NOTIFICATION: The above findings were communicated via telephone by Dr.
___ to Dr. ___ at 20:50 on ___, 2 min after discovery.
|
10193065-RR-31
| 10,193,065 | 20,678,041 |
RR
| 31 |
2129-04-03 01:06:00
|
2129-04-03 04:20:00
|
INDICATION: ___ male with congestive heart failure and dyspnea on
exertion. Please evaluate for pulmonary edema.
TECHNIQUE: PA and lateral chest radiographs were obtained.
COMPARISON: Chest radiograph from ___.
FINDINGS:
The heart continues to be enlarged with mild to moderate CHF. Possible
minimal blunting of both costophrenic angles could reflect small bilateral
effusions. There is bibasilar atelectasis. No focal consolidation or
pneumothorax is detected.
Right-sided rib fractures are better seen on the dedicated chest CT.
IMPRESSION:
Cardiomegaly with mild CHF. Possible very small bilateral effusions.
|
10193065-RR-32
| 10,193,065 | 20,678,041 |
RR
| 32 |
2129-04-03 01:57:00
|
2129-04-03 07:33:00
|
INDICATION: ___ male with congestive heart failure, dementia,
unwitnessed fall and right flank ecchymosis and tenderness. The patient has
posterior lower rib crepitus on this exam. Evaluate for intrathoracic or
intra- abdominal injury.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,641 mGy-cm.
COMPARISON: CT torso from ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: There is aneurysmal dilation of the ascending aorta
and aortic arch measuring 4.6 cm and 4.2 cm, similar to prior exam (series
3:image 35). A bovine arch is incidentally noted (series 601b:image 69). The
descending aorta is tortuous with mild calcified and noncalcified plaque along
the left posterior aspect. The heart is enlarged, and no pericardial effusion
is seen. There is dilation of the main pulmonary artery measuring 3.6 cm.
There is a new filling defect in a right lower lobe posterolateral
subsegmental branch (series 2:image 69). There is no evidence of right heart
strain.
AXILLA, HILA, AND MEDIASTINUM: No axillary, supraclavicular or hilar
lymphadenopathy is present. A top-normal in size right paratracheal lymph
node is noted measuring 10 mm in short axis (series 3:image 16). No
mediastinal mass or hematoma.
PLEURAL SPACES: There are trace pleural effusions.
LUNGS/AIRWAYS: Again noted is a left lower lobe 15 mm pulmonary nodule
(series 3:image 65). The airways are patent to the level of the segmental
bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
The thyroid gland is unremarkable.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits. The hepatic and portal veins are patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration. An accessory spleen is noted.
ADRENALS: Bilateral adrenal nodules are again noted, which are incompletely
evaluated on this exam (series 2:image 106, 96).
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of hydronephrosis. Bilateral small subcentimeter renal
hypodensities are too small to characterize but likely reflective of cysts.
Right upper pole cortical thinning may be due to prior insult such as ischemia
or infection (series 2:image 105). There is no perinephric abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. The small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. Few
scattered colonic diverticula are noted. The appendix is normal. There is no
evidence of mesenteric injury. There is no free fluid or free air in the
abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. A
prominent left para-aortic lymph node measures 9 mm and is not multiple
enlarged by CT size criteria (series 2:image 161). There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is ectasia of the infrarenal aorta measuring 2.4 cm. There is
aneurysmal dilation of the left common iliac artery measuring 2.0 cm. Ectasia
of the right common iliac artery measures 1.7 cm. Moderate atherosclerotic
disease is noted. The abdominal aorta and its major branches are patent. A
left retroaortic renal vein is incidentally noted.
BONES: There are minimally displaced posterolateral right tenth and eleventh
rib fractures, similar to prior exam. No focal suspicious osseous
abnormality.
SOFT TISSUES: Soft tissue swelling along the right flank overlying the
aforementioned rib fractures is again noted.
IMPRESSION:
1. Minimally displaced right posterolateral tenth and eleventh rib fractures,
similar to the CT from ___. No evidence of new traumatic injury
in the chest, abdomen or pelvis.
2. New right lower lobe subsegmental pulmonary embolism.
3. 15 mm left lower lobe pulmonary nodule. Recommend PET-CT for further
evaluation.
4. Bilateral adrenal nodules are incompletely evaluated and statistically
likely to reflect adenomas.
5. Similar aneurysmal dilation of the ascending thoracic aorta to 4.6 cm and
aneurysm dilation of the left common iliac artery.
6. Dilated pulmonary artery suggestive of pulmonary hypertension.
7. Cardiomegaly and trace bilateral pleural effusions.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 10:18 AM, 1 minutes after
updated findings.
|
10193065-RR-33
| 10,193,065 | 20,678,041 |
RR
| 33 |
2129-04-03 20:29:00
|
2129-04-03 21:06:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old man with CHF. newly diagnosed R subsegmental PE,
evaluate for 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 is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10193065-RR-34
| 10,193,065 | 20,678,041 |
RR
| 34 |
2129-04-03 21:03:00
|
2129-04-03 21:59:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with afib, PMH hemorrhagic strokes, CHF, found
down at rehab // Intracranial hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Head CT ___
FINDINGS:
There is chronic infarct involving medial left thalamus. There are stable
chronic lacunar infarct involving right upper thalamus, anterior limb right
internal capsule, right putaminal, left caudate head. There are extensive
bihemispheric chronic cortical infarcts involving bilateral frontal, bilateral
parietal, left occipital, right temporal lobes, stable. There is no evidence
of new or acute infarction, hemorrhage, edema, or mass. The ventricles and
sulci are normal in size and configuration.
There is right frontal burr hole. There is no evidence of fracture. There is
submucosal retention cyst in the right maxillary sinus. The visualized
portion of the remaining paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. There are no acute findings.
2. There are chronic multiple infarcts which are stable.
|
10193065-RR-36
| 10,193,065 | 20,678,041 |
RR
| 36 |
2129-04-04 21:29:00
|
2129-04-05 10:15:00
|
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: History of intraparenchymal hemorrhage with new pulmonary embolus
requiring heparin. Evaluate for micro bleed or stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Noncontrast head CTs dating from ___ through ___.
FINDINGS:
There is unchanged encephalomalacia from bifrontal, biparietal, right
occipital and right temporal infarcts. There is an additional chronic left
thalamic infarct as well as a small lacunar infarct in the right thalamus.
There is no new focus of slowed diffusion to suggest acute infarction. There
is no evidence of hemorrhage, edema, masses, mass effect, midline shift or
infarction. There is prominence of the ventricles and sulci suggestive of
involutional changes. Background areas of confluent pontine, periventricular,
subcortical and deep white matter T2/FLAIR hyperintensity likely reflect a
combination of infarct and chronic small vessel ischemic disease.
The principal intracranial vascular flow voids are preserved. The vertebral
arteries, basilar artery, anterior and middle cerebral arteries appear
ectatic.
There is postsurgical change from a right frontal burr hole. There are
numerous areas of susceptibility artifact in the bilateral basal ganglia,
thalami, midbrain, pons, medulla and bilateral cerebellar hemispheres, in a
pattern suggestive of chronic hypertensive encephalopathy. A few other
scattered areas of chronic microhemorrhage are seen in the bilateral parietal
lobes at the gray-white matter junction, with some in areas of prior infarct.
There is a tiny mucous retention cyst in the inferior aspect of the right
maxillary sinus. The remainder of the paranasal sinuses are grossly clear.
The orbits are grossly unremarkable.
IMPRESSION:
1. No acute infarct or acute hemorrhage.
2. Numerous chronic infarcts with associated volume loss, as described.
3. Numerous scattered areas of chronic microhemorrhage in the bilateral basal
ganglia, bilateral thalamus, brainstem and bilateral cerebellar hemispheres in
a distribution suggestive of chronic hypertensive etiology.
4. Moderate global atrophy with diffuse white matter signal abnormality
suggestive of chronic small vessel ischemic disease.
|
10193065-RR-53
| 10,193,065 | 29,152,780 |
RR
| 53 |
2130-11-02 14:11:00
|
2130-11-02 14:48:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB, cough.// Pneumonia/pulm edema?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Enlargement of the cardiac and mediastinal silhouette is grossly stable.
Large area of right mid to lower lung opacity is worrisome for pneumonia.
There is also mild pulmonary edema. Left perihilar opacity could relate to
pulmonary edema versus additional site of infection. No large pleural
effusion but trace pleural effusion the be present. There is no evidence of
pneumothorax.
IMPRESSION:
Large right lower is lobe consolidation, worrisome for pneumonia. Bilateral
perihilar opacities may be due to pulmonary edema, but additional site of
infection are not excluded.
Persistent enlargement of the cardiomediastinal silhouette.
|
10193065-RR-54
| 10,193,065 | 29,152,780 |
RR
| 54 |
2130-11-03 11:52:00
|
2130-11-03 12:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with history of b/l CVA, vascular dementia with
aphasia// Acute stroke?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: ___ noncontrast brain MRI. ___
noncontrast head CT.
FINDINGS:
Grossly stable left frontal, right parietal, left parietal, right temporal and
right occipital encephalomalacia is again noted.
Cavum septum pellucidum is again noted. There is prominence of the ventricles
and sulci suggestive of involutional changes. There are periventricular and
subcortical lucencies, which may represent small vessel ischemic changes.
Atherosclerotic vascular calcifications are noted of bilateral cavernous
portions of internal carotid arteries.
There is no evidence of acute large territorial infarction, acute intracranial
hemorrhage,edema,or mass. Right frontal burr hole is again noted.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, and middle ear cavities are clear. The visualized portion of the
orbits are preserved. Right mastoid air cell nonspecific partial
opacification noted. Soft tissue density is noted within the right external
auditory canal, which may represent cerumen.
IMPRESSION:
1. No acute intracranial abnormality with no definite evidence of acute large
territorial infarct. Please note MRI of the brain is more sensitive for the
detection of acute infarct.
2. Atrophy, probable small vessel ischemic changes, multiple chronic
infarcts, and atherosclerotic vascular disease as described.
3. Nonspecific partial right mastoid air cell opacification.
|
10193071-RR-6
| 10,193,071 | 25,403,919 |
RR
| 6 |
2171-06-28 15:10:00
|
2171-06-28 15:39:00
|
HISTORY: Abdominal pain status post colonoscopy, question free air.
TECHNIQUE: AP portable upright view of the chest.
COMPARISON: None.
FINDINGS:
There are relatively low lung volumes and likely bibasilar atelectasis. No
definite focal consolidation is seen. There is no large pleural effusion or
evidence of pneumothorax. The cardiac silhouette is top-normal. The aorta is
slightly tortuous. There is gaseous distention of the partially imaged bowel,
presumed related to recent colonoscopy.
IMPRESSION:
Low lung volumes. Gaseous distention of the partially imaged bowel.
No evidence of free air.
|
10193071-RR-7
| 10,193,071 | 25,403,919 |
RR
| 7 |
2171-06-28 16:51:00
|
2171-06-28 18:33:00
|
INDICATION: Status post colonoscopy with abdominal pain and distention, here
to evaluate for evidence of bowel perforation or solid organ injury.
COMPARISON: No prior studies available. Same-day chest radiograph performed
at 1510 p.m.
TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases to
the pubic symphysis following the uneventful administration of 130 cc
Omnipaque intravenous contrast. No enteric contrast was administered.
Coronal and sagittal reformatted images were generated and reviewed.
FINDINGS:
LUNG BASES: The imaged lung bases are clear. Limited imaging of the heart
demonstrates normal size without pericardial effusion. The distal esophagus
and descending thoracic aorta are within normal limits.
ABDOMEN: The liver enhances homogeneously without focal hepatic lesions.
Hypodensity in the right inferior tip of the liver (3:21) is thought to
represent artifact. The portal, splenic and superior mesenteric veins are
well opacified with intravenous contrast. No intrahepatic or extrahepatic
biliary ductal dilation is seen. The gallbladder, pancreas, spleen, accessory
spleen and bilateral adrenal glands are within normal limits. Both kidneys
enhance symmetrically and excrete contrast normally without evidence of
hydronephrosis. A left parapelvic cyst measures 3.4 x 2.4 cm (601B:43).
There is a 1.9 cm hypodensity in the cortex of the mid-to-lower left kidney
compatible with a renal cyst. No suspicious renal lesions are identified.
The stomach and duodenum are unremarkable. The jejunum is collapsed. There
are multiple borderline dilated air- and fluid-filled loops of distal small
bowel without transition point, but gradual decreased caliber in the left
lower quadrant. The large bowel is diffusely air-filled, but otherwise
unremarkable. Suture material in the right lower quadrant (3:52) most likely
represents evidence of prior appendectomy. No free air or ascites is present.
There are no pathologically enlarged retroperitoneal or mesenteric lymph nodes
by CT size criteria. The abdominal aorta is normal in caliber throughout.
PELVIS: The urinary bladder, prostate, seminal vesicles, the rectum and
sigmoid colon are within normal limits. There is no free pelvic fluid or
inguinal/pelvic lymphadenopathy.
OSSEOUS STRUCTURES: There are no osseous destructive lesions concerning for
malignancy. Mild degenerative changes are noted in the lumbar spine.
IMPRESSION:
1. No evidence of bowel perforation or solid organ injury. Suture material
in the right lower quadrant is compatible with prior appendectomy.
2. Diffusely air-filled large bowel, compatible with recent colonoscopy.
3. Multiple dilated loops of small bowel without transition point, but
gradual return to normal caliber in the left lower quadrant most likely
represents ileus and, less likely, early partial small-bowel obstruction.
|
10193074-RR-19
| 10,193,074 | 22,392,305 |
RR
| 19 |
2121-02-11 18:35:00
|
2121-02-11 21:00:00
|
INDICATION: ___ female with recent wisdom tooth extraction now with
right neck swelling, pain and fever. Evaluate for evidence of abscess.
COMPARISON: None available.
TECHNIQUE: Axial helical MDCT images were obtained from the skull base to the
upper lungs after the administration of IV contrast. Coronal and sagittal
reformations were generated.
DLP: 384.23 mGy-cm.
CTDI: 13.766.
FINDINGS: There is thickening of the soft tissues along the buccal aspect of
the right mandible, with numerous locules of gas tracking from the right
pterygoid muscles down to the right side of the floor of the mouth
(300B:48-300B:27). There is significant soft tissue edema extending from the
vicinity of the phlegmon, down to the superficial tissues of the right side of
the neck, obliterating the fat planes of the parapharyngeal space and possibly
extending focally to the retropharyngeal space (2:45). There is no drainable
fluid collection. Bilateral jugulodigastric lymphadenopathy is present, on
the right measuring 1.8 x 1.6 cm (2:38), and one node in the left measuring
1.8 x 1.4 cm (2:40).
There is no pneumomediastinum. The cervical lordosis is reversed. There is
no fracture or malalignment. No degenerative changes are observed. The
visualized lung apices are clear. The visualized intracranial structures are
also unremarkable. The paranasal sinuses, mastoid air cells and middle ear
cavities are clear. The salivary glands are within normal limits.
IMPRESSION:
1. Phlegmonous changes and multiple locules of gas tracking down from the
right pterygoid muscles into the right side of the floor of the mouth
compatible with Ludwig angina. Significant stranding and edema of the soft
tissues is present, extending into the lower anterior neck, obliterasting the
fat plane of the right parapharyngeal space and tracking posteriorly along
right neck with a possible focus of retropharyngeal edema.
2. No definite mediastinal involvement. No drainable fluid collection.
3. There is displacement of the airways to the left, without significant
compression. Bilateral cervical lymphadenopathy is likely reactive.
These findings were communicated to Dr. ___ on ___ at 8:00 p.m.,
immediately after discovery of the findings by Dr. ___.
|
10193074-RR-20
| 10,193,074 | 22,392,305 |
RR
| 20 |
2121-02-11 21:44:00
|
2121-02-12 09:58:00
|
PORTABLE AP CHEST
INDICATION: Patient with new tube.
COMPARISON: None.
FINDINGS:
ET tube ends 2.4 cm above the carina. NG tube is in the stomach. The lungs
are otherwise clear. Mediastinal and cardiac contours are normal. There is
no pleural effusion or pneumothorax.
CONCLUSION:
1. Tube and lines are in adequate position.
2. The remaining of the exam is normal.
|
10193074-RR-21
| 10,193,074 | 22,392,305 |
RR
| 21 |
2121-02-12 08:40:00
|
2121-02-12 10:55:00
|
INDICATION: ___ female patient with new left PICC line placement.
COMPARISON: Prior chest radiograph from ___.
TECHNIQUE: Portable AP chest radiograph.
FINDINGS: As compared to prior chest radiograph from ___, there
has been interval placement of a left PICC line, with its tip projecting over
the lower SVC. The line demonstrates an unremarkable course and there are no
complications, particularly no pneumothorax. An endotracheal tube terminates
3 cm above the carina. NG tube is seen projecting over the stomach, the tip is
not included in this image. The heart is normal in size. The hilar and
mediastinal contours are normal. The lungs are well expanded and clear.
There are no pleural effusions.
IMPRESSION: Left-sided PICC line tip at lower SVC with no pneumothorax.
These findings were discussed with ___, RN by Dr. ___ via
telephone on ___ at 10:00 a.m., at time of discovery.
|
10193074-RR-22
| 10,193,074 | 22,392,305 |
RR
| 22 |
2121-02-13 07:31:00
|
2121-02-13 09:09:00
|
CHEST RADIOGRAPH
INDICATION: Evaluation for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the nasogastric tube has
been removed. The other monitoring and support devices are constant.
Unchanged lung volumes. Minimal right pleural effusion that has newly
appeared. Minimal atelectasis at the right lung base. Unchanged size of the
cardiac silhouette. Unchanged appearance of the left lung.
|
10193074-RR-23
| 10,193,074 | 22,392,305 |
RR
| 23 |
2121-02-13 12:12:00
|
2121-02-13 18:54:00
|
INDICATION: ___ woman with nausea, large gastric bubble, ?
obstruction
COMPARISON: None available.
FINDINGS: Frontal supine and left lateral decubitus abdominal radiographs
demonstrate a non-distended stomach with normal bowel gas pattern. There is
no free air. Bones are unremarkable.
IMPRESSION: Non-obstructive bowel gas pattern.
|
10193074-RR-24
| 10,193,074 | 22,392,305 |
RR
| 24 |
2121-02-14 07:59:00
|
2121-02-14 09:41:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Intubated patient concerning for ET tube migration.
ET tube tip is in the standard position 3.2 cm above the carina.
Cardiomediastinal contours are normal. Left PICC tip is at the cavoatrial
junction. There is no pneumothorax. Right lower lobe opacity is a
combination of atelectasis and a small effusion. Minimal retrocardiac
atelectasis is unchanged.
|
10193074-RR-25
| 10,193,074 | 22,392,305 |
RR
| 25 |
2121-02-14 12:04:00
|
2121-02-14 15:21:00
|
HISTORY: Ludwig angina now with 3 days of antibiotics and steroids.
TECHNIQUE: Axial helical MDCT images were obtained from the skullbase to the
lung apices after the administration of IV contrast. Multiplanar reformatted
images were generated in the coronal and sagittal planes.
DLP: 398 point T2 mGy-cm.
COMPARISON: CT neck with contrast ___.
FINDINGS:
Again appreciated is a phlegmonous collection with internal locules of gas and
surrounding soft tissue thickening extending superiorly from the base of the
tongue tracking along the buccal aspect of the right mandible and along the
pterygoid muscles inferiorly to the parapharyngeal space. Mild surrounding
subcutaneous fat stranding is unchanged from prior exam. The extent of
phlegmon and surrounding inflammation is unchanged however there is decreased
internal loculation of gas with continuous organization of the phlegmon with a
greater fluid component than previously. The carotid spaces are well
maintained. Lucency and gas collection within the tooth extraction sites is
mildly improved compared to prior exam. Bilateral jugulodigastric
lymphadenopathy is unchanged.
There is no pneumomediastinum. There is reversal of normal cervical lordosis.
No fracture or cervical malalignment is identified. The visualized lung
apices remain clear. The thyroid gland is unremarkable. The trachea is
midline and there has been an interval placement of an endotracheal tube with
the resolution of a small fluid collection within the hypopharynx. The
visualized paranasal sinuses, mastoid air cells and middle ear cavities are
clear. The salivary glands are unremarkable with note of posterior and
lateral displacement of the right submandibular gland.
IMPRESSION:
1. Continued organization with decrease in loculated gas of a right submental
phlegmon, with unchanged area of extends and surrounding stranding and edema.
No evidence of mediastinal invasion. There is still no drainable fluid
collection. Close follow up is advised.
2. Previously identified possible focus of retropharyngeal edema has resolved.
Results were discussed over the telephone with Dr. ___ by Dr. ___
at 13:50 on ___ at time of initial review.
|
10193074-RR-27
| 10,193,074 | 22,392,305 |
RR
| 27 |
2121-02-16 08:09:00
|
2121-02-16 11:02:00
|
HISTORY: Ludwig's angina was intubated/extubated with overall improvement but
now with worsening submandibular swelling and fevers with concern for abscess
formation.
TECHNIQUE: Axial helical MDCT images were obtained from the skullbase to the
lung apices after the administration of IV contrast. Multiplanar reformatted
images were generated in the coronal and sagittal planes.
DLP: 384.35 mGy-cm.
COMPARISON: CT neck with contrast ___.
FINDINGS:
There has been further organization of the previously appreciated phlegmon
within the submandibular space which has further organized into a discrete rim
enhancing abscess. Internal gas loculations are relatively unchanged from
prior exam. The abscess itself is mainly centered in the submandibular space
bounded laterally by the submandibular glands. There is a redemonstration of
significant surrounding fat stranding indicative of cellulitis extending as
far superiorly on the right to the condyloid process as well as involvement of
the parapharyngeal space with stranding seen at the root of the bilateral ___
molars at the presumed site of infection, the base of the tongue and extending
inferiorly to cervical level III. Inflammation does not appear to extend to
the retropharyngeal space and there is no involvement of the mediastinum.
Reactive lymphadenopathy in cervical levels IA and IB as well as reactive
inflammation of the submandibular glands is unchanged. The vascular spaces
remain well maintained and the arterial vasculature appears patent.
There is no pneumomediastinum. The thyroid gland is unremarkable. The
trachea is midline and the imaged lung apices remain clear.
IMPRESSION:
Continued organization of submandibular space phlegmon now with discrete
abscess formation with rim enhancement. The abscess is relatively superficial
with a distinct drainable component. The surrounding extent of cellulitis
appears unchanged. The cervical vascular structures remain well maintained
and there is no evidence of mediastinal invasion.
Results were discussed over the telephone with Dr. ___ by Dr,
___ at 9:20 on ___ at time of initial review.
|
10193074-RR-28
| 10,193,074 | 22,392,305 |
RR
| 28 |
2121-02-16 14:57:00
|
2121-02-16 16:35:00
|
HISTORY: ___ female with recent nasotracheal intubation and probable
aspiration.
STUDY: PORTABLE AP CHEST RADIOGRAPH.
COMPARISON: ___.
FINDINGS: The endotracheal tube sits 3 cm above the carina. A left-sided
PICC terminates in the mid SVC. The heart size and mediastinal contours are
within normal limits. Ill-defined right basilar airspace opacity is present.
There is no pleural effusion or pneumothorax.
IMPRESSION: Right basilar opacity likely reflects aspiration or hemorrhage.
|
10193074-RR-29
| 10,193,074 | 22,392,305 |
RR
| 29 |
2121-02-17 05:58:00
|
2121-02-17 12:00:00
|
CLINICAL HISTORY: Nasogastric tube placed with epistaxis.
CHEST AP
COMPARISON: ___.
Position of the endotracheal tube remains satisfactory. The tip of the PICC
line lies in the mid SVC. The heart is not enlarged. The lung fields are
clear. A right basilar opacity seen on the prior chest x-ray is not seen, but
may be masked by the numerous overlying wires.
IMPRESSION: Chest clear.
|
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