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|---|---|---|---|---|---|---|---|
10193074-RR-30
| 10,193,074 | 22,392,305 |
RR
| 30 |
2121-02-18 05:48:00
|
2121-02-18 11:29:00
|
CHEST RADIOGRAPH
INDICATION: Traumatic intubation, evaluation for parenchymal opacities.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is an unchanged
evidence of a minimal opacity at the right lung base that could reflect
aspiration or atelectasis. No new parenchymal opacities. No pleural
effusions. No pneumothorax. Normal size of the cardiac silhouette.
Unchanged endotracheal tube and left PICC line.
|
10193074-RR-31
| 10,193,074 | 22,392,305 |
RR
| 31 |
2121-02-18 15:39:00
|
2121-02-18 18:10:00
|
HISTORY: ___ woman with Ludwigs Angina. Evaluate for interval
change.
COMPARISON: ___ as well as ___ and ___.
TECHNIQUE: CT of the neck with IV contrast as well as CT of the neck without
IV contrast was performed. Multiplanar reformatted images were generated in
the coronal and sagittal planes. CTDIvol 22 DLP 459.
FINDINGS: In the interval, two drains have been placed terminating on the
right side within the previously large collection of fluid and gas. While the
overall size of the collection and especially the amount of gas directly
adjacent to the catheter tips has decreased, there is still a collection of
fluid more inferiorly located (800B:25). These two pockets communicate with
one another (800B:32). This collection extends across the midline to the
contralateral side. Redemonstration of significant surrounding fat stranding
somewhat improved since the prior study. Inflammation does not appear to
extend into the retropharyngeal space and there is no involvement of the
mediastinum. Reactive lymphadenopathy is unchanged.
There is no pneumomediastinum. Trachea is midline and the imaged lung bases
are clear. The vascular spaces remain well maintained and the arterial
vasculature is patent.
IMPRESSION: Interval placement of two catheters which has decreased the
amount of fluid and particularly the gas within the collection. More
inferiorly, a portion of the collection crosses and communicates with the
pocket where the catheters are located.
|
10193074-RR-32
| 10,193,074 | 22,392,305 |
RR
| 32 |
2121-02-19 05:33:00
|
2121-02-19 08:22:00
|
PORTABLE CHEST X-RAY OF ___
COMPARISON: ___ radiograph.
FINDINGS: Indwelling support and monitoring devices are in standard position.
Cardiomediastinal contours are within normal limits. Nonspecific patchy
bibasilar opacities have slightly improved in the interval, particularly in
the left retrocardiac area. No new areas of lung opacity are evident in the
remainder of the lungs, and there are no definite pleural effusions or
pneumothoraces. Mild gastric distention is present in the upper abdomen.
|
10193295-RR-11
| 10,193,295 | 21,361,871 |
RR
| 11 |
2132-02-04 09:24:00
|
2132-02-04 12:26:00
|
INDICATION: Right upper quadrant pain radiating to the back.
COMPARISON: Liver gallbladder ultrasound ___.
TECHNIQUE: Grayscale and color Doppler ultrasound images of the abdomen were
obtained.
FINDINGS: The liver does not contain any focal lesion or textural
abnormality. Unchanged small 9-mm cyst is seen in the left lobe of the liver.
In the right lobe of the liver there is a 6 x 6 x 7 mm cyst that was not
visualized on the prior study. There is no intrahepatic biliary duct
dilation. The common bile duct measures 3 mm.
The tail of the pancreas is obscured by overlying bowel gas, however, the
visualized portion of the pancreas is unremarkable without evidence of focal
lesions or pancreatic duct dilation. The spleen measures 11 cm and has a
homogeneous echotexture. Kidneys are normal without evidence of
hydronephrosis or stones. Visualized portions of the aorta and superior vena
cava are unremarkable. There is marked gastric distention that is new
compared to the prior study.
IMPRESSION: Normal gallbladder and intra- and extra-hepatic biliary ducts.
Marked gastric distention, new since the prior exam. Consider radiograph or
CT if there is concern for bowel obstruction.
|
10193295-RR-12
| 10,193,295 | 21,361,871 |
RR
| 12 |
2132-02-04 12:14:00
|
2132-02-05 10:05:00
|
INDICATION: Epigastric pain.
COMPARISON: None.
TECHNIQUE: MDCT axial images through the abdomen were obtained after the
administration of 130 cc Omnipaque intravenous contrast and oral contrast
administration. Coronal and sagittal reformatted images were obtained.
FINDINGS: The visualized portions of the lung bases are clear. There is no
pericardial or pleural effusion.
CT ABDOMEN WITH IV AND ORAL CONTRAST: In the liver, subcentimeter
hypodensities are too small to further characterize. Gallbladder, spleen and
adrenal glands are unremarkable. The pancreas is compressed by the stomach
and is otherwise unremarkable. The kidneys concentrate and excrete contrast
bilaterally and there is no hydronephrosis. There are two subcentimeter
hypodensities in the left kidney that are too small to further characterize.
The stomach is massively dilated measuring up to 29 cm and contains contrast,
fluid, air, and particulate matter. The stomach wall is thinned and
featureless. A calibur transition at the pylorus is appreciated, however,
there is no obvious space occupying lesion or extrinsic mass and contrast has
passed into the duodenum. There is no bowel wall thickening. The small
bowel is mildly distended with air. There is no colonic wall thickening or
distention concerning for obstruction. The appendix is visualized in the
right lower quadrant and is unremarkable. The aorta is of normal caliber
throughout. The portal vein is patent. There is no free air, free fluid or
abdominal wall hernias.
CT OF THE PELVIS WITH IV AND ORAL CONTRAST: The bladder is collapsed. The
uterus contains a calcified fibroid and is otherwise unremarkable. The adnexa
are unremarkable. There is no pelvic free air or free fluid.
OSSEOUS STRUCTURES: In the T1 vertebral body a 5 mm well-circumscribed
sclerotic focus is most likely a bone island. There are no osteoblastic or
osteolytic lesions concerning for malignancy.
IMPRESSION: Marked gastric distention and dilation concerning for gastric
outlet obstruction. No cause identified. Correlation with endoscopy is
recommended.
|
10193755-RR-10
| 10,193,755 | 22,813,869 |
RR
| 10 |
2167-07-08 11:53:00
|
2167-07-08 15:15:00
|
EXAMINATION: L-SPINE (AP AND LAT) IN O.R.
INDICATION: L1-3 XLIF
TECHNIQUE: Frontal and lateral fluoroscopic images of the lumbar spine.
Total cumulative dose of 46.99 mGy and total fluoro time of 100.3 seconds.
COMPARISON: None
FINDINGS:
Fluoroscopic intraoperative images of the lumbar spine were obtained during
surgical manipulation without a radiologist present. Vertebral body spacers
are seen in the lumbar spine. Please refer to operative note for further
details.
IMPRESSION:
Please refer to intraoperative note for further details.
|
10193755-RR-11
| 10,193,755 | 22,813,869 |
RR
| 11 |
2167-07-10 07:42:00
|
2167-07-10 13:08:00
|
EXAMINATION: LUMBAR SP,SINGLE FILM IN O.R.
INDICATION: T10-S1 fusion laminectomy lumbar
FINDINGS:
3 intraoperative images were acquired without a radiologist present.
Images show fusion hardware and retractors and intervertebral spacers
overlying the lower thoracic and lumbar vertebral bodies during fusion and
laminectomy.
IMPRESSION:
Intraoperative images were obtained during T10-S1 fusion and laminectomy.
Please refer to the operative note for details of the procedure.
|
10193755-RR-12
| 10,193,755 | 22,813,869 |
RR
| 12 |
2167-07-10 12:19:00
|
2167-07-10 14:14:00
|
EXAMINATION: SCOLIOSIS SERIES IN O.R.
INDICATION: T10-S1 FUSION
TECHNIQUE: Portable intraoperative frontal radiograph of the chest and
abdomen.
COMPARISON: None available.
FINDINGS:
Intraoperative images were acquired without a radiologist present during T10
through S1 fusion with hardware including pedicle screws and left vertical rod
and intervertebral spacers. Multilevel degenerative changes of the thoracic
spine with disc space narrowing is again demonstrated.
Limited evaluation of the chest demonstrates ET tube in the lower thoracic
trachea, in close proximity to the carina. Opacities in the left lower lung
likely reflect atelectasis. Limited visualization of the abdomen demonstrates
a nonspecific nonobstructive bowel gas pattern.
Right hip arthroplasty partially visualized.
IMPRESSION:
Intraoperative images were obtained during T10-S1 fusion. Please refer to the
operative note for details of the procedure.
Limited evaluation of the chest demonstrates ET tube in the lower thoracic
trachea in close proximity to the carina. Opacities in the left lower lung
likely reflects atelectasis.
|
10193755-RR-13
| 10,193,755 | 22,813,869 |
RR
| 13 |
2167-07-10 13:08:00
|
2167-07-10 15:11:00
|
EXAMINATION: SCOLIOSIS SERIES
INDICATION: T10-S1 FUSION
TECHNIQUE: Frontal chest and abdomen radiographs were obtained
intraoperatively with
FINDINGS:
Intraoperative images were acquired without a radiologist present.
Images show spinal fusion hardware from T10-S1 fusion with a right vertical
rod and pedicle screws. Since the prior radiographs, there appears to be
adjustment to the position of the vertical rod and addition of a screw
projecting over the lower left lumbar spine.
IMPRESSION:
Intraoperative images were obtained during T10 through S1 fusion. Please refer
to the operative note for details of the procedure.
|
10193755-RR-8
| 10,193,755 | 22,813,869 |
RR
| 8 |
2167-07-06 11:37:00
|
2167-07-06 13:19:00
|
EXAMINATION: MRI CERVICAL AND THORACIC
INDICATION: ___ year old woman with leg weakness// eval compression
TECHNIQUE: MRI of the cervical and thoracic spine was performed using
sagittal T1, T2, water IDEAL, and axial T2 weighted images. Sagittal and
axial T1 weighted images were also obtained.
COMPARISON: None.
FINDINGS:
CERVICAL: Minimal anterolisthesis of C3 on C4 is noted. Elsewhere, cervical
vertebral bodies are preserved in alignment and they are preserved in height
throughout. No focal suspicious marrow lesion identified. Intervertebral
disc height loss is most severe at C4-5 but also seen at C5-6.
The cervical spinal cord is preserved in caliber and signal. Included portion
of the posterior fossa is unremarkable. Post-contrast images demonstrate no
abnormal enhancement.
At C2-3, there is a small disc bulge and extensive right facet joint
hypertrophy though without significant canal or foraminal narrowing.
At C3-4, there is a disc osteophyte complex and right greater than left
uncovertebral joint hypertrophy. There are extensive right facet joint
hypertrophic changes. Overall, these changes result in mild canal narrowing,
mild left and moderate right foraminal narrowing.
At C4-5, there is a disc osteophyte complex and right greater than left
uncovertebral joint hypertrophy. There is extensive right facet joint
hypertrophic changes. There is moderate to severe right foraminal narrowing
and overall mild canal narrowing. No significant left foraminal narrowing.
At C5-6, there is a disc osteophyte complex and bilateral uncovertebral joint
hypertrophy. These changes result in mild canal narrowing, moderate left and
mild-to-moderate right foraminal narrowing.
At C6-C7, there is a small disc osteophyte complex and left greater than right
uncovertebral joint hypertrophy. There is moderate left and mild-to-moderate
right foraminal narrowing. No significant overall canal narrowing.
There is a partially visualized at least 1.2 cm right thyroid nodule.
Included paraspinal soft tissues are otherwise grossly unremarkable.
THORACIC: Thoracic vertebral bodies are maintained in height and alignment.
Degenerative bone marrow signal changes seen at multiple levels including at
the endplates adjacent to the T1-T2 and T8-T9 through T10-T11 intervertebral
discs. No focal suspicious marrow lesion identified.
The spinal cord is preserved in signal and caliber. Post-contrast images
demonstrate no abnormal enhancement.
At T1-T2, there is a disc bulge and facet joint hypertrophy which result in
mild canal and moderate bilateral right worse than left foraminal narrowing.
At T2-T3, there is a disc bulge and facet joint hypertrophy resulting in mild
right foraminal and minimal overall canal narrowing.
At T3-T4, there is thickening of the ligamentum flavum without canal or
foraminal narrowing.
At T4-T5 through T8-T9, there are mild disc bulges and facet joint
hypertrophic changes though without significant canal or foraminal narrowing.
At T9-T10, there is a mild disc bulge and facet joint hypertrophy resulting in
mild canal and moderate right foraminal narrowing.
At T10-T11, there is a disc bulge and moderate facet joint hypertrophic
changes with thickening of the ligamentum flavum. These changes result in
moderate canal narrowing particularly in the AP dimension. There is contact
and remodeling of the cord at this level which appears preserved in signal.
There is also moderate bilateral right worse than left foraminal narrowing.
At T11-T12, there is disc bulge and facet joint hypertrophy resulting in mild
canal narrowing.
At T12-L1, there is no significant canal or foraminal narrowing.
Based on sagittal images: At L1-L2, there is intervertebral disc height loss
and a left central disc extrusion extending superiorly to level of the mid
third of the L1 vertebral body level and causing at least mild canal narrowing
eccentric to the left. Centered at the right posterior-lateral aspect of the
canal at the L1 level is a T2 hyperintense nonenhancing structure displacing
the tip of the conus and traversing nerve roots of the cauda equina
anteriorly. This structure extends off the inferior field of view and where
seen contributes to mild canal narrowing.
Included paraspinal soft tissues are unremarkable.
IMPRESSION:
1. Degenerative changes in the cervical spine resulting in up tomild canal
narrowing and moderate to severe right foraminal narrowing. No abnormal
enhancement.
2. Degenerative changes in the thoracic spine most extensive at T10-T11 where
there is a disc bulge and facet joint hypertrophy with thickening of the
ligamentum flavum causing moderate canal narrowing with contact and chronic
remodeling with flattening of the thoracic cord at this level. No cord signal
abnormality. No abnormal enhancement
3. Degenerative changes partially visualized with a left central disc
extrusion extending superiorly, only visualized on sagittal images on this
examination.
4. Incompletely visualized T2 hyperintense structure in the posterior aspect
of the canal at the L1 level posterolaterally on the right, more fully
evaluated on lumbar spine imaging.
5. Incompletely visualized right thyroid nodule which measures at least 1.2 cm
in size.
|
10193755-RR-9
| 10,193,755 | 22,813,869 |
RR
| 9 |
2167-07-07 12:53:00
|
2167-07-07 15:16:00
|
EXAMINATION: LUMBAR SINGLE VIEW IN OR
INDICATION: ANT. L3-S1 FUSION
TECHNIQUE: Cross-table portable view of the lumbar spine.
COMPARISON: None.
FINDINGS:
These images were obtained for guidance of procedure. No radiologist was
present for the exam. Mild joint space narrowing is seen in the visualized
lumbar spine. For full description of the exam, please refer to the
procedural note. Incidental note is made of a hip prosthesis.
IMPRESSION:
Images were obtained for procedural guidance. No radiologist was present for
the exam. Mild joint space narrowing is seen in the visualized lumbar spine.
For full description of the exam, please refer to the procedural note.
|
10193875-RR-64
| 10,193,875 | 20,281,843 |
RR
| 64 |
2165-08-19 22:26:00
|
2165-08-20 00:02:00
|
CHEST, TWO VIEWS: ___
HISTORY: ___ male with complaints of body pain and chest pain.
FINDINGS: PA and lateral views of the chest were compared to previous exam
from ___. Lungs are hyperinflated but clear of consolidation or
effusion. The cardiomediastinal silhouette is within normal limits. Osseous
and soft tissue structures are unremarkable.
IMPRESSION: Hyperinflation without acute cardiopulmonary process.
|
10193946-RR-16
| 10,193,946 | 22,870,970 |
RR
| 16 |
2119-02-12 03:03:00
|
2119-02-12 06:03:00
|
EXAMINATION: SHOULDER 1 VIEW RIGHT
INDICATION: History: ___ with dislocated r shoulder// do not obtain axillary
or unwrap- she dislocates easily. please obtain Velpeaux view in addition to
standard views do not obtain axillary or unwrap- she dislocates easily.
please obtain Velpeaux view in addition to standard views
TECHNIQUE: AP view of the right shoulder.
COMPARISON: Outside hospital shoulder radiographs ___
FINDINGS:
There is anterior dislocation of the right shoulder. No fracture seen. There
are no significant degenerative changes. No suspicious lytic or sclerotic
lesions are identified. No periarticular calcification or radio-opaque foreign
body is seen.
IMPRESSION:
Anterior shoulder dislocation.
|
10193946-RR-17
| 10,193,946 | 22,870,970 |
RR
| 17 |
2119-02-12 11:34:00
|
2119-02-12 13:18:00
|
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT
IMPRESSION:
Fluoroscopic images show steps in a closed reduction of the right shoulder.
Further information can be gathered from the operative report.
|
10194132-RR-19
| 10,194,132 | 20,336,899 |
RR
| 19 |
2189-09-13 06:52:00
|
2189-09-13 07:08:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ M s/p fall with ICH // eval for progression of ICH.
Please perform at 7AM
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: CT RADIATION DOSE SUMMARY:
This study involved 3 CT acquisition(s) with dose indices as follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0s, 16.4 cm; CTDIvol: 54.4 mGy (Head) DLP:
891.9 mGy-cm.
Total DLP: 892 mGy-cm.
COMPARISON: CT of the head dated ___.
FINDINGS:
There has been no significant interval change in size or appearance of the
left frontal lobe hemorrhagic lesion with surrounding edema. As before,
high-density material seen extending into what appears to the the extra-axial
space adjacent to this lesion. No new foci of hemorrhage are identified. The
ventricles and sulci are unchanged in size configuration. The basal cisterns
appear patent.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No significant interval change in size or appearance of the left frontal lobe
hemorrhagic mass with surrounding edema, with high-density material seen
extending into what appears to be the extra-axial space adjacent to this
lesion. No new foci of hemorrhage identified.
|
10194132-RR-20
| 10,194,132 | 20,336,899 |
RR
| 20 |
2189-09-13 20:15:00
|
2189-09-13 22:31:00
|
EXAMINATION: MRI AND MRA BRAIN
INDICATION: History: ___ s/p fall with ICH // eval for hemorrhage vs mass
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
An MRI of the head without contrast was also performed. Three dimensional
maximum intensity projection and segmented images were generated. This report
is based on interpretation of all of these images.
COMPARISON: Prior MRI available for comparison. Prior head CT dated ___
FINDINGS:
MRI head: There is a left frontal lobe intraparenchymal hematoma with
surrounding vasogenic edema again noted. Accounting for differences in
modality, this appears similar to appearance on prior CT scan. There is no
evidence of new hemorrhage. There is no evidence of acute territorial
infarction. The ventricles and sulci are prominent but within normal limits
for age. Major vascular flow voids are preserved. The orbits are
unremarkable. There is moderate mucosal thickening within the ethmoid air
cells. The remaining paranasal sinuses and mastoid air cells are clear.
MRA head: Image quality is degraded by motion artifact. The major
intracranial arteries appear normal with no evidence of stenosis, occlusion,
or aneurysm formation.
IMPRESSION:
1. No significant interval change in left frontal lobe intraparenchymal
hematoma with small amount of surrounding vasogenic edema. Intravenous
contrast was not administered. This limits evaluation for the presence of
underlying mass which cannot be entirely excluded. Followup MRI examination
with contrast to evaluate for underlying mass lesion is recommended.
2. MRA images degraded by motion artifact. No definite evidence of aneurysm,
vascular malformation, or stenosis.
RECOMMENDATION(S): Followup MRI examination with contrast to evaluate for
underlying mass lesion is recommended.
|
10194314-RR-10
| 10,194,314 | 29,997,991 |
RR
| 10 |
2130-03-30 18:33:00
|
2130-03-31 14:44:00
|
MRI OF THE HEAD
CLINICAL INFORMATION: ___ woman with new left MCA stroke. Evaluate
for ischemic damage.
COMPARISON: CT of the head with perfusion, ___.
TECHNIQUE: Non-contrast MRI examination of the head was performed with T1-
and T2-weighted images, as well as diffusion-weighted imaging and axial FLAIR
sequence.
FINDINGS: There is restricted diffusion in the distribution of the superior
division of the left MCA involving the insula extending into the left frontal
lobe superiorly. There is no evidence of hemorrhage. The FLAIR images
demonstrate mildly increased signal in the corresponding regions. There are
also scattered foci of increased signal in the subcortical white matter
bilaterally.
There is no mass lesion or hemorrhage. Normal flow voids are present in the
major intracranial vessels. Visualized paranasal sinuses, mastoids, and
orbital contents are unremarkable.
IMPRESSION: Subacute infarct in the distribution of the superior division of
the left middle cerebral artery. No hemorrhagic transformation.
COMMENT: Findings were communicated to Dr. ___, by Dr. ___
textpage at 2:55 p.m. on ___.
|
10194314-RR-8
| 10,194,314 | 29,997,991 |
RR
| 8 |
2130-03-30 13:40:00
|
2130-03-30 23:20:00
|
INDICATION: Right facial droop and pronator drift, to evaluate for stroke.
COMPARISON: OSH CT head done on the same day, report not available for
perusal.
TECHNIQUE: CT head without contrast; CT angiogram of the head and neck; CT
cerebral perfusion study, perfusion color maps and 2D and 3D reformations of
the intra- and extra-cranial arteries.
FINDINGS:
CT HEAD: There is a hypodense area in the left MCA territory in the frontal
lobe, extending into the insular region. No definite hemorrhage is noted.
A tiny dense focus noted in the MCA branch in the left Sylvian fissure, series
2, image 11, which may represent a focus of calcification.
A hypodense focus is noted in the left caudate likely represents a lacunar
infarct.
No suspicious osseous lesions are noted.
CT CEREBRAL PERFUSION STUDY: There is a large area of altered perfusion, in
the left frontal lobe in the MCA territory, with increased MTT and low blood
flow and blood volume, representing changes related to ischemia and
infarction.
CT ANGIOGRAM OF THE HEAD AND NECK:
There is decreased visualization of some of the branches of the left MCA.
CT NECK: Thyroid nodule is noted in the right lobe.
IMPRESSION:
1. Left MCA territory infarct in the left frontal lobe. Tiny dense focus,
question thrombus/calcification in the left sylvian fissure.
2. Slightly decreased visualization of some of the MCA branches on the left
side.
DETAILS TO FOLLOW AS ADDENDUM.
|
10194314-RR-9
| 10,194,314 | 29,997,991 |
RR
| 9 |
2130-03-30 16:13:00
|
2130-03-30 17:40:00
|
CHEST RADIOGRAPH
INDICATION: Acute left MCA stroke, questionable pulmonary process.
COMPARISON: ___, 11:55 (outside hospital).
FINDINGS: The lung volumes are normal. Borderline size of the cardiac
silhouette with signs of blood flow redistribution and relatively large
vascular diameters. The findings suggest mild-to-moderate pulmonary edema.
No pleural effusions. No pneumonia. No pneumothorax.
At the time of dictation and observation, at 4:50 p.m., on ___, the
referring physician, ___ was paged for notification. Findings were
subsequently discussed over the telephone.
|
10194423-RR-9
| 10,194,423 | 25,670,259 |
RR
| 9 |
2126-12-11 21:22:00
|
2126-12-11 21:48:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Status post fall with left frontal subdural hematoma. Assess for
interval change.
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast. Multiplanar reformats were generated in the coronal and sagittal
planes.
DOSE: DLP: 891.93 mGy-cm
CTDI: 55.2 mGy
COMPARISON: Outside hospital head CT ___.
FINDINGS:
Left frontoparietal subdural hematoma measure up to 4 mm (02:13, 602b:64,
601b:61) has not significantly changed compared to the prior examination. No
new focus of hemorrhage. There is no evidence of infarction, edema, or mass.
The ventricles and sulci are stable size and configuration with re-
demonstration of greater than expected frontal and cerebellar atrophy.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No significant interval change of a 4 mm left frontoparietal subdural
hematoma.
|
10194602-RR-24
| 10,194,602 | 29,342,922 |
RR
| 24 |
2134-06-18 00:53:00
|
2134-06-18 03:40:00
|
INDICATION: History: ___ with cough// ? pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CT from ___
FINDINGS:
Lungs are well expanded clear. Cardiac silhouette is top-normal in size.
Tortuous aorta re-demonstrated. Mediastinal silhouette and hila are normal.
No pneumothorax or pleural effusion.
IMPRESSION:
No pneumonia.
|
10194602-RR-25
| 10,194,602 | 29,342,922 |
RR
| 25 |
2134-06-18 02:12:00
|
2134-06-18 02:47:00
|
EXAMINATION: RENAL U.S.
INDICATION: History: ___ with colon cancer and ___// evaluation for
nephrolithiasis or obstructive causes ___
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
The right kidney measures 11.6 cm. The left kidney measures 13.1 cm. There is
no hydronephrosis or masses in either kidney. In the right kidney, a 3.1 x
3.1 cm anechoic cyst is re-demonstrated. No definite stones. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is only minimally distended and can not be fully assessed on the
current study.
Hepatic masses are consistent with known metastatic disease, better assessed
on recent CT.
IMPRESSION:
No hydronephrosis or definite stones.
|
10194602-RR-26
| 10,194,602 | 29,342,922 |
RR
| 26 |
2134-06-18 15:52:00
|
2134-06-18 17:21:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with colon cancer and new ___, concern for
possible renal thrombus// e/o thrombus
TECHNIQUE: Grey scale and color Doppler and spectral ultrasound images of the
kidneys were obtained.
COMPARISON: Renal ultrasound from ___ CT abdomen and pelvis ___.
FINDINGS:
The right kidney measures 11.4 cm. The left kidney measures 12.9 cm. There is
no hydronephrosis, or masses bilaterally. Stable 3.1 cm cyst in the right
kidney. Nonobstructing 5 mm calculus in the interpolar region of the right
kidney, unchanged compared to the prior CT. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally. The renal arteries and
renal veins are patent by color Doppler with normal waveforms.
The bladder is moderately well distended with small amount of debris.
IMPRESSION:
No evidence of renal vein thrombosis or hydronephrosis.
|
10194756-RR-19
| 10,194,756 | 24,976,083 |
RR
| 19 |
2183-03-15 16:06:00
|
2183-03-15 16:25:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough, shortness of breath// Pneumonia
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. It elevated right hemidiaphragm
is mild-to-moderate. Lungs are clear. There is no focal consolidation,
effusion, or pneumothorax. There are no signs of congestion or edema. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process. Elevated right hemidiaphragm.
|
10194756-RR-20
| 10,194,756 | 24,976,083 |
RR
| 20 |
2183-03-15 15:38:00
|
2183-03-15 16:03:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with liver failure acute, abdominal pain, jaundice// Portal
vein thrombosis
TECHNIQUE: Right upper quadrant ultrasound
COMPARISON: None.
FINDINGS:
The liver is markedly echogenic with poor penetration, limiting assessment.
Evaluation for focal discrete lesion is limited though no large lesions are
seen. Main portal vein is patent with hepatopetal flow. No ascites is seen.
Sludge and stones are seen within the gallbladder. There is no sonographic
___ sign or ultrasound evidence for acute cholecystitis. The common bile
duct common bile duct is normal in size measuring up to 5 mm. No intrahepatic
biliary ductal dilation is seen. The right kidney appears normal measuring
10.3 cm in length. No hydronephrosis or worrisome lesion. The spleen is
mildly enlarged at 13.3 cm in length. The left kidney appears normal
measuring 12.2 cm in length. No worrisome lesion or hydronephrosis.
IMPRESSION:
1. Echogenic liver with poor penetration, suboptimally assessed, may
represent steatosis, though more advanced forms of liver disease not excluded
on the basis of this appearance.
2. Cholelithiasis without evidence of cholecystitis.
3. Main portal vein patent with hepatopetal flow.
4. Mild splenomegaly.
|
10194804-RR-18
| 10,194,804 | 28,431,878 |
RR
| 18 |
2141-03-17 19:37:00
|
2141-03-18 12:06:00
|
EXAMINATION: MRI CERVICAL AND THORACIC; MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with L leg numbness/weakness, history of
fluctuating neurological symptoms, white matter lesions, and prior diagnosis
of possible MS // Query demyelinating disease or other process. Need sagittal
FLAIR. Please do on 3T scanner. Please do not re-protocol without discussing
with primary team.
TECHNIQUE: MR head: FLAIR 3D cube with coronal and axial reformats, axial
FLAIR, axial T1 pre and postcontrast, axial T2, axial gradient echo, sagittal
MPRAGE postcontrast with coronal and axial reformats, axial diffusion-weighted
sequences of the brain following departmental MS protocol.
MR cervical and thoracic spine: Sagittal T1 pre and postcontrast, sagittal T2,
sagittal ideal water, fat, inphase sequences of the cervical and thoracic
spine. Axial T2 and T1 postcontrast sequences of the cervical and thoracic
spine also obtained following departmental MS protocol.
6 cc Gadavist.
COMPARISON: None
FINDINGS:
MR head: There are several nonenhancing subcortical, periventricular and
pontine white matter T2/FLAIR hyperintensities, some of which extends
perpendicularly from the corpus callosum, compatible with a demyelinating
process such as MS.
___ for enhancement limited on the MPRAGE postcontrast sequences due to
significant pulsation artifacts related to the 3 T scanner.
Sulci, ventricles and cisterns are within expected limits for the patient's
age. There is no evidence of acute infarct or intracranial hemorrhage. No
intra or extra-axial mass effect.
The Major intracranial flow voids are preserved. The dural venous sinuses are
patent.
There is mild mucosal thickening of the ethmoid air cells, otherwise the a
remainder the paranasal sinuses are essentially clear. The orbits are
unremarkable. The mastoid air cells are clear.
Slightly hypointense marrow signal.
MR cervical and thoracic spine:
Evaluation is slightly suboptimal secondary to motion and pulsation artifacts,
particularly of the postcontrast axial sequences.
There is a possible focus of increased T2 signal intensity in the cervical
cord at C3 level without enhancement.
There is a focus of T2 hyperintense signal in the left lateral cord spanning
the C6 and C7 vertebral levels demonstrating postcontrast enhancement. There
is also a focus of T2 hyperintense signal demonstrating mild postcontrast
enhancement of the anterior cord at the T10-11 level.
Cervical alignment is anatomic. Disc and vertebral body heights are
maintained. There is no suspicious marrow signal. The craniocervical junction
is unremarkable. The anterior atlantodental interval is also unremarkable. The
marrow signal is unremarkable. The conus terminates at the superior endplate
of L1, within expected limits.
C2-3 and C3-4: There is no significant spinal canal or neural foraminal
narrowing.
C4-5: There is a central disc protrusion as well as bilateral facet and
uncovertebral arthropathy. This results in a mild bilateral neural foraminal
narrowing, right more than left, without significant spinal canal narrowing,
although the disc does contact and minimally efface the ventral aspect of the
thecal sac.
C5-6: There is a small central disc protrusion as well as right greater than
left uncovertebral arthropathy. This results in mild to moderate right neural
foraminal narrowing and no significant left neural foraminal narrowing.
C6-7: There is a small central disc protrusion as well as mild bilateral
uncovertebral arthropathy. There is no significant spinal canal or neural
foraminal narrowing.
C7-T1: There is no significant spinal canal or neural foraminal narrowing.
Thoracic spine: There is no significant disc herniation, no spinal canal or
neural foraminal narrowing.
Other: The thyroid gland appears unremarkable. Prevertebral and paraspinal
soft tissues also appear unremarkable. Visualized abdominal organs are also
unremarkable.
IMPRESSION:
1. Multiple foci of white matter FLAIR hyperintense signal of the subcortical
and periventricular as well as pontine white matter in a distribution
compatible with demyelinating process such as multiple sclerosis. There are no
intracranial enhancing lesions to suggest active demyelinating plaque,
assessment somewhat limited due to significant pulsation artifacts.
No evidence of acute infarct.
2. T2 hyperintense mildly enhancing foci at the left aspect of the cervical
cord at C6-7 as well as of the anterior thoracic cord at T10-11, suggesting
active demyelinating process. Additional T2 nonenhancing hyperintense lesion
at the C3 level.
3. Multilevel mild cervical spondylosis as described above with foraminal
narrowing at C4-5, C5-6 levels.
|
10194804-RR-19
| 10,194,804 | 28,431,878 |
RR
| 19 |
2141-03-17 21:24:00
|
2141-03-18 12:06:00
|
EXAMINATION: MRI CERVICAL AND THORACIC; MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with L leg numbness/weakness, history of
fluctuating neurological symptoms, white matter lesions, and prior diagnosis
of possible MS // Query demyelinating disease or other process. Need sagittal
FLAIR. Please do on 3T scanner. Please do not re-protocol without discussing
with primary team.
TECHNIQUE: MR head: FLAIR 3D cube with coronal and axial reformats, axial
FLAIR, axial T1 pre and postcontrast, axial T2, axial gradient echo, sagittal
MPRAGE postcontrast with coronal and axial reformats, axial diffusion-weighted
sequences of the brain following departmental MS protocol.
MR cervical and thoracic spine: Sagittal T1 pre and postcontrast, sagittal T2,
sagittal ideal water, fat, inphase sequences of the cervical and thoracic
spine. Axial T2 and T1 postcontrast sequences of the cervical and thoracic
spine also obtained following departmental MS protocol.
6 cc Gadavist.
COMPARISON: None
FINDINGS:
MR head: There are several nonenhancing subcortical, periventricular and
pontine white matter T2/FLAIR hyperintensities, some of which extends
perpendicularly from the corpus callosum, compatible with a demyelinating
process such as MS.
___ for enhancement limited on the MPRAGE postcontrast sequences due to
significant pulsation artifacts related to the 3 T scanner.
Sulci, ventricles and cisterns are within expected limits for the patient's
age. There is no evidence of acute infarct or intracranial hemorrhage. No
intra or extra-axial mass effect.
The Major intracranial flow voids are preserved. The dural venous sinuses are
patent.
There is mild mucosal thickening of the ethmoid air cells, otherwise the a
remainder the paranasal sinuses are essentially clear. The orbits are
unremarkable. The mastoid air cells are clear.
Slightly hypointense marrow signal.
MR cervical and thoracic spine:
Evaluation is slightly suboptimal secondary to motion and pulsation artifacts,
particularly of the postcontrast axial sequences.
There is a possible focus of increased T2 signal intensity in the cervical
cord at C3 level without enhancement.
There is a focus of T2 hyperintense signal in the left lateral cord spanning
the C6 and C7 vertebral levels demonstrating postcontrast enhancement. There
is also a focus of T2 hyperintense signal demonstrating mild postcontrast
enhancement of the anterior cord at the T10-11 level.
Cervical alignment is anatomic. Disc and vertebral body heights are
maintained. There is no suspicious marrow signal. The craniocervical junction
is unremarkable. The anterior atlantodental interval is also unremarkable. The
marrow signal is unremarkable. The conus terminates at the superior endplate
of L1, within expected limits.
C2-3 and C3-4: There is no significant spinal canal or neural foraminal
narrowing.
C4-5: There is a central disc protrusion as well as bilateral facet and
uncovertebral arthropathy. This results in a mild bilateral neural foraminal
narrowing, right more than left, without significant spinal canal narrowing,
although the disc does contact and minimally efface the ventral aspect of the
thecal sac.
C5-6: There is a small central disc protrusion as well as right greater than
left uncovertebral arthropathy. This results in mild to moderate right neural
foraminal narrowing and no significant left neural foraminal narrowing.
C6-7: There is a small central disc protrusion as well as mild bilateral
uncovertebral arthropathy. There is no significant spinal canal or neural
foraminal narrowing.
C7-T1: There is no significant spinal canal or neural foraminal narrowing.
Thoracic spine: There is no significant disc herniation, no spinal canal or
neural foraminal narrowing.
Other: The thyroid gland appears unremarkable. Prevertebral and paraspinal
soft tissues also appear unremarkable. Visualized abdominal organs are also
unremarkable.
IMPRESSION:
1. Multiple foci of white matter FLAIR hyperintense signal of the subcortical
and periventricular as well as pontine white matter in a distribution
compatible with demyelinating process such as multiple sclerosis. There are no
intracranial enhancing lesions to suggest active demyelinating plaque,
assessment somewhat limited due to significant pulsation artifacts.
No evidence of acute infarct.
2. T2 hyperintense mildly enhancing foci at the left aspect of the cervical
cord at C6-7 as well as of the anterior thoracic cord at T10-11, suggesting
active demyelinating process. Additional T2 nonenhancing hyperintense lesion
at the C3 level.
3. Multilevel mild cervical spondylosis as described above with foraminal
narrowing at C4-5, C5-6 levels.
|
10194804-RR-21
| 10,194,804 | 28,431,878 |
RR
| 21 |
2141-03-20 09:19:00
|
2141-03-20 11:23:00
|
EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO)
INDICATION: ___ year old woman with suspected multiple sclerosis, needs LP for
MS profile, failed bedside attempts at L3-4 and L4-5 // Multiple sclerosis?
CNS Lyme?
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A preprocedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs. A preprocedure scout film was obtained and the L4-5 level
was selected.
Puncture was performed at L4-5.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia into
the subcutaneous tissues at L4-5. Under fluoroscopic guidance, a 20 gauge
spinal needle was inserted into the thecal sac. There was good return of CSF.
Opening pressure was 25 cm H2O (measured in the prone position). 18 cc's of
clear colorless CSF was collected in 4 tubes and sent for requested analysis.
Total fluoroscopy time was 43 seconds; skin dose 3 mGy.
COMPARISON: MRI head, cervical and thoracic spine ___
FINDINGS:
Opening pressure 25 cm H2O (measured in the prone position). 18 cc's of clear
colorless CSF was collected in 4 tubes.
IMPRESSION:
Lumbar puncture at L4-5 without complication.
I, Dr. ___ supervised the trainee during the key components
of the above procedure and I reviewed and agree with the Resident's findings
and dictation.
NOTIFICATION: Findings discussed by Dr. ___ of radiology with Dr.
___ by phone at 11:15 a.m. ___.
|
10194974-RR-12
| 10,194,974 | 28,046,822 |
RR
| 12 |
2201-04-07 13:35:00
|
2201-04-07 14:46:00
|
INDICATION: Status post fall downstairs, stat trauma
COMPARISON: None
FINDINGS:
Portable supine AP view the chest provided. The endotracheal tube terminates
4.4 cm above the carina. The OG tube terminates at the GE junction. The
lungs appear grossly clear. Cardiomediastinal silhouette appears normal.
Imaged bony structures are intact.
IMPRESSION:
OG tube terminates at the GE junction. Please note, the OG tube is coiled in
the pharynx as seen on CT of the cervical spine. Repositioning is advised.
ET tube positioned appropriately.
|
10194974-RR-13
| 10,194,974 | 28,046,822 |
RR
| 13 |
2201-04-07 13:44:00
|
2201-04-07 14:36:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ status post fall down stairs.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Small focus of extra-axial hemorrhage is seen along the right middle cranial
fossa measuring up to 4 mm in thickness, series 2, image 7 adjacent to a right
squamous temporal bone fracture. A small amount of adjacent subarachnoid
hemorrhage is noted as well as minimal inferior right temporal lobe contusion.
There is a small area of hemorrhagic contusion in the left inferior temporal
lobe, series 2, image 8 with minimal adjacent subarachnoid hemorrhage which is
best seen on series 602, image 62. No additional sites of hemorrhage.
Gray-white matter differentiation is preserved. Ventricular size is normal.
Basal cisterns are patent. No significant mass effect or midline shift.
There is a fracture involving the right frontal bone extending to the right
orbital roof. Additionally, there is a fracture of right squamous temporal
bone which is minimally displaced. Additional fractures involving the
bilateral greater wing of sphenoid, and bilateral lamina papyracea are
described in further detail on concurrently performed CT facial bones.
IMPRESSION:
1. Hemorrhagic contusion with subarachnoid and small subdural hemorrhage in
the right inferior temporal lobe without significant mass-effect.
2. Hemorrhagic contusion with adjacent subarachnoid hemorrhage in the left
inferior temporal lobe.
3. Multiple fractures, specifically involving the right squamous temporal
bone, right frontal bone extending to the right orbital roof, bilateral
sphenoid greater wing fractures and bilateral lamina papyracea fractures
described in further detail on concurrently performed CT of the facial bones.
NOTIFICATION: The findings were discussed with Dr. ___ by ___,
M.D. on the telephone on ___ at 2:10 pm, 1 minutes after discovery of the
findings.
|
10194974-RR-14
| 10,194,974 | 28,046,822 |
RR
| 14 |
2201-04-07 13:45:00
|
2201-04-07 14:19:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall down stairs.
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations.
DOSE: Total DLP (Body) = 585 mGy-cm.
COMPARISON: None
FINDINGS:
The orogastric tube is coiled in the pharynx. There is no fracture or
malalignment within the cervical spine. No prevertebral edema. Mild endplate
spurring is seen at C5 through C7. No critical stenosis. Thyroid appears
normal.
IMPRESSION:
1. Orogastric tube coiled in the pharynx, recommend repositioning.
2. No fracture or malalignment in the cervical spine.
|
10194974-RR-15
| 10,194,974 | 28,046,822 |
RR
| 15 |
2201-04-07 13:45:00
|
2201-04-07 14:37:00
|
EXAMINATION: CT CHEST, ABDOMEN, AND PELVIS
INDICATION: Status post fall down stairs.
TECHNIQUE: Multidetector CT through the chest, abdomen, and pelvis was
performed following IV contrast administration with multiplanar reformations
provided.
DOSE Total DLP (Body) = 1,734 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST: The endotracheal tube terminates approximately 3.8 cm above the
carina. The endogastric tube terminates at the GE junction. The thoracic
aorta is normal in course and caliber without appreciable atherosclerotic
calcifications. The main pulmonary artery is normal in size with patent
central branches. There is no adenopathy or mediastinal hematoma. The heart
is normal in size and shape without pericardial effusion.
Posterior basal opacities are most suggestive of atelectasis and sequelae of
aspiration. No signs of contusion, laceration, pneumothorax or hemothorax.
ABDOMEN: The liver is intact. A peripheral 8 mm hyperdensity within segment
4 A/B on series 2, image 99 is indeterminate, possibly a hemangioma or
perfusional anomaly. Main portal vein is patent. No biliary ductal dilation.
The gallbladder is decompressed and contains a small stone. The spleen is
intact and normal in size. Adrenals are normal bilaterally. The pancreas is
somewhat fat replaced though otherwise unremarkable. The kidneys appear
intact and without concerning focal lesion. The abdominal aorta is normal in
course and caliber without significant atherosclerosis. No retroperitoneal
hematoma or adenopathy. The stomach is moderately distended with gas and
ingested content. The duodenum is normal.
PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. No
signs of bowel or mesenteric injury. The appendix is normal. The colon
contains a moderate fecal load. Urinary bladder is partially distended and
appears intact. No pelvic free fluid. No free air. No pelvic sidewall or
inguinal adenopathy. Streak artifact through the pelvis from right hip
arthroplasty limits assessment.
BONES: No acute fracture is seen. Right hip arthroplasty appears
uncomplicated. Mild degenerative disease at the left hip noted with mild spur
formation.
IMPRESSION:
1. No acute sequelae of trauma.
2. Lower lung posterior opacities likely atelectasis and sequelae of
aspiration.
3. OG tube terminates the GE junction and is coiled in the pharynx as seen on
concurrently performed CT cervical spine.
|
10194974-RR-16
| 10,194,974 | 28,046,822 |
RR
| 16 |
2201-04-07 14:08:00
|
2201-04-07 16:15:00
|
EXAMINATION: CT facial bones
INDICATION: ___ year old man with trauma s/p fall down multiple stairs//
facial fractures
TECHNIQUE: Multidetector CT through the facial bones with axial coronal and
sagittal reformations provided.
DOSE Total DLP (Head) = 601 mGy-cm.
COMPARISON: Same-day head CT
FINDINGS:
There is a minimally displaced frontal bone fracture, right-sided extending to
the right orbital roof and the lateral right orbital wall. The fracture line
involves the greater wing of the right sphenoid near the right orbital apex,
series 2, image 36. Associated fractures are seen involving the right
squamous temporal bone and right zygomatic arch. Small amount of extraconal
hematoma and gas is seen along the superior margins of the right orbit. The
right globe is intact without intraconal hematoma. There is significant right
preseptal hematoma and edema.
There is a nondisplaced fracture involving the left greater wing of the
sphenoid, series 2, image 44, closely approximating the left orbital apex with
adjacent locules of soft tissue gas within the left temporal fossa. A small
amount of left extraconal orbital gas and small extraconal and intraconal
hematoma noted. The left globe is intact. There is significant left
preseptal hematoma and edema.
Fractures involving the bilateral lamina papyracea are seen. There is a right
nasal bone fracture, minimally displaced. The fracture is seen involving the
right anterior and lateral maxillary sinus walls without displacement. There
is subtle disruption of the lateral left pterygoid plate, series 2 image 57 a
subtle fracture line involving the lateral wall the left maxillary sinus is
noted with adjacent gas in the left masticator space. Mucosal thickening is
noted within the maxillary sinuses. Significant ethmoid air cell opacity is
noted. There is mild bifrontal opacification.
Mastoid air cells and middle ear cavities are well aerated. The mandible is
intact. No definite dental fracture.
An OG tube is seen coiled in the pharynx.
IMPRESSION:
1. Multiple fractures as described above including: Right frontal and
squamous temporal bone, bilateral greater wing of sphenoid, bilateral
maxillary sinus, left lateral pterygoid plate, bilateral lamina papyracea,
right nasal bone.
2. Bilateral extraconal orbital hematoma and gas with small volume left
intraconal hematoma.
3. Bilateral orbital proptosis and significant preseptal hematoma and soft
tissue swelling.
4. OG tube coiled in the pharynx.
|
10194974-RR-17
| 10,194,974 | 28,046,822 |
RR
| 17 |
2201-04-07 14:55:00
|
2201-04-07 17:22:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ intubated, s/p change of OG tube// eval OG tube placement
TECHNIQUE: Portable supine chest
COMPARISON: CT torso with contrast from ___
FINDINGS:
Lung volumes are low with bronchovascular crowding. The tip of an ETT seen
6.6 cm above the carina. An enteric tube is seen slightly below the
gastroesophageal junction. Bibasilar opacities, left greater than right,
likely represent atelectasis or aspiration and were better seen on the same
day dedicated CT torso exam. There is mild pulmonary vascular congestion.
There is no pulmonary edema, pneumothorax, or large pleural effusion. The
cardiomediastinal silhouette and hilar contours are normal.
IMPRESSION:
1. Tip of an ETT is seen approximately 6.6 cm above the carina. Enteric tube
terminates just below the GE junction.
2. Lower lung opacities, slightly increased on the left may reflect worsening
atelectasis or sequelae of aspiration.
3. Possible mild pulmonary vascular congestion.
|
10194974-RR-18
| 10,194,974 | 28,046,822 |
RR
| 18 |
2201-04-07 18:01:00
|
2201-04-07 19:26:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with decreased responsiveness, evaluate for change
in bleed// Decreased responsiveness, change in bleed
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 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head without contrast from ___.
CT sinus/mandible/maxillofacial without contrast from ___
FINDINGS:
Increased conspicuous of the vasculature is in keeping with recent contrast
administration. Again seen is right hemorrhagic contusion with subarachnoid
hemorrhage and a 3 mm subdural hemorrhage along the right temporal convexity
(02:17) without significant mass effect, similar to the earlier same day
study. There is left hemorrhagic contusion with adjacent subarachnoid
hemorrhage in the left inferior temporal lobe, which appears slightly
increased in size since earlier same day study (02:13). A 1.0 cm hyperdense
extra-axial collection in the right vertex is slightly increased in size since
the prior study with more conspicuous appearance of 2 mm subdural hematoma
seen layering in the right parietal convexity (401: 48, 60). There is new
apparent 0.6 cm extra-axial hemorrhage seen in the left convexity with
unchanged small 2-3 mm subdural component seen layering along the left
parietal convexity (401:48). No midline shift is seen. Possible very subtle
small amount of intraventricular hemorrhage in the bilateral posterior horns.
Unchanged appearance of multiple facial fractures including right frontal,
squamous temporal, bilateral greater wing of the sphenoid, bilateral maxillary
sinus, lateral left pterygoid plate, bilateral lamina papyracea, right nasal
bone which are better described on dedicated same day CT maxillofacial study.
There is near complete opacification of the ethmoid air cells. Moderate
mucosal thickening is seen in the maxillary sinuses. Mild mucosal thickening
in the sphenoid and frontal sinuses. The mastoid air cells and middle ear
cavities appear clear. A calcified 1.6 cm subcutaneous lesion along the
frontal scalp is unchanged. Increased bilateral preseptal edema and hematomas
appear similar to the prior exam.
IMPRESSION:
1. Small bilateral acute subdural hematomas: 1.0 cm hyperdense extra-axial
collection in the right vertex with small amount of 2 mm subdural hematoma
seen layering in the right parietal convexity, which is increased in
prominence since the earlier same day exam. New left subdural hematoma 0.6 cm
in width along the left convexity with more conspicuous 2-3 mm subdural
component seen layering along the left parietal convexity as compared to the
prior study.
2. Stable right hemorrhagic contusion with subarachnoid hemorrhage and a 3 mm
subdural hemorrhage along the right temporal convexity
3. Left hemorrhagic contusion with adjacent subarachnoid hemorrhage in the
left inferior temporal lobe appears slightly increased in size since prior
exam.
4. Possible very subtle small amount of intraventricular hemorrhage in the
bilateral posterior horns.
5. Unchanged appearance of multiple facial fractures including right frontal,
squamous temporal, bilateral greater wing of the sphenoid, bilateral maxillary
sinus, lateral left pterygoid plate, bilateral lamina papyracea, and right
nasal bone which are better described on same day CT maxillofacial study.
|
10194974-RR-19
| 10,194,974 | 28,046,822 |
RR
| 19 |
2201-04-08 04:06:00
|
2201-04-08 06:13:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with no known PMHx who was found down with
multiple facial fractures.// eval progression of intracranial hemorrhage
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head performed 11 hours prior.
FINDINGS:
Again demonstrated are multiple areas of subarachnoid, subdural, and
intraparenchymal hemorrhage as described below:
-A right hemorrhagic contusion with subarachnoid hemorrhage and 3 mm subdural
hemorrhage along the right temporal convexity, slightly less conspicuous
compared to prior exam performed 11 hours prior. There is no significant mass
effect.
-Left hemorrhagic contusion with adjacent subarachnoid hemorrhage in the left
inferior temporal lobe appears similar to slightly decreased in size compared
to most recent prior exam (02:16).
-A hyperdense extra-axial collection at the right vertex is decreased in size
compared to prior exam and more hyperdense measuring 1.1 x 0.7 cm, previously
1.5 x 1.0 cm.
-Hyperdense collection measuring up to 0.6 cm, is associated with adjacent
subarachnoid blood and is not appreciably changed in size.
-A right parietal subdural collection measures up to 3 mm in with, unchanged
(02:27).
-Subarachnoid blood products at the left vertex is slightly more prominent,
likely secondary to redistribution.
-A left parietal subdural collection is also unchanged measuring up to 6 mm in
with, previously 5 mm (02:28).
-Additional sites of subarachnoid blood in the right parietal vertex appears
similar (601:91).
Small volume intraventricular blood layering in the bilateral occipital horns
appears similar to prior exam. There is no significant midline shift of
structures. No evidence of infarction.
Extensive facial fractures, are unchanged and better evaluated on recent CT
maxillofacial. There is moderate mucosal thickening of the bilateral
maxillary sinuses. Mild mucosal thickening of the sphenoid and frontal
sinuses is also noted. The visualized globes are unremarkable. There is
unchanged appearance of a right frontoparietal subgaleal hematoma. A 1.5 cm
calcific density within the subcutaneous soft tissues of the vertex is also
unchanged.
IMPRESSION:
1. Multiple areas of subarachnoid, intraparenchymal, subdural hemorrhage, and
intra-ventricular hemorrhage are not appreciably changed compared to prior
exam performed 11 hours prior. No significant midline shift of structures.
2. No evidence of infarction.
3. Extensive facial fractures, as detailed on prior CT maxillofacial exam
performed ___.
|
10194974-RR-20
| 10,194,974 | 28,046,822 |
RR
| 20 |
2201-04-08 08:08:00
|
2201-04-08 14:28:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with head trauma producing foul brown
secretions// aspiration? aspiration?
COMPARISON: Chest x-ray ___
FINDINGS:
Endotracheal tube and nasogastric tube are unchanged in position. Right
costophrenic angle is sharp. Retrocardiac opacification with obscuration of
the left hemidiaphragm right basilar opacities improved since the prior study.
Low lung volumes with bronchovascular crowding. No pulmonary edema or
pneumothorax.
IMPRESSION:
Persistent retrocardiac opacification with obscuration of the left
hemidiaphragm which could represent pneumonia.
|
10194974-RR-21
| 10,194,974 | 28,046,822 |
RR
| 21 |
2201-04-08 15:29:00
|
2201-04-08 19:26:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with ICH// worsening bleed? edema? shift? Please
do at 1700 ___
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 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
There is a hemorrhagic contusion with subarachnoid hemorrhage and a 3 mm
subdural hemorrhage along the right temporal convexity, similar appearance
from prior (02:19). A hemorrhagic contusion with associated subarachnoid
hemorrhage in the inferior left temporal lobe is stable from prior with
ongoing acute components (02:15). There is an unchanged hyperdense
extra-axial collection at the right vertex measuring 11 x 6 mm (302:66). A 3
mm right parietal subdural collection is stable (02:25). Subarachnoid and
subdural blood products at the left vertex appear similar from prior when
accounting for differences in patient positioning (2:31, 302:59). Left
parietal subdural hematoma appears slightly smaller from prior now measuring 4
mm, previously 6 mm likely related to redistribution of blood. Small amount
of blood products layering within the occipital horns of the lateral
ventricles is similar from prior. Irregular parafalcine blood in the
posterior falx cerebri anterolateral leaflets is stable. There is no midline
shift. The ventricles are unchanged in size and morphology. No evidence of
interval large territorial infarction.
A right frontal subgaleal hematoma stable. Patient is status post
endotracheal intubation. Copious secretions in nasal and oropharynx are
likely related to intubated status. Mucosal thickening the maxillary and
sphenoid sinuses is again noted. Known fracture are better evaluated on the
prior CT maxillofacial dated ___.
IMPRESSION:
1. Stable interval exam with multifocal sites of intraparenchymal, subdural,
intraventricular and subarachnoid hemorrhage. No evidence of interval large
territorial infarction. No midline shift.
2. Known extensive facial fractures are better evaluated on the CT
maxillofacial dated ___
|
10194974-RR-22
| 10,194,974 | 28,046,822 |
RR
| 22 |
2201-04-09 06:02:00
|
2201-04-09 09:37:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with productive sputum ?aspiration// PNA?
PNA?
COMPARISON: ___
FINDINGS:
There has been interval removal of the esophageal probe. Support devices are
otherwise not significantly changed in positioning. Lung volumes remain low
with bronchovascular crowding. There is increased opacification of the right
lung base which could represent aspiration pneumonia. No pneumothorax.
IMPRESSION:
Increased opacification right lung base which could represent aspiration
pneumonia.
|
10194974-RR-23
| 10,194,974 | 28,046,822 |
RR
| 23 |
2201-04-08 13:17:00
|
2201-04-08 15:34:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with L IJ placement// PTX? Placement? Contact
name: ___: ___ PTX? Placement?
COMPARISON: Chest x-ray ___ 09:29 hours
FINDINGS:
Status post placement of left IJ central venous catheter with distal tip at
the caval atrial junction. In the antrum and esophageal probe has been
placed. There remaining support devices are unchanged in position. No
pneumothorax. Low lung volumes with bronchovascular crowding. The left
basilar opacification is improved compared to the prior study.
IMPRESSION:
No pneumothorax. Improving left basilar opacification.
|
10194974-RR-24
| 10,194,974 | 28,046,822 |
RR
| 24 |
2201-04-08 15:29:00
|
2201-04-08 20:37:00
|
EXAMINATION: CT ORBIT, SELLA AND IAC W/O CONTRAST Q115 CT HEADSUB
INDICATION: ___ year old man with R temporal bone fx// Please do a temporal
bone CT of the R temporal bone with fine cuts to eval for temporal bone fx
that involves otic capsule facial nerve skull base carotid canal.
TECHNIQUE: Routine MDCT study of temporal bone was performed with coronal
reconstructions.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.2 s, 14.3 cm; CTDIvol = 54.4 mGy (Head) DLP = 778.5
mGy-cm.
Total DLP (Head) = 779 mGy-cm.
COMPARISON: CT head without contrast dated ___ and ___.
FINDINGS:
Extensive facial bone fractures and fracture of the right frontal bone are
better demonstrated on the prior facial bone CT.
RIGHT TEMPORAL BONE:
Multifocal fracture of the inferior right parietal, squamous portion of the
right temporal bones, no extension into the inner ear structures, no auto
capsule disruption. Fracture right signal medic arch.
No evidence of carotid canal violation. Right temporomandibular joint is
maintained.
Probable mild cerumen in the right external auditory canal. The middle ear
cavity is clear. The ossicles are intact and aligned. Tegmen tympani and
tegmen mastoideum are intact. The mastoid air cells and aditus ad antrum are
clear.
No superior semicircular canal dehiscence. Facial nerve follows a normal
course through the middle ear.
LEFT TEMPORAL BONE:
Partially seen is fracture through the left sphenoid bone, left sphenoid
temporal buttress. No evidence of otic capsule violating fracture. Mild
opacification of the left mastoid air cells. Aditus ad antrum is clear.
Clear middle ear.
Probable mild cerumen in the external auditory canal. The middle ear cavity is
clear. The ossicles are intact and aligned. Tegmen tympani and tegmen
mastoideum are intact. No superior semicircular canal dehiscence or fracture.
The facial nerve follows a normal course through the middle ear.
OTHER: Partially visualized multifocal subarachnoid, subdural, bilateral
temporal intraparenchymal hemorrhage. Facial fractures, refer to
maxillofacial CT ___.
Near complete opacification of ethmoid sinuses and mild mucosal
thickening/soft tissue attenuation of the right greater than left maxillary
sinuses and sphenoid sinuses.
Soft tissue edema and edema of the temporalis muscles bilaterally.
IMPRESSION:
1. Right parietal, squamous temporal bone fractures.
2. Left spheno-temporal buttress fracture.
3. No fracture of petrous, mastoid segments or optic capsule.
4. Intracranial hemorrhage, similar.
5. Mild opacification left mastoid air cells, no adjacent fracture.
|
10194974-RR-25
| 10,194,974 | 28,046,822 |
RR
| 25 |
2201-04-09 04:23:00
|
2201-04-09 05:22:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with ICH// worsening bleed, edema, shift. Please
do at 0500 (next TSICU rounds).
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 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: Noncontrast head CTs between ___ and ___. ___ facial bone CT.
FINDINGS:
Hemorrhagic left temporal lobe contusion, adjacent edema, and possible small
parenchymal hemorrhagic contusion very anterior right temporal lobe, stable.
Subdural and subarachnoid small volume hemorrhages are not appreciably
changed. No evidence of new intracranial hemorrhage. No evidence of acute
large territorial infarction. No midline shift. The ventricles and sulci are
normal in size and configuration. Minimal effacement perimesencephalic
cistern. The basal cisterns are patent.
Subgaleal hematoma and soft tissue edema are similar to the prior examination.
Extensive facial bone fractures, fracture right frontal bone, right ___ on
are better characterized on prior facial bone CT. Unchanged near-complete
ethmoid air cell opacification and otherwise moderate paranasal sinus mucosal
thickening with small air-fluid levels. RO enteric and endotracheal tubes are
partially imaged. A partially calcified subcutaneous nodule at the vertex is
unchanged.
IMPRESSION:
1. Stable intracranial hemorrhage.
2. No midline shift or herniation. No evidence of new hemorrhage.
3. Extensive fractures, similar.
|
10194974-RR-26
| 10,194,974 | 28,046,822 |
RR
| 26 |
2201-04-10 06:03:00
|
2201-04-10 08:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man found down with intracranial hemorrhage, remains
intubated// please perform morning of ___ to evaluate lung fields
IMPRESSION:
In comparison with the study of ___, there again are low lung volumes.
Monitoring and support devices are stable, as is the appearance of the heart
and lungs. Indistinctness of pulmonary vessels is consistent with some
elevation of pulmonary venous pressure.
No evidence of acute focal consolidation at this time.
|
10194974-RR-28
| 10,194,974 | 28,046,822 |
RR
| 28 |
2201-04-18 10:05:00
|
2201-04-18 11:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ y/o M with leukocytosis// evaluate for pneumonia
IMPRESSION:
No previous images. Cardiac silhouette is within normal limits and there is
no vascular congestion, pleural effusion, or acute focal pneumonia.
|
10195252-RR-17
| 10,195,252 | 26,056,423 |
RR
| 17 |
2110-11-19 02:12:00
|
2110-11-19 10:06:00
|
INDICATION: Headache with outside hospital CT concerning for venous sinus
thrombosis.
COMPARISON: Outside hospital CT head ___.
TECHNIQUE: Sagittal T1, axial T2, diffusion-weighted, susceptibility, and
FLAIR sequences were obtained through the brain without contrast. 2D TOF MR
venogram was then obtained without contrast.
FINDINGS:
MRI HEAD: There is no acute intracranial hemorrhage, infarction, edema, mass,
or mass effect seen. There is loss of flow void in the superior sagittal
sinus and the visualized right internal jugular vein. Multiple scattered
T2/FLAIR hyperintensities are seen in bilateral periventricular and
subcortical white matter which are nonspecific. Note is made of a prominent
right superior ophthalmic vein. There are no diffusion abnormalities. There
is abnormal susceptibility seen in the expected location of the straight
sinus, superior sagittal sinus and the right transverse and sigmoid sinuses.
Thrombus within the sinuses appears isointense on T1, and iso to hyperintense
on T2 weighted images with central portions of the thrombus showing abnormal
susceptibility. Major intracranial arterial flow voids are preserved.
Visualized orbits, paranasal sinuses, and mastoid air cells are unremarkable.
Note made of prominent adenoids.
MRV HEAD: There is loss of flow signal in the superior sagittal
sinus,straight sinus, right transverse sinus, right sigmoid sinus, and
visualized right internal jugular vein. There is preserved flow signal in the
internal cerebral veins, vein of ___, left transverse and sigmoid sinuses.
IMPRESSION: 1. Extensive venous sinus thrombosis involving the superior
sagittal, straight sinus, right transverse, right sigmoid, and visualized
right internal jugular vein. Based on the MR imaging characteristics, the
thrombus appears to be acute/early subacute.
2. No acute intracranial infarction or hemorrhage is detected.
3. Note made of prominent adenoids. Please correlate with clinical findings.
Findings discussed by Dr ___ with Dr ___ on
___ at 11am, and by Dr ___ with Dr. ___, shortly
thereafter.
|
10195252-RR-18
| 10,195,252 | 26,056,423 |
RR
| 18 |
2110-11-22 15:06:00
|
2110-11-22 19:50:00
|
INDICATION: ___ male with extensive venous sinus thrombosis, new left
lip numbness.
COMPARISON: CT from ___ and MRI/MRA brain from ___.
TECHNIQUE: Contiguous non-contrast axial images were obtained through the
brain, and reconstructed at 5-mm intervals.
FINDINGS: Relative ___ of the superior sagittal, straight, right
transverse, and right sigmoid sinuses is compatible with known thrombus.
There is mild diffuse cerebral edema with obscuration of the gray-white matter
junction and sulcal effacement, stable to slightly increased from prior
examination. There is no acute hemorrhage or vascular territorial infarct.
Remote left putaminal lacune is noted. Midline structures are preserved.
Paranasal sinuses are well aerated. The mastoid air cells and middle ear
cavities are clear. Orbits and intraconal structures are symmetric.
IMPRESSION: Venous sinus thrombosis, with mild diffuse cerebral edema, and no
evidence of hemorrhage.
|
10195252-RR-19
| 10,195,252 | 26,056,423 |
RR
| 19 |
2110-11-25 08:45:00
|
2110-11-25 14:13:00
|
INDICATION: Right cerebral venous sinus thrombosis, now with intermittent
confusion and difficulty following commands. Subtle leftward pronator drift.
COMPARISON: Head CT of ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain. No
contrast was administered.
FINDINGS: Again seen is relative ___ of the superior sagittal,
straight, right transverse, and right sigmoid sinus compatible with known
venous sinus thrombosis. There is no evidence of hemorrhage, edema, mass,
mass effect, or vascular territorial infarction. Ventricles and sulci are
normal in size and configuration. Left putamen lacunar infarct is again
noted. The visualized paranasal sinuses and mastoid air cells are well
aerated.
IMPRESSION: No change in known venous sinus thrombosis. No evidence of large
territorial infarction or hemorrhage. Follow up with MRI/MRV as indicated.
|
10195870-RR-30
| 10,195,870 | 29,349,814 |
RR
| 30 |
2188-06-11 08:08:00
|
2188-06-11 12:52:00
|
INDICATION: Postoperative pain.
COMPARISON: CTA abdomen ___.
FINDINGS: AP supine and upright views of the abdomen were obtained. The
abdominal gas pattern is non-specific. Surgical clips are located right mid
abdomen, chain sutures are located in the left mid abdomen and a surgical
drain ends over the region of the right upper abdomen. There is no free
intra-abdominal air. The visualized lung bases are clear.
IMPRESSION: Nonspecific abdominal gas pattern. No free air.
|
10195870-RR-31
| 10,195,870 | 29,349,814 |
RR
| 31 |
2188-06-11 12:14:00
|
2188-06-11 16:06:00
|
INDICATION: Increasing pain, nausea and vomiting and decreased flatus and
bowel movements in a patient postop from a Whipple.
COMPARISON: CTA abdomen, ___.
TECHNIQUE: MDCT axial images through the abdomen and pelvis were obtained
after the administration of 100 cc Omnipaque intravenous contrast. Coronal
and sagittal reformatted images were obtained.
FINDINGS: The visualized portions of the lung bases are clear. There is no
pleural or pericardial effusion.
ABDOMEN AND PELVIS WITH IV CONTRAST: The patient is status post
pancreaticoduodenostomy for a pancreatic head mass that was performed,
___. The stomach is distended to the gastrojejunostomy site,
however, oral contrast has passed into distal decompressed loops of jejunum.
In the mid abdomen a distended loop of bowel contain fecalized material and
exhibits wall thickening. An abrupt caliber change of this distended loop is
located slighlty to the right of the midline just deep to the abdominal wall
near surgical staples (602B:27). Some oral contrast and fecalized material is
seen just distal to the transition point suggesting that this is not a
complete obstruction at this time. The distal small bowel loops are even more
decompressed.
A small amount of intra-abdominal air is expected from the drain entering via
a right lateral abdominal approach and ending in the left upper quadrant
adjacent to the lesser curvature of the stomach. Pancreatic body and tail are
severely atrophic which is unchanged compared to the prior study.
One of the superior mesenteric vein contributories demonstrates an eccentric
areas of hypoattenuation (2:36) which may represent a thrombus adjacent to
surgical clips.
Free fluid in the abdomen and pelvis is more than expected postoperatively.
Subtle areas of peritoneal enhancement may indicate peritonitis. No abdominal
or pelvic lymphadenopathy.
The liver, spleen and kidneys are unremarkable. The gallbaldder and protions
of the duodenum are surgically absent. The appendix is visualized in the
right lower quadrant and is normal. The bladder, uterus and adnexa are
unremarkable. There are no abdominal wall hernias.
OSSEOUS STRUCTURES: There are no osteoblastic or osteolytic lesions
concerning for malignancy.
IMPRESSION:
1. Findings concerning for early or partial small bowel obstructon. A
distended loop of small bowel has a thickened wall and contains fecalized
material with a transition point located just deep to surgical staples to the
right of midline in the mid abdomen. Some contrast has passed into the distal
collapsed loops suggesting perhaps a partial obstruction at this time. The
wall thickening may be reactive or inflammatory, however, ischemia is not
excluded.
2. A superior mesenteric contributory vein adjacent to surgical clips
demonstrates an eccentric area of hypoattenuation which may represent
nonoclussive thrombus vs postop changes with narrowing.
3. The stomach is distended proximal to the gastrojejunostomy site however
contrast is passing into the distal decompressed jejunum.
4. Intra-abdominal and pelvic free fluid that is more than expected
post-operatively. Possible areas of peritoneal enhancement. Correlation with
the possibility of peritonitis is recommended.
COMMENT: These findings were communicated to Dr. ___ by Dr. ___
___ via telephone at 2:30 p.m. on ___, 10 minutes after the
time of discovery.
|
10195979-RR-44
| 10,195,979 | 22,570,972 |
RR
| 44 |
2144-11-13 21:47:00
|
2144-11-13 23:02:00
|
HISTORY: ___ male with recent portal vein thrombosis, presenting with
abdominal pain and increased drain output.
TECHNIQUE: Grayscale and color ultrasound images of the abdomen were
obtained.
COMPARISON: Comparison is made to ultrasound of the liver from ___.
FINDINGS:
There is a focal region of heterogeneous echogenicity in the right lobe of the
liver anteriorly, which is in keeping with known hepatic laceration/contusion
as seen on recent CT from ___, and although difficult to
measure, appears decreased in size since the prior ultrasound of the abdomen
from ___. An overlying drain is seen in the right upper quadrant,
extending down the right flank. An area of fat anterior to the liver is also
seen, also seen with the findings from recent CT.
Doppler examination of the main portal vein is patent, and demonstrates normal
hepatopetal flow. The left portal vein is also patent, with normal flow. The
main and left hepatic arteries are also patent with normal vascular waveforms.
The right anterior and posterior portal veins are not identified on this
study, secondary to limited acoustic windows.
IMPRESSION:
1. The main and left portal veins are patent, however the right portal vein is
not visualized secondary to poor acoustic window.
2. Changes from known laceration/contusion involving the right lobe of the
liver.
|
10195979-RR-45
| 10,195,979 | 22,570,972 |
RR
| 45 |
2144-11-15 13:00:00
|
2144-11-15 14:59:00
|
HISTORY: ___ man with hepatic collections, drain in place. Please
send cultures.
PHYSICIANS: Dr. ___, abdominal radiology attending, Dr. ___
___, abdominal radiology fellow.
PROCEDURE:
The procedure including risks, benefits and alternatives were explained to the
patient and after a detailed discussion, informed written consent was obtained
from the patient. A preprocedure timeout was performed using three patient
identifiers as per ___ protocol.
The patient was prepped and draped in the usual sterile fashion. 5 cc of 1%
lidocaine were used for local anesthesia in the subcutaneous tissues. An
additional 4cc of 1% lidocaine were administered under ultrasound guidance to
the region of the liver capsule for local anesthetic effect.
Under ultrasound guidance, an 18-gauge spinal needle was inserted into the
collection in the hepatic surgical bed and 1 cc of yellow-coloured purulent
fluid was withdrawn and sent for analysis. In addition, under ultrasound
guidance, an 18-gauge ___ needle was inserted into the hepatic surgical
bed collection and ___ guidewire was introduced into the collection.
The tract was dilated with an 8 ___ dilator and subsequently exchange was
mad for an 8 ___ ___ pigtail catheter. A total of 35 cc of
yellow-coloured purulent fluid were withdrawn.
The pigtail catheter was formed and fixed in place with a StatLock and
attached to a JP suction bulb for drainage. The procedure was well tolerated
and there were no immediate post-procedural complications. Post-procedure
orders were written in the ___ medical record.
Moderate sedation was provided by administrating divided doses of fentanyl and
Versed throughout the total intraservice time of 35 minutes, during which the
patient's hemodynamic parameters were continuously monitored. A total of 300
mcg of fentanyl and 3.5 mg of Versed were administered to the patient.
The attending radiologist, Dr. ___, was present for the entire
duration of the procedure.
IMPRESSION:
Technically successful ultrasound-guided drainage of hepatic surgical bed
collection with culture sent. No immediate post-procedural complications.
|
10196085-RR-57
| 10,196,085 | 21,559,477 |
RR
| 57 |
2169-10-18 01:56:00
|
2169-10-18 10:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new hypoxemia// evidence of worsening
pulmonary edema, effusions, other cause of hypoxia evidence of worsening
pulmonary edema, effusions, other cause of hypoxia
IMPRESSION:
Compared to chest radiograph ___.
Severe enlargement of cardiac silhouette has not improved. Small bilateral
pleural effusions are stable or decreased. No pneumothorax. New, mild
interstitial edema is likely.
Consolidation in the left lower lobe and perihilar right upper lobe are new.
Both suggest pneumonia although a component of atelectasis is typically seen
at the lung base.
|
10196241-RR-14
| 10,196,241 | 29,251,950 |
RR
| 14 |
2132-04-01 17:28:00
|
2132-04-01 18:17:00
|
HISTORY: Postop gastric bypass with shortness of breath, chest pain and left
leg pain.
TECHNIQUE: Helical CT acquisition through the chest following uneventful
administration of 100 cc Omnipaque IV contrast. Coronal and sagittal
reformats as well as oblique maximum intensity protocol images were provided
by technologist.
COMPARISON: None.
DLP: 552 mGy-cm.
FINDINGS:
No lower cervical adenopathy. Normal appearance of the visualized thyroid
gland. No mediastinal adenopathy by size criteria. Heart size at the upper
limits of normal. The there is borderline enlargement of the right ventricle
and.
There is good opacification of the pulmonary arteries. A pulmonary embolus is
seen in at the lobar branching of the right pulmonary artery extending into
the right lower lobe lateral segmental artery, posterior segmental artery and
right middle lobe segmental arteries. The thrombus does not appear to be
completely occlusive. Segmental emboli are seen in the left lower lobe
arteries with left upper lobe arteries are patent.
Lungs demonstrate normal background parenchymal pattern without evidence of
nodule or mass. No evidence of infarct at this point.
Osseous structures and aorta appear appropriate for age.
IMPRESSION:
Bilateral pulmonary emboli as described above without evidence of significant
right heart strain or pulmonary infarct.
NOTIFICATION: Dr. ___ the above findings with Dr. ___
___ at 17:59 via telephone on ___ within 10 minutes of
discovery. The patient was sent to the emergency room.
|
10196241-RR-15
| 10,196,241 | 29,251,950 |
RR
| 15 |
2132-04-01 22:30:00
|
2132-04-02 08:42:00
|
EXAM: CT abdomen and pelvis with oral contrast.
COMPARISON: No direct comparison available.
TECHNIQUE: Helical CT acquisition through the abdomen and pelvis following
uneventful administration of 900 cc oral contrast. Coronal and sagittal
reformats provided by technologist.
DLP: 813 mGy-cm.
FINDINGS:
ABDOMEN:
Assessment of solid viscera somewhat limited without IV contrast.
Lung bases are clear. Heart size is at the upper limits of normal. Patient
is status post Roux-en-Y gastric bypass. There is a moderate amount of fluid
in the excluded stomach remnant. However, the duodenum is not dilated.
Normal appearance of the gastrojejunal anastomosis without evidence of leak.
Distal small and large bowels are unobstructed.
Liver demonstrates focal fat near the falciform ligament but otherwise, normal
non-contrast appearance. Normal non-contrast appearance of the gallbladder,
pancreas, spleen, and adrenals. The kidneys continue to excrete contrast from
CT chest angiogram performed five hours earlier. Water density, cystic lesion
in the right kidney measures 1.4 cm and likely represents a simple cyst.
There is no evidence of free air. Normal caliber of the aorta.
PELVIS:
Essure devices are noted in the uterus. The uterus is bulky and enlarged.
The bladder is filled with previously administered contrast.
No acute osseous abnormality. Incidental note of right greater than left
osteitis condensans iliac. Degenerative spondylosis of the lumbar spine is
present.
IMPRESSION:
1. No acute intra-abdominal or pelvic process. No evidence of anastomotic
leak.
2. Moderate amount of retained fluid in the excluded stomach remnant, without
evidence of duodenal dilation. No enteric contrast in the excluded stomach.
3. Enlarged, bulky uterus likely due to fibroids versus adenomyosis.
|
10196336-RR-17
| 10,196,336 | 20,770,222 |
RR
| 17 |
2188-05-02 01:15:00
|
2188-05-02 13:54:00
|
EXAMINATION: RENAL U.S. PORT
INDICATION: ___ year old man with Hep C, recent pine ___ ingestion presenting
with acute renal failure. // evidence of hydronephrosis, obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.1 cm. The left kidney measures 10.2 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance. Scattered
echogenic foci consistent with debris are seen within the bladder.
IMPRESSION:
No evidence of hydronephrosis.
|
10196360-RR-11
| 10,196,360 | 25,427,434 |
RR
| 11 |
2121-03-19 10:00:00
|
2121-03-19 11:20:00
|
INDICATION: History: ___ with sob // pulmonary edema
COMPARISON: ___
IMPRESSION:
Mediastinal wires are seen. There is marked cardiomegaly which is stable.
There is mild prominence of the pulmonary interstitial markings without overt
pulmonary edema. No focal consolidation or pneumothoraces are seen.
|
10196360-RR-12
| 10,196,360 | 25,427,434 |
RR
| 12 |
2121-03-19 09:37:00
|
2121-03-19 10:01:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with AOCKD // Is there e/o hydronephrosis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound ___
FINDINGS:
The right kidney measures 11.7 cm. The left kidney measures 10.7 cm. There is
no hydronephrosis, stones, or masses bilaterally. Note is made of a simple
cyst in the upper pole of the right kidney that measures 0.9 x 0.7 x 0.8 cm.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
The bladder is moderately well distended and normal in appearance.
Prostate gland measures 3.1 x 4.2 x 3.2 cm, for a total volume of 22 cc.
IMPRESSION:
Sub-centimeter simple renal cyst in the right upper pole. Otherwise normal
renal ultrasound. No hydronephrosis.
|
10196360-RR-15
| 10,196,360 | 22,054,493 |
RR
| 15 |
2121-08-28 04:32:00
|
2121-08-28 11:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SVT, recent TAVR// c/f intra-thoracic
process, RLL PNA c/f intra-thoracic process, RLL PNA
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Severe cardiomegaly is chronic. Mild pulmonary vascular congestion is also
long-standing. There is no pulmonary edema or focal pulmonary abnormality
although the very large cardiac silhouette obscures the lower lungs. Lateral
view would be very helpful for their assessment. No appreciable pleural
effusion. No pneumothorax.
|
10196360-RR-8
| 10,196,360 | 26,789,435 |
RR
| 8 |
2118-01-11 19:40:00
|
2118-01-11 20:11:00
|
CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Dyspnea, evaluate for fluid overload or local
consolidation.
FINDINGS: PA and lateral views of the chest were provided. Midline
sternotomy wires and mediastinal clips are noted. The heart is moderately
enlarged. There is mild interstitial edema without lobar consolidation,
effusion, or pneumothorax. The mediastinal contour appears somewhat
prominent, likely due to an unfolded thoracic aorta with linear calcification
along the ascending aorta. The imaged osseous structures are intact, though
note is made of an old right mid clavicular shaft deformity
IMPRESSION: Mild edema and cardiomegaly.
|
10196360-RR-9
| 10,196,360 | 26,789,435 |
RR
| 9 |
2118-01-12 09:25:00
|
2118-01-12 10:09:00
|
INDICATION: ___ male with new kidney failure. Evaluate for
obstruction or any other abnormalities.
COMPARISON: None available.
TECHNIQUE: Grayscale and color Doppler images of the kidneys and urinary
bladder were obtained.
FINDINGS: The right kidney measures 11.9 cm and the left kidney measures 10.5
cm. There is no hydronephrosis, nephrolithiasis, or focal renal lesions
bilaterally.
IMPRESSION: No ultrasonographic abnormalities of the kidneys identified.
|
10196368-RR-54
| 10,196,368 | 20,365,916 |
RR
| 54 |
2188-03-08 22:50:00
|
2188-03-09 08:40:00
|
HISTORY: Central catheter placement.
FINDINGS: In comparison with study of ___, there is a right IJ catheter that
extends to the mid portion of the SVC. No evidence of pneumothorax.
There are low lung volumes. Nevertheless, there is substantial enlargement of
the cardiac silhouette with evidence of pulmonary vascular congestion.
Retrocardiac opacification is consistent with volume loss in the lower lobes.
Blunting of the costophrenic angle on that side is consistent with a small
effusion.
|
10196368-RR-55
| 10,196,368 | 20,365,916 |
RR
| 55 |
2188-03-14 11:02:00
|
2188-03-14 20:28:00
|
TORSO CT FROM ___
HISTORY: This is a ___ man with alcoholic cirrhosis, BPH, and Crohn's
disease (status post proctocolectomy/ileostomy) with unexplained
hypercalcemia. Evaluate for evidence of malignancy.
TECHNIQUE: Multidetector axial images were carried out through the abdomen
and pelvis after administration of high-density oral contrast and with
intravenous injection of 150 cc of Omnipaque 300 nonionic contrast. Coronal
and sagittal reformatted images were filmed.
DOSE REPORT: Total exam DLP is 1271.54 mGy-cm.
COMPARISON: Comparison is made to CT of the abdomen and pelvis dated ___.
FINDINGS: The aortic arch is atherosclerotic and calcified plaque is also
seen in the origins of the coronary arteries and the great vessels. No
pathologically enlarged lymph nodes are seen in either axillary region or in
the mediastinum or hilar regions. What can be seen of the thyroid is normal
in appearance. The heart is moderately enlarged. Bilateral pleural effusions
are present with some overlying subsegmental atelectasis. No parenchymal or
pleural mass is seen. Intervertebral disc space narrowing with irregular
sclerosis and superior endplate compression is seen at the superior endplate
of T8.
In the abdomen, there is slight interval change in the contour of the liver
noted in the left lobe and inferiorly in the right lobe where it has become
slightly more undulating. A 7-mm hypodensity deforming in the anterior
subcapsular region of the left lobe is again seen, but there are now two new
hypodensities in the left lobe, one measuring 4.5 mm (series 2, image 52) and
one measuring 8.5 mm (series 2, image 59). It is possible that these
represent cysts but they are new from the ___ study and are too small to
further characterize. THe pateint is s/p cholecystectomy.
Posteriorly in the right lobe of the liver (series 2, image 55) is a vaguely
wedge-shaped region of heterogeneous density with some serpiginous
hypodensity. There is a very small sliver of free intra-abdominal fluid just
anterior to the liver. There is no significant mass effect associated with
this vaguely wedge-shaped region and by history, the patient has not had liver
biopsy or other intervention. This may be sequela from the patient's recent
episodes of sepsis and further information may be gained with magnetic
resonance imaging. Portal vein is patent.
In the pancreas, a 4-mm hypodensity is seen at the junction of the body and
tail (series 2, image 65) too small to further characterize but possibly a
cyst or IPMN. It is not definitely identified in the ___ study where in
general the pancreas had the same somewhat atrophic appearance as it has on
the current exam.
Calcified atherosclerotic plaque seen in thorax continues into the abdominal
aorta and the origins of great vessels but none appear significantly stenotic
on this routine study. A 9-mm lymph node is seen in the porta hepatis. An
8-mm lymph node is seen near the crux of the diaphragm (series 2, image 58)
with the latter nodes smaller than on the previous exam. Smaller scattered
intra-abdominal lymph nodes are seen. There is no dominant mass identified.
The adrenal glands are normal in appearance. Kidneys enhance symmetrically
and excrete contrast into unobstructed collecting systems.
The spleen is large, up to 18 cm in length and appears increased compared to
___ where it was also outside of normal in its size.
Evaluation of the gut shows that the patient has an ileostomy in the right
lower quadrant pain, which is patent. Normal-appearing small bowel loops are
identified extending down to the rectovesical space. There is some haziness
in the mesentery (series 2, image 100) of uncertain significance.
Bilateral fat-containing inguinal hernias are seen, and the prostate is large
measuring 6.3 cm x 6.4 x 6.7 cm, not significantly different from ___. The
patient now has an indwelling Foley catheter with hypodensity seen in the
posterior prostate adjacent to this. The bladder is decompressed but the wall
is diffusely thickened. No inguinal or pelvic sidewall adenopathy is seen.
Evaluation of bones shows degenerative disease and irregular endplates and
osteophytosis in the vertebral column. There is irregular contour and
trabecular irregularity to the posterior iliac wing on the right adjacent to
the sacroiliac joint. The appearance may be post-traumatic or post-infective
but the appearance is not different compared to ___.
CONCLUSION:
1. New hepatic hypodensities, two in the left lobe, possibly representing
cysts but new compared to ___ and heterogeneous serpiginous hypodensity
posteriorly in the right lobe, possibly sequela from the patient's recent
episodes of sepsis but for which magnetic resonance imaging is recommended for
further evaluation. Note that this occurs on a background of mild cirrhotic
change, splenomegaly and trace ascites.
2. Status post ileostomy with no evidence of obstruction or abdominal mass.
Mild mesenteric stranding.
3. Stable prostate enlargement with thickened bladder wall and indwelling
Foley.
4. Atherosclerosis including coronary artery disease and mild-to-moderate
cardiomegaly.
5. Contour and trabecular irregularity in the posterior right iliac wing not
changed compared to ___.
6. A 4- to 5-mm pancreatic hypodensity, question IPMN. This can be assessed
with MRI when the patient's liver abnormality is evaluated.
|
10196368-RR-57
| 10,196,368 | 20,365,916 |
RR
| 57 |
2188-03-17 11:47:00
|
2188-03-17 12:56:00
|
HISTORY: ___ man with left lower extremity edema. Evaluate for DVT.
COMPARISON: None.
FINDINGS:
Grayscale and color Doppler ultrasonography of the bilateral common femoral
veins as well as the left femoral, popliteal, posterior tibial, and peroneal
veins were performed. The posterior tibial and peroneal veins were not well
seen within the calf. All other imaged vessels demonstrated normal
compressibility, flow, and augmentation.
IMPRESSION:
No evidence of left lower extremity deep venous thrombosis. The calf veins
were not well evaluated.
|
10196368-RR-58
| 10,196,368 | 20,365,916 |
RR
| 58 |
2188-03-18 09:20:00
|
2188-03-18 18:04:00
|
HISTORY: ___ year old man with cirrhosis with new hepatic hypodensity and
pancreas hypodensity, MRI recommended for further evaluation REASON FOR THIS
EXAMINATION: characterization of hepatic/pancreas hypodensity
COMPARISON: CT torso ___
TECHNIQUE: Multiplanar T1 and T2 weighted images were acquired on a 1.5 tesla
magnet, including dynamic 3D imaging, obtained prior to, during, and after the
uneventful intravenous administration of 0.1 mmol/kg (12 cc) of Gadavist
gadolinium contrast. Patient also received 1 cc of Gadavist gadolinium in 50
cc of water for oral contrast.
FINDINGS:
Trace bilateral pleural effusions with associated bibasilar subsegmental
atelectasis. Persistent cirrhotic appearance of the liver. Scattered small
sub-cm T2 hyperintense lesions in the liver could represent small cysts versus
biliary hamartomas. Segment 4A hyper enhancing lesion demonstrating washout
and measuring 18 x 19 mm, consistent with HCC. Serpiginous branch like T2
hypointense lesions in segments 6 and 7 are again visualized, with peripheral
hyperenhancement, similar in appearance compared to prior CT, most likely
represent focal thrombophlebitis. Splenomegaly measuring 18.4 cm in length
unchanged. Multiple small cystic lesions scattered throughout the pancreatic
parenchyma, with some parenchymal atrophy, the largest of these measures 13 x
19 mm in the uncinate process, which appears to contain an enhancing mural
nodule measuring 10 x 13 mm. The pancreatic duct in the body measures
approximately 3-4 mm in diameter, slightly prominent. Sub-cm cortical cysts
bilateral kidneys. Mild bilateral perinephric fat stranding, nonspecific.
Normal caliber abdominal aorta. No evidence of significant lymphadenopathy.
The gallbladder is surgically absent. Partially visualized small and large
bowel appear unremarkable. No evidence of ascites. Small mesenteric and
splenorenal varices are seen. The visualized osseous structures unremarkable.
Image quality is somewhat degraded by motion artifact.
IMPRESSION:
1. Segment 4A 1.9 cm hypervascular lesion with washout consistent with HCC.
2. Segments ___ T2 hypointense branch like lesions most likely represent
focal thrombophlebitis.
3. Persistent cirrhosis, splenomegaly, small varices.
4. Multiple cystic lesions throughout the pancreatic parenchyma, the largest
in the uncinate process containing an enhancing mural nodule, with slightly
dilated main duct, consistent multiple side branch IPMN's.
|
10196692-RR-12
| 10,196,692 | 24,402,467 |
RR
| 12 |
2117-09-01 14:49:00
|
2117-09-01 15:15:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with SOB // r/o acute process r/o acute
process
COMPARISON: There are no prior chest radiographs available for review appear
FINDINGS:
Right hemidiaphragm is elevated, usually due to eventration. Lungs are clear.
Heart size top-normal exaggerated by AP orientation. No pleural abnormality
or evidence of central lymph node enlargement.
IMPRESSION:
Essentially normal chest for age.
|
10196692-RR-13
| 10,196,692 | 24,402,467 |
RR
| 13 |
2117-09-01 15:08:00
|
2117-09-01 15:40:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with subdural hemorrhage and head laceration
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 18.0 s, 18.1 cm; CTDIvol = 50.0 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head ___ at 06:25 from outside institution
FINDINGS:
Re- demonstrated is a hypodense extra-axial collection overlying the right
frontoparietal cerebral convexity measuring approximately 7 mm wide, unchanged
in size and appearance from the previous CT examination and compatible with a
subacute subdural hematoma. There is no shift of normally midline structures
or significant mass effect. No new intracranial hemorrhage or edema is
identified. Periventricular, subcortical and deep white matter hypodensities
are nonspecific, but likely reflect the sequela of chronic microvascular
infarction. Prominence of the sulci and ventricles suggests age-related
involutional changes. Atherosclerotic calcifications of the cavernous carotid
arteries are noted.
Left frontal soft tissue swelling and laceration is demonstrated towards the
vertex with overlying skin staples. There is no evidence of fracture. Mild
mucosal thickening is seen within the right sphenoid sinus in a few scattered
ethmoid air cells bilaterally. The visualized portion of the remaining
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits demonstrate evidence of prior lens
replacement surgery bilaterally.
IMPRESSION:
1. Unchanged right cerebral convexity subacute subdural hematoma without
significant mass effect or shift of normally midline structures. No new
intracranial hemorrhage.
2. Left frontal soft tissue swelling and laceration towards the vertex without
underlying fracture.
|
10196757-RR-23
| 10,196,757 | 29,070,483 |
RR
| 23 |
2153-01-31 14:12:00
|
2153-01-31 15:33:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old man with several months of back pain, acutely
worsening last night // pls perform second read for outside hospital scan
(the one performed at 8am, not the first one earlier in the morning).
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration at an outside institution.
Oral contrast was not administered.
Coronal and sagittal reformations were performed.
DOSE: Please refer to original report from outside hospital.
COMPARISON: Reference outside noncontrast CT abdomen and pelvis from ___ obtained at 06:00.
FINDINGS:
LOWER CHEST: Mild atelectatic changes are seen in the lung bases. Coronary
stents are noted along with median sternotomy changes from prior coronary
artery bypass surgery.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. There is hyperdense material seen
layering in the gallbladder, likely sludge.
PANCREAS: A calcification is seen in the pancreatic body (02:27). Pancreas is
otherwise unremarkable without pancreatic ductal dilatation or focal lesion.
There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A subcentimeter hypodensity is seen in the right upper renal pole, too small
to fully characterize but likely cyst. There may be a cortical scar in the
right lower pole, possibly from an old ischemic insult or infection, adjacent
to another too small to characterize hypodensity. There is no evidence of
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis is
noted in the sigmoid colon without evidence of acute diverticulitis.
Otherwise, the colon and rectum are within normal limits. The appendix is not
visualized.
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 mesenteric lymphadenopathy. Prominent
retroperitoneal lymph nodes are noted, the largest seen being a left
para-aortic node measuring up to 0.9 cm (02:40). There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. A 2.2 x 2.3 x 5.6 cm
heterogeneously hypodense oval round lesion is seen posterior to the
suprarenal aorta, at the level of the celiac take off. The smooth contour of
the lesion and displacement of the intimal calcifications within the aorta
(2:23) are more compatible with marked posterior compression of the aorta
rather than intraluminal thrombus resulting in near complete occlusion.
Additionally, there is hypodensity extending from this lesion into the
anterior aspect of the L1-L2 vertebral disc space with mild asymmetric
widening anteriorly and suggestion of possible erosion of the anterior
bridging osteophyte at L1 (602:74). Mild adjacent fat stranding is identified
about this hypodense lesion. Extensive atherosclerotic disease is noted with
noncalcified plaque within the left gastric artery likely resulting in marked
narrowing. The celiac artery, superior mesenteric artery, and inferior
mesenteric artery are patent.
BONES: There is no evidence of acute fracture. Moderate to severe multilevel
degenerative changes are seen in the lumbosacral spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 2.2 x 2.3 x 5.6 cm hypodense lesion posterior to the suprarenal aorta with
extensive compression and near complete occlusion of the aorta demonstrates
surrounding stranding and extension to the anterior aspect of the L1-L2
intervertebral disc. Findings may be due to a hematoma, abscess formation
from adjacent lumbar discitis at the L1-L2 vertebral level, or other cystic
lesion external to the aorta. MRI of the lumbar spine with intravenous
contrast along with MRA of the abdomen are recommended for further assessment.
2. Gallbladder sludge.
3. Diverticulosis without acute diverticulitis.
RECOMMENDATION(S): MRI of the lumbar spine with intravenous contrast along
with MRA of the abdomen are recommended for further assessment.
|
10196757-RR-24
| 10,196,757 | 29,070,483 |
RR
| 24 |
2153-01-31 17:55:00
|
2153-01-31 20:21:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: History: ___ with ?aortic compression from disc, vs aortic
thrombus. Disc bulge?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 16 mL of
MultiHance contrast agent.
COMPARISON: CT chest from ___ and outside CT abdomen from ___.
FINDINGS:
Based on the count down from the level of first rib-bearing thoracic
vertebrae, there are 5 non-rib-bearing lumbar vertebrae.
The alignment of the lumbar spine is maintained. The vertebral body heights
are maintained at all levels. The visualized lower spinal cord appears
unremarkable with the conus terminating at L1.
There is diffuse decrease in the marrow signal from T12-L5 on T1 and T2
weighted images without any corresponding enhancement on postcontrast images,
nonspecific, either secondary to diffuse marrow infiltrative process or
myeloproliferative disorder. There is however fatty infiltration of the
sacrum. This can be seen related to prior pelvic radiation. Also seen are
___ type 2 changes at T11-T12.
There are large prominent anterior osteophytes at L1-L2 with a lesion just
anterior to the osteophytes. The lesion demonstrates peripheral rim of T1 and
T2 hypointensity with central T2 hyperintensity without any enhancement. This
is favored to be a large focal disc extrusion with peripheral fibrosis and
reactive changes. This appears to be exerting significant mass effect on the
aorta at that level displacing it and narrowing the lumen. However, no
definite infiltration of the aorta is seen. Note that the low signal
intensity on T2 weighted images of the intervertebral disc and the lack of
edema in the vertebral bodies argue strongly against discitis. However, the
prevertebral fluid collection and enhancement raise a concern of possible
infection superimposed on the large disc protrusion. Please refer to separate
dictation of MRA of the abdomen for patency of the lumen.
Also seen are linear tract of T2 hyperintensity, T1 hypointensity with
enhancement on postcontrast images extending inferiorly from the level of
L1-L2 vertebrae to L3-L4 vertebrae as seen on image 3:10 and 10:10 which
demonstrates low signal on previous CT of the abdomen and is favored to be
extruded disc material.
There is atherosclerosis involving the abdominal aorta. There is a 1 cm cyst
in the interpolar region of right kidney. The remaining visualized
retroperitoneal, paravertebral and paraspinal soft tissues appear
unremarkable.
At T12-L1, the intervertebral disc height and signal is maintained. Bilateral
neural foramen and spinal canal are patent.
At L1-L2, there is loss of disc height and signal with prominent anterior
osteophytes in extruded disc material as described above. There is mild
bilateral facet arthropathy. Neural foramen and spinal canal are patent.
At L2-L3, there is loss of disc height and signal with broad-based disc bulge
and superimposed left foraminal disc protrusion resulting in mild left neural
foraminal narrowing. The right neural foramen is patent. The spinal canal is
patent. There is mild narrowing of bilateral lateral recesses contacting the
traversing L3 nerve roots.
At L3-L4, there is loss of disc height and signal with broad-based disc bulge
and bilateral facet arthropathy resulting in mild bilateral neural foramen
narrowing. The spinal canal is patent. There is narrowing of bilateral
lateral recesses contacting the traversing L4 nerve roots.
At L4-L5, there is loss of disc height and signal with broad-based disc bulge,
severe bilateral facet arthropathy resulting in mild bilateral neural foramen
narrowing. Spinal canal is patent.
At L5-S1, there is loss of disc height and signal with broad-based disc bulge
and severe facet arthropathy resulting in moderate bilateral neural foramen
narrowing. Spinal canal is patent.
IMPRESSION:
1. Large prominent anterior osteophytes at L1-L2 with a lesion just anterior
to the osteophytes which exerts mass effect on the aorta causing luminal
narrowing. The lesion is favored to be extruded disc material which extends
inferiorly up to the level of L3 vertebrae as described above. The
prevertebral fluid is likely inflammatory response to the disc protrusion.
However, consider the possibility of superimposed infection, although there is
no evidence of diskitis or osteomyelitis.
2. Diffusely low T1/T2 marrow signal involving the visualized lower thoracic
and lumbar vertebrae, nonspecific, either secondary to myeloproliferative or
infiltrative disorder. Clinical correlation is recommended.
3. Diffuse fatty marrow involving the sacrum, probably secondary to prior
radiation therapy.
4. Multilevel multifactorial degenerative disease of the lumbar spine, worst
at L5-S1 with moderate bilateral neural foramen narrowing.
5. Please refer to separate dictation of MRA of the abdomen for evaluation of
aortic patency.
NOTIFICATION: The concern of possible infection superimposed on disc
protrusion was discussed by telephone by Dr. ___ t 12:30 2 min
after observing the findings.
|
10196757-RR-25
| 10,196,757 | 29,070,483 |
RR
| 25 |
2153-01-31 17:55:00
|
2153-01-31 20:28:00
|
INDICATION: History: ___ with ?aortic compression from disc, vs aortic
thrombusIV contrast to be given at radiologist discretion as clinically needed
// please eval for aortic thrombus. Contrast PRN.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen and pelvis
were acquired in a 1.5 T magnet.
Intravenous contrast: 16 mL Gadavist
COMPARISON: CT abdomen and pelvis ___.
MR of the lumbar spine ___, ___.
FINDINGS:
Lower thorax: Lower lung bases, pleural spaces and lower mediastinal
structures are grossly normal.
Liver: Liver demonstrates homogeneous signal intensity enhancement with no
focal mass. As seen on the comparison CT scan there is subtle nodularity of
the liver, along with a positive posterior notch sign, indicative of
underlying cirrhosis. No intra or extrahepatic ductal dilatation. Layering
material is seen within the gallbladder which likely reflects vicarious
excretion of contrast.
Pancreas: Pancreas demonstrates homogeneous signal intensity with no focal
mass, ductal dilatation or peripancreatic abnormality.
Spleen: Spleen is normal in size and appearance with no focal mass.
Adrenal Glands: Adrenal glands are unremarkable.
Kidneys: Kidneys enhance symmetrically with no dilatation of the collecting
system. Simple cysts are seen within the right kidney, largest measuring up
to 8 mm.
Gastrointestinal Tract: Visualized loops of large and small bowel are within
normal limits with no dilated loops or areas of bowel wall thickening.
Lymph Nodes: No retroperitoneal or upper abdominal lymphadenopathy.
Vasculature: At the level of the origin of the celiac axis the abdominal aorta
is extrinsically narrowed, spanning a length of approximately 3 cm in the CC
dimension, and demonstrating luminal narrowing up to 75%. The abdominal aorta
at this level does not demonstrate internal thrombosis, or dissection. The
luminal narrowing is caused by a nonenhancing cystic structure measuring 2.1 x
1.5 cm (series 6, image 13), which is new when compared to the multiple prior
MR studies. Along the inferior aspect of the cystic structure there is some
low-grade enhancement, favored to represent granulation tissue appear At the
level of luminal narrowing there is evidence of herniated disc, best
appreciated on the MR lumbar spine performed ___, and this
finding has progressed when compared to multiple prior lumbar spines, however
is not favored to represent the cause of the aortic narrowing. Just inferior
to the herniated disc is markedly T2 bright tubular structures within the
retroperitoneum (MR lumbar spine ___, series 3, image 10),
favored to represent dilated lymphatic channels. The constellation of
findings described by is favored to represent background degenerative disc
disease/osteophyte formation which has caused disruption of retroperitoneal
lymphatics, and subsequent granulation tissue. Confirmatory assessment may be
obtained via percutaneous sampling of this cystic structure narrowing the
abdominal aorta, however consultation with interventional radiology is
recommended if this is pursued .
Osseous and Soft Tissue Structures: Multilevel degenerative disc disease,
documented on recent performed MR lumbar spine.
IMPRESSION:
The abdominal aorta at the level of the celiac axis is extrinsically narrowed
by approximately 75% by a 2.1 x 1.5 cm cystic lesion, favored to represent
focally dilated lymphatics. There is no evidence of aortic dissection or
intraluminal thrombus. The constellation of of findings is favored to
represent background chronic degenerative disc disease/ osteophyte formation
which has caught disruption of retroperitoneal lymphatics with subsequent
formation of granulation tissue, and cystic structure representing focally
dilated lymphatic channel exerting mass effect and narrowing the abdominal
aorta. Alternatively the cystic lesion could represent hemorrhagic material,
representative of a "discal cyst". Confirmatory assessment may be obtained
via percutaneous sampling of this cystic structure, however consultation with
intervention radiology is recommended if this is sought after.
|
10196757-RR-26
| 10,196,757 | 29,070,483 |
RR
| 26 |
2153-02-01 08:58:00
|
2153-02-01 11:03:00
|
EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ year old man with disk protrusion compressing aorta // pre-op
Surg: ___ (spine surgery) BACK PAIN
IMPRESSION:
Heart size and mediastinum are stable. 's postsurgical changes are stable.
Lungs are clear. No pleural effusion or pneumothorax.
|
10196757-RR-28
| 10,196,757 | 29,070,483 |
RR
| 28 |
2153-02-02 11:18:00
|
2153-02-02 13:02:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old male with disc extrusion at L1/L2 causing deformity
of aorta, possible abscess. Evaluate for changes to aorta.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Total DLP (Body) = 1,358 mGy-cm.
COMPARISON: CT from ___ and MRI from ___.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is a 2.6 x 2.4 x 4.9 cm
hypodense lesion in the prevertebral region and, with marked mass-effect on
the proximal abdominal aorta, at the level of the diaphragmatic hiatus. This
appears similar in size to prior exam and causes extrinsic compression and
marked narrowing of the abdominal aorta at this location. At its maximal
narrowing, the abdominal aorta measures 2.5 x 0.6 cm in diameter (series
6:image 40). There is severe narrowing or occlusion of the celiac artery
origin. The SMA demonstrates mild atherosclerosis but is patent. The
inferior mesenteric artery is patent. Bilateral renal arteries are patent.
There is conventional hepatic arterial anatomy.
LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no
pleural or pericardial effusion. Mediastinal surgical clips are compatible
with prior CABG. The patient is status post median sternotomy.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The
liver has a nodular appearance. There is no evidence of focal lesions. There
is no evidence of intrahepatic or extrahepatic biliary dilatation.
Gallbladder sludge or vicarious excretion of contrast is noted without
evidence of cholecystitis.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. A pancreatic body
calcification is again noted (series 9:image 46). There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones or hydronephrosis. A right renal hypodensity
is too small to characterize but statistically likely to reflect is cyst
(series 9:image 57). There are no urothelial lesions in the kidneys or
ureters. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is mildly distended and unremarkable. The
small bowel loops demonstrate normal caliber, wall thickness and enhancement
throughout. The colon is normal in caliber without evidence of obstruction.
Sigmoid colonic diverticulosis is noted without evidence of diverticulitis.
The appendix is not visualized, though there are no secondary findings to
suggest appendicitis. There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: Mildly prominent retroperitoneal lymph nodes are noted
without meeting CT size criteria for pathologic enlargement (series 9:image
59).
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Prostate is unremarkable, within limits of CT.
BONES: Degenerative changes are seen in the lumbar spine, better delineated on
the recent MR ___. No acute fracture is noted, and the patient is status
post median sternotomy.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Surgical
clips are noted along the left groin.
IMPRESSION:
1. Similar appearance of prevertebral hypodense with mass effect on the
posterior aspect of the suprarenal abdominal aorta at the level of the
diaphragmatic hiatus, near the origins of the celiac axis and superior
mesenteric artery, which causes extrinsic compression and severe narrowing of
the abdominal aorta. There is severe narrowing or occlusion of the celiac
artery origin.
2. Diverticulosis without evidence of diverticulitis.
3. Nodular appearance of the liver concerning for cirrhosis. Recommend
correlation with clinical history and liver function tests.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 8:50 ___, 5 minutes after
updated findings.
|
10196817-RR-27
| 10,196,817 | 23,322,665 |
RR
| 27 |
2144-02-08 02:54:00
|
2144-02-08 05:10:00
|
INDICATION: ___ with severe diarrhea, on chemo w/ side effect of colitis //
? colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 5.1 s, 55.5 cm; CTDIvol = 15.9 mGy (Body) DLP = 880.2
mGy-cm.
Total DLP (Body) = 892 mGy-cm.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
LOWER CHEST: A 10 mm right lower lobe pulmonary nodule is new from ___ and
___ (2:5). Two 6 mm pulmonary nodules in the right lung base are
unchanged from ___ (02:13, 02:14). . There is no evidence of pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The
hepatic hypodensity, adjacent to the fiducial marker in hepatic segment ___
measures 2.1 x 1.4 cm, slightly smaller than on ___. A 6 mm hypodensity in
the hepatic dome is too small to characterize and unchanged from ___. A
hypodensity in the left lobe of the liver measures 2.0 x 2.0 cm, previously
1.0 x 1.1 cm on ___. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of hydronephrosis. Subcentimeter bilateral renal
hypodensity is too small to characterize and likely represents a cyst. There
is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate contains calcifications and seminal vesicles
are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Lytic osseous lesions in the left iliac wing adjacent to the
sacroiliac joint, and right superior acetabulum are unchanged from ___. No
pathologic fracture identified. Degenerative changes are seen in the lumbar
spine. Mild anterior wedging of the L2 vertebral body is unchanged from ___.
SOFT TISSUES: Left paraspinal soft-tissue lesion measures 3.5 x 3.3 cm,
increased in size from ___ (02:48).
IMPRESSION:
1. No evidence of colitis or intra-abdominal infection.
2. Increased size of left lobe hepatic hypodensity, right paraspinal soft
tissue lesion, and new 10 mm right lower lobe pulmonary nodule are concerning
for progressive metastatic disease.
3. Stable osseous metastasis since ___ without evidence of pathologic
fracture.
|
10196817-RR-28
| 10,196,817 | 23,322,665 |
RR
| 28 |
2144-02-13 09:35:00
|
2144-02-13 10:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with melanoma p/w ipilimumab-induced autoimmune
colitis, now with new onset dyspnea. // ?PNA ?PNA
IMPRESSION:
In comparison with the study of ___, there is little change and no
evidence of acute cardiopulmonary disease. No pneumonia, vascular congestion,
or pleural effusion. Mild tortuosity of the descending aorta.
|
10196817-RR-36
| 10,196,817 | 27,093,784 |
RR
| 36 |
2144-07-05 08:37:00
|
2144-07-05 10:53:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old man with metastatic melanoma on nivolumuab with
worsening left knee pain, effusion palpated on exam // evaluate effusion, OA
evaluate effusion, OA
IMPRESSION:
No previous images. The bony structures and joint spaces are within normal
limits except for a small superior patellar spur. There is a moderate joint
effusion.
Of incidental note is extensive vascular calcification in the trifurcation
vessels.
|
10197135-RR-10
| 10,197,135 | 27,859,404 |
RR
| 10 |
2169-04-01 02:31:00
|
2169-04-01 03:20:00
|
EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: Please perform duplex. Eval for liver pathology, budd-chiari,
PVT. Also please eval for splenomegaly.
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: None
FINDINGS:
Liver: The hepatic parenchyma is within normal limits. Simple cysts
measuring 1.6 cm and 0.8 cm are seen in the right and left hepatic lobes,
respectively. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation.
CHD: 4 mm
Gallbladder: The gallbladder appears within normal limits, without stones,
abnormal wall thickening, or edema.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture.
Spleen length: 9.7 cm
Kidneys: No stones, masses, or hydronephrosis are identified in either kidney.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 17.2 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
IMPRESSION:
1. Patent hepatic vasculature with appropriate direction of flow.
2. No sonographic findings specific to Budd-Chiari.
3. Normal spleen.
|
10197669-RR-27
| 10,197,669 | 29,663,549 |
RR
| 27 |
2170-04-15 16:18:00
|
2170-04-15 17:45:00
|
INDICATION: NO_PO contrast; History: ___ status post fall from 20 feet,
exclude any fractures
TECHNIQUE: Contiguous axial images were obtained through the chest, abdomen
and pelvis without intravenous contrast. Coronal and sagittal reformats were
performed.
DOSE: Total DLP (Body) = 1,587 mGy-cm.
COMPARISON: Lumbar spine MRI from ___ and lumbar spine radiographs
from outside facility from ___.
FINDINGS:
CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury based on an unenhanced scan. There is mild calcific
atherosclerotic disease within the thoracic aorta. Heart size is normal.
There is extensive coronary artery and aortic valvular calcification. No
pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is minimal bibasilar dependent atelectasis. Otherwise,
lungs are clear without masses or areas of parenchymal opacification.
Calcified left lower lobe granuloma is present. The airways are patent to the
level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a calcified granuloma in the right hepatic dome.There is no
perihepatic free fluid. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is not visualized.
PANCREAS: There is mild fatty atrophy of the 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 within the limitation of an unenhanced
scan.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The right kidney is atrophic. The left kidney demonstrates mild
nonspecific perinephric stranding. It is overall normal in size. There is no
evidence of a perinephric hematoma. There is no hydronephrosis or
nephrolithiasis.
GASTROINTESTINAL: There is a moderate hiatus hernia. Small bowel loops
demonstrate normal caliber. The colon and rectum are within normal limits.
The appendix is not visualized. There is no evidence of mesenteric injury.
There is no 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. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is stranding with blood products in the retroperitoneum
tracking along the bilateral psoas muscles and left pericolic gutter (for
example 2:125). This is most likely related to the lumbar vertebral body
fractures. Moderate atherosclerotic disease is noted. The abdominal aorta is
normal in caliber.
BONES: There is a 2 column burst fracture of the L3 vertebral body with
approximately 3 mm of retropulsion into the spinal canal. In addition, there
is a fracture through the anterior osteophyte of the L2 vertebral body with a
transverse lucency within the vertebral body and mild height loss, concerning
for a mild compression fracture, but without retropulsion (601:84).
Additionally, mild irregularity of the superior endplate of the L4 vertebral
body (103:82, 83) could a reflect mild compression fracture. There is
widening of the anterior disc spaces at L2-3 and L3-4, which may be indicative
of ligamentous injury especially in the setting of acute fracture and
prevertebral soft tissue swelling. Diffuse idiopathic skeletal hyperostosis
is present. Moderate to severe a multilevel degenerative changes are seen
with severe central canal stenosis at L2-3, L3-4, and L4-5.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Acute 2 column burst fracture of the L3 vertebral body. There is 3 mm of
bony retropulsion into the central canal with severe canal narrowing at that
level.
2. There are additional fractures of the anterior osteophyte of the L2
vertebral body as well as a probable transverse fracture through the L2
vertebral body with mild height loss, but no retropulsion. There is also a
fracture of the anterior inferior osteophyte at L1 and mild irregularity of
the superior endplate of L4 with slight height loss also suggestive of acute
fracture. Widening of the anterior disc spaces at L2-3 and L3-4 is concerning
for ligamentous injury.
3. Blood products tracking along the bilateral psoas muscles and the
retroperitoneum is related to the acute vertebral fractures.
4. Atrophic right kidney.
RECOMMENDATION(S): MRI can be obtained for further assessment of ligamentous
injury and spinal canal narrowing.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:54 pm, 5 minutes after discovery
of the findings.
|
10197669-RR-29
| 10,197,669 | 29,663,549 |
RR
| 29 |
2170-04-15 16:19:00
|
2170-04-15 16:41:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ status post fall from 20 feet, exclude any fractures
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 608 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified.There are multilevel
mild-to-moderate degenerative changes with disc space narrowing, osteophyte
formation and facet arthropathy. There is mild canal narrowing extending from
C3 through C5-6. Neural foraminal narrowing is most severe on the right at
C4-5 and C5-6 where it is moderate to severe in extent.There is no
prevertebral soft tissue swelling. There is no evidence of infection or
neoplasm.
The imaged thyroid gland is unremarkable. Lung apices are grossly clear.
IMPRESSION:
1. No evidence of fracture or traumatic subluxation.
2. Multilevel moderate degenerative change as described above.
|
10197669-RR-32
| 10,197,669 | 29,663,549 |
RR
| 32 |
2170-04-16 08:16:00
|
2170-04-16 11:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest pain// acute changes acute
changes
IMPRESSION:
Compared to prior chest radiographs none more recent than ___.
Lung volumes are very low but lungs are clear. Heart is normal size.
Mediastinal silhouette is a normal postoperative appearance given low lung
volumes. Central lymph node calcifications may be present. No pleural
abnormality.
|
10197669-RR-33
| 10,197,669 | 29,663,549 |
RR
| 33 |
2170-04-16 08:57:00
|
2170-04-16 14:50:00
|
EXAMINATION: US RENAL ARTERY DOPPLER LEFT
INDICATION: ___ year old man s/p trauma, possible renal injury// ?renal
vascular injury
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON:
CT abdomen pelvis ___
FINDINGS:
The right kidney is severely atrophic and not well visualized. The left
kidney measures 11.7 cm. There is moderate left-sided hydronephrosis,
increased when compared to prior CT.. Normal cortical echogenicity and
corticomedullary differentiation is seen.
Left renal Doppler: Intrarenal arteries show normal waveforms with sharp
systolic peaks and continuous antegrade diastolic flow. The resistive indices
of the left intra renal arteries range from 0.71-0.72. The left main renal
arteries is patent with normal waveforms. The peak systolic velocity on the
left is 29 centimeters/second. Left main renal veins is patent with normal
waveforms.
The bladder is moderately well distended and normal in appearance with a
volume of 352 cc. Patient was unable to void.
IMPRESSION:
1. Moderate left hydronephrosis, increased compared to prior exam.
2. Pre void bladder volume of 352 cc. Postvoid residual was not calculated as
patient was unable to void.. Consider repeat examination after voiding to
assess for resolution of hydronephrosis.
3. Severely atrophic right kidney is not well visualized.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:30 pm, 180 minutes after
discovery of the findings.
|
10197669-RR-34
| 10,197,669 | 29,663,549 |
RR
| 34 |
2170-04-16 09:43:00
|
2170-04-16 14:39:00
|
INDICATION: ___ year old man with trauma, abd pain// trauma
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: CT abdomen performed ___.
FINDINGS:
Mild distention of the stomach with otherwise no abnormally dilated loops of
large or small bowel.
There is no free intraperitoneal air.
Osseous structures are notable for compression deformity of the L3 vertebral
body is better visualized on CT abdomen performed ___.
Circular hyperdensity overlying the right hip, is likely external to the
patient. There are no unexplained soft tissue calcifications or radiopaque
foreign bodies.
IMPRESSION:
1. Distended stomach with normal bowel-gas pattern.
2. No evidence of free intraperitoneal air.
3. Compression deformity of the L3 vertebral body is better visualized on CT
abdomen performed ___.
|
10197669-RR-35
| 10,197,669 | 29,663,549 |
RR
| 35 |
2170-04-16 13:28:00
|
2170-04-16 17:30:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with s/p fall from a 20 feet ladder onto feet,
injuries: L3 burst fx, L1/L2 osteophyte fx, L2 body fx, L4 endplate fx, L2-4
ligamentous injury// further evaluate lumbar spine fractures further
evaluate lumbar spine fractures
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: CT torso trauma ___. MR ___ ___.
FINDINGS:
There is mild grade 1 retrolisthesis of L1 on L2, similar to ___. No rotation
or subluxation of the vertebral bodies are noted.
There is re-demonstration of the burst compression fracture of the L3
vertebral body with increased retropulsion of the posterior cortex into the
spinal canal, progressed since most recent CT torso. There is increased STIR
signal within the interspinous ligaments from L2-L3 through L3-L4, without
evidence of a through and through tear. No abnormal signal is noted in the
bilateral facet joints. The L2 anterior inferior endplate fracture is better
seen on prior CT, indicating a disrupted anterior longitudinal ligament.
Prevertebral edema is noted anterior to the L1-L2 through L3-L4 vertebral
bodies.
Increased STIR signal in the posterior inferior endplate of the L1 and
superior endplate of L2 vertebral bodies are consistent with Schmorl's nodes.
Increased STIR signal in the inferior endplate of L5 and L4 are likely
degenerative and without evidence of fracture on prior CT torso.
Conus medullaris terminates at T12-L1. The spinal cord appears normal in
caliber and configuration.
Multilevel degenerative changes are again noted with loss of disc height and
signal, osteophyte formation, ligamentum flavum thickening, facet hypertrophy,
and posterior disc bulge.
At T12-L1, there is no significant spinal canal stenosis or neural foraminal
narrowing.
At L1-L2, posterior disc bulge with a posterior arachnoid cyst results in at
least moderate spinal canal stenosis. No significant neural foraminal
narrowing.
At L2-L3, there is at least moderate spinal canal stenosis.
At the level of the L3 burst fracture, there is severe spinal canal narrowing
and compression of the cauda equina. No significant neural foraminal
narrowing.
At L3-L4, there is severe spinal canal narrowing. There is mild-to-moderate
narrowing of bilateral neuroforamen.
At L4-L5, there is moderate to severe in spinal canal narrowing. There is
bilateral moderate neural foraminal narrowing.
At L5-S1, there is no significant spinal canal narrowing. There is bilateral
mild-to-moderate neural foraminal narrowing.
Other: Atrophic right kidney with multiple exophytic cysts and multiple
parapelvic cysts in the left kidney are again noted, similar to prior.
IMPRESSION:
1. There is increased retropulsion of the posterior cortex of the L3 burst
compression fracture since most recent CT torso. Increased STIR signal within
interspinous ligaments without evidence of a through and through tear. No
signal abnormality was noted in bilateral facet joints.
2. There is severe spinal canal narrowing with compression of the cauda equina
nerve roots at the level of the L3 burst fracture and at L3-L4.
3. The acute fracture through the anterior inferior endplate of the L2
vertebral bodies better seen on prior CT.
|
10197669-RR-36
| 10,197,669 | 29,663,549 |
RR
| 36 |
2170-04-16 11:35:00
|
2170-04-16 12:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p spinal fracture// Check correct positioning
of NGT Check correct positioning of NGT
IMPRESSION:
Compared to chest radiographs since ___, most recent ___.
Nasogastric drainage tube ends just below the gastroesophageal junction with
lead to be advanced at least 10 cm to move all the side ports into the
stomach.
Lungs are very low in volume but clear. Heart size is normal.
Cardiomediastinal and hilar silhouettes and pleural surfaces are unremarkable.
|
10197669-RR-37
| 10,197,669 | 29,663,549 |
RR
| 37 |
2170-04-17 14:41:00
|
2170-04-17 15:49:00
|
EXAMINATION: CT ___ W/O CONTRAST Q331 CT SPINE
INDICATION: ___ year old man with L3 burst fracture// assess stability
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.4 s, 26.6 cm; CTDIvol = 27.2 mGy (Body) DLP = 723.5
mGy-cm.
Total DLP (Body) = 724 mGy-cm.
COMPARISON: MR ___ ___, L spine radiograph ___
FINDINGS:
There is a burst compression fracture of L3 with 50% reduction in height and
retropulsion into the spinal canal with less than 25% spinal canal narrowing.
Again seen is an anterior endplate fracture of L2. There is prevertebral soft
tissue swelling at the level of L2 and L3.
There are multilevel degenerative changes including osteophyte formation, loss
of disc height, and facet hypertrophy. There is moderate canal stenosis at
L4-L5. There is vacuum disc phenomenon at L4-L5. There is left-sided
foraminal narrowing at L5-S1. there is no evidence of infection or neoplasm.
OTHER: Atrophic right kidney, similar to prior study.
IMPRESSION:
1. Burst compression fracture of L3 with 50% reduction in height and
retropulsion into the spinal canal causing mild spinal canal narrowing.
2. Anterior endplate fracture of L2.
3. Multilevel degenerative changes.
|
10197669-RR-38
| 10,197,669 | 29,663,549 |
RR
| 38 |
2170-04-19 14:20:00
|
2170-04-19 15:41:00
|
EXAMINATION: SCROTAL U.S. PORT
INDICATION: ___ y/o M s/p urethral dilation and foley, now w/ testicular
pain// eval for epididymitis
TECHNIQUE: Grayscale with color and spectral Doppler ultrasound of the
scrotum was performed with a linear transducer.
COMPARISON: None.
FINDINGS:
The right testicle measures: 3.2 x 3.3 x 2.2 cm.
The left testicle measures: 3.1 x 2.0 x 2.5 cm.
The testicular echogenicity is normal, without focal abnormalities.
Vascularity within the testes is symmetrical. A small coarse calcification is
noted in the left testicle measuring about 1 mm.
Several small cysts are noted in the head of the right epididymis measuring up
to 3 mm. Otherwise the epididymis is unremarkable bilaterally.
Small bilateral hydroceles are noted. Two small scrotal pearls are
incidentally noted lateral to the left testis.
IMPRESSION:
1. No suspicious intra testicular mass.
2. Small bilateral hydroceles are noted.
|
10197716-RR-23
| 10,197,716 | 20,135,166 |
RR
| 23 |
2168-06-29 10:06:00
|
2168-06-29 14:43:00
|
HISTORY: ___ woman with severe constipation.
COMPARISON: None available.
FINDINGS:
Air is seen in nondilated central loops of small bowel. There are several
air-fluid levels in borderline dilated loops of large bowel with a maximal
diameter of 6.2 cm. There is no evidence of pneumoperitoneum or pneumatosis.
IMPRESSION:
Nonspecific bowel gas pattern with borderline dilated large bowel to 6.2 cm
with multiple air-fluid levels.
|
10197716-RR-24
| 10,197,716 | 20,135,166 |
RR
| 24 |
2168-06-30 15:38:00
|
2168-06-30 18:13:00
|
INDICATION: ___ woman with lung cancer, undergoing chemoradiation,
now with new left upper extremity swelling.
LEFT UPPER EXTREMITY: Grayscale and Doppler sonograms of left internal
jugular, subclavian, axillary, and brachial veins were performed. There is
normal compressibility and flow throughout. Complete thrombosis of the entire
course of the cephalic vein is seen. Loss of respiratory variation throughout
the entire left upper extremity venous system is likely due to compression of
the left brachiocephalic vein as it drains into the SVC.
IMPRESSION: Left cephalic vein thrombophlebitis. No DVT in the left upper
extremity.
Findings discussed with ___ at 6:00 .m on ___.
|
10197716-RR-38
| 10,197,716 | 23,656,886 |
RR
| 38 |
2169-03-21 20:12:00
|
2169-03-21 22:24:00
|
HISTORY:
___ female with lung cancer, radiation pneumonitis, now with cough and
dyspnea for several days.
COMPARISON: ___ and PET-CT dated ___
TECHNIQUE: Helically acquired axial CT images of the chest were performed
after administration of intravenous contrast. Coronal, sagittal, and bilateral
maximum intensity projection oblique reformatted images were created and
reviewed.
FINDINGS:
There is been interval development of multiple large hypodense rim enhancing
lesions throughout the atelectatic fibrotic right upper lung, compatible with
increased tumor burden. The right upper lobe bronchus is completely occluded
and the right upper lobe is collapsed. There is a new large right pleural
effusion. Multiple rim enhancing mediastinal and para-aortic lymph nodes are
new compared to prior. Multiple scattered lung nodules are new or increased
bilaterally; the largest of which measures 1 cm in the left lower lobe. There
is a small left pleural effusion. No pneumothorax is seen. The heart and
great vessels are appropriately opacified without evidence for pulmonary
embolus. The right upper lobe pulmonary artery is severely attenuated. No
pericardial effusion is seen.
Numerous enlarged liver lesions have substantially increased or developed
compared to prior, compatible with worsening metastatic disease. At least 2
subcentimeter hypodense lesions in the spleen are new compared to prior and
likely represent metastatic disease.
A lytic lesion in the left ___ posterior rib is noted.
IMPRESSION:
Markedly worsening metastatic disease in the lungs bilaterally, right greater
than left, mediastinum, liver, and likely spleen. Occluded right upper lobe
bronchus with collapse of the right upper lobe and severely attenuated right
upper lobe pulmonary artery.
Preliminary findings were reported to ___ by ___ by
telephone at 21:56 on ___ at the time of initial review of the
study.
|
10197727-RR-16
| 10,197,727 | 22,818,424 |
RR
| 16 |
2158-05-11 02:15:00
|
2158-05-11 05:39:00
|
EXAMINATION: TRAUMA #2 (AP CXR AND PELVIS PORT)
INDICATION: History: ___ with MVA*** WARNING *** Multiple patients with same
last name! // trauma survey
TECHNIQUE: Frontal views of the chest and pelvis.
COMPARISON: Same day CT torso.
FINDINGS:
The endotracheal tube terminates approximately 6.0 cm above the carina. There
is a basilar directed left-sided chest tube. The lung volume is low,
exaggerating bronchovascular markings. The right lung is clear. Opacities in
the left lung are consistent with a combination of hemorrhage and atelectasis
as seen on same day chest CT. The left costophrenic angle is blunted
consistent with known hemothorax seen on same day chest CT. No pneumothorax
is better seen on same day chest CT. Widened mediastinum is noted consistent
with known aortic laceration and mediastinal hematoma from same day CT.
There is displaced comminuted fractures of the right acetabulum with posterior
dislocation of the right femoral head. No additional fracture is identified
in the pelvis. There are mild degenerative changes of the left hip. No
suspicious osseous lesions.
IMPRESSION:
1. Widened mediastinum consistent with known aortic laceration and
mediastinal hematoma.
2. Opacities in the left lung are consistent with a combination of hemorrhage
and atelectasis. Left hemopneumothorax is better appreciated on same day
chest CT.
3. Comminuted and displaced right acetabular fracture with posterior
dislocation of the right femoral head.
|
10197727-RR-17
| 10,197,727 | 22,818,424 |
RR
| 17 |
2158-05-11 02:48:00
|
2158-05-11 04:06:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ s/p MVA*** WARNING *** Multiple patients with same
last name! // trauma survey
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 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is fluid in the nasal cavity and nasopharynx. The visualized portion of
the paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
The visualized portion of the orbits are normal. There is left frontal skin
laceration and approximately 4.2 x 0.8 cm subgaleal hematoma. Patient is
intubated.
IMPRESSION:
1. No acute intracranial process.
2. No calvarial fracture.
3. Left frontal laceration with underlying approximately 4.2 x 0.8 cm
subgaleal hematoma.
|
10197727-RR-18
| 10,197,727 | 22,818,424 |
RR
| 18 |
2158-05-11 02:49:00
|
2158-05-11 04:56:00
|
EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST
INDICATION: History: ___ s/p MVA*** WARNING *** Multiple patients with same
last name! // trauma survey
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.8 s, 77.3 cm; CTDIvol = 24.0 mGy (Body) DLP =
1,854.3 mGy-cm.
Total DLP (Body) = 1,854 mGy-cm.
COMPARISON: Same day chest and pelvic radiograph.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
There is irregularity and caliber change of the proximal descending thoracic
starting approximately 1.6 cm distal to the left subclavian artery. Extensive
mediastinal and periaortic hematoma are noted. Findings are consistent with
traumatic aortic tear/laceration. The heart is normal in size. No
pericardial effusion is seen.
Suggestive
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: There is left-sided chest tube in situ with a moderate left
hemothorax. There is trace left pneumothorax in the lower anterior chest.
LUNGS/AIRWAYS: The right lung is clear except for dependent atelectasis.
There is pulmonary hemorrhage surrounding the left chest tube. There is also
left lower lobe atelectasis. There is no suspicious pulmonary nodule or mass.
The airways are patent to the level of the segmental bronchi bilaterally. The
patient is intubated.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: There are foci of splenic laceration in the superior and inferior
spleen with small amount of adjacent intraperitoneal blood. No evidence of
active extravasation.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
No hydronephrosis in either kidney. Scattered renal cysts are noted measuring
up to 1.1 cm in the right kidney. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no free
air. Haziness surrounding the mesentery (series 601, image 62) raises concern
for mesentery hematoma. No evidence of bowel ischemia.
PELVIS:
The urinary bladder is collapsed with a Foley in place. There is small amount
of blood in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is posterior dislocation of the right femur.
There is displaced comminuted fracture of the acetabulum. There is hematoma
adjacent to the right acetabulum in the right perirectal fat. No evidence of
active extravasation. There is transverse fracture through the T9 vertebral
body (series 605, image 101). No definite retropulsion identified. There are
mildly displaced right fifth, sixth, and eighth rib fractures. There arm
minimally displaced left fourth 2 6 fractures. There are mildly displaced
left seventh to ninth rib fractures. The abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. Traumatic aortic tear/laceration approximately 1.6 cm distal to the
takeoff of the left subclavian artery with extensive periaortic and
mediastinal hematoma.
2. Left pneumohemothorax with chest tube in situ with associated pulmonary
hemorrhage along the chest tube.
3. Splenic lacerations with small amount of adjacent intraperitoneal blood.
No evidence of active extravasation.
4. Haziness surrounding the mesentery raises concern for mesenteric hematoma.
The mesenteric vessels are patent. No evidence of bowel ischemia.
5. Right posterior hip dislocation with comminuted acetabulum fracture with
associated intrapelvic hematoma.
6. Transverse fracture through T9 vertebral body. No definite retropulsion
identified.
7. Multiple bilateral rib fractures as described in the body of report.
NOTIFICATION: The findings were discussed with the trauma team by ___
___, M.D. on the telephone on ___ at 3:25 am, 2 minutes after discovery
of the findings.
The updated impressions including impression number 4 were discussed with
acute care surgery resident by ___, M.D. on the telephone on
___ at 9:05 am, 2 minutes after discovery of the findings.
|
10197727-RR-19
| 10,197,727 | 22,818,424 |
RR
| 19 |
2158-05-11 02:49:00
|
2158-05-11 04:10:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ s/p MVA*** WARNING *** Multiple patients with same
last name! // trauma survey
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 25.8 cm; CTDIvol = 23.2 mGy (Body) DLP = 597.4
mGy-cm.
Total DLP (Body) = 597 mGy-cm.
COMPARISON: None available.
FINDINGS:
Alignment is normal. No fractures are identified.The vertebral body and disc
heights are preserved. Minimal anterior posterior osteophytes are noted
throughout the cervical spine. No substantial spinal canal stenosis.
Uncovertebral and facet osteophytes cause mild right neural foraminal
narrowing at C3-4 and C4-5.
There is no prevertebral edema. The patient is intubated.
The thyroid is unremarkable. Please see separate report performed on same day
for detailed evaluation of the chest.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. Mild multilevel degenerative changes of the cervical spine, worst at C3-4
and C4-5.
3. Please see separate report performed on same day for detailed evaluation
of the chest.
|
10197727-RR-20
| 10,197,727 | 22,818,424 |
RR
| 20 |
2158-05-11 03:52:00
|
2158-05-11 05:52:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: History: ___ with central line*** WARNING *** Multiple patients
with same last name! // ?central line placement
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Same day chest radiograph and CT torso.
FINDINGS:
The tip of the ET tube is difficult to evaluate, probably 6.7 cm above the
carina. The left central venous catheter terminates in the left
brachiocephalic vein. The enteric tube terminates in the stomach. The left
basilar directed chest tube is unchanged.
The right lung remains clear. Opacity in the left lung are unchanged. Left
hemopneumothorax is better evaluated on chest CT. Widened mediastinum is
unchanged. No rib fractures are better seen on same day CT torso.
IMPRESSION:
Left central venous catheter terminates in the left brachiocephalic vein. The
remaining monitoring support devices are described above. Otherwise no
substantial interval changes compared to 1 hour prior.
|
10197727-RR-21
| 10,197,727 | 22,818,424 |
RR
| 21 |
2158-05-11 04:45:00
|
2158-05-11 07:07:00
|
EXAMINATION: KNEE( (SINGLE VIEW) RIGHT
INDICATION: ___ year old man with polytrauma // R-knee fractgure/dislocation
TECHNIQUE: Single frontal view of the right knee.
COMPARISON: None available.
FINDINGS:
No fracture or dislocation is seen. Minimal lateral compartment joint space
narrowing. Otherwise no substantial degenerative changes. There is normal
osseous mineralization. No suspicious lytic or sclerotic lesions are
identified. There is diffuse subcutaneous edema in the medial thigh.
IMPRESSION:
No acute fracture or dislocation within the limitations of this single view.
|
10197727-RR-22
| 10,197,727 | 22,818,424 |
RR
| 22 |
2158-05-11 05:57:00
|
2158-05-11 11:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with trauma // eval for interval change
TECHNIQUE: Portable AP supine chest radiograph
COMPARISON: Large superior mediastinal hematoma appears stable. Left-sided
chest tube in situ. Hemothorax is decreased in size compared to prior CT. No
left pneumothorax (please note that a portable supine radiograph decreases the
sensitivity for this). ET tube in situ with the tip projecting over the level
of the medial clavicles. Left central line in situ with the tip present in
the left brachiocephalic vein. Enteric tube in situ in the stomach. Right
lung is clear.
FINDINGS:
Supporting lines and tubes are unchanged in position. Large superior
mediastinal hematoma is unchanged. Left chest tube in situ with decrease in
size of the left hemothorax compared to prior CT. Right lung clear.
|
10197727-RR-23
| 10,197,727 | 22,818,424 |
RR
| 23 |
2158-05-11 06:42:00
|
2158-05-11 08:34:00
|
EXAMINATION: DX PELVIS AND FEMUR
INDICATION: Trauma
TECHNIQUE: AP pelvis, AP left femur
COMPARISON: CT chest abdomen and pelvis ___
FINDINGS:
There is persistent visualization of a right acetabular fracture,
predominately transverse with posterior wall component. Alignment of the hip
joint appears improved, however given widening of the joint space a persistent
dislocation is suspected. Excreted contrast seen in the bladder.
Degenerative changes in the left hip. Left femur appears grossly intact, no
fracture seen.
IMPRESSION:
Unchanged right acetabular fracture with probable persistent dislocation of
the right hip.
|
10197727-RR-24
| 10,197,727 | 22,818,424 |
RR
| 24 |
2158-05-11 08:17:00
|
2158-05-11 15:08:00
|
INDICATION: Pin placement
TECHNIQUE: Two views right femur
COMPARISON: None
FINDINGS:
Two views of the right femur demonstrate placement of a external fixation pin
across the distal femur. There is no acute fracture. The overlying soft
tissues are unremarkable.
|
10197727-RR-25
| 10,197,727 | 22,818,424 |
RR
| 25 |
2158-05-11 08:18:00
|
2158-05-11 12:49:00
|
INDICATION: Pain question fracture
TECHNIQUE: Two views of each knee
COMPARISON: ___
FINDINGS:
On the right, the external fixation rod is noted. No acute fracture is
visualized. There is a small joint effusion. The joint spaces appear
preserved.
On the left, there is no acute fracture or dislocation. The joint spaces are
preserved. There are venous varicosities.
|
10197727-RR-26
| 10,197,727 | 22,818,424 |
RR
| 26 |
2158-05-11 08:23:00
|
2158-05-11 12:46:00
|
INDICATION: Trauma
TECHNIQUE: Two views of each foot
COMPARISON: None
FINDINGS:
Right foot: There is no acute fracture or dislocation. The joint spaces are
preserved. There is mild midfoot degenerative change.
Left foot: There is no acute fracture or dislocation. The joint spaces are
preserved. There is mild midfoot degenerative change.
IMPRESSION:
No acute fracture or dislocation.
|
10197727-RR-27
| 10,197,727 | 22,818,424 |
RR
| 27 |
2158-05-11 08:19:00
|
2158-05-11 15:04:00
|
INDICATION: Trauma
TECHNIQUE: Two views of each ankle
COMPARISON: None
FINDINGS:
Right ankle: There is no acute fracture or dislocation. The tibiotalar joint
appears preserved. There is spurring at the talonavicular joint. Overlying
soft tissues are unremarkable.
Left ankle: A transversely oriented fracture through the medial malleolus
demonstrates mild distraction. The tibiotalar joint is preserved. There is
soft tissue swelling. Talonavicular joint degenerative changes noted.
IMPRESSION:
Transversely oriented left medial malleolar fracture. Proximal views of the
knees are recommended.
NOTIFICATION: .
|
10197727-RR-28
| 10,197,727 | 22,818,424 |
RR
| 28 |
2158-05-11 08:15:00
|
2158-05-11 15:02:00
|
INDICATION: Pain
TECHNIQUE: Two views left femur
COMPARISON: None
FINDINGS:
There is no acute fracture or dislocation. The overlying soft tissues are
unremarkable. No suspicious lytic or sclerotic lesion.
IMPRESSION:
No acute fracture or dislocation.
|
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