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2158-05-13 02:40:00
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2158-05-13 13:31:00
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EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ s/p high speed MVC, intoxicated driver vs parked car with CT
C/A/P pos for T9 vertebral fracture, currently intubated/sedated. // Please
eval for cervical spine pathology in order to clear c-collar precautions.
Please eval for cervical spine pathology in order to clear c-collar
precautions., Please evaluate T9 vertebral fx
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: CT chest, abdomen and pelvis dated ___
FINDINGS:
CERVICAL:
Alignment is normal.There is multilevel disc desiccation with loss of
intervertebral disc height at C4-C5 and C5-C6. There is subtle increased T2
signal intensity only seen on the sagittal images at the level of C4-C5
(series 5, image 9).The spinal cord otherwise appears normal in caliber and
configuration. There is no evidence of spinal canal or neural foraminal
narrowing. There is no evidence of infection or neoplasm.
C2-C3: No spinal canal or neural foraminal stenosis.
C3-C4: Mild disc bulge and mild right neural foraminal narrowing. No spinal
canal stenosis.
C4-C5: Diffuse disc bulge with mild bilateral neural foraminal narrowing. No
spinal canal stenosis.
C5-C6: Diffuse disc bulge without significant spinal canal or neural foraminal
stenosis.
C6-C7 and C7-T1: No significant spinal canal stenosis or neural foraminal
narrowing.
THORACIC:
There is a horizontally oriented fracture involving the anterior and middle
columns of T9 with fracture extension into the inferior endplate/disc and into
the right neural foramen. There is possible extension into the superior
endplate of T10 (series 4, image 16). There is possible increased T2 signal
within the spinal cord at the level of T9 (series 12, image 11 and 13). There
is prevertebral soft tissue swelling with mild edema in the interspinous
ligament at T9-T10. There is multilevel disc desiccation with prominent
Schmorl's nodes at T7-T8 and T8-T9. A small posterior disc bulges noted at
the level of T7-T8 without significant spinal canal narrowing. Alignment is
otherwise normal.There is no evidence of spinal canal or neural foraminal
narrowing. There is no evidence of infection or neoplasm.
LUMBAR:
There are right transverse process fractures of L1 and L2. There is
multilevel disc desiccation with loss of intervertebral disc height at L4-L5
and ___ type 1 changes along the endplates adjacent to the intervertebral
disc. Alignment is otherwise normal.Vertebral body signal intensity otherwise
appear normal.The spinal cord appears normal in caliber and
configuration.There is no evidence of infection or neoplasm.
T12-L1:
L1-L2: No spinal canal or neural foraminal stenosis.
L2-L3: Diffuse disc bulge with a posterior disc annular fissure, ligamentum
flavum thickening and facet hypertrophy resulting in mild-to-moderate spinal
canal stenosis without neural foraminal stenosis.
L3-L4: Diffuse disc bulge with posterior disc annular fissure, ligamentum
flavum thickening and facet hypertrophy resulting in mild-to-moderate spinal
canal narrowing and mild bilateral neural foraminal narrowing.
L4-L5 diffuse disc bulge, ligamentum flavum thickening and facet arthropathy
resulting in moderate spinal canal stenosis and moderate bilateral neural
foraminal stenosis.
L5-S1: Diffuse disc bulge and ligamentum flavum thickening without spinal
canal stenosis. Moderate left and mild-to-moderate right neural foraminal
stenosis.
OTHER: Multiple partially visualized rib fractures bilaterally with a
mediastinal hematoma, bilateral airspace disease, effusions and a left-sided
chest tube. Partially visualized hematoma in the pelvis
IMPRESSION:
1. Horizontally oriented fracture through the T9 vertebral body involving the
anterior and middle columns with extension into the intervertebral disc at
T9-T10, superior endplate of T10 and right neural foramen with possible cord
edema at this level. No significant retropulsion or epidural hematoma.
2. Questionable increased T2 signal intensity at the level of C4-C5, seen only
on the sagittal T2 images, possibly related to artifact with edema not
entirely excluded. Follow-up imaging may be considered.
3. Right transverse fractures of the L1 and L2 vertebral bodies.
4. Multilevel degenerative changes of the cervical, thoracic and lumbar spine,
most advanced at L4-L5 where there is moderate spinal canal stenosis and
bilateral neural foraminal narrowing as detailed above.
5. Partially visualized mediastinal hematoma with bilateral pleural effusions,
airspace disease and bilateral rib fractures.
6. Partially visualized pelvic hematoma.
PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects
without low back pain:
Overall evidence of disk degeneration 91% (decreased T2 signal, height loss,
bulge)
T2 signal loss 83%
Disk height loss 58%
Disk protrusion 32%
Annular fissure 38%
Jarvik, et all. Spine ___ 26(10):1158-1166
Lumbar spinal stenosis prevalence- present in approximately 20% of
asymptomatic adults over ___ years old
___, et al, Spine Journal ___ 9 (7):545-550
These findings are so common in asymptomatic persons that they must be
interpreted with caution and in context of the clinical situation.
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2158-05-11 17:39:00
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2158-05-11 19:25:00
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EXAMINATION: DX TIB/FIB AND ANKLE
INDICATION: ___ year old man with medial malleoulus, s/p reduction and
splinting // fracture fracture
TECHNIQUE: 6 views of the left tibia, fibula and ankle were obtained
COMPARISON: ___ from earlier in the day
FINDINGS:
Splint material obscures fine osseous detail. Re demonstrated is a
transversely oriented medial malleolus fracture with slight interval decrease
in the extent of destruction. No new fractures are identified. The
tibiotalar joint is preserved. The mortise shows some slight asymmetric
widening laterally. Diffuse soft tissue swelling is present around the ankle.
IMPRESSION:
Slight asymmetry in the appearance of the mortise with widening laterally. Re
demonstrated is a mildly distracted transversely oriented medial malleolar
fracture.
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2158-05-12 04:42:00
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2158-05-12 11:54:00
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EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man MVC polytrauma w mediastinal hematoma, L chest
tube // interval change
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-rays from ___, CT chest ___.
FINDINGS:
Enteric tube is visualized in the stomach. ET tube is visualized about 4.5 cm
from carina with tip projecting over the level of the medial clavicles. Left
central line with tip present in the left brachiocephalic vein. Left-sided
chest tube is visualized and appropriately placed. Low lung volumes.
Mediastinal width is relatively unchanged compared to prior. Left hemothorax
is unchanged. No pneumothorax is visualized (please note that a portable
supine radiograph decreases the sensitivity for this). Lungs appear similar
compared to prior scan.
IMPRESSION:
Supporting lines and tubes are unchanged in position. Large superior
mediastinal hematoma is unchanged. Left chest tube is in appropriate
position. Left hemothorax is unchanged.
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2158-05-12 09:37:00
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2158-05-12 22:55:00
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EXAMINATION: CTA TORSO
INDICATION: ___ year old man with traumatic aortic injury, plan for OR today
// eval for size of aorta, interval change- operative planning for TEVAR to be
done today to fix aorta
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 5.5 s, 72.4 cm; CTDIvol = 24.5 mGy (Body) DLP =
1,772.0 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.3
mGy-cm.
3) Stationary Acquisition 7.8 s, 0.5 cm; CTDIvol = 34.9 mGy (Body) DLP =
17.5 mGy-cm.
Total DLP (Body) = 1,791 mGy-cm.
COMPARISON: CT torso ___.
FINDINGS:
The study is limited by its non gated nature as well as exclusion of the lung
apices and superior aortic arch from the images. Within these confines,
provided measurements of the thoracic aorta are as follows:
Aortic annulus: 3.8 x 2.3 cm
Sinus of Valsalva: 3.2 x 2.9 cm
Sinotubular junction: 3.0 x 2.7 cm
Mid ascending aorta: 2.8 x 2.6 cm
Proximal descending aorta: 3.6 x 3.1 cm, at the level of the acute aortic
injury
Distal descending aorta: 2.2 x 2.0 cm
Main pulmonary artery: 4.0 x 3.3 cm
No areas of stenosis measuring less than 6-7 mm within the abdominal aorta,
bilateral iliac and femoral arteries.
CHEST:
HEART AND VASCULATURE: The study is not optimized for evaluation of pulmonary
vasculature. There is no large, central filling defect to indicate a
pulmonary embolus. Again seen is contour irregularity and an abrupt caliber
change of the proximal descending thoracic aorta, just distal to the origin of
the left subclavian artery, likely at the level of the ligamentum arteriosum,
with extensive mediastinal hematoma, not substantially changed, compatible
with acute aortic rupture/laceration. Small amount of hemorrhage seen
anterior to the pulmonary truncus, decreased.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: A left chest tube is in place, with the tip terminating at the
left lower posterior pleural space, with surrounding opacification, likely
hemorrhage. A trace left anterior pneumothorax is decreased in size from
prior. Small volume, intermediate density left pleural effusion is compatible
with hemothorax. No right pneumothorax or pleural effusion.
LUNGS/AIRWAYS: Mild right dependent atelectasis. A consolidation adjacent to
the left pneumothorax is compatible with atelectasis. Retained secretions in
the distal trachea and left mainstem bronchus. The airways are otherwise
patent to the level of the segmental bronchi bilaterally.
BONES AND SOFT TISSUE: Non to mildly displaced fractures of the right lateral
fifth and sixth, posterior eighth, and lateral ninth ribs are unchanged.
Multiple mildly displaced left-sided rib fractures appears similar to prior.
A horizontally oriented, mildly distracted fracture of the T9 vertebral body,
extending to the right neural foramen, is unchanged.
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 contains layering
hyperdense material, likely reflecting vicarious excretion of previously
administered contrast. Trace perihepatic hematoma appears new (2:121), likely
secondary to redistribution.
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 throughout. Splenic lacerations are less
conspicuous compared to prior. Small volume perisplenic hematoma appears
unchanged.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: An enteric tube is partially imaged, with the tip
terminating in the gastric fundus. Small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. Colonic diverticulosis,
without evidence of acute diverticulitis. No evidence of bowel wall
thickening, pneumatosis, or free intraperitoneal air. The appendix is normal.
Areas of haziness of the mesenteric fat appear slightly improved (2:111, 138),
concerning for mesenteric injury.
PELVIS:
The bladder is decompressed around a Foley catheter. Hyperdense material
within the bladder reflects excreted contrast. Small volume pelvic hematoma.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Mild stranding around the superior mesenteric artery appears
unchanged. The SMA appears patent, although is suboptimally assessed on this
study. There is no abdominal aortic aneurysm. No atherosclerotic disease is
noted.
BONES AND SOFT TISSUES: Displaced fractures of the right transverse process of
L1 and L2 and left transverse process of L5. Again seen is a comminuted right
acetabular fracture, with improved alignment of the femoroacetabular joint,
likely following reduction. Multiple adjacent fracture fragments remain
displaced. A hematoma posterior to the right hip, anterior to the right
gluteus muscles, measures approximately 5.2 x 4.7 cm (2:242), possibly due to
recent reduction. Blood products adjacent to the pelvic sidewall also appear
slightly increased compared to the prior study. No evidence of active
extravasation.
There is no evidence of worrisome osseous lesions. The abdominal and pelvic
wall is within normal limits.
IMPRESSION:
The study is limited by exclusion of the lung apices and superior aortic arch
from the images as well as its non gated nature. Within these confines:
1. No substantial change in the acute aortic injury, just distal to the origin
of the left subclavian artery, with extensive mediastinal hematoma. A gated
chest CTA is recommended for more optimal measurement and assessment of
thoracic aorta and aortic arch (for more accurate pre-surgical measurements).
2. Small, residual left anterior pneumothorax, following chest tube placement.
No substantial change in small volume left hemothorax.
3. Slight interval improvement in haziness of the mesenteric fat, concerning
for mesenteric injury. No evidence of bowel wall thickening, pneumatosis, or
free intraperitoneal air.
4. No substantial change in fat stranding surrounding the superior mesenteric
artery. The SMA is suboptimally assessed on this non arterial phase study.
Attention on follow-up imaging is recommended to ensure this reflects
mesenteric injury rather than dissection with surrounding stranding.
5. New, interval small perihepatic hematoma, likely secondary to
redistribution.
6. Interval decrease in conspicuity of splenic lacerations, with unchanged,
small volume perisplenic hematoma.
7. Redemonstrated comminuted right acetabular fracture, with improved
alignment of the femoroacetabular joint, likely following reduction. Small
volume hematoma adjacent to the right hip and slightly increased blood
products adjacent to the right pelvic sidewall may be sequela of recent
reduction. No evidence of active extravasation.
8. Redemonstrated fractures of the T9 vertebral body; transverse processes of
L1, L2, and L5; and multiple bilateral ribs. Please refer to the spine MRI
performed on ___ for further characterization of the
aforementioned fractures.
RECOMMENDATION(S): Gated CTA thoracic aorta
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2158-05-13 06:04:00
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2158-05-13 12:12:00
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EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: ___ year old man MVC polytrauma w mediastinal hematoma, L chest
tube now s/p TEVAR for pseudoaneurysm // Interval change Interval change
IMPRESSION:
Compared to chest radiographs ___.
New aortic endograft in place. No change in severe generalized widening of
the upper mediastinum. Heart size top-normal. Lower lung volumes explain
vascular crowding. There is no appreciable pneumothorax or pleural effusion
and probably no pulmonary edema.
ET tube in standard placement. Nasogastric drainage tube ends in the upper
stomach. Lateral entry thoracostomy tube still terminates at the base of the
paramedian left hemithorax.
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2158-05-14 05:40:00
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2158-05-14 10:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax, aortic injury // ? interval
change ? interval change
IMPRESSION:
Left chest tube is in place. Left PICC line tip is in the proximal right
atrium, should be pulled back 2 cm to secure it position at the cavoatrial
junction or above.
Mediastinal contour is stable including the known hematoma associated with
aortic injury. Left chest tube is in place. Left pleural effusion is small.
Left chest wall air, subcutaneous has minimally increased in the interim.
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2158-05-15 05:47:00
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2158-05-15 09:47:00
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EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with polytrauma incl L hemoptx w CT // eval
hemoptx
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
The lungs are low volume with bibasilar atelectasis. There is subsegmental
atelectasis in the left lung base. Left-sided chest tube is unchanged.
Subcutaneous emphysema in the left-lateral chest wall is also stable.
Left-sided PICC line projects to the cavoatrial junction. There is moderate
pulmonary vascular congestion. No pneumothorax. The nodular opacity in the
left upper paraspinal location could represent an aneurysm and is unchanged.
The aortic stent is in place.
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2158-05-15 13:23:00
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2158-05-15 16:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with polytrauma and hemothorax now s/p chest tube
removal at 930AM // interval changes 4 hour post chest tube removal. please
for 1:30 ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
In comparison with the prior study, the left chest tube has been removed with
no evidence of pneumothorax. Asymmetric left basal opacification is worrisome
for aspiration/pneumonia. Large component of the subcutaneous emphysema is
out of the field of view, thus not comparable with the prior study. Stable
appearance of the widened mediastinum with presence of a known hematoma. Left
PICC line ends in the proximal portion of the right atrium, unchanged.
IMPRESSION:
Left chest tube interval removal, no evidence of pneumothorax.
Asymmetric opacity in the left base is worrisome for aspiration/pneumonia.
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2158-05-18 10:05:00
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2158-05-18 16:28:00
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EXAMINATION: PELVIS (AP, INLET AND OUTLET)
TECHNIQUE: Intraoperative imaging
COMPARISON: Radiographs dated ___
IMPRESSION:
Intraoperative images were obtained during fixation of right acetabular
fracture and fusion of left SI joint. Total fluoroscopic time of 32.3
seconds.. Please refer to the operative note for details of the procedure.
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2158-05-18 12:08:00
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2158-05-18 15:10:00
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EXAMINATION: ANKLE (AP, LAT AND OBLIQUE) LEFT IN O.R.
TECHNIQUE: Intraoperative imaging
COMPARISON: Prior radiographs dated ___
IMPRESSION:
Intraoperative images were obtained during steps demonstrating open reduction
and internal fixation of the fracture of medial malleolus.. Please refer to
the operative note for details of the procedure.
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2158-05-21 09:17:00
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2158-05-21 17:29:00
|
EXAMINATION: CTA TORSO
INDICATION: ___ year old man s/p TEVAR for type B aortic dissection // s/p
TEVAR
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 4.6 s, 72.7 cm; CTDIvol = 6.6 mGy (Body) DLP = 482.4
mGy-cm.
2) Spiral Acquisition 4.3 s, 67.9 cm; CTDIvol = 20.4 mGy (Body) DLP =
1,385.1 mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.2 mGy (Body) DLP = 1.1
mGy-cm.
4) Stationary Acquisition 7.0 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP =
15.7 mGy-cm.
Total DLP (Body) = 1,884 mGy-cm.
COMPARISON: CT torso ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: There is a partially occlusive filling defect within a
subsegmental branch of the right pulmonary artery within the right lower lobe
(3:53). Otherwise, the pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The patient is status post TEVAR for an acute aortic injury. The stent
appears patent. Small volume mediastinal hematoma has not substantially
changed from the prior study. The heart, pericardium, and great vessels are
otherwise within normal limits. No pericardial effusion is seen. The tip of a
central venous catheter terminates in the distal SVC.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: A small volume, intermediate density left pleural effusion,
compatible with hemothorax, appears similar. No right pleural effusion. No
pneumothorax.
LUNGS/AIRWAYS: The right apical lung is excluded from the images. A
perifissural pulmonary nodule within the right upper lobe measures 6 mm
(3:14). Mild, bilateral, dependent atelectasis. No evidence of pulmonary
infarct. The airways are patent to the level of the segmental bronchi
bilaterally.
SOFT TISSUES AND BONES: Extensive subcutaneous emphysema within the left
lateral chest wall, following interval chest tube removal. Diffuse
subcutaneous edema. Redemonstrated fractures of the right lateral fifth and
sixth, posterior eighth, and lateral ninth ribs appears slightly less
conspicuous, denoting interval healing. Multiple, displaced left-sided rib
fractures have not substantially changed. A horizontally oriented fracture of
the T9 vertebral body is less conspicuous.
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: Previously seen splenic lacerations are not as conspicuous on this
study. Small volume perisplenic hematoma has resolved.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Colonic
diverticulosis, without evidence of acute diverticulitis. The appendix is
normal. There is no free intraperitoneal fluid or free air. Stranding within
the mesenteric fat of the mid abdomen (3:160) appears slightly more
conspicuous, and may be sequela of prior mesenteric injury.
PELVIS:
The bladder appears unremarkable. Trace pelvic hematoma, decreased from
prior.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Fat stranding around the superior mesenteric artery appears less
conspicuous. There is no abdominal aortic aneurysm. No atherosclerotic
disease is noted.
BONES AND SOFT TISSUES: Displaced fractures of the right transverse processes
of L1 and L2 and left transverse process of L5 are again seen. A screw
traverses the left sacroiliac joint. The patient is status post ORIF of the
comminuted right acetabular fracture, with improved overall alignment of the
femoroacetabular joint. Small volume hematoma around the right hip has
decreased in size. Diffuse subcutaneous edema.
IMPRESSION:
1. Status post TEVAR for an acute aortic injury, with patent stent and
unchanged, small volume mediastinal hematoma.
2. Partially occlusive pulmonary embolus within a subsegmental branch of the
right pulmonary artery of the right lower lobe. No evidence of pulmonary
infarct or right heart strain.
3. No substantial change in small volume left hemothorax.
4. Slight interval increase in conspicuity of stranding within the mesenteric
fat, which may be sequela of prior mesenteric injury.
5. Interval resolution of small volume perisplenic hematoma and decrease in
trace pelvic hematoma.
6. Improved alignment following ORIF of the comminuted right acetabular
fracture, with decrease in small volume hematoma around the right hip.
7. Extensive subcutaneous emphysema within the left lateral chest wall, which
may be from prior chest tube removal.
8. 6 mm perifissural pulmonary nodule within the right upper lobe, which may
be infectious or inflammatory in etiology.
9. Interval healing of multiple bilateral rib fractures and a fracture of the
T9 vertebral body. No substantial change in fractures of the right transverse
processes of L1 and L2 and left transverse process of L5.
RECOMMENDATION(S): For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:55 pm, 2 minutes after discovery
of the findings.
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2158-05-21 09:59:00
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2158-05-21 11:28:00
|
EXAMINATION: PELVIS (AP, INLET AND OUTLET)
INDICATION: ___ year old man with s/p ORIF R acetabular fx, Left SI joint,
Left ankle // s/p ORIF R acetabular fx, Left SI joint, Left ankle
IMPRESSION:
In comparison with the operative images of ___, there is little
change in the appearance of the fixation device about the displaced fracture
of the right acetabulum and the screw across the widened left SI joint. No
evidence of hardware-related complication.
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2158-05-21 09:59:00
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2158-05-21 11:29:00
|
EXAMINATION: ANKLE (2 VIEWS) LEFT
INDICATION: ___ year old man with s/p ORIF R acetabular fx, Left SI joint,
Left ankle // s/p L ankle ORIF
IMPRESSION:
In comparison with the operative study of ___, there is little change
in the fixation device about a fracture of the medial malleolus. No evidence
of hardware-related complication or displacement. The ankle mortise is
stable.
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2158-05-22 13:13:00
|
2158-05-22 16:02:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with subsegmental PE // ? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
On the left side, triphasic Doppler waveforms are seen in the femoral,
superficial femoral, popliteal. The posterior tibial and dorsalis pedis
arteries cannot be evaluated as the patient has a splint in his calf. No
monophasicwaveforms are seen.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10197727-RR-46
| 10,197,727 | 22,818,424 |
RR
| 46 |
2158-05-26 11:25:00
|
2158-05-27 11:39:00
|
EXAMINATION: CHEST (PA, LAT AND OBLIQUES)
INDICATION: s/p TEVAR on ___ // evaluate thoracic stent graft for
migration fracture
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
Left sided central line tip terminates at the cavoatrial junction. Status
post placement of endovascular stent in aorta, position of stent is unchanged.
Stable appearance of widened mediastinum.
Improved subcutaneous air in the left lateral chest wall. Worsening of left
pleural effusion. Improved left lower lobe atelectasis. Bilateral pleural
effusions, left greater than right. No pulmonary vascular congestion. No
pneumothorax.
IMPRESSION:
1. Unchanged position of thoracic stent graft..
2. Improved left lower lobe atelectasis. Bilateral pleural effusions, left
greater than right.
|
10197826-RR-19
| 10,197,826 | 21,433,640 |
RR
| 19 |
2165-07-27 15:39:00
|
2165-07-27 17:04:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with preop for spine surgery// pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Outside reference MR ___ from ___
FINDINGS:
The lungs appear clear without focal consolidation. There is no pulmonary
edema, pneumothorax, or pleural effusion. Right-sided aortic arch is noted.
The cardiomediastinal silhouette hilar contours are otherwise unremarkable.
Mild degenerative changes are seen along the visualized thoracic spine.
IMPRESSION:
No acute cardiopulmonary process.
Incidentally noted right-sided aortic arch.
|
10197826-RR-20
| 10,197,826 | 21,433,640 |
RR
| 20 |
2165-07-28 16:00:00
|
2165-07-29 09:37:00
|
EXAMINATION: LUMBAR SP,SINGLE FILM IN O.R.
COMPARISON: MR ___ ___, CT lumbar spine ___
FINDINGS:
6 intraoperative images were acquired without a radiologist present.
Images show steps in T11-12 laminectomy and posterior spinal fusion. Final
image demonstrates improved spinal alignment.
IMPRESSION:
Intraoperative images were obtained during T11-12 laminectomy and spinal
fusion. Please refer to the operative note for details of the procedure.
|
10197826-RR-21
| 10,197,826 | 21,433,640 |
RR
| 21 |
2165-07-30 13:52:00
|
2165-07-30 16:44:00
|
EXAMINATION: L-SPINE (AP AND LAT)
INDICATION: ___ year old man with TLIF T11-T12// standing eval hardware,
include all hardware
TECHNIQUE: Frontal and lateral view radiographs of the lumbar spine.
COMPARISON: Intraoperative images dated ___
FINDINGS:
The bones are severely osteopenic. The patient is post posterior fusion of
T11-T12 as well as placement of an interbody spacer. No hardware related
complications are identified. 5 non-rib-bearing lumbar vertebral bodies are
present. There is a dextroconvex scoliosis of the lumbar spine. Extensive and
severe degenerative changes present within the lumbar spine, better assessed
on the recent CT scan with near complete disc space loss at L2-L3 and L4-L5.
There are mild degenerative changes of the hips bilaterally.
IMPRESSION:
Status post T11-T12 fusion as well as placement of an interbody spacer. No
acute hardware related complications identified.
Severe degenerative change of the lumbar spine.
|
10197826-RR-22
| 10,197,826 | 21,433,640 |
RR
| 22 |
2165-07-30 05:32:00
|
2165-07-30 10:55:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ male with a past medical history of lumbar spinal
stenosis, T11-T12 severe spinal stenosis, right foot drop now s/p T11-L1
Lami/Fusion with T11-L2 Interbody spacer on ___ with Dr. ___. Now with
bilateral hand numbness and difficulty holding a cup. Rule out cervical
stenosis.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: MRI thoracic spine dated ___ from outside facility.
FINDINGS:
Advanced degenerative changes cervical spine. Congenital narrowing spinal
canal. Disc space narrowing C3-C4 through C7-T1 levels, with disc osteophyte
complexes. Advanced posterior element hypertrophic changes. Multilevel facet
joint effusions. Edema C4, C5, C6, C7 vertebral bodies, likely
degenerative/reactive. Edema posterior elements left C3, C4 level, likely
degenerative/reactive, minimal adjacent paraspinal edema.
Cord signal abnormality from C3-C4 through C6-C7 levels within both central
left and right hemi cords, left greater than right. There predominantly very
bright T2 signal changes, favoring if spondylotic myelomalacia, there may be
component of spondylotic myelopathy.
At C2-C3, mild central canal narrowing. Mild bilateral foraminal narrowing.
At C3-C4, severe central canal narrowing, cord flattening. Small left
paramedian disc protrusion. Moderate left, severe right foraminal narrowing.
At C4-C5 severe central canal narrowing, cord flattening. Central canal
measures approximately 0.4 cm in AP diameter. Broad-based central disc
protrusion, possibly calcified.
At C5-C6, severe central canal narrowing, cord flattening. Severe bilateral
foraminal narrowing.
At C6-C7, severe central canal narrowing, cord flattening. Severe bilateral
foraminal narrowing.
At C7-T1, mild central canal narrowing. Moderate bilateral foraminal
narrowing.
At T1-T2, mild central canal narrowing, small central disc protrusion,
moderate to severe bilateral foraminal narrowing.
At T2-T3, mild central canal narrowing, moderate severe bilateral foraminal
narrowing.
IMPRESSION:
1. Severe degenerative changes cervical spine.
2. Congenital narrowing spinal canal.
3. Severe central canal narrowing C3-C4, C4-C5, C5-C6, C6-C7 levels, with cord
compression.
4. Cord signal abnormality C3-C4 through C6-C7 levels, with areas of
spondylotic cord myelomalacia, and possibly spondylotic cord myelopathy.
5. Multilevel severe foraminal narrowing, as above.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:53 am.
|
10198377-RR-24
| 10,198,377 | 29,256,780 |
RR
| 24 |
2152-05-03 09:52:00
|
2152-05-03 10:47:00
|
HISTORY: Pacemaker placement.
FINDINGS: No previous images. Dual-channel pacer device inserted through the
left subclavian vein has leads extending to the right atrium and apex of the
right ventricle. No evidence of pneumothorax.
No acute focal pneumonia, vascular congestion, or pleural effusion.
|
10198600-RR-129
| 10,198,600 | 29,856,792 |
RR
| 129 |
2126-09-16 14:56:00
|
2126-09-16 15:46:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ w/hypotension, please eval for occult pna, pulm edema
COMPARISON: Prior exam dated ___.
FINDINGS:
AP upright and lateral views of the chest provided. Cervical spinal hardware
is partially visualized in the lower neck. There is a right shoulder
prosthesis. Overlying EKG leads are present. Lung volumes are low. Lungs
are clear. No convincing signs of pneumonia or edema. No large effusion or
pneumothorax. The cardiomediastinal silhouette appears relatively unchanged.
Bony structures are intact.
IMPRESSION:
No acute findings.
|
10198664-RR-19
| 10,198,664 | 26,752,143 |
RR
| 19 |
2151-12-11 00:13:00
|
2151-12-11 00:47:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with metastatic pancreatic cancer likely// r/o
intracranial mets
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.3 cm; CTDIvol = 49.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture, infarction, hemorrhage,edema,or mass. There
is prominence of the ventricles and sulci suggestive of involutional changes.
Periventricular and subcortical white matter hypodensities are nonspecific but
compatible with mild chronic small vessel ischemia.
There is aerosolized material seen within the bilateral sphenoid sinuses and
partial opacification of the ethmoid air cells bilaterally. Otherwise, the
visualized portion of the paranasal sinuses, mastoid air cells,and middle ear
cavities are clear. Patient is status post bilateral lens replacements.
IMPRESSION:
1. No evidence of mass, hemorrhage or infarction.
2. Paranasal sinus inflammatory changes.
|
10198664-RR-20
| 10,198,664 | 26,752,143 |
RR
| 20 |
2151-12-11 17:23:00
|
2151-12-11 18:21:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with possible pancreatic mass?, multiple liver
mets, unknown primary// please eval for malignancy
TECHNIQUE: Contiguous axial images were obtained through the chest with
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. There is
mild atherosclerotic disease in the aortic arch and in the descending thoracic
aorta. The heart, pericardium, and great vessels are within normal limits.
No pericardial effusion is seen.
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 mild biapical pleuroparenchymal scarring. There is a
6 mm pulmonary nodule in the left lung base (6:204). There are innumerable
bilateral sub 3 mm peripheral nodules, which are likely inflammatory versus
infectious in etiology. There are bilateral perifissural nodules measuring up
to 3 mm in the left lower lobe (6: 173) and 3 mm in the right middle lobe
(6:203), which may represent intrapulmonary lymph nodes. Lungs are clear
without masses or areas of parenchymal opacification. 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: Although the study is not tailored for evaluation of subdiaphragmatic
structures, again seen are innumerable ill-defined, hypodense lesions
scattered throughout the liver measuring up to 2.2 cm in the left hepatic lobe
(04:52). A mass arising from the pancreatic body measuring approximately 5.0
x 3.2 cm is again demonstrated. The mass is inseparable from the lesser
curvature of the stomach (04:53). As before, the splenic vein is obliterated.
There is a 1.3 cm accessory spleen near the splenic hilum. There are multiple
omental soft tissue nodules measuring up to 2.3 x 1.5 cm (04:58), suspicious
for metastatic disease. An enlarged gastrohepatic lymph node measures
approximately 1.7 x 1.2 cm (04:50).
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
There is moderate dextrocurvature of the thoracic spine, with apex at
approximately T6. There are moderate multilevel degenerative changes
throughout the visualized thoracolumbar spine.
IMPRESSION:
1. Although better appreciated on the prior CT abdomen pelvis, re-demonstrated
is a pancreatic body mass with innumerable hepatic lesions, peripancreatic
adenopathy and mesenteric and omental nodules.
2. A 6 mm nodule in the left lung base for which attention on follow-up
imaging is recommended..
3. Millimetric perifissural nodules bilaterally are nonspecific, but may
represent intrapulmonary lymph nodes.
4. Innumerable bilateral peripheral micro nodules are also nonspecific, but
may be infectious versus inflammatory in etiology.
|
10198664-RR-21
| 10,198,664 | 26,752,143 |
RR
| 21 |
2151-12-11 12:51:00
|
2151-12-11 15:43:00
|
EXAMINATION: SECOND OPINION CT TORSO
INDICATION: ___ year old woman with pancreatic mass, hepatic lesions// CT
abdomen from ___
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: 1131 mGy-cm.
COMPARISON: None.
FINDINGS:
The lung bases appear clear. There is no pericardial or pleural effusion.
The heart size is normal.
There are numerous (greater than 25) ill-defined hypoenhancing hepatic lesions
involving all hepatic segments, the majority subcentimeter in size, with the
largest lesion measuring up to 2.2 cm, most compatible with metastases (series
2, image 23, 17, 28). There is no intra or extrahepatic bile duct dilation.
The gallbladder is decompressed, and appears normal. No radiopaque ductal
stones are seen.
There is a 4.5 x 5.2 cm pancreatic body mass which extends anteriorly to
contact the lesser curvature of the stomach, with obscure a shin of the
intervening fat plane (series 2, image 22, 25). There is mild upstream
pancreatic duct dilation with tail atrophy (series 2, image 24). The mass
obliterates the splenic vein. There is also encasement of splenic artery
(series 2, image 24). The mass also contacts the portal splenic confluence
(series 42,224 image 34), without attenuation of the main portal vein. The
SMV appears patent. The SMA is separate from the lesion. There is encasement
of the proximal common hepatic artery (series 2, image 25).
Adjacent adenopathy is present, including a 1.4 cm gastrohepatic node (series
2, image 24) and multiple enlarged porta hepatis nodes (series 2, image 27,
24). In addition, there are multiple mesenteric and omental nodules
throughout the abdomen (series 2, image 28, 31, 33, 35, 42), the largest
measuring 2.3 x 1.8 cm along the left abdomen (series 2, image 35).
The spleen size is within normal limits. There are no focal splenic lesions.
The adrenal glands are normal in size and shape.
The kidneys are normal in size and enhance symmetrically, without
hydronephrosis.
The stomach and intra-abdominal and intrapelvic loops of small and large bowel
are normal in caliber. No focal gastrointestinal lesion is detected.
There is extensive colonic diverticulosis.
The bladder is mildly distended, and appears normal. The uterus is
retroverted, and normal in size. A partially calcified fundal fibroid is
incidentally noted (series ___, image 44).
No concerning adnexal lesions are detected.
There are moderate atherosclerotic calcifications throughout the abdominal
aorta and iliac branches, without dissection or flow-limiting stenosis. No
aneurysm is detected.
The there are no osseous lesions concerning for malignancy or infection.
There is extensive lumbar spondylosis, without spondylolisthesis.
IMPRESSION:
1. 4.5 x 5.2 cm pancreatic body mass with numerous (greater than 25) hepatic
lesions, porta hepatis and peripancreatic adenopathy, a numerous mesenteric
and omental nodules. The constellation of findings favor metastatic
pancreatic adenocarcinoma.
2. The pancreatic mass obliterates the splenic vein, with encasement of the
splenic artery, proximal common hepatic artery, and splenic artery. The mass
contacts the main portal vein, without significant attenuation.
3. Extensive colonic diverticulosis.
4. Fibroid uterus.
|
10198664-RR-22
| 10,198,664 | 26,752,143 |
RR
| 22 |
2151-12-14 12:53:00
|
2151-12-14 17:55:00
|
INDICATION: ___ year old woman with as above // ___ found to have
pancreatic mass with innumerable hepatic lesions
COMPARISON: ___ opinion CT torso ___
PROCEDURE: Ultrasound-guided left omental biopsy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the
key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the ultrasound scan table.
Limited preprocedure ultrasound of the left upper abdomen was performed.
Based on the ultrasound findings an appropriate position for the biopsy was
chosen. The site was marked.
The site was prepped and draped in the usual sterile fashion. 1% lidocaine
were administered to the subcutaneous and deep tissues for local anesthetic
effect. Under continuous ultrasound guidance, an 18 gauge core biopsy device
with a 22 mm throw was used to obtain 3 core biopsy specimens, which were sent
for pathology.
The procedure was tolerated well, although there was a small hematoma around
the omental lesion following the biopsies.
The patient was examined on the floor approximately 2 hours postprocedure by
___, MD and was hemodynamically stable, appeared clinically well, and
demonstrated minimal abdominal tenderness which had largely improved since
immediately following the procedure.
SEDATION: Moderate sedation was provided by administering divided doses of 1
mg Versed and 50 mcg fentanyl throughout the total intra-service time of 50
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
18 gauge core biopsy samples placed in formalin and sent for pathology
protocol.
IMPRESSION:
Technically successful ultrasound-guided left omental biopsy with small
postprocedural hematoma.
NOTIFICATION: Postprocedural hematoma discussed with ___, MD by
___, MD via telephone at 16:50 on ___.
|
10198913-RR-47
| 10,198,913 | 22,853,423 |
RR
| 47 |
2171-05-24 14:25:00
|
2171-05-26 10:20:00
|
INDICATION: ___ female patient with right facial droop and increased
confusion; evaluate for stroke.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during IV infusion of 70 mL Omnipaque-350
contrast material. Images were processed curved-planar reformatted,
volume-rendered 3D-reconstructed, and thick-slab maximum intensity projection
images created and viewed on an independent workstation.
TOTAL EXAM DLP: 3544.90 mGy-cm.
CTDIvol: 647.85 mGy.
COMPARISON: None available.
FINDINGS:
HEAD CT: The study is limited due to patient motion. There is no evidence of
hemorrhage, edema, mass, mass effect, or acute infarction. There is
prominence of cortical sulci, ventricles, and extra-axial CSF spaces
representing atrophy, likely age-related. Hypodensities in the
periventricular white matter are likely the sequelae of chronic small vessel
ischemic disease. No suspicious osseous lesion is identified.
HEAD AND NECK CTA: There is atherosclerotic mural calcification of the aortic
arch. The carotid and vertebral arteries are patent. The right cervical
internal carotid artery measures 8.5 mm in minimum diameter, proximally, and
4.0 mm in diameter, distally. The left cervical internal carotid measures 6.5
mm in minimum diameter, proximally, and 3.5 mm in diameter, distally. There
is no evidence of steno-occlusive disease. Calcified plaque is noted in the
left subclavian artery.
The right vertebral artery is hypoplastic in comparison to the dominant left
vertebral artery. There is kinking at the origins of both vertebral arteries,
with no evidence of flow-limiting stenosis. Incidentally noted is a
"patulous" basilar summit with conjoined infundibular origins of the superior
cerebellar and posterior cerebral arteries, a common variant.
There is tortuosity of the carotid siphons with mural calcification, but no
flow-limiting stenosis. The remaining intracranial circulation is
unremarkable, with no significant mural irregularity, flow-limiting stenosis,
or aneurysm larger than 2 mm.
There is good opacification of the principal dural venous sinuses and deep
cerebral veins, with no evidence of thrombosis.
The thyroid gland is multinodular and heterogeneous, with dominant right
mid-pole nodule measuring 1.6 x 1.4 cm.
There is a cervical dextroscoliosis, with multilevel, multifactorial
degenerative disease. Disc-endplate osteophyte complexes are most marked at
the C5-C6 level, where prominent right paracentral disc effaces the ventral
CSF and indents the cord. Neural foraminal narrowing at the C5-C6 level is
worse on the left than on the right. There is evidence of ocular lens
surgery.
IMPRESSION:
1. No acute intracranial abnormality.
2. No evidence of flow-limiting stenosis, dissection, cerebral aneurysm
larger than 2 mm, or other vascular abnormality.
3. Multinodular goiter; correlate clinically.
|
10198913-RR-48
| 10,198,913 | 22,853,423 |
RR
| 48 |
2171-05-24 20:03:00
|
2171-05-25 09:28:00
|
REASON FOR EXAMINATION: Altered mental status, concern for seizure.
Portable AP radiograph of the chest was reviewed in comparison to ___.
Heart size is normal. Mediastinum is normal. Lungs are clear. No pleural
effusion or pneumothorax is seen.
|
10198913-RR-49
| 10,198,913 | 22,853,423 |
RR
| 49 |
2171-05-25 02:04:00
|
2171-05-25 10:30:00
|
REASON FOR EXAMINATION: New NG tube placement.
AP radiograph of the chest was reviewed in comparison to ___.
The NG tube tip is in the stomach. Heart size and mediastinum are
unremarkable. Lungs are essentially clear. No pleural effusion or
pneumothorax is seen.
|
10198913-RR-50
| 10,198,913 | 22,853,423 |
RR
| 50 |
2171-05-25 05:27:00
|
2171-05-25 06:36:00
|
INDICATION: Altered mental status and right-sided weakness, assess for acute
process.
COMPARISONS: ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Coronal and sagittal reformations were prepared.
FINDINGS: No acute intracranial hemorrhage, edema, mass effect or major
vascular territorial infarction. Confluent subcortical and periventricular
white matter hypodensities compatible with chronic small vessel ischemic
disease. Ventricles and sulci are prominent, compatible with age-related
involutional changes with septum pellucidum et vergae noted. There is no
shift of normally midline structures. There is no fracture or suspicious
osseous lesion. A small lucent lesion in the right parietal bone is unchanged
since ___ and benign appearing. Imaged paranasal sinuses and mastoid air
cells are well aerated.
IMPRESSION: No acute intracranial hemorrhage or mass effect.
|
10198913-RR-51
| 10,198,913 | 22,853,423 |
RR
| 51 |
2171-05-25 09:36:00
|
2171-05-25 16:46:00
|
INDICATION: Baseline dementia and history of TIAs, encephalopathic, seizures.
COMPARISON: MR brain done on ___.
TECHNIQUE: MR head without and with IV contrast.
FINDINGS: There is a small focus of slow diffusion in the right frontal lobe
subcortical white matter anteriorly, series 502, image 20, representing a
small acute infarct. This is new since the prior study.
There are extensive FLAIR hyperintense areas, some of which are confluent and
some are discrete, in the centrum semiovale, corona radiata, sublentiform
location along with mildly increased signal intensity in the region of the
mamillary bodies and periventricular location on both sides. There is
moderate dilation of the lateral and the third ventricles and mild dilation of
the third ventricle along with a prominent cavum septum pellucidum et vergae.
There are also vaguely defined FLAIR hyperintense areas in the pons and in the
subinsular regions. Foci noted along the insular cortex, are new since the
prior study. However, the overall extent of the abnormality has not
significantly changed allowing for the technical differences.
The major intracranial arterial flow voids are noted with a dominant left
vertebral artery and diminutive right vertebral artery.
IMPRESSION:
1. A small curvilinear focus of acute infarction in the right frontal lobe
subcortical white matter, without surrounding edema or mass effect. Correlate
clinically if this explains the symptoms.
2. Extensive cerebral changes as described above, most of which were seen on
the prior study of ___. Faint foci, in the pons. Given the similar in
appearance to the prior study, these are likely nonspecific in appearance and
may relate to small vessel ischemic changes. However, if there is continued
concern for seizures related or encephalitis type of phenomena, followup can
be considered to assess stability. Clinical and lab correlation recommended.
|
10199438-RR-15
| 10,199,438 | 20,643,500 |
RR
| 15 |
2170-06-12 01:46:00
|
2170-06-12 03:55:00
|
EXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF W/WANDWO C AND RECONS
INDICATION: ___ year old man with pus in left leg wound. Please eval left
graft w/ runoff to left leg
TECHNIQUE: Run off CTA: Non-contrast images and arterial phase images were
acquired from diaphragm through toes. Delayed images were obtained from the
knees to the toes.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 18.3 s, 144.1 cm; CTDIvol = 4.4 mGy (Body) DLP =
634.6 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 24.3 mGy (Body) DLP =
12.1 mGy-cm.
3) Spiral Acquisition 17.4 s, 137.0 cm; CTDIvol = 9.6 mGy (Body) DLP =
1,320.2 mGy-cm.
4) Spiral Acquisition 9.3 s, 72.9 cm; CTDIvol = 5.4 mGy (Body) DLP = 390.7
mGy-cm.
Total DLP (Body) = 2,358 mGy-cm.
COMPARISON: CT studies from outside hospital dated ___ and ___.
FINDINGS:
VASCULAR:
There are moderate atherosclerotic calcifications of the abdominal aorta
without aneurysmal dilatation.
CTA abdomen/pelvis:
-Abdominal aorta:Mild stenosis (<50%).
-Celiac axis: Not imaged.
-SMA: No stenosis.
-___: No stenosis.
-Renal arteries: Left: No stenosis.; Right: No stenosis.
-Left common iliac: Mild stenosis (<50%).
-Right common iliac: Mild stenosis (<50%) the origin.
-Left external iliac: Mild stenosis (<50%).
-Right external iliac: Mild stenosis (<50%).
-Left internal iliac: Moderate stenosis (50-69%).
-Right internal iliac: Mild stenosis (<50%).
CTA run-off RLE:
-Common femoral artery: Mild stenosis (<50%).
-Superficial femoral artery: Mild stenosis (<50%). Patent bypass graft from
the distal SFA to the posterior tibial artery.
-Deep femoral artery: Mild stenosis (<50%).
-Popliteal artery: Multifocal sites of occlusion.
-Anterior tibial artery: Heavy calcification of the origin. Patent to the
foot.
-Posterior tibial artery: Heavy calcification of the origin. Patent to the
foot.
-Peroneal artery: Patent to the ankle.
-Dorsalis pedis: Patent.
CTA run-off LLE:
-Common femoral artery: Mild stenosis (<50%).
-Superficial femoral artery with stent: Occluded. 1.5 cm pseudoaneurysm at
the origin of the left SFA and bypass graft. Patent bypass graft from the
proximal SFA to the posterior tibial artery. Occluded stents in the SFA and
popliteal arteries.
-Deep femoral artery: Mild stenosis (<50%).
-Popliteal artery: Occluded.
-Anterior tibial artery: Occluded origin with reconstitution through
collateral flow. Patent to the foot.
-Posterior tibial artery: Occluded origin with reconstitution through
collateral flow. Patent to the foot.
-Peroneal artery: Patent to the ankle.
-Dorsalis pedis: Patent.
ABDOMEN:
HEPATOBILIARY: The imaged portion of the inferior liver demonstrates
homogenous attenuation without focal lesions. The gallbladder is
unremarkable. No biliary ductal dilatation where visualized.
PANCREAS: The pancreas is partially imaged. There is no main ductal
dilatation.
SPLEEN: The partially imaged inferior aspect of the spleen is unremarkable.
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, focal renal lesions, or hydronephrosis. There
is no perinephric abnormality.
GASTROINTESTINAL: Imaged bowel loops are normal in caliber. There is sigmoid
diverticulosis.
RETROPERITONEUM: No lymphadenopathy in the visualized abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis. Mildly enlarged left inguinal lymph nodes are likely
reactive.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Post-operative changes in the subcutaneous tissues of the left
groin and medial thighs bilaterally. There is a rim-enhancing intramuscular
fluid collection in the medial left thigh surrounding the junction of the two
left SFA stents, measuring 3.1 x 3.2 cm in axial dimension and 5.0 cm
craniocaudal (series 4, image 199), which could represent hematoma or abscess.
There is also a 3.9 x 2.9 cm partially rim-enhancing fluid collection
surrounding the left distal SFA stent just above the popliteal fossa, with
irregular fluid extending medially into the subcutaneous tissues and skin,
concerning for abscess. The fluid in the subcutaneous tissues contacts the
bypass graft.
IMPRESSION:
-LEFT: Occluded stents in the left superficial femoral and popliteal arteries.
Patent bypass graft from the proximal SFA to the posterior tibial artery. The
anterior tibial, posterior tibial and peroneal arteries reconstitute through
collateral flow, with three-vessel runoff to the ankle/foot. Patent dorsalis
pedis.
-RIGHT: Multifocal sites of occlusion of the popliteal artery. Patent bypass
graft from the distal SFA to the posterior tibial artery. Three-vessel runoff
to the ankle/foot. Patent dorsalis pedis.
-3.9 x 2.9 cm partially rim-enhancing fluid collection surrounding the left
distal SFA stent just above the popliteal fossa, with irregular fluid
extending medially into the subcutaneous tissues and skin, concerning for
abscess.
-Rim-enhancing intramuscular fluid collection in the medial left thigh
surrounding the junction of the two left SFA stents, measuring 3.1 x 3.2 cm in
axial dimension and 5.0 cm craniocaudal, which could represent hematoma or
abscess.
.
|
10199438-RR-16
| 10,199,438 | 20,643,500 |
RR
| 16 |
2170-06-12 12:39:00
|
2170-06-12 14:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man intubated from OR// evaluate ETT evaluate
ETT
COMPARISON: Chest x-ray ___
FINDINGS:
The patient is intubated with the endotracheal tube tip approximately 4 cm
above the carina. Lung volumes are low with crowding of pulmonary
vasculature. Costophrenic angles are sharp. Mild pulmonary edema. No
pneumothorax.
IMPRESSION:
Endotracheal tube tip 4 cm above the carina. Mild pulmonary edema.
|
10199438-RR-17
| 10,199,438 | 20,643,500 |
RR
| 17 |
2170-06-12 15:40:00
|
2170-06-12 15:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man LLE infection. intubated. OGT placed// OGT
placement
TECHNIQUE: AP radiograph of the lower chest and abdomen.
COMPARISON: Chest radiograph ___ at 12:42.
IMPRESSION:
There has been interval placement of an orogastric tube which terminates in
the body of the stomach. The partially visualized lung bases demonstrate
linear opacities, which most likely represent subsegmental atelectasis. There
is no large pleural effusion. There are no abnormally dilated loops of small
or large bowel. No radiopaque calculi are identified.
|
10199438-RR-18
| 10,199,438 | 20,643,500 |
RR
| 18 |
2170-06-13 03:51:00
|
2170-06-13 10:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with LLE infection. Intubated// ETT tube
placement. Interval change
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
The ET and NG tube are unchanged. Cardiomediastinal silhouette is stable.
There is bibasilar atelectasis. There is a small left pleural effusion. No
pneumothorax
|
10199438-RR-19
| 10,199,438 | 20,643,500 |
RR
| 19 |
2170-06-13 11:02:00
|
2170-06-13 11:51:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new line// new left PICC 51 cm 1 cm out
___ Contact name: ___: ___
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Prior chest radiographs, most recently ___ 6 hours prior
FINDINGS:
There has been interval insertion of left-sided PICC, which terminates in the
proximal right atrium. Redemonstration of an endotracheal tube and enteric
tube, unchanged in position compared to prior exam.
Low lung volumes. No focal consolidations. No pneumothorax. Small bibasilar
atelectasis and small left-sided pleural effusion. Cardiomediastinal
silhouette is unchanged.
IMPRESSION:
Left-sided PICC terminates at the level of the proximal right atrium.
Redemonstration of small bibasilar atelectasis and left-sided pleural
effusion.
RECOMMENDATION(S): Consider retracting PICC by 2-3 cm.
NOTIFICATION: The findings were discussed with ___, R.N. by ___
___, M.D. on the telephone on ___ at 11:49 am, 3 minutes after discovery
of the findings.
|
10199438-RR-20
| 10,199,438 | 20,643,500 |
RR
| 20 |
2170-06-13 18:31:00
|
2170-06-13 19:14:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man with hx of multiple LLE vascular interventions
admitted with left popliteal purulent drainage// rule out osteo in left foot
TECHNIQUE: AP, lateral and oblique view radiographs of the left foot.
COMPARISON: Left foot radiographs ___.
IMPRESSION:
There is diffuse soft tissue swelling around the forefoot. There is erosion
along the medial and plantar aspect of the first metatarsal head, which is
concerning for osteomyelitis. The first proximal and distal phalanges appear
osteopenic, which may represent additional sites of osteomyelitis. The first
toe is dorsal lateral subluxed at the level of the metatarsophalangeal joint.
There is a small plantar calcaneal spur.
|
10199438-RR-21
| 10,199,438 | 20,643,500 |
RR
| 21 |
2170-06-16 11:23:00
|
2170-06-16 13:55:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old man s/p left ___ met head resection// eval s/p ___
met head resection
IMPRESSION:
In comparison with the study of ___, there has been resection of the head
of the first metatarsal with standard postsurgical changes in soft tissues.
Further information can be gathered from the operative report.
|
10199438-RR-22
| 10,199,438 | 20,643,500 |
RR
| 22 |
2170-06-16 15:46:00
|
2170-06-16 16:42:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE LEFT
INDICATION: ___ s/p L ___, s/p LLE angio w/ PTA of ___, L AK vein
graft-distal ___ bypass jump graft w/ R ceph vein s/p PTA of bypass p/w L knee
infxn s/p wash+SFA stent removal. also s/p L foot debridement for osteo// left
thigh ultrasound to evaluate for residual fluid collections above wound vac
TECHNIQUE: Grayscale and color Doppler ultrasound images were obtained of the
superficial tissues of the left thigh.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left thigh superior to the wound VAC in place. There is soft tissue edema
noted, however no drainable fluid collection is visualized.
IMPRESSION:
Soft tissue edema is noted however there is no evidence of fluid collection
within the soft tissues of the left thigh adjacent to the wound VAC.
|
10199636-RR-136
| 10,199,636 | 25,494,735 |
RR
| 136 |
2197-06-23 17:36:00
|
2197-06-23 18:28:00
|
INDICATION: ___ year old woman with DM2, history of hysterectomy here with
left sided flank and abdominal pain.
TECHNIQUE: Contiguous helical MDCT images were obtained through the abdomen
and pelvis with the patient prone first without IV contrast and then after
administration of 130 cc of Omnipaque IV contrast. . Multiplanar axial,
coronal and sagittal images were generated.
DOSE: Total body DLP: 1482 mGy-cm
COMPARISON: CT abdomen pelvis ___ and ___.
FINDINGS:
LOWER CHEST: The included lung bases show mild dependent changes. Heart size
is normal without pericardial effusion.
CT ABDOMEN WITH CONTRAST:
HEPATOBILIARY: The liver is diffusely hypoattenuating suggesting fatty liver.
There are no focal lesions. There is no intra or extrahepatic biliary duct
dilation. The gallbladder is normal without stones or wall thickening. The
portal vein is patent.
PANCREAS: The pancreas has normal attenuation without focal lesions, duct
dilation or peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation without focal lesions.
ADRENALS: Bilateral adrenal glands are normal in size and shape.
URINARY: Both kidneys excrete contrast promptly and symmetrically. There is
new mild hydronephrosis on the left although the ureter is normal in caliber
with abrupt transition point in the caliber of the collecting system at the
ureteropelvic junction. A small vessel is noted crossing near the the site of
transition, possibly resulting in mild ureteropelvic junction obstruction.
There is no renal stone. No evidence of renal atrophy.
GASTROINTESTINAL: The stomach, small and large bowel are normal in caliber
without wall thickening or obstruction. The appendix is normal. There are
sigmoid diverticuli without evidence of diverticulitis.
RETROPERITONEUM: There is no mesenteric or retroperitoneal lymphadenopathy.
VASCULAR: The abdominal aorta and iliac arteries are normal in caliber with a
few scattered atherosclerotic plaques.
There is no free air or free fluid.
CT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. There is
no pelvic wall or inguinal lymphadenopathy and no free fluid. Patient is
status post hysterectomy.
BONES AND SOFT TISSUES: There are no worrisome blastic or lytic lesions.
Small fat containing umbilical hernia is noted. No The pelvic wall is within
normal limits.
IMPRESSION:
1. Mild left hydronephrosis with abrupt transition in caliber of the
collecting system at the ureteropelvic junction. There appears to be a small
crossing vessel at the site of transition which may result in mild
ureteropelvic junction obstruction. No evidence of nephrolithiasis. No renal
atrophy.
2. Fatty liver. Diverticulosis without diverticulitis. Small fat containing
umbilical hernia.
NOTIFICATION: The findings were telephoned to ___ by ___ at
approximately 22:00, ___, 5 min after discovery.
|
10199636-RR-137
| 10,199,636 | 25,494,735 |
RR
| 137 |
2197-06-25 20:45:00
|
2197-06-26 09:26:00
|
EXAMINATION: BILAT HIPS (AP,LAT AND AP PELVIS)
INDICATION: ___ year old woman with significant ab pain radiating to hip and
thigh, worse with movement // evaluate for fracture, deformity evaluate
for fracture, deformity
TECHNIQUE: AP pelvis and bilateral hips, 5 images total.
COMPARISON: 3 foot standing radiographs from ___.
FINDINGS:
There is no acute fracture or dislocation. There is an old healed right
inferior pubic ramus fracture. There are mild degenerative changes about both
femoroacetabular joints. The sacroiliac joints are grossly unremarkable. Mild
degenerative changes are seen along the lower lumbar spine. There is an 11 mm
relatively well-circumscribed sclerotic lesion within the right iliac bone,
not significantly changed dating back through at least ___,
compatible with a bone island.
IMPRESSION:
1. No acute fracture or dislocation. Old healed right inferior pubic ramus
fracture.
2. Mild bilateral hip joint degenerative changes.
|
10199636-RR-138
| 10,199,636 | 25,494,735 |
RR
| 138 |
2197-06-26 22:36:00
|
2197-06-27 12:08:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ 10:40 ___
INDICATION: ___ year old woman with severe ab/back pain radiating to leg //
___ changes in lumbar spine, nerve compression?
TECHNIQUE: Multisequence, multiplanar MRI of the lumbar spine without
intravenous gadolinium.
COMPARISON: MRI lumbar spine ___.
FINDINGS:
Numbering used is shown on se 3, im 14.
There is levoconvex curvature of the lumbar ___ at the L3-L4 level.
The vertebral body heights and alignment are maintained.
There is multilevel degenerative disc disease with associated degenerative
marrow endplate changes and probable additional areas of focal fatty marrow.
At the T11-T12 level, there is bilateral facet arthropathy and ligamentum
flavum thickening. The spinal canal and neural foramina appear normal.
At the T12-L1 level, there is bilateral facet arthropathy and ligamentum
flavum thickening. The spinal canal and neural foramina appear normal.
At the L1-L2 level, there is bilateral facet arthropathy and ligamentum flavum
thickening as well as a diffuse disc bulge with left foraminal disc protrusion
which cause moderate left neural foraminal narrowing and mild right neural
foraminal narrowing. The spinal canal appears normal.
At the L2-L3 level, there is bilateral facet arthropathy, ligamentum flavum
thickening, and a diffuse disc bulge with small left foraminal protrusion
which cause moderate left neural foraminal narrowing, mild right neural
foraminal narrowing, and mild spinal canal narrowing with contact of the
traversing right L3 nerve root.
At the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum
thickening, and diffuse disc bulge with superimposed posterior disc protrusion
which cause moderate right neural foraminal narrowing, mild left neural
foraminal narrowing, and mild-moderate spinal canal narrowing with contact of
the traversing right L4 nerve root by disc protrusion.
At the L4-L5 level, there is bilateral facet arthropathy with mild edema and
facet joint effusions, ligamentum flavum thickening, and a diffuse disc bulge,
slightly increased from prior exam, which cause moderate to severe spinal
canal narrowing with crowding of nerves of thecal sac and compression of the
traversing L5 nerve roots between disc bulge and facet osteophyte as well as
moderate right and mild to moderate left neural foraminal narrowing.
Mild edema in and around the facet joints.
At the L5-S1 level, there is bilateral facet arthropathy with mild edema and a
diffuse disc bulge which causes mild spinal canal narrowing with contact of
the traversing left S1 nerve root, as well as mild bilateral neural foraminal
narrowing, left greater than right.
Mild type ___ ___ changes at T11 and T12 levels.
The conus medullaris is normal in position and morphology and terminates at
the L1-L2 level.
There is a probable right renal cyst. The remaining paraspinal and
prevertebral soft tissues are unremarkable.
IMPRESSION:
1. Degenerative lumbar spondylosis including and facet arthropathy and disc
protrusions with multilevel neural foraminal and spinal canal stenoses, as
described, slightly increased at the L4-L5 level compared to ___.
|
10199879-RR-18
| 10,199,879 | 22,636,062 |
RR
| 18 |
2110-05-31 15:10:00
|
2110-05-31 15:38:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with chest pain x 1 day, radiating to L arm //
infection
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10199879-RR-19
| 10,199,879 | 22,636,062 |
RR
| 19 |
2110-05-31 14:35:00
|
2110-05-31 15:13:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with left leg pain. Evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10199945-RR-16
| 10,199,945 | 23,358,585 |
RR
| 16 |
2172-01-03 16:44:00
|
2172-01-03 17:34:00
|
EXAMINATION: LEFT TOE RADIOGRAPHS
INDICATION: Left second toe ulcer.
TECHNIQUE: Left toe, three views.
COMPARISON: None.
FINDINGS:
Soft tissues are particularly prominent along the second digit, where there is
irregularity to the soft tissue contour, but no evidence of fracture,
dislocation or bone destruction. No erosions are seen. The joint spaces
appear preserved.
IMPRESSION:
No evidence of bony lysis. Soft tissue swelling and irregularity along the
second digit.
|
10199945-RR-25
| 10,199,945 | 25,949,698 |
RR
| 25 |
2173-07-18 18:51:00
|
2173-07-18 20:13:00
|
EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old woman s/p R ___ toe amp // s/p R ___ toe amp
TECHNIQUE: Non-weightbearing frontal, oblique, and lateral view radiographs
of the right foot.
COMPARISON: ___
FINDINGS:
The patient is status post right second digit amputation at the level of the
proximal phalanx. Cortical irregularity of the bone is noted at the resection
margin. Extensive soft tissue swelling is present around the forefoot.
Unchanged nonspecific irregularity of the third metatarsal head. There are
degenerative changes seen involving the tarsal metatarsal joints and
intertarsal joints. A plantar calcaneal enthesophyte is again noted.
IMPRESSION:
Status post second digit amputation at the level of the proximal phalanx as
described above.
|
10200169-RR-19
| 10,200,169 | 29,874,747 |
RR
| 19 |
2175-07-06 13:14:00
|
2175-07-06 14:44:00
|
HISTORY: Femur fracture, question other injury.
COMPARISON: Outside hospital left femur radiographs from ___ 08:50
FINDINGS:
AP view of the pelvis and the 2 views of the left femur were obtained.
Pelvis: The patient is status post bilateral total hip arthroplasty with no
evidence ___ hardware lucency or hardware fracture. Degenerative changes
of the lower lumbar spine are noted. A large amount of stool for projects
over the right inguinal region likely representing hernia containing a loop of
bowel.
Left femur: There is a spiral fracture of the midshaft of the left femur
distal to the left hip prosthesis with approximately 1.8 cm of lateral
displacement of the distal fragment and approximate 2.3 cm of the proximal
overriding of the distal fragment. Vascular calcifications are noted.
IMPRESSION:
1. Left displaced mid femoral shaft spiral fracture.
2. Large amount of stool projecting over the right inguinal region likely
representing a bowel containing right inguinal hernia.
|
10200169-RR-21
| 10,200,169 | 29,874,747 |
RR
| 21 |
2175-07-07 08:47:00
|
2175-07-07 15:09:00
|
PORTABLE CHEST, ___
HISTORY: ___ man with leg fracture.
IMPRESSION: AP chest reviewed in the absence of prior chest radiographs:
Tubular partially solid opacity in the right lower lung is not well
characterized by this conventional chest radiograph. It should be reevaluated
with conventional chest films when feasible, and a CT scan if it persists. It
looks like mucoid impaction in area of possible bronchiectasis. On the left
is a band of plate-like atelectasis. The upper lungs are clear. No good
evidence for pneumonia or heart failure. Heart is top normal size. Thoracic
aorta is tortuous but not clearly dilated. There is no pleural abnormality.
|
10200169-RR-22
| 10,200,169 | 29,874,747 |
RR
| 22 |
2175-07-07 09:49:00
|
2175-07-08 09:24:00
|
INTRAOPERATIVE RADIOGRAPH OF THE LEFT FEMUR
CLINICAL INDICATION: ___ male status post ORIF of a left femur
periprosthetic fracture.
TECHNIQUE: Multiple intraoperative radiographs of the left femur were
obtained.
___.
FINDINGS: Multiple intraoperative radiographs demonstrate interval plate and
screw fixation for the obliquely oriented complete fracture through the
diaphysis of the left femoral shaft with lateral displacement of the distal
fracture fragments. No hardware complication is seen. A left femoral
prosthesis is in place. Please refer to the intraoperative report for further
details.
IMPRESSION: Status post ORIF of left femoral periprosthetic fracture. Please
refer to the intraoperative report for further details.
|
10200169-RR-23
| 10,200,169 | 29,874,747 |
RR
| 23 |
2175-07-07 20:22:00
|
2175-07-08 09:38:00
|
PA AND LATERAL CHEST, ___
HISTORY: ___ man with lung nodules.
IMPRESSION: PA and lateral chest compared to ___:
The region questioned on portable chest radiograph earlier on ___ at base
of the right lung does not look like lung nodules. It is probably a region of
atelectasis or bronchiectasis in the right lower lobe. Lungs are clear.
Heart size is top normal. Lateral view shows tiny volume of pleural effusion
layering posteriorly, side indeterminate. Thoracic aorta is heavily calcified
and somewhat irregular, with possible mild focal dilatation in the posterior
aspect of the arch.
There is no evidence of pneumonia or cardiac decompensation.
|
10200169-RR-25
| 10,200,169 | 20,991,076 |
RR
| 25 |
2175-07-13 12:02:00
|
2175-07-13 13:30:00
|
INDICATION: Left hip fracture and worsening lower extremity edema.
Evaluation for DVT.
TECHNIQUE: Grayscale and pulse wave Doppler of the left lower extremity.
COMPARISON: None.
FINDINGS: There is normal respiratory phasicity in the common femoral veins
bilaterally. There is normal compressibility, flow, and augmentation of the
left common femoral, superficial femoral, and popliteal veins. Note is made
of a 4.2 x 2.4 x 1.8 cm ___ cyst with internal debris. The calf veins are
not visualized.
IMPRESSION: No evidence of deep vein thrombosis. Calf veins not visualized.
|
10200479-RR-10
| 10,200,479 | 25,650,421 |
RR
| 10 |
2126-12-14 20:16:00
|
2126-12-14 20:58:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: Shortness of breath and new onset atrial fibrillation.
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is
normal in the lungs are clear. No pleural effusion or pneumothorax is seen. No
acute osseous abnormalities demonstrated. Moderate degenerative changes with
osteophytes are seen in the thoracic spine. Deformity of the left
superolateral rib cage appears chronic.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10200479-RR-11
| 10,200,479 | 25,650,421 |
RR
| 11 |
2126-12-14 20:06:00
|
2126-12-14 20:38:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ male with new onset atrial fibrillation, sudden onset
abdominal pain, bloody diarrhea, presence of vascular occlusion, mesenteric
ischemia
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis without contrast and after the administration of intravenous
contrast in the arterial and portal venous phases. Axial images were
interpreted in conjunction with coronal and sagittal reformats. Oral contrast
was not administered.
DLP: 1807 mGy-cm
COMPARISON: None available.
FINDINGS:
CHEST: The visualized lung bases are clear. There is no pericardial or pleural
effusion.
ABDOMEN:
The liver enhances homogeneously and is without focal lesions. The portal
venous system is patent. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is normal and without gallstones.
The spleen and adrenal glands are unremarkable. The pancreas enhances
homogenously and is without focal lesions.
The kidneys display symmetric nephrograms. A 1.9 cm hypodensity in the midpole
of the right kidney represents a simple cyst (4b: 253). There is no
hydronephrosis. The ureters are normal in caliber and course to the bladder.
The distal esophagus is normal without a hiatal hernia. The stomach is
decompressed. The small bowel is normal in caliber without wall thickening.
Beginning just distal to the splenic flexure is a long segment of descending
colon which displaced wall thickening and mild surrounding fat stranding
(601b:62). There is diverticulosis of the sigmoid colon without evidence of
diverticulitis. The appendix is not definitely visualized but there are no
secondary signs of appendicitis the right lower quadrant. There is no
abdominal free fluid or free air. There is no portal venous gas.
There is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.
PELVIS:
The bladder is well distended and normal. There is no pelvic side-wall or
inguinal lymphadenopathy by CT size criteria. No free pelvic fluid is
identified. Coarse calcifications are noted within the prostate.
CTA ABDOMEN AND PELVIS: The abdominal aorta is normal in caliber without
aneurysmal dilation. There is moderate calcified atherosclerotic disease of
the abdominal aorta most pronounced in the infrarenal portion and branching
into the iliac arteries. The celiac axis, SMA, and ___ are widely patent. The
portal, splenic, and SMV are patent.
OSSEOUS STRUCTURES: Mild multilevel degenerative changes are noted. No focal
lytic or sclerotic lesion concerning for malignancy.
IMPRESSION:
1. Colitis involving a long segment of descending colon, possibly related to
ischemia given the location, but infectious and inflammatory etiologies are
also possible.
2. Patent intra-abdominal and pelvic vasculature. No evidence of vascular
occlusion.
|
10200495-RR-6
| 10,200,495 | 26,686,178 |
RR
| 6 |
2125-05-22 11:22:00
|
2125-05-22 13:39:00
|
HISTORY: Bandemia without cough, to assess for pneumonia.
FINDINGS: No previous images. Cardiac silhouette is within normal limits,
and the lungs are free of acute pneumonia, and there is no vascular
congestion. Single-channel pacer defibrillator device extends to the apex of
the right ventricle.
Of incidental note are multiple metallic shrapnel fragments as well as several
old healed fractures.
|
10200741-RR-12
| 10,200,741 | 23,153,671 |
RR
| 12 |
2153-03-07 14:25:00
|
2153-03-07 15:15:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/ CONTRAST Q1217 CT HEADSINUS
INDICATION: History: ___ with left upper molar pain that radiates through her
face to her left eye subjective fevers// Abscess
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.6 s, 20.3 cm; CTDIvol = 25.8 mGy (Head) DLP = 524.3
mGy-cm.
Total DLP (Head) = 524 mGy-cm.
COMPARISON: None.
FINDINGS:
The left maxillary sinus is almost entirely opacified with hypodense material.
There is also partial opacification of adjacent left-sided ethmoid air cells,
and a small amount of mucosal thickening is present in the left frontal sinus.
The right maxillary sinus, sphenoid sinuses, right frontal sinus, bilateral
middle ear canals and mastoid air cells are otherwise clear. No evidence of
periapical lucency to suggest periodontal disease. No fluid collection or
abscess.
The ostiomeatal units are patent. The cribriform plates are intact. The lamina
papyracea are intact. Globes appear intact.
IMPRESSION:
1. Near complete opacification of the left maxillary sinus, as well as partial
opacification of the left-sided ethmoid air cells, and mild mucosal thickening
in the left frontal sinus, findings concerning for acute sinusitis given the
clinical context.
2. No evidence of facial abscess or periodontal disease.
|
10200741-RR-13
| 10,200,741 | 23,153,671 |
RR
| 13 |
2153-03-07 18:54:00
|
2153-03-07 20:30:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with left maxillary dental pain, night sweats,
right headache, right Bell's palsy, left facial sensory deficit (V1-2>3). No
meningismus or systemic signs at present.// Evaluate for infection or
inflammation causing multiple cranial neuropathies. Please include thin cuts
of brainstem, ___, and ___ nerves as appropriate.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CT sinus ___
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. Dural venous sinuses are patent. Major intracranial flow
voids are maintained.
There is complete opacification, enhancement, and slowed diffusion of the left
maxillary sinus with partial opacification, enhancement, and slowed diffusion
of the adjacent anterior left ethmoid air cells. The left frontal sinus
exhibits moderate mucosal thickening. The right maxillary sinus, sphenoid
sinuses, and right frontal sinus are clear. The mastoid air cells and middle
ear cavities are clear.
The globes and retro bulbar soft tissues are unremarkable. There is bilateral
symmetric enhancement of the facial nerves, particularly seen within the
tympanic segments (15:54 and 58).
IMPRESSION:
1. Findings compatible with sinusitis in an ostiomeatal unit pattern involving
the left maxillary sinus, anterior left ethmoid air cells, and left frontal
sinus. Correlate for acuity.
2. No definite cranial nerve abnormality. Specifically, bilateral symmetric
enhancement of the facial nerves, particularly within the tympanic segments,
is likely normal given its bilaterally and is of unlikely clinical
significance.
|
10200966-RR-16
| 10,200,966 | 28,178,166 |
RR
| 16 |
2161-03-28 01:49:00
|
2161-03-28 02:51:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: History: ___ with melanotic stool s/p ___ AAA repair //
?aortoenteric fistula
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) = 1,760 mGy-cm.
COMPARISON: CT torso dated ___, and virtual colonoscopy dated ___.
FINDINGS:
VASCULAR:
Patient has undergone prior repair of an abdominal aortic aneurysm. There is
a small amount of mural thrombus seen posteriorly along the infrarenal
abdominal aorta. No evidence of aneurysm recurrence. There is no evidence of
ectopic gas adjacent to or within the aorta, or periaortic soft tissue
thickening/stranding. The duodenum, in particular as it courses anterior to
the aorta, has an unremarkable appearance.
There is dense contrast, matching blood pool on the arterial phase, within the
proximal jejunum (3a:54). This area does not appear to spread out/pool on the
delayed phase. This focus is located approximately 3.8 cm from the aorta.
The native common iliac arteries appear occluded. Bilateral external iliac
grafts are patent.
LOWER CHEST: Small right and trace left nonhemorrhagic pleural effusions with
adjacent atelectasis. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Several subcentimeter hypodensities are seen within the liver, which are too
small to fully characterize, but likely represent cysts or biliary hamartomas.
There is no evidence of intrahepatic or extrahepatic biliary dilatation.
There is gallbladder wall thickening, without evidence of radiopaque
gallstones.
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.
Multiple hypodense lesions are seen within the bilateral kidneys, some of
which are too small to fully characterize, and some of which are consistent
with simple cysts. Several right-sided hyperdense renal lesions are present,
consistent with hemorrhagic cysts. There is no evidence of stones, solid renal
lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or
ureters. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is under distended, but grossly normal. As
described above, an area of dense contrast is seen within the proximal jejunum
on the arterial phase of the study. Small bowel loops demonstrate normal
caliber, wall thickness and enhancement throughout. There is colonic
diverticulosis, without evidence of wall thickening or fat stranding.
Appendix is normal. There is a moderate amount of nonhemorrhagic ascites, and
fluid within the mesentery. A calcification in the right mid abdomen is
stable, and may represent a torsed epiploic appendage.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is a moderate amount of
nonhemorrhagic free fluid in the pelvis.
REPRODUCTIVE ORGANS: Coarse calcifications are seen within the prostate gland,
which does not appear enlarged.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is diffuse anasarca. There are several small fat
containing ventral wall and paraumbilical hernias.
IMPRESSION:
1. Dense contrast, matching arterial blood pool, is seen within the proximal
jejunum. Although this area does not appear to spread out/pool on the delayed
phase, given the density of contrast on the arterial phase, it remains
concerning for upper GI bleed. This area is located approximately 3.8 cm from
the aorta. There is no evidence of ectopic gas adjacent to or within the
aorta, or periaortic soft tissue thickening/stranding, making aortoenteric
fistula less likely.
2. Small bilateral simple pleural effusions, moderate amount of simple
intra-abdominal ascites, and diffuse anasarca are consistent with volume
overload status.
3. Gallbladder wall thickening is felt to be secondary to third spacing in the
setting of ascites.
4. Diverticulosis.
|
10200966-RR-18
| 10,200,966 | 28,178,166 |
RR
| 18 |
2161-03-30 15:22:00
|
2161-03-30 16:14:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with GI bleed, CKD, new cough // ?acute
pulmonary process ?acute pulmonary process
IMPRESSION:
Comparison to ___. No relevant change. Mild pulmonary edema.
Moderate cardiomegaly and retrocardiac atelectasis. The presence of minimal
pleural effusions cannot be excluded. No new focal parenchymal changes.
|
10201059-RR-21
| 10,201,059 | 24,815,491 |
RR
| 21 |
2135-09-06 13:50:00
|
2135-09-06 15:30:00
|
EXAMINATION: HIP 1 VIEW
INDICATION: LEFT HIP HEMI FOR FEMORAL NECK
TECHNIQUE: AP view of the left hip.
COMPARISON: Radiograph of the hip dated ___.
FINDINGS:
The patient is status post left hip hemi arthroplasty, in overall anatomic
alignment. No periarticular fracture is detected.
IMPRESSION:
Status post hip prosthesis in overall anatomic alignment.
|
10201059-RR-22
| 10,201,059 | 24,815,491 |
RR
| 22 |
2135-09-07 17:05:00
|
2135-09-07 17:39:00
|
EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: ___ year old woman s/p POD 2 L hip hemiarthroplasty // alignment
TECHNIQUE: Left femur two views
COMPARISON: ___
FINDINGS:
Left hip hemiarthroplasty, similar to prior. Postoperative changes in the
soft tissues, surgical staples. Degenerative changes knee joint.
IMPRESSION:
Left hip hemiarthroplasty
|
10201558-RR-23
| 10,201,558 | 29,441,570 |
RR
| 23 |
2168-09-14 11:55:00
|
2168-09-14 12:20:00
|
HISTORY: Right facial droop.
TECHNIQUE: Contiguous axial CT images were obtained through the brain without
the administration of IV contrast. Reformatted coronal and sagittal sections
and thin-section bone algorithm reconstructed images were acquired.
DLP: 1025.72 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
infarction. The ventricles and sulci are normal in size and configuration for
age. The basal cisterns appear patent, and there is preservation of
gray-white matter differentiation.
No fractures are identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
IMPRESSION:
No acute intracranial pathology.
|
10201558-RR-24
| 10,201,558 | 29,441,570 |
RR
| 24 |
2168-09-14 16:29:00
|
2168-09-14 19:37:00
|
HISTORY: ___ female, with left facial droop. Assess for vascular
pathology for stroke.
COMPARISON: Non-contrast CT head earlier on the same day.
TECHNIQUE: MDCT images were acquired through the aortic arch to the vertex
after administration of IV iodinated contrast. Dedicated 3D rendering was
performed to better assess the underlying vasculature.
CTA HEAD: Major intracranial vessels are patent. There is symmetric
arborization of the MCA branches bilaterally. There is no intracranial
aneurysm greater than 3 mm. No arteriovenous malformation or distal occlusion
is noted. The left vertebral artery is slightly dominant. The basilar artery
is patent and normal in caliber. The posterior communicating arteries are not
well visualized. The anterior communicating artery complex is patent and
normal. Principal venous sinuses are patent.
CTA NECK: There is a bovine variant of the aortic arch. The great
mediastinal vessels are slightly tortuous but remain patent. The vertebral
arteries are patent throughout. There is no evidence of aneurysm, occlusion
or dissection. There is no proximal ICA stenosis by NASCET criteria. There
is mild dependent atelectasis in the visualized lung apices.
The patient is status post left hemithyroidectomy with clips in the surgical
bed. There are small cervical lymph nodes but no lymphadenopathy. The
parotid glands, submandibular glands and major cervical musculature are normal
and symmetric. There are degenerative changes in the visualized cervical
thoracic spine.
There is appearance of the medialization of the right vocal cord, with
asymmetric prominent of the right pyriform sinus.
IMPRESSION:
1. Major intracranial and cervical vessels patent, without evidence of
aneurysm, arteriovenous malformation, dissection or occlusion.
2. Appearance of medialization of the right vocal cord, with asymmetric
prominent of the right pyriform sinus. The findings could be seen in right
vocal paralysis. Recommend clinical correlations.
3. Status post left hemithyroidectomy.
|
10201558-RR-25
| 10,201,558 | 29,441,570 |
RR
| 25 |
2168-09-14 20:58:00
|
2168-09-15 09:47:00
|
AP CHEST, 9:09 P.M. ON ___
HISTORY: ___ woman with a stroke and possible pneumonia.
IMPRESSION: AP chest compared to ___:
Borderline cardiomegaly is stable. Lungs are clear. No pleural abnormality.
|
10201558-RR-26
| 10,201,558 | 29,441,570 |
RR
| 26 |
2168-09-15 00:14:00
|
2168-09-15 08:59:00
|
HISTORY: ___ year old woman with right facial numbness and left facial droop
concerning for brainstem infarct.
COMPARISON: Head CT and CTA, ___.
TECHNIQUE: Non contrast MRI of the head was performed including axial
diffusion, FLAIR, T2, susceptibility sequences and sagittal T1 weighted
sequences. Additional 3 mm T2 weighted axial images were acquired through the
posterior fossa and brainstem.
FINDINGS:
The ventricles, sulci, and subarachnoid spaces are normal in size and
configuration. There is no evidence of acute infarct or hemorrhage. There is
no focal signal abnormality in the brain. There is no abnormal intra or
extra-axial fluid collection, no shift of normally midline structures, and no
mass lesion or mass effect.
There are normal major intracranial vascular flow voids. There is minimal
ethmoidal air cell and maxillary sinnus mucosal thickening. Otherwise, the
visualized paranasal sinuses, mastoid air cells, and orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality. No evidence of infarct, hemorrhage, or
mass.
|
10201591-RR-13
| 10,201,591 | 29,917,330 |
RR
| 13 |
2154-05-23 11:16:00
|
2154-05-23 13:21:00
|
CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Chest CTA from ___.
CLINICAL HISTORY: Chest pain and cough and fever.
FINDINGS: AP portable upright and lateral views of the chest provided.
Cardiomegaly is noted with bilateral effusions, small in size, with bibasilar
atelectasis. Please note, findings are better appreciated on the CT chest
performed approximately 20 minutes earlier. Right mediastinal mass-like
prominence corresponds with ectatic vasculature on CT. Degenerative changes
at the shoulders are also better assessed on CT.
|
10201591-RR-14
| 10,201,591 | 29,917,330 |
RR
| 14 |
2154-05-23 09:13:00
|
2154-05-23 11:08:00
|
HISTORY: Transient left-sided deficits.
TECHNIQUE: Contiguous axial MDCT images were obtained of the head without IV
contrast. Multiplanar reformatted images were generated in the coronal and
sagittal planes as well as thin section bone algorithm images.
DLP: 1153.93 mGy-cm.
COMPARISON: Multiple noncontrast head CT dated back to ___, MRA
head and neck ___.
FINDINGS:
There is no hemorrhage, edema, mass effect or acute large territory infarct.
Prominent ventricles and sulci compatible with age-related involutional
change. The basal cisterns appear patent and there is preservation of
gray-white matter differentiation. No acute fracture is identified. Old
fixation hardware is seen along the left maxillary bone. A mucous retention
cyst is visualized left maxillary sinus as well as left frontal sinus. The
mastoid air cells and middle ear cavities are clear. The globes are
unremarkable.
IMPRESSION:
No acute intracranial process.
|
10201591-RR-15
| 10,201,591 | 29,917,330 |
RR
| 15 |
2154-05-23 10:28:00
|
2154-05-23 11:41:00
|
HISTORY: Chest pain, abdominal pain and abdominal tenderness.
TECHNIQUE: Axial helical MDCT images were obtained of the chest, abdomen and
pelvis after the administration of IV contrast. Images of the chest were
obtained in the arterial phase with coronal and sagittal reformats with
bilateral oblique maximum intensity projection images. The abdomen and pelvis
images were obtained in the portal venous phase with coronal and sagittal
reformats.
DLP: 1248.73 mGy-cm.
COMPARISON: CT abdomen and pelvis without contrast ___, CT C-spine
___.
FINDINGS:
CTA chest: There is a multinodular enlarged thyroid which appear is roughly
stable from ___. The trachea is midline and the airways are patent
to the subsegmental level. There is bilateral moderate simple pleural
effusion with adjacent compressive atelectasis. Motion artifact slightly
limits examination however the lungs are otherwise without nodules,
consolidations or pneumothorax.
Heart size is enlarged with biatrial hypertrophy. The aortic arch is of
normal caliber without evidence of acute pathology including aneurysm or
dissection. Coronary artery and aortic arch atherosclerotic calcifications
are noted. There is no filling defect in the pulmonary arterial system to the
segmental level to suggest pulmonary embolus. There are no enlarged
supraclavicular, axillary, mediastinal or hilar lymph nodes by CT size
criteria.
CT abdomen: Evaluation of the upper abdomen is somewhat limited by beam
hardening artifact from arms overlying the abdomen. Within this limitation
the liver appears to enhance homogeneously without focal lesions or
intrahepatic biliary ductal dilatation. The portal vein is patent. Multiple
gallstones are layering within an otherwise unremarkable gallbladder. The
spleen and adrenal glands are unremarkable in appearance. The pancreas is
somewhat atrophied with a 7 mm hypodense lesion in the body not clearly
identified on previous noncontrast scan. The kidneys are atrophied
bilaterally but without focal lesions, pelvocaliceal dilatation or perinephric
abnormality.
The stomach, duodenum and small bowel are unremarkable in appearance without
evidence of obstruction. The large bowel is unremarkable in appearance.
The abdominal aorta is of normal caliber. Following a tortuous course with
neural atherosclerotic calcification noted. The celiac axis and SMA appear
patent. The takeoff of the ___ is not clearly seen. Dense calcifications at
the origins of bilateral renal arteries appear to stenosis of the lumen.
There is no pneumoperitoneum. There is global misty appearing mesentery
likely from third-spacing of fluid. There are no enlarged mesenteric or
retroperitoneal lymph nodes by CT size criteria.
CT pelvis: Evaluation of the pelvic structures is limited by beam hardening
artifact from adjacent right-sided hip replacement. Within these limitations
a Foley catheter and air is seen within a collapsed bladder. The rectum is
unremarkable. There appears to be a small amount of pelvic fluid likely from
third-spacing.
Osseous structures: A right-sided hip prosthesis is in place. There is
severe degenerative change of the left hip. There are severe bilateral
degenerative changes in the glenohumeral joints with subscapular sequestered
fluid. There is generalized osteopenia. There are multiple vertebral body
compression fractures with significant loss of vertebral body height at the
levels of L1 and L3. Another compression fracture of T12 is less severe. The
compression fracture at L3 appears new since prior radiograph on ___. There are no focal blastic or lytic lesions in the visualized osseous
structures concerning for malignancy. There is global edema of the in the
subcutaneous soft tissues likely from third-spacing of fluid.
IMPRESSION:
1. No acute thoracic, abdominal or pelvic process.
2. Multiple findings suggestive of congestive heart failure including
cardiomegaly, bilateral pleural effusions, and there is third spacing of fluid
in the mesentery and soft tissues.
3. Multiple vertebral body compression fractures with the L3 fracture new
since prior exam on ___. Severe bilateral glenohumeral joint
degenerative changes with associated effusion sequestering in the subscapular
space.
4. 7 mm hypodensity in the pancreatic body. MRCP recommended.
5. Cholelithiasis.
6. Multinodular enlarged thyroid appearing roughly stable from ___.
|
10201591-RR-17
| 10,201,591 | 29,917,330 |
RR
| 17 |
2154-05-26 21:27:00
|
2154-05-27 10:00:00
|
HISTORY: Compression deformities, with lower extremity weakness.
COMPARISON: MRI from ___ and ___.
TECHNIQUE: Multiplanar MR images were acquired through the total spine
including sequences acquired prior to and following the uneventful intravenous
administration of gadolinium based contrast.
FINDINGS:
MR CERVICAL SPINE:
Vertebral body heights are normal. Alignment reveals a grade 1, 1 mm
anterolisthesis of C4 over C5. Bone marrow signal reveals multilevel
degenerative findings, though there is no focal concerning abnormality. There
is no abnormal focus of enhancement.
C2-C3: There is no spinal canal or neural foraminal stenosis. There is no
disk herniation.
C3-C4: There is mild right neural foraminal and a left neural foraminal
stenosis. There is minimal spinal canal narrowing. There is no disc
herniation.
C4-C5: There is no spinal canal narrowing, and mild left neural foraminal
narrowing. Note is made of severe right neural foraminal narrowing. Findings
are related to right worse than left uncovertebral and facet arthropathy.
C5-C6: There is mild spinal canal narrowing, mild bilateral neural foraminal
narrowing. Note is made of a circumferential disk bulge, and small posterior
vertebral body osteophytes.
C6-C7: There is moderate spinal canal narrowing and mild bilateral neural
foraminal narrowing. Findings are related to a circumferential disk bulge and
posterior vertebral body osteophytes. There is minimal deformation of the
spinal cord. Note is made of perineural cysts along both exiting nerves at
this level.
Incidental note is again made of an incompletely characterized heterogeneous,
partially cystic nodule arising from the left lobe of the thyroid gland,
measuring approximately 2.2 x 2.2 cm (series 16, image 50). This appears
minimally changed in size from the CT done on ___. Note is also
made of a small left maxillary sinus mucous retention cyst.
MR THORACIC SPINE:
Vertebral body heights are notable for a minimal superior endplate deformity
of the T3 vertebral body unchanged from the most recent comparison CT and a
compression deformity of the T12 vertebral body, also into the. This latter
is reduced to approximately 50% of total height, at the point of greatest
depression. Vertebral body alignment is normal. Bone marrow signal reveals
multilevel degenerative changes, with no focal concerning abnormality. Spinal
cord signal is normal. There is no significant spinal canal stenosis.
Incidental note is made of large bilateral partially septated T2
hyperintensity surrounding the glenohumeral joints bilaterally, possibly
complex joint effusions /bursal fluid. Note is also made of bilateral pleural
effusions and atelectasis.
MR LUMBAR SPINE:
Vertebral body heights are notable for a severe compression deformity of the
L1 vertebral body. Note is also made of loss of height centrally involving
the L3 vertebral body. These findings are unchanged from the most recent
comparison CT study, and are new since ___. Alignment is notable for a
grade 1 anterolisthesis of L5 over S1 and of L3 over L4. Bone marrow signal
reveals degenerative findings, with no focal concerning abnormality,
space-occupying mass or abnormal focus of enhancement. Edema in the L2
vertebra is noted, new from prior examinations. The conus medullaris
terminates posterior to the L1 vertebral body remnant.
T12-L1: There is moderate spinal canal narrowing, related to retropulsion of
the superior aspect of the compressed L1 vertebral body. Facet joints are
normal. There is mild right and no left neural foraminal stenosis.
L1-L2: There is mild spinal canal narrowing, and no neural foraminal
narrowing. Findings are related to a circumferential disc bulge. There is
minimal bilateral facet arthropathy.
L2-L3: There is mild spinal canal narrowing, and moderate bilateral neural
foraminal narrowing. There is no disk herniation. Note is made of moderate
bilateral facet arthropathy.
L3-L4: There is moderate spinal canal stenosis and mild bilateral neural
foraminal narrowing. Note is made of a circumferential disc bulge and
moderate bilateral facet arthropathy. Disk and facet material combine to
narrow the subarticular zones bilaterally.
L4-L5: There is moderately severe spinal canal stenosis. Note is made of a
circumferential disc bulge, with central annular fissure as well as thickening
of the ligamentum flavum bilaterally and mild bilateral facet arthropathy.
Note is also made of mild bilateral neural foraminal stenosis.
L5-S1: There is minimal spinal canal narrowing, and minimal neural foraminal
narrowing. Findings are related to a circumferential disc bulge. Facet joints
are normal.
Incidental note is made of numerous bilateral renal parapelvic cysts.
IMPRESSION:
1. Compression deformities as above, most strikingly involving the L1
vertebral body where there is mild retropulsion of the superior aspect of that
vertebral body. However, this does not result in severe spinal canal stenosis
at this (or any other fractured) level.
2. Degenerative changes as catalog above, including moderately severe spinal
canal narrowing at L4-L5.
3. Extensive lobulated T2 hyperintensity surrounding the glenohumeral joints
bilaterally, appearing septated in areas. This is incompletely evaluated
though likely represents large joint effusions or adjacent bursal fluid
collections.
|
10201591-RR-19
| 10,201,591 | 29,917,330 |
RR
| 19 |
2154-05-29 17:19:00
|
2154-05-31 10:21:00
|
CLINICAL HISTORY: ___ female with incidental finding of IPMN. Please
evaluate.
TECHNIQUE: Multiplanar, multiphasic MR images of the abdomen were obtained
both pre- and post administration of 8 cc of Gadovist intravenously and 3 cc
of diluted Gadovist orally. A prior CT study of the abdomen dated ___ was available for comparison.
FINDINGS:
LUNG BASES: A moderate-sized right-sided pleural effusion is again identified
with associated compressive atelectasis. There is interval resolution of the
previously described left-sided pleural effusion.
The liver and spleen are normal in size. No focal hepatic lesions are
identified. The gallbladder contains numerous small gallstones. There is no
evidence for cholecystitis. The intra- and extra-hepatic bile ducts are
unremarkable. The pancreas is normal in size. Within the pancreatic body,
there is an 11-mm cystic pancreatic lesion identified which appears to
communicate with the main pancreatic duct which is otherwise unremarkable. No
worrisome features are identified in the cystic pancreatic lesion and the
lesion most likely represents a side branch IPMN. There is no retroperitoneal
or mesenteric lymphadenopathy. The kidneys are normal in size. A simple
renal cyst measuring 7 mm is identified arising in the upper pole of the right
kidney. Bilateral peripelvic cysts are identified. The visualized portions
of the GI tract and axial skeleton are unremarkable.
IMPRESSION:
1. 1.2-cm cystic pancreatic lesion in the pancreatic body, most likely
representing a side branch IPMN. Envisioning the patient's age and size of
the lesion a followup MRI exam in one year is recommended to ensure stability.
2. Cholecystolithiasis with a focal area of fundal adenomyomatosis.
3. Moderate-sized right-sided pleural effusion.
4. Right upper pole renal cysts.
|
10201591-RR-20
| 10,201,591 | 29,917,330 |
RR
| 20 |
2154-05-26 12:33:00
|
2154-05-26 14:12:00
|
TYPE OF THE EXAMINATION: Chest, AP portable single view.
INDICATION: ___ female patient with history of aspiration, pleural
effusion on exam, now very dyspneic. Evaluate for effusion versus aspiration.
FINDINGS: AP single view of the chest was obtained with patient in
semi-upright position. Comparison is made with the next preceding similar
study of ___. Cardiac enlargement as before. Bilateral hazy
densities over the bases are again observed and consistent with previously
made diagnosis of bilateral pleural effusion fluid accumulations in the inter-
lobar fissures, although lateral view not obtained in this repeat study. New
discrete parenchymal infiltrates suggestive of pneumonia cannot be identified.
|
10201591-RR-21
| 10,201,591 | 29,917,330 |
RR
| 21 |
2154-05-30 15:51:00
|
2154-05-30 17:39:00
|
HISTORY: Compression fracture.
FINDINGS: No previous images. There is a compression fracture of L1 with
associated fracture at T12 and extensive bridging osteophytes, suggesting that
this represents an old injury. An apparent acute compression fracture is seen
at L3. There may be slight anterolisthesis at the L3-4 level.
There is marked narrowing at L4-5 and L5-S1, consistent with substantial
degenerative changes.
|
10201643-RR-36
| 10,201,643 | 28,004,948 |
RR
| 36 |
2197-05-07 17:07:00
|
2197-05-07 17:24:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with DOE // r/o acute process
COMPARISON: Prior study from ___
FINDINGS:
AP upright and lateral views of the chest provided. AICD again seen with
leads positioned in the region of the right atrium and right ventricle.
Pleural effusions are noted, small, though increased from prior. A loculated
left pleural effusion is again noted with pleural based opacity noted along
the lateral margin of the left mid to lower lung. A spiculated nodule is
noted in the left infrahilar region. Cardiomediastinal contour is unchanged.
No convincing signs of edema or pneumonia. The bony structures are intact.
IMPRESSION:
As above.
|
10201643-RR-37
| 10,201,643 | 28,004,948 |
RR
| 37 |
2197-05-08 07:51:00
|
2197-05-08 10:29:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT).
INDICATION: ___ year old man with lung cancer and new lower extremity swelling
// rule out DVT, BOTH legs please. Ok to do on ___ after 7 AM but morning
please thanks!
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the left posterior tibial veins. One of
the left peroneal veins is noncompressible, with no flow demonstrated. Normal
color flow is demonstrated in the right tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
There is subcutaneous edema bilaterally.
IMPRESSION:
Deep vein thrombosis in one of the left peroneal (calf) veins.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 10:28 AM, 10 minutes after discovery of the
findings.
|
10201891-RR-15
| 10,201,891 | 24,862,430 |
RR
| 15 |
2162-01-12 05:45:00
|
2162-01-12 09:32:00
|
HEAD MRI WITH AND WITHOUT CONTRAST, ___
INDICATION: Left frontal mass.
COMPARISON: Non-contrast CT performed at ___
___ on ___.
TECHNIQUE: Sagittal T1-weighted, and axial T1-weighted, T2-weighted, FLAIR,
gradient echo, and diffusion-weighted images of the brain were obtained.
Following intravenous gadolinium administration, multiplanar T1-weighted
images of the head were obtained.
FINDINGS: There is a mass with a thick irregular rim of contrast enhancement
located in the inferior medial left frontal lobe, measuring 3.1 cm transverse
x 4.2 cm AP x 3.3 cm craniocaudad (images 13:12 and 101:38). The enhancing
rim demonstrates slow diffusion, indicating hypercellularity. Foci of low
signal within the mass on gradient echo images indicate blood products. There
is extensive vasogenic edema in the left frontal lobe, as well as in the genu
and body of the corpus callosum bilaterally. The right inferior frontal lobe
is displaced to the right and partially compressed; it is not clear whether it
is also invaded by the mass. The frontal horns of the lateral ventricles are
compressed, left greater than right. The medial left temporal lobe is
displaced towards the midbrain, but the perimesencephalic cistern is not
completely effaced. The left cerebellar tonsil terminates at the level of the
foramen magnum, and the right cerebellar tonsil terminates 2 mm below the
foramen magnum. The fourth ventricle is not compressed. The flow voids of
the A2 segments of the anterior cerebral arteries are displaced to the right
and may be narrowed.
IMPRESSION:
1. Aggressive, hypercellular rim-enhancing mass in the inferior medial left
frontal lobe, with significant mass effect including left subfalcine
herniation, compression of the right inferior frontal lobe (cannot exclude
invasion), displacement and likely narrowing of the A2 segments of the
anterior cerebral arteries, and medial displacement of the left uncus without
midbrain compression. The appearance of the mass is most suggestive of
glioblastoma. A metastasis is less likely. Lymphoma is unlikely, given the
heterogeneity of the lesion, unless the patient is immunocompromised.
2. 2-mm displacement of the right cerebellar tonsil below the foramen magnum,
which may be related to either congenital tonsillar ectopia or sequela of
increased intracranial pressure.
|
10202010-RR-2
| 10,202,010 | 25,676,260 |
RR
| 2 |
2134-08-27 14:08:00
|
2134-08-27 14:40:00
|
EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: History: ___ with acute onset severe headache, dysarthria
weakness 1300 // Eval for ICH, e/o stroke.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 49.0 mGy (Head) DLP =
24.5 mGy-cm.
3) Spiral Acquisition 5.3 s, 41.7 cm; CTDIvol = 32.1 mGy (Head) DLP =
1,338.2 mGy-cm.
Total DLP (Head) = 2,260 mGy-cm.
COMPARISON: No prior examinations of the head and neck are available.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of infarction, hemorrhage, edema, or mass.
The ventricles and sulci are normal in size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
There is mild atherosclerosis involving bilateral cavernous carotid arteries.
The vessels of the circle of ___ and their principal intracranial branches
appear otherwise unremarkable without stenosis, occlusion, or aneurysm
formation. The dural venous sinuses are patent.
CTA NECK:
There is mild atherosclerosis involving bilateral carotid artery bifurcations
without any stenosis by NASCET criteria. The carotid and vertebral arteries
and their major branches appear otherwise unremarkable with no evidence of
stenosis or occlusion. Note is made of dense arteriosclerotic plaque adjacent
to the origin of the left vertebral artery with no evidence of underlying
stenosis (image 42, series 602b)
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There are slightly prominent bilateral
level 2 lymph nodes measuring up to 1 cm, nonspecific, likely reactive in
etiology. There is atherosclerosis involving the left subclavian artery
without significant stenosis.
IMPRESSION:
1. Unremarkable head and neck CTA noting mild atherosclerosis.
2. No acute intracranial abnormality.
|
10202010-RR-3
| 10,202,010 | 25,676,260 |
RR
| 3 |
2134-08-27 18:06:00
|
2134-08-27 18:28:00
|
INDICATION: ___ with stroke // acute process?
TECHNIQUE: Single portable view of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. There is no focal consolidation, effusion, or edema.
The cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities. Surgical clips noted in the upper abdomen.
IMPRESSION:
No acute cardiopulmonary process.
|
10202010-RR-4
| 10,202,010 | 25,676,260 |
RR
| 4 |
2134-08-27 18:58:00
|
2134-08-27 19:16:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Stroke status post tPA.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: CTA head and neck ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
No osseous abnormalities seen. There is mild mucosal wall thickening of the
bilateral anterior ethmoid air cells. The remainder of the visualized
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality. Specifically, no hemorrhage.
|
10202010-RR-5
| 10,202,010 | 25,676,260 |
RR
| 5 |
2134-08-28 01:08:00
|
2134-08-28 09:02:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD.
INDICATION: ___ year old man with L posterior circulation stroke // evaluate
for stroke extent - STROKE PROTOCOL MRI.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Head CT from ___.
FINDINGS:
The study is degraded by motion somewhat limiting the evaluation. Within this
confines:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration.
Incidentally seen is partially empty sella.
The orbits are unremarkable. There is mild mucosal thickening in bilateral
anterior ethmoid air cells and bilateral maxillary sinuses with a mucous
retention cyst in the floor of left maxillary sinus. The remaining visualized
paranasal sinuses and mastoid air cells are clear. Intracranial flow voids
are maintained.
IMPRESSION:
1. No acute intracranial abnormality.
2. Paranasal sinus disease as described above.
|
10202010-RR-6
| 10,202,010 | 25,676,260 |
RR
| 6 |
2134-08-28 14:50:00
|
2134-08-28 16:21:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with L posterior circ stroke s/p tPA // Eval for
bleed- obtain at 14:30 ___.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Head MRI from ___.
FINDINGS:
There is no evidence of territorial infarction, intracranial hemorrhage,
edema, or mass effect. The ventricles and sulci are normal in size and
configuration for the patient's age.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses are notable for mucosal thickening in the frontal ethmoidal recess and
bilateral ethmoidal air cells, no air-fluid levels are identified,the mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. There is no evidence of acute intracranial process or hemorrhage
2. Mild paranasal sinus disease as described above
|
10202010-RR-7
| 10,202,010 | 25,676,260 |
RR
| 7 |
2134-08-28 21:53:00
|
2134-08-28 22:23:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ male diagnosed with a new stroke, found to have
elevated LFTs. Evaluate for hepatobiliary pathology.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver echotexture is coarse and diffusely echogenic. The contour
of the liver is smooth. There is no focal liver mass. The main portal vein
is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: Mild intrahepatic biliary dilatation is likely due to
postcholecystectomy state. The CBD measures 6 mm.
GALLBLADDER: Patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 10.1 cm.
KIDNEYS: The right kidney measures 10.8 cm. The left kidney measures 10.2 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease and
more advanced liver disease including steatohepatitis or significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
2. Minimal intrahepatic biliary dilatation is likely related to post
cholecystectomy state.
|
10202035-RR-11
| 10,202,035 | 23,128,703 |
RR
| 11 |
2197-12-28 09:42:00
|
2197-12-28 15:54:00
|
EXAMINATION: Intraoperative fluoroscopy.
INDICATION: Intraoperative fluoroscopy
TECHNIQUE: HIP UNILAT MIN 2 VIEWS LEFT IN O.R.
IMPRESSION:
17 spot fluoroscopy images were obtained during the process of left hip open
reduction internal fixation of the neck fracture. Note is made that there
etiologies was not attending the procedure. Total fluoroscopy time of 122.4
seconds was recorded. For pre size details please review procedure report
|
10202394-RR-17
| 10,202,394 | 29,488,607 |
RR
| 17 |
2199-02-14 16:54:00
|
2199-02-14 19:18:00
|
INDICATION: ___ male with history of pancreatic and common bile duct
dilatation, now presenting with worsening jaundice.
COMPARISON: CT torso from ___.
RIGHT UPPER QUADRANT ULTRASOUND: The liver is homogeneous in echogenicity
without suspicious focal lesion. The main portal vein is patent with
hepatopetal flow. The gallbladder is somewhat distended and it contains
sludge. Minimal pericholecystic and perihepatic ascites is identified. No
gallbladder wall thickening or stones are evident. There is diffuse
intrahepatic biliary ductal dilatation similar in severity compared to prior
CT from ___. The common bile duct is markedly dilated throughout
its course, measuring 7 mm at the porta hepatis and 14 mm more distally. At
the level of the pancreatic head, there is an irregular hypoechoic mass which
is similar to prior CT, though incompletely evaluated. The margins are
difficult to evaluate, though it measures approximately 4.5 x 3.7 x 3.4 cm.
The main pancreatic duct also remains dilated measuring up to 8 mm.
IMPRESSION:
1. Diffuse intra- and extra-hepatic biliary ductal dilatation and an
irregular hypoechoic mass seen at the level of the pancreatic head. Diffuse
main pancreatic ductal dilatation measuring up to 8 mm. Given recent CT
findings and ultrasound findings, findings are concerning for a primary
pancreatic or ampullary neoplasm leading to obstruction. Recommend GI
consultation and possible MRI for further characterization.
3. Trace perihepatic ascites.
4. Sludge-filled gallbladder.
|
10202394-RR-18
| 10,202,394 | 29,488,607 |
RR
| 18 |
2199-02-16 09:34:00
|
2199-02-16 11:13:00
|
HISTORY: Possible IPMN. Evaluate prior to potential surgery.
TECHNIQUE: MDCT axial images were acquired during the multiphasic enhancement
of the pancreas with 200 mL of Omnipaque. Imaging of the chest and pelvis was
performed as well. Coronal and sagittal reformations were provided and
reviewed. The patient received pre-medication prior to the study given his
history of a skin reaction to contrast.
DLP: 2473.60 mGy/cm.
COMPARISON: CT torso ___.
FINDINGS:
Chest: The included thyroid is normal. There is no axillary or
supraclavicular lymphadenopathy. Mediastinal lymphadenopathy has slightly
increased in size, ranging up to 17 x 13 mm in anterior to the trachea,
previously 15 x 11 mm (7:37). The aorta and main pulmonary artery are normal
caliber. There is no large, central pulmonary arterial filling defects. The
heart is normal in size. Trace fluid within the pericardial recesses is
likely physiologic. Heavy calcifications involve the aortic valve. There is
a small amount of focal coronary artery calcifications as well.
Small, nonhemorrhagic bilateral pleural effusions are new. The trachea is
normal caliber. The airways are patent through the subsegmental level. There
is no bronchial wall thickening or bronchiectasis. Linear
scarring/atelectasis is noted at the bases. Subpleural reticular interstitial
opacities may relate to chronic lung disease and are unchanged. There are no
worrisome lung nodules or masses.
CTA pancreas: There has been a marked interval increase in size of the
complex, multiseptated cystic mass within the uncinate process of the pancreas
measuring 40 x 33 mm and previously 31 x 26 mm. Dilation of the main
pancreatic duct ranges up to 17 mm, previously 12 mm. Extensive side branch
dilation has increased as well. There is no mesenteric or retroperitoneal
lymphadenopathy.
The common bile duct has increased in size, now measuring 14 mm and previously
8 mm. A plastic biliary stent is positioned within the CBD and duodenum.
Despite its presence there is a moderate amount of intrahepatic biliary ductal
dilation which is worse from prior. The gallbladder is distended, however,
there is no evidence for acute cholecystitis.
CTA: There is a moderate amount of atherosclerosis within a non aneurysmal
aorta. The renal, celiac, superior mesenteric and inferior mesenteric
arteries are patent. There is conventional hepatic arterial anatomy. The
portal vein, splenic vein and superior mesenteric vein are patent. The fat
planes surrounding the superior mesenteric artery and superior mesenteric vein
are preserved.
CT abdomen: The liver enhances homogeneously without focal lesions. Spleen
is top normal in size. The adrenal glands are unremarkable. The kidneys
enhance symmetrically and excrete contrast without hydronephrosis.
Hypodensities within both kidneys are unchanged, the largest are 5.6 cm on the
right and 1.8 cm on the left. There is a small amount of ascites.
The stomach, large and small bowel are unremarkable. Apparent thickening of
the cecum is thought secondary to collapse. There is no obstruction. The
appendix is normal (7:161). There is no free air.
CT pelvis: Diffuse thickening of the bladder is unchanged and may relate to
radiation cystitis. There is slight increase in thickening of the rectum from
prior and again this may relate to radiation proctitis. There is a moderate
amount of simple fluid within the pelvis. There is no free air.
Bones and soft tissues: There is diffuse anasarca. There are no concerning
lytic or blastic osseous lesions.
Pancreatic Tumor Table:
I: Pancreatic tumor present: Yes
a) Location: Head and uncinate
b) Size: 40 x 33 mm
c) Enhancement relative to pancreas: ___
d) Confined to pancreas with clear fat planes (duodenum and IVC do not apply):
Yes
e) Remaining pancreas: Normal.
II. Adenopathy present:
a) Size and location of largest lymph node: Mediastinum, 17 x 13 mm.
b) Necrosis in lymph nodes: No
c) Size of gastroduodenal artery node, "node of importance": No
III. Metastatic disease, definitely present: No
IV: Ascites/peripancreatic fluid: No
Pancreatic Vascular Table
I: Vascular Tumor Involvement:
a) Celiac involvement: No
b) SMA involvement: No
c) SMV involvement and percent encasement: No
d) Less than 1 cm SMV between tumor and first major SMV branch: Yes
e) Portal vein involvement: No
g) Splenic vein involvement: No
h) Splenic artery involvement and distance from tumor to celiac artery
bifurcation: 2.8 cm
i) Vascular Involvement, Other: None
II: Thrombosis, any vessel: No
III: Aberrant Anatomy: None
a) Replaced right hepatic artery: No
IMPRESSION:
1. Marked increased in size of a complex cystic mass within the uncinate
process with further dilation of the main pancreatic duct and side branches
from ___. The findings are in keeping with a mixed IPMN. No
definite evidence for metastatic disease.
2. New, moderate intrahepatic biliary ductal dilation and further dilation of
the common bile duct and gallbladder. Common bile duct stent in situ,
however, patency is not assessed but can be correlated with bilirubin levels.
3. Slight increase in nonspecific mediastinal lymphadenopathy.
4. Volume overload as evidenced by anasarca, trace bilateral pleural
effusions and a small amount of ascites.
5. Heavy aortic valvular calcifications, enough to be hemodynamically
significant.
|
10202778-RR-28
| 10,202,778 | 21,365,589 |
RR
| 28 |
2184-01-18 11:02:00
|
2184-01-18 12:21:00
|
INDICATION: ___ DM, charcot's s/p R guillotine amp ___ completion
BKA presents from clinic with concern for stump infection // please evaluate
right BKA site for signs of deeper infection
TECHNIQUE: CT of the lower extremity extending to the amputation stump
without IV contrast
DOSE: 900 mGy-cm
COMPARISON: None
FINDINGS:
The patient is status post below-the-knee amputation. Extensive vascular
calcifications are present throughout the imaged extremity. The distal aspect
of the tibial stump is sharply marginated. The fibular stump has a slightly
irregular distal aspect, but probably within normal limits given the prior
surgery.
Within the muscle flap, deep to the superficial fascia there is a collection
of hypodense material within minimal intervening areas of hyperdense material
spanning 9.3 x 3.9 x 4.5 cm. Surrounding this collection of fluid as well as
extending superiorly to above the knee is extensive soft tissue edema.
A small knee joint effusion is noted. Tricompartmental degenerative changes of
the knee are present without any evidence of acute fracture.
IMPRESSION:
1. Large collection of fluid that appears to be within the muscular flap, deep
to the superficial fascia. Infection cannot be ruled out, although other
considerations could include postoperative seroma/ hematoma. Extensive soft
tissue edema extends superiorly from the stump and collection to above the
knee
|
10203235-RR-74
| 10,203,235 | 24,203,891 |
RR
| 74 |
2130-04-23 01:39:00
|
2130-04-23 01:55:00
|
INDICATION: Evaluate for pneumothorax or pneumonia in a patient with chest
pain.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___.
FINDINGS:
Frontal and lateral chest radiographs demonstrate intact sternal wires. There
is mild cardiomegaly. The lungs are fairly well-expanded, with bilateral
pulmonary opacities consistent with moderate pulmonary edema. There is no
focal consolidation, appreciable pleural effusion, or pneumothorax. The
visualized upper abdomen is unremarkable.
IMPRESSION:
Moderate pulmonary edema.
|
10203235-RR-75
| 10,203,235 | 27,901,592 |
RR
| 75 |
2130-06-01 03:38:00
|
2130-06-01 04:06:00
|
INDICATION: History: ___ with cp // eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___
FINDINGS:
PA and lateral chest radiographs were provided. Median sternotomy wires
appear intact. Surgical clips project over the left mediastinal border.
Comparison is made to radiographs dated ___. Mild cardiomegaly
is stable. Bilateral pulmonary opacities are present though improved relative
to prior study consistent with pulmonary edema. Blunting of bilateral
costophrenic angles likely reflect small pleural effusions. No evidence of
pneumothorax.
IMPRESSION:
Mild to moderate pulmonary edema improved relative to examination dated ___.
|
10203235-RR-80
| 10,203,235 | 27,652,177 |
RR
| 80 |
2130-08-14 01:52:00
|
2130-08-14 03:24:00
|
INDICATION: History: ___ with acute dyspnea // eval for acute process
TECHNIQUE: Portable upright chest radiograph
COMPARISON: ___
FINDINGS:
There is moderate pulmonary edema, but no pleural effusions or pneumothorax.
Heart size is top-normal, likely accentuated by the portable technique.
Sternal wires are intact. No obvious osseous abnormality.
IMPRESSION:
1. Moderate pulmonary edema. No pleural effusions.
2. Mild cardiomegaly.
|
10203235-RR-95
| 10,203,235 | 28,960,005 |
RR
| 95 |
2133-10-05 00:30:00
|
2133-10-05 03:45:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with cp// cp
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiograph from ___, ___
FINDINGS:
Lung volumes are low with bronchovascular crowding. Retrocardiac opacities
likely represent atelectasis. There may be mild pulmonary vascular congestion
without frank edema. No pneumothorax or large pleural effusions. The
cardiomediastinal silhouette is accentuated by low lung volumes, but remains
mildly enlarged. Atherosclerotic calcifications are noted in the aortic knob.
Median sternotomy wires are redemonstrated.
IMPRESSION:
1. Hypoinflated lungs with pulmonary vascular congestion.
2. Retrocardiac opacities likely represent atelectasis.
|
10203383-RR-69
| 10,203,383 | 21,087,991 |
RR
| 69 |
2139-06-17 10:08:00
|
2139-06-17 11:55:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with lymphoma, neutropenic fever, and
persistent cough and influenza // eval for pna eval for pna
IMPRESSION:
Heart size is normal. There is interval increase in right pleural effusion.
Right basal opacity is even more conspicuous, concerning for developing
infection. Upper lungs are clear. There is no left pleural effusion.
|
10203383-RR-70
| 10,203,383 | 21,087,991 |
RR
| 70 |
2139-06-22 09:09:00
|
2139-06-22 09:21:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with follicular lymphoma and febrle
neutropenia. // Please evaluate for infection
IMPRESSION:
In comparison to ___ chest radiograph, cardiomediastinal contours
are stable, and a small right pleural effusion is unchanged. Confluent right
lower lobe opacity and patchy and linear left lower lobe opacity have both
slightly improved in the interval. There are no new or worsening areas of
lung opacification.
|
10203383-RR-71
| 10,203,383 | 21,087,991 |
RR
| 71 |
2139-06-26 13:46:00
|
2139-06-26 15:39:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with neutropenia, increased sputum produc,
known Right sided infiltrate, please assess interval change, thanks // assess
interval change in right sided infiltrate, thanks
IMPRESSION:
In comparison to ___ chest radiograph, cardiomediastinal contours
are stable in appearance. A confluent right lower lobe opacity has slightly
improved, and adjacent right pleural effusion and/or pleural thickening is not
appreciably changed linear left lower lobe opacities have also improved.
|
10203383-RR-77
| 10,203,383 | 25,683,106 |
RR
| 77 |
2141-03-09 06:59:00
|
2141-03-09 10:53:00
|
EXAMINATION: Chest Radiograph
INDICATION: History: ___ with fever// Eval for PNA
COMPARISON: Radiograph dated ___.
FINDINGS:
PA and lateral views of the chest provided.Lungs are well aerated. No focal
consolidations. Right basilar atelectasis and scarring is noted.
Cardiomediastinal and hilar silhouettes are stable. No pulmonary edema. No
pleural effusions. No pneumothorax.
IMPRESSION:
No focal consolidation.
|
10203383-RR-78
| 10,203,383 | 25,683,106 |
RR
| 78 |
2141-03-10 18:12:00
|
2141-03-10 20:16:00
|
INDICATION: ___ year old woman with recurrent follicular stabilized on
idelalisib who presents with febrile neutropenia, with suspected urinary
source. S/p 1 day of treatment with nitrofurantoin by PCP, presented with
fevers with ANC 150, now on cefepime. Assess for disease vs infection //
fevers, assess for lymphoma and also for infection
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 10.5 s, 67.9 cm; CTDIvol = 6.6 mGy (Body) DLP = 446.5
mGy-cm.
Total DLP (Body) = 447 mGy-cm.
COMPARISON: CT abdomen pelvis ___ and ___ and ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver 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: 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 focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Note is made of fibroid uterus. No adnexal masses.
LYMPH NODES: The visualized retroperitoneal and mesenteric lymph nodes are not
enlarged. Mesenteric soft tissue haziness (series 3, image 79) has
significantly improved compared to ___. There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minima atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes of the thoracolumbar spine are mild.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No acute process within the abdomen or pelvis.
2. No abdominal or pelvic lymphadenopathy.
3. Mesenteric soft tissue haziness has significantly improved compared to ___.
4. Please see separate report performed on the same day for detailed
evaluation of the chest.
|
10203383-RR-79
| 10,203,383 | 25,683,106 |
RR
| 79 |
2141-03-10 18:13:00
|
2141-03-10 20:09:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ female with lymphoma presenting with no neutropenia
for evaluation of infectious etiology.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
contiguous 5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and
parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 10.5 s, 67.9 cm; CTDIvol = 6.6 mGy (Body) DLP = 446.5
mGy-cm.
Total DLP (Body) = 447 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Multiple prior chest CT dated back to ___ the most
recent chest CT from ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The patient is status post thyroidectomy.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
PULMONARY PARENCHYMA: Perifissural opacity (series 4, image 153) in the right
middle lobe is most likely atelectasis. No additional focal consolidation to
suggest pneumonia. No new or growing pulmonary nodules. There is no
emphysema.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is no pleural effusion.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild. No acute fractures.
UPPER ABDOMEN: Please see separately submitted Abdomen and Pelvis CT report
for subdiaphragmatic findings.
IMPRESSION:
1. Perifissural opacity in the right middle lobe is most likely atelectasis.
No focal consolidation to suggest pneumonia.
2. No lymphadenopathy.
3. Please see separate report performed on the same day for detailed
evaluation of the abdomen pelvis.
|
10203383-RR-80
| 10,203,383 | 25,683,106 |
RR
| 80 |
2141-03-11 15:59:00
|
2141-03-11 16:58:00
|
EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old woman with urinary frequency// hydroneprhosis,
structural abnormality
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys and
bladder were obtained.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
The right kidney measures 10.4 cm. The left kidney measures 10.1 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical echogenicity
and corticomedullary differentiation are seen bilaterally.
The bladder is normal in appearance.
Prevoid volume of the bladder is 359.8 cc.
Postvoid volume of the bladder is 12.4 cc.
IMPRESSION:
1. Normal kidney and bladder ultrasound.
2. post void residual of 12.4 cc.
|
10203665-RR-51
| 10,203,665 | 21,525,249 |
RR
| 51 |
2165-08-15 03:56:00
|
2165-08-15 05:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with flank pain, fever// ?PNA
TECHNIQUE: Chest AP radiograph upright
COMPARISON: Chest radiograph from ___.
FINDINGS:
Airspace opacity in right lower lobe can represent atelectasis however
pneumonia cannot be excluded in the correct clinical setting. Small bilateral
pleural effusions. No evidence of pneumothorax. Hilar and cardiac contours
are unremarkable. No evidence of displaced fracture.
IMPRESSION:
Right lung base airspace opacity can represent atelectasis however pneumonia
cannot be excluded correct clinical setting. Small bilateral pleural
effusions.
|
10203665-RR-52
| 10,203,665 | 21,525,249 |
RR
| 52 |
2165-08-15 08:50:00
|
2165-08-15 09:52:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: History: ___ with flank pain, fever. NO_PO contrast// ?kidney
stone, pyelo
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration through the
left wrist.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.4 s, 50.1 cm; CTDIvol = 14.2 mGy (Body) DLP = 711.4
mGy-cm.
Total DLP (Body) = 711 mGy-cm.
COMPARISON: CT abdomen pelvis ___, chest radiograph ___.
FINDINGS:
LOWER CHEST: Small pleural effusions, right greater than left, are noted.
There is atelectasis in the left lower lobe. Opacities in the right lower
lobe may represent subsegmental atelectasis or aspiration.
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: 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.
Multiple bilateral tiny hypodensities are too small to characterize. There is
no evidence of solid renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is colonic
diverticulosis without signs of active inflammation. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Patient is status post hysterectomy. A 2 x 1.2 cm cyst
in the right ovary is decreased in size since ___, previously measured 2.8 x
2.6 cm. No masses are seen in the left adnexa.
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. Redemonstrated multiple venous collaterals to the left infra
para-aortic space and prominent left gonadal vein.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Multilevel degenerative changes are at least moderate. Since ___, there is
compression of the superior endplate of T12, which appears chronic, and
progression of the degenerative changes most prominent at L1-L2 and L2-L3
levels. Grade 1 anterolisthesis of L4 on L5 is unchanged. Multiple levels of
broad-based disc bulging associated with severe facet joint hypertrophy
resulting in narrowing of the canal, worse at the L4-L5 level, likely chronic.
There are moderate degenerative changes of both hips.
SOFT TISSUES: Tiny fat containing left inguinal hernia. The partially
visualized right arm, above the elbow, shows subcutaneous soft tissue edema,
skin thickening and locules of air, which may present an infiltrated IV.
IMPRESSION:
1. No acute intraabdominal or pelvic findings.
2. Incompletely evaluated right basilar opacities, could represent atelectasis
or aspiration/pneumonia.
3. Small bilateral pleural effusions (right greater than left).
4. Subcutaneous soft tissue edema, skin thickening and locules of air in the
right upper arm, which is likely related to prior infiltrated IV. Please
correlate with physical exam.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:50 am, 15 minutes after
discovery of the findings.
|
10203920-RR-6
| 10,203,920 | 26,408,767 |
RR
| 6 |
2171-03-20 16:50:00
|
2171-03-20 17:14:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with c/o feeling unwell, decreased breath sound in
LLL, vomiting// Please eval for PNA, effusion
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is normal. The aorta is mildly tortuous. Mild atherosclerotic
calcifications are seen at the aortic knob which appears mildly ectatic.
Mediastinal and hilar contours are otherwise unremarkable. Pulmonary
vasculature is not engorged. Patchy opacities are noted in the lung bases.
No pleural effusion or pneumothorax. No acute osseous abnormality.
IMPRESSION:
Patchy bibasilar opacities could reflect atelectasis with aspiration and
infection not excluded in the correct setting.
|
10204466-RR-3
| 10,204,466 | 27,259,697 |
RR
| 3 |
2147-04-02 15:19:00
|
2147-04-02 17:13:00
|
CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Chest pressure and dyspnea on exertion, assess for
pneumonia.
FINDINGS: PA and lateral views of the chest were provided. There is a subtle
opacity at the right lung base, which could represent atelectasis or a very
early pneumonia. Otherwise, the lungs are clear. The heart and mediastinal
contours are stable. Bony structures are intact.
IMPRESSION: Very subtle opacity in the right lung base, which overlaps with
the underlying rib and could represent atelectasis, pneumonia is also possible
in the right clinical setting.
|
10204710-RR-25
| 10,204,710 | 21,766,133 |
RR
| 25 |
2152-04-10 14:30:00
|
2152-04-10 15:28:00
|
INDICATION: History: ___ with bicycle accident// ?fractured clavicle
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: None.
FINDINGS:
Lung volumes are low. Heart size is accentuated as result appearing mildly
enlarged. Mediastinal and hilar contours are unremarkable. Crowding of
bronchovascular structures is present without frank pulmonary edema. Patchy
opacities in the lung bases likely reflect atelectasis. No definite pleural
effusion or pneumothorax. Minimally displaced fractures of the left second,
third posterior ribs are noted, as well as minimally displaced fractures of
the left fourth and fifth lateral ribs. A fracture of the left mid clavicle
is demonstrated with superior displacement of the distal fracture fragment.
Cholecystectomy clips are noted in the right upper quadrant of the abdomen.
IMPRESSION:
1. Superiorly displaced left midclavicular fracture.
2. Fractures of the left second through fifth ribs. No definite pleural
effusion or pneumothorax.
3. Low lung volumes with bibasilar atelectasis.
|
10204710-RR-26
| 10,204,710 | 21,766,133 |
RR
| 26 |
2152-04-10 14:44:00
|
2152-04-10 15:12:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with bicycle accident// traumatic injury
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.7 cm; CTDIvol = 48.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
Mild soft tissue swelling and scalp laceration is seen in the left
supraorbital region. No underlying fractures. No osseous abnormalities seen.
The paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
The orbits are unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Left supraorbital scalp laceration. No underlying fracture.
|
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