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10204710-RR-27
| 10,204,710 | 21,766,133 |
RR
| 27 |
2152-04-10 14:44:00
|
2152-04-10 15:14:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with bicycle accident// traumatic injury
traumatic injury
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 26.0 cm; CTDIvol = 22.9 mGy (Body) DLP = 596.2
mGy-cm.
Total DLP (Body) = 596 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal.No cervical spine fracture identified. There are
nondisplaced fractures of the posterior left second and third ribs.No
significant spinal canal or neural foraminal narrowing.There is no
prevertebral soft tissue swelling.No cervical lymphadenopathy. Imaged thyroid
gland is unremarkable. Imaged lung apices are clear.
IMPRESSION:
1. Nondisplaced fractures of the posterior left second and third ribs.
2. No acute fracture or traumatic malalignment in the cervical spine.
NOTIFICATION: Updates to the wet read were discussed with Dr. ___.
|
10204710-RR-28
| 10,204,710 | 21,766,133 |
RR
| 28 |
2152-04-10 14:57:00
|
2152-04-10 15:16:00
|
INDICATION: History: ___ with bicycle fall, L clavicle fx on CXR// eval L
clavicle
TECHNIQUE: Left shoulder, 2 views and left clavicle, two views
COMPARISON: Chest radiograph ___ at 14:22
FINDINGS:
Fracture of the mid left clavicle is demonstrated with superior displacement
of the distal fracture fragment by approximately 1 shaft with an approximately
12 mm of override. The acromioclavicular and glenohumeral joints are
preserved without dislocation. No suspicious lytic or sclerotic osseous
abnormality. Left second and third posterior rib fractures are seen which
appear nondisplaced or minimally displaced. No pneumothorax identified within
the imaged left lung.
IMPRESSION:
1. Superiorly displaced left mid clavicle fracture with approximately 12 mm of
override between fracture fragments. No dislocation.
2. Nondisplaced left second posterior rib fracture and minimally displaced
left third posterior rib fracture.
|
10204710-RR-29
| 10,204,710 | 21,766,133 |
RR
| 29 |
2152-04-10 17:27:00
|
2152-04-10 19:38:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: History: ___ with left rib fracture on C-spine//Please evaluate
for rib fractures; please extend to include left shoulder as axillary view
will be difficult given pain to r/o dislocation
TECHNIQUE: Axial multidetector CT images were acquired through the chest
without the administration of IV contrast. Coronal and sagittal reformats
were provided.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.6 s, 44.1 cm; CTDIvol = 20.9 mGy (Body) DLP = 923.0
mGy-cm.
Total DLP (Body) = 923 mGy-cm.
COMPARISON: None
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Imaged thyroid gland is
unremarkable. There is no supraclavicular lymphadenopathy. No axillary
lymphadenopathy. Mild symmetric gynecomastia is noted.
UPPER ABDOMEN: Limited view of the upper abdomen is notable post
cholecystectomy changes. There is apparent focal intrahepatic biliary
dilation in segment 4 of unclear etiology.
MEDIASTINUM: No mediastinal lymphadenopathy. Minimal soft tissue density
intermixed with fat in the anterior mediastinal soft tissues is suggestive of
thymic hyperplasia. No definite overlying sternal fracture to suggest
mediastinal hematoma.
HILA: No hilar lymphadenopathy within limitations of an unenhanced scan.
HEART and PERICARDIUM: Heart is normal size. There is no pericardial
effusion. No significant coronary artery calcifications.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: There is mild dependent atelectasis bilaterally.
2. AIRWAYS: Airways are patent to subsegmental levels bilaterally.
3. VESSELS: The thoracic aorta and main pulmonary artery are normal caliber.
CHEST CAGE: There is a comminuted fracture of the midportion of the left
clavicle with slight superior displacement of the distal fracture fragment.
Surrounding hematoma is noted about the clavicle fracture site. No left AC or
glenohumeral joint dislocation. There is nondisplaced fracture of the
posterior left second rib at the costovertebral junction as well as a fracture
of its anterior aspect. There are nondisplaced fractures of the posterior and
anterior aspects of the left third rib. There are nondisplaced fracture of
the posterior and anterolateral aspects of the left fourth rib. There is a
minimally displaced anterolateral left fifth rib fracture.
IMPRESSION:
1. Comminuted, displaced fracture of the midportion of the left clavicle.
2. Multiple nondisplaced left-sided rib fractures involving the left second
through fifth ribs including segmental fractures of the left second through
fourth ribs.
3. Focal intrahepatic biliary dilation in segment 4 of the liver of unclear
etiology. Recommend further evaluation on a nonemergent basis with MRCP if no
relevant prior imaging has been previously obtained.
RECOMMENDATION(S): Focal intrahepatic biliary dilation in segment 4 of the
liver of unclear etiology. Recommend further evaluation on a nonemergent basis
with MRCP, if no relevant prior imaging has been previously obtained.
|
10204908-RR-38
| 10,204,908 | 20,439,008 |
RR
| 38 |
2188-02-07 00:32:00
|
2188-02-07 15:51:00
|
HISTORY: Nonresectable gallbladder adenocarcinoma and history of duodenal
perforation, now with worsening abdominal pain. Evaluate for perforation.
COMPARISON: CT abdomen/pelvis from ___, and abdominal radiograph
from ___.
FINDINGS:
Portable upright and supine abdominal radiographs demonstrate a normal bowel
gas pattern without evidence of obstruction or ileus. Rounded opacities along
the expected course of the descending and sigmoid colon represent diverticula
containing residual oral contrast. Multiple overlying lines somewhat limit
the exam; however, there is no evidence of intra-abdominal free air or
pneumatosis. The visualized osseous structures are unremarkable. Also noted
is an elevated right hemidiaphragm and biliary stents.
IMPRESSION:
Normal bowel gas pattern without evidence of obstruction or ileus, and no
evidence of free air.
|
10204908-RR-39
| 10,204,908 | 20,439,008 |
RR
| 39 |
2188-02-07 10:45:00
|
2188-02-07 12:23:00
|
HISTORY: Metastatic gallbladder cancer, status post subtotal cholecystectomy
presenting with Gram-negative rod sepsis. Previously visualized hepatic
abscesses on CT scan, evaluate size of abscesses for potential drainage.
COMPARISON: This study is compared with previous CT abdomen from ___.
FINDINGS:
There are three predominantly hypochoic lesions within the right lobe of the
liver, the largest measuring 2.3 x 3.1 x 2.6 cm, the other two measuring 2.2 x
2.4 x 2.3 cm and 1.6 cm respectively. The above described lesions are most
compatible with the previously seen hepatic abscesses on the prior CT scan;
however, the size of these lesions is not amenable to drainage at this time.
The common bile duct stent is again noted with associated pneumobilia,
suggesting patency of the stent. There is a small amount of intrahepatic bile
duct dilatation. There is a small amount of fluid anterior to the liver,
similar to the prior CT.
IMPRESSION:
1. Three hepatic hypochoic lesions within the right lobe of the liver,
compatible with abscesses, the largest measuring 3.1 cm, not amenable to
drainage at this time.
2. Common bile duct stent noted in place with small amount of pneumobilia
suggestive of stent patency. Mild amount of intrahepatic bile duct
dilatation.
3. Small amount of fluid anterior to the liver.
Findings were discussed with Dr. ___ at 11:30 a.m. on ___, 15 minutes after discovery of the findings.
|
10204908-RR-40
| 10,204,908 | 20,439,008 |
RR
| 40 |
2188-02-10 14:45:00
|
2188-02-10 15:31:00
|
HISTORY: Sepsis, liver abscess and tachypnea. Evaluation for pneumonia or
pulmonary edema.
TECHNIQUE: Frontal view of the chest.
COMPARISON: ___.
FINDINGS:
The heart is enlarged and the structures of the mediastinum are shifted to the
left. There is elevation of the right hemidiaphragm. The lung volumes are
low and there is some opacification at the base of the right lung consistent
with atelectasis. Additionally, there is a small pleural effusion on the
right. There is no evidence of pneumothorax.
IMPRESSION:
1. Elevated right hemidiaphragm, which is pushing the heart and structures of
the mediastinum to the left.
2. Atelectasis at the base of the right lung and small right pleural effusion.
No evidence of pneumonia or pulmonary edema.
|
10204908-RR-41
| 10,204,908 | 20,439,008 |
RR
| 41 |
2188-02-10 17:36:00
|
2188-02-10 20:06:00
|
HISTORY: Unresectable gallbladder adenocarcinoma, sepsis and liver abscesses.
Worsening clinical status and rising lactate.
COMPARISON: Ultrasound ___, CT ___.
FINDINGS:
There is a large subcapsular fluid collection along segments 7 and 8 of the
right lobe measuring 14 cm SI x 10 cm AP x 8.4 cm TV. The collection has
complex internal echoes dependently and more anechoic fluid superiorly. The
three hypoechoic liver lesions have increased in size. In segment 8 there is
a 3 x 3.2 x 3.4 cm lesion adjacent to the collection. There is a large 8.4 x
8.4 x 7.2 cm hypoechoic lesion in the right lobe. More superiorly in the
right lobe there is a 3.1 x 2.3 x 3.7 cm hypoechoic lesion. The main, left,
and anterior right portal veins are patent. The left posterior portal vein is
not visualized. CBD stent and pneumobilia are again seen.
IMPRESSION:
1. Large subcapsular area along segments 7 and 8,complex and hence, probable
abscess.
2. Increasing size of 3 hyperechoic liver lesions.
Findings were discussed with Dr. ___ telephone at 22:00 on ___.
|
10205542-RR-22
| 10,205,542 | 23,664,114 |
RR
| 22 |
2193-05-24 15:09:00
|
2193-05-24 16:51:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with abdominal pain. Evaluate for small bowel obstruction.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 608 mGy-cm.
COMPARISON: CT abdomen pelvis of ___ and ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. Minimal intrahepatic biliary
dilatation is likely due to the postcholecystectomy status. No common bile
duct dilatation.
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. Patient is post right
hemicolectomy. There are several loops of fluid-filled, relatively mildly
dilated distal ileum in the right lower quadrant (6:36-56) measuring up to 2.5
cm with some fecalization of internal contents.There is fluid within the neo
terminal ileum, as well as within the proximal transverse colon. Re-
demonstration of mild fat stranding and adenopathy in the region of the neo
terminal ileum (6:47). The appendix is surgically absent.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes of the lumbar spine are mild.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Relative dilatation of several fluid-filled distal ileal loops in the right
lower quadrant, leading up to the ileocolonic anastomosis. Fluid and air are
demonstrated within the large bowel distal to the anastomosis. Findings may
represent an early or partial small bowel obstruction at the level of the
anastomosis.
|
10205544-RR-14
| 10,205,544 | 28,757,511 |
RR
| 14 |
2127-03-12 03:39:00
|
2127-03-12 06:57:00
|
INDICATION: Status post MVA. Assess for fracture.
COMPARISON: CT torso from ___.
AP CHEST AND AP PELVIS: A trauma board slightly limits evaluation of this
study. The lungs are clear. The heart size is normal. The mediastinal
contours are normal. There are no pleural effusions. No pneumothorax is
seen.
There is no acute fracture involving the bony pelvis or proximal femurs.
There is no dislocation. The bilateral femoroacetabular joints spaces are
preserved. Keys project over the right proximal femur.
IMPRESSION:
1. No acute cardiac or pulmonary process.
2. No acute fracture or dislocation involving the pelvic girdle.
|
10205544-RR-15
| 10,205,544 | 28,757,511 |
RR
| 15 |
2127-03-12 03:40:00
|
2127-03-12 04:54:00
|
INDICATION: Status post MVC. Assess for acute intracranial process.
TECHNIQUE: Sequential axial images were acquired through the head without
administration of intravenous contrast material. Multiplanar reformats were
performed.
COMPARISON: None.
FINDINGS: There is no evidence of intracranial hemorrhage, edema, shift of
normally midline structures, hydrocephalus, or acute large vascular
territorial infarction. The visualized portions of the orbits are
unremarkable. The imaged aspects of the paranasal sinuses and mastoid air
cells are well aerated. There is no acute fracture.
IMPRESSION: No acute intracranial process.
|
10205544-RR-16
| 10,205,544 | 28,757,511 |
RR
| 16 |
2127-03-12 03:41:00
|
2127-03-12 04:55:00
|
INDICATION: Status post MVC. Assess for fracture or malalignment.
COMPARISON: None.
TECHNIQUE: MDCT axial images were acquired through the cervical spine without
administration of intravenous contrast material. Multiplanar reformats were
performed.
FINDINGS: There is no acute fracture. Straightening of the cervical spine is
likely secondary to a cervical collar. There is otherwise no malalignment.
No prevertebral soft tissue edema or hematoma is seen. The visualized
portions of the lung apices are clear. The thyroid gland is unremarkable.
There are no pathologically enlarged cervical lymph nodes. The visualized
aspects of the maxillary sinuses and mastoid air cells are well aerated.
IMPRESSION:
1. No acute fracture.
2. Straightening of the cervical spine, likely secondary to cervical collar.
Otherwise, no malalignment.
|
10205544-RR-17
| 10,205,544 | 28,757,511 |
RR
| 17 |
2127-03-12 03:41:00
|
2127-03-12 04:59:00
|
INDICATION: Status post MVC. Assess for acute injury.
COMPARISON: None.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen, and
pelvis during administration of 130 cc of intravenous Omnipaque contrast
material. Multiplanar reformats were performed.
TOTAL DLP: 488 mGy-cm.
CHEST CT: The visualized portion of the thyroid gland is unremarkable. The
thoracic aorta is normal in caliber, and otherwise unremarkable. The right
ventricular outflow tract and its central branches are patent. The heart size
is normal. There is no pericardial effusion. There is no mediastinal
hematoma or pneumomediastinum. No pathologically enlarged mediastinal, hilar,
or axillary lymph nodes are seen.
There is minimal bilateral lower lobe dependent atelectasis. The lungs are
otherwise clear. The tracheobronchial tree is patent to the segmental level
bilaterally. There are no pleural effusions. No pneumothorax is seen.
An 8-mm simple cyst is seen within the left hepatic lobe. No additional
hepatic lesions are identified. There was no intrahepatic biliary duct
dilatation. The portal vein is patent. The gallbladder, spleen, pancreas,
adrenal glands, and kidneys are normal. The thoracic esophagus is mildly
patulous, without associated wall thickening. The stomach is unremarkable.
There are several fluid-filled loops of small bowel in the mid abdomen, with
associated mild wall thickening and mild surrounding mesenteric stranding,
nonspecific in nature, but concerning for bowel injury (2:78). The small
bowel is otherwise normal. The colon and appendix are normal. There is no
free fluid or free air in the abdomen. No pathologically enlarged abdominal
lymph nodes are seen. The abdominal aorta is normal in caliber.
PELVIS CT: The bladder is unremarkable. There is a small quantity of
intraperitoneal high-density free fluid in the pelvis (2:107), likely
hemorrhagic in nature. There are no pathologically enlarged pelvic lymph
nodes.
BONE WINDOW: There is no acute fracture. Mild deformity of the
superoposterior aspect of the L2 vertebral body is likely degenerative in
nature.
IMPRESSION:
1. Loops of mid-to-distal small bowel in the mid abdomen demonstrate mild
distension and slight wall thickening. There is minimal surrounding
mesenteric stranding. These findings are nonspecific in nature, but
concerning for bowel injury.
2. Small quantity of intraperitoneal hemorrhagic material in the dependent
portion of the pelvis.
3. No acute process in the chest.
|
10205544-RR-18
| 10,205,544 | 28,757,511 |
RR
| 18 |
2127-03-12 04:20:00
|
2127-03-12 07:31:00
|
INDICATION: Status post trauma with obvious deformity of the right wrist.
Evaluate for fracture.
COMPARISON: None.
RIGHT WRIST, FOREARM, AND ELBOW, 10 VIEWS TOTAL: There is a transverse
fracture through the distal right radius with dorsal and proximal displacement
of the dominant fracture fragment, including overriding of the fracture
fragments by 2.5 cm. The radius aligns appropriately with the lunate abd
capitate as seen on the lateral view. There is dislocation of the distal
radioulnar joint, with widening of the joint space to 8 mm. There is no
definite right elbow joint effusion. No fracture or dislocation of the right
elbow. Bone mineralization is normal. There is marked soft tissue swelling
about the wrist.
IMPRESSION: Fracture dislocation of the right wrist, fully described above.
|
10205544-RR-19
| 10,205,544 | 28,757,511 |
RR
| 19 |
2127-03-12 04:20:00
|
2127-03-12 07:19:00
|
INDICATION: Status post MVC, assess for fracture or dislocation.
COMPARISON: None.
BILATERAL FEMURS, TIBIAS, FIBULAS, AND ANKLES, 18 VIEWS TOTAL: There is a
dorsal avulsion fracture through one of the left cuneiform/midfoot bones. No
additional acute fracture is identified. There is no dislocation. No knee
joint effusions are seen. Mild soft tissue swelling is seen along the dorsum
of the left mid foot. Unchanged right os acetabulare.
IMPRESSION:
1. Dorsal avulsion fracture of one of the left cuneiform/midfoot bones.
Further evaluation with dedicated left foot radiographs is recommended.
2. No additional fractures are seen in either lower extremity.
|
10205544-RR-20
| 10,205,544 | 28,757,511 |
RR
| 20 |
2127-03-12 07:51:00
|
2127-03-12 15:08:00
|
RIGHT WRIST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior exam from earlier today.
CLINICAL HISTORY: Post-reduction, assess alignment.
FINDINGS: Post-reduction views of the right wrist with AP, lateral, oblique
projections were obtained. Overlying plaster splint is in place, which
somewhat limits the evaluation of fine bony detail. There has been interval
reduction with improvement in alignment at the distal radius. However, there
is persistent dorsal angulation of the radiocarpal joint with impaction of the
proximal and distal fracture fragments. Ulnar styloid fracture is
re-demonstrated.
|
10205544-RR-21
| 10,205,544 | 28,757,511 |
RR
| 21 |
2127-03-12 07:59:00
|
2127-03-12 13:40:00
|
LEFT FOOT RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Pain in the left foot. Assess fracture.
FINDINGS: There are fractures involving the base of the second, third, and
likely fourth metatarsals concerning for Lisfranc fracture dislocation. Also
noted is a fracture lucency, transverse in orientation through the proximal
shaft of the second metatarsal. Associated soft tissue swelling is seen and
may be a mild subluxation of the mid foot as seen on the lateral projection.
CT is advised.
|
10205544-RR-22
| 10,205,544 | 28,757,511 |
RR
| 22 |
2127-03-12 11:11:00
|
2127-03-12 13:19:00
|
STUDY: Right wrist, ___.
CLINICAL HISTORY: Patient with distal radius ORIF.
FINDINGS: Several images of the right wrist in the operating room demonstrate
placement of a volar fracture plate and associated screws fixating a fracture
of the distal radius. There is good anatomic alignment, and there are no
signs for hardware-related complications. The total intraservice fluoroscopic
time was 68.8 seconds. Please refer to the operative note for additional
details.
|
10205925-RR-38
| 10,205,925 | 22,796,722 |
RR
| 38 |
2189-03-08 16:04:00
|
2189-03-08 18:58:00
|
HISTORY: Pain status post fall.
TECHNIQUE: 3 views of the right knee.
COMPARISON: None.
FINDINGS:
No evidence of acute fracture or dislocation is seen. There may be a small
suprapatellar joint effusion. Minimal patellar spurring is seen. There is
chondrocalcinosis. There are extensive vascular calcifications.
IMPRESSION:
No acute fracture or dislocation.
Chondrocalcinosis.
Extensive vascular calcifications.
|
10205925-RR-39
| 10,205,925 | 22,796,722 |
RR
| 39 |
2189-03-08 16:40:00
|
2189-03-08 18:12:00
|
HISTORY: Fall with weakness in the lower extremities with history of spinal
stenosis, evaluate for acute bony injury.
TECHNIQUE: MDCT axial images were acquired from the liver to the pubic
symphysis without the administration of IV or oral contrast. Coronal and
sagittal reformations were provided and reviewed.
DLP: 636.8 mGy/cm.
COMPARISON: CT torso ___.
FINDINGS:
CT abdomen: The imaged lung bases demonstrate bibasilar atelectasis and
scarring. There is no pleural effusion or pneumothorax. The imaged portion
of the heart is large in size. There is no pericardial effusion. Mild
coronary artery calcifications are noted.
Evaluation of the intrapelvic contents is limited by the lack of IV contrast.
Within this limitation the liver, spleen, pancreas and adrenal glands are
unremarkable. The gallbladder is surgically absent and there is persistent
mild intrahepatic and extrahepatic biliary ductal dilation. There is no
hydronephrosis of the kidneys. A 5 mm nonobstructing stone is seen in the
interpolar region of the left kidney. There is no free air or free fluid.
The stomach, large and small bowel are normal. Evaluation of vessel patency
is unremarkable. Hypoattenuation of the blood pool may relate to underlying
anemia. Dense calcifications are seen at the origin of the renal, celiac and
superior mesenteric arteries.
CT pelvis: The bladder is distended. The rectum is markedly capacious and
filled with stool. There is no inguinal lymphadenopathy. There is no free
pelvic fluid. There is mild sigmoid diverticulosis without diverticulitis.
Bones: There are no suspicious osseous lesions. There is no fracture. Soft
tissue densities are seen surrounding the hip joints and are unchanged from
___ but may reflect an underlying inflammatory process. There are severe
degenerative changes throughout the lumbar spine with loss of intervertebral
disc height, endplate sclerosis and osteophytosis. There is extensive facet
arthropathy. Grade 1 anterolisthesis of L5 on S1 is unchanged. The
degenerative changes have resulted in significant spinal stenosis throughout
the lower lumbar spine, however, it appears unchanged from the prior CT.
Assessment for nerve root involvement is limited. There is a slight
levoscoliosis.
IMPRESSION:
1. No acute intra-abdominal process.
2. No acute fracture.
3. Severe degenerative changes of lower lumbar spine with spinal canal
stenosis, grossly similar to ___. Assessment of nerve root involvement is
limited and would be better assessed by MRI.
|
10205925-RR-40
| 10,205,925 | 22,796,722 |
RR
| 40 |
2189-03-08 19:37:00
|
2189-03-08 21:47:00
|
HISTORY: ___ male, status post fall. Assess for cord compression.
TECHNIQUE: Noncontrast multiplanar multisequence T1 and T2 weighted images
were acquired through the lumbar spine. Dedicated sagittal STIR images were
also obtained per trauma protocol.
COMPARISON: CT torso on ___.
FINDINGS: There are postsurgical changes in the posterior paraspinous soft
tissues. The conus medullaris terminates at T12-L1. There is clumping of
nerve roots, could represent either post-surgical changes and/or sequela of
prior arachnoiditis.
There are moderate-to-severe multilevel degenerative changes.
There is significant loss of the disc spaces at L2-3 to L4-5. In the prior CT
torso in ___, there was vacuum gas at these levels.
At T11-12, there is a large osteophyte or a calcified disc protrusion. In
combination with ligamentum flavum thickening, there is significant spinal
canal narrowing, resulting in cord thinning and signal abnormality, compatible
with chronic myelomalacia. The osteophyte and the bony canal narrowing were
already evident in ___. There is severe bilateral neural foraminal
narrowing.
At T12-L1, there is no disc herniation. There is ligamentum flavum thickening
with facet arthropathy, resulting in mild spinal canal narrowing. There is
moderate-to-severe bilateral neural foraminal narrowing.
At L1-L2, there is probable L1-2 left hemilaminectomy. There is a
left-eccentric disc protrusion, resulting in left lateral recess narrowing.
There is severe bilateral neural foraminal narrowing.
At L2-3, there is a prominent disc protrusion. In combination with facet
arthropathy and ligamentum flavum thickening, there is severe spinal canal
stenosis. There is bilateral several neural foraminal narrowing.
At L3-4, there is probable L3-4 right hemilaminectomy. There is a prominent
disc protrusion. In combination with facet arthropathy and ligamentum flavum
thickening, there is moderate spinal canal stenosis. There is bilateral
moderate-to-several neural foraminal narrowing.
At L4-5, there is grade 1 anterolisthesis of L4 on L5. There is a prominent
disc protrusion. In combination with facet arthropathy and ligamentum flavum
thickening, there is severe spinal canal stenosis. There is bilateral
moderate-to-several neural foraminal narrowing.
At L5-1, there is a prominent disc protrusion. In combination with facet
arthropathy and ligamentum flavum thickening, there is moderate-to-severe
spinal canal stenosis. There is bilateral moderate neural foraminal
narrowing.
There is no abnormal STIR hyperintense to suggest acute fracture.
IMPRESSION:
1. Severe multilevel degenerative changes, already evident in ___, with
multilevel severe spinal canal stenosis and severe neural foraminal narrowing,
as described above.
2. Appearance of chronic myelomalacia at T11-T12.
3. Clumping of the nerve roots, could represent post-surgical changes or
sequela of prior arachnoiditis.
4. No evidence of acute fracture or malalignment.
|
10205925-RR-41
| 10,205,925 | 22,796,722 |
RR
| 41 |
2189-03-09 00:56:00
|
2189-03-09 02:29:00
|
HISTORY: ___ male, with lower extremity weakness. Upgoing Babinski
sign. Assess for cord compression.
TECHNIQUE: Noncontrast multiplanar multisequence T1 and T2 weighted images
were acquired through the cervical, thoracic and lumbar spine.
COMPARISON: Multiple prior studies with the latest MR lumbar spine on ___ and MR cervical spine on ___.
FINDINGS: The image quality is mildly degraded by motion. Within the
confines of the study:
CERVICAL SPINE: There is overall no significant interval change alignment in
the cervical spine. There are grade 1 the anterolisthesis of C5 on C6 as well
as C7 on T1. There is no loss of vertebral height. There is diffuse disc
desiccation.
At the craniocervical junction, there is a large pannus, measuring 1.5 cm in
thickness and resulting in moderate narrowing of the foramen magnum, similar
to the ___ study.
At C2-C3, there is no disc herniation, spinal canal narrowing or neural
foraminal narrowing.
At C3-C4, there is a prominent disc bulge. In combination with significant
ligamentum flavum thickening, there is moderate-to-severe spinal canal
stenosis. However, there is no significant cord deformity or cord signal
abnormality. There is moderate left neural foraminal narrowing but no
significant right neural foraminal narrowing.
At C4-C5, there is no disc herniation, spinal canal stenosis, or neural
foraminal narrowing.
At C5-C6, there is uncovering of the disc secondary to the grade 1
anterolisthesis. There is mild spinal canal narrowing, improved from prior.
There is subtle cord signal abnormality with cord thinning, reflecting minimal
chronic myelomalacia. There is no significant neural foraminal narrowing.
At C6-C7, there is a diffuse disc bulge. In combination with ligamentum
flavum thickening, there is mild spinal canal stenosis. There is
mild-to-moderate neural foraminal narrowing.
At C7-T1, there is uncovering of the disc from grade 1 anterolisthesis. In
combination with ligamentum flavum thickening, there is moderate spinal canal
narrowing. There is also mild-to-moderate bilateral neural foraminal
narrowing.
THORACIC SPINE: The vertebral body height and disc height are preserved.
There is normal thoracic kyphosis.
A T1- and T2-hyperintense focus in the T4 vertebral body is compatible with an
intraosseous hemangioma.
At T6-T7, there is a prominent disc protrusion. In combination with moderate
focal ligamentum flavum thickening, there is moderate-to-severe spinal canal
narrowing.. When correlating with the CT Torso in ___, the findings
represent a partially calcified ligamentum flavum hypertrophy, and largely
unchanged .
At T7-T8 and T8-T9 and T9-T10, there are similar, but smaller focal ligamentum
flavum thickening.
At T11-T12, there is moderate loss of disc space and a large posterior disc
protrusion. In combination with significant focal ligamentum flavum
thickening, there is severe spinal canal stenosis. Cord thinning with T2
hyperintense cord signal represents chronic myelomalacia.
LUMBAR SPINE: Detailed description of multilevel severe lumbar spinal canal
stenosis and neural foraminal narrowing was already given in the study 5 hours
earlier. There are no significant interval changes.
IMPRESSION:
1. No evidence of acute cervical and thoracic abnormality.
2. Multilevel degenerative changes. Large retro-odontoid pannus, unchanged.
T6-T7 and T11-T12 severe spinal canal stenosis, secondary to combination of
disc herniation and ligamentum flavum thickening. Evidence of chronic
myelomalacia T11-12.
3. Please refer to the report of MR lumbar spine study performed 5 hour
earlier for detailed description of severe multilevel lumbar spondylosis.
|
10205925-RR-43
| 10,205,925 | 24,483,928 |
RR
| 43 |
2189-03-22 02:59:00
|
2189-03-23 18:14:00
|
MR EXAMINATION "CODE CORD COMPRESSION," WITHOUT AND WITH CONTRAST, ___
HISTORY: ___ male with severe spinal stenosis, acute back pain and
bilateral lower extremity weakness.
TECHNIQUE: Routine ___ enhanced "Code Cord" study, including large
field-of-view sagittal T1-weighted SE and T2-weighted SPACE and STIR FSE
sequences through the thoracolumbar spine, pre-, with reformatted axial images
from the T2-weighted acquisition, as well as sagittal and axial T1-weighted SE
sequences through the thoracolumbar spine, post-contrast administration, all
employing standard FOV.
N.B. According to the MR ___ note, "patient is in a great deal of
pain. Toward the end of scan (post-gad), can't move (removed flex coil from
neck)... best possible images at this time, with some repeats."
FINDINGS: The study is compared with the very recent non-enhanced MR
examinations of the lumbar spine dated ___, and cervicothoracic spine, dated
___. There is no significant change since these recent examinations.
Allowing for the limitations, above, as well as the moderate thoracolumbar
S-scoliosis with rotatory component, levoconvex in the lumbar spine, there is
no new vertebral compression or abnormality of alignment. There is no
evidence of spinal epidural or subdural hematoma. There is persistent focal
T2-hyperintensity associated with cord thinning at the T11-12 level, related
to severe multifactorial spinal canal narrowing and cord compression, as
before. There is no new abnormality of cord signal through the conus
medullaris. Following contrast administration, there is no new pathologic
vertebral, paravertebral or epidural soft tissue, leptomeningeal,
intramedullary or radicular focus of enhancement.
As thoroughly documented in the reports of the recent examinations, there is
severe multilevel, multifactorial degenerative disease which, in combination
with marked thickening and ossification of the ligamenta flava and
superimposed on congenitally abnormal spinal canal geometry, results in severe
canal stenosis with cord remodeling. This is most marked at:
The T6-T7 level where a prominent disc protrusion moderately severely narrows
the ventral canal, indenting the spinal cord.
At T11-12, as above, a large disc-endplate spondylotic complex, with marked
ligamentum flavum thickening, severely narrows the spinal canal, compressing
the cord with resultant thinning and signal abnormality, representing
established myelomalacia.
At L1-2, a disc-endplate spondylotic complex, eccentric to the left, severely
narrows that subarticular zone and both neural foramina.
At L2-3, a prominent disc protrusion moderately narrows the spinal canal.
Again demonstrated is the grade 1 degenerative anterolisthesis of L4 on L5. At
both the L4-5 and L5-S1 level, disc-endplate spondylotic complexes,
superimposed on the above factors severely narrow the spinal canal with marked
central crowding of the traversing nerve roots and loss of the normal
CSF-signal within the thecal sac. There is also severe neural foraminal
narrowing at these levels, as before.
IMPRESSION: No acute abnormality and no change since the recent studies of
___ and ___, highlighted by:
1. No evidence of thoracolumbar spinal epidural or subdural hematoma.
2. Multilevel spinal cord compression with stable cord thinning and signal
abnormality at the T11-12 level, representing established myelomalacia.
3. Multilevel spinal canal and neural foraminal stenosis with spinal cord
remodeling and exiting neural impingement, as documented previously. There is
very severe lumbar spinal canal stenosis, particularly at the L4-5 level.
4. No pathologic focus of enhancement.
COMMENT: A detailed preliminary impression to this effect was posted to
RIS-web, by Dr. ___ at 5:26 a.m., and I both reviewed the study and updated
the preliminary report at 7:59 p.m., on ___.
|
10206108-RR-11
| 10,206,108 | 29,616,521 |
RR
| 11 |
2170-08-27 01:27:00
|
2170-08-27 04:06:00
|
INDICATION: ___ man with stabbing to the face. Evaluate for acute
process.
COMPARISON: No relevant comparisons available.
ONE VIEW OF THE CHEST:
The lungs are well expanded and clear. The cardiomediastinal silhouette,
hilar contours, and pleural surfaces are normal. No pleural effusion or
pneumothorax is present.
IMPRESSION:
No acute intrathoracic process.
|
10206108-RR-12
| 10,206,108 | 29,616,521 |
RR
| 12 |
2170-08-27 01:41:00
|
2170-08-27 04:53:00
|
INDICATION: ___ man with status post stab wound who was intoxicated.
Question fracture.
COMPARISON: No relevant comparisons available.
TECHNIQUE: MDCT images were acquired through the cervical spine, without
contrast. Standard soft tissue algorithms, bone algorithms and multiplanar
reformations were obtained and reviewed.
FINDINGS:
There is no evidence of fracture or malalignment. The prevertebral soft
tissues are normal. The thyroid gland is unremarkable. The partially imaged
lung apices are clear. High density fluid in the right maxillary sinus is
partially imaged.
IMPRESSION:
1. No evidence of fracture or malalignment.
2. High-density fluid is partially imaged in the right maxillary sinus.
|
10206108-RR-13
| 10,206,108 | 29,616,521 |
RR
| 13 |
2170-08-27 01:42:00
|
2170-08-27 04:10:00
|
INDICATION: ___ man with status post stab wound, intoxicated,
question bleed.
COMPARISON: No relevant comparisons available.
TECHNIQUE: MDCT images were acquired through the head without contrast.
Standard soft tissue algorithms, bone algorithm and multiplanar reformations
were obtained and reviewed.
FINDINGS:
There is a depressed right frontal calvarial fracture which communicates with
the subcutaneous soft tissues. This is associated with a possible small
subdural hematoma. No other areas of hemorrhage, infarction, shift of midline
structures or mass effect is present. The ventricles and sulci are normal in
size and configuration. The visible paranasal sinuses and mastoid air cells
show right maxillary sinus fluid.
Also noted is an acute fracture of the right zygomaticotemporal arch and the
lateral wall of the right maxillary sinus.
IMPRESSION:
1. Depressed fracture of the right frontal bone.
2. Right zygomaticotemporal arch and right lateral wall of the maxillary
sinus fracture with blood within the right maxillary sinus.
|
10206108-RR-14
| 10,206,108 | 29,616,521 |
RR
| 14 |
2170-08-27 01:56:00
|
2170-08-27 04:10:00
|
INDICATION: ___ man with trauma to the knee. Evaluate for fracture.
COMPARISON: No relevant comparisons available.
THREE VIEWS OF THE RIGHT KNEE:
A linear ossific density is noted next to the medial femoral condyle with
associated overlying soft tissue swelling. This may be associated with a
small effusion. No significant joint space abnormalities are noted.
IMPRESSION:
Possible fracture of the medial femoral condyle.
|
10206108-RR-16
| 10,206,108 | 29,616,521 |
RR
| 16 |
2170-08-27 17:45:00
|
2170-08-27 20:26:00
|
INDICATION: Stabbing blunt trauma to the head, please evaluate for facial
bone sinus fracture.
COMPARISON: Comparison is made to head CT performed ___ at 1:40
a.m.
TECHNIQUE: Non-contrast axial images are obtained through the face. Coronal
and sagittal reformations are provided.
FINDINGS: The known right posterior calvarial depressed fracture is excluded
from images. There is a comminuted minimally displaced fracture of the right
zygomaticotemporal arch extending into the lateral wall of the right maxillary
sinus (2:66, 2:69). Associated air-fluid levels are identified within the
right maxillary sinus. No other acute fractures are identified.
The remaining paranasal sinuses are normally aerated. The right ostiomeatal
unit is fluid filled whereas the left is patent. The cribriform plates are
intact. The clinoid processes are not pneumatized. There is no nasal septal
defect. The lamina papyracea are intact. Nasal septum is midline. The
sphenoid septum is not midline and inserts upon the left carotid canal.
Patient is status post craniotomy.
IMPRESSION: Re-demonstration of known comminuted right zygomaticotemporal
arch bone with extension into the lateral wall of the maxilla. Overlying soft
tissue swelling. No other fractures identified.
|
10206108-RR-17
| 10,206,108 | 29,616,521 |
RR
| 17 |
2170-08-27 17:45:00
|
2170-08-27 20:54:00
|
INDICATION: Depressed skull fracture status post right craniotomy, elevation
of fragments, post-op interval change.
COMPARISON: Comparison is made to head CT performed ___.
TECHNIQUE: Non-contrast axial images were obtained through the brain.
Coronal and sagittal reformations were provided.
FINDINGS: Patient is status post craniotomy with elevation of fragments
related to a previously noted right anterior depressed skull fracture. The
previously noted small associated subdural hematoma is no longer evident. No
extra-axial hemorrhage identified. There is no intraparenchymal hemorrhage
noted. No significant edema identified. . Gray-white matter differentiation
is maintained. No shift of midline structures apparent. Small right frontal
residual pneumocephalus, othrewise the ventricles and sulci are normal. Right
frontoparietal subgaleal hematoma slightly increased in size compared to prior
study. The known right zygomatic arch fracture is not well seen on current
study.
IMPRESSION: Status post right craniotomy with elevation of fracture
fragments. A previously noted subdural hematoma is no longer evident.
Slightly increased right frontoparietal subgaleal hematoma.
|
10206418-RR-20
| 10,206,418 | 27,759,864 |
RR
| 20 |
2195-06-12 15:57:00
|
2195-06-12 17:02:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ woman with with left lower extremity edema; evaluate
for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
LEFT Lower extremity:
The lumen of the left common femoral vein is distended, contains echogenic
debris, is not completely compressible, and demonstrates some color and
spectral Doppler flow, compatible with nonocclusive thrombus. The left
greater saphenous vein is also noncompressible.
The left superficial femoral vein and popliteal vein are also distended with
echogenic debris but are not compressible and do not demonstrate color or
spectral Doppler flow, compatible with complete occlusive thrombus.
The left posterior tibial veins and peroneal veins are distended with
echogenic thrombus and do not compress, compatible with likely occlusive
thrombus. Color flow was not assessed in the left calf veins.
RIGHT Lower extremity:
There is normal compressibility, flow, and augmentation of the right common
femoral vein. There is normal compressibility and flow of the right
superficial femoral vein.
The right popliteal vein essentially completely compresses; however, on color
images there may be a portion of the lumen that does not show wall-to-wall
flow, suggesting a focal area of slow flow or eccentric peripheral thrombus.
The right posterior tibial vein is distended with echogenic thrombus, and does
not completely compress, and shows minimal color flow, compatible with
nonocclusive thrombus.
The right peroneal veins are distended with echogenic thrombus, do not
compress, and do not show color flow, compatible with complete occlusive
thrombus.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Soft tissue edema is moderate at the level of the knee and the calf of the
left leg.
IMPRESSION:
1. Bilateral lower extremity acute deep venous thrombosis:
(i) Non-occlusive thrombus of the left common femoral vein and complete
occlusive thrombus of the left superficial femoral, popliteal, and calf veins.
(ii) Non-occlusive thrombus of the right posterior tibial vein, and complete
occlusive thrombus of the right peroneal veins.
2. Moderate soft tissue edema in the left lower extremity.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:53 ___, 1 minutes after
discovery of the findings.
|
10206418-RR-21
| 10,206,418 | 27,759,864 |
RR
| 21 |
2195-06-12 17:47:00
|
2195-06-12 20:20:00
|
EXAMINATION: CTA Chest with CT abdomen and pelvis
INDICATION: ___ woman with RUQ abdominal pain, ___ edema, and SOB s/p
recent ERCP and CBD stenting. Please do CTA chest to eval for PE. Please
continue scan into abdomen to eval for complication of recent biliary stent
placement such as abscess or leak.
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) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 0.8 mGy (Body) DLP = 0.4
mGy-cm.
2) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 4.1 mGy (Body) DLP = 2.0
mGy-cm.
3) Spiral Acquisition 3.9 s, 30.6 cm; CTDIvol = 5.6 mGy (Body) DLP = 172.7
mGy-cm.
4) Spiral Acquisition 4.2 s, 45.5 cm; CTDIvol = 7.4 mGy (Body) DLP = 335.9
mGy-cm.
Total DLP (Body) = 511 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___ from an outside facility
and uploaded onto PACS.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Extensive bilateral acute pulmonary emboli are
demonstrated. Filling defects are seen within the right upper lobe lobar and
segmental arteries as well as right middle and lower lobar, segmental, and
subsegmental arteries. Filling defect is also seen in the left upper lobe
lobar, segmental and probably subsegmental arteries as well as the left lower
lobar, segmental, and subsegmental arteries. The heart is mildly enlarged,
predominantly the right heart with likely right heart strain including
straightening of the interventricular septum as well as mild reflux of
intravenous contrast into the intrahepatic IVC and hepatic veins. No
pericardial effusion. The main, left, and right pulmonary arteries are
however normal in caliber.
The thoracic aorta is normal in caliber without evidence of dissection.
Atherosclerotic calcifications within the thoracic aorta and the origins of
its 3 major branches are mild-to-moderate. Coronary artery calcifications are
moderate. No significant cardiac valve calcifications.
AXILLA, HILA, AND MEDIASTINUM: Scattered mediastinal lymph nodes are
measurable but not enlarged by CT size criteria. No axillary, mediastinal, or
hilar lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Detailed evaluation of the pulmonary parenchyma is limited by
respiratory and cardiac motion artifact. Wedge- shaped peripheral opacity in
the right middle lobe is concerning for pulmonary infarct (series 3, image
128, 131). No obvious pulmonary nodule within the limitation of respiratory
and cardiac motion artifact. There is bibasilar atelectasis as well as left
lower lobe segmental atelectasis. The airways are otherwise patent to at
least the segmental level bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: Parenchymal hypodensities with surrounding rim enhancement
persist but appear increased in size since ___, favoring abscesses given
the short time interval between exams, rather than rapidly growing metastases.
At least 2 lesions are in the right hepatic lobe segment 5 and measure,
respectively, 2.2 cm (previously 1.7 cm; series 2b, image 123) and 1.8 cm
(previously 1.4 cm; series 2b, image 125) in maximum dimension. A smaller
peripheral lesion in the right hepatic lobe now measures 9 mm, previously 6 mm
(series 2b, image 132). Diffuse intrahepatic biliary ductal dilation persists
but has improved since the prior exam, now with pneumobilia, most prominent in
the anti-dependent aspects of the liver, compatible with interval placement of
a biliary stent. The newly placed stent is seen in the right intrahepatic
ducts draining through the CBD into the duodenum. There is gallbladder wall
edema, perhaps related to third spacing. There is also gallbladder fundal
adenomyomatosis (series 2b, image 133). No ascites.
PANCREAS: The pancreas has normal attenuation throughout. The main pancreatic
duct is now mildly dilated, measuring up to 5 mm, more prominent from the
prior exam (series 2b, image 130). This may be related to the presence of the
CBD stent. No peripancreatic stranding or fluid collection.
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 in size with normal nephrograms. Mild
thinning of the right lower pole cortex without surrounding fat stranding is
similar the prior exam and may suggest sequelae of prior insult and scarring
(series 606b, image 36). Bilateral renal cortical hypodensities are too small
to accurately characterize on CT but statistically most likely cysts. There
is an extrarenal right pelvis. No perinephric abnormality. Prominence of the
left renal calices is mild without frank hydronephrosis.
GASTROINTESTINAL: Ingested oral contrast reaches the rectum. A hiatal hernia
is small. Small bowel loops demonstrate normal caliber, wall thickness, and
enhancement throughout. There is colonic diverticulosis without evidence of
diverticulitis. The rectum is within normal limits. No free intraperitoneal
fluid or free air. No bowel obstruction.
PELVIS: The urinary bladder and distal ureters are unremarkable. No free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or
inguinal lymphadenopathy.
VASCULAR: No abdominal aortic aneurysm. Extensive atherosclerotic disease is
noted. Moderate calcifications are noted at the bilateral origins of the
renal arteries. Left common femoral and superficial femoral deep venous
thromboses are detailed in the ultrasound from the same day. Additionally,
there appears to be minimal nonocclusive thrombus in the right common femoral
vein (2b:167)
BONES AND SOFT TISSUES: No evidence of worrisome osseous lesions or acute
fracture. Extensive levoconvex scoliosis of the lumbar spine is noted.
Extensive multilevel degenerative changes of the lumbar spine in are again
seen. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Extensive bilateral acute pulmonary emboli involving all of the lobar
arteries as well as multiple subsegmental and segmental branches with evidence
of right heart strain and likely a right middle lobe pulmonary infarct.
2. Multiple hepatic hypodensities, particularly in right hepatic lobe segment
5 with apparent rim enhancement that are slightly larger since ___.
Given the short interval growth, abscess favored rather than a rapidly growing
metastasis.
3. Persistent but improved intrahepatic ductal dilatation after the placement
of a biliary stent with expected pneumobilia.
4. Mild dilation of the main pancreatic duct up to 5 mm with tapering more
distally, new or more conspicuous since the prior exam, perhaps related to
interval biliary stent placement.
5. Diverticulosis.
6. Bilateral renal cortical lesions are too small to characterize on CT,
statistically most likely cysts.
7. Mild left renal caliectasis without frank hydronephrosis.
8. Gallbladder fundal adenomyomatosis.
9. Known deep venous thrombosis in the lower extremities, incompletely imaged
and detailed on the ultrasound from the same day.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 7:00 ___, 1 minute after
discovery of the findings.
|
10206418-RR-22
| 10,206,418 | 27,759,864 |
RR
| 22 |
2195-06-18 13:13:00
|
2195-06-18 14:45:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with hepatic abscess; ___ asked for liver US for
further drainage assessment // ?hepatic abscess and ability to drain by ___
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LIVER: There are two vaguely identified hypoechoic lesions in segment 4B/5
measuring 4.8 x 4.0 x 3.0 cm and 2.0 x 1.4 cm. The lesions are not anechoic
and do not demonstrate posterior acoustic enhancement. The contour of the
liver is smooth. Nodular lesions along the liver surface in segments 6 and 5
inferior to the dominant lesion seen on CT, could not be specifically
identified with ultrasound. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is diffuse intrahepatic biliary dilation with pneumobilia
present.
There is a small right pleural effusion.
IMPRESSION:
Two vague hypoechoic hepatic lesions in segment 4B/5 which likely corresponds
to abnormalities identified on recent abdominal CT. By imaging, these are
more concerning for solid hepatic lesions such as malignancy or metastatic
disease, however infection is still a possibility particularly given history
of cholangitis. Biopsy or attempted aspiration would be technically difficult
given imaging limitations and patient immobility. Risk of procedure with
intrahepatic biliary dilatation should also be considered.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:35 ___, 20 minutes after
discovery of the findings.
|
10206502-RR-48
| 10,206,502 | 24,665,446 |
RR
| 48 |
2128-11-08 17:07:00
|
2128-11-08 19:58:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with difficulty swallowing, chest pain.
COMPARISON: ___ and chest CT from ___.
FINDINGS:
AP upright and lateral views of the chest provided. Abandoned pacer leads
again seen projecting over the right chest wall extending into the heart.
There is a left chest wall pacemaker with leads extending into the coronary
sinus, right atrium and right ventricle. Fibrotic changes are again noted
most prominent in the lower lungs, left greater than right. No convincing
signs of a superimposed pneumonia. Calcified pleural plaque projects over the
right hemi thorax as seen on prior CT chest. No pneumothorax.
Cardiomediastinal silhouette is stable. Bony structures are intact.
IMPRESSION:
Pulmonary fibrosis, similar in overall pattern to prior exam. Calcified
pleural plaque. Pacemaker in place.
|
10206502-RR-50
| 10,206,502 | 24,665,446 |
RR
| 50 |
2128-11-09 01:31:00
|
2128-11-09 11:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxic respiratory failure // interval
change
COMPARISON: ___ AT 17 11
FINDINGS:
COMPARED TO THE MOST RECENT PRIOR FILM, I DOUBT SIGNIFICANT INTERVAL CHANGE.
|
10206502-RR-51
| 10,206,502 | 24,665,446 |
RR
| 51 |
2128-11-10 04:58:00
|
2128-11-10 10:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHF, food impaction, oliguria and recent EGD
with cough, SOB and worsening oliguria // please assess for pulm edema new
PNA.
COMPARISON: None.
FINDINGS:
Compared to ___ at 01:27 and allowing for technical differences,
the medial left hemidiaphragm is slightly less distinct. Otherwise, I doubt
significant interval change. An AICD type device and leads are unchanged.
Abandoned leads also noted.
Cardiomediastinal silhouette with sternotomy wires, is unchanged. Background
COPD with hyperinflation again noted. Patchy increased interstitial markings
are present in both lungs. These could represent a combination of chronic
fibrotic changes and/or superimposed edema. Again seen is blunting of both
costophrenic angles. In this setting, superimposed infectious infiltrates
would be difficult to exclude.
IMPRESSION:
Extensive interstitial markings again seen in both lungs, most pronounced at
the bases. The medial left hemidiaphragm is slightly less distinct than on
the prior film, raising the question of more confluent opacification in this
area. Otherwise, I doubt significant interval change
|
10206502-RR-53
| 10,206,502 | 24,665,446 |
RR
| 53 |
2128-11-12 01:33:00
|
2128-11-12 08:36:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHF, crackles on exam and new O2 req after
2L IVF // evaluate for pulm edema
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the extent of a right pleural effusion
has minimally increased. The lung volumes continue to be low and reticular
opacities are seen at both lung bases. Mild fluid overload is present.
Unchanged appearance of the cardiac silhouette.
|
10206590-RR-10
| 10,206,590 | 26,927,205 |
RR
| 10 |
2155-05-03 10:59:00
|
2155-05-03 12:44:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ female with membranous nephropathy, now here
unresponsive and s/p 1x GTC. Eval for focal mass/infection as source of
seizures, eval for any signs of venous thrombosis given possible coagulopathy
from nephropathy. Please include MP-RAGE sequence.
TECHNIQUE: Sagittal T1, axial T1, and axial DTI images were obtained. After
the administration of Gadavist intravenous contrast, axial GRE, axial FLAIR,
coronal T2, coronal MPRAGE, and axial T1 images were obtained. Additional
sagittal and axial reformatted images of the MPRAGE images were then produced.
The examination was performed using a 1.5T MRI scanner.
COMPARISON: MRI head without contrast dated ___.
CT head without contrast dated ___.
FINDINGS:
Moderately motion degraded exam.
There is no evidence of restricted diffusion to suggest acute infarction.
There are chronic infarcts in the left putamen and right insular region. No
evidence of acute intracranial hemorrhage. There is mineralization of the
bilateral basal ganglia. Moderate prominence of the ventricles and sulci is
suggestive of involutional changes. There is no mass effect or midline shift.
Bilateral hippocampal formations are grossly preserved in signal and
configuration. There is no disproportionate medial temporal atrophy. There is
no focal lobar encephalomalacia.
There is no abnormal enhancement after contrast administration.
Patchy to confluent areas of T2 and FLAIR hyperintense signal abnormalities
in the periventricular and subcortical white matter are nonspecific, but
likely reflect chronic small vessel ischemic changes.
Moderate rightward deviation of the nasal septum. Mild mucosal thickening of
the ethmoid sinuses. Postsurgical changes of bilateral lens replacement.
IMPRESSION:
1. No evidence of acute infarction or intracranial hemorrhage.
2. Moderate parenchymal volume loss and severe chronic small vessel ischemic
disease.
3. No definite evidence of mesial temporal sclerosis. No gray matter
heterotopia, focal cortical dysplasia or focal lobar encephalomalacia.
|
10206590-RR-11
| 10,206,590 | 26,927,205 |
RR
| 11 |
2155-05-07 16:04:00
|
2155-05-07 17:02:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with dysphagia// s/p dobhoff pacement
IMPRESSION:
In comparison with the study of ___, the nasogastric tube is been
removed and replaced with a Dobhoff tube that extends to the upper stomach.
It could be pushed forward another 5-8 cm for more optimal positioning.
The endotracheal tube is no longer seen. Little overall change in the
appearance of the heart and lungs.
|
10206590-RR-12
| 10,206,590 | 26,927,205 |
RR
| 12 |
2155-05-08 11:55:00
|
2155-05-08 14:16:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// R SL Power PICC 41cm ___
___ Contact name: ___: ___
TECHNIQUE: Chest frontal radiograph
COMPARISON: Multiple prior chest radiographs most recently from ___
FINDINGS:
There has been interval placement of a right upper extremity PICC line with
tip projecting near the cavoatrial junction. A right internal jugular central
venous catheter tip is in the mid SVC. A Dobhoff tube is again seen coursing
below the diaphragm with tip outside the field of view. The heart appears
mildly enlarged compared to prior and there is worsening pulmonary vascular
congestion. Opacities at the lung bases are stable on the right and
intervally worsened on the left, likely representing combination of moderate
to large pleural effusion and compressive atelectasis.
IMPRESSION:
1. Right upper extremity PICC with the tip projecting near the cavoatrial
junction. Right internal jugular central venous catheter tip is in the mid
SVC.
2. Interval enlargement of the heart with worsening pulmonary vascular
congestion.
3. Worsening pleural effusion and atelectasis at the left lung base.
|
10206590-RR-13
| 10,206,590 | 26,927,205 |
RR
| 13 |
2155-05-09 09:03:00
|
2155-05-09 11:26:00
|
EXAMINATION: Video swallow study
INDICATION: ___ year old woman with dysphagia// ?aspiration
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 4 minutes 40 seconds
COMPARISON: None
FINDINGS:
There is penetration of thin liquids that is not clear. Penetration of nectar
thick liquids with large sequential straw sips. Moderate oral residue seen
with ground consistencies that clear with additional swallows. Mild
pharyngeal residue is seen with liquids that clear with cued swallow. There
is delayed initiation of swallow.
IMPRESSION:
There is penetration of thin and nectar thick liquids. Moderate oral residue
with ground consistencies. Delayed initiation of swallow.
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
10206590-RR-2
| 10,206,590 | 26,927,205 |
RR
| 2 |
2155-04-27 16:43:00
|
2155-04-27 16:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with intubation, transfer; AMS// eval ETT tube
position; eval bleed
TECHNIQUE: Supine AP view of the chest
COMPARISON: None. Patient is currently listed as EU critical.
FINDINGS:
Low lying endotracheal tube terminates approximately 6 mm from the carina and
approaches the orifice of the right mainstem bronchus. Enteric tube courses
into the stomach with tip off of the inferior borders of the film. Heart size
is normal. The mediastinal and hilar contours are unremarkable. The
pulmonary vasculature is normal. Hazy opacification in the lung bases may
reflect a combination of atelectasis and layering small bilateral pleural
effusions. No large pneumothorax identified on this supine exam. Scarring is
seen within the lung apices. There are no acute osseous abnormalities.
IMPRESSION:
1. Low lying endotracheal tube. Recommend interval withdrawal by
approximately 2.5 cm for optimal positioning.
2. Enteric tube in standard position.
3. Hazy bibasilar opacities may reflect a combination of small layering
bilateral pleural effusions and bibasilar atelectasis. Aspiration or
infection is not excluded.
|
10206590-RR-3
| 10,206,590 | 26,927,205 |
RR
| 3 |
2155-04-27 18:12:00
|
2155-04-27 18:34:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with intubation, transfer; AMS// eval ETT tube
position; eval bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Reference head CT from ___ at 13:11.
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass. Extensive periventricular and subcortical white matter hypodensity
is nonspecific, but likely related to sequelae of chronic small vessel
ischemic disease. Bilateral insular hypodensities likely reflect remote
infarcts. There is prominence of the ventricles and sulci suggestive of
involutional changes.
There is no evidence of fracture. There is nonspecific thinning of both
parietal bones. Mild anterior ethmoid air cell mucosal thickening.
Aerosolized secretions are seen in the sphenoid sinuses. Mastoid air cells
and middle ear cavities are clear. The visualized portion of the orbits are
unremarkable with the exception of bilateral lens implants. Moderate
atherosclerotic calcifications of the cavernous carotid arteries.
IMPRESSION:
No acute intracranial abnormality.
|
10206590-RR-4
| 10,206,590 | 26,927,205 |
RR
| 4 |
2155-04-27 22:25:00
|
2155-04-27 22:55:00
|
EXAMINATION: CR - CHEST PORTABLE LINE TUBE PLACEMENT 2 EXAMS
INDICATION: ___ year old woman with pneumonia and respiratory failure, now
intubated.// ET tube placement
TECHNIQUE: Two sequential AP radiographs of the chest.
COMPARISON: Chest radiographs ___ at 16:41.
IMPRESSION:
The endotracheal tube now terminates 2.2 cm above the carina. An enteric tube
crosses the diaphragm and terminates outside of the field of view. No other
significant interval change.
|
10206590-RR-5
| 10,206,590 | 26,927,205 |
RR
| 5 |
2155-04-29 01:32:00
|
2155-04-29 11:10:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ is an ___ woman with a past medical history
significant for CKD, membranous nephropathy, HTN, HLD, chronic pleural
effusions, depression, and sciatica who presented to ___ after being found
unresponsive and hypoxic, subsequently transferred to ___ after she was
witnessed to have generalized tonic clonic activity c/f seizure.// ? Lesion
that could be seizure focus
TECHNIQUE: Sagittal T1, axial T1, GRE, FLAIR, T2 and DTI images were
obtained. Coronal T2 were obtained. All images were reviewed in the
production of this report. The examination was performed using a 1.5T MRI
scanner.
COMPARISON: CT head without contrast ___.
FINDINGS:
Evaluation is suboptimal due to motion artifact. Within this confine:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are prominent, consistent with global
cerebral volume loss. An old lacunar infarct is seen in the left putamen.
Confluent periventricular T2 hyperintensities are most consistent with chronic
microvascular angiopathy.
Additional patchy T2/FLAIR hyperintensities are seen involving the
bihemispheric cortices. No associated diffusion abnormalities are seen.
These may be related to the recent seizure activity.
Bilateral hippocampal formations and mammillary bodies are preserved in signal
and configuration. There is no disproportionate medial temporal atrophy. There
is no focal lobar encephalomalacia. There are no focal cortical dysplasias or
gray matter heterotopia noted.
The paranasal sinuses, mastoid air cells and middle ear cavities are clear.
The patient is status post bilateral lens replacement.
IMPRESSION:
1. No evidence of mass, hemorrhage or recent infarction.
2. Patchy abnormal signal within the bihemispheric cortices without associated
diffusion abnormalities may be related to the recent seizure activity.
3. Chronic microvascular angiopathy changes.
|
10206590-RR-6
| 10,206,590 | 26,927,205 |
RR
| 6 |
2155-04-28 16:34:00
|
2155-04-28 18:35:00
|
EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old woman with new CVL// CVL position Contact name:
___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: None.
IMPRESSION:
The endotracheal tube terminates 3.7 cm above the carina. A right internal
jugular central venous catheter terminates in lower superior vena cava. The
enteric tube terminates in the body of the stomach.
There are small bilateral pleural effusions (right greater than left). There
is no focal consolidation, pneumothorax or pulmonary edema. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities are identified.
|
10206590-RR-7
| 10,206,590 | 26,927,205 |
RR
| 7 |
2155-04-29 00:20:00
|
2155-04-29 09:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with AMS and seizure. Intubated s/p OG tube
placement.// OG Tube placement OG Tube placement
IMPRESSION:
Comparison to ___. The patient has received a new feeding tube.
The course of the tube is unremarkable, the tip projects over the central
parts of the stomach. No complications, notably no pneumothorax. The
remaining monitoring and support devices are in stable correct position. No
change in appearance of the heart and the lung parenchyma.
|
10206590-RR-8
| 10,206,590 | 26,927,205 |
RR
| 8 |
2155-04-30 13:44:00
|
2155-04-30 14:35:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old woman with hx of CKD ___ membranous nephropathy,
presenting with new refractory seziures of unclear etiology// Malignancy
Screening:1) Lung: known 11 mm RLL nodule (on yearly survailance, last checked
in ___ 2) Abd/pelvis: specifically for evidence of colon or ovarian cancer
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 62.2 cm; CTDIvol = 8.5 mGy (Body) DLP = 530.3
mGy-cm.
Total DLP (Body) = 530 mGy-cm.
COMPARISON: None.
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 homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains gallstones without wall thickening or
evidence of inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
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. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There are punctate nonobstructing left renal calculi.
There is no perinephric abnormality.
GASTROINTESTINAL: An enteric tube is in place, terminating in the stomach.
Small bowel loops demonstrate normal caliber and wall thickness throughout.
There is severe sigmoid colonic diverticulosis without evidence of
diverticulitis. The appendix is normal. Trace ascites.
PELVIS: The urinary bladder is decompressed and contains a Foley catheter.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Chronic left pubic rami fractures are noted. There is diffuse osseous
demineralization.
SOFT TISSUES: There is diffuse anasarca.
IMPRESSION:
1. No evidence of malignancy in the abdomen or pelvis given the limitations of
an unenhanced scan.
2. Uncomplicated cholelithiasis.
3. Nonobstructing punctate left renal calculi.
4. Colonic diverticulosis without evidence of diverticulitis.
5. Please refer to the separately dictated CT chest report from the same date
for a description of thoracic findings.
|
10206590-RR-9
| 10,206,590 | 26,927,205 |
RR
| 9 |
2155-04-30 13:44:00
|
2155-04-30 17:38:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with hx of CKD ___ membranous nephropathy,
presenting with new refractory seziures of unclear etiology. Malignancy
Screening:1) Lung: known 11 mm RLL nodule (on yearly survailance, last checked
in ___
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 62.2 cm; CTDIvol = 8.5 mGy (Body) DLP = 530.3
mGy-cm.
Total DLP (Body) = 530 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W/O CONTRAST)
COMPARISON: None
FINDINGS:
THORACIC INLET:Visualized portions of the base of the neck show no
abnormality. The visualized thyroid is normal. Supraclavicular lymph nodes
are not enlarged.
THORACIC LYMPH NODES: No axillary lymphadenopathy. Scattered mediastinal
lymph nodes measure up to 0.9 cm in short axis (302:69). Evaluation of hilar
lymphadenopathy is limited on this noncontrast enhanced exam.
HEART, VESSELS and PERICARDIUM: The thoracic aorta is normal in caliber.
Coronary artery calcifications are moderate. A central venous catheter
projects over the lower SVC. There is extensive calcific atherosclerotic
disease involving the aortic arch and descending thoracic aorta. No
pericardial effusion.
PLEURA: Large bilateral pleural effusions with overlying compressive
atelectasis.
LUNG: There is mild centrilobular emphysema predominately seen in the upper
lobes. There is near entire collapse of the left lower lobe. Intraluminal
bronchial secretions are demonstrated at the left lung base. Bibasilar
consolidations likely reflect atelectasis on the right and may reflect a
combination of aspiration and atelectasis on the left. Evaluation of lung
nodules and masses is suboptimal in the setting of respiratory motion artifact
and bibasilar atelectasis/pleural effusions. Enteric tube is seen projecting
2.5 cm above the carina. Otherwise, the airways are patent to the segmental
level.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion. There
is diffuse soft tissue edema.
UPPER ABDOMEN: Enteric tube is seen terminating in the stomach. Please see
separately submitted Abdomen and Pelvis CT report for subdiaphragmatic
findings..
IMPRESSION:
1. Large bilateral pleural effusions with compressive atelectasis. Bronchial
secretions seen within the left lower lobe raise the possibility of a
combination of aspiration and atelectasis of the left lung base.
2. Moderate coronary artery calcifications.
3. Scattered mediastinal lymph nodes measure up to 0.9 cm in short axis and
are not pathologically enlarged by CT size criteria.
4. Diffuse anasarca.
5. Please refer to separate report of CT abdomen and pelvis for description of
the subdiaphragmatic findings.
|
10206973-RR-49
| 10,206,973 | 23,072,356 |
RR
| 49 |
2160-05-26 08:00:00
|
2160-05-26 12:32:00
|
EXAMINATION: CT T-SPINE W/ CONTRAST
INDICATION: ___ year old woman with two year history of persistent pain in
spine. Previous MRI revealed disc protrusions at T7 to T9. LP revealed
normal CSF. // R/O masses, cystic lesions of T-Spine R/O masses, cystic
lesions of T-Spine
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 1356 mGy
DLP: 31 mGy-cm
COMPARISON: MRI thoracic spine dated ___
FINDINGS:
Numbering used is shown on se 602b, im 53.
Alignment is normal. No fractures are identified. A rounded lucency in the
T7 vertebral body represents fat deposition as seen on the prior MRI. (se
602b, im 54)
Minimal loss of disc height is seen at T3-4 with minimal anterior osteophytes.
Multilevel small anterior osteophytes with mild calcifications in the discs
noted from T7- T11.
At T7-8 there is loss of disc height with endplate irregularity and Schmorl's
node small anterior osteophytes. Mild disc bulge with central component is
better seen on prior MRI
There is also ossification along the posterior longitudinal ligament at the
T7-8 level towards the right side, causing mild canal narrowing better seen on
sagittal ref. (se 602b, im 55).
A disc herniation at T8-9 indents the thecal sac anteriorly.
There is no evidence of spinal canal or neural foraminal narrowing.
There is no suspicious neoplastic lesion noted.
S/p thyroidectomy.
IMPRESSION:
Multilevel, mild degenerative changes, as seen on prior MRI, in particular at
T7-8 and T8-9 levels with mild canal narrowing.
Also likely ossification along the posterior longitudinal ligament at the T7-8
level, contributing to mild canal narrowing better seen on sagittal
reformations.
Other details as above
|
10206973-RR-50
| 10,206,973 | 23,072,356 |
RR
| 50 |
2160-05-26 11:52:00
|
2160-05-26 12:47:00
|
EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ with fall landed on right elbow. Eval fx.
TECHNIQUE: Right elbow, 3 views.
COMPARISON: None
FINDINGS:
There is an acute mildly displaced fracture through the olecranon. Posterior
soft tissue swelling is noted. There is elevation of the anterior fat pad
compatible with joint effusion.
IMPRESSION:
Acute mildly displaced fracture of the olecranon with joint effusion and
posterior soft tissue swelling.
|
10206973-RR-51
| 10,206,973 | 23,072,356 |
RR
| 51 |
2160-05-26 14:47:00
|
2160-05-26 15:04:00
|
EXAMINATION: CHEST (PRE-OP PA AND LAT)
INDICATION: ___ with elbow fracture needs ORIF // evalauate for CHF
COMPARISON: ___. ___.
FINDINGS:
PA and lateral views of the chest provided. Lateral view somewhat obscured
due to patient arm projecting over the field of view. There is no focal
consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. Imaged osseous structures are intact. No free air below the right
hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10206973-RR-52
| 10,206,973 | 23,072,356 |
RR
| 52 |
2160-05-27 14:44:00
|
2160-05-27 17:56:00
|
INDICATION: Intraoperative radiographs for surgical guidance.
COMPARISON: ___.
FINDINGS:
Multiple fluoroscopic views of the right elbow were obtained for surgical
guidance during fixation of an olecranon fracture. Plate and screw fixation is
noted. Please refer to full operative note for further details.
|
10207354-RR-51
| 10,207,354 | 24,602,624 |
RR
| 51 |
2186-02-23 13:33:00
|
2186-02-23 16:24:00
|
INDICATION: ___ with hx breast cancer, hairy cell s/p admission for
hyponatremia and anemia. Presenting with fever 102, epistaxis. Evaluate for
pneumonia.
TECHNIQUE: AP and lateral views of the chest
COMPARISON: Multiple prior chest radiographs with direct comparison made to
study from ___
FINDINGS:
There is a retrocardiac opacity concerning for infection. There is also mild
interstitial edema. The cardiac silhouette is mildly enlarged. There is a
small left pleural effusion. Diffuse sclerotic osseous metastases are
identified.
IMPRESSION:
1. Retrocardiac opacity concerning for infection.
2. Mild interstitial edema and small left pleural effusion.
|
10207354-RR-52
| 10,207,354 | 24,602,624 |
RR
| 52 |
2186-02-23 15:42:00
|
2186-02-23 17:05:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with history of breast cancer, hairy cell
leukemia presenting with fevers to 102 with elevated bilirubin, INR, low
albumin. Evaluate for evidence of obstruction, cirrhosis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: The gallbladder is mildly distended. No gallstone is identified.
There is no pericholecystic fluid or gallbladder wall thickening.
PANCREAS: The pancreas was not well seen secondary to overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 12.5 cm.
KIDNEYS: Survey views of the right kidney do not demonstrate any masses,
hydronephrosis, or stones.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Mildly distended gallbladder. No other findings to suggest acute
cholecystitis. No evidence of intra or extrahepatic biliary ductal
dilatation.
|
10207354-RR-53
| 10,207,354 | 24,602,624 |
RR
| 53 |
2186-02-24 17:38:00
|
2186-02-24 19:10:00
|
INDICATION: ___ year old man with hairy cell leukemia and breast cancer now
admitted with sepsis/bacteremia // Please use PO contrast only NO IV
contrast, looking for source of sepsis
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
with oral, without intravenous contrast. Non-contrast scan has several
limitations in detecting vascular and parenchymal organ abnormalities,
including tumor detection.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 10.8 s, 73.9 cm; CTDIvol = 6.7 mGy (Body) DLP = 465.2
mGy-cm.
Total DLP (Body) = 465 mGy-cm.
COMPARISON: Attenuation correction CT images dated ___.
FINDINGS:
Optimal evaluation of organ pathology and vasculature is limited without the
benefit of intravenous contrast.
LOWER CHEST: There are bilateral small nonhemorrhagic pleural effusions.
Relaxation atelectasis is seen in both lower lobes adjacent to the effusions.
The cardiac interventricular septum is prominent, raising concern for
underlying anemia. Trace pericardial effusion noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is distended and demonstrates no radiopaque
calculi within it.
PANCREAS: The uncinate process, head and proximal body of the pancreas is
enlarged and appears hypoattenuating relative to the tail of the pancreas.
There are scattered foci of calcification within the pancreatic head and
proximal body. There is extensive stranding of peripancreatic fat along with
minimal free fluid localized to the peripancreatic region. Reactive edema of
the C-loop of duodenal wall is also noted. Within limitations of lack of
intravenous contrast, no large peripancreatic fluid collection noted. The
inflammatory stranding surrounding the pancreas extends to the perinephric
space with thickening of Gerota's and lateroconal fascia on both sides.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. There is a 1.6 cm splenule at the hilum (series 3,
image 61).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There is no hydronephrosis. No renal calculi noted. There is a
hyperdense 9 mm rounded lesion arising from the posterior cortex of the right
renal lower pole (series 3, image 70) likely a hemorrhagic cyst. Another
similar hyperdense exophytic rounded lesion arises from the outer cortex of
the left renal lower pole (series 3, image 77) also a hemorrhagic cyst.
GASTROINTESTINAL: There is reactive edema of the duodenum wall in the region
of the C-loop as described above. No bowel obstruction.
PELVIS: The urinary bladder is distended, unremarkable. There is a small
amount of free fluid in the pelvis. The prostate is enlarged and measures 4.4
by 5.1 by 5.4 cm.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: All visualized bones in the pelvis, thoracolumbar vertebrae and ribs
demonstrate a diffused sclerotic and moderate appearance, related to the known
leukemia and metastatic breast cancer. There are more discrete lytic lesions
within the L1, L4 and L5 vertebrae. This appearance is not significantly
changed compared to ___. No pathologic fracture noted.
SOFT TISSUES: There is a fat containing right inguinal hernia. There are 2
small fluid pockets located in the right inguinal region measuring 2.1 x 2.2
cm (series 3, image 104 and 1.4 x 1.8 cm (series 3, image 107) respectively.
IMPRESSION:
1. Findings compatible with acute pancreatitis involving the uncinate process
head and proximal body as described in detail above. Lack of intravenous
contrast limits evaluation of extent of parenchymal necrosis, or any
associated vascular thrombosis. No large peripancreatic fluid collections
noted.
2. There are foci of discrete calcification within the pancreatic parenchyma
suggestive of prior episodes of pancreatitis. The main duct however is not
dilated.
3. There are bilateral moderate pleural effusions and a small amount of free
fluid in the pelvis. Bibasilar read lack station atelectasis related to the
pleural effusions is also seen.
4. Extensive osseous metastatic disease is unchanged compared to ___
with no pathologic fracture noted.
|
10207354-RR-54
| 10,207,354 | 24,602,624 |
RR
| 54 |
2186-02-24 17:39:00
|
2186-02-24 19:11:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ man with hairy cell leukemia and breast cancer
now with sepsis.
TECHNIQUE: MULTI DETECTOR HELICAL SCANNING OF THE CHEST WAS PERFORMED
WITHOUT INTRAVENOUS CONTRAST AGENT, RECONSTRUCTED AS CONTIGUOUS 5 AND 1.25 MM
THICK AXIAL, 5 MM THICK CORONAL AND PARASAGITTAL, AND 8 MM MIP AXIAL IMAGES.
SUBSEQUENT SCANNING OF THE ABDOMEN AND PELVIS WILL BE REPORTED SEPARATELY, AND
WILL PROVIDE THE TOTAL DOSAGE OF SCANNING THE ENTIRE TORSO. ALL IMAGES OF THE
CHEST WERE REVIEWED.
DOSAGE: TOTAL DLP will be noted in the separate report of the CT of the
abdomen and pelvis performed concurrently.mGy-cm
COMPARISON: PET CT scans ___.
FINDINGS:
An 8 x 11 mm right peripectoral lymph node, 4:80, was smaller in ___.
There is no supraclavicular or left axillary adenopathy. Patient has had left
chest wall surgery for breast cancer, reflected in the loss of subcutaneous
tissue, but there is no evidence of local tumor recurrence.
There are no soft tissue abnormalities in the chest wall suspicious for
malignancy. Findings below the diaphragm will be reported separately.
Thyroid is unremarkable. Atherosclerotic calcification is not apparent in
head and neck vessels, but the coronaries are heavily calcified. There is
mild aortic valvular calcification. Hypoattenuation of cardiac contents
reflects anemia. Esophagus is unremarkable.
Mediastinal lymph nodes are not pathologically enlarged despite nodal
calcification, probably due to prior granulomatous infection in the upper pole
the right hilus. Aorta is normal size. Main pulmonary artery and right
pulmonary artery are mildly dilated, 33 mm and 28 mm respectively. Moderate
cardiomegaly involves all chambers, particularly the atria. Pericardium is
physiologic. Small nonhemorrhagic pleural effusions layer posteriorly.
Respiratory motion obscures fine detail in the lungs. There no findings in
the upper lungs to suggest pneumonia. At both lung bases opacification it
could be due to moderate atelectasis so small pneumonia, particularly on the
left is not excluded. A 3 mm left lower lobe nodule, 4:243, was 6 mm on an
abdomen CT ___. .
Generalized skeletal tumor involvement is generally blastic with several large
lytic regions in the sternum and thoracic and lumbar vertebrae, but no
compression fractures or pathologic fractures anywhere else.
IMPRESSION:
New borderline enlargement right peripectoral lymph node, contralateral to
left mastectomy. No evidence of local tumor recurrence.
Moderate cardiomegaly, occluding biatrial enlargement, company by probable
pulmonary arterial hypertension.
Mild bibasilar pulmonary consolidation most likely relaxation atelectasis.
New small layering nonhemorrhagic pleural effusions. No evidence of pleural
malignancy, despite extensive skeletal metastasis involving all the bones of
the chest cage. No pathologic fractures.
|
10207354-RR-55
| 10,207,354 | 24,602,624 |
RR
| 55 |
2186-02-24 19:45:00
|
2186-02-24 20:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with nausea, recent vomiting, and with GPC
bacteremia. C/f aspiration or PNA // aspiration pneumonitis vs PNA
aspiration pneumonitis vs PNA
IMPRESSION:
Known breast cancer with diffuse bony metastasis. Moderate cardiomegaly. Low
lung volumes. Minimal retrocardiac and right basilar atelectasis. No pleural
effusions. No pneumonia. No pulmonary edema.
|
10207354-RR-56
| 10,207,354 | 24,602,624 |
RR
| 56 |
2186-02-26 16:09:00
|
2186-02-26 21:04:00
|
EXAMINATION: MRCP.
INDICATION: ___ year old man with hairy cell leukemia, breast cancer and now
pancreatitis and rising direct bilirubin as well as MSSA bacteremia //
Etiology of pancreatitis unclear, perplexing LFT picture.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 7 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT examination from ___.
FINDINGS:
Lower Thorax: Small bilateral pleural effusions appear slightly enlarged since
the ___ examination (series 4, image 10). The heart is mildly
enlarged. There is no pericardial effusion.
Liver: The hepatic parenchyma demonstrates normal signal intensity on T1 and
T2 weighted sequences. No focal hepatic mass is detected, however, evaluation
for small lesions is limited, as non breath hold sequences were utilized for
this examination due to difficulty with breath holding.
Biliary: There is no intra or extrahepatic bile duct dilation. The
gallbladder appears normal. No gallstones or ductal stones are detected.
Pancreas: Stranding and edema about the pancreas is again demonstrated, better
visualized on the CT examination from ___, reflecting known
pancreatitis. No pseudocyst or focal fluid collections are seen. The main
pancreatic duct is normal in caliber. No concerning pancreatic lesion is
seen. Sub 3 mm cystic lesions along the pancreatic tail may represent tiny
side branch IPMN (series 4, image 25, 28, 27), versus a tiny dilated side
branches.
Spleen: The spleen size is top normal, measuring 12.6 cm (series 11, image
32). No focal splenic lesions are detected. An accessory spleen is
incidentally noted (series 4, image 25).
Adrenal Glands: The adrenal glands are normal.
Kidneys: The kidneys are normal in size and enhance symmetrically,. There is
no hydronephrosis. An 8 mm exophytic lesion arising from the lower pole of
the right kidney demonstrates low signal intensity on T2 weighted sequences
(series 4, image 36), however, it is not well visualized on pre or
postcontrast T1 weighted images due to motion artifact, however, corresponds
to the hyperdense lesion seen on the prior CT, suggestive of a hemorrhagic
cyst, but incompletely characterized.
Gastrointestinal Tract: The stomach and intra-abdominal loops of small and
large bowel are normal in caliber. No focal gastrointestinal mass is
detected.
Lymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.
Vasculature: The portal hepatic veins appear patent. The abdominal aorta,
celiac trunk, SMA, and renal arteries are patent. No large pseudoaneurysm is
detected.
Osseous and Soft Tissue Structures: Known widespread osseous metastases are
better evaluated on the prior CT examination.
IMPRESSION:
1. Exam limited by motion artifact.
2. Normal gallbladder. No gallstones or ductal stones. No intra or
extrahepatic bile duct dilation.
3. Normal MR signal characteristics of the liver, without focal lesion.
4. Stranding and edema about the pancreas, compatible with known history of
pancreatitis, without pancreatic duct dilation or fluid collections. No focal
lesions detected.
5. Tiny cystic lesions within the pancreatic tail may reflect mildly dilated
side branches versus tiny side branch IPMN.
RECOMMENDATION(S): 12 month followup MRCP following resolution of acute
symptoms, for reassessment of the pancreatic tail cystic lesions.
|
10207354-RR-57
| 10,207,354 | 24,602,624 |
RR
| 57 |
2186-02-26 09:47:00
|
2186-02-26 10:51:00
|
INDICATION: ___ year old man with h/o breast cancer (metastatic) hair cell
leukemia now with pancreatitis and bacteremia. // concern for ileus
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
There are air-filled borderline dilated loops of large bowel, measuring a
maximum of 6.1 cm in the transverse colon. There are air-filled and
abnormally dilated loops of small bowel measuring maximum of 3.1 cm. There is
retained oral contrast in the cecum and ascending colon These findings are
most compatible with generalized ileus. Limited without upright or lateral
decubitus views, but there is no gross free intraperitoneal air.
IMPRESSION:
1. Dilated loops of small and large bowel most compatible with a generalized
ileus.
|
10207354-RR-59
| 10,207,354 | 24,602,624 |
RR
| 59 |
2186-02-26 12:23:00
|
2186-02-26 13:09:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new R PICC // R DL Power PICC 42cm ___
___ Contact name: ___: ___ R DL Power PICC 42cm ___ ___
COMPARISON: PRIOR CHEST RADIOGRAPHS SINCE ___ MOST RECENTLY
DECEMBER ___.
IMPRESSION:
New right PIC line ends close to the superior cavoatrial junction. Severe
cardiomegaly is chronic. Mild pulmonary edema is difficult to exclude in the
setting of such severe sclerotic bone involvement. Small bilateral pleural
effusions are likely and aeration in the left lower lobe is compromised either
by atelectasis or pneumonia. No pneumothorax.
|
10207354-RR-60
| 10,207,354 | 24,602,624 |
RR
| 60 |
2186-02-28 18:43:00
|
2186-02-28 20:38:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with leukemia and GPC bacteremia now with altered
mental status, on anticoagulation // please rule out intracranial bleed or
other abnormality that might cause confusion/altered mental status
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
4) Stationary Acquisition 2.0 s, 7.7 cm; CTDIvol = 44.4 mGy (Head) DLP =
342.2 mGy-cm.
5) Stationary Acquisition 1.0 s, 4.0 cm; CTDIvol = 42.8 mGy (Head) DLP =
171.1 mGy-cm.
Total DLP (Head) = 1,198 mGy-cm.
COMPARISON: MR head dated ___, CT head dated ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
Periventricular and subcortical white matter hypodensities are noted, likely
the sequelae of chronic small vessel ischemic disease. There is preservation
of gray-white matter differentiation. The basal cisterns remain patent.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No evidence of hemorrhage, infarction or mass.
|
10207354-RR-62
| 10,207,354 | 24,602,624 |
RR
| 62 |
2186-03-02 10:03:00
|
2186-03-02 14:29:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old man with breast cancer and hairy cell leukemia, with
resolving bloodstream infection and pancreatitis, now with worsening mental
status and somnolence. Evaluate for acute infarct and extent of intracranial
metastatic disease.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ contrast brain MRI.
___ cervical spine CT.
___ head CT PET-CT.
FINDINGS:
Study is moderately degraded by motion, especially on postcontrast imaging.
There is new diffuse pachymeningeal enhancement (see 4, 13:15). New
corresponding dural and adjacent subdural fluid FLAIR hyperintensities are
also noted. The mamillopontine distance is preserved. No definite subdural
collections are identified. No definite pial enhancement is identified.
There is limited visualization of patient's known skullbase and cervical spine
blastic metastatic lesions secondary to motion degradation.
There is no evidence of mass effect, midline shift or infarction. The
ventricles and sulci are normal in caliber and configuration. Bilateral
maxillary sinus and ethmoid sinus mucosal thickening is present.
IMPRESSION:
1. Study is moderately degraded by motion.
2. New dural enhancement and signal intensity abnormalities without as
described. Differential considerations include meningioma metastatic disease,
or procedure related changes. Recommend correlation with history of lumbar
puncture.
3. Limited visualization of patient's known skullbase and cervical spine
blastic metastatic lesions.
4. No evidence of acute infarct.
RECOMMENDATION(S): New dural enhancement and signal intensity abnormalities
without as described. Differential considerations include meningioma
metastatic disease, or procedure related changes. Recommend correlation with
history of lumbar puncture.
|
10207354-RR-63
| 10,207,354 | 24,602,624 |
RR
| 63 |
2186-03-04 12:46:00
|
2186-03-04 16:06:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with CHF, pancreatitis, bacteremia, altered
mental status and ___ as well has hairy cell leukemia and breast cancer //
Patient with acute renal failure and decreases urine output
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen pelvis dated ___
FINDINGS:
The right kidney measures 11.6 cm. The left kidney measures 11.1 cm. There is
no hydronephrosis, stones, or masses bilaterally. 7 mm and 9 mm anechoic
simple cysts are seen in the left kidney as well as a 1 cm anechoic cyst in
the lower pole of the right kidney. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
No evidence of hydronephrosis or obstruction.
|
10207354-RR-64
| 10,207,354 | 24,602,624 |
RR
| 64 |
2186-03-05 11:31:00
|
2186-03-05 13:59:00
|
INDICATION: ___ year old man with pulm edema, small bilateral pleural
effusions and atelectasis // ___ year old man with pulm edema, small bilateral
pleural effusions and atelectasis
COMPARISON: ___
FINDINGS:
Interval worsening of pulmonary edema which is now moderate. Greater
opacification of the right lung mean reflect asymmetric edema or concurrent
infection. Increasing bilateral small to moderate effusions with substantial
retrocardiac atelectasis. No pneumothorax. Right-sided PICC terminates in the
low SVC. Bones are widely sclerotic.
IMPRESSION:
Interval worsening of pulmonary edema asymmetric on the right may reflect
superimposed infection or asymmetric edema.
|
10207354-RR-65
| 10,207,354 | 24,602,624 |
RR
| 65 |
2186-03-13 19:50:00
|
2186-03-13 20:38:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ y/o male with a past medical history of hairy cell leukemia
s/p rituxan, breast cancer (ER/PR+, HER2 neg) s/p left mastectomy in ___
and adjuvant tamoxifen, then switched to fulvestrant in ___ for metastatic
progression by tumor markers admitted for ___ exacerbation, severely volume
overloaded c/b poor diuresis on Lasix gtt 20/hr and diuril boluses. EGD
showing gastritis and esophagitis, as well as portal hypertensive gastropathy
without history of cirrhosis or e/o cirrhosis on recent prior scan // Please
eval liver with Doppler US for causes of portal hypertension
TECHNIQUE: Gray scale and color Doppler sonographic evaluation of the right
upper quadrant was obtained.
COMPARISON: None.
FINDINGS:
The liver isdemonstrates normal, homogeneous echotexture.. No intrahepatic
biliary ductal dilation is seen. The common bile duct is normal in caliber
and measures3 mm. The gallbladder is contracted. The patient was not NPO..
No gallbladder wall thickening or pericholecystic fluid is seen.
The pancreas is obscured by overlying bowel gas. The spleen is normal in
size, measuring 11.4 cm in length. Limited imaging of the bilateral kidneys
demonstrates no hydronephrosis. No ascites is seen.
There are bilateral pleural effusions.
Liver Doppler:
The main portal vein and right and left portal vein branches are patent with
appropriate directional flow. Main portal vein velocity was 26.5
centimeters/second. The left, middle, and right hepatic veins are patent.
The main hepatic artery is patent with brisk upstroke.
IMPRESSION:
Patent hepatic vasculature.
Bilateral pleural effusions.
|
10207354-RR-66
| 10,207,354 | 24,602,624 |
RR
| 66 |
2186-03-26 11:52:00
|
2186-03-26 14:13:00
|
INDICATION: Mr. ___ is an ___ y/o male with a past medical history of hairy
cell leukemia s/p rituxan, breast cancer (ER/PR+, HER2 neg) s/p left
mastectomy in ___ and adjuvant tamoxifen, then switched to fulvestrant in
___ for metastatic progression by tumor markers and on PET-CT (bone and
lymph nodes), CAD s/p BMS (to proximal ramus ___, MR with MVP, dCHF (EF
55%), HTN, AF, CKD stage III // evaluate for RP bleed
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 4.5 s, 48.9 cm; CTDIvol = 11.8 mGy (Body) DLP = 578.2
mGy-cm.
Total DLP (Body) = 578 mGy-cm.
COMPARISON: ___
FINDINGS:
LOWER CHEST: There are moderate bilateral pleural effusions, increased from
the examination of ___. Atelectatic right and left lower lobes
persist, with calcified granulomas noted. The imaged portion of heart shows
mild enlargement and coronary artery calcifications.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: Scattered punctate calcifications are seen throughout the pancreas
compatible with changes of chronic pancreatitis. No focal lesions are
identified. There is no pancreatic ductal dilatation. There is no
peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Right adrenal gland is unremarkable. Left adrenal gland is mildly
bulky without discrete nodule, unchanged.
URINARY: The kidneys are of normal and symmetric size. 8 mm intermediate
density exophytic left renal lesion is unchanged in size and appearance. 7 mm
exophytic intermediate density right renal lesion is also unchanged. Smaller
exophytic hypodensities measuring up to 6 mm are seen bilaterally. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness 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: Prostate is moderately enlarged. Seminal vesicles appear
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy. No evidence of retroperitoneal
hematoma.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Diffusely sclerotic bones with multiple lucent lesions compatible
diffuse metastatic disease. The vertebral body heights are grossly preserved.
The appearance is not significantly changed.
SOFT TISSUES: Fat containing right inguinal hernia. A small amount of fluid
or lymph node is seen within the hernia sac.
IMPRESSION:
1. No evidence of retroperitoneal hematoma.
2. Diffuse osseous metastatic disease appears grossly unchanged.
3. Findings consistent with chronic pancreatitis including multiple
parenchymal calcifications, but no evidence for acute inflammatory changes.
4. Bilateral pleural effusions, moderate, increased in size.
5. Bilateral renal lesions, not fully characterized on a noncontrast CT, not
significantly changed.
|
10207354-RR-67
| 10,207,354 | 24,602,624 |
RR
| 67 |
2186-04-03 12:46:00
|
2186-04-03 13:11:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ y/o male with a past medical history of hairy cell leukemia
s/p rituxan, breast cancer (ER/PR+, HER2 neg) s/p left mastectomy in ___.
Now presenting with right groin swelling. Evaluate for lymph no versus
hernia.
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right groin.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right groin. As seen on the prior CT, there is an echogenic oval region
measuring approximately 3.6 x 1.2 x 2.0 cm without internal vascularity
compatible with a fat containing inguinal hernia. The hernia defect appears
prominent on Valsalva and the neck measures approximately 1.1 cm. No definite
lymphadenopathy is seen at the right groin.
IMPRESSION:
3.6 cm predominantly fat containing right inguinal hernia, corresponding to
the swelling at the groin. This is better seen on the recent CT, which
demonstrated a small amount of fluid versus a non-enlarged lymph node within
the hernia sac.
|
10207476-RR-167
| 10,207,476 | 28,276,158 |
RR
| 167 |
2180-03-24 19:28:00
|
2180-03-24 20:09:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with dyspnea// r/o acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Comparison with the prior study, there has been no significant interval
change. Re-demonstrated aortic stent graft. Cardiac and mediastinal
silhouettes are stable. Stable mild biapical pleural thickening. No pleural
effusion or focal consolidation is seen. There is no evidence of
pneumothorax.
IMPRESSION:
No significant interval change from ___.
|
10207476-RR-185
| 10,207,476 | 28,884,246 |
RR
| 185 |
2181-05-17 17:36:00
|
2181-05-17 18:33:00
|
EXAMINATION: Noncontrast CT torso
INDICATION: ___ with general weakness and hypotension // eval aneurysm sp
repair
TECHNIQUE: Noncontrast CT torso with axial coronal and sagittal reformations.
Dose: Total DLP (Body) = 842 mGy-cm.
COMPARISON: MRA torso performed on ___ and PET-CT scan from ___
FINDINGS:
CHEST: The imaged base of neck is unremarkable though the thyroid appears
somewhat atrophic. There is a graft in the thoracic aorta extending along the
arch. The position of the stent is similar to prior. An aneurysm sac is
again seen at the arch measuring approximately 15 x 25 x 34 mm, which is
stable from prior PET-CT dated ___. There is no mediastinal hematoma.
The thoracic aorta is normal in size. There is mild atherosclerotic
calcifications. The heart is normal in size without pericardial effusion.
Coronary artery calcification is moderate. No adenopathy. Airspace
consolidation is noted within the right upper lobe which is concerning for
pneumonia. Motion artifact limits assessment. No pleural effusion and no
pneumothorax.
ABDOMEN: The unenhanced appearance of the liver is normal. Gallstones are
seen within the gallbladder without evidence of acute cholecystitis. The
pancreas appears slightly atrophic. The spleen is not enlarged. The adrenals
are normal. The kidneys appear normal without stones or hydronephrosis. The
abdominal aorta is moderately calcified. There is ectasia of the abdominal
aorta with a fusiform aneurysm along the infrarenal segment measuring 4.1 x
3.7 cm, unchanged from prior PET-CT. No retroperitoneal hematoma. No
adenopathy, free air or free fluid. The stomach is decompressed. The
duodenum is normal.
PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The
appendix is normal. Colonic diverticulosis is noted throughout. Suture at
the rectosigmoid junction likely reflects a prior sigmoid resection. The
uterus is atrophic. There is no adnexal mass. Urinary bladder is only
partially distended though appears normal. No pelvic sidewall or inguinal
adenopathy.
BONES: Multiple compression deformities are again seen in the lower thoracic
and upper lumbar spine with evidence of prior vertebroplasty at T12, L1 and L2
levels. A compression fracture is noted at T11 which appears subacute to
chronic though not definitively seen on prior.
IMPRESSION:
1. Right upper lobe pneumonia.
2. Status post aortic arch stenting with stable size of excluded aneurysm.
3. Stable size of an abdominal aortic aneurysm.
4. Vertebroplasty changes at the thoracolumbar junction with newly evident
compression fracture at T11 which appears subacute to chronic.
5. Additional nonemergent findings as above.
|
10207476-RR-186
| 10,207,476 | 28,884,246 |
RR
| 186 |
2181-05-19 13:02:00
|
2181-05-19 15:34:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with hx notable for afib on DOAC admitted for
PNA, found to have edema in RLE > LLE. // ? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Right unilateral venous ultrasound dated ___
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial. Limited evaluation
of the peroneal veins demonstrates wall to wall flow.
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 visualized right lower extremity
veins.
|
10207476-RR-187
| 10,207,476 | 28,884,246 |
RR
| 187 |
2181-05-20 14:41:00
|
2181-05-20 15:21:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with history of CAD s/p inferior MI ___ s/p DES to RCA and
CABG (LIMA/LAD), HFrEF (LVEF 42%), paroxysmal AF on Xarelto, mild MR, asthma,
aortic pseudoaneurysm s/p EVAR, and AML s/p alloHSCT in ___ c/b pulmonary
GVHD and JAK2+ myeloproliferative d/o (on hydrea) pw sepsis ___ RUL PNA. Now
with persistent dyspnea. // Please evaluate for evolution of PNA, edema
TECHNIQUE: Frontal and lateral view radiographs of the chest.
COMPARISON: CT chest, abdomen and pelvis ___. Chest radiograph ___.
IMPRESSION:
There is consolidation in the right upper lobe, which appears slightly
improved compared to prior CT. No new consolidation is identified. There is
pleural effusion or pneumothorax. There is an aortic arch stent. The
cardiomediastinal silhouette is stable in appearance. No acute osseous
abnormalities are identified. Compression deformities in the lower thoracic
and upper lumbar spine, some of which have been treated with kyphoplasty, are
unchanged.
|
10207476-RR-189
| 10,207,476 | 28,601,579 |
RR
| 189 |
2181-07-06 19:22:00
|
2181-07-06 19:42:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with weakness and fever // pna?
COMPARISON: Chest CT ___
Chest radiograph ___
FINDINGS:
AP and lateral views of the chest provided.
Lungs are hyperinflated. No focal consolidation. No pleural effusion or
pneumothorax. Cardiomediastinal silhouette is within normal limits. Stent
material in the aortic arch is noted. Coronary artery stents are also noted.
Multiple lower thoracic vertebral compression deformities some containing
cement are unchanged.
IMPRESSION:
No focal consolidation.
|
10207476-RR-190
| 10,207,476 | 28,601,579 |
RR
| 190 |
2181-07-08 19:47:00
|
2181-07-08 20:51:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with pulmonary GVHD presenting with fever and
shortness of breath CXR unremarkable ?any evidence of infection or GVHD //
?any evidence of infection or GVHD
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.7 s, 35.3 cm; CTDIvol = 6.7 mGy (Body) DLP = 238.6
mGy-cm.
Total DLP (Body) = 239 mGy-cm.
COMPARISON: CT chest ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The visualized portion of the
thyroid gland is unremarkable. There is no supraclavicular or axillary
lymphadenopathy. A 6 mm calcified lesion in the right breast is unchanged.
UPPER ABDOMEN: Limited view of the unenhanced upper abdomen shows gallstones
within the gallbladder. There is a small hiatal hernia and diverticulosis of
the colon without evidence of acute diverticulitis.
MEDIASTINUM: There is no mediastinal lymphadenopathy or mediastinal mass.
HILA: No evidence of hilar adenopathy within the limitations of a noncontrast
enhanced exam
HEART and PERICARDIUM: Heart size is mildly enlarged. No pericardial
effusion. Dense coronary artery calcifications are noted.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: Compared to the prior chest CT there are new areas of
ground-glass opacification in the right upper lobe which are concerning for
infection. There is unchanged subsegmental atelectasis/scarring in the left
upper lobe. There is bibasilar dependent atelectasis. Sub 3 mm nodules are
noted (4:36, 82, 128, 181). A 4 mm nodule seen in the left lower lobe is new
compared to prior (4:211). A calcified granuloma is seen at the right lung
base.
2. AIRWAYS: The airways are patent to the subsegmental level bilaterally.
3. VESSELS: The patient is status post stenting along the abdominal aortic
arch. Again seen is an excluded 3.1 x 1.6 cm aneurysm off the aortic arch,
unchanged in size compared to prior when measured at the same level. The main
pulmonary artery is borderline enlarged measuring up to 3 cm in diameter.
CHEST CAGE: Numerous compression deformities are seen in the lower thoracic
and upper lumbar spine with evidence of prior vertebroplasties.
IMPRESSION:
1. New ground-glass opacifications in the right upper lobe concerning for
infection.
2. Scattered pulmonary nodules measure up to 4 mm, follow-up is recommended
per the ___ criteria as detailed below.
3. Stable size of the excluded aortic arch aneurysm.
4. Cholelithiasis.
RECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules
smaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an
optional CT follow-up 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:
___
|
10207925-RR-116
| 10,207,925 | 21,126,849 |
RR
| 116 |
2173-06-14 14:07:00
|
2173-06-14 14:33:00
|
HISTORY: NG tube placement.
FINDINGS: Nasogastric tube extends to the mid to lower portion of the body of
the stomach. There is enlargement of the cardiac silhouette without definite
vascular congestion or pneumonia.
|
10208053-RR-3
| 10,208,053 | 24,398,147 |
RR
| 3 |
2135-01-11 13:53:00
|
2135-01-11 15:06:00
|
CHEST, TWO VIEWS: ___.
HISTORY: ___ male with direct trauma to head with loss of
consciousness.
FINDINGS: Frontal and lateral views of the chest. No prior. The lungs are
clear. There is no pneumothorax or effusion. Cardiomediastinal silhouette is
within normal limits noting prosthetic valve and median sternotomy wires.
Osseous and soft tissue structure is notable for mild wedge deformity at mid
thoracic spine and hypertrophic changes.
IMPRESSION: No definite acute cardiopulmonary process. Mild anterior wedge
deformity of mid thoracic spine age indeterminant, potentially old although no
priors available for comparison.
|
10208053-RR-4
| 10,208,053 | 24,398,147 |
RR
| 4 |
2135-01-11 13:19:00
|
2135-01-11 15:41:00
|
INDICATION: ___ man with direct trauma to the head with possible loss
of consciousness, question bleed.
COMPARISON: None.
TECHNIQUE: MDCT axial imaging was obtained through the brain without the
administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
FINDINGS: There is no acute hemorrhage, edema, mass effect, or territorial
infarction. The ventricles and extra-axial spaces adjacent to the frontal
lobes are mildly prominent consistent with atrophy. The visualized paranasal
sinuses, mastoid air cells and middle ear cavities are clear. There are no
acute fractures.
IMPRESSION: No acute intracranial process. Mild age-related atrophy.
|
10208053-RR-5
| 10,208,053 | 24,398,147 |
RR
| 5 |
2135-01-13 08:32:00
|
2135-01-13 10:27:00
|
INDICATION: ___ man status post dual-chamber pacemaker. Evaluate
lead position and rule out pneumothorax.
___ at 6:54 p.m. and ___.
FINDINGS: Frontal and lateral views were obtained. Low lung volumes result
in bronchovascular crowding. The pacemaker leads end in the expected
locations of the right atrium and right ventricle. There is no focal
consolidation, pleural effusion or pneumothorax. Right basilar atelectasis.
Heart is borderline enlarged. Mediastinal silhouette and hilar contours are
normal allowing for lung volumes with prosthetic valve and intact median
sternotomy wires. Multiple wedge compression deformities in the mid thoracic
spine are seen.
IMPRESSION: No pneumothorax. Pacemaker leads in satisfactory position.
|
10208053-RR-6
| 10,208,053 | 24,398,147 |
RR
| 6 |
2135-01-12 18:36:00
|
2135-01-13 07:52:00
|
CHEST RADIOGRAPH
INDICATION: Dual-chamber pacemaker, rule out pneumothorax.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, a left pectoral pacemaker
has been placed. The course of the leads is unremarkable, there is no
fracture. The position of the leads is as expected, with one lead in the
right atrium and one lead in the right ventricle.
The lung volumes remain low. There is no evidence of pneumothorax. No
pulmonary edema. No pleural effusions. The heart continues to be borderline
in size.
|
10208178-RR-37
| 10,208,178 | 26,400,939 |
RR
| 37 |
2145-05-12 14:10:00
|
2145-05-12 16:59:00
|
HISTORY: Chest pain, evaluate for pneumonia.
COMPARISON: CTA chest from ___.
FINDINGS:
An upright portable radiograph of the chest was obtained. The base of the
right hemithorax is obscured by an overlying pacemaker. The dual leads extend
to the expected positions of the right atrium and ventricle. The patient is
status post bilateral shoulder arthroplasties. A left base/retrocardiac
opacity may represent consolidation. There may also be a small left pleural
effusion. Additionally, there is a superimposed central pulmonary vascular
engorgement. The cardiomediastinal contour is enlarged, as on prior exam.
There is no pneumothorax.
IMPRESSION:
1. Left base/retrocardiac opacity, which may represent consolidation as well
as a small left pleural effusion.
2. Central pulmonary vascular engorgement
|
10208178-RR-38
| 10,208,178 | 26,400,939 |
RR
| 38 |
2145-05-12 21:47:00
|
2145-05-13 09:10:00
|
CHEST RADIOGRAPH
INDICATION: AFib, evaluation for pneumonia or chronic heart failure.
COMPARISON: ___, 2:13 p.m.
FINDINGS: As compared to the previous radiograph, the lung volumes have
increased, likely reflecting improved ventilation. There is unchanged
moderate cardiomegaly, but the pre-existing signs of fluid overload have
completely resolved. No pleural effusions. Minimal atelectasis at the left
lung bases. No pneumonia. Unchanged pacemaker position, unchanged position
of the bilateral shoulder replacement.
|
10208372-RR-48
| 10,208,372 | 26,278,747 |
RR
| 48 |
2165-03-21 14:15:00
|
2165-03-21 14:56:00
|
INDICATION: ___ with hemoptysis// r/o PNA
TECHNIQUE: PA and lateral views the chest
COMPARISON: Chest CT from ___
FINDINGS:
Spiculated left hilar mass is re-demonstrated, though better seen on prior CT.
Secondary volume loss in the left hemithorax is again noted with component of
a layering pleural effusion, also seen previously. Left midlung opacities
laterally also noted on prior chest CT. The right lung remains clear. No
acute osseous abnormalities.
IMPRESSION:
No significant interval change noting a left hilar mass with secondary
left-sided volume loss and pleural effusion.
|
10208372-RR-49
| 10,208,372 | 26,278,747 |
RR
| 49 |
2165-03-21 21:02:00
|
2165-03-21 23:27:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with stage IV lung adenocarcinoma presenting with
hemoptysis// eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
2) Spiral Acquisition 4.3 s, 33.8 cm; CTDIvol = 11.7 mGy (Body) DLP = 394.6
mGy-cm.
Total DLP (Body) = 402 mGy-cm.
COMPARISON: Multiple prior comparisons, most recent CT chest from ___
FINDINGS:
HEART AND VASCULATURE: There is unchanged complete obliteration of the left
main pulmonary artery due to encasement by the left hilar mass, described
below. There is some reconstitution of the segmental and subsegmental
branches, somewhat decreased compared to prior, though possibly due to timing
of the contrast bolus. Assessment for left sided pulmonary embolism is
therefore limited due to occlusion of the left main pulmonary artery. Right
pulmonary arterial system appears patent to the subsegmental level without
evidence of acute pulmonary embolus. The thoracic aorta is normal in caliber
without evidence of dissection or intramural hematoma. Heart is mildly
enlarged, unchanged. There are moderate to extensive coronary artery
calcifications, most notable in the circumflex. There is no pericardial
effusion. Great vessels are within normal limits.
AXILLA, HILA, AND MEDIASTINUM: Again seen is a prominent right upper
paraesophageal node, measuring 10 mm (series 2; image 8), previously measuring
7 mm. Left hilar mass (series 3; image 97) is essentially unchanged to
minimally increased in size compared to prior. Mass continues to encase and
obliterate the left main pulmonary artery as well as partially obstruct the
left mainstem bronchus. There is no axillary or supraclavicular
lymphadenopathy.
PLEURAL SPACES: There has been interval increase in now moderate left-sided
pleural effusion. There is no pneumothorax.
LUNGS/AIRWAYS: Previously seen left hilar mass is unchanged to minimally
increased in size, measuring approximately 5.1 x 3.5 cm (3:97). There is
biapical pleuroparenchymal scarring. Several small satellite nodular
opacities are seen in the left lobe, which appears slightly more prominent
compared to prior exam. For example, one of these nodules is larger compared
to prior and measures up to 9 mm on today's exam (series 3; image 96,
previously 7 mm). Multiple additional nodules appear relatively similar
compared to prior and are better described on recent exam from ___.
Right-sided nodules appear relatively stable in size.
There is unchanged encasement and severe narrowing of the left mainstem
bronchus by the left hilar mass, as well as occlusion of the left upper lobe
bronchi. Right sided and left basilar airways are otherwise patent to the
subsegmental levels. Mild bronchiectasis in the left greater than right lower
lobes is unchanged. Mild centrilobular emphysema is redemonstrated.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Chronic rib fractures are noted in the lateral right eighth and ninth ribs.
IMPRESSION:
1. Left hilar mass as well as multiple left lung nodules are unchanged to
minimally increased in size compared to prior. Mass continues to obstruct the
main left pulmonary artery, encase and narrow the left mainstem bronchus, and
occlude left upper lobe bronchi as seen on most recent prior on ___.
2. Assessment of the left segmental and subsegmental pulmonary arteries system
is limited due to the occlusion of the main left pulmonary artery.
3. No right-sided pulmonary embolus.
4. Moderate left pleural effusion has increased in size compared to prior.
|
10208372-RR-63
| 10,208,372 | 25,738,748 |
RR
| 63 |
2166-06-11 11:15:00
|
2166-06-12 12:53:00
|
EXAMINATION: MR ___ W AND W/O CONTRAST T___ MR ___
INDICATION: ___ year old man with known metastatic lung cancer and new small
brain met, s/p SRS. // DO NOT MOVE, TO RESCHEDULE ___ ___, rule out
progression or new lesions.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MR ___ ___.
FINDINGS:
There is interval reduction in the size of the ring-enhancing lesion in the
left precentral gyrus, which now measures 4 mm x 4 mm (6 mm x 5 mm
previously). No new enhancing lesions are identified. Note is again made of
an unchanged small developmental venous anomaly in the left frontal lobe
posteriorly. There is no evidence of hemorrhage, edema, mass effect, midline
shift or infarction. There are a few nonspecific bilateral supratentorial
T2/FLAIR white matter hyperintensities, which may represent sequelae of
chronic microangiopathy. The ventricles and sulci are normal in caliber and
configuration.
There is mild mucosal thickening in the ethmoid air cells, persistent mild
right, and moderate left maxillary sinus mucosal thickening with a left mucous
retention cyst. Opacification of the mastoid air cells bilaterally remains
unchanged.
IMPRESSION:
1. Reduction in the size of the peripherally enhancing lesion in the left
precentral gyrus. No new enhancing lesions are identified.
2. Paranasal sinuses and persistent opacification of the mastoid air cells
bilaterally as described above.
|
10208372-RR-66
| 10,208,372 | 25,738,748 |
RR
| 66 |
2166-06-11 17:54:00
|
2166-06-11 18:21:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with right lower extremity swelling // Assess for
DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Color flow is demonstrated in
the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10208372-RR-67
| 10,208,372 | 25,738,748 |
RR
| 67 |
2166-06-12 09:33:00
|
2166-06-12 11:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with dyspnea. // Cause of dyspnea? Pulmonary
vascular congestions? Cause of dyspnea? Pulmonary vascular congestions?
IMPRESSION:
Comparison to ___. Known left hilar mass, last documented on a CT
examination from ___. The associated left pleural effusion has
slightly increased and now occupies approximately 30% of the left hemithorax.
Moderate cardiomegaly. No pulmonary edema. Normal appearance of the right
lung.
|
10208781-RR-11
| 10,208,781 | 22,847,710 |
RR
| 11 |
2142-11-12 01:59:00
|
2142-11-12 07:50:00
|
HISTORY: ___ female status post MVA with right femur.
COMPARISON: None available in the ___ system.
RIGHT FEMUR AND KNEE RADIOGRAPHS, FIVE IMAGES: There is no acute fracture or
dislocation. A dystrophic calcification within the proximal soft tissues of
the right thigh is noted. Imaged portions of the pelvis appear intact.
Excreted contrast within the bladder overlies the pelvic inlet. Complete
evaluation of the sacrum is limited by overlying bowel gas. There are
degenerative changes of the right knee joint with tricompartmental joint space
narrowing and sclerosis. In the proximal tibial diaphysis, there is a
nonaggressive-appearing sclerotic focus.
IMPRESSION: No acute fracture or dislocation.
|
10208781-RR-12
| 10,208,781 | 22,847,710 |
RR
| 12 |
2142-11-12 05:02:00
|
2142-11-12 11:44:00
|
INDICATION: Status post motor vehicle collision with rib fractures; please
evaluate for pulmonary process.
COMPARISON: Comparison is made to chest radiograph performed ___
and CT chest performed ___.
FINDINGS: Single portable chest radiograph demonstrates unremarkable
mediastinal, hilar and cardiac contours. Rounded opacity projecting over the
right upper lung adjacent to anterolateral fourth rib deformity may reflect
sequaelae of trauma. Known acute left lower limb fracture is not well
appreciated on current study. No pleural effusion or pneumothorax is evident.
IMPRESSION:
Opacity projecting over right upper lung with adjacent rib deformity may
reflect prior injury. Recommend re-evaluation in 6 weeks to assess for
resolution.
|
10208867-RR-16
| 10,208,867 | 22,470,664 |
RR
| 16 |
2150-02-20 01:16:00
|
2150-02-20 03:16:00
|
INDICATION: Postprandial right upper quadrant pain.
TECHNIQUE: Ultrasonography of the right upper quadrant.
No comparison studies available.
FINDINGS:
The liver echotexture is normal, and there is no focal intrahepatic lesion or
intrahepatic bile duct dilation. The main portal vein is patent,
demonstrating proper hepatopetal flow. The gallbladder is filled with
numerous mobile stones. However, there is a 9-mm gallbladder neck stone that
is immobile. The gallbladder is not distended, the wall is not thickened, and
there is no pericholecystic fluid, however, mild focal tenderness is present.
The IVC is normal. Included views of the pancreatic body, head, and tail are
normal. The aorta is normal in caliber. No ascites is present.
The right kidney measures 10.6 cm, and there is no stone or hydronephrosis.
IMPRESSION: Cholelithiasis with impacted 9 mm gallbladder neck stone. There
is mild focal tenderness on examination. The gallbladder is not distended, and
there is no wall thickening, however, early acute cholecystitis is a
possibility given the history and findings.
|
10208884-RR-13
| 10,208,884 | 29,568,450 |
RR
| 13 |
2137-05-17 04:55:00
|
2137-05-17 06:00:00
|
EXAMINATION: SECOND OPINION CT TORSO
INDICATION: ___ male with known left hip fracture after a fall
TECHNIQUE: Multidetector axial CT images were acquired of the chest, abdomen
and pelvis after the administration of intravenous contrast. Coronal and
sagittal reformats were obtained. Oral contrast was not administered.
DOSE: DLP: 556 mGy-cm
COMPARISON: None available.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Patient is status post stenting of a descending
thoracic aortic aneurysm. The excluded aneurysm sac measures up to 6.4 cm in
diameter. No evidence of endoleak. The heart, pericardium, and great vessels
are within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi
bilaterally. There is subtle ground glass opacity in the right upper lobe
(02:19) that may represent an infectious process. No pneumothorax, pleural
effusion, or laceration.
THYROID: There is a calcified nodule in the right lobe of the thyroid gland
(2:6).
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a 0.8 cm hypodensity in hepatic segment VI (04:30) that is too small
to characterize, but most likely represents a cyst. No evidence of liver
laceration. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. Cholelithiasis, without evidence of acute cholecystitis.
PANCREAS: The pancreas is diffusely atrophy, although more pronounced in the
head and body, relative to the tail (05:33). No pancreatic ductal dilation.
There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The right kidney is normal in size and enhances homogeneously. There
are two stones in the lower pole of the right kidney (04:41), and an
additional 1.3 cm stone in the right renal pelvis. There is surrounding fat
stranding about the proximal right ureter (04:38) which raises the possibility
of underlying infection. There is cortical atrophy of the left kidney, which
contains a 6.2 x 6.2 cm multiseptated cyst in the upper pole. No
hydronephrosis. No perinephric fat stranding.
GASTROINTESTINAL: There is abnormal wall thickening throughout the esophagus.
Within the distal esophagus, there is a focus of hyperdensity along the
posterior wall measuring approximately 1.1 cm (4:6, 6:30), which requires
further evaluation. Intrinsic enhancement cannot be accessed on this single
phase study. There is a moderately-sized hiatal hernia. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout.
Incidental note is made of a duodenal diverticulum (05:35). There is wall
thickening of the ascending colon (05:36), which may reflect mild colitis.
Remaining loops demonstrate normal wall thickness and caliber throughout.
There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There has been prior graft repair of an abdominal aortic aneurysm,
which is patent. A stent is present in the native right common iliac artery.
There is mild stenosis at the level of the distal graft anastomosis with the
native femoral arteries bilaterally (05:35, 05:31), but vessels demonstrate
normal patency distally.
BONES: There is an acute fracture of the left femoral neck at the head/ neck
junction with surrounding hematoma. There is varus angulation, and mild
impaction of the distal fragment. The distal fracture fragment is superiorly
displaced by approximately 1 cm relative to the femoral head component. No
other fractures are identified. The Ill-defined sclerosis of the right sixth
rib (02:31) may represent fibrous dysplasia.
SOFT TISSUES: There is a left iliacus hematoma that measures approximately
7.6 x 4.5 cm (04:50). Thickening of the left adductor muscles inferiorly,
more pronounced in the adductor minimus (4:83), likely represents an
additional site/extension of intramuscular hematoma. There is evidence of
weakening of the ventral wall hernia mesh (04:29).
IMPRESSION:
1. Acute left femoral subcapital fracture, with surrounding adductor
intramuscular hematoma extending superiorly to involve the left iliacus
muscle.
2. No evidence of trauma within the chest. No solid organ injury within the
abdomen or pelvis.
3. Right upper lobe ground glass opacity may represent infection in the
appropriate clinical setting.
4. Acute ascending colitis.
5. Right nephrolithiasis, including a 1.3 cm stone in the right renal pelvis.
Surrounding periureteral fat stranding raises the possibility of underlying
urinary tract infection.
6. Evidence of ventral wall mesh weakening.
7. Abnormal esophageal wall thickening with a 1.1 cm hyperdense focus along
the posterior wall distally, which can be further evaluated by endoscopy.
8. Status post stenting of a descending thoracic aortic aneurysm, with the
excluded sac measuring 6.4 cm.
9. Mild stenosis at the distal endovascular graft-femoral artery anastomosis
bilaterally.
NOTIFICATION: Updated findings were telephoned to Dr. ___ by ___
___ on ___ at 10:41 AM, approximately 60 minutes after discovery.
|
10208884-RR-14
| 10,208,884 | 29,568,450 |
RR
| 14 |
2137-05-17 06:26:00
|
2137-05-17 09:19:00
|
EXAMINATION: DX FEMUR AND TIB/FIB
INDICATION: ___ male with a known left hip fracture after a fall.
TECHNIQUE: Images of the left hip, knee and ankle for a total of 12 images
COMPARISON: CT torso ___
FINDINGS:
Hip: There is an acute subcapital fracture of the right femoral neck with
superior displacement, varus angulation and mild impaction of the distal
fragment. The distal fracture fragment is superiorly displaced by
approximately 1 cm relative to the femoral head component.
Knee: No acute fracture or dislocation. Medial and lateral compartment
spaces appear preserved. No joint effusion is seen.
Left ankle: Limited images of the left ankle demonstrate no evidence of
fracture.
IMPRESSION:
Acute right femoral subcapital fracture. No other fractures identified.
|
10208884-RR-16
| 10,208,884 | 29,568,450 |
RR
| 16 |
2137-05-20 07:06:00
|
2137-05-20 14:41:00
|
INDICATION: Mr. ___ is a ___ gentleman with history of Crohn's
disease and RA (on methotrexate, Remicade as well as occasional prednisone),
CAD, PVD (s/p stent), AAA repair, and anticoagulated with warfarin for hx of
DVT/PE who is presented after fall with hip fracture, now s/p fixation by
ortho, found to have pancytopenia. // ? colonic dilation
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Limited evaluation without upright or lateral decubitus films, but there is no
gross intraperitoneal free air seen. There are 2 stents overlying the lower
thorax and right hemipelvis, respectively, which are compatible with patient's
known history of descending thoracic aortic aneurysm stent and right common
iliac artery stent. There are corkscrew like metallic densities overlying the
abdomen and compatible with patient's known history of ventral hernia repair.
There is a clip overlying the left mid abdomen. A left total hip arthroplasty
is incompletely visualized.
IMPRESSION:
1. No evidence of small bowel or large bowel dilatation.
|
10208884-RR-17
| 10,208,884 | 29,568,450 |
RR
| 17 |
2137-05-20 13:42:00
|
2137-05-20 14:59:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS LEFT
INDICATION: ___ year old man POD2 L hip hemi // post op hip hemi post
op hip hemi
TECHNIQUE: AP pelvis and two views of the left hip.
COMPARISON: ___
FINDINGS:
Left hip hemiarthroplasty. Mild background hip joint degenerative change
bilaterally. There is vascular calcification. There is an apparent vascular
stent in the right hemipelvis. Density in the soft tissues of the medial
right thigh unchanged from prior. Apparent prior mesh hernia repair in the
lower abdomen right flank. Degenerative changes lower lumbar spine partly
seen. Soft tissue gas and staples along the left hip surgical site. Small
corticated bone fragment is seen along the native left femoral neck, measuring
2.7 cm in length.
IMPRESSION:
Satisfactory appearance of left total hip arthroplasty.
Small bone fragment along the native left medial femoral neck is noted.
|
10208884-RR-18
| 10,208,884 | 29,568,450 |
RR
| 18 |
2137-05-24 16:17:00
|
2137-05-24 17:05:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ gentleman with history of Crohn's disease and RA (on
prednisone, methotrexate, Remicade), CAD, PVD (s/p stent), AAA repair, and
anticoagulated with warfarin for hx of DVT/PE admitted for L hip fracture and
pancytopenia. // ? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Soft tissue thickening is seen overlying the left calf.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the ___ ___ at 5:02 ___, 1 minutes after discovery of
the findings.
|
10208917-RR-10
| 10,208,917 | 29,555,885 |
RR
| 10 |
2183-04-17 19:10:00
|
2183-04-17 20:23:00
|
HEAD CT
HISTORY: Fall, head injury and seizure.
COMPARISONS: Prior head CT studies from ___ and ___, the
latter an outside study as scanned into ___ PACS.
TECHNIQUE: Non-contrast head CT.
FINDINGS: There is a stable area of encephalomalacia involving the left
frontal lobe. There is no evidence of intra- or extra-axial hemorrhage.
There is no mass effect, hydrocephalus or shift of the normally midline
structures. Secretions are present in the nasopharynx. The scout view shows
that the patient is intubated with an orogastric tube. The mastoid air cells
appear clear. There is persistent moderate mucosal thickening among ethmoid
air cells and at the frontoethmoid recesses. The nasal bones show
irregularity but similar to the prior study suggesting earlier fractures. The
patient is status post left frontal craniotomy. There is no evidence for
recent fracture. Vascular calcifications are widespread.
IMPRESSION: No evidence of acute intracranial process.
|
10208917-RR-11
| 10,208,917 | 29,555,885 |
RR
| 11 |
2183-04-17 19:13:00
|
2183-04-17 20:27:00
|
CT OF THE CERVICAL SPINE
HISTORY: Seizure, fall, and head injury.
COMPARISONS: None.
TECHNIQUE: Multidetector CT images of the cervical spine were obtained
without intravenous contrast. Sagittal and coronal reformations were also
performed.
FINDINGS: Anterior osteophytes of moderate size involve the C5-C6 and C6-C7
levels. Small anterior osteophytes are present at C2-C3 and C3-C4.
Prevertebral soft tissues are mildly prominent but this can be seen with
endotracheal intubation. There is no evidence of fracture, dislocation or
bone destruction. There is no spondylolisthesis.
IMPRESSION: No evidence for fracture or dislocation.
|
10208917-RR-12
| 10,208,917 | 29,555,885 |
RR
| 12 |
2183-04-18 02:17:00
|
2183-04-18 13:35:00
|
INDICATION: ___ male with seizure in setting of likely alcohol use,
now intubated.
COMPARISON: Comparison is made with chest radiographs from ___
and ___.
FINDINGS: Two frontal images of the chest demonstrate a left basilar hazy
opacity concerning for left lower lobe pneumonia. There is no pleural
effusion or pneumothorax. There is some vascular crowding likely due to low
lung volumes from poor inspiration. Heart size is normal.
IMPRESSION: Right lower lobe opacity consistent with pneumonia.
|
10208917-RR-13
| 10,208,917 | 29,555,885 |
RR
| 13 |
2183-04-19 00:10:00
|
2183-04-19 09:41:00
|
STUDY: MRI of the cervical spine.
CLINICAL INDICATION: ___ man with neck pain, status post fall,
trauma, rule out cervical injury.
COMPARISON: Prior CT of the cervical spine dated ___.
TECHNIQUE: Sagittal T1, T2, and sagittal STIR sequences were obtained
throughout the cervical spine, axial T2 and axial gradient echo sequences were
also performed.
FINDINGS: The examination is partially limited due to patient motion. The
visualized elements of the posterior fossa and the craniocervical spine are
unremarkable.
The signal intensity throughout the cervical spinal cord is normal with no
evidence of focal or diffuse lesions. There is no evidence of cervical
subluxation or malalignment. The anterior prevertebral soft tissues are
grossly normal. At C2/C3 and C3/C4 levels, there is no evidence of spinal
canal stenosis or nerve root compression.
At C4/C5 level, there is disc desiccation and mild posterior disc bulge,
causing anterior thecal sac deformity, mild bilateral uncovertebral
hypertrophy is present, causing mild-to-moderate right-sided neural foraminal
narrowing (image #21, series #6).
At C5/C6 level, there is a posterior disc protrusion, causing mild anterior
thecal sac deformity, additionally bilateral uncovertebral hypertrophy is
present, causing moderate-to-severe bilateral neural foraminal narrowing
(images #25, 26, series #6).
At C6/C7 level, there is bilateral uncovertebral hypertrophy, causing
bilateral neural foraminal narrowing, left greater than right (image #30,
series #6). C7/T1 level appears unremarkable.
IMPRESSION:
1. There is no evidence of cervical malalignment, the signal intensity
throughout the cervical spinal cord is normal with no evidence of focal or
diffuse lesions.
2. Multilevel disc degenerative changes, more significant at C4/C5, C5/C6 and
C6/C7 levels.
These findings were communicated to Dr. ___, via phone call by Dr. ___
___ at 8:32 a.m. on ___.
|
10208917-RR-9
| 10,208,917 | 29,555,885 |
RR
| 9 |
2183-04-17 18:55:00
|
2183-04-18 09:46:00
|
HISTORY: ET tube placement.
FINDINGS: In comparison with study of ___, there is an endotracheal tube in
place with its tip approximately 5.5 cm above the carina. Nasogastric tube
extends to the upper stomach with the side hole distal to the esophagogastric
junction.
No evidence of acute focal pneumonia or vascular congestion.
|
10209056-RR-12
| 10,209,056 | 22,246,020 |
RR
| 12 |
2132-09-05 09:40:00
|
2132-09-05 09:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with chronic cough, posterior rib/back pain //
eval for PNA, rib fracture
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Low lung volumes accentuate the cardiomediastinal contours and result in
crowding broad the bowel is structures at the lung bases. With this
limitation, heart size is normal, and lungs are clear except for minimal
linear bibasilar atelectasis. No pleural effusion or pneumothorax. No
pleural effusion or pneumothorax is seen. There are no acute osseous
abnormalities.
IMPRESSION:
Low lung volumes with minimal bibasilar atelectasis.
|
10209056-RR-13
| 10,209,056 | 22,246,020 |
RR
| 13 |
2132-09-06 16:20:00
|
2132-09-06 17:25:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with localized left-sided back pain at the level
of T7-T9, SIADH. // Please evaluate bone for lytic lesions and lung
parenchyma for masses or nodules.
TECHNIQUE: Multidetector CT performed without the administration of contrast
of the entire volume of the thorax with multi planar reformations and MIP
reconstructions.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 38.0 cm; CTDIvol = 15.6 mGy (Body) DLP = 591.8
mGy-cm.
Total DLP (Body) = 592 mGy-cm.
COMPARISON: No priors.
FINDINGS:
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: No thyroid lesions. No
supraclavicular or axillary adenopathy. No breast lesions.
UPPER ABDOMEN: This study was not tailored to evaluate the subdiaphragmatic
organs. No adrenal lesions. Dense contrast seen dependently in the
gallbladder in keeping with vicarious excretion of contrast. Mild distention
of the gallbladder measuring 97 x 55 mm. No surrounding stranding or fluid
for.
MEDIASTINUM: No mediastinal adenopathy.
HILA: No hilar adenopathy.
HEART and PERICARDIUM: Normal cardiac configuration. No aortic valve
calcification. Mild LAD and right coronary artery calcification. No
pericardial effusion.
PLEURA: No pleural effusion.
LUNG:
-PARENCHYMA: No suspicious pulmonary nodules or masses. No pneumonia. No
diffuse lung disease.
-AIRWAYS: Patent to the subsegmental level.
-VESSELS: Pulmonary arteries not enlarged.
CHEST CAGE: Spondylotic changes of the thoracic spine. No lytic/ destructive
lesions.
IMPRESSION:
No CT findings explaining the clinical condition of the patient.
Mild distention of the gallbladder containing contrast (vicarious excretion of
contrast).
|
10209431-RR-10
| 10,209,431 | 22,784,629 |
RR
| 10 |
2153-09-25 15:43:00
|
2153-09-25 16:07:00
|
IMPRESSION:
___
Department of Radiology
Standard Report Carotid US
Study: Carotid Series Complete
Reason: ___ year old man with CAD, pre/op CABG.
Findings:
Duplex evaluation was performed of bilateral carotid arteries. On the right
there is mild heterogeneous plaque in the ICA. On the left there is mild
heterogeneous plaque seen in the ICA.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 90/21, 88/23, 80/22, cm/sec. CCA peak systolic
velocity is 107 cm/sec. ECA peak systolic velocity is 157 cm/sec. The ICA/CCA
ratio is .84 . These findings are consistent with <40% stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 85/18, 48/9, 70/24, cm/sec. CCA peak systolic
velocity 97 cm/sec. ECA peak systolic velocity is 125 cm/sec. The ICA/CCA
ratio is .87 . These findings are consistent with <40% stenosis.
Right antegrade vertebral artery flow.
Left antegrade vertebral artery flow.
Impression:
Right ICA <40 % stenosis
Left ICA <40% stenosis.
|
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