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10209431-RR-12
| 10,209,431 | 22,784,629 |
RR
| 12 |
2153-09-27 12:14:00
|
2153-09-27 13:32:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with CAD s/p CABG. Please ___ at
___ with abnormalities. // FAST TRACK EXTUBATION CARDIAC SURGERY, FAST
TRACK EXTUBATION CARDIAC SURGERY Contact name: ___: ___
FAST TRACK EXTUBATION CARDIAC SURGERY, FAST TRACK EXTUBATION
IMPRESSION:
Arison to study of ___, the there is been a CABG procedure performed with
intact midline sternal wires. Endotracheal tube tip lies approximately 5 cm
above the carina. Right IJ J catheter extends to the lower SVC. Nasogastric
tube coils within the stomach with the side port well distal to the
esophagogastric junction. Left chest tube is in place and there is no
evidence of pneumothorax.
There are low lung volumes that accentuate the prominence of pulmonary
vessels. Atelectatic changes are seen in the retrocardiac region.
|
10209431-RR-13
| 10,209,431 | 22,784,629 |
RR
| 13 |
2153-09-28 10:06:00
|
2153-09-28 16:58:00
|
INDICATION: ___ year old man with ct's to water seal // please eval for PTX-
obtain CXR at 10:30am
TECHNIQUE: Single AP view
COMPARISON: ___
FINDINGS:
There has been interval extubation and removal of enteric tube. Right-sided
central line terminates at the cavoatrial junction. Left chest tube to water
seal with a 1.3 cm left apical pneumothorax. Low lung volumes and bibasilar
atelectasis noted. Stable cardiomegaly.
IMPRESSION:
Left-sided chest tube to water seal, 1.3 cm left apical pneumothorax present.
|
10209431-RR-14
| 10,209,431 | 22,784,629 |
RR
| 14 |
2153-09-28 16:06:00
|
2153-09-28 18:00:00
|
INDICATION: ___ year old man s/p CABG // eval pneumo
TECHNIQUE: Single AP radiograph of the chest
COMPARISON: ___
FINDINGS:
Low lung volumes with unchanged bibasilar atelectasis. No pleural effusion or
pneumothorax. Unchanged cardiomegaly. Patient is status post extubation.
Right-sided central line terminates at the cavoatrial junction. Left chest
tubes in unchanged position.
IMPRESSION:
No pneumothorax. Persistent low lung volumes with unchanged bibasilar
atelectasis. Unchanged cardiomegaly.
|
10209431-RR-15
| 10,209,431 | 22,784,629 |
RR
| 15 |
2153-09-29 09:55:00
|
2153-09-29 13:24:00
|
INDICATION: ___ year old man with SOB - chest tubes found off sxn // eval for
PTX
TECHNIQUE: APsingle view
COMPARISON: ___
FINDINGS:
The lung volumes are low with unchanged bibasilar patchy and linear opacities.
Small left pleural effusion. No pneumothorax noted on this single radiograph.
Unchanged position of right IJ catheter and left chest tube. Unchanged
cardiomegaly, sternal sutures and surgical material projecting over the
mediastinum.
IMPRESSION:
No pneumothorax. Persistent low lung volumes with bibasilar atelectasis.
|
10209431-RR-16
| 10,209,431 | 22,784,629 |
RR
| 16 |
2153-09-30 09:31:00
|
2153-09-30 11:11:00
|
INDICATION: ___ year old man with cabg // r/o ptx, s/p ct d/c
COMPARISON: Radiographs from ___
IMPRESSION:
The right IJ central line has the distal lead tip at the cavoatrial junction.
The left basilar chest tube has been removed. There is again seen markedly
low lung volumes with atelectasis at the lung bases. No definite
consolidation or pneumothoraces are identified.
|
10209431-RR-8
| 10,209,431 | 22,784,629 |
RR
| 8 |
2153-09-24 17:32:00
|
2153-09-24 20:13:00
|
EXAMINATION: CHEST RADIOGRAPHS
INDICATION: Chest pain.
TECHNIQUE: Chest, PA and lateral.
COMPARISON: ___.
FINDINGS:
There is similar mild to moderate relative elevation of the right
hemidiaphragm. Lungs are also overall low in volume. Opacity along the right
hemidiaphragm is consistent with unchanged atelectasis associated with the
right hemidiaphragm. A previously noted opacity in the right upper lobe has
resolved. There is no pleural effusion or pneumothorax.
IMPRESSION:
No evidence of acute cardiopulmonary disease.
|
10209608-RR-52
| 10,209,608 | 24,841,722 |
RR
| 52 |
2135-01-17 19:36:00
|
2135-01-17 22:30:00
|
EXAMINATION: Chest radiograph, portable AP upright.
INDICATION: Diabetic ketoacidosis, shortness of breath on exertion,
leukocytosis.
COMPARISON: Prior study from ___, earlier on the same day.
FINDINGS:
Heart is normal in size. Mediastinal and hilar contours appear within normal
limits. Lungs appear clear. There is no pleural effusion or pneumothorax.
IMPRESSION:
No evidence of acute cardiopulmonary disease.
|
10209685-RR-21
| 10,209,685 | 20,456,737 |
RR
| 21 |
2128-04-18 09:31:00
|
2128-04-18 11:17:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with asymmetric LLE swelling // DVTY?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
Please note that there is a discrepancy between the ordered side ,which was
the left side, and the side which the patient complained of pain, the right
side. This was clarified with the ordering team by the tech, and a scan of
the right side was obtained.
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 and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
There is a medial popliteal fossa (___) cyst measuring 5 cm x 1 cm is noted.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. ___ cyst measuring 5 cm x 1 cm in the right popliteal fossa.
|
10209685-RR-22
| 10,209,685 | 20,456,737 |
RR
| 22 |
2128-04-18 13:34:00
|
2128-04-18 14:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with aflutter, looking to see if PNA/pulmonary edema
// any consolidation, volume overload?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Lungs are relatively hyperinflated. No definite focal consolidation is seen.
There is no large pleural effusion or pneumothorax. Cardiac silhouette is
mildly to moderately enlarged. No overt pulmonary edema is seen.
IMPRESSION:
No overt pulmonary edema. Cardiomegaly.
|
10209685-RR-5
| 10,209,685 | 20,705,174 |
RR
| 5 |
2123-11-22 13:07:00
|
2123-11-22 13:30:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with history of atrial fibrillation presents with
lightheadedness and vertigo.
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: None.
FINDINGS:
Cardiac silhouette size is normal. Mediastinal and hilar contours are
unremarkable. Pulmonary vasculature is normal. Lungs are essentially clear
except for minimal atelectasis in the lower lobes. No focal consolidation,
pleural effusion or pneumothorax is present. Moderate degenerative changes
with anterior osteophyte formation seen in the lower thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10209685-RR-6
| 10,209,685 | 20,705,174 |
RR
| 6 |
2123-11-22 15:52:00
|
2123-11-22 17:01:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ with history of atrial fibrillation who presents with new
onset vertigo and presyncope.
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered, curved
reformatted and segmented images were generated. This report is based on
interpretation of all of these images.
DOSE: This study involved 5 CT acquisition phases with dose indices as
follows: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced
Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP = 897.1 mGy-cm. 4)
Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 65.3 mGy (Head) DLP = 32.7
mGy-cm. 5) Spiral Acquisition 4.9 s, 38.3 cm; CTDIvol = 35.5 mGy (Head) DLP =
1,361.7 mGy-cm. Total DLP (Head) = 2,292 mGy-cm.
COMPARISON: None available.
FINDINGS:
Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or
acute vascular territorial infarction. Prominent ventricles and sulci are
likely due to age-related volume loss. Bilateral periventricular, subcortical
and deep white matter densities are non-specific, but may be a sequela of
chronic small vessel ischemic disease. No fractures are identified. There is
mucosal thickening within the bilateral maxillary and ethmoid sinuses.
Frontal and sphenoid sinuses are clear. The mastoid air cells are well
aerated bilaterally. The orbits are unremarkable.
Head CTA: The anterior and posterior circulation vessels are widely patent,
without evidence of aneurysm, stenosis or dissection. Incidental note is made
of a fetal origin of the right PCA, a normal variant.
Neck CTA: There is a normal 3-vessel arch. Atherosclerotic calcifications
are seen at the aortic arch and cavernous portions of bilateral internal
carotid arteries. The carotid and vertebral arteries and their major branches
are otherwise patent with no evidence of stenoses. There is no evidence of
internal carotid stenosis by NASCET criteria.
There is a small focus of nonspecific density/consolidation along the anterior
lateral aspect of the left upper lobe (5:10). There is a 10 x 8 mm hypodense
nodule in the left thyroid lobe (5:90). Mild multilevel degenerative changes
are noted in the cervical spine.
IMPRESSION:
1. No acute vascular territory infarction or intracranial hemorrhage. Chronic
changes include atrophy and probable small vessel ischemic changes.
2. No evidence of arterial dissection, stenosis or aneurysm >3mm in the great
vessels of the head and neck.
3. 10 x 8mm left thyroid nodule.
RECOMMENDATION(S): Consider non-urgent thyroid ultrasound for further
characterization of the left thyroid nodule described above, if clinically
warranted.
|
10209685-RR-7
| 10,209,685 | 20,705,174 |
RR
| 7 |
2123-11-22 23:26:00
|
2123-11-23 08:58:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old woman with resolved but sudden onset and vertigo x
hours // ? e/o small stroke or broken up embolus in the cerebellum
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique.
COMPARISON: CTA head and neck ___.
FINDINGS:
There is no evidence of hemorrhage or mass effect. The ventricles and basal
cisterns appear normal.
There are normal vascular flow voids. There is no evidence of infarction.
There is diffuse brain parenchymal volume loss. There are punctate and
confluent areas of T2/FLAIR signal hyperintensity within the subcortical and
periventricular white matter, a nonspecific finding though most often ascribed
to sequelae of chronic small vessel ischemic disease.
There is a right maxillary sinus mucosal retention cyst. The orbits and
mastoid air cells are unremarkable.
IMPRESSION:
1. No evidence of hemorrhage, mass effect, or infarction.
2. Brain parenchymal volume loss and probable sequelae of chronic
microangiopathy.
|
10210153-RR-68
| 10,210,153 | 29,401,675 |
RR
| 68 |
2202-01-02 16:50:00
|
2202-01-03 17:50:00
|
HISTORY: Unsteady gait of uncertain etiology
COMPARISON: MRI from ___
TECHNIQUE:
Multi planar MR images are acquired through the cervical spine without
intravenous contrast
FINDINGS:
Vertebral body heights and alignment are normal. Bone marrow signal reveals
degenerative changes, though no focal concerning abnormality. Spinal cord
signal is normal.
C2-C3: There is no spinal canal or neural foraminal narrowing. There is no
disk herniation.
C3-C4: There is mild spinal canal narrowing, and no neural foraminal
narrowing. Note is made of a small disc bulge, and minimal right
uncovertebral arthropathy.
C4-C5: There is moderate spinal canal narrowing and moderate bilateral neural
foraminal narrowing. The findings are related to a disc bulge, with
superimposed central disc protrusion which results in moderate deformation of
the spinal cord. Note is also made of bilateral uncovertebral arthropathy.
C5-C6: There is moderately severe spinal canal and bilateral neural foraminal
narrowing. Findings are related to a disc bulge, with central and left
paracentral disc protrusion as well as bilateral uncovertebral arthropathy.
There is associated deformation of the spinal cord.
C6-C7: There is moderate spinal canal narrowing, severe right neural
foraminal narrowing and minimal left neural foraminal narrowing. Findings are
related to a disc bulge, superimposed right paracentral disc protrusion and
right uncovertebral arthropathy. There is associated deformation of the
spinal cord.
Overall, when accounting for differences in technique, findings are minimally
changed since ___.
IMPRESSION:
Extensive cervical spinal degenerative change, including moderate spinal canal
narrowing with deformation of the spinal cord from C4 through C7. Overall,
when accounting for differences in technique, findings are minimally changed
since ___.
|
10210328-RR-64
| 10,210,328 | 25,464,052 |
RR
| 64 |
2190-11-17 14:38:00
|
2190-11-17 15:18:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with ruq abd pain and jaundice // blocked CBD
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MR abdomen ___
FINDINGS:
LIVER: The liver is shrunken with a nodular contour and heterogeneous
echotexture compatible with known cirrhosis. There is a known 1.6 cm cyst in
the left lobe. There is a heterogeneous 4.5 x 2.8 x 3.1 cm ablation site in
segment 7 previously evaluated by MRI.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm.
GALLBLADDER: The gallbladder contains numerous stones and shows wall
thickening and minimal pericholecystic fluid likely reflecting underlying
liver disease. This is similar to recent MRI.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 14.3 cm.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
Right-sided pleural effusion is noted.
IMPRESSION:
Cholelithiasis. Gallbladder wall thickening and pericholecystic fluid which
could be related to underlying liver disease similar to recent MRI but to be
correlated clinically. No intra or extrahepatic biliary duct dilation.
|
10210328-RR-65
| 10,210,328 | 25,464,052 |
RR
| 65 |
2190-11-18 12:14:00
|
2190-11-18 17:03:00
|
EXAMINATION: MRCP
INDICATION: ___ year old woman with ? dilated CBD and elevated tbili - eval
for CBD dilation, obstruction // ___ year old woman with ? dilated CBD and
elevated tbili - eval for CBD dilation, obstruction
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 3.0 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: Comparison made to previous MRI from ___.
FINDINGS:
Lower Thorax: Moderate right pleural effusion, decreased compared to previous.
There is associated dependent subsegmental atelectasis within bilateral bases.
Liver: Cirrhotic liver with multiple siderotic nodules. There is a 1.1 x 1.5
cm cyst in segment ___ as well as multiple cysts in segment 7, largest
measuring 0.7 cm. RFA site within segment ___ measures 3.0 x 4.0 cm which is
similar compared to previous. There is some internal coagulation necrosis.
No evidence of residual tumor is appreciated. There is surrounding
non-nodular enhancement representing expected hyperemia post RFA.
Additionally, there is associated segmental intrahepatic biliary ductal
dilatation, within expected post procedural limits. The second RFA site is
appreciated in segment 7 and measures 1.6 x 1.8 cm, unchanged compared to
previous, with evidence of intrinsic T1 hyperintense coagulation necrosis. No
residual tumor is appreciated. There are no lesions that meet OPTN criteria
for HCC. There is a peripheral arterially enhancing nodule within segment ___
(1301:68), likely a perfusion anomaly. Overall there is reticular enhancement
on the delayed phase due to underlying fibrosis.
There is extensive paraesophageal and gastric varices, as well as splenic
varices in this patient. There is a patent splenorenal shunt. The left main
portal vein is attenuated. There is a recanalized umbilical vein, with
extensive varices. However, the main portal vein is patent. There is minimal
perihepatic ascites.
Biliary: No intrahepatic or extrahepatic biliary ductal dilatation.
Cholelithiasis without evidence of cholecystitis. Possible adenomyomatosis at
the fundus versus a phrygian cap with calculus.
Pancreas: Normal appearance of the pancreas. There are small sub 5 mm cysts
within the pancreatic body and tail. The main pancreatic duct is not dilated.
Spleen: Splenomegaly measuring 16.7 cm. Multiple Gamna Gandy bodies are
present.
Adrenal Glands: Normal appearance of the right adrenal gland. The left
adrenal gland is not well seen due to the surrounding collaterals.
Kidneys: There are few small simple cysts within the kidneys bilaterally. No
evidence of hydronephrosis.
Gastrointestinal Tract: The imaged alimentary tract is within normal limits.
No evidence of bowel wall thickening or dilatation.
Lymph Nodes: No intra-abdominal or retroperitoneal lymphadenopathy.
Vasculature: There is conventional anatomy of the visceral arteries.
Osseous and Soft Tissue Structures: There is a T11 vertebral body hemangioma.
IMPRESSION:
1. Post RFA status of segment 7 and segment 4B/ 5, without evidence of
residual tumor. No lesions meeting OPTN Class 5 for HCC in the current study.
2. Cirrhosis and confluent fibrosis, with sequelae of portal hypertension
including splenomegaly with Gamma Gandy bodies, extensive esophageal and
gastric varices, and recanalized umbilical vein.
3. Cholelithiasis without cholecystitis.
4. Mild interval decrease in the size of the moderate right non hemorrhagic
pleural effusion.
5. No evidence of biliary obstruction.
|
10210832-RR-10
| 10,210,832 | 26,289,690 |
RR
| 10 |
2157-05-24 18:05:00
|
2157-05-24 18:36:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD
INDICATION: ___ year old man with skull base lesion, please perform CT/CTA
with image guidance/EEA protocol (include tip of nose, NO eye shield). //
Evaluate anatomy, Pre-operative planning
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
4) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 59.9 mGy (Head) DLP =
30.0 mGy-cm.
5) Spiral Acquisition 3.7 s, 28.9 cm; CTDIvol = 30.6 mGy (Head) DLP = 881.7
mGy-cm.
Total DLP (Head) = 1,815 mGy-cm.
COMPARISON: Comparison is made to MRI/ MRA of the brain from earlier today,
as well as outside CTA of the head from ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is re- demonstration of a hyperdense mass centered in the right
cavernous sinus, with extension into the right sphenoid sinus and erosion of
the clivus and sella on the right (02:12). Elsewhere, there is no evidence of
acute vascular territorial infarction, intracranial hemorrhage, or edema. The
ventricles and sulci are normal in size and configuration.
The middle ear cavities and mastoid air cells are clear, as are the bilateral
maxillary and frontal sinuses. The orbits are unremarkable.
CTA HEAD:
Multiple serpiginous, tear-drop shaped, and rounded foci of arterial
enhancement centered within the right cavernous sinus mass suggest dense
vascularity or pseudoaneurysm formation (3:111), although there is no distinct
connection between the apparent internal carotid artery on the right. No
sequelae of carotid cavernous fistula is noted, as the parent right internal
carotid artery is normal in caliber, with no evidence of aneurysmal formation
or stenosis, in the superior right ophthalmic vein is normal in appearance.
The mass measures approximately 3.0 x 1.8 cm in the axial plane, not
significantly changed. There is slight ___ lateral displacement of the
right internal carotid artery, which is otherwise unremarkable. The remaining
vessels of the circle of ___ and their principal intracranial branches
appear normal with no evidence of stenosis,occlusion or aneurysm. The dural
major venous sinuses are patent.
The previously described expansile lytic lesion centered in the right
mandibular ramus demonstrates postcontrast enhancement centrally (2:2, 3:70).
Along the inferior aspect of the mass as it approaches the angle of the
mandible, there is anterior cortical bone loss (03:56). The patient is
partially edentulous along the posterior right mandible, with absence of the
first through third molars, and a small amount of residual soft tissue or
fluid in the expected location of the first and second mandibular molars on
the right (03:39, 46).
IMPRESSION:
1. Lobulated, densely vascular mass is centered in the right cavernous sinus
and appears partially cystic, with extension into the right sphenoid sinus and
erosion of the right clivus and sella. Differential diagnosis is broad and
includes ___'s cell histiocytosis, sarcoma, and less likely atypical
hemangioma or atypical mucocele.
2. Expansile, lytic lesion in the right mandible with central enhancing
component could also be explained by ___'s cell histiocytosis or
sarcoma.
3. Numerous enhancing blood vessels and possible pseudoaneurysms within the
right cavernous sinus mass are demonstrated on the CTA, and although the right
internal carotid artery is slightly anterolaterally displaced, there is no
evidence of internal carotid artery stenosis or discrete feeding vessel.
4. No CTA sequelae of carotid-cavernous fistula.
RECOMMENDATION(S): Dedicated catheter angiogram is recommended for further
evaluation of findings described in IMPRESSION #'s 1 and 3.
|
10210832-RR-11
| 10,210,832 | 26,289,690 |
RR
| 11 |
2157-05-26 16:48:00
|
2157-05-26 17:52:00
|
EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: ___ year old man with erosive sinus lesion, evaluate soft tissue
involvement // ___ year old man with erosive sinus lesion, evaluate soft
tissue involvement
TECHNIQUE: Imaging was performed after administration of Omnipaque
intravenous contrast material.
MDCT acquired helical axial images were obtained from the thoracic inlet
through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 7.8 s, 30.0 cm; CTDIvol = 15.7 mGy (Body) DLP = 445.4
mGy-cm.
Total DLP (Body) = 463 mGy-cm.
COMPARISON: CTA and MRI/ MRA of the head dated ___.
FINDINGS:
Redemonstrated is a highly vascularized, lobular, erosive mass extending from
the right cavernous sinus into the right sphenoid sinus with associated
erosion of the right clivus and sella. A second, expansile, lytic lesion is
again seen within the right mandible, without evidence of cortical
breakthrough.
Evaluation of the aerodigestive tract demonstrates no intraluminal mass, and
no areas of focal mass effect.
The salivary glands enhance normally and are without mass or adjacent fat
stranding. The thyroid gland appears normal. There is no lymphadenopathy by
CT criteria. The neck vessels are patent.
The imaged portion of the lung apices are clear and there are no concerning
pulmonary nodules.
IMPRESSION:
Unchanged appearance of highly vascular erosive mass centered in the right
cavernous sinus and a lytic expansile mass centered in the right mandible. No
evidence of inferior extension into the soft tissues of the neck. No
pathologic cervical lymphadenopathy is identified.
|
10210832-RR-13
| 10,210,832 | 26,289,690 |
RR
| 13 |
2157-05-26 17:17:00
|
2157-05-26 18:37:00
|
EXAMINATION: Mandible (panorex)
INDICATION: ___ year old man with right mandibular lesion // ___ year old man
with right mandibular lesion
TECHNIQUE: One view of the mandible
COMPARISON: CTA neck ___ and CT neck ___
FINDINGS:
The previously identified expansile lesion in the right mandible is not well
seen on this examination. There is a faint ill-defined lucency within the
angle/body the right mandible which may correlate with findings on prior
imaging. No fracture or evidence of cortical destruction. No lucent lesions
or periapical lucency.
IMPRESSION:
The previously identified expansile lesion in the right mandible is not well
seen on this examination and is better characterized on prior imaging.
|
10210832-RR-9
| 10,210,832 | 26,289,690 |
RR
| 9 |
2157-05-24 04:36:00
|
2157-05-24 06:37:00
|
EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: ___ year old male with headaches, visual changes, CN3 and 6
deficits with sphenoid sinus mass eroding into cavernous sinus.
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
Three dimensional maximum intensity projection and segmented images were
generated. Sagittal and axial T1 weighted imaging were performed along with
diffusion imaging. After administration of 8 mL of Gadavist intravenous
contrast, axial imaging was performed with gradient echo, FLAIR, T2, and T1
technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and
coronal orientations. This report is based on interpretation of all of these
images.
COMPARISON: Head CT/CTA from ___.
FINDINGS:
MRI BRAIN:
There is a 2.8 cm AP x 2.1 cm TR x 1.9 cm SI lobulated, heterogeneous mass
within the right lateral aspect of the cavernous sinus and within the right
sphenoid sinus. The mass demonstrates hyperintensity with multiple linear
foci of low signal (likely flow voids) on T2 weighted images, isointensity to
the brain with multiple small foci of hyperintensity (likely flow related
enhancement within small blood vessels) on precontrast T1 weighted images, and
relatively homogeneous enhancement on postcontrast T1 weighted images. The
mass appeared hypervascular on the preceding CTA. The mass extends into the
sella, displacing the pituitary gland superiorly and to the left, and
displacing the infundibulum to the left. The pituitary gland approaches but
does not compress the optic chiasm on the right. The preceding CTA
demonstrates erosion of the right sellar floor. There is abnormal signal in
the right lateral clivus, where the preceding CTA demonstrates erosion.
Slightly asymmetric there dural enhancement along the right medial floor of
the middle cranial fossa is seen, which may be reactive or may indicate
invasion.
There is an expansile T2 hyperintense enhancing lesion involving the right
mandibular body, angle, and ramus, which was partially visualized on the
preceding CTA.
Within the brain parenchyma, there is no evidence for edema, abnormal
diffusion, blood products, or mass.
There is mild mucosal thickening in the ethmoid air cells.
MRA BRAIN:
The intracranial vertebral and internal carotid arteries and their major
branches appear widely patent without evidence for flow-limiting stenosis or
aneurysm formation. Fetal configuration of the right posterior cerebral
artery is noted with a small P1 segment and a large right posterior
communicating artery, a normal variant. While the preceding CTA demonstrated
a large blood vessel with the same density as the arteries within the right
cavernous sinus/sphenoid mass, the present MRA demonstrates no definite
arterial flow within the mass. The mass displaces the right cavernous carotid
artery anterolaterally without narrowing.
IMPRESSION:
1. Large lobulated mass within the right cavernous sinus mass and the right
sphenoid sinus, with erosion into the right aspect of the sella and erosion of
the right clivus. The mass demonstrates multiple small blood vessels. While
the CTA from one day earlier demonstrated a large blood vessel with same
density as other arteries within the mass, the present MRA does not
demonstrate any arterial flow within the mass.
2. Expansile aggressive lesion in the right mandible, which is only partially
included on the present MRI and the preceding CT, and is therefore not
optimally assessed.
3. Diagnostic considerations for the right cavernous sinus/right sphenoid
sinus mass include atypical aggressive hemangioma (although the large blood
vessel with arterial density on the preceding CTA new would be unusual even
for an atypical hemangioma). Diagnostic considerations for both
above-described lesions include Langerhans cell histiocytosis and sarcoma.
Metastatic disease is less likely but may also be considered in an appropriate
clinical setting.
4. The right cavernous internal carotid artery is displaced anterolaterally by
the right cavernous sinus/sphenoid mass without narrowing.
RECOMMENDATION(S):
1. Recommend conventional cerebral angiography to determine whether there is
any arterial flow within the right cavernous sinus/sphenoid sinus mass.
2. Recommend a dedicated CT of the mandible for better characterization of the
right mandibular lesion.
|
10210916-RR-17
| 10,210,916 | 26,080,000 |
RR
| 17 |
2113-11-01 13:38:00
|
2113-11-01 15:23:00
|
EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with concern for first time seizure. Evaluate
for stroke or seizure focus.
TECHNIQUE: Sagittal MP RAGE with multiplanar reformations, sagittal 3D FLAIR
with multiplanar reformations, coronal FSTIR, axial diffusion weighted, and
axial gradient echo images of the brain were obtained. All images were
reviewed in the production of this report. The examination was performed using
a 1.5T MRI scanner.
COMPARISON: Head CT from ___
FINDINGS:
There is no evidence of edema, mass effect, acute infarction, or blood
products. Prominence of the ventricles and sulci is compatible with
involutional changes. Small foci of high T2 signal in the periventricular,
deep, and subcortical white matter of the cerebral hemispheres are nonspecific
but likely reflect sequelae of chronic small vessel ischemic disease in this
age group.
Symmetric severe volume loss of the bilateral hippocampi is disproportionate
to the moderate age-related parenchymal volume loss in the remainder of the
brain. No hippocampal signal abnormalities are seen. No other structural
abnormalities are seen.
IMPRESSION:
1. No evidence of a seizure focus on non-contrast MRI. No evidence for acute
intracranial abnormalities.
2. Severe, symmetric bilateral hippocampal volume loss is disproportionate to
the moderate age-related parenchymal volume loss in the remainder of the
brain. Please correlate with any memory problems.
|
10211120-RR-12
| 10,211,120 | 21,230,206 |
RR
| 12 |
2129-08-27 20:40:00
|
2129-08-28 12:09:00
|
TECHNIQUE: MRI of the brain without gad. MR venogram
HISTORY: Persistent headaches and visual complaints.
COMPARISON: None.
FINDINGS: There is no intracranial mass, mass effect or midline shift. There
is no hydrocephalus or acute ischemia. Flow voids are maintained. MR
venogram demonstrates no evidence for venous sinus thrombosis. There is
mucosal thickening in the right maxillary sinus.
IMPRESSION:
Unremarkable study.
|
10211404-RR-60
| 10,211,404 | 20,311,499 |
RR
| 60 |
2131-06-15 13:10:00
|
2131-06-15 15:45:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with ETOH, syncope, low grade temps, breast
cancer. // Please perform CXR to look for cause of low grade temps and or
syncope. Please perform CXR to look for cause of low grade temps and or
syncope.
IMPRESSION:
Compared to chest radiographs ___.
Heart size top-normal unchanged. Lungs clear. No pleural abnormality or
evidence of central lymph node enlargement.
|
10211404-RR-61
| 10,211,404 | 20,311,499 |
RR
| 61 |
2131-06-16 14:02:00
|
2131-06-16 14:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with syncope two days ago with mandibular
fracture, now with hypertensive crisis, bradycardia, lightheadedness. Please
eval for ICH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 1,504 mGy-cm.
COMPARISON: Head CT ___
FINDINGS:
The examination is motion degraded. Within these confines:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. The ventricles and sulci are mildly enlarged for the patient's age
suggesting mild cerebral atrophy. Again seen, is a hyperdense 0.8 x 0.5 cm
dural based lesion involving the left frontoparietal region, most consistent
with a meningioma, unchanged.
Known mandibular condyles fracture partially imaged on this CT. No new
fractures identified. Visualized paranasal sinuses are clear. Orbits are
intact.
IMPRESSION:
No acute intracranial abnormality on noncontrast head CT. Specifically there
is no intracranial hemorrhage.
|
10212287-RR-20
| 10,212,287 | 21,417,519 |
RR
| 20 |
2188-09-27 08:56:00
|
2188-09-27 09:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ man with recent T1 fracture managed conservatively,
presented to OSH after a shallow pool drive, found to have a C6 fracture who
is transferred for further management.
TECHNIQUE: Portable supine AP chest radiograph
COMPARISON: None
FINDINGS:
Clear lungs with adequate volume. No pleural effusion or pneumothorax. The
cardiomediastinal silhouette is unremarkable. Bony structures appear intact.
IMPRESSION:
No acute intrathoracic process.
|
10212287-RR-21
| 10,212,287 | 21,417,519 |
RR
| 21 |
2188-09-27 10:17:00
|
2188-09-27 11:22:00
|
EXAMINATION: SECOND OPINION CT CERVICAL SPINE
INDICATION: ___ year old man with shallow dive at the pool, transfer with C6
fracture. Patient also had a T1 fracture after an MVC in ___ of this year,
managed conservatively.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Study performed at outside facility.
COMPARISON: None.
FINDINGS:
There is a 4 mm anterior translation of C6 on C7. An acute fracture through
the C6 left inferior facet is noted with associated anterior subluxation.
There is associated narrowing of the C6-7 neural foramina. On the right,
there is mild anterior subluxation of the inferior C6 facet relative to C7.
No additional fracture. The visualized lung apices, thyroid glands are
unremarkable. Chronic fracture of the left T1 anterior rib.
IMPRESSION:
Anterior translation of C6 relative to C7 with anterior subluxation with
fracture of the left C6 inferior facet. Anterior subluxation of the right C6
inferior facet.
|
10212287-RR-23
| 10,212,287 | 21,417,519 |
RR
| 23 |
2188-09-27 14:49:00
|
2188-09-27 16:15:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE.
INDICATION: History: ___ with C6 fractureIV contrast to be given at
radiologist discretion as clinically needed// evaluate c6 fracture, pre-op
planning.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: Outside hospital noncontrast CT C-spine ___.
FINDINGS:
In comparison brain CT of the cervical spine dated ___ from an
outside institution, there is grossly unchanged anterolisthesis of C6 with
respect to C7 measuring approximately 3-4 mm. Fracture through the left
inferior articular process of C6 is again seen (3:12, 13). The perched facet
at this level causes severe left-sided neural foraminal narrowing (05:29),
with a bone fragment projecting towards the lateral aspect of the thecal sac
(05:30), however, there is no evidence of spinal cord signal abnormality.
There is no significant central spinal canal stenosis. Ligament and
interspinous process edema is seen from C2-C3 through C7-T1 levels processes
on the left mild prevertebral edema is noted at the C7 level. There is
high-signal intensity at the endplates and middle aspect of T1, T2 and T3
vertebral bodies suggesting bone edema, the possibility of bone contusion
versus nondisplaced fractures at this levels is a consideration.
IMPRESSION:
1. Redemonstration of fracture through the left inferior articular process of
C6.
2. Left Perched facet at this level causes severe left-sided neural foraminal
narrowing. 3. Unchanged anterolisthesis at C6-C7 with no significant central
spinal canal narrowing or spinal cord signal abnormality.
4. Bone edema at the endplates and mid aspect of T1, T2 and T3 vertebral
bodies suggest bone contusion and possible nondisplaced fractures.
|
10212287-RR-24
| 10,212,287 | 21,417,519 |
RR
| 24 |
2188-09-28 08:26:00
|
2188-09-28 14:56:00
|
EXAMINATION: C-SPINE (PORTABLE) IN O.R.
IMPRESSION:
Images from the operating suite show steps in a posterior cervical C5-T11
decompression. Further information can be gathered from the operative report.
|
10212287-RR-25
| 10,212,287 | 21,417,519 |
RR
| 25 |
2188-09-30 08:42:00
|
2188-09-30 09:09:00
|
EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS IN O.R.
INDICATION: S/p C5-T1 instrumented fusion; upright POD2// S/p C5-T1
instrumented fusion; upright POD2
IMPRESSION:
In comparison with the study ___, there is little overall change in the
appearance of the posterior cervical C5-T1 decompression. Anterolisthesis of
C6 with respect to C7. No prevertebral soft tissue swelling.
|
10212492-RR-29
| 10,212,492 | 28,756,051 |
RR
| 29 |
2125-02-09 15:05:00
|
2125-02-09 16:50:00
|
LEFT FOREARM AND WRIST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Status post MVA with left forearm pain and deformity,
assess for fracture.
FINDINGS: A total of five images were provided of the left wrist and forearm.
There are displaced fractures of both the radius and ulna. The radial
fracture involves the distal third shaft of the radial diaphysis with slight
dorsal and lateral displacement of the distal fracture fragment and
approximately 1.5 cm of overlap between proximal and distal fracture
fragments. Involving the distal shaft of the ulna is a comminuted fracture
with slight lateral displacement of the distal fracture fragment. No
additional fractures are seen. Please note evaluation of the scaphoid is
limited, though no definite fracture is evident. Limited views of the left
elbow demonstrate no additional fracture or signs of joint effusion.
IMPRESSION: Fractures involving distal shaft of the left radius and ulna with
significant displacement of fracture fragments as detailed above.
|
10212492-RR-30
| 10,212,492 | 28,756,051 |
RR
| 30 |
2125-02-09 15:05:00
|
2125-02-09 16:57:00
|
CHEST RADIOGRAPH PERFORMED ON ___.
COMPARISON: None.
CLINICAL HISTORY: MVA with extensive extremity injury, assess for
intrathoracic injury.
FINDINGS: Supine portable AP chest radiograph obtained. Lungs are clear and
well expanded. No focal consolidation, large effusion, or supine signs of
pneumothorax is seen. Cardiomediastinal silhouette appears normal. No bony
abnormalities are evident.
IMPRESSION: No intrathoracic injury seen.
|
10212492-RR-31
| 10,212,492 | 28,756,051 |
RR
| 31 |
2125-02-10 21:07:00
|
2125-02-11 10:35:00
|
HISTORY: ORIF left forearm.
COMPARISON: Forearm radiographs ___.
Three images, AP and lateral of the forearm were obtained during an open
reduction and internal fixation procedure. Three intraoparative images of the
forearm show placement of ulnar and radial plate and screws with reduction of
the ulnar and radial fractures. In addition, a single transvers fixation pin
has been placed across the distal radioulnar articulation.
|
10213059-RR-57
| 10,213,059 | 29,029,082 |
RR
| 57 |
2154-07-11 18:49:00
|
2154-07-11 20:25:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with hx AF on xarelto, AMS, s/p fall, c/f fracture/bleed. ___
with bilateral ulcers and erythema, c/f osteo.
COMPARISON: ___
FINDINGS:
AP portable upright view of the chest. Patient is slightly rotated to his
right. Mild to moderate cardiomegaly noted with prominence of the left
atrium. Hilar congestion and mild interstitial edema is present. No
convincing signs of edema. No large effusion or pneumothorax. No convincing
evidence for pneumonia. The aorta is slightly unfolded. Deformity of the
left distal clavicle and coracoid likely reflect old injury. Chronic
appearing left rib deformities noted.
IMPRESSION:
Cardiomegaly, hilar congestion and mild interstitial edema.
|
10213059-RR-58
| 10,213,059 | 29,029,082 |
RR
| 58 |
2154-07-11 18:49:00
|
2154-07-11 20:24:00
|
INDICATION: ___ with hx AF on xarelto, AMS, s/p fall, c/f fracture/bleed. ___
with bilateral ulcers and erythema, c/f osteo.
COMPARISON: None
FINDINGS:
AP and lateral views of both feet provided.
Right foot: There has been prior resection of the head and neck of the
proximal phalanx of the great toe. Also noted is resection of the terminal
phalanx of the second ray. No definite fracture dislocation or signs of
osteomyelitis.
Left foot: There has been prior transmetatarsal amputation of the left foot.
The bones appear demineralized diffusely and there is diffuse soft tissue
swelling most pronounced at the distal stump. No soft tissue gas or
radiopaque foreign body. There is lack of cortical detail at the level of the
calcaneal base which is concerning for osteomyelitis. Absence of prior
studies limits assessment.
IMPRESSION:
Findings, as detailed above, raise concern for osteomyelitis at the base of
the left calcaneus.
|
10213059-RR-59
| 10,213,059 | 29,029,082 |
RR
| 59 |
2154-07-11 18:52:00
|
2154-07-11 20:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with hx AF on xarelto, AMS, s/p fall, c/f fracture/bleed. ___
with bilateral ulcers and erythema, c/f osteo.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed. Motion artifact limits assessment.
DOSE: Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: CT head without contrast from ___
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction.
Prominence of ventricles and sulci are compatible with age related
involutional changes. There are ill-defined periventricular subcortical white
matter hypodensities, likely sequela of small-vessel ischemic disease. Mild
mucosal thickening is noted in the left sphenoid sinus. Otherwise, the
remaining paranasal sinuses appear clear. Mastoid air cells and middle ear
cavities are well aerated. The bony calvarium is intact. There is
degenerative changes in the bilateral temporomandibular joints.
The visualized portions of the right parotid gland appears somewhat enlarged
compared to the left, but is incompletely evaluated on this nondedicated exam.
IMPRESSION:
No acute intracranial process. Motion artifact limits evaluation.
|
10213059-RR-60
| 10,213,059 | 29,029,082 |
RR
| 60 |
2154-07-11 18:53:00
|
2154-07-11 21:03:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with hx AF on xarelto, AMS, s/p fall, c/f fracture/bleed. ___
with bilateral ulcers and erythema, c/f osteo.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 769 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified.Moderate to severe
degenerative changes are seen throughout the cervical spine, most pronounced
at the C3-C4 vertebral level, with mild straightening of the C-spine. There
is mild narrowing of the spinal canal at the C3-C4 due to osteophyte formation
and disc bulge, with probable contact upon the cord. Narrowing of the neural
foramina are noted at the bilateral C3-C4 and C4-C5 vertebral levels due to
uncovertebral hypertrophy.
There is no prevertebral soft tissue swelling.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. Moderate to severe degenerative changes are seen throughout the cervical
spine, most pronounced at the C3-C4 vertebral level.
|
10213059-RR-61
| 10,213,059 | 29,029,082 |
RR
| 61 |
2154-07-12 13:52:00
|
2154-07-13 16:06:00
|
EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old man with PVD and osteomyelitis // eval ABI's
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with Doppler signal recordings, pulse volume
recordings and segmental limb the pressure measurements.
COMPARISON: None
FINDINGS:
Triphasic Doppler waveforms were seen in the posterior tibial and dorsalis
pedis arteries bilaterally.
The right ABI is 1.41 and the left ABI is 1.23 at rest.
Pulse volume recordings showed symmetric amplitudes.
IMPRESSION:
No evidence of significant arterial insufficiency to the lower extremities at
rest.
|
10213059-RR-63
| 10,213,059 | 29,029,082 |
RR
| 63 |
2154-07-12 14:29:00
|
2154-07-12 16:08:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with history of IVDU, HBV, HCV, afib on xarelto, chronic
pain, hypothyroidism, CHF, CAD who presents with altered mental status. //
Treated for HCV in remission since ___ although lost to follow up. Eval for
evidence of cirrhosis, PVT, ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Comparisons are not available at the time of the exam due to PACs
technical issues.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. 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 intrahepatic
portion of the CHD is normal and measures 4 mm. There is dilatation of the
free segment of the CBD measuring up to 1.1 cm with no stones or obstruction
identified.
GALLBLADDER: There is no evidence of stones. The gallbladder is mildly
distended with mild wall thickening but no edema. There is scant
pericholecystic fluid. These findings are nonspecific and could be related to
underlying liver disease.
PANCREAS: A cystic structure measuring 6 mm is identified within the neck of
the pancreas with a punctate echogenic focus posteriorly showing twinkle
artifact. This cystic structure is in close proximity with, and may connect
to the main pancreatic duct. This could represent a side branch duct or a
cystic lesion.
SPLEEN: Normal echogenicity, measuring 16.1 cm.
KIDNEYS: Limited views of the right and left kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver morphology, without evidence of focal lesion, or ascites.
The portal vein is patent.
2. Splenomegaly.
3. Mildly distended gallbladder with wall thickening but no edema. There is
also scant pericholecystic fluid. These findings are nonspecific but could be
related to underlying liver disease.
4. 6 mm cystic structure within the neck of the pancreas, as described above,
which could be a dilated side branch or a cystic lesion and can be further
evaluated with MRCP.
5. Mildly dilated extrahepatic segment of the CBD up to 1.1 cm with no
obstruction identified. No intrahepatic biliary dilatation.
|
10213059-RR-64
| 10,213,059 | 29,029,082 |
RR
| 64 |
2154-07-13 13:06:00
|
2154-07-13 14:28:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with left PICC // Left 52cm PICC ___ ___
Contact name: ___: ___ Left 52cm PICC ___ ___
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
New left PIC line ends in the low SVC.
Edema, improved, persists in the left lower lung. No pleural effusion or
pneumothorax.
Moderate to severe cardiomegaly is chronic. Bilateral healed rib fractures
are long-standing.
|
10213059-RR-65
| 10,213,059 | 29,029,082 |
RR
| 65 |
2154-07-19 14:31:00
|
2154-07-19 18:11:00
|
EXAMINATION: MRI PELVIS W/O CONTRAST
INDICATION: ___ with history of IVDU, HBV, HCV s/p Ribavirin/interferon in
___ in SVR, afib with atrial clot on xarelto (although not taking), chronic
pain on methadone prescribed by PCP, ___, CHF on lasix, CAD who
presents with altered mental status found to have infected ulcers on ___. He
was recently treated for left calcaneal osteo at CHA s/p resection and clean
margins. On exam he has deep ulcers at his coccyx and perianal region. //
Concerned for osteomyelitis at the coccyx
TECHNIQUE: Multiplanar images of the pelvis were performed without the
administration of intravenous contrast using a infection evaluation MR
protocol. Patient could not tolerate the entire exam. Contrast enhanced
images could not be obtained.
COMPARISON: No prior pelvic MRI available comparison. Left hip CT ___.
FINDINGS:
There is susceptibility artifact at both hips, compatible with previous
surgery. Mildly enlarged inguinal lymph nodes bilaterally measure 1.3 cm
short axis on the left, 1.1 cm on the right.
Diffuse muscle atrophy is seen.
Along the anterolateral border of the right psoas muscle at the level of the
iliac crest, there is a rounded focus of mixed signal abnormality measuring
3.1 by 2.2 cm. This is heterogeneous on T1 weighted imaging but largely T1
hyperintense. On STIR sequence, this lesion is centrally hyperintense,
peripherally hypointense. There is some retroperitoneal fat stranding on the
T1 weighted images surrounding this lesion.
There is subcutaneous edema in the lower posterior gluteal region. There is
also mild patchy muscle edema along the inferior medial aspect of the gluteus
maximus muscles, asymmetrically more marked on the right (series 4, image 31).
The sacral marrow signal is preserved with no evidence of edema or signal loss
on T1 weighted imaging. Mild cortical contour abnormality at the junction of
the S2 and S3 segments suggests prior injury. Degenerative changes at L5-S1
are seen.
There appears to be some edema of the scrotal soft tissues however this is
incompletely evaluated on this exam. Bilateral anterior gluteal subcutaneous
edema also noted.
IMPRESSION:
1. Limited exam as patient could not tolerate the entire study, including
omission of contrast-enhanced evaluation.
2. Soft tissue edema at the posterior lower gluteal region could reflect
cellulitis in this clinical setting. Edema of the adjacent gluteal
musculature which is more marked on the right could reflect myositis, and
early pyomyositis is not excluded. No large fluid collection is demonstrated,
however evaluation for microabscess formation is limits on noncontrast exam.
3. The sacrum and coccyx do not demonstrate evidence of osteomyelitis.
4. There is a right sided retroperitoneal ovoid area of signal abnormality
which is partly T1 hyperintense, suggestive of a retroperitoneal hematoma,
possibly nonacute.
5. Soft tissue edema in the scrotum, incompletely evaluated, recommend
clinical evaluation.
Recommendation: Consider further evaluation with contrast-enhanced CT which
may better depict the retroperitoneal lesion in addition to excluding small
rim enhancing foci of microabscess formation the right gluteal region.
NOTIFICATION: The findings were discussed with Dr ___, M.D. by ___
___, M.D. on the telephone on ___ at 6:10 ___, 10 minutes after
discovery of the findings.
|
10213059-RR-66
| 10,213,059 | 29,029,082 |
RR
| 66 |
2154-07-20 17:07:00
|
2154-07-20 18:05:00
|
INDICATION: ___ year old man with coccygeal ulcer, MRI r/o osteo but noted
?pyomyositis on R gluteal region // microabscesses, evidence of pyomyositis R
gluteus
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the pelvis following intravenous contrast administration with split
bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.7 s, 29.8 cm; CTDIvol = 23.3 mGy (Body) DLP = 660.6
mGy-cm.
Total DLP (Body) = 672 mGy-cm.
COMPARISON: MRI ___.
FINDINGS:
GASTROINTESTINAL: The visualized small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. There is stool
throughout the colon.
PELVIS: The urinary bladder is incompletely distended and largely obscured due
to streak artifact from the patient's hip prostheses.
Along the right psoas muscle, there is a 3.6 x 3.3 cm fluid collection. This
was seen on the prior MRI. This could represent a retroperitoneal hematoma ;
however, superimposed in cannot be completely excluded in the appropriate
clinical setting.
REPRODUCTIVE ORGANS: The area of the reproductive organs is completely
obscured by streak artifact.
LYMPH NODES: Prominent lymph nodes in the inguinal regions may be reactive.
VASCULAR: Moderate atherosclerotic disease is noted.
BONES: The patient is status post bilateral total hip replacement.
SOFT TISSUES: There is diffuse subcutaneous edema throughout the visualized
subcutaneous soft tissues.
A small subcutaneous collect of fluid in the right buttock (series 3, image
18) measures 4.0 x 1.5 cm. While this could be related to a subcutaneous
injection, a small abscess collection cannot be completely excluded. .
Evaluation of the soft tissues at the level of the hips is markedly limited
due to streak artifact from the patient's hip prostheses.
There is a small umbilical hernia containing fat.
IMPRESSION:
1. Markedly limited exam due to streak artifact from patient's bilateral hip
prostheses.
2. Right psoas muscle fluid collection measuring 3.6 cm. This is consistent
with a hematoma. Superinfection of this fluid collection cannot be completely
excluded in the appropriate clinical setting.
3. Small subcutaneous fluid collection in the right buttock. This may be
related to subcutaneous injection.
4. No drainable fluid collection in the gluteus muscles on the right
|
10213059-RR-67
| 10,213,059 | 29,029,082 |
RR
| 67 |
2154-07-21 17:11:00
|
2154-07-21 19:05:00
|
INDICATION: ___ yo M with history of IVDU, HBV, HCV, afib on xarelto, chronic
pain, hypothyroidism, diastolic CHF, CAD who presents with altered mental
status and found to have large coccygeal ulcer with MRI ruling out
osteomyelitis. // Please aspiration psoas muscle fluid collection and send
for culture
COMPARISON: CT pelvis ___
PROCEDURE: CT-guided aspiration of a right psoas collection.
OPERATORS: Dr. ___, radiology fellow and Dr. ___,
attending radiologist. Dr. ___ supervised the trainee during
the key components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the aspiration was chosen. The
site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection, however no fluid could be obtained. CT
fluoroscopy images confirmed placement of the needle in the collection.The
needle was repositioned twice and both times position within the collection
was confirmed. However again no fluid could be aspirated. In order to obtain
a sample, The needle was then irrigated with 1 cc of saline. The needle was
removed.
Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.1 s, 18.6 cm; CTDIvol = 23.6 mGy (Body) DLP = 406.7
mGy-cm.
2) Stationary Acquisition 0.7 s, 1.0 cm; CTDIvol = 5.9 mGy (Body) DLP = 5.9
mGy-cm.
3) Stationary Acquisition 5.1 s, 1.4 cm; CTDIvol = 52.7 mGy (Body) DLP =
75.9 mGy-cm.
4) Stationary Acquisition 1.8 s, 1.4 cm; CTDIvol = 34.2 mGy (Body) DLP =
49.2 mGy-cm.
Total DLP (Body) = 547 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 1
mg Versed and 50 mcg fentanyl throughout the total intra-service time of 30
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
No fluid could be aspirated from the collection. Irrigation of the needle
with 1 cc of saline was performed to obtain a sample for microbiology
evaluation.
IMPRESSION:
CT-guided aspiration of a right psoas collection, no fluid could be aspirated.
This finding is consistent with hematoma. Sample was sent for microbiology
evaluation.
|
10213059-RR-68
| 10,213,059 | 29,330,929 |
RR
| 68 |
2154-08-18 13:54:00
|
2154-08-18 15:47:00
|
INDICATION: History: ___ with fall from being seated. Status post left
forefoot amputation // ? Fracture
TECHNIQUE: Left ankle, two views and left foot, two views
COMPARISON: ___ left foot radiographs
FINDINGS:
The osseous structures are diffusely demineralized. Patient is status post
transmetatarsal amputation. No acute fracture or dislocation is present. No
cortical destruction is seen. Assessment of the ankle mortise is slightly
limited due to the lack of a dedicated mortise view. Mild degenerative
changes are noted involving the midfoot. Flattening of the base of the
calcaneus likely reflects interval debridement, with adjacent heterotopic
calcification within the plantar soft tissues. There is diffuse soft tissue
swelling without subcutaneous gas. Pes planus deformity is again noted.
IMPRESSION:
No acute fracture or dislocation.
|
10213059-RR-69
| 10,213,059 | 29,330,929 |
RR
| 69 |
2154-08-18 20:32:00
|
2154-08-18 22:10:00
|
INDICATION: ___ year old man with HFpEF, volume overloaded on exam with DOE.
// pulm edema?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
Interval removal of the left PICC line. There is again marked enlargement of
the cardiac silhouette. Minimal left basilar atelectasis. There is mild
pulmonary vascular congestion without overt pulmonary edema. No large pleural
effusion or pneumothorax is identified.
Chronic appearing left rib fractures.
IMPRESSION:
Pulmonary vascular congestion without overt pulmonary edema. Marked
enlargement of the cardiac silhouette.
|
10213338-RR-378
| 10,213,338 | 26,849,416 |
RR
| 378 |
2161-12-18 11:06:00
|
2161-12-18 14:34:00
|
EXAM: Right shoulder, three views.
CLINICAL INFORMATION: ___ female with history of right shoulder pain,
question AVN.
COMPARISON: None.
FINDINGS: Internal rotation, external rotation, and Y views of the right
shoulder were obtained. Per the radiology technology note, patient unable to
extend shoulder for axillary view. No acute fracture or dislocation is seen.
The right acromioclavicular joint is intact. There is slight subtle linear
sclerosis along the superomedial humeral head and if clinical concern for
avascular necrosis, early avascular necrosis is not excluded. Suggest further
evaluation with MRI would be warranted.
Chain sutures are noted in the right lung apex.
IMPRESSION: No evidence of acute fracture or dislocation. Subtle linear
sclerosis along the superomedial humeral head, similar to left shoulder
radiographs of ___ which on the prior study noted consistent with known
bone infarcts. Early avascular necrosis is not excluded. Consider correlation
with MRI.
|
10213338-RR-379
| 10,213,338 | 26,849,416 |
RR
| 379 |
2161-12-18 16:09:00
|
2161-12-18 17:59:00
|
PROCEDURE: RIGHT SHOULDER ASPIRATION UNDER FLUOROSCOPIC GUIDANCE ___
CLINICAL INDICATION: ___ year old woman swollen painful right shoulder
COMPARISON: Right shoulder radiographs from ___
TECHNIQUE: Written informed consent was obtained after explaining the
procedure to be performed, risks, and alternatives. A preprocedure timeout
confirmed the procedure to be performed and the identity of the patient using
three patient identifiers.
The skin entry site in the right shoulder was chosen and the skin was prepped
in standard sterile fashion. Approximately 2 mL of 1% lidocaine was
infiltrated into the subcutaneous soft tissues overlying region of interest.
Under intermittent fluoroscopic guidance, a 20 gauge spinal needle was
advanced into the right glenohumeral joint space. Approximately ___ mL of
reddish cloudy right glenohumeral joint space fluid was aspirated.
The needle was removed, pressure applied to needle entry site, and hemostasis
achieved. Patient tolerated the procedure well. There were no immediate
complications.
FINDINGS: Linear serpiginous sclerosis of right humeral head. No acute
fracture or dislocation.
IMPRESSION:
1. Uneventful right glenohumeral joint aspiration of approximately 3 mL of
reddish cloudy right glenohumeral joint fluid. Specimens were obtained and
carried directly to the pathology laboratory.
2. Right humeral head AVN.
Important findings discussed directly via phone with Dr. ___ at
5:00 pm ___ by MSK radiology fellow Dr. ___
Dr. ___, the attending radiologist, was present and supervising
throughout the procedure.
|
10213338-RR-402
| 10,213,338 | 25,467,944 |
RR
| 402 |
2163-04-09 16:11:00
|
2163-04-09 16:41:00
|
HISTORY: Shortness of breath, fever.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Heart size is borderline enlarged. Aortic knob is calcified. Mediastinal and
hilar contours are unremarkable. No pulmonary vascular congestion is present.
Linear opacity in the left lower lobe is compatible with subsegmental
atelectasis. No focal consolidation, pleural effusion or pneumothorax is
present. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10213338-RR-403
| 10,213,338 | 25,467,944 |
RR
| 403 |
2163-04-10 08:57:00
|
2163-04-10 11:10:00
|
HISTORY: ___ female with end-stage renal disease and elevated
transaminases with fevers.
COMPARISON: Liver ultrasound ___ and ___.
FINDINGS:
The liver is unremarkable in appearance. No focal liver lesion is identified.
There is central intrahepatic biliary dilatation with dilation of the
extrahepatic common bile duct measuring up to 1.0 cm in diameter. No
obstructing stone or mass is visualized.
The patient is status post cholecystectomy. The pancreas is normal in
appearance. The pancreatic duct is not dilated. The spleen is normal in size
measuring 10.0 cm. Innumerable small granulomas are seen throughout the
spleen. A small accessory spleen is noted measuring 1.0 cm. The aorta is
atherosclerotic however no aneurysm is visualized. The visualized portion of
the IVC is unremarkable.
The native kidneys are atrophic and difficult to visualize. No hydronephrosis
is seen. The right kidney measures 6.3 cm and the left kidney measures 5.8
cm. Two tiny simple cysts measuring up to 6 mm are seen in the right kidney.
A simple cyst measuring 1.3 cm is seen in the left kidney.
DOPPLER EXAMINATION: Color Doppler and spectral waveform analysis was
performed. The main, right and left portal veins are patent with hepatopetal
flow. The splenic vein and SMV demonstrate forward flow. The IVC and hepatic
veins are patent. Appropriate arterial waveforms are seen in the main hepatic
artery.
IMPRESSION:
1. Central intrahepatic biliary dilatation with extrahepatic CBD dilatation up
to 1.0 cm. Note is made that biliary dilatation was not seen on the prior
liver ultrasound of ___ but was present on the liver ultrasound of ___. The etiology of this dilatation is not apparent. An MRCP could be
performed for further evaluation.
2. Patent hepatic vasculature.
3. Atrophic kidneys with small bilateral simple renal cysts.
4. Atherosclerotic aorta. No aneurysm is identified.
|
10213338-RR-410
| 10,213,338 | 21,676,158 |
RR
| 410 |
2163-06-12 00:42:00
|
2163-06-12 02:22:00
|
INDICATION: Dyspnea, here to evaluate for acute cardiopulmonary process.
COMPARISON: Chest radiograph dated ___.
TECHNIQUE: PA and lateral radiographs of the chest.
FINDINGS: There is increased opacity in the right lung base corresponding to
density over the spine on the lateral view compatible with right lower lobe
pneumonia. A small right pleural effusion is noted on the lateral view.
There is no left pleural effusion or pneumothorax. There is potential mild
pulmonary edema. The cardiac silhouette is moderately enlarged but stable.
Prominence of the main pulmonary artery is unchanged, suggesting underlying
pulmonary hypertension.
IMPRESSION:
1. Increased opacity in the right lung base concerning for right lower lobe
pneumonia.
2. Small right pleural effusion and potential mild pulmonary edema.
3. Stable cardiomegaly and prominence of the main pulmonary artery.
|
10213338-RR-411
| 10,213,338 | 28,630,596 |
RR
| 411 |
2163-06-14 18:50:00
|
2163-06-14 19:24:00
|
HISTORY: ___ female with shortness of breath, fever and cough.
COMPARISON: ___.
FINDINGS:
PA and lateral views of the chest. Moderate cardiomegaly is again noted.
There has been interval improvement of the right lung base opacity. There has
also been decrease in size of the pleural effusion on the right which is now
trace. Persistent slightly increased interstitial markings are noted. There
is no new consolidation.
IMPRESSION:
Interval improvement of the right basilar opacity and small effusion.
Otherwise, no change. There is potentially mild interstitial edema, not
significantly changed.
|
10213338-RR-415
| 10,213,338 | 28,630,596 |
RR
| 415 |
2163-06-16 21:11:00
|
2163-06-17 11:54:00
|
HISTORY: ___ woman with recent TIA now concern for seizure activity.
Area of old infarct versus mucous cerebritis. Patient on dialysis.
TECHNIQUE: A noncontrast brain MRI is obtained utilizing the following
sequences: Sagittal T1, axial T2, axial FLAIR, axial T2 star GRE, axial DWI,
axial T2 trace.
COMPARISON: A brain MRI from ___.
FINDINGS:
There is stable mild to moderate confluence of the periventricular and
scattered subcortical white matter T2/FLAIR hyperintensities, nonspecific, but
likely are related to chronic microvascular ischemic disease.
In the left frontal lobe, there is a stable small focal area of signal
abnormality extending to the cortex that could represent old infarct and/or
small vessel ischemia.
There is no acute infarct. There is no hemorrhage, hydrocephalus or mass
effect.
The major intracranial vessel flow voids are unremarkable.
The visualized paranasal sinuses and orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
Stable white matter changes likely related to chronic microvascular ischemic
disease. Stable mall focal area of FLAIR hyperintensity in the left frontal
lobe, likely related to an old infarct and/or small vessel ischemia.
|
10213338-RR-416
| 10,213,338 | 28,630,596 |
RR
| 416 |
2163-06-16 13:55:00
|
2163-06-16 15:35:00
|
INDICATION: History of end-stage renal disease who spiked a fever, please
evaluate for pneumonia.
COMPARISON: Multiple chest radiographs dating back to at least ___.
TECHNIQUE: Single portable exam of the chest.
FINDINGS: The heart size is moderately enlarged, overall stable compared to
the prior exams. There is mild pulmonary vascular congestion with
cephalization of the vessels and bilateral hilar fullness, without evidence of
definite pulmonary edema. There is a new focal consolidation overlying the
right lower lobe compared to the prior exam. There is increased left lung base
atelectasis. No large pleural effusions are identified. There is no evidence
of a pneumothorax.
IMPRESSION:
1. New focal consolidation overlying the right lower lobe concerning for
pneumonia.
2. Stable cardiomegaly with cephalization of the vessels and hilar fullness,
without evidence of pulmonary edema.
|
10213338-RR-417
| 10,213,338 | 28,630,596 |
RR
| 417 |
2163-06-18 16:50:00
|
2163-06-18 17:55:00
|
HISTORY: ___ woman with end-stage renal disease on hemodialysis,
hypertension, congestive heart failure, and SLE with chronic, progressive
dyspnea and now with acute worsening of symptoms found to have a pneumonia.
Persistently febrile despite antibiotics. Due to progressive nature of
symptoms prior to developing pneumonia would like to evaluate for PE and also
evaluate for abscess or empyema.
TECHNIQUE: Axial helical MDCT of the chest was performed using chest CTA
protocol after the administration of 100 cc of Omnipaque intravenous contrast.
Multiplanar coronal, sagittal and oblique images were generated. DLP:
191.21mGy-cm.
COMPARISON: This study compared to previous chest CT at torso from ___.
FINDINGS:
CTA chest:
There are no filling defects within the main pulmonary artery, right or left
pulmonary artery extending to the subsegmental level to suggest pulmonary
embolus. The aorta is of normal caliber with no findings of dissection or
aneurysmal dilatation. There is mild atherosclerosis of the aorta. There are
no signs of right heart strain. There is global cardiomegaly. There are
coronary calcifications.
There is a tiny pericardial effusion. There is a tiny left pleural effusion
and a small right pleural effusion. There is bibasilar atelectasis at the
lung bases. There is linear right upper lobe scarring, unchanged since the
previous study.
The tracheobronchial tree is patent. The visualized portions of the thyroid
gland appear unremarkable. There is no mediastinal, hilar or axillary
lymphadenopathy. Within the upper abdomen there is a 1.5 cm splenic
hypodensity which is stable since the examination from ___ and
may represent a cyst versus hemangioma. There are splenic calcifications
which may be related to previous granulomatous disease. The visualized
portion of the liver and adrenal glands appear unremarkable.
Osseous structures: There is diffuse sclerosis of the bones most consistent
with renal osteodystrophy, similar to the prior study.
IMPRESSION:
1. No findings of pulmonary embolism or aortic dissection.
2. Bilateral pleural effusions right side greater than left with bibasilar
atelectasis. Tiny pericardial effusion.
3. Stable splenic hypodensity may represent a cyst or hemangioma.
4. Diffuse sclerosis of the bones most consistent with renal osteodystrophy,
similar to the prior study.
|
10213338-RR-418
| 10,213,338 | 28,630,596 |
RR
| 418 |
2163-06-20 12:02:00
|
2163-06-20 13:52:00
|
INDICATION: Dyspnea, currently on antibiotics, with continued fevers and
chronic right lower and upper quadrant abdominal pain. This patient has a
longstanding history of systemic lupus erythematosus complicated by lupus
nephritis with end-stage renal disease, post failed right renal transplant
with subsequent removal. The patient is also post laparoscopic
cholecystectomy and hysterectomy.
TECHNIQUE: MDCT-acquired axial images of the abdomen and pelvis were obtained
following the uneventful administration of oral contrast and 100 cc of
Omnipaque intravenous contrast. Coronal and sagittal reformations were
performed at 5 mm slice thickness.
CT OF THE ABDOMEN WITH IV CONTRAST:
A moderate right pleural effusion (2:5) and moderate adjacent compressive
atelectasis of the right lower lobe are unchanged since the chest CT
examination from ___. Mild left lower lobe scarring is again seen
(2:5). There is no pericardial effusion. Mild cardiomegaly is again seen
(2:1).
The patient is post cholecystectomy. There is no intra- or extra-hepatic bile
duct dilation. No focal intrahepatic mass is detected. The portal veins
remain widely patent. The pancreas, adrenal glands, and stomach appear
normal. The native kidneys are atrophic, demonstrating numerous subcentimeter
hypodense lesions most compatible with cystic changes in the setting of
chronic hemodialysis. 12 mm well-circumscribed lesion along the superior
aspect of the spleen is unchanged and likely a cyst (2:10).
The abdominal aorta is moderately calcified, without aneurysmal dilation. The
celiac trunk, SMA, and renal arteries appear patent and normal in caliber.
There are moderate calcifications throughout the ___, which is not definitely
patent (2:41).
Multiple enlarged para-aortic lymph nodes are present, measuring up to 2.5 x
1.6 cm axially (2:29).
There is moderate stranding throughout the mesentery (601:26, 2:39), which, in
combination with overlying subcutaneous edema, is likely due to third spacing.
No focal fluid collections are seen.
CT OF THE PELVIS WITH IV CONTRAST:
Multiple surgical clips and suture material within the right lower quadrant
(2:58) mark the prior renal transplant site.
A 30 x 15 mm focus of soft tissue along the right pelvic side wall (2:65)
appears slightly more prominent since the ___ pelvic CT examination,
likely reflecting post-surgical scar tissue, and somewhat obscured by a small
amount of neighboring free fluid. A focus of right lower posterior fascial
thickening (2:45, 47) also appears unchanged, and is also likely post-surgical
in etiology.
The iliac vessels are patent and normal in caliber, demonstrating moderate
atherosclerotic calcifications.
A small fat-containing left inguinal hernia (2:73) is unchanged since the ___
CT examination.
The patient is post hysterectomy. No adnexal masses are detected.
OSSEOUS STRUCTURES:
The patient is post right total hip arthroplasty (601B:30). Moderate
sclerotic changes are seen throughout the left humeral head (601B:29),
accompanied by subchondral cystic changes (601B:28), suspicious for
combination of avascular necrosis and longstanding osteoarthritis. There are
no bony lesions concerning for malignancy or infection. Again seen is marked
marrow replacement throughout the vertebral bodies (602B:34), likely
reflecting chronic renal disease. A coarse calcification resides within the
L2/3 disc space (602b:34).
IMPRESSION:
1. No acute intra-abdominal or intrapelvic process. Specifically, no CBD
stricture, intrahepatic bile duct dilation, or acute liver process detected.
2. Diffuse mesenteric stranding, in combination with subcutaneous edema,
likely third spacing. No focal intra-abdominal fluid collections are seen.
3. Post-surgical changes within the right lower quadrant, reflecting prior
renal transplant site. A focus of soft tissue along the right pelvic side
wall appears slightly more prominent since ___, likely post-surgical in
etiology.
4. Extensive paraaortic lymphadenopathy, in keeping with known history of
SLE.
5. Atrophic native kidneys with cystic changes related to chronic dialysis.
6. Post-cholecystectomy.
7. Avascular necrosis of the left femoral head. Right total hip arthroplasty.
8. Small fat containing left inguinal hernia.
9. This protocol was not optimized specifically to evaluate for
hemosiderosis, as no precontrast scan was obtained.
|
10213338-RR-419
| 10,213,338 | 28,630,596 |
RR
| 419 |
2163-06-21 10:44:00
|
2163-06-21 14:58:00
|
CLINICAL HISTORY: Status post thoracentesis on the right.
CHEST AP:
The heart is enlarged. Some upper zone redistribution is again seen. No
evidence of an effusion is now currently seen on either side.
No evidence of a pneumothorax is identified on semi-erect film.
IMPRESSION: No evidence of pneumothorax. No effusion is seen.
|
10213338-RR-420
| 10,213,338 | 28,630,596 |
RR
| 420 |
2163-06-26 06:05:00
|
2163-06-26 15:03:00
|
HISTORY: ___ old female with SLE, and end-stage renal disease on hemodialysis.
Fever of unknown origin. Retroperitoneal lymph node biopsy. .
COMPARISON: CT abdomen/ pelvis ___.
OPERATORS: Dr. ___ abdominal imaging fellow, and Dr. ___
staff ___.
PROCEDURE:
The patient received DDAVP prior to commencing the procedure.
The procedure, including risks, benefits and alternatives were explained to
the patient, and after detailed discussion, informed written consent was
obtained from the patient. A time-out was performed using 3 unique patient
identifiers prior to commencing the procedure utilizing the ___ protocol.
And limited non contrast CT was performed through the area of interest, and
the skin was marked. The patient was prepped and draped in the usual sterile
fashion.
Approximately 10 cc of 1% lidocaine was utilized for local anesthesia. Using
CT guidance, with the patient in left lateral decubitus position a 15 cm 17
gauge guide needle was advanced just proximal to an enlarged left
retroperitoneal lymph node at the level of the left kidney.
The inner stylet was removed, and a 22 gauge FNA sample was obtained. Cytology
revealed only blood. Subsequently three 18 gauge core needle samples were
obtained with 11 mm throw. The first specimen was deemed adequate by
pathology and put into Formalin. Additional samples were obtained for RPMI,
the first did not result in a good core. Therefore a second sample was
obtained that was of adequae size.
There are no immediate postprocedural complications. The patient tolerated
the procedure satisfactorily. There were no immediate complications.
The patient received 4 doses of fentanyl (total 200mcg) and 4 doses of versed
(total 4mg). The patient's vitals were continuously moderate by a dedicated
Radiology nursing.
The attending radiologist Dr. ___ was present for the entire procedure.
FINDINGS:
Enlarged lymph nodes. The target left para-aortic lymph node measures 2.4 cm
transverse dimension.
IMPRESSION:
CT guided left retroperitoneal lymph node biopsy. Pathology pending.
|
10213338-RR-421
| 10,213,338 | 23,340,206 |
RR
| 421 |
2163-07-05 05:57:00
|
2163-07-05 08:36:00
|
PA AND LATERAL CHEST RADIOGRAPH DATED ___
COMPARISON: Radiograph of ___.
FINDINGS: Cardiac silhouette is enlarged, similar in size to ___,
but markedly increased when compared to earlier chest x-ray of ___. Pulmonary vascular engorgement is also present as well as peribronchial
cuffing and scattered interstitial opacities. A more confluent patchy opacity
in the right infrahilar region is also present, as well as small bilateral
pleural effusions, with fluid also demonstrated within the right major and
minor fissures.
IMPRESSION:
Cardiomegaly and interstitial edema, accompanied by small pleural effusions.
Patchy right infrahilar opacity, which may be due to asymmetrical edema, early
infectious pneumonia, aspiration, or lupus pneumonitis.
|
10213338-RR-485
| 10,213,338 | 20,880,022 |
RR
| 485 |
2165-04-27 14:31:00
|
2165-04-27 18:54:00
|
EXAMINATION: TOE(S), 2+ VIEW LEFT
INDICATION: ___ woman being treated for osteomyelitis of the left ___
toe; reevaluate for osteomyelitis.
TECHNIQUE: 3 non-stress radiograph views of the left foot were obtained (AP,
lateral, oblique).
COMPARISON: Left foot radiograph dated ___.
FINDINGS:
Erosive changes and lysis in the fifth distal phalanx appear slightly
progressed compared to the prior exam with less distinction of the distal
cortex of the associated tuft. Associated soft tissue swelling of the fifth
digit. Stable, diffuse soft tissue swelling. No soft tissue gas. The
appearance of the first phalanx is slightly progressed with equivocal erosive
change at the tuft of the first distal phalanx. There is persistent
flattening of the medial first metatarsal head and narrowing of the first
metatarsophalangeal joint. Stable bony irregularity along the posterior margin
of the calcaneus, possibly post-traumatic or post-inflammatory. Stable
deformity of the fifth proximal phalanx, likely chronic and post-traumatic.
Stable small inferior calcaneal spur. Stable narrowing of the tarometatarsal
and metatarsophalangeal joints. Mild hallux valgus metatarsus varus is again
noted.
IMPRESSION:
1. Slight progression of erosion and lysis of the tuft of the fifth distal
phalanx since the prior exam, concerning for osteomyelitis.
2. Slight progression of erosive change at the tuft of the first distal
phalanx, concerning for osteomyelitis.
|
10213338-RR-486
| 10,213,338 | 20,880,022 |
RR
| 486 |
2165-04-27 14:31:00
|
2165-04-27 15:57:00
|
EXAMINATION: CHEST RADIOGRAPHS
INDICATION: Tachycardia.
TECHNIQUE: Chest, AP upright and lateral.
COMPARISON: ___.
FINDINGS:
The cardiac, mediastinal and hilar contours appear stable. There is unchanged
cardiomegaly and enlargement of the main pulmonary artery contour. The lungs
appear clear. There are no pleural effusions or pneumothorax.
IMPRESSION:
No evidence of acute cardiopulmonary disease.
|
10213338-RR-487
| 10,213,338 | 20,880,022 |
RR
| 487 |
2165-04-29 18:18:00
|
2165-04-29 21:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fever, altered mental status // focal
consolidation review of OMR suggest additional history ofSLE, ESRD
COMPARISON: None.
FINDINGS:
There may be mild hyperinflation. Again seen is multi chamber cardiomegaly.
The aortic knob is calcified and calcifications in the upper extremity are
noted. There is upper zone redistribution, without overt CHF. Again seen is
linear atelectasis at the left lung base.
No focal infiltrate suggestive of pneumonia is identified. No pleural
effusions are seen. Slight asymmetry in the degree of hyperlucency of the
lungs, greater on the left, may be related to slight rotation. Mild
retraction of the minor fissure is noted, but no obvious right upper lobe
atelectasis is identified.
Of note, there is a rounded density measuring 16 mm in the right infrahilar
region. I suspect that this represents a nipple shadow. Equivocal rounded
density measuring approximately 14.5 mm overlying the right seventh anterior
rib was not seen on the ___ radiograph may be an artifact due to
overlap of rib shadows.
Rounded lucency in the left humeral head, suggestive of osteonecrosis.
IMPRESSION:
1. Multi chamber cardiomegaly, unchanged.
2. No focal infiltrate to suggest pneumonia identified.
3. Mild upper zone redistribution, without overt CHF.
4. Rounded densities in the right lower zone are thought to represent a nipple
shadow and artifact due to overlapping ribs. Consider repeat frontal
radiograph with nipple markers to confirm this.
5. Suspected osteonecrosis left humeral head.
|
10213338-RR-488
| 10,213,338 | 20,880,022 |
RR
| 488 |
2165-05-01 10:48:00
|
2165-05-01 15:57:00
|
INDICATION: ___ year old woman with ESRD on HD, has prolonged bleeding post
dialysis with a scab on the fistula.
COMPARISON: Fistulagram ___.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure.
The attending, Dr. ___ supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
200mcg of fentanyl and 3 mg of midazolam throughout the total intra-service
time of 65 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl and midazolam.
CONTRAST: 70 ml of optiray contrast.
FLUOROSCOPY TIME AND DOSE: 6.9 minutes, 8 mGy
PROCEDURE:
1. Left upper extremity AV fistulagram.
2. Complete fistulogram via a brachial vein approach, imaging from the
anastomosis to the right atrium.
3. Balloon angioplasty of the basilic, brachial and axillary vein stenoses
using 10, 12, and 12 mm balloon, respectively.
4. Post angioplasty fistulagram.
PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the left upper
extremity abducted and stabilized.
Clinical examination demonstrated a palpable thrill over the left arm AV
fistula. Further evaluation by targeted ultrasound demonstrated a patent
fistula. The left upper extremity was prepped and draped in the usual sterile
fashion. A preprocedure timeout was performed as per ___ protocol.
Using ultrasound and fluoroscopy, the arterial inflow and outflow stent levels
were identified and the skin was marked with a skin marker. Following
administration of lidocaine antegrade (directed towards the venous outflow)
access was obtained using a 21G micropuncture needle. A 018 wire was then
advanced easily into the outflow vein under fluoroscopic guidance. A 4.5F
micropuncture sheath was advanced. A fistulagram was obtained through the
micropuncture sheath demonstrating moderate stenoses at the basilic, brachial,
and axillary veins. A glidewire was introduced and the micropuncture sheath
was exchanged for an 8 ___ sheath. A 12 mm balloon was introduced and
angioplasty was performed at the axillary and brachial veins. The balloon was
exchanged for a 10 mm balloon and angioplasty was performed at the basilic
vein. Fistulagram was performed 12 the balloon was inflated to delineate the
AV fistula anastomosis which was patent. The balloon was deflated and
removed. Post angioplasty fistulogram and venogram were performed
demonstrating no significant stenoses.
Clinical examination revealed a satisfactory thrill along the length of the
fistula and outflow vein. The Sheath was removed and hemostasis was achieved
with a ___ Ethilon pursestring suture. There were no immediate complications.
FINDINGS:
1. Fistulagram demonstrating moderate stenoses at the basilic, brachial, and
axillary veins. Patent AV fistula arterial anastomosis / inflow without
stenosis.
2. No flow-limiting stenoses on post angioplasty venogram.
IMPRESSION:
Successful angioplasty of left axillary, brachial, and basilic outflow veins
stenoses.
|
10213338-RR-489
| 10,213,338 | 20,880,022 |
RR
| 489 |
2165-05-02 14:22:00
|
2165-05-02 17:46:00
|
EXAMINATION: AORTA AND BRANCHES
INDICATION: ___ year old woman with lupus, ESRD on HD, with chest pain, please
eval for AAA // please eval for AAA
TECHNIQUE: Grayscale and color Doppler ultrasound of the abdominal aorta was
performed.
COMPARISON: None.
FINDINGS:
The aorta measures 2.1 cm in the proximal portion, 1.8 cm in mid portion and
1.4 cm in the distal abdominal aorta. There are extensive calcified
atherosclerotic plaques seen throughout the aorta.
Wall-to-wall color flow is seen within aorta with appropriate arterial
waveforms.
The iliac arteries and kidneys were not assessed as the patient refused to to
complete the exam.
IMPRESSION:
Extensive atherosclerotic plaque in the aorta however no aneurysm visualized.
|
10213338-RR-501
| 10,213,338 | 28,193,598 |
RR
| 501 |
2165-09-19 08:52:00
|
2165-09-19 10:34:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with lupus nephritis s/p failed renal
transplant on immunosuppression now with RUQ pain. // Please evaluate
etiology.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___ ultrasound.
FINDINGS:
LIVER: The hepatic parenchyma demonstrates diffuse heterogeneity, although not
significantly changed compared to ___. 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 patient is status post cholecystectomy.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Multiple calcified granulomas are identified, measuring 9.4 cm.
KIDNEYS: Echogenic atrophic native kidneys, history of renal transplant.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
The liver is again noted to be heterogenous in appearance but no focal liver
lesions identified.
No gallstones or other findings to explain patient's RUQ pain.
|
10213338-RR-503
| 10,213,338 | 28,193,598 |
RR
| 503 |
2165-09-19 15:49:00
|
2165-09-19 17:06:00
|
EXAMINATION: ART EXT REST AND EXERCISE
INDICATION: ___ year old woman with ESRD and known bilateral PVD w poorly
healing wound w purulence at site of hallux amputation. assess status of
known PVD.
TECHNIQUE: Non-invasive evaluation of the arterial system in the lower
extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
COMPARISON: ___
FINDINGS:
On the right side, biphasic Doppler waveforms are seen in the common femoral
artery. Monophasic Doppler waveforms are seen in the superficial femoral,
popliteal, and dorsalis pedis artery. No waveform was identified in the
posterior tibial artery.
The right ABI was 1.07, although likely artifactually elevated due to
calcified vessels.
On the left side, biphasic Doppler waveforms are seen in the common femoral
artery. Monophasic Doppler waveforms are seen in the superficial femoral,
popliteal, and dorsalis pedis artery. No waveform was identified in the
posterior tibial artery.
The left ABI was 1.02, although likely artifactually elevated due to calcified
vessels.
Pulse volume recordings showed absent pulse volumes in both posterior tibials.
IMPRESSION:
Bilateral inflow aortoiliac arterial disease with additional arterial
insufficiency of the bilateral tibial arteries, left greater than right, not
significantly changed compared with prior exam from ___.
|
10213338-RR-506
| 10,213,338 | 28,193,598 |
RR
| 506 |
2165-09-20 12:34:00
|
2165-09-20 15:40:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old woman with s/p revision hallux partial amputation //
post op eval post op eval
TECHNIQUE: Three views of the left foot.
COMPARISON: The foot radiographs on ___.
FINDINGS:
There has been amputation of the head of the first proximal phalanx. Previous
amputation of the base of the fifth proximal phalanx is unchanged. There is
diffusely decreased bone mineralization. Vascular calcifications are noted.
Subcutaneous air and the distal aspect of the big toe is likely postoperative.
IMPRESSION:
Interval amputation of the great toe proximal phalanx head. Subcutaneous air
this region is likely postoperative. Otherwise unchanged compared to ___.
|
10213338-RR-507
| 10,213,338 | 28,193,598 |
RR
| 507 |
2165-09-21 14:39:00
|
2165-09-21 15:47:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with left foot ulcer // Vein mapping of lower
extremities
TECHNIQUE: Realtime imaging of the greater saphenous and small saphenous
veins were obtained bilaterally with measurements of these veins along their
entire length. .
COMPARISON: None.
FINDINGS:
Right leg: The greater saphenous vein is patent throughout measuring 1.9-2.6
mm in the calf, 4.6 mm at the knee and 3.4-5.4 mm in the thigh.
The small saphenous vein measures 2.7 mm distally, 3.3 mm in the mid calf and
a 2.9 mm proximally.
Left leg: The greater saphenous vein is patent throughout. This measures 3
to 4 mm in the calf, 3.9 mm at the level of the knee and 4.2 for to 5 mm in
the proximal thigh.
The small saphenous vein measures 2 mm distally, 2.4 mm in the mid calf and
2.5 mm proximally.
IMPRESSION:
Patent greater saphenous and small saphenous veins on both sides. Measurements
as indicated above.
|
10213338-RR-508
| 10,213,338 | 28,193,598 |
RR
| 508 |
2165-09-21 14:39:00
|
2165-09-21 15:56:00
|
EXAMINATION: VENOUS DUP UPPER EXT BILATERAL
INDICATION: ___ year old woman with left foot ulcer // Vein mapping
TECHNIQUE: Grey scale and Doppler evaluation was performed on the bilateral
upper extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The bilateral internal jugular and axillary veins are patent, show normal
color flow and compressibility.
The bilateral brachial, basilic, and cephalic veins are patent, compressible
and show normal color flow and augmentation.
Right arm: The cephalic vein is patent to the level of the above the elbow
level. This measures 1.4-2 mm in the forearm 1.4 mm at the level of the elbow
and 4.6 mm just above the elbow. However, there are areas of calcifications
above the elbow. The basilic vein is patent measures 3.8 mm at the elbow and
4.5-4.6 mm above the elbow.
Left arm: The cephalic vein is patent measuring 2.3-2.9 mm in the forearm,
2.7 mm at the elbow and 4.3 mm above the elbow. The patient has a brachial
basilic arteriovenous fistula which is bandaged. Multiple varicosities are
noted in the upper arm related to the cephalic vein.
IMPRESSION:
1. Nonvisualization of the cephalic vein in the upper arm on the right,
patent basilic vein as indicated above.
2. Left brachial basilic AV fistula which is bandaged. The cephalic vein is
patent and there are associated varicosities in the upper arm.
|
10213338-RR-520
| 10,213,338 | 24,846,149 |
RR
| 520 |
2166-01-06 12:24:00
|
2166-01-07 00:18:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with SLE/ESRD with angina and dyspnea, ischemic EKG
changes // evaluate for acute process
COMPARISON: Chest radiographs ___
FINDINGS:
Single upright view of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. Streaky left
lower lobe atelectasis is similar to prior. Moderate cardiomegaly is similar
to prior. Imaged osseous structures are intact. No free air below the right
hemidiaphragm is seen. Aortic arch calcification appears similar to prior.
IMPRESSION:
No acute intrathoracic process.
|
10213338-RR-521
| 10,213,338 | 22,160,556 |
RR
| 521 |
2166-01-09 16:37:00
|
2166-01-09 16:57:00
|
INDICATION: ___ with cp // eval for ptx
TECHNIQUE: Portable AP
COMPARISON: Chest radiograph dated ___
FINDINGS:
AP upright chest radiograph demonstrates hyperexpanded lungs. Nipple shadows
project over the lung bases bilaterally. Moderate cardiomegaly is stable
relative to prior examination dated ___. There is no evidence of
pulmonary edema. No large pleural effusion or pneumothorax is identified. No
focal consolidation convincing for an infectious process is identified. There
is no air under the right hemidiaphragm.
IMPRESSION:
Moderate cardiomegaly. No evidence of pulmonary edema.
|
10213338-RR-522
| 10,213,338 | 22,160,556 |
RR
| 522 |
2166-01-09 19:10:00
|
2166-01-09 19:39:00
|
EXAMINATION: Chest CTA
INDICATION: ___ with chest pain // 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: 253 mGy cm
COMPARISON: CTA dated ___
FINDINGS:
Imaged thyroid is unremarkable. No adenopathy. Mild thickening of the mid
and distal esophageal wall is similar to prior, question esophagitis.
The thoracic aorta is normal in course and caliber with minimal
atherosclerotic calcification. The arch branches appear normal. The main
pulmonary artery is within normal limits in caliber. Pulmonary arterial tree
opacifies normally without filling defect to suggest the presence of a
pulmonary embolism. The heart is top-normal in size with biatrial
enlargement. No pericardial effusion. There are tiny bilateral pleural
effusions.
Bronchial mucoid impaction is present within the small airways of the left
lower lobe with associated subsegmental atelectasis. This appears to have
been present on examination dated ___, not significantly changed.
Minimal atelectasis involves the left upper lobe peripherally. Suture
material is identified within the right apex. There is no consolidation
worrisome for infectious process. No suspicious nodule or mass is seen.
Although study is not tailored for subdiaphragmatic evaluation, imaged
portions of the abdomen demonstrate a 1.3 cm hypodensity within the anterior
aspect of the spleen (2:93) likely a cyst or hemangioma, stable.
Bones: Bones appear diffusely sclerotic as on prior study. There is no
worrisome lesion present suspicious for malignancy or infection. Subchondral
patchy sclerosis of the imaged left humeral head is concerning for AVN, as on
prior.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Bronchial mucoid impaction in the left lower lobe with associated
subsegmental atelectasis.
3. Mild thickening of the mid and distal esophageal wall appears to been
present on prior study and may relate to esophagitis.
4. Tiny pleural effusions.
5. Persistent sclerosis of the imaged left humeral head may reflect AVN.
6. Mild cardiomegaly.
|
10213338-RR-523
| 10,213,338 | 22,160,556 |
RR
| 523 |
2166-01-12 02:20:00
|
2166-01-12 07:06:00
|
INDICATION: Abdominal pain.
TECHNIQUE: Portable supine frontal abdominal radiographs were obtained.
COMPARISON: None.
FINDINGS:
There are multiple dilated loops of small bowel measuring up to 4.2 cm in
diameter. Fecalized bowel loops are noted in the left lower quadrant. This
exam is not optimized for the evaluation of intraperitoneal free air. Clips
are noted projecting over the right pelvis. The patient is status post right
hip replacement.
IMPRESSION:
Multiple dilated loops of small bowel measuring up to 4.2 cm, with fecalized
bowel loops in the left lower quadrant. These findings can be seen in the
setting of small bowel obstruction. If there is clinical concern, CT can be
obtained for further evaluation.
NOTIFICATION: These findings were discussed via telephone by Dr. ___
___ with Dr. ___ at approximately 05:00 on ___, during
initial review.
|
10213338-RR-524
| 10,213,338 | 22,160,556 |
RR
| 524 |
2166-01-12 09:13:00
|
2166-01-12 10:22:00
|
EXAMINATION: CT ABDOMEN PELVIS WITH IV CONTRAST.
INDICATION: ___ year old woman with ESRD on HD, acute on chronic diffuse
abdominal pain, fecalization on KUB. // Evaluate for bowel obstruction,
perforation
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 4.0 s, 44.4 cm; CTDIvol = 6.9 mGy (Body) DLP = 305.2
mGy-cm.
3) Spiral Acquisition 0.9 s, 10.0 cm; CTDIvol = 6.9 mGy (Body) DLP = 68.9
mGy-cm.
Total DLP (Body) = 385 mGy-cm.
COMPARISON: CTA chest: ___.
CT abdomen pelvis: ___.
FINDINGS:
LOWER CHEST: Subsegmental atelectasis is noted in the left lung base (2:4).
There is no pleural or pericardial effusion. Dense calcifications are noted
in the Coronary arteries. There is a small hiatal hernia.
ABDOMEN:
HEPATOBILIARY: There is new widespread portal venous gas in the right and left
hepatic lobes compared to the prior study from ___ (2:7, 10, 16).
No focal lesion is identified in the liver. The patient is post
cholecystectomy, with unchanged mild central intrahepatic and extrahepatic
biliary ductal prominence. Along the inferior tip of the right hepatic lobe,
there is a dropped metallic surgical clip (02:19).
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: A 1.3 x 1.4 cm splenic hypodensity is unchanged compared to the prior
study, likely benign such as a hemangioma. Other dense calcifications within
the spleen may be partly vascular as the splenic artery is heavily calcified.
Prior granulomatous infection can also result in coarse splenic
calcifications. Multiple small accessory spleens are noted (2:23, 25).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are atrophic bilaterally, with numerous small
hypodensities, too small to characterize but grossly unchanged. There is no
hydronephrosis or perinephric abnormality bilaterally. No renal mass is
identified.
GASTROINTESTINAL: There is diffuse wall thickening and edema throughout the
cecum and proximal ascending colon (___:19). Small foci of pneumatosis are
also noted in the cecum and ascending colon (02:50, 46). Also in the
ascending colon, there is focal lack of mucosal mucosal wall enhancement
(02:44) and air within adjacent mesenteric veins (02:40). Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout.
Numerous surgical clips are present about the cecal base in the right lower
quadrant (___:22), unchanged. Additionally, coarse calcifications along the
right pericolic gutter are unchanged (02:44).
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
LYMPH NODES: Retroperitoneal lymphadenopathy is again noted, measuring up to
1.1 x 2.0 cm in the right common iliac station (02:39), unchanged. There is
no pelvic or inguinal lymphadenopathy.
VASCULAR: The abdominal aorta and principal branch vessels are densely
calcified, including the bilateral renal arteries. The celiac trunk and its
branch vessels, as well as the superior mesenteric artery appear patent.
BONES: The bones are diffusely sclerotic, compatible with sequelae of renal
osteodystrophy. There is persistent grade anterolisthesis of L4 on 5. A
right hip total arthroplasty the is again seen. Densely sclerotic left
femoral head potentially represents avascular necrosis, although this is
somewhat difficult to ascertain given diffuse sclerotic appearance of osseous
structures elsewhere. There is no evidence of femoral head collapse.
Extensive subchondral cystic change is also noted at the left femoroacetabular
joint.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. New extensive portal venous gas and other findings are highly concerning
for bowel necrosis involving the cecum and ascending colon. In the setting of
extensive atherosclerotic disease, an ischemic cause is considered most
likely. However longstanding immunosuppression could contribute to an
infectious etiology such as typhlitis, given cecal and right colonic
distribution.
2. Bilateral atrophic kidneys and mild retroperitoneal lymphadenopathy are
unchanged compared to the prior study.
3. Diffuse osseous sclerosis is unchanged, reflecting the sequelae of renal
osteodystrophy.
NOTIFICATION:
The findings were discussed by Dr. ___ with Dr. ___ resident)
on the telephoneon ___ at 9:57 AM, 5 minutes after discovery of the
findings.
|
10213338-RR-525
| 10,213,338 | 22,160,556 |
RR
| 525 |
2166-01-12 15:07:00
|
2166-01-12 16:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p extended right colectomy with new CVL and
ETT // confirm line and tube placement confirm line and tube placement
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
The pulmonary vasculature is more engorged suggesting that new peribronchial
opacification in the right lower lobe could be dependent edema, as well as
pneumonia. Left lower lobe consolidation is more likely atelectasis.
Moderate cardiomegaly is stable.
Generalized vertebral sclerosis is probably in indication of metabolic bone
disease. Clinical correlation advised.
ET tube and right internal jugular line and nasogastric drainage tube are in
standard placements respectively.
|
10213338-RR-526
| 10,213,338 | 22,160,556 |
RR
| 526 |
2166-01-14 04:44:00
|
2166-01-14 09:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ESRD and new mesenteric ischemia s/p right
colectomy, open abdomen plan for return to OR ___ // please eval for acute
process or any interval change please eval for acute process or any
interval change
IMPRESSION:
Compared to prior chest radiographs since ___, most recently ___
through ___.
Moderate cardiomegaly is chronic. Pulmonary vascular congestion is recently
improved. Greater opacification in the right lower lobe is still concerning
for recent aspiration, pneumonia, or atelectasis. Left lower lobe grossly
clear. Pleural effusions small if any.
|
10213338-RR-527
| 10,213,338 | 22,160,556 |
RR
| 527 |
2166-01-14 12:13:00
|
2166-01-14 12:48:00
|
INDICATION: Laparoscopic closure.
TECHNIQUE: Single supine abdominal radiograph obtained in the operating room.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
A single abdominal radiograph obtained in the operating room to evaluate for
retained surgical material demonstrates a enteric tube terminating in the
stomach with the proximal side hole at the gastroesophageal junction.
Additionally, there are surgical clips in the right lower quadrant and midline
vertical skin staples.
Multiple vascular calcifications are noted in the left upper quadrant and of
the abdominal aorta. There is no evidence of unexpected retained surgical
material.
Right hip arthroplasty is partially imaged.
IMPRESSION:
No evidence of unexpected retained surgical material.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 12:46 ___, 1 minutes after discovery of the
findings.
|
10213338-RR-529
| 10,213,338 | 22,160,556 |
RR
| 529 |
2166-01-15 05:10:00
|
2166-01-15 08:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ SLE, ESRD on HD s/p failed LRRT (___) s/p ACS/DESx2
(___) p/w mesent ischemia s/p R colectomy/open abd, now s/p
washout, primary anst, closure. // interval assesment
IMPRESSION:
As compared to the prior study of 1 day earlier, cardiomegaly is accompanied
by worsening pulmonary vascular congestion, development of mild edema, and a
small right pleural effusion. Bibasilar atelectasis has worsened in the
interval. No other relevant changes.
|
10213338-RR-530
| 10,213,338 | 22,160,556 |
RR
| 530 |
2166-01-16 04:39:00
|
2166-01-16 10:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ SLE, ESRD on HD s/p failed LRRT (___) s/p ACS/DESx2
(___) p/w mesent ischemia s/p R colectomy/open abd, now s/p
washout, primary anst, closure. // interval change interval change
IMPRESSION:
Compared to prior chest radiographs, ___ through ___.
ET tube, right internal jugular line, nasogastric drainage tube all in
standard placements.
Bibasilar consolidation has not improved. Pulmonary vasculature is engorged
and chronic severe cardiomegaly is unchanged. No pneumothorax.
|
10213338-RR-531
| 10,213,338 | 22,160,556 |
RR
| 531 |
2166-01-15 10:29:00
|
2166-01-16 09:26:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ lupus nephritis, ESRD on HD s/p failed LRRT (___) s/p
cardiac stentsx2 on ___ now with mesenteric ischemia s/p extend right
colectomy, temp abd closure // s/p R IJ line exchange; please eval for
placement and r/o complications Contact name: ___: ___
s/p R IJ line exchange; please eval for placement and r/o complications
IMPRESSION:
Compared to prior chest radiographs ___ through ___ through
___.
Moderate Cardiomegaly is long-standing. Mild pulmonary edema has improved
very slightly since ___. Alternatively this could be due to increase
positive pressure ventilator support. Moderate bibasilar consolidation, left
greater than right, has not cleared, could be atelectasis with dependent edema
or alternatively aspiration and pneumonia. Careful followup advised. Pleural
effusion is presumed, but not large. No pneumothorax.
Tip of the endotracheal tube at the thoracic inlet is 6 cm from the carina
with the chin in neutral position, standard placement. Right jugular line has
been substitute it, terminating in the mid to low SVC. Esophageal drainage
tube passes into the stomach and out of view.
|
10213338-RR-533
| 10,213,338 | 22,160,556 |
RR
| 533 |
2166-01-24 08:51:00
|
2166-01-24 16:32:00
|
INDICATION: ___ year old woman with CAD s/p stent and ischemic bowel s/p
colectomy now with worsening abdominal pain // Any evidence of obstruction?
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: Comparison is made with abdominal radiographs from ___ and ___ and CT abdomen and pelvis from ___.
FINDINGS:
Multiple gas filled but nondistended loops of small large bowel are noted
throughout the abdomen.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
Surgical clips are seen in the right lower quadrant and right upper quadrant.
Surgical staples are seen in the midline. There is a right total hip
arthroplasty.
IMPRESSION:
No distended loops of small or large bowel to suggest obstruction.
|
10213338-RR-534
| 10,213,338 | 22,160,556 |
RR
| 534 |
2166-01-24 15:35:00
|
2166-01-24 17:55:00
|
INDICATION: ___ year old woman with CAD s/p PCI, ischemic colitis s/p partial
colectomy, now with worsening abd pain, distension. // Any evidence of
ongoing bowel ischemia? leakage from anastomosis. Need CT AP with PO and IV
contrast.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 4.3 s, 46.9 cm; CTDIvol = 6.9 mGy (Body) DLP = 325.0
mGy-cm.
Total DLP (Body) = 339 mGy-cm.
COMPARISON: Comparison is made to prior from ___.
FINDINGS:
LOWER CHEST: Small bilateral pleural effusions, right greater than left, new
compared to previous. There is associated bibasal subsegmental atelectasis.
Moderate cardiomegaly.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder has been removed
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Multiple small calcifications within the spleen, representing a
combination of vascular calcifications and granulomas.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Bilateral kidneys are atrophic, with multiple cysts. No evidence of
hydronephrosis. The bladder is decompressed.
GASTROINTESTINAL: The stomach is unremarkable. Patient is status post partial
colectomy with and ileocolic anastomosis located in the midline upper abdomen.
There is evidence of anastomotic leak with extraluminal air and oral contrast
located anterior to the ileocolic suture line (02:38). There is also
extension of the oral contrast through an anterior fascia of defect into the
subcutaneous soft tissues, and likely exiting through the anterior skin
surgical staples. Moderate volume free fluid.
LYMPH NODES: There are multiple mildly enlarged retroperitoneal lymph nodes,
likely reactive. There is an anterior caval lymph node which measures up to
1.4 cm in short axis (02:38).
VASCULAR: There is no abdominal aortic aneurysm. Moderate to severe
atherosclerotic disease is noted.
BONES: Diffuse heterogeneous mixed lytic and sclerotic appearance of the
vertebral bodies in spine. Grade 1 anterolisthesis of L4 on L5 with moderate
changes. Patient is status post total right hip arthroplasty. Subchondral
lucencies within the left femoral head, without evidence of collapse, similar
compared to previous. Overall, these are most likely secondary to renal
osteodystrophy.
SOFT TISSUES: Oral contrast and air tracking along the anterior subcutaneous
soft tissues.
IMPRESSION:
1. Anastomotic leak on the anterior aspect of the ileocolic anastomosis with
intraperitoneal and extraperitoneal extension of extraluminal contrast and air
through the anterior subcutaneous soft tissues. No evidence of residual bowel
ischemia.
2. Bilateral atrophic kidneys with cystic uremic changes. Unchanged
appearance of renal osteodystrophy.
3. Retroperitoneal lymphadenopathy, unchanged, likely reactive.
4. Small bilateral pleural effusions.
|
10213338-RR-535
| 10,213,338 | 22,160,556 |
RR
| 535 |
2166-01-25 12:00:00
|
2166-01-25 13:34:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: ___ year old woman now intubated s/p exlap // confirm ETT
position
TECHNIQUE: AP VIEW OF THE CHEST
COMPARISON: CHEST RADIOGRAPHS FROM ___
FINDINGS:
An endotracheal tube terminates just above the carina and should be pulled
back 3-4 cm for ideal positioning. A right internal jugular catheter
terminates in the mid SVC. An enteric tube descends below the field of view,
likely within the stomach.
There is a persistent left basal opacity which suggests consolidation or
atelectasis, minimally increased from the prior examination. There is minimal
right basal atelectasis. There is no large effusion or pneumothorax.
IMPRESSION:
Endotracheal tube should be pulled back 3-4 cm for ideal positioning, as it
not terminates just above the carina.
Dense retrocardiac opacity could reflect atelectasis or consolidation.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on ___ at 1:31 ___, 5 minutes after discovery of the findings.
|
10213338-RR-536
| 10,213,338 | 22,160,556 |
RR
| 536 |
2166-01-25 15:22:00
|
2166-01-25 16:14:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman NGT placement // NGT placement
TECHNIQUE: AP view of the chest
COMPARISON: Multiple prior radiographs from ___
FINDINGS:
An endotracheal tube terminates 9 mm above the carina. A right internal
jugular catheter terminates in the mid SVC as before. An enteric tube
terminates within the stomach.
A dense retrocardiac opacity persists which could reflect atelectasis or
consolidation.
IMPRESSION:
Endotracheal tube terminates 9 mm above the carina. Dense retrocardiac
opacity persists.
|
10213338-RR-537
| 10,213,338 | 22,160,556 |
RR
| 537 |
2166-01-26 08:08:00
|
2166-01-26 09:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman intubated s/p resuscitation c/f volume ovelroad
// interval change
IMPRESSION:
In comparison to previous radiograph of 1 day earlier, endotracheal tube now
terminates 2 cm above the carinal with the neck in a flexed position. There
is otherwise no relevant change in the appearance of the chest since recent
study.
|
10213338-RR-538
| 10,213,338 | 22,160,556 |
RR
| 538 |
2166-01-27 04:55:00
|
2166-01-27 09:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ESRD - extuabted // interval change
interval change
IMPRESSION:
In comparison with the study of ___, the endotracheal tube has been
removed. Continued enlargement of the cardiac silhouette with evidence of
elevated pulmonary venous pressure. Retrocardiac opacification again is
consistent with substantial volume loss in the left lower lobe, probably
associated with some pleural fluid.
Other monitoring and support devices are unchanged.
|
10213338-RR-540
| 10,213,338 | 22,160,556 |
RR
| 540 |
2166-02-05 15:32:00
|
2166-02-05 17:17:00
|
EXAMINATION: CT ABDOMEN AND PELVIS
INDICATION: ___ year old woman with persistent nausea following revision of
leaking anastomosis and end ileostomy // w/ PO and IV contrast; rule out
abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence: 1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol
= 14.4 mGy (Body) DLP = 7.2 mGy-cm. 2) Spiral Acquisition 4.2 s, 46.4 cm;
CTDIvol = 8.4 mGy (Body) DLP = 390.9 mGy-cm. Total DLP (Body) = 398 mGy-cm.
COMPARISON: Comparison is made with CT abdomen and pelvis from ___.
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. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: Multiple hyperdensities are seen in the spleen consistent with
splenic calcifications and granulomas, unchanged from prior exam. A
nonspecific hypodense lesion is noted in the dome of the spleen.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are atrophic bilaterally. Multiple hypodensities too
small to characterize but likely representing renal cysts are seen in the
bilateral kidneys. There is no evidence of focal renal lesions or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. The patient is status post
partial colectomy with end ileocolonic anastomosis. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. The
remaining colon and rectum are within normal limits. There is no evidence of
active leak.
The moderate free fluid associated with previously seen anastomotic leak now
demonstrates areas of rim enhancement consistent with abscesses. The rim
enhancing collection in the in the right lower quadrant (2:44) measures 4.8 x
2.8 x 4.7 cm. The rim enhancing collection in the deep pelvis (2:59) measures
7.7 x 2.9 x 3.9 cm. The intra-abdominal rim enhancing collection in the
surgical site (2:39) measures 1.7 x 1.0 x 0.9 cm. The rim enhancing
collection in the subcutaneous soft tissues near the surgical site (2:32)
measures 1.7 x 0.6 x 1.6 cm. Non rim enhancing collections are also seen in
the soft tissues of the anterior abdominal wall (2:30).
PELVIS
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild anterolisthesis of L4 over L5 again noted.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Status post partial colectomy with end ileocolonic anastomosis. No
evidence of active bowel leak.
2. Multiple rim enhancing fluid collections in the abdomen and pelvis
consistent with multiple abscesses, as described above.
3. Status post cholecystectomy.
|
10213338-RR-541
| 10,213,338 | 22,160,556 |
RR
| 541 |
2166-02-06 10:21:00
|
2166-02-06 13:10:00
|
EXAMINATION: . AP chest
INDICATION: ___ year old woman with newly placed DHT // KUB DHT placement
KUB DHT placement
IMPRESSION:
Compared to prior chest radiographs ___ through ___
Sequential chest radiographs show advancement of the esophageal feeding tube
with the wire stylet from the lower esophagus to the mid stomach.
Severe cardiomegaly is chronic but pulmonary vascular congestion and previous
pleural effusions have improved since ___. Lungs are grossly clear.
Nipple shadow should not be mistaken for lung nodules. There is no current
pleural abnormality. Right jugular line ends
|
10213338-RR-542
| 10,213,338 | 22,160,556 |
RR
| 542 |
2166-02-12 09:34:00
|
2166-02-12 10:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with newly placed DHT // DHT placement
IMPRESSION:
Radiographs performed for assessment of a Dobhoff tube placement demonstrates
tip of tube terminating in the region of the gastroduodenal junction. A
comparison the ___ chest radiograph, cardiomegaly and increased
pulmonary vascularity persist. Small bilateral pleural effusions are new,
accompanied by bibasilar atelectasis.
|
10213338-RR-543
| 10,213,338 | 22,160,556 |
RR
| 543 |
2166-02-13 11:55:00
|
2166-02-13 14:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: (E) ___ SLE, ESRD on HD s/p failed LRRT (___) s/p ACS/DESx2 p/w
mesent ischemia s/p R colectomy/open abd, washout, primary anst, closure, s/p
rxn leaking anastomosis, end ileostomy with R CVL ? pulled back // assess
location of R CVL (? pulled back) assess location of R CVL (? pulled back)
IMPRESSION:
Comparison to ___. No relevant change. Both monitoring and support
devices are in stable position. No pneumothorax or other complications.
Minimally increasing retrocardiac atelectasis. Otherwise unchanged
radiograph.
|
10213338-RR-544
| 10,213,338 | 22,160,556 |
RR
| 544 |
2166-02-14 08:17:00
|
2166-02-14 09:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with vomiting this morning, and tape connection
off tubing on assessment // Assess placement of the feeding tube Assess
placement of the feeding tube
IMPRESSION:
In comparison with the study of ___, there is continued opacification at
the left base silhouetting the hemidiaphragm, consistent with volume loss in
the left lower lobe and pleural effusion. No convincing evidence of new
consolidation.
The view of the abdomen shows the tip of the Dobhoff tube in the distal
stomach. Right IJ catheter extends to the mid to lower portion of the SVC.
|
10213338-RR-545
| 10,213,338 | 22,160,556 |
RR
| 545 |
2166-02-18 15:08:00
|
2166-02-18 16:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sudden onset chest pain // etiology chest
pain etiology chest pain
IMPRESSION:
Right internal jugular line tip is at the level of superior SVC. Dobbhoff
tube passes below the diaphragm with its tip not included in the field of
view. Cardiomegaly is unchanged. There is mild vascular congestion but
overall improvement in interstitial pulmonary edema. No appreciable
pneumothorax.
|
10213338-RR-546
| 10,213,338 | 22,160,556 |
RR
| 546 |
2166-02-22 23:55:00
|
2166-02-23 11:53:00
|
INDICATION: ___ w/ SLE, ESRD on HD s/p failed LRRT (___) s/p ACS/DESx2 p/w
mesenteric ischemia s/p R colectomy/open abd, washout, primary anst, closure,
s/p leaking anastomosis, revision, and end ileostomy. Patient has been stable
from a GI perspective, but developed new abdominal pain this evening and had
two episodes of emesis. // Pls perform 2-view KUB to assess for new abdominal
pain and emesis x2. Please rule out obstruction, free air, etc.
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is
general paucity of bowel gas with contrast in the descending colon, sigmoid
and the rectum. Diffuse vascular calcifications, right total arthroplasty are
again seen. Enteric tube is seen coursing below the diaphragm with its tip
projecting over L5.
There is no free intraperitoneal air.
Osseous structures are notable for severe degenerative changes of the right
hip joint. Surgical clips are seen in the pelvis, and right upper quadrant.
Midline drain projecting over the sacrum.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Paucity of small bowel gas with contrast in the descending, sigmoid colon and
the rectum. No pneumoperitoneum.
|
10213338-RR-551
| 10,213,338 | 28,130,637 |
RR
| 551 |
2166-06-06 00:41:00
|
2166-06-06 01:07:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ with fever, cough // infiltrate
TECHNIQUE: AP upright views of the chest
COMPARISON: Prior radiographs most recent on ___
FINDINGS:
The heart is enlarged but stable from the prior examination. There is
prominence of the pulmonary vasculature without frank pulmonary edema.
Streaky bibasilar peribronchiolar opacities are new No pneumothorax or pleural
effusion.
IMPRESSION:
New peribronchial lower lobe opacities could potentially be due to aspiration
or developing bronchopneumonia. Followup PA and lateral chest radiographs may
be helpful for more complete assessment.
|
10213338-RR-552
| 10,213,338 | 28,130,637 |
RR
| 552 |
2166-06-06 04:39:00
|
2166-06-06 09:54:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old woman with large effusion likely in setting of lupus
flare vs. septic joint // Evidence of ongoing arthritis, evidence of septic
joint Evidence of ongoing arthritis, evidence of septic joint
TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the left knee.
COMPARISON: Radiographs of the left knee ___
FINDINGS:
There is progressive sclerosis of the medial and lateral femoral condyles and
superior pole of the patella concerning for areas of osteonecrosis. There is
worsening bony destruction with lucency and fragmentation of the lateral
femoral condyle. There is no fracture or dislocation. There are extensive
vascular calcifications. There may be a small suprapatellar joint effusion.
There is mild generalized subcutaneous soft tissue edema about the thigh.
IMPRESSION:
1. Worsening lucency and fragmentation of the lateral femoral condyle and
small suprapatellar effusion is worrisome for septic joint and osteomyelitis
until proven otherwise.
2. Worsening bony sclerosis of the medial and lateral femoral condyles and
patella likely reflects bone infarcts in the setting of lupus.
NOTIFICATION: The findings were telephoned to ___ by ___
at 09:51, ___, 20 min after discovery.
|
10213338-RR-553
| 10,213,338 | 28,130,637 |
RR
| 553 |
2166-06-06 17:20:00
|
2166-06-07 01:37:00
|
EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA LEFT
INDICATION: ___ year old woman with complicated history including primarily
with SLE, with renal and ___ involvement, presenting with new onset L
shoulder pain, swelling and limited ROM. Being worked up for septic joint vs.
SLE exacerbation // evaluate for increased joint space, ___ changes i/s/o
new shoulder pain and swelling. septic vs. SLE exacerbation evaluate for
increased joint space, ___ changes i/s/o new shoulder pain and swelling.
septic vs. SLE exacerbation
TECHNIQUE: AP in internal rotation, Grashey in external rotation, and
axillary view radiographs of the left shoulder.
COMPARISON: Radiographs left shoulder ___
FINDINGS:
There is no fracture or dislocation. Degenerative change at the AC joint is
mild. There are mixed areas of sclerosis and lucency in the left humeral head
similar to ___.
IMPRESSION:
Mixed areas of sclerosis and lucency in the left femoral head similar to ___
in part reflect areas of known osteonecrosis. However, an erosion cannot be
excluded and in this patient with renal failure, amyloid arthropathy could
have a similar appearance. A follow-up MRI could be considered to evaluate
for possible erosive changes.
NOTIFICATION: The findings were communicated by telephone to ___ by
___ at 10:00, ___, 20 min after discovery.
|
10213338-RR-554
| 10,213,338 | 28,130,637 |
RR
| 554 |
2166-06-06 16:04:00
|
2166-06-06 17:50:00
|
EXAMINATION: INJ/ASP MAJOR JT W/FLUORO
INDICATION: ___ year old woman with SLE with h/o of joint involvement with
acute L knee swelling and pain c/f septic arthritis vs. SLE exacerbation. Need
tap prior to initiating treatment // L knee aspiration septic arthritis vs.
SLE exacerbation
TECHNIQUE: The risks, benefits and alternatives were explained to the patient
and written informed consent was obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
4 cc 1% Lidocaine was used to achieve local anesthesia.
Under intermittent fluoroscopic guidance, a 18-gauge spinal needle was
advanced into the left knee joint. There was immediate aspiration of
approximately 10 cc of blood-tinged synovial fluid. Samples have been sent
for fluid culture, cell count and crystal analysis as requested.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in stable
condition. There were no immediate complications.
COMPARISON: Left knee radiographs ___.
FINDINGS:
Fluoroscopic images demonstrated persistent cortical regularity along the
lateral femoral condyle as seen on the prior radiographs.
IMPRESSION:
1. Findings - cortical irregularity along the lateral femoral condyle
concerning for infection.
2. Procedure - Uneventful fluoroscopic-guided left knee aspiration.
|
10213338-RR-555
| 10,213,338 | 28,130,637 |
RR
| 555 |
2166-06-07 13:46:00
|
2166-06-07 15:40:00
|
EXAMINATION: INJ/ASP MAJOR JT W/FLUORO
INDICATION: ___ year old woman with h/o SLE with new onset L knee and shoulder
swelling and pain most c/f septic joint vs. lupus flare // L shoulder
aspiration for ? septic joint vs. lupus flare
COMPARISON: Radiographs of the left shoulder ___
PROCEDURE: The procedure was supervised by Dr. ___, attending
radiologists, was present for the procedure. Dr. ___ was consulted
during the procedure.
The risks, benefits, and alternatives were explained to the patient and
written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
A total of 10 cc 1% Lidocaine was used to achieve local anesthesia. Under
intermittent fluoroscopic guidance, a 18-gauge spinal needle was advanced into
the left shoulder joint space. Appropriate position was confirmed by the
injection of a 3cc of water soluble contrast. Approximately 0.5 cc of pink
tinged fluid was aspirated and sent for culture.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the satisfactorily well and left the department in
stable condition. There were no immediate complications or complaints.
FINDINGS:
Re- demonstrated is mixed sclerosis and lucency in the left humeral head
reflecting areas of known osteonecrosis. Please see the recently performed
radiographs of the left shoulder for further details.
IMPRESSION:
1. Imaging Findings - Re- demonstrated is mixed sclerosis and lucency in the
left humeral head reflecting areas of known osteonecrosis. Please see the
recently performed radiographs of the left shoulder for further details.
2. Procedure - Technically successful left shoulder aspiration.
I Dr. ___ supervised the Resident/Fellow during the key
components of the above procedure and I have reviewed and agree with the
Resident/Fellow findings/dictation.
|
10213338-RR-556
| 10,213,338 | 28,130,637 |
RR
| 556 |
2166-06-11 13:34:00
|
2166-06-12 17:15:00
|
EXAMINATION: ___ AVF/DUPLEX HEMO/DIAL ACCESS LEFT
INDICATION: ___ year old woman w/ septic arthitis in knee/shoulder, SLE, ESRD
on HD, LUE AV graft concerning for an infectious source of the septic
arthritis // c/f infectious source in graft
TECHNIQUE: Grayscale, color and Doppler spectral ultrasound images were
obtained of the left upper extremity AV graft.
COMPARISON: None available.
FINDINGS:
There is no evidence of fluid collection around the graft to suggest infection
or abscess formation.
The graft is patent with peak flows ranging between 266 and 399
milliliters/minute.
Average peak systolic velocities throughout the graft and outflow vein range
between 42 and 173 cm/sec. A fairly high peak systolic velocity of 490 cm/sec
was seen at the level of the shoulder/axilla suggesting significant stenosis
in the outflow vein.
IMPRESSION:
1. No evidence of fluid collection or abscess around the graft.
2. Low-flow volumes and elevated peak systolic velocity in the outflow vein
suggestive of significant outflow vein stenosis
|
10213338-RR-557
| 10,213,338 | 28,130,637 |
RR
| 557 |
2166-06-12 13:21:00
|
2166-06-12 13:43:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: Ms. ___ is a ___ lady with a PMH notable for SLE, ESRD
on HD, CAD s/p DES to LAD and D1, and history of ventricular tachycardia
presented with septic arthritis of the L knee and L shoulder, now transferred
to the CCU for bradycardia. // Overload? Pulmonary process? CENTRAL LINE
PLACEMENT POSITION. OVERLOAD? PULMONARY PROCESS?
IMPRESSION:
Comparison to ___. The patient has received a right internal jugular
vein catheter. The course of the catheter is unremarkable, the tip of the
catheter projects over the lower SVC. No complications, notably no
pneumothorax.
|
10213338-RR-558
| 10,213,338 | 28,130,637 |
RR
| 558 |
2166-06-12 20:10:00
|
2166-06-12 20:28:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with new transaminitis. Stone/obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth with enlargement of the left hepatic lobe, similar in
appearance to ___. There is no focal liver mass. The main portal vein
is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 3 mm.
GALLBLADDER: Surgically absent.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
KIDNEYS: Limited views of the right kidney demonstrate an atrophic kidney
with 2 nonobstructing 0.4 cm right lower pole renal stones, unchanged in
appearance since ___.
IMPRESSION:
1. Normal liver parenchyma without evidence of intrahepatic or extrahepatic
biliary duct dilatation.
2. Atrophic right kidney with 2 nonobstructing small renal stones.
|
10213338-RR-559
| 10,213,338 | 28,130,637 |
RR
| 559 |
2166-06-13 12:38:00
|
2166-06-13 13:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with septic joints, intermittent fevers. //
Eval placement of lines and tubes, eval for pneumonia. Eval placement of
lines and tubes, eval for pneumonia.
IMPRESSION:
Comparison to ___. Moderate cardiomegaly. Normal lung volumes. No
pulmonary edema, no pleural effusions. No pneumonia. Staples over the left
axillary region. Right internal jugular vein catheter in situ.
|
10213338-RR-560
| 10,213,338 | 28,130,637 |
RR
| 560 |
2166-06-14 00:25:00
|
2166-06-14 03:21:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT PORT
INDICATION: ___ year old woman with left calf pain and swelling, s/p ortho
procedure L knee, not on AC // DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow is demonstrated in
the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
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