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10213338-RR-562
| 10,213,338 | 28,130,637 |
RR
| 562 |
2166-06-14 13:04:00
|
2166-06-14 18:25:00
|
EXAMINATION: ART DUP EXT LO UNI;F/U LEFT
INDICATION: ___ year old woman with SLE and CKD, admitted with L septic knee
and L septic shoulder both s/p OR washout, also history of paroxysmal AFib //
PLEASE DO PORTABLE. New non-palpable left DP pulse, cool feet, concern for
occlusion
TECHNIQUE: Grayscale ultrasound, color and spectral Doppler were performed of
the left lower extremity.
COMPARISON: None available.
FINDINGS:
The common femoral artery is patent with triphasic waveform and peak systolic
velocity of 80 cm/sec. The deep femoral artery is patent with a triphasic
waveform and peak systolic velocity of 59 cm/sec. The proximal SFA is patent
with triphasic waveform and a peak systolic velocity of 64 cm/sec. The mid
SFA is patent with a monophasic waveform and PSV of 67 cm/sec. The distal SFA
is patent with a monophasic waveform and PSV of 51 cm/sec. The popliteal
artery is patent with a monophasic waveform and PSV of 29 cm/sec. There is
low flow with the peroneal artery with PSV of 19 cm/sec. There is no flow
seen in the anterior tibial, posterior tibial and dorsalis pedis arteries.
IMPRESSION:
No flow seen within the anterior tibial, posterior tibial and dorsalis pedis
arteries.
Low flow within the peroneal artery.
Monophasic waveforms within the mid and distal SFA and popliteal artery.
NOTIFICATION: These findings were discussed with ___ MD by ___
___ MD at 18:20 on ___ by telephone at time of discovery.
|
10213338-RR-563
| 10,213,338 | 28,130,637 |
RR
| 563 |
2166-06-27 15:07:00
|
2166-06-27 16:50:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with h/o SLE, ESRD, CAD with persistent GI
bleed planning for surgical intervention. // cholestasis or other diagnoses
for LFT abnormalities
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Liver ultrasound ___
FINDINGS:
LIVER: The hepatic parenchyma is diffusely heterogeneous with abnormal
architecture and echotexture. The contour of the liver is smooth. Again noted
is enlargement of the left hepatic lobe, similar compared to prior studies.
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 5 mm.
GALLBLADDER: The patient is status post cholecystectomy.
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.
SPLEEN: Multiple splenic granulomas are seen. The spleen measures 11.4 cm.
KIDNEYS: Again seen is atrophy of the right kidney. 2 previously described
stones within the right kidney are not well seen on today's study. The left
kidney is also atrophic. There is no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Diffuse heterogeneity of the hepatic parenchyma with abnormal architecture and
echotexture, a nonspecific finding suggestive of diffuse liver disease.
Consider MRI for further evaluation.
Status post cholecystectomy.
Bilateral renal atrophy compatible with medical renal disease, unchanged.
|
10213765-RR-10
| 10,213,765 | 28,522,861 |
RR
| 10 |
2113-04-11 09:51:00
|
2113-04-12 10:07:00
|
EXAMINATION: PELVIS (AP, INLET AND OUTLET) IN O.R.
INDICATION: PELVIS FX
TECHNIQUE: 51 intraoperative fluoroscopic spot images of the pelvis were
obtained without the radiologist present. Total fluoroscopy time is 01:00 29
seconds.
COMPARISON: Radiographs of the pelvis and CT of the torso ___.
FINDINGS:
Sequential images demonstrate localizing devices over the right inferior pubic
ramus, the sacrum and the left iliac bone with subsequent fixation of left
sacroiliac joint diastasis with a lag screw and fixation of a fracture through
the left superior pubic ramus with an additional lag screw. There is no
evidence of hardware complication. There is redemonstration of a left inferior
pubic ramus fracture.
IMPRESSION:
Open reduction internal fixation of a fracture through the left superior pubic
ramus and left sacroiliac joint diastasis. Please see the operative report for
further details.
|
10213765-RR-11
| 10,213,765 | 28,522,861 |
RR
| 11 |
2113-04-11 20:16:00
|
2113-04-12 08:06:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with fall from 30 ft // eval ptx
IMPRESSION:
AS COMPARED TO THE PREVIOUS RADIOGRAPH FROM EARLIER THE SAME DATE, A SMALL
RIGHT APICAL PNEUMOTHORAX IS SIMILAR TO THE PRIOR STUDY. RIGHT LOWER LOBE
OPACITY HAS PARTIALLY RESOLVED, AND REMAINDER OF THE LUNGS AND PLEURA ARE
UNCHANGED.
|
10213765-RR-12
| 10,213,765 | 28,522,861 |
RR
| 12 |
2113-04-12 11:38:00
|
2113-04-12 12:50:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with +LOC, polytrauma, grade 2 liver lac, infr
pubic rami/iliac frx, R PTX, R 7th rib frx // Evaluation of pneumothorax
COMPARISON: ___.
IMPRESSION:
As compared to the previous image, there is no substantial change in dimension
of the right apical pneumothorax. The patient shows no evidence of tension.
The pre described subtle right lower lung parenchymal opacity has completely
resolved, a small atelectasis in the infra hilar right lung regions persists.
Unremarkable left lung. Normal size of the cardiac silhouette. No pneumonia
or pleural effusions.
|
10213765-RR-13
| 10,213,765 | 28,522,861 |
RR
| 13 |
2113-04-12 11:38:00
|
2113-04-12 16:02:00
|
INDICATION: ___ year old man with fall from 30 ft // eval fracture
TECHNIQUE: Three views right wrist.
COMPARISON: None
FINDINGS:
No fracture or dislocation. Carpal rows appear intact. No radiopaque foreign
body. Soft tissues unremarkable.
IMPRESSION:
No fracture or dislocation of the wrist.
|
10213765-RR-4
| 10,213,765 | 28,522,861 |
RR
| 4 |
2113-04-10 11:11:00
|
2113-04-10 12:24:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with fall from 30 ft // trauma
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 891 mGy-cm
CTDI: 53 mGy
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration. The basal cisterns are
patent. Gray-white matter differentiation is preserved.
No osseous abnormalities seen. There is mucosal thickening in the right
frontal sinus and frontoethmoidal recess. There is opacification of bilateral
anterior ethmoid air cells. There is minimal mucosal thickening in the
sphenoid sinuses and mild mucosal thickening in the partially imaged maxillary
sinuses. The mastoids are underdeveloped but clear. The middle ear cavities
are clear.
IMPRESSION:
Minimal paranasal sinus inflammatory changes. Otherwise normal study.
|
10213765-RR-5
| 10,213,765 | 28,522,861 |
RR
| 5 |
2113-04-10 11:11:00
|
2113-04-10 12:19:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall from 30 ft // trauma trauma
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 37 mGy
DLP: 817 mGy-cm
COMPARISON: None
FINDINGS:
Alignment is normal. No fractures are identified. There is no evidence of
spinal canal or neural foraminal narrowing. There is no evidence of infection
or neoplasm.
There is partially imaged right apical pneumothorax. The palatine tonsils are
enlarged with several tonsilliths. There are prominent but symmetric cervical
lymph nodes likely within normal limits for patient's age.
IMPRESSION:
1. No evidence of fracture or dislocation. Right apical pneumothorax
partially imaged.
2. Enlarged palatine tonsils with several tonsilliths.
3. Prominent cervical all lymph nodes likely within normal limits for
patient's age.
|
10213765-RR-6
| 10,213,765 | 28,522,861 |
RR
| 6 |
2113-04-10 11:12:00
|
2113-04-10 11:54:00
|
INDICATION: History: ___ with fall from 30 ft // trauma
TECHNIQUE: Frontal radiographs of the chest and pelvis.
COMPARISON: CT of the torso performed on ___ at 11:42am.
FINDINGS:
CHEST: The lungs are well expanded and clear. Cardiomediastinal and hilar
contours are unremarkable. There is no pneumothorax, pleural effusion, or
consolidation. No acute displaced rib fractures are identified.
PELVIS: Frontal radiograph of the pelvis demonstrates fractures involving the
left inferior pubic ramus and left iliac bone, and through the superior pubic
ramus as well.
IMPRESSION:
1. Fractures of the left inferior pubic ramus, left iliac bone, and superior
pubic ramus.
2. No acute cardiopulmonary process.
|
10213765-RR-7
| 10,213,765 | 28,522,861 |
RR
| 7 |
2113-04-10 11:12:00
|
2113-04-10 12:14:00
|
INDICATION: History: ___ with fall from 30 ft // trauma
TECHNIQUE: Contiguous helical MDCT images were obtained through the abdomen
and pelvis after administration of 130 cc of Omnipaque IV contrast.
Multiplanar axial, coronal and sagittal images were generated.
DOSE: Total body DLP: 445 mGy-cm
COMPARISON: None
FINDINGS:
CT CHEST WITH CONTRAST: Partially imaged thyroid unremarkable. No
lymphadenopathy. Esophagus normal. Heart size is normal without pericardial
effusion. Aorta and main thoracic vessels wall opacified. Main pulmonary
artery is normal in caliber. There is pneumomediastinum.
There is moderate right pneumothorax. Multiple rounded peripheral opacities
throughout the right lung are compatible with lung contusions. There is no
pleural effusion. Left lung is essentially clear. The tracheobronchial tree is
patent to the subsegmental level.
CT ABDOMEN WITH CONTRAST: There is a 5.6 x 3.1 x 9.3 cm intraparenchymal
contusion in the liver (series 602B image 21). There is small amount of
hemorrhage around the liver which tracks inferiorly along the paracolic gutter
into the pelvis. There is no intra or extrahepatic biliary duct dilation. The
gallbladder is normal.
6 mm hypodense peripheral focus in the upper aspect of the spleen may be a
small contusion. There is no perisplenic hemorrhage. The spleen, adrenal
glands, and kidneys are normal. Kidneys excrete contrast symmetrically without
hydronephrosis. The ureters are normal throughout their visualized course.
The stomach, small large bowel are normal in caliber without obstruction. The
abdominal aorta and iliac arteries are normal in caliber.
CT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. As
mentioned above hemorrhagic free fluid tracks into the right hemipelvis. Trace
amount of hemorrhage is also seen in the left hemipelvis.
BONES AND SOFT TISSUES: There is a nondisplaced fracture of the right seventh
rib laterally (series 2, image 35). There are fractures of the superior and
inferior left pubic rami. There also fractures of the left sacral ala and the
left ischial tuberosity (series 2, image 89). There are small anterior
fractures of the right and left pubic bones (2:109) at the pubic symphysis.
IMPRESSION:
1. Moderate right pneumothorax and pneumomediastinum. Multiple right lung
contusions. Nondisplaced right seventh rib fracture.
2. Grade two liver injury as detailed above. Small amount of perihepatic
hemorrhage tracking inferiorly into the pelvis.
3. Possible tiny contusion in the superior aspect of the spleen.
4. Fractures of the superior and inferior left pubic rami. Fractures of the
left sacral ale and left ischial tuberosity. Small anterior fractures of the
right and left pubic bones at the pubic symphysis
NOTIFICATION: Fracture of the pubic symphysis.
|
10213765-RR-8
| 10,213,765 | 28,522,861 |
RR
| 8 |
2113-04-10 19:06:00
|
2113-04-10 22:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p fall with rib frx, pneumothorax,
pneumomediastinum // Pls perform at 6 ___. please look for interval change in
pneumothorax/pneumomediastinum Pls perform at 6 ___. please look for
interval change in , pn
COMPARISON: Chest radiographs and chest CT performed between 11 and 11:45
today.
IMPRESSION:
Heterogeneous consolidation in the right lower lobe, new since earlier in the
day is local bleeding due to contusion and small laceration seen on the chest
CT scan. Followup advised.
Small right pneumothorax, confirmed by the chest CT scan, is most readily seen
along the right lower costal surface and is no larger now than it was earlier
in the day.
Small pneumomediastinum is unchanged. In the setting of closed chest trauma
this need not indicate disruption of the esophagus or tracheal bronchial tree,
either of which would probably produce more air in the mediastinum and
conceivably hemo mediastinal hematoma. Otherwise the cardiomediastinal
silhouette has a normal appearance. Left lung is clear and there is no left
pleural abnormality.
Detection of chest wall trauma is more reliable with torso CT.
|
10213765-RR-9
| 10,213,765 | 28,522,861 |
RR
| 9 |
2113-04-11 08:11:00
|
2113-04-11 10:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ yo male s/p 30 ft fall with multiple injuries // assess for
interval changes. expiratory, sit up as much as possible assess for
interval changes. expiratory, sit up as much as p
COMPARISON: Chest radiographs on ___, read in conjunction with torso
CT also ___.
IMPRESSION:
The expiration view was obtained on the instructions of the requesting
physician. This may account for the apparent increase in size of the small
right pneumothorax which, in reality, may be unchanged. It may also
exaggerate the confluence of the previous consolidation in the right lower
lobe due to local bleeding. I have discussed the advisability of retaining of
obtaining full inspiratory chest radiographs hereafter.
Interval increase in heart size and mediastinal venous caliber is due in part
to lower lung volumes, but most likely increased intravascular volume as well.
Left lung is clear and there is no left pleural abnormality.
NOTIFICATION: Dr. ___ reported the findings to Dr ___ by telephone
on ___ at 10:44 AM, 5 minutes after discovery of the findings. The
explained that the patient has no findings to suggest continued bleeding in
the lung or pneumonia.
|
10213803-RR-61
| 10,213,803 | 26,255,243 |
RR
| 61 |
2192-10-01 06:06:00
|
2192-10-01 07:02:00
|
INDICATION: Cough and syncope. Per review of the ___ medical records, the
patient has a history of leukemia, and is status post a bone marrow transplant
approximately ___ years ago.
COMPARISON: Chest radiograph from ___. Chest radiograph from
___. CT of the chest from ___.
TECHNIQUE: A single AP upright view of the chest was obtained.
FINDINGS: Since the prior exam, the lung volumes are lower, with a new
opacity at the right base with associated elevation of the right
hemidiaphragm. No other consolidation is identified. There is no pulmonary
edema, pleural effusion or pneumothorax. The cardiomediastinal silhouette is
normal.
IMPRESSION: Right basilar opacity, most consistent with a new pneumonia.
|
10214395-RR-12
| 10,214,395 | 29,443,407 |
RR
| 12 |
2179-11-25 08:39:00
|
2179-11-25 13:24:00
|
EXAMINATION: SHUNT SERIES AP AND LAT SKULL, AP CHEST, AP ABDOMEN
INDICATION: ___ year old woman with longstanding VP shunt placed at OSH //
localize for operative planning
TECHNIQUE: 6 images obtained as part of a shunt series
COMPARISON: None available
FINDINGS:
The skull radiographs demonstrates a the scaphocephaly configuration. The
interventricular portion of the shunt is visualized. The catheter tubing is
then visualized in neck however contiguity between these 2 structures is not
demonstrated. Many of the ventriculoperitoneal shunts have a non radiopaque
portion and correlation with the precise type of shunt is recommended. The
catheter tubing thin visualized distally passing over the chest wall, down
into the upper abdomen. No other areas of discontinuity are appreciated.
Numerous clips are projecting throughout the abdomen. Surgical clips in the
right upper quadrant. Limited evaluation of the lungs is grossly clear.
IMPRESSION:
As above.
|
10214881-RR-21
| 10,214,881 | 20,147,582 |
RR
| 21 |
2129-04-26 15:34:00
|
2129-04-26 15:42:00
|
INDICATION: ___ female with new onset seizures // Please eval for
any infectious process
TECHNIQUE: Frontal and lateral chest radiographs were obtained with the
patient in the upright position.
COMPARISON: None available.
FINDINGS:
Lung volumes are low, which accentuate the bronchovascular markings, but no
definite focal consolidation seen.
.No pleural effusion or pneumothorax is seen. The heart size is normal. The
mediastinal contours are normal.
IMPRESSION:
Low lung volumes which accentuate the bronchovascular markings, but no
definite focal consolidation seen.
|
10214881-RR-22
| 10,214,881 | 20,147,582 |
RR
| 22 |
2129-04-26 18:39:00
|
2129-04-27 10:11:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with no significant past medical history who
presents with a first time seizure and right frontal hypodensity on CT.
TECHNIQUE: Sagittal and axial T1, gradient echo, FLAIR, diffusion, and T1
imaging was performed. After administration of intravenous gadolinium, axial
T1 and sagittal MPRAGE imaging was performed and re-formatted in axial and
coronal orientations
COMPARISON: ___ CT head ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage.
There is a T2 hyperintense mass expanding the cortex of the right frontal
lobe, centered in the middle frontal gyrus , without associated hemorrhage,
calcification, contrast enhancement, or surrounding edema. The mass measures
4.1 cm AP x 3.6 cm transverse x 3.2 cm superior-inferior. There are several
linear foci of slow diffusion along the anterior margin of the mass suggesting
foci a hypercellularity. There is no mass effect on the ventricles, which are
normal in size, and no shift of midline structures. No signal abnormalities
are seen elsewhere in the brain parenchyma.
There are normal major arterial flow voids. Major dural venous sinuses are
patent.
IMPRESSION:
Non-enhancing T2 hyperintense cortically-based mass in the right middle
frontal gyrus without surrounding edema, most consistent with low-grade
neoplasm such as astrocytoma or dysembryoplastic neuroepithelial tumor (DNET).
Oligodendroglioma is less likely.
|
10214881-RR-23
| 10,214,881 | 20,147,582 |
RR
| 23 |
2129-04-27 16:37:00
|
2129-04-28 09:57:00
|
INDICATION: ___ year old woman with new GTC, R frontal mass on MRI // ___ year
old woman with new GTC, R frontal mass on MRI
TECHNIQUE: MR perfusion and spectroscopy was performed.
COMPARISON: Prior MRI dated ___.
FINDINGS:
There is a FLAIR hyperintense mass again noted within the cortex of the right
frontal lobe which appears grossly unchanged in size and signal compared to
recent prior study. No new regions of parenchymal signal abnormality are
identified. There is no extra-axial collection. There is no shift of midline.
The ventricles and sulci are normal in size and configuration. The orbits are
unremarkable. There is mucosal thickening within the ethmoid air cells. The
mastoid air cells are clear.
ASL perfusion images reveal no definite increased profusion in the region of
signal abnormality in the right frontal lobe.
Single a multi voxel spectroscopy reveal elevated choline peaks (see voxel 1)
consistent with a neoplastic lesion.
IMPRESSION:
No significant interval change in T2/FLAIR hyperintense lesion in the right
frontal lobe. An cell perfusion images reveal no increased perfusion in this
region. On spectroscopy, there elevated choline peaks consistent with
neoplasm.
|
10214881-RR-24
| 10,214,881 | 20,147,582 |
RR
| 24 |
2129-04-27 19:28:00
|
2129-04-27 20:31:00
|
EXAMINATION: CT abdomen and pelvis with intravenous contrast.
INDICATION: ___ year old woman with new GTC, R frontal mass on MRI // eval
for primary malignancy
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis prior
to and following intravenous contrast administration.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 904.88 mGy-cm (abdomen and pelvis).
IV Contrast: 100 mL Omnipaque
COMPARISON: None.
FINDINGS:
LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
Abdomen/pelvis:
Liver has uniform density without evidence of mass. There is no intrahepatic
or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.
Spleen is within normal limits. There is no evidence of pancreatic mass or
pancreatic ductal dilatation.
Adrenal glands are within normal limits. There is symmetric renal enhancement
and excretion of intravenous contrast. There is no evidence of renal mass or
hydronephrosis. Urinary bladder is moderately distended without gross
abnormality.
There is intrauterine device within the endometrial canal which appears to be
low-lying with tip within the internal os. Non-mass-like areas of low-density
near the uterine fundus are likely perfusional in etiology. The ovaries are
normal in appearance with normal follicular change.
There are no dilated loops of bowel. There is no bowel wall thickening. There
is no intraperitoneal free air or free fluid.
Abdominal aorta has normal course and caliber. There are no enlarged inguinal,
iliac chain, or retroperitoneal lymph nodes.
There is no suspicious osseous lesion.
IMPRESSION:
1. No abdominopelvic malignancy detected.
2. Low lying IUD with tip within the cervix.
3. Please see separate same day CT chest dictation for dedicated thoracic
findings.
|
10214881-RR-25
| 10,214,881 | 20,147,582 |
RR
| 25 |
2129-04-27 19:30:00
|
2129-04-27 20:33:00
|
EXAMINATION: Chest CT
INDICATION: new GTC, R frontal mass on MRI
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: DLP: Reported in the concurrent abdomen ct
COMPARISON: None
FINDINGS:
There is no evidence of pulmonary parenchymal abnormality. There is no pleural
effusion. The airways are patent to the subsegmental level. 2 mm subpleural
nodule in the lingula is statistically benign.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion.
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
No evidence of intrathoracic malignancy.
|
10214881-RR-26
| 10,214,881 | 20,147,582 |
RR
| 26 |
2129-04-29 13:50:00
|
2129-04-29 14:39:00
|
EXAMINATION:
CT STEREOTAXIS W/ CONTRAST
INDICATION: ___ year old woman with R frontal lesion planned for stereotactic
biopsy // please complete study prior to OR (start 11:15) IN FRAME on
___, operative planning
TECHNIQUE: Routine MDCT axial imaging was obtained of the brain following the
administration intravenous contrast material.
DOSE: DLP: 804.7 mGy-cm; CTDI: 25.2 mGy
COMPARISON: CT head from ___. MRI of the brain from ___.
FINDINGS:
Contrast-enhanced CT scan of the brain was performed with a stereotactic halo
in place. Again seen is a hypodensity within the right frontal lobe
corresponding to the known mass seen on the MRI. There is no significant
enhancement. No other lesions are identified. The ventricles and sulci are
normal in size and configuration. The intracranial vessels are unremarkable.
There is mucosal thickening within the ethmoid air cells. Remainder the
paranasal sinuses, mastoid air cells and middle ear cavities are clear. The
bones are unremarkable.
IMPRESSION:
Right frontal hypodensity consistent with known mass seen on the prior MRI.
|
10214881-RR-27
| 10,214,881 | 20,147,582 |
RR
| 27 |
2129-04-29 17:59:00
|
2129-04-29 18:34:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with right frontal brain mass, status post
stereotatic brain biopsy, please evaluate for post operative changes. Please
obtain by 7pm.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 897 mGy-cm
CTDI: 56 mGy
COMPARISON: CT from ___ at 13:50 and MR from ___. .
FINDINGS:
The patient is status post right frontal craniotomy. There is expected small
amount of pneumocephalus underneath the craniotomy site. Hypodensity within
the right frontal lobe correlates with the lesion seen on MR. ___ is no
evidence of infarction or hemorrhage. The ventricles and sulci are normal in
size and configuration. There is mild mucosal thickening of the ethmoid air
cells bilaterally. The mastoid air cells and middle ear cavities are clear.
The orbits are unremarkable.
IMPRESSION:
Expected postsurgical changes at the right frontal craniotomy site without
hemorrhage.
|
10215159-RR-23
| 10,215,159 | 24,039,782 |
RR
| 23 |
2127-12-14 17:30:00
|
2127-12-14 18:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with ETT*** WARNING *** Multiple patients with same
last name! // ETT
TECHNIQUE: Single frontal view of the chest
COMPARISON: None
FINDINGS:
Endotracheal tube is seen terminating approximately 4 cm above the level of
the carina. There is bibasilar atelectasis, platelike on the right. No
definite focal consolidation is seen. The cardiac silhouette is top-normal to
mildly enlarged. The aorta is tortuous. No large pleural effusion is seen
although a trace pleural effusion would be difficult to exclude, particularly
on the right. There is no pneumothorax.
IMPRESSION:
Endotracheal tube terminates approximately 4 cm above the level of the carina
|
10215159-RR-25
| 10,215,159 | 24,039,782 |
RR
| 25 |
2127-12-14 18:34:00
|
2127-12-14 19:01:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with frontal intraparenchymal bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head performed at an outside facility on the same date, ___ approximately 3 hours prior.
FINDINGS:
An approximately 6.6 x 2.7 x 5.5 cm right frontal lobe intraparenchymal
hemorrhage is identified with intraventricular extension of blood products
expanding the right lateral ventricle. Blood is identified additionally
within the third ventricle as well as filling the fourth ventricle and
possibly the posterior aspect of the left frontal horn. Hemorrhage
additionally extend into the occipital horn of the left lateral ventricle.
Prominence of the ventricles is noted concerning for evolving hydrocephalus.
There is effacement of the frontal horn of the right lateral ventricle with
approximate 0.8 cm leftward shift of normal midline structures. The edema
within the white matter of the frontal convexities is present with effacement
of sulci, moderate in degree. Basal cisterns appear patent. Additional note
is made of likely subdural hemorrhage layering along the falx anteriorly.
An endotracheal tube is identified. Mild mucosal thickening involving the
frontal sinuses, ethmoidal air cells, sphenoid sinuses and maxillary sinuses
is noted. Mastoid air cells and middle ear cavities are clear. Carotid
siphon vascular calcifications are moderate to severe.
IMPRESSION:
Large right frontal intraparenchymal hemorrhage with intraventricular
extension involving the bilateral lateral ventricles, third ventricle as well
as extending into the fourth ventricle and foramina of Luschka. Prominent
ventricles are noted concerning for evolving hydrocephalus. Mass effect with
effacement of the frontal horn of the right lateral ventricle, sulcal
effacement, and approximately 0.8 cm leftward shift of normally midline
structures.
Small amount of acute subdural hemorrhage layers along the falx anteriorly.
|
10215159-RR-26
| 10,215,159 | 24,039,782 |
RR
| 26 |
2127-12-14 18:34:00
|
2127-12-14 19:18:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with intracranial hemorrhage, intubated*** WARNING
*** Multiple patients with same last name! // eval for trauma eval for
trauma
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) = 851 mGy-cm.
COMPARISON: None.
FINDINGS:
No acute fracture or malalignment is identified. Multilevel degenerative
changes are identified, most pronounced at the C6-C7 level. There is endplate
irregularity and sclerosis as well as disc space narrowing at this level.
Vertebral body heights appear preserved. Evaluation of the central cord is
limited though no obvious stenosis is identified. There is no abnormal
prevertebral soft tissue swelling.
Patient is intubated and endotracheal tube within the trachea. The imaged
thyroid gland is unremarkable. Biapical lungs demonstrate centrilobular
emphysema. Dependent atelectasis is additionally noted. Foci of air within
the left supracavicular region with soft tissue induration may relate to
attempted central line placement.
IMPRESSION:
1. No acute fracture or subluxation. Degenerative changes are most pronounced
at the C6-C7 level with endplate sclerosis irregularity and disc space
narrowing.
2. Foci of air within the left supracavicular region with soft tissue
induration may relate to attempted central line placement. Correlation with
history of such.
|
10215159-RR-27
| 10,215,159 | 24,039,782 |
RR
| 27 |
2127-12-14 18:55:00
|
2127-12-14 19:12:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD
INDICATION: ___ year old woman with right parenchymal hemorrhage. Evaluate
for vascular malformation.
TECHNIQUE: 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) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 49.0 mGy (Head) DLP =
24.5 mGy-cm.
4) Spiral Acquisition 3.0 s, 23.7 cm; CTDIvol = 31.3 mGy (Head) DLP = 743.0
mGy-cm.
Total DLP (Head) = 767 mGy-cm.
COMPARISON: CT head ___ at 18:48.
FINDINGS:
There is mild calcified plaque in bilateral proximal internal carotid arteries
without stenosis by NASCET criteria. Distal cervical internal carotid
arteries are mildly tortuous. There is calcified plaque in the left greater
than right V3 segments of the vertebral arteries, without stenosis.
There is calcified plaque in bilateral carotid siphons with a short-segment
mild narrowing of the cavernous right internal carotid artery, image 2:99 and
image 358:18. There is a small focus of calcified plaque in the V4 segment of
the left vertebral artery with mild short-segment narrowing, image 2:52. The
other vessels of the circle of ___ and their principal intracranial
branches are patent with no evidence of flow-limiting stenosis.
There is a 3 mm aneurysm versus infundibulum arising from right internal
carotid artery at the right posterior communicating artery origin, images
2:103 and 603b:27.
The A2 segments and distal branches of the anterior cerebral arteries are
slightly displaced to the left due to the mass effect from the right frontal
intraparenchymal hematoma, which is better assessed on the noncontrast head CT
performed 10 min earlier. There is no evidence of arterial extravasation
within the hematoma.
The major dural venous sinuses are patent.
There is mild mucosal thickening in the right frontal sinus and right
frontoethmoidal recess. The mastoid air cells are clear. The patient is
status post bilateral cataract surgery. An endotracheal tube is partially
visualized.
IMPRESSION:
1. 3 mm aneurysm versus infundibulum of the right internal carotid artery at
the right posterior communicating artery origin. This is not related to the
right frontal lobar parenchymal hematoma, which is better assessed on the
noncontrast CT performed 10 min earlier.
2. No evidence for active arterial-phase extravasation within the right
frontal lobar parenchymal hematoma.
3. Multifocal atherosclerosis. Short-segment mild narrowing of the cavernous
right internal carotid artery and of the V4 segment of the left vertebral
artery.
NOTIFICATION: The findings were discussed by Dr. ___ with PA ___ on the
telephone on ___ at 9:34 AM, 10 minutes after discovery of the
findings.
|
10215159-RR-28
| 10,215,159 | 24,039,782 |
RR
| 28 |
2127-12-14 23:28:00
|
2127-12-15 10:40:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ETT and OGT // please assess placement
please assess placement
IMPRESSION:
In comparison with the study of ___, the tip of the endotracheal tube
is probably about 2.5 cm above the carina. Nasogastric tube is in place with
the tip extending at least to the mid body of the stomach, where it crosses
the lower margin of the image.
The cardiac silhouette remains within upper limits of normal in size, though
there is some elevation of pulmonary venous pressure that appears to have
worsened since the prior study. Bibasilar atelectatic changes are seen,
though no evidence of acute focal pneumonia.
|
10215159-RR-29
| 10,215,159 | 24,039,782 |
RR
| 29 |
2127-12-15 00:12:00
|
2127-12-15 08:32:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with parenchymal and intraventricular
hemorrhage s/p right craniotomy, evacuation of parenchymal hemorrhage.
Postoperative evaluation.
TECHNIQUE: Noncontrast head CTwith sagittal and coronal reformatted images.
DLP 803 mGy cm.
COMPARISON: Noncontrast head CT ___ at 18:48
FINDINGS:
There has been interim right craniotomy and evacuation of the right frontal
parenchymal hemorrhage. Deep to the craniotomy, there is a small extra-axial
collection of air and blood products. Within the right frontal surgical site,
there is a small amount of residual blood as well as multiple foci of air. A
small amount of subarachnoid and subdural hemorrhage along the anterior falx
bilaterally is unchanged. There is also a small amount of subarachnoid
hemorrhage within the sulci along bilateral convexities, images 2:18, 2:21,
more conspicuous than on the prior study.
There is persistent blood throughout the right lateral ventricle, third
ventricle, and fourth ventricle, as well as within the occipital horn of the
left lateral ventricle, not significantly changed.
Right to left subfalcine herniation has resolved. There is only minimal
residual leftward shift of the septum pellucidum. Anterior portions of the
right lateral ventricle have re-expanded. The remainder of the ventricular
system is stable in size and appears age-appropriate. The baseline size of
the patient's ventricles is not known, and it is difficult to determine
whether any subtle obstructive hydrocephalus is present. Away from the right
frontal surgical site, cerebral sulci appear age-appropriate in size.
No fracture is detected.
Endotracheal and orogastric tubes are present. Secretions are again seen in
the nasopharynx. There is minimal mucosal thickening in the inferior frontal
sinuses and anterior ethmoid air cells, as well as in the inferior right
maxillary sinus. Bilateral maxillary sinus walls and the frontal sinus septum
are mildly thickened, which may indicate sequela of chronic inflammation.
Middle ear cavities and mastoid air cells are well aerated.
IMPRESSION:
1. Status post right craniotomy with small underlying extra-axial collection
of air and blood.
2. Status post evacuation of right frontal parenchymal hematoma with small
amount of blood and foci of air in the surgical bed.
3. Stable small amount of subarachnoid and subdural hemorrhage along the
anterior falx bilaterally. Small amount of subarachnoid hemorrhage along
bilateral convexities is more conspicuous compared to approximately 6 hr
earlier.
4. Unchanged blood throughout the right lateral ventricle, third ventricle and
fourth ventricle, as well as in the occipital horn of the left lateral
ventricle. Stable ventricular size, age-appropriate. In the absence of more
remote studies for comparison, it is not known whether any subtle obstructive
hydrocephalus may be present.
|
10215159-RR-31
| 10,215,159 | 24,039,782 |
RR
| 31 |
2127-12-15 10:36:00
|
2127-12-15 11:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman continuing to desat. assess location of ETT
position. // assess location of ETT assess location of ETT
IMPRESSION:
In comparison with the study of ___, the tip of the endotracheal tube
measures approximately 3 cm above the carina. Little change in the appearance
of the heart and lungs.
|
10215159-RR-32
| 10,215,159 | 24,039,782 |
RR
| 32 |
2127-12-15 17:11:00
|
2127-12-15 19:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH s/p craniotomy and evacutation //
evaluate NGT placement evaluate NGT placement
COMPARISON: Prior chest radiographs since ___ most recently ___
and ___ at 10:37.
IMPRESSION:
Two views of the chest and upper abdomen showed esophageal drainage tube
ending in the stomach on both the rib following a slightly different course.
Moderate left pleural effusion is new. Heart size is normal. Following
tracheal extubation, right basal atelectasis and pulmonary vascular congestion
are stable.
|
10215159-RR-33
| 10,215,159 | 24,039,782 |
RR
| 33 |
2127-12-16 09:57:00
|
2127-12-16 12:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH and new LLL opacity on CXR ___ //
Evaluate for PNA Evaluate for PNA
COMPARISON: CHEST RADIOGRAPHS ___.
IMPRESSION:
Opacification in both lower lobes not appreciably changed could represent
atelectasis or aspiration. If it is pneumonia it is not progressing. There
is no pneumonia elsewhere. No pleural effusion. Heart size normal.
Esophageal drainage tube passes into the stomach and out
|
10215159-RR-34
| 10,215,159 | 24,039,782 |
RR
| 34 |
2127-12-16 11:55:00
|
2127-12-16 15:36:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with IPH/IVH s/p evacuation // ? hydro
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 4.8 s, 16.9 cm; CTDIvol = 50.1 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: ___ noncontrast head CT
FINDINGS:
Since prior study, the ventricles are unchanged in size. Status post
evacuation of right frontal hematoma with residual hemorrhage at the surgical
site, decreased from prior study. Small air collections in the right frontal
lobe are decreased from prior study. Intraventricular hemorrhage involving
the right lateral ventricle, temporal horn of the left lateral ventricle,
third ventricle, and fourth ventricle are unchanged from prior study. Mild
edema at surgical site.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Stable size of ventricles.
2. Status post evacuation of right frontal hematoma with expected evolution
since prior study. No evidence of new hemorrhage.
|
10215159-RR-35
| 10,215,159 | 24,039,782 |
RR
| 35 |
2127-12-17 10:32:00
|
2127-12-17 11:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IPH and increasing O2 requirement // r/o
acute cardiopulmonary process r/o acute cardiopulmonary process
COMPARISON: ___
IMPRESSION:
NG tube tip is in the stomach. Heart size and mediastinum are unchanged but
the res interval development of increased left pleural effusion as well as
left basal consolidation, concerning for aspiration. Mild vascular congestion
is present but overall unchanged.
|
10215159-RR-36
| 10,215,159 | 24,039,782 |
RR
| 36 |
2127-12-17 17:48:00
|
2127-12-17 19:03:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with IPH s/p craniotomy, hx cardiac stents, now
with increased RR. Assess for?DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10215159-RR-37
| 10,215,159 | 24,039,782 |
RR
| 37 |
2127-12-18 03:45:00
|
2127-12-18 13:56:00
|
EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with IPH, increased RR // ? consolidation
TECHNIQUE: Portable chest
COMPARISON: Portable chest radiograph dated ___
Portable chest radiograph dated ___
FINDINGS:
Bibasilar opacities are better appreciated on today's examination and may
reflect underlying atelectasis or developing infectious process. Mild
pulmonary vascular congestion is unchanged without pulmonary edema. Heart
size is top-normal. Left pleural effusion is small, if present. An enteric
tube passes into the stomach and outside the field of view.
IMPRESSION:
Bibasilar opacities are concerning for pneumonia, alternatively atelectasis.
|
10215159-RR-38
| 10,215,159 | 24,039,782 |
RR
| 38 |
2127-12-18 10:40:00
|
2127-12-18 13:58:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p IPH with IVH, s/p resection of IVH now not
following commands, // ? hydrocephalus/ ? infarct/interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 10.0 s, 17.5 cm; CTDIvol = 47.1 mGy (Head) DLP =
824.4 mGy-cm.
Total DLP (Head) = 838 mGy-cm.
COMPARISON: ___ noncontrast CT head
FINDINGS:
Since prior study there has been a mild increase in the size of the
ventricles, most noticeable at the temporal horns of the lateral ventricles
bilaterally (03:15). There is residual intraparenchymal hemorrhage at the
site of evacuation of right frontal hematoma, with expected evolution since
prior study. Mild edema at the surgical site Since prior study there is a
decrease in the extent of the intraventricular hemorrhage involving the right
lateral ventricle, temporal horn of left lateral ventricle, third ventricle,
and fourth ventricle. No evidence of midline shift. Basal cisterns are
clear. There is no evidence of fracture. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Mild increase in ventricular size since prior study. Attention to
follow-up is recommended.
2. Stable intraventricular hemorrhage with expected evolution since prior
study. No evidence of new hemorrhage or extension of pre-existing image.
NOTIFICATION: The findings were discussed by Dr. ___ with NP ___
on the telephone on ___ at 2:17 ___, 5 minutes after discovery of the
findings.
|
10215159-RR-39
| 10,215,159 | 24,039,782 |
RR
| 39 |
2127-12-19 04:33:00
|
2127-12-19 08:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/o craniotomy and tachypnea // interval
change
IMPRESSION:
Compared to prior study of 1 day earlier, nonspecific bibasilar opacities are
persistent on the right and slightly worse on the left. No other relevant
changes.
|
10215159-RR-40
| 10,215,159 | 24,039,782 |
RR
| 40 |
2127-12-21 14:26:00
|
2127-12-21 14:45:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ year old woman with Right crani evac IPH // ? aspiration PNA
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph ___
FINDINGS:
A nasoenteric tube is unchanged in position compared to the prior study. The
cardiomediastinal contour and lung volumes are also unchanged. No
consolidation, pneumothorax or pleural effusions seen.
IMPRESSION:
No significant interval change when compared to the prior study.
|
10215159-RR-41
| 10,215,159 | 24,039,782 |
RR
| 41 |
2127-12-21 14:04:00
|
2127-12-22 09:09:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with Right crani evac IPH // please perform by
2 pm to eval for interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 927 mGy-cm.
COMPARISON: ___
FINDINGS:
Since the most recent examination, the ventricles have overall remained
largely stable in size. There are residual foci of intraparenchymal
hemorrhage at the site of evacuation with stable, expected evolution.
Intraventricular component of hemorrhage has decreased significantly. Mild
edema remains at the surgical site. There is no marked midline shift. The
basilar cisterns are patent.
The visualized portions of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. Overall stable examination with persistent intraparenchymal and
intraventricular hemorrhage.
|
10215159-RR-42
| 10,215,159 | 24,039,782 |
RR
| 42 |
2127-12-22 02:53:00
|
2127-12-22 08:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman. Tachypnea. Desat. // consolidation? effusion?
consolidation? effusion?
IMPRESSION:
As compared to ___, no relevant change is seen. The tip of the
nasogastric tube projects over the proximal parts of the stomach. Normal lung
volumes. Borderline size of the cardiac silhouette. Platelike areas of
bilateral atelectasis. No larger pleural effusions. No pneumonia.
|
10215159-RR-43
| 10,215,159 | 24,039,782 |
RR
| 43 |
2127-12-22 07:47:00
|
2127-12-22 11:34:00
|
EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: ___ hx CAD DES 4 months ago admitted ___ for a large right
frontal intraparenchymal hemorrhage s/p emergent evacuation on ___ d/c'd
from SICU ___, readmitted for respiratory distress, evaluate for interval
change.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Total DLP: 1131.65 mGy cm.
COMPARISON: Unenhanced head CT ___.
FINDINGS:
In comparison to most recent head CT from ___ at 14:04, there has
been little interval change. Specifically, again seen are sequelae of right
lobar intraparenchymal hematoma, including a small amount of residual acute
blood products (series 2, image 25), more anterior hypodensity involving the
right frontal lobe at the surgical site, a small amount of layering hyperdense
blood in the occipital horns of the lateral ventricles, and post craniotomy
changes seen along the right frontal region, including calvarial defect, right
frontoparietal subcutaneous soft tissue swelling, and a stable subgaleal
hematoma with overlying skin staples. Mass effect is stable, including mild
diffuse right cerebral hemispheric sulcal effacement, and approximately 3 mm
leftward shift of midline structures. The basal cisterns remain patent. There
are no new foci of hemorrhage. There is no evidence of superimposed acute
infarction.
Mild prominence of the ventricles and sulci is compatible with age-appropriate
global atrophy. A right nasoenteric tube is noted. The imaged paranasal
sinuses and mastoid air cells are clear. The patient is status post bilateral
lens removal, otherwise the globes and bony orbits are unremarkable. Carotid
siphon calcifications are again seen.
IMPRESSION:
1. Stable appearance of sequelae of right frontal lobar hematoma status post
craniotomy.
2. Stable intraventricular hemorrhage.
3. Stable minimal mass-effect. No herniation.
4. No new foci of hemorrhage. No acute infarction.
5. Chronic findings including age appropriate global atrophy and vascular
calcifications.
|
10215159-RR-44
| 10,215,159 | 24,039,782 |
RR
| 44 |
2127-12-23 03:56:00
|
2127-12-23 08:21:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ hx CAD DES 4 months ago admitted ___ for a large right
frontal intraparenchymal hemorrhage s/p emergent evacuation on ___ d/c'd
from SICU ___, readmitted for respiratory distress // ?interval change
?interval change
IMPRESSION:
Comparison to ___. The monitoring and support devices are
constant. Unchanged normal lung volumes but interval development of bilateral
basal areas of parenchymal opacities. No a larger pleural effusions. No
pulmonary edema, no pneumonia. No pneumothorax.
|
10215159-RR-45
| 10,215,159 | 24,039,782 |
RR
| 45 |
2127-12-22 08:25:00
|
2127-12-22 10:59:00
|
EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with resp distress, transferred to sicu // ?NT
tube placement
TECHNIQUE: Portable chest
COMPARISON: Portable chest radiograph dated ___ at 02:59
FINDINGS:
In comparison to the chest radiograph obtained 2.5 hours prior, there are
increased opacities at the left lung base. Lungs are otherwise expanded and
clear. Pleural effusions small, if any. Heart size and cardiomediastinal
silhouettes are unchanged. An enteric tube passes below the diaphragm in
outside the field of view.
IMPRESSION:
Increased left basilar opacities most concerning for aspiration, alternatively
atelectasis or developing pneumonia. NG tube terminates at least in the
distal stomach.
|
10215159-RR-47
| 10,215,159 | 24,039,782 |
RR
| 47 |
2127-12-22 12:51:00
|
2127-12-22 13:36:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with PICC // Pt had a right picc,44cm ___
___ Contact name: ___: ___
IMPRESSION:
Compared to prior study from earlier the same date, a right PICC has been
placed, terminating in the mid superior vena cava. Exam is otherwise
remarkable for bibasilar atelectasis and small pleural effusions.
|
10215159-RR-48
| 10,215,159 | 24,039,782 |
RR
| 48 |
2127-12-23 04:01:00
|
2127-12-23 04:41:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with right intraparenchymal hematoma status
post craniotomy and evacuation, now with right pupil dilation. Evaluate for
stability of postoperative change.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) Sequenced Acquisition 18.0 s, 18.6 cm; CTDIvol = 48.6 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: ___ noncontrast
head CT.
FINDINGS:
Evolving postoperative changes related to the patient's right frontal
craniotomy with subdural hemorrhage evacuation is again noted. Soft tissue
swelling overlying surgical cavity is again seen. Edema and loss of
gray-white differentiation is again noted within the right frontal lobe.
There are sequela of right frontal lobe intraparenchymal hematoma with a small
amount of residual blood products within the evacuation cavity (series 2,
image 22). Intraventricular hemorrhage layering within the occipital horns of
the lateral ventricles is unchanged. There is no new hemorrhage identified.
Ventricular size and configuration is unchanged. Grossly stable approximately
3 mm right to left midline shift is again seen. The basal cisterns are
patent.
The paranasal sinuses are clear. There are calcifications within the
bilateral carotid arteries within the siphons. The orbits are unremarkable.
IMPRESSION:
1. Stable intraparenchymal and intraventricular hemorrhage as described.
2. Evolving postoperative changes related to patient's right frontal
craniotomy and subdural hematoma evacuation.
3. Grossly stable approximately 3 mm right to left midline shift.
4. Please note MRI of the brain is more sensitive for the detection of acute
infarct.
|
10215159-RR-49
| 10,215,159 | 24,039,782 |
RR
| 49 |
2127-12-24 03:53:00
|
2127-12-24 09:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ hx CAD DES 4 months ago admitted ___ for a large right
frontal intraparenchymal hemorrhage s/p emergent evacuation on ___ d/c'd
from SICU ___, readmitted for respiratory distress // ?interval change
?interval change
IMPRESSION:
Comparison to ___. No relevant change. Monitoring and support
devices are in constant position. Bilateral areas of atelectasis and minimal
pleural effusions are constant. No new focal parenchymal opacities.
Unchanged moderate cardiomegaly.
|
10215159-RR-50
| 10,215,159 | 24,039,782 |
RR
| 50 |
2127-12-24 14:02:00
|
2127-12-24 17:34:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 3 EXAMS
INDICATION: ___ year old woman for dobhoff placement // please assess dobhoff
placement please assess dobhoff placement
COMPARISON: Prior chest radiographs ___ through ___.
IMPRESSION:
Three views of the chest server successive advancement of the feeding tube,
with the wire stylet in place from the upper to the mid esophagus to the mid
stomach. Moderate right pleural effusion and bibasilar atelectasis have
worsened since earlier in the day. There is no pneumothorax. Mild
cardiomegaly and pulmonary vascular engorgement are unchanged.
Right PIC line ends in the low SVC.
|
10215159-RR-51
| 10,215,159 | 24,039,782 |
RR
| 51 |
2127-12-25 04:20:00
|
2127-12-25 13:22:00
|
EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with IPH and tachypnea // r/o acute
cardiopulmonary process
TECHNIQUE: Portable chest
COMPARISON: Portable chest radiographs dated ___
FINDINGS:
Since ___, a moderate right pleural effusion with associated right
basilar atelectasis is unchanged. A small left pleural effusion has increased
and left basilar atelectasis persists. The mid and upper lung fields are
clear. Mild cardiomegaly is unchanged. No pulmonary vascular congestion or
pulmonary edema. A right-sided PICC terminates in the mid SVC. An enteric
tube passes into the stomach outside the field of view.
IMPRESSION:
Increased, small left pleural effusion and atelectasis. Unchanged, small
right pleural effusion and atelectasis.
|
10215159-RR-52
| 10,215,159 | 24,039,782 |
RR
| 52 |
2127-12-24 18:02:00
|
2127-12-24 19:45:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ woman with an intraparenchymal hemorrhage. Evaluate
for worsening IPH given worsening neuro exam.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.2 mGy (Head) DLP =
819.7 mGy-cm.
Total DLP (Head) = 832 mGy-cm.
COMPARISON: Noncontrast head CT exams dated ___ and ___.
FINDINGS:
Post right frontal craniotomy to evacuate a right subdural hemorrhage findings
are again noted. A low-density (16 ___ right subdural fluid collection
measures up to 8 mm, increased from the prior exam. Hyperintensity of the
dura at the craniotomy site is unchanged. Loss of gray-white matter
differentiation in the anterior aspect of the right frontal lobe with
surrounding edema is overall unchanged since at least ___. Small,
hyperintense foci within the parenchyma of the right frontal lobe are less
conspicuous but persistent compared ___, consistent with
intraparenchymal hemorrhage with expected evolution and residual blood
product. Overall ventricle size is unchanged with mild dilatation. Overall
layering intraventricular hemorrhage in the occipital horns of the lateral
ventricles is unchanged when accounting for slice selection and slight
differences in patient orientation. 3-mm midline shift is overall unchanged.
The basilar cisterns are patent. Soft tissue swelling at the craniotomy site
on the right is overall similar in size. No evidence of acute territorial
infarct. Superimposed periventricular and subcortical white matter
hypodensities are unchanged from prior exam and are nonspecific, but likely
representing chronic microangiopathy in a patient of this age. Small amount
of fluid in the mastoid air cells is likely related to prolonged dependent
positioning. No acute osseous abnormality. The partially visualized
paranasal sinuses are clear. Incidental note is made of a metopic suture.
IMPRESSION:
1. Post-right frontal craniotomy changes with evolving intraparenchymal
hemorrhage and unchanged 3-mm midline shift.
2. Approximately 8-mm right extra-axial fluid collection, slightly increased
from the prior exam.
3. No new focal area of acute hemorrhage.
NOTIFICATION: The findings were discussed via telephone by ___ with
Dr. ___ on ___ at 7:36 ___, 1 minutes after discovery of the
findings.
|
10215159-RR-53
| 10,215,159 | 24,039,782 |
RR
| 53 |
2127-12-25 13:15:00
|
2127-12-25 14:24:00
|
EXAMINATION: CT HEAD W/ AND W/O CONTRAST
INDICATION: ___ year old female with large right frontal intraparenchymal
hemorrhage status post emergent evacuation. Please evaluate for CSF leak.
TECHNIQUE: Contiguous axial images of the brain were obtained before and
after the intravenous administration of 90 mL of Omnipaque contrast agent.
Thin bone-algorithm reconstructed images and coronal and sagittal reformatted
images were then produced.
DOSE: Total DLP (Head) = 1,706 mGy-cm.
COMPARISON: CT from ___ and ___.
FINDINGS:
The patient is status post right frontal craniotomy. There is suggestion of
interval increase in the extra-axial 8 mm in in greatest with hyperdense fluid
collection along the right lateral convexity concerning for a subdural CSF
hygroma/effusion, although this may be secondary to differences in
positioning. The subcutaneous fluid collection overlying the right frontal
bone also has slightly increased in size, increasing in width from 9 mm to 11
mm (series 2:image 14). There is a possible defect in the dura underlying the
craniotomy site, where the postoperative extra-axial fluid collection
underlying the craniotomy appears contiguous with the evacuation site (series
601 B, image 150 for and series 5, image 36), potentially representing CSF
leak.
There is no new intracranial hemorrhage, infarct or mass seen. Layering
intraventricular hemorrhage is again noted in the occipital horns of the
bilateral lateral ventricles. The ventricles are stable in size. There is
sulcal effacement and mild 3 mm leftward shift of midline structures from mass
effect due to the extra-axial fluid. There is no abnormal enhancement on post
contrast images.
There is mild mucosal thickening of the left frontal sinus and sphenoid sinus
and bilateral ethmoid air cells. A nasoenteric tube is noted. The patient is
status post bilateral lens replacement, and the orbits are otherwise
unremarkable.
IMPRESSION:
1. There is apparent increased size of subcutaneous fluid overlying the right
frontal craniotomy, although this may be secondary to patient positioning.
Given a possible defect within the dura underneath the right frontal
craniotomy site, the findings could represent CSF leak if the subcutaneous
collection continues to grow in size.
2. Apparent increase in size of the extra-axial fluid along the right lateral
convexity concerning for a CSF hygroma, although this may be secondary to
differences in patient positioning.
2. Similar post-surgical findings including intraventricular hemorrhage and
mild leftward 3 mm shift.
3. No new intracranial hemorrhage.
|
10215159-RR-54
| 10,215,159 | 24,039,782 |
RR
| 54 |
2127-12-26 01:23:00
|
2127-12-26 09:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with large R frontal IPH, fever to 101.7 //
?infection ?infection
COMPARISON: Prior chest radiographs ___ through ___.
IMPRESSION:
The only region of abnormal lung is at the right base. Whether this is
atelectasis or pneumonia is radiographically indeterminate, but it is grossly
unchanged since ___. Left lung is clear. Small bilateral pleural
effusions are stable. Normal cardiomediastinal silhouette.
Right PIC line ends in the low SVC. Esophageal feeding tube ends in the upper
stomach.
|
10215159-RR-55
| 10,215,159 | 24,039,782 |
RR
| 55 |
2127-12-27 15:51:00
|
2127-12-27 16:48:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman POD ___ from R evac of ___, now with anisocoria
(R > L by 3mm, concern for worsening external hydrocephalus.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 4.8 s, 16.0 cm; CTDIvol = 52.9 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: Unenhanced head CT ___.
FINDINGS:
The patient is rotated during the acquisition of images.
There is no evidence of acute major vascular territorial infarction. There is
severe ventriculomegaly, also worsened from two days prior.
Patient is status post right frontal craniotomy, with interval increase in
overlying soft tissue fluid since ___, remaining concerning for a
CSF leak. Bilateral intraventricular hemorrhage is overall stable in
appearance. No new hemorrhage. However, as in comparison to the prior study,
the amount of adjacent right frontal edema has increased slightly (302b:27).
There appears to be approximately 9 mm leftward shift of midline structures
(3:16), which would be progressed from the prior study where it measured 3mm,
although this may be exaggerated by patient positioning. CSF density
fluid/hygroma overlying the right cerebral convenxity may be minimally
increased overlying the right frontal and temporal lobes (302b:20).
The visualized paranasal sinuses, mastoid air cells and middle ear cavities
are unremarkable. Orbits are unremarkable.
IMPRESSION:
1. This study is slightly limited by patient rotation.
2. Worsening ventriculomegaly.
3. Increasing amount of fluid overlying the right frontal craniotomy,
remaining concerning for CSF leak.
4. Mildly increased right frontal cerebral edema, with suggestion of worsening
leftward shift of midline structures.
5. Stable intraventricular hemorrhage. No new hemorrhage.
NOTIFICATION: The findings were discussed by Dr. ___ with ___
___ on the telephoneon ___ at 4:41 ___, 3 minutes after discovery of
the findings.
|
10215159-RR-56
| 10,215,159 | 24,039,782 |
RR
| 56 |
2127-12-28 05:57:00
|
2127-12-28 07:20:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with fevers and leukocytosis, now with elevated
LFTs. ID recommending RUQ U/S. // Assessment for etiology of transaminitis.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: Tiny stones are noted in the gallbladder, without evidence of
acute cholecystitis.
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.
KIDNEYS: Limited views of the right kidney are unremarkable.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
2. Cholelithiasis without evidence of acute cholecystitis.
|
10215159-RR-57
| 10,215,159 | 24,039,782 |
RR
| 57 |
2127-12-28 06:08:00
|
2127-12-28 08:20:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with external hydrocephalus. // Interval
assessment of hydrocephalus and MLS. Please peform at 0600 tomorrow.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Comparison is made with PET-CT from ___.
FINDINGS:
The patient is status post right frontal craniotomy. The hypodense collection
overlying the right cerebral convexity has decreased from prior exam. Blood
products are seen in the occipital horns of the bilateral lateral ventricles,
unchanged from prior exam. The ventricles are stable in size and
configuration. There is 5 mm leftward midline shift, decreased from prior exam
(previously 9 mm). No new hemorrhage is seen. Right frontal edema is
similar to prior exam. No acute infarction is seen.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Interval decreased in hyperdense collection overlying the right cerebral
convexity.
2. Stable blood products in the lateral ventricles. Stable ventricular size
and configuration.
3. Decreased leftward midline shift.
4. No new hemorrhage or infarction.
|
10215159-RR-58
| 10,215,159 | 24,039,782 |
RR
| 58 |
2127-12-30 15:12:00
|
2127-12-30 15:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ y/o woman on aspirin and Plavix, found down by family with
large right frontal parenchymal hemorrhage with intraventricular extension,
status post evacuation. Assess for interval change.
TECHNIQUE: Noncontrast head CTwas performed. The patient's head was tilted,
limiting evaluation. Images were therefore reconstructed in the axial plane.
DLP 840 mGy cm.
COMPARISON: ___ head CT.
FINDINGS:
Right craniotomy is again seen with decreased soft tissue swelling in the
overlying scalp. Hypodense subdural collection overlying the right cerebral
hemisphere has increased in size, without acute blood products. There is
increased frontal and parietal sulcal effacement and new effacement of the
right lateral ventricle and third ventricle. The left lateral ventricle is
also slightly smaller in size. Leftward shift of midline structures has
slightly increased. Blood layering in the occipital horns of the lateral
ventricles is unchanged. The basal cisterns are not compressed.
Hypodensity in the right frontal lobe at the site of prior hematoma evacuation
is unchanged, containing scattered punctate foci of hyperdensity without
evidence for new blood products.
There is no evidence for new parenchymal edema. Foci of low density are again
seen in the subcortical and periventricular white matter of the cerebral
hemispheres, nonspecific but likely sequela of chronic small vessel ischemic
disease in this age group.
No concerning osseous abnormalities are detected. Nasogastric tube is
partially visualized. The imaged paranasal sinuses and mastoid air cells are
grossly well aerated.
IMPRESSION:
1. Increased hypodense subdural collection overlying the right cerebral
hemisphere without acute blood products. Increased effacement of the right
frontal and parietal sulci and new effacement of the ventricles. Slightly
increased leftward shift of midline structures.
2. Stable hypodensity at the site of prior right frontal hematoma evacuation
without evidence for new blood products.
NOTIFICATION: Results were discussed over the telephone by Dr. ___ with NP
___ from neurosurgery at 16:00 on ___.
|
10215159-RR-59
| 10,215,159 | 24,039,782 |
RR
| 59 |
2127-12-30 16:31:00
|
2127-12-30 19:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p R craniotomy for evac IPH, increased size
of subdural collection with left midline shift // R/o pneumonia Surg:
___ (Left frontal VP shunt) R/o pneumonia
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
Lungs well expanded and clear. Small left pleural effusion probably present,
unchanged. Normal cardiomediastinal silhouette. Feeding tube ends in the
upper stomach. Right PIC line ends in the low SVC. No pneumothorax.
|
10215159-RR-60
| 10,215,159 | 24,039,782 |
RR
| 60 |
2128-01-01 09:16:00
|
2128-01-01 17:45:00
|
EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ year old woman with dysphagia // ?aspiration
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 2.7 min.
COMPARISON: None
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was no gross aspiration. There is penetration of thin
liquids and nectar consistency. An NG tube is noted.
IMPRESSION:
Penetration of thin liquids and nectar consistency without aspiration.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10215159-RR-61
| 10,215,159 | 24,039,782 |
RR
| 61 |
2128-01-02 05:13:00
|
2128-01-02 10:07:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ yo F on ASA and Plavix found down by family, last seen 1 day
prior, with large right frontal IPH with IVH and MLS // Assess for interval
change. Needs to be done in early morning on ___ as pt is going to the OR
for VP shunt placement.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 18.0 s, 19.4 cm; CTDIvol = 46.5 mGy (Head) DLP =
903.1 mGy-cm.
4) Spiral Acquisition 10.2 s, 21.1 cm; CTDIvol = 53.4 mGy (Head) DLP =
1,127.8 mGy-cm.
Total DLP (Head) = 2,031 mGy-cm.
COMPARISON: ___, CT head without contrast
___ CT head without contrast
FINDINGS:
The patient is status post right craniotomy. Subcutaneous fluid collection
and soft tissue tissue swelling in the overlying scalp is similar in
appearance to the prior exam. A hypodense subdural fluid collection overlying
the right cerebral hemisphere has significantly reduced in size from the prior
exam and now measures 4 mm at its greatest diameter previously 1.1 cm.
Hypodensity involving the right frontal lobe at the site of prior hematoma
evacuation is slightly increased in size from the prior study. There is no
appreciable shift of midline structures. There is blood layering in the
occipital horns of the lateral ventricles, not significantly increased from
the prior examination.
There is no evidence of new hemorrhage or territorial infarction. As before,
foci of low density are again seen in this of subcortical and periventricular
white matter of the cerebral hemispheres, likely related to chronic small
vessel ischemic disease.
IMPRESSION:
1. Hypodense subdural fluid collection overlying the right cerebral hemisphere
is significantly reduced in size from the prior examination. Soft tissue
swelling and fluid collection overlying the right scalp is similar-appearing
to slightly improved.
2. Hypodensity at the site of prior right frontal hematoma evacuation is
slightly increased from the prior examination, expected evolution.
3. No new hemorrhage or acute infarction.
|
10215159-RR-63
| 10,215,159 | 24,039,782 |
RR
| 63 |
2128-01-02 14:50:00
|
2128-01-02 15:49:00
|
INDICATION: ___ year old woman post cranitomy for IPH evacuation; KUB per ACS
for PEG placement
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: None.
FINDINGS:
Dobhoff tube is present with tip terminating in appropriate position below the
diaphragm. Contrast fills the colon and rectum. There are no abnormally
dilated loops of large or small bowel. Supine assessment limits detection for
free air; there is no gross pneumoperioneum. Osseous structures are
unremarkable.
IMPRESSION:
1. Dobhoff tube terminating in appropriate position below the diaphragm.
2. No obstruction or gross pneumoperitoneum.
|
10215159-RR-64
| 10,215,159 | 24,039,782 |
RR
| 64 |
2128-01-06 22:06:00
|
2128-01-06 23:27:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with pupillary changes // interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 6.4 s, 16.6 cm; CTDIvol = 64.3 mGy (Head) DLP =
1,070.3 mGy-cm.
Total DLP (Head) = 1,070 mGy-cm.
COMPARISON: ___, CT head without contrast
___, CT head without contrast
FINDINGS:
As before, the patient is status post right craniotomy. A right subcutaneous
fluid collection and soft tissue swelling overlying the scalp adjacent to the
craniotomy site is increased in size from the prior examination and now
measures 2 cm at its greatest diameter (previously 1.6 cm). A hypodense
subdural fluid collection overlying the right cerebral hemisphere measures 3
mm and is stable to minimally decreased in size from the prior examination
(Previously 4 mm). Hypodensity involving the right frontal lobe at the site
of prior hematoma evacuation is stable to minimally increased from the prior
examination. There is no appreciable shift of midline structures. A small
amount of blood is seen layering in the occipital horns of the lateral
ventricles, not significantly changed from the prior exam. The basal cisterns
are patent and there is no evidence of herniation.
There is no evidence of new hemorrhage or territorial infarction.
Periventricular and deep subcortical white matter hypodensities suggest
chronic small vessel ischemic disease.
IMPRESSION:
1. Subcutaneous fluid collection and soft tissue swelling overlying the scout
adjacent to the craniotomy site is increased from the prior examination and
now measures 2 cm at its greatest diameter.
2. Hypodense subdural fluid collection and hypodensity involving the right
frontal lobe are stable from the prior examination.
3. No new hemorrhage or acute infarction. No evidence of herniation or
midline shift.
|
10215159-RR-65
| 10,215,159 | 24,039,782 |
RR
| 65 |
2128-01-07 14:01:00
|
2128-01-07 16:34:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old female on ASA and Plavix found down by family, last
seen 1 day prior, with large right frontal IPH with IVH and MLS. Assess for
interval changes of external hydrocephalus.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 5.4 s, 18.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
954.0 mGy-cm.
Total DLP (Head) = 954 mGy-cm.
COMPARISON: Head CT from ___.
FINDINGS:
Right frontal craniotomy changes are seen with slight interval decrease in
size of the overlying subcutaneous low-density fluid collection, measuring 1.2
cm in greatest transverse diameter. There is stable encephalomalacia in the
right frontal lobe from the prior intraparenchymal hematoma evacuation. A
small extra-axial fluid collection is seen underlying the craniotomy site
measuring 0.5 cm in greatest dimension. A small amount of residual hemorrhage
is seen layering in the occipital horns.
There is stable appearance of the periventricular and subcortical white matter
hypodensities.
There is prominence of the ventricles, stable in comparison to the prior
study. Atherosclerotic calcification of the cavernous internal carotid
arteries is seen.
Bilateral cataract extractions are seen. The paranasal sinuses are clear.
Minimal fluid is seen in the mastoid air cells.
IMPRESSION:
1. Right frontal craniotomy changes with slight interval decrease in size of
the overlying subcutaneous scalp fluid collection.
2. Stable appearance of the evacuation cavity in the right frontal lobe with
stable small amount of residual hemorrhage layering in the occipital horns.
No new intracranial hemorrhage.
3. Stable prominence of the ventricles.
|
10215159-RR-66
| 10,215,159 | 24,039,782 |
RR
| 66 |
2128-01-10 05:18:00
|
2128-01-10 05:40:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with tachypnea and hypoxia // PNA vs effusion
TECHNIQUE: Single AP view
COMPARISON: Chest radiograph ___ lungs are hyperexpanded. A
right PICC ends in the mid SVC. There has been interval removal of an enteric
tube. There is no pneumothorax. Small bilateral pleural effusions. The lung
fields are clear. Osseous structures are grossly unremarkable.
FINDINGS:
The lungs are hyperexpanded. A right PICC ends in the mid SVC. There has
been interval removal of an enteric tube. There is no pneumothorax. Small
bilateral pleural effusions. Patchy opacities at the right lung base is new.
Osseous structures are grossly unremarkable.
IMPRESSION:
Patchy opacities at the right lung base may be consistent with aspiration or
pneumonia. No pneumothorax.
|
10215159-RR-67
| 10,215,159 | 24,039,782 |
RR
| 67 |
2128-01-10 15:31:00
|
2128-01-10 17:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ yo F on ASA and Plavix found down by family, last seen 1 day
prior, with large right frontal IPH with IVH and MLS // increased external
collection of CSF in setting of vomiting this AM. Please confirm stable
collection, overall stable NCHCT intracranially.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 4.8 s, 16.9 cm; CTDIvol = 50.3 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: Unenhanced head CT ___.
FINDINGS:
Re- demonstrated is a large area of hypodensity involving the right frontal
lobe consistent with sequelae of prior intraparenchymal hematoma status post
evacuation via right frontal craniotomy. A tiny hypodense extra-axial fluid
collection underlying the right frontal craniotomy site is unchanged in
appearance, measuring 5 mm from the inner surface of the adjacent calvarium at
greatest extent (series 4, image 19), as on prior. There is a trace residual
amount of layering blood products seen in the occipital horns of the lateral
ventricles (series 4, image 15), decreased from prior. Overall, the
ventricles are stable in size and configuration. There is no new focus of
hemorrhage elsewhere, or evidence of interval rebleeding. There is a stable
appearance of periventricular white matter hypodensity bilaterally,
nonspecific however compatible with sequelae of chronic small vessel ischemic
changes. There is no evidence of acute large vascular territorial infarction.
The basal cisterns are patent. There is no shift of normally midline
structures.
There is been significant interval enlargement of the hypodense subcutaneous
fluid collection overlying the right craniotomy site, measuring 7.5 x 1.4 cm
in axial ___ a greatest extent (series 4, image 17). The visualized
paranasal sinuses and mastoid air cells are clear. The globes and bony orbits
are intact and unremarkable. Carotid siphon calcifications are again noted.
IMPRESSION:
1. Interval enlargement of the hypodense subcutaneous fluid collection
overlying the right craniotomy site, now 7.5 x 1.4 cm in axial ___.
2. Stable right frontal hypodensity, sequela of prior right frontal
intraparenchymal hematoma. Persistent small amount of layering
intraventricular blood products, decreased from prior. No new hemorrhage or
interval rebleed. Stable 5 mm small hypodense extra-axial fluid collection
underlying right frontal craniotomy site.
3. No mass effect. Patent basal cisterns.
4. Stable ventricular and sulcal caliber.
5. Other findings, as above.
|
10215159-RR-68
| 10,215,159 | 24,039,782 |
RR
| 68 |
2128-01-11 12:03:00
|
2128-01-11 13:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ICH and recent aspiration event // r/o
aspiration PNA
TECHNIQUE: Portable chest
COMPARISON: 11 7
FINDINGS:
Compared to the prior study there is no significant interval change. There
continue to be compressive changes at the bases. An underlying infiltrate
secondary to a aspiration in these regions cannot be excluded
IMPRESSION:
No change.
|
10215159-RR-69
| 10,215,159 | 24,039,782 |
RR
| 69 |
2128-01-15 12:39:00
|
2128-01-15 16:14:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with IVH and MLS on ___ s/p craniotomy.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.2 mGy (Head) DLP =
819.7 mGy-cm.
Total DLP (Head) = 831 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
There is a large area of hypodensity involving the right frontal lobe
consistent with sequela of prior intra parenchymal hematoma and evacuation. 5
mm extra-axial fluid collection under the right frontal craniotomy site is
unchanged in appearance and size. Again seen is a small amount of layering
blood products within the occipital horns bilaterally, unchanged from prior.
The ventricles are prominent, however unchanged from prior. There is stable
appearance of periventricular white matter hypodensity bilaterally, likely due
to chronic small vessel ischemic disease. There is no evidence of infarction.
The basal cisterns are patent. There is no midline shift.
There is an interval enlargement of the hypodense subcutaneous fluid
collection overlying the right craniotomy site. It measures 8.5 x 2.0 cm
compared to 7.5 x 1.4 cm on ___.
There is stable postsurgical appearance of right frontal craniotomy. There is
minimal fluid in the left mastoid air cells. The visualized portion of the
other paranasal sinuses, mastoid air cells, and middle ear cavities are mostly
clear. The visualized portion of the orbits are unremarkable. There is
evidence of bilateral lens replacements.
IMPRESSION:
1. Stable hypodense subcutaneous fluid collection overlying the right
craniotomy site, measuring 8.5 x 2.0 cm, previously 7.5 x 1.4 cm.
2. No acute intracranial abnormalities. No evidence of infarction or new
hemorrhage.
3. Stable appearance of postsurgical changes, including axial fluid
collection.
|
10215416-RR-23
| 10,215,416 | 27,534,252 |
RR
| 23 |
2170-05-20 15:53:00
|
2170-05-20 17:01:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with dyspnea // acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10215709-RR-13
| 10,215,709 | 25,035,026 |
RR
| 13 |
2156-07-01 12:35:00
|
2156-07-01 19:47:00
|
INDICATION: ___ woman with incidental finding of left ICA aneurysm.
COMPARISON: Outside hospital MRI and MRA and CTA from ___.
PROCEDURE: Right common carotid, left vertebral, left common and left
internal carotid artery angiograms.
ANESTHESIA: Moderate sedation was provided by administering divided doses of
100 mcg of fentanyl and 2.5 mg of Versed throughout the total intraservice
time of 50 minutes, during which the patient's hemodynamic parameters were
continuously monitored.
DETAILS OF PROCEDURE: After explaining the risks, benefits and alternatives
of the procedure, written informed consent was obtained. The patient was
brought to the angiography suite and placed supine on the imaging table. Both
groins were prepped and draped in standard sterile fashion.
Access was gained into the right common femoral artery using Seldinger
technique and a 5 ___ vascular sheath was placed. The sheath was connected
to a continuous heparinized saline sidearm flush. Using a combination of a 5
___ ___ 2 catheter and a 0.035-inch Glidewire, the right common
carotid, left vertebral, left common carotid and left internal carotid
arteries were sequentially catheterized and selective arteriograms obtained.
Right common carotid and left internal carotid artery rotational angiograms
were also obtained. The catheter and Glidewire was then removed. The
vascular sheath was removed and hemostasis was achieved by applying manual
compression for 20 minutes. Sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
Right common carotid artery arteriogram shows no evidence of stenosis,
occlusion or dissection. The right internal carotid artery fills well along
the cervical, petrous, cavernous and supraclinoid portion with patent major
branches . There is no significant cross-filling to the left hemisphere.
Left common carotid artery arteriogram shows no evidence of stenosis or
occlusion. The left ICA angiogram demonstrates that the left internal carotid
artery fills well along the cervical, petrous, cavernous and supraclinoid
portion with patent major branches and no evidence of stenosis or occlusion.
A 4 mm-sized left superior hypophyseal artery aneurysm is noted arising from
the ICA just at the level of the ophthalmic artery from the posterior aspect
and pointing medially and inferiorly.
Left vertebral artery angiogram demonstrates brisk filling of both vertebral
arteries and basilar artery, which appear normal in course and caliber. There
is no evidence of stenosis, occlusion, dissection or aneurysm formation. Both
superior cerebellar and AICA and ___ are well visualized.
IMPRESSION: Ms. ___ underwent cerebral angiography, which
revealed a 4 mm-sized left superior hypophyseal artery aneurysm pointing
medially and inferiorly into the cavernous sinus. The patient tolerated the
procedure well and there were no immediate complications.
|
10215709-RR-14
| 10,215,709 | 25,035,026 |
RR
| 14 |
2156-07-03 13:48:00
|
2156-07-03 18:21:00
|
INDICATION: ___ woman with known left internal carotid artery
aneurysm. Presents today for coil embolization of the aneurysm.
COMPARISON: Cerebral angiogram from ___.
PROCEDURE PERFORMED: Left internal carotid artery angiogram.
INTERVENTIONAL PROCEDURE PERFORMED: Coil embolization of left internal
carotid artery aneurysm.
ATTENDING: Dr. ___.
DETAILS OF THE PROCEDURE:
After explaining the risks, benefits and alternatives of the procedure,
written informed consent was obtained. The patient was brought to the
angiography suite and placed supine on the imaging table. Anesthesia was
induced. Following this, both groins were prepped and draped in standard
sterile fashion. The right common femoral artery was accessed using Seldinger
technique and a 6 ___ vascular sheath was placed. Using a combination of
___ 2 catheter and a 0.035 Glidewire, the left common carotid artery and
subsequently the left internal carotid artery were selectively catheterized
and angiogram performed. 4-mm-sized left superior hypophyseal artery aneurysm
arising off the internal carotid artery was redemonstrated. We decided to
treat the aneurysm endovascularly. The ___ 2 catheter was then exchanged
for a Neuron 6 ___ catheter over an exchange length Glidewire. Following
this, an SL-10 microcatheter and a Synchro standard guidewire were used to
access the aneurysm. The aneurysm was then coiled using a 3.5 mm x 6.6 cm
Microsphere coil and two 2 mm x 3 cm Target 360 Ultra coils. A total of
three coils were deployed. Post-coil embolization angiogram revealed complete
occlusion of the aneurysm with no residual filling. The coils appear tightly
packed within the aneurysmal sac. There is preserved flow in the distal left
internal carotid artery and the ACA and MCA branches. The catheters and
guidewires were removed. The arterial sheath was removed and a 6 ___
Angio-Seal was deployed for closure of the arteriotomy site. Sterile
dressings were applied.
FINDINGS: Left internal common carotid artery angiogram shows normal filling
of the left ICA along the cervical, petrous, cavernous and supraclinoid
portions. The anterior and middle cerebral arteries are well seen with no
evidence of stenosis, occlusion, dissection or aneurysm formation.
Successful embolization of left superior hypophyseal artery aneurysm using 3.5
mm x 6.6 cm Microsphere coil and 2 mm x 3 cm Target 360 Ultra coil.
Post-coil embolization left ICA arteriogram reveals satisfactory occlusion of
the aneurysm with preserved flow in the distal ICA and its branches.
IMPRESSION: ___ underwent cerebral angiography and coil
embolization of a left superior hypophyseal artery aneurysm that was
uneventful.
IMPRESSION: Ms. ___ underwent cerebral angiography and coil
embolization of left internal carotid artery aneurysm. This was uneventful
and there were no immediate complications.
|
10215709-RR-15
| 10,215,709 | 25,035,026 |
RR
| 15 |
2156-07-02 16:03:00
|
2156-07-02 18:42:00
|
TYPE OF EXAMINATION: Chest PA and lateral.
INDICATION: ___ female patient with cerebral aneurysm, preoperative
to angio procedure with coiling. Surgery ___.
FINDINGS: PA and lateral chest views were obtained with patient in upright
position. The heart size is normal. No configurational abnormalities
identified. Thoracic aorta unremarkable. No mediastinal abnormalities are
seen. The pulmonary vasculature is normal. No signs of acute or chronic
parenchymal infiltrates are present, and the lateral and posterior pleural
sinuses are free. No evidence of pneumothorax in the apical area on the
frontal view. Skeletal structures of the thorax grossly within normal limits.
IMPRESSION: Normal chest findings on preoperative examination.
|
10216074-RR-10
| 10,216,074 | 20,697,613 |
RR
| 10 |
2179-09-27 21:19:00
|
2179-09-27 22:10:00
|
INDICATION: History: ___ status post elbow reduction // postreduction film
TECHNIQUE: Two views of the left elbow
COMPARISON: ___ at 15:11
FINDINGS:
An overlying splint has been placed which limits fine osseous detail. There
has been interval reduction of the previously noted elbow dislocation with
normal humeroulnar and humeroradial articulations. Previously seen fracture
fragments are not well visualized on the current exam.
|
10216074-RR-11
| 10,216,074 | 20,697,613 |
RR
| 11 |
2179-09-27 21:04:00
|
2179-09-27 21:40:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with ___ with abnormal cervical -spine findings following
trauma. Distracting injury and cannot clear spine as rotated initially.
Please do this more erect.
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Total DLP (Body) = 851 mGy-cm.
COMPARISON: CT cervical spine from 6 hours prior
FINDINGS:
Previously noted rotation of C1 on C2 has improved and likely was due to
changes in head positioning. Again noted is minimal anterolisthesis of C4 on
C5, which is likely degenerative in nature. No prevertebral soft tissue
abnormalities are identified. No definite fractures are identified. Again
noted are multilevel mild to moderate degenerative changes causing mild
central canal and moderate bilateral neural foraminal narrowing, most
pronounced at C3-4 and C5-6.
The thyroid is heterogeneous, with a hypodense nodule on the right and
hyperdense nodule on the left. No significant abnormalities are seen at the
lung apices.
IMPRESSION:
Previously noted rotation of C1 on C2 has improved, and attributable to
differences in head positioning. No acute fracture. Minimal anterolisthesis
of C4 on C5, which is likely degenerative in nature.
|
10216074-RR-12
| 10,216,074 | 20,697,613 |
RR
| 12 |
2179-09-28 10:37:00
|
2179-09-28 15:17:00
|
EXAMINATION: Fluoroscopic spot images
INDICATION: Left elbow and wrist ORIF
TECHNIQUE: Fluoroscopic spot images
COMPARISON: Radiograph from ___
FINDINGS:
6 intraoperative images were acquired without a radiologist present.
Images showplate and screw fixation of the left distal radial fracture and
external fixation pins at the left humerus and ulna. There is normal humeral
ulnar and humeral radial articulation.
Fluoroscopic time is 38.9 seconds.
IMPRESSION:
Intraoperative images were obtained during left wrist ORIF and external
fixation of left elbow. Please refer to the operative note for details of the
procedure.
|
10216074-RR-13
| 10,216,074 | 20,697,613 |
RR
| 13 |
2179-09-28 07:34:00
|
2179-09-28 09:09:00
|
EXAMINATION: WRIST(3 + VIEWS) LEFT PORT
INDICATION: ___ year old man with recent fall and distal radius fracture
TECHNIQUE: Three views of the left wrist
COMPARISON: Previous radiographs right hand 1 day ago but no comparison exams
left hand/wrist at this facility.
FINDINGS:
Overlying cast material obscures bone detail as does the bedside imaging.
There is a comminuted intra-articular fracture of the distal radius which
cannot be assessed on lateral and oblique images.
IMPRESSION:
Inadequately assessed intra-articular fracture distal radius
|
10216074-RR-14
| 10,216,074 | 20,697,613 |
RR
| 14 |
2179-10-01 14:00:00
|
2179-10-02 10:39:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with several days of AMS following a fall and OR
for left elbow and distal radius fracture dislocation // please evaluate for
ICH or possible ischemic changes in setting of intraoperative hypotension
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 1,010 mGy-cm.
COMPARISON: CT head ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are prominent, appropriate to age. .
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
Atrophy. No evidence of hemorrhage, fracture or infarction.
|
10216074-RR-15
| 10,216,074 | 20,697,613 |
RR
| 15 |
2179-10-04 14:20:00
|
2179-10-04 14:58:00
|
EXAMINATION: PELVIS W/JUDET VIEWS (3V)
INDICATION: ___ year old man with Left acetabular fracture // Please obtain
judet views to assess acetabular fracture Please obtain judet views to
assess acetabular fracture
IMPRESSION:
Serious images do not demonstrate the left acetabular fracture as well as the
scout view and tomographic sections of the CT scan dated ___.
Otherwise, little change from the CTs scout study.
|
10216074-RR-4
| 10,216,074 | 20,697,613 |
RR
| 4 |
2179-09-27 14:38:00
|
2179-09-27 15:28:00
|
INDICATION: ___ with trauma fell 16 feet off ladder.
TECHNIQUE: Single supine view of the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. There is no effusion or pneumothorax based on this
supine film. Cardiomediastinal silhouette is within normal limits for
technique noting a tortuous descending thoracic aorta. Calcifications noted
at the aortic arch. No displaced fractures identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10216074-RR-5
| 10,216,074 | 20,697,613 |
RR
| 5 |
2179-09-27 14:46:00
|
2179-09-27 15:23:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall, lac to head. high mechanism
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no evidence of large territorial infarction, hemorrhage, edema, or
mass effect. There is age-related cortical volume loss.
Small soft tissue swelling is seen just superior to the left orbit. No
osseous abnormalities seen. There is mucosal thickening of the paranasal
sinuses. The mastoid air cells and middle ear cavities are clear. The orbits
are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
|
10216074-RR-6
| 10,216,074 | 20,697,613 |
RR
| 6 |
2179-09-27 14:46:00
|
2179-09-27 15:28:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall, lac to head. high mechanism // eval for bleed
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Total DLP (Body) = 932 mGy-cm.
COMPARISON: None.
FINDINGS:
There is minimal anterolisthesis of C3 on C4 which may be degenerative given
left greater than right facet joint hypertrophy. Alignment is otherwise
normal. No fractures are identified. The prevertebral soft tissues are
unremarkable. Multilevel degenerative changes are noted, worst at C5-C6.
Degenerative changes result in mild, multilevel central canal narrowing and
moderate bilateral neural foraminal narrowing, worst on the right at C3-C4.
The thyroid is heterogeneous, with a hypodense nodule in the right and
hyperdense nodule on the left. The lung apices are better evaluated on the CT
torso.
IMPRESSION:
No acute fracture.
Minimal anterolisthesis of C3 on C4 which is likely degenerative but to be
correlated clinically.
Rotation of C1 with respect to C2 which is likely positional, also to be
correlated with physical exam regarding the possibility of rotary subluxation.
NOTIFICATION: Updated wet read discussed with Dr. ___ by Dr. ___.
|
10216074-RR-7
| 10,216,074 | 20,697,613 |
RR
| 7 |
2179-09-27 14:47:00
|
2179-09-27 15:40:00
|
EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST
INDICATION: ___ with fall, pain. low O2
TECHNIQUE: MDCT acquired axial images of the chest, abdomen, and pelvis were
obtained after administration of 130 mL Omnipaque intravenous contrast.
Enteric contrast was not given. Coronal and sagittal reformats were prepared
and reviewed.
DOSE: Total DLP (Body) = 1,034 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST: Aside from aortic valvular and mitral annular calcifications, the
heart and great vessels are unremarkable. There is no mediastinal hematoma.
There is no pericardial effusion. The thyroid is better evaluated on recent
CT of the C-spine.
The lungs are clear without worrisome nodule, mass, or consolidation. There
is bibasilar atelectasis. Airways are patent to the subsegmental level.
There is no evidence of contusion or laceration. There is no pneumothorax or
pleural effusion.
ABDOMEN: The liver is intact without focal lesion of signs of acute injury.
The spleen is intact and normal in size. The gallbladder contains gallstones
without evidence of acute cholecystitis. The pancreas, and adrenals are
unremarkable. The kidneys enhance symmetrically and excrete contrast promptly
without hydronephrosis. A simple cyst is seen in the lower pole of the right
kidney. A cortical region of nonenhancement is seen in the lower pole of the
right kidney as well, which may be sequela of prior insult. A circumscribed
but not completely simple lesion is seen in the lower pole of the left kidney,
with apparent internal calcification and septation, and is incompletely
characterized on this study. Peripheral enhancement superomedially may
related to artifact. A subcentimeter hypodense lesion is noted in the upper
pole of the left kidney, which is too small to characterize, but likely
represents a small cyst. There is no evidence of renal or collecting system
injury. The abdominal aorta is normal in course and caliber with widely
patent major branches. Mild to moderate atherosclerotic calcifications are
noted. Retro aortic left renal vein is seen. No lymphadenopathy, free air,
or free fluid.
The stomach and small bowel are unremarkable.
PELVIS: The small bowel is unremarkable, without ileus or obstruction. There
is no evidence or bowel or mesenteric injury. The colon is unremarkable. The
appendix is not definitively identified, there are no secondary signs of
appendicitis. The bladder is unremarkable. Hematoma is seen along the left
pelvic sidewall, abutting the external iliac vessels with extension
superiorly, anterior to the left iliacus muscle. This hematoma is in
association with the comminuted left pelvic fractures detailed below. There
is secondary mass effect with rightward displacement of the prostate and
bladder.
BONES: There is a complex, comminuted fracture of the left acetabulum
extending into the iliac wing and left superior and inferior pubic rami. A
cortical defect along the superior left sacrum which extends inferiorly is
also an acute fracture. Adjacent left pelvic sidewall hematoma is noted
extending anteriorly to the iliacus muscle. No active extravasation is
identified. No definite vascular injury is noted. No definite rib or
vertebral column fractures are identified.
IMPRESSION:
1. Fractures of the left acetabulum and sacrum as described above with
associated left pelvic sidewall hematoma. No other evidence of acute
intrathoracic or intra-abdominal injury.
2. Incompletely characterized left renal lesion that should be better
assessed with nonemergent ultrasound.
3. Cholelithiasis.
|
10216074-RR-8
| 10,216,074 | 20,697,613 |
RR
| 8 |
2179-09-27 15:10:00
|
2179-09-27 15:43:00
|
INDICATION: ___ with fall, pain // eval for fx
TECHNIQUE: Three views of the left elbow. Two views of the left forearm.
COMPARISON: None.
FINDINGS:
There is posterior dislocation of the radius and ulna with respect to the
distal humerus. Small calcific densities are noted adjacent to the radial
head, the donor site of which is felt to be from the distal humerus. There is
significant associated subcutaneous gas.
Partially visualized is a comminuted, volarly displaced, impacted distal left
radius fracture.
IMPRESSION:
Dorsal dislocation of the left elbow. Fracture fragments adjacent to the
radial head which may arise from the distal humerus.
Acute comminuted distal left radius fracture, partially imaged.
|
10216074-RR-9
| 10,216,074 | 20,697,613 |
RR
| 9 |
2179-09-27 15:10:00
|
2179-09-27 15:40:00
|
INDICATION: ___ with fall, pain eval for fx
TECHNIQUE: Three views of the right hand.
COMPARISON: None.
FINDINGS:
There is an abnormal configuration of the lunate which not well assessed on
these hand films. Degenerative changes seen at the distal interphalangeal
joint particularly of the index finger. Elsewhere, osseous structures are
unremarkable. Joint spaces are preserved.
IMPRESSION:
Lunate appears small and sclerotic although not well assessed on these hand
films. Consider dedicated wrist films, especially ifpain localizes to this
region.
|
10216097-RR-14
| 10,216,097 | 23,709,960 |
RR
| 14 |
2189-06-10 18:26:00
|
2189-06-10 20:26:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with sob // ? chf
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Opacity involving the right mid
through lower lung is concerning for pneumonia with associated small effusion.
Left lung appears grossly clear. The heart size cannot be assessed. No
pneumothorax. Bony structures are intact.
IMPRESSION:
Right mid to lower lung opacity concerning for right middle and lower lobe
pneumonia with associated right pleural effusion. Recommend followup to
resolution.
|
10216097-RR-15
| 10,216,097 | 23,709,960 |
RR
| 15 |
2189-06-11 14:39:00
|
2189-06-11 15:55:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with ascites, CHF // Eval for cirrhosis, portal
venous system
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits.The contour of the
liver is smooth. There is no focal liver mass. Main portal vein is patent with
pulsatile hepatopetal flow. There is a large volume of ascites.
DOPPLER: The left right and main portal veins are patent and show pulsatile
flow and Doppler waveforms. Left middle and right hepatic veins are patent
with normal flow and the inferior vena cava is also patent.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Pancreas is not well seen due to overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 14.1 cm.
KIDNEYS: The right kidney measures 10.1 cm. The left kidney measures 11.6 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones or hydronephrosis in the
kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
There is a large volume of ascites, and the portal vein is patent with
pulsatile flow, suggestive of right heart failure. No focal liver
abnormalities. Moderate splenomegaly.
|
10216097-RR-16
| 10,216,097 | 23,709,960 |
RR
| 16 |
2189-06-12 14:31:00
|
2189-06-12 16:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with large right pleural effusion s/p 8fr pigtail
placement // ? PTX ? PTX
IMPRESSION:
In comparison with the study of ___, there has been placement of a
pigtail catheter at the right base with removal of some of pleural fluid. No
evidence of pneumothorax. Some residual opacification is consistent with
pleural fluid and volume loss in the lower lungs.
Cardiac silhouette is prominent and there is some indistinctness of pulmonary
vessels suggesting some underlying vascular congestion.
|
10216097-RR-17
| 10,216,097 | 23,709,960 |
RR
| 17 |
2189-06-13 09:30:00
|
2189-06-13 14:09:00
|
Arison: The.
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PMH significant for AFib (on coumadin),
CAD, sCHF (LVEF 47% per echo ___ who presents with dyspnea. s/p chest
tube placement yesterday. Looking for interval improvement in pleural
effusion. // Looking for interval improvement in pleural effusion. Looking
for interval improvement in pleural effusion.
COMPARISON: Chest radiographs ___.
IMPRESSION:
\Small right pleural effusion remains, changed in distribution but not in
overall volume since ___ following insertion of the small bore pleural
drainage catheter. There is no pneumothorax. Moderate enlargement of the
cardiac silhouette due to cardiomegaly and/or pericardial effusion is
unchanged. Left lung is grossly clear. Normal hilar and upper mediastinal
contours.
|
10216097-RR-18
| 10,216,097 | 23,709,960 |
RR
| 18 |
2189-06-14 07:24:00
|
2189-06-14 15:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PMH significant for AFib (on coumadin), CAD,
sCHF (LVEF 47% per echo ___ who presents with dyspnea. s/p chest tube
placement ___. Looking for interval improvement in pleural effusion. //
Interval change of pleural effusion Interval change of pleural effusion
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
Small right pleural effusion not appreciably changed since ___,
pleural drainage catheter still in place. Mild enlargement of cardiac
silhouette, improved. Lungs grossly clear. No pneumothorax.
|
10216097-RR-19
| 10,216,097 | 23,709,960 |
RR
| 19 |
2189-06-15 08:43:00
|
2189-06-15 11:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sCHF, R pleural effusion s/p chest tube
placement and removal on ___ // Interval change
IMPRESSION:
As compared to ___, right pleural catheter has been removed, with
slight increase in size of a moderate right pleural effusion but no definite
pneumothorax. Persistent enlarged cardiac silhouette accompanied by pulmonary
vascular congestion and worsening edema.
|
10216097-RR-20
| 10,216,097 | 23,709,960 |
RR
| 20 |
2189-06-16 12:40:00
|
2189-06-16 14:23:00
|
EXAMINATION: US-GUIDED PARACENTESIS
INDICATION: ___ year old man with R heart failure, ascites. //
therapeautic/diagnostic paracentesis: Please notify team 4 hrs before
procedure so we can stop heparin gtt, thx!
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Abdominal US from ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated small to
moderate volumeascites. A suitable target in the deepest pocket in the right
upper quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
upper quadrant and 1 L of clear, straw-colored fluid was removed.
Fluid samples were sent to pathology/microbiology as requested by the ordering
provider.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful US-guided therapeutic and diagnostic paracentesis, with
removal of 1L of straw-colored fluid.
|
10216097-RR-22
| 10,216,097 | 23,709,960 |
RR
| 22 |
2189-06-17 00:33:00
|
2189-06-17 00:55:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with recent chest tubes. // Is there an acute
process in the lungs?
TECHNIQUE: CHEST (PA AND LAT)
COMPARISON: ___
IMPRESSION:
There is substantial interval increase in right pleural effusion with the
leftward shift of the mediastinum. No substantial left pleural effusion
demonstrated. No definitive pulmonary edema is seen. No pneumothorax is
present.
NOTIFICATION:
___ D/w Dr. ___ ___ at 12:50 AM at time of discovery.
|
10216097-RR-24
| 10,216,097 | 23,709,960 |
RR
| 24 |
2189-06-17 08:57:00
|
2189-06-17 14:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R pleural effusion concern for hemothorax
s/p insertion of ___ catheter given supsected hemothorax. // eval R chest
tube eval R chest tube
IMPRESSION:
In comparison with the earlier study of this date, a right chest catheter is
in place and there has been removal of a substantial amount of pleural fluid
on the right. Nevertheless, the large effusion persists. No evidence of
pneumothorax.
The left lung remains clear and there is no evidence of pulmonary vascular
congestion.
|
10216097-RR-25
| 10,216,097 | 23,709,960 |
RR
| 25 |
2189-06-17 09:56:00
|
2189-06-17 11:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax s/p pigtail placement //
interval change, check tube position interval change, check tube position
COMPARISON: Chest radiographs on ___.
IMPRESSION:
Substantial right pleural effusion remains despite pleural catheter drainage.
There is no pneumothorax. Right Middle and lower lobe are substantially
atelectatic. Heart is chronically moderately severe. Left lung is clear. No
left pneumothorax.
|
10216097-RR-26
| 10,216,097 | 23,709,960 |
RR
| 26 |
2189-06-17 14:40:00
|
2189-06-17 15:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax s/p evacuation // eval post op
change eval post op change
IMPRESSION:
In comparison with the earlier study of this date, there now are 2 chest tubes
in place on the right following drainage of the substantial hemothorax there
is increase in size of the cardiac silhouette with indistinctness of pulmonary
vessels consistent with some elevated pulmonary venous pressure. Left basilar
opacification suggests small layering effusion with compressive atelectasis in
the left lower lung. .
|
10216097-RR-27
| 10,216,097 | 23,709,960 |
RR
| 27 |
2189-06-18 07:42:00
|
2189-06-18 12:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R hemothorax s/p VATS and thoracentesis with
3 chest tubes in place // Eval for interval change
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
3 right chest tubes are in place. There is questionable minimal apical
pneumothorax on the right. There is also fluid within the major fissure.
Cardiomediastinal silhouette is unchanged as well as there is no change in
bibasal atelectasis.
|
10216097-RR-28
| 10,216,097 | 23,709,960 |
RR
| 28 |
2189-06-19 07:53:00
|
2189-06-19 12:37:00
|
INDICATION: Hemothorax with multiple chest tubes. Evaluate for change.
TECHNIQUE: Single upright AP view of the chest.
COMPARISON: Multiple chest radiographs, including the most recent from ___.
FINDINGS:
Three chest tubes are unchanged in position. No definite pneumothorax is
identified. There has been improved aeration at the right base, likely due to
improved atelectasis. A small amount of right pleural fluid remains, though
has decreased since the prior exam. Subcutaneous air along the right chest
wall is likely from the recent chest tube insertions.
There is mild left basilar atelectasis and a tiny left pleural effusion. Since
the prior exam, vascular congestion has slightly worsened. There is no
evidence of pneumonia. No left pneumothorax is identified. The mediastinal
contours are normal. The cardiac silhouette is significantly enlarged, and
unchanged.
IMPRESSION:
1. Improved aeration at the right base, likely due to decreased atelectasis
and a slightly decrease in the amount of residual pleural fluid.
2. Slight interval worsening of mild vascular congestion.
3. Enlarged cardiac silhouette, which is presumably due to cardiomegaly,
though a pericardial effusion cannot be completely excluded.
|
10216097-RR-29
| 10,216,097 | 23,709,960 |
RR
| 29 |
2189-06-19 13:57:00
|
2189-06-19 14:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with right pleural effusion s/p VATS evacuation
and 3x chest tubes. Anterior chest tube now removed. // Eval post chest tube
removal. ***Please perform exam at 1430 today*** Eval post chest tube
removal. ***Please perform exam at 1430
IMPRESSION:
In comparison with the earlier study of this date, the anterior chest tube has
been removed. No evidence of pneumothorax. Increasing opacification at the
right base is consistent with effusion and atelectasis, though in the
appropriate clinical setting superimposed pneumonia would have to be
considered. Substantial enlargement of the cardiac silhouette process.
|
10216097-RR-30
| 10,216,097 | 23,709,960 |
RR
| 30 |
2189-06-20 07:51:00
|
2189-06-20 13:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleural effusion s/p drain placement. // Is
there interval change?
COMPARISON: ___
FINDINGS:
Again seen is a right chest tube, with opacity and pleural fluid/ thickening
at the right base. There has been slight improvement compared with 1 day
earlier. Otherwise, I doubt significant interval change. No pneumothorax
detected.
IMPRESSION:
Slight interval improvement in opacities at right base.
|
10216097-RR-31
| 10,216,097 | 23,709,960 |
RR
| 31 |
2189-06-20 12:24:00
|
2189-06-20 15:29:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CT DC. Please perform around 1230PM //
Evaluation of post pull PTX
COMPARISON: Chest x-ray from ___ at 839
FINDINGS:
The right-sided chest tube is been removed. There is a tiny right apical
pneumothorax and possible tiny loculated pneumothorax at the base of the right
lung. Otherwise, I doubt significant interval change. Minimal blunting of the
right costophrenic angle is again noted.
IMPRESSION:
As above..
|
10216097-RR-32
| 10,216,097 | 23,709,960 |
RR
| 32 |
2189-06-21 07:12:00
|
2189-06-21 14:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p VATS decortication with basilar ___ drain.
Please perform ___ AM // Routine evaluation for PTX
COMPARISON: Chest x-ray from ___ at 12:25
FINDINGS:
Again seen is the drain along the base of the right lung. There is minimal
atelectasis. Equivocal trace pneumothorax at the right lung apex. Previously
seen lucency at right lung base is no longer visualized.
New on today's exam, there is an ellipsoid opacity in the right mid zone. This
is partly accounted for by the overlying scapular angle. Doubt pneumonic
consolidation.
Bibasilar atelectasis is slightly increased. Upper zone redistribution is also
slightly more pronounced. No gross left effusion.
The cardiomediastinal silhouette is enlarged, but unchanged.
IMPRESSION:
1. Right lung base drain remains in place. Minimal , if any, residual
pneumothorax.
2. Upper zone redistribution bibasilar atelectasis slightly increased. No
overt CHF.
3. Ovoid opacity right mid lung -- question artifact due to overlying scapula.
Attention to this area on followup films is requested.
|
10216097-RR-33
| 10,216,097 | 23,709,960 |
RR
| 33 |
2189-06-21 11:20:00
|
2189-06-21 17:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p VATS decortication, s/p DC of basilar drain.
Please perform around noon. // Post pull evaluation
COMPARISON: CHEST X-RAY FROM ___ AT 07:32.
FINDINGS:
THE DRAIN PREVIOUSLY SEEN AT THE BASE OF THE LEFT LUNG IS NOT DEFINITIVELY
IDENTIFIED. POSSIBLE SMALL RIGHT APICAL PNEUMOTHORAX.
SMALL RIGHT EFFUSION AND HAZY OPACITY ALONG THE LOWER RIGHT CHEST IS NOT
SIGNIFICANTLY CHANGED. THE PREVIOUSLY SEEN ELLIPSOID DENSITY IN THE RIGHT
MIDZONE IS NO LONGER VISUALIZED. MINIMAL PLATELIKE ATELECTASIS OR TRACE FLUID
IN THE MINOR FISSURE IS NOW NOTED.
OTHERWISE, I DOUBT SIGNIFICANT INTERVAL CHANGE.
IMPRESSION:
INTERVAL REMOVAL OF DRAIN. SUSPECT SMALL RIGHT APICAL PNEUMOTHORAX.
|
10216097-RR-34
| 10,216,097 | 23,709,960 |
RR
| 34 |
2189-06-22 00:42:00
|
2189-06-22 08:16:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent VATS for hemothorax now with new
hemoptysis. // Is there a new process in the lung?
IMPRESSION:
As compared to ___, a small right apical pneumothorax is similar to
prior study. Hazy increased opacity with oblique orientation A in the right
mid lung probably represents loculated pleural fluid. New patchy right
retrocardiac opacity could reflect atelectasis, aspiration, and less likely
developing pneumonia. Short-term followup radiographs may be helpful in this
regard.
|
10216097-RR-35
| 10,216,097 | 23,709,960 |
RR
| 35 |
2189-06-22 10:46:00
|
2189-06-22 11:59:00
|
EXAMINATION: CR-PORTABLE ABDOMEN
INDICATION: ___ year old man with CHF exacerbation, acites, abdominal pain. ?
distention
TECHNIQUE: 2 portable supine views of the abdomen.
COMPARISON: None available.
FINDINGS:
There is air in non-distended loops of small and large bowel, without an
obstructive pattern. No free intra-abdominal air is identified.
|
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