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10216097-RR-36
| 10,216,097 | 23,709,960 |
RR
| 36 |
2189-06-23 08:03:00
|
2189-06-23 10:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHF exacerbation, hemothorax, pneumo, s/p
RHC/LHC, still dyspnic. // please eval evolution of effusion, edema, pneumo
please eval evolution of effusion, edema, pneumo
IMPRESSION:
In comparison with the study of ___, there is little change. Again there
is substantial enlargement of the cardiac silhouette with some elevation of
pulmonary venous pressure in prominence of the mediastinum. Probable
loculated pleural fluid is again seen in the right mid zone.
|
10216097-RR-37
| 10,216,097 | 23,709,960 |
RR
| 37 |
2189-06-22 22:10:00
|
2189-06-23 10:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hemothorax s/p chest tube X 3 // please
eval for interval change in hemothorax please eval for interval change in
hemothorax
IMPRESSION:
In comparison with the study of ___, there again is substantial
enlargement of the cardiac silhouette with apparent loculated pleural fluid in
the right mid zone. Mild elevation of pulmonary venous pressure is again seen.
Asymmetric opacification at the right base raises the possibility of
atelectasis, aspiration, or even pneumonia. Prominence of interstitial
markings is consistent with some elevation of pulmonary venous pressure.
|
10216097-RR-38
| 10,216,097 | 23,709,960 |
RR
| 38 |
2189-06-25 14:43:00
|
2189-06-25 17:23:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with heart failure and hemothorax s/p VATS.
?loculated effusion, PNA.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agentand reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images.
DOSE: DLP: 679.1 mGy-cm.
COMPARISON: Comparison is made to numerous prior chest radiographs, as
recently as ___. Comparison is also made to images from outside
chest CT obtained at ___ on ___ via the ___
___ Record.
FINDINGS:
MEDIASTINUM: The thyroid is normal. Numerous small supraclavicular lymph
nodes are present (2:5), as well as marked enlargement of multiple central
mediastinal lymph nodes, measuring up to 15 x 25 mm in the right lower
paratracheal station (02:25).
A heterogeneous, slightly hyperdense lobulated mass in the anterior
mediastinum is difficult to measure entirely in a single axial image, but
spans approximately 4.8 x 7.6 cm in greatest coronal dimension (601b:33).
Surrounding stranding of the anterior mediastinal fat is present, along with a
moderate pericardial effusion of simple fluid density (02:49). There is no
evidence of cardiac tamponade physiology. Mild to moderate Coronary arterial
and aortic valve calcifications are noted (02:38, 35). The heart is mildly
enlarged.
PLEURA: Nonhemorrhagic multi-loculated pleural effusion and
hydro-pneumothorax is noted on the right (02:53, 601b:86), with fluid
extending along the major fissure. There is suggestion of pleural nodularity
versus small loculated effusion along the posterior medial right pleural
surface (2:31, 34, 41, 50), difficult to assess given the lack of IV contrast.
A trace left pleural effusion is also noted.
LUNGS: Background centrilobular emphysema is mild to moderate in severity.
Right greater than left interlobular septal thickening is likely due to
lymphovascular engorgement from associated large pleural effusion.
No concerning lung nodules are identified.
BONES AND SOFT TISSUES: There are no destructive focal osseous lesions
concerning for malignancy within the imaged thoracic skeleton.
UPPER ABDOMEN: Although this study is not designed for the assessment of
subdiaphragmatic structures, small volume perihepatic and perisplenic ascites
is of simple fluid density (02:59). An accessory spleen is noted along the
anteromedial splenic contour (2:63).
IMPRESSION:
1. 7.6 cm intrinsically hyperdense, heterogeneously lobulated anterior
mediastinal mass is new since the prior outside CT of the chest from ___. Possibilities include lymphoma given extensive supraclavicular and
mediastinal lymphadenopathy, as well as thymic neoplasm such as thymic
carcinoma, or germ-cell tumor.
2. Moderate nonhemorrhagic pericardial effusion, with no CT evidence of
tamponade physiology.
3. Nonhemorrhagic multiloculated right pleural effusion and hydropneumothorax
is moderate in volume. Posteromedial right pleural nodularity versus small
loculated pleural effusion, difficult to assess given the lack of IV contrast.
4. Trace left pleural effusion.
5. Mild to moderate centrilobular emphysema.
6. Small volume perihepatic and perisplenic ascites.
NOTIFICATION: The findings were discussed via telephone by Dr. ___ with
Dr. ___ resident) on ___ at 5:12 ___, 5 minutes after
discovery of the findings.
|
10216097-RR-40
| 10,216,097 | 23,709,960 |
RR
| 40 |
2189-06-29 07:09:00
|
2189-06-29 09:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with right multiloculated pleural effusion in the
setting of recent thoracentesis c/b hemothorax now s/p VATS // please
evaluate right pleural effusion for possible IP intervention please
evaluate right pleural effusion for possible IP inter
IMPRESSION:
In comparison with the study of ___, there is little overall change. Again
there is substantial enlargement of the cardiac silhouette with relatively
mild elevation in pulmonary venous pressure, raising the possibility of
cardiomyopathy or pericardial effusion. Opacification in the right mid lung is
again consistent with loculated pleural effusion. If the condition of the
patient permits, a lateral view would allow better definition of the pleural
collection.
|
10216097-RR-41
| 10,216,097 | 23,709,960 |
RR
| 41 |
2189-06-30 13:00:00
|
2189-07-01 11:29:00
|
EXAMINATION: MRI MEDIASTINUM
INDICATION: ___ year old man with CHF, afib, ___, anterior mediastinal
mass c/f lymphoma // R/O anterior mediastinal mass as a hematoma.
TECHNIQUE: Multiplanar T1 and T2 weighted images were obtained through the
chest from the aortic arch to the diaphragm. Due to patient's impaired renal
function, no intravenous gadolinium was administered.
COMPARISON: CT chest ___, PET CT ___
FINDINGS:
A 7.7 x 4.6 x 7.3 cm mass in the anterior mediastinum (4a:87, 12:64)
demonstrates areas of T1 and T2 hyperintensity with other areas of
intermediate and dark signal intensity on the T1 and T2 weighted images,
suggesting hemorrhage of different ages. There is no evidence of intra voxel
fat within the mass. Restricted diffusion within the lesion (15:31) is likely
related to blood products. Full evaluation is limited without intravenous
contrast.
Enlarged mediastinal lymph nodes are again seen measuring up to 1.5 cm in the
right lower paratracheal station and 2.7cm in the subcarinal station. The
findings are unchanged from ___. A prominent right supraclavicular
lymph node is 10 mm in short axis (4A:35, 3:12). No axillary lymphadenopathy.
There is a small right pleural effusion with loculated fluid in the right
major fissure. A moderate pericardial effusion persists. Consolidation in the
left lower lobe is new from ___ and may represent pneumonia or
aspiration.
The imaged thoracic aorta is normal in caliber. Incidentally noted is a two
vessel takeoff from the aortic arch, normal variant. The main pulmonary artery
is enlarged to 3.6 cm, suggesting underlying pulmonary arterial hypertension.
No discrete nodule is seen within the imaged thyroid gland.
IMPRESSION:
1. Anterior mediastinal mass is most consistent with a hematoma. Areas of
small focal nodularity or vascularity cannot be assessed without IV contrast
but no obvious solid mass lesion is seen. If follow up is desired, IV
contrast would be needed to provide additional information but the hematoma
itself and related mass effect could be followed up using chest radiographs.
2. Left lower lobe consolidation may represent pneumonia or aspiration, new
from ___. Stable right pleural effusion and pericardial effusion.
3. Mediastinal lymphadenopathy is unchanged from ___. The patient
underwent biopsy of the right supraclavicular lymph node on ___.
4. Enlarged main pulmonary artery suggests underlying pulmonary arterial
hypertension.
|
10216097-RR-42
| 10,216,097 | 23,709,960 |
RR
| 42 |
2189-07-01 07:57:00
|
2189-07-01 10:07:00
|
INDICATION: ___ year old man with CHF, AFIB, large ant mediastinal mass with
FDG avid lymph nodes, notably paratracheal and in clavicular region. //
Please perform excisional biopsy of clavicular lymph node
COMPARISON: Chest CT of ___. PET-CT of ___.
TECHNIQUE: Right supraclavicular lymph node fine needle aspiration.
OPERATORS: Dr. ___ (radiology resident), Dr. ___ (radiology
fellow), and Dr. ___ radiologist. Dr. ___ supervised the
trainee during the key components of the procedure and reviewed and agree with
the trainee's findings.
FINDINGS:
Limited scanning of the right supraclavicular region was performed. Again
identified is a 3.2 x 1.3 x 0.9 cm hypoechoic lymph node superficial to the
medial clavicle.
PROCEDURE: The risks and benefits of the procedure were explained to the
patient, and written informed consent was obtained. The preprocedure time out
was performed per ___ protocol. An entrance site for the FNA was determined
over the right supraclavicular lymph node. The patient was prepped and draped
in usual sterile fashion. 1% lidocaine was injected subcutaneously for local
anesthesia.
Using ultrasound guidance, 3 fine needle aspirates were obtained from the
lymph node using 25 gauge needles. Two samples were submitted in Cytolyt and
one sample was submitted in RMPI. No periprocedural complications were
encountered. The patient tolerated the procedure well and was sent back to the
floor in stable condition.
IMPRESSION:
Technically successful fine needle aspiration of the enlarged right
supraclavicular lymph node. No periprocedural complications. Cytology is
pending.
|
10216097-RR-43
| 10,216,097 | 23,709,960 |
RR
| 43 |
2189-07-03 19:37:00
|
2189-07-03 20:29:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with restrictive cardiomyopathy // Evaluate PA
line position Contact name: ___: ___
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the patient has received a Swan-Ganz
catheter, inserted over the right internal jugular vein. The course of the
catheter is unremarkable, the tip of the catheter projects over the proximal
parts of the right pulmonary artery. No pneumothorax or other complication.
The loculated right pleural effusion has minimally increased in size. Moderate
cardiomegaly persists. No pulmonary edema.
|
10216097-RR-44
| 10,216,097 | 23,709,960 |
RR
| 44 |
2189-07-06 07:30:00
|
2189-07-06 09:36:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with heart failure, mediastinal mass // Please
eval PA line position, volume status Please eval PA line position, volume
status
IMPRESSION:
In comparison with the study of ___, there is little overall change. The
tip of the Swan-Ganz catheter again extends into the right pulmonary artery
beyond the mediastinal border. Loculated pleural effusion within the major
fissure on the right is essentially unchanged. Moderate enlargement of the
cardiac silhouette is again seen with mild indistinctness of pulmonary vessels
suggesting some elevated pulmonary venous pressure. Blunting of the right
costophrenic angle is again noted.
|
10216097-RR-45
| 10,216,097 | 23,709,960 |
RR
| 45 |
2189-07-06 14:22:00
|
2189-07-06 15:42:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with heart failure with PA catheter in place //
eval PA catheter placement eval PA catheter placement
IMPRESSION:
In comparison with the earlier study of this date, the PA catheter is been
pulled back to a good position within the mediastinal portion of the right
pulmonary artery. Otherwise little change.
|
10216097-RR-46
| 10,216,097 | 23,709,960 |
RR
| 46 |
2189-07-07 14:32:00
|
2189-07-07 15:43:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHF now with tailored therapy // eval PA
catheter placement eval PA catheter placement
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Continued substantial enlargement of the cardiac silhouette with mild
elevation of pulmonary venous pressure and pseudo tumor of pleural fluid in
the major fissure on the right. Swan-Ganz catheter remains in good position.
|
10216153-RR-119
| 10,216,153 | 29,755,610 |
RR
| 119 |
2161-07-13 16:31:00
|
2161-07-13 19:03:00
|
INDICATION: ___ year old woman with breast ca, sob/cp // ? PE, also eval for
extent of metastatic disease
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 1.4
mGy-cm.
2) Stationary Acquisition 13.2 s, 0.2 cm; CTDIvol = 89.4 mGy (Body) DLP =
17.9 mGy-cm.
3) Spiral Acquisition 4.2 s, 27.1 cm; CTDIvol = 2.6 mGy (Body) DLP = 69.4
mGy-cm.
Total DLP (Body) = 89 mGy-cm.
COMPARISON: CT chest ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation.
The pulmonary arteries are well opacified to the segmental level, with no
evidence of filling defect within the main, right, left, lobar, or segmental
pulmonary arteries.
There is massive hypervascular lymphadenopathy seen in the lower neck,
mediastinum and both hilar regions. This appears essentially unchanged
compared to the most recent prior CT. An ill-defined lesion arising from the
right lobe of the thyroid measures approximately 3.8 x 2.8 cm (05:14). A
conglomerate of precarinal lymph nodes measures approximately 2.7 x 3.3 cm.
The SVC is compressed but patent (05:41). At the level of the hila, a
conglomerate area of left hilar lymphadenopathy measures 4.2 x 3.3 cm,
previously 4.2 x 3.4 cm. Subcarinal lymphadenopathy is also unchanged in size
measuring 3.2 x 2.4 cm.
There is a moderate to large right pleural effusion with a pleural catheter in
place. The tip of the catheter terminates along the right upper anterior
pleural surface. There is a smaller left pleural effusion with a pleural
catheter in place. There is a small amount of pericardial fluid.
At the level of the right cardiophrenic angle there is an area of abnormal
peripherally enhancing soft tissue which extends from the pleural space
through into the chest wall (series 5, image 81) with destruction of the
adjacent sternum and appears similar in size to the prior exam measuring 8.1 x
6.0 cm.
There is a stable area of bandlike atelectasis in the right middle lobe.
There is probable bibasilar atelectasis related to pleural effusions. The
trachea and mainstem bronchi are patent.
A large hypervascular liver mass at the hepatic dome is mildly increased in
size measuring 3.3 x 2.8 cm, previously 3.0 x 2.6 cm. Numerous additional
peripherally- enhancing liver lesions were not clearly seen on the prior exam
and are highly suspicious for new liver metastatic disease..
There are heterogeneous areas of lucency and sclerosis throughout the spine
consistent with diffuse osseous metastatic disease. Multiple vertebral
compression fractures appear unchanged from the prior exam.
IMPRESSION:
1. No evidence of pulmonary embolism to the segmental level.
2. Massive hypervascular lymphadenopathy seen throughout the mediastinum, in
the hilar regions and in the lower neck. This appears stable in size compared
to the prior exam.
3. Enhancing soft tissue mass extending from the region of the right
cardiophrenic angle through into the chest wall with destruction of the
adjacent sternum, similar to the prior exam.
4. Bilateral pleural effusions with pleural catheters in place.
5. Findings of diffuse osseous metastatic disease.
6. Mild increase in size of hypervascular lesion at the liver dome. Numerous
new smaller peripherally enhancing liver lesions are likely reflective of
progressive hepatic metastatic disease.
NOTIFICATION: The findings were discussed with Dr ___. by ___
___, M.D. on the telephone on ___ at 7:00 ___, 10 minutes after
discovery of the findings.
|
10216556-RR-17
| 10,216,556 | 23,888,667 |
RR
| 17 |
2131-06-13 11:27:00
|
2131-06-13 12:21:00
|
HISTORY: Altered mental status.
TECHNIQUE: Contiguous axial MDCT images were obtained of the head without IV
contrast. Multiplanar reformatted images were generated in the coronal and
sagittal planes as well as thin section bone algorithm images.
DLP: 1025.72 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no hemorrhage, edema, mass effect or acute large territory infarct.
Prominent ventricles and sulci are suggestive of age-related involutional
change. Periventricular and subcortical white matter hypodensities are
compatible with chronic small vessel ischemic disease. The basal cisterns
appear patent and there is preservation of gray-white matter differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. Fluid in the nasopharynx is related
to endotracheal tube placement. The globes are unremarkable. Atherosclerotic
calcifications are noted in the carotid siphons.
IMPRESSION:
No acute intracranial process.
|
10216556-RR-18
| 10,216,556 | 23,888,667 |
RR
| 18 |
2131-06-13 11:27:00
|
2131-06-13 12:36:00
|
HISTORY: Altered mental status and intubated.
TECHNIQUE: Axial helical MDCT images were obtained of the chest, abdomen and
pelvis without IV contrast due to history of renal failure. Multiplanar
reformatted images were generated in the coronal and sagittal planes.
DLP: 1076.39 mGy-cm.
COMPARISON: CT abdomen pelvis noncontrast ___.
FINDINGS:
CT chest: The thyroid is unremarkable. The trachea is midline and the
airways are patent the subsegmental level the patient is intubated and the tip
of the endotracheal tube is 3.5 cm from the carina. There is bibasilar
atelectasis. The lungs are otherwise clear without nodules or pneumothorax.
There is trace left effusion. The mitral valve replacement is in place. The
heart size is normal. There are no enlarged supraclavicular, axillary,
mediastinal or hilar lymph nodes by CT size criteria.
CT abdomen: Evaluation of intra-abdominal organs is limited on this
noncontrast study. The liver appears small with a nodular contour but
otherwise without gross lesions. The spleen is massively enlarged measuring
22 cm in its longest axis. The gallbladder appears collapsed with possible
small stones or sludge layering dependently. The pancreas and adrenal glands
are grossly unremarkable. The kidneys are atrophic and there are multiple
bilateral simple renal cysts with the largest in the right upper pole
measuring 2.4 cm. A 9 mm right upper pole renal exophytic cystic lesion
slightly high in density to characterize as simple by CT but likely represents
a cyst. There are no stones or pelvocaliceal dilatation.
An OG tube terminates in the mid stomach. The stomach, duodenum, small and
large bowel are grossly unremarkable without evidence of obstruction.
The abdominal aorta is of normal caliber with mural atherosclerotic
calcifications noted. There is large ascites. There is no pneumoperitoneum.
There is a small ventral abdominal hernia at the level of T12. There are no
enlarged mesenteric or retroperitoneal lymph nodes by CT size criteria.
CT pelvis: The bladder is decompressed and grossly unremarkable. The
prostate and rectum are grossly unremarkable. There are no enlarged inguinal
or pelvic wall lymph nodes by CT size criteria.
Osseous structures and soft tissue: No acute bony abnormality is identified.
Sternotomy wires are in place. There are no focal blastic or lytic lesions in
the visualized osseous structures concerning for malignancy. There is a
subcutaneous fluid collection with calcified margins in the postsacral space
just left of midline which is likely an old hematoma.
IMPRESSION:
1. No acute thoracic, abdominal or pelvic process within the limitations of a
noncontrast examination.
2. Nodular liver, large ascites and massive splenomegaly compatible with
cirrhosis.
3. 9 mm intermediate density cystic lesion in the right renal upper pole which
is likely a proteinaceous or hemorrhagic cyst. This can be further
characterized by ultrasound.
4. Fat containing ventral hernia.
5. Possible gallstones or sludge.
|
10216556-RR-19
| 10,216,556 | 23,888,667 |
RR
| 19 |
2131-06-13 11:28:00
|
2131-06-13 13:22:00
|
CHEST RADIOGRAPH PERFORMED ON ___
Comparison is made with the same-day CT torso.
CLINICAL HISTORY: Altered mental status.
FINDINGS: Supine portable AP view of the chest provided. Midline sternotomy
wires and cardiac valve as well as mediastinal clips are in place. Bibasilar
atelectasis, left greater than right with small pleural effusion noted.
Cardiomediastinal silhouette appears grossly unremarkable. No pneumothorax.
No bony abnormalities. The endotracheal tip resides 3.3 cm above the carina.
NG tube courses into the left upper quadrant.
IMPRESSION: Bibasilar atelectasis, left greater than right with small left
effusion. Findings are better assessed on same-day chest CT performed
concurrently. ET and gastrostomy tubes positioned appropriately.
|
10216556-RR-20
| 10,216,556 | 23,888,667 |
RR
| 20 |
2131-06-13 12:00:00
|
2131-06-13 12:45:00
|
CT OF THE CERVICAL SPINE PERFORMED ON ___.
COMPARISON: None.
CLINICAL HISTORY: Altered mental status. Assess fracture or malalignment.
TECHNIQUE: Multidetector CT through the cervical spine without contrast with
multiplanar reformations.
FINDINGS: Endotracheal and orogastric tubes are in place. There is also an
IV line in the right neck soft tissues, though not clearly residing with a
vein. There is no acute fracture or traumatic malalignment within the
cervical spine. Mild degenerative change at C1-2 noted with osteophytes along
the atlantodens interval. The disc spaces are relatively preserved in the
cervical spine. The visualized outline of the thecal sac appears relatively
normal on the sagittal reformations. The prevertebral soft tissues are
difficult to assess given the presence of an endotracheal tube. Facets align
normally as do the atlanto-occipital joints. There is emphysema noted at the
imaged lung apices. Thyroid gland appears normal.
IMPRESSION: No fracture or malalignment within the cervical spine.
Endotracheal and orogastric tubes in place. A catheter within the right neck
soft tissues is noted, though not clearly residing within a vein. Please
correlate for function and desired location.
|
10216556-RR-21
| 10,216,556 | 23,888,667 |
RR
| 21 |
2131-06-13 17:41:00
|
2131-06-14 08:09:00
|
HISTORY: ET tube placement.
FINDINGS: In comparison with the earlier study of this date, the tip of the
endotracheal tube lies approximately 3.8 cm above the carina. Elevation of
the right hemidiaphragm persists. There is patchy opacification involving the
left hemithorax. Much of this could reflect a combination of atelectasis and
vascular congestion, though in the appropriate clinical setting, supervening
pneumonia would have to be considered.
|
10216556-RR-22
| 10,216,556 | 23,888,667 |
RR
| 22 |
2131-06-14 10:17:00
|
2131-06-14 17:18:00
|
LIVER OR GALLBLADDER ULTRASOUND (SINGLE ORGAN)
INDICATION: ___ male with newly discovered cirrhosis, suspected
hepatic encephalopathy, hepatosplenomegaly on CT. Please evaluate for portal
vein thrombosis.
COMPARISON: CT torso of ___.
TECHNIQUE: Multiple sonographic grayscale images were obtained of the abdomen
with color Doppler evaluation.
FINDINGS: The liver demonstrates diffusely increased, and heterogeneous
echogenicity with coarsened echotexture and nodular contour, compatible with
cirrhosis. There is moderate perihepatic ascites. Portal vein is patent with
normal hepatopetal flow and peak systolic velocity of 18.4 cm/sec. There is
no intrahepatic or extrahepatic biliary ductal dilatation. Gallbladder is
decompressed and contains a shadowing stone. Normal caliber common bile duct
measures 0.3 cm. The left upper quadrant of the abdomen was not visible due
to patient positioning. Limited evaluation of the left lower quadrant
demonstrates moderate ascites.
IMPRESSION:
1. Heterogeneous echogenicity with coarse echotexture and nodular contour,
compatible with cirrhosis. No suspicious hepatic lesions are identified.
Moderate abdominal ascites.
2. Cholelithiasis without sonographic evidence of acute cholecystitis.
3. Patent portal vein with normal hepatopetal flow.
|
10216556-RR-23
| 10,216,556 | 23,888,667 |
RR
| 23 |
2131-06-14 19:30:00
|
2131-06-15 09:33:00
|
SINGLE FRONTAL VIEW OF THE CHEST.
REASON FOR EXAM: Assess new line.
Comparison is made with prior study, ___.
New right IJ catheter tip is in the low SVC. There is a new right small
apical pneumothorax. There are persistent low lung volumes, bibasilar
atelectasis larger on the left side and small bilateral pleural effusions.
Moderate interstitial pulmonary edema has increased.
Findings were discussed with Dr. ___ by Dr. ___.
ET tube is in standard position. NG tube is out of view below the diaphragm.
|
10216556-RR-24
| 10,216,556 | 23,888,667 |
RR
| 24 |
2131-06-15 05:16:00
|
2131-06-15 09:50:00
|
AP CHEST, 5:21 A.M. ON ___
HISTORY: ___ man with a right apical pneumothorax.
IMPRESSION:
AP chest compared to ___:
The previously small right apical pneumothorax is larger, probably
underestimated on this supine view, which suggests pleural air at the base of
the right hemithorax is substantial and increased. Also increased since
___ is what is probably pulmonary edema, even though heart size is
normal. Small left pleural effusion is likely. There is no left
pneumothorax. Azygous distention could be due to supine positioning alone.
ET tube and right internal jugular line and an upper enteric trained imaged
tube are in standard placements respectively. Resident caring for this
patient was paged at 9:30 a.m. and the findings were recognized.
|
10216556-RR-25
| 10,216,556 | 23,888,667 |
RR
| 25 |
2131-06-15 14:30:00
|
2131-06-17 10:44:00
|
PARACENTESIS
COMPARISON: Ultrasound from ___.
INDICATION: ___ man with new ascites, cirrhosis, diagnostic for SBP.
CLINICIANS: Dr. ___, abdominal imaging fellow, and Dr. ___,
___ radiologist.
PROCEDURE:
The procedure, risks, benefits, and alternatives were discussed with the
patient, and written informed consent was obtained prior to performing the
procedure. A preprocedure timeout was performed discussing the planned
procedure, confirming the patient's identity with two identifiers, and
reviewing a checklist per ___ protocol.
Under bedside ultrasound performed in the ICU, an entrance site was selected
from the right extreme lateral approach. It was noted that the patient's
ascites was significantly mobile with a slight oblique position, thus the
patient was placed on supine position for accessibility of the best and
largest pocket in the right lower quadrant. Skin was prepped and draped in
the usual sterile fashion. 1% lidocaine was administered for local
anesthetic.
A 5 ___ ___ catheter was advanced into the right lower quadrant fluid
collection. This was a diagnostic paracentesis, thus only 25 cc of the
straw-colored ascitic fluid was removed. This was sent for microbiology,
cytology, and chemistry.
The patient tolerated the procedure well without immediate complication.
Minimal estimated blood loss was noted.
Dr. ___ attending radiologist, was present throughout the entire
procedure.
IMPRESSION:
Ultrasound-guided diagnostic paracentesis with removal of 25 cc of
straw-colored yellowish fluid sent for microbiology, cytology, and chemistry.
|
10216556-RR-26
| 10,216,556 | 23,888,667 |
RR
| 26 |
2131-06-15 17:38:00
|
2131-06-16 08:13:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Assess NG tube.
Small right pneumothorax has increased compared to prior study performed the
same day earlier in the morning.
NG tube tip is out of view below the diaphragm. ET tube is in standard
position. Right IJ catheter tip is in the lower SVC. There are low lung
volumes. Mild-to-moderate pulmonary edema is stable. Cardiomediastinal
contours are unchanged. Sternal wires are aligned.
|
10216556-RR-27
| 10,216,556 | 23,888,667 |
RR
| 27 |
2131-06-15 23:48:00
|
2131-06-16 17:21:00
|
INDICATION: Absent bowel sounds.
TECHNIQUE: Single frontal supine radiograph of the abdomen and pelvis.
COMPARISON: Review of CT torso dated ___.
FINDINGS: Evaluation is somewhat limited due to body habitus; however, air is
seen within the large bowel and no dilated loops to suggest obstruction are
seen.
|
10216556-RR-28
| 10,216,556 | 23,888,667 |
RR
| 28 |
2131-06-15 23:48:00
|
2131-06-16 08:18:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Followup pneumothorax.
Small right pneumothorax is stable since six hours earlier. Right IJ catheter
tip is in the low SVC/cavoatrial junction. There are persistent low lung
volumes. Cardiomediastinal contours are stable. Moderate pulmonary edema is
stable. If any, there is small left effusion. ET tube is in standard
position. NG tube tip is not visualized due to technique below the diaphragm.
|
10216556-RR-29
| 10,216,556 | 23,888,667 |
RR
| 29 |
2131-06-16 07:12:00
|
2131-06-17 10:47:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Pneumothorax.
Small right pneumothorax is unchanged. Moderate-to-severe pulmonary edema is
grossly unchanged. There are low lung volumes. Cardiomegaly and widened
mediastinum are stable. Right IJ catheter tip is in the lower SVC. ET tube
is in standard position. NG tube tip is out of view below the diaphragm.
Bibasilar atelectases, largely on the right, have increased on the right. A
small left effusion is probably unchanged. Sternal wires are aligned.
|
10216556-RR-30
| 10,216,556 | 23,888,667 |
RR
| 30 |
2131-06-16 14:01:00
|
2131-06-16 16:06:00
|
TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with cirrhosis, status post right
internal jugular placement complicated by pneumothorax. Evaluate for interval
change as patient is now extubated.
FINDINGS: AP single view of the chest has been obtained with patient in
semi-upright position. Comparison is made with the next preceding similar
study obtained six and a half hours earlier during the same day. Status post
sternotomy and cardiac enlargement with typical annuloplasty of mitral valve
prosthesis as before. Patient is now extubated. Previously described right
internal jugular central venous line remains in unchanged position and
terminates in lower SVC. There remains a small approximately 1 cm wide
pneumothorax in the right apical area. On the next preceding examination, the
pneumothorax is difficult to identify. Thus,the question if pneumothorax has
increased in size cannot be assessed. There is no evidence of new pulmonary
abnormalities. On the preceding chest examination, the patient was still
intubated. The pulmonary vasculature was more prominent, but this may be
related to technical image factors.
IMPRESSION: Persistent small right apical pneumothorax.
|
10216556-RR-31
| 10,216,556 | 23,888,667 |
RR
| 31 |
2131-06-18 10:42:00
|
2131-06-18 13:41:00
|
PORTABLE CHEST FILM ___ AT 1053
CLINICAL INDICATION: ___ with small apical pneumothorax from central
line placement, assess for interval change.
Comparison is made to the patient's prior study dated ___ at 1412.
A portable upright chest film ___ at 1053 is submitted.
IMPRESSION:
1. Right internal jugular central line is unchanged in position. A
nasogastric tube is seen coursing to the level of the distal esophagus with
the tip not identified due to underpenetration. There is a stable small right
apical pneumothorax. In the interim, however, there has been interval
appearance of bilateral perihilar and airspace process most likely
representing moderate pulmonary edema. There are layering bilateral
effusions. The heart remains enlarged status post median sternotomy for CABG
and mitral valve replacement. Findings were communicated to ___, the
patient's nurse by phone on ___ at 1:12 p.m.
|
10216556-RR-32
| 10,216,556 | 23,888,667 |
RR
| 32 |
2131-06-24 17:01:00
|
2131-06-25 09:06:00
|
AP CHEST, 5:09 P.M., ___
HISTORY: Recent small pneumothorax after right IJ line placement. Assess
change.
IMPRESSION: AP chest compared to ___:
Previous small right pneumothorax has decreased. Lung volumes have improved,
though still low, and mild pulmonary edema has also decreased slightly.
Pulmonary vasculature is still engorged, moderate cardiomegaly unchanged and
small left pleural effusion persists.
|
10216740-RR-14
| 10,216,740 | 23,135,539 |
RR
| 14 |
2167-06-07 17:49:00
|
2167-06-07 18:41:00
|
EXAM: Right hand, three views.
CLINICAL INFORMATION: Increased swelling and erythema.
___ and ___.
FINDINGS: The patient is status post ORIF of a fifth proximal phalangeal
fracture. Two fixation plates, screws, a cerclage wire, and two wires,
similar in appearance as compared to the prior study given differences in
patient positioning. The patient's fingers are relatively flexed and the
mid-to-distal fifth digit is not optimally evaluated; however, no new fracture
is identified.
Suggestion of associated soft tissue swelling is again seen.
IMPRESSION: Status post ORIF of the fifth digit proximal phalanx comminuted
fracture, similar in appearance compared to the prior study.
|
10217041-RR-57
| 10,217,041 | 21,082,885 |
RR
| 57 |
2150-05-12 09:07:00
|
2150-05-12 10:09:00
|
HISTORY: ___ female with pelvic fracture.
COMPARISON: None available.
FINDINGS:
3 views of the pelvis demonstrates multiple pelvic fractures status post ORIF
with a threaded screw transfixing the left sacroiliac joint and external
fixation device with pins entering the bilateral iliac bones. Comminuted
fracture of the left superior pubic ramus extending to the pubic symphysis is
noted, along with the bilateral inferior pubic rami fractures. On the left,
there is a minimally displaced fracture fragment from the inferior pubic ramus
fracture. Overlying bowel gas somewhat obscures bony detail of the sacrum.
The bilateral femoral acetabular joints appear congruent and symmetric.
IMPRESSION:
Multiple pelvic fractures status post ORIF with no evidence ___ hardware
lucency to suggest hardware related complications.
|
10217041-RR-58
| 10,217,041 | 21,082,885 |
RR
| 58 |
2150-05-12 14:28:00
|
2150-05-12 15:23:00
|
HISTORY: ___ female with pelvic fracture.
TECHNIQUE: Single AP view of the pelvis.
FINDINGS: The screws seen overlying the left sacroiliac joint but with only 1
view available, the exact location cannot be determined. There is no SI joint
or pubic symphysis diastasis. There are multiple pelvic fractures seen with an
external fixator which appears to be in satisfactory position with no evidence
of hardware complications.
IMPRESSION: Multiple pelvic fractures with appropriate placement of hardware
with no evidence of hardware failure.
|
10217041-RR-59
| 10,217,041 | 21,082,885 |
RR
| 59 |
2150-05-13 07:59:00
|
2150-05-13 08:25:00
|
INTRAOPERATIVE RADIOGRAPH OF THE PELVIS
CLINICAL INDICATION: ___ female with pelvic fractures.
TECHNIQUE: Single intraoperative radiograph of the pelvis.
___.
FINDINGS:
Single intraoperative radiograph of the pelvis was obtained, which
demonstrates multiple fractures including at the bilateral superior and
inferior pubic rami. Partial visualization of screw projecting over the right
iliac bone is noted. Please refer to the operative report for further
details.
|
10217041-RR-60
| 10,217,041 | 24,067,749 |
RR
| 60 |
2150-06-12 12:13:00
|
2150-06-12 13:39:00
|
HISTORY: Status post MVC with pelvic fractures and prolonged immobility, here
to evaluate for deep venous thrombosis.
COMPARISON: Venous duplex ultrasound of the right lower extremity dated ___.
Technique: Grayscale, color and spectral Doppler analysis of the right lower
extremity veins was performed.
FINDINGS:
There is normal compressibility, augmentation and flow of the right common
femoral, proximal femoral, mid femoral, and distal femoral and popliteal
veins. Normal color flow and compressibility is demonstrated in the right
posterior tibial and peroneal veins. There is normal respiratory variation in
the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity.
|
10217041-RR-61
| 10,217,041 | 24,067,749 |
RR
| 61 |
2150-06-12 13:46:00
|
2150-06-12 14:11:00
|
HISTORY: Status post MVC with pelvic fractures now with worsening labial
swelling, here to evaluate for hematoma or abscess.
COMPARISON: Remote prior CT of the abdomen and pelvis dated ___.
TECHNIQUE: Multi detector CT acquired axial images were obtained through the
pelvis following the uneventful administration of 130 cc Omnipaque intravenous
contrast. Coronal and sagittal reformatted images were generated and
reviewed.
FINDINGS:
CT PELVIS: There is a rim enhancing left labial fluid collection measuring
6.8 x 6.3 cm with active extravasation arising from a branch of the left
internal pudendal artery adjacent to a comminuted fracture of the left
inferior pubic ramus (3:83). The hematoma also extends posterior to the anus
at this level.
There is a rim enhancing 6.6 x 5.0 cm fluid collection in the subcutaneous fat
lateral to the right hip without evidence of active hemorrhage, which is
contiguous with a rim enhancing fluid collection in the right gluteal and
superior gluteal region measuring approximately 11.9 x 1.7 cm. The superior
aspect of this fluid collection is incompletely imaged.
The urinary bladder is well distended. The uterus, rectum and sigmoid colon
are within normal limits. A fluid filled structure in the left adenxa may
represent hydrosalpinx or adnexal cysts. There is no free pelvic fluid or
inguinal / pelvic lymphadenopathy. The intra pelvic loops of small and large
bowel are normal in caliber without abnormal wall thickening. The bilateral
iliac vessels appear intact.
OSSEOUS STRUCTURES: There are multiple pelvic fractures including a
comminuted fracture of the left inferior pubic ramus, a displaced fracture of
the right inferior pubic ramus, comminuted fractures of the bilateral superior
pubic rami and a fracture of the right pubic bone extending into the pubic
symphysis without associated symphyseal widening. There is an extensive
vertically oriented and comminuted fracture of the left hemi sacrum, which is
fixated by a large orthopedic screw through the left iliac bone into S1. The
bilateral sacroiliac joints are not widened.
IMPRESSION:
1. 6.8 cm left labial hematoma with active extravasation arising from a
branch of the left internal pudendal artery.
2. Large rim enhancing fluid collection extending from the right gluteal
region into the right lateral hip without evidence of active hemorrhage may
represent abscess or hematoma.
3. Multiple pelvic fractures as detailed above.
4. Fluid-filled structure in left adnexa may represent hydrosalpinx or
adnexal cysts.
|
10217517-RR-9
| 10,217,517 | 23,637,976 |
RR
| 9 |
2130-03-20 05:40:00
|
2130-03-20 06:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with known aortic ulceration, back pain.
TECHNIQUE: AP chest radiograph.
COMPARISON: None.
FINDINGS:
The thoracic aorta is tortuous. Otherwise, the cardiomediastinal silhouettes
are within normal limits. The bilateral hila are unremarkable. There are low
lung volumes. There may be mild atelectasis at the lung bases. There is no
focal lung consolidation. There is no evidence of pulmonary vascular
congestion. There is no pneumothorax or pleural effusion. A hiatus hernia is
noted.
IMPRESSION:
No acute cardiopulmonary process. Hiatus hernia.
|
10217776-RR-5
| 10,217,776 | 20,416,140 |
RR
| 5 |
2153-05-17 14:07:00
|
2153-05-17 15:54:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ with primary hyperparathyroidism// presence of kidney stones?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. The kidneys are
atrophic and the renal cortex is echogenic bilaterally consistent with medical
renal disease.
Right kidney: 8.3 cm. A simple cyst at the upper pole of the right kidney
measures 1.4 x 1.3 x 1.2 cm.
Left kidney: 8.8 cm. A simple cyst at the lower pole of the left kidney
measures 2.6 x 2.0 x 2.3 cm.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Echogenic atrophic kidneys consistent with medical renal disease. There is no
hydronephrosis. No renal stones or suspicious solid masses are visualized.
Small simple cysts are noted bilaterally.
|
10217918-RR-28
| 10,217,918 | 21,084,833 |
RR
| 28 |
2183-08-26 16:08:00
|
2183-08-26 19:06:00
|
EXAM: Right upper quadrant ultrasound.
CLINICAL INFORMATION: ___ male with history of known gallstones, here
with right upper quadrant pain.
COMPARISON: None.
FINDINGS: The liver demonstrates normal homogeneous echotexture without focal
intrahepatic lesion seen. There is no evidence of intrahepatic biliary
dilatation. The gallbladder contains sludge and multiple small stones. No
pericholecystic fluid or gallbladder wall thickening is seen. The sonographic
___ sign was absent. The common bile duct is normal in caliber measuring
0.2 cm in diameter. The main portal vein is patent. The spleen is normal in
size measuring 10.7 cm in length.
IMPRESSION: Gallbladder sludge and stones without biliary dilatation. No
secondary findings to suggest acute cholecystitis.
|
10217918-RR-29
| 10,217,918 | 21,084,833 |
RR
| 29 |
2183-08-28 18:09:00
|
2183-08-29 13:44:00
|
MRCP
INDICATION: Rising bilirubin, cholecystitis, query CBD stones.
COMPARISON: Ultrasound ___.
TECHNIQUE: Multiplanar T1- and T2-weighted imaging were acquired on a 1.5
Tesla magnet including dynamic 3D imaging obtained prior to, during and after
the uneventful intravenous administration of 20 mL of Magnevist. In addition
5 cc of Magnevist and 75 cc of water were administered orally.
FINDINGS:
The imaged lung bases are clear. There is normal hepatic parenchymal signal
intensity. Within segment V of the liver, there is a 12 mm lesion identified
which demonstrates arterial hyperenhancement on the arterial phase of imaging
and becomes isointense to liver on more delayed phases of imaging. It does
not demonstrate a correlate on either T1- or T2-weighted imaging (series 1401,
image 56). Findings are consistent either with a region of focal nodular
hyperplasia or other benign entity within the liver. No additional hepatic
lesions are seen. Sludge and gallstones are noted within the gallbladder
which demonstrates mild gallbladder wall edema, consistent with acute or
subacute cholecystitis. There is no central intrahepatic or extrahepatic
biliary dilatation. The common bile duct tapers normally towards the head of
the pancreas without evidence for choledocholithiasis. There is conventional
hepatic arterial anatomy. The visualized hepatic and portal veins are patent.
Spleen is normal in size. Both adrenal glands and kidneys are unremarkable.
The pancreas is of homogeneous signal intensity and enhances uniformly. There
are no retroperitoneal masses or adenopathy. There is a retroaortic left
renal vein (normal variant; series 1401, image 131). No abnormally dilated or
thickened small or large bowel loop in the visualized upper abdomen. No free
fluid.
Bone marrow signal is normal and no osseous lesions are identified.
IMPRESSION:
1. Gallstones and sludge within the gallbladder with associated mild
gallbladder wall edema and pericholecystic fluid. Overall, findings are
consistent with acute or subacute cholecystitis. No biliary abnormality or
evidence of biliary stone.
This was discussed with Dr. ___ telephone at 9:55 a.m. on ___.
2. 11 mm region of abnormal hyperenhancement noted on arterial phase of
imaging within segment V of the liver consistent either with a region of focal
nodular hyperplasia versus other benign entity within the liver.
|
10217984-RR-19
| 10,217,984 | 20,225,069 |
RR
| 19 |
2132-11-22 16:30:00
|
2132-11-22 17:11:00
|
INDICATION: ___ year old woman with epilepsy, presents with 2 week subacute
cognitive decline. ? paraneoplastic. // eval for evidence of underlying
malignancy
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technqiue.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 479 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:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding. There is a moderate periampullary duodenum diverticulum.
SPLEEN: Normal size, with multiple punctate calcifications consistent with
granulomas.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There are symmetric nephrograms bilaterally. Subcentimeter
hypodensities indicate within the kidneys bilaterally are largely too small to
accurately characterize, though a 9 mm right lower pole hypodensity meets
criteria for a cyst.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colon and rectum are within normal
limits. Appendix contains air, has normal caliber without evidence of fat
stranding.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is mild to moderate
calcium burden in the abdominal aorta and great abdominal arteries. Mild
narrowing of the celiac artery at its origin is noted, along with mild
poststenotic dilation measuring up to 11 mm. Superior mesenteric artery and
inferior mesenteric artery are grossly patent. There is fusiform aneurysmal
dilation of the right common iliac artery, which measures 2 cm. The left
common iliac artery shows fusiform dilation to 1.8 cm, and there is a saccular
aneurysm component measuring 1.8 cm arising from the left common iliac artery
just proximal to the bifurcation with eccentric mural thrombus (5:85).
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: A 1 cm hypodensity, consistent with a cyst, is seen
within the left ovary.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. Diffuse aortic atherosclerotic calcification. Aneurysmal dilation of right
and left common iliac arteries, with fusiform dilation on the right and both
fusiform and saccular aneurysmal dilation on the left.
2. No evidence of malignancy in the abdomen or pelvis.
3. Splenic calcifications consistent with granulomas. Bilateral renal
hypodensities including a right lower pole cyst and additional hypodensities
too small to characterize.
4. 1 cm left ovarian cyst appears homogeneous and according to current
departmental guidelines, does not require specific imaging followup.
5. Please refer to separately dictated chest CT report of same date for
detailed evaluation of thoracic findings.
|
10217984-RR-20
| 10,217,984 | 20,225,069 |
RR
| 20 |
2132-11-22 16:31:00
|
2132-11-22 21:40:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with epilepsy, presents with 2 week subacute
cognitive
decline. ? paraneoplastic.
eval for evidence of underlying malignancy
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. IV contrast was administered. Axial images were interpreted in
conjunction with sagittal and coronal reformats.
COMPARISON: Chest radiograph on ___
FINDINGS:
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph
nodes are not pathologically enlarged.
The great vessels are normal caliber. The heart size is normal. No
pericardial effusion. There is significant calcified atherosclerosis of the
coronary arteries.
The airways are patent to subsegmental levels. There is trace bibasilar
atelectasis. There is minimal scarring at the bilateral apices. No focal
consolidation, pleural effusion, or pneumothorax.
Intra-abdominal findings will be dictated under another clip number.
OSSEOUS STRUCTURES: No suspicious osseous lesions are identified.
IMPRESSION:
No evidence of intrathoracic malignancy. No acute intrathoracic process
identified.
|
10217984-RR-22
| 10,217,984 | 20,225,069 |
RR
| 22 |
2132-11-28 10:11:00
|
2132-11-28 14:11:00
|
EXAMINATION: THYROID U.S.
INDICATION: ___ year old woman with hashimotos encephalopathy. eval thyroid
// eval thyroid in woman with anti-TPO and ___ ab with hashimotos
encephalopathy.
TECHNIQUE: Grey scale ultrasound images of the thyroid were obtained.
COMPARISON: None.
FINDINGS:
The right lobe of the thyroid measures: (transverse) 1.3 x
(anterior-posterior) 1.6 x (craniocaudal) 4.1 cm.
The left lobe of the thyroid measures: (transverse) 1.1 x (anterior-posterior)
1.9 x (craniocaudal) 5.0 cm.
The AP diameter of the isthmus measures 0.2 cm.
The thyroid parenchyma is diffusely heterogeneous and has increased
vascularity on color Doppler imaging. The appearance is consistent with
thyroiditis. Morphologically normal but prominent lymph nodes are
incidentally noted bilaterally in the neck. Note is made that prominent lymph
nodes can be seen in the setting of thyroiditis. No discrete nodules are
present.
IMPRESSION:
Heterogeneous hypervascular thyroid consistent with thyroiditis. No discrete
nodule identified.
|
10217984-RR-23
| 10,217,984 | 20,225,069 |
RR
| 23 |
2132-12-01 08:42:00
|
2132-12-01 11:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new afib // infx, volume overload
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Cardiomegaly is substantial. Tortuous aorta is demonstrated. Lungs are
essentially clear. There is no pleural effusion or pneumothorax. Minimal right
basal atelectasis is noted but no evidence of infection is seen. No pulmonary
edema is present. Dilated ascending aorta is better appreciated on chest CT
from ___.
|
10218060-RR-61
| 10,218,060 | 25,033,900 |
RR
| 61 |
2139-04-26 20:51:00
|
2139-04-26 23:31:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with weakness for some days// ? pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
In comparison with the prior study from ___, re-demonstrated is
extensive fibrotic chronic lung disease with diffuse prominence of the
interstitial markings. Findings are stable to possibly minimally increased on
the left, and underlying infection or pulmonary edema is not excluded. No
pleural effusion is seen. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
Re-demonstrated, extensive, diffuse chronic interstitial lung disease with
possible subtle increase in opacity, particularly on the left, underlying
pulmonary edema or infection are difficult to exclude.
|
10218060-RR-62
| 10,218,060 | 25,033,900 |
RR
| 62 |
2139-04-27 11:45:00
|
2139-04-27 14:26:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: h/o IPF, pulmonary MAC, aspergillosis, LLL mass likely adenoCA,
CAD s/p CABG, who presented to the ___ ED with worsening fatigue and
decreased PO intake c/f worsening infection // Worsening cavitary lesion? New
PNA? Aspiration? Pulmonary edema?
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 32.0 cm; CTDIvol = 7.3 mGy (Body) DLP = 234.1
mGy-cm.
Total DLP (Body) = 234 mGy-cm.
COMPARISON: Compared to chest CT scanning since ___, most recently ___.
FINDINGS:
Supraclavicular and subcentimeter axillary lymph nodes are not pathologically
enlarged there is no soft tissue abnormality in the imaged chest wall
concerning for malignancy. This study is not appropriate for subdiaphragmatic
diagnosis but shows the absence of adrenal mass.
Moderate gaseous distension of the upper and mid esophagus is more pronounced
since ___.
There are no thyroid findings warranting further imaging evaluation.
Atherosclerotic calcification is moderate in head and neck vessels and severe
in all major coronary arteries. Aortic valvular calcification is also severe.
Maximum diameter of the ascending thoracic aorta, 42 mm, is unchanged. Main
pulmonary artery diameter is increased from 31 mm to 35 mm suggesting
increased pulmonary artery pressure, could be acute to to left ventricular
decompensation. Assessment cardiomegaly would require echocardiography.
There is no pericardial effusion. Small layering nonhemorrhagic pleural
effusions, left greater than right are new.
Thoracic lymph nodes:
Prevascular, 14 mm, 4:72, 13 mm in ___.
Right lower paratracheal and right hilar are calcified.
Paraesophageal mediastinal, 17 mm, 15 mm in ___.
Lungs and airways:
The consolidative residual of the previously cavitated right upper lobe lung
lesion, is smaller today than in ___.
Widespread peribronchial infiltration in both lungs, right greater than left,
is more pronounced today, but given the accompanying pleural effusions,
including a fissural component in the major fissure, this may be a function
pulmonary edema.
Severe fibrosing interstitial lung disease is largely responsible for traction
bronchiectasis as well as honeycombing in the right lung. Large discrete
region of ground-glass opacification in the left lower lobe, 44 x 29 mm, 4:149
was 52 x 22 mm in ___ and 46 x 25 mm in ___.
Chest cage:
No pathologic or compression fractures or large destructive bone lesions.
IMPRESSION:
No evidence of new infection since ___ following involution of previous
Aspergillus abscess, right upper lobe. Probable congestive heart failure,
explaining generalized increase in peribronchial radiodensity of the right
lung and new pleural effusions, and new increase diameter, main pulmonary
artery.
Severe pulmonary fibrosis, right lung greater than left.
|
10218060-RR-63
| 10,218,060 | 25,033,900 |
RR
| 63 |
2139-04-27 11:45:00
|
2139-04-27 16:57:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: Mr. ___ is an ___ w/ h/o IPF, pulmonary MAC, aspergillosis,
LLL mass likely adenoCA, CAD s/p CABG, presents with altered mental status and
failure to thrive. Rule out intracranial causes of altered mental status.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Noncontrast CT head ___ and noncontrast CT head ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territory infarct. There is prominence of the
ventricles and sulci suggestive of involutional changes. Periventricular and
subcortical white matter hypodensities are likely sequelae of chronic small
vessel disease.
There is dense atherosclerotic vascular calcifications in the internal carotid
arteries, left greater than right as well as in the right vertebral artery
which were visualized in a prior study in ___.
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. No evidence of acute intracranial hemorrhage, midline shift, mass effect,
or acute large vascular territory infarct.
2. Dense atherosclerotic disease in the carotid siphons, unchanged from prior
exams.
|
10218060-RR-64
| 10,218,060 | 25,033,900 |
RR
| 64 |
2139-04-28 10:02:00
|
2139-04-28 16:54:00
|
EXAMINATION: VIDEO OROPHARYNGEAL SWALLOW
INDICATION: ___ w/ h/o IPF, pulmonary MAC, aspergillosis, LLL mass likely
adenoCA, CAD s/p CABG, who presented to the ___ ED with lethargy and failure
to thrive. Video oropharyngeal swallow study performed to evaluate for any
mechanical obstacle for swallowing.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 4:51 min.
Skin dose: 67 mGy
DAP: 667 uGym2
COMPARISON: None.
FINDINGS:
Mild oropharyngeal dysphagia with no aspiration. Delayed swallow initiation.
Penetration with thin/nectar thick liquids before and during the swallow.
IMPRESSION:
Mild oropharyngeal dysphagia with no aspiration. Penetration with thin/nectar
thick liquids.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10218168-RR-59
| 10,218,168 | 28,349,018 |
RR
| 59 |
2139-06-22 17:46:00
|
2139-06-22 19:02:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with h/o DVT on Coumadin and recurrent ___ cellulitis who
presents with worsening RLE pain, swelling, and redness//
TECHNIQUE: Grayscale and Doppler evaluation of the right common femoral,
superficial femoral, and popliteal veins was performed.
COMPARISON: None.
FINDINGS:
Limited evaluation due to large body habitus. There are symmetric waveforms
comparing right and left common femoral vein with appropriate response to
Valsalva maneuver. There is compressibility, blood flow and response to
augmentation within the right common femoral, superficial femoral, popliteal
veins. Calf veins could not be assessed. No ___ cyst is seen.
IMPRESSION:
Limited exam without definite signs of right leg DVT.
|
10218168-RR-60
| 10,218,168 | 28,349,018 |
RR
| 60 |
2139-06-23 09:23:00
|
2139-06-23 09:46:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: ___ w/Hx of DVT on Coumadin, Stage 3 CKD, HTN, HLD, IBS, EIN, and
cholelithiasis, and recurrent ___ cellulitis who presents with worsening RLE
pain, redness, and swelling in the setting of PO Abx.// pleural effusions,
pulm edema, ?CHF
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
There is mild central pulmonary vascular engorgement without overt pulmonary
edema. No focal consolidation or pleural effusion is seen. There is no
evidence of pneumothorax. The cardiac silhouette is mildly enlarged.
Mediastinal contours are unremarkable.
IMPRESSION:
Mild central pulmonary vascular engorgement without overt pulmonary edema. No
pleural effusion.
|
10218242-RR-5
| 10,218,242 | 26,440,379 |
RR
| 5 |
2153-01-06 23:47:00
|
2153-01-06 15:46:00
|
EXAMINATION: MRCP
INDICATION: ___ year old man with hx of CAD presents with one day hx of
abdominal pain, found to have obstructive jaundice on labs and US, CBD on
outside hospital; records 13 mm, sludge within the gallbladder. Pulsatile flow
within the portal vein// evaluate the biliary tree for obstruction
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 9 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Outside ultrasound from ___.
FINDINGS:
Lower Thorax: No pleural effusion.
Liver: Mild hepatic steatosis. Arterially enhancing focus measuring 7 mm
(Image 27, series 1401), involving segment 7, indeterminate, may reflect a
vascular shunt.
Biliary: No cholelithiasis. Gallbladder-wall edema, without adjacent
hyperenhancement to suggest acute process. Mildly prominent CBD measuring up
to 1 cm, with a focus of filling defect noted along the distal CBD seen on
multiple sequences, with possible movement between sequences (image 28, series
4) (image 34, series 5), this may represent choledocholithiasis, measuring up
to 5 mm. Mildly prominent central hepatic ducts, with minimal periportal
edema.
Pancreas: Symmetric enhancement of the pancreas. No pancreatic ductal
dilatation.
Spleen: No splenomegaly.
Adrenal Glands: Symmetric bilaterally.
Kidneys: No hydronephrosis.
Gastrointestinal Tract: No abnormally dilated loops of bowel. Colonic
diverticulosis.
Lymph Nodes: No lymphadenopathy.
Vasculature: Hepatic and portal veins are patent. Normal caliber abdominal
aorta.
Osseous and Soft Tissue Structures: No destructive osseous lesions.
Discussion degenerative changes of the lower lumbar spine.
IMPRESSION:
1. Subcentimeter focal filling defect along the distal CBD, may represent
small choledocholithiasis. Prominent CBD measuring up to 1 cm. Mildly
prominent central hepatic ducts with minimal periportal edema.
2. Hepatic steatosis. Patent hepatic vasculature.
3. Other findings as detailed above.
|
10218444-RR-38
| 10,218,444 | 20,818,668 |
RR
| 38 |
2157-04-13 09:32:00
|
2157-04-13 10:29:00
|
INDICATION: History: ___ with abdominal pain
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 286 mGy-cm.
COMPARISON: PET-CT ___. MR pelvis ___. CT abdomen
pelvis ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN: The liver enhances normally. A few sub-centimeter hypodensities in
the liver are unchanged since ___ and may reflect biliary hamartomas
or small cysts (2:17, 23, 13). The gallbladder is unremarkable. 7 mm
hypodense focus in the head of the pancreas (02:25) is unchanged. The spleen
and adrenal glands are normal. The kidneys enhance symmetrically without
hydronephrosis. 6 mm hypodense focus in the interpolar region of the left
kidney (02:24) is unchanged and is most likely a simple cyst.
The stomach is distended with ingested material and enteric contrast. There
is a diverting colostomy in the left lower quadrant (02:46). The rectal
stump contains a small amount of fluid (___) and shows mild wall
thickening similar to prior PET-CT. The colon is otherwise unremarkable.
There is a small amount of ascites. There is no free air. No mesenteric or
retroperitoneal mass is detected on this study.
There are multiple loops of dilated small bowel measuring up to 2.9 cm
containing fluid and demonstrating air-fluid levels. There are two adjacent
sites of transition in the mid upper pelvis (601b:20 and 22) with dilated
proximal small bowel, a closed-loop in the mid pelvis, and collapsed bowel
distally (601b:23, 22). Enhancement of the small bowel mucosa appears normal
throughout.
Abdominal aorta is normal in caliber with mild atherosclerotic disease
demonstrated.
PELVIS: There are postoperative changes in the pelvis following cystic mass
resection. The urinary bladder appears normal. There is no evidence of
pelvic wall or inguinal lymphadenopathy. Pelvic venous congestion is again
noted. Enhancing 3.3 x 2.8 cm uterine fibroid is re- demonstrated.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Closed loop small-bowel obstruction with 2 sites of transition in the upper
mid pelvis with mild ascites. No specific evidence of ischemia or
perforation. Surgical consultation is recommended.
2. Retained fluid and mild wall thickening of the rectal stump is similar to
prior FDG PET and may reflect postradiation change.
3. Multiple chronic findings including small hypodensities in the liver,
pancreas and left kidney are unchanged. Also, pelvic venous congestion and
3.3 cm uterine fibroid.
|
10218965-RR-18
| 10,218,965 | 29,855,994 |
RR
| 18 |
2132-11-26 20:54:00
|
2132-11-26 21:36:00
|
INDICATION: ___ with cat bite//cellulitis// osteo
COMPARISON: No priors
FINDINGS:
AP, lateral and oblique views of the right hand and AP and lateral views of
the right forearm provided. An overlying fiberglass splint is noted. There is
no fracture or dislocation. No definite radiopaque foreign body is seen. No
soft tissue gas. Degenerative changes are noted at the base of thumb
involving the first carpometacarpal and triscaphe joints with mild loss of
joint space and flattened joint surfaces.
IMPRESSION:
As above.
|
10218965-RR-19
| 10,218,965 | 29,855,994 |
RR
| 19 |
2132-11-26 23:42:00
|
2132-11-27 00:12:00
|
EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old woman with cat bite. Swelling over the radial
styloid and thenar eminence. Please evaluate for drainable fluid collections
in those areas. Plastic surgery requested as part of planning for bedside
incision and drainage versus OR// Fluid collection?
TECHNIQUE: Grayscale and color ultrasound images were obtained of the
superficial tissues of the right wrist and hand
COMPARISON: Right forearm and wrist radiographs from ___ at 20:59.
FINDINGS:
No drainable fluid collection involving the thenar eminence or dorsum of the
right hand. Subcutaneous soft tissue edema. No retained foreign object
visualized.
IMPRESSION:
1. No drainable fluid collection. Subcutaneous soft tissue edema.
2. No retained foreign object visualized.
|
10219100-RR-48
| 10,219,100 | 24,462,171 |
RR
| 48 |
2167-04-13 09:37:00
|
2167-04-13 12:18:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with new ppm placed, please confirm placement//
post-ppm placement
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph.
FINDINGS:
A left chest wall pacemaker has been placed in the interim. The leads end
within the right atrium and right ventricle. The cardiomediastinal silhouette
remains prominent. There is no pulmonary edema. There is no parenchymal
consolidation or pleural effusion. No pneumothorax.
IMPRESSION:
1. Left chest wall pacemaker with leads in the right atrium and right
ventricle.
2. Cardiomegaly. No pulmonary edema. No pneumothorax.
|
10219419-RR-11
| 10,219,419 | 25,680,789 |
RR
| 11 |
2164-10-14 13:15:00
|
2164-10-14 14:27:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ man with history of ampullary cancer, obstructive
jaundice status post PTB deep placement x3, now with persistent hiccups.
TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed with IV
contrast. Multiplanar reformations were provided. No oral contrast
administered.
DOSE: Total DLP (Body) = 749 mGy-cm.
COMPARISON: MRCP ___, PTBD ___, CT chest from ___
and CT abdomen from ___.
FINDINGS:
Lung Bases: Subsegmental lower lobe atelectasis is noted. No pleural or
pericardial effusion. The imaged portion of the heart is unremarkable. There
is thickening of the distal esophagus. A prominent subcarinal lymph nodes is
partially seen measuring up to 12 mm in short axis. Mild coronary artery
calcification an aortic valve calcification is noted.
Abdomen: There has been recent placement of 3 PTB drains. A left anterior
approach drain is coiled in the duodenum and terminates in segment 2 of the
duodenum. 2 right hepatic access PTBDs travel together into the fourth
segment of the duodenum. There is persistent dilation of the intrahepatic
biliary tree mostly involving the left lobe.
There is marked gastric distension. An abrupt point of transition is seen on
series 2, image 30 and series 602b, image 38. Distal to this transition
point, the duodenum is completely decompressed, containing only the 3 PTB
drains. Main portal vein appears patent. The pancreas appears somewhat
atrophic but otherwise unremarkable. Reported ampullary mass is not clearly
identified. Gallbladder is surgically absent. Spleen is normal. Adrenal
glands are normal. The kidneys enhance symmetrically and excrete contrast
promptly. Multiple simple renal cysts are seen the largest on the right
measuring up to 12.7 x 13.6 cm arising from the lower pole. No signs of
pyelonephritis or hydronephrosis.
Abdominal aorta is moderately calcified with tortuous iliac branches. No
retroperitoneal adenopathy is seen. No adenopathy in the upper abdomen or
porta hepatis.
Pelvis: Loops of small and large bowel demonstrate no signs of ileus or
obstruction. The appendix is not seen though there are no secondary signs of
appendicitis. The colon contains a mild fecal load without wall thickening or
signs of acute inflammation. The urinary bladder is decompressed. No free
pelvic fluid.
Bones: No worrisome lytic or blastic osseous lesion is seen.
IMPRESSION:
1. Marked gastric distention with apparent high-grade obstruction at the
gastric outlet. NG tube decompression is advised.
2. PTBD x3 in place as detailed. Persistent intrahepatic biliary ductal
dilation as on prior, most notable in the left lobe.
3. Reported ampullary mass not seen.
4. Distal esophageal thickening, correlate for esophagitis.
5. Renal cysts, stable from prior.
|
10219419-RR-12
| 10,219,419 | 25,680,789 |
RR
| 12 |
2164-10-14 15:58:00
|
2164-10-14 16:19:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ Klatskin's tumor s/p Ant,Post,L PTBDs (___) currently sch
for exp laparoscopy vs possible hepatic lobectomy vs extrahepatic CBD
resection for ___ p/w nausea and vomiting. CT demonstrates post-gastric
obstruction. // NG tube is in stomach?
COMPARISON: Same-day CT abdomen pelvis.
FINDINGS:
AP portable upright view of the chest. There has been interval placement of
a nasogastric tube which is seen descending into the upper abdomen though the
tip is not clearly visualized. There is mild left basal atelectasis.
Multiple PTBD is noted projecting over the upper abdomen.
IMPRESSION:
NG tube descends into the upper abdomen.
|
10219419-RR-13
| 10,219,419 | 25,680,789 |
RR
| 13 |
2164-10-21 18:07:00
|
2164-10-21 21:50:00
|
INDICATION: ___ year old man with probable Klatskin tumor s/p trilateral
stenting. // trilateral metallic stenting, biliary biopsy / brushings
COMPARISON: Multiple prior PTBDs, most recently of ___,
and ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 3 mg of midazolam throughout the total intra-service
time of 53 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site
MEDICATIONS: 1 g ceftriaxone.
CONTRAST: 30 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 12 min, 33 mGy
PROCEDURE:
1. Limited abdominal ultrasound.
2. Right posterior pull-back sheath cholangiogram.
3. Brushings and biopsy via right posterior ducts.
4. Exchange for new right posterior PTBD catheter.
5. Left pull-back sheath cholangiogram.
6. Brushings and biopsy via left ducts.
7. Exchange for new left PTBD catheter.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right and left abdomen were prepped and draped in the usual
sterile fashion.
Limited abdominal ultrasound of the liver demonstrating no discrete nodule
suitable for percutaneous US-guided for biopsy.
Initial scout images demonstrated trilateral internal external biliary drains
in appropriate position. Following the subcutaneous injection of 1% lidocaine
and instillation of lidocaine jelly into the skin site, the right posterior
catheter was cut and ___ wire was advanced through the catheter into the
duodenum. A sheath was inserted over the ___ wire and a safety wire was
advanced. A sheath cholangiogram was performed through the right posterior
ducts, with findings as detailed below. One set of biliary brushings were
obtained and prepared in Cytolyte. Three radial jaw forceps biopsy samples
were obtained from the area of biliary stricture. Visual inspection confirmed
sampling of solid tissue. A new 10 ___ internal external PTBD was deployed
in the right posterior biliary access. Position was confirmed by hand
injection of contrast.
The left catheter was cut and ___ wire was advanced through the catheter
into the duodenum. A sheath was inserted over the ___ wire and a safety
wire was advanced. A sheath cholangiogram was performed through the left
ducts, with findings as detailed below. One set of biliary brushings were
obtained and prepared in Cytolyte. Two radial jaw forceps biopsy samples were
obtained from the area of biliary stricture. Visual inspection confirmed
sampling of solid tissue. A new 10 ___ internal external PTBD was deployed
in the left biliary access. Position was confirmed by hand injection of
contrast.
All needles, wires, and sheaths were removed. All catheters were left capped.
Sterile dressings were applied. The patient tolerated the procedure well and
there were no immediate post-procedure complications.
FINDINGS:
1. Trilateral percutaneous transhepatic biliary drainage catheters.
2. Abdominal ultrasound demonstrating no discrete nodule for biopsy.
3. Right posterior access sheath cholangiogram demonstrating moderate
intrahepatic bile duct dilatation with complete occlusion of the right
posterior system at the hilum with no contrast flow on to the CBD. The CBD
itself appears smooth and patent.
4. Left access sheath cholangiogram demonstrating moderate intrahepatic bile
duct dilatation with narrowed but patent left ducts with flow seen to the CBD.
5. Successful exchange of 10 ___ right posterior and left percutaneous
transhepatic biliary drainage catheters with new 10 ___ catheters.
IMPRESSION:
1. Successful brushings and biopsies via right posterior and left biliary
ductal accesses.
2. Successful exchange of existing right posterior and left percutaneous
transhepatic biliary drainage catheters with new ___ Fr catheters. Right
anterior PTBD left in stable position.
|
10219419-RR-14
| 10,219,419 | 25,680,789 |
RR
| 14 |
2164-10-22 00:10:00
|
2164-10-22 11:46:00
|
INDICATION: ___ man with nausea and vomiting and known gastric outlet
obstruction. Evaluate for ileus versus gastric obstruction.
TECHNIQUE: Frontal supine abdominal radiographs were obtained.
COMPARISON: CT from ___.
FINDINGS:
3 internal-external biliary drain catheters are noted. There is a nonspecific
bowel gas pattern without evidence of obstruction or dilation of the stomach.
High-density material projecting over the cecum is likely from recent
cholangiogram from ___. There are no signs of pneumatosis or portal
venous gas on this supine radiograph.
IMPRESSION:
Non-specific non-obstructive bowel gas pattern.
|
10219419-RR-15
| 10,219,419 | 25,680,789 |
RR
| 15 |
2164-10-28 16:42:00
|
2164-10-28 23:36:00
|
EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ man with a Klatskin's tumor status post anterior,
posterior, and left PTBDs also status post diagnostic laparoscopy, assess
extent of abdominal the distension (air bubble).
TECHNIQUE: Portable radiographs of the abdomen.
COMPARISON: Abdominal radiographs ___.
FINDINGS:
Again seen are 3 internal-external biliary catheters in which are unchanged
location and orientation in comparison to the ___ radiograph. The
stomach is moderately distended by gas and fluid. Multiple colonic air-fluid
levels are noted, however there is no evidence of abnormally dilated large or
small bowel, and rectal air is noted. There is evidence of free
intraperitoneal air no concerning soft tissue calcifications are seen.
IMPRESSION:
1. Moderately distended stomach with gas and fluid. No small or large bowel
dilation.
2. No free intraperitoneal air.
3. Unchanged orientation of three biliary catheters.
|
10219419-RR-16
| 10,219,419 | 25,680,789 |
RR
| 16 |
2164-11-01 14:12:00
|
2164-11-01 15:44:00
|
EXAMINATION: US INTRA-OP LIVER ___ MINS
INDICATION: ___ year old man with cholangiocarcinoma scheduled for left
lobectomy, cholecystectomy, extra bile duct excision // Please use US during
OR for assistance
TECHNIQUE: Open intraoperative ultrasound was performed of the liver and
common duct, using 3 different high-frequency probes.
COMPARISON: MR ___.
FINDINGS:
Scans of the liver were performed using a side-fire T- probe and a biplane
probe imaging at 10 megahertz frequency. Dilated bile ducts can be seen in
both the left and right lobe extending towards the common hepatic duct
bifurcation. Intra biliary stents are seen in both the right and left
systems. Despite extensive efforts and multiple different acoustic windows
and probe positions, a target a bubble or mass could not be identified within
the liver.
Attention was then directed to the confluence and common hepatic duct where
eccentric wall thickening was identified around the to intra biliary stents,
most consistent with infiltrating tumor. Extensive attempts were made to
findings safe to biopsy this eccentric wall thickening to obtain a tissue
diagnosis. A third hockey stick probe was also to utilize, but I safe
posterior of cooperation ultrasound-guided biopsy could not be identified.
IMPRESSION:
Eccentric show thickening of the common hepatic duct just at the distal and
near the bifurcation compatible with a cholangiocarcinoma. Because of the
typical location, ultrasound-guided biopsies could not be performed. .
|
10219419-RR-17
| 10,219,419 | 25,680,789 |
RR
| 17 |
2164-11-06 20:20:00
|
2164-11-07 11:00:00
|
INDICATION: ___ year old man with gastric outlet obstruction from an ulcer,
s/p open GJ. // evaluate for ileus, obstruction
TECHNIQUE: Frontal abdominal radiographs were obtained.
COMPARISON: Abdominal radiograph dated ___.
FINDINGS:
The lung bases appear clear bilaterally.
There are 3 internal-external percutaneous transhepatic biliary catheters
which appear unchanged in location and orientation in comparison to the prior
abdominal radiograph. There are multiple small midline abdominal surgical
staples and 3 linear surgical clips noted in the right upper quadrant.
The bowel gas pattern is unremarkable with gas seen in nondistended loops of
large and small bowel, which is an improvement in comparison to the prior
abdominal radiograph. There is no evidence of ileus or obstruction. There is
no evidence of intraperitoneal free air. The bony structures are unremarkable.
IMPRESSION:
Non-obstructive bowel gas pattern.
|
10219419-RR-18
| 10,219,419 | 25,680,789 |
RR
| 18 |
2164-11-07 03:35:00
|
2164-11-07 10:07:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p ex-lap with temp 102.2 // evsl source of
infx
COMPARISON: ___.
IMPRESSION:
As compared to the previous image, the nasogastric tube was removed. The
abdominal drains are in unchanged position. Mild elevation of the right
hemidiaphragm. Resolution of a pre-existing retrocardiac atelectasis. Normal
size of the heart. Mild elongation of the descending aorta. No pneumonia, no
pleural effusions. No pulmonary edema.
|
10219457-RR-10
| 10,219,457 | 22,278,453 |
RR
| 10 |
2186-03-31 18:07:00
|
2186-03-31 22:23:00
|
INDICATION: Hypotension. Known abdominal aortic aneurysm.
TECHNIQUE: Multidetector helical CT scan of the chest, abdomen and pelvis was
obtained prior to the administration of contrast. Post-contrast imaging of
the abdomen and pelvis was obtained after the administration of 100 ml IV
Omnipaque contrast. Coronal and sagittal reformations were prepared. 3D
reformations of the aorta were also generated on a separated workstation.
COMPARISON: None available. Correlation with abdominal aortic ultrasound of
the same date obtained at ___.
FINDINGS:
CTA: There is a ruptured abdominal aortic aneurysm measuring up to 7.3 x 6.9
cm in transverse ___ (3:82) by approximately 13.5 cm in craniocaudal
dimension (601B:34). The aneurysm begins at the level of the renal arteries
and extends to approximately 8 mm just proximal to the aorto-biliac
bifurcation. The iliac arteries are not aneurysmal dilated. The rupture of
the aorta appears in the anterolateral wall with active contrast extravasation
(3:82). There is extensive retroperitoneal hematoma. Superior to the level
of the renal arteries, there is a focal posterior linear filling defect
suggestive of a dissection flap at the level of the SMA.
Atherosclerotic disease is present throughout the aorta and iliac arteries.
The celiac artery and SMA appear patent. The right renal artery is patent.
There are two left renal arteries, patent. The ___ is not definitively
visualized.
CHEST: There is a 3-mm right upper lobe pulmonary nodule (2:21). There are
mild emphysematous changes with upper lobe predominance. No pleural effusion
is seen. The intrathoracic aorta demonstrates atherosclerotic calcifications,
however, is not aneurysmally dilated. There are coronary artery
calcifications. No pericardial effusion is seen.
There is a right internal jugular venous catheter with tip in the SVC. No
pathologically enlarged lymph nodes are seen. No evidence of endobronchial
lesion is identified.
ABDOMEN: Multiple hepatic hypodensities are seen, the largest of which are
simple cysts. Some subcentimeter hypodensities are too small to characterize.
There is cholelithiasis. The spleen, pancreas, adrenal glands, and right
kidney appear grossly unremarkable. The left kidney contains a hypodensity,
incompletely characterized (3:54). Loops of small and large bowel are normal
in size and caliber. No abdominal free air or lymphadenopathy is seen.
Extensive retroperitoneal hemorrhage is present as noted above.
PELVIS: The uterus contains a large calcified fibroid. Distal loops of large
bowel and rectum are normal in size and caliber with diverticulosis and no
evidence of diverticulitis. The bladder is collapsed around a Foley catheter.
No free air or lymphadenopathy is identified. There is fluid tracking
predominantly within the retroperitoneum, consistent with hemorrhage.
There are degenerative changes of the lumbar spine as well as multilevel
bridging anterior osteophytes of the thoracic spine. No concerning osseous
lesion is seen.
IMPRESSION:
1. Ruptured abdominal aortic aneurysm extending from the level of the renal
arteries (two left renal arteries, one right) to approximately 8 mm proximal
to the aortic bifurcation. The iliac arteries are not involved. Active
extravasation is seen from the anterolateral wall. Extensive retroperitoneal
hemorrhage.
2. Possible focal dissection flap seen superior to the abdominal aortic
aneurysm could represent focal dissection at the level of the SMA.
3. Mild emphysema.
4. 3 mm right upper lobe pulmonary nodule. Followup examination in one year
is recommended.
5. Cholelithiasis.
6. Diverticulosis.
|
10220107-RR-36
| 10,220,107 | 27,514,460 |
RR
| 36 |
2203-07-25 11:52:00
|
2203-07-25 12:26:00
|
HISTORY: Aphasia and right visual change.
COMPARISON: No prior neuroimaging at this institution.
FINDINGS:
In there is a diffuse hypodensity within the territory of the left PCA artery.
Gray-white matter differentiation is lost in the medial occipital lobe along
the left tentorium (602:72). There is no hemorrhage mass or shift of the
midline structures. A small cavum septum pellucidum is incidentally noted.
The visualized paranasal sinuses are normally pneumatized and aerated. Bones
and extracranial soft tissues are unremarkable.
IMPRESSION:
Hypodensity and loss of gray-white matter differentiation in the left PCA
territory may represent infarction of undetermined age. MRI is more sensitive
for acute ischemia.
|
10220107-RR-37
| 10,220,107 | 27,514,460 |
RR
| 37 |
2203-07-25 12:16:00
|
2203-07-25 12:58:00
|
HISTORY: Weakness.
COMPARISON: ___ through ___.
FINDINGS:
Two PA and 1 lateral chest radiograph were obtained. A right lobe
perivascular ground-glass opacity partially clears on the repeat PA view. The
small left pleural effusion has slightly increased since ___. There
is a small effusion in the right minor fissure. Left lower lobe atelectasis
and bilateral horizontal plate-like atelectasis are unchanged. Median
sternotomy wires are intact.
IMPRESSION:
1. Perivascular ground-glass opacity compatible with atelectasis.
2. Small but increased left pleural effusion.
|
10220107-RR-38
| 10,220,107 | 27,514,460 |
RR
| 38 |
2203-07-25 17:11:00
|
2203-07-26 11:15:00
|
CTA HEAD WITHOUT AND WITH CONTRAST ___
HISTORY: Vision changes. Question blood flow compromise.
Contiguous axial images were obtained through the brain before contrast
administration. Subsequently, CTA was performed during infusion of 70 ml of
Omnipaque intravenous contrast. CTA images were processed on a separate
workstation.
Comparison to a head CT of ___.
FINDINGS: The pre-contrast images again demonstrate hypodensity in the
distribution of the left posterior cerebral artery, involving the posterior
temporal and a small portion of the occipital lobe. This is compatible with a
subacute infarction. There is no evidence of hemorrhage. There is no
evidence of infarction elsewhere. No masses are identified.
CTA imaging of the neck demonstrates no significant abnormalities. There is
no evidence of stenosis involving the internal carotid arteries by NASCET
criteria. The origins of the great vessels appear normal. The vertebral
arteries appear normal.
Intracranial CTA demonstrates no evidence of arterial stenosis or occlusion.
CONCLUSION: Left medial temporal lobe hypodensity most likely subacute
infarction. No evidence of hemorrhage. Incidentally noted are bilateral
pleural effusions and left lower lobe atelectasis.
|
10220107-RR-39
| 10,220,107 | 27,514,460 |
RR
| 39 |
2203-07-26 00:35:00
|
2203-07-26 15:48:00
|
MR HEAD WITHOUT CONTRAST, ___
HISTORY: Left posterior cerebral artery infarction.
Sagittal short TR, short TE spin echo imaging was performed followed by axial
imaging with ___ TR, long TE fast spin echo, gradient echo, and
diffusion technique. No contrast was administered. Comparison to a head CT
and CTA of ___.
FINDINGS: There is an extensive area of slow diffusion corresponding to, but
larger than, the area of hypodensity demonstrated on the CT scans. A small
focus of slow diffusion also involves the left occipital pole. These findings
are consistent with the impression of acute-subacute infarction. There is no
evidence of hemorrhage. Images of the remainder of the brain demonstrate
periventricular and subcortical white matter hyperintensities on ___ that
suggest chronic small vessel ischemia. There are no other findings to suggest
recent infarction. Incidentally noted is a mucous retention cyst in the right
maxillary sinus.
CONCLUSION: Findings consistent with left posterior cerebral artery
infarction. No evidence of hemorrhage.
|
10220107-RR-43
| 10,220,107 | 27,122,498 |
RR
| 43 |
2205-01-24 12:33:00
|
2205-01-24 14:11:00
|
EXAMINATION: CHEST RADIOGRAPH ___
INDICATION: ___ year old man with post ERCP bleed // Question of aspiration
during EGD
TECHNIQUE: Portable radiograph of the chest.
COMPARISON: Comparison is made to chest radiographs from ___. The
study is read in conjunction with abdomen CT from ___.
FINDINGS:
The lungs are well-expanded, with a linear area of atelectasis in the left
midlung, similar in appearance compared to the prior chest radiograph. Median
sternotomy wires are again noted, along with mediastinal clips, in unchanged
position. A moderate hiatal hernia is present. The cardio mediastinal
silhouette is stable.
There is no pneumothorax, pleural effusion, pulmonary edema, or focal airspace
consolidation concerning for aspiration or pneumonia.
IMPRESSION:
No acute cardiopulmonary pathology. Moderate hiatal hernia.
|
10220107-RR-44
| 10,220,107 | 27,122,498 |
RR
| 44 |
2205-01-25 18:48:00
|
2205-01-25 19:53:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with newly diagnosed pancreatic ca. Please
evaluate for. Evaluate for metastases.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agentand reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images.
DOSE: DLP: 716.0 mGy-cmfor the entire examination of the torso.
COMPARISON: Comparison is made to chest radiograph from ___.
FINDINGS:
MEDIASTINUM: The thyroid is normal. There is no supraclavicular, axillary,
mediastinal, or hilar lymphadenopathy. The aorta and pulmonary arteries are
normal in size. The heart size is top-normal normal in size and there is no
pericardial effusion. The patient is status post median sternotomy and CABG,
with multiple vascular clips in place, and dense atherosclerotic
calcifications of the native coronary arteries. A large hiatal hernia is
present (4:182), along with mild thickening of the upper esophagus, at the
level of the aortic arch (4:77).
PLEURA: There is no pneumothorax. There is no pleural effusion.
LUNGS: The airways are patent. No concerning pulmonary nodules or masses are
identified. Subpleural atelectasis is noted in the bilateral lung bases and
linear atelectasis in the lingula. Small areas of subpleural atelectasis are
also noted along the right middle lobe (04:154). Minimal bronchiectasis is
present in the lung bases.
BONES: A tiny sclerotic focus in the left scapula (4:102), and a lucent area
in the posterior tenth rib, with sclerotic margin (04: 178) are likely benign.
No lesion concerning for malignancy is identified in the chest cage.
UPPER ABDOMEN: Although the study is not designed for evaluation of
subdiaphragmatic structures, a metal common bile duct stent is in place
adjacent to a large hypodense pancreatic head mass (4:247), with associated
pneumobilia and air within the fundus of the gallbladder, along with multiple
hepatic hypodensities. Other findings within the abdomen and pelvis are better
characterized on separately reported CT of the abdomen and pelvis from ___.
IMPRESSION:
1. No evidence of intrathoracic malignancy.
2. Large hiatal hernia.
3. Minimal bilateral lower lobe bronchiectasis.
|
10220150-RR-16
| 10,220,150 | 21,122,220 |
RR
| 16 |
2131-04-29 10:32:00
|
2131-04-29 10:47:00
|
EXAMINATION: CTA HEAD AND NECK WITH PERFUSION PQ149 CT HEADNECK
INDICATION: Suspected stroke with acute neurological deficit.// Please
exclude ICH, signs of early ischemic stroke, large vessel occlusion, or other
vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 19.2 s, 8.0 cm; CTDIvol = 314.2 mGy (Head) DLP =
2,513.8 mGy-cm.
3) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 38.1 mGy (Head) DLP =
19.1 mGy-cm.
4) Spiral Acquisition 4.9 s, 38.7 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,236.1 mGy-cm.
Total DLP (Head) = 4,572 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction,hemorrhage,edema,ormass. The ventricles
and sulci are normal in size and configuration.
There is complete opacification of the left mastoid air cells. The right
mastoid air cells, bilateral middle ear cavities, and paranasal sinuses are
clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
otherwise appear normal without stenosis, occlusion, or aneurysm formation.
The dural venous sinuses are patent.
CTA NECK:
The carotidandvertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
CT perfusion:
CBF <30% volume: 0 mL
Tmax>6.0s volume: 0 mL
Mismatch volume: 0 mL
OTHER:
The visualized portion of the lungs are clear. Changes of thyroidectomy,
including multiple surgical clips about the expected region of the bilateral
thyroid lobes, are seen. There is no lymphadenopathy by CT size criteria.
IMPRESSION:
1. No evidence of infarction or hemorrhage.
2. Normal CTA
|
10220150-RR-17
| 10,220,150 | 21,122,220 |
RR
| 17 |
2131-04-29 11:25:00
|
2131-04-29 13:34:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with shortness of breath, code stroke// Shortness of breath
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Lungs are clear. There is no
focal consolidation, effusion, or pneumothorax. There are no signs of
congestion or edema. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. No free air below the right hemidiaphragm is
seen.
IMPRESSION:
No acute intrathoracic process.
|
10220150-RR-19
| 10,220,150 | 21,122,220 |
RR
| 19 |
2131-04-30 10:29:00
|
2131-04-30 12:25:00
|
INDICATION: ___ year old woman with history of lupus, factor V ___, who
presents with acute onset face and right arm sensory changes. Evaluate for
stroke vs DVST (please do MPRAGE sequence - did not order contrast due to
patient's acute kidney injury.)
TECHNIQUE: 3 dimensional phase contrast MRV was performed through the brain.
Three dimensional maximum intensity projection and segmented images were
generated.
Sagittal T1 weighted and axial T2 weighted, FLAIR, gradient echo, and
diffusion-weighted images of the brain were obtained.
This report is based on interpretation of all of these images.
COMPARISON: CTA head and neck ___.
FINDINGS:
MR BRAIN:
There is no evidence of acute infarction, intracranial blood products, edema
or mass effect. Scattered punctate foci of T2/FLAIR hyperintensity in the
periventricular and subcortical white matter of the cerebral hemispheres are
nonspecific but may be secondary to the patient's lupus. Ventricles, sulci,
and basal cisterns are normal in size.
Complete opacification of the left mastoid air cells is again demonstrated.
MRV BRAIN:
The dural venous sinuses are better assessed on the preceding head CTA than on
the present noncontrast exam, demonstrating patency. On the present exam,
expected flow is seen in the superior sagittal, inferior sagittal, transverse
and sigmoid sinuses, and in the included upper internal jugular veins.
IMPRESSION:
1. No evidence for an acute infarction or other acute intracranial
abnormalities.
2. No evidence for dural venous sinus thrombosis on noncontrast MRV. Dural
venous sinuses were better assessed on the preceding head CTA, demonstrating
patency.
3. Complete opacification of the left mastoid air cells is again demonstrated.
|
10220335-RR-7
| 10,220,335 | 21,739,872 |
RR
| 7 |
2143-11-01 00:18:00
|
2143-11-01 02:53:00
|
INDICATION: ___ female with right lower quadrant abdominal pain.
Question appendicitis.
COMPARISON: No relevant comparisons available.
TECHNIQUE: MDCT images were acquired through the abdomen and pelvis with IV
and oral contrast. Multiplanar reformations were obtained and reviewed.
FINDINGS:
The partially imaged lungs are clear. The partially imaged heart is
unremarkable.
CT OF THE ABDOMEN WITH IV CONTRAST:
The liver, spleen, both adrenals, both kidneys, pancreas and gallbladder are
unremarkable. No abdominal, retroperitoneal or mesenteric lymphadenopathy per
CT size criteria is present. No abdominal free fluid or free air is present.
The small bowel loops are unremarkable. There is discrete pneumatosis within
the mid ascending colonic wall with mild thickening of the adjacent
lateroconal fascia.
Most of the appendix is normal in caliber, filled with contrast and air.
However, the tip of the appendix is hyperenhancing with minimal adjacent
stranding (2:61). No portal or mesenteric venous gas, abdominal or
retroperitoneal free air or abdominal free fluid is present.
CT OF THE ABDOMEN WITH IV AND ORAL CONTRAST:
The rectum, sigmoid colon, bladder, uterus, and both adnexa are unremarkable.
There is moderate amount of free fluid within the pelvis, which measures 30
___.
OSSEOUS STRUCTURES:
The visible osseous structures show no suspicious lytic or blastic lesions or
fractures.
IMPRESSION:
1. Hyperenhancing and slightly thickened tip of the appendix could represent
early "tip appendicitis" or, alternatively, reflect "passive" inflammation
related to the process centered in the right colon (#2, below).
2. Focal segmental pneumatosis of the mid-ascending colon, of uncertain
significance. There is no significant mural thickening in this well-opacified
and -distended segment. There is also no mesenteric or portal venous gas.
There is relatively mild thickening of the lateral conal fascia and parietal
peritoneum in this region.
3. Moderate amount of slightly complex but non-hemorrhagic pelvic free fluid
may relate to either of the two processes, above.
COMMENT: These findings may be related to focal segmental ischemia, as has
been reported with drugs of abuse, particularly cocaine. Other diagnostic
considerations, including typhilitis, are unlikely in the absence of history
of immunocompromise and/pr the use of corticosteroids or chemotherapeutic
agents. This appearance is atypical for "benign" idiopathic pneumatosis
cystoides intestinalis. Though the patient demographics are appropriate for
the entity of right colonic diverticulitis, the absence of colonic thickening
and adjacent fat-stranding, as well as the lack of a "culprit" diverticulum
would be most unusual.
These findings, including the reported relationship of right colonic ischemia
to drug abuse, were discussed with Dr. ___, by Dr. ___
telephone, at 10:33 am on ___.
|
10220448-RR-29
| 10,220,448 | 25,347,810 |
RR
| 29 |
2132-03-12 09:47:00
|
2132-03-12 18:28:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ ___ man w/ NIDDM, HTN, hyperlipidemia, and COPD who
is currently being worked up by urology for urinary retention that started at
the end of ___ and is referred to the ED from urgent care clinic after
they were unable to straight cath him for urinary retention.// eval for
hydronephrosis or e/o pyelonephritis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen ___.
FINDINGS:
The right kidney measures 8.9 cm. The left kidney measures 9.9 cm. There is a
3.1 cm avascular cyst with a thin septation in the right upper pole. There is
a 1.7 cm right lower pole cyst with an avascular linear echogenic structure in
the cyst which may represent a septation, unchanged in size since ___. There is no hydronephrosis, stones, or suspicious masses bilaterally.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
The bladder contains a catheter tip, is decompressed and cannot be evaluated.
IMPRESSION:
No hydronephrosis.
|
10220895-RR-16
| 10,220,895 | 29,386,357 |
RR
| 16 |
2154-08-15 17:47:00
|
2154-08-15 18:55:00
|
INDICATION: Dizziness, vision changes, and confusion. Evaluate for etiology.
COMPARISONS: MRI of the brain from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Sagittal, coronal and thin-section
bone reformatted images were obtained and reviewed.
TOTAL DLP: 1114.91 mGy-cm.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect, or large
vascular territory infarction. The ventricles and sulci are prominent,
consistent with age-related volume loss. The basal cisterns are patent.
Periventricular confluent white matter hypodensities are consistent with
chronic small vessel ischemic disease. Overall, these findings are similar to
the prior MRI from ___.
No fracture is identified. There are severe degenerative changes in the left
temporo-mandibular joint. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The soft tissues are unremarkable.
IMPRESSION: No acute intracranial abnormality. Unchanged age-related volume
loss and chronic small vessel ischemic disease.
|
10221179-RR-20
| 10,221,179 | 21,815,961 |
RR
| 20 |
2119-10-04 16:46:00
|
2119-10-04 18:06:00
|
EXAMINATION: CTA CHEST CARDIOTHORACIC SECTION
INDICATION: CTA chest to evaluate for aortic arch or subclavian
disease/coarction of the aorta in the setting of asymmetric blood pressure
readings, R > ___ year old man with differences in systolic blood pressure
averaging 50+ points greater in the RUE than the LUE. ___ Cardiology
recommends obtaining a CTA chest to evaluate for aortic arch and subclavian
disease. Please perform ___// CTA chest to evaluate for aortic arch or
subclavian disease/coarction of the aorta in the setting of asymmetric blood
pressure readings, R > L.
TECHNIQUE: Multidetector gated CTA through the chest performed with IV
contrast. Reformatted coronal, sagittal, thin slice axial images, oblique
maximal intensity projection images, and 3D reconstructions were submitted to
PACS and reviewed.
COMPARISON: CTA torso ___.
FINDINGS:
ANGIOGRAM:
The aorta is patent, with no evidence of stenosis, occlusion, dissection or
aneurysmal formation. There is no evidence of penetrating atherosclerotic
ulcer. Aortic atherosclerotic burden is severe, with discontinuous dystrophic
atherosclerotic calcifications in the descending aorta.
There is a common origin of the right brachiocephalic and left common carotid
arteries. There is severe high-grade stenosis (>90%) at the origin of the left
subclavian artery (series 3, image 87) by calcified plaque increased compared
to ___, but contrast is seen distal to the the stenosis suggesting patency.
The right subclavian artery is patent.
While the study is not designed for evaluation of the coronary arteries, there
is severe calcifications of the proximal LAD and moderate calcifications of
the proximal left circumflex and RCA.
Measurements done by imaging lab, accuracy =/- 5% (at the level of the):
Aortic annulus: 21.1 x 27.9 mm
Aortic sinuses: 30.7 x 33.0 mm
Sinotubular junction: 32.0 x 29.2 mm
Mid ascending aorta: 33.4 x 36.1 mm
Proximal to common origin of innominate artery and left common carotid artery:
31.5 x 30.3 mm
Proximal to left subclavian artery: 25.8 x 27.8 mm
Distal to left subclavian artery: 28.2 x 24.6 mm
Mid descending aorta: 25.9 x 29.5 mm
Aortic hiatus: 21.2 x 24.6 mm
Main pulmonary artery: 31.3 x 26.8 mm
CHEST FINDINGS:
There is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy.
The thyroid gland is unremarkable.
Small bilateral pleural effusions. No pericardial effusion.
There is mild bilateral pulmonary edema. Moderate bibasilar atelectasis is
seen. Numerous bilateral pulmonary nodules measuring up to 7 mm in the left
upper lobe are unchanged compared to ___ (3; 41). Calcified granuloma is
noted in the left upper lobe. There is moderate bilateral peribronchial wall
thickening with endobronchial secretions suggestive of small airways
inflammation.
Limited images of the upper abdomen demonstrate a large hiatal hernia.
No suspicious osseous lesions are identified. No acute fractures. Mild
dextroscoliosis of the thoracic spine is noted.
IMPRESSION:
1. High-grade stenosis of the origin of a patent left subclavian artery by
atherosclerotic calcification worsened compared to ___. No coarctation of
the aorta.
2. While the study is not designed for evaluation of coronary arteries, there
is moderate to severe calcifications of the proximal LAD, left circumflex and
RCA.
3. Extensive dystrophic atherosclerotic calcifications in the descending
aorta.
4. Multiple bilateral pulmonary nodules measuring up to 7 mm in the left upper
lobe are unchanged since ___. Given ___ year stability the, these may
represent intraparenchymal lymph nodes. See below for ___ criteria.
5. Small bilateral pleural effusions with mild bilateral pulmonary edema.
6. Moderate hiatus hernia.
NOTIFICATION: For incidentally detected multiple solid pulmonary nodules
measuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a
low-risk patient, with an optional CT follow-up in 18 to 24 months. In a
high-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months
is recommended.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10221179-RR-22
| 10,221,179 | 21,815,961 |
RR
| 22 |
2119-10-07 13:58:00
|
2119-10-07 21:48:00
|
EXAMINATION: Intraoperative fluoroscopy, cervical spine.
INDICATION: Posterior C1-C2 fusion.
TECHNIQUE: 3 fluoroscopic spot images were obtained during on going posterior
C1-C2 fusion in the operating room without presence of radiologist.
Dose: Fluoroscopy time 63 seconds, cumulative dose 521.60 milli rad.
COMPARISON: Prior studies from ___.
FINDINGS:
Fluoroscopic spot images show ongoing posterior C1-C2 fusion.
IMPRESSION:
C1-C2 fusion.
|
10221179-RR-23
| 10,221,179 | 21,815,961 |
RR
| 23 |
2119-10-07 23:15:00
|
2119-10-08 09:36:00
|
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man remaining intubated postop, please evaluate ETT
placement// Evaluate ETT placement
TECHNIQUE: Chest AP
COMPARISON: Chest CT from ___.
Chest radiograph from ___.
FINDINGS:
Endotracheal tube terminates 3.8 cm above the carina, in appropriate position.
Lung volumes are low. Stable pulmonary vascular congestion and left greater
than right basilar atelectasis. Small bilateral pleural effusions appear
stable. No pneumothorax.
IMPRESSION:
1. Endotracheal tube in appropriate position.
2. Stable small bilateral pleural effusions with adjacent atelectasis.
|
10221179-RR-24
| 10,221,179 | 21,815,961 |
RR
| 24 |
2119-10-09 04:52:00
|
2119-10-09 09:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with C1-C2 fusion. post-extubation//
pna/effusion, edema
TECHNIQUE: Chest PA
COMPARISON: ___
FINDINGS:
There has been interval extubation.
The lung volumes are low with bibasilar atelectasis.
Cardiomediastinal silhouette is unchanged with mild cardiomegaly.
Visualized bones are unremarkable.
IMPRESSION:
Interval extubation with low lung volumes and bibasilar atelectasis.
|
10221318-RR-12
| 10,221,318 | 20,086,643 |
RR
| 12 |
2169-12-02 00:10:00
|
2169-12-02 01:38:00
|
EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: History: ___ with severe headache, recent neg CTA/CT/MRI. // r/o
ICH, dissection, thrombosis
TECHNIQUE: Contiguous axial images were obtained through the brain after the
administration of intravenous contrast. Subsequently, repeat exam was
performed after the administration of intravenous contrast. Images were
processed on a separate workstation with curved reformats, 3D volume rendered
images, and maximum intensity projection images.
DOSE: DLP: ___ MGy-cm
COMPARISON: CTA head neck dated ___.
FINDINGS:
CT HEAD: There is no infarct, hemorrhage, or mass effect. The ventricles,
sulci and cisterns are appropriate for age. There is incidental note of a
right choroidal fissure cyst. The orbits, paranasal sinuses, mastoid air cells
and visualized soft tissues are unremarkable.
CTA HEAD AND NECK: [] There is calcified plaque of the cavernous ICAs without
significant stenosis. The anterior and middle cerebral arteries are
unremarkable. There is a fetal type left PCA with a hypoplastic P1 segment.
There is a dominant left vertebral artery. The right vertebral artery is
hypoplastic and the V4 segment is poorly visualized, which may relate to a
combination of hypoplasia and atherosclerotic disease. There is no aneurysm or
other vascular abnormality.
There is soft and calcified plaque at the carotid bifurcations bilaterally,
without evidence of significant stenosis based on NASCET criteria.
The right vertebral artery is hypoplastic. The as cervical vertebral arteries
are otherwise unremarkable without evidence of significant stenosis.
IMPRESSION:
Unremarkable head CT without evidence of infarct, or hemorrhage.
CTA head neck demonstrates hypoplastic right vertebral artery with a poorly
visualized V4 segment, which may relate to a combination of hypoplasia and
atherosclerotic disease. There is no aneurysm or other vascular abnormality.
|
10221321-RR-34
| 10,221,321 | 20,843,630 |
RR
| 34 |
2124-04-20 11:23:00
|
2124-04-20 11:54:00
|
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old woman with severe, long standing RA now with right
knee pain. Please assess // ? arthritis secondary to RA ? arthritis
secondary to RA
TECHNIQUE: Three views of the right knee
COMPARISON: ___
FINDINGS:
There is a moderate to large knee joint effusion. There is a total knee
arthroplasty which demonstrates evidence of loosening of the tibial component.
There is markedly abnormal increased lucency at the bone prosthesis interface
of the tibial stem measuring up to 1 cm. The tibial prosthesis is also
slightly medially displaced, and the tibia is slightly varus angulated with
respect to the tibial tray. There is also some reactive sclerosis along the
medial proximal tibia which is likely reactive.
IMPRESSION:
Loosening of tibial component of total knee arthroplasty.
NOTIFICATION: The impression and recommendation above was entered by Dr. ___
___ on ___ at 11:52 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
10221321-RR-58
| 10,221,321 | 23,085,302 |
RR
| 58 |
2127-10-10 09:54:00
|
2127-10-10 10:40:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// R DL Power PICC 49cm ___
___ Contact name: ___: ___
COMPARISON: Chest CT ___
FINDINGS:
Portable AP view of the chest provided.
Interval placement of a right PICC which appears terminate at the cavoatrial
junction. Extensive multifocal airspace opacities are similar to prior and
concerning for multifocal pneumonia. No large pleural effusion or
pneumothorax. Cardiomediastinal silhouette is within normal limits.
IMPRESSION:
Right PICC appears to terminate at the cavoatrial junction. Persistent
extensive airspace opacities concerning for multifocal pneumonia.
|
10221321-RR-59
| 10,221,321 | 23,085,302 |
RR
| 59 |
2127-10-16 18:57:00
|
2127-10-16 19:59:00
|
EXAMINATION: CT CHEST WITHOUT CONTRAST
INDICATION: ___ year old woman with pmxh of vulvar cancer, RA with substantial
chronic steroids here with hypoxemic respiratory failure.// interval change in
her pulmonary nodules
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.5 s, 35.9 cm; CTDIvol = 18.7 mGy (Body) DLP = 659.7
mGy-cm.
Total DLP (Body) = 660 mGy-cm.
COMPARISON: Prior chest CTA from ___..
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is unremarkable. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. Mild atherosclerotic
calcifications in the head and neck arteries..
HEART AND VASCULATURE:
The heart is normal size and shape. No pericardial effusion. Mild
atherosclerotic calcifications in the coronary arteries, none in the aorta or
cardiac valves. The pulmonary arteries and aorta are normal caliber
throughout.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. No hilar lymphadenopathy
although evaluation is limited by the absence of intravenous contrast.
PLEURA:
No pleural effusions. No apical scarring bilaterally.
LUNGS:
The airways are patent to the subsegmental levels. No bronchial wall
thickening, bronchiectasis or mucus plugging. Significant improvement in the
diffuse bilateral and extensive centrilobular nodules which previously formed
coalescent consolidations but now only remaining mild ill-defined ground-glass
opacities throughout all lobes. No suspicious lung nodules or masses.
Atelectasis in lingula remains relatively unchanged.
CHEST CAGE:
There is a left reverse shoulder arthroplasty. Severe arthropathy is also
noted in the right shoulder. Multiple prior rib fractures bilaterally.
Redemonstration of severe compression fracture of T9 with adjacent compression
deformities in the T7 and T8 vertebral bodies as well. There is a chronic
deformity of the lower sternum.
UPPER ABDOMEN:
The limited sections of the upper abdomen show no significant abnormal
findings.
IMPRESSION:
Significant improvement of the extensive bilateral coalescent opacities with
very mild diffuse residual ground-glass opacities remaining, making these
findings more suggestive of a resolving infectious process.
|
10221321-RR-61
| 10,221,321 | 29,419,926 |
RR
| 61 |
2127-12-19 17:41:00
|
2127-12-19 19:36:00
|
EXAMINATION: Chest radiograph, portable AP upright.
INDICATION: Shortness of breath.
COMPARISON: Radiograph is available from ___, and a chest CT is
available from ___.
FINDINGS:
Heart is mildly enlarged, and perhaps somewhat increased in size, even
allowing for differences in technique. Mediastinal and hilar contours are
probably unchanged allowing for technique. Although not as striking as on
___, mild interstitial process suggests pulmonary edema. Platelike
opacity at the left costophrenic angle suggests atelectasis. Slight blunting
of each costophrenic angle may indicate small and/or subpulmonic pleural
effusions. No pneumothorax. The patient is status post left shoulder
arthroplasty.
IMPRESSION:
Finding suggests mild pulmonary edema.
|
10221321-RR-63
| 10,221,321 | 29,419,926 |
RR
| 63 |
2127-12-19 19:03:00
|
2127-12-19 19:47:00
|
EXAMINATION: Bilateral shoulder radiographs, three views on the right and
four views on the left.
INDICATION: Concern for humerus fracture in avascular necrosis.
COMPARISON: Recent left shoulder radiographs dated ___. The right
can be compared to ___.
FINDINGS:
On the right, there is similar attenuation of the articular surface of the
humeral head with narrowing of the joint space, sclerosis and small
osteophytes. Sclerosis is also again noted along the glenoid. These findings
could be seen as sequela avascular necrosis or other bony destructive process
such as inflammatory arthropathy or infection with superimposed degenerative
changes. No evidence of acute fracture. Bones appear demineralized.
Right-sided rib fractures appear unchanged.
On the left, there is a total reverse shoulder arthroplasty. Periprosthetic
fracture along the stem of the humeral component remains displaced by somewhat
greater than a shaft with. The only change is proliferation of callus about
the fracture site but without bony bridging. Left-sided rib fractures are
unchanged.
IMPRESSION:
No significant change in the right shoulder. New callus along fracture site
of the proximal left humerus, but otherwise no significant change.
|
10221321-RR-64
| 10,221,321 | 29,419,926 |
RR
| 64 |
2127-12-19 19:03:00
|
2127-12-19 19:38:00
|
EXAMINATION: Left shoulder radiographs, two views.
INDICATION: Concern for left humerus fracture in avascular necrosis.
COMPARISON: ___
FINDINGS:
There is increased callus about the site of a displaced para prosthetic
fracture at the level of the stem of the humeral component of a total reverse
left shoulder arthroplasty. Displacement is still by somewhat greater than a
shaft with.
IMPRESSION:
Aside from some callus formation, no significant change in displaced
periprosthetic fracture about the proximal left humerus.
|
10221321-RR-65
| 10,221,321 | 29,419,926 |
RR
| 65 |
2127-12-23 12:17:00
|
2127-12-23 16:57:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ with PMhx of bicuspid AV, vulvar squamous cell carcinoma,
chronic hypercarbia with home trilogy, polyarticular erosive severe RA on
chronic steroids, who p/w acute on chronic hypoxia likely ___ acute on chronic
diastolic heart failure. Now dry and still hypoxic. Recently treated for
possible PCP ___// Pls evaluate for ongoing alveolar filling process ? edema,
? atypical infection
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent and reconstructed as contiguous 5 mm and 1.25 mm
thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 30.4 cm; CTDIvol = 15.7 mGy (Body) DLP = 483.0
mGy-cm.
Total DLP (Body) = 483 mGy-cm.
COMPARISON: Prior Chest CTs ___ and ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal. Evaluation
the left axilla is limited due to streak artifact from adjacent surgical
hardware. Within these limitations there is no supraclavicular and axillary
lymphadenopathy.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is mild coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
PULMONARY PARENCHYMA: There are scattered peribronchial nodular opacities in
the left lower lobe (05:41), likely infectious versus inflammatory in
etiology. Linear atelectasis is present in the left lung base. A 1.4 cm
pleural based opacity in the left lung base (5:218) is new and likely
represents rounded atelectasis.
A 1.9 cm pleural based nodule in the right middle lobe has increased in size,
previously 0.9 cm (5:99). Just inferior to this, there is a second pleural
based nodule measuring up to 7 mm (05:13), which is new. An additional 3 mm
pleural based nodule in the right middle lobe (5:131) is also new compared to
the prior study.
A 5 mm perifissural nodule in the right upper lobe (05:56) is also new. An
additional subpleural nodule in the right lower lobe measuring 5 mm is new
since the prior study (5:172).
A 5 mm nodule in the right lung base (5:125) is unchanged.
Lingular atelectasis is relatively unchanged.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is no pleural effusion.
CHEST WALL AND BONES: There are extensive erosive degenerative changes in the
bilateral shoulders. There are multilevel healing rib fractures bilaterally.
Severe compression deformities of the T7 through 9 vertebral bodies are
unchanged. A healing fracture of the lower sternum is again noted.
Multilevel degenerative changes are moderate.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is notable for mild
splenomegaly measuring up to 14.3 cm..
IMPRESSION:
1. Interval increase in size and number of bilateral pleural based nodular
opacities measuring up to 1.9 cm in the right middle lobe, which are
concerning for metastatic disease given patient's history of malignancy.
Recommend PET-CT for further evaluation.
2. Peribronchiolar nodular opacities in the left lower lobe are likely
inflammatory versus infectious in etiology.
3. Mild splenomegaly.
RECOMMENDATION(S): PET-CT
|
10221634-RR-22
| 10,221,634 | 27,654,198 |
RR
| 22 |
2164-02-12 10:16:00
|
2164-02-12 11:30:00
|
HISTORY: ___ man with seizure and fall.
FINDINGS:
SINGLE AP VIEW OF THE CHEST: The lungs are clear. Cardiomediastinal
silhouette and hilar contours are unremarkable. No pneumothorax or pleural
effusion is identified. Patient is intubated with the ET tube approximately 5
cm from the carina. Prior surgical cervical spine hardware is noted.
SINGLE AP VIEW OF THE PELVIS: No fractures or dislocations are identified.
No significant degenerative changes of the hips or sacroiliac joints. No
lytic or sclerotic lesions.
Both are better assessed on the recent CT of the Torso.
|
10221634-RR-23
| 10,221,634 | 27,654,198 |
RR
| 23 |
2164-02-12 10:15:00
|
2164-02-12 12:44:00
|
INDICATION: ___ man with seizure and trauma. Question bleed.
COMPARISON: None.
TECHNIQUE: CT of the head without IV contrast.
FINDINGS: No evidence of acute intracranial hemorrhage, mass effect, shift of
normally midline structures or vascular territorial infarct. Ventricles and
sulci are unremarkable for the patient's age. There is surgical closure
devices in the left frontal skull consistent with the patient's prior history
of left frontal meningioma removal as well as resultant encelophmalacia.
Subgaleal soft tissue hematoma is noted in the left frontal region. The
ethmoid air cells are opacified secondary to recent intubation.
IMPRESSION:
1) No acute intracranial process.
2) Status post meningioma removal with encephalomalacia in the left frontal
lobe.
|
10221634-RR-24
| 10,221,634 | 27,654,198 |
RR
| 24 |
2164-02-12 10:15:00
|
2164-02-12 13:59:00
|
HISTORY: ___ man with seizure.
COMPARISON: None.
TECHNIQUE: CT of the cervical spine without IV contrast.
FINDINGS: Patient is intubated, limiting the evaluation of soft tissue
swelling. No fracture is identified. Anterior fusion hardware is noted at
the C5 through C7 levels with no evidence of hardware complications. No
critical spinal canal cord stenosis is identified. No acute malalignment or
fracture abnormalities.
IMPRESSION: No acute fracture or alignment abnormality.
|
10221634-RR-25
| 10,221,634 | 27,654,198 |
RR
| 25 |
2164-02-12 10:16:00
|
2164-02-12 13:57:00
|
HISTORY: ___ man with seizure, recent brain surgery and fall and head
strike. Trauma torso.
COMPARISON: None.
TECHNIQUE: CT of the chest, abdomen and pelvis with IV contrast with
multiplanar reformations.
CT OF THE CHEST: There is no axillary, mediastinal or hilar lymphadenopathy.
The patient is intubated with the endotracheal tube terminating approximately
5 cm from the carina. Aorta and the great vessels are unremarkable. No
pericardial or pleural effusion. Tracheobronchial tree is patent to the
segmental level. There is atelectasis at the lung bases.
CT OF THE ABDOMEN: Tiny hypodensity in the dome of the liver (2:34) is too
small to fully characterize. Otherwise, the liver is free of focal lesions.
Portal vein is patent. Spleen, bilateral adrenals are unremarkable. Pancreas
is normal in appearance. Bilateral kidneys enhance and excrete contrast
symmetrically with no evidence of hydronephrosis, stones or masses. Minimal
perinephric stranding is non-specific. Gallbladder is unremarkable. NG tube
is noted with its tip within the stomach. The stomach, small and large bowel
are normal in course and caliber throughout with the exception of a duodenal
diverticulum. No retroperitoneal or mesenteric lymphadenopathy by CT criteria
is identified.
CT OF THE PELVIS: Prostate, bladder and rectosigmoid colon are unremarkable.
No pelvic or inguinal lymphadenopathy by CT criteria is noted.
BONES: No suspicious lytic or sclerotic lesions are noted. No fractures are
identified.
IMPRESSION: No acute sequela of trauma.
|
10221634-RR-26
| 10,221,634 | 27,654,198 |
RR
| 26 |
2164-02-12 10:24:00
|
2164-02-12 12:43:00
|
HISTORY: ___ man with abrasions to the left face, evaluate for facial
fracture.
COMPARISON: None.
TECHNIQUE: CT of the sinuses.
FINDINGS: Ethmoid air cells are opacified, consistent with the patient's
recent intubation. Thickening of the caudal aspect of the left maxillary
sinus (2:100) is noted as well as mucus retention cyst (2:86). Small
retention cysts in the right maxillary sinus are also present. Soft tissue
swelling is noted over the left frontal skull. Also noted are the previous
surgical resection closure devices in the left frontal skull. No fracture is
identified. The C-spine is better evaluated on the CT of the C-spine from the
same day.
IMPRESSION: No evidence of fracture. Opacification of the paranasal sinuses,
consistent with recent intubation.
|
10221634-RR-27
| 10,221,634 | 27,654,198 |
RR
| 27 |
2164-02-12 11:06:00
|
2164-02-12 13:07:00
|
CLINICAL HISTORY: ___ man with seizure and fall.
THREE RADIOGRAPHS OF THE LEFT KNEE: There is no fracture or dislocation. No
significant degenerative changes are noted. No soft tissue swelling.
IMPRESSION: No evidence of fracture or dislocation.
|
10221634-RR-28
| 10,221,634 | 27,654,198 |
RR
| 28 |
2164-02-12 20:42:00
|
2164-02-13 07:57:00
|
CLINICAL INDICATION: ___ man with left shoulder pain status post
tonic-clonic seizure.
FINDINGS: Four views of the left shoulder were obtained without prior studies
available for comparison. There is an osseous fragment along the posterior
aspects of the glenoid, likely representing a reverse Bankart lesion.
Additionally, there is abnormal indentation of the inferior aspects of the
humeral head likely representing a reverse ___ lesion. Moderate soft
tissue swelling is seen around the shoulder joint. No radiopaque foreign
bodies are identified.
IMPRESSION: Abnormal osseous fragment seen inferior to the glenoid, with
abnormal indentation/impaction of the humerus as described likely representing
a reverse ___ deformity. These findings are felt to be related to
sequale of posterior shoulder dislocation, and may be better evaluated with CT
(or MRI) of the shoulder.
Findings discussed with Dr. ___ at 7:38am at ___ by Dr.
___
|
10221634-RR-29
| 10,221,634 | 27,654,198 |
RR
| 29 |
2164-02-13 13:54:00
|
2164-02-13 16:47:00
|
INDICATION: ___ man with left shoulder pain after tonic-clonic
seizure and suspicious appearance of shoulder radiographs.
COMPARISONS: Shoulder radiographs ___.
TECHNIQUE: MDCT-acquired axial images were obtained through the left shoulder
without intravenous contrast. Coronal and sagittal reformations were
prepared.
FINDINGS: The humeral head is well seated in the glenoid without evidence of
fracture. The imaged lung shows atelectasis dependently which is better
assessed on the recently obtained CT torso. Soft tissues of the axilla are
normal without adenopathy. The imaged ribs and muscle bulk are normal.
IMPRESSION: No fracture of the humeral head or glenoid.
|
10221634-RR-31
| 10,221,634 | 25,519,779 |
RR
| 31 |
2164-11-15 10:47:00
|
2164-11-15 13:21:00
|
INDICATION: History of known brain cancer who presents for evaluation of
altered mental status.
COMPARISONS: MRI head ___.
TECHNIQUE: ___ MDCT images were obtained through the brain without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axis, and bone algorithms were generated and reviewed.
FINDINGS: There is no evidence of hemorrhage, mass, mass effect, or acute
infarction. The patient is status post left frontal craniotomy and tumor
resection with residual left frontal hypodensity noted, unchanged. The patient
is status post left frontal craniotomy. Note is made of a right basal ganglia
dilated perivascular space. The ventricles and sulci are normal in size and
configuration. The basal cisterns appear patent and there is otherwise
preservation of gray-white matter differentiation.
No acute fracture is identified. There is mucosal thickening of the left
maxillary sinus. The right maxillary sinus, mastoid air cells, middle ear
cavities, sphenoid sinus, and frontal sinuses are clear. Secretions are
identified in the posterior nasopharynx, likely secondary to patient's
intubation. Note is made of right frontal soft tissue swelling.
IMPRESSION:
1. No evidence of acute hemorrhage or infarction.
2. Status post left frontal lobe lesion resection with residual hypodensity
compatible with post-operative changes.
|
10221634-RR-32
| 10,221,634 | 25,519,779 |
RR
| 32 |
2164-11-15 10:52:00
|
2164-11-15 13:25:00
|
INDICATION: History of brain cancer and altered mental status who presents
for evaluation of acute cardiopulmonary process.
COMPARISONS: None.
TECHNIQUE: Portable supine exam of the chest.
FINDINGS: The endotracheal tube terminates 6 cm above the carina. There is
an enteric tube coursing below the diaphragm with the sidehole within the
stomach. The heart is mildly enlarged. There are low lung volumes, with
evidence of bibasilar atelectasis. No definite evidence of focal
consolidations concerning for infection is identified. There is no pleural
effusion or pneumothorax. The visualized osseous structures are unremarkable.
IMPRESSION:
1. No focal consolidations concerning for infection identified. Bibasilar
atelectasis.
2. Endotracheal tube terminates 6-cm above the carina.
|
10221634-RR-33
| 10,221,634 | 25,519,779 |
RR
| 33 |
2164-11-15 10:59:00
|
2164-11-15 13:34:00
|
INDICATION: History of seizure, trauma, intubated. Rule out C-spine
fracture.
COMPARISON: None.
TECHNIQUE: ___ MDCT axial 2.5-mm images were obtained from the base of the
skull to T2. Multiplanar reformatted images in coronal and sagittal axes were
generated and reviewed.
FINDINGS: The patient has anterior fusion hardware from C5 through C7,
without evidence of hardware failure. There are also intervertebral disc
spacer devices seen at C5-C6 and C6-C7. No acute fractures are identified. No
subluxation is present. There is no evidence of prevertebral soft tissue
swelling.
There is evidence of degenerative disease with posterior osteophytosis worst
from C5 to C7 with mild canal narrowing and mild bilateral neural foraminal
narrowing. The patient is intubated. Again seen are posterior nasopharyngeal
secretions likely secondary to patient's intubation. No lymphadenopathy is
identified. The visualized apices of the lungs are unremarkable.
CT is unable to provide intrathecal detail comparable to MRI, but the
visualized outline of the thecal sac is unremarkable.
IMPRESSION:
No acute fracture or subluxation. Status post C5 through C7 anterior fusion
without evidence of hardware complications. Mild degenerative changes
throughout the cervical spine.
|
10221634-RR-34
| 10,221,634 | 25,519,779 |
RR
| 34 |
2164-11-16 05:16:00
|
2164-11-16 13:41:00
|
HISTORY: Intubated, evaluate for interval change.
CHEST, SINGLE AP PORTABLE VIEW. No previous chest x-rays on PACS record for
comparison.
An ET tube is present, the tip approximately 5.8 cm above the carina.
An NG tube is present, tip extending beneath diaphragm, off film.
There are low inspiratory volumes. Allowing for this, no definite
cardiomediastinal enlargement. There are patchy opacities at both lung bases.
No CHF or gross effusion.
An unusual curvilinear density overlies the left scapular neck, not fully
characterized, but nonaggressive in appearance.The lower portion of a cervical
neck fusion plate is noted, not fully evaluated.
IMPRESSION:
1) ET tube at the level of the lower medial clavicles, slightly high.
Clinical correlation requested.
2) Bibasilar opacities.
3) Unusual opacity overlying left medial scapula, possibly artifact versus
nonaggressive lucent lesion. Consider further evaluation with dedicated
shoulder radiographs.
|
10221634-RR-40
| 10,221,634 | 28,007,793 |
RR
| 40 |
2166-01-17 14:56:00
|
2166-01-17 15:48:00
|
EXAMINATION:
CHEST (AP AND LAT)
INDICATION: History: ___ with seizures and hypoxia // Eval for pneumonia
TECHNIQUE: Chest AP and Lateral
COMPARISON: ___
FINDINGS:
There are low lung volumes, which accentuate the bronchovascular markings.
Patchy basilar opacity is seen, particularly on the lateral view of which
could be due to atelectasis but infection or aspiration not excluded. No
pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are stable. Cervical spine hardware is noted.
IMPRESSION:
Low lung volumes, which accentuate the bronchovascular markings. Patchy
basilar opacity is seen, particularly on the lateral view of which could be
due to atelectasis but infection or aspiration not excluded
|
10221634-RR-41
| 10,221,634 | 28,007,793 |
RR
| 41 |
2166-01-17 16:35:00
|
2166-01-17 17:34:00
|
EXAM: Non-contrast-enhanced CT of the head.
CLINICAL INFORMATION: Seizures and fall with head strike, also history of
left frontal meningioma resection.
COMPARISON: Head CT from ___ as well as brain MRIs from ___ and
___.
TECHNIQUE: Non-contrast-enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
TOTAL EXAM DLP: 910.92 mGy-cm.
FINDINGS: There is stable left frontal hypodensity at site of prior surgery,
compatible with post-surgical change. No acute intracranial hemorrhage is
seen. There is no midline shift, mass effect, or evidence of acute large
vascular territorial infarct. Patient is status post left frontal craniotomy,
stable in appearance. The visualized paranasal sinuses and the mastoid air
cells are clear. No acute fracture is seen.
IMPRESSION: No acute intracranial process. Stable left frontal post-surgical
changes.
|
10221648-RR-18
| 10,221,648 | 20,191,073 |
RR
| 18 |
2189-10-05 11:43:00
|
2189-10-05 12:50:00
|
INDICATION: Fall one week ago. New nausea and vomiting. Evaluate for
hemorrhage.
COMPARISONS: None.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Sagittal, coronal, and thin slice
bone reformats were obtained and reviewed.
FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or
large vascular territory infarction. The ventricles and sulci are prominent,
consistent with age-related volume loss. The basal cisterns are patent.
Periventricular confluent white matter hypodensities are most consistent with
chronic small vessel ischemic disease. Atherosclerotic calcifications are
noted in the vertebral and internal carotid arteries.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The soft tissues are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
2. Age-related volume loss and chronic small vessel ischemic disease.
|
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