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10221648-RR-19
| 10,221,648 | 20,191,073 |
RR
| 19 |
2189-10-05 12:05:00
|
2189-10-05 14:02:00
|
INDICATION: Shortness of breath.
COMPARISON: None available.
FINDINGS: AP and lateral views of the chest. Sternotomy wires are intact.
There is no focal consolidation, pleural effusion, or pneumothorax. Coarsened
interstitial markings may represent mild fibrosis/emphysema. There are aortic
calcifications. The cardiomediastinal and hilar contours are within normal
limits. There is a mild vertebral compression deformity noted in the lower
T-spine.
IMPRESSION: No acute cardiopulmonary process.
|
10221767-RR-16
| 10,221,767 | 21,843,161 |
RR
| 16 |
2146-09-23 13:43:00
|
2146-09-23 14:28:00
|
INDICATION: ___ female with right tibia/fibula and patella fracture
COMPARISON: CT from ___.
FINDINGS:
3 intraoperative images were acquired without a radiologist present.
Images show the previously noted right patella and tibial fractures..
Fluoroscopic time: 4.3 seconds.
IMPRESSION:
Intraoperative images were obtained during intraoperative fixation of patellar
and tibial fractures. Please refer to the operative note for details of the
procedure.
|
10221833-RR-48
| 10,221,833 | 25,958,424 |
RR
| 48 |
2116-10-31 12:22:00
|
2116-10-31 13:03:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with metastatic sarcoma, brain metastasis, now with severe
headache, assess hemorrhage.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: Prior head CT from ___ and prior MRI of the brain
from ___.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage. There is a slightly
hyperdense mass again noted abutting the right lateral ventricle in the deep
white matter of the right posterior frontal lobe measuring approximately 2.0 x
2.0 cm with increasing surrounding edema again noted. There is new 6 mm
leftward shift of midline structures. There is a 13 mm hyperdense lesion
abutting the left frontal lobe with associated mild edema not significantly
changed. Known small left cerebellar lesion is not clearly visualized.
Basilar cisterns remain patent. Paranasal sinuses appear well aerated as do
the mastoid air cells and middle ear cavities. The bony calvarium is intact.
IMPRESSION:
Intracranial metastasis with increasing edema surrounding the right posterior
frontal lesion with new 6 mm leftward shift of midline structures. No
hemorrhage.
|
10221833-RR-49
| 10,221,833 | 26,528,151 |
RR
| 49 |
2116-11-18 16:57:00
|
2116-11-18 17:42:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with PMH sodt tissue sarcoma with brain mets and h/o brain
edema p/w HA, n/v. Neuro intact
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
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: Head CT on ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage. A hyperdense mass
abutting the right lateral ventricle and deep white matter of the right
posterior frontal lobe is unchanged from ___. Edema surrounding
this lesion is minimally decreased in extent from the prior examination. 4 mm
of leftward shift of normally midline structures is minimally decreased from
the prior exam when it was previously 6 mm. An additional hyperdense lesion
along the left frontal convexity with associated edema is re- demonstrated.
Edema adjacent to this mass appears increased from the prior examination.
There is no evidence of acute fracture. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
1. Intracranial metastases with surrounding edema are re- demonstrated. A
left frontal lobe hyperdense metastatic lesion shows minimally increased
surrounding edema. A right frontal lobe lesion is re-demonstrated and shows
minimally decreased surrounding edema.
2. No acute intracranial hemorrhage.
|
10221833-RR-50
| 10,221,833 | 26,528,151 |
RR
| 50 |
2116-11-19 09:58:00
|
2116-11-19 13:23:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old man with known brain metastasis, presenting with new
headache // interval change
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 10 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI from ___
FINDINGS:
There are multiple intracranial lesions. The 4 mm left cerebellar lesion is
stable with mild surrounding FLAIR hyperintense signal. There is a stable 2
mm focus of enhancement in the middle right cerebellar peduncle, better
visualized on the current MRI. There is been mild interval increase in size
of the left 2 cm AP by 1.6 cm TR dural based mass with interval increased
surrounding FLAIR hyperintense signal and mild associated sulcal effacement.
No midline shift is seen at this level. There is a stable 1.8 cm x 1.8 cm
enhancing mass in the right parietal lobe, with mild interval decrease
surrounding FLAIR hyperintense signal which extends into the splenium of the
corpus callosum. A prominent vessel is noted extending into this lesion.
There is a stable 0.4 cm focus of enhancement in the right frontal
leptomeningeal is, series 900b, image 94. There is a stable 0.7 cm area of
enhancement along the left parietal convexity, series 900b, image 79.
The major vascular flow voids are preserved. The orbits paranasal sinuses and
mastoid air cells are normal. Visualized soft tissues are normal.
IMPRESSION:
1. Slight interval increase in size of the dural based left frontal convexity
mass with increased surrounding edema and mild local sulcal effacement and no
midline shift.
2. Stable size of the right parietal lesion with mild decreased surrounding
edema.
3. Two stable small cerebellar lesions and small right frontal leptomeningeal
lesion, as described above.
4. Stable 0.7 cm area of enhancement along the left parietal convexity, which
may represent a dural based lesion versus confluence of vessels.
5. No new intracranial metastatic disease.
|
10222300-RR-14
| 10,222,300 | 21,667,741 |
RR
| 14 |
2163-03-24 14:33:00
|
2163-03-24 20:19:00
|
INDICATION: Patient with reported history of right UVJ stone and fevers.
Assess for abscess formation.
COMPARISONS: Abdominal radiographs of ___.
TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis
were obtained with and without intravenous contrast at 5-mm slice thickness.
Coronally and sagittally reformatted images were displayed.
FINDINGS:
CT OF THE ABDOMEN:
Imaged lung bases demonstrate linear opacities, compatible with atelectasis.
Otherwise, lung bases are clear without focal pulmonary masses or nodules.
There is no pleural effusion. The heart is normal in size without pericardial
effusion.
There are numerous renal stones within the collecting system of the right
kidney. Several additional renal stones are seen within the right pelvis.
There is apparent thickening of the right renal pelvis. Multiple renal stones
are also seen within the left collecting system. There is a 6 x 3 x 3 mm
stone within the mid left ureter. The kidneys enhance and excrete contrast
symmetrically without hydronephrosis. Mild perinephric fat stranding is
noted, which may be nonspecific in nature. Multiple bilateral renal cysts are
also seen. For example, a 3.2 x 2.3 cm hypodense lesion arising from the
lower pole of left kidney measures 16 Hounsfield units in attenuation,
compatible with a cyst (501b:34). An additional 2.9 x 1.7 cm hypodense lesion
arising from the interpolar region of the left kidney is also noted measuring
22 Hounsfield units in attenuation, compatible with a cyst (501b:39).
Multiple bilateral focal hypodensities are seen within the renal parenchyma,
many of which are too small to characterize, and likely represent renal cysts.
There is no evidence of phlegmon or abscess formation.
The liver demonstrates homogeneous enhancement. Multiple focal hepatic
hypodensities are noted, many of which are too small to characterize and
likely represent cysts or hamartomas. The largest hypodensities are seen
within the dome measuring 11.3 x 10 mm (___). A 1.4 x 1.3 cm hypodensity
within segment V is also noted (___). There is no evidence of intrahepatic
or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.
The gallbladder is incompletely distended without gallbladder wall thickening
or pericholecystic fluid collection to suggest acute inflammation. No
calcified gallstones are seen within its lumen. The spleen is unremarkable.
A splenule is incidentally noted. The pancreas enhances homogeneously without
ductal dilatation or peripancreatic fluid collection. The adrenal glands are
normal.
The bowel loops are normal in caliber without evidence of bowel wall
thickening or obstruction. There is no free air or free fluid within the
abdomen. No pathologically enlarged mesenteric or retroperitoneal lymph nodes
are seen.
CT OF THE PELVIS:
The bladder, distal ureters, seminal vesicles, rectum and sigmoid colon are
unremarkable. There is a 9 x 4 mm bladder renal stone closely adjacent to the
site of right ureter insertion (___). There is no free air or free fluid
within the pelvis. No pathologically enlarged pelvic or inguinal lymph nodes
are seen. Small bilateral fat-containing inguinal hernias are noted.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is seen.
Multilevel DJD of the thoracolumbar spine is noted. Minimal anterolisthesis
of L2-L3 is present.
IMPRESSION:
1. Numerous bilateral renal stones within bilateral collecting systems
without associated hydronephrosis. A 6 x 4 x 3 mm renal stone in the mid left
ureter. Renal stone is also seen within the bladder adjacent to the right
ureteral orifice. There is no evidence of a phlegmon or abscess formation at
this time.
2. Bilateral renal cysts, as described above.
3. Multiple hepatic hypodensities, some of which are too small to
characterize, and likely represent cysts or hamartomas.
|
10222637-RR-11
| 10,222,637 | 25,339,739 |
RR
| 11 |
2184-01-25 00:15:00
|
2184-01-25 03:07:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK.
INDICATION: History: ___ with PMHx of ___ transferred from OSH with CT
negative LP positive for blood// Given patient's report of "worst headache of
her life" report from OSH of negative head CT, but positive LP - concerned
for ruptured aneurysm.
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
administration of 70 mL of Omnipaque350 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) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 32.7 mGy (Head) DLP =
16.3 mGy-cm.
3) Spiral Acquisition 4.6 s, 36.4 cm; CTDIvol = 30.9 mGy (Head) DLP =
1,125.2 mGy-cm.
Total DLP (Head) = 1,944 mGy-cm.
COMPARISON: MRA head ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of no evidence of infarction, hemorrhage, edema, or mass.
There is patchy white matter hypoattenuation that is nonspecific but can be
seen in the setting of chronic small vessel ischemic changes. the ventricles
and sulci are normal in size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
There is a 2 mm outpouching off the lateral aspect of the proximal cavernous
left ICA compatible with a small aneurysm (series 3, image 214), unchanged
from prior. There is a left ACA A3 is segment aneurysm measuring up to 5 mm
(series 3, image 256), unchanged from prior. The right cavernous ICA
demonstrates a tortuous course. There are bilateral partial persistent fetal
origins of the PCAs. The vessels of the circle of ___ and their principal
intracranial branches appear otherwise normal. The dural venous sinuses are
patent.
CTA NECK:
Mild irregularity of the bilateral vertebral artery V3 segments is likely
artifactual. The carotid and vertebral arteries and their major branches
appear otherwise normal with no evidence of stenosis or occlusion. There is no
evidence of internal carotid stenosis by NASCET criteria.
OTHER:
There is a 7 mm ground-glass opacity with subtle peripheral nodularity at the
left lung apex (series 3, image 61). There are multiple hypodense thyroid
nodules with the largest seen within the left thyroid lobe demonstrating
peripheral calcifications and measuring up to 1.5 cm. There is no
lymphadenopathy by CT size criteria. Mild multilevel degenerative changes
throughout the cervical spine consistent with anterior and posterior
spondylosis, more significant from C4-C7 levels.
IMPRESSION:
1. Unchanged left ACA A3 segment 5 mm aneurysm.
2. Unchanged 2 mm outpouching off the lateral aspect of the proximal cavernous
left ICA compatible with a small aneurysm.
3. Evidence of patchy white matter chronic small vessel ischemic changes.
4. A 7 mm mixed solid/sub solid opacity at the left lung apex. Per the ___
___ criteria, a follow-up chest CT in ___ months is recommended to
confirm persistence of a mixed sub-solid/solid nodules greater than or equal
to 6 mm, then annual CT for ___ years.
See the ___ ___ Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
4. Multi nodular thyroid with the largest nodule in the left thyroid lobe
demonstrating peripheral calcifications and measuring up to 1.5 cm. If there
are no recent outside ultrasound comparisons, ultrasound follow up is
recommended.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or ___, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
10222662-RR-6
| 10,222,662 | 23,662,589 |
RR
| 6 |
2114-12-10 11:18:00
|
2114-12-10 13:02:00
|
EXAMINATION: CHEST (PA AND LAT) ___
INDICATION: Mr. ___ is a ___ with h/o Fragile X syndrome, chronic
hyponatremia, HLD, seizures, left DVT (on warfarin) who presented as transfer
from North Shore ED for concern for Ludwig's angina. Now with productive cough
and relative hypoxia.// Pneumonia? Infiltrate to suggest aspirate?
Pneumonia? Infiltrate to suggest aspirate?
IMPRESSION:
Lungs are low in volume. Mild bronchial cuffing or bronchial wall thickening
seen in the left lung. Although there is no focal consolidation, subtle
alveolitis might be missed on conventional chest radiographs and detectable
only on chest CT. Heart size normal. No evidence of central adenopathy. No
pleural abnormality.
RECOMMENDATION(S): Consider chest CT for detection of subtle lung infection.
|
10222662-RR-7
| 10,222,662 | 23,662,589 |
RR
| 7 |
2114-12-10 10:58:00
|
2114-12-10 12:17:00
|
EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: Mr. ___ is a ___ with h/o Fragile X syndrome, chronic
hyponatremia, HLD, seizures, left DVT (on warfarin) who presented as transfer
from ___ ED for concern for Ludwig's angina.// Reevaluation of abscess
per ENT recommendation
TECHNIQUE: Imaging was performed after administration of Omnipaque
intravenous contrast material.
MDCT acquired helical axial images were obtained from the thoracic inlet
through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.3 s, 26.2 cm; CTDIvol = 14.9 mGy (Body) DLP = 390.0
mGy-cm.
Total DLP (Body) = 390 mGy-cm.
COMPARISON: CT neck with contrast from OSH dated ___.
FINDINGS:
Dental amalgam streak artifact and patient positioning limits study.
Re-demonstrated is a multiloculated, rim enhancing lesion in the midline floor
of the mouth measuring at least 1.8 x 2.4 cm overall. Allowing for difference
technique, finding is grossly similar compared to prior outside exam, though
direct comparison is limited.
Minimal nonspecific thickening of the platysma and induration of submandibular
soft tissues is again seen.
Otherwise, the salivary glands enhance normally and are without mass or
adjacent fat stranding.
Enlarged approximately 18 mm left supraclavicular lymph node is seen (see
301:50). Additional scattered subcentimeter nonspecific lymph nodes are noted
throughout the neck bilaterally and mediastinum , without definite enlargement
by CT size criteria.
The imaged portion of the lung apices demonstrate minimal left upper lobe
patchy opacities versus volume averaging artifact.There is moderate mucosal
thickening of the ethmoid air cells and bilateral maxillary sinuses.
Limited imaging the teeth demonstrate left maxillary second premolar
periapical lucency (see 602:27).
The thyroid gland appears preserved. Nonspecific atrophy of the left parotid
gland is noted.
IMPRESSION:
1. Dental amalgam streak artifact and patient positioning limits study.
2. Multiloculated, rim enhancing lesion in the midline floor of the mouth
again concerning for abscesses as described, grossly stable compared to prior
exam.
3. Enlarged left supraclavicular lymph node measuring up to 1.8 cm, with
additional scattered subcentimeter nonspecific lymph nodes are noted
throughout the neck bilaterally.
4. Minimal nonspecific thickening of the platysma and induration of
submandibular soft tissues, grossly stable. While finding may represent
artifacts, cellulitis is not excluded on the basis of this examination.
5. Paranasal sinus disease, as described.
6. Question patchy left upper lobe lung opacities versus artifact. If
clinically indicated, consider correlation with dedicated chest imaging.
7. Left maxillary periodontal disease as described.
|
10222892-RR-20
| 10,222,892 | 28,301,831 |
RR
| 20 |
2171-01-04 00:50:00
|
2171-01-04 01:16:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with stroke// Assess for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Lung volumes are hyperexpanded. The lungs are clear. The cardiomediastinal
silhouette and hilar silhouette are normal. Pleural surfaces are normal. The
descending thoracic aorta is torturous.
IMPRESSION:
Hyperexpanded lungs without of evidence of acute cardiopulmonary process.
|
10222892-RR-21
| 10,222,892 | 28,301,831 |
RR
| 21 |
2171-01-04 02:25:00
|
2171-01-04 02:57:00
|
EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEAD NECK.
INDICATION: History: ___ with stroke// Assess stroke, vasculature.
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
intravenous administration of 55 mL of Omnipaque 350 nonionic contrast.
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) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.9 mGy (Body) DLP =
12.5 mGy-cm.
3) Spiral Acquisition 5.3 s, 41.4 cm; CTDIvol = 15.3 mGy (Body) DLP = 631.8
mGy-cm.
Total DLP (Body) = 644 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI Head ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is an old lacunar infarct in the head of right caudate nucleus. There
are bilateral supratentorial white matter hypodensities, which are nonspecific
and may represent moderate chronic small-vessel ischemic disease. There is no
evidence of infarction,hemorrhage,edema,ormass. The ventricles and sulci are
normal in size and configuration. 1.3 cm calcified extra-axial mass overlying
the right parietal lobe, in keeping with a calcified meningioma.
The right ethmoid air cells are partially opacified. The visualized portion
of the remaining paranasal sinuses,mastoid air cells,and middle ear cavities
are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation greater than
3mm. The dural venous sinuses are patent.
CTA NECK:
There is atheromatous calcification at the carotid bifurcations bilaterally,
however there is no evidence of significant carotid stenosis by NASCET
criteria.
The carotid arteries and their major branches appear normal with no evidence
of stenosis or occlusion. There is atheromatous calcification of the aortic
arch and brachiocephalic trunk. There is a thin linear filling defect in the
V3 segment of the right vertebral artery, this may represent atheroma or
alternatively dissection (series 451, image 4, series 3, images 211, and 212).
Close follow-up is advised. There is a moderate stenosis at the origin of the
left vertebral artery, with poststenotic dilatation. This is likely
atheromatous in nature.
OTHER:
There are mild emphysematous changes at the lung apices.. The visualized
portion of the thyroid gland is within normal limits. There is no
lymphadenopathy by CT size criteria. Multilevel degenerative changes are
visualized throughout the cervical spine, more significant at C5-C6 and C6-C7
levels.
IMPRESSION:
1. No acute intracranial abnormality.
2. 1.3 cm calcified extra-axial mass overlying the right parietal lobe, in
keeping with a calcified meningioma.
3. Patent circle of ___ without definite evidence of stenosis,occlusion,or
aneurysm.
4. Linear filling defect in the V3 segment of the right vertebral artery,
which may represent atheroma, or alternatively, dissection. Close clinical
follow-up is advised. Moderate stenosis at the origin of the left vertebral
artery, with poststenotic dilatation, which is likely atheromatous in nature.
5. Patent bilateral cervical carotid arteries without definite evidence of
stenosis, occlusion, or dissection.
|
10222892-RR-22
| 10,222,892 | 28,301,831 |
RR
| 22 |
2171-01-04 04:06:00
|
2171-01-04 11:13:00
|
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old woman with facial droop, dysarthria. Evaluate for
stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck ___
FINDINGS:
2 punctate foci of restricted diffusion are identified, the first in the
periventricular white matter anterior to the frontal horn of the left lateral
ventricle, and the second in the left posterior frontal corona radiata (images
15 and 21 of series 3 and 4). These are in keeping with acute to early
infarcts.
There is extensive confluent T2/FLAIR hyperintensity in the periventricular
and deep white matter of the cerebral hemispheres, with more patchy
subcortical involvement, nonspecific but likely secondary to chronic small
vessel ischemic disease in this age group. There is a combination of chronic
infarcts and prominent perivascular spaces in the bilateral basal ganglia.
There are multiple chronic microhemorrhages in the right putamen. Additional
chronic microhemorrhages are seen in the left cerebellar hemisphere on image
10:7, left lateral putamen/external capsule on image 10:14.
Again seen is a there is a 17 mm x 9 mm extra-axial mass at the right anterior
parietal vertex, which is hypointense on the present study and calcified on
the prior CT, consistent with a calcified meningioma. No edema in the
adjacent brain parenchyma.
Multiple right anterior ethmoid air cells are opacified. Right
frontoethmoidal recess is opacified with mucosal thickening extending into the
right frontal sinus. There is minimal mucosal thickening in the left anterior
ethmoid air cells and left frontal sinus. There is mild mucosal thickening
and small mucous retention cysts in the bilateral maxillary sinuses. Status
post bilateral cataract surgery.
Sagittal images demonstrate incompletely evaluated degenerative changes in the
included upper cervical spine.
IMPRESSION:
1. Two punctate acute to early subacute infarcts in the left frontal
periventricular white matter and left posterior frontal corona radiata.
2. Multiple chronic small vessel infarcts in the bilateral basal ganglia.
3. Extensive T2/FLAIR signal abnormalities in the supratentorial white matter,
nonspecific but likely sequela of chronic small vessel ischemic disease in
this age group.
4. Chronic microhemorrhages in the right greater than left basal ganglia and
left cerebellar hemisphere, potentially hypertensive in etiology.
5. Small probable calcified meningioma at the right anterior parietal vertex
without edema in the adjacent brain parenchyma.
RECOMMENDATION(S): Follow-up MRI with and without contrast in 6 months could
be considered to confirm expected stability of the presumed calcified
meningioma, though growth of a completely calcified lesion would be unlikely.
|
10223157-RR-73
| 10,223,157 | 23,981,349 |
RR
| 73 |
2192-07-01 03:26:00
|
2192-07-01 05:17:00
|
INDICATION: ___ with elevated INR, AMS // Eval for infiltrate
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
The cardiomediastinal and hilar contours are stable with moderate
cardiomegaly. There is no pneumothorax. A small to moderate left pleural
effusion is noted. A small right pleural effusion may also be present. Lung
volumes are low. Pulmonary edema is worsened, now least moderate. Bibasilar
opacities are new, most pronounced in the right, concerning for pneumonia.
IMPRESSION:
1. Right lower lobe pneumonia.
2. Worsening pulmonary edema, now moderate.
|
10223157-RR-74
| 10,223,157 | 23,981,349 |
RR
| 74 |
2192-07-01 06:09:00
|
2192-07-01 06:57:00
|
EXAMINATION: FOOT AP,LAT AND OBL BILAT
INDICATION: History: ___ with ___ cellulitis vs. ischemia, nonhealing wounds.
Podiatry requested X rays // Eval for fx, signs of osteo
TECHNIQUE: 6 total views of both feet obtained nonstanding.
COMPARISON: Left foot radiographs ___. No prior radiographs of
the right foot.
FINDINGS:
Right foot: There is an irregular mixed lytic/erosive and sclerotic area of
the distal shaft of the fifth metatarsal with overlying soft tissue swelling.
Contour irregularity of the mid shaft of the fifth metatarsal on the right is
suggestive of a superimposed prior healed fracture. There is no subcutaneous
gas. There is no acute fracture. Alignment is maintained in the midfoot. Soft
tissue and probable vascular calcifications are present.
Left foot: There is no acute fracture. Apparent pes cavus these nonweight
bearing images. No osteolysis or periosteal new bone formation is detected.
Posterior and plantar calcaneal spurs noted bilaterally. No subcutaneous
emphysema is identified. Diffuse osteopenia is present. Vascular
calcifications are also present.
IMPRESSION:
Concern for osteomyelitis of the right distal ___ metatarsal although this
appearance conceivably relates to old healed fracture this bone
|
10223157-RR-78
| 10,223,157 | 23,981,349 |
RR
| 78 |
2192-07-03 13:50:00
|
2192-07-03 19:11:00
|
EXAMINATION: Noninvasive peripheral arterial study
INDICATION: ___ year old woman with UTI, RLE cellulitis, venous stasis disease
in the ___ and ___ discoloration of the R toes // Please ___ for evidence
of occlusion
TECHNIQUE: Non-invasive evaluation of the arterial system in the lower
extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
COMPARISON: None.
FINDINGS:
Please note patient's legs were wrapped from distal to the tip just below the
knees with gauze an Ace bandage, unable to performed Doppler evaluation at
these levels.
Triphasic Doppler waveforms are seen in the bilateral femoral arteries.
Monophasic waveforms are present in the bilateral superficial femoral,
popliteal, posterior tibial and dorsalis pedis arteries.
Pulse volume recordings showed symmetric decreased amplitudes bilaterally, at
the calf, ankle, and metatarsal levels.
IMPRESSION:
Moderate bilateral arterial insufficiency in the superficial femoral and
posterior tibial arteries bilaterally.
|
10223157-RR-79
| 10,223,157 | 23,981,349 |
RR
| 79 |
2192-07-04 07:49:00
|
2192-07-04 12:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with afib with rvr and cellulitis also evidence
of volume overload on exam and prior CXR // please eval for pulmonary edema
and RLL PNA
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Mild pulmonary edema has improved. Moderate cardiomegaly is stable. Bilateral
effusions left greater than right associated with adjacent atelectasis are
grossly unchanged allowing the difference in positioning of the patient. There
is no evident pneumothorax. Right lower lobe opacity is grossly unchanged
could be part of the atelectasis and effusion but superimposed infection can't
be excluded
|
10223157-RR-80
| 10,223,157 | 23,981,349 |
RR
| 80 |
2192-07-05 07:46:00
|
2192-07-05 09:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with afib with rvr and cellulitis also evidence
of volume overload on exam and prior CXR // Please eval interval change of
pulm edema and ?RLL infiltrate/PNA
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Moderate cardiomegaly is stable. Pulmonary edema is mild and stable. Large
bilateral pleural effusions with adjacent atelectasis have increased on the
right. There is no pneumothorax ..
|
10223157-RR-81
| 10,223,157 | 29,662,390 |
RR
| 81 |
2192-08-21 17:43:00
|
2192-08-21 18:19:00
|
INDICATION: ___ with n/v for 3 days, diffusely tenders, KUB showed distended
loops of bowel at nursing home. hx of afib on coumadinNO_PO contrast // eval
for SBO vs diverticulitis vs colitis
TECHNIQUE: CT of the Abdomen and Pelvis with IV contrast and without oral
contrast
DOSE: DLP: 666 mGy-cm. If not specified, please see PACs series 999 for
dose information.
COMPARISON: Chest x-ray from ___
FINDINGS:
LOWER CHEST: There is partial atelectasis of the right middle lobe. There is a
small right pleural effusion. ___ opacities are noted in the left
lower lobe. There is also a trace left pleural effusion. Mild cardiomegaly is
noted. Aortic valvular calcifications are seen in addition to coronary artery
calcifications. There is a small hiatal hernia. There is also calcification
of the aortic valve.
ABDOMEN:
The liver, spleen, gallbladder, adrenal glands, pancreas are within normal
limits. Kidneys enhance and excrete contrast symmetrically. Numerous renal
hypodensities are noted the largest which are compatible with simple cysts.
The abdominal aorta is severely tortuous with moderate atherosclerotic
calcifications throughout. There is aneurysmal dilatation of the right common
iliac artery at 2.5 cm with a substantial mural thrombus (coronal image 27)
causing approximately 40% narrowing of the artery. Severe calcifications of
the ostia of the SMA and celiac as well as the renal arteries. Small amount
of perihepatic free fluid is identified.
There are numerous abnormalities of the bowel at the level of the deep pelvis.
This includes an the sinus tract extending from the rectosigmoid colon leading
to an extra luminal area of fluid and gas spanning 2.2 x 0.9 cm (2:67) in the
mid pelvis. There is severe tethering of the bowel loops to one another in
this area including tethering of the adjacent small bowel (2:69); slightly
superiorly, there is also noted to be abnormal bowel tethering (2:62).
Finally, there is a 9 cm segment of the sigmoid colon (2:69) which is markedly
thickened and proximal to which there is fluid filled and partially
obstructed. Dilated small bowel loops are seen throughout the abdomen, some of
which demonstrate wall edema, no pneumatosis. The rectum is stool-filled. A
number of the small bowel loops throughout the abdomen are also noted to have
abnormal mucosal hyperenhancement (coronal image 29, in the right lower
quadrant). Scattered sigmoid diverticula are noted.
PELVIS:
Evaluation the pelvic structures is limited due to streak artifact from the
left total hip arthroplasty and is partially described above. In addition,
there is a cystic structure within the pelvis on the left in close association
with the fistulous tracts. This cyst measures 4.7 x 6.9 cm (2:75). Smaller
cystic structures seen in the pelvis on the right measures approximately 3.8 x
3.1 cm. The bladder is not well assessed due to artifact and is thought to be
decompressed. No lymphadenopathy is noted in the pelvis.
BONES AND SOFT TISSUES: No suspicious blastic or lytic lesions. There is
severe degenerative changes of the lumbar spine as well as a S-shaped
scoliosis. Left hip arthroplasty changes are identified.
IMPRESSION:
1. Markedly abnormal bowel in the deep pelvis with apparent fistulous
communication, an extraluminal collection, multiple areas of tethering and a
segment of thickened sigmoid proximal to which there is partially obstructed
bowel. The differential includes possible inflammatory bowel disease versus
prior diverticulitis and subsequent complications. A neoplasm cannot be ruled
out.
2. Cystic structures in the pelvis which should be further assesses on a
nonurgent basis
3. Right common iliac aneurysm with partial mural thrombus
4. Left lower lobe ___ opacities. Question infectious process or
aspiration.
5. Right middle lobe partial collapse.
6. Small right and trace left pleural effusion
7. Aortic valve calcifications
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ in person. If further characterization in detailed evaluation of the
pelvic structures is desired, MR may be of use.
|
10223157-RR-82
| 10,223,157 | 29,662,390 |
RR
| 82 |
2192-08-22 17:46:00
|
2192-08-24 09:09:00
|
EXAMINATION: MR ___
INDICATION: ___ year old woman with fistula/large bowel obstruction
TECHNIQUE: T1 and T2-weighted multiplanar images of the abdomen and pelvis
were acquired within a 1.5 T magnet, without the use of intravenous contrast.
Oral contrast consisted of 900 mL of VoLumen. Examination was terminated
prior to completion due to patient inability to continue.
COMPARISON: Sigmoidoscopy from ___. CT abdomen pelvis from ___
FINDINGS:
MR ENTEROGRAPHY:
The majority of the small bowel and colon continues to be distended, fluid
filled, with multiple air-fluid levels. The level of obstruction within the
mid pelvis is unfortunately poorly evaluated, due to the incomplete,
noncontrast nature of this examination, with particular limitation due to
artifact associated with patient's left hip prosthetic.
Accounting for these limitations, there continues to be a segmental narrowing
of the mid sigmoid colon, with circumferential wall thickening. Adjacent
loops of small bowel are tethered towards this segment. Fistula from the
rectum tracking to the distal sigmoid colon, and continuing superiorly into an
abscess is redemonstrated. This abscess is located along the left side of the
sigmoid mesocolon, approximately 3 cm in largest diameter 10:26. This process
is better characterized on the recent CT. A few scattered diverticula are
seen within the colon.
There is a small hiatal hernia. Nasogastric tube extends into the proximal
stomach which is subsequently decompressed.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Trace bilateral pleural effusions are noted. Small volume ascites is scattered
throughout the abdomen and pelvis, predominantly seen in a perihepatic
distribution.
The noncontrast appearance of the liver, spleen, pancreas and adrenal glands
is unremarkable. There are bilateral T2 hyperintense structures within the
renal parenchyma, almost certainly representing cysts. No hydronephrosis is
noted.
The abdominal aorta is tortuous and following the contour of patient's
levoscoliosis with the apex at the lumbosacral junction.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
As was seen on recent CT scan, there is aneurysmal change of the right common
iliac artery with maximum diameter of 2.3 cm. This is partially thrombosed.
Two pelvic cystic structures are again identified 10:35, without apparent
communication with adjacent bowel loops and not demonstrating peristalsis on
dynamic imaging. These are T2 hyperintense, measuring 6.4 cm on the left and
3.8 cm on the right. These are located in the expected region of the adnexa,
along the course of the gonadal vessels. No thick wall or nodularity is noted.
Each is concerning for a cystic ovarian neoplasm.
The bladder is currently decompressed with a Foley catheter.
IMPRESSION:
Limited, incomplete examination without additional characterization of the
complex, obstructive process within the pelvis beyond the recent CT.
A narrowed and thickened segment of mid sigmoid is noted with tethering of
adjacent small bowel loops, fistularization to rectum and adjacent 3 cm
abscess. Degree of bowel obstruction is relatively unchanged. Findings again
remain concerning for malignancy with perforation, although recent colonoscopy
did not identify a lesion. Alternatively, an inflammatory stricture,
potentially related to diverticulitis, is a consideration.
Two simple appearing pelvic cystic structures, suspicious for bilateral
ovarian cystic neoplasms.
|
10223157-RR-84
| 10,223,157 | 22,211,582 |
RR
| 84 |
2192-10-23 17:58:00
|
2192-10-23 20:01:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: Nausea/vomiting and abdominal pain in a patient with a prior
large bowel obstruction.
TECHNIQUE: Helical axial MDCT images were obtained from the bases of the
lungs through the pubic symphysis, after the administration of IV contrast.
Reformatted images in coronal and sagittal axes were generated.
DLP: 488 mGy-cm.
COMPARISON: CT abdomen/pelvis from ___.
FINDINGS:
Bilateral pleural effusions, left greater than right, with associated
compressive atelectasis on the left. The left-sided pleural effusion is
moderate in size. The right-sided effusion is very small. No pericardial
effusion is identified. There are calcifications along the mitral and aortic
valves as well as coronary arteries.
LIVER: The liver enhances homogeneously without focal lesion or intrahepatic
biliary duct dilation. The portal vein is patent. There is a small amount of
perihepatic free fluid. The gallbladder is distended, without stone or
gallbladder wall edema or thickening.
SPLEEN: The spleen is homogeneous and normal in size.
PANCREAS: The pancreas is without focal lesion or peripancreatic stranding or
fluid collection.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast
promptly. Again noted are multiple hypodensities in each kidney, most of
which are too small to characterize but doubtful in significance. A 1.8 cm
simple cyst can be characterized in the left interpolar region. These are all
unchanged from the most recent CT.
GI:There is a small to moderate hiatal hernia. The stomach is incompletely
distended, but there is no obvious intraluminal mass or wall thickening.There
is diffusely fluid-filled dilated small and distended large bowel with a few
interspersed segments of decompressed small bowel. Again seen is the thickened
sigmoid colon, partially obscured by metallic artifact from the left hip
prosthesis. Proximal colonic wall is borderline thickened only. The
extraluminal soft tissue density with tethering of adjacent bowel loops and a
fistula from the sigmoid colon in the left hemipelvis is again seen, possibly
with slightly increased surrounding stranding. Overall, fluid collections
have generally decreased over time but there are probably residual sinus
tracks and patent fistulas are not excluded.
RETROPERITONEUM: The aorta is tortuous, but normal in caliber, with moderate
atherosclerotic calcifications. Again seen is aneurysmal dilation of the right
common iliac artery with mural thrombus, unchanged. There is no
retroperitoneal or mesenteric lymph node enlargement by CT size criteria.
CT PELVIS: Evaluation is significantly limited secondary to streak artifact
from the left hip prosthesis. Pelvic fluid collections and inflammatory
changes have generally decreased over time, but there is still some left
adnexal fullness, probably sequela of prior inflammatory process or relatively
large ovary.
OSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.
IMPRESSION:
1. Fluid filled, dilated small bowel and distended large bowel, terminating in
a thickened sigmoid colon, consistent with large bowel obstruction.
2. Small amount of perihepatic ascites.
3. Bilateral pleural effusions, left greater than right.
4. Unchanged left pelvic extraluminal soft tissue density with tethering of
adjacent bowel loops and focal thickening, probably stricture, involving the
sigmoid colon. Fluid collections and inflammatory changes have generally
decreased. This appearance may be secondary to stricturing from complicated
diverticular disease but malignancy is not excluded.
5. Unchanged bilateral adnexal fullness, probably associated with sequelae of
inflammatory changes, which have decreased. However, evaluation with pelvic
ultrasound is recommended.
|
10223157-RR-85
| 10,223,157 | 22,211,582 |
RR
| 85 |
2192-10-26 08:07:00
|
2192-10-26 09:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ ___ episode of LBO w/sigmoid wall thickening/adhesions
concerning for possible malignancy vs diverticular abscess now s/p exlap,
sigmoid colectomy, 1'repair SB injury, end colostomy // eval pulm edema
IMPRESSION:
Free intraperitoneal air below the right hemidiaphragm is likely due to
provided history of recent abdominal surgery. Marked leftward patient rotation
limits evaluation of cardiomediastinal contours. Moderate to large left
pleural effusion is accompanied by adjacent left lower lobe collapse. Right
lung is clear except for minor linear atelectasis of the right lung base and a
small adjacent pleural effusion. Repeat nonrotated radiograph would be helpful
for more complete assessment of the chest when the patient's condition
permits.
|
10223662-RR-11
| 10,223,662 | 27,129,617 |
RR
| 11 |
2167-06-05 16:55:00
|
2167-06-05 19:56:00
|
EXAMINATION: CT-guided percutaneous nephrostomy drainage catheter exchange
INDICATION: ___ year old woman with recurrent UTI, pyelo/hydronephrosis, UPJ
obstruction, s/p PCN placement// PCNU placement; FYI SC heparin was not held
last night or this morning but pt not on any other anticoagulation, INR 1.4
COMPARISON: CT dated ___, percutaneous nephrostomy dated ___
PROCEDURE: CT-guided drainage of right pyelo/hydronephrosis.
OPERATORS: Dr. ___, interventional radiology fellow and Dr.
___ radiologist. Dr. ___ supervised the
trainee during the key components of the procedure and reviewed and agrees
with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection and position of
existing percutaneous tube. The existing tube was found to be retracted away
from right renal collecting system. Based on the CT findings an appropriate
skin entry site for the drain placement was chosen. The site was marked. Local
anesthesia was administered with 1% Lidocaine solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the abdominal wall. Once in the fat plane, sharp tip of the
___ Needle was exchanged for a blunt end tip which was advanced in the fat
plane around bowel and adjacent to the right renal collection. The Needle tip
was again exchanged from a blunt and Needle to a sharp and Needle and advanced
into the right renal collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 Amplatz wire was placed through
the needle and needle was removed. This was followed by placement of ___
30 cm Bard pigtail catheter into the collection. The metal stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 5 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam. !If this Fluency report was activated before the completion
of the dose transmission, please reinsert the token called CT DLP Dose to load
new data.
SEDATION: Moderate sedation was provided by administering divided doses of 0
mg Versed and 200 mcg fentanyl throughout the total intra-service time of 80
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. 1 g of Ancef was given
pre-procedurally.
FINDINGS:
Preprocedure CT scan demonstrated existing nephrostomy tube was retracted away
from the right renal collecting system. Right renal collecting system was
dilated with market perinephric stranding.
Intraprocedural CT scans demonstrated a small window in between 2 bowel loops.
Final images demonstrate catheter in appropriate position with pigtail in
right nephric collection with catheter adjacent to bowel loops but not through
them.
IMPRESSION:
Successful CT-guided placement of an ___ 30 cm pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
RECOMMENDATION(S): Keep drainage to bag
|
10223662-RR-5
| 10,223,662 | 27,129,617 |
RR
| 5 |
2167-05-29 13:29:00
|
2167-06-05 10:33:00
|
EXAMINATION: SECOND OPINION CT TORSO
INDICATION: ___ diabetic, morbidly obese female with purported
recurrent urinary tract infection, ESBL organism historically recovered from
urine, transferred from two hospitals for probable percutaneous nephrostomy in
the context of hydronephrosis and superimposed pyelonephritis secondary to
chronic ureteropelvic junction obstruction.// reports submitted to achieve on
CC3
TECHNIQUE: Outside institution single phase contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP 2997.50 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a small subcentimeter low-density lesion in hepatic segment 6 (series
3, image 36) too small to adequately characterize. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spine is within upper limits of normal size
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The right kidney is markedly enlarged measuring 13.1 cm on axial
dimension and 9.3 cm craniocaudal dimension, demonstrating extensive
perinephric stranding compatible with severe hydronephrosis with
pyelonephritis. There is no stone seen. Evaluation of obstructive mass or
tumor is limited on this noncontrast exam. There is also extensive
inflammatory stranding surrounding a dilated ureter extending to the bladder.
Findings are compatible with severe hydroureteronephrosis with superimposed
pyelonephritis. The left kidney is normal.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits.
PELVIS: The bladder is under distended. There is no free fluid in the pelvis.
LYMPH NODES: Prominent retroperitoneal lymph node likely inflammatory.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
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. Severe right-sided hydroureteronephrosis with superimposed pyelonephritis.
No definite calculus or obstructive lesion seen, although evaluation of tumor
is limited on this noncontrast exam.
2. Prominent abdominal lymph nodes likely reactive.
|
10223662-RR-6
| 10,223,662 | 27,129,617 |
RR
| 6 |
2167-05-29 17:18:00
|
2167-05-30 09:57:00
|
INDICATION: ___ year old woman with supapubic tenderness with infected R
kidney// PCN placement
COMPARISON: Ultrasound ___
TECHNIQUE: OPERATORS: Dr. ___, attending Interventional
Radiologist performed the procedure.
ANESTHESIA: General anesthesia was provided.
MEDICATIONS:
CONTRAST: 0 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: None
PROCEDURE: 1. Right ultrasound guided renal collecting system access.
2. Right nephrostomy tube placement.
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 flank was prepped and draped in the usual sterile
fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues,
the right renal collecting system was accessed anteriorly under ultrasound
guidance using a 21 gauge Cook needle. Ultrasound images of the access were
stored on PACS. Prompt return of purulent material confirmed appropriate
positioning. Under ultrasound guidance, a Nitinol wire was advanced into the
renal collecting system. After a skin ___, the needle was exchanged for an
Accustick sheath. One the tip of the sheath was in the collecting system; the
sheath was advanced over the wire, inner dilator and metallic stiffener. The
wire and inner dilator were then removed. A ___ wire was advanced through
the sheath and coiled in the collecting system. The sheath was then removed
and a 10 ___ nephrostomy tube was advanced into the renal collecting
system. The wire was then removed and the pigtail was formed in the collecting
system. The catheter was then flushed, 0 silk stay sutures applied and the
catheter was secured with a Flexitrack device and sterile dressings. 300 cc
of purulent material was aspirated from the renal collecting system. The
catheter was attached to a bag.
FINDINGS:
Marked hydronephrosis of the right kidney.
300 + cc of purulent material aspirated from the right renal collecting system
and sent for culture.
Satisfactory placement of a ___ F right PCN by ultrasound. A CT is recommended
to confirm proper positioning given visual limitations due to body habitus.
IMPRESSION:
Successful placement of an anterior approach 10 ___ nephrostomy on the
right.
|
10223662-RR-7
| 10,223,662 | 27,129,617 |
RR
| 7 |
2167-05-30 01:58:00
|
2167-05-30 02:56:00
|
EXAMINATION: ?PCN placement
INDICATION: ___ diabetic, morbidly obese female with purported
recurrent urinary tract infection, ESBL organism historically recovered from
urine, transferred from two hospitals for probable percutaneous nephrostomy in
the context of hydronephrosis and superimposed pyelonephritis secondary to
chronic ureteropelvic junction obstruction. S/p ultrasound guided PCN
placement by ___ on ___, requesting CT abd to demonstrate proper placement.//
?PCN placement
TECHNIQUE: MDCT axial images were acquired through the abdomen without
intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
COMPARISON: ___ CT abdomen and pelvis
FINDINGS:
The lack of intravenous contrast administration and the patient's body habitus
limits evaluation of the intra-abdominal solid organs and the bowel.
Lungs: There is mild atelectasis in the bilateral lung bases. The partially
imaged main pulmonary is dilated, measuring 4.5 cm in caliber, suggesting
underlying pulmonary hypertension. There is no pleural effusion.
Liver: The liver is homogeneous with a smooth contour.
Biliary: There is no intrahepatic or extrahepatic bile duct dilatation. The
gallbladder is grossly unremarkable.
Spleen: The spleen is not enlarged and is homogeneous.
Pancreas: There is fatty atrophy of the pancreas. There is no main duct
dilatation.
Adrenal glands: Unremarkable.
Urinary: There has been interval placement of a right percutaneous
nephrostomy. The pigtail is probably within a mid to upper calyx of the right
kidney, with interval improvement in the degree of dilatation of the renal
pelvis. There is persistent enlargement of the kidney, in keeping with known
pyonephrosis (output from the nephrostomy tube is reportedly purulent). There
is persistent perinephric fluid and stranding.
The left kidney is unremarkable. No renal stones are seen.
Gastrointestinal: Visualized small and large bowel loops are normal in
caliber, without obstruction.
Vascular: There are mild atherosclerotic calcifications of the abdominal
aorta.
Lymph nodes: There is no size significant lymph nodes.
Bone and soft tissues: There is no suspicious osseous lesion. There are
severe degenerative changes of the lumbar spine.
IMPRESSION:
Technically limited study. Interval placement of a right percutaneous
nephrostomy. Pigtail is probably within a mid to upper calyx of the right
kidney, with interval improvement the degree of dilatation of the renal
pelvis. Persistent enlargement of the kidney, in keeping with known
pyonephrosis (output from the nephrostomy tube is reportedly purulent).
|
10223662-RR-8
| 10,223,662 | 27,129,617 |
RR
| 8 |
2167-05-31 11:53:00
|
2167-05-31 18:05:00
|
INDICATION: ___ diabetic, morbidly obese female with purported
recurrent urinary tract infection, ESBL organism historically recovered from
urine, transferred from two hospitals for probable percutaneous nephrostomy in
the context of hydronephrosis and superimposed pyelonephritis secondary to
chronic ureteropelvic junction obstruction now s/p PCN with WBC count
concerning to ___ for malpositioining of PCN.// eval PCN location
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.6 s, 60.7 cm; CTDIvol = 24.5 mGy (Body) DLP =
1,484.4 mGy-cm.
Total DLP (Body) = 1,484 mGy-cm.
COMPARISON: prior abdominal CT from ___.
FINDINGS:
Optimal evaluation of organ pathology and vasculature is limited without the
benefit of intravenous contrast.
LOWER CHEST: Redemonstration of small consolidations versus subsegmental
atelectasis in both lower lobes, right greater the left. There is no evidence
of pleural or pericardial effusion. Enlarged main pulmonary artery measuring
5.3 cm, raises question of underlying pulmonary arterial hypertension.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. The gallbladder is incompletely evaluated in the absence of intravenous
contrast.
PANCREAS: There is uniform atrophy of the pancreatic parenchyma without main
duct dilation.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Redemonstration of an enlarged right kidney with perinephric fat
stranding. There is an anterior approach percutaneous nephrostomy tube with
identical positioned compared to prior CT from ___. the right kidney
cannot be additionally evaluated given lack of intravenous contrast. There is
significant stranding of fat surrounding the right kidney, which may be
related to the nephrostomy procedure along with hyperdense material in the
expected location of the right renal pelvis.
GASTROINTESTINAL: No bowel obstruction.
PELVIS: The urinary bladder is decompressed with an indwelling Foley catheter.
There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Pelvic phleboliths are noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative disc disease is seen at L2-3 and L3-4 levels.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Re-demonstrated is an anterior approach percutaneous nephrostomy tube
terminating within the right renal collecting system, unchanged in position
compared to the CT from ___. Limited assessment of the right
kidney in the absence of intravenous contrast. Persistent stranding of fat
surrounding the right kidney noted.
2. Subsegmental atelectasis is seen at bilateral lung bases.
3. Severely enlarged main pulmonary artery concerning for underlying pulmonary
hypertension. Recommend correlation with echocardiogram Findings.
|
10223662-RR-9
| 10,223,662 | 27,129,617 |
RR
| 9 |
2167-06-02 09:50:00
|
2167-06-02 10:45:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with picc// r picc 55cm ping iv ___ Contact
name: ping, ___: ___
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: None.
FINDINGS:
Right-sided PICC line terminates at the level of the mid SVC. Heart size is
normal. Hilar and mediastinal contours are normal aside from mild pulmonary
vascular congestion. There is mild left basilar atelectasis. There is no
pleural effusion or pneumothorax. Visualized osseous structures are grossly
unremarkable.
IMPRESSION:
Right-sided PICC line terminates within the mid SVC.
|
10223996-RR-34
| 10,223,996 | 28,831,691 |
RR
| 34 |
2180-05-11 16:03:00
|
2180-05-11 16:24:00
|
INDICATION: History: ___ with abdominal pain//evaluate for small bowel
obstruction
TECHNIQUE: Supine and upright AP views of the abdomen
COMPARISON: CT abdomen pelvis ___
FINDINGS:
Several dilated loops of small bowel measure up to 3.8 cm in the left abdomen
with differential air-fluid levels on the upright view and a "string of
pearls" sign. No free intraperitoneal air is noted. Large amount of stool
seen in the sigmoid colon. There is no pneumatosis. Cholecystectomy clips
are demonstrated in the right upper quadrant of the abdomen. No concerning
osseous abnormality is seen. Mild degenerative changes are noted in the lower
lumbar spine.
IMPRESSION:
1. Findings concerning for small bowel obstruction. Consider further
assessment with CT of the abdomen with intravenous contrast.
2. Large amount of stool in the sigmoid.
|
10223996-RR-35
| 10,223,996 | 28,831,691 |
RR
| 35 |
2180-05-11 20:42:00
|
2180-05-11 21:28:00
|
EXAMINATION: CT abdomen pelvis
INDICATION: ___ with h/o sbo, CCY, sm bowel resection who is here with abd
pain, nausea, and no flatus c/f sbo// sbo?
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) = 1,533 mGy-cm.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: Lung bases are clear. 3 mm right lower lobe pulmonary nodule no
pleural effusion. Partially imaged extensive atherosclerotic coronary artery
calcifications noted. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. Minimal intrahepatic biliary dilation
likely related to patient's cholecystectomy. No extrahepatic biliary
dilation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality. A 4.0 cm simple cyst noted in lower pole left
kidney. Numerous additional subcentimeter hypodensities bilaterally too small
to characterize, but likely represent simple cysts.
GASTROINTESTINAL: The stomach contains an NG-tube. Proximal small bowel loops
are diffusely dilated measuring up to 3.7 cm. Transition point is seen in the
low anterior abdomen just distal to a small bowel anastomosis (02:55). Small
bowel loops are decompressed distal to this. No evidence of small-bowel wall
hypoenhancement. No free air to suggest perforation. The colon and rectum
are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small fat containing umbilical hernia is noted.
IMPRESSION:
Small-bowel obstruction with transition point occurring just distal to a small
bowel anastomosis in jejunal loops in the low mid abdomen. No evidence of
ischemia or perforation.
|
10223996-RR-36
| 10,223,996 | 28,831,691 |
RR
| 36 |
2180-05-12 12:42:00
|
2180-05-12 18:21:00
|
INDICATION: ___ year old man with SBO (To be done 13)// gastroview progression
(To be done 13)
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: Chest CT ___.
FINDINGS:
No bowel obstruction or free air demonstrated. The oral contrast is now in
the rectum. No dilated loops of bowel are seen. Lung bases are clear.
Cholecystectomy clips.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No bowel obstruction, evidenced by oral contrast in the rectum.
|
10224171-RR-41
| 10,224,171 | 28,866,833 |
RR
| 41 |
2189-08-03 20:33:00
|
2189-08-04 11:00:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old man with shortness of breath // ?new consolidation
COMPARISON: Chest radiographs ___ through ___ at 11:12.
IMPRESSION:
Right lower lobe collapse and small right pleural effusion unchanged. Lungs
otherwise grossly clear. Heart size normal. No pneumothorax.
|
10224171-RR-42
| 10,224,171 | 28,866,833 |
RR
| 42 |
2189-08-03 21:57:00
|
2189-08-03 22:59:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with hypoxia and shortness of breath. Evaluate
for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the bilateral lower extremity veins.
|
10224171-RR-44
| 10,224,171 | 28,866,833 |
RR
| 44 |
2189-08-07 08:24:00
|
2189-08-07 09:31:00
|
EXAMINATION:
CHEST PORT. LINE PLACEMENT
INDICATION:
___ year old man with new line // new right brachial POWER PICC 37 ___
___ Contact name: ___: ___
TECHNIQUE: Chest single view
___
IMPRESSION:
There is new right-sided PICC line with tip at the cavoatrial junction. There
continues to be right lower lobe collapse. There is hazy alveolar infiltrate
on the right that slightly increased. The right-sided effusion is also
slightly increased. There is a minimally displaced right postero lateral
fifth rib fracture that is displaced more than on prior studies. The
appearance of the left lung is unchanged
|
10224171-RR-45
| 10,224,171 | 28,866,833 |
RR
| 45 |
2189-08-08 09:16:00
|
2189-08-08 17:10:00
|
EXAMINATION: Video oropharyngeal swallow
INDICATION: ___ year old man with suspected aspiration // aspirating?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: None available
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was trace penetration with thin liquid. There was
pharyngeal residue.
IMPRESSION:
Trace penetration with thin liquid.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10224171-RR-48
| 10,224,171 | 28,866,833 |
RR
| 48 |
2189-08-10 12:53:00
|
2189-08-10 14:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with RML collapse // s/p bronch
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Interval similar appearance is in the right lower and right middle lobe with
persistent and potentially slightly worsening atelectasis. Right pleural
effusion is present. The rest of the lung appear to be unchanged. The rib
fracture of the right fifth rib is re- demonstrated.
|
10224171-RR-49
| 10,224,171 | 28,866,833 |
RR
| 49 |
2189-08-10 16:52:00
|
2189-08-10 22:34:00
|
INDICATION: ___ year old man with HCAP, lung cancer s/p lobectomy // Please
perform dyanamic CT airway to evaluate for tracheobronchomalacia
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen at end inspiration and during dynamic expiration. Dynamic expiratory
phase imaging was repeated. IV Omnipaque contrast was administered. Axial
images were interpreted in conjunction with sagittal and coronal reformats.
DLP: 663 mGy-cm
COMPARISON: Prior exams, most recent chest CT of ___.
FINDINGS:
AIRWAYS:
The patient is status post right lower lobe lobectomy for squamous cell
carcinoma. The appearance of the right lower lobe bronchial stump is stable
without new soft tissue to suggest local recurrence. Dynamic expiratory phase
imaging is limited by inability of the patient to perform respiration tasks
required for the exam, and there is no significant collapsibility demonstrated
on dynamic expiratory vs inspiratory imaging. The trachea is enlarged,
measuring 3.1 cm in diameter, and has a lunate configuration, consistent with
tracheomegaly. The tracheal wall is neither thickened nor calcified. Both the
right and the left mainstem bronchi are also enlarged.
Retained secretions are present in the lower trachea and the bronchus
intermedius. The right upper lobe bronchus is widely patent. The takeoff of
the right middle lobe bronchus appears narrowed, similar to ___.
Bronchiectasis is severe and cystic in the right middle lobe, similar to ___, with near complete collapse of the right middle lobe.
Bronchiectasis and mucous plugging in the left lower lobe has overall improved
since ___.
LUNGS:
Ground-glass and consolidative opacities within the peripheral posterior
segment of the right upper lobe is similar to ___. Peripheral
irregular and nodular consolidation along the left lower lobe are also similar
to ___, but have increased since ___. 9 mm spiculated left
upper lobe nodular opacity (4:150) has become more confluent since ___ and is new since ___. Ill-defined but approximately 2.4 x 1.7
cm left lower lobe central peribronchovascular opacity (4:181) is new since ___ and is unlikely to represent neoplasm given short interval
development. No new areas of consolidation compared to ___. Severe
centrilobular and paraseptal emphysema is upper zone predominant. Increased
lucency of the left lower lobe is consistent with air trapping.
Small loculated right pleural effusion is slightly decreased in volume since
___, but thickening of the visceral and parietal pleura is more
apparent, suggesting a complex exudative effusion. No significant left pleural
effusion. No pneumothorax.
SOFT TISSUES:
The main pulmonary artery and remaining lobar and segmental pulmonary arteries
appear well opacified without evidence of filling defect. The aorta is normal
caliber. A right PICC terminates at the superior cavoatrial junction.
Scattered thoracic aortic calcifications, aortic valvular calcifications, and
dense coronary artery calcifications are similar to prior. The heart size is
normal. No pericardial effusion.
Numerous mildly enlarged mediastinal lymph nodes are similar or slightly
enlarged compared to ___, including 18 x 12 mm right lower
paratracheal (2:37), 11 mm subcarinal node, and 11 mm prevascular node (2:35).
Prominent bilateral hilar nodes, ranging in size up to 9 mm on the left and 12
mm on the right, appear stable. Axillary and supraclavicular nodes are not
pathologically enlarged. The thyroid gland is normal.
The esophagus is patulous throughout its course and a small fluid-contrast
level is present in the lower esophagus. Moderate-sized hiatal hernia is
similar to prior. The gallbladder appears distended without wall thickening
but is incompletely imaged. Cystic right renal lesion is stable.
OSSEOUS STRUCTURES:
No focal lytic or sclerotic lesion concerning for malignancy. Sternotomy
wires are intact. Right lateral rib fractures are stable and may be
post-operative. Multilevel cervical and thoracic spine degenerative changes
are similar to prior.
IMPRESSION:
1. Status post right lower lobe lobectomy.
2. Assessment for tracheobronchomalacia is limited due to poor voluntary
ability to cooperate with inspiratory and expiratory respiratory instructions.
No excessive collapsibility is observed but bronchoscopic assessment or repeat
trachea CT when the patient is able to better cooperate may be considered for
more complete assessment, especially given the presence of
tracheobronchomegaly and lunate configuration of the trachea.
3. Multifocal ground-glass, consolidative, and nodular opacities, similar to
___ but increased since ___. Findings are most compatible
with a multifocal infectious pneumonia or cryptogenic organizing pneumonia.
However, given the nodular configuration of several of these opacities, close
followup imaging is recommended to assess for resolution after therapy in
order to exclude malignancy.
4. Intraluminal airway l secretions within the lower trachea and lower lobe
bronchi. Persistent right middle lobe collapse since ___, with
narrowing of the right middle lobe bronchus.
5. Small loculated right pleural fluid with adjacent mild enhancement of
pleural thickening, suggesting a complex exudative effusion.
6. Mediastinal and hilar lymphadenopathy, minimally increased since ___.
7. Large hiatal hernia with patulous esophagus containing retained contrast
and fluid distally, which may predispose the patient to aspiration.
8. Distended gallbladder without wall thickening.
|
10224335-RR-16
| 10,224,335 | 27,287,008 |
RR
| 16 |
2190-02-10 21:14:00
|
2190-02-10 23:39:00
|
INDICATION: Post-Whipple on ___ with bloody fluid from the surgical
drain.
COMPARISON: CT available from ___.
TECHNIQUE: MDCT-acquired 5-mm axial images of the abdomen and pelvis were
obtained following the uneventful administration of 130 mL of intravenous
contrast. Coronal and sagittal reformations were performed at 5-mm slice
thickness.
ABDOMEN: Included views of the lung bases demonstrate mild linear
atelectasis. There is no pericardial or pleural effusion. The heart size is
top normal.
The patient is status post Whipple procedure. Surgical suture material (2:25)
is unchanged in orientation and position. Adjacent to the pancreatojejunostomy
anastomosis is a 6.3 x 3.6 cm poorly marginated fluid and gas containing
collection (2:23). A surgical drain is seen with its tip extending over the
superior margin of this collection (2:21). Of note, since prior exam, the gas
content in this collection is new. Fluid and moderate stranding again extends
along the pancreatic body and tail along the anterior pararenal space, as seen
on the prior examination, slightly increased since the prior exam (2:24). The
pancreatic remnant enhances uniformly.
The main portal vein, SMV, and splenic veins remain patent. The celiac trunk
and SMA are patent and normal in caliber. No definite pseudoaneurysm is seen.
No active extravasation of intravenous contrast is detected.
There is no free air. Multiple enlarged retroperitoneal lymph nodes (2:36)
are unchanged.
Multiple subcentimeter hypodense hepatic lesions (2:13), too small for more
definitive characterization are stable. There is no intrahepatic bile duct
dilation. The spleen, adrenal glands, kidneys, and stomach are normal. The
gastrojejunal anastamosis appears intact. A subcentimeter hypodensity at the
lower pole of the left kidney (2:44) is unchanged.
PELVIS: There is extensive colonic diverticulosis. There is no intrapelvic
free fluid or lymphadenopathy. The urinary bladder, prostate, distal ureters,
and rectum are normal.
OSSEOUS STRUCTURES: There is no acute fracture. No concerning blastic or
lytic lesions are identified. A chronic superior endplate deformity at L1,
likely degenerative, is unchanged (300B:50).
IMPRESSION:
1. S/p Whipple with poorly defined fluid/gas collection adjacent to the
pancreatojejunostomy raising concern for an anastamotic leak. Early abscess
cannot be excluded with this technique.
2. Slight interval increase in fluid around the pancreatic body and tail.
3. No definite pseudoaneurysm or evidence of active contrast extravasation.
4. Patent main portal vein, splenic vein, and SMV.
|
10224335-RR-17
| 10,224,335 | 27,287,008 |
RR
| 17 |
2190-02-11 12:32:00
|
2190-02-11 13:43:00
|
CHEST RADIOGRAPH.
INDICATION: PICC line placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has received a
new left-sided PICC line. The tip of the line projects over the cavoatrial
junction, the course of the line is unremarkable. The previously placed right
internal jugular vein catheter has been removed. Moreover, the previously
placed nasogastric tube was removed.
No evidence of complications, no pneumothorax.
|
10224335-RR-18
| 10,224,335 | 27,287,008 |
RR
| 18 |
2190-02-16 14:38:00
|
2190-02-16 18:40:00
|
STUDY: CT of the abdomen and pelvis with IV and enteric contrast.
INDICATION: ___ male with duodenal adenocarcinoma, status post
Whipple procedure. Evaluate for new leak or collection.
COMPARISON: CT of the abdomen and pelvis dated ___ and ___.
TECHNIQUE: Axial CT images of the abdomen and pelvis was performed from the
level of the lung bases to the proximal femur after the administration of IV
and water-soluble enteric contrast. Multiplanar reconstructions were
performed and reviewed.
Dose Report: Total exam DLP: 923 mGy-cm
FINDINGS:
LUNG BASES: Patchy, linear opacities are seen in the left lung base
reflective of atelectasis. There is a small left pleural effusion.
ABDOMEN AND PELVIS: Within the liver, note is again made of
subcentimeter-sized hypodensities, which are too small to characterize, but
appear stable since previous study. There is a new hypodensity in the left
hepatic lobe extending to the capsule which could be post surgical ( Series 2,
image 9).
The spleen and adrenal glands appear within normal limits. The right kidney
appears normal. Note is again made of a subcentimeter-sized low-attenuation
lesion within the inferior pole of the left kidney, stable.
There is again noted an ill-defined region of fluid and gas adjacent to the
site of the pancreatico-jejunal anastomosis and jejunal stump (series 2,
images ___. This fluid is seen extending along the length of the inferior
aspect of the pancreas in the anterior pararenal space extending to the level
of the hilum of the spleen, slightly decreased since previous study. No focal
abnormalities are seen within the pancreas. The spleen vein, superior
mesenteric vein and portal vein are patent. The celiac axis and SMA appear
within normal limits. There are surgical staples again seen anterior to the
IVC at the level of the renal vein-IVC confluence. There is a drainage
catheter, which extends from the region of the lesser curvature of the stomach
along the inferior portion of the liver exiting the right anterior abdominal
wall. There are again noted multiple mildly prominent porta hepatis and
retroperitoneal and mesenteric lymph nodes, stable since previous study.
There are post-surgical changes and edematous changes involving the mesentry.
There is thickening of the anterior pararenal fascia on the left. There is
slightly increased fluid medial and inferior to the stomach (series 2, images
___ extending up to the level of the gastrojejunostomy site.
There is no extraluminal collection of contrast to suggest leak, although
please note that the administered oral contrast transits through the
gastrojejunal anastomosis and does not travel retrograde towards the site of
pancreatico-jejunal anastomosis.
The small bowel is normal in caliber. Contrast is seen within the large
bowel. There are colonic diverticula, predominantly within the sigmoid and
left colon without evidence of diverticulitis.
Minimal quantity of pelvic free fluid is seen. The pelvic organs otherwise
appear within normal limits.
There is no pelvic lymphadenopathy.
Bilateral benign-appearing iliac lymph nodes are seen with fatty hila (series
2, image 68).
Atherosclerotic vascular calcification of the abdominal aorta is again noted.
No suspicious osteolytic or osteoblastic lesions are seen within the
visualized osseous structures. There are degenerative changes within the
spine.
IMPRESSION:
Slight interval decrease in size of ill-defined fluid collection adjacent to
site of pancreatico-jejunostomy and extending along the inferior aspect of the
pancreas. No defined abscess.
Small new ill-defined fluid collection along the inferomedial aspect of the
stomach without enhancing wall.
Contrast did not reflux up to the stump to assess for leak here.
Unchanged prominent mesenteric, porta hepatis and retroperitoneal lymph nodes.
Small left pleural effusion.
Diverticulosis without evidence of diverticulitis.
|
10224335-RR-29
| 10,224,335 | 22,606,002 |
RR
| 29 |
2192-07-03 02:16:00
|
2192-07-03 03:32:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: History: ___ with h/o duodenal cancer, CAD presenting with visual
changes, confusion and word finding difficulties // please eval for stroke or
abnormalities
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of 70 cc of Omnipaque
intravenous contrast material. Images were processed on a separate workstation
with display of curved reformats, 3D volume redendered images, and maximum
intensity projection images.
DOSE: DLP: ___ MGy-cm
COMPARISON: Outside hospital noncontrast head CT dated ___.
FINDINGS:
[HEAD CT: There is encephalomalacia involving the right parietal and
occipital lobes. There is hypodensity with loss of the gray-white matter
differentiation in the left the occipital lobe indicative of an evolving acute
infarct. There is no hemorrhage, mass effect or midline shift. The ventricles,
sulci and cisterns are appropriate for age.
The orbits, paranasal sinuses and mastoid air cells are unremarkable.
HEAD AND NECK CTA: There is mild calcified atherosclerotic disease of the
carotid siphons without evidence of significant stenosis. The anterior, and
middle cerebral arteries are unremarkable. The posterior communicating
arteries are not identified. There is mild bulbous dilatation of the basilar
tip.
There is a 3 vessel left-sided aortic arch there is calcified atherosclerotic
disease at the carotid bifurcations bilaterally without evidence of
significant stenosis based on NASCET criteria.
The left vertebral artery is dominant. There is moderate stenosis at the
origin of the right vertebral artery.
There is a 6 mm nodule within the left upper lobe.
IMPRESSION:
Evolving acute infarct involving the left occipital lobe. Unchanged
encephalomalacia involving the right parietal and occipital lobes. There is no
intracranial hemorrhage.
Head CTA is unremarkable without evidence of significant stenosis, aneurysm or
other vascular abnormality.
There is moderate stenosis at the origin of the right vertebral artery. The
neck CTA is otherwise unremarkable.
There is a 6 mm nodule within the left upper lobe. Recommend a dedicated chest
CT for further evaluation.
|
10224335-RR-30
| 10,224,335 | 22,606,002 |
RR
| 30 |
2192-07-03 08:51:00
|
2192-07-03 12:33:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with new onset vision loss and nonfluent aphasia
// assess infarct, lesion, PRES
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of cc of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT angiography of ___ 14.
FINDINGS:
There are multiple acute infarcts identified. A left posterior cerebral artery
territory infarct as well as a right parietal occipital posterior cerebral
artery infarct are identified. In addition, there are multiple small infarcts
seen in both cerebral hemispheres in the parietal and frontal lobes as well as
several foci of acute infarction within both cerebellar hemispheres. Small
acute infarct is seen in the left thalamus. There is no midline shift or
hydrocephalus. Mild changes of small vessel disease seen. No abnormal
enhancement identified. No evidence of acute or chronic blood products.
IMPRESSION:
Multiple acute infarcts are identified without blood products as described
above. The larger infarcts are seen in both posterior cerebral artery
territories.
|
10224335-RR-31
| 10,224,335 | 22,606,002 |
RR
| 31 |
2192-07-03 17:57:00
|
2192-07-03 21:47:00
|
EXAMINATION: CT TORSO W/CONTRAST
INDICATION: ___ year old man with known history of duodenal carcinoma with
lung and liver mets. Now here with two embolic strokes. Looking for recurrent
disease, compare with last scan in ___ // Mets?
TECHNIQUE: MDCT imaging of the abdomen and pelvis with intravenous contrast
performed. Multiplanar reformats were prepared and reviewed.
DOSE: DLP: mGy-cm
COMPARISON: Comparison is made with CT torso from ___ and OSH CT
abdomen from ___.
FINDINGS:
CHEST: Two new pulmonary nodules are seen in the right middle lobe, measuring
12 x 7 mm (2:37) and 8 x 6 mm (2:40). Innumerable sub 4 cm pulmonary nodules
are again seen throughout the lungs. Some of the nodules appear to be new from
prior exam while other previously seen nodules are less conspicuous on this
exam. A subpleural nodule measuring 13 x 6 mm (2:46) is seen in the left lung
base, unchanged from prior exam. The lungs are otherwise clear. The airways
are patent to the subsegmental levels bilaterally. No pathologically enlarged
axillary, mediastinal, or hilar lymph nodes are identified. There is no
pleural effusion. The heart and pericardium are within normal limits.
ABDOMEN: LIVER: Innumerable hypodense lesions are seen scattered throughout
the liver, new from prior exam and consistent with increased metastatic
disease. There is no biliary ductal dilatation.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The patient is status post Whipple. The remaining pancreas enhances
homogeneously and is unremarkable.
SPLEEN: The spleen demonstrates a focal hypodense lesion, which could
represent metastasis or possibly an infarct.
ADRENALS: The adrenal glands are unremarkable bilaterally.
KIDNEYS: A hypodensity is seen in the left kidney too small to characterize
likely representing a renal cyst. The kidneys are otherwise unremarkable.
GI: The patient is status post Whipple. The remaining stomach, remaining small
bowel, and large bowel are normal in caliber and unremarkable. The appendix
is unremarkable.
RETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.
VASCULAR: The abdominal aorta demonstrates atherosclerotic calcifications but
is otherwise normal in appearance.
PELVIS: There is colonic diverticulosis without diverticulitis. The sigmoid
colon and rectum are normal in appearance. The distal ureters and bladder are
normal. There is no pelvic or inguinal lymphadenopathy. There is no free fluid
in the pelvis.
BONES AND SOFT TISSUES: Sclerotic osseous lesions suspicious for metastatic
disease are seen in T12 and L2. The lesion in L2 demonstrates destruction of
the cortex of the vertebral body with large soft tissue component of the
tumor, which measures 3.9 x 3.3 cm. A sclerotic lesion is seen in the sacrum
adjacent to the SI joint on the left.
IMPRESSION:
1. Two new pulmonary nodules in the right middle lobe, which may represent
metastatic disease.
2. New innumerable hypodense lesions scattered throughout the liver,
consistent with increased metastatic disease.
3. Splenic hypodense lesion, which could represent metastasis or possibly
infarct.
4. Sclerotic osseous lesions in T12 and L2, consistent with metastatic
disease. The L2 lesion demonstrates cortical destruction and a large soft
tissue component.
|
10224362-RR-31
| 10,224,362 | 20,664,466 |
RR
| 31 |
2157-12-13 13:26:00
|
2157-12-13 14:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p L sided chest tube for pleural effusoin //
evaluate for pneumothorax
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left pleural effusion has decreased in volume. There is improved atelectasis
in the left lower lobe. Cardiomediastinal silhouette is stable. Small right
pleural effusions unchanged.
|
10224362-RR-32
| 10,224,362 | 20,664,466 |
RR
| 32 |
2157-12-14 08:09:00
|
2157-12-14 10:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest tube in place // Evaluation of
pleural fluid
TECHNIQUE: Portable chest AP
COMPARISON: Chest radiograph dated ___
FINDINGS:
The pigtail catheter remains unchanged in position at the left lung base.
In comparison to the radiograph from ___, there has been interval
decrease in size of the left pleural effusion. There is associated
compressive atelectasis of the left lower lobe. Right basilar atelectasis.
No new focal consolidation. No pneumothorax. Cardiomediastinal silhouette is
enlarged but unchanged.
IMPRESSION:
1. Interval decrease in size of the left pleural effusion.
2. Associated compressive atelectasis of the left lower lobe.
3. No pneumothorax.
|
10224362-RR-33
| 10,224,362 | 20,664,466 |
RR
| 33 |
2157-12-15 07:58:00
|
2157-12-15 09:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with chest tube // Evaluation of pleural
effusion
IMPRESSION:
In comparison with the study of ___, the left chest tube remains in
place and there is little change in the degree of pleural effusion with
compressive atelectasis at the base. No evidence of appreciable pneumothorax.
Cardiomediastinal silhouette is stable. There has been substantial
improvement in pulmonary vascular status with only relatively mild vascular,
congestion at this time.
|
10224362-RR-34
| 10,224,362 | 20,664,466 |
RR
| 34 |
2157-12-16 10:40:00
|
2157-12-16 15:56:00
|
INDICATION: ___ year old man with pleural effusion // evaluation of pleural
effusion
COMPARISON: ___
IMPRESSION:
No significant change in left-sided pigtail catheter. Cardiomediastinal
silhouette is stable. There may be interval improvement in aeration of the
left lung base with persistent small left pleural effusion with compressive
atelectasis. Mild prominence of the pulmonary vasculature. Left basilar and
retrocardiac atelectasis. Tortuous aorta. There are no pneumothoraces.
|
10224374-RR-21
| 10,224,374 | 28,232,517 |
RR
| 21 |
2171-07-11 20:48:00
|
2171-07-11 22:38:00
|
INDICATION: ___ with ascites.
TECHNIQUE: Grayscale and color ultrasound images of the liver and gallbladder
were obtained.
COMPARISON: None.
FINDINGS: There is moderate-to-large amount of mainly simple ascites in all
four quadrants, most pronounced in the right lower quadrant. There is liver
cirrhosis with slightly increased echogenicity of the liver. The portal vein
is patent with normal hepatopetal flow. The gallbladder has been surgically
removed. The CBD is normal measuring 4 mm. The spleen is enlarged measuring
15 cm in length.
IMPRESSION:
1. Patent main portal vein with hepatopetal flow.
2. Moderate-to-large amount of mainly anechoic ascites with small quantities
of echogenic debris.
3. Findings consistent with cirrhosis.
4. Splenomegaly.
|
10224486-RR-23
| 10,224,486 | 28,029,898 |
RR
| 23 |
2135-06-27 08:06:00
|
2135-06-27 09:46:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with altered mental status, nausea, vomiting
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: ___
FINDINGS:
Cardiac silhouette size remains mildly enlarged. Mediastinal and hilar
contours are relatively unchanged. Mild pulmonary edema is present with
perihilar haziness and vascular indistinctness. There may be a trace left
pleural effusion. Patchy bibasilar opacities likely reflect atelectasis. No
pneumothorax is detected.
IMPRESSION:
Mild pulmonary edema and probable bibasilar atelectasis. Small left pleural
effusion is likely present.
|
10224486-RR-24
| 10,224,486 | 28,029,898 |
RR
| 24 |
2135-06-27 08:08:00
|
2135-06-27 09:05:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with altered mental status, nausea, vomiting
TECHNIQUE: Contiguous axial images of the brain were obtained without
intravenous contrast. Coronal and sagittal as well as thin bone-algorithm
reconstructed images were obtained.
DOSE: DLP: 892 mGy-cm;
CTDIvol: 54 mGy
COMPARISON: CT head without IV contrast ___, and MRI ___
FINDINGS:
There is no evidence of acute major vascular territory infarction, hemorrhage,
edema, or mass. Hypodense region in the right cerebellum which is new since
___, likely reflects an area of interval infarction. Bilateral
periventricular, subcortical and deep white matter hypodensities are likely a
sequela of chronic small vessel ischemic disease. Prominent ventricles and
sulci suggest the age-related volume loss, grossly unchanged from prior. Basal
cisterns are patent.
No osseous abnormalities seen. There is mucosal thickening within the
anterior ethmoid air cells and left frontal sinus. Remainder of the visualized
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
orbits are unremarkable.
The known anterior communicating artery aneurysm is better visualized on the
prior MRA dated ___.
IMPRESSION:
No acute intracranial process. Interval development of right cerebellar
infarct since ___.
|
10224486-RR-25
| 10,224,486 | 28,029,898 |
RR
| 25 |
2135-06-29 10:05:00
|
2135-06-29 16:16:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with h/o CVA ___ (right hippocampus and right
internal capsule), interval cerebellar infarct, admitted w/ worsening
imbalance // eval for interval ischemic changes
TECHNIQUE: T1 sagittal and axial and FLAIR, T2, susceptibility and diffusion
axial images of the brain were acquired. Following gadolinium administration,
the MPRAGE sagittal images were acquired with axial and coronal reformats. 2
D time-of-flight and Gadolinium enhanced MRA of the neck was acquired.
COMPARISON: ___.
FINDINGS:
Acute infarcts in the distribution of the right posterior inferior cerebellar
artery. No other infarcts are identified. There is no evidence of acute or
chronic blood products. There is no significant mass effect seen on the fourth
ventricle. There are moderate changes of small vessel disease in the
periventricular white matter and in the brainstem. No abnormal enhancement is
seen.
MRA of the neck demonstrates slight delayed acquisitions. The proximal right
vertebral artery is not visualized. This appears to be slight extension of
changes seen on the previous MRA examination. The distal V2, V3 and V4
segments of the right vertebral artery are visualized on the postcontrast MRA.
Limited evaluation of both carotid arteries demonstrate no evidence of
vascular occlusion or stenosis. The left vertebral artery proximal portion is
not well visualized on maximum intensity projections but appears normal on the
source images.
IMPRESSION:
1. Acute right posterior inferior cerebellar artery infarct. Small-vessel
disease and brain atrophy. No enhancing brain lesions.
2. MRA of the neck demonstrates nonvisualization of the proximal portion of
the right vertebral artery which could be due to intrinsic disease. This
appears to be further extension compared to the previous MRA.
|
10224486-RR-26
| 10,224,486 | 23,093,095 |
RR
| 26 |
2135-07-17 10:57:00
|
2135-07-17 11:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with recent CVA p/w dizizness x 1 hour
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 892 mGy-cm
COMPARISON: MR brain from ___, CT head from ___, MR brain
from ___, CT head from ___.
FINDINGS:
In the area of recent right cerebellar infarcts, subtle hypodensity is noted
consistent with infarct evolution. There is no superimposed hemorrhage. Aside
from this, no acute findings are identified. Ventriculomegaly is stable. White
matter hypodensity is unchanged. Imaged sinuses notable for mild mucosal
thickening. Mastoid air cells and middle ear cavities are well aerated.
IMPRESSION:
Evolving right cerebellar infarct without superimposed hemorrhage.
|
10224486-RR-27
| 10,224,486 | 26,143,533 |
RR
| 27 |
2135-08-05 08:42:00
|
2135-08-05 09:49:00
|
INDICATION: History: ___ with dizziness. Code stroke. // eval for ICH
TECHNIQUE: CT of the head without IV contrast; CT angiogram of the head and
neck with IV contrast ; 2D and 3D reformations of the intra and extracranial
arteries and segmented reformations were obtained. Report based on all these
images.
COMPARISON: CT head without IV contrast ___ and MRI & MR angiogram
of the neck ___.
FINDINGS:
CT HEAD WITHOUT IV CONTRAST:
No acute intracranial hemorrhage or mass effect.
Hypodense foci are noted in the cerebellar hemispheres right more than left,
similar to the prior study and related to the prior infarcts.
However, these are better assessed on the subsequent MRI performed.
There are multiple periventricular and subcortical white matter hypodense foci
noted in the frontal and the parietal lobes on both sides, can relate to small
vessel ischemic changes.
Moderate dilation of the lateral and the third ventricles along with prominent
extra-axial CSF spaces and sulci, related to diffuse parenchymal volume loss.
Mild carotid cavernous calcifications noted.
No suspicious osseous lesions noted in the skull.
Mild ethmoidal mucosal thickening.
Status post right lens replacement.
The soft tissues of the scalp are unremarkable.
The included portions of the paranasal sinuses and the mastoid air cells are
clear.
CT ANGIOGRAM HEAD:
The left vertebral artery is dominant.
The major intracranial arteries of the anterior and the posterior circulation
are patent, without focal flow-limiting stenosis, occlusion.
There is a lobulated aneurysm at the anterior communicating artery, measuring
approximately 4 x 5 mm, prior study of ___ allowing for the
technical differences.
Paucity of branches in the right cerebellar hemisphere can relate to prior
infarcts.
CT ANGIOGRAM NECK:
The origins of the arch vessels are patent.
Calcified and noncalcified plaques are noted at the aortic arch and the
origins of the arch vessels.
Calcifications are noted at the brachiocephalic trunk deviation.
The brachiocephalic trunk and the left common carotid artery or closely
approximate origin.
The included portions of the subclavian arteries are patent.
The right common carotid artery is tortuous in course.
Mild calcifications are noted at the common carotid bifurcation, on both
sides, without significant stenosis.
In the right cervical internal carotid artery proximally, there are calcified
and noncalcified plaques, with approximately 20% stenosis.
The right cervical internal carotid artery is tortuous in course and indents
the right side of the oropharynx series 6, image 12.
The left cervical internal carotid artery is mildly tortuous in course,
without focal flow-limiting stenosis or occlusion.
The left vertebral artery is dominant and patent, with mild tortuosity and
calcifications.
the right vertebral artery is not well seen proximally, progressed compared
to prior MRA studies and is seen from the level of C4 upwards. The caliber of
the artery increases intracranially. The right posterior inferior cerebellar
artery is patent.
CT NECK:
Multilevel, multifactorial degenerative changes, with mild canal and moderate
to severe foraminal narrowing by disc uncovertebral and facet degenerative
changes.
Submandibular and parotid glands are unremarkable.
The thyroid is normal.
Multiple small nodes noted in the neck on both sides and in the superior
mediastinum, some of which are mildly prominent, however, not abnormally
enlarged by size criteria.
Likely basal atelectasis, right more than left.
Scattered foci of emphysematous changes are noted in both lungs.
A small 4.5 mm nodule in the right upper lung -series 6, image 50.
IMPRESSION:
1. No acute intracranial hemorrhage or mass effect. Hypodense foci in the
cerebral and cerebellar hemispheres, as before. Please see MRI performed
subsequently.
2. Nonvisualization of the right vertebral artery proximally in the V1 and
part of V2 segments, progressed to some extent compared to the prior MR
angiogram studies of ___ and ___, allowing for the technical
differences.
3. Patent left vertebral and bilateral carotid arteries as described above
without focal flow-limiting stenosis or occlusion.
4. Stable 4 x 5 mm aneurysm at the anterior communicating artery, allowing
for the technical differences. Consider interventional neuroradiology consult
to decide on further management/followup.
5. Multilevel, multifactorial degenerative changes, with moderate foraminal
narrowing.
6. Mildly enlarged mediastinal and hilar lymph nodes are not present measuring
up to 10 mm.
A 5 mm nodule in the right upper lobe. Correlate clinically and with dedicated
CT Chest. No priors available.
|
10224486-RR-28
| 10,224,486 | 26,143,533 |
RR
| 28 |
2135-08-05 11:29:00
|
2135-08-05 12:47:00
|
INDICATION: ___ year old man with ? stroke // ? intrathoracic process
COMPARISON: Radiographs from ___
IMPRESSION:
Cardiomediastinal silhouette is upper limits of normal. There is bibasilar
atelectasis. There is mild improvement of the pulmonary interstitial edema
since the previous study. No definite areas of consolidation are seen. There
are no pneumothoraces.
|
10224486-RR-29
| 10,224,486 | 26,143,533 |
RR
| 29 |
2135-08-05 16:08:00
|
2135-08-06 09:34:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old man with nausea, vomiting, dysequilibrium - known
posterior circulation disease // ? posterior circulation stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique.
COMPARISON: Prior MRI of the brain dated ___.
FINDINGS:
Chronic infarctions are noted in the right cerebellar hemisphere, evolved
since prior study with some mineralization.
There is no evidence of hemorrhage, edema, mass effect, or acute infarction.
The ventricles and sulci are dilated likely reflecting age-related parenchymal
volume loss.
Sparse foci of T2/FLAIR signal hyperintensity in the periventricular,
subcortical, and deep white matter as well as within the central pons likely
reflecting chronic small vessel ischemic disease.
A 4 mm aneurysm of the anterior communicating artery is again noted and
unchanged.
Right vertebral artery not well seen, better assessed on the prior MR
angiogram and recent CT angiogram studies.
Patient is status post right lens replacement.
There is mucosal thickening within the ethmoid air cells.
Small amount of fluid in the right mastoid air cells.
Mild ethmoidal mucosal thickening.
Status post right lens replacement.
IMPRESSION:
1. No evidence of acute infarction, hemorrhage, or mass effect.
2. Chronic infarctions in the right greater than left cerebellar hemispheres.
3. T2/FLAIR signal hyperintensity in the periventricular, subcortical, and
deep white matter which is nonspecific but likely on the basis of chronic
small vessel ischemic disease.
4. A 4mm anterior communicating artery aneurysm, unchanged.
Right vertebral artery not well seen, better assessed on the prior MR
angiogram and recent CT angiogram studies.
|
10224486-RR-30
| 10,224,486 | 26,143,533 |
RR
| 30 |
2135-08-07 17:42:00
|
2135-08-07 18:48:00
|
INDICATION: ___ year old man with new stroke who had fall with head strike //
eval skull for fracture/IPH
TECHNIQUE: Contiguous axial MDCT sections were obtained through the brain
without administration of IV contrast. Coronal and sagittal reformations, and
thin slice bone algorithm reconstructions were reviewed.
CTDIvol: 55 mGy.
DLP: 897 mGy-cm.
COMPARISON: Head MRI of ___. PET-CT of ___.
FINDINGS:
Right cerebellar infarction continues to evolve with increased hypodensity.
There is no intracranial hemorrhage. No new mass effect or acute territorial
infarction. Prominent ventricles and sulci are compatible with age-related
volume loss.Periventricular white matter hypodensities are consistent 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.
IMPRESSION:
No intracranial hemorrhage. Continued evolution of right cerebellar
infarction.
|
10224486-RR-31
| 10,224,486 | 20,204,009 |
RR
| 31 |
2135-08-29 09:28:00
|
2135-08-29 10:07:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with headache, evaluate for intracranial hemorrhage, CVA.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 1003.42 mGy-cm
CTDI: 52.38 mGy
COMPARISON: Prior CT dated ___.
FINDINGS:
There is no evidence of acute infarction, hemorrhage, edema, or mass. Changes
of cerebellar encephalomalacia, right worse than left, related to previous
cerebellar infarction are stable from prior study. The ventricles and sulci
are prominent, compatible with moderate age-related involutional changes.
Periventricular and deep subcortical white matter hypodensities are compatible
with moderate chronic small vessel ischemic changes. Prior right thalamic
lacunar infarcts are also noted.
No osseous abnormalities seen. Scattered ethmoid air cell opacification,
mucosal thickening in the left maxillary sinus and left frontal sinus is
noted. The other paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The orbits are notable for prior right-sided cataract
removal and are otherwise unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Stable changes from prior cerebellar infarction.
3. Moderate age related involutional changes and moderate chronic small
vessels ischemic changes.
|
10224486-RR-32
| 10,224,486 | 20,204,009 |
RR
| 32 |
2135-08-29 09:54:00
|
2135-08-29 12:17:00
|
INDICATION: ___ with HA // ICH, CVA
TECHNIQUE: AP and lateral views the chest.
COMPARISON: ___.
FINDINGS:
There mild bibasilar opacities. Superiorly, the lungs are clear. There is no
effusion or pneumothorax. The cardiomediastinal silhouette is within normal
limits.
IMPRESSION:
Bibasilar opacities which are most likely atelectasis noting that infection is
not entirely excluded.
|
10224486-RR-34
| 10,224,486 | 20,204,009 |
RR
| 34 |
2135-08-31 14:59:00
|
2135-08-31 16:35:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with multiple strokes and episodes of light
headedness, marked worsening of truncal ataxia over the last several weeks.
Unable to get a MRI secondary to recent placement of reveal device // eval
for new cerebellar stroke in patient with worsening trucal ataxia
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 897 mGy-cm
CTDI: 55 mGy
COMPARISON: ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Prominent
ventricles and sulci are compatible with age-related volume loss.
Periventricular white matter hypodensities are consistent with chronic small
vessel ischemic disease. No osseous abnormalities seen. The paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The orbits are
unremarkable.
IMPRESSION:
No evidence of hemorrhage or infarction.
|
10224486-RR-35
| 10,224,486 | 20,204,009 |
RR
| 35 |
2135-09-01 16:39:00
|
2135-09-04 13:20:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ year old man with history of strokes presents with new stroke
// eval new cerebellar stroke, eval vessels
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered, curved
reformatted and segmented images were generated. This report is based on
interpretation of all of these images.
DOSE: DLP: 2554.9 mGy-cm; CTDI: 55.8 mGy
COMPARISON: Comparison is made to multiple prior studies, including most
recent noncontrast CT of the head from ___ at 14:59 and brain MRI/neck
MRA From ___. Comparison is also made to MRI/MRA of the head and neck
from ___.
FINDINGS:
Head CT: There is a wedge-shaped hypodensity in the left cerebellar
hemisphere which is compatible with subacute infarct. Encephalomalacia in the
right greater than left cerebellar hemispheres is due to prior chronic
infarcts. Subcortical and periventricular white matter hypodensities reflect
the sequelae of chronic small vessel ischemic disease. Global atrophy is
noted, with stable size and configuration of enlarged lateral ventricles.
There is no midline shift or mass effect. No intracranial hemorrhage is
identified. No osseous abnormalities are detected. Mild mucosal thickening
seen in the maxillary sinuses bilaterally and within the left frontal sinus.
Head CTA: There is a 4 x 4 x 3 mm saccular aneurysm arising from the anterior
communicating artery (3:75, 602b:34), not significantly changed compared to
prior MRA from ___. The left superior cerebellar artery is seen well
proximally, but is more diminuitive distally, asymmetric compared to the
right. It is difficult to assess for interval change given differences in
technique compared to prior MRI. Relatively hypoplastic left A1 is noted, a
normal variant, with superimposed narrowing near its origin similar to prior.
There is also irregular narrowing of the P1 and P2 segments of the right PCA
which demonstrated lack of flow related signal on prior MRA.
Neck CTA: Atherosclerotic calcifications are noted in the aortic arch, and
at the origins of the brachiocephalic and left subclavian artery, with no
flow-limiting stenosis identified. There is a dominant left vertebral artery.
There is no contrast filling of the right vertebral artery in the V1 segment,
beginning approximately 1 cm distal to the origin (3: 91, 92) with gradual
distal reconstitution at the C3-4 level of the V2 segment. This appearance is
similar compared to prior MRA neck. Mild atherosclerotic calcification is
noted of the bilateral carotid arterial bifurcations. There is no evidence of
internal carotid stenosis by NASCET criteria.
A calcified granuloma measuring 5 mm is noted in the left apex (3:72).
IMPRESSION:
1. Bilateral cerebellar hemispheric infarcts with subacute infarct on the
left.
2. Diminutive distal left superior cerebellar artery compared to the right.
3. Non-opacification of the V1 segment of the proximal right vertebral
artery, not significantly changed since MRA from ___.
4. Stable 4 mm saccular aneurysm arising from the anterior communicating
artery.
5. Irregular narrowing of the right PCA which demonstrate lack of flow on
prior MRI.
|
10224753-RR-17
| 10,224,753 | 29,671,345 |
RR
| 17 |
2176-03-10 14:24:00
|
2176-03-10 15:27:00
|
EXAMINATION: CHEST PA AND LATERAL
INDICATION: ___ with SS disease here with abdominal pain, abnormal EKG,
report of abnormal CXR from OSH last night. Evaluate for pneumonia or acute
chest process.
TECHNIQUE: Chest PA and lateral
COMPARISON: CT abdomen and pelvis from earlier on the same date.
FINDINGS:
There is moderate cardiomegaly. The left hilar contour is prominent,
consistent with known pulmonary hypertension. There is right basilar
atelectasis. No focal consolidation or pneumothorax.
IMPRESSION:
Cardiomegaly without acute cardiopulmonary process.
|
10224753-RR-18
| 10,224,753 | 29,671,345 |
RR
| 18 |
2176-03-10 13:51:00
|
2176-03-10 15:20:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with sickle cell disease here with diffuse abdominal pain in
setting of colonoscopy prep. Evaluate for bowel obstruction or edema.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
No oral contrast was administered.
DOSE: Total DLP (Body) = 690 mGy-cm.
IV Contrast: 130 mL Omnipaque
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is right basilar atelectasis without pleural effusion.
Mild cardiomegaly identified. A small hiatal hernia is identified.
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 unremarkable.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is shrunken and calcified, consistent with auto-infarction
in the setting of known sickle cell disease.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There are multiple bilateral subcentimeter hypodensities in the
kidneys, too small to characterize but likely cysts. In the lower pole of the
left kidney there is a 1.3 cm simple cyst (601b:32 and 2:36). Bilateral areas
of cortical thinning is likely due to prior scarring. The kidneys are
otherwise symmetric and size with normal nephrogram. No evidence of
hydronephrosis.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits. The
appendix is not visualized, compatible with history of appendectomy. There is
no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium
burden in the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is a trace amount of
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus contains a calcified fibroid.
BONES AND SOFT TISSUES: H-shaped lumbar vertebral bodies are identified, in
keeping with the history of sickle cell disease. AVN of the bilateral femoral
heads, more extensive on the right, without loss of the normal contour of the
femoral heads, is noted and likely due to sickle cell disease. Other than
calcified soft tissue granulomas, the abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. No evidence of bowel obstruction or inflammation.
2. Changes related to sickle cell disease, as described above.
|
10224753-RR-19
| 10,224,753 | 29,671,345 |
RR
| 19 |
2176-03-11 08:27:00
|
2176-03-11 12:01:00
|
INDICATION: ___ year old woman with sickle cell crisis and pulm htn // r/o
edema and consolidation
COMPARISON: Radiographs from ___
IMPRESSION:
There is unchanged cardiomegaly. There are no focal consolidations, pleural
effusion, or pulmonary edema. There are no pneumothoraces. There is sclerosis
of the humeral heads which may relate to osteonecrosis from the patient's
sickle cell disease.
|
10224976-RR-30
| 10,224,976 | 28,714,752 |
RR
| 30 |
2164-01-23 17:37:00
|
2164-01-23 18:49:00
|
HISTORY: ___ male with fever. Question pneumonia. Patient also has
history of osteosarcoma.
COMPARISON: ___.
FINDINGS:
Frontal and lateral views of the chest. Pseudo mass seen in the right
perihilar region compatible with fluid within the major fissure on the lateral
view. The posterior costophrenic angles are blunted compatible with small
residual effusions. There may also be pleural thickening on the right as
well. Streaky right basilar opacities seen suggestive of atelectasis. There
is no definite new region of consolidation. Cardiomediastinal silhouette is
stable. No acute osseous abnormality is detected. Right chest wall port is
again seen.
IMPRESSION:
No definite acute cardiopulmonary process. Persistent small bilateral
effusions with fluid within the right major fissure.
|
10224976-RR-31
| 10,224,976 | 28,714,752 |
RR
| 31 |
2164-01-28 09:21:00
|
2164-01-28 10:56:00
|
HISTORY: ___ male with osteosarcoma and altered mental status, now
complaining of abdominal pain. Evaluate for obstruction or ileus.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
Two frontal views of the abdomen demonstrate a large amount of stool noted
throughout the colon and rectum. There is minimal gas seen in the ascending
colon. The visualized osseous structures demonstrate metallic plates and
screws in the right pelvis and right hip replacement. The remaining
visualized osseous structures are unremarkable.
IMPRESSION:
1. Nonspecific bowel gas pattern without evidence of obstruction or ileus.
2. Large amount of stool seen throughout the colon and rectum.
|
10224976-RR-32
| 10,224,976 | 28,714,752 |
RR
| 32 |
2164-01-30 05:04:00
|
2164-01-30 11:47:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Fever and chest pain.
Comparison is made with prior study, ___.
Cardiac size is top normal. Loculated small-to-moderate right pleural
effusion is unchanged. New opacities in the left lower lobe are worrisome for
pneumonia. Left effusion is small. Multiple left lung nodules are better
seen in prior CT. Right Port-A-Cath is in standard position.
|
10225055-RR-10
| 10,225,055 | 23,223,406 |
RR
| 10 |
2127-09-30 04:00:00
|
2127-09-30 08:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure.// interval change
IMPRESSION:
In comparison with the study of ___, the endotracheal tube has been
pulled back with its tip now approximately 5 cm above the carina. Nasogastric
tube extends well into the stomach.
The cardiomediastinal silhouette is stable and there is no evidence acute
pneumonia, pleural effusion, or appreciable vascular congestion.
|
10225055-RR-13
| 10,225,055 | 23,223,406 |
RR
| 13 |
2127-09-29 22:58:00
|
2127-09-29 23:42:00
|
EXAMINATION: ED STROKE CTA HEAD AND NECK WITH PERFUSION
INDICATION: ___ year old woman found unresponsive this AM with history of
possible hives and possible angioedema, intubated and sent to ___ for further
management of possible anaphylaxis. Now neuro exam with LEFT hemiparesis.//
rule ICH
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 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 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 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
4) Spiral Acquisition 5.2 s, 41.0 cm; CTDIvol = 31.9 mGy (Head) DLP =
1,309.0 mGy-cm.
Total DLP (Head) = 4,753 mGy-cm.
COMPARISON: Subsequent MR brain ___.
FINDINGS:
CT HEAD:
Areas of hypodensity within the white matter extending to the cortical surface
are seen most notably along the right occipital lobes and posterolateral high
right frontal lobes. These correlate with areas of late acute to early
subacute infarction as seen on subsequent MRI.
There is no evidence for acute intracranial hemorrhage. No mass, mass effect,
or midline shift. The basal cisterns remain patent. The ventricles and sulci
are prominent compatible global parenchymal volume loss. Periventricular and
subcortical white matter hypodensities are noted, a nonspecific finding that
most likely represents the sequelae of chronic small vessel ischemic disease.
There is mild mucosal thickening seen in scattered ethmoid air cells. The
remainder of the paranasal sinuses, middle ear cavities, and mastoid air cells
are clear. The orbits are grossly unremarkable bilaterally.
CTA HEAD AND NECK:
There is a normal 3 vessel aortic arch identified. Minimal calcifications are
seen at the origin of the left V1 segment. The vertebral arteries are patent
without high-grade stenosis or occlusion.
The bilateral common carotid arteries are patent. Mild-to-moderate
calcifications are noted involving the left carotid bulb, with minimal
calcifications at the right carotid bulb. There is no evidence of internal
carotid stenosis by NASCET criteria.
The patient is status post vascular stent placement involving the right
cavernous and paraclinoid internal carotid artery, with apparent stent
patency. Peripherally calcific structure abutting the supraclinoid right ICA
laterally measuring up to 8 mm (4:276) likely represents peripheral wall
calcification at site of aneurysm. There is no contrast opacification within
the lumen of this aneurysm. Mild-to-moderate calcifications are seen
involving the left cavernous internal carotid artery.
There is a probable infundibular origin to the distal basilar artery tip at
the level of the bilateral posterior cerebral arteries. Allowing for this,
the intracranial vasculature is grossly patent without high-grade stenosis,
occlusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.
CT Perfusion:
The perfusion sequences technically limited secondary to suboptimal arterial
inflow attenuation changes.
OTHER:
The lungs demonstrate moderate bilateral centrilobular emphysematous changes.
No large pleural effusion or consolidation. 6 mm hypodense nodule in the
right thyroid lobe is noted. There is no cervical lymphadenopathy by CT size
criteria. Anterior left rib fractures appear well corticated and are likely
chronic.
IMPRESSION:
1. Late acute versus early subacute infarcts involving the right occipital and
high right posterior frontal lobes, better characterized on subsequent MRI
examination.
2. No convincing evidence for acute intracranial hemorrhage.
3. Status post placement of a right cavernous and paraclinoid ICA vascular
stent, which appears patent within the limitations of CT. Adjacent
peripherally calcific structure which likely represents patient's known
aneurysm without visualized contrast opacification within its lumen.
4. Multifocal atherosclerotic disease throughout the intracranial and cervical
vasculature, without high-grade stenosis, occlusion, or definite aneurysm.
5. Technically limited and essentially nondiagnostic CT perfusion examination.
|
10225055-RR-14
| 10,225,055 | 23,223,406 |
RR
| 14 |
2127-09-30 09:44:00
|
2127-09-30 10:45:00
|
EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old woman with altered mental status s/p intubation for
possible anaphylactic reaction, now with left sided deficits- not following
commands in left upper extremity; possible left facial weakness.// Are
deficits seen on CTA acute or subacute?
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T1-weighted, axial fast spin echo T2-weighted,axial flair,
axial diffusion weighted and axial gradient echo images .
COMPARISON: CT angiography of ___.
FINDINGS:
Acute infarcts are identified in the distribution of right middle cerebral
artery as well as in the watershed distribution in the right frontal and
parietal lobes. Subtle area of susceptibility low signal in the right frontal
cortical region (12:20) indicating petechial hemorrhage. Mild brain atrophy
and small vessel disease are seen. The vascular flow voids are maintained.
Suprasellar and craniocervical regions are unremarkable. Visualized paranasal
sinuses are clear.
IMPRESSION:
Acute infarcts in the distribution of right middle cerebral artery extending
to the watershed distributions. Petechial hemorrhage in the right frontal
lobe.
|
10225055-RR-9
| 10,225,055 | 23,223,406 |
RR
| 9 |
2127-09-29 11:05:00
|
2127-09-29 11:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with intubated*** WARNING *** Multiple patients with
same last name!// pna? confirm tube placement?
TECHNIQUE: Portable AP view of the chest
COMPARISON: None. Patient is currently listed as EU critical.
FINDINGS:
Endotracheal tube tip terminates approximately 3 cm from the carina. Enteric
tube courses below the left diaphragm, into the stomach, and tip is off of the
inferior borders of the film. Cardiac silhouette size is normal. Mediastinal
and hilar contours are unremarkable. Pulmonary vasculature is not engorged.
No focal consolidation, pleural effusion, or pneumothorax is seen. Clips
project over the base of the right neck.
IMPRESSION:
Standard positioning of the enteric and endotracheal tubes. No focal
consolidation to suggest pneumonia.
|
10225233-RR-14
| 10,225,233 | 24,759,243 |
RR
| 14 |
2134-03-04 00:30:00
|
2134-03-04 02:05:00
|
EXAMINATION: Left femur AP and lateral
INDICATION: History: ___ with fall, s/p fall, gross deformity to L knee//left
femur fracture fx
TECHNIQUE: Multiple views of the left femur.
COMPARISON: None
FINDINGS:
There is a left hip prosthesis with a transverse displaced and medially
angulated fracture of the proximal left femur at the inferior margin of the
prosthesis. There is medial 1 half shaft width displacement and angulation of
the distal fracture fragment. The instrumentation appears intact. There is
an old healed fracture of the distal left femur. Tricompartmental
osteoarthritis of the left knee is also noted.
IMPRESSION:
Left periprosthetic displaced angulated proximal femoral fracture.
|
10225233-RR-15
| 10,225,233 | 24,759,243 |
RR
| 15 |
2134-03-04 00:38:00
|
2134-03-04 02:01:00
|
EXAMINATION: Chest radiograph AP
INDICATION: ___ female with left femur fracture, preoperative
evaluation.
TECHNIQUE: Single AP view of the chest.
COMPARISON: None
FINDINGS:
Lung volumes are slightly low. There is interstitial line thickening
bilaterally, which may be due to a mild pulmonary edema. There is blunting of
the left costophrenic angle and retrocardiac opacity, which may be due to
small left pleural effusion with left lower lobe atelectasis, aspiration or
infection. The heart size appears prominent. No pneumothorax.
IMPRESSION:
Left lower lobe opacity, which may be due to a combination of left lower lobe
atelectasis or aspiration and small effusion, however infection may present
similarly. There is mild pulmonary edema.
NOTIFICATION: These findings were discussed with ___ by Dr. ___
___ at 07:50 on ___.
|
10225233-RR-16
| 10,225,233 | 24,759,243 |
RR
| 16 |
2134-03-04 12:14:00
|
2134-03-04 15:35:00
|
EXAMINATION: Intraoperative radiographs of the left hip
INDICATION: Open reduction internal fixation of a left femur fracture
TECHNIQUE: Intraoperative radiographs from open reduction internal fixation
of a left femur fracture were obtained without a radiologist present.
COMPARISON: Radiograph from ___ at 00:38
FINDINGS:
7 intraoperative images were acquired without a radiologist present.
Images show interval reduction of a periprosthetic fracture off the proximal
left femur with fracture fragments now in near anatomic alignment..
IMPRESSION:
Intraoperative images were obtained during open reduction and internal
fixation of the periprosthetic fracture of the left femur. Please refer to
the operative note for details of the procedure.
|
10225498-RR-10
| 10,225,498 | 28,667,941 |
RR
| 10 |
2176-09-29 18:24:00
|
2176-09-30 13:11:00
|
STUDY: PA and lateral chest, ___.
CLINICAL HISTORY: ___ woman with recent right IJ line removal.
FINDINGS: No previous studies for comparison.
The heart size is within normal limits. There are slightly low lung volumes.
There are no pneumothoraces. No catheters are seen which is consistent with
the right IJ central venous line removal. Bony structures are intact.
|
10225567-RR-19
| 10,225,567 | 20,746,341 |
RR
| 19 |
2156-03-12 07:55:00
|
2156-03-12 09:10:00
|
EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with HCT drop and significant bloody BM this a.m. Rule out
acute bleed.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.0 s, 47.1 cm; CTDIvol = 6.4 mGy (Body) DLP = 301.1
mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 24.3 mGy (Body) DLP =
12.1 mGy-cm.
3) Spiral Acquisition 6.2 s, 49.1 cm; CTDIvol = 17.0 mGy (Body) DLP = 831.5
mGy-cm.
4) Spiral Acquisition 6.2 s, 49.1 cm; CTDIvol = 16.9 mGy (Body) DLP = 828.7
mGy-cm.
Total DLP (Body) = 1,973 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
The aorta is ectatic measuring up to 2.4 cm infrarenally. There is a
retroaortic left renal vein. 2 accessory right renal veins are incidentally
noted. There is moderate calcium burden in the abdominal aorta and great
abdominal arteries.
LOWER CHEST: Bibasilar atelectasis is noted, right greater than left.
Coronary artery calcifications are noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Low-density liver parenchyma adjacent to the gallbladder likely represents
focal fat (series 5, image 45). There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is contains stones, without
evidence of gallbladder wall thickening or pericholecystic fluid.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Bilateral simple renal cysts are noted, measuring up to 10 cm in the upper
pole of the right kidney and 6.5 cm in the upper pole of the left kidney.
Clips are seen in the left renal pelvis and at the lower pole. Bilateral
nonobstructing renal stones measure up to 1.3 cm on the right and 1.3 cm on
the left. No hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Hyperdensity on
postcontrast imaging is compatible with active arterial bleeding within the
descending colon (series 4, image 81 and series 5, image 81) which grows on
more delayed phase. There are diverticuli throughout the colon without
diverticulitis. Appendix is not visualized.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Degenerative changes seen in the lumbar spine, particularly at L3-L4, with
joint space narrowing and endplate osteophytes.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Findings compatible with active arterial bleeding in the descending colon.
2. Bilateral nonobstructing renal calculi.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 8:59 am, 3
minutes after discovery of the findings.
|
10225567-RR-20
| 10,225,567 | 20,746,341 |
RR
| 20 |
2156-03-12 12:31:00
|
2156-03-12 15:38:00
|
INDICATION: ___ year old man with lower GI bleed, active bleeding on CTA//
Embolization of bleed in descending colon seen on CTA. Currently bleeding in
ED
COMPARISON: CTA abdomen and pelvis ___.
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and Dr.
___ fellow performed the procedure. The
attending(s) personally supervised the trainee during any key components of
the procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 60 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1%
lidocaine was injected in the skin and subcutaneous tissues overlying the
access site.
MEDICATIONS: As above
CONTRAST: 65 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 10 minutes 49 seconds, 136 mGy
PROCEDURE:
1. Ultrasound-guided right common femoral artery access.
2. Arteriogram of the right common femoral artery.
3. Inferior mesenteric arteriogram.
4. Sub selective angiogram of the left colic artery.
5. Sub selective angiogram of left colic arterial branch toward area bleeding
seen on same day CT.
6. Superior mesenteric arteriogram.
7. Mynx closure of right common femoral artery access.
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. Both groins were
prepped and draped in the usual sterile fashion.
Using palpatory, fluoroscopic, and ultrasound guidance, the right common
femoral artery was punctured using a micropuncture set at the level of the
mid-femoral head. A 0.018 wire was passed easily into the vessel lumen. A
small skin incision was made over the needle. Then the inner dilator and wire
were removed and ___ wire was advanced under fluoroscopy into the aorta.
The micropuncture sheath was exchanged for a 5 ___ sheath which was
attached to a continuous heparinized saline side arm flush.
A ___ catheter was advanced over ___ wire into the aorta. The wire
was removed and the inferior mesenteric artery was selectively cannulated and
a small contrast injection was made to confirm position. And STC
microcatheter with a pre loaded fathom wire was advanced through the ___
catheter into the main inferior mesenteric artery. A inferior mesenteric
arteriogram was performed.
At that time, the microcatheter was used to sub select the left colic artery.
A left colic arteriogram was performed.
At that time, the microcatheter was used to sub select a distal branch of the
left colic artery supplying the mid descending colon. An arteriogram was
performed.
At that time, the microcatheter and wire were removed. The ___ catheter
was disengaged from the ___ and used to catheterize the superior mesenteric
artery. A small hand injection of contrast confirmed position within the
superior mesenteric artery. A formal superior mesenteric arteriogram was
performed.
The ___ catheter was disengaged from the superior mesenteric artery and
straightened in the aorta 8 with the use of ___ wire. The catheter and
wire were removed.
At that time, a 5 ___ Mynx closure device was used and the right common
femoral artery 5 ___ sheath was removed. Mynx occlusion device used to
close arteriotomy. After successful Mynx closure device deployment, gentle
manual pressure was held for approximately 5 minutes. Hemostasis was
achieved. A sterile dressing was applied. 2+ pulses in the right femoral
artery post procedure.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
Patent ___, left colic, and SMA arteries without evidence of contrast
extravasation. Sub selective interrogation of the distal left colic arterial
branches supplying the mid descending colon were negative for contrast
extravasation.
For reporting clarification, diagnostic arteriograms were medically necessary
to evaluate for anatomy, abnormal vasculature, and the presence or absence of
active bleeding, pseudoaneurysms, and or arteriovenous fistula.
IMPRESSION:
Successful superior mesenteric and inferior mesenteric angiogram without
evidence of active extravasation, pseudoaneurysm, or arteriovenous fistula.
|
10225619-RR-18
| 10,225,619 | 21,697,329 |
RR
| 18 |
2129-06-04 00:23:00
|
2129-06-04 01:07:00
|
INDICATION: ___ man with recent cardiac arrest for cardiomyopathy.
Evaluate for cardiomegaly.
COMPARISON: Multiple chest radiographs from ___ through ___.
FINDINGS: A frontal upright view of the chest was obtained portably. The
lungs are clear with interval resolution of right middle lobe opacity. There
is no pleural effusion or pneumothorax. Heart size is normal. Mediastinal
silhouette and hilar contours are normal.
IMPRESSION: No acute cardiothoracic process.
|
10225620-RR-49
| 10,225,620 | 27,738,516 |
RR
| 49 |
2167-11-21 13:30:00
|
2167-11-21 14:04:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough, fever. // pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Lung volumes are low. Again seen is a large periesophageal hernia. No
definite focal consolidation is identified. There is no pleural effusion or
pneumothorax.
IMPRESSION:
No acute intrathoracic abnormality.
|
10225620-RR-50
| 10,225,620 | 27,738,516 |
RR
| 50 |
2167-11-21 15:35:00
|
2167-11-21 16:34:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with history of DVT with a red/swollen leg.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: Bilateral lower extremity venous ultrasound exams dated ___ and ___.
FINDINGS:
LEFT: Small amount of eccentric echogenic debris in the antidependent aspect
of the left common femoral vein near the junction with the GSV without
associated distension of the vein is again seen. The vein is only partially
compressible at this area but has demonstrable color and spectral Doppler
flow. These findings indicate partial nonocclusive thrombus and has the
appearance of chronicity, in the same location and overall similar to prior
exams dating back to ___.
There is normal compressibility and flow in the left femoral and popliteal
veins. Normal color flow and compressibility are demonstrated in the left
posterior tibial and peroneal veins.
RIGHT: There is normal compressibility, flow, and augmentation in the right
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the right posterior tibial and peroneal
veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. No evidence of acute deep venous thrombosis in the left lower extremity
veins.
2. Tiny partial/non-occlusive thrombus at the proximal left common femoral
vein appears chronic and in the same location of prior deep venous thrombosis
in ___ and ___.
3. No right lower extremity deep venous thrombosis.
|
10225620-RR-51
| 10,225,620 | 27,738,516 |
RR
| 51 |
2167-11-27 12:06:00
|
2167-11-27 13:20:00
|
EXAMINATION:
DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION:
___ year old woman with new L PICC // 55cm L cephalic SL PICC - ___ ___
Contact name: ___: ___
TECHNIQUE: CHEST SINGLE VIEW
COMPARISON: ___
IMPRESSION:
There is a new left-sided PICC line. . The tip is difficult to precisely
locate that it is either in the distal SVC or cavoatrial junction and
therefore is in a good position for use. There continues to be dense
consolidation/volume loss in the retrocardiac region. There is also patchy
areas of volume loss in the right lower lobe. There is no pneumothorax.
|
10225793-RR-105
| 10,225,793 | 23,989,569 |
RR
| 105 |
2133-07-07 18:36:00
|
2133-07-07 18:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hx lung cancer, now left side chest pain,
shortness of breath. Evaluate for mass recurring, pneumonia, infiltrate
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest CT ___ and chest radiograph ___
FINDINGS:
Heart size remains mildly enlarged but unchanged. The mediastinal and hilar
contours are within normal limits. Fiducial marker within the left upper lobe
is re-demonstrated with adjacent linear opacity compatible with
atelectasis/scarring. Remainder of the lungs are clear without focal
consolidation. No pleural effusion or pneumothorax is present. The pulmonary
vasculature is normal. No acute osseous abnormalities detected.
IMPRESSION:
Fiducial marker in the left upper lobe with adjacent scarring/atelectasis.
Otherwise, no acute cardiopulmonary abnormality.
|
10225793-RR-106
| 10,225,793 | 23,989,569 |
RR
| 106 |
2133-07-08 01:02:00
|
2133-07-08 02:04:00
|
EXAMINATION: CT pulmonary angiogram
INDICATION: ___ year old woman with Stage I ___ s/p radiation and cirrhosis
p/w progressive, pleuritic chest pain// r/o PE. Patient received
methylprednisolone 40mg IV @ ___
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 12.1 mGy (Body) DLP =
6.1 mGy-cm.
2) Spiral Acquisition 3.9 s, 30.6 cm; CTDIvol = 17.1 mGy (Body) DLP = 523.1
mGy-cm.
Total DLP (Body) = 529 mGy-cm.
COMPARISON: CT scan of the thorax dated ___.
FINDINGS:
HEART AND VESSELS: There is satisfactory opacification of the pulmonary
arteries. No filling defect to suggest acute pulmonary embolism. Linear
filling defects within the main pulmonary artery (axial series 2, image 40 and
42) are favored to be on the basis of motion artifact. The main pulmonary
trunk is normal in caliber. Mild cardiomegaly. The aorta and major vessels
to the neck are unremarkable.
LUNGS AND AIRWAYS: Stable post treatment changes within the left upper lobe
with fiducial marker in situ. Patchy areas of this ache attenuation
throughout both lungs may be in keeping with areas of air trapping. The
tracheobronchial tree is patent.
PLEURA/PERICARDIUM: No pleural or pericardial effusion.
MEDIASTINUM: No hilar or mediastinal adenopathy.
ESOPHAGUS AND NECK: Unremarkable.
BONES AND SOFT TISSUES: Healing fracture of the left second rib
anterolaterally.
UPPER ABDOMEN: Hepatic cirrhosis, partially imaged.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. New healing fracture of the left second rib anteriorly.
3. Stable post treatment changes within the left upper lobe.
4. Hepatic cirrhosis, partially imaged.
|
10225793-RR-108
| 10,225,793 | 27,868,882 |
RR
| 108 |
2133-08-21 16:23:00
|
2133-08-21 16:48:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with weakness// r/o pna
COMPARISON: Chest radiograph ___
Chest CT ___
FINDINGS:
PA and lateral views of the chest provided.
Area of scarring in the left hilar region with a surgical clip or fiducial is
unchanged from prior exams. There is no focal consolidation. No pleural
effusion or pneumothorax. Cardiomediastinal silhouette is within normal
limits.
IMPRESSION:
No acute intrathoracic process.
|
10225793-RR-109
| 10,225,793 | 27,868,882 |
RR
| 109 |
2133-08-21 16:07:00
|
2133-08-21 16:37:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with cirrhosis presenting with weakness, fatigue,
hyponatremia// portal vein thrombosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. There is in the right lobe of
the liver, there is an ill-defined hypoechoic structure measuring 1.6 x 1.8 x
1.9 cm, which was not clearly seen on MRI from ___ or prior
ultrasound from ___. This finding is indeterminate.. There is also
a tiny cyst at the hepatic dome, as also present on MRI from ___.
The main portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 1.1
cm.
GALLBLADDER: Status post cholecystectomy.
PANCREAS: Partially obscured by overlying bowel gas. No pancreatic ductal
dilatation seen.
IMPRESSION:
Coarsened nodular liver consistent with history of cirrhosis.
1.6 x 1.8 x 1.9 cm indeterminate hypoechoic lesion in the right lobe of the
liver, not clearly seen on prior studies. Recommend liver MRI for further
characterization.
Patent main portal vein.
RECOMMENDATION(S): Liver MRI for further characterization of hypoechoic
lesion in the right lobe of the liver.
|
10225793-RR-110
| 10,225,793 | 27,868,882 |
RR
| 110 |
2133-08-21 22:39:00
|
2133-08-21 23:06:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with HCV cirrhosis p/w ___// r/o hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.3 cm. The left kidney measures 12.3 cm. In the
lateral mid polar region of the left kidney, there is a 1.5 x 1.0 x 1.4 cm
simple renal cyst. There is no hydronephrosis or stone bilaterally. Slightly
increased renal cortical echogenicity noted bilaterally.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Slightly increased renal cortical echogenicity bilaterally suggestive of
chronic medical renal disease. No hydronephrosis.
|
10225793-RR-116
| 10,225,793 | 29,168,430 |
RR
| 116 |
2133-09-16 18:17:00
|
2133-09-16 20:31:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with HCV cirrhosis presenting w new confusion, hx
choked on a popcorn// aspiration PNA?
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
PA and lateral views of the chest provided.
Scarring with fiducial marker/clip is seen in the left upper lobe. There is
no focal consolidation, effusion, or pneumothorax. The cardiomediastinal
silhouette is normal.
IMPRESSION:
No acute intrathoracic process.
|
10225793-RR-117
| 10,225,793 | 29,168,430 |
RR
| 117 |
2133-09-16 19:40:00
|
2133-09-16 20:52:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ female with cirrhosis. Evaluate for signs of portal
venous thrombosis.
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Abdominal ultrasound ___ and ___
CT abdomen and pelvis ___
FINDINGS:
This study was limited due to patient's inability to hold breath
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is smooth. In the right lobe of the liver, there is a hypoechoic lesion
measuring 2.1 x 1.8 x 1.8 cm, grossly unchanged from abdominal ultrasound ___. The main portal vein is patent with hepatopetal flow. There is no
ascites. A recanalized umbilical vein is noted.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 10 mm,
grossly unchanged from abdominal ultrasound ___
Gallbladder: The gallbladder appears within normal limits, without stones,
abnormal wall thickening, or edema.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen is enlarged measuring 15 cm.
Kidneys: The right kidney measures 11.3 cm. The left kidney measures 9.9 cm.
No stones, masses, or hydronephrosis are identified in either kidney.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 23 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
IMPRESSION:
1. Cirrhotic morphology liver with splenomegaly and recanalized umbilical
vein. Patent hepatic vasculature.
2. Hypoechoic lesion in the right lobe of the liver measuring up to 2.1 cm is
indeterminate in etiology and grossly unchanged as compared to abdominal
ultrasound ___. Multiphasic CT or MRI is recommended for further
characterization.
RECOMMENDATION(S): Multiphasic CT or MRI is again recommended for further
characterization of liver lesion.
|
10225793-RR-118
| 10,225,793 | 29,168,430 |
RR
| 118 |
2133-09-17 22:13:00
|
2133-09-18 01:29:00
|
EXAMINATION: MR of the abdomen.
INDICATION: ___ year old woman with Hep C, ETOH cirrhosis p/w altered mental
status concerning for HE// Triphasic to evaluate liver lesion seen on MRI
TECHNIQUE: Multiplanar T1- and T2- weighted images of the abdomen were
obtained on a 1.5 T magnet without intravenous contrast administration.
COMPARISON: Prior MR from ___, CT from ___, and more
recent ultrasound from the prior day.
FINDINGS:
Liver again demonstrates a cirrhotic morphology.
In segment VIII of the liver there is an oval focal abnormality measuring up
to 18 mm (10:12, 8:22 and 15:8). The lesion is slightly hyperintense on
T1-weighted images compared to background without indication of intravoxel
fat. It is minimally hypointense on T2-weighted and HASTE images and shows no
restricted diffusion. Enhancement characteristics were not assessed.
Along the lateral margin of the hepatic dome a very small focus of
hyperintensity on T2-weighted images suggests a very small marginal cyst as
seen previously, measuring up to 8 mm.
The patient is status post cholecystectomy. There is no biliary dilatation.
An 8 mm cyst in the pancreatic body appears unchanged although not fully
assessed with this technique. Spleen is again enlarged measuring up to 14.6
cm in length. Adrenals are unremarkable.
A T2-hyperintense focus in the mid right kidney of 8 mm is not fully
characterized but likely to represent a simple cyst. An 18 mm simple cyst is
again noted along the posterior interpolar left kidney.
Small amount of ascites is present. Visualized bowel is unremarkable. No
enlarged lymph nodes are found. Bone marrow signal intensities are
unremarkable.
IMPRESSION:
Faint lesion in segment VIII of the liver suspected to correspond to the
sonographic finding. It is not fully characterized, however, without
administration of intravenous contrast. However, available information about
signal characteristics may favor a benign lesion, although dysplastic nodule
would not be excluded.
Since the lesion is fairly well seen on ultrasound, it may be appropriate to
consider follow-up surveillance with that modality.
Multiphasic CT was not helpful previously in evaluating the lesion, but it may
be appropriate to consider imaging with gadolinium if the patient is able to
do a breath-hold examination in the future.
|
10225793-RR-119
| 10,225,793 | 29,168,430 |
RR
| 119 |
2133-09-19 13:27:00
|
2133-09-19 17:44:00
|
EXAMINATION: MRI of the Abdomen
INDICATION: ___ year old woman with Hep C, ETOH cirrhosis p/w altered mental
status concerning for HE and liver lesion seen on US (note pt can hold breath
for ten seconds)// Triphasic to evaluate liver lesion
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
COMPARISON: Liver MRI ___, liver MRI ___, MRCP ___
Abdominal ultrasound ___
FINDINGS:
Lower Thorax: Limited evaluation is unremarkable.
Liver: Please note that evaluation for hepatic lesions is markedly limited due
to motion.
The liver is shrunken and nodular, compatible with cirrhosis. There are
several foci of apparent hypoenhancement in the right hepatic lobe measuring
up to 10 mm that are seen on different delayed postcontrast phases. There is
no definite correlate on arterial phase or T2 weighted imaging (series 16,
image 21; series 18, image 21).
Note is made of a 15 mm lesion in segment VIII that is intrinsically
hyperintense on T1 weighted imaging, and is a possible correlate to the prior
sonographic finding (6:7).
Biliary: The CBD is dilated measuring up to 16 mm, recently measuring 10 mm on
___ (02:20). Mild central intrahepatic biliary dilation. No
choledocolithiasis. Post cholecystectomy.
Pancreas: There is a 6 mm cystic lesion in the body of the pancreas, unchanged
from ___.
Spleen: Spleen is enlarged measuring up to 14.8 cm. No focal lesions are
identified.
Adrenal Glands: Unremarkable.
Kidneys: Other than bilateral simple renal cysts, the kidneys are
unremarkable.
Gastrointestinal Tract: There is no bowel obstruction. Trace ascites.
Lymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.
Vasculature: Abdominal aorta is not aneurysmal. Large portosystemic shunt is
seen in the lower abdomen (02:20).
Osseous and Soft Tissue Structures: No focal osseous lesions identified. Mild
body wall edema.
IMPRESSION:
1. Markedly limited examination due to respiratory motion. A few hypoenhancing
hepatic lesions measuring up to 10 mm seen on different post-contrast phases,
are indeterminate. No definite OPTN l5 esions identified, within the
limitations of this exam.
2. 16 mm T1 hyperintense lesion in segment VIII is indeterminate and does not
meet OPTN 5 criteria, but may correspond to the prior sonographic finding.
3. Worsening biliary dilation compared to two days prior of unknown etiology.
No choledocolithiasis.
4. 6 mm cystic lesion in the pancreatic body may represent a side branch IPMN
or sequela of chronic pancreatitis.
RECOMMENDATION(S): The patient would benefit from multiphasic CT, as the two
prior MRI examinations have been limited by difficulty with breathholding.
Please identify the specific allergic reaction to iodinated contrast, as the
patient may be amenable to premedication in the event of mild/moderate past
reactions.
|
10225793-RR-121
| 10,225,793 | 29,168,430 |
RR
| 121 |
2133-09-20 21:52:00
|
2133-09-20 22:46:00
|
EXAMINATION: Liver lesions on ultrasound an MRI that cannot be further
characterized.
INDICATION: ___ year old woman with hepc/etoh cirrhosis, p/w ams, potential
liver transplant candidate// evaluating for possible hepatic lesion, please
perform triphasic scan, ___
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 25.3 cm; CTDIvol = 7.5 mGy (Body) DLP = 180.3
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 5.0 s, 1.0 cm; CTDIvol = 11.6 mGy (Body) DLP =
11.6 mGy-cm.
4) Spiral Acquisition 6.6 s, 25.3 cm; CTDIvol = 17.3 mGy (Body) DLP = 410.6
mGy-cm.
5) Spiral Acquisition 12.4 s, 47.5 cm; CTDIvol = 19.4 mGy (Body) DLP =
891.8 mGy-cm.
6) Spiral Acquisition 6.7 s, 25.7 cm; CTDIvol = 17.3 mGy (Body) DLP = 417.7
mGy-cm.
Total DLP (Body) = 1,930 mGy-cm.
COMPARISON: Liver ultrasound from ___, liver CT from ___ and
liver MRI from ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates morphology consistent with chronic
fibrosis with a nodular contour, re-cannulized paraumbilical vein and portal
lymph nodes. A tiny subcentimeter cyst is seen in the periphery of segment 8
as was demonstrated on a recent MRI. No solid lesions are seen within the
liver. No early enhancing lesions are present within the liver. No areas of
delayed washout are seen in the liver. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder has been surgically
removed.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
solid focal lesions or pancreatic ductal dilatation. Again seen is a small
low-attenuation cyst in the neck of the pancreas. There is no peripancreatic
stranding.
SPLEEN: The spleen is enlarged associated with numerous retroperitoneal venous
varices..
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
No hydronephrosis is present. A 19 x 16 mm likely cyst is present in the
posterior mid left kidney.. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal lymphadenopathy. Small amount of
fluid is seen in the root of the mesentery associated with mesenteric
lymphadenopathy not appreciably changed from prior studies. There is no
pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits apart from
some induration and gas in the left mid abdomen consistent with recent
subcutaneous injection..
IMPRESSION:
1. No solid enhancing lesions are identified in the liver. No lesions
demonstrating early washout are identified that are concerning for ___. A
tiny likely cyst is seen in the periphery of segment 8. The liver and spleen
demonstrate features of portal hypertension with a nodular fibrotic liver,
recanalized paraumbilical vein splenomegaly and extensive mesenteric and
retroperitoneal varices.
2. Simple cyst in left kidney. Small cyst in neck of pancreas is again
demonstrated.
|
10225793-RR-141
| 10,225,793 | 25,564,623 |
RR
| 141 |
2134-04-03 13:26:00
|
2134-04-03 14:56:00
|
EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ year old woman with cirrhosis and moderate ascites s/p
___ in ___// TIPS for recurrent ascites
TECHNIQUE: Grey scale ultrasound images of the abdomen were obtained.
COMPARISON: Prior ultrasound dated ___.
FINDINGS:
Evaluation of 4 abdominal quadrants revealed a minimal amount of ascitic fluid
in the right upper quadrant, which is insufficient for therapeutic
paracentesis. No other ascitic fluid pockets seen.
IMPRESSION:
Small ascitic fluid pocket seen in the right upper quadrant is insufficient
for paracentesis. This was discussed with the primary team.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:53 pm, 5 minutes after
discovery of the findings.
|
10225793-RR-142
| 10,225,793 | 25,564,623 |
RR
| 142 |
2134-04-04 09:48:00
|
2134-04-04 11:54:00
|
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ year old woman with ETOH cirrhosis being assessed for TIPS//
**Patient is allergic to contrast and being pre-medicated**Per ___: TRIPHASIC
CT-A abdomen and pelvis for TIPS planning
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen and pelvis in the portal venous phase, followed by a scan of the
abdomen in equilibrium phase (3-min delay).
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 31.2 cm; CTDIvol = 5.9 mGy (Body) DLP = 184.1
mGy-cm.
2) Spiral Acquisition 1.6 s, 20.9 cm; CTDIvol = 24.1 mGy (Body) DLP = 504.3
mGy-cm.
3) Spiral Acquisition 4.0 s, 52.7 cm; CTDIvol = 24.2 mGy (Body) DLP =
1,276.7 mGy-cm.
4) Spiral Acquisition 1.6 s, 20.9 cm; CTDIvol = 24.1 mGy (Body) DLP = 503.9
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
6) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 20.1 mGy (Body) DLP =
10.1 mGy-cm.
Total DLP (Body) = 2,481 mGy-cm.
COMPARISON: Abdominal pelvis CT from ___
FINDINGS:
LOWER CHEST: Small left pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver is known to be cirrhotic. Only appreciated on the
delayed phase images, there is a 1.6 cm hypoattenuating focus in segment VIII
(series 305, image 18). This could represent a regenerating nodule. There is
no arterially hyperenhancing lesion meeting OPTN 5 criteria.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is resected.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is top normal measuring 13.1 cm in the craniocaudal
dimension.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are unremarkable besides a 1.8 cm simple cyst at the
interpolar region of the left kidney. Other subcentimeter hypodensities in
the right kidney are too small to be characterize but unchanged since ___. No hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. Small to
moderate amount of ascites is again noted and unchanged.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: No abdominal or pelvic lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted. There is a replaced left hepatic artery from the left
gastric artery. The portal veins, hepatic veins, portal splenic confluence
and SMV are patent.
There is recanalization of the umbilical vein with epiploic varices. S/p
embolization of an IMV-left iliac vein shunt. The main distal trunk is
significantly smaller measuring 8 mm in diameter and there is a prominent 8 mm
draining vein originating right after the distal end of the embolization
material and communicates with the left internal iliac vein.
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. Cirrhotic liver with signs of portal venous hypertension.
2. Small left pleural effusion.
3. No hepatic lesion meeting OPTN 5 criteria.
|
10225793-RR-143
| 10,225,793 | 25,350,529 |
RR
| 143 |
2134-05-26 12:21:00
|
2134-05-26 14:20:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with confusion, encephalopathy// eval PNA; eval PVT
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest x-rays, most recently ___ chest
CT ___
FINDINGS:
Again seen, is a fiducial in the left upper lobe with adjacent linear density
likely representing chronic scarring. No consolidation is seen concerning for
pneumonia. No large effusion, pneumothorax or signs of edema.
Cardiomediastinal silhouette appears normal and stable. Bony structures are
intact.
IMPRESSION:
No acute intrathoracic process. Fiducial again noted in the left upper lobe.
|
10225793-RR-144
| 10,225,793 | 25,350,529 |
RR
| 144 |
2134-05-26 12:29:00
|
2134-05-26 13:19:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with confusion, encephalopathy// eval PNA; eval PVT
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound ___, CT abdomen pelvis ___
FINDINGS:
Study is significantly limited due to overlying bowel gas.
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. Grossly, there is no focal liver
mass. The main portal vein and left Portal vein are patent with hepatopetal
flow. The right portal vein could not be visualized. There is a small amount
of ascites.
BILE DUCTS: There is no obvious intrahepatic biliary dilation.
CHD: 7 mm, similar in size to recent CT
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity. Mild splenomegaly, similar in size to recent
CT.
Spleen length: 13.8 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.Again seen is a
1.5 x 1.4 x 1.7 cm simple renal cyst within the interpolar region of the left
Kidney, not significantly changed in size from prior CT.
Right kidney: 9.4 cm
Left kidney: 9.8 cm
RETROPERITONEUM: The aorta and IVC could not be visualized on current exam.
IMPRESSION:
1. Cirrhotic liver with a small amount of ascites and mild splenomegaly.
2. Patent main portal vein and left portal vein with hepatopetal flow. The
right portal vein could not visualized.
|
10225793-RR-145
| 10,225,793 | 25,350,529 |
RR
| 145 |
2134-05-28 08:31:00
|
2134-05-28 12:56:00
|
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ w/ HCV/EtOH cirrhosis and refractory HE s/p ___ (___) p/w hepatic encephalopathy with unclear trigger concerning for shunt
recurrence vs new shunt development// Please evaluate for recurrence of
IMV-iliac vein shunt versus development of new shunt to explain recurrent HE
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen and pelvis in the portal venous phase, followed by a scan of the
abdomen in equilibrium phase (3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 2,843 mGy-cm.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken and nodular in contour compatible with
cirrhosis. Again seen is a 1.7 cm lesion in segment 8 of the liver (305:20)
which demonstrates mild arterial enhancement and washout on the delayed
imaging without a pseudocapsule. A few subcentimeter hypodensities in the
liver too small to characterize likely cysts/biliary hamartomas. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is surgically absent. There is mild perihepatic ascites.
OPTN CRITERIA (any lesion greater than 1cm, up to 5 lesions)
Maximum lesion diameter (late arterial or portal venous phase): 2.0 x 1.6cm
Location: Segment 8
Arterial enhancement: yes
Washout:yes
Late capsule or pseudocapsule enhancement on delayed phase: no
Growth (maximal diameter increase >50% in <=6 months): no
Classification: Class 5B: size 2-5cm, arterially enhancing AND washout OR
pseudocapsule OR growth OR bipsy proven
PANCREAS: The pancreas has normal attenuation throughout, without pancreatic
ductal dilatation. A 7 mm hypodensity in the body of the pancreas is again
noted. There is no peripancreatic stranding.
SPLEEN: The spleen is enlarged measuring 14.1 cm without focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A 2.2 cm hypodensity in the left kidney is compatible with a cyst. There is
no evidence of focal renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
moderate free fluid in the pelvis.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Again noted are embolization coils in the IMV to iliac shunt. The
right iliac to IMV and IMV to SMV/portal vein collaterals persist, not
significantly changed compared to the prior study. The replaced left hepatic
artery off of the left gastric artery. A recanalized umbilical vein is again
noted. Hepatic veins, portal vein and its branches, splenic vein, and SMV are
patent.
There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted.
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. A 2 cm arterially enhancing lesion with washout in segment 8 of the liver
meets OPTN 5b criteria for HCC.
2. Iliac to IMV and IMV to SMV/portal vein collaterals persists, not
significant changed compared to the prior study.
3. Mild perihepatic ascites and moderate pelvic free fluid.
4. 7 mm pancreatic hypodensity, likely side branch IPMN. Recommend MRCP for
further evaluation.
RECOMMENDATION(S): MRCP
|
10225793-RR-185
| 10,225,793 | 21,795,896 |
RR
| 185 |
2134-09-28 16:38:00
|
2134-09-28 17:54:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with cirrhosis abdominal pain// obstructive process? ?PVT
(pls do with doppler).
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Abdominal MRI ___ and Doppler liver ultrasound ___
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. Limited evaluation of the liver shows no focal lesions. Known
ablation cavity in segment VII/VIII is not seen.
There is large ascites, as seen on recent MRI.
There is stable splenomegaly, with the spleen measuring 12.4 cm.
There is no intrahepatic biliary dilation. The CHD measures 6 mm and patient
is status post cholecystectomy..
The main portal vein is patent with hepatopetal flow.
The TIPS is only patent proximally. Mid and distal portions of the TIPS
remain occluded.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 52.9 cm/sec, previously 18.6 cm/sec
Proximal TIPS: 50.3 cm/sec, previously 51.1 cm/sec
Flow within the left portal vein is away from the TIPS shunt. Anterior and
posterior branches of the right portal vein are not seen. Appropriate flow is
seen in the hepatic veins and IVC.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. TIPS in place with occlusion of the mid and distal portions.
2. Unchanged hepatopetal flow of the left hepatic vein.
3. Moderate ascites, unchanged from ___ and unchanged splenomegaly.
|
10225793-RR-186
| 10,225,793 | 21,795,896 |
RR
| 186 |
2134-09-28 19:24:00
|
2134-09-28 19:56:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ with Nausea abdominal distension abdominal surgeries+PO
contrast// ?SBO
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,416 mGy-cm.
COMPARISON: MRI abdomen ___ and CT abdomen pelvis ___. Same
day right upper quadrant ultrasound.
FINDINGS:
LUNG BASES: Imaged lung bases are clear.
ABDOMEN:
HEPATOBILIARY: Cirrhotic appearance of the liver the with redemonstration of a
2.4 cm hypodense lesion in segment VII/VIII, corresponding with known treated
cavity, poorly evaluated without IV contrast and better seen on recent MRI.
Patient is status post TIPS, with occlusion demonstrated on same day
ultrasound. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent. Moderate amount of ascites
again seen.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within limitations of unenhanced CT. No
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Oral contrast opacifies the
small bowel and cecum. No bowel obstruction. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within
normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Patency of the TIPS cannot be assessed on the current study.
Patient is status post embolization of the IV a.m. and associated large
collaterals at the level of the aortic bifurcation, with associated streak
artifact.
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. No bowel obstruction.
2. Cirrhotic liver with moderate ascites. TIPS is better assessed on same day
ultrasound.
3. Post ablation cavity in segment VII/VIII is better characterized on prior
MRI.
|
10225793-RR-187
| 10,225,793 | 21,795,896 |
RR
| 187 |
2134-09-29 08:36:00
|
2134-09-29 08:48:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with abdominal ascites and dyspnea on
exertion// evaluate for evidence of pulmonary congestions, pleural effusions,
enlarged cardiac silhouette, PNA, hyperinflation
IMPRESSION:
In comparison with the study ___, there again are low lung volumes. The
cardiac silhouette remains within normal limits and there is no vascular
congestion, pleural effusion, or acute focal pneumonia.
Fiducial clip and post ablation changes are seen in the left upper zone.
|
10225793-RR-193
| 10,225,793 | 23,126,553 |
RR
| 193 |
2134-11-02 16:18:00
|
2134-11-02 17:10:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with ascites. Evaluation for portal venous
thrombosis.
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Comparison to prior ultrasound from ___.
FINDINGS:
Study is moderately limited due to overlying bowel gas and poor sonographic
penetration. The liver appears diffusely coarsened and nodular consistent
with known cirrhosis. No focal liver lesions are identified.
There is large ascites.
The spleen measures 12.7 cm.
There is no intrahepatic biliary dilation. The patient is status post
cholecystectomy.
The TIPS is visualized, however no color Doppler flow is seen within the TIPS,
similar in appearance to prior study.
Flow within the left portal vein is away from the TIPS shunt. The right
anterior portal vein is not visualized. Appropriate flow is seen in the left
hepatic vein and IVC.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Moderately limited study due to overlying bowel gas and poor sonographic
penetration.
2. No flow is seen within the TIPS and flow is reversed in the left portal
vein, similar in appearance to prior ultrasound from ___ and
consistent with occlusion of the TIPS.
3. Cirrhotic liver with large volume ascites.
|
10225793-RR-194
| 10,225,793 | 23,126,553 |
RR
| 194 |
2134-11-03 12:53:00
|
2134-11-03 14:30:00
|
EXAMINATION: Ultrasound-guided therapeutic paracentesis.
INDICATION: ___ with hx of HCV/EtOH cirrhosis c/b ascites and HE s/p BRTO and
TIPS, prior SBP, and ___ s/p ablation who presented with abdominal
distension/pain found to have SBP.// therapeutic paracentesis also iso SBP
TECHNIQUE: Ultrasound-guided therapeutic paracentesis
COMPARISON: Paracentesis from ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: Ultrasound guided therapeutic paracentesis
Location: left lower quadrant
Fluid: 4 L of clear, straw-colored fluid
Samples: None
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided therapeutic paracentesis.
2. 4 L of fluid were removed.
|
10225793-RR-207
| 10,225,793 | 22,812,527 |
RR
| 207 |
2135-01-20 13:05:00
|
2135-01-20 15:11:00
|
EXAMINATION: Ultrasound-guided therapeutic and diagnostic paracentesis.
INDICATION: ___ year old woman with cirrhosis, refractory ascites // weekly
lVP
TECHNIQUE: Ultrasound-guided therapeutic and diagnostic paracentesis.
COMPARISON: Images from multiple prior ultrasound guided paracentesis most
recent dated ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis
Location: left lower quadrant
Fluid: 7.55 L of cloudy, straw-colored fluid
Samples: 15 cc of fluid were sent for microbiology and cell count.
The procedure, risks, benefits and alternatives were discussed with the
patient and existing annual signed consent was reviewed.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 7.55 L of fluid were removed in 15 cc of fluid were sent for analysis.
|
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