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10027602-RR-51 | 10,027,602 | 28,166,872 | RR | 51 | 2201-11-05 17:35:00 | 2201-11-05 21:05:00 | EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old woman with fevers, please evaluate for infectious
process. // ___ year old woman with fevers, please evaluate for infectious
process.
COMPARISON: Chest radiographs ___ through ___.
IMPRESSION:
ET tube in standard placement. Sharp definition of the cuff than indicates
secretions pooling above it.
Nasogastric tube ends in the stomach, left subclavian line ends in the upper
right atrium, both unchanged. Right lung clear. There is some abnormality at
the base of the left lung posterior to the heart, either consolidation or a
small pleural collection. Right lung is clear. Pleural effusion on the right
is small if any. No pneumothorax.
|
10027602-RR-52 | 10,027,602 | 28,166,872 | RR | 52 | 2201-11-06 07:51:00 | 2201-11-06 18:00:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: A ___ woman with intraventricular hemorrhage, please
evaluate for increase in hemorrhage and EVD placement.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows.
DOSE: DLP: 1131.65 mGy-cm
CTDI: 70.73 mGy
COMPARISON: CT head without contrast obtained ___.
FINDINGS:
Again seen in stable position is right ventriculostomy catheter which
terminates in the foramen of ___. There is evolution of known
intraventricular hemorrhage, with no evidence of new hemorrhage. There has
been a significant interval decrease in ventricular dilation in comparison
with prior CT from ___. There is evidence of continued
resolution of known posterior falcine subdural hematoma. There now high
density material at the left edge of the foramen magnum, consistent with
embolization material.
There is no mass, or shift of normally midline structures. The basal cisterns
are patent. The paranasal sinuses are clear. There is no evidence of
fracture.
IMPRESSION:
1. Evolution and decrease in extent of intraventricular hemorrhage. No new
area of hemorrhage or recent infarct is seen. Significant interval decrease in
ventricular dilation since ___.
2. Stable location of right ventriculostomy catheter with tip terminating in
the foramen of ___.
3. Resolving posterior falcine subdural hematoma.
|
10027602-RR-53 | 10,027,602 | 28,166,872 | RR | 53 | 2201-11-06 14:46:00 | 2201-11-06 17:26:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: A ___ woman with interventricular hemorrhage status post
new EVD, confirm placement of new EVD.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 780.44 mGy-cm
CTDI: 53.02 mGy
COMPARISON: Portable unenhanced head CT obtained same day, ___ at
09:00.
FINDINGS:
There is again seen a right ventriculostomy catheter which terminates in the
body of the right lateral ventricle. There is now evidence of minimal gas
along the course of the catheter and in the right ventricle.
Again seen is evidence of known intraventricular hemorrhage, as well as
resolving posterior falcine subdural hematoma. There is no evidence of new
intracranial hemorrhage. There is no evidence of recent infarct. There is no
mass or shift of normally midline structures. The paranasal sinuses and
mastoid air cells are clear. There is no evidence of fracture.
IMPRESSION:
1. Interval placement of new right ventriculostomy catheter which terminates
in the body of the right lateral ventricle.
2. No interval change in resolving posterior falcine subdural hematoma or
known evolving intraventricular hemorrhage.
|
10027602-RR-54 | 10,027,602 | 28,166,872 | RR | 54 | 2201-11-07 15:32:00 | 2201-11-07 17:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ found down by roommate in bathroom next to emesis with
intraventricular hemorrhage found to have AV dural fistula s/p embolization
___, now re-intubated // ?ETT placement
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
ET tube is in standard position the tip is 3.4 cm above the carina. NG tube
tip is in the stomach. Cardiomediastinal contours are normal. The lungs are
grossly clear. There is no pneumothorax. If any there is a small right
effusion. Left subclavian catheter tip is in the cavoatrial junction/ upper
right atrium, unchanged
|
10027602-RR-55 | 10,027,602 | 28,166,872 | RR | 55 | 2201-11-08 15:26:00 | 2201-11-08 20:21:00 | PROCEDURE PERFORMED: Diagnostic cerebral angiography with catheterization of
the left vertebral artery, the right common carotid artery, the right external
carotid artery , catheterization of the right internal maxillary artery and
middle meningeal arteries, Onyx embolization of dural AV fistula.
INDICATIONS: Ms. ___ is a ___ white female who had an
intraventricular hemorrhage from a ruptured dural AV fistula. This has been
attempted to be embolized in the past and she now presents for attempted
embolization today.
ATTENDING: Dr. ___.
ASSISTANT: Dr. ___.
ANESTHESIA: General endotracheal anesthesia.
MEDICATIONS EMPLOYED: ___ units of heparin IV, 200 mcg of intra-arterial
nitroglycerin.
DESCRIPTION OF PROCEDURE: Ms. ___ was brought in the neuroangio suite
under general anesthesia and bilateral groins were prepped and draped in the
usual sterile fashion. A timeout was performed. Her right femoral artery was
accessed using anatomic and radiographic landmarks utilizing a micropuncture
needle set and a Seldinger technique to place a 6 ___ long sheath within
the right femoral artery. This was sutured in place, connected to a
continuous heparinized saline flush. Next, a 5 ___ Berenstein catheter was
connected to an RHV, three-way stopcock, contrast power injector and
continuous heparinized saline flush using an 0.038 Terumo Glidewire, was
brought up over the aortic arch and used to select the right common carotid
artery. A roadmap was performed. Under roadmap guidance, the right external
carotid artery was selected and intracranial AP and lateral angiography then
followed. Then, under high magnification oblique view through the guide
catheter, a Marathon microcatheter with a Mirage microwire was then used to
gain access into the internal maxillary artery. At this point, ___ units of
heparin IV were given and then serially IA nitroglycerin was injected first
100 mcg within the more proximal external carotid artery and then 100 mcg into
the middle meningeal artery for vasospasm. Further roadmaps allowed further
distal access within the middle meningeal branch that supplied the dural AV
fistula with a combination of a Mirage microwire and the Expedient 0.010
microwire. The catheter was unable to get further distal penetration, so Onyx
embolization occurred after the catheter was flushed with 5 mL of saline and
prepped with 0.23 mL of DMSO. Onyx embolization occurred in multiple stages
from the catheter with some penetration distally within the middle meningeal
branches a fair amount of reflux. When it became clear that no further distal
penetration would be achieved, the catheter was then removed as well as the 5
___ Berenstein. Next, a 4 ___ Berenstein 2 catheter was connected to
the RHV assembly and using the wire was brought up over the aortic arch to do
final selection of the right common carotid artery for intracranial AP and
lateral angiography and then connected to the left subclavian artery and left
vertebral artery was then selected for intracranial AP and lateral
angiography. The catheter was then removed and a roadmap was performed of the
femoral artery access and a 6 ___ Angio-Seal was used for hemostasis.
IMAGING FINDINGS:
1. EXTERNAL CAROTID ARTERY: ECA injection demonstrates mild reflux down into
the internal carotid artery, but otherwise demonstrates largely
normal-appearing branches of the ECA starting with the lingual facial complex,
the distal runoff of the occipital and the posterior auricular as well as the
internal maxillary artery and the STA and the MMA branches. There does appear
to be subtle filling of the ___ 3 dural AV fistula from a medial and
falcine branch of the MMA. Subsequent high magnification microinjections
demonstrate placement of the catheter within the middle meningeal artery and
subsequent configurations with distal penetration of the middle meningeal
artery.
2. RIGHT MAXILLARY ARTERY : confirms presence of dural AV fistula as above.
3. RIGHT MIDDLE MENINGEAL ARTERY : demonstrates falcine dural AV fistula.
4. RIGHT COMMON CAROTID ARTERY: CCA injection demonstrates again
normal-appearing branches of the ECA with subsequent occlusion of the middle
meningeal artery following penetration within the foramen spinosum. The
internal carotid artery branches appear unremarkable and there is
normal-appearing ophthalmic artery with good retinal blush, a normal-appearing
PCom artery and anterior choroidal artery. The ACA and MCA vasculature
appears unremarkable with good parenchymal filling and venous egress.
5. LEFT VERTEBRAL ARTERY: Good injection is seen within the left vertebral
artery with no reflux down into the right vertebral artery, but an
unremarkable appearing basilar trunk. There is a ___ complex on the
left and a normal-appearing AICA on the right. The bilateral SCAs and PCAs
appear unremarkable; however, there appears to be distal small penetrating
branches from the right distal PCA that arc over within the falx and then
descend to continue to supply the dural AV fistula with early venous drainage
running underneath the corpus callosum and then deep into the straight sinus.
Otherwise, the parenchymal and venous egress appears unremarkable. There no
longer appears to be a posterior meningeal branch that fills this fistula.
CONCLUSIONS:
1. ___ type 3 dural AV fistula now continuing to be fed from distal PCA
branches that feed into an early draining vein that drains into the straight
sinus. Previously, this has been drained by middle meningeal branches and
Onyx embolization, has occluded the middle meningeal on the right with no
longer filling of the fistula from these vessels.
2. No evidence of thromboembolic complications.
|
10027602-RR-56 | 10,027,602 | 28,166,872 | RR | 56 | 2201-11-09 04:12:00 | 2201-11-09 13:48:00 | INDICATION: Evaluate ETT. Febrile.
COMPARISON: Radiographs from ___.
IMPRESSION:
The tip of the endotracheal tube is 4.8 cm above the carina, appropriately
sited. There is a left sided central venous line with distal tip in the
cavoatrial junction.
Lungs are grossly clear without focal consolidation, pleural effusions, or
pneumothoraces. There is no pulmonary edema. Heart size and mediastinal
structures are within normal limits. Bony structures are intact.
|
10027602-RR-57 | 10,027,602 | 28,166,872 | RR | 57 | 2201-11-10 13:47:00 | 2201-11-10 14:30:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with AVM s/p surgery, changes in MS //
incranial bleed, interval change
TECHNIQUE: Contiguous axial CT images were obtained through the brain without
the administration of IV contrast. Reformatted coronal, sagittal and thin
section bone algorithm-reconstructed images were then generated.
DOSE: DLP: 829 mGy-cm
CTDI: 52
COMPARISON: Head CT on ___
FINDINGS:
A right ventriculostomy catheter which terminates in the body of the right
lateral ventricle is stable in position.
Intraventricular hemorrhage seen dependently in the occipital horns is similar
in distribution to the prior study. No evidence of new hemorrhage or acute
territorial infarction. There is no evidence of mass effect or midline shift.
Subtle density along the posterior falx is consistent with a resolving
subdural hematoma. The basal cisterns are patent and there is preservation of
gray-white matter differentiation The paranasal sinuses are clear. There is
partial opacification of the bilateral mastoid air cells. There is no evidence
of fracture.
IMPRESSION:
Intraventricular hemorrhage and a small posterior falcine subdural hematoma
are stable from the prior exam. No evidence of new hemorrhage or acute
territorial infarction.
|
10027602-RR-58 | 10,027,602 | 28,166,872 | RR | 58 | 2201-11-11 04:12:00 | 2201-11-11 11:48:00 | EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ found down by roommate in bathroom next to emesis with
intraventricular hemorrhage found to have AV dural fistula s/p coil
embolizations ___ and ___ // NGT position
COMPARISON: Chest radiographs since ___ most recent ___.
IMPRESSION:
Lungs essentially clear. Heart size top- normal. No pleural abnormality or
evidence of central adenopathy.
Nasogastric tube passes into the nondistended stomach and out of view. Left
subclavian line ends in the upper right atrium. No pneumothorax or
appreciable pleural effusion.
|
10027602-RR-59 | 10,027,602 | 28,166,872 | RR | 59 | 2201-11-11 07:20:00 | 2201-11-11 13:02:00 | EXAMINATION: PORTABLE HEAD CT W/O CONTRAST
INDICATION: A ___ woman with a dural AV fistula status post EVD, now
with EVD clamped, assess interval change.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows.
DOSE: DLP: 1273.10 mGy-cm
CTDI: 70.73 mGy
COMPARISON: Noncontrast head CT obtained ___.
FINDINGS:
The current study is limited by hardware artifact, patient motion, and
sub-optimal patient positioning. There is again seen a right ventriculostomy
catheter terminating in the right lateral ventricle as before. Again seen is
bilateral ventricular enlargement, decreased since the prior study. There is
continued evolution of prior known intraventricular hemorrhage and subdural
hematoma. There is no evidence of new hemorrhage or of infarction. There is
no evidence of mass, cerebral edema, or shift of normally midline structures.
The basal cisterns are patent. The bilateral mastoid air cells are not well
assessed due to patient motion. Embolization material is again seen in the
anterior right temporal region. There has been interval placement of a right
nare NG tube.
IMPRESSION:
1. Decreased ventricular caliber status the prior study.
2. No new evidence of infarction or new hemorrhage. Continued evolution of
prior known intraventricular hemorrhage and subdural hematoma.
|
10027602-RR-62 | 10,027,602 | 28,166,872 | RR | 62 | 2201-11-16 12:37:00 | 2201-11-16 18:05:00 | INDICATION: PEG placement
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal chest radiograph.
IMPRESSION:
A nasogastric tube terminates within the stomach. The heart size is normal.
The hilar and mediastinal contours are within normal limits. Mild
atherosclerotic calcifications are seen within the aortic arch. There is no
pneumothorax, focal consolidation, or pleural effusion.
|
10027602-RR-63 | 10,027,602 | 28,166,872 | RR | 63 | 2201-11-19 05:10:00 | 2201-11-19 06:20:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with fall out of bed. Patient has had a
complicated preceding hospital course, initially presenting with subarachnoid
and intraventricular hemorrhage, s/p embolization of dural AV fistula supplied
by the left posterior meningeal artery on the ___, and s/p right
middle meningeal artery embolization on ___.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm
CTDI: 55.13 mGy
COMPARISON: Head CT ___.
FINDINGS:
Embolization material is again seen along the right frontal and temporal
convexity, with associated streak artifact slightly limiting evaluation of the
adjacent extra-axial space and superficial parenchyma.
Small amount of blood in the occipital horns of the lateral ventricles has
decreased compared to ___. No residual subarachnoid hemorrhage is
seen. Small amount of high density along the posterior falx may represent
residual subdural blood. No new acute hemorrhage is seen.
There has been interval removal of the right ventriculostomy catheter. The
ventricles have slightly increased in size compared to ___. There
is mild hypodensity without mass effect along the prior path of the catheter
through the right frontal lobe, with 2 small calcifications. There are also
subependymal calcifications along the posterior body of the right lateral
ventricle on image 2:17.
Mild periventricular white matter hypodensities are again seen, compatible
with either small vessel ischemic changes or sequela of transependymal CSF
flow.
There is no evidence for new edema or large vascular territorial infarction.
There is partial opacification of right mastoid tip air cells.
IMPRESSION:
1. No evidence for acute intracranial injury.
2. Small amount of blood in the occipital horns of lateral ventricles has
decreased since ___. Small amount of residual subdural blood may be
present along the posterior falx.
3. The ventricles have slightly increased in size compared to ___,
s/p interim removal of the right ventriculostomy catheter.
|
10027602-RR-64 | 10,027,602 | 28,166,872 | RR | 64 | 2201-11-19 05:12:00 | 2201-11-19 06:30:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ year old woman with fall out of bed. The patient has been
hospitalized with intracranial hemorrhage, with dural AVF status post
embolization of the left posterior meningeal and right middle meningeal
arteries.
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 37.08 mGy
DLP: 837.8 mGy-cm
COMPARISON: ___ CT cervical spine ___.
FINDINGS:
No fractures are identified. Minimal anterolisthesis of C3 on C4 is
unchanged. There is no evidence for prevertebral edema. There are multilevel
degenerative changes. There is a right paracentral disc extrusion at C4-5
mildly indenting the ventral thecal sac, and a broad-based disc osteophyte
complex at C5-6 mildly indenting the ventral thecal sac. There is multilevel
neural foraminal narrowing, mostly by uncovertebral osteophytes, with facet
osteophytes at some levels.
Embolization material adjacent to the distal V3 and proximal V4 segments of
the left vertebral artery, extending along the posterior and medial left
cerebellum, is new compared to ___.
A 8 mm hypodense nodule is present in the left lobe of the thyroid.
In the apical left upper lobe, there is a partially visualized spiculated
lesion with a central solid component and peripheral mild ground-glass
component, highly concerning for malignancy. The solid component measures 1.6
cm in image 2:69, and the ground-glass component is not fully included on the
images. This lesion was also partially visualized on the ___ CT.
IMPRESSION:
1. No fracture or acute subluxation.
2. Multilevel degenerative disease.
3. Mixed solid/ ground-glass spiculated lesion in the apical left upper lobe,
highly concerning for malignancy. If this has not been previously worked up
elsewhere, PET-CT and surgical consultation should be considered.
4. 8 mm left lobe thyroid nodule, which should be further assessed by
ultrasound if not previously performed elsewhere.
|
10027602-RR-65 | 10,027,602 | 28,166,872 | RR | 65 | 2201-11-19 06:14:00 | 2201-11-19 11:33:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with fall OOB // eval for fx
COMPARISON: Chest radiographs ___
FINDINGS:
Intervalremoval of feeding tube. Heart size is normal. The mediastinal and
hilar contours are normal. The pulmonary vasculature is normal. No focal
consolidation, pleural effusion, or pneumothorax. No fractures.
IMPRESSION:
No fractures or acute cardiopulmonary abnormalities.If clinical symptoms
persist, dedicated rib series is recommended due to higher sensitivity of that
technique.
|
10027602-RR-66 | 10,027,602 | 28,166,872 | RR | 66 | 2201-11-19 17:59:00 | 2201-11-19 20:46:00 | EXAMINATION: CT abdomen and pelvis, baseline oncology protocol.
INDICATION: ___ year old woman with new left lung mass at the apex noted on CT
of the cervical spine. please ___ evaluate lung mass. // ___ year old
woman with new left lung mass at the apex noted on CT of the cervical spine.
please ___ evaluate lung mass.
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis prior
to and following intravenous contrast administration with split bolus
technique.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was administered.
DOSE: DLP: 2056 mGy-cm (abdomen and pelvis.
IV Contrast: 130 mL Omnipaque
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings. There is bibasilar atelectasis. There
is no pleural or pericardial effusion.
ABDOMEN:
Hepatic attenuation is uniform without evidence of hepatic steatosis. There is
no evidence of hepatic mass. There is no intrahepatic biliary ductal
dilatation. There is unchanged prominence of the common duct which tapers
normally at the pancreatic head. There is an unchanged gallstone without
evidence of acute cholecystitis.
Spleen is unremarkable. There is an unchanged 9 mm splenule in the splenic
hilum. 2-3 mm hypodensities within the pancreatic uncinate process likely
represent small side branch IPMN. The pancreas is otherwise unremarkable
without evidence of mass or pancreatic ductal dilatation.
The adrenal glands are unremarkable. There is symmetric renal enhancement and
excretion of intravenous contrast. There is no evidence of hydronephrosis.
Urinary bladder is decompressed by indwelling Foley catheter.
Uterus is unremarkable. There is a the 1.7 x 1.8 cm fluid attenuation
structure in the left adnexal region.
There are no dilated loops of bowel. There are diverticula of the rectosigmoid
without evidence of diverticulitis. There is a small amount of nonspecific
presacral fat stranding. There is no evidence of bowel wall thickening. There
is a gastrostomy tube. Small amounts of free air in the upper abdomen may
relate to gastrostomy tube.
There is no suspicious osseous lesion. There are degenerative changes of the
lower lumbar spine. There is no evidence of abdominal aortic aneurysm.
IMPRESSION:
1. No evidence of metastatic disease in the abdomen or pelvis
2. 1.7 x 1.8 cm left adnexal cystic structure. If patient is to receive
followup CT abdomen and pelvis examinations, this finding may be re-evaluated
in ___ year. If patient will not have CT abdomen and pelvis performed in ___ year,
pelvic ultrasound examination is recommended in ___ year to re-evaluate left
adnexa.
3. Trace amounts of intraperitoneal free air likely related to recent
gastrostomy tube placement.
4. 2- 3 mm hypodensities in the pancreatic head likely represent small IPMN.
5. Please see separate dictation for dedicated CT chest report.
|
10027602-RR-67 | 10,027,602 | 28,166,872 | RR | 67 | 2201-11-19 18:00:00 | 2201-11-19 20:47:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Evaluate lung lesion seen in spine CT
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent reconstructed as
axial, coronal , parasagittal, and ,MIPs axial images.
DOSE: DLP: Reported in the concurrent abdomen CT in
COMPARISON: None
FINDINGS:
The thyroid has sub cm hypodense nodule in the right lobe and hyperdense
subcentimeter nodule in the left lobe. Supraclavicular, axillary, mediastinal
and hilar lymph nodes are not enlarged. Aorta and pulmonary arteries are
normal size. Cardiac configuration is normal and there is no appreciable
coronary calcification.
Irregular spiculated nodule in the left apex has a solid component that
measures 9 x 13 mm, its peripheral ground-glass component is difficult to
measure, aprox 32x16 mm (7:47)
Bibasilar dependent atelectasis are larger on the right side. There is right
apical scarring.
There is no pleural or pericardial effusion.
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings.
There are no bone findings of malignancy
IMPRESSION:
Spiculated left apical semi-solid lesion concerning for lung malignancy.
|
10027957-RR-37 | 10,027,957 | 28,485,516 | RR | 37 | 2172-08-29 00:00:00 | 2172-08-29 00:22:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with new onset seizure, fall at home. Evaluate for
hemorrhage or mass.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.1 cm;
CTDIvol = 49.9 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles, sulci, and basal cisterns are normal in size.
Cerebellar tonsils are normally positioned.
There is no evidence for a fracture. There is mild mucosal thickening in the
inferior frontal sinuses and frontoethmoidal recesses. Several anterior
ethmoid air cells are opacified on both sides. There is substantial mucosal
thickening in a single left posterior ethmoid air cell. There are mucous
retention cysts in the partially visualized right maxillary sinus and mild
mucosal thickening in bilateral partially visualized maxillary sinuses.
Middle ear cavities and mastoid air cells are clear.
IMPRESSION:
No evidence for acute intracranial abnormalities.
RECOMMENDATION(S): MRI would be more sensitive for detecting a seizure
source, if clinically warranted.
|
10027957-RR-38 | 10,027,957 | 28,485,516 | RR | 38 | 2172-08-29 00:01:00 | 2172-08-29 00:28:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with new onset seizure, fall at home. Evaluate for
cervical spine fracture.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 21.1 cm; CTDIvol = 36.9 mGy (Body) DLP = 778.5
mGy-cm.
Total DLP (Body) = 778 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified. There is no prevertebral
soft tissue swelling. Evaluation of the spinal canal by CTs limited compared
to MRI. However, multiple disc herniations are visualized. A large right
paracentral disc herniation at C5-C6 severely narrows the right aspect of the
spinal canal with mass effect on the spinal cord. A left paracentral disc
herniation at C4-C5 moderately narrows the left aspect of the spinal canal
with spinal cord remodeling. There is also multilevel neural foraminal
narrowing by uncovertebral and facet osteophytes.
There is mucosal thickening in the visualized inferior posterior portions of
the maxillary sinuses, right more than left. Concurrent head CT is reported
separately.
A 6 mm nodule is noted in the left thyroid lobe. Visualized upper lungs are
clear.
IMPRESSION:
1. No evidence of a fracture or subluxation
2. Multilevel degenerative disease with apparent severe spinal canal narrowing
at C5-C6 and moderate spinal canal narrowing at C4-C5.
RECOMMENDATION(S): If the patient has acute or chronic neurologic symptoms
related to cervical spinal stenosis, then further evaluation may be performed
by cervical spine MRI.
NOTIFICATION: At 10:57 on ___, Dr. ___ paged Dr.
___ regarding the presence of spinal stenosis and consideration of
MRI.
|
10027957-RR-39 | 10,027,957 | 28,485,516 | RR | 39 | 2172-08-29 20:28:00 | 2172-08-29 22:32:00 | EXAMINATION: MRI AND MRA BRAIN PT12 MR HEAD
INDICATION: History of Crohn's disease and new onset seizure. Evaluate for
dural venous sinus thrombosis or other abnormality.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
3D phase-contrast MRV of the head was obtained. Sagittal T1 weighted imaging
was performed. Three dimensional maximum intensity projection and segmented
images of the MRV were then generated. This report is based on interpretation
of all of these images.
COMPARISON: MR head ___. Noncontrast head CT ___.
FINDINGS:
Examination is moderately motion degraded.
MR head: There is an irregular area of dural based enhancement in the
anterior interhemispheric fissure extending bilaterally measuring roughly 18 x
9 mm on sagittal view (10:131), with adjacent edema and probable mild
expansion of the left straight gyrus, extending the left orbital gyrus and
adjacent white matter (___). There is no associated slowed diffusion.
On the same-day CT examination, there is mild irregularity of the adjacent
fovea ethmoidalis, without hyperostosis. There is mild opacification of the
adjacent bilateral ethmoid air cells. Given this appearance including mild
bony erosion and possible immunosuppression given Crohn's disease, this is
most suspicious for fungal infection, possibly secondary to intracranial
infiltration from adjacent sinus disease. The next most likely possibility
would be dural inflammatory pseudotumor. And unlikely, but possible
differential etiology would be meningioma, though the appearance suggests
against this and the degree of adjacent edema would not be expected from a
meningioma of this size.
There is no evidence of hemorrhage, midline shift or infarction. The
ventricles and sulci are normal in caliber and configuration. Few scattered
areas of periventricular and subcortical white matter T2/FLAIR hyperintensity
are in a configuration most suggestive of chronic small vessel ischemic
disease. There is no abnormal focus of slowed diffusion. The principal
intracranial vascular flow voids are preserved. The dural venous sinuses are
patent on MP -RAGE images.
There is mild polypoid mucosal wall thickening in the floor of the right
maxillary sinus and minimal mucosal thickening in the remainder of the
visualized paranasal sinuses. The orbits are grossly unremarkable.
MRV: Normal flow signal is demonstrated within the superior sagittal sinus,
straight sinus, transverse sinuses, and sigmoid sinuses. The jugular bulbs and
proximal jugular veins are patent. Evaluation of the deep venous systems
reveals normal flow signal in the internal cerebral veins. The vein ___
is also unremarkable.
IMPRESSION:
1. Slightly irregular area of dural based enhancement in the anterior
interhemispheric fissure adjacent to the left straight gyrus measuring up to
18 x 9 mm with adjacent edema of the left straight/orbital gyri, as described,
favored to represent infection, particularly given adjacent mild bony
irregularity of the fovea ethmoidalis, possibly fungal in this patient with a
history of Crohn's disease with immunosuppression. Dural inflammatory
pseudotumor would be the next most likely etiology. Meningioma is considered
unlikely, though possible.
2. Minimal areas of white matter signal abnormality in a configuration most
suggestive of chronic small vessel ischemic disease.
3. No dural venous sinus thrombosis.
4. Mild paranasal sinus opacification, as described.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 11:13 AM, 10 minutes
after discovery of the findings.
|
10027957-RR-41 | 10,027,957 | 28,485,516 | RR | 41 | 2172-08-31 17:09:00 | 2172-09-01 08:45:00 | EXAMINATION: CT SINUS W/O CONTRAST FOR SURGICAL PLANNING Q114 CT HEADSINUS
INDICATION: ___ year old woman with Crohns with new onset seizure and left
frontal lesion and dural enhancement // pt will go for sinus biopsy with ENT,
ENT requested dedicated sinus CT with fusion to help with approach
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.9 s, 22.4 cm; CTDIvol = 25.9 mGy (Head) DLP = 579.5
mGy-cm.
Total DLP (Head) = 580 mGy-cm.
COMPARISON: CT head without contrast from ___.
MRI and MRA brain from ___
FINDINGS:
Opacifications are seen in the right maxillary sinus and left posterior
ethmoidal air cells. The left frontal recess is occluded. There are
intermittent regions of dehiscence of the frontal bone overlying the bilateral
posterior ethmoidal air cells, concerning for possible intracranial extension
(series 602b: Image 68 and 76-77). The enhancing soft tissue component seen
on the prior MRI appears to involve the ethmoid air cells and likely
correlates to regions of opacification on the current exam. Bilaterally
A small amount of mucosal thickening is seen in the right ethmoid air cells
and left maxillary sinus. The visualized mastoid air cells and middle ear
cavities are clear. The ostiomeatal units are otherwise patent. The
cribriform plates are intact. The lamina papyracea are intact. There is mild
rightward deviation of the nasal septum. The orbits are unremarkable.
Limited views of the brain are remarkable for hypodensity redemonstrated in
the left frontal cortex, likely representing mild edema which was better seen
on the prior MRI in ___.
IMPRESSION:
1. There is opacification of the posterior ethmoidal air cells bilaterally
with occlusion of the left frontal ethmoidal recess. Bilateral regions of
intermittent dehiscence of the bone overlying the bilateral posterior
ethmoidal air cells are concerning for possible intracranial extension. These
findings are concerning for infection in the setting of immunosuppression.
Other differential considerations include Wegener's or malignancy.
2. Mild edema in the left frontal cortex is better seen on the prior MRI from
___.
|
10027957-RR-43 | 10,027,957 | 28,485,516 | RR | 43 | 2172-09-01 01:06:00 | 2172-09-01 10:33:00 | EXAMINATION: CT SINUS W/O CONTRAST FOR SURGICAL PLANNING Q114 CT HEADSINUS
INDICATION: ___ year old woman with Crohn's Dz and HTN presenting w/ multiple
episodes concerning for seizures, new L frontal lesion with dural enhancement
// Pt to go for sinus biopsy w/ ENT, request CT Sinus fusion for surgical
approach
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.1 s, 24.0 cm; CTDIvol = 26.0 mGy (Head) DLP = 624.1
mGy-cm.
Total DLP (Head) = 624 mGy-cm.
COMPARISON: CT sinus without contrast from ___.
FINDINGS:
As seen on earlier exam, opacifications are seen in the right maxillary sinus
and bilateral posterior ethmoidal air cells. The left frontal recess is
occluded, unchanged since prior study. There are intermittent regions of
dehiscence of the frontal bone overlying the bilateral posterior ethmoidal air
cells, concerning for possible intracranial extension.
A small amount of mucosal thickening is seen in the right ethmoid air cells
and left maxillary sinus. The visualized mastoid air cells and middle ear
cavities are clear. The ostiomeatal units are otherwise patent. The cribriform
plates are intact. The lamina papyracea are intact. There is mild rightward
deviation of the nasal septum. The orbits are unremarkable.
Limited views of the brain are remarkable for hypodensity redemonstrated in
the left frontal cortex, likely representing mild edema which was better seen
on the prior MRI in ___.
IMPRESSION:
1. Unchanged appearance of opacification of the posterior ethmoidal air cells
with occlusion of the left frontal recess with concern for bilateral frontal
bone dehiscence and intracranial extension of possible infection, in the
setting of immunosuppression. Alternative considerations include Wegener's or
malignancy.
|
10027957-RR-44 | 10,027,957 | 28,485,516 | RR | 44 | 2172-09-01 14:09:00 | 2172-09-01 17:22:00 | INDICATION: ___ year old woman with seizures and left frontal lobe lesion,
concern for infection or malignancy.
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) = 897 mGy-cm.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
CT ABDOMEN:
HEPATOBILIARY: Focal fatty infiltration is seen near the falciform ligament.
A segment III hypodensity is too small to characterize, likely a simple
hepatic cyst or biliary hamartoma. The liver otherwise enhances
homogeneously without evidence of concerning focal lesion. There is no
intrahepatic biliary ductal dilation. The portal vein is patent. The
gallbladder is unremarkable without evidence of wall thickening or
inflammation.
PANCREAS: The pancreas enhances homogeneously. There is no peripancreatic
stranding or ductal dilation.
SPLEEN: There is no splenomegaly or focal splenic lesion.
ADRENALS: The adrenal glands are normal.
URINARY: 11 mm hypodense focus within the medial left upper pole renal cortex
(2, 55) is larger in comparison to prior exam from ___, at that time
measuring 7 mm, however previously demonstrating MRI characteristics of a
simple renal cyst, now demonstrating a thin internal calcification.
Otherwise, the kidneys enhance normally and symmetrically. There is no
hydronephrosis.
GASTROINTESTINAL: The stomach and duodenum are unremarkable. Non-dilated
small bowel loops are normal in course and caliber without evidence of wall
thickening or obstruction. The colon is unremarkable. The appendix is
normal.
VASCULAR AND LYMPH NODES: The abdominal aorta is normal in caliber without
evidence of aneurysm or dilation. Major proximal tributaries are patent.
Scattered retroperitoneal and mesenteric lymph nodes are not pathologically
enlarged. There is no free intraperitoneal air or fluid.
CT PELVIS:
There is no worrisome focal uterine or adnexal abnormality. There is no
pelvic or inguinal lymphadenopathy. There is no free pelvic fluid.
MUSCULOSKELETAL: There is no concerning focal subcutaneous or musculoskeletal
soft tissue abnormality. There is rectus abdominus diastasis containing only
fat. There is a 10 mm sclerotic focus in the right iliac bone (2, 101)
unchanged since ___, likely a bone island. The imaged thoracolumbar
vertebral bodies are normally aligned. There is mild multilevel degenerative
change. Vertebral body heights are preserved. No concerning focal lytic or
sclerotic osseous lesions are seen.
IMPRESSION:
1. No evidence of malignancy within the abdomen or pelvis. No acute process
identified.
2. Septated cyst in the medial left kidney has grown slightly since ___.
Although favored to be benign, given apparent septum not clearly seen
previously, ___ year follow up ultrasound is recommended.
3. Subcentimeter segment III hepatic hypodensity is favored to be benign,
however is too small to definitively characterize of this exam. Attention on
follow-up.
4. Please see separate report for intrathoracic findings from same-day CT
chest.
RECOMMENDATION(S): ___ year follow-up renal ultrasound.
|
10027957-RR-45 | 10,027,957 | 28,485,516 | RR | 45 | 2172-09-01 14:13:00 | 2172-09-01 16:44:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION:
___ woman with seizures and left frontal lobe lesion, infection versus
malignancy. Evaluate for malignancy.
TECHNIQUE: Helical axial MDCT images were acquired through the chest as part
of a CT torso exam after the administration of IV contrast. Reformatted
images in coronal and sagittal axes were generated. Maximum intensity
projection images were generated on a separate workstation reviewed on PACs.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 6.5 s, 71.9 cm; CTDIvol = 12.3 mGy (Body) DLP = 882.8
mGy-cm.
Total DLP (Body) = 897 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: CTA chest from ___.
FINDINGS:
The lungs are fairly well-expanded, with dependent atelectasis. A sub-4 mm
triangular nodular opacity is noted in the right middle lobe (04:104). No
concerning nodule, mass, or focal consolidation is identified. No pleural
effusion or pneumothorax is present.
Subcentimeter hypodensities are seen in the left lobe of the thyroid gland.
There is no supraclavicular, mediastinal, or hilar lymphadenopathy. Left
axillary lymph nodes are enlarged, but demonstrate normal morphology with
fatty hila. The heart is mildly enlarged with a small pericardial effusion.
There is no significant coronary artery calcification. The aorta is normal in
caliber. The pulmonary artery is mildly enlarged, measuring 3.1 cm in
diameter. This is suggestive but not diagnostic of pulmonary artery
hypertension. There is a 7 mm aneurysm of a left upper lobe artery, and
possible aneurysmal dilation at the origin of the left lower lobe pulmonary
artery, both of which are unchanged compared to ___. The lower
esophagus is mildly thickened but not hyperemic.
No focal lytic or sclerotic osseous lesion is identified.
Please see the dedicated CT abdomen/pelvis report from the same day for
detailed evaluation of infra diaphragmatic structures.
IMPRESSION:
1. No evidence of intrathoracic malignancy.
2. Small pericardial effusion.
3. Possible pulmonary hypertension. Two subcentimeter pulmonary artery
aneurysms, stable for at least a year, origin and significance uncertain,
probably not due to an active condition.
|
10027957-RR-53 | 10,027,957 | 25,485,223 | RR | 53 | 2173-02-25 02:44:00 | 2173-02-25 09:36:00 | INDICATION: ___ year old woman with Crohn's on methotrexate presenting with
left orbital vision loss concerning for extraintestinal manifestation of
Crohn's versus sarcoidosis// Lymphadenopathy
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
CT chest from ___.
FINDINGS:
Lungs are well expanded and clear. Cardiomediastinal silhouette and hila are
within normal limits. No pneumothorax or pleural effusion
IMPRESSION:
No acute cardiopulmonary process, mediastinal or hilar lymphadenopathy or
lobar consolidation.
|
10027957-RR-54 | 10,027,957 | 29,592,503 | RR | 54 | 2173-03-07 17:27:00 | 2173-03-07 17:42:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with fever, leukocytosis// eval for pna
TECHNIQUE: Chest two views
COMPARISON: ___
FINDINGS:
Heart size at the upper limits are normal. Normal pulmonary vascularity. No
edema, effusion, infiltrate or pneumothorax. Mild gastric distention.
IMPRESSION:
No acute findings.
|
10027957-RR-55 | 10,027,957 | 29,592,503 | RR | 55 | 2173-03-09 05:42:00 | 2173-03-09 10:13:00 | EXAMINATION: MRI BRAIN AND ORBITS PT4 MR ___
INDICATION: ___ year old woman with a history of Crohn's disease on
methotrexate, with recent admission to BI acute onset left eye vision loss
found to have an abnormal MRI consistent with left perioptic neuritis which
has improved and she now returns with a positive lyme IgM. Evaluate for
interval change
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations. Orbit images acquired at 3 mm slice thickness. Precontrast
sequences included axial and coronal T1, coronal STIR. Postcontrast sequences
included axial and coronal T1 with fat saturation.
COMPARISON: MRI brain and orbits ___, MR ___ ___
FINDINGS:
MRI ORBITS:
There is interval decrease in diffuse enhancement surrounding the intracranial
left optic nerve extending to the orbital canal with decrease in retro-orbital
fat stranding. The optic nerves appear symmetric without evidence of abnormal
enhancement. The extraocular muscles are uniform in size and normal in
signal. The right retro-orbital fat appears unremarkable. There is symmetric
appearance of the cavernous sinuses without filling defects.
MRI BRAIN:
There is similar to decreased enhancement along the interhemispheric fissure
and inferior left orbital gyrus (14:10, 18). There is no evidence of
infarction. The ventricles are normal in size without mass effect or midline
shift. There is mild mucosal thickening of the right maxillary and the
ethmoid air cells. The arterial vascular flow voids are preserved.
IMPRESSION:
1. Interval decrease in left perioptic enhancement and retro-orbital fat
stranding suggestive of perineuritis.
2. Stable to decreased enhancement along the interhemispheric fissure and the
inferior left orbital gyrus.
3. No evidence of infarction or new abnormal enhancement.
|
10028480-RR-85 | 10,028,480 | 25,485,913 | RR | 85 | 2195-03-22 10:55:00 | 2195-03-22 11:44:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with CHF, Afib, dyspnea, chest pain// volume status,
pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
Cardiac silhouette size remains mildly enlarged. Mediastinal and hilar
contours are unremarkable. Lung volumes remain low. Mild pulmonary edema
appears new in the interval. No focal consolidation, pleural effusion, or
pneumothorax is seen. There are mild degenerative changes seen in the
thoracic spine.
IMPRESSION:
Mild pulmonary edema, new in the interval.
|
10028480-RR-86 | 10,028,480 | 25,485,913 | RR | 86 | 2195-03-26 16:27:00 | 2195-03-26 17:58:00 | EXAMINATION: Portable chest x-ray
INDICATION: Patient is an ___ year old woman with a PMH of HTN, HLD, T2DM,
HFrEF (25%), stage 3 CKD, afib on warfarin, OSA, who presents with SOB, lower
extremity edema, and chest tightness most likely CHF exacerbation.// r/o PNA,
pulmonary edemaINTERVAL CHANGE
TECHNIQUE: Portable chest x-ray
COMPARISON: Previous portable chest x-ray from ___
FINDINGS:
The heart is enlarged, stable. The trachea is midline. There is mild
pulmonary edema, unchanged when allowing for differences in technique. Mild
degenerative changes are seen in the spine.
IMPRESSION:
Mild pulmonary edema. Cardiomegaly.
|
10028683-RR-26 | 10,028,683 | 23,978,212 | RR | 26 | 2170-03-15 13:37:00 | 2170-03-15 14:35:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ woman with endometeriosis and severe abdominal pain
and vaginal bleeding, s/p laparoscopic essure coil removal and bilateral
salpingectomy.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after the administration of intravenous contrast. Axial images were
interpreted in conjunction with coronal and sagittal reformats. Oral contrast
was administered.
DLP: 463 mGy-cm
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
CHEST: The visualized lung bases are clear. The heart is normal in size and
there is no evidence of pericardial effusion.
ABDOMEN:
The liver enhances homogeneously and is without focal lesions. The portal
venous system is patent. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is normal and without gallstones.
The spleen and adrenal glands are unremarkable. The pancreas enhances
homogenously and is without focal lesions.
The kidneys display symmetric nephrograms and excretion of contrast. There are
no focal renal lesions. There is no hydronephrosis. The ureters are normal in
caliber and course to the bladder.
The distal esophagus is normal without a hiatal hernia. The stomach is grossly
unremarkable in appearance. The small and large bowel are normal in caliber
and without evidence of wall thickening. The appendix is not visualized
however there are no secondary signs of appendicitis right lower quadrant.
The abdominal aorta and its major branches are patent . The aorta and iliac
branches are normal in course and caliber. There is no retroperitoneal or
mesenteric lymphadenopathy by CT size criteria. There is no pneumoperitoneum.
PELVIS:
The bladder is well distended and normal. There is no pelvic side-wall or
inguinal lymphadenopathy by CT size criteria. There is moderate hypersense
fluid compatible with blood within the pelvis. Essure devices are not seen,
tubal ligation slips are identified. Uterus is grossly unremarkable.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. Moderate blood within the pelvis. No evidence of active extravasation of
contrast.
2. Normal the CT appearance of the uterus.
3. No evidence of bowel obstruction or ileus.
|
10028683-RR-27 | 10,028,683 | 23,978,212 | RR | 27 | 2170-03-15 15:03:00 | 2170-03-15 16:28:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ woman s/p essure removal and b/l salpingectomy
presents with 2 days of heavy vaginal bleeding.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: CT abdomen and pelvis from same day.
FINDINGS:
The uterus is anteverted and measures 7.5 x 4.4 x 5.3 cm cm. The endometrium
is unremarkable and measures 8 mm. The ovaries are normal. There is moderate
complex fluid in the pelvis.
IMPRESSION:
1. Moderate complex free fluid in the pelvis, consistent with blood.
2. Unremarkable appearance of the uterus.
|
10029038-RR-12 | 10,029,038 | 20,484,353 | RR | 12 | 2154-08-29 09:21:00 | 2154-08-29 11:33:00 | INDICATION: ___ gentleman with headaches, right arm dystonic
posturing, evaluate for cardiopulmonary process.
COMPARISON: No prior studies available.
TECHNIQUE: AP portable upright chest radiograph.
FINDINGS: Heart appears to be normal in size and configuration. Trachea is
midline. Cardiomediastinal contours are unremarkable. Lung fields are clear
with no evidence of focal infiltrates. No pleural effusions or pneumothorax.
Bony structures show some degenerative changes, but are otherwise
unremarkable.
IMPRESSION: Normal radiographic study of the chest.
|
10029108-RR-10 | 10,029,108 | 20,360,088 | RR | 10 | 2145-05-28 10:42:00 | 2145-05-28 12:52:00 | EXAMINATION: MRI of the Pelvis
INDICATION: ___ year old man with perirectal abscess s/p I D, n/w concern for
undrained collection // pls assess for undrained collection
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen and pelvis
wereacquired in a 1.5 T magnet.
Intravenous contrast: 8 mL Gadavist
COMPARISON: CT from ___
FINDINGS:
Re- demonstration of a 2.3 x 1.4 x 1.2 cm abscess replacing the internal
sphincter and occupying the intersphincteric space in the mid anus. It has
shown slight interval increase in size from previous, where measured 2.0 x 1.3
cm. There is no trans sphincteric extension.
There is thinning of the posterior aspect of the internal sphincter from the 4
o'clock to the 8 o'clock position extending almost the entire length of the
internal sphincter, with inflammatory/ postsurgical changes noted at the very
distal aspect of the internal sphincter. Only the very proximal 1.2 cm of the
internal sphincter is preserved and of normal thickness.
There is a linear area of low signal on T2, touching the left external
sphincter and extending through the ischial anal fossa to the perineum,
compatible with an old area of scarring.
The prostate is enlarged measuring 6.7 x 4.7 x 5.4 cm, compatible with benign
prostatic hypertrophy. There are no suspicious prostate lesions identified.
Remainder of the visualized small and large bowel loops are within normal
limits.
The bladder is unremarkable.
Visualized bony structures are unremarkable.
IMPRESSION:
1. Residual abscess measuring 2.3 x 1.4 x 1.2 cm replacing the internal
sphincter and occupying the intersphincteric space posteriorly, with no trans
sphincteric extension as detailed above.
2. Thinning of the posterior aspect of the internal sphincter from the 4
o'clock to the 8 o'clock position, extending almost the entire length of the
internal sphincter, sparing the upper 1.2 cm.
3. Inflammatory/post surgical changes are noted at the very distal aspect of
the internal sphincter posteriorly and perineum, without definite collection
seen at this level.
4. Benign prostatic hypertrophy.
|
10029295-RR-16 | 10,029,295 | 27,059,161 | RR | 16 | 2180-10-14 16:20:00 | 2180-10-14 17:38:00 | HISTORY: Trauma.
TECHNIQUE: Portable AP view of the chest.
COMPARISON: None.
FINDINGS:
Lung volumes are low. Heart size is top normal. Mediastinal and hilar
contours are unremarkable. There is no pulmonary vascular engorgement. Lungs
are clear. No pleural effusion or pneumothorax is identified, with mild
elevation of the right hemidiaphragm noted. No acutely displaced fractures
are identified.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10029295-RR-17 | 10,029,295 | 27,059,161 | RR | 17 | 2180-10-14 16:32:00 | 2180-10-14 17:43:00 | HISTORY: Trauma.
TECHNIQUE: 2 views of the right forearm. Single view of the right humerus.
COMPARISON: None.
FINDINGS:
Evaluation is limited due to lack of standard radiographic positioning.
Fracture-dislocation of the distal forearm is present with a comminuted
fracture of the distal radial diaphysis noted with approximately 4-cm of
proximal and radial displacement of the dominant fracture fragment. Fracture
line does not appear to extend to the articular surface and the radio-carpal
joint appears preserved. Additionally, there is dislocation of the ulnocarpal
joint with the ulna located medial and dorsal to the carpal bones. The distal
radius and ulna are rotated with respect to the carpal bones. Extensive soft
tissue swelling is noted about the distal forearm. Elbow appears grossly
intact.
Single view of the humerus demonstrates no acute osseous abnormality.
IMPRESSION:
Dislocation of the ulnocarpal joint and displaced comminuted fracture of the
distal radius.
|
10029295-RR-18 | 10,029,295 | 27,059,161 | RR | 18 | 2180-10-17 17:38:00 | 2180-10-21 08:56:00 | HISTORY: Intraoperative fluoroscopic imaging was provided for open reduction
internal fixation of distal radial and ulnar fracture- dislocation.
TECHNIQUE: Five intraoperative fluoroscopic images of the right forearm.
COMPARISON: ___.
FINDINGS:
A volar surgical fixation plate extends along the distal radius. Multiple
intact screws are in place. There is marked improved osseous alignment since
___.
Two new percutaneous pin extend through the distal radius and ulna. There is
a displaced ulnar styloid fracture. There is marked irregularity of the soft
tissues of the forearm.
TOTAL FLUOROSCOPY TIME: 1 minute 44 seconds.
IMPRESSION:
1. Intraoperative fluoroscopic imaging was provided for open reduction
internal fixation of distal right radial and ulnar fracture dislocation.
2. Surgical hardware appears grossly intact.
Please refer to the operative report for further evaluation.
|
10029429-RR-10 | 10,029,429 | 22,981,727 | RR | 10 | 2187-01-05 22:21:00 | 2187-01-05 22:47:00 | EXAMINATION: Right knee radiographs, two views.
INDICATION: Distal femur fracture.
COMPARISON: Earlier on the same day.
FINDINGS:
There is a complete oblique fracture through the distal femoral metaphysis,
shortly proximal to the tibial prosthesis of a total knee replacement. The
prosthesis does not seem to be involved although fairly closely approached.
Small comminuted fragments are found in the vicinity. Fracture is displaced
by half of a shaft with and impacted. Large joint effusion is present. Bones
appear demineralized. Vascular calcification is moderate.
IMPRESSION:
Distal femur fracture. No definite involvement of the prosthesis
radiographically.
|
10029429-RR-11 | 10,029,429 | 22,981,727 | RR | 11 | 2187-01-07 10:43:00 | 2187-01-07 16:36:00 | EXAMINATION: CR, FEMUR AP AND LATERAL RIGHT
INDICATION: RIGHT FEMUR FRACTURE ORIF
COMPARISON: Imaging from ___
FINDINGS:
Four intraoperative images were acquired without a radiologist present. Total
61 seconds fluoro time.
Images show oblique fracture through distal femoral metaphysis, better
demonstrated on prior imaging. There is a lateral surgical plate with
associated screws affixing the distal femur. No evidence of hardware
complication.
IMPRESSION:
1. Intraoperative images were obtained during right femur fracture ORIF.
Please refer to the operative note for details of the procedure.
|
10029429-RR-12 | 10,029,429 | 22,981,727 | RR | 12 | 2187-01-07 15:58:00 | 2187-01-07 17:21:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ year old woman with ankle pain// ? fracture ? fracture
TECHNIQUE: 3 portable views of the right ankle were obtained
COMPARISON: None
FINDINGS:
No fracture or dislocations are seen. There are mild degenerative changes
throughout the midfoot. The mortise is congruent on these nonweightbearing
views. The tibial talar joint space is preserved and no talar dome
osteochondral lesion is identified. No suspicious lytic or sclerotic lesion is
identified. No soft tissue calcification or radiopaque foreign body is
identified.
IMPRESSION:
No acute osseous injury of the right ankle.
|
10029429-RR-13 | 10,029,429 | 22,981,727 | RR | 13 | 2187-01-09 11:24:00 | 2187-01-09 13:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hx CHF now POD ___ s/p ORIF R Femur//
evaluate for pulmonary edema/pleural effusion
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Continued enlargement of the cardiac silhouette with mild elevation of
pulmonary vasculature. No evidence of acute focal pneumonia or pleural
effusion.
|
10029429-RR-14 | 10,029,429 | 22,981,727 | RR | 14 | 2187-01-10 07:58:00 | 2187-01-10 08:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with CHF and ___// assess volume status
assess volume status
IMPRESSION:
Comparison to ___. Lung volumes have decreased. Although there
is presence of bilateral areas of atelectasis and moderate cardiomegaly, no
signs of pulmonary edema present. No pleural effusions. No pneumonia. No
pneumothorax.
|
10029429-RR-15 | 10,029,429 | 22,981,727 | RR | 15 | 2187-01-11 07:09:00 | 2187-01-11 09:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with CHF// assess volume status assess
volume status
IMPRESSION:
Heart size is enlarged, unchanged. There is prominence of the main pulmonary
artery, similar to previous examination. There is interval improvement in
pulmonary edema. There is only mild vascular congestion currently present.
No appreciable pleural effusion or pneumothorax.
|
10029429-RR-16 | 10,029,429 | 22,981,727 | RR | 16 | 2187-01-13 08:40:00 | 2187-01-13 09:40:00 | EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) LEFT
INDICATION: ___ year old woman with RLE surgery, now with contralateral calf
pain// eval DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow 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 left lower extremity veins.
|
10029429-RR-8 | 10,029,429 | 22,981,727 | RR | 8 | 2187-01-05 21:46:00 | 2187-01-05 22:15:00 | EXAMINATION: CHEST (PRE-OP AP ONLY)
INDICATION: History: ___ with hip fracture, preop// Please evaluate for PNA
or effusion
TECHNIQUE: Frontal views of chest.
COMPARISON: Chest x-ray ___, performed at an outside facility.
FINDINGS:
The heart is mild to moderately enlarged. Otherwise, the mediastinal contour
is unremarkable. Mild prominence of the pulmonary vasculature. No definite
pleural effusion or focal consolidation. No pneumothorax.
IMPRESSION:
1. No evidence of pneumonia.
2. Mild prominence of the pulmonary vasculature.
3. Mild to moderate cardiomegaly.
|
10029429-RR-9 | 10,029,429 | 22,981,727 | RR | 9 | 2187-01-05 22:03:00 | 2187-01-05 22:49:00 | EXAMINATION: Right lower extremity CT
INDICATION: ___ year old woman with periprosthetic femur fx// assess for
loosening of components and intraarticular extension
TECHNIQUE: 2.5 mm axial slices reconstructed from multidetector helical
acquisition. 2 mm coronal slices were also reconstructed. All images were
reviewed. No contrast injection was performed.
COMPARISON: Prior right femur radiographs dated ___.
FINDINGS:
Linear oblique fracture of the distal right femoral diaphysis. There is
lateral displacement of approximately 1 shaft's width and also mild inferior
displacement of approximately 2.5 cm. There to displaced fragments, a 6 mm
adjacent to the distal fracture line (3:155) and a 18 mm adjacent to the
proximal fragment, insinuating into the bone marrow.
The overall appearance of the entire femur is unremarkable, with intact
remaining cortical ridges and normal density throughout, with no suggestion
for pathological fracture due to malignancy.
There is intermuscular edema and a medial small hematoma measuring
approximately 3.5 x 3.0 x 2.0 cm.
A knee prosthesis appears intact and well placed.
IMPRESSION:
Distal comminuted, impacted fracture of the femur femoral diaphysis with 2
small fragments associated. There is lateral inferior displacement. Bone
density is regular throughout. Small adjacent medial hematoma and edema are
associated.
|
10029468-RR-5 | 10,029,468 | 28,440,970 | RR | 5 | 2169-01-16 02:52:00 | 2169-01-16 04:59:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman s/p MVC// pericardial effusion status
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.6 s, 36.0 cm; CTDIvol = 5.9 mGy (Body) DLP = 210.8
mGy-cm.
Total DLP (Body) = 211 mGy-cm.
COMPARISON: No prior chest CT scans for comparison.
FINDINGS:
CHEST PERIMETER: Iodine content of the thyroid is low. Within that
limitation, no focal abnormalities are seen. Breast evaluation is reserved
for mammography. Subcentimeter supraclavicular and axillary lymph nodes are
not enlarged and there are no soft tissue abnormalities elsewhere in the chest
chest cage. This study is not designed for subdiaphragmatic evaluation.
Abdomen CT scan performed elsewhere, dated ___ has been up loaded to
PACs.
Subcutaneous generator in the right lower back sends to leads superiorly into
the soft tissue on the cervical spine, and out of view.
CARDIO-MEDIASTINUM:Esophagus is unremarkable. Atherosclerotic calcification
is not apparent in head and neck vessels or coronary arteries. It aorta and
pulmonary arteries and cardiac chambers are normal size. Small volume of
serous density pericardial fluid lies anteriorly, probably physiologic. In
the absence of any traumatic abnormality in the sternum, anterior pleura, lung
or chest wall soft tissue, this is unlikely to be related to the reported
motor vehicle accident. There is no associated pleural abnormality and no
mediastinal fluid collection or hematoma.
THORACIC LYMPH NODES: Lymph nodes in the chest are not pathologically
enlarged.
LUNGS, AIRWAYS, PLEURAE: Lungs are clear and the tracheobronchial tree is
normal to subsegmental levels. There is no pleural abnormality.
CHEST CAGE: Unremarkable. No evidence of trauma
IMPRESSION:
Essentially normal chest CT. No evidence of trauma.
|
10029484-RR-9 | 10,029,484 | 20,764,029 | RR | 9 | 2160-11-09 23:33:00 | 2160-11-10 01:29:00 | HISTORY: Coronary artery disease, hypertension, hyperlipidemia and diabetes
presenting with ongoing severe diarrhea. Infectious workup negative.
Evaluate for intra-abdominal pathology.
TECHNIQUE: Axial helical MDCT images were obtained through the abdomen and
pelvis after administration of Omnipaque intravenous contrast and oral
contrast. Multiplanar reformatted images in coronal and sagittal axes were
generated.
DLP: 765 mGy-cm
COMPARISON: None available
FINDINGS:
The bases of the lungs are clear. The visualized heart and pericardium are
unremarkable with the exception of coronary artery calcifications.
CT abdomen: There is a 9 mm hypodensity in segment 2 of the liver which is
too small to characterize. The liver otherwise enhances homogeneously without
focal lesions or intrahepatic biliary dilatation. The gallbladder is
unremarkable and the portal vein is patent. The pancreas, spleen and adrenal
glands are unremarkable. The kidneys present symmetric nephrograms and
excretion of contrast with no pelvicaliceal dilation or perinephric
abnormalities.
The small bowel is fluid-filled with some areas which are mildly dilated;
however, without sharp transition point. Contrast reaches the mid sigmoid
colon. There is no evidence of obstruction. The appendix is visualized and
there is no evidence of appendicitis. The intraabdominal vasculature is
unremarkable. There is no mesenteric or retroperitoneal lymph node
enlargement by CT size criteria. No ascites, free air or abdominal wall
hernia is noted.
CT pelvis: The urinary bladder is unremarkable. There is no pelvic free
fluid. There is no inguinal or pelvic wall lymphadenopathy.
Osseous structures: No lytic or sclerotic lesions suspicious for malignancy
is present.
IMPRESSION:
Fluid-filled small bowel with some mildly dilated loops, as can be seen in the
setting of enteritis. No evidence of obstruction.
|
10030549-RR-35 | 10,030,549 | 28,978,916 | RR | 35 | 2141-11-12 00:38:00 | 2141-11-12 02:03:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: History: ___ with RUE and RLE weakness, penile cancer, ?mass on
CT // mass?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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 dated ___
FINDINGS:
There is 10 mm ovoid enhancing mass in the posterior aspect of the left
superior frontal gyrus. There is surrounding vasogenic edema involving in the
left frontal and parietal lobe. There is associated mass effect on the
adjacent parenchyma, without midline shift. No associated central slow
diffusion.
No additional enhancing lesion are identified.
There is no evidence of hemorrhage or infarction. The ventricles and sulci
are prominent, likely reflecting age-related involutional changes. There are
a few minimal scattered T2/FLAIR hyperintensities in the white matter which
are nonspecific but may reflect chronic small vessel disease in this age
group. There are chronic infarcts in the left cerebellum. The visualized
flow voids are grossly preserved. There is mucosal thickening of the ethmoid
air cells and bilateral maxillary sinuses. The mastoid air cells are clear.
There is abnormal T1 hypointensity in the C4 and C5 vertebral bodies on the
sagittal T1 images. This can reflect osseous metastatic disease. Note of low
lying cerebellar tonsils which protrude below the foramen magnum by
approximately 9 mm, and are pointed with crowding of the CSF spaces at the
foramen magnum.
IMPRESSION:
1. 1 cm ovoid enhancing lesion in the posterior with aspect of the left
superior frontal gyrus with surrounding moderate vasogenic edema, raises
concern for metastatic disease. Primary brain malignancy is also differential
consideration.
2. No additional intraparenchymal lesions are identified.
3. There is T1 hypointensity in the C4 and C5 vertebral bodies which is
incompletely assessed on this examination but can reflect osseous metastatic
disease. Consider dedicated imaging of the cervical spine.
4. No acute infarct or hemorrhage.
5. Cerebellar tonsils are pointed and protrude below the foramen magnum by
approximately 1 cm, which can reflect Chiari type configuration in the
appropriate setting.
|
10030549-RR-37 | 10,030,549 | 28,978,916 | RR | 37 | 2141-11-13 18:39:00 | 2141-11-13 22:09:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with metastatic penile SCC // Asses for
metastatic disease
TECHNIQUE: 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: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 4.4 s, 0.2 cm; CTDIvol = 74.4 mGy (Body) DLP =
14.9 mGy-cm.
3) Spiral Acquisition 10.3 s, 66.9 cm; CTDIvol = 10.9 mGy (Body) DLP =
724.5 mGy-cm.
4) Spiral Acquisition 4.1 s, 26.9 cm; CTDIvol = 8.4 mGy (Body) DLP = 219.8
mGy-cm.
Total DLP (Body) = 961 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Bulla at the right lung base. Subtle bibasilar atelectasis.
There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is 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 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 solid 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. Appendix not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: A lucent lesion in the T 11 vertebral body with associated soft tissue,
better seen on the same day thoracic spine MRI. Degenerative changes are seen
in the lumbar spine with formation of anterior osteophytes.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Lucent lesion in the T11 vertebral body with associated soft tissue, better
characterized on the same day thoracic spine MRI, likely a metastasis.
2. Same date chest CT is reported separately.
|
10030549-RR-38 | 10,030,549 | 28,978,916 | RR | 38 | 2141-11-14 00:08:00 | 2141-11-14 16:03:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ year old man with metastatic penile SCC, new brain met and
suspected C-spine met on CT. // ? C-spine mets ? C-spine mets
Assess for metastatic disease
Assess for metastatic disease
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of Gadavist contrast agent,
additional axial and sagittal T1 images were obtained.
COMPARISON: CT abdomen pelvis dated ___
FINDINGS:
CERVICAL:
Alignment is normal. There is nonspecific diffuse loss of normal T1 marrow
signal throughout the cervical spine. There is mild retrolisthesis of C5
relative to C6. There is mild loss of vertebral body height or of C5 and C6.
There is multilevel disc desiccation with loss of of intervertebral disc
height, more pronounced at C5-C6 and C6-C7.
At C2-C3, there is central disc protrusion slightly deforming the anterior
surface of the spinal cord. There is no significant neural foraminal
narrowing bilaterally.
At C3-C4, there is diffuse disc bulge flattening the spinal cord. There is
uncovertebral disc osteophyte resulting in mild bilateral neural foraminal
narrowing.
At C4-C5, there is a disc bulge and midline protrusion flattening the ventral
cord. There are bilateral vertebral joint osteophyte resulting in moderate
bilateral neural foraminal narrowing.
At C5-C6, there is a diffuse disc bulge flattening the ventral spinal cord.
There are bilateral uncovertebral osteophytes, worse on the left resulting in
severe left neural foraminal narrowing. No significant right neural foraminal
narrowing.
At C6-C7, there is a midline disc protrusion indenting the anterior surface of
the spinal cord. There are bilateral uncovertebral osteophytes resulting in
mild bilateral neural foraminal narrowing.
At C7-T1, there is mild disc bulge without significant spinal canal or neural
foraminal narrowing.
THORACIC:
Alignment is normal. Vertebral body and intervertebral disc signal intensity
appear normal. The spinal cord appears normal in caliber and configuration.
There is mild disc bulge at T5-T6, otherwise there is no evidence of spinal
canal or neural foraminal narrowing.
There is hypointense T1, hyperintense T2, enhancing lesion involving the right
lateral aspect of T11 vertebral body with cortical destruction. It measures
approximately 2.0 x 1.7 cm.
LUMBAR:
There is 5 non rib-bearing lumbar type vertebrae. There is loss of signal of
the intervertebral discs on the T2 weighted images throughout the lumbar spine
with loss of intervertebral disc height, more pronounced at L5-S1. The spinal
cord appears normal in caliber and configuration. There is no evidence of
infection or neoplasm. There is no abnormal enhancement after contrast
administration.
At T12-L1, there is no significant disc disease, spinal canal or neural
foraminal narrowing.
At L1-L2, there is mild disc bulge and ligamentum flavum thickening resulting
in mild bilateral neural foraminal narrowing. No significant spinal canal
stenosis.
At L2-L3, there is disc bulge, ligamentum flavum thickening, bilateral facet
osteophytes, resulting in moderate bilateral neural foraminal narrowing. No
significant spinal canal stenosis.
At L3-L4, there is disc bulge, ligamentum flavum thickening, bilateral facet
osteophytes resulting in moderate spinal canal stenosis and severe neural
foraminal narrowing bilaterally.
At L4-L5, there is disc bulge, ligamentum flavum thickening, bilateral facet
osteophytes resulting in mild spinal canal narrowing and severe bilateral
neural foraminal narrowing.
At L5-S1, there is disc bulge, ligamentum flavum thickening, bilateral facet
osteophytes resulting in severe bilateral neural foraminal narrowing. There
is no significant spinal canal narrowing.
OTHER:
IMPRESSION:
1. Enhancing lesion involving the T11 vertebral body, raises concern for
metastatic disease. No additional lesions are identified in the spine.
2. Severe bilateral neural foraminal narrowing at L3-L4, L4-L5 and L5-S1.
3. Severe spinal canal narrowing at L4-5 due to degenerative disease.
4. Additional multilevel multifactorial cervical and lumbar spondylosis as
described above.
PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects
without low back pain:
Overall evidence of disk degeneration 91% (decreased T2 signal, height loss,
bulge)
T2 signal loss 83%
Disk height loss 58%
Disk protrusion 32%
Annular fissure 38%
Jarvik, et all. Spine ___ 26(10):1158-1166
Lumbar spinal stenosis prevalence- present in approximately 20% of
asymptomatic adults over ___ years old
___, et al, Spine Journal ___ 9 (7):545-550
These findings are so common in asymptomatic persons that they must be
interpreted with caution and in context of the clinical situation.
|
10030549-RR-39 | 10,030,549 | 28,978,916 | RR | 39 | 2141-11-13 18:39:00 | 2141-11-13 20:42:00 | EXAMINATION: CT CHEST W/CONTRAST ___
INDICATION: ___ year old man with metastatic penile SCC // Asses for
metastatic disease
TECHNIQUE: Multi-detector helical scanning of the chest, coordinated with
intravenous infusion of nonionic, iodinated contrast agent, following oral
administration of contrast agent for selected abdominal studies, and/or
followed by scanning of the neck, was reconstructed as contiguous 5 mm and 1.0
or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and parasagittal, and 8 mm
MIP axial images. Concurrent scanning of the abdomen and pelvis and/or neck
will be reported separately. All images of the chest were reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 4.4 s, 0.2 cm; CTDIvol = 74.4 mGy (Body) DLP =
14.9 mGy-cm.
3) Spiral Acquisition 10.3 s, 66.9 cm; CTDIvol = 10.9 mGy (Body) DLP =
724.5 mGy-cm.
4) Spiral Acquisition 4.1 s, 26.9 cm; CTDIvol = 8.4 mGy (Body) DLP = 219.8
mGy-cm.
Total DLP (Body) = 961 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: No prior chest CT scans available.
FINDINGS:
CHEST PERIMETER: No thyroid findings warrant further imaging. Supraclavicular
and numerous small bilateral axillary lymph nodes are not pathologically
enlarged. No soft tissue abnormalities elsewhere in the chest wall. Findings
below the diaphragm will be reported separately.
CARDIO-MEDIASTINUM: Esophagus is unremarkable. Atherosclerotic calcification
is not apparent head neck vessels or coronary arteries. Central venous
infusion catheter ends in the right atrium with no evidence of thrombosis.
Aorta and pulmonary arteries and cardiac chambers are normal size and the
pericardium is physiologic
THORACIC LYMPH NODES: No lymph nodes in the chest, including diaphragmatic,
posterior mediastinal and retrocrural stations, are pathologically enlarged.
LUNGS, AIRWAYS, PLEURAE: 2 x 4 mm triangular opacity, right lung apex, 6:48,
could be a branching vessel, but if it is a lung nodule the shape is more
typical for lymphoid aggregate than metastasis.
2 cm wide, air-filled cystic space in the right lower lobe, 6:201 is of no
active concern.
Left apical location of 3 mm subpleural nodule, 6:33, suggests it is a
granuloma or scar.
Subsegmental atelectasis left lung base, has a mildly nodular configuration.
Lungs otherwise clear. Bronchial wall thickening in the lower lobes reflects
mild inflammation. No bronchiectasis or peribronchial infiltration.
CHEST CAGE: Although there are no bone lesions in the imaged chest cage
suspicious for malignancy or infection, it should be noted that radionuclide
bone and FDG PET scanning are more sensitive in detecting early osseous
pathology than chest CT scanning.
IMPRESSION:
No good evidence for intrathoracic malignancy. 3 mm solid nodule left lung
apex is indeterminate but more likely a scar than a solitary metastasis.
Recommendations for such incidental findings provided below.
Benign air-filled cyst, right lower lobe.
RECOMMENDATION(S): For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10030549-RR-40 | 10,030,549 | 28,978,916 | RR | 40 | 2141-11-17 10:40:00 | 2141-11-17 15:38:00 | EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE
INDICATION: ___ year old man with penile SCC with new brain lesion concerning
for metastasis // History of penile SCC, new brain lesions concerning for
metastasis, trialed LP x 2 on floor unsuccessfully, needs CSF analysis for
cytology
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A pre-procedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs.
Puncture was performed at L3-4.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 20 gauge, 3.5 cm spinal needle was inserted
into the thecal sac. There was good return of clear CSF. 13 mls of CSF were
collected in 5 tubes and sent for requested analysis.
COMPARISON: Lumbar spine MRI dated are ___.
FINDINGS:
13 mls of CSF were collected in 5 tubes.
IMPRESSION:
1. Lumbar puncture at L3-4 without complication.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
|
10030579-RR-53 | 10,030,579 | 26,743,162 | RR | 53 | 2189-07-04 07:16:00 | 2189-07-04 09:37:00 | INDICATION: Status post fall. Evaluate for fractures or pneumothorax.
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
Supine AP chest radiograph demonstrate a normal cardiomediastinal silhouette.
Lungs are hyperinflated but clear. . There is no focal consolidation, pleural
effusion, or pneumothorax. No acute fracture is identified. Right humeral
head fracture is well-healed.
IMPRESSION:
No acute cardiopulmonary abnormality. Probable COPD.
Although no acute fracture or other chest wall lesion is seen, conventional
chest radiographs are not sufficient for detection or characterization of such
abnormalities. If the demonstration of a fracture or other trauma is
clinically warranted, the location where there are focal findings should be
clearly marked and imaged with either bone detail views or CT scanning.
|
10030579-RR-54 | 10,030,579 | 26,743,162 | RR | 54 | 2189-07-04 07:17:00 | 2189-07-04 09:27:00 | INDICATION: Status post fall with right hip deformity and leg shortening.
COMPARISON: None available.
FINDINGS:
AP view of the pelvis, two views of the right hip, AP and lateral views of the
right femur, and cross-table lateral views of the right hip, demonstrate a
comminuted displaced right intertrochanteric fracture with foreshortening. No
additional fracture is identified. There is no radiopaque foreign body or soft
tissue calcification. There is no knee joint effusion.
There are mild degenerative changes at the hip joints bilaterally, and at the
right knee.
Lucencies projecting over the distal femur, and proximal tibia and fibula on
frontal projection are likely artifactual with no correlate seen on lateral
view.
IMPRESSION:
Displaced right intertrochanteric fracture with foreshortening.
|
10030579-RR-55 | 10,030,579 | 26,743,162 | RR | 55 | 2189-07-04 07:25:00 | 2189-07-04 09:50:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ s/p fall with distracting injury to leg.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 1115 mGy-cm
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
Mucosal thickening is noted within the paranasal sinuses. Mastoid air cells
are partially opacified bilaterally though the middle ear cavities are well
aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process.
|
10030579-RR-56 | 10,030,579 | 26,743,162 | RR | 56 | 2189-07-04 07:25:00 | 2189-07-04 09:56:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ s/p fall with distracting injury to leg
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations. No IV contrast administered. Dose DLP 886.4 mGy-cm.
COMPARISON: None
FINDINGS:
There is no acute fracture or malalignment in the cervical spine. The
visualized outline of the thecal sac is unremarkable. Degenerative changes are
most pronounced at C5-6 C6-7 with loss of disc space and endplate
irregularity, and sclerosis. No prevertebral edema. The aerodigestive tract
appears patent. Nuchal ligament calcification noted. Lung apices are clear.
Thyroid gland appears normal. Partial opacification of the inferior mastoid
air cells noted bilaterally. Calcification at the carotid bulb noted
bilaterally.
IMPRESSION:
Degenerative changes without fracture or malalignment.
|
10030579-RR-57 | 10,030,579 | 26,743,162 | RR | 57 | 2189-07-04 11:04:00 | 2189-07-04 12:08:00 | EXAMINATION: Intraoperative radiographs for surgical guidance.
INDICATION: ORIF right hip fracture
TECHNIQUE: 92 fluoroscopic images provided.
COMPARISON: Pelvis radiograph from ___.
FINDINGS:
92 intraoperative images were acquired without a radiologist present. Images
show placement of a short IM rod and gamma nail a within the right proximal
femur.
IMPRESSION:
Intraoperative images were obtained during ORIF right femoral neck. Please
refer to the operative note for details of the procedure.
|
10030682-RR-18 | 10,030,682 | 25,960,647 | RR | 18 | 2117-12-16 16:49:00 | 2117-12-16 18:57:00 | EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS
INDICATION: ___ year old woman POD#5 LAMINECTOMY FUSION W/INSTRUMENTATION
C3-C7 now s/p drain removal// Evaluate hardware and for residual drain
Evaluate hardware and for residual drain
TECHNIQUE: Frontal and lateral views of the cervical spine were obtained
COMPARISON: Intraoperative images dated ___
FINDINGS:
C1 through C5 are visualized on the lateral view. The patient is status post
laminectomy and fusion of C3 through C7. The spinal hardware on the lateral
views however early seen at C3, C4 and C5. What is visualized, there is no
evidence of acute hardware related complications. Skin staples remain
present. There is no prevertebral swelling over the upper cervical spine.
The vertebral body heights are preserved. Disc space loss at C4-C5 is present
as well as anterior osteophytes at this level. The lung apices are
unremarkable on the frontal view. There are no radiodense foreign bodies
identified to suggest a retained drain.
IMPRESSION:
No findings are visualized to suggest a retained drain. No evidence of acute
hardware related complications on the provided views.
|
10030682-RR-19 | 10,030,682 | 25,960,647 | RR | 19 | 2117-12-17 00:29:00 | 2117-12-17 08:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with central cord syndrome s/posterior fusion
s/p MVC// Evaluate for pneumonia
IMPRESSION:
No previous images. The cardiac silhouette is enlarged without appreciable
vascular congestion, pleural effusion, or acute focal pneumonia.
Posterior fusion device is seen in the lower cervical region.
|
10030682-RR-20 | 10,030,682 | 25,960,647 | RR | 20 | 2117-12-18 18:34:00 | 2117-12-18 21:07:00 | EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA RIGHT
INDICATION: ___ year old woman status post MVC with spinal cord injury,
complaining of significant right shoulder pain, please evaluate for fracture//
Evaluate right shoulder to rule out fracture Evaluate right shoulder to
rule out fracture
TECHNIQUE: Three views of the right shoulder were obtained
COMPARISON: CT scan of the chest dated ___
IMPRESSION:
There is no definite fracture or dislocation involving the glenohumeral or AC
joint. A well corticated rounded density measuring 6 mm is seen adjacent to
the greater tuberosity of the right shoulder, also evaluated on the prior CT
chest. The appearance is atypical for an acute displaced fracture and is
thought to reflect sequela of remote injury or calcific tendinitis. There are
no significant degenerative changes. No suspicious lytic or sclerotic lesions
are identified.
|
10030682-RR-22 | 10,030,682 | 25,960,647 | RR | 22 | 2117-12-19 00:07:00 | 2117-12-19 01:24:00 | EXAMINATION: CT C-SPINE W/O CONTRAST.
INDICATION: ___ year old woman s/p MVC last week now ___ s/p C3-7
Laminectomy and posterior fusion. STAT CT Cervical Spine without contrast to
evaluate for hemorrhage or other etiology of diffuse weakness.// STAT CT
Cervical Spine without contrast to evaluate for hemorrhage or other etiology
of new diffuse weakness.
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.8 s, 22.9 cm; CTDIvol = 25.1 mGy (Body) DLP = 575.0
mGy-cm.
Total DLP (Body) = 575 mGy-cm.
COMPARISON: MR dated ___
FINDINGS:
There is streak artifact from posterior spinal fusion hardware and dental
amalgam, which limits the evaluation.
The cervical spine alignment is normal. The patient is status post C3 through
7 laminectomy. No acute cervical spine fractures are identified.Posterior
osteophytosis at C4-5 and C5-6 contribute to likely mild spinal canal
narrowing at these levels, though evaluation of the spinal canal is limited
due to streak artifact.There is no prevertebral edema.
The thyroid and included lung apices are unremarkable.
IMPRESSION:
Status post C3-7 laminectomy and posterior fusion. Evaluation of the spinal
canal is limited due to streak artifact, though no gross abnormalities are
identified. No findings are identified to explain the patient's diffuse
weakness.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 1:15am, 2 minutes after
discovery of the findings.
|
10030682-RR-23 | 10,030,682 | 25,960,647 | RR | 23 | 2117-12-19 05:21:00 | 2117-12-19 09:07:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST
INDICATION: ___ year old woman s/p C3-7 Laminectomy and posterior fusion
performed ___ now with increasing weakness of bilateral arms and legs.
MRI Cervical Spine to evaluate integrity of spinal cord and eval for etiology
of weakness.// MRI Cervical Spine to evaluate integrity of spinal cord and
eval for etiology of weakness. MRI Cervical Spine to evaluate integrity of
spinal cord and eval for etiology of weakness.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed.
COMPARISON: CT C-spine dated ___ an MRI of the cervical spine dated
___.
FINDINGS:
The patient is post bilateral laminectomy and posterior fusion at C3-C7.
There is increased T2 signal within the cord extending from behind C3, down to
C5. Although there is some degree of suspected myelomalacia given the chronic
spinal canal narrowing and narrowing of the cord at the C5 level, there is
cord expansion with more focal T2 hyperintense signal at the C3-4 level which
was not visualized on the preoperative exam.
Postsurgical edema is seen involving the interspinous ligaments and paraspinal
muscles at this level. There is minimal prevertebral edema and swelling at
this level as well, decreased in the interim. There is mild reversal of the
normal cervical lordosis. There is mild multilevel loss of vertebral and disc
height.
The degree of spinal canal narrowing from C2-C7 is improved, with the worst
level, at C2-3, now displaying mild to moderate spinal canal narrowing.
IMPRESSION:
1. Status post bilateral laminectomy and posterior fusion at C3-C7 with
expected postsurgical changes.
2. New focal expansion and increased T2 signal within the cord at the C3-4
level. Some degree of underlying myelomalacia is suspected at the C4-5 level.
3. Overall improvement in the degree of spinal canal narrowing from C2-C7,
with the worst level, at C2-3, displaying mild to moderate spinal canal
narrowing.
|
10030682-RR-24 | 10,030,682 | 25,960,647 | RR | 24 | 2117-12-19 20:57:00 | 2117-12-19 21:50:00 | INDICATION: ___ year old woman with a spinal cord injury, constipation, and
distended abdomen// Evaluate for bowel obstruction
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: None
FINDINGS:
Air-filled prominent loops of large and small bowel are seen throughout the
abdomen and pelvis with multiple air-fluid levels seen on the decubitus view.
The small-bowel loops measure up to 4 point 5 cm in diameter.
There is no free intraperitoneal air.
Osseous structures are notable for degenerative changes at the lumbosacral
junction and of the left hip with a small mineralized density projecting over
the lateral joint space.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Prominent loops of large and small bowel throughout the abdomen and pelvis are
suggestive of ileus. Continued follow-up is recommended.
|
10030682-RR-25 | 10,030,682 | 25,960,647 | RR | 25 | 2117-12-19 15:10:00 | 2117-12-19 16:57:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with spinal cord injury, significant right
wrist pain// Evaluate for etiology of right wrist pain, blood clot
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
vein.
The right internal jugular, axillary and brachial veins are patent, show
normal color flow and compressibility. The right basilic and cephalic veins
are patent.
Additional images were obtained of the vessels in the forearm and wrist. The
cephalic vein appears patent. The radial veins at the wrist are patent. The
ulnar veins at the wrist are patent.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10030682-RR-26 | 10,030,682 | 25,960,647 | RR | 26 | 2117-12-20 10:52:00 | 2117-12-20 17:08:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with fever, leukocytosis, POD#9 and immobile//
evaluate for DVTs
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of venous thrombosis.
|
10030682-RR-27 | 10,030,682 | 25,960,647 | RR | 27 | 2117-12-20 12:12:00 | 2117-12-20 15:34:00 | INDICATION: ___ year old woman with postop ileus// interval evaluation
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: Abdominal radiograph ___
FINDINGS:
There is interval improvement to large and small bowel dilatation. Multiple
air-fluid levels are again visualized on the decubitus view.
There is no free intraperitoneal air.
There are degenerative changes to the lumbar spine and pelvis.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Interval improvement of ileus.
|
10030682-RR-28 | 10,030,682 | 25,960,647 | RR | 28 | 2117-12-21 10:48:00 | 2117-12-21 15:33:00 | INDICATION: ___ year old woman with ileus. KUB to evaluate for resolving
ileus.// KUB to evaluate for resolving ileus.
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: Abdominal radiograph ___
FINDINGS:
There continues to be interval improvement to large and small bowel dilation.
Multiple air-fluid levels are again visualized on the decubitus view.
There is no free intraperitoneal air.
There are degenerative changes lumbar spine and pelvis.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Continued ileus with interval improvement.
|
10030682-RR-29 | 10,030,682 | 25,960,647 | RR | 29 | 2118-01-09 14:26:00 | 2118-01-09 17:28:00 | INDICATION: ___ year old woman s/p C3-C7 laminectomies with posterior fusion//
interval changes, follow up post operatively
COMPARISON: Prior MRI from ___
IMPRESSION:
There is posterior fusion hardware from C3 to C7. No hardware related
complications are seen. There are degenerative changes with loss of
intervertebral disc height at several levels and worse at C3-C4 and C4-C5.
Lung apices are grossly clear.
|
10030682-RR-30 | 10,030,682 | 25,960,647 | RR | 30 | 2118-01-13 12:00:00 | 2118-01-13 12:48:00 | INDICATION: ___ w/ cervical stenosis s/p MVC with central cord syndrome now
s/p C3-C7 lami/fusion// Patient presenting with decreased bowel movements and
abdominal distension. Please evaluation for ileus
TECHNIQUE: Supine and left lateral decubitus views of the abdomen and pelvis
COMPARISON: Abdominal radiographs performed between ___ and ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is a
large amount of colonic stool.
There is no free intraperitoneal air.
No acute osseous abnormalities are identified. There are no unexplained soft
tissue calcifications or radiopaque foreign bodies.
IMPRESSION:
No radiographic evidence of obstruction or ileus. Large amount of colonic
stool.
|
10030682-RR-31 | 10,030,682 | 25,960,647 | RR | 31 | 2118-01-18 09:45:00 | 2118-01-18 11:43:00 | EXAMINATION: SHOULDER ___ VIEWS NON TRAUMA LEFT
INDICATION: ___ year old woman status post MVC with spinal cord injury,
complaining of significant LEFT shoulder pain, limited ROM, please evaluate
for fracture// evaluate LEFT shoulder for injury
TECHNIQUE: Left shoulder, three views
COMPARISON: None.
FINDINGS:
There is no fracture or dislocation involving the glenohumeral or AC joint,
associated with minimal degenerative change.
Amorphous heterotopic calcification projected adjacent to the greater
tuberosity in keeping with calcific tendinosis.
Partially visualized fusion hardware projecting over the left neck.
Visualized Left lung unremarkable.
IMPRESSION:
1. Calcific tendinosis of the supraspinatus/infraspinatus.
2. Minimal degenerative changes in the left shoulder
3. No acute fracture or dislocation.
|
10030746-RR-18 | 10,030,746 | 22,297,761 | RR | 18 | 2169-07-07 16:01:00 | 2169-07-07 16:24:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with DM2 presented with chest pressure, found to
have 3VD now awaiting CABG// pre CABG pre CABG
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
pleural effusion. There is no pneumothorax.
|
10030746-RR-19 | 10,030,746 | 22,297,761 | RR | 19 | 2169-07-08 14:52:00 | 2169-07-08 17:05:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man s/p CABG// fast track Contact name: icu
provider, Phone: 1 fast track
IMPRESSION:
Heart size and mediastinum are stable. Mediastinal drain, left chest tube, NG
tube in the ET tube are in appropriate locations. Lungs overall clear. There
is no appreciable pleural effusion or pneumothorax. There is no evidence of
pulmonary edema.
|
10030746-RR-20 | 10,030,746 | 22,297,761 | RR | 20 | 2169-07-09 09:53:00 | 2169-07-09 11:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p cabg with Ct on water seal// assess for ptx
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Comparisons made to multiple prior chest radiographs, most
recently ___.
FINDINGS:
The cardiac silhouette is borderline enlarged. Mediastinum has an expected
postoperative appearance and the midline sternotomy wires are intact and
well-aligned. The mediastinal drain, right IJ catheter, and left chest tube
are in stable position without signs of pneumothorax. There is a mildly
worsening opacity to the right base, which may represent atelectasis versus
early infection.
IMPRESSION:
No evidence of pneumothorax. Worsening opacity in the right lung base, which
may represent simple atelectasis versus early infection.
|
10030746-RR-21 | 10,030,746 | 22,297,761 | RR | 21 | 2169-07-10 12:51:00 | 2169-07-10 15:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p clamp trial, perform at 1200// ___ year old
man s/p clamp trial, perform at 1200
TECHNIQUE: Frontal AP chest radiograph
COMPARISON: Comparisons made to multiple prior chest radiographs, most
recently from yesterday.
FINDINGS:
Cardiac silhouette is borderline enlarged and the mediastinal contours, hila,
and pleural surfaces are normal. Mildly improved right lung base opacity,
which may be related to persistent atelectasis or infection. The left chest
tube is in stable position and there is no evidence of pneumothorax. Midline
sternotomy wires are intact and well approximated..
IMPRESSION:
Mild improvement of right basilar opacity. Stable postoperative appearance of
the chest without signs of pneumothorax.
|
10030746-RR-22 | 10,030,746 | 22,297,761 | RR | 22 | 2169-07-10 16:02:00 | 2169-07-10 17:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p chest tube removal// eval for ptx
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The left chest tube has been removed and a small left pneumothorax is present.
Left lower lobe opacities likely reflect atelectasis. There is no sizable
pleural effusion or right pneumothorax. The size of the cardiac silhouette is
unchanged.
IMPRESSION:
Small left apical pneumothorax following removal of the left chest tube.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 5:34 pm, 1 minutes after
discovery of the findings.
|
10030746-RR-23 | 10,030,746 | 22,297,761 | RR | 23 | 2169-07-11 14:08:00 | 2169-07-11 14:43:00 | INDICATION: ___ year old man with s/p CABGx3// eval ptx, effusions, congestion
TECHNIQUE: AP and lateral views the chest
COMPARISON: Chest x-ray from ___.
FINDINGS:
There are small bilateral pleural effusions and there is mild retrocardiac
atelectasis. Elsewhere, lungs are clear. There is no pulmonary edema. No
pneumothorax. Cardiomediastinal silhouette is within normal limits. Median
sternotomy wires and mediastinal clips are noted. No acute osseous
abnormalities.
IMPRESSION:
Small bilateral pleural effusions.
|
10030753-RR-190 | 10,030,753 | 27,035,421 | RR | 190 | 2194-04-24 03:10:00 | 2194-04-24 06:01:00 | INDICATION: Diffuse body aches and chest pain.
TECHNIQUE: Single frontal radiograph of the chest.
COMPARISON: Multiple prior examinations, most recent dated ___.
FINDINGS: Lung volumes are low. No focal opacity to suggest pneumonia is
seen. No pleural effusion, pulmonary edema or pneumothorax is present. The
heart size is top normal.
IMPRESSION: No evidence of acute cardiopulmonary process.
|
10030753-RR-191 | 10,030,753 | 27,035,421 | RR | 191 | 2194-04-25 14:03:00 | 2194-04-25 14:53:00 | INDICATION: Mid axillary and clavicular right-sided chest pain following a
fall.
COMPARISON: Chest radiograph available from ___.
FRONTAL CHEST RADIOGRAPH AND THREE CONED-DOWN VIEWS OF THE RIGHT RIBS:
No displaced fracture is present. No sclerotic or lytic lesions are
identified. On the frontal chest radiograph, the heart size is normal, and
the hilar and mediastinal contours are within normal limits. There is no
focal consolidation, pleural effusion, or pneumothorax. The patient is
post-cholecystectomy.
IMPRESSION: No rib fractures detected.
|
10030753-RR-195 | 10,030,753 | 26,285,510 | RR | 195 | 2194-10-19 23:26:00 | 2194-10-19 23:43:00 | INDICATION: Nausea and vomiting. Hyperglycemia.
TECHNIQUE: Two views of the chest.
COMPARISON: Multiple prior examinations, most recent dated ___.
FINDINGS: No focal opacity to suggest pneumonia is seen. No pleural
effusion, pulmonary edema, or pneumothorax is present. The heart size is
normal. There is plate-like atelectasis at the right lower hemithorax.
Surgical clips are noted in the right upper quadrant.
IMPRESSION: No evidence of acute cardiopulmonary process.
|
10030753-RR-196 | 10,030,753 | 26,285,510 | RR | 196 | 2194-10-20 10:02:00 | 2194-10-20 11:52:00 | RENAL TRANSPLANT ULTRASOUND
CLINICAL INDICATION: ___ female with renal transplant in ___, now
with worsening renal function. Assess for obstruction or signs of rejection.
The transplant kidney is imaged in the left hemipelvis and measures 12.7 cm in
length. Echogenicity and renal architecture is normal, and there are no signs
of ___ fluid collection or hydronephrosis.
Color flow and pulsed Doppler assessment demonstrate normal arterial waveforms
in the main renal artery with no delay in acceleration time and normal peak
velocities of 72 cm/sec. Venous outflow is also normal. Arterial flow is
symmetrically seen throughout the transplant, but the resistive indices are
elevated ranging from 0.79-0.85. The bladder is not evaluated due to drainage
by Foley catheter.
CONCLUSION: Mildly to moderately elevated resistive indices. No evidence of
obstruction.
|
10030753-RR-220 | 10,030,753 | 23,960,805 | RR | 220 | 2198-07-07 20:19:00 | 2198-07-07 21:20:00 | INDICATION: ___ with pain swelling
COMPARISON: None
FINDINGS:
AP, lateral, obliques views as well as a dedicated navicular view of the right
wrist provided. Overlying IV limits assessment. There is extensive vascular
calcification noted. Carpal alignment appears preserved. The scaphoid
appears intact. Distal radius and ulna appear intact. No acute fracture or
dislocation. No significant DJD. Soft tissue swelling is seen dorsally at
the wrist.
IMPRESSION:
Dorsal soft tissue swelling along the wrist without underlying fracture.
Extensive vascular calcification.
|
10030753-RR-221 | 10,030,753 | 23,960,805 | RR | 221 | 2198-07-07 20:41:00 | 2198-07-07 21:23:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with head trauma // head trauma on coumadin
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT from ___
FINDINGS:
There is no acute intracranial hemorrhage, mass, mass effect or large
territorial infarction. An old infarction is seen within the left centrum
semiovale. Bilateral basal ganglia mineralization is identified. The
ventricles and sulci are normal in size and configuration. The basilar
cisterns are patent, and there is otherwise good preservation gray-white
matter differentiation.
A right frontal supraorbital superficial soft tissue hematoma is identified.
No underlying fracture is seen. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
Extensive carotid calcifications are seen.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Right frontal supraorbital superficial soft tissue hematoma. No underlying
fracture seen.
|
10030753-RR-222 | 10,030,753 | 23,960,805 | RR | 222 | 2198-07-07 20:41:00 | 2198-07-07 21:29:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with head trauma. Please evaluate.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE:
Total DLP (Body) = 861 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no fracture, or alignment. There is no prevertebral soft tissue
swelling. No significant degenerative changes are seen throughout the
cervical spine. The thyroid is normal. There is no cervical lymphadenopathy.
The visualized apices of lungs are clear.
IMPRESSION:
No fracture or malalignment in the C-spine.
|
10030753-RR-223 | 10,030,753 | 23,960,805 | RR | 223 | 2198-07-08 07:59:00 | 2198-07-08 10:03:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ year old woman with renal transplant presenting with n/v and
inability to take rejection meds // eval for evidence of rejection
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Renal transplant ultrasound ___.
FINDINGS:
The left iliac fossa transplant renal morphology is normal. Specifically, the
cortex is of normal thickness and echogenicity, pyramids are normal, there is
no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.76 to 0.82, which is
mildly elevated and slightly increased since prior exam. The main renal
artery shows a normal waveform, with prompt systolic upstroke and continuous
antegrade diastolic flow, with peak systolic velocity of 59 cm/sec.
Vascularity is symmetric throughout transplant. The transplant renal vein is
patent and shows normal waveform.
IMPRESSION:
Mildly elevated intrarenal resistive indices which are slightly higher than ___.
|
10030753-RR-224 | 10,030,753 | 23,960,805 | RR | 224 | 2198-07-09 13:04:00 | 2198-07-09 13:13:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with recent fall with INR 4.8, lots of
bruising, decreased breath sounds on R // pulmonary contusion, effusion
pulmonary contusion, effusion
IMPRESSION:
IN COMPARISON WITH THE STUDY OF ___, THERE IS LITTLE CHANGE AND NO
ACUTE CARDIOPULMONARY DISEASE. THE CARDIAC SILHOUETTE IS ENLARGED AND THERE
IS NO EVIDENCE OF VASCULAR CONGESTION, PLEURAL EFFUSION, OR ACUTE FOCAL
PNEUMONIA.
|
10030753-RR-225 | 10,030,753 | 23,960,805 | RR | 225 | 2198-07-09 12:18:00 | 2198-07-09 13:26:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ woman with a recent mechanical fall in the setting of
a supratherapeutic INR, now with increased lethargy. Evaluate for evidence of
acute intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.0 cm; CTDIvol = 49.7 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: ___ noncontrast head CT.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration. An old infarct is
again seen in the left centrum semiovale. Stable, bilateral basal ganglia
calcification. Mild periventricular white-matter hypodensities are
nonspecific, but likely reflect chronic microvascular ischemic disease. Dense
calcification of the carotid siphons and vertebral arteries at the V4 segments
appear unchanged.
Small, residual, supraorbital, right frontal scalp hematoma. There is no
evidence of fracture. Mild mucosal thickening in the sphenoid sinuses,
maxillary sinuses, and ethmoid air cells. Otherwise, the visualized portion
of the frontal sinuses, mastoid air cells, and middle ear cavities are clear.
The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Small, residual, supraorbital, right frontal scalp hematoma.
|
10030753-RR-226 | 10,030,753 | 23,960,805 | RR | 226 | 2198-07-09 12:19:00 | 2198-07-09 13:17:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman presenting after fall and recent cardiac
catheterization in setting of supratherapeutic INR, now with downtrending
Hgb/Hct concerning for bleed. // ?RP bleed
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis without
intravenous contrast administration.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was not administered.
IV contrast: 130ml Omnipaque
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 53.4 cm; CTDIvol = 15.6 mGy (Body) DLP = 834.5
mGy-cm.
Total DLP (Body) = 834 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___
FINDINGS:
Optimal evaluation of organ pathology and vasculature is limited without the
benefit of intravenous contrast.
LOWER CHEST:
There is minimal bibasilar dependent atelectasis. Mild mitral valve
calcification is present. Trace pericardial fluid noted.
ABDOMEN:
GENERAL: There is no intra-abdominal free air or free fluid. No intra or
retroperitoneal hematoma identified.
HEPATOBILIARY: Within limitations of a non contrast-enhanced scan, the
hepatic parenchyma demonstrates a homogeneous attenuation. Punctate
calcification in segment 7 is likely capsular and benign.
The gallbladder is surgically absent.
PANCREAS: There is diffuse pancreatic parenchymal atrophy without main duct
dilation.
SPLEEN: No splenomegaly.
ADRENALS: No adrenal nodules.
URINARY: The native kidneys are highly at trophic with severe thinning of the
renal cortical parenchyma. In the absence of intravenous contrast presence of
any enhancing mass cannot be evaluated. No hydronephrosis.
There is a transplant kidney in the left lower quadrant with no
hydronephrosis.
GASTROINTESTINAL: There is a moderate amount of stool throughout the colon.
No bowel obstruction. There is mild hyperdense fluid within the gastric
fundus that may be related to enteric contents.
LYMPH NODES: Within limitations of a non contrast-enhanced scan, there are sub
cm retroperitoneal (para-aortic, bilateral common iliac) lymph nodes. There
are numerous small mesenteric lymph nodes measuring up to 9 mm in short axis.
VASCULAR: Extensive atherosclerotic calcification of the abdominal aorta and
its branches is noted without aneurysmal dilation.
PELVIS:
The bladder is distended, unremarkable. The uterus and adnexae are
unremarkable. There is no free fluid in the pelvis..
BONES AND SOFT TISSUES:
There are no suspicious osteolytic or blastic bone lesions.
There are scattered soft tissue nodules in the subcutaneous fat of the
anterior abdominal wall, likely related to subcutaneous injections. No
intramuscular hematoma noted in the body wall. There is a small fat
containing umbilical hernia.
IMPRESSION:
1. No intra or retroperitoneal or intramuscular hematoma noted in the abdomen
or pelvis.
2. Transplant kidney in the left lower quadrant demonstrates no
hydronephrosis.
3. Moderate amount of stool throughout the colon without bowel obstruction.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 1:15 ___, 2 minutes after
discovery of the findings.
|
10030753-RR-227 | 10,030,753 | 23,960,805 | RR | 227 | 2198-07-11 15:04:00 | 2198-07-11 18:16:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with R vision changes and worsening n/v. //
?head bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.4 cm; CTDIvol = 51.6 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: Noncontrast head CT ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration. Minimal bilateral
periventricular white matter hypodensities are nonspecific, but likely
represent a sequela of chronic small vessel disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
Residual right frontal/supraorbital scalp swelling is minimal.
IMPRESSION:
1. No evidence of fracture, infarction or intracranial hemorrhage.
2. Minimal residual right frontal/supraorbital scalp swelling.
|
10030753-RR-240 | 10,030,753 | 25,629,024 | RR | 240 | 2199-05-11 18:07:00 | 2199-05-11 18:53:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with hx of renal txp with weakness, hypotension// eval for
pna, renal txp functioning
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. There is a residual tiny right
pleural effusion decreased from prior with persistent minimal linear
atelectasis in the right lower lung. Otherwise lungs are clear. The heart
remains mildly enlarged. Mediastinal contour is stable. Bony structures are
intact.
IMPRESSION:
Stable mild cardiomegaly, decreased right pleural effusion, now tiny.
|
10030753-RR-241 | 10,030,753 | 25,629,024 | RR | 241 | 2199-05-11 17:44:00 | 2199-05-11 18:13:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ with hx of renal txp with weakness, hypotension
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Prior recent exam from ___
FINDINGS:
The left lower quadrant transplant renal morphology is normal measuring 13.2
cm in length. Specifically, the cortex is of normal thickness and
echogenicity, pyramids are normal, there is no urothelial thickening, and
renal sinus fat is normal. There is no hydronephrosis and no perinephric
fluid collection.
Doppler: There is absent diastolic flow main renal artery as well as the
intralobar branches, which is more convincing on todays exam compared with
prior. The main renal vein is patent.
IMPRESSION:
Absent diastolic flow within the left lower quadrant transplant kidney is
concerning for rejection. Please correlate with results from recent biopsy.
|
10030753-RR-242 | 10,030,753 | 27,987,271 | RR | 242 | 2199-05-30 19:37:00 | 2199-05-30 20:47:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with elevated troponin, presyncope// Evaluate for
pulmonary vascular congestion
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Minimal right base atelectasis/scarring is re-demonstrated. No focal
consolidation is seen. There is no pleural effusion or pneumothorax. The
cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10030753-RR-243 | 10,030,753 | 27,987,271 | RR | 243 | 2199-05-31 13:28:00 | 2199-05-31 15:37:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ s/p living kidney transplant ___ on cyclosporine,
cellcept, prednisone, CREST, now with suprapubic pain and dysuria.// evaluate
transplant
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Renal transplant ultrasound ___
FINDINGS:
The transplant kidney in the left lower quadrant measures 12.2 cm in length.
The transplant renal morphology is normal. Specifically, the cortex is of
normal thickness and echogenicity, pyramids are normal, there is no urothelial
thickening, and renal sinus fat is normal. There is no hydronephrosis and no
perinephric fluid collection.
The urinary bladder is partially distended. Some echogenic material is noted
within the bladder which moves when the patient turns into the decubitus
position.
The resistive index of intrarenal arteries are mildly elevated ranging from
0.77 to 0.83. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 42 cm/sec. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
IMPRESSION:
1. Patent renal transplant vasculature. No hydronephrosis and no
peritransplant fluid collection identified.
2. Small amount of movable debris noted within the urinary bladder which could
represent sludge, infectious material or blood. Correlation with urinalysis
is suggested.
|
10030753-RR-244 | 10,030,753 | 24,506,973 | RR | 244 | 2199-07-18 18:20:00 | 2199-07-18 19:15:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ s/p renal transplant, presenting with fevers likely
due to cellulitis but given URI, immunosuppression r/o for other sources// ?
pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
There is minor right middle lobe atelectasis. No focal consolidation is seen.
No pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are stable. Right upper quadrant surgical clips are seen,
presumed prior cholecystectomy.
IMPRESSION:
No acute cardiopulmonary process.
|
10030753-RR-245 | 10,030,753 | 24,506,973 | RR | 245 | 2199-07-18 20:02:00 | 2199-07-18 22:18:00 | EXAMINATION: CT ORBIT, SELLA AND IAC W/O CONTRAST Q115 CT HEADSUB
INDICATION: ___ with pre-septal cellulitis// ? evidence of orbital swelling
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 1.9 s, 14.5 cm; CTDIvol = 25.0 mGy (Head) DLP = 364.0
mGy-cm.
Total DLP (Head) = 364 mGy-cm.
COMPARISON: None.
FINDINGS:
There is mild to moderate right preseptal and periorbital cellulitis/soft
tissue swelling without postseptal involvement. No drainable fluid collection
is seen. There is right periorbital soft tissue swelling. No evidence of
abscess.
Significant vascular calcifications are noted throughout, most notably in the
cavernous portion of the bilateral ICAs.
The paranasal sinuses are normally aerated, with no mucosal thickening or
air-fluid levels identified. The ostiomeatal units are patent. The cribriform
plates are intact. The lamina papyracea are intact.
IMPRESSION:
1. Pre-septal and periorbital soft tissue cellulitis without drainable fluid
collection or post-septal cellulitis.
|
10030753-RR-246 | 10,030,753 | 24,506,973 | RR | 246 | 2199-07-21 12:05:00 | 2199-07-21 13:40:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with new hypoxia overnight, please evaluate for
new pleural edema, pneumonia
TECHNIQUE: Portable Chest.
COMPARISON: Chest radiograph ___
FINDINGS:
Compared to prior, there is a new right pleural effusion. There is also
increased vascular congestion with mild pulmonary edema. There is no
pneumothorax. Heart size is mildly enlarged.
IMPRESSION:
Mild pulmonary edema with a small right pleural effusion.
|
10030753-RR-252 | 10,030,753 | 21,257,920 | RR | 252 | 2199-11-19 05:01:00 | 2199-11-19 05:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever and SOB// ?pneumonia
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiographs from ___.
FINDINGS:
Compared to ___, the cardiac silhouette remains moderately
enlarged. There is increased vascular congestion with moderate bilateral
pulmonary edema. Small bilateral pleural effusions are again seen. No focal
infiltrates or pneumothorax.
IMPRESSION:
1. Compared to ___, persistent moderate cardiomegaly and increased
vascular congestion, now with moderate bilateral pulmonary edema.
2. Small bilateral pleural effusions.
|
10030753-RR-253 | 10,030,753 | 21,257,920 | RR | 253 | 2199-11-21 16:49:00 | 2199-11-21 17:34:00 | INDICATION: ___ year old woman with fever and crackles// Pneumonia?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The size of the cardiac silhouette is enlarged. There is a small left pleural
effusion with subjacent atelectasis/pneumonia. The right lung is grossly
clear. There is no pneumothorax or right pleural effusion.
IMPRESSION:
New opacities at the left lung base are reflective of a pleural effusion with
subjacent atelectasis/pneumonia.
|
10030753-RR-258 | 10,030,753 | 20,090,856 | RR | 258 | 2200-05-24 05:17:00 | 2200-05-24 06:24:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with SAH// interval hemorrhage eval
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: CT head without contrast from 11 hours prior
FINDINGS:
Re-demonstrated is right sided subarachnoid hemorrhage, centered in the
sylvian fissure. No extension or new hemorrhage is identified. Basal ganglia
calcifications are unchanged. No new large territorial infarct or mass
effect. There is prominence of the ventricles and sulci suggestive of
involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
-Essentially unchanged examination from 11 hours prior.
|
10030753-RR-259 | 10,030,753 | 20,090,856 | RR | 259 | 2200-05-25 10:23:00 | 2200-05-25 11:25:00 | EXAMINATION: MRA BRAIN W/O CONTRAST T9711 MR HEAD
INDICATION: ___ year old woman with SAH, likely traumatic// eval right MCA,
right SAH
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
No contrast was administered. Three dimensional maximum intensity projection
and segmented images were generated. This report is based on interpretation of
all of these images. No contrast was administered.
COMPARISON: ___ brain MRI/MRA and neck MRA.
FINDINGS:
Study is moderately degraded by motion. Within these confines:
New nonocclusive irregularity of the right M1 segment is noted, likely related
artifact (see 2: 89-104).
New focal occlusion versus high-grade stenosis of the left SCA is noted (see
104:7 on current study and 505:8 on prior exam).
The right posterior cerebral artery demonstrates a fetal origin.
Otherwise, the intracranial vertebral and internal carotid arteries and their
major branchesappear grossly patent without definite evidence of stenosis,
occlusion, or aneurysm formation.
IMPRESSION:
1. Study is moderately degraded by motion.
2. New left SCA focal occlusion versus high-grade stenosis compared to ___
prior exam.
3. New nonocclusive irregularity of right M1 segment compared to ___ prior
exam, likely artifactual as described.
4. Otherwise grossly patent circle of ___ as described.
|
10030753-RR-260 | 10,030,753 | 22,045,511 | RR | 260 | 2200-06-09 16:16:00 | 2200-06-09 16:39:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with CHF, incr pedal edema, wgt gain; also w R
midback pain, new petechiae// ?acute process ?edema/ ?biliary obstruction
?portal vein thrombosis
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and CT chest ___
FINDINGS:
Cardiac silhouette size remains moderately enlarged with dense coronary artery
calcifications noted. The mediastinal and hilar contours are normal.
Pulmonary vasculature is not engorged. Linear atelectasis in the right middle
lobe is noted. Lungs are otherwise clear. No focal consolidation, pleural
effusion, or pneumothorax is present. Clips in the right upper quadrant of
the abdomen indicate prior cholecystectomy.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10030753-RR-261 | 10,030,753 | 22,045,511 | RR | 261 | 2200-06-09 16:03:00 | 2200-06-09 16:26:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with CHF, incr pedal edema, wgt gain; also w R
midback pain, new petechiae// ?acute process ?edema/ ?biliary obstruction
?portal vein thrombosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Renal ultrasound from ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 10.3 cm.
KIDNEYS: The native right kidney is markedly atrophic. A left lower quadrant
transplant kidney is partially imaged and appears grossly unremarkable.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
No evidence of biliary obstruction or portal vein thrombosis.
|
10030753-RR-263 | 10,030,753 | 22,045,511 | RR | 263 | 2200-06-11 09:58:00 | 2200-06-11 10:34:00 | EXAMINATION: RIB UNILAT, W/ AP CHEST RIGHT
INDICATION: ___ year old woman with history of ESRD s/p LURT, recent admission
with traumatic fall and SAH with right sided flank pain and tenderness to
palpation// Eval for rib fracture
COMPARISON: Radiographs from ___
FINDINGS:
Heart size is prominent but stable.There is minimal atelectasis versus early
infiltrate at the right base, slightly worse.There are no displaced rib
fractures. There are no pneumothoraces. Irregular calcification projecting
over the right upper abdomen is likely a gallstone.
IMPRESSION:
1. Right lower lobe atelectasis versus early infiltrate, slightly worse.
Follow up to resolution is recommended to exclude pneumonia.
2. No displaced rib fracture.
|
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