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10033661-RR-21 | 10,033,661 | 23,080,369 | RR | 21 | 2162-06-28 10:47:00 | 2162-06-28 11:20:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with ? SAH// ? SAH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.5 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: CT head dated ___
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass effect. The previously seen region of linear hyperdensity in the left
parietal lobe is not demonstrated on the current study, and was most likely
artifactual. There is prominence of the ventricles and sulci suggestive of
involutional changes. There are periventricular and subcortical hypodensities,
which may represent small vessel ischemic changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavitiesare essentially clear.
There are bilateral lens replacements. The visualized portion of the orbits
are otherwise unremarkable.
IMPRESSION:
1. The previously seen region of linear hyperdensity in the left parietal lobe
is not demonstrated on the current study, and was most likely artifactual.
2. No evidence of intracranial hemorrhage or acute large territorial infarct.
|
10033710-RR-10 | 10,033,710 | 25,343,985 | RR | 10 | 2168-11-24 07:53:00 | 2168-11-24 10:50:00 | EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST
INDICATION: History: ___ with unwitnessed fall // Rule out traumatic
injuries
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.8 s, 61.3 cm; CTDIvol = 11.9 mGy (Body) DLP = 728.3
mGy-cm.
Total DLP (Body) = 728 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen. Incidentally noted is
aberrant vascular anatomy noting the right subclavian coming off the aortic
arch and coursing posterior to the esophagus and the right vertebral coming
off the right common carotid.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: There is a small right pleural effusion. No pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. 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 lesion or laceration.
ADRENALS: There is a 1.2 cm left adrenal nodule, incompletely characterized on
this exam. The right adrenal gland is unremarkable.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There may be mild circumferential wall thickening involving
the antrum/pylorus of the stomach. Remainder of the stomach is slightly
distended with fluid contents. Small bowel loops demonstrate normal caliber,
wall thickness, and enhancement throughout. The colon and rectum are within
normal limits. The appendix is normal. There is no evidence of mesenteric
injury.
There is no free fluid or free air in the abdomen.
PELVIS:
The urinary bladder is decompressed about a Foley catheter. Distal ureters
are unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is grossly unremarkable. There is a 2.4 cm
left adnexal cyst. Right adnexa is unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Extensive atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
Dynamic compression screw is seen in the left proximal femur. There is an
acute, comminuted intertrochanteric fracture of the right femoral neck with
varus displacement and impaction of the distal fragment. There is a
compression fracture of T11 with approximately 25% loss of height, minimal
retropulsion of fracture fragments and a sclerotic line within the vertebral
body suggestive of an acute or subacute fracture. There are age-indeterminate
compression deformities of L1 (75% loss of body height) and L2 (25% loss of
body height). Chronic deformities of the right clavicle and bilateral sacral
insufficiency fractures also noted. Sclerosis of the left parasymphyseal
region could reflect remote healed fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Acute, comminuted intertrochanteric fracture of the right femoral neck with
mild varus displacement and impaction of the distal fragment.
2. Age-indeterminate, likely acute to subacute, fracture of T11 vertebral body
with 25% loss of vertebral body height and minimal retropulsion of fracture
fragments.
3. Age-indeterminate L1 and L2 compression deformities.
4. Bilateral sacral insufficiency fractures.
5. Small right pleural effusion.
6. 1.2 cm indeterminate left adrenal nodule. If clinically relevant, consider
recommendations below.
7. Possible mild circumferential wall thickening involving the distal stomach.
Correlate clinically, and if clinically indicated despite the patient's
advanced age, can be further evaluated with endoscopy.
RECOMMENDATION(S): Incidentally discovered adrenal lesion without prior
studies for comparison measuring 1-2 cm. If there is no history of malignancy,
this is probably benign. Follow up dedicated adrenal CT in 12 months could be
considered. If there is a history of malignancy, a dedicated adrenal CT is
recommended.
Recommendations based on ___ ACR guidelines:
___
NOTIFICATION: These findings were discussed with the ACS team at time of
dictation.
|
10033710-RR-8 | 10,033,710 | 25,343,985 | RR | 8 | 2168-11-24 05:49:00 | 2168-11-24 06:43:00 | EXAMINATION: CLAVICLE RIGHT
INDICATION: History: ___ with fall and right clavicle pain // Evaluate for
fracture
TECHNIQUE: Two views of the right clavicle
COMPARISON: None
FINDINGS:
There is generalized osteopenia. There is a healed fracture of the mid right
third clavicle, with residual moderate superior apex angulation. Also noted
is a healed fracture of the posterior right third rib. No evidence of acute
clavicular fracture. There is mild biapical pleural thickening. Irregular 1
cm calcification projects over the upper right lung field.
IMPRESSION:
Healed fracture right mid clavicle without acute osseous abnormality seen.
|
10033710-RR-9 | 10,033,710 | 25,343,985 | RR | 9 | 2168-11-24 12:21:00 | 2168-11-24 15:26:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT
INDICATION: Open reduction internal fixation of the right hip with short
cephalomedullary nail
TECHNIQUE: Intraoperative still
COMPARISON: CT chest abdomen pelvis from ___
FINDINGS:
6 intraoperative images were acquired without a radiologist present.
Images show cephalomedullary nail and distal transfixing screw about an
intratrochanteric fracture.
IMPRESSION:
6 intraoperative images were obtained over a span of 57.5 seconds. Please
refer to the operative note for details of the procedure.
|
10034049-RR-12 | 10,034,049 | 20,693,789 | RR | 12 | 2156-11-05 13:03:00 | 2156-11-05 14:17:00 | INDICATION: ___ year old woman with chronic pain on methadone,chronic BLE
venous stasis ulcers and recurrent UTIs who presents with AMS and worsening
lower abdominal pain// eval RLQ and LLQ for ? abscess, colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.1 s, 46.4 cm; CTDIvol = 28.0 mGy (Body) DLP =
1,280.3 mGy-cm.
Total DLP (Body) = 1,280 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
The lung bases demonstrate mild dependent atelectasis. There is no
pericardial or pleural effusion. The heart size is normal.
The hepatic parenchyma demonstrates decreased density, compatible with
steatosis (series 3, image 21). There is no focal hepatic mass. There is no
intra or extrahepatic bile duct dilation. The gallbladder is not visualized.
The pancreas demonstrates normal density, with mild atrophy (series 3, image
25).
The spleen size is within normal limits. There is no focal splenic lesion.
The adrenal glands are normal in size and shape.
The kidneys are normal in size and enhance symmetrically, without
hydronephrosis. A focal cortical defect is noted along the upper pole of the
right kidney, likely the sequela of prior infection or infarction, with an
associated calyceal diverticulum (series 5, image 49, series 3, image 26).
The there is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.
The abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac
branches are patent. There are moderate calcifications along the abdominal
aorta, without flow limiting stenosis or dissection. The portal and hepatic
veins are patent.
The bladder appears normal. The patient is post hysterectomy. No concerning
adnexal lesions are detected.
Again seen are prominent bilateral pelvic sidewall lymph nodes (series 3,
image 60, 62), unchanged since ___.
A 12 mm fat-containing nodule adjacent to the anterior aspect of the bladder
demonstrates internal soft tissue density (series 3, image 60, series 6, image
33), likely a sigmoid epiploic appendage, without significant adjacent
stranding to suggest active appendagitis.
There are no focal fluid collections.
There are no osseous lesions concerning for malignancy or infection. Moderate
levoscoliosis centered about L3 is again demonstrated, with moderate lateral
spondylolisthesis, joint space narrowing, and fusion of L3 and L4 (series 5,
image 50), unchanged from prior. A healing left ninth rib fracture is again
demonstrated (series 3, image 15).
IMPRESSION:
1. No acute abdominopelvic process. No CT findings correlating to the
reported history of worsening lower abdominal pain. No focal fluid
collections.
2. Unchanged prominent pelvic lymph nodes.
3. Hepatic steatosis.
4. A 12 mm fat-containing nodule abutting the bladder anterior is likely a
sigmoid epiploic appendage, possibly reflecting prior epiploic appendagitis.
No active inflammation is seen.
|
10034049-RR-13 | 10,034,049 | 20,693,789 | RR | 13 | 2156-11-07 16:45:00 | 2156-11-08 09:10:00 | EXAMINATION: W 8, REDUCED SERVICES
INDICATION: ___ year old woman with MRSA UTI, urinary retention and lower back
pain, point tender over L4/L5. Please eval for epidural collection.
TECHNIQUE: Incomplete examination with acquisition of localizer and sagittal
T2 images. No contrast was given.
COMPARISON: ___ abdominal and pelvic CT
FINDINGS:
Incomplete examination with acquisition of localizer and sagittal T2 images
only. The provided images demonstrate levoscoliosis with apex at L2-L3 with
lateral subluxation of L3 on L4 by 1.4 cm. There is increased T2 signal from
L2-L3 through L5-S1 levels, with significant loss of intervertebral disc
height at L3-L4 level, likely related to degenerative process. There is fluid
within the intervertebral disc space at L4-L5. There is hyperintense T2
signal of T12 vertebral body, possibly representing a hemangioma but
incompletely assessed on this study.
The provided sagittal images demonstrate moderate to severe spinal canal
stenosis at L3-L4 and severe spinal canal stenosis at L4-L5 secondary to disc
bulge, ligamentum flavum thickening, and facet arthropathy. There is severe
right neural foraminal narrowing at L2-L3 and L4-L5 levels with moderate right
neural foraminal narrowing at L3-L4 and L5-S1 levels. There is severe left
neural foraminal narrowing at left L4-L5 and L5-S1 levels. There is
compression of bilateral L4 exiting nerve roots.
IMPRESSION:
1. Incomplete examination with acquisition of localizer and sagittal T2 images
only.
2. Provided images demonstrate levoscoliosis with moderate to severe L3-L4 and
severe L4-L5 spinal canal stenosis with moderate to severe multilevel neural
foraminal narrowing, as detailed above. Recommend repeat examination when the
patient is able to better tolerate the entire exam.
3. Suboptimal evaluation for epidural fluid collection on this study although
there is no obvious evidence.
|
10034049-RR-20 | 10,034,049 | 24,278,210 | RR | 20 | 2157-11-18 09:14:00 | 2157-11-18 10:43:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ with diffuse abdominal ttp, sepsis//eval abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.Oral contrast was not administered. Coronal and
sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,209 mGy-cm.
COMPARISON: ___ CT abdomen pelvis, CT lumbar spine from ___ and MR lumbar spine from ___
FINDINGS:
LOWER CHEST: The imaged lung bases are clear aside from mild basal dependent
atelectasis. The imaged portion of the heart is unremarkable. No pleural
effusion is seen. There is again noted to be trace pericardial fluid.
ABDOMEN: The liver enhances normally without focal concerning lesion. The
main portal vein is centrally patent. No intrahepatic biliary ductal
dilation. The gallbladder is not visualized. The spleen is normal in size.
The adrenal glands appear normal bilaterally. The pancreas is normal.
Bilateral renal cortical hypodensities are noted, several too small to
characterize, possibly simple cysts. A small cyst arising from the upper pole
right kidney appears slightly increased from prior measuring 13 x 14 mm. Left
perinephric fluid is new from prior and nonspecific. No evidence of
pyelonephritis or hydronephrosis. A focus of right renal upper pole scarring
is noted. The abdominal aorta is calcified moderately and normal in caliber
appearing tortuous along the distal segment. No retroperitoneal hematoma or
adenopathy is seen. The stomach contains several radiodense tablets. The
duodenum is unremarkable also containing a tablet.
PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. No
free air or free fluid is seen. The appendix is normal. The colon contains a
mild fecal load. No free air or free fluid is seen. The urinary bladder is
only partially distended though appears slightly thickened with hyperemia
which may reflect cystitis. No pelvic sidewall adenopathy. Mildly prominent
bilateral inguinal lymph nodes are likely reactive.
BONES: Severe degenerative disease in the lower lumbar spine is most notable
at L4-5 and L5-S1. Endplate lucency at L4-5 appears unchanged and is been
assessed on prior CT lumbar spine. Bilateral SI joint sclerosis and
irregularity is again noted consistent with degenerative disease and possible
sacroiliitis.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Bladder appears mildly inflamed, correlate for cystitis. No signs of
pyelonephritis.
2. Marked degenerated disease at L4-5, similar to prior, better assessed on
prior CT and MRI. Please correlate clinically.
3. Renal hypodensities, possibly cysts, several too small to characterize.
|
10034049-RR-27 | 10,034,049 | 20,053,563 | RR | 27 | 2158-02-22 10:22:00 | 2158-02-22 10:32:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with AMS, abdominal pain, fall.// Please assess for
IC bleed, C spine or thoratic fx, intraabdomal pathology (abscess,
obstruction).
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, 16.9 cm; CTDIvol = 47.4 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
There is no evidence of acutelarge territory infarction,hemorrhage,edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Multiple hypodensities within the subcortical and
periventricular white matter are nonspecific but may be sequela of chronic
small vessel ischemic disease or prior therapy.
There is no evidence of acute 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:
No acute intracranial process.
Diffuse hypodensities in the white matter again seen, similar in extent to CT
head dated ___ and ___ which could be related to prior
therapy or due to extensive small vessel disease.
|
10034049-RR-28 | 10,034,049 | 20,053,563 | RR | 28 | 2158-02-22 10:21:00 | 2158-02-22 10:39:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with AMS, abdominal pain, fall.// Please assess for
IC bleed, C spine or thoratic fx, intraabdomal pathology (abscess,
obstruction). Please assess for IC bleed, C spine or thoratic fx,
intraabdomal pathology (abscess, obstruction).
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 4.5 s, 17.8 cm; CTDIvol = 22.4 mGy (Body) DLP = 397.4
mGy-cm.
Total DLP (Body) = 397 mGy-cm.
COMPARISON: CT C-spine dated ___.
FINDINGS:
No acute fracture. Re-demonstrated, is a anterolisthesis of C2 on C3 that is
likely degenerative unchanged from prior CT C-spine dated ___
peer alignment of the other vertebral bodies is preserved. Moderate multi
level degenerative changes including intervertebral disc space narrowing,
osteophytosis, uncovertebral facet joint hypertrophy are demonstrated worse at
C4-C5. Multilevel posterior osteophytosis and calcified disc bulge are noted
which is result in moderate spinal canal narrowing most severe at C3-C4.
Multilevel uncovertebral and facet joint hypertrophy result in the mild neural
foraminal stenosis worse that right C3- C4 facet joint. There is no
prevertebral soft tissue swelling.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Multilevel degenerative changes including mild anterolisthesis of C2 on C3,
intervertebral disc space narrowing, and osteophytosis worse at C4-C5.
3. Multilevel posterior osteophytosis and calcified disc bulge result in
moderate spinal canal narrowing most severe at C3-C4.
4. Multilevel uncovertebral facet joint hypertrophy resulting mild neural
foraminal stenosis worse than right C3-C4 facet joint.
|
10034049-RR-30 | 10,034,049 | 20,053,563 | RR | 30 | 2158-02-22 10:26:00 | 2158-02-22 11:24:00 | EXAMINATION: CT torso with intravenous contrast
INDICATION: ___ year old woman with LUQ pain after fall// assess for traumatic
injuries
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.2 s, 64.3 cm; CTDIvol = 23.6 mGy (Body) DLP =
1,520.5 mGy-cm.
Total DLP (Body) = 1,521 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There are nodular ground-glass opacification in the posterior
aspect of the right upper lung which may represent infection. Bibasilar
atelectasis is seen. The airways are patent to the level of the segmental
bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation. There is no
evidence of focal lesion or laceration. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: There spleen is borderline in size, measuring up to 13 cm with
homogeneous attenuation throughout, without evidence of focal lesion or
laceration.
ADRENALS: There is subtle focal fat stranding between the left adrenal gland
and kidney, which may relate to acute injury or possible ascending GU
infection. The right and left adrenal glands are otherwise normal in size and
shape.
URINARY: There are multiple hypodensities throughout the bilateral kidneys,
most likely representing cysts, the largest is located in the interpolar
region of the right kidney measuring up to 1.2 cm. The kidneys are of normal
and symmetric size with normal nephrogram. There is no hydronephrosis. There
is no perinephric abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall
thickness, and enhancement throughout. The colon and rectum are within normal
limits. The appendix is normal. There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS:
Redemonstrated at the anterior of the bladder is a 1.1 x 1.9 cm fat containing
nodule which may represent a sigmoid epiploic appendage without evidence
active appendagitis. There is subtle fat stranding at the at the urinary
bladder which may relate to the patient's UTI. The distal ureters are
unremarkable.
REPRODUCTIVE ORGANS: The uterus is surgically absent.
LYMPH NODES: There is relatively unchanged bilateral inguinal lymphadenopathy
measuring up to 2.2 cm in short axis, (series 2, image 211). Prominent,
bilateral external iliac lymph nodes are again seen that measure up to 0.9 cm
in short axis.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted.
BONES: Redemonstrated, is levoscoliosis centered at L3 unchanged, fusion of
the vertebral bodies of L3 and L4, (series 602 image 91). There is
irregularity and lucency of the superior endplates of L5 and inferior endplate
of L4 which is slightly progressed when compared to prior dated ___,
cannot exclude infection. Interval increase in adjacent soft tissue density
at the level of L5 and L4 that may demonstrate disc bulge. There is no acute
fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Nodular, ground-glass opacification in the posterior right upper lobe
concerning for pneumonia. In the setting of trauma, underlying pulmonary
contusion is not excluded.
2. Mild stranding between the left adrenal gland and kidney is nonspecific,
but may relate to acute injury or ascending GU infection.
3. Irregularity and lucency at the superior endplate of L5 and inferior
endplate of L4 are slightly progressed when compared to prior dated ___ and infection cannot be excluded.
4. Nonspecific, unchanged prominent pelvic lymph nodes.
|
10034049-RR-32 | 10,034,049 | 20,053,563 | RR | 32 | 2158-02-23 08:37:00 | 2158-02-23 11:10:00 | EXAMINATION: DX BILATERAL HIPS
INDICATION: ___ Yo w/ severe RA w/ leuksocytoclastis vasculitis, venous
insufficiency, hypothyroid, DM, chronic opioid use presenting with UTI, AMS
and repeat falls. Acutely being treated for her UTI, AMS and L-sided abdominal
pain. Now s/p fall from bed onto ?head. Confused but intermittently
complaining of hip pain.// evidence of fracture?
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of both hips.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
IV contrasts from recent CT opacifies the grossly distended bladder, projected
over the pelvis, which limits assessment for subtle sacral fractures
particularly given background demineralization.
No acute fracture or dislocation.
IMPRESSION:
No evidence of acute fracture or dislocation. If this is a serious clinical
concern, MRI could be considered for further evaluation.
|
10034049-RR-33 | 10,034,049 | 20,053,563 | RR | 33 | 2158-02-23 08:53:00 | 2158-02-23 09:30:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ Yo w/ severe RA w/ leuksocytoclastis vasculitis, venous
insufficiency, hypothyroid, DM, chronic opioid use presenting with UTI, AMS
and repeat falls. Acutely being treated for her UTI, AMS and L-sided abdominal
pain. Now s/p fall onto ?head.// rule out bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.5 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: ___ head CT
FINDINGS:
Beam hardening artifact limits evaluation of bilateral frontal lobes.
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Extensive subcortical and periventricular deep white
matter hypodensities are re-demonstrated bilaterally and are nonspecific,
likely representing sequela of chronic microvascular ischemic disease.
Atherosclerotic vascular calcifications are noted of bilateral cavernous
portions of internal carotid arteries.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells bilaterally and the right maxillary sinus. The visualized
portion of the mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Beam hardening artifact limits evaluation of bilateral frontal lobes.
2. No acute intracranial abnormality.
3. No evidence acute intracranial hemorrhage or fracture.
4. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
5. Paranasal sinus disease , as described.
|
10034049-RR-34 | 10,034,049 | 20,053,563 | RR | 34 | 2158-02-26 15:36:00 | 2158-02-26 16:14:00 | INDICATION: ___ year old woman with abdominal pain// r/o perf, obstruction
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: CT chest, abdomen and pelvis ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is a
mild amount of stool within the large bowel. No free intraperitoneal air is
identified. There is levoscoliosis of the lumbar spine severe degenerative
changes in the lower lumbar spine. No calculi or radiopaque foreign bodies
are identified.
IMPRESSION:
No radiographic evidence of bowel obstruction or free intraperitoneal air.
|
10034049-RR-35 | 10,034,049 | 20,053,563 | RR | 35 | 2158-02-27 19:45:00 | 2158-02-27 20:51:00 | EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with multiple abdominal surgeries and on
chronic prednisone, complaining of severe abdominal pain// infection? abscess?
obstruction?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.6 s, 48.2 cm; CTDIvol = 11.8 mGy (Body) DLP = 569.9
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 33.4 mGy (Body) DLP =
16.7 mGy-cm.
Total DLP (Body) = 588 mGy-cm.
COMPARISON: Multiple prior examinations, most recent trauma torso from ___
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis without concerning focal
consolidation. There are trace bilateral pleural effusions, left greater than
right.
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 collapsed.
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. There is a 5
mm hypodense lesion in the spleen which most likely represents a lymphangioma
or hemangioma..
ADRENALS: The adrenal glands are normal.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no hydronephrosis. There are multiple hypodensities in both kidneys,
some of which are too small to characterize, but statistically most likely
represent simple cysts. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: Re-demonstrated anterior to the bladder is a 1.2 x 2.0 cm fat
containing nodule, which may represent sigmoid epiploic appendage without
evidence of active appendagitis. The bladder wall appears thickened compared
to prior study. Distal ureters are unremarkable. There is no free fluid in
the pelvis.
REPRODUCTIVE ORGANS: Uterus is surgically absent.
LYMPH NODES: There is relatively unchanged bilateral inguinal lymphadenopathy,
measuring up to 2.2 cm in short axis on the left. Prominent bilateral
external iliac nodes are again seen, similar compared to prior. There is no
pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Re-demonstrated is levoscoliosis of the lumbar spine, centered at L3,
unchanged. There is fusion of the L3-L4 vertebral bodies with irregularity
and lucency of the superior endplate L5 and the inferior endplate L4, which is
similar compared to prior but mildly progressed compared to ___.
Infection cannot be excluded.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No etiology identified for severe abdominal pain. Specifically, no
intra-abdominal abscess or small bowel obstruction.
2. The bladder wall appears mildly thickened, which may be related to
nondistention, however, cystitis should be considered and correlation with
urinalysis is recommended.
3. Redemonstration of the irregularity and lucency at the superior endplate of
L5 in the inferior endplate of L4, which is unchanged compared to ___ but slightly progressed compared to ___. Findings may represent
progressive neuropathic degenerative changes however underlying infection
cannot be excluded.
4. Unchanged, nonspecific prominent/enlarged pelvic/inguinal lymph nodes.
|
10034049-RR-36 | 10,034,049 | 20,053,563 | RR | 36 | 2158-02-28 22:19:00 | 2158-02-28 23:01:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ year old woman with subacute R sided weakness without
significant abnormality on CTHNC at OSH and ___, would like to eval for
potential etiology of CVA to explain her weakness.// eval for etiology of CVA
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.5 mGy-cm.
2) Spiral Acquisition 4.8 s, 38.0 cm; CTDIvol = 13.3 mGy (Body) DLP = 504.0
mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
4) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 32.7 mGy (Body) DLP =
16.3 mGy-cm.
Total DLP (Body) = 522 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: MRI head performed earlier on same day on ___ at
21:52, CT head on ___, CT torso on ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Again seen is a hypodensity in the left corona radiata, correlating with the
focus of late acute to subacute infarct seen on MRI performed earlier on same
day. There is prominence of the ventricles and sulci consistent with age
related involutional changes. Extensive subcortical periventricular
white-matter hypodensities are not significantly changed, and may be sequela
of prior therapy or chronic small vessel ischemic disease. No intracranial
hemorrhage.
There is mucosal thickening in the bilateral maxillary sinuses, right greater
than left. A small mucous retention cyst in the right maxillary sinus is
noted. The visualized portion of the remainder of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
CTA HEAD:
There is mild calcification of the bilateral cavernous and supraclinoid
carotid arteries without significant narrowing. Mild multifocal narrowing of
the P2 and P3 segments bilaterally is identified compatible with
atherosclerotic disease. The vessels of the circle of ___ and their
principal intracranial branches appear normal without stenosis, occlusion, or
aneurysm formation. The dural venous sinuses are patent.
CTA NECK:
Allowing for mild atherosclerotic disease, the carotid and vertebral arteries
and their major branches appear normal with no evidence of stenosis or
occlusion. There is no evidence of internal carotid stenosis by NASCET
criteria.
OTHER:
Nodular and ground-glass opacities in the posterior right upper lobe are
significantly improved compared with CT torso ___. The visualized
portion of the thyroid gland is within normal limits. There is no
lymphadenopathy by CT size criteria.
IMPRESSION:
1. Redemonstration of a focus of late acute to subacute infarct in the left
corona radiata. No intracranial hemorrhage.
2. Atrophy and stable extensive white matter disease, possibly related to
prior therapy or chronic small vessel ischemic disease.
3. No severe vascular stenosis, occlusion or aneurysm. Mild atherosclerotic
disease is noted in the posterior cerebral arteries and cavernous internal
carotid arteries.
4. Improved nodular and ground-glass opacities in the posterior right upper
lobe, consistent with resolving infection or contusion.
5. Additional findings as described above.
|
10034049-RR-37 | 10,034,049 | 20,053,563 | RR | 37 | 2158-02-28 21:18:00 | 2158-03-01 10:20:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with subacute R side hemiparesis consistent
with CVA with unremarkable NCHCT, would like to eval for stroke.// CVA?
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head on ___, CT head on ___, and ___
FINDINGS:
There is a focus of slow diffusion in the left corona radiata with associated
FLAIR/T2 signal abnormality and mild ADC hypointensity, consistent with late
acute to subacute infarct. There is no evidence of acute intracranial
hemorrhage. There is prominence of the ventricles and sulci suggestive of
age-related involutional changes. Extensive subcortical and periventricular
T2/FLAIR white matter hyperintensities are not significantly changed. The
major intracranial flow voids are preserved.
There is mild mucosal thickening in the right maxillary sinus with mucous
retention cyst and mucosal thickening of the ethmoid air cells. There is no
abnormal fluid signal in the remainder of the visualized paranasal sinuses or
mastoid air cells. The orbits are grossly unremarkable.
IMPRESSION:
1. Late acute to subacute in the left corona radiata. No intracranial
hemorrhage.
2. Atrophy and stable extensive white matter signal abnormality, possibly
related to prior therapy or chronic small vessel ischemic disease.
3. Additional findings described above.
|
10034345-RR-6 | 10,034,345 | 27,724,752 | RR | 6 | 2184-10-08 14:06:00 | 2184-10-08 15:55:00 | INDICATION: Acute back pain. Hypertension, evaluate for aortic dissection.
COMPARISON: None available.
TECHNIQUE: MDCT images were obtained through the chest with IV contrast.
Coronal and sagittal reformations were performed. Right and left MIP
reconstructions were performed.
FINDINGS: There is no axillary, mediastinal or hilar lymphadenopathy. The
thyroid is normal. The airways are patent to the subsegmental level. The
esophagus is normal. There is no filling defect in the pulmonary arteries to
the subsegmental level. The aorta is normal in caliber. Mild atherosclerotic
calcifications. No evidence of dissection. There are coronary artery
calcifications. No pericardial effusion. Heart size is normal. There is no
pleural effusion, focal consolidation, or pneumothorax. There is no acute
bony abnormality. Patient is status post sternotomy.
IMPRESSION:
1. No evidence of aortic dissection. No pulmonary embolism.
2. Coronary artery calcifications.
|
10034354-RR-5 | 10,034,354 | 27,657,995 | RR | 5 | 2159-05-11 21:13:00 | 2159-05-13 12:07:00 | EXAM: CT PERFUSION OF THE HEAD AND CTA HEAD AND NECK.
CLINICAL INFORMATION: Patient with TIA, question of left MCA infarct.
TECHNIQUE: Axial images of the head were obtained without contrast. Using
departmental protocol, CT perfusion of the head and CT angiography of the head
and neck acquired. Reformatted images were obtained.
FINDINGS: Head CT shows no evidence of acute hemorrhage, mass effect or
midline shift. Gray-white matter differentiation maintained.
CT perfusion of the head shows normal mean transit times, blood volume and
blood flow.
CT angiography of the neck demonstrates normal flow in the arteries of
anterior and posterior circulation without stenosis or occlusion.
CT angiography of the head shows no evidence of stenosis, occlusion, or
aneurysm greater than 3 mm in size.
IMPRESSION: Normal CT head. Normal CT perfusion head. Normal CT angiography
of the head and neck.
|
10034354-RR-6 | 10,034,354 | 27,657,995 | RR | 6 | 2159-05-12 03:13:00 | 2159-05-12 12:39:00 | TECHNIQUE: MRI of the brain without gad.
HISTORY: Right hand weakness, question insular ribbon sign on the left.
COMPARISON: CTA ___.
FINDINGS: There is no evidence for acute ischemia or hydrocephalus.
Intracranial flow voids are maintained. Minimal scattered small vessel
ischemic changes are seen in the white matter. There is mucosal thickening in
the right maxillary sinus.
IMPRESSION: No evidence for acute ischemia.
|
10034742-RR-28 | 10,034,742 | 27,391,040 | RR | 28 | 2152-06-13 02:44:00 | 2152-06-13 04:32:00 | INDICATION: History of prior spinal surgeries. Please evaluate for hardware.
COMPARISONS: CT pelvis from ___ and MR abdomen from ___.
TECHNIQUE: AP and Lateral views of the lumbosacral spine.
FINDINGS: There are five non-rib-bearing lumbar vertebral bodies. Lumbar
lordosis appears to be preserved. There is no evidence of fracture or
malalignment. There is no SI joint or pubic symphysis diastasis. There are
severe degenerative changes of the lumbar spine with lost of height and mild
anterolisthesis at L4-5. No focal lytic or sclerotic lesions are identified.
There is no evidence of a radiopaque foreign body.
IMPRESSION: No acute abnormalities of the lumbosacral spine identified.
|
10034933-RR-44 | 10,034,933 | 28,591,708 | RR | 44 | 2111-12-10 20:24:00 | 2111-12-10 23:01:00 | EXAMINATION: Chest CT.
INDICATION: ___ with metastatic HCC here w/ confusion. Evaluate for pleural
effusion.
TECHNIQUE: Contiguous axial images were obtained through the chest with
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: Chest CT ___. Chest x-ray ___, performed
at an outside facility. CT abdomen and pelvis ___.
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. Though not
performed as a dedicated exam, there is no central pulmonary embolism. Severe
coronary artery calcifications. Moderate to severe atherosclerotic
calcifications of the aortic arch and thoracic aorta. Otherwise, the heart,
pericardium, and great vessels are within normal limits. No pericardial
effusion is seen. A right-sided Port-A-Cath tip terminates in the right
atrium.
AXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal nodes, for
example in the subcarinal station (8:139), measure up to 9 mm, grossly stable
from the prior examination. No axillary lymphadenopathy. No mediastinal mass
or hematoma.
PLEURAL SPACES: Compared to the prior study, lobulated, right greater than
left pleural effusions are new.
LUNGS/AIRWAYS: Calcified granuloma within the left upper lobe (08:48).
Micronodule within the left upper lobe (8:69). Mild, dependent, subsegmental
atelectasis. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: A 6 mm left hypodense thyroid nodule appears stable. Otherwise,
visualized portions of the base of the neck show no abnormality.
ABDOMEN: The liver contour is nodular, compatible with cirrhosis. The patient
is status post right hepatic lobe resection. Evaluation of hepatic masses is
not fully assessed on this single-phase study. Within this limitation,
multiple hepatic masses are again seen, measuring up to 8.1 x 6.0 cm,
compatible with known multifocal hepatocellular carcinoma. Moderate volume
ascites. A wedge-shaped hypodensity in the spleen (8:295) could be due to
contrast bolus timing, although a splenic infarct could have a similar
appearance. Within the left adrenal gland is an approximately 4.3 x 4.0 cm
metastatic lesion, not significantly changed in size from 4.0 x 3.7 cm
previously. Multiple nodules within the right adrenal gland measure up to 0.8
cm, similar in appearance to the prior study. A simple appearing cyst in the
right kidney measures 1.7 cm.
BONES: Chronic appearing rib deformity of the right lateral sixth rib.
Multiple osseous metastatic lesions of the ribs and multilevel vertebra appear
unchanged. There is no acute fracture. Oblong soft tissue density anterior
to the T4 vertebral body on the right as likely soft tissue extension from
adjacent osseous metastatic disease. Soft tissue extension medial to the
right pedicle at this level into the canal is grossly unchanged from prior
exam.
IMPRESSION:
1. New, lobulated, right greater than left, small pleural effusions.
2. No evidence of new or growing pulmonary nodules.
3. Cirrhotic liver, with multiple hepatic masses measuring up to 8.1 cm,
compatible with known multifocal hepatocellular carcinoma, not fully assessed
on this study.
4. New, wedge-shaped hypodensity within the spleen, which could be due to
contrast bolus timing, although a splenic infarct could have a similar
appearance.
5. Stable bilateral adrenal metastases.
6. No significant change in osseous metastatic disease of the ribs and
vertebrae.
7. Other findings, as described above.
|
10034933-RR-45 | 10,034,933 | 28,591,708 | RR | 45 | 2111-12-11 08:41:00 | 2111-12-11 11:21:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with HCC, now w/ worsening TBili, r/o
obstruction, also assess for poss splenic infarct seen on CT// ___ year old man
with HCC, now w/ worsening TBili, r/o obstruction, also assess for poss
splenic infarct seen on CT
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis dated ___ and CT chest dated ___.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. Redemonstrated is a
large, heterogeneous mass in the left hepatic lobe measuring approximately 7.9
x 5.9 cm, although this is better appreciated on CT dated ___.
Additional hepatic masses are better appreciated on the prior CT. The main
portal vein is patent with hepatopetal flow. There is small to moderate
ascites.
BILE DUCTS: There is moderate intrahepatic biliary ductal dilatation,
primarily in the left hepatic lobe, similar to prior. There is no significant
central biliary ductal dilatation.
CHD: 4 mm
GALLBLADDER: There is no evidence of stones. The gallbladder is relatively
decompressed. The gallbladder wall appears diffusely thickened, measuring up
to 6 mm adjacent to the liver, likely secondary to third spacing in the
setting of chronic liver disease.
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. There is a focal, wedge shaped area of
hypoechogenicity along the lateral margin of the spleen, which could represent
a splenic infarct. Punctate echogenic foci scattered throughout the spleen
likely represent calcified granulomas.
Spleen length: 14.3 cm
KIDNEYS: Normal cortical echogenicity and corticomedullary differentiation is
seen bilaterally. There is no evidence of masses, stones, or hydronephrosis
in the kidneys.
Right kidney: 10.9 cm
Left kidney: 13.1 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver with redemonstration of a large, heterogeneous left
hepatic mass. Additional masses are better appreciated on prior CT.
2. Sequela of portal hypertension including mild splenomegaly and small to
moderate volume ascites.
3. Persistent moderate intrahepatic biliary ductal dilatation, primarily in
the left hepatic lobe, similar to prior. No evidence of common bile duct
dilatation.
4. Focal, wedge shaped area of hypoechogenicity along the lateral margin of
the spleen may represent a splenic infarct.
|
10034933-RR-46 | 10,034,933 | 28,591,708 | RR | 46 | 2111-12-12 19:22:00 | 2111-12-12 21:40:00 | EXAMINATION: MRCP WITHOUT AND WITH CONTRAST
INDICATION: ___ year old man with metastatic HCC and rising bilirubin.//
Evaluate for the level of biliary obstruction for possible drainage by ___ or
ERCP. Please advise if CT would be sufficient.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
COMPARISON: CT abdomen and pelvis ___. CT chest ___.
FINDINGS:
Lower Thorax: There are small bilateral pleural effusions, appearing slightly
loculated on the right. Bibasilar atelectasis.
Liver: Cirrhotic liver morphology, without significant steatosis. There are
innumerable lesions scattered throughout the liver, consistent with known
multifocal hepatocellular carcinoma (HCC). Several lesions appear new or
increased in size compared to the prior CT performed on ___,
although comparison is somewhat limited due to differences in modality. A
representative example is in segment VII where there are two adjacent lesions,
with the 1.3 cm lesion appearing larger than the prior CT and the adjacent
smaller lesion appearing new from prior (1301:49). More inferiorly in
segments V and VI, there are innumerable lesions, many of which appear new
from prior (1301:100). A superior caudate lesion appears new (1301:40).
There is also extensive tumor involvement of the left hepatic lobe. There is
invasion of the left portal venous branches, which has progressed compared to
the prior CT (___).
Biliary: Gallbladder wall edema is likely due to third spacing. There is
mild/moderate intrahepatic biliary dilation involving segment II and III
branches. No intrahepatic biliary dilation on the right.
Pancreas: Pancreas is atrophic. No parenchymal lesions are identified. There
is no main duct dilation.
Spleen: Spleen is mildly enlarged, measuring up to 15.6 cm.
Adrenal Glands: Bilateral adrenal metastases measuring 1 cm on the right, and
4.4 cm on the left, are not significantly changed from the prior CT performed
in ___.
Kidneys: Kidneys enhance homogeneously. No solid parenchymal renal masses.
There are bilateral simple renal cysts. No hydronephrosis.
Gastrointestinal Tract: Stomach is unremarkable. There is no evidence of
bowel obstruction. Small volume ascites throughout the peritoneal cavity.
Lymph Nodes: No retroperitoneal adenopathy. A 1 cm peripancreatic node is
likely reactive (1301:94).
Vasculature: Abdominal aorta is not aneurysmal. Moderate stenosis at the
origin of the celiac artery due to atherosclerosis shown on the prior CT
(___). Hepatic arterial anatomy is conventional. Superior mesenteric
artery and bilateral renal arteries are patent, although noting severe
atherosclerotic narrowing at the origin of the right renal artery (1301:89).
Osseous and Soft Tissue Structures: Osseous metastases are again seen.
Representative examples include several known pathologic left-sided rib
fractures ___: 29, 36, 38, 117). Additional nodular enhancing
focus abutting the posterior T11 transverse process may represent an
additional metastasis (1301:48). Soft tissues are unremarkable.
IMPRESSION:
1. Probable progression of multifocal HCC compared to ___ with
increased number and size of multiple lesions, although comparison is
suboptimal due to differences in modality.
2. Worsening tumor thrombus in left portal venous branches.
3. Mild/moderate intrahepatic biliary dilation in segments II/III, worse
compared to ___. No evidence of cholangitis or hepatic
microabscess.
4. Bilateral adrenal and multiple osseous metastases.
5. Small bilateral pleural effusions, appearing slightly loculated on the
right.
|
10034933-RR-47 | 10,034,933 | 28,591,708 | RR | 47 | 2111-12-13 14:10:00 | 2111-12-13 14:38:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man with HCC admitted with weakness. L>R peripheral
edema// 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, color flow, and spectral doppler 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.
|
10035631-RR-18 | 10,035,631 | 29,462,354 | RR | 18 | 2112-09-18 11:43:00 | 2112-09-18 15:05:00 | INDICATION: Acute leukemia and breast masses, evaluate for staging.
COMPARISON: None available.
TECHNIQUE: MDCT images were obtained through the abdomen and pelvis with IV
and oral contrast. Coronal and sagittal reformations were performed. TOTAL
DLP: 1175 mGy-cm.
FINDINGS: The imaged lung bases are clear. The visualized heart and
pericardium are unremarkable.
The liver enhances homogeneously and there are no focal hepatic lesions. The
gallbladder is normal. The pancreas is normal. The spleen is mildly enlarged
measuring 13.6 cm. The adrenal glands are normal. There is minimal scarring
at the lower pole of the left kidney, otherwise the kidneys are unremarkable.
The stomach is normal. The small bowel is normal. There is no evidence of
obstruction. The appendix is normal. The colon demonstrates descending and
sigmoid colon diverticulosis without evidence of diverticulitis. There is no
retroperitoneal or mesenteric lymphadenopathy.
PELVIS: The rectum is normal. The prostate and seminal vesicles are normal.
The bladder is moderately distended. There is no free fluid in the pelvis.
No pelvic or inguinal lymphadenopathy. No hernias are identified.
The aorta is normal in caliber.
BONES: No suspicious bony abnormalities. There are mild degenerative changes
of the L2-L3 with disc space narrowing and marginal osteophytes. No
suspicious bony abnormalities.
IMPRESSION:
1. Mild splenomegaly.
2. Sigmoid diverticulosis but no diverticulitis.
|
10035631-RR-19 | 10,035,631 | 29,462,354 | RR | 19 | 2112-09-18 13:42:00 | 2112-09-18 17:53:00 | BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM WITH ICAD AND LEFT BREAST ULTRASOUND
INDICATION: Bruise and new lump left breast, thrombocytopenia.
Breast tissue is largely fatty. There is moderate bilateral gynecomastia. A
BB is present on the skin overlying a lump in the outer aspect of the left
breast where there is a partially circumscribed round 2 cm x 2.2 cm mass.
Lateral to the mass in the outer aspect of the left breast, the breast
markings are somewhat coarsened. A few scattered benign calcifications are
evident. No adenopathy is noted in the axillae.
Ultrasound of left breast was performed. At 3 o'clock, approximately 4 cm
from the nipple, there is a mixed echogenic and hypoechoic mass measuring 2.1
cm x 1.5 cm x 1.6 cm mass. There is peripheral color flow and some of the
images suggest flow internally. Slightly inferior to this mass at 3:30
o'clock, a second similar-appearing mass is present measuring 1.1 cm x 1.0 cm.
Subareolar hypoechoic tissue has the appearance of a gynecomastia. A number
of normal-appearing lymph nodes in the left axilla are present.
IMPRESSION:
1. There are two echogenic/hypoechoic masses lateral to the left nipple
having the appearance of hematomas. Follow up imaging would be recommended.
If, however, tissue diagnosis is required, biopsy preceded by platelet
infusion could be performed.
2. Bilateral moderate gynecomastia.
BI-RADS 3 -- probably benign.
|
10035631-RR-20 | 10,035,631 | 29,462,354 | RR | 20 | 2112-09-18 13:23:00 | 2112-09-18 14:37:00 | ULTRASOUND, LEFT BREAST
INDICATION: Bruising with left breast lump.
Refer to combined bilateral diagnostic mammogram and left breast ultrasound
reports on ___ under clip ___.
BI-RADS 3 -- probably benign.
|
10035631-RR-21 | 10,035,631 | 29,462,354 | RR | 21 | 2112-09-18 12:48:00 | 2112-09-18 18:01:00 | REASON FOR EXAMINATION: Evaluation of the patient with acute leukemia and
breast mass.
COMPARISON: No prior studies available for comparison.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen with subsequent 1.25- and 5-mm collimation axial images reviewed in
conjunction with coronal and sagittal reformats.
FINDINGS:
Assessment of the chest reveals left breast nodule, solid and
well-circumscribed, approximately 15.1 x 12.8 mm in diameter, 2:34,
corresponding to the nodule demonstrated on the mammography. No axillary
pathologically enlarged lymph nodes demonstrated, although several small lymph
nodes are present. No other nodules within the breast demonstrated. Neither
ipsi- nor contralaterally. No hilar or mediastinal lymphadenopathy is seen.
Aberrant right subclavian artery is demonstrated, anatomical variant. Cluster
of lymph nodes is noted at the lower aspect of the right axilla, again not
pathologically enlarged but multiple.
Aorta and pulmonary arteries are unremarkable. No pericardial or pleural
effusion is seen. The imaged portion of the upper abdomen reveals no
appreciable abnormality.
For the assessment of the thoracic inlet review CT neck and the corresponding
report.
There are no bone lesions worrisome for infection or neoplasm.
Airways are patent to the subsegmental level bilaterally. Assessment of the
lung parenchyma demonstrates several pulmonary nodules: 4:70, 4:136,
4:60,lingular nodule, 4:212.
IMPRESSION:
1. Left breast nodule as described that should be further correlated with
tissue biopsy.
2. Right axillary lymph nodes, not pathologically enlarged but multiple.
3. Several pulmonary nodules that should be reassessed in three months for
assessment of stability.
|
10035631-RR-22 | 10,035,631 | 29,462,354 | RR | 22 | 2112-09-18 12:50:00 | 2112-09-18 14:40:00 | HISTORY: Leukemia staging.
COMPARISON: None available.
TECHNIQUE: Enhanced axial MDCT study of the neck was performed with images
obtained from the skullbase to the thoracic inlet using 2.5 mm thick sections.
Coronal and sagittal reformats were generated.
Total exam DLP: ___
FINDINGS:
Evaluation of the aerodigestive tract demonstrates no exophytic mucosal lesion
or finding of focal mass-effect. Evaluation of cervical lymph node stations
does not demonstrate lymphadenopathy by imaging size criteria. The thyroid
and salivary glands are unremarkable in appearance. Cervical vessels enhance
bilaterally without significant stenosis.
Evaluation of osseous structures demonstrates significant neural foraminal
stenosis at the C5-C6 level, worse on the right and less severe on the left,
due to facet and uncovertebral spondylosis. No blastic or lytic lesions
concerning for malignancy identified. No osseous destruction identified. Lung
apices and included paranasal sinuses are clear.
IMPRESSION:
1. No focal soft tissue mass or cervical lymphadenopathy.
2. Right neural foraminal stenosis at the C5-C6 level.
COMMENT: The role of this study in staging of (reported) AML is unclear.
|
10035631-RR-23 | 10,035,631 | 29,462,354 | RR | 23 | 2112-09-19 11:08:00 | 2112-09-19 14:09:00 | HISTORY: Acute myelogenous leukemia. Starting chemotherapy. The patients
platelets were 8. Two units of platelets were transfused prior to the start of
the procedure.
COMPARISON: CT of the neck from ___.
TECHNIQUE:
OPERATORS: Dr. ___ radiology fellow) performed the
procedure. The attending Dr. ___ was supervising the procedure.
CONTRAST: None.
ANESTHESIA: 1% subcutaneous lidocaine.
PROCEDURE:
PROCEDURE DETAILS: Following the explanation of the risks, benefits and
alternatives to the procedure, written informed consent was obtained. The
patient was then brought to the angiography suite and placed supine on the
exam table. A pre-procedure time-out was performed per usual ___ protocol.
The upper chest was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Hard copy
ultrasound images were obtained before and after intravenous access.
Subsequently a Nitinol wire was passed into the right atrium using
fluoroscopic guidance. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced into the IVC.
A triple-lumen central venous catheter was advanced over the wire into the
superior vena cava with the tip in the cavoatrial junction. All 3 access ports
were aspirated, flushed and capped. The catheter was secured to the skin with
a 0 silk suture and sterile dressings were applied. Final spot fluoroscopic
image demonstrating good alignment of the catheter and no kinking.
The patient tolerated the procedure well without immediate complications.
FINDINGS:
Patent right internal jugular vein. Final flouroscopic image showing right
internal jugular approach triple lumen central venous catheter with catheter
tip terminating in the cavoatrial junction.
IMPRESSION:
Successful placement of a right internal jugular triple lumen temporary
central venous catheter. The line is ready to use.
|
10035631-RR-24 | 10,035,631 | 29,462,354 | RR | 24 | 2112-10-05 15:14:00 | 2112-10-05 19:14:00 | HISTORY: Neutropenic fever.
FINDINGS: No previous images. The heart is within normal limits. There is
no evidence of vascular congestion or pleural effusion. Specifically, no
evidence of acute focal pneumonia.
Right IJ catheter tip extends to lower portion of the SVC.
|
10035631-RR-25 | 10,035,631 | 29,462,354 | RR | 25 | 2112-10-07 16:39:00 | 2112-10-07 18:03:00 | INDICATION: Headache, meningismus, low platelets. Evaluate for intracranial
bleeding or obvious ___.
COMPARISON: None.
TECHNIQUE: Axial helical MDCT images were obtained through the brain without
IV contrast. Multiplanar coronal, sagittal and thin section bone algorithm
reconstructed images were acquired.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect or large
territorial infarction. The ventricles and sulci are normal in size and
configuration for patient's age. The basal cisterns are patent and there is
preservation of gray-white differentiation.
There is no fracture. The visualized paranasal sinuses, mastoid air cells and
middle ear cavities are clear. A small soft tissue focus in the left external
auditory canal is nonspecific that likely represents cerumen. The globes are
unremarkable. There is atherosclerotic calcification of the cavernous
internal carotid arteries.
IMPRESSION: No evidence of acute intracranial process.
|
10035631-RR-26 | 10,035,631 | 29,462,354 | RR | 26 | 2112-10-09 16:11:00 | 2112-10-09 17:20:00 | TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with acute myelocytic leukemia, now
neutropenic with new cough, evaluate for possible new pneumonia.
FINDINGS: AP single view of the chest has been obtained with patient in
sitting semi-upright position. Analysis is performed in direct comparison
with the next preceding similar study of ___. On the single AP
view chest examination, the heart size remains unchanged and is within normal
limits. The pulmonary vasculature is not congested. No signs of acute new
infiltrates in comparison with the previous study obtained four days earlier.
No evidence of pleural effusion as the lateral pleural sinuses are free. A
previously existing right internal jugular approach central venous line has
been removed. There is no evidence of pneumothorax in the apical area.
IMPRESSION: No evidence of pneumonia.
|
10035631-RR-27 | 10,035,631 | 29,462,354 | RR | 27 | 2112-10-10 15:03:00 | 2112-10-10 17:40:00 | HISTORY: ___ man with AML and ongoing neutropenic fever associated
with cough despite broad-spectrum antibiotics.
COMPARISON: Comparison is made to CT of the chest from ___.
TECHNIQUE: MDCT images are obtained of the thorax without the use of
intravenous contrast. Reformatted coronal, sagittal and axial maximum
intensity projection images were reviewed.
CT THORAX WITHOUT IV CONTRAST: Numerous bilateral axillary lymph nodes are
not pathologically enlarged, and are stable to decreased in size since the
prior study (3:14). No supraclavicular lymphadenopathy is present. Multiple
prominent mediastinal lymph nodes are not pathologically enlarged, the
measuring up to 6 mm in short axis diameter in the precarinal station (3:13).
No pleural or pericardial effusion is identified. The heart and pericardium
are unremarkable. The intrathoracic aorta and pulmonary arteries are normal
in caliber.
A left breast nodule is again seen (5:154) and intervally decreased in size
since the prior study, now measuring 13 x 11 mm, previously 15 x 13 mm,
consistent with a hematoma, as suggested on diagnostic mammogram and
ultrasound from ___.
Lung windows demonstrate interval development of numerous bilateral semisolid
(5:91) and ground-glass nodules (5:57), which are randomly distributed in all
lobes of the lungs and range from 1 mm to 3 mm in size (5:134). Subsegmental
bibasilar atelectasis is also present. A punctate calcified granuloma is
identified in the right lower lobe (5:171). A trace left pleural effusion is
present (5:206).
Although the study is not designed for the evaluation of subdiaphragmatic
structures, the unenhanced appearance of the upper abdomen is unremarkable.
OSSEOUS STRUCTURES: No lytic or blastic lesion suspicious for malignancy is
identified.
IMPRESSION:
1. Numerous small ground glass and semi-solid pulmonary nodules are randomly
distributed throughout all lobes of both lungs and are new since the prior
study. Although this finding is not concerning for malignant disease, their
presence in a neutropenic patient could represent an inflammatory or
infectious process such as viral pneumonia. No evidence of bacterial or
fungal pneumonia.
2. Interval decrease in size of left breast nodule, in keeping with a
hematoma as described on recent diagnostic mammogram from ___.
3. Numerous bilateral axillary and mediastinal lymph nodes are not
pathologically enlarged.
4. Trace left pleural effusion (5:206).
The above findings were communicated to Dr. ___ by Dr. ___ telephone
at 4:15 p.m., within five minutes of discovery.
|
10035631-RR-28 | 10,035,631 | 29,462,354 | RR | 28 | 2112-10-12 19:31:00 | 2112-10-13 11:17:00 | BRAIN MRI WITHOUT CONTRAST, ___
INDICATION: ___ man with acute myelogenous leukemia, previously
neutropenic, found to have bacteremia with worsening intermittent headaches.
Previously negative head CT. Evaluate for intracranial abscess or presence of
infection.
COMPARISON: Non-contrast head CT from ___ is available for
correlation.
TECHNIQUE: The bone marrow transplant team requested for this study to be
performed without intravenous contrast. Sagittal T1-weighted, and axial
T2-weighted, FLAIR, gradient echo, and diffusion-weighted images of the brain
were obtained.
FINDINGS: There is no evidence for edema, mass effect, abnormal diffusion, or
blood products in the brain parenchyma. Scattered punctate foci of high T2
signal in bifrontal deep and subcortical white matter are nonspecific, but may
reflect sequela of mild chronic small vessel ischemic disease in a patient of
this age. Ventricles, sulci, and basal cisterns are normal in size for age.
There is no abnormal leptomeningeal or pachymeningeal signal on FLAIR images.
There is no pathologic extra-axial collection. The major intracranial flow
voids are grossly preserved.
The right frontal sinus is not pneumatized. Other paranasal sinuses appear
grossly well aerated. Mastoid air cells also appear well aerated.
Correlation with the preceding CT scan confirms that high signal in bilateral
inferior mastoids corresponds to non-pneumatized bone marrow.
IMPRESSION: Within the limits of non-contrast MRI, there is no evidence for
intracranial infection. However, meningitis may be occult on imaging.
|
10035631-RR-67 | 10,035,631 | 21,476,294 | RR | 67 | 2115-11-09 10:29:00 | 2115-11-09 12:03:00 | INDICATION: ___ year old man with a history of breast cancer, AML s/p allo
transplant, h/o pulmonary aspergillosis, here with myalgias, night sweats, and
leukocystosis concerning for leukemia // eval for lymphadenopathy, infection,
hemorrhage
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis as part of CT torso following intravenous
contrast administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 11.0 s, 0.2 cm; CTDIvol = 186.7 mGy (Body) DLP =
37.3 mGy-cm.
3) Spiral Acquisition 11.4 s, 73.9 cm; CTDIvol = 11.1 mGy (Body) DLP =
815.5 mGy-cm.
4) Spiral Acquisition 5.8 s, 37.4 cm; CTDIvol = 9.9 mGy (Body) DLP = 363.0
mGy-cm.
Total DLP (Body) = 1,218 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast ___
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings. Trace bilateral pleural
effusions and minimal bibasilar atelectasis are noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. No
focal lesion is identified. Intra and extrahepatic bile ducts are not
dilated. Gallbladder is unremarkable.
PANCREAS: Pancreas demonstrates homogeneous attenuation throughout. There is
no pancreatic duct dilation.
SPLEEN: Enlarged spleen measures 14.9 cm, similar to ___.
ADRENALS: Bilateral adrenal glands are unremarkable.
URINARY: A 0.7 cm hypodense lesion in the upper pole of left kidney is too
small to be characterized. Bilateral nephrograms are symmetric. There is no
hydronephrosis.
GASTROINTESTINAL: Stomach is unremarkable. Small and large bowel loops are
normal caliber. Colonic diverticulosis is noted. Appendix is unremarkable.
PELVIS: Bladder is unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles are normal size.
LYMPH NODES: There is no lymphadenopathy.
VASCULAR: Celiac and SMA common trunk is noted. Splenic artery arises from
the aorta. There is no abdominal aortic aneurysm. Minimal Atherosclerotic
disease is noted.
BONES: No suspicious bone lesion is identified.
SOFT TISSUES: Left mastectomy is noted. Fat containing left inguinal hernia
is small.
IMPRESSION:
1. No intra-abdominal infection or hemorrhage is identified.
2. Splenomegaly.
|
10035631-RR-68 | 10,035,631 | 21,476,294 | RR | 68 | 2115-11-08 20:13:00 | 2115-11-08 20:49:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with prior AML with thrombocytopenia and
headache. Evaluate for 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) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 45.5 mGy (Head) DLP =
855.5 mGy-cm.
Total DLP (Head) = 856 mGy-cm.
COMPARISON: CT head of ___.
FINDINGS:
There is no evidence of large vascular territorial infarction,acute
intracranial hemorrhage, edema, or mass effect. There is mild 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:
No evidence of acute intracranial hemorrhage.
|
10035631-RR-69 | 10,035,631 | 21,476,294 | RR | 69 | 2115-11-09 10:29:00 | 2115-11-09 11:37:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: AML
TECHNIQUE: MULTI DETECTOR HELICAL SCANNING OF THE CHEST WAS COORDINATED WITH
INTRAVENOUS INFUSION OF NONIONIC CONTRAST AGENT, RECONSTRUCTED AS CONTIGUOUS 5
AND 1.25 MM THICK AXIAL, 5 MM THICK CORONAL AND PARASAGITTAL, AND 8 MM MIP
AXIAL IMAGES. SUBSEQUENT SCANNING OF THE ABDOMEN AND PELVIS AND THE TOTAL
DOSAGE OF SCANNING THE ENTIRE TORSO WILL BE REPORTED SEPARATELY.
DOSAGE: TOTAL DLP reported separatelymGy-cm
COMPARISON: ___.
FINDINGS:
Small, subcentimeter axillary and mediastinal lymph nodes are similar in size
and number to the prior CT. Heart size is normal, and there is no pericardial
effusion. Small bilateral pleural effusions are new, dependent in location,
with adjacent bibasilar atelectasis. Additional foci of linear atelectasis
are present in the mid lungs bilaterally.
Skeletal structures of the thorax demonstrate no new suspicious lytic or
blastic lesions.
Within the lungs, assessment is limited by inadvertent expiratory phase of
respiration and motion artifact. Diffuse ground-glass opacities and septal
thickening are new since the prior CT. Previously reported subcentimeter
nodules are difficult to compare to the prior study due to the technical
limitations described above. A 9 mm sub solid nodule in the left upper lobe
(97, 6) is potentially slightly more dense and larger than on the prior study,
but technical differences limit comparison. Additionally, a few of the
previously described opacities are potentially obscured by new dependent
atelectasis.
IMPRESSION:
1. New ground-glass opacities with septal thickening and dependent small
pleural effusions, most suggestive of hydrostatic edema. Differential
diagnosis includes atypical infection and less likely leukemic infiltration.
2. Pre-existing lung nodules are difficult to compare to the prior CT due to
technical limitations of today's exam. Consider a ___ month followup CT to
allow more precise comparison of a potentially growing left upper lobe nodule
in order to exclude the possibility of a slowly growing lesion within the lung
adenocarcinoma spectrum.
3. Please see separately dictated CT of the abdomen and pelvis for complete
description of subdiaphragmatic findings.
|
10035631-RR-70 | 10,035,631 | 21,476,294 | RR | 70 | 2115-11-09 17:32:00 | 2115-11-09 18:17:00 | INDICATION: ___ year old man with PICC // Pt had a R PICC,50cm, ___ ___
Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT chest dated ___
FINDINGS:
The tip of the right PICC line extends into the right jugular system.
Low bilateral lung volumes. No pleural effusion or pneumothorax identified.
Mild pulmonary vascular congestion. The size the cardiac silhouette is
enlarged which may be secondary to low lung volumes and portable technique.
IMPRESSION:
The tip of the right PICC line courses cranially, projecting over the right
jugular system.
NOTIFICATION: The findings were discussed with ___ by ___
___, M.D. on the telephone on ___ at 6:16 ___, 5 minutes after
discovery of the findings.
|
10035631-RR-71 | 10,035,631 | 21,476,294 | RR | 71 | 2115-11-09 18:49:00 | 2115-11-09 19:30:00 | INDICATION: ___ year old man with AML relapse had PICC placed and tip went up
to neck. IV RN tried powerflush to reset. Want to check before calling ___ to
revise it. // location of PICC tip - neck vs. SVC Contact name: ___
___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The tip of the right PICC line is again noted to be extending cranially into
the right jugular venous system.
Unchanged bibasilar opacities likely reflecting atelectasis no pleural
effusion or pneumothorax identified. The size the cardiac silhouette enlarged
but unchanged.
IMPRESSION:
No significant interval change since the prior radiograph.
NOTIFICATION: The findings were discussed with ___ by ___
___, M.D. on the telephone on ___ at 7:28 ___, 2 minutes after
discovery of the findings.
|
10035631-RR-72 | 10,035,631 | 21,476,294 | RR | 72 | 2115-11-09 19:48:00 | 2115-11-09 20:40:00 | INDICATION: ___ year old man with PICC going to IJ, needs repositioning // ___
year old man with PICC going to IJ, needs repositioning
COMPARISON: Radiograph of the chest dated ___
TECHNIQUE: OPERATORS: Dr. ___, attending radiologist performed
the procedure.
ANESTHESIA: None.
MEDICATIONS: None
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 6 seconds, 1 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Scout image demonstrated the tip of the PICC line to be in
the right internal jugular vein. After alcohol was used to prep the hub of 1
of the PICC lumens, a 3 cc syringe with saline was attached. The PICC was
flushed and noted to reposition itself with the tip at the SVC/RA junction. A
fluoroscopic image was acquired to confirm appropriate positioning.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach PICC with tip in the internal jugular vein that
was successfully repositioned with the tip near the SVC/RA junction.
IMPRESSION:
The line is ready to use.
|
10035780-RR-37 | 10,035,780 | 22,919,435 | RR | 37 | 2131-08-07 15:23:00 | 2131-08-07 16:12:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new leukocytosis. // R/O infection
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
There is a dialysis catheter overlying the right chest with the tip in the
cavoatrial junction. Heart size is stable. The mediastinal and hilar
contours are stable. The pulmonary vasculature is normal. Lungs are clear. No
pleural effusion or pneumothorax is seen. There are no acute osseous
abnormalities.
IMPRESSION:
No evidence of pneumonia.
|
10035780-RR-38 | 10,035,780 | 25,186,901 | RR | 38 | 2131-11-09 09:12:00 | 2131-11-09 11:40:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with chest pain, cough, and fever // Please eval
for pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Cardiac and mediastinal silhouettes are stable. No definite focal
consolidation is seen. There is no large pleural effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process. No focal consolidation to suggest
pneumonia.
|
10035780-RR-39 | 10,035,780 | 25,186,901 | RR | 39 | 2131-11-09 21:23:00 | 2131-11-10 13:08:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with HBV, HCV, ESRD on HD, s/p CCY here with
fever. alk phos elevated // eval for cholangitis, ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound dated ___.
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 CBD measures 8 mm.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 9.6 cm.
KIDNEYS: Limited views the right kidney are unremarkable.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No evidence of focal hepatic lesions.
2. No ascites.
3. Dilatation of the common bile duct is similar to prior, and likely relates
to post-cholecystectomy state.
|
10035780-RR-40 | 10,035,780 | 21,074,018 | RR | 40 | 2132-05-14 15:37:00 | 2132-05-14 17:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with confusion // eval for pna
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
No focal consolidation is seen. There is no large pleural effusion or
pneumothorax. The cardiac and mediastinal silhouettes are stable.
IMPRESSION:
No significant change from the prior study.
|
10035780-RR-41 | 10,035,780 | 21,074,018 | RR | 41 | 2132-05-14 16:31:00 | 2132-05-14 17:07:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with AMS // eval for bleed
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 19.2 cm; CTDIvol = 47.0 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None
FINDINGS:
There is no evidence of acute intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territorial infarct. Prominence of the
ventricles and sulci is consistent with atrophy. Periventricular and
subcortical white matter hypodensities are likely sequelae of chronic small
vessel disease. Small 7 mm hypodensity in the right pons suggest prior
infarct. The visualized paranasal sinuses are clear. The mastoid air cells
are clear. No acute fracture is seen.
IMPRESSION:
No acute intracranial process. Lacunar infarct in the right pons. Additional
chronic changes. MRI is more sensitive in detecting acute ischemia.
|
10035780-RR-42 | 10,035,780 | 21,074,018 | RR | 42 | 2132-05-15 10:40:00 | 2132-05-15 14:01:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with transaminitis // ?biliary obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Liver gallbladder ultrasound ___.
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 is prominent
but stable since prior exam measuring 10 mm.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 9.1 cm.
KIDNEYS: The right kidney measures 10.6 cm. The left kidney measures 9.5 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys. A simple cortical cyst is identified in the right kidney measuring
1.6 x 1.4 x 1.7 cm.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Prominent extra hepatic bile duct measuring up to 10 mm without intrahepatic
dilatation. This finding is stable since prior exam however if LFTs suggest
biliary obstruction further evaluation with MRCP could be obtained.
|
10035780-RR-45 | 10,035,780 | 28,030,709 | RR | 45 | 2132-11-23 09:43:00 | 2132-11-23 10:26:00 | EXAMINATION: CT HEAD W/O CONTRAST.
INDICATION: History: ___ with s/p fall with head strike and significant
laceration with bleeding // ?ICH ?fractures.
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, 17.0 cm; CTDIvol = 47.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head without contrast dated ___.
FINDINGS:
Skin staples are seen overlying a small right frontoparietal scalp hematoma.
There is no evidence of underlying fracture.
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. Extensive subcortical, deep, and periventricular white matter
hypodensities are nonspecific, but likely represent the sequela of chronic
microvascular ischemic disease. There is prominence of the ventricles and
sulci suggestive of involutional changes. Dense vascular atherosclerotic
calcifications appear unchanged, involving the basilar artery, vertebral
arteries, and bilateral carotid siphons.
A mucous retention cyst is seen within the right maxillary sinus. Otherwise,
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:
Skin staples overlying a small right frontoparietal scalp hematoma without
evidence of underlying fracture or intracranial hemorrhage.
|
10035780-RR-46 | 10,035,780 | 28,030,709 | RR | 46 | 2132-11-23 09:43:00 | 2132-11-23 10:36:00 | EXAMINATION: CT C-SPINE W/O CONTRAST.
INDICATION: History: ___ with s/p fall with head strike and significant
laceration with bleeding // ?ICH ?fractures ?ICH? fractures.
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 5.8 s, 22.6 cm; CTDIvol = 37.3 mGy (Body) DLP = 842.3
mGy-cm.
Total DLP (Body) = 842 mGy-cm.
COMPARISON: None.
FINDINGS:
Minimal anterolisthesis of C4 on C5 and C7 on T1, likely degenerative in
nature, however there are no priors for comparison. Otherwise, alignment is
normal. No fractures are identified.There is no prevertebral soft tissue
swelling. There is no evidence of infection or neoplasm.
Multilevel mild degenerative disc disease with small posterior intervertebral
osteophytes, but no significant spinal canal stenosis. Moderate right neural
foraminal stenosis is seen at C4-5 predominantly due to a large facet
osteophyte.
The thyroid gland and partially visualized lung apices are within normal
limits. No cervical lymphadenopathy.
IMPRESSION:
1. Minimal anterolisthesis of C4 on C5 and C7 on T1 levels, likely
degenerative in nature, however there are no priors for comparison.
2. No acute fractures.
3. Moderate right neural foraminal stenosis at C4-5.
|
10035780-RR-47 | 10,035,780 | 28,030,709 | RR | 47 | 2132-11-23 09:44:00 | 2132-11-23 11:15:00 | EXAMINATION: CT chest, abdomen, and pelvis with IV contrast.
INDICATION: History: ___ with s/p fall with significant chest pain and
tenderness // ?rib fractures ?pneumothorax
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 508 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Atherosclerotic calcifications noted of the aortic
arch, at the origin of the head and neck vessels, and of the coronary
arteries. Mild calcifications of the aortic annulus. The thoracic aorta is
normal in caliber without evidence of acute injury. The heart, pericardium,
and great vessels are within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Multiple enlarged mediastinal lymph nodes are
demonstrated. Right peritracheal measuring 12 x 11 mm (series 2, image 17).
Left peritracheal lymph node conglomerate measuring 2.9 x 1.5 cm (series 2,
image 28). Right precarinal measuring 10 x 8 mm. (series 2, image 30). Left
hilus measuring 1.5 x 1.0 cm (series 2, image 41). No axillary
lymphadenopathy. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Partially calcified pleural parenchymal scarring is seen
within the right upper lobe. Mild dependent atelectasis bilaterally. No
focal consolidations. 5 mm solid nodular opacity within the left lower lobe
(series 2, image 39) likely represents atelectasis. The airways are patent to
the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates slightly heterogeneous attenuation
without evidence of focal lesions. There is no evidence of laceration. There
is no evidence of intrahepatic biliary dilatation. The gallbladder is
surgically absent. The common bile duct is prominent, likely due to
postcholecystectomy state.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions. Mild pancreatic ductal dilatation, unchanged, likely due to
prior pancreatitis. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There are numerous hypodensities within the kidneys bilaterally, some
of which are consistent with simple cysts, others are too small to
characterize. Otherwise, the kidneys are of normal and symmetric size with
normal nephrogram. There is no evidence of solid renal lesions or
hydronephrosis. Mild perinephric stranding bilaterally is within normal
limits for patient of this age.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is moderate
wall thickening and mild fat stranding surrounding an approximately 9 cm
segment of proximal transverse colon (series 2, image 121), likely
representing segmental colitis. There is no nodularity to the colonic wall
thickening to suggest a neoplasm. Portions of the ascending and descending
colon are collapsed. The large bowel enhances normally. The appendix is
normal. There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The bladder is decompressed and cannot be adequately evaluated on this
examination. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is a large gastrohepatic lymph node conglomerate with
cystic components measuring 2.7 x 1.4 cm (series 2, images 94). There is an
additional large portacaval lymph node conglomerate measuring 3.5 x 2.0 cm.
There are multiple subcentimeter periaortic retroperitoneal lymph nodes, the
largest at the level of the renal veins measuring 11 x 7 mm. There is no
pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Moderate atherosclerotic disease is noted.
BONES: Grade 1 anterolisthesis of L4 on L5, unchanged. There is no acute
fracture. Multiple chronic anterior rib fractures are seen. No focal
suspicious osseous abnormality.
SOFT TISSUES: Tiny fat containing umbilical hernia. Injection granulomas are
seen overlying the gluteal muscles bilaterally. Otherwise, the abdominal and
pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of traumatic injury within the chest, abdomen or pelvis.
2. Numerous enlarged mediastinal lymph nodes and gastrohepatic and portacaval
lymph node conglomerate measuring up to 3.5 x 2.0 cm with possibly cystic
components, suspicious for malignancy, although a definite primary is not
visualized on this examination. Lymphoma is a consideration.
3. Focal segment of proximal transverse colon demonstrating wall thickening
and surrounding fat stranding, which likely represents segmental colitis. No
nodularity to suggest an underlying primary malignancy.
4. Grade 1 anterolisthesis of L4 on L5, unchanged.
|
10035780-RR-48 | 10,035,780 | 28,030,709 | RR | 48 | 2132-11-23 16:27:00 | 2132-11-23 19:06:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: C4-C5 anterolisthesis with neck pain status post fall. Assess
for posterior ligamentous damage.
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.
COMPARISON: CT cervical spine ___
FINDINGS:
There is 1-2 mm anterolisthesis at C4-C5 and C7-T1 levels. Otherwise, the
alignment of the cervical spine is maintained. The vertebral body heights and
disc spaces are preserved. There is no suspicious marrow replacing lesion.
There is no evidence of ligamentous injury.
C2-C3: No spinal canal or neural foraminal narrowing.
C3-C4: There is a central disc protrusion with suggestion of annular fissure,
resulting in mild spinal canal stenosis without spinal cord deformity or cord
compression. There is no neural foraminal narrowing.
C4-C5: There is a central disc protrusion with bilateral facet and
uncovertebral joint hypertrophy resulting in mild spinal canal stenosis
without spinal cord deformity. There is mild bilateral neural foraminal
narrowing.
C5-C6: There is a central disc protrusion combined with ligamentum flavum
thickening and bilateral facet and uncovertebral joint hypertrophy, resulting
in mild spinal canal stenosis, mild bilateral neural foraminal narrowing.
C6-C7: There is a mild central disc protrusion with ligamentum flavum
thickening, bilateral facet and uncovertebral joint hypertrophy, without
significant spinal canal or neural foraminal narrowing.
C7-T1: There is mild facet and ligamentum flavum thickening without spinal
canal or neural foraminal narrowing.
IMPRESSION:
1. Grade 1 spondylolisthesis without evidence of ligamentous injury.
2. Mild multilevel degenerative changes of the cervical spine, as detailed
above.
3. No evidence of bony or ligamentous injury.
|
10035780-RR-50 | 10,035,780 | 28,030,709 | RR | 50 | 2132-12-10 08:28:00 | 2132-12-10 09:05:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with medistinal lymphadenopathy s/p
mediastinoscopy on ___ now with chest pain, dyspnea, and cough // eval
mediastinum for mediastinoscopy complications, eval PNA eval mediastinum
for mediastinoscopy complications, eval PNA
IMPRESSION:
In comparison with the scout radiograph from the CT of ___, there is
little overall change. Prominence of these hilar and mediastinal regions are
concerning for underlying malignancy.
Following mediastinoscopy, there is no evidence of pneumothorax or
pneumomediastinum.
|
10035780-RR-51 | 10,035,780 | 28,030,709 | RR | 51 | 2132-12-12 15:55:00 | 2132-12-12 16:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with mediastinal lymphadenopathy, w/u pending,
now w/increased cough and low grade temperatures // evaluate PNA
TECHNIQUE: Chest single view
COMPARISON: ___ 08:31 shallow inspiration accentuates heart
size, pulmonary vascularity, similar. Tortuous, ectatic thoracic aorta, with
aortic wall calcifications, stable since prior. Stable appearance of
mediastinum and hila. Suggestion trace pleural effusions, more prominent
since prior. Minimal left basilar opacity, likely atelectasis in the setting
of shallow inspiration. No pneumothorax. Stable right apical pleural
thickening. Surgical clips right upper quadrant. Vascular stent is partially
seen the wall proximal left upper extremity.
FINDINGS:
Trace pleural effusions. Mild left basilar opacity, likely atelectasis in the
setting of shallow inspiration.
|
10035780-RR-53 | 10,035,780 | 27,291,894 | RR | 53 | 2133-01-31 01:25:00 | 2133-01-31 03:22:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with HA, hypotension, abd pain // PNA? bleed?
intraabd abscess?
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, 16.1 cm; CTDIvol = 50.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Confluent
white matter hypodensities are nonspecific, but likely represent the sequela
of chronic microvascular ischemic disease. There is prominence of the
ventricles and sulci in an atrophic pattern. There is calcification of the
cavernous carotid arteries and the intracranial vertebral arteries
bilaterally.
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:
Chronic findings as noted above. No evidence of mass, hemorrhage or
infarction.
|
10035780-RR-54 | 10,035,780 | 27,291,894 | RR | 54 | 2133-01-31 01:25:00 | 2133-01-31 03:38:00 | EXAMINATION: CT chest abdomen pelvis without IV contrast.
INDICATION: ___ with HA, hypotension, abd pain. PNA? bleed? intraabd
abscess?
TECHNIQUE: Contiguous axial images were obtained through the chest, abdomen
and pelvis without intravenous contrast. Coronal and sagittal reformats were
performed.
DOSE: Total DLP (Body) = 801 mGy-cm.
COMPARISON: CT torso dated ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Moderate atherosclerotic calcifications of the aortic
arch, at the origin of the head and neck vessels, and the coronary arteries.
Mild calcifications of the aortic annulus. The thoracic aorta is normal in
caliber without evidence of acute injury based on an unenhanced scan. The
heart, pericardium, and great vessels are within normal limits. No pericardial
effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes,
some of which appear calcified, unchanged compared to ___. No
axillary lymphadenopathy.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Dependent atelectasis bilaterally. No focal consolidations.
Calcified granuloma and scarring within the right upper lobe. The airways are
patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration within the limitation of an
unenhanced scan.There is no perihepatic free fluid. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration within the limitation of an unenhanced
scan. Calcification at the splenic hilum likely represents a splenic artery
aneurysm measuring up to 11 mm (series 2, image 50). Multiple splenic
granulomas.
ADRENALS: The right adrenal gland is normal in size and shape. There is
diffuse thickening of the left adrenal gland without focal nodularity,
unchanged.
URINARY: A 1.8 cm simple cyst is seen with the lower pole of the right kidney.
Additional hypodensities within the kidneys bilaterally are too small to
characterize, but also likely represent simple cysts. 2 hyperdense slightly
exophytic subcentimeter lesions within the right kidney (series 2, image 71,
72) may represent hyperdense cysts. There is a punctate calcification within
the upper pole of the right kidney is likely vascular in nature (series 2,
image 63). Otherwise, the kidneys are of normal and symmetric size. There is
no evidence of hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber. The colon and rectum are within normal limits. The appendix
is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis. Numerous phleboliths are visualized.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: Known porta hepatis lymph nodes are grossly unchanged in size
measuring up to 1.4 cm in short axis (series 2, image 57, 58). There is no
new retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or
inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Moderate atherosclerotic disease is noted.
BONES: There are bilateral chronic appearing rib fractures. Grade 1
anterolisthesis of L4 on L5, unchanged. There is no acute fracture. No focal
suspicious osseous abnormality.
SOFT TISSUES: Injection granulomas overlying the gluteal muscles bilaterally.
Focal fat stranding overlying the right gluteal muscle (series 2, image 112).
The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No acute abnormality within the chest, abdomen, or pelvis.
2. Stable lymphadenopathy of mediastinal and porta hepatis lymph nodes remains
unclear in etiology.
|
10035780-RR-57 | 10,035,780 | 23,172,477 | RR | 57 | 2135-07-15 11:43:00 | 2135-07-15 12:49:00 | INDICATION: ___ year old woman with left forearm AV graft loop with question
of thrombosis// Left forearm AV graft loop with question of thrombosis .
Need for urgent dialysis.
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and Dr.
___ fellow performed the procedure. Dr. ___
___ supervised the trainee during any key components of the procedure
where applicable and reviewed and agrees with the findings as reported below.
ANESTHESIA: None.
MEDICATIONS: None.
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: 0.8 minutes, 3 mGy
PROCEDURE: PROCEDURE DETAILS: Due to the need for urgent dialysis, emergent
temporary dialysis Catheter was placed. The procedure was deemed a medical
necessity for patient care. The patient was unable to give consented and
despite extensive efforts to reach the ___ medical proxy and family
members over the past several days, no written consents was obtained.
Based on the emergent need for the procedure, the patient was then brought to
the angiography suite and placed supine on the exam table. A pre-procedure
time-out was performed per ___ protocol. The neck was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath.
The Nitinol wire was removed and a short Amplatz wire was advanced into the
IVC. After sequential dilation of the soft tissue tract a triple lumen
dialysis catheter was advanced over the wire into the superior vena cava with
the tip in the distal SVC. Both access ports were aspirated, flushed and
capped. The catheter was secured to the skin with a 0 silk suture and sterile
dressings were applied. Final spot fluoroscopic image demonstrating good
alignment of the catheter and no kinking.
The patient tolerated the procedure well without immediate complications.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing the
catheter tip terminating in the distal superior vena cava.
IMPRESSION:
Successful placement of a right internal jugular approach triple lumen
temporary dialysis catheter. The line is ready to use.
|
10035780-RR-58 | 10,035,780 | 23,172,477 | RR | 58 | 2135-07-17 12:35:00 | 2135-07-18 11:33:00 | INDICATION: ___ year old woman with ESRD here with clotted fistula// for
thrombectomy
COMPARISON: Graftogram ___
TECHNIQUE: OPERATORS: Dr. ___, attending Interventional
Radiologist performed the procedure.
ANESTHESIA: MAC was provided with anesthesia. 1% lidocaine was injected in
the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 5000 units heparin, 6 mg tPA
CONTRAST: 50 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 40 min, 18 mGy
PROCEDURE:
1. Left upper extremity formed loop graft fistulagram.
2. Axillary, subclavian and super vena cava venography.
3. Chemical and mechanical thrombolysis of the thrombosed graft and outflow
vein using an 8 mm balloon and the Angiojet device.
4. Balloon angioplasty of the intragraft and outflow vein stenoses.
5. ___ balloon pull through of the arterial inflow.
6. Extension of the existing arterial limb stent utilizing an 8 mm x 50 mm
Viabahn stent.
PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the left upper
extremity abducted and stabilized.
Clinical examination demonstrated a palpable, but completely thrombosed graft
in the left extremity. Further evaluation by targeted ultrasound demonstrated
a completely thrombosed graft extending into the outflow vein. The left upper
extremity was prepped and draped in the usual sterile fashion. A preprocedure
timeout and huddle was performed as per ___ protocol.
Using ultrasound and fluoroscopy, the arterial inflow and outflow stent levels
were identified. Antegrade (directed towards the venous outflow) access into
the thrombosed graft was obtained under continuous ultrasound guidance using a
21 G micropuncture needle. Permanent ultrasound images were saved. An 0.018
wire was then advanced easily into the outflow vein under fluoroscopic
guidance. A 4.5F micropuncture sheath was advanced and used to exchange for an
0.035 Glidewire. The glide wire was advanced to the level of the subclavian
vein. A short 6 ___ sheath was placed over the wire. A ___ Kumpe catheter
was then advanced over the wire and slowly withdrawn while injecting dilute
contrast to establish the distal extent of thrombus into the outflow vein. 6
mg of tPA was then laced throughout the thrombus extending from the venous
outflow the stent to the antegrade access in the arterial limb of the loop
graft and allowed to dwell. Following, an exchange length stiffglide wire was
advanced via the Kumpe into the IVC for stability.
Retrograde access directed towards the arterial inflow was then obtained in a
similar fashion using continuous ultrasound and intermittent fluoroscopic
guidance. Permanent ultrasound images were saved. At this point 3000 IU of
heparin was administered systemically.
At this point, it was noted that the distal aspect of the arterial limb stent
was kinked. The antegrade wire was retracted and ___ was advanced through
the sheath and used to cross with the assistance of a Kumpe catheter through
the stent confirming intraluminal position. The ___ wire was then advanced
through the retrograde sheath and used across the stent confirming
intraluminal position. The ___ wire was then exchanged for a Glidewire via
the Kumpe catheter and was positioned within the brachial artery.
An 8 mm balloon was advanced over the antegrade access wire and angioplasty
was performed throughout the loop graft and venous outflow tract. A 5.5
___ ___ balloon was advanced over the retrograde access wire but was
unable to pass within the proximal loop graft. Balloon plasty through the
antegrade access followed by the retrograde access was performed of the
proximal aspect of the loop graft. The 5.5 ___ ___ balloon was then
advanced beyond the arterial anastomosis, partially inflated and pulled back
was performed through the arterial anastomosis into the graft. This resulted
in restoration of flow and a faint thrill in the graft. Repeat 8 mm balloon
plasty was performed throughout the graft and venous outflow. The Angiojet
was then advanced over the wire and used in thrombectomy mode in an antegrade
and retrograde direction.
Fistulogram was performed demonstrating restoration of flow throughout the
graft with significant clot at the distal aspect of the arterial limb stent.
A reflux fistulogram was performed demonstrating satisfactory appearance of
anastomosis. The exchange length stiff glide wire was exchanged the a Kumpe
catheter for a 200 cm V18 wire. An 8 mm x 50 mm Viabahn stent was advanced
over the wire and deployed overlapping the distal aspect of the arterial limb
stent.
A completion fistulagram was performed from the proximal brachial artery
demonstrating brisk flow throughout the entire graft with no significant
residual stenosis. A small pseudoaneurysm was noted at the antegrade access
site and the arterial limb as well as irregularity at the loop graft
cannulation site of the venous limb. Clinical examination revealed a
satisfactory thrill along the length of the graft.
The sheaths were removed and hemostasis was achieved with two 0-silk
pursestring sutures. Subsequent swelling at the antegrade access site was
noted. Evaluation by ultrasound demonstrated a moderate pseudoaneurysm at the
access site. Approximately ___ minutes of pressure was held and post
pressure ultrasound demonstrated near complete thrombosis of the
pseudoaneurysm and no additional bleeding at the antegrade access site.
The patient was transferred to PACU. Ultrasound examination postprocedure
demonstrated thrombosis of the pseudoaneurysm. Radial and ulnar pulses were
intact. Frequent monitoring of the left upper extremity will be performed
overnight.
FINDINGS:
1. Complete thrombosis of the left upper extremity AV graft to the level of
the outflow vein.
2. Outflow vein stenosis at the distal aspect of the stent with improvement to
approximately 20% following angioplasty to 8 mm.
3. Extension/re-lining of the arterial limb stent with an 8 mm x 50 mm Viabahn
stent.
4. Satisfactory appearance of the arterial anastomosis. No central venous
stenosis.
5. Post procedure pseudoaneurysm at the antegrade access site with resolution
following ___ minutes of manual pressure. Follow-up ultrasound to be
performed in the a.m. to confirm resolution.
IMPRESSION:
Satisfactory restoration of flow following chemical and mechanical
thrombolysis with a good angiographic and clinical result.
|
10035780-RR-59 | 10,035,780 | 23,172,477 | RR | 59 | 2135-07-18 16:02:00 | 2135-07-18 17:08:00 | EXAMINATION: ART DUP EXT UP UNI OR LMTD LEFT
INDICATION: ___ year old woman with AV fistula in the left arm with clot now
s/p opening with ___, eval for pseudoaneurysm// eval for pseudoaneurysm at the
antegrade access
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left arm.
COMPARISON: None
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left arm. In the antecubital fossa just medial to the medial stitch there is
a small vascular structure which measures 0.6 x 0.6 x 0.4 cm. This structure
is immediately anterior to the AV fistula and has the sonographic appearance
of pseudoaneurysm. Arterial vascular flow is seen within this structure.
IMPRESSION:
Small pseudoaneurysm immediately anterior to the AV fistula in the left
antecubital fossa.
|
10035844-RR-4 | 10,035,844 | 27,129,365 | RR | 4 | 2143-08-15 15:36:00 | 2143-08-15 16:04:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with AMS // PNA?
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: None.
FINDINGS:
Cardiac silhouette size is normal. Mediastinal and hilar contours are
unremarkable. Pulmonary vasculature is normal. Lung volumes are low with
mild atelectasis in the lung bases. No pleural effusion or pneumothorax. No
acute osseous abnormalities. Multiple clips are seen in the right upper
quadrant of the upper abdomen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10035844-RR-5 | 10,035,844 | 27,129,365 | RR | 5 | 2143-08-15 16:53:00 | 2143-08-15 17:29:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with right hemiparalysis // LVO?
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 6.0 s, 6.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
301.0 mGy-cm.
3) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.9 mGy (Body) DLP =
12.5 mGy-cm.
4) Spiral Acquisition 5.1 s, 40.4 cm; CTDIvol = 15.2 mGy (Body) DLP = 615.2
mGy-cm.
Total DLP (Body) = 628 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: Carotid ultrasound dated ___
MRI brain dated ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Images are degraded by extensive motion artifact. Within these confines:
There is no definite evidence of acute territorial
infarction,hemorrhage,edema,ormass. There is prominence of the ventricles and
sulci suggestive of involutional changes. Periventricular and subcortical
hypodensities are nonspecific but compatible with chronic small vessel
ischemic changes.
There are mild ethmoid sinus mucosal inflammatory changes. Otherwise, the
visualized portion of the paranasal sinuses, mastoid air cells,and middle ear
cavities are clear. The visualized portion of the orbits are normal.
CTA HEAD:
There are atherosclerotic calcifications at the bilateral carotid siphons
without stenosis. The vessels of the circle of ___ and their principal
intracranial branches appear normal without stenosis, occlusion, or aneurysm.
The dural venous sinuses are patent.
CTA NECK:
There are mild calcifications of the aortic arch. The bilateral carotid and
vertebral artery origins are patent.
There is motion artifact at the level of the carotid bifurcations, limiting
evaluation. Linear filling defect within the proximal right internal carotid
artery (3:157), may reflect artifact related to patient motion. There is no
significant stenosis of the right internal carotid artery by NASCET criteria.
There is moderate calcified plaque formation at the left carotid bifurcation
with approximately 20% stenosis of the left proximal internal carotid artery
by NASCET criteria.
Otherwise, the carotidandvertebral arteries and their major branches appear
normal with no evidence of stenosis or occlusion.
OTHER:
Evaluation of the visualized lungs is limited by motion artifact, although no
significant pulmonary abnormality is appreciated. The thyroid gland appears
small but otherwise unremarkable. There is no lymphadenopathy by CT size
criteria. There are multilevel degenerative changes within the visualized
spine.
IMPRESSION:
1. Head CT: Images degraded by motion artifact. Within this confine: No
definite acute territorial infarct, intracranial hemorrhage, mass or mass
effect.
2. Head CTA: Patent circle of ___ without evidence of stenosis,occlusion,or
aneurysm. Mild atherosclerotic calcifications of the bilateral carotid
siphons.
3. Neck CTA: Images degraded by motion artifact. Within these confines:
Linear filling defect within the proximal right internal carotid artery
(3:157) is felt to reflect artifact related to patient motion. There is
approximately 20% stenosis of the left proximal internal carotid artery by
NASCET criteria. Otherwise, patent bilateral cervical carotid and vertebral
arteries without evidence of stenosis, occlusion,or dissection.
|
10035844-RR-6 | 10,035,844 | 27,129,365 | RR | 6 | 2143-08-16 19:14:00 | 2143-08-17 08:30:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman s/p tonic clonic seizure // Any signs of
watershed infarcts or stokes
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Head CT and CTA dated ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are globally prominent reflecting
involutional changes. There are mild scattered T2/FLAIR hyperintensities in
the subcortical and periventricular white matter which are nonspecific but
likely reflect chronic small vessel disease in this age group.
The major intracranial vascular flow voids are preserved. Orbits and
visualized extracranial soft tissues are unremarkable. There is mild mucosal
thickening in the ethmoid air cells.
IMPRESSION:
1. No acute intracranial abnormality. No evidence of acute or subacute
infarct.
2. Mild nonspecific white matter signal changes most likely reflecting chronic
small vessel disease in this age group
|
10035844-RR-7 | 10,035,844 | 27,129,365 | RR | 7 | 2143-08-17 12:29:00 | 2143-08-17 12:53:00 | EXAMINATION: Carotid Artery ultrasound
INDICATION: ___ year old woman with tonic-clonic seizure // stenosis
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: None
FINDINGS:
RIGHT:
There is mild heterogenous atherosclerotic plaque in the right carotid artery.
Segment: PSV (cm/s) / EDV (cm/s)
----------------------------------------------
CCA ___: 86.1 cm/s / 11.7 cm/s
CCA Distal: 66.1 cm/s / 11 cm/s
ICA ___: 71.3 cm/s / 10.3 cm/s
ICA Mid: 67.3 cm/s / 13.5 cm/s
ICA Distal: 83.2 cm/s / 18.2 cm/s
ECA: 123 cm/s
Vertebral: 70 cm/s
ICA/CCA Ratio: 1.26
The right vertebral artery flow is antegrade with a normal spectral waveform.
LEFT:
There is mild heterogenous atherosclerotic plaque in the left carotid artery.
Segment: PSV (cm/s) / EDV (cm/s)
----------------------------------------------
CCA ___: 98.7 cm/s / 14.7 cm/s
CCA Distal: 81.3 cm/s / 13.3 cm/s
ICA ___: 65.8 cm/s / 10.7 cm/s
ICA Mid: 64 cm/s / 16.2 cm/s
ICA Distal: 71 cm/s / 14 cm/s
ECA: 89.9 cm/s
Vertebral: 45.6 cm/s
ICA/CCA Ratio: 0.87
The left vertebral artery flow is antegrade with a normal spectral waveform.
IMPRESSION:
Right ICA <40% stenosis.
Left ICA <40% stenosis.
|
10036086-RR-102 | 10,036,086 | 25,086,233 | RR | 102 | 2206-01-25 13:28:00 | 2206-01-25 15:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with SOB// eval for PNA
TECHNIQUE: AP view of the chest
COMPARISON: Chest radiograph from ___, ___, ___
FINDINGS:
Lungs appear hypoinflated with lower lobe volume loss and bronchovascular
crowding. There is no definite focal consolidation. No evidence of pulmonary
edema, pneumothorax, or large pleural effusion. The cardiac size is
accentuated by low lung volumes, but likely at least mildly enlarged.
IMPRESSION:
Hypoinflated lungs with lower lobe volume loss. No definite evidence of
pneumonia.
|
10036086-RR-103 | 10,036,086 | 25,086,233 | RR | 103 | 2206-01-25 13:33:00 | 2206-01-25 15:13:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with RLE swelling// eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. There is loss of normal color
flow and compressibility with nonocclusive echogenic material in a posterior
tibial vein, compatible with deep vein thrombus. Normal color flow and
compressibility are demonstrated in the right peroneal veins and in the other
posterior tibial vein.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Non-occlusive deep vein thrombus of one right posterior tibial vein.
|
10036086-RR-104 | 10,036,086 | 25,086,233 | RR | 104 | 2206-01-25 16:20:00 | 2206-01-25 17:02:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with dyspnea and tachycardia// eval for pe
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.4 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
3) Spiral Acquisition 3.4 s, 27.1 cm; CTDIvol = 26.9 mGy (Body) DLP = 729.0
mGy-cm.
Total DLP (Body) = 741 mGy-cm.
COMPARISON: CT torso dated ___.
FINDINGS:
HEART AND VASCULATURE: There are pulmonary emboli extending from the distal
right main pulmonary artery to lobar to segmental pulmonary arteries in the
right upper and middle lobes and to lobar to subsegmental pulmonary arteries
in the right lower lobe. The main pulmonary artery and left pulmonary
arteries and its branches are patent without filling defect. No evidence of
right heart strain. Some atherosclerotic changes are seen along the aorta, at
the aortic arch. are mild to moderate coronary artery calcifications. No
pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is bilateral lower lung linear subsegmental atelectasis.
Scattered areas of subsegmental atelectasis seen elsewhere, including in the
bilateral upper lobes, right middle lobe, and lingula. No focal
consolidation. An azygos lobe is incidentally noted.
BASE OF NECK: Scattered hypoattenuating nodule in the right thyroid lobe are
noted measuring up to asthma in 7 mm.
ABDOMEN: Limited evaluation of the upper abdomen demonstrate slight nodular
contour of the liver parenchyma. The spleen may be surgically absent.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Degenerative changes of thoracic spine are moderate. Evidence of DISH is seen
along the thoracic spine.
IMPRESSION:
1. Pulmonary emboli extending from the distal right main pulmonary artery to
segmental level in right upper and middle lobes and subsegmental level in
right lower lobe. No left-sided pulmonary emboli. Difficult to exclude right
heart strain. Echocardiogram would further assess.
2. No focal consolidation.
3. Mild nodular contour of the liver raise concern for cirrhosis.
Correlation with liver function test is recommended for further evaluation.
4. Status post splenectomy.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:53 pm, 2 minutes after
discovery of the findings.
|
10036086-RR-105 | 10,036,086 | 24,186,608 | RR | 105 | 2206-03-06 01:46:00 | 2206-03-06 04:25:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: History: ___ with s/p R IJ placement// ?PTX
COMPARISON: Multiple prior chest radiographs dating back to ___,
most recently ___.
FINDINGS:
AP portable upright view of chest provided.
Lung volumes are low bilaterally. There has been interval placement of a
right chest port with tip overlying the cavoatrial junction. Streaky linear
bibasilar opacities likely represent atelectasis. There is no focal
consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is
likely mildly enlarged although this is likely exaggerated by low lung volumes
and the AP technique. No acute osseous abnormalities are identified.
IMPRESSION:
1. Interval placement of a right chest port with tip overlying the cavoatrial
junction. No pneumothorax.
2. Redemonstration hypoinflated lungs with lower lobe volume loss.
|
10036086-RR-106 | 10,036,086 | 24,186,608 | RR | 106 | 2206-03-06 03:20:00 | 2206-03-06 08:56:00 | INDICATION: ___ year old man with submassive pulmonary embolism.// Place lysis
catheters.
COMPARISON: CTA Chest ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr. ___
Interventional ___ and Dr. ___, Interventional Radiology
fellow performed the procedure. Dr. ___ personally supervised
the trainee during any key components of the procedure where applicable and
reviewed and agrees with the findings as reported below.
ANESTHESIA: Mac sedation was provided by anesthesia.
MEDICATIONS: A total of 8 mg of tPA were infused during the procedure.
CONTRAST: 60 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 21.7 minutes, 1122 mGy
PROCEDURE: 1. Right IJ central venous access under ultrasound guidance.
2. Left pulmonary arteriogram.
3. Left pulmonary artery chemical thrombolysis.
4. Lysis catheter placement in the left lower lobe pulmonary artery.
5. Right pulmonary arteriogram.
6. Right pulmonary artery mechanical and chemical thrombolysis.
7. Repeat right pulmonary arteriogram.
8. Lysis catheter placement in the right lower lobe pulmonary artery.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The neck and both groins were prepped and draped in the usual
sterile fashion.
Preliminary ultrasound images of the right IJ were stored. The overlying skin
was anesthetized with 1% lidocaine solution. A 21 gauge needle was advanced
into the right IJ under ultrasound guidance. A microwire was advanced through
the needle into the SVC. A small skin ___ was made at the needle insertion
site. The needle was exchanged for a micropuncture access sheath. The wire
and inner dilator were removed ___ wire was advanced into the SVC. The
micro sheath was then exchanged for a 6 ___ sheath. The inner dilator and
___ wire were then removed.
A 5 ___ C2 Cobra glide catheter and Glidewire were then advanced through
the sheath and used to navigate into the left pulmonary artery. The wire was
removed. At this point, the catheter was used to measure pulmonary artery
pressures (the left mean pulmonary artery pressure was 51). Contrast was
injected to confirm positioning. A digital was retracted left pulmonary
arteriogram was performed, demonstrating large filling defect in the proximal
pulmonary artery and a paucity of lower lobe pulmonary artery branches. At
this point, the patient's hemodynamic status began to decline. 2 mg of
diluted tPA were injected directly into the proximal thrombus. A ___ wire
was then advanced through the Cobra catheter, which was subsequently exchanged
for a 6 cm EKOS infusion catheter.
A 21 gauge needle was advanced into the right IJ at a separate access site
under ultrasound guidance. A microwire was advanced through the needle into
the SVC. A small skin ___ was made at the needle insertion site. The needle
was exchanged for a micropuncture access sheath. The wire and inner dilator
were removed ___ wire was advanced into the SVC. The micro sheath was
then exchanged for a 6 ___ sheath. The Cobra catheter was advanced through
the new sheath and navigated into the right pulmonary artery with a Glidewire.
Glidewire was removed. Contrast was injected to confirm positioning. A
digitally subtracted right pulmonary arteriogram was performed, demonstrating
proximal thrombus and near complete occlusion of the right lung sparing only 2
segments in the right upper lobe. 2 mg of dilute tPA were infused directly
into the thrombus.
A ___ wire was advanced through the Cobra catheter. The Cobra catheter was
exchanged for a Omni flush catheter. The Omni Flush catheter was used to
perform mechanical thrombectomy as an additional 4 mg of tPA were infused.
The ___ wire was injected advanced through the Omni Flush catheter. The
Omni Flush catheter was then removed. The 6 ___ sheath was exchanged for
an 8 ___ sheath. A penumbra aspiration catheter was advanced over the
___ wire and into the right pulmonary artery. The aspiration catheter was
used for thrombectomy transiently. Shortly after initiation of thrombectomy,
the patient's hemodynamic status significantly improved. The aspiration
catheter was then exchanged over ___ wire for the Omni Flush catheter.
A repeat digitally subtracted right pulmonary arteriogram was performed
demonstrating improved flow the right lung. The ___ wire was then advanced
through the Omni Flush catheter and positioned in the right lung base. The
Omni Flush catheter was then exchanged for a 12 cm EKOS infusion catheter.
Contrast was injected through both EKOS catheters to confirm positioning. The
coast catheters were then assembled unattached to respective devices. Both
sheaths and infusion catheters were secured to the skin with 0 silk suture. A
sterile dressing was applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the ICU in stable
condition.
FINDINGS:
Pulmonary arteriograms demonstrated extensive thrombosis bilaterally.
Local tPA was infused (total of 8 mg).
Post thrombolysis/thrombectomy arteriogram showed improvement in pulmonary
arterial flow.
Successful placement of bilateral pulmonary arterial EKOS lysis catheters.
IMPRESSION:
Successful pulmonary arterial thrombus debulking.
Successful placement of bilateral pulmonary arterial EKOS lysis catheters.
RECOMMENDATION(S): Lysis catheter management orders were placed in POE.
|
10036086-RR-107 | 10,036,086 | 24,186,608 | RR | 107 | 2206-03-06 11:15:00 | 2206-03-07 11:47:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with saddle PE on EKOS protocol, R>L ___ edema//
evidence of DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: ___
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral vein. There is echogenic material within the right distal
femoral vein which is noncompressible without residual flow seen, as well as
in the right popliteal vein, new from prior. Flow is seen within the one of
the right posterior tibial veins, with no flow seen in the other posterior
tibial vein. No flow is seen within the right peroneal veins.
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. There is echogenic material in
one of the left posterior tibial veins and the peroneal veins without residual
flow seen.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Deep vein thrombosis in the right lower extremity extending from the right
distal femoral vein to the calf veins, progressed compared with ___.
2. Deep vein thrombosis in the calf veins in the left lower extremity.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 11:43 am, 10 minutes after
discovery of the findings.
|
10036086-RR-108 | 10,036,086 | 24,186,608 | RR | 108 | 2206-03-08 17:15:00 | 2206-03-09 14:31:00 | INDICATION: ___ year old man with DVT and history of bleeding from
anticoagulation// IVC filter placement
COMPARISON: Lower extremity venous duplex dated ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___,
performed the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: 25 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 4.7, 484 mGy
PROCEDURE:
1. IVC venogram.
2. Infrarenal Denali IVC filter deployment.
3. Post-filter placement venogram.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. the right neck was prepped and draped in the usual sterile fashion.
An Amplatz wire was placed through the existing 8 ___ sheath. The sheath
was removed over the wire and a new 8 ___ sheath was placed. The Amplatz
wire was passed down into the distal IVC and left iliac vein. Over the wire,
a straight flush catheter was placed. A inferior vena cava venogram was
performed. Based on the results of the venogram, detailed below, a decision
was made to place a Denali filter. The catheter and sheath were removed over
the wire and the sheath of a Denali filter was advanced over the wire into the
IVC past the take-off of the renal vessels. An Denali vena cava filter was
advanced over the wire until the cranial tip was at the level of the inferior
margin of the lower renal vein. The sheath was then withdrawn until the filter
was deployed. The wire and loading device were then removed through the sheath
and a repeat contrast injection was performed, confirming appropriate filter
positioning. The final image was stored on PACS.
The sheath was removed and pressure was held for 5 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with single bilateral renal veins
and no evidence of a clot.
2. Successful deployment of an infra-renal Denali IVC filter.
IMPRESSION:
Successful deployment of a Denali IVC filter.
|
10036086-RR-109 | 10,036,086 | 24,186,608 | RR | 109 | 2206-03-13 13:03:00 | 2206-03-13 17:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with gi bleed, s/p over the scope clip deployed
in duodenum// air under the diaphragm?
TECHNIQUE: Chest frontal radiograph
COMPARISON: Multiple prior chest radiographs most recently from ___
FINDINGS:
There is no evidence of pneumoperitoneum, though detection is severely limited
given patient positioning. Lung volumes are low bilaterally. No focal
consolidation is seen. Blunting of the left costophrenic angle is unchanged
and likely secondary to pericardial fat as demonstrated on CT from ___. The right internal jugular central line has been removed.
IMPRESSION:
No evidence of pneumoperitoneum, though detection severely limited by patient
positioning and portable technique.
|
10036086-RR-110 | 10,036,086 | 24,186,608 | RR | 110 | 2206-03-15 12:43:00 | 2206-03-15 21:00:00 | INDICATION: ___ year old man s/p Massive PEs requiring EKOS, patient with
difficult access requiring frequent lab draws// picc needs to be repositioned
per IV nurse
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATOR: Dr. ___ radiology attending)
performed the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: 0 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 1.1 minutes, 5.2 mGy
PROCEDURE: 1. Replacement of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
double lumen PIC line measuring 42 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach PICC with tip in the axillary vein replaced
with a new double lumen PIC line with tip in the distal SVC.
IMPRESSION:
Successful placement of a 42 cm right arm approach double lumen PowerPICC with
tip in the distal SVC. The line is ready to use.
|
10036086-RR-80 | 10,036,086 | 27,288,283 | RR | 80 | 2200-11-08 18:46:00 | 2200-11-08 19:51:00 | HISTORY: History of nephrolithiasis, HIV and prostate cancer. Now with acute
kidney injury, left flank pain and hematuria.
TECHNIQUE: Multi detector CT images through the abdomen and pelvis were
obtained without the administration of IV contrast. Coronal and sagittal
reformatted images were obtained.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS: There is bibasilar atelectasis; otherwise, the lung bases are
clear. There is no pleural or pericardial effusion.
The liver is without focal lesions or intrahepatic biliary duct dilation. The
pancreas and adrenal glands appear normal. The spleen is surgically absent
and there is suture material in the left upper quadrant. There is bilateral
perinephric fat stranding. There are no stones in the kidneys; however, in
the distal portion of the left ureter there is a 4 mm stone. There is
resultant mild left hydronephrosis and mild left hydroureter. There is fat
stranding around the distal portion of the left ureter. The right kidney is
without masses or hydronephrosis.
The stomach appears normal and is filled with contrast. The small and large
bowel appear normal without evidence of wall thickening or obstruction. The
appendix is visualized and right lower quadrant and appears normal. The
bladder appears normal. There are brachytherapy and seeds in the prostate
consistent with the history of prostate cancer. There is a tiny fat
containing umbilical hernia.
The aorta is normal in caliber and contains atherosclerotic calcification at
the takeoff of the celiac artery. There is no free fluid, free air or
lymphadenopathy.
Osseous structures: Mild degenerative changes in the spine are noted. No
concerning osteoblastic or osteolytic lesions are seen.
IMPRESSION:
1. Mild left hydronephrosis and hydroureter secondary to 4 mm obstructing
stone in the distal left ureter.
2. Chronic findings as described above.
|
10036086-RR-83 | 10,036,086 | 27,288,283 | RR | 83 | 2200-11-09 14:05:00 | 2200-11-13 13:45:00 | HISTORY: Ureteral stent placement for left-sided ureteral stone.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
An intraoperative fluoroscopic image was submitted for review. Image shows a
wire within the left ureter and ending in the collecting system. Contrast is
seen filling the left collecting system. For more detail, please refer to the
operative note in OMR.
|
10036086-RR-92 | 10,036,086 | 22,023,413 | RR | 92 | 2203-12-01 17:51:00 | 2203-12-01 18:06:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with leg swelling // ?pulmonary edema
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low. Heart size remains at least mildly enlarged with a left
ventricular predominance. The mediastinal contour is unremarkable. Crowding
of bronchovascular structures is present without pulmonary edema. Elevation
of the right hemidiaphragm is unchanged. Patchy opacities in the lung bases
likely reflect areas of atelectasis. No pleural effusion or pneumothorax is
present. There are mild to moderate degenerative changes noted in the
thoracic spine.
IMPRESSION:
Low lung volumes with patchy bibasilar airspace opacities likely reflective of
atelectasis. No pulmonary edema.
|
10036821-RR-19 | 10,036,821 | 20,948,493 | RR | 19 | 2151-04-23 16:25:00 | 2151-04-23 17:40:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with abd pain, severe. has port in place// r/o free air on
Xrayr. Or intra abdominal process.
TECHNIQUE: Chest PA and lateral
COMPARISON: No previous chest radiographs available for comparison.
FINDINGS:
The trachea is midline. The lungs are expanded without evidence of focal
consolidation. There is no pleural effusion. The cardiomediastinal
silhouette is normal. There is no pneumothorax. Right-sided Port-A-Cath
terminating in the mid SVC. No evidence of subdiaphragmatic free air.
IMPRESSION:
No evidence of acute thoracic process. No free subdiaphragmatic free air.
|
10036821-RR-20 | 10,036,821 | 20,948,493 | RR | 20 | 2151-04-23 17:15:00 | 2151-04-23 18:33:00 | INDICATION: NO_PO contrast; History: ___ with abd pain, severe. has port in
placeNO_PO contrast// r/o free air on Xrayr.o intra abdominal proicess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 6.6 s, 51.6 cm; CTDIvol = 11.2 mGy (Body) DLP = 575.1
mGy-cm.
Total DLP (Body) = 587 mGy-cm.
COMPARISON: Outside CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of concerning lesions. 4 mm hypodensity in the left lobe
is unchanged since ___ when measured similarly, too small to
characterize. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. Portal vein is patent. 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 focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The gastric mucosa is not well evaluated on CT. Small bowel
loops demonstrate normal caliber, wall thickness, and enhancement throughout.
No bowel obstruction. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are
unremarkable.
LYMPH NODES: Gastrohepatic lymph node measuring 1.3 cm in short axis (02:16)
measured 1.6 cm on ___. 2 cm upper abdominal lymph node (02:20) is
unchanged since ___. 1.6 cm upper abdominal necrotic lymph node
(02:23) was not necrotic on ___. 1 cm anterior perigastric lymph
node (02:22) previously measured 1.4 cm. Haziness of the left omentum is
similar to ___. There is no retroperitoneal lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No pneumoperitoneum.
2. Upper abdominal lymphadenopathy is again seen, with some unchanged in size,
some with interval decrease in size, and interval development of central
necrosis in 1 lymph node. Haziness of the left omentum is again seen.
|
10036821-RR-38 | 10,036,821 | 26,439,594 | RR | 38 | 2151-10-08 04:10:00 | 2151-10-08 05:14:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: +PO contrast; History: ___ with recent gastric ca surgery, here w
significant abd pain. see ED ___ for summary of recent surgical course// +PO
contrast. acute process? Please ensure that the CT abdomen pelvis extends
cranially enough to image the esophago-jejunal anastomosis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
2) Spiral Acquisition 6.8 s, 53.6 cm; CTDIvol = 11.9 mGy (Body) DLP = 636.6
mGy-cm.
Total DLP (Body) = 644 mGy-cm.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: Trace left pleural effusions is decreased in size from prior
exam. There is bibasilar atelectasis. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Subcentimeter hypodensities in segment 7 and segment 2 are too small to
characterize, but likely represent simple cysts or biliary hamartomas. There
is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: Evaluation of the pancreatic head is slightly limited secondary to
extensive streak artifact from contrast in the right colon. Within this
limitation, pancreas is unremarkable. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Status post gastrectomy with esophagojejunal anastomosis as
well as jejunojejunal anastomosis. A previously seen subdiaphragmatic fluid
collection in the region of the esophagojejunostomy anastomosis is no longer
seen. Small bowel loops demonstrate normal caliber, wall thickness, and
enhancement throughout. Jejunostomy tube is noted. The colon and rectum are
within normal limits. The appendix is not visualized. Enteric contrast extends
at least to the level of the transverse colon. Small amount of contrast seen
in the rectum may be from recent upper GI exam. No extraluminal contrast is
seen. A surgical drain approaching from the right lower quadrant terminates
along the spleen, unchanged.
PELVIS: Bladder is distended, but is otherwise unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: There is marked prostatomegaly. Seminal vesicles are
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Right lower quadrant approach surgical chain and jejunostomy
tubes are noted as above. Small foci of subcutaneous gas in the lower
quadrants bilaterally are likely related to injections.
IMPRESSION:
1. Evaluation of the upper abdomen is slightly limited by extensive streak
artifact from dense contrast opacification of the right colon. Within this
limitation, no acute intra-abdominal process. Oral contrast extends at least
to the level of the transverse colon without evidence of extraluminal
contrast. No bowel obstruction.
2. Interval resolution of previously seen left subdiaphragmatic fluid
collection adjacent to the esophageal jejunal anastomosis.
3. Decreased size of now trace left pleural effusion.
4. Marked prostatomegaly.
|
10036821-RR-39 | 10,036,821 | 26,439,594 | RR | 39 | 2151-10-09 09:46:00 | 2151-10-09 20:23:00 | EXAMINATION: Fluoroscopy guided drain manipulation.
INDICATION: ___ T3N2M0 gastric cancer s/p neoadj chemoRx, robotic total
gastrectomy, roux-en-y esophagojejunostomy (___) c/b EJ abscess p/w abd
pain// requesting repositioning of drain; based on CT from ___, CT from
___ and UGIS from ___ requesting drain be moved back to sit along right
side of anastomosis (currently all the way across to LUQ), by our measurements
would require moving back 10cm, d/w Dr. ___
___: CT of the abdomen and pelvis from ___.
PROCEDURE: Repositioning of surgical drain under fluoroscopy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: Reposition of surgical drain under fluoroscopic guidance.
DOSE: Skin: 19 mGy
DAP: 423.0 mGy2
Time: 3:28
SEDATION: None
FINDINGS:
The risks, benefits, and alternatives of the procedure were explained to the
patient. After a detailed discussion, informed written consent was obtained.
The patient was placed in a supine position on the fluoroscopy table. A spot
view was obtained to localize the surgical drain. After the surgical drain was
identified the ___ bulb was disconnected from the drain and under
intermittent fluoroscopic guidance, a guidewire was inserted into the tube and
advanced to the distal end. The suture loop locking the drain in place to the
skin was removed, leaving the purse-string suture in the skin intact. Under
fluoroscopy the tube was retracted approximately 10 cm, with the tip sitting
at the targeted location adjacent to the esophago-jejunal anastomosis.
The guidewire was then removed and the surgical drain was secured to the
existing purse-string suture. The ___ bulb was attached to the
drain. Sterile occlusive dressing was then applied at the entry point of the
drain followed by 4 x 4 gauze and tape.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
IMPRESSION:
Successful fluoroscopy guided reposition of surgical drain with tip now
adjacent to the esophago-jejunal anastomosis.
|
10036942-RR-17 | 10,036,942 | 23,803,237 | RR | 17 | 2174-09-08 16:21:00 | 2174-09-08 16:43:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with fall, AMS, chest pain // Eval acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
No focal consolidation, pleural effusion, or evidence of pneumothorax is seen.
Cardiac silhouette is borderline in size. Mediastinal contours are
unremarkable. No displaced fracture is seen.
IMPRESSION:
Borderline cardiac silhouette size, likely accentuated by AP technique.
Otherwise, no definite acute intrathoracic process.
|
10036942-RR-18 | 10,036,942 | 23,803,237 | RR | 18 | 2174-09-08 17:03:00 | 2174-09-08 20:12:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall, AMS, chest pain // Eval acute process
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: Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of fracture, acute major infarction,hemorrhage,edema,or
discrete mass. The ventricles and sulci are normal in size and configuration.
There is a tiny mucous retention cyst in the right maxillary sinus. The
visualized portion of the other paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The visualized portion of the orbits are
normal. There is congenital nonunion of the anterior and posterior arches of
C1.
IMPRESSION:
No acute intracranial process or fracture.
|
10036942-RR-19 | 10,036,942 | 23,803,237 | RR | 19 | 2174-09-10 16:47:00 | 2174-09-10 18:00:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man with IVDU and GPC bacteremia with concern for
endocarditis. Significant point tenderness on left costochondrol joint. //
evidence of infective costochondritis vs abscess vs fracture
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and axial maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.6 s, 40.7 cm; CTDIvol = 8.4 mGy (Body) DLP = 343.0
mGy-cm.
Total DLP (Body) = 343 mGy-cm.
COMPARISON: ___ chest radiographs
FINDINGS:
HEART AND VASCULATURE: Heart size is normal. No pericardial effusion. The
thoracic aorta is normal in caliber. No evidence of dissection or penetrating
atherosclerotic ulcer formation. A no appreciable atherosclerosis.
Incidental calcified ductus arteriosus remnant. The main pulmonary artery is
normal in caliber. No central filling defect.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally. There is minimal bronchial wall thickening suggesting
inflammation.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Possible minimal bronchial inflammation. The lungs are otherwise clear.
2. No evidence of rib fracture or other osseous or soft tissue abnormality.
|
10037598-RR-18 | 10,037,598 | 24,022,026 | RR | 18 | 2162-03-14 09:55:00 | 2162-03-14 11:06:00 | INDICATION: ___ male with shortness of breath and history of
congestive heart failure. Evaluate.
COMPARISON: None.
TECHNIQUE: Frontal AP and lateral chest radiograph.
FINDINGS: There is bilateral hilar engorgement and prominence of the central
pulmonary vessels. Mild-to-moderate cardiomegaly is also present. There is
no pleural effusion or pneumothorax.
IMPRESSION: Findings compatible with pulmonary edema in the setting of
mild-to-moderate cardiomegaly.
|
10037598-RR-19 | 10,037,598 | 24,022,026 | RR | 19 | 2162-03-14 09:56:00 | 2162-03-14 11:07:00 | INDICATION: ___ male with right knee pain. Evaluate for evidence of
fracture or any other injury.
COMPARISON: None.
TECHNIQUE: Right knee, three views.
FINDINGS: The sunrise view is suboptimal as the full patella and
patellofemoral joint is not included. Given this, there is no evidence of
acute fracture or dislocation. Moderate degenerative changes are noted, with
tricompartmental osteophytes, loss of joint height, more pronounced in the
medial compartment. There may be a small suprapatellar joint effusion.
IMPRESSION: Moderate degenerative changes. No evidence of fracture or
dislocation.
|
10037598-RR-20 | 10,037,598 | 24,022,026 | RR | 20 | 2162-03-14 10:07:00 | 2162-03-14 11:01:00 | INDICATION: Right knee pain and right knee injury. Evaluate for DVT.
COMPARISONS: None.
TECHNIQUE: Grayscale, Doppler, and spectral ultrasound images were obtained
through the right lower extremity veins.
FINDINGS: The bilateral common femoral veins demonstrate normal flow and
respiratory variation. The right common femoral vein, superficial femoral
vein, and popliteal vein demonstrate normal flow, compression, and response to
augmentation. The right posterior tibial veins and peroneal veins demonstrate
normal compression. There is a 3.5 x 2.2 x 6.0 cm heterogeneous fluid
collection in the popliteal fossa consistent with a complex ___ cyst.
IMPRESSION:
1. No evidence of deep vein thrombosis in the right lower extremity.
2. Moderate-sized complex right ___ cyst.
|
10037602-RR-34 | 10,037,602 | 26,699,121 | RR | 34 | 2151-04-17 09:36:00 | 2151-04-17 11:30:00 | EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old woman s/p R TKR// s/p R TKR s/p R TKR
TECHNIQUE: Portable frontal and cross lateral radiographs of the right knee
COMPARISON: Right knee radiographs ___
FINDINGS:
The patient is status post right total knee arthroplasty with expected
post-surgical changes. Hardware appears intact without evidence of
complication at this time. No fracture or dislocation is seen. There are no
significant degenerative changes. There is no knee joint effusion. There is
normal osseous mineralization. No suspicious lytic or sclerotic lesions are
identified.
IMPRESSION:
Expected postoperative changes status post right total knee arthroplasty. No
evidence of complications at this time.
|
10037818-RR-16 | 10,037,818 | 26,686,311 | RR | 16 | 2189-03-21 18:12:00 | 2189-03-21 18:56:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ female with right upper quadrant pain.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The echogenicity of the liver is homogeneous. The contour of the liver
is smooth. There is no focal liver mass. Main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. A
small polyp is noted within the gallbladder which measures 3 mm. No
pericholecystic fluid collection is identified.
PANCREAS: The pancreatic duct is top-normal measuring 3.5 cm. Patient's serum
lipase is elevated and this could relate to pancreatitis. Follow-up. No
peripancreatic fluid collection is identified.
SPLEEN: Normal echogenicity, measuring 9.4 cm.
KIDNEYS: The right kidney measures 10.9 cm. The left kidney measures 10.5 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones or hydronephrosis in the
kidneys.
Incidental note is made of a trace pericardial effusion.
IMPRESSION:
Mildly prominent pancreatic duct. In the setting of an elevated lipase, these
findings may relate to acute pancreatitis. Follow-up.
No evidence of acute cholecystitis. A small gallbladder polyp is noted without
thickening of the gallbladder wall.
|
10037818-RR-17 | 10,037,818 | 26,686,311 | RR | 17 | 2189-03-21 19:12:00 | 2189-03-21 19:37:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with pancreatitis // eval for effusion
TECHNIQUE: Chest Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable. Some degenerative changes are seen, most noted in the mid
thoracic spine.
IMPRESSION:
No acute cardiopulmonary process.
|
10037928-RR-65 | 10,037,928 | 22,490,490 | RR | 65 | 2177-07-14 16:39:00 | 2177-07-14 19:18:00 | EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: Weakness.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. Lungs are
clear without focal consolidation. No pleural effusion or pneumothorax is
seen. Cardiac and mediastinal silhouettes are unremarkable. The patient is
status post vertebroplasty/kyphoplasty at the lower thoracic spine.
IMPRESSION: No acute cardiopulmonary process.
|
10037928-RR-68 | 10,037,928 | 22,326,517 | RR | 68 | 2177-12-21 17:31:00 | 2177-12-21 17:44:00 | HISTORY: Cough and dyspnea.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The cardiac, mediastinal and hilar contours are within normal limits. The
pulmonary vasculature is normal. Streaky opacities in the lung bases likely
reflect atelectasis, and no focal consolidation is demonstrated. There is no
pleural effusion or pneumothorax. There is evidence of prior vertebroplasty
within a total body at the thoracolumbar junction.
IMPRESSION:
Streaky bibasilar opacities most likely reflective of atelectasis.
|
10037928-RR-73 | 10,037,928 | 24,225,421 | RR | 73 | 2178-09-28 22:23:00 | 2178-09-28 22:41:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with cough, fever // please evaluate for
pneumonia
COMPARISON: ___.
FINDINGS:
PA and lateral views of the chest provided. There is no focal consolidation,
effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. Vertebroplasty cement is noted within a lower
thoracic vertebral body, unchanged. No free air below the right hemidiaphragm
is seen.
IMPRESSION:
No acute intrathoracic process.
|
10037928-RR-74 | 10,037,928 | 24,225,421 | RR | 74 | 2178-09-29 10:50:00 | 2178-09-29 13:01:00 | EXAMINATION: CT TEMPORAL BONE
INDICATION: ___ year old woman with poorly controlled DM who presents with ear
pain, now with serosanguinous drainage, elevated ESR and leukocytosis,
evaluate temporal bone.
TECHNIQUE: Routine MDCT study of temporal bone was performed with coronal
reconstructions.
DOSE: DLP: 1476 mGy-cm; CTDI: 138 mGy
COMPARISON: CT head and C-spine ___.
FINDINGS:
Left : The external auditory canal is normal. The middle ear cavity is clear.
The ossicles and tegmen are intact. There is no evidence for enlarged
vestibular aqueduct or superior semicircular canal dehiscence. The facial
nerve follows a normal course through the middle ear. There is no evidence for
inner ear dysplasia. The mastoids are clear.
Right: There is soft tissue density in the right external auditory canal
extending to the middle ear, including into ___'s space. The scutum is
maintained. The mastoid air cells are fluid filled. There is no evidence of
bony destruction. Inflammatory changes extend into the soft tissues with
changes of the parapharyngeal fat. The ossicles and tegmen are intact. There
is no evidence for enlarged vestibular aqueduct or superior semicircular canal
dehiscence. The facial nerve follows a normal course through the middle ear.
There is no evidence for inner ear dysplasia.
There is asymmetric fullness of the ___ fossa on the right, new from
___ (02:23). There is no bony erosion of the visualized pterygoid
plates. Limited views of the brain are unremarkable.
IMPRESSION:
1. Soft tissue density in the right external auditory canal and middle ear
with inflammatory changes extending into the soft tissues, findings are
concerning for malignant otitis externa, recommend skullbase MRI for further
assessment. No bony destruction identified.
2. Asymmetric fullness of the ___ fossa on the right, new from
___, could be secondary to inflammation in this region however,
underlying mass is a concern, recommend direct visualization. This finding can
also be assessed on a contrast enhanced skullbase MRI.
NOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___
the telephone on ___ at 13:00, 15 min after they were made, updated
findings were discussed at 14:51 with Dr. ___.
|
10037928-RR-81 | 10,037,928 | 23,721,604 | RR | 81 | 2179-03-27 15:28:00 | 2179-03-27 15:48:00 | EXAMINATION: CHEST (AP AND LATERAL)
INDICATION: History: ___ with cough
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: ___
FINDINGS:
Cardiac, mediastinal and hilar contours are within normal limits. Pulmonary
vasculature is normal. Lungs are clear. No focal consolidation, pleural
effusion, or pneumothorax is visualized. There is evidence of prior
kyphoplasty of T11.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10037928-RR-82 | 10,037,928 | 23,721,604 | RR | 82 | 2179-03-28 13:49:00 | 2179-03-28 14:25:00 | INDICATION: ___ year old woman with cough // eval for infiltrate s/p fluids
COMPARISON: Radiographs from ___.
IMPRESSION:
Cardiomediastinal silhouette is normal. There are no signs for focal
consolidation or overt pulmonary edema. There are no pleural effusions or
pneumothoraces.
|
10037928-RR-83 | 10,037,928 | 23,721,604 | RR | 83 | 2179-03-30 13:58:00 | 2179-03-30 14:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with persistent hypoxia, worsening crackles b/l
on exam // eval for infiltrates, edema
COMPARISON: ___
IMPRESSION:
No relevant change. No pneumonia. No pulmonary edema. Normal size of the
cardiac silhouette. No pleural effusions. The lateral radiograph reveals a
status post vertebroplasty.
|
10037928-RR-84 | 10,037,928 | 23,721,604 | RR | 84 | 2179-04-01 14:48:00 | 2179-04-01 17:18:00 | EXAMINATION: Chest CT
INDICATION: ___ admitted w/ nonproductive cough, hypoxia of unclear etiology.
CXR negative x3, no flu syx, TTE WNL, remains hypoxic (SaO2 low ___ with mild
resp alkalosis. // HI-RES. R/o IPF, other interstitial processes, possible
nitrofuratoin-induced pulmonary toxicity.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen. Axial images were reviewed in conjunction with coronal and sagittal
reformats
COMPARISON: ___
FINDINGS:
No pathologically enlarged mediastinal hilar or axillary lymph nodes
demonstrated. Aorta and pulmonary arteries are normal in diameter. Coronary
calcifications are present. Heart size is normal. No pericardial pleural
effusion is seen. Image portion of the upper abdomen reveals no appreciable
abnormality
Airways are patent to the subsegmental level bilaterally. Diffuse bronchial
wall thickening is noted as well as some irregularity of the upper trachea.
No lytic or sclerotic lesions worrisome for infection or neoplasm have been
demonstrated. Compression vertebral fracture and vertebroplasty is
demonstrated, unchanged.
Assessment of the lung parenchyma demonstrate diffuse primarily ground-glass
opacities with septal thickening D ground-glass opacities are multiple and
there are also pulmonary nodules noted with surrounding halo,, largest 1 in
the right lower lobe, series 6 image 146.
No distinct interstitial process demonstrated. No evidence of septal
thickening to suggest pulmonary edema is present.
IMPRESSION:
Combination of ground-glass opacities, solid nodules and solid/ground-glass
nodules within hello might be consistent with diffuse infectious process.
Alternatively atypical mycobacterial infection, hypersensitivity reaction,
aspiration or vasculitis would be a possibility. Neoplasm is substantially
less likely. Cryptogenic organizing pneumonia is another less likely
possibility
Diffuse bronchial wall thickening and endobronchial secretions might reflect
part of the in infection/inflammatory process.
Irregularity of the upper trachea with be beneficial to proceed with direct
evaluation.
|
10038141-RR-21 | 10,038,141 | 21,658,233 | RR | 21 | 2170-10-25 18:19:00 | 2170-10-25 19:47:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with confusion, disinhibition, altered gait.// NPH?
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, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute major vascular territorial
infarction,hemorrhage,edema,or mass. There is prominence of the ventricles
and sulci suggestive of involutional changes. Ill-defined periventricular and
subcortical white matter hypodensities are nonspecific but likely due to
chronic small vessel ischemic disease. The basilar cisterns appear patent.
Moderate atherosclerotic calcifications are seen in both carotid siphons.
There is no evidence of fracture. Moderate mucosal thickening is seen in the
left sphenoid sinus. Otherwise, the remaining visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial abnormalities. Specifically, no evidence
for normal pressure hydrocephalus.
2. Age related global atrophy and chronic microangiopathy.
3. Mild left sphenoid sinus disease.
|
10038141-RR-22 | 10,038,141 | 21,658,233 | RR | 22 | 2170-10-27 16:45:00 | 2170-10-27 17:38:00 | EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE.
INDICATION: Acute progression of dementia. Failed bedside lumbar puncture.
TECHNIQUE: After informed consent was obtained from the patient's healthcare
proxy via telephone 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 L4-5.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 22 gauge, 15 cm spinal needle was inserted into
the thecal sac. There was good return of clear CSF. 11 mls of CSF were
collected in 4 tubes and sent for requested analysis.
Fluoroscopy time: 0.4 minutes
Air kerma: 10.1 mGy
Dose area product: 130.83 uGy m 2
COMPARISON: None.
FINDINGS:
11 mls of CSF were collected in 4 tubes. Opening pressure was measured at 21
cm CSF.
IMPRESSION:
1. Lumbar puncture at L4-5 without complication.
2. Mildly elevated opening pressure of 21 cm CSF.
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.
|
10038332-RR-59 | 10,038,332 | 22,514,900 | RR | 59 | 2172-11-15 00:43:00 | 2172-11-15 01:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever PNA// fever PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple chest radiographs, most recently dated ___
FINDINGS:
The lungs are hyperexpanded expanded but clear. Cardiomediastinal and hilar
silhouettes are normal. Abnormal configuration of the diaphragmatic contours
is chronic, not an indication of pleural effusion. Bullet fragments
projecting over the lower midline are long-standing.
IMPRESSION:
No focal consolidation. No evidence of pneumonia.
|
10038332-RR-60 | 10,038,332 | 22,514,900 | RR | 60 | 2172-11-16 23:12:00 | 2172-11-17 02:54:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old man with T10 paraplegia, neurogenic bladder, hx of
prior pyelo, prostatitis p/w recurrent UTI// r/o prostatic abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.9 s, 51.2 cm; CTDIvol = 7.6 mGy (Body) DLP = 386.0
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 7.8 s, 0.5 cm; CTDIvol = 39.6 mGy (Body) DLP =
19.8 mGy-cm.
Total DLP (Body) = 407 mGy-cm.
COMPARISON: Prior studies including the most recent CT dated ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is decompressed.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is
significant amount of fecal loading throughout the large bowel with mild
distention. The appendix is not definitively visualized.
PELVIS: Urinary bladder is mildly distended. Mild bladder wall thickening is
unchanged. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is not significantly enlarged. There is an
ill-defined oval-shaped hypodensity within the posterolateral apex measuring
2.2 x 1 cm which is similar in appearance to the prior MRI from ___.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. Note
is made of prominent inguinal lymph nodes bilaterally measuring up to 10 mm in
short axis which are likely reactive.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Note is again made of a bullet fragment lodged within the left
posterior aspect of T10 vertebra with fragments within the lamina and
vertebral body. There is heterotopic ossification anterior to the right
anterior superior and inferior iliac spines.
SOFT TISSUES: Thickening and fat stranding noted just inferior to the coccyx
and posterior to the ischium bilaterally similar to the prior study, likely
secondary to chronic decubitus ulceration. Smooth erosion of the posterior
right ischium may be a sequela remote osteomyelitis. There is no CT evidence
of active osteomyelitis.
IMPRESSION:
1. 2.2 x 1 cm oval-shaped hypodensity in the right posterolateral prostatic
apex is similar in appearance to prior MRI from ___ and may represent a
chronic abscess or phlegmon. Consider pelvic MRI for further evaluation.
2. No CT evidence of pyelonephritis or renal abscess.
3. Diffuse fecal loading throughout the large bowel.
|
10038332-RR-61 | 10,038,332 | 22,514,900 | RR | 61 | 2172-11-18 13:33:00 | 2172-11-18 16:20:00 | EXAMINATION: Prostate MR.
___: ___ year old man with T10 paraplegia, neurogenic bladder,
recurrent abscesses/UTI, p/w UTI, found on CT A/P to have ? prostate abscess
vs. phlegmon. Assess for prostatic abscess.
TECHNIQUE: Multiplanar T1 and T2 weighted images were acquired on a 3.0 T
magnet.
No endorectal coil was used.
1 mg of intramuscular glucagon was administered to reduce artifact related to
bowel motion.
Intravenous contrast: 6 mL Gadavist.
COMPARISON: CT abdomen pelvis with contrast ___
MR ___ ___
MR ___.
FINDINGS:
The prostate gland measures 3.7 x 2.9 x 4.2 cm (AP x SI x TV), yielding a
calculated volume of 23.4 cc. No evidence of benign prostatic hypertrophy.
No findings of clinically significant prostate cancer. No fluid collection or
phlegmon demonstrated. Specifically, abnormality noted on CT from ___ within the right peripheral zone corresponds to normal prostatic
parenchyma. There is evidence of prior prostatitis with hyper enhancement of
the left peripheral which extends from base to apex.
The neurovascular and seminal vesicles appear unremarkable. Small amount of
pelvic free fluid noted. There is no significant adenopathy. Minimal
nonocclusive thrombus in the right internal pudendal vein noted (500:51).
Otherwise patent central iliac vasculature.
This study is not dedicated for the evaluation of osteomyelitis, however again
noted are chronic bilateral sacral decubitus ulcers with hyper enhancement
along the left gluteus musculature, improved from remote MR.
___:
1. No prostatic abscess or phlegmon. Specifically, abnormality noted on CT
from ___ within right peripheral zone corresponds to normal
prostatic parenchyma.
2. Evidence of prior prostatitis within left peripheral zone.
3. Chronic bilateral sacral decubitus ulcers. Of note, study is not
dedicated for evaluation of osteomyelitis and the findings are markedly
improved compared to prior MR.
|
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