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19994379-RR-18

RR

2131-05-06 23:31:00

2131-05-07 00:52:00

EXAMINATION: CT ABDOMEN PELVIS WITHOUT CONTRAST INDICATION: ___ year old man with hypotension to 60/40, with 1.5 point hgb drop since admission// retroperitoneal bleed TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 4.1 s, 54.2 cm; CTDIvol = 20.0 mGy (Body) DLP = 1,082.0 mGy-cm. 2) Spiral Acquisition 1.3 s, 16.7 cm; CTDIvol = 21.5 mGy (Body) DLP = 358.1 mGy-cm. Total DLP (Body) = 1,440 mGy-cm. COMPARISON: CT abdomen pelvis from ___. FINDINGS: LOWER CHEST: Volume loss in the right lower lobe may represent atelectasis or infection. There is a moderate right pleural effusion. No left pleural or pericardial effusion. Coronary artery calcifications are severe. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. 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 within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. Mild bilateral perinephric stranding is likely secondary to known medical renal disease. GASTROINTESTINAL: A posterior gastric diverticulum is again noted (02:25). Small bowel loops demonstrate normal caliber throughout. Gaseous distention of the proximal colon is similar to prior. The colon and rectum are otherwise grossly unremarkable. The appendix is not visualized. No free intra-abdominal fluid. No retroperitoneal hematoma. PELVIS: The bladder contains intermediate density fluid, which may represent excreted iodinated contrast from a prior CT study or hemorrhage products. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate is enlarged and the 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. Extensive atherosclerotic disease is noted. BONES: There are no aggressive appearing osseous lesions. No acute fracture. Post-operative changes in the lumbar spine. SOFT TISSUES: A right inguinal hernia containing fat is noted. IMPRESSION: 1. Volume loss in the right lower lobe may represent atelectasis or infection. Please correlate with clinical status. 2. No retroperitoneal hematoma or free intra-abdominal fluid. 3. Intermediate density fluid in the bladder may represent delayed excretion of iodinated contrast from prior CT study or hemorrhage products. Please correlate with visual inspection of the urine or urinalysis. 4. Moderate right pleural effusion.

19994379-RR-19

RR

2131-05-08 11:29:00

2131-05-08 15:58:00

INDICATION: ___ year old man with ___, hypotension, abdominal distension// ?dilation, evidence of obstruction TECHNIQUE: Portable supine abdominal radiographs were obtained. COMPARISON: CT scan from ___ FINDINGS: There is gaseous distension of the colon, appearing stable compared to the recent CT scan, with the descending colon dilated up to 9 cm. There is no free intraperitoneal air. Small right-sided pleural effusion. A Postsurgical fixation hardware in the lumbar spine. IMPRESSION: Gaseous distension of the colon, appearing unchanged compared to the recent CT scan

19994379-RR-20

RR

2131-05-08 23:12:00

2131-05-09 11:48:00

EXAMINATION: Chest radiograph INDICATION: ___ year old man with increasing O2 requirement// assess for pulmonary edema TECHNIQUE: Chest AP COMPARISON: Chest radiograph dated ___. Chest radiograph dated ___. FINDINGS: Right pleural fibrosis and/or effusion is best appreciated along the lateral costal pleural margin. Atelectasis of the right lower lobe has increased. No pulmonary abnormality seen in the left lung. Enlargement of the left hila, with obscuration of the right hilus. Mild to moderate enlargement of the cardiac silhouette has increased and distended azygos, likely reflective of elevated central venous pressures or volume. IMPRESSION: 1. Uniform thickening of the lateral aspect of the right pleural margin with right lower lobe atelectasis. Further evaluation with lateral decubitus projection may be obtained for better visualization of fluid layering. 2. Moderate mediastinal enlargement. 3. Distended azygos vein, likely reflective of elevated central venous pressures or volume.

19994379-RR-21

RR

2131-05-09 04:43:00

2131-05-09 10:33:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with ___ and hypoxia// Please evaluate effusion/PNA/CHF Please evaluate effusion/PNA/CHF IMPRESSION: Compared to chest radiographs since ___ most recently ___ at 23:18. Moderate right pleural abnormality, either recurrent effusion alone and/or pleural thickening is unchanged since earlier in the day. Mild cardiomegaly mediastinal venous engorgement are also stable. There has been a slight increase in pulmonary vascular congestion, but as yet no edema or left pleural effusion. No pneumothorax.

19994379-RR-22

RR

2131-05-09 12:25:00

2131-05-09 14:01:00

INDICATION: ___ year old man with r pleural effusion// s/p chest tube placement, r/o pneumo TECHNIQUE: Chest AP COMPARISON: ___ IMPRESSION: A right-sided pigtail catheter has been placed in the interim. The right pleural effusion has slightly decreased in volume. There is a small right basilar pneumothorax. Cardiomediastinal silhouette is stable. Interstitial abnormality has slightly worsened could represent worsening pulmonary edema.

19994379-RR-23

RR

2131-05-10 04:22:00

2131-05-10 08:21:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: PTX? TECHNIQUE: AP chest x-ray COMPARISON: ___ FINDINGS: There is increased density in the right hemithorax with evidence of right pleural thickening and or fluid as before. A pigtail catheter is been withdrawn. There is evidence for a tiny loculated right pneumothorax, which is probably stable. Prominent interstitial markings are stable. Mediastinal structures are unchanged. IMPRESSION: Removal of right pigtail catheter. Tiny right pneumothorax appears stable.

19994379-RR-24

RR

2131-05-10 08:29:00

2131-05-10 10:46:00

EXAMINATION: RENAL U.S. INDICATION: ___ year old man with uniltateral pleural effusion with low pH, ?urinothorax// evidence of damage to kidneys/ureters TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were obtained. COMPARISON: Abdomen CT ___. FINDINGS: The right kidney measures 11.9 cm. The left kidney measures 10.7 cm. There is no hydronephrosis, stones, or masses bilaterally. Normal cortical echogenicity and corticomedullary differentiation are seen bilaterally. The bladder is collapsed. IMPRESSION: No hydronephrosis in either kidney.

19994379-RR-25

RR

2131-05-11 06:28:00

2131-05-11 10:18:00

INDICATION: ___ year old man with R > L effusion, eval for reaccumulation// pleural effusion interval development after IVF given TECHNIQUE: Semi-upright portable radiograph of the chest. COMPARISON: Radiograph of the chest performed 1 day prior. FINDINGS: Opacification of the right hemithorax appears grossly unchanged compared to the prior exam. Moderate right pleural effusion is unchanged. The left lung is clear. The previously noted pneumothorax, is not definitively seen on the current exam. Mild cardiomegaly is persistent. Prominence of the mediastinal contours is likely sequelae of pulmonary vascular congestion. IMPRESSION: Overall, stable appearance of the moderate right pleural effusion and additional opacities overlying the right lung. Previously noted small pneumothorax is not definitively seen on the current exam.

19994379-RR-26

RR

2131-05-12 17:15:00

2131-05-12 18:06:00

EXAMINATION: Chest radiograph INDICATION: ___ year old man with R pleural effusion s/p attempted thoracentesis// eval for PTX TECHNIQUE: Portable frontal view of the chest. COMPARISON: ___. IMPRESSION: There is essentially no change compared the prior examination from 1 day prior. Small to moderate loculated right-sided pleural effusion appears unchanged in volume, with persistent opacities throughout the right lung. There is no pneumothorax. The left lung remains essentially clear. The cardiomediastinal silhouette is unchanged.

19994379-RR-28

RR

2131-05-13 10:28:00

2131-05-13 12:00:00

EXAMINATION: DX PELVIS AND FEMUR INDICATION: ___ year old man with hip and thigh pain// fracture? TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and frog-leg lateral views of the bilateral femurs. COMPARISON: A CT abdomen pelvis ___. FINDINGS: Posterior fusion hardware of the lumbar spine appears similar. Large osteophytes are seen. Mild degenerative changes of bilateral SI joints. Mild degenerative changes of bilateral hip. Mild degenerative change of pubic symphysis appear prominent enthesopathic changes of the iliac crests. Vascular calcifications. No fracture of the lesser femur. Status postleft total knee arthroplasty no definite evidence of hardware complication. Small knee effusion. No fracture of the right femur. Right suprapatellar enthesophyte. Moderate degenerative change of the right knee. Small knee effusion. IMPRESSION: No fracture of the bilateral femurs.

19994379-RR-29

RR

2131-05-12 18:53:00

2131-05-12 19:21:00

EXAMINATION: Chest radiograph INDICATION: ___ year old man with persistent pleural effusion, s/p chest tube// f/u pleural effusion TECHNIQUE: Portable frontal view of the chest. COMPARISON: ___ 17:52 IMPRESSION: Compared to the recent prior study, there has been placement of a right lung base pigtail catheter, with essentially no change in volume of the small to moderate sized loculated right pleural effusion. No pneumothorax. No other interval change.

19994379-RR-30

RR

2131-05-13 04:02:00

2131-05-13 08:30:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with new chest tube// eval for pneumo eval for pneumo IMPRESSION: Comparison to ___. Stable position of the right pigtail catheter. Stable extent of the pre-existing right pleural effusion and the parenchymal opacities in the right lung. Moderate cardiomegaly persists. Stable normal appearance of the left lung. No pneumothorax.

19994379-RR-31

RR

2131-05-13 17:49:00

2131-05-13 19:12:00

EXAMINATION: CT CHEST W/O CONTRAST INDICATION: ___ year old man with w/ HFrEF on xarelto, CAD s/p stent, atrial fibrillation, ___ syndrome, CKD, chronic neck pain ___ cervical disc disease and multiple spine surgeries here for pain control, HAP on cefepime, pleural effusion, ___// evaluation of pleural effusion, pleural space TECHNIQUE: Axial sections obtained through the thorax without administration of intravenous contrast with multiplanar reformats. DOSE: Acquisition sequence: 1) Spiral Acquisition 2.5 s, 39.7 cm; CTDIvol = 18.0 mGy (Body) DLP = 715.1 mGy-cm. Total DLP (Body) = 715 mGy-cm. COMPARISON: None. FINDINGS: NECK, THORACIC INLET, AXILLAE, CHEST WALL: The soft tissues of the neck are within normal limits. Noncontrast appearance of the thyroid glands is unremarkable. There is evidence of bilateral gynecomastia. UPPER ABDOMEN: Partially imaged upper abdomen demonstrates mild mesenteric stranding and a small gastric diverticulum containing a small amount of hyperdense ingested material. MEDIASTINUM & HILA: Multiple prominent sized mediastinal lymph nodes are seen in the paratracheal pre-vascular, subaortic, subcarinal locations, largest measuring 1.1 cm in the right paratracheal location (series 2, image 20). Few prominent right hilar lymph nodes are seen, largest measuring 1.0 cm (series 2, image 36). HEART and PERICARDIUM: The heart is normal in size. There is no pericardial effusion. There is evidence of mild calcific atherosclerotic changes involving the thoracic aorta and triple-vessel coronary calcific atherosclerosis. This evidence of fat deposition in the interventricular septum as well as the subendocardial region of the left ventricular apex, this may be related to chronic infarct. PLEURA: Free-flowing mild-to-moderate pleural effusion seen on the left side. The right pleural space demonstrates mild-to-moderate amount of pleural fluid with thin internal loculations and a moderate amount of air with as well as some linear mildly hyperdense contents. A chest tube is seen in good position within the right pleural space. LUNG: 1. PARENCHYMA: Multiple areas of peripheral ground-glass opacification are seen scattered throughout both lungs, predominantly involving both upper and right middle lobe. There is evidence of mild interlobular septal thickening especially involving the right upper lobe as well as the left lingula. There is evidence of near complete atelectasis of the right lower lobe as well as passive subsegmental atelectasis in the left lower lobe. 2. AIRWAYS: The central tracheobronchial tree is clear. 3. VESSELS: Not assessed on this unenhanced study. CHEST CAGE: Dish-like changes seen involving the thoracic vertebral bodies with evidence of mild vertebral body height loss involving T4-T9 vertebral bodies. IMPRESSION: 1. Mild to moderate right pleural collection containing loculated fluid and air with a chest tube in situ. Mild-to-moderate free-flowing left pleural effusion. 2. Bilateral patchy peripheral ground-glass opacities are concerning for an atypical infection. Presence of interlobular septal thickening may be secondary to pulmonary edema. Clinical correlation is recommended. 3. Mild mediastinal and hilar lymphadenopathy is nonspecific and could be related to infections.

19994379-RR-32

RR

2131-05-14 09:25:00

2131-05-14 12:20:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with chronic pleural effusion s/p chest tube, c/f PNA as well.// acutely desatting, has chest tube, likely trapped lung, any changes from prior that are concerning? acutely desatting, has chest tube, likely trapped lung, any changes from prior that are concerning? IMPRESSION: Compared to chest radiographs ___ through ___ one. Combination circumferential right pleural thickening and residual effusion overall unchanged with more dependent distribution of the fluid. Right pigtail drainage catheter still in place. No pneumothorax. Substantial right lower lobe atelectasis is unchanged. No pulmonary or pleural abnormality in the left hemithorax. Mild to moderate cardiomegaly unchanged.

19994379-RR-33

RR

2131-05-18 10:38:00

2131-05-18 11:21:00

INDICATION: ___ year old man with acute onset increase SOB, dizziness// any evidence of changes in volume overload? TECHNIQUE: Chest AP COMPARISON: Ill ___ IMPRESSION: Right-sided pigtail catheter has been removed in the interim. There is a small loculated right hydro pneumothorax. Interstitial abnormality is slightly worsened. Stable volume loss in the right lung. Cardiomediastinal silhouette is stable.

19994379-RR-34

RR

2131-05-18 10:39:00

2131-05-18 17:54:00

INDICATION: ___ year old man with acute onset increase SOB, dizziness, pt w recent hx of oligve's, now w cdiff and on opioids for pain// any evidence free air or colonic distension? TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: Comparison included abdominal radiograph done on ___. FINDINGS: There is still distension of large bowel however there has been interval improvement. There are no dilated loops of small bowel. There is no evidence of bowel obstruction. There is no intraperitoneal free air. Unchanged position of lumbar spine hardware. IMPRESSION: Interval improvement of dilation of large bowel, however large bowel dilation has not resolved. There is no evidence of intraperitoneal free air.

19994379-RR-36

RR

2131-05-30 14:37:00

2131-05-30 14:55:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ with HFrEF and weight gain and new sob and O2 requirement.// evaluate for pna, congestion, effusion COMPARISON: Prior chest CT dated ___ and recent chest radiograph from ___. FINDINGS: AP portable upright view of the chest. No significant change from recent prior exam with loculated right pleural effusion tracking circumferentially with a similar overall pattern. Opacities within the right lung again noted. Left lung is grossly clear. The heart appears mildly enlarged. Mediastinal contour stable. Imaged bony structures are intact. Multiple surgical anchors are noted at bilateral humeral heads. IMPRESSION: No significant interval change.

19994379-RR-37

RR

2131-06-02 09:12:00

2131-06-02 10:21:00

EXAMINATION: CT CHEST W/O CONTRAST INDICATION: ___ year old man with HFrEF, trapped lung s/p anterior approach to L2-L3 fusion. please perform thin cuts for surgical planning per thoracics team.// trapped lung, compare to prior. please perform thin cuts for surgical planning per thoracics team TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as 5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP axial images. Contrast agent was not administered. All images were reviewed. DOSE: Acquisition sequence: 1) Spiral Acquisition 2.5 s, 39.7 cm; CTDIvol = 13.8 mGy (Body) DLP = 548.5 mGy-cm. Total DLP (Body) = 548 mGy-cm. COMPARISON: Compared to chest CT one ___. FINDINGS: CHEST PERIMETER: No thyroid findings warranting further imaging evaluation. Supraclavicular and axillary lymph nodes are not enlarged and there are no soft tissue abnormalities in the imaged chest wall concerning for malignancy. This study is not appropriate for subdiaphragmatic diagnosis but shows no adrenal abnormality. CARDIO-MEDIASTINUM:Midportion of the esophagus is mildly patulous. Atherosclerotic calcification is moderate to heavy in head and neck vessels and severe in major coronary arteries. Aorta and pulmonary arteries are normal size. Assessment of cardiomegaly would require echocardiography. Pericardium is physiologic. THORACIC LYMPH NODES: Numerous subcentimeter mediastinal lymph nodes in upper and lower paratracheal and prevascular stations are stable thoracic lymph nodes are pathologically enlarged by size criteria. LUNGS, AIRWAYS, PLEURAE: Large posteriorly loculated right hydropneumothorax contains more fluid and very little air, following removal of the right pleural drainage catheter, but the overall size is unchanged. The extent of thickening of the parietal pleura and where it is separable from atelectasis, the visceral pleura along the entire posterior surface of the right lung has not changed appreciably. Most of the volume loss in the right lung is in the lower lobe which is still largely atelectatic. Small moderate, nonhemorrhagic, posteriorly collected left pleural effusion is substantially smaller today. The mild edema persists in the right upper lobe, probably a function of engorged lymphatics. Previous multifocal peribronchovascular ground glass opacification in the left lung has improved but not resolved. I doubt that this is edema, given its non gravitational distribution in the absence of septal thickening. This could be residual infection or hemorrhage, but I am uncertain of the diagnosis. Central bronchial tree is patent. CHEST CAGE: No evidence of infection or malignancy in the chest cage. IMPRESSION: Persistent large and probably loculated right hydropneumothorax, probably reflecting chronic restrictive right pleural thickening, in combination with severe lower lobe atelectasis. No contributory bronchial obstruction. Severe coronary atherosclerosis. Mild cardiomegaly. Substantially improved bilateral airspace pulmonary abnormality, nature indeterminate, could be post infectious or slow to resolve hemorrhage.

19994379-RR-40

RR

2131-06-04 16:35:00

2131-06-04 17:01:00

INDICATION: ___ year old man with hx of c.diff,now with constipation// eval for obstruction TECHNIQUE: Supine and upright abdominal radiograph was obtained. COMPARISON: Radiographs dating back to ___ and CT ___. FINDINGS: There is distention of the colon, worse than on prior examination, with an abrupt cutoff in the proximal descending colon, which was seen on prior CT. Although the supine appearance resembles a sigmoid volvulus, in view of the prior CT findings, this is most likely a tortuous transverse colon and the abrupt cutoff in the descending colon corresponds to the point of transition on prior CT. No free air demonstrated on supine. Spinal fusion hardware and intervertebral spacers are again noted. Small right pleural effusion and compressive atelectasis seen. IMPRESSION: Colonic obstruction, worse than on prior examination. There is an abrupt cutoff of the colonic dilatation in the proximal descending colon, as on prior CT. The possibility of a stricture at this level is suggested. No free air on supine.

19994379-RR-41

RR

2131-06-05 16:59:00

2131-06-05 17:53:00

EXAMINATION: CT ABDOMEN PELVIS WITHOUT CONTRAST INDICATION: ___ year old man with ___ syndrome, C.diffc, obstruction on KUB// evidence of colonic stricture/obstruction, PO CONTRAST only TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 4.1 s, 54.7 cm; CTDIvol = 21.0 mGy (Body) DLP = 1,148.9 mGy-cm. Total DLP (Body) = 1,149 mGy-cm. COMPARISON: CT abdomen and pelvis ___ and ___. FINDINGS: LOWER CHEST: Re-demonstrated partially visualized hydropneumothorax of the right appears unchanged from the prior examination. Rounded consolidation adjacent to the pleural effusion may represent rounded atelectasis and is unchanged. Ground-glass opacifications in the visualized central left lower and anterior left upper lobe are nonspecific and may reflect and infectious or inflammatory process. ABDOMEN: The study is limited for evaluation of the parenchyma and visceral organs due to lack of IV contrast. HEPATOBILIARY: The gallbladder is absent. Liver is unremarkable. No intra or extrahepatic biliary ductal dilatation PANCREAS: Unremarkable. SPLEEN: Enlarged. Small splenules along the anterior aspect of the spleen are unchanged. ADRENALS: Unremarkable bilaterally. URINARY: No hydronephrosis or nephrolithiasis. The ureters are unremarkable GASTROINTESTINAL: Gastric fundal diverticulum is re-demonstrated. The small bowel is normal caliber. Again seen is a marked distension of the ascending and transverse colon with smooth tapering at the mid to proximal descending colon the distension measures up to approximately 8.1 cm which is mildly increased since the prior study findings are again suggestive ___ syndrome. No stricturing is seen. Air-fluid levels within the colon suggests a diarrheal state. PELVIS: Bladder is mostly decompressed. Multiple pelvic phleboliths. Prostate and seminal vesicles are within normal limits. PERITONEUM/RETROPERITONEUM: Fat containing right inguinal hernia is unchanged. No ascites or pneumoperitoneum. LYMPH NODES: No adenopathy VASCULAR: Moderate atherosclerotic calcifications of the aorta which is normal caliber. The IVC is normal caliber. BONES: Lumbar spinal hardware is re-demonstrated. The overall appearance of the lumbar and lower thoracic spine is unchanged. No suspicious osseous lesion SOFT TISSUES: There is a moderate to large fat containing right inguinal hernia. IMPRESSION: 1. Colonic distension is minimally increased since the prior study measures approximately 8.1 cm, previously measured 7 cm with smooth tapering in the proximal descending colon is suggestive ___ syndrome. No gross stricture identified. 2. Small bowel is normal caliber. No evidence of bowel obstruction. 3. Air-fluid levels within the colon suggests a diarrheal state. 4. Partially visualized known right hydropneumothorax. 5. Ground-glass opacifications in the visualized central left lower and anterior left upper lobe are nonspecific and may reflect an infectious or inflammatory process. 6. Additional findings as above.

19994379-RR-42

RR

2131-06-06 05:24:00

2131-06-06 08:20:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with increasing O2 requirement, known trapped lung// ?interval change ?interval change IMPRESSION: Comparison to ___. No relevant change is noted. Moderate cardiomegaly. Stable elevation of the left hemidiaphragm, caused by intestinal distention. Stable parenchymal opacities and pleural thickening in the right hemithorax. Stable appearance of the left lung.

19994379-RR-43

RR

2131-06-06 06:24:00

2131-06-06 09:37:00

INDICATION: ___ year old man with hypotension, increasing lactate// ?perf TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: Prior abdominal radiographs dating back to ___. Abdominal CT ___ and ___. FINDINGS: No change in severe colonic distension. No free air on supine. Spinal hardware is again seen. Pelvic phleboliths. IMPRESSION: No change in colonic distension.

19994379-RR-44

RR

2131-06-10 11:37:00

2131-06-10 12:28:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ YO M with afib on ___, CAD s/p stent placement, HFrEF (EF ___, mitral valve prolapse, HTN, HLD, depression, multiple spine surgeries, cholecystectomy who presents from rehab with dyspnea, felt to be in acute heart failure exacerbation ___ holding of diuretic regimen at rehab. ___ c/b overdiuresis, ___ syndrome, hypotensive episode requiring pressors for <24hrs, acute GI bleed, now back on floor getting diuresis with shortness of breath// interval change interval change IMPRESSION: Comparison to ___. Stable moderate to severe cardiomegaly. Stable over distension of the stomach. Stable bilateral parenchymal opacities with air bronchograms, right more than left, and stable right pleural effusion. No new parenchymal changes. No pneumothorax.

19994379-RR-45

RR

2131-06-11 15:24:00

2131-06-11 19:58:00

EXAMINATION: CT CHEST W/O CONTRAST INDICATION: ___ year old man with HFrEF, trapped lung, hydropneumothorax, now with increasing SOB and hypoxia// Please evaluate interval change for pulmonary edema, pleural effusion, trapped lung. TECHNIQUE: Noncontrast axial multidetector CT images through the chest with coronal sagittal reformations. COMPARISON: ___ noncontrast CT FINDINGS: In comparison to the prior chest CT of ___, there is interval development extensive and more confluent peribronchial ground-glass opacities in the left lung. Previously seen patchy ground-glass opacities in the right upper and middle lobes are either stable or have slightly improved. A moderate size right hydropneumothorax with partial collapse of the right lower lobe appears similar to before. A small left pleural effusion has slightly increased in size. Heart is mildly enlarged. Diffuse three-vessel coronary artery calcifications noted. There is no significant pericardial effusion. There is no axillary, mediastinal, or hilar lymphadenopathy by CT size criteria although there are multiple small mediastinal nodes that appear prominent by count, overall unchanged and likely reactive. Limited noncontrast view of the upper abdomen is unremarkable. Postsurgical changes in bilateral shoulders are noted. Anterior bridging osteophytes along the spine can be seen with diffuse idiopathic skeletal hyperostosis (DISH). IMPRESSION: 1. Extensive progression of more confluent areas of ground-glass opacification in a peribronchovascular distribution involving the entire left lung since the prior study of ___, raises concern for infection. Asymmetric pulmonary edema could also be considered.. 2. Overall stable appearance moderate right hydropneumothorax and associated collapse of the left lower lobe. 3. Slightly increased size of small left pleural effusion. 4. Additional findings as described.

19994379-RR-47

RR

2131-06-17 15:29:00

2131-06-17 16:50:00

EXAMINATION: Chest: Frontal and lateral views INDICATION: ___ year old man with trapped lung and increased GGOs seen in left lung on last CT chest, treated with diuresis and abx for pneumonia// Interval change? Evidence of volume overload, or continued signs of infection? TECHNIQUE: Chest: Frontal and Lateral COMPARISON: Chest radiograph dated ___ and CT chest dated ___ FINDINGS: The heart size is enlarged, stable in appearance as compared to ___. Re-demonstrated are bilateral parenchymal opacities, unchanged with associated air bronchograms, more prominent on the right. There is a loculated right pleural effusion, no left pleural effusion. There is near complete atelectasis with the right lower lobe. There is unchanged over distention of the stomach. There is no pneumothorax. IMPRESSION: In comparison to the prior radiograph dated ___, there is stable appearance of near complete right lower lobe atelectasis with a now larger loculated right pleural effusion. Persistent bibasilar opacities.

19994505-RR-16

RR

2185-11-03 04:48:00

2185-11-03 10:01:00

HISTORY: Fall. Pain. ? right upper extremity fracture. These exams consist of six radiographs of the right shoulder, right humerus, right elbow and right hand and wrist. This study is not optimal and apparently obtained bedside. No fracture is identified and no dislocation. I cannot assess the presence of an elbow effusion. Prominent vascular calcifications.

19994505-RR-17

RR

2185-11-03 04:49:00

2185-11-03 10:42:00

HISTORY: Fall. ? fracture. These exams consist of six radiographs of the shoulders, left humerus, left elbow, and left hand and wrist. Exam is slightly limited, particularly of the elbow, with bedside technique. No fracture. I cannot assess the presence of an effusion in the elbow. Incidental degenerative changes in several DIP joints. There is a partially visualized pacing device overlying the left upper thorax. Extensive vascular calcifications. Similar radiographs of the right upper extremity obtained at the same time also showed no fracture and are reported separately.

19994505-RR-18

RR

2185-11-03 04:49:00

2185-11-03 11:55:00

INDICATION: Status post fall, intubated. ___, CT torso, ___. FRONTAL SUPINE PORTABLE CHEST: Left intracardiac device leads project over the expected locations of the right atrium and right ventricle. Endotracheal tube ends 5.7 cm above the carina. Nasoenteric tube courses to the stomach with the tip out of view. Low lung volumes result in bronchovascular crowding. Mild pulmonary edema is unchanged from ___. Moderate cardiomegaly is stable. There is no substantial pleural effusion or pneumothorax.

19994505-RR-19

RR

2185-11-03 13:54:00

2185-11-03 16:26:00

HISTORY: ___ male with small right temporal subarachnoid hemorrhage and facial fractures. COMPARISON: None. TECHNIQUE: Contiguous axial MDCT images of the brain were obtained without administration of IV contrast. Reformatted coronal, sagittal and thin section bone algorithm reconstructed images were acquired. DLP: 891.93 mGy-cm. FINDINGS: Small amount of subarachnoid hemorrhage seen in the right temporal region, without associated edema or mass effect. No intraparenchymal hemorrhage. Mild prominence of the ventricles and sulci are related to age-appropriate cortical volume loss. Faint periventricular, subcortical and deep white matter hypodensities are likely sequela of chronic small vessel ischemic disease. Bifrontal and right occipital encephalomalacia is likely from prior infarcts. The basal cisterns are patent and there is elsewhere preservation of gray-white matter differentiation. No shift of midline structures. Minimally displaced anterior and lateral wall fractures of the right maxillary sinus with a nondisplaced right orbital floor fracture is seen without displacement of orbital fat or extraocular muscle entrapment. Hyperdense material in bilateral sphenoids and layering in the left maxillary sinus is consistent with hemorrhage. Small amount of layering hyperdense material in the left maxillary sinus likely represents hemorrhage. The right middle ear cavity and right mastoid air cells are opacified. The globes are unremarkable. IMPRESSION: 1. Small right temporal subarachnoid hemorrhage. 2. Minimally displaced fracture of the anterior and lateral walls of the right maxillary sinus with a nondisplaced right orbital floor fracture. No CT evidence of extraocular muscle entrapment. 3. Hemorrhage in bilateral sphenoids and left maxillary sinus. 3. Opacified right mastoid air cells and right middle ear cavity may be related to patient's prone positioning/intubation; however, given history of trauma cannot exclude temporal bone fracture. If possible correlation with prior exam from presentation would be helpful in determining etiology of middle ear and mastoid opacification.

19994505-RR-20

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2185-11-04 18:07:00

2185-11-05 09:20:00

HISTORY: ET tube position. FINDINGS: In comparison with study of ___, the tip of the endotracheal tube is at the lower clavicular level, approximately 5.4 cm above the carina. Enteric tube has been removed. Enlargement of the cardiac silhouette persists with the dual-channel pacer leads in place. Evidence of elevated pulmonary venous pressure is again seen. Increased opacification at the bases could merely reflect atelectasis, though in the appropriate clinical situation, supervening pneumonia would have to be considered.

19994505-RR-21

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2185-11-05 05:22:00

2185-11-05 09:03:00

SINGLE FRONTAL VIEW OF THE CHEST REASON FOR EXAM: CHF. Comparison is made with prior study ___. Moderate cardiomegaly is stable. Pacer leads are in standard position. Bibasilar opacities have increased on the left likely increasing atelectasis, but superimposed infection cannot be excluded. There is stable moderate pulmonary edema. There is no pneumothorax. ET tube is in standard position. NG tube tip is out of view below the diaphragm.

19994505-RR-22

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2185-11-05 11:31:00

2185-11-05 13:30:00

HISTORY: Bronchoscopy, to assess for change. FINDINGS: In comparison with the earlier study of this date, following bronchoscopy, there is little overall change. Specifically, no evidence of pneumothorax.

19994505-RR-23

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2185-11-05 15:09:00

2185-11-05 16:06:00

HISTORY: Status post unwitnessed fall out of bed nursing home with axillary and orbital trauma as well as small right subarachnoid hemorrhage. Now with mental status change. Evaluate for interval change. Technique: Contiguous axial MDCT images were obtained through the brain without the administration of IV contrast. Reformatted coronal and sagittal and thin section bone algorithm-reconstructed images were acquired. CTDIvol: 53 mGy DLP: 1014 mGy-cm COMPARISON: CT of the head dated ___. FINDINGS: Compared to the prior study from ___, there has been interval resoluation of the right temporal subarachnoid hemorrhage and there is no evidence of new hemorrhage, mass effect, edema, or infarct. The ventricles and sulci are prominent but no more so than the prior study. The likely related to global atrophy. Periventricular white matter hypodensities are again noted and likely related to chronic small vessel ischemic disease. Again demonstrated are multiple nondisplaced fractures of the bilateral maxilla and orbital walls with opacification of the right maxillary sinus, right ethmoid sinuses, right sphenoid sinus, right mastoid air cells and middle ear cavity, and partial opacification of the left sphenoid sinus, left maxillary sinus, and left side of the nasal cavity. Additionally there is fluid seen within the left mastoid air cells however the middle ear cavity is clear. IMPRESSION: 1. Resolution of right temporal subarachnoid hemorrhage and no evidence of new hemorrhage, edema, mass effect, or infarct. 2. No significant change in the complex bilateral maxillary sinus and orbital wall fractures. Continued opacification of the right maxillary, sphenoid, ethmoid sinuses as well as the mastoid air cells.

19994505-RR-24

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2185-11-06 05:13:00

2185-11-06 09:09:00

REASON FOR EXAMINATION: Evaluation of the patient with history of congestive heart failure. Portable AP radiograph of the chest was reviewed in comparison to ___. The NG tube tip passes below the diaphragm terminating in the stomach. The ET tube tip is approximately 5 cm above the carina. The pacemaker defibrillator leads are in unchanged position. Cardiomegaly is unchanged. There is interval mild improvement in still present, at least moderate interstitial pulmonary edema associated with bilateral pleural effusions. No definitive evidence of focal consolidation to suggest infectious process seen.

19994505-RR-25

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2185-11-07 05:21:00

2185-11-07 08:44:00

HISTORY: Intubation. FINDINGS: In comparison with study of ___, the endotracheal tube and nasogastric tube have been removed. Right IJ catheter tip extends to the mid portion of the SVC. Pacer device with leads is essentially unchanged. Again there is enlargement of the cardiac silhouette with moderate pulmonary edema. Atelectatic changes are seen at the bases with probable bilateral pleural effusions.

19994505-RR-26

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2185-11-06 12:54:00

2185-11-06 15:28:00

REASON FOR EXAMINATION: Unstable C-spine, new central venous line. AP chest radiograph compared to ___ radiograph obtained at 05:42 a.m. Currently, there is new right subclavian line inserted with its tip terminating at the level of mid to low SVC. Patient continues to be in pulmonary edema that appears to be progressing. Moderate bilateral pleural effusions are noted. Rest of the supporting devices are unchanged. No pneumothorax is seen.

19994588-RR-68

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2194-07-01 12:26:00

2194-07-01 15:42:00

CHEST RADIOGRAPHS HISTORY: Shortness of breath and history of lung cancer. COMPARISONS: PET-CT imaging was recently performed on ___. Prior chest radiograph is available from ___. TECHNIQUE: Chest, AP upright and lateral. FINDINGS: There is a large right-sided pleural effusion which is difficult to directly compare to the prior PET-CT, but probably similar in size. A suspicious nodule projects over the right upper lobe, measuring 9 mm in diameter. There is only slight leftward shift of mediastinal structures so areas of atelectasis in the right lung coinciding with an effusion, particularly involving the right lower lobe, are suspected. The left lung remains clear. There is no pneumothorax. The cardiac, mediastinal and hilar contours appear unchanged. The bones are probably demineralized. IMPRESSION: Large right-sided pleural effusion. Suspicious nodule projecting over the right upper lobe.

19994588-RR-69

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2194-07-01 15:27:00

2194-07-01 16:41:00

INDICATION: ___ female with somnolence and lung metastases. Question intracranial hemorrhage. COMPARISON: CT dated ___ and MR dated ___. TECHNIQUE: Contiguous non-contrast axial images were acquired through the brain with multiplanar reformations. FINDINGS: A 1.6 cm hyperdense lesion is again seen in olfactory groove, compatible with known meningioma, similar in appearance as compared to ___. In remainder of the brain, there is no evidence of hemorrhage, mass effect, edema, or shift of normally midline structures. Known metastatic disease is not demonstrated on non-contrast CT imaging. The gray-white matter differentiation appears preserved. Periventricular white matter hypoattenuation is compatible with small vessel ischemic disease. Ventricles and sulci are age appropriate. Suprasellar and basilar cisterns are patent. Paranasal sinuses and mastoid air cells are well aerated with the exception of trace mucosal thickening in the posterior left maxillary sinus. The mastoids are under-pneumatized. Vascular calcifications are seen in the cavernous carotid and vertebral arteries. Globes and soft tissues are unremarkable. A sclerotic focus in the right parietal bone is again suspicious for blastic metastatic disease. IMPRESSION: 1. No acute intracranial process. 2. Stable olfactory groove meningioma. 3. Bone metastasis in the right parietal bone. Parenchymal brain metastases are not explicitly demonstrated on this study because it is a non-constrast examination, but there is no evidence for significant edema or mass effect.

19994588-RR-70

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2194-07-01 15:28:00

2194-07-01 18:13:00

INDICATION: ___ female with lung cancer and acute shortness breath since yesterday. Question pulmonary embolism. COMPARISON: Recent PET-CT from ___ an earlier diagnostic chest CT is also available from ___. TECHNIQUE: CTA of the chest was performed prior to and following administration of intravenous contrast as per CTA protocol with multiplanar reformations including oblique projections. CTA CHEST: The aorta is normal in caliber without acute pathology. Moderate calcified and noncalcified mural plaque extends into the proximal arch vessels, involves the arch, and extends the entire way of the thoracic aorta. The heart is normal in size with small amount of pericardial effusion. Multivessel coronary arterial disease is present. The pulmonary arterial tree is opacified to the subsegmental level on the right without filling defects to suggest pulmonary embolism. The right pulmonary arterial tree is somewhat attenuated by a right hilar mass and subjacent atelectasis but likely patent at least to the segmental level. Ill-defined hilar and mediastinal lymph nodes do not appear changed since the very recent prior PET-CT. A few small lung nodules and a vaguely defined right perihilar soft tissue appear unchanged and were recently characterized by PET imaging. A large right-sided pleural effusion with associated areas of atelectasis appears not significantly changed. In particular the right middle lobe is fully collapsed with patchy but widespread with lower lobe atelectasis. Central airways are again thickened bilaterally with narrowing that is particularly prominent along the right hilum. Also associated with a large pleural effusion is moderate leftward shift of mediastinal structures. A trace effusion is also present on the left. Secretions are present in the trachea (3, 26), which could be sequestered secretion vs. disease extension. Trace effusion is present on the left. Limited views of the upper abdomen are unremarkable. BONES: Widespead blastic metastatic disease is again noted. IMPRESSION: 1. No evidence of pulmonary embolism. 2. Large right-sided pleural effusion, but not significantly changed, with associated atelectasis involving portions of the right lung. Small pericardial and left-sided pleural effusions are also present. 3. Widespread blastic metastases and suspected malignant involvement of the mediastinum and right hilum, but assessed very recently with PET-CT imaging where the degree of disease activity was more optimally characterized. 4. Secretions or debris in the trachea. 5. Vascular calcifications including coronary artery calcifications. 6. Large left-sided thyroid nodule.

19994588-RR-71

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2194-07-03 00:15:00

2194-07-03 15:51:00

HISTORY: Check for worsening pleural effusion. FINDINGS: In comparison with the study of ___, there may be some further increase in the right pleural effusion, though this could reflect differences in patient position. Mild prominence of central pulmonary vessels on the right suggests some elevated pulmonary venous pressure. The left lung is essentially clear. The questioned nodule projecting over the right upper zone is again seen. It remains in conjunction with the second rib.

19994588-RR-73

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2194-07-04 11:55:00

2194-07-05 10:28:00

INDICATION: ___ woman with history of metastatic non-small cell cancer presenting with confusion and weakness. Evaluate for cord compression. COMPARISON: MRI from ___. TECHNIQUE: Multiaxial multisequence images of the cervical, thoracic and lumbar spine were obtained without the administration of contrast. FINDINGS: Images are very limited due to patient motion. This study is incomplete. Only few sequences of the thoracic and lumbar spine were obtained. The thoracic spine demonstrates normal anatomic alignment. There are multilevel Schmorl's nodes and degenerative type endplate changes. There are hypointense lesions at T12 and T6. There is no evidence of fracture. The spinal cord demonstrates normal signal intensity. No evidence of cord compression. There is no evidence of significant disc bulge, spinal canal stenosis and neural foraminal narrowing. There is a large right pleural effusion and a small left pleural effusion. LUMBAR SPINE: Images were evaluated by patient motion. This study is incomplete. There is normal anatomic alignment. There are multilevel degenerative type endplate changes. At the level of L5 on S1, there is a hypointense T1 lesion which is bright and heterogeneous on STIR which is suspicious for metastatic disease given patient's history of lung cancer. The spinal cord terminates at L1-2 level with normal distribution of the cauda equina nerve roots. At L4-5 level, there is a disc bulge, bilateral facet arthrosis and ligamentum flavum thickening causing mild spinal canal stenosis and moderate left and mild-to-moderate right neural foraminal narrowing. At L5-S1 level, there is moderate-to-severe narrowing of the right neural foramen and mild-to-moderate narrowing of the left neural foramen. No evidence of cord compression. IMPRESSION: 1. No evidence of cord compression. 2. Limited evaluation of the spine demonstrates new lesions at T6, T12, L4, L5 and S1 vertebral bodies, highly suspicious for metastatic disease. 3. Multilevel degenerative changes of the lumbar spine as described above, worse at L4-L5 and L5-S1 levels. 4. Large right pleural effusion and small left pleural effusion. Findings were communicated to the ordering physician using the radiology dashboard.

19994588-RR-74

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2194-07-04 17:13:00

2194-07-05 08:34:00

CHEST RADIOGRAPH INDICATION: Pleural effusion, status post thoracocentesis, evaluation for pneumothorax. COMPARISON: ___. FINDINGS: As compared to the previous radiograph, the patient has undergone right thoracocentesis. Right pleural effusion has substantially decreased. The remaining effusion is limited to the costophrenic sinus. There is no evidence of pneumothorax or other complications. Otherwise, unchanged radiographic appearance.

19994592-RR-21

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2134-04-07 16:53:00

2134-04-07 18:29:00

EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD INDICATION: ___ year old woman with pmhx of depression and bipolar disorder who presented to the ED with her family for concerns of AMS and ? seizure like activity, concern for intracranial process.// evaluate further mass vs hematoma TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 9 mL of Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. COMPARISON: CT performed ___. FINDINGS: In the left posterior fossa, there is a round 3.2 x 2.9 x 3.0 cm dural-based mass inseparable from the left tentorium, abutting the superolateral aspect of the left cerebellar hemisphere, presumably meningioma. It is isointense to gray matter on T1 and T2 weighted imaging with homogeneous avid enhancement. There is regional T2 prolongation within the left cerebellar hemisphere consistent with vasogenic edema with and mild effacement of the fourth ventricle. No hydrocephalus. No evidence of hemorrhage or infarction. The left transverse sinus is hypoplastic. The left distal transverse sinus and sigmoid sinus do not enhance and may be compressed or occluded by the presumed meningioma. The left internal jugular vein traits postcontrast enhancement. The remainder of the dural venous sinuses are patent. IMPRESSION: Dural-based mass in the left posterior fossa, consistent with a meningioma. There is regional vasogenic edema with mild effacement of the fourth ventricle but no obstructing hydrocephalus. No definite enhancement of the distal left transverse sinus and sigmoid sinus which may be severely compressed with occlusion a possibility. There is reconstitution of contrast enhancement of the left internal jugular vein.

19994592-RR-22

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2134-04-06 08:59:00

2134-04-06 13:37:00

INDICATION: ___ year old woman with AMS now with intracerebral mass.// patient unable to undergo MRI checklist. Eval for metal prior to MRI TECHNIQUE: Supine AP views of the neck and lower abdomen and pelvis. COMPARISON: None. FINDINGS: Neck: Osseous structures are grossly unremarkable. There is no radiopaque foreign body in the neck. Dental amalgam is noted. Lower abdomen/pelvis. Phleboliths are identified in the pelvis. There is no visualized radiopaque foreign body noting that the right lateral aspect of of the abdomen are not entirely visualized. IMPRESSION: No visualized radiopaque foreign body.

19994730-RR-26

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2169-08-26 11:53:00

2169-08-26 13:51:00

CHEST RADIOGRAPHS HISTORY: Right-sided chest pain. COMPARISONS: Chest radiographs from ___ and ___. TECHNIQUE: Chest, PA and lateral. FINDINGS: The cardiac, mediastinal, and hilar contours appear unchanged. There are patchy new opacities in the left mid-to-lower lung, predominantly in the lingula, but streaky in morphology. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Moderate anterior osteophytes are present along the mid-to-lower thoracic spine. IMPRESSION: Patchy new left mid and lower lung opacities, typical in morphology for atelectasis, although an infectious etiology is difficult to completely exclude based on the imaging.

19994730-RR-27

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2169-08-26 10:15:00

2169-08-26 11:03:00

___ man with right upper quadrant pain and right-sided chest pain, evaluate for cholecystitis. COMPARISON: CT from ___. FINDINGS: The liver is echogenic, consistent with fatty infiltration. There is no intra- or extra-hepatic ductal dilatation. The liver is of normal echogenicity in the right lobe. In the left lobe, there is an ill-defined area of hyperechogenicity of the liver parenchyma. On the CT from the same day, an area in the left lobe of the liver can be seen with different enhancement. Main portal vein is patent with appropriate hepatopetal flow. Gallbladder shows significant sludge; however, no evidence of cholecystitis with no gallbladder wall edema or pericholecystic fluid. Common bile duct is not dilated measuring 3 mm. Limited views of the left and right kidney are unremarkable. The spleen is enlarged measuring 18.3 cm without any focal lesions. IMPRESSION: 1. Gallbladder sludge without evidence of cholecystitis. 2. Splenomegaly. 3. Hyperechoic area in the left lobe of the liver is also seen on the CT from the same day. Differential includes old lymphomatous infiltration, area of greater fatty infiltration, or possibly an unusual appearance of a benign lesion such as an atypical hemangioma could be considered. There has been no definite recent change although the lesion is easier to visualize on this study. If further characterization is desired, then MR imaging may be useful.

19994730-RR-28

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2169-08-26 11:47:00

2169-08-26 13:46:00

CT TORSO HISTORY: ___ man with lymphoma, on chemo and steroids, also on therapeutic dose of Lovenox, presenting with right-sided chest pain. Also with abdominal pain. COMPARISON: ___ PET-CT and ___ CTA of the chest, abdomen and pelvis. TECHNIQUE: CTA of the chest was performed per departmental PE protocol followed by CT of the abdomen and pelvis. FINDINGS: CT OF THE CHEST: Numerous mediastinal lymph nodes are stable to slight smaller in size since the prior PET-CT. For example, a prevascular conglomerate measures 1.4 x 2.0 cm (2:16), whereas previously it measured 1.4 x 2.5 cm. A right lower paratracheal node measures 1.3 cm (2:10), whereas previously it measured 1.8 cm and a prevascular node today measures 7.2 mm whereas previously it measured 8.0 mm (2:20). Coronary calcifications are present. Tracheobronchial tree is patent to the subsegmental level. There is bilateral dependent atelectasis as well as slight scarring and pleural thickening in the right upper lobe (2:23). Again seen are filling defects within the pulmonary arteries: Left thrombus extending from the distal portions of the left main pulmonary artery extending into the lobar arteries. Evaluation of the segmental and subsegmental arteries is limited due to suboptimal contrast bolus timing. Overall, the total thrombus burden appears somewhat reduced since ___ and ___ and remaining clot appears chronic. CT OF THE ABDOMEN: Region of low attenuation in the left lobe of the liver corresponds to the hyperechoic area seen on the ultrasound from the same day. The region is similiar to extent as on prior scans, specifically the ___ CT and was not avid on PET, and indeed less avid than background liver, although more conspicuous on today's scan perhaps because of differences in technique. The area does not appear more extensive, however, and corresponds to marked volume loss in the left lateral segments and also segment IV to some extent. Caudate hypertrophy may be compensatory. The spleen is enlarged up to 17.2 cm in length. Portal vein is patent. Gallbladder has hyperdense contents consistent with sludge seen on ultrasound from the same day. Pancreas is unremarkable. Multiple celiac and retroperitoneal lymph nodes are stable since the PET-CT and from ___. As an example, a large retrocaval node (3b:118) today measures 12.1 mm and previously 12.6 mm. Bilateral adrenals are unremarkable. Bilateral kidneys enhance and excrete contrast symmetrically with no evidence of hydronephrosis. Small and large bowel loops are unremarkable. CT PELVIS: Rectosigmoid colon, bladder, and prostate are all unremarkable in this patient. Pelvic lymphadenopathy seems to have decreased as evidenced by a right-sided pelvic node (3b:152), today measuring 10 mm and prior 13 mm. No new lymphadenopathy is noted. Bilateral fat-containing inguinal hernias are stable. BONES: No suspicious lytic or sclerotic lesions. IMPRESSION: 1. Chronic pulmonary embolism with no evidence of new acute pulmonary embolism. 2. Geographical distribution of a hypodense area in the left lobe of the kidney, also seen on the ultrasound of the same day. While the relative degree of ___ is more striking on today's exam, the etiology is uncertain. This was not avid on recent PET scan. Differential includes old lymphomatous infiltration with marked atrophy involving the left lobe or atrophy of other etiology; there may be relative fatty infiltration at the site and an unusual benign lesion such as a hemangioma could also be involved. 3. Overall, extensive mediastinal, retroperitoneal, celiac and pelvic lymphadenopathy appears to be stable to slightly decreased in size since the PET-CT from ___. 4. Splenomegaly. 5. No acute intra-abdominal or intrathoracic process to explain the patient's pain.

19994730-RR-30

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2169-09-01 13:10:00

2169-09-01 17:32:00

INDICATION: ___ man with Hodgkin's lymphoma, history of bilateral PE and new oxygen requirement, concern for pneumonia or CHF. COMPARISONS: PA and lateral chest radiographs from ___. CTA of the chest from ___. TECHNIQUE: PA and lateral chest radiographs are provided. FINDINGS: Since the prior radiograph there are now small bilateral pleural effusions. Left retrocardiac opacity likely represents lower lobe pneumonia. There is no pneumothorax. The cardiomediastinal silhouette is similar in appearance to the prior radiograph. Bony structures are intact. IMPRESSION: 1. Interval development of bilateral pleural effusions. 2. Retrocardiac opacity likely represents left lower lobe pneumonia. These findings were reported to ___ by Dr. ___ telephone at 5 p.m.

19994730-RR-31

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2169-09-02 13:25:00

2169-09-02 15:14:00

INDICATION: ___ man with Hodgkin's lymphoma and atrial fibrillation, status post diuresis, interval change in pulmonary edema. COMPARISON: ___. FINDINGS: PA and lateral chest radiographs are obtained. Heart is normal size and cardiomediastinal contours are unchanged. Lungs do not demonstrate significant changes compared to the prior radiograph. Opacification of the left base represents atelectasis or consolidation. Persistent small right pleural effusion with increased small left pleural effusion. No pneumothorax. IMPRESSION: 1. Persistent small pleural effusions bilaterally. 2. Left lower lobe atelectasis or consolidation.

19994772-RR-36

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2181-03-13 00:19:00

2181-03-13 01:33:00

INDICATION: History of right frontal glioblastoma. Patient has undergone multiple resections and chemoradiation. Last surgery was on ___. Presenting with sudden onset of severe headache and vomiting. TECHNIQUE: Contiguous axial images were obtained through the brain without IV contrast. Coronal, sagittal, and thin section bone reconstruction algorithm images were prepared. COMPARISON: NECT of the head, ___ and ___. FINDINGS: Large region of encephalomalacia is seen involving most of the right frontal lobe and extends to the right lateral ventricle with ex vacuo dilatation. There is no hemorrhage, edema, shift of midline structures, or evidence of acute infarction. The basal cisterns are patent and gray-white matter differentiation is preserved. Post-surgical changes from prior right frontoparietal craniotomy are noted. The visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. IMPRESSION: 1. No acute hemorrhage or mass effect. 2. Large area of encephalomalacia in the right frontal lobe at the site of multiple prior resections.

19994772-RR-37

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2181-03-13 17:22:00

2181-03-14 12:08:00

TECHNIQUE: MRI of the brain without and with gad. HISTORY: GBM status post resection with headache, nausea, vomiting, and neck stiffness, concern for infection. COMPARISON: ___. FINDINGS: There is a large resection cavity in the right frontal lobe without any nodular enhancement. The postoperative cavity appears to have minimally increased in size. There is a right frontal cranioplasty. No fluid collection is noted superficial or deep to the cranioplasty. There are no foci of restricted diffusion. There is a stable infiltrative signal abnormality along the margin of the operative cavity and extending into the corpus callosum on the left frontal lobe which could represent combination of post-treatment changes and infiltrative neoplasm. No evidence for acute ischemia or hydrocephalus is seen.There is mild meningeal enhancement, which could be postoperative in nature, but this should be correlated with CSF studies. Ventricles are unchanged in size and configuration. IMPRESSION: Postoperative changes in the right frontal lobe, but no definite evidence for infection noted. There is mild meningeal enhancement, which could be postoperative in nature, but this should be correlated with CSF studies.

19994772-RR-38

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2181-03-14 14:38:00

2181-03-14 15:45:00

HISTORY: Glioblastoma with bacterial meningitis and hypoxia. FINDINGS: In comparison with study of ___, there are substantially lower lung volumes, which may account for much of the apparent increase in transverse diameter of the heart. No evidence of vascular congestion. There is some retrocardiac opacification medially. It is unclear how much of this could represent some volume loss or even consolidation in the lower lobe and how much could merely be a manifestation of low lung volumes and the supine portable technique. If clinically possible, lateral view would be extremely helpful. The right IJ catheter extends to about the level of the cavoatrial junction or possibly in the upper portion of the right atrium itself.

19994772-RR-39

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2181-03-16 08:35:00

2181-03-16 09:07:00

HISTORY: Brain tumor with spiking fevers. FINDINGS: In comparison with study of ___, the patient has taken a much better inspiration. Again there is an area of increased opacification in the retrocardiac region with poor definition of the descending aorta. Although this could merely reflect atelectasis, the possibility of supervening pneumonia would have to be considered in the appropriate clinical setting.

19994772-RR-41

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2181-03-16 13:24:00

2181-03-17 10:11:00

HISTORY: Bacterial meningitis. Is there evidence of epidural abscess? TECHNIQUE: Sagittal imaging was performed with T2, and T2 weighted IDEAL, and T1 technique. Several axial T2 weighted sequences were attempted. The patient was confused and unable to cooperate. After multiple attempts to obtain satisfactory precontrast images, the study was abandoned. For this reason, and no contrast agent was administered. COMPARISON: None. FINDINGS: The study is severely limited by motion artifact and the incomplete nature of the examination. Within these serious limitations, there are no findings to suggest epidural abscess. Although there are changes of degenerative disc disease, there are no findings to suggest diskitis or osteomyelitis. No abnormal fluid collections are detected. Incidentally noted are right-sided nerve root sheath cysts just distal to the neural foramina at C4-5 and C6-7. IMPRESSION: Severely limited study due to motion artifact. Although there are no findings to suggest epidural abscess, the study must be considered nondiagnostic.

19994772-RR-42

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2181-03-20 19:04:00

2181-03-21 16:00:00

CLINICAL HISTORY: ___ woman with recurrent glioblastoma presenting with bacterial meningitis. TECHNIQUE: A cervical, thoracic, and lumbar spine MRI is obtained after the administration of 7 cc of intravenous Gadavist. The following sequences are utilized: Sagittal T1, sagittal T2, axial T2, sagittal IDEAL, sagittal T1 post, and axial T1 post. Compared to an MRI from ___. FINDINGS: CERVICAL SPINE: There is multilevel degenerative disc disease, most notably at the C4-C5, C5-C6 and C3-C4 levels. Evaluation of the neural foramina and spinal canal is limited due to the motion artifact on the axial images. The vertebral bodies and disc spaces are maintained throughout the thoracic and lumbar spine. The bone marrow and spinal cord signal is unremarkable. There is no abnormal enhancement. There are no rim-enhancing collections. IMPRESSION: Study limited by motion artifact, but no definite evidence of abscess. Multilevel degenerative disc disease in the cervical spine, most prominently from the C4 through C7. Evaluation of canal and foraminal stenosis limited by motion artifact.

19994772-RR-43

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2181-03-21 15:32:00

2181-03-21 17:34:00

HISTORY: GBM status post right craniectomy and drain placed in a cyst. Evaluate for post-op changes. COMPARISON: Non-contrast head CT ___, MR ___ ___. TECHNIQUE: Contiguous axial MDCT images were obtained of the head without contrast. Coronal, sagittal and thin section bone algorithm reformats were generated. DLP: 936.52 mGy-cm. CTDIvol: 55.97 mGy. FINDINGS: Again identified is a large right frontal cystic collection from a prior resection cavity. There has been interval right frontal craniectomy and placement of a drainage catheter which terminates anteriorly at the level of the gyrus rectus. The fluid collection is smaller compared to prior examination and measures approximately 6.0 x 5.0 cm in greatest axial dimension. This cystic focus contains an air-fluid level with pneumocephalus likely from surgery and instrumentation. There has been reduction of localized mass effect with mild decrease in effacement of local sulci and the frontal horn of the right lateral ventricle. Otherwise, there is no hemorrhage, edema or infarct. Ventricles and sulci are unchanged in size and configuration compared to prior examination. The basal cisterns remain patent and there is preservation of gray-white matter differentiation. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are well aerated. The globes are unremarkable. IMPRESSION: Status post right frontal craniectomy and drainage catheter placement in a right frontal post-operative cystic collection with interval decrease in size of a fluid collection.

19994772-RR-44

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2181-03-24 22:24:00

2181-03-24 23:45:00

UNDERLYING MEDICAL CONDITION: ___ year old woman s/p craniectomy with clamped cystic drain. REASON FOR THIS EXAMINATION: Evaluate for any interval changes or reaccumulation of cyst. COMPARISON: Non contrast head CT dated ___. TECHNIQUE: Multi detector CT axial imaging of the head was obtained without intravenous contrast. Coronal and sagittal reformatted images as well as thin section images in a bone window algorithm were generated and reviewed. CTDIvol 64, DLP 1026 FINDINGS: The patient is status post right frontal craniectomy and placement of a right frontal drainage catheter, which is unchanged in position terminating anteriorly in the midline at the level of the falx. Again seen is a large right frontal cystic fluid collection with CSF density corresponding to the prior surgical resection cavity. The fluid collection is increased in size from the most recent prior CT, measuring 6.8 x 4.8 cm on axial imaging (previously 5.7 x 4.6 cm on a similar axial slice). There is a decreased air-fluid level from the prior CT compatible with decreased postoperative pneumocephalus. There is similar or slightly increased associated mass effect with effacement of the adjacent sulci and frontal horn of the right lateral ventricle. There is leftward bulging of the septum pellucidum and anterior falx without shift of normally midline structures. There is no acute intracranial hemorrhage or edema. The gray-white matter interface is preserved without evidence of acute major vascular territorial infarct. The ventricles and sulci are overall unchanged in size and configuration compared to the prior CT. The basal cisterns remain patent. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are clear bilaterally. IMPRESSION: 1. Increased size of right frontal postoperative cystic fluid collection from the most recent prior head CT of ___ without significantly increased mass effect. 2. Status post right frontal craniectomy with unchanged position of drainage catheter. NOTE ADDED AT ATTENDING REVIEW: I agree with the above interpretation, except that the volume of the cyst appears unchanged since the study of ___.

19994772-RR-45

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2181-03-28 11:21:00

2181-03-28 13:10:00

HISTORY: ___ female with low-grade temperature and bed bound, rule out DVT. COMPARISON: Bilateral leg ultrasound ___. FINDINGS: Grayscale, color and Doppler images were obtained of bilateral common femoral, femoral, popliteal and tibial veins. Normal flow, compression and augmentation is seen in all of the vessels. IMPRESSION: No evidence of deep vein thrombosis in the either leg.

19994772-RR-47

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2181-04-18 17:32:00

2181-04-18 19:14:00

HISTORY: ___ female with brain tumor status post multiple resections, now with altered mental status and fever. TECHNIQUE: MDCT images of the head were acquired without intravenous contrast. Coronal and sagittal reformatted images were reviewed. COMPARISON: MR dated ___ and CT dated ___. FINDINGS: Postoperative changes from right frontal mass resection are again seen. The large right frontal fluid collection persists measuring 6.3 x 4.6 cm, which is similar compared to prior. There is adjacent white matter hypodensity which appears unchanged. The air-fluid level has resolved. Pneumocephalus has resolved. Associated mass effect on the anterior falx appears unchanged. There is no CT evidence for acute intracranial hemorrhage, new edema, or hydrocephalus. There is preservation of gray-white matter differentiation. The basal cisterns appear patent. The visualized portions of the paranasal sinuses and mastoid air cells appear well aerated. Right frontal craniectomy changes are seen. No acute bony abnormality is detected. No acute extracranial soft tissue abnormality is detected. IMPRESSION: Stable right frontal cyst without CT evidence for acute change.

19994772-RR-48

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2181-04-18 20:57:00

2181-04-19 13:48:00

HISTORY: Status post right craniectomy and glioblastoma, now with altered mental status and fever, rule out intrathoracic process. COMPARISON: ___. FINDINGS: Frontal and lateral chest x-rays were obtained. A Port-A-Cath terminates in the lower SVC. The lungs are fully extended and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. IMPRESSION: No radiographic evidence for acute cardiopulmonary process.

19994772-RR-49

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2181-04-19 22:22:00

2181-04-20 11:13:00

HISTORY: Glioblastoma now with fevers and lumbar puncture consistent with meningitis. TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial gradient echo, T1 FLAIR, FLAIR, T2, and diffusion imaging were performed. After administration of 5 cc of Gadavist intravenous contrast, axial T1 and T1 FLAIR imaging were performed along with sagittal MP rage. The MP rage images were re-formatted into axial and coronal orientations. COMPARISON: Brain MR ___. FINDINGS: Again seen is a right frontal surgical site with postoperative changes in the adjacent brain. There is minimal enhancement surrounding the surgical site, somewhat decreased since ___. There is mild increased signal on adjacent to the surgical site on FLAIR imaging. This has not increased since the most recent study and is less prominent than on prior MR examinations. The ependymal enhancement in the occipital horns of the lateral ventricles is barely detectable on the current examination. Although these studies are somewhat limited by motion artifact, this appears to be improvement since the prior examination. Small amounts of slow diffusion material in the lateral ventricles bilaterally appear unchanged. This likely represents intraventricular pus. IMPRESSION: Study somewhat limited by motion artifact, but there appears to be a mild decrease in the intensity of enhancement around the surgical site and within the occipital horns of the lateral ventricles. Slow diffusion material in the occipital horns appears unchanged. These findings are consistent with intraventricular infection. No new abnormalities are detected.

19994772-RR-50

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2181-04-20 19:11:00

2181-04-20 22:24:00

INDICATION: Status post wound revision of craniotomy. Evaluate the postoperative surgical bed. COMPARISONS: CT of the head from ___. MRI of the head from ___. CT of the head from ___. TECHNIQUE: Continuous axial MDCT images were obtained through the brain without the administration of IV contrast. Sagittal, coronal, and thin bone reformatted images were obtained and reviewed. FINDINGS: Since prior exam, the patient has had a revision of the right frontal craniectomy wound. There is new pneumocephalus layering along the anterior right frontal convexity with the right frontal fluid collection. This large right frontal cyst is not significantly changed in size, measuring 6.1 x 4.6 cm in transverse dimension (2, 14). Mild associated mass effect on the anterior falx is unchanged. The minimal surrounding hypodensity, particularly superiorly, is unchanged. There is no evidence of postoperative hemorrhage. Within the subcutaneous tissues overlying the craniectomy site, there is a thin collection of fluid measuring 5 mm in width with an air-fluid level, extending the length along the craniectomy defect (2, 14). This is new from the prior exam. The ventricles are unchanged in size and configuration. The basal cisterns are patent. There is no evidence of a large vascular territory infarction. The visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Other than postoperative changes along the craniectomy site, the soft tissues are unremarkable. IMPRESSION: 1. New pneumocephalus layering within the large right frontal cyst, which is stable in size from the pre-operative exam. 2. New thin 5 mm fluid collection with an air-fluid level in the subcutaneous tissues along the craniectomy bed. 3. No evidence of acute hemorrhage.

19994772-RR-51

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2181-04-23 19:06:00

2181-04-24 09:12:00

HISTORY: Patient's glioblastoma and status post resection with bacterial meningitis rule out epidural abscess. TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 axial images of the cervical, thoracic and lumbar spine were obtained before gadolinium. T1 sagittal and axial images of cervical, thoracic and lumbar spine spine were acquired following gadolinium. COMPARISON: Comparison was made with the spine MRI examinations of ___ and ___. FINDINGS: There is no evidence of an epidural abscess in the cervical thoracic or lumbar region. There is no evidence of spinal cord compression seen on intrinsic spinal cord signal abnormality is identified. There is no evidence of discitis or osteomyelitis. At the visualized levels on axial images not paraspinal abscess is seen. Degenerative changes in the cervical thoracic and lumbar region are noted as described previously with disk bulging from C3-4 and C6-7. Note is made of mild enhancement of the lumbar nerve roots within the thecal sac which could be consistent with patient's history of meningitis. There is also increased fluid visualized within both facet joints at L4-5 level which could be degenerative in nature. There is A somewhat distended urinary bladder identified. IMPRESSION: 1. Somewhat motion limited study. 2. No evidence of epidural abscess discitis osteomyelitis in the cervical thoracic and lumbar region. 3. No evidence of cord compression or abnormal signal within the spinal cord. 4. Mild enhancement of the lumbar nerve roots consistent with patient's history of meningitis. 5. Areas of apparent increased signal within the lower lumbar spinal canal on post gadolinium sagittal T1 images are artifactual.

19994873-RR-8

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2160-03-07 20:22:00

2160-03-07 21:48:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man s/p fall I/s/o weakness// rule out infection TECHNIQUE: Chest two views COMPARISON: None FINDINGS: Increased heart size, pulmonary vascular congestion. No edema. Suboptimal lateral radiograph with arms down. Suggestion of small pleural effusion. Minimal basilar opacities, likely atelectasis. Repeat lateral radiograph would be helpful. Surgical clips right upper quadrant. No pneumothorax. Acute to early subacute fracture of the distal right clavicle. IMPRESSION: Increased heart size, mild pulmonary vascular congestion. Suggestion of pleural effusion. Basilar opacity, likely atelectasis, repeat lateral radiograph suggested. Acute or subacute fracture distal right clavicle.

19995012-RR-136

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2161-02-12 09:43:00

2161-02-12 14:10:00

INDICATION: ___ with dyspnea on exertion. pulm edema? pneumonia? TECHNIQUE: Frontal and lateral views the chest. COMPARISON: ___. FINDINGS: Slightly lower lung volumes on the current exam. Lungs remain clear without consolidation, effusion, or edema. Cardiomediastinal silhouette is stable. Atherosclerotic calcifications seen at the aortic arch. No acute osseous abnormalities, hypertrophic changes again noted in the spine. IMPRESSION: No acute cardiopulmonary process.

19995012-RR-137

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2161-02-12 10:49:00

2161-02-12 11:30:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with fall, head strike, left sided headache. // bleed? fracture? TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.4 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: Noncontrast head CT ___ FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in size and configuration. There is no evidence of fracture. There is a mucus retention cyst in the right maxillary sinus. Otherwise, the remaining visualized portions 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 abnormality. No evidence acute intracranial hemorrhage or fracture.

19995012-RR-138

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2161-02-12 10:50:00

2161-02-12 11:51:00

EXAMINATION: CT C-SPINE W/O CONTRAST INDICATION: ___ with fall, head strike, left sided headache. // bleed? fracture? bleed? fracture? TECHNIQUE: Non-contrast helical multidetector CT was performed through the cervical spine. Soft tissue and bone algorithm images were generated. Coronal and sagittal reformations were then constructed. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.9 s, 22.8 cm; CTDIvol = 37.1 mGy (Body) DLP = 847.5 mGy-cm. Total DLP (Body) = 848 mGy-cm. COMPARISON: CT neck ___ Cervical radiographs ___ FINDINGS: Alignment is normal. No fractures are identified. There is no prevertebral soft tissue swelling. Degenerative changes notable for disc bulges and thickening of the ligamentum flavum. Disc protrusion at C2-3 and C3-4 effaces the ventral CSF and may contact the ventral aspect of the cord. Thyroid is small but grossly unremarkable. Lung apices are notable for a 3 mm right apical nodule (3:70), unchanged from prior. IMPRESSION: No acute fracture or malalignment of the cervical spine. A 3 mm right apical pulmonary nodule unchanged since prior ___. RECOMMENDATION(S): If patient has risk factors such as smoking or malignancy, ___ year followup suggested for followup of a 3 mm right apical pulmonary nodule. Otherwise no additional imaging necessary.

19995012-RR-139

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2161-02-12 10:50:00

2161-02-12 12:59:00

EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST INDICATION: ___ with fall with head strike, left ZMC tenderness // left ZMC fracture? TECHNIQUE: Helical axial images were acquired through the facial bones. Bone and soft tissue reconstructed images were generated. Coronal and sagittal reformatted images were also obtained. DOSE: Acquisition sequence: 1) Spiral Acquisition 2.8 s, 22.1 cm; CTDIvol = 25.9 mGy (Head) DLP = 572.9 mGy-cm. Total DLP (Head) = 573 mGy-cm. COMPARISON: None. FINDINGS: There is no facial bone fracture. Pterygoid plates are intact. There is no mandibular fracture and the temporomandibular joints are anatomically aligned. The orbits are intact. The globes and extra-ocular muscles are unremarkable. There is no orbital hematoma. Included paranasal sinuses are clear besides a mucous retention cyst in the right maxillary sinus. Included extracranial soft tissues are unremarkable. IMPRESSION: No fracture.

19995012-RR-141

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2161-02-15 23:31:00

2161-02-16 00:05:00

EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ year old woman with hx of HTN and recent fall with continued HA and elevated blood pressure // r/o acute process/bleed 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 14.0 s, 14.3 cm; CTDIvol = 49.3 mGy (Head) DLP = 702.4 mGy-cm. Total DLP (Head) = 702 mGy-cm. COMPARISON: CT head without contrast ___ FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. There is prominence of the ventricles and sulci suggestive of involutional changes. There is no evidence of fracture. Small mucous retention cyst is noted in the right anterior ethmoid sinus. The visualized portion of the orbits are unremarkable. IMPRESSION: 1. No acute intracranial process.

19995012-RR-143

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2161-04-27 03:10:00

2161-04-27 04:41:00

EXAMINATION: CT abdomen and pelvis INDICATION: NO_PO contrast; History: ___ with rapid onset abdominal pain, diffuse, diarrhea. NO_PO contrast*** WARNING *** Multiple patients with same last name!// Evaluate for volvulus, SBO, intraabdominal infection 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 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP = 15.6 mGy-cm. 2) Spiral Acquisition 5.0 s, 54.0 cm; CTDIvol = 16.8 mGy (Body) DLP = 905.5 mGy-cm. Total DLP (Body) = 921 mGy-cm. COMPARISON: CT abdomen and pelvis ___ FINDINGS: LOWER CHEST: Visualized lung fields are within normal limits. There is no evidence of pleural or pericardial effusion.Mild coronary artery calcifications ABDOMEN: HEPATOBILIARY: The liver demonstrates mild steatosis. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically absent. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. 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. Multiple cysts are seen in bilateral kidneys the largest measuring 2.4 cm in the upper pole of the right kidney. There is no evidence of hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. A duodenal diverticulum is noted. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Extensive sigmoid diverticulosis. The rectum is within normal limits. The appendix is normal. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The uterus is surgically absent. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Moderate degenerative changes of the thoracolumbar spine and bilateral hip joints noted. SOFT TISSUES: Re-demonstrated are 2 midline, ventral abdominal wall hernias. A supraumbilical hernia contains nonobstructed loops of transverse colon. The umbilical hernia contains a loop of nonobstructed small bowel as well as a small amount of fluid. Just inferior to the umbilicus, hernia repair mesh scarring is seen, similar to the prior study IMPRESSION: 1. Re-demonstrated are 2 midline, ventral abdominal wall hernias-the hernia located more cranially contains a small segment of the nonobstructed transverse colon, while the hernia located caudally contains a small portion of a small bowel loop. There is trace fluid within the hernial sac containing the small bowel however no transition point or other evidence to suggest bowel obstruction noted. There has been prior mesh repair of the ventral abdominal wall and the mesh is located inferior to the latter hernial sac. 2. Mild hepatic steatosis, extensive sigmoid diverticulosis, severe atherosclerotic calcification of the abdominal aorta and its branches with focal narrowing (up to 50%) at the origin of the celiac artery are additional incidental findings. NOTIFICATION: The findings were discussed with ___ by ___ ___, M.D. on the telephone on ___ at 11:06 am, 20 minutes after discovery of the findings.

19995012-RR-144

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2161-04-27 15:10:00

2161-04-27 16:12:00

EXAMINATION: CHEST (PRE-OP PA AND LAT) INDICATION: ___ NIDDM, CAD (cath ___ and PDA occlusion not amenable to revascularization), hyperlipidemia presents with an incarcerated ventral hernia// preop TECHNIQUE: Chest two views COMPARISON: ___ FINDINGS: Increased heart size, accentuated by shallow inspiration, more prominent since prior. Mildly prominent pulmonary vascularity. No pulmonary edema. Prominent main pulmonary artery, suggest pulmonary artery hypertension, stable. No effusion. No pneumothorax. Minimal basilar opacities, likely atelectasis. IMPRESSION: Shallow inspiration accentuates heart size, pulmonary vascularity. Suggestion of pulmonary artery hypertension.

19995127-RR-40

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2138-03-07 14:30:00

2138-03-07 16:30:00

HISTORY: ___ male, with altered mental status changes and depression. Assess for intracranial hemorrhage. COMPARISON: None. TECHNIQUE: Non-contrast MDCT images were acquired through the head. FINDINGS: There is no acute intracranial hemorrhage, mass effect, edema or major vascular territorial infarct. The ventricles and sulci are mildly prominent, compatible with age-related global atrophy. There are moderate-to-significant periventricular and subcortical white matter hypodensities, nonspecific, but most likely representing chronic microvascular ischemic changes. The gray-white matter differentiation is preserved. There is no acute skull fracture. There is scattered ethmoidal mucosal thickening. The remaining visualized paranasal sinuses and mastoid air cells are clear. IMPRESSION: 1. No acute intracranial process. No intracranial hemorrhage. 2. Chronic microvascular ischemic changes with global atrophy.

19995127-RR-41

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2138-03-07 18:59:00

2138-03-08 09:45:00

CLINICAL HISTORY: Cough, evaluate for pneumonia. CHEST, PA AND LATERAL COMPARISON FILM: ___. A mass is present in the superior segment of the left lower lobe and therefore malignancy must be considered. Elsewhere, the left lung appears clear. There is no effusion. Calcified pleural plaque is present in the right mid zone. The right lung appears clear. Some tracheal displacement to the right is present at the thoracic inlet probably due to thyroid, but lymph nodes should also be considered. IMPRESSION: Left lung mass. CT should be performed.

19995127-RR-42

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2138-03-07 20:33:00

2138-03-07 22:19:00

HISTORY: Mass on chest radiograph. TECHNIQUE: CT images were obtained through the chest after the uneventful intravenous administration of 75 cc of Omnipaque contrast media. Multiplanar reformations were prepared. COMPARISON: ___, CT abdomen ___ FINDINGS: The left thyroid lobe remains heterogeneous and enlarged as on previous studies in this patient status post recent radioactive iodine therapy on ___ (2:2). The aorta and major branches are patent and normal in caliber with mild atherosclerotic calcifications. The heart and pericardium are unremarkable without pericardial effusion. The previously described anterior mediastinal lesion concerning for thymoma has resolved. An 8.5 x 6.8 x 6.0 cm mass (602b:49 and 2:30) traverses the left major fissure involving superior segment of the left lower lobe as well as the inferior aspect of the apicoposterior segment of the left upper lobe. The mass exerts marked local mass effect resulting in segmental occlusion of the left lower lobe pulmonary artery with distal reconstitution (2:32 and 601b:32), mild attenutation of the left upper lobe airways and moderate compression of the left lower lobe bronchus without lobar collapse. Mild septal thickening and ground glass opacity along the lateral and inferior aspect of the lesion could reflect lymphangitic spread of tumor, mild atelectasis or postobstructive changes. The lesion drapes along 180 degrees of the descending thoracic aortic circumference with somewhat blurred fat planes (2:26) and extends along the medial aspect of the posterior pleura at the site of a calcified pleural plaque without accompanying pleural effusion. A confluent soft tissue projection extends from the lesion into the mediastinum measuring 3.7 x 4.2 cm (2:24) with anterior and rightward displacement of the carina and esophagus and mild attenuation of the left mainstem bronchus. The esophagus appears compressed with circumferential esophageal mural thickening noted slightly more distally (2:27). Multiple subcentimeter right upper paratracheal lymph nodes are notable in number (2:14). Moderate predominantly centrilobular emphysema is unchanged. Bilateral calcified pleural plaques and a predominantly basilar subpleural interstitial abnormality is consistent with the previous diagnosis of asbestosis. The trachea and right-sided airways appear patent to the segmental level. A right major fissural 5 mm nodule is unchanged (4:104). Although this study is not tailored for subdiaphragmatic evaluation the imaged upper abdomen reveals unchanged nodularity in the lateral limb of the left adrenal gland measuring 9 mm and body of the left adrenal gland measuring 12 mm (2:61 and 58), which is stable. OSSEOUS STRUCTURES: No definite lytic or blastic bony lesion is seen to suggest malignancy with mild heterogeneity in the T3 vertebral body of uncertain significance. IMPRESSION: 1. 8.5 cm left upper and lower lobe mass traverses the major fissure, infiltrates the mediastinum with loss of fat planes with the esophagus, and occludes a short segment of the left lower lobe pulmonary artery with distal reconstitution. Mild narrowing of the left upper and lower lobe airways without lobar collapse. Mild surrounding septal thickening could reflect postobstructive changes or lymphangitic tumor spread. 2. Esophageal compression and thickening from the mass, correlate for history of dysphagia. 3. Pleural plaques with subpleural reticulation consistent with asbestosis from prior exposure. 4. Moderate emphysema. 5. Heterogeneous enlarged left thyroid gland as before status post recent radioactive iodine therapy. 6. Unchanged left adrenal nodularity. While the nodules were of indeterminate density on prior non-contrast abdominal CT examinations, stability in size since ___ suggests benignity. 7. Mild heterogeneity in the T3 vertebral body is nonspecific and can be correlated with bone scan if indicated. Preliminary findings were discussed with Dr. ___ by Dr. ___ at 2215 on ___ by phone.

19995127-RR-53

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2138-05-10 11:09:00

2138-05-10 12:26:00

INDICATION: Hypotension, on chemotherapy, here to evaluate for acute cardiopulmonary process. COMPARISON: Chest radiographs dated ___ and ___. CT chest with contrast dated ___. TECHNIQUE: Portable semi-erect frontal radiograph of the chest. FINDINGS: In comparison to the most recent prior study, there is increased opacification in the medial right lung base which may represent an early developing pneumonia in the appropriate clinical context but could also represent atelectasis. A large left juxtahilar mass is unchanged, corresponding to the patient's biopsy-proven small cell carcinoma, better characterized on recent CT of the chest. Bilateral calcified pleural plaques are present. No significant pleural effusion or pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size but stable. The thoracic aorta is tortuous. The trachea is midline. IMPRESSION: 1. Slightly increased opacification at the medial right lung base could represent an early developing pneumonia in the appropriate clinical context or, alternatively, atelectasis. 2. Left juxtahilar mass corresponding to known small cell carcinoma, better characterized on recent CT of ___. 3. Calcified pleural plaques compatible with prior asbestos exposure.

19995127-RR-54

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2138-05-10 13:30:00

2138-05-10 15:59:00

HISTORY: ___ male with history of metastatic non-small cell lung carcinoma, now presenting after a fall; assess for intracranial hemorrhage. COMPARISON: Non-contrast head CT from ___ and enhanced MR studies from ___ and ___. TECHNIQUE: MDCT axial images of the brain were obtained without intravenous contrast. Bone and soft tissue algorithms were reviewed. Coronal and sagittal reformations were prepared. CT HEAD WITHOUT INTRAVENOUS CONTRAST: There is ___ hemorrhage, mass, mass effect, or acute large territorial infarction. Extensive hypoattenuation in the centra semiovale and periventricular white matter is unchanged from prior and consistent with sequelae of chronic small vessel ischemic disease. Mild proportionate enlargement of the ventricles and sulci is consistent with age-related global atrophy. A previously seen tiny focus of enhancement within the left cerebellum has ___ clear correlate on the non-contrast head CT. ___ focus of new edema is identified to suggest development of underlying new metastatic lesion. ___ scalp hematoma or acute skull fracture is identified. IMPRESSION: 1. ___ acute intracranial process. 2. Previously seen 3 mm enhancing lesion within the left cerebellar hemisphere is without correlate on this non-contrast head CT; note that this lesion ___ longer enhanced on the more recent MR. ___ evidence of new mass lesion.

19995127-RR-55

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2138-05-10 13:31:00

2138-05-10 19:27:00

HISTORY: ___ male with small cell lung carcinoma status post chemotherapy. Patient now presenting after syncopal episode with hypotension. Assess for pulmonary embolism or traumatic injury. COMPARISON: CT chest with contrast from ___, PET-CT from ___, CT abdomen and pelvis from ___ TECHNIQUE: MDCT-acquired axial images from the thoracic inlet to the lung bases were displayed with 1.25- and 2.5-mm slice thickness. Arterial phase imaging through the chest was acquired. Subsequently, delayed phase imaging was acquired through the abdomen or pelvis and displayed with 5-mm slice thickness. Intravenous contrast was administered. Coronal, sagittal, and MIP oblique reformations were prepared. CT CHEST WITH INTRAVENOUS CONTRAST: Heterogeneous enlargement of the left thyroid gland is stable compared to prior examination. Aside from known tumor, remaining mediastinal lymph nodes are subcentimeter and appear unchanged compared to prior examination. No supraclavicular or axillary lymphadenopathy is identified. The heart size is normal, and there is no pericardial effusion. Thoracic aorta is non-aneurysmal and patent. Known small cell lung carcinoma within the posterior segment of the left upper lobe and within the superior segment of the left lower lobe is similar to recent prior examination from 11 days prior. Inferior portion measures 26 x 31 mm as compared to 23 x 25 mm previously. Superior portion measures 44 x 27 mm as compared to 48 x 27 mm previously (2A:54). The superior segment left lower lobe bronchus continues to contain tumor, however, is not fully occluded, unchanged. Tumoral invasion and thrombus within the left lower lobe pulmonary artery appears unchanged (2A:60). The remainder of the pulmonary arterial tree is widely patent without sign of superimposed acute pulmonary embolism. No distal propagation of tumoral thrombus is evident. Irregular opacities within the posterior right upper lobe (2A:46 and 54) are stable compared to prior examination, are are likely infectious or inflammatory in etiology. Previously described sub-3-mm pulmonary nodules are not well characterized on this examination likely due to differences in technique. No new suspicious pulmonary nodule or mass is identified. Diffuse emphysema is unchanged. Numerous calcified pleural plaques are unchanged and consistent with asbestosis. There is mild basilar atelectasis. CT ABDOMEN WITH INTRAVENOUS CONTRAST: Focal irregular arterial enhancement within the hepatic dome is not seen on delayed phase imaging and likely reflects a perfusional abnormality. No suspicious hepatic lesion is identified. Hepatic veins and portal venous system are grossly patent. No intra- or extra-hepatic biliary ductal dilatation is identified. Tiny hypodense foci within the gallbladder may reflect nitrogen-containing stones. The gallbladder is otherwise unremarkable. The spleen, pancreas, and right adrenal gland are normal. An 11 mm indeterminate left adrenal nodule is stable dating back to ___, likely a small adenoma. The kidneys enhance symmetrically without suspicious focal lesion or hydronephrosis. Subcentimeter hypodensities within the left kidney remain too small to characterize, though likely small cysts. No perinephric fluid collection or hydronephrosis is evident. No pathologically enlarged mesenteric or retroperitoneal lymph nodes are identified. The stomach and small bowel loops are normal in caliber and configuration without evidence of obstruction or inflammation. The appendix is visualized and is normal. No abdominal free fluid or free air is evident. The abdominal aorta and branch vessels are non-aneurysmal and patent. Redemonstrated is aneurysmal dilatation of the left common iliac artery measuring 4.2 x 4.5 cm. Thrombosis of >75% of the left common iliac aneurysm is stable. Distal flow is preserved to the left external iliac, internal iliac, and common femoral artery. CT PELVIS WITH INTRAVENOUS CONTRAST: Rectum and colon are normal in caliber and configuration without evidence of obstruction or inflammation. A Foley catheter and a small amount of air are seen within the urinary bladder. Prostatic enlargement is unchanged from prior. A hypodense lesion within the anterior aspect of the prostate gland is stable and likely represents a small cyst (2B:185). There is no pelvic free fluid. No pathologically enlarged pelvic or inguinal lymph nodes are identified. BONES AND SOFT TISSUES: No bone destructive lesion or acute fracture is identified. Heterogeneity of the sacrum is unchanged compared to ___, findings consistent with a benign process. No bone destructive lesion is identified. IMPRESSION: 1. Stable small cell lung carcinoma within the left upper and lower lobes with invasion into the mediastinum. Ongoing tumoral invasion into the left lower lobe bronchus and left lower lobe pulmonary artery. Findings are unchanged compared to recent prior examination from ___. 2. No superimposed acute pulmonary embolism 3. Ground-glass nodules within the right upper lung persist, though are likely infectious/inflammatory in etiology. Attention on followup is recommended. Additional millimeteric pulmonary nodules not seen likely due to technical differences. 5. Stones in an otherwise normal gallbladder. 6. Stable 11-mm left adrenal lesion, likely an adenoma. 7. Stable 4.5-cm partially thrombosed left common iliac aneurysm 8. Stable prostatic enlargement with an anterior prostatic cyst. 9. Stable heterogeneous enlargement of the left lobe of the thyroid gland which can be characterized by ultrasound if it has not been done previously.

19995258-RR-84

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2130-06-09 00:28:00

2130-06-09 11:06:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with NGT // ?NGT placement ?NGT placement COMPARISON: ___ IMPRESSION: NG tube tip is in the distal esophagus and should be advanced at least 15 cm. Heart size is normal. Mediastinum is normal. Bibasal opacities are linear and most likely represent atelectasis. Upper lungs are clear. There is no pleural effusion or pneumothorax.

19995258-RR-85

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2130-06-10 14:18:00

2130-06-10 15:28:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with ET tube s/p ex lap // eval ET tube and NGT eval ET tube and NGT IMPRESSION: In comparison with the study of ___, there has been placement of an endotracheal tube with its tip approximately 3.5 cm above the carina. Nasogastric tube extends to the stomach, though the side port is above the esophagogastric junction. Basilar opacifications consistent with atelectasis are less prominent on the current study.

19995258-RR-86

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2130-06-11 09:47:00

2130-06-11 12:33:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with large bowel obstruction s/p sigmoid colectomy, ileocecectomy, TAH/BSO, and diverting loop ileostomy who has been given large volume resuscitation and is still on neo gtt. // please eval for interval change please eval for interval change COMPARISON: Prior chest radiographs since ___ most recently ___. IMPRESSION: Mild pulmonary edema is improving, but following tracheal extubation severe bibasilar atelectasis, stable on the right, as worsening on the left, and there is new bilateral pleural effusion, moderate on the right, small on the left. Heart size top-normal unchanged. Esophageal drainage tube ends in the stomach. No pneumothorax.

19995258-RR-87

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2130-06-12 03:58:00

2130-06-12 13:25:00

EXAMINATION: Portable chest radiograph INDICATION: ___ year old woman with large bowel obstruction s/p sigmoid colectomy, ileocecectomy, TAH/BSO, and diverting loop ileostomy who has been given large volume resuscitation and has increased O2 requirement // please eval for interval change TECHNIQUE: Portable chest COMPARISON: Portable chest radiograph dated ___ FINDINGS: In comparison to the chest radiograph obtained 1 day prior, right greater than left left pleural effusions are probably unchanged, taking into account changes in patient positioning. Bibasilar atelectasis is also unchanged. Lungs are otherwise clear without focal consolidations. Heart size and cardiomediastinal silhouette are unchanged. Mild pulmonary edema has resolved. IMPRESSION: Unchanged, bilateral, moderate pleural effusions with associated bibasilar atelectasis. Interval resolution of mild pulmonary edema.

19995478-RR-36

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2128-07-01 10:29:00

2128-07-01 15:00:00

EXAMINATION: TRAUMA INDICATION: ___ man status post motor vehicle accident. TECHNIQUE: Frontal chest radiograph COMPARISON: Same day CT torso. FINDINGS: Patient is status post right upper lobectomy as seen on CT. The lungs are grossly clear. Chronic blunting of the right lateral costophrenic angle, likely related to prior surgery. Cardiomediastinal silhouette is within normal limits. There is a displaced fracture of the mid left clavicle better demonstrated on same day CT torso. IMPRESSION: 1. Displaced fracture of the mid left clavicle. 2. No acute cardiopulmonary process.

19995478-RR-37

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2128-07-01 11:03:00

2128-07-01 11:43:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with trauma// trauma TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained without intravenous contrast. Coronal and sagittal reformats were also performed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 19.8 cm; CTDIvol = 45.7 mGy (Head) DLP = 903.1 mGy-cm. 2) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 100.3 mGy-cm. Total DLP (Head) = 1,003 mGy-cm. COMPARISON: Brain MRI from ___. FINDINGS: There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or acute major vascular territorial infarct. Gray-white matter differentiation is preserved. Ventricles and sulci are unremarkable. Basilar cisterns are patent. Included paranasal sinuses and mastoids are essentially clear. Skull and extracranial soft tissues are unremarkable. IMPRESSION: No acute intracranial process. No hemorrhage.

19995478-RR-38

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2128-07-01 11:04:00

2128-07-01 11:44:00

EXAMINATION: CT C-SPINE W/O CONTRAST INDICATION: ___ with trauma// trauma MVC, T bone. 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 5.3 s, 21.0 cm; CTDIvol = 22.7 mGy (Body) DLP = 476.3 mGy-cm. Total DLP (Body) = 476 mGy-cm. COMPARISON: None. FINDINGS: Alignment is normal. No fractures are identified. There is no prevertebral edema. Degenerative changes are most notable at C5-6 and C6-7 with intervertebral disc height loss, posterior osteophytes and uncovertebral joint hypertrophy. There is secondary mild to moderate canal narrowing at these levels. Moderate two severe right foraminal narrowing noted at the latter level. Moderate bilateral foraminal narrowing noted at C5-6 and on the left at C6-7. The visualized lung and thyroid are unremarkable. IMPRESSION: 1. No acute fracture or traumatic malalignment. 2. Multilevel degenerative changes as above.

19995478-RR-39

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2128-07-01 11:04:00

2128-07-01 12:08:00

EXAMINATION: CT torso. INDICATION: ___ with trauma// trauma 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 8.6 s, 68.1 cm; CTDIvol = 23.9 mGy (Body) DLP = 1,627.1 mGy-cm. Total DLP (Body) = 1,627 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. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. 9 mm right paratracheal lymph node is noted. 1.0 cm adjacent right paratracheal lymph node is seen more superiorly. No mediastinal mass or hematoma. The right hilum demonstrates postoperative changes following right upper lobectomy. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: There is a 7 mm pulmonary in the left upper lobe, (series 2, image 50). There is a 4 mm subpleural pulmonary nodule in the right lower lobe, (series 2, image 69) and a 3 mm right middle lobe nodule (02:50). There are patchy areas of atelectasis at the lung bases. Central airways are patent. Regions of mucous plugging with bronchial wall thickening noted in the right lower lobe segmental and subsegmental bronchi. 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: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. Tiny hypodensity at the upper pole the right kidney is too small to characterize but statistically a cyst. There is no evidence of focal suspicious renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: Small hiatal hernia, otherwise the stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon and rectum are within normal limits. The appendix is not visualized. There is no evidence of mesenteric injury. There is no free fluid or free air in the abdomen. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate is enlarged, slightly protruding into the inferior bladder. The 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 or retroperitoneal hematoma. Mild atherosclerotic disease is noted. BONES: There is a displaced comminuted fracture of the mid left clavicle. Chronic right posterior right rib fracture is noted. There is bilateral L4 spondylolysis resulting in grade 2 spondylolisthesis of L4 on L5. The vertebral bodies of L4 and L5 are fused together suggesting that the changes at L4-5 are chronic. There is hematoma within the right abdominal musculature just anterior to the right iliac wing with subcutaneous stranding in the overlying soft tissues as well as extension medially to overlie the iliacus. A 6 mm high-density focus just anterior to the bone (3:171) could represent a small osseous fragment (though no donor site identified), versus extravasation of contrast. Right L5 transverse process fracture is acute. SOFT TISSUES: The abdominal and pelvic wall is otherwise within normal limits. IMPRESSION: 1. Displaced comminuted fracture of the mid left clavicle. 2. Hematoma within the right lateral abdominal musculature adjacent to the right iliac wing with small hematoma overlying the left iliacus as well. Associated small high density 6 mm focus overlying the iliac bone, potentially small fracture fragment (though no donor site identified) versus extravasation of contrast. 3. Acute right L5 transverse process fracture. 4. No acute intra-abdominal process. No sequela of trauma in the abdomen and pelvis. 5. The patient is status post right upper lobectomy with expected postsurgical changes without evidence of disease recurrence in the surgical bed. 6. There are a few pulmonary nodules in the measuring up to 7 mm. Follow-up will be necessary unless imaging performed elsewhere document long-term stability. RECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules measuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient, with an optional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is recommended. See the ___ ___ Society Guidelines for the Management of Pulmonary Nodules Incidentally Detected on CT" for comments and reference: ___ NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:02 pm, 5 minutes after discovery of the findings. Updated findings were discussed with Dr. ___ by Dr. ___ at 14:04 the same day.

19995593-RR-11

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2110-11-18 17:26:00

2110-11-18 18:16:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with CODE STROKE TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed images were obtained. DOSE: This study involved 3 CT acquisition phases with dose indices as follows: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced Acquisition 10.0 s, 17.5 cm; CTDIvol = 52.7 mGy (Head) DLP = 921.6 mGy-cm. Total DLP (Head) = 935 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence of acute major vascular territorial infarction, hemorrhage, edema, or mass. Bilateral periventricular and subcortical white matter hypodensities are nonspecific but may be the sequela of chronic small vessel ischemic changes. Prominence of the ventricles and sulci are compatible with age related involutional changes. Atherosclerotic calcifications are noted within the bilateral carotid siphons. No osseous abnormalities seen. There is mild mucosal thickening within the bilateral maxillary and ethmoid sinuses. Sphenoid sinuses are clear. Mastoid air cells and middle ear canals are clear. The orbits are unremarkable. IMPRESSION: No acute intracranial process.

19995593-RR-12

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2110-11-18 18:39:00

2110-11-18 21:10:00

EXAMINATION: CTA HEAD AND CTA NECK INDICATION: History: ___ with L leg TIA, hx R carotid CEA 1 month prior, eval per code stroke // eval ? r carotid stenosis (s/p CEA) TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the brain during infusion of Omnipaque intravenous contrast material. Three-dimensional angiographic volume rendered, curved reformatted and segmented images were generated. This report is based on interpretation of all of these images. DOSE: This study involved 4 CT acquisition phases with dose indices as follows: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Stationary Acquisition 7.0 s, 0.5 cm; CTDIvol = 76.2 mGy (Head) DLP = 38.1 mGy-cm. 4) Spiral Acquisition 5.4 s, 42.2 cm; CTDIvol = 35.7 mGy (Head) DLP = 1,506.9 mGy-cm. Total DLP (Head) = 1,545 mGy-cm. COMPARISON: No prior CTA. Prior head CT dated ___. FINDINGS: Head CTA: There is arthrosclerotic irregularity and narrowing of the distal left vertebral artery. There is a severe stenosis and near occlusion of basilar artery. There is narrowing of the distal left internal carotid artery extending into the proximal anterior and middle cerebral arteries. There is no evidence of aneurysm or malformation. There is a fetal type left PCA. Neck CTA: Patient is status post right carotid endarterectomy with expected surgical changes. These include swelling at the surgical site as well as a patulous vessel and small areas of apparent dissection at the proximal and distal anastomoses. There is moderate atherosclerotic calcification of the aortic arch within normal three-vessel takeoff. The vertebral arteries are patent without evidence of significant stenosis. The left vertebral artery is noted to be dominant. There is calcified plaque involving the left carotid bifurcation with proximal left ICA narrowing of approximately 35-40%. The there is no evidence of stenosis of the right internal carotid artery by NASCET criteria. There is interlobular septal thickening and mosaic attenuation in the included lungs which is a nonspecific finding but may be seen with pulmonary edema. The pulmonary artery is enlarged suggestive of pulmonary arterial hypertension. Mildly enlarged mediastinal and hilar lymph nodes are noted which may be reactive. The thyroid gland is atrophic but normal. The salivary glands image normally. There are degenerative changes in the spine. IMPRESSION: 1. No evidence of aneurysm or vascular malformation 2. Atherosclerotic irregularity and narrowing of the left distal intracranial vertebral artery and basilar artery. 3. Patient is status post right carotid endarterectomy with expected postsurgical changes including a patulous vessel and small dissections at the proximal and distal anastomoses. 4. Calcification of the left carotid bifurcation with resulting 35-40% narrowing of the proximal left internal carotid artery. 5. Enlarged pulmonary artery compatible with pulmonary arterial hypertension. RECOMMENDATION(S): Interlobular septal thickening, mosaic attenuation, and mildly enlarged mediastinal and hilar lymph nodes are noted in the included lung fields which could be seen in the setting of pulmonary edema. Clinical correlation is recommended.

19995593-RR-13

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2110-11-18 23:37:00

2110-11-19 09:17:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with episodic ___ weakness // r/o infection TECHNIQUE: CHEST (PORTABLE AP) COMPARISON: None. IMPRESSION: Heart size and mediastinum are mildly enlarged. The patient is after median sternotomy and CABG. Lung volumes are preserved. Mild interstitial changes are noted bilaterally, potentially representing chronic changes but mild interstitial edema is a possibility. No definitive focal consolidations to suggest infectious process demonstrated. No pleural effusion or pneumothorax.

19995593-RR-14

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2110-11-19 20:11:00

2110-11-20 09:38:00

EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD INDICATION: ___ year old man with extensive vascular history and recent R CEA, presents with sterotyped episodes of LLE weakness without sensory change // stroke eval TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was performed with gradient echo, FLAIR, diffusion, and T2 technique. COMPARISON: Head CT and CTA ___ FINDINGS: There is no evidence of hemorrhage, edema, masses, mass effect, midline shift or infarction. The ventricles and sulci are normal in caliber and configuration. There is periventricular and subcortical white matter hyperintensity on the FLAIR images suggesting chronic small vessel ischemia. No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. The visualized portion of the vascular flow foids are preserved. IMPRESSION: 1. Findings suggesting chronic small vessel ischemia. Otherwise normal study with no evidence of hemorrhage or infarction

19995595-RR-10

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2126-10-22 05:37:00

2126-10-22 08:32:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change// ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change IMPRESSION: Comparison to ___. The monitoring and support devices are stable. Moderate cardiomegaly persists. Minimal bilateral pleural effusions. Signs of mild pulmonary edema. No new focal parenchymal changes.

19995595-RR-11

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2126-10-21 19:38:00

2126-10-21 20:16:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with hypoxemic respiratory failure, two episodes of desaturation this afternoon.// Atelactasis, new consolidation TECHNIQUE: AP radiograph of the chest. COMPARISON: Chest radiograph ___ at 05:37. IMPRESSION: The support lines and tubes are in stable position. Low lung volumes are noted. Small bilateral pleural effusions and bibasilar opacities are unchanged. There is no overt pulmonary edema. The cardiomediastinal silhouette is stable in appearance. No acute osseous abnormalities are identified.

19995595-RR-13

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2126-10-23 05:50:00

2126-10-23 14:48:00

EXAMINATION: CHEST (PORTABLE AP) ___ INDICATION: ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change// ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change ___ year old man with ruptured aortobifem now intubated w/ evolving RLL consolidation please eval for change IMPRESSION: Compared to chest radiographs ___ through ___. Left lower lobe collapse unchanged. Mild pulmonary edema more pronounced in the right lung, moderate right pleural effusion is small left pleural effusion unchanged. No pneumothorax. Heart size normal. Cardiopulmonary support devices in standard placements.

19995595-RR-14

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2126-10-24 05:36:00

2126-10-24 15:38:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man who presented with ruptured aorta bifem anastomosis s/p proximal aortic cuff x4. Currently intubated.// assess for lung volumes TECHNIQUE: Chest AP film COMPARISON: ___ FINDINGS: In comparison to study completed on ___, there is increased vascular congestion bilaterally. Low lung volumes bilaterally with bilateral atelectasis. Moderate layering pleural effusion on the right and small pleural effusion on the left. Borderline cardiomediastinal silhouette. Trachea is patent, midline. No pneumothorax. ET tube is about 5.6 cm above the carina. Right IJ catheter extends to the upper to mid SVC. Enteric tube is seen extending past the mid-body, tip is out of view. IMPRESSION: Low lung volumes bilaterally, with increased vascular congestion. Moderate pleural effusion on the right and small pleural effusion on the left.

19995595-RR-15

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2126-10-25 05:36:00

2126-10-25 10:13:00

EXAMINATION: CHEST (PORTABLE AP) ___ INDICATION: ___ year old man who presented with ruptured proximal anastomosis s/p proximal aortic cuff x4. Currently intubated.// assess lung volumes assess lung volumes IMPRESSION: Compared to chest radiographs ___ through ___. Patient is rotated to his left, obscuring the left lower lobe which is probably still collapsed. Basal atelectasis is also persistent in the right lower lobe, severity indeterminate. The right upper lobe is clear. The heart is not enlarged. There is no pneumothorax. ET tube in standard placement. Transesophageal drainage tube passes into the stomach and out of view. Left jugular line ends in the low SVC.

19995595-RR-16

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2126-10-26 05:33:00

2126-10-26 12:07:00

EXAMINATION: CHEST (PORTABLE AP) ___ INDICATION: ___ year old man who presented with ruptured proximal anastomosis s/p proximal aortic cuff x4. Currently intubated.// assess lung volumes assess lung volumes IMPRESSION: Compared to chest radiographs ___ through ___. There is no longer pulmonary edema. Severe left lower lobe atelectasis and small pleural effusions persist. Heart size top-normal. No pneumothorax. Cardiopulmonary support devices in standard placements.

19995595-RR-17

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2126-10-27 05:02:00

2126-10-27 08:33:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man who presented with ruptured proximal anastomosis s/p proximal aortic cuff x4. Currently intubated.// assess lung volumes IMPRESSION: In comparison with the study of ___, there again are low lung volumes. Monitoring and support devices are stable. Cardiac silhouette is enlarged and there is increased engorgement of ill defined pulmonary vessels consistent with elevated pulmonary venous pressure. Bilateral pleural effusions with compressive atelectasis is seen.

19995595-RR-18

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2126-10-24 13:06:00

2126-10-24 14:34:00

EXAMINATION: CHEST PORT. LINE PLACEMENT INDICATION: ___ year old man with anastamotic rupture// New Left IJ Central line Contact name: ___, Phone: ___ IMPRESSION: In comparison with the study of 6 hours previously, there has been placement of a left IJ catheter that extends to the lower SVC. No evidence of post procedure pneumothorax. Cardiomediastinal silhouette is less prominent and there is substantial decrease in the bilateral pulmonary opacifications that most likely represented pulmonary edema. There again are bilateral pleural effusions with compressive basilar atelectasis, more prominent on the right.

19995595-RR-21

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2126-10-25 18:34:00

2126-10-25 20:21:00

EXAMINATION: UNILAT UP EXT VEINS US LEFT INDICATION: ___ year old man with APLAS, now with LUE swelling and petechial rash// ?LUE DVT TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper extremity veins. COMPARISON: None. FINDINGS: There is normal flow with respiratory variation in the left subclavian veins. The left internal jugular, axillary, and brachial veins are patent, show normal color flow, spectral doppler, and compressibility. The left basilic, and cephalic veins are patent, compressible and show normal color flow. There is moderate subcutaneous edema over the dorsum of the hand. IMPRESSION: No evidence of deep vein thrombosis in the left upper extremity.

19995595-RR-23

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2126-10-28 13:32:00

2126-10-28 15:03:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with hypoxemic respiratory failure// worsening tachypnea TECHNIQUE: Chest AP COMPARISON: ___ IMPRESSION: Lungs are low volume with small bilateral effusions right greater than left. Cardiomediastinal silhouette is stable. There is mild pulmonary vascular congestion. The ETT, NG tube and left-sided central line are unchanged. No pneumothorax.

19995595-RR-24

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2126-10-28 22:32:00

2126-10-29 08:28:00

EXAMINATION: CHEST (PORTABLE AP) ___ INDICATION: ___ year old man with hypoxic respiratory failure// worsened hypoxemia worsened hypoxemia IMPRESSION: Compared to chest radiographs ___ through ___. Pulmonary vascular congestion persists. Large area of consolidation right lower lobe in smaller regions of peribronchial opacification suggest widespread pneumonia. Heart size normal. Small pleural effusions are likely. No pneumothorax. Cardiopulmonary support devices in standard placements.