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19995595-RR-25 | 19,995,595 | 21,784,060 | RR | 25 | 2126-10-29 11:12:00 | 2126-10-29 16:28:00 | EXAMINATION: CTA TORSO
INDICATION: ___ year old man s/p repair of ruptured aortobifemoral bypass, now
with persistent leukocytosis also Hgb drop overnight (unknown source).
suspected VAP. Evaluation for bleeding, VAP, abdominal source of
leukocytosis/fevers.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 74.7 cm; CTDIvol = 4.3 mGy (Body) DLP = 317.2
mGy-cm.
2) Spiral Acquisition 5.6 s, 74.7 cm; CTDIvol = 14.9 mGy (Body) DLP =
1,112.0 mGy-cm.
3) Spiral Acquisition 5.6 s, 74.7 cm; CTDIvol = 14.9 mGy (Body) DLP =
1,110.8 mGy-cm.
4) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
5) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.3 mGy (Body) DLP =
6.6 mGy-cm.
Total DLP (Body) = 2,548 mGy-cm.
COMPARISON: Comparison to CT abdomen/pelvis performed at outside hospital
from ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Moderate atherosclerotic calcification along the aortic
arch and descending thoracic aorta. The heart, pericardium, and great vessels
are within normal limits. Moderate coronary artery calcifications. No
pericardial effusion is seen. Left-sided central venous line with tip
extending to the mid SVC.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. A mildly enlarged right hilar lymph node measures 1.3 cm in short
axis (301:54), presumably reactive.
PLEURAL SPACES: No pneumothorax. Stable small left pleural effusion and new
small right pleural effusion, with adjacent compressive atelectasis.
LUNGS/AIRWAYS: Focal ground-glass opacities in the right upper lobe (301:34),
possibly infectious or asymmetric edema. Mild upper lobe predominant
emphysema. Compressive atelectasis at the bilateral lung bases. The airways
are patent to the level of the segmental bronchi bilaterally. Patient is
intubated with endotracheal tube in appropriate position at the midthoracic
trachea.
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 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 adrenal gland is normal in size and shape. The left
adrenal gland contains a 1.9 cm nodule (303:125).
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Enteric tube courses beyond the gastroesophageal junction
and into the stomach. The stomach is unremarkable. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. The
colon and rectum are within normal limits. The appendix is normal.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy. A mildly prominent left external
iliac lymph node measures 1.3 cm in short axis (303:213), however demonstrates
a normal fatty hilum.
VASCULAR: Interval repair of a ruptured infrarenal abdominal aortic aneurysm
with aortobifemoral graft placement. Expected interval evolution of the large
hematoma in the right hemiabdomen, measuring 11.5 x 7.6 x 17.0 cm (303:173,
601:69), which appears to be involuting. No evidence of active extravasation
identified. Persistent occlusion of the aortobifemoral bypass is again
demonstrated. Persistent occlusion of the fem-fem graft is also noted. There
is stable appearance of a chronic bilobed fluid collection in the left
inguinal region, measuring 6.0 x 4.8 x 6.8 cm (303:259, 601:74). Stable
appearance of a right common femoral pseudoaneurysm measuring approximately
2.2 x 1.8 cm (301:252).
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. Right hip hardware appears intact. Mild multilevel
degenerative change of the thoracolumbar spine, including mild wedging of few
midthoracic vertebral bodies, unchanged. Postsurgical changes in the anterior
abdominal midline, including superficial skin staples.
IMPRESSION:
1. Interval repair of a ruptured infrarenal abdominal aortic aneurysm with
aortobifemoral graft placement.
2. Expected interval evolution of the large hematoma in the right hemiabdomen,
which appears to be involuting and measures up to 17.0 cm. No evidence of
active extravasation identified.
3. Stable right common femoral pseudoaneurysm measuring approximately 2.2 x
1.8 cm.
4. Unchanged appearance of a chronic bilobed fluid collection in the left
inguinal region, measuring up to 6.8 cm.
5. Nonspecific 1.9 cm left adrenal nodule, indeterminately characterized but
most commonly adenoma. A dedicated CT/MRI with adrenal protocol on a
nonemergent basis as an outpatient may be performed if needed for better
characterization.
6. Focal ground-glass opacities in the right upper lung, possibly representing
infection or asymmetric edema.
7. Persistent small left pleural effusion and new small right pleural
effusion, with adjacent compressive atelectasis.
8. Mildly enlarged right hilar lymph node measuring 13 mm, presumably
reactive.
|
19995595-RR-26 | 19,995,595 | 21,784,060 | RR | 26 | 2126-10-30 05:09:00 | 2126-10-30 08:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p ruptured aortic graft w/ concern for fluid
overload and possible PNA. Please eval for interval changes// Please eval for
interval changes
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are unchanged and in satisfactory position. Improved, though still relatively
low lung volumes. Cardiomediastinal silhouette is stable and there is
indistinctness of engorged pulmonary vessels consistent with the clinical
concern for volume overload. Opacification at the left base silhouetting
hemidiaphragm is consistent with pleural fluid and volume loss in left lower
lobe. Band of atelectasis at the right base is now seen instead of the more
amorphous opacification previously noted. Nevertheless, the possibility of
superimposed pneumonia would have to be considered in the appropriate clinical
setting.
|
19995595-RR-27 | 19,995,595 | 21,784,060 | RR | 27 | 2126-10-31 05:34:00 | 2126-10-31 17:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxemic resp failure// hypoxemia
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest radiographs since ___, most recent
___, and chest CTA from ___.
FINDINGS:
Right lower lobe band atelectasis is stable. Left basilar opacification
silhouetting the hemidiaphragm and suggesting left lower lobe collapse and
mild pleural effusion is unchanged, however a superimposed focal consolidation
cannot be excluded in the proper clinical setting. Monitoring and support
devices are in stable position.
IMPRESSION:
Right atelectatic band in left lower lobe collapse are unchanged. However, in
the appropriate clinical setting, it would be difficult to exclude
superimposed consolidation.
|
19995595-RR-29 | 19,995,595 | 21,784,060 | RR | 29 | 2126-10-30 18:14:00 | 2126-10-31 09:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with vap// ? vap
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple chest radiographs since ___, most recent on ___, and chest CTA from ___.
FINDINGS:
Right lower lobe band atelectasis is stable. Left basilar opacification
silhouetting the hemidiaphragm and suggesting left lower lobe collapse and
mild pleural effusion is unchanged, however, a superimposed focal
consolidation cannot be excluded in the proper clinical setting. Monitoring
and support devices are in stable position.
IMPRESSION:
Right atelectatic band and left lower lobe collapse are unchanged. However,
in the appropriate clinical setting, it would be difficult to exclude
superimposed consolidation.
|
19995595-RR-3 | 19,995,595 | 21,784,060 | RR | 3 | 2126-10-18 02:42:00 | 2126-10-18 10:34:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with ruptured aortobifem now intubated and with
new CVL// evaluate Contact name: ___: ___ evaluate
IMPRESSION:
No comparison. The patient is intubated. The tip of the endotracheal tube
projects approximately 3 cm above the carinal. The course of the feeding tube
is normal. Right internal jugular vein catheter, left internal jugular vein
catheter, both in correct position. Lung volumes are low. There is mild
cardiomegaly and mild to moderate pulmonary edema, combines to a small left
pleural effusion as well as a relatively extensive right basilar atelectasis.
No pneumothorax.
|
19995595-RR-30 | 19,995,595 | 21,784,060 | RR | 30 | 2126-10-30 23:42:00 | 2126-10-31 08:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with increased O2 requirement, poor left breath
sounds// please eval for ?PTX
TECHNIQUE: Chest AP film
COMPARISON: ___ through ___
FINDINGS:
In comparison to the study completed on ___, patient has been
extubated. There is a nasogastric tube seen past the midbody, distal tip out
of view. Left IJ catheter terminating in the distal SVC.
Lower lung volumes today compared to the prior study. Stable
cardiomediastinal silhouette. Mildly improved engorgement of pulmonary
vascular congestion. Ill-defined opacity seen in the right lower lung that
may be represent aspiration/pneumonia in the correct clinical setting. Small
to moderate left pleural effusion with volume loss in the left lower lobe.
Stable right base atelectasis. No pneumothorax.
IMPRESSION:
1. No evidence of pneumothorax.
2. Improved pulmonary vascular congestion.
3. Possible aspiration/pneumonia in the right lower lung in the correct
clinical setting.
|
19995595-RR-31 | 19,995,595 | 21,784,060 | RR | 31 | 2126-11-01 05:34:00 | 2126-11-01 09:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with VAP// VAP
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Patient is rotated to the right. The left IJ line projects at the junction of
the left brachiocephalic and SVC. The NG tubes are unchanged. Lungs are low
volume with patchy parenchymal opacity in the right lower lobe and left lower
lobe, unchanged. Small bilateral effusions left greater than right are
unchanged. No pneumothorax. Mild pulmonary vascular congestion.
|
19995595-RR-32 | 19,995,595 | 21,784,060 | RR | 32 | 2126-10-31 11:55:00 | 2126-10-31 16:15:00 | EXAMINATION: Radiographs with limited views of chest and abdomen.
INDICATION: ___ year old man with dobhoff placement// dobhoff placement
TECHNIQUE: 4 portable upright images with limited views of the chest and
abdomen.
COMPARISON: CT scan dated ___, dedicated chest radiograph dated ___.
FINDINGS:
CHEST:
Limited visualization of the chest due to patient being outside the field of
view.
Right basilar lung opacities previously seen have resolved, there is
persistent left basilar opacity and pleural effusion.
ABDOMEN:
Dobhoff tube is seen coursing through the esophagus, below the diaphragm and
eventually coiling in the antrum of the stomach. There is another NG tube
also in the stomach.. Central line terminates in the azygos vein.
Endotracheal tube terminates 5-6 cm above the carina.
IMPRESSION:
1. Dobhoff tube successfully placed in the stomach.
2. Central line terminates in the azygos vein.
3. Interval resolution of right-sided basilar lung opacities, persistence of
left-sided basilar opacities and pleural effusion.
NOTIFICATION: Findings communicated to ___, MD by ___
___, MD at 16:33 on ___ 20 minutes after discovery of the
findings.
|
19995595-RR-33 | 19,995,595 | 21,784,060 | RR | 33 | 2126-11-02 05:47:00 | 2126-11-02 08:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxemic resp failure// hypoxemia
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are stable. Continued low lung volumes with enlargement of the cardiac
silhouette and elevation of pulmonary venous pressure. Retrocardiac
opacification with obscuration of the hemidiaphragm is consistent with volume
loss in left lower lobe and pleural effusion. The opacification at the right
base has substantially decreased.
|
19995595-RR-34 | 19,995,595 | 21,784,060 | RR | 34 | 2126-11-03 05:19:00 | 2126-11-03 08:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with intubation// intubation
IMPRESSION:
In comparison with the study of ___, the patient has taken a much better
inspiration. The tip of the endotracheal tube is approximately 5 cm above the
carina. Other monitoring and support devices are stable.
Continued relatively low lung volumes with enlargement of the cardiac
silhouette and moderate pulmonary edema. Opacification in the retrocardiac
region with obscuration hemidiaphragm is again consistent with volume loss in
left lower lobe and pleural effusion.
There is an area of increased opacification above the right hemidiaphragmatic
contour. This most likely represents merely atelectatic changes. However, in
the appropriate clinical setting, superimposed aspiration/pneumonia would have
to be considered.
|
19995595-RR-35 | 19,995,595 | 21,784,060 | RR | 35 | 2126-11-02 10:04:00 | 2126-11-02 10:56:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ year old man with AMS. Evaluation for etiology of AMS.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.3 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: No relevant prior imaging for comparison.
FINDINGS:
There is no evidence of intracranial hemorrhage, acute large territorial
infarction, edema,or mass. Extensive encephalomalacia within the posterior
right parietal lobe is consistent with prior infarct. Chronic infarction is
also noted of the adjacent to the right caudate nucleus. There is prominence
of the ventricles and sulci suggestive of involutional changes.
Periventricular and subcortical hypodensities are nonspecific, though likely
sequela of chronic small vessel ischemic disease.
There is no evidence of fracture. Partial opacification of the bilateral
ethmoid air cells. Mild mucosal thickening of the bilateral sphenoid sinuses
and maxillary sinuses with small amount of layering fluid. Complete
opacification of the bilateral mastoid air cells. The middle ear cavities are
clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial abnormality or hemorrhage.
2. Chronic right caudate nucleus infarct, and chronic posterior right parietal
lobe infarct as described above.
3. Moderate paranasal sinus disease with complete opacification of the
bilateral mastoid air cells and layering fluid within the bilateral sphenoid
sinuses and maxillary sinuses, possibly sequela of intubation.
|
19995595-RR-36 | 19,995,595 | 21,784,060 | RR | 36 | 2126-11-02 12:10:00 | 2126-11-02 13:46:00 | EXAMINATION: BILAT UP EXT VEINS US
INDICATION: ___ year old man with pmh significant for anti-phospholipid
anitbiody syndrome, hypercoagulable state, PAD s/p R BKA, multiple strokes due
to clotting disorder now has LUE swelling, persistent fevers despite extensive
infectious work up, concern for venous thrombus.// Please eval for DVT or
etiology of upper extremity swelling and persistent fevers.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the bilateral
upper extremity veins.
COMPARISON: Left upper extremity venous ultrasound from ___
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular vein is noncompressible with an intraluminal linear
echogenicity, attached to the vessel wall cranially, compatible with an
nonocclusive thrombus. Left internal jugular, and bilateral axillary, and
brachial veins are patent, show normal color flow, spectral doppler, and
compressibility.
The bilateral basilic, and cephalic veins are patent, compressible and show
normal color flow.
IMPRESSION:
Nonocclusive venous thrombosis in the right internal jugular vein. Remainder
of the right upper extremity veins and left extremity veins are without
thrombus.
|
19995595-RR-37 | 19,995,595 | 21,784,060 | RR | 37 | 2126-11-04 04:25:00 | 2126-11-04 12:51:00 | EXAMINATION: GO TO NOTIFICATION CHEST (PORTABLE AP) ___
INDICATION: ___ year old man with intubation// acute process acute
process
IMPRESSION:
Compared to chest radiographs ___ through ___.
Although lung volumes are still relatively low, previous left lower lobe
atelectasis has improved substantially. Pulmonary edema is mild. Mild
cardiomegaly has improved since ___. Small left pleural effusion
unchanged. No pneumothorax.
No endotracheal tube is seen. Transesophageal drainage tube ends at the
thoracic inlet either in the airway or upper esophagus. Transesophageal
feeding tube ends in the proximal duodenum. Left jugular line tip in the low
SVC.
NOTIFICATION:
The findings were discussed with ___, RN, by ___, M.D. on the
telephone at 12:49, IMMEDIATELY following discovery of the findings.
|
19995595-RR-38 | 19,995,595 | 21,784,060 | RR | 38 | 2126-11-05 05:38:00 | 2126-11-05 08:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxemic respiratory failure, now s/p
extubation// hypoxemia
IMPRESSION:
In comparison with the study of ___, there are slightly improved lung
volumes. The endotracheal tube is been removed. What appears to of been a
transesophageal drainage tube has been removed. The other monitoring and
support devices appear stable.
Cardiomediastinal silhouette is unchanged. Mild engorgement of ill defined
pulmonary vessels is consistent with elevated pulmonary venous pressure.
Basilar opacification on the left is consistent with pleural fluid and
atelectatic changes.
|
19995595-RR-39 | 19,995,595 | 21,784,060 | RR | 39 | 2126-11-09 13:28:00 | 2126-11-09 14:46:00 | INDICATION: ___ year old man with increased O2 requirements// Eval for pulm
edema, effusion
COMPARISON: Radiographs from ___
IMPRESSION:
There has been improvement of the pulmonary edema. The left IJ central line
has been removed. There is a feeding tube with distal tip is below the edge
of the film, past the GE junction.. There remains bibasilar opacities at the
lung bases, left greater than right. There are no pneumothoraces.
|
19995595-RR-4 | 19,995,595 | 21,784,060 | RR | 4 | 2126-10-19 05:20:00 | 2126-10-19 07:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ruptured aortobifem now intubated, please
eval for interval change// ___ year old man with ruptured aortobifem now
intubated, please eval for interval change ___ year old man with ruptured
aortobifem now intubated, please eval for interval change
IMPRESSION:
Comparison to ___. Stable correct position of the monitoring and
support devices. New small to moderate bilateral pleural effusions, with
subsequent areas of basilar atelectasis, in addition to the pre-existing right
perihilar and basal opacity and consolidation. There also is a new
retrocardiac atelectasis. No pulmonary edema. No pneumothorax.
|
19995595-RR-5 | 19,995,595 | 21,784,060 | RR | 5 | 2126-10-20 03:52:00 | 2126-10-20 09:13:00 | 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
IMPRESSION:
In comparison with the study of ___, there is little change in the
monitoring and support devices. The cardiac silhouette is again mildly
enlarged with elevated pulmonary venous pressure that appears less prominent
than on the prior study. The layering pleural effusions with compressive
basilar atelectasis also are less prominent, though much of this could merely
reflect a more upright position of the patient.
|
19995595-RR-6 | 19,995,595 | 21,784,060 | RR | 6 | 2126-10-19 13:12:00 | 2126-10-19 13:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man post-op vent dependence still with open abdomen.
Bronch'd this morning for ?mucus plugging in RLL.// worsening hypoxemia s/p
bronch/BAL worsening hypoxemia s/p bronch/BAL
IMPRESSION:
Comparison to ___. Stable monitoring and support devices. Minimal
increase in extent of the moderate right and small left pleural effusion.
Stable basal areas of atelectasis. On the current image, signs of mild
pulmonary edema present. Mild cardiomegaly persists. No pneumothorax.
|
19995595-RR-8 | 19,995,595 | 21,784,060 | RR | 8 | 2126-10-21 05:22:00 | 2126-10-21 08:52:00 | 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:
ET tube tip is 6 cm above the carina. NG tube tip is in the stomach. Right
internal jugular line tip is at the level of mid SVC.
Heart size and mediastinum are stable. Bibasal consolidations and bilateral
pleural effusions are unchanged. There is interval improvement in pulmonary
edema with only pulmonary vascular congestion currently present.
|
19995595-RR-9 | 19,995,595 | 21,784,060 | RR | 9 | 2126-10-20 19:36:00 | 2126-10-20 20:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NGT// ? NGT
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___ at 03:59.
IMPRESSION:
The nasogastric tube terminates in the body of the stomach. The remaining
support lines and tubes are in stable position. No other significant interval
change compared to study from earlier today.
|
19996783-RR-30 | 19,996,783 | 22,140,408 | RR | 30 | 2188-04-22 22:43:00 | 2188-04-23 10:05:00 | INDICATION: ___ year old man with large pancreatic mass, N/V// please assess
for gastric outlet obstruction
TECHNIQUE: Portable supine
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
Stent in the expected course of the CBD.
The stomach is mildly dilated. There are no abnormally dilated loops of small
bowel. Gas and fecal contents in the large bowel. There is no free
intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonspecific bowel gas pattern. Stomach is mildly dilated. No evidence of
small-bowel obstruction. Gas and stool filling the large bowel loops.
|
19996783-RR-31 | 19,996,783 | 21,880,161 | RR | 31 | 2188-05-09 05:42:00 | 2188-05-09 09:12:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with chest pain// Eval for PNA
TECHNIQUE: AP and lateral views the chest
COMPARISON: CT chest ___, chest radiograph ___
FINDINGS:
The cardiomediastinal silhouette is stable from ___. Patchy opacity
in the infrahilar space on the lateral view, is unchanged from ___.
The lungs are otherwise clear. No pleural effusion.
IMPRESSION:
An infrahilar opacity best seen on lateral view is unchanged from ___.
In the appropriate clinical setting this may represent pneumonia, although
this could represent atelectasis given low volumes.
|
19996783-RR-32 | 19,996,783 | 21,880,161 | RR | 32 | 2188-05-09 06:24:00 | 2188-05-09 07:26:00 | EXAMINATION: CT torso
INDICATION: History: ___ with chest pain, shortness of breath, tachycardia,
active pancreatic CA// eval for PE, intrabdominal infection
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration.
IV Contrast: 130 mL Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 7.6 mGy (Body) DLP = 3.8
mGy-cm.
2) Spiral Acquisition 3.2 s, 25.1 cm; CTDIvol = 6.9 mGy (Body) DLP = 172.9
mGy-cm.
3) Spiral Acquisition 6.4 s, 50.6 cm; CTDIvol = 8.3 mGy (Body) DLP = 420.9
mGy-cm.
Total DLP (Body) = 598 mGy-cm.
COMPARISON: CT chest ___, CT abdomen pelvis ___
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. Small pulmonary
embolus is noted in a paramediastinal subsegmental branch of the right lower
lobe (series 3, image 70-65). No evidence of right heart strain.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: ___ opacities in the lingula and ground-glass in the
left lung base are unchanged. Ground-glass and consolidation in the
paramediastinal right lower lobe is unchanged from ___ and unlikely to
represent pulmonary infarction. 8 mm pulmonary nodule in the right middle
lobe (series 4, image 105) unchanged from ___ and may represent
impacted bronchus.
BASE OF NECK: There is a 4 mm nodule in the right lobe of the thyroid.
ABDOMEN:
HEPATOBILIARY: There has been interval placement of a CBD stent with expected
pneumobilia and decompression of the intrahepatic biliary tree. There is
extensive soft tissue density at the distal tip of the CBD stent and partial
or impending occlusion can't be excluded although dilatation is improved from
___. Several rounded hypodensities are compatible with simple cysts
measuring up to 2.0 cm. A 9 mm hypodensity in the right hepatic lobe (series
5, image 15) demonstrated central enhancement on the prior study and could
represent a hemangioma but metastatic disease can't be excluded. Additional
hypodensities scattered throughout the liver too small to characterize and
statistically likely represent simple cysts or biliary hamartomas.
PANCREAS: Re-demonstrated large 7.6 x 6.9 cm hypoenhancing mass centered
within the head of the pancreas with mild upstream pancreatic ductal
dilatation. There is again extensive peripancreatic lymphadenopathy which
allowing for technical differences is mildly increased in size from prior
examination. For example a 4.6 x 3.1 cm lymph node conglomerate along the
anterior aspect of the pancreatic body previously measured 4.6 x 2.5 cm
(series 5, image 28). Extensive hypoenhancing soft tissue extends into the
second and third portions of the duodenum with upstream dilatation of the
duodenum and stomach, new from prior. The mass obliterates the main portal
vein at the confluence and encases the SMA. The mass extends to and abuts the
abdominal aorta.
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.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is dilated and likely obstructed due to the
pancreatic mass invading the second and third portion of the duodenum. The
colon and rectum are within normal limits. The appendix is normal.
There is a small amount of free fluid in the abdomen and pelvis.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The prostate is within normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Moderate atherosclerotic disease is noted.
BONES: Multiple old, bilateral rib fractures are noted.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Small, subsegmental right lower lobe pulmonary embolus. No evidence of
right heart strain or definite pulmonary infarction.
2. ___ and ground-glass opacities most conspicuous at left lung base
and lingula, appear similar to ___ and are likely infectious or
inflammatory.
3. No significant interval change in the large hypoenhancing mass arising from
the head of the pancreas. Peripancreatic adenopathy is overall minimally
increased. The mass invades the second and third portion of the duodenum
resulting in upstream obstruction which appears progressed in comparison to
the prior examination. There has been interval CBD stent placement with
decompression of the intrahepatic biliary tree and expected pneumobilia,
however there is extensive soft tissue at the inferior ostium of the stent and
partial or impending obstruction can't be excluded. The mass again
obliterates the main portal vein, abuts the aorta and encases the SMA.
4. 8 mm right middle lobe pulmonary nodule, unchanged from ___.
5. Multiple bilateral old rib fractures are noted.
|
19996783-RR-33 | 19,996,783 | 21,880,161 | RR | 33 | 2188-05-09 09:14:00 | 2188-05-09 10:24:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with known PE will need anticoag, ams// SDH? ICH?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: Head CT study of ___..
FINDINGS:
There is no evidence of acute major infarction,hemorrhage,edema,or discrete
mass. Periventricular, subcortical white matter hypodensities are
nonspecific, likely represent sequela of chronic small vessel ischemic
disease. There is prominence of the ventricles and sulci suggestive of
involutional changes.
There is no acute fracture. The paranasal sinuses demonstrate retention cysts
in the right maxillary and sphenoid sinuses. Mild mucosal thickening within
the ethmoidal air cells. The mastoid air cells and middle ear cavities are
clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No acute intracranial process.
2. Paranasal sinus retention cysts, similar to previous study.
|
19996783-RR-34 | 19,996,783 | 21,880,161 | RR | 34 | 2188-05-09 13:15:00 | 2188-05-09 10:28:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with PE// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the lower extremities.
|
19996783-RR-36 | 19,996,783 | 21,880,161 | RR | 36 | 2188-05-12 11:31:00 | 2188-05-12 12:14:00 | INDICATION: ___ year old man with malignant gastric ulcers, recent GIB now
stabilized, with new abdominal distention// eval for ileus
TECHNIQUE: Supine AP view of the abdomen
COMPARISON: ___ abdominal radiograph and abdominal and pelvic CT ___
FINDINGS:
There is massive distention of the stomach. Paucity of bowel gas is seen in
the small bowel with small amount of gas seen within the right colon and
rectum. Assessment for free intraperitoneal air is limited without upright
views, though no large amounts are seen. Common bile duct stent is
re-demonstrated. There are no acute osseous abnormalities. Vascular
calcifications are seen along with calcified phleboliths in the pelvis.
IMPRESSION:
Massive distention of the stomach for which nasogastric tube decompression is
recommended. No evidence for small or large bowel obstruction.
|
19996783-RR-37 | 19,996,783 | 21,880,161 | RR | 37 | 2188-05-12 11:30:00 | 2188-05-12 12:12:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with Stage III-IV pancreatic cancer on palliative gemcitabine
(C1D1 ___, transferred from OMED to CCU for missed STEMI. Chest pain free
on medical management. Concern for aspiration// aspiration
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph and CT ___
FINDINGS:
Cardiac silhouette size is mildly enlarged but unchanged from the previous
exam. The mediastinal and hilar contours are similar. The pulmonary
vasculature is not engorged. Patchy retrocardiac opacity is demonstrated, as
seen previously. No new focal consolidation, pleural effusion, or
pneumothorax is seen. There is marked distension of the stomach. Metallic
biliary stent in the right upper quadrant is re-demonstrated.
IMPRESSION:
Patchy retrocardiac opacity, potentially atelectasis with infection or
aspiration not excluded in the correct clinical setting. Marked distension of
the stomach.
|
19996783-RR-38 | 19,996,783 | 21,880,161 | RR | 38 | 2188-05-13 15:01:00 | 2188-05-13 16:53:00 | INDICATION: ___ year old man with malignant gastric ulcers, recent GIB now
stabilized, with new abdominal distention// interval change?
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominopelvic radiograph ___
FINDINGS:
NG tube in the stomach is looping back into the esophagus.
Previously seen gastric distension has improved. There are no abnormally
dilated loops of large or small bowel.
There is no free intraperitoneal air in supine position.
Biliary stent again redemonstrated.
IMPRESSION:
NG tube in the stomach loops back into the still esophagus. Improvement of
the gastric distension.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:51 pm, 1 minutes after
discovery of the findings.
|
19996783-RR-39 | 19,996,783 | 21,880,161 | RR | 39 | 2188-05-15 09:25:00 | 2188-05-15 10:07:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with picc// r picc 40cm iv ping ___ Contact
name: ping, ___: ___ r picc 40cm iv ping ___
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
New right PIC line ends in the mid SVC. Aside from mild left basal
atelectasis or recent aspiration, lungs are clear. Pleural effusions small on
the left if any. No pneumothorax. Heart size normal.
As before the stomach is severely distended with air and fluid.
|
19996783-RR-40 | 19,996,783 | 21,880,161 | RR | 40 | 2188-05-17 01:18:00 | 2188-05-17 15:20:00 | INDICATION: ___ year old man with pancreatic cancer and bowel obstruction//
?bowel obstruction ?perforation
TECHNIQUE: Supine and left lateral decubitus abdominal radiographs were
obtained.
COMPARISON: Multiple prior abdominal radiographs most recent dated ___
FINDINGS:
There is re-demonstrated massive distention of the stomach similar in
appearance to study of ___ with air-fluid levels within the duodenum
compatible with gastric outlet obstruction. Additional mildly dilated loops
of large bowel are visualized.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There is re-demonstration of a common bile duct stent. Phleboliths are
re-demonstrated within the pelvis. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
Massive distention of the stomach similar in appearance to study of ___ with duodenal air-fluid levels compatible with gastric outlet
obstruction.
|
19996783-RR-41 | 19,996,783 | 21,880,161 | RR | 41 | 2188-05-17 03:14:00 | 2188-05-17 09:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with gastric outlet obstruction// NG placement
NG placement
IMPRESSION:
Extensive dilatation of the stomach is re-demonstrated with the stomach bubble
approaching 27 x 19 cm. NG tube tip is projecting over the stomach bubble
left basal consolidation is most likely representing atelectasis. Right PICC
line tip is at the cavoatrial junction no appreciable pleural effusion
demonstrated.
|
19996902-RR-25 | 19,996,902 | 23,688,425 | RR | 25 | 2156-09-22 15:00:00 | 2156-09-22 16:43:00 | HISTORY: Left lower quadrant pain with ultrasound concerning for tubo-ovarian
abscess. Question feasibility for drainage.
TECHNIQUE: Single phase helical CT acquisition through the pelvis following
uneventful administration of 130 cc Omnipaque IV contrast. Coronal and
sagittal reformats provided by technologist.
DLP: 520. MGy-cm.
COMPARISON: Abdominal ultrasound ___, pelvic ultrasound from same
day.
FINDINGS:
The small and large bowel are unobstructed. There is colonic wall thickening
adjacent to the left adnexal abscess. There is diffuse mesenteric and omental
edema, likely related to pelvic inflammation. In the region of the left
adnexa there is a 3.1 x 3.2 x 5.2, cm fluid collection with thick enhancing
rim which is indistinguishable from the left ovary. Medial to this there is a
thin-walled fluid collection measuring 3.5 x 3.3cm. In the pelvic cul-de-sac,
there is a 3.3 x 5.5 x 6.1 cm rim enhancing fluid collection consistent with
abscess. Normal appearance of the right adnexa.
No significant osseous or vascular abnormalities.
There is a prominent left internal iliac node which is likely reactive to
pelvic inflammation.
IMPRESSION:
1. Pelvic cul-de-sac abscess would likely be accessible with CT guidance. The
left adnexal presumed abscess which is indseparable from the ovary also likely
amenable to CT-guided drainage.
2. The midline fluid collection without a thick rim may represent a
noninfected cystic structure and would be very difficult to access with CT or
ultrasound guidance.
3. Diffuse mesenteric and omental edema likely related to pelvic inflammation.
|
19996902-RR-26 | 19,996,902 | 23,688,425 | RR | 26 | 2156-09-23 13:03:00 | 2156-09-23 17:56:00 | PROCEDURE: CT-guided abscess drainage.
CLINICAL INDICATION: ___ woman with multiple pelvic abscesses,
request CT-guided drainage.
COMPARISON: CT pelvis, ___, pelvic ultrasound ___.
PHYSICIANS: Dr. ___ Dr. ___.
MEDICATIONS: Versed 6 mg, fentanyl 300 mcg, normal saline 300 mL.
Moderate sedation was provided by administering divided doses of fentanyl and
Versed throughout the total intraservice time of 120 minutes, during which the
patient's vital signs were continuously monitored by on-site nursing.
FINDINGS/TECHNIQUE:
Informed consent was obtained. The patient was placed prone on the CT table
and initial scanning carried out demonstrating a fluid collection in the
pelvic cul-de-sac and a gas-distended rectum. Fluid collection is also noted
in the right adnexa. A site was marked. A final timeout was performed using
three patient identifiers and confirming the location to be the pelvic
cul-de-sac and left adnexae.
A foley catheter was placed in the rectum to decompress the distended rectum.
The skin overlying the planned tract was prepped and draped in sterile fashion
and anesthetized using 1% lidocaine. Under CT guidance, an 18-gauge ___
needle was advanced into the perirectal fluid collection, and a small amount
of pus was aspirated. A ___ wire was then advanced through the needle
into the collection, and the needle was removed. Serial dilators up till 8
___ were then advanced. Finally, an 8 ___ drain was placed into the
collection and coiled in position. 25 cc of pus was aspirated. A sample was
sent for culture. The drain was secured to the skin with a StatLock adhesive
device. The patient tolerated this portion of the procedure well, and we then
flipped her over into supine position for an attempt to access one of the left
adnexal collections. The skin overlying the left lower quadrant was prepped
and draped in sterile fashion and anesthetized using 1% lidocaine. Under CT
guidance, ___ needle was used to attempt to access one of the left
adnexal collections; however, there was a very small window and the left
adnexal demonstrated significant mobility. We were ultimately unable to
aspirate fluid. The patient tolerated the procedure well and was returned to
the floor in stable condition.
COMPLICATIONS: None.
IMPRESSION:
1. Successful pelvic cul-de-sac abscess drainage, 8 ___ drain in place.
No complications. 25 cc purulent fluid aspirated and sent for analysis.
2. Unsuccessful left adnexal aspiration/drainage. A repeat attempt could be
made with transabdominal ultrasound which may be better able to compensate for
mobility of the left adnexa.
|
19997367-RR-258 | 19,997,367 | 27,185,507 | RR | 258 | 2127-05-06 10:12:00 | 2127-05-06 10:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hemoptysis // Any progression of a PNA?
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the lung volumes have minimally
decreased, causing an apparent increase in radiodensity at the right lung
base. However, there is no new focal parenchymal opacity and no progression of
the pre-existing changes. No pulmonary edema. Borderline size of the cardiac
silhouette. Unchanged alignment of the sternal wires.
|
19997367-RR-259 | 19,997,367 | 27,185,507 | RR | 259 | 2127-05-06 18:00:00 | 2127-05-07 08:56:00 | CT CHEST WITH CONTRAST, ___
COMPARISON: ___.
TECHNIQUE: Multidetector CT was performed following intravenous
administration of Omnipaque. Images were presented at 5-mm and 1.25-mm
thickness.
FINDINGS: Recently described multifocal mediastinal lymphadenopathy appears
similar to the prior CT. For example, a lower right paratracheal lymph node
currently measures 11 mm x 18 mm and previously measured 13 mm x 17 mm (18,
2). Right hilar lymphadenopathy has minimally increased, with increased
thickening of the posterior wall of the right upper lobe bronchus but similar
diameter of discrete lymph nodes. Heart is upper limits of normal in size,
and a small pericardial effusion has developed. Subcentimeter right
pericardial lymph node appears similar to the prior exam. Moderate, partially
loculated right pleural effusion has slightly decreased in size since the
previous study, particularly along the lateral pleural surface. Previously
reported nodular foci of pleural abnormality have also substantially decreased
and probably represented loculated fluid. Note is made of previous median
sternotomy, mitral valve replacement, and indwelling pacing device, similar to
the prior study. Small, partially loculated left pleural effusion is
minimally increased since previous study.
Lower esophageal varices are again demonstrated. Exam was not tailored to
evaluate the subdiaphragmatic region, but no new concerning findings are
identified in this region on this very limited assessment.
Skeletal structures demonstrate healed left rib fractures and evidence of
previous sternotomy. Status post left mastectomy with prosthesis in place.
Within the lungs, paramediastinal fibrosis is again demonstrated in the left
upper lobe with associated marked volume loss. Minimal nonspecific scarring
is also seen at the right lung apex, without change. New foci of
peribronchiolar consolidation have developed bilaterally, with the largest in
the left lower lobe superior segment measuring 1.8 x 1.6 cm. It contains a
prominent internal air bronchogram, but no discrete cavitation. Similar but
smaller peribronchiolar consolidations are present in the right lower lobe
with associated marked bronchial wall thickening. Note is also made of
smoothly marginated septal thickening bilaterally, with lower lung
predominance.
With regard to the peribronchiolar consolidations, they are predominantly
dependent in location, most marked in the posterior right upper lobe and
dependent portions of both lower lobes. A more focal right upper lobe opacity
on ___ CT has improved.
IMPRESSION:
1. Multifocal dependently distributed peribronchiolar consolidations, several
of which have a rounded configuration, but none of which demonstrate
cavitation. Observed findings favor multifocal aspiration/aspiration
pneumonia, but septic emboli are also possible given history of endocarditis.
2. Decrease in extent of multiloculated right pleural effusion compared to
___, but very minimal increase in small left effusion. Small
pericardial effusion.
3. Similar mediastinal lymphadenopathy compared to ___, but slight
increase in right hilar lymphadenopathy.
4. Basilar predominant septal thickening, most likely due to hydrostatic
edema.
|
19997367-RR-260 | 19,997,367 | 27,185,507 | RR | 260 | 2127-05-09 11:20:00 | 2127-05-09 14:58:00 | EXAMINATION: CHEST RADIOGRAPH ___
INDICATION: ___ year old woman who presented with hemoptysis, developing
shortness of breath. // Is there any acute change on CXR?
TECHNIQUE: Single upright portable view of the chest was obtained.
COMPARISON: Comparison is made to chest radiograph from ___.
FINDINGS:
Since prior study, there has been no interval change in position of right
chest wall Port-A-Cath, terminating in the upper right atrium, as well as a
left chest wall pulse generator, with dual lead pacing wires terminating in
the right atrium and right ventricle. Median sternotomy wires are intact. A
right pleural effusion has slightly increased compared to the prior study,
along with fluid tracking along the horizontal fissure on the right, and
subsegmental atelectasis in the right lung base. Left basilar atelectasis is
also increased, as has a small left pleural effusion. There is no
pneumothorax. Biapical pleural thickening is stable. The overall heart size is
unchanged.
IMPRESSION:
Interval increase in size of moderate right and small left pleural effusions,
with bibasilar atelectasis.
|
19997367-RR-261 | 19,997,367 | 27,185,507 | RR | 261 | 2127-05-11 08:01:00 | 2127-05-11 11:45:00 | REASON FOR EXAMINATION: Shortness of breath.
AP radiograph of the chest was compared to ___.
Heart size and mediastinum are unchanged in appearance including replaced
aortic valve. As compared to the prior study, there is mild interval increase
in interstitial opacities consistent with interval progression of interstitial
pulmonary edema, moderate, associated with small and partially loculated
pleural effusions.
|
19997367-RR-262 | 19,997,367 | 22,967,208 | RR | 262 | 2127-05-24 09:20:00 | 2127-05-24 12:10:00 | INDICATION: ___ with dyspnea // eval for pneumonia
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Compared with prior, there has been no significant interval change. Right
chest wall port and left chest wall dual lead pacing device are again seen.
Partially loculated right-sided pleural effusion persists. Probable small left
effusion is partially loculated laterally. Right basilar opacities medially
may be due to atelectasis, similar to prior. The cardiomediastinal silhouette
is unchanged, mitral valve prosthesis again noted. Surgical clips seen in the
right upper quadrant. No acute osseous abnormalities.
IMPRESSION:
No significant interval change. Bilateral effusions. Right medial basilar
opacity potentially atelectasis noting that infection is not excluded.
|
19997367-RR-267 | 19,997,367 | 27,445,461 | RR | 267 | 2127-08-20 10:01:00 | 2127-08-20 12:03:00 | EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ year old woman with recent S. bovis pulmonic valve
endocarditis, and non-cirrhotic portal hypertension presenting with altered
mental status and mild SOB. // Please evaluate for tappable ascites and MARK
appropriate area for bedside diagnostic paracentesis.
TECHNIQUE: Grey scale images of the abdomen were obtained.
COMPARISON: None.
FINDINGS:
Targeted ultrasound was performed of the 4 quadrants of the abdomen. No
ascites is identified and no skin marking was placed.
IMPRESSION:
No intra-abdominal ascites.
|
19997538-RR-10 | 19,997,538 | 26,704,044 | RR | 10 | 2168-10-30 16:42:00 | 2168-10-30 17:14:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ man with rectal cancer status post LAR, with sudden
onset nausea vomiting and abdominal pain, no flatus.
TECHNIQUE: Multidetector CT of the abdomen and pelvis was performed with IV
contrast only. Multiplanar reformations were provided.
DOSE: Total DLP (Body) = 1,271 mGy-cm.
COMPARISON: Prior CT abdomen pelvis from ___, outside hospital MRI
from ___
FINDINGS:
Lung Bases: The imaged lung bases are clear. The imaged portion of the heart
is notable for mitral annular calcification. Partially imaged heart appears
normal in size.
Abdomen: The liver contains a subtle hypodensity within segment 4B best seen
on series 2, image 21 measuring approximately 10 x 10 mm, similar to that on
prior. Please correlate with result from prior MRI report. Main portal vein
is patent. No biliary ductal dilation. Gallbladder is normal. Spleen is
normal. Adrenals are normal. Pancreas is normal. Kidneys enhance
symmetrically. The abdominal aorta is mildly calcified and normal in caliber.
No retroperitoneal lymphadenopathy. Stomach is normal. A periampullary
duodenal diverticulum noted. Duodenum otherwise unremarkable.
Pelvis: Proximal small bowel is decompressed. There is progressive dilation
of bowel loops which can be traced to the point of abrupt caliber transition
in the right lower quadrant which is best seen on series 601, image 24 and 25.
Just distal to the transition point, the decompressed bowel appears to take a
posterior course behind the small bowel mesentery, series 2, image 51 and then
takes a hairpin turn into the right lower quadrant, series 2, image 57. The
anatomy is distorted in this region in the possibility of an internal hernia
is raised. There is mesenteric congestion involving bowel just proximal to
the abrupt transition point. Distal small bowel is entirely decompressed.
Distal to this point there is an enteroenteric anastomosis which appears
patent. The appendix is normal. The colon contains a minimal fecal load is
mostly there is a small amount of free fluid in the left lower quadrant,
series 601, image 27.. No free air. Urinary bladder is decompressed around a
Foley catheter. Suture at the level of the rectum indicates prior site of
LAR. No pelvic sidewall or inguinal adenopathy.
Bones: No worrisome lytic or blastic osseous lesion is seen.
IMPRESSION:
High-grade small-bowel obstruction with abrupt transition point in the right
lower quadrant. Possible internal hernia, as described above. Small volume
free fluid and mesenteric edema as described.
NOTIFICATION: Findings were discussed with Medical ___ the time
of initial review.
|
19997538-RR-11 | 19,997,538 | 26,704,044 | RR | 11 | 2168-10-30 18:04:00 | 2168-10-30 18:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with s/p NGT placement// eval NGT placement
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Enteric tube tip is within the stomach. Left internal jugular central venous
catheter tip terminates in the low SVC. Heart size is normal. The
mediastinal and hilar contours are normal. The pulmonary vasculature is
normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There
are no acute osseous abnormalities. No subdiaphragmatic air.
IMPRESSION:
1. Enteric tube tip within the stomach.
2. No acute cardiopulmonary abnormality.
|
19997538-RR-12 | 19,997,538 | 26,704,044 | RR | 12 | 2168-10-31 19:32:00 | 2168-10-31 21:57:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SBO, NGT replaced with high output. please
eval NGT tip placement// NGT replaced with high output. please eval NGT tip
placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the nasogastric tube projects over the stomach. A central venous
catheter tip projects over the distal SVC. The lung bases are clear with no
focal consolidation or pleural effusion. No dilated loops of bowel are seen
overlying the upper abdomen.
IMPRESSION:
The tip of the nasogastric tube projects over the stomach.
|
19997540-RR-21 | 19,997,540 | 29,178,502 | RR | 21 | 2154-03-03 00:29:00 | 2154-03-03 01:15:00 | HISTORY: Foreign body sensation, evaluate for acute intrathoracic process.
TECHNIQUE: PA and lateral views of the chest (3 exposures).
COMPARISON: None.
FINDINGS: There is no radiopaque foreign body identified. Lungs are equal in
volume, without evidence for air trapping. There is no pneumothorax,
pneumomediastinum or air seen underneath the diaphragm. Cardiac, mediastinal
and hilar contours are unremarkable.
IMPRESSION: No radiopaque foreign body identified.
|
19997886-RR-41 | 19,997,886 | 20,793,010 | RR | 41 | 2186-11-13 12:03:00 | 2186-11-13 14:41:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with history of PBC, schizoaffective disorder,
chronic cough coming in with decompensated cirrhosis and cachexia and weight
loss, concern for malignancy// please evaluate for malignancy in the abdomen,
please given PO and IV contrast, please do triphasic to evaluate for HCC
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,073 mGy-cm.
COMPARISON: MR ___ ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken and nodular in contour compatible with
cirrhosis. There is no evidence of focal lesions on this contrast enhanced
study, however evaluation for HCC is limited as this is not a dedicated
triphasic liver study. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is under distended. There is large
volume ascites.
PANCREAS: The pancreas is atrophic. Multiple hypodensities in the pancreas
measuring up to 1.8 cm (601:36), likely side branch IPMNs, better evaluated on
MR from ___. there is no peripancreatic stranding.
SPLEEN: The spleen is enlarged measuring 14.3 cm.
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 bilateral renal cysts the largest in the left kidney measuring 5.3
cm. Multiple subcentimeter hypodensities are seen in bilateral kidneys, too
small to characterize, likely simple cysts. There is no evidence of focal
renal lesions or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: The portal vein is patent. Splenic and gastric varices are noted.
There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted.
BONES: Bilateral rounded lucencies the anterosuperior aspect of the femoral
necks compatible with synovial herniation pits. There is no evidence of
worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Cirrhotic liver without focal liver lesions. Evaluation for ___ is limited
on this portal venous phase contrast-enhanced study. Recommend further
evaluation a dedicated liver CT which includes the noncontrast, arterial, and
3 minutes delayed phases. The portal venous phase does not need to be
repeated.
2. Large volume ascites, splenomegaly, and portosystemic varices compatible
with sequela of portal hypertension.
3. Multiple pancreatic cystic lesions better evaluated on MR, likely represent
side branch IPMNs. Recommend attention on follow-up imaging.
4. Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
RECOMMENDATION(S): Evaluation for HCC is limited on this portal venous phase
contrast-enhanced study. Recommend further evaluation a dedicated liver CT
which includes the noncontrast, arterial, and 3 minute delayed phases. The
portal venous phase does not need to be repeated.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:39 pm, 15 minutes after
discovery of the findings.
|
19997886-RR-42 | 19,997,886 | 20,793,010 | RR | 42 | 2186-11-13 12:02:00 | 2186-11-13 14:31:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with history of PBC, schizoaffective disorder,
chronic cough coming in with decompensated cirrhosis and cachexia and weight
loss, concern for malignancy// evaluate for malignancy, non contrast
TECHNIQUE: Multi-detector helical scanning of the chest, coordinated with
intravenous infusion of nonionic, iodinated contrast agent, following oral
administration of contrast agent for selected abdominal studies, and/or
followed by scanning of the neck, was reconstructed as contiguous 5 mm and 1.0
or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and parasagittal, and 8 mm
MIP axial images. Concurrent scanning of the abdomen and pelvis and/or neck
will be reported separately. All images of the chest were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 75.7 cm; CTDIvol = 13.8 mGy (Body) DLP =
1,044.0 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
4) Stationary Acquisition 9.1 s, 0.5 cm; CTDIvol = 50.7 mGy (Body) DLP =
25.4 mGy-cm.
Total DLP (Body) = 1,073 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: No prior chest CTs available.
FINDINGS:
CHEST PERIMETER: Subcentimeter low-density lesion in the imaged portion of the
lower thyroid is too small to require further imaging evaluation.
Supraclavicular and axillary lymph nodes are not enlarged. No soft tissue
abnormalities in the fat depleted chest wall soft tissue. Findings below the
diaphragm including severe ascites and severe cirrhosis will be reported
separately.
CARDIO-MEDIASTINUM:Mid and lower esophagus are moderately patulous but there
is no mass or fluid retention to suggest obstruction. Atherosclerotic
calcification is minimal in head neck vessels and coronary arteries.
Noncalcified ascending thoracic aorta is dilated in a fusiform fashion to
maximum diameter of 50 mm. There is no aortic valvular calcification or any
structural abnormality in the aorta to explain the dilatation. Pulmonary
artery and cardiac chambers are top-normal size and the pericardium is
physiologic.
THORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged.
LUNGS, AIRWAYS, PLEURAE: Mild to moderate non fibrosing subpleural
interstitial pulmonary abnormality. No honeycombing or traction
bronchiectasis. No consolidation or lung nodule suspicious for malignancy.
CHEST CAGE: Unremarkable. No evidence of malignancy or infection.
IMPRESSION:
Mild-to-moderate diffuse interstitial lung disease may explain chronic cough.
NS IP is the most likely diagnosis alternatively severe elevation of the
diaphragm due to ascites may be triggering coughing.
Fusiform aneurysm noncalcified ascending thoracic aorta, 50 mm diameter.
|
19997886-RR-43 | 19,997,886 | 20,793,010 | RR | 43 | 2186-11-13 16:06:00 | 2186-11-13 18:16:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 3 EXAMS
INDICATION: ___ year old man with malnutrition s/p dobhoff placement// 2 step
dobhoff placement
TECHNIQUE: 3 AP portable chest radiographs were obtained
COMPARISON: CT chest from earlier today
FINDINGS:
3 sequential images demonstrate advancement of a Dobhoff which ultimately
extends to the stomach. There are low bilateral lung volumes. No pleural
effusion or pneumothorax. Please refer to the CT chest from earlier today for
more detailed intrathoracic findings. The size of the cardiomediastinal
silhouette is unchanged.
IMPRESSION:
3 sequential images demonstrate advancement of a Dobhoff which ultimately
extends to the stomach.
|
19997886-RR-44 | 19,997,886 | 20,793,010 | RR | 44 | 2186-11-14 09:55:00 | 2186-11-14 11:53:00 | EXAMINATION: Post pyloric NG tube advancement.
INDICATION: ___ year old man with PBC c/b cirrhosis, dobhoff placed
yesterday// Please advance to post-pyloric
DOSE: Acc air kerma: 5 mGy; Accum DAP: 142 uGym2; Fluoro time: 00:57
COMPARISON: No relevant prior studies.
FINDINGS:
The left nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, the existing Dobhoff feeding tube was advanced
post-pylorically using a guidewire.
10 cc of Optiray contrast were used to confirm post pyloric placement. Final
fluoroscopic spot images demonstrated the tip of the feeding tube in the third
portion of the duodenum.
The feeding tube was affixed to the patient's nose and cheek using tape.
IMPRESSION:
Successful post-pyloric advancement of a Dobhoff feeding tube. The tube is
ready to use.
|
19997886-RR-46 | 19,997,886 | 20,793,010 | RR | 46 | 2186-11-16 14:54:00 | 2186-11-16 15:49:00 | EXAMINATION: Chest radiograph, 2 portable AP upright views.
INDICATION: Dobhoff placement.
COMPARISON: Match 27, ___.
FINDINGS:
Both views show Dobhoff tube passing through the right mainstem bronchus.
Lung volumes are low. Cardiac, mediastinal and hilar contours appear stable
including mild cardiac enlargement with a left ventricular configuration.
Lung volumes remain low with mild relative elevation of the right
hemidiaphragm. Lungs appear clear within the limitations of technique.
IMPRESSION:
Dobhoff tube across the right mainstem bronchus. No evidence of acute
cardiopulmonary disease.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:49 pm, 3 minutes after
discovery of the findings.
|
19997886-RR-47 | 19,997,886 | 20,793,010 | RR | 47 | 2186-11-17 15:06:00 | 2186-11-17 17:03:00 | EXAMINATION: Chest radiographs, two AP upright views.
INDICATION: Dobhoff placement
COMPARISON: ___.
FINDINGS:
Second of two views shows the Dobhoff tube terminating in the stomach. No
other short-term change.
IMPRESSION:
Dobhoff tube terminating in the stomach.
|
19997886-RR-48 | 19,997,886 | 20,793,010 | RR | 48 | 2186-11-22 12:11:00 | 2186-11-22 16:31:00 | INDICATION: ___ year old man with cirrhosis and refractory ascites.// Please
place a TIPS.
COMPARISON: CT abdomen pelvis ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ and Dr.
___, Interventional Radiology fellow performed the procedure. Dr.
___ supervised the trainee during any key components of the
procedure where applicable and reviewed and agrees with the findings as
reported below.
ANESTHESIA: General sedation was provided by anesthesia.
MEDICATIONS: Please see anesthesia note for medication details.
CONTRAST: 80 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 16 minutes into seconds, 101 mGy
PROCEDURE: 1. Right upper quadrant ultrasound.
2. Right internal jugular venous access using ultrasound.
3. Pre-procedure right atrial and portal vein pressure measurements.
4. CO2 portal venogram.
5. Contrast enhanced portal venogram.
6. Placement of a 10 mm x 6 cm x 2 cm Viatorr covered stent.
7. Post-stenting balloon angioplasty of the TIPS shunt with a 10 mm balloon.
8. Post-stenting portal venogram.
9. Post stenting right atrial portal vein pressure measurements.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck and abdomen were prepped and draped in the usual
sterile fashion.
Right upper quadrant ultrasound revealed only trace ascites, too small in
volume to perform paracentesis.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Images of
ultrasound access were stored on PACS. Subsequently a Nitinol wire was passed
into the right atrium using fluoroscopic guidance. A small incision was made
at the needle entry site. The needle was exchanged for a micropuncture sheath.
The Nitinol wire was removed and ___ wire was advanced distally into the
IVC.
The micropuncture sheath was then removed and a 10 ___ sheath was advanced
over the wire into the right atrium. A right atrial pressure measurement was
obtained. An MPA catheter was then advanced over the ___ wire into the
IVC. The ___ wire was removed. The MPA catheter was used to select the
right hepatic vein. A Glidewire was used to advance the MPA catheter more
distally to the right hepatic vein. A right hepatic venogram was performed. A
___ wire was advanced through the MPA catheter. The 10 ___ sheath was
then advanced over the MPA catheter ___ wire into the right hepatic vein.
The MPA catheter was then exchanged for a balloon occlusion catheter. The
balloon was inflated and contrast was injected to confirm stasis.
Subsequently, CO2 was injected to perform a CO2 portal venogram. The balloon
was then deflated and the balloon catheter was removed.
The Roche ___ cannula was advanced through the sheath and positioned in the
right hepatic vein. The ___ wire was removed and the Roche ___ needle
and catheter were advanced through the cannula. The cannula was rotated
anteriorly and the needle was advanced distally. The needle was then removed.
The catheter was slowly withdrawn while applying gentle suction. Upon blood
return, a Glidewire Advantage was introduced and advanced into the portal vein
and subsequently the SMV. The catheter, Roche ___ sheath and 10 ___
sheath were advanced through the liver parenchyma and into the main portal
vein.
The Roche ___ system was then exchanged for a flush marking catheter. The
wire was removed and a portal pressure measurement was obtained.
Subsequently, a portal venogram was performed.
The Glidewire Advantage was advanced through the straight flush catheter into
the superior mesenteric vein. The catheter was removed and a 10 mm x 6 cm x 2
cm Viatorr covered covered stent was advanced into appropriate position and
deployed. Following stent deployment, the stent was dilated using a 10 mm
balloon catheter.
A straight flush catheter was advanced over the wire and the wire was removed.
Repeat portal pressure measurement was obtained. A post TIPS portal venogram
was performed. The sheath was then withdrawn into the right atrium and a
repeat right atrial pressure measurement was obtained.
The sheath was then removed from the right internal jugular vein site and
pressure held for 10 minutes to achieve hemostasis. Steri-strips and sterile
dressings were applied.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was transferred to the PACU in
stable condition.
FINDINGS:
1. Pre-TIPS right atrial pressure of 11 mm Hg and balloon-occluded portal
pressure measurement of 31 mm Hg resulting in portosystemic gradient of 20
mmHg.
2. CO2 portal venogram predominantly shunted into alternative hepatic veins
with minimal opacification of the portal vein.
3. Contrast enhanced portal venogram showing patent portal venous system and
hepatopetal flow.
4. Post-TIPS portal venogram showing predominant flow of contrast through the
TIPS.
5. Post-TIPS right atrial pressure of 14 mm Hg and portal pressure of 20 mmHg
resulting in portosystemic gradient of 6 mmHg.
6. Right upper quadrant ultrasound demonstrated trace ascites, too small
volume for paracentesis
IMPRESSION:
Successful transjugular intrahepatic portosystemic shunt placement with
decrease in porto-systemic pressure gradient from 20 to 6 mmHg.
|
19997886-RR-49 | 19,997,886 | 20,793,010 | RR | 49 | 2186-11-23 16:15:00 | 2186-11-23 18:32:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with PBC cirrhosis now s/p TIPS// Any evidence of
pulmonary edema?
TECHNIQUE: PA and lateral chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the feeding tube projects over the stomach. The colon is diffusely
air-filled. A fine interstitial prominence may be reflective of interstitial
lung disease, better assessed on the CT chest dated ___. There is
no overt evidence of pulmonary edema. No focal consolidation, pleural
effusion or pneumothorax is identified. The size of the cardiac silhouette is
unchanged.
IMPRESSION:
No evidence of pulmonary edema. Fine interstitial prominence may be
reflective of interstitial lung disease, better assessed on the CT chest dated
___
|
19997886-RR-50 | 19,997,886 | 20,793,010 | RR | 50 | 2186-11-29 10:15:00 | 2186-11-29 15:43:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old man with PBC cirrhosis s/p TIPS on ___ day
post-TIPS US
TECHNIQUE: Grey scale, color, and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___.
FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. There is moderate ascites.
There is stable splenomegaly, with the spleen measuring 15.1 cm. There is no
intrahepatic biliary dilation. The CHD measures 3 mm. There is no evidence of
stones or gallbladder wall thickening.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 64 cm/sec
Proximal TIPS: 145 cm/sec
Mid TIPS: 166 cm/sec
Distal TIPS: 131 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Patent TIPS in this baseline ultrasound. Velocities as reported.
|
19997886-RR-51 | 19,997,886 | 20,793,010 | RR | 51 | 2186-12-06 08:17:00 | 2186-12-06 11:51:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with history of cirrhosis s/p TIPS with new
leukocytosis and AMS// eval for pneumonia
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 2 weeks prior
FINDINGS:
Enteric tube extends below the diaphragm with the tip in the body of stomach.
Mild cardiomegaly is unchanged. Hilar and mediastinal contours are stable.
Retrocardiac opacity appears progressed compared to the prior exam. No
evidence of pneumothorax.
IMPRESSION:
Overall, retrocardiac opacity concerning for an infectious process appears
new/progressed.
|
19997886-RR-52 | 19,997,886 | 20,793,010 | RR | 52 | 2186-12-06 08:17:00 | 2186-12-06 09:55:00 | INDICATION: ___ year old man with history of cirrhosis s/p TIPS with new
leukocytosis and AMS and abdominal tenderness// eval for ileus
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis from ___
FINDINGS:
There is a hazy appearance of the abdomen compatible with known ascites.
There are multiple loops of air distended large bowel, for example measuring
up to 8.4 cm in the area of the transverse colon. There is air density in the
right upper quadrant adjacent to the diaphragm which likely represents the
hepatic flexure given the presence of haustra markings. This loop is more
medial on the second image, likely representing movement of the hepatic
flexure within ascites. No definite pneumoperitoneum, though difficult to
fully exclude on these two views.
A TIPS stent is again noted. The enteric tube courses below the diaphragm
with the tip and side port within the stomach. Osseous structures are
unremarkable. There are no unexplained soft tissue calcifications.
IMPRESSION:
1. No definite pneumoperitoneum, however given the appearance of the colonic
hepatic flexure adjacent to the diaphragm on one image, recommend left lateral
decubitus radiograph or CT abdomen pelvis to definitively exclude free
intraperitoneal air.
2. Non-specific air distended loops of large bowel.
NOTIFICATION: The findings and recommendations were discussed with ___
___, M.D. by ___, M.D. on the telephone on ___ at
9:28 am, 2 minutes after discovery of the findings.
|
19997886-RR-54 | 19,997,886 | 20,793,010 | RR | 54 | 2186-12-06 10:55:00 | 2186-12-06 13:29:00 | INDICATION: ___ year old man with cirrhosis, now altered mental status and
shock with abdominal pain/distension. KUB with possible perforation.// LATERAL
DECUBITUS TO EVALUATE FOR FREE AIR
TECHNIQUE: Left lateral decubitus views of the abdomen were obtained.
COMPARISON: Previous supine abdominal radiographs from today.
FINDINGS:
Left lateral decubitus views were obtained as a follow-up to the supine images
to evaluate for free air. The uppermost portion of the abdomen is excluded
from the images.
There are multiple dilated small and large bowel loops as seen on the previous
study, some containing air-fluid levels.
There is no evidence of pneumoperitoneum.
Osseous structures are grossly unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. NG tube is noted, projecting over the expected location of the
stomach.
IMPRESSION:
No evidence of pneumoperitoneum.
NOTIFICATION: The findings were discussed with the referring ICU physician by
___, M.D. on the telephone on ___ at 1:26 pm, 0 minutes after
discovery of the findings.
|
19997886-RR-55 | 19,997,886 | 20,793,010 | RR | 55 | 2186-12-06 13:24:00 | 2186-12-06 14:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SC CVL placmenet// eval CVL Position
IMPRESSION:
In comparison with the study of earlier in this date, there has been placement
of a left subclavian catheter that extends to the lower SVC. No evidence of
post procedure pneumothorax. Otherwise, the cardiomediastinal silhouette is
stable and there is engorgement of ill defined pulmonary vessels consistent
with elevated pulmonary venous pressure.
|
19997886-RR-56 | 19,997,886 | 20,793,010 | RR | 56 | 2186-12-07 20:39:00 | 2186-12-07 22:55:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with PBC cirrhosis, abdominal distension,
peritonitis// evaluate for evidence of perforation
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 6.0 s, 1.0 cm; CTDIvol = 13.9 mGy (Body) DLP =
13.9 mGy-cm.
3) Spiral Acquisition 16.6 s, 57.2 cm; CTDIvol = 12.6 mGy (Body) DLP =
702.6 mGy-cm.
Total DLP (Body) = 730 mGy-cm.
COMPARISON: ___
FINDINGS:
LOWER CHEST: Interval increase in bibasilar dependent consolidations, possibly
reflecting pneumonia particularly within the lingula and left lower lobe. The
ascending aorta measures up to 4.4 cm, previously characterized on the CT
chest dated ___.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken and nodular in contour compatible with
cirrhosis. No evidence of focal lesions on this single-phase study. No intra
or extrahepatic biliary ductal dilatation. The gallbladder is collapsed.
PANCREAS: The pancreas has normal attenuation throughout. Multiple
hypodensities are again seen measuring up to 1.5 cm in the pancreatic head
region (06:30). There is no peripancreatic stranding.
SPLEEN: The spleen is enlarged measuring 14.4 cm.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. Multiple bilateral
cysts are unchanged measuring up to 5.3 cm in the left kidney. Other
hypodensities are too small to characterize. No hydronephrosis or perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. A rectal tube is
present. There is a large amount of stool within the rectum and distal
sigmoid colon. Air and fluid filled colonic loops are seen throughout
measuring up to 7.4 cm in the transverse colon. No evidence of
pneumoperitoneum, pneumatosis or mesenteric venous gas. No abnormal bowel
wall thickening.
PELVIS: The urinary bladder is decompressed around a Foley catheter. There is
small to moderate volume ascites, decreased in extent since prior.
REPRODUCTIVE ORGANS: The prostate is grossly unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: The TIPS is patent. The portal vein, SMV and splenic vein are also
patent. Multiple varices are present throughout the upper abdomen. Mild
atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of perforation. Air and fluid filled mildly dilated colon.
2. Patent TIPS
3. Cirrhosis and findings compatible with portal hypertension. Interval
decrease in extent of abdominopelvic ascites.
4. Unchanged pancreatic hypodensities, presumably reflecting IPMNs.
|
19997886-RR-57 | 19,997,886 | 20,793,010 | RR | 57 | 2186-12-10 00:00:00 | 2186-12-10 09:10:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old man PBC cirrhosis status post recent TIPS, now with
change in speech. Evaluate for acute to subacute stroke.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 cc Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI head without contrast ___.
FINDINGS:
Motion artifact moderately limits evaluation.
No evidence for an acute infarction, intracranial mass, edema, or blood
products. There is mild T2/FLAIR hyperintensity along the lateral ventricles
and few scattered small T2/FLAIR hyperintensities in the supratentorial white
matter, nonspecific but likely sequela of mild chronic small vessel ischemic
disease in this age group. There is mild-to-moderate global parenchymal
volume loss with prominent ventricles and sulci.
Major arterial flow voids are grossly preserved. Dural venous sinuses are
patent on postcontrast MP RAGE images.
There is partial opacification of bilateral underpneumatized mastoids, which
may be secondary to prolonged supine positioning in the inpatient setting.
There is also mild-to-moderate mucosal thickening in the left maxillary sinus
IMPRESSION:
Moderately motion limited exam. No evidence for an acute infarction or other
acute intracranial abnormalities.
|
19997886-RR-58 | 19,997,886 | 20,793,010 | RR | 58 | 2186-12-09 20:58:00 | 2186-12-09 22:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PBC, esophageal varices, abdominal
distention, treating for VAP with vanc/cefepime/flagyl, newly febrile to
101.3// ?aspiration ?consolidation, ?pneumonia
TECHNIQUE: AP portable chest radiograph
COMPARISON: Chest radiograph ___, chest CT ___, chest
radiograph ___
FINDINGS:
Left-sided subclavian central venous catheter tip projects over the low SVC.
The enteric tube terminates in the body of the stomach. Prominent
interstitial markings bilaterally is unchanged from multiple recent
examinations, but new compared to ___, and suggests interstitial
pulmonary edema. Bibasilar opacities may represent atelectasis or
aspiration/pneumonia. Mild enlargement of the cardiac silhouette is
unchanged. No acute osseous abnormalities identified. There are multiple
dilated colonic loops. Right hemidiaphragm is chronically elevated.
IMPRESSION:
1. Unchanged bibasilar opacities may represent atelectasis or
pneumonia/aspiration.
2. Mild interstitial pulmonary edema.
3. Multiple dilated colonic loops.
|
19997886-RR-59 | 19,997,886 | 20,793,010 | RR | 59 | 2186-12-09 20:58:00 | 2186-12-09 22:34:00 | INDICATION: ___ year old man with PBC, esophageal varices, worsening abdominal
distention, treating for VAP with vanc/cefepime/flagyl, newly febrile to
101.3// ?abdominal sources of infection, ileus, obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT dated ___
FINDINGS:
Dilated predominantly colonic bowel loops are seen throughout the abdomen and
pelvis. Evaluation for dilated small bowel loops is limited given the degree
of air-filled loops. The presumed transverse colon measures up to 10 cm in
diameter.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable. The enteric tube projects over the
stomach. A TIPS is seen over the right upper quadrant.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Dilated colonic bowel loops measuring up to 10 cm. Evaluation for small bowel
dilatation is limited.
|
19997886-RR-60 | 19,997,886 | 20,793,010 | RR | 60 | 2186-12-10 02:29:00 | 2186-12-10 08:25:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old man with NGT placement// ?NGT placement
IMPRESSION:
In comparison with the study of ___, on the final image the nasogastric
tube extends to the lower body of the stomach.
Increasing bilateral opacifications involving various areas of the lung are
worrisome for developing multifocal pneumonia.
|
19998330-RR-16 | 19,998,330 | 23,137,777 | RR | 16 | 2178-10-10 13:38:00 | 2178-10-10 14:03:00 | INDICATION: Diabetes mellitus with hypoglycemia.
COMPARISON: ___.
UPRIGHT AP VIEW OF THE CHEST: Lung volumes are present. Persistent
moderate-to-severe cardiomegaly is again noted. The mediastinal contours are
unchanged, with tortuosity of the thoracic aorta again noted. Fullness of the
right paratracheal stripe is also unchanged, and may be due to mediastinal fat
deposition, but is longstanding. There is mild pulmonary vascular congestion.
Persistent bibasilar airspace opacities are noted, left worse than right,
which could reflect atelectasis. Small bilateral pleural effusions are
present. There is an elevation of the right hemidiaphragm. There are no
acute osseous abnormalities.
IMPRESSION: Mild pulmonary vascular congestion with small bilateral pleural
effusions. Bibasilar airspace opacities may reflect atelectasis.
|
19998330-RR-17 | 19,998,330 | 21,135,114 | RR | 17 | 2178-10-21 14:22:00 | 2178-10-21 14:54:00 | CHEST RADIOGRAPH PERFORMED ON ___
Comparison is made with prior study from ___.
CLINICAL HISTORY: Dyspnea, COPD, question pneumonia.
FINDINGS: Portable semiupright chest radiograph is obtained portably.
Patient is rotated to her right, which limits the evaluation. There is
persistent pulmonary edema with bilateral pleural effusions noted, size cannot
be assessed. No pneumothorax is seen.
Degenerative changes of the left shoulder again noted.
IMPRESSION: Pulmonary edema, small bilateral effusions. If there is oncern
for pneumonia, recommend repeat chest radiograph post-diuresis.
|
19998330-RR-18 | 19,998,330 | 21,135,114 | RR | 18 | 2178-10-21 16:54:00 | 2178-10-21 18:23:00 | CHEST RADIOGRAPH
HISTORY: Intubated and respiratory distress.
COMPARISONS: Earlier on the same afternoon.
TECHNIQUE: Chest, AP portable supine.
FINDINGS: An endotracheal tube has been placed since the prior examination,
which terminates 3 cm above the carina. An orogastric tube courses towards
the stomach. Its tip not visualized. The sidehole, however, appears to lie
slightly above the left hemidiaphragm. Superimposed on background elevation
of the right hemidiaphragm, there is persistent opacification at the right
lung base with right infrahilar opacification and suspected pleural effusion.
Aeration is much better in the left lower lung, however, which appears better
expanded with reduction in opacification. There is no pneumothorax. Mild
congestion appears similar to slightly decreased with enlarged indistinct
vessels.
IMPRESSION:
1. Status post endotracheal tube placement; sidehole of orogastric tube
projecting above the gastroesophageal junction. The clinician was aware of
the finding and the tube had apparently been replaced by the time of
interpretation.
2. Findings suggesting mild vascular congestion.
3. Persistent right basilar opacification suggesting atelectasis associated
with elevation of the right hemidiaphragm and suspected pleural effusion.
4. Improved aeration of the left lung base.
|
19998330-RR-19 | 19,998,330 | 21,135,114 | RR | 19 | 2178-10-22 04:37:00 | 2178-10-22 09:12:00 | CHEST RADIOGRAPH
INDICATION: COPD, chronic heart failure, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. Monitoring and support devices are constant. Moderate cardiomegaly,
mild fluid overload and atelectatic opacities at both lung bases. No new
parenchymal opacities, notably no evidence of pneumonia.
|
19998330-RR-20 | 19,998,330 | 21,135,114 | RR | 20 | 2178-10-23 04:48:00 | 2178-10-23 11:28:00 | AP CHEST, 5:11 A.M., ___
HISTORY: ___ woman with COPD, extubated.
IMPRESSION: AP chest compared to ___:
Lung volumes are unchanged following extubation. Moderate right and small
left pleural effusion and severe right basal atelectasis are unchanged as is
severe enlargement of the cardiac silhouette. No pneumothorax.
|
19998350-RR-17 | 19,998,350 | 27,108,332 | RR | 17 | 2128-02-21 08:57:00 | 2128-02-21 09:30:00 | INDICATION: ___ man with chest pain, evaluate for cardiopulmonary
process.
COMPARISON: None.
FINDINGS: PA and lateral chest radiographs are provided. Lung volumes are
low. There is no focal consolidation, pleural effusion or pneumothorax. The
heart size is mildly enlarged. There is no evidence of CHF.
IMPRESSION: No acute cardiopulmonary process.
|
19998444-RR-12 | 19,998,444 | 29,729,593 | RR | 12 | 2156-01-13 07:17:00 | 2156-01-13 08:54:00 | HISTORY: Chronic pancreatitis, right upper quadrant pain.
COMPARISON: Ultrasound ___, CT ___.
FINDINGS:
Evaluation of the liver is limited by suboptimal acoustic windows. The
visualized hepatic parenchyma is homogeneous. No focal liver lesions are
identified. There is no intra or extrahepatic biliary dilatation. The main
portal vein is patent with hepatopetal flow. The gallbladder is thin walled
and nondistended. Visualized portion of the pancreatic parenchyma are
homogeneous. Limited views of the right kidney show no hydronephrosis. The
14 cm spleen is enlarged.
IMPRESSION:
1. Normal gallbladder and CBD.
2. Splenomegaly.
|
19998444-RR-5 | 19,998,444 | 21,096,018 | RR | 5 | 2155-06-05 08:31:00 | 2155-06-05 14:38:00 | LIVER OR GALLBLADDER ULTRASOUND (SINGLE ORGAN)
INDICATION: ___ male with recurrent/chronic pancreatitis. Please
evaluate for cholelithiasis.
COMPARISON: None.
TECHNIQUE: Multiple sonographic images were obtained of the abdomen with
color Doppler evaluation.
FINDINGS: The midline structures of the abdomen are obscured by bowel gas,
limiting evaluation.
The liver demonstrates normal echogenicity without focal lesions. The portal
vein is patent with normal hepatopetal flow. No intrahepatic or extrahepatic
biliary ductal dilatation. The gallbladder is well distended, without
echogenic stones. The common bile duct is normal in caliber measuring 4 mm.
The spleen is enlarged measuring 15 cm in length without focal lesions. The
left kidney measures 13.9 cm. The right kidney measures 12.6 cm. Both
kidneys demonstrate normal echogenicity with normal corticomedullary
differentiation. No hydronephrosis, suspicious renal lesions, or stones. The
pancreatic body demonstrates normal echogenicity. The pancreatic head and
tail are obscured by bowel gas.
The abdominal aorta is normal in caliber. Limited evaluation of the IVC
demonstrates it to be normal caliber.
IMPRESSION:
1. No sonographic evidence of cholelithiasis.
2. Splenomegaly.
|
19998444-RR-6 | 19,998,444 | 21,096,018 | RR | 6 | 2155-06-06 11:29:00 | 2155-06-06 12:56:00 | INDICATION: ___ man with history of chronic pancreatitis and
Hirschsprung disease. Evaluate for free air and evidence of pancreatic
calcification and chronic pancreatitis.
COMPARISON: None.
TECHNIQUE: PA and lateral chest radiographs were provided.
FINDINGS: The lungs are clear. There is no focal consolidation, pleural
effusion, or pneumothorax. The cardiomediastinal silhouette is normal. There
is no free air under the hemidiaphragms. No pancreatic calcificaitons
visualized. Osseous structures are intact.
IMPRESSION: No acute cardiopulmonary process. No evidence of free air.
|
19998444-RR-7 | 19,998,444 | 21,096,018 | RR | 7 | 2155-06-06 11:29:00 | 2155-06-06 19:55:00 | INDICATION: ___ male with history of chronic pancreatitis and
Hirschsprung disease, now requiring assessment for free air, pancreatic
calcification, transition point, and intussusception.
COMPARISON: None.
FINDINGS: Upright and supine images of the abdomen demonstrate dilated loops
of small and large bowel. Dilated loops of small bowel are located in the
right lower quadrant. Dilated loops of large bowel are seen in the mid
abdomen. It is possible that this configuration could represent a cecal
volvulus. There is no pneumatosis or free air under the diaphragm. There is
no air seen in the rectum or the descending colon. Multiple coils are noted
in the right pelvis. The visualized osseous structures are unremarkable and
there are no soft tissue calcifications. The lung bases are clear.
IMPRESSION: Dilated loops of small and large bowel, concerning for possible
cecal volvulus. Recommend followup CT scan to further characterize. These
findings were communicated with Dr. ___ at 4:50 p.m. today.
|
19998444-RR-8 | 19,998,444 | 21,096,018 | RR | 8 | 2155-06-07 11:01:00 | 2155-06-07 13:44:00 | INDICATION: ___ man with Hirschsprung disease and status post
colostomy as an infant, now with questionable diagnosis of chronic
pancreatitis, status post multiple ERCPs and stent placement, now presents
with abdominal pain.
COMPARISON: Abdomen ultrasound ___.
DLP: 1380.17 mGy-cm.
TECHNIQUE: Multidetector CT imaging of the abdomen was obtained without
intravenous contrast. Subsequently, MDCT images of the abdomen and pelvis
were obtained after administration of 130 cc of Omnipaque intravenous contrast
and oral contrast. Sagittal and coronal reformations were performed and
reviewed.
FINDINGS: The imaged lung bases are clear of pulmonary nodules and pleural
effusions. The imaged portion of the heart and pericardium is unremarkable.
The liver enhances homogeneously, without focal lesions. Mild hypoattenuation
of the liver suggests fatty infiltration. There is no intra- or extra-hepatic
biliary dilatation. The gallbladder is unremarkable. There is no intra- or
extra-hepatic biliary dilatation. The adrenal glands are normal. The spleen
is in the upper limits, measuring 13.5 cm. The panreas is normal, without
evidence of parenchymal calcification or ductal dilatation to suggest chronic
pancreatitis. There is no peripancreatic fat stranding. The stomach and
small bowel are normal in appearance, without evidence of bowel wall
thickening or obstruction. Subtle bowel wall thickening in the cecum and
proximal ascending colon, is likely due to underdistention. Scattered colonic
diverticulosis is seen, without evidence of acute diverticulitis. The
abdominal aorta is normal in course and caliber. Small scattered
retroperitoneal lymph nodes do not meet CT criteria for significant
adenopathy. There is no intra-abdominal free fluid or air.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The urinary bladder, prostate,
rectum and sigmoid colon are unremarkable. No pelvic lymphadenopathy or free
fluid is seen.
BONES AND SOFT TISSUES: No bone lesions suspicious for infection or
malignancy are detected.
IMPRESSION:
1. No acute abdominal pathology, especially no evidence of bowel obstruction.
2. No CT evidence of acute or chronic pancreatitis.
|
19998444-RR-9 | 19,998,444 | 21,096,018 | RR | 9 | 2155-06-08 14:27:00 | 2155-06-08 18:40:00 | INDICATION: ___ man with acute on chronic abdominal pain, urinary
hesitancy and retention, now with scrotal pain.
COMPARISON: CT of the abdomen and pelvis ___.
SCROTAL ULTRASOUND: The right testicle measures 3.9 x 2.7 x 2.3 cm and the
left testicle measures 3.8 x 2.3 x 2.1 cm. Both testes and epididymides
demonstrate normal echogenicity and symmetric vascularity. Normal arterial
and venous flow is seen in both testes.
IMPRESSION: Normal scrotal ultrasound without evidence of testicular mass or
torsion.
|
19998497-RR-24 | 19,998,497 | 27,909,016 | RR | 24 | 2144-01-13 01:27:00 | 2144-01-13 06:08:00 | HISTORY: Left hip fracture, pre-op.
COMPARISON: ___.
FINDINGS:
Frontal radiograph of the chest demonstrates stable top-normal heart size.
Normal mediastinal and hilar contours. Clear lungs. No pleural effusion or
pneumothorax. Multiple left old posterior rib deformities.
IMPRESSION:
No acute process.
|
19998497-RR-25 | 19,998,497 | 27,909,016 | RR | 25 | 2144-01-14 11:27:00 | 2144-01-15 15:09:00 | HISTORY: ORIF left hip.
Fluoroscopic assistance provided to surgeon in the OR without the radiologist
present. 13 spot views obtained. Fluoro time recorded as 60.9 seconds on the
electronic requisition. Views demonstrate steps related to fixation of a left
hip fracture. Correlation with real-time findings and when appropriate
conventional radiographs is recommended for full assessment.
|
19998497-RR-26 | 19,998,497 | 27,909,016 | RR | 26 | 2144-01-15 10:11:00 | 2144-01-15 11:47:00 | HISTORY: Found down, evaluate for potential intracranial bleed.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were acquired.
CTDIvol: 53.16
DLP: 891.93
COMPARISON: None.
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or infarction. The
ventricles and sulci are normal in size and configuration. Minimally
prominent ventricles and sulci suggest age-related involutional changes or
atrophy. Periventricular white matter hypodensities are consistent with
chronic small vessel ischemic disease.
The basal cisterns appear patent and there is preservation of gray-white
matter differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
The globes are unremarkable.
IMPRESSION:
No evidence of acute intracranial process.
|
19999068-RR-10 | 19,999,068 | 21,606,769 | RR | 10 | 2161-08-27 04:40:00 | 2161-08-27 09:14:00 | REASON FOR EXAMINATION: Followup of the patient intubated with NG tube.
COMPARISON: ___.
ET tube tip is 4.5 cm above the carina. NG tube tip is in the stomach. Heart
size and mediastinum are unremarkable. Right lower lobe opacity and minimal
left basal opacities appear unchanged, as previously mentioned potentially
demonstrating atelectasis versus infectious process. Given the unchanged
appearance of those abnormalities, aspiration is less likely.
|
19999068-RR-11 | 19,999,068 | 21,606,769 | RR | 11 | 2161-08-27 17:25:00 | 2161-08-27 18:16:00 | INDICATION: ___ man with recent head trauma three days ago, now with
new slight anisocoria of unclear duration. The patient is currently
intubated, to rule out intracranial pathology.
COMPARISON: CT head, ___.
TECHNIQUE: Multidetector CT imaging of the head was performed without
intravenous contrast. The initial set of images were limited by motion
artifact, and repeat imaging was performed which was also somewhat limited by
motion.
FINDINGS: Within this limitation, no large intracranial hemorrhage, edema,
masses, or mass effect is seen. The gray-white matter differentiation is
preserved. The ventricles are mildly enlarged, consistent with involutional
changes. The basal cisterns are normal. Mild mucosal thickening is seen in
bilateral maxillary sinuses. The mastoid air cells are clear. The orbits are
unremarkable.
IMPRESSION: Study is somewhat limited by motion; within this limitation, no
acute abnormality is seen.
ATTENDING NOTE: Study limited. Outside CT shows blood near left temporal horn
which is not apparent on current study. The scalp hematoma is decreased.
|
19999068-RR-12 | 19,999,068 | 21,606,769 | RR | 12 | 2161-08-29 05:00:00 | 2161-08-29 09:38:00 | REASON FOR EXAMINATION: Alcoholic withdrawal, intubated.
Portable AP radiograph of the chest was reviewed in comparison to ___ and chest CT from ___.
Bibasal opacities concerning for atelectasis/aspiration appear to be
unchanged. Heart size and mediastinum are stable in appearance. The patient
was extubated. No appreciable pleural effusion is demonstrated. No
pneumothorax seen.
|
19999068-RR-13 | 19,999,068 | 21,606,769 | RR | 13 | 2161-08-31 10:04:00 | 2161-08-31 10:27:00 | INDICATION: Ethanol abuse, now with delirium.
TECHNIQUE: PA and lateral chest radiographs.
COMPARISON: Multiple priors, most recently on ___.
FINDINGS: There is no focal consolidation, pleural effusion, vascular
congestion, or pneumothorax. The cardiac, hilar, and mediastinal contours
within normal limits.
IMPRESSION: No acute cardiopulmonary abnormality.
|
19999068-RR-14 | 19,999,068 | 21,606,769 | RR | 14 | 2161-09-01 13:59:00 | 2161-09-01 15:45:00 | INDICATION: ___ man with admission for alcohol intoxication and
withdrawal. Intraventricular hemorrhage on from prior imaging. Assess for
intracranial bleed.
COMPARISONS: NECT head of ___. NECT outside hospital head of
___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast.
FINDINGS: No evidence of hemorrhage, edema, mass effect, or acute infarction.
Previously seen left temporal horn hemorrhage is no longer present. Right
temporal soft tissue swelling appears improved since the prior exam.
Prominent ventricles and sulci suggest age-related atrophy. Periventricular
and subcortical white matter hypodensities are compatible with chronic small
vessel ischemic disease. Well-defined hypodensity in the right inferior
frontal lobe is compatible with evolving changes from a prior contusion, and
is unchanged since ___. The basal cisterns appear patent, and
there is preservation of the gray-white matter differentiation. The
visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear.
IMPRESSION: No acute intracranial hemorrhage or mass effect. Previously seen
left temporal horn hemorrhage is resolved.
|
19999068-RR-5 | 19,999,068 | 21,606,769 | RR | 5 | 2161-08-24 06:05:00 | 2161-08-24 10:24:00 | CHEST RADIOGRAPH
INDICATION: Evaluation for pneumonia or aspiration.
COMPARISON: ___, 0:31 p.m.
FINDINGS: Compared to the previous radiograph, there is a subtle right medial
and basal opacity, consistent with aspiration in the appropriate clinical
setting. Otherwise, unchanged normal chest radiograph with normal size of the
cardiac silhouette. The observation was made at 10:08 a.m. on ___
and the findings were communicated at the same time to the referring
physician, ___ the findings were discussed over the telephone.
|
19999068-RR-6 | 19,999,068 | 21,606,769 | RR | 6 | 2161-08-25 11:17:00 | 2161-08-25 14:57:00 | DATE: ___.
TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with alcohol withdrawal, concerns and
aspiration risk, evaluate for interval change.
FINDINGS: AP single view of the chest has been obtained with patient in
semi-upright position. Comparison is made with the next previous similar
study of ___. On previous examination identified right lower
parenchymal density partially overshadowed by the heart contours and
apparently located in the right lower lobe posterior segment has cleared up.
No new pulmonary abnormalities are identified and no pulmonary vascular
congestion is found. Similar as on the preceding examination of ___,
there is a rounded mass overlying the contour of the ascending arch. This
abnormality has not changed significantly since yesterday. Comparison with a
supine chest examination transferred from ___ Hospital, this mass is
new. Unfortunately, the transferred image is not identified by date.
This surprising finding is noted and transmitted by page to referring
physician, ___. During the subsequent discussion performance of a
chest CT was recommended as the finding most likely represents an acute
uncommon aortic dissection.
|
19999068-RR-7 | 19,999,068 | 21,606,769 | RR | 7 | 2161-08-25 15:53:00 | 2161-08-25 16:59:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Patient with alcohol withdrawal and concern for aortic
dissection, intubated for sedation for CT.
Comparison is made with prior study performed five hours earlier.
ET tube tip is in standard position, 4.2 cm above the carina. There are lower
lung volumes with increasing bibasilar opacities. There is no evident
pneumothorax. Cardiomediastinal silhouette is unchanged.
|
19999068-RR-8 | 19,999,068 | 21,606,769 | RR | 8 | 2161-08-25 16:51:00 | 2161-08-26 11:09:00 | CLINICAL HISTORY: ___ man with widened mediastinum on chest
radiograph and dissociate pulses. Evaluate for dissection.
COMPARISON: Chest radiographs ___ from 11:29 a.m. and 4:29 p.m. and
___ from ___
TECHNIQUE: Volumetric multidetector CT acquisition of the chest was performed
with 70 mL Omnipaque intravenous contrast. Images are presented for display
in the axial plane at 5 mm. Coronal and sagittal reformats as well as axial
MIP images were obtained for evaluation.
CT CHEST WITH INTRAVENOUS CONTRAST: The thoracic aorta is normal in caliber
without evidence of dissection or pseudoaneurysm. Contrast bolus timing is
not optimized to evaluate the subsegmental pulmonary arteries, but there is no
central filling defect to suggest pulmonary embolism. The heart is slightly
enlarged with moderate coronary artery calcifications.
No pathologically enlarged axillary, mediastinal, or hilar lymph nodes are
present, measuring up to 7 mm in the subcarinal station (2:28). There is no
pleural or pericardial effusion. No nodule is seen in the thyroid gland.
Lung window images demonstrate moderate enhancing bibasilar consolidations,
compatible with atelectasis. Supervening aspiration cannot be excluded.
There is no pneumonia. Airways are patent to the subsegmental levels
bilaterally with small secretions in the left main stem bronchus. A 4-mm right
middle lobe nodule is seen (2:34).
The patient is intubated with the endotracheal tube ending in the mid trachea.
The study is not tailored for subdiaphragmatic evaluation. Diffuse
hypoattenuation throughout the liver is compatible with fatty deposition. No
adrenal mass is seen. The visualized portions of the gallbladder, pancreas,
spleen, and kidneys are normal.
BONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.
IMPRESSION:
1. No acute aortic pathology. No CT abnormality to account for the
radiographic abnormality described on chest radiographs ___.
2. Bibasilar atelectasis with volume loss in the lower lobes bilaterally.
Supervening aspiration cannot be excluded. No pneumonia. Secretions in the
left main stem bronchus.
3. 4-mm right middle lobe nodule. If the patient has no risk factors for
malignancy, no followup is needed. If the patient has risk factors for
malignancy, followup with dedicated chest CT in one year is recommended if
there is no prior imaging documenting stability.
4. Fatty liver.
Dr. ___ discussed the findings with Dr. ___ at 7 p.m. on
___.
|
19999068-RR-9 | 19,999,068 | 21,606,769 | RR | 9 | 2161-08-26 21:56:00 | 2161-08-27 09:02:00 | REASON FOR EXAMINATION: Alcohol withdrawal, intubated after OG tube
placement.
AP radiograph of the chest was reviewed in comparison to ___.
ET tube tip is 4.5 cm above the carina. The NG tube tip is in the stomach.
Heart size and mediastinum are unchanged in appearance. Right lower lobe
opacity and left lower lobe opacity, are persistent and although might reflect
atelectasis, infectious process cannot be excluded. No appreciable
pneumothorax is seen.
|
19999287-RR-60 | 19,999,287 | 22,997,012 | RR | 60 | 2197-07-26 03:10:00 | 2197-07-26 05:27:00 | INDICATION: ___ year old woman with lung cancer and COPD p/w acute onset
dyspnea. Please evaluate.
TECHNIQUE: AP radiograph of the chest.
COMPARISON: PET-CT from ___. Chest radiograph from ___.
FINDINGS:
New collapse of the left upper lobe around a large, obstructing, left hilar
mass explains leftward shift of the mediastinum and elevation of the left lung
base though subpulmonic pleural effusion is probably also present, and
aeration of the left lower lobe is poor, probably also due to bronchial
obstruction.
Patient has had right upper lobectomy. There may be a small right pleural
effusion. There is no evidence for pneumothorax. The visualized osseous
structures are unremarkable.
IMPRESSION:
1. New upper lobe collapse and some lower lobe atelectasis around a large
obstructing left hilar mass.
2. Probable small bilateral pleural effusions.
NOTIFICATION: Findings were discussed with Dr. ___ at 4:30A, approximately
2-minutes after discovery by Dr. ___ on the day of the exam.
|
19999784-RR-14 | 19,999,784 | 26,194,817 | RR | 14 | 2119-06-18 16:25:00 | 2119-06-18 16:41:00 | INDICATION: ___ with weakness// r/o PNA
TECHNIQUE: PA and lateral views the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear without consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities. S-shaped thoracic scoliosis is noted within upper
levoscoliosis and mid dextroscoliosis.
IMPRESSION:
No acute cardiopulmonary process.
|
19999784-RR-15 | 19,999,784 | 26,194,817 | RR | 15 | 2119-06-19 11:49:00 | 2119-06-19 15:14:00 | EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with concern for ALS// r/o acute pathology
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed. After administration
of Gadavist intravenous contrast, sagittal and axial T1 weighted imaging was
performed.
COMPARISON: None.
FINDINGS:
There is slight reversal of the cervical lordosis. There is mild multilevel
vertebral body height loss extending from C3 through C7, likely degenerative.
Diffuse signal heterogeneity of the vertebral bodies is likely on a
degenerative basis. Although multilevel patchy cervical vertebral body T1
hypointensity relative to the intervertebral discs with possible minimal
postcontrast enhancement raises concern for a potential marrow infiltrative
process if there is a history of malignancy.
C2-C3: Facet osteophytes result in severe right neural foraminal narrowing.
C3-C4: Disc bulging and endplate/uncovertebral osteophytes results in mild
spinal canal stenosis with mild cord flattening without evidence of abnormal
cord signal. There is moderate to severe left and moderate right neural
foraminal narrowing.
C4-C5: Disc bulging and endplate/uncovertebral osteophytes with mild spinal
canal stenosis and mild flattening of the cord without evidence of abnormal
cord signal. There is severe left and moderate right neural foraminal
narrowing.
C5-C6: Endplate and uncovertebral osteophytes result in moderate spinal canal
stenosis with flattening of the cord without abnormal cord signal. There is
severe bilateral neural foraminal narrowing.
C6-C7: Disc bulging and endplate/uncovertebral osteophytes with moderate left
and mild right neural foraminal narrowing.
C7-T1: Facet osteophytes with mild left neural foraminal narrowing.
For the visualized portions of the brain, please refer to the report for the
concurrently performed MRI brain study.
IMPRESSION:
1. Multilevel degenerative changes of the cervical spine with multilevel mild
flattening of the cord without of evidence of abnormal cord signal.
Degenerative changes are most significant at C5-C6 where there is moderate
spinal canal stenosis and severe bilateral neural foraminal narrowing.
2. Multilevel patchy cervical vertebral body T1 hypointensity relative to the
intervertebral discs with possible minimal postcontrast enhancement raises
concern for a potential marrow infiltrative process if there is a history of
malignancy. Alternatively, findings may also represent sequela of
degenerative change.
|
19999784-RR-16 | 19,999,784 | 26,194,817 | RR | 16 | 2119-06-19 11:49:00 | 2119-06-19 14:59:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old man with concern for als// eval for acute pathology
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration 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: None.
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 a
5 mm retention cyst within the right maxillary sinus. There is a mild amount
of nonspecific fluid within the mastoid air cells. There is no abnormal
enhancement after contrast administration.
For details of the cervical spine please refer to the concurrently performed
MRI cervical spine study.
IMPRESSION:
1. No acute intracranial abnormality.
2. For details of the cervical spine please refer to the concurrently
performed MRI cervical spine study.
|
19999784-RR-18 | 19,999,784 | 26,194,817 | RR | 18 | 2119-06-20 16:46:00 | 2119-06-20 19:20:00 | EXAMINATION: CT scan of the abdomen pelvis with contrast
INDICATION: ___ year old man with smoking history, weight loss, dysphagia and
lower extremity weakness. concern for occult malignancy// ? malignancy
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 71.2 cm; CTDIvol = 9.4 mGy (Body) DLP = 670.8
mGy-cm.
2) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.4 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 682 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Moderate OA of the left hip, with subchondral sclerosis and geodes.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No intra-abdominal malignancy.
2. Severe left hip osteoarthritis.
|
19999784-RR-19 | 19,999,784 | 26,194,817 | RR | 19 | 2119-06-20 16:52:00 | 2119-06-20 20:44:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Rule out malignancy.
TECHNIQUE: MDCT of the chest was performed with intravenous contrast.
Coronal and sagittal reformats were sent to PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 71.2 cm; CTDIvol = 9.4 mGy (Body) DLP = 670.8
mGy-cm.
2) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 23.4 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 682 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: None.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid gland is unremarkable.
There are no enlarged lower cervical, supraclavicular, or axillary lymph
nodes.
UPPER ABDOMEN: Please refer to separate report for intra-abdominal findings.
MEDIASTINUM: There is no mediastinal adenopathy.
HILA: There is no hilar lymphadenopathy.
HEART and PERICARDIUM: The heart is not enlarged. There is no pericardial
effusion.
PLEURA: There are no pleural effusions.
LUNG:
1. PARENCHYMA: The lungs are clear. No focal parenchymal abnormality is
identified.
2. AIRWAYS: The airways are patent.
3. VESSELS: There is no thoracic aortic aneurysm. The pulmonary artery is
nonenlarged. There is no pulmonary embolism.
CHEST CAGE: There are no suspicious bony lesions. Degenerative changes at
T8-T9, and C6-C7, incompletely visualized.
IMPRESSION:
No intrathoracic malignancy.
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19999784-RR-20 | 19,999,784 | 26,194,817 | RR | 20 | 2119-06-21 00:57:00 | 2119-06-21 09:42:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with dysphagia and LLE weakness and EMG notable
for L4 radiculopathy// ? L4 compression
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: Torso CT ___.
FINDINGS:
The visualized portions of the distal spinal cord demonstrate mild expansion
and T2/STIR hyperintensity, particularly at the level of T12-L1. Differential
considerations include inflammatory etiologies such as transverse myelitis,
demyelinating disease, or intramedullary neoplasm.
Vertebral body heights are maintained. Vertebral body alignment is within
normal limits, without evidence for subluxation.
The lumbar spine bone marrow is diffusely T1 and T2 hypointense. Otherwise,
there is no concerning focal bone marrow signal abnormality. The conus
medullaris terminates at the level of L1-L2.
There is loss of intervertebral disc height and signal in multiple levels,
most prominent at L4-L5. There are multilevel degenerative changes as
follows:
T12-L1: Unremarkable.
L1-L2: There is a mild posterior disc bulge with superimposed left sided disc
protrusion resulting in minimal canal narrowing without neural foraminal
narrowing. Of note, the disc bulge at this level nearly contacts the
descending left L2 nerve root.
L2-L3: Mild posterior disc bulging is noted without canal stenosis or neural
foraminal narrowing.
L3-L4: A mild posterior disc bulge flattens the ventral thecal sac and
combines with thickening of the ligamentum flavum and prominent dorsal
epidural fat to result in minimal canal narrowing with minimal neural
foraminal narrowing bilaterally. The disc bulge at this level abuts the
descending left L4 nerve root.
L4-L5: A posterior disc bulge flattens the ventral thecal sac without canal
narrowing, but causing bilateral subarticular recess narrowing and minimally
contacting the bilateral descending L5 nerve roots. There is mild-to-moderate
left and mild right neural foraminal narrowing. The disc bulge at this level
also contacts the exiting left L4 nerve root.
L5-S1: There is a posterior disc bulge with slightly left sided superimposed
protrusion which narrows the left subarticular recess and minimally abuts the
descending left S1 nerve root. Otherwise, there is no canal stenosis or
significant neural foraminal narrowing.
Several small T2 hyperintense renal cysts are noted. The remainder of the
visualized paraspinal soft tissues are grossly unremarkable.
IMPRESSION:
1. Mild expansion and T2/STIR hyperintensity of the distal lumbar spinal cord.
Differential considerations include inflammatory etiologies such as transverse
myelitis, demyelinating disease, or intramedullary neoplasm. If there is
ongoing clinical concern, consider repeat thoracic/lumbar spine MRI evaluation
with intravenous contrast.
2. Multilevel spondylosis of the lumbar spine, as detailed above, with L3-L4
disc bulge abutting the descending left L4 nerve root and L4-L5 disc bulge
contacting the exiting left L4 nerve root.
3. Mild, diffusely T1/T2 hypointense bone marrow signal, similar to findings
fat were previously noted in the cervical spine. Although this finding can be
seen in the setting of chronic anemia or smoking, an marrow infiltrative
process is not excluded.
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19999784-RR-21 | 19,999,784 | 26,194,817 | RR | 21 | 2119-06-21 23:13:00 | 2119-06-22 08:44:00 | EXAMINATION: MRI THORACIC AND LUMBAR PT6 MR SPINE
INDICATION: ___ year old man with L4 radiculopathy and weakness iun left leg//
Can just do post contrast scan to evaluate for contrast enhancement associated
with T2 signal on prior study w/o contrast
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging through the thoracic spine. Post-contrast
imaging was subsequently performed in sagittal and axial planes through the
thoracic and lumbar spine.
COMPARISON: Noncontrast MR lumbar spine ___, MR cervical spine ___.
FINDINGS:
THORACIC:
There is mild S shaped scoliosis of the thoracic spine. The thoracic
vertebral body heights are grossly maintained. Sagittal spinal alignment is
maintained.
The bone marrow signal is mildly heterogeneous, but without focal suspicious
lesion. The upper and mid thoracic spinal cord is normal in morphology and
signal intensity, without evidence of abnormal enhancement. The known signal
abnormality in the distal thoracic and lumbar spinal cord is discussed below.
Multilevel disc bulges are seen throughout the thoracic spine, most notable at
T3-4, T6-7, T7-8, and T8-9, all of which result in minimal to no spinal canal
stenosis. There is no significant neural foraminal narrowing.
LUMBAR:
Vertebral body heights are maintained. Vertebral body alignment is within
normal limits, without evidence for subluxation.
Within the distal spinal cord, at the level of T12-L1, there is a enhancing
lesion within the slightly left and ventral of center cord which measures
approximately 1.5 x 0.6 x 0.5 cm (SI by AP by TV). There is both superior and
inferior extension of this abnormal enhancement, which involves the
leptomeningeal surface and extends inferiorly to the level of L2 (13:8).
Posterior leptomeningeal extension is also noted (13:10, with potential
involvement of the adjacent nerve roots.
Again, there is associated with cord expansion and surrounding T2/STIR signal
abnormality which extends from the superior endplate of T12 to the superior
endplate of L2
Background spondylosis of the lumbar spine are again noted, previously
detailed in a level by level description on the recent noncontrast MR lumbar
spine examination performed earlier on the same day.
IMPRESSION:
1. 1.5 x 0.6 x 0.5 cm T12-L1 intramedullary enhancing focus with surrounding
STIR/T2 signal abnormality and associated cord expansion. Notably, there is
extensive leptomeningeal involvement which extends both superiorly and
inferiorly beyond the margins of the intramedullary lesion, with possible
involvement of the adjacent nerve roots. Differential considerations include
inflammatory processes such as sarcoid, infection, or leptomeningeal seeding
from metastatic disease. Lymphoma is a is a possibility. A primary spinal
neoplasm is less likely given the extent of the leptomeningeal component.
2. No additional areas of abnormal cord signal or contrast enhancement.
3. Unremarkable examination of the thoracic spine with minimal spondylosis.
4. Multilevel degenerative changes of the lumbar spine are again noted,
previously detailed in a level by level description on the recent noncontrast
MR lumbar spine examination performed earlier on the same day.
|
19999784-RR-22 | 19,999,784 | 26,194,817 | RR | 22 | 2119-06-26 13:40:00 | 2119-06-26 16:58:00 | INDICATION: ___ year old man with spinal cord lesions, monoclonal spike,
evaluate for lesions consistent with multiple myeloma.
TECHNIQUE: Multiple radiographs were obtained as part of a skeletal survey.
Views include single view of the skull, two views each of the thoracic and
lumbar spine, single view each of the right and left humerus and right left
femur, and a single AP view of the pelvis.
COMPARISON: CT torso ___.
FINDINGS:
SKULL: No concerning focal lucent lesions. Well pneumatized sinuses. Dental
amalgam is noted.
THORACIC SPINE: There is mild dextrocurvature of the thoracic ___
at approximately T6. There are moderate multilevel thoracic spine
degenerative changes including multilevel disc height loss and small anterior
intervertebral osteophytes. No gross vertebral body compression. Probable
diffuse osteopenia. No gross lytic or sclerotic lesion detected
radiographically.
LUMBAR SPINE: There is minimal dextrocurvature of the lumbar ___ at
L3-4. There are minimal multilevel lumbar spine degenerative changes,
including disc height loss most pronounced at L4-5, and suggestion of
posterior element hypertrophic changes at L4-5 and L5-S1. Vertebral body
heights are preserved. No obvious lytic or sclerotic lesion.
PELVIS: Sclerosis of the left SI joint is seen worst on the iliac side of the
joint about the middle and inferior thirds of the joint line. More subtle
sclerosis involving the inferior right SI joint was better
visualized/evaluated on the prior CT of ___. Increased sclerosis
along the subchondral/weight-bearing surface of the left femoral head without
articular collapse likely relates to at least moderate left hip degenerative
changes. Focal lucencies in this area, also better seen on the prior CT, are
suggestive of subchondral cysts/geodes. Otherwise, no concerning focal lucent
lesions. ___ CT also shows a small focus of mirror-image
osteoarthritis in the right femoral head.)
FEMURS: Allowing for aforementioned changes in the left femoral head, no
concerning focal lucent lesions detected.
HUMERI: No concerning focal lucent lesions.
IMPRESSION:
1. No concerning focal lytic osseous lesions identified. Focal lucencies in
the left femoral head likely represent geodes related to left hip
osteoarthritis which is at least moderate, as seen on prior CT.
2. Bilateral, asymmetric left more than right sacroiliitis. Although this was
better assessed on the prior CT, findings nonetheless raise concern for
seronegative spondyloarthropathy including psoriatic arthritis or reactive
arthritis. Please correlate with clinical signs/symptoms.
3. Scoliosis and degenerative changes in the thoracolumbar spine.
|
19999828-RR-20 | 19,999,828 | 29,734,428 | RR | 20 | 2147-07-18 11:10:00 | 2147-07-18 11:34:00 | INDICATION: ___ year old woman with new right 41cm PICC// PICC tip location
Contact name: ___: ___
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: None.
FINDINGS:
Right PICC tip in the mid SVC. Heart size is mildly enlarged. Mediastinal
and hilar contours are unremarkable. Lungs are hyperinflated. Streaky
atelectasis is noted in the left lung base. No pleural effusion or
pneumothorax is present. No acute osseous abnormalities visualized.
IMPRESSION:
Right PICC in the mid SVC. No acute cardiopulmonary process.
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19999828-RR-21 | 19,999,828 | 29,734,428 | RR | 21 | 2147-08-01 00:14:00 | 2147-08-01 11:59:00 | INDICATION: ___ year old woman with multiple abdominal surgery and fistula
with WVac// Question of ileus with increased abd pain
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph ___ CT abdomen and pelvis ___
FINDINGS:
A new wound VAC device projects over the mid abdomen. There are no abnormally
dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
There are moderate degenerative changes of the lower lumbar spine.
Multiple surgical clips scattered throughout the abdomen appear in grossly
similar position to the study on ___.
IMPRESSION:
No acute abnormality with nonobstructive bowel gas pattern. Interval
placement of wound VAC which projects over the mid abdomen.
|
19999828-RR-22 | 19,999,828 | 29,734,428 | RR | 22 | 2147-08-01 11:46:00 | 2147-08-01 16:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with increasing WBC count, no fevers or
hemodynamic instability// PNA? collection?
COMPARISON: Chest radiograph from ___
FINDINGS:
Portable semi-upright view of the chest provided.
No focal consolidation, pleural effusion, or pneumothorax is identified. The
cardiac silhouette is normal. The mediastinal and hilar contours are
unremarkable. Right-sided PICC terminates in the mid SVC, unchanged from
prior.
IMPRESSION:
No acute cardiopulmonary process.
|
19999987-RR-16 | 19,999,987 | 23,865,745 | RR | 16 | 2145-11-02 20:22:00 | 2145-11-02 21:20:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Prior chest radiograph from earlier same day.
CLINICAL HISTORY: Transfer from outside hospital with intubation, assess
position of tube.
FINDINGS: Portable supine AP view of the chest provided demonstrates an
endotracheal tube with tip positioned approximately 3.5 cm above the carina.
The NG tube courses into the left upper abdomen. There is bibasilar
atelectasis. Heart and mediastinal contour appears grossly unremarkable. The
bony structures appear intact.
IMPRESSION: Appropriately positioned ET and NG tubes. Bibasilar atelectasis.
|
19999987-RR-17 | 19,999,987 | 23,865,745 | RR | 17 | 2145-11-02 22:37:00 | 2145-11-03 18:55:00 | HISTORY: ___, with left occipital bleeding. Assess for intracranial
process.
COMPARISON: Outside CT head on ___.
TECHNIQUE: Non-contrast MDCT images were acquired through the head.
Following IV administration of iodinated contrast, MDCT images were acquired
from the aortic arch to the vertex per CTA head and neck protocol. Dedicated
3D rendering was performed to better assess the underlying vasculature:
FINDINGS:
NON-CONTRAST CT HEAD: There is a 3.9 x 2.2 cm intraparenchymal hemorrhage in
the left occipital lobe. There is mild ___ edema. No
significant interval changes are noted compared to the outside study
approximately 7 hours prior. There is no new hemorrhagic focus. The
ventricles remain normal and symmetric in size. There is no intraventricular
hemorrhagic extension. There is no shift of normally midline structures.
There is no evidence of acute skull fracture. There is a small amount of
retained fluid in the posterior nasal passage, in keeping with patient's
intubation status. The mastoid air cells are clear.
CTA NECK: There is a normal three-vessel aortic arch. Major cervical vessels
and great mediastinal vessels are patent. There is no significant ICA
stenosis by NASCET criteria. There is no evidence of aneurysm, dissection, or
occlusion. The visualized lung apices are noted with minimal dependent
atelectasis, but otherwise unremarkable. The thyroid gland is normal. Major
cervical musculature is symmetric. The parotid glands and submandibular
glands are normal and symmetric. There is no lymphadenopathy. Multilevel
degenerative changes are moderate in the visualized cervicothoracic spine.
CTA HEAD: Major intracranial vessels are patent. There is no evidence of
aneurysm, arteriovenous malformation, or occlusion. A hypoplastic right P1
segment is noted with a robust right posterior communicating artery,
representing a fetal-type right PCA. The left vertebral artery is slightly
dominant.
IMPRESSION:
1. Unchanged 3.9 x 2.2 cm left occipital intraparenchymal hemorrhage. No
midline shift. No intraventricular hemorrhagic extension.
2. Normal CTA head and neck, without aneurysm, dissection, vascular
malformation or significant atherosclerotic disease.
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