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10014610-RR-106 | 10,014,610 | 20,579,647 | RR | 106 | 2174-05-31 00:04:00 | 2174-05-31 08:56:00 | EXAMINATION: DX FEMUR AND TIB/FIB
INDICATION: ___ year old man with right knee prosthetic jt infection s/p
explant / abx spacer with ortho // post op
TECHNIQUE: Multiple AP and lateral views of the right lower extremity.
COMPARISON: ___.
FINDINGS:
There is been interval removal of right knee arthroplasty. Placement of wires
and cement beads presumably antibiotic impregnated along the operative site is
evident. There is cortical discontinuity of the right proximal to mid femoral
shaft compatible with a mildly displaced fracture. This appears
longitudinally orientated. It extends from a subtrochanteric location to the
distal end of the right femur.
IMPRESSION:
Right femoral fracture. Postsurgical change.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 8:53 AM, 2 minutes after
discovery of the findings.
|
10014610-RR-107 | 10,014,610 | 20,579,647 | RR | 107 | 2174-06-02 11:44:00 | 2174-06-02 13:54:00 | EXAMINATION: FEMUR (AP AND LAT) RIGHT
INDICATION:
Fracture repair in OR of right femur
TECHNIQUE: Fluoroscopic assistance provided to the clinician in the OR
without the radiologist present. 19 spot views obtained. Fluoro not recorded
on the available requisition/paper work. Spot views not labeled as to side.
COMPARISON: Right femur radiographs from ___ j.
FINDINGS:
Views demonstrate steps related to femoral fracture fixation . Antibiotic
impregnated beads again noted.
IMPRESSION:
Correlation with real-time findings and, when appropriate, conventional
radiographs is recommended for further assessment.
|
10014610-RR-108 | 10,014,610 | 20,579,647 | RR | 108 | 2174-06-05 17:40:00 | 2174-06-05 18:46:00 | EXAMINATION: Chest radiograph
INDICATION: ___ man with new right PICC
TECHNIQUE: Portable chest radiograph
COMPARISON: Chest radiograph ___.
FINDINGS:
A right PICC tip projects at the confluence of the right brachiocephalic vein
an superior vena cava, should be advanced 9 cm. There is no pneumothorax.
Cardiomediastinal silhouette is unchanged. There is a small right pleural
effusion, stable. Lungs are grossly clear. Median sternotomy wires are
intact. Degenerative arthritis left shoulder. New
IMPRESSION:
Right PICC tip projects at the confluence of the right brachiocephalic vein
and superior vena cava.
NOTIFICATION: Findings discussed over the telephone with ___ the IV nurse
by Dr. ___ on ___ at 18:40, 1 minutes after they were made.
|
10014610-RR-109 | 10,014,610 | 20,579,647 | RR | 109 | 2174-06-06 11:26:00 | 2174-06-06 18:47:00 | INDICATION: ___ year old man with PICC placed today. unfortunately not
central. ___ team had difficulty get past 15 cm and therefore reluctant to
exchange. // PICC replace
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.7 min, 8 mGy
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
single lumen PIC line measuring 46 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach PICC with tip in the right subclavian vein
replaced with a new single lumen PIC line with tip in the distal SVC.
IMPRESSION:
Successful placement of a 46 cm right arm approach single lumen PowerPICC with
tip in the distal SVC. The line is ready to use.
RECOMMENDATION(S): The PICC may be used at this time
|
10014610-RR-96 | 10,014,610 | 23,859,571 | RR | 96 | 2174-01-05 13:21:00 | 2174-01-05 15:52:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: History: ___ s/p cardiac surgery now with R hand weakness // ?
stroke vs Cspine compression
TECHNIQUE: T1 sagittal and FLAIR, T2, susceptibility and diffusion axial
images of the brain were acquired. 3D time-of-flight MRA of the circle of
___ was obtained. 2D time-of-flight MRA of the neck vessels was acquired.
COMPARISON: None
FINDINGS:
A small focus of increased signal identified in the left periatrial white
matter (4 02:16) on diffusion images demonstrate no corresponding low signal
on the ADC map. There is also FLAIR hyperintensity in this location. These
findings indicate a late subacute infarct (at least few days old). No
definite acute infarct is identified in the supra or infratentorial brain. A
few foci of FLAIR hyperintensity in the white matter indicate mild changes of
small vessel disease. There is a chronic left parietal cortical infarcts
(08:19) are also seen. Acute or chronic blood products are identified. There
is no mass effect midline shift or hydrocephalus.
MRA of the head shows normal signal in the arteries of the anterior and
posterior circulation. No evidence of vascular occlusion stenosis or an
aneurysm greater than 3 mm in size seen.
MRA of the neck demonstrates normal flow in the carotid and vertebral
arteries.
IMPRESSION:
Subacute appearing infarcts in the left periatrial white matter. No definite
acute infarct. Chronic left-sided watershed frontoparietal infarcts. Mild
changes of small vessel disease. No significant abnormalities are seen on MRA
of the head and neck.
|
10014610-RR-97 | 10,014,610 | 23,859,571 | RR | 97 | 2174-01-05 13:21:00 | 2174-01-05 16:02:00 | EXAMINATION:
MRI OF THE CERVICAL SPINE
INDICATION: History: ___ s/p cardiac surgery now with R hand weaknessIV
contrast to be given at radiologist discretion as clinically needed // ?
stroke vs Cspine compression
TECHNIQUE: T1, T2 and inversion recovery sagittal and gradient sequence T2
axial images of cervical spine obtained.
COMPARISON: None
FINDINGS:
There is no abnormal signal within the ligaments of the vertebral bodies to
indicate bony or ligamentous injury.
At the craniocervical junction and C2-3 levels mild degenerative change seen.
At C3-4 diffuse disc bulge and thickening of the ligaments resulting in
moderate spinal stenosis with mild extrinsic indentation on the spinal cord by
disc bulging. There is moderate bilateral foraminal narrowing.
At C4-5 there is been fusion of the vertebral bodies with obliteration of the
intervertebral disc. The spinal canal is patent without foraminal narrowing.
At see C5-6 level, there is diffuse disc bulge and thickening of the
ligaments. There is moderate spinal stenosis with mild extrinsic indentation
on the spinal cord. There is mild-to-moderate bilateral foraminal narrowing.
At C6-7 level disk bulging and mild spinal canal narrowing is seen with mild
to moderate narrowing of both foramina.
At C7-T1 and inferiorly to T3-4 mild degenerative changes identified.
The spinal cord shows normal intrinsic signal. Subtle increased signal within
the pons (3:9) appears to be due to a prominent perivascular space.
IMPRESSION:
1. No evidence of bony or ligamentous injury.
2. Moderate spinal stenosis at C3-4 and C5-6 levels. Spinal fusion at C4-5
level.
3. Mild extrinsic indentation on the spinal cord by disc bulging and
thickening of the ligaments at C3-4 and C5-6 levels without abnormal increased
signal within the spinal cord.
4. Foraminal changes as described above.
|
10014610-RR-98 | 10,014,610 | 20,579,647 | RR | 98 | 2174-05-26 14:51:00 | 2174-05-26 15:07:00 | INDICATION: Right knee pain.
TECHNIQUE: 3 views of the right knee.
COMPARISON: Radiographs from ___.
FINDINGS:
A right knee prosthesis is again demonstrated. The femoral component appears
well-seated but is only partially visualized. The tibial component exams
demonstrates loosening, with increased valgus and posterior angulation in
comparison to the configuration seen on ___. There is moderate
overlying soft tissue swelling. No definite acute osseous fractures are
detected. Extensive adjacent heterotopic bone formation has increased since
___.
IMPRESSION:
Hardware loosening of the tibial component was also present in ___ but there
is increased posterior and varus angulation. Extensive overlying soft tissue
swelling. No definite superimposed osseous fracture.
|
10014610-RR-99 | 10,014,610 | 20,579,647 | RR | 99 | 2174-05-26 18:07:00 | 2174-05-26 18:57:00 | EXAMINATION: RENAL U.S.
INDICATION: History: ___ with history of urinary retention s/p TURP who has
history of post-procedural retention with ___. // Evaluate for hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 10.3 cm. The left kidney measures 11.0 cm. There
are multiple simple renal cysts in the right kidney measuring up to 1.6 cm.
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
There is debris in the bladder. A 4 mm echogenic focus in the bladder may
represent a stone. Bilateral ureteral jets are present.
Postvoid bladder volume measured 429 cc.
IMPRESSION:
1. No hydronephrosis.
2. Debris in the bladder, and possible 4 mm bladder stone.
3. Postvoid bladder volume measured 429 cc.
|
10014651-RR-11 | 10,014,651 | 24,341,393 | RR | 11 | 2139-06-06 18:59:00 | 2139-06-06 20:15:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: ___ year old woman with HFrEF, DM2, HTN, HLD, CKD p/w worsening
cough and dyspnea on exertion// Evaluate for pulmonary edema, pleural
effusions, CXR
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
There are low lung volumes. No focal consolidation, pleural effusion,
evidence of pneumothorax is seen. Cardiac silhouette size is likely
accentuated by low lung volumes and appears borderline to mildly enlarged.
Mediastinal contours are unremarkable. No pulmonary edema is seen.
IMPRESSION:
Low lung volumes without focal consolidation.
|
10014652-RR-59 | 10,014,652 | 24,754,012 | RR | 59 | 2148-03-22 17:15:00 | 2148-03-22 21:11:00 | LEFT HAND RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Left hand pain status post fall, assess for fracture.
FINDINGS: AP, lateral, oblique views of the left hand were provided
demonstrating a dorsal dislocation at the fifth MCP joint. No fracture is
identified. Degenerative changes at the base of thumb noted.
IMPRESSION: Dorsal dislocation of the fifth finger at the MCP joint. No
fracture seen.
|
10014652-RR-60 | 10,014,652 | 24,754,012 | RR | 60 | 2148-03-22 08:45:00 | 2148-03-26 09:35:00 | HISTORY: Pain. Fluoroscopy.
Two fluoroscopic views of the fifth finger of the left hand show no definite
abnormalities. There is equivocal joint space narrowing in the fifth PIP
joint, but no dislocation. Lack of clinical history and no previous
comparison exams at this facility limit assessment.
|
10014670-RR-12 | 10,014,670 | 24,563,254 | RR | 12 | 2187-05-09 01:03:00 | 2187-05-09 05:26:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ female with C1 fracture identified on outside
hospital CT. Evaluation for ligamentous injury or other fractures.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed. Sagittal diffusion
weighted imaging was then performed.
COMPARISON: ___ 00:00 outside noncontrast cervical spine CT.
FINDINGS:
There is a fracture through the anterior C1 arch (6:4), with mild prevertebral
soft tissue swelling and minimally increased fluid sensitive signal intensity
in the atlantodental interval (2:88, 3:8), without significant widening.
Craniocervical junction alignment is grossly preserved.
There is minimal anterolisthesis of C4 on 5, and minimal retrolisthesis of C5
on 6. Vertebral body heights are maintained. Minimal edema along the
anterior inferior C5 endplate with no definite loss of vertebral body height
with minimal prevertebral edema is noted (see 2, 3, 4:8).
Multilevel cervical disc height loss and desiccation is noted. The visualized
portion of the spinal cord is preserved in signal and caliber. No diffusion
abnormalities are noted throughout the cervical spine. Within the limits of
this noncontrast examination, there is no evidence of infection or neoplasm.
From the craniocervical junction through the C2-3 level, there is no
significant spinal canal or neural foraminal narrowing.
At C3-4, there is a small disc bulge and left-greater-than-right facet
arthropathy, contributing to mild to moderate left neural foraminal narrowing
(05:17).
At C4-5, there is a small disc bulge, ligamentum flavum thickening and
bilateral facet arthropathy, with no significant spinal canal or neural
foraminal narrowing.
At C5-6, a central disc protrusion, ligamentum flavum thickening, and
bilateral facet arthropathy contribute to moderate spinal canal narrowing with
remodeling of the anterior spinal cord (06:22). There is also mild right
neural foraminal narrowing at this level (05:21).
At C6-7, there is a central disc protrusion and bilateral facet arthropathy
causing mild bilateral neural foraminal narrowing (05:24).
At C7-T1, there is no significant spinal canal or neural foraminal narrowing.
IMPRESSION:
1. Anterior C1 arch fracture associated with mild prevertebral soft tissues
and atlantodental interval fluid without significant atlantodental widening,
concerning for underlying ligamentous injury.
2. Fractured elements and osseous injury are better depicted on prior outside
cervical spine CT.
3. Edema along anterior inferior C5 endplate with minimal prevertebral edema
and no definite loss of vertebral body height, concerning for occult fracture
and ligamentous injury. Recommend clinical correlation.
4. Multilevel cervical spondylosis as described, most pronounced at C5-6,
where there is erect spinal canal narrowing and remodeling of the anterior
spinal cord without definite cord signal abnormality.
RECOMMENDATION(S): Edema along anterior inferior C5 endplate with minimal
prevertebral edema and no definite loss of vertebral body height, concerning
for occult fracture and ligamentous injury. Recommend clinical correlation.
|
10014765-RR-35 | 10,014,765 | 26,650,343 | RR | 35 | 2198-11-18 11:36:00 | 2198-11-18 16:45:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with chest pain and SOB// eval PNA, pleural effusion
COMPARISON: Prior chest radiograph from ___
FINDINGS:
PA and lateral views of the chest provided. Left chest wall pacer device is
again seen with leads extending to the region of the right atrium and right
ventricle. Midline sternotomy wires also again noted as well as multiple
surgical clips projecting over the superior mediastinum. There is interval
increase in size of a right pleural effusion which is now large and result in
compressive atelectasis of the majority of the right mid and lower lobes. No
shift of midline structures. Left lung remains clear. Bony structures are
intact.
IMPRESSION:
Large right pleural effusion with significant compressive atelectasis of the
right mid and lower lobes. Please refer to subsequent CT for further details.
|
10014765-RR-36 | 10,014,765 | 26,650,343 | RR | 36 | 2198-11-18 13:52:00 | 2198-11-18 15:07:00 | EXAMINATION: CTA CHEST
INDICATION: ___ with chest pain, SOB// eval PE, malignancy
TECHNIQUE: Multidetector CT through the chest performed with IV contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 680 mGy-cm.
COMPARISON: Same-day chest radiograph
FINDINGS:
Left chest wall pacemaker noted with leads extending to the region the right
atrium and right ventricle. Midline sternotomy wires are present. Multiple
surgical clips are noted in the superior mediastinum. Thoracic aorta is
mildly calcified and normal in course and caliber. The main pulmonary artery
is normal in size. No filling defect is seen within the branches of the
pulmonary arterial tree to suggest the presence of a pulmonary embolism.
There is a large right pleural effusion with complete collapse of the right
middle and lower lobe as well as significant collapse of the right upper lobe.
Within the collapsed right lower lobe, there is relative hypodensity best seen
on series 602, image 35, measuring 5.3 x 4.3 x 4.9 cm, which could reflect
malignancy or pneumonia. Mild emphysema is noted. No worrisome nodule mass
or consolidation within the left lung.
Within the imaged portion of the upper abdomen, gallstones are seen within the
collapsed gallbladder. There is an calcified aneurysm of the splenic artery
measuring approximately 1.8 x 1.6 cm. Also noted is a partially imaged cyst
likely rising from the left kidney.
Bones: There is a sclerotic focus within the T6 vertebra best seen on series
602, image 45, attention on follow-up advised. Otherwise no worrisome bony
lesions.
IMPRESSION:
1. No pulmonary embolism or acute aortic process.
2. Large right pleural effusion with significant collapse of the right lung.
3. Relative hypodense mass seen within the collapsed right lower lobe raises
potential concern for malignancy or pneumonia. Consider thoracentesis with
cytology.
4. Sclerotic focus with the T6 vertebra - attention on followup advised.
NOTIFICATION: Findings were discussed with Dr. ___ at the time of initial
review.
|
10014765-RR-38 | 10,014,765 | 26,650,343 | RR | 38 | 2198-11-19 20:26:00 | 2198-11-19 21:11:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with effusion// post tube placement
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
IMPRESSION:
There has been interval placement of a right basilar chest tube. The right
pleural effusion has substantially decreased and is now small in size. Linear
opacities in the right lung base most likely represent atelectasis. No large
pneumothorax is identified. The left lung is clear. There is unchanged
cardiomegaly without significant pulmonary edema. Postsurgical changes from
CABG are noted. There is a left chest wall cardiac pacing device with two
leads terminating in the regions of the right atrium and right ventricle.
|
10014765-RR-39 | 10,014,765 | 26,650,343 | RR | 39 | 2198-11-20 08:26:00 | 2198-11-20 11:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with large R pleural effusion s/p chest tube//
evaluate interval change in pleural effusion, if pneumothorax, and placement
of chest tube.
TECHNIQUE: Chest AP
COMPARISON: Comparisons to prior radiograph studies dated ___, and ___.
FINDINGS:
There is interval worsening of the the right mid lung parenchymal opacity.
The right pleural effusion and basilar atelectasis appear unchanged compared
to prior study. The left lung appears stable. There is no pneumothorax.
Cardiomediastinal silhouette remains unchanged. There are stable postsurgical
changes from prior CABG. The left chest pacemaker is intact with leads
terminating in the area projecting over the right atrium and right ventricle.
There are multiple surgical clips projecting over the superior mediastinum.
Again seen is a chest tube projecting over the right lung base.
IMPRESSION:
Interval increased right mid lung parenchymal opacity. Stable right pleural
effusion and atelectasis. No pneumothorax.
|
10014765-RR-40 | 10,014,765 | 26,650,343 | RR | 40 | 2198-11-20 17:47:00 | 2198-11-20 19:59:00 | EXAMINATION: CT CHEST WITHOUT CONTRAST
INDICATION: ___ year old man with 5 lbs. weight loss, cough, SOB, found to
have large R pleural effusion c/f malignancy// eval for mass or other etiology
for Large R pleural effusion s/p chest tube placement ad lymphadenopathy
TECHNIQUE: CT of the chest was performed without administration of IV
contrast. Coronal, sagittal and axial MIP reformat were performed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.3 s, 36.7 cm; CTDIvol = 15.9 mGy (Body) DLP = 582.0
mGy-cm.
Total DLP (Body) = 582 mGy-cm.
COMPARISON: CTA chest ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: A left chest wall pacemaker remains
in place with its leads terminating in the right atrium and right ventricle.
UPPER ABDOMEN: Again noted is a calcified aneurysm of the splenic artery
measuring 1.7 x 1.5 cm (301:50). Cholelithiasis is also present. A partially
imaged left renal cyst is unchanged. Two 5 mm hypodensity in the inferior
right hepatic lobe (301:61) and left hepatic lobe are nonspecific (301:49).
MEDIASTINUM: Multiple surgical clips are again noted in the superior
mediastinum.
HILA: There is no hilar adenopathy, although evaluation is limited by the
absence of intravenous contrast.
HEART and PERICARDIUM: There are postsurgical changes from CABG. Severe
coronary artery calcifications are noted. There is no pericardial effusion.
PLEURA: A right chest tube is in place. There is a small right pleural
effusion, which is significantly decreased in size compared to prior CT. A
small right pneumothorax is also noted.
LUNG:
1. PARENCHYMA: Diffuse ground-glass opacity throughout the right lung likely
represents edema in setting of recent re-expansion. There are areas of more
dense consolidation in the right middle lobe and right lower lobe. Mild
dependent atelectasis is appreciated in the left lung. There are multiple
pulmonary nodules in right upper lobe measuring up to 4 mm (for example,
302:30, 67). There is a punctate nodule in the left lung apex (___) and a
2 mm pulmonary nodule in the left upper lobe (302:47).
2. AIRWAYS: The airways are patent to the subsegmental level.
3. VESSELS: Evaluation of the vasculature is limited due to lack of IV
contrast. There is mild atherosclerotic disease in the aorta. There is no
aortic aneurysm.
CHEST CAGE: Median sternotomy wires are in place. There is a defect in the
most inferior median sternotomy wire.
IMPRESSION:
1. Interval reexpansion of the right lung status post chest tube placement,
with scattered areas of ground glass opacity in the right lung likely
representing reexpansion pulmonary edema.
2. A small right pneumothorax, which was not visualized on prior chest
radiographs, and a small residual right pleural effusion.
3. Areas of residual opacity primarily in the right middle lobe and right
lower lobe are favored to represent atelectasis, however underlying pneumonia
or a small mass cannot be entirely excluded.
4. Unchanged calcified aneurysm of the splenic artery.
5. Nonspecific 5 mm hypodensities in the liver, which can be further
evaluated with MRI Abdomen with contrast.
|
10014765-RR-41 | 10,014,765 | 26,650,343 | RR | 41 | 2198-11-22 04:28:00 | 2198-11-22 11:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with large R sided pleural effusion, now s/p
chest tube placement, pneumothorax on CT chest// eval for size of
pneumothorax, pleural effusion, placement of chest tube.
TECHNIQUE: Chest AP
COMPARISON: Comparisons to multiple prior radiograph studies dated from ___ to ___.
FINDINGS:
Cardiomediastinal silhouette is unchanged. Interval worsening of the right
mid and lower lung parenchymal opacities, likely representing worsening right
pleural effusion and atelectasis. Left lung remains clear. Small right
apical pneumothorax. Left chest pacemaker is intact with leads terminating in
the appropriate position. Sternal wires appear intact. Surgical clips are
again seen projecting over the superior mediastinum. Right chest tube
projects over the right lung base.
IMPRESSION:
1. Interval worsening of large right mid and lower lung opacities likely
representing a combination of pleural effusion and atelectasis. However, a
superimposed infectious process or underlying neoplastic lesion cannot be
excluded, as per the prior CT.
2. Small right apical pneumothorax.
|
10014765-RR-42 | 10,014,765 | 26,650,343 | RR | 42 | 2198-11-22 21:52:00 | 2198-11-22 22:31:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with large R pleural effusion found to have
adenocarcinoma on cytology, likely metastatic// evaluate for malignancy,
adenocarcinoma seen on cytology from pleural effusion, markers not consistent
with lung primary, likely GI source, special attention to pancreas, biliary
tree
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.6 s, 60.7 cm; CTDIvol = 20.3 mGy (Body) DLP =
1,232.4 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 8.4 s, 0.5 cm; CTDIvol = 47.0 mGy (Body) DLP =
23.5 mGy-cm.
Total DLP (Body) = 1,258 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
LOWER CHEST: There is a loculated right pleural effusion with subjacent
atelectasis, better evaluated on the CT chest from ___. There has
been interval removal of a right pleural catheter. There is no pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Scattered subcentimeter hypodensities in the liver are too small to
characterize. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is decompressed and contains gallstones.
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. Subcentimeter
hypodensities in the right kidney are too small to characterize, but are
statistically likely to be simple cysts. A lobulated 7.6 cm simple cyst
arises from the upper pole of the left kidney. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate to severe
atherosclerotic disease is noted. A 1.8 cm calcified splenic artery aneurysm
is noted. Incidental note is made of a retroaortic left renal vein.
BONES: There is no evidence of worrisome osseous lesions or acute fracture. A
chronic posterior tenth left rib fracture is noted. Multiple lytic areas in
the lumbar spine are likely due to degenerative subchondral cystic formation.
The patient is status post median sternotomy.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of primary malignancy or metastatic disease in the abdomen or
pelvis.
2. Cholelithiasis without evidence cholecystitis.
3. Partially visualized loculated right pleural effusion.
|
10014790-RR-13 | 10,014,790 | 25,010,346 | RR | 13 | 2171-11-04 12:08:00 | 2171-11-04 14:09:00 | EXAMINATION: CT abdomen and pelvis with contrast.
INDICATION: NO_PO contrast; History: ___ with CD, recent colonoscopy, severe
abd painNO_PO contrast// eval for perfuration
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP =
7.2 mGy-cm.
2) Spiral Acquisition 4.6 s, 50.9 cm; CTDIvol = 8.9 mGy (Body) DLP = 452.2
mGy-cm.
Total DLP (Body) = 459 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. There is periportal edema. The
gallbladder is within normal limits. There is a small amount of
pericholecystic fluid.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: There are duplicated collecting systems and duplicated ureters
bilaterally. There is delayed excretion of contrast and mild hydronephrosis
of the left inferior moiety. The mid to distal left ureteral is not well
assessed but no definite ureteral stone is seen. Cause of the obstructed
inferior left moiety is not identified; correlate with history of GU reflux.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. No bowel obstruction is seen.
The wall of the mid to distal sigmoid and rectum is hyperemic and mildly
thickened. The terminal ileum is collapsed. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
trace amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: An IUD is seen extending just beyond the borders of the
myometrium in the pelvis to the right of midline. There is bowel adjacent to
the IUD. No free air is seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No 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. Hyperemia of the rectosigmoid and mild wall thickening concerning for flare
of inflammatory bowel disease.
2. An IUD is seen extending just beyond the borders of the myometrium in the
pelvis, to the right of midline.
3. Bilateral duplicated collecting systems and ureters. The inferior moiety
of the duplicated renal collecting system demonstrates delayed excretion of
contrast and mild hydronephrosis. The mid to distal left inferior ureter is
not well assessed, but no definite ureteral stone is seen. Other sources of
obstruction cannot be excluded. Correlate with history of vesicoureteral
reflux. If this has not been previously evaluated, recommend outpatient
urology follow-up.
4. Periportal edema, which can be seen in the setting of aggressive hydration.
|
10014790-RR-14 | 10,014,790 | 25,010,346 | RR | 14 | 2171-11-05 12:14:00 | 2171-11-05 15:41:00 | EXAMINATION: MR ___
INDICATION: ___ year old woman with IBD// IBD
TECHNIQUE: T1 and T2-weighted multiplanar images of the abdomen and pelvis
were acquired within a 1.5 T magnet, including 3D dynamic sequences performed
prior to, during, and following the administration of 0.1 mmol/kg of Gadavist
intravenous contrast (7 cc). Oral contrast consisted of 900 mL of VoLumen. 1.0
mg of Glucagon was administered IM to reduce bowel peristalsis.
COMPARISON: CT scan of the abdomen pelvis performed ___
FINDINGS:
MR ENTEROGRAPHY:
The visualized small bowel loops are unremarkable, without evidence of
stricture. Contrast has progressed to the colon. There is no bowel
obstruction.
There is mucosal hyperenhancement of the rectum and distal sigmoid colon, with
surrounding inflammatory changes in the mesorectal fat. There are small lymph
nodes in the mesorectal fat measuring up to 8 mm, likely reactive.
No perirectal fluid collections or abscesses. No fistulous tract seen.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
The liver enhances homogeneous the with no focal lesions identified. There is
no intra or extrahepatic biliary duct dilatation. The gallbladder is
unremarkable.
The pancreas is normal in signal intensity and morphology. The pancreatic
duct is not dilated.
There is no splenomegaly.
The adrenal glands are unremarkable.
A duplex left collecting system is noted, without hydronephrosis. There is a
7 mm cortical cyst in the interpolar region of the left kidney.
Bony structures are unremarkable.
IMPRESSION:
Mucosal hyperenhancement of the distal sigmoid colon and rectum with
surrounding inflammatory changes in the mesorectal fat and reactive lymph
nodes. The findings are compatible with proctocolitis, for which inflammatory
bowel disease is a consideration given the clinical history.
The visualized small bowel loops are unremarkable. No evidence of
intra-abdominal abscesses or fistula.
|
10014790-RR-15 | 10,014,790 | 25,010,346 | RR | 15 | 2171-11-04 22:39:00 | 2171-11-04 23:41:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman presenting w/ LLQ pain in the setting of recent
IBD diagnosis (Crohn's v UC) w/ incidental finding of ?IUD migration into
myometrium on CT abd.// IUD migration?
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: Same-day CT abdomen and pelvis
FINDINGS:
The uterus is anteverted and measures 7.4 x 2.7 x 4.2 cm. The endometrium is
homogenous and measures 2 mm. As seen on same-day CT, the IUD extends past
the borders of the myometrium. A small portion of the IUD appears to be in
the endometrium.
The ovaries are normal. There is a small amount of free fluid.
IMPRESSION:
1. As seen on same-day CT, the IUD extends past the borders of the myometrium.
A small portion of the IUD appears to be in the endometrial canal
2. Small amount of free fluid.
|
10014790-RR-16 | 10,014,790 | 25,010,346 | RR | 16 | 2171-11-07 21:42:00 | 2171-11-07 22:55:00 | EXAMINATION: MRI of the pelvis
INDICATION: ___ year old woman with IBD with elevated CRP out of proportion to
presentation concerning for perianal disease, previous MR enterography without
pelvic imaging.// Evidence of IBD in the perianus (abscess vs fistula vs signs
of inflammation)?
TECHNIQUE: T1- and T2-weighted multiplanar images of the pelvis were acquired
in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
COMPARISON: MR enterography ___
FINDINGS:
No evidence of perianal fistula, sinus tract or abscess.
INTRAPELVIC BOWEL AND RECTUM:
Again seen is mucosal hyperenhancement of the distal sigmoid colon and rectum
with surrounding inflammatory changes in the mesorectal fat and reactive lymph
nodes, better seen on prior enterography from ___.
UTERUS AND ADNEXA:
As before, the IUD is malpositioned and with sidebars extending through the
myometrium and beyond the serosa.
The junctional zone is not thickened.
The right ovary is visualized and appears within normal limits.
The left ovary is visualized and appears within normal limits.
Moderate pelvic free fluid is within physiologic limits.
BLADDER AND DISTAL URETERS: Unremarkable.
VASCULATURE: Unremarkable.
OSSEOUS STRUCTURES AND SOFT TISSUES: No suspicious osseous lesions.
IMPRESSION:
1. No evidence of perianal fistula, sinus tract or abscess.
2. Again seen is mucosal hyperenhancement of the distal sigmoid colon and
rectum with surrounding inflammatory changes in the mesorectal fat and
reactive lymph nodes.
3. Again seen is a malpositioned intrauterine device likely perforating the
uterus as previously reported.
|
10014991-RR-16 | 10,014,991 | 24,216,569 | RR | 16 | 2131-06-24 21:18:00 | 2131-06-24 22:34:00 | EXAMINATION: CT chest abdomen pelvis with contrast
INDICATION: ___ with fall down 12 stairs, known rib fx and clavicle fx.
Evaluate for poly trauma.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,305 mGy-cm.
COMPARISON: Radiographs from ___.
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. There is mild luminal
irregularity of the left external jugular vein adjacent to the left clavicular
fracture with a focal area of central hypodensity, which may represent mural
injury or focal thrombus. Although there is mild adjacent stranding, there is
no active extravasation of IV contrast.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma. There is mild
stranding likely extending from the left supraclavicular region surrounding
the internal jugular vein and common carotid artery on the left.
PLEURAL SPACES: No pleural effusion. There is a small pneumothorax in the
anterior lung base (2:67).
LUNGS/AIRWAYS: There is mild left basilar atelectasis. The airways are
patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck are notable for mild
stranding in the supraclavicular region without other details as above.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. There is intrahepatic
biliary dilatation with dilation of the CBD, measuring up to 1.4 cm. The
gallbladder is not visualized.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesion. The main pancreatic duct is within normal limits. There is no
peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right adrenal gland is normal in size and shape. The left
adrenal gland is homogeneously thickened, likely due to hypertrophy
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 besides scattered colonic diverticulosis.
There is a large amount of stool in the rectum. The appendix is normal.
There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no
evidence of adnexal abnormality bilaterally.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted. The left gonadal vein is dilated, may
be secondary to pelvic congestion.
BONES and SOFT TISSUES:
There is comminuted fracture of the left clavicle with soft tissue stranding
surrounding the fracture site. There is comminuted fracture of the base of
the first metacarpal. There are nondisplaced fractures of the left lateral
third, fourth and fifth ribs. Patient is status post bilateral hip
replacements. Subcutaneous tissue stranding in the left hip may be related to
recent trauma.
IMPRESSION:
1. Acute left clavicular and left third through fifth rib fractures.
2. Small left pneumothorax.
3. Luminal irregularity and focal hypodensity in the left external jugular
vein, likely representing mural injury with nonocclusive thrombus secondary to
the adjacent left clavicular fracture. No active extravasation.
4. Biliary ductal dilatation, potentially due to post cholecystectomy state.
NOTIFICATION: The updated findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:10PM, 10 minutes after discovery
of the findings.
|
10014991-RR-17 | 10,014,991 | 24,216,569 | RR | 17 | 2131-06-28 10:44:00 | 2131-06-28 14:59:00 | EXAMINATION: MRCP
INDICATION: ___ y/o F s/p CCY w/ incidental finding of dilated CBD 1.4cm and
PD 4mm // eval for form of obstruction
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered for
oral contrast.
COMPARISON: CT of the chest, abdomen and pelvis from ___.
FINDINGS:
Lower Thorax: The heart is normal in size. There is linear scarring or
subsegmental atelectasis of the bilateral lung bases. There is a small left
pleural effusion and no right pleural effusion. There is also edema of the
posterior lateral left chest wall musculature, incompletely imaged and related
to recent trauma.
Liver: The liver is normal in size and smooth in contour. There is no
evidence of hepatic steatosis. No focal hepatic lesion is detected.
Biliary: The gallbladder surgically absent. There is no intrahepatic biliary
ductal dilatation. The common bile duct is top normal in caliber for the
patient's age, measuring up to 8 mm, with smooth tapering in the periampullary
region, which could be related to post cholecystectomy state or represent
sphincter of Oddi dysfunction. There is no choledocholithiasis. No
periampullary mass is seen.
Pancreas: The pancreas is normal in bulk and signal intensity. No focal
lesion is detected. There is no main pancreatic ductal dilatation.
Spleen: The spleen is within normal limits.
Adrenal Glands: The adrenal glands are within normal limits.
Kidneys: The kidneys are symmetric in size. There is no focal renal lesion or
hydronephrosis.
Gastrointestinal Tract: Visualized upper abdominal bowel loops are normal in
caliber.
Lymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.
Vasculature: The abdominal aorta and major mesenteric branch vessels are
normal ___ caliber and patent.
Osseous and Soft Tissue Structures: No suspicious osseous lesion is
identified. There is fatty marrow signal in the sacrum. There are multilevel
spinal degenerative changes.
IMPRESSION:
Top normal in caliber common bile duct, measuring up to 8 mm, with smooth
tapering in the periampullary region, which could be related to post
cholecystectomy state or represent sphincter of Oddi dysfunction. No
choledocholithiasis. No periampullary mass.
|
10014991-RR-18 | 10,014,991 | 24,216,569 | RR | 18 | 2131-06-28 17:18:00 | 2131-06-28 17:46:00 | EXAMINATION: TOE(S), 2+ VIEW LEFT
INDICATION: ___ year old woman s/p fall with left great toe pain. // ?
fracture dislocation
TECHNIQUE: Left great toe three views, left foot single-view.
COMPARISON: None
FINDINGS:
No great toe fracture or dislocation. Scattered mild degenerative changes
midfoot, forefoot.
IMPRESSION:
No fracture great toe
|
10015487-RR-27 | 10,015,487 | 28,610,978 | RR | 27 | 2173-05-01 08:25:00 | 2173-05-01 10:42:00 | EXAMINATION: Chest radiograph
INDICATION: Shortness of breath. Assess for acute process.
COMPARISON: Chest radiograph ___.
FINDINGS:
Frontal and lateral chest radiograph demonstrates hypoinflated lungs with
crowding of vasculature. Right lung is clear. Heterogeneous opacity within
the left lower lobe with elevation of the left hemidiaphragm is noted.
No definite pleural effusion. No pneumothorax. Top normal heart size is
accentuated due to low lung volumes and patient positioning. Mediastinal
contour and hila are otherwise unremarkable.
IMPRESSION:
Subtle left lower lobe opacity could reflect pneumonia in the appropriate
clinical setting.
|
10015701-RR-13 | 10,015,701 | 25,619,291 | RR | 13 | 2133-08-01 16:23:00 | 2133-08-01 18:05:00 | INDICATION: Patient with exertional dyspnea.
COMPARISONS: None available.
FINDINGS: Frontal and lateral views of the chest demonstrate low lung volumes.
There is no pleural effusion, focal consolidation, or pneumothorax. Hilar and
mediastinal silhouettes are unremarkable. Heart size is normal. There is no
pulmonary edema. Partially imaged upper abdomen is unremarkable.
IMPRESSION: No acute cardiopulmonary process.
|
10015701-RR-14 | 10,015,701 | 25,619,291 | RR | 14 | 2133-08-02 02:36:00 | 2133-08-02 05:22:00 | HISTORY: Generalized weakness, early satiety, palpable abdominal mass with
positive D-dimer.
TECHNIQUE: Contiguous axial MDCT images were taken through the chest,
abdomen, and pelvis after the administration of 100 cc of Omnipaque
intravenous contrast and 900 cc ___ Cat oral contrast material. Coronal
and sagittal reformats as well as oblique MIPS were examined.
DLP: 652.8 cm mGy-cm.
COMPARISON: None.
FINDINGS:
The thyroid is unremarkable. The airways are patent to the subsegmental
level. The pulmonary arteries are well opacified. There is no evidence for
pulmonary embolism. The heart and pericardium are within normal limits.
There is no axillary, hilar, or mediastinal lymphadenopathy. Lung windows did
not reveal any concerning focal opacity. There is no pleural effusion or
pneumothorax. Mild bibasilar atelectasis is seen.
The liver enhances homogeneously without focal lesions or intrahepatic biliary
ductal dilatation. The spleen is significantly enlarged, measuring 24 cm in
the craniocaudal dimension. The pancreas is unremarkable without focal
lesions, peripancreatic stranding, or fluid collection. The adrenal glands
are unremarkable. A small 4 mm hypodensity is noted in the upper pole of the
right kidney, consistent with simple cyst. The kidneys presents symmetric
nephrograms and excretion of contrast.
The stomach and small bowel show no evidence of wall thickening or
obstruction. Note is made of slightly abnormal position of small bowel loops
are lateral to the ascending colon, raising the question of internal hernia
(606b:30). The colon is unremarkable. There is no mesenteric or
retroperitoneal lymphadenopathy. Calcification of the abdominal aorta is
noted. There is no ascites, free air, or abdominal wall hernias.
The bladder and terminal ureters are unremarkable. The uterus is
unremarkable. There is no pelvic sidewall or inguinal lymphadenopathy. There
is no free fluid in the pelvis.
Degenerative changes of the spine are noted with levoscoliosis centered at
L2-3. No suspicious lesions are present visualized osseous structures.
IMPRESSION:
1. Enlarged spleen, measuring 24 cm in the craniocaudal dimension.
2. No pulmonary embolism.
3. Right sided position of a portion of small bowel lateral to the ascending
colon, possibly representing an internal hernia.
|
10015785-RR-17 | 10,015,785 | 23,058,424 | RR | 17 | 2150-05-10 15:35:00 | 2150-05-10 17:13:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall/unresponsiveness. Evaluate for acute intracranial
process.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 1,496 mGy-cm.
COMPARISON: MRI brain from ___.
FINDINGS:
This study is somewhat limited due to patient motion, despite multiple
attempts are rescanning.
There is no acute hemorrhage or large vascular territorial infarction. A 3.5
x 3.0 x 2.8 cm hyperdense rounded lesion with internal calcification is
centered in the interhemispheric fissure. A 8mm T2 hypointense lesion was
seen in similar location on the prior MRI from ___. There is some mass
effect on the anterior horn of the left lateral ventricle but the ventricles
are overall unchanged in size since prior study. There are extensive
periventricular and subcortical white matter hypodensities, which are
nonspecific but likely reflect sequelae of chronic small vessel ischemic
disease. Old lacunar infarcts of the bilateral thalami are present.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens
replacements are noted. Atherosclerotic calcifications of the carotid siphons
are identified.
IMPRESSION:
1. Moderately motion limited exam.
2. No acute intracranial hemorrhage or large vascular territorial infarction.
3. 3.5 x 3.0 x 2.8 cm hyperdense mass centered in the anterior
interhemispheric fissure, significantly increased in size since ___. MRI is
recommended for further evaluation.
4. Chronic small vessel ischemic disease.
RECOMMENDATION(S): MRI of the brain with contrast
|
10015785-RR-18 | 10,015,785 | 23,058,424 | RR | 18 | 2150-05-10 16:18:00 | 2150-05-10 16:48:00 | INDICATION: ___ with syncopal episode, evaluate for pneumonia.
TECHNIQUE: AP and lateral views of the chest were obtained.
COMPARISON: Chest x-ray from ___
FINDINGS:
The lungs are well inflated and clear. The heart is normal in size. The
mediastinal contours are unchanged. The aorta remains tortuous. There is no
pleural effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10015785-RR-20 | 10,015,785 | 23,058,424 | RR | 20 | 2150-05-12 00:34:00 | 2150-05-12 11:07:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with syncope and possible seizure-like activity
during episode now with 3 cm intrahemispheric mass seen on head CT //
further characterization of mass seen on CT scan (differentiation of possible
malignant etiologies)
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 8 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI head of ___, CT head without contrast of ___.
FINDINGS:
There is significant interval increase size of a frontal lobe extra-axial
parafalcine eccentric to the left homogeneously enhancing T1 isointense to
gray matter 3.1 x 3.0 x 3.1 cm lesion exerting mass effect on the adjacent
brain parenchyma and corpus callosum. There is central gradient echo
susceptibility compatible with calcification. The lesion demonstrates a
peripheral rim of FLAIR and T2 hyperintense signal (series 11, image 19) and
abuts the superior sagittal sinus without evidence of invasion. Degree of
underlying parenchymal edema pattern is difficult to assess given the
essentially unchanged confluent periventricular, subcortical and deep white
matter FLAIR hyperintense signal seen on prior examination of ___,
which are is nonspecific, but likely represents sequela of chronic
microangiopathy.
There is no acute infarct or intracranial hemorrhage. There is no ventricular
The major intracranial flow voids are preserved. The dural venous sinuses are
patent. The paranasal sinuses are essentially clear. The orbits are
unremarkable, noting bilateral lens replacements. Fluid signal is seen in the
right greater than left mastoid tip.
IMPRESSION:
1. Significant interval increase size of an extra-axial frontal lobe
parafalcine lesion, compatible with a meningioma. Given the rapid growth in
size am prominent peripheral FLAIR hyperintense signal, this could represent
an atypical meningioma.
2. The lesion abuts the superior sagittal sinus without evidence of invasion.
3. No additional lesions are identified.
|
10015785-RR-22 | 10,015,785 | 23,958,054 | RR | 22 | 2150-12-08 14:48:00 | 2150-12-08 18:33:00 | INDICATION: ___ year old woman alzheimer's dementia with RLE DVT, high risk
for bleeding with meningioma, falls. // please place IVC filter
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
20 mcg of fentanyl and 0 mg of midazolam throughout the total intra-service
time of 20 min during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS:
CONTRAST: 15 ml of Opti spray contrast.
FLUOROSCOPY TIME AND DOSE: 3.12 min, 17.38 mGy
PROCEDURE:
1. Left iliac vein and IVC venogram.
2. Infrarenal permanent IVC filter deployment.
3. Post-filter placement venogram.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient's niece. The patient was then brought to the angiography suite and
placed supine on the exam table. A pre-procedure time-out was performed per
___ protocol. The right neck was prepped and draped in the usual sterile
fashion.
Under ultrasound and fluoroscopic guidance, the patent and compressible right
internal jugular vein was punctured using a 21G micropuncture needle.
Ultrasound images of the access was stored on PACS. A ___ wire was
advanced through the micropuncture sheath into the inferior vena cava. A 5
___ sheath was exchanged for the micropuncture sheath. After the inner
dilator was removed, an Omniflush catheter was advanced over the wire into the
IVC. The ___ wire was exchanged for an angled Glidewire, which was
advanced into the left common iliac vein and the catheter tip was advanced
into the left common iliac vein.
A left common iliac and inferior vena cava venogram was performed. Based on
the results of the venogram, detailed below, a decision was made to place a
temporary infrarenal inferior vena cava filter. The catheter and sheath were
removed over the wire and the sheath of an temporary Denali filter was
advanced over the wire into the IVC past the take-off of the renal vessels. An
temporary infrarenal vena cava filter was advanced over the wire until the
cranial tip was at the level of the inferior margin of the lower renal vein.
The sheath was then withdrawn until the filter was deployed. The wire and
loading device were then removed through the sheath and a repeat contrast
injection was performed, confirming appropriate filter positioning. The final
image was stored on PACS.
The sheath was removed and pressure was held for 10 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with single bilateral renal veins
and no evidence of a clot.
2. Successful deployment of an infra-renal permanent infrarenal IVC filter.
IMPRESSION:
Successful deployment of temporary infrarenal IVC filter.
|
10015860-RR-23 | 10,015,860 | 28,236,161 | RR | 23 | 2187-09-15 16:22:00 | 2187-09-15 17:57:00 | HISTORY: Diabetic foot ulcer.
TECHNIQUE: 3 views of the right foot.
COMPARISON: ___.
FINDINGS:
Soft tissue ulcer is seen along the plantar aspect of the foot at the level of
the metatarsal heads and lateral to the head of the ___ metatarsal head. No
subcutaneous gas is definitively noted, and there is no cortical destruction
seen to suggest osteomyelitis. No acute fracture or dislocation is noted.
There are diffuse degenerative changes with involvement of the IP joints
diffusely as well as the ___ MTP joint with joint space narrowing and
osteophytic spurring. There is diffuse demineralization of the osseous
structures. Large dorsal and moderate size plantar calcaneal spurs are
visualized. There is diffuse soft tissue edema.
IMPRESSION:
Plantar soft tissue ulcer at the level of the metatarsal heads with no
radiographic evidence for osteomyelitis or soft tissue gas.
|
10015860-RR-24 | 10,015,860 | 28,236,161 | RR | 24 | 2187-09-15 16:43:00 | 2187-09-15 18:14:00 | HISTORY: ___ male with right lower extremity swelling.
TECHNIQUE: Grayscale and color and spectral Doppler evaluation was performed
of the right lower extremity veins.
COMPARISON: None.
FINDINGS: There is normal compressibility, flow, and augmentation of the
right common femoral, proximal femoral, mid femoral, distal femoral, and
popliteal veins. Normal color flow is demonstrated in the right posterior
tibial and peroneal veins. There is normal respiratory variation of the
common femoral veins bilaterally.
IMPRESSION: No evidence of deep vein thrombosis in the right lower extremity.
|
10015860-RR-27 | 10,015,860 | 20,854,119 | RR | 27 | 2188-08-06 00:05:00 | 2188-08-06 05:51:00 | HISTORY: History of diabetic foot ulcer. Please evaluate for acute
abnormalities.
COMPARISON: Radiographs dating back to ___.
TECHNIQUE: Frontal, lateral, and oblique views of the right foot.
FINDINGS:
The patient is status post resection of the mid to distal ___ metatarsal, with
medial angulation. There appears to be diffuse demineralization of the bones
with significant soft tissue swelling and ulceration. There also appears to
be an acute fracture at the head of the ___ metatarsal. With lateral
displacement of the head. Again there is significant overlying soft tissue
swelling, as well as diffuse demineralization of the bones.
IMPRESSION:
1. Acute fracture of the head of the ___ metatarsal, with lateral
displacement.
2. Diffuse demineralization of the bones, with significant overlying soft
tissue swelling raises concern for possible osteomyelitis.
These findings were discussed with Dr. ___ by Dr. ___ by telephone at
05:50 on the day of the exam.
|
10015860-RR-28 | 10,015,860 | 20,854,119 | RR | 28 | 2188-08-07 08:39:00 | 2188-08-07 12:03:00 | RIGHT FOOT SERIES, ___ AT 858
CLINICAL INDICATION: ___ with right foot infection, status post right
fourth ray resection.
Comparison is made to the patient's prior study dated ___ at 12:04 a.m.
The lateral and oblique views of the right foot were obtained portably in this
recently post-operative patient.
There has been interval resection of the mid and distal right fourth
metatarsal. The previous resection of the mid to distal fifth metatarsal with
medial angulation is stable. There has been interval appearance of a soft
tissue defect in the region of surgery. Spurring of the calcaneus is again
noted.
IMPRESSION:
1. Post-operative changes in the right foot with interval resection of the
mid-to-distal right fourth metatarsal.
|
10015860-RR-29 | 10,015,860 | 20,854,119 | RR | 29 | 2188-08-09 13:14:00 | 2188-08-09 14:37:00 | STUDY: Right foot, ___.
CLINICAL HISTORY: ___ man with right foot ulcer and osteomyelitis.
Status post fourth ray resection.
FINDINGS: Comparison is made to the prior radiographs from ___
and ___.
Patient has undergone resection of the majority of the distal fourth
metatarsal as well as of the fourth proximal phalanx. There remains some soft
tissue swelling and gas consistent with the recent surgery and this is stable.
There are postoperative changes involving the fifth ray, which are stable.
There is a large os peronei adjacent to the cuboid. Spurs about the calcaneal
tuberosity are present. On the lateral view, there is a plantar soft tissue
ulcer seen adjacent to the metatarsal heads.
|
10015860-RR-30 | 10,015,860 | 20,854,119 | RR | 30 | 2188-08-12 09:09:00 | 2188-08-12 11:29:00 | HISTORY: ___ man with new right PICC placement.
COMPARISON: Prior radiographs of the chest dated ___ through ___.
FINDINGS:
Portable semi-upright radiograph of the chest demonstrates well-expanded clear
lungs. The heart is mildly enlarged. There is mild cardiomegaly. There is
no pneumothorax, consolidation, or pleural effusion. The right-sided PIC line
ends at the atrium, and should be pulled back 3-4 cm for positioning in the
distal SVC.
IMPRESSION: Right-sided PIC line ends in the right atrium and should be
pulled back 3-4 cm for positioning in the distal SVC.
COMMENTS: These findings were discussed with ___ (PICC nurse) by Dr. ___
___ telephone at 10:25am on ___, 5 minutes after discovery.
|
10015860-RR-59 | 10,015,860 | 25,103,777 | RR | 59 | 2192-07-31 14:00:00 | 2192-07-31 16:24:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with +blood cultures, fever// acute process?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Large bore dual lumen left-sided central venous catheter terminates at the
cavoatrial junction/proximal right atrium. Cardiac mediastinal silhouettes
are unremarkable. No pleural effusion, focal consolidation, evidence of
pneumothorax is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10015860-RR-60 | 10,015,860 | 25,103,777 | RR | 60 | 2192-07-31 16:48:00 | 2192-07-31 17:10:00 | INDICATION: ___ year old man with infected HD catheter// remove infected HD
catheter
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___ (radiology resident) and Dr. ___
___ radiology attending) performed the procedure. The attending,
Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: None
PROCEDURE: 1. Left chest tunneled dialysis catheter removal.
PROCEDURE DETAILS: The procedure was performed at bedside. The Left chest
tunneled line site was cleaned and draped in standard sterile fashion. 1%
lidocaine was administered around the tube track. The cuff was loosened with a
bent forceps. The catheter was removed with gentle traction while manual
pressure was held at the venotomy site. Hemostasis was achieved after 5 min of
manual pressure. A clean sterile dressing was applied. The patient tolerated
the procedure well. There were no immediate postprocedural complications.
FINDINGS:
Expected appearance after tunneled line removal.
IMPRESSION:
Successful removal of a left chest tunneled line.
|
10015860-RR-62 | 10,015,860 | 25,103,777 | RR | 62 | 2192-08-04 14:31:00 | 2192-08-04 17:42:00 | INDICATION: ___ year old man with DMII, ESRD on HD MWWF, p/w MRSA/GPR
bacteremia// place tunneled dialysis line
COMPARISON: Tunneled central line replacement from ___.
TECHNIQUE: OPERATORS: Dr. ___, Radiology resident and Dr. ___
___, attending radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 35 during which the patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. 1% lidocaine was injected
in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Versed and fentanyl
FLUOROSCOPY TIME AND DOSE: 4 min, 28 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation 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 left upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent left internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 27cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. Steri-strips were also used to close the venotomy incision site.
Final spot fluoroscopic image demonstrating good alignment of the catheter and
no kinking. The tip is in the right atrium. The catheter was flushed and both
lumens were capped. Sterile dressings were applied. The patient tolerated the
procedure well.
FINDINGS:
Patent left internal jugular vein. Final fluoroscopic image showing
hemodialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 27cm tip-to-cuff length tunneled dialysis line.
The tip of the catheter terminates in the right atrium. The catheter is ready
for use.
|
10015860-RR-65 | 10,015,860 | 26,352,758 | RR | 65 | 2192-09-24 00:22:00 | 2192-09-24 01:33:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: History: ___ with preop// preop
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The cardiomediastinal silhouette and pulmonary vasculature are unchanged. A
left sided diastasis catheter is also unchanged. No definite focal
consolidation is identified.
IMPRESSION:
Left-sided central venous catheter with its tip projected over the cavoatrial
junction.
Stable moderate cardiomegaly
|
10015860-RR-66 | 10,015,860 | 26,352,758 | RR | 66 | 2192-09-24 02:23:00 | 2192-09-24 03:05:00 | INDICATION: History: ___ with left hip pain// Evaluate for fracture/ anatomy
TECHNIQUE: 2.5 mm axial images were obtained through the pelvis without the
administration of intravenous contrast. Coronal sagittal reformatted images
were also obtained.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.1 s, 39.6 cm; CTDIvol = 25.1 mGy (Body) DLP = 992.6
mGy-cm.
Total DLP (Body) = 993 mGy-cm.
COMPARISON: Comparison is made to the radiographs from the same day.
FINDINGS:
There is an intertrochanteric fracture of the left proximal femur. Fracture
lines are seen extending through the lesser and greater trochanters. There is
slight impaction of the femoral neck. The left iliacus and adjacent hip
muscles are slightly prominent likely due to hematoma related to the proximal
femur fracture.
There are baseline mild-to-moderate degenerative changes of both hip joints
with acetabular spurring. Degenerative changes of the inferior sacroiliac
joints and of the lower lumbar spine are also present. There are vascular
calcifications.
There is extensive fatty atrophy of the left gluteal muscles. There is a
right testicular prosthesis with surrounding calcification.
IMPRESSION:
1. Left intertrochanteric fracture.
2. Degenerative changes of both hip joints.
3. Fatty atrophy of the left gluteal muscles.
|
10015860-RR-67 | 10,015,860 | 26,352,758 | RR | 67 | 2192-09-24 10:09:00 | 2192-09-24 10:59:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO LEFT
INDICATION: Left hip ORIF
TECHNIQUE: Flouroscopic assistance provided in the OR without the radiologist
present.
2 spot views obtained.
46.3 seconds of flouro time recorded on the requisition.
COMPARISON: None.
FINDINGS:
Views demonstrate steps related to ORIF of the left hip.
IMPRESSION:
Please refer to procedure note for further details.
|
10015860-RR-79 | 10,015,860 | 28,196,804 | RR | 79 | 2193-11-23 17:50:00 | 2193-11-23 18:23:00 | EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ year old man with L AVF with swelling and redness of L arm//
___ year old man with L AVF with swelling and redness of L arm
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian veins.
The left internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The left basilic,
and cephalic veins are patent and show normal color flow. There is edema in
the biceps. The fistula appears patent.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity.
|
10015860-RR-81 | 10,015,860 | 28,196,804 | RR | 81 | 2193-11-27 07:45:00 | 2193-11-27 12:00:00 | INDICATION: ___ year old man with ESRD on ___ HD with a left sided AV fistula
which has history of left brachiocephalic vein occlusion ___ s/p stenting
now with very swollen and red left arm.// fistulagram +/- intervention
COMPARISON: ___
TECHNIQUE: OPERATOR: Dr. ___ radiology attending)
performed the procedure.
PROCEDURE:
1. Left upper extremity AV fistulagram.
2. Axillary, subclavian and super vena cava venography.
3. Balloon angioplasty of the occluded brachiocephalic stent.
4. Balloon angioplasty of the small amount of clot proximal to the
brachiocephalic stent.
PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the left upper
extremity abducted and stabilized.
Clinical examination demonstrated a palpable, patent fistula with faint thrill
in the left extremity. Further evaluation by targeted ultrasound demonstrated
patent fistula. The left upper extremity was prepped and draped in the usual
sterile fashion. A preprocedure timeout and huddle was performed as per ___
protocol.
Using ultrasound and fluoroscopy, the arterial inflow and outflow stent levels
were identified and the skin was marked with a skin marker. Antegrade
(directed towards the venous outflow) access into the fistula was obtained
under continuous ultrasound guidance using a 21G micropuncture needle.
Permanent ultrasound images were saved. An 0.018 wire was then advanced easily
into the outflow vein under fluoroscopic guidance. A 4.5F micropuncture sheath
was advanced and used to exchange for an 0.035 Glidewire. The glide wire was
advance to the level of the subclavian vein. A short 6 ___ sheath was
placed over the wire. A ___ Kumpe catheter was then advanced over the wire.
Venogram was then performed which showed complete occlusion of the
brachiocephalic graft with significant collaterals in the chest. The fistula
is patent throughout
Kumpe catheter and ___ wire were used to navigate through the stent. 14mm
Balloon was used to plasty the stent. Venogram was then performed which
showed restoration of flow centrally, no collaterals with strong thrill in the
fistula. Small amount of clot was seen proximal to the stent, which was then
macerated and pushed centrally with 10mm baloon. Completion venogram showed
good flow centrally without residual clot.
The sheaths was removed and hemostasis was achieved with 0-silk pursestring
suture. There were no immediate complications.
FINDINGS:
1. Complete occlusion of the brachiocephalic vein stent with severe central
collaterals.
2. Restoration of flow after balloon angioplasty.
IMPRESSION:
Restoration of flow through brachiocephalic stent following balloon
angioplasty with a good angiographic and clinical result.
|
10016084-RR-10 | 10,016,084 | 23,267,624 | RR | 10 | 2155-11-25 12:50:00 | 2155-11-25 16:21:00 | INDICATION: Fever. Evaluate for pneumonia.
COMPARISONS: None.
FINDINGS: The right hemidiaphragm is elevated. There is no consolidation,
edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. In the bilateral acromioclavicular joints, there is joint space
narrowing and osteophyte formation, likely degenerative.
IMPRESSION:
1. No acute cardiopulmonary process.
2. Elevated right hemidiaphragm.
|
10016084-RR-11 | 10,016,084 | 23,267,624 | RR | 11 | 2155-11-25 22:30:00 | 2155-11-26 09:01:00 | LEFT FOOT
CLINICAL HISTORY: Query fracture, Charcot foot, gout. Severe left foot pain
on standing.
COMPARISON: None.
FINDINGS: Three views of the left foot and three views of the left ankle are
provided. Osseous alignment is anatomic. The ankle mortise is congruent.
There is a spurring of the distal fibula, likely related to prior trauma.
There is a well corticated 0.7 cm ossified body adjacent to the medial
malleolus, also likely the sequela of prior trauma. There are degenerative
changes throughout the mid foot and hindfoot, most pronounced at the
tibiotalar joint anteriorly. There is a small tibiotalar joint effusion.
There is an enthesophyte at the dorsal calcaneus at the insertion of the
Achilles. There is mild periarticular osteopenia in the forefoot. There are
no fractures or dislocations. There is diffuse soft tissue swelling about the
ankle. No evidence of erosive disease.
IMPRESSION: Moderate degenerative changes throughout the hindfoot and mid
foot. No acute fracture.
|
10016084-RR-12 | 10,016,084 | 23,267,624 | RR | 12 | 2155-11-25 22:09:00 | 2155-11-25 22:42:00 | INDICATION: Patient with left foot swelling for one week.
COMPARISONS: None available.
FINDINGS:
Grayscale and color Doppler images of bilateral common femoral, left
superficial femoral, popliteal veins were obtained. There was normal color
flow, compressibility and augmentation. Color flow was also demonstrated in
the left posterior tibial veins. The left peroneal veins were not visualized.
IMPRESSION:
No evidence of deep venous thrombosis of the left lower extremity. Left
peroneal veins were not visualized.
|
10016084-RR-14 | 10,016,084 | 23,267,624 | RR | 14 | 2155-11-26 17:07:00 | 2155-11-27 13:18:00 | LEFT FOOT MRI WITHOUT CONTRAST
CLINICAL INDICATION: ___ man with diabetes, new diagnosis of gout,
elevated temperature, assess for fluid collections with history of foot and
ankle swelling. Assess for abscess formation.
COMPARISON: Left foot radiographs from ___ and left ankle MRI from
same date.
TECHNIQUE: Left foot MRI without contrast utilizing standard departmental
protocol.
FINDINGS: Osseous erosive changes are seen at the tarsometatarsal levels 2
through 5, most pronounced laterally at the base of the fourth and fifth
metatarsal, lateral cuneiform and cuboid bone. There are also erosive changes
at the dorsal aspect of the medial cuneiform. Associated lobulated
predominantly T2-hyperintense mass-like lobulated collection with internal
punctate areas of low signal intensity seen predominantly laterally
surrounding extensor digitorum tendons and fourth and fifth tarsometatarsal
level with associated osseous erosive changes. No acute fracture. Mild
degenerative osseous edematous changes are seen in a patchy distribution
throughout the mid foot. The Lisfranc ligament and interval is maintained.
Mild degenerative changes at the first MTP. Remaining MTP, PIP and DIP joints
are otherwise maintained.
Dorsal foot subcutaneous soft tissue edematous changes, predominantly
dorsolaterally.
Visualized flexor and extensor tendons crossing the foot are maintained.
Moderate tenosynovitis of extensor digitorum tendons 3 through 5 dorsally
(5:34).
Muscular edema throughout the plantar musculature.
Well-circumscribed T1-hyperintense, STIR-hypointense lobulated soft tissue
mass measuring 2.5 x 1.0 x 1.0 cm at plantar lateral aspect of mid first
metatarsal diaphysis level soft tissues within the flexor hallucis brevis,
consistent with simple intramusclular lipoma.
IMPRESSION:
1. Osseous erosive changes at the lateral tarsometatarsal level with
associated lobulated soft tissue mass likely representing tophaceous gouty
arthritis with associated osseous erosive changes, detailed above.
2. Early mid foot Charcot neuro-osteoarthropathic changes.
3. Moderate tenosynovitis of extensor digitorum tendons 3 through 5.
4. Dorsal foot subcutaneous soft tissue swelling and edema, which could
represent cellulitis in the appropriate clinical setting. No definite abscess
formation.
5. Small flexor hallucis brevis intramuscular lipoma at the plantar lateral
aspect mid first metatarsal diaphysis level.
6. Mild degenerative changes of first MTP joint.
|
10016084-RR-15 | 10,016,084 | 23,267,624 | RR | 15 | 2155-11-26 17:07:00 | 2155-11-27 13:35:00 | LEFT ANKLE MRI WITHOUT CONTRAST
CLINICAL INDICATION: ___ man with diabetes, gout, elevated
temperature, concern for fluid collection in ankle, assess for abscess.
COMPARISON: Left foot MRI without contrast from same date and left foot
radiographs from ___.
TECHNIQUE: Left ankle MRI without contrast utilizing standard departmental
protocol.
FINDINGS: Moderate tenosynovitis involving the peroneus longus and brevis
tendons. Mild tendinosis of the peroneus longus at the level of and inferior
to the lateral malleolus. Longitudinal tear of the distal peroneus brevis
(4:39-42) extending from level of distal calcaneus to base of fifth
metatarsal.
Moderate tenosynovitis of the flexor hallucis longus at posterior ankle and at
master knot of ___. Mild tenosynovitis of flexor digitorum at posterior
ankle and master knot of ___. Moderate tenosynovitis of posterior tibialis
at the level of talus. Otherwise, medial flexor tendons are grossly intact.
Anterior talofibular, posterior talofibular, calcaneofibular and syndesmotic
ligaments are intact. Grossly intact deltoid ligament and spring ligaments.
Mild tibiotalar degenerative changes and also patchy degenerative changes seen
throughout the midfoot osseous structures. Talar dome is otherwise intact.
Small amount of retrocalcaneal bursal fluid. Distal Achilles is intact with
enthesopathy at the posterior calcaneus. Plantar fascia is intact. Loss of
normal fat signal in the sinus tarsi with associated edematous changes.
Old osseous avulsion injury at medial malleolus with corticated osseous
fragment. Trace osseous edema in medial malleolus. No acute fractures.
Muscular edema is seen throughout the plantar musculature and soft tissues and
also mild muscular edema within the flexor hallucis longus and peroneus brevis
muscles (7:9).
Osseous erosive changes are seen at the base of the lateral aspect fourth and
fifth metatarsal, lateral cuneiform, and cuboid bone, better detailed on foot
MRI examination performed on same date. There is also associated lobulated
mass-like signal heterogeneity that is predominantly T2 hyperintense with
several scattered foci of low signal intensity extending around the lateral
extensor tendons (___) and at the lateral tarsometatarsal level. The
anterior tibialis and extensor tendons are otherwise intact with moderate
tenosynovitis of extensor digitorum tendons 3 through 5.
Moderate subcutaneous soft tissue edematous changes are seen in the
dorsolateral ankle and foot.
IMPRESSION:
1. Likely tophaceous gouty deposit at lateral aspect foot tarsometatarsal
level with associated osseous erosive changes, detailed above.
2. Muscular edema in plantar musculature, flexor hallucis longus and peroneus
brevis may reflect sequela of diabetic neuropathy.
3. Moderate subcutaneous soft tissue edematous changes at the dorsal lateral
ankle and foot. Correlate clinically to exclude the possibility of
cellulitis. No definite findings to suggest abscess formation.
4. Early degenerative changes seen at the tibiotalar joint and throughout the
midfoot, likely representing early Charcot neuro-osteoarthropathic changes.
5. Longitudinal tear of distal peroneus brevis tendon extending towards
attachment to base of fifth metatarsal.
6. Mild tendinosis of peroneus longus at level of and inferior to lateral
malleolus.
7. Tenosynovitis of medial and lateral ankle tendons, detailed above.
8. Old osseous avulsion injury at medial malleolus.
9. Sinus tarsi edema which can be seen in sinus tarsi syndrome.
|
10016084-RR-16 | 10,016,084 | 23,267,624 | RR | 16 | 2155-11-27 17:07:00 | 2155-11-28 09:35:00 | REASON FOR THE EXAMINATION: This is a ___ man with chronic kidney
disease, MGUS, diabetes mellitus, and gout presenting now with fever and ankle
pain for unclear etiology, the concern is for infection and malignancy.
COMPARISON: No relevant priors are available.
TECHNIQUE: CT of the abdomen and pelvis without IV and the oral contrast.
Coronal and sagittal reformations were made.
Total exam DLP: 759.5 mGy-cm.
FINDINGS: Bilateral subsegmental atelectases are seen.
Otherwise, the visualized lung bases are within normal limits.
The visualized portions of the heart are within normal limits.
Coronary calcifications are seen.
ABDOMEN: The liver and gallbladder are within normal limits. There is no
intra- or extra-hepatic biliary duct dilatation.
The spleen, pancreas, and both adrenals are with no gross pathology.
Both kidneys are unremarkable. No hydronephrosis or stones are identified.
There is no mesenteric or retroperitoneal lymphadenopathy.
The small and large bowel are within normal limits.
Note is made to a small fat containing umbilical hernia and small hiatal
hernia. Atherosclerotic changes are seen along the course of the aorta.
PELVIS: There are prostate calcifications.
Diffuse thickening of the urinary bladder wall most probably secondary to
under filling of the urinary bladder.
No pelvic fluid or lymphadenopathy is seen within the pelvis.
OSSEOUS STRUCTURES: Degenerative changes are seen along the course of the
lumbar spine. Degenerative changes are seen in the right hip joint with
secondary atrophy of the right psoas muscle.
IMPRESSION:
1. No signs of infection or fluid collections are seen.
2. No evidence for malignancy.
|
10016084-RR-17 | 10,016,084 | 23,267,624 | RR | 17 | 2155-11-29 11:48:00 | 2155-11-29 14:40:00 | HISTORY: Gout and postoperative bone biopsy.
FINDINGS: In comparison with the study of ___, there is apparent gas within
soft tissues or ulceration to the lateral portion of the base of the fifth
metatarsal and distal tarsal row. This could well be the area of surgical
intervention.
There is a substantial posterior calcaneal spur. Mild degenerative changes
are again seen throughout the hind foot and mid foot.
|
10016084-RR-18 | 10,016,084 | 23,267,624 | RR | 18 | 2155-11-30 20:24:00 | 2155-12-01 13:00:00 | STUDY: MRI of the cervical spine.
CLINICAL INDICATION: ___ man with history of MSSA bacteremia, with
superimposed septic arthritis and new left upper extremity weakness, rule out
epidural abscess.
COMPARISON: No prior examinations of the cervical spine are available.
TECHNIQUE: This is a limited examination due to patient motion. Only T1, T2
and IDEAL sagittal images were obtained.
FINDINGS: The visualized elements of the posterior fossa and craniocervical
junction are unremarkable. The alignment of the cervical vertebral bodies
appears maintained. The examination is extremely limited due to patient
motion, lack of axial images and gadolinium contrast. There is an equivocal
hyperintense area at the level of C7 on the left, identified on the IDEAL
sequences (image #9, series #4 and series 401), possibly representing volume
averaging versus a focal lesion, additionally vague areas of high signal
intensity are visualized adjacent to the spinous process at the level of
C7/T1. The T2-weighted sequence is suboptimal due to motion artifact,
however, multilevel disc degenerative changes are seen, more significant at
C4/C5, C5/C6 and C6/C7 levels.
IMPRESSION: Extremely limited examination due to patient motion, lack of
gadolinium contrast and axial images. There is a questionable lesion with
high signal intensity at the level of C7 on the left, with possible soft
tissue edema in the interspinous process, epidural or intrdural lesions cannot
be completely excluded, please consider repeating this examination under
conscious sedation for further characterization.
These findings were communicated to Dr. ___, via phone call at
11:51 hours by Dr. ___ on ___.
|
10016084-RR-19 | 10,016,084 | 23,267,624 | RR | 19 | 2155-12-01 09:57:00 | 2155-12-01 11:05:00 | STUDY: AP chest ___.
CLINICAL HISTORY: Patient with PICC line placed.
FINDINGS: The tip of PICC line is at the cavoatrial junction appropriately
sited. There are no pneumothoraces. There is elevation of the right
hemidiaphragm. No focal consolidation or pleural effusions are seen.
Discuss with Carmel from the PICC service.
|
10016084-RR-20 | 10,016,084 | 23,267,624 | RR | 20 | 2155-12-01 16:23:00 | 2155-12-01 17:02:00 | STUDY: Cervical spine intraoperative study ___.
CLINICAL HISTORY: Patient with laminectomy.
FINDINGS: Single view of the cervical spine from the operating room
demonstrates a posterior marker at the level of C4 posteriorly. Please refer
to the procedure note for additional details.
|
10016084-RR-22 | 10,016,084 | 23,267,624 | RR | 22 | 2155-12-03 10:42:00 | 2155-12-03 15:05:00 | STUDY: Left foot three views ___.
CLINICAL HISTORY: ___ man with I and D of the mid foot.
FINDINGS: There is soft tissue swelling and gas consistent with the recent
surgery. The erosive changes of the mid foot seen on the prior MRI are not
well seen. There are mild degenerative changes of the first MTP joint. There
is a prominent amount of soft tissue swelling. Spurs about the calcaneal
tuberosity is present.
|
10016084-RR-23 | 10,016,084 | 23,267,624 | RR | 23 | 2155-12-04 15:20:00 | 2155-12-04 17:06:00 | INDICATION: ___ man with right PICC line 45 cm.
COMPARISONS: Portable AP chest radiograph from ___.
FINDINGS: The right PICC line catheter tip ends in the lower SVC. There is
no pneumothorax, focal consolidation or pleural effusion. There is stable
elevation of the right hemidiaphragm. The heart size is upper limits of
normal with a left ventricular configuration.
IMPRESSION: Right PICC line tip in the distal SVC.
These findings were discussed with ___ IV nurse by Dr. ___
telephone at 4:30 p.m.
|
10016084-RR-24 | 10,016,084 | 23,267,624 | RR | 24 | 2155-12-06 11:23:00 | 2155-12-06 16:29:00 | MRI OF THE LEFT FOREFOOT
CLINICAL HISTORY: Gout, chronic renal disease and diabetes, with known
osteomyelitis and bacteremia. Concern for additional infection in the left
ankle. Please image left foot and ankle. Evaluate for abscess.
COMPARISON: MRI ___.
TECHNIQUE: Due to depressed eGFR of 23, the study was protocoled without
contrast as a routine forefoot and hindfoot; however, the patient was unable
to tolerate the examination due to pain and the examination was discontinued
after three sequences at the patient's request. Coronal and sagittal T1, and
axial T2 sequences were acquired through the forefoot without gadolinium. The
examination was performed on a 1.5 Tesla scanner.
FINDINGS: Severely limited examination with only 3 sequences acquired. The
hindfoot/ankle was not evaluated.
There has been interval debridement of the dorsolateral aspect of the forefoot
with removal of the soft tissues dorsal to the proximal fifth metatarsal and
cuboid, as well as the overlying skin. There is packing material in place
within the defect, which measures 1.9 x 1.6 x 4.3 cm (ML x CC x AP), and
extends down to bone.
Otherwise, there has been no significant interval change, within the limits of
this examination. There is stable, extensive erosive disease with sharp
sclerotic margins and overhanging edges throughout the mid foot. The small
lipoma within the flexor hallucis brevis muscle is unchanged. Within the
limits of this examination, there are no soft tissue abscesses. The Lisfranc
ligament is intact.
IMPRESSION:
1. Interval debridement at the dorsal lateral aspect of the foot.
2. Extensive erosive disease with characteristic features of gout, not
significantly changed.
3. Limited examination, stopped early due to patient discomfort. Reimaging
may be performed when the patient is better able to tolerate the exam.
|
10016084-RR-26 | 10,016,084 | 23,267,624 | RR | 26 | 2155-12-06 13:07:00 | 2155-12-06 14:49:00 | CHEST RADIOGRAPH
INDICATION: Evaluate for PICC placement. Concern that it has been pulled
back. To evaluate for position.
TECHNIQUE: AP upright portable chest view was reviewed in comparison with
prior chest radiograph from ___.
FINDINGS:
A right-sided PICC line tip ends in the lower SVC, unchanged since ___. Bilateral lung volumes persistently remain low. Bibasal opacities
could be a function of low lung volumes. Right hemidiaphragm is persistently
elevated. Heart size is normal. Mediastinal and hilar contours are
unremarkable.
IMPRESSION: Right-sided PICC line is unchanged in position since prior
radiographs and the tip ends in the lower SVC.
|
10016367-RR-21 | 10,016,367 | 26,107,656 | RR | 21 | 2135-04-02 00:22:00 | 2135-04-02 05:01:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: History: ___ with sob and palps pls eval edema vs pna //
History: ___ with sob and palps pls eval edema vs pna
TECHNIQUE: PA and lateral radiographs of the chest.
COMPARISON: ___.
FINDINGS:
The inspiratory lung volumes are appropriate. Atelectasis or scarring at the
right lung base is unchanged. There is no focal consolidation, pleural
effusion or pneumothorax. The pulmonary vasculature is not engorged. The
cardiomediastinal and hilar contours are within normal limits. No acute
osseous abnormality is detected. There is kyphotic curvature of the spine.
IMPRESSION:
No acute cardiopulmonary process.
|
10016367-RR-31 | 10,016,367 | 23,401,924 | RR | 31 | 2137-12-11 11:47:00 | 2137-12-11 13:58:00 | INDICATION: History: ___ with syncope, lethargy and fever// eval for
pneumonia
TECHNIQUE: AP and lateral radiographs of the chest.
COMPARISON: CT chest from ___.
FINDINGS:
Heart size is normal. Hilar and mediastinal contours are normal. Subtle
opacity is seen within the left lung base. There is no pleural effusion or
pneumothorax. Mild compression deformities are seen within the mid thoracic
spine. Mild aortic calcifications are seen.
IMPRESSION:
Subtle opacity within the left lung base could be secondary to atelectasis
however a superimposed infectious process cannot be excluded.
|
10016367-RR-32 | 10,016,367 | 23,401,924 | RR | 32 | 2137-12-11 11:59:00 | 2137-12-11 13:11:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall// eval for ICH or fracture
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.9 cm; CTDIvol = 47.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head without contrast dated ___.
FINDINGS:
There is no evidence of acute large territorial infarction or hemorrhage.
There is no evidence of edema or mass lesion. Ventricles and sulci are
prominent consistent with age related involutional changes. Periventricular
and subcortical white matter hypodensities are felt to likely represent the
sequelae of chronic small vessel ischemic disease. Again seen is a punctate
hypodensity within the left caudate head which may represent the sequelae of a
prior lacunar infarct, unchanged in appearance. Punctate calcification within
the left tentorium is unchanged, felt to possibly represent a small meningioma
calcification (02:10).
The visualized portion of the paranasal sinuses, mastoid air cells and middle
ear cavities are clear. A focal density within the left external auditory
canal likely represents cerumen. Patient is status post bilateral lens
replacements. Otherwise, the visualized orbits are unremarkable. No
prominent soft tissue swelling seen.
IMPRESSION:
1. No evidence of acute large territorial infarction or hemorrhage.
2. No evidence of calvarial fracture.
|
10016367-RR-33 | 10,016,367 | 23,401,924 | RR | 33 | 2137-12-11 12:00:00 | 2137-12-11 13:58:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall// eval for ICH or fracture eval for
ICH or fracture
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 19.3 cm; CTDIvol = 22.5 mGy (Body) DLP = 433.0
mGy-cm.
Total DLP (Body) = 433 mGy-cm.
COMPARISON: CT C-spine without contrast dated ___.
FINDINGS:
No evidence of acute traumatic fracture. No prevertebral soft tissue swelling
is seen. No evidence of infection or neoplasm. Alignment is unchanged from
the prior exam. The bones are diffusely osteopenic. There is mild
anterolisthesis of C3 on C4. Multilevel degenerative changes are again seen
throughout the cervical spine again most pronounced at the level of C4 through
C7 including loss of intervertebral disc height, uncovertebral and facet joint
hypertrophy, endplate irregularity with sclerosis and osteophyte formation.
Re-demonstrated is mild bilateral neural foraminal narrowing. The visualized
thyroid gland is unremarkable. The visualized lungs are clear. The
visualized aerodigestive tract is unremarkable.
IMPRESSION:
1. No evidence of acute traumatic fracture or traumatic malalignment.
2. Unchanged degenerative disease as described above.
NOTIFICATION:
1. No evidence of acute traumatic fracture or traumatic malalignment.
2. Unchanged degenerative disease about the cervical spine.
|
10016742-RR-10 | 10,016,742 | 28,506,150 | RR | 10 | 2178-07-14 12:59:00 | 2178-07-14 14:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ALS currently trached with acute hypoxic
respiratory distress. // Please evaluate for acute cardiopulmonary process.
Please evaluate for acute cardiopulmonary process.
IMPRESSION:
Comparison to ___. Improved ventilation of the right lung basis.
The persisting areas of atelectasis at the right and the left lung basis are
minimal. There is no evidence of larger pleural effusions. No pneumothorax.
No pulmonary edema. Normal size of the heart. The tracheostomy tube is in
stable position.
If the clinical symptoms persist, CT should be considered, given the better
spatial resolution in the assessment of the lung parenchyma.
|
10016742-RR-11 | 10,016,742 | 28,506,150 | RR | 11 | 2178-07-15 07:13:00 | 2178-07-15 11:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ALS, chronic respiratory failure with
tracheostomy, on treatment for VAP, with worsening hypoxemia requiring bronch
// please assess for re-accumulation of infiltrate please assess for
re-accumulation of infiltrate
IMPRESSION:
Heart size and mediastinum are stable. Right PICC line tip terminates at the
level of superior SVC. Heart size and mediastinum are stable. Tracheostomy
is in unchanged position. No interval development of of new consolidations is
seen except for persistent right basal opacity which most likely represents a
combination of atelectasis and infection. There is small amount of pleural
effusion bilaterally.
|
10016742-RR-12 | 10,016,742 | 28,506,150 | RR | 12 | 2178-07-16 03:45:00 | 2178-07-16 10:12:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ventilator dependent ALS // Interval
pulmonary changes, trach tube position confirmation Interval pulmonary
changes, trach tube position confirmation
IMPRESSION:
Comparison to ___. Stable position of the tracheostomy tube. Stable
mild elevation of the right hemidiaphragm with subsequent atelectasis at the
right lung bases. Small platelike atelectasis at the left lung bases. Normal
size of the cardiac silhouette. No interval appearance of focal parenchymal
opacities.
|
10016742-RR-9 | 10,016,742 | 28,506,150 | RR | 9 | 2178-07-13 16:06:00 | 2178-07-13 16:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ALS, with tracheostomy, recently diagnosed
with VAP, presenting now with decreased responsiveness concerning for
seizures. // please assess for persistent RLL infiltrate, as well as location
of PICC line and tracheostomy tube please assess for persistent RLL
infiltrate, as well as location of PICC line and tracheostomy tube
IMPRESSION:
In comparison with the study ___, there is little interval change.
Tracheostomy tube remains in place, as does the right subclavian PICC line.
Again there is opacification of the right base with obscuration of the
hemidiaphragm. Although this could represent volume loss in the right lower
lobe with associated pleural effusion, in the appropriate clinical setting
superimposed pneumonia would have to be considered. Probable atelectatic
changes at the left base.
|
10017393-RR-15 | 10,017,393 | 21,985,481 | RR | 15 | 2179-07-20 17:34:00 | 2179-07-20 17:59:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with rapidly progressive vasculitis// nodules, pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema
is seen.
IMPRESSION:
No acute cardiopulmonary process. If clinical concern persists for small
pulmonary nodules, chest CT is more sensitive.
|
10017393-RR-16 | 10,017,393 | 21,985,481 | RR | 16 | 2179-07-22 15:28:00 | 2179-07-22 16:08:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old woman with right lower extremity swelling// Evaluate
for dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow is 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 right lower extremity veins.
|
10017764-RR-21 | 10,017,764 | 28,307,589 | RR | 21 | 2123-07-02 23:12:00 | 2123-07-02 23:53:00 | HISTORY: ___ female with nephrolithiasis status post lithotripsy and
Foley catheter placement, now with fever.
TECHNIQUE: Frontal radiographs of the abdomen and pelvis were obtained with
the patient in upright and supine positions.
COMPARISON: ___.
FINDINGS:
There has been interval placement of a left stent, likely nephroureteral, but
exact placement is indeterminate on these images. There is a normal bowel gas
pattern without evidence for intestinal obstruction. A small amount of stool
is seen in the cecum and sigmoid colon. No radiopaque renal stone is
identified.
IMPRESSION:
No radiographic evidence for intestinal obstruction.
|
10017764-RR-22 | 10,017,764 | 28,307,589 | RR | 22 | 2123-07-02 22:42:00 | 2123-07-02 23:24:00 | HISTORY: ___ female with nephrolithiasis status post lithotripsy and
Foley catheter placement, now with fever.
TECHNIQUE: Transabdominal ultrasound examination of the kidneys and urinary
bladder was performed.
COMPARISON: ___.
FINDINGS:
The right kidney measures 9.7 cm. The right kidney does not demonstrate
hydronephrosis, stones, or large masses. The left kidney measures 11.9 cm. A
1.2 cm stone is seen in the left lower pole, as seen previously. No left
hydronephrosis is seen. A Foley catheter is seen within a partially distended
bladder.
IMPRESSION:
1. No hydronephrosis. 1.2-cm stone in the lower pole of the left kidney, as
seen previously.
2. Partially distended urinary bladder which contains a Foley catheter;
clinical correlation for Foley catheter function is recommended.
Findings discussed with ___ by ___ by telephone at 11:35
p.m. on ___.
|
10017764-RR-23 | 10,017,764 | 28,307,589 | RR | 23 | 2123-07-02 17:57:00 | 2123-07-07 10:56:00 | HISTORY: Left nephrolithiasis with left stent placement.
COMPARISON: Cystogram ___, complete GU ultrasound ___.
FINDINGS: Left retrograde urography demonstrates 2 filling defects within the
left ureter as well as filling defects within the renal pelvis. Prominence of
the left collecting system is noted. Left ureteral stent is placed.
|
10018081-RR-10 | 10,018,081 | 21,027,282 | RR | 10 | 2133-12-19 09:41:00 | 2133-12-19 11:00:00 | CHEST RADIOGRAPH
INDICATION: Endotracheal tube placement, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. On the current image, the tip of the endotracheal tube projects
approximately 6 cm above the carina. Unchanged size of the cardiac
silhouette. Retrocardiac atelectasis. Minimal right basal atelectasis but no
convincing evidence of pneumonia. Mild fluid overload, no overt pulmonary
edema.
|
10018081-RR-11 | 10,018,081 | 21,027,282 | RR | 11 | 2133-12-21 05:17:00 | 2133-12-21 08:38:00 | CHEST RADIOGRAPH
INDICATION: Sepsis, ischemic bowel disease, intubation, evaluation for
interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the monitoring and support
devices are unchanged. Moderate-to-severe cardiomegaly remains unchanged, but
a pre-existing left pleural effusion has slightly decreased in extent. Also
decreased is a pre-existing left perihilar opacity. Overall, the lungs appear
better ventilated. Plate-like atelectasis at the right lung bases, associated
with a small right pleural effusion. No new parenchymal opacities. No
pneumothorax.
|
10018081-RR-12 | 10,018,081 | 21,027,282 | RR | 12 | 2133-12-20 14:07:00 | 2133-12-20 16:05:00 | CHEST RADIOGRAPH
HISTORY: Arrhythmia. Question central line positioning.
COMPARISONS: Earlier in the same day.
TECHNIQUE: Chest, portable AP upright.
FINDINGS: The patient remains intubated. The endotracheal tube terminates
about 5-6 cm above the carina. An orogastric tube courses into the stomach,
its distal course not fully imaged. A right internal jugular catheter
terminates at the cavoatrial junction. There is a new focal opacity in the
left upper lobe with a geometric appearance, probably compatible with
atelectasis; a newly forming area of pneumonia is not excluded, however.
Dense extensive retrocardiac opacification with air bronchograms and a
probable associated pleural effusion persists without clear change. A pleural
effusion is not apparent on the right on this study, which may be due to a
true decrease or consequence of differences in positioning.
IMPRESSION: New left upper lobe opacity, probably due to atelectasis, but a
new focus of infection is not excluded; short-term follow-up radiographs may
be helpful to help distinguish if clinical concerns may include the
possibility of developing infection. Persistent extensive retrocardiac
opacification, most commonly due to atelectasis, with a pleural effusion.
|
10018081-RR-13 | 10,018,081 | 21,027,282 | RR | 13 | 2133-12-22 05:55:00 | 2133-12-22 14:03:00 | AP CHEST, 6:02 A.M., ___
HISTORY: ___ man, intubated. Evaluate any interval change.
IMPRESSION: AP chest compared to ___:
ET tube in standard placement. Left lower lobe consolidation has not improved
since ___, accompanied by small left pleural effusion. Small right
pleural effusion increased since ___. Previous mild interstitial
edema has changed in distribution but not in overall severity. Severe cardiac
enlargement, unchanged.
Upper enteric drainage tube passes into the stomach and out of view. Right
jugular line ends low in the SVC. No pneumothorax.
|
10018081-RR-14 | 10,018,081 | 21,027,282 | RR | 14 | 2133-12-23 05:42:00 | 2133-12-23 13:40:00 | AP CHEST, 5:55 A.M., ___
HISTORY: ___ man with pulmonary edema. Intubated. Suspect
pneumonia.
IMPRESSION: AP chest compared to ___:
Small-to-moderate right pleural effusion is smaller and extent of mild
atelectasis at the right lung base is unchanged, nor is there pulmonary edema.
On the left, the lower lobe has been virtually airless since ___ and
that has not changed, accompanied by a small pleural effusion which one would
expect in the setting of chronic atelectasis. Left upper lobe is clear.
Cardiac silhouette is moderately to severely enlarged but unchanged due to
cardiomegaly and/or pericardial effusion. ET tube is in standard placement.
Right jugular line ends low in the SVC and upper enteric drainage tube passes
into the stomach and out of view.
|
10018081-RR-15 | 10,018,081 | 21,027,282 | RR | 15 | 2133-12-22 10:26:00 | 2133-12-22 10:56:00 | HISTORY: Right-sided weakness, unequal pupils. Evaluate for stroke.
COMPARISON: Nne available
TECHNIQUE: Axial contiguous MDCT images were obtained through the head
without administration of IV contrast. Coronal, sagittal, and thin slice bone
reformations were generated.
DLP: 936 mGy-cm
CTDI: 54.21 mGy
FINDINGS:
There is no hemorrhage, edema, mass, mass effect, large territorial
infarction. The sulci and ventricles are prominent suggesting age related
atrophy. Periventricular white matter changes are consistent with chronic
small vessel ischemic disease. There is preservation of gray-white matter
differentiation and the basal cisterns appear patent.
There is no fracture. There is opacification of scattered bilateral ethmoid
air cells as well as minimal bilateral maxillary mucosal thickening and mild
concentric mucosal thickening of the right sphenoidal sinus. Atherosclerotic
calcification of the carotid siphons and vertebral arteries is present. There
is a right scleral buckle.
IMPRESSION:
No CT evidence of acute intracranial process. Chronic changes as described
above. MRI would be more sensitive for brainstem ischemia.
|
10018081-RR-16 | 10,018,081 | 21,027,282 | RR | 16 | 2133-12-24 05:17:00 | 2133-12-24 09:45:00 | HISTORY: ___ male with ventilatory to dependent respiratory
insufficiency. Evaluate for interval change.
COMPARISON: Chest radiograph stated through ___.
FINDINGS:
Portable chest radiograph demonstrates an endotracheal tube which terminates
4.5 cm above the level of the carina in appropriateposition. A right internal
jugular line terminates in the low SVC. An enteric tube descends in in
uncomplicated course, its terminal end outside the field of view. Heart size
is mildly enlarged, unchanged. New mild interstitial edema in the right lower
lobe. The left lung appears grossly clear and better aerated. No
pneumothorax.
IMPRESSION:
New mild right lower lobe interstitial edema.
|
10018081-RR-17 | 10,018,081 | 21,027,282 | RR | 17 | 2133-12-25 05:33:00 | 2133-12-25 08:28:00 | HISTORY: ___ male with bowel ischemia and volume overload. Evaluate
interval change.
COMPARISON: Multiple chest radiographs dated through ___.
FINDINGS:
Portable frontal chest radiograph demonstrates an endotracheal tube which
terminates 4 cm above the level of the carina in appropriate position. An
enteric tube descends in an uncomplicated course to the distal esophagus, its
end out of view. A right jugular line ends at the low superior vena cava.
Allowing for changes in patient positioning, the lungs appear largely
unchanged with mildly increased interstitial edema. There is no new focal
consolidation. There are likely small bilateral pleural effusions, unchanged.
There is no pneumothorax.
IMPRESSION:
Mildly increased interstitial pulmonary edema.
|
10018081-RR-18 | 10,018,081 | 21,027,282 | RR | 18 | 2133-12-26 05:01:00 | 2133-12-26 11:48:00 | PORTABLE CHEST FILM, ___ AT 5:06 A.M.
CLINICAL INDICATION: ___ with respiratory failure, assess for
interval change.
Comparison to prior study of ___ at 1541.
Portable AP semi-erect chest film, ___ at 5:06AM is submitted.
IMPRESSION:
1. Nasogastric tube is again seen coursing below the diaphragm with the tip
not identified. Overall cardiac and mediastinal contours are stable.
Interval reduction in lung volumes with appearance of patchy opacity at both
bases, right greater than left, most likely representing patchy atelectasis in
the setting of low lung volumes. No large effusions. No pneumothorax. No
evidence of pulmonary edema.
|
10018081-RR-19 | 10,018,081 | 21,027,282 | RR | 19 | 2133-12-25 15:37:00 | 2133-12-25 18:31:00 | AP CHEST, 3:41 P.M., ___
HISTORY: ___ woman. NG tube placed.
IMPRESSION: AP chest compared to ___, 5:43 a.m.:
ET tube has been removed, lung volumes are well maintained. Mild cardiomegaly
and small left pleural effusion stable. Previous left lower lobe atelectasis
has improved. There is no pulmonary edema. Upper enteric drainage tube
passes into a non-distended stomach and out of view.
|
10018081-RR-20 | 10,018,081 | 21,027,282 | RR | 20 | 2133-12-27 09:22:00 | 2133-12-27 09:58:00 | HISTORY: ___ male with altered mental status and rising white count.
Evaluate for pneumonia.
COMPARISON: Chest radiograph status through ___.
FINDINGS:
Portable AP chest radiograph demonstrates new bibasilar interstial edema with
mildly increased vascular congestion. No focal consolidation identified. There
is opacification of the left hemidiaphragm concerning for atelectasis versus
pleural effusion. There is no pneumothorax. The cardiomediastinal contour is
unchanged in appearance. An enteric tube is seen descending and an
uncomplicated course, its terminal end out of view. Chronic deformed right
clavicle redemonstrated.
IMPRESSION:
Mild interstial edema and vascular congestion.
|
10018081-RR-21 | 10,018,081 | 21,027,282 | RR | 21 | 2133-12-27 16:09:00 | 2133-12-27 18:14:00 | HISTORY: ___ man with leukocytosis after bowel resection, altered
mental status and colostomy. Evaluate for abscess. Please give p.o.
contrast.
COMPARISON: Prior outside CT torso from ___.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the uneventful administration of oral contrast. No IV contrast was
provided. Sagittal and coronal reformats were generated.
Total exam DLP: 796 mGy-cm.
FINDINGS:
For a full report of the chest portion of this examination, please refer to
clip number ___.
CT of the abdomen: Evaluation of solid abdominal viscera is limited by lack
of IV contrast. The liver is borderline fatty. No focal hepatic lesions are
identified. There is no intra or extrahepatic biliary ductal dilatation. The
gallbladder has been surgically removed. Surgical clips are seen in the right
upper quadrant. The adrenal glands, pancreas and spleen are within normal
limits. An orogastric tube terminates in the gastric fundus. The stomach is
contrast filled. The kidneys do not demonstrate any hydronephrosis or renal
masses.
Patient is status post right colectomy and diverting ileostomy. Fat stranding
is seen along the anterior abdominal wall and right ileostomy with no evidence
of fluid collection or abscess formation. Surgical sutures are seen along the
remaining portions of the transverse colon and at the level of the rectum
(3:81, 94). Multiple diverticula are seen throughout the small bowel and
sigmoid colon with no evidence of acute diverticulitis. There is no evidence
of small bowel obstruction. Small and large bowel are otherwise grossly
unremarkable. Note is made of a left abdominal wall defect containing
multiple loops of small bowel with no evidence of strangulation. The
intra-abdominal aorta and its branches demonstrate moderate atherosclerotic
calcifications. Vessel patency cannot be evaluated in this examination.
There is no evidence of free fluid or free air. There is no retroperitoneal
or mesenteric lymph node enlargement by CT size criteria.
CT of the pelvis: A Foley catheter is seen within the urinary bladder. Note
is made of a 3.1 cm diverticulum along the posterior aspect of the bladder.
Coarse calcifications are seen within the prostate. The seminal vesicles are
normal. There is no pelvic free fluid. There is no inguinal or pelvic lymph
node enlargement by CT size criteria.
Osseous structures: No blastic or lytic lesion concerning for malignancy is
present. Moderate degenerative changes are noted along the thoracolumbar
spine, most prominent at the L2-L3 level with endplate sclerosis, anterior
osteophytosis and vacuum disc phenomenon at this level.
IMPRESSION:
1. Status post right colectomy and diverting ileostomy with no evidence of
fluid collection or abscess formation.
2. Small bowel and sigmoid diverticulosis, no evidence of acute
diverticulitis.
3. Left abdominal wall defect containing multiple loops of small bowel
without evidence of bowel strangulation, likely secondary to diastasis of the
rectus abdominis muscles versus herniation.
|
10018081-RR-22 | 10,018,081 | 21,027,282 | RR | 22 | 2133-12-27 16:23:00 | 2133-12-27 17:16:00 | CHEST CT, ___
HISTORY: A ___ man with a bowel resection, altered mental status and
rising white count. Evaluate for infection or abscess.
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25 mm thick
axial, 5 mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images,
compared to images of the lower chest on a torso CT, ___.
FINDINGS: Previously demonstrated pleural plaque, in both hemithoraces,
noncalcified, is partially obscured by a new subpleural atelectasis, a common
findings after abdominal surgery. Heavy secretions pooling in the trachea and
right main bronchus could be either retained from the lung or recently
aspirated. The esophagus is not distended. It transmits a small catheter
into a large stomach filled with oral contrast agent.
Emphysema is moderate, and explains the mild sagittal elongation of the upper
trachea. Upper lungs are otherwise clear. Axillary and supraclavicular lymph
nodes, mediastinal and hilar nodes are not pathologically enlarged. There is
no pericardial effusion. Cardiomegaly, predominantly left ventricular and
left atrial is substantial, but there is no pulmonary vascular engorgement or
edema. Calcification in the aortic valve is minimal.
Findings below the diaphragm will be reported separately.
There are no bone findings in the chest cage suspicious for malignancy or
infection.
IMPRESSION:
1. Mild opacification at the lung bases, is most likely atelectasis.
Endobronchial material is either retained secretions or recent aspiration.
None of the contrast agent filling the stomach is present in the
tracheobronchial tree.
2. Asbestos-related pleural plaques. No evidence of intrathoracic
malignancy.
3. Mild-to-moderate emphysema.
4. Moderate cardiomegaly. No pulmonary edema.
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10018081-RR-23 | 10,018,081 | 21,027,282 | RR | 23 | 2133-12-28 10:03:00 | 2133-12-28 11:10:00 | INDICATION: Patient with history of bowel ischemia status post exploratory
laparotomy and ileostomy, who now presents with acute kidney injury. Assess
for hydronephrosis.
COMPARISONS: CT abdomen and pelvis of ___.
FINDINGS:
The right kidney measures 12.4 cm and the left kidney measures 11 cm. There
is no evidence of hydronephrosis, renal masses or nephrolithiasis bilaterally.
There is a 9 mm hyperechoic focus in the lower pole of the left kidney, which
likely represent calcium deposit within a caliceal diverticulum. This finding
was also seen on ___ CT exam. The bladder was not imaged due to
overlying bandage material.
IMPRESSION:
No evidence of hydronephrosis.
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10018081-RR-24 | 10,018,081 | 21,027,282 | RR | 24 | 2133-12-29 05:50:00 | 2133-12-29 10:07:00 | PORTABLE CHEST FILM ___ AT 6:04 A.M.
CLINICAL INDICATION: ___ with bowel ischemia, status post exploratory
laparotomy, evaluate for pneumonia.
Comparison is made to the patient's prior study dated ___ at 10 p.m.
A portable AP upright chest film ___ at 604 is submitted.
IMPRESSION:
1. Nasogastric tube is again seen coursing below the diaphragm with the tip
not identified. The heart remains stably enlarged. There is a stable
retrocardiac consolidation likely with an associated effusion. In addition,
there is more focal patchy opacity developing at the right lung base.
Although these findings may represent atelectasis, aspiration and/or bibasilar
pneumonia should also be considered. No pneumothorax. No evidence of
pulmonary edema.
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10018081-RR-25 | 10,018,081 | 21,027,282 | RR | 25 | 2133-12-28 19:58:00 | 2133-12-29 10:04:00 | PORTABLE CHEST FILM ___ AT 10 P.M.
CLINICAL INDICATION: ___ with respiratory distress, evaluate left
chest for decreased breath sounds.
Comparison to prior study dated ___ at 927.
A portable AP upright chest film ___ at 10 p.m. is submitted.
IMPRESSION:
1. A nasogastric tube is seen coursing below the diaphragm with the tip not
identified. There is increasing retrocardiac consolidation with a probable
associated effusion. Although this may represent partial lower lobe
atelectasis, aspiration and pneumonia should also be considered. Right lung
is grossly clear. Heart remains stably enlarged. No pneumothorax is
appreciated. No evidence of pulmonary edema.
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10018081-RR-26 | 10,018,081 | 21,027,282 | RR | 26 | 2133-12-30 05:46:00 | 2133-12-30 09:44:00 | PORTABLE CHEST FILM ___ AT 601
CLINICAL INDICATION: ___ with leukocytosis, left effusion, question
pneumonia.
Comparison to prior study of ___ at 604.
A portable AP upright chest film ___ at 601 is submitted.
IMPRESSION:
1. Nasogastric tube is again seen coursing below the diaphragm with the tip
not identified. The heart is stably enlarged. Persistent retrocardiac
consolidation and more patchy opacity at the right base remain and are
concerning for atelectasis, aspiration or bibasilar pneumonia. Clinical
correlation is advised. There is a layering left effusion. No pulmonary
edema. No pneumothorax.
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10018081-RR-27 | 10,018,081 | 21,027,282 | RR | 27 | 2134-01-01 05:42:00 | 2134-01-01 11:00:00 | CHEST RADIOGRAPH
INDICATION: Evaluation for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is increasing
atelectasis at the right lung base. The pleural effusion on the left and the
subsequent atelectasis are constant in appearance. Constant size of the
cardiac silhouette. Unchanged course of the nasogastric tube.
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10018081-RR-28 | 10,018,081 | 21,027,282 | RR | 28 | 2134-01-02 08:53:00 | 2134-01-02 12:05:00 | CHEST RADIOGRAPH.
INDICATION: Evaluation of pleural effusions and pulmonary edema.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is resolution of the
pre-existing right basal atelectasis. Mild pleural effusion on the left,
combined to substantial left lower lobe atelectasis. No pneumonia, no overt
pulmonary edema. No pneumothorax.
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10018081-RR-29 | 10,018,081 | 21,027,282 | RR | 29 | 2134-01-02 15:47:00 | 2134-01-02 17:36:00 | AP CHEST, 4 P.M., ___
HISTORY: A ___ man after exploratory laparotomy. Evaluate Dobbhoff
tube placement.
IMPRESSION: AP chest compared to 9 a.m.:
Feeding tube with a wire stylet withdrawn several centimeters from the tip
coils in the upper portion of non-distended stomach. Right lung is clear.
Opacification at the base of the left lung is residual atelectasis and some
pleural fluid, but substantially improved since ___ and earlier today.
There is no pneumothorax. Heart is moderately enlarged, but there is no
pulmonary vascular congestion or edema.
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10018081-RR-30 | 10,018,081 | 21,027,282 | RR | 30 | 2134-01-02 17:04:00 | 2134-01-03 09:55:00 | PATIENT HISTORY: ___ years old man with pneumatosis, portal/mesenteric venous
catheter, status post exploratory laparotomy with extended right colectomy for
ischemic colon and prior anastomosis, now status post abdominal closure,
ileostomy with Dobbhoff placement.
COMPARISON: Exam is compared to chest x-ray of the same day at 4:00 p.m.
FINDINGS: AP single view portable chest x-ray shows Dobbhoff tube with tip
ending in mid gastric cavity. Left lung base opacity has worsened since prior
chest x-ray due to increased pleural effusion and left lower lobe collapse. In
the appropriate clinical setting pneumonia should be considered. Right lung is
clear without consolidation, nodules or pleural effusion. There is no
pneumothorax. Heart size is partially obscured by left pleural effusion but
appears within normal limits.
IMPRESSION: Correct positioning of Dobbhoff tube ending in mid gastric
cavity. Interval increase of left lung base collapse and pleural effusion, is
concerning for pneumonia.
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10018081-RR-31 | 10,018,081 | 21,027,282 | RR | 31 | 2134-01-02 22:28:00 | 2134-01-03 08:34:00 | CHEST RADIOGRAPH
INDICATION: New tachypnea, increasing oxygen requirement, rule out PE.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, no relevant change is
noted. The lung volumes are low. Atelectasis of the left lower lobe with
potential accompanying small left pleural effusion. Unchanged moderate
cardiomegaly. No change in appearance of the normal right lung. Nasogastric
tube is in unchanged position.
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10018081-RR-32 | 10,018,081 | 21,027,282 | RR | 32 | 2134-01-03 00:08:00 | 2134-01-03 01:11:00 | HISTORY: Increasing O2 requirement with concern for pulmonary embolism.
COMPARISON: None.
FINDINGS:
Grayscale, color, and spectral Doppler evaluation was performed of the
bilateral lower extremity veins. There is normal phasicity of the common
femoral veins bilaterally. There is normal compression and augmentation of
the bilateral common femoral, proximal femoral, mid femoral, distal femoral,
popliteal, posterior tibial, and peroneal veins.
IMPRESSION:
No evidence of DVT in either the right or the left lower extremity.
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10018081-RR-33 | 10,018,081 | 21,027,282 | RR | 33 | 2134-01-03 11:42:00 | 2134-01-03 15:41:00 | PATIENT HISTORY: ___ years old man with pneumatosis, portal/mesenteric venous
catheter, status post exploratory laparotomy with extended right colectomy for
ischemic colon, prior anastomosis, now status post abdominal closure,
ileostomy with ___, now with fever and tachypnea. Assess for pneumonia.
TECHNIQUE: Multidetector helical scanning of the chest without infusion of
contrast material agent. Images were reconstructed as contiguous 5- and
1.25-mm thick axial helical, thick coronal and parasagittal, and 8 x 8 mm MIPs
projections.
COMPARISON: Exam is compared to chest CT of ___.
FINDINGS: Mucoid secretions are in the lower trachea, 4:56, minimally reduced
since ___. In the left lower lobe, there is new consolidation
involving the superior segment of the left lower lobe and mainly the
posterobasal segment of the same lobe, 4:111 to 4:163. The bronchus for the
superior segment of the left lower lobe is obstructed by hypodense material
and might be mucus. Adjacent to the consolidation there is an area of
ground-glass and bronchiolar nodules, 4:125. These findings are suggestive of
pneumonia. Right lower lobe atelectasis, 4:172, has improved since ___, now with residual ground-glass and linear opacity. Two punctate
subpleural nodules in the right upper lobe, 4:50, 54 and 4 mm parafissural
nodule in the right lower lobe are unchanged since ___. Severe
centrilobular emphysema and bronchial wall thickening are unchanged since the
prior examination.
Thyroid gland is unremarkable. There is no peripheral or central
lymphadenopathy. Great vessels have normal in size. Heart size is moderately
enlarged. Mild enlargement of all four chambers, but especially the left
chamber. Aortic valve calcification are mild, 2:34, unchanged since ___. Mild blood density is compatible with anemia. There is no pericardial
or pleural effusion.
UPPER ABDOMEN: Even though this exam is not tailored for abdominal imaging,
it shows normal liver, spleen, adrenals, and pancreas in a patient who has had
cholecystectomy as denoted by metal clips in the gallbladder bed. NG tube
ends coiled in the fundus of stomach 2:39.
BONES: There are no bone lesions suspicious for malignancy or infection.
IMPRESSION:
1. Left lower lobe pneumonia, potentialy due to aspiration.
2. Two punctate nodules in the right upper lobe and parafissural nodule in the
right lower lobe are unchanged since ___.
3. No lymphadenopathy.
4. Moderate cardiomegaly is unchanged since the prior examination.
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10018081-RR-34 | 10,018,081 | 21,027,282 | RR | 34 | 2134-01-04 08:50:00 | 2134-01-04 10:41:00 | INDICATION: ___ male with probable pneumonia. Assess for interval
change.
COMPARISON: Chest radiograph from ___ and chest CT from ___
PORTABLE FRONTAL CHEST RADIOGRAPH: There is slight improved aeration of the
left lung base as compared to most recent prior radiograph, likely due to
decreased atelectasis. However, a moderate consolidation and associated
moderate effusion persist and are consistent with the clinical history of
pneumonia. There is increased pulmonary vascular congestion, mild, though no
overt interstitial edema. There is no pneumothorax. An enteric catheter
terminates within the stomach.
IMPRESSION:
1. Unchanged left lower lobe pneumonia, with slightly improved aeration
likely due to decreased adjacent atelectasis.
2. Increased mild pulmonary vascular congestion.
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10018081-RR-35 | 10,018,081 | 21,027,282 | RR | 35 | 2134-01-05 08:21:00 | 2134-01-05 11:08:00 | PORTABLE SEMI-UPRIGHT CHEST, ___
COMPARISON: ___.
FINDINGS: Persistent left retrocardiac opacity, with increasing volume loss
manifested by inferior displacement of the left hilum and apparent
displacement of left major fissure, consistent with left lower lobe
atelectasis. Coexisting pneumonia is possible in the appropriate clinical
setting. Right lung and pleural surfaces are clear.
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