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10000032-RR-22 | 10,000,032 | 22,841,357 | RR | 22 | 2180-06-26 17:15:00 | 2180-06-26 19:28:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with cirrhosis, increased abdominal pain
TECHNIQUE: Grey scale and color Doppler ultrasound images of the right upper
quadrant were obtained.
COMPARISON: Abdominal ultrasound from ___
FINDINGS:
The liver is extremely course and nodular in echotexture similar to the prior
examination consistent with a history of cirrhosis. Parenchymal heterogeneity
limits detection focal lesions. Note is made of a dominant nodule measuring
3.3 x 2.7 cm exerting mass effect on the gallbladder, relatively unchanged
from the prior examination. There is no intrahepatic biliary dilation. The CBD
measures 5 mm. Main, right anterior and right posterior portal veins are
patent with hepatopetal flow. The gallbladder is normal without stones or wall
thickening. Pancreas is not well evaluated. The spleen measures 11.9 cm in
length and has homogeneous echotexture. There is moderate ascites throughout
the abdomen.
IMPRESSION:
1. Extremely coarse and nodular liver echotexture consistent with cirrhosis.
2. Moderate ascites.
3. Patent portal vein.
|
10000032-RR-23 | 10,000,032 | 22,841,357 | RR | 23 | 2180-06-26 17:17:00 | 2180-06-26 17:28:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with shortness of breath
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature
is normal. Lungs are clear. No pleural effusion or pneumothorax is present.
Multiple clips are again seen projecting over the left breast. Remote
left-sided rib fractures are also re- demonstrated.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10000117-RR-13 | 10,000,117 | 22,927,623 | RR | 13 | 2181-11-15 00:40:00 | 2181-11-15 07:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with PMH GERD presenting with sensation of foreign
body in her throat, SOB. // Foreign body or soft tissue mass in throat?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
Lungs remain hyperinflated, without focal consolidation, pleural effusion, or
pneumothorax. On lateral view, the prominent esophagus is identified between
the posterior heart and anterior aortic arch. The cardiomediastinal
silhouette is unremarkable. The trachea is not deviated.
IMPRESSION:
Prominent esophagus on lateral view, without air-fluid level. Given the
patient's history and radiographic appearance, barium swallow is indicated
either now or electively.
|
10000117-RR-14 | 10,000,117 | 22,927,623 | RR | 14 | 2181-11-15 00:47:00 | 2181-11-15 01:12:00 | EXAMINATION: NECK SOFT TISSUES
INDICATION: ___ woman with dysphasia. Evaluate for soft tissue mass.
TECHNIQUE: Frontal and lateral radiograph of the neck.
COMPARISON: None available.
FINDINGS:
There is no evidence of prevertebral soft tissue swelling or soft tissue mass,
within the limitations of plain radiography. C1 through T2 are imaged. Mild
degenerative changes of the cervical spine are most pronounced at C5-C6 and
C6-C7, were there is disc space narrowing and small osteophyte formation. No
evidence of cervical spinal fracture. Lung apices are grossly clear.
IMPRESSION:
Within the limitation of plain radiography, no evidence of prevertebral soft
tissue swelling or soft tissue mass in the neck.
|
10000935-RR-71 | 10,000,935 | 21,738,619 | RR | 71 | 2187-07-11 11:16:00 | 2187-07-11 11:42:00 | HISTORY: Recurrent vomiting, subjective fever and cough.
TECHNIQUE: Upright AP and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Lung volumes are low. The heart size is normal. The mediastinal and hilar
contours are unremarkable. New nodular opacities are clustered within the
left upper lobe, and to a lesser extent, within the right upper lobe. There
is no pneumothorax or left-sided pleural effusion. Pulmonary vascularity is
within normal limits. Postsurgical changes are noted in the right chest with
partial resection of the right 6th rib, lateral right pleural thickening and
chronic blunting of the costophrenic sulcus.
IMPRESSION:
New nodular opacities within both upper lobes, left greater than right.
Findings are compatible with metastases, as was noted in the lung bases on the
subsequent CT of the abdomen and pelvis performed later the same day.
|
10000935-RR-72 | 10,000,935 | 21,738,619 | RR | 72 | 2187-07-11 11:31:00 | 2187-07-11 12:50:00 | HISTORY: History of high-grade small bowel obstruction, presents with nausea,
vomiting, and left upper quadrant pain. Evaluate for SBO, fluid collection,
perforation, ischemic colitis.
TECHNIQUE: Helical MDCT images were obtained of the abdomen and pelvis after
administration of 150 cc of Omnipaque IV contrast utilizing sterile technique.
Multiplanar axial, coronal, and sagittal images were acquired.
COMPARISON: CT abdomen pelvis ___. CT abdomen and pelvis ___.
FINDINGS:
The partially visualized lung bases reveal innumerable bilateral sub-cm
nodules.
CT abdomen: The liver is markedly enlarged and contains numerous
heterogeneous hypodensities which are most distinct in the left lobe and
become more numerous and confluent in the right lobe. The contour of the
liver is nodular. The liver extends into the left upper quadrant displacing
the stomach posteriorly. Additionally, there may be some component of mass
effect on the gastroesophageal junction. The gallbladder appears normal
without stones. The portal vein is patent without obvious metastatic
invasion. The pancreas is normal without focal lesions, peripancreatic
stranding, or fluid collections. The spleen is normal in size and
homogeneous. Adrenal glands are unremarkable. A 9 mm hypodensity in the
upper pole of the right kidney is too small to characterize but statistically
is most likely to represent a simple cyst. The kidneys are otherwise normal
without solid lesions and present symmetric nephrograms and excretion of
contrast. There is no pelvocaliceal dilation or perinephric abnormalities.
The stomach, duodenum, and small bowel are unremarkable without wall
thickening or evidence of obstruction. The colon is within normal limits.
The appendix is visualized and there is no evidence of appendicitis.
The intra-abdominal vasculature is unremarkable. There is no retroperitoneal
or mesenteric lymph node enlargement by CT size criteria. There is no ascites
or free air bowel wall hernias.
CT pelvis: The urinary bladder and distal ureters are normal. There is no
pelvic wall or inguinal lymph node enlargement. There is no pelvic free
fluid.
Osseous structures: Similar to ___ there is sclerosis of the iliac regions
of both sacroiliac joints consistent with osteitis condensans ilii. There are
no suspicious sclerotic or lytic lesions.
IMPRESSION:
1. Innumerable hepatic and pulmonary metastases. No obvious primary
malignancy is identified on this study.
2. No evidence of small bowel obstruction, ischemic colitis, fluid collection,
or perforation.
|
10000935-RR-79 | 10,000,935 | 25,849,114 | RR | 79 | 2187-10-10 12:58:00 | 2187-10-10 13:32:00 | HISTORY: Dyspnea and history of lung cancer.
TECHNIQUE: Semi-upright AP view of the chest.
COMPARISON: CT torso ___ and chest radiograph ___.
FINDINGS:
Lung volumes are low. This results in crowding of the bronchovascular
structures. There may be mild pulmonary vascular congestion. The heart size
is borderline enlarged. The mediastinal and hilar contours are relatively
unremarkable. Innumerable nodules are demonstrated in both lungs, more
pronounced in the left upper and lower lung fields compatible with metastatic
disease. No new focal consolidation, pleural effusion or pneumothorax is
seen, with chronic elevation of right hemidiaphragm again seen. The patient
is status post right lower lobectomy. Rib deformities within the right
hemithorax is compatible with prior postsurgical changes.
IMPRESSION:
Innumerable pulmonary metastases. Possible mild pulmonary vascular
congestion. Low lung volumes.
|
10000935-RR-80 | 10,000,935 | 25,849,114 | RR | 80 | 2187-10-10 15:09:00 | 2187-10-10 18:23:00 | HISTORY: Shortness of breath, evaluate for pulmonary embolism.
TECHNIQUE: MDCT images were obtained through the chest following
administration of IV contrast. Coronal and sagittal reformations are
performed. Right and left MIP reconstructions were performed.
COMPARISON: CT torso on ___.
FINDINGS:
No axillary lymphadenopathy. An enlarged subcarinal lymph node measuring 1.6
cm is unchanged. Heart size is normal. The aorta is normal in caliber.
There is no central or segmental pulmonary artery filling defect. Suboptimal
bolus limits evaluation of the subsegmental branches. No evidence of right
heart strain. No pericardial effusion. The airways are patent to the
subsegmental level. There are innumerable pulmonary nodules bilaterally,
similar in appearance to prior study in most cases although some have mildly
increased. The largest measures 10 mm in diameter within the right lower
lobe. No focal consolidation, pleural effusion or pneumothorax.
Calcification along the right lateral lung is unchanged and consistent with
previous right lung surgery.
The liver is very enlarged with multiple low-density lesions, similar to prior
study. The exact degree of metastatic involvement is difficult to compare for
small changes but also seems to have increased.
The vertebral heights are preserved. No acute bone abnormality.
IMPRESSION:
1. No central or segmental filling defect in the pulmonary arteries.
Evaluation is slightly limited due to suboptimal IV bolus.
2. Innumerable bilateral pulmonary nodules, simas seen on the prior CT study
on ___, slightly increased. No focal consolidation or pleural
effusion.
3. Enlarged liver with multiple hypodense lesions, with suggestion of
increased burden of disease.
|
10000935-RR-81 | 10,000,935 | 25,849,114 | RR | 81 | 2187-10-11 16:43:00 | 2187-10-11 17:03:00 | HISTORY: ___ female with known metastatic cancer, unknown primary
with liver metastases and elevated liver function tests.
COMPARISON: CT ___.
FINDINGS:
The liver is diffusely involved with innumerable metastatic nodules throughout
all portions of the liver and replacing much of the liver parenchyma. There
is no bile duct dilatation. The gallbladder is normal in size and partially
filled with sludge. There is no evidence of ascites or splenomegaly. Limited
views of the kidneys show no hydronephrosis.
IMPRESSION:
Extensive diffuse hepatic metastatic disease. No evidence of biliary duct
obstruction.
|
10000935-RR-82 | 10,000,935 | 25,849,114 | RR | 82 | 2187-10-14 10:45:00 | 2187-10-14 11:47:00 | HISTORY: ___ year old woman with probable malignancy of unknown primary,
involving liver and lung
PROCEDURE:
PHYSICIANS: ___
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained. A preprocedure timeout was
performed discussing the planned procedure, confirming the patient's identity
with three identifiers, and reviewing a checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 18 gauge biopsy needle was advanced into a target lesion within right
hepatic lobe under ultrasound guidance via a right lateral intercostal
approach and a 2 core biopsies were obtained. An on site cytopathologist
confirmed that the samples were adequate.
Moderate sedation was provided by administering divided doses of 1.5 mg versed
and 100 mcg fentanyl throughout the total intra-service time of 15 minutes
during which the patient's hemodynamic parameters were continuously monitored
by radiology nursing personnel.
The patient tolerated the procedure well with no immediate complication.
Estimated blood loss was minimal.
Dr. ___ attending radiologist, was present throughout the entire
procedure. Post-procedure instructions were written in the ___ medical
record.
FINDINGS:
Multiple echogenic nodules are seen diffusely scattered throughout the liver.
One within the right hepatic lobe was targeted for biopsy.
IMPRESSION:
Ultrasound-guided 18 gauge non-targeted liver core biopsy. 2 passes.
Cytology confirmed the sample was adequate. Pathology pending.
|
10000935-RR-85 | 10,000,935 | 25,849,114 | RR | 85 | 2187-10-16 12:24:00 | 2187-10-16 17:29:00 | HISTORY: Leukocytosis, low-grade temperature, rule out focal infiltrate.
TECHNIQUE: Portable semi-upright AP radiograph of the chest.
COMPARISON: Multiple prior radiographs of the chest most recent ___
CT of the chest ___.
FINDINGS:
Lung volumes remain low. There are innumerable bilateral scattered small
pulmonary nodules which are better demonstrated on recent CT. Mild pulmonary
vascular congestion is stable. The cardiomediastinal silhouette and hilar
contours are unchanged. Small pleural effusion in the right middle fissure is
new. There is no new focal opacity to suggest pneumonia. There is no
pneumothorax.
IMPRESSION:
1. Low lung volumes and mild pulmonary vascular congestion is unchanged.
2. New small right fissural pleural effusion.
3. No new focal opacities to suggest pneumonia.
|
10000935-RR-86 | 10,000,935 | 25,849,114 | RR | 86 | 2187-10-17 16:53:00 | 2187-10-18 10:25:00 | INDICATION: Metastatic colon cancer with left hip pain.
COMPARISON: CT torso dated ___.
ONE VIEW PELVIS AND TWO VIEWS LEFT HIP.
There is no acute fracture or dislocation. Femoroacetabular joint is grossly
preserved. There is no definite lytic or sclerotic lesion. Two surgical
clips overlie the pelvis.
IMPRESSION: No definite lytic lesion; however, an MRI can be performed to
evaluate for an osseous lesion if indicated.
|
10000935-RR-87 | 10,000,935 | 25,849,114 | RR | 87 | 2187-10-17 16:40:00 | 2187-10-17 21:29:00 | HISTORY: Newly diagnosed metastatic colon cancer, evaluate for brain
metastases, altered mental status.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered.
COMPARISON: CT head on ___.
FINDINGS:
There is no evidence of acute hemorrhage, edema, mass, mass effect, or acute
territorial infarction. The ventricles and sulci are normal in size and
configuration for the patient's age. The gray-white differentiation is
preserved. The visualized paranasal sinuses and mastoid air cells are well
aerated. The acute bony abnormality.
IMPRESSION:
No acute intracranial process. No mass is identified. MRI is more sensitive
for evaluation of metastases.
|
10000935-RR-88 | 10,000,935 | 25,849,114 | RR | 88 | 2187-10-19 14:08:00 | 2187-10-19 16:43:00 | PORTABLE SUPINE ABDOMEN, ___
COMPARISON: Radiograph of ___.
FINDINGS: Radiographs of the abdomen and pelvis demonstrate a nonobstructed
bowel gas pattern. A relative paucity of bowel gas is present in the upper
and mid abdomen, likely due to marked enlargement of the liver, displacing
bowel loops. Note that the upright view is technically suboptimal, and limits
evaluation for free intraperitoneal air. If free intraperitoneal air is
suspected clinically, a left lateral decubitus view of the abdomen would be
recommended.
|
10000935-RR-90 | 10,000,935 | 25,849,114 | RR | 90 | 2187-10-21 17:43:00 | 2187-10-21 19:10:00 | HISTORY: Evaluation for obstruction or perforation in a patient with
abdominal pain, distention and vomiting and widely metastatic colon cancer.
COMPARISON: Abdominal radiograph ___.
FINDINGS: Portable supine frontal abdominal radiographs demonstrate
non-dilated gas-filled loops of small and large bowel. Supine radiographs are
limited for detection of free intraperitoneal air. There is a relative
paucity of bowel gas in the upper right abdomen and displacement of bowel
loops inferiorly/to the left due to the marked enlargement of the liver.
IMPRESSION: No radiographic evidence of obstruction. Supine films are limited
for detection of free intraperitoneal air.
|
10000980-RR-58 | 10,000,980 | 29,654,838 | RR | 58 | 2188-01-03 13:41:00 | 2188-01-03 14:11:00 | INDICATION: Shortness of breath.
COMPARISONS: ___.
FINDINGS: PA and lateral views of the chest demonstrate low lung volumes.
Tiny bilateral pleural effusions are new since ___. No signs of
pneumonia or pulmonary vascular congestion. Heart is top normal in size
though this is stable. Aorta is markedly tortuous, unchanged. Aortic arch
calcifications are seen. There is no pneumothorax. No focal consolidation.
Partially imaged upper abdomen is unremarkable.
IMPRESSION: Tiny pleural effusions, new. Otherwise unremarkable.
|
10000980-RR-62 | 10,000,980 | 26,913,865 | RR | 62 | 2189-06-27 06:44:00 | 2189-06-27 07:49:00 | INDICATION: ___ female with shortness of breath.
COMPARISON: Chest radiograph from ___ and ___.
AP FRONTAL CHEST RADIOGRAPH: A triangular opacity in the right lung apex is
new from prior examination. There is also fullness of the right hilum which
is new. The remainder of the lungs are clear. Blunting of bilateral
costophrenic angles, right greater than left, may be secondary to small
effusions. The heart size is top normal.
IMPRESSION: Right upper lobe pneumonia or mass. However, given right hilar
fullness, a mass resulting in post-obstructive pneumonia is within the
differential. Recommend chest CT with intravenous contrast for further
assessment.
Dr. ___ communicated the above results to Dr. ___ at
8:55 am on ___ by telephone.
|
10000980-RR-64 | 10,000,980 | 26,913,865 | RR | 64 | 2189-06-29 10:46:00 | 2189-06-29 14:32:00 | INDICATION: History of coronary artery disease, hypertension, hyperlipidemia
who presents with shortness of breath, echo with severe mitral regurgitation,
preoperative exam, question opacity in the right upper lobe.
COMPARISONS: Chest radiograph from ___.
TECHNIQUE: MDCT axial imaging was obtained through the chest without the
administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
FINDINGS: The thyroid gland is unremarkable. There are no enlarged
supraclavicular or axillary lymph nodes. There are prominent mediastinal
nodes, for example, 9 mm node (2:16), subcarinal node measures 8 mm in short
axis. There are dense coronary artery calcifications as well as mild aortic
valvular calcifications. There is no pericardial effusion. The aorta is of
normal caliber. Pulmonary artery is enlarged, specifically the right main
branch measures 2.5 cm. The airways are patent to the subsegmental levels.
Large areas of confluent, relatively central ground-glass opacity, involve
contiguous, central right upper lobe and lower lobes. There are no nodules or
masses. Left upper lobe subpleural opacity (4:46) is noted. No pleural
effusion or pneumothorax. There is no large focal consolidation. There are
areas of scarring and paraseptal emphysema in the right middle lobe and
lingula.
This study is not tailored for evaluation of subdiaphragmatic structures, but
limited views demonstrate atherosclerotic disease at the origins of the celiac
artery and SMA.
There are no concerning bony lesions.
IMPRESSION:
1. Diffuse confluent ground-glass opacities predominantly in the right upper
lobe and right lower lobe most likely represent residual pulmonary edema,
localized to the right lung because of direction of jet in mitral
regurgitation.
2. Possible pulmonary hypertension.
3. Moderate coronary artery disease.
|
10000980-RR-65 | 10,000,980 | 26,913,865 | RR | 65 | 2189-06-30 09:39:00 | 2189-06-30 11:11:00 | HISTORY: ___ female with coronary artery disease.
COMPARISON: ___
TECHNIQUE: Evaluation of bilateral extracranial internal carotid arteries was
performed with grayscale, color and spectral Doppler ultrasound.
FINDINGS:
Mild to moderate heterogeneous plaque is noted at the bifurcation of both
carotid systems.
On the right side, the peak systolic/ diastolic velocities were 36/13 cm/sec
in the proximal ICA, 54/20 cm/sec in the mid ICA, as well as 45/19 cm/sec in
the distal right ICA. Additionally, peak systolic velocity in the right
common carotid artery was 83 cm/sec and peak systolic velocity in the right
external carotid artery was 66 cm/s. The right vertebral artery demonstrates
antegrade flow with a peak systolic/diastolilc velocity of 33 cm/sec. The
right ICA/CCA ratio was 0.65.
On the left side, the peak systolic/diastolic velocities were 52/12 cm/sec in
the proximal ICA, 49/16 cm/sec in the mid ICA, as well as 58/25 cm/sec in the
distal left ICA. Additionally, peak systolic velocity in the left common
carotid artery was 72 cm/sec and peak systolic velocity in the left external
carotid artery was 87 cm/s. The left vertebral artery demonstrates antegrade
flow with a peak systolic/diastolilc velocity of 48 cm/sec. The left ICA/CCA
ratio was 0.8.
IMPRESSION:
No evidence of hemodynamically significant internal carotid stenosis on either
side.
|
10000980-RR-71 | 10,000,980 | 25,242,409 | RR | 71 | 2191-04-03 15:42:00 | 2191-04-03 16:47:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with PVD, complaining of lower Left leg numbness and pain
since last night // DVT or Arterial clot of Left leg?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, femoral, and popliteal veins. There is echogenic thrombus within one
of the left posterior tibial veins and both of the right posterior tibial
veins, which appear occlusive. Peroneal veins are not well visualized
bilaterally.
There is normal respiratory variation in the common femoral veins bilaterally.
There is a 2.0 x 1.3 x 1.8 cm ___ cyst on the right.
IMPRESSION:
1. Deep venous thrombosis in the bilateral posterior tibial veins.
2. 2.0 x 1.3 x 1.8 cm right-sided ___ cyst.
|
10000980-RR-72 | 10,000,980 | 25,242,409 | RR | 72 | 2191-04-06 19:09:00 | 2191-04-06 21:00:00 | EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL LEFT
INDICATION: ___ year old woman with acute onset left arm swelling. ?DVT in
left upper extremity.
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 bilateral subclavian
veins.
The left internal jugular and axillary veins are patent and compressible with
transducer pressure.
The left brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
In the left antecubital fossa, there is a mixed echogenicity collection,
likely an evolving hematoma.
IMPRESSION:
1. No evidence of deep vein thrombosis in the left upper extremity.
2. Likely evolving hematoma in the left antecubital fossa.
|
10000980-RR-73 | 10,000,980 | 25,242,409 | RR | 73 | 2191-04-08 12:00:00 | 2191-04-08 18:43:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with bilateral DVT on heparin drip, had
multiple bleeding episodes on drip, ?new neurologic findings, ?bleed // ?bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced
Acquisition 9.0 s, 15.8 cm; CTDIvol = 47.1 mGy (Head) DLP = 741.9 mGy-cm.
Total DLP (Head) = 757 mGy-cm.
COMPARISON: Comparison is made with prior CT head from ___.
FINDINGS:
There is no evidence of acute infarction, hemorrhage,or edema. There is
evidence of multiple bilateral old lacunar infarcts of the basal ganglia.
Redemonstrated right cerebellar volume loss appears similar to prior imaging
from ___. There is no midline shift or mass effect. Gray-white
differentiation is preserved. The basilar cisterns are patent.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Ill-defined periventricular and subcortical white matter
hypodensities are visualized bilaterally, representing a sequela of chronic
ischemic small vessel disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute infarction, hemorrhage, fractures.
|
10000980-RR-75 | 10,000,980 | 25,911,675 | RR | 75 | 2191-05-23 05:40:00 | 2191-05-23 06:47:00 | EXAMINATION: Chest radiograph.
INDICATION: ___ with wheezing and dyspnea. Assess for pulmonary edema.
TECHNIQUE: Single portable upright frontal chest radiograph.
COMPARISON: ___ chest radiograph. ___ chest radiograph.
FINDINGS:
In comparison to study performed on of ___ there is new mild
pulmonary edema with small bilateral pleural effusions. Lung volumes have
decreased with crowding of vasculature. No pneumothorax. Severe cardiomegaly
is likely accentuated due to low lung volumes and patient positioning.
IMPRESSION:
1. New mild pulmonary edema with persistent small bilateral pleural effusions.
2. Severe cardiomegaly is likely accentuated due to low lung volumes and
patient positioning.
|
10000980-RR-76 | 10,000,980 | 25,911,675 | RR | 76 | 2191-05-23 12:32:00 | 2191-05-23 13:14:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with recent DVT, now with anemia while on
anticoagulation, wish to assess interval change in DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Bilateral lower extremity ultrasound dated ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. There is normal color flow and
compressibility of the peroneal veins bilaterally.
There is nonocclusive right deep vein thrombosis of one of the paired right
posterior tibial veins, with the degree of thrombus appearing less than the
prior study. There is nonocclusive left deep vein thrombosis, improved from
prior, within one of the paired left posterior tibial veins.
There is a complex right ___ cyst measuring 2.3 x 1.5 x 0.7 cm with internal
debris.
IMPRESSION:
1. Nonocclusive deep vein thrombosis of one of the paired posterior tibial
veins bilaterally. The extent of thrombus bilaterally has decreased. No new
deep venous thrombosis in either lower extremity.
2. Right complex ___ cyst.
|
10000980-RR-80 | 10,000,980 | 29,659,838 | RR | 80 | 2191-07-16 12:32:00 | 2191-07-16 15:04:00 | INDICATION: ___ with c/o SOB // ? PNA or CHF
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
There is mild pulmonary edema with superimposed region of more confluent
consolidation in the left upper lung. There are possible small bilateral
pleural effusions. Moderate cardiomegaly is again seen as well as tortuosity
of the descending thoracic aorta. No acute osseous abnormalities.
IMPRESSION:
Mild pulmonary edema with superimposed left upper lung consolidation,
potentially more confluent edema versus superimposed infection.
|
10001217-RR-10 | 10,001,217 | 24,597,018 | RR | 10 | 2157-11-18 21:55:00 | 2157-11-19 15:09:00 | STUDY: MRI OF THE HEAD WITH AND WITHOUT CONTRAST.
CLINICAL INDICATION: ___ woman with history of multiple sclerosis,
presenting with numbness, paresthesias, and weakness on the left, evaluate for
demyelinating lesion.
COMPARISON: No prior examinations are available.
TECHNIQUE: Pre-contrast axial and sagittal T1-weighted images were obtained,
axial FLAIR, axial T2, axial magnetic susceptibility, and axial
diffusion-weighted sequences. The T1-weighted images were repeated after the
administration of gadolinium contrast in axial T1, sagittal MP-RAGE and
multiplanar reconstructions were reviewed.
FINDINGS: There is a ring-enhancing lesion in the area of the right
precentral sulcus, involving mainly the right frontal region, measuring
approximately 21 x 16 x 14 mm in transverse dimension, this lesion is
associated with vasogenic edema and also restricted diffusion on the
diffusion-weighted sequence. The FLAIR and T2-weighted images demonstrate
multiple scattered foci of high signal intensity, distributed in the
subcortical white matter and apparently extending at callososeptal region,
likely consistent with lesions due to multiple sclerosis. No other areas with
abnormal enhancement are seen. The major vascular flow voids are present and
demonstrate normal distribution, the orbits are unremarkable, the paranasal
sinuses and the mastoid air cells are clear.
IMPRESSION:
1. Ring-enhancing lesion identified in the area of the right precentral
sulcus frontal lobe, with associated vasogenic edema, restricted diffusion,
possibly consistent with an abscess, other entities cannot be completely ruled
out such as metastases or primary brain neoplasm.
2. Multiple FLAIR and T2 hyperintense lesions in the subcortical white matter
along the callososeptal region, consistent with known multiple sclerosis
disease.
These findings were discussed with Dr. ___ by Dr. ___, via
phone call at 10:49 p.m. on ___, at the time of the discovery of
these findings.
|
10001217-RR-11 | 10,001,217 | 24,597,018 | RR | 11 | 2157-11-20 08:00:00 | 2157-11-21 09:55:00 | STUDY: MRI of the head with contrast.
CLINICAL INDICATION: ___ woman with right frontal enhancing lesion,
left hand clumsiness.
COMPARISON: Prior MRI of the brain dated ___.
TECHNIQUE: After the administration of gadolinium contrast, axial T1, coronal
MP-RAGE sequences were obtained, multiplanar reconstructions were provided.
Fiducial markers are in place.
FINDINGS: There is no significant change in the previously demonstrated
ring-enhancing lesion in the right precentral sulcus, with associated
vasogenic edema and effacement of the sulci. No new lesions are identified in
this short interval.
IMPRESSION: Unchanged ring-enhancing lesion identified in the area of the
right precentral sulcus of the frontal lobe, with associated vasogenic edema.
The differential diagnosis again includes possible abscess, other entities,
however, cannot be completely excluded.
Fiducial markers are in place. No new lesions are identified since the most
recent study.
|
10001217-RR-13 | 10,001,217 | 24,597,018 | RR | 13 | 2157-11-20 14:14:00 | 2157-11-20 18:10:00 | HISTORY: UNDERLYING MEDICAL CONDITION: ___ year old woman s/p R temporal crani
for likely abscess.
REASON FOR THIS EXAMINATION: Assess postoperative changes.
COMPARISON: Enhanced MRI studies of the head dated ___ and ___.
TECHNIQUE: Multidetector CT axial imaging of the head was obtained without
intravenous contrast.
DLP: 922 mGy-cm
CDTIvol: 54 mGy
FINDINGS:
The patient is status post right parietal craniotomy. A region of mixed
density in the region of the right precentral sulcus likely corresponds to the
ring-enhancing lesion seen on recent MR of ___. There is
surrounding hypodensity compatible with vasogenic edema. There is mild
effacement of the right parieto-occipital sulci but no shift of normally
midline structures. No focus of intracranial hemorrhage is detected. A small
focus of right pneumocephalus is expected in the postoperative setting.
Bifrontal subcortical white matter hypodensities correspond to areas of
increased FLAIR signal on the MR of ___ compatible with with
underlying multiple sclerosis. There is no evidence of acute major vascular
territorial infarct. A hyperdense focus in the right sphenoid sinus
inferiorly (3:5) likely represents an osteoma. The remainder of the paranasal
sinuses, middle ear cavities and mastoid air cells are well pneumatized and
aerated bilaterally.
IMPRESSION:
1. Status post right parietal craniotomy with mixed density lesion in the
right precentral sulcus and surrounding edema not significantly changed from
prior MR of ___ allowing for difference in technique.
2. No acute intracranial hemorrhage or major vascular territorial infarct.
3. Bifrontal subcortical white matter hypodensities compatible with
underlying multiple sclerosis.
|
10001217-RR-14 | 10,001,217 | 24,597,018 | RR | 14 | 2157-11-21 13:59:00 | 2157-11-21 17:09:00 | CT OF THE HEAD WITHOUT CONTRAST, ___
HISTORY: ___ female status post craniotomy with brain abscess,
new-onset lethargy and left leg weakness.
TECHNIQUE: Contiguous 5-mm axial MDCT sections were obtained from the skull
base to the vertex and viewed in brain and bone window on the workstation.
FINDINGS: Study is compared with the most recent NECT, obtained roughly 21
hours earlier.
The patient is status post recent right parietal vertex craniotomy and biopsy,
with expected post-surgical changes and very small amount of pneumocephalus at
the operative bed. Otherwise, the post-operative pneumocephalus has resolved.
There is no intra- or extra-axial hemorrhage. The geographic low-attenuation
region involving the right frontal lobe, including the region of the
precentral sulcus, is unchanged over the series of recent studies. Also
unchanged is the extensive multifocal low-attenuation in the white matter of
both cerebral hemispheres, corresponding to the known underlying multiple
sclerosis. Allowing for these background abnormalities, there is no new
sulcal effacement or loss of gray-white matter differentiation to specifically
suggests acute vascular territorial infarction. There is no further shift of
the normal midline structures.
IMPRESSION: Expected post-operative appearance, with otherwise short interval
change. Again demonstrated is the biopsied lesion at the right frontovertex,
reportedly felt to represent an abscess.
|
10001217-RR-15 | 10,001,217 | 24,597,018 | RR | 15 | 2157-11-22 12:22:00 | 2157-11-22 14:42:00 | HISTORY: Female with new right PICC.
TECHNIQUE: Single portable frontal chest radiograph.
COMPARISON: Chest radiograph ___.
FINDINGS:
Right PICC tip is in the proximal SVC with wire ending at the junction of the
right brachiocephalic and subclavian vein. Mild vascular engorgement with
mediastinal vein dilatation and top normal heart size. No pleural effusion or
pneumothorax. Mediastinal contour and hila are otherwise normal. No bony
abnormality.
IMPRESSION:
1. Right PICC wire ends at right brachiocephalic and subclavian vein junction
with the right PICC tip in proximal SVC.
2. Mild vascular congestion.
|
10001217-RR-16 | 10,001,217 | 24,597,018 | RR | 16 | 2157-11-23 18:14:00 | 2157-11-24 09:21:00 | AP CHEST, 6:28 P.M., ___
HISTORY: PICC line, withdrawn 7 cm.
IMPRESSION: AP chest compared to ___:
Right PICC line now ends in the axilla outside the chest. Lungs clear. Heart
size top normal. No pleural abnormality. Thoracic scoliosis is probably
exaggerated by patient position.
|
10001217-RR-18 | 10,001,217 | 24,597,018 | RR | 18 | 2157-11-25 16:35:00 | 2157-11-25 17:34:00 | INDICATION: Brain abscess status post right craniotomy. Follow up post-op
changes.
COMPARISON: Head CT ___, head MRI ___.
TECHNIQUE: Axial MDCT images were obtained through the brain without the
administration of IV contrast. Axial bone algorithm reformats in coronal and
sagittal images were also obtained.
CTDIvol: 65mGy
DLP:1130 mGy-cm
FINDINGS: The patient is status post right parietal vertex craniotomy and
biopsy with expected post-surgical changes. The previously seen small amount
of pneumocephalus has resolved. Area of hypodensity in the right frontal lobe
involving the central sulcus is unchanged. There is no intra or extra-axial
hemorrhage. Additional bilateral white matter hypodensities are consistent
with patient's known history of sclerosis. There is no shift of normally
midline structures. Ventricles and sulci are normal in size and configuration
for age. Basal cisterns remain patent.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
IMPRESSION: Stable post-operative changes with unchanged hypodensity in the
right frontal vertex.
NOTE ADDED AT ATTENDING REVIEW: Although I agree there is no evidence of
hemorrhage, the mass effect and edema associated with the right frontal lesion
have increased since ___.
|
10001217-RR-9 | 10,001,217 | 24,597,018 | RR | 9 | 2157-11-18 18:53:00 | 2157-11-18 19:29:00 | HISTORY: Multiple sclerosis, presenting with flaring fever.
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: None.
FINDINGS:
There is mild left base atelectasis seen on the frontal view without clear
correlate on the lateral view. No definite focal consolidation is seen.
There is no pleural effusion or pneumothorax. The aorta is slightly tortuous.
The cardiac silhouette is not enlarged. There is no overt pulmonary edema.
IMPRESSION:
Mild left base atelectasis. Otherwise, no acute cardiopulmonary process.
|
10001338-RR-40 | 10,001,338 | 27,987,619 | RR | 40 | 2142-02-27 05:44:00 | 2142-02-27 07:52:00 | HISTORY: ___ female with right lower quadrant pain and history of
diverticulitis status post sigmoid resection many years ago. Evaluation for
appendicitis.
COMPARISON: CT abdomen and pelvis from ___.
TECHNIQUE: ___ MDCT-acquired axial images from the lung bases to the pubic
symphysis were displayed with 5-mm slice thickness. No intravenous contrast
was administered as there is reported allergy. Oral contrast was given.
Axial images through the mid-pelvis were repeated to further characterize the
cecum after passage of oral contrast material distally.
CT ABDOMEN WITHOUT INTRAVENOUS CONTRAST: Scattered calcified granulomas in
the lung bases are stable. There is no new focal pulmonary nodule,
consolidation, or effusion. The cardiac apex is within normal limits.
Complete evaluation of the intra-abdominal viscera is limited by the
non-contrast technique. However, the liver appears homogeneous without focal
lesion. No intra- or extra-hepatic biliary ductal dilatation is identified.
The gallbladder, spleen, and pancreas appear within normal limits. The
adrenal glands are symmetric without focal nodule. The kidneys appear
homogeneous without focal lesion or hydronephrosis. The abdominal aorta is
non-aneurysmal throughout its visualized course. The second and third
portions of the duodenum are equivocally thickened which may be due to
underdistension. No small bowel obstruction is identified. The appendix is
well visualized and is normal in appearance. There is no free fluid or free
air.
CT PELVIS WITHOUT INTRAVENOUS CONTRAST: Initial images demonstrated a solid
mass like abnormality in the cecal tip measuring approximately 3 cm (2:51).
As this was potentially concerning for a cecal mass, rescanning of a limited
portion of pelvis was performed after passage of oral contrast, confirming the
finding and demonstrating a 3 cm mass with thickening of the adjacent cecal
wall (601:15). The adjacent appendix is normal and there is no pericecal
inflammatory change.
The remainder of the colon is normal without evidence of obstruction or
inflammation. The surgical anastomosis within the lower midline pelvis
appears unremarkable. There is no pelvic free fluid. The uterus and adnexa
appear within normal limits. The bladder is markedly distended but is
otherwise unremarkable. No pathologically enlarged pelvic or inguinal lymph
nodes are identified.
OSSEOUS STRUCTURES: No bone destructive lesion or acute fracture is
identified.
IMPRESSION:
1. Findings consistent with a 3 cm cecal mass and thickening of the cecal tip
concerning for neoplasm. Atypical infectious process causing this appearance
is felt less likely due to lack of inflammatory stranding. Recommend
colonoscopy for further evaluation.
2. Normal appendix, no signs of inflammation.
3. No small or large bowel obstruction.
4. Equivocal thickening of duodenum likely related to underdistention.
Dr. ___ communicated the updated findings and recommendations to
Dr. ___ (ED physician) at 9:53 am on ___ by telephone.
|
10001338-RR-41 | 10,001,338 | 27,987,619 | RR | 41 | 2142-02-27 07:48:00 | 2142-02-27 09:25:00 | INDICATION: ___ woman with right lower quadrant pain, evaluate
ovaries and flow.
COMPARISON: CT abdomen and pelvis without contrast from ___.
LMP: ___
FINDINGS: Transabdominally the uterus measures 8.6 x 4.6 x 5.4 cm, and is
slightly heterogeneous in appearance with no distinct fibroids seen.
Transvaginal exam was performed for better evaluation of the uterus and
adnexa. The endometrial stripe measures 5 mm. The left ovary measures 3.5 x
1.6 x 1.8 cm. The right ovary measures 2.9 x 1.4 x 1.7 cm. There is a small
echogenic focus within the right ovary measuring 5 x 4 x 4 mm, likely a small
hemorrhagic cyst. Both ovaries demonstrate normal arterial and venous
waveforms.
IMPRESSION:
1. No evidence of ovarian torsion.
2. Small right ovarian hemorrhagic cyst.
|
10001401-RR-16 | 10,001,401 | 26,840,593 | RR | 16 | 2131-06-19 19:27:00 | 2131-06-19 20:18:00 | INDICATION: ___ with recent surg, very distended abd // perf? SBO?
COMPARISON: Prior study from ___.
FINDINGS:
Multiple supine images of the abdomen and pelvis were provided. In this
patient with history of cystectomy and ileal conduit, a left ureteral stent is
in place which appears to extend to the ileal conduit. Clips in the right
upper quadrant noted. The stomach is gas-filled and there is significant
distention and mild dilation of small bowel loops likely jejunal raising
concern for small bowel obstruction. Gas is seen within the colon though the
colon is nondilated. Evaluation for free air limited without upright or
decubitus views.
IMPRESSION:
Findings concerning for small bowel obstruction.
|
10001401-RR-17 | 10,001,401 | 26,840,593 | RR | 17 | 2131-06-19 19:27:00 | 2131-06-19 20:20:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with abd distention // PNA? free air
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. Lung volumes are low with mild
bibasilar atelectasis. No convincing signs of pneumonia or edema. No large
effusion or pneumothorax is seen. The cardiomediastinal silhouette appears
normal. There is no free air below the right hemidiaphragm. Fluid level is
noted within the stomach.
IMPRESSION:
Mild bibasilar atelectasis. No signs of free air below the right
hemidiaphragm.
|
10001401-RR-18 | 10,001,401 | 26,840,593 | RR | 18 | 2131-06-19 21:40:00 | 2131-06-19 23:16:00 | EXAMINATION: CT abdomen pelvis
INDICATION: ___ with abd pain. hx of sbo
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
without IV contrast. Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 868 mGy-cm.
COMPARISON: CT ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
pleural or pericardial effusion.
ABDOMEN: Small amount of free air in the abdomen is likely related to prior
recent surgery. Moderate volume free fluid is noted throughout the abdomen
and extending into the pelvis.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
hypodensity in the right lobe of the liver (series 2, image 10) is likely a
cyst though not fully assessed. The gallbladder is surgically absent.
PANCREAS: There is atrophy of the pancreas.
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 has been recent cystectomy with ileal conduit. There is mild
to moderate right hydronephrosis without hydroureter. There is a left
ureteral stent in place which extends from the left renal pelvis through the
level of the stoma. There is residual fullness of the left renal collecting
system. No kidney stone. The neobladder appears intact.
GASTROINTESTINAL: There is a small hiatal hernia. Proximal small bowel loops
are distended and dilated up to 4.4 cm. There is no transition point to
suggest small bowel obstruction with gradual tapering extending into the lower
abdomen (Series 2, image 40). Distal loops of small bowel are decompressed.
Small bowel anastomosis in the right lower quadrant appears uncomplicated.
Overall appearance of small bowel loops is most compatible with an adynamic
ileus. Moderate volume of free fluid is noted. The colon contains fluid
levels though is nondilated. No evidence of colonic wall thickening.
Assessment for leak is limited without oral contrast.
PELVIS: The urinary bladder is surgically absent. Free fluid extends into the
pelvis. Clips along the left pelvic sidewall noted. The uterus is surgically
absent. The vaginal cuff is not visualized.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate 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. Status post cystectomy with neobladder formation. Left ureteral stent in
place. Persistent fullness of the left collecting system and mild right
hydronephrosis could reflect reflux.
2. Moderate volume free fluid in the abdomen pelvis is of unclear etiology.
Trace free air is likely related to recent post surgical status.
3. Dilated small bowel containing numerous air-fluid levels without abrupt
transition point is most suggestive of adynamic ileus.
4. Status post hysterectomy.
|
10001401-RR-19 | 10,001,401 | 26,840,593 | RR | 19 | 2131-06-19 23:47:00 | 2131-06-20 06:21:00 | EXAMINATION: Chest radiograph.
INDICATION: History: ___ with SBO s/p NG*** WARNING *** Multiple patients
with same last name! // NG tube placement
TECHNIQUE: Single AP view
COMPARISON: Chest radiograph from the same date.
FINDINGS:
The right costophrenic angle is not imaged. Otherwise, the lungs are clear.
The heart size is upper limits of normal. Enteric tube courses below the
level of the diaphragm. There is no pneumothorax.
IMPRESSION:
An enteric tube courses below the level of the diaphragm.
|
10001401-RR-20 | 10,001,401 | 26,840,593 | RR | 20 | 2131-06-20 12:03:00 | 2131-06-20 13:41:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC for TPN // 40 cm R basilic DL
PICC - ___ ___ Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
Right PICC tip is in thelower SVC. Cardiac size is normal. Bibasilar
opacities are consistent with atelectasis, increasing from prior study. .
There is no pneumothorax or pleural effusion.
|
10001401-RR-21 | 10,001,401 | 26,840,593 | RR | 21 | 2131-06-20 13:31:00 | 2131-06-20 17:18:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with NGT re-placed // Assess for NGT
placement, interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph ___ 12:12
FINDINGS:
NG tube is coiled in the stomach. Right PICC in lower SVC is unchanged in
position. Cardiac size is normal. Mild bibasilar opacities consistent with
atelectasis, unchanged compared to chest radiograph performed earlier in the
same day. There is no pneumothorax or pleural effusion.
IMPRESSION:
NG tube in expected position with tip coiled in the stomach. No other
interval change since chest radiograph performed earlier on the same day.
|
10001401-RR-22 | 10,001,401 | 26,840,593 | RR | 22 | 2131-06-23 10:58:00 | 2131-06-23 15:42:00 | EXAMINATION: CT abdomen/pelvis with oral and IV contrast
INDICATION: ___ year old woman who status post cystectomy with ileal loop on
___, readmitted ___ with ileus, also has gram neg bacteremia. No bowel
function yet.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 890 mGy-cm.
COMPARISON: ___ noncontrast CT abdomen/pelvis
FINDINGS:
LOWER CHEST: There is mild bibasilar atelectasis and few, scattered
pneumatoceles. There is no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: There is an approximately 1.1 x 0.8 cm hypoattenuating lesion
in the right hepatic lobe which is unchanged and consistent with a cyst or
biliary hamartoma (05:13). The liver otherwise demonstrates homogenous
attenuation throughout. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Multiple hypoattenuating lesions in the right kidney are too small to
completely characterize, but statistically likely simple cysts. Moderate
right hydronephrosis is unchanged. A a left ureteral stent extends from the
renal pelvis through the stoma.
GASTROINTESTINAL: There is a small hiatal hernia. An enteric tube
terminates in the gastric fundus. Loops of small bowel have decreased in
caliber with a single pelvic loop dilated to approximately 3.9 cm (5:75).
There is overall mild small bowel wall thickening. A small bowel anastomosis
in the right lower quadrant appears unchanged. There is a large communicating,
intra-abdominal, interloop, simple fluid collection with rim enhancement
spanning up to 18.7 x 11.9 x 15.4 cm (5:52, 7:18), increased in size compared
to 4 days prior. There is no evidence of extra luminal oral contrast.
Diverticulosis of the sigmoid colon is noted, without evidence of wall
thickening and fat stranding.
PELVIS: The urinary bladder is surgically absent. There is a small amount of
free pelvic fluid.
REPRODUCTIVE ORGANS: The patient appears status-post hysterectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There mild lumbar spine degenerate changes and grade 1 anterolisthesis of L4
on L5.
SOFT TISSUES: There is a significant amount of soft tissue stranding
throughout the lateral abdominal soft tissues raising the possibility of
anasarca. Fibrotic changes in the midline anterior abdominal wall suggest
prior laparotomy. There is a small fat containing umbilical hernia.
IMPRESSION:
1. A large interloop simple fluid collection appears increased in size
compared to 4 days prior, now measuring up to 18.7 x 11.9 x 15.4 cm with
peripheral rim enhancement raising the possibility of infection.
2. Improving ileus.
3. Persistent moderate right hydronephrosis, which is the non stented ureter.
Right-sided ileal conduit and left ureteral stent. No left collecting system
obstruction.
4. Diverticulosis.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:01 ___, approximately
120 minutes after discovery of the findings.
|
10001401-RR-23 | 10,001,401 | 26,840,593 | RR | 23 | 2131-06-24 13:12:00 | 2131-06-24 17:41:00 | INDICATION: ___ year old woman who is s/p radical cystectomy with ileal loop
urinary diversion on ___, readmitted ileus ___ but repeat CT shows increased
free abdominal fluid. Patient also with blood culture growing citrobacter //
Requesting drain placement for intra-abdominal collection. Please send fluid
for microbiology and Creatinine (concerned for urine leak)
COMPARISON: CT abdomen/pelvis from ___.
PROCEDURE: CT-guided drainage of a lower abdominal collection.
OPERATORS: Dr. ___ resident and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the CT
findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 650 cc of initially purulent, then clear yellow fluid was
aspirated with a sample sent for microbiology and chemistry including
creatinie evaluation. The catheter was secured by a StatLock. The catheter was
attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence: 1) Spiral Acquisition 10.3 s, 54.7 cm; CTDIvol =
11.9 mGy (Body) DLP = 652.7 mGy-cm. 2) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 3) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 4) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 5) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 6) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 7) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 8) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 9) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 10) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 11) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 12) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 13) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 14) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 15) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 16) Free Acquisition 0.5 s, 1.2 cm; CTDIvol
= 3.5 mGy (Body) DLP = 4.2 mGy-cm. 17) Spiral Acquisition 10.3 s, 54.7 cm;
CTDIvol = 11.9 mGy (Body) DLP = 652.7 mGy-cm. Total DLP (Body) = 1,368 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 40
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Lower abdominal fluid collection.
2. Appropriate post-procedure position of an ___ pigtail catheter within the
left aspect of the lower abdominal fluid collection.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
|
10001401-RR-24 | 10,001,401 | 26,840,593 | RR | 24 | 2131-06-27 08:59:00 | 2131-06-27 12:11:00 | INDICATION: ___ year old woman with NGT for ileus s/p Cystectomy with ileal
conduit and s/p pelvic abscess drain. // Assess for interval change.
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: ___ abdominal radiograph
FINDINGS:
There is interval resolution of the degree of gastric small bowel loop
distention. Air is visualized throughout the colon and within the rectum.
There are no abnormally dilated loops of large or small bowel. Supine
assessment limits detection for free air; there is no gross pneumoperitoneum.
The tip of the NG tube is within the stomach and the side port is at the GE
junction. The left ureteral stent, extending from the left kidney to the
ileal conduit, remains in situ. The tip of a left-sided percutaneous drain
projects over the left upper pelvis. Left-sided pelvic and right upper
quadrant surgical clips remain in situ.
Stable degenerative changes are noted in the lumbar spine and bilateral hip
joints.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
1. Resolution of small bowel obstruction when compared to ___
abdominal radiograph.
2. Interval placement of a left-sided percutaneous drain catheter; the tip
projects over the left upper pelvis.
|
10001401-RR-25 | 10,001,401 | 26,840,593 | RR | 25 | 2131-06-30 09:45:00 | 2131-06-30 11:30:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman s/p cystectomy, bilateral ___ edema, some R
ankle/calf pain // r/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, right femoral and popliteal veins. There is an occlusive
thrombus within the duplicated mid and distal left femoral veins with no
appreciable flow and no compressibility. The proximal left femoral vein
appears to be patent. Normal color flow and compressibility are demonstrated
in the posterior tibial and peroneal veins.
There is slow flow in the common femoral veins bilaterally, though with normal
variation with Valsalva maneuver.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Acute deep vein thrombosis of the duplicated mid and distal left femoral
veins. Patent proximal left femoral vein, popliteal and calf veins.
2. No evidence of deep venous thrombosis in the rightlower extremity veins.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:25 AM, 2 minutes after discovery
of the findings.
|
10001401-RR-26 | 10,001,401 | 24,818,636 | RR | 26 | 2131-07-30 13:51:00 | 2131-07-30 14:06:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with SOB // r/o acute process
COMPARISON: ___
FINDINGS:
AP upright and lateral views of the chest provided.
Mild basal atelectasis noted. Hilar congestion noted without frank edema. No
large effusion or pneumothorax. Heart size is normal. Mediastinal contour is
unchanged. Bony structures are intact. No free air below the right
hemidiaphragm.
IMPRESSION:
Hilar congestion without frank edema. No convincing signs of pneumonia.
|
10001401-RR-27 | 10,001,401 | 24,818,636 | RR | 27 | 2131-07-30 19:03:00 | 2131-07-30 19:56:00 | EXAMINATION: CTA chest
INDICATION: History: ___ status post robotic radical cystectomy on ___
with post op LLE DVT has been on lovenox, now presenting with new oxygen
requirement and worsening dyspnea on exertion x 1 day // eval for pulmonary
embolism
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.5 s, 0.5 cm; CTDIvol = 4.6 mGy (Body) DLP = 2.3
mGy-cm.
2) Spiral Acquisition 3.8 s, 29.6 cm; CTDIvol = 9.5 mGy (Body) DLP = 280.3
mGy-cm.
Total DLP (Body) = 283 mGy-cm.
COMPARISON: CT chest ___, PET-CT ___
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
Moderate atherosclerotic calcifications are noted throughout the thoracic
aorta.
There is extensive thrombus seen extending from the right main pulmonary
artery into the right upper, middle, and lower lobes. Additionally, there are
smaller thrombi seen in the segmental branches of the left upper and lower
lobes. The main and right pulmonary arteries, however, are normal in caliber,
and there is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
Rim calcified 9 mm thyroid nodule is unchanged (3:2). Aortic and mitral
valvular calicifications R presents. Heart size is normal.
There is no evidence of pericardial effusion. There is no pleural effusion.
Several pulmonary nodules are noted, as seen previously, with the largest
measuring up to 1 cm in the right middle lobe (series 2: Image 59), all of
which appear unchanged from prior exam. The airways are patent to the
subsegmental level.
Limited images of the upper abdomen are remarkable for a a 1.1 cm hypodense
structure in the liver dome, likely day hepatic cyst. There is a small hiatal
hernia.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
Degenerative changes are noted in the thoracic spine. 2 soft tissue nodules
are identified within the left breast measuring 11 and 7 mm, similar to the
previous CT.
IMPRESSION:
1. Extensive pulmonary embolism with thrombus seen extending from the right
main pulmonary artery into the segmental and subsegmental right upper, middle,
and lower lobe pulmonary arteries. No right heart strain identified.
2. Additionally, there are smaller pulmonary emboli seen in the segmental and
subsegmental branches of the left upper and lower lobes.
3. Several pulmonary nodules are noted, as noted previously, with the largest
appearing spiculated and measuring up to 1 cm in the right middle lobe,
suspicious for malignancy on the previous PET-CT.
4. Re- demonstration of 2 left breast nodules for which correlation with
mammography and ultrasound is suggested.
RECOMMENDATION(S): Left breast ultrasound and mammography for the 2 breasts
nodules, as previously recommended.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 7:55 ___, 2 minutes after discovery
of the findings.
|
10001401-RR-28 | 10,001,401 | 24,818,636 | RR | 28 | 2131-07-31 08:44:00 | 2131-07-31 11:33:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with recent LLE DVT now presents with PE //
evaluate for progression of DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Lower extremity ultrasound on ___
FINDINGS:
Compared with ___, a previously seen occlusive thrombus
involving the mid and distal left femoral veins now also involves the proximal
femoral vein, which demonstrates no appreciable flow and no compressibility.
The deep femoral vein at the bifurcation is noncompressible, however
demonstrates some residual flow, consistent with nonocclusive thrombus. There
is normal compressibility, flow, and augmentation of the left common femoral
and popliteal veins. The left calf veins were not visualized due to an
overlying dressing.
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. The right calf veins were not
visualized due to overlying dressing.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
1. Interval progression of deep vein thrombosis in the left lower extremity,
with occlusive thrombus involving the entire femoral vein, previously only
involving the mid and distal femoral vein. There is additional nonocclusive
thrombus in the deep femoral vein. The left common femoral and popliteal
veins are patent.
2. The bilateral calf veins were not visualized due to an overlying dressing.
Otherwise no evidence of deep venous thrombosis in the right lower extremity.
|
10001401-RR-29 | 10,001,401 | 24,818,636 | RR | 29 | 2131-08-02 11:28:00 | 2131-08-02 12:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new PE. This morning with dyspnea and mild
leukocytosis. // Evidence of pulmonary edema or PNA Evidence of
pulmonary edema or PNA
IMPRESSION:
Compared to chest radiographs ___ through ___.
Heart size top-normal. Lungs grossly clear. No pleural abnormality or
evidence of central lymph node enlargement.
|
10001667-RR-20 | 10,001,667 | 22,672,901 | RR | 20 | 2173-08-22 15:07:00 | 2173-08-22 16:00:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD.
INDICATION: ___ year old woman with afib on Eliquis p/w an episode of
dysarthria and confusion, found to have L M2 stenosis// eval for stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Prior CTA dated ___.
FINDINGS:
There is no evidence of intracranial hemorrhage, edema, masses, mass effect,
midline shift or acute large territory infarction. No diffusion abnormalities
are detected. The ventricles and sulci are prominent, suggestive of
involutional changes. Subcortical and periventricular areas of T2/FLAIR
high-signal intensity are nonspecific and may reflect changes due to chronic
small vessel disease. The major vascular flow voids are present and
demonstrate normal distribution. There is partial empty sella. The paranasal
sinuses demonstrate mild mucosal thickening in the posterior ethmoidal air
cells, the mastoid air cells are essentially clear. The orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality. Specifically, no large territory
infarction or hemorrhage.
2. Scattered foci of T2/high-signal intensity in the subcortical and
periventricular white matter are nonspecific and may reflect changes due to
chronic small vessel disease.
|
10001667-RR-21 | 10,001,667 | 22,672,901 | RR | 21 | 2173-08-23 07:48:00 | 2173-08-23 12:04:00 | EXAMINATION: CT ANGIOGRAPHY HEAD AND NECK
INDICATION: ___ year old woman with AFib on eliquis, CHF, HLD, HTN who
presents with acute onset dysarthria.
Outside read: CTA demonstrating left M2 branch attenuation concerning for
partial thrombosis or significant stenosis, left vertebral artery occlusion.
// second opinion for CTA head and neck from ___. Images are in
OMR/PACS
TECHNIQUE: CT of the head was acquired. Following contrast administration and
departmental protocol CT angiography of the head and neck was obtained.
Curved and 3D reformats were not included with the submitted outside exam.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: None
FINDINGS:
CT head:
There is no evidence of large territory infarction, edema, hemorrhage or mass
effect. There are mild periventricular white matter hypodensities,
nonspecific, most likely sequela of chronic small vessel disease. The
ventricles and sulci are enlarged, likely related to involutional change.
There is no gross evidence of acute fracture. Partially opacified right
sphenoid sinus (201:13). The left sphenoid sinus, ethmoid, frontal and
maxillary sinuses are clear. The middle air cavities are unremarkable.
Patient is status post lens replacement on the left.
CTA neck:
Traditional 3 vessel takeoff at the level of the aortic arch. Mild
calcification in the aortic arch and carotid bifurcations, right greater than
left. No measurable stenosis of the carotid arteries bilaterally. Right
dominant vertebral artery. The left vertebral artery is patent at origin.
CTA head:
CT angiography of the head shows left vertebral artery occlusion, specifically
the V4 segment, of indeterminate chronicity, likely chronic as there is no
evidence of ischemia on correlated MRI. The hypoplastic left vertebral artery
re-presents at the foramina of segment C2. Additionally, there is a small
attenuated left M2 branch, without evidence of focal occlusion. There is mild
hypoattenuation of the left posterior inferior cerebellar artery. No aneurysm
greater than 3 mm in size is identified. There is moderate calcification at
the carotid siphons.
Other:
No lymphadenopathy by radiographic criteria. The visualized lung fields and
thyroid lobes are within normal limits. Mild degenerative changes of the
visualized spine with grade 1 anterolisthesis of C4 on C5 (403:55) with mild
facet arthropathy. Mild loss of the T1 and T4 vertebral body height appears
chronic in nature. Temporomandibular joint narrowing bilaterally.
IMPRESSION:
1. Segmental left vertebral artery occlusion of indeterminate chronicity. No
evidence of ischemia.
2. Somewhat small caliber attenuated left M2 inferior branch, without
evidence of focal occlusion.
3. No acute intracranial abnormality on noncontrast CT head.
|
10001860-RR-19 | 10,001,860 | 21,441,082 | RR | 19 | 2188-03-27 00:45:00 | 2188-03-27 04:43:00 | HISTORY: Injury after fall. Evaluate chest.
COMPARISON: None.
FINDINGS: A single frontal view of the chest was performed. There is no
pleural effusion, pneumothorax or focal airspace consolidation. The cardiac
silhouette is moderately enlarged. The mediastinal contours and hilar
structures are unremarkable. There is no displaced rib fracture.
IMPRESSION: No acute cardiopulmonary process. Moderately enlarged cardiac
silhouette which may reflect a cardiomyopathy or pericardial effusion.
|
10001860-RR-20 | 10,001,860 | 21,441,082 | RR | 20 | 2188-03-27 00:44:00 | 2188-03-27 04:50:00 | HISTORY: Injuries after fall, evaluate.
COMPARISON: None.
FINDINGS: Frontal, lateral and oblique views of the hands were performed.
There is no fracture or dislocation. There is likely an old fracture of the
right ___ metacarpal. The bones are demineralized. The soft tissues are
unremarkable. A dorsal plate and screws seen in the distal right radius are
in satisfactory position. Degenerative changes at the ___ MCP joints
bilaterally are noted.
IMPRESSION: No acute fracture.
|
10001860-RR-21 | 10,001,860 | 21,441,082 | RR | 21 | 2188-03-27 01:56:00 | 2188-03-27 04:55:00 | HISTORY: Fall, evaluate for fracture.
COMPARISON: None.
FINDINGS: A frontal view of the pelvis was performed. There is no fracture.
The hip joints are symmetric. The sacroiliac joints, pubic symphysis and
sacrum are unremarkable. Injection granulomas are noted.
IMPRESSION: No fracture. If concern for a fracture persists, cross-sectional
imaging would be of utility.
|
10001860-RR-22 | 10,001,860 | 21,441,082 | RR | 22 | 2188-03-27 01:57:00 | 2188-03-27 02:46:00 | HISTORY: Fall and C3 fracture question vertebral artery injury
TECHNIQUE: Contiguous axial images were obtained through the neck during
infusion of 70 cc of Omnipaque intravenous contrast. Images were processed on
a separate workstation.
COMPARISON: None
FINDINGS:
There is no evidence of vertebral artery injury. A C2 horizontal fracture is
identified. Within the limits of this study performed for vascular
evaluation, there is no evidence of the C3 fracture. The C2 fracture enters
the transverse foramen and is in intimate relationship to the left vertebral
artery.
The origins of the great vessels from the aortic arch demonstrates
atheromatous changes, but no evidence of stenosis. The common carotid
arteries appear normal. Is mild atherosclerotic plaque at the internal
carotid artery origins bilaterally, but no evidence of stenosis by NASCET
criteria
IMPRESSION:
Horizontal fracture of C2 extending to the left transverse foramen. No
evidence of vertebral artery injury.
|
10001884-RR-116 | 10,001,884 | 26,170,293 | RR | 116 | 2130-04-15 17:07:00 | 2130-04-15 17:15:00 | INDICATION: ___ with Hx COPD and CAD with c/o CP and SOB // ? PNA
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are hyperinflated but clear without confluent consolidation or
effusion. The cardiomediastinal silhouette is within normal limits. No acute
osseous abnormalities identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10001884-RR-125 | 10,001,884 | 29,678,536 | RR | 125 | 2130-10-08 17:26:00 | 2130-10-08 18:52:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with persisting wheeze and sob w hypoxia // concern
pna
TECHNIQUE: Single frontal view of the chest
COMPARISON: None
FINDINGS:
Relative increase in opacity over the lung bases bilaterally is felt due to
overlying soft tissue rather than consolidation or pleural effusion. Lateral
view may be helpful for confirmation. No large pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable. No overt pulmonary edema is seen
IMPRESSION:
Relative increase in opacity over the lung bases bilaterally felt due to
overlying soft tissue rather than consolidation. Lateral view may be helpful
for confirmation.
|
10001884-RR-126 | 10,001,884 | 29,678,536 | RR | 126 | 2130-10-09 15:50:00 | 2130-10-10 09:53:00 | INDICATION: ___ year old woman with COPD, afib, worsening dyspnea // eval for
PNA
COMPARISON: The comparison is made with prior studies including ___.
IMPRESSION:
There is hyperinflation. There is no pneumothorax, effusion, consolidation or
CHF. There is probable osteopenia.
|
10001884-RR-134 | 10,001,884 | 28,664,981 | RR | 134 | 2130-11-28 15:44:00 | 2130-11-28 16:36:00 | EXAMINATION: Chest radiograph
INDICATION: ___ y.o. woman, multiple medical problems most notable for HTN,
CAD, Afib, COPD on home O2 presenting with dyspnea.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and chest CT from ___.
FINDINGS:
PA and lateral views the chest provided. Biapical pleural parenchymal
scarring noted. No focal consolidation concerning for pneumonia. No effusion
or pneumothorax. No signs of congestion or edema. Cardiomediastinal
silhouette is stable with an unfolded thoracic aorta and top-normal heart
size. Bony structures are intact.
IMPRESSION:
No acute findings. Top-normal heart size.
|
10001884-RR-135 | 10,001,884 | 28,664,981 | RR | 135 | 2130-11-29 18:21:00 | 2130-11-29 19:17:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with COPD being considered for long-term
therapy with azithromycin. // Evidence of MAC?
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 38.4 cm; CTDIvol = 10.1 mGy (Body) DLP = 387.8
mGy-cm.
2) Spiral Acquisition 4.2 s, 33.0 cm; CTDIvol = 7.4 mGy (Body) DLP = 242.6
mGy-cm.
3) Spiral Acquisition 4.6 s, 35.9 cm; CTDIvol = 7.3 mGy (Body) DLP = 262.4
mGy-cm.
Total DLP (Body) = 893 mGy-cm.
COMPARISON: ___ CT chest without contrast.
FINDINGS:
There are no pathologically enlarged axillary, mediastinal, or hilar lymph
nodes. Heart size is normal. There is no pericardial effusion. Extensive
coronary artery calcifications are present. Aortic valve and thoracic aorta
are also calcified. The thoracic aorta is normal in caliber. The main and
right pulmonary artery are enlarged measuring up to 3.0 cm.
There is minimal airway wall thickening and mild mucous plugging, most
prominent in the right lower lobe. The airways are patent to subsegmental
level. There is no bronchiectasis. There is moderate to severe centrilobular
and paraseptal emphysema with upper lobe predominance. Biapical pleural
parenchymal scarring is unchanged. A 4 mm anterior right middle lobe nodule,
if not slightly smaller, is not larger. There is a new irregular nodule in
the left lower lobe (4:189). The nodule is difficult to measure exactly as it
is superimposed on adjacent pulmonary artery branches, but could measure as
large as 6 x 8 mm. Several scattered calcified granulomas are also noted.
There is no consolidation or evidence of infection. No pleural effusion.
Limited view of the upper abdomen is notable for an 8 mm hypodensity in
hepatic segment VII that is unchanged but remains too small to characterize.
There is fusiform aneurysmal dilatation of a heavily calcified abdominal aorta
measuring up to 3.7 cm in maximum axial dimension, previously 3.2 cm. There
is a small hiatal hernia.
Osseous structures of the thorax do not show suspicious lytic or sclerotic
lesions.
IMPRESSION:
1. Moderate upper lobe predominant centrilobular and paraseptal emphysema.
2. New left lower lobe nodule, potentially measuring as large as 6 x 8 mm,
warrants close follow-up. Stable to slightly smaller 4 mm right middle lobe
nodule.
3. Severe coronary artery calcifications. Aortic valve calcifications.
4. Enlargement of the main and right pulmonary arteries is suggestive of
chronic pulmonary arterial hypertension.
5. Fusiform aneurysmal dilatation of the abdominal aorta measuring up to 3.7
cm has progressed compared to prior examination.
RECOMMENDATION(S): Follow-up CT in ___ months as per ___ society
guidelines for evaluation of new left lower lobe pulmonary nodule.
|
10001884-RR-137 | 10,001,884 | 27,507,515 | RR | 137 | 2130-12-23 15:14:00 | 2130-12-23 16:43:00 | EXAMINATION: Chest radiograph.
INDICATION: History: ___ with COPD, acute dyspnea // ?cpd
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
The cardiac silhouette is normal in size. The hilar and mediastinal contours
are stable. There is mild bibasilar atelectasis. There is no focal
consolidation, pleural effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10002013-RR-104 | 10,002,013 | 25,442,395 | RR | 104 | 2166-04-06 16:53:00 | 2166-04-06 17:10:00 | INDICATION: History: ___ with L great toe ulcer and spreading erythema// eval
osteomyelitis
TECHNIQUE: Left foot, three views
COMPARISON: Left foot radiographs ___
FINDINGS:
Soft tissue swelling is seen about the great toe without soft tissue gas. As
seen previously, ulceration is seen along the medial aspect of the distal
great toe with erosion along the medial base of the great toe distal phalanx,
perhaps minimally progressed in the interval. No additional areas of new
cortical destruction or periosteal new bone formation. No radiopaque foreign
body. Mild degenerative changes are seen involving the first MTP joint. No
worrisome lytic or sclerotic osseous abnormalities. Large plantar calcaneal
spur is present.No acute fracture or dislocation.
IMPRESSION:
Re-demonstration of ulceration along the medial distal aspect of the great toe
and erosion along the medial base of the distal phalanx of the great toe, the
latter of which is perhaps slightly progressed in the interval. Findings again
remain concerning for osteomyelitis and MRI with contrast could be obtained
for further assessment.
|
10002013-RR-106 | 10,002,013 | 25,442,395 | RR | 106 | 2166-04-07 11:08:00 | 2166-04-07 11:35:00 | EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old woman with left hallux osteomyelitis// Post-op eval
TECHNIQUE: Three views left foot obtained at the patient's bedside
COMPARISON: Left foot radiographs ___
FINDINGS:
Compared to the prior study there has been interval surgery at the base of the
first toe distal phalanx with a small amount of subcutaneous air seen and a
bony defect along the medial aspect of the base of the distal phalanx. A
small calcification is seen in the surgical bed, presumed reflect small bone
fragment related to the prior osteophytes. Mild degenerative changes at the
first metatarsophalangeal joint. Incidental note is made of a bipartite
tibial sesamoid at the first metatarsal. Moderate-sized plantar calcaneal
spur. Moderate vascular calcification.
IMPRESSION:
Postoperative changes as described
|
10002013-RR-107 | 10,002,013 | 25,442,395 | RR | 107 | 2166-04-09 08:22:00 | 2166-04-09 10:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with DMII, HTN who is POD1 after left hallux
bone amputation who was found to be afebrile to 100.5 on evening of ___//
concern for possible pneumonia post surgery
IMPRESSION:
In comparison with the study of ___, the there is no interval change or
evidence of acute cardiopulmonary disease. Cardiomediastinal silhouette is
stable and there is no vascular congestion. Blunting of the left costophrenic
angle is unchanged.
Specifically, no evidence of acute focal pneumonia.
|
10002013-RR-108 | 10,002,013 | 25,442,395 | RR | 108 | 2166-04-10 15:25:00 | 2166-04-10 19:21:00 | INDICATION: ___ year old woman with poorly controlled diabetes, peripheral
arterial disease, admitted for diabetic foot ulcer complicated by
osteomyelitis, requiring hallux amputation.// Assess need for vascular
consult.
TECHNIQUE: Non-invasive evaluation of the arterial system in the
lower extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
COMPARISON: Exam dated ___
FINDINGS:
On the right side, triphasic Doppler waveforms are seen in the right femoral,
popliteal, and dorsalis pedis arteries. Absent waveform in the posterior
tibial artery.
The right ABI was 1.6, artifactually elevated due to noncompressible vessels.
On the left side, triphasic Doppler waveforms are seen at the left femoral and
popliteal arteries. Monophasic waveforms are seen in the posterior tibial and
dorsalis pedis arteries.
The left ABI could not be calculated
Pulse volume recordings showed decreased amplitudes at the level the right
calf, ankle and metatarsal.
IMPRESSION:
Significant bilateral tibial arterial insufficiency to the lower extremities
at rest, more significant on the right side.
|
10002013-RR-109 | 10,002,013 | 25,442,395 | RR | 109 | 2166-04-12 10:37:00 | 2166-04-12 14:00:00 | EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old woman s/p left hallux amputation// Post op eval
TECHNIQUE: Three views of the left foot.
COMPARISON: Multiple radiographs most recently dated ___.
FINDINGS:
Patient is status post left first phalangeal amputation at the MTP. The
remaining first metatarsal is unremarkable in appearance other than mild
degenerative changes. There is residual mild soft tissue swelling of the
stump and trace amount of subcutaneous tissue emphysema, likely postsurgical
changes. There is a large plantar calcaneal osteophyte. The overall
mineralization is within normal limits. Vascular calcifications are noted.
IMPRESSION:
Status post amputation of the first ray at the MTP joint
|
10002013-RR-110 | 10,002,013 | 25,442,395 | RR | 110 | 2166-04-13 11:47:00 | 2166-04-13 14:09:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with osteomyelitis of left hallux s/p
amputation POD#1. Worsening cough with new presentation of rales at bases
b/l.// New pulmonary process? New pulmonary process?
IMPRESSION:
Comparison to ___. No relevant change is noted. Alignment of the
sternal wires is unremarkable. Mild elongation of the descending aorta.
Borderline size of the heart. No pleural effusions. No pneumonia, no
pulmonary edema.
|
10002013-RR-111 | 10,002,013 | 25,442,395 | RR | 111 | 2166-04-16 19:54:00 | 2166-04-16 23:41:00 | EXAMINATION: MR foot with contrast
INDICATION: ___ year old woman with osteomyelitis ___ diabetic foot ulcer s/p
left hallux amputation// Abscess or other fluid collection?
TECHNIQUE: T1 and T2 weighted images of the left foot was obtained with and
without contrast in axial and coronal planes.
COMPARISON: Radiograph from ___
FINDINGS:
Bones: Patient is status post first hallux amputation at the MTP.
The head of the first metatarsal demonstrate high signal with a 4 mm focus of
low T1 signal, which demonstrated subtle enhancement (5:12, 6:12, 9:12).
There is mild bony edema pattern at the tibial sesamoid bone. The remaining
bone marrow signal is within normal limits.
Soft tissues: Susceptibility is noted at the skin of the stump, consistent
with surgical history. There are at least 2 sinus tracts, 1 distally near the
edge of the stump (801:12) and medial to the head of the first metatarsal
(801:16). At the more proximal sinus tract, high signal is seen tracking
along the medial aspect of the head of the first metatarsal, which may
represent trace edema (04:16).
In addition, the soft tissue stump demonstrate extensive edema (04:12, 14)
with peripheral enhancement and no significant enhancement of the fat (801:12,
14), which extends to the fat pad under the second, third and fourth middle
phalanges. The nonenhancing portion measures at least 2.2 x 6.2 cm. However,
there is no discrete fluid collection.
The plantar soft tissues demonstrate diffuse edema. There is dorsal swelling
and edema, without a discrete fluid collection. Skin thickening is noted
throughout the foot.
Evaluation of the extensor and flexor tendons are limited on the current
study. However, no discrete tear is identified.
Edema in first sesamoid.
IMPRESSION:
1. Nonenhancing stump soft tissue and the plantar fat pad under the middle
phalanges, concerning for devitalized tissue. No evidence of drainable
abscess.
2. 4 mm focus of low T1 signal with edema at the most distal cortex of the
first metatarsal. This is nonspecific as there was no comparison study and
focus of osteomyelitis cannot be excluded.
3. 2 sinus tracts medial to the head of the first metatarsal, status post
amputation at the first MTP with postsurgical changes.
4. Dorsal swelling and diffuse skin edema.
NOTIFICATION: The findings were discussed with ___. by ___
___, M.D. on the telephone on ___ at 2:26 pm, 30 minutes after discovery
of the findings.
|
10002013-RR-112 | 10,002,013 | 25,442,395 | RR | 112 | 2166-04-17 18:45:00 | 2166-04-17 20:26:00 | EXAMINATION: Portable upright chest radiograph
INDICATION: ___ year old woman with osteomyelitis of diabetic foot ulcer s/p
left hallux amputation// PICC placement Contact name: ___:
___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
A new right PICC is in place with its tip projecting over the junction of the
superior vena cava and right atrium. Post CABG changes are again appreciated.
The heart size is normal. There is no focal consolidation, pleural effusion
or pneumothorax.
IMPRESSION:
New right PICC with tip projecting over the junction of the superior vena cava
and right atrium. No pneumothorax. Clear lungs.
|
10002013-RR-46 | 10,002,013 | 21,975,601 | RR | 46 | 2159-12-15 00:47:00 | 2159-12-15 09:29:00 | CHEST RADIOGRAPHS
INDICATION: Questionable pneumothorax.
COMPARISON: ___.
Normal chest radiograph, no evidence of pneumothorax.
|
10002013-RR-70 | 10,002,013 | 24,848,509 | RR | 70 | 2162-07-08 16:22:00 | 2162-07-08 19:49:00 | EXAMINATION: CT abdomen and pelvis without and with intravenous contrast. CT
urography protocol.
INDICATION: ___ year old woman with right flank pain and UTI, hematuria //
PLEASE DO STONE PROTOCOL. ? Nephrolithiasis / perinephric findings.
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis prior
to and following the intravenous administration of contrast.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was not administered.
DOSE: DLP: 1360.38 mGy-cm (abdomen and pelvis.
IV Contrast: 60 mL Omnipaque
COMPARISON: CT chest from ___.
FINDINGS:
LOWER CHEST:
There are two left basilar partly pleural based nodular densities each
measuring approximately 8 x 8 mm (06:10) with an additional 6 mm nodule
inferiorly (06:11). These were not present on remote chest CT examinations,
and not clearly evident on immediate prior chest CT although atelectasis and
effusions limited assessment at that time. There is no pleural effusion.
Heart size is within normal limits.
ABDOMEN:
Noncontrast imaging of the abdomen and pelvis demonstrates a punctate
nonobstructing calculus in the right collecting system (02:31). There is no
left renal calculus. There is no evidence of ureteral or urinary bladder
calculus. There is symmetric renal enhancement and excretion of intravenous
contrast. Subcentimeter cortically based hypodensity in the left interpolar
region (06:30) is too small to accurately characterize but likely represents
renal cyst. There is no evidence of collecting system filling defect. There
are segments of the mid to distal ureters are not well opacified, possibly
secondary to peristalsis, however there is no evidence of inflammatory change
or mass about the ureters. The adrenal glands are unremarkable.
Low hepatic attenuation on noncontrast imaging is consistent with hepatic
steatosis. There is no evidence of focal hepatic mass. There is no
intrahepatic or extrahepatic biliary ductal dilatation. There are numerous
gallstones within the gallbladder without evidence of acute cholecystitis.
The spleen is not enlarged. There is no pancreatic ductal dilatation or
evidence of pancreatic mass.
There are no dilated loops of bowel. There is no evidence of bowel wall
thickening. There is no intraperitoneal free air or free fluid.
There are no enlarged inguinal, iliac chain, retrocrural, or retroperitoneal
lymph nodes. Abdominal aorta has a normal course and caliber with moderate
atherosclerotic calcification. There is atherosclerotic calcification of the
superior mesenteric artery origin. There is no suspicious osseous lesion.
IMPRESSION:
1. Tiny nonobstructing right collecting system calculus.
2. Hepatic steatosis.
3. 3 nodular pulmonary densities in the left basilar region measuring up to 8
x 8 mm. These findings may may represent areas of rounded atelectasis, however
short-term followup with nonemergent CT chest is recommended.
|
10002131-RR-18 | 10,002,131 | 24,065,018 | RR | 18 | 2128-03-17 11:44:00 | 2128-03-17 12:22:00 | EXAMINATION: PELVIS (AP ONLY)
INDICATION: Evaluate for fracture in a patient with right hip pain.
TECHNIQUE: AP view of the pelvis.
COMPARISON: None.
FINDINGS:
There is no acute fracture or dislocation. No focal lytic or sclerotic
osseous lesion is seen. There is no radiopaque foreign body. Vascular
calcifications are noted. The visualized bowel gas pattern is nonobstructive.
IMPRESSION:
No acute fracture or dislocation.
|
10002131-RR-19 | 10,002,131 | 24,065,018 | RR | 19 | 2128-03-17 11:44:00 | 2128-03-17 12:23:00 | INDICATION: Evaluate for pneumonia in a patient with progressive decline.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___ and ___.
FINDINGS:
Frontal and lateral chest radiographs demonstrate bilateral pleural effusions,
which make evaluation of the cardiomediastinal silhouette difficulty. These
effusions are large on the right and small on the left. There is no definite
focal consolidation, although evaluation is limited secondary to these
effusions. No pneumothorax is appreciated. The visualized upper abdomen is
unremarkable.
IMPRESSION:
Bilateral pleural effusions, large on the right and small on the left. No
definite focal consolidation identified, although evaluation is limited
secondary to these effusions.
|
10002131-RR-20 | 10,002,131 | 24,065,018 | RR | 20 | 2128-03-17 11:45:00 | 2128-03-17 12:31:00 | EXAMINATION: UNILAT LOWER EXT VEINS BILATERAL
INDICATION: ___ with Left ___ edema, evaluate for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility and flow of the right common femoral, femoral,
and popliteal veins. Evaluation of the right calf veins was limited.
There is deep vein thrombosis involving the left common femoral vein extending
to the popliteal vein. The left calf veins were not clearly identified and
possibly also occluded.
There is normal respiratory variation in the right common femoral vein.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Deep vein thrombosis of the left common femoral vein extending into at
least the popliteal vein. Left calf veins were not clearly identified,
possibly also occluded.
2. No right DVT.
|
10002167-RR-25 | 10,002,167 | 24,023,396 | RR | 25 | 2166-05-15 01:32:00 | 2166-05-15 07:17:00 | INDICATION: History: ___ with lap band p/w n/v // assess for obstructive
pattern, position of lap band
TECHNIQUE: Supine and upright views of the abdomen and pelvis are obtained.
COMPARISON: Upper GI study from ___
FINDINGS:
The gastric lap band is again identified in the left upper quadrant. Its
position is grossly unchanged since prior study from ___. As before, it
is oriented relatively horizontal, with a phi angle of approximately 82
degrees. Air is noted in the expected location of the gastric fundus. Bowel
gas pattern is overall nonobstructive, with gas seen in scattered nondilated
loops of colon. Surgical clips project over the right upper quadrant. No
intraperitoneal free air or pneumatosis is detected. Osseous structures are
grossly unremarkable.
IMPRESSION:
Gastric lap band appears to be in unchanged position. As before, it is
somewhat horizontally positioned. If there is concern for prolapse, an upper
GI study may be obtained.
Nonobstructive bowel gas pattern.
|
10002221-RR-155 | 10,002,221 | 20,237,862 | RR | 155 | 2204-07-03 12:22:00 | 2204-07-03 13:43:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with RLE pain// dvt?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility and color flow of the right common femoral,
femoral, and popliteal veins. The right peroneal and posterior tibial veins
were not visualized.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Right calf veins not visualized. Otherwise, no evidence of deep venous
thrombosis in the right lower extremity veins.
|
10002221-RR-156 | 10,002,221 | 20,237,862 | RR | 156 | 2204-07-03 20:26:00 | 2204-07-03 21:19:00 | EXAMINATION: Q62R
INDICATION: ___ year old woman with severe right lower extremity pain, worse
in the right lateral thigh and right posterior calf.// Evaluate for evidence
of vascular occlusion, muscle infarction, or other acute process
TECHNIQUE: Contiguous axial images obtained through the right calf after the
administration of intravenous contrast. Coronal sagittal reformats were
reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.9 s, 54.6 cm; CTDIvol = 11.9 mGy (Body) DLP = 648.1
mGy-cm.
Total DLP (Body) = 648 mGy-cm.
COMPARISON: None.
FINDINGS:
Popliteal artery is patent. The peroneal and posterior tibial arteries are
patent to the level of the foot. Anterior tibial artery is patent proximally
though diminutive in the distal calf and not seen in its entirety to the
ankle.
Despite being passed arterial phase, venous structures are not opacified at
this level. The posterior tibial and peroneal veins are visualized.
Numerous superficial varicosities are also identified.
No obvious muscular abnormality or area altered enhancement. No peripherally
enhancing fluid collection. Osseous structures are unremarkable. Mild
degenerative changes noted at the knee. No fracture.
IMPRESSION:
Unremarkable contrast enhanced CT of the right calf with a two vessel runoff
to the foot.
The veins of the lower extremity are not opacified therefore cannot be
assessed for patency. Consider repeat ultrasound to more fully evaluate.
No focal collection or obvious muscular abnormality identified by CT.
|
10002221-RR-157 | 10,002,221 | 20,237,862 | RR | 157 | 2204-07-04 15:11:00 | 2204-07-04 19:00:00 | INDICATION: ___ year old woman with history of breast cancer, presenting with
severe pain on the right greater trochanter, likely bursitis though need to
r/o fracture// r/o fracture, lytic lesions
COMPARISON: CT scan of the abdomen and pelvis from ___
IMPRESSION:
No acute fractures or dislocations are seen. There are mild degenerative
changes of the hip joints with acetabular spurring bilaterally. There are
severe degenerative changes of the lower lumbar spine with loss of disc height
and prominent spurs.
|
10002221-RR-158 | 10,002,221 | 20,237,862 | RR | 158 | 2204-07-04 15:12:00 | 2204-07-04 18:51:00 | INDICATION: ___ year old woman with history of breast cancer, presenting with
severe pain on the right greater trochanter, likely bursitis though need to
r/o fracture// r/o fracture, lytic lesions
COMPARISON: CT scan from ___ and radiographs from ___
IMPRESSION:
Two views of the right lower leg demonstrate no signs for acute fractures or
dislocations. No focal lytic or blastic lesions are seen. There are varicose
veins within the medial soft tissues. Ankle mortise is grossly preserved.
There are mild degenerative changes of the right knee with minimal spurring
within the patellofemoral and medial compartments.
|
10002221-RR-159 | 10,002,221 | 20,237,862 | RR | 159 | 2204-07-04 14:28:00 | 2204-07-04 15:22:00 | EXAMINATION: US DRAIN/INJ MAJOR JOINT/BURSA W US GUID
INDICATION: ___ year old woman with severe right sided trochanteric bursitis
leading to inability to ambulate// please aspirate and perform
lidocaine/steroid bursa injection
COMPARISON: CT lower extremity ___
TECHNIQUE: Following discussion of the risks, benefits, and alternatives to
the procedure informed written patient consent was obtained.
The patient was brought to the ultrasound suite and initial limited ultrasound
was performed.
A pre-procedure timeout confirmed three patient identifiers.
Under ultrasound guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
5 cc 1% Lidocaine was used to achieve local anesthesia. Under direct
ultrasound visualization, a 20gauge needle was advanced into the right greater
trochanteric bursa. Subsequently, a solution of 40 cc of Kenalog and 0.25%
bupivacaine was injected under ultrasound guidance.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in stable
condition. There were no immediate complications.
The patient did experience subjective pain relief following the procedure.
FINDINGS:
There is a small amount of fluid within the right greater trochanteric bursa,
prior to injection, with at least one small dystrophic calcification within
the bursal space. The superficial soft tissues are otherwise grossly
unremarkable.
IMPRESSION:
1.. Uneventful ultrasound-guided injection of long-acting anesthetic and
steroid into theright greater trochanteric bursa.
2. Prior injection, small amount of fluid in the right greater trochanteric
bursa and dystrophic calcification within the bursal space. Findings raise
suspicion for chronic trochanteric bursitis.
|
10002348-RR-10 | 10,002,348 | 22,725,460 | RR | 10 | 2112-12-01 09:42:00 | 2112-12-01 12:43:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: History: ___ with new cerebellar mass// mass?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence: 1) Spiral Acquisition 4.9 s, 65.2 cm; CTDIvol =
5.6 mGy (Body) DLP = 366.4 mGy-cm. 2) Stationary Acquisition 0.6 s, 0.5 cm;
CTDIvol = 3.0 mGy (Body) DLP = 1.5 mGy-cm. 3) Stationary Acquisition 4.8 s,
0.5 cm; CTDIvol = 24.4 mGy (Body) DLP = 12.2 mGy-cm. Total DLP (Body) = 380
mGy-cm.
COMPARISON: There are no comparisons studies listed.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: There a few subcentimeter hypoattenuating lesions with the
liver which are too small to characterize. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Suture is seen in
the RLQ, possibly from prior appendectomy. The colon and rectum are otherwise
within normal limits.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Fibroid uterus. No adnexal masses.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: L1 vertebral body measures 85 Hounsfield units, suggestive for
osteopenia given the patient's age and gender. There is no evidence of
worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No suspicious mass within the abdomen or pelvis.
2. Osteopenia
3. Same-day chest CT is reported separately.
|
10002348-RR-11 | 10,002,348 | 22,725,460 | RR | 11 | 2112-12-01 09:42:00 | 2112-12-01 13:42:00 | EXAMINATION: Chest CT with contrast
INDICATION: ___ with new cerebellar mass. Right for thoracic metastases.
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
IV Contrast: 130 mL Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 65.2 cm; CTDIvol = 5.6 mGy (Body) DLP = 366.4
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 24.4 mGy (Body) DLP =
12.2 mGy-cm.
Total DLP (Body) = 380 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: None.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is unremarkable without
nodules warranting further evaluation. No supraclavicular or axillary
lymphadenopathy. Largest axillary node on the right measures 7 mm (02:20).
No suspicious lesions in the chest wall.
UPPER ABDOMEN: Please refer to separate report for abdominopelvic CT from the
same day for detailed abdominopelvic findings.
MEDIASTINUM: No mass or lymphadenopathy. Several lower left paratracheal
nodes are not pathologically enlarged, measuring up 8 mm (302:78). Subcarinal
node is in the upper limits of normal measuring approximately 10 mm (302:106).
HILA: No hilar mass or lymphadenopathy.
HEART and PERICARDIUM: Heart is normal size. The aorta is tortuous and mildly
calcified. Moderate calcifications are seen in coronary arteries, mild in the
aortic valve. No pericardial effusion.
PLEURA: No pleural effusion or pneumothorax.
LUNG:
1. PARENCHYMA: Extensive upper lobe dominant centrilobular emphysema. Left
paramedian spiculated mass abutting the aortic arch measures 2.2 x 1.7 cm
(302: 47). Also noted is a right upper lobe nodule 1.3 cm with associated
peribronchial thickening and bronchiectasis (302:25).
2. AIRWAYS: Traction bronchiectasis most notable in the right upper lobe.
Bilateral scattered endobronchial mucous plugging, more extensive at the
segmental level in the lower lobes.
3. VESSELS: Pulmonary artery is normal caliber. No central pulmonary emboli.
CHEST CAGE: No suspicious osseous lesions or acute fracture.
IMPRESSION:
1. Left paramedian spiculated mass measuring up to 2.2 cm. Amenable to
endobronchial tissue sampling.
2. Irregular right upper lobe nodule, also suspicious for malignancy.
3. Extensive centrilobular emphysema with bronchiectasis and scattered mucous
plugging.
|
10002348-RR-13 | 10,002,348 | 22,725,460 | RR | 13 | 2112-12-04 16:17:00 | 2112-12-05 09:34:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with new cerebellar brain mass. Fiducial
planning intraoperative guidance.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: Head CT with and without contrast dated ___.
Head CT without contrast dated ___.
CT torso from ___.
FINDINGS:
There are postsurgical changes of left frontal craniotomy with susceptibility
artifacts from the left supraclinoid ICA aneurysm clip.
There is a large, lobulated, heterogenous enhancing mass in the left
cerebellar hemisphere which demonstrates central intrinsic T1 hyperintensity
with central susceptibility artifact, compatible with blood products and/or
calcification. The periphery of the mass demonstrates slow diffusion,
indicating hypercellularity. The mass measures approximately 3.1 x 3.1 x 2.8
cm (AP, transverse, SI) on images 14:42 and 100:144. There is significant
surrounding vasogenic edema, resulting in partial effacement of the left
quadrigeminal cistern and mild effacement of bilateral prepontine cistern.
The fourth ventricle is displaced to the right and partially effaced.
Cerebral aqueduct remains patent.
The lateral ventricles, the third ventricle, and the bilateral temporal horns
are slightly enlarged, disproportionate to the size of the cerebral sulci.
There is nonspecific T2/FLAIR hyperintensity in the periventricular white
matter along the lateral ventricles and along the cerebral aqueduct, which may
reflect transependymal CSF flow versus chronic small vessel ischemic changes.
There also T2/FLAIR hyperintense foci in the deep and subcortical white matter
of the cerebral hemispheres, nonspecific but likely sequela of chronic small
vessel ischemic changes in this age group.
There is mild cortical volume loss in the left superior frontal gyrus, which
may be secondary to prior infarction.
No additional enhancing intracranial lesions are identified. No evidence for
an acute infarction. Major arterial flow voids are grossly preserved. Dural
venous sinuses are patent on postcontrast MP RAGE images.
Status post left cataract surgery. Small amount of fluid in the left
maxillary sinus.
IMPRESSION:
1. 3.1 cm heterogenously enhancing mass with blood products plus/minus
calcifications. In the setting of the pulmonary lesions suspicious for
malignancy seen on the ___ CT, this may represent a metastasis.
2. Extensive left cerebellar edema with partial effacement of the left
quadrigeminal plate cistern, as well as displacement and partial effacement of
the fourth ventricle.
3. At least mild hydrocephalus involving the lateral and third ventricles with
periventricular T2/FLAIR hyperintensity which may represent transependymal CSF
flow, versus sequela of chronic small vessel ischemic disease.
4. Mild cortical volume loss in the left superior frontal gyrus, which may be
secondary to prior infarction.
5. Status post left craniotomy and left supraclinoid ICA aneurysm clipping.
|
10002348-RR-14 | 10,002,348 | 22,725,460 | RR | 14 | 2112-12-05 01:24:00 | 2112-12-05 02:30:00 | EXAMINATION: ?LOCATION OF LOST MICRO ___
INDICATION: Suboccipital craniotomy, missing micropattie
TECHNIQUE: Single radiograph of missing device (micropattie), single lateral
view of the skull/bony calvarium
COMPARISON: CT from ___ MRI from ___ skull radiograph ___.
FINDINGS:
The missing device has a radiopaque rectangular marker, approximately 6 mm in
long axis.
The lateral view of the skull shows site of the suboccipital craniotomy with
appearance of three fixation plates.
There are two additional calvarial fixation plates seen in the frontal region
as well as an aneurysm clip, unchanged. External fixation hardware is also
present.
There is no corresponding radiopacity with appearance of the radiopaque marker
identified. It is noted that depending on the degree of the radiopacity of
the micropattie marker, overlapping structures of the bony calvarium or the
external fixation device may obscure visualization of the marker.
These finding called to the PA in the OR at ___, 2:00 AM.
IMPRESSION:
No radiopaque micropattie marker is identified. It is notable that
overlapping structures of the bony calvarium or the external fixation device
may obscure visualization of the marker; if needed additional projections or
CT would be needed to fully exclude a more subtly radiopaque marker, as
clinically necessitated.
|
10002348-RR-9 | 10,002,348 | 22,725,460 | RR | 9 | 2112-11-30 18:32:00 | 2112-11-30 19:57:00 | EXAMINATION: CT HEAD W/ AND W/O CONTRAST
INDICATION: ___ with new cerebellar mass, headache, disequilibrium// eval per
nsg
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 1,605 mGy-cm.
COMPARISON: CT head from outside institution ___ at 12:42.
FINDINGS:
There is a 3.3 x 3.2 x 2.8 cm left cerebellar hemispheric mass which
demonstrates central calcification, peripheral enhancement and areas of
central hypoenhancement/necrosis. There is extensive surrounding vasogenic
edema with rightward shift of the cerebellar hemisphere by approximately 5 mm
and mass effect on the fourth ventricle which is only slightly patent. The
ambient cisterns and prepontine cisterns are also effaced.
The ventricular size and configuration is similar to prior study, however does
appear dilated disproportionally when compared to the sulcal space, which
appear diffusely effaced considering patient's age. These findings suggest
obstructive hydrocephalus. Addition, there is transependymal flow along the
frontal horns of the lateral ventricles.
There is no evidence of acute large territorial infarction or acute
intracranial hemorrhage. Small areas of encephalomalacia noted in the left
frontal lobe as well as scattered subcortical white matter hypodensities,
likely sequela of chronic small vessel disease. In the left frontal lobe.
There is evidence of a left frontal craniotomy with a left paraclinoid
metallic aneurysm coil. Otherwise, no acute osseous abnormalities seen.
There is a small air-fluid level in left maxillary sinus. Otherwise, the
remaining partially imaged paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The orbits demonstrate no acute abnormalities.
IMPRESSION:
1. 3.2 x 3.3 cm left cerebellar partially calcified, partially enhancing,
partially necrotic mass, more likely a metastatic lesion than a primary
intracranial cerebellar neoplasm.
2. There is resultant mass effect on the fourth ventricle which is nearly
occluded resulting in upstream obstructive hydrocephalus.
|
10002428-RR-100 | 10,002,428 | 23,473,524 | RR | 100 | 2156-05-19 02:33:00 | 2156-05-19 08:38:00 | HISTORY: Pseudomonas with intubation.
FINDINGS: In comparison with the study of ___, there is little change in the
monitoring and support devices. Substantial bilateral pleural effusions, more
prominent on the right with bibasilar atelectasis. Unusual configuration to
the collection of opacification at the left base raises the possibility of
some loculated fluid. There is again evidence of increased pulmonary venous
pressure.
Overlapping structures somewhat obscure visualization of the left upper zone
and simulate the appearance of cavitary process. This area should be closely
checked on subsequent radiographs.
|
10002428-RR-101 | 10,002,428 | 23,473,524 | RR | 101 | 2156-05-20 02:11:00 | 2156-05-20 08:51:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Intubated patient, hypoxic respiratory failure.
Comparison is made with prior study, ___.
Cardiac size is normal. Lines and tubes are in the standard position. Large
right and moderate left pleural effusions are grossly unchanged allowing the
differences in positioning of the patient. Right upper lobe opacity has
improved consistent with improving atelectasis. Pleural effusions are
associated with atelectasis, larger on the right side. There is mild vascular
congestion.
|
10002428-RR-104 | 10,002,428 | 28,676,446 | RR | 104 | 2157-07-16 02:51:00 | 2157-07-16 07:33:00 | INDICATION: ___ female with left hip fractures. Preop.
COMPARISONS: Chest radiograph from ___.
FINDINGS: Single AP supine chest radiograph was provided. The lungs are
clear without focal consolidation, pleural effusion or pneumothorax. The
cardiomediastinal silhouette is normal.
IMPRESSION: No acute cardiopulmonary process.
|
10002428-RR-105 | 10,002,428 | 28,676,446 | RR | 105 | 2157-07-16 04:15:00 | 2157-07-16 07:36:00 | INDICATION: Femoral neck fracture.
COMPARISONS: None.
FINDINGS: Single view of the left hip was provided. There is an impacted
subcapital fracture of the femoral neck imaged on one view. No other
fractures are identified. The visualized soft tissues are unremarkable.
There is non-obstructive bowel gas pattern.
IMPRESSION: Impacted left subcapital femoral neck fracture.
|
10002428-RR-106 | 10,002,428 | 28,676,446 | RR | 106 | 2157-07-16 12:23:00 | 2157-07-16 16:16:00 | LEFT HIP
REASON FOR EXAM: ORIF.
54 fluoroscopic views of the left hip were submitted for review taken in the
OR without the presence of a radiologist for documentation of sequential steps
of left hip ORIF .
Please refer to the OR note for complete description of the procedure.
|
10002428-RR-58 | 10,002,428 | 28,662,225 | RR | 58 | 2156-04-12 12:37:00 | 2156-04-12 13:14:00 | INDICATION: Fever, tachycardia and history of bronchiectasis, evaluate for
pneumonia.
COMPARISON: ___ and CT chest, ___.
FINDINGS: Frontal and lateral views of the chest were performed. The lung
volumes are low which results in vascular crowding. However, despite this,
there appear to be bibasilar, right greater than left, nodular opacities and
interstitial thickening. There is likely a small right pleural effusion.
Heart size is normal. There is no pneumothorax. There are no suspicious
osseous lesions. Multiple dilated loops of small bowel are present.
IMPRESSION:
1. Bibasilar opacities would be consistent with pneumonia and/or aspiration
in the right clinical setting. Likely some component of pulmonary edema given
the interstitial thickening.
2. Multiple dilated loops of small bowel may represent ileus or obstruction.
Dedicated abdominal radiograph may be performed for better characterization.
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10002428-RR-59 | 10,002,428 | 28,662,225 | RR | 59 | 2156-04-12 12:30:00 | 2156-04-12 14:33:00 | INDICATION: Fever, diarrhea with tenderness to palpation, evaluate for
colitis.
COMPARISONS: CT chest of ___.
TECHNIQUE: MDCT axial images were obtained from the dome the liver to the
pubic symphysis after the administration of IV contrast. Coronal and sagittal
reformations were provided and reviewed.
ABDOMEN: Increased ground-glass opacities seen at the right middle and lower
lobes are compatible with acute infection or aspiration. In addition, septal
thickening is seen and may be a result of pulmonary edema. Calcifications are
seen within the mitral annulus. There are no nodules or masses seen. A small
right pleural effusion is identified. There is no pneumothorax. The heart
size is normal. There is no pericardial effusion.
The liver contour is unremarkable. There are no focal liver lesions
identified. The gallbladder is distended and there is intrahepatic biliary
ductal dilatation. There is no evidence of gallbladder wall edema and the
common bile duct is prominent but appropriate for age. The spleen and
pancreas are normal. The pancreatic duct is seen but not pathalogically
enlarged. The adrenal glands are not definitively identified. The kidneys
enhance symmetrically and excrete contrast without hydronephrosis or
nephrolithiasis. There is a moderate-to-severe amount of atherosclerosis
without aneurysmal dilatation involving the descending and thoracic aorta.
The small bowel is air filled, but otherwise unremarkable. There is no free
air or free fluid. No retroperitoneal or mesenteric lymphadenopathy is
identified.
PELVIS: There is diffuse colonic mucosal hyperenhancement with areas of bowel
wall edema most markedly seen in the descending and sigmoid colon. A Foley
catheter is present within a decompressed bladder. There are multiple
calcified fibroids seen within the uterus. The ovaries are not definitively
identified; however, no adnexal masses are seen. There is no pelvic or
inguinal lymphadenopathy.
BONES: There are no suspicious osseous lesions.
IMPRESSION:
1. Diffuse colonic mucosal hyperenhancement and bowel wall thickening is
consistent with pancolitis.
2. Ground-glass opacities within the right middle and right lower lobes
compatible with acute infection and/or aspiration. Possible mild pulmonary
edema.
3. Intrahepatic biliary ductal dilatation and prominence of the common bile
and pancreatic ducts could be better characterized with non-emergent MRCP.
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10002428-RR-60 | 10,002,428 | 28,662,225 | RR | 60 | 2156-04-12 15:36:00 | 2156-04-12 22:15:00 | STUDY: Chest radiograph.
INDICATION: ?pneumonia, now hypoxic. Please evaluate for pulmonary edema.
TECHNIQUE: Portable AP radiograph was obtained.
COMPARISON: ___ at 12:37, current radiograph time 15:37.
REPORT: There is extensive bilateral air space consolidation, more pronounced
in the right side. There are increased lung markings, but this probably
reflects chronic COPD changes. There is no definitive evidence of fluid
overload or pulmonary edema.
CONCLUSION: Bilateral pneumonia. Background likely COPD.
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10002428-RR-61 | 10,002,428 | 28,662,225 | RR | 61 | 2156-04-13 02:59:00 | 2156-04-13 09:45:00 | HISTORY: Sepsis with mitral regurgitation and possible worsening pulmonary
edema.
FINDINGS: In comparison with the study of ___, the bibasilar opacification
has somewhat decreased bilaterally. The time course suggests that much of
this appearance may have reflected improved pulmonary edema. Nevertheless,
there is continued engorgement of pulmonary vessels more prominent on the
right, consistent with some persistent elevation of pulmonary venous pressure.
Hazy opacification on the right suggests pleural fluid.
In the appropriate clinical setting, supervening pneumonia would certainly
have to be considered. Loss of the medial aspect of the left hemidiaphragm
suggests some volume loss in the retrocardiac portion of the lower lobe.
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10002428-RR-62 | 10,002,428 | 28,662,225 | RR | 62 | 2156-04-13 09:08:00 | 2156-04-13 16:47:00 | ABDOMEN
HISTORY: Diarrhea and colitis. Increasing abdominal distention.
COMPARISON: Abdominal CT ___.
There is no subdiaphragmatic free air. There are multiple distended loops of
bowel, most likely representing both colon and small bowel. Findings are most
consistent with an ileus. Air-fluid levels are seen on the left lateral
decubitus view.
IMPRESSION: Dilated colon and small bowel consistent with ileus.
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10002428-RR-63 | 10,002,428 | 28,662,225 | RR | 63 | 2156-04-14 10:10:00 | 2156-04-14 13:07:00 | INDICATION: ___ woman admitted to the ICU for pneumonia and colitis.
COMPARISONS: ___ to ___. CT ___
FINDINGS: Single portable AP chest radiograph was obtained. There is minimal
improvement in teh right lower and middle lobe pneumonia that was better
deliniated on recent CT. Pulmonary edema hs also improved. Blunting of the
left costophrenic angle is unchanged. The cardiac and mediastinal contours
are unremarkable. No pneumothorax is present.
IMPRESSION: Mild improvement in right middle and lower lobe pnuemonia.
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10002428-RR-64 | 10,002,428 | 28,662,225 | RR | 64 | 2156-04-14 01:42:00 | 2156-04-14 17:22:00 | STUDY: KUB.
INDICATION: History of pancolitis with ileus. Evaluate for possible toxic
megacolon.
TECHNIQUE: Single view was obtained.
COMPARISON: ___.
REPORT:
There is significant dilatation of both large and small bowel noted, with
findings suggestive of a degree of thumbprinting particularly on the right
side. The maximum bowel distention appears to be about 6.5 cm. It represents
a minimal increase over the prior study and probably little interval change
from prior CT.
CONCLUSION:
Findings consistent with ongoing colitis. No good evidence of free air.
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10002428-RR-65 | 10,002,428 | 28,662,225 | RR | 65 | 2156-04-15 01:39:00 | 2156-04-15 10:01:00 | INDICATION: ___ woman with pneumonia, severe mitral regurgitation and
sepsis.
COMPARISONS: ___ to ___.
FINDINGS: A single portable semi-erect chest radiograph is obtained. There
is no significant change in the middle and lower lobe pneumonia, better
appreciated on recent CT. There is no increased pulmonary edema, new
consolidation, or pneumothorax. Layering left pleural effusion has gotten
slightly bigger. Cardiac and mediastinal contours are unchanged.
IMPRESSION: No significant change in right middle and lower lobe pneumonia.
Small increase in left pleural effusion.
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10002428-RR-66 | 10,002,428 | 28,662,225 | RR | 66 | 2156-04-15 01:39:00 | 2156-04-15 11:22:00 | INDICATION: ___ female with C. diff and concern for toxic megacolon.
COMPARISON: ___.
TECHNIQUE: Single frontal radiograph of the abdomen and pelvis was obtained
portably with the patient in a supine position.
FINDINGS: There is slightly increased bowel dilation. Areas of thumbprinting
are still seen, consistent with known colitis. There is no indirect evidence
for large free intraperitoneal air.
IMPRESSION: Persistent, slightly increased bowel dilation.
Discussed with Dr. ___ by Dr. ___ by phone at 1:40 p.m. on ___.
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10002428-RR-67 | 10,002,428 | 28,662,225 | RR | 67 | 2156-04-14 15:02:00 | 2156-04-14 16:28:00 | INDICATION: ___ woman with need for central access, status post PICC
line placement.
FINDINGS: A left-sided PICC line terminates in the low SVC. There is no
change in the right basilar pneumonia and small left effusion.
IMPRESSION: Left PICC line in the low SVC.
Findings were discussed with the IV RN at 15:15 on ___.
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