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10022037-RR-137

RR

2169-02-04 15:55:00

2169-02-04 17:46:00

EXAM: CHEST, FRONTAL AND LATERAL VIEWS. CLINICAL INFORMATION: One month of weakness. ___. FINDINGS: Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. IMPRESSION: No acute cardiopulmonary process.

10022037-RR-138

RR

2169-02-04 18:58:00

2169-02-04 21:09:00

INDICATION: History of liver transplant, and one month of left upper quadrant and left lower quadrant pain. Evaluate for obstruction, diverticulitis or splenic infarct. COMPARISONS: Abdominal ultrasound from ___. MRI of the abdomen from ___. CT of the abdomen and pelvis from ___. TECHNIQUE: Contiguous axial MDCT images were obtained through the abdomen and pelvis after the administration of IV contrast only. Sagittal and coronal reformatted images were obtained and reviewed. TOTAL DLP: 366.95 mGy-cm. FINDINGS: LUNG BASES: The bases of the lungs are clear. There is no discrete nodule, consolidation or pleural effusion. The base of the heart is normal in size. Trace pericardial fluid is likely within normal physiologic range. ABDOMEN: The liver is normal in shape and contour. There are post-surgical changes from a prior transplant. The hepatic veins and portal veins are patent. Due to the phase of contrast, the arterial anatomy is not well assessed. There are no focal hepatic lesions. There is mild prominence of the central intrahepatic common bile duct up to 11 mm. This is unchanged from the prior MRI. The remainder of the common bile duct is normal in caliber. There is no intrahepatic biliary duct dilation. The gallbladder is surgically absent. The spleen is normal in size. There are no focal splenic lesions or evidence of splenic infarct. The pancreas is normal. The bilateral adrenal glands are normal. In the right kidney, there is a 26 mm hypodensity, consistent with a simple cyst. Two other subcentimeter hypodensities in the right kidney are too small to fully characterize, but also likely represent cysts. The right kidney is normal in size. There is normal cortical thickness. There is no evidence of pyelonephritis or hydronephrosis. It enhances and excretes contrast appropriately. The left kidney is atrophic with significant cortical thinning and scarring. The collecting system is mildly dilated. The upper and mid ureter are normal in caliber. There is delayed excretion. This is new from the prior exam in ___, though stable from the prior MRI in ___. This likely is from chronic obstruction. There is no significant perirenal fat stranding. No perirenal fluid collection is identified. The stomach and small bowel are normal in course and caliber. There is no evidence of obstruction. There are no acute inflammatory changes. There is no free air or free fluid. The abdominal vasculature is normal in caliber. There is no evidence of an abdominal aortic aneurysm. Mild atherosclerotic calcifications are noted along the abdominal aorta. There is no periportal, retroperitoneal or mesenteric lymphadenopathy. PELVIS: Evaluation of the pelvis is significantly limited by metallic artifact from the bilateral total hip arthroplasties. The imaged portions of the sigmoid colon are mostly collapsed, which somewhat limits its evaluation. Apparent mild wall thickening is present at the junction of the sigmoid colon and the descending colon, and is likely due to underdistension. There is no evidence of diverticulitis. The remainder of the large bowel is normal. The bladder and prostate are not well visualized. The distal ureters are not well visualized. There is no obvious free fluid in the pelvis. OSSEOUS STRUCTURES: The patient is status post bilateral total hip arthroplasties. There is no obvious evidence of hardware complication. There are no concerning lytic or sclerotic osseous lesions. There are mild degenerative changes in the lower thoracic spine with calcifications in the T11-12 disc space. No fracture is identified. There is moderate diffuse anasarca in the soft tissues. IMPRESSION: 1. Significant atrophy and cortical thinning in the left kidney with mild dilation of the collecting system, and delayed contrast excretion. This appearance is essentially unchanged from the prior MRI in ___. 2. Mild nonspecific colonic wall thickening at the junction of the sigmoid colon and descending colon, likely due to underdistension. 3. Status post a liver transplant with mild central intrahepatic biliary duct prominence, unchanged from the prior MRI. It otherwise is normal in appearance. 4. Normal spleen. Changes to the wet read were text paged to Dr. ___ at 8:40 ___ on ___ via by Dr. ___ at the time the findings were discovered.

10022373-RR-10

RR

2150-02-28 15:57:00

2150-02-28 16:58:00

INDICATION: ___ with hypotension elevated wbc // eval for pna TECHNIQUE: AP and lateral views the chest. COMPARISON: CT chest from ___. FINDINGS: Right chest wall port is seen with catheter tip at the mid SVC. The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Mild height loss of a lower thoracic vertebral body is unchanged. IMPRESSION: No acute cardiopulmonary process.

10022373-RR-15

RR

2150-05-18 08:52:00

2150-05-18 13:29:00

EXAMINATION: CTA ABD AND PELVIS INDICATION: ___ year old woman with pancreatic cancer encasing blood vessels with severe abdominal pain and intractable vomiting and elevated lactate, evaluate for ischemic colitis or other acute intra-abdominal process to explain pain, vomiting, elevated lactate. TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and post-contrast images were acquired through the abdomen and pelvis. Oral contrast was not administered. MIP reconstructions were performed on independent workstation and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 4.4 s, 48.6 cm; CTDIvol = 2.1 mGy (Body) DLP = 102.4 mGy-cm. 2) Spiral Acquisition 7.3 s, 47.2 cm; CTDIvol = 6.1 mGy (Body) DLP = 285.0 mGy-cm. Total DLP (Body) = 387 mGy-cm. COMPARISON: CTAs of the abdomen and pelvis dated ___ and ___. FINDINGS: VASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium burden in the abdominal aorta and great abdominal arteries. LOWER CHEST: Moderate centrilobular emphysema and small bilateral pleural effusions, right greater than left are noted at the lung bases. Scattered areas of ___ opacity in the right lower lobe may represent aspiration or early pneumonia (03:11, 9). ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits, without stones or gallbladder wall thickening. PANCREAS: The ill-defined hypoattenuating mass in the uncinate process of the pancreas continues to decrease in size, currently measuring 2.3 x 1.7 cm (03:55), previously measuring 2.7 x 2.0 cm. Encasement and occlusion of an early branch from the SMA is unchanged (03:51-54). Less than 180 degrees of contact with additional early branches from the SMA is unchanged (03:56). There is otherwise no vascular involvement. CyberKnife fiducials are in unchanged position. There is no significant biliary or pancreatic ductal dilatation. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. A small accessory spleen is incidentally noted. 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 stones, focal renal lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality. GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. Colon and rectum are within normal limits. Appendix contains air, has normal caliber without evidence of fat stranding. There is no evidence of mesenteric lymphadenopathy. RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is seen. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. No evidence of acute intra-abdominal process. 2. Unchanged appearance of hypo attenuating uncinate process pancreatic mass with encasement of an early branch of the SMA. No abnormal bowel wall enhancement or pneumatosis. 3. Right lower lobe areas of ___ opacity suggesting either aspiration or early infection.

10022373-RR-17

RR

2150-05-25 13:24:00

2150-05-25 14:15:00

INDICATION: ___ year old woman with pancreatic cancer, persistent n/v and inability to tolerate PO. Assess for UGI obstruction. 1 hour post contrast TECHNIQUE: Single portable upright frontal abdominal radiograph. COMPARISON: CT abdomen/pelvis ___. FINDINGS: There are no abnormally dilated loops of large or small bowel. Large fecal load throughout the colon. Recently ingested oral contrast is not well visualized due to residual contrast from prior CT scan. 3 linear radiopacities projecting over the L1 vertebral body are most consistent with fiducial markers.There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Recently ingested oral contrast is not well visualized due to residual contrast from prior CT scan. Recommend increased density contrast ingestion with repeat serial abdominal radiographs. There is a large fecal load throughout the colon without bowel obstruction.

10022373-RR-18

RR

2150-05-25 16:22:00

2150-05-25 17:06:00

INDICATION: ___ year old woman with pancreatic cancer // evaluate for UGI obstruction, 4 hours post contrast TECHNIQUE: Supine abdominal radiograph was obtained. COMPARISON: Radiograph of the abdomen from ___. FINDINGS: There are no abnormally dilated loops of large or small bowel. Surgical clips are not noted in the mid abdomen. There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Nonobstructive bowel gas pattern.

10022373-RR-19

RR

2150-06-01 17:54:00

2150-06-01 23:47:00

INDICATION: ___ woman with pancreatic cancer now presenting with new fever. TECHNIQUE: Chest PA and lateral COMPARISON: Chest PA and lateral dated ___. FINDINGS: The cardiomediastinal silhouette is normal. The hila are normal. There is a large region of heterogeneous opacity extending from the mid lower to upper lung zone likely representing pneumonia. No pleural abnormalities. No pneumothorax. The visualized bones and soft tissues are normal. The right port is in satisfactory position. IMPRESSION: There is a large region of heterogeneous opacity extending from the mid lower to upper lung zone likely representing pneumonia.

10022373-RR-20

RR

2150-06-01 18:11:00

2150-06-01 18:45:00

EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ year old woman with pancreatic cancer, chronic abdominal pain here with worsening nausea and vomiting. Now with new fever. // Eval biliary obstruction. Eval ascites TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: CTA of the abdomen pelvis dated ___. FINDINGS: LIVER: The hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm. GALLBLADDER: The gallbladder is decompressed. No evidence of cholelithiasis. PANCREAS: Known mass within the uncinate process is not well seen. The body of the pancreas appears within normal limits. The pancreatic tail is not well seen due to the presence of overlying bowel gas. SPLEEN: Normal echogenicity, measuring 12.1 cm. KIDNEYS: The right kidney measures 8.8 cm. The left kidney measures 10.8 cm. Limited views of the bilateral kidneys are grossly unremarkable. No evidence of hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. The gallbladder is decompressed. No evidence of cholelithiasis. 2. No intra or extrahepatic biliary ductal dilatation. 3. Known mass within the uncinate process of the pancreas is not well seen.

10022373-RR-21

RR

2150-06-02 14:12:00

2150-06-02 16:32:00

EXAMINATION: CT of the abdomen and pelvis with contrast. INDICATION: ___ year old woman with pancreatic cancer. Intractable nausea and vomiting. New fever // Eval fever and intractable nausea and vomiting TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9 mGy-cm. 2) Stationary Acquisition 11.4 s, 0.2 cm; CTDIvol = 194.5 mGy (Body) DLP = 38.9 mGy-cm. 3) Spiral Acquisition 8.1 s, 52.4 cm; CTDIvol = 6.7 mGy (Body) DLP = 348.6 mGy-cm. Total DLP (Body) = 389 mGy-cm. COMPARISON: CT of the abdomen and pelvis from ___. FINDINGS: LOWER CHEST: Limited evaluation of the lung bases shows persistent tree in ___ nodules in the right lower and right middle lobes which could be related to aspiration. There is also an unchanged 5 mm left lower lobe nodule (4:8). ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: Fiducial seeds are again noted within a 2.1 x 1.7 cm lesion in the uncinate process of the pancreas that has not significantly changed compared to prior (04:53), and is again noted to encase and completely occlude an early branch of the SMA. 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. Again noted is a diverticulum arising from the third portion of the duodenum. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Note is made of significant amount of residual dense oral contrast in the rectum and sigmoid colon since last study raising concern for barium impaction. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The patient 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. Mild atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. No significant interval changes in an uncinate process pancreatic lesion encasing and occluding an early branch of the SMA. No abnormal wall enhancement noted. 2. Significant amount of residual dense oral contrast in the rectum and sigmoid colon since last study raises concern for barium impaction. 3. Persistent ___ nodules in the right lower and right middle lobes are likely due to aspiration. 4. Unchanged 5 mm left lower lobe lung nodule should be reassessed at the time of the follow-up. RECOMMENDATION(S): The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 4:31 ___, 10 minutes after discovery of the findings.

10022373-RR-22

RR

2150-06-04 17:00:00

2150-06-04 21:30:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with pancreatic cancer, abdominal pain, new hypotension // Eval etiology hypotension Eval etiology hypotension IMPRESSION: Compared to chest radiographs ___ and ___ one. Heterogeneous peribronchial opacification in the right lung has improved consistent with decreasing pneumonia. Left lung clear. No pleural abnormality. Normal cardiomediastinal silhouette. Right transjugular central venous infusion catheter ends in the low SVC.

10022373-RR-23

RR

2150-06-04 17:00:00

2150-06-04 21:34:00

INDICATION: ___ year old woman with pancreatic cancer, worsening abdominal pain, now new hypotension // Eval etiology hypotension TECHNIQUE: Two views of the abdomen and pelvis. COMPARISON: CT abdomen pelvis ___. FINDINGS: No evidence of free air. Nonobstructive bowel gas pattern. Phleboliths are noted in the pelvis. No unexplained radiopaque foreign bodies identified. IMPRESSION: No free air or obstruction.

10022373-RR-9

RR

2150-02-28 14:43:00

2150-02-28 17:29:00

EXAMINATION: CTA ABD AND PELVIS INDICATION: ___ with pancreas ca p/w syncope hypotensionNO_PO contrast // eval for worsening pancreatic cancer necrosis vs billary dilation obstrucion TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and post-contrast images were acquired through the abdomen and pelvis. Oral contrast was not administered. MIP reconstructions were performed on independent workstation and reviewed on PACS. DOSE: DLP: 1427 mGy cm. COMPARISON: CT abdomen pelvis from ___. FINDINGS: VASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden in the abdominal aorta and great abdominal arteries which are all patent. LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no pleural or pericardial effusion. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is contracted. PANCREAS: Hypoenhancing lesion centered at the uncinate process of the pancreas is unchanged from exam performed 8 days prior. The pancreas otherwise has normal attenuation throughout. There is no pancreatic ductal dilatation. 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 stones, focal renal lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality. GASTROINTESTINAL: There is a small hiatal hernia. Stomach is otherwise unremarkable. Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. Duodenal diverticulum is noted. Colon and rectum are within normal limits. Appendix is not visualized. There is no evidence of mesenteric lymphadenopathy. RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: Uterus is not visualized. No adnexal abnormalities identified. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: Mass centered in the uncinate process of the pancreas which is unchanged from exam 8 days prior. No evidence of acute intra-abdominal process.

10022500-RR-15

RR

2140-11-21 11:22:00

2140-11-21 14:51:00

INDICATION: ___ year old man with abdominal pain after flex sig// eval abdominal pain TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: None available. FINDINGS: There are no abnormally dilated loops of large or small bowel, with an overall paucity of small bowel gas. Assessment for free intraperitoneal air is limited on supine radiographs. If there is clinical concern for pneumoperitoneum, advise upright or left lateral decubitus radiograph, or cross-sectional imaging. Osseous structures are unremarkable. Surgical clips are demonstrated within the pelvis. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Nonobstructive bowel gas pattern with an overall paucity of bowel gas.

10023117-RR-39

RR

2174-06-07 21:41:00

2174-06-07 21:57:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with shortness of breath TECHNIQUE: Chest PA and lateral COMPARISON: ___ chest radiograph and ___ chest CT FINDINGS: Left-sided AICD device is noted with leads terminating in the regions of the right atrium, right ventricle and coronary sinus, unchanged. Severe cardiomegaly is again noted. Mediastinal and hilar contours are unchanged. No pulmonary edema is demonstrated. No focal consolidation, pleural effusion or pneumothorax is present. Atelectasis is noted in both lung bases. There are no acute osseous abnormalities. IMPRESSION: Severe cardiomegaly without congestive heart failure or pneumonia.

10023239-RR-21

RR

2137-06-19 15:36:00

2137-06-19 16:26:00

CHEST, TWO VIEWS: ___ HISTORY: ___ female with nausea and vomiting and shortness of breath. COMPARISON: None. FINDINGS: There is subtle right basilar opacity and lack of visualization of the right heart border. There is minimal increased density projecting over the cardiac sillouette on the lateral view. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified. IMPRESSION: Loss of the right heart border with subtle increased right lower lung opacity which could represent right middle lobe pneumonia.

10023239-RR-27

RR

2140-10-03 07:54:00

2140-10-03 08:42:00

EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with T1DM and ?sarcoid, in DKA// dka ?sarcoid; r/o infection TECHNIQUE: Chest: Frontal and Lateral COMPARISON: CT chest ___. FINDINGS: Bilateral hilar lymphadenopathy, better visualized on recent CT chest which can be seen in sarcoidosis.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. IMPRESSION: Bilateral hilar adenopathy, better seen on recent chest CT, can be seen in sarcoidosis but lymphoma and other neoplastic etiologies cannot be excluded.

10023239-RR-28

RR

2140-10-04 21:17:00

2140-10-04 21:41:00

EXAMINATION: Portable chest x-ray INDICATION: ___ year old woman s/p lung bx today// ?interval change TECHNIQUE: Portable chest x-ray COMPARISON: Previous chest x-ray from ___. FINDINGS: Alveolar airspace opacity is seen in the lower aspect of the right lung, possibly hemorrhage. The left lung appears unchanged. There is bilateral hilar adenopathy, better visualized on a recent CT scan of the chest. The heart is normal in size. The trachea is midline. IMPRESSION: New alveolar airspace opacity when compared to the previous study. Hemorrhage as well as other etiologies should be considered in this patient who is status post lung biopsy. Bilateral hilar adenopathy.

10023239-RR-29

RR

2140-10-05 11:03:00

2140-10-05 11:20:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with recent BAL// resolution of airspace opacities? resolution of airspace opacities? IMPRESSION: Comparison to ___. There is only minimal decrease in extent and severity of the severe bilateral parenchymal opacities. The multiple pre-existing rounded consolidations in the lung parenchyma are stable. No evidence of pneumothorax. No pleural effusions.

10023239-RR-30

RR

2140-10-06 09:33:00

2140-10-06 10:35:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with EBUS/bronch biopsy with developing hypoxia 2 days post procedure// ? infiltrates ? infiltrates IMPRESSION: Comparison to ___. The postprocedure parenchymal opacities, notably on the right, are unchanged as compared to the previous image and resemble in severity those from ___. There currently is no evidence for the presence of a pneumothorax. Stable appearance of the cardiac silhouette.

10023239-RR-31

RR

2140-10-07 06:44:00

2140-10-07 09:57:00

INDICATION: ___ year old woman with LN, fever join pain hypoxemia// Interval change TECHNIQUE: Portable AP radiograph of the chest. COMPARISON: Radiograph of the chest from ___. FINDINGS: The moderate to severe parenchymal opacities, predominantly within the mid to lower right lung with air bronchograms appears grossly unchanged compared to the prior exam. Small right pleural effusion is persistent. The cardiomediastinal silhouette otherwise appears unchanged. The visualized osseous structures are unremarkable. There is no evidence of a pneumothorax. IMPRESSION: Overall, stable appearance of the moderate to severe parenchymal opacities within the right lung compared to the prior exam from ___.

10023486-RR-25

RR

2151-07-09 16:51:00

2151-07-09 18:07:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ with fever, AMS// pneumonia? TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph ___. FINDINGS: Evaluation is mildly limited due to technique. Within this limitation, there is mild bilateral pulmonary vascular congestion. Previously seen left lower lobe opacity is not as well visualized. No pneumothorax. No large pleural effusion, however evaluation of the left costophrenic angles limited and excluded from field of view. Cardiomediastinal contours appear mildly enlarged and similar to prior. 3 anchors are noted in the left humeral head. Fusion hardware of the lower cervical spine is again demonstrated. IMPRESSION: Mild bilateral pulmonary vascular congestion. Previously seen left lower lobe opacity is not as well visualized on this current study. No large pleural effusion.

10023486-RR-26

RR

2151-07-09 17:47:00

2151-07-09 19:50:00

EXAMINATION: CT abdomen pelvis without contrast INDICATION: ___ s/p L nephrectomy for traumatic injury to left kidney, now with pain and induration at ___ drain site// PLease evaluate for subcutaneous fluid collection at ___ drain site TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 6.9 s, 54.1 cm; CTDIvol = 27.7 mGy (Body) DLP = 1,497.4 mGy-cm. Total DLP (Body) = 1,497 mGy-cm. COMPARISON: Outside CTA abdomen pelvis ___. ___ renal embolization ___. FINDINGS: LOWER CHEST: Right basilar opacity is likely atelectasis, but may also represent aspiration. Small left pleural effusions similar to prior. No pericardial effusion. Mild aortic valve calcifications are noted. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder contains layering sludge. PANCREAS: The pancreas is atrophic without focal lesions within limits of this noncontrast scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen is massively enlarged measuring up to 27.4 cm, previously 25.1 cm with normal attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: No hydronephrosis of the right kidney. Multiple subcentimeter hypodense lesions are noted in the right kidney, which are too small to be characterized but may represent cysts. There is mild perinephric stranding. Patient is status post left nephrectomy with hematoma in the left nephrectomy bed containing area of increased density measuring up to 53 in ___ (601; 33), unable to compared to prior as there are no postoperative images obtained. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. Diverticulosis throughout the colon without evidence of diverticulitis. The appendix is normal. PELVIS: The bladder is decompressed with a Foley catheter. Distal ureters appear unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. 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. Posterior fusion hardware at L2-L3 are again demonstrated without evidence of perihardware lucency or fracture. Alignment is anatomic. Mild-to-moderate multilevel degenerative changes are noted, most notable at L1-L2 with disc space narrowing, Schmorl's node, and vacuum phenomenon. SOFT TISSUES: There is a left anterior approach catheter terminating adjacent to the spleen in the left mid abdomen. No fluid collections are noted along the course of this catheter. Minimal soft tissue edema is noted. Postsurgical changes are noted along the incision in the anterior abdominal wall with air and soft tissue edema along the surgical scar. IMPRESSION: 1. No fluid collection is noted along the course of the left anterior approach drain terminating adjacent to the spleen in the left mid abdomen. The tip of the drain does not terminate in a fluid collection. No substantial subcutaneous changes are noted along its course. 2. Hematoma in the left nephrectomy bed contains area of increased density measuring up to 53 in ___ suggestive of areas of more acute hemorrhage, but difficult to compare as there are no postoperative images. 3. Air and soft tissue edema is noted along the tract of the surgical scar along the mid abdomen, consistent with recent intervention NOTIFICATION: The findings were discussed with Dr. ___. by ___, M.D. on the telephone on ___ at 7:38 pm, 10 minutes after discovery of the findings.

10023708-RR-45

RR

2144-08-30 13:20:00

2144-08-30 15:58:00

INDICATION: ___ female with acute onset of nausea, lightheadedness, elevated lactate. Evaluate for acute cardiopulmonary process. COMPARISON: ___. TECHNIQUE: PA and lateral chest radiograph. FINDINGS: A round retrocardiac opacity with an air fluid level abutting the left paravertebral stripe is a hiatal hernia. No other focal opacities are noted. Cardiomnediastinal and hilar contours are unremarkable. No pleural effusion or pneumothorax. IMPRESSION: Hiatal hernia. Otherwise, unremarkable chest radiographic examination.

10023708-RR-46

RR

2144-08-30 16:12:00

2144-08-30 18:07:00

INDICATION: Patient with nausea, vomiting, and elevated lactate. Assess for bowel ischemia. COMPARISONS: None available. TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis were obtained with and without intravenous contrast. Coronally and sagittally reformatted images were displayed. FINDINGS: Imaged lung bases are clear. Bibasilar atelectases is noted. There is no pleural effusion. Minimal bronchiectasis in the lung bases is present. Heart is normal in size with small pericardial effusion. Moderate hiatal hernia is noted. The liver enhances homogeneously without focal lesions. There is no evidence of intrahepatic or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent. The spleen is unremarkable. The pancreas appears slightly atrophic but enhances homogeneously without ductal dilatation or peripancreatic fluid collection. The adrenal glands are normal. Kidneys enhance and excrete contrast symmetrically without evidence of hydronephrosis or renal masses. Bilateral focal hypodensities are too small to characterize and likely represent renal cyst. Small and large bowel loops are normal in caliber without evidence of bowel wall thickening or obstruction. The intra-abdominal aorta and its branches are notable for severe calcified atherosclerotic disease without associated aneurysmal changes. There are scattered mesenteric and retroperitoneal lymph nodes which do not meet CT criteria for pathologic enlargement. There is no free air or free fluid within the abdomen. CT OF THE PELVIS: The bladder, distal ureters, rectum, and sigmoid colon appear unremarkable. Uterus is normal. There is a 3.7 x 3.7 x 4 cm (4A:115, 500B:26) predominantly solid heterogeneously enhancing left adnexal mass with small internal cystic components. There are no pathologically enlarged pelvic or inguinal lymph nodes. Trace amount of free fluid is seen within the pelvis. There is no free air. OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is seen. Moderate rotatory scoliosis of the lumbar spine is noted. IMPRESSION: 1. No evidence of bowel ischemia. 2. Left adnexal heterogeneously enhancing solid mass, concerning for malignancy. Further assessment by the pelvic ultrasound exams is recommended. 3. Moderate hiatal hernia. 4. Small pericardial effusion. 5. Extensive calcified atherosclerotic disease of the aorta without associated aneurysmal changes.

10023708-RR-47

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2144-08-31 09:01:00

2144-08-31 14:05:00

INDICATION: Weight loss, nausea, vomiting, and left adnexal mass seen on CT. COMPARISONS: CT abdomen and pelvis ___. FINDINGS: A transabdominal ultrasound was performed. The lesion of concern was too high in the pelvis to access transvaginally. In the left adnexa is a 3.7 x 3.9 x 3.1 cm solid, heterogeneous, vascular mass concerning for malignancy. The borders are somewhat irregular. There is no cystic component. The uterus is unremarkable and measures 6.5 x 3.1 x 3.5 cm. The right adnexa is unremarkable without large mass. There is no ascites. IMPRESSION: 3.9 cm solid vascular mass in the left adnexa is concerning for malignancy.

10023948-RR-12

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2135-07-12 20:27:00

2135-07-12 22:07:00

EXAMINATION: CT PELVIS W/O CONTRAST INDICATION: ___ with chief complaint of right hip dislocation// Dislocation position? TECHNIQUE: Multidetector CT images of the pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 7.8 s, 38.6 cm; CTDIvol = 25.1 mGy (Body) DLP = 969.6 mGy-cm. Total DLP (Body) = 970 mGy-cm. COMPARISON: Hip radiograph performed ___, 11 hours prior. FINDINGS: PELVIS: Evaluation of the intrapelvic structures is somewhat limited in the setting of streak artifact from bilateral hip arthroplasties. Within this limitation, there is mild sigmoid diverticulosis without convincing evidence of diverticulitis. No evidence of bowel obstruction. Foley catheter is demonstrated within a somewhat decompressed bladder. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The visualized portions of the uterus and bilateral adnexal are unremarkable. LYMPH NODES: There is no pelvic or inguinal lymphadenopathy. VASCULAR: No atherosclerotic disease is noted. BONES: Patient is status post bilateral hip arthroplasties with anterior superior dislocation of the right-sided femoral component, seen anterior to the right iliac bone. The left total hip prosthesis appears appropriately aligned. No evidence of periprosthetic fracture. Spinal fixation hardware at L5-S1 appears appropriately positioned, without evidence of hardware related complication. Multilevel laminectomies of the lumbosacral junction are also noted. There is endplate sclerosis of the endplates adjacent to the L5-S1 intervertebral disc. SOFT TISSUES: The right iliopsoas is expanded with a 4.7 x 2.2 cm high attenuating hematoma (03:29). Additional large right gluteal hematoma measures up to 6.1 x 5.6 x 3.5 cm (3:61, 401:47). IMPRESSION: 1. Anterior superior dislocation of the femoral component of the right-sided hip arthroplasty with associated right iliopsoas and right gluteal hematomas. No evidence of a periprosthetic fracture. 2. Normal alignment of the left hip arthroplasty. 3. Sigmoid diverticulosis without evidence of diverticulitis.

10023948-RR-13

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2135-07-13 10:18:00

2135-07-13 11:50:00

EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT INDICATION: ___ female presenting with right hip dislocation. TECHNIQUE: Intraoperative fluoroscopic images were provided. COMPARISON: Right hip radiograph and CT pelvis dated ___. FINDINGS: 13 intraoperative images were acquired without a radiologist present. Images show steps related to reduction of the dislocated right THA. The left THA is also noted. Total intraoperative fluoroscopic time 216.1 seconds. IMPRESSION: Please refer to the operative note for details of the procedure.

10023948-RR-16

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2135-07-16 20:25:00

2135-07-16 21:48:00

EXAMINATION: PELVIS AP ___ VIEWS INDICATION: ___ year old woman s/p right hip explant antibiotic spacer placement// shoot through lateral TECHNIQUE: AP radiograph of the pelvis and lateral radiograph of the right hip. COMPARISON: CT pelvis ___. IMPRESSION: There has been interval removal of the right total hip arthroplasty and placement of antibiotic spacers. There is a surgical pin in the right femur. A left total hip arthroplasty is also noted.

10023948-RR-17

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2135-07-17 16:10:00

2135-07-17 19:30:00

EXAMINATION: KNEE (2 VIEWS) RIGHT INDICATION: ___ year old woman with history of R TKA, bilateral THR now with R hip joint infection and R knee pain/tenderness and warmth// r/o loosening of hardware R knee TECHNIQUE: Frontal and lateral view radiographs of the right knee. COMPARISON: None. IMPRESSION: Postsurgical changes from right total knee arthroplasty with patellar resurfacing are noted. There is focal lucency long the media tibial plateau and along the anterior bone-cement interface, which may represent demineralization, however hardware loosening cannot be excluded. Correlation with prior outside radiographs is recommended to assess for interval change. A ring like metallic density projecting over the anterior tibial metadiaphysis may represent postsurgical changes from prior ligament reconstruction. No acute fracture is identified. Alignment is anatomic.

10023948-RR-18

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2135-07-19 10:29:00

2135-07-24 11:44:00

EXAMINATION: US DRAIN/INJ INTERMED JOINT/BURSA W US GUID INDICATION: ___ year old woman with history of R TKA, bilateral THR now with R hip PJI and R knee warmth/swelling// please aspirate knee and send for cell count, gram stain, cultures, AFB fungal and crystals TECHNIQUE: The risks, benefits, and alternatives were explained to the patient and written informed consent obtained. A pre-procedure timeout confirmed three patient identifiers. Under ultrasound guidance, an appropriate spot was marked the right lateral knee. The area was prepared and draped in standard sterile fashion. Three cc of 1% Lidocaine was used to achieve local anesthesia. Under intermittent ultrasound guidance, a 19-gauge needle was advanced into the lateral right knee joint. Approximately 2 cc of bloody non purulent fluid was aspirated. The needle was removed, hemostasis achieved, and a sterile bandage applied. The patient tolerated the procedure well and left the department in good condition. There were no immediate complications. COMPARISON: Compared to radiographs of the right knee from ___ FINDINGS: There is a trace amount of suprapatellar knee joint fluid. This was targeted. There is extensive subcutaneous soft tissue edema skin thickening. The quadriceps tendon and patellar ligament are intact IMPRESSION: 1. Imaging Findings - as above. 2. Procedure-aspiration of 2 cc of bloody non purulent fluid from the right knee.

10023948-RR-19

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2135-07-19 17:33:00

2135-07-19 18:11:00

EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT INDICATION: ___ year old woman with picc// r picc 40cm ___ iv ___ Contact name: ___: ___ TECHNIQUE: AP radiograph of the chest. COMPARISON: None. FINDINGS: There is a right upper extremity PICC which terminates in the lower superior vena cava. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified. Healed right rib fractures are noted. There is partially visualized posterior spinal fusion hardware in the cervical spine and thoracolumbar spine. IMPRESSION: 1. The right upper extremity PICC terminates in the lower superior vena cava. 2. No pneumonia or acute cardiopulmonary process.

10024012-RR-45

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2134-08-12 20:03:00

2134-08-12 20:38:00

INDICATION: ___ with fall// fx? COMPARISON: Pelvis and right hip radiographs performed on same date from outside hospital. FINDINGS: AP pelvis and AP and lateral views of the right femur were provided. The previously described right subcapital femoral neck fracture is not well visualized. No fracture is seen involving the remainder of the right femur. Degenerative changes at the right knee are mild to moderate in extent with marginal spurring. No joint effusion at the right knee. Vascular calcifications are present. The bony pelvic ring appears intact. The left hip appears to align normally. IMPRESSION: Right femoral neck fracture better assessed on outside hospital radiographs performed on same date. No additional fracture is seen.

10024012-RR-47

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2134-08-12 19:36:00

2134-08-12 20:29:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ with hypoxia// hypoxia COMPARISON: Prior chest radiograph is dated ___ FINDINGS: AP portable upright view of the chest. Midline sternotomy wires are again noted. There is a large retrocardiac density which is better assessed on prior study which included a lateral view and most suggestive of a large hiatal hernia. A prosthetic cardiac valve is again seen projecting over the heart. There is no consolidation concerning for pneumonia. No large effusion or pneumothorax. No overt signs of edema. Imaged bony structures are intact. Overall cardiomediastinal silhouette appears stable. No free air below the right hemidiaphragm. IMPRESSION: 1. Large retrocardiac opacity likely represents known large hiatal hernia. 2. No gross signs for pneumonia or edema.

10024012-RR-48

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2134-08-12 22:31:00

2134-08-12 23:48:00

EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: History: ___ with AF with RVR and new hypoxia// pe? TECHNIQUE: Axial multidetector CT images were obtained through the thorax after the uneventful administration of intravenous contrast. Reformatted coronal, sagittal, thin slice axial images, and oblique maximal intensity projection images were submitted to PACS and reviewed. DOSE: Acquisition sequence: 1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP = 7.6 mGy-cm. 2) Spiral Acquisition 3.4 s, 26.8 cm; CTDIvol = 7.2 mGy (Body) DLP = 193.9 mGy-cm. Total DLP (Body) = 201 mGy-cm. COMPARISON: None available. FINDINGS: HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the subsegmental level without filling defect to indicate a pulmonary embolus. The main pulmonary artery is dilated up to 3.0 cm suggestive of but not diagnostic of pulmonary arterial hypertension. The ascending thoracic aorta is mildly dilated measuring up to 3.6 cm. The descending thoracic aorta is normal in caliber. Incidental note made of an aberrant right subclavian artery, a normal variant. No evidence of dissection or intramural hematoma. The heart is moderately enlarged. Patient is status post aortic valve replacement. Moderate coronary artery calcifications. No pericardial effusion. AXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are noted measuring up to 0.8 cm. Scattered prominent hilar lymph nodes are also noted on the left measuring up to 0.7 cm. No axillary lymphadenopathy. No mediastinal mass. There is a large hiatal hernia. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: There is bilateral dependent atelectasis. Septal thickening is consistent with mild interstitial edema. There is a 1.3 x 1.0 cm right upper lobe nodular opacity (series 3, image 55). Subcentimeter nodular opacities throughout the lungs, for example in the upper lobe on series 3, image 26, in right middle and lower lobes on series 3, image 133, an in left upper lobe on series 3, image 75. There is mild diffuse bronchial wall thickening, concerning for infection/inflammation. Otherwise, the airways are patent to the level of the segmental bronchi bilaterally. BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ABDOMEN: Limited evaluation of the upper abdomen is unremarkable aside form a large hiatal hernia. BONES: No suspicious osseous abnormality is seen.? degenerative changes of the thoracic spine are severe. Compression deformity of T8 indeterminate chronicity, although no definite surrounding hematoma or fracture line identified. Median sternotomy wires are intact. There is a 3.9 x 1.6 cm left subscapularis lipoma. IMPRESSION: 1. No evidence of pulmonary embolism or aortic abnormality. 2. Mild interstitial edema. 3. Multiple subpleural rule opacities throughout the lungs with the largest measures 1.3 x 1.0 cm in the right upper lobe, which may be infectious/inflammatory. Follow-up chest CT in 3 months is recommended to assess resolution. 4. T8 deformity of indeterminate chronicity, although no definite surrounding hematoma or fracture line identified.

10024012-RR-49

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2134-08-13 11:52:00

2134-08-13 14:00:00

EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT INDICATION: Closed reduction pinning. COMPARISON: Preoperative radiograph of the pelvis and both hips ___. FINDINGS: 2 intraoperative images were acquired without a radiologist present. Images show 3 cannulated screws placed within the right femoral neck, for subcapital fracture.. Total fluoroscopic time 82.7 seconds. IMPRESSION: Please refer to the operative note for details of the procedure.

10024012-RR-50

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2134-08-16 12:54:00

2134-08-16 16:36:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with history of AF, AS s/p AVR, presenting with R femoral neck fracture s/p ORIF, now with worsening AMS// Eval for PNA TECHNIQUE: Portable chest radiograph COMPARISON: CT chest dated ___ Chest radiograph dated ___ FINDINGS: Compared to recent imaging on ___, there is interval improved aeration of the bilateral lungs. There is no suspicious focal consolidation, effusion, or pneumothorax. The mediastinum is unremarkable. Large hiatus hernia partially obscures cardiac silhouette. Redemonstration of multiple intact median sternotomy wires. IMPRESSION: 1. No evidence of pneumonia. 2. Large hiatal hernia.

10024331-RR-97

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2144-02-27 16:15:00

2144-03-01 17:35:00

INDICATION: ___ man with asymmetric edema of the right leg. COMPARISON: No previous exam for comparison. FINDINGS: On a surveillance of unread cases, this exam was discovered and is unread from ___. Gray-scale, color and Doppler images were obtained of the right common femoral, femoral, popliteal and tibial veins. Normal flow, compression and augmentation is seen in all of the vessels. There is superficial edema noted in the right calf and in the right popliteal fossa. IMPRESSION: No evidence of deep vein thrombosis in the right leg. Superficial edema is seen in the right popliteal fossa and calf regions.

10024913-RR-55

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2164-07-22 04:17:00

2164-07-22 05:48:00

INDICATION: Chest pain, evaluate for acute cardiopulmonary process. COMPARISON: Chest radiograph on ___. FINDINGS: PA and lateral views of the chest. There are lower lung volumes compared to prior study, which exaggerates the size of the heart and the interstitial markings. There is likely bibasilar atelectasis which may be exaggerated by low lung volumes. No pleural effusion or pneumothorax is seen. The mediastinal contours are normal. A calcified pleural plaque is again seen in the right lower lung. The aorta is either tortuous or dilated, unchanged compared to ___. There are significant coronary artery calcifications. IMPRESSION: Low lung volumes and likely bibasilar atelectasis. No definite evidence of acute cardiopulmonary process.

10024982-RR-18

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2203-09-17 18:30:00

2203-09-17 18:41:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with exertional chest pain and shortness of breath TECHNIQUE: Chest PA and lateral COMPARISON: CT chest ___ and chest radiograph ___ FINDINGS: Patient is status post median sternotomy and CABG. A left-sided dual-lumen pacemaker device is noted with leads terminating in the right atrium and right ventricle. Heart size remains moderately enlarged but unchanged. Mediastinal and hilar contours are similar. There is mild pulmonary vascular congestion without overt pulmonary edema. Small right pleural effusion appears new in the interval. Streaky bibasilar airspace opacities may reflect atelectasis though infection cannot be completely excluded. No pneumothorax is detected. Mild degenerative changes are noted in the thoracic spine. IMPRESSION: Small right pleural effusion with patchy bibasilar airspace opacities, possibly atelectasis though infection is not excluded. Mild pulmonary vascular congestion.

10025647-RR-61

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2180-09-10 10:12:00

2180-09-10 12:26:00

CHEST RADIOGRAPH PERFORMED ON ___ Comparison is made with prior study from ___. CLINICAL HISTORY: ___ man with history of CHF, now with cough and dyspnea, question pneumonia or CHF. FINDINGS: PA and lateral views of the chest are provided. AICD device is unchanged in position with lead tips extending to the coronary sinus and right ventricle. The midline sternotomy wires and mediastinal clips are again noted. There is interval development of pulmonary edema with pulmonary vascular congestion and subtle alveolar ground-glass opacity noted. Bilateral pleural effusions, left greater than right are noted with left basilar atelectasis, likely compressive. Bony structures are intact. Overall, cardiomediastinal silhouette is stable. Calcified granuloma in the left upper lung noted. IMPRESSION: Interval development of pulmonary edema with bilateral pleural effusions, left greater than right.

10025647-RR-65

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2180-09-12 16:07:00

2180-09-13 11:29:00

REASON FOR EXAMINATION: Evaluation of the patient with pulmonary edema after diuresis. PA and lateral upright chest radiographs were reviewed in comparison to ___. Heart size and mediastinum are stable. There is substantial interval improvement up to almost complete resolution of pulmonary edema. Minimal retrocardiac opacity is noted in the left lower lung, potentially representing atelectasis. Pacemaker leads including the abandoned lead terminate in right atrium, right ventricle and the left ventricle epicardial location. Small amount of pleural effusion is better appreciated on the lateral view, most likely on the left with potentially minimal amount of right pleural effusion demonstrated as well.

10025647-RR-66

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2180-11-18 08:52:00

2180-11-18 11:32:00

INDICATION: Cough, flu-like symptoms. Please evaluate for pneumonia. COMPARISON: Comparison is made to multiple prior chest radiographs, most recently dated ___. FINDINGS: Unchanged mediastinal and hilar borders. Heart size demonstrates stable cardiomegaly. Multifocal opacifications throughout both lungs and may represent atypical infectious process with a less likely consideration given to pulmonary edema; there is relative absence of central pulmonary vessel prominence. No pleural effusion or pneumothorax is evident. Redemonstration of pacemaker including abandoned leads in the right atrium, right ventricle and left ventricle epicardial location, unchanged. IMPRESSION: Multifocal opacification throughout both lungs, possibly representing atypical infectious process, with a less likely consideration given to pulmonary edema.

10025647-RR-68

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2181-05-11 20:26:00

2181-05-11 21:58:00

EXAM: Chest, frontal and lateral views. CLINICAL INFORMATION: Shortness of breath and cough. ___. FINDINGS: Frontal and lateral views of the chest were obtained. Triple lead left-sided pacemaker is again seen with leads similar in position. There is elevation of the left hemidiaphragm and slight blunting of the left costophrenic angle which may be due to a small pleural effusion with overlying atelectasis. Calcifications project over the left mid lung. No right pleural effusion is seen. The right lung is clear. IMPRESSION: Left base opacity may be due to combination of pleural effusion and atelectasis.

10025647-RR-69

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2181-05-11 19:57:00

2181-05-11 21:30:00

HISTORY: Coumadin, status post fall and INR of 9. COMPARISON: Non-contrast head CT ___. TECHNIQUE: Contiguous axial MDCT images were obtained of the head without contrast. Multiplanar reformatted images were generated in the coronal and sagittal planes as well as thin section bone algorithm images. FINDINGS: There is no hemorrhage, edema, mass effect or acute vascular territorial infarct. Prominent ventricles and sulci are suggestive of age-related involutional change. Diffuse periventricular, subcortical and deep white matter hypodensity is compatible with chronic small vessel ischemic disease. The basal cisterns are patent and there is preservation of gray-white matter differentiation. No fracture is identified. Mucosal wall thickening is noted in the left frontal sinus. The remainder of the paranasal sinuses, mastoid air cells and middle ear cavities are clear. Globes are intact. IMPRESSION: No acute intracranial abnormality.

10025647-RR-70

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2181-05-11 19:57:00

2181-05-11 21:28:00

HISTORY: Coumadin status post fall and INR of 9. TECHNIQUE: Axial helical MDCT images were obtained of the cervical spine without contrast. Multiplanar reformatted images were generated in the coronal and sagittal planes as well as thin-section bone algorithm images. DLP: 735.03 mGy-cm. COMPARISON: Noncontrast C-spine CT ___. FINDINGS: The osseous structures are grossly demineralized. No fracture or malalignment is identified. The prevertebral soft tissues are unremarkable. There are multilevel multifactorial degenerative changes of the cervical spine with prominent anterior and posterior osteophytes particularly at the level of C5/C6 which mildly indents the ventral thecal sac. Multilevel disc space narrowing is most severe at the C5/C6. Multilevel facet joint and uncovertebral hypertrophic changes mildly narrow the neural foramina. A calcification is again noted in the right thyroid lobe. The thyroid is otherwise unremarkable. The trachea is midline. The imaged lung apices are clear. Left-sided pacer leads are partially imaged. IMPRESSION: No acute fracture or malalignment.

10025747-RR-34

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2182-12-03 15:14:00

2182-12-03 15:37:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with hypoxia, weakness//evaluate for pneumonia TECHNIQUE: Upright AP view of the chest COMPARISON: None. FINDINGS: Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Elevation of the right hemidiaphragm is of indeterminate chronicity. Patchy opacities within the lung bases likely reflect areas of atelectasis. No pleural effusion or focal consolidation is noted. There are no acute osseous abnormalities. No subdiaphragmatic free air is present. IMPRESSION: Elevation of the right hemidiaphragm of unknown chronicity. Patchy opacities in lung bases may reflect atelectasis. No subdiaphragmatic free air.

10025747-RR-35

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2182-12-03 19:57:00

2182-12-03 21:48:00

EXAMINATION: CT CHEST ABDOMEN AND PELVIS INDICATION: ___ year old woman with abd pain and hypoxia hx of chrons. Rule out pulmonary embolism and evaluate for acute intra-abdominal process. TECHNIQUE: Axial multidetector CT images were obtained through the thorax after the uneventful administration of intravenous contrast in the arterial phase. Then, imaging was obtained through the abdomen and pelvis in the portal venous phase. Reformatted coronal and sagittal images through the chest, abdomen, and pelvis, and oblique maximal intensity projection images of the chest were submitted to PACS and reviewed. Volumen oral contrast was administered. DOSE: Total DLP (Body) = 974 mGy-cm. COMPARISON: None. FINDINGS: CHEST: HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the subsegmental level without filling defect to indicate a pulmonary embolus. The thoracic aorta is normal in caliber without evidence of dissection or intramural hematoma. The heart, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Bilateral diaphragmatic eventration is, right greater than left are associated with areas of atelectasis in the lower lungs. A 5 mm left fissural nodule and 4 mm right middle lobe nodule are noted (02:49 and 02:44 respectively). The airways are patent to the level of the segmental bronchi bilaterally. BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is an 8.6 x 6.2 cm cyst in the left inferior pole that measures 8.6 x 6.2 cm and is simple fluid density, although has multiple septations (2:131). There is no evidence of focal renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon is mildly dilated and fluid-filled reflecting Volumen prep. Thickening and hyperemia of the colon extends from the proximal transverse colon through the descending colon. The sigmoid colon appears relatively normal though slightly dilated up to 6.8 cm in diameter. Overall appearance is most suggestive of acute on chronic Crohn's flare. No definite bowel obstruction. There is no free intraperitoneal fluid or free air. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The uterus contains multiple hypodense rounded structures and calcification, most likely fibroids. The adnexae are unremarkable. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. BONES AND SOFT TISSUES: Degenerative changes of the lumbar spine are noted. There is no evidence of worrisome osseous lesions or acute fracture. There is a small fat containing umbilical hernia. IMPRESSION: 1. No pulmonary embolism or acute aortic abnormality. 2. Acute on chronic Crohn's flare with thickened hyperemic transverse and descending colon. No definite bowel obstruction. 3. Large left upper pole renal cyst with septations may be further assessed with non-emergent renal ultrasound. 4. Fibroid uterus. 5. Two lung nodules measuring up to 5 mm along the left fissure. RECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules smaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an optional CT follow-up in 12 months is recommended in a high-risk patient. See the ___ ___ Society Guidelines for the Management of Pulmonary Nodules Incidentally Detected on CT" for comments and reference: ___

10025747-RR-36

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2182-12-05 09:04:00

2182-12-05 10:02:00

EXAMINATION: Chest single view INDICATION: ___ with a history of Crohn's onHumira presenting with abdominal pain and leukocytosis found tohave colitis on CT, concerning for acute-on-chronic Crohns flare.// febrile TECHNIQUE: Chest portable AP COMPARISON: ___ FINDINGS: The scoliosis of the spine convex to the right. There is elevation of the right hemidiaphragm, unchanged the previous film. The heart is not enlarged. There is increased patchy opacity in the left base which may represent pneumonia and which appears more prominent than on the previous radiograph IMPRESSION: Suspect the left lower lobe pneumonia.

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2182-12-05 14:02:00

2182-12-05 15:25:00

INDICATION: ___ year old woman with hx of chrons and abdominal distention// ?ileus TECHNIQUE: Supine and upright abdominal radiographs were obtained. COMPARISON: CT abdomen and pelvis from ___ FINDINGS: In addition to diffuse colonic distension seen on ___, there is new small bowel dilation in the mid abdomen. Large amount of stool is seen in the rectum. Multiple radiopaque rounded densities are seen projecting over the left lower lung, presumably ingested material in the esophagus. There is no large free intraperitoneal air. Osseous structures are unremarkable, aside from mild S shaped scoliosis. IMPRESSION: Interval development of small bowel dilation in addition to diffuse colonic ileus. Multiple air-fluid levels are seen in the colon. While this appearance is most likely due to small bowel and colonic ileus, consider obtaining cross-sectional imaging if there is concern for obstruction.

10025747-RR-38

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2182-12-06 08:20:00

2182-12-06 16:19:00

INDICATION: ___ year old woman with Crohn's disease, increasing distention. Concern for obstruction. TECHNIQUE: Frontal and left lateral decubitus views of the abdomen COMPARISON: Abdominal x-ray from ___ CT abdomen and pelvis from ___ FINDINGS: Diffuse colonic and small bowel dilatation. Multiple colonic air-fluid levels. There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Colonic and small bowel dilatation likely ileus, consider cross-sectional imaging if there is concern for obstruction.

10025747-RR-39

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2182-12-08 10:51:00

2182-12-08 15:44:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old woman with active Crohns flare and LLL pneumonia. Hypoxic to low ___ on 4L O2. Please evaluate for worsening pneumonia.// Please evaluate for worsening pneumonia. Please evaluate for worsening pneumonia. IMPRESSION: Compared to chest radiographs ___ and ___. Left basal peribronchial opacification is improved slightly. Right hemidiaphragm remains severely elevated and is responsible for new right middle lobe atelectasis. Upper lungs are clear. Heart size is normal. Pleural effusions small if any. No pneumothorax.

10025747-RR-40

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2182-12-09 08:31:00

2182-12-09 12:05:00

INDICATION: ___ year old woman with Crohn's flare, comparison to previous abdomen film TECHNIQUE: Frontal and left lateral decubitus radiographs of the abdomen COMPARISON: Abdominal radiographs from ___ FINDINGS: No significant change in multiple mildly dilated small bowel loops filled with gas and mild gas distention of the colon. No definite free air. IMPRESSION: No significant change in bowel distention from the exam done two days ago. No free air demonstrated.

10025747-RR-41

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2182-12-12 15:42:00

2182-12-12 16:11:00

INDICATION: ___ year old woman with new hypoxia and recent CAP.// atelectasis evolution, pulmonary edema TECHNIQUE: Chest PA and lateral COMPARISON: ___ FINDINGS: There are low bilateral lung volumes. The right hemidiaphragm is again noted to be markedly elevated in comparison to the left. Bibasilar linear opacities likely reflect atelectasis. There is no evidence of pulmonary edema or pleural effusions. No pneumothorax. The size of the cardiac silhouette is within normal limits. There is an S shaped scoliosis of the thoracic spine. IMPRESSION: No significant interval change since the prior chest radiograph. No evidence of pulmonary edema.

10025747-RR-42

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2182-12-15 17:08:00

2182-12-15 18:37:00

EXAMINATION: CT abdomen and pelvis with IV and PO contrast. INDICATION: ___ year old woman with Crohn' s and worsening leukocytosis//R/U abscess TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 3.6 s, 57.7 cm; CTDIvol = 9.7 mGy (Body) DLP = 557.1 mGy-cm. 2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 23.5 mGy (Body) DLP = 11.7 mGy-cm. Total DLP (Body) = 569 mGy-cm. COMPARISON: CT abdomen pelvis ___. Abdominal MRI ___. FINDINGS: LOWER CHEST: Right-greater-than-left basilar atelectasis. There is no evidence of pleural or pericardial effusion. ABDOMEN: HEPATOBILIARY: Wedge-shaped area of relative decreased perfusion of the superior right hepatic lobe/dome is suggestive of a hepatic infarct. This is more conspicuous than the prior study and consistent with infarct evolution. 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 unchanged in size with normal nephrogram. No hydronephrosis bilaterally. Large exophytic cyst arising from the upper pole of the left kidney with thin enhancing septations measures 8.5 x 6.2 cm, previously measured 5.1 cm. There is no perinephric abnormality. GASTROINTESTINAL: Similar mild thickening of the lower esophagus is nonspecific. Mild distended stomach filled with debris. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Interval resolution of wall thickening and fat stranding of the left colon. Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening and fat stranding. Moderate colonic stool, consider constipation. The appendix is not visualized. No evidence of intra-abdominal abscess. PELVIS: Bladder is mildly distended but otherwise unremarkable. The bilateral ureters are normal caliber. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus including a partially calcified fibroid. No adnexal abnormality is seen. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. IVC normal caliber. Portal vein is patent. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Rotatory scoliosis. Degenerative change of the spine. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. No evidence of intra-abdominal abscess. 2. Interval increased conspicuity of right hepatic lobe wedge-shaped perfusion abnormality likely representing evolving infarct. 3. Moderate colonic stool, consider constipation. 4. Mildly increased size of left renal cyst with thin enhancing septations measuring 8.5 cm, previously measured 5.1 cm. 5. Additional findings as above.

10025747-RR-43

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2182-12-18 12:13:00

2182-12-18 19:47:00

EXAMINATION: MRI of the Abdomen INDICATION: ___ year old woman with crohn's flare, found to have peripheral liver lesion suspicious for infarct, want to r/u underlying lesion// peripheral liver lesion suspicious for liver lesion, r/u underlying lesion TECHNIQUE: Multiplanar multisequence MR imaging of the abdomen was performed without and with intravenous administration of 7 cc Gadavist contrast as per ___ liver mass protocol COMPARISON: ___ abdomen and pelvis CT FINDINGS: Lower Thorax: A linear opacity at the right lung base, likely represents atelectasis. There is no pleural effusion. Liver: The liver demonstrates normal shape, contour, and signal intensity. The enhancement is homogeneous without focal lesions. Previously seen wedge-shaped area of hypoenhancement at the dome of the liver on recent CT is not well appreciated on MRI. Biliary: There is no intra or extrahepatic biliary dilatation. The gallbladder is within normal limits. Pancreas: The pancreas demonstrate normal signal on T1 weighted images. The main pancreatic duct is not dilated. There is no focal lesion or peripancreatic stranding. Spleen: The spleen is normal. Adrenal Glands: Adrenal glands are within normal limits. Kidneys: The kidneys enhance and excrete symmetrically. There a simple left renal cyst that is large and exophytic measuring 8.5 cm. An additional millimetric left renal cyst is also noted. There is no hydronephrosis. Gastrointestinal Tract: Visualized loops of small and large bowel are unremarkable. Lymph Nodes: There is no lymphadenopathy. Vasculature: The abdominal aorta is normal in caliber. The celiac axis and its major branches are patent. The portal vein, splenic vein, and superior mesenteric vein are patent. Osseous and Soft Tissue Structures: Thoracolumbar scoliosis is noted. IMPRESSION: Previously seen abnormality at dome of the liver is not visualized on MRI. The liver enhances homogeneously and there is no evidence of focal mass or infarction.

10025791-RR-5

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2170-11-15 13:25:00

2170-11-15 14:10:00

HISTORY: ___ male with question new CHF diagnosis. Question pulmonary edema. COMPARISON: None. FINDINGS: Frontal and lateral views of the chest. The lungs are clear of consolidation, effusion, or pulmonary vascular congestion. The cardiac silhouette slightly enlarged and the aorta is tortuous. No acute osseous abnormality detected. IMPRESSION: No acute cardiopulmonary process. Note evidence of congestive failure.

10025981-RR-26

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2150-02-14 19:25:00

2150-02-14 20:20:00

EXAMINATION: UNILAT LOWER EXT VEINS RIGHT INDICATION: ___ with RLE swelling and pain, s/p right knee arthroplasty and hx of dvt // please evaluate for dvt TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the right lower extremity veins. COMPARISON: None. FINDINGS: There is normal compressibility, flow, and augmentation of the right common femoral and femoral veins. There is normal color flow in the popliteal vein. The posterior tibial and peroneal veins could not be evaluated due to patient discomfort and habitus. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. IMPRESSION: 1. No evidence of deep venous thrombosis in the right common femoral, deep and superficial femoral, and popliteal veins. 2. The peroneal and posterior tibial veins could not be assessed.

10025981-RR-27

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2150-02-14 21:42:00

2150-02-14 21:58:00

INDICATION: ___ with right ___ pain, right knee pain // please evaluate for bony abnormality TECHNIQUE: AP, oblique, and lateral views of the right knee. COMPARISON: ___ knee films. FINDINGS: Postoperative changes of right total knee arthroplasty are again noted. There is no periprosthetic lucency nor fracture. Skin staples are in place. Prior drains have been removed. Soft tissue swelling seen superior and anterior to the patella compatible with recent surgery. IMPRESSION: No fracture.

10026246-RR-13

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2138-02-27 07:30:00

2138-02-27 10:04:00

EXAMINATION: CT abdomen and pelvis without contrast INDICATION: ___ with acute onset abd pain while in ED, tenderness. Evaluate for small-bowel obstruction. TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 390 mGy-cm. COMPARISON: MR ___ with contrast performed ___. FINDINGS: LOWER CHEST: Multiple pleural plaques, several calcified reflect prior asbestos exposure. No worrisome pulmonary nodule or mass. There is mild pericardial thickening versus trace pericardial effusion. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is mild prominence of the intrahepatic biliary tree. No evidence of extrahepatic biliary dilatation. The gallbladder is distended and contains multiple layering calcified gallstones without wall thickening or evidence of inflammation. There is no definite evidence for a common bile duct stone. PANCREAS: The pancreas is atrophic, without evidence of focal lesions within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The bilateral kidneys are atrophic but symmetric in size. Simple appearing left renal cyst in the right upper and lower pole kidney measuring 1.1 x 1.3 cm and 1.6 x 1.6 cm respectively (02: 20, 27). Otherwise, there is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. GASTROINTESTINAL: Small hiatal hernia, the stomach is otherwise unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. Incidental note is made of a duodenal diverticulum (601:32). Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening and fat stranding. The appendix is normal. PELVIS: Herniation of the urinary bladder into the right inguinal canal without evidence of incarceration (2:72, 601:25). Otherwise, the remaining visualized urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: Small aneurysm of the infrarenal abdominal aorta measures 3.0 x 2.4 cm (02:29). Extensive atherosclerotic disease is noted. BONES: Again seen, is an acute burst fracture of the L1 vertebral body with 4 mm posterior fragment retropulsion is better assessed on MR lumbar spine performed ___. Otherwise there is mild to moderate degenerative changes of the lumbar spine including chronic appearing decreased in height with a superior endplate Schmorl's node at the L5 vertebral body. SOFT TISSUES: Bladder containing right-sided inguinal hernia as described above. Otherwise, the abdominal and pelvic wall is within normal limits. IMPRESSION: 1. Cholelithiasis with gallbladder distension and apparent mild intrahepatic biliary ductal dilation raises potential concern for choledocholithiasis/cholangitis. Please correlate clinically. 2. L1 burst fracture with 4 mm posterior fragment retropulsion, better assessed on MR lumbar spine performed ___. 3. Extensive atherosclerotic calcifications with a small aneurysm of infrarenal abdominal aorta measuring up to 3.0 x 2.4 cm. 4. Right inguinal hernia containing a portion of the urinary bladder, uncomplicated. 5. Calcified pleural plaques the lung bases likely reflect prior asbestos exposure. RECOMMENDATION(S): Clinical correlation for possible choledocholithiasis/cholangitis given prominence of the intrahepatic biliary tree, gallbladder distension and gallstones.

10026246-RR-14

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2138-02-27 15:10:00

2138-02-27 15:50:00

EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ with abdominal pain// eval for cholecystitis, cbd diameter TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: CT abdomen pelvis ___ FINDINGS: LIVER: The hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is mild intrahepatic biliary dilation. The CHD measures 5 mm. GALLBLADDER: The gallbladder is distended and filled with stones and sludge. There is no gallbladder wall edema or pericholecystic fluid. PANCREAS: The pancreas is not well visualized, largely obscured by overlying bowel gas. KIDNEYS: Limited views of the right kidney show no hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: Cholelithiasis with gallbladder distension and dilation of the intrahepatic biliary tree with normal caliber CBD. Findings raise potential concern for Mirizzi syndrome.

10026255-RR-10

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2200-09-21 10:13:00

2200-09-21 14:08:00

TYPE OF EXAMINATION: Chest PA and lateral. INDICATION: ___ male patient status post fall with right-sided pneumothorax, recent removal of right-sided pigtail catheter, evaluate for pneumothorax. FINDINGS: Patient's clinical condition required examination in sitting semi-upright position using AP frontal and left lateral views. Comparison is made with the next preceding similar chest examination of ___. The pigtail and right-sided pleural drainage catheter had been removed already prior to the preceding examination of ___. Consequently status of patient is unchanged during the latest one-day examination interval. Again, there is no evidence of pneumothorax in the apical area. No new pulmonary parenchymal infiltrates are seen and the bilateral basal linear densities representing atelectasis remain rather unchanged. IMPRESSION: No pneumothorax.

10026255-RR-11

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2200-09-23 16:49:00

2200-09-24 10:10:00

HISTORY: Shortness of breath and productive cough. History of recent fall and rib fractures. COMPARISON: ___. FINDINGS: Cardiomediastinal and hilar contours unchanged from ___. No focal consolidation, pleural effusion or pneumothorax. Bilateral basilar atelectasis unchanged from ___. Right lower rib fractures again noted. IMPRESSION: No focal consolidation. Unchanged bilateral basal atelectasis.

10026255-RR-12

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2200-09-27 14:02:00

2200-09-27 16:30:00

HISTORY: ___ male with a questionable history of COPD and recent fall, evaluate pneumothorax, now with persistent dyspnea and increased oxygen requirement. STUDY: Chest CTA; 100 mL of Omnipaque intravenous contrast was administered without adverse reaction or complication in the arterial phase. Coronal and sagittal reformatted images were generated as well as right and left oblique maximum intensity projection images. COMPARISON: Chest CT with contrast from ___. FINDINGS: The visualized portion of the thyroid appears unremarkable. There is no axillary, hilar, or mediastinal lymphadenopathy. The aorta is of a normal caliber along its course without evidence of dissection. The pulmonary arterial tree is patent at subsegmental level, and the pulmonary arterial trunk is of normal caliber. There is no pericardial or pleural effusion. The lungs demonstrate diffuse emphysema with resolution of the previously described pneumothorax. Additionally, consolidation of the left base has progressed since prior exam. The visualized portion of the upper abdomen shows no abnormality. The visualized bones demonstrate partially imaged anterior cervical spine fusion plate (401B:38). There are no aggressive-appearing lytic or sclerotic lesions. Additionally, the bones continue to demonstrate minimally displaced fractures of the posterior tenth as well as lateral ninth, eighth and seventh ribs on the right. IMPRESSION: 1. No evidence of PE or aortic injury. 2. Emphysema and resolution of previously described pneumothorax, with worsening left lower lobe consolidation. 3. Stable right-sided minimally displaced rib fractures as described above.

10026255-RR-13

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2200-09-27 15:53:00

2200-09-27 17:14:00

HISTORY: Prior hepatitis B and hepatitis C, evaluate liver echotexture for mass, cirrhosis, etc. TECHNIQUE: Grayscale and color Doppler evaluation of the upper abdomen. COMPARISON: CT chest angiogram from same day. FINDINGS: Normal appearance of the head and body of the pancreas, the tail is not well seen. The liver demonstrates a mildly coarsened echotexture without focal liver lesion, intrahepatic biliary dilatation or abnormal flow in the portal vein. The gallbladder contains anechoic fluid without evidence of stone or wall thickening. The common bile duct measures at the upper limits of normal at 6 mm. The spleen measures within normal limits. No ascites. IMPRESSION: Mildly coarsened echotexture of the liver is nonspecific, but could be seen in the setting of early fibrosis. No focal liver lesions identified.

10026255-RR-14

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2200-09-29 10:45:00

2200-09-29 11:21:00

HISTORY: Left lower lobe consolidation, to compare for change. FINDINGS: In comparison with the chest radiograph of ___, there is some increasing opacification at the left base with slightly less opacification in the right. Although much of this probably represents atelectasis, there is a more consolidative aspect, consistent with the left lower lobe pneumonia seen on the CT examination of ___. Otherwise, little change.

10026255-RR-3

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2200-09-17 19:18:00

2200-09-17 20:06:00

HISTORY: Right-sided chest pain, dyspnea and cough status post trauma, here to evaluate for rib fracture or pneumothorax. COMPARISON: No prior studies available. Technique: PA and lateral radiographs of the chest. FINDINGS: There is a moderate-sized right pneumothorax without significant tension component Streaky opacification of the right lung base most likely reflects bronchovascular crowding and associated collapse of the lung. Small bilateral pleural effusions are present on the right greater than the left. The lungs are hyperexpanded with flattening of the diaphragm compatible with COPD. The pulmonary vasculature is not engorged. Cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. There are minimally displaced fractures of the ___ anterolateral, ___ posterolateral, and ___ anterolateral ribs. Multilevel degenerative changes are noted in the thoracic spine. IMPRESSION: 1. Moderate-sized right pneumothorax with no significant tension component. 2. Minimally displaced right sided rib fractures of the ___ anterolateral, ___ posterolateral, and ___ anterolateral ribs. 3. Small bilateral pleural effusions on the right greater than the left. 4. Findings consistent with underlying COPD.

10026255-RR-5

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2200-09-18 00:17:00

2200-09-18 09:40:00

PORTABLE CHEST X-RAY AT 12:18 A.M. COMPARISON: Chest x-ray of one day earlier. FINDINGS: Interval placement of right pigtail pleural catheter with decrease in size of right pneumothorax with residual small right apical pneumothorax remaining. Heart size is normal. Lungs are slightly overexpanded with apparent upper lobe emphysema. Heterogeneous opacities at the lung bases are present, and could reflect atelectasis, aspiration, and/or contusion. Acute lower right rib fractures are again demonstrated.

10026255-RR-6

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2200-09-18 02:55:00

2200-09-18 09:37:00

PORTABLE CHEST OF ___ COMPARISON: Study of earlier the same date. FINDINGS: Right pigtail pleural catheter remains in place, with a small right apical pneumothorax which has slightly decreased in size since the recent study. Heart size remains normal. Worsening heterogeneous opacities at the lung bases, which may be due to atelectasis, aspiration, and/or contusion given known right lower rib fractures.

10026255-RR-7

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2200-09-18 15:13:00

2200-09-18 16:54:00

HISTORY: Right pigtail placement for pneumothorax, persistent hypoxia. Evaluate for pneumonia. TECHNIQUE: Multidetector CT of the chest was performed with IV contrast. Coronal and sagittal reformats were provided. FINDINGS: There is a pigtail catheter anteriorly within the right pleural space. There is a tiny residual anterior right-sided pneumothorax (less than 5%). There is a small right non-hemorrhagic pleural effusion. Throughout both lungs, there is evidence of severe centrilobular emphysema which is most marked within the upper lobes bilaterally. Consolidation is identified within both lung bases and is more marked in the left lower lobe than the right. There is debris within the right lower lobe bronchus (sequence 3 image 35). There is hyperexpansion of the left lung in comparison to the right. No pulmonary nodules or masses. Subcentimeter pretracheal, precarinal and subcarinal lymph nodes are identified and are unlikely to be of significance. No hilar or axillary adenopathy. Cardiac size is normal. No pericardial effusion. The visualized upper abdominal viscera are normal. There are fractures of the lateral aspect of the right ___ - 9th ribs. No destructive osseous lesions. IMPRESSION: 1. Tiny residual anterior right-sided pneumothorax (less than 5%) with pigtail catheter in the anterior right pleural space. 2. Severe emphysema throughout both lungs. 3. Consolidation in both lung bases, worse on the left than the right, consistent with pneumonia. 4. Small right pleural effusion. 5. Fractures of the lateral aspect of the right ___ to 9th ribs.

10026255-RR-8

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2200-09-19 16:23:00

2200-09-19 17:56:00

PORTABLE CHEST X-RAY OF ___ COMPARISON: ___ radiograph. FINDINGS: Right pleural catheter remains in place. Right apical pneumothorax has nearly resolved. Heart size, mediastinal and hilar contours are normal. Heterogeneous opacities at the lung bases are again demonstrated, with slight worsening in the left lower lobe. Acute right rib fractures are again visualized.

10026255-RR-9

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2200-09-20 14:28:00

2200-09-20 16:10:00

CHEST RADIOGRAPH INDICATION: Right biopsy, recent removal of the right pigtail. Evaluation. COMPARISON: ___. FINDINGS: As compared to the previous radiograph, the right pigtail catheter has been removed. The opacities at the lung bases are constant. There is no larger pleural effusion and no evidence of right pneumothorax. Unchanged appearance of the cardiac silhouette. Unchanged vertebral stabilization devices. No new lung parenchymal abnormality.

10026263-RR-27

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2139-11-28 14:10:00

2139-11-28 15:47:00

INDICATION: Intermittent exertional dizziness, evaluate for pneumonia or heart failure. COMPARISONS: Chest radiograph ___. PA AND LATERAL VIEWS OF THE CHEST: The cardiomediastinal, pleural and pulmonary structures are unremarkable. There is no pleural effusion or pneumothorax. No focal airspace consolidation is seen to suggest pneumonia. Heart size is normal. There are mild degenerative changes of thoracic spine, with anterior osteophytosis. IMPRESSION: No acute cardiopulmonary process.

10026263-RR-30

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2140-09-28 11:37:00

2140-09-28 12:52:00

HISTORY: ___ male with concern for left-sided incarcerated hernia. TECHNIQUE: Axial CT images through the abdomen and pelvis were acquired after administration of intravenous contrast. Coronal and sagittal reformatted images were reviewed. COMPARISON: ___. FINDINGS: Abdomen: The lung bases demonstrate minimal dependent atelectasis. No pleural or pericardial effusion is seen. A subcentimeter hypodensity in segment 4A of the liver likely represents a cyst. Calcification is again seen in the spleen. An accessory spleen is noted. The gallbladder, pancreas, adrenal glands, stomach, and small bowel are within normal limits. Bilateral renal hypodensities most likely represent cysts; the largest arises from the lower pole of the right kidney and measures 4.4 x 3.8 cm. Neither kidney demonstrates hydronephrosis. Colonic diverticula do not demonstrate evidence for acute inflammation. There is no free intraperitoneal air or ascites. Major intra-abdominal vasculature appears patent and normal in caliber with dense calcified and non-calcified aortic atherosclerotic plaque. Pelvis: The prostate, seminal vesicles, and rectum demonstrate no acute abnormalities. The bladder is distended with layering contrast. No free fluid is seen in the pelvis. Fat containing right inguinal hernia is seen. No left inguinal hernia is seen. No concerning lytic or sclerotic osseous lesions are detected. IMPRESSION: No CT evidence for acute intra-abdominal or pelvic process or incarcerated hernia.

10026404-RR-22

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2125-10-02 14:05:00

2125-10-02 16:21:00

EXAMINATION: RENAL U.S. INDICATION: ___ year old man with uncontrolled hypertension previously requiring 4 agents. // Renal artery Doppler for evaluation of renal artery stenosis in the setting of uncontrolled hypertension TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were obtained. COMPARISON: None. FINDINGS: The right kidney measures 13.0 cm. The left kidney measures 13.7 cm. There is no hydronephrosis, stones, or masses bilaterally. The kidneys are somewhat lobulated in appearance however normal cortical echogenicity and corticomedullary differentiation are seen bilaterally. The bladder is moderately well distended and normal in appearance. The prostate is mildly enlarged with a volume of 40-45 cc. DOPPLER EXAMINATION: Note is made that the Doppler examination is limited due to the patient's limited ability to hold his breath. Arterial waveforms are seen in the right main renal artery with peak systolic flow measuring 47 cm/sec. Sharp upstrokes are seen in the left main renal artery with peak systolic flow measuring 54 cm/sec. The main renal vein is patent bilaterally. Resistive indices of the intraparenchymal arteries in the right kidney range from 0.57-0.60 and within the left kidney range from 0.5 a to 0.64. IMPRESSION: No evidence of renal artery stenosis in the left kidney and likely no stenosis in the right kidney however the Doppler examination is somewhat limited due to the patient's limited ability to hold his breath.

10026406-RR-13

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2129-01-03 00:11:00

2129-01-03 02:06:00

INDICATION: ___ with facial trauma. Assess for fracture or bleed. TECHNIQUE: Contiguous axial MDCT images were obtained through the brain without administration of IV contrast. Reformatted coronal, sagittal, and thin section bone algorithm reconstructed images were generated. DOSE: DLP: 891.93 mGy-cm CTDI: 50.10 COMPARISON: None available FINDINGS: No evidence of hemorrhage, edema, mass effect, or acute large territorial infarction.The ventricles and sulci are normal in size and configuration. The basal cisterns are patent and there is preservation of gray-white matter differentiation. No fracture identified. Mild mucosal thickening of the left maxillary sinus. The additional visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The globes are unremarkable. Small subgaleal hematoma posteriorly (3:60). IMPRESSION: Small posterior subgaleal hematoma. No fracture. Otherwise normal head CT. No intracranial hemorrhage.

10026406-RR-14

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2129-01-03 00:12:00

2129-01-03 03:07:00

EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST INDICATION: ___ with facial trauma. Assess for fracture or bleed. TECHNIQUE: Helical axial images were acquired through the paranasal sinuses. Coronal reformatted images were also obtained DOSE: DLP: 554.55 mGy-cm CTDI: 25.79 mGy COMPARISON: none FINDINGS: Moderate mucosal thickening of the left mastoid air cells. The additional visualized paranasal sinuses are normally aerated, without mucosal thickening or air-fluid levels. The right ostiomeatal unit is patent. Soft tissue density seen within the left ostiomeatal unit. The anterior skull base and cribriform plates are intact. No bony sclerosis. Comminuted fracture of the right nasal bone. No soft tissue hematoma. The anterior clinoid processes are not pneumatized. The lamina papyracea is intact. The nasal septum slightly deviates towards the left. Fracture likely extends through the proximal most portion of the nasal septum (601b: 81). The orbits and nasopharyngeal soft tissues are unremarkable. Limited assessment of the brain and neck soft tissues are unremarkable. IMPRESSION: Deformity of the nasal bone and anterior septum due to fracture of undetermined age. No additional fracture. No soft tissue hematoma.

10026406-RR-15

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2129-01-03 00:13:00

2129-01-03 02:40:00

INDICATION: ___ with facial trauma. Assess for fracture or bleed. TECHNIQUE: Axial helical MDCT images were obtained from the skull base through the cervical spine without intravenous contrast. Sagittal, coronal, soft tissue and thin section bone algorithm reconstructed images were acquired. DOSE: DLP: 934.63 mGy-cm CTDIvol: 37.24 mGy COMPARISON: None. FINDINGS: 4 mm ossific fragment anterior to C5 vertebral body appears well corticated however there is a similar-appearing donor site along the superior left C5 endplate, (602b:37 and 601b: 12). No additional fracture. No retropulsion. No widening of the disc space appear. No compression fracture. No acute malalignment. Multilevel degenerative changes are noted throughout the cervical spine most notable at C1-C2 and C5-C6. Pre and paravertebral soft tissues are normal. Visualized portions of the skullbase show no abnormalities. Limited assessment of the spinal canal is unremarkable.Visualized portions of the aerodigestive tract are patent. Limited assessment of the lung apices are clear. IMPRESSION: Bony oaaicle near superior endplate of C5 indicating avulsion injury of undetermined age. . No compression fracture. No retropulsion.

10026406-RR-16

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2129-01-03 04:09:00

2129-01-03 04:55:00

INDICATION: ___ with assault injury and pain. Assess vertebral alignment TECHNIQUE: Four lateral views of the cervical spine in flexion and extension. COMPARISON: CT cervical spine ___. FINDINGS: The spine is visualized only to the top of C7. Normal vertebral alignment and relatively normal motion on flexion and extension. No prevertebral soft tissue swelling or bone destruction. There are tiny osteophytic changes anterior to C4-5 with no associated disc narrowing. This appearance suggests degenerative disease and acute fracture is not suggested. Remainder of discs and vertebral bodies are normal. Appearances are better assessed on accompanying CT scan IMPRESSION: Radiographic appearances do not suggest, in my opinion, a fracture, and particularly not an acute fracture, although this possibility at C4-5 apparently has been raised by the accompanying CT scan

10026406-RR-17

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2129-01-03 06:30:00

2129-01-03 06:54:00

EXAMINATION: CT ABD AND PELVIS W/O CONTRAST INDICATION: ___ with abd pain, lumbar spine. Assess for fracture or intra-abdominal pathology. TECHNIQUE: MDCT images were obtained from the lung bases to the pubic symphysis without the administration of intravenous contrast. Axial images were interpreted in conjunction with coronal and sagittal reformats. DLP: 592.01 mGy-cm COMPARISON: None. FINDINGS: The examination is limited secondary to the lack of intravenous contrast. CHEST: Limited assessment of lung bases demonstrates bibasilar atelectasis. No pleural effusion or large pneumothorax. The visualized heart is normal in size without pericardial effusion. ABDOMEN: The liver is diffusely hypodense consistent with hepatic steatosis. The gallbladder is normal without calcified gallstones. The multiple calcified granulomas are noted within the spleen which is otherwise unremarkable. An accessory splenule is noted. The pancreas is homogeneous without peripancreatic fat stranding or focal fluid collection. The adrenal glands are unremarkable. The kidneys are symmetric in size. No focal renal lesions. No hydronephrosis or hydroureter identified. No renal or proximal ureter calculi. The distal esophagus is normal without hiatal hernia. The stomach is grossly unremarkable in appearance. The small bowel is normal in caliber without wall thickening. The large bowel is normal in caliber without wall thickening, fat stranding, or focal mass lesion. Colonic diverticulosis is present without evidence of acute diverticulitis. The appendix is normal without evidence of acute appendicitis. The abdominal aorta is normal in caliber without aneurysmal dilatation. Small amount of atherosclerotic calcification noted. The iliac arteries are normal in course and caliber. No retroperitoneal or mesenteric lymph node enlargement by CT size criteria. No free abdominal fluid, abdominal wall hernia, or pneumoperitoneum. PELVIS: The bladder is largely distended and normal. No pelvic side-wall or inguinal lymph node enlargement by CT size criteria. No free pelvic fluid seen. The prostate and seminal vesicles are unremarkable. OSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen within the visualized thoracolumbar spine. A chronic nonunion of a left L4 transverse and right L1 transverse fractures noted (02:56). A 0.6 cm (2:95) bone island is seen within the proximal left femur. No focal lytic or sclerotic lesion concerning for malignancy. Multiple old left posterior rib fractures noted. No acute lower thoracic or lumbar vertebral fracture. IMPRESSION: 1. Hepatic steatosis. 2. No acute lower thoracic or lumbar vertebral fracture. 3. Largely distended, normal-appearing bladder. 4. No acute intra-abdominal pathology. No free fluid.

10026479-RR-13

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2189-02-05 05:45:00

2189-02-05 07:59:00

CLINICAL INFORMATION: ___ female with generalized abdominal pain in the right lower quadrant pain, question appendicitis. COMPARISON: None. TECHNIQUE: Helical MDCT images were acquired of the abdomen and pelvis following the administration of intravenous contrast. FINDINGS: LUNG BASES: The lung bases are clear, with the exception of minimal bibasilar atelectasis. There is no pleural or pericardial effusion. ABDOMEN: Multiple hypodensities within the liver are compatible with cysts, the largest of which measures 7.7 cm within segment VIII with rim calcification and an imperceptible wall. Others are too small to characterize but also are statistically likely to represent cysts. The liver is otherwise normal in appearance. Spleen is unremarkable. The pancreas appears normal with mild prominence of the pancreatic duct. The gallbladder is normal in appearance without intra- or extra-hepatic biliary ductal dilatation. The adrenal glands are normal in appearance bilaterally. The kidneys demonstrate symmetric contrast enhancement and brisk bilateral excretion without hydronephrosis. A hypodensity in the right mid renal pole measures 9 mm and is too small to characterize. The stomach is collapsed. Loops of small bowel are normal in caliber. Within distal small bowel several air-fluid levels are seen. There is a corkscrew appearance of vessels in the right lower quadrant, best seen in the coronal plane on the series 601B, image 18 at the root of a massively dilated (10 cm) portion of bowel, consistent with cecal volvulus. There is no pneumatosis. The remainder of the colon is collapsed. The aorta is normal in caliber along its course, its major branches appear patent. There is no retroperitoneal lymphadenopathy. PELVIS: The bladder, uterus, and adnexa are normal appearing. There is a small amount of pelvic free fluid. The colon is collapsed. BONE WINDOWS: There is no concerning lytic or blastic osseous lesion. Note is made of disc degenerative change at L4-L5 and L5-S1. IMPRESSION: 1. Cecal volvulus with closed loop obstruction. 2. Multiple hypodensities within the liver, the largest of which are compatible with cysts. Others are too small to characterize but are statistically likely to represent cysts. These findings were discussed with Dr. ___ at 7:20 a.m. by phone.

10026479-RR-14

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2189-02-09 11:20:00

2189-02-09 18:22:00

ABDOMEN REASON FOR EXAM: Status post right hemicolectomy. Assess for ileus versus partial obstruction. Air-fluid levels in the right lower quadrant are associated with air-filled non-dilated small bowel loops. There is air in the descending colon and rectum. There is a small amount of pneumoperitoneum due to recent surgery. Skin staples are noted. IMPRESSION: Ileus or early obstruction. Followup is recommended.

10026658-RR-7

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2142-03-24 16:08:00

2142-03-24 17:10:00

INDICATION: Lower abdominal pain and diarrhea. COMPARISON: None. TECHNIQUE: Multidetector CT images of the abdomen and pelvis were obtained without oral contrast. Intravenous contrast was administered. Sagittal and coronal reformations were also performed. FINDINGS: The visualized lung bases appear clear. There are no pleural effusions. Coronary artery calcification is present. The heart is normal in size. The liver is hypodense consistent with fatty infiltration. There is no biliary dilatation. The spleen is normal in size. The gallbladder, pancreas, and adrenal glands are unremarkable. In the interpolar left kidney, a small hypodense focus of 4 mm is too small to characterize although doubtful in significance. A calcification is noted along the pancreatic neck which may be postinflammatory. The central mesentery demonstrates increased attenuation as well as several mildly prominent but subcentimeter lymph nodes of shortest axis dimension up to at most 6 mm for the most part suggesting mesenteric panniculitis, which is a common incidental finding. There is a small axial hiatal hernia. The small bowel is unremarkable. Sigmoid diverticulosis is moderate to severe. A small quantity of ascites is present in the lower pelvis of low density compatible with simple fluid. This represents an abnormal finding. There are diverticula at the rectosigmoid junction that lie along the fluid. This does not necessarily mean that diverticulitis is the cause but that is a possibility. Diverticulosis is also moderate along the cecum without milder diverticulosis seen more generally throughout the rest of the colon. Atherosclerotic disease is moderate. The lower infrarenal abdominal aorta is mildly ectatic measuring up to 27 mm in diameter. In this patient is status post bilateral total hip replacements, streak artifact obscures lower pelvic structures to some extent. There are no suspicious lytic or blastic bone lesions. The vertebral body heights and interspaces appear preserved. IMPRESSION: 1. Small amount of ascites in the lower pelvis which is abnormal but not specific. Given clinical concern for diverticulitis the possibility could be considered when it is noted that the fluid resides near as diverticula at the rectosigmoid junction. 2. Fatty infiltration of the liver. 3. Findings consistent with mesenteric panniculitis. 4. Moderate atherosclerotic change, including mild aortic ectasia. Follow-up ultrasound is suggested to reassess in one year. DOSE: ___ mGy-cm.

10026950-RR-36

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2133-03-14 11:53:00

2133-03-14 14:19:00

CHEST, TWO VIEWS, ___ HISTORY: ___ male with elevated troponins and shortness of breath. FINDINGS: AP and lateral views of the chest are compared to study performed at ___ from earlier the same day. There has been interval development of indistinct pulmonary vascular markings. Small- to moderate-sized bilateral pleural effusions are more clearly delineated on the current exam. The lung volumes are seen. Cardiac silhouette is prominent, likely accentuated due to AP technique and low inspiratory effort. Osseous and soft tissue structures are unremarkable. IMPRESSION: Findings suggestive of congestive failure and moderate bilateral effusions.

10026950-RR-37

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2133-03-15 08:10:00

2133-03-15 11:21:00

PORTABLE CHEST OF ___. COMPARISON: Radiograph ___. FINDINGS: Persistent cardiomegaly with improved pulmonary vascular congestion but persistent moderate right and small left pleural effusion with adjacent basilar atelectasis and/or consolidation. Diffuse haziness in upper abdomen suggest the possibility of ascites.

10026950-RR-38

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2133-03-15 16:46:00

2133-03-15 19:51:00

INDICATION: ___ male with new right bundle-branch block, concern for PE, but unable to get CTA. Assess for DVT. COMPARISONS: None. Grayscale and color Doppler sonographic evaluation was performed of the bilateral lower extremities. Normal compressibility and flow was seen in the bilateral common femoral, superficial femoral, popliteal, peroneal, and posterior tibial veins without evidence of DVT. Mild left sided subcutaneous edema noted. IMPRESSION: No lower extremity DVT.

10026950-RR-39

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2133-03-15 16:47:00

2133-03-15 19:53:00

INDICATION: Hematuria and hydronephrosis, assess for hydronephrosis or clot burden in the bladder. COMPARISONS: CT abdomen and pelvis from ___. RENAL ULTRASOUND: Assessment of the kidneys is somewhat limited due to body habitus and overlying bowel gas. The right kidney measures 9.5 cm. The left kidney was not as well seen, measuring 9.6 cm. No definite hydronephrosis is seen bilaterally. The bladder is decompressed with a Foley catheter with a 4.4 x 3.8 cm avascular lesion within the bladder. IMPRESSION: No definite hydronephrosis on this limited study with 4.4-cm avascular echogenbic lesion in the bladder. This could reflect clot given the history though a mass is not excluded. Consider contrast enhanced CT or direct visualization.

10027407-RR-8

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2188-03-24 03:55:00

2188-03-24 04:44:00

INDICATION: Abdominal pain with history of SBO. TECHNIQUE: 2 frontal views of the abdomen. COMPARISON: None. FINDINGS: Nonspecific bowel gas pattern with paucity of small bowel gas. Normal caliber large bowel. There is no free intraperitoneal air. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Nonspecific bowel gas pattern with paucity of small bowel gas, though no specific plain radiographic evidence for obstruction. If SBO remains of clinical concern, followup imaging should be considered.

10027407-RR-9

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2188-03-24 06:01:00

2188-03-24 06:32:00

EXAMINATION: CT abdomen and pelvis with contrast INDICATION: History of small bowel obstruction status post partial bowel resection secondary to Crohn's disease. Presenting with abdominal pain and no flatus. TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. IV Contrast: 130 mL Omnipaque. Coronal and sagittal reformations were performed and reviewed on PACS. Oral contrast was not administered. DOSE: Total DLP (Body) = 820 mGy-cm. COMPARISON: Same day abdominal radiograph FINDINGS: Heart size is normal without significant pericardial fluid. Trace bibasilar atelectasis. Imaged lung bases are otherwise clear. CT abdomen with contrast: Several millimetric hypodensities in the right lobe of the liver are too small to fully characterize but likely represent biliary hamartomas. Liver otherwise enhances homogeneously without biliary dilatation. Portal vein is patent. Gallbladder is unremarkable. Spleen, pancreas and adrenal glands are unremarkable. No made of small perisplenic ascites. Kidneys present symmetric nephrograms and excretion of contrast without focal lesion or hydronephrosis. Stomach is distended but otherwise unremarkable. Duodenum is unremarkable. Mild distension of a segment of jejunum with a midabdominal transition point (series 601, image 22) compatible with partial or early small bowel obstruction. Trace surrounding free fluid. The large bowel is largely decompressed and unremarkable. Abdominal aorta is normal caliber. No mesenteric or retroperitoneal lymphadenopathy. No pneumoperitoneum or ventral abdominal hernia. CT pelvis with contrast: Bladder, prostate and rectum are unremarkable. No free pelvic fluid or air. No inguinal or pelvic sidewall lymphadenopathy. Bones and soft tissues: No suspicious focal bone lesion. IMPRESSION: Mild distention of mid jejunum up to 3 cm with slight surrounding free fluid and two proximal and distal transition points. This could be seen in setting of partial or early small bowel obstruction or possibly enteritis, and is not suggestive of a high-grade obstruction.

10027557-RR-22

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2136-02-05 14:55:00

2136-02-05 16:08:00

CHEST, TWO VIEWS: ___. HISTORY: ___ female with weakness and altered mental status. COMPARISON: ___ and chest CT from ___. FINDINGS: Frontal and lateral views of the chest. Relatively low lung volumes are seen with secondary crowding of the bronchovascular markings. There is, however, no confluent consolidation nor effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified. Surgical clips in the right upper quadrant suggest prior cholecystectomy. IMPRESSION: No acute cardiopulmonary process.

10027557-RR-23

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2136-02-06 00:32:00

2136-02-06 11:21:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ year old woman with HCC, AMS and ? weakness on exam concern for possible head bleed. R/o head bleed TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain, intermediate and bone windows. Coronal and sagittal reformats were also performed. DOSE: DLP: 891 mGy-cm COMPARISON: None. FINDINGS: There is no acute intracranial hemorrhage,mass or midline shift. There is no hydrocephalus. The port introduced in the white matter including in the subcortical white matter which most likely due to small vessel disease. However, this study without contrast cannot exclude metastatic disease. Visualized paranasal sinuses and mastoid air cells are clear. There is no fracture. IMPRESSION: No acute abnormalities are seen. No hemorrhage identified. Small vessel disease. The metastatic disease is concerned, coronal post enhanced CT or MRI can help further assessment if indicated.

10027602-RR-37

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2201-10-30 11:01:00

2201-10-30 12:16:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with ICH, intubated // eval ETT TECHNIQUE: Single frontal view of the chest COMPARISON: ___ at 09:37 at outside institution FINDINGS: Endotracheal tube terminates approximately 2.6 cm above the level of the carina. An enteric tube courses below the level the diaphragm, inferior aspect not included on this study, but likely courses at least into the stomach. The lungs are clear without focal consolidation. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. IMPRESSION: Endotracheal tube terminates approximately 2.6 cm above the level of the carina. An enteric tube courses below the level the diaphragm, inferior aspect not included on this study, but likely courses at least into the stomach. Clear lungs.

10027602-RR-39

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2201-10-30 11:40:00

2201-10-30 12:31:00

EXAMINATION: Q1213 INDICATION: History: ___ with ich // ? extension of bleed TECHNIQUE: CT of the head was acquired. Following contrast administration and departmental protocol CT angiography of the head and neck was obtained. 3D and curved reformatted images were obtained on the independent workstation. . DOSE: DLP: 2319 mGy-cm COMPARISON: Outside head CT ___ FINDINGS: CT head shows intraventricular and subarachnoid hemorrhage which is predominantly in the quadrigeminal cistern, unchanged from the previous outside CT examination. There is ventriculomegaly with dilatation of the temporal horns indicating hydrocephalus which is unchanged. CT angiography of the neck shows normal appearance of the carotid and vertebral arteries without stenosis or occlusion or dissection. CT angiography of the head shows normal appearance of the arteries of the anterior and posterior circulation without stenosis or occlusion or aneurysm greater than 3 mm in size. No abnormal vascular structures are identified. Small hypodensities seen in both lobes of thyroid. IMPRESSION: Intraventricular and subarachnoid hemorrhage is unchanged. CT vessels no evidence of vascular occlusion, stenosis, dissection, or abnormal vascular structures or aneurysm greater than 3 mm in size. This report is provided without 3D and curved reformats. When these images are available, and if additional information is obtained, then an addendum may be given to this report.

10027602-RR-40

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2201-10-30 15:06:00

2201-10-30 16:14:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ year old woman with ICH and IVH s/p R frontal EVD placement. TECHNIQUE: Contiguous axial MDCT images were obtained through the brain without the administration of IV contrast. Reformatted coronal, sagittal and thin section bone algorithm-reconstructed images were then generated. DOSE: CTDIvol: ___ MGy DLP: ___ MGy-cm COMPARISON: CTA head study from ___ at 11:41. FINDINGS: Patient is now status post right frontal approach ventriculostomy catheter placement, with the tip terminating just beyond the septum pellucidum in the left lateral ventricle. There has been interval decrease in the size of the lateral ventricles, however there is still persistent dilatation of bilateral temporal ventricular horns. There is no evidence of hemorrhage along the catheter path. Since prior exam 4 hr ago, there is stable appearance of the intraventricular hemorrhage in bilateral lateral ventricles, third ventricle, and fourth ventricle. Subarachnoid hemorrhage that is predominantly in the quadrigeminal cistern is unchanged. Subdural hemorrhage in the posterior falx is also stable. There is no shift in midline structures. Gray-white matter is well differentiated without evidence of acute large territorial infarction. The paranasal sinuses, mastoid air cells, and middle ear cavities are clear. IMPRESSION: 1. Right frontal approach ventriculostomy catheter in appropriate position with interval decrease in the lateral ventricle sizes. No evidence of new hemorrhage. 2. Stable multi-compartment intracranial hemorrhage.

10027602-RR-41

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2201-10-30 14:47:00

2201-10-30 16:58:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman s/p ETT and NGT // confirm placement of ETT and NGT COMPARISON: ___ IMPRESSION: No relevant change as compared to the previous examination. Normal lung volumes. Unchanged monitoring and support devices no pneumothorax. No pulmonary edema. No pleural effusions.

10027602-RR-42

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2201-10-30 16:37:00

2201-10-30 17:07:00

EXAMINATION: CHEST PORT. LINE PLACEMENT INDICATION: ___ year old woman with new line placement // evaluate new line Contact name: ___: ___ COMPARISON: ___ IMPRESSION: As compared to the previous radiograph, the patient has received the new left subclavian line. The course of the line is unremarkable, the tip of the line projects over the cavoatrial junction. No complications, notably no pneumothorax. Unchanged position of nasogastric tube and endotracheal tube.

10027602-RR-43

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2201-11-02 01:43:00

2201-11-02 14:25:00

EXAMINATION: MRI AND MRA BRAIN INDICATION: ___ year old woman with IVH // for prognostication TECHNIQUE: Sagittal T1, axial T1 pre and postcontrast, diffusion weighted, gradient echo, FLAIR, T2, sagittal MP rage postcontrast sequences of the brain. 3D time-of-flight angiography of the brain with rotational reformats. 7 cc Gadavist. COMPARISON: CT head without contrast ___, CTA with and without contrast of ___. FINDINGS: MRI HEAD: Right frontal burr hole and ventriculostomy shunt is noted, the tip terminating at the level of the foramen ___. Again noted is intraventricular hemorrhage within the frontal horn of the right lateral ventricle, body of the left lateral ventricle, bilateral posterior horns, third ventricle, cerebral aqueduct and fourth ventricle, essentially unchanged in size and configuration from prior CT examinations of ___. There is diffuse ventriculomegaly, also essentially unchanged in size from prior exam. FLAIR hyperintense signal capping the ventricles is noted, consistent with transependymal flow. Gyriform focus of the slow diffusion of the medial left frontal lobe (series 8, image 25) is noted, with mild associated FLAIR hyperintense signal, compatible with the acute to subacute infarct. An additional periventricular punctate focus of slow diffusion along the posterior horn of the left lateral ventricle (series 8, image 18) is also noted, also likely representing a focus of acute infarct. The major intracranial flow voids are preserved. The paranasal sinuses are essentially clear. The orbits are unremarkable. Fluid signal is seen in the bilateral mastoids. HEAD MRA: Evaluation is slightly limited by motion artifact, particular at the level of the body of the lateral ventricles. Allowing for this limitation however normal flow related signal is seen in the intracranial internal carotid, middle cerebral and anterior cerebral arteries without significant mural irregularity or stenosis. There is normal symmetric arborization of the MCA branches. There is no aneurysm greater than 3 mm. Normal flow related signal is seen in the codominant intracranial vertebral arteries, the basilar artery, and the bilateral superior cerebellar and posterior cerebral arteries. Intraventricular hemorrhage within the third ventricles, anterior horn of the right lateral ventricle, body of the left lateral ventricle, bilateral posterior horns, cerebral aqueduct and fourth ventricle is noted, similar in configuration from a CTA examination of ___. IMPRESSION: 1. Diffuse intraventricular hemorrhage, unchanged in configuration from prior CT examinations. There is ventriculomegaly, unchanged from exam of ___ but significantly increased since exam of ___. 2. There are foci of slow diffusion involving the left frontal medial cortex as well as along the white matter of the posterior horn of the left lateral ventricle, likely representing late acute to subacute infarcts. NOTIFICATION: The findings were discussed by Dr. ___ with NP ___ on the telephone on ___ at 2:18 ___, 20 minutes after discovery of the findings.

10027602-RR-45

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2201-11-01 04:53:00

2201-11-01 09:43:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with IVH // evaluate for pulmonary process TECHNIQUE: Single frontal view of the chest COMPARISON: ___ IMPRESSION: Cardiac size is top normal. Bibasilar atelectasis have increased. If any there are small stable bilateral pleural effusions. ET tube is in standard position. Left subclavian catheter tip is at the cavoatrial junction. NG tube tip is in the stomach. There is no pneumothorax.

10027602-RR-46

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2201-11-03 11:03:00

2201-11-04 05:16:00

CLINICAL HISTORY: Patient is a ___ lady who presented with sudden onset of unconsciousness, fall and intraventricular and subarachnoid hemorrhage. Her CT angiography was suspected to have a vascular malformation. This is her first cerebral angiography for confirming any vascular abnormality. ATTENDING PHYSICIAN: Dr. ___. ASSISTANT: Dr. ___. PROCEDURE PERFORMED: Left common carotid artery roadmap angiography, left common carotid artery cerebral angiography, right common carotid artery roadmap angiography, right common carotid artery cerebral angiography, left vertebral artery angiography, right vertebral artery angiography. SEDATION: Moderate conscious sedation was provided by administering divided doses of 100 mcg of fentanyl and 2 mg of midazolam throughout the total intraservice time of 55 minutes during which the patient's hemodynamic parameters were continuously monitored. DESCRIPTION OF THE PROCEDURE: An informed consent was signed by the patient's daughter. The patient was brought to the angiography unit intubated and connected to ventilator. She was transferred to the angiography unit. After settling down her EVD and other vascular lines, a moderate conscious sedation was inducted as described below. Subsequently, using usual sterile techniques, the bilateral groins were prepped and draped. Subsequently, using a micropuncture set access to the right common femoral artery was obtained in a modified Seldinger technique. A 5 ___ sheath was inserted into the right common femoral artery. Subsequently, a 4 ___ Berenstein 2 catheter was connected to a continuous heparinized saline and a power injector and this catheter over the 0.035-inch Terumo wire was advanced into the aortic arch and left common carotid artery was navigated and this catheter was parked at the proximal left CCA. Subsequently, by injecting into this artery a roadmap angiography was performed to see the carotid bifurcation. Then by injecting into this artery, a cranial angiography of the internal and external carotid arteries in AP, lateral and oblique projections were performed. Then, the catheter was pulled down to the aortic arch and left vertebral artery was navigated using a roadmap by injecting into the left subclavian artery. The catheter was advanced into the proximal left vertebral artery and by injecting into this artery, the cranial angiography of the vertebrobasilar system was performed in the AP, lateral and oblique projections. Then the catheter was advanced into the right common carotid artery and a roadmap angiography was performed to the carotid bifurcation. Then by injecting into this artery, the cranial angiography of the right ICA and ECA are obtained in AP, lateral and oblique projections. Finally the catheter was pulled down into the aortic arch and the right vertebral artery was also navigated and catheter was advanced into this artery. By injecting into this artery the right vertebrobasilar angiography was also performed in AP, lateral and oblique projections. At the end, we exchanged the 5 ___ short femoral sheath with a 6 ___ easy flex femoral sheath and we kept a line for tomorrow's embolization procedure. We fixed the femoral sheath in place using a stitch and connect it to heparinized saline flush and also recommended to be transfused. No procedure-related complication was noted. FINDINGS: The left common carotid artery angiogram showed opacification of the left ICA and ECA in normal size and shape without significant carotid stenosis. The intracranial angiography of the left internal carotid artery shows very well opacification of its petrous, cavernous and supraclinoid along with its terminal MCA and ACA branches. There is no evidence of aneurysm or arteriovenous malformation in this territory. The left ICA and ECA are not contributed in any dural AV fistula. The cranial branches of the left internal carotid arteries also seen very well without any evidence of participating into a dural AV fistula. Injection into the left subclavian artery and obtaining a roadmap angiogram showed normal origin of the left vertebral artery from the subclavian artery. The cranial vertebrobasilar angiogram shows very well opacification of the V4 segment of the vertebral artery, basilar artery along with its ICA and superior cerebellar artery and PCA branches. It is obviously seen that the posterior meningeal artery has hypertrophied and finally at the tentorial edge is connecting into the small venous pouch which found to be fistulous area and this venous pouch is finally draining via a single vein into the straight sinus. Moreover as it is seen in the lateral angiogram some posterior cerebral artery branches are also connecting into this fistulous connection which signifies the dual feeding into this artery. It is not very well clear, however it sounds that the middle branch from the left superior cerebral artery is also involving this dural AV fistula. As the arteriovenous abnormal connection is at the level of the cortical vein, therefore, this is considered as a type 3 Cognard dural AV fistula. Injection into the right vertebral artery shows opacification of a ___, AICA and superior cerebellar artery and PCAs with retrograde filling of the left vertebral artery and therefore a posterior meningeal artery which results in opacification of the dural AV fistula by injecting in this side also. No other vascular abnormality is seen in this angiogram. Injection into the right common carotid artery shows unremarkable carotid bifurcation with very tortuous cervical part of the ICA and ECA. The cranial angiography of the right internal carotid artery shows opacification of its petrous, cavernous and supraclinoid segments along with the ACA and MCA branches. The anterior communicating artery and contralateral A2 is not filling through this angiogram and just right ACA is seen along with its recurrent Heubner. The cranial branches of the external carotid artery including middle meningeal artery and superficial temporal artery are also seen very well without any obvious contribution into the dural AV fistula. No aneurysm or AVM or other vascular abnormalities seen by injecting into the right common artery. The capillary and venous phase of this angiogram also looks normal. Also there is no contribution from these arteries into the dural AV fistula was noted. No procedure-related thromboembolic complication was noted. IMPRESSION: A cerebral angiography on this ___ lady who had a recent collapse, IVH and subsequent hemorrhage showed a dural AV fistula is found that the left posterior tentorial edge fed mainly by a posterior meningeal branch of the left vertebral artery. Other contributions are seen into this dural AV fistula are from the left posterior cerebral artery and probably from the left superior cerebral artery. At this arteriovenous connection is at the level of a cortical vein which finally drains into the straight sinus. This is considered to type 3 Cognard dural AV fistula. Patient has been considered for attempt embolization tomorrow. No procedure-related complication was noted. This procedure was performed by Dr. ___ and Dr. ___.

10027602-RR-47

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2201-10-31 18:19:00

2201-10-31 18:37:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ year old woman with IVH, now posturing // evaluate for interval change, please obtain STAT TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain, intermediate and bone windows. Coronal and sagittal reformats were also performed. DOSE: Please see PACs ___ FINDINGS: There is extensive intraventricular hemorrhage within the lateral ventricles, third ventricle and fourth ventricle. The basal cisterns are patent. No intraparenchymal hemorrhage is noted. A ventriculostomy catheter terminates at the foramen of ___. The ventricles are prominent size suggesting hydrocephalus. No extra-axial collections. Midline structures are midline. Gray-white matter differentiation is preserved. No evidence of acute vascular territory infarct. IMPRESSION: Diffuse intraventricular hemorrhage. Increase in ventricular size particularly of the temporal horns slightly compared with the previous CT of ___.

10027602-RR-48

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2201-11-04 08:41:00

2201-11-06 16:02:00

PREOPERATIVE DIAGNOSIS: Dural AV fistula with hemorrhage. PROCEDURES PERFORMED: Left vertebral artery arteriogram, left posterior meningeal artery arteriogram, left external carotid artery arteriogram, left common carotid artery arteriogram, right external carotid artery arteriogram. Rotational angiography of left vertebral artery with post-processing on a separate workstation with concurrent physician ___. Final images used for interpretation and for guidance of interventional procedure. INTERVENTIONAL PROCEDURE PERFORMED: Onyx embolization of left posterior meningeal artery. ATTENDING PHYSICIAN: ___, M.D. ASSISTANT: ___, M.D. ANESTHESIA: General. DETAILS OF THE PROCEDURE: The patient was brought to the angiography suite. IV sedation was given. Following this, both groins were prepped and draped in a sterile fashion. Access was gained to the right common femoral artery using a Seldinger technique and a 5 ___ vascular sheath was placed in the right common femoral artery. We now catheterized the left vertebral artery and AP, lateral filming was done along with three-dimensional rotational angiography. This demonstrated that the posterior meningeal artery was the main supply to the dural AV fistula. At this point, I catheterized the left vertebral artery with a 6 ___ Neuron catheter and this was connected to a continuous saline flush. We now catheterized the left posterior meningeal artery with a Marathon catheter and this demonstrated a dural AV fistula with a large draining vein coursing to the vein of ___. Several attempts were made to pass the catheter more distally; however, this was unsuccessful and therefore Onyx embolization was performed from the posterior meningeal artery. Though the posterior meningeal artery was obliterated, we were unable to get distal enough to penetrate the fistulous communication itself. At this point, we did a left common carotid artery arteriogram and a left external carotid artery arteriogram, which did not show any significant supply from the common carotid artery. A right vertebral artery arteriogram was done which showed no new areas of supply to the fistula. Right common carotid artery arteriogram and a right external carotid artery arteriogram was done. This revealed supply from the right middle meningeal artery. We attempted to catheterize the right middle meningeal artery; however, this was prevented by severe spasm of the internal maxillary artery secondary to the initial Glidewire. Therefore, we stopped the procedure, planning to bring her back on another day. The right common femoral artery sheath was removed and manual pressure applied for closure of the site. Left vertebral artery arteriogram shows that the left posterior meningeal artery supplies the dural AV fistula. Left posterior meningeal artery shows that there is significant supply going along the branch, which courses along the tentorium and then seen a fistulous communication into vein that drains along with the straight sinus into the torcula. Left external carotid artery arteriogram shows no evidence of supply to the dural AV fistula. Left common carotid artery arteriogram again demonstrates no evidence of dural AV fistula, specifically there are no tentorial branches supplying the fistula. Right vertebral artery arteriogram demonstrates that there is no evidence of supply to the dural AV fistula. The right external carotid artery arteriogram shows supply to the dural AV fistula, most likely through branches of the middle meningeal artery. Because of the severe spasm, the opacification of the fistula is not apparent. IMPRESSION: ___ underwent cerebral angiography and embolization of posterior meningeal artery, which was supplying dural AV fistula. The veins predominantly drain into the vein ___ system and into the straight sinus and into the torcula. The patient tolerated the procedure well. There were no complications. She will be brought back for additional embolization to the right middle meningeal artery.