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10002428-RR-68

RR

2156-04-16 02:22:00

2156-04-16 10:32:00

INDICATION: ___ woman with C. difficile colitis and increasing oxygen requirement. FINDINGS: A single portable semi-erect chest radiograph was obtained. Small left and moderate layering right pleural effusions have increased in size since the preceding day's exam. The right middle lobe pnemonia seen on recent CT is not clearly differentiated, but the right heart border is obscured. Left basilar atelectasis is stable. No new focal consolidation or pneumothorax is present. Hila remain indistinct. A left-sided PICC line tip remains in the upper SVC. IMPRESSION: Interval increase inmoderate to large right and small left pleural effusions. Persistent right basilar pneumonia.

10002428-RR-69

RR

2156-04-17 03:23:00

2156-04-17 12:54:00

AP CHEST, 4 A.M. ON ___ HISTORY: ___ woman with colitis and aggressive intravenous fluids, now requiring oxygen. IMPRESSION: AP chest compared to ___: Moderate bilateral pleural effusions, right greater than left, both increased since ___, causing more atelectasis at both lung bases. No pulmonary edema. Heart size is normal. Left PIC line ends in the left brachiocephalic vein. No pneumothorax.

10002428-RR-70

RR

2156-04-18 09:10:00

2156-04-18 19:36:00

ABDOMEN, 9:28 A.M., ___ HISTORY: ___ woman with severe C. difficile colitis. Bowel dilated previously, persistently distended belly. Evaluate interval change. IMPRESSION: Supine view of the abdomen shows that the entire colon is still distended. The maximum diameter of the proximal transverse colon, 74 mm, was 71 mm on ___, and the distal transverse colon 70 mm, was 65 mm on ___. In addition, there may be small regions of pneumatosis in the wall of the colon, in the distal third of the transverse colon and in the mid descending colon. There is no clear evidence of pneumoperitoneum or mass effect in the abdomen, but the supine view alone is not sensitive in detecting small volumes of pneumoperitoneum. Dr. ___ was paged at 7:03 pm., three minutes after the findings were recognized; I discussed the findings of possible progressing colitis with Dr ___, who responded, at 7:10pm.

10002428-RR-71

RR

2156-04-19 09:08:00

2156-04-19 11:52:00

CLINICAL HISTORY: ___ woman with severe C. diff dilated colon. Evaluate for interval change. COMPARISON: ___. SINGLE AP PORTABLE VIEW: Again noted is colonic distention up to 7 cm around the splenic flexure, similar in size and configuration to the prior study. Bony structures are stable. No signs of pneumoperitoneum based on the limited supine film.

10002428-RR-72

RR

2156-04-19 09:07:00

2156-04-19 10:19:00

AP CHEST, 9:27 A.M., ___ HISTORY: Severe C. difficile colitis. Aggressive volume resuscitation. Worsening tachypnea. IMPRESSION: AP chest compared to ___: Moderate to large right and moderate left pleural effusions have both increased in size. Upper lungs are clear. Heart is obscured by the effusions, but not substantially enlarged. No free subdiaphragmatic gas. Left PIC line ends in the left brachiocephalic vein.

10002428-RR-73

RR

2156-04-19 21:22:00

2156-04-19 23:49:00

INDICATION: ___ woman with severe C. diff colitis and acute mental status changes with hypercarbia, the left arm pain, assess for acute intracranial process. COMPARISONS: ___. TECHNIQUE: Contiguous axial images were obtained through the brain without intravenous contrast. Coronal and sagittal reformations were prepared. FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect, or major vascular territorial infarction. There is no shift of normally midline structures. Ventricles and sulci are mildly prominent, compatible with age-related involutional changes. Periventricular white matter hypodensities suggest chronic small vessel ischemic disease. Punctate basal ganglial calcifications are seen, more pronounced on the right. There is no fracture. Imaged paranasal sinuses and mastoid air cells demonstrate minimal ethmoid air cell mucosal thickening. Mild right greater than left temporomandibular joint degenerative disease is noted. IMPRESSION: No acute intracranial process.

10002428-RR-75

RR

2156-04-19 21:35:00

2156-04-20 08:55:00

CHEST RADIOGRAPH INDICATION: Severe colitis, status post intubation and line placement. COMPARISON: ___. FINDINGS: The image is compared to ___. The left PICC line remains in place. In the interval, the patient has been intubated. The tip of the endotracheal tube projects approximately 3 cm above the carina. The nasogastric tube shows a normal course, the tip of the tube projects over the middle parts of the stomach. The patient has also received a right internal jugular vein catheter, tip of the catheter projects over the right atrium and should be pulled back by approximately 3-4 cm. There is no evidence of complications, the relatively extensive right pleural effusion and the small-to-moderate left pleural effusion show different distributions but unchanged severity. Atelectatic changes at both lung bases but no evidence of acute lung disease appeared in the interval. Unchanged intestinal distention.

10002428-RR-76

RR

2156-04-20 00:35:00

2156-04-20 06:30:00

HISTORY: ___ female with C. diff colitis and altered mental status, question worsening colitis. COMPARISON: ___. TECHNIQUE: Helical CT images were acquired of the abdomen and pelvis following the administration of oral and intravenous contrast, and reformatted in coronal and sagittal planes. FINDINGS: LUNG BASES: There are large bilateral pleural effusions, significantly increased compared with the prior study, with adjacent compressive atelectasis. ABDOMEN: There has been an interval increase in abdominal ascites, which is now moderate. The liver, spleen are normal appearing. The pancreas is normal in appearance, with a mildly prominent pancreatic duct. The gallbladder is distended, though there is no wall thickening, or stones. The adrenals are normal in appearance bilaterally. Kidneys demonstrate symmetric contrast enhancement and brisk bilateral excretion. The stomach is opacified by positive contrast. Loops of small bowel are normal in caliber. The small bowel mesentery is normal appearing. There is atherosclerosis at the origin of the celiac and SMA, though these remain patent. PELVIS: The colon is again noted to be hyperenhaceing, dilated and ahaustral, though this is not significantly changed on ___, and is in keeping with C. difficile colitis. The uterus contains coarse calcification and is otherwise normal in appearance. The bladder contains a Foley catheter and is unremarkable. BONE WINDOWS: There is no concerning lytic or blastic osseous lesion. There is diffuse anasarca. IMPRESSION: Interval increase in bilateral pleural effusions, and in abdominal ascites. The colon remains dilated and ahaustral, in keeping with C. difficile colitis.

10002428-RR-77

RR

2156-04-20 01:03:00

2156-04-20 10:18:00

INDICATION: ___ woman status post right IJ CVL line adjustment. COMPARISONS: ___ to ___. FINDINGS: A single portable AP chest radiograph was obtained. Since the prior exam, a right internal jugular line has been retracted with the tip now located in the upper right atrium. Endotracheal tube tip remains 4 cm above the carina. An enteric catheter extends inferiorly off the film. Moderate right greater than left pleural effusions are unchanged. Bibasilar atelectasis is unchanged. No pneumothorax or new consolidation is present. Cardiac and mediastinal contours are unremarkable. IMPRESSION: Successful retraction of right IJ catheter to the upper right atrium. Stable moderate right and small left pleural effusions.

10002428-RR-78

RR

2156-04-21 02:22:00

2156-04-21 10:23:00

SINGLE FRONTAL VIEW OF THE CHEST REASON FOR EXAM: Respiratory failure, intubated. Comparison is made with prior study ___. Large right and moderate left pleural effusions are unchanged. Cardiomediastinal contours are normal. Right IJ catheter tip is at the cavoatrial junction. ET tube is in standard position. NG tube tip is out of view below the diaphragm. There is no evident pneumothorax.

10002428-RR-79

RR

2156-04-21 07:31:00

2156-04-21 10:30:00

CLINICAL HISTORY: ___ woman with severe C. diff. Question free air. COMPARISON: ___. FINDINGS: Areas the transverse colon measure up to 7.5 cm. Left lateral decubitus films do not show evidence of pneumoperitoneum. Bony structures are stable. Opacity in the bladder/rectal area is likely contrast from the contrast study dated ___. IMPRESSION: No evidence of pneumoperitoneum.

10002428-RR-80

RR

2156-04-22 02:20:00

2156-04-22 09:09:00

CHEST RADIOGRAPH INDICATION: Colitis, respiratory failure, evaluation for interval change, evaluation for pleural effusion. COMPARISON: ___. FINDINGS: As compared to the previous radiograph, the monitoring and support devices are constant. Constant extent and distribution of the known left pleural effusion with mild to moderate retrocardiac and basal atelectasis. On the right, the pleural drain is in unchanged position and there is no evidence of a larger pleural effusion. No pneumothorax. Unchanged size of the heart.

10002428-RR-81

RR

2156-04-21 10:55:00

2156-04-21 11:40:00

SINGLE FRONTAL VIEW OF THE CHEST REASON FOR EXAM: Status post right thoracentesis and pigtail catheter placement. Comparison is made with prior study performed nine hours earlier. There is decrease in now small right pleural effusion. There is no pneumothorax. There is a new right pacer pigtail catheter. Cardiomediastinal contours are unchanged. Lines and tubes are in standard position. Left lower lobe opacities, a combination of pleural effusion and atelectasis, are unchanged.

10002428-RR-82

RR

2156-04-21 17:16:00

2156-04-22 17:04:00

INDICATION: ___ woman with C. diff colitis, slightly increased abdominal distention. Evaluate for perforation or interval change. COMPARISON: Portable abdominal radiograph from ___. CT abdomen and pelvis from ___. FINDINGS: There is an NG tube within the stomach. There is distention of the transverse colon with thumbprinting compatible with known colitis. There is no evidence of free air; however, this study is not tailored for free air since it is a supine radiograph. Bony structures are unremarkable. Degenerative changes are present in the lumbar spine. IMPRESSION: Dilated colon with areas of thumbprinting, consistent with known colitis. No evidence of free air, although this is not evaluated well on supine radiographs; recommend upright and left lateral decubitus.

10002428-RR-83

RR

2156-04-23 02:46:00

2156-04-23 10:28:00

INDICATION: ___ woman with C. diff colitis, recent decompensation and pleural effusions, status post right thoracentesis and pigtail placement. COMPARISONS: ___. FINDINGS: A single portable chest radiograph is obtained. Endotracheal and enteric tubes have been removed. A right internal jugular catheter tip terminates in the right atrium. A right pleural drain remains in the right base. A tiny right effusion and small left effusion are visualized. Cardiac contours are unchanged. No consolidation, pneumothorax or nodules present. A left-sided PICC line tip terminates in the left brachiocephalic vein. IMPRESSION: Unchanged appearance of small bilateral pleural effusions status post extubation.

10002428-RR-84

RR

2156-04-24 03:40:00

2156-04-24 10:22:00

STUDY: AP chest, ___. CLINICAL HISTORY: ___ woman with C. diff sepsis. Severe mitral regurgitation. Evaluate for placement of various central lines. FINDINGS: Comparison is made to previous study from ___. There has been removal of the right IJ central venous line. There is again seen a large amount of loculated pleural fluid along the left chest, which has increased in size since the prior study. Pigtail catheter is seen within the right lower lobe. Cardiac silhouette is upper limits of normal. There is mild prominence of the pulmonary markings without overt pulmonary edema.

10002428-RR-85

RR

2156-04-24 22:08:00

2156-04-25 10:14:00

STUDY: AP chest ___. CLINICAL HISTORY: Patient with Dobbhoff tube placement. FINDINGS: Comparison is made to prior study from ___ at 4:05 a.m. There is a Dobbhoff tube whose distal tip is within the mid-to-distal esophagus. This could be advanced 15 to 20 cm for more optimal placement. Cardiac silhouette is within normal limits. There are bilateral pleural effusions, left side worse than right and a left retrocardiac opacity. No overt pulmonary edema is seen.

10002428-RR-86

RR

2156-04-24 22:17:00

2156-04-25 10:14:00

STUDY: AP chest, ___. CLINICAL HISTORY: Patient with advancement of the Dobbhoff tube. FINDINGS: Distal tip of the Dobbhoff is now in the fundus of the stomach. This could be advanced an additional 5 cm for more optimal placement. There are unchanged bilateral pleural effusions, left greater than right. A pleural catheter is seen at the right base. There are no pneumothoraces identified.

10002428-RR-87

RR

2156-04-26 03:24:00

2156-04-26 09:28:00

STUDY: AP chest ___. CLINICAL HISTORY: ___ woman with aspiration pneumonia, left-sided pleural effusion. Evaluate for worsening effusion. FINDINGS: Comparison is made to previous study from ___. There is a Dobbhoff tube whose distal tip is in the body of the stomach. There are bilateral pleural effusions. There is a right-sided pleural-based catheter. There is no pneumothoraces or signs for overt pulmonary edema. Overall, these findings are stable since prior study from ___.

10002428-RR-88

RR

2156-04-30 19:19:00

2156-04-30 21:59:00

PORTABLE CHEST: ___. HISTORY: ___ female with shortness of breath. FINDINGS: Single portable view of the chest is compared to previous exam from ___. Enteric tube is seen with tip off the inferior field of view. Left PICC is seen; however, tip is not clearly delineated. Persistent bibasilar effusions and a right pigtail catheter projecting over the lower chest. There is possible right apical pneumothorax. Superiorly, the lungs are clear of consolidation. Cardiac silhouette is within normal limits. Osseous and soft tissue structures are unremarkable. IMPRESSION: No significant interval change with bilateral pleural effusions with right pigtail catheter in the lower chest. Possible small right apical pneumothorax.

10002428-RR-89

RR

2156-04-30 20:47:00

2156-04-30 22:59:00

INDICATION: ___ female with tachypnea and low-grade temperature, evaluate pulmonary embolism. COMPARISON: ___. TECHNIQUE: MDCT axial images were obtained through the chest without the administration of IV contrast. Multiplanar reformats were generated and reviewed. CT OF THE CHEST: The visualized lungs demonstrate bilateral pleural effusions, moderate on the right, trace on the left with adjacent compressive atelectasis. A pigtail catheter is noted draining the pleural fluid on the right. The pulmonary vasculature shows no evidence of filling defects to suggest a pulmonary embolism. There is no evidence of acute aortic injury. Mediastinal, axillary and hilar lymph nodes do not meet CT size criteria for pathology. Feeding tube is noted extending into the stomach with tip not clearly visualized on the field of view provided. The study is not optimized for subdiaphragmatic evaluation. Within this limitation again noted is ascites. Limited evaluation of the upper abdominal structures is unremarkable. Visualized osseous structures show no focal lytic or sclerotic lesion suspicious for malignancy. IMPRESSION: 1. No evidence of pulmonary embolism. 2. Bilateral pleural effusions, small to moderate on the left, decreased since the most recent prior examination and trace on the right, markedly decreased compared to ___ with pigtail catheter noted in place on the right. 3. Ascites.

10002428-RR-91

RR

2156-05-11 11:59:00

2156-05-11 13:27:00

INDICATION: ___ female with new intubation. Evaluate tube placement. COMPARISONS: None. FINDINGS: Frontal supine view of the chest was obtained. The heart is of normal size with normal cardiomediastinal contours. The right hemithorax demontrates increased opacity, compatible with a moderate-to-large size layering pleural effusion. A small left pleural effusion is also present. No pneumothorax is seen. A right PICC line terminates in the axilla. Endotracheal tube terminates 1.8 cm above the carina. A Dobbhoff feeding tube and a gastric tube terminate below the diaphragm. The sidehole of the gastric tube is positioned in the distal esophagus. IMPRESSION: 1. Bilateral pleural effusion, right greater than left. Underlying consolidation cannot be completely excluded. 2. Endotracheal tube terminates 1.8 cm above the carina. Recommend repositioning. 3. NG tube terminates in stomach with sidehole in distal esophagus. 3. Right PICC terminates in the axilla.

10002428-RR-92

RR

2156-05-11 12:42:00

2156-05-11 13:46:00

INDICATION: ___ female with altered mental status. Evaluate for intracranial hemorrhage. COMPARISONS: None. TECHNIQUE: Contiguous axial MDCT images were obtained through the brain without administration of IV contrast. Axial images were interpreted in conjunction with coronal and sagittal reformats. FINDINGS: There is no evidence of hemorrhage, edema, infarction, or mass effect. The ventricles and sulci are prominent, suggesting age-related involutional changes or atrophy. Periventricular white matter hypodensities are compatible with chronic small vessel ischemic disease. Basal cisterns appear patent, and there is preservation of gray-white matter differentiation. No fracture is identified. There is fluid within the nasal cavity, likely secondary to intubated state. Atherosclerotic mural calcifications of the internal carotid arteries are present. The visualized paranasal sinuses, mastoid air cells, and middle ear cavities are otherwise clear. Bilateral ocular lenses have been replaced. IMPRESSION: No intracranial hemorrhage or mass effect.

10002428-RR-93

RR

2156-05-11 16:57:00

2156-05-11 17:55:00

INDICATION: Respiratory failure. COMPARISON: ___. SEMI-UPRIGHT AP VIEW OF THE CHEST: Endotracheal tube has been slightly withdrawn in the interval, now terminating approximately 5 cm from the carina. A Dobbhoff tube is noted with tip in the fundus of the stomach. A nasogastric tube is also seen, with tip at the level of the gastroesophageal junction, and side port within the distal esophagus, in unchanged position. The cardiac, mediastinal and hilar contours are stable. Moderate to large right and small left bilateral pleural effusions are again noted. Bibasilar compressive atelectasis is present. There is no pneumothorax. There is no pulmonary vascular congestion. No acute osseous abnormality is present. The right PICC remains unchanged in position, with tip terminating in the region of the axillary/subclavian vein. IMPRESSION: 1. Endotracheal tube has been withdrawn, now lying approximately 5 cm from the carina. 2. Unchanged positioning of the orogastric tube with tip at the gastroesophageal junction and side port in the distal esophagus. This should be advanced for appropriate positioning. 3. Bilateral pleural effusions, moderate to large on the right and small on the left with bibasilar atelectasis.

10002428-RR-94

RR

2156-05-11 18:41:00

2156-05-12 09:50:00

AP CHEST, 6:46 P.M., ___ HISTORY: ___ woman with respiratory failure. Enteric tube advanced. IMPRESSION: AP chest compared to ___ and ___, 5:05 p.m.: The enteric tube has been advanced to the distal stomach and out of view. Feeding tube ends in the upper stomach. ET tube is in standard placement. Moderate right and smaller left pleural effusions are unchanged. Heart size is normal size. Aside from attendant basal atelectasis, lungs are clear. There is no pneumothorax. Right PIC line ends in the right axilla.

10002428-RR-95

RR

2156-05-12 04:03:00

2156-05-12 09:35:00

SINGLE FRONTAL VIEW OF THE CHEST REASON FOR EXAM: Respiratory failure. Comparison is made with prior study, ___. Cardiac size is normal. Large right and moderate left pleural effusions are grossly unchanged allowing for differences in positioning of the patient. NG tubes are in the stomach. ET tube is in the standard position. Right peripherally inserted catheter tip is in the right subclavian vein, unchanged.

10002428-RR-96

RR

2156-05-13 04:14:00

2156-05-13 10:19:00

INDICATION: ___ woman with respiratory failure, assess for interval change. COMPARISONS: ___ Endotracheal tube has been removed. The nasogastric and feeding tubes course into the stomach. Large right and moderate left effusions are slightly increased from the previous day's examination, though similar in distribution to the third study from ___ perhaps due to differences in positioning. Accompanying atelectasis is unchanged. Cardiac size and silhouette is normal without pulmonary edema. IMPRESSION: Large right and moderate left pleural effusions as above.

10002428-RR-97

RR

2156-05-15 08:16:00

2156-05-15 12:41:00

STUDY: AP chest ___. CLINICAL HISTORY: Patient with placement of PICC line. FINDINGS: Comparison is made to previous study from ___. There is an endotracheal tube whose distal tip is 5.6 cm above the carina. There is a left-sided central line with distal lead tip in the distal SVC. There is a feeding tube and a nasogastric tube whose tips and side ports are below the GE junction. There are persistent bilateral pleural effusions and a left retrocardiac opacity.

10002428-RR-98

RR

2156-05-17 03:20:00

2156-05-17 11:06:00

INDICATION: Pseudomonas UTI, hypoxic respiratory failure secondary to chronic deconditioning. COMPARISON: Most recent chest radiographs from ___ dating back to ___. FINDINGS: A bedside AP radiograph of the chest demonstrates interval improvement in mild pulmonary edema compared to the most recent study from ___. A moderate right pleural effusion is stable and a small left pleural effusion has also decreased in size. Aside from persistent bibasilar atelectasis, the lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. An endotracheal tube terminates no less than 4.6 cm above the carina. A left PICC terminates in the mid SVC. A Dobbhoff tube terminates in the stomach and a second enteric tube enters the stomach and courses inferiorly beyond the field of view. IMPRESSION: Compared to the most recent study, there is improvement in the mild pulmonary edema and decrease in the small left pleural effusion. Moderate right pleural effusion and bibasilar atelectasis are stable.

10002428-RR-99

RR

2156-05-18 02:30:00

2156-05-18 09:44:00

INDICATION: ___ woman with pseudomonas UTI, intubated for hypoxic respiratory failure, assess for interval change. COMPARISONS: ___. Portable semi-upright chest radiograph is presented for review. Endotracheal tube terminates 2.3 cm above the carina. Nasogastric and Dobbhoff tubes course into the stomach and out of view. Bilateral right greater than left moderate pleural effusions and bibasilar atelectasis are unchanged without new pulmonary opacities and unchanged mild pulmonary edema. Left PICC is unchanged.

10002430-RR-54

RR

2125-09-28 16:16:00

2125-09-28 16:27:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ with DOE // pulm edema? COMPARISON: Prior study from ___. FINDINGS: PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips again noted. Suture is again noted in the right lower lung with adjacent rib resection. There is mild scarring in the right lower lung as on prior. There is no focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. The heart remains moderately enlarged. The mediastinal contour is stable. IMPRESSION: Postsurgical changes in the right hemi thorax. Mild cardiomegaly unchanged. No edema or pneumonia.

10002430-RR-55

RR

2125-09-28 20:31:00

2125-09-28 21:49:00

EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: History: ___ with acute R heart failure. SOB // 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 2.0 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0 mGy-cm. 2) Spiral Acquisition 3.2 s, 24.6 cm; CTDIvol = 11.7 mGy (Body) DLP = 288.0 mGy-cm. Total DLP (Body) = 291 mGy-cm. COMPARISON: Comparison is made with CT abdomen and pelvis from ___. And CT chest from ___. FINDINGS: 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 main pulmonary artery is dilated, which can be seen with pulmonary arterial hypertension. There is moderate to severe cardiomegaly. The pericardium is 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: Extensive emphysematous changes are noted throughout the lungs. A suture line is seen in the right lung base, consistent with prior right lower segmentectomy. Bibasilar atelectasis is seen. Lungs are clear without masses or areas of parenchymal opacification. 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: There is a small hiatal hernia. Otherwise, the included portion of the upper abdomen is unremarkable. BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. Confluent anterior osteophytes are noted, consistent with DISH. IMPRESSION: 1. No evidence of pulmonary embolism or aortic abnormality. 2. Main pulmonary artery is dilated, which can be seen with pulmonary arterial hypertension. 3. Moderate to severe cardiomegaly. 4. Extensive pulmonary emphysema.

10002557-RR-78

RR

2152-11-12 21:12:00

2152-11-12 23:51:00

EXAMINATION: CHEST RADIOGRAPHS INDICATION: Epigastric and chest pain. TECHNIQUE: Chest, PA and lateral. COMPARISON: ___. FINDINGS: The heart is mildly enlarged with a left ventricular configuration. There is mild unfolding of the thoracic aorta. The cardiac, mediastinal and hilar contours appear stable. There is a small eventration of the right hemidiaphragm. The lungs appear clear. Mild degenerative changes are similar along the visualized thoracic spine. Right breast is absent. IMPRESSION: No evidence of acute cardiopulmonary disease.

10002557-RR-79

RR

2152-11-12 20:38:00

2152-11-12 21:16:00

EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: History: ___ with colicky RUQ Pain // r/o cholecystitis TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: Right upper quadrant ultrasound dated ___ and is CT 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 CBD measures 10 mm. GALLBLADDER: There is a porcelain gallbladder with calcification of the wall of the gallbladder, similar to previous. No associated mass is seen. PANCREAS: Imaged portion of the pancreas appears within normal limits, without masses or pancreatic ductal dilation, with portions of the pancreatic tail obscured by overlying bowel gas. SPLEEN: Normal echogenicity, measuring 9.4 cm. KIDNEYS: Limited views of the right kidney are unremarkable. Note is made of a dual collecting system. No hydronephrosis seen. RETROPERITONEUM: Visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. Porcelain gallbladder with calcification of the wall of the gallbladder, similar to previous. Stable dilatation of the common bile duct.

10002557-RR-81

RR

2152-11-15 11:46:00

2152-11-15 16:21:00

EXAMINATION: ABDOMEN (SUPINE ONLY) INDICATION: ___ female with laparoscopic cholecystectomy. TECHNIQUE: Intraoperative cholangiogram. FINDINGS: 2 fluoroscopic images were taking without a radiologist present. Contrast is seen opacifying the remaining biliary system, without filling defect. IMPRESSION: Intraoperative cholangiogram. Please see intraoperative note for additional details.

10002559-RR-8

RR

2179-06-05 02:57:00

2179-06-05 09:16:00

CHEST RADIOGRAPH INDICATION: Unexplained fever, evaluation for pneumonia. COMPARISON: No comparison available at the time of dictation. FINDINGS: Mild thoracic scoliosis with subsequent asymmetry of the rib cage. The lung volumes are normal. Normal appearance of the cardiac silhouette. No pleural effusions, no pneumothorax. No lung parenchymal abnormalities such as pneumonia or pulmonary edema. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures.

10002930-RR-19

RR

2196-04-14 09:57:00

2196-04-14 10:22:00

HISTORY: Altered mental status. TECHNIQUE: Contiguous axial MDCT images were obtained through the brain without the administration of IV contrast. Reformatted coronal and sagittal and thin section bone algorithm-reconstructed images were acquired. DLP: 1337mGy-cm. CTDIvol: 110 mGy. COMPARISON: None available. FINDINGS: There is no hemorrhage, mass effect or midline shift, edema, or acute infarct. The basal cisterns are patent and there is normal gray-white matter differentiation. Encephalomalacia in the left parietal lobe with mild ex vacuo dilatation of the left lateral ventricle and overlying bony defect may be sequela of prior trauma. The ventricles and sulci are otherwise unremarkable. No other bony abnormality is seen. The visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The orbits are unremarkable. Prominence of the posterior nasopharyngeal soft tissues is noted. IMPRESSION: 1. No acute intracranial abnormality. 2. Prominence of the posterior nasopharyngeal soft tissues is seen and correlation with direct visualization is recommended. 3. Encephalomalacia in the left parietal lobe with overlying bony defect, possibly from prior trauma.

10002930-RR-21

RR

2198-04-17 15:31:00

2198-04-17 16:34:00

EXAMINATION: Chest radiograph. INDICATION: ___ with EtOH, repeat head strikes, mid thoracic spine pain TECHNIQUE: Chest AP upright and lateral COMPARISON: None FINDINGS: AP upright and lateral views the chest were provided. Mild left basal atelectasis. Lungs are otherwise clear. No signs of pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm. IMPRESSION: 1. Mild left basal atelectasis. Otherwise unremarkable. 2. No definite displaced rib fracture though if there is continued concern dedicated rib series may be performed to further assess.

10002930-RR-22

RR

2198-04-17 16:27:00

2198-04-17 17:54:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with EtOH, repeat head strikes, mid thoracic spine pain // Eval for acute injury TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. DOSE: Total DLP (Head) = 1,003 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence of acute major vascular territorial infarction, hemorrhage, edema or large mass. A small, focus of encephalomalacia of the left parietal periventricular white matter is unchanged. There is minimal opacification of the mastoid air cells on the left. Otherwise, the visualized portion of the paranasal sinuses,and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. No acute calvarial fracture. There is a chronic appearing defect within the left parietal bone. IMPRESSION: 1. No acute intracranial abnormality. 2. Stable left periventricular encephalomalacia.

10003019-RR-39

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2174-10-21 10:44:00

2174-10-21 11:30:00

HISTORY: ___ male with severe diffuse abdominal pain. Evaluate for free air. COMPARISON: Multiple prior chest radiographs, most recently of ___. FINDINGS: Single frontal view of the chest was obtained. Free air is present underneath both hemidiaphragms. Lung volumes are low. The vascular pedicle is widened and there is slightly increased rightward shift of the trachea, which may be projectional. Multi focal ill-defined lung opacities are similar to prior and consistent with history of sarcoidosis although superimposed infection cannot be excluded. No pneumothorax or substantial pleural effusion. Chain sutures in the right mid lung are similar to prior. IMPRESSION: 1. Pneumoperitoneum. 2. Widening of the vascular pedicle may be related to low lung volumes and intravascular volume status.

10003019-RR-72

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2175-10-31 18:57:00

2175-10-31 21:42:00

INDICATION: ___ male with history of sarcoidosis with suspected brain involvement as well as Hodgkin's lymphoma on chemotherapy, presenting with near syncopal event. Evaluate. COMPARISON: CT head without contrast on ___ and MR head with and without contrast on ___. TECHNIQUE: Contiguous axial MDCT images were obtained of the head before and after the administration of IV contrast. Coronal, sagittal and thin slice bone reformats were generated. DLP: 1783.85 mGy-cm. CTDI: 54.63 mGy. FINDINGS: There is no hemorrhage, edema, mass, mass effect or large territorial infarction. The sulci and ventricles are prominent, compatible with age-related atrophy. Periventricular white matter changes are consistent with chronic small vessel ischemic disease. There is preservation of gray-white matter differentiation. The basal cisterns are patent. There is no abnormal focus of enhancement. No pachymeningeal enhancement is identified. There is no evidence of fracture. There are air-fluid levels in both sphenoidal sinuses. The remaining paranasal sinuses, mastoid air cells and middle ear cavities are clear. IMPRESSION: 1. No evidence of acute intracranial process. No focal enhancement or pachymeningeal enhancement identified, although the study is suboptimal for assessment of neurosarcoidosis. If there is further clinical concern, a contrast-enhanced brain MRI should be performed. 2. Air-fluid levels in the sphenoid sinuses compatible with acute inflammatory sinus disease.

10003019-RR-73

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2175-11-01 04:09:00

2175-11-01 08:14:00

PA AND LATERAL CHEST RADIOGRAPHS, ___ COMPARISON: Portable chest x-ray of ___. FINDINGS: Allowing for differences in technique and projection, there has been little interval change in the appearance of the chest since the previous radiograph, with no new focal areas of consolidation to suggest the presence of pneumonia. Multifocal linear areas of scarring appear unchanged, previously attributed to sarcoidosis. Band-like opacity at periphery of left lung base has slightly worsened and is attributed to localize atelectasis.

10003019-RR-74

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2175-11-01 11:31:00

2175-11-01 17:45:00

MR EXAMINATION OF BRAIN WITHOUT AND WITH CONTRAST, MRA OF THE HEAD WITHOUT CONTRAST, MRA OF THE NECK WITH CONTRAST, ___ HISTORY: ___ male with history of neurosarcoidosis, admitted with presyncope. TECHNIQUE: Routine ___ enhanced MR examination of the brain, including T1-weighted axial SE and sagittal MP-RAGE sequences, post-contrast administration, the latter with axial and coronal reformations. Non-enhanced 3D-TOF cranial MRA and enhanced coronal 3D-VIBE acquisition of the cervical vessels was performed, with review of axial and coronal source and rotational targeted and large field-of-view MIP-reconstructed images, respectively, on a separate workstation. FINDINGS: The study is compared with the CECT obtained the previous day, as well as the enhanced cranial MR examination dated ___. There are now progressive T2-/FLAIR-hyperintense lesions in bihemispheric subcortical, deep and periventricular, as well as central pontine white matter. These are non-specific, but may represent the sequelae of chronic small vessel ischemic disease, neurosarcoidosis or a combination of the two. There is no focus of slow diffusion to suggest acute ischemia, and the principal intracranial vascular flow-voids are preserved (see MRA, below), including those of the dural venous sinuses, and these structures enhance normally. There is no pathologic parenchymal, leptomeningeal or dural focus of enhancement. There is no intra- or extra-axial hemorrhage, the midline structures are in the midline and the ventricles and cisterns are normal in size and configuration. Noted is layering fluid in both sphenoid air cells, as well as a small amount dependently within the nasopharynx, with fluid-opacification of scattered mastoid air cells, bilaterally. These findings are more marked since the ___ study. There is normal flow-related enhancement in the included intracranial portions of both internal carotid and proximal middle and anterior cerebral arteries. There is normal, symmetric arborization of MCA branches and no significant mural irregularity or flow-limiting stenosis. There is normal flow-related enhancement in tortuous dominant left and the right distal vertebral artery, as well as the basilar and bilateral superior cerebellar and posterior cerebral arteries, with no significant mural irregularity or flow-limiting stenosis. Anterior and small-caliber bilateral posterior communicating arteries are demonstrated with no aneurysm larger than 3 mm. The included portion of the aortic arch and the great vessel origins are normal in caliber and contour, without flow-limiting stenosis. The common and cervical internal and external carotid arteries are normal in course, caliber and contour, without significant mural irregularity or flow-limiting stenosis. They demonstrate normal, uniform enhancement, with no finding to suggest dissection. The vertebral arteries are normal in course, caliber and contour from their subclavian arterial origins through the vertebrobasilar junction, with no significant mural irregularity, flow-limiting stenosis or evidence of dissection. IMPRESSION: 1. No acute intracranial abnormality. 2. Progressive multifocal T2-hyperintensities in bihemispheric and central pontine white matter, which may represent sequelae of chronic small vessel ischemic disease, neurosarcoidosis, or a combination of the two. 3. No pathologic parenchymal, leptomeningeal or dural enhancement to suggest active inflammation related to neurosarcoidosis. 4. Unremarkable cranial and cervical MRA, with no significant mural irregularity, flow-limiting stenosis or evidence of dissection. 5. Inflammatory disease involving, particularly the sphenoid air cells, with likely layering fluid, suggesting an acute component; this should be correlated clinically, as there is also a small amount of layering fluid in the nasopharynx and fluid-opacification of scattered mastoid air cells, which may relate to protracted supine positioning.

10003400-RR-58

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2136-12-09 13:30:00

2136-12-09 13:48:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with fever, atrial fibrillation TECHNIQUE: Portable upright AP view of the chest COMPARISON: ___ FINDINGS: Right-sided Port-A-Cath tip terminates in the proximal right atrium. Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. Pulmonary vasculature is normal. The lungs are clear. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Partially imaged is a pigtail catheter overlying the right upper quadrant of the abdomen. No acute osseous abnormalities are detected. IMPRESSION: No acute cardiopulmonary abnormality.

10003400-RR-59

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2136-12-09 14:57:00

2136-12-09 15:22:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with portable CXR with wide mediastinum TECHNIQUE: Chest PA and lateral COMPARISON: ___ at 13:37 FINDINGS: Right-sided Port-A-Cath tip terminates in the proximal right atrium, unchanged. Heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Lungs are essentially clear with minimal subsegmental atelectasis in the left lung base. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary abnormality.

10003400-RR-60

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2136-12-31 18:08:00

2136-12-31 18:57:00

EXAMINATION: CHEST RADIOGRAPHS INDICATION: Confusion. Question pneumonia. COMPARISON: ___. TECHNIQUE: Chest, AP and lateral. FINDINGS: A Port-A-Cath again terminates in the right atrium. The cardiac, mediastinal and hilar contours appear stable including mild cardiomegaly and mild unfolding of the thoracic aorta. There is no pleural effusion or pneumothorax. The lungs appear clear. IMPRESSION: No evidence of acute cardiopulmonary disease.

10003400-RR-61

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2137-01-01 16:10:00

2137-01-01 16:28:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ female with altered mental status. Evaluate for hemorrhage or acute territorial infarct. TECHNIQUE: Contiguous axial images images of the brain were obtained without contrast. DOSE: DLP: 897.12 mGy-cm CTDI: 55.3 mGy COMPARISON: None. FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci are prominent suggesting age-related involution. Trace areas of periventricular and subcortical white matter hypodensity likely represents chronic small vessel disease. No osseous abnormalities seen. The paranasal sinuses, and middle ear cavities are clear. Mastoid air cells are underpneumatized bilaterally. The orbits are unremarkable. 15 mm heterogeneous lesion in the superficial soft tissues of the right neck (3:1) likely represents a dermal inclusion cyst. IMPRESSION: 1. No acute intracranial abnormality. 2. Please note MRI of the brain is more sensitive for the evaluation of acute infarct. 3. Atrophy and probable small vessel ischemic changes as described. 4. 15 mm right posterior neck probable dermal inclusion cyst as described. Recommend clinical correlation and correlation with direct examination.

10003502-RR-78

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2169-08-26 12:49:00

2169-08-26 13:41:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ status post fall, bradycardic // ? effusion, infectious process TECHNIQUE: Semi-upright AP view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Heart size is difficult to assess given the presence of moderate to large bilateral pleural effusions, but appears at least moderately enlarged. The mediastinal contours are grossly unremarkable. Perihilar haziness with vascular indistinctness and diffuse alveolar opacities are compatible with moderate pulmonary edema. Bibasilar compressive atelectasis is demonstrated. No pneumothorax is seen. Moderate multilevel degenerative changes are noted in the thoracic spine. IMPRESSION: Moderate pulmonary edema with moderate to large bilateral pleural effusions and bibasilar atelectasis.

10003502-RR-79

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2169-08-26 19:48:00

2169-08-26 20:28:00

INDICATION: ___ with new oxygen requirement // evaluate for worsening pulmonary edema TECHNIQUE: AP portable view of the chest. COMPARISON: ___ at 13:06. FINDINGS: Moderate to large bilateral pleural effusions are again seen, likely right greater than left. There is suspected superimposed pulmonary edema may have slightly improved since prior although detailed evaluation is limited given layering pleural effusions. Vasculature appears less engorged. Cardiac silhouette cannot be assessed. IMPRESSION: Mild to large bilateral, right greater than left pleural effusions. Degree of pulmonary edema may have slightly improved since prior exam although detailed evaluation is limited.

10003502-RR-80

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2169-08-27 08:06:00

2169-08-27 10:47:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with heart failure, dyspnea // Eval for pulmonary edema. Eval for pulmonary edema. IMPRESSION: Compared to chest radiographs since ___, most recently ___. Large right and moderate left pleural effusions and severe bibasilar atelectasis are unchanged. Cardiac silhouette is obscured. No pneumothorax. Pulmonary edema is mild, obscured radiographically by overlying abnormalities.

10003637-RR-21

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2146-01-22 16:52:00

2146-01-22 17:23:00

INDICATION: History: ___ with rectal pain // Evaluate for perirectal 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 not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 3.2 s, 35.0 cm; CTDIvol = 14.8 mGy (Body) DLP = 515.8 mGy-cm. Total DLP (Body) = 516 mGy-cm. COMPARISON: Rectal MRI from ___. FINDINGS: Compared to the prior MRI from ___, the horseshoe shaped right-sided perianal fistula has increased in volume and extent. Increased fluid tracks anteriorly to the 12 o'clock position, as well as posteriorly to the 6 o'clock position. The inferior extent of the collection (02:44) is also increased in volume. The superior extent tracts approximately 6.2 cm above the anal verge. The abscess is closely apposed to the posterior aspect of the prostate. Edema in the ischiorectal and ischioanal fat is moderate, worse on the right. Reactive perirectal stranding extends to the level of the sacrum. The urinary bladder is well distended and thin walled. The imaged loops of small and large bowel are normal in caliber. The appendix is air-filled normal. Pelvic vasculature demonstrates mild atherosclerotic calcification, but no aneurysm. Osseous structures are intact. IMPRESSION: Compared to ___, increased volume of the right-sided perianal fistula, extending from the 6 to 12 o'clock positions, extending approximately 6 cm above the anal verge. No definite evidence of supralevator disease, however for detailed evaluation of the pelvic soft tissues including sphincter anatomy, MRI of the pelvis is recommended.

10003637-RR-23

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2146-02-18 14:36:00

2146-02-18 15:04:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with hypotension // ? infectious process TECHNIQUE: Upright AP view of the chest COMPARISON: Chest radiograph ___. FINDINGS: Patient is status post median sternotomy and CABG. Left-sided AICD is noted with single lead terminating in the right ventricle. Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax. No acute osseous abnormalities are detected. IMPRESSION: No acute cardiopulmonary abnormality.

10003731-RR-54

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2146-11-18 07:58:00

2146-11-18 12:02:00

EXAMINATION: UNILAT LOWER EXT VEINS INDICATION: ___ year old woman with left leg swelling // evaluate for DVT TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the left lower extremity veins. COMPARISON: None. FINDINGS: There is normal compressibility, flow and augmentation of the left common femoral, superficial femoral, and popliteal veins. Normal color flow is demonstrated in the left posterior tibial and peroneal veins. There is normal respiratory variation in the common femoral veins bilaterally. Note is made of subcutaneous edema in the area of redness in the mid to distal left shin. IMPRESSION: 1. No evidence of deep venous thrombosis in the left lower extremity veins. 2. Subcutaneous edema in the area of redness in the mid to distal left shin.

10004322-RR-22

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2135-02-06 13:43:00

2135-02-06 14:27:00

INDICATION: History: ___ with ams*** WARNING *** Multiple patients with same last name! // ?pna TECHNIQUE: Single supine AP portable view of the chest COMPARISON: ___ FINDINGS: The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Degenerative changes are seen at the right greater than left acromioclavicular joints. IMPRESSION: No acute cardiopulmonary process. No focal consolidation to suggest pneumonia.

10004322-RR-23

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2135-02-06 13:12:00

2135-02-06 14:08:00

EXAMINATION: CT HEAD W/O CONTRAST INDICATION: History: ___ with recent fall, altered mental status*** WARNING *** Multiple patients with same last name! // ?fx or bleed TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained. Reformatted coronal and sagittal images were also obtained. DOSE Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 17.2 cm; CTDIvol = 46.7 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: ___ FINDINGS: There is no evidence of acute intracranial hemorrhage, midline shift, mass effect, or acute large vascular territorial infarct. Prominence of the ventricles and sulci is consistent with atrophy. Periventricular and subcortical white matter hypodensities are likely sequelae of chronic small vessel disease. The visualized paranasal sinuses are clear. The mastoid air cells are clear. No acute fracture is seen. IMPRESSION: No acute intracranial process.

10004322-RR-24

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2135-02-06 13:13:00

2135-02-06 14:31:00

EXAMINATION: CT C-SPINE W/O CONTRAST INDICATION: ___ with recent fall, altered mental status// ?fx or bleed TECHNIQUE: Contiguous axial images obtained through the cervical spine without intravenous contrast. Coronal and sagittal reformats were reviewed. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.2 s, 20.3 cm; CTDIvol = 36.8 mGy (Body) DLP = 749.1 mGy-cm. Total DLP (Body) = 749 mGy-cm. COMPARISON: None. FINDINGS: Alignment is normal. No acute fractures are identified.There is no prevertebral edema. Small anterior osteophytes are noted. Atherosclerotic vascular calcifications are noted of bilateral vertebral arteries, right greater than left. The thyroid and included lung apices are unremarkable. IMPRESSION: No acute fracture or malalignment of the cervical spine.

10004322-RR-25

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2135-02-08 11:53:00

2135-02-08 17:12:00

INDICATION: ___ year old man with AMS and abdominal pain and concern for obstruction // R/O obstruction TECHNIQUE: Supine and left lateral decubitus abdominal radiographs. COMPARISON: CT abdomen and pelvis from ___. FINDINGS: Air fills the stomach, small and large bowel in a nonobstructive pattern. There are no abnormally dilated loops of small or large bowel. Stool balls are seen in the distal sigmoid colon and rectum. 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 in the stomach, small bowel and colon. No evidence of pneumoperitoneum.

10004606-RR-32

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2159-03-21 15:29:00

2159-03-21 17:00:00

INDICATION: ___ year old woman with constipation.// obstruction TECHNIQUE: Supine and lateral decubitus abdominal radiographs were obtained. COMPARISON: CT abdomen pelvis performed ___. FINDINGS: Air and stool is visualized in the large bowel without evidence of abnormally dilated loops of large or small bowel. There is no free intraperitoneal air. Osseous structures are unremarkable. Bilateral external iliac stents are visualized. Surgical clips in the right upper abdomen correspond to history of cholecystectomy. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Normal bowel gas pattern.

10004606-RR-40

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2159-09-14 11:04:00

2159-09-14 13:34:00

EXAMINATION: Carotid Doppler Ultrasound INDICATION: ___ year old woman with history of CVA, recurrent presyncope, +L carotid bruit// Please eval for carotid stenosis TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound imaging of the carotid arteries was obtained. COMPARISON: None. FINDINGS: RIGHT: There is moderate heterogeneous soft plaque throughout the common carotid artery. There is marked heterogeneous soft plaque within the right carotid bifurcation and ICA, greatest within the mid ICA. The peak systolic velocity in the right common carotid artery is 93 cm/sec. The peak systolic velocities in the proximal, mid, and distal right internal carotid artery are 71, 532, and 88 cm/sec, respectively. The peak end diastolic velocity in the right internal carotid artery is 238 cm/sec. The ICA/CCA ratio is 7.3. The external carotid artery has peak systolic velocity of 152 cm/sec. The vertebral artery is patent with antegrade flow. LEFT: There is moderate heterogeneous soft plaque throughout the left common carotid artery and ECA. There is marked heterogeneous soft and calcified plaque within the carotid bifurcation and ICA, greatest within the mid ICA. The peak systolic velocity in the left common carotid artery is 110 cm/sec. The peak systolic velocities in the proximal, mid, and distal left internal carotid artery are 255, 460, and 110 cm/sec, respectively. The peak end diastolic velocity in the left internal carotid artery is 198 cm/sec. The ICA/CCA ratio is 4.2. The external carotid artery has peak systolic velocity of 190 cm/sec. The vertebral artery is patent with antegrade flow. IMPRESSION: Moderate-to-marked predominantly heterogeneous soft plaque within the bilateral carotid arteries most profound within the mid ICAs, right greater than left, resulting in hemodynamically significant stenosis estimated to be 80-99% bilaterally. Findings of hemodynamically significant ICA stenosis were communicated to Dr. ___ at 13:31 on ___.

10004606-RR-42

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2159-09-16 19:11:00

2159-09-16 19:30:00

EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT INDICATION: ___ year old woman with vascular disease, recent fall, with worsening right hip pain.// eval for fracture TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and frog-leg lateral views of the right hip. COMPARISON: ___ FINDINGS: There is no fracture or dislocation. Evaluation of the sacrum is limited due to overlying bowel. There are no gross degenerative changes. There is no suspicious lytic or sclerotic lesion. There is no soft tissue calcification or radio-opaque foreign body. Vascular calcification is present as well as an aorto bi-iliac stent graft. IMPRESSION: No acute osseous injury is identified of the pelvis or right hip.

10004606-RR-44

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2159-09-18 12:05:00

2159-09-18 16:24:00

INDICATION: ___ with history of CVA, seizures, upper GI AVM's with chronic anemia, HTN, peripheral vasculopathy, presents after presyncopal fall.// capsule endoscopy on ___ unsure if she passed it, eval for capsule presence TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: CT abdomen pelvis dated ___ FINDINGS: A radiopaque foreign body is seen overlying the more proximal portion of the descending colon, which likely represents the reported endoscopy pill capsule. There is mild-to-moderate colonic stool burden. There are no abnormally dilated loops of large or small bowel. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are unremarkable. Bilateral iliac stents are again seen. Cholecystectomy clips are seen in the right upper quadrant. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Endoscopy capsule in the proximal descending colon.

10004606-RR-45

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2159-09-21 11:02:00

2159-09-21 14:15:00

INDICATION: ___ year old woman s/p capsule endoscopy. Unsure if she had passed capsule.// eval for capsule presence TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: Abdominal radiograph dated ___. FINDINGS: A radiopaque object is now seen overlying the lower midline pelvis. This represents the endoscopy pill capsule, now probably in the sigmoid colon. Moderate colonic stool burden is noted. There are no abnormally dilated loops of large or small bowel. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are unremarkable. Bilateral iliac stents are again seen. Cholecystectomy clips are visualized in the right upper quadrant. IMPRESSION: Endoscopy pill capsule has migrated since ___, now located within the mid low pelvis, possibly in the sigmoid colon.

10004606-RR-46

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2159-09-22 12:52:00

2159-09-22 14:46:00

INDICATION: ___ year old woman s/p capsule endoscopy being discharged home today.// eval final location of capsule TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: Abdominal radiograph dated ___ and ___. FINDINGS: The endoscopy pill capsule is seen in similar position in the lower pelvis overlying the superior pubic ramus. In retrospect, and given the lack of passage in 24 hours, the pill capsule is likely still within the small bowel. There are no abnormally dilated loops of large or small bowel. Large stool burden is noted throughout the colon. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are unremarkable. Bilateral iliac stents are again visualized. Cholecystectomy clips are again seen in the right upper quadrant. IMPRESSION: 1. In retrospect, and given the lack of pill passage in 24 hours, the endoscopy pill capsule does not appear to be in the colon and is still likely within the small bowel. 2. Large colonic stool burden.

10004648-RR-13

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2135-12-07 12:14:00

2135-12-07 15:04:00

INDICATION: ___ old female with ectopic pregnancy, status post methotrexate this past ___, presenting with vaginal bleeding and abdominal cramps. Evaluate for ruptured ectopic pregnancy or fluid collection. COMPARISONS: None available. LMP: ___. FINDINGS: Both transabdominal and transvaginal examinations were performed, the latter for better visualization of the endometrium and adnexa. The uterus is unremarkable. There is a bulbous focal thickening of the endometrium that contains material with a single focus of detected vascularity extending into the lower uterine segment. The right ovary measures 3.4 x 2.3 x 1.9 cm and is normal. The left ovary contains a cystic structure inseparable from the ovary suggesting a corpus luteum rather than an ectopic; including this structure, the left ovary measures 5.1 x 2.2 x 2.7 cm. No definite ectopic pregnancy or complex free fluid is seen. IMPRESSION: Bulbous focal thickening of endometrium with focus of vascularity suggesting prodcuts of conception; no definite evidence of complex free fluid or ectopic pregnancy. Correlation with HCG levels, prior ultrasound imaging, and other clinical factors is recommended.

10004719-RR-19

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2183-08-30 16:18:00

2183-08-30 17:03:00

EXAMINATION: UNILAT LOWER EXT VEINS RIGHT INDICATION: History: ___ with R leg pain // eval for dvt TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the bilateral lower extremity veins. COMPARISON: None. FINDINGS: Right lower extremity: There is normal compressibility, flow, and augmentation of the right common femoral, femoral, and popliteal veins. There is occlusive thrombus in one of the posterior tibial veins on the right, in the mid to distal right calf. Normal color flow and compressibility are demonstrated in the peroneal veins. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. Given the abnormal findings in the right lower extremity, the left lower extremity was also evaluated per protocol. Left lower extremity: There is normal compressibility, flow, and augmentation of the left common femoral, femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the posterior tibial and peroneal veins. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. IMPRESSION: 1. Occlusive thrombus in one of the right posterior tibial veins. 2. No deep venous thrombosis in the left lower extremity.

10004719-RR-20

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2183-08-31 09:18:00

2183-08-31 17:47:00

Study arterial duplex lower extremity. Reason prior graft Findings duplex evaluation was performed of the right lower extremity. The right superficial femoral and popliteal artery are patent triphasic waveform. The graft is occluded. Impression occluded right popliteal to posterior tibial artery bypass

10004719-RR-21

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2183-08-31 09:18:00

2183-08-31 17:45:00

Arterial Doppler lower extremity. Reason claudication Findings. Doppler evaluation was performed of both lower extremity arterial systems at rest. On the right the tibial waveforms are monophasic and there is no audible Waveforms are flat. The left all waveforms are triphasic. The ankle-brachial index is 1.3. Impression severe ischemia right lower extremity

10004719-RR-22

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2183-09-01 08:18:00

2183-09-01 14:25:00

Study venous duplex bilateral. Vein mapping. Findings both small saphenous veins are patent but diminutive at less than 0.25 cm. The right greater saphenous vein has been harvested. On the left the greater saphenous vein is patent but diminutive with diameters of 0.2-0.29. Impression patent left greater saphenous vein, small saphenous veins bilaterally. Evaluate scanned worksheet for diameter.

10004719-RR-23

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2183-09-01 08:16:00

2183-09-01 14:26:00

Study venous duplex upper extremity bilateral. Reason vein mapping. Findings. Duplex evaluation was performed of both cephalic and basilic veins. All named veins are patent. The diameters are detailed in the scanned worksheet. Impression patent bilateral cephalic and basilic veins. Evaluate scanned work sheet

10004719-RR-24

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2183-08-31 17:57:00

2183-09-01 06:11:00

EXAMINATION: Chest radiograph INDICATION: ___ year old woman with occluded graft. Preoperative chest radiograph. TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph dated ___. FINDINGS: Lung volumes remain slightly low. No focal consolidation, edema, effusion, or pneumothorax. Diminished relative vasculature in the upper lobes bilaterally is sometimes a manifestation of emphsema. Heart size is normal. Mediastinum is not widened. No acute osseous abnormality. IMPRESSION: No focal pneumonia or edema.

10004749-RR-22

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2129-03-20 20:44:00

2129-03-20 23:17:00

INDICATION: ___ woman with right lower quadrant abdominal pain. Evaluate for appendicitis. COMPARISON: CT of the abdomen and pelvis from ___. TECHNIQUE: MDCT-acquired axial images from the lung bases through the pubic symphysis were obtained after administration of enteric and 130 cc Omnipaque intravenous contrast material. Coronal and sagittal reformats reviewed. FINDINGS: The lower chest is unremarkable. ABDOMEN: There are several tiny millimetric hypodensities in the liver, likely representing simple cysts or biliary hamartomas, but that are too small to characterize by CT. The gallbladder and biliary tree are normal. The spleen, pancreas, adrenal glands, and kidneys appear normal. The abdominal aorta is normal in caliber, with patent main branches. The portal and systemic venous systems are normal. There is no abdominal lymphadenopathy. The stomach appears normal. There are several loops of small bowel in the right lower quadrant of abdomen and extending into the pelvis, with mural edema. Adjacent to this is minimal fat stranding and trace ascites. The appendix is 5-6 mm in diameter. The large bowel is unremarkable. There is no evidence of obstruction. There is no intraperitoneal free air or fluid collection. PELVIS: The urinary bladder, uterus, ovaries, and rectum appear normal. There is no pelvic mass or lymphadenopathy. Abnormal loops of small bowel as above. MUSCULOSKELETAL: There are no destructive osseous lesions concerning for malignancy or infection. Spondylolisthesis of L5 is noted. IMPRESSION: 1. Enteritis involving several loops of small bowel located in the right lower quadrant of the abdomen and within the pelvis. Differential diagnosis includes infectious, inflammatory, and ischemic etiology. 2. The appendix is 5-6 mm in diameter, and given the diffuse inflammatory findings, appendicitis is not likely the cause of the patient's symptoms.

10004749-RR-23

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2129-03-21 11:38:00

2129-03-21 12:13:00

CHEST RADIOGRAPH INDICATION: Severe watery diarrhea, evaluation for pleural effusion. COMPARISON: No comparison available at the time of dictation. FINDINGS: The lung volumes are normal. No pleural effusions. No parenchymal abnormalities. Normal size of the cardiac silhouette.

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2138-04-12 10:32:00

2138-04-12 18:20:00

EXAMINATION: ABDOMEN (SUPINE ONLY) INDICATION: ___ year old man with metatstatic colon ca s/p stent placement with increased abdominal pain/bloating // please assess for stent migration or bowel obstruction. TECHNIQUE: Supine abdominal radiographs. CT abdomen dated ___. COMPARISON: CTA chest dated ___. CT abdomen pelvis dated ___. FINDINGS: The large bowel is air filled, nondistended. There are no dilated loops of small bowel. A small right pleural effusion is noted. A rectal stent is seen overlying the sacrum. Contrast is filling the bladder from recent CTA chest. IMPRESSION: 1. Rectal stent overlying the sacrum. 2. No bowel obstruction. 3. Likely interval decrease of small right pleural effusion. NOTIFICATION: The impression was spoken via telephone to ___ (Sub I) at 2:30pm by Dr. ___.

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2138-04-12 18:44:00

2138-04-12 20:09:00

EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: ___ year old man with metastatic colon adenocarcinoma s/p palliative colonic stenting 2 weeks ago now with septicemia and diffuse abdominal pain // PO contrast. ?Stent migration, obstruction, perforation TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Coronal and sagittal reformations were performed and reviewed on PACS. Oral contrast was administered. DOSE: DLP: 589 mGy-cm (abdomen and pelvis). IV Contrast: 130 mL Omnipaque COMPARISON: CT abdomen and pelvis ___ FINDINGS: LOWER CHEST: There are moderately-sized non-hemorrhagic pleural effusions bilaterally, overall similar to ___. Multiple pulmonary metastases are re-demonstrated in the remaining visualized lung bases. ABDOMEN: HEPATOBILIARY: Innumerable metastatic lesions are re-demonstrated in the liver, the largest of which appears to be a conglomerate of masses spanning an area of 5.9 x 6.7 cm in segment VIII (5:25). The gallbladder is within normal limits, without stones or gallbladder wall thickening. 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 a 6 mm hypodensity in the lower pole of the right kidney (5:43) that this too small to characterize but most likely represents a cyst. There is no evidence of stones, suspicious renal masses 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. Since the prior CT on ___, there has been interval placement of a stent in the rectosigmoid colon. Soft tissue mass encasing the stent is compatible with known malignancy. Anterior and inferior to the stent, there is a 10.4 x 7.4 cm (5:66) circumscribed fluid collection containing small locules of gas, suggestive of stent perforation. There is also a moderate/large amount of free air along the right aspect of the stent as well as more superiorly in the peritoneal cavity. Small amount of ascites also noted. RETROPERITONEUM: There is extensive abdominal lymphadenopathy. Notably, there is a large conglomerate of necrotic lymph nodes in the porta hepatis (5:29), which appears overall unchanged since the prior study in ___. This results in narrowing of the origin of the left renal vein (5:27). It also encases the splenic vein-SMV confluence and bilateral renal arteries (5:26), but do not result in significant intraluminal narrowing of these vessels. VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic calcifications are noted in the abdominal aorta and bilateral iliac branches. PELVIS: Anterior inferior pelvic fluid collection, as described above. The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. REPRODUCTIVE ORGANS: The prostate is unremarkable. BONES AND SOFT TISSUES: Multilevel degenerative changes and noted throughout the thoracolumbar spine. There is grade I retrolisthesis of L5 on S1, overall unchanged from the prior study. No lytic or sclerotic lesions that are concerning for malignancy are identified. Abdominal and pelvic wall is within normal limits. IMPRESSION: 1. Interval (since ___ placement of a colonic stent, 2. Circumscribed 10.4 x 7.4mm anterior pelvic fluid collection containing small locules of gas, likely an abscess from sigmoid tumor perforation. This is amenable to drainage. 2a. Moderate/large amount of free air, and small amount of free fluid within the peritoneum. 3. Extensive lymphadenopathy in the retroperitoneum and porta hepatis, which results in narrowing of the origin of the left renal vein. Encasement of the splenic vein-SMV confluence and bilateral renal arteries is also demonstrated, without significant intraluminal narrowing in these vessels. Normally enhancing kidneys on today's study. 4. Innumerable hepatic metastases. 5. Innumerable pulmonary metastases, lungs only partially imaged. 6. Moderately-sized bilateral non-hemorrhagic pleural effusions. RECOMMENDATION(S): Consult with CT interventional service NOTIFICATION: Final results above were telephoned to Dr. ___ by Dr. ___ on ___ at 12:12PM.

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2138-03-30 15:51:00

2138-03-31 11:20:00

EXAMINATION: CT CHEST W/CONTRAST INDICATION: ___ year old man with newly diagnosed colorectal cancer // evaluate for metastatic burden of chest TECHNIQUE: Contrast-enhanced chest CT was performed acquiring sequential axial images from the thoracic inlet through the adrenal glands. Thin section axial, coronal, sagittal and axial MIP's were also obtained. 75 cc of Omnipaque 350 were administered intravenously without reported complication. DOSE: Total DLP = 699.52mGy-cm COMPARISON: None available. FINDINGS: The thyroid gland is unremarkable. There are multiple pathologically enlarged supraclavicular, mediastinal and bilateral hilar lymph nodes. A representative left supraclavicular lymph node measures 16 x 26 mm (2, 6). A subcarinal lymph node measures 34 x 48 mm (2, 29). A right hilar lymph node measures 20 x 28 mm (2, 28). A prevascular lymph node measures 20 x 20 mm (2, 26). Several cardiophrenic lymph nodes measure up to 6 x 11 mm (4, 213). Heart size is normal with no pericardial effusion. The main pulmonary artery and thoracic aorta are normal caliber. No incidental pulmonary embolus is identified. Moderate right and small left layering nonhemorrhagic pleural effusions are present. Innumerable bilateral pulmonary metastases are mostly solid, but a few in the upper lobes are cavitating. The largest right middle lobe metastasis measures 10 x 14 mm (4, 161). A left upper lobe metastasis measures 6 x 8 mm (4, 77). Another inferior lingular metastasis measures 8 x 9 mm (4, 188). Airways are patent to the subsegmental level. Extensive hypodense hepatic lesions involving both lobes of the liver are compatible with metastases. A representative left hepatic lobe metastasis measures 31 x 38 cm (4, 259). There is extensive porta hepatis, celiac axis, portacaval, and retroperitoneal lymphadenopathy. Lymphadenopathy encases and mildly attenuates multiple vessels without frankly including them. The left adrenal gland is mildly thickened, which is worrisome for metastasis. There is also a small amount of upper abdominal perihepatic ascites. Please refer to the separate report from the outside CT scan of the abdomen/pelvis for a more detailed discussion. No lytic or sclerotic bone lesions are identified. IMPRESSION: Extensive intrathoracic metastases including supraclavicular, mediastinal and bilateral hilar lymphadenopathy, as well as numerous pulmonary metastases as detailed above. Moderate right and small left nonhemorrhagic pleural effusions. Widespread hepatic metastases and suspected left adrenal metastasis. Extensive porta hepatis, celiac axis, portacaval and retroperitoneal lymphadenopathy. Small upper abdominal ascites.

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2138-04-10 10:20:00

2138-04-10 13:18:00

EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with metastatic colon cancer and SOB // please assess for pneumonia please assess for pneumonia COMPARISON: There no prior conventional chest radiographs available for review. The examination is read in conjunction with chest CT scan on ___. IMPRESSION: There is no clear radiographic change over the past 11 days. Bilateral pleural effusions moderate on the right small on the left and callus pulmonary nodules are unchanged. Extent of central adenopathy is better revealed by the chest CT scan. Confluent opacification at the base of the right lung is probably atelectasis, pleural mild pneumonia is difficult to exclude. In all other locations there no findings that would raise the possibility of pneumonia.

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2138-04-10 13:36:00

2138-04-10 14:19:00

EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT) INDICATION: ___ year old man with metastatic colon ca, with tachycardia and swollen legs. // please assess for DVT TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the bilateral lower extremity veins. COMPARISON: None. FINDINGS: There is normal compressibility, flow and augmentation of the bilateral common femoral, proximal, mid, distal femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the posterior tibial and peroneal veins. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. IMPRESSION: No evidence of deep venous thrombosis in the bilaterallower extremity veins.

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2138-04-11 16:34:00

2138-04-11 17:07:00

INDICATION: ___ year old man with SOB and tachycardia // please assess for worsening pna or effusion //___ year old man with SOB and tachycardia TECHNIQUE: AP view of the chest COMPARISON: ___ CT and ___ x-ray FINDINGS: Numerous nodular opacities compatible the patient's metastatic disease are again appreciated. In addition, there is worsening pulmonary edema as well as a worsening right lower lobe infiltrate which could represent pneumonia in the correct clinical setting. A right pleural effusion is also increased in size. IMPRESSION: Worsening combination of pleural effusion, pulmonary edema and possibly pneumonia particularly in the right lower lobe.

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2138-04-11 20:06:00

2138-04-11 20:55:00

EXAMINATION: CHEST CTA INDICATION: ___ year old man with metastatic colon cancer to lungs/liver, w/ sinus tachycardia and tachypnea. Concern for pneumonia versus pulmonary embolism. TECHNIQUE: Axial multidetector CT images were obtained through the thorax after the uneventful administration of 100 cc of Omnipaque intravenous contrast. Reformatted coronal, sagittal, thin slice axial images, and oblique maximal intensity projection images were submitted to PACS and reviewed. DOSE: DLP: 699 mGy-cm COMPARISON: CT chest from ___ FINDINGS: The aorta is major branches opacify normally without evidence of dissection, intramural hematoma, or penetrating atherosclerotic ulcer. Motion artifact limits evaluation of some the segmental pulmonary arteries, however there is no central, lobar, or segmental pulmonary embolism. There is diffuse supraclavicular, axillary, mediastinal, hilar, paraesophageal, and upper retroperitoneal lymphadenopathy in kidney with known metastatic disease. Since the prior study from ___, bilateral nonhemorrhagic pleural effusions have enlarged, moderate to large on the right and small to moderate on the left. The pulmonary parenchyma demonstrates innumerable metastases, which appear to have increased in number and size since the prior CT from ___. The esophagus is partially fluid filled and demonstrates multiple hyperdense nodules within the distal ___ of the esophagus, which may represent intraluminal metastases versus enteric contents. Limited images of the upper abdomen demonstrate diffuse intrahepatic metastases, nodularity of the adrenal glands, ascites, and significant abdominal lymphadenopathy. Healed left lower posterior rib fractures are noted. No concerning osseous lesions are seen. IMPRESSION: 1. Partially limited evaluation of the subsegmental pulmonary arteries, however no evidence of central, lobar, or segmental pulmonary embolism. 2. Since ___, increase in size and number of innumerable pulmonary metastases, as well as enlargement of bilateral pleural effusions, large on the right and moderate on the left. 3. Partially imaged upper abdomen demonstrates diffuse intrahepatic metastasis and considerable upper abdominal lymphadenopathy.

10005308-RR-7

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2178-04-17 00:28:00

2178-04-17 02:25:00

EXAMINATION: FOOT AP,LAT AND OBL RIGHT; TIB/FIB (AP AND LAT) RIGHT INDICATION: History: ___ with fall and deformity// eval for fracture TECHNIQUE: Two views of the right tibia and fibula. Three views of the right ankle. COMPARISON: None available. FINDINGS: Acute fracture-dislocation of the distal tibia and fibula. There is anterior and medial dislocation at the tibiotalar joint. Inferiorly displaced fracture of the medial malleolus. Oblique fracture through the distal fibula at the level of the syndesmosis with significant apex medial angulation. Smaller bone fragments superior to the talar dome may arise from the distal tibia or fibula. No talar dome osteochondral lesion. No subtalar dislocation. Significant surrounding soft tissue swelling. Knee is unremarkable in appearance without fracture or dislocation. No knee joint effusion. No hindfoot, midfoot, or forefoot fractures. Small os peroneus. There are no significant degenerative changes. Mineralization is normal. No radiopaque foreign objects. IMPRESSION: Acute fracture-dislocation of the distal tibia and fibula. Significant medial dislocation of tibia in relation to the talus. And apex medial angulation of the distal fibula.

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2178-04-17 02:57:00

2178-04-17 03:09:00

EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT INDICATION: ___ year old woman with right ankle fracture/dislocation// s/p closed reduction s/p closed reduction TECHNIQUE: Three views of the right ankle. COMPARISON: Ankle radiographs with the same date. FINDINGS: Interval casting. Cast material obscures fine bony detail. Complete reduction of the previously visualized tibiotalar dislocation. Ankle mortise appears congruent. No talar dome lesions. Improved alignment of the distal tibia and fibular fractures, now near anatomic. IMPRESSION: Complete reduction of the previously visualized tibiotalar dislocation. Distal tibia and fibular fractures have improved in alignment, now near anatomic.

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2178-04-18 10:59:00

2178-04-18 14:01:00

EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT INDICATION: Right ankle fracture dislocation. TECHNIQUE: Fluoroscopic time 66.8 seconds. COMPARISON: ___. FINDINGS: 14 intraoperative images were acquired without a radiologist present. Images show ORIF of right ankle fracture dislocation with laterally applied plate, multiple fixation and syndesmotic screws and medial malleolar K-wire with screw and figure-of-eight cerclage wire. IMPRESSION: Intraoperative images were obtained during ORIF of right ankle fracture dislocation. Please refer to the operative note for details of the procedure.

10005606-RR-20

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2143-12-06 05:23:00

2143-12-06 12:45:00

EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE. INDICATION: ___ year old man with fall down 30 feet with and multiple cervical spine fractures// eval fractures and ligamentous injury. TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique. Axial T2 and gradient echo imaging were next performed. COMPARISON: CT cervical spine performed 6 hours earlier. FINDINGS: Redemonstrated are multilevel acute to subacute compression fractures of the C5, C6 and C7 vertebral bodies. Of note, abnormal STIR signal at the superior endplates of the T2 and T3 vertebral bodies raises suspicion for additional acute to subacute compression deformities with minimal loss of vertebral body height. Additional multilevel mildly displaced cervical spine fractures extending from C4 through C7 are better characterized on the recent CT cervical spine study. Redemonstrated is a moderate amount of prevertebral edema, likely trauma related. At C4-C5 there is increased interspinous distance (7 mm) and evidence of ligamentum flavum disruption. There appears to be CSF communicating through the LF disruption suspicious for CSF leak. There is extensive edema of the posterior paraspinal musculature extending from C2 through T1. At C2-3 there is no vertebral canal or neural foraminal narrowing. At C3-4 there is mild disc bulging and uncovertebral osteophytes with mild right neural foraminal narrowing. At C4-5 there are uncovertebral osteophytes with mild left neural foraminal narrowing. At C5-6 there is traumatic kyphotic deformity and disc bulging resulting in mild spinal canal narrowing and flattening of the ventral cord without evidence of abnormal cord signal. There are uncovertebral osteophytes with moderate to severe right neural foraminal narrowing. At C6-7 there mild disc bulging and uncovertebral osteophytes with mild spinal canal narrowing, severe right and moderate left neural foraminal narrowing. At C7-T1 there is no vertebral canal or neural foraminal narrowing. IMPRESSION: 1. Redemonstrated acute to subacute compression deformities of the C5, C6 and C7 vertebral bodies with associated unchanged traumatic kyphotic deformity at C5-C6. There is also evidence of acute to subacute compression deformities of the superior endplates of the T2 and T3 vertebral bodies with minimal loss of vertebral body height. 2. Redemonstrated multilevel mildly displaced cervical spine fractures extending from C4 through C7, better described on the recent CT cervical spine study. 3. Evidence of increased interspinous interval and ligamentum flavum disruption at C4-C5 with findings suspicious for CSF leak at this level. 4. Extensive edema of the posterior paraspinal musculature extending from C2 through T1. 5. Unchanged traumatic kyphotic angulation at C5-C6. 6. Moderate prevertebral edema is likely trauma related. 7. Degenerative changes of the cervical spine most significant at C5-C6 where superimposed traumatic kyphotic deformity results in mild spinal canal narrowing and flattening of the ventral cord without evidence of abnormal cord signal.

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2143-12-07 05:08:00

2143-12-07 08:52:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with c-spine fractures// r/o pneumonia IMPRESSION: In comparison with the study of ___, the monitoring support devices are unchanged. The nasogastric tube again and extends to the stomach, though the side port is in the lower esophagus and the tube should be pushed forward at least 5 cm for more optimal positioning. Specifically, no evidence of aspiration or pneumonia.

10005606-RR-22

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2143-12-06 13:27:00

2143-12-06 17:03:00

EXAMINATION: Intra op images INDICATION: Anterior cervical fusion TECHNIQUE: 2 sets of images were obtained in the operating room for total of 11 images. COMPARISON: MRI of the cervical spine ___ FINDINGS: 11 intraoperative images were acquired without a radiologist present. Images show the patient is intubated. Instruments and hardware are evident involving the lower cervical spine.. IMPRESSION: Intraoperative images were obtained during anterior cervical fusion. Please refer to the operative note for details of the procedure.

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2143-12-06 16:44:00

2143-12-06 17:03:00

EXAMINATION: Intra op images INDICATION: Anterior cervical fusion TECHNIQUE: 2 sets of images were obtained in the operating room for total of 11 images. COMPARISON: MRI of the cervical spine ___ FINDINGS: 11 intraoperative images were acquired without a radiologist present. Images show the patient is intubated. Instruments and hardware are evident involving the lower cervical spine.. IMPRESSION: Intraoperative images were obtained during anterior cervical fusion. Please refer to the operative note for details of the procedure.

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2143-12-06 17:27:00

2143-12-06 17:54:00

INDICATION: ___ year old man with cervical fractures, status post ACDF remains intubated// ETT position, interval change TECHNIQUE: Portable chest x-ray, series of 2 COMPARISON: CT scan of the chest ___ FINDINGS: The endotracheal tube is in good position. The tip of the NG tube is just distal to the GE junction, repositioning is advised. The heart is normal in size. Postoperative changes are seen in the cervical spine. There are low lung volumes. There is no pneumothorax. IMPRESSION: The endotracheal tube is in good position. The tip of the NG tube is in the proximal stomach. Low lung volumes. RECOMMENDATION(S): Recommend advancing the NG tube approximately 8 cm for more secure positioning.

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2143-12-07 11:39:00

2143-12-07 13:21:00

EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM INDICATION: This ___ with no significant past medical history who presents s/p fall from 30 feet with multiple mildly displaced comminuted fractures through the C5, C6, and C7 vertebral bodies, sternal fracture, right sided pulmonary contusion; s/p OGT advancement by 5cm// please eval OGT location s/p advancement IMPRESSION: In comparison with the study of earlier in this date, the nasogastric tube is been pushed forward with the tip in the lateral aspect of the fundus. The side-port is clearly distal to the esophagogastric junction. Otherwise, little change.

10005606-RR-27

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2143-12-07 18:16:00

2143-12-07 18:47:00

INDICATION: ___ old woman with history of CAD c/b recent MI s/p stent (___), perforated diverticulitis s/p sigmoid resection (___) with colostomy status post reversal who presents with concern for recurrent perforated diverticulitis versus ___ perforation. Now status post ex lap and colon resection ___. now with new desats// interval change TECHNIQUE: Chest PA and lateral COMPARISON: Portable chest x-ray ___, approximately 6 hours previous FINDINGS: There are low lung volumes. The NG tube descends below the left hemidiaphragm, the tip is not visualized. The endotracheal tube is in good position. Postoperative changes are seen in the cervical spine. There is no consolidation. The cardiomediastinal silhouette is stable. The trachea is midline. There is no large pleural effusion. IMPRESSION: Low lung volumes. No consolidation.

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2143-12-08 05:54:00

2143-12-08 10:09:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: This ___ with no significant past medical history who presents s/p fall from 30 feet with multiple mildly displaced comminuted fractures through the C5, C6, and C7 vertebral bodies, sternal fracture, right sided pulmonary contusion. New desats yesterday, increased PEEP.// interval change interval change IMPRESSION: Compared to chest radiographs ___ and ___. Small right pleural effusion has decreased. Relatively mild peribronchial infiltration around the left hilus and in the right lower lobe has worsened progressively suggesting chronic aspiration. No pneumothorax. ET tube in standard placement. Nasogastric drainage tube passes below the diaphragm and out of view.

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2143-12-08 11:53:00

2143-12-08 13:12:00

EXAMINATION: DX ANKLE AND FOOT INDICATION: ___ year old man with right ankle swelling bruising// eval for fracture eval for fracture eval for fracture TECHNIQUE: Three views of the right ankle and foot. COMPARISON: None IMPRESSION: Alignment appears preserved. Bone mineralization appears preserved. There may be a tiny focus of mineralization along the anterior tibiotalar joint and dorsal aspect of the talar neck which could represent sequela from small avulsion type ligamentous or capsular injuries. Mild soft tissue swelling about the ankle. No frank fracture is identified.

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2143-12-08 16:08:00

2143-12-08 20:44:00

EXAMINATION: Intra op x-ray INDICATION: Fusion laminectomy/cervical posterior C4 through T2 COMPARISON: X-rays ___ FINDINGS: 4 intraoperative images were acquired without a radiologist present. Images show instruments and hardware for posterior cervical fusion/laminectomy. IMPRESSION: Intraoperative images were obtained during posterior cervical fusion. Please refer to the operative note for details of the procedure.

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2143-12-10 04:21:00

2143-12-10 08:25:00

INDICATION: ___ year old man with alcoholism s/p cervical anterior and posterior decompression and fusions// interval change TECHNIQUE: Chest AP view COMPARISON: ___ IMPRESSION: Lungs are low volume with stable bibasilar atelectasis. Pulmonary edema has slightly worsened since the prior study. The ET tube projects approximately 3 cm from the carina and is unchanged in its position. The NG tube projects below the left hemidiaphragm and is also unchanged. Small bilateral effusions are stable. No new consolidations. No pneumothorax is seen.

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2143-12-09 09:18:00

2143-12-09 11:25:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with newly placed OGT while intubated// OGT position OGT position IMPRESSION: ET tube tip is 2.5 cm above the carina. NG tube tip is at the proximal stomach or gastroesophageal junction and should be advanced at least in cm. Spinal hardware is in expected location. Heart size and mediastinum are stable but there is interval development of moderate pulmonary edema, interstitial primarily.

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2143-12-12 09:55:00

2143-12-12 10:55:00

EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with fever// r/o PNA IMPRESSION: In comparison with the study of ___, the bilateral layering pleural effusions are no longer seen. However, this appearance could merely reflect a more upright position of the patient. No pneumonia, vascular congestion, or other abnormality. Cervical fusion device is again seen.

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2145-09-13 14:36:00

2145-09-13 15:09:00

EXAMINATION: Chest radiograph INDICATION: ___ woman with recent cough, elevated glucose. Evaluate for PNA. TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph dated ___. FINDINGS: Left pleural effusion is small. The right pleural effusion is trace. Trace amount of fluid tracks in the minor fissure. No pulmonary edema, focal consolidation, or pneumothorax. The heart remains enlarged, unchanged. Mediastinal and hilar contours are unchanged. The thoracic aorta is slightly tortuous and/or ectatic. Aortic knob calcifications are mild. Mild loss of a mid thoracic vertebral body height is similar to the prior exam. Anterior compression fracture of the L1 vertebral body is unchanged. IMPRESSION: Persistent small left and trace right pleural effusions and cardiomegaly. No pulmonary edema.

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2145-09-13 15:01:00

2145-09-13 15:42:00

EXAMINATION: RENAL TRANSPLANT U.S. INDICATION: ___ woman with worsening renal function. Evaluate for renal transplant. TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images of the renal transplant were obtained. COMPARISON: Abdominal ultrasound dated ___. FINDINGS: The right iliac fossa transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. There is no hydronephrosis and no perinephric fluid collection. A simple cyst in the upper renal pole measures up to 1.4 cm. A cyst in the interpolar region measures up to 2.3 cm and is notable for peripheral calcification. The resistive index of intrarenal arteries ranges from 0.69 to 0.79, within the normal range to slightly elevated. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 53 cm/s. Vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. IMPRESSION: 1. Patent renal transplant vasculature. 2. Borderline to minimally elevated intrarenal resistive indices measuring up to 0.79 in the interpolar region.

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2172-07-16 10:09:00

2172-07-16 11:43:00

CLINICAL INDICATION: Fall with multiple fractures. COMPARISON: MR lumbar spine ___. FRONTAL AND LATERAL VIEWS OF THE LUMBAR SPINE: There are five lumbar-type vertebral bodies. There is marked multilevel degenerative changes including anterior osteophytes on T11, T12, L4 and L5 vertebral bodies. There is marked facet joint hypertrophy that is most prominent at the L5-S1 level. Grade I anterolisthesis of L3 on L4 and L4 on L5 appears unchanged compared to be prior MR lumbar spine. No definite compression fracture is identified or new malalignment. Study is slightly limited due to the patient's body habitus. IMPRESSION: Marked multilevel degenerative changes with no definite evidence of new malalignment or fracture. If there is high clinical concern for fracture, CT of the lumbar spine could be obtained. If there are worsening neurological symptoms, MR of the lumbar spine could be obtained. ___ discussed with ___ at 10:30 a.m. on ___, at the time of discovery.

10005858-RR-120

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2172-07-16 10:09:00

2172-07-16 12:02:00

CLINICAL INDICATION: Fall with multiple fractures. COMPARISON: Three-foot standing radiograph ___ and bilateral knee radiographs ___. THREE VIEWS OF THE RIGHT KNEE: A total knee replacement is seen without periprosthetic lucency to suggest failure. There is no fracture or traumatic malalignment. Heterotopic bone formation involving the quadriceps and patellar tendons is unchanged. There is a small joint effusion. THREE VIEWS OF THE LEFT KNEE: There is a total knee arthroplasty with no periprosthetic lucency to suggest hardware failure. There is no fracture or traumatic malalignment. Heterotopic bone formation involving the quadriceps and patellar tendons is unchanged. There is a small joint effusion. IMPRESSION: Bilateral knee arthroplasties without evidence of hardware failure or fracture.

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2172-07-16 10:09:00

2172-07-16 11:46:00

CLINICAL INDICATION: Fall with multiple fractures. COMPARISON: Three-foot standing view radiograph ___ and bilateral knee radiographs ___. FRONTAL VIEW OF THE PELVIS: No acute fracture or traumatic malalignment is seen. There are moderate degenerative changes within the sacroiliac and bilateral hip joints. There are no concerning osteoblastic or osteolytic lesions. FOUR VIEWS OF THE LEFT FEMUR: There is a left knee prosthesis. Prosthesis appears unchanged in alignment compared to the prior radiograph. No fracture or traumatic malalignment is seen. There are no concerning osteoblastic or osteolytic lesions. Heterotopic bone formation involving the quadriceps and patellar tendons is unchanged. IMPRESSION: No acute fracture or traumatic malalignment. Moderate degenerative changes.