Musculoskeletal
MR joint
Clinical information: [Pain]
Technique: MRI of the [right] [knee] was performed [without] contrast
utilizing multiplanar / multi-echo technique. [No prior study] available for comparison.
Findings:
[]
Impression: []
MR Lumbosacral Spine
Clinical information: [Back pain]
Technique: Magnetic resonance imaging [without] contrast of the lumbosacral spine was performed utilizing multiplanar / multi-echo technique. [No prior
study] available for comparison.
Findings:
[Desiccation of multiple intervertebral discs is seen indicating degeneration
of intervertebral discs.]
[
L1-2: []
L2-3: []
]
L3-4: []
L4-5: []
L5-S1: []
Impression: []
[Degeneration of intervertebral discs and disc displacements as described.]
MR Cervical Spine
Clinical information: [Pain]
Technique: Magnetic resonance imaging [without] contrast of the cervical spine
was performed utilizing multiplanar / multi-echo technique. [No prior study]
available for comparison.
Findings:
[Desiccation of multiple intervertebral discs is seen indicating degeneration
of intervertebral discs.]
[
C1-2: []
C2-3: []
]
C3-4: []
C4-5: []
C5-6: []
C6-7: []
C7-T1: []
Impression: []
[Degeneration of intervertebral discs and disc displacements as described.]
MR Thoracic Spine
Clinical information: [Back pain]
Technique: Magnetic resonance imaging [without] contrast of the thoracic spine
was performed utilizing multiplanar/multi-echo technique. [No prior study]
available for comparison.
Findings:
[Desiccation of multiple intervertebral discs is seen indicating degeneration
of intervertebral discs.]
T8-9: []
T9-10: []
T10-11: []
T11-12: []
T12-L1: []
Impression: []
[Degeneration of intervertebral discs and disc displacements as described.]
MR Thoracolumbar Spine
Clinical information: [Back pain]
Technique: Magnetic resonance imaging [without] contrast of the lumbosacral
spine and thoracic spine was performed utilizing multiplanar/multi-echo
technique. [No prior study] available for comparison.
Thoracic MRI:
[Desiccation of multiple intervertebral discs is seen indicating degeneration
of intervertebral discs.]
T8-9: []
T9-10: []
T10-11: []
T11-12: []
T12-L1: []
Lumbosacral MRI:
[Desiccation of multiple intervertebral discs is seen indicating degeneration
of intervertebral discs.]
[
L1-2: []
L2-3: []
]
L3-4: []
L4-5: []
L5-S1: []
Impression:
1. Thoracic MRI: [Degeneration of intervertebral discs and disc displacements
as described.]
2. Lumbosacral MRI: [Degeneration of intervertebral discs and disc
displacements as described.]
X-ray Bone Fracture
Clinical History: [Pain]
Examination: [] views of the [] are submitted for review [ without prior
radiographs available for comparison].
Findings: []
[There is no evidence of fracture or dislocation.]
Impression:
[No evidence of fracture or dislocation.]
X-ray Feldman
Clinical History: [Status post injury]
Examination: [] views of the [] are submitted for review. No prior
radiograph is available for comparison.
Findings: []
[There is no evidence of bony or articular abnormality.]
Impression:
[No bony or articular abnormality.]
X-ray Cervical Spine
Clinical Information: [Motor vehicle accident]
Description: AP, lateral, and open-mouth views of the cervical spine
are submitted for review.
[No evidence of fracture or malalignment is seen. Vertebral heights and
intervertebral disc spaces are maintained. The prevertebral soft-tissues are
unremarkable. There is no evidence of focal osteolytic or blastic lesion. ]
Impression:
[No evidence of fracture or malalignment.]
X-ray Thoracic Spine
Clinical information: [Back pain]
Description: AP and lateral views of the thoracic spine are submitted
for review.
[No evidence of fracture or malalignment is seen. Vertebral heights and
intervertebral disc spaces are preserved. There is no evidence of focal
osteolytic or blastic lesion. Osseous mineralization is unremarkable.]
Impression:
[No evidence of osseous or articular abnormality.]
X-ray Lumbosacral Spine
Clinical information: [Back pain]
Description: AP, lateral, and coned down lateral views of the
lumbosacral spine are submitted for review.
[No evidence of fracture or malalignment is seen. Vertebral heights and
intervertebral disc spaces are preserved. There is no evidence of focal
osteolytic or blastic lesion. Osseous mineralization is unremarkable.]
Impression:
[No evidence of osseous or articular abnormality.]
Body / Cardiovascular MR
MR Liver
Clinical Statement: []
Technique: [1.5] Tesla, phased array coil, coronal SSFSE, Axial T1 in phase and
out-of-phase breathhold SPGR, axial T2 SSFSE, dynamic Gd enhanced axial 3D
gradient echo with fat saturation and post Gd coronal 2D gradient echo with fat
saturation. Images were reviewed and reconstructed on a computer workstation.
[No prior study] available for comparison.
Findings:
Ascites: []
Liver: []
Biliary ducts: []
Pancreas & duct: []
Spleen: []
Adrenal glands: []
Kidneys: []
Retroperitoneum: []
IMPRESSION:
[]
MR Liver + MRCP
Clinical Statement: []
Technique:
[1.5] Tesla, phased array coil, coronal SSFSE, Axial T1 in phase and out-of-
phase breathhold SPGR, axial T2 SSFSE, dynamic Gd enhanced axial 3D gradient
echo with fat saturation and post Gd coronal 2D gradient echo with fat
saturation. Images were reviewed and reconstructed on a computer workstation.
[1.5] Tesla, phased array coil, MRCP with thick and thin sections in multiple
planes. Images were reviewed and reconstructed on a computer workstation.
[No prior study] available for comparison.
Findings:
Ascites: []
Liver: []
Biliary ducts: []
Pancreas & duct: []
Spleen: []
Adrenal glands: []
Kidneys: []
Retroperitoneum: []
IMPRESSION:
[]
MR Fibroids
Clinical History: [Fibroids]
Technique: [1.5] Tesla, phased array coil,
- axial, coronal and sagittal fast spin echo T2
- axial T1
- axial T1 with fat saturation pre and post gadolinium
- coronal T1 with fat saturation post gadolinium.
Findings:
Uterus: []
Endometrial stripe: []
Cervix: []
Right ovary: []
Left ovary: []
Lymph nodes: []
Bones: []
Impression: []
MR Prostate
Clinical History: Prostate cancer, ? extent, ? adenopathy
Technique: [1.5] Tesla, phased array coil, coronal SSFSE and Axial T1 of lower
abdomen and pelvis. then an endorectal coil was inserted and high resolution
images of the prostate were obtained using T2 in sagittal, axial and coronal
planes as well as axial T1.
Findings:
Prostate: []
Seminal vessicles: []
Lymph nodes: []
Bones: []
Impression:
[]
MR Renal MRA
Clinical history: []
Technique: [1.5] Tesla, phased array coil, Coronal and axial SSFSE, 2D time-of-
flight localizer coronal 3-D gadolinium enhanced MRA, axial 3-D phase contrast,
post gadolinium coronal 3-D gradient echo during excretory phase. 3D images
were reconstructed on a computer workstation to obtain optimized MIPs.
Findings:
Aorta: []
Celiac axis: []
SMA: []
IMA: []
Right renal artery: []
Left renal artery: []
Delayed images show symmetrical excretion of gadolinium by both kidneys into
the collecting systems and ureters.
Right common iliac: []
Right external iliac: []
Right internal iliac: []
Left common iliac: []
Left external iliac: []
Left internal iliac: []
Limited MRI of the abdomen and pelvis shows no evidence of adenopathy or mass.
Impression:
[]
MR Renal Transplant MRA
Clinical history: []
Technique: [1.5] Tesla, phased array coil, Coronal and axial SSFSE, 2D time-of-
flight localizer coronal 3-D gadolinium enhanced MRA, axial 3-D phase contrast,
post gadolinium coronal 3-D gradient echo during excretory phase. 3D images
were reconstructed on a computer workstation
Findings:
Aorta: []
Celiac axis: []
SMA: []
IMA: []
Right renal artery: []
Left renal artery: []
transplant renal artery
Delayed images show excretion of gadolinium by the tranplant kidney into the
collecting system, ureter and bladder.
Right common iliac: []
Right external iliac: []
Right internal iliac: []
Left common iliac: []
Left external iliac: []
Left internal iliac: []
Limited MRI of the abdomen and pelvis shows no evidence of adenopathy or mass.
Impression:
[]
MR Run-off
Clinical Statement: []
Technique: [1.5] Tesla, 3D time-resolved MRA of feet in head coil followed by
3D bolus chase Gd:MRA with mask subtraction and subsystolic blood pressure cuff
compression of veins in PV coil. 3D image data was post-processed on a
computer workstation.
Findings:
Abdominal Aorta: []
Celiac: []
SMA: []
IMA: []
Right Renal artery: []
Left Renal artery: []
Right Leg Arteries
common iliac: []
internal iliac: []
external iliac: []
common femoral: []
profunda femoral: []
SFA: []
Popliteal: []
tibio-peroneal trunk: []
Anterior tibial: []
Peroneal: []
posterior tibial: []
Left leg:
common iliac: []
internal iliac: []
external iliac: []
common femoral: []
profunda femoral: []
SFA: []
Popliteal: []
tibio-peroneal trunk: []
Anterior tibial: []
Peroneal: []
posterior tibial: []
No soft tissue masses were noted but note that the imaging sequences were not
optimized for evaluation of non-vascular structures.
Impressions:
1) Right leg: []
2) Left leg: []
MR Aorta
History: []
Technique: [1.5] Tesla, phased array coil, EKG gating, axial double IR,
coronal 3D dynamic Gd:MRA, post Gd axial 2D time-of-flight of Chest and abdomen.
| Aorta location |
diameter (cm) |
| Sinuses of valsalva |
[] |
| ascending at RPA |
[] |
| arch |
[] |
| descending at RPA |
[] |
| descending at diaphragm |
[] |
| supraceliac abdominal aorta |
[] |
| aorta at renal arteries |
[] |
| infrarenal aorta |
[] |
Findings:
Aorta: []
Innominant: []
Left common carotid: []
Left subclavian: []
Celiac: []
SMA: []
IMA: []
Right renal artery: []
Left renal artery: []
Heart: []
Pericardium: []
Mediastinum: []
Impression:
[]
MR Cardiac
History: []
Technique:
1.5 Tesla, free breathing
axial double inversion black blood
2 chamber FIESTA
4 chamber FIESTA
short axis FIESTA
[Perfusion]
[Coronal 3D ECG-gated Gd MRA]
PC flow of aorta
PC flow of PA
[Delayed enhancement (4-chamber, short axis)]
Findings:
Situs: [normal]
Cardiac Apex: [left]
Concordance: [normal]
SVC: []
IVC: []
Right Atrium: []
Tricuspid Valve: []
Right Ventricle: []
[
RV End diastolic volume: [] ml
RV End systolic volume: [] ml
RV Stroke volume: [] ml
RV Cardiac output: [] L/min
RV Ejection Fraction: [] %
[RV mass:[] g]
]
Pulmonic Valve: []
Pulmonary Arteries: []
MPA: []
RPA: []
LPA: []
Left atrium: []
Mitral valve: []
Left Ventricle: []
LV End diastolic volume: [] ml
LV End systolic volume: [] ml
LV Stroke volume: [] ml
LV Cardiac output: [] L/min
LV Ejection Fraction: [] %
LV mass: [] g
Aortic valve: []
Aorta: []
Ascending: []
Descending: []
Arch: []
Coarctation?: [No]
Mediastinum: []
Impression: []
MR appendicitis
Clinical Statement: [Right lower quadrant pain]
Technique: [1.5] Tesla, phased array coil. Coronal, axial, sagittal SSFSE and
coronal, axial, sagittal IR.
[No prior study] available for comparison.
Findings:
Appendix: []
IMPRESSION:
[]
Neuro
CT head
Clinical information: []
Description: Axial images from a head CT without IV contrast are
reviewed [without prior studies available for comparison].
Findings:
[No evidence of a mass, hemorrhage, or large acute infarct is seen. The
visualized paranasal sinuses and mastoids are clear.]
Impression:
[No evidence of acute intracranial abnormality.]
CT head (bis)
Clinical information: []
Description: Axial images from a head CT without IV contrast are reviewed
[without prior studies available for comparison].
[No evidence of a mass, hemorrhage, or definite infarct is seen.]
Impression:
[Unremarkable noncontrast head CT.]
CT Preliminary
This is preliminary report dictated by the on call resident for a/an [Head] CT.
HISTORY: [Altered Mental Status]
FINDINGS: [No evidence of acute intracranial abnormality]
[1. []
2. []
3. []]
Final report to follow. PLEASE CHECK FINAL REPORT.
MR brain noncontrast
Clinical Information: [Headache]
Technique: An MRI of the brain without contrast was performed.
Sagittal T1, axial T1, T2, PD, FLAIR, and diffusion weighted images of the
brain were obtained, [without prior studies available for comparison.]
Findings: []
[No acute infarct, mass, or hemorrhage is seen. The visualized paranasal
sinuses and mastoid air cells are clear.]
Impression:
[No abnormal signal to suggest acute infarct, mass or hemorrhage.]
MR brain with contrast
Clinical Information: [Headache]
Technique: An MRI of the brain with and without contrast was performed.
Sagittal T1, axial T1, T2, PD, FLAIR[,] and diffusion weighted images and post
contrast axial, coronal, and sagittal T1 weighted images of the brain were
obtained, [without prior studies available for comparison].
Findings: []
[]
Impression:
[No evidence of focal mass or area of abnormal enhancement.]
MRI Head, MRA Head, MRA Neck
History:
Technique:
MRI BRAIN:
Multiple MR images of the brain were obtained using a combination of sagittal
and axial T1 weighted images, axial proton density and T2 weighted images,
axial FLAIR images and axial diffusion-weighted images.
MRA BRAIN:
MRA images of the circle of Willis were performed using 3D time-of-flight
technique. Images were subsegmented with IVI images of the anterior and
posterior circulations.
MRA NECK:
MRA of the extracranial carotid and vertebral arteries was performed using 2D
time-of-flight technique. Images were subsegmented into the left and right
circulations using IVI technique.
FINDINGS:
MRI BRAIN:
The midline structures are unremarkable. There is no evidence of focal or
diffuse abnormal signal. The ventricles are not enlarged. The diffusion
weighted images show no evidence of infarction. Extra-axial collections are
not present.
The visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.
MRA BRAIN:
Unremarkable flow related enhancement is noted within the major vessels of the
circle of Willis. The skull base, precavernous, cavernous, supraclinoid
segments of the internal carotid arteries are unremarkable. Extremely
hypoplastic posterior communicating arteries are noted bilaterally. A
hypoplastic anterior communicating artery is also present.
MRA NECK:
There is no evidence of hemodynamically significant stenoses in the carotid
artery bifurcations. Both vertebral arteries are present, the [right / left] being slightly dominant.
IMPRESSION:
MRI BRAIN:
Unremarkable noncontrast study of the brain.
MRA BRAIN:
Congenital variants as described; otherwise unremarkable study of the circle of
Willis.
MRA NECK:
No evidence of hemodynamically significant stenoses at the carotid
bifurcations.
MR Brain IAC
History: []
Technique:
MR evaluation of the brain was performed with and without Gadolinium, using the
following sequences: axial and sagittal Tl, axial T2, proton density, FLAIR ,
and diffusion weighted axial imaging sequences. Additional pre and post
Gadolinium T1 weighted 3 mm thick axial and post Gadolinium 3 mm thick coronal
sequences were obtained through the internal auditory canals. Post contrast
images of the entire brain were also obtained. [No prior study is available
for direct comparison.]
Findings:
[The internal auditory canals are unremarkable bilaterally. There is no
evidence of soft tissue asymmetry. No abnormal signal or enhancement is seen.
No abnormal signal or enhancement is seen in the cerebellopontine angles
bilaterally.
No T2 signal abnormalities are noted in the brain stem.
There is no evidence of abnormal parenchymal enhancement. No acute infarct is
seen. No intracranial mass, hemorrhage, or extra-axial collection is noted. ]
IMPRESSION:
[No evidence of abnormal signal or enhancement in the internal auditory canal,
bilaterally.]
MR Neck MRA / MRV
Clinical Statement: [End stage renal disease, history of left innominate vein]
Technique: 1.5 Tesla, 2D time of flight and 3D time-resolved MRA and MRV of
neck and thorax. 3D image data was post-processed on a computer workstation.
Findings:
_Arteries_
Aorta: []
Right innominate: []
Right subclavian: []
Right carotid: []
Left carotid: []
Left subclavian: []
_Veins_
SVC: []
Right innominate: []
Right subclavian: []
Right carotid: []
Left innominate: []
Left subclavian: []
Left carotid: []
Impressions: []
Body – CT, X-ray, GI, GU
CT abdomen / pelvis – pain
Clinical statement: [Abdominal Pain]
Procedure #1: CT scan of the abdomen. Prior study [not] available for
comparison.
The visualized lung bases are clear.
The liver [is unremarkable.]
The spleen, pancreas, and adrenal glands are unremarkable in appearance. Both
kidneys appear unremarkable.
There is no abdominal lymphadenopathy or ascites.
The bowel demonstrates no evidence of obstruction or bowel wall thickening. []
Procedure #2: CT scan of the pelvis.
Evaluation of the pelvis reveals a normal appearing urinary bladder.
There is no pelvic lymphadenopathy or ascites.
[There are no suspicious lytic or blastic osseous lesions.]
Impression:
Abdomen:
[Unremarkable CT scan of the abdomen.]
Pelvis:
[Unremarkable CT scan of the pelvis.]
CT abdomen / pelvis – mets
Clinical statement: [[Breast] cancer. Rule out metastasis.]
Procedure #1: CT scan of the abdomen. Prior study [not] available for
comparison.
The visualized lung bases are clear.
The liver [is unremarkable.]
The spleen, pancreas, and adrenal glands are unremarkable in appearance. Both
kidneys appear unremarkable.
There is no abdominal lymphadenopathy or ascites.
The bowel demonstrates no evidence of obstruction or bowel wall thickening. []
Procedure #2: CT scan of the pelvis.
Evaluation of the pelvis reveals a normal appearing urinary bladder.
There is no pelvic lymphadenopathy or ascites.
[There are no suspicious lytic or blastic osseous lesions.]
Impression:
Abdomen:
[No evidence of metastatic disease in the abdomen.]
Pelvis:
[No evidence of metastatic disease in the pelvis.]
X-ray abdomen
Clinical Information: []
Description: Supine and upright frontal views of the abdomen are
submitted[.]
The bowel gas pattern is normal. There is no evidence of free intraperitoneal
air, pathologic calcification, or soft tissue mass.
The osseous structures are intact. The visualized portions of the lung bases
are clear.
Impression:
[Unremarkable abdominal x-ray.]
X-ray feeding tube
Clinical information: [Feeding tube placement]
Description: A single frontal view of the abdomen is submitted for review[].
A feeding tube is seen with its distal tip in the [stomach].
The bowel gas pattern [appears nonobstructive]. [There is no evidence of free intraperitoneal air.] []
[The visualized portions of the lung bases are clear. ]
Impression:
[Feeding tube tip seen in] [stomach].
GI Upper GI
Clinical Information: []
Description:
A scout supine frontal view of the abdomen demonstrates a normal bowel gas
pattern, with no evidence of pathologic calcification, free intraperitoneal
air, or soft tissue mass. The osseous structures are intact.
A double-contrast upper GI series was performed. The esophagus is unremarkable,
with no evidence of intraluminal filling defect or mucosal irregularity.
The stomach is unremarkable. There is no evidence of gastroesophageal reflux or
hiatus hernia.
The duodenum is unremarkable.
Impression:
[Unremarkable upper GI series.]
GI Upper GI and Small Bowel Series
Clinical Information: []
Description:
A scout supine frontal view of the abdomen demonstrates a normal bowel gas
pattern, with no evidence of pathologic calcification, free intraperitoneal
air, or soft tissue mass. The osseous structures are intact.
A double-contrast upper GI series was performed. The the esophagus is
unremarkable, with no evidence of intraluminal filling defect or mucosal
irregularity.
The stomach is unremarkable. There is no evidence of gastroesophageal reflux or
hiatus hernia.
A small bowel follow-through was performed. The small bowel contrast
transit time is normal.
The duodenum and jejunum are unremarkable, with no evidence of increase in
number or width of folds, intraluminal filling defect, or mucosal abnormality.
The ileum is unremarkable. The terminal ileum is well visualized, and is normal
in appearance.
Impression:
[Unremarkable upper GI and small bowel series.]
GI Small Bowel Series
Clinical Information: []
Description:
A scout supine frontal view of the abdomen demonstrates an unremarkable bowel
gas pattern, with no evidence of free intraperitoneal air, soft tissue mass, or
pathologic calcification.
A small bowel follow-through was performed. The small bowel contrast transit
time is normal.
The duodenum and jejunum are unremarkable, with no evidence of increase in
number or width of folds, intraluminal filling defect, or mucosal abnormality.
The ileum is unremarkable. The terminal ileum is well visualized, and is normal
in appearance.
Impression:
[Unremarkable small bowel follow through.]
GI Barium Enema
Clinical Information: []
Description: A scout view of the abdomen, multiple fluoroscopic images
after the barium enema, and multiple radiographs in the PA and decubiti views
of the abdomen are submitted for review.
There is no evidence of mass, stricture, diverticulum, or colonic polyps. The
architecture and mucosal surfaces of the colon appear normal. There is no
evidence of colonic abnormality.
Impression:
[No evidence of mass, stricture, diverticulum, or colonic abnormality.]
GI Barium Swallow
Clinical Information: []
Description:
A scout supine frontal view of the chest demonstrates clear lungs and normal cardiomediastinal borders.
A double-contrast esophogram was performed. The esophagus is unremarkable, with no evidence of intraluminal filling defect or mucosal irregularity.
There is no evidence of gastroesophageal reflux or hiatus hernia.
Impression:
[Unremarkable esophogram.]
GI Modified Barium Swallow – Aspiration
Clinical History: [Aspiration]
Description: [A modified barium swallow was performed in conjunction
with the speech pathology service with thin barium and puree.
No evidence of penetration was seen.]
Impression: [
No evidence of penetration.]
GI Gastric Bypass
Clinical Information: [Status post gastric bypass]
Description:
A scout supine frontal view of the chest demonstrates clear lungs and normal cardiomediastinal borders.
A modified esophogram was performed with gastrograffin and thin barium. The esophagus is unremarkable, with no evidence of intraluminal filling defect or mucosal irregularity. No evidence of leak or obstruction is seen at the site of anastomosis
Gastroesophageal reflux is noted.
Impression:
[No evidence of leak or obstruction at the site of anastomosis.]
GI Defacography
Clinical History: [Constipation]
Description: [Defacography was performed in conjunction with the general
surgery service. Contrast was injected into the rectum.]
The rectum is well visualized and the contours are unremarkable. The
contrast was excreted with Valsava maneuver.
Impression:
Unremarkable defacography
GU IVP
Clinical Information: []
Description:
A scout supine frontal view of the abdomen demonstrates a normal bowel gas
pattern, with no evidence of free intraperitoneal air, pathologic
calcification, or soft tissue mass. The osseous structures are unremarkable.
Following the administration of intravenous contrast, prompt and symmetric
bilateral nephrograms are identified. The kidneys are normal in size, contour,
axis, and position.
Prompt excretion is noted bilaterally into normal renal collecting systems and
ureters, with no evidence of intraluminal filling defect or mucosal
irregularity.
The bladder is smooth-walled, with no evidence of intraluminal filling defect
or mucosal abnormality. There is no significant post void residual.
Impression:
[Unremarkable excretory urogram.]
GU Hysterosalpingogram
Clinical History: [Infertility]
Description: [A hysterosalpingogram was performed in conjunction with
the gynecology service. Contrast was injected into the uterus via a catheter.]
The uterus was well visualized and is unremarkable. The fallopian tubes are
patent bilaterally.
Impression:
Unremarkable hysterosalpingogram
Ultrasound
US Lower Extremity Dopplers
Clinical history: [Bilateral lower extremity swelling]
Procedure: Gray scale ultrasound and color Doppler were utilized to
evaluate the lower extremity deep venous systems.
Findings: There is normal compression, augmentation and respiratory
variation in the common femoral veins, superficial femoral veins and popliteal
veins bilaterally.
Impression: []
[No evidence of deep venous thrombosis in either lower extremity. ]
US Right Lower Extremity Dopplers
Clinical history: [Right lower extremity swelling]
Procedure: Gray scale ultrasound and Doppler were utilized to evaluate
the right lower extremity deep venous system.
Findings: There is normal compression, augmentation and respiratory
variation in the right common femoral vein, the right superficial femoral vein
and the right popliteal vein.
Impression:
[No evidence of deep venous thrombosis in the right lower extremity.]
US Left Lower Extremity Dopplers
Clinical history: [Left lower extremity swelling]
Procedure: Gray scale ultrasound and color Doppler were utilized to
evaluate the left lower extremity deep venous system.
Findings: There is normal compression, augmentation and respiratory
variation in the left common femoral vein, the left superficial femoral vein
and the left popliteal vein.
Impression:
[No evidence of deep venous thrombosis in the left lower extremity. ]
US Abdomen
Clinical history: []
Procedure: Gray scale ultrasound was utilized to evaluate the abdomen.
Color Doppler and spectral Doppler were utilized to assist evaluation of cystic
and vascular structures.
Findings: The liver is [normal in size] at [] cm in length. It is
[normal] in echogenicity[.] There are no focal liver masses. There is no
intrahepatic ductal dilatation.
[There are no] gallstones. [No pericholecystic fluid, gallbladder wall
thickening, or sonographic Murphy's sign is noted.] [There is no] extrahepatic
ductal dilatation. The common duct is [] mm in size.
The [tail] of the pancreas could not be visualized. The remainder of the
pancreas is normal.
The right kidney is [] cm in length. The left kidney is [] cm in length. No
hydronephrosis and no renal calculi are seen.
The spleen is normal in echotexture and size at [] cm in length.
There is no ascites.
Impression: []
US Abdomen – Dopplers
Clinical history: []
Procedure: Gray scale ultrasound[,] color Doppler[, and spectral
Doppler] were utilized to evaluate the abdomen.
Findings: The liver is [normal in size] at [] cm in length. It is
[normal] in echogenicity[] There are no focal liver masses. There is no
intrahepatic ductal dilatation.
[There are no gallstones.] [There is no] extrahepatic ductal dilatation. The
common duct is [] mm in size.
The main portal vein, left portal vein and right portal vein are patent with
normal waveforms. The hepatic veins are patent with normal waveforms. The
hepatic artery is patent with normal waveforms.
The [tail] of the pancreas could not be visualized. The remainder of the
pancreas is normal.
The right kidney is [] cm in length. The left kidney is [] cm in length. No
hydronephrosis and no renal calculi.
The spleen is normal in echotexture and size at [] cm in length.
There is no ascites.
Impression: []
US Renal
Clinical history: []
Procedure: Grayscale ultrasound was utilized to evaluate the kidneys.
[Color Doppler] [was] [utilized to assist evaluation of cystic and vascular
structures.]
Findings:
The right kidney is [] cm in length. []
The left kidney is [] cm length. []
There is no hydronephrosis and there are no renal calculi in either kidney.
The urinary bladder is unremarkable.
Impression:
[Normal renal sonogram.]
US renal transplant
Clinical history: Status post renal transplant.
Procedure: Gray scale ultrasound, color Doppler and spectral Doppler
were utilized to evaluate the [] lower quadrant renal transplant.
Findings: The [] lower quadrant transplant kidney is [] cm in length. There
is [no / mild / mod / severe] hydronephrosis.
There [are / are no] peritransplant collections.
Resistive indices range from [0.xx] to [0.xx], which are [normal / in the
indeterminate range / elevated, suggesting rejection or ATN].
The transplant artery and vein have normal waveforms. [The feeding iliac artery
has a normal waveform.]
The urinary bladder is [unremarkable / decompressed at the time of the examination].
IMPRESSION:
1. [No / Mild / Mod / Severe] hydronephrosis.
2. There [are / are no] peritransplant collections.
3. RI's which are [normal / in the indeterminate range / elevated, suggesting
rejection or ATN].
US Upper Extremity Bilateral
Clinical history: [Bilateral upper extremity swelling]
Procedure: Gray scale ultrasound, color Doppler and spectral Doppler
were utilized to evaluate the upper extremity deep venous systems.
Findings: There is normal color filling, compression and respiratory
variation in the jugular veins bilaterally. There is normal color filling and
respiratory variation in the innominate veins, subclavian veins and axillary
veins bilaterally. The brachial veins have normal color filling and compression
bilaterally.
Impression:
[No evidence of deep venous thrombosis in either upper extremity.]
US Right Upper Extremity
Clinical history: [Right upper extremity swelling]
Procedure: Gray scale ultrasound, color Doppler and spectral Doppler
were utilized to evaluate the right upper extremity deep venous system.
Findings: There is normal color filling, compression and respiratory
variation in the right jugular vein. There is normal color filling and
respiratory variation in the right innominate vein, the right subclavian vein
and the right axillary vein. The right brachial vein has normal color filling
and demonstrates normal compression.
Impression:
[No evidence of deep venous thrombosis in the right upper extremity.]
US Left Upper Extremity Ultrasound
Clinical history: [Left upper extremity swelling]
Procedure: Gray scale ultrasound, color Doppler and spectral Doppler
were utilized to evaluate the left upper extremity deep venous system.
Findings: There is normal color filling, compression and respiratory
variation in the left jugular vein. There is normal color filling and
respiratory variation in the left innominate vein, the left subclavian vein and
the left axillary vein. The left brachial vein has normal color filling and
demonstrates normal compression.
Impression:
[No evidence of deep venous thrombosis in the left upper extremity.]
US Thyroid
Clinical history: []
Procedure: Gray scale ultrasound and color Doppler were utilized to
evaluate the thyroid gland.
Findings: The right thyroid lobe is [] cm in size without focal
lesions.
The left thyroid lobe is [] cm in size without focal lesions.
Impression:
Normal thyroid sonogram.
US Thyroid Multinodular Goiter
Clinical history: [Multinodular goiter.]
Procedure: Gray scale ultrasound and color Doppler were utilized to
evaluate the thyroid gland.
Findings: The right thyroid lobe is [] cm in size with multiple nodules,
largest [] cm in the [] pole.
The left thyroid lobe is [] cm in size with multiple nodules, largest [] cm in
the [] pole.
Impression:
Multinodular goiter.
US Thyroid Biopsy
Clinical history: [] thyroid nodule.
Procedure: Gray scale ultrasound was utilized to localize the []
thyroid nodule and, under sterile conditions, using local anesthetic, biopsy
was subsequently performed.
Impression:
Ultrasound guided biopsy of [] thyroid nodule. The specimen slides were sent to
Cytopathology for microscopic evaluation.
US Scrotum
Clinical history: []
Procedure: Gray scale ultrasound, color Doppler and spectral Doppler
were utilized to evaluate the scrotum.
Findings: The right testicle is [] cm in size without focal lesions. The
right epididymis is normal. []
The left testicle is [] cm in size without focal lesions. The left epididymis
is normal. []
Impression:
[Normal scrotal sonogram.]
US Renal Biopsy
Clinical history: Renal failure.
Procedure: Ultrasound guidance was provided for biopsy of the []
kidney, which was performed by the clinical service. There were no immediate
complications.
Impression:
Ultrasound guidance for renal biopsy, performed by the clinical service,
without immediate complication.
US Mark For Paracentesis
Clinical history: [Mark for paracentesis]
Procedure: A limited gray scale ultrasound was utilized to evaluate
ascites and mark the abdomen for paracentesis. Color Doppler and spectral
Doppler were utilized to assist evaluation of cystic and vascular structures.
Findings: Massive ascites is seen in the abdomen. The skin of the
right lower quandrant was marked for paracentesis where ascites is seen 2.5 cm
from the skin.
Impression: [
Ascites marked in the right lower quadrant for paracentesis.]
Peds
Peds Voiding Cystourethrogram
HISTORY: [UTI]
DESCRIPTION: A voiding cystourethrogram was performed. Using aseptic
technique, urethral orifice was prepped with iodine. Pediatric catheter was
carefully inserted into the bladder, and nonionic contrast was administered.
Urinary bladder demonstrates no evidence of abnormal filling defects. The wall
is smooth in contour. There is no evidence of ureteral reflux bilaterally.
During voiding, images of the urethra were obtained, and demonstrate no
abnormalities.
Small postvoid residual was present.
IMPRESSION:
Unremarkable voiding cystourethrogram.
Peds Head Ultrasound
Clinical History: [Premature infant]
Description: [Sonogram of the head was performed.]
Findings:
[No evidence of hydrocephalus or intraventricular hemorrhage is seen.]
Impression: [
No evidence of hydrocephalus or intraventricular hemorrhage.]
Peds Hip Ultrasound
HIP ULTRASOUND: There are no comparison studies.
CLINICAL INDICATION: [] hip click.
FINDINGS: Bilateral ultrasonographic evaluation of the hips demonstrates
normal femoral heads without evidence of subluxation or dislocation.
IMPRESSION:
NORMAL HIP ULTRASOUND AS DESCRIBED.
Peds Upper GI
HISTORY: [Vomiting].
DESCRIPTION: Upper GI series was performed.
After administration of barium, images of the esophagus, stomach and upper
abdomen were obtained. The scout view demonstrates no evidence of small bowel
obstruction.
No evidence of gastroesophageal reflux was identified. Stomach and duodenum
demonstrate normal transit time. There is no evidence of malrotation.
Proximal ileum is unremarkable.
IMPRESSION:
Unremarkable upper GI series.
Peds Scoliosis
Clinical information: [Scoliosis]
Technique: AP and lateral standing radiographs of the entire spine are submitted.
Findings:
[There is [mild thoracolumbar] scoliosis. No intrinsic vertebral anomalies are seen.]
Impression:
[Mild] scoliosis
Peds Bone Age
Clinical information: [Short stature]
The [left] hand is submitted for evaluation of the patient's bone age. The patient's Chronological age is [age] years [six] months. The bone age corresponds best to the [male] standard in Greulich and Pyle of [] years.
IMPRESSION:
Within normal limits
Peds Chest X-ray
Clinical information: []
Description: A single frontal view of the chest performed at [] is
reviewed [without prior studies available for comparison].
Both lungs are clear. No focal consolidation or pleural effusion is noted.
The cardiothymic borders are unremarkable.
Impression:
[No evidence of acute cardiopulmonary disease.]
Peds Chest X-ray ICU
Clinical information: [Respiratory distress]
Description: A single frontal view of the chest and upper abdomen
performed at [ ] is reviewed and compared with a prior study dated [12/16/2004].
[[Both lungs are clear. No focal consolidation or pleural effusion is noted.]
The cardiothymic borders are unremarkable.]
Impression:
[No evidence of acute cardiopulmonary disease.]
Peds CT Chest, Abdomen, Pelvis
Clinical statement: [[Lymphoma]. Rule out metastasis.]
Procedure #1: CT scan of the chest. Prior study [not] available for
comparison.
Both lungs are clear. No evidence of mass or nodule is seen. No
lymphadenopathy is noted. No evidence of pleural or pericardial effusion is
seen. The heart appears unremarkable.
Procedure #2: CT scan of the abdomen. Prior study [not] available for
comparison.
The liver [is unremarkable.]
The spleen, pancreas, and adrenal glands are unremarkable in appearance. Both
kidneys appear unremarkable.
There is no abdominal lymphadenopathy or ascites.
The bowel demonstrates no evidence of obstruction or bowel wall thickening. []
Procedure #3: CT scan of the pelvis. Prior study [not] available for
comparison.
Evaluation of the pelvis reveals a normal appearing urinary bladder.
There is no pelvic lymphadenopathy or ascites.
[There are no suspicious lytic or blastic osseous lesions.]
Impression:
Chest:
[No evidence of metastatic disease in the chest.]
Abdomen:
[No evidence of metastatic disease in the abdomen.]
Pelvis:
[No evidence of metastatic disease in the pelvis.]
Chest
X-ray Chest PA and Lateral
Clinical information: []
Description: PA and lateral views of the chest are reviewed [without
prior studies available for comparison].
Both lungs are clear. No focal consolidation, pleural effusion, pulmonary
edema or pneumothorax is noted. The cardiomediastinal borders are
unremarkable. The bony structures are unremarkable.
Impression:
[No evidence of acute cardiopulmonary disease.]
X-ray Chest AP
Clinical information: []
Description: A single frontal view of the chest is reviewed [without
prior studies available for comparison].
Both lungs are clear. No focal consolidation, pleural effusion, pulmonary
edema or pneumothorax is noted. The cardiomediastinal borders are
unremarkable. The bony structures are unremarkable.
Impression:
[No evidence of acute cardiopulmonary disease.]
X-ray Chest ICU
Clinical History: []
Description: A single frontal portable chest radiograph is reviewed and compared with a prior study dated [5/25/2004].
[]
Impression: []
CT Chest
Clinical information: []
Technique: 5 mm spiral CT images through the chest were obtained
without intravenous contrast [without prior studies available for comparison].
Description: No evidence of masses or nodules is present.
No lymph node enlargement is noted in the chest. There is no evidence of
pleural or pericardial effusion.
The airways are patent bilaterally. Visualized portions of the upper abdomen
demonstrate no gross abnormality.
Visualized bony structures demonstrate no evidence of focal blastic or lytic
lesion.
Impression: []
[Unremarkable CT of the chest.]
CT Chest Biopsy
Clinical Information: [Right lower lobe] nodule
Procedure: C. T. guided core biopsy of [right lower lobe] nodule
Physicians: [Resident], [Attending]
Anesthesia: 1 % lidocaine SQ.
Complications: None.
Procedure Description:
The risks, benefits, and alternatives of the procedure were fully explained to
the patient. all questions were answered. Informed consent was obtained.
The patient was placed supine on the CT table and preliminary 5 mm images of
the lungs were obtained to localize the lesion. A [1.5] cm nodule in the [right
lower lobe] was reidentified superior to the right hemidiaphragm. Using
sterile technique, the skin was prepped and draped and an access window was
localized and 1 % local lidocaine was administered SQ. CT fluoroscopy was
used to guide a 19 gauge Temno introducer to the margin of the lesion. The
position was confirmed using CT fluoroscopy and [two] coaxial core biopsies
were obtained using a 20 gauge Temno needle. The specimens were sent to
surgical pathology.
The patient tolerated the procedure well. The follow-up CT scan demonstrated
no evidence of pneumothorax and the patient left the department after one hour
in the recovery room without immediate post procedure complications and was
sent home with standard discharge instructions.
CT Chest Angio (Pulmonary Embolism)
Clinical information: []
Technique: 2 mm spiral CT images through the chest and additional
images of the lower pelvis and thighs were obtained with intravenous contrast
[without prior studies available for comparison].
Description: No evidence of pulmonary embolus or DVT is seen.
No evidence of masses or nodules is present.
No lymph node enlargement is noted in the chest. There is no evidence of
[pleural or] pericardial effusion.
The airways are patent bilaterally. Visualized portions of the upper abdomen
demonstrate no gross abnormality.
Visualized bony structures demonstrate no evidence of focal blastic or lytic
lesion.
Impression: []
[No evidence of pulmonary embolus or DVT]
NM Bone Scan – Normal
Clinical information: [Prostate cancer], rule out metastatic disease.
Description:
After the intravenous administration of [20] millicuries of technetium 99m-HDP,
whole body planar images were obtained in the anterior and posterior
projections.
[There is no abnormal accumulation of radiotracer].
IMPRESSION:
No evidence of metastatic disease.
NM Bone Scan – Degenerative Changes
Clinical information: [Prostate] cancer, rule out metastatic disease.
Description:
After the intravenous administration of [20] millicuries of technetium 99m-HDP,
whole body planar images were obtained in the anterior and posterior
projections.
There is increased radiotracer activity in the [cervical spine, thoracic spine,
lumbar spine, and knees,] which likely represent degenerative in etiology.
Otherwise, there is no evidence of abnormal accumulation of radiotracer to
suggest metastatic disease.
IMPRESSION:
No evidence of metastatic disease. Probable degenerative changes as described.
NM Bone Scan – Compare, No Change
Clinical information: [Breast] cancer, rule out metastatic disease.
Description:
After the intravenous administration of [20.9] millicuries of technetium 99m-
HDP, whole body planar images were obtained in the anterior and posterior
projections. Comparison is made with prior bone scan of [10/24/2002].
There is increased radiotracer activity in the [thoracic spine], which is
likely degenerative in etiology. Otherwise, there is no abnormal accumulation
of radiotracer. There is only physiologic distribution of the radiotracer.
IMPRESSION:
NO EVIDENCE OF METASTATIC DISEASE. NO SIGNIFICANT CHANGE SINCE BONE SCAN OF [10/24/2002].
NM Brain
Clinical information: [].
Description: After the intravenous injection of [20.5] millicuries of
technetium 99m-HMPAO, images of the brain were obtained.
There is [moderate heterogeneity]. [There is evidence for white matter disease
and decreased cortical perfusion.]
Impression:
[Heterogeneous]. [Evidence for white matter disease and] decreased cortical
perfusion. Differential diagnosis includes but not excluded to drugs,
encephalitis, and vasculitis.]
NM Brain – Suggest Diamox
Clinical information: [73] year old [male] with history of [dementia and
personality change] is referred for a brain SPECT to evaluate cortical
perfusion.
Description: After the intravenous injection of [21.2] millicuries of
technetium 99m-HMPAO, images of the brain were obtained. No other studies are
available for correlation.
There is severe decreased bilateral cortical perfusion with extensive white
matter disease. The sensorimotor cortex is not preserved.
Impression:
Severe, global, cortical hypoperfusion including the white matter. This
pattern is atypical for Alzheimer's dementia, and a component of the decrease
may be age related. A possible etiology for the bilateral decreased perfusion
is bilateral vascular disease. A repeat brain SPECT with Diamox can be
obtained to assess vascular reserve.
NM Brain Lyme
Clinical information: [58] year old [female] with Lyme disease is referred for
a brain SPECT to evaluate cortical perfusion.
Description: After the intravenous injection of [21] millicuries of technetium
99m-HMPAO, images of the brain were obtained. No other studies are available
for correlation.
There is [moderate], global, cortical hypoperfusion with heterogeneity. The
hypoperfusion involves the white matter.
Impression:
[Moderate], global, cortical hypoperfusion with heterogeneity. This perfusion
pattern is consistent with encephalitis or vasculitis, such as from infections
[e.g. Lyme disease], autoimmune causes or secondary to some medications.
NM Brain Lyme Comparison
Clinical information: [47] year old [female] with Lyme disease is referred for
a brain SPECT to evaluate cortical perfusion.
Description: After the intravenous injection of [21.6] millicuries of
technetium 99m-HMPAO, images of the brain were obtained. Comparison is made
with prior brain SPECT dated [12/28/99].
There is [moderate], global, cortical hypoperfusion with heterogeneity, which
has [improved] since prior examination.
IMPRESSION:
[MODERATE], GLOBAL, CORTICAL HYPOPERFUSION WITH HETEROGENEITY, WHICH HAS
[IMPROVED] SINCE PRIOR EXAMINATION OF [12/28/99]. THIS PERFUSION PATTERN IS
CONSISTENT WITH ENCEPHALITIS OR VASCULITIS, SUCH AS FROM INFECTIONS [E.G. LYME
DISEASE], AUTOIMMUNE CAUSES OR SECONDARY TO SOME MEDICATIONS.
NM Brain Lyme with Depression
Clinical information: [54] year old [21.4] with Lyme disease is referred for a
brain SPECT to evaluate cortical perfusion.
Description: After the intravenous injection of [21] millicuries of technetium
99m-HMPAO, images of the brain were obtained. No other studies are available
for correlation.
There is [moderate], global, cortical hypoperfusion with heterogeneity. The
hypoperfusion is more pronounced frontally. The hypoperfusion involves the
white matter.
Impression:
[Moderate], global, cortical hypoperfusion with heterogeneity, which is more
pronounced in the frontal regions. This perfusion pattern is consistent with
encephalitis or vasculitis, such as from infections [e.g. Lyme disease],
autoimmune causes or secondary to some medications. The frontal predominance of
the hypoperfusion raises the possibility of an underlying component of
depression.
NM Lymphoscintigraphy
Clinical information: [53] year old woman with [left]-sided breast carcinoma.
Lymphoscintigraphy is now requested as preoperative evaluation proceeding
sentinel lymphadenectomy.
Description:
A total dose of 0.5 millicuries of technetium 99m-sulfa colloid was injected
just lateral to the biopsy site. Imaging was then performed in the anterior
and lateral projections. The skin was marked overlying the sentinel lymph node.
IMPRESSION:
SCINTIGRAPHIC IDENTIFICATION OF SENTINEL LYMPH NODE.
NM Cisternography
Clinical History: [70 year old man with gait impairment. Possible NPH]
Description: [500] uCi of Indium-111 DTPA was administered intrathecally by the
neurologist. Images were obtained at 6, 24, 48 hours in multiple projections.
[The study demonstrates that the ventricles are visualized at 6 hours. However
at 24 and 48 hours, activity is not appreciated in the ventricles. This is
consistent with atrophy.]
Impression:
[FINDINGS INCONSISTENT WITH NPH. MOST LIKELY REPRESENTS ATROPHY]
NM Gallium FUO
Clinical information: Fever of unknown origin.
Description:
[24][ and 48] hours after the intravenous injection of [1.8] millicuries of
gallium-67, whole body planar images were performed in the anterior and
posterior projections. SPECT imaging was also performed of the [chest].
On the whole body images, there is [radiotracer accumulation in the anterior
mediastinum]. [The location of this radiotracer uptake is confirmed on the
SPECT imaging of the chest]. [The SPECT imaging of the chest is somewhat
limited secondary to patient motion].
Otherwise, there is physiologic distribution of the radiotracer.
Impression:
[Radiotracer accumulation in the anterior mediastinum].
NM Gastric Emptying, Egg
History: [] question of delayed gastric emptying.
Description:
After the oral administration of [500] uCi of technetium 99m radiolabeled
sulfur colloid in an egg meal. Imaging over the abdomen was performed in the
anterior and posterior projections. The halftime clearance of the radiotracer
was calculated using the geometric mean.
There is [no] evidence of gastroesophageal reflux. The clearance halftime is
calculated at [] minutes, which is [prolonged].
Impression:
1. [No evidence] of gastroesophageal reflux.
2. [Prolonged] gastric emptying.
NM Hepatobiliary
CLINICAL INFORMATION: []
DESCRIPTION:
After the intravenous administration of [5.4] millicuries technetium-99m
Choletec, imaging of the abdomen was performed. [Of note, after adequate
visualization of bowel structures, 2.5 mg morphine sulfate was administered
intravenously.]
There is prompt radiotracer uptake in the liver with subsequent excretion into
the intrahepatic and extrahepatic biliary system. Following administration of
morphine sulfate there is prompt opacification of the gallbladder
IMPRESSION:
NO SCINTIGRAPHIC EVIDENCE FOR CHOLECYSTITIS.
NM I-123 Uptake
Clinical information: Toxic goiter.
Description:
Twenty-four hours after the oral administration of [276] microcuries of iodine-
123, a 24 hour uptake was calculated.
The 24 hour uptake of I-123 is calculated to be [71] percent which is
[elevated].
IMPRESSION:
[MARKEDLY ELEVATED] UPTAKE OF I-123 OF [71] PERCENT.
NM I-111
Clinical information: Fever of unknown origin.
Description:
24 hours after the intravenous injection of 425 microcuries of indium 111
tactic white blood cells, whole body planar images were performed in the
anterior and posterior projections. SPECT imaging was also performed of the
chest.
On the whole body images, there is radiotracer accumulation in the right
subclavian region. The location of this radiotracer uptake is confirmed on the
SPECT imaging of the chest.
Impression:
Radiotracer accumulation in the right subclavian region, which may represent
infectious process at the site of the patient's subclavian central venous
catheter.
Liver Spleen
Clinical History: [72 year old male with history if idiopathic
thrombocytopenia. Rule out remnant spleen.]
Description: Approximately [5.4] mCi of Tc-99m labeled sulfer colloid was
administered intravenously. Images were then obtained in multiple
projections. No evidence of spleen.
Impression:
[NO EVIDENCE FOR AUXILLARY SPLEEN TISSUE.]
NM VQ quantitation
Clinical information: [pulmonary hypertension]
Description: After the inhalation of [10.3] millicuries of xenon-133 gas,
signal breath, equilibrium, and washout images were performed of the lungs in
the anterior and posterior projections. After the intravenous injection of
[0.5] millicuries of technetium 99m-MAA, perfusion images were obtained in
multiple obliquities. Regional quantitative ventilation and perfusion was then
performed. Comparison is made with chest film of the same date.
There is relatively homogeneous distribution of the radiotracer on the single
breath image which is maintained during equilibrium images. There is mild
retention of the radiotracer at the right lung base on the washout images.
There is marked heterogeneous perfusion throughout both lungs on the perfusion
images. There is no significant left to right shunt.
Regional perfusion to thirds of the lungs as calculated by geometric mean from
anterior and posterior images are:
RIGHT LEFT
UPPER [] []
MIDDLE [] []
LOWER [] []
TOTAL [] []
Regional ventilation to thirds of the lungs as calculated by geometric mean
from anterior and posterior images are:
RIGHT LEFT
UPPER [] []
MIDDLE [] []
LOWER [] []
TOTAL [] []
IMPRESSION:
[]
NM VQ Intermediate Probability
Clinical information: [60] year old [male] with [shortness of breath,]
Description: After the inhalation of [22 ]millicuries of technetium 99m-DTPA,
ventilation images were obtained in multiple obliquities. Corresponding
perfusion images were obtained after the intravenous administration of [4.5]
millicuries of technetium 99m-MAA. Correlation is made with chest film of [the
same date].
On the ventilation images, [there is central deposition of the radiotracer
which is consistent with airway disease].
There are matched perfusion/ventilation defects at [the right apex and right
posterior lung base]. [There are corresponding opacities on the chest film of
the same date.] [The perfusion to the left lung is relatively homogeneous.]
Impression:
Intermediate probability for pulmonary embolism.
NM VQ Low Probability
Clinical information: [17] year old [female] with shortness of breath and
chest pain.
Description: After the inhalation of [22] millicuries of technetium 99m-DTPA,
ventilation images were obtained in multiple obliquities. Corresponding
perfusion images were obtained after the intravenous administration of [4.5]
millicuries of technetium 99m-MAA. Correlation is made with chest film of the
same date.
On the ventilation images, there is central deposition of the radiotracer which
is consistent with airway disease.
There is a small matched perfusion/ventilation defect at the right posterior
lung base. Otherwise, there relative homogeneous distribution of the
radiotracer on the perfusion images.
Impression:
Low probability for pulmonary embolism.
NM VQ Low Probability, Airway
Clinical information: [17] year old [female] with shortness of breath and
chest pain.
Description: After the inhalation of [22] millicuries of technetium 99m-DTPA,
ventilation images were obtained in multiple obliquities. Corresponding
perfusion images were obtained after the intravenous administration of [4.5]
millicuries of technetium 99m-MAA. Correlation is made with chest film of the
same date.
On the ventilation images, there is central deposition of the radiotracer which
is consistent with airway disease.
There is a small matched perfusion/ventilation defect at the right posterior
lung base. Otherwise, there relative homogeneous distribution of the
radiotracer on the perfusion images.
Impression:
Low probability for pulmonary embolism.
NM VQ Matched Defects Low Probability
Clinical information: [58] year old [female] with [shortness of breath and
chest pain].
Description: After the inhalation of [25[ millicuries of technetium 99m-DTPA,
ventilation images were obtained in multiple obliquities. Corresponding
perfusion images were obtained after the intravenous administration of [5.1]
millicuries of technetium 99m-MAA. Correlation is made with chest film of the
same date.
There is a small matched perfusion/ventilation defect in the [periphery of the
right mid lung], without corresponding chest x-ray abnormality. Otherwise,
there relative homogeneous distribution of the radiotracer on the perfusion and
ventilation images.
Impression:
Low probability for pulmonary embolism.
NM VQ Negative
Clinical information: [44] year old [male] with shortness of breath , rule out
pulmonary embolism.
Description: After the inhalation of [25] millicuries of technetium 99m-DTPA,
ventilation images were obtained in multiple obliquities. Corresponding
perfusion images were obtained after the intravenous administration of [5.4]
millicuries of technetium 99m-MAA. Correlation is made with chest film of the
same date.
On the ventilation images, there is uniform distribution of the radiotracer.
On the perfusion images, there is relative homogeneous distribution of the
radiotracer.
Impression:
No evidence for pulmonary embolism.
NM Meckels
Clinical information: [3-year-old girl with anemia]. Rule out Meckel's
diverticulum.
Description: After injection of [4.5] millicuries of technetium 99m-
pertechnetate, sequential imaging of the abdomen was performed for 30 minutes.
[There was no abnormal radiotracer uptake]. There was [] only physiologic
uptake was observed.
IMPRESSION:
[No evidence of Meckel's diverticulum].
NM Neuroblastoma Negative I-131
Clinical information: Neuroblastoma[, stage 3, off therapy for nine to ten
months].
Description: 24 hours after the intravenous administration of [4.4]
microcuries of I-131 MIBG, whole body planar images were obtained in the
anterior and posterior projections. Comparison is made with prior MIBG scans,
the most recent dated [2-14-01].
There is physiologic distribution of the radiotracer. No abnormal foci of the
radiotracer accumulation is noted.
Impression:
No evidence for recurrent/residual neuroblastoma.
NM Neuroblastoma I-123
Clinical information: Neuroblastoma[, stage 3, off therapy for nine to ten
months].
Description: 24 hours after the intravenous administration of [4.4]
millicuries of I-123 MIBG, whole body planar images were obtained in the
anterior and posterior projections. Comparison is made with prior MIBG scans,
the most recent dated [2-14-01].
There is physiologic distribution of the radiotracer. No abnormal foci of the
radiotracer accumulation is noted.
Impression:
No evidence for recurrent/residual neuroblastoma.
NM Octreotide
Clinical Information: [Carcinoid syndrome]
Description: After injection of [7.2] mCi of Indium 111-Octreotide, images
were whole body views, axial, coronal, and sagittal images were obtained.
There is normal visualization of the liver, spleen, and kidneys. There is no
abnormal uptake visualized.
Impression:
No evidence of metastatic disease.
NM Parathyroid Subtraction, Negative
CLINICAL INFORMATION: Elevated calcium and parathyroid hormone.
DESCRIPTION:
Approximately 24 hours after the oral administration of [305] microcuries I-
123, imaging of the neck was performed. Subsequently, [22] mCi Tc 99m
sestamibi was injected intravenously and imaging of the neck was performed.
Iodine counts were then subtracted from the sestamibi counts. [Of note, the
patient moved during imaging, rendering the subtraction images
uninterpretable]. [The patient then underwent two hour delayed sestamibi
imaging.]
There is physiologic distribution of radiotracer. There is no focus of
radiotracer uptake to suggest parathyroid adenoma.
IMPRESSION:
NO SCINTIGRAPHIC EVIDENCE FOR PARATHYROID ADENOMA.
NM PET Lymphoma
Clinical information: [Non-Hodgkin's] lymphoma status post [chemotherapy] is
referred for follow-up PET scan to assess residual/recurrent disease.
Description: Approximately 50 minutes after the intravenous administration of
[9.68] millicuries of Fluorine-18-FDG, a transmission corrected PET scan of the
neck, chest, abdomen and pelvis was performed. Comparison is made with [prior
PET scan dated 1-30-01 as well as prior CT scan of the neck, chest, abdomen and
pelvis dated 5-2-01].
[There has been interval resolution of the hypermetabolic activity in the neck,
chest, abdomen, pelvis, and extremities. There is no evidence for new
hypermetabolic activity.] There is only physiologic distribution of the
radiotracer in the neck, chest, abdomen and pelvis.
IMPRESSION:
[INTERVAL RESOLUTION OF THE HYPERMETABOLIC ACTIVITY IN THE NECK, CHEST,
ABDOMEN, PELVIS AND EXTREMITIES SINCE PRIOR PET SCAN OF 12/30/2002.] NO
EVIDENCE OF MALIGNANCY AT THIS TIME.
NM Prostascint
Clinical information: Prostate cancer, status post RRP 5 years ago with
rising PSA: Rule out metastatic disease.
Description:
After the intravenous injection of [6.0] millicuries of indium-111 labeled
Prostascint, triplanar SPECT imaging was performed of the chest, abdomen, and
pelvis at both 30 minutes and 96 hours. Additionally, whole body planar images
was carried out at 96 hours in the anterior posterior projections.
IMPRESSION:
[]
NM Renal Mag 3
CLINICAL INFORMATION: []
DESCRIPTION:
Following adequate hydration and shortly after the IV administration of [1.25]
mg Vasotec, [5.2] mCi Tc 99m labeled MAG 3 was administered IV. Subsequent
dynamic and static images of the kidneys were obtained in the posterior
projection. Ten minutes after radiotracer injection, [20] mg Lasix was
administered intravenously.
Following adequate aortic bolus of radiotracer there is good perfusion to both
kidneys followed by normal cortical localization. There is subsequent prompt
excretion of radiotracer bilaterally and normal clearance from the collecting
systems.
[No evidence of obstruction was seen.]
Time activity curves were calculated revealing time to peak and T1/2 clearance
[within normal limits bilaterally.]
IMPRESSION:
1. NO SCINTIGRAPHIC EVIDENCE FOR RENAL ARTERY STENOSIS
2. NO EVIDENCE OF OBSTRUCTION
NM Schilling’s
Clinical information: [Celiac disease].
Description:
The patient was given an oral dose of 0.5 microcuries of cobalt-57 labeled
vitamin B12, and an oral dose of 0.5 microcuries of cobalt-58 labeled vitamin
B12 with intrinsic factor. Then after one hour, an intermuscular injection of
1000 micrograms of unlabeled vitamin B12 was given to the patient. The patient
was given a container, and instructed to collect [his] urine for 24 hours, to
be returned to the department of nuclear medicine the next day.
The 24 hour urine volume was measured to be [1100] ml. The fraction of
excreted radiolabeled cobalt 57 vitamin B12 was measured as [5.0] percent,
which is less than normal limits of 8-34%. The fraction of excreted
radiolabeled cobalt 58 vitamin B12 was measured as [3.7] percent, which is also
lower than normal range of 9-33%.
Impression:
[FINDINGS CONSISTENT WITH A MALABSORPTION SYNDROME, NOT CAUSED BY LACK OF
INTRINSIC FACTOR].
NM Sestamibi Whole Body
Clinical information: Thyroid cancer
Description: After the intravenous administration of 22 millicuries of
technetium 99m SESTAMIBI, whole body images were obtained in the anterior and
posterior projections. Delayed whole body images as well as imaging over the
neck wer also performed.
On the initial whole body images, there are several foci of increased
radiotracer accumulation within the liver. These foci appear to be in both
lobes of the liver. They do not persist on the delayed images. Otherwise,
there is physiologic distribution of the radiotracer.
Impression:
Several foci of abnormal radiotracer accumulation within the liver on the
initial whole body images. These foci are suspicious for metastatic disease.
NM therapy, samarium
Clinical information: Metastatic [prostate] cancer. [He] is referred for
treatment with Samarium-153 for palliative therapy of intractable bone pain.
Description: The risks of therapy with Samarium-153 were discussed with the
patient [and his wife], which included but were not limited to, bone marrow
suppression and failure of response. Potential benefits were also discussed.
Informed consent was obtained from the patient.
After the patient's identity was confirmed with two forms of identification,
one with photograph, reliable intravenous access was obtained, and
approximately 500 ml of saline was infused. A total dose of [73.3] millicuries
Samarium-153 was administered intravenously without incident. The patient
remained in the nuclear medicine suite for approximately six hours thereafter,
during which time [his] urine was collected and disposed of properly.
The patient was informed to follow up with [his urologist].
Impression:
INTRAVENOUS ADMINISTRATION OF [83] MILLICURIES OF SAMARIUM-153 FOR PALLIATIVE
THERAPY OF INTRACTABLE BONE PAIN FROM METASTATIC [PROSTATE] CANCER.
NM Three Phase Bone Scan, Osteomyelitis
Clinical information: [Left knee] pain, rule out osteomyelitis.
Description:
After the intravenousadministration of [dose] millicuries of technetium 99m-
HDP, blood flow, blood pool, and delayed images were performed of the [knees].
Correlation is made with plain films of the [] dated [].
On the blood flow imaged, blood pool images, and delayed images, there is
increased radiotracer activity in the [].
Impression:
Increased radiotracer accumulation about the [left knee] on all three phaases,
in the absence of fracture, these findings are consistent with osteromyelitis.
NM Three Phase Bone Scan, Negative
Clinical information: Diabetic with [fever and] [right foot] pain, rule out
osteomyelitis.
Description:
After the intravenous administration of [22] millicuries of technetium 99m-HDP,
blood flow, blood pool, and delayed images were performed of the feet.
Correlation is made with plain films of the [right] foot dated [6/25/01].
On the blood flow imaged, blood pool images, and delayed images, there is no
evidence of increased radiotracer activity in the [feet].
IMPRESSION:
NO EVIDENCE OF OSTEOMYELITIS OF THE [RIGHT FOOT].
NM Thyroid Therapy
CLINICAL INFORMATION: [86 old woman with hyperthyroidism.]
DESCRIPTION:
The risks and benefits of radioactive iodine therapy were discussed, the
patient's identity was confirmed, and appropriate informed consent was
obtained.
A dose of [20] mC I 131 was subsequently administered orally, without incident.
The patient was informed of appropriate precautions and restrictions, and was
told to follow up with her physician in a 4-6 weeks.
IMPRESSION:
ORAL ADMINISTRATION OF [20] MILLICURIES I 131 FOR TREATMENT OF HYPERTHYROIDISM.
NM Thyroid Therapy (bis)
CLINICAL INFORMATION: [Hyperthyroidism]
DESCRIPTION:
The risks and benefits of radioactive iodine therapy were discussed, the
patient's identity was confirmed, and appropriate informed consent was
obtained.
A dose of [20] mC I 131 was subsequently administered orally, without incident.
The patient was informed of appropriate precautions and restrictions, and was
told to follow up with her physician in a 4-6 weeks.
IMPRESSION:
ORAL ADMINISTRATION OF [20] MILLICURIES I 131 FOR TREATMENT OF HYPERTHYROIDISM.
NM Thyroid I-131
Clinical information: Thyroid cancer.
Description:
48 hours after the oral administration of [276] microcuries of iodine-131,
whole body imaging was performed in the anterior and posterior projections.
There is physiologic distribution of the radiotracer. [No abnormal
accumulation of radiotracer is noted].
IMPRESSION:
[NO EVIDENCE OF METASTATIC DISEASE].
NM Thyroid I-123 Uptake
Clinical information: Toxic goiter.
Description: Twenty-four hours after the oral administration of [267]
microcuries of iodine-123, a 24 hour uptake was calculated.
The 24 hour uptake of I-123 is calculated to be [40] percent which is
[elevated].
IMPRESSION:
[ELEVATED] UPTAKE OF I-123 OF [40] PERCENT.
NM Testicular Torsion, Abnormal
History: [3 month-old male with swollen right testicle.] Rule out torsion.
Description: After injection of [5] millicuries of technetium 99m
pertechnetate, flow and blood pool images were obtained.
Blood pool images showed photopenia in the area of the [right] testicle
consistent with torsion.
Impression:
Probable [right] testicular torsion
Interventional Radiology
IR CT Abscess Drainage
Pre procedure diagnosis: []
Post-Procedure diagnosis: []
Procedure:
1. Non contrast CT of the abdomen/pelvis.
2. Placement of 12 french drainage catheter under CT guidance.
Physicians: [], [] (Attending present for entire procedure)
Anesthesia: 1 % lidocaine SQ, versed and fentanyl IV with nursing supervision.
Complications: None.
Contrast: None.
Procedure Description:
The risks, benefits, and alternatives of the procedure were fully explained to
the patient. Informed consent was obtained.
The patient was placed supine on the CT table and limited images of the abdomen
and pelvis were obtained to localize the fluid collection. An access window
was localized and 1 % local lidocaine was administered SQ. Using trocar
technique, a 12 french multipurpose drainage catheter was placed within the
collection. The catheter was locked in position and placed to gravity
drainage. Approximately 40 cc of dark brown material was aspirated and sent
for culture and sensitivity and bilirubin.
The patient tolerated the procedure well and left the department without
immediate post procedure complications.
Procedure Findings:
[The initial CT scan demonstrated a multiloculated gas containing fluid
collection anterior to the left lobe of the liver in the left epigastrium
extending along the anterior abdominal wall into the pelvis. This was
successfully drained with an 12 french multipurpose drain,as described.]
IR Aortoiliac Run-off (AIRO)
HISTORY: []
PROCEDURE:
1. Fluoroscopy.
2. Abdominal aortogram.
3. Pelvic arteriogram.
4. Bilateral lower extremity runoff.
POST PROCEDURE DIAGNOSIS:
1. []
PHYSICIANS: [], []. The attending was present for the entire procedure.
COMPLICATIONS: None.
CONTRAST: Visipaque.
MEDICATIONS: Intravenous conscious sedation, one percent lidocaine.
PROCEDURE DESCRIPTION:
Following description of risks, benefits and alternatives to the procedure
informed consent was obtained. Patient was placed on the angiography table and
both groins were sterilely prepped and draped. Under ultrasound guidance, a 21
gauge micropuncture needle was advanced into the left common femoral artery and
following arterial return, and 018 Cope Mandrell wire was advanced. The needle
was exchanged for a 5 French dilator. The inner dilator and guide wire were
removed, and a 35 Newton 15J guide wire was advanced into the upper abdominal
aorta. Over the guide wire, a 5 French racket catheter was placed in the upper
abdominal aorta and abdominal aortogram was performed. The catheter was then
placed above the iliac bifurcation and pelvic arteriograms were performed.
From this position, bilateral lower extremity runoffs were performed using a
multistation technique. The catheter was then removed and following manual
compression, hemostasis was achieved. Patient tolerated procedure without
difficulty.
FINDINGS:
ABDOMINAL AORTA: [Bilateral single patent renal arteries are identified.
There are symmetric bilateral nephrograms. The celiac axis and superior
mesenteric artery are opacified. There is moderate to narrowing of the distal
abdominal aorta at the bifurcation.]
PELVIS: [A high-grade stenosis of the proximal right common iliac artery is
present. There is mild post stenotic dilatation of the common iliac artery.
The distal common iliac artery, right external iliac artery and right common
femoral artery are all patent, however they are diffusely small in caliber.
The left common iliac artery, external iliac artery and common femoral artery
are all patent, and are also diffusely small in caliber.]
RIGHT LOWER EXTREMITY: [The right profunda femoral artery, superficial femoral
artery and popliteal artery are widely patent. The right anterior tibial
artery is continuous with the dorsalis pedis artery. The tibioperoneal trunk,
peroneal artery and posterior tibial artery are all widely patent. The right
posterior tibial artery continuous as the medial malleolar artery.]
LEFT LOWER EXTREMITY: [The left profunda femoral artery, superficial femoral
artery, popliteal artery are widely patent. The left anterior tibial artery is
continuous with the dorsalis pedis artery. The left posterior tibial artery is
continuous with the medial malleolar artery. The tibioperoneal trunk and
peroneal artery are also patent.]
IR Biliary Change
Preprocedure diagnosis: Status post liver transplant with poorly functioning
internal/external biliary drainage catheter.
Post procedure diagnosis:
1. Poorly functioning internal/external biliary drainage catheter exchanged
for a new custom-designed 7 French Dawson Mueller catheter.
Procedure performed:
1. Catheter cholangiogram.
2. Internal/External biliary drainage catheter exchange.
Physicians: [],[](Attending physician present for entire procedure)
Complications: none.
Contrast:Visipaque.
Anesthesia: none.
Procedure description: The risks, benefits and alternatives of the procedure
were discussed with the patient's mother. All questions were answered and
informed written consent was obtained.
The patient was brought to the angiography suite and placed supine. The site
of her biliary drainage catheter was prepped and draped sterling. Contrast was
injected and the tube was manipulated.
Given the findings, the catheter was exchanged over a 0.035 Newton J wire for
any new custom-designed 7 French Dawson Mueller drainage catheter. Repeat
contrast injection was performed.
The catheter was secured at the skin and left to gravity drainage.
Procedure findings:
The initial cholangiogram reveals filling of the jejunum without evidence of
intrahepatic biliary ductal filling. With tube manipulation at the scan, there
was demonstration of intrahepatic biliary ducts. However, adequate drainage
was not seen.
Following replacement of the catheter with a newer version containing larger
holes over a longer segment, improved intrahepatic bilary ductal filling and
drainage was noted.
IR Biliary Stricture Dilatation
Preprocedure diagnosis: Patient with living related liver transplant for
biliary atresia now with obstructive liver function tests.
Post procedure diagnosis: Same.
Procedure performed:
1. Percutaneous transhepatic cholangiogram.
2. Biliary enteric stricture dilatation.
3. Internal and external biliary drainage.
Physicians: [], [](Attending physician present for entire procedure)
Complications: none.
Contrast: Visipaque.
Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and
fentanyl with nursing supervision.
Procedure description: The risks, benefits and alternatives of the procedure
were discussed with the patient. All questions were answered and informed
written consent was obtained.
The patient was placed supine on the angiography table. Intravenous Rocephin
was administered. The right side of the abdomen was prepped and draped
sterilely. Sonographic evaluation of the right upper quadrant was performed.
An appropriate puncture site in the right axillary line was selected and the
skin anesthetized. Through a small dermatotomy, several passes with a 21 gauge
Accustick needle were made in an attempt to allow opacification of the biliary
ducts. Eventually a central biliary duct was entered and a cholangiogram was
performed. Several passes using a second 21 gauge Accustick needle to access a
more peripheral duct via the same dermatotomy were unsuccessful. A second,
more anterior and superior puncture was made and a more peripheral posterior
right biliary duct was entered. A 0.018 inch Microvena guide wire was passed
more centrally and the Accustick set of nested dilators was then exchanged for
the needle. Utilizing a 0.035 inch Terumo glide wire and a four French Kumpe
catheter the biliary enteric anastomosis was cannulated. The guide wire was
then exchanged for a 0.035 Amplatz wire.
Serial dilatation of the anastomotic stricture was performed utilizing, first a
4 x 20 mm balloon then a 5 x 40 mm balloon. In a 25 French biliary drainage
catheter with additional side holes was fashioned and placed across this region
with its locking loop of centrally within the jejunum. The catheter was then
injected with contrast to demonstrate appropriate function. The catheter was
secured at the skin and left to gravity drainage.
Procedure findings:
1. Completely obstructed right biliary ducts secondary to a tight stricture of the biliary enteric anastomosis.
2. Successful balloon dilatation of biliary anastomotic stricture to 5 mm.
3. 8.5 French internal to external biliary drainage catheter placement, as described.
IR Chemoembolization
Preprocedure diagnosis: [Hepatoma]
Post procedure diagnosis: same.
Procedure performed:
1. Visceral arteriograms (celiac and superior mesenteric arteries).
2. Hepatic chemo embolization.
Physicians: [],[](Attending physician present for entire procedure)
Complications: none.
Contrast: Visipaque
Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and
fentanyl with nursing supervision.
Procedure description:
The risks, benefits, and alternatives to the procedure were discussed with the
patient. Written informed consent was obtained. Preprocedure medications were
administered including cephazolin, metronidazole, odansetron, decadron, and
diphenhydramine intravenously.
The patient was brought into the angiography suite and placed supine.
Following standard prepping and draping, the [right OR left] common femoral
artery was punctured. An 035 wire was advanced into the abdominal aorta and
then a 5 French sheath was placed.
A C2 catheter was used to identify the superior mesenteric artery.
Arteriography was performed. The catheter was repositioned within the celiac
artery and repeat arteriography was performed. [Additional subselective
angiograms of the []arteries were performed.] Chemo embolization was
undertaken utilizing, cisplatin, doxorubicin, mitomycin, lipiodol and PVA.
This was performed until near stasis in the tumor vessels.
The patient tolerated the procedure well and was transferred to the recovery
room in stable condition.
Procedure Findings:
Visceral arteriogram:
Injection of the superior mesenteric artery demonstrated normal arterial
branches with a patent portal vein.
Injection of the celiac artery demonstrated patent splenic, left gastric,
common and proper hepatic, and gastroduodenal arteries. The left hepatic artery
[]. The right hepatic artery [].
Hepatic chemo embolization:
The tumor vasculature in the [right OR left] lobe of the liver was successfully
chemo embolized to near complete stasis.
IR Gastrojejunostomy
Preprocedure diagnosis: 6 month old boy with congenital spinal atrophy and
aspiration risk requiring long term gastric feeding.
Post procedure diagnosis: Same.
Procedure performed: Fluoroscopically guided percutaneous gastrojejunostomy
tube placement.
Physicians: [], [] (Attending physician present for entire procedure)
Complications: none.
Contrast: Conray.
Anesthesia: Subcutaneous one percent lidocaine; general anesthesia supervision.
Procedure description: The risks, benefits and alternatives of the procedure
were discussed with the patient's mother with the aid of a translator. All
questions were answered and informed written consent was obtained.
The patient was brought to the Babies operating room and placed supine. The
upper abdomen was evaluated with ultrasound and then prepped and draped
sterilely. Air was then insufflated into the patient's NG tube. Selection of
an appropriate puncture site over the gastric body/antral junction was
performed. Care was made to avoid the colon and liver. A 19 gauge double wall
needle was advanced into the stomach pointing towards the antrum. Next two
cope anchoring devices were deployed and an 0.035 inch guide wire was passed
easily into the stomach. The stomach was retracted to the anterior abdominal
wall. The wire was directed into the jejunum with the aid of an angled
catheter. Over a stiff 0.038" guide wire a 12 French Shetty transgastric
jejunostomy tube was placed with its distal tip in the proximal jejunum. The
locking loop was appropriately positioned within the stomach. Contrast was
administered to demonstrate appropriate position.
The gastrojejunostomy tube was secured to the skin and a sterile dressing was
applied. The patient on the procedure without complication.
Procedure findings:
1. Status post successful placement of 12 French Shetty percutaneous
gastrojejunostomy tube, as described.
Plan:
1. Gastrojejunostomy tube to gravity drainage for 24 hours.
IR GI Bleed Embolization
Preprocedure diagnosis: History of bright red blood per rectum and mouth from
bleeding pseudoaneurysm s/p embolization 12 hours ago now with question of
rebleed. Followup study.
Post procedure diagnosis: No evidence of active bleeding.
Procedure performed:
1. left transfemoral aortic catheterization.
2. celiac trunk arteriogram.
3. second order splenic arteriogram.
4. second order left gastric arteriogram.
5. embolization of the left gastric artery.
6. superior mesenteric arteriogram.
7. second order replaced right hepatic arteriogram.
8. arteriotomy closure with Perclose device.
Physicians: [], []. (Attending physician present for entire procedure)
Complications: none.
Contrast: Visipaque.
Anesthesia: Subcutaneous one percent lidocaine; Fentanyl and versed conscious
sedation with radiology nursing supervision.
Procedure description: The risks, benefits and alternatives were discussed
with the patient. All questions were answered and informed consent was then
obtained.
The patient was brought to the angiography suite and placed supine. The left
groin was prepped and draped sterilely. Utilizing a 19 gauge single wall
needle, the left common femoral artery was entered. A 0.035 inch guide wire
passed easily into the abdominal aorta. Utilizing a series of nested dilators,
this wire was exchanged for a 0.035 inch 15 J wire. Over this a 5 French long
sheath was placed in the groin. A 5 French C2 Cobra glide catheter and 035
glide wire were used to canulate the celiac trunk and angiogram was performed.
Next, the catheter was position in the splenic artery over a wire and an
arteriogram is performed. Next, catheter was exchanged over a wire for a four
French C2 catheter. A woman's loop was formed at the aortic arch, and the
catheter withdrawn into the celiac trunk which was then used to catheterize the
left gastric artery. An arteriogram was performed. Next, embolization using
gelfoam slurry was performed until near stasis was achieved. Repeat are two
grams then performed.
The catheter was then withdrawn and the Waltman loop undone and used to
cannulate the superior mesenteric artery. An arteriogram was performed. Over
a wire, the replaced right hepatic artery was then cannulated and an
arteriogram was performed. Given the findings, a coaxial microcatheter was
advanced into the right hepatic artery across the pseudoaneurysm, and multiple
microcoils were deployed proximal, at, and distal to the pseudoaneurysm. The
catheter then exchanged over a wire for the 5 French glide Cobra catheter, and
additional larger coils were then deployed until stasis was achieved within the
replaced right hepatic order. Repeat arteriogram was performed.
The catheters and wires were then removed and the the arteriotomy site closed
with a Perclose device successfully. The patient tolerated the procedure,
there were no complications.
The patient was transferred to the ICU without immediate complication in stable
condition.
Procedure findings:
Large approximately 2.5 cm pseudoaneurysm within the replaced right hepatic
artery successfully treated and occluded with multiple coils.
No additional bleeding sides were identified within the celiac axis and
superior mesenteric arteries. The patient is status post Whipple's procedure
consistent with the findings of absence of the gastroduodenal artery.
The left gastric artery was empirically embolized with gelfoam slurry to near
stasis.
IR IVC Filter (Greenfield Groin)
Preprocedure diagnosis: [DVT]
Post procedure diagnosis: same, status post infrarenal IVC filter placement.
Procedure:
1. Left transfemoral catheterization of the IVC.
2. Inferior Venacavagram.
3. Infra-renal Greenfield IVC filter placement.
Physicians: [], []. The attending was present for the entire procedure.
Anesthesia: 1% Lidocaine SQ.
Contrast: Visipaque.
Complications: none.
Procedure Description: The risks, beneftis and alternatives of the procedure
were fully discussed with the patient . All questions were answered and
informed consent obtained from the patient.
The patient was placed in the supine position and the [left] groin was prepped
and draped in a sterile manner. The [left] common femoral vein was punctured
with a 19 gauge needle. An 035 Newton J guide wire was passed easily into the
inferior vena cava. Over this, a 5 French pigtail catheter was placed at the
iliac venous confluence. An inferior venocavagram was obtained.
The pigtail catheter was exchanged over the 035 guidewire for the filter
delivery device. The inner dilator and wire were removed and the Greenfield IVC
filter was advanced to the end of the delivery device. The IVC filter was
deployed in the infrarenal IVC filter. The sheath was then removed and pressure
held at the left groin until hemostasis was achieved. The patient tolerated the
procedure without immediate complications and was discharged from the
department in stable condition.
Procedure Findings:
1. Patent inferior vena cava without anomalies. T
2. Successful infrarenal Greenfield IVC filter placement.
IR AV Shunt Widely Patent
Preprocedure diagnosis: Left arm dialysis AV graft follow-up for IMPRA study
Post procedure diagnosis: same.
Procedure performed:
1. Left upper extremity dialysis fistulagram.
2. Central venogram.
Physicians: [], [](Attending physician present for entire procedure).
Complications: none.
Contrast: Visipaque.
Anesthesia: Subcutaneous one percent lidocaine.
Procedure description: The risks, benefits and alternatives to the procedure
were discussed with the patient. Informed written consent was obtained.
The patient was placed supine on the angiography table. After standard
surgical prepping and draping, the left extremity dialysis graft was punctured
using a 21 G needle. A 0.018" guide wire was easily advanced toward the venous
anastamosis. The needle was removed and exchanged for the inner 3 French
dilator from the micropuncture kit. Contrast evaluation of the venous
anastomoses was performed. Additional central venograms were also performed.
The dilator was removed and hemostasis was obtained with manual compression.
The patient was transferred to the recovery room and discharged home in stable
condition.
Procedure findings:
1. Patent left AVG with strong pulse and thrill.
2. Impra stent widely patent, measureing 7.1 cm. The venous limb measures 7.0 cm. The axillary vein just central to the anastomosis measures 11.1 cm.
3. Patent central veins.
Plan: 4 month follow up.
IR AVF Venous Dilatation
Preprocedure diagnosis: Left arm dialysis AV graft with poor flows.
Post procedure diagnosis: same.
Procedure performed:
1. Left upper extremity dialysis fistulagram.
2. Venous anastamotic angioplasty.
Physicians: Duwe, Rundback (Attending physician present for entire procedure).
Complications: none.
Contrast: Visipaque.
Anesthesia: Subcutaneous one percent lidocaine.
Procedure description: The risks, benefits and alternatives to the procedure
were discussed with the patient. Informed written consent was obtained.
The patient was placed supine on the angiography table. After standard
surgical prepping and draping, the left extremity dialysis graft was punctured
using a 21 G needle. A 0.018" guide wire was easily advanced toward the venous
anastamosis. A series of nested micropuncture dilators were advanced and the
inner dilator and wire removed. Contrast evaluation of the arterial and
venous anastomoses was performed. Additional central venograms were also
performed.
Given the venous anastamotic stricture, a 6 Fr sheath was placed and the lesion
was crossed with a 0.035" Terumo glide wire and a 5 Fr Kumpe catheter. The
wire was then exchanged for a 0.035" Rosen. Over this wire, the stricture was
dilated to 7 and then 8mm using 7 and 8 x 40 mm balloons. Follow up venography
was performed. The sheath was removed and hemostasis was obtained with manual
compression. The patient was transferred to the recovery room and discharged
home in stable condition.
Procedure findings:
1. Patent left brachial artery to basilic vein PTFE AVG.
2. Hemodynamically significant venous anastamotic stricture status post successful dilatation to 8mm.
3. Patent central veins and arterial anastamosis.
Plan: 3 month follow up.
IR Nephrostomy
HISTORY: []
PROCEDURE:
1. Fluoroscopy.
2. Ultrasound guided right percutaneous nephrostomy placement.
POST PROCEDURE DIAGNOSIS:
1. [Right hydronephrosis].
2. No significant left hydronephrosis.
3. Ultrasound and fluoroscopically guided right 8.5 French 25 cm multipurpose pigtail catheter nephrostomy placement.
PHYSICIANS: [], []. The attending was president for entire procedure.
CONTRAST: Visipaque.
COMPLICATIONS: None.
MEDICATIONS: Intravenous conscious sedation, one percent lidocaine.
PROCEDURE DESCRIPTION:
Following discussion of risks, benefits and alternatives of the procedure,
informed consent was obtained. The patient was placed on fluoroscopy table in
prone position and both kidneys were studied with ultrasound. The flanks were
sterilely prepped and draped. Under ultrasound guidance, an accustick needle
was advanced into the right renal collecting system and following urine return,
contrast was gently injected to opacify the renal pelvis and calyces under
fluoroscopic visualization. Air was also injected to outline a suitable
posterior calix. Under fluoroscopic guidance, an Accustick needle was then
advanced towards the posterior calix. Following aspiration of urine, an .018
guide wire was advanced into the collecting system. The needle was exchanged
out for the Accustick dliator/stylet system. The .018 guidewire was left in
place, and an .035 180 cm Rosen wire was advanced into the renal pelvis. The
Accustick system was removed and 6, 7, and 8 French dilators were serially
advanced. After tract dilation, an 8.5 Fr 25 cm multipurpose pigtail catheter
was advanced and the distal pigtail was locked within the renal pelvis via
locking suture. The catheter was secured to the skin with a Percu-stay
adhesive device and left to gravity bag drainage externally. Next, attempts to
access the left renal collecting system were made unsuccessfully, due to lack
of hydronephrosis. Sterile dressings were applied and the patient left
fluoroscopy suite in satisfactory condition.
FINDINGS:
Preprocedure ultrasound demonstrates moderate right hydronephrosis and no
collecting system dilatation on the left. And 8.5 French 25 cm multipurpose
pigtail drainage catheter was successfully placed on the right side, with the
distal catheter in the renal pelvis. Placement of left percutaneous
nephrostomy tube was unsuccessful.
IR Nephrostomy Exchange
HISTORY: History of chronic left distal ureteral obstruction of unclear
etiology at. Left nephrostomy tube was displaced accidentally.
PROCEDURE:
1. Antegrade nephrostogram.
2. Exchange of nephrostomy tube
3. Fluoroscopic guidance.
POST PROCEDURE DIAGNOSIS:
1. Distal left ureteral obstruction.
2. Misplaced left nephrostomy tube which was exchanged for a new 8.5 French tube now in good position.
PHYSICIANS: [], []. The attending was president for entire procedure.
CONTRAST: Conray.
COMPLICATIONS: None.
MEDICATIONS: one percent lidocaine.
PROCEDURE DESCRIPTION:
The patient was placed on fluoroscopy table in prone position.The left flank
was sterilely prepped and draped. The percutaneous site was anesthetized with
one percent lidocaine. Contrast was injected into the left nephrostomy tube and
multiple images were obtained.
Using an 035 guide wire, the nephrostomy tube was exchanged for new 8.5 French
multipurpose pigtail catheter coiled in the renal pelvis. The catheter was
secured to the skin and left to gravity bag drainage externally.
FINDINGS:
The antegrade nephrostogram demonstrated the existing catheter to be coiled
within a renal calix. There was no evidence of leakage however. Following
exchange of the 8.5 French percutaneous nephrostomy tube within the renal
pelvis, contrast injection revealed appropriate tube function.
PLAN:
1. External drainage.
IR Nephrostomy to Nephroureterostomy
HISTORY: History of distal ureteral obstruction secondary to prostate cancer.
Follow-up study secondary to leaking around the nephrostomy tube.
PROCEDURE:
1. Antegrade nephrostogram.
2. Exchange of nephrostomy tube for a nephroureterostomy tube.
POST PROCEDURE DIAGNOSIS:
1. Left UVJ obstruction.
2. Retracted left nephrostomy tube which was exchanged for a new 8.5 French nephroureterostomy in good position.
PHYSICIANS: [], [](Attending present for entire procedure).
CONTRAST: Conray.
COMPLICATIONS: None.
MEDICATIONS: one percent lidocaine and conscious sedation with radiology
nursing supervision.
PROCEDURE DESCRIPTION:
The patient was placed on fluoroscopy table in prone position.The left flank
was sterilely prepped and draped. The percutaneous site was anesthetized with
one percent lidocaine. Contrast was injected into the left nephrostomy tube and
multiple images were obtained.
Using an 035 guide wire, the nephrostomy tube was exchanged for a long six
French sheath. Using a 5 French Kumpy catheter and an angled Terumo glide
wire, access was made into the urinary bladder through the distal UVJ severe
stenosis. The wire was then exchanged for an Ultra stiff Amplatz 035 wire.
The catheter and sheath were then removed and exchanged for a 26 cm
nephroureterostomy tube with the distal aspect curled within the urinary
bladder and the proximal coils within the renal pelvis. Repeat contrast
injection was then performed through the tube and images obtained including the
patient in the reversed Trendelenberg position. The catheter was secured to the
skin with pink tape and 0-0 silk sutres and left to gravity bag drainage
externally.
FINDINGS:
The antegrade nephrostogram demonstrated the existing catheter to be coiled
within a renal calix. The percutaneous nephrostomy tube was exchanged for a 26
cm nephroureterostomy tube which was passed across the UVJ obstruction from the
patient's known prostate cancer. This tube was placed to external drainage.
PLAN:
1. External drainage.
IR Non-tunnel Dialysis Catheter
History: []
Procedure:
1. Ultrasound guided puncture of [right] internal jugular vein.
2. Placement of non-tunneled central venous catheter.
3. Fluoroscopic localization of catheter tip.
Post-Procedure diagnosis:
1. Successful placement of 15 cm 11.5 French straight double lumen catheter
via [right] internal jugular vein with tip in the RA. Catheter is ready for
use.
Attending radiologist: []
Assistant radiologist: [], []
Anesthesia: Local
Complications: None.
Contrast: None.
Description of procedure:
The risks, benefits, and alternatives of the procedure were fully explained to
the patient. The patient understood and witnessed, signed, informed consent
was obtained.
The patient was placed supine on the fluoroscopic table and the neck and upper
chest were prepped and draped in the usual sterile fashion. Using ultrasound
guidance and a 21 gauge needle access into the [right] internal jugular vein
was achieved and exchange was made over wire for the 5 French micropuncture
kit. Following this the 5 French dilator was exchanged over a wire for an 11
French dilator. The catheter was then inserted over wire.
The catheter flushed and aspirated easily. The catheter was secured to the
skin with 2-0 surgipro. Sterile dressings were applied, and the catheter was
heparinized.
Patient tolerated the procedure well and left the department without immediate
post procedure complications.
Findings:
The [right] internal jugular vein is patent and compressible. Successful
placement of non tunneled central venous catheter with tip in the RA. Catheter
is ready for use.
IR Permacath Removal
History:
End Stage Renal Diasese with infected permacath.
Procedure:
Removal of a Permacath
Post procedure diagnosis: same
Attending radiologist: []
Assistant radiologist: []
Anesthesia: Local
Contrast: None.
Complications: None.
Patient was placed in supine position. 1 % lidocaine was given for local
anesthetic. The Permacath was removed, and hemostasis was obtained. There were
no complications. The tip of the catheter was sent for culture and
sensitivity.
IR Portacath
Preprocedure diagnosis: Breast cancer requiring chemotherapy.
Post procedure diagnosis: Same.
Procedure performed: Right internal jugular tunneled Bard 6.6 Fr single lumen
port placement.
Physicians: [], [] (Attending physician present for entire procedure)
Complications: none.
Contrast: none.
Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and
fentanyl with nursing supervision.
Procedure description: The risks, benefits, and alternatives of the procedure
were fully explained to the patient. The patient understood and informed
consent was obtained.
The patient was given her standing order of Zosyn on the floor at 6am today.
The patient was placed supine on the fluoroscopic table and the neck and upper
chest were prepped and draped in the usual sterile fashion. Using ultrasound
guidance and a 21 gauge needle access into the right internal jugular vein was
achieved and exchange was made over wire for the micropuncture kit. A 5Fr
dilator was placed through which a 0.035 in Rosen wire was advanced to the
IVC. The site on the right upper chest was anesthetized with lidocaine with
epinephrine and a dermatotomy was made to accommodate the port. A pocket for
the port was bluntly dissected in the subcutaneous tissues. The distal end of
the catheter was connected to the tunneling device and this was used to bring
the catheter through from the pocket to the internal jugular puncture site.
Following this the 5 French dilator was exchanged over a wire for an 7 French
dilator/ peel away sheath. The inner dilator and wire were removed and the
catheter was inserted into the peel away sheath. The proximal end of the
catheter was cut to length and afixed to the port. The port was positioned in
the pocket and sutured at two ends to the deep tissues with 4-0 nylon sutures.
The incision site for the port was sutured with interrupted subcutaneous and
subcuticular absorbable sutures. The port was accessed through the skin. The
port flushed and aspirated easily. The port was heparinized.
The patient tolerated the procedure well and left the department without
immediate post procedure complications.
Procedure findings:
1. Successful placement of right internal jugular 6.6 Fr single lumen chest port with tip at junction of SVC/RA junction.
2. Patent right internal jugular vein.
IR Ileal Conduit Stent Study
Preprocedure diagnosis: Patient with ileal conduit formation following
cystectomy, one week postoperative evaluation.
Post procedure diagnosis:
1. Bilaterally patent ureters without evidence of ureteral injury or
obstruction.
2. Ileal conduit.
Procedure performed:
1. Bilateral antegrade nephrostograms.
Physicians: [], [] (Attending physician present for entire procedure)
Complications: none.
Contrast: Conray.
Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and
fentanyl with nursing supervision.
Procedure description: The risks, benefits and alternatives of the procedure
were discussed with the patient. All questions were answered and informed
consent was obtained.
The patient was brought to the angiography suite and placed supine having
received preprocedural antibiotics. The patient's ureteral stents extending
from the ostomy site were catheterized and contrast was injected.The ureteral
stents were then removed over a 035 Bentson guide wire.
The patient tolerated procedure without complication.
Procedure findings:
The nephrostograms demonstrated no evidence of contrast extravasation or
collecting system dilatation. Contrast is seen flowing easily around the
ureteral stents into the ileal conduit.
IR TDC Exchange
Pre procedure diagnosis: End Stage Renal Diasese with infected permacath.
Post procedure diagnosis: same.
Procedure:
Permacath exchange over a wire.
Physicians: [], []. (The attending was present for the entire procedure).
Anesthesia: Intravenous versed and fentanyl and radiology nursing supervision,
and subcutaneous lidocaine with epinephrine.
Contrast: None.
Complications: None.
Procedure description: The risks, benefits and alternatives of the procedure
were discussed with the patient. Informed consent was obtained.
The patient was placed supine on the angiography table and the right sided
catheter site over the upper chest was prepped and draped sterilely.
The tract along the catheter was anesthetized copiously. Blunt dissection was
performed to release the cuff. At this point, two stiff 035 Glide wires were
advanced via the catheter lumen throught the right atrium, IVC and into the
right external iliac veins.
The catheter was withdrawn over the wires and a new 19 cm catheter was placed
with its distal tip at the RA/SVC junction.The catheter was secured at the skin
site and a bandage was applied. The catheter was heparinized.
The patient tolerated procedure without immediate complication.
Procedure findings: Status post successful exchange of tunneled dialysis
catheter, as described The catheter is ready for immediate use.
IR T-Tube Post Transplant
Preprocedure diagnosis: One week status post living related liver transplant.
Post procedure diagnosis: Widely patent biliary anastomosis without evidence
of leak or obstruction.
Procedure performed: T-tube cholangiogram.
Physicians: [], [] (Attending physician present for entire procedure)
Complications: none.
Contrast: Visipaque.
Anesthesia: none.
Procedure description: The risk benefits and alternatives of the procedure
were discussed with the patient. Informed consent was obtained. The patient
was placed supine on the angiography table. A scout radiograph was obtained
followed by opacification of the patient's biliary tree via a percutaneous T-
tube. Delayed images were obtained five minutes after tube capping.
Procedure findings: The scout radiograph demonstrates surgical clips, drains
and skin staples over the right upper quadrant with an appropriately positioned
T-tube. Following contrast injection, the anastomosis of the right intrahepatic
ducts to the common bile plaque is patent. Contrast fills unremarkable
intrahepatic biliary ducts. Adjacent to the T-tube in the common bile duct is a
small amount of debris. No contrast extravasation or obstruction to flow was
identified. Delayed iimages demonstrated adequate drainage into the duodenum.
IR Tunnel Dialysis Catheter
Pre procedure diagnosis: ESRD with failed graft requiring hemodialysis.
Post procedure diagnosis: Same.
Procedure:
1. Ultrasound guided puncture of [right] internal jugular vein.
2. Placement of tunneled hemodialysis catheter.
3. Fluoroscopic localization of catheter tip.
Physician: [], [] (Attending was present for the entire procedure).
Anesthesia: Intravenous conscious sedation with radiology nursing supervision.
Patient received IV fentanyl and Versed and local lidocaine with 1:100,000
epinepherine.
Complications: None.
Contrast: None.
Procedure Description:The risks, benefits, and alternatives of the procedure
were fully explained to the patient. The patient understood and witnessed,
signed, informed consent was obtained.
The patient was placed supine on the fluoroscopic table and the neck and upper
chest were prepped and draped in the usual sterile fashion. Using ultrasound
guidance and a 21 gauge needle access into the [right] internal jugular vein
was achieved and exchange was made over wire for the micropuncture kit. A cap
was placed on the 5 French dilator and the site on the right upper chest was
anesthetized with lidocaine and a small dermatotomy was made. The catheter was
connected to the tunneling device and this was used to bring the catheter
through the internal jugular puncture site. Following this the 5 French
dilator was exchanged over a wire for an 11 French dilator. Then exchange was
made for the 15 French peel away sheath. The inner dilator and wire were
removed and the catheter was inserted into the peel away sheath and the peel
away removed. Under fluoroscopic guidance the catheter tip was localized.
The catheter flushed and aspirated easily. The catheter was secured to the
skin with 2-0 surgipro. The puncture site was closed with 4-0 polysorb and
steri-strips. Sterile dressings were applied. The catheter was heparinized.
Patient tolerated the procedure well and left the department without immediate
post procedure complications.
Procedure Findings:The [right] internal jugular vein is patent and
compressible. Successful placement of tunneled hemodialysis catheter with tip
at the SVC/RA junction. Catheter is ready for use.
