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14 September 13

23. Comparison: Prior CT abdomen/pelvis from 14 February 2013 and 23 April 2012. Technique: Helical CT scan examination of the abdomen and pelvis was performed following the IV administration of 100 and of non-ionic contrast Isovue-300. Oral contrast was given prior to the start of the study. 5 mm axial images were obtained with coronal and sagittal reformations. Renal delayed images were also obtained. Findings: The visualized lung demonstrate no mass, consolidation or pleural effusion. Dependent atelectasis is seen. Limited views of the heart are unremarkable. Again seen is recanalized portal vein thrombosis consistent with cavernous transformation of the portal vein. The liver demonstrate a small nonenhancing lesion within the posterior lobe most likely representing simple cyst. The biliary system is unremarkable. There is heterogeneous enhancement of the pancreatic head which is unchanged from prior. This could be related to cavernous transformation of portal vein. The spleen is surgically missing. Multiple surgical clips are noted consistent with the splenectomy. The adrenals and the bilateral kidneys demonstrate normal morphology and enhancement without mass lesions. The enteric contrast extends to the ascending colon. There is no evidence of free fluid or free air in the peritoneal cavity. The hollow viscera are without evidence of wall thickening, mass or obstruction. There is no evidence of adenopathy. The bladder is normal. The gynecologic organs are unremarkable. The reminder of the soft tissues are unremarkable. Posterior fusion hardware spanning S1-L1 levels is seen without evidence of complication. Mild degenerative changes of the thoracolumbar spine is noted. Impression: 1. Unchanged cavernous transformation of the portal vein. 2. Chronic stable changes as above. **************** 22. Comparisons: None. Technique: Multiple transverse and longitudinal images of the upper abdomen were obtained with B-Mode and color Doppler ultrasound. Findings: The visualized pancreas demonstrates no diffuse or focal enlargement. The liver demonstrates normal morphology and echotexture. No focal lesions or dilated intrahepatic bile ducts are seen. Normal hepatopedal blood flow is seen in portal vein. The gallbladder is well-visualized and demonstrate multiple echogenic foci that layers and causes posterior acoustic shadowing. The gallbladder wall measures 6 mm and the common bile duct has a diameter of 7 mm. No pericholecystic fluid is seen. Impression: Findings above are consistent with acute cholecystitis in the setting of cholelithiasis. **************** 21. COMPARISON: []. EXAM: Multiple transverse and longitudinal images of the pelvis were obtained using transabdominal and transvaginal sonography. Color Doppler was employed as appropriate. FINDINGS: The endometrial cavity demonstrates an anechoic sac in the lower uterine segment without evidence of yolk sac or fetal pole. The left ovary demonstrates slightly hyperechoic mass with evidence of blood flow by Doppler signal consistent with corpus luteum. There is no adnexal mass. There is small amount of free fluid in the pelvic cul-de-sac. Measurements: Uterus: 8.5 x 3.8 x 5.1 cm The endometrial stripe: 10 mm Right ovary: 2.1 x 1.6 x 2.5 cm Left ovary: 1.9 x 1.5 x 2.9 cm hCG: 939 IMPRESSION: Findings above may represent early intrauterine pregnancy, pseudogestational sac or early spontaneous abortion. Recommend serial followup with hCG and ultrasound. Discussed with Dr. Buras at 1418 hours on 9/14/2013 2013 by phone. ************** 20. Technique: Thin section transverse helical images through the facial bones with coronal and sagittal reformations. No contrast was administered. Comparison: None. Findings: The facial bones including the mandible, temporomandibular joints, orbits, paranasal sinuses, nasal bone are without fracture, dislocation, or air-fluid level. Mucous retention cyst is noted within the right maxillary sinus. Mild deviation of the nasal septum to the right is noted. Nasal cavity is patent. The osteomeatal units are patent bilaterally. The orbital globes are normal. The demonstrated intracranial contents are normal. The mastoid air cells are clear. There is no lymphadenopathy. Soft tissue laceration of the left lip is noted. Mild soft tissue edema of left-sided face is noted. Impression: 1. No evidence of mandibular fracture as queried. 2. Soft tissue laceration of the left lip area. 3. Mucus retention cysts of the right maxillary sinus. *************** 19. Comparison: Multiple prior chest radiographs most recent dated 24 November 2012. Findings: A single, frontal, portable chest radiograph demonstrate adequate lung volumes without evidence of airspace or interstitial disease. The aorta is mildly ectatic. The cardiomediastinal silhouette and pulmonary vascularity are within normal limits. There is no pneumothorax. The soft tissue of the thorax are unremarkable. Moderate degenerative disease of thoracic spine is noted. Depression: No acute cardiopulmonary disease. ************** 18. Comparison: Abdominal series from 25 July 2013 and chest radiograph dated 8 June 2012. Findings: Frontal and lateral radiographs of the chest demonstrate adequate lung volumes without evidence of interstitial or airspace disease. Atherosclerotic calcifications are noted within the tortuous aorta. The cardiomediastinal silhouette and pulmonary vascularity are within normal limits. There is no pneumothorax. Moderate degenerative changes of the thoracolumbar spine are noted. There is unchanged posterior fusion hardware with orthopedic rods without evidence of complication. Surgical staples are overlying the thoracolumbar spine. Impression: 1. No acute cardiopulmonary disease. 2. Chronic stable changes as above. ********************* 17. Comparison: Prior chest radiograph dated 21 April 2006. Findings: Frontal and lateral radiographs of the chest demonstrate adequate lung volumes. Right costophrenic angle is blunted. There are reticular interstitial opacities more pronounced at the left base. There is no airspace disease. Atherosclerotic calcifications are noted within the tortuous aorta. Calcified plaque likely within the left carotid is noted. The cardiomediastinal silhouette and pulmonary vascularity are within normal limits. There is no pneumothorax. There is chronically-appearing compression wedge fracture at L1 level. Moderate degenerative changes of thoracic spine are noted. The soft tissues of the thorax are unremarkable. Impression: 1. Small right-sided pleural effusion without evidence of focal consolidation. 2. Atherosclerotic vascular disease. 3. Chronic compression wedge fracture at L1 level. ************ 16. CT head without contrast: Routine transverse head CT images without contrast with sagittal reformations. Comparison study: CT head from 21 April 2006. FINDINGS: There is an chronic left parietal lobe encephalomalacia indicating old or chronic infarct, new since 21 April 2006. There is an old infarct in the right basal ganglia unchanged from prior. There is a modest diffuse brain parenchymal atrophy with commensurate prominence of the intra and extra-axial CSF spaces. There is diffuse periventricular white matter hypodensity compatible with chronic microvascular ischemic disease. There is no hemorrhage, mass effect, hydrocephalus, pathologic fluid collection or herniation. There are atherosclerotic calcifications in the left vertebral artery. There are no calvarial lesions. Mastoid air cells and middle ear cavities are unremarkable. The paranasal sinuses are within normal limits. IMPRESSION: 1. No CT evidence of acute intracranial pathology. 2. Findings compatible with chronic small vessel ischemic change. 3. Old infarcts within the left parietal lobe and right basal ganglia. ******************* 15. Comparison: Multiple prior chest radiographs most recent from the same day. Technique: A single, frontal, portable chest radiograph was obtained. Findings/Impression: 1. There is unchanged right-sided IJ central catheter with the tip terminating within the mid superior vena cava. There is no evidence of right-sided pigtail catheter as queried. 2. There is no pneumothorax. No subcutaneous air is seen. 3. There is unchanged bibasilar airspace disease and pleural effusions. Discussed with Dr. Peterson at 1206 on 9/14/2013 by phone. ************ 14. Comparison: None. Findings: Frontal radiograph of the right hand and cone-down lateral and frontal views of the right thumb reveal no fracture or dislocation. Joint spaces are well maintained. Soft tissues are normal. CONCLUSION: No acute osseous abnormalities identified. ****************** 13. Comparison: None. Findings: Frontal, oblique and lateral views of the right hand demonstrate no fracture or dislocation. Joint spaces are well maintained. Soft tissues are normal. Impression: No acute osseous abnormalities identified. ************** 12. Comparison: None. Findings: Frontal, oblique and lateral views of the right hand reveal no fracture or dislocation. Joint spaces are well maintained. Minimal ulnar side soft tissue edema is noted. CONCLUSION: Minimal ulnar side soft tissue edema without acute osseous abnormalities. ***************** 11. Comparison: Prior right foot radiographs dated 29th of August 2013 and 22 August 2013. Findings: Frontal, oblique and lateral radiographs of the right foot demonstrate unchanged hardware at the base of the first metatarsal fused to the medial cuneiform without evidence of hardware loosening or fracture. There is persistent soft tissue edema. There is no evidence of bony osteolysis or gas in the soft tissues. No new fractures are identified. There is unchanged mild osteopenia. Impression: 1. Unchanged status post instrumentation around the base of the first toe. 2. Soft tissue swelling, unchanged from prior. 2. Osteopenia of disuse. ********************** 10. Comparison: None. Findings: Frontal, oblique and lateral views of the [left] ankle reveal no fracture or dislocation. The ankle mortise is intact. There is no arthritic or inflammatory change. Soft tissue edema of the lateral malleolus is noted. Impression: Soft tissue edema without acute osseous abnormality. Recommend repeat radiographs in 7 to 10 days if no clinical improvement. ************************ 9. Comparison: None available. FINDINGS: Frontal and lateral views of the chest demonstrate satisfactory lung volumes without airspace or interstitial disease. The cardiomediastinal silhouette and pulmonary vascularity are within normal limits. There is no evidence of pneumothorax, pneumomediastinum or pneumoperitoneum. The soft tissue and skeletal structures of the thorax are unremarkable. IMPRESSION: No acute cardiopulmonary disease. ************************ 8. Comparison: Multiple prior chest radiographs most recent from earlier today. Findings: A single, frontal, portable chest radiograph demonstrate unchanged position of the tip of endotracheal tube just above the carina. There is unchanged enteric tube with the side-port below the diaphragm and the tip outside of field-of-view. Left-sided PICC with the tip terminating within the mid to proximal SVC is unchanged from prior. Right upper lobe opacification is unchanged from prior. The cardiothymic silhouette is unchanged. There is no pneumothorax. The bowel gas pattern is unchanged from prior. There is no free air under the diaphragm noted. The reminder of the exam is unchanged from prior Impression: 1. Unchanged right upper lobe atelectasis. Recommend repositioning of the ET tube. 2. Unchanged bowel gas pattern. Discussed with Dr. Anisowicz at 1026 on 9/14/2013 by phone. ***************** 7. Comparison: None. Findings: Frontal, oblique and lateral views of the left ankle and left foot reveal no fracture or dislocation. The ankle mortise is intact. There is no arthritic or inflammatory change. Soft tissue edema is noted. Impression: Soft tissue edema without evidence of acute osseous abnormality of left ankle and foot. ************************ 6. Comparison: 1. Multiple prior chest radiographs most recent dated 23 August 2013 and 21 August 2013. 2. CT chest from 10 July 2013. Findings: Frontal and lateral chest radiographs demonstrate adequate lung volumes. The left costophrenic angle is blunted, better seen on lateral view. There are increased interstitial markings more pronounced at the bilateral bases, unchanged from prior. The aorta is tortuous. The cardiomediastinal silhouette and pulmonary vascularity are unchanged from prior. There is no pneumothorax. The soft tissues of the thorax are normal. Moderate degenerative changes of thoracolumbar spine are noted. Impression: 1. Unchanged left pleural effusion without evidence of focal consolidation. 2. Increased interstitial markings are secondary to the patient's known emphysema. *********************** 5. Comparison: None. Findings: Frontal, oblique and lateral views of the right ankle and right foot demonstrate well ossified fragment adjacent to the medial malleolus and multiple well ossified bodies adjacent to the distal fibula likely related to old injuries. The ankle mortise is intact. There is no arthritic or inflammatory change. Soft tissue edema of the medial malleolus is noted. Impression: Soft tissue edema of the medial malleolus without acute osseous abnormality. Findings above are likely related to old injuries. *********************** 4. Comparison: None. Findings: Frontal radiograph of the left hand and cone-down lateral, oblique and frontal views of the second finger demonstrate no fracture or dislocation. Minimal soft tissue edema is noted. Joint spaces are well maintained. Impression: No acute osseous abnormalities identified. *********************** 3. Comparison: []. Findings: AP internal and external rotation views, axillary, scapular Y views of the left shoulder demonstrates no fracture or dislocation. There is no calcific tendinopathy. The glenohumeral and acromioclavicular joints are unremarkable. The visualized lung is normal. CONCLUSION: No acute osseous abnormality is identified. *********************** 2. Comparison: Multiple chest radiographs dated 28 August 2013, 8 July 2013, 17 September 2011. Findings: Frontal and lateral radiographs of the chest demonstrates enlarged lung volumes with increased interstitial markings without evidence of airspace disease. Atherosclerotic calcifications are noted within the tortuous aorta. The cardiomediastinal silhouette and pulmonary vascularity are unchanged from prior. There is no pneumothorax. Again noted is unchanged displaced right-sided distal clavicular fracture. There is a compression fracture of L1 vertebrae, new since 17 September 2011. Moderate degenerative changes of thoracolumbar spine are noted. Impression: 1. No acute cardiopulmonary disease. 2. Unchanged right-sided displaced distal clavicle fracture. 3. Compression fracture of L1, new since 17 September 2011. 4. Unchanged chronic interstitial lung disease. *********************** 1.Comparison: CT abdomen/pelvis from 14 February 2013 and 23 April 2012. Findings: Frontal radiograph of the chest demonstrate adequate lung volumes without evidence of focal consolidation or pneumothorax. The cardiomediastinal silhouette is within normal limits. Bilateral old rib fractures are noted. Upright and supine views of the abdomen demonstrate multiple air-fluid levels throughout the abdomen. The bowel is of normal caliber. There is no evidence of pneumoperitoneum. Posterior fusion hardware without complication is noted spanning L5 and S1 level. Surgical clips are overlying proximal sacrum. Degenerative changes are present within the hips. Impression: Multiple scattered air-fluid levels suggesting early small bowel obstruction.