Please read these suggestions on dictation.
CHEST
GI
BODY
BONE/MSK
NEURO
ULTRASOUND
PEDIATRICS
INTERVENTIONAL
NUCLEAR MEDICINE
CTRL-F = find
PA
and lateral views of the chest. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
There is no pulmonary consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette and pulmonary vasculature are within normal limits.
No acute osseous abnormalities.
Impression:
No acute cardiopulmonary process.
Portable
AP view of the chest. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
There is no pulmonary consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette and pulmonary vasculature are within normal
limits. No acute osseous abnormalities.
Impression:
Nonacute chest.
KUB,
[x] views of the [<chest and>] abdomen. <<Order Observation
Time>>
Indication:
[x]
Comparison:
[x]
Findings:
There is no pulmonary consolidation, pleural effusion, or pneumothorax. The
cardiomediastinal silhouette and pulmonary vasculature are within normal
limits. No acute osseous abnormalities.
Scattered
abdominal bowel gas in a nonobstructive pattern. Mild amount of residual stool
in the colon. No pathological calcifications. No acute osseous abnormalities.
Impression:
1.
Nonobstructive bowel gas pattern.
2.
No acute cardiopulmonary process.
Modified
barium swallowing study with speech pathology,
<<Order Observation Time>>
Indication:
[x].
Comparisons:
[x].
Technique:
Various liquid, semisolid and solid barium containing substances were provided.
Lateral images were obtained. Speech pathologist was present. Video obtained.
Findings:
There is no laryngeal penetration or tracheal aspiration. For further details
please refer to speech pathology report.
Single
contrast Esophagram. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
A standard air contrast esophagram was performed.
Findings:
The patient swallowed barium without difficulty. The oral and pharyngeal phases
of swallowing are unremarkable. There is no nasal regurgitation, laryngeal
penetration or aspiration identified. Esophageal motility is within the limits
of normal.
The
esophagus is structurally normal without intrinsic or extrinsic masses. The
esophageal mucosa appears unremarkable. No gastroesophageal
reflux was demonstrated during this examination, despite the performance of
maneuvers to elicit GE reflux.
Impression:
Unremarkable esophagram.
Double
contrast Esophagram. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
A standard single contrast esophagram was performed.
Findings:
The patient swallowed barium without difficulty. The oral and pharyngeal phases
of swallowing are unremarkable. There is no nasal regurgitation, laryngeal
penetration or aspiration identified. Esophageal motility is within the limits
of normal.
The
esophagus is structurally normal without intrinsic or extrinsic masses. The
esophageal mucosa appears unremarkable. No gastroesophageal
reflux was demonstrated during this examination, despite the performance of
maneuvers to elicit GE reflux.
Impression:
Unremarkable esophagram.
Single
UGI. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
A standard single contrast upper GI series was performed.
Findings:
The patient swallowed barium without difficulty. The esophagus is structurally
normal without intrinsic or extrinsic masses. The esophageal mucosa appears unremarkable.
The
stomach demonstrates normal distensibility. No mass
or ulceration is identified. There is no evidence of gastritis. The duodenal
bulb and sweep are unremarkable. No ulcers can be identified.
No gastroesophageal reflux was demonstrated during this
examination, despite the performance of maneuvers to elicit GE reflux.
Impression:
Unremarkable upper GI series.
Double
UGI. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
A standard air contrast upper GI series was performed.
Findings:
The patient swallowed barium without difficulty. The esophagus is structurally
normal without intrinsic or extrinsic masses. The esophageal mucosa appears
unremarkable.
The
stomach demonstrates normal distensibility. No mass
or ulceration is identified. There is no evidence of gastritis. The duodenal
bulb and sweep are unremarkable. No ulcers can be identified.
No gastroesophageal reflux was demonstrated during this
examination, despite the performance of maneuvers to elicit GE reflux.
Impression:
Unremarkable upper GI series.
Modified
Gastrografin esophagram, <<Order Observation Time>>
Indication:
[x]
Findings:
The patient was administered Gastrografin solution without difficulty. Gastroesophageal junction was evaluated for patency status
post [x]. Gastrografin solution passed without difficulty into the stomach.
There is no evidence of contrast extravasation.
Contrast is seen passing into the duodenal bulb.
Impression:
1.
Negative modified Gastrografin esophagram.
Small
Bowel Series. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
Standard barium small bowel series was performed with multiple overhead
radiographs. In addition, the small bowel was examined fluoroscopically
intermittently throughout the examination.
Findings:
The small bowel is of normal course and caliber. No intrinsic or extrinsic mass
lesions are identified. The transit time is within normal limits. The terminal
ileum appears normal.
Impression:
Unremarkable small bowel series.
Single
barium enema <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
Standard single contrast barium enema was performed.
Findings:
Scout film of the abdomen demonstrates an unremarkable bowel gas pattern. No
pathologic intra-abdominal calcifications are noted.
The
colon is visualized in its entirety. The colonic mucosa appears normal. No
annular constricting or obstructing lesions are identified. No polyps are
noted. Reflux is seen into a normal appearing terminal ileum.
Impressions:
Normal single contrast barium enema.
Double
barium enema. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
Standard air contrast barium enema was performed.
Findings:
Scout film of the abdomen demonstrates an unremarkable bowel gas pattern. No
pathologic intra-abdominal calcifications are noted.
The
colon is visualized in its entirety. The colonic mucosa appears normal. No
annular constricting or obstructing lesions are identified. No polyps are
noted. Reflux is seen into a normal appearing terminal ileum.
Impressions:
Normal double contrast barium enema.
VCUG,
<<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
A pediatric Foley catheter was placed through the urethra, and the urinary
bladder was filled with approximately [70] cc of dilute Cystografin
contrast by gravity. The bladder fills normally and is normal in size and
contour. There were no filling defect identified. Images of the bladder and
kidneys were taken at the various positions and demonstrated no evidence of vesicoureteral reflux on maximum filling. Fluoroscopic voiding images demonstrate a
normal appearing urethra there was no evidence of vesicoureteral
reflux or significant post void residual.
Impression:
1.
Normal filling of the bladder with no evidence of vesicoureteral
reflux or significant post void residual.
ERCP
images, <<Order Observation Time>>
Indication:
[x].
Findings-
[x] limited interoperative fluoroscopic images of an
ERCP. Images demonstrate cannulization of the
proximal common bile duct with contrast filling the proximal portion of the
main pancreatic duct and filling the common bile duct, common hepatic ducts and
proximal intrahepatic ducts. No significant abnormal dilatation or focal
stricture appreciated. Please correlate with intraoperative findings.
Hysterosalpingogram. <<Order
Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
A hysterosalpingogram was performed by [the referring
physician] and [x] images are submitted for review.
Findings:
The endometrial cavity is normal in contour without any filling defects.
Contrast
is seen in the fallopian tubes bilaterally which are normal in course and
caliber. There is free intraperitoneal spill of contrast bilaterally.
Impression:
Normal hysterosalpingogram.
CT of
the chest [with/without] contrast. <<Order Observation Time>>
Indications:
[x].
Comparison:
[x].
Technique:
Volumetric Multidetector CT images of the chest were
obtained [following the administration of Isovue 370 contrast] from the lung
apices to the lung bases. Multiple planes were reconstructed for examination.
Findings:
(A check list)
Lines
Subcutaneous tissues
Muscles
Axillary lymph nodes
Thyroid gland
Trachea
Cardiac chambers
Pericardium
Aortic arch
Great vessels
Mediastinal lymph nodes
Lungs
Esophagus
Bones
Visualized abdominal organs (stomach, liver, spleen, pancreas, gallbladder,
adrenals, kidney)
Impressions:
Normal CT of the chest.
CTA
of the chest with contrast. <<Order Observation Time>>
Indications:
[x].
Comparison:
[x].
Technique:
Volumetric Multidetector CT images of the chest were
obtained following the administration of Isovue 370 contrast per PE protocol
from the lung apices to the lung bases. Multiple planes were reconstructed for
examination.
Findings:
There are no filling defects in the main or proximal branch pulmonary arteries
to suggest a pulmonary embolism.
(A
check list)
Lines
Subcutaneous tissues
Muscles
Axillary lymph nodes
Thyroid gland
Trachea
Cardiac chambers
Pericardium
Aortic arch
Great vessels
Mediastinal lymph nodes
Lungs
Esophagus
Bones
Visualized abdominal organs (stomach, liver, spleen, pancreas, gallbladder,
adrenals, kidney)
Impressions:
No PE.
Routine
CT of the abdomen and pelvis [with/without] contrast. <<Order Observation
Time>>
Indications:
[x].
Comparison:
[x].
Technique:
Volumetric Multidetector CT images of the abdomen and
pelvis were obtained following the administration of Isovue 370 and oral barium
contrast from the lung bases to the pubic symphysis. Multiple planes were
reconstructed for examination.
Findings:
(A check list)
Lines
Subcutaneous tissues
Muscles
Lung bases
Distal Esophagus
Stomach
Liver
Gallbladder
Pancreas
Biliary ducts
Spleen
Adrenal glands
Kidneys
Small bowel
Large bowel (appendix to rectum)
Free air
Free fluid
Mesentary
Abdominal lymph nodes
Aorta
IVC
Bones
Impressions:
Normal CT of the abdomen and pelvis.
CT of
the abdomen and pelvis without contrast. <<Order Observation Time>>
Indications:
Suspected kidney stone.
Comparison:
[x].
Technique:
Volumetric Multidetector CT images of the abdomen and
pelvis were obtained from the lung bases to the pubic symphysis. Multiple
planes were reconstructed for examination.
Findings:
There are no calcifications within the renal collecting systems to suggest a
stone. There is no hydronephrosis, hydroureter, or perinephric fat stranding.
No acute osseous abnormalities. Limited evaluation of the small and large
bowel, visceral organs and vasculature secondary to lack of oral and IV
contrast. [look for appendix]. No other significant findings.
Impressions:
No renal stones.
CT of
the chest, abdomen, and pelvis [with/without] contrast. <<Order
Observation Time>>
Indications:
[x].
Comparison:
[x].
Technique:
Volumetric Multidetector CT images of the chest,
abdomen, and pelvis were obtained following the administration of Isovue 370
and oral barium contrast from the lung apices to the pubic symphysis. Multiple
planes were reconstructed for examination.
Findings:
(A check list)
Lines
Subcutaneous tissues
Muscles
Axillary lymph nodes
Thyroid gland
Trachea
Cardiac chambers
Pericardium
Aortic arch
Great vessels
Mediastinal lymph nodes
Lungs
Esophagus
Stomach
Liver
Gallbladder
Pancreas
Biliary ducts
Spleen
Adrenal glands
Kidneys
Small bowel
Large bowel (appendix to rectum)
Free air
Free fluid
Mesentary
Abdominal lymph nodes
Aorta
IVC
Bones
Impressions:
Normal CT of the chest, abdomen, and pelvis.
High-resolution
CT chest without contrast, <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
Volumetric multidetector CT images were obtained
through the chest from the lung apices to the posterior costophrenic
angles following administration of IV contrast. Expiratory and inspiratory images were obtained in lung windows.
Findings:
Inspiratory and expiratory views show no findings of
air trapping. There is no interstitial lung thickening or fibrotic change. No
bronchiectasis. No pleural effusion or pneumothorax.
Impression:
1.
[x]
CT of
the [x] [without] contrast. <<Order Observation Time>>
Indication:
CT guided radiation therapy planning for [x].
Technique:
Volumetric CT images of the [x] are provided for radiation therapy planning.
Impression:
Images provided for radiation planning.
MRI
abdomen [with/without] contrast, <<Order Observation Time>>
Indication:
[x].
Technique:
[Multiplanar multisequence
MR images] of the abdomen without administration of IV contrast.
Findings:
[Motion artifact severely limits portions of this examination.] The liver,
gallbladder, spleen, pancreas, bilateral adrenal glands and bilateral kidneys
appear grossly unremarkable. Visualized portions of the small large bowel
appear grossly unremarkable. There are no areas of increased signal intensity
no abnormal areas of enhancement. In MRCP view, the pancreatic duct, common
bile duct, cystic duct and intrahepatic biliary system are well visualized,
without evidence of stone or obstruction. The visualized portions of the
thoracic and lumbar spine appear grossly unremarkable.
Impressions:
1. Unremarkable MRI Abdomen.
Thank
you for this consultation.
MRCP, <<Order
Observation Time>>
Indication:
[x].
Technique:
[Multiplanar multisequence
MR images] of the abdomen without administration of IV contrast.
Findings:
[Motion artifact severely limits portions of this examination.] The liver,
gallbladder, spleen, pancreas, bilateral adrenal glands and bilateral kidneys
appear grossly unremarkable. Visualized portions of the small large bowel
appear grossly unremarkable. There are no areas of increased signal intensity
no abnormal areas of enhancement. In MRCP view, the pancreatic duct, common
bile duct, cystic duct and intrahepatic biliary system are well visualized,
without evidence of stone or obstruction. The visualized portions of the
thoracic and lumbar spine appear grossly unremarkable.
Impressions:
1. [Unremarkable MRCP].
MRI the pelvis [without] contrast, [x].
Indication: [x].
Comparison: [x].
Technique: T2 sagittal, T1 axial, T2 coronal, T2 fast spin-echo axial, and T2
axial images were obtained from L4 vertebral body to the pubic symphysis.
Findings: The visualized portions of the small and large bowel are grossly
unremarkable. There is no evidence of acute osseous abnormality. There is no
significant free fluid within the pelvis.
Impression:
1.
SHOULDER, <<Order
Observation Time>>
Indication:
[x]
Technique:
[x] views of the [x] shoulder.
Comparison:
[x]
Findings:
No fracture or dislocation is identified. Articular surfaces are smooth without
focal irregularity or arthritic change. The AC joint is intact.
Impression:
No osseous or articular abnormalities of the [x] shoulder.
ELBOW, <<Order
Observation Time>>
Indication:
[x]
Technique:
2 views of the [x] elbow (AP and lateral views).
Comparison:
[x]
Findings:
No fracture or dislocation is seen. No joint effusion is detected. Articular
surfaces are smooth without focal irregularity or arthritic change. No
significant soft tissue swelling is seen.
Impression:
No osseous or articular abnormalities of the [x] elbow.
HAND, <<Order
Observation Time>>
Indication:
[x]
Technique:
3 views of the [x] hand (PA, lateral, and oblique views).
Comparison:
[x]
Findings:
No fracture or dislocation is identified. Articular surfaces are smooth without
focal irregularity or arthritic change. No significant soft tissue swelling is
seen.
Impression:
No osseous or articular abnormalities of the [x] hand.
PELVIS, <<Order
Observation Time>>
Indication:
[x]
Technique:
[x] views of the pelvis.
Comparison:
[x]
Findings:
No fracture or dislocation is seen. Articular surfaces are smooth without focal
irregularity or arthritic change. The hips joints, sacroiliac joints, and
symphysis pubis are well-maintained.
Impression:
No osseous or articular abnormalities of the pelvis.
HIP, <<Order
Observation Time>>
Indication:
[x]
Technique:
[x] views of the [x] hip. [An AP radiograph of the pelvis was obtained to
assess joint symmetry].
Comparison:
[x]
Findings:
No fracture or dislocation is seen. Articular surfaces are smooth without focal
irregularity or arthritic change. The hip joint is well-maintained.
Impression:
No osseous or articular abnormalities of the [x] hip.
KNEE, <<Order
Observation Time>>
Indication:
[x]
Technique:
[x] views of the [x] knee.
Comparison:
[x]
Findings:
No fracture or dislocation is seen. No joint effusion is identified. Articular
surfaces are smooth without focal irregularity or arthritic change. No
significant soft tissue swelling is seen.
Impression:
No osseous or articular abnormalities of the [x] knee.
ANKLE, <<Order
Observation Time>>
Indication:
[x]
Technique:
3 views of the [x] ankle (PA, lateral, and oblique views)
Comparison:
[x]
Findings:
No fracture or dislocation is seen. The ankle mortise appears intact and
symmetric. Articular surfaces are smooth without focal irregularity or
arthritic change. No significant soft tissue swelling is identified.
Impression:
No osseous or articular abnormalities of the [x] ankle.
FOOT, <<Order
Observation Time>>
Indication:
[x]
Technique:
3 views of the [x] foot (AP, lateral, and oblique views).
Comparison:
[x]
Findings:
No fracture or dislocation is seen. Articular surfaces are smooth without focal
irregularity or arthritic change. No significant soft tissue swelling is
identified.
Impression:
No osseous or articular abnormalities of the [x] foot.
CERVICAL
SPINE, <<Order Observation Time>>
Indication:
[x]
Technique:
[x] views of the cervical spine.
Comparison:
[x]
Findings:
The cervical spine is visualized from [C1-T1]. [The cervicothoracic junction is
intact.] No prevertebral soft tissue swelling is seen. The cervical alignment
is maintained without spondylolithesis. No acute
fracture is identified. The vertebral body and disc space heights are
preserved. The odontoid process is intact.
Impression:
Unremarkable examination of the cervical spine.
THORACIC
SPINE, <<Order Observation Time>>
Indication:
[x]
Technique:
[x] views of the thoracic spine.
Comparison:
[x]
Findings:
The vertebral body and disc space heights are preserved. The spinal alignment
is maintained without evidence of spondylolithesis.
No acute fracture is identified. No lytic or blastic lesions are seen.
Impression:
Unremarkable examination of the thoracic spine.
LUMBOSACRAL
SPINE, <<Order Observation Time>>
Indication:
[x]
Technique:
[x] views of the lumbosacral spine.
Comparison:
[x]
Findings:
The vertebral body and disc space heights are preserved. The spinal alignment
is maintained without evidence of spondylolithesis.
No acute fracture is identified. No lytic or blastic lesions are seen. The SI
joints are unremarkable.
Impression:
Unremarkable examination of the lumbosacral spine.
OSSEOUS
SURVEY, <<Order Observation Time>>
Indication:
[x]
Technique:
Complete osseous survey, Including [x] images.
Comparison:
[x]
Findings:
Skull:
[No lytic or blastic lesions are seen.]
Cervical
Spine: [No lytic or blastic lesions are seen.]
Thoracic
Spine: [No lytic or blastic lesions are seen.]
Lumbosacral
Spine: [No lytic or blastic lesions are seen.]
Pelvis:
[No lytic or blastic lesions are seen.]
Bilateral
upper extremities: [No lytic or blastic lesions are seen.]
Bilateral
lower extremities: [No lytic or blastic lesions are seen.]
Impression:
[No
lytic or blastic lesions seen on complete osseous survey.]
OR
FLOUROSCOPY, <<Order Observation Time>>
Indication:
OR fluoroscopy.
Findings:
[x] limited spot fluoroscopic views of the [x] were obtained in the OR by the
referring physician and submitted for interpretation.
Panorex, <<Order
Observation Time>>
Indication: [x]
Findings: No fracture or dislocation of the mandible. The TMJs are normal in
appearance. There is no periodontal or dental disease. Visualized sinuses are
patent.
Impressions:
1. [x]
Dedicated
rib series, <<Order Observation Time>>
Indication:
[x].
Comparison:
Not available.
Findings:
Evaluation of the visualized lungs and thoracic structures are limited. There
is no displaced rib fractures identified on detailed rib series.
Impressions:
No displaced rib fractures identified.
Thank
you for this consultation.
MRI
of the [x] knee. <<Order Observation Time>>
Indication: [x]
Examination- Multiple sequences were obtained in the axial, sagittal and
coronal planes.
Comparison: [x]
Findings: The distal femur, proximal tibia, fibula and patella show normal
morphology and signal characteristics. There is no evidence of marrow edema or microfracture. The quadriceps and patellar tendons are
intact. The ACL, PCL, MCL, LCL are intact with normal signal throughout. The
lateral and medial meniscus shows normal morphology. No joint effusion or
Baker's cyst is seen.
Impression:
1. Nomal [x] knee.
MRI
of the [x] shoulder, <<Order Observation Time>>
Indication: [x]
Technique- Multiple sequences were obtained in the axial, sagittal and coronal
planes.
Comparison:
Findings: The articular cartilage of the glenohumeral joint appears intact. The
teres minor tendon is intact. The infra and supraspinatus tendons are
unremarkable. There is no subacromial or subdeltoid bursitis. There is no
muscle atrophy. The long head of the biceps is maintained in anatomic location,
with an intact anchor. The subscapularis tendon is normal. Bone marrow signal
is normal.
Impression:
1. Normal [x] shoulder exam.
[x]
hip arthrogram and therapeutic injection, <<Order Observation Time>>
Indication:
[x] hip pain
Findings-
The procedure hip arthrography and therapeutic injection was explained to the
patient and written consent was obtained. The patient was placed in supine position
on the fluoroscopy table. The skin overlying the anterior aspect of the [x] hip
was prepped and draped in a sterile fashion. 1% lidocaine
without epinephrine was used local anesthetic. Under fluoroscopic guidance, a
22-gauge spinal needle was directed into the [x] hip joint. A small amount of
Isovue 370 was injected to confirm intra-articular position of the needle.
Following this, approximately 10 cc of a mixture of 2 cc Depo-Medrol
(40 mg/cc) and 8 cc 0.5% Marcaine was injected. The
tubing was cleared by injecting a small amount of saline. The needle was then
withdrawn and a sterile dressing was applied. The procedure was well tolerated
and there were no complications. The patient left the fluoroscopy suite in
stable condition.
Impression:
Fluoroscopic guided [x] hip arthrogram and
therapeutic injection performed without complication as described above.
CT
Head without contrast. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Technique:
Volumetric multidetector CT images were obtained
through the brain from the skull base to vertex without administration of
contrast. Bone windows were also analyzed.
Findings: There is no acute territorial infarct or
hemorrhage, mass, mass effect, midline shift, or extra-axial fluid collections.
The visualized paranasal sinuses and mastoid air cells are clear. The bilateral
orbits are unremarkable. The lateral ventricles, quadrigeminal cisterns, and
basilar cisterns are within normal limits. There are no osseous abnormalities.
Impression:
No acute intracranial abnormalities.
Facial
CT without contrast. <<Order Observation Time>>
Indications:
[x]
Technique:
Axial MDCT images were obtained through the bilateral orbits and facial bones
from the superior orbital rim to the inferior mental process and filmed in both
bone and soft tissue windows. IV contrast not demonstrated.
Findings:
There is no fracture. Bilateral orbits and globes are intact. Nasal bones,
maxilla, zygoma, and pterygoid
plates are intact. Mandible is intact. Visualized paranasal sinuses and mastoid
air cells are clear. Visualized brain parenchyma is unremarkable.
Impression:
No facial bone fracture.
CT
IAC without contrast. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Technique:
Volumetric multidetector CT images were obtained of
the internal auditory canals from the level of the frontal sinus to C1
vertebral body. No contrast was administered.
Findings:
The bilateral semicircular canals, cochlea, internal auditory canals,
vestibular aqueducts, cochlear ducts, facial nerve canals, and ossicles are
grossly unremarkable. External auditory canal is clear. There is no evidence of
bony erosion. The visualized paranasal sinuses and mastoid air spaces are
clear. There is no visualized soft tissue abnormality.
Impression:
No visualized osseous abnormalities of the bilateral temporal bones or
ossicles.
CT
lumbar spine without contrast. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
MDCT images of the lumbar spine were obtained and reviewed utilizing multi-planar
reformations. IV contrast was not administered.
Findings-
Alignment of the lumbar spine is grossly normal. The vertebral body heights and
disc heights are well-maintained without focal irregularity. No evidence of
fracture or subluxation. The paravertebral soft tissues are grossly normal.
There is no bony compromise of the spinal canal.
Impression:
No acute osseous or acute alignment abnormality of the lumbar spine.
CT
cervical spine. <<Order Observation Time>>
Indication:
[x]
Comparison:
None
Technique:
MDCT images were obtained of the cervical spine. Images were reconstructed into
multiple windows and reformatted into multiple planes for review. No IV
contrast was administered.
Findings:
No fracture or acute alignment abnormality of the cervical spine. The vertebral
body heights and disk heights are well-maintained with no focal irregularities.
The atlanto-axial and cervicothoracic articulation is intact, and there is no
pre-vertebral soft tissue swelling. No compromise of the spinal canal.
Impression:
No acute osseous or acute alignment abnormality of the cervical spine as
described.
CT
orbits with contrast. <<Order Observation Time>>
Indication:
[x]
Comparisons:
[x]
Findings:
The bilateral globes are intact. There is no evidence of soft tissue stranding
or abnormal thickening of the extraocular muscles. There is no evidence of
fracture on bone windows. The bilateral orbits are intact. Limited views of the
brain parenchyma are grossly unremarkable.
Impressions:
No gross abnormality of the bilateral orbits.
Sinus
CT without contrast. <<Order Observation Time>>
Indications:
[x]
Technique:
Axial MDCT images were obtained through the bilateral orbits and facial bones
from the superior orbital rim to the inferior mental process and filmed in both
bone and soft tissue windows. IV contrast not demonstrated.
Findings:
The paranasal sinuses are well-developed and aerated. There is no mucosal
disease or air-fluid level. The cribriform plate appears intact. The nasal
septum is not deviated. No osseous lesion or fracture is visualized.
Impression:
Normal CT sinuses.
CT
thoracic spine without contrast. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Technique:
MDCT images of the thoracic spine were obtained and reviewed utilizing
multi-planar reformations. IV contrast was not administered.
Findings:
Alignment of the thoracic spine is grossly normal. The vertebral body heights
and disc heights are well-maintained without focal irregularity. No evidence of
fracture or subluxation. The paravertebral soft tissues are grossly normal.
There is no bony compromise of the spinal canal.
Impression:
No acute osseous or acute alignment abnormality of the thoracic spine.
CTA
head with [and without] contrast. <<Order Observation Time>>
Indication:
[x]
Technique:
Volumetric multidetector CTA images of the head were
obtained with [and without] contrast.
Comparisons:
[x]
Findings:
There is no acute territorial infarct or hemorrhage, mass, mass effect, midline
shift, or extra-axial fluid collections. The visualized paranasal sinuses and
mastoid air cells are clear. The bilateral orbits are unremarkable. The lateral
ventricles, quadrigeminal cisterns, and basilar cisterns are within normal
limits. There are no osseous abnormalities.
The
visualized portions of the anterior cerebral arteries, middle cerebral
arteries, and posterior cerebral arteries are grossly unremarkable. The
anterior and posterior communicating arteries are visualized and are grossly
unremarkable. The visualized internal carotid arteries, vertebral arteries, and
basilar arteries are grossly unremarkable. There is no evidence of any definite
aneurysm.
Impression:
No acute intracranial abnormalities.
CTA
neck with [and without] contrast. <<Order Observation Time>>
Indications:
[x]
Comparison:
[x]
Technique:
Volumetric multidetector CT images of the neck were
obtained from the skull base to the level of the clavicles after administration
of Isovue-370 contrast. Coronal and sagittal planes were examined, as well as
3-D reconstructions of the vessels.
Findings:[normal]
The common carotid, internal and external carotid arteries are patent without
areas of significant stenosis or aneurysm.
[abnormal]
There is approximately [x]% stenosis of the [x] internal carotid artery,
approximately [x] cm from the bifurcation. Native lumen diameter measures
approximately [x] mm, while the focal stenosis measures approximately [x] mm in
diameter.
No
significant plaque is visualized. The vertebral body heights and disc heights
are well-maintained. No acute osseous or alignment abnormalities of the
cervical spine. There is no pathologic adenopathy noted.
Impressions:
[x].
MRI
Brain [with and without] contrast. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Technique:
MR images of the brain were obtained using ADC map, DWI, hemoflash,
FLAIR, T1, and T2 sequences. [contrast]
Findings:
There is no mass, mass-effect, midline shift, territorial infarction,
intraparenchymal hemorrhage, or extra-axial fluid collections. Bilateral orbits
are grossly normal. The visualized paranasal sinuses and mastoid cells are
clear. [There are no contrast-enhancing lesions.]
Impression:
[No intracranial abnormalities.]
MRA
cerebral vasculature. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Technique:
3-D time-of-flight images of the intracranial vasculature were obtained in
multiple projections. Source images are are also
obtained for examination. [x] cc Magnevist contrast was administered.
Findings:
The vertebral basilar system and posterior cerebral arteries are within normal
limits. The right posterior communicating arteries are visualized are grossly
unremarkable. The anterior cerebral artery, middle cerebral artery, and
intracranial internal carotid arteries are grossly unremarkable. The anterior
communicating artery is visualized and is grossly unremarkable.
Impressions:
[No focal abnormality within the intracranial arteries.]
MRI
of the cervical spine without contrast. <<Order Observation
Time>>
Indication: [x]
Technique: T1 sagittal, T2 sagittal, and flash axial sequences were
obtained.
Comparison: [x]
Findings: The spinal cord appears normal in signal, caliber, and contour. There
is no evidence of disc desiccation. The vertebral body heights and disc heights
are well maintained without evidence of focal irregularities. The paravertebral and paraspinous
soft tissues are grossly unremarkable.
C2-C3:
There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
C3-C4: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
C4-C5: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
C5-C6: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
C6-C7: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
C7-T1:
There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
Impression: [x]
MRI
of the thoracic spine without contrast. <<Order Observation
Time>>
Indication: [x]
Technique: T1 sagittal and axial, T2 axial and sagittal sequences were
obtained.
Comparison: [x]
Findings: The spinal cord appears normal in signal, caliber, and contour. There
is no evidence of disc desiccation. The vertebral body heights and disc heights
are well maintained without evidence of focal irregularities. The paravertebral and paraspinous
soft tissues are grossly unremarkable.
T1-T2: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T2-T3: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T3-T4: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T4-T5:
There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T5-T6: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T6-T7: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T7-T8: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T8-T9: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T9-T10: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T10-T11: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T11-T12: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
T12-L1: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
Impression: [x]
MRI
of the lumbar spine without contrast. <<Order Observation
Time>>
Indication: [x]
Technique: T1 sagittal and axial, T2 axial and sagittal sequences were
obtained.
Comparison: [x]
Findings: The spinal cord terminates at the [x] vertebral level. The
spinal cord appears normal in signal, caliber, and contour. There is no
evidence of disc desiccation. The vertebral body heights and disc heights are
well maintained without evidence of focal irregularities. The paravertebral and paraspinous
soft tissues are grossly unremarkable.
L1-L2:
No axial images available for interpretation at this level.
L2-L3: No axial images available for interpretation at this level.
L3-L4: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
L4-L5: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
L5-S1: There is no evidence of disc bulge, neural foraminal narrowing, facet
arthrosis, ligamentum flavum thickening, or nerve root compression.
Impression: [x]
MRA
of the neck with [and without] contrast. <<Order Observation
Time>>
Indication: [x]
Technique: 2-D time of flight images of neck arteries and 3-D acquisition
during intravenous administration of contrast. Source images and
reformatted images were reviewed. [x] cc Magnevist contrast was administered.
Comparison: [x]
Findings: There is no evidence of significant stenosis of the bilateral common
carotid or internal carotid arteries including the bifurcation. The bilateral
vertebral arteries are patent and grossly unremarkable.
Impression: [Grossly unremarkable MRA of the neck.]
Thank you for this consultation
MRI
temporal bone/IAC with and without contrast. <<Order
Observation Time>>
Comparison: [x].
Indication: [x]
Technique- Contiguous axial MR images of the brain were obtained using DWI, ADC
map, hemoflash, FLAIR, T1, and T2 sequences. Thin
slice axial T1, and postcontrast thin slice axial and
coronal T1-weighted images of the temporal bones were obtained. [18] cc
Magnevist IV contrast was administered and post contrast axial T1 weight images
were obtained.
Findings- No enhancing lesion or abnormality demonstrated in the internal
auditory canals. Bilateral cranial nerve VII and VIII are unremarkable. The
bilateral vestibular aqueducts and cochlear ducts are within normal limits.
Unremarkable bilateral semicircular canals and cochlea.
Periventricular white matter changes related to small vessel disease are noted.
There is no evidence of acute intracranial infarct, intracranial hemorrhage, or
extra-axial fluid collection. There is no evidence of intracranial mass,
mass-effect, or midline shift. The visualized paranasal sinuses and mastoid air
cells are clear. Bilateral orbits are intact. There is no evidence of contrast
enhancing lesions.
Impression: No evidence of ICA or CPA abnormality or contrast-enhancing lesion.
OB
ultrasound. <<Order Observation Time>>
Indication- [x. Quantitative HCG of approximately [x].
Findings- Real-time sonography of the pelvis was obtained transabdominally
and transvaginally. Images show a single intrauterine
gestation with gestational sac and fetal pole. Cardiac activity is documented
with estimated heart rate of [x] beats per minute. The crown-rump length
measures [x] cm which corresponds with a menstrual age of [x]. Overall
measurements of the gestational sac are approximately [x] cm. Endometrial
double wall thickness of [x] cm. No endometrial canal fluid. There is no free
fluid. Normal appearing left ovary with measurements of [x] cm. Normal
appearing right ovary with measurements of [x] cm. Overall uterus appears
homogenous in echotexture and measures [x] cm.
Impression:
1. [Single intrauterine pregnancy. Recommend follow-up serial HCG and
ultrasound.]
Transabdominal and transvaginal complete pelvic ultrasound.
<<Order Observation Time>>
Indication:
[x].
Comparison:
None.
Findings:
Real-time sonographic transabdominal
and transvaginal evaluation of the pelvis
demonstrated the uterus that is normal in size and contour. The uterus measures
[x]. The endometrial stripe is smooth and thin with a double wall
measurement of [x] mm.
The
ovaries are normal in echogenicity and size with intravascular flow
demonstrated on color Doppler bilaterally. The right ovary measures [x].
The left ovary measures [x]. There is no evidence of free fluid or mass.
Impression:
Normal pelvic Ultrasound.
Retroperitoneal
ultrasound of the kidneys. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Findings:
The right and left kidneys are normal in contour, echogenicity and size.
There are no evidence of hydronephrosis, shadowing stone, focal parenchyma
abnormalities or perinephric fluid collection. The right kidney measures
[x] cm x [x] cm x [x] cm in AP, transverse and length dimensions, respectively.
The right cortex measures []cm. The right resistive index measures [x] and is
normal. The left kidney measures [x]cm x [x]cm x [x]cm in AP, transverse and
length dimensions, respectively. The left cortex measure [x]cm. The left
resistive index measures [x] and is normal. The urinary bladder is mild to
moderately filled and appeared grossly unremarkable. Ureteral jets was
visualized on the left and right side within the bladder.
Impression:
1. Unremarkable renal ultrasound.
Thank
you for this consultation.
Limited
Abdominal Ultrasound. <<Order Observation Time>>
Indications:
[x].
Comparison:
[x].
Findings:
Realtime sonographic images
of the right upper quadrant were obtained. The liver demonstrates smooth
contours and homogeneous echogenicity with a maximal measurement of [x] cm. The
common bile duct is not dilated with a luminal diameter of approximately [x]
mm. The head of the pancreas is unremarkable. The gallbladder is unremarkable
with the wall thickness of [x] mm. [Negative/positive] sonographic Murphy's
sign. The IVC and aorta are visualized and appear grossly unremarkable. The
portal vein demonstrates antegrade flow. Right kidney has measurements of
approximately [x]. There are no masses or free fluid.
Impression:
1. Unremarkable ultrasound of the right upper quadrant.
Thank
you for this consultation.
Complete
abdominal ultrasound. <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Findings:
The liver is within normal limits in contour, echogenicity and size with the
right liver measuring [x] cm. There is no evidence of focal parenchyma
abnormality or intrahepatic biliary ductal dilatation. The portal venous flow
is antegrade and is grossly unremarkable. The visualized portions of the aorta
and IVC is grossly normal. The head and body of the pancreas appears grossly
unremarkable. The pancreatic tail is partially obscured by overlying bowel gas.
There is no evidence of ascites. The gallbladder appears sonographically
normal without evidence of wall thickening, intraluminal stone or sludge. The
patient was not noticeably tender to transducer palpation over the gallbladder.
The common bile duct appears sonographically normal
with diameter measurement of [x] mm in the porta hepatis. The right and left
kidneys are normal in contour, echogenicity and size with length measurement of
[x]cm and [x]cm, respectively. There is no evidence of hydronephrosis,
shadowing stone, focal parenchyma abnormalities or perinephric fluid
collection. The spleen appears sonographically normal
with length measurement of of [x]cm.
Impression:
1.
Unremarkable abdominal ultrasound.
Scrotal
ultrasound. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
Real-time sonographic evaluation of the scrotal contents was accomplished. The
right testes is normal in size, contour, and echotexture and measures [x]. The
right epididymis measures [x] mm. There is no evidence of a hydrocele on the
right.
The
left testes is normal in size, contour, and echotexture, and measures [x]. The
left epididymis measures [x] mm. There no evidence of a hydrocele on the left.
There are normal flow to bilateral testicles.
Impression:
1. Unremarkable scrotal ultrasound.
Thank
you for this consultation.
Thyroid
ultrasound. <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
Real-time sonographic images of the thyroid glands were obtained. Images
demonstrate a right thyroid that is normal in size, contour, and echogenicity.
The right thyroid measures approximately [x] cm in longitudinal and transverse
measurement. The left thyroid is also normal in size, contour, and echogenicity
with a measurement of approximately [x] cm in longitudinal and transverse
measurement. The isthmus measures approximately [x] mm.
Impression:
Normal thyroid ultrasound.
Breast
ultrasound bilateral, <<Order Observation Time>>
Indication:
[x].
Comparison:
[x].
Findings/Impression:
Real time sonographic images of the breasts bilaterally were obtained. Images
demonstrate homogenous breast echotexture. No cystic or solid lesions are seen
and there are no areas of abnormal shadowing. No findings to suggest abscess.
Thank
you for this consultation.
Single
view of the chest [including abdomen], <<Order Observation Time>>
Indication:
[x]
Comparison:
[x]
Findings:
There is no pulmonary consolidation, pleural effusion, or pneumothorax. The cardiothymic silhouette and pulmonary vasculature are
within normal limits. Gas filled loops of bowel that appear grossly
unremarkable. No acute osseous abnormalities.
Impression:
No acute cardiopulmonary process.
Bone
age hand and wrist, <<Order Observation Time>>
Gender:
[x]
Chronological age: [x] years, [x] months ([x] months)
Skeletal Age: [x] years, [x] months ([x] months)
Expect Mean Skeletal Age: [x] months (Brush Foundation Scale)
Standard Deviation: [x] months (Brush Foundation Scale)
Interpretation:
[Normal bone age/Delayed bone age, [x] SD below the mean/Accelerated bone age,
[x] SD above the mean]
PICC
line placement, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The [right] arm was prepped and draped in the usual sterile
fashion. Under ultrasound guidance, the [right basilic vein] was punctured. An
0.018 in wire was introduced, the needle removed and a 5.5 French sheath
placed. Under fluoroscopic observation and via the peel-away sheath, a [x] cm 5
French [double lumen] PICC line was placed with its tip at the junction of the
distal superior vena cava. The catheter was flushed with heparinized
saline and sutured to the patient's skin. The patient tolerated the procedure
well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Uncomplicated placement of [right] upper extremity [double lumen] PICC line.
Placement
of [x] sided double lumen venous access port, <<Order Observation
Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The [x] side of the neck and chest was prepped and draped in
the usual sterile fashion. 2 % lidocaine was used for
local anesthesia. In trendelenberg position, and
under ultrasound guidance, the [x] internal jugular vein was accessed using a micropuncture needle and a guidewire
was passed.
1% lidocaine with epinephrine local anesthesia was
administered to the [x] chest wall. An incision was made and a subcutaneous
pocket was developed as well as a subcutaneous tunnel connecting the pocket to
the puncture site.
Using
Seldinger technique, the catheter was passed through a peel-away sheath. The
double lumen port was seated in the subcutaneous pocket and connected to the
catheter through the subcutaneous tunnel. Under fluoroscopy, the catheter tip
was confirmed to be at the junction of the SVC and the right atrium. The port
had good forward flush and return.
Wound
closure was accomplished using interrupted 4-0 Vicryl
subcutaneous stitches, followed by a running 4-0 Vicryl
subcuticular stitch. Steri-strips
were applied. The port was instilled with heparinized
saline. The wound was dressed. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] IV, versed [x] mg IV, ancef [x] mg IV.
Impression:
Uncomplicated placement of a [x] internal jugular vein, 10 Fr. double lumen
Bard MRI compatible venous access port.
Double
lumen (Duraflow) tunneled catheter placement,
<<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position.
The
[right] side of the neck and chest was prepped and draped in the usual sterile
fashion. 1% lidocaine with epinephrine local
anesthesia was administered. Under ultrasound guidance and using a micropuncture needle, the [right] internal jugular vein was
accessed and a guidewire passed. The needle was
exchanged for the micropuncture introducer/sheath.
A
subcutaneous tunnel was developed over the chest wall connecting to the
puncture site in the neck. Under fluoroscopic observation, a [x] cm tip to cuff
double lumen [Duraflow] catheter, after being
advanced through the subcutaneous tunnel, was passed into the [x] internal
jugular vein via a peel-away sheath. The catheter tip was placed in the right
atrium. Both ports had good forward flush and return. The catheter was sutured
at the skin exit site and it was flushed with heparinized
saline.
The
incision in the neck was closed with a Vicryl suture.
The
patient tolerated the procedure well, and the procedure was without
complications.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, Versed [x] mg IV.
Impression:
Uncomplicated placement of a [right] internal jugular vein, [x] cm tip to cuff,
double lumen tunneled catheter.
Double
lumen ( Vaxcel ) tunneled catheter placement,
<<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position.
The
[x] side of the neck and chest was prepped and draped in the usual sterile
fashion. 1% lidocaine with epinephrine local
anesthesia was administered. Under ultrasound guidance and using a micropuncture needle, the [x] internal jugular vein was
accessed and a guidewire passed. The needle was
exchanged for the micropuncture introducer/sheath.
A
subcutaneous tunnel was developed over the chest wall connecting to the
puncture site in the neck. Under fluoroscopic observation, a [x]cm tip to cuff
double lumen Vaxcel catheter, after being advanced
through the subcutaneous tunnel, was passed into the [x] internal jugular vein
via a peel-away sheath. The catheter tip was placed in the right atrium. Both
ports had good forward flush and return. The catheter was sutured at the skin
exit site and it was flushed with heparinized saline.
The
incision in the neck was closed with a Vicryl suture.
The
patient tolerated the procedure well, and the procedure was without
complications.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] IV, Versed [x] IV.
Impression:
Uncomplicated placement of a [x] internal jugular vein, [x]cm tip to cuff,
double lumen tunneled catheter.
Ultrasound
and fluoroscopically guided non-tunneled catheter placement, <<Order
Observation Time>>
Indication:
[x]
Technique:
Informed
consent was obtained after explaining the risks and and
benefits of the procedure. The patient was placed supine on the angiographic
table.
The
[right] neck was prepped and draped in a sterile fashion. A small incision was
made at the base of the [right] neck after giving local anesthesia. With a
21gauge needle, the [right] internal jugular vein was punctured and a 5 French
sheath was placed within the [right] IJ.
After
serial dilitations, a [x] cm double lumen [ Schon XL] dialysis catheter was introduced and placed
within the right atrium. The catheter was sutured to the patient's skin with prolene and flushed with heparin.
The
patient tolerated the procedure well without complications.
Findings:
Initial
ultrasound demonstrates a widely patent [right] IJ vein.
Final
image demonstrates a [right] IJ non-tunneled dialysis catheter with tip in the
right atrium.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg, Fentanyl [x] mcg.
Impression:
Successful placement of non-tunneled dialysis catheter through the [right]
internal jugular vein.
Fluoroscopically
guided exchange of tunneled dialysis catheter, <<Order Observation
Time>>
Indication:
[x]
Technique:
Informed
consent was obtained and the patient was placed supine on the angiography
table. The [right] neck and [right] upper chest wall were prepped and draped in
a sterile fashion. After administration of local anesthesia and using blunt
dissection, the the cuff of the [right] tunneled
catheter was loosened. A glidewire was then threaded
through the catheter into the inferior vena cava. The catheter was removed and
a new, [23] cm tip to cuff [Ashe] tunneled dialysis catheter was threaded over
the wire and through the tunnel with its tip placed in the right atrium. The
catheter was sutured to the patient's skin with Prolene
and a sterile dressing was applied.
Findings:
Initial
images demonstrate a [23] cm tip to cuff [Ash] catheter with tip in right
atrium. Final images again demonstrate a [23] cm tip to cuff [Ashe] catheter
with with the tip in the right atrium.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, fentanyl [x] ug
IV, Ancef [x] gram IV.
Impression:
Successful exchange of [right] tunneled dialysis catheter.
Removal
of double lumen venous access port, <<Order Observation Time>>
Indication:
[x]
Procedure:
Removal of [right] double lumen venous access port.
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The [right] side of the neck and chest was prepped and draped
in the usual sterile fashion. 1% lidocaine with
epinephrine local anesthesia was administered to the right chest wall. An
incision was made and blunt dissection was performed. The Medi
-Port and catheter were removed.
Wound
closure was accomplished using interrupted 4-0 Vicryl
subcuticular stitches, followed by a running 4-0 Vicryl subcuticular stitch and Dermabond. The wound was dressed. The patient tolerated the
procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, versed [x] mg IV
Impression:
Uncomplicated removal a [right] internal jugular vein, double lumen venous
access port.
Tunneled
catheter removal, <<Order Observation Time>>
Indication:
[x]
Procedure:
With
the patient in supine position, the [right] side of the neck and the existing
catheter were prepped and draped in a sterile fashion. 2% Lidocaine
was injected subcutaneously around the catheter tract. Blunt dissection of the
tract was performed and the catheter was removed without complications. [The
tip was cut and sent for culture and sensitivity.]
With
the patient now sitting upright, pressure was held over the entry site in the
[right] internal jugular vein and hemostasis was
achieved. Dressings were placed over the skin wound on the subclavicular
region. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful removal of [right] internal jugular vein tunneled catheter. [Tip
sent for culture.]
Percutaneous
biliary drainage, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The right side of the abdomen was prepped and draped in the
usual sterile fashion. 2 % lidocaine was used for
local anesthesia. Review of PET CT scan from 8/1 shows no dilatation of the
left biliary ducts and decreased dilatation of the right anterior biliary ducts
compared with the CT scan from 7/27. There was residual contrast in the right
posterior ducts.
The
scout film demonstrates residual contrast in the gallbladder, a right hepatic
duct stent and the pancreatic duct stent.
A 21
gauge needle was utilized to access the posterior right duct system from the
posterior axillary line between the 9th and 10th ribs. A wire was advanced into
the biliary system. A 5 French introducer set was then advanced into the right
posterior hepatic duct. Contrast was injected and demonstrated complete
obstruction at the hilar region. A wire was then advanced past the CBD into the
duodenum and a 8.5 French catheter with extra side holes was placed with its
distal tip in the duodenum and connected to external drainage.
The
catheter was sutured to the skin and a sterile dressing was applied.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, versed [x] mg IV, Benadryl [x]
mg IV
Impression:
Successful percutaneous biliary drainage of right posterior hepatic ducts with
a 8.5 French catheter placed distal to the obstruction.
Percutaneous
biliary tube exchange, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The procedure was performed under general
anesthesia. The patient was identified and placed in the supine position. The
right side of the abdomen and right biliary drain were prepped and draped in
the usual sterile fashion. Contrast was injected through existing tube and
demonstrated biliary drainage catheter within the distal CBD. The right biliary
ducts that were opacified were not dilated. A guidewire was advanced through the existing tube into the
duodenum. The biliary drainage tube was exchanged over the wire and a new 10.2
French 40 cm long biliary drainage tube with 3 cm of extra side-holes added.
The
left side of the abdomen and left biliary drain were prepped and draped in the
usual sterile fashion. Contrast was injected through existing tube and
demonstrated the catheter tip crossing into the right biliary tree. A guidewire was advanced through the existing tube and the tube
was exchanged over the wire for a new 10.2 French 40 cm long biliary drainage
tube with 32 side-holes.
Both
catheters were sutured to the skin and a sterile dressing was applied.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
per anesthesia
Impression:
Successful exchange of a right internal/external biliary drainage and a
left-to-right external biliary drainage catheter.
Liver
chemoembolization, <<Order Observation Time>>
Indication:
[x]
Technique:
The procedure, risks, benefits and alternatives were explained to the patient
who expressed understanding and signed an informed consent. The patient was
identified and placed in the supine position. The right groin was prepped and
draped in the usual sterile fashion. 1% lidocaine was
used for local anesthesia.
The
right common femoral artery was catheterized using a 5 French Pigtail catheter.
An aortogram was performed, followed by selective cathterization of the superior mesenteric artery using anOmni SOS 2 selective catheter. A selective SMA angiogram
demonstrated a patent portal vein on portal phase images. There was no evidence
of a replaced right hepatic artery. The celiac axis was catheterized and selective
arteriogram demonstrated a surgically removed splenic artery. There were
multiple hypervascular masses thoroughout
both lobes of the liver.
Coaxially
the Renagade Hi- Flo microcatheter
was advanced into the right hepatic artery. Selective right hepatic arteriogram
was performed. Embolization was performed with 50 mg of adriamycin , 10 mg of mitomycin , 100 mg of cisplatin ,
ethiodol and embospheres
size 100-300 micron.
Post-embolization
angiogram was performed, and demonstrated 80-90% stasis. The catheters were
removed. The vascular sheath was removed and hemostasis
was achieved by direct compression over the puncture site for 15 minutes. There
was a small 3 cm hematoma at the puncture site. The patient tolerated the
procedure well. The patient was admitted to the hospital for post- embolization
care and pain control.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful embolization of the right lobe of the liver was performed using
chemotherapeutic agents and embosphere particles.
Post embolization angiogram demonstrated sluggish flow within the right hepatic
artery and with the hypervascular masses no longer visualized.
Ultrasound-guided
cholecystostomy tube placement, <<Order Observation Time>>
Indication:
[x]
Technique:
After
obtaining informed consent, the right upper quadrant was prepped and draped in
a sterile fashion and the patient was placed in a supine position.
Using
ultrasound guidance, a 21 gauge needle was advanced into the gallbladder via an
anterolateral approach. After a series of exchanges and under fluoroscopic
guidance, an [8] French APD catheter was placed within the gallbladder and
attached to a drainage bag. The catheter was left to gravity drainage.
Findings:
Initial
ultrasound images demonstrate [a distended gallbladder with multiple calculi
seen in the gallbladder neck]. Fluoroscopic images demonstrate an [8] French
APD catheter coiled within the right upper quadrant. [85] cc's of [bile] was
aspirated from the collection. A sample was sent for culture and sensitivity.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful placement of [8] Fr cholecystostomy tube. Cultures pending.
Cholecystostomy
tube exchange, <<Order Observation Time>>
Indication:
[x]
Technique:
The patient was placed supine on the angiography table. The existing catheter
was identified and prepped/draped in the usual sterile sterile
fashion. Contrast was injected into the existing catheter with opacification of
the gallbladder fundus. A guidewire was advanced into
the catheter and coiled within the gallbladder fundus. The existing 10 French
cholecystostomy tube was removed. A 12 French all-purpose drainage catheter was
exchanged with its tip in the gallbladder fundus. Contrast was injected via a
new cholecystostomy tube and demonstrated opacification of the gallbladder
fundus. The tube was secured with 2-0 Prolene.
The
patient tolerated the procedure without evidence of immediate complication.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful exchange of a new 12 French cholecystostomy tube.
CT-guided
abscess drainage, <<Order Observation Time>>
Indication:
[x]
Technique:
[x]
After
informed consent was obtained the patient was placed [supine] on the CT table.
Initial images of the [lower abdomen] were obtained. The puncture site was
marked on the patient's skin and 1% lidocaine was
administered. Using a 19 gauge needle and under CT guidance the [right lower
quadrant] collection was punctured via a [right posterior] approach. A J-wire
was threaded through the needle into the collection.
After
serial dilatations a [12] French APD was placed within the collection and
sutured to the patient's skin with 2-0 silk.
Findings:
Initial
CT images demonstrate [the patient status post right hemicolectomy
with an ileocolonic anastomosis and an adjacent
air-containing collection in the right lower quadrant].
Final
images demonstrate the [12] French APD within this collection.
Approximately
[200] cc of [purulent] fluid was aspirated and a sample was sent for culture
and sensitivity.
The
patient tolerated the procedure well without complications.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, Fentanyl [x] mcg IV
Impression:
Successful CT-guided drainage of the [right lower quadrant] collection. The
catheter was left to gravity drainage. Cultures pending.
Retroperitoneal
angiogram and embolization, <<Order Observation Time>>
Indication:
[x]
Technique
and findings:
After
obtaining informed consent, the patient was placed supine on the angiography
table. The right groin was prepped and draped in a sterile fashion. Following
the administration of lidocaine , the right common
femoral artery was accessed using a 19 gauge needle. A Bentson
wire was threaded into the abdominal aorta. The needle was removed and a 4
French omni flush catheter was threaded over the wire
into the upper abdominal aorta. An aortogram was
performed.
The
flush catheter was removed and a 5 French sheath was placed into the right
common femoral artery. Through the sheath and over the wire a Sos Omni 2 selective catheter was then used to cannulate the superior mesenteric artery artery and an angiogram demonstrated a normal SMA.
The
inferior mesenteric artery was then cannulated and an
angiogram demonstrated bleeding into sigmoid/left colon from small branches of
the IMA.
A
Renegade high flow catheter was then used to selectively cannulate
the small branch from the IMA that was bleeding. A 2 mm x 10 mm coil was placed
within that vessel with good results. Nitroglycerin was then injected
intra-arterially to localize other areas of possible bleeding. 2 other coils
were placed in a second small branch of the IMA. Post embolization angiogram
demonstrates no active bleeding.
A 7
French triple-lumen catheter was placed via the right common femoral vein with
its tip within the IVC.
The
sheath was removed and pressure was applied to the right groin until hemostasis was achieved. The triple lumen catheter was
sutured to the skin and a sterile dressing was applied.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] ug IV, Versed
[x]mg IV, nitroglycerin [x] ug intra-arterial,
Benadryl [x] mg IV.
Contrast:
[x] cc of Omni 300.
Impression:
1.
Normal SMA.
2.
Bleeding into sigmoid and left colon from small branches of IMA. Two small
vessels were embolized with 2 mm x 10 mm coils x 3.
3. No
bleeding was seen in the post embolization images.
4. 7
French triple-lumen catheter placed via right common femoral vein.
Angiogram,
angioplasty and venogram of AV graft, <<Order
Observation Time>>
Indication:
[x]
Technique:
After
informed consent was obtained, the [left] arm was prepped and draped in a
sterile fashion. The AV [graft] was punctured with a 21 gauge needle. After a
series of exchanges a 4 French dilator was left within the AV [graft]. Multiple
angiograms were performed.
A Bentson wire was threaded through the 5 French dilator
which was exchanged for a [5] fr sheath. Through the
sheath a [7] mm x [4] cm balloon was threaded to the venous anastomosis of the
AV [graft] at which point was dilated. The balloon was removed and an
additional angiogram was performed through the sheath.
At
this point the catheter and wires were removed and the sheath was taped to the
patient's skin. While in the recovery room the sheath was removed and
compression was held until hemostasis was achieved.
Findings:
Initial
images demonstrate a [left] [brachial] artery to [brachial] vein AV [graft]
with a severe stenosis at the venous anastomosis. Following angioplasty with a
[7] mm x [4] cm balloon there is an excellent angiographic result. The arterial
anastomosis appears widely patent. The [left] subclavian vein, brachiocephalic
vein and SVC are widely patent.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, Fentanyl [x] ug
IV, heparin [x] units IV.
Contrast:
[x] cc of Omnipaque-300.
Impression:
[Right] [ brachial ] artery to [brachial] vein AV [graft] with a severe
stenosis at the venous anastomosis which was successfully angioplastied
with an excellent angiographic result.
Gastrostomy
tube placement, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient with identified and placed in the
supine position.
A
limited ultrasound examination of the left upper quadrant was performed to
understand the relationship of the spleen and liver to the intended access
site. The abdomen was prepped and draped in the usual sterile fashion. Under
fluoroscopic observation, the stomach was insufflated with air through the
existing nasogastric tube. The skin was anesthetized
with 2% lidocaine. The stomach was accessed with a
single puncture using a 19-gaugesingle wall needle. Appropriate gastric access
was confirmed by aspiration of air and contrast injection defining rugal folds. A Rosen wire was advanced through the needle
which was then removed. A 5 Fr Bernstein was advanced over the wire which. The guidewire was successfully directed towards the gastro-
esophageal junction and passed cephalad where it was
retrieved in the oral cavity. Through a Berenstein
catheter passed into the oral, the Bentson wire was
exchanged for an long stiff wire. A 20 French pull-through Ross Flexiflo gastrostomy tube was
passed antegrade from the mouth into the stomach over the guidewire.
The guidewire was removed. The gastrostomy tube was
stabilized at the skin with external and internal bumpers and a sterile
dressing applied. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Findings:
The ultrasound demonstrates [left lobe liver position and spleen position].
Preliminary scout films and those after gastric air insufflation demonstrated
[anatomy of colon with contrast and stomach]. Completion images demonstrate
[tube position].
Medication:
Versed [x] mg IV, Fentanyl [x] mcgs
IV, Glucagon [x] mg IV, Clindamycin [x] mg IV
Impression:
Successful placement of a 20 French pull-through Ross gastrostomy tube.
IVC
filter placement via the internal jugular vein, <<Order Observation
Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The [right] side of the neck and chest wall was prepped and
draped in the usual sterile fashion. 2% lidocaine
local anesthesia was administered. Under ultrasound guidance, the [right]
internal jugular vein was accessed using a micropuncture
needle. A guidewire was passed and the needle was
exchanged for the micropuncture introducer/sheath.
The micropuncture wire was exchanged for an Amplatz
wire, over which a 5 French omni flush catheter was
placed with the distal extent in the left common iliac vein. An IVC venogram was obtained, showing normal anatomical relation
between the IVC, renal veins and left common iliac vein. The absence of
thrombus was also documented. The omni flush catheter
was exchanged for the IVC filter introducer/sheath system through which a [ Venatech LP] filter was deployed under fluoroscopic
observation in an infrarenal location. Hemostasis was assured at the puncture site in the neck. A
sterile dressing was applied. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, Versed [x] mg IV.
Impression:
Uncomplicated placement of infrarenal [ Venatech LP] IVC filter via the right internal jugular
vein.
IVC
filter placement via the common femoral vein, <<Order Observation
Time>>
History
: [x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The [left] groin was prepped and draped in the usual sterile
fashion. 2% lidocaine local anesthesia was
administered. The [left] common femoral vein was accessed using a 19 Gauge
needle needle. A guidewire
was passed and the needle was exchanged for a 5 French omni
flush catheter was placed with the distal extent in the left common iliac vein.
An IVC venogram was obtained, showing normal
anatomical relation between the IVC, renal veins and left common iliac vein.
The absence of thrombus was also documented. The omni
flush catheter was exchanged for the IVC filter introducer/sheath system
through which a Bard Recoverable filter was deployed under fluoroscopic
observation in an infrarenal location. Hemostasis was assured at the groin. A sterile dressing was
applied. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, Versed [x] mg IV.
Impression:
Uncomplicated placement of infrarenal Bard
Recoverable IVC filter via the [left] common femoral vein.
Inferior
vena cavagram and Gunther
Tulip IVC filter removal, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed
consent was obtained. The patient was identified and placed in the supine
position. The right neck triple lumen catheter was prepped and draped in the
usual sterile fashion. 2% lidocaine local anesthesia
was administered. A guidewire was passed through the
triple lumen catheter which was exchanged for an Amplatz wire, over which a 5
French straight flush catheter was placed in the distal IVC.
An
IVC venogram was obtained. The flush catheter was
exchanged for the 12 French sheath through which a 15 mm Amplatz gooseneck
snare was used to grab the indwelling Gunther Tulip
filter. A coaxial 9 French sheath was threaded over the filter and was then
removed. The Amplatz wire was reintroduced and the flush catheter was placed
over the Amplatz wire in the distal IVC. A repeat venacavogram
was performed.
Hemostasis was assured at the
puncture site in the neck with manual compression. A sterile dressing was
applied. The patient tolerated the procedure well.
Findings:
The
IVC venogram demonstrates no IVC thrombus in or
around the indwelling Gunther Tulip filter.
Final
venogram demonstrates interval removal of the Gunther Tulip filter and no IVC thrombus and no evidence of
caval injury.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Local lidocaine.
Impression:
Normal inferior venacavogram. Uncomplicated placement
of removal of Gunther Tulip IVC filter via the right
internal jugular vein.
Inferior
vena cavagram and Bard recovery IVC filter removal,
<<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The right side of the neck and chest wall was prepped and
draped in the usual sterile fashion. 2% lidocaine
local anesthesia was administered. Under ultrasound guidance, the right internal
jugular vein was accessed using a micropuncture
needle. A guidewire was passed and the needle was
exchanged for the micropuncture introducer/sheath.
The micropuncture wire was exchanged for an Amplatz
wire, over which a 5 French straight flush catheter was placed through the Bard
recovery IVC filter, within the distal IVC. An IVC venogram
was obtained. The absence of thrombus was documented.
The
flush catheter was exchanged for the 12 French sheath through which the Bard
Recoverable device was used to grab the indwelling IVC filter. The sheath was
threaded over the filter and the filter and sheath were then removed. Through
the Amplatz wire, the flush catheter was placed in the distal IVC. A repeat venacavogram was performed.
Hemostasis was assured at the
puncture site in the neck with manual compression. A sterile dressing was
applied. The patient tolerated the procedure well.
Findings:
The
IVC venogram demonstrates no IVC thrombus in or
around the IVC filter.
Final
venogram demonstrates interval removal of the filter
and no IVC thrombus and no evidence of caval injury.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, Fentanyl [x] mcg IV.
Impression:
Normal inferior venacavogram. Uncomplicated removal
of Bard Recovery filter via the right internal jugular vein.
Replacement
of J tube, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. The right side of the abdomen, where the previous J-tube entry
site was prepped and draped in the usual sterile fashion. 2 % lidocaine was used for local anesthesia. A Bernstein
catheter was introduced through the existing ostomy
in the skin and contrast was injected. Utilizing a guidewire
and catheter combination, access was obtained into the jejunum. A 12 French
catheter was then advanced over the wire into the jejunum. Contrast was
injected through the new jejunostomy tube confirmed its position.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful
replacement of a 12 French jejunostomy tube.
Fluoroscopically
guided placement of [x] sided nephrostomy tube, <<Order Observation
Time>>
Indication:
[x]
Technique:
After
informed consent was obtained, the patient was placed prone on the fluoroscopy
table. The [left] flank was prepped and draped in a sterile fashion. After
administration local anesthesia and under ultrasound guidance, a lower pole
calix of the [left] kidney was punctured with a 21 gauge needle. After a series
of exchanges a 6 French introducer catheter was placed in the [left] renal pelvis.
A guidewire was then advanced into the [left] renal
pelvis. The intoducer was exchanged over the wire. A
[8] French APD was placed within the [left] renal pelvis. The cathter was sutured to the patient's skin and a sterile
dressing was applied.
Findings:
Initial
ultrasound images demonstrate [moderate left hydronephrosis ]. Pyelogram images confirm the hydronephrosis.
Final
images demonstrate an [8] French APD within the left renal pelvis.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, Fentanyl [x] ug
IV.
Impression:
Successful placement of [left] 8 French nephrostomy tube.
Fluoroscopically
guided bilateral nephrostomy tube check and exchange, <<Order Observation
Time>>
Indication:
[x]
Technique:
After
informed consent was obtained, the patient was placed prone on the fluoroscopy
table. Contrast was injected through the right percutaneous nephrostomy tube.
Multiple images were obtained. Contrast was then injected into the left
percutaneous nephrostomy tube and multiple fluoroscopic images were obtained.
The
left flank and catheter were prepped and draped in a sterile fashion. After
administration local anesthesia, a guidewire was advanced
through the existing tube into the renal pelvis. The tube was exchanged and a
new 8 French nephrostomy tube was placed, with its tip coiled in the left renal
pelvis. The catheter was sutured to the patient's skin and a sterile dressing
was applied.
The
right flank and catheter were prepped and draped in a sterile fashion. After
administration local anesthesia, a guidewire was
advanced through the existing tube into the renal pelvis. The tube was
exchanged and a new 8 French nephrostomy tube was placed, with its tip coiled
in the right renal pelvis. The catheter was sutured to the patient's skin and a
sterile dressing was applied.
Findings:
Initial
images demonstrates the right nephrostomy tube to be partially out. The left nephrostomy
tube was coiled within a lower pole calix. Final images demonstrate two new 8
French APD within both renal pelvis.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV, Fentanyl [x] ug
IV.
Impression:
Successful replacement of bilateral 8 French nephrostomy tubes.
[x]
sided pyelogram, percutaneous
nephrostomy and ureteral
stent palcement, <<Order Observation
Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
prone position. The right flank was prepped and draped in the usual sterile
fashion. A retrograde pyelogram was performed via the
ureteral stent placed by Urology prior to this procedure. An appropriate skin
site was chosen and infiltrated with 2% lidocaine.. A
calyx was accessed under fluoroscopy using a 19-gauge needle. The appropriate
access was confirmed by aspiration of urine and contrast injection. A
0.018-inch guidewire was passed into the renal
collecting system. A 6 French introducer was passed over the guidewire to function as a nephrostomy. A 4 French glidecath was passed coaxially into the nephrostomy
introducer. Using an angled glide wire it was used to negotiate the right
ureter and access the urinary bladder. The 4 French glidecath
was advanced over the angled guidewire into the
urinary bladder to function as a ureteral stent. The guidewire
was removed. The coaxial arrangement of 4 French Glidecath
within the 6 French nephrostomy introducer was sutured to the skin using a silk
stitch. The Glidecath was capped. A sterile dressing
was applied. The patient tolerated the procedure well.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Findings:
[Right]-sided
renal calculus.
Medications:
Fentanyl [x] ug IV, Versed
[x] mg IV
Impression:
Successful [right]-sided percutaneous nephrostomy and ureteral stent placement.
[x]
sided nephrostogram and exchange of PCN for nephroureteral stent, <<Order Observation
Time>>
Indication:
[x]
Technique:
Informed
consent was obtained. The patient was identified and placed prone in the
angiographic table. The left flank and left percutaneous nephrostomy tube were
prepped and draped in the usual sterile fashion.
Contrast
was injected through the existing left percutaneous nephrostomy
and a nephrostogram was obtained, which demonstrated
a left distal ureteral stricture. A guidewire was
advanced into the left renal pelvis and the catheter was exchanged over a wire.
A Bernstein catheter was advanced into the left renal pelvis and a slightly guidewire access was obtained into the bladder. A new 26 cm
long 8 French nephroureteral stent was then advanced
into the bladder. Contrast injection onfirms the
catheter position with its distal tip of the bladder and the proximal end
coiled within the left renal pelvis.
The
catheter was sutured to the patient's skin and sterile dressing was applied.
The catheter was connected to a leg bag.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
Successful replacement of the left PCN for a left 26 cm long 8 French nephroureteral stent.
Pulmonary
angiogram, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed
consent was obtained from the patient after the discussing benefits, potential
complications and alternatives. The patient was placed supine on the angio table. The right groin was prepped and draped in
sterile fashion. Local anesthesia was applied and utilizing Seldinger technique
a 19 gauge needle was used to gain access into the right common femoral vein. A
Bentson wire was advanced and the needle exchanged
for a 5F dilator. Images of the inferior vena cava were obtained. The dilator
was removed and a 7F Mont-1 catheter was advanced over the wire and pressure in
the inferior vena cava was obtained. The catheter was advanced into the right
atrium and right ventricle where pressure were recorded. The catheter was then
advanced into the [left] main pulmonary artery where pressure measurement was
again performed. Images of the [left] pulmonary artery and branches were
obtained in two planes. This was followed by selective catheterization of the
[right] main pulmonary artery. Images of the [right] pulmonary vasculature were
obtained in two planes. The catheter was removed over the wire and hemostasis was achieved at the puncture site.
The
patient tolerated the procedure well.
Findings:
Images
of the inferior vena cava show that this vessel has normal caliber and flow
with no evidence of clots.
Mean
IVC pressure equals [x] mm Hg, mean right atrial pressure equals [x] mm Hg,
right ventricular pressure equals [29/1] mm Hg and the left main pulmonary
artery pressure equals [21/6] mm HG. Images obtained revealed normal pulmonary
vasculature bilaterally and no evidence of pulmonary embolism.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Versed [x] mg IV and Fentanyl [x] mcg IV
Contrast:
[x] ml of Visipaque
Impression:
Normal pulmonary arteriogram. No angiographic evidence of pulmonary embolism.
Abdominal
aortogram and bilateral selective renal artery
angiograms, <<Order Observation Time>>
Indication:
[x]
Technique:
After
obtaining informed consent, the patient was placed supine on the angiography
table. The right groin was prepped and draped in a sterile fashion. Following
the administration of lidocaine , the right common
femoral artery was accessed using a 19 gauge needle. A Bentson
wire was threaded into the abdominal aorta. The needle was removed and a 4
French omni flush catheter was threaded over the wire
into the upper abdominal aorta. An aortogram was
performed.
The
flush catheter was removed and a 5 French sheath was placed into the right
common femoral artery. Through the sheath and over the wire a Sos Omni 2 selective catheter was then used to cannulate the right renal artery. An angiogram was
performed.
The
catheter was then withdrawn from the right renal artery and, the left renal
artery was cannulated. An additional angiogram was
performed.
The
catheter and wire were withdrawn and the sheath was taped to the patient's skin
and the patient was transferred to the recovery room.
While
in the recovery room the sheath was removed and pressure was applied to the
right groin until hemostasis was achieved.
Findings:
The
initial aortogram demonstrates a normal abdominal
aorta.
Selective
renal arteriograms demonstrate normal main and branch
renal arteries and normal renal parenchyma.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] ug IV, Versed
[x] mg IV, heparin [x] units IV, nitroglycerin [x] ug
intra-arterial.
Contrast:
[x] cc of 60% ionic contrast.
Impression:
Normal renal arteriogram. Normal aorta.
Abdominal
aortogram , bilateral selective renal artery
angiograms and bilateral renal artery stenting, <<Order Observation
Time>>
Indication:
[x]
Technique:
After
obtaining informed consent, the patient was placed supine on the angiography
table. The right groin was prepped and draped in a sterile fashion. Following
the administration of lidocaine , the right common
femoral artery was accessed using a 19 gauge needle. A Bentson
wire was threaded into the abdominal aorta. The needle was removed and a 4
French omni flush catheter was threaded over the wire
into the upper abdominal aorta. An aortogram was
performed.
The
flush catheter was removed a 5 French sheath was placed into the right common
femoral artery. Through the sheath and over the wire a Sos
Omni 2 selective catheter was then used to cannulate
the right renal artery. Nitroglycerin was injected through the catheter and
pressure measurements were acquired. Heparin was administered. A wire was
threaded through the omni catheter into a more distal
right renal artery. The omni catheter and sheath were
removed and a long, 6 French Balkan sheath was then threaded over the wire into
the mid-abdominal aorta. A 6 mm x 15 mm stent was then threaded over the wire
into the proximal right renal artery and deployed. An additional angiogram and
pressure measurements were acquired.
The
catheter was then withdrawn from the right renal artery and, after some
difficulty, the left renal artery was cannulated.
Nitroglycerin was injected through the catheter and pressure measurements were
acquired. Heparin was administered. A wire was threaded through the omni catheter into a more distal left renal artery. A 6 mm
x 15 mm stent was then threaded over the wire into the proximal left renal
artery and deployed. An additional angiogram was performed.
The
catheter and wire were withdrawn and the sheath was retracted into the right
external iliac artery. The sheath was taped to the patient's skin and the
patient was transferred to the recovery room.
While
in the recovery room the sheath was removed and pressure was applied to the
right groin until hemostasis was achieved.
Findings:
The
initial aortogram demonstrates a mild-to-moderately
calcified and irregular aorta.
There
is a 15 mm long moderate to severely stenotic segment
in the proximal right renal artery which yielded a 40 mm pressure gradient
initially. Following angioplasty with the 6 mm x 20 mm balloon there is a
residual 50% stenosis with a significant pressure gradient. Following placement
of a 6 mm x 15 mm omni flex stent there is no
pressure gradient and excellent angiographic results.
Angiogram
and measurements in the left renal artery demonstrates a 15 mm long moderate
stenosis with a 5-10 mm pressure gradient.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] ug IV, Versed
[x] mg IV, heparin [x] units IV, nitroglycerin [x] ug
intra-arterial.
Contrast:
[x] cc of 60% ionic contrast.
Impression:
1.
Moderate to severely stenotic right proximal renal
artery which was successfully stented with no
residual pressure gradient.
2.
Moderate left proximal renal artery stenosis with no clinically significant
pressure gradient.
3.
Mildly calcified and irregular abdominal aorta.
[x]
sided renal angiogram and embolization, <<Order Observation Time>>
Clinical
Indication: [x]
Technique
and findings:
After
obtaining informed consent, the patient was placed supine on the angiography
table. The right groin was prepped and draped in a sterile fashion. Following
the administration of lidocaine , the right common
femoral artery was accessed using a 19 gauge needle. A Bentson
wire was threaded into the abdominal aorta. The needle was removed and a 5
French sheath was placed into the right common femoral artery.
Through
the sheath, a 4 French omni flush catheter was
threaded over the wire into the upper abdominal aorta. An aortogram
was performed.
The
catheter was removed and a Cobra catheter was then used to cannulate
the left renal artery and an angiogram was obtained.
A
Renegade high flow catheter was then advanced into multiple branches of the
left kidney, where 4 cc's of Embospheres 700-900
micron and 2 vials of Contour 700-900 micron to complete stasis. Three 8 mm
coils were then placed in the mid left renal artery. Post embolization
angiogram demonstrates no flow to the left kidney.
The
splenic artery was then selectively catheterized and an angiogram demonstrates
the splenic artery to be displaced superiorly, with no branches feeding the
left upper pole mass.
A
flush catheter was then re-advanced into the upper abdominal aorta and repeat aortogram was performed.
The
catheter and sheath were removed and pressure was applied to the right groin
until hemostasis was achieved. A sterile dressing was
applied.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] ug IV, Versed
[x] mg IV, Ancef [x] g IV
Contrast:
[x] cc of Omni 300.
Impression:
Large mass in the left kidney, successfully embolized
as described above. No flow is seen towards the left kidney on repeat
angiogram.
Retrograde
exchange of [x] sided ureteral stent, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. A Foley catheter was inserted into the bladder. The perineum
was prepped and draped in the usual sterile fashion. 2 % lidocaine
was used for local anesthesia.
The
bladder was distended with fluid and contrast. The Foley catheter was cut and a
J-wire was advanced into the bladder. The Foley was exchanged over the wire for
a 14 French vascular sheath. A snare was introduced through the sheath and the
lower loop of the ureteral stent was snared and pulled back into the vascular
sheath. A Bentson wire was threaded through the stent
into the upper collecting system. The stent was exchanged for a Bernstein
catheter, through which contrast was injected. A 10 French 20 cm long custom
made ureteral stent was then advanced, with the upper loop forming in the upper
collecting system in the lower loop forming in the bladder.
Findings:
Markedly
dilated [right] upper collecting system.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] mcg IV, versed [x] mg IV
Impression:
Retrograde exchange of a 10 French 20 cm custom made [right] ureteral stent.
[x]
sided lower extremity angiogram and thrombolysis, <<Order Observation
Time>>
Indication:
[x]
Technique:
[x]
After
obtaining informed consent, the patient was placed supine on the angiography
table. The left groin was prepped and draped in a sterile fashion. Following
the administration of lidocaine , the left common
femoral artery was accessed using a 19 gauge needle. A Bentson
wire was threaded into the abdominal aorta. The needle was removed and a 4
French omni flush catheter was threaded over the wire
into the lower abdominal aorta. A pelvic aortogram
was performed.
Utilizing
road-mapping technique, the catheter was then advanced over a wire into the
right common femoral artery. An angiogram and runoff were performed. A guidewire was advanced into the right superficial femoral
artery followed by the catheter. A Rosen wire was then utilized to cross the
area of stenosis and occlusion. The omni flush
catheter was removed and a 5.5 French long Balkan sheath was placed over the
bifurcation in the proximal right superficial femoral artery. Through the
sheath and over a wire, a pulse spray catheter was placed within the occluded
segment and within the occluded graft. A repeat angiogram through the catheter
was performed to confirm position. Through the catheter, 5 mg of TPA were
pulse-sprayed into the occluded segment.
The
sheath and catheter were taped to the patinent's leg
and infusion of TPA through the catheter was started at 0.5 mg/hour. An
infusion of heparin at 300 units/hour was also started through the sheath and
the patient was transferred to the surgical ICU for monitoring overnight.
Findings:
There
is complete thrombosis of the right fem-pop endovascular graft. There is
reconstitution of the popliteal artery distal to the graft with stenosis in the
popliteal artery below the knee. There is a single vessel runoff via the right
anterior tibial artery. Thrombolysis of the graft was initiated as described
above.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Medications:
Fentanyl [x] ug IV, Versed
[x] mg IV, [x] mg TPA IA , Heparin [x] U IV.
Contrast
: [x] cc of 50 % Omni.
Impression:
1.
Thrombosed right fem-pop graft.
2.
Reconstitution of the popliteal artery distal to the graft with stenosis below
the knee.
3.
Single-vessel runoff via AT.
4.
Thrombolysis as described above.
TIPS
procedure, <<Order Observation Time>>
Indication:
[x]
Technique:
Informed consent was obtained. The patient was identified and placed in the
supine position. General anesthesia was administered by anesthesiology staff
who remained in attendance. The right side of the neck was prepped and draped
in the usual sterile fashion. Under ultrasound guidance, the right internal
jugular vein was accessed using a 21 gauge micropuncture
needle and an 0.018 inch guidewire was passed. The
needle was exchanged for a 4.5 French vascular introducer. The 0.018 inch guidewire was removed and replaced with an 0.035 inch Bentson guidewire. The vascular
introducer was exchanged for a 5 French specialty catheter (from a transjugular
intrahepatic access set) which was used to cannulate
the hepatic vein. CO2 portogram was performed to
define the portal system. The right hepatic vein was selected and after several
attempts, the right portal vein was successfully accessed using a transjugular
needle and a guidewire was passed. The tract between
the right hepatic vein and the right portal vein was dilated with a balloon
catheter and a repeat venogram was obtained. The TIPS
coduit was stented with two
10mm X 68mm Wallstents. The measured pre-Tips
pressure gradient was 16 mm Hg and the corresponding post-TIPS value was 6
mmHg. An excellent immediate post-TIPS result was documented. The vascular
introducer was removed and hemostasis was obtained at
the puncture site by direct compression. The patient tolerated the procedure
well, was hemodynamically stable throughout the
entire procedure and was successfully extubated.
Dr.
[x], the attending interventional radiologist, was present for the critical
portions of the procedure and reviewed all images obtained.
Impression:
1.
Small liver with hepatopetal flow.
2.
Minimal varices.
3.
Successful creation of TIPS shunt between the right hepatic vein and the right
portal vein. Pre-TIPS and post-TIPS pressure gradients were 16 mm Hg and 6 mm
Hg, respectivel
3 PHASE BONE SCAN <<Order
Observation Time>>
HISTORY: The patient is a [x]
PROCEDURE: A 3 phase bone scan limited to the [x] was obtained following
the IV administration of [x] mCi of Tc99m-MDP.
Anterior and posterior whole body images were then obtained at 3 hours.
FINDINGS: The three phase bone scan demonstrates normal uptake in [x].
Blood pool and flow are [x]. Whole body images demonstrate normal distribution
of radiopharmaceutical throughout the visualized osseous structures.The
kidneys are present and unremarkable.
IMPRESSION:
Normal radionuclide 3 phase bone scan. No evidence of infection.
Thyroid scan with uptake. <<Order Observation Time>>
Impression:
1. Normal thyroid uptake. [Findings may be suggestive of functional
tissue in the left thyroid nodule.]
Indication: [x]
Technique: The patient was administered [x] uCi
of iodine 123 orally. At 4 hours and 24 hours, the uptakes were calculated. At
24 hours planar images using pinhole collimation were obtained with and without
markers in the anterior and oblique views.
Findings: 4 hours uptakes was [x] % and 24 hours uptake was [x] %. Normal
4 hours uptake is 5 to 15% and normal range for 24-hour uptake is 15 to 35%.
There is a inhomogeneous area of slight decreased uptake within the [left
upper] pole which may be related to [strap muscle artifact/normal
inhomogeneity]. In comparison with thyroid ultrasound report of [x], the
ultrasound visualized [left/right] thyroid nodule is [not] discretely
visualized as a cold nodule [and may be related to a functioning nodule or
resolution limitations of the examination].
Brain perfusion scan. <<Order Observation Time>>
Impression:
1. [Perfusion defect of the mid left cerebral hemisphere with some
peripheral preservation].
2. [Normal perfusion of the right cerebral hemisphere and brainstem].
History: [x]
Technique: Following the IV injection of [x] mCi
of Tc-99m Neurolite, immediate dynamic flow images
were obtained over the head and neck in the anterior projection. Delayed planar
images were then obtained over the head and neck in the anterior and bilateral
projections. Comparison is made to [x].
Findings: There is decreased flow to the mid left cerebral hemisphere and
normal flow to the right cerebral hemisphere on arterial phase imaging. The
static images obtained in anterior and both lateral projections show decreased
activity within the mid left cerebral hemisphere with some peripheral
preservation of perfusion corresponding to CT findings. Normal activity
distribution is seen within the right cerebral hemisphere. Activity
distribution within the cerebellum and brainstem also appears normal, however the
images are more oblique than lateral which is not ideal for evaluation.
The images results of the study were reviewed with [x].
GI bleed scan. <<Order Observation Time>>
Impression:
1. [No GI bleed demonstrated\Positive GI bleed in ].
Indication:[x]
Technique: Following the IV administration of [x] mCi
of Tc 99m pertechnetate labeled to toe was RBCs, a GI
bleed scan was performed. Initial angiographic images were obtained over the
abdomen or. 1 minute, which was followed by dynamic imaging obtained over the
abdomen 1 frames/min over a period of 60 minutes.
Findings: The angiographic phase reveals no abnormal radiotracer uptake.
The dynamic images obtained reveals no abnormal radiotracer uptake. These
findings were discussed with [x].
Hepatobiliary scintigraphy. <<Order Observation Time>>
Impression:
1. Normal hepatobiliary function with gallbladder ejection fraction of
[x] %.
2. [Minimal enterogastric reflux]
History: [x]
Technique: Following the IV injection of [x] mCi
of Tc-99m mebrofenin, dynamic imaging was performed
over the abdomen for 60 minutes. The patient then received intravenous infusion
of a weight titrated dose of [x] mcg of CCK over 30 minutes during which time
additional dynamic imaging was performed. An area of interest was drawn around
the gallbladder and time-activity curve generated.
Findings: There is normal uptake and secretion of the radiopharmaceutical
by the liver which is normal in size and contour. The gallbladder is seen
promptly at [x] minutes. Small bowel activity was seen at [x] minutes. During
CCK infusion, there is prompt gallbladder response with normal contraction.
Minimal enterogastric reflux noted at the end of the
CCK images. The gallbladder ejection fraction is calculated at [x] %, which is
[x].
Tagged red blood cell liver and spleen nuclear medicine study.
<<Order Observation Time>>
Impression:
1. Focal delayed and persistent uptake in the left lobe of the liver
correlates with the lesion identified both by ultrasound and CT and is
consistent with a hemangioma.
Indication: [Liver mass]
Comparison Study: [x]
Technique: Following the IV administration of [x] mCi
of Tc-99m pertechnetate labeled to autologous RBCs, a hemangioma
study was performed. Initial angiographic images were obtained over the abdomen
over 1 minute, followed by dynamic delayed images approximately 1-1/2 hours
into the study.
Findings: Angiographic phase reveals no abnormal increased radiotracer
uptake. Dynamic delayed images demonstrate focal uptake in the left lobe of the
liver. No other areas of abnormal uptake.
MUGA scan, <<Order Observation Time>>
Impression:
1. Left ventricular ejection fraction of [x] %.
2. Normal chamber size and wall motion.
Indication: History of [x]
Technique: Patient's RBCs were labeled in vitro with [x] mCi of Tc-99m pertechnetate using
the standard kit. The patient's RBCs were then reinjected
and gated images in the LAO projection were obtained of the heart at rest.
Gated equilibrium data was used to calculate the left ventricular ejection
fraction. Images were evaluated in cine mode. Comparison was made to [x]
Findings: Calculated left ventricular ejection fraction is [x] %,
compared to the prior LVEF of [x] %. There is no regional wall motion
abnormality seen on cine mode images.
Myocardial perfusion scan. <<Order Observation Time>>
Impression:
1. No scintigraphic evidence of clinically
significant myocardial ischemia.
2. Small fixed perfusion defect of the distal inferior and inferolateral wall most likely due to prior infarct.
3. Elevated left ventricular volumes with a low ejection fraction of 40%
corresponding to history of congestive heart failure.
History: [x].
Technique: A resting myocardial perfusion study was performed following
the IV injection of [x] mCi of Tc-99m Tetrafosmin using SPECT protocol. After an interval of
about 1 hour, the patient underwent a stress myocardial perfusion study using a
six minute adenosine infusion protocol at the standard dose. At the height of
myocardial stress, [x] mCi of Tc-99m Tetrafosmin was injected IV and gated stress SPECT images
were acquired. The data was reconstructed in the short axis, horizontal long
axis, and vertical long axis planes and ventricular ejection fraction was
calculated.
Findings: There is a small area of mildly decreased activity within the
distal inferior and inferolateral wall. This is fixed
on stress and rest images and most likely corresponds to prior infarct. Mildly
decreased activity is also seen within the proximal inferolateral
wall as well as the mid anteroseptal wall. These
areas are seen on rest and stress images and most likely correspond to breast
and soft tissue attenuation artifact. There is no evidence of reversible
perfusion defect to suggest myocardial ischemia. The remainder of the
myocardium demonstrates normal activity distribution. The left ventricular
ejection fraction is calculated at [x], which is [low/normal/high]. The EDV is
[x] mL and the ESV is [x] mL,
both of which are [low/normal/elevated]. The gated SPECT images reveal inferior
wall hypokinesis and otherwise normal left
ventricular wall motion and normal wall thickening.
Results of the study were [x]
Sentinel node injection. <<Order Observation Time>>
Impression:
1. Injection of radiopharmaceutical for sentinel node localization.
History: [x] year-old [x] with [x]
Technique: [x] was prepped using the usual aseptic technique. [Local
anesthesia was then provided via subcutaneous injection of approximately 1 mL of 1% lidocaine mixed with
bicarbonate] Interstitial injection of [x] mCi of
Tc-99m filtered sulfur colloid was then performed without immediate
complication. No images were obtained. The patient was then transported to the
operating room in stable condition for sentinel node localization and biopsy.
Pulmonary Ventilation and Perfusion Scintigraphy. <<Order
Observation Time>>
Impression: [Normal ventilation and perfusion scan].
Indication: [x].
Technique: A ventilation image study of the lungs was performed following
inhalation of [x] mCi of Xe-133 gas through a close
loop system. Ventilation images were obtained in the posterior projection using
single breath, equilibrium and washout phases. Subsequently a perfusion image
study of the lungs was performed following IV injection of [x] mCi of Tc-99m MAA. The perfusion images were obtained in
the standard projections.
Findings: Ventilation images reveal normal activity distribution on
initial and equilibrium images without evidence of retention on washout images.
Perfusion images also demonstrate normal activity distribution throughout all
lung fields. There is no evidence of segmental or subsegmental
perfusion defects. Overall, these findings are consistent with a normal
ventilation and perfusion scan.
Results of the study were called to [x]