Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘ct’ Category

Acalculous Cholecystitis CT criteria

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2 major or 1 major + 2 minor

Major criteria:

  • Gallbladder wall thickening greater than 3 mm
  • Subserosal halo (ie, gallbladder wall edema)
  • Pericholecystic fatty inflammation
  • Pericholecystic fluid (without ascites or hypoalbuminemia)
  • Mucosal sloughing
  • Intramural gas

Minor criteria:

  • Gallbladder distention (>5 cm transverse)
  • High-attenuation bile (sludge)

Written by lmwong

December 19, 2009 at 2:18 am

Posted in abdomen, ct, gallbladder, gi

Acute Ischemic Stroke

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Cytotoxic edema is cell death with efflux of K and influx of Ca, Na, and water. Edema peaks at day 7.

CT noncontrast

  • Hyperdense artery sign on brain windows = thrombus; MCA most common (asymmetric)
  • Loss of gray-white matter distinction, loss of insular ribbon;
  • Parenchymal hypodensity = edema/cell necrosis
  • Gyral swelling = 12-24hrs
  • Hemorrhagic transformation = 24-48hrs
  • if negative, get MRI
MRI
  • Perfusion defect = ADC dark, DWI bright
  • Edema = T1 low, T2 high
  • if MRI negative and still strong clinical suspicion, do MRA or CTA neck/head

Stroke Timing

Time CT MRI
Minutes no change absent flow void, arterial enhancement, DWI high
2-6 hrs hyperdense artery sign, insular ribbon sign brain swelling (T1), subtle T2 high
6-12 hrs sulcal effacement, decreased attenuation T2 high
12-24 hrs decreased attenuation T1 low
3-7 d max swelling
3-21 d gyral enhancement
30-90 d encephalomalacia, loss of enhancement

Which vessel territory?

Causes of acute stroke by age group
Pediatrics
  • CHD
  • Blood dyscrasias
  • meningitis
  • arterial dissection
  • trauma
  • extracorporeal membrane oxygenation (ECMO)
  • venous thrombosis
Young Adult
  • Cardiac emboli
  • ASD
  • drug abuse
  • arterial dissection
  • coagulopathy
  • venous thrombosis
Elderly
  • ASD
  • cardiac emboli
  • coagulopathy
  • amyloid
  • vasculitis
  • venous thrombosis

Written by lmwong

April 12, 2008 at 3:12 pm

Posted in ct, mri, neuro, stroke

C-Spine CT Dictation

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Indication: Neck injury.

Technique: Multiple contiguous 3 mm axial images were obtained from the skull base through the thoracic inlet without intravenous contrast. Reformats in the coronal and sagittal planes were also obtained.

Comparison: [x]

Findings: No prevertebral soft tissue swelling is seen. The cervical alignment is maintained without spondylolisthesis. No acute fracture is identified. The vertebral body and disk space heights are preserved. The odontoid process is intact.

Impression: [x]

Written by lmwong

April 9, 2008 at 11:01 am

Posted in ct, neck, neuro, sample dictation

Petrous Temporal Bone CT Dictation

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Indication: [x]

Technique: A CT of the petrous temporal bone was obtained utilizing multiple contiguous 1 mm axial and coronal images without the use of intravenous contrast. Sagittal and coronal reformats were also obtained.

Comparison: [x]

Findings: The external auditory canals, tympanic membranes, and osseous labyrinths are normal bilaterally. There is no evidence of erosion of the ossicles, scutum, or tegmen tympani. The mastoid air cells are well-pneumatized and well aerated. No suspicious osseous lesion or fracture is identified.

Impression: Normal petrous temporal bone CT.

Written by lmwong

April 9, 2008 at 11:00 am

Neck Soft Tissue CT Dictation

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Indication: [x]

Technique: Contiguous 3mm axial images were obtained from the skull base to the thoracic inlet following the administration of intravenous contrast.

Comparison: [x]

Findings: The nasopharynx, oropharynx and hypopharynx are normal. No cervical mass or collection is seen. No aerodigestive tract mass is identified. The parotid, submandibular and thyroid glands are normal. No lymphadenopathy is identified. The osseous structures are intact.

Impression: Normal neck CT.

Written by lmwong

April 9, 2008 at 11:00 am

Posted in ct, neck, neuro, sample dictation

Facial CT Dictation

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Indication: Facial injury.

Technique: A facial CT was performed utilizing contiguous 3 mm axial images with reformats in the coronal and sagittal planes. No intravenous contrast was administered.

Comparison: [x]

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 facial CT.

Written by lmwong

April 9, 2008 at 10:59 am

Head CT Dictation

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Indication: [x]

Technique: Multiple contiguous 5 mm axial images were obtained from the skull base to the vertex without the use of intravenous contrast.

Comparison: [x]

Findings: The ventricles and sulci are within normal limits. No intracranial hemorrhage or extra-axial fluid collection is identified. There is no evidence of acute territorial infarct, focal mass lesion or midline shift. The osseous structures are intact. The paranasal sinuses are well-aerated.

Impression: Normal head CT.

Written by lmwong

April 9, 2008 at 10:58 am

Posted in ct, head, neuro, sample dictation

CT-guided abscess drainage Dictation

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History: [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.

Written by lmwong

April 7, 2008 at 9:02 pm

CT Guided Lung Biopsy Dictation

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Indication: [x]:

Procedure: Informed consent was obtained. The patient was placed in a [supine/prone] position. A [x] lobe lesion was localized under CT guidance. The patient was prepped and draped in the usual sterile fashion. The needle was inserted under CT guidance. One pass was made. The patient tolerated the procedure well. The specimen was given to cytology for evaluation. Post procedure there is no evidence for significant pneumothorax. The patient was sent to recovery room for observation.

Dr. [x] was present throughout the entire procedure.

Impression: Successful fine needle aspiration of [x].

Written by lmwong

April 7, 2008 at 4:35 am

Chest CT Dictation

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Indication: [x]

Technique: A chest CT was performed utilizing contiguous axial images from the thoracic inlet to the level of the adrenal glands [with/without] the use of intravenous contrast.

Comparison: [x]

Findings: No thoracic lymphadenopathy is present. No pleural or pericardial effusion is seen. The heart is normal in size.

The lungs are clear. The trachea and central airways are patent.

Impression: Normal chest CT.

Written by lmwong

April 7, 2008 at 4:34 am

Posted in chest, ct, sample dictation

Chest CT for PE Dictation

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Indication: [x]

Technique: A CT of the chest, pelvis and lower extremities was performed following the administration of intravenous contrast as per routine pulmonary embolus protocol.

Comparison: [x]

Findings: No evidence of a pulmonary embolus or deep venous thrombosis is seen.
No thoracic lymphadenopathy is identified. No pleural or pericardial effusion is identified. The heart is normal in size.

The trachea and central airways appear patent. The lungs are clear.

Impression: No evidence of central pulmonary embolus or deep venous thrombosis.

Written by lmwong

April 7, 2008 at 4:34 am

Abdomen & Pelvis CT for Renal Stones Dictation

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Indication: [x]
Technique: A CT of the abdomen and pelvis was performed utilizing contiguous axial images without the use of oral or intravenous contrast.
Comparison: [x]
Findings: [x]
Evaluation of the solid and hollow viscera is limited secondary to lack of intravenous and oral contrast. The liver, gallbladder, common bile duct, spleen, pancreas and adrenal glands are unremarkable. No hydroureteronephrosis or perinephric stranding is visualized. No radiopaque renal, ureteral or urinary bladder calculi are visualized. The bowel is unremarkable. No abdominal or pelvic lymphadenopathy or ascites is identified.
The urinary bladder and [uterus/prostate] are unremarkable. [No adnexal masses are seen.]
Impression: [x]

Written by lmwong

April 7, 2008 at 3:51 am

Routine Abdomen & Pelvis CT Dictation

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Indication: [x]
Technique: A CT of the abdomen and pelvis was performed utilizing contiguous axial images following the administration of oral and intravenous contrast.
Comparison: [x]
Findings: [x]
The liver is normal in size without focal hepatic lesions. No intrahepatic ductal dilatation is seen. The hepatic and portal veins are patent. The gallbladder, common bile duct, spleen, pancreas, kidneys and adrenal glands are unremarkable. The bowel is unremarkable. No abdominal or pelvic ascites or lymphadenopathy is identified. The urinary bladder and [uterus/prostate] are unremarkable. [No adnexal masses are seen.]
Impression: [x]

Written by lmwong

April 7, 2008 at 3:47 am