margaret fahy
Guru
Hi,
Are any of you folk coding these? MR Lymphangiographies?
What do you think would be the proper code(s)?
Margie
Technique: True Fisp Static Axials, T2w 3d Space, Dynamic
Intranodal Time Resolved Contrast Enhanced 3d Mr Lymphangiography
(DCMRL) And Delayed 3d Ir Flash Sequences Were Performed.
Bi-Inguinal Intranodal Magnevist Was Given By Dr Followed By
Saline Flush. Post Processing Multiplanar Volume Rendered
Reconstructions Were Done.
Sedation: Images Were Obtained With GETA .
Comparison: No previous lymphatic MR studies.
Comments: In The Upper Abdomen, The Spleen Is on the left. The
Gastric Fundus is on the left and the Liver Is on the right.
T2 weighted lymphatic mapping demonstrated moderate pleural
effusion on the left and mild amount of pleural fluid on the
right. There is a small pericardial effusion. There is diffuse T2
enhancement in the lumbar regions all the way up to the
retroperitoneal space in the abdomen surrounding the aorta and
the IVC. There is also diffuse bilateral T2 enhancement in the
interstitial lung spaces as well as in the mediastinum and
bilateral supraclavicular and cervical regions. These findings
are suggestive of a diffuse lymphoproliferative disorder
consistent with lymphangiomatosis.
DCMRL with injection of contrast into bilateral inguinal lymph
nodes demonstrated dilated and proliferative lumbar lymphatics as
well as abdominal retroperitoneal lymphatics The thoracic duct is
dilated and intact measuring 4.5 mm at its maximal diameter with
brisk flow. At the mid thorax the thoracic duct bifurcates and
then reconstitutes to form a proper thoracic duct that empties
into the left innominate vein. In addition contrast is seen
spilling from the terminal thoracic duct through an additional
channel into the mediastinal and pleural spaces.
High resolution 3D IR FLASH sequence confirmed the DCMRL
findings.
Static true-FISP sequences were performed in the axial plane
using continuous slices to evaluate the heart and will be
reported elsewhere. This report is focused on the lymphatic
system imaging findings not related to the lymphatic system will
not be reported here.
1. Diffuse lymphoproliferative disorder consistent with
lymphangiomatosis.
2. Thoracic duct is dilated with brisk lymphatic flow.
3. Leak of lymphatic fluid from a duct exiting of the terminal
thoracic duct and supplying flow to the mediastinum and pleural
spaces.
Study Result
HISTORY: The patient is a 22 year old female who presents for
cardiac MR for MR lymphangiogram. This report will contain the
anatomic assessment based on the static axial 3-dimensional data
set. The lymphatics data will be interpreted by Dr. Dori in a
separate report.
TECHNIQUE: True FISP static axials, T2 dark blood, time resolved
and IR flash MR lymphangiography.
COMPARISON: No previous cardiac MR studies.
COMMENTS: True FISP and HASTE static axials demonstrate situs
solitus of the atria, ventricular D-loop, and solitus great
arteries. There are normal systemic and pulmonary venous
connections. The patient has a left aortic arch with a normal
branching pattern.
There is a small pericardial effusion. There is a small to
moderate right-sided pleural effusion. There is a moderate sized
left-sided pleural effusion.
Qualitatively, the right ventricle is neither significantly
dilated nor hypertrophied. The right ventricular outflow tract,
main pulmonary artery, and branch pulmonary arteries are
unobstructed.
Qualitatively, the left ventricle is neither significantly
dilated nor hypertrophied. The left ventricular outflow tract and
the entire aorta are unobstructed.
This was a cardiac MRI focusing on the cardiovascular system, the
trachea and their relationships to each other in the chest.
Pathology outside this organ system may not have been fully
evaluated and may not be delineated in this report. Therefore, if
pathology is suggested clinically, other testing should be
performed.
IMPRESSION
1. Normal segmental anatomy. No evidence of volume overload.
2. There is a small pericardial effusion. There is a small to
moderate right-sided pleural effusion. There is a moderate sized
left-sided pleural effusion.
Are any of you folk coding these? MR Lymphangiographies?
What do you think would be the proper code(s)?
Margie
Technique: True Fisp Static Axials, T2w 3d Space, Dynamic
Intranodal Time Resolved Contrast Enhanced 3d Mr Lymphangiography
(DCMRL) And Delayed 3d Ir Flash Sequences Were Performed.
Bi-Inguinal Intranodal Magnevist Was Given By Dr Followed By
Saline Flush. Post Processing Multiplanar Volume Rendered
Reconstructions Were Done.
Sedation: Images Were Obtained With GETA .
Comparison: No previous lymphatic MR studies.
Comments: In The Upper Abdomen, The Spleen Is on the left. The
Gastric Fundus is on the left and the Liver Is on the right.
T2 weighted lymphatic mapping demonstrated moderate pleural
effusion on the left and mild amount of pleural fluid on the
right. There is a small pericardial effusion. There is diffuse T2
enhancement in the lumbar regions all the way up to the
retroperitoneal space in the abdomen surrounding the aorta and
the IVC. There is also diffuse bilateral T2 enhancement in the
interstitial lung spaces as well as in the mediastinum and
bilateral supraclavicular and cervical regions. These findings
are suggestive of a diffuse lymphoproliferative disorder
consistent with lymphangiomatosis.
DCMRL with injection of contrast into bilateral inguinal lymph
nodes demonstrated dilated and proliferative lumbar lymphatics as
well as abdominal retroperitoneal lymphatics The thoracic duct is
dilated and intact measuring 4.5 mm at its maximal diameter with
brisk flow. At the mid thorax the thoracic duct bifurcates and
then reconstitutes to form a proper thoracic duct that empties
into the left innominate vein. In addition contrast is seen
spilling from the terminal thoracic duct through an additional
channel into the mediastinal and pleural spaces.
High resolution 3D IR FLASH sequence confirmed the DCMRL
findings.
Static true-FISP sequences were performed in the axial plane
using continuous slices to evaluate the heart and will be
reported elsewhere. This report is focused on the lymphatic
system imaging findings not related to the lymphatic system will
not be reported here.
1. Diffuse lymphoproliferative disorder consistent with
lymphangiomatosis.
2. Thoracic duct is dilated with brisk lymphatic flow.
3. Leak of lymphatic fluid from a duct exiting of the terminal
thoracic duct and supplying flow to the mediastinum and pleural
spaces.
Study Result
HISTORY: The patient is a 22 year old female who presents for
cardiac MR for MR lymphangiogram. This report will contain the
anatomic assessment based on the static axial 3-dimensional data
set. The lymphatics data will be interpreted by Dr. Dori in a
separate report.
TECHNIQUE: True FISP static axials, T2 dark blood, time resolved
and IR flash MR lymphangiography.
COMPARISON: No previous cardiac MR studies.
COMMENTS: True FISP and HASTE static axials demonstrate situs
solitus of the atria, ventricular D-loop, and solitus great
arteries. There are normal systemic and pulmonary venous
connections. The patient has a left aortic arch with a normal
branching pattern.
There is a small pericardial effusion. There is a small to
moderate right-sided pleural effusion. There is a moderate sized
left-sided pleural effusion.
Qualitatively, the right ventricle is neither significantly
dilated nor hypertrophied. The right ventricular outflow tract,
main pulmonary artery, and branch pulmonary arteries are
unobstructed.
Qualitatively, the left ventricle is neither significantly
dilated nor hypertrophied. The left ventricular outflow tract and
the entire aorta are unobstructed.
This was a cardiac MRI focusing on the cardiovascular system, the
trachea and their relationships to each other in the chest.
Pathology outside this organ system may not have been fully
evaluated and may not be delineated in this report. Therefore, if
pathology is suggested clinically, other testing should be
performed.
IMPRESSION
1. Normal segmental anatomy. No evidence of volume overload.
2. There is a small pericardial effusion. There is a small to
moderate right-sided pleural effusion. There is a moderate sized
left-sided pleural effusion.