Download Reporting Template General, TCH/Cassady

Reporting Template General, TCH/Cassady
Referring MD:
The ultrasound examination is performed to assess for fetal viability and lie prior to MRI
examination.
There is no prior examination available for comparison.
There is a single living intrauterine gestation in vertex/breech/transverse position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is fe/male.
The placenta is ventral/dorsal/fundal and away from the cervical os.
There is a normaldecreased/increased volume of amniotic fluid (AFI = ).
There is a two/three vessel cord.
The cervix is long and closed ( mm).
There is no periuterine abnormality identified.
Composite dating is concordant with the estimated delivery date assigned to the patient
by the patient's report:
LMP
GA
EDD
By today's ultrasound,
AUA
EDD(AUA)
The MR study was performed without sedation or contrast after informed consent was
obtained. Sequences after SSFP localizers consist primarily of T2-weighted single shot
imaging with additional SSFP images.
The ultrasound and MR findings together reveal
No other fetal abnormality is detected.
IMPRESSION:
Based on the findings described above, the patient may benefit from consultations with
pediatric surgery and neonatology.
Reporting Template CDH, TCH/Cassady
Referring MD:
The ultrasound examination is performed to assess for fetal viability and lie prior to MRI
examination.
There is no prior examination available for comparison.
There is a single living intrauterine gestation in vertex/breech/transverse position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is male/female.
The placenta is ventral/dorsal/fundal and away from the cervical os.
There is a normal/decreased/increased volume of amniotic fluid (AFI = ).
There is a two/three vessel cord.
The cervix is long and closed.
There is no periuterine abnormality identified.
Composite dating is concordant with the estimated delivery date assigned to the patient
by the patient's report:
LMP
GA
EDD
By today's ultrasound,
AUA
EDD (AUA)
The MR study was performed without sedation or contrast after informed consent was
obtained. Sequences after bFFE localizers consist primarily of T2-weighted single shot
imaging with additional SSFP images.
The ultrasound and MR findings together reveal a small/large right/left
intrapleural/mediastinal hernia with liver/bowel/stomach/spleen/kidney within the right/left
chest. There is consequent mass effect and mediastinal shift to the left/right. Except for
the position, the heart is unremarkable. There is no evidence of pericardial effusion, or
any other evidence of hydrops.
LHR:
O/E LHR:
MR right lung volume:
MR left lung volume:
TFLV:
O/E TFLV:
% liver up:
No other fetal abnormality is detected.
IMPRESSION:
There is a large left intrapleural hernia containing much of the left lobe of the liver, the
stomach, and other organs. The LHR is . The O/E TFLV is . The % of herniated liver is
. Based on the findings described above, the patient may benefit from consultations with
pediatric surgery and neonatology.