CT CHEST
PAYABLE
NONPAYABLE
Tumors: malignant neoplasm (lung,
respiratory system), neoplasm (breast),
lymphoma; Diagnoses: emphysema, lung
disease, Findings: pleural effusion,
enlarged lymph nodes; Symptoms:
respiratory abnormality, shortness of
breath, hemoptysis, chest pain
(unspecified), tightness in chest; Signs:
swelling/mass/lump of chest; abnormal
findings (lung field); Injury (trauma): chest
injury, trunk injury
Chronic airway obstruction,
abnormal weight loss,
abdominal pain
(unspecified).
Templates
Generic
Symptom
checklist (with
tables): chest pain,
cough, dyspnea
Disease template:
pulmonary
embolism
Checklist Template
X
X
X
X
X
X
X
X
X
X
X
X
X
Disease Macros
Template ordered finding list
Chest pain
Cough
Dyspnea
Hemoptysis
Finding List
Indication
Disease List
Disease macro:
pulmonary nodule
Pulmonary embolism
Pulmonary embolism
Follow up:
1. Need to query McKesson about whether “cough” is payable.
2. Need to query McKesson about whether “dyspnea” may be used instead of “shortness of
breath.”
3. Use entire template, rather than a macro, when dictating pulmonary embolism cases.
File name: “CT chest with contrast”
CONTRAST ENHANCED CHEST CT
INDICATION:
[+Payable: Tumors: malignant neoplasm (lung, respiratory system), neoplasm (breast),
lymphoma; Diagnoses: emphysema, lung disease, Findings: pleural effusion, enlarged lymph
nodes; Symptoms: respiratory abnormality, shortness of breath, hemoptysis, chest pain
(unspecified), tightness in chest; Signs: swelling/mass/lump of chest; abnormal findings (lung
field); Injury (trauma): chest injury, trunk injury.+]
[+Nonpayable: chronic airway obstruction, abnormal weight loss, abdominal pain
(unspecified).+]
COMPARISON STUDIES: []
TECHNICAL INFORMATION: Volumetric data in an axial plane from above the thoracic inlet
to below the diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL.
[+Optional as indicated: "Images were reviewed at a separate workstation, and axial and oblique
coronal MIP images were obtained and saved to PACS."+]
INTERPRETATION:
Pulmonary structures:
Lungs: []
Tracheobronchial tree: []
Pleura and pleural space: []
Cardiovascular structures:
Heart: []
Thoracic aorta and branches: []
Pulmonary arteries: []
Other structures:
Mediastinal and hilar lymph nodes: []
Musculoskeletal structures: []
Visualized neck: []
Visualized abdomen and esophagus: []
IMPRESSION:
[]
Dictated at []
ALTERNATIVE FOR CHEST CT
File name: “CT chest with contrast”
CONTRAST ENHANCED CHEST CT
INDICATION:
[+Payable: Tumors: malignant neoplasm (lung, respiratory system), neoplasm (breast),
lymphoma; Diagnoses: emphysema, lung disease, Findings: pleural effusion, enlarged lymph
nodes; Symptoms: respiratory abnormality, shortness of breath, hemoptysis, chest pain
(unspecified), tightness in chest; Signs: swelling/mass/lump of chest; abnormal findings (lung
field); Injury (trauma): chest injury, trunk injury.+]
[+Nonpayable: chronic airway obstruction, abnormal weight loss, abdominal pain
(unspecified).+]
COMPARISON STUDIES: []
TECHNICAL INFORMATION: Volumetric data in an axial plane from above the thoracic inlet
to below the diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL.
[+Optional as indicated: "Images were reviewed at a separate workstation, and axial and oblique
coronal MIP images were obtained and saved to PACS."+]
INTERPRETATION:
Visualized neck: []
Musculoskeletal structures: []
Tracheobronchial tree: []
Lungs: []
Pleura and pleural space: []
Heart: []
Thoracic aorta and branches: []
Pulmonary arteries: []
Mediastinal and hilar lymph nodes: []
Visualized abdomen and esophagus: []
IMPRESSION:
[]
Dictated at []
File name: “CT chest without contrast”
UNENHANCED CHEST CT
INDICATION:
[+Payable: Tumors: malignant neoplasm (lung, respiratory system), neoplasm (breast),
lymphoma; Diagnoses: emphysema, lung disease, Findings: pleural effusion, enlarged lymph
nodes; Symptoms: respiratory abnormality, shortness of breath, hemoptysis, chest pain
(unspecified), tightness in chest; Signs: swelling/mass/lump of chest; abnormal findings (lung
field); Injury (trauma): chest injury, trunk injury.+]
[+Nonpayable: chronic airway obstruction, abnormal weight loss, abdominal pain
(unspecified).+]
COMPARISON STUDIES: []
TECHNICAL INFORMATION: Volumetric data in an axial plane from above the thoracic inlet
to below the diaphragm was obtained without oral or intravenous contrast material.
INTERPRETATION:
Pulmonary structures:
Lungs: []
Tracheobronchial tree: []
Pleura and pleural space: []
Cardiovascular structures:
Heart: []
Thoracic aorta and branches: []
Pulmonary arteries: []
Other structures:
Mediastinal and hilar lymph nodes: []
Musculoskeletal structures: []
Visualized neck: []
Visualized abdomen and esophagus: []
IMPRESSION:
[]
Dictated at []
Cause
CHEST PAIN
Clinical Features
Imaging Findings
Pulmonary Diseases
Pneumothorax or
pneumomediastinum
Pneumonia –
community
acquired, aspiration,
pneumocystis, and
tuberculosis
Lung cancer –
primary
Lung cancer –
metastatic
Mesothelioma
Asthma
All, including community acquired
pneumonia (CAP): Fever (may be
absent in elderly), SOB, crackles or
dullness, productive cough, chills,
HA, elevated WBC count
(>10,400).
Aspiration pneumonia:
Obtundation from dementia, stroke,
drugs, or alcohol.
Pneumocystis: known HIV/AIDS
or risk factors for HIV/AIDS.
Pneumonia from tuberculosis: As
pneumonia with night sweats and
involuntary weight loss.
Smoking; involuntary weight loss;
hemoptysis; shortness of breath
(from associated
COPD/Emphysema).
XR, CT: consolidation and/or pleural
effusion (a normal XR does not rule out
pneumonia if the pre-test probability is
high); unilateral relatively dense lobar
consolidation is more likely CAP; bilateral
less dense consolidation is typical of
pneumocystis; apical consolidation is more
typical of pneumonia from tuberculosis.
Abnormal breath sounds
(especially wheezing) activated by
recognizable trigger (e.g. exercise,
cold, animal dander); shortness of
breath
XR, CT: Usually normal; hyperinflation.
XR, CT: lung mass with possible
“upstream” pneumonia with consolidation;
additional pulmonary nodules/masses,
lymphadenopathy, or bone lesions from
metastatic deposit.
Pleuritis
Cardiovascular Diseases
Myocardial
ischemia/infarction
Pulmonary
embolism
Thoracic aortic
aneurysm
Pericarditis
Aortic stenosis
Prolapsed mitral
Chest pain and dyspnea; history of
lower deep venous thrombosis
(usually lower extremity);
hypercoagulable states.
Chest pain (with ulceration or
dissection)
XR, CT: peripheral wedge-shaped lung
opacity (“Hampton’s hump”) with
infarction; pleural effusion; CT: filling
defects in the arterial tree; VQ scan:
ventilation perfusion mismatches.
XR, CT: dilated, tortuous aorta distorting
the trachea.
valve
Gastrointestinal Diseases
Gastroesophageal
reflux disease
Esophageal rupture
Heartburn; known hiatal hernia
No direct findings; XR, CT may show a
hiatal hernia.
Pancreatitis
Musculoskeletal Diseases
Rib fracture
Disc disease
Bone metastatic
deposit
COUGH WITH NO IMAGING FINDINGS
ON CHEST IMAGING STUDIES
Anxiety, costochondritis (Tietze’s syndrome), cholecystitis, esophageal spasm, herpes zoster, muscle
spasm, peptic ulcer disease,
ABBREVIATIONS
CT = computed tomography; MR = magnetic resonance imaging; US = ultrasound; VQ = (nuclear
medicine) ventilation/perfusion lung scan; WBC = white blood cell count; XR = x-ray radiography.
File name: “CT chest done for pain”
CONTRAST ENHANCED CHEST CT
INDICATION: [+Chest pain.+]
COMPARISON: []
TECHNIQUE: Volumetric data in an axial plane from above the thoracic inlet to below the
diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL. [+Optional as
indicated: "Images were reviewed at a separate workstation, and axial and oblique coronal MIP
images were obtained and saved to PACS."+]
Pulmonary structures:
Lungs: [+Pneumothorax, nodule/mass, GGO/consolidation, atelectasis,
hyperinflation/bullae.+]
Tracheobronchial tree: [+Foreign body, bronchiectasis, peribronchial thickenning.+]
Pleura and pleural space: [+No pleural effusion or mass identified (pneumonia, cancer,
pulmonary edema, pulmonary embolism).+]
Cardiovascular structures:
Heart: [+Cardiomegaly, pericardial effusion.+]
Thoracic aorta and branches: [+Aneurysm, dissection.+]
Pulmonary arteries: [+Filling defects, pruning.+]
Other structures:
Mediastinal and hilar lymph nodes: [+Lymphadenopathy.+]
Musculoskeletal structures: [+Bone tumor or fracture.+]
Visualized neck: []
Visualized abdomen and esophagus: [+Esophageal mass or dissection; subdiaphragmatic
abscess; hepatosplenomegaly; pancreatitis; cholelithiasis.+]
IMPRESSION:
[]
Dictated at []
File name: “CT chest showing pulmonary embolism”
CONTRAST ENHANCED CHEST CT
INDICATION: [+Chest pain or dyspnea.+]
COMPARISON: []
TECHNIQUE: Volumetric data in an axial plane from above the thoracic inlet to below the
diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL. [+Optional as
indicated: "Images were reviewed at a separate workstation, and axial and oblique coronal MIP
images were obtained and saved to PACS."+]
Pulmonary structures:
Lungs: [+Describe any Hampton’s hump, ground glass opacity, or consolidation to
suggest acute infarct. Describe any mosaic attenuation to suggest chronic emboli.+]
Tracheobronchial tree: []
Pleura and pleural space: [+Describe any effusion accompanying infarction.+]
Cardiovascular structures:
Heart: [+Describe right heart size and interventricular septum configuration.+]
Thoracic aorta and branches: []
Pulmonary arteries: Filling defects are seen in [+describe size, location, and extend of
pulmonary emboli+]. The main pulmonary artery is [+normal in size; distended and measures xx
mm compared to the aorta which measures xx mm+]. [+Describe any webs or irregularity of
pulmonary arteries which may indicate chronic emboli.+]
Other structures:
Mediastinal and hilar lymph nodes: []
Musculoskeletal structures: []
Visualized neck: []
Visualized abdomen and esophagus: []
IMPRESSION:
1. Pulmonary embolism. There are [+minimal/moderate/extensive+] emboli in the [+location+].
2. There [+is/is not+] evidence of associated right heart failure, with [+normal sized right
ventricle, normal position of interventricular septum, and normal sized pulmonary artery.
3. There [+is/is not+] an associated pulmonary infarction. [+Describe.+]
Dictated at []
Cause
COUGH
Clinical Features
Imaging Findings
Pulmonary Diseases
Pneumonia –
community acquired,
aspiration,
pneumocystis, and
tuberculosis
Emphysema/COPD
Asthma
Lung Cancer
All, including community
acquired pneumonia (CAP):
Fever (may be absent in elderly),
SOB, crackles or dullness,
productive cough, chills, HA,
elevated WBC count (>10,400).
Aspiration pneumonia:
Obtundation from dementia,
stroke, drugs, or alcohol.
Pneumocystis: known HIV/AIDS
or risk factors for HIV/AIDS.
Pneumonia from tuberculosis: As
pneumonia with night sweats and
involuntary weight loss.
Smoking; shortness of breath;
distant breath sounds; chronic
bronchitis with persistent
productive cough.
Abnormal breath sounds
(especially wheezing) activated
by recognizable trigger (e.g.
exercise, cold, animal dander);
shortness of breath
Smoking; involuntary weight
loss; hemoptysis; shortness of
breath (from associated
COPD/Emphysema).
Foreign body
History of obtundation or known
aspiration or swallowing
difficulty or choking episode.
Bronchiectasis
Copious sputum production;
repeated prior bouts of
pneumonia.
Pneumoconiosis and
other interstitial lung
disease
Shortness of breath; exposure to
inciting agent of organic or
mineral substance; accompanying
connective tissue disease (e.g.
scleroderma or systemic lupus
erythematosis).
XR, CT: consolidation and/or pleural
effusion (a normal XR does not rule out
pneumonia if the pre-test probability is
high); unilateral relatively dense lobar
consolidation is more likely CAP; bilateral
less dense consolidation is typical of
pneumocystis; apical consolidation is
more typical of pneumonia from
tuberculosis.
XR, CT: Hyperinflation and bullae.
XR, CT: Usually normal; hyperinflation.
XR, CT: lung mass with possible
“upstream” pneumonia with consolidation;
additional pulmonary nodules/masses,
lymphadenopathy, or bone lesions from
metastatic deposit.
XR, CT: visualization of a radiodense
foreign body; CT: visualization of an
isodense or radiolucent foreign body in the
trachobronchial tree.
XR, CT: dilated bronchi with tubular
nontapering bronchi seen in profile and
“signet ring” sign (bronchi larger than
associated bronchial artery) in cross
section; bronchi extending to within 3 cm
of the pleural surface.
XR, CT: ground glass lung opacity;
honeycombing; small nodules; air
trapping.
Cardiovascular Diseases
Congestive heart failure
Thoracic aortic
aneurysm
Pulmonary embolism
Mitral valve stenosis
Shortness of breath with
pulmonary edema; chest pain
with myocardial ischemia;
dependent edema.
Chest pain (with ulceration or
dissection)
Chest pain and dyspnea; history
of lower deep venous thrombosis
(usually lower extremity);
hypercoagulable states.
Shortness of breath; fatigue;
dependent edema; heart
palpitations.
XR, CT: increased lung opacity in either a
ground glass or consolidation pattern;
septal lines; pleural effusions;
accompanying cardiomegaly.
XR, CT: dilated, tortuous aorta distorting
the trachea.
XR, CT: peripheral wedge-shaped lung
opacity (“Hampton’s hump”) with
infarction; pleural effusion; CT: filling
defects in the arterial tree; VQ scan:
ventilation perfusion mismatches.
XR, CT: cardiomegaly with left atrial
enlargement; increased lung opacity in
either a ground glass or consolidation
pattern; septal lines; pleural effusions.
Other Diseases
Gastroesophageal reflux
disease
Goiter with
compression of the
trachea
Lymphadenopathy with
compression of the
trachea
Heartburn; known hiatal hernia
With accompanying
hypothyroidism: fatique,
constipation, depression, cold
sensitivity, weight gain.
With malignant
lymphadenopathy, constitutional
symptoms such as fatigue and
weight loss.
No direct findings; XR, CT may show a
hiatal hernia.
XR, CT, US: enlarged thyroid with
extrinsic compression of the trachea.
XR, CT: enlarged lymph nodes.
COUGH WITH NO IMAGING FINDINGS
ON CHEST IMAGING STUDIES
ACE inhibitors; cigarette smoke; dry, cold, or hot air; sinusitis; rhinitis; dust; pollution; vocal cord
polyps; external auditory canal disease (impacted foreign bodies or cerumen); bronchitis including
nonasthmatic eosinophilic bronchitis; premature ventricular contractions (PVCs); influenza (unless there
is also pneumonia)
ABBREVIATIONS
CT = computed tomography; MR = magnetic resonance imaging; US = ultrasound; VQ = (nuclear
medicine) ventilation/perfusion lung scan; WBC = white blood cell count; XR = x-ray radiography.
File name: “CT chest done for cough”
CONTRAST ENHANCED CHEST CT
INDICATION: [+Chest pain.+]
COMPARISON: []
TECHNIQUE: Volumetric data in an axial plane from above the thoracic inlet to below the
diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL. [+Optional as
indicated: "Images were reviewed at a separate workstation, and axial and oblique coronal MIP
images were obtained and saved to PACS."+]
Pulmonary structures:
Lungs: [+Pneumothorax, nodule/mass, GGO/consolidation, atelectasis,
hyperinflation/bullae.+]
Tracheobronchial tree: [+Foreign body, bronchiectasis, peribronchial thickenning.+]
Pleura and pleural space: [+No pleural effusion or mass identified (pneumonia, cancer,
pulmonary edema, pulmonary embolism).+]
Cardiovascular structures:
Heart: [+Cardiomegaly, pericardial effusion.+]
Thoracic aorta and branches: [+Aneurysm, dissection.+]
Pulmonary arteries: [+Filling defects, pruning.+]
Other structures:
Mediastinal and hilar lymph nodes: [+Lymphadenopathy.+]
Musculoskeletal structures: [+Bone tumor or fracture.+]
Visualized neck: []
Visualized abdomen and esophagus: [+Esophageal mass or dissection; subdiaphragmatic
abscess; hepatosplenomegaly; pancreatitis; cholelithiasis.+]
IMPRESSION:
[]
Dictated at []
DYSPNEA
Clinical Features
Cause
Imaging Findings
Pulmonary and Airway Abnormalities
Asthma
Cough, dyspnea, abnormal
(reversible) PFTs, response to
challenge test
COPD/Emphysema
Smoking, cough, dyspnea, abnormal
(fixed) PFTs
Pulmonary edema
History of CHF; fatigue; peripheral
edema
Dyspnea
Fever (may be absent in elderly),
SOB, crackles or dullness, productive
cough, chills, HA, elevated WBC
count (>10,400)
Obtundation from dementia, stroke,
drugs, or alcohol
Pulmonary embolism
Pneumonia – community
acquired
Pneumonia – aspiration
Pneumonia – pneumocystis
Pneumonia – tuberculosis
Pulmonary hypertension
Pneumothorax
Interstitial lung disease
As pneumonia with night sweats and
involuntary weight loss
Usually not done except for
excluding pneumonia,
pneumothorax, or pulmonary
collapse
XR, CT hyperinflation, bullae,
straightened pulmonary
vasculature; associated
pneumonia
XR, CT increased lung density,
septal lines, pleural effusion
CTA
XR, CT consolidation; a normal
XR does not rule out pneumonia
if the pre-test probability is high
XR, CT consolidation; a normal
XR does not rule out pneumonia
if the pre-test probability is high
XR, CT consolidation,
especially if apical
Organic: hay, cotton, grain; mineral:
asbestosis, silicosis, coal; idiopathic:
sarcoid, connective tissue disease,
Wegener’s granulomatosis
Cardiovascular Abnormalities
Myocardial diseases (CAD,
HTN, EtOH), diastolic failure
(HTN, AS, HTC)
Pericardial effusion
History of CHF; fatigue; peripheral
edema
Atrial fibrillation, arrhythmia
Palpidations, irregular heart rate;
abnormal EKG
EKG (may require Holter
monitor for intermittent
abnormality)
Rheumatic heart disease; murmur
Echocardiography
Conduction bradycardia
Valvular heart disease
Other Abnormalities
Pleural effusion (unrelated to
lung abnormalities listed
above)
DYSPNEA WITH NO IMAGING FINDINGS
ON CHEST IMAGING STUDIES
Anemia
ABBREVIATIONS
CT = computed tomography; MR = magnetic resonance imaging; US = ultrasound; WBC = white blood
cell count; XR = plain film radiography;
File name: “CT chest done for dyspnea”
CONTRAST ENHANCED CHEST CT
INDICATION: Dyspnea. []
COMPARISON: []
TECHNIQUE: Volumetric data in an axial plane from above the thoracic inlet to below the
diaphragm was obtained following IV injection of [] mL of Isovue 370 mg/mL. [+Optional as
indicated: "Images were reviewed at a separate workstation, and axial and oblique coronal MIP
images were obtained and saved to PACS."+]
Pulmonary structures:
Lungs: [+Pneumothorax, nodule/mass, consolidation/GGO, hyperinflation/bullae,
atelectasis.+]
Tracheobronchial tree: [+Foreign body, peribronchial cuffing, bronchiectasis.+]
Pleura and pleural space: [+Mass, effusion.+]
Cardiovascular structures:
Heart: [+Cardiomegaly, pericardial effusion).+]
Thoracic aorta and branches: []
Pulmonary arteries: [+Filling defects, pruning.+]
Other structures:
Mediastinal and hilar lymph nodes: []
Musculoskeletal structures: [+metastatic bone lesions+]
Visualized neck: []
Visualized abdomen and esophagus: [+hepatosplenomegaly+]
IMPRESSION:
[]
Dictated at []
File name: “CT pulmonary nodule”
[+For a discussion of current recommendations regarding follow-up of pulmonary nodules seen
on CT examination, see MacMahon H, Austin JHM, Gamsu G et al. Guidelines for management
of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society.
Radiology 2005;237:395-400.+]