Text_summarization/task84_mimic_ct_head_and_neck_summarization.json

{
    "Contributors": "MIMIC",
    "Source": "MIMIC-IV",
    "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/",
    "Categories": [
        "Summarization"
    ],
    "Definition": [
        "Summarize the CT imaging diagnostics' detailed findings for the Head_and_neck into a concise conclusion."
    ],
    "Reasoning": [],
    "Input_language": [
        "English"
    ],
    "Output_language": [
        "English"
    ],
    "Instruction_language": [
        "English"
    ],
    "Domains": [
        "Medicine",
        "Clinical Reports",
        "CT",
        "Head_and_neck"
    ],
    "Positive Examples": [],
    "Negative Examples": [],
    "Instances": [
        {
            "input": "The patient is status post partial left temporoparietal craniotomy and partial\nleft temporal lobectomy.  There is moderate amount of fluid and air within the\nsurgical bed.  Large amount of pneumocephalus overlying the left frontal and\ntemporal lobe is similar to prior study.  There is 5 mm of rightward midline\nshift, unchanged.  There is unchanged effacement of the left sided sulci and\nleft lateral ventricle.  No definite evidence of intracranial hemorrhage.  No\nacute large territorial infarction.  Encephalomalacia in the left cerebral\nhemisphere and right cerebral peduncle is unchanged.\n\nA partially visualized right nasoenteric tube is noted.  There is atelectasis\nof the right maxillary sinus, which is likely secondary to chronic sinus\ndisease.  The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.  The visualized portion of the\norbits are normal.",
            "output": "1. Status post left temporoparietal craniotomy and partial left temporal\nlobectomy with expected postsurgical changes.  No evidence of intracranial\nhemorrhage.\n2. Stable mass effect with approximately 5 mm of rightward midline shift."
        },
        {
            "input": "The patient is status post left-sided craniotomy and partial left temporal\nlobectomy and hippocampectomy.  There is expected evolving postsurgical\nchange, with a small amount of residual hyperdense material near the surgical\nbed, and improving pneumocephalus.  Left convexity subdural fluid measures up\nto 6 mm, not substantially changed.  Mostly low attenuating\nextracranial/subgaleal collection measures up to 8 mm.  Minimal 3 mm rightward\nmidline shift is improved from ___.  There is stable to slightly\nimproved effacement of the left-sided sulci and left lateral ventricle.  No\nnew or expanding intracranial hemorrhage.  Left cerebral encephalomalacia is\nunchanged.\n\nAgain noted is atelectasis of the right maxillary sinus, likely secondary to\nchronic sinus disease.  Partial opacification of the mastoid air cells is\nunchanged.  The middle ear cavities are clear.  The visualized portion of the\norbits are unremarkable.",
            "output": "1. Status post left-sided craniotomy and partial left temporal lobectomy with\nexpected evolution of postsurgical change, as above.\n2. Slightly improved mass effect from ___ with 3 mm rightward midline\nshift.\n3. No evidence of an acute intracranial complication."
        },
        {
            "input": "There is 1.6 cm x 1.4 cm acute parenchymal hematoma centered on the upper left\nthalamus and caudate body, extending into adjacent corona radiata, internal\ncapsule and posterior left putamen, mild surrounding edema.  Compared with\nhead CT ___ at 00:42 parenchyma hematoma is stable surrounding\nmild edema slightly more prominent.  Mild volume intraventricular extension of\nhemorrhage, more prominent, with blood in the left greater than right lateral\nventricles, including left temporal horn.  No hydrocephalus.  In ___, there\nacute was hemorrhage centered in the left thalamus.\n\nModerate sized chronic infarct right parietal lobe, stable.  Probably moderate\nchronic small vessel ischemic changes, similar to prior.  Mild generalized\nbrain parenchymal atrophy. No evidence of midline shift or on uncus\nherniation.  Patent foramina magnum, suprasellar and prepontine cisterns.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.",
            "output": "Stable parenchymal hemorrhage centered on left thalamus.  Mild\nintraventricular extension of hemorrhage, mildly worsened since prior.  No\nhydrocephalus.\n\nChronic moderate size right parietal lobe infarct.  Moderate chronic small\nvessel ischemic changes.  Mild brain parenchymal atrophy.\n\nRECOMMENDATION(S):  Follow-up to resolution."
        },
        {
            "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct.  Prominence of the\nventricles and sulci is consistent with involutional changes.  Punctate\nthalamic lacunar infarcts are again seen.  Previously seen right pons lacunar\ninfarct is subtly seen, better seen on the prior study.  Old left occipital\ninfarct is also again demonstrated..  The visualized paranasal sinuses\ndemonstrate opacification of a right sided ethmoid air cell.  Otherwise, the\npartially imaged paranasal sinuses are grossly clear.  The mastoid air cells\nare clear.  No acute fracture is seen.",
            "output": "No acute intracranial process."
        },
        {
            "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nLeft occipital encephalomalacia and lacunar right thalamic infarct are again\nnoted, also seen on prior.  Periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy  There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.",
            "output": "No acute intracranial process."
        },
        {
            "input": "Hyperdense sulci involving the right frontal, as well as bilateral temporal\nand parietallobes is consistent with subarachnoid hemorrhage.  There is a\nsmall subdural hematoma layering along the right frontal convexity (series 2,\nimage 18).  Hemorrhage all seen layering within the interpeduncular cistern. \nThickening of the bilateral leaflets of the tentorium also suggestive of small\nsubdural hematomas.    There are small bilateral temporal lobe contusions with\nsurrounding vasogenic edema (series 2, image 15).  There is no significant\nshift of midline structures.  The basilar cisterns are patent.  The ventricles\nand sulci normal in size and configuration.  Small calcific extra-axial\ndensity overlying the left parietal lobe may represent calcifications of the\nfalx or potentially calcified meningioma.\n\nThere is an acute fracture in the left temporal bone extending into the left\nexternal auditory canal and also likely into the left middle ear (series 3,\nimage 25).  There is a possible associated extra-axial hematoma which in the\nsetting of the left temporal bone fracture is concerning for an epidural\nhematoma.  Nondisplaced fracture seen extending superiorly to involve the\nparietal bone as well.\n\nIncreased density material in the sphenoid and ethmoidal air cells is\nconsistent with hemorrhage.  No other fracture identified.  There is mild\nmucosal thickening of the bilateral maxillary sinuses.  There is a small\nsubgaleal hematoma overlying the left parietal bone.",
            "output": "1.  Left temporal bone fracture extending into the left external auditory\ncanal and likely the middle ear.  Possible associated small extra-axial\nhematoma, possibly an epidural hematoma, is noted just adjacent to the left\ntemporal bone fracture.\n2. Subarachnoid hemorrhage involving the right frontal as well as bilateral\ntemporal and parietal sulci.\n3.  Small subdural hematoma extending into the right frontal convexity\n4. Probable extension of the subdural hematomas along the tentorium.\n5.  Small bitemporal cerebral contusions.\n\nRECOMMENDATION(S):  Findings 1 through 3 discussed in person with the surgical\nteam on ___ at 21:40, 5 minutes after discovery.  Final impression\ndiscussed with Dr. ___ by NSR via telephone on ___ at 23:15."
        },
        {
            "input": "Evolving left temporoparietal scalp soft tissue swelling and subgaleal\nhematoma are again seen.\n\nAgain seen is diffuse subarachnoid hemorrhage, not significantly changed from\nthe prior study.  The right frontal subdural hematoma is also unchanged, now\nmeasuring 4 mm in maximal diameter (see 02:16).  Bitemporal hemorrhagic\ncontusions are again seen.  There is unchanged sizing configuration of the\nventricles and sulci.  There is no shift of normally midline structures and\nthe basal cisterns appear patent.\n\nThe left temporal bone fracture is again visualized extending into the left\nexternal auditory canal and the left middle ear with complete opacification of\nthe left middle ear.  Nasogastric and endotracheal tubes are partially\nvisualized.  Nonspecific opacification of the paranasal sinuses and\nnasopharynx are again seen, which may be related to intubation status.",
            "output": "1. Evolving left temporoparietal scalp soft tissue swelling and subgaleal\nhematoma.\n2. Stable diffuse subarachnoid hemorrhage, right subdural hematoma, measuring\nup to 4 mm in maximum diameter and bike temporal parenchymal hemorrhagic\ncontusions.\n3. Stable nondisplaced left temporal bone fracture."
        },
        {
            "input": "There is stable to minimal decrease of diffuse subarachnoid hemorrhage.  The\nright frontal subdural hematoma is also unchanged from prior measuring 4 mm in\nthe inner table.  Hemorrhagic contusion in the right temporal lobe appears\nstable.  There is no evidence of acute hemorrhage.  The ventricles and sulci\nare unchanged in size and configuration.   No evidence of midline shift.  The\nbasal cisterns appear patent.\n\nThe left temporal bone fracture is is better visualized on prior examination\n(see 4:9 on current study and 03:17 on ___ prior exam).\n\nSoft tissue swelling overlying the left parietal bone is unchanged.  Mild\nmucosal thickening of bilateral maxillary sinuses noted.  Near complete\nopacification of the ethmoid air cells and near complete opacification of the\nright sphenoid sinus likely secondary to endotracheal intubation.  The\nvisualized portion of the orbits are unremarkable.",
            "output": "1. Stable to minimal decrease in diffuse subarachnoid hemorrhage.\n2. Stable subdural hematoma and bilateral temporal lobe hemorrhagic\ncontusions.\n3. Stable appearance of the ventricles and sulci without evidence of midline\nshift.\n4. Stable nondisplaced left temporal bone fracture."
        },
        {
            "input": "CT head:  There is hyperdense subarachnoid hemorrhage at the at the bilateral\ntemporal lobe sulci, bilateral sylvian fissures, and bilateral cerebral\nconvexities, right greater than left, which has decreased in comparison to\nprior study.  There are evolving hypodense cortical contusions involving the\nbilateral anterior temporal lobes, right greater than left, with mild amount\nof parenchymal hemorrhage.  There is a small amount of hyperdense blood\nlayering within the bilateral occipital horn lateral ventricles and within the\ninterpeduncular cistern.  There is mild prominence of the ventricles and\ncortical sulci consistent with volume loss.  There is no midline shift or\ndownward herniation.  There is a 2 mm left parietal convexity dural\ncalcification versus calcified meningioma (5:294).\n\nThe orbits are unremarkable.  There is a small subgaleal hematoma.  There is a\nminimally displaced fracture of the left parietal and squamous temporal\ncalvarium.  There is a nondisplaced longitudinal fracture of the left mastoid\ntemporal bone extending into the middle ear with associated hemotympanum. \nThere is opacification of the right middle ear.  There is mild mucosal\nthickening within the bilateral maxillary sinuses.  There is near complete\nopacification of the bilateral ethmoid sinuses and partial opacification of\nthe frontal sinuses, left greater than right.  There is complete opacification\nof sphenoid sinus with central hyperdensity.\n\nCTA head:  There is motion artifact at the skullbase which limits spatial\nresolution.  There is calcification of the bilateral intracranial internal\ncarotid arteries, which are patent.  The bilateral posterior communicating\narteries are visualized.  The anterior communicating artery is not\ndefinitively seen.  There is a left fetal origin posterior cerebral artery. \nThere are codominant vertebral arteries.  The anterior and posterior arterial\ncirculations are patent without occlusion, dissection, significant stenosis,\nor aneurysm.  There is normal dural venous sinus enhancement.  There is no\nevidence of vascular malformation.\n\nCTA neck:  There is a 3 vessel aortic arch.  No the carotid arteries are\npatent without significant stenosis by NASCET criteria.  There is motion\nartifact at the thoracic inlet which limits spatial resolution.  The vertebral\narteries are patent and demonstrate codominance.\n\nThere is a nasoenteric and endotracheal catheters in place with fluid layering\nwithin the nasopharynx.  The thyroid and salivary glands are unremarkable. \nThe masticator and parapharyngeal spaces are unremarkable.  There are no\nsuspicious lymph nodes by size or morphology.  There are multilevel\ndegenerative changes of the cervical spine.  There is a comminuted fracture of\nthe distal right clavicle with inferiorly displaced fracture fragment measured\n1.8 cm with adjacent hematoma (5:99).  There is multifocal airspace disease\nwithin the lung apices.  There are small bilateral pleural effusions, right\ngreater than left.",
            "output": "1. Patent intracranial and neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm.\n2. Hyperdense subarachnoid hemorrhage at the bilateral temporal lobe sulci and\ncerebral convexities, right greater than left, which have decreased in\ncomparison to prior study.  Small amount of subarachnoid blood layering within\nthe bilateral occipital horn lateral ventricles and interpeduncular cistern.\n3. Evolving bilateral anterior temporal lobe hemorrhagic contusions, right\ngreater than left.\n4. Re- demonstration of a left parietal temporal calvarial fracture and\nlongitudinal mastoid temporal fracture extending into the middle ear with\nassociated hemotympanum.  These are better characterized on dedicated temporal\nbone CT from ___ and head CT from ___.\n5. Significant paranasal sinus disease with hyperdense fluid within the\nsphenoid sinus which may represent blood versus inspissated secretions.\n6. Comminuted fracture of the distal right clavicle with inferiorly displaced\nfracture fragment an adjacent hematoma.\n7. Multifocal airspace disease with small bilateral pleural effusions, right\ngreater than left, suspicious for aspiration and/or pneumonia."
        },
        {
            "input": "Previously seen hemorrhage has resolved.  Encephalomalacia is seen in both\ntemporal region from evolution of previously seen contusions.  There is no new\nhemorrhage seen.  Mild to moderate brain atrophy identified.  There is no\nmidline shift or hydrocephalus.  The previously seen or fractures less\nseparate.",
            "output": "No acute abnormalities.  Resolution previously seen hemorrhage."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass.  The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.",
            "output": "1. No acute intracranial hemorrhage.  No large territorial infarction.  No\nskull fractures.  No midline shift or other mass effect."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.  Periventricular white matter\nhypodensity likely represents sequela of chronic small vessel disease.\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses demonstrate minimal mucosal thickening in the bilateral maxillary\nsinuses.  The remainder of the imaged paranasal sinuses are clear.  The\nmastoid air cells and middle ear cavities are clear.",
            "output": "1. No acute intracranial hemorrhage.  If clinically indicated, consider MRI\nfor better evaluation for acute ischemia"
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass.  The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.",
            "output": "1. No evidence of acute large territorial infarct or acute intracranial\nhemorrhage.\n2. Within limits of this noncontrast examination, no definite evidence of\nintracranial mass.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct or intracranial mass."
        },
        {
            "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema.  A rounded hypodensity in the left basal ganglia\n(02:15) may represent a chronic lacunar infarction versus prominent\nperivascular space.  The ventricles and sulci are mildly prominent compatible\nglobal parenchymal volume loss.\n\nA mucous retention cyst is seen in the right maxillary sinus.  The remainder\nof the paranasal sinuses, middle ear cavities, and mastoid air cells are\nclear. The patient is status post bilateral lens resections..\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified.  The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent.  There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe cavernous carotid arteries are tortuous bilaterally.  Again, there is a\n3-4 mm left M1/M2 bifurcation aneurysm which is laterally directed (3:\n272-274).  Probable infundibular origin is seen at the right M1/M2 bifurcation\n(3:276).\n\nAdditional, probable infundibula are seen inferiorly directed extending from\nthe bilateral cavernous/supraclinoid internal carotid arteries (3:274 on the\nleft, 3:275 an 277 on the right).  These are unchanged from the previous\nexamination.  In addition, there is a probable infundibulum arising from the\nright lateral aspect of the anterior communicating artery (3:276) also\nunchanged.\n\nNo additional sites of potential aneurysm formation are identified\nintracranially.  There is no evidence of high-grade vessel stenosis or\nocclusion.  The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. A small, punctate calcified granuloma\nin the left lung apex unchanged.  The thyroid is again heterogeneous with a\nlarge, 5.6 cm right-sided thyroid nodule causing rightward displacement of the\nright subclavian and common carotid arteries.  Prominent bilateral cervical\nlymph nodes are identified, none of which are pathologically enlarged by CT\nsize criteria.",
            "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. Unchanged, 3-4 mm laterally directed aneurysm extending from the left M1/M2\nbifurcation.\n3. Additional sites of probable infundibular origins versus small aneurysms\ninvolving the right M1/M2 bifurcation, bilateral cavernous/supraclinoid ICAs,\nand anterior communicating artery.\n4. No additional sites of potential aneurysm are identified intracranially. \nNo evidence of high-grade vessel stenosis or occlusion.\n5. Unchanged heterogeneous thyroid with a dominant right-sided nodule\nmeasuring up to 5.6 cm.  As previously noted, not dedicated nonurgent thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S):  As previously noted, not dedicated nonurgent thyroid\nultrasound is recommended for further evaluation.\n\nNOTIFICATION:  Updated findings were conveyed by Dr. ___ to the ___ QA\nnurses via email at 15:29 on ___, 2 minutes after interpretation\nof the findings."
        },
        {
            "input": "There is no intra-axial or extra-axial hemorrhage, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction.  No\nevidence of intracranial masses or vasogenic edema.  Ventricles and sulci are\nmildly prominent consistent with age-related involutional changes.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.",
            "output": "No acute intracranial process.  No evidence of intracranial mass within the\nlimits of this noncontrast CT scan."
        },
        {
            "input": "CTA NECK:\nThere is a normal 3 vessel aortic arch identified.  Evaluation of the distal\nV2 and V3 segments is somewhat limited secondary to extensive streak artifact\nfrom dental amalgam.  Allowing for this, the vertebral arteries appear patent\nbilaterally.\n\nThe bilateral common carotid arteries are patent.  There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nNondedicated imaging of the intracranial arterial vasculature demonstrates a\nprobable 2-3 mm left M1/M2 bifurcation aneurysm (2:270).  At the right M1/M 2\nbifurcation, there is an additional questionable, 1-2 mm aneurysm (601:23).\n\nProbable small infundibula are also noted extending inferiorly from the\ncavernous internal carotid arteries, measuring 3-4 mm on the left (2:272) and\n2mm on the right (2:274).\n\nAllowing for this, the visualized portions of the intracranial vasculature\nappear patent without high-grade stenosis.  The left posterior communicating\nartery is patent, a normal variant.  The patient is status post bilateral lens\nresections.\n\n\nOTHER:\nThe lungs apices are clear bilaterally.  A small calcified granuloma is seen\nwithin the left lung apex.  A heterogeneous, 4.2 x 3.1 x 5.6 cm right-sided\nthyroid nodule is incidentally noted, causing rightward displacement of the\nright subclavian and common carotid arteries..  Multiple prominent cervical\nlymph nodes are seen bilaterally, measuring up to 7 mm in short axis at the\nleft level 2a station (2:139).  None of which are pathologically enlarged by\nCT size criteria.",
            "output": "1. Grossly patent cervical vasculature without high-grade stenosis, occlusion,\nor evidence for dissection.\n2. Included portions of the intracranial vasculature demonstrate several\nprobable small aneurysm at the bilateral M1/M2 bifurcations, measuring 2-3 mm\non the left and 1-2 mm on the right. Recommend follow-up examination with\ndedicated brain CTA or MRA for further evaluation.\n3. Small bilateral cavernous ICA infundibulum versus additional sites of small\naneurysm.\n4. 5.6 cm heterogeneous right-sided thyroid nodule, for which dedicated\nthyroid ultrasound is recommended on a nonurgent basis.\n\nRECOMMENDATION(S):  1.  Multiple small apparent intracranial aneurysms. \nRecommend dedicated brain CTA or MRA.\n\n2.  Thyroid nodule.  Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION:   As the ordering physician ___ is not in the\n___ patging directory, the impression and recommendation above was entered\nby Dr. ___ on ___ at 13:31 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There is a 2.7 cm x 4.3 cm x 3.9 cm peripherally enhancing, centrally necrotic\nlymph node at the left station II cervical chain, deep to the\nsternocleidomastoid, posterior to the submandibular gland, and lateral to the\ncarotid (02:52).\n\nThere is a 1.2 cm TV x 1.9 cm AP x 2.2 cm SI heterogeneous, centrally\ncalcified lymph node at right station III cervical chain (2:62; 06:19).\n\nThere are no additional suspicious lymph nodes by size or morphology.  There\nis a 1.1 cm hypodense nodule within the right thyroid lobe (2:77).  There is a\ncoarse calcification within the right thyroid lobe measuring 6 mm (2:74).  The\nsalivary glands are unremarkable.  There is mild asymmetric prominence of the\nleft palatine tonsil (02:48), otherwise the pharynx and larynx are\nunremarkable.\n\nThere is asymmetric enlargement of the left mylohyoid muscle with ill-defined\nlow-density lesion within the deep fibers measuring approximately 2.7 cm SI x\n0.9 cm TV x 2.9 cm AP (02:55; 05:20).\n\nThere is mild mucosal thickening within the bilateral frontal sinuses and\npartial opacification of the ethmoid sinuses.  The mastoid air cells and\nmiddle ears are clear.  The masticator and parapharyngeal spaces are\nunremarkable.  There is artifact from dental almalgam that obscures adjacent\nstructures, otherwise the dentition is intact.  There is anterior cervical\nfusion from C5 through C7 with intact hardware and osseous ___.\n\nThe vasculature is patent with calcific atherosclerosis at the bilateral\ncarotid bifurcations and bulbs.  There is a 7 mm AP x 4 mm TV x 6 mm SI oval\nhyperdense mass at the dorsum sella (05:29; 06:34; 02:17) which has similar\nattenuation as the circle ___.  This may represent an aneurysm or a dense\nor enhancing mass, perhaps arising from the infundibulum.\n\nThere is motion artifact.  The lung apices which limit spatial resolution. \nWithin this limitation, the lung apices are clear.",
            "output": "1. 2.7 x 4.3 x 3.9 cm peripherally enhancing, centrally necrotic lesion a\ncervical chain lymph node suspicious for neoplastic nodal disease.\n2. Asymmetric enlargement of the left mylohyoid muscle with ill-defined focal\narea of hypodensity within the anterior deep fibers which could represent a\nlesion versus denervation.  This could be further characterized with dedicated\nneck MRI.\n3. Asymmetric enlargement of the left palatine tonsil.  Recommend direct\nvisualization to assess for a mucosal lesion.\n4. 1.2 x 1.9 x 2.2 cm microlobular lesion at right station III deep cervical\nchain which demonstrates T2 hyperintensity on prior MR from ___\nand is relatively unchanged in size as compared to ___.  Findings\nfavor calcified phleboliths within a venolymphatic malformation with\ndifferential including a calcified lymph node.  This is likely benign given\nits stability in comparison to ___.\n5. 1.1 cm nodule within the right thyroid lobe.  Per the ___ College of\nRadiology guidelines, absent higher risk clinical indicators, incidental\nthyroid nodules less than 1.5 cm in patient's greater than ___ years of age do\nnot require ultrasound evaluation.\n6. 7 x 4 x 6 mm oval hyperdense suprasellar mass at the dorsum sella. \nRecommend dedicated noncontrast head CT to assess for calcification and head\nand pituitary MRI and MRA for further characterization.\n\nRECOMMENDATION(S):  Recommend dedicated noncontrast head CT and head and\npituitary MRI with head MR angiogram to further characterize the suprasellar\nlesion.\nRecommend direct visualization of the pharynx to evaluate for a left palatine\ntonsil mucosal lesion.\nConsider dedicated neck MRI to evaluate the left mylohyoid lesion.\n1.1 cm nodule within the right thyroid lobe. Per the ___ College of\nRadiology guidelines, thyroid nodules less than 1.5 cm in patient's greater\nthan ___ years of age do not require imaging follow up."
        },
        {
            "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.  There is\nslight prominence seen within the suprasellar region where a mass was\nidentified on the MRI of the pituitary gland of ___.  No\ncalcification is identified.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.",
            "output": "No acute intracranial abnormalities are identified.  No suprasellar\ncalcification is seen."
        },
        {
            "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPreviously noted thickening of the infundibulum is not well assessed on the\ncurrent exam.\n\nThere is no evidence of acute fracture.  There is partial opacification of the\nright more so than left mastoid air cells.  Mild mucosal thickening is noted\nin the ethmoid air cells and bilateral frontal sinuses.  The visualized\nportion of the sphenoid sinus, left mastoid air cells, and middle ear cavities\nare clear.  The visualized portion of the orbits are unremarkable.  There are\nmultiple dental caries in the imaged maxillary teeth.  Incisive canal cyst is\nnoted.",
            "output": "1. No acute intracranial abnormalities on the noncontrast head CT.\n2. Multiple dental caries in the imaged maxillary teeth.  Further assessment\nwith dental exam is recommended.\n3. Mild sinus disease and partial right mastoid air cell opacification."
        },
        {
            "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent consistent with age related\natrophy.  Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nNo acute osseous abnormalities seen.  Incidental note is made of congenital\nnonunion of the posterior arch of C1.  The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable apart\nfrom right lens replacement.  Dense atherosclerotic calcifications of the\ncavernous carotid arteries and mild to moderate atherosclerotic calcifications\nof the V4 segments of the distal vertebral arteries.",
            "output": "No acute intracranial abnormality."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass.  There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\nMild periventricular white matter hypodensities in a configuration most\nsuggestive chronic small vessel ischemic disease.\n\nThere is mild mucosal wall thickening in the right frontoethmoidal recess and\nright frontal sinus.  The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a left dominant vertebrobasilar system.  There are mild\ncalcifications of the bilateral intracranial internal carotid arteries without\nsignificant stenosis.  The vessels of the circle of ___ and their principal\nintracranial branches appear patent without significant stenosis, occlusion,\nor aneurysm formation.  The dural venous sinuses are patent.\n\nCTA NECK:\nThere is heavy calcified and noncalcified atherosclerotic plaque in the aortic\narch.  There are atherosclerotic calcifications at the origin of the great\nvessels, without significant stenosis.  There is moderate stenosis at the\norigin of the right subclavian artery.  There is mild narrowing at the origin\nof the bilateral vertebral arteries secondary to atherosclerotic\ncalcification.  There is mild narrowing of the V1 segment of the left\nvertebral artery secondary to atherosclerotic calcification (7:98).  There is\nadditionally punctate atherosclerotic calcification in the proximal V2 segment\nof the left vertebral artery.\n\nThere are severe bilateral atherosclerotic calcifications of the carotid\nbifurcations.  There is near complete occlusion of the right internal carotid\nartery at the level of the bifurcations with a thin wisp of residual contrast\nflow (7:141).  There is roughly 50% stenosis of the left internal carotid\nartery by NASCET criteria.\n\nThe carotid and vertebral arteries and their major branches are otherwise\npatent with no evidence of occlusionor dissection.\n\nOTHER:\n8 mm triangular left apical nodule is unchanged from the prior chest CT\nexamination.  The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.  There is moderate\nmultilevel cervical spondylosis.",
            "output": "1. Near occlusion of the right internal carotid artery at the level of the\ncarotid bifurcation with thin wisp of residual contrast flow.\n2. 50% stenosis of the left internal carotid artery by NASCET criteria.\n3. Scattered cervical atherosclerotic disease, as described, with cervical\nvasculature otherwise patent without occlusion or dissection.\n4. No acute intracranial abnormality.\n5. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm.\n6. Stable 8 mm triangular left apical subpleural nodule.\n\nRECOMMENDATION(S):  Follow-up chest CT examination is recommended in ___, as recommended on the prior chest CT examination."
        },
        {
            "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or discrete mass.  There is prominence of the ventricles and\nsulci suggestive of involutional changes.  Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel disease changes.\n\nLeft parietal burr hole is again seen.  There is no evidence of fracture. \nSoft tissue density seen in the left external auditory canal, compatible with\ncerumen.  The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.  The visualized portion of the orbits are\nunremarkable.",
            "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence for acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction.  Unchanged hypodensity in the left frontal\nsubcortical white matter on image 2:22, nonspecific but likely secondary to\nchronic small vessel ischemic disease based on the prior MRI.  Mild prominence\nof the ventricles and sulci is again seen indicating mild global parenchymal\nvolume loss.  All components of the left lateral ventricle a larger than the\nright, as before, which may be secondary to congenital or developmental\nfactors.  Basal cisterns are preserved.\n\nLeft anterior parietal burr hole is again noted.  Mild mucosal thickening in\nthe ethmoid air cells.  Small mucous retention cyst in the right maxillary\nsinus.  Mastoid air cells and middle ear cavities are well aerated.  Left\nmastoid is underpneumatized.  The orbits appear unremarkable.\n\nCTA NECK:\nConventional branching of the great vessel origins.  Mild calcified plaque at\nthe left subclavian artery origin without flow-limiting stenosis.  There is\nminimal noncalcified plaque in the proximal right ICA and mild mixed,\npredominantly noncalcified plaque in the proximal left ICA, without stenosis\nby NASCET criteria.  Left vertebral artery is dominant.  No evidence for\nflow-limiting stenosis in the right or left cervical vertebral arteries.\n\nCTA HEAD:\nThere is minimal calcified plaque in the carotid siphons and in the\nintracranial left vertebral artery without flow-limiting stenosis.  Non\ndominant intracranial right vertebral artery is hypoplastic.  There is\notherwise no evidence for flow-limiting stenosis in the major intracranial\narteries.  No evidence for an aneurysm.  The dural venous sinuses are patent.\n\nThe right intradural vertebral artery is diminutive, and the left vertebral\nartery is dominant.  Otherwise the basilar artery, and the bilateral vertebral\nartery are unremarkable.  There is no evidence of high-grade occlusion,\naneurysm, or vascular malformation.\n\nOTHER:\nRight submandibular gland is atrophic.  No lymphadenopathy by CT criteria. \nThe thyroid is partially obscured by streak artifact from concentrated\ncontrast in the bilateral lower cervical and upper chest wall veins, but\ngrossly unremarkable in appearance.\n\nThere is moderate calcified pleural/parenchymal scarring at the lung apices,\npresent dating back to multiple prior studies, for example a chest CT from ___.\n\nThere are degenerative changes in the cervical spine.  A sclerotic lesion in\nthe right C3 vertebral body on image 3:164 was not associated with edema on\nthe last cervical spine MRI from ___, probably a bone island.",
            "output": "1. No evidence for acute intracranial abnormalities.  MRI would be more\nsensitive for an acute infarction or recurrent lymphoma, if clinically\nwarranted.\n2. Mild bilateral proximal ICA atherosclerosis without stenosis by NASCET\ncriteria.\n3. No evidence for flow-limiting stenosis in the major intracranial arteries. \nMinimal atherosclerosis of bilateral carotid siphons and intracranial left\nvertebral artery."
        },
        {
            "input": "There is a 20 x 12 mm soft tissue mass adjacent to the maxillary alveolus in\nthe pre maxillary region (4: 76) which mildly enhances compared to the\nadjacent musculature.  There is no underlying bony erosion identified.  There\nis no regional lymphadenopathy seen.  Mild mucosal thickening is identified\nwithin the maxillary sinuses with a retention cyst in the alveolar recess of\nright maxillary sinus.  Mild mucosal thickening identified adjacent to both\ninfundibula of ostiomeatal units.  No periapical lucencies about the maxillary\nteeth identified.\n\nThere is no evidence of soft tissue mass or asymmetry within the\nsphenopalatine recesses or cavernous sinus.  Both orbits are symmetric and\nnormal in appearance without intra or extraconal mass lesion.  Both globes\ndemonstrate normal appearances.\n\nNo enhancing brain lesions are identified in the partially visualized brain. \nMild mucosal thickening is seen in the remaining sinuses without fluid levels\nor aerosolized secretions.\n\nThe mandible shows normal appearances without periapical lucencies or bony\nerosion.",
            "output": "1. 20 x 12 mm soft tissue mass in the pre maxillary region is overall\nunchanged compared to the previous MRI of ___.  No regional\nlymphadenopathy is identified or underlying bony erosion is seen.\n2. Mild mucosal thickening in maxillary sinuses.\n3. No intra orbital mass lesions.\n4. No asymmetry or mass in the sphenopalatine recesses or cavernous sinuses."
        },
        {
            "input": "A subtle area of hypodensity in the left thalamus (02:13), extending into the\nleft cerebral peduncle (02:12) is new compared to the prior CT from ___, and no correlating abnormality in this area was identified on the prior\nMRI from ___. There is no intracranial hemorrhage, edema, mass effect,\nor acute vascular territorial infarction.  A focal hypodensity in the deep\nwhite matter of the left frontal lobe (02:22) is similar compared to the prior\nCT and MRI. The ventricles and sulci are unchanged in size and configuration,\nwith persistent slight asymmetric enlargement of the left lateral ventricle\ncompared to the right. There is no shift of the normally midline\nstructures.The basal cisterns appear patent and there is preservation of the\ngray-white matter differentiation.\n\nA left frontal burr hole defect is again seen. No fracture or suspicious\nosseous lesion is identified.The included paranasal sinuses, and middle ear\ncavities are clear.  The mastoids are underpneumatized.",
            "output": "1. New subtle areas of hypodensity in the left thalamus extending into the\nleft cerebral peduncle could represent progression of lymphoma. A dedicated\nMRI with and without contrast is recommended.\n2. No acute intracranial hemorrhage is seen."
        },
        {
            "input": "There is no evidence of acute territorial infarction or hemorrhage. Left\nposterior limb of the internal capsule hypodensity extending into the left\ncerebral peduncle is again noted, and corresponds to the abnormalities seen on\nFLAIR sequence on recent MRI.  Focal white matter hypodensity in the left\nfrontal centrum semiovale (02:22) is nonspecific, but may be due to chronic\nsmall vessel ischemic disease.  Mild prominence of the ventricles and sulci is\nsuggestive of age-appropriate involutional changes.\n\nLeft frontal burr hole is again seen.  Mucosal thickening in the left\nmaxillary sinus is minimal.  There is mild mucosal thickening in the ethmoid\nair cells, sphenoid sinuses, and left frontoethmoidal recess.  The mastoid air\ncells and middle ear cavities are clear. The orbits are unremarkable.",
            "output": "1. No acute intracranial hemorrhage or new mass effect.\n2. Hypodensity within the posterior limb of the left internal capsule\nextending into the left cerebral peduncle appears similar to the signal\nabnormalities seen on prior MRI and are better assessed on that modality.  No\nnew gross lesions are identified on this CT exam, but MRI with contrast is a\nmore sensitive study."
        },
        {
            "input": "Right frontal scalp hematoma demonstrates mixed attenuation, predominantly\nhypodense, contains scattered foci of gas, likely reflecting recent\nintervention, and currently measures 17 mm in greatest thickness (2:19),\npreviously 22 mm.  No underlying calvarial fracture identified.  No new scalp\nor intracranial hematoma identified.\n\nThere is no acute large territorial infarction, edema or mass.  There is no\nshift of normally midline structures.  Basal cisterns are patent and there is\npreservation of gray-white matter differentiation.  Scattered periventricular\nand subcortical white matter hypodensities are nonspecific, though likely the\nsequelae of chronic small vessel ischemic disease.  Prominent ventricles and\nsulci suggest age-related involutional changes.\n\nVisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear.  Visualized portions of the orbits are unremarkable.  Moderate\natherosclerotic calcification of the cavernous portions of the bilateral\ninternal carotid arteries are noted.",
            "output": "1. Interval decrease in size of mixed-attenuation, predominantly hypodense\nright frontal scalp hematoma, currently measuring 17 mm in greatest thickness\nand containing scattered foci of gas, likely reflecting recent intervention.\n2. No acute large territorial infarction or intracranial hemorrhage.\n3. Chronic changes, including age-related global atrophy and white matter\nsmall vessel ischemic disease."
        },
        {
            "input": "Allowing for patient motion and beam hardening artifact which limits\nevaluation of posterior fossa, there are multiple hyperdensities with\nsurrounding edema involving the bilateral cerebellar hemispheres.  This\nresults in compression of the fourth ventricle and secondary obstructive\nhydrocephalus with enlargement of the lateral and third ventricles, new from\nthe previous examination. There is crowding involving the prepontine cistern\nand foramina magnum, also new from the previous examination.\nThere is high density along the tentorium bilaterally, suggesting subdural\nhemorrhage.  High density in the cerebellar sulci suggest a component of\nsubarachnoid hemorrhage.\n\nNo additional sites of definite intracranial hemorrhage are identified.  There\nis no evidence of recent supratentorial infarction.  No evidence for\ntransependymal flow of CSF. A chronic infarct within the left corona radiata\nis noted.\n\nThe paranasal sinuses and mastoid air cells are clear.  Patient is status post\nright lens replacement.  Cervical posterior fusion hardware is partially\nimaged.",
            "output": "1. Motion degraded examination, particularly affecting evaluation of the\nposterior fossa.\n2. Bilateral cerebellar hemorrhage with surrounding edema that compress the\nfourth ventricle, new from prior examination.\n3. This results in new obstructive hydrocephalus involving the lateral and\nthird ventricles.  Crowding is seen at the prepontine cistern and upper\nforamina magnum, worrisome for early inferior herniation.  Consultation with\nNeurosurgery, followed by Neurology, is recommended.\n4. Subdural hematoma along the tentorium and subarachnoid hemorrhage are\npresent in the posterior fossa.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 16:35 on ___, 2 minutes after interpretation."
        },
        {
            "input": "Re-demonstrated are multiple posterior fossa hyperdensities with surrounding\nedema involving the bilateral cerebellar hemispheres, with blood tracking\nalong the bilateral tentorium.  The fourth ventricle is compressed as on prior\nwith secondary obstructive hydrocephalus and enlargement of the lateral and\nthird ventricles.  Basilar cistern crowding most prominent at the prepontine\ncistern and foramina magnum appears unchanged from earlier same day study.\n\nOverall, fourth ventricular compression, posterior fossa mass effect, and\nhydrocephalus are worse than on the prior study.  Tentorial subdural hematoma\nalso appears somewhat worse.\n\nHypodensity over the left corona radiata is unchanged.  No displaced calvarial\nfractures are noted. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.  Patient is status post right\nlens replacement.  Cervical fixation screws and hardware is partially imaged\nthrough C2.",
            "output": "1. Increase posterior fossa mass effect, fourth ventricular compression, and\nhydrocephalus since the earlier study of ___.\n2. Increase in tentorial subdural hematoma.\n3. Bilateral cerebellar hemisphere hemorrhage and edema suggesting hemorrhagic\ninfarction.\n\nNOTIFICATION:  The findings were discussed with the neurosurgical team, M.D.\nby ___, M.D. on the telephone on ___ at 5:15 pm, at the\ndiscovery of the findings.\n\nA revised report indicating progression of hemorrhage, edema, posterior fossa\nmass effect, and hydrocephalus since the earlier study ___ was discussed\nby telephone by Dr. ___ with Dr. ___ 6:25pm ___, 5 minutes after\nreviewing the images."
        },
        {
            "input": "Patient is status post right frontal approach ventricular catheter placement,\nwith tip in the body of the right lateral ventricle.  There is right frontal\npneumocephalus within expected limits.  Ventriculomegaly is minimally improved\nsince prior.\n\nPosterior fossa hemorrhage, in addition to blood tracking along the tentorium\nbilaterally is unchanged since prior.  Compression of the fourth ventricle is\nsimilar to prior.  Basilar cistern and foramen magnum crowding are similar to\nprior.  There is no evidence of acute territorial infarction or large mass. \nLeft corona radiata hypodensity is unchanged since prior.\n\nThere is no evidence of fracture.  Cervical spine fusion hardware is partially\nimaged.  The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.  The orbits are unchanged since prior.  Endotracheal tube is partially\nimaged.",
            "output": "Interval placement of a right frontal approach ventricular catheter, with tip\nin the body of the right lateral ventricle and minimally improved\nventriculomegaly since prior."
        },
        {
            "input": "Right frontal approach ventriculostomy tip terminates near the right foramina\n___, unchanged compared to prior.\n\nAgain demonstrated, is similar degree of posterior fossa/bilateral cerebellar\nhemorrhage with surrounding vasogenic edema and similar effacement of the\nfourth ventricle and prepontine cistern.  Resultant obstructive upstream\nhydrocephalus is stable compared to prior.  There is similar degree of\ncrowding of the foramen magnum.\n\nSubdural extension of hemorrhage along the bilateral tentorium cerebelli is\nsimilar prior.  Similar degree of subarachnoid hemorrhage within the sulci of\nthe posterior fossa.\n\nThere is new small volume bilateral occipital horn dependently layering\nintraventricular hemorrhage, right greater than left (02:14).\n\nThere is no evidence of acute large territorial infarction.\n\nThe ventricles and sulci are unchanged in size and configuration.\n\nPosterior cervical spinal fusion hardware is partially visualized.  Otherwise,\nno acute osseous abnormalities seen.  There is partial opacification of the\nbilateral mastoid air cells which may be seen with prolonged supine\npositioning in the inpatient setting.  Otherwise, the partially imaged\nparanasal sinuses and middle ear cavities are clear. The orbits demonstrate no\nacute abnormalities.",
            "output": "1.   Redemonstration of posterior fossa hemorrhage with effacement of the\nfourth ventricle and stable resultant obstructive upstream hydrocephalus.\n2. Interval increase in bilateral occipital horn intraventricular hemorrhage.\n3. Similar degree of local mass effect."
        },
        {
            "input": "There has been interval removal of a right frontal ventricular catheter.  A\nmoderate amount of pneumocephalus in the frontal horn of the right lateral\nventricle is new.  There is a small to moderate amount of intraparenchymal and\nmild subarachnoid hemorrhage tracking along the course of the recently removed\nventriculostomy catheter.  Surrounding vasogenic edema is mild and there is no\nsignificant mass effect.\n\nPeriventricular and deep white matter hypodensities are nonspecific, but\nlikely represent sequela of chronic small vessel ischemic disease.\n\nThe size of the ventricles is unchanged from prior.  Layering hemorrhage in\nthe dependent lateral ventricles is unchanged.  There is a similar degree of\nposterior fossa and cerebellar hemorrhage.\n\nCrowding at the foramen magnum and effacement of the fourth ventricle,\nquadrigeminal and ambient cisterns is unchanged.\n\nNo large territorial infarction.  Right frontal pneumocephalus is unchanged.\n\nPosterior cervical spinal fusion hardware is partially visualized.\n\nThe paranasal sinuses and mastoid air cells are clear.  The right ocular lens\nhas been surgically replaced.",
            "output": "1. New small to moderate hemorrhage tracking along the course of the recently\nremoved ventriculostomy catheter.  There is a small amount of surrounding\nvasogenic edema without significant mass effect or midline shift.\n2. Interventricular and posterior fossa hemorrhage is unchanged.\n3. Effacement of the fourth ventricle, ambient and quadrigeminal cisterns and\ncrowding at the foramen magnum is also unchanged.\n4. Additional findings described above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:34 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Again demonstrated, is a stable right frontal intraparenchymal hemorrhage\nalong the site of prior ventriculostomy with surrounding vasogenic edema and\nintraventricular extension involving small stable layering hemorrhage in the\nbilateral occipital horns.\n\nThere is a similar degree of posterior fossa and cerebellar intraparenchymal\nhemorrhage (2:6) and trace subdural hemorrhage tracking along the tentorium\ncerebelli bilaterally (02:14).  Additionally, there is similar partial\neffacement of the fourth ventricle cerebral aqueduct and crowding of the\nforamen magnum.\n\nThere is no evidence of acute large territorial infarction.\n\nThe ventricles and sulci are unchanged in size and configuration.  There is\ninterval redistribution of intraventricular pneumocephalus with decreased air\nin the right frontal horn and increased air in the right temporal horn\n(02:12).\n\nRight frontal calvaria defect from prior ventriculostomy is visualized. \nOtherwise, no additional acute is osseous abnormalities are identified.  The\npartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits demonstrate no acute abnormalities.",
            "output": "Interval redistribution of intraventricular pneumocephalus.  Otherwise, no\nsignificant interval change of multi-compartmental intracranial hemorrhage."
        },
        {
            "input": "The right frontal intraparenchymal hemorrhage with surrounding vasogenic edema\nis similar in size and configuration when compared to the study of ___.  No new areas of hemorrhage are noted.  There has been interval\nresolution of the pneumocephalus in the anterior horn of the right ventricle. \nFocal pneumocephali along the inner table of the right frontal lobe and in the\nright temporal horn are present, but have decreased in size.  Bilateral small\nlayered hemorrhages in the occipital horns are again noted.\n\nThere is a slight redistribution of hematocrit associated with the\nintraparenchymal hemorrhage in the posterior fossa, but no evidence of new\nhemorrhage.  Intraparenchymal hemorrhages involving both cerebellar\nhemispheres are again seen.\nThere is no significant shift of midline structures.  There is mild effacement\nof the ambient cistern on the left.  Overall, basal cisterns appear patent.\n\nHypodensity in the left basal ganglia likely representing a previous infarct\nis present.\n\nAgain noted is a right frontal calvarial defect from prior ventriculostomy. \nNo acute fractures are seen.  Fusion rods are seen through the imaged Atlas. \nThere is also a partially imaged nasogastric tube.  The paranasal sinuses,\nmastoid cells, and middle ear cavities are unremarkable.",
            "output": "1. Stable appearance of right frontal intraparenchymal, posterior fossa, and\ncerebellar hemorrhages, without evidence of new bleed.\n2. Interval improvement of pneumocephali.\n3. Patent basal cistern."
        },
        {
            "input": "The right globe appears normal without evidence of radiopaque foreign body. \nThe intra and extraconal fat is preserved.\n\nThe left lobe appears normal without evidence of radiopaque foreign body.  A 1\nmm radiopaque density in the region of the left trochlea likely represents a\ncalcified trochlear apparatus (series 3, image 23).  The intra and extraconal\nfat is preserved.\n\nThere is minimal mucosal thickening in the ethmoid air cells, maxillary\nsinuses and sphenoid sinuses.  There is evidence of prior fiberoptic\nendoscopic sinus surgery.  The mastoid air cells in external auditory canals\nare clear.  Although the study is not designed to evaluate the intracranial\ncontents, the visual portion of the brain is unremarkable.",
            "output": "1. No radiopaque foreign body in the right orbit.\n2. 1 mm radiopaque density in the region of the left trochlea most likely\nrepresents a calcified cochlear apparatus."
        },
        {
            "input": "Limited evaluation due to timing of contrast bolus.\n\nThere is a congenitally hypoplastic right vertebral artery with dominant left\nvertebral artery.  The right vertebral artery at the level of C1 is patent\nwithout vessel irregularity.  Along the posterior right arch there is an\nossific fragment just anterior to the vertebral artery (2:194) as it traverses\nintra cranially (2:195).  The carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses.  No evidence for dissection\nis seen.By NASCET criteria, there is no stenosis of the internal carotid\narteries.\n\nLimited evaluation of the osseous structures again demonstrates anterior and\nposterior arch of C1 fractures with an avulsed transverse ligament.  There is\n3 mm lateral subluxation of the right C1 lateral mass with 2 mm lateral\nsubluxation of the left C1 lateral mass.  C1 fracture is better characterized\non dedicated CT cervical spine performed the same day.\n\nLimited assessment of the lung apices is unremarkable.  The thyroid is within\nnormal limits.",
            "output": "1. Patent vasculature.  No evidence of vertebral artery dissection\n2. Anterior and posterior C1 right arch fracture with mild bilateral lateral\nmass subluxation and avulsed transverse ligament, better characterized on\ndedicated CT cervical spine performed the same day."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect.  The\nventricles and sulci are prominent consistent with global cerebral volume\nloss.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.",
            "output": "No acute intracranial pathology identified.  Please note MRI is more sensitive\nfor small intracranial lesions."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen.  There is minimal fluid in the bilateral\nmaxillary sinuses.  The orbits are unremarkable.",
            "output": "No acute intracranial process."
        },
        {
            "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified.  The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent.  There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\n The intracranial vasculature is grossly patent without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.",
            "output": "1. Normal head and neck CTA."
        },
        {
            "input": "No acute fracture. The mandible and temporomandibular joints appear normal. \nExtensive periapical lucencies are seen involving multiple maxillary and\nmandibular teeth compatible with periodontal disease.  The pterygoid plates\nare intact.\n\nEthmoid sinuses are partially opacified.  There is mucosal thickening of the\ninferior frontal, sphenoid, and left maxillary sinuses and layering\nlow-density fluid in the right maxillary sinus.\n\nSoft tissue swelling with locules of soft tissue gas suggesting laceration are\nnoted adjacent to the left mandible.  There is no evidence of abnormal fluid\ncollections.\n\nBilateral mastoids appear normal.\n\nRight scleral buckle is present along with evidence of right lens resection. \nThe globes are otherwise intact.  The extraocular muscles, optic nerves, and\nretrobulbar fat appear normal.",
            "output": "1. No acute fracture or temporomandibular joint dislocation.  Soft tissue\nswelling and laceration overlying the left mandible.\n2. Extensive periapical lucencies involving multiple maxillary and mandibular\nteeth suggestive of periodontal disease.  Correlation with dental exam\nrecommended.\n3. Sinus disease as described."
        },
        {
            "input": "There is soft tissue edema and locules of soft tissue gas compatible with\nlaceration involving the left forehead and posterolateral to the left jaw.  No\nacute fracture is seen.  There is no evidence of acute territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen.  There is partial opacification of the ethmoid\nsinuses.  Layering low-density fluid in the right maxillary sinus and mucosal\nthickening noted in the inferior frontal and left maxillary sinuses.  The\nmastoid air cells and middle ear cavities are clear.  Right scleral buckle is\npresent and the patient is status post right lens resection.  Orbits are\notherwise unremarkable.",
            "output": "1. No intracranial hemorrhage or acute fracture.\n2. Soft tissue swelling and laceration overlying the left frontal bone and\nleft mandible."
        },
        {
            "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass effect.\n\nThere is prominence of the ventricles and sulci suggestive of age advanced\ncerebral volume loss.\n\nNo acute fracture is seen.  There is a moderate sized right maxillary sinus\nmucous retention cyst.  Otherwise, the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.",
            "output": "No acute intracranial process.  No evidence acute intracranial hemorrhage or\nfracture."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture.  There is trace mucosal thickening of the\nleft maxillary sinus.  The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear.  Changes\nrelated to left partial mastoidectomy are noted.  The visualized portion of\nthe orbits are unremarkable.",
            "output": "1. No acute intracranial process.\n2. Evaluation for mass is limited in the absence of IV contrast.  There is no\nedema or mass effect to suggest intracranial metastatic disease.  If there is\nsignificant clinical concern for metastatic disease, MRI should be obtained."
        },
        {
            "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass.  Mild periventricular white matter hypodensities likely represent\nchronic microangiopathy.  There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.",
            "output": "No evidence of acute territory infarction or hemorrhage."
        },
        {
            "input": "Partially limited exam due to patient motion, within this limits, grossly the\ngray-white matter differentiation is maintained.  There is no evidence of\nacute intracranial hemorrhage,edema,or mass.  Generalized brain parenchymal\natrophy with prominent the ventricles and sulci, likely age related and\ninvolutional nature.  Periventricular white matter hypodensities are\nnonspecific and suggest mild chronic small vessel disease, grossly unchanged.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.   The\nvisualized portion of the orbits are unremarkable.There is dental hardware in\nthe maxillary bone and mandible.",
            "output": "1. Limited exam due to patient motion, within this limitation, there is no\nevidence of acute intracranial process or hemorrhage.\n2. Subtle areas of low attenuation in the subcortical white matter suggests\nchronic microvascular ischemic disease.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:05 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation.No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.",
            "output": "No acute intracranial process."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminent ventricles and sulci are suggestive of age-related involutional\nchanges.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation.  Multifocal\nmild narrowing of the cavernous carotid arteries bilaterally is compatible\nwith atherosclerotic disease.  There is also and stenosis of the right A1\norigin.  The dural venous sinuses are patent.\n\nCTA NECK:\nCalcified and noncalcified plaque at the bilateral carotid bifurcations\nresults in approximately 90% occlusion of the right internal carotid artery\n(3:150) and 80% occlusion of the left internal carotid artery (3:140).  There\nis mild narrowing and atherosclerotic calcification at the origin of the left\nvertebral artery.  The right vertebral artery origin appears widely patent. \nThere is no flow-limiting stenosis, occlusion, or dissection within the\nvertebral arteries.  No dissection is identified within the carotid arteries.\n\nOTHER:\nThe visualized portion of the lungs are clear.  The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.",
            "output": "1. Calcified and noncalcified plaque at the bilateral carotid bifurcations\nresulting in approximately 90% occlusion of the right internal carotid artery\nand 80% occlusion of the left internal carotid artery.\n2. Multifocal mild narrowing of the cavernous carotid arteries bilaterally,\ncompatible with atherosclerotic disease.  Stenosis of the right A1 segment is\nalso noted.\n3. Mild narrowing and atherosclerotic calcification at the origin of the left\nvertebral artery."
        },
        {
            "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass.  Left basal ganglia chronic lacunar infarct is again seen. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture.  Complete opacification of the right\nsphenoid sinus is unchanged since prior.  The paranasal sinuses, mastoid air\ncells, and middle ear cavities are otherwise clear.  The right orbit is\nunremarkable.  Dystrophic left globe with calcified lines is unchanged since\nprior.  Multiple periodontal lucencies are again seen.  There is bilateral\ncarotid siphon calcification.",
            "output": "No acute intracranial hemorrhage."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nMildly limited study due to beam hardening artifact and motion degradation of\nthe skullbase.  Within these confines:\n\nThere is no evidence of acute intracranial hemorrhage, infarction, edema, or\nmass effect.  The ventricles and sulci are normal in caliber and\nconfiguration. Bilateral mild periventricular white matter hypodensity is\nnon-specific, but compatible with mild changes of chronic white matter\nmicroangiopathy.\n\n No evidence of a displaced calvarial fracture.  Aerosolized secretions are\nseen in the sphenoid sinus.  Remaining visualized paranasal sinuses, mastoids,\nmiddle ear cavities are well pneumatized and clear.  The globes and orbits are\nunremarkable.\n\nCT PERFUSION:\nSubjective review of CT perfusion images demonstrates no evidence of elevated\nmean transit time/T-max greater than 6 seconds, nor areas of abnormally\ndecreased cerebral blood flow or abnormal cerebral blood volume.  No\nconvincing evidence of ischemic penumbra or infarct core.  CBF <30% volume 0\nmL, T-max >6 seconds volume 4 mL.\n\nCTA HEAD:\nThere is a left dominant vertebral artery, a normal variant.  Fetal type left\nPCA, a normal anatomic variant.  The left P1 is not well seen, either\ndiminutive or absent.  Widely patent vertebrobasilar system. Patent bilateral\nposterior cerebral arteries with normal distal runoff.\n\nThere are areas of mild luminal narrowing of the cavernous, supraclinoid, and\nparaophthalmic intracranial ICAs bilaterally due to calcified plaque. \nOtherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with normal distal runoff.\n\nPatent major dural venous sinuses.\n\nCTA NECK:\nThere is moderate motion degradation focally at the level of the carotid bulbs\nand proximal ICAs which somewhat limits evaluation.  Within these confines:\n\nThere is mild calcified plaque at the origin of the right internal carotid\nartery which does not appear to cause luminal narrowing by NASCET criteria\n(___).\n\nThere is focal calcified plaque at the origin of the left cervical ICA,\ncausing approximately 15 % luminal narrowing by NASCET criteria (series ___,\nimage 23).\n\nThe cervical vertebral arteries are tortuous but otherwise widely patent and\nunremarkable bilaterally.\n\nOTHER:\nThere is moderate calcification of the aortic arch.  Arch branch vessel\norigins are patent.  Proximal arch vessels are severely tortuous but otherwise\nwidely patent, including the innominate, proximal left common carotid, left\nsubclavian, and proximal right subclavian.  There is a 2 mm pulmonary nodule\nseen in the lateral aspect of the right upper lobe (04:14).  The thyroid is\nunremarkable.  Scattered bilateral multilevel cervical lymph nodes are not\npathologically enlarged.  Prevertebral paraspinal soft tissues are without\nacute focal abnormality.  There is an exaggerated cervical lordosis.  There\nappear to be age-indeterminate compression deformities of the T2 through at\nleast T8 vertebral bodies, not well assessed on this study.  No definite\naggressive focal osseous lesion seen.",
            "output": "Study is limited due to moderate motion degradation.  Within these confines:\n\n1. No evidence of acute intracranial abnormality.\n2. CT perfusion without convincing evidence of ischemic penumbra or infarct\ncore.\n3. Mild narrowing of the intracranial carotid siphons bilaterally due to\ncalcified plaque.  Otherwise, widely patent circle of ___ vasculature\nwithout additional stenosis, occlusion, or aneurysm.\n4. 15% luminal narrowing of proximal left ICA due to calcified plaque. \nOtherwise, widely patent bilateral cervical vertebral and carotid arteries. \nNo right ICA stenosis by NASCET criteria.\n5. Suggestion of multiple contiguous compression deformities in the upper\nthoracic spine spanning T2-T8, not well evaluated on this study and\nage-indeterminate.  Correlate with patient's symptoms and consideration of\ndedicated CT cervical spine imaging, or comparison with outside hospital prior\nexams, if available.\n6. Incidentally noted 2 mm solid pulmonary nodule in the lateral right upper\nlobe.  Recommend correlation with patient risk factors in consideration of\nfollow-up dedicated CT chest imaging, as above. Other incidental findings, as\nabove.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\n\nAgain noted is a 1.7 x 1.0 cm intraparenchymal hemorrhage at the left\ntemporal/ occipital junction, stable in size. Mild surrounding edema has\nslightly increased. 4 mm hemorrhage in the left temporal lobe is also stable\nwith minimal surrounding edema (series 3, image 16. No new hemorrhages are\nnoted. There is no evidence of new loss of gray/ white matter differentiation.\nVentricle and cisterns are normal in size.\n\nThere is severe opacification of bilateral anterior ethmoid air cells\nextending into the frontoethmoidal recesses, as well as moderate mucosal\nthickening in the inferior right frontal sinus and mild mucosal thickening in\nthe inferior left frontal sinus, unchanged. There is minimal mucosal\nthickening in the left maxillary sinus. There is mild to moderate mucosal\nthickening as well as likely fluid in the sphenoid sinuses. Sphenoid sinus\nabnormalities have progressed since ___, likely related to\nprolonged supine positioning in the inpatient setting. Mastoid air cells are\nclear.\n\n\nCTA AND CTV HEAD:\n\nMultifocal atherosclerotic calcification of the carotid siphons is noted\nwithout flow-limiting stenosis. The ACA, MCA and their major branches are\nunremarkable. Atherosclerotic calcification of the bilateral mid intracranial\nvertebral arteries are also noted.\n\nThere is thrombosis of the left transverse sinus extending to the torcula\nmedially, as well as thrombosis of the left sigmoid sinus and jugular bulb.\nThere is reconstitution of flow within the left internal jugular vein at the\ninferior margin of the jugular foramen. Extensive prominent cortical and\nmedullary blood vessels in the left parietal, occipital, and temporal region\nmost likely represent venous collaterals secondary to sinus thrombosis.\nHowever, enlarged. Dural arterial branches cannot be definitively excluded.\nBranches of the left posterior cerebral artery also approach the area of the\nabnormal blood vessels and a difficult to evaluate.\n\nVisualized portions of the common carotid and extracranial internal carotid\narteries are unremarkable.\n\nOTHER FINDINGS:\n\n\n\nBilateral palatine tonsiliths are noted, presumably sequela of prior\ninfection. No suspicious sclerotic or lytic osseous lesions are seen.",
            "output": "1. Thrombosis of the left transverse sinus, sigmoid sinus and jugular bulb,\nwith reconstitution of the left internal jugular vein at the inferior margin\nof the jugular foramen.\n2. Extensive venous collaterals in the left parietal, occipital, and temporal\nregion. Abnormal dural arterial branches or abnormal branches of the left\nposterior cerebral artery cannot be definitively excluded. Conventional\ncerebral angiogram would be more sensitive for excluding an AV fistula.\n3. The dominant left temporal/ occipital hemorrhage is stable in size with\nmild, but slightly increased surrounding edema. Additional 4 mm focus of\nhemorrhage in the left temporal lobe is stable.\n4. Persistent opacification of anterior ethmoid air cells and frontoethmoidal\nrecesses, with right greater than left mucosal thickening in the inferior\nfrontal sinuses ; please correlate with symptoms. New fluid and mucosal\nthickening in the sphenoid sinuses is likely related to prolonged supine\npositioning in the inpatient setting."
        },
        {
            "input": "Evaluation is somewhat limited due to motion artifact. There is\nredemonstration of a 1.5 x 1.2 cm intraparenchymal hemorrhage in the left\ntemporal lobe with minimal edema. Additional focus of hemorrhage in the left\ntemporal lobe is again seen and measures approximately 4 mm (series 2a, image\n10). There is no evidence of shift of normally midline structures or of\ninfarction. Ventricles and sulci are normal in size and configuration. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation. Known venous sinus thrombosis is not appreciated on this\nnoncontrast enhanced study.\n\nThere is no fracture. Aerosolized secretions are seen in the right\nfrontoethmoidal recess. There is mucosal thickening and fluid in the ethmoid\nair cells, sphenoid sinuses, and left maxillary sinus. The bilateral middle\near cavities and mastoid air cells are clear.",
            "output": "Redemonstration of intraparenchymal lobar cerebral hemorrhages essentially\nstable since prior examinations."
        },
        {
            "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction.  The ventricles and sulci are normal in size\nconfiguration.  The basal cisterns are patent.  Gray-white matter\ndifferentiation is preserved.\n\nThere is no fracture.  The nasal septum is mildly leftward deviated with a\nleft-sided spur (3:2).  The partially imaged paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.",
            "output": "1. No acute intracranial abnormality.\n2. Mild leftward deviation of the nasal septum with a left-sided spur."
        },
        {
            "input": "There is no intracranial hemorrhage, edema, mass effect or major vascular\nterritorial infarct.  Prominent ventricles and sulci are compatible with mild\nglobal age-related atrophy. Basal cisterns are preserved. There is no shift of\nnormally midline structures. Gray-white matter differentiation is preserved. \nNo osseous abnormality is identified.  The scalp overlying the left calvarium\nis thicker than the right, which may be due to asymmetric soft tissue edema.\nParanasal sinus mucosal thickening with mucous retention cysts in the\nbilateral maxillary sinuses and air-fluid levels in the bilateral maxillary\nand sphenoid sinuses may in part be related to intubation. Hyperdensity within\nthe nasopharynx may represent blood products related to intubation.",
            "output": "No acute intracranial abnormality. If clinical concern for stroke is high, MRI\nis more sensitive.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with ___\n___ on the telephone on ___ at 11:25 a.m.."
        },
        {
            "input": "NON-CONTRAST HEAD CT:  There is no evidence of infarct, hemorrhage, or mass. \nThe ventricles, cisterns and sulci are age-appropriate.\n\nCTA HEAD AND NECK:  The aortic arch has mild calcific arteriosclerosis.  There\nis three-vessel takeoff off the aortic arch with no stenosis of these great\nvessel origins.\n\nThe left vertebral artery is markedly dominant.  There is minimal calcific\narteriosclerosis of the carotid bifurcations bilaterally, and the cervical\ninternal carotid arteries are quite tortuous, but there is no flow-limiting\nstenosis within the neck.\n\nCTA HEAD:  The right A1 segment is slightly dominant.  No posterior\ncommunicating arteries are identified.  The dural venous sinuses and major\nintracranial veins are patent.  There is no evidence of intracranial\nflow-limiting stenosis or aneurysm.\n\nThere are age-related mild osseous degenerative changes.",
            "output": "No apparent acute intracranial pathology.  No flow-limiting\nstenosis or aneurysm.  No explanation for the patient's headache is seen."
        },
        {
            "input": "There is mild smooth circumferential wall thickening of the subglottic trachea\n(2:66) extending for approximately 7-cm in craniocaudal dimension.  The airway\nis otherwise patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.  Tonsils appear normal without enlargement or hyperemia.  The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria. The\nneck vessels are patent.  No mass lesion or abscess identified.  Major\ncervical vessels appear unremarkable.  No retropharyngeal abscess or\nprevertebral soft tissue swelling.\n\nThe imaged portion of the lung apices show mild biapical pleural thickening. \nThere are no concerning pulmonary nodules. No concerning lytic or sclerotic\nlesions.  Mild degenerative changes as cervical spine are most severe at the\nlevels C4-3 where there is disc height loss and the anterior osteophytosis.",
            "output": "1. Nonspecific mild circumferential wall thickening of the subglottic trachea\nmay relate to an infectious or inflammatory process.  Airway remains patent.\n2. No evidence of abscess."
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular, subcortical and deep white matter hypodensities are\nlikely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.  Mild calcification of the cavernous\nportions of the internal carotid arteries are noted.",
            "output": "1. No acute intracranial process.  Specifically no intracranial hemorrhage.\n\n2. Chronic changes as described above."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is massive intraventricular hemorrhage, greater on the right than left\nas well as subarachnoid hemorrhage filling the right sylvian fissure.  There\nis a dense FLAIR of clot in the ambient cistern surrounding a large\nnon-opacified aneurysm in the expected location of the right posterior\ncommunicating artery.\nThere is severe hydrocephalus with periventricular hypodensities suggesting\ntransependymal resorption of CSF.\nThere is dense calcifications of the cavernous and supraclinoid internal\ncarotid arteries bilaterally as well as the vertebral arteries bilaterally. \nThere is no evidence of infarction, within the limitations of the other\nabnormalities documented on the scan.  There is right to left midline shift.\nNo masses are identified.  No osseous abnormalities are detected.\nThere is fluid in the nasopharynx and partial opacification of the ethmoid air\ncells, greater on the right than left.  The patient is intubated..\n\nCTA HEAD:\nThere is an approximately 18 mm aneurysm arising from the supraclinoid right\ninternal carotid artery the expected origin of the posterior communicating\nartery.  The ICA is heavily calcified in this location, but the aneurysm\nitself appears free of calcification.  There is a wide aneurysm neck,\nmeasuring at least 12 mm in diameter.\nThere is fusiform dilatation of the basilar artery.\nNo other aneurysms are identified.  There is extensive intracranial\natheromatous disease with narrowing and irregularity of the anterior and\nposterior circulation arterial branches down to the limit of resolution of\nCTA.\n\nCTA NECK:\nThere is calcified plaque at the origins of the great vessels and along the\naortic arch.  There are calcified plaques at the origins of the internal\ncarotid arteries bilaterally with no evidence of stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear.  The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.",
            "output": "1. Massive subarachnoid hemorrhage dear hydrocephalus.\n2. Approximately 18 mm aneurysm arising at the origin of the right posterior\ncommunicating artery\n3. Fusiform dilatation of the basilar artery.\n4. Extensive intracranial atheromatous disease.  The"
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass.  The\nventricles and sulci are normal in size and configuration for age.  Areas of\nconfluent periventricular, subcortical and deep white matter hypodensity are\nin a configuration most suggestive of chronic small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification in the V4 segment of the left\nvertebral artery without significant narrowing.  There is mild narrowing of\nthe right P1/P2 portion of the right PCA.  There are moderate atherosclerotic\ncalcifications of the bilateral intracranial internal carotid arteries without\nsignificant narrowing.  The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without significant\nstenosis, occlusion, or aneurysm formation.  The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch.  There are\nmoderate atherosclerotic calcifications at the origins of the great vessels,\nwithout significant narrowing, most severe at the origin of the left\nsubclavian artery.  There is moderate atherosclerotic calcification at the\norigin of the right subclavian artery without significant narrowing.  There is\nmild right and trace left atherosclerotic calcification at the origins of the\nvertebral arteries without significant narrowing.  There is moderate\natherosclerotic calcification at the bilateral carotid bifurcations.  There is\nadditional focal moderate calcification in the proximal left internal carotid\nartery producing up to 60% stenosis by NASCET criteria.  There is 80% stenosis\nof the right internal carotid artery by NASCET criteria just distal to\nbifurcation.  There is also moderate left and mild right narrowing of the\nexternal carotid artery origins.  The carotid and vertebral arteries and their\nmajor branches otherwise appear patent without evidence of dissection or\nocclusion.\n\nOTHER:\nThere is a 3 mm nodule in the right upper lobe (07:23).  Small areas of mucous\nplugging are noted in the subsegmental upper lobe airways (07:54, 60).  The\nimaged lung apices are otherwise clear.  There are bilateral thyroid nodules,\nwith up to a 14 mm densely rim calcified nodule in the right lobe (7:91). \nThere is no lymphadenopathy by CT size criteria.  There is moderate multilevel\ncervical spondylosis.  Lucency through the anterior arch of C1 is unchanged\ndating back to ___.",
            "output": "1. No acute intracranial abnormality.\n2. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n3. 80% right and 60% left stenosis of the proximal internal carotid arteries\nby NASCET criteria.\n4. Otherwise patent cervical arterial vasculature without occlusion or\ndissection.\n5. 3 mm pulmonary nodule in the right upper lobe.\n6. Multiple bilateral thyroid nodules with up to a 14 mm densely rim calcified\nnodule in the right lobe.  The ___ College of Radiology guidelines\nsuggest that in the absence of risk factors for thyroid cancer, no further\nevaluation is recommended.\n\nRECOMMENDATION(S):\n1. The ___ Society guidelines for pulmonary nodule guidelines suggest\nfor pulmonary nodules less than or equal to 4mm, no follow-up needed in\nlow-risk patients, and 12 month follow-up in high risk patients.\n2.  Thyroid nodule.  No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150."
        },
        {
            "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or midline\nshift.  The ventricles and sulci are normal in size and configuration.\n\nSurrounding soft tissue stranding and swelling seen along the left face. \nThere is a minimally displaced fracture through the left nasal bone.  There is\nno evidence of skull fracture.  Minimal fluid level of the left maxillary\nsinus.  Otherwise, the remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.  The visualized portion\nof the orbits are unremarkable.",
            "output": "1. Soft tissue swelling and stranding along the left face.\n2. Left nasal bone fracture, to be correlated clinically regarding acuity.\n3. No evidence of intracranial hemorrhage or skull fracture.\n4. Minimal fluid level of the left maxillary sinus.\n5. Please see dedicated maxillofacial CT for assessment of facial bones."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.  The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is moderate to severe stenosis involving the entire M1 segment of left\nMCA with focal stenosis also involving the M2 branches.  Otherwise,\nintracranial vasculature is grossly unremarkable without other areas of focal\nstenosis. The intracranial is circulation is patent with no aneurysm formation\ngreater than 3 mm.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.  There is thin\nlinear filling defect along posterior wall the proximal right ICA just distal\nto the bulb (04:37), raising possibility of a small carotid web..\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear.  The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.",
            "output": "1. No acute intracranial abnormality.\n2. There is moderate to severe stenosis involving the M1 and proximal M2\nbranches of the left MCA.  Otherwise, unremarkable intracranial vasculature.\n3. Possible small right sided carotid web.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. No dural venous sinus thrombosis.\n\nNOTIFICATION:  Updated left MCA findings were discussed by Dr. ___ with Dr.\n___ at 16:15 on ___."
        },
        {
            "input": "The patient is status post extraction ___ 32.  , there is mild mucosal\nthickening the right maxillary sinus, likely consistent with mucous retention\ncyst.  Subtle fat stranding within the subcutaneous tissue overlying both both\nplatysma muscles (image 15, series 2),  with a 6 x 8 mm in transverse\ndimension rounded area of low density, probably consistent with small amount\nof fluid on the left platysma. Evaluation of the aerodigestive tract\ndemonstrates no exophytic mass, nor areas of focal mass effect. Evaluation of\nthe cervical lymph chains demonstrate no pathologic lymphadenopathy by imaging\ncriteria. The visualized salivary glands are unremarkable in appearance. No\nthyroid mass is seen. Neck vessels are patent without associated fat\nstranding. Upper lung fields are clear. No bony abnormality is seen.",
            "output": "1.   Subtle fat stranding within subcutaneous tissue overlying both platysma\nmuscles may be postsurgical in nature however can be seen in the setting of a\nmild cellulitis.  Clinical correlation is recommended.\n2.  6 x 8 mm in transverse dimension rounded area overlying the area of the\nleft platysma muscle, suggestive of a small amount of fluid.  There is no\nevidence of extension into the danger space or upper mediastinum.  The major\nvascular structures appear patent."
        },
        {
            "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus.\nExuberant vascular calcifications are seen in the posterior fossa. There is\nbeen no significant interval change. Mild to moderate brain atrophy and small\nvessel disease are seen.",
            "output": "No acute intracranial abnormalities are identified.  No change since the\nprevious CT examination."
        },
        {
            "input": "There is no evidence of hemorrhage, acute infarction, edema, mass, or mass\neffect.  A 6 mm hypodensity in the area of the right basal ganglia/external\ncapsule may represent sequela of prior/chronic lacunar infarct versus a\ndilated perivascular space.  Elsewhere, there is preservation of gray-white\nmatter differentiation.  The basal cisterns are patent.  There is no shift of\nnormally midline structures.  Prominence of the ventricles and sulci is\ncompatible with age-related atrophy.  Periventricular and subcortical white\nmatter hypodensities are compatible with chronic small vessel ischemic change.\nHyperostosis frontalis interna is noted.  The visualized paranasal sinuses and\nmastoid air cells are clear.  The patient is status post bilateral lens\nremoval; otherwise, the globes and bony orbits are unremarkable.",
            "output": "1. No acute intracranial process.\n2. Chronic findings including global atrophy and chronic white matter small\nvessel ischemic change."
        },
        {
            "input": "There is no acute large territorial infarction, intracranial hemorrhage, edema\nor mass effect.  A punctate hypodensity in the right basal ganglia/ external\ncapsule is unchanged and may represent a chronic lacune versus perivascular\nspace.  Periventricular and subcortical white matter hypodensities are\nnonspecific, though likely sequelae of small vessel ischemic disease. \nProminent ventricles and sulci suggest age-related involutional changes.\n\nNo acute fracture identified.  Hyperostosis frontalis interna is noted.  There\nis mild mucosal thickening of left ethmoid air cells come anteriorly.  Minimal\nair slight secretions are seen in the left frontal sinus.  Mastoid air cells\nand middle ear cavities are well aerated.",
            "output": "1. No acute intracranial process."
        },
        {
            "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema, or mass effect.  A punctate hypodensity in the\nright basal ganglia may represent a chronic lacune versus perivascular space\nand appears similar to prior.  Subcortical and periventricular white matter\nhypodensities are nonspecific, likely the sequelae of small vessel ischemic\ndisease in a patient of this age.  There is prominence of the ventricles and\nsulci suggestive of involutional changes.  Atherosclerotic calcifications are\nseen along bilateral carotid siphons.\n\nThere is no evidence of fracture.  Hyperostosis frontalis interna is noted. \nThe partially imaged left maxillary sinus demonstrates new opacification with\nsubtle sclerosis of the sinus wall, suggesting chronic inflammation.  There is\nmild mucosal thickening of the ethmoid air cells.  The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits show bilateral lens replacement.",
            "output": "1. No acute intracranial process.\n2. Paranasal sinus disease."
        },
        {
            "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect.  Ventricles and sulci are prominent, consistent with age-related\nglobal parenchymal loss.  Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nmicrovascular ischemic disease.  Again seen in the right basal ganglia is\npunctate hypodensity, likely prior lacune versus perivascular space.  These\nfindings are similar to prior.\n\nThere is no evidence of acute fracture.  Again seen is hyperostosis frontalis\ninterna, unchanged.  There is near complete opacification of the left\nmaxillary and frontal sinuses.  There is also a mild-to-moderate mucosal\nthickening of the bilateral anterior ethmoid air cells, left greater than\nright.  Mastoid air cells and middle ear cavities are clear.",
            "output": "1. No acute intracranial abnormality.\n2. Unchanged global parenchymal loss and likely sequela of chronic\nmicrovascular ischemic disease.\n3. Paranasal sinus disease, as above."
        },
        {
            "input": "Evaluation is limited by patient motion.  There is no evidence of a grossly\ndisplaced fracture, large acute territorial infarction,hemorrhage,edema,or\nmass.  There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere is near complete opacification of the left maxillary sinus.  The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare otherwise clear.  Status post bilateral lens replacement; the\nvisualized portion of the orbits are otherwise normal.",
            "output": "1. Evaluation is significantly limited by patient motion.  Within this\nlimitation, no large hemorrhage or acute territorial infarction is identified.\n2. Chronic small vessel ischemic disease.  Involutional changes.\n3. No acute displaced calvarial fracture."
        },
        {
            "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass.  Mild\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely represent sequela of chronic small vessel ischemic disease.  There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is severe bilateral hyperostosis frontalis interna.  Other than mild\nmucosal thickening in the left maxillary sinus and the left anterior ethmoid\nair cells, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.  Status post bilateral lens replacement. \nOtherwise, the visualized portion of the orbits are normal.",
            "output": "No evidence of fracture, hemorrhage or infarction."
        },
        {
            "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.   There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nNote is made of hyperostosis frontoparietalis.  There is near complete\nopacification of the left frontal sinus and partial opacification of the\nbilateral anterior ethmoid air cells; otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nStatus post bilateral lens replacement; otherwise, the visualized portion of\nthe orbits are normal.",
            "output": "1. No acute hemorrhage or infarction identified.\n2. Atrophic changes.  Probable sequelae of chronic small vessel ischemic\ndisease."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThere are scattered periventricular and subcortical white matter\nhypodensities, nonspecific but likely reflect sequelae of chronic small vessel\nischemic disease.  There is no evidence of infarction,hemorrhage,edema,ormass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits demonstrate\npostsurgical changes related to bilateral lens replacement with a right\nscleral band.\n\nCTA HEAD:\nThere is a stent in the M1 segment of the left middle cerebral artery.  There\nis mild calcified atherosclerotic plaque in the bilateral cavernous and\nsupraclinoid segments of the internal carotid arteries.  There is fetal type\norigin of the bilateral posterior cerebral arteries, a normal anatomic\nvariant.\nThe vessels of the circle of ___ and their principal intracranial branches\notherwise appear patent without stenosis, occlusion, or aneurysm.  The dural\nvenous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcifications are noted along the aortic arch and origins of\nthe major vessels without stenosis.\nBilateral carotid and vertebral artery origins are patent.\nCalcified and noncalcified atherosclerotic plaque is noted at the bilateral\ncommon carotid artery bifurcations resulting in 20% stenosis of the proximal\nleft internal carotid artery and no stenosis of the right internal carotid\nartery by NASCET criteria.\nThe carotidandvertebral arteries and their major branches otherwise appear\npatent with no evidence of stenosis or occlusion.\n\n\nOTHER:\nThe visualized portion of the lungs are clear.  The visualized portion of the\nthyroid gland is demonstrates a 9 mm hypodense nodule in the right thyroid\nlobe.  There is no lymphadenopathy by CT size criteria.",
            "output": "1. No evidence of infarction, hemorrhage, mass effect or midline shift.\n2. Scattered periventricular and subcortical white matter hypodensities,\nnonspecific but may reflect sequelae of chronic small vessel ischemia.\n3. Stent in the left M1 segment of the MCA.  Comparison with prior studies may\nbe helpful for further evaluation.\n4. Otherwise patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n5. Mild atherosclerotic plaque at the bilateral common carotid artery\nbifurcations with 20% atheromatous stenosis of the proximal left internal\ncarotid artery.\n6. Otherwise patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection."
        },
        {
            "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.",
            "output": "No acute intracranial process.  Of note MR is more sensitive in detection of\ninfarcts."
        },
        {
            "input": "There is a large subgaleal hematoma overlying the right frontal and parietal\nbone. There is no underlying fracture. There is no evidence of acute large\nterritorial infarction,intracranial hemorrhage,edema,or mass.  There is a\nprobable chronic infarct in the pons (02:10).  Additional chronic lacunar\ninfarcts are present in both basal ganglia, and right centrum semiovale. \nAdditional periventricular and subcortical white matter hypodensity is\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease.  There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\n There is mucosal thickening in the anterior ethmoid air cells, otherwise the\nparanasal sinuses are clear.  Right mastoid air cells are under pneumatized\nand partially opacified.  Left mastoid air cells appear clear.  The visualized\nportion of the orbits are unremarkable, with the exception of bilateral lens\nreplacements.",
            "output": "1. Large right frontoparietal subgaleal hematoma.  No underlying calvarial\nfracture or intracranial hemorrhage.\n2. Multiple chronic lacunar infarcts, as described above."
        },
        {
            "input": "There are several metallic staples within the subcutaneous tissues of the\nright vertex with interval decrease in size of the previously-seen subgaleal\nhematoma.  There continues to be a hyperdense frontoparietal scalp hematoma\nmeasuring up to 4.3 x 1.5 cm in the axial plane.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass.  Redemonstration of hypodensities in the right pons (series 2, image 14)\nand in the right posterior centrum semiovale (series 2, image 23), which\nlikely represent chronic infarcts.  The ventricles and sulci are normal in\nsize and configuration for age.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The right\nmastoid air cells are underpneumatized.  Patient is status post bilateral lens\nreplacements.  The visualized portions of the orbits are otherwise\nunremarkable.",
            "output": "Interval decrease in size of large right subgaleal hematoma, although there\nappears to be a residual collection of acute blood products.  No evidence of\nadditional intracranial or extracranial hemorrhage."
        },
        {
            "input": "There is trace minimal parafalcine subdural hematoma along the mid falx\nextending posteriorly, similar compared to ___ allowing for\ndifferences in modality.  Hematoma is less dense compared to the ___,\ncompatible with evolution.  There is no evidence of acute territorial\ninfarction, edema, or large mass.  Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent chronic small\nvessel ischemic disease. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture.  There is mild mucosal thickening in the\nanterior ethmoid air cells.  The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear.  The orbits\nare unremarkable. There is bilateral carotid siphon and vertebral artery\ncalcification.",
            "output": "Trace minimal parafalcine subdural hematoma along the mid falx extending\nposteriorly, similar in size compared to ___ allowing for differences\nin modality. Hematoma is less dense compared to the ___, compatible\nwith evolution."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nTrace amount of hyperdense material tracking along the posterior left aspect\nof the falx is compatible with a small subdural hematoma.\n\nThere is no evidence of infarction or mass effect.  There is mild\nperiventricular white matter hypoattenuation compatible with small vessel\ndisease.  The ventricles and sulci are normal in size and configuration. 7 x 9\nmm in transverse dimension and 8 by 17 mm in sagittal projection calcification\ncentered in the right tentorium is again seen and appears unchanged as well as\nfrontal and parietal dural calcifications.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcifications of the carotid siphons.  There is a partial\npersistent fetal origin of the left PCA with a diminutive left P1 segment,\nlikely congenital.  There is mild-to-moderate focal narrowing of the right PCA\nP2 segment (5:97).  The vessels of the circle of ___ and their principal\nintracranial branches appear normal otherwise with no evidence of stenosis,\nocclusion, or aneurysm.  There are mild calcifications of the intracranial\nvertebral arteries.  The dural venous sinuses are patent.\n\nThere are calcifications of the visualized carotid bifurcations.\n\nDegenerative changes of the upper cervical spine, consistent with anterior and\nposterior spondylosis and uncovertebral hypertrophy at C2-C3 and C3-C4 levels\nare partially evaluated this examination.",
            "output": "1. There is a trace amount of hyperdense material tracking along the posterior\nleft aspect of the falx compatible with a small subdural hematoma.\n2. No intracranial dissection, aneurysm or occlusion.\n3. Mild-to-moderate focal narrowing of the right PCA P2 segment.\n4. Mild white matter small vessel disease.\n5. Dystrophic dural calcifications appear unchanged."
        },
        {
            "input": "Again seen is relatively stable focal hyperdensity along the superior,\nposterior fall also (series 2, image 24, 25), measuring 4 mm in width,\nconsistent with the extra-axial hemorrhage, most likely representing acute\nsubdural hematoma versus less likely subarachnoid hemorrhage.  There is no\nevidence of large territorial infarction edema,or mass effect.  Ventricles and\nsulci are mildly prominent consistent with age-related global parenchymal\nloss, unchanged compared to prior.  Periventricular, subcortical, and deep\nwhite matter hypodensities are mild and nonspecific, but likely represent\nsequela of chronic microvascular ischemic disease.\n\nThere is no evidence of acute fracture.  There is mild mucosal thickening of\nthe bilateral maxillary sinuses and anterior ethmoid air cells. Mastoid air\ncells and middle ear cavities are clear.  Patient is status post bilateral\nlens resections.",
            "output": "1. Relatively unchanged hyperdensity along the falx consistent with relatively\nunchanged extra-axial hemorrhage, most likely subdural hematoma.  No\nsuggestion of large territorial infarction, edema, or mass effect.\n2. Prominence of the ventricles and sulci consistent with age-related global\nparenchymal loss and likely sequela of chronic microvascular ischemic disease."
        },
        {
            "input": "Left frontal lobe encephalomalacia with ex vacuole dilatation of the frontal\nhorn of the left lateral ventricle remains unchanged.  There is no evidence of\nnew acute territorial infarction,hemorrhage,edema,or mass.  There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nPatient is status post bilateral lens replacement.  Otherwise the orbits are\nunremarkable.",
            "output": "1. No acute intracranial process.\n2. No calvarial fracture."
        },
        {
            "input": "Extensive hypodensity involving the left temporal lobe, occipital lobe,\nbilateral thalami, and the left aspect of the midbrain (2; 16) consistent with\nposterior cerebral artery territory infarction.  Additionally, hypodensities\nare noted in bilateral cerebellum (2; 11).  Encephalomalacia is noted in the\nright occipital lobe consistent with prior infarct.  There is hyperdensity of\nthe distal basilar suggesting thrombus.  There is no evidence of hemorrhage,\nedema, or mass.  There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.  Periventricular and subcortical white matter\nhypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits demonstrate bilateral lens replacement.\n\nET tube is partially visualized.",
            "output": "1. Extensive hypodensity involving the left temporal lobe, left occipital\nlobe, bilateral thalami, and the left mid brain consistent with large left PCA\nterritory infarct as well hypodensities in as bilateral cerebellum are noted.\n2. No evidence of midline shift or hemorrhage."
        },
        {
            "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass.  The ventricles and sulci are normal in size and configuration.\n\nThere is a small right parietal subgaleal hematoma.  There is mild mucosal\nthickening throughout the ethmoid air cells.  There is minimal opacification\nof a right sided mastoid air cell.  There is no evidence of fracture.  The\nvisualized portion of the paranasal sinuses, left mastoid air cells, and\nmiddle ear cavities are clear.  The visualized portion of the orbits are\nunremarkable.",
            "output": "Small right parietal subgaleal hematoma without calvarial fracture or\nintracranial hemorrhage."
        },
        {
            "input": "Study is limited by motion.\nThere is no evidence of infarction, hemorrhage, edema, or mass.  The\nventricles and sulci are slightly prominent for the patient's age, suggesting\nmild cortical volume loss, however, this finding is nonspecific.\n\nThere is mild soft tissue swelling in the right parietal region (image 25,\nseries 28), there is no evidence of underlying fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.  The visualized portion of the orbits are unremarkable.",
            "output": "1. Study is limited by motion. No acute intracranial process.\n2. Mild soft tissue swelling is noted on the right parietal convexity with no\nevidence of underlying fracture.\n3. Prominent sulci for the patient's age, suggesting cortical volume loss,\nthis finding however is nonspecific."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\nThe hypodensity associated with loss of gray-white matter differentiation in\nthe right temporal and occipital lobes in the PCA distribution is consistent\nwith known acute infarct.  Elsewhere, there is no evidence of additional acute\ninfarction, hemorrhage, edema, mass, or mass effect.  The ventricles and sulci\nare normal in caliber and configuration.  The basal cisterns are patent.  The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nwell pneumatized and clear.  The globes and orbits are unremarkable.\n\nCTA HEAD:\nThere is likely severe/occlusion stenosis involving the proximal P2 segment of\nthe right PCA (series 3, images 249 and 248).  The PCA distal to this on the\nright is not well seen.  There is relative oligemia of the right\ntemporo-occipital infarcted area as compared with the normal left side.  There\nis a small, approximately 2 x 2 mm posteromedially projecting infundibulum at\nthe expected origin of the right posterior communicating artery (3:247). \nThere is mild focal luminal narrowing of the very proximal M1 segment of the\nright MCA (3:250), presumably related to underlying atheromatous disease. \nOtherwise, the remainder of the circle of ___ vasculature and principal\nintracranial branches are patent without additional area of stenosis,\nocclusion, or aneurysm.  The major dural venous sinuses are grossly patent.\n\nCTA NECK:\nPatent bilateral vertebral and carotid arteries in the neck.  No ICA stenosis\nby NASCET criteria.  No dissection.\n\nOTHER:\nScattered bilateral multilevel cervical lymph nodes are not pathologically\nenlarged.  Thyroid is within normal limits.  Bone apices are grossly clear. \nNo concerning focal osseous lesions.",
            "output": "1. Severe luminal stenosis of the proximal P2 segment of the right PCA, with\nsegments distal to this not well seen/opacified.  Relative oligemia of the\nright temporo-occipital PCA distribution infarct.\n2. 2 x 2 mm posteromedially projecting infundibulum arising from the expected\nlocation of the origin of the right posterior communicating artery.\n3. Mild focal luminal stenosis of the proximal segment of the right MCA\npresumably due to underlying atheromatous disease.\n4. Otherwise, patent and unremarkable circle ___ vasculature.\n5. Hypodensity in the right medial temporal and occipital lobes corresponding\nto known acute infarct in this location.  No acute intracranial hemorrhage.\n6. Patent bilateral vertebral and carotid arteries in the neck.  No ICA\nstenosis by NASCET criteria."
        },
        {
            "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns are patent. There is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The soft tissues and orbits are\nunremarkable.",
            "output": "No acute intracranial abnormality."
        },
        {
            "input": "Patient motion degrades evaluation of the exam and making this a nondiagnostic\nstudy.",
            "output": "Nondiagnostic study secondary to degradation from patient motion."
        },
        {
            "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of acute hemorrhage or infarction.  Patient is status\npost occipital craniotomy.  An unchanged 1.7 x 1.6 cm calcified rounded lesion\nis seen in the left posterior fossa, and likely represents a calcified\nmeningioma, with no significant mass effect, there are multiple unchanged\nsupratentorial dural-based calcifications.  There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is near complete opacification of the right maxillary sinus.  The right\nmastoid air cells are also opacified.  These findings may indicate chronic\nsinus disease.  The other visualized portions of the paranasal sinuses,left\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid arteries appear normal without evidence of stenosis or occlusion. \nThere is dominance of the left vertebral artery as compared to the right\nvertebral artery, which is a normal anatomic variant.  The rightvertebral\nartery appears to be hypoplastic at the V4 segment as compared to the left\nvertebral artery V4 segment, but appears patent and is most likely congenital.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nAtherosclerotic calcifications are noted in the aortic arch, the origin of the\nright vertebral artery, bilateral bifurcations of the carotid arteries, and\nthe bilateral carotid siphons.  There is slight fullness noted of the left\npiriform recess as compared to the right.\n\nCervical spine alignment is maintained.\n\nOTHER:\nSmall pleural effusions are seen bilaterally, right greater than left.   The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.",
            "output": "1. Hypoplastic V4 segment of the right vertebral artery without significant\nocclusion or stenosis.  No aneurysm is seen greater than 3 mm.\n2. There is a 1.7 x 1.6 cm calcified rounded lesion in the left posterior\nfossa which most likely represents a calcified meningioma, with no evidence of\nmass effect.\n3. Near complete opacification of the right maxillary sinus and right mastoid\nair cells, which may indicate chronic sinus disease.\n4. Small pleural effusions seen in the bilateral lungs, right greater than\nleft.\n5. Atherosclerotic calcifications seen bilaterally throughout the vasculature,\nas described above.\n6. No evidence of acute hemorrhage, infarcts, or fractures."
        },
        {
            "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct.  Gray-white matter\ndifferentiation is preserved.  There is no hydrocephalus.  The visualized\nparanasal sinuses minimal mucosal thickening of the bilateral ethmoid air\ncells.  The remainder of the partially imaged paranasal sinuses are clear.. \nThe mastoid air cells are clear.  No acute fracture is seen.",
            "output": "No acute intracranial process."
        },
        {
            "input": "Evaluation is moderately limited by motion beam hardening artifact at the\nvertex and skullbase.  No acute intracranial hemorrhage, edema, or mass effect\nis identified.  Ventricles and sulci are normal in size configuration. Pineal\ncalcification noted incidentally.\n\nNo acute fracture is see..  There is mild mucosal thickening of the ethmoid\nsinuses.  The remaining the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.",
            "output": "1. No acute intracranial process on mildly motion limited exam."
        },
        {
            "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.  Hyperdense appearance of the dura along the right frontal lobe at\nthe site of prior surgery likely region reflect postsurgical change. \nVentricles and sulci appear normal in overall pattern.  Basilar cisterns are\npatent.  Minimal mucosal thickening within the maxillary sinuses.  Mastoid air\ncells and middle ear cavities appear well aerated.  Postsurgical changes\ninvolving the frontal bone noted.",
            "output": "No acute intracranial process.  Postsurgical changes in the right frontal\nlobe."
        },
        {
            "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia.  There is minimal amount of fluid layering within the\nleft mastoid air cells, which are otherwise clear.  There is no abnormal\nenhancement on post contrast imaging.\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear. There is no abnormal enhancement\non post contrast imaging.\nOther: Visualized brain and neck soft tissues are normal.",
            "output": "1. Minimal amount of fluid layering within the left mastoid air cells. \nOtherwise, normal temporal bone examination.\n2. No acute intracranial process noted within visualized portions of the\nbrain.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 5:38 ___, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "A mixed density subdural hemorrhage overlying the right cerebral hemisphere\nmeasures 1.6 cm in greatest axial thickness, similar to the prior study. \nSubdural hemorrhage is also seen layering along the falx and tentorium.  There\nis moderate sulcal and right lateral ventricle effacement resulting in 12 mm\nleftward midline shift, previously 11 mm.  There is partial effacement of the\nfrontal and temporal horns of the right lateral ventricle.\n\nThere is no intraventricular hemorrhage, intraparenchymal hemorrhage, or\nsubarachnoid hemorrhage visualized.  There is no evidence of acute major\nvascular territorial infarction.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated.\n\nThe bony calvarium is intact.",
            "output": "Acute on chronic right subdural hemorrhage with 12 mm leftward midline shift,\nnot significantly changed since the prior study."
        },
        {
            "input": "Patient is status post right-sided craniotomy for evacuation of subdural\nhematoma.  Expected postsurgical changes are noted, including small amount of\nnearby edema and blood products, as well as moderate pneumocephalus along the\nright frontal convexity.  Small amount of residual blood is seen layering\nalong the falx.  No evidence of new intracranial hemorrhage or acute large\nterritorial infarction.  Persistent effacement of the right-sided sulci and\nright lateral ventricle.  Leftward shift of midline structures measures 5 mm,\nimproved from 12 mm on prior study.\n\nDense vascular atherosclerotic calcifications are seen in the carotid siphons\nbilaterally.  The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.  The visualized portion of the\norbits are unremarkable.",
            "output": "1. Expected postsurgical changes status post right-sided craniotomy for\nevacuation of subdural hematoma.\n2. Mild persistent effacement of the right-sided sulci and right lateral\nventricle, with leftward shift of midline structures measuring 5 mm, improved\nfrom 12 mm on prior study.\n3. No evidence of new intracranial hemorrhage or acute large territorial\ninfarction."
        },
        {
            "input": "Again demonstrated are postsurgical changes related to a right-sided\ncraniotomy with interval decrease in now small volume pneumocephalus.  There\nhas been interval removal of the intracranial drain.  There has been improved\neffacement on the right lateral ventricle now with 4 mm of right-to-left\nmidline shift, previously 5 mm (02:16).  There is decreased right frontal\nsulcal edema compared to prior exam.  Hyperdense material, likely compatible\nwith postoperative blood products, at the evacuation site appear similar to\nslightly decreased in extent.  Residual hemorrhagic blood products near the\nanterior falx is decreased compared to recent exam, currently measuring up to\n6 mm in width, previously 8 mm (02:23). Isodense subdural collection in the\nright frontal convexity measures up to 5 mm in width and was previously\nobscured by pneumocephalus on the prior exam (02:16).  There is no new areas\nof intracranial hemorrhage or evidence of infarction.\n\nMultiple surgical skin staples are seen overlying the right frontotemporal\nconvexity.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.  Patient is status post bilateral lens replacements.",
            "output": "1. Status post right sided craniotomy with interval removal of an intracranial\ndrain and improved pneumocephalus.\n2. Improved effacement of the right lateral ventricle and right frontal sulci\nwith now 4 mm of leftward midline shift, previously 5 mm.\n3. Interval decrease in hemorrhagic blood products at the anterior falx.\n4. No new areas of intracranial hemorrhage."
        },
        {
            "input": "Right parietal craniotomy.  Interval near resolution of right hemispheric\nsubdural collection, tiny residual low-density collection..  Mild dural\nthickening.  No acute blood products.  Mild-to-moderate cerebral, moderate\ncerebellar atrophy.  Findings consistent with mild chronic small vessel\nischemic change..  Mild opacification inferior bilateral mastoid air cells,\nwith calcification, consistent with chronic from a shin..  Minimal paranasal\nsinus disease.  Degenerative arthritis right temporomandibular joint.",
            "output": "Near resolution of subdural fluid collection.\nBrain parenchymal atrophy."
        },
        {
            "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus.  Visualized paranasal sinuses and mastoid\nair cells are clear.  There is no fracture.",
            "output": "Unremarkable unenhanced head CT."
        },
        {
            "input": "The examination is partially limited due to patient motion. There is no acute\nintracranial hemorrhage,acute infarction, mass or midline shift.  The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is preservation of gray-white matter differentiation. The\norbits are unremarkable. There is no fracture. The visualized paranasal\nsinuses, middle ear cavities and mastoid air cells are clear.  There has been\nno significant interval change compared to the same day prior study.",
            "output": "Unremarkable unenhanced head CT without change from earlier same day\nexamination."
        },
        {
            "input": "There has been interval placement of a bolt through the right frontal bone\nwhich terminates approximately 1.2 cm into the right frontal lobe as measured\nfrom the inner table of the calvarium. There is no evidence of hemorrhage,\nhowever, hardware artifact limits sensitivity for detection of hemorrhage in\nthe immediate vicinity of the bolt. There is no evidence of infarction, mass\nor edema, or shift of normally midline structures. There is no\nventriculomegaly. The paranasal sinuses and mastoid air cells are clear. There\nis no evidence of fracture.",
            "output": "1. Interval placement of right frontal bone bolt. No evidence of hemorrhage;\nhowever, hardware artifact limits sensitivity for detection of hemorrhage in\nthe immediate vicinity of the bolt.\n2. Otherwise, unchanged unenhanced head CT."
        },
        {
            "input": "Again seen is right frontal bolt insertion through the frontal bone, in\nunchanged position.  There is no evidence of hemorrhage; however, sensitivity\nfor detection of hemorrhage is lowered in the immediate vicinity of the bolt\ndue to hardware artifact.\n\nThere is no evidence of infarct, mass effect, edema, shift of normally midline\nstructures, or ventriculomegaly. The basal cisterns are patent.  The\nvisualized paranasal sinuses are clear. The mastoid air cells are clear. There\nis no evidence of fracture.",
            "output": "No evidence of hemorrhage; however, CT sensitivity for detection of hemorrhage\nis lowered in the immediate vicinity of bolt due to hardware artifact.  No\nsignificant interval change in unenhanced CT head."
        },
        {
            "input": "There is a small hypodense tract in the right frontal lobe with a punctate\nhigh density focus which may represent trace blood products with prior bolt\nplacement. There is no other focus of hemorrhage,acute infarction, mass or\nmidline shift.  There is no hydrocephalus.  The ventricles and sulci are\nnormal in size and configuration. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. The orbits are\nunremarkable.  Visualized paranasal sinuses and middle ear cavities are clear.\nCompared to the prior study, there has been interval increased opacification\nof the bilateral mastoid air cells.  There is no fracture.",
            "output": "1. Small hypodense tract in the right frontal lobe with punctate focus of\ntract hemorrhage from removal of bolt hardware.\n2. Interval increase in opacification of the bilateral mastoid air cells which\nin the correct context could represent mastoiditis/related to intubation, etc.\nCorrelate clinically"
        },
        {
            "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture.  The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.  The visualized\nportion of the orbits are unremarkable.",
            "output": "1. No acute intracranial abnormality.\n2. No evidence of intracranial mass."
        },
        {
            "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are prominent, associated with age-advanced\ninvolution changes. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.",
            "output": "No acute intracranial abnormalities."
        },
        {
            "input": "Interval right parietal craniotomy, and surgical resection of a ring-enhancing\ncystic mass lesion of the right parietal lobe, with expected postsurgical\nchanges. There is postprocedural pneumocephalus with small foci of air in the\nright parietal lobe and along the right frontal convexity and surgical cavity.\nPostsurgical subarachnoid hemorrhage along the sulci adjacent to the surgical\nbed, extending anteriorly towards the falx and leftward into the left parietal\nlobe. There is no mass effect or midline shift. Persistent and grossly\nunchanged vasogenic edema is noted in the surgical bed.\n\nThere are mild aerosolized secretions of the bilateral maxillary sinuses.  The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.  The visualized portion of the orbits are\nunremarkable.",
            "output": "1. Status post interval right parietal craniotomy, and surgical resection of a\nright parietal lobe ring-enhancing cystic mass lesion, with expected\npostsurgical changes, including pneumocephalus, subarachnoid hemorrhage, and\nvasogenic edema of the surgical bed as described above.\n2. No mass effect or midline shift."
        }
    ]
}