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Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previuos measurements History: none CHEST:LUNGS AND PLEURA: Apical scarring. No new pulmonary nodules.MEDIASTINUM AND HILA: Scattered small subcentimeter lymph nodes are unchanged. Calcified thyroid nodule unchanged. Status post CABG. severe coronary calcification.CHEST WALL: Status post sternotomy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy. Small splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic presumed left renal cyst, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube has been removedBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: adenoid cystic ca eval for mets History: adenoid cystic ca eval for mets LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules are present, one which is calcified. No suspicious pulmonary nodule or masses seen. No consolidation or pleural effusion.MEDIASTINUM AND HILA: Nonspecific thyroid hypodensities are present. No mediastinal or hilar lymphadenopathy seen. The heart is normal in size and there is no pericardial effusion. No coronary calcifications are present.CHEST WALL: Bilateral subglandular saline breast implants are seen in place. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. A gallstone is noted without evidence of complication. | No evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | There are unchanged posttreatment findings related to right tonsillectomy and right neck dissection with no mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. Right distal internal jugular venous thrombosis is again seen superior to the site of right MediPort catheter entry. The remaining major cervical vessels are patent. The osseous structures are unchanged with moderate multilevel cervical degenerative changes. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Stable posttreatment findings with no locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Female 63 years old Reason: protuberance at right clavicular head, lipoma vs. cyst vs. mass History: none Focused ultrasound performed over the right sternoclavicular joint. There is soft tissue in the sternoclavicular junction with mild capsular hypertrophy. There is no fluid collection, soft tissue mass or cyst. The appearance is suggestive of osteoarthritic change.Incidental note is made of multiple thyroid nodules. There is a solid nodule with a hypoechoic rim in the left thyroid lobe measuring 1.1 x 0.7 x 0.7 cm. The appearance is suspicious for a follicular neoplasm. | 1. Osteoarthritis of the right sternoclavicular joint. No fluid collection, cyst or soft tissue mass.2. Incidental note is made of multiple thyroid nodules which are incompletely evaluated on this study. A left thyroid nodule is suspicious for a follicular neoplasm. Dedicated thyroid ultrasound should be considered for further evaluation. |
Generate impression based on findings. | 4-year-old male with cough and coarse breath sounds.VIEW: Chest AP (one view) 2/8/2015 1041 Right upper extremity central venous catheter tip at IVC/right atrial junction. Endotracheal tube has been removed. Gastrostomy tube balloon is partially visualized. Normal cardiothymic silhouette. New right lower lobe airspace opacity. No pleural effusion or pneumothorax. | 1.New right lower lobe airspace opacity, for which differential considerations include atelectasis or infection.2.Right upper extremity central venous catheter tip at junction of right atrium and IVC. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is extremely dense, limiting the sensitivity of mammography and increasing the importance of physical examination, unchanged in pattern and distribution. Bilateral retropectoral saline implants are normal in contour and shape.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Reason: mets lung cancer, s/p resection and chemo. Pls c/w previous study and evalaute dx status. History: lung ca CHEST:LUNGS AND PLEURA: Extensive posttreatment changes in the left hemithorax from left lower lobectomy and XRT.Stable appearance of the left upper lobe and scarring. Small left pleural effusion stable.Emphysema. Scar like superior segment right lower lobe nodule stable at 12 x 10 mm (series 7 image 52). Nonspecific clustered micronodules within the right middle lobe are also not significantly changed (image 60/119). No new pulmonary nodules.MEDIASTINUM AND HILA: A right hilar lymph node is not significantly changed measuring 1.8 x 1.0 cm (series 5 image 44).High left paraesophageal lymph node is stable measuring 2.4 x 1.3 cm (series 5 image 16). Multiple prevascular lymph nodes also stable. Trace pericardial fluid unchanged.CHEST WALL: Multilevel degenerative changes within the spine. No focal osseous lesions. Redemonstration of multiple mildly prominent left axillary lymph nodes. A subpectoral lymph node is perhaps minimally increased in size measuring 15 x 8 mm (series 3 image 27), previously 13 x 6 mm..ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple subcentimeter hypoattenuation which are too small to characterize but stable.SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic ligament lymph nodes are stable.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: Multilevel degenerative changes. No focal suspicious osseous lesion..OTHER: No significant abnormality noted.. | Stable reference measurements as above. |
Generate impression based on findings. | Reason: pt quad and recent ddimer + but left AMA after suboptimal study History: chest pain, SOB PULMONARY ARTERIES: No evidence of pulmonary embolism to the segmental level.LUNGS AND PLEURA: 4-mm nodular density along the minor fissure (series 7, image 99) is likely a pulmonary lymph node. No other abnormal pulmonary nodules or masses. Mild basilar subsegmental atelectasis. Linear atelectasis or scarring at the left lung base. Linear scarring with calcification and bullet fragments at the left apex from prior gunshot wound.MEDIASTINUM AND HILA: The heart is normal in size. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Bullet fragments in posterior soft tissues and spinal canal. Chronic presumably post traumatic deformity of left clavicle.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter right hepatic lobe hypodensity is too small to accurately characterize. Nonspecific nodularity of the right adrenal gland, unchanged. | No evidence of pulmonary embolism. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | One day old male with increasing respiratory distress and O2 requirement.VIEW: Chest and abdomen AP (two views) 2/8/2015 1328 Chest: Endotracheal tube tip between the thoracic inlet and carina. Upper normal cardiothymic silhouette. Minimal diffuse lung haziness. No focal pulmonary opacity, pleural effusion, or pneumothorax. Left-sided aortic arch, cardiac apex, and stomach.Abdomen: Umbilical venous catheter tip at the right atrial/SVC junction. Nonobstructive organized bowel gas pattern. No pneumatosis, pneumoperitoneum, or portal venous gas. | 1.Endotracheal tube tip between thoracic inlet and carina.2.UVC tip at junction of superior vena cava and right atrium. |
Generate impression based on findings. | 86-year-old female with left shoulder pain, fall in 2013 with chronic pain, known osteoarthritis. Degenerative changes are noted about the sternoclavicular joints without acute dislocation or fracture. The partially visualized right lung consolidation, right apical chest tube and loculated air in the right apical pleural space is better appreciated on the recent previous CT. | No evidence of fracture or dislocation. The right lung consolidation, right apical chest tube and loculated air in the right apical pleural space are better appreciated on the recent chest CT. |
Generate impression based on findings. | 70-year-old female with history of fall. Evaluate for intracranial hemorrhage. There is mild confluent periventricular white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. There is no evidence of intracranial hemorrhage. No midline shift or mass effect. The basal cisterns are patent and symmetric. The visualized paranasal sinuses and mastoid air cells are clear. There is no evidence of calvarial fracture. The soft tissues of the scalp are unremarkable. | 1.No evidence of acute intracranial hemorrhage.2.Mild age-indeterminate small vessel ischemic disease. |
Generate impression based on findings. | Seven week old male with micrognathia There is micrognathia, mandibular hypoplasia, with shallow bilateral temporomandibular joint glenoid fossae.There is generalized calvarial flattening on the left involving left parietal, temporal, and occipital regions. There is no sutural overlap. Intracranial contents are unremarkable without evidence of mass, mass lesion, mass effect, or acute intracranial hemorrhage. Fluid is present within bilateral mastoid air cells and middle ear cavities. A nasogastric tube is present the left nares. | 1.There is micrognathia, mandibular hypoplasia, with shallow bilateral temporomandibular joint glenoid fossae.2.There is generalized calvarial flattening on the left involving left parietal, temporal, and occipital regions. 3.Fluid is present within bilateral mastoid air cells and middle ear cavities. |
Generate impression based on findings. | 59-year-old male with an abrasion and pain status post fall with concomitant right ankle fracture. Two views of the right knee show no evidence of a fracture or dislocation. There is mild osteophyte formation indicating osteoarthritis. There is chondrocalcinosis within the lateral aspect of the knee joint. Surgical clips are visualized within the superficial soft tissues medially. Vascular calcifications are noted in the soft tissues. | Osteoarthritis and chondrocalcinosis but no evidence of fracture or dislocation. |
Generate impression based on findings. | 59-year-old male with a right distal fibular fracture. Evaluate for medial widening. Limited evaluation with only a single view. There is an oblique fracture of the distal fibula with slight displacement and extension of the fracture into the joint. There is associated soft tissue swelling. A small avulsion fracture is noted of the distal medial malleolus. The ankle mortise joint is symmetric without evidence of widening. | Limited evaluation with only a single view. Oblique fracture of the distal fibula with slight displacement and extension of the fracture into the joint. Small avulsion fracture of the distal medial malleolus. No evidence of widening of the tibiotalar joint. |
Generate impression based on findings. | Reason: severe asthma, r/o bronchiectasis History: cough LUNGS AND PLEURA: Diffuse moderate bronchial wall thickening which is nonspecific but can be seen in asthma. There are also areas of mucus plugging. Moderate left upper lobe scarring with areas of very mild bronchiectasis and bronchial wall thickening. Patchy multifocal air trapping on expiratory phase imaging.Punctate calcified granulomas bilaterally.MEDIASTINUM AND HILA: Scattered small centimeter lymph nodes. Small hiatal hernia.CHEST WALL: Subacute right-sided rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Diffuse moderate bronchial wall thickening which is nonspecific but can be seen in asthma. There are also areas of mucus plugging. Moderate left upper lobe scarring with areas of very mild bronchiectasis and bronchial wall thickening. Patchy multifocal air trapping on expiratory phase imaging. |
Generate impression based on findings. | 79-year-old female with a skin ulcer. Rule out osteomyelitis. Two radiographic views of the right foot show diffuse soft tissue swelling about the foot and ankle with indistinctness to the cortical margin along the dorsal aspect of the foot which is highly suspicious for osteomyelitis. There is suggestion of a shallow ulcer but no gas is noted in the soft tissues. Stress fractures with callus formation are visualized about the second and third metatarsal diaphyses. Diffuse demineralization, which limits sensitivity, and diffuse moderate degenerative changes are otherwise noted about the foot similar to the previous exam. In particular degenerative changes particularly involve the medial malleolus of the ankle, which is incompletely visualized. Vascular calcifications are noted in the soft tissues. | Findings suspicious for osteomyelitis of the dorsum of the foot. This can be evaluated with a three phase bone scan or MRI if there is a need for further characterization. Stress fractures with callus formation about the second and third metatarsal diaphyses. |
Generate impression based on findings. | 42 year-old female with history of sinus pain. There is mild mucosal thickening of bilateral maxillary sinuses with air/fluid levels and obstruction of the infundibula bilaterally. Additionally, there is mild scattered mucosal thickening of the ethmoid air cells. The frontoethmoidal recesses are obstructed bilaterally. A mild rightward nasal septal deviation is present. The lamina papyracea are intact. | Mild paranasal sinus mucosal thickening and other findings as above. |
Generate impression based on findings. | Injury.VIEWS: Left elbow AP/lateral (two views) 02/09/15 Cast has been removed. Periosteal reaction encircles the proximal ulna. Periosteal reaction is noted along the posterior aspect of the distal humerus. Alignment is anatomic. | Healing fractures of distal humerus and proximal ulna. |
Generate impression based on findings. | 57 year old with history of multiple lumpectomies in the past, including most recently in January 2013. Three standard views of both breasts and left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable postsurgical changes in each breast. Bilateral benign calcifications are again noted. Intramammary lymph node in the right outer breast again seen. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 67 years old; Reason: metastatic appendiceal colon cancer / adenocarcinoma, status post debulking History: abd discomfort ABDOMEN:LUNG BASES: Trace pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonobstructive nephrolithiasis. Large left lower pole calculus measures 1.9 x 1.2 cm (series 5 and image 61) is not significantly changed compared to prior study. Retroaortic left renal vein. There is mild prominence of the mid right ureter in the region of the peritoneal thickening. This is not significantly changed compared to prior study. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes do not meet CT criteria for enlargement.BOWEL, MESENTERY: Status post omentectomy and appendectomy. Mild peritoneal thickening and nodularity without discrete measurable disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post omentectomy and appendectomy. Mild peritoneal thickening and nodularity without discrete measurable disease. Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Peritoneal thickening and nodularity suspicious for early metastatic disease, without discrete measurable disease. |
Generate impression based on findings. | 15 year old female with patellofemoral instability. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The medial facet of the trochlea and trochlear groove appear flattened, consistent with dysplasia. Again seen is chondromalacia of the patellofemoral compartment which is better characterized on the recent previous MRI. Small well corticated osseous fragments are noted along the patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1.Findings compatible with trochlear dysplasia. 2.Patellofemoral chondromalacia which is better characterized on the recent previous MRI. |
Generate impression based on findings. | Male 77 years old Reason: Please assess for recurrence of metastatic melanoma History: None CHEST:LUNGS AND PLEURA: Biapical fibrosis, unchanged.Left lower lobe micronodules again seen measuring 5 mm, previously 4 mm (series 6, image 85).Other scattered micronodules, unchanged.No pleural effusion.MEDIASTINUM AND HILA: Right hilar lymph node measuring 1.4 x 1.0 cm, previously 1.1 x 0.9 cm (series 4, image 45).Other calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease.Normal heart size without pericardial effusion.Atherosclerotic calcifications of the aorta with mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: LIVER, BILIARY TRACT: Stable left hepatic lobe cyst. Hepatic vessels are patent.No new lesions.SPLEEN: Multiple punctate calcifications, unchanged, consistent with prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Stable fusiform dilatation of the infra-renal aorta with calcifications and plaque, measuring up to 2.3 cm (series 4, image 123).PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | No evidence of residual or recurrent disease. No significant interval change. |
Generate impression based on findings. | Reason: h/o HNC, post surgical baseline History: none CHEST:LUNGS AND PLEURA: Patchy upper lobe opacities, right greater than left, are new from the prior study and likely represents areas of aspiration/infection. The findings are not typical of metastases though continued follow up is recommended. No pleural effusion is seen.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion. No coronary artery calcification.CHEST WALL: No axillary lymphadenopathy is seen.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific left liver hypodensity too small to characterize. Incidental note is made of a replaced left hepatic artery.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. | Patchy upper lobe opacities, right greater than left, are new from the prior study and likely represents areas of aspiration/infection. The findings are not typical of metastases though continued follow up is recommended. |
Generate impression based on findings. | Male; 59 years old. Reason: h/o CHF, CKD, p/w epigastric pain please evaluate for stones. LIVER: There is mild hepatomegaly. The liver measures 17.8 cm in length with coarsened echotexture. No focal hepatic lesions are identified. The main portal vein demonstrates normal directional flow, peak velocity measures 20 cm/sec.BILIARY TRACT: The gallbladder is normal in appearance without cholelithiasis, wall thickening, or pericholecystic fluid. There is no intra-or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm.PANCREAS: The head of the pancreas appears unremarkable. The pancreatic tail is not well seen due to overlying bowel gas.SPLEEN: The spleen measures 9.7 cm in length.RIGHT KIDNEY: The right kidney measures 11.2 cm and is diffusely echogenic, compatible with the patient's history of chronic kidney disease. | Mild hepatomegaly. No cholelithiasis or evidence of acute cholecystitis. |
Generate impression based on findings. | Pain to anteromedial knee. Slammed door into knee one day prior. Minimal osteoarthritis. No fracture or malalignment. | No fracture or malalignment. |
Generate impression based on findings. | Pain Limited examination with one frontal view provided.No fracture or malalignment evident. | Limited study with no abnormality evident. |
Generate impression based on findings. | 64-year-old male patient status post subtotal colectomy in 2006 for complicated diverticulitis with abscess formation presents with history of recent right lower quadrant abdominal pain. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 30 minutes. Fluoroscopic evaluation showed numerous areas of distortion in the small bowel suspicious for adhesions without evidence of obstruction or bowel dilatation, most notably in the left hemiabdomen. Series 13 and 14 are representative cine images. There was normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae. There are postsurgical changes from a subtotal colectomy with anastomosis in the pelvis at the sigmoid colon without evidence of an obstructive stricture. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 4:28 minutes | 1.Postsurgical changes from subtotal colectomy without evidence of anastomotic stricture.2.Findings compatible with nonobstructive adhesions of the small bowel, most notably in the left hemiabdomen. |
Generate impression based on findings. | Reason: pt with MRI shows signal in T2 and T12 inconclusive for hemangioma. Eval chest and vertebral bodies for masses History: chronic low back pain LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Visualized thoracic spine is essentially normal with no evidence of hemangioma. There is very minimal degenerative disc disease.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small left hepatic cyst. Status post cholecystectomy. | Visualized thoracic spine is essentially normal with no evidence of hemangioma. There is very minimal degenerative disc disease. MR is more sensitive for evaluation of spinal pathology. |
Generate impression based on findings. | Fracture.VIEWS: Right wrist PA/lateral (two views) 02/09/15 Cast has been removed.Periosteal reaction is noted along the posterior aspect of the radius. Sclerosis is seen at the buckling fracture. Alignment is anatomic. | Continued healing of fracture of distal radius. |
Generate impression based on findings. | PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement. GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: Multilevel degenerative disk disease is seen, most conspicuously affecting the C5-6 level where there is a right paracentral/foraminal disk osteophyte. | No evidence of active disease in the neck. No significant interval change compared with prior studies. |
Generate impression based on findings. | 76-year-old female with stage IV melanoma. There are innumerable enhancing, partially-enhancing and nonenhancing cutaneous and subcutaneous soft tissue lesions extending throughout the left lower extremity. Additionally, there are cutaneous and subcutaneous lesions in the visualized lower abdomen and pelvis. Reference lesion measurements are as follows:1.Anterior to the patellar tendon (series 80348, image 206) measures 23 x 11 mm, previously 23 x 11 mm.2.Anterior to the mid tibia (series 80348, image 243) measures 46 x 26 mm, previously 46 x 26 mm.3.Along the medial aspect of the lower leg (series 80348, image 285) measures 24 x 28 mm, previously 24 x 28 mm. 4.Along the medial aspect of the lower leg (series 80348, image 301) measures 25 x 15 mm, previously 25 x 15 mm.5.Posterior to the distal fibula (series 80348, image 306) measures 31 x 26 mm, previously 31 x 26 mm.Subjectively, the remaining innumerable lesions are comparable in size to the prior exam. Extensive involvement of the foot is again noted with erosion of the base of the fifth metatarsal and cuboid. Severe degenerative disease affects the lumbar spine. Moderate osteoarthritis affects both hips. Mild osteoarthritis affects the left knee. There is an arthroplasty at the first MTP joint. | Metastatic melanoma extensively seen throughout the left lower extremity without significant change in reference measurements, as described above. |
Generate impression based on findings. | Pain and swelling of the fourth finger and knuckle areaVIEWS: Left hand AP, lateral and oblique 2/9/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Reason: pulmonary opacities, history of smoking History: none LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular emphysema is present with right apical lung scarring. The right apical lung scarring correlates with the nodular opacities seen on chest radiograph. There is also a small area of nodular scarring on the left (image 66/112) which correlates with an opacity noted on prior CXR.A small right pleural effusion is present. A 1.4-cm nodule seen in the right lung base along the major fissure (image 78, series 7). MEDIASTINUM AND HILA: Right central venous catheter tip lies within the right atrium. Several prominent mediastinal lymph nodes are noted. Moderate cardiomegaly is present with mild coronary artery calcifications, however no pericardial effusion is identified. The main pulmonary artery diameter is dilated measuring up to 3.4 cm suggesting pulmonary hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. A small amount of ascites is seen in the upper abdomen. Nonspecific thickening of the adrenal glands is noted. | 1.Multiple pulmonary opacities, some of which likely represent scarring. A 1.4-cm nodule in the right lung base is also likely related to scarring or may represent an intrapulmonary lymphnode, however comparison to prior studies is recommended. If prior studies are not available, follow-up CT is recommended in 3 months to further evaluate as malignancy cannot be excluded.2.Moderate centrilobular emphysema. |
Generate impression based on findings. | Reason: Patient w/ h/o HIV, here with chronic cough, want to evaluate lung parenchyma History: cough, SOB LUNGS AND PLEURA: Mosaic attenuation is seen predominantly in the lower lobes, likely secondary to air trapping. Diffuse bronchiolar wall thickening is also present. Scattered ground glass opacities are seen in the upper lobes. There are also small centrilobular nodular opacities and scattered areas of tree in bud opacity. These findings are new from the prior study. Scattered pulmonary micronodules, many of which are calcified, are compatible prior granulomatous disease.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is seen measuring up to 1.5 cm in short axis (image 20, series 5), previously 8 mm. Moderate to severe cardiomegaly with severe coronary artery calcifications. No pericardial effusion is identified.CHEST WALL: Mild bilateral axillary lymphadenopathy is present. T10 vertebral body hemangioma is unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. A small amount of perihepatic ascites is present. Embolization coils in the left renal arteries partially visualized with cortical thinning of the visualized kidney. Hypodense, expanded appearance of the kidney may be related to prior renal artery embolization, however is partially visualized and incompletely evaluated. | 1. Upper lobe predominant ground glass opacities, diffuse bronchiolar wall thickening, mosaic attenuation, and centrilobular nodules and tree in bud likely representing bronchiolitis. An infectious bronchiolitis is favored though in an HIV patient follicular bronchiolitis can also occur. Hypersensitivity pneumonitis or drug reaction are alternative considerations. 2. Mediastinal and axillary adenopathy. |
Generate impression based on findings. | FractureVIEWS: Left ankle AP/lateral/oblique (3 views) 02/09/15 A cast has been applied. Alignment appears anatomic. Probable fracture of fibula is again seen. | Interval cast application. |
Generate impression based on findings. | 56-year-old with history of bilateral benign biopsies. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Biopsy clip again noted in the left lower outer breast. Stable asymmetry just posterior to the biopsy clip. Mild postsurgical change in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: eval for infiltrate, effusion, consolidation History: t-MDS s/p HSCT presenting with fever, LLL atelectasis v effusion on CXR LUNGS AND PLEURA: Scattered pulmonary micronodules, some calcified without new abnormal pulmonary nodules or masses. Decreased prominence of scattered areas of ground glass opacity thought to represent aspiration. No new focal air space consolidation. New small bilateral effusions with associated subsegmental atelectasis.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No mediastinal or hilar lymphadenopathy by CT size criteria. A pretracheal lymph node measures up to 0.8 cm in short axis (series 5, image 37), slightly more prominent compared to the prior exam. Mitral valvular calcifications. No significant coronary artery calcification. Mild calcification of the thoracic aorta.CHEST WALL: No axillary lymphadenopathy. Soft tissue infiltration in the anterior left upper chest may be due to manipulation from line placement. Left arm PICC, tip in the subclavian vein. Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right hepatic lobe hypodensity is incompletely evaluated on non-contrast imaging, unchanged from the prior exam. Partially visualized right renal calyceal prominence. Small hiatal hernia. | New bilateral pleural effusions may be due to volume overload. |
Generate impression based on findings. | Lower abdominal pain, evaluate for diverticulitis or abscess. ABDOMEN:LUNG BASES: Sternotomy changes are partially visualized. Mild basilar scarring/dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral simple renal cysts with additional bilateral low attenuation lesions too small to characterize but likely benign. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: There is diffuse colonic wall thickening as well as scattered mucosal hyperenhancement likely due to an infectious or inflammatory etiology. No significant diverticular disease is noted. There is an area of focal information within the pelvis adjacent to the cecum and small bowel loops (coronal series, image 50), but no drainable abscesses are present. The appendix is not definitely visualized.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diffuse colonic wall thickening as well as scattered mucosal hyperenhancement likely due to an infectious or inflammatory etiology. No significant diverticular disease is noted. There is an area of focal information within the pelvis adjacent to the cecum and small bowel loops (coronal series, image 50), but no drainable abscesses are present. The appendix is not definitely visualized.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Pancolitis likely due to infectious or inflammatory etiology, further evaluation recommended. Associated focal inflammation within the pelvis without discrete drainable abscess. Appendix not visualized. |
Generate impression based on findings. | Reason: recurrence of larynx atypical carcinoid s/p resection History: evaluate for distant disease CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified, are unchanged from the prior study. No suspicious pulmonary nodule or mass is seen. No consolidation or pleural effusion.MEDIASTINUM AND HILA: Several small paratracheal lymph nodes are unchanged in size. Large hiatal hernia is again noted. No hilar lymphadenopathy is seen. The heart is normal in size no pericardial effusion. Lipomatous hypertrophy of the interatrial septum is present. Mild coronary artery calcifications are present.CHEST WALL: No axillary lymphadenopathy is seen. Mild degenerative changes are seen throughout the lower thoracic and lower lumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Geographic hypoattenuation adjacent to the falciform ligament is unchanged from multiple prior studies and likely represents focal fatty infiltration. No suspicious liver lesion is identified. Status post cholecystectomy.SPLEEN: Accessory spleen is seen posterior medial to the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Skin thickening over the left and right anterior abdomen is favored to be iatrogenic scarring from prior procedure, however cellulitis cannot be entirely excluded. | No evidence of metastatic disease. |
Generate impression based on findings. | History of metastatic prostate cancer, evaluate disease response. CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules appear similar to prior. No suspicious nodules or masses.MEDIASTINUM AND HILA: Reference left supraclavicular lymph node (series 3, image 12) measures 1.6 x 1.1 cm, 1.2 x 1.0 cm previously. Mildly enlarged prevascular lymph node (series 3, image 43) appears similar to prior. Coronary artery calcifications.CHEST WALL: There has been interval progression of osseous metastatic disease with increased sclerotic lesions within the ribs and partially visualized lower cervical vertebral bodies. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephroureteral stents in place with improved mild hydronephrosis on the right and resolved hydronephrosis on the left.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node (series 3, image 131) measures 1.3 x 1.3 cm, previously 1.3 x 1.3 cm. Reference left para-aortic soft tissue density, likely lymph node, at level of aortic bifurcation (series 3, image 159) measures 2.8 x 1.5 cm, previously 3.2 x 1.6 cm. Atherosclerotic calcifications of the abdominal aorta and its branches with ectasia of the infrarenal aorta, unchanged.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Scattered mildly enlarged mesenteric lymph nodes appear similar to prior.BONES, SOFT TISSUES: There has been interval progression of osseous metastatic disease with increase in sclerotic lesions within the visualized thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Postoperative changes in the location of the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Enlarged mesenteric intrapelvic lymph nodes again seen. The confluent nodal group in the right pelvis now measures 3.1 x 1.7 cm (series 3, image 179), previously measuring 4.4 x 2.3 cm. Left pararectal lymph node measures 1.2 x 1.4 cm (series 3, image 168), previously 1.7 x 1.3 cm. BONES, SOFT TISSUES: There has been interval progression of osseous metastatic disease with increase in sclerotic lesions within the visualized thoracolumbar spine. Sclerotic metastases within the pelvis and right femur appear similar to prior.OTHER: No significant abnormality noted | 1.Overall mixed response of lymphadenopathy. Interval increase in size of left supraclavicular lymph node. Abdominal and pelvic lymph nodes stable to slightly decreased in size. Reference measurements as above.2.Interval progression of osseous metastases in the spine. Please see bone scan from same day for additional details.3.Bilateral ureteral stents with improved mild hydronephrosis on the right and resolved hydronephrosis on the left. |
Generate impression based on findings. | Cancer of the right great toe. Sentinel node location.RADIOPHARMACEUTICAL: The right foot was prepared in a sterile manner. A total of 0.526 mCi Tc-99m filtered sulfur colloid was injected into two locations at the base of the right great toe. A focus of increased activity is noted in the right inguinal region representing the sentinel node. This region was marked with an indelible marker. | Sentinel node identified in the right inguinal region. |
Generate impression based on findings. | 69 year old with history of right breast cancer status post mastectomy and lymph node dissection. Three standard views of the left breast with repeat left MLO and CC views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Stable positions of the two biopsy clips. Stable asymmetry in the left central breast. A Port-A-Cath obscures the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 49-year-old with history of right breast DCIS status post mastectomy. Two standard and 2 implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Retropectoral silicone implant is unchanged.Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Redemonstrated are postsurgical changes including paired pedicle screws at L4, L5, and S1. A disc spacer has been placed at L5/S1, there has been L4 and L5 laminectomy, and posterior bone grafting is again noted.There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Redemonstrated are renal cysts, otherwise the visualized intra-abdominal and paraspinal contents are unremarkable.There is grade I retrolisthesis of L2 on L3 and L3 on L4 as well as grade I anterolisthesis of L5 on S1, unchanged. T12/L1: Unremarkable and unchangedL1/2: Unremarkable and unchangedL2/3: There is a new right paracentral disc protrusion as well as worsening of diffuse annular disc bulge. Posterior epidural fat is slightly more prominent. Slightly worsening bilateral facet hypertrophy is now mild to moderate. There is now moderate central, moderate left lateral recess, severe right lateral recess, and mild bilateral neural foraminal stenosis, all demonstrating progression.L3/4: The central canal is widely patent at this postoperative level. As before, there is moderate bilateral neural foraminal stenosis.L4/5: The central canal is widely patent at this postoperative level. As before, there is mild bilateral neural foraminal stenosis.L5/S1:The central canal is widely patent at this postoperative level. As before, there is moderate bilateral neural foraminal stenosis. | 1.L2/3: There is a new right paracentral disc protrusion as well as worsening of diffuse annular disc bulge. Posterior epidural fat is slightly more prominent. Slightly worsening bilateral facet hypertrophy is now mild to moderate. There is now moderate central, moderate left lateral recess, severe right lateral recess, and mild bilateral neural foraminal stenosis, all demonstrating progression.2.Findings at other levels are stable in appearance, as described in detail above. |
Generate impression based on findings. | Fall. History of multiple myeloma. No fracture or malalignment. Marked degenerative disk disease in the lower lumbar spine. Mild osteoarthritis of the sacroiliac and hip joints. Evaluation of the upper pelvis is limited by overlying bowel gas and stool. Small lucencies in the obturator rings and proximal femurs are nonspecific but may represent myelomatous deposits, similar to prior. | No fracture or malalignment. |
Generate impression based on findings. | 71-year-old with history of left breast cancer status post mastectomy. Three standard views of the right breast and a laterally exaggerated CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Scattered calcifications predominantly in the right upper breast are not significantly changed. Intramammary lymph node in the right upper outer breast is slightly more prominent mammographically this year.ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: lung cancer s/p chemorads History: none CHEST:LUNGS AND PLEURA: Right lower lobe mass has decreased in size and now appears spiculated and measures 3.4 x 2.6 cm (image 62, series 7), previously 5.1 x 4.6 cm. Scarring is seen in the right lung base. No new pulmonary nodules are identified. Mild to moderate upper lobe predominant centrilobular emphysema is present. No pleural effusion or consolidation.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The previously described precarinal lymph node now measures 9 mm in short axis (image 36, series 5), previously 14 mm.Hypodense left thyroid nodule is nonspecific and unchanged. Common origin of the right brachiocephalic and left common carotid arteries is noted, a normal variant. The heart is normal in size and there is no pericardial effusion. No coronary artery calcifications are seen.CHEST WALL: Mild degenerative changes are seen throughout the visualized spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter nonspecific liver hypodensities are incompletely characterized, however unchanged from the prior study.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense right renal lesion is again higher density than expected for a renal cyst, however is not significantly changed. Nonobstructing right renal stone again noted. Cortical scarring of the right anterior kidney is also unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticulosis is present without complication.BONES, SOFT TISSUES: No significant abnormality noted. | Decrease in size of right lower lobe mass. Decrease in mediastinal and right hilar lymphadenopathy. |
Generate impression based on findings. | Male 65 years old Reason: colon cancer restaging History: colon cancer CHEST:LUNGS AND PLEURA: Soft tissue ground-glass nodule in the right upper lobe is unchanged.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Gallbladder is contracted with multiple calcified stones.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Soft tissue mass involving the colon near the suture margin with peritoneal and omental extension. The mass measures at least 4.0 x 3.9 cm (image 120/series 3). The proximal small bowel is dilated due to partial obstruction or slow transit at the anastomotic site. The remainder of the descending colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Recurrent colon cancer near the surgical anastomosis causing small bowel dilatation proximally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: h/o pharyngeal space tumor with area of malignant transformation History: r/o lung mets LUNGS AND PLEURA: Scattered pulmonary micronodules, some calcified, unchanged from the prior exam. No new abnormal pulmonary nodules or masses. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No significant coronary artery patient. No mediastinal or hilar lymphadenopathy by CT size criteria.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Ms. McKnight is a 44 year old female with known right breast cancer. Recent MRI demonstrated multiple additional enhancing lesions, the medial one of which was palpated by Dr. Chhablani. In addition, Dr. Chhablani palpated a right axillary lymph node. The targets for today's biopsy will be:- ultrasound-guided biopsy of index cancer in the right breast for research purposes.- ultrasound guided biopsy of satellite lesion in the right breast.- ultrasound-guided biopsy of right axillary lymph node. (1) Right breast ultrasound re-identified the index lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 1.8 x 1.2 x 2.2 cm at the 3 o’clock position with increased vascularity, 5 cm from the nipple. The lesion was readily visible.(2) Right breast ultrasound identified the satellite lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 0.7 x 0.9 x 0.9cm at the 3 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was approximately 3.5 cm medial to the index lesion.(3) Right axillary ultrasound identified a prominent axillary lymph for biopsy. The lesion to be targeted is a prominent lymph node measuring 0.8 cm. The lesion was readily visible.(1) US GUIDED BIOPSY OF RIGHT BREAST SATELLITE LESION: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferomedial to superolateral approach, three 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. (2) US GUIDED BIOPSY OF RIGHT BREAST INDEX LESION: Using the same incision as from initial procedure, continuous ultrasound guidance and a inferolateral to superomedial approach, six 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.A specimen radiograph was taken to ensure that the percutaneously placed clip from outside hospital was not removed during the sampling process. No clip is seen within the specimens, therefore, no clip was placed at this time. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip.Specimens were delivered to the research assistant with an accompanying history sheet. (3) US GUIDED BIOPSY OF RIGHT AXILLARY LYMPH NODE: The right axilla was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and inferior to superior approach, a 14-gauge core needle (InRad) was directed into the target node and four specimens were obtained, using the open-trough technique. Samples were obtained centrally through the hypoechoic cortex and at the periphery. Targeting was judged very good. One specimen sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Whitish tissue was noted in at least one specimen.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC, laterally exaggerated right CC, and ML views revealed percutaneously placed clips to be in the expected locations at the:- satellite lesion (right breast 3:00 anterior depth) - hydromark clip- index lesion (right breast, 3:00 posterior depth) - rod shaped- axillary lymph node (right axilla) - hydromark clipNo evidence of hematoma or other complication.Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsies of:- right index cancer for research purposes- right satellite lesion- right axillary lymph node Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Pain Fracture through the mid to distal tibial diaphysis with minimal lateral displacement of the distal fracture fragment. Non-displaced oblique fracture through the distal fibular diaphysis. Ankle joint effusion noted. | Tibial and fibular fractures, as above. |
Generate impression based on findings. | Reason: s/p lung resection History: s/p lung resection, no symptoms CHEST:LUNGS AND PLEURA: Postsurgical volume loss and paramediastinal radiation fibrosis in the right lung appear similar to the prior study. Debris is seen within the right mainstem bronchus. Mild paraseptal emphysema is present. MEDIASTINUM AND HILA: Incidental note is made of direct origin of the left vertebral artery from the aortic arch. No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion. No coronary artery calcifications are seen.CHEST WALL: Postsurgical deformity of the right fifth rib is unchanged. Healed left ninth rib fracture is present. ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis is present without complication. No suspicious liver lesion is identified.SPLEEN: Accessory spleen is seen medial to the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1.No evidence of recurrent or metastatic disease.2.Debris is seen within the right mainstem bronchus. |
Generate impression based on findings. | Myeloma SKULL: No significant abnormality noted. No myelomatous deposits evident.CERVICAL SPINE: Extensive degenerative chagnes throughout the cervical spine, with relative sparing of T2/3. No myelomatous deposits evident.THORACIC SPINE: Mild compression deformities of the T7 and T12 vertebral bodies. No myelomatous deposits evident.LUMBAR SPINE: Extensive degenerative changes throughout the lumber spine. No myelomatous deposits evident.RIBS: No significant abnormality noted. No myelomatous deposits evident.PELVIS: The pelvis is partially obscured by bowel gas and stool. No myelomatous deposits evident.UPPER EXTREMITY: Bilateral diffusely mottled appearance of the bilateral distal clavicles, humeri, radii, and ulnas are non-specific and may represent demineralization. Additional lucencies in the left humerus with endosteal scalloping likely represent myelomatous deposits. LOWER EXTREMITY: Intramedullary rod and screw device affixes the left femur. No definite myelomatous deposits evident. Mild osteoarthritis affects the hip joints. | 1. Lucencies in the left humerus with endosteal scalloping likely represent myelomatous deposits. 2. Bilateral diffusely mottled appearance of the distal clavicles, right humerus, and bilateral radii and ulnas without definite discrete lesions are non-specific and may represent demineralization. 3. Extensive degenerative changes of the cervical and lumbar spine. |
Generate impression based on findings. | Reason: Small cell lung cancer please compare to prior exam per recist criteria. History: Small Cell Lung Cancer LUNGS AND PLEURA: Right upper lobe reference nodule measures 20 x 13 mm on image 33/177 (19 x 11 previously). Adjacent pleural based nodule is stable to marginally increase. Reticulonodular interstitial thickening in the right upper lung is consistent with lymphangitic spread of tumor. New small right pleural effusion.Minimal dependent atelectasis/scarring, worse on the left.MEDIASTINUM AND HILA: Heart size is upper limits of normal, unchanged. Severe coronary artery calcifications, including atherosclerosis of the aorta its branches.Reference mediastinal right paratracheal lymph node (image 35/116) conglomerate is stable to marginally increased measuring 45 x 39 mm though the margins are difficult to separate from surrounding structures without IV contrast This mass involves the SVC. Right hilar lymph node conglomerate (image 37/116) has increased in size.CHEST WALL: Sclerotic focus within the posterior inferior corner of the T12 vertebral body, unchanged. S/p sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Diverticulosis affects the colon. Arterial calcifications of the aorta and its branches. | Marginally increased reference measurements. New small right pleural effusion. |
Generate impression based on findings. | Reason: h/o lung ca/brain mets, s/p Chemo, compare to 7/12/14 and 12/17/14 images to assess evidence of recurrent/progressive disease History: none CHEST:LUNGS AND PLEURA: Previously referenced left upper lobe nodule now measures 11 mm (image 46, series 5), previously 9 mm. Scattered pulmonary micronodules are unchanged from the prior study. Mild bronchiolar wall thickening is unchanged. No pleural effusion or consolidation. No new suspicious pulmonary nodule or mass. MEDIASTINUM AND HILA: Right hilar mass now measures 1.5 x 1.3 cm (image 39, series 3), previously 1.3 x 1.4 cm. This is unchanged when compared with 7/12/2014 where it measured 1.4 x 1.4 cm. Residual thymic tissue is noted. Right port catheter seen in place with its tip in the SVC. Calcified fibrin sheath is again seen within the left brachiocephalic vein. No mediastinal lymphadenopathy is seen. Left hilar lymphadenopathy is noted. The heart is normal in size and there is no pericardial effusion. Mild coronary artery calcifications are present.CHEST WALL: Surgical clips are seen throughout the axilla. Moderate to severe degenerative changes are seen throughout the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodense renal lesions are unchanged and likely represent cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged in size.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes affect the lower lumbar spine. | 1.Increase in size of left upper lobe nodule now measuring 11 mm. This previously measured 4 mm on the prior study dated 7/12/2014. 2.No change in right hilar mass.3.Mild left hilar lymphadenopathy. |
Generate impression based on findings. | Reason: Metastatic breast cancer on systemic therapy. Evaluate for treatment response and extent of disease. History: Primary right breast mass intact. Bone mets. CHEST:LUNGS AND PLEURA: New scattered patchy ground glass opacities more prominent the bases, may represent infectious/inflammatory process, including aspiration. Additional scattered pulmonary micronodules are unchanged. Scattered pleural based thickening/nodularity is stable compared to the prior exam. The previously referenced nodule in the azygoesophageal recess measures 1.4 x 1.2 cm (series 5, image 19), unchanged accounting for differences in measurement technique. No new suspicious pulmonary nodules or masses. Mild subsegmental atelectasis. No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Marked coronary artery calcifications. No mediastinal or hilar lymphadenopathy by CT size criteria. A previously referenced cardiophrenic lymph node (3 image 66 are in measures 1.2 x 0.8 cm, slightly decreased in prominence from the prior exam. Unchanged right thyroid nodule.CHEST WALL: Right breast calcified mass measures 3.3 x 2.8 cm (series 3, image 30), unchanged. A right axillary lymph node measures up to 1.1 cm (series 3, image 22), unchanged. Nonspecific sclerosis in the sternum is unchanged. Healing right eighth rib fracture. Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable calcifications of gallbladder wall. Mild intrahepatic and extrahepatic biliary ductal dilatation without pancreatic ductal dilatation. No choledochal stone seen.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. New scattered patchy ground glass/nodular pulmonary opacities may represent infectious/inflammatory process, including aspiration. 2. Additional findings, including a right breast mass, prominent cardiophrenic lymph node, and pleural nodularity are stable from the prior exam. |
Generate impression based on findings. | 30-year-old female patient with history of malrotation and abdominal pain. The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is no evidence of obstructing or constricting lesions. The colonic mucosa is normal in appearance with no evidence of ulceration, edema, or mass lesions. There was no reflux of barium into the terminal ileum. There is average redundancy of the transverse colon and greater than average redundancy of the sigmoid colon. Particular attention was paid to the area of the patient's pain in the left upper quadrant. Inspiratory and expiratory phase cine images were obtained (series #72). All loops of bowel were mobile during external compression (cine series # 61 and 62). | No anatomic explanation for patient's symptoms. |
Generate impression based on findings. | 62-year-old male with lower back pain and relapse of IgA myeloma with history of T-spine compression. SKULL: Nonspecific lucencies are noted about the skull without definite findings to indicate multiple myeloma.CERVICAL SPINE: Degenerative changes especially at C5-6 and C6-7 but no myelomatous lesions are noted. A well corticated osseous fragment is visualized posterior to the C5 spinous process.THORACIC SPINE: An old T11 compression fracture is visualized with kyphoplasty material. A posterior spinal fusion is noted from the T10 to T12 levels with pedicle screw fixation. No myelomatous lesions are noted in the thoracic spine.LUMBAR SPINE: Degenerative changes are noted about the L5-S1 level with loss of disk space height but no myelomatous lesions are noted.RIBS: Demineralization of the ribs without evidence of myelomatous lesions. Cholecystectomy clips are noted.PELVIS: No evidence of myelomatous lesions.UPPER EXTREMITY: No evidence of myelomatous lesions.LOWER EXTREMITY: A suspicious lesion is visualized in the right femur with endosteal scalloping which is nonspecific but suspicious for myelomatous lesion. | 1.Finding suspicious for a myelomatous lesion within the right femur and nonspecific lucent areas within the skull.2.Collapsed T11 vertebral body with kyphoplasty material and posterior fixation from T10 to T12. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 56-year-old male status post ORIF. Three views of the right hand show a side plate and screws affixing a fracture of the first metacarpal which is in near-anatomic alignment and without evidence of complication or loosening. There is evidence of healing. | Status post side plate and screw fixation of a first metacarpal fracture without evidence of complication. |
Generate impression based on findings. | Reason: mets lung cancer. On tx for BRAF mutation now. Pls c/w previous study to evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Nodular bronchial and interstitial opacity consistent with lymphangitic tumor spread, though decreased.Dominant mass in the right lower lobe significantly decreased to 18 mm on image 75/116 (31 mm on prior). Second reference nodule also significantly decreased to 9mm on image 70/116 (16 mm on prior).MEDIASTINUM AND HILA: Severe coronary artery calcification.Lymphadenopathy has decreased. Reference subcarinal node measure 12 mm on image 53/153 (21 mm on prior).CHEST WALL: Widespread skeletal metastases are unchanged. Right sided rib fracture unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific hypoattenuating subcentimeter lesions in the liver too small to characterize but stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe vascular calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable osseous metastases.OTHER: No significant abnormality noted. | Interval decrease in reference measurements. |
Generate impression based on findings. | 55-year-old male with pain. Three views of the right wrist show a comminuted fracture of the distal radial metadiaphysis suspicious for extension to the articular surface. In the proper clinical setting, this may represent an old deformity with a new superimposed fracture. There is mild subluxation of the radiocarpal joint. Minimal swelling is noted about the adjacent soft tissues. | Comminuted fracture of the distal radial metadiaphysis with probable extension to the articular surface. This may represent an old deformity with a new superimposed fracture. Mild subluxation of the radiocarpal joint. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are scattered bilateral maxillary sinus mucous retention cysts. The skull and extracranial soft tissues are unremarkable. CERVICAL: There is no acute fracture or subluxation. There is no prevertebral soft tissue swelling. There straightening of the cervical spine. There is beam hardening artifact limiting evaluation of the spinal canal at C5 level and below. | No acute traumatic injury to the brain or cervical spine. |
Generate impression based on findings. | Reason: Please assess for metastatic disease History: Large renal mass LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Anteriorly displaced comminuted fracture of the medial clavicle with extensive lucency involving the clavicular head, cannot exclude pathologic fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Large left renal mass and abdominal aortic aneurysm only partially visualized. Please see dedicated abdomen pelvis CT report for further details. Compression fracture of L1 only partially visualized. | No evidence of pulmonary metastases. Anteriorly displaced comminuted fracture of the medial clavicle with extensive lucency involving the clavicular head, cannot exclude pathologic fracture. Compression fracture of L1 only partially visualized.Large left renal mass and abdominal aortic aneurysm only partially visualized. Please see dedicated abdomen pelvis CT report for further details. |
Generate impression based on findings. | Ms. Echevarria is a 61 year old female with a personal history of left breast mastectomy in 2004 for cancer followed by chemoradiation, along with right breast reconstruction in 2012. Family history of breast cancer in two maternal cousins. No current breast related complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral scattered coarse calcifications and benign morphology masses are stable when compared to prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | Bilateral benign calcifications and benign-morphology masses in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Pain Intramedullary rod and screw fixation of a prior distal radius fracture, with fracture line no longer evident. Ulnar styloid fracture non-union. Mild to moderate radiocarpal joint osteoarthritis, unchanged. No acute fracture or malalignment. | No acute fracture or malalignment |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of reduction surgery in 02/2012. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. Both breasts appears significant smaller than previous, due to reduction surgery. The breast parenchyma is mostly fatty replaced. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 77 years, Male. Reason: h/o prostate cancer s/p cystoprostatectomy, ileal conduit and ileostomy presents with SBO History: abdominal pain A drain tip projects over the right lower quadrant, presumably within a stoma. Surgical sutures, staples, and beads are noted throughout the lower abdomen. Degenerative changes affect the lower lumbar spine, better evaluated on prior CT. Residual contrast within portions of the bowel.Diffusely air distended loops of small and large bowel in ileus type pattern. | Ileus type bowel gas pattern. |
Generate impression based on findings. | Reason: h/o tonsil ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are stable and presumably post inflammatory. No new pulmonary nodules.MEDIASTINUM AND HILA: Minimal ectasia of the ascending aorta unchanged.CHEST WALL: Right chest port tip in SVC. Minimal degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Interval decrease in biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Interval decrease in ductal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Interval removal gastrostomy tube.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. Interval decrease in biliary and pancreatic ductal dilatation. |
Generate impression based on findings. | Male 20 months old with history of multicystic dysplastic kidney status post right nephrectomy, now with dark colored urine. Follow-up scan status post right nephrectomy. KIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: Not visualized Left: 0 Length*** Right: Not visualized Left: 6.6 cm Mean for age: 7 cm Range for age: 5.5 - 7.5 cmADDITIONAL OBSERVATIONS: Status post right nephrectomy. | The left kidney is normal. Status post right nephrectomy.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Hand injury. No fracture or malalignment. Non-specific juxta-articular osteopenia. No osseous erosions or joint space abnormality evident. Ulnar minus variant noted. | No fracture or malalignment. |
Generate impression based on findings. | 5th MC fracture. Again seen is the fracture through the neck of the fifth metacarpal. The volar angulation of the distal fracture fragment appears unchanged compared to the most recent prior study. | Unchanged fifth metacarpal fracture. |
Generate impression based on findings. | 55 years, Male. Reason: Confirm dobhoff placement History: Pt pulled at Dobbhoff Nonobstructive bowel gas pattern. The lung bases are within normal limits. Note that the pelvis is excluded from the field-of-view. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 13 years old Reason: fracture History: fractureVIEWS: Right wrist AP and lateral 2/9/15 (two views) Cast material obscures fine bone details. Periosteal reaction of the distal radius and ulna is again noted. Alignment is anatomic. | Healing fractures, in anatomic alignment. |
Generate impression based on findings. | Female 61 years old Reason: 61 F with metastatic colon cancer s/p right lower lobectomy, please evaluate for any evidence of disease. History: none CHEST:LUNGS AND PLEURA: Acute pulmonary embolism in the right lower lobar pulmonary artery at the arterial stump. Pulmonary artery is enlarged measuring up to 40 mm suggestive of pulmonary hypertension. No evidence of right heart strain.Interval post surgical changes from partial right lower lobectomy with removal of suspicious nodules seen on prior study.Small right pleural effusion.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Heart size is normal without pericardial effusion.Vascular occluder device.Right chest wall port with tip in the SVC.Scattered atherosclerotic calcifications of the aorta and its branches with mild coronary calcifications.CHEST WALL: Median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Several stable subcentimeter hypoattenuating foci in the liver are too small to characterize but likely cysts. No biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Extrarenal pelvis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No evidence of bone metastasis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable postoperative changes from left hemi-colectomy.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. | 1.Acute right lower lobar pulmonary embolism with evidence of pulmonary arterial hypertension. 2.No definite evidence of recurrent or residual disease. 3.Interval postsurgical changes from right lower lobectomy.Emergent findings were discussed by telephone with Dr. Manish Sharma, pager 3837, at 11:30 am on 2/9/2015. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Thumb pain Chronic post traumatic changes at the thumb IP joint. Severe degenerative changes at the basilar joint. No acute fracture or malalignment. | Degenerative and post-traumatic changes, as above. |
Generate impression based on findings. | Male 56 years old; Reason: Patient with HCC off of therapy. Please evaluate disease status History: na ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cirrhotic morphology of the liver is again noted with post ablative defect in the right hepatic dome appearing similar to the prior study. Subtle segment 2 subcapsular arterial enhancing lesion without definite washout is unchanged again measuring up to 8 mm (image 34; series 11). Hyperdense material in segment 5 from prior chemo-embolization is unchanged. No new suspicious liver lesion is identified. Distal esophageal varices are again noted.SPLEEN: Multiple splenorenal collateral vessels are unchanged. Direct origin of the splenic artery from the aorta is noted, a normal variant.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1.No change in arterial enhancing segment 2 liver lesion. While there is no definite washout, continued attention to this area on subsequent exams is recommended. 2.Cirrhotic liver status post ablation and embolization without new suspicious liver lesion. Sequela of portal hypertension. |
Generate impression based on findings. | Right knee pain Mild osteoarthritis of the right knee. No fracture or malalignment. No joint effusion evident.Mild osteoarthritis of the left knee as seen on frontal views. | Mild bilateral knee osteoarthritis. |
Generate impression based on findings. | Female 40 years old; Reason: Hodgkin's Disease History: s/p 2 cycles of chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive mediastinal lymphadenopathy. Anterior mediastinal soft tissue mass measures 7.6 x 4.1 cm (image 41/series 701) previously, 15.7 x 7.6 cmCHEST WALL: Bilateral breast implants. No axillary lymphadenopathy.Right central venous catheter terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mediastinal soft tissue mass. This has decreased in size from prior. |
Generate impression based on findings. | Fracture The non-displaced proximal clavicular fracture is unchanged. Irregular lucency at the fracture site is suggestive of a pathological fracture. | Unchanged proximal clavicular fracture |
Generate impression based on findings. | Shortness of breath, post-pulmonary embolism. Question of improvement. The comparison chest radiograph performed on 2/9/15 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is mild Xe-133 retention during the wash-out phase suggestive of COPD. The perfusion images show multiple mismatched segmental perfusion defects within the bilateral lungs, right greater than left, which do not appear significantly changed since the prior examination in size or distribution. | Multiple perfusion defects compatible with pulmonary emboli without significant interval change since the 11/25/2014 examination; acute emboli cannot be excluded on the background changes of chronic pulmonary emboli. |
Generate impression based on findings. | Check fracture healing, fourth metatarsal neck Mild continued interval healing without evidence of significant change in alignment. Minimal impaction and angulation persist. Moderate degenerative changes of the midfoot also observed, most pronounced involving the cuneiform navicular articulations. | Mild healing of the fourth metacarpal neck fracture |
Generate impression based on findings. | Dorsal foot pain, following trauma. Moderate osteoarthritic changes of the first MTP with hallux valgus deformity and bunion. No superimposed acute process, specifically no fracture or malalignment. Soft tissues are unremarkable other than a questionable small ankle effusion | Moderate degenerative changes |
Generate impression based on findings. | Pain.VIEWS: Left foot standing AP/lateral (two views) 02/09/15 Hindfoot valgus is present. No fracture is seen. | Hindfoot valgus. |
Generate impression based on findings. | Pain. Flat foot.VIEWS: Right foot standing AP/lateral (2 views) 02/09/15 Pes planovalgus continues. No fracture is seen. | Pes planovalgus, unchanged. |
Generate impression based on findings. | One day old male born prematurely with respiratory distress.VIEW: Chest and abdomen AP (two views) 2/9/2015 0559 Chest: Endotracheal tube tip at level of carina. Feeding tube tip in gastric body with sidehole past GE junction. Normal cardiothymic silhouette. Diffuse bilateral lung haziness again noted. No pleural effusion or pneumothorax.Abdomen: Paucity of visualized bowel gas. Umbilical venous catheter tip in left portal vein with interval improvement in portal venous gas due to catheter placement. | 1.Diffuse bilateral lung haziness likely representing surfactant deficiency. 2.Paucity of visualized bowel gas with interval improvement in portal venous gas s/p UVC placement. |
Generate impression based on findings. | Tibial plateau fracture, follow-up Interval demonstration of mild lateral tibial plateau changes, compatible with a horizontal fracture plane extending through to the lateral tibial spine. Alignment preserved. Superimposed mild osteoarthritic changes | Nondisplaced right lateral tibial plateau fracture, subacute. |
Generate impression based on findings. | History of bladder cancer s/p cystectomy with ileal conduit, surveillance imaging. ABDOMEN:LUNG BASES: Right lower lobe pulmonary nodule (series 6, image 6) measures 5 mm, unchanged compared to 2011 exam. No new suspicious pulmonary nodules.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Stable nonspecific pancreatic tail calcification. Whether this calcification may be in a small lesion at the pancreatic tail is unclear, but given its stability, continued follow-up on routine surveillance imaging is suggested.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS:Right mid renal lesion (series 7, image 42) measures 2.0 x 1.6 cm, unchanged in size. The lesion demonstrates internal enhancement and is suspicious for a small renal cell carcinoma.There is slight delayed excretion of contrast from the left kidney as no contrast is seen in the ureter distal to the UPJ. Stable bilateral mild to moderate hydronephrosis, worse on the left with suggestion of a left extrarenal pelvis. There appears to be narrowing of the left ureter as it crosses over the midline which may be related to scarring. The right ureter excretes normally into the conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious lytic or blastic osseous lesions. Multilevel degenerative changes.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Status post cystectomy with ileal conduit.LYMPH NODES: Previously seen 1.5 x 2.0 cm left common iliac lymph node (series 7, image 85) is thought to represent residual left gonadal vein.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No suspicious lytic or blastic osseous lesions. Stable sclerotic focus in the left pubic bone likely represents a bony island. Multilevel degenerative changes.OTHER: No significant abnormality noted | 1.Right renal lesion unchanged in size but suspicious for small renal cell carcinoma.2.No specific evidence of metastatic disease. 3.Stable appearance of bilateral collecting systems, with stable mild to moderate hydronephrosis, worse on left which may be related to left ureteral narrowing/scarring. |
Generate impression based on findings. | Pain No radiographic abnormalities observed. Alignment appears normal, however a lateral projection was augmented with-assisted positioning, this may have corrected and mild flexion abnormality involving the DIP articulation. | Normal |
Generate impression based on findings. | Check prosthesis IM tibial rod appears unchanged that evidence of complication. Partial continued healing of the distal diaphyseal comminuted fracture with increasing callus formation and decreased fracture plane visualization | Continued healing of the distal tibial fracture |
Generate impression based on findings. | Pain and anterior tibia Incompletely visualized right total knee arthroplasty without gross complication. The lower leg however demonstrates no discrete focal acute abnormality, specifically no evidence of a distinct cortical abnormality however a mild periosteal reaction is observed in the mid right tibial diaphysis which is of uncertain significance or chronicity. If prior imaging was available this may increase sensitivity and may be related to vascular changes given moderate to more extensive atherosclerotic disease. Incompletely visualized moderate degenerative changes of the distal ankle | Nonspecific minimal periosteal reaction, possibly related to vascular changes, however serial imaging and/or comparison with prior imaging if available would increase sensitivity |
Generate impression based on findings. | Check for disk disease. Pain Minimal osteoarthritic changes with osteophytes and minimal lower facet sclerosis. Preservation of vertebral body heights, disk spaces and alignment other than minimal narrowing of the L5-S1 disk space. Posterior elements appear intact and the SI joints are unremarkable | Minimal osteoarthritis |
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