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Generate impression based on findings. | Left knee pain Mild tricompartmental osteoarthritic similar 2012. Changes are mildly greater than medial compartment with narrowing, sclerosis and small osteophytes. Small punctate calcifications observed in subcutaneous soft tissues of the left patella, presuming old and posttraumatic | Mild tricompartmental osteoarthritis |
Generate impression based on findings. | Pain Mild scattered osteoarthritic changes large involving the radiocarpal joint and first MCP. Questionable diffuse juxta articular osteoporosis without evidence of distinct superimposed inflammatory arthritic changes. Soft tissues are unremarkable. | Mild osteoarthritic changes with nonspecific questionable juxta-articular osteoporosis |
Generate impression based on findings. | 82-year-old female with altered mental status as well as right-sided facial droop, history of right MCA distribution stroke Encephalomalacia with adjacent gliosis and right lateral ventricular ex-vacuo dilatation is consistent with interval evolution of the patient's right MCA distribution stroke identified in 2010.Small foci of encephalomalacia are present along the left occipital lobe, and periventricular/subcortical white matter hypodensities are present, confluent in some locations.The visualized portions of the paranasal sinuses are essentially clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal vertebral and internal carotid arteries. | 1.Encephalomalacia with adjacent gliosis and right lateral ventricular ex-vacuo dilatation is consistent with interval evolution of the patient's right MCA distribution stroke identified in 2010.2.Advanced small vessel ischemic disease of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | 64 with history of left lumpectomy for breast cancer in 2012. Three standard views of both breasts and lumpectomy 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 new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Postoperative distortion and density in the left lower inner breast is again noted, with surgical clips and benign calcifications. Mild skin thickening of the left breast compatible with radiation therapy change. Bilateral benign calcifications are again noted elsewhere in each breast. Benign morphology mass in the right retroareolar region is unchanged. | 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. | Total hip arthroplasty Hip and pelvis: Interval removal of surgical drain. Underlying left total hip arthroplasties otherwise intact without evidence of complication or change other than minimal heterotopic bone adjacent to the superior acetabular rim. | Left total hip arthroplasty with minimal heterotopic bone formation |
Generate impression based on findings. | Reason: lung nodule History: follow up LUNGS AND PLEURA: Status post right lower lobectomy with postsurgical change.Scattered stable micronodules.Right lower lobe nodule (image 165 series 5) measures 4 mm present measuring 5 mm.Mild/moderate upper lobe predominant centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion..CHEST WALL: Mild degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable left adrenal nodule. | 1.Stable small 4-mm right lower lobe nodule. No new pulmonary nodules identified.2.Mild/moderate upper lobe predominant centrilobular emphysema.3.Stable small left adrenal nodule incompletely characterized. |
Generate impression based on findings. | Male 42 years old; Reason: 42M with metastatic rectal cancer to liver s/p neoadj chemoRT, right hepatectomy (12/26/14). please eval for any new lesions prior to surgery for to resect the primary tumor History: eval for further mets prior to resection of primary tumor CHEST:LUNGS AND PLEURA: No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes in the liver with a fluid collection that occupies segments 6 and 7 measuring 16.8 x 10.9 cm (image 87/series 3). Remainder of the liver is normal in morphology. There is mild ductal dilatation adjacent to the surgical resection margin. No new lesions identified. The residual hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered upper abdominal ascites and slight nodularity of the peritoneum and omentum possibly due to postsurgical change. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac pelvic node measures 1.0 x 1.0 cm (image 193/series 3) previously, 1.2 x 0.8 cm.BOWEL, MESENTERY: Rectal thickening has decreased.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Status post right hepatic resection; no evident metastatic disease. |
Generate impression based on findings. | There is an incompletely imaged heterogeneously enhancing anterior mediastinal mass, which measures 37 mm in thickness compared to 80 mm previously. There is a left supraclavicular lymph node measuring up to 6 mm in short axis, previously measuring up to 10 mm in short axis. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures show no focal lesions. There is reversal of cervical lordosis with scattered minimal degenerative changes in cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is a right breast implant, which is partly imaged. | Interval decrease in size of the left supraclavicular and upper mediastinal lymphadenopathy, indicating response to therapy. |
Generate impression based on findings. | Male 75 years old; Reason: metastatic prostate cancer post chemotherapy. eval for progression History: metastatic prostate cancer to bones, pulm nodules CHEST:LUNGS AND PLEURA: Reference right upper lobe pulmonary micronodule measures 3 mm on image 45 series 5, without change.MEDIASTINUM AND HILA: Coronary calcifications. No mediastinal lymphadenopathy. Reference mediastinal lymph node measures 7 x 7 mm on image 38/series 3, unchanged.CHEST WALL: Sclerotic metastatic disease to the thoracic spine.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right upper pole probable complex cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease.OTHER: No significant abnormality noted | 1.Sclerotic osseous metastatic disease; no new sites of disease. |
Generate impression based on findings. | Reason: Asthma SOB History: SOB, asthma, possible infiltrate LUNGS AND PLEURA: Peribronchial thickening with septal nodularity and diffuse groundglass opacities predominantly in a bronchovascular and centrilobular distribution.Bronchial wall thickening.Subpleural microcystic changes in the right upper lobe.No focal areas of consolidation.No pleural effusions.MEDIASTINUM AND HILA: Prominence peritracheal lymph nodes.Cardiac size is normal without evidence of pericardial effusion.Moderate coronary artery calcification and marked valvular calcification.CHEST WALL: Median sternotomy identified.Degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | Septal and peribronchial thickening/nodularity with diffuse ground groundglass and nodular opacities in a centrilobular and bronchovascular distribution. Suspect this may all represent sarcoidosis. Additional etiologies in the differential diagnosis would include atypical endobronchial infections including MAI. |
Generate impression based on findings. | There are post-treatment findings with persistent diffuse pharyngeal mucosal space, retropharyngeal space, and parapharyngeal space edema. There is interval increase in size of a heterogeneous left level 2 lymph nodes that measure up to 16 mm in short axis, previously 12 mm in short axis. There is also an adjacent ill-defined heterogeneous lymph node that measures 18 mm in short axis, previously 11 mm, with tumor extending along the lateral aspect of the left soft palate treatment bed, collectively forming a conglomerate. In addition, there is a newly apparent pathological-appearing left level 3 lymph node that measures 9 mm. The lesions abut the left carotid space and compress the left internal jugular vein. There is unchanged hyperemia of the submandibular glands. The thyroid gland is unremarkable. There is mild plaque at the carotid bifurcations. There is unchanged multilevel degenerative spondylosis. There are multiple dental caries. There is mild paranasal sinus mucosal thickening. There is pulmonary emphysema in the lung apices. Please also refer to the separately dictated chest CT report. | 1. Interval disease progression in left neck, including lymphadenopathy with suggestion of extracapsular extension and perhaps tumor recurrence along the lateral aspect of the left soft palate treatment bed.2. Extensive dental disease. |
Generate impression based on findings. | Opacification is found throughout the paranasal sinuses, excluding the frontal sinuses. This includes frothy material within bilateral sphenoid sinuses and posterior ethmoid air cells as well as and a small air-fluid level the left maxillary sinus. Bilateral ostiomeatal units, sphenoethmoidal recesses, and frontoethmoidal recesses are obstructed.Bilateral mastoid air cells and middle ear cavities are clear. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is mildly deviated rightward. Bilateral orbits and the posterior nasopharynx appear unremarkable. | Acute on chronic sinusitis as described in detail above. |
Generate impression based on findings. | There is a interval placement of a left posterior frontal burr hole. There is interval development of a large intraparenchymal hemorrhage in the left frontoparietal region that measures up to approximately 40 mm with a small amount of associated subarachnoid hemorrahge. There is local mass effect on the left lateral ventricle and surrounding edema. There is also a smaller area of hyperattenuation in the left parietal lobe that may correspond to the additional tumor. There is a 5 mm left to right midline shift. There is also a left subdural hematoma along the left frontotemporal convexity measuring up to 5 mm in width. There is mild parenchymal volume loss. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with mild age-indeterminate small vessel ischemic changes. There are chronic lacunar infarcts in the right basal ganglia. The imaged portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is mild scalp emphysema and minimal subgaleal hematoma at the burr hole site. There are bilateral lens implants. There is marked flattening and sclerosis of the right mandibular condyle. | 1. Post-surgical findings related to left parietal lobe mass biopsy with extensive new intraparenchymal hemorrhage and a small amount of subarachnoid hemorrahge in the left frontoparietal region with rightward midline shift measuring 5 mm.2. New left frontotemporal convexity subdural hematoma measuring 5 mm in width. 3. Mild age-indeterminate small vessel ischemic changes and evidence of basal ganglia lacunar infarcts.4. Advanced right temporomandibular joint degenerative change.Urgent findings discussed with Dr. Havlin on 2/9/2015 at 12:50 pm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 70 years old Female. Reason: history of breast cancer 20 years ago s/p radiation now with new nodule removed and diagnosed with invasive ductal breast caner. This exam is for staging and treatment options. RADIOPHARMACEUTICAL: 14.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 113 mg/dL. Today's CT portion grossly demonstrates a large low-attenuation lesion in the right axilla. A calcified nodule is seen in the right breast. There is a patchy opacity in the left lingular lobe. There is a low-attenuation lesion in the sphenoid sinus. Multiple low-attenuation cystic lesions are seen in the right kidney. Numerous diverticula are noted in the colon.Today's PET examination demonstrates demonstrates nodular and curvilinear FDG uptake in the periphery of the low-attenuation lesion in the right axilla. The maximum SUV in the nodular uptake is 4.3.There is a mild FDG uptake in several normal sized lymph nodes in both sides of the neck at left levels II/III and the right supraclavicular region. The maximum SUV in the most intense neck lymph node at right supraclavicular region is 1.8.Mild FDG uptake is seen in the low-attenuation lesion in the sphenoid sinus.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. There is no abnormal FDG uptake in the low-attenuation cystic lesions in the right kidney. | 1.A large low-attenuation lesion in the right axilla with peripheral increased metabolic activity, which can be due to post surgical change or residual tumor.2.Multiple nonspecific normal sized lymph nodes with mild FDG uptake in the neck.3.No other evidence of FDG avid tumor.4.Minimal FDG uptake in the sphenoid sinus opacity is most likely due to sinusitis. |
Generate impression based on findings. | Female 77 years old; Reason: STAGE III RECTAL CANCER COMPLETED THERAPY JULY 2013. EVALUATE FOR INTERVAL CHANGE History: RECTAL CANCER CHEST:LUNGS AND PLEURA: Nodular thickening adjacent to pleural surface in the right upper lobe is nonspecific. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is slightly nodular.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left body wall parastomal hernia contains loops of small bowel without obstruction.BONES, SOFT TISSUES: Left body wall colostomy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is displaced posteriorly into the presacral space.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes in the rectum.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Status post left lower abdominal colostomy following rectal resection without specific evidence for metastatic disease. |
Generate impression based on findings. | Patient fell on tailbone today. Tenderness.VIEWS: Lumbar spine AP/lateral/lumbosacral junction lateral (3 views), sacrum AP, coccyx AP (two views) 02/09/15 Vertebral body heights and disk spaces are maintained. No fracture is identified. The sacrum and coccyx are normal in appearance. | Normal examination. |
Generate impression based on findings. | Female 4 years old Reason: PICC placement History: abdominal painVIEW: Chest AP (one view) 2/9/15 at 1233 hrs. Central line tip is at the RA/RV junction. The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette size is top normal. Left retrocardiac streaky opacities, likely atelectasis or pneumonia. No effusions or pneumothorax. | Central line positioning as described.Left retrocardiac opacity. Atelectasis or pneumonia are considerations. |
Generate impression based on findings. | Malignant melanoma stage IIB. Nonspecific pulmonary nodules unless scan. CHEST:LUNGS AND PLEURA: Interval enlargement of multiple pulmonary nodules indicating these likely represent metastases. Index nodule measures 9-mm in diameter (image 69; series 5), larger compared to prior when it measured 5 mm. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomas.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.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Enlarging pulmonary nodules compatible with metastases. PWRNP |
Generate impression based on findings. | Male 75 years old; Reason: history of metastatic prostate cancer- S/P 3 cycles treatment evaluate for response History: history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Reference subcarinal lymph node measures 1.6 x 0.8 cm (image 41/series 3) previously, 1.6 x 1.1 cm.Reference left paraesophageal lymph node measures 1.3 x 0.9 cm (image 45/series 3) previously, 1.2 x 1.0 cm.Extensive coronary calcifications and subendocardial infarction in the left ventricle.CHEST WALL: Sclerotic metastases to the bone.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal morphology. No focal hepatic lesion. Hepatic and portal veins are patent.Layering gallstones within a nondistended gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland is nodular.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic osseous metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease.OTHER: No significant abnormality noted | 1.Stable measurements of the reference mediastinal lymph nodes.2.Osseous metastatic disease better evaluated on the accompanying bone scan. |
Generate impression based on findings. | T2N2b soft palate squamous cell carcinoma, treated via resection, chemotherapy, and radiation. There are post-treatment findings in the neck, including mucosal edema in the oropharyngeal region. There is interval decrease in size of multiple bilateral cervical lymph nodes, with formation of dystrophic calcifications. For example, a left level 2A lymph node measures 7 mm in short axis, previously 10 mm, a left level 3 lymph node measures 5 mm in short axis, previously 8 mm, and a right level 2B lymph node measures 5 mm in short axis, previously 8 mm. The thyroid and major salivary glands appear unchanged. There is mild plaque at the left carotid bifurcation. There is a right internal jugular venous catheter. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Interval decrease in size of the treated cervical lymphadenopathy and no convincing evidence of measurable mass in the oropharynx. |
Generate impression based on findings. | History urothelial carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable moderately large hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Interval decrease in size of soft tissue focus at the proximal end of the ileal conduit best seen on image 97 of series 12 now measuring 0.7 x 1 cm; this compares to 1.5 x 1 cm on 2/14/2014.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval decrease in size of soft tissue focus at the proximal end of the ileal conduit; otherwise stable examination. |
Generate impression based on findings. | Reason: pt with a history of urothealial cancer, please assess for disease progression History: urothelial cancer LUNGS AND PLEURA: Mild nonspecific bronchial wall thickening. No evidence of pulmonary metastases. Scattered punctate micronodules are stable and presumably benign.MEDIASTINUM AND HILA: Hiatal hernia. Moderate coronary calcification. Calcified nodes consistent with healed granulomatous disease.CHEST WALL: Interval removal of portacatheter. New heterogeneous predominantly sclerotic lesion in T7 vertebral body is suspicious for metastatic disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Abdomen will be reported separately. Please see separate report. | New heterogeneous predominantly sclerotic lesion in T7 vertebral body is suspicious for metastatic disease. |
Generate impression based on findings. | Global headache. Evaluate for mass and chronic subdural hemorrhage. There is no evidence of acute intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a subcentimeter left ethmoid sinus osteoma. The imaged paranasal sinuses and mastoid air cells are otherwise clear. The skull and extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant change in numerous bilateral pulmonary metastatic nodules. Reference right upper lobe nodule best seen on image 48 of series 5 measures 1.4 x 1.5 cm. Reference left lower lobe nodule best seen on image 39 of series 5 measures 1.8 x 1.7 cm.Slight increase in size of small left pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No change in multiple bilobar low attenuation foci. Reference segment 5/6 lesion best seen on image 103 of series 3 measures 2.9 x 2.5 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant change in left adrenal metastasis best seen on image 89 of series 3 measuring 4.9 x 3.9 cm.KIDNEYS, URETERS: No significant change in extensive bulky mass lesions occupying the left perinephric space. Reference mass best seen on 120 of series 3 measures 14.8 x 10.6 cm.RETROPERITONEUM, LYMPH NODES: No change in extensive bulky retroperitoneal adenopathy. Reference preaortic space lymph node mass best seen on image 120 of series 3 measures 13.5 by 9.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No change in extensive left common iliac, left psoas, and left internal iliac metastatic nodal disease. Reference left internal iliac lymph node mass best seen on image 169 of series 3 measures 3.9 x 3.4 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change in extensive widespread metastatic disease |
Generate impression based on findings. | 40 years old Female. Reason: s/p 2 cycles of chemotherapy. History: Hodgkin's Disease. This study was performed for restaging.RADIOPHARMACEUTICAL: 11.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates no definite evidence of FDG avid tumor in the neck, chest, abdomen and pelvis. Linear areas of increased activity in the right axilla and right upper mediastinal region at the PICC line are consistent with retained tracer in the catheter.Mild FDG uptake is seen the anterior mediastinal mass with maximal SUV of 2.2, significantly decreased as compared with prior study.Physiological activity is seen in the liver, spleen, kidneys, intestines, uterus and bladder. | 1.No definite evidence of FDG avid tumor. 2.Anterior mediastinal mass with mild FDG uptake, significantly decreased as compared with prior study and consistent with post-therapy change.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Pain L-spine: No radiographic abnormalityPelvis and hip: No radiographic abnormalityShoulder and humerus: Minimal shoulder osteoarthritis with minimal sclerosis and small insignificant osteophytes. The humerus demonstrate a side plate affixing an old healed deformity the proximal diaphysis representing a remote healed fracture. No hardware complications | Right humerus ORIF without complication. Minimal shoulder osteoarthritis without additional abnormality |
Generate impression based on findings. | Reason: h/o HNC tonsil, h/o CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Stable right peri-fissural opacity probably an intrapulmonary lymph node, without evidence of pulmonary or pleural metastases. Emphysema.MEDIASTINUM AND HILA: No significant abnormality noted. Borderline right hilar lymphoid tissue is unchanged.CHEST WALL: No significant abnormality noted.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: Stable presumed right renal cyst.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.OTHER: No significant abnormality noted. | No evidence of metastases |
Generate impression based on findings. | Female 84 years old; Reason: fluid collection, sepsis source History: septic shock ABDOMEN:LUNG BASES: Small bilateral pleural effusions and bi-basilar atelectasis.LIVER, BILIARY TRACT: Liver is mostly hypoattenuating. There is very heterogeneous perfusion of the liver. Differential considerations include fatty infiltration the liver, poor cardiac output or hypoperfusion syndrome.Common bile duct stent terminates in the duodenum. No intrahepatic biliary ductal dilatation. Small focus of gas within the gallbladder lumen. No pericholecystic fluid.SPLEEN: Poor enhancement of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Adrenal glands are nodular. Infiltration of the fat surrounding the adrenal glands may represent early adrenal hemorrhage.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Extensive bowel wall pneumatosis involving the cecum and ascending colon due to bowel ischemia. There is fluid adjacent to the colon most suggestive of bowel perforation.Small bowel dilatation likely due to ileus. The bowel loops in the lower abdomen have very poor mucosal enhancement suggestive of ischemia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Upper abdominal ascitesPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Bladder is decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites. | 1.Abnormal CT scan with findings most suggestive of a hypoperfusion or shock syndrome with colonic ischemia involving the cecum and ascending colon, hepatic infarction causing the elevations in liver enzymes and splenic infarction.2.Findings highly suspicious for small bowel ischemia as there is very poor enhancement of its mucosa involving the ileum.3.Findings discussed with Dr. Shah at the time of dictation. |
Generate impression based on findings. | Male, 67 years old, with intracranial hemorrhage. Since the prior examination, hyperdense blood product within or along the right thalamus has nearly completely resolved. There remains at this location some parenchymal edema and mass effect with partial effacement of the body of the right lateral ventricle, similar to prior.Intraventricularly, almost all of the previously seen blood product has resolved. There remains only minimal layering blood product in the right occipital horn. The ventricular system is non-dilated and essentially stable in morphologyNo new intracranial hemorrhage or any other abnormal extra-axial fluid is detected. Aside from that mentioned above, no significant parenchymal edema or mass effect is detected. | Continued interval resolution of parenchymal and intraventricular blood product with no new intracranial abnormality. |
Generate impression based on findings. | Check for metacarpal fracture Comminuted fracture of the second metacarpal head without significant displacement. No definite fracture planes extending to the articular surface. Overlying soft tissue swelling. Remaining digits unremarkable.Ulnar plus variant | Second metacarpal head fracture, see detail provided |
Generate impression based on findings. | Abdominal pain. Left flank pain. Rule out nephrolithiasis. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 2-cm probable simple cysts in the left lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Both kidneys are irregular in contour and contain nodules which are isodense to the renal parenchyma. These may represent proteinaceous cysts but are indeterminate on unenhanced study. Consider pre-and post enhanced CT or MRI for further evaluation as clinically indicated. No evidence of nephrolithiasis. No evidence of hydronephrosis of either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: DiverticulosisBONES, 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: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No definite findings to explain left flank pain. No evidence of renal calculi or hydronephrosis. Both kidneys are irregular in contour with nodules isodense to renal parenchyma. The multiplicity of these suggest that they represent proteinaceous cysts but all are indeterminate on unenhanced CT scan; correlation with pre-and post enhanced cross-sectional imaging would enable more definitive characterization if clinically indicated. |
Generate impression based on findings. | Chronic sinusitis and anosmia and history of Klebsiella sinusitis. There are nonspecific linear opacities in the medial portions of the maxillary sinuses. The paranasal sinuses are otheriwe clear. The right frontal sinus is hypoplastic. The nasal cavity, including the olfactory recesses, is also clear. The middle turbinates appear atrophied. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | No evidence of acute sinusitis or sinonasal mass lesions. A brain MRI with anosmia protocol may be useful for further evaluation, if clinically indicated. |
Generate impression based on findings. | Pain. Fracture, sprain, tendon damage? I see no fracture, soft tissue abnormality, or other specific findings to account for the patient's pain. An elongated sclerotic focus within the distal fibula is again noted, perhaps representing a benign bone island or healed fibrous cortical defect. | No fracture or other findings to account for the patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Calcified granulomas. Other scattered punctate micronodules are also unchanged. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Scattered small subcentimeter lymph nodes are unchanged. Punctate foci of air in the pulmonary artery are presumably related to power injection. Aspirated debris in central airways.CHEST WALL: Right chest port tip in SVC.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable cyst in hepatic dome.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Atrophic with areas of calcification.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube tip in stomach.BONES, SOFT TISSUES: Degenerative change involving the lumbar spine.OTHER: No significant abnormality noted. | No evidence of metastases |
Generate impression based on findings. | 39 years old male. Reason: evaluate extent of disease/staging. History: newly diagnosed follicular lymphoma of left preauricular space. RADIOPHARMACEUTICAL: 13.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 96 mg/dL. Today's CT portion grossly demonstrates mucosal thickening of the right maxillary sinus and bilateral ethmoid sinuses.Today's PET examination demonstrates a focus of increased activity in the left face at preauricular region. The maximal SUV in the lymph node is 11.5. There is a focus of of increased activity in the left axilla with SUVmax of 4.7, corresponding to a small lymph node seen on CT. Symmetrical, diffuse and mild FDG uptake is seen in the bilateral parotid glands, which is nonspecific.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Hypermetabolic lymph nodes in the left face and left axilla, consistent with the patient's diagnosis of lymphoma.2.Nonspecific bilateral parotid mild FDG uptake. |
Generate impression based on findings. | Male, 77 years old.RFO trigger: Multiple surgical teams Suspected RFO location: abdomen Name of suspected RFO: none, counts correctAttending Surgeon name/pager: Shalhav/9889 Body Mass Index (BMI): 23.06 Extensive linear artifacts are present from overlying cloth material. Left upper quadrant suture material is noted. Expected intraperitoneal free air. No unexpected radiopaque foreign objects. | No unexpected radiopaque foreign objects. These findings were discussed by telephone with Dr. Shalhav, the attending surgeon, on 2/9/2015 at 1:40 p.m. |
Generate impression based on findings. | Status post debridement of left distal femur/knee for osteomyelitis. Evaluate for interval change. There is mixed lucency and sclerosis within the distal femoral metaphysis compatible with the stated history of treated osteomyelitis. The previously seen antibiotic coated cement beads are no longer visible. Periosteal reaction along the medial aspect of the distal femoral metaphysis appears to have matured when compared with the prior study. Periosteal reaction along the lateral aspect of the distal femur appears similar to the prior study. There is an obliquely oriented linear lucency through the posterior cortex of the distal femur that is more distinct on the current study the prior study and could represent a nutrient vessel foramen or perhaps a sinus tract; a fracture is considered less likely. I see no joint effusion. | Evolving changes of treated osteomyelitis as described above; I see no definite complications, but if further imaging evaluation is clinically warranted, MRI may be considered.. |
Generate impression based on findings. | Reason: mets lung cancer, pericardium mets and clot. s/p 2 cycles of chemo. pls c/w previous study and evalaute tx response. History: lung ca CHEST:LUNGS AND PLEURA: Right lower lobe mass measures 84 x 59 mm on image 63/110, not significant changed. There is invasion into the left atrium. Surrounding consolidation has improved. There is improved right lower lobe aeration.The right upper lobe pulmonary nodule measures 13 x 12 mm on image 43/110, not significant changed. There is severe emphysema. No new pulmonary nodules.MEDIASTINUM AND HILA: Reference subcarinal lymph node has decreased to 10 mm on image 50/157. The left hilar lymph node (image 40/157) has also decreased. Mild coronary calcification.CHEST WALL: No significant abnormality noted.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: Left adrenal nodule unchanged measuring 19 x 18 mm on coronal image 43/100KIDNEYS, 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.OTHER: No significant abnormality noted. | 1. Pulmonary mass and nodules grossly stable.2. Intrathoracic lymphadenopathy decreased.3. Nonspecific left adrenal nodule unchanged. |
Generate impression based on findings. | Hip arthroplasty Pelvis: Interval placement of bilateral total hip arthroplasties without evidence of interval complication other than very minimal punctate heterotopic bone adjacent to the left greater trochanter. The remainder of the pelvis is otherwise unremarkableHip: Femoral stem component is otherwise intact without evidence of additional associated abnormality. Scattered minimal vascular clips in the thigh. | Bilateral total hip arthroplasties without apparent complication |
Generate impression based on findings. | Reason: r/o bleed History: HA The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. 2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Treated rectal carcinoma with diffuse metastases CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Right thyroid low-attenuation focus.CHEST WALL: Right posterior T8 mixed sclerotic and lytic destructive rib lesion with associated soft tissue component. This lesion was recently biopsied and is new since 2012. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple lytic lesions involving multiple vertebral bodiesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Trace free fluid within the pelvic cul-de-sac.BONES, SOFT TISSUES: Multiple lytic lesions involving multiple vertebral bodies.OTHER: No significant abnormality noted | Right posterior T8 rib metastasis associated with lytic lesions involving multiple vertebral bodies also worrisome for metastatic foci. Trace free fluid within the pelvis of unknown clinical significance. Right thyroid nodule; correlation with ultrasound would be helpful if further characterization desired. |
Generate impression based on findings. | Pain and swelling. No relayed history of injury Foot: Mild to moderate osteoarthritic changes with a bunion involving the first MTP with more minimal changes scattered distally. Alignment maintained and more minimal changes observed in the mid foot and talonavicular articulations. Small Achilles heel spurs. Note is made of minimal periosteal reaction observed in the second and third digits, possibly a stress reaction. Please correlate with patient's site of symptomsAnkle: Mild diffuse soft tissue swelling with underlying degenerative changes. No superimposed acute abnormalities | Scattered mild to moderate degenerative changes and possible stress reaction of the second and third metatarsals. Please correlate with patient's site of symptoms |
Generate impression based on findings. | 51 years old Male. Reason: Please compare to prior PET scan. History: GE Junction esophageal cancer. Please perform PET/CT exam per CALGB 80803 requirements. This study was performed for restaging. RADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion grossly demonstrates nonspecific mild thickening of the gastroesophageal junction is noted, likely corresponding with known cancer. Several small gastrohepatic lymph nodes are present. Hypodense right renal lesions, unchanged from prior and likely representing cysts. Lipoma of the left iliopsoas muscle again noted.Today's PET examination demonstrates increased FDG uptake in the gastroesophageal junction with maximal SUV of 5.8 (it was 6.0 on prior study). Small hypermetabolic lymph node in the gastrohepatic ligament seen on prior study has resolved.There are several new mildly to moderately hypermetabolic lymph nodes in the neck at bilateral level 2 regions and in the right level 5 region. The maximal SUV of the most intense neck lymph nodes at the right level 2 region is 5.0.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Stable gastroesophageal junction hypermetabolic tumor.2.Interval resolution of hypermetabolic lymph node in the gastrohepatic ligament.3.New mild to moderate hypermetabolic lymph nodes in both sides neck, which are nonspecific. |
Generate impression based on findings. | Swelling and pain. Fracture? I see no fracture, malalignment, or joint effusion. I see no specific findings to account for the patient's pain. | No fracture or other findings to account for patient's pain are evident. |
Generate impression based on findings. | IM rod check Unchanged left femoral IM rod without evidence of new complications. Proximal diaphyseal lucency with endosteal scalloping appears similar to prior study. This latter lesion again suggest suspected breast metastatic lesion. Soft tissues unremarkable | IM rod unchanged |
Generate impression based on findings. | Ms. Jones is a 73 year old female with a personal history of left cyst aspiration in May 2011. No current breast related complaints. Three standard views of both breasts and one left spot compression 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. A spot compression view of the left inferior breast demonstrates two focal asymmetries which are stable when compared to multiple prior exams. Focal asymmetry in the medial right breast is also stable. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Bilateral stable focal asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended as the patient has been recalled from screening multiple times. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 74 years old; Reason: recent worsening of HTN and acute kidney injury w/ patient taking ACE-I and ARB together; eval for renal dx and renal artery stenosis History: AKI, HTN ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 11 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.. .LEFT KIDNEY: The left kidney measures 12 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.. .URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted. | 1.No Doppler evidence of renal artery stenosis.2.Echogenic renal cortices compatible with medical renal disease. |
Generate impression based on findings. | Tenderness wrist with swelling. Fell Mild diffuse degenerative changes of the radiocarpal joint with more marked degenerative changes involving the base of the first digit. Diffuse demineralization limits sensitivity, however within this limit, no discrete acute focal abnormality is observed. Specifically no fracture or malalignment. Soft tissues are unremarkable | Scattered mild to moderate degenerative most pronounced involving the base of the thumb. See above |
Generate impression based on findings. | Reason: evaluate ILD History: cough soboe fibrosis LUNGS AND PLEURA: Peripheral basilar predominant reticular opacities and fibrosis is present with traction bronchiectasis in the lower lobes. No ground glass opacities or definite honeycombing is identified. Status post wedge resections of the right upper, middle, and lower lobes. Mild centrilobular emphysema affects the upper lobes. No airtrapping is seen on the expiratory phase images. No consolidation or pleural effusion is identified.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion. Moderate coronary artery calcifications are present.CHEST WALL: No axillary lymphadenopathy is seen. Degenerative changes are seen thoracic spine. Wedge deformity of the T12 vertebral body is compatible with an age indeterminate compression fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hypodense exophytic renal lesions likely represent cysts. Accessory spleen is seen anterior to the spleen. | Peripheral basilar predominant fibrosis is compatible with a somewhat atypical UIP pattern which may related to collagen vascular disease or idiopathic. Chronic hypersensitivity pneumonitis and drug reaction are alternative diagnoses. |
Generate impression based on findings. | Reason: eval for aspiration PNA vs PE vs other acute pathology History: cough, hemoptysis PULMONARY ARTERIES: A filling defect within the left lower lobe basilar pulmonary artery (series 6 comment 175) extends into the segmental branches, compatible with acute pulmonary embolism. A peripheral filling defect more proximally within the left lower lobe pulmonary artery may be more chronic in nature. The main pulmonary artery measures up to 2.8 cm in diameter. No evidence of right heart strain.LUNGS AND PLEURA: Patchy peribronchovascular and peripheral predominant consolidation throughout the right lung, similar in appearance to the comparison CT abdomen pelvis. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Prominent right hilar and subcarinal lymph nodes measuring up to 1.6 cm (series 6, image 96) may be reactive.CHEST WALL: Changes of a median sternotomy. Small lipoma in right latissimus dorsi.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Previously described hyper attenuating liver lesion is not well characterized on this exam due to phase of contrast. Partially visualized right renal cyst is unchanged. Left adrenal nodularity is unchanged. | 1. Acute pulmonary embolism in the left lower lobar arterial branch, without associated right heart strain.2. Patchy consolidation throughout the right lung, most compatible with pneumonia, with likely reactive right hilar and subcarinal lymphadenopathy. Pulmonary hemorrhage or infarct could have a similar appearance and should also be considered.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Single.Most Proximal: Lobar.RV Strain: Negative. Findings discussed via telephone with Dr. Sridharan at 2:13 PM |
Generate impression based on findings. | Bone pain. Metastatic prostate cancer, assess for progression. There are numerous new areas of increased uptake throughout the axial and appendicular skeleton including the skull, spine, bilateral ribs, bilateral humeri, pelvis, and bilateral femurs. The previously identified lesions are also more confluent and prominent.Normal renal uptake is identified bilaterally. | Numerous new and worsening existing osseous lesions compatible with increased osseous metastatic disease. |
Generate impression based on findings. | Female, 65 years old.Status post abdominal surgery with multiple surgical teams. Suture material projects over the left upper quadrant and right mid abdomen. Cholecystectomy staples again noted over the right upper quadrant. An enteric tube projects over the right lower quadrant. There are numerous skin staples in the midabdomen. No unexpected radiopaque foreign objects. Note that the pelvis is excluded from the field-of-view. | No unexpected radiopaque foreign objects.Findings discussed with Dr. Alverdy via telephone at 1:50 PM by Dr. S. McCann on 2/9/2015. |
Generate impression based on findings. | There are post-surgical findings related to partial ethmoidectomy, sphenoidectomy and left maxillary antrostomy. The middle and inferior turbinates have been surgically removed bilaterally. The right ethmoid sinus remains completely opacified with high attenuation material, mainly in the right posterior ethmoid air cells, compatible with fungal sinusitis. The left frontal sinus and frontoethmoidal recesses remain opacified. There is mild mucosal thickening in the left ethmoid sinus and left maxillary sinus. There is partial opacification of the left sphenoid sinuses. There is unchanged near complete opacification of the right maxillary sinus. The right ostiomeatal unit is completely opacified. The left antrostomy is patent. There is mild mucosal thickening of the left maxillary sinus. The sphenoid cavity is clear. The mastoid air cells are clear. There is mild leftward deviation of the nasal septum with small osseous spur. Remodeling of the dorsum sella and clivus are unchanged and the bilateral carotid grooves are dehiscent. Redemonstrated are multiple ground glass lesions in the craniofacial skeleton, which are unchanged. Tooth #16 is carious. | 1. Persistent chronic fungal rhinosinusitis. 2. Polyostotic craniofacial fibrous dysplasia. 3. Tooth #16 is carious. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: evaluate ILD History: cough soboe LUNGS AND PLEURA: Bilateral lower lobe predominant linear interstitial abnormality with traction bronchiectasis and areas of honeycombing. No evidence of significant groundglass opacity. Minimal patchy air trapping on expiratory phase imaging. There are scattered calcified granulomas.Small sub-pleural subcentimeter nodular opacity in the left upper lobe posteriorly (image 99/311) likely scarring though continued follow up is recommended to exclude growth/malignancy.MEDIASTINUM AND HILA: Left-sided pacemaker lead in RV apex. Severe coronary calcification. Moderate cardiomegaly. Scattered small subcentimeter lymph nodes.CHEST WALL: Degenerative change involving the thoracic spine. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Pulmonary fibrosis in pattern consistent with UIP.2. Small sub-pleural subcentimeter nodular opacity in the left upper lobe posteriorly likely scarring though continued follow up is recommended to exclude growth/malignancy.3. Other findings as above. |
Generate impression based on findings. | Ms. Mora is a 59 year old female with a personal history of right breast mastectomy in 2004 for IDC followed by chemotherapy along with left breast reconstruction. No current breast related complaints. Three standard views of the left breast 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. Focal asymmetry in the lateral left breast is stable when compared to multiple prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | Stable focal asymmetry in the left breast. 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. | 63 years old female with esophageal carcinoma. This study was performed for initial staging.RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 104 mg/dL. Today's CT portion grossly demonstrates wall thickening of the gastroesophageal junction. A cystic lesion is seen in the right kidney.Today's PET examination demonstrates a large hypermetabolic mass in the gastric cardia with SUV Max of 10.7, which is consistent with the patient's diagnosis of gastroesophageal junction tumor. There is a focus of increased activity in the posterior mediastinum at right para-aortic region and at the level of right inferior pulmonary vein, without definite CT correlation.There is a focus increased activity in the left anterior pelvis near the midline, which may be in the intestines or peritoneum. The maximal SUV in the abnormal uptake is 6.5. There is an additional focus of increased activity in the right pelvic wall at internal obturator muscle with SUVmax of 12.4. Diffuse FDG uptake is seen in the mid and distal esophagus, which is most likely due to esophagitis.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, kidneys, spleen, intestines, ureters and bladder. | 1.Hypermetabolic tumor in the gastroesophageal junction, consistent with patient's diagnosis of esophageal cancer.2.Two foci of increased FDG uptake in the anterior portion of the pelvis and right internal obturator muscle, suspicious for metastasis. However, informatory change may have a similar FDG uptake. 3.A focus of increased activity in the posterior mediastinal para-aortic region with CT correlation, which is nonspecific. |
Generate impression based on findings. | Metastatic prostate cancer post chemotherapy. Evaluate for progression. There is redemonstration of multiple areas of increased uptake within the ribs, spine, pelvis, and proximal femurs. Some lesions exhibit mildly increased radiotracer uptake compared to the most recent exam, particularly a lesion within the right first rib, right pubic bone, and the L2 vertebral body. Mildly increased uptake is again noted in the maxillary sinuses.Normal bilateral renal uptake is seen. | No significant interval change in number of multiple osseous metastatic lesions given differences in positioning and technique. |
Generate impression based on findings. | Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There are some artifacts, which somewhat limits the study. There are several small cysts in both breasts. There is no solid or suspicious mass identified. | No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Female 72 years old Reason: bladder cancer- History: bladder cancer ABDOMEN:LUNG BASES: Bilateral basilar atelectasis. No pleural effusion. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral simple cysts and peripelvic cysts, unchanged.Additional bilateral subcentimeter hypodensities too small to characterize and likely representing simple cysts.No perinephric fat stranding, hydroureter, or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine.Right curvature of the lumbar spine and leftward curvature of the lower thoracic spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Previously seen enhancing nodule with associated filling defect within the bladder lumen is not seen on the current study. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrent bladder cancer or metastasis. |
Generate impression based on findings. | 30 years, Female. Reason: rule out constipation History: abdominal pain There is a mildly greater than average stool burden in the ascending and proximal transverse colon with a less than average to burden in the descending and sigmoid colon. Nonobstructive bowel gas pattern with suture material noted in the right lower quadrant. | Mildly greater than average stool burden in the ascending and proximal transverse colon. |
Generate impression based on findings. | 50 year-old female with delayed gastric emptying, history of gastric polyps, with abdominal pain, nausea and vomiting-evaluate for gastric outlet obstruction Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary peristaltic wave at the midesophagus. Spontaneous secondary waves were noted with slight delay in transit through the lower esophageal sphincter.The stomach was normal in size, shape, and position. No gastric polyps were noted. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal. No delay in transit of contrast into the duodenum. No evidence of obstructing lesion at the gastric antropyloric region.The duodenal bulb and sweep were within normal limits. TOTAL FLUOROSCOPY TIME: 5:31 minutes | 1.Mild motor abnormality of the esophagus as described above.2.Otherwise, normal examination of the esophagus, stomach, and duodenum. |
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. Stable benign intramammary lymph node is present in the right upper outer quadrant.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. | Female; 19 years old. Reason: Acute on CKD. History: Renal transplant, acute on CKD. RENAL TRANSPLANT: The transplanted kidney measures 10.9 cm in length. Mild hydronephrosis is redemonstrated. The corticomedullary differentiation is normal.LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: The native kidneys are not evaluated.COLLECTING SYSTEM/URETER: Redemonstrated mild hydronephrosis of the transplanted kidney.URINARY BLADDER: The bladder is partially distended and incompletely evaluated.VASCULAR DOPPLER DATA: Peak systolic flow in the anastomosis is 90 cm/sec.Peak systolic flow in the renal artery artery: Proximal - 59 cm/sec Mid - 76 cm/sec Distal - 99 cm/secThe resistive indices very between 0.54 and 0.62.The renal vein is patent.OTHER: There is no peri-nephric fluid collection. | 1.Mild hydronephrosis of the transplant kidney.2.Patent renal vasculature. |
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. | Ms. Matthews is a 61 year old female with a personal history of left breast mastectomy approximately 25 years ago. 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 composed of scattered fibroglandular density. There is a benign morphology mass in the medial right breast, mid depth. There are no suspicious microcalcifications or areas of architectural distortion identified in the right breast. | Mass in the medial right breast. An attempt to obtain patient's prior mammograms should be made in order to confirm stability of this finding. A release form was signed by the patient at time of appointment and will be faxed to Rush Hospital. If the prior studies cannot be submitted, then further evaluation with ultrasound will be needed. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
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. | 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. Circumscribed mass in the upper mid depth left breast is unchanged.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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 50 year old with history of benign left breast biopsy in 2004. 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. Stable benign calcifications and bilateral focal asymmetries are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Tomosynthesis may be of benefit. Automated screening whole breast ultrasound can also be considered based on the patient's breast density. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 11-month-old female with history of aspiration on previous OPM. Assess for aspiration, ability to handle PO liquids, solids and oral secretions.EXAMINATION: Oropharyngeal motility study 2/9/2015 Beth Harrison, speech and language therapist, supervised the examination.1 minute and 47 seconds of fluoroscopy was used.There were oral and pharyngeal deficits identified. Decreased lingual cupping and poor latch to bottle were noted. No suction and no attempts at nutritive suck/expression were made. Decreased bolus maintenance and manipulation. Diffuse bolus loss/poor propulsion with bolus eventually trickling to base of tongue and diffuse residual. Piecemeal deglutition was present. Mild pharyngonasal reflux. Decreased pharyngeal strength resulted in residue along base of tongue, valleculae and posterior pharyngeal wall. Delayed pharyngeal swallow. No visualized penetration/aspiration but assessment of pharyngeal phase was limited by extensive oral phase deficit. | Oral and pharyngeal deficits with no aspiration.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | 19 years, Female. Reason: rlq pain associated with constipation History: right lower quadrant pain and tenderness Amorphous stool throughout the entire colon. No evidence of obstruction. The lung bases are clear. | Above average stool burden. |
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. Mild architectural distortion is present in lower inner quadrant in the left breast, likely due to prior surgery. 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: 2 - Benign finding.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. 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. | Ms. Kolimja is a 46 year old female presenting for a short-term follow-up for an asymmetry over the right pectoralis muscle. Personal history of benign right breast biopsy in 01/2014. Three standard views of both breasts with one right spot compression 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. Previously described benign morphology mass projected over the pectoralis muscle appears similar in size when compared to the prior study (07/28/2015), but smaller when compared to the original study from 01/28/2015, compatible with a waxing and waning cyst. A ribbon clip is present in the right upper outer quadrant, at site of prior benign biopsy. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Benign morphology mass in the posterior right breast, likely representing a cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 1 year to confirm stability of these findings. 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. Tomosynthesis images are also obtained. 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. | 84 years, Male. Reason: rule out SBO History: rule out SBO Nasogastric tube side port at the GE junction with tip in the proximal stomach.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Nonobstructive bowel gas pattern. NG tube side port at the GE junction, recommend advancement.Findings relayed to Dr. Gera at 1502 on 2/9/15. |
Generate impression based on findings. | History metastatic breast cancer, evaluate disease status. CHEST:LUNGS AND PLEURA: Moderate emphysema. Micronodule along the right major fissure (series 4, image 45) stable since 2009. No suspicious nodules or masses.MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications of the coronary arteries. Moderate atherosclerotic disease affects the thoracic aorta including mural thrombus. No hilar or mediastinal lymphadenopathy by size criteria. Stable subcentimeter low attenuation lesion within the right thyroid. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are two right hepatic lobe hemangiomas, which are unchanged from the prior exam. There is an additional unchanged punctate low attenuation lesion in hepatic segment 4a, too small to characterize but similar to prior. There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered low-attenuation renal lesions too small to characterize but likely benign.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches as well as mural thrombus appearing similar to prior. Scattered mildly prominent retroperitoneal lymph nodes appearing similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is unchanged vertebral body sclerosis affecting the T7 through T10 vertebral bodies, which is likely degenerative in etiology. These findings were present and have not significantly changed since the 4/30/2009 examination.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small pelvic lymph nodes, similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine appearing similar to prior.OTHER: No significant abnormality noted. | 1.No specific evidence of new metastatic or recurrent disease.2.Stable sclerosis within several thoracolumbar vertebral bodies, unchanged from 2009 examination and likely degenerative. |
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. A small circumscribed mass with a central calcification in the lower inner quadrant of the left breast is unchanged. 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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | History of metastatic prostate cancer. There is redemonstration of increased uptake within the thoracolumbar spine, sacrum and pelvis. Degenerative disease related increased uptake is seen within the cervical spine, sternoclavicular joints, shoulders, and knees. | No significant change in osseous metastases. |
Generate impression based on findings. | 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. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or mass effect. |
Generate impression based on findings. | Pain. Patient states her finger was slammed in a door today. Pain and swelling throughout the entire middle finger. Soft tissue swelling is present in the middle finger, particularly about the PIP joint. We see no fracture or malalignment. | Soft tissue swelling without fracture. |
Generate impression based on findings. | 35 years, Female. Reason: 35yo female with abdominal pain and constipation. Assess stool burden History: abdominal pain and constipation Average stool burden in the colon. Nonobstructive bowel gas pattern. | Average stool burden without evidence of obstruction. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (1/21/15, 1/22/15), ultrasound images of left breast (1/22/15), images from ultrasound guided biopsy and postprocedural left digital mammographic images (1/22/15) performed at Kenosha Medical Center. For comparison, digital mammographic images (10/2/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (1/21/15, 1/22/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A new focal asymmetry is present at lower inner quadrant in the left breast, measuring approximately 10 x 10 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (1/22/15):An irregularly shaped hypoechoic lesion, measuring 11 x 7 mm, is visualized. Per outside radiology report, this hypoechoic lesion is located in the lower inner left breast, and it presumably corresponds to the focal asymmetry on mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (1/22/15):Ultrasound guided biopsy was performed with an appropriate needle placement. Postprocedural left mammographic images show that a marker clip is placed medial aspect of the asymmetry in the lower inner quadrant.Per outside pathology report, the result was malignant; infiltrating ductal carcinoma grade 2. | Biopsy proven left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Prostate cancer. Findings limited due to motion. There is increased uptake within the bilateral ribs, thoracolumbar spine, and pelvis.There is asymmetric prominence of the right renal pelvis and faint uptake of tracer of the left kidney. | 1. Multifocal osseous metastatic disease.2. Asymmetric prominence of the right renal pelvis may be related to some degree of obstruction; dedicated imaging may be considered if clinically warranted. |
Generate impression based on findings. | Female 54 years old; Reason: Met breast cancer needs re-evaluation and compare to prior scans. Measurements when applicable. Patient currently on clinical trial. History: Met breast cancer needs re-evaluation and compare to prior scans. Measurements when applicable. CHEST:LUNGS AND PLEURA: Stable subpleural fibrotic changes in the anterior segments of the right lower lobe related to radiation. No new dominant lung lesion.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 8 mm (image 37/series 4) previously, 10 mm. Other small mediastinal lymph nodes persist.Heart size is normal. No pericardial effusion.CHEST WALL: Left chest wall port terminates at the cavoatrial junction. Osseous sclerotic metastatic disease to the spine.ABDOMEN:LIVER, BILIARY TRACT: Reference segment two lesion measures 1.5 x 1.3 cm (image 76/series 4) previously, 1.5 x 0.7 cm. No definite new liver lesions.Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland mass measures 5.6 x 5.3 cm (image 88/series 4) previously, 5.5 x 5.2 cm. it is previously characterized as an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic osseous metastatic disease to the thoracolumbar spine.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: Colonic diverticulosisBONES, SOFT TISSUES: Sclerotic osseous metastatic disease.OTHER: No significant abnormality noted. | 1.Near stable size measurements of the reference lesions.2.Osseous metastatic disease. |
Generate impression based on findings. | Female 54 years old; Reason: s/p reduction and application of long leg splint. Evaluation of osseous detail is limited by overlying cast material.Again seen is an oblique fracture of the tibial diaphysis reduced to near anatomic alignment. The fracture fragments of the oblique spiral fracture of the distal fibula remain in near anatomic alignment. | Distal tibia and fibula fractures, as above. |
Generate impression based on findings. | Right ear granuloma. Right: There is nonspecific soft tissue along the anterior aspect of the tympanic membrane, which measures up to 5 mm. There is no convincing evidence of associated bony erosion and the middle ear and mastoid air cells are otherwise clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve canal describes a normal course. The jugular bulb and carotid canal are intact. Left: There is linear debris within the left external auditory canal, which may represent cerumen. Otherwise, the external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve canal describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There are bubbly secretions in the right sphenoid sinus. | 1. Nonspecific subcentimeter soft tissue along the anterior aspect of the right tympanic membrane is compatible with a granuloma. The middle ear cavity, including the attic, is otherwise clear.2. Findings suggestive of acute sinusitis. |
Generate impression based on findings. | Elevated PVR. Question of VQ mismatch. The comparison chest radiograph performed on 2/8/2015 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 no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a single moderate perfusion defect within the left upper lobe. | Intermediate probability for pulmonary embolus. |
Generate impression based on findings. | Reason: Eval for sarcoidosis History: cough LUNGS AND PLEURA: Scattered punctate < 4-mm pulmonary nodules. No specific evidence of sarcoidosis.MEDIASTINUM AND HILA: Scattered small subcentimeter nodes, none are pathologic by size criteria.CHEST WALL: Scattered small subcentimeter axillary nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No specific evidence of sarcoidosis. Scattered nonspecific punctate <4-mm nodules which are too small to characterize. In a high risk patient, one year CT follow-up is recommended. In low risk patients, since these are likely postinflammatory, no specific imaging follow up is typically required. |
Generate impression based on findings. | 6 year old male, fell on his right knee yesterday in trampoline, now with swelling and pain. Rule out fracture.VIEWS: Right Knee AP, Oblique, Lateral, skyline (4 views) There is no evidence of joint effusion. There is no evidence of fracture. | Normal examination. |
Generate impression based on findings. | 70 years, Female. Reason: abd pain, r/o ileus History: epigastric pain, reflux. Recent constipation Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. Lung bases are clear. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | History of 6-month weight loss and nausea/vomiting, evaluate celiac artery and SMA. CT Angiography: Severe atherosclerotic disease affects the abdominal aorta and its branches with severe narrowing at the origin of the celiac axis. The proximal SMA is thrombosed with re-constitution of the distal SMA. There is severe narrowing of the origins of the right renal artery as well as the inferior mesenteric artery. No evidence of aortic aneurysm or dissection.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Two subcentimeter low attenuation lesions within the hepatic dome are too small to characterize.SPLEEN: Heterogeneous attenuation of the spleen likely secondary to poor perfusion given severe stenosis at the origin of the celiac axis.PANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measures 1.6 x 1.9 cm (series 11, image 36) and demonstrates an attenuation of 2 Hounsfield units on noncontrast images compatible with adenoma. KIDNEYS, URETERS: Atrophic right kidney. Subcentimeter hypoattenuating focus at the inferior pole of the right kidney is too small to characterize. There is delayed enhancement of the kidneys compatible with poor renal function.RETROPERITONEUM, LYMPH NODES: See above for description of vasculature. Multiple subcentimeter retroperitoneal lymph nodes are nonspecific with left para-aortic lymph node measuring 0.8 x 0.8 cm (series 11, image 46).BOWEL, MESENTERY: Increased gastric mucosal enhancement on arterial phase without pooling on delayed phase suggests gastritis. Ascending colonic submucosal fat deposition most suggestive of chronic colitis. No additional bowel wall thickening. No evidence of bowel obstruction. There is a 4.0 x 3.1 x 3.5 cm (series 11, image 85) pericecal collection with foci of air and surrounding inflammatory changes which most likely represents an abscess, slightly increased in size.BONES, SOFT TISSUES: Moderate degenerative changes affect the thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Moderate degenerative changes affect the thoracolumbar spine. OTHER: No significant abnormality noted | 1.Pericecal abscess measuring up to 4 cm has slightly increased in size and may be secondary to perforated appendix or ischemic colitis.2.Thrombosed proximal SMA with reconstitution distally. Severe stenosis at the origins of the celiac artery, right renal artery, and IMA.3.Heterogenous spleen secondary to poor perfusion.4.Atrophic right kidney. Delayed renal enhancement reflecting poor renal function.5.Left adrenal adenoma.6.Findings suggestive of gastritis.Discussed findings with ordering physician Dr. Lio. |
Generate impression based on findings. | There is hypoattenuation with mild local mass effect in the left insula, left middle and inferior frontal gyri consistent with acute infarct. There is no acute intracranial hemorrhage, or midline shift. The ventricles and basal cisterns are prominent consistent with age-related volume loss. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Acute nonhemorrhagic left distal MCA territory infarction.Findings were discussed with Dr. Ben Weber from the ED via telephone at 2:45 p.m. on 2/9/2015. |
Generate impression based on findings. | Female 64 years old Reason: drains in correct location History: abdominal fluid collections ABDOMEN:LUNG BASES: Large bilateral pleural effusions with overlying compressive atelectasis.LIVER, BILIARY TRACT: Mild scattered upper abdominal ascites is present. Linear hypo-densities in the left hepatic lobe are unchanged and likely represent periportal edema.Status post cholecystectomySPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged hypoattenuating focus within the superior pole of the left kidney consistent with a simple cyst. Additional subcentimeter left hypoattenuating foci are incompletely characterized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval placement of abdominal drain into fluid and gas containing collection in the midline upper abdomen which is decreased and now measures 9.4 x 3.3 cm, previously 11.0 x 7.1 cm (series 3, image 41). A portion of the side holes on the drainage catheter extends beyond the abscess cavity, but remains within the subcutaneous tissues and may need to be repositioned. Interval placement of abdominal drain into fluid and gas containing collection immediately posterior to the midline incision with decrease in size measuring 5.1 x 1.6 cm, previously 14.5 x 3.3 cm (series 3, image 74). Residual subcutaneous emphysema. The drainage catheter appears well positioned within the abscess cavity.Interval placement of abdominal drain into fluid and gas containing collection in the right lower quadrant measuring 4.0 x 2.8 cm (series 3, image 125). The drainage catheter appears well positioned within the abscess cavity.Enhancing and thickened bowel wall is present. The findings are nonspecific but likely postoperative in nature.Enteric tube with tip in the gastric fundus. BONES, SOFT TISSUES: Moderate degenerative change of the lower thoracic spine.OTHER: Central venous catheter with tip in the SVC.Atherosclerotic calcifications of the aorta.PELVIS:UTERUS, ADNEXA: Surgically absent with surgical clips in pelvis.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged lucent lesion within the sacrum. OTHER: No significant abnormality noted | 1.Interval improvement in dominant abscesses within the epigastric region, left upper quadrant and right lower quadrant following placement of percutaneous drainage catheters. 2.Persistent large pleural effusions. |
Generate impression based on findings. | There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. There is diffuse cerebral volume loss. There is a corpus callosum lipoma with possible dysgenesis of of the corpus callosum. There is no midline shift or herniation. The mastoid air cells are clear. There is mild scattered paranasal sinus mucosal thickening. The skull and scalp soft tissues are unremarkable. | 1. No acute intracranial hemorrhage.2. Diffuse cerebral volume loss. 3. Corpus callosum lipoma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 24-year-old male with pain. Evaluate for fracture or sprain. Three views of the right ankle show no evidence of an acute fracture or dislocation. The ankle mortise joint is intact. | No evidence of an acute fracture or dislocation. |
Generate impression based on findings. | 63-year-old male with a history of 3rd metacarpal fracture, please evaluate for base of 5th metacarpal fracture. Three views of the right hand again show a comminuted fracture of the mid diaphysis of the third metacarpal with foreshortening, posterior displacement, and volar angulation of the distal fracture fragment appearing similar to that seen on 2/7/2015. Dorsal soft tissue swelling is noted. No evidence of an acute fracture of the remaining hand including the fifth digit. There is deformity of the fifth metacarpal head from prior fracture. | Third metacarpal diaphyseal fracture appearing similar to the prior exam. No evidence of an additional fracture. |
Generate impression based on findings. | 59-year-old male with acute injury (fall), history of left hip arthritis. Able to bear weight. Two views of left hip shows severe joint space narrowing and subchondral sclerosis with osteophyte formation indicating severe osteoarthritis which has progressed since the prior exam. No evidence of a fracture or dislocation. | Severe osteoarthritis of the left hip which has progressed since the prior exam. No evidence of fracture or dislocation. |
Generate impression based on findings. | There is small focal mild to moderate decreased activity of the anterior most portion of the bilateral anterior frontal lobes. This raises the question of hypoperfusion from Lyme disease, though given symmetry, may be artifactual and are of unclear clinical significance. The remaining portions of the brain have symmetric uniform perfusion. | Small focal hypoperfusion of the bilateral anterior frontal lobes which may be related to artifact given the symmetry, but conceivably could represent small true perfusion defects such as can be seen with Lyme disease. |
Generate impression based on findings. | 80 year-old female with hand pain. Evaluate for bone abnormality. Three views of the left hand show diffuse osteopenia and degenerative changes about the DIP and PIP joints as well marked degenerative change at the first CMC. No evidence of acute fracture or dislocation. Drooping osteophytes are noted about the metacarpal heads which could represent a CPPD arthropathy.Three views of the right hand again show degenerative changes at the DIP and PIP joints as well as marked degenerative changes of the first CMC joint. No evidence of acute fracture or dislocation. Drooping osteophytes are noted about the metacarpal heads which could represent a CPPD arthropathy. | Osteoarthritis most severe at the first CMC joints bilaterally and findings suggestive of a CPPD arthropathy. |
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