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Generate impression based on findings. | Male 45 years old Reason: Evaluate abdominal wall for hernia/redundancy of bowel near the old stoma site with Pain and spasms. History: Abdominal pain and spasms with occasional partial obstructions 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: Nonobstructing right inferior pole calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes related to prior proctocolectomy and ileoanal pouch anastomosis. There are multiple areas of bowel narrowing and angulation likely secondary to adhesions.In the right upper midabdomen, there is short segment of bowel narrowing measuring up to 5 cm (series 3, image 59 and series 80268, image 65) just proximal to the surgical margin. There is an additional area of angulation in the right midabdomen between the duodenum and ileum (series 80268, image 53) with a focal area of adjacent mesenteric inflammation.No bowel herniation at the previous stoma site.Moderately dilated loops of small bowel in the right upper quadrant measuring up to 3.4 cm without obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted. | 1.No evidence of obstruction.2.Multiple areas of small bowel narrowing and angulation likely secondary to adhesions. 3.No evidence of herniation at the previous stoma site. |
Generate impression based on findings. | Reason: 46F with metastatic poorly differentiated HNC presented for surveillance films History: surveillance films CHEST:LUNGS AND PLEURA: Bilateral upper lobe scarring and subpleural linear and nodular scarring again seen, unchanged in appearance, compatible with post-radiation reaction. Residual nodular scarring in the dependent portions of the lungs bilaterally are likely due to prior aspiration. A previously described right upper lobe ground glass nodule (series 5, image 27), is stable, likely representing additional scarring. No new suspicious pulmonary nodules or masses. No focal air space consolidations. No pleural effusions.A low tracheal bronchus supplies the apical segment of the right lung.MEDIASTINUM AND HILA: The heart is mildly enlarged without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest port catheter tip in the right atrium.Surgical changes in the left humeral head.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: 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: Previously described sclerotic lesion in the right ilium is partially visualized.OTHER: No significant abnormality noted. | Stable reticular and nodular lung scarring compatible with radiation reaction and prior aspiration. No specific evidence of metastatic disease. |
Generate impression based on findings. | No evidence of enhancement, enlargement, or surrounding inflammatory changes of the right and grant. Apparent enlargement of the left submandibular gland is most likely artifact of positioning. The parotid glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. There is no clinically significant adenopathy. There are no soft tissue masses.Posterior pulmonary opacities in the visualized lung bases may represent atelectasis versus scarring. Infection is considered less likely.Multilevel degenerative changes affect the cervical spine, most severe at C5/6. There is mild rotation of C1 relative to C2 which in part may be positional in etiology. | 1.No evidence of inflammatory changes or a radiopaque stone within the right submandibular gland as clinically questioned.2.Mild rotation of C1 relative to C2 which in part may be positional in etiology.3.Multilevel cervical spine degenerative changes, most severe at C5/6. |
Generate impression based on findings. | Lumbago There is mild degenerative disease at L5/S1. Streaky calcification within the L4/5 intervertebral disk space may reflect additional mild degenerative disk disease. There is a minimal anterolisthesis of L4 relative to L5, but otherwise alignment is normal. Vertebral body heights are preserved. | Mild degenerative disk disease. |
Generate impression based on findings. | Reason: midweek scan to followup prior CTH. Hx of Rapidly enlarging (since 2/3/15) bilateral subdural collections, could be related to ongoing bleeding into subdural spaces. History: see above There is redemonstration of a 16 x 10 mm hematoma centered in the left superior frontal gyrus which appears stable when compared to the previous exam. There is redemonstration of bilateral subdural effusions measuring 11 mm on the left hand 8 mm on the right. These are stable compared to the prior exam. Subarachnoid hyperdensities adjacent to the right temporal lobe are stable compared to the prior exam.Subdural effusions in the posterior fossa are stable.There is redemonstration of small hypodense foci in the thalami bilaterally and to a lesser degree basal ganglia Atherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries.Periventricular and subcortical white matter hypodensities of a mild degree are present.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. | 1.Bilateral subdural effusions are stable when compared to the prior exam 2.Stable intraparenchymal hemorrhage in the left frontal lobe with continued evolution.3.Evolution of subarachnoid blood products in the right temporal lobe4.Redemonstration of old lacunar infarcts in the thalami and basal ganglia5.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. | 83-year-old female with a history of right breast DCIS status post lumpectomy in 1999 and radiation. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Postsurgical architectural distortion, skin retraction, and increased density are stable in the right breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Clinical question: Rule out ICH, stroke. Signs and symptoms: Left-sided weakness and AMS. Nonenhanced head CT:There is no convincing evidence of an acute intracranial process. CT however these insensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white gray differentiation remains within normal.Unremarkable calvarium and soft tissues of the scalp.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Paranasal sinuses demonstrate mild bilateral maxillary chronic sinus disease unremarkable otherwise.Unremarkable images through the orbits. | Unremarkable nonenhanced head CT. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes. |
Generate impression based on findings. | Clinical question: New headache. Signs and symptoms, new headache. Nonenhanced head CT:There is no acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Mild to moderate periventricular and subcortical low attenuation of white matter grossly similar to prior exam and likely representing age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces otherwise and is stable since prior exam.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. Mild left posterior ethmoid air cell opacification there is noted. | 1.No acute intracranial process.2.Findings on indeterminant small vessel ischemic strokes remains similar to prior exam.3.Well pneumatized paranasal sinuses and mastoid air cells/middle ear cavities. |
Generate impression based on findings. | History metastatic prostate cancer, evaluate for progression. CHEST:LUNGS AND PLEURA: Severe emphysema. Right lower lobe mass (series 5, image 86) measures 2.4 x 2.9 cm, previously 2.4 x 2.9 cm, unchanged. Scattered nonspecific micronodules, some of which are calcified, are also unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Slightly prominent right hilar lymph node (series 3, image 46) measures 1.6 x 1.0 cm, previously 1.6 x 1.0 cm, unchanged. Additional subcentimeter mediastinal lymph nodes appear similar to prior.CHEST WALL: Right chest Port-A-Cath with tip of catheter in the distal superior vena cava. Scattered scattered foci within the visualized osseous structures are grossly similar to prior.ABDOMEN:LIVER, BILIARY TRACT: Benign hepatic cysts appear similar to prior without new focal lesion. Cholelithiasis without evidence of cholecystitis. No biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Again, mildly enlarged para-aortic nodes are seen clustered about the aorta, similar to prior. The reference left periaortic node (series 3, image 122) measures 1.1 x 0.9, previously 1.1 x 0.9 cm; the slightly more inferior node (series 3, image 127) measures 1.3 x 1.2 cm, previously 1.3 x 1.2 cm.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: Enlarged left common iliac lymph nodes are again seen appearing similar to prior. Reference node (series 3, image 144) measures 1.4 x 1.2 cm, previously 1.4 x 1.2 cm. No new foci of lymph node enlargement are seen. More distally the external iliac chains do not show lymphadenopathy although mild enlargement of a right inguinal lymph node is unchanged (series 3, image 188).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerosis in the T12 vertebral body is again noted and is compatible with metastatic disease. Additional scattered sclerotic foci are present within the visualized osseous structures, and nuclear medicine bone scan is more accurate indicator of metastatic skeletal disease.OTHER: No significant abnormality noted | 1.Stable right lower lobe pulmonary mass lesion.2.Stable para-aortic and left common iliac adenopathy.3.Scattered sclerotic skeletal foci most likely metastases grossly similar to prior, though bone scan is more accurate indicator of metastatic skeletal disease. 4.No new lesions identified. 5.Severe emphysema. |
Generate impression based on findings. | 81 year old with history of left lumpectomy for IDC in 2003 and radiation therapy. No breast symptoms currently. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. There are stable postsurgical changes in the left breast with distortion and volume loss. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Grave's disease. The thyroid images demonstrate a diffusely enlarged thyroid gland including enlargement of the pyramidal lobe. There is significantly increased uptake within a majority of the gland. There are medium sized hypofunctioning nodules in the right mid- and lower poles and possibly a third within the right upper pole, although correlation with ultrasound can be made for confirmation. The 5-hour radioactive iodine uptake is 53% and the 22-hour uptake is 68% (normal range 10-30% at 24-hours). | 1. Enlarged gland with diffusely increased uptake compatible with Grave's disease. 2. At least two hypofunctioning right thyroid nodules (most notably in the right mid and lower pole) with are indeterminate for malignancy; these may be further evaluated with ultrasound/biopsy as clinically warranted. |
Generate impression based on findings. | History of right buccal mucosa squamous cell carcinoma, T2N2bM0 who completed treatment in March 2011. Please compare to prior study. There are post-treatment findings related to remote right neck dissection, right submandibular gland resection and radiation treatment. There is no evidence of mass lesions or significant cervical lymphadenopathy. The right parotid gland appears atrophic. The thyroid and other major salivary glands are unremarkable. The major cervical vessels are patent. The right vertebral artery is small in caliber. There is degenerative cervical spondylosis. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is mild mucosal thickening of the bilateral maxillary sinuses. There are a few small calcified granulomas in the right lung apex. The imaged portions of the lungs are otherwise clear. | Posttreatment changes of the neck without evidence of tumor recurrence or cervical lymphadenopathy. |
Generate impression based on findings. | Infection and placement. Gunshot wound.VIEW: Chest AP (one view) 02/10/15, 0927 Left upper extremity PICC tip is in left brachiocephalic vein. Projectile fragment is again seen at the T12 level.Cardiothymic silhouette is normal. No focal lung opacity is present. No pneumothorax or pleural effusion is identified. | Left PICC tip in left brachiocephalic vein. |
Generate impression based on findings. | Ms. Beard is a 44 year old female with an incidentally detected benign morphology mass in the left superior breast. Patient strongly desired histologic sampling for pathologic confirmation. She presents today for ultrasound guided biopsy of this area. Left breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 9 mm at the 12 o’clock position without increased vascularity, 2 cm from the nipple. The lesion was somewhat subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 12-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the 12 o'clock position of the left breast. Given the extreme density of the patient's breast, no discrete underlying mass is seen to correlate with the sonographic findings. No evidence of hematoma or other complication. If this lesion requires excision, localization of the mass under sonographic guidance is suggested. A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 54 years old Reason: 54yr old male with history of PCL, post-auto sct evaluation History: evaluate for multiple myeloma. SKULL: Two views of the skull show no definitive myelomatous lesions. CERVICAL SPINE: Two views of the cervical spine show no discrete myelomatous lesions. Severe degenerative disk disease affects the C5-C6 levels.THORACIC SPINE: The bones appear demineralized, but we see no discrete myelomatous lesions. Mild degenerative disk disease affects the thoracic spine. LUMBAR SPINE: Two views of the lumbar spine show no discrete myelomatous lesions. Mild degenerative disk disease affects the lumbar spine with anterior vertebral body osteophytes.RIBS: AP views of the ribs show no discrete myelomatous lesions.PELVIS: AP views of the pelvis show no discrete myelomatous lesions.UPPER EXTREMITY: Two views of the right humerus show no discrete myelomatous lesions. Two suture anchors are noted in the right humeral head, likely from prior rotator cuff repair. Two views of the left humerus show no definitive myelomatous lesions.AP views of the forearms show no discrete myelomatous lesions.LOWER EXTREMITY: Four views of the right femur show no discrete myelomatous lesions. Note of a normal variant bipartite patella is made. Four views of the left femur show no discrete myelomatous lesions.AP views of the bilateral tibia/fibula show no discrete myelomatous lesions. | Degenerative arthritic changes as described above. We see no discrete myelomatous lesions. |
Generate impression based on findings. | 53 year old male. Status post esophageal leak status post esophagectomy with increasing WBC. CHEST:LUNGS AND PLEURA: Moderate loculated right basilar pleural effusion with associated pleural thickening and foci of air, decreased from prior. Interval removal of right pigtail drain. Adjacent compressive atelectasis in the right lower lobe.Small loculated left basilar pleural effusion, decreased from prior, with interval expansion of the lung base. Within this effusion, there is high-density oral contrast that extravasates from the distal esophagus (series 3, image 68). There is extension of this loculated pleural fluid along the mediastinal pleura to the apex. Two left chest tubes, tips terminating in the mid left posterior hemithorax and abutting the anterior mediastinum at the level of the aortic arch.There remains left lung atelectasis and nonspecific consolidation adjacent to the pleural fluid.MEDIASTINUM AND HILA: Interval placement of a tracheostomy tube, tip terminating above the carina. NG tube tip terminates in the mid to distal esophagus.Interval removal of distal esophageal stent. Normal heart size without pericardial effusion. No visible coronary artery calcification.CHEST WALL: Mild degenerative changes of the thoracolumber spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube terminates in the stomach. Jejunostomy tube is noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumber spine.OTHER: No significant abnormality noted. | 1. Findings consistent with distal esophageal rupture with extravasation of oral contrast into the left pleural space.2. Moderate loculated right and small loculated left pleural effusions with associated pleural thickening highly suspicious for empyema, decreased from prior. Decreased atelectasis in the left base. Interval removal of right pigtail drain and esophageal stent. |
Generate impression based on findings. | 84 years, Female. Reason: evaluate for obstruction History: abdominal distention Multiple gas-filled loops of small and large bowel. A central grossly distended loop of large bowel measures 13.3 cm in maximum transverse dimension. Although there is no beaking at the inferior aspect of this loop which suggest a sigmoid volvulus apparent loops of gas filled large bowel loops, felt to represent hepatic flexure, would suggest a more distal large bowel obstruction. Paucity of gas in the left colon and rectum. No pneumatosis or free intraperitoneal air however this is a supine radiograph. | Massively distended colonic loop at risk for acute perforation. Concern for volvulus, possibly sigmoid volvulus. Urgent colonic decompression should be considered.Findings discussed by Dr. Dachman with Dr. Saint-Hilaire at 10 a.m. 02/10/15. |
Generate impression based on findings. | Reason: eval lung mass History: mets bony disease LUNGS AND PLEURA: A left perihilar mass measures up to 5.8 x 5.3 cm (series 5, image 37) and may include a component of distal atelectasis. The mass severely narrows the left upper lobe bronchus and encases the left descending pulmonary artery. Small associated subsegmental atelectasis. An additional solid nodular density in the lateral lingula measures up to 1.9 x 1.2 cm (series 7, image 48). Nodular scarring in the left lower lobe (series 7, image 67) and right middle lobe appear unchanged from the prior exam dated 01/2011. Scattered calcified granulomas. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcification. Atherosclerotic calcification of the thoracic aorta. New mediastinal lymphadenopathy. For reference, a subcarinal lymph node measures up to 19 mm (series 5, image 38). A precarinal lymph node measures up to 23 mm (series 5, image 32). Additional high paratracheal (contralateral) lymph node enlargement (series 5, image 21). A left hilar lymph node measures up to 20 mm (series 5, image 40). CHEST WALL: Degenerative disease of the thoracic spine. Numerous lytic and sclerotic lesions in the thoracic vertebral bodies and ribs are new from the prior exam, suspicious for metastatic disease. No vertebral body collapse.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Scattered splenic calcifications from prior granulomatous disease. Mild left adrenal nodularity is unchanged from the prior exam dated 01/2011. Left renal calcifications. | 1. New large left perihilar mass, with additional lingular nodules and ipsilateral and contralateral mediastinal and hilar lymphadenopathy, suspicious for primary lung cancer. 2. Numerous lytic and sclerotic lesions in the vertebral bodies and ribs, suspicious for osseous metastatic disease. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (4/17/14) performed at Saint Elizabeth Medical Center. For comparison, digital mammographic images (12/20/12, 10/13/11) are available. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. There is a partially visualized mass-like density at left axilla, seen only on MLO view. | Partially visualized mass-like density at left axilla, seen only on MLO view. Since the study was performed 10 months ago, repeat left mammogram and possible ultrasound for the left axilla is recommended. Mammogram for right breast can be performed at the same time, as annual mammogram is due in two months.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Female 77 years old Reason: scoliosis evaluate. History: scoliosis evaluate. There is moderate to severe multilevel degenerative disk disease throughout the spine. There is approximately 15 degrees of dextroscoliosis measured from the superior endplate of T6 to the inferior endplate of L3. Please note that this measurement may be affected by pelvic tilt, as the left iliac crest is approximately 1.5 cm higher than the right iliac crest. There is a slight positive coronal balance (approximately 1 cm). There is a slight positive sagittal balance (approximately 1 cm). | Multilevel degenerative disk disease, mild scoliosis, and other findings as above. |
Generate impression based on findings. | 82-year-old with history of right lumpectomy for ILC in 2003 and radiation therapy. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Post surgical changes of architectural distortion and scarring in the central posterior right breast are unchanged. Scattered benign calcifications are present in both breasts.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Lung mass consistent with lung cancer. Staging.RADIOPHARMACEUTICAL: 12.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 123 mg/dL. Today's CT portion grossly demonstrates a spiculated left upper lobe mass measuring approximately 4 cm which abuts the major fissure and is similar to the recent diagnostic chest CT. There is also left hilar and AP window lymphadenopathy. There are multiple emphysematous bullae. There is a small cluster of left paratracheal and left supraclavicular lymph nodes. There are severe coronary artery calcifications. There is calcific atherosclerotic disease of the aorta and its branches. There are multilevel degenerative changes of the spine. Today's PET examination demonstrates a markedly hypermetabolic left upper lobe mass with a SUV max of 9.4 which is consistent with lung cancer. There are markedly hypermetabolic left hilar and AP window lymph nodes with a SUV max of 7.0 which are compatible with ipsilateral lymph node metastases. Multiple additional lymph nodes which are mildly FDG avid extend from the left paratracheal to left supraclavicular region with a SUV max of 3.5. While these may be inflammatory in etiology, additional metastases cannot be excluded. There is no suspicious FDG avid tumor within the contralateral chest.There is no suspicious FDG avid tumor within the abdomen, pelvis, or skeleton. Multilevel degenerative activity is noted in the mid-lumbar facets. | 1.Markedly hypermetabolic left upper lobe mass consistent with lung cancer.2.Markedly hypermetabolic left hilar and AP window lymph nodes consistent with regional metastases. Additional mildly hypermetabolic left paratracheal and left supraclavicular lymph nodes may be benign though additional metastases cannot be excluded.3.No contralateral chest, abdominal, or pelvic FDG avid tumor is identified. |
Generate impression based on findings. | Redemonstrated is posterior spinal fusion at L4-S1, utilizing posterior fusion rods, bilateral pedicle screws, interbody spacer devices and bone graft material. There is no evidence of hardware failure. There is some resorption of the right-sided bone graft material. The vertebral body heights are maintained. There is unchanged mild anterolisthesis of L4 on L5. There is degenerative spondylosis, most prominent at L5-S1, with loss of disc height and marginal osteophytes, contributing to bilateral mild foraminal narrowing. There is no significant spinal canal stenosis. Incidentally noted is mild pelvic free fluid and ventriculoperitoneal shunt tubing within the pelvis. | 1. Posterior spinal fusion at L4 through S1 without evidence of hardware failure.2. Degenerative spondylosis with bilateral mild neural foramen narrowing at L5-S1. No significant spinal canal stenosis. This is stable compared to the prior exam. |
Generate impression based on findings. | 46 year old male. Tongue cancer. CHEST:LUNGS AND PLEURA: Scattered calcified micronodules consistent with healed granulomatous disease. No suspicious nodules or masses are identified. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: No suspicious focal osseous lesion is identified.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Bilobar multiple subcentimeter hepatic hypodensities are too small to characterize, likely cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Mild atherosclerotic calcification of the abdominal aorta without aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Nonspecific mild mesenteric haziness with associated small lymph nodes, which may be seen with mesenteric panniculitis.BONES, SOFT TISSUES: No suspicious focal osseous lesion is identified.OTHER: No significant abnormality noted. | No evidence of metastatic disease in the chest or abdomen. |
Generate impression based on findings. | LIVER: Normal hepatic echotexture. No focal hepatic lesions.BILIARY TRACT: No gallbladder wall thickening or pericholecystic fluid. Common bile duct measures 2 mm. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreatic head and body are normal. The tail is obscured by gas.KIDNEYS: The right kidney measures 12. 4 cm. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.5 cm. No shadowing calculi or hydronephrosis is present. Both kidneys are low-lying with a configuration suggestive of a horseshoe kidney.SPLEEN: The spleen measures 10.5 cm. in length. | 1. Normal exam without evidence of biliary ductal dilatation or vascular abnormality.2. Low-lying kidneys and probable horseshoe kidney without hydronephrosis. |
Generate impression based on findings. | Female 53 years old Reason: osteoporosis History: mid-low back pain. The bones appear demineralized, suggesting osteopenia/osteoporosis. There are small osteophytes anteriorly at L2/L3. We see no compression fracture. | Demineralized bones and small vertebral body osteophytes. We see no compression fractures. |
Generate impression based on findings. | History of elevated PSA and bone METs, history of carcinoid. ABDOMEN:LUNG BASES: Coronary artery calcifications. Minimal left pleural thickening appearing similar to prior. Subacute fractures of the ninth and tenth posterior left ribs as well as sclerotic lesion in the left tenth posterior right rib.LIVER, BILIARY TRACT: Status post cholecystectomy with expected dilatation of the common bile duct. There is a low attenuation lesion within segment 6 of the liver (series 8, image 49) which measures 1.7 x 2.2 cm, measured 1.4 x 1.3 previously. The lesion demonstrates arterial hyperenhancement with washout. Given history of carcinoid, most likely represents carcinoid metastasis as opposed to primary liver malignancy.SPLEEN: No significant abnormality notedPANCREAS: The pancreas is atrophic.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral benign renal simple cysts with additional subcentimeter low attenuation lesions too small to characterize. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches. No retroperitoneal lymphadenopathy by size criteria.BOWEL, MESENTERY: Postsurgical changes of partial small bowel resection with mild nonspecific wall thickening of bowel proximal to the anastomosis. Colonic diverticulosis without evidence of complicated diverticulitis.BONES, SOFT TISSUES: Numerous sclerotic foci are present within the visualized osseous structures compatible with metastatic disease, progressed from prior. For example, sclerotic foci are present within the L3-L5 vertebral bodies, right iliac crest, left pubic bone, and right sacrum which have increased compared to the prior exam. There are moderate compression deformities at T11-L1 which have progressed compared to the 11/6/2014 CT.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is mildly enlarged measuring 5.1 X 3.5 cm and contains coarse calcifications.BLADDER: Small bladder diverticulum.LYMPH NODES: No pelvic lymphadenopathy by size criteria.BOWEL, MESENTERY: Postsurgical changes of partial small bowel resection with mild nonspecific wall thickening of bowel proximal to the anastomosis. Colonic diverticulosis without evidence of complicated diverticulitis.BONES, SOFT TISSUES: Numerous sclerotic foci are present within the visualized osseous structures compatible with metastatic disease, progressed from prior. For example, sclerotic foci are present within the L3-L5 vertebral bodies, right iliac crest, left pubic bone, and right sacrum which have increased compared to the prior exam. There are moderate compression deformities at T11-L1 which have progressed compared to the 11/6/2014 CT.OTHER: No significant abnormality noted | 1.Hyperenhancing liver lesion increased in size from prior and most likely representing carcinoid metastasis.2.Widespread sclerotic osseous metastases which may be from prostate or carcinoid primary, increased from prior. 3.Multilevel thoracolumbar vertebral body compression fractures which have progressed from prior.4.Postsurgical changes of prior small bowel resection with mild nonspecific bowel wall thickening proximal to the anastomosis.5.Colonic diverticulosis without evidence of complicated diverticulitis. |
Generate impression based on findings. | 5-month-old female with CDH on outside hospital x-ray. Evaluate sidedness and anatomy for surgical planning. LUNGS AND PLEURA: No pulmonary nodules or masses are present. There is no pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Heart and thymus are normal. Branching pattern of the great vessels is normal.CHEST WALL: The bones are normal.UPPER ABDOMEN: An anterior central protrusion of bowel loops into the chest is present. Bowel extends to the level of the thymus. | Morgagni hernia.Findings were discussed with Christa Fox by phone on 2/10/2015 at 1400. |
Generate impression based on findings. | 57-year-old female. Tachycardia, COPD exacerbation for evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Right upper lobe cavitary lesion is 86 x 65 m (series 10, image 32), previously 8.9 x 6.4 cm. It demonstrates eccentric wall thickening at its right anterior aspect, which likely represent necrotic lung parenchyma and measures 8 mm as compared to 10 mm previously. The internal debris is not significantly changed in volume, although appears to have migrated inferiorly within the cavity.A smaller communicating anterior cavitary lesion (series 10, image 39) is not significantly changed in size or appearance. Tree in bud opacities in the medial aspect of the right upper lobe and also in the right middle lobe and lower lobe are decreased from prior.Moderate centrilobular emphysema and paraseptal emphysema.Mild left basilar linear scarring.MEDIASTINUM AND HILA: Unchanged small mediastinal and hilar lymph nodes, including the reference precarinal lymph node that is 8 mm (series 7, image 106).No visible coronary artery calcification. Mild atherosclerotic calcification of the thoracic aorta.Normal heart size without pericardial effusion.Nonspecific hypoattenuating nodule the left thyroid gland.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Right upper lobe bilobed cavitary lesion is stable in overall size with mild decrease in its nondependent wall thickness (representing necrotic tissue). Associated internal debris is unchanged in volume though shifted inferiorly within this cavity.3. Tree in bud opacities in the right lung suspicious for MAI infection are decreased.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Intoeing. Left greater than right.VIEWS: Pelvis AP/frog leg (two views) 02/10/15 The round, smooth femoral heads are well directed into normally formed acetabula. No fracture is seen. | Normal examination. |
Generate impression based on findings. | Reason: h/o oral mucosa ca/CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing pulmonary micronodules, some calcified, unchanged from the prior exam, compatible with previous infection and intrapulmonary lymph nodes. No new suspicious pulmonary nodules or masses. Minimal basilar subsegmental atelectasis/scarring. No focal airspace consolidation. Nodular calcified pleural plaques, likely asbestos-related. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Metastatic breast cancer, on chemotherapy. Followup scan, restaging, response to therapy.RADIOPHARMACEUTICAL: 13.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion again grossly demonstrates several stable right-sided rib fractures with callus formation. Also again visualized are compression fractures of the T6 and T11 vertebral bodies which are unchanged. A mucus retention cyst or polyp is seen again in the right maxillary sinus. The thyroid is enlarged. Surgical clips are noted in the left axilla.Today's PET examination again demonstrates multiple new small but markedly hypermetabolic right axillary lymph nodes with a maximum SUV of 6 and are very suspicious for progression of tumor activity. Otherwise no FDG avid activity to indicate breast cancer elsewhere.The previous healing right rib fracture activity is stable. The previous uterine and right adnexal activity is also stable. The previously questioned left colonic activity appears represent an unusually laterally located left adnexa on this exam. The bilateral adnexal and uterine activity is stable and may be benign although gynecological malignancy cannot be excluded. | 1.Several small but markedly hypermetabolic right axillary lymph nodes are new from the previous exam and are very suspicious for progression of metastatic disease. No metastatic breast cancer activity elsewhere.2.Stable uterine and bilateral adnexal activity which may be benign although gynecological malignancy cannot be entirely excluded. |
Generate impression based on findings. | 7-year-old female with constipation and abdominal painVIEW: Abdomen AP (one view) 2/10/15 10:32 The bowel gas pattern is nonobstructive. Small sized stool burden. | Normal exam. |
Generate impression based on findings. | Evaluate fracture Three views of the left fifth digit reveal a nondisplaced fracture of the proximal phalanx. The fracture line is indistinct consistent with healing. The bones are in anatomic alignment. | Healing fifth proximal phalanx |
Generate impression based on findings. | Female 47 years old Reason: 46 y/o F with dysphagia to solids, reported history of possible leiomyoma of proximal esophagus, evaluate for etiology of dysphagia and check if leiomyoma is rate-limiting to barium flow History: Dysphagia Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus demonstrated prominence of the cricopharyngeus muscle consistent with a cricopharyngeal bar. There was a 1.2 x 1.6 cm smooth, filling defect within the proximal esophagus which appeared soft in nature (i.e. deformable) but did not contribute to significant hold up of oral contrast. The smooth outline is suggestive of a submucosal location. The soft nature suggests etiologies including GIST, leiomyoma, lipoma (soft), duplication cyst (soft).The gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, there was spontaneous gastroesophageal reflux to the level of the thoracic inlet with rapid clearing. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.Visualized portions of the stomach, duodenum and jejunum were normal.TOTAL FLUOROSCOPY TIME: 7:36 minutes | 1. Prominence of the cricopharyngeus muscle impression consistent with a cricopharyngeal bar.2. 1.6 cm submucosal lesion within the proximal esophagus. Differential diagnoses include GIST, leiomyoma, lipoma, duplication cyst.3. Spontaneous gastroesophageal reflux to the level of the thoracic inlet with rapid clearing.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 14-year-old male post-op with pain in joints, ankle and footVIEWS: Left knee AP/Lateral (Two views) 2/10/2015 10:29:55 Left lateral tibial hemiepiphysiodesis with prongs of the staple not diverging. For assessment of left Blount's disease, please refer to same day bone length study. There is no evidence of fracture or effusion. | Prongs of the staple of left lateral tibial hemiepiphysiodesis not diverging. Please refer to same day bone length study for additional findings. |
Generate impression based on findings. | Reason: hx of recurrent PNA, concern for endobronchial obstruction vs organizing pna History: productive cough LUNGS AND PLEURA: Mild bronchial wall thickening without focal areas of consolidation or air space opacities.No pleural effusions.No suspicious nodules or masses.MEDIASTINUM AND HILA: Scattered mildly prominent mediastinal lymph nodes without definite evidence of lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Mild degenerative changes in the thoracic spine. Partially visualized cervical stabilization hardware.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild bronchial wall thickening without focal areas of consolidation or airspace opacity. |
Generate impression based on findings. | History of chronic mastoiditis status post right-sided mastoidectomy (8/8/14) and right-sided tympanostomy tube placement (8/12/14) presents with right ear purulent discharge x 2 weeks, right ear bleeding x 3 days, and fevers to 102.5F x 2 days. Evaluate for mastoiditis. RIGHT TEMPORAL BONE: There are post-surgical findings related to right cortical mastoidectomy and right-sided tympanostomy tube placement. There is interval resolution of opacification of the right external auditory canal. There is partial opacification of the right middle ear cavity, and most of the remaining right mastoid air cells. There is interval increase in air in the mastoidectomy defect. There is enhancing superficial and deep soft tissue with inflammatory changes at the surgical bed, slightly decreased in thickness compared to prior study. There are no definite erosive changes of the right mastoid defect. There is no discrete fluid collection.LEFT TEMPORAL BONE: 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 describes a normal course. | Post-surgical findings related to right cortical mastoidectomy with overlying soft tissue inflammatory changes, which may represent evolving post-operative change versus cellulitis. No definite fluid collection to suggest abscess. No definite bony erosive changes of the surgical defect; however, early osteomyelitis cannot be entirely excluded. |
Generate impression based on findings. | 65 year old female status post right lumpectomy for DCIS in December 2010 followed by radiation, presents today for routine follow up. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Surgical clips and expected postsurgical parenchymal changes are present in the upper outer quadrant of the right breast, without interval changes. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 42-year-old female with history of concussion. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. The ventricles and sulci are symmetric. The basal cisterns are intact. 11 mm calcification is seen along the right frontal convexity. No intracranial mass effect. No extra-axial collections or hydrocephalus. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are intact. | 1. No evidence of intracranial hemorrhage.2. 11 mm calcification along the right frontal convexity may represent a nonspecific dural calcification versus possibly a small calcified meningioma. No associated mass effect. |
Generate impression based on findings. | 78 year old female with history of right breast lumpectomy for carcinoma in 2009. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Post surgical distortion and scarring is again seen in the right breast at the 12 o'clock position, with surgical clips . Dystrophic coarse calcification is noted anterior to the scar tissue. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 80 years, Male, Reason: metastatic prostate cancer, evaluation of disease during therapy with investigational treatment History: metastatic prostate cancer. CHEST:LUNGS AND PLEURA: 6-mm left upper lobe reference nodule is stable (4/38) scarring in the right middle lobe. No focal consolidation or pleural effusion.No new nodules or masses.MEDIASTINUM AND HILA: Subcentimeter right thyroid nodule. Atherosclerotic calcifications of the aorta and its branches. Multiple small mediastinal nodes are unchanged. An enlarged paraesophageal node is unchanged measuring 1.7 x 1.2 cm (3/48), previously 1.6 x 1.1 cm. Heart size is normal without pericardial effusion. Severe coronary artery c a alcifications. Small retrocrural nodes are stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic hypodensities are unchanged. Hyperattenuating lesion within the gallbladder is unchanged over multiple exams in size and location, likely a polyp or stone.SPLEEN: Small splenules.PANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged at 1.2 x 1.0 cm (3/96), previously 1.3 x 1.0 cm. KIDNEYS, URETERS: Right renal scarring. Multiple hypoattenuating lesions are unchanged. A posterior hyperattenuating lesion in the right kidney is stable measuring 1.9 x 1.9 cm (3/95), previously 2.0 x 1 .8 cm, likely proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are stable with any reference left para-aortic node measuring 1.9 x 2.0 cm (3/113), previously 2.1 x 2.0 cm.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine. Please note that bone scan performed on the same day is more sensitive for the evaluation of osseous metastases.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Bilateral fat-containing inguinal hernias.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. | 1.Stable exam.2.Hyperattenuating lesion within the gallbladder is stable and may represent a stone or polyp. Ultrasound recommended for further evaluation. |
Generate impression based on findings. | Female, 46 years old, with history of right thyroid mass and necrotic lymphadenopathy, on pathology found to be an epithelioid malignant neoplasm compatible with poorly differentiated carcinoma, with osseous metastasis. Again seen is a centrally hypoattenuating, peripherally calcified nodule in the right thyroid lobe which measures between 12 and 13 mm in diameter. This lesion has not significantly changed from the prior exam.No evidence of pathologically enlarged or growing lymph nodes is seen in the neck. A right level IIb reference node measures 6 mm short axis (image 35 series 7), previously 6 mm. A right supraclavicular node measures up to 10 mm short axis (image 60 series 7), previously 10 mm. A left supraclavicular lymph node measures up to 10 mm short axis (image 59 series 7), previously 12 mm.The salivary glands are free of focal lesions. Cervical vessels enhance normally with a right IJ catheter in place. Mild reticulation is unchanged in the lung apices. A subcentimeter lucent lesion within the anterior right C7 vertebral body is unchanged. No new osseous lesions are detected. | 1.Stable nodule in the right thyroid lobe with no evidence of locally progress disease.2.Stable reference lymph nodes in the neck. |
Generate impression based on findings. | Reason: head and neck cancer History: hx of head and neck cancer LUNGS AND PLEURA: Right redemonstration of bilateral apical post radiation changes.Bilateral pleural effusions stable.Nonspecific focal air space opacities in the lingula and middle lobe most likely related to aspiration and atelectasis.A significant amount of debris noted within the trachea.No suspicious pulmonary nodules or masses identified.MEDIASTINUM AND HILA: Stable enlarged right paratracheal lymph node (image 35 series 4) measuring 11 mm in short axis.Cardiac size is enlarged with hypoattenuation of the blood pool compatible with anemia.No evidence of a pericardial effusion.Severe coronary artery calcification.CHEST WALL: Median sternotomy intact.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Bilateral large renal cysts unchanged. | 1.Moderate-sized bilateral pleural effusions unchanged.2.Considerable amount of tracheal debris with evidence of atelectasis/aspiration.3.No evidence of metastatic disease. |
Generate impression based on findings. | Male 69 years old Reason: hx of bladder ca, hx of renal cell ca. surveillance scan. History: hx of bladder ca, hx of renal cell ca CHEST: LUNGS AND PLEURA: Subcentimeter nodule in the left major fissure, which is unchanged and likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: Mild atherosclerotic calcifications of the aorta and its branches with moderate coronary arterial calcifications. Normal heart size without pericardial effusionCHEST WALL: Nonspecific sclerotic lesion of the T4 vertebral body, unchanged.ABDOMEN: The study is limited by the absence of oral and intravenous contrast. In particular, evaluation of the solid organs for malignancy is limited.LIVER, BILIARY TRACT: Multiple hypoattenuating liver lesions, unchanged, and most consistent with benign hepatic cysts. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculus. Scattered nonspecific hyperdense lesions in the right kidney.Postsurgical changes from left superior pole partial nephrectomy with persistent perinephric fat necrosis. Hypodense lesion in the left kidney which is unchanged and likely represents a renal cyst.No evidence of recurrent disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status prostatocystectomy.BLADDER: Status prostatocystectomy. No evidence of tumor recurrence.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes consistent with neobladder.BONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1.Stable postsurgical changes related to partial left nephrectomy and cystoprostatectomy with neobladder formation.2.No evidence of tumor recurrence or metastatic disease within the limitations of this noncontrast study. |
Generate impression based on findings. | History metastatic bladder carcinoma; request repeat biopsy per research protocol of right pelvic wall mass PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Unremarkable neobladderLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Significant interval decrease in size of right pelvic metastatic mass lesion best seen on image 23 of series 3 now measuring 4.9 x 1.6 cm; this is in comparison to 6.7 x 3.7 cm on 12/26/2014. Due to the interval decrease in size of the mass and its now more medial location, no safe access to biopsy this lesion percutaneously could be found.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval decrease in size of right pelvic metastatic mass lesion. Due to the interval decrease in size of the mass and its now more medial location, no safe access to biopsy this lesion percutaneously could be found. As a result, the biopsy was not performed. |
Generate impression based on findings. | 62 year-old woman with a history of right lumpectomy in June 2007 for grade 3 invasive ductal carcinoma with high-grade DCIS. Patient is status post radiation and hormonal therapy. No current breast complaints. No current breast complaints. 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, unchanged in pattern and distribution. There are stable postsurgical changes of the right breast with volume loss, distortion, and surgical clips. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. In view of dense breasts, annual screening MRI may be beneficial for this patient. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 61-year-old male with metastatic Prostate cancer. Please complete PCWG2 form. Multiple foci of increased radiotracer activity is again noted in the axial and proximal appendicular skeleton, including: the posterior right fifth and eighth ribs, the posterior left sixth rib, right humerus, left scapula, sternum, T12 vertebral body, and left ileum just lateral to the left sacroiliac joint, all of which are unchanged compared to the previous exam.The previous foci of increased radiotracer uptake, including in the approximate right lateral fourth rib, medial right seventh rib and along the right lateral margin of the sternum are not as well seen compared to prior exam. | Redemonstration of multifocal osseous metastases without significant interval change from the prior exam. |
Generate impression based on findings. | 56 year-old female with history of right breast carcinoma status post lumpectomy in 2005 with radiation and chemotherapy. No family history of breast cancer. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A loosely clustered coarse calcifications are unchanged in the right upper outer quadrant. Stable postsurgical increased density, architectural distortion and surgical clips are present in the lumpectomy bed and right axilla. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 77-year-old male status post cystoprostatectomy with rectal injury during surgery requiring temporary diverting ileostomy; status post ileal conduit. The scout film shows a nonobstructive bowel gas pattern. A catheter is within the diverting ileostomy on the left. Residual barium from prior barium enema study 1/5/15 is noted within the colon. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or strictures. A few bowel loops, one particularly in the left upper quadrant, were fixed with angulation suggestive of adhesions. Distended loops of small bowel was noted in the left and right upper quadrant measuring up to 3 cm. Transit time to the ileostomy was 100 minutes. No ventral hernias were evident.TOTAL FLUOROSCOPY TIME: 10:35 minutes | Findings compatible with nonobstructive adhesions as described above. |
Generate impression based on findings. | 64 years, Female, Reason: restaging scans s/p 9 cycles of investigational immunotherapy History: hx of metastatic bladder cancer. CHEST:LUNGS AND PLEURA: Left upper lobe part solid part cystic nodule is slightly increased in size measuring 1.3 x 1.1 cm (6/36), previously 0.9 x 0.6 cm. Right lower lobe solid nodule measures 1.4 x 0.9 cm (6/46), previously 1.1 x 0.9 cm. Cavitated right lower lobe lesion measures 2.2 x 2.0 cm (6/57), previously 2.2 x 1.5 cm. Nodule along the right minor fissure measuring 7 mm is unchanged (6/57). No pleural effusions.MEDIASTINUM AND HILA: Right-sided catheter tip terminates at the cavoatrial junction. Small subcarinal node is unchanged measuring 1.0 x 0.7 cm (4/45), previously 0.9 x 0.6 cm.CHEST WALL: Right sided port ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy is unchanged with an index left para-aortic node measuring 2.3 x 1.5 cm (4/114), previously 2.4 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Right adnexal cyst is stable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Vertebral body hemangiomas and degenerative changes are unchanged.OTHER: No significant abnormality noted. | 1.Progression of pulmonary metastases with some nodules increased in size and others unchanged.2.Stable retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Male, 46 years old, with history of cT1-T2 N2b stage IVa right base of tongue squamous cell carcinoma. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Neck:The base of tongue tonsillar tissues are bulky and prominent, mostly on the right but to a lesser degree on the left as well. The right aspect of this tissue measures 26 x 16 mm (image 113 series 3). This tissue projects into and partially effaces the right vallecula.Bulky, heterogeneously enhancing adenopathy is demonstrated in the right neck involving level 2 and minimally level 3. A level 2 nodal aggregate measures 26 x 23 mm (image 105 series 3). The fat planes separating this lesion from the adjacent submandibular gland and sternocleidomastoid muscle are effaced suggesting extracapsular spread. In fact, the right submandibular gland itself is bulkier than the left which may reflect normal variation, but the possibility of tumor infiltration should also be considered. At least by size criteria, no definite pathologic adenopathy is seen below level 3 on the right, or at any point in the left neck.Except as above, the salivary glands are unremarkable and the thyroid is free of focal lesions. The cervical vessels enhance normally. No concerning osseous lesions are detected. | 1. A base of tongue mass is evident on the right with extension into the right aspect of the vallecula. The left base of tongue tonsillar tissues are also slightly bulky and as such the possibility of extension to the contralateral side cannot be excluded.2. Pathologic adenopathy in the right neck involving level 2, possibly level 3 and possibly the submandibular gland itself. No contralateral adenopathy is detected by size criteria.3. No evidence of intracranial metastatic disease. |
Generate impression based on findings. | There is mild bilateral maxillary, scattered bilateral ethmoid and trace right sphenoid sinus mucosal thickening. The mastoid air cells are clear. There is narrowing of the ostiomeatal complexes which may be developmental, without frank obstruction. The nasal cavity is clear. The nasal septum is deviated to the left side superiorly and to the right side inferiorly. There is a small osseous spur along the right inferior nasal septum which is barely in contact with the right inferior turbinate. There are unchanged postoperative findings related to posterior cervical fusion, incompletely imaged. The intracranial structures are grossly unremarkable. The orbits and osseous structures are intact. | Scattered mild paranasal sinus mucosal thickening as described above. |
Generate impression based on findings. | Reason: head and neck cancer for tumor assessment History: as above CHEST:LUNGS AND PLEURA: Unchanged uniformly distributed pulmonary cysts, previously suggested to be mild lymphangioleiomyomatosis.Mild basilar scarring.No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.No coronary artery calcifications are seen, with the heart and pericardium normal in appearance.CHEST WALL: Degenerative abnormalities are unchanged in the thoracolumbar spine. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted, except for a benign appearing left renal cyst. KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dense vascular calcifications.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticula, some containing retained contrast. Gastrostomy tube unchanged.BONES, SOFT TISSUES: Degenerative abnormalities of the lumbar spine, with severe superior endplate depression of L2, unchanged.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 44 year old with history of left mastectomy for multicentric DCIS in 2014, presents for ultrasound study for palpable mass in left axilla, and annual right mammogram. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. There is a palpable mass in the superior left axilla. Focused ultrasound detects a hypoechoic mass, measuring 5 x 4 mm, located superficially with ill-defined margins and increased blood flow. | 1. Suspicious mass in the left superior axilla. FNA under palpation guidance is recommended.2. No mammographic evidence for malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Pain. Fracture? There is diffuse soft tissue swelling. There is also widening of the lateral aspect of the tibiotalar joint suggesting ligamentous laxity or disruption. A subcentimeter ossicle seen on the AP view distal to the fibular tip appears corticated and may represent old trauma but I do not see a donor site to confirm an acute fracture fragment. I see no ankle joint effusion. | Diffuse soft tissue swelling and widening of the lateral aspect of the ankle joint may represent ligamentous laxity or disruption. I see no definite acute fracture. |
Generate impression based on findings. | Female 75 years old Reason: Pancreas NET to liver follow up CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in the size of the liver metastases. Index left lobe lesion now measures 4 x 2.7 cm on image number 23, series number 6. Other metastatic lesions have also increased in size compared to previous study. Moderate to severe intra-and extrahepatic biliary dilatation throughout the common bile duct is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic tail mass measures 1.8 x 1.9 cm on image number 93, series number 7, slightly smaller to unchanged compared to previous study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic adenopathy now measures 1.8 x 1.2 cm on image number 102, series number 7 increase in size compared to previous study. Previously, it was measuring 1.2 x 1.1 cm on image number 54, series number 3.BOWEL, MESENTERY: Cystic mass in the body of the stomach is grossly unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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. | Interval increase in the size of the hepatic metastases and retroperitoneal adenopathy. Patient's known pancreatic tail mass is slightly decreased to unchanged. Gastric mass is unchanged. |
Generate impression based on findings. | Female 6 years old Reason: Prosthetic Mitral valve. Subaortic narrowing. Cardiac Morphology:Left Ventricle: Left ventricular concentric hypertrophy. There is a significant 6-mm narrowing of the subaortic outflow tract with mild to moderate dilatation of the sinus of Valsalva.Wall motion assessment: Not performed.Right Ventricle:Normal size and appearance of the right ventricle. Left Atrium: Left atrial dilatation. There are four distinct pulmonary veins which drain normally into the left atrium. No evidence of pulmonary vein obstruction noted.Right Atrium: The right atrium is structurally normal. Cardiac Veins: The coronary sinus is slightly dilated.Cardiac Valves: There are no aortic calcifications. There is a 21 mm St Jude's tilting disc on the mitral valve position.Great Vessels: Aorta: The aortic arch is left sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 19 mm Ascending: 22 mm Arch: 13 mm Descending: 17 mmPulmonary Artery: Main PA: 17 mmRight PA: 8 mmLeft PA: 8 .6 mmVena Cavae: The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. RCA: The RCA arises normally from the right sinus of Valsalva. | 1. Postsurgical changes of the mitral valve.2. 6-mm narrowing of the subaortic outflow tract with mild to moderate dilatation of the sinus of Valsalva.3. Left atrial dilatation and concentric left ventricular hypertrophy.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings. |
Generate impression based on findings. | Head:No areas of abnormal attenuation or pathological enhancement. No mass effect or midline shift. There is no intracranial hemorrhage. Gray white matter differentiation is preserved. No extra-axial fluid collections. The ventricles and sulci are within normal limits for stated age. The visualized portions of the paranasal sinuses and mastoid air cells are clear.Soft tissue neck:Unchanged soft tissue irregularity involving the supraglottic larynx without evidence of discrete masses. Mild glottic and supraglottic edema again seen. The laryngeal cartilages are intact. No significant narrowing of the airways. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified.The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. No significant cervical lymphadenopathy seen. Major cervical vasculature is patent.Mild emphysematous changes and biapical pleural thickening again seen. There are degenerative changes in the cervical spine without suspicious osseous lesions. | Treatment-related changes without evidence of locoregional tumor recurrence. No significant cervical lymphadenopathy. No evidence of intracranial metastases. |
Generate impression based on findings. | Pain Moderate to severe osteoarthritis affects the first metatarsophalangeal joint. Mild osteoarthritis affects the interphalangeal joint of the great toe. There is mild deformity of the head of the fifth proximal phalanx which may be due to prior trauma or surgery. | Osteoarthritis and other findings as above. |
Generate impression based on findings. | Lumbago. Moderate to severe degenerative disk disease affects L2/3. Mild degenerative disk disease affects L4/5 and L5/S1. Alignment is within normal limits and I see no instability between the flexion and extension views. | Degenerative disk disease. |
Generate impression based on findings. | Follow-up laminectomy and fusion. Evaluate stability of spine, hardware and fusion. Surveillance imaging. Again seen are posterior rods with screws entering the C3 through C6 vertebrae. The hardware appears similar to that seen on the prior study, without acute complication evident. Evaluation of the lower cervical spine on the lateral views is limited by overlying anatomy. There is straightening of the cervical spine and perhaps minimal retrolistheses of C3 and C4, but I see no frank instability between the flexion, neutral, and extension views. Small osteophytes project from the anterior aspects of multiple cervical vertebrae. | Postoperative changes of cervical spine fusion as described above without evidence of instability. |
Generate impression based on findings. | Reason: h/o cavernous and ophthalmic aneurysm History: surveillance Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive diseaseCT ANGIO HEAD WWO, 2/10/2015 12:42 PMCLINICAL INFORMATION:Reason: h/o cavernous and ophthalmic aneurysm History: surveillanceCOMPARISON: 2/24/14TECHNIQUE: CT of the head without contrast and CTA of the head with contrast were obtained as follows:Contiguous axial images were obtained of the brain. Subsequently, High-resolution contiguous axial images were obtained through the brain during bolus injection of intravenous contrast. A total of milliliters Omnipaque 350 was used. Sagittal and coronal reconstructions were performed. 3-D reconstructions were performed on an independent workstation.FINDINGS:Brain CTA: There is a 2-mm aneurysm directed superiorly off of the proximal ophthalmic segment of the left internal carotid artery. This is stable when compared to the previous exam it does correspond to the origin of the left ophthalmic artery and it may represent an infundibulum.There is a 4mm left-sided millimeter left cavernous carotid aneurysm directed laterally at the posterior band. Additionally there is a distal left clinoidal carotid aneurysm directed medially measuring 4 mm in size. Both are stable compared to the prior examThe pituitary fossa appears enlarged the pituitary gland itself appears somewhat heterogeneous.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.The anterior communicating artery is small. The posterior communicating arteries are barely visible.There is extracranial origin of the left posterior inferior cerebellar artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. |
Generate impression based on findings. | Altered mental status, multiple CVA No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal volume loss relatively greater in the frontal lobes and advanced for age. There is ex vacuo dilatation of the ventricular system without evidence of hydrocephalus. There is extensive hypoattenuation in the bilateral periventricular and subcortical white matter which is nonspecific but compatible with advanced chronic small vessel ischemic disease. There is encephalomalacia involving the left frontal corona radiata extending into the subinsular white matter compatible with prior infarct.The visualized portions of the paranasal sinuses are clear. Opacification of concha bullosa on the left noted. Mastoid air cells are clear. Calvarium is intact. Nasogastric tube in place. | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Chronic infarct involving the left subinsular white matter and left frontal corona radiata.3. Advanced chronic small vessel ischemic disease.4. Global parenchymal volume loss, which is advanced for age. |
Generate impression based on findings. | Follow-up Again seen is a fracture of the patella with fracture fragments in near-anatomic alignment. On the AP view, the fracture is slightly less distinct on the current study when compared with the prior study, suggesting some interval healing. There is persistent anterior soft tissue swelling as well as a moderate-sized joint effusion. Moderate osteoarthritis affects the knee. The bones appear demineralized ingesting osteopenia/osteoporosis. | Healing patellar fracture and other findings as above. |
Generate impression based on findings. | Malignant melanoma CHEST:LUNGS AND PLEURA: Index right apical nodule measures 8 by 5 mm image number 17, series number 4, not significantly changed in size compared to previous study. Other non-reference nodules are also stable.MEDIASTINUM AND HILA: Index precarinal node measures 1.5 x 1 cm on image number 34, series number 3, unchanged from previous study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver and numerous hepatic cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval increase in the size of the left para-aortic lymph node which now measures 1.8 x 1.6 cm in image number 108, series number 3. This lymph node was measuring 13 by 10 mm on image number 110, series number 5 on the prior study. The index lymph node measured on the previous study, however is unchanged measuring 16 x 13 millimeters on image number 115, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable appearance of described soft tissue density in the right upper thigh. | Slight interval increase in one of the non-reference left retroperitoneal lymph nodes. Other findings are grossly stable from previous study. |
Generate impression based on findings. | Pain after fall, injury I see no fracture or malalignment. Moderate osteoarthritis affects the acromioclavicular joint, with adjacent soft tissue calcification likely residing in the joint capsule. Mild osteoarthritis affects the glenohumeral joint, with faint calcification along the superior aspect of the humeral head that may reside in the articular cartilage or rotator cuff. Mild chronic appearing enthesopathic changes are noted along the greater tuberosity at the expected site of insertion of the rotator cuff. The bones appear slightly demineralized. Mild degenerative arthritic changes affect the visualized spine. | Osteoarthritis and other degenerative arthritic changes as described above. I see no fracture. |
Generate impression based on findings. | Female 36 years old Reason: eval for disease progression. compare to study 7/2014 History: familial GIST 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: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: Large left upper quadrant mass now measures 17.6 x 10 cm on image number 47, series number 7.More inferior second mass now measures 5.1 by 4.3 cm on image number 84, series number 7, slightly smaller compared to previous study. This mass is within the small bowel mesentery. There are also additional multiple enlarged mesenteric nodes adjacent to this mass. There also slightly decreased within the internal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cystic mass now measures 8.5 x 5 cm on image number 116, series number 7 are increased in size compared to previous study. This represent a primary or metastatic ovarian neoplasm.Fibroid within the uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Cystic left inguinal lesion is smaller in size and now measures 2.3 x 1.9 cm on image number 138, series number 7. | Mixed response with stable large left upper quadrant cystic mass and interval decrease in the size of the mesenteric masses as described above.Left adnexal cystic mass is increased in size but the left inguinal cystic lesion is decreased in size. |
Generate impression based on findings. | Status post right total knee arthroplasty Components of a right total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | Knee pain. Assess severity of DJD. Four views of the left knee are provided. There is moderate narrowing of the lateral tibiofemoral compartment with osteophyte formation that has progressed when compared with the prior study. Small patellofemoral osteophytes are also noted. The bones appear slightly demineralized, suggesting osteopenia.Moderate osteoarthritis also affects the right knee as seen on the frontal view. | Moderate osteoarthritis. |
Generate impression based on findings. | Lumbar back pain Again seen is a posterior stabilization device with screws entering the L2, L3, and L4 vertebrae. I see no hardware complications. Severe degenerative disk disease affects L5/S1. Moderate degenerative disk disease affects the remaining lumbar levels. There are minimal anterolistheses of L1 and L2. Vertebral body heights are preserved. Overall the findings are similar to those seen on the prior study. | Postoperative changes of lumbar spine fusion and degenerative disk disease as described above. |
Generate impression based on findings. | Male 59 years old Reason: PSA 629- now with hip and back pain- family history of prostate cancer- biopsies to follow History: PSA 629- now with hip and back pain- family history of prostate cancer- biopsies to follow 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: Retroperitoneal adenopathy. Left para-aortic index node measures 1.6 by 2 cm in image number 65, series number 7.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic bone metastases involving the entire skeleton.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneously enhancing peripheral zone of the prostate suspicious for prostate cancer.BLADDER: No significant abnormality notedLYMPH NODES: Pelvic adenopathy. Index left para-iliac node measures 3.6 x 2.7 cm on image number 101, series number 7.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases throughout the entire skeleton.OTHER: No significant abnormality noted | Extensive bone metastases throughout the entire skeleton. Extensive retroperitoneal and pelvic adenopathy. |
Generate impression based on findings. | Pain, history of recurrent ovarian cancer Moderate osteoarthritis affects the acromioclavicular joint. The glenohumeral joint appears normal, and I otherwise see no specific findings to account for the patient's scapular pain. There is a right-sided central venous access device with its tip overlying the cavoatrial junction. | Acromioclavicular joint osteoarthritis. |
Generate impression based on findings. | Left knee pain Four views of the left knee are provided. Small osteophytes and mild medial compartment narrowing indicate mild osteoarthritis. There may also be a small joint effusion. Mild irregularity of the articular surface of the medial femoral condyle probably represents osteophyte formation, although I cannot exclude the possibility of a chronic osteochondral defect.There is mild narrowing of the medial tibiofemoral compartment of the right knee as seen on the frontal view. | Mild osteoarthritis and other findings as above. |
Generate impression based on findings. | Male 24 years old Reason: 24 year old man with stage IVB DLBCLymphoma cycle 6 of R-CHOP and 2 cycles of HD MTX in need of restagin. Please compare to prior. History: DLBCL CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Interval increase in the size of a hypodense lesion at the inferior aspect of the left thyroid lobe in the mediastinum. This lesion now measures 3.3 x 2 cm on image number 12, series number 701 and likely represents an adenopathy. Other anterior lymph nodes also increased in size. Another index lesion now measures 4 by 2.4 cm on image number 27, series number 701. This lesion was measuring 2.2 x 1.4 cm on image number 28, series number 3. Indexed subcarinal node measures 1.2 x 1 cm image number 35, series number 701, slightly decreased in size compared to previous study.CHEST WALL: Index right axillary lymph node measures 1.2 x 0.7 cm on image number 24, series number 701. This node has decreased in size compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Significant interval decrease in the size of the solid hypodense lesions throughout the liver. Index lesion in the left hepatic lobe is not well seen on today's study. As a reference, another lesion in the right lobe now measures 1.7 by 1.2 cm on image number 81, series number 701. This lesion was measuring 4.7 x 3.8 cm on image number 93, series number 3. Mild intrahepatic biliary dilatation has not significantly changed.SPLEEN: Spleen is smaller in size. Previously described hypodense lesion in the spleen is nonvisualized.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval resolution of the left hydronephrosis.RETROPERITONEUM, LYMPH NODES: Significant interval decrease in the size of the extensive retroperitoneal adenopathy. Increased measured index left para-aortic node now measures 1 cm in diameter image number 124, series number 701.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: Index left aggregate mass in the pelvis as near completely resolved and now measures 2.9 x 1.5 cm on image number 186, series number 701. Index left inguinal adenopathy measures 1.2 x 1.2 cm on image number 26, series number 701. This is also significant decrease in size compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Significant interval decrease in the size of the retroperitoneal and pelvic adenopathy and splenic size. Hepatic lesions are also significant decrease in size. Splenic lesion has resolved in the interval. Interval decrease in the size of the axillary lymph nodes.Interval increase in the size of the anterior mediastinal lymph nodes. |
Generate impression based on findings. | Clinical question: ICH? Signs and symptoms: Fall, head trauma on ASA. Unenhanced head CT:There is no evidence of an acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Mild chronic bilateral maxillary sinus disease and unremarkable paranasal sinuses otherwise.Partial patchy opacification of left mastoid air cells with normal pneumatization of the middle ear cavity. Well pneumatized right mastoid air cells and middle ear cavity | 1.Negative head CT and without evidence of any posttraumatic findings.2.Mild bilateral maxillary chronic sinus disease. |
Generate impression based on findings. | Status post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery. | Total knee arthroplasty as above. |
Generate impression based on findings. | Low back pain. Pars defect? For the purposes of this study I will designate 5 non-rib bearing lumbar type vertebra with an additional transitional lumbosacral vertebra ("T"). There is mild degenerative disk disease at L5/T. The remaining intervertebral disk spaces appear normal. Vertebral body heights are preserved. Alignment is within normal limits. I see no spondylolysis or spondylolisthesis. | Mild degenerative disk disease without evidence of pars defect. |
Generate impression based on findings. | Fell yesterday onto buttocks with severe buttock pain. History of rheumatoid arthritis and steroid use. The bones appear slightly demineralized suggesting osteopenia. There is narrowing of both hip joints, left greater than right, with coxa profunda deformities and findings suggestive of acetabular overcoverage, perhaps related to the patient's history of rheumatoid arthritis. Mild osteoarthritis affects the right sacroiliac joint. Mild degenerative arthritic changes affect the visualized lower lumbar spine. I see no fracture. I see no specific radiographic features of avascular necrosis. | Arthritic changes as described above likely representing combination of rheumatoid arthritis an osteoarthritis. I see no fracture. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No sign of pulmonary or pleural metastases.Mild apical paraseptal emphysema is unchanged.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy although there are calcified nodes from prior granulomatous infection, unchanged.Small to moderate size pericardial effusion is unchanged.Moderate coronary calcifications are noted, as well as calcification of the aortic root and descending aorta. CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive vascular calcifications are noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube identified, the retention balloon no longer inflated.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine.OTHER: No significant abnormality noted. | 1. No evidence of metastatic disease or other significant abnormality.2. Gastrostomy tube reidentified, but the retention balloon is no longer inflated, which could increase the likelihood of accidental removal. |
Generate impression based on findings. | Back pain Severe degenerative disk disease affects L1/2, L2/3, and L3/4. Moderate degenerative disease affects L4/5 and L5/S1. There is also moderate to severe multilevel facet joint osteoarthritis. There is a slight leftward curvature of the lumbar spine. There are minimal anterolistheses of L3 and L4. Vertebral body heights are preserved. The bones appear slightly demineralized, suggesting osteopenia/osteoporosis. | Degenerative disk disease and osteoarthritis appearing similar to, or perhaps slightly worse than that seen on the prior study. |
Generate impression based on findings. | Right flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver.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: 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 significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or neoplastic process. Fatty infiltration of the liver. |
Generate impression based on findings. | Persistent back pain with point tenderness on spinal processes Moderate to severe degenerative disk disease affects L5/S1. Severe facet joint osteoarthritis affects the lower lumbar spine. There are minimal anterolistheses of L4 and L5. Vertebral body heights are preserved. | Degenerative disk disease and facet joint osteoarthritis. |
Generate impression based on findings. | Reason: patient with R-MCA stroke History: R-MCA stroke. Evaluate for intracranial or extracranial cerebrovascular occlusion/stenosis. Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. Atherosclerotic calcifications are present at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals.There are patchy air space opacities present along the upper lung fields bilaterally right more than leftIn the left lobe of the third gland is enlarged and heterogeneous in density.Brain CTA: There is occlusion of the right M1 segment at its mid portion. The superior division appears to have origin just proximal to the occlusion site. There is partial occlusion of the superior division of the right middle cerebral artery.There are multiple foci of mild narrowing along the intracranial course of the right internal carotid artery. Foci of narrowing are present at the Petrus segment there is approximate 40% narrowing at the cavernous segment where there is 40% narrowing as well as at the proximal ophthalmic segment where there is 40% narrowing. Additionally there is approximate 30% narrowing of the proximal right M1 segment.There is 50% stenosis at the origin of the right anterior cerebral artery. There are mild narrowing along the cavernous segment of the left internal carotid artery.There is approximately 40% narrowing of the basilar artery along its mid section between the level of the superior cerebellar arteries and the anterior/inferior cerebellar arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:There is loss of gray-white differentiation involving the right middle and superior temporal gyri and right insular cortex.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. | 1.Occlusion of the midportion of the right M1 segment. Please note that the superior division which is partially occluded as origin immediately proximal to the mid M1 segment the occlusion site.2.Multiple intracranial foci of arterial narrowing involving posterior and anterior circulation.3.There is occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals.4.Acute Infarction involving the right superior and middle temporal gyri.5.There is air space disease present involving the upper lung fields bilaterally.6.The left thyroid gland lobe is enlarged and heterogeneous. It is a non-specific finding. Please note that CT is inaccurate in the evaluation for thyroid disease. |
Generate impression based on findings. | Again seen is intra- parenchymal hematoma in the left cerebral hemisphere centered in the left posterior frontal lobe measuring approximately 54 x 36 mm and unchanged. There is stable vasogenic edema surrounding the hemorrhage with an unchanged thin 4-mm left frontal hyperdense extra-axial hematoma. There is persistent mass effect with sulcal effacement, partial effacement of the left lateral ventricle, with midline shift to the right of 8 mm without change. There are no separate new foci of intracranial hemorrhage. No uncal or cerebellar tonsillar herniation. The imaged paranasal sinuses and mastoid air cells are clear. Left parietal burr hole. | Stable acute parenchymal hematoma in the left cerebral hemisphere with unchanged associated mass effect and midline shift. No new intracranial hemorrhage. |
Generate impression based on findings. | History of pancreatic mass on ultrasound. ABDOMEN:LUNG BASES: Minimal dependent atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The portal venous system is patent.SPLEEN: No significant abnormality notedPANCREAS: There is a solid mass within the neck of the pancreas corresponding to the on seen on recent ultrasound (series 10, image 43) which measures 2.7 x 1.4 cm and demonstrates hyperenhancement on the arterial phase images. There is no pancreatic ductal dilatation. The arteries of the celiac axis are patent and do not appear to be involved by the mass.ADRENAL GLANDS: Nonspecific mild nodular thickening of the bilateral adrenal glands.KIDNEYS, URETERS: Left renal simple cyst with additional bilateral subcentimeter low attenuation renal lesions too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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 significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered benign bone islands in the pelvis. OTHER: No significant abnormality noted | 1.Hyperenhancing pancreatic neck mass measuring 2.7 x 1.4 cm which most likely represents a pancreatic neuroendocrine tumor. No evidence of metastasis.2.Mild nonspecific thickening of the bilateral adrenal glands. |
Generate impression based on findings. | 50 year-old female. SOB, hypoxia. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism to the segmental level.LUNGS AND PLEURA: Small bilateral pleural effusions with adjacent atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Postsurgical findings of bilateral mastectomies with foci of air and small loculated pockets of fluid in the anterior chest wall. Partially visualized surgical drains in the lateral chest wall on both sides.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Numerous hypoattenuating foci in the liver, the larger of which are water density and consistent with cysts. The subcentimeter foci are too small to characterize and similar to prior exam. | 1. No evidence of pulmonary embolism.2. Bilateral small pleural effusions with adjacent atelectasis. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 71 years old Reason: 71 y/o M with DLBCL s/p Rituxan monotherapy with PD needs restaging please History: R face/neck swelling CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left lower pole nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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 significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Left lower pole nephrolithiasis. No measurable adenopathy. |
Generate impression based on findings. | Pain. Rule out arthritis. Four views of the left knee are provided. There is severe osteoarthritis of the medial tibiofemoral compartment with near bone-on-bone apposition. There are also tricompartment osteophytes. I see no large joint effusion.Osteoarthritis also affects the right knee as seen on the frontal view. A sclerotic focus in the right femoral diaphysis may represent an enchondroma or less likely a focus of chronic bone infarction. | Osteoarthritis as above. |
Generate impression based on findings. | Female 54 years old; Reason: evaluate neuroendocrine tumor, pancreas History: none ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Scattered tiny cysts are unchanged. Segment 7 hemangioma is unchanged. Additional hypervascular subcentimeter foci are unchanged. The hepatic and portal veins are patent. No intra-or extrahepatic or ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Post operative changes in the pancreas with a small anterior defect in the pancreatic body. No surrounding fluid collections. A cyst gastrostomy stent terminates within the stomach lumen. The tail has undergone mild atrophy. The ductal dilatation has resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Mild nodularity of the left anterior abdominal omentum which is likely postsurgical.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous uterus.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. | 1.Postsurgical changes in the pancreas without a residual fluid collection or evidence for metastatic disease. |
Generate impression based on findings. | Male 65 years old Reason: s/p ex-lap with liver abscess drainage and unroofing 1/20/15. Please eval resolution of abscess to determine abx duration. History: as above This study is limited due to lack of intravenous contrastABDOMEN:LUNG BASES: Near atelectasis at the lung bases.LIVER, BILIARY TRACT: There is interval decrease in the size of the abscess in the liver dome. Now the collection measures 3 x 2.7 cm on image number 11, series number 3. Small amount of perihepatic fluid persists.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: 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: Bilateral inguinal adenopathy. An index right inguinal node now measures 2.2 x 1.6 cm on image number 87, series number 3, not significantly changed from previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Slight interval decrease in the size of the patient's known hepatic abscess. Bilateral inguinal adenopathy, stable from previous study. Its etiology is unknown. |
Generate impression based on findings. | Right upper quadrant colic. OSH ultrasound with questionable stone vs gallbladder polyp. Angiographic images are unremarkable. Prompt clearance of radiotracer from the blood pool and uniform accumulation of the tracer by the liver is present. There is normal excretion of tracer into the intrahepatic ducts, common bile duct, gallbladder and duodenum, indicating patent common bile and cystic ducts.Following CCK administration, there was visually significant gall bladder emptying with the GB ejection fraction calculated to be 86% (normal >40%).The patient did report significant abdominal discomfort during the CCK portion of the exam which she described as similar to her typical symptoms. | 1. Normal hepatobiliary imaging. No evidence of acute or chronic cholecystitis.2. Normal gall bladder contractile response to CCK. Note, however, the patient did report abdominal discomfort during the CCK portion of the exam which she described as similar to her typical symptoms. |
Generate impression based on findings. | Male 63 years old Reason: Rule out Renal Cell Cancer. Use renal protocol History: Post transplant erythrocytosis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys consistent with patient's known history of endstage kidney failure.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left iliac fossa renal transplant, unremarkable. Right iliac fossa and are surely calcified cystic mass likely representing an old transplant measuring 6.8 x 7.1 cm.PELVIS: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 | Atrophic kidneys without any focal lesions suspicious for renal cell carcinoma.Cholelithiasis.Left iliac fossa transplant kidney, unremarkable.Right iliac fossa cystic partially calcified lesion, likely representing an old rejected transplant. |
Generate impression based on findings. | 42 day-old male with emesis and bloody stoolsVIEW: Abdomen AP (one view) 2/10/15 12:39 A gastrostomy tube is again noted. The bowel gas pattern remains somewhat disorganized, but improved from the prior exam. No pneumatosis or evidence of obstruction. | Continued improvement in bowel gas pattern. |
Generate impression based on findings. | Left shoulder pain. Neck pain. Evaluate for degenerative disk disease. Four views of the left shoulder are provided. Mild osteoarthritis affects the glenohumeral joint. Mild to moderate osteoarthritis affects the acromioclavicular joint. A small ossicle along the superior aspect of the acromioclavicular joint may reflect old trauma, but this is equivocal. The acromiohumeral interval is maintained. Glenohumeral joint alignment is normal. Metallic densities overlying the mediastinum likely represent bullet fragments. Degenerative changes affect the visualized thoracic spine.Eight views of the cervical spine are provided. Moderate degenerative disk disease affects C4/5. There is bulky degenerative ossification along the anterior aspect of the mid and lower cervical spine. There is mild to moderate multilevel facet joint osteoarthritis. There is narrowing of the neural foramina of the upper cervical spine which may in part be an artifact of patient rotation. There is a minimal (grade 1) retrolisthesis of C4 relative to C5 that appears stable between the flexion, neutral, and extension views. | Osteoarthritis and degenerative disk disease as described above. |
Generate impression based on findings. | Distal radius fracture. ORIF Three views of the left wrist reveal some residual dorsal soft tissue swelling. There is a slightly distally displaced ulnar styloid fracture. The fracture of the radius is fixed with a sideplate and multiple screws. In anatomic alignment. No change in position from previous. | Fixation of distal radius fracture in anatomic alignment |
Generate impression based on findings. | 9 day old male status post PICC placementVIEW: Chest AP (one view) 2/10/15 Right PICC tip projects over the central right subclavian vein. NG tube tip and side-port project over the distal thoracic esophagus. Diaphragmatic hernia is again noted. | PICC tip at the right subclavian vein. |
Generate impression based on findings. | 56 years, Male. Reason: DHT placement History: - Dobbhoff tube tip with guide wire projects over the proximal gastric body. Surgical clips project over the left hemipelvis.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip with guide wire projects over the proximal gastric body. |
Generate impression based on findings. | 87-year-old female. Axillary ulcer, here with fevers, leukocytosis. History of right breast cancer s/p mastectomy. EPIC history: 1.5 x 2 cm wound on right chest wall near axilla present for over a year. LUNGS AND PLEURA: Stable calcified and noncalcified micronodules, which are most likely post inflammatory. No suspicious pulmonary nodules or masses.No focal airspace consolidation or pleural effusion.Right basilar linear scarring.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy.Moderate coronary artery calcification.Stable bilateral hypoattenuating nodules in the thyroid.CHEST WALL: Post-surgical findings of right mastectomy. Right lateral chest wall superficial soft tissue density lesion with ulceration is stable in size at 1.1 x 2.7 cm (series 3, image 20). Adjacent right axillary lymphadenopathy is unchanged.Left axillary surgical clips.Nonspecific left retroareolar soft tissue density with punctate calcifications in the left breast is unchanged in size. Correlate with mammograms as clinically warranted.Scoliosis and multilevel degenerative disk disease of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating focus in the left hepatic lobe is too small to characterize, unchanged and likely a cyst. Tiny hypoattenuating focus in the spleen is nonspecific, unchanged. Calcified splenic and hepatic granulomas. Hypoattenuating lesion in the proximal pancreatic body measures 1.4 x 1.4 cm (series 3, image 84), previously 1.4 x 1.2 cm. Large cysts in the upper poles of both kidneys, incompletely imaged. Calcified atherosclerotic disease of the abdomen aorta. | 1. No evidence of pneumonia.2. Right lateral chest wall ulcerating soft tissue lesion adjacent to the axilla is unchanged. Stable adjacent axillary lymphadenopathy.3. Mild increase in size of the proximal pancreatic body hypodense lesion, presumably an IPMN. There has been significant enlargement over the past 4 years, however. |
Generate impression based on findings. | Bone pain with known bone metastases and getting radiation therapy. Numerous lesions are noted, including in the skull, thoracic spine, lower lumbar spine iliac wings and sacrum consistent with metastatic disease. A lesion more laterally in the left posterolateral 10th rib also likely represents a metastasis. Lesions in the lower cervical spine are likely degenerative in nature. The lesions noted in the left T8-10 ribs likely represent rib fractures and correspond with the findings on the most recent CT exam. Increased linear activity in the lower thoracic and upper lumbar spine are compatible with degenerative changes and compression fractures. | Multiple osseous metastases |
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