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Generate impression based on findings. | Gas in RLE. History of RLE infection. Status post amputation. The patient has undergone an above the knee amputation. The distal soft tissues at the amputation site are irregular and edematous. The distal 2-3 cm of the femur is exposed, extending beyond the soft tissue margin. Foci of gas are present in the posterior and medial compartments of the thigh, extending cranially to the proximal to mid thigh and compatible with infection. No drainable fluid collection is identified. The bone marrow attenuation is within normal limits. The amputation margin at the distal femur is sharp, without erosions. Extensive vascular calcifications are noted. | Irregular post-surgical soft tissue margin, exposed femur, and soft tissue gas compatible with infection. |
Generate impression based on findings. | 69 years, Male. Reason: stool burden History: G tube feed nausea and vomiting Percutaneous gastrostomy tube tip projects over the expected location of the distal stomach. There is a slightly greater than average desiccated stool burden throughout the colon. An esophageal stent and numerous clips project over the mediastinum. | 1.Percutaneous G-tube tip projects over the distal stomach.2.Slightly greater than average desiccated stool burden throughout the colon. |
Generate impression based on findings. | Previous great toe fracture. Previous humeral head fracture. Three views of the left first digit reveals a fracture of the proximal phalanx and extends into the metatarsophalangeal joint. This is unchanged from previous exam January 19. Three views of the right shoulder reveals a nondisplaced fracture of the greater tuberosity of humerus. The fracture is less distinct consistent with healing | Left great toe fracture unchanged. Healing fracture of the greater tuberosity of the right humerus |
Generate impression based on findings. | 60 year-old female, evaluate for fractureVIEWS: Right third digit, PA and lateral (two views) 2/10/15 13:13 There is a small curvilinear ossicle volar to the proximal aspect of the middle phalanx of the third finger, likely representing a small avulsion fracture. An additional linear density adjacent to the head of the proximal phalanx likely represents a second fracture fragment. Adjacent soft tissue swelling is noted. | Fractures about the PIP joint as described above. |
Generate impression based on findings. | Bilateral knee pain Four views of the right knee are provided. Moderate osteoarthritis affects the knee, particularly the patellofemoral joint. There is a small joint effusion.Four views of the left knee are provided. Moderate osteoarthritis affects the knee, particularly the patellofemoral joint. There is a small joint effusion. | Osteoarthritis. |
Generate impression based on findings. | Male 59 years old; Reason: restaging scans s/p 6 weeks on investigational targeted oral agent History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: Bi-basilar atelectasis, left greater than right. Scattered areas of ground-glass opacities and bronchial wall thickening.Bilateral pleural effusions, left greater than right with left pleural effusion occupying approximately 40% the left hemithorax and right pleural effusion occupying at least 30%. No pneumothorax.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Right chest wall port terminates at the cavoatrial junction. Mediastinal lymph node measures 1.7 x 1.1 cm (image 40/series 3) previously, 1.6 x 1.1 cm.CHEST WALL: Multiple sclerotic foci throughout the thoracic spine.OTHER: ABDOMEN:LIVER, BILIARY TRACT: There are multiple bilobar hepatic metastases. The reference right hepatic lobe lesion measures 3.0 x 2.4 cm (image 121/series 3) previously, 2.6 x 2.0 cm.Small amount of perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is atrophic. Mild mild right renal system dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bony metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: No significant abnormality notedLYMPH NODES: Soft tissue nodule in the right lower pelvis likely representing a lymph node is not significantly changed.BOWEL, MESENTERY: Post surgical changes in the bowel. Right lower abdominal ileal conduit.BONES, SOFT TISSUES: Sclerotic bony metastases. Subcutaneous nodule in the right groin measures 1.1 cm on image 210/series 3 and is unchanged.OTHER: No significant abnormality noted | 1.Slight increase in the size of the reference metastatic deposits in the liver. |
Generate impression based on findings. | Lumbar pain Four the purposes of the study I will designate 5 lumbar vertebrae with small hypoplastic ribs at L1. There is a minimal leftward curvature of the thoracolumbar spine. Moderate-severe degenerative disk disease affects L5/S1. Mild degenerative disk disease affects L4/5. Mild facet joint osteoarthritis affects the lower lumbar spine. Vertebral body heights are preserved. I see no spondylolisthesis. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | Male 61 years old Reason: hx resected renal cancer, on surveillance History: hx resected renal cancer, on surveillance This study is limited due to lack of intravenous contrast.CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right lower lobe on image number 45, series number 6, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.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 | Limited study. No significant change from previous study. |
Generate impression based on findings. | 18 year-old female with fevers, abscess, orocutaneous fistula, assess for fluid collection At the left neck incision site there is no evidence of fluid collection or abscess. Scattered prominent cervical lymph nodes are likely reactive in etiology. The thyroid gland appears normal. | No evidence of loculated fluid collection or abscess. |
Generate impression based on findings. | Status post fall Examination is mildly motion degraded. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. There multiple areas of hypoattenuation in the periventricular and subcortical white matter, particularly involving the right frontal corona radiata, right basal ganglia, and left thalamus which are not changed since prior and compatible with chronic small vessel ischemic disease. There also appears to be a small chronic infarct involving the left cerebellar hemisphere.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Chronic small vessel ischemic disease. |
Generate impression based on findings. | Hip pain and knee pain Two views of the right hip are provided. Small osteophytes indicate very mild osteoarthritis. On the frog leg view, there is slight prominence of the anterolateral aspect of the femoral head/neck junction, perhaps representing a mild cam deformity.The AP view of the pelvis shows mild osteoarthritis of both hips. Ovoid lucencies within both femoral necks with thin sclerotic margins likely represent synovial herniation pits. Gas density within the sacroiliac joints may reflect mild osteoarthritis. The remainder of the pelvis is unremarkable.Four views of the right knee are provided. The knee appears normal for age, with no specific findings to account for the patient's pain. The left knee likewise appears normal for age as seen on the frontal views. | Mild hip joint osteoarthritis and other findings as above. |
Generate impression based on findings. | 24 year old man with stage IVB DLBC lymphoma cycle 6 of R-CHOP and 2 cycles of HD MTX in need of restaging. RADIOPHARMACEUTICAL: 9.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion of the neck is unremarkable. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis. Today's PET examination demonstrates dramatic interval improvement with near complete resolution of extensive tumor activity previously seen within the neck, chest, abdomen, and pelvis. However, there are two regions of activity within the pelvis while decreased in size remain significantly FDG avid. One region within the soft tissues anterior to the left sacroiliac joint near the left internal iliac vasculature or in the adjacent musculature has a SUV max of 10.4, previously 21.2. Another tubular focus of markedly hypermetabolic activity within the right pelvic mesentery has decreased in size but remains significantly FDG avid with an SUV max of 12.8, previously 20.2. These areas are suspicious for tumor activity. Alternatively, these may represent inflammation. | Near complete resolution of extensive tumor activity within the chest, abdomen, and pelvis. However, there are two pelvic foci, while significantly improved, are still markedly FDG avid and suspicious for residual current tumor metabolism. Alternatively, these could represent benign inflammation. Attention to these regions on follow-up PET imaging would be useful.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 57-year-old male with history of recurrent sinusitis. There is a tiny polypoid opacity located at the posterior aspect of the right maxillary sinus which likely represents a mucous retention cyst. There is a small amount of mucosal thickening anteriorly within the left maxillary sinus. Minimal left frontal mucosal thickening. The anterior and posterior ethmoids, sphenoids and frontal sinuses are otherwise clear The infundibula are narrowed, but appear patent. The sphenoethmoidal and frontoethmoidal recesses are clear. There is rightward deviation of the vomer. The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | No significant paranasal sinus disease. |
Generate impression based on findings. | 62-year-old with history of left breast cancer status post mastectomy in 2013 with reconstruction. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Stable benign morphology mass in the right outer breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral 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. | Small bowel carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Interval decrease in degree of small bowel distention.BONES, SOFT TISSUES: Stable right abdominal ileostomy.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Postsurgical changes from cervical laminoplasty with interval resolution of subcutaneous air within the soft tissues and the extradural space. Additionally, the bone graft margins within the laminectomy defects on the right at the C4 and C6 levels are indistinct compatible with incorporation. Laminoplasty extends from C3 to C7.Unchanged straightening of the normal cervical lordosis. Vertebral body heights are well-maintained. Stable moderate loss of disk height from C3 through C7T1 levels. Small to moderate anterior osteophytes at multiple levels.C2-C3: small central disk osteophyte complex causing effacement of the ventral CSF space. There is moderate left neural foraminal stenosis.C3-C4: mild broad-based disk bulge with bilateral uncovertebral hypertrophy. Posterior spinal canal decompression. Moderate to severe bilateral neural foraminal stenosis.C4-C5: moderate disk osteophyte complex with bilateral uncovertebral hypertrophy. Posterior spinal canal decompression. Moderate to severe bilateral neural foraminal stenosis.C5-C6: disk osteophyte complex with bilateral uncovertebral hypertrophy. Posterior spinal canal decompression. Severe bilateral neural foraminal stenosis.C6-C7: disk osteophyte complex with bilateral uncovertebral hypertrophy. Moderate spinal canal stenosis. Severe right as well as moderate left neural foraminal stenosis.C7-T1: moderate disk osteophyte complex causing moderate spinal canal stenosis, with moderate left, and mild to moderate right neural foraminal stenosis. | Status post cervical laminoplasty from C3 to C7 levels as above with multilevel cervical spondylosis. |
Generate impression based on findings. | History of cholangiocarcinoma completed therapy in November of 2009, evaluate for disease. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules some of which are calcified and compatible with granulomas, similar to prior. Reference left upper lobe nodule (series 5, image 39) measures 5 mm, unchanged.MEDIASTINUM AND HILA: Reference cardiophrenic lymph node (series 3, image 67) measures 0.9 X 1.8 cm, unchanged. No additional mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hilar soft tissue mass poorly visualized on this noncontrast examination but grossly similar to prior. Percutaneous right-sided biliary drain and two internal biliary stents with distal tips in the duodenum. Marker for percutaneous drain flush with surface of liver, retracted from prior. Expected pneumobilia. Mild intrahepatic biliary ductal prominence, unchanged. Status post cholecystectomy. No fluid collection to suggest abscess. No perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic ligament and periportal lymph nodes, unchanged.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fat-containing paraumbilical hernia. Scattered abdominal wall soft tissue nodules may be related to injections. 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: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: L5 mild compression deformity, unchanged.OTHER: No significant abnormality noted. | 1.Findings consistent with stated history of cholangiocarcinoma without significant interval change compared to the prior studies. No evidence of new disease.2.Marker for percutaneous biliary drain flush with surface of the liver and may need to be repositioned. Discussed with Dr. Polite at time of dictation.3.Persistent 5 mm left upper lobe nodule. |
Generate impression based on findings. | Six months post ACDF There is an anterior plate with screws entering the C6 and C7 vertebrae. I see no acute hardware complications. There is also an intervertebral spacer at C6-7. There may be early fusion of the posterior aspects of the cervical vertebral bodies at this level, but this is equivocal. Severe degenerative disk disease affects C3/4 with anterior and posterior vertebral body osteophytes. Mild to moderate degenerative disk disease affects C4/5 and C5/6. There are grade 1 retrolistheses of C3 and C4. | Degenerative disk disease and postoperative changes of ACDF at described above. |
Generate impression based on findings. | 60-year-old male. Hypopharyngeal SCC s/p CRT. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Right apical scarring, unchanged.Scattered stable micronodules, most likely postinflammatory. No suspicious pulmonary nodules or masses.Very mild bronchiectasis bilaterally in the upper and lower lobes, similar to prior exam. Small area of groundglass opacity in the right middle lobe, likely relates to aspiration. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.Severe coronary artery calcification.Left chest port terminates in the SVC.CHEST WALL: Left chest port.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified liver granulomas. Left hepatic lobe cyst, unchanged.SPLEEN: Calcified splenic granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta without aneurysm. No lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable sclerosis in the inferior endplate of T8, likely degenerative in etiology.OTHER: No significant abnormality noted. | No evidence of metastatic disease in the chest or abdomen, or other significant abnormality. |
Generate impression based on findings. | History of cervical fracture. Surveillance. There is mild depression of the superior endplate of the C7 vertebral body compatible with a compression fracture as seen on prior CT scans. There is approximately 3 mm of anterolisthesis of C6 on flexion that decreases to 2 mm on extension. The remaining cervical vertebrae appear normal. | C7 fracture as described above with mild C6 anterolisthesis. |
Generate impression based on findings. | Fracture.VIEWS: Left femur AP/lateral (two views) 02/10/15 Cast remains in place. Oblique fracture of the proximal mid femur is again seen. The distal fracture fragment is displaced medially and anteriorly. Approximately 1.5 cm of overlap is present. There may be some periosteal reaction. | Probable early healing of the femoral fracture. |
Generate impression based on findings. | All of the paranasal sinuses are clear. Bilateral mastoid air cells and middle ear cavities are clear. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is midline. Bilateral orbits and the posterior nasopharynx appear unremarkable. Coarse calcifications in the right tonsil compatible with prior inflammation. | Unremarkable CT scan of the sinuses. |
Generate impression based on findings. | Fluid collection and pain. Fracture versus arthritis. There is diffuse soft tissue swelling with reticulation of the subcutaneous fat. The bones are slightly demineralized. Severe osteoarthritis affects the knee, particularly at the patellofemoral joint. There may be a small joint effusion. There is mild deformity of the distal femoral metadiaphysis which may reflect an old healed fracture, but I see no acute fracture. | Osteoarthritis and other findings as above. I see no acute fracture. If there is strong clinical concern for acute fracture, CT or MRI may be considered. |
Generate impression based on findings. | THORACIC SPINE: The partially imaged cervical spine demonstrates endplate degenerative changes at C6-7 with left uncovertebral spur, contributing to moderate left foraminal stenosis. Mild C7 on T1 anterolisthesis. There is mild dextrocurvature of the thoracic spine. There is minimal anterolisthesis of T2 on T3. The vertebral body heights are well maintained. There is multilevel vacuum disc phenomenon and loss of disc height at T6-7, T7-8 and T8-9. At T7-8, there is a left paramedian osseous spur/calcified disc. There is associate narrowing of the left ventral thecal sac at this level. There is no significant spinal canal or foraminal stenosis within the remainder of the thoracic spine.LUMBAR SPINE: There is moderate dextrocurvature of the lumbar spine with apex at L2-3. There is mild lateral subluxation of L4 on L5. There is minimal retrolisthesis of L1 on L2. The vertebral body heights are well-maintained. There is marked loss of disc height at L5-S1. There are moderate degenerative changes throughout the lumbar spine with small disc bulges at L2-3, L3-4, L4-5 and L5-S1 and vacuum phenomenon at multiple levels. There is mild spinal canal stenosis at L3-4 and L4-5 related to disc bulge, ligamentum flavum thickening, and facet arthropathy. Mild to moderate left L2-3, L3-4, and L4-5 neural foraminal narrowing. There is moderate right L5-S1 neural foraminal narrowing. There is mild multilevel facet arthropathy throughout the lumbar spine. Other: A left hemithoracic ICD device is present. There are marked atherosclerotic changes of the aorta and coronary artery calcifications. Mild pericardial effusion. Minimal emphysematous changes. Mildly prominent mediastinal lymph nodes, not enlarged by CT size criteria. | 1. Degenerative changes in the thoracic and lumbar spine without high grade spinal stenosis at any level. There is mild spinal canal narrowing at the left T7-8 level in the thoracic spine. There is mild spinal canal stenosis at L3-4 and L4-5 in the lumbar spine. 2. There is moderate right L5-S1 neural foraminal narrowing which may be impinging on the right L5 nerve root. Additional levels as detailed above. |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. CHEST:LUNGS AND PLEURA: Stable scattered nonspecific micronodules. No suspicious pulmonary nodules or masses. No pleural effusion.Minimal basilar atelectasis.MEDIASTINUM AND HILA: Stable right paratracheal (image 31 series 3) measuring 9 mm and right hilar lymph node (image 43 series 3) measuring 11 mm.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Right breast mass (image 45 series 3) now measuring 2.8 cm x 2.8 cm previously measuring 2.8 cm x 2.9 cm with associated skin thickening.Right axillary lymphadenopathy stable.Diffuse osteolytic metastatic lesions throughout the vertebrae and ribs and partial collapse of the T6 vertebrae unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Extensive heterogeneity throughout the liver with multiple hypodense lesions compatible with diffuse metastatic disease.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: Numerous enlarged retroperitoneal and periaortic lymph nodes with reference left periaortic lymph node (image 108 series 3) now measuring 17 mm in short axis previously measuring 19 mm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: As noted above, extensive metastatic disease involving the axial skeleton. There is stable partial collapse of the L3 vertebraeOTHER: No significant abnormality noted. | 1.Right breast mass stable. 2.Extensive osseous, hepatic, and lymphadenopathy consistent with metastatic disease without significant interval change.3.No new sites of disease identified. |
Generate impression based on findings. | Chronic back pain. Evaluate for bony pathology. Three views of the thoracic spine are provided. There are tiny vertebral body osteophytes, but otherwise I see no specific findings to account for the patient's pain.Five views of the lumbar spine are provided. Vertebral body heights and intervertebral disk spaces are within normal limits. Facet joints are within normal limits. I see no specific findings to account for the patient's pain. Linear metallic densities in the pelvis likely reflect contraceptive devices. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | 14-year-old male status post tarsal coalition removalVIEWS: Right foot oblique, AP, Lateral (3 views) 2/10/2015 10:24:37 and 11:38:22 Interval removal of the k-wire and cast. Postsurgical changes of calcaneonavicular coalition resection with interposition fat graft. Alignment is normal. No evidence of fracture or effusion. | Postsurgical changes with no evidence of malalignment or fracture. |
Generate impression based on findings. | Reason: Follow-up of lung nodule in a smoker History: As above LUNGS AND PLEURA: Severe centrilobular emphysema. A right lower lobe well circumscribed pleural based nodule measures 8 x 8 mm (series 7, image 77), previously measuring 7 x 7 mm on 9/11/2013, 6x 7 mm on 2/2/2013 and 5 x 5 mm on 1/12/2010. There is no visible internal calcification, but internal fat density is identified. Additional scattered reticular and nodular densities in the right upper and lower lobes are new from the prior exam (series 7; images 37, 45, 75). Scattered subsegmental atelectasis/scarring appears unchanged. No focal air space consolidations. No pleural effusions.MEDIASTINUM AND HILA: Mild cardiomegaly, without pericardial effusion. No visible coronary artery calcification. Enlarged, heterogeneous left thyroid lobe appears unchanged. Mild paratracheal chain lymphadenopathy is again seen. A previously referenced low left paratracheal lymph node measures 12 mm (series 5, image 37), stable to slightly decreased. A precarinal lymph node measures up to 14 mm (series 5, image 40), unchanged.CHEST WALL: Scattered small axillary lymph nodes are again seen. Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Continued mild increase in size of an 8mm fat-containing, noncalcified right lower lobe nodule. The appearance and growth rate favor hamartoma, but malignancy cannot be excluded.2. Stable mild paratracheal lymphadenopathy.3. Severe emphysema. |
Generate impression based on findings. | Low back/lumbar spine pain. The bones appear demineralized suggesting osteopenia. Vertebral body heights and intervertebral disk spaces are within normal limits. Tiny osteophytes project from the anterior aspects of the lumbar vertebrae, of doubtful clinical significance. Surgical clips in the right upper quadrant likely reflect prior cholecystectomy. There is atherosclerotic calcification of the distal abdominal aorta. | I see no specific findings to account for the patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Male 65 years old Reason: eval for acute process, s/p slipped/fall History: diffuse l anterior/lat rib pain. The bones appear slightly demineralized. There are minimally displaced fractures of the lateral aspects of the left eighth rib and possibly the left ninth rib. We see no additional acute rib fractures. Note is made of multiple thoracic vertebral body compression deformities which may be chronic in etiology. There is cement within the L2 and L4 vertebrae. There is a slight rightward curvature of the thoracic spine. Calcified mediastinal lymph nodes are noted. Please refer to chest radiograph report for pulmonary findings. | Acute rib fractures of the left eighth and possibly ninth ribs. |
Generate impression based on findings. | Metastatic prostate cancer, evaluation of disease during therapy with investigational treatment; please complete PCWG2 form. No abnormal osseous foci are identified to indicate metastatic disease.Degenerative changes are noted of the mid-cervical region, right sacroiliac joint and glenohumeral joints | No evidence of bone metastasis. |
Generate impression based on findings. | Male 67 years old Reason: lumbar back pain History: lumbar back pain. There is severe degenerative disk disease at L5/S1. There is moderate to severe degenerative disk disease at L4/L5 and moderate degenerative disk disease at L3/L4. There is also severe degenerative disk disease at T12/L1. We see no spondylolisthesis or instability between the flexion, extension, and neutral views. There is moderate facet joint osteoarthritis affecting the lower lumbar spine. There is also hypertrophy of the lumbar spinous processes with mild associated degenerative arthritic changes. There is a slight leftward curvature of the lumbar spine. | Degenerative disk disease and osteoarthritis as described above. |
Generate impression based on findings. | DLBCL status-post Rituxan monotherapy with PD needs restaging please.RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion of the neck grossly demonstrates a large approximately 4.5 cm mass in the region of the right parotid gland. Adjacent surgical clips are visualized. Today's PET examination demonstrates a large, markedly hypermetabolic mass in the region of the right parotid gland. The SUVmax previously was 7.7 and is now 14.3. This is consistent with tumor progression.There is a new small but significantly increased focus of activity visualized inferoposterior to the right parotid mass, with an SUVmax of 11.8 and is also consistent with tumor progression.There are several additional new foci of activity immediately surrounding the recently inserted right portacath which demonstrates an SUVmax of 5.6. Given recent instrumentation this is more likely inflammatory rather than tumor progression. No evidence of suspicious FDG avid tumor elsewhere. | 1.Markedly hypermetabolic tumor in right neck, which has progressed compared to the previous exam.2.No convincing FDG avid tumor activity elsewhere. FDG avid activity along the right porta-cath is more likely reactive in etiology than additional tumor activity.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 48-year-old female with history of excisional biopsy for focal ADH in the right breast in 2012, with final pathology results showing fibrocystic changes, apocrine metaplasia and columnar cell change. 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 are present in the upper outer quadrant posterior depth. 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. | 21-year-old male with dyspnea on exertion, evaluate for abnormalityVIEW: Chest AP (one view) 2/10/15 14:10 Right central venous catheter tip at the cavoatrial junction. Low lung volumes without consolidation or pleural effusion. The cardiomediastinal silhouette is unchanged. | No evidence of infection. |
Generate impression based on findings. | Female 26 years old Reason: r/o fx History: lateral ankle pain s/p fall. There is mild soft tissue swelling about the ankle. We see no fracture. | Mild soft tissue swelling without fracture. |
Generate impression based on findings. | Reason: follow up, lung nodules, smoker History: lung nodules LUNGS AND PLEURA: Multifocal areas of groundglass opacities seen predominantly in the lower lobes. Several of these have mild interval increase in size.Reference right lower lobe subpleural nodule (image 61 series 5) now measures 12 mm on the prior exam this measured 9 mm.Reference left lower lobe solid and groundglass nodule (image 57 series 5) measures 19 mm previously measuring 17 mm.No pleural effusions.Mild upper lobe predominant centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes without definite evidence of lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Minimal coronary calcifications.Enlargement of the pulmonary artery compatible with pulmonary arterial hypertension.CHEST WALL: Mildly prominent axillary lymph nodes.Bilateral breast implants.Scoliosis of the thoracic spine with accompanying severe degenerative changes .UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Post cholecystectomy. | 1.Multiple groundglass and semi-solid nodules predominantly in lower lobes are either stable or increased in size and suspicious of adenocarcinoma. Chronic inflammatory etiologies cannot be excluded. |
Generate impression based on findings. | 6-month-old female, assess for fractureVIEWS: Left humerus, AP and lateral (two views) 2/10/15 Deformity and callus formation about the proximal left humeral metaphysis consistent with healing fracture with mild medial angulation of the distal fragment. No new fracture is identified. | Healing proximal humerus fracture as described above. |
Generate impression based on findings. | Fracture Evaluation of fine detail is limited by overlying cast material. Again seen is a transverse fracture of the distal radius with fracture fragments in near anatomic alignment. There is perhaps slight widening of the scapholunate interval which may reflect ligamentous laxity or disruption. Mild osteoarthritis affects the basilar joint. | Distal radius fracture in near-anatomic alignment. |
Generate impression based on findings. | History of laryngeal squamous cell carcinoma status post prior chemoradiation therapy. Evaluation is limited by lack of intravenous contrast. Again seen are posttreatment changes with mild soft tissue thickening involving the supraglottic and glottic larynx. No discrete mass. Unchanged irregularity of the thyroid and cricoid cartilage. There is asymmetric enlargement of the left mandibular foramen with preserved surrounding fat density around the nerve. There is fatty atrophy of the left muscles of mastication which was present on remote MRI from 4/4/2011. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is diffuse idiopathic skeletal hyperostosis and cervical spondylosis. The imaged intracranial structures are unremarkable. The imaged portions of the lungs demonstrate moderate bilateral, left greater than right, pleural effusions. There is a subcentimeter right apical lung nodule. There is a left lens implant. | 1. Limited study due to lack of contrast. Mild thickening involving the laryngeal soft tissues is unchanged and may represent treatment change. No discrete mass or significant cervical lymphadenopathy. 2. Subcentimeter right apical lung nodule and bilateral pleural effusions. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Male, 71 years old, with history of squamous cell carcinoma of the left neck. Ill defined soft tissue thickening and effacement of the fascial planes along the left carotid space are stable findings. No new mass or abnormal enhancement is seen. Supraglottic mucosal edema is also stable and likely related to therapy.No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are free of focal lesions. The left IJ vein fails to opacify through the region of soft tissue thickening, but elsewhere is patent. Atherosclerotic calcification is evident at the carotid bifurcations. Peripheral cystic change is redemonstrated in the lung apices along with a right apical micronodule, unchanged. Osseous fusion of the C2 and C3 levels is demonstrated. No concerning or destructive bony lesions are demonstrated. | Redemonstration of findings compatible with treated tumor in the left neck. No evidence of progressive disease is seen. |
Generate impression based on findings. | Hip and back pain with a history of prostate cancer and a PSA of 629, prostate cancer- biopsies to follow. Innumerable osteoblastic lesions are visualized throughout the entire axial and proximal appendicular skeleton compatible with metastases. Absence of renal and other soft tissue activity indicates a "metastatic superscan". | Innumerable osseous metastases. |
Generate impression based on findings. | Pain after injury Best seen on the oblique view is an intra-articular fracture through the dorsal aspect of the base of the distal phalanx of the ring finger (mallet fracture). Alignment is near-anatomic. Mild osteoarthritis affects scattered interphalangeal joints. A round lucency within the distal pole of the scaphoid likely represents a degenerative cyst or ganglion. | Ring finger mallet fracture as above. |
Generate impression based on findings. | Knee pain for one day. Rule out bony abnormality.VIEWS: Right knee AP/lateral/oblique (3 views) 02/10/15 A joint effusion is not seen. The bones are normal in appearance. No fracture is identified. | Normal examination. |
Generate impression based on findings. | 14-year-old male, assess for fractureVIEWS: Left ankle, AP, lateral, and oblique (3 views) 2/10/15 14:22 Splint material obscures underlying osseous detail. Fractures of the medial malleolus and distal fibula are again identified in near anatomic alignment. | Casted ankle fractures in near-anatomic alignment. |
Generate impression based on findings. | Right finger swollen and with difficulty for patient to bend finger. Please assess for possible broken index finger. Patient with recent injury after falling on ice. I see no fracture or malalignment of the index finger. There is mild deformity of the dorsal aspect of the base of the distal phalanx of the fifth finger which I suspect represents a mallet fracture that may be chronic in etiology. The remainder of the hand is unremarkable. | No findings to suggest an index finger fracture. Deformity of the base of the distal phalanx of the fifth finger likely represents a mallet fracture, perhaps chronic. |
Generate impression based on findings. | 60-year-old female with a history of metastatic breast CA, restaging, response to therapy.RADIOPHARMACEUTICAL: 11.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates stable innumerable predominantly sclerotic osseous lesions. Right proximal humeral sideplate with screws is noted again. Left chest port catheter tip is in the right atrium. Stable left mid lung atelectasis or scarring. Cholecystectomy clips are noted again. Scattered atherosclerotic calcifications are seen.Today's PET examination again demonstrates widespread significantly metabolically active bone metastases, including in the spine, manubrium, pelvis, bilateral ribs, right hip. These lesions have progressed in size, number and metabolic activity from the previous exam. Examples include the right hip lesion which has increased in size and has increased in the SUVmax activity from 10.0 to 13.1. Vertebral body lesions at L1, T11, T4 and T3 are new from the previous exam with an SUVmax of 9.3. There is mild activity in the right breast and involving bilateral axillary lymph nodes which are stable and could represent inflammation or stable tumor.Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder. | Multiple significantly metabolically active osseous metastases, moderately progressed from previous with multiple new and larger lesions. |
Generate impression based on findings. | Ms. Hillhope is a 70-year-old female with a highly suspicious right breast mass. Recent imaging suggest metastatic osseous disease, concerning for breast primary. She presents today for biopsy of the right breast mass. Right breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 2.9 cm at the 12 o’clock position with increased vascularity, 2 cm from the nipple. The lesion was readily visible.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 right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, four 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral aspect of the lesion. No evidence of hematoma or other complication. It is noted that the sonographic and mammographic findings are enlarged since the time of her previous diagnostic evaluation. 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 right breast lesion with clip placement. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Left ankle pain There is mild soft tissue swelling about the ankle. A tiny ossicle distal to the medial malleolus may reflect old trauma, but I see no findings to suggest an acute fracture. Faint calcific density along the talus may reflect chondrocalcinosis, but this is equivocal. There is a small plantar calcaneal spur. | Mild degenerative and possibly old post-traumatic changes as described above. |
Generate impression based on findings. | PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: The reference left level IIa lymph node measures 10 x 5 mm (series 7, image 42), previously measuring 6 x 11 mm.The reference level III lymph node measures 5 x 4 mm (series 7, image 60 ), previously measuring 4 x 6 mm. This node currently measures 12 millimeters in cranial caudal dimension, unchanged.OTHER: There are moderate spondylotic changes involving the cervical spine. There is a partially visualized left-sided Port-A-Cath. | No significant interval change in the reference level IIa and level III lymph nodes. |
Generate impression based on findings. | Bilateral hip pain. Femoroacetabular impingement. There is slight prominence of the anterolateral aspect of the femoral head/neck junction on the modified Dunn view indicating a CAM deformity with an alpha angle of approximately 70 degrees. The lateral center edge angle is approximately 37 degrees. The anterior center edge angle is approximately 44 degrees. The femoral neck shaft angle is approximately 132 degrees. While there is suggestion of an acetabular crossover sign bilaterally, I imagine that this is accentuated by pelvic tilt. | Cam deformity and other findings/measurements as described above. |
Generate impression based on findings. | 49 year old with history of asymmetry in the left breast. 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. Post surgical scar is re-demonstrated at in the breast without significant change. 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 normal, bilateral screening mammogram is recommended annually. In view of dense breasts, tomosynthesis is preferable. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Recent chest CT showed asymmetric tissue in the left breast. 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. 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 normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 88-year-old male on Coumadin with history of confusion x 1 week. Evaluate for intracranial hemorrhage. There is no evidence of acute intracranial hemorrhage. There is extensive confluent periventricular subcortical and white matter hypoattenuation most compatible with chronic small vessel ischemic disease. The grey-white differentiation is preserved. The ventricles and sulci are prominent, but symmetric. There is no mass-effect or midline shift. There is mild mucosal thickening of the left sphenoid sinus, but otherwise the remaining paranasal sinuses, orbits, and mastoid air cells are clear. | 1.No evidence of acute intracranial hemorrhage.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Female, 68 years old, history of tongue cancer status post wide local excision and right neck dissection in 2009, now with a mass suspicious for recurrence. Anatomic asymmetry is seen along the ventral tongue and anterior floor of mouth which is of uncertain significance. No discrete or measurable tumor is seen in these locations. Please note that evaluation of this area is partially degraded by streak artifact from dental amalgam.No pathologic adenopathy is detected on either side of the neck by size criteria. The right submandibular gland is absent. Infiltration of the fascial planes in the right neck is compatible with prior dissection. The remaining salivary glands are free of focal lesions. Hypoattenuating lesions in the left thyroid lobe are unchanged. The cervical vessels opacify normally. No concerning osseous lesions are detected. | Anatomic asymmetry along the ventral tongue and anterior floor of mouth is of uncertain significance and could reflect change related to prior surgery. No discrete or measurable mass is detected, though please note that CT is insensitive for the detection of superficial lesions, and image quality is somewhat degraded by metallic streak artifact in the region.No evidence of pathologic adenopathy is seen on either side of the neck. |
Generate impression based on findings. | Osteoporosis and "spinal punch tenderness". Pain over L1 -- 2 with known osteoporosis. The bones appear demineralized. There is a mild scoliosis of the visualized thoracolumbar spine that appears similar to that seen on the prior study. Severe degenerative disk disease affects L4/5 and L5/S1. Moderate degenerative disk disease affects L1/2. Moderate facet joint osteoarthritis affects the lower lumbar spine. Lumbar vertebral body heights are preserved, but there appears to be a compression fracture of T12 that might be better assessed with dedicated thoracic spine radiographs. There is hypertrophy of the spinous processes with mild associated degenerative changes. | Degenerative disk disease of the lumbar spine. T12 compression fracture might be better assessed with dedicated thoracic spine radiographs if clinically warranted. |
Generate impression based on findings. | Female 75 years old Reason: eval Type 1 endoleak repair with SMA/renal artery stent History: s/p EVAR with Type 1 endoleak ABDOMEN:LUNG BASES: Bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mildly atrophic left kidney with multiple hypodense lesions likely representing simple cyst.Hypodense lesion in the inferior pole of the right kidney likely representing a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Extensive atherosclerotic calcifications of the thoracic aorta and its branches with moderate coronary calcifications.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine with rightward curvature.OTHER: Right pelvic embolization coils. IVC filter in place. CT Angiography: Extensive atherosclerotic calcifications of the thoracic aorta.Aneurysm of the thoracic aorta measuring up to 6.3 cm in greatest axial dimension (series 11, image 107).EVAR in place with proximal portion at the level of the SMA with distal extension into the common iliac arteries. Stents in the SMA and bilateral renal arteries.There is a type I endoleak with contrast within the aneurysm sac adjacent to the proximal attachment of the EVAR (series 11, image 96). | Type 1 endoleak at the proximal attachment of the EVAR. |
Generate impression based on findings. | Ms. Kimbrough is a 67 year old female with a personal history of right breast lumpectomy in April 2013 for IDC, mucinous type, followed by radiation therapy and a benign left breast biopsy in 1999. No current breast related 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-lumpectomy changes are identified in the right lower inner quadrant, with area of scarring with architectural distortion and few surgical clips. A circumscribed mass is present in the lower inner left breast, unchanged since 7/23/10. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound for left lower outer quadrant confirmed a circumscribed mass, likely a fibroadenoma, at 7 o'clock position. | 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. | Non-small cell lung cancer. RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates a spiculated right apical lung mass measuring approximately 2.8 x 1.7 cm. There is a moderate right-sided pleural effusion with overlying compressive atelectasis. There is paraseptal emphysema. There are enlarged mediastinal and hilar lymph nodes. There are multiple right chest wall masses causing destruction of the right 3rd, 8th, and 9th ribs. There are enlarged bilateral supraclavicular and left retroparotid lymph nodes. There is enlargement of the right adrenal gland. There is calcific atherosclerotic disease involving the coronary arteries, the aorta, and its branches. Today's PET examination demonstrates a markedly hypermetabolic right apical mass, max SUV of 26.8, consistent with history of lung cancer. There are multiple markedly hypermetabolic lymph nodes in the right hilum, subcarinal, bilateral paratracheal, and prevascular stations consistent with metastatic disease, max SUV of 49.9. Additional hypermetabolic lymph nodes are seen in the bilateral supraclavicular, right axillary, and left jugular stations. There are additional hypermetabolic lymph nodes involving several locations in the right chest wall causing destruction of the several ribs with a max SUV of 52.1. There also appears to be metastatic involvement of the posterolateral tenth rib.In the upper abdomen, there are markedly hypermetabolic bilateral adrenal gland nodules, max SUV of 34.5, consistent with metastatic disease. Additional hypermetabolic soft tissue abdominal metastases are seen involving retrocrural and diaphragmatic lymph nodes as well as medial to the left kidney and of the pancreatic tail. | 1.Markedly hypermetabolic right apical mass consistent with lung cancer.2.Extensive markedly hypermetabolic metastatic disease involving the bilateral neck, chest, upper abdomen, and bone. |
Generate impression based on findings. | Distant history of trauma, now with increasing hip pain Normal appearance of the left hip joint. No fracture or malalignment is present. The visualized muscles and soft tissues are normal in appearance. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | 40 year-old male, assess for fractureVIEWS: Right tibia and fibula, AP and lateral (two views) 2/10/15 14:55 Deformity of the proximal fibula compatible with healing/healed fracture in near-anatomic alignment. Two screws traverse the distal tibia and fibula metaphyses in near-anatomic alignment without evidence of hardware complication. | Healing/healed fractures in near-anatomic alignment. |
Generate impression based on findings. | 37-year-old pregnant female with suspected left wrist fracture after fall onto outstretched hand. Wrist swelling and pain. Three views of the left wrist are provided. I see no fracture or malalignment. There is perhaps mild soft tissue swelling.Three views of the left hand are provided. I see no fracture or malalignment. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | The images are degraded by patient motion. There is mandibular hypoplasia with 14 mm of overjet and apparent 9 mm of underbite, as well as glossoptosis with marked narrowing of the oropharyngeal airway, measuring as little as 3 mm in width. There is deficiency of the posterior hard palate, consistent with cleft palate. There is opacification of the left middle ear and mastoid air cells. There is also possible deficiency of the posterior semicircular canals. The ventricles appear small, although the images are not optimized for delineating the intracranial structures. A nasogastric tube is partially imaged. | 1. Stigmata of Pierre Robin sequence with mandibular hypoplasia, narrowing of the oropharyngeal airway, cleft palate, as well as suggestion of left otomastoiditis. 2. Possible deficiency of the posterior semicircular canals. A dedicated temporal bone CT may be useful for further evaluation, if clinically warranted.3. The ventricles appear small, although the images are not optimized for delineating the intracranial structures. Dedicated brain imaging may be useful for further evaluation, if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Blount's disease postop.VIEWS: Left tibia-fibula AP/lateral (two views) 02/10/15 The Ilizarov type device is intact. The anterior skin staples have been removed. Minimal soft tissue swelling is noted laterally. The proximal tibial osteotomy alignment is unchanged in appearance. The gap is very similar in appearance. Increased density is seen in the gap most likely due to early new bone formation. | Unchanged alignment of proximal tibial osteotomy. |
Generate impression based on findings. | 70 year-old female with chronic constipationVIEW: Abdomen AP (one view) 2/10/1515:00 There is a moderate stool burden. No evidence of bowel obstruction. | Moderate stool burden. |
Generate impression based on findings. | 62 years, Male. Reason: assess for obstruction vs ileus History: distension, nausea vomiting, history g tube Gastrostomy tube is in place. Residual contrast is noted within the stomach, proximal bowel, and possibly within the gallbladder. Nonobstructive bowel gas pattern. No pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 64 years, Male. Reason: Eval placement NG tube History: Dysphagia Dobbhoff tube tip projects over the body of the stomach. Nonobstructive bowel gas pattern. IVC filter noted. The lung bases are clear. Healed right lateral rib fracture noted.Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projecting over the body of the stomach. |
Generate impression based on findings. | Male 54 years old Reason: r/o fx History: lateral ankle pain s/p fall. Three views of the right ankle show an oblique fracture of the distal fibula with fracture fragments in anatomic alignment. We see no additional fracture. | Distal fibular fracture in near anatomic alignment. |
Generate impression based on findings. | 13-week-old female with reflux, dysphagia, bradycardia and desaturation with feeds. EXAMINATION: Oropharyngeal motility study 2/10/2015 10:50:00 Beth Harrison, speech and language therapist, supervised the examination.1 minutes and 28 seconds of fluoroscopy was used.Rapid expression of thins. Mild premature spillage of thins. 2 sucks/swallow of nectar-thick liquid. Bradycardia with thin via slow flow. Slight delay of pharyngeal swallow trigger. Mild residue in valleculae intermittently with all consistencies. Decreased coordination of swallow with nectar thick liquids via clear rim. Bolus in valleculae prior to completion of swallow. No evidence of penetration or aspiration. | Mildly impaired swallow function with no evidence of penetration or aspiration. Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Left hip pain Subjectively, there is slight prominence of the anterolateral aspect of the right femoral head/neck junction, although the alpha angle measures 50 degrees, which is within normal limits. The lateral center edge angle is approximately 39 degrees. The anterior center edge angle is approximately 45 degrees. The femoral neck-shaft angle is approximately 129 degrees.There are slight bilateral coxa profunda deformities. Note is made of slight prominence of the lateral aspect of the right femoral head/neck junction. A small focus of ossification along the inferomedial aspect of the body of the right pubic bone likely represents an unfused apophysis. There appears to be incomplete fusion of the posterior neural arch of S1, a normal variant. | Borderline acetabular overcoverage with measurements as described above. |
Generate impression based on findings. | Male 65 years old Reason: inflammation of joints in wrist bilaterally History: joint inflammation. Left wrist: There is mild soft tissue swelling along the dorsum of the wrist. We see no erosions. There is chondrocalcinosis in the lunotriquetral interval. Right wrist: There is mild soft tissue swelling particularly along the dorsal and ulnar aspects of the wrists. We see no erosions. Mild osteoarthritis affects the first carpometacarpal joint. | Mild arthritic changes as described above appear degenerative in etiology. We see no specific radiographic features of inflammatory arthritis. |
Generate impression based on findings. | 62 year old female with history of severe necrotizing pancreatitis, s/p ERCP with necrosectomy and transgastric drainage 1/20/15. Pt still with abdominal pain requiring narcotics. ABDOMEN:LUNG BASES: Linear density within the right lower lobe may be related to prior surgery. Mild basilar atelectasisLIVER, BILIARY TRACT: No focal hepatic masses. Status post cholecystectomy. There is mild intrahepatic biliary ductal dilatation. Common bile duct is dilated measuring up to 1.9 cm in diameter.There is attenuation of the main portal vein and superior mesenteric vein. The splenic vein is occluded. SPLEEN: Multiple well-defined low-attenuation lesions which extend to the periphery compatible with splenic infarcts involving approximately 10% of the splenic parenchyma. No evidence of splenic artery aneurysm. PANCREAS: Post surgical changes of pancreatic necrosectomy. A peripancreatic multiloculated fluid collection with enhancing walls and foci of gas is present (series 10, image 51) which measures 13.0 x 6.2 cm in the axial plane and at least 18 cm in the sagittal plane. Multiple pigtail drainage catheters extend from the stomach into the fluid collection. An additional drainage catheter extends from the fluid collection to the duodenum. The majority of the pancreas is necrotic with minimal residual enhancing parenchyma in the head and tail.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter low attenuation lesion within the left kidney too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes to the stomach of prior pancreatic necrosectomy as described above. Colonic diverticulosis without evidence of complicated diverticulitis. Mild colonic wall thickening likely related to pancreatitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of scattered abdominopelvic free fluid is present.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of complicated diverticulitis. Mild colonic wall thickening likely related to pancreatitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Necrotizing pancreatitis with only minimal residual viable pancreatic tissue remaining. 2.Large peripancreatic fluid collection and post surgical changes of pancreatic necrosectomy. 3.Splenic vein thrombosis. Attenuated main portal vein and superior mesenteric vein. 4.Colonic diverticulosis without evidence of complicated diverticulitis. |
Generate impression based on findings. | Female 57 years old Reason: Evaluate for healed osteotomy History: none. We have two views of the right forearm that show a plate and screw device affixing an osteotomy of the distal ulnar diaphysis in near anatomic alignment. The third to most distal screw appears to have retracted by approximately 4 mm and the head of the screw is no longer flush with the plate.The osteotomy remains visible, although there is callus formation adjacent to the osteotomy indicating an attempt at healing. The bones appear slightly demineralized. A small ossicle distal to the ulna was present on the prior study. | Orthopedic fixation of healing distal ulnar osteotomy with retraction of one of the screws as described above. |
Generate impression based on findings. | 8-month-old male with fractureVIEWS: Left femur, AP, lateral (two views) 2/10/15 15:10 Residual deformity of the mid femoral diaphysis consistent with a healed fracture. | Healed femoral fracture. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is nasal septal deviation to the left with a septal spur. | No acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | Abdominal pain ABDOMEN:LUNG BASES: CardiomegalyLIVER, BILIARY TRACT: Mild bilobar intrahepatic ductal dilatation associated with mild extrahepatic ductal dilatation without obvious distal obstructing lesion. Maximal diameter of the common bile duct is 0.9 cm.Diffuse gallbladder wall thickening with gallbladder wall calcification consistent with porcelain gallbladder. Cholelithiasis without acute inflammation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts.RETROPERITONEUM, LYMPH NODES: Abdominal aortic ectasia.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus atrophic or absentBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mild bilobar intrahepatic and mild extrahepatic ductal dilatation without obvious distal obstructing lesion.Porcelain gallbladder with probable cholelithiasis without acute inflammation no worrisome mass at this time.Otherwise negative examination. |
Generate impression based on findings. | Male 45 years old Reason: OA History: left knee pain. There is narrowing of the medial tibiofemoral compartment, particularly on the skier's view, where there is near bone on bone apposition indicating severe osteoarthritis. There are also tricompartmental osteophytes. There is a slight varus deformity of the left knee and a slight lateral tilt of the left patella. There is a large joint effusion of the left knee. Overall, the osteoarthritis appears to have slightly progressed from the prior study.Relatively mild osteoarthritis affecting the right knee is seen on the frontal views. | Left knee shows severe osteoarthritis and joint effusion. |
Generate impression based on findings. | Ms. Love is a 53 year old female with a personal history of right breast abscess in October 2014 that underwent incision and drainage by Dr. Jaskowiak. Three standard views of both breasts with an additional left MLO view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A linear marker is placed on a scar overlying the right breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.The patient also signed a release form in order to obtain prior mammograms from Mercy hospital for future comparison purposes.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 8-month-old female, assess NJ tube placementVIEW: Abdomen AP (one view) 2/10/15 15:29 NJ tube tip is within the distal duodenum. Left central venous catheter tip at the cavoatrial junction. IVC stent and suture material in the right upper quadrant again noted. Low lung volumes with basilar atelectasis and mild vascular engorgement without pleural effusion. The cardiothymic silhouette is unchanged.Disorganized bowel gas pattern without evidence of obstruction. | NJ tube tip in the distal duodenum. |
Generate impression based on findings. | Female 53 years old Reason: djd vs carpal instability History: pain at base of thumb with finger extension. The trapezium is absent, presumably due to prior surgical resection. There are also surgical defects in the base of the first metacarpal. Punctate densities in the adjacent soft tissue were present on the prior study and are of doubtful clinical significance. We see no specific findings to suggest instability. Mild to moderate osteoarthritis affects the first metacarpophalangeal joint. Note is made of small dorsal carpal osteophytes. | Postoperative changes of basilar joint arthroplasty and other findings as above. |
Generate impression based on findings. | Ms. Coleman is a 44 year old female with a personal history of left breast mastectomy in O8/2007 for IDC/DCIS followed by chemoradiation therapy. History of right breast reduction and left breast reconstruction in 3/2014. Family history of breast cancer in maternal aunt. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Postsurgical changes consistent with recent breast reduction surgery are identified. There is no new mass, suspicious microcalcifications or areas of nonsurgical architectural distortion identified in the right breast. | Expected postsurgical changes from recent breast reduction surgery. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Clinical question: Status post MUD stem cell transplant. Acute mental status changes. Signs and symptoms: As above. Nonenhanced head CT:No evidence of acute intracranial process, CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT |
Generate impression based on findings. | Male 72 years old; Reason: Patient enrolled in clinical trial History: Compare to prior scans CHEST:LUNGS AND PLEURA: Mild to moderate emphysematous changes. No suspicious pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Left chest wall port terminates at the cavo-atrial junction.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Slight atrophy of the right hepatic lobe, unchanged. No focal hepatic lesions. Hepatic and portal veins are patent. There are gallstones within a nondistended gallbladder. The biliary tree is normal in caliber.SPLEEN: Spleen is top normal in size. A small amount of fluid or soft tissue adjacent to the splenic surface on the lateral aspect, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph node measures 0.9 x 0.7 cm (image 125/series 4) previously, 1.0 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right inguinal lymph node measures 1.5 x 0.9 cm (image 195/series 4) previously, 1.4 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes affects the lower lumbar spine.OTHER: No significant abnormality noted | 1.Stable exam without size change in the reference lesions. |
Generate impression based on findings. | Female 78 years old Reason: back pain, rule out compression fx History: as above. We see no compression fracture. The bones appear slightly demineralized. Severe degenerative disk disease affects L4/L5. There is a grade 1 anterolisthesis of L4. There is mild calcification of the intervertebral disks at L2/3 and L3/4 with slight posterior disk bulging. Moderate facet joint osteoarthritis affects the lower lumbar spine. There are atherosclerotic calcifications of the abdominal aorta and its branches. Globular calcification within the pelvis likely represents a uterine fibroid. There is an IVC filter anterior to L3/L4. There are surgical clips in the right hemi-abdomen. There is an additional metallic density overlying the pelvis, which likely represents a bullet fragment and is unchanged from prior exam. | Degenerative disk disease and facet joint osteoarthritis, as described above, appearing similar to prior study. |
Generate impression based on findings. | Status post hernia repair ABDOMEN:LUNG BASES: Cardiomegaly; extensive coronary calcification.LIVER, BILIARY TRACT: Status post cholecystectomy.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: Interval resolution of previously noted small bowel loop obstruction.BONES, SOFT TISSUES: Interval repair of large ventral hernia. While there is no evidence for obvious fascial defect, there is a 9.8 x 5.4 cm bland appearing loculated fluid collection associated with the ventral wall repair as seen on image 96 of series 3.Small superior ventral hernia without bowel involvement unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus is absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status-post repair of large ventral hernia. Large bland appearing loculated fluid collection associated with hernia repair; favor benign postoperative collection such as seroma or resolving hematoma. No evidence for fascial defect. Small more superiorly located fat-containing ventral hernia unchanged.Interval resolution of small bowel obstruction. |
Generate impression based on findings. | Rheumatoid arthritis. New synovitis. RIGHT HAND: Again seen are findings compatible with rheumatoid arthritis, including narrowing of the 3rd PIP joint, 1st MCP joint, 2nd MCP joint, and 3rd MCP joint with small associated lucencies which may reflect erosions. These findings are minimally progressed compared to prior. Mild osteoarthritis affects the basilar joint.LEFT HAND: Again seen are findings compatible with rheumatoid arthritis, including narrowing of the 2nd MCP joint and 3rd MCP joint. These findings are minimally progressed compared to prior. A chronic erosion is identified in the hamate. Mild osteoarthritis affects the basilar joint.RIGHT FOOT: There is a mild hallux valgus deformity. No definite erosions are evident. LEFT FOOT: The pes planus valgus deformity with osteoarthritic changes of the midfoot are similar to prior. No definite erosions are evident. | Findings compatible with rheumatoid arthritis in the hands with minimal disease progression since 2013. |
Generate impression based on findings. | Male 8 years old Reason: healed distal radius fx? History: none The previously seen distal radius fracture is less distinct on the current study when compared to the prior study, indicating some interval healing. There is also focal sclerosis within the distal ulnar diaphysis indicating a healing fracture. | Healing/healed distal radius and ulnar fractures. |
Generate impression based on findings. | Previous trauma. Continued pain. Decreased range of motion Three views of the right shoulder reveal no evidence of fractures or dislocations. There is small calcific density adjacent to the humeral head that represents calcific tendinopathy of the rotator cuff | Small focus of calcific tendinopathy. Otherwise negative |
Generate impression based on findings. | Female 64 years old Reason: diffuse pain, hx hand/wrist swelling, as well as foot swelling 2/2 gout, evaluate for gouty as well as other inflammatory arthritis changes History: diffuse pain, hx hand/wrist swelling, as well as foot swelling 2/2 gout, evaluate for gouty as well as other inflammatory arthritis changes. Right hand: There is mild osteoarthritis of the interphalangeal joints and moderate osteoarthritis of the basilar joint. We see no specific radiographic features of gout or inflammatory arthritis.Left hand: There is mild to moderate osteoarthritis of the interphalangeal joints and moderate to severe osteoarthritis of the basilar joint. We see no specific radiographic features of gout or inflammatory arthritis.Right foot: Mild hallux valgus deformity. There is mild narrowing of the first metatarsophalangeal joint which may be degenerative in etiology. There is mild soft tissue swelling along the first metatarsal head with a corticated defect in the underlying first metatarsal head, which may represent an old gouty erosion. There is a mild pes planovalgus deformity. There is a type II accessory navicular. Left foot: Mild hallux valgus deformity. There is mild narrowing of the first metatarsophalangeal joint that may be degenerative in etiology. There is mild soft tissue swelling over the first metatarsal head with a lucency in the underlying first metatarsal head that may represent a chronic gouty erosion, but this is equivocal. Note is made of a type II accessory navicular. We see no specific radiographic features of inflammatory arthritis. | Arthritic changes of the hands and feet appear predominantly degenerative in etiology, although there appear to be chronic erosions of the first metatarsal heads bilaterally that may represent long-standing gout. |
Generate impression based on findings. | Transformed Follicular lymphoma s/p 3 cycles RCHOP.RADIOPHARMACEUTICAL: 8.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 111 mg/dL. Today's CT portion grossly demonstrates surgical clips in the right axilla. A Port-A-Cath is noted in the right chest terminating in the right SVC/RA junction. Atherosclerotic calcifications are noted of the aorta. Cholecystectomy clips are seen in the right upper quadrant. Multiple retroperitoneal soft tissue lesions/lymph nodes have decreased in size compared to the previous exam. Multiple borderline enlarged mesenteric lymph nodes are noted.Today's PET examination demonstrates complete resolution of the previously described hypermetabolic left supraclavicular, mediastinal, left paratracheal, right axillary, splenic, mesenteric and retroperitoneal lesions. However, there are two small to medium sized markedly hypermetabolic mesenteric lymph nodes which are new/progressed from previous exam with an SUVmax of 8.1. No additional suspicious FDG avid lesions are visualized. There is extensive benign muscle activity involving the strap, intercostal and paraspinal muscles. Linear activity involving the superior endplates of T11 and T12 vertebral bodies is consistent with benign activity. | 1.Several markedly hypermetabolic mesenteric lymph nodes consistent with active tumor, progressed from previous.2.Otherwise complete interval resolution of tumor seen elsewhere in the abdomen and chest. |
Generate impression based on findings. | Female 58 years old; Reason: Pt is a 57 y/o female with met rcc, evaluate for progression s/p anti PD-1 therapy History: met RCC CHEST:LUNGS AND PLEURA: Right right nodule measures 6 mm (image 37/series 4) is unchanged.Right middle right nodule measures 6 x 6 mm on image 63/series 4 previously, 7 x 5 mm. Multiple subtle nodularities are noted in both lungs predominantly in the upper lobes. For example, a nodule in the right upper lobe (image 27/series 7)appears to have a branching airway passing through it and has increased in size.There is mild subpleural emphysematous changes, mild scattered bronchiectatic changes and subpleural reticulations.MEDIASTINUM AND HILA: Heart size is normal. Moderate coronary calcifications. No pericardial effusion2CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe lesion measures 11 x 11 mm (image 97/series 3) unchanged since study of 8/1/2014SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No retroperitoneal lymphadenopathy. Small calcification lower pole of the right kidney may represent vascular calcification or small non obstructing calculus.RETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease affects the aorta.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: No significant abnormality noted. | 1.Stable reference measurements with no new sites of disease.2.Progression of the lung findings with multiple small nodules in the upper lobes with mild subpleural emphysema and bronchiectasis. Imaging findings are most suggestive of respiratory bronchiolitis interstitial lung disease (RB- ILD) related to smoking. |
Generate impression based on findings. | Evaluate for right femoral acetabular impingement syndrome Three views of the right hip reveal a bony prominence at the femoral head and neck junction consistent with femoral acetabular impingement. | Findings consistent with FAI |
Generate impression based on findings. | Male 21 years old Reason: possible trauma to right distal medial foot and great toe: evaluate for fracture History: exquisite pain at medial distal right foot and great toe for 2-3 daysVIEWS: Right foot AP, lateral and oblique 2/10/15 at 1550 hrs. (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Right foot pain/numbness. History lumbar laminectomy. Evaluate abnormality, stability of the spine. The patient is status post lower lumbar laminectomy. The bones appear demineralized suggesting osteopenia/osteoporosis. Moderate degenerative disk disease affects L5/S1. The remaining intervertebral disk spaces are preserved. There is a grade 1 anterolisthesis of L4 relative to L5 that appears grossly stable between the flexion, neutral, and extension views. Vertebral body heights are preserved. | Postoperative changes, degenerative disk disease, and grade 1 L4 anterolisthesis that appears stable between the flexion, neutral and extension views. |
Generate impression based on findings. | Total knee arthroplasty Two portable views of the left knee reveal a total knee arthroplasty in anatomic alignment.. No evidence of fracture-dislocation. Note is made of skin staples | New total knee arthroplasty in anatomic alignment |
Generate impression based on findings. | "Found a new friend". Obvious ganglion cyst. There is lobulated soft tissue opacity along the radial aspect of the wrist and basilar joint that is nonspecific but could represent a ganglion. It is between 2.5 and 3 cm in longitudinal dimension and approximately 1 cm in transverse dimension. I see no destruction of the underlying bone. There is moderate basilar joint osteoarthritis. There is volar rotary subluxation of the scaphoid which may indicate scapholunate ligamentous laxity or disruption. Mild degenerative arthritic changes at the first second and third metacarpophalangeal joints may reflect CPPD arthropathy; although we see no definite chondrocalcinosis at these joints, there is suggestion of faint chondrocalcinosis of the triangular fibrocartilage. | Soft tissue mass along the radial aspect of the wrist is nonspecific but could represent a ganglion. Arthritic changes as described above may represent a combination of osteoarthritis and CPPD arthropathy. |
Generate impression based on findings. | Patient with HCC here for therasphere mapping in conjunction with a nuclear medicine MAA. There is mild to moderate shunting to the lungs (lung fraction = 10%). There is radiotracer activity within the right lobe of the liver compatible with the patient's known hepatocellular carcinoma. Mild bilateral renal and diffuse stomach activity is consistent with mild free pertechnetate. Otherwise, there is no abnormal extrahepatic intraabdominal activity. | 1. Mild to moderate lung shunting. 2. Radiotracer accumulation in the right hepatic lobe compatible with the patient's known hepatocellular carcinoma. |
Generate impression based on findings. | Right leg pain. Left shoulder pain. Two views of the right femur are provided. Moderate to severe osteoarthritis affects the right hip joint. Mild osteoarthritis affects the knee with chondrocalcinosis of the menisci. Chronic enthesopathic changes are noted along the patella. Streaky foci of mineralization within the posteromedial aspect of the proximal thigh may reflect heterotopic ossification from old trauma. There is calcification of the femoral artery. Four views of the left shoulder are provided. The bones appear slightly demineralized. Moderate osteoarthritis affects the glenohumeral joint. Mild osteoarthritis affects the acromioclavicular joint. Mineralization projecting just above the greater tuberosity likely reflects calcification of the rotator cuff. Glenohumeral joint alignment is within normal limits. | Osteoarthritis of the right hip and left shoulder with other findings as described above. |
Generate impression based on findings. | Abdominal distention, evaluate for obstruction. ABDOMEN:LUNG BASES: Small amount of fluid or pleural thickening along the right major fissure.LIVER, BILIARY TRACT: Subcentimeter low attenuation lesion in segment 6 of the liver (series 3, image 38) too small to characterize. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mildly prominent extrarenal pelvises without hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube with retention device in place without evidence of complication. Normal caliber bowel without evidence of obstruction. The appendix is not definitely visualized but no right lower quadrant inflammation to suggest appendicitis. No free intraperitoneal air or fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is mildly distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Gastrostomy tube with retention device in place without evidence of complication. Normal caliber bowel without evidence of obstruction. The appendix is not definitely visualized but no right lower quadrant inflammation to suggest appendicitis. No free intraperitoneal air or fluid.BONES, SOFT TISSUES: Degenerative changes affect the visualized thoracolumbar spine most prominent at L5-S1.OTHER: No significant abnormality noted | 1.No evidence of bowel obstruction or other specific findings to account for the patient's pain.2.Partially visualized non-specific small amount of pleural fluid or pleural thickening along the right major fissure. 3.Subcentimeter low attenuation liver lesion too small to characterize. |
Generate impression based on findings. | History of c-section and large abdominal hernia now with intractable nausea/vomiting, evaluate for SBO, incarcerated hernia. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated left basilar atelectasis/consolidation.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Sharply marginated low attenuation lesion within the superior aspect of the spleen with volume loss, favor chronic benign process. PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys without hydronephrosis or obstructing stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large wide-mouth left sided ventral hernia containing loops of both small and large bowel. The small bowel proximal to and within the hernia sac is dilated up to 4 cm with an apparent transition point (coronal series, image 83) with collapse of the small bowel and colon distal to the transition point. No intraperitoneal free air or portal venous gas. A small amount of interloop fluid is present in the hernia sac and ischemia cannot be excluded.BONES, SOFT TISSUES: Large left anterior abdominal wall hernia as described above. Mild anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a large wide-mouth left sided ventral hernia containing loops of both small and large bowel. The small bowel proximal to and within the hernia sac is dilated up to 4 cm with an apparent transition point (coronal series, image 83) with collapse of the small bowel and colon distal to the transition point. No intraperitoneal free air or portal venous gas. A small amount of interloop fluid is present in the hernia sac and ischemia cannot be excluded.BONES, SOFT TISSUES: Large left anterior abdominal wall hernia as described above. Mild anasarca. Mild degenerative changes affect the visualized thoracolumbar spine.OTHER: No significant abnormality noted | 1.Large left anterior abdominal wall hernia containing small and large bowel.2.High-grade small bowel obstruction with transition point in the hernia sac likely due to adhesion. Ischemia cannot be excluded.3.Bilateral small pleural effusions and left basilar atelectasis/consolidation.Findings communicated to Dr. West at 4:45 p.m. on 2/10/2015. |
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