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Generate impression based on findings. | Metastatic uterine sarcoma with concern for bony mets in L3 and S1 based on CT and radiograph imaging. The known lesions on CT at L3 and S1 do not have significant osteoblastic activity on this examination. No other lesions are identified. Prominence of the right renal collecting system and right ureter may represent some degree of obstruction or reflux. | 1. No suspicious osteoblastic lesion. Specifically, no abnormal radiotracer uptake is seen relating to the known lesions at L3 and S1 on CT. FDG-PET may be useful to further evaluate for possible bone or soft tissue metastases. 2. Prominent right renal collecting system may represent some degree of obstruction. |
Generate impression based on findings. | 59 years, Male. Reason: Dobbhoff History: Dobbhoff Air distended stomach and small bowel. Dobbhoff tube tip projects over the gastric pyloric area. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the gastric pyloric area. Air distended loops of small bowel may represent ileus or air from procedure. |
Generate impression based on findings. | Male 50 years old; Reason: eval type B dissection s/p thoracic endograft and carotid to subclavian bypass History: eval s/p TEVAR and carotid subclavian bypass CHEST:LUNGS AND PLEURA: No dominant lung lesion pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Ascending aorta measures 3.1 cm at the level of the main pulmonary pulmonary artery.Status post stent graft placement with the proximal limb starting about the level of the left brachycephalic artery. The proximal limb at its superior aspect partially encroaches upon the orifice of the left brachiocephalic artery.The left carotid to subclavian graft is patent.There is contrast within the false lumen of the thoracic aorta. There are a few intercostal vessels that originates from the false lumen and may constitute to the filling. More importantly, the majority of the contrast comes from the retrograde flow from the abdominal aorta due to fenestration between the true and false lumen at the level of the renal artery as seen on image 142/series 9.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. The hepatic and portal veins are patent. The biliary tree is without diagnostic abnormality.SPLEEN: Subcentimeter hyperdense focus in the tip of the spleen is nonspecific.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic dissection extends to the level of the left common iliac artery.The celiac, superior mesenteric and right renal artery originates from the true lumen while the left renal artery and IMA arise from the false lumen.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: Postsurgical changes in the right inguinal region related to stent placement. No pseudoaneurysm is identified.OTHER: No significant abnormality noted | 1.Filling of the false lumen of the thoracic aorta from a combination of flow from the intercostal vessels and retrograde flow from the abdominal aorta where there is flow in both lumens. 2.Patent left carotid to subclavian graft. |
Generate impression based on findings. | 13-year-old male with history of Blount's disease. Preop. VIEWS: Right knee standing lateral (one view) 2/10/2015 16:10:13 Two staples are noted in the proximal tibia. The tibial physis is still open. No evidence of fracture or effusion. | Proximal tibial stapling related to history of Blount's disease. |
Generate impression based on findings. | 75 year old man with moderate to severe AS, CAD s/p cabg and recent syncope who presents for CT as evaluation prior to possible TAVRCPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. There is moderate calcification of the left and right subclavian arteries and mild calcification of the left carotid artery. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is mild calcification of the aortic root and aortic arch. There is mild to moderate calcification of the descending aorta. No aortic coarctation is noted. Aortic Annulus: Dimension: 21 mm x 28 mm Perimeter: 8.2 cm Area: 5.3 cm2Sinus of Valsalva: Width: 37 mm x 35 mm x 36 mm Height: 24 mmSinotubular Junction: 29 mm x 28 mmAscending Aorta (4cm from annulus): 41 x 41 mmMid Aortic Arch: 30 mm x 29 mmDescending Aorta: 29 mm x 29mmAnnulus to LM Height: 22mmAnnulus to RCA Height: 22mmAortic Leaflet Length: 16mmFluoroscopic Angle: LAO 13 CAU 3Aortic Valve: The aortic valve is trileaflet. There is moderate aortic valve calcification, which involves all three cusps. Mitral Valve: There is severe calcification of the posterior mitral annulus extending onto the posterior leaflet. Minimal calcification of the anterior leaflet.Left Ventricle: There is moderate left ventricular hypertrophy. The left ventricular end-systolic volume is normal. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is mildly sigmoid. Right Ventricle: Visually the right ventricular end-systolic volume is within normal limits.Left Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is severe calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is severe calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal, posterolateral, and posterior descending branches. There is severe calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. There is moderate calcification of the RCA. Coronary Bypass Grafts:Lima to LAD SVG to Ramus, OM1, PDA. The graft originates 4.5cm from the aortic valve plane. | 1. Thoracic aortic anatomy as described above. 2. Moderate to severe aortic valve calcification. 3. Moderate left ventricular hypertrophy. 4. Severe coronary calcification with evidence of bypass grafts as described above. 5. Severe mitral annular calcification.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdomen/ pelvis CTA will be reported separately. |
Generate impression based on findings. | Mesothelioma ABDOMEN:LUNG BASES: Please see separate chest CT report for description of extensive left pleural parenchymal, and chest wall abnormalities.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No change in tumor adjacent arising from the left hemidiaphragm encroaching upon the splenic surface.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable renal cysts.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: Stable right anterior musculature lipomaOTHER: No significant abnormality noted | Stable examination without metastatic disease within the abdomen or pelvis. |
Generate impression based on findings. | Reason: smoking history, undergoing heart transplant work up History: smoking history, undergoing heart transplant work up LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No focal areas of consolidation or air space opacities.No pleural effusions.MEDIASTINUM AND HILA: Left-sided ICD with lead wire in the right ventricle.Cardiac enlargement without evidence of a pericardial effusion.Status post CABG.Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | Cardiomegaly without evidence of pulmonary edema or pleural effusions. No suspicious pulmonary nodules or masses. |
Generate impression based on findings. | Reason: Pleural mesothelioma. Please compare to prior exam per RECIST criteria. History: Pleural mesothelioma LUNGS AND PLEURA: Again seen is circumferential left hemithorax pleural thickening and nodularity, compatible with known mesothelioma. Reference measurements are as follows:At the level of the aortic arch (series 4, image 31): The lesion at the three o'clock position measures 21 mm, previously 14 mm. Lesion at the eight o'clock position measures 11 mm, previously 11 mm. The lesion at the nine o'clock lesion measures 30 mm, previously 26 mm.At the level of main pulmonary artery (series 4, image 53): The lesion at the twelve o'clock position measures 33 mm, previously 17 mm. The lesion at eight o'clock position measures 31 mm, previously 25 mm. Fissural measurement of 42 mm, previously 28 mm.At the level of the cardiac apex (series 4, image 83): The lesion at the one o'clock position measures 22 mm, previously 22 mm. The lesion at the two o'clock position measures 36 mm, previously 27 mm. The lesion at the four o' clock position measures 9 mm, previously 15 mm.Anterior chest wall/pleural nodule (series 4, image 57) measures 19 mm, previously 22 mm.Numerous pulmonary metastases bilaterally and are slightly increased in size and increased in number compared to the prior exam. The reference right lower lobe nodule (series 5, image 133) measures 6 mm, unchanged. The reference right upper lobe nodule (series 5, image 130) measures 5 mm, unchanged.Small right pleural fluid collection appears similar to the prior exam. Loculated left pleural fluid collection appears similar to the prior exam. Interval removal of left Pleurx catheter.MEDIASTINUM AND HILA: Rightward mediastinal shift. Pleural tumor involves the anterior and posterior mediastinum, with periaortic fat infiltration at the level of the aortic arch and descending thoracic aorta. Stable pericardial thickening and nodularity. Moderate pericardial effusion has increased from the prior exam. Mediastinal and hilar lymph nodes are not significantly changed from the prior exam.CHEST WALL: Extensive left chest wall tumor extension appears similar to the prior exam. Left internal mammary chain lymphadenopathy appears unchanged. Low left cervical lymph nodes appear larger.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Thickening of the left diaphragmatic crus is similar to the prior exam. See same day CT abdomen report for additional details. | 1. Slight rightward mediastinal shift due to bulky pleural tumor on the left, reference measurements provided in the body of the report.2. Slightly increased size and increased number of numerous right intrapulmonary metastases, though the reference lesions are unchanged.3. Increased pericardial fluid volume with nodular pericardial thickening and mass effect on the pericardium by adjacent pleural tumor.4. Decreased volume of loculated pleural fluid on the left. |
Generate impression based on findings. | Bladder carcinoma CHEST:LUNGS AND PLEURA: Biapical scarring.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN: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: Mildly prominent retroperitoneal lymph nodes. A representative left para-aortic lymph node best seen on image 111 of series 4 measures 1.1 x 0.9 cm.BOWEL, MESENTERY: Mildly prominent mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Unremarkable neobladder.LYMPH NODES: Mildly prominent pelvic mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Midline wound dehiscence.OTHER: 4.1 x 2.7 cm complex loculated fluid collection arising from the left pelvic wall best seen on image 176 of series 4. | Status post cystoprostatectomy with unremarkable neobladder. No obvious metastatic focus. Mildly prominent retroperitoneal and mesenteric lymph nodes without measurable adenopathy.Complex loculated fluid collection arising from the left pelvic wall; favor benign postoperative collection over metastatic focus. However, would pay special attention to this lesion on future surveillance scans. |
Generate impression based on findings. | Male 69 years old Reason: unresectable pancreatic cancer, treated with SBRT in jan 2015. evaluate for response and establish new baseline History: none CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusion.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes likely secondary to prior granulomatous disease.Heart size is normal without pericardial effusion.Mild coronary artery concentrations.Nonspecific scattered calcified and noncalcified micronodules, unchanged.CHEST WALL: Left chest wall port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic hypodensity is too small to characterize and unchanged since prior exam.No definite evidence of liver metastasis.Biliary stent in appropriate position within the common bile duct.Small amount of intrahepatic pneumobilia is unchanged, likely post procedural.SPLEEN: Splenic granulomata.PANCREAS: Ill-defined fullness in the pancreatic head measuring 21.6 x 17.9 cm (series 11, image 111) consistent with patient's known pancreatic adenocarcinoma. The lesion was not definitively measurable previously but appears grossly unchanged in size.There is persistent encasement of the hepatic artery.Atrophy of the pancreatic tail again seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities are too small to characterize but unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval midline surgical incision with fat stranding along the anterior peritoneum adjacent to the suture line, presumably postsurgical.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with prominent median lobe.BLADDER: Left-sided Hutch diverticulum again seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Pancreatic adenocarcinoma with encasement of the hepatic artery and measurements as above. The lesion was not definitively measurable previously but appears grossly unchanged in size. |
Generate impression based on findings. | 21-day-old male with abdominal distention. Previous x-ray with equivocal pneumatosis. Evaluate for pneumatosis or pneumoperitoneum.VIEWS: Abdomen AP, lateral decubitus (two views) 2/10/2015 16:36:38 Feeding tube tip in gastric body.Persistent mildly dilated bowel loops with interval change in position of the foamy bowel content, now located in the right lower quadrant and left midabdomen. No evidence of obstruction, free air or portal venous gas. | Interval change in position of the foamy bowel content. Findings are more consistent with fecal matter although pneumatosis intestinalis cannot be entirely excluded. No free air. |
Generate impression based on findings. | 13-year-old male with history of right Blount's disease.VIEWS: Tibia/fibula lateral (1 view) 2/10/2015 16:43:08 Two staples are present related to prior right lateral tibial hemiepiphysiodesis. The tibial physis is still open. No evidence of fracture. | Right proximal tibial stapling related to history of Blount's disease. |
Generate impression based on findings. | History of plasmacytoma, paraproteinemia, gait unsteadiness, fatigue.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 83 mg/dL. Today's CT portion grossly demonstrates a small consolidative focus in the right lung base which is stable and non-FDG avid and may represent round atelectasis. A hypodense right renal lesion likely represents a cyst. There are scattered lucent foci including a destructive lesion in the right iliac wing and a lucent focus in the C6 vertebral body. Today's PET examination demonstrates complete resolution of the previously markedly hypermetabolic large right iliac wing lesion. Several smaller mildly active bilateral rib lesions are noted. For example, a left posterior 7th rib lesion measures max SUV of 3.2 and a right posterior 9th rib measures max SUV of 3.0; this is not clearly seen on the prior examination given differences in technique. | Complete resolution of hypermetabolic activity of the right iliac wing lesion without definite FDG active tumor currently. Several small mildly active rib lesions may be benign though tumor cannot be entirely excluded; attention to these areas should be made on follow up imaging. |
Generate impression based on findings. | Shortness of breath. Evaluate for a PE. The comparison chest radiograph performed on 2/9/2015 demonstrates cardiomegaly and a right sided pacemaker device. No focal pulmonary opacities or pleural fluid are visualized. On the ventilation portion of the exam, there are regions of delayed washout bilaterally in the upper and lower lobes.The perfusion portion of the exam shows multiple small and medium sized defects bilaterally. many of these are matched, there is one large in the left lower lobe and one medium in the left upper lobe that are not matched. Therefore this is intermediate probability. | Intermediate probability ventilation-perfusion scan. |
Generate impression based on findings. | Male 61 years old Reason: 61 yo male with new diagnosis of cholangiocarcinoma; pt has pancreatitis following stent placement; please evaluate extent of disease, pancreatitis resolve and abnormalities History: cholangiocarcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense lesions throughout the liver consistent with metastatic disease. An index lesion in the right lobe measures 1.1-cm in diameter image number 112, series number 4.Plastic biliary stent is present. Mild pneumobilia due to stent.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct is diffusely dilated up to the level of the pancreatic head. There is a 1.7 x 1.3 cm mass in the region of the pancreatic head, best seen on image number 122, series number 4. This is suspicious for patient's known malignancy. Small amount of fat stranding is seen around the pancreas head which may represent changes secondary to pancreatitis versus tumor extension. Small amount of fluid is also present around the IVC.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Multiple hepatic lesions suspicious for metastatic disease. Ill-defined lesion in the pancreatic head at the region of the transition of the pancreatic duct suspicious for malignancy. Peripancreatic fluid density, likely representing changes secondary to resolving pancreatitis. |
Generate impression based on findings. | 11 year old female with tender right proximal humerus. Evaluate for proximal humerus fracture.VIEWS: Right shoulder internal and external rotation (two views) 2/10/2015 Humeral head is normally positioned with respect to the glenoid fossa. Internal and external rotation were done well. No fracture is present. | Normal examination. |
Generate impression based on findings. | Ankle pain. Stress view right ankle. The previously seen distal fibular fracture is barely evident on this study. Ankle joint alignment is within normal limits. | Distal fibular fracture in anatomic alignment. Ankle joint in anatomic alignment. |
Generate impression based on findings. | Neck pain Evaluation of C7 and the cervicothoracic junction on the lateral views is limited by overlying anatomy. There is an anterior plate with screws entering the C6 and C7 vertebrae. I see no hardware complications. The C6 and C7 vertebral bodies appear fused. I see no instability between the flexion, neutral, and extension views. There is ossification along the anterior aspect of C5-6 projecting from the C5 vertebral body that appears similar to that seen on the prior CT scan. There is moderate multilevel facet joint osteoarthritis. | Facet joint osteoarthritis and surgical fusion of C6 and C7 as described above. |
Generate impression based on findings. | History of neuroblastoma female with radiation. Left kidney will have radiation and be removed leaving the patient with only the right. Assess split function to assure right renal function is appropriate. The posterior abdominal radionuclide angiogram demonstrates decreased perfusion to the left kidney.Sequential renal images show the right kidney to be of normal size and morphology. The left kidney appears significantly diminished in size. There is prompt uptake and excretion of the radiopharmaceutical by the right kidney as well as of the diminutive left kidney. The estimated contribution of the right kidney to total renal function is 76% and that of the left kidney is 24%. There are no abnormalities of the ureters or bladder visualized. No evidence of current urinary obstruction in either kidney. | Significantly diminished left renal parenchymal function. |
Generate impression based on findings. | Knee pain after basketball injury. Four views of the right knee are provided. There is slight depression of the articular surface of the lateral femoral condyle. Although this may reflect normal anatomy for this patient, this could represent an impaction fracture sustained in association with anterior cruciate ligament tear. The lateral tibial plateau appears slightly sclerotic which could conceivably represent an additional impaction fracture, although I see no discrete fracture line or depression of the articular surface. There does appear to be a small joint effusion.The left knee appears normal as seen on the frontal views. | Findings as described above could represent impaction fractures sustained in association with anterior cruciate ligament tearing. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Chronic back pain, kyphotic. Evaluate spine alignment, sagittal balance, abnormality. Moderate degenerative disk disease affects the lower lumbar spine with mild degenerative disease affecting the thoracic spine. There appear to be 6 non-rib bearing lumbar type vertebrae. There is approximately 30 degrees of kyphosis as measured from the superior endplate of T4 to the inferior endplate of T12. There appears to be slight anterior wedging of T12. Visualization of the C7 vertebral body on the lateral view limits assessment of sagittal balance, however there is a positive sagittal balance that I estimate to be approximately 8 cm. There is loss of the normal cervical lordosis. There is a slight leftward curvature of the thoracolumbar spine, but no frank scoliosis. There is a negative coronal balance of approximately 4 cm. | Positive sagittal balance and other findings as described above. |
Generate impression based on findings. | Feeding tube placement.VIEW: Abdomen AP (one view) 02/10/15, 1648 Giant omphalocele is again seen. Feeding tube tip is in the stomach which is contained within the omphalocele. Left lower extremity PICC tip is in right atrium.Bowel gas pattern remains abnormal. Multiple dilated loops are present. Gas is seen in the rectosigmoid.Focal opacity is present in the left lower lobe. | Continued dilated bowel loops. |
Generate impression based on findings. | Metastatic breast cancer. Baseline prior to starting new treatment regimen. Known metastases to bone. Exam is somewhat limited by patient body habitus as well as her inability to completely position arms due to pain. A focus of increased activity is seen in the right mid humerus compatible with presumed metastasis and orthopedic rods. A mild focus of increased activity is present at the right seventh costovertebral junction corresponding with benign degenerative osteophyte. Otherwise no suspicious osseous lesion is identified to indicate currently osteoblastic lesion. There is a suggestion of permeative lytic lesions involving bilateral ribs and possibly the spine on comparison CT. Lack of uptake on bone scan may reflect lytic nature to these lesions or these are healed metastases. | 1.Osteoblastic lesion in the right mid humerus consistent with metastasis and orthopedic surgery.2.No active osteoblastic metastases elsewhere. Suggestion of multiple lucent lesions in the ribs and spine on the comparison CT are not avid on bone scan. This may indicate lytic and/or healed bone metastases. FDG PET may be useful to further evaluate for soft tissue and osseous metastatic activity. |
Generate impression based on findings. | Pain at base of fifth metatarsal. Evaluate for fracture. I see no fracture or malalignment. A tiny ossicle seen on the oblique view in the soft tissues lateral to the calcaneocuboid joint likely represents a normal variant os peroneum. Small lucencies within the fifth metatarsal head may represent cysts, or less likely chronic erosions as the fifth metatarsophalangeal joint otherwise appears normal. | I see no fracture or other specific findings to account for the patient's pain. |
Generate impression based on findings. | Left knee pain status post fall Three views of the left knee are provided. I see no fracture or joint effusion. Moderate osteoarthritis affects the knee. Ossification within the distal quadriceps tendon just above the patella is likely chronic in etiology and of doubtful current clinical significance. Arterial calcifications are noted within the posterior soft tissues.Moderate osteoarthritis also affects the right knee as seen in the frontal view. | Osteoarthritis and other findings as described above, without fracture evident. |
Generate impression based on findings. | Back pain. Assess for "spondy". There is a levoscoliosis of the thoracolumbar spine of approximately 25 degrees as measured from the superior endplate of T12 to the inferior endplate of L4. The lumbar spine appears slightly hyperlordotic, but I see no findings I see no frank spondylolisthesis or spondylolysis. I see no instability between the flexion, neutral, and extension views. Subjectively, the L3/4 and L5/S1 intervertebral disk spaces appear slightly narrowed, but this may be an artifact of the patient's scoliosis. Vertebral body heights are normal | Scoliosis and other findings as described above. I see no spondylolysis or spondylolisthesis. |
Generate impression based on findings. | Status post right total knee arthroplasty Components of a right total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery. Presumed posttraumatic deformity of the proximal tibia and fibula appears similar to that seen on the prior study. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | Left knee pain and instability. Assess degree of osteoarthritis. Four views of the left knee are provided. There is moderate osteoarthritis with narrowing of the medial tibiofemoral compartment, subchondral sclerosis of the medial tibial plateau, and tricompartmental osteophytes.Moderate osteoarthritis also affects the right knee, to a slightly lesser degree. | Moderate osteoarthritis. |
Generate impression based on findings. | Fell and injured right lower lateral ribs. Pain over patella status post fall. Rule out fracture. Three views of the ribs are provided. A marker was placed along the lateral aspect of the right lower rib cage. I see no fracture. I see no specific findings to account for the patient's rib pain. Multilevel degenerative disk disease affects the spine, and facet joint osteoarthritis affects the lower lumbar spine.Four views of the left knee are provided. I see no fracture or malalignment. Moderate osteoarthritis affects the knee. | Left knee osteoarthritis and degenerative arthritis of the spine, without fracture evident. |
Generate impression based on findings. | Hip bipolar with Zimmer (right hip); intraoperative x-ray during surgery to measure bone alignment for hardware. Evaluation of the pelvis is limited by overlying artifact. The superior aspect of the pelvis is not included on the field-of-view of this study. Trial components of a right hip hemiarthroplasty device are situated in near-anatomic alignment. Overlying gas density reflects a surgical wound. | Trial components of a right hip hemiarthroplasty situated in near-anatomic alignment. |
Generate impression based on findings. | Knee pain. Rule-out DJD. Four views of the right knee are provided. Moderate osteoarthritis affects the knee, appearing similar to that seen on the prior study.Four views of the left knee are provided. There is severe osteoarthritis of the medial tibiofemoral compartment with near bone-on-bone apposition that appears to have progressed slightly compared with the prior study. There are also tricompartmental osteophytes and a large joint effusion. | Osteoarthritis as above. |
Generate impression based on findings. | 43-year-old male with right big toe pain status post glass table falling on it. Swelling and pain. MVA and lumbosacral pain for the past month. Please evaluate for fracture. Three views of the right first toe are provided. I see no fracture or dislocation. There is perhaps mild soft tissue swelling.Five views of the lumbar spine are provided. I see no fracture or malalignment. Central end plate concavities appear similar to those seen on prior studies. | No fracture evident. |
Generate impression based on findings. | Sarcoid lung disease, pulmonary embolism and S.O.B. PULMONARY ARTERIES: Technically diagnostic quality infusion. No pulmonary emboli are identified. The main pulmonary artery is within normal limits in caliber.LUNGS AND PLEURA: Moderate paraseptal and centrilobular emphysema.Diffuse traction bronchiectasis and upper lobe volume loss from scarring in a pattern consistent with sarcoidosis.Subtle diffuse parenchymal groundglass opacity without zonal predilection.Scattered solid stellate nodules in the upper lobes, most compatible with sarcoidosis, though conservative follow-up is suggested as non-benign lesions could have a similar radiographic appearance.MEDIASTINUM AND HILA: Mild cardiomegaly, with enlargement of the right cardiac chambers. No pericardial fluid. No visible coronary artery calcifications on this non-Cardiac-gated study. Mild to moderate mediastinal and hilar lymphadenopathy, with some lymph nodes containing internal calcifications. For reference, a right subcarinal lymph node measures 2.2-cm in short axis (7/140). Moderate hiatal hernia; the posterior gastric wall has a masslike appearance with posterior wall thickness measuring up to 2.8-cm (7/212). This is incompletely assessed given the lack of oral contrast.CHEST WALL: Thoracic kyphosis. Nonspecific mild lymphadenopathy in the lower neck bilaterally, right greater than left. Mild internal mammary chain lymph node enlargement.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small lymph nodes noted in the upper abdomen. Limited scanning range. | 1. No evidence of acute pulmonary embolus. Right-sided cardiac chamber enlargement suggests chronic right heart strain.2. Masslike appearance of the posterior gastric wall; an underlying neoplasm cannot be excluded given lack of under distention and incomplete evaluation on this examination. This may be further assessed with endoscopy or upper GI fluoroscopy utilizing oral contrast if required.3. Diffuse lymphadenopathy and pulmonary fibrosis in a pattern most consistent with sarcoidosis. Diffuse background groundglass opacity most likely reflects a combination of scarring and alveolar disease. Spiculated nodular opacities in the upper lobes bilaterally are consistent with scarring is seen in the sarcoidosis however suggest conservative imaging follow-up in 6-12 months as non--benign entities may have a similar radiographic appearance. One alternatively, if the referring clinical service can obtain and submit remote outside prior examinations to prove stability, an addendum to this report can be provided.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Cough and fever assess for infection. LUNGS AND PLEURA: No pleural fluid or pneumothorax. Multi-focal groundglass subs solid density nodules measuring up to 15 x 18 mm (8/56), most consistent with bronchopneumonia. Mild thickening of the affected airways supplying lesions.Mild interlobular septal thickening in the right upper lobe, with areas of pleural retraction and hypoattenuation of the lung parenchyma in its periphery.MEDIASTINUM AND HILA: Normal heart size. Severe coronary artery calcifications. Calcified mitral annulus. No pericardial fluid or lymphadenopathy.CHEST WALL: Mild thoracic kyphosis and degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. Mild intrahepatic biliary ductal dilatation may be related to prior cholecystectomy. Nonspecific subcentimeter hypoattenuating lesions in the spleen are too small to characterize, statistically most likely benign in the absence of known disease. The visualized portion of the pancreas appears atrophic. | Large multifocal air space nodules most compatible with a bronchopneumonia pattern in an adult patient, follow-up PA and lateral chest radiographs may be obtained in 6 weeks to assess for clearance. Severe coronary artery calcifications. |
Generate impression based on findings. | Clinical question: Head trauma. Signs and symptoms: Fat and head trauma. Nonenhanced head CT:No detectable acute posttraumatic intracranial or calvarial findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces on gray -- white matter differentiation.Minimal soft tissue thickening and hemorrhage in the left super orbital scalp is noted.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate acute process. Signs and symptoms: Unresponsive. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus.Extensive low attenuation of the right hemisphere with areas of internal calcification of the cortex and subcortical white matter in the right frontal lobe is noted. There is ex vacuo that additional right lateral ventricle suggesting chronic state of the above detailed findings. Findings could represent changes of a large chronic ischemic stroke. There are no prior exams for comparison. Correlate with history and if there are outside studies available and provided to the radiology department an addendum to this report will be submitted after review.There is evidence of a chronic right-sided frontal craniotomy. Mild to moderate periventricular and subcortical low attenuation of white matter in the left hemisphere is not a specific however it could represent age indeterminate to small vessel ischemic strokes.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.No detectable acute intracranial hemorrhage or mass effect.2.Extensive low-attenuation of the right hemisphere with internal foci of calcification and ex vacuo dilatation of right lateral ventricle as detailed. Findings could represent a chronic large stroke. There is evidence of right-sided craniotomy.3.Periventricular and subcortical low attenuation of white matter in the left hemisphere is a nonspecific finding however it could represent age indeterminate advanced to small vessel ischemic strokes.4.No prior exams for comparison. If such studies are available and provided to the radiology department an addendum to this report will be submitted after review. |
Generate impression based on findings. | S.O.B. and DOE rule out PE. PULMONARY ARTERIES: Technically diagnostic quality infusion within the main pulmonary artery however at the level of the descending arterial vasculature there appears to be flow artifact. The main pulmonary artery is enlarged measuring 4.5-cm in transverse dimension, consistent with pulmonary arterial hypertension.Although contrast infusion quality is limited in the lower lobes bilaterally, within the posterior branches of the left lower lobe pulmonary artery there are eccentric filling defects consistent with chronic pulmonary emboli. Within the proximal left lower lobe artery, there is also a filling defect suspicious for an acute to subacute embolus seen on series 6 images 204-209. The pulmonary arterial vessels distal to this level are unopacified. On the right, there is a similar pattern of flow artifact in the right descending pulmonary artery, with eccentric and linear filling defects suggestive of chronic pulmonary emboli.LUNGS AND PLEURA: Subpleural reticulation, traction bronchiectasis and honeycombing in a pattern compatible with UIP, slightly progressed compared to the prior examination of 2013.MEDIASTINUM AND HILA: Upper normal heart size with dilatation of the left ventricular apex again noted. Right atrium is dilated. Straightening of the intraventricular septum noted. Severe triple vessel coronary artery calcifications. Calcifications involving the aortic valve and annulus noted. Small sliding-type hiatal hernia. No pericardial fluid. Mild mediastinal and hilar lymph node enlargements not significantly changed and likely related to known chronic lung disease.CHEST WALL: Sternal wires. Interval placement of a right glenohumeral prosthesis. Degenerative changes of the spine with anterior osteophyte formation and endplate degeneration.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Severe atherosclerotic calcifications of the aorta and its branches. Reflux of contrast into the hepatic veins. | Infusion quality in the lower lobes is limited however there is evidence of chronic bilateral lower lobe pulmonary emboli, right heart strain and findings suspicious for acute or subacute small nonocclusive embolus in the left lower lobe. If confirmation of the acuity of embolic disease is required, please annotate the requisition form a with "request for delayed timing", as this is likely the result of sluggish cardiac output. Dr. Pulimi was contacted by the radiology resident on call regarding final interpretation at 7: 30 a.m. on 2/11/2015 and the case was discussed via telephone.PULMONARY EMBOLISM: PE: Positive.Chronicity: Indeterminate.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Positive. |
Generate impression based on findings. | Clinical question: Evaluate for acute process. Signs and symptoms: Diffuse headache for one month. Nonenhanced head CT:There is no detectable acute intracranial process. CT however be insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is a slight prominence of the cerebellar and vermian folia for patient's stated age and unremarkable images through posterior fossa otherwise.Images through the supratentorial space demonstrate normal cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, mastoid air cells/middle ear cavities, and orbits and paranasal sinuses. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Fall and hit head, evaluate for bleed. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are patchy foci of subcortical and periventricular low attenuation of white matter which considering patient's stated age of 87 likely representing age indeterminate small vessel ischemic strokes of mild to moderate degree. There is a slight prominence of cortical sulci and subarachnoid space which may be still within normal for patient stated age of 87.There is no significant change since prior examination from January of 2015.Moderate bilateral cavernous carotid and supraclinoid internal carotid calcification is noted.Mild bilateral vertebral artery calcification is detected.Fluid level within bilateral maxillary sinuses as was noted on prior exam is again noted and the rest of the paranasal sinuses as well as bilateral mastoid air cells and middle ear cavities remain well pneumatized. | 1.No acute intracranial process.2.Mild to moderate age indeterminate small vessel ischemic strokes are noted.3.Air-fluid level in bilateral maxillary sinuses and well pneumatized other sinuses similar to prior exam. |
Generate impression based on findings. | Clinical question: Rule out subarachnoid hemorrhage. Signs and symptoms: Worst headache of life. Unenhanced head CT:There is no detectable acute intracranial process. CT however he is insensitive for early detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, mastoid air cells and middle ear cavities.Paranasal sinuses demonstrate multiple small retention cysts within bilateral maxillary sinuses and unremarkable otherwise. | 1.Unremarkable nonenhanced head CT.2.Small bilateral retention cysts of maxillary sinuses and unremarkable paranasal sinuses otherwise |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:No acute intracranial process. CT however it is insensitive for early detection of acute nonhemorrhagic stroke.Extensive periventricular and subcortical low-attenuation white matter is highly suggestive of age indeterminate small vessel ischemic strokes of moderate to advanced degree. There is resultant ex vacuo dilatation of lateral ventricles as well as the third ventricle.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Advanced age indeterminate small vessel ischemic strokes with resultant ex vacuo dilatation of the supratentorial ventricular system. |
Generate impression based on findings. | known nasopharyngeal ca patients with prior multiple episode of carotid blow out. New profuse oral bleeding since last afternoon. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere are evidence of bilateral common carotid artery stents and bilateral inferior thyroidal artery coils indicating prior embolizations. Both stents were patent without evidence of significant in stent stenosis.However, there is no CT angiographic evidence of contrast extravasations or pseudoaneurysm formation.The patient is status post tracheostomy, laryngectomy, voice prosthesis, partial thyroidectomy and right neck dissection. There is irregularity and soft tissue mass like lesion on the left side of the neopharynx, this lesion could represent acute hematoma. The salivary glands and residual left thyroid lobe are unchanged.There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Right Pcom artery is patent and Acom artery is also patent. The left Pcom artery is not seen.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Patent bilateral CCA stents. No evidence of contrast extravasation or pseudoaneurysm formation.3. Soft tissue mass like lesion on the left side of neopharynx which may represent acute or subacute hematoma |
Generate impression based on findings. | Pain with movement of right arm. Evaluate for pathology. The bones are demineralized suggesting osteopenia/osteoporosis. There is flattening of the superolateral aspect of the humeral head which may represent a Hill-Sachs deformity from prior anterior dislocation. Mild osteoarthritis affects the glenohumeral joint. An ossicle anterior to the acromion likely represents an os acromiale, a normal variant. On the Grashey view, the humeral head is slightly high-riding, with narrowing of the acromiohumeral interval; this may reflect a chronic rotator cuff tear or atrophy. There is a PICC in the right arm with its tip overlying the right axilla. Leads of a cardiac conduction device are incompletely imaged on this study. | Mild glenohumeral joint osteoarthritis, possible rotator cuff tear, and other findings as described above. |
Generate impression based on findings. | Clinical question: Assess for traumatic injury -- patient struck right frontal area last evening. Signs and symptoms: A trauma with loss of consciousness for two to 3 minutes last evening, headache with diplopia today. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic stroke.Paucity of cortical sulci is within normal range for patient's stated age of 27.Unremarkable cerebral cortex, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Minimal right super orbital soft tissue thickening of the scalp is noted. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate mass and enlargement versus other acute process. Signs and symptoms: Headache, vision changes. Enhanced head CT:There is no detectable acute intracranial process. If CT is insensitive for early detection of acute non-hemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation is within normal for patient's stated age of 79.Calvarium and soft tissues of the scalp as well as the orbits, paranasal sinuses and mastoid air cells are unremarkable. | Unremarkable nonenhanced exam for patient stated age. |
Generate impression based on findings. | Fifth digit foreign body.VIEWS: Right foot AP, lateral and oblique 2/10/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. No evidence of red opaque foreign bodies. | Normal examination. |
Generate impression based on findings. | Status post pinning of right femoral neck fracture Orthopedic screws affix a right femoral neck fracture in near-anatomic alignment. I see no complications. The hip joints and the remainder of the pelvis appear normal for age. | Orthopedic fixation of right femoral neck fracture. |
Generate impression based on findings. | Clinical question: Evaluate for acute change. Signs and symptoms: Worsening altered mental status. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, mass, mass effect, midline shift or hydrocephalus.Patchy foci of white matter low-attenuation in the subcortical and periventricular white matter as well as right basal ganglia are highly suggestive of age indeterminate small vessel ischemic strokes of mild to moderate degree.Small focus of encephalomalacia along the superior aspect of the right cerebellum consistent with a small chronic ischemic stroke. There is mild cerebellar volume loss. The cerebral cortex and cortical sulci as well as ventricular system remains within normal for age.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Mild chronic pansinusitis and postoperative changes of endoscopic functional sinus surgery are noted. | 1.No acute intracranial process.2.Age indeterminate the smaller systemic strokes and a small right superior cerebellar chronic ischemic stroke as detailed.3.Mild chronic pansinusitis and postoperative changes of the paranasal sinuses. |
Generate impression based on findings. | Male 15 years old Reason: evaluate for fx History: laceration via knifeVIEWS: Right hand AP, lateral and oblique 2/10/15 (3 views) There is a soft tissue laceration of the lateral aspect of the PIP joint level of the second finger, with no evidence of fracture, malalignment or joint effusions. | Soft tissue laceration with no fracture as described. |
Generate impression based on findings. | Status post hemi- The AP view of the right hip shows components of a hemiarthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the right. Mild osteoarthritis affects the left hip. Degenerative arthritic changes affect the visualized lower lumbar spine. | Right hip hemiarthroplasty as above. |
Generate impression based on findings. | 65 year old woman with worsening shock on 2 pressors despite adequate antibiotic coverage for UTI. Looking for intraabdominal source with recent cholecystectomy and biliary stent placement. CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions with associated basilar atelectasis/consolidation.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip at the SVC atrial junction. Debris within the esophagus.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse severe fatty infiltration of the liver which is enlarged. Status post cholecystectomy. A common bile duct plastic stent is in place.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Enteric tube with tip in gastric body. Mild bowel wall thickening nonspecific but may be related to hypoalbuminemia. No bowel obstruction. BONES, SOFT TISSUES: Anasarca. Postsurgical changes from lumbar spine fusion and laminectomy with pedicle screws.OTHER: Small-moderate abdominal pelvic ascites, increased, without discrete loculated fluid collection to suggest abscess.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild bowel wall thickening nonspecific but may be related to hypoalbuminemia. No bowel obstruction. BONES, SOFT TISSUES: Postsurgical changes in the lumbar spine. Nonspecific skin thickening involving the lower abdominal wall soft tissues with anasarca.OTHER: No significant abnormality noted. | 1.Bilateral small pleural effusions with associated basilar atelectasis/consolidation which may be a source of infection.2.No evidence of abdominal abscess or other specific abdominal source of infection.3.Severe hepatic steatosis worrisome for severe parenchymal dysfunction.4.Mild-moderate abdominopelvic ascites, increased from prior. |
Generate impression based on findings. | 58 years, Female, Reason: r/o acute process History: abd pain. 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.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Bilateral essure devices.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the visualized spine, progressed at L2-L3.OTHER: No significant abnormality noted | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Reason: r/o renal calculi History: left flank pain with hematuria 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: No significant abnormality notedLIVER, BILIARY TRACT: Gallbladder is contracted. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate left renal superior pole density (series 3, image 38) may represent 1-2mm nonobstructive calyceal calculus versus vascular calcification. Otherwise, no definite radiopaque renal or ureteral stone evident. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine including facet arthritis at L4-L5.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Possible 1-2-mm nonobstructive left renal calyceal calculi. No obstructing stones or hydroureteronephrosis.2.Otherwise, no specific findings to account for patient's symptoms. |
Generate impression based on findings. | Reason: assess pancreatic necrotic lesion for potential drainage History: abdominal distension 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 pleural effusion on the right. Moderate pleural effusion on the left which has increased. Basilar compressive atelectasis/consolidation. LIVER, BILIARY TRACT: Cholelithiasis. Contracted gallbladder. Infiltration of the fat in the gallbladder fossa. Mild widening of the hepatic fissures. SPLEEN: No significant abnormality notedPANCREAS: There has been interval insertion of a percutaneous drain with the tip within the lesser sac peripancreatic fluid collection (series 3, image 65) which measures approximately 15.1 x 10.2 centimeters, not significantly changed in size. The peripancreatic collection extends inferiorly along the left pararenal space. There are expected foci of gas within the collection. A pancreatic duct stent is in place with the tip in the duodenum. Though incompletely evaluated without intravenous contrast, the pancreas again appears necrotic. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: New infrarenal IVC filter.BOWEL, MESENTERY: An enteric tube terminates in the second portion of the duodenum. There are areas of bowel wall thickening involving the duodenum, jejunum, ileum and ascending colon likely related to the pancreatitis. There is nodularity of the peritoneum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is slight increase in the abdominal free fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There are areas of bowel wall thickening involving the duodenum, jejunum, ileum and ascending colon likely related to the pancreatitis. There is nodularity of the peritoneum.BONES, SOFT TISSUES: There is superior endplate height loss of the L4 vertebral body.OTHER: There is increased pelvic ascites. | 1.Necrotizing pancreatitis. Interval placement of drain into complex peripancreatic fluid collection which remains similar in size. 2.Basilar atelectasis/consolidation and left pleural effusion, increased. 3.Moderate abdominopelvic ascites, slightly increased.4.Enteric tube with tip proximal to the ligament of Treitz. |
Generate impression based on findings. | Shoulder and arm pain status post fall Two views of the right shoulder and two views of the right humerus show no definite fracture. There is mild irregularity along the inferior margin of the glenoid which I suspect simply represents osteophyte formation and/or mild spurring at the capsular attachment. Glenohumeral joint alignment is within normal limits. Small osteophytes are noted at the acromioclavicular joint. | Osteoarthritis without definite fracture. If there is strong clinical concern for fracture, CT may be considered. |
Generate impression based on findings. | Patient with history of bowel segment inflammation now with epigastric abdominal pain and rebound tenderness. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Segment 6 low-attenuation hepatic lesion with peripheral nodule enhancement, likely benign hemangioma. Segment 4 subcentimeter low-attenuation lesion too small to characterize but likely benign. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter low attenuation renal lesions too small to characterize but likely benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Bowel wall thickening involving a long segment of the mid to distal small bowel compatible with enteritis, likely infectious or inflammatory. The terminal ileum and colon appear uninvolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: A spinal-peritoneal shunt is noted with tip in the pelvis without evidence of complication. Small amount of abdominal free fluid is present.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Bowel wall thickening involving a long segment of the mid to distal small bowel compatible with enteritis, likely infectious or inflammatory. The terminal ileum and colon appear uninvolved. Small to moderate amount of abdominal free fluid is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A spinal-peritoneal shunt is noted with tip in the pelvis without evidence of complication. Small amount of pelvic ascites. | 1.Small bowel wall thickening involving a long segment of mid to distal small bowel compatible with enteritis, likely infectious or inflammatory.2.No evidence of bowel obstruction.3.Small amount of abdominopelvic ascites.4.Low attenuation liver lesions, favor benign. |
Generate impression based on findings. | 72 years, Female. Reason: Dobbhoff placement History: same LVAD device and pacer leads are unchanged. Dobbhoff tube tip has been advanced now projecting over the pyloric area. Bilateral chest tubes and mediastinal drains are unchanged. Retrocardiac opacity appears improved since prior exam obtained 2/10/15 at 1153 and is better evaluated on accompanying CXR.Relative paucity of bowel gas throughout the abdomen. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the pyloric area. |
Generate impression based on findings. | headache and fever, suspected meningitis. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Comment: if clinically indicated, brain MRI with and without contrast would be more sensitive for imaging evaluation of meningitis. |
Generate impression based on findings. | IPF exacerbation of valuate for PE. Hypoxemia. PULMONARY ARTERIES: Technically adequate infusion quality. No evidence of pulmonary embolus.LUNGS AND PLEURA: Severe pulmonary fibrosis, unchanged. No evidence of superimposed acute abnormality.MEDIASTINUM AND HILA: Mildly prominent lymph nodes unchanged. Small hiatal hernia. Mild cardiomegaly with straightening of the interventricular septum suggesting right heart strain however the main pulmonary artery is only minimally enlarged, 3-cm in transverse dimension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Postsurgical changes of the stomach and ventral abdominal wall. Hypoattenuating lesions in the hepatic parenchyma measure the density of simple fluid, likely benign. | No evidence of acute pulmonary embolus or other acute pulmonary abnormality. Unchanged pulmonary fibrosis with signs suggesting mild pulmonary hypertension..PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Abdominal pain and gas in urine, evaluate for perforation. ABDOMEN:LUNG BASES: New bilateral small pleural effusions with associated basilar atelectasis/consolidation.LIVER, BILIARY TRACT: Cholelithiasis without specific evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Aorta and branch vessel atherosclerosis. Retroperitoneal and iliac chain lymph nodes are nonspecific but may be reactive.BOWEL, MESENTERY: Nonspecific areas of small bowel thickening which are seen on the prior study. No evidence for obstruction. Air is present within the bladder. The posterior bladder wall is thickened and is inseparable from the sigmoid colon in the region of prior diverticulitis. A focus of air within the posterior bladder wall likely represents colovesical fistulization (series 5, image 77). Colonic diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air is present within the bladder. Findings suggestive of colovesical fistula as described above. LYMPH NODES: Retroperitoneal and iliac chain lymph nodes are nonspecific but may be reactive.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings compatible with colovesical fistula involving the posterior bladder wall in area of prior sigmoid diverticulitis.2.Nonspecific mild thickening of the small bowel which may be infectious or inflammatory in etiology.3.Colonic diverticulosis. 4.New small bilateral pleural effusions with associated compressive atelectasis/consolidation.5.Cholelithiasis.6.Atrophic kidneys. |
Generate impression based on findings. | Female 76 years old Reason: r/o rupture of known AAA History: severe epigastric pain CT ANGIOGRAM: Extensive atherosclerotic calcifications of the abdominal aorta with an infrarenal abdominal aortic fusiform aneurysm. The aneurysm is without significant change now measuring 4.5 x 4.3 cm (series 9, image 122), previously 4.4 x 4.3 cm. The aneurysm extends into the right common iliac artery, unchanged. No evidence of contrast extravasation to suggest an abdominal aortic leak. No evidence of dissection or thrombus in the abdominal aorta.Moderate to severe atherosclerotic calcifications affect the origins of the celiac and SMA branches and the origins of the renal arteries bilaterally. The common, external, and internal iliac arteries are patent without evidence of a thrombus or dissection.ABDOMEN:LUNG BASES: Stable left lower lobe micronodule.LIVER, 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: Multiple loops of dilated small bowel and fecalization of small bowel enteric contents with a transition point in the distal jejunum/proximal ileum. Findings are suspicious for a partial small bowel obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1.Stable infrarenal abdominal aortic aneurysm without evidence of leak.2.Partial small bowel obstruction 3.Extensive atherosclerotic disease of the abdominal aorta and its branches are again seen.The findings related to the small bowel obstruction were communicated by telephone to the emergency department attending at 8:45 a.m. on 2/11/2015. |
Generate impression based on findings. | Pain in right leg. Fall. I see no fracture. Mild to moderate osteoarthritis affects the knee. | Osteoarthritis of the knee without fracture evident. |
Generate impression based on findings. | 67 years, Male. Reason: NGT placement History: NGT placement Dobbhoff tube with tip projecting over the gastroesophageal junction. Nonobstructive bowel gas pattern with multiple air-filled loops of bowel. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projecting over the gastroesophageal junction. |
Generate impression based on findings. | History LVAD now with acute respiratory decompensation, evaluate for hemorrhage. 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: Persistent right lower lobe atelectasis and consolidation likely secondary to chronic elevation of the right hemidiaphragm, similar to 2/5/2015 exam. Superimposed increased subsegmental basilar atelectasis/consolidation which is nonspecific but may represent infection and/or aspiration. Smooth septal thickening suggestive of pulmonary edema. Innumerable calcified micronodules consistent with prior granulomatous infection.MEDIASTINUM AND HILA: Tracheostomy with tip above the carina. Mediastinal lymphadenopathy appearing similar to prior. Cardiomegaly without pericardial effusion. Atherosclerotic calcifications of the aorta with mild coronary artery calcifications. LVAD and ICD are grossly unchanged in position, however, evaluation is limited secondary to lack of intravenous contrast. Postoperative changes consistent with heart transplant.CHEST WALL: Left chest wall subcutaneous pacemaker generator. Median sternotomy fixation devices.Mildly enlarged left internal mammary chain lymph nodes are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal scarring with marked right renal atrophy.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and branches. No retroperitoneal hematoma as clinically questioned.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter is present in decompressed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Increased basilar subsegmental atelectasis/consolidation which may be related to infection and/or aspiration superimposed upon chronic right lower lobe atelectasis/consolidation.2.No evidence of hemorrhage is clinically questioned.3.LVAD and other chronic findings as described above. |
Generate impression based on findings. | Male 22 days old Reason: is there pneumatosis/pneumoperitoneal History: pneumatosisVIEW: Abdomen AP (one view) 2/10/15 at 2226 hrs NG tube tip is in the stomach. Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, slightly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | 16 year-old female with abdominal fullness. Assess for toxic megacolon, free air.VIEWS: Abdomen AP erect, supine (two views) 2/10/2015 Moderate fecal burden. Nonobstructive bowel gas pattern. No evidence of pneumatosis intestinalis, pneumoperitoneum, portal venous gas or ascites. Focal punctate calcification in the right hemipelvis may represent an appendicolith or phlebolith. | Nonobstructive bowel gas pattern. No free air. |
Generate impression based on findings. | pain and weakness in right upper extremity for 2-3 days. known right carotid body tumor. History of right thyroid lobectomy. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKRight thyroid lobe is not seen with multiple surgical clips indicating prior surgery.About 11mm x 11mm sized well enhancing right carotid bifurcation lesion indicating carotid body tumor does not show any significant interval change in terms of size, location and configuration since prior exam (Neck CT scan).There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries are patent and Acom artery is also patent.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. Right carotid body tumor, no change in size, configuration and location since prior exam.2. No evidence of acute ischemic or hemorrhagic leison.3. No significant arterial luminal stenosis, intracranial aneurysm or major artery occlusion. |
Generate impression based on findings. | 42 years, Male, Reason: concern for nephrolithiasis History: flank pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small splenulePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Punctate nonobstructing stones in the renal pelvises bilaterally, the largest measuring up to 4 mm. There is minimal right-sided periureteral stranding and dilatation, which may reflect a recently passed stone.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 2 mm stone within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.2 mm stone within the bladder and minimal right-sided ureteral dilatation and periureteral stranding, possibly the sequela of a recently passed stone.2.Multiple nonobstructing stones in the renal pelvises bilaterally. 3.No hydronephrosis. |
Generate impression based on findings. | Heel ulcer. Evaluate for heel osteomyelitis. There is loss of soft tissue along the posterior aspect of the calcaneus. Overall, the bones appear demineralized, but I see no specific radiographs features of osteomyelitis. Poorly defined density within the calcaneus and distal tibia may represent chronic bone infarction, but this is equivocal. | Soft tissue loss without specific radiographic features of osteomyelitis. If there is strong clinical concern for osteomyelitis, MRI may be considered. |
Generate impression based on findings. | 61 years, Male. Reason: constipated, concern for possible SBO. History: as above Rectal tube is in place. IVC filter is noted. A 3 cm radiodense object projects over the L1 vertebral body, probable bullet fragment. Surgical clips project over the right upper abdomen. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Chest pain tachycardia, history of ALL. PULMONARY ARTERIES: Diagnostic quality and fusion without evidence of pulmonary embolus. The main pulmonary artery appears normal in caliber.LUNGS AND PLEURA: Right upper lobe peribronchial groundglass opacities with no bronchial wall thickening. Linear subsegmental atelectasis or scarring in the right upper lobe. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: No visible coronary artery calcifications. Normal heart size. Small hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Diffuse hypoattenuation of the hepatic parenchyma suggestive of fatty liver. The gallbladder is near isoattenuating to the hepatic parenchyma and may be filled with sludge, incompletely assessed. Renal vascular calcifications and a 7 x 4 mm left nephrolith. | Noted acute pulmonary embolism. Diffuse ground glass opacities in the right upper lobe without bronchial wall thickening could in the appropriate clinical context represent infection such as viral pneumonia however the finding is nonspecific and blood products from acute pulmonary hemorrhage or aspiration pneumonitis could have a similar radiographic appearance and cannot be excluded.Left nephrolithiasis without hydronephrosis.Diffuse fatty infiltration of the liver.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Fall, rule out bleed and fracture Head: No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes.There is mild mucosal thickening involving the partially imaged right maxillary sinus. Mastoid air cells are clear. Calvarium is intact.Cervical spine: No acute fracture or subluxation within the cervical spine. Vertebral body heights and alignment are maintained. Degenerative changes are seen particularly at C4-C5, C5-C6, and C6-C7 with moderate loss of intervertebral disk height and osteophyte formation. There is no significant spinal canal stenosis. There is mild bilateral neural foramina narrowing at C5-C6 and C6-C7.There is a low density nodule involving the right thyroid lobe measuring up to 1.5 cm in diameter. Ultrasound can be considered as clinically indicated. | 1. No evidence of intracranial hemorrhage or calvarial fracture. Please note if there is suspicion for maxillofacial fracture, consider dedicated maxillofacial CT evaluation2. No evidence of acute fracture or subluxation within the cervical spine.3. 1.5-cm right thyroid lobe nodule which can be evaluated with ultrasound as clinically indicated. |
Generate impression based on findings. | 59-year-old female with right hip pain s/p fall. Two views of the right hip again show postoperative and arthritic changes which appear similar to the prior study, perhaps reflecting chronic changes from underlying hip dysplasia or old trauma.Two views of the left hip demonstrate moderate osteoarthritis without acute fracture. Coxa vara deformity could reflect prior slipped capital femoral epiphysis (SCFE). Tubular lucencies seen within the proximal left femur are likely secondary to prior orthopedic intervention.Single AP view of the pelvis demonstrates the aforementioned hip abnormalities. Demineralized bones are compatible with osteopenia. | Chronic postoperative and degenerative changes of the hips as described above without acute fracture.Findings discussed with the orthopedic surgery resident on call on 2/11/2015 at 0130. |
Generate impression based on findings. | 83-year-old female with descending aortic aneurysm -- routine surveillance. Thoracic aneurysm without mention of rupture. CHEST:LUNGS AND PLEURA: Emphysematous changes predominating at the lung apices. Motion artifact degrades some of the images.MEDIASTINUM AND HILA: Ascending aorta appears with normal diameter and unchanged. Since the prior examination, there's been interval placement of an aortic stent graft extending from the thoracic aorta to approximately the level of the diaphragm. The stent graft is patent but at its midportion, there is a type III endoleak (image 80; series 11) measuring 1.7 x 1.2 cm. The aneurysm has not changed substantially in size compared to the prior examination again measuring 6.1 cm in diameter (image 69; series 11).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.AORTA: Infrarenal abdominal aortic aneurysm measuring 4.6 cm in diameter (image 107; series 15) stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 3.8-cm fluid collection in the tissues anterior to the right lower abdomen. Degenerative changes throughout the thoracolumbar spine without other focal abnormality.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: Scattered sigmoid diverticular changes without complication.BONES, SOFT TISSUES: Degenerative changes throughout the thoracolumbar spine without other focal abnormality.OTHER: There is a 12-mm saccular outpouching extending from the right common iliac artery (image 198; series 11) which is new since the prior examination. This presumably represents the remnants of a conduit used to deploy the stent graft. Correlate with surgical history. | Status post thoracic endograft insertion with type III endoleak. Small fluid collection in the subcutaneous tissues anterior to the right rectus muscle. Presumed partially thrombosed conduit extending from the right common iliac artery. Clinical service notified of these findings at the time of dictation. |
Generate impression based on findings. | Female 11 years old Reason: Cochlear implant placement History: Post-op cochlear implantVIEWS: Skull AP and lateral 2/10/15 (two views) Interval left cochlear implant placement. The implant does the complete curl of the cochlea. No evidence of kinking or disconnections. Normal, visualized paranasal sinuses pneumatization. Normal alignment of the visualized cervical spine with no prevertebral soft tissue thickening. No evidence of tracheal compression or deviation. | Status post left cochlear implant as described. |
Generate impression based on findings. | 4-year-old female, walking with left leg lengthVIEWS: Left femur, AP and lateral (two views),left tibia/fibula, AP and lateral (two views) , 2/11/15, 0:09 Alignment is anatomic. The the femoral head is well directed within the acetabulum. No fracture or other specific finding to account for patient's symptoms. | Normal examination. |
Generate impression based on findings. | 59-year-old female with right hip pain status post fall. Two views of the right hip demonstrate an orthopedic plate and screw device which affixes the proximal right femur in gross anatomic alignment. Deformity of the underlying femoral head and neck may represent old trauma or chronic changes from long-standing hip dysplasia. Severe osteoarthritis and associated acetabular remodeling are also noted. We see no acute fracture. | Orthopedic fixation of the proximal right femur with chronic arthritic changes of the right hip. |
Generate impression based on findings. | Female, 49 years old s/p robot assisted laparoscopic supracervical hysterectomy and sacral colpopexy. RFO Trigger: Sponge count incorrect however given laparoscopic surgery, no sponge was used within the abdomen. Suspected RFO Location: Abdomen. Suspected RFO: Raytec sponge No unexpected radiopaque foreign bodies. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign bodies. Findings were discussed with attending surgeon, Dr. Valaitis, over phone, at 2110 on 2/10/15. |
Generate impression based on findings. | 42 year-old woman with history of questionable architectural distortion noted in the left breast on screening mammogram. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The previously seen area of architectural distortion in the left breast at 12 o'clock position largely disperses on spot compression. ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 64 years, Male. Reason: OG placement History: vomiting Note that the upper abdomen and lower pelvis are excluded from the field-of-view. Dobbhoff tube tip projects over the expected location of the proximal duodenum. Orogastric tube tip projects over the antrum and sidehole projects over the body of the stomach. A percutaneous drain projects over the left hemiabdomen. Nonobstructive bowel gas pattern. | Dobbhoff tube tip projects over the proximal duodenum and orogastric tube tip projects over the antrum. |
Generate impression based on findings. | There is generalized age compatible cerebral volume loss without acute hemorrhage, mass-effect, midline shift, or CT evidence of large territorial ischemia. There is mild ex vacuo dilation of the ventricular system in the setting of cerebral atrophy. There is mild periventricular hypoattenuation which is nonspecific but most likely represents age indeterminate small vessel ischemic disease. There is leftward nasal septal deviation likely may be related to prior trauma and a small left maxillary retention cyst. | No evidence of intracranial hemorrhage or mass effect. If there is continued suspicion for acute ischemia, consider MRI for further evaluation. |
Generate impression based on findings. | 29 years, Female. Reason: impaction? History: abdominal pain Surgical clips project over the right and left upper quadrants. Increased stool burden is seen throughout colon, particularly within a gas distended descending colon. No pneumoperitoneum. | Increased stool burden since the prior exam. |
Generate impression based on findings. | 15-year-old female with NG tube. Assess placement.VIEW: Abdomen AP (one view) 2/10/2015 18:38:15 NG tube tip overlying the stomach. Spinal rods are again seen. Nonobstructive bowel gas pattern. Previously noted right pleural effusion on chest x-ray is not definitively seen. | NG tube tip overlying the stomach. |
Generate impression based on findings. | 10-week-old male coughing for two weeks, evaluate for pneumoniaVIEWS: Chest AP/lateral (two views) 2/11/15 0:59 Mild bronchial wall thickening suggesting reactive airway disease or bronchiolitis. The cardiothymic silhouette is normal. | Reactive airway disease or bronchiolitis. |
Generate impression based on findings. | 67 years, Female. Reason: NG tube placement History: SBO s/p NG placement Enteric feeding tube projects over the gastric antrum. Nonobstructive bowel gas pattern. No pelvis is incompletely included in the field-of-view. | Enteric feeding tube projects over the gastric antrum. |
Generate impression based on findings. | 51 years, Female. Reason: Evalute for stool burden. h/o metastatic colon cancer. History: Constipation alternating with diarrhea Amorphous stool is noted within the descending colon with desiccated stool throughout the transverse and ascending colon. Nonobstructive bowel gas pattern. No pneumoperitoneum. Hepatomegaly as noted on CT. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Abnormal movements. Nonenhanced head CT:A around well-demarcated cystic appearing lesion in the left postcentral gyrus at the site of previously seen presumed remaining enhancing metastatic focus is again identified. This finding measures a 11 x 10.5-mm which is slightly smaller than prior MRI examination measurement of 15 x 13-mm. Surrounding vasogenic is again identified without significant change. The mass effect is regional in subtle effacement of cortical sulci. No evidence of hemorrhage is present. Ventricular system remain within normal size and with maintained midline.Subtle subcortical and proven to attenuation of white matter similar to prior exam and likely representing age indeterminate small vessel ischemic strokes. | 1.No detectable acute intracranial hemorrhage, midline shift or hydrocephalus. 2.Cystic presumed metastatic lesion in the left postcentral gyrus measures at 11 x 10.5-mm which is a smaller than prior MRI exam measurements are 15 x 13mm. Surrounding edema and resultant regional mass-effect remains identical to prior study.3.Age indeterminate small vessel ischemic strokes grossly similar to prior studies |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A metallic device superimposes over left lateral posterior aspect.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: lung cancer s/p 6 cycles of chemo please assess response to therapy and compare to previous imaging History: lung cancer CHEST:LUNGS AND PLEURA: Interval increase in size of a right perihilar mass, which is now bilobed, and measures up to 18 x 18 mm (series 6, image 44), previously measuring 14 x 13 mm. The inferior portion now measures 11 x 10 mm (series 6, image 47).Minimal residual multifocal ground glass opacities in the periphery of the right lung. Interval decrease in scattered subsolid micronodules in the right lung. The previously referenced right lower lobe nodule is no longer measurable. The left lung remains clear. Mild dependent atelectasis. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcifications. Stable to slightly decreased mediastinal lymph nodes. Reference precarinal lymph node measures 4 mm (series 6, image 31), decreased in prominence from the prior exam.CHEST WALL: Scattered nonenlarged axillary lymph nodes.Reference left sub-pectoral lymph node measures 4 mm (series 6, image 17), unchanged.Stable appearance of a PET negative sclerotic lesion in the left aspect of the T10 vertebral body, which was present on prior exams and is most compatible with a benign bone island.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable scattered subcentimeter hypoattenuating foci, likely benign cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the normal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval increase in size of an 18mm solid right perihilar mass. Stable appearance of mediastinal and axillary lymph nodes.2. Continued interval improvement of multifocal nodular ground glass opacities and decreased prominence of likely post-inflammatory scattered micronodules in the right lung. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. A small cluster of calcifications is present at upper quadrant in the right breast.No suspicious masses or areas of architectural distortion are present. | A small cluster of calcifications at upper quadrant in the right breast. Comparison to the old mammogram is recommended to check for stability. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | Surgical female status post extubationVIEW: Chest AP (one view) 2/11/15 6:30 Findings right center venous catheter tip in the SVC. Epicardial pacer leads and postoperative change of the upper mediastinum are again noted. NG tube in the stomach.Cardiomegaly and bronchial wall thickening with interval improvement in atelectasis in the right base. Left basilar opacity persists. No evidence of pneumothorax. | Bronchial wall thickening and improvement in atelectasis. |
Generate impression based on findings. | Aphasia, right upper extremity weakness, right face weakness. Evaluate evolution of left MCA territory infarct. There is evolution of the left MCA territory infarct with increased hypoattenuation and local mass effect of the left insula, left middle and inferior frontal gyri. There is no evidence of acute intracranial hemorrhage. There is a background of diffuse parenchymal volume loss. There is left to right midline shift measuring 4 mm, previously 3 mm. The imaged paranasal sinuses and mastoid air cells are clear. There are atherosclerotic calcifications of the cavernous portion of the bilateral carotid arteries. The skull and extracranial soft tissues are unremarkable. There is debris within the left external auditory canal. There are bilateral lens implants. | Evolution of a recent left middle cerebral atery territory infarct without evidence of acute hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 42 year-old female with right shoulder pain. Three views of the right shoulder show no acute fracture or malalignment. Faint amorphous calcification seen adjacent to the posterolateral humeral head is likely within the infraspinatus tendon. | 1.No acute fracture or malalignment.2.Findings suggestive of calcific tendinosis/tendinopathy involving the infraspinatus tendon. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 54 years old. Reason: r/o hematoma. History: IBD s/p colectomy with SBR, pelvic bleeding, now with foul smelling d/c. 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: Status post ileostomy with small parastomal hernia. No evidence of obstruction. Status post total colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Scattered atherosclerotic calcifications of the aorta and the proximal renal arteries.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: Small foci of air within the bladder is likely post procedural. No definite evidence to suggest fistulous communication to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pre-sacral mixed gas-fluid collection measuring 6.7 x 5.6 cm (series 3, image 105) which is worrisome for an abscess. Small foci of gas in the vaginal fornix suggesting fistulous communication to the vagina.No definite evidence to suggest fistulous communication to the small bowel adjacent to the fluid collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Presacral mixed gas-fluid collection with possible fistulous communication to the vagina which is suspicious for an abscess. 2.No definitive evidence of fistulous connection to the bladder or small bowel. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Altered mental status No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. No extra-axial collections. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent advanced chronic small vessel ischemic changes. There appears to be some progression since were 4/27/2008.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 58-year-old male with chronic left lateral hip pain. Two views of the left hip demonstrate severe joint space narrowing and osteophyte formation, compatible with severe osteoarthritis. No acute fracture or dislocation is identified. | Severe osteoarthritis without acute fracture. |
Generate impression based on findings. | Lymphadenopathy. There is extensive left cervical, left axillary, and upper mediastinal lymphadenopathy. For example, a left level 4 lymph node measures 26 x 30 mm, a left level 5B lymph node measures 12 x 16 mm, and a left level 3 lymph node measures 14 x 20 mm. There is also prominent left paraspinal soft tissue. There is compression of the left internal jugular vein and the left brachiocephalic vein. The carotid arteries are patent. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are subcentimeter retention cysts in the right maxillary sinus. The imaged portions of the lungs are clear. | Extensive left cervical, left axillary, and upper mediastinal lymphadenopathy, as well as prominent left paraspinal soft tissue is suggestive of lymphoma or leukemia. |
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