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Generate impression based on findings. | Evaluate for osseous abnormalities. CT of the pelvis reveals cortical thickening in both pubic and ischiac bones. There's also cortical thickening involving the right iliac wing. These findings represent Paget's disease. There is narrowing of both hip joints consistent with moderate osteoarthritis. No acute abnormalities.Two views of the sacrum are unremarkable. | Paget's disease involving the pelvis. No acute abnormalities |
Generate impression based on findings. | 0-day-old female, evaluate ETT positionVIEW: Chest AP (one view) 2/11/15 10:46 ETT tip above the thoracic inlet. Streaky bilateral pulmonary opacities and basilar atelectasis. Left sided cardiac apex, aortic arch and stomach. The cardiothymic silhouette is normal. The bowel gas pattern is normal for age. | 1. ETT tip above thoracic inlet.2. Streaky pulmonary opacities likely relate to RDS. |
Generate impression based on findings. | Female 64 years old Reason: evaluate for bilateral hip OA History: hip and groin pain. AP view of the pelvis shows severe osteoarthritis of both hips, appearing similar to that seen on prior hip radiographs in September 2014. Degenerative arthritic changes also affect the visualized lower lumbar spine. | Severe osteoarthritis. |
Generate impression based on findings. | Female 60 years old Reason: eval for si DJD History: hip pain running.VIEWS: Two views of the pelvis. We have two views of the pelvis. Mild osteoarthritis affects both hip joints, slightly more advanced on the left. The sacroiliac joints appear normal for patient's age. Degenerative arthritic changes affect the visualized lower lumbar spine. | Osteoarthritis of the hips and lower lumbar spine. The sacroiliac joints appear normal. |
Generate impression based on findings. | Status post fall on outstretched hand.VIEWS: Right AP, lateral and oblique 2/11/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 41 years, Female. Reason: Stent placement History: Abdominal pain A right-sided nephroureterostomy stent proximal tip projects over the upper pole of the right kidney with proximal tip projecting over the expected location of the bladder. Multiple surgical clips are also noted at the upper pole of the right kidney. Nonobstructive bowel gas pattern. | Right-sided nephrouretereostomy stent in the expected location. |
Generate impression based on findings. | Female 64 years old Reason: Prosthetic assess History: post-op. Two views of the left hip show components of a hip hemiarthroplasty device situated in near anatomic alignment, without radiographic evidence of hardware complication.AP view of the pelvis shows mild osteoarthritis of the right hip. Also, mild degenerative arthritis affects the pubic symphysis, sacroiliac joints, and lower lumbar spine. | Left hip hemiarthroplasty in near anatomic alignment. |
Generate impression based on findings. | 73-year-old male patient status post urethroplasty. Scout film demonstrated a suprapubic catheter in place.Cystografin was administered by gravity via the Foley catheter and maximal distention was achieved at 200 cc, at which point the examination was terminated secondary to patient involuntarily voiding.Again seen is a small contrast filled collection on the left anterolateral wall of prostatic and possibly membranous urethra, which currently measures a 2.0 x 1.1 cm, previously 1.5 x 0.5 cm. Additionally, there is a sinus tract from the posterolateral aspect of the urethra at the same level, extending up to 1.6 cm from the urethral wall (series 8). On the prior examination, this area of the wall was irregular in contour. | Enlarging contained left anterolateral leak and new right posterolateral sinus tract. |
Generate impression based on findings. | 45 year old woman with history of asymmetry in the right breast on prior mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. The asymmetry previously seen in the right breast is no longer visualized. | 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: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 39 years old Reason: eval for arthritis, pain/swelling in knee History: eval for arthritis, pain/swelling in knee. We have 4 views of the right knee and 4 views of the left knee. There is severe osteoarthritis of the left knee, particularly affecting the medial compartment where there is near bone on bone apposition. There are also tricompartmental osteophytes and a mild varus deformity of the left knee. Four views of the right knee show moderate tricompartmental osteoarthritis. | Osteoarthritis of the bilateral knees, left greater than right. |
Generate impression based on findings. | Male 49 years old Reason: pain History: pain. Three views of the left knee show severe osteoarthritis predominantly affecting the medial compartment where there is near bone on bone apposition. There are also tricompartmental osteophytes and a mild varus deformity of the knee. There is a small joint effusion with a 1.5 cm loose body in the suprapatellar pouch. Ossification in the soft tissues along the medial femoral condyle likely reflects prior injury to the medial collateral ligament. Soft tissue fullness along the medial joint line may reflect meniscal extrusion and associated inflammatory changes. There is a bony excrescence measuring approximately 20 x 12 mm projecting from the posterior aspect of the distal femoral diaphysis, which may represent a peculiar osteochondroma.Mild osteoarthritis affects the right knee seen on the frontal view. Deformity of the proximal right fibula may reflect additional osteoarthritis. There also appears to be a bipartite patella. | Severe osteoarthritis and other findings as described above. |
Generate impression based on findings. | Wrist pain. Fracture years ago Three views of the left wrist reveal multiple defects from previous orthopedic hardware. There is narrowing and sclerosis of the basilar joint consistent with osteoarthritis. No acute abnormalities. When compared to the previous exam there has been removal of the orthopedic hardware | Removal of previously seen orthopedic hardware. Basilar joint osteoarthritis |
Generate impression based on findings. | Medial condylar intra-articular fracture Four views of the left elbow show decreased soft tissue swelling when compared to the previous exam. No joint effusion. There is a small ossific fragment adjacent to the medial condyle that represents a small fracture. | Small medial condylar fracture unchanged |
Generate impression based on findings. | Ms. Brooks is a 71 year old female with a personal history of left breast DCIS status post mastectomy. Recent diagnostic mammogram demonstrated a new asymmetry in the superior right breast with sonographic correlate. This will be the target for today's biopsy. Right breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 1.6 x 0.8 x 1.1 cm at the 12 o’clock position with increased vascularity, 10 cm from the nipple. The lesion was somewhat subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | SCLC restaging. CHEST:LUNGS AND PLEURA: Trace pleural fluid on the right. Disease bronchiolitis in the lower lobes with debris in the right lower lobe bronchus most consistent with aspiration related bronchiolitis.Right upper lobe bronchial wall thickening and linear scar like opacities about the same; one lesion in the right upper lobe posterior laterally is slightly more solid in appearance (4/42), but not readily measurable. Right middle lobe bronchial wall thickening is unchanged.MEDIASTINUM AND HILA: Interval progression of the confluent tumor and lymphadenopathy at the right hilum insinuating into the pericardial spaces, measuring 6.3 x 6.2 cm, previously 3 x 1.9 cm (3/52). At this level, the superior vena cava is compressed into a luminal dimension of 6 x 7 mm (3/52). Slightly above the level (it 3/48), there is an eccentric intraluminal filling defect laterally within the SVC which may be adherent thrombus or direct invasion by tumor.Right upper paramediastinal mass measures 2.5 x 2.9 cm (3/48), previously 2.4 x 2.6 cm.Right lower paratracheal lymph node measures 2.8-cm, previously 0.8-cm (3/45 closed. Interval development of contralateral mediastinal and hilar lymphadenopathy, mild and progression of interlobar and lobar lymphadenopathy on the right. No pericardial fluid. Moderate coronary artery calcifications.CHEST WALL: A right cardiophrenic lymph node is larger (3/66). Degenerative changes spine. Healed fracture deformities of right-sided ribs.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild prominence of the intrahepatic biliary ducts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal renal artery calcifications, right kidney incompletely included with this scanning range.PANCREAS: Pancreatic duct is mildly dilated, probably within limits of normal for age.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L1 sclerotic metastasis, about the same.OTHER: No significant abnormality noted. | Interval enlargement of right hilar mass which now narrows be the superior vena cava, consistent with SVC syndrome.. A small eccentric filling defect within the SVC may be due to adherent mural thrombus or localized intravascular extension of tumor. Diffuse bronchiolitis pattern most compatible with aspiration. Increased size and number of enlarged mediastinal and hilar lymph nodes. Stable skeletal metastasis. |
Generate impression based on findings. | 23-year-old male with dysphagia, G tube. Evaluate for aspiration. History of Lennox Gastaut with developmental disability. EXAMINATION: Oropharyngeal motility study 2/11/2015 10:15:00 Beth Harrison, speech and language therapist, supervised the examination.2 minutes and 26 seconds of fluoroscopy was used.Decreased strength, delay, decreased clearance with resultant residue in valleculae and pyriformis. Penetration with thin and nectar thick liquids. Aspiration with thin after swallow as evidenced by barium coating anterior tracheal wall after penetration. No cough reflex was noted. | Aspiration with no cough reflex. Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | 7-year-old female with history of neuroblastoma, off therapy CHEST:LUNGS AND PLEURA: Minimal basilar atelectasis. No suspicious nodules or masses.MEDIASTINUM AND HILA: Note is made of common origin of the left carotid and right brachiocephalic artery. No mediastinal or hilar lymphadenopathy. There is prominence of the left atrium, of unclear etiology.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. The gallbladder is poorly distended with minimal wall thickening, unchanged.SPLEEN: No significant abnormality notedPANCREAS: Normal pancreatic enhancement.ADRENAL GLANDS: Status post right adrenalectomy with multiple surgical clips extending inferiorly along the retroperitoneum without evidence of residual or recurrent disease.KIDNEYS, URETERS: Normal symmetric renal cortical enhancement without hydronephrosis.RETROPERITONEUM, LYMPH NODES: Few subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Moderately distended and otherwise normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrent disease. |
Generate impression based on findings. | 14 years old Female. Reason: initial staging for lymphoma. History: anterior mediastinal mass. This study was performed for initial staging.RADIOPHARMACEUTICAL: 6.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates a large mediastinal mass and pericardial effusion. There are bilateral pleural effusions. Airspace consolidations are seen in both lungs predominantly in the lower lobes. Ascites is noted. Pericardium catheter and left chest tube are noted.Today's PET examination demonstrates intense FDG uptake in the mediastinum mass involving anterior and middle mediastinum with SUVmax of 5.8. The mass encases the great vessels in the mediastinum. Diffuse and increased FDG uptake is also seen in the pericardium. The multiple foci of increased activity in the posterior mediastinal and right pericardial lymph nodes. Increased activity is also seen in the pleural thickening of the left lower lobe.Mild and diffuse FDG uptake is seen in the consolidations in both lungs. Diffuse and mild FDG uptake is seen in the spleen.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, kidneys, intestines, uterus and bladder. | 1.Hypermetabolic mediastinal mass and lymph nodes, consistent with the patient's diagnosis of lymphoma. The hypermetabolic mass involves anterior and middle mediastinum and encases the great vessels.2.Hypermetabolic pericardial and left pleural thickening, suspicious for tumor involvement.3.Nonspecific a mild FDG uptake in the spleen.4.Small ascites, pericardial effusion and bilateral pleural effusions.5.Inflammatory changes in both lungs. |
Generate impression based on findings. | 10 day old female with increased work of breathing. Evaluate for presence of atelectasis or pneumothorax.VIEW: Chest AP (one view) 2/11/2015 11:22:53 Feeding tube tip in the stomach. Umbilical venous catheter tip in the right atrium. Bilateral hazy opacities similar to prior study. No pleural effusion or pneumothorax. Cardiothymic silhouette is normal. Focal bulge along the medial aspect of the right hemidiaphragm unchanged. | Persistent diffuse bilateral hazy lung opacities. |
Generate impression based on findings. | AIH. Evaluate for HCC. LIVER: The liver measures 16.4 cm in length. Mildly echogenic compatible with fatty infiltration and nodular in contour suggesting cirrhosis. There are no focal lesions identified. There is no evidence of intrahepatic biliary ductal dilatation. The portal vein is patent with flow towards the liver and color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 12.6 cm in length and the left kidney measures 12.5 cm in length.OTHER: Spleen measures 12.8 cm in length. | Cirrhotic appearing liver with no focal liver lesions. Mild splenomegaly suggesting portal hypertension. |
Generate impression based on findings. | Hypoxia, RV failure. Chronic thromboembolic pulmonary hypertension. The comparison chest radiograph performed on 2/10/2015 demonstrates a small left pleural effusion with overlying atelectasis/consolidation and a trace right pleural effusion. The ventilation images show decreased activity on single-breath and wash-in images within the bilateral lung bases, left greater than right. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show matched defects within the bilateral lung bases. There are also small peripheral defects in the right upper lung. | Low probability for pulmonary embolus. |
Generate impression based on findings. | Assess for skull base tumor. History of pulsatile tinnitus and dizziness. Family history of colon cancer. CT: There is an expansile lucent lesion in the left lateral posterior skull base with internal hyperattenuating foci and what may represent periosteal reaction inferiorly. Overall, the lesions measures up to 35 mm. There is no evidence of intradural extension of the lesion or acute intracranial hemorrhage. The ventricles are normal in size and configuration. There is no midline shift or herniation. There are multiple paranasal sinus, right mandible, and subcentimeter calvarial osteomas. There are scattered paranasal sinus retention cysts. The mastoid air cells are clear. CTA: There is no evidence of significant steno-occlusive arterial lesions or cerebral aneurysms. However, there is compression of the left sigmoid sinus and superior portion of the internal jugular vein by the mass and there is asymmetric presence of a left condylar canal. | 1. Expansile lucent lesion in the left lateral posterior skull base that measures up to 35 mm with compression of the left sigmoid sinus and superior portion of the internal jugular vein. Differential considerations include fibrous dysplasia or desmoid tumor, versus malignant neoplasms, such as sarcomas, perhaps arising from underlying fibrous dysplasia.2. Multiple paranasal sinus, right mandible, and subcentimeter calvarial osteomas may indicate underlying Gardner syndrome (familial polyposis syndrome), which may also be related to the skull base lesion. |
Generate impression based on findings. | 54 year old woman with history of T-cell lymphoma and prior left breast mass biopsy in 2014. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A ribbon biopsy clip is seen at the two o'clock position with associated asymmetry, unchanged in position from the prior examination and without interval change. A circumscribed, round mass is seen in the mid left lateral breast, unchanged from prior examinations and compatible with a lymph node as seen on prior ultrasound. No other dominant masses, suspicious microcalcifications, or areas of architectural distortion are seen in the left breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months (to get her back on a bilateral annual schedule). Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 76 years, Female. Reason: ng History: ng NG tube side-port is at the distal esophagus with tip at the gastroesophageal junction. Sternotomy wires noted.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube side-port is at the distal esophagus with tip at the gastroesophageal junction, recommend advancement. Findings paged to pager 7816 at 1200 on 2/11/15. |
Generate impression based on findings. | Back pain There is mild narrowing of the L5/S1 intervertebral disk space which may reflect mild degenerative disk disease. I see no frank scoliosis. Coronal balance is within normal limits. There is a mild negative sagittal balance of less than 2 cm. There is loss of the normal cervical lordosis. | Mild negative sagittal balance and findings suggestive of mild degenerative disk disease at L5-S1. |
Generate impression based on findings. | Hypoxemia rule out PE. Motion artifact.PULMONARY ARTERIES: Technically suboptimal infusion quality, but no pulmonary emboli to the lobar level. Segmental and subsegmental emboli may not be visible.LUNGS AND PLEURA: Significant interval worsening of diffuse tree in bud and ground glass alveolar distribution opacities. Interval development of localized homogeneous intralobular septal thickening in the left upper lobe, predominantly abutting the fissure and paramediastinal pleural surfaces. A similar pattern is seen in the posterior aspect of the right upper lobe.New focal subpleural consolidation in the lower lobes, right greater than left. No pleural fluid or pneumothoraxMEDIASTINUM AND HILA: Normal heart size, no pericardial fluid. No significant adenopathy. No visible coronary calcifications on this non-cardiac-gated study. The main pulmonary artery appears normal in caliber.CHEST WALL: Multi-level vertebral body endplate compression deformities in the midthoracic and visualized upper lumbar spine, chronic with progression of fracture deformities at the T9 and T10 levels.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Small spleen containing multiple calcifications. | 1. Suboptimal examination with no evidence of pulmonary embolus to the lobe are level. Segmental and subsegmental emboli may not be visualized by this study and cannot be entirely excluded.2. Significant progression of endobronchial/alveolar opacities which may reflect infectious or cellular debris. Intralobular septal thickening is a pattern that may be seen with pulmonary hemorrhage.3. Right lower lobe consolidation occurs over over a larger surface area of than would be expected for distal PE and most likely represents pneumonia.4. Worsening T9 and T10 superior endplate compression fractures since the prior study.PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative. |
Generate impression based on findings. | Evaluate for HCC. Cirrhosis LIVER: The liver measures 17.5 cm in length. No evidence of intrahepatic biliary ductal dilatation or dominant lesion. It is nodular in contour compatible with cirrhosis. The portal vein is patent with flow toward the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Common duct measures 4 mm which is within normal limits.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 10.4 cm in length and the left kidney measures 11.8 cm in length.OTHER: Spleen is enlarged measuring 22 cm in length. No ascites. | No substantial interval change compared to prior. Cirrhotic appearing liver with findings compatible with portal hypertension (splenomegaly). |
Generate impression based on findings. | Pain following crush injury. Rule out forefoot fracture. I see no fracture or dislocation. I see no specific findings to account for the patient's pain. | No fracture evident. |
Generate impression based on findings. | 77-year-old with history of left breast pain. The patient describes nonfocal pain. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | 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: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Knee pain and shoulder pain Four views of the right knee are provided. Moderate osteoarthritis affects the knee, particularly the medial tibiofemoral compartment. There is also chondrocalcinosis of the menisci. I see no joint effusion.Four views of the left knee are provided. Moderate osteoarthritis affects the knee, particularly the medial tibiofemoral compartment. There is also chondrocalcinosis of the menisci. I see no joint effusion.Three views of the right shoulder are provided. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. Tiny densities along the inferior margin of the glenoid rim may reflect labral chondrocalcinosis. A couple of tiny densities along the greater tuberosity may represent small foci of calcification within the rotator cuff at its insertion.Three views of the left shoulder are provided. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. Degenerative arthritic changes also affect the visualized spine. | Osteoarthritis of the knees and shoulders with other findings as described above. |
Generate impression based on findings. | 66 years old female with a history of lung cancer s/p chemoradiation with RUL mass and LN. Reason: evaluate for residual disease. RADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates a stable cavitary nodule in the superior segment of the right lower lobe. Linear opacities are seen in the lung bases. There is a stable small pericardial effusion. Multiple small gallstones are noted in the gallbladder. The uterus is enlarged with multiple calcified nodules.Today's PET examination demonstrates interval decrease of the metabolic activity in the nodule in the superior segment of the right lower lobe with SUVmax of 6.6 (it was 9.0 on prior study). There is also interval decreased metabolic activity in the right hilar lymph node with SUVmax of 3.0 (it was 5.4 on prior study). However, the new focus of increased activity in a soft tissue density in the cutaneous/subcutaneous tissue of the left lower posterior abdominal wall with SUVmax of 9.4. Several new hypermetabolic normal-sized lymph nodes are also seen in the left inguinal region with SUVmax of 2.6.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1. Interval decreased metabolic activity in the right lung nodule and right hilar lymph nodes.2.New FDG avid lesion in the left posterior abdominal wall. Suggest clinical correlation.3.New normal-sized mildly and metabolically active lymph nodes in the left inguinal region. Suggest clinical correlation. |
Generate impression based on findings. | Reason: mesothelioma s/p resection on observation, eval EOD, compare to previous History: none CHEST:LUNGS AND PLEURA: Postoperative changes in the left hemithorax redemonstrated.Nodular pleural thickening along the left hemidiaphragm (image 64 series 3) is stable.Small amount of loculated pleural fluid at the left costophrenic angle similar to the prior exam.No new left pleural nodules identified.Multifocal areas of pleural thickening and pleural calcification within the right hemithorax are unchanged. No evidence of contralateral disease.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary artery calcification.Patulous esophagus.Stable enlargement of the thyroid gland with multiple hypodense nodules.CHEST WALL: Postsurgical changes in the left hemithorax.Previously noted enhancement within the left latissimus dorsi muscle adjacent to the left scapular tip is unchanged and most likely is related to prior thoracotomy.Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hyperattenuating left renal mass (image 105 series 3) is unchanged and compatible with a hemorrhagic or proteinaceous cystPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta and iliac vessels.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Marked degenerative changes and degenerative disk disease within the lumbar spine.OTHER: No significant abnormality noted. | 1.Stable appearance to the pleural nodularity along the left hemidiaphragm and postsurgical changes left hemithorax. No definite evidence of recurrent disease.2.Multifocal areas of pleural thickening and pleural calcification in the right hemithorax unchanged.3.Patulous appearance of the esophagus compatible with achalasia.4.Stable appearance of hyperattenuating left renal mass most likely representing a hemorrhagic or proteinaceous cyst. |
Generate impression based on findings. | Pleural mesothelioma. CHEST:LUNGS AND PLEURA: Multiple pulmonary, septal and pleural nodules compatible with metastases, some of which are slightly larger. The reference right lung nodule measures 9 mm, previously 7-mm (5/41). Moderate right pleural fluid collection is new.Loculated pleural fluid and nodular pleural thickening on the left consistent with provided history of mesothelioma. Note is made of dehiscence of the left diaphragmatic mesh from the chest wall which was present previously. Left hemithorax reference pleural measurements as follows:Level of the great vessels (3/23): 10 o'clock position 11 mm, unchanged. 8 o'clock position 7 mm, previously 8-mm.Level of the left coronary artery (3/45): 12 o'clock position 10 mm, unchanged. 9 o'clock position 11 mm, previously 8-mm, slightly larger.Level of the left costophrenic angle (3/79): Six o'clock position 11 mm, previously 14-mm, the borders of the mesh/neo-diaphragm are better seen on today's study. Seven o'clock position 31 mm, previously 24 mm, larger.MEDIASTINUM AND HILA: Bulky bilateral mediastinal and hilar lymphadenopathy in all compartments, appearing increased in some areas such as the left subcarinal space. Nodular pericardial tumor involvement, about the same. Mild coronary artery calcification. Port tip in the SVC. The posterior mediastinum is invaded by tumor which extends between the esophagus and descending thoracic aorta, causing compression of the esophagus. The distal descending thoracic aorta is surrounded by tumor over approximately 50% of its circumference and its margins are effaced.Branches of the left pulmonary artery to the lower lobe are markedly attenuated.CHEST WALL: Intercostal space soft tissue at T9/T10 and T10/T11 is unchanged from the prior examination but new from remote earlier examinations, consistent with chest wall tumor. Low left intercostal lymphadenopathy (3/44, 3/60) is unchanged. Tumor extending into the left paravertebral fat at the thoracic inlet level (3/24), unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: New moderate volume of perihepatic ascites.SPLEEN: Soft tissue nodules in the splenic hilum better seen on today's study and consistent with foci of tumor (3/84), unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged cyst-like lesions.PANCREAS: Poorly defined 14-mm hypoattenuating lesion in the pancreatic head (3/120), likely localized ductal dilatation due to stenosis or mass versus a cystic neoplasm and present previously in retrospect, unchanged.RETROPERITONEUM, LYMPH NODES: Stranding and nodularity in the gastrohepatic ligament.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Peritoneal and omental nodularity, thickening and stranding compatible with peritoneal tumor, extending to the visualized pelvic inlet, with ascites.The left upper quadrant soft tissue mass measures 4.2 x 3.9 cm, previously 3.9 x 3.2 cm (3/75, 3/72).BONES, SOFT TISSUES: Scattered small nonspecific sclerotic foci in the spine, unchanged.OTHER: No significant abnormality noted. | Interval progression of disease in the upper abdomen. Left pleural disease not significantly changed however bulky lymphadenopathy has increased in some areas of the mediastinum as detailed in the body of the report. Right pleural effusion and ascites, new from the prior study. |
Generate impression based on findings. | Left leg weakness. Evaluate for CVA. There is subtle hypoattenuation in the posterior limb of the right internal capsule, which is age-indeterminate. There is mild parenchymal volume loss. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with mild age-indeterminate small vessel ischemic changes. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is opacification of the mastoid air cells bilaterally. There are calcifications of the cavernous portion of the bilateral internal carotid arteries. The skull and extracranial soft tissues are unremarkable. There is debris in the left external auditory canal. | 1. Subtle hypoattenuation in the posterior limb of the right internal capsule, which is age-indeterminate. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is no contraindications, MRI of the brain is recommended.2. No evidence of intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 47 years old; Reason: GIST s/p resection, eval EOD, compare to previous History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. The hepatic and portal veins are patent. Small hypodense focus in segment 4 of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the stomach. No residual mass is identified. Small bowel is normal in caliber and course.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: Nonspecific nodularity adjacent near the cecum. The appendix is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam following partial gastrectomy without evident metastatic disease. |
Generate impression based on findings. | Female, 49 years old s/p c-section, bilateral salpingectomy, and ureteral stent placement. RFO Trigger: Multiple surgical teams. Suspected RFO Location: Pelvis. Suspected RFO: None. JP drain, bilateral nephroureterostomy tubes, and midline staples are noted. No additional unexpected radiopaque foreign bodies. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign bodies. Findings were discussed with attending surgeon, Dr. Lengyel, over phone, at 1210 on 2/11/2015. |
Generate impression based on findings. | Status post fall on February 5. Ambulatory but with prepatellar swelling. Four views of the right knee are provided. There is swelling of the soft tissues anterior to the patella compatible with hematoma. There is a transverse/oblique fracture of the underlying patella with fracture fragments in near anatomic alignment. The fracture appears to disrupt the undersurface of the patella, but I see no large joint effusion. Tiny osteophytes indicate minimal osteoarthritis.The left knee appears normal as seen on the frontal views. | Nondisplaced patellar fracture. This was relayed to Dr. Birnie in person at the time of dictation. |
Generate impression based on findings. | History of T3N2b p16+ left tonsillar cancer status post chemoradiation completed 4/6/12 with subsequent right lung oligometastasis s/p SBRT completed 05/24/2013, then with progressed disease in lung on PET 3/2014, s/p VATS wedge resection with findings of multiple parenchymal and pleural-based nodules. Started pembrolizumab / MK-3475 trial (IRB 130311) clinical trial 7/11/14. After 6 cycles treatment was discontinued due to PD. Now being treated with cisplatin/5-FU/cetuximab started on 11/21/14. There are post-treatment findings in the neck, but no definite measurable mass to suggest locoregional tumor recurrence. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands appear unchanged. The major cervical vessels are patent. There is a right internal jugular venous catheter. The osseous structures are unchanged, including a prominent posterior osteophyte at T1. The airways are patent. The imaged intracranial structures are unremarkable. There is a fluid within the left maxillary sinus. A right internal jugular approach port-a-catheter is partially imaged. The partially imaged lungs are clear. | 1. Post-treatment findings in the neck without evidence of measurable locoregional tumor recurrence or significant lymphadenopathy in the neck. 2. Fluid within the left maxillary sinus may indicated acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 78 years old; Reason: Reassess lung metastases History: COugh ABDOMEN:LUNG BASES: The thorax will be reported separately.LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cyst appears simple. Other small cortical cysts of the right kidney are too small to fully characterize. Upper pole cyst in the left kidney has a thin wall. No definite nodularity. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy .BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bone metastases involving the lumbar spine and pelvis.OTHER: No significant abnormality noted. | 1.Osseous metastatic disease of the lumbar spine and pelvis. |
Generate impression based on findings. | 76-year-old abnormality seen on CT of the liver. Please evaluate. LIVER: The liver measures 14.3 cm in length. The recent abnormality identified on CT measures 1.6 cm in diameter. It is near anechoic with posterior acoustic enhancement, findings most characteristic of a simple cyst. The calcification seen on recent CT is not identified. A more definitive evaluation could be obtained with pre-and post enhanced cross-sectional imaging if desired clinically. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis. The right kidney measures 11.2 cm in length and the left kidney measures 11.6 cm in length.OTHER: The spleen measures 10 cm in length. | The liver nodule has sonographic features most compatible with a cyst; calcification noted on CT was not identified. A more definitive evaluation could be performed pre-and post enhanced cross-sectional imaging although a benign etiology is thought to be most likely based on imaging features. |
Generate impression based on findings. | Pain after fall. Rule out fracture. There is mild swelling of the anterior soft tissues of the leg, but I see no underlying fracture. Mild osteoarthritis affects the knee. Mild osteoarthritis also affects the ankle. A well corticated ossicle along the anterior aspect of the ankle joint may reflect old trauma or potentially a loose body in the joint. | Soft tissue swelling and osteoarthritis without acute fracture evident. |
Generate impression based on findings. | No history of trauma. Pain along dorsal and ulnar aspect of wrist, possibly distal radioulnar joint. There is mild soft tissue swelling along the ulnar styloid. I see no fracture or malalignment, and the wrist otherwise appears normal. | Mild soft tissue swelling along the ulnar styloid is nonspecific. |
Generate impression based on findings. | Balance problems. Back pain. Evaluate for degenerative disk disease. History of ACDF. History of lumbar laminectomy. Three views of the cervical spine are provided. Severe degenerative disease affects C4/5, C5/6, and C6/7. There is a minimal retrolisthesis of C5 relative to C6. There are minimal anterolistheses of C2 and C3. There is loss of the normal cervical lordosis. There is moderate multilevel facet joint osteoarthritis. Calcifications in the soft tissues lateral to the cervical spine likely reside in the carotid vasculature. I see no spinal hardware. Please note the cervical thoracic junction is not well seen on the lateral views due to overlying anatomy.Two views of the lumbar spine are provided. There is approximately 25 degrees of levoscoliosis of the lumbar spine as measured from the superior endplate of L1 to the inferior endplate of L4. The patient is status post lower lumbar laminectomy. There is severe degenerative disk disease throughout the lumbar spine. Severe degenerative disease also affects T11/12 and T12/L1. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. | Severe degenerative disk disease and other findings as above. |
Generate impression based on findings. | Female, 27 years old, with nasal blockage. Assess for chronic sinusitis. The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells, anterior and posterior, are clear. The maxillary sinuses are free of significant mucosal thickening/debris. The maxillary outflow pathways are unobstructed. Minimal mucosal thickening or secretion is evident within the superior aspect of the left nasal cavity. The nasal cavity is otherwise clear. The nasal septum is intact showing an S-shaped curvature in the axial and coronal planes with a leftward projecting bony spur. The turbinates are unremarkable.The lateral lamellae and fovea ethmoidalis are intact. The left fovea ethmoidalis is higher than the right, and the left olfactory groove is narrower than the right, all anatomic variations. | No evidence of acute or chronic sinusitis. |
Generate impression based on findings. | Right leg pain. Metastatic prostate cancer, femoral rod, new pain. Two views of the right femur and two views of the right hip are provided. Again seen is an intramedullary rod and screw/nail device affixing the femur in anatomic alignment. I see no hardware complications. A poorly defined sclerotic lesion in the intratrochanteric region appears similar to that seen on the prior study. The tensile trabeculae of the femoral neck are not well visualized compared to the prior study, which I suspect simply represents a benign "stress shielding" phenomenon, although I cannot entirely exclude osteolysis due to progression of metastatic disease. I see no fracture. Additional metastatic foci affecting the right obturator ring appear similar to the prior study. Mild osteoarthritis affects the right hip. | Orthopedic fixation of the femur, and metastatic prostate cancer as described above. |
Generate impression based on findings. | The thoracic spine is in normal alignment with a normal thoracic kyphosis. There are minimal degenerative changes; the vertebral body and disk heights are otherwise well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.The spinal cord is of normal caliber and signal. Mild apparent patchy T2 signal in the mid to lower thoracic cord is most likely artifactual.Degenerative changes in the cervical spine with minimal spinal canal stenosis at C6-C7 is again seen. Paraspinous soft tissue structures in the thoracic spine are unremarkable. | 1. No thoracic cord signal abnormality. 2. No spinal canal stenosis in the thoracic spine. |
Generate impression based on findings. | Female, 38 years old, with nasal blockage and headache. Assess for chronic sinusitis, deviated nasal septum. The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells, anterior and posterior, are clear. A lobular region of mucosal thickening or mucous retention cyst is evident along the medial wall of the left maxillary sinus. The maxillary sinuses are otherwise free of significant mucosal thickening/secretions. The maxillary outflow pathways are unobstructed.The nasal septum is intact and shows no significant deviation. The nasal turbinates are unremarkable. The nasal cavity is clear.The lateral lamellae and fovea ethmoidalis are intact and symmetric. The olfactory grooves are shallow bilaterally.Calcifications are evident in the palatine tonsils compatible with prior inflammation. | 1. No evidence of significant active or chronic sinusitis.2. No significant nasal septal deviation or other findings which would account for the patient's symptoms. |
Generate impression based on findings. | EGFR mutation on afatinib. CHEST:LUNGS AND PLEURA: Unchanged mildly nodular visceral and parietal pleural thickening. Right lower lobe lesion measures 16 x 9 mm, unchanged (5/66). No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: The reference right prevascular region lymph node measures 6-mm, previously 5-mm (3/25). Nonindex anterior mediastinal lymph node near the midline appears measures 10 mm, previously 9 mm (3/43). Nonindex right cardiophrenic lymph nodes unchanged.Normal heart size. Unchanged calcified subcarinal and right hilar region lymph nodes.CHEST WALL: Vertebral body hemangioma lower thoracic spine. Osteophytes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Sludge in the gallbladder. Granulomas.SPLEEN: Granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating cortical lesion left kidney probably a cyst but incompletely characterized.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged lymph node near the porta hepatis measuring 14 mm, previously 13-mm nonspecific. Calcified right iliac lymph nodes.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. | Stable right lower lobe lesion and nodular pleural thickening. No significant change in the reference mediastinal lymph nodes. A nonindex upper abdominal lymph node is not significantly changed but should continue to be monitored, nonspecific. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: Head trauma with loss of consciousness Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, midline shift or hydrocephalus.The gray -- white matter differentiation is preserved. The CSF cisterns remain patent bilateral cement pressures are fairly small in size.There is near complete effacement of cerebral cortical sulci which could be within normal patient stated age of 22. Possibility of mild underlying cerebral edema however cannot be entirely excluded. Recommend correlation with neurological assessment and consider repeat head CT or MRI if there is clinical concern for cerebral edema.Calvarium and soft tissues of the scalp are unremarkable and without evidence of posttraumatic changes.Almost the vessels and bilateral middle ear cavities as well as all visualized paranasal sinuses are well pneumatized. | 1.No acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus.2.Gray -- white matter is preserved.3.There is paucity of cortical sulci which could be within normal limits for patient of stated age of 22. Correlate with neurological evaluation and consider repeat CT if clinical concern persist. |
Generate impression based on findings. | Pain Three views of the right knee are provided. There is severe osteoarthritis with bone-on-bone apposition of the medial tibiofemoral compartment and tricompartmental osteophytes. There is a mild varus deformity of the knee.Three views of the left knee are provided. Severe osteoarthritis affects the knee, with near bone-on-bone apposition of the medial tibiofemoral compartment and tricompartmental osteophytes. There is a mild varus deformity of the knee. | Severe osteoarthritis. |
Generate impression based on findings. | Female, 64 years old, with metastatic head and neck squamous cell carcinoma enrolled in clinical trial (IRB 130311). Assessment of the oral cavity is significantly limited by streak artifact from dental amalgam. The floor of mouth and tongue base are unremarkable. No evidence of recurrent tumor is seen elsewhere along the aerodigestive tract.No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally. A heterogeneous but predominantly sclerotic lesion involving the manubrium is unchanged in size and overall appearance. No new osseous lesions are detected. | 1. No evidence of progressive disease in the neck.2. Stable predominantly sclerotic lesion involving the manubrium. |
Generate impression based on findings. | Back pain, possible DJD. Mild degenerative disk disease affects L2/3, L3/4, and L4/5. Small osteophytes project from the anterior aspects of the lumbar vertebrae. Mild facet joint osteoarthritis affects the lower lumbar spine. Vertebral body heights are preserved and alignment is within normal limits. | Mild degenerative disk disease as above. |
Generate impression based on findings. | Pain Two views of the right hip show severe osteoarthritis with bone on bone apposition superiorly.The AP view of the pelvis reveals the aforementioned severe osteoarthritis of the right hip. Relatively mild osteoarthritis affects the left hip. Sclerosis within the body of the left pubic bone is likely degenerative in etiology. Moderate to severe degenerative disk disease affects the visualized lower lumbar spine. Surgical clips are noted in the pelvis. | Osteoarthritis and other findings as above. |
Generate impression based on findings. | Postop ORIF Evaluation of fine detail is limited by overlying cast material. A plate and screw device affixes a fracture of the distal fibula in near-anatomic alignment. Two orthopedic screws also affix a fracture of the medial malleolus in near anatomic alignment. The "posterior malleolar" fracture seen on prior studies is not well visualized on the current study due to overlying hardware. | Orthopedic fixation of distal fibular and tibial fractures as above. |
Generate impression based on findings. | Metastatic esophageal cancer status post 12 cycles of FOLFOX. CHEST:LUNGS AND PLEURA: Mild emphysema and scattered granulomas, but no suspicious lesions. The background lung parenchymal is slightly high in density.MEDIASTINUM AND HILA: Small mediastinal and hilar lymph nodes are stable to slightly improved. The reference posterior mediastinal lymph node near the level of the diaphragm measures 10 mm, unchanged (3/93). Other small non-index lymph nodes in the posterior mediastinum are stable to slightly smaller. Very minimal thickening of the distal GE junction appears improved (3/93).No pericardial fluid. Severe coronary artery calcifications.CHEST WALL: Right chest port tip in the SVC, with some adherent thrombus near the tip of the catheter.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous poorly defined and indolent hepatic lesions without significant change. It is difficult to assess the borders of the reference lesion, approximately 16 x 29 mm, previously 16 x 27 mm (3/100).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive left renal calculus. Cortical low attenuating left renal lesion unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Suggestion of mild wall thickening and enhancement of the proximal stomach, about the same (3/96), though incompletely evaluated due to under distention of the stomach in the absence of oral contrast. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Small mediastinal lymph nodes are stable to slightly smaller in appearance. Minimal residual thickening of the distal GE junction appears improved and the gastric thickening appears similar. No significant change in hepatic lesions. |
Generate impression based on findings. | Rheumatoid arthritis. DJD. Pain and subluxation and limited motion. Three views of the left hand are provided. There is narrowing of the distal radioulnar joint with osteophyte formation. There is mild narrowing of the radioscaphoid articulation with small osteophytes. Moderate osteoarthritis affects the basilar joint. Mild irregularity of the margin of the trapezium on the oblique view may reflect chronic erosion, but this is equivocal. There is narrowing of the carpometacarpal joints with lucencies in the bases of the second and third metacarpals that may represent cysts or chronic erosions. There is severe uniform narrowing of the second metacarpophalangeal joint with volar subluxation of the proximal phalanx. There is a hitchhiker deformity of the thumb with osteoarthritic changes at the interphalangeal joint. There is narrowing of the third and fourth metacarpophalangeal joints with osteophytes projecting from the third, fourth and fifth metacarpal heads. There is narrowing of the proximal interphalangeal joints and distal interphalangeal joints of the fingers with osteophyte formation.Three views of the right wrist are provided. There is narrowing of the distal radioulnar joint with osteophyte formation. There is a slight positive ulnar variance. Moderate osteoarthritis affects the basilar joint, and there also appears to be narrowing of the midcarpal joint articulations. There is narrowing of the second and third carpometacarpal joints as well. Lucencies within the trapezoid and capitate may represent cysts or chronic erosions. There is narrowing of the first through fourth metacarpophalangeal joints with volar subluxation of the second proximal phalanx. Osteophytes project from the heads of the metacarpals. There is narrowing of the interphalangeal joints of the thumb and fingers with osteophytes. A small metallic density is noted adjacent to the neck of the proximal phalanx of the index finger, likely represent a foreign body.Three views of the right shoulder are provided. Severe osteoarthritis affects the glenohumeral joint. There may be slight posterior subluxation of the humeral head relative to the glenoid as seen on the transscapular view, but this is equivocal. Osteoarthritis also affects the acromioclavicular joint. The humeral head is high riding, suggestive of a chronic rotator cuff tear. | Severe arthritic changes as described above appear predominantly degenerative in etiology, although may be secondary to an underlying inflammatory arthritis such as rheumatoid arthritis. |
Generate impression based on findings. | Ankle pain. Rule-out fracture.VIEWS: Right ankle AP/lateral/oblique (3 views), left ankle AP/lateral/oblique (3 views) 02/11/15 The bones are normal in appearance. Alignment is anatomic. No fracture is seen. A joint effusion is not present. | Normal ankles. |
Generate impression based on findings. | 84 year old male. Mesothelioma restaging. Cough. CHEST:LUNGS AND PLEURA: Two separate areas of nodular pleural thickening consistent with tumor in the left hemithorax:1. Left posterior mediastinal pleural tumor encasing the descending thoracic aorta at the level of the left superior pulmonary vein, 8 o'clock position: 18 mm thickness (series 3, image 52).2. Left hemidiaphragm pleural tumor, 10 o'clock position: 22 mm thickness (series 3, image 91). Fine curvilinear pleural calcifications bilaterally consistent with prior asbestos exposure. Calcified right lung granulomas consistent with healed granulomatous disease.MEDIASTINUM AND HILA: Calcified mediastinal and right hilar lymph nodes consistent with healed granulomatous disease.Severe coronary artery calcifications.Normal heart size without pericardial effusion.CHEST WALL: Very mild degenerative changes of the thoracolumber spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic calcifications consistent with healed granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Calcified atherosclerotic disease of the abdominal aorta and ectatic common iliac arteries (measuring up to 1.9 cm) with eccentric mural thrombus. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Focal lytic lesion in the T11 vertebral body with coarsened trabeculae consistent with hemangioma.OTHER: No significant abnormality noted. | Two nodular areas of pleural thickening in the left hemithorax consistent with known mesothelioma. Invasion into the diaphragm by the left basilar tumor cannot be excluded. No additional evidence of disease in the abdomen.Severe coronary artery calcifications. |
Generate impression based on findings. | Right hip pain. Rule-out fracture.VIEWS: Pelvis AP/frog leg (two views) 02/11/15 The femoral heads are round and smooth. There well directed into normally formed acetabula. Alignment is anatomic. No fracture is seen. | Normal examination. |
Generate impression based on findings. | 16-year-old female with knee pain, evaluate for fractureVIEWS: Right knee, AP, lateral, sunrise, skiers (4 views), left knee AP, lateral, sunrise, skiers (4 views), lumbar spine, AP and lateral (two views.) 2/11/15 11:54 Knees: Alignment is anatomic. There is no fracture, joint effusion or other specific finding to account for patient's symptoms.Lumbar spine: Vertebral body heights and disk spaces are maintained. There is mild straightening of the lumbar spine without other specific finding to account for the patient's pain. | Normal examination. |
Generate impression based on findings. | 0 day old male (per chart 32 week old newborn infant) with respiratory distress. Evaluate endotracheal tube placement.VIEW: Chest and Abdomen AP (two views) 2/11/2015 11:46 ET tube tip at the level of the thoracic inlet. Persistent diffuse bilateral hazy lung opacities with minimal improvement. No pleural effusion or pneumothorax. Cardiothymic silhouette is normal. Nonobstructive bowel gas pattern. | ET tube tip at the level of the thoracic inlet. Persistent diffuse bilateral hazy lung opacities with minimal improvement. |
Generate impression based on findings. | Clinical question: Status post LVAD. History of ischemic stroke. Evaluate stroke. Signs and symptoms: Right arm weakness. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is interval evolution of a left MCA territory posterior temporal -- parietal subacute stroke two a chronic phase. There is resultant mild expansion of left lateral ventricle. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. A tiny left ethmoid osteoma is again identified. | 1.No acute intracranial findings. 2.Interval evolution of previously seen acute stroke or chronic phase in the left posterior temporal -- parietal region. |
Generate impression based on findings. | 65 years, Male. Reason: Dobbhoff placement History: Dobbhoff placement Bilateral chest tubes are unchanged. Median sternotomy wires, fixation plates, and mediastinal clips are unchanged. Interval removal of Swan-Ganz catheter. Dobbhoff tube tip projects over the first portion of the duodenum.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the first portion of the duodenum. |
Generate impression based on findings. | Patient with metastatic prostate cancer (right pelvic lesion); needs surveillance scans. CHEST:LUNGS AND PLEURA: Mild chronic lung disease including sub pleural reticulation with mild traction bronchiectasis, similar to prior. Stable pulmonary micronodules. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mild coronary artery calcifications.CHEST WALL: Stable sclerotic foci in fourth and sixth left ribs.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Left percutaneous nephroureteral stent in place without hydronephrosisRETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter, new from prior.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged. Abnormal soft tissue extends from the posterolateral prostate gland toward the left pelvic sidewall appearing similar to prior. BLADDER: No significant abnormality notedLYMPH NODES: A left internal iliac lymph node (series 3, image 152) measures 1.4 x 2.8 cm and in retrospect appears similar to multiple prior studies. BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing right inguinal hernia. Stable appearance of the right inferior pubic ramus sclerotic lesion. OTHER: No significant abnormality noted | 1.Stable exam without evidence of new metastatic disease from patient's known prostatic carcinoma.2.Please see bone scan from same day for additional details regarding osseous metastases. |
Generate impression based on findings. | 13-year-old female with ankle pain, evaluate for fractureVIEWS: Left ankle, AP, oblique, and lateral (3 views), right ankle, AP, oblique, and lateral (3 views.) 2/11/15 12:06 Left ankle: Alignment is anatomic. No fracture or soft tissue swelling. The tibiotalar joint appears normal.Right ankle: Alignment is anatomic. No fracture or soft tissue swelling. The tibiotalar joint appears normal. | Normal examination. |
Generate impression based on findings. | History of bladder cancer, assess for recurrence ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Segment 4b subcentimeter low-attenuation hepatic lesion stable and likely benign. Status post cholecystectomy.SPLEEN: Calcified splenic granulomas, similar to prior.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter low attenuation left renal lesion too small to characterize but likely benign cyst, unchanged. No hydronephrosis. Prompt and symmetric excretion of contrast is seen into normal pyelocalyceal systems bilaterally. Ureters are well opacified with normal appearance through their entire length to the continent pelvic neobladder.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease of the abdominal aorta and its branches including mild ectasia of the infrarenal aorta appearing similar to prior.BOWEL, MESENTERY: Postsurgical changes to the GI tract. No evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine, similar to prior. OTHER: No significant abnormality notedPELVIS: Evaluation of the pelvic structures limited by metallic streak artifact from bilateral hip prostheses; within this limitation:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Post cystectomy with continent neobladder in expected position with no abnormality seen and no evidence of tumor recurrence in the surgical bed.LYMPH NODES: Extensive surgical clips seen bilaterally from prior lymphadenectomy. No evidence of recurrent lymph node enlargement or abnormal masses seen.BOWEL, MESENTERY: Postsurgical changes to the GI tract. No evidence of obstruction.BONES, SOFT TISSUES: Bilateral hip prostheses. Degenerative changes of the thoracolumbar spine, similar to prior. OTHER: No significant abnormality noted | 1.Status post cystectomy with continent neobladder. 2.No evidence of tumor recurrence or metastatic disease. |
Generate impression based on findings. | Clinical question: Evaluate for acute process, hypertensive in emergency room. Signs and symptoms: Four days of headache. Nonenhanced head CT:There is no detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic stroke.In the cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal for patient stated age of 43.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses, mastoid air cells and middle ear cavities. | Negative nonenhanced head CT. |
Generate impression based on findings. | Lung mass in a patient with smoking history.RADIOPHARMACEUTICAL: 11.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates a spiculated left upper lobe mass, similar in size to the prior CT, which abuts the major fissure. Two additional subcentimeter nodules are identified in the left upper lobe and right upper lobe. There are calcified hilar and mediastinal lymph nodes. There are severe coronary artery calcifications. The thyroid is prominent with substernal extension. Two hypodense left and right hepatic lobe lesions are incompletely characterized on this examination. A coarse hepatic parenchymal calcification is noted in the right hepatic dome. Three exophytic left renal lesions are again identified. There is a right inguinal hernia containing a non-obstructed loop of colon. There is a coarsened appearance of the trabeculae of the pelvic bones. There is mild loss of height of the L5 vertebral body.Today's PET examination demonstrates a markedly hypermetabolic left upper lobe mass with a max SUV of 11.4 consistent with primary lung cancer. An additional subcentimeter left upper lobe nodule, max SUV of 4.6, may represent a synchronous primary or metastatic disease. A subcentimeter right upper lobe pulmonary nodule is non-specific, max SUV of 1.1. A right lower lobe opacity is likely inflammatory. There are several foci of mild FDG activity in the left hilum which are suspicious for nodal metastases, max SUV of 3.4. A mildly hypermetabolic pretracheal lymph node is also seen, max SUV of 2.8. All three left renal masses demonstrate increased FDG activity. The left lower pole renal lesion containing macroscopic fat on the prior CT has a max SUV of 3.8, the midpole lesion has a max SUV of 3.3, and the largest posterior lesion has a max SUV of 2.7. There is increased FDG in the right ischial bone though no focal lesion. Increased FDG activity within the L5 vertebral body with loss of height is likely related to trauma. | 1.Markedly hypermetabolic left upper lobe mass is consistent with lung cancer. A smaller hypermetabolic left upper lobe nodule may represent a synchronous malignancy or metastatic disease. 2.Mildly hypermetabolic left hilar and pretracheal lymph nodes are suspicious for nodal metastases.3.Three left renal lesions with increased FDG avidity are suspicious for renal cell carcinoma.4.Right upper lobe pulmonary nodule is non-specific and may represent a benign inflammatory process or small tumor. |
Generate impression based on findings. | 66 years, Male. Reason: dht placement History: dht placement Dobbhoff tube is coiled with tip projecting over the gastric cardia. Prosthetic mitral valve. Chest findings unchanged from prior exam.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the gastric cardia. |
Generate impression based on findings. | Reassess lung metastases. Previous history of adenocarcinoma. LUNGS AND PLEURA: Consolidation surrounding the left upper lobe bronchus and extending to the lung apex appears less bulky, 21 x 37 mm (axial image 40) when measured in a similar fashion (previously 45 x 27 mm). The hypoattenuating component laterally measures 17 x 16 mm, decreased from a previous size of 23 x 25 mm (image 42).Right upper lobe lesion measures 6 x 8mm (image 53 lung windows, previously 7 x 8mm.A hypoattenuating endovascular filling defect which appears to be within a descending pulmonary artery branch is smaller (image 77). This appeared to demonstrate internal vasculature or enhancement on the prior examination, atypical for a pulmonary embolus and suspicious for an endovascular metastasis. Minimal pleural thickening/fluid on the left has improved. Scarring bilaterally, about the same. MEDIASTINUM AND HILA: Right paratracheal lymphadenopathy appears improved, no longer measurable of the reference level, but at a slightly higher level near the aortic arch it has decreased to 11-mm from a prior size of 15-mm (image 45). Bilateral hilar and subcarinal lymphadenopathy about the same.Small volume pericardial fluid, unchanged. Nodular thyroid gland, nonspecific. Moderate coronary artery calcifications.CHEST WALL: Skeletal metastases similar to previous with pathologic fracture of the right side of the T11 vertebral body and the superior endplate of T8. A T11 osseous lesion extends into the spinal canal, effacing the thecal sac, please note that this technique is insensitive for detection of cord compression.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range appears unchanged. | Overall improvement in reference measurements. T11 vertebral body expansile metastasis effaces the thecal sac, cord compression cannot be accurately excluded by this technique. |
Generate impression based on findings. | 34-year-old female patient with abdominal pain and early satiety. UPPER GI:Double contrast visualization of the esophagus showed normal appearing mucosa. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface had thickened rugal folds and prominent area gastricae in the fundus and body (series 9 and 14). No ulcers were seen.There was nodularity in the first and second portions of the duodenum that were soft and effaceable (series 14). No ulcers were seen.SMALL BOWEL FOLLOW THROUGH:Transit time to the colon was 30 minutes. Fluoroscopic evaluation showed normal mucosa throughout the ileum and jejunum, with no ulcers, sinus tracts, fistulae, or adhesions. Spot compressions in the area of the patient's pain in the left hemiabdomen were normal in appearance (cine series #38). No separation of bowel loops was present to suggest fibrofatty proliferation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 11:20 minutes | 1.Thickened rugal folds and prominence of the area gastricae in the stomach as well as soft nodularity of the duodenum are compatible with gastroduodenitis.2.No abnormalities identified in the jejunum or ileum. |
Generate impression based on findings. | History of right frontal oligodendroglioma (grade 3) diagnosed 6/13, status post XRT and chemo (on decadron) with craniotomy. Evaluate for fluid collection at craniotomy site. There are post-surgical findings related to a right frontal craniotomy. There is diffuse white matter hypoattenuation of the bilateral frontal lobes, right greater than left. There are scattered calcific densities in the right frontal lobe. Evaluation for abscess and tumor is otherwise limited by the lack of intravenous contrast. There is an epidural collection beneath the craniotomy flap measuring 3 mm in width. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a partially empty sella. | 1. Post-surgical findings related to a right frontal craniotomy with a nonspecific epidural collection beneath the craniotomy flap measuring 3 mm in width.2. White matter hypoattenuation of the bilateral frontal lobes may represent edema, tumor infiltration, and/or radiation effects.3. Evaluation for abscess and tumor is otherwise limited by the lack of intravenous contrast and MRI may be useful for further characterization if there are no contraindications for this modality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 25 years old Reason: r/o fx History: slammed in car door. There is a 2-mm density along the ulnar aspect of the tuft of the distal phalanx, likely representing a small, minimally displaced fracture fragment. There is swelling of the soft tissues of the finger tip. | Minimally displaced fracture of the ulnar aspect of the tuft of the distal phalanx. |
Generate impression based on findings. | Male 50 years old Reason: RLQ pain History: same ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Dysmorphic hepatic contour is again seen and unchanged from prior exam.SPLEEN: Stable splenomegaly.PANCREAS: 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: Redemonstrated are gastroesophageal varices and splenorenal shunting consistent with portal hypertension.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No acute abnormality is evident to explain patient's right lower quadrant pain.2.Stable examination with dysmorphic contour of the liver and findings compatible with portal hypertension. |
Generate impression based on findings. | History of Diabetes. Feels food and water stay stuck in her stomach. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 64.3 % of peak activity (normal >70 %)1 hour: 35.2 % of peak activity (normal 30-90 %) 2 hours: 8.4 % of peak activity (normal <60 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | 72-year-old female. NSCLC. Please restage. CHEST:LUNGS AND PLEURA: Circumferential right pleural thickening is stable to mildly decreased. The reference right upper lobe pleural thickening is 11 mm, previously 14 mm (series 3, image 48). Reference pleural thickening adjacent to the right brachiocephalic vein is unchanged at 4 mm (series 4, image 34).Right basilar pulmonary masses have decreased in size. The reference larger mass is 42 x 46 mm (series 3, image 71), previously 60 x 66 mm. The more anterior smaller mass is 17 x 36 mm, previously 33 x 38 mm (series 3, image 72).Small amount of loculated pleural fluid at the right base is similar to prior. Stable scattered calcified and noncalcified micronodules, most likely postinflammatory.MEDIASTINUM AND HILA: Confluent subcarinal lymphadenopathy, not significantly changed. Calcified mediastinal nodes consistent with healed granulomatous disease.Moderate coronary artery calcification.Nonspecific thyroid nodules, unchanged.Left chest wall port tip in SVC.CHEST WALL: Extension of tumor through the right chest wall with soft tissue metastasis, not significantly changed. The reference lesion is 25 x 9 mm (series 3, image 83), previously 25 x 11 mm. Right axillary surgical clips.Mild degenerative changes of the thoracolumber spine. Stable sclerotic lesion in the T4 vertebral body, likely a bone island.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Significant motion artifact in the left upper abdomen limits evaluation.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic calcifications consistent with healed granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe calcified atherosclerotic disease of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumber spine.OTHER: No significant abnormality noted. | Interval decreased size of right lung masses. No new sites of disease identified. |
Generate impression based on findings. | Prostate cancer, now with rising PSA following prostatectomy. New exam. No abnormal osseous foci are identified to indicate metastatic disease.Small lesions are noted in the left posterolateral 11th and 12th ribs represent healing fractures and correlate with the CT chest from 5/7/2013. A nonspecific focus is also seen in the lateral aspect of the ninth rib which likely is post-traumatic in etiology. The focus in the sternal region is without change and more likely represents degenerative changes, correlating with the region of a sterno-sternal joint on prior CT. Degenerative changes are noted about the glenohumeral joints, hips, knees and first metatarsals bilaterally. The left ischial/acetabular activity has decreased and is not well visualized on this exam. | Degenerative osseous changes and post-traumatic activity in the ribs without discrete evidence of bone metastases. |
Generate impression based on findings. | 15-year-old female with right tibial periosteal reaction. Chronic periosteal reaction is noted along the posterior aspect of the proximal tibia. This finding is compatible with stress fracture and appears similar to prior outside radiographs and CT. No acute fracture or dislocation. | Chronic periosteal reaction compatible with stress fracture and not significantly changed. |
Generate impression based on findings. | Clinical question: No skull or abdomen. Bump on top of the head. Tender to touch. Signs and symptoms: Szabo. Nonenhanced head CT:Examination demonstrate no evidence of acute intracranial process.There is normal density and anatomical morphology of cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter initiation.Calvarium demonstrate diffuse scalloping along the inner table of the skull with multiple foci of moderate bony thinning. There is a posterior frontal high convexity immediate left paramedian focus of calvarial scalloping (sagittal series 80491 image 23 and coronal series 80388 image 17) with resultant moderate bony thickening of barium. A slightly smaller similar finding immediately on the right is also present. On the left there is very subtle underlying prominence of subarachnoid space which may be an anatomical variation or possibly a tiny arachnoid cyst. There is no evidence of any bony erosive/destructive changes associated with bony scalloping. There is also no evidence of subgaleal or scalp associated findings.This finding is nonspecific and could represent an anatomic variation. This finding could conceivably be secondary to increased intracranial pressure however on this exam there is no evidence of increased intracranial pressure on the CSF cisterns as well as cortical sulci remain within normal.Unremarkable images through the orbits.Bilateral mastoid air cells and middle ear cavities remain well pneumatized and unremarkable. Paranasal sinuses demonstrate mild to moderate chronic pansinusitis. | 1.No acute intracranial process.2.Diffuse scalloping deformity of the inner table of the skull with resultant bony thinning of the calvarium however without evidence of destructive/erosive changes of the calvarium and without associated extracranial or intracranial findings. Similar bony changes in the bilateral immediate paramedian posterior frontal region could represent site of clinically indicated bump on the calvarium.3.Consider follow-up with an MRI if clinically deemed necessary.4.Unremarkable intracranial content as detailed. Please see above comments. |
Generate impression based on findings. | 70 year-old woman with history of left breast ILC status post mastectomy in 2010. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Vascular calcifications are noted. A few scattered asymmetries are stable. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Dysphonia, weight loss, and neck mass There is an infiltrative necrotic mass involving the supraglottic larynx and hypopharynx with extension to the vocal cord and the subglottic region on the left with moderate airway narrowing. The laryngeal cartilage framework appears to be grossly intact. There are enlarged cervical lymph nodes, with the largest left level 2 lymph node measuring 2.3 x 1.7 cm. There is very poor dentition with nearly all teeth absent and the remainder are carious. There is multilevel cervical spondylosis with scattered nonspecific lucencies within the vertebral bodies of C5, C6, and C7. A small sclerotic focus in the left clavicular head likely represents a benign bone island. A lobulated focus of high attenuation is present in the left thalamus measuring 1.3 x 0.6 cm with perhaps mild surrounding edema and mass effect. The salivary and thyroid glands appear unremarkable. There is mild paraseptal emphysema of the lung apices. | 1. An infiltrative and necrotic supraglottic laryngeal mass and hypopharynx with extension to the vocal cord and the subglottic region on the left likely represents squamous cell carcinoma with moderate airway narrowing. 2. Bilateral cervical lymphadenopathy likely represents lymph node metastases. 3. Focal high attenuation in the left thalamus without significant associated edema or mass effect. Differential considerations include an incidental vascular malformation and intracranial metastasis. MRI brain is recommended for further evaluation, if there are no contraindications for this modality. 4. Nonspecific lucencies within the vertebral bodies of C5, C6, and C7 are likely be degenerative in nature. 5. Dental disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: h/o SGLarynx ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: A new rounded solid nodule at the right lung apex measures 11 x 11 mm (series 4, image 47), suspicious for solitary pulmonary metastasis or primary lung malignancy. No other new suspicious pulmonary nodules or masses are seen. Mild basilar atelectasis/scarring, dependent atelectasis. No focal airspace consolidation. No pleural effusions. Mild upper lobe predominant paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: The heart is mildly enlarged without pericardial effusion. Severe coronary artery calcifications. Atherosclerotic calcification of the thoracic aorta and its branches. Increasing mediastinal lymphadenopathy, with right paratracheal lymph node measuring up to 14 mm in short axis (series 3, image 29).CHEST WALL: Right chest wall port, tip in right atrium.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable mild intrahepatic and extrahepatic biliary ductal dilatation, without obstructing mass or common bile duct stone definitively seen.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal nodularity, left greater than right is stable from prior exams.KIDNEYS, URETERS: Stable bilateral renal cysts.PANCREAS: No significant pancreatic ductal dilatation or pancreatic atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. A new solid 1cm nodule at the right lung apex is suspicious for solitary pulmonary metastasis or primary lung malignancy. 2. Enlarging right paratracheal lymph node concerning for metastatic lymphadenopathy. |
Generate impression based on findings. | Female 67 years old Reason: fall on outstretched hands History: severe pain, limited ROM. Three views of the right shoulder are provided. The bones appear demineralized. We see no acute fracture or dislocation. Mild osteoarthritis affects the acromioclavicular joint. There are enthesopathic changes along the greater tuberosity at the expected site of insertion of the rotator cuff.We have 4 views of the right elbow. We see no fracture or malalignment. We see no joint effusion. There are mild chronic appearing enthesopathic changes along the medial and lateral epicondyles of the distal humerus.We have 3 views of the right wrist. There is slight widening of the scapholunate interval, which may reflect scapholunate ligamentous laxity or disruption, but is not necessarily of current clinical significance. Mild osteoarthritis affects the basilar joint. | Mild degenerative changes of the shoulder, right elbow, and wrist as described above without a fracture. Please note that the humerus and bones of the forearm are not included in their entirety on these studies, and if further imaging evaluation is clinically warranted, dedicated humerus and forearm radiographs may be considered. |
Generate impression based on findings. | History of NHL; Day 100 status-post auto stem cell transplant.RADIOPHARMACEUTICAL: 12.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 111 mg/dL. Today's CT portion grossly demonstrates lymphadenopathy within the right supraclavicular, anterior mediastinal, subcarinal and right cardiophrenic regions. The left chest port is noted with the tip in the SVC. Multiple small calcified pulmonary nodules are noted.Today's PET examination demonstrates significantly increased FDG avid activity corresponding with lymph nodes within the left posterior level V cervical, right supraclavicular, anterior mediastinal, right paratracheal, right hilar, subcarinal, right cardiophrenic, portocaval and peripancreatic regions as well as involvement of several lymph nodes in the paraortic retroperitoneal region. The highest SUV is within the 2.6 cm mass in the right cardiophrenic angle which measures 31. The left glenohumeral region is likely degenerative. | Interval significant recurrence of the lymphoma within multiple lymph node regions in the neck, chest and abdomen. |
Generate impression based on findings. | History of neuroblastoma, now off therapy.RADIOPHARMACEUTICAL: 3.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 113 mg/dL. Today's CT portion of the neck demonstrates multiple small level II, III, and IV cervical lymph nodes, right greater than left, which have slightly increased in number and size compared to the prior examination. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates multiple level II, III, and IV lymph nodes with mild to moderate FDG activity. For example a right level II lymph node measures max SUV of 3.8, previously 2.7. Normal thymic activity is again seen.No abnormal FDG activity is seen within the abdomen or pelvis. | Interval increase in number and size of multiple cervical lymph nodes with mild to moderate FDG activity in both sides of the neck. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 40 year-old male patient with history of a left ileal ureter. Evaluate for reflux. Scout film demonstrated no abnormal calcification.Cystografin was administered by gravity via the Foley catheter and maximal distention was achieved at 500 cc, at which point the examination was terminated secondary to significant retrograde filling of the left ileal ureter.No mucosal abnormality was evident and the bladder contour was normal. There was spontaneous reflux of contrast into the left ileal replaced ureter, past the anastomosis with the proximal ureter, and into the left renal calyxes. The anastomosis of the ileal ureter to the bladder measures 1.5-1.8 cm in diameter. The average diameter of the ileal ureter is approximately 4.3 cm. 1.5 cm of the proximal native ureter remains. There was no hydronephrosis seen. There was brisk antegrade peristalsis of the ileal segment (cine series 16). Subsequently, the urinary catheter was removed and the patient was instructed to void. After numerous attempts, there was no passage of contrast into the urethra. The distended bladder in lateral projection measures 9.0 cm AP x 9.6 cm CC. | 1.Reflux of contrast into the left ileal ureter without evidence of hydronephrosis. 2.Patient unable to void distended bladder. |
Generate impression based on findings. | 84-year-old female status post left total hip arthroplasty. Two views of the left hip demonstrate a total arthroplasty device in anatomic alignment without evidence of hardware complication or loosening. Subcortical lucency along the medial aspect of the femoral component of the device has been stable since at least 2013. Single AP view of the pelvis again shows the total left hip arthroplasty as well as a total right hip arthroplasty device which is in anatomic alignment without evidence of loosening or complication. No acute fracture or dislocation identified. Severe degenerative disease is again noted in the lower lumbar spine. | Bilateral total hip arthroplasty devices without evidence of complication or interval change. |
Generate impression based on findings. | 60 year old female with history of epigastric pain, assess for gastric hernia, diverticulum, or paraduodenal hernia Double contrast visualization of the hypopharynx showed no mucosal abnormality or diverticulum. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. No Zenker's diverticulum, webs, bars, or strictures. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Swallowed barium pill passed into the stomach without delay.The stomach was normal in size, shape, and position. No hernia. Prominent areae gastricae throughout the stomach may be normal or represent gastritis. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal.The duodenal bulb and sweep were within normal limits. TOTAL FLUOROSCOPY TIME: 10:14 minutes | Normal examination of the esophagus, stomach, and duodenum. |
Generate impression based on findings. | 55-year-old female status post orthopedic fixation of distal radioulnar joint. Metallic distal ulnar prosthesis status post distal ulnar resection. Orthopedic sideplate/screw device is noted in the distal radius with surrounding defects from previous sideplate and screw device which has been removed. The radiocarpal joint is fused. Alignment is near anatomic and there is no evidence of hardware complication or loosening. | Orthopedic fixation of the distal radius and ulna with wrist fusion as described above. |
Generate impression based on findings. | Head and neck carcinoma CHEST:LUNGS AND PLEURA: Stable reference right middle lobe nodule best seen on image 64 series 5 measuring 1 x 0.6 cm.Previously mentioned subcentimeter ground glass opacity within the right lower lobe no longer appreciated.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar low attenuation foci. Status post cholecystectomy.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.BOWEL, MESENTERY: Stable high attenuation focus within the right paracolic gutter best seen on image 156 of series 3 measuring 0.7 x 0.7 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination. |
Generate impression based on findings. | Male 62 years old Reason: 62 yo M with PMH of psoriatic arthritis and OA in b/l hands History: b/l hand pain. We have 3 views of the left hand which show severe arthritic changes of interphalangeal joints, with osteophytes and predominately central erosions. There is ankylosis of the proximal interphalangeal joint of the fifth finger and the distal interphalangeal joint of the index finger. There is mild narrowing of the first and second metacarpophalangeal joints, and moderate to severe osteoarthritis of the basilar joint. There is also moderate to severe osteoarthritis of the triscaphe joint.Three views of the right hand show severe arthritic changes of the interphalangeal joints with osteophytes and central erosions. There is ankylosis of the proximal interphalangeal joint of the fifth finger. There may be some narrowing of the metacarpophalangeal joints, but this is equivocal. Severe osteoarthritis affects the basilar joint and the triscaphe joint.We have 3 views of the left foot. There is fusion of the distal interphalangeal joints of the third and fifth toes that we suspect is congenital in etiology rather than due to underlying inflammatory arthritis. Mild osteoarthritis affects the remaining interphalangeal joints, as well as the first metatarsophalangeal joint. The remainder of the foot is unremarkable.We have 3 views of the right foot. There is narrowing of the interphalangeal joints likely representing osteoarthritis. There are also erosions of the interphalangeal joints of the third and fourth toes. Mild to moderate osteoarthritis affects the ankle. There is a lucency in the first metatarsal head which may represent a cyst or, less likely, a chronic erosion.We have 3 views of the sacroiliac joints. Mild osteoarthritis of the sacroiliac joints which otherwise appear normal for age. Degenerative disk disease affects the lower lumber spine. | Severe arthritic changes predominantly affecting the interphalangeal joints of the hands as described above. The overall picture is that of erosive osteoarthritis. |
Generate impression based on findings. | 61-year-old female with history of right greater tuberosity fracture as well as ORIF of proximal tibia. Three views of the right shoulder demonstrate an indistinct and nondisplaced greater tuberosity fracture line compatible with interval healing. The bones are diffusely demineralized.Two views of the right lower extremity demonstrate an orthopedic plate and screw device which affixes the right proximal tibia in near-anatomic alignment. Sclerotic changes in the lateral tibial metaphysis and lack of a distinct fracture line are compatible with interval healing. | Healing greater tuberosity and tibial plateau fractures as described above. |
Generate impression based on findings. | 41-year-old female with outside hospital CT in September suggesting ileus versus small partial obstruction and complaints of abdominal pain and bloating after eating. No prior surgical history. The scout film shows a nonobstructive bowel gas pattern. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. The bowel loops were freely mobile during fluoroscopically monitored palpation. Transit time to the terminal ileum was 30 minutes. Spot films of the terminal ileum were within normal limits although the patient was tender to deep palpation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal with opacification of the appendix. TOTAL FLUOROSCOPY TIME: 7:09 | Essentially normal examination of the small bowel and proximal colon. |
Generate impression based on findings. | 60 year-old female with distal fibular and posterior tibial plafond fractures. Spiral fracture of the distal fibula is again noted which extends to the tibiotalar joint. An additional nondisplaced fracture of the posterior malleolus is also again identified. Both of these fractures appear similar to the prior study. Soft tissue swelling about the lateral ankle. | No significant interval change in ankle fractures as described above. |
Generate impression based on findings. | Reason: Re-evaluate for growth right middle lobe nodule and assess any change in adenopathy. Patient has history of lung cancer. Prior bilateral upper lobe wedge resections. History: none LUNGS AND PLEURA: Status post right upper lobe resection, with stable linear and nodular scarring along the suture line. A previously described right middle lobe ground glass nodule measures approximately 9 mm (series 7, image 62), similar in appearance compared to the prior exam.Scattered small right lower lobe nodules are new from the prior exam, likely inflammatory in etiology, including aspiration. Mild basilar subsegmental atelectasis/scarring. No focal air space consolidation. No pleural effusions. Mild centrilobular emphysema.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Mild coronary artery calcification. Scattered small mediastinal and hilar lymph nodes are unchanged.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable right retrocrural lymph node measuring 7 mm (series 5, image 95), previously 8 mm. Additional small retrocrural nodes are unchanged. | 1. Stable 9mm right middle lobe ground glass nodule most likely representing AAH (atypical adenomatous hyperplasia). Continued followup imaging is recommended.2. New scattered small right lower lobe nodules, likely related to inflammatory process, including aspiration. 3. Bilateral upper lobe wedge resections without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 47 years, Male. Reason: Dobbhoff History: Dobbhoff Support devices are unchanged. Dobbhoff tube with tip projecting over the proximal gastric body.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 47 years, Male. Reason: Dobhoff placement History: Dobbhoff placement Support devices are unchanged. Interval removal of NG tube and placement of Dobbhoff tube with tip projecting over the proximal gastric body.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | History of metastatic breast cancer on treatment, compare to prior imaging and evaluate for response and extent of disease. Numerous metastatic lesions in the axial skeletal and skull are not significantly changed. No new osseous lesions. | Stable extensive osseous metastases. |
Generate impression based on findings. | 28 years, Female. Reason: Assess for obstipation or colonic distension History: Hx of Crohn's; abdominal pain and distension Air-filled colon with average stool burden in the sigmoid colon and rectum. Nonobstructive bowel gas pattern. No intramural gas or pneumoperitoneum identified. | Average stool burden in the sigmoid colon and rectum. |
Generate impression based on findings. | Female 77 years old Reason: malabsorption / r/o vascular disease History: malabsorption / diarrhea CT Angiography: Mild aneurysmal dilatation of the abdominal aorta measuring up to 2.5 cm (series 9, image 60). There is no evidence of aortic dissection or significant stenosis. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent. Significant atherosclerotic disease of the aorta and its branches is present. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild bilobar biliary ductal dilatation likely secondary to chronic biliary disease. No evidence of obstructing mass.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion within the uncinate process of the pancreas likely benign in etiology. Favor a side branch IPMN (series 10, image 49). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Abnormally thickened and edematous bowel wall in the proximal colon consistent with a focal colitis. No evidence of pneumatosis or portal venous gas.BONES, SOFT TISSUES: Prior compression fracture of the L1 vertebral body status post vertebroplasty.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Abnormal edematous bowel wall thickening of the proximal colon consistent with focal colitis. Favor infectious or inflammatory etiology over ischemic disease.2.Severe aortic atherosclerotic disease with mild aneurysmal dilatation of the abdominal aorta. No evidence of aortic dissection or ischemia.3.Nonspecific cystic lesion within the pancreas, favor side branch IPMN. |
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