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Generate impression based on findings. | Female 44 years old Reason: R Buttock abscesss History: above UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There are inflammatory changes along the gluteal creases bilaterally as well as within the perianal region extending anteriorly throughout the medial perineum and around the vulva. No evidence of drainable abscess.OTHER: No significant abnormality noted | No evidence of drainable abscess. |
Generate impression based on findings. | Male 19 years old Reason: r/o obstruction, infection History: pain, s/p appy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Proximal small bowel loops are dilated measuring up to 4.2 cm in diameter. Distal small bowel loops are decompressed. These findings are consistent with small bowel obstruction with transition point in the mid lower abdomen, best seen on image number 64, series number 80496.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mid/distal small bowel obstruction with a transition point in the lower midabdomen. Significant dilatation of the proximal small bowel loops. |
Generate impression based on findings. | Female 64 years old Reason: Metastatic pancreas cancer please assess and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Hypervascular nodule arising from the right thyroid lobe extending into the superior mediastinum measures 2.5 x 2 cm on image number 17, series number 3. The etiology and significance of this nodule is unknown.CHEST WALL: Right axillary adenopathy. An index right axillary node measures 1.6 by 1 cm on image number 37, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts. However, there are also additional hypodense lesions in the liver suspicious for metastatic disease. An index lesion in the left lobe measures 2.2 x 2.5 cm on image number 87, series number 3. Mild intra-and extrahepatic biliary prominence.SPLEEN: Chronic thrombosis of the splenic vein due to invasion by pancreatic cancer and associated collateral vessels.PANCREAS: 3.7 by 4.3-cm mass in the body of the pancreas consistent with patient's known history of pancreatic cancer, best seen in image number 104, series number 3. The mass invades the splenic vein and the portal confluence. The mass also infiltrates the retroperitoneum and encases the celiac trunk, common hepatic artery and the proximal SMA.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric enlarged lymph nodes suspicious for metastatic disease. An index node measures 1.4 x 0.9 cm on image number 119, series number 3.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. | Locally invasive large pancreatic body cancer with hepatic and mesenteric metastatic disease.Right axillary adenopathy of uncertain etiology and significance.Hypervascular thyroid nodule extending into the superior mediastinum. A thyroid malignancy cannot be excluded. |
Generate impression based on findings. | Male 61 years old Reason: Eval for intraabdominal abscess, infection History: 61 yo M with abd pain, n/v, constipation, leukocytosis to 26 This study is limited due to lack of intravenous contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Splenomegaly. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in both kidneys cannot be optimally characterized due to lack of intravenous contrast. Left upper pole nephrolithiasis. Left upper pole peripherally calcified hypodense lesion. This may represent a complex cyst, however, a solid lesion cannot be entirely excluded.RETROPERITONEUM, LYMPH NODES: There is an IVC filter in place. Bilateral common iliac veins and extending iliac veins demonstrate high density suggestive of thrombosis. Lack of intravenous contrast severely limits optimal evaluation of these veins. There is significant fat stranding surrounding the sauce muscles and external iliac, common iliac vessels in the pelvis. No evidence of drainable abscess. Enlarged lymph nodes along the iliac vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: A Foley catheter is in place. Bladder cannot be optimally evaluated since its decompressed.LYMPH NODES: Pelvic adenopathy. An index right obturator node measures 3 by 2.1 cm in image 145, series number 3. Bilateral inguinal adenopathy. Fat stranding throughout the pelvis.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Within the limitations high density within the bilateral common iliac and external iliac veins likely suggest thrombus involving these veins. Pelvic adenopathy and fat stranding in the retroperitoneum and pelvis.Decompressed bladder with a Foley catheter is in place. Bladder cannot be optimally evaluated with this noncontrast study.Dr. Wendlandt was notified and acknowledged about the above findings at the time of dictation. |
Generate impression based on findings. | Clinical question: Metastases? Signs and symptoms: History of cancer, AMS Nonenhanced head CT:Examination demonstrate a high density mass measuring approximately 32 mm in the left frontal lobe and with extensive surrounding vasogenic edema. Additional high density mass measuring at 29-mm in the left anterior frontal lobe is also present with extensive surrounding vasogenic edema. There are multiple smaller foci of vasogenic edema highly suspected additional foci of metastatic disease. The findings in the left hemisphere results in approximately 7 mm midline shift to the right.There is a focus of low attenuation in the right posterior temporal -- parietal region with ex vacuo dilatation of right lateral ventricle suspect that of a chronic ischemic stroke.In addition tiny foci of low-attenuation in the periventricular and subcortical white matter of cerebral hemispheres are suggestive of age indeterminate small vessel ischemic strokes.Noted are subacute hemorrhage is detected.Calvarium is intact.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.Multiple high density masses with extensive surrounding vasogenic edema consistent with metastatic disease.2.Rightward deviation of midline of approximately 7 mm.3.Age indeterminate small vessel ischemic strokes on a chronic right MCA territory ischemic stroke is also noted. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Seizure. Nonenhanced head CT:Examination is partially degraded due to motion artifact. Within this limitation however there is no detectable acute intracranial process. Paucity of cortical sulci is within expected range for patient stated age of 23. Ventricular system remains within normal size and with maintained midline. Gray -- white matter differentiation is preserved.Calvarium is thickened with given anatomical variation. Images through the orbits, paranasal sinuses and mastoid air cells are severely degraded due to motion artifact however no gross abnormalities are detected. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: seizure. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. Mild chronic maxillary sinus disease however is noted. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: ICH. Signs and symptoms: Altered mental status, fell yesterday. Nonenhanced head CT:Examination demonstrates a focus of low-attenuation in the right basal ganglia and including the and right caudate head with associated mass effect on the right frontal horn consistent with a subacute nonhemorrhagic lacunar infarct.Prominence of the cerebral cortical sulci and slight prominence of lateral ventricles remain within normal for patient stated age of 89. There is no evidence of deviation of midline.The gray -- white matter differentiation remains intact. Mild large vessel intracranial vascular calcification is noted.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.Subacute nonhemorrhagic large lacunar infarct of right basal ganglia as detailed.2.Unremarkable exam otherwise for stated age of 89. |
Generate impression based on findings. | Male 60 years old Reason: Newly dx partially obstructing ascending colon cancer History: abdominal pain CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Well-defined low-density round lesion in the anterior mediastinum measuring 2.4 by 1.9-cm image number 25, series number 3. Exact etiology of this lesion is unknown, however, this may represent an anterior mediastinal adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Patient's known descending colon cancer is not well seen on CT but is likely seen on image number 117, series number 3. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's abdominal pain. Ascending colon mass consistent with nations known history of colon cancer.Well-defined, round hypodense lesion in the superior mediastinum. Exact etiology of this lesion is unknown. Although, cannot be entirely excluded, it's unlikely that this lesion could represent a metastatic adenopathy without evidence of other metastatic disease. |
Generate impression based on findings. | Clinical question: Pituitary hemorrhage, ICH. Signs and symptoms: Pituitary adenoma. Nonenhanced head CT:Examination redemonstrates a large pituitary adenoma with resultant expansion of the sella, extension into the left cavernous sinus and superior extension into the right subfrontal region. Compared to prior exam there is higher density of the pituitary adenoma which may indicate internal hemorrhage. There is also interval increased size of pituitary adenoma since prior exam. There is interval further expansion of the left cavernous sinus and increased size of tumor within the sella and in right subfrontal region. Recommend follow-up with dedicated MRI exam. The adjacent surrounding brain parenchyma demonstrate no evidence of hemorrhage or edema. Cerebral cortex, cortical sulci, ventricular system and the CSF spaces are unremarkable otherwise.Calvarium and soft tissues of the scalp as well as paranasal sinuses and mastoid air cells are unremarkable. An osteoma of the left frontal sinus is again noted without interval change. | 1.Interval increased size of patient's previously known microadenoma. It demonstrates higher density than prior exam which could represent internal hemorrhage however high density of pituitary macroadenoma could be within normal. With MRI is recommended.2.Unremarkable exam otherwise and without evidence parenchymal edema or hemorrhage surrounding the normal. |
Generate impression based on findings. | Female 20 years old Reason: eval for acute process, p/w 1 d h/o diffuse abd pain, pmt periumbilical History: abd pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distended stomach. Intussusception in the left upper quadrant, likely transient without causing any bowel obstruction. Mild diffuse wall thickening of the colon segments. Lack of optimal distention of the small bowel loops precludes optimal evaluation of the small bowel segments. Mild hyperemia of the small bowel wall.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mild wall thickening involving the colon and small bowel segments. MR enterography may be obtained for further evaluation. No evidence of bowel obstruction or bowel perforation. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: AMS on anti-coagulation. Nonenhanced head CT:There is no detectable acute intracranial process, CT however is insensitive for early detection acute nonhemorrhagic ischemic strokes.Periventricular and subcortical patchy low attenuation of white matter is suggestive of age indeterminate to small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSFS. otherwise for patient's stated age and without interval change since prior exam.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Female 51 years old Reason: r/o renal mass History: R flank pain. blood in urine ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst. Small left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Simple appearing right renal cyst, otherwise unremarkable CT. |
Generate impression based on findings. | Clinical question: Rule out worsening stroke. Signs and symptoms: Facial droop. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. Findings suggestive of mild age indeterminate small vessel ischemic strokes is again noted.Mild prominence of lateral ventricles with deviation of midline remain similar to prior exam. The cerebral cortex and cortical sulci are unremarkable.Calvarium and soft tissues of the scalp as well as orbits are unremarkable.Paranasal sinuses are unremarkable. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 30 years, Female. Reason: patient with NJ tube placement today, confirm placement in small bowel History: abdominal pain Enteric feeding tube tip is in the right quadrant and likely projects over the proximal jejunum, given history of malrotation. Nonobstructive bowel gas pattern with residual barium in the colon. | Enteric feeding tube tip likely in the proximal jejunum. |
Generate impression based on findings. | Male 60 years old Reason: r/o occult infection, no contrast due to acute kidney injury and CKD History: hypotension This study is limited due to lack of intravenous contrast. CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions and dependent atelectasis. Superimposed infection cannot be excluded. Septal thickening is suggestive of edema.MEDIASTINUM AND HILA: Cardiomegaly.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Duplicated left renal collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large midline tissue defect. Large right lateral wall hernia containing nonobstructed bowel segments, unchanged.BONES, SOFT TISSUES: Generalized anasarca, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Large bilateral pleural effusions, cardiomegaly and atelectasis. Superimposed infections cannot be excluded with this noncontrast CT. |
Generate impression based on findings. | Male 30 years old; Reason: evaluate for torsion, clot History: acute scrotal pain/swelling RIGHT TESTIS: The right testis measures 4.5 x 2.8 x 2.4 cm and is of normal echotexture. Small right hydrocele noted.LEFT TESTIS: The left testis measures 3.9 x 2.6 x 2.1 cm and is of normal echotexture.RIGHT EPIDIDYMIS: The right epididymis measures 0.8 x 0.9 x 1.4 cm and is unremarkable.LEFT EPIDIDYMIS: The left epididymis is not clearly seen.OTHER: Bilateral scrotal skin thickening, felt likely to reflect edema. Bilateral varicoceles noted. | No evidence of testicular torsion. Bilateral varicoceles noted. Scrotal skin thickening, likely reflects edema. |
Generate impression based on findings. | 47 years, Male. Reason: Dobbhoff placement History: Dobbhoff Placement Support devices are unchanged. Dobbhoff tube tip projects over the pyloric area of the stomach. Nonobstructive bowel gas pattern.Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the pyloric area. |
Generate impression based on findings. | 34 years, Female. Reason: bowel obstruction History: abd pain, distension Nonobstructive bowel gas pattern. Few dilated loops in the midabdomen are compatible with redundant colon. Note that the pelvis is excluded from the field-of-view.There is a large right pleural effusion with air-fluid level, compatible with cavitary lesion seen on prior CT. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 14 years old Reason: r/o fracture History: pain, swelling, traumaVIEWS: Left ankle AP, lateral and oblique 2/11/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. Navicular spur is likely a normal variant or chronic degenerative changes | Normal examination. |
Generate impression based on findings. | 55 years, Male. Reason: evaluate abdominal distension History: abdominal distension Loop of air distended redundant colon is noted in the midabdomen. Nonobstructive bowel gas pattern. Prominent stool burden in the rectum is noted. | Nonobstructive bowel gas pattern with prominent stool burden in the rectum. |
Generate impression based on findings. | Female 11 years old Reason: trauma, r/o fracture History: knee pain, swellingVIEWS: Left knee AP, lateral and oblique 2/12/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Reason: r/o PE History: tachycardia. History of thymic carcinoid. PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber. No evidence of right heart strain.LUNGS AND PLEURA: Left paramediastinal dense radiation fibrosis, unchanged.A nodule within the left major fissure measures up to 11 mm (series 6, image 69), slightly increased from the prior exam.Multiple additional pulmonary nodules and pleural metastases are stable to slightly increased from the prior exam.Reference left lower lobe pleural nodule measures 25 x 13 mm (series 6, image 11), unchanged.Debris is again seen in the left mainstem bronchus.No new focal air space consolidation.MEDIASTINUM AND HILA: The heart is normal in size without significant pericardial effusion. No visible coronary artery calcification.Surgical clips in the anterior mediastinum. Bilateral brachiocephalic vein obstruction.Enlarged mediastinal and hilar lymph nodes are stable to slightly increased compared to the prior exam.A left supraclavicular lymph node measures up to 12 mm (series 5, image 35), unchanged.Reference right paramediastinal lymph node measures up to 23 mm in long axis (series 5, image 139), mildly increased from the prior exam.Reference left paramediastinal lymph node measures up to 17 mm in short axis (series 5, image 129), unchanged.Reference left cardiophrenic lymph node measures up to 16 mm in short axis (series 5, image 254), unchanged.CHEST WALL: Mild degenerative disease of the thoracic spine. A right retrocrural lymph node measures up to 10 mm (series 5, image to 69), unchanged. Additional scattered retrocrural lymph nodes are unchanged in appearance.Right chest port, tip in the SVC.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple subcentimeter hepatic hypodensities are partially visualized, unchanged. Interval placement of biliary stent, with pneumobilia.Partially visualized pancreatic metastases. Lesion in the pancreatic tail measures up to 36 mm (series 5, image 272), unchanged.Multiple tortuous vascular structures in the splenic bed.Mild left adrenal nodularity partially visualized, stable. | 1. No evidence of pulmonary embolism. 2. Multiple pulmonary/pleural nodules and enlarged mediastinal/hilar lymph nodes, stable to slightly increased from the prior exam.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 49 year old woman with rising lactate, recent liver bx, question of right lung infiltrate. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: Diffuse patchy groundless opacities with associated smooth septal thickening likely pulmonary edema although atypical infection or hemorrhage may appear similarly. No pleural effusions.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip at the SVC atrial junction. ICD device with single lead tip at right ventricular apex. Nonspecific mildly prominent pretracheal lymph node (series 3, image 35) measures 1.5 cm in short axis.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No perihepatic hematoma.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: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Fat containing left ventral hernia. Degenerative changes of the visualized osseous structures.OTHER: Anasarca. PELVIS:UTERUS, ADNEXA: Course calcifications within the uterus compatible with uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the visualized osseous structures most prominent in the lower lumbar spine.OTHER: Anasarca. | 1.Diffuse patchy pulmonary opacities and septal thickening likely pulmonary edema although infection or hemorrhage may appear similarly.2.Nonspecific mediastinal lymphadenopathy. 3.No perihepatic hematoma.4.Anasarca. |
Generate impression based on findings. | 73 years, Female. Reason: r/o constipation History: N/V Spinal fixation rod and screw device traversing L2 to S1 is noted. Cholecystectomy clips right upper quadrant and surgical clips in the mid pelvis. Partially visualized cardiac leads. Mild compression deformity of L1. Flowing syndesmophytes from L2 to S1.Nonobstructive bowel gas pattern. Greater than average stool burden. | Greater than average stool burden. |
Generate impression based on findings. | 40 years, Female. Reason: r/o obstruction History: nausea, bilious emesis Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern |
Generate impression based on findings. | 63 years, Female. Reason: evaluate dobhoff placement History: dobhoff placement Enteric feeding tube tip projects over the distal gastric body. Left lower extremity central venous catheter is partially visualized in the left hemipelvis. Note that the majority of the pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | 14-year-old male with history of Crohn's disease presents with abdominal pain, emesis. Concerning abdominal x-ray. Rule out cecal volvulus. ABDOMEN:LUNG BASES: The lung bases are normal. No suspicious pulmonary nodules or masses. No pleural effusion.LIVER, BILIARY TRACT: Liver is normal. No intra-intrahepatic biliary ductal dilatation. Gallbladder is normal. SPLEEN: Spleen is normal.PANCREAS: Pancreas is normalADRENAL GLANDS: Adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Scattered mildly enlarged mesenteric lymph nodes.BOWEL, MESENTERY: Bowel wall thickening with submucosal edema involving approximately the distal 10 cm of the terminal ileum with surrounding soft tissue stranding and free fluid in the lower abdomen and pelvis. There is associated slight narrowing of this bowel segment with proximal ileum dilated up to 4.8 cm in diameter (series 3, image 105) suggestive of partial proximal small bowel obstruction. BONES, SOFT TISSUES: Normal alignment with no evidence of fracture or dislocation. Soft tissues are normal. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged mesenteric lymph nodes. BOWEL, MESENTERY: Moderate stool burden in the colon.BONES, SOFT TISSUES: Normal alignment with no evidence of fracture or dislocation. Soft tissues are normal. OTHER: Moderate free fluid in the pelvis. | Findings are consistent with terminal ileitis likely related to known history of Crohn's disease. There is associated slight narrowing of the terminal ileum and partial proximal small bowel obstruction. |
Generate impression based on findings. | 66 years, Female. Reason: increasing lactate, ?free air History: increasing lactate, ?free air Surgical staples project over the pelvis. Drainage catheter tip projects over the right hemipelvis. Foley catheter with contrast within the bladder. Degenerative changes affect the lumbar spine with rightward curvature of the lumbar spine. Dilated loops of small bowel with relative paucity of bowel gas distally. Supine images are suboptimal for the evaluation of free air. Within this limitation, no large pneumoperitoneum is evident. | Dilated loops of small bowel favors ileus. Crosstable lateral or lateral decubitus views are recommended for evaluation of free air. |
Generate impression based on findings. | 80 years, Female. Reason: Eval for ileus History: Abdominal pain Nonobstructive bowel gas pattern. IVC filter and right up quadrant surgical clips are noted. Cardiac support devices and bibasilar opacities are unchanged. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 45 years, Female. Reason: 45F hx cervical CA s/p anterior exenteration c/b chronic constipation. Evaluate stool burden History: Constipation Nonobstructive bowel gas pattern with average stool burden in the colon. Bilateral retrograde nephroureterostomy catheters with distal tips projecting over the right hemiabdomen, compatible with known ileal conduit. Ostomy in the left hemiabdomen and surgical clips in the pelvis are noted. | Nonobstructive bowel gas pattern with average stool burden in the colon. |
Generate impression based on findings. | Male 14 years old Reason: r/o SCFE v hip dislocation v. fracture History: limp, pain s/p minor "pop" traumaVIEWS: Pelvis AP and frog leg 2/11/15 (two views) Irregularity and fragmentation of the right anterior and inferior iliac spine is concerning for avulsion fracture. Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. No evidence of AVN or SCFE. | Findings concerning for avulsion fracture of the right anterior-inferior iliac spine |
Generate impression based on findings. | 51 years, Male. Reason: Dobbhoff placement History: Dobbhoff placement Multiple surgical clips, surgical drains, and an IVC filter is noted. Dobbhoff tube projects over the gastric antrum. Residual contrast within the small bowel and colon.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube projects over the gastric antrum. |
Generate impression based on findings. | 63 year-old female. Tachycardia, tachypnea, SOB. Concern for PE. PULMONARY ARTERIES: Examination is diagnostic for PE to the segmental level. Low attenuation in a right lower lobe subsegmental artery is likely due to poor opacification (series 7, image 153). No definite pulmonary embolus is identified.LUNGS AND PLEURA: Lower lung zone predominant diffuse groundglass opacities with subpleural sparing and associated mild traction bronchiectasis are again seen and suggestive of a chronic interstitial lung disease, specifically NSIP. There is interval resolution of small left pleural effusion and decreased left lower lobe consolidation.MEDIASTINUM AND HILA: Stable moderate cardiomegaly without pericardial effusion.No visible coronary artery calcification.No mediastinal lymphadenopathy. Mildly enlarged right hilar lymph node is unchanged.CHEST WALL: Multilevel degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism to the segmental level.2. Lower lung zone predominant ground glass opacities with associated mild traction bronchiectasis is most suggestive of a chronic interstitial lung disease, particularly NSIP. Further evaluation with dedicated ILD CT imaging as clinically warranted.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 11-day-old male with increased FiO2 requirement.VIEW: Chest AP (one view) 2/12/15 Enteric tube tip in the stomach. Right PICC coiled in the right subclavian vein. Epidural catheter tip at T5. Soft tissue gas in the right lower chest wall is again noted from recent surgery. The cardiothymic silhouette is normal.Interval improvement in basilar atelectasis. Right lower lobe opacity and blunting of the right costophrenic angle, likely postoperative in etiology with possible small pleural effusion. | Status post diaphragmatic hernia repair with improvement in right basilar opacity and atelectasis as described above. |
Generate impression based on findings. | 64 years, Male. Reason: Evaluate NG position History: Evaluate NG position NG tube tip projects over the gastric body. IVC filter is noted. Lung bases are clear. Residual contrast is noted throughout the colon.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the gastric body. |
Generate impression based on findings. | 35 years, Female. Reason: Abdominal discomfort History: Abdominal discomfort Metallic linear radiodensities project over the upper mid abdomen. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 11-day-old male status-post CDH repairVIEW: Chest AP, Abdomen AP (two views) 2/11/15 18:01 Right PICC tip coiled in the subclavian vein. Enteric tube and side-port in the stomach. Epidural catheter tip at T6. Interval repair of diaphragmatic hernia. Bi-basilar atelectasis and right lower lobe opacity as well as lucency in the right lower lobe, which may represent a small subpulmonic pneumothorax. The cardiothymic silhouette is mildly enlarged. Gas in the soft tissues of the right chest wall reflects recent surgery. Disorganized of bowel gas pattern. The bladder appears distended. | Status post diaphragmatic hernia repair with right basilar opacity and questionable right subpulmonic pneumothorax. |
Generate impression based on findings. | Stability of subdural collections There is interval evolution and decrease in size of small intraparenchymal hematoma involving the left superior frontal gyrus. Bilateral subdural fluid collections measuring approximately 11 millimeters on the left and 9 mm on the right are unchanged. Unchanged mild associated mass effect. Small amount of subarachnoid blood products in the right temporal lobe also demonstrate slight interval evolution and decrease in conspicuity. No new hemorrhage, new mass-effect, midline shift, or downward herniation. No hydrocephalus. Unchanged mild areas of hypoattenuation in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. Lacunar infarcts in the thalami and basal ganglia also unchanged.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. | Compared to 2/10/2015, slight evolution of small left frontal intraparenchymal hematoma and right temporal subarachnoid hemorrhage. No significant change in bilateral subdural effusions. Unchanged mild associated mass effect. No new hemorrhage or new mass effect. |
Generate impression based on findings. | Pain to 4th and 5th toes status post box falling on area Lateral soft tissue swelling. No fracture or malalignment. Os peroneus noted, a normal variant. | No fracture or malalignment. |
Generate impression based on findings. | 68 years, Male. Reason: NG tube position History: Evaluate NG position NG tube with tip projecting over the gastric fundus. Residual contrast within the colon. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube with tip projecting over the gastric fundus. |
Generate impression based on findings. | 5-year-old male with irregular breathingVIEWS: Chest AP/lateral (two views) 2/11/15 17:15 The cardiothymic silhouette is normal. Mild bronchial wall thickening, flattening of the hemidiaphragms and large lung volumes suggesting reactive airway disease or bronchiolitis. | Bronchial wall thickening and large lung volumes suggesting bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Swelling Soft tissue swelling about the ankle. Tibiotalar joint effusion noted. No fracture or malalignment. | No fracture or malalignment. |
Generate impression based on findings. | 63 years, Female. Reason: Dobbhoff History: na Dobbhoff tube tip projects over the expected location of the proximal gastric body/fundus. Splenic artery calcifications noted. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube projects over the proximal gastric body/fundus. |
Generate impression based on findings. | History of aortic stenosis, pre-operative TAVR evaluation. Note that the far lateral aspects of the abdomen and pelvis are not included in the field-of-view. ANGIOGRAM: Please see accompanying cardiac CT report for description of thoracic aorta. Moderate atherosclerotic affect the abdominal aorta and branches. There is mild narrowing of the origin of the celiac artery. There is severe narrowing of the origin of the SMA which remains patent. The origin of the IMA is moderately narrowed. There is mild narrowing of the origin of the right renal artery. There is an aneurysm of the infrarenal aorta measuring up to 3.3 x 2.7 cm (series 80492, image 446). Significant atherosclerotic calcifications are present at the aortic bifurcation with narrowing of the origin of the right common iliac artery to approximately 6 mm (series 80498, image 6). There is moderate tortuosity of the proximal right common iliac artery. There is severe tortuosity of the proximal left common iliac artery causing narrowing to approximately 5 mm (series 80497, image 8). Moderate atherosclerotic calcifications are present in the bilateral common femoral arteries.SUPRARENAL ABDOMINAL AORTA: 2.3 X 2.3 cmINFRARENAL ABDOMINAL AORTA: 1.7 X 1.8 cmRIGHT COMMON ILIAC ARTERY: 8.5 x 10.5 mmRIGHT EXTERNAL ILIAC ARTERY: 9.5 x 10.5 mmRIGHT COMMON FEMORAL ARTERY: 7.2 X 7.6 mmLEFT COMMON ILIAC ARTERY: 14.5 x 14.9 mmLEFT EXTERNAL ILIAC ARTERY: 10.1 x 10.6 mmLEFT COMMON FEMORAL ARTERY: 7.3 X 6.9 mmABDOMEN:LUNG BASES: Please see accompanying cardiac CT report for description of pulmonary findings. LIVER, BILIARY TRACT: Cholelithiasis without CT evidence of cholecystitis.SPLEEN: Spleen is mildly enlarged measuring 17 cm.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: Severe degenerative changes affect the visualized thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right hip total arthroplasty device causes metallic streak artifact which somewhat obscures structures in the pelvis. Severe degenerative changes affect the visualized thoracolumbar spine. Moderate-severe degenerative disease affects the left hip joint. OTHER: No significant abnormality noted | 1.Moderate-severe atherosclerotic disease of the abdominal aorta. Severe narrowing of the origin of the SMA. Mild-moderate narrowing of the origins of the celiac artery, IMA, and right renal artery. 2.Infrarenal aortic aneurysm measuring 3.3 x 2.7 cm. 3.Significant tortuosity and atherosclerotic disease of the bilateral proximal common iliac arteries with narrowing of the right proximal common iliac artery to approximately 6 mm and left proximal common iliac artery to approximately 5 mm.4.Moderate atherosclerotic calcifications of the common femoral arteries.5.Cholelithiasis. 6.Splenomegaly. |
Generate impression based on findings. | History of VSD status post repair, presents with new onset heart failure; found to have enlarged thyroid on exam, TSH 0.01, markedly elevated free T3, T4. The thyroid images demonstrate uniform activity in a gland of normal size and configuration. The 4-hour radioactive iodine uptake is 53.8% and the 24-hour uptake is 70.6% (normal range 10-30%).Scintigraphic planar images demonstrates diffuse enlargement of and increased activity within the thyroid gland including a prominent pyramidal lobe. There is no evidence of thyroid nodules. | Abnormally diffusely increased thyroid uptake compatible with Graves' disease. |
Generate impression based on findings. | Pain. History of fracture. Soft tissue swelling about the wrist. No fracture or malalignment. No significant abnormality is otherwise evident. | No fracture or malalignment |
Generate impression based on findings. | Global aphasia, right-sided weakness There is continued evolution of the left middle cerebral artery territory infarct with hypoattenuation and local mass effect of the left insula, left middle and inferior frontal gyri, as well as small areas within the left putamen and left caudate head. There is no evidence of acute intracranial hemorrhage. There is a background of diffuse parenchymal volume loss. Mild effacement of the left lateral ventricle. There is left to right midline shift measuring 4 mm and unchanged. Unchanged bilateral lens implants with calcification on the right. The imaged paranasal sinuses and mastoid air cells are clear. There are atherosclerotic calcifications of the cavernous portion of the bilateral carotid arteries. The skull and extracranial soft tissues are unremarkable. | Continued evolution of subacute left middle cerebral artery territory infarct. There is mild local mass effect and minimal rightward midline shift which are not significantly changed since 2/10/2015. No evidence of hemorrhagic conversion. |
Generate impression based on findings. | 14-year-old male with history of Crohn's with abdominal pain, emesis. Evaluate for free air, obstruction, acute pathology.VIEWS: Abdomen AP erect and supine (two views) 2/11/2015 Prominence of dilated bowel in the midabdomen measuring up to 5.9 cm. Air is seen distally in the rectum. No evidence of pneumatosis intestinalis, pneumoperitoneum, portal venous gas or ascites. | Prominently dilated bowel loop in the midabdomen may represent small bowel or cecum with no definite evidence of obstruction or free air. A follow-up CT scan has been obtained, please refer to CT scan report for additional findings. |
Generate impression based on findings. | Reason: r/o PE History: hx of DVT on Xarelto, tachy, hypoxemic PULMONARY ARTERIES: Suboptimal study due to motion and poor contrast opacification. No large central pulmonary embolism. The main pulmonary artery measures up to 33 mm in diameter (series 8, image 131), suggestive of pulmonary hypertension.LUNGS AND PLEURA: Bilateral lobe segmental consolidation, left greater than right, and mild basilar subsegmental atelectasis/scarring.Septal thickening likely relates to edema.Scattered small nodules throughout the right lung may be related to inflammatory process, including aspiration.No significant pleural effusion.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.Large left diaphragmatic hernia containing colonic loops and stomach, increased in size, with more lateral extent compared to the prior exam, and additional increased eventration of the diaphragm.CHEST WALL: Diffuse anasarca.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Suboptimal study for pulmonary embolism. No large central pulmonary embolus. At the time of exam, repeat imaging was not obtained due to the patient's renal status.2. Large left diaphragmatic hernia containing colonic loops and stomach is increased in extent from the prior exam with additional increased eventration of the diaphragm.3. Bibasilar consolidation/atelectasis, pulmonary edema, and anasarca. Findings may relate to CHF/fluid overload.PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 62 years old Reason: patient with HCV and thrombocytopenia evaluate for cirrhosis History: HCV with thrombocytopenia LIVER: The liver measures 15.8 cm in length and the hepatic parenchyma is coarsely echogenic. Multiple abnormal hyperechoic lesions are identified throughout the liver. A reference lesion in the left lobe measures 2.6 x 1.7 cm. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, pericholecystic fluid or gallbladder wall thickening. There is no biliary dilatation.PANCREAS: The pancreas is poorly visualized. KIDNEYS: The right kidney measures 10.8 cm. The left kidney measures 10.7 cm. Bilateral renal cysts.OTHER: No significant abnormalities noted. | Coarsely echogenic hepatic parenchyma consistent with chronic liver disease. Multiple echogenic lesions within the liver are nonspecific. Hepatocellular carcinoma can not be excluded.Further evaluation with triphasic liver MRI is recommended.Findings discussed by myself Dr. Ward with Dr. Adebajo # 3736 02/12/15I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Trauma to face. There is extensive left cheek stranding and swelling with a more focal globular area of hyperattenuation in the left nasolabial fold region that likely represents a hematoma. There is also a small amount of subcutaneous emphysema in the left cheek and swelling of several left muscles of facial expression. There is a slightly displaced left nasal bone fracture. The orbital contents and walls appear to be intact bilaterally. The temporomandibular joints are intact. There is mild scattered paranasal sinus mucosal thickening. Opacities in the bilateral external auditory canals likely represent cerumen. The imaged intracranial structures appear to be unremarkable. | 1. Left face contusion and subcutaneous emphysema.2. Age-indeterminate slightly displaced left nasal bone fracture. |
Generate impression based on findings. | Vertebral artery dissection. Lateral neck pain, posterior headache. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is no evidence of arterial luminal narrowing, intra luminal filling defects, dissection flap or pseudoaneurysm formation. There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries are not seen but Acom artery is patent.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of arterial dissection, arterial luminal stenosis, or intracranial arterial aneurysm. |
Generate impression based on findings. | Female 56 years old Reason: hep c cirrhosis, screen for hcv History: same LIVER: The liver is coarsely echogenic with a nodular contour consistent with history of chronic liver disease with cirrhosis. No focal liver lesion. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.1 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid. No biliary dilatation.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 9.9 cm. The left kidney measures 10.4 cm. There is no hydronephrosis.OTHER: The spleen measures 10.6 cm. | Cirrhotic liver morphology. No focal mass lesion identified. |
Generate impression based on findings. | Male 69 years old Reason: RCC eval for interval change History: none ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: 1.7 x 1.6 cm hyperdense lesion in the tail of the pancreas is unchanged from CT dated 10/25/2008. Although benign islet cell tumor cannot be entirely excluded this most likely represents an intrapancreatic spleen.ADRENAL GLANDS: Diffuse thickening of bilateral adrenal glands, unchanged.KIDNEYS, URETERS: Changes secondary to left partial nephrectomy. Previous described fluid density lesion with thick gram in the upper pole of the left kidney measures 5.3 x 2.9 cm on image number 34, series number 3, slightly increased compared to previous study. However no definite solid component is seen within the cystic component. More caudal and posterior higher density component of the lesion measures 2.3 x 1.4 cm on image number 38, series number 3. This component is not significantly changed compared to previous study. This likely represents postsurgical changes.Cyst in the lower pole of the right kidney a metallic density around the right kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left inguinal hernia.OTHER: No significant abnormality noted | Slight interval increase in the size of the left renal cystic lesion, otherwise no significant change from previous study. |
Generate impression based on findings. | Metastatic prostate cancer. Again visualized is a single focus of increased activity in the superior left scapula consistent with metastatic disease with suggestion of an interval slight increase in size along the superolateral margin of the lesion.No new suspicious osseous foci identified. Redemonstration of asymmetrically decreased radio tracer uptake in an atrophic right kidney. Degenerative disease of the shoulders, lower lumbosacral spine and bilateral hips is stable when compared to previous exam. | Stable to slight increase in size of the single osseous metastasis in the left scapula. No new suspicious osseous lesion is identified. |
Generate impression based on findings. | Intracranial hemorrhage Portable technique slightly limits evaluation. Compared to 2/8/2015, there is no significant change size of left intraparenchymal hematoma measuring approximately 5.0 x 4.4 x 4.6 cm in the AP, transverse, and craniocaudal dimensions. There is surrounding vasogenic edema not significantly change involving the left frontal and temporal lobes. Again seen is mass-effect with severe effacement of the lateral ventricles and entrapment of the right lateral ventricle. There is rightward midline shift measuring approximately 16 mm at the level of the foramen of Monro not significantly changed. There is diffuse effacement of the cerebral sulci.Again seen is diffuse effacement of the suprasellar cistern and mild asymmetric enlargement of the left ambient cistern. Unchanged position of the right transfrontal EVD.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. Compared to 2/11/2015, no significant change in size of large left cerebral intraparenchymal hematoma and surrounding edema. No significant change in rightward midline shift. There is mild worsening in severe effacement of the lateral and third ventricles. Again seen is downward herniation with diffuse effacement of the suprasellar cistern and mild left uncal herniation. 2. Unchanged size of the entrapped right lateral ventricle. |
Generate impression based on findings. | Female 27 years old Reason: r/o fx History: ankle pain There is limited view of the ankle. Within these limitations no acute fracture or malalignment is identified. There is no joint effusion.There is a comminuted, intra-articular fracture with multiple fragments extending into the diaphysis of the proximal tibia. There is subtle depression along the medial aspect of the lateral tibial plateau. There is a large 11-cm butterfly fragment along the medial aspect. There is a Segond fracture is likely associated with the comminuted tibial fracture; however, an ACL injury cannot be excluded. There is also mildly displaced oblique fracture of the proximal fibular metadiaphysis. There is an associated small joint effusion. | Comminuted intra-articular tibial fracture as described above. Minimally displaced of the fibular fracture as described above. |
Generate impression based on findings. | Female 27 years old Reason: r/o traumatic inj History: pain. This is a limited study of the shoulder. There is no acute fracture or dislocation. There is no soft tissue swelling. | No acute fracture or dislocation. Limited study of the shoulder. |
Generate impression based on findings. | Reason: Hx of inflammatory breast cancer, clinical evidence of recurrence, assess extent of disease History: R SCV fixed node CHEST:LUNGS AND PLEURA: Right greater than left apical pleural and parenchymal nodularity/scarring.No suspicious pulmonary nodules or masses.Anterolateral right lung fibrosis likely related to postradiation changes. No other focal air space consolidation.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcifications.No mediastinal or hilar lymphadenopathy, within limits of noncontrast imaging.An enlarged conglomerate of right neck level Vb lymph nodes is only partially visualized on CT images of the chest. Cervical lymphadenopathy is seen in greater detail on same day CT soft tissue neckCHEST WALL: Status post right mastectomy, right axillary lymph node dissection.Degenerative disease of the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic calcifications from prior granulomatous disease.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. An enlarged conglomerate of right level Vb lymph nodes is only partially visualized on CT images of the chest. See same-day CT soft tissue neck for additional details on cervical lymphadenopathy. 2. No CT evidence of recurrent or metastatic disease within the chest or upper abdomen. |
Generate impression based on findings. | Male 78 years old Reason: s/p R hip hemiarthroplasty History: see above. Again seen are components of a right bipolar hemiarthroplasty device in anatomic alignment. There is no evidence of fracture or dislocation. Skin staples and drain in the soft tissues reflect recent surgery. There is heterotopic bone formation in the soft tissues. | No evidence of fracture or dislocation. Right bipolar hemiarthroplasty device in anatomic alignment. |
Generate impression based on findings. | Female 47 days old Reason: follow up lung fields History: s/p cardiac surgeryVIEW: Chest AP (one view) 2/12/15 at 818 hours. Mediastinal clips, epicardial pacer leads and NG tube unchanged. Interval removal of right IJ central line. Cardiac silhouette size is enlarged but stable. Left upper and lower lobe opacities, likely atelectasis with no effusions or pneumothorax. | Multifocal opacities as described. |
Generate impression based on findings. | 5 year old female with left thumb pain. VIEWS: Left hand PA, Left thumb PA and lateral (three views) 2/12/2015 There is a Salter-Harris type II fracture of the left thumb proximal phalanx with dorsal and lateral angulation. | Salter-Harris type II fracture of the left thumb with dorsal and lateral angulation.Findings were discussed with patient's father in person on 2/12/2015 at 8:45 AM. Several attempts were made to contact Dr. Lauren Conti's office, unable to reach. However discussed with father to contact Dr. Conti or to see her in clinic to address these findings. |
Generate impression based on findings. | Female 5 months old Reason: follow up right lung atelectasis History: respiratory distressVIEW: Chest AP (one view) 2/12/15 at 836 hours. Feeding tube terminates at the antral pyloric region. Cardiac silhouette size is normal. Right medial upper lobe opacities, likely atelectasis or pneumonia on a background of large lung volumes and bronchial wall thickening. | Persistent multifocal opacities as described. |
Generate impression based on findings. | Male 78 years old Reason: r shoulder pain, r/o dislocation History: see above. Single Velpeau view does not show any acute fracture or dislocation. There is mild irregularity along the inferior margin of the glenoid, likely representing small osteophyte formation. | No acute fracture or dislocation. |
Generate impression based on findings. | cerebrovascular accident There is a mass like lesion on the right frontal lobe with significant surrounding edema and mass effect.The mass lesion is measured about 27mm x 20mm with irregular thick high attenuation rim.The midline shift toward left side at the level of foramen of Monroe is about 8 to 10mm.The right lateral ventricle appears to be deformed due to mass effects.There is left parietal inferior lobule chronic ischemic infarction with encephalomalacia.There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. Right frontal lobe mass with surrounding edema and mass effects as described above.2. Chronic ischemic infarction with encephalomalacia on the left parietal lobe.The findings were discussed with Dr. Cheema of ER at the time of this dictation. |
Generate impression based on findings. | 60 year-old with right benign appearing mass presents for follow-up mammogram for the right breast and annual mammogram for the left breast. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A circumscribed oval mass is unchanged in the 6 o'clock position of right breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. In view of patient's dense breasts, tomosynthesis will be useful. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 18 years old Reason: fx History: pain. There is mild soft tissue swelling along the lateral ankle. However, there is no acute fracture or dislocation. There is no joint effusion. | No acute fracture or dislocation. |
Generate impression based on findings. | Elevated ICP, subarachnoid hemorrhage Compared to 2/10/2015, there is evolution of postsurgical changes related to right frontal craniotomy and clipping of anterior communicating artery aneurysm. There is mild increase in hypoattenuation involving the right anterior temporal lobe which may represent edema or cytotoxic injury.Again seen is a right transfrontal ventriculostomy tube with tip in the left lateral ventricle. There is some intraventricular blood present similar to prior. No hydrocephalus. Minimal leftward midline shift. No downward herniation.Moderate opacification of the paranasal sinuses. | 1. Evolution of postsurgical changes of anterior communicating artery aneurysm clipping. 2. Slight increase in hypoattenuation involving the right anterior temporal lobe which may represent cytotoxic injury. 3. No hydrocephalus. |
Generate impression based on findings. | There is an unchanged right frontal calvarial defect with well corticated borders and stable subjacent right frontal parenchymal area of hypoattenuation/encephalomalacia. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration without hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are otherwise unremarkable. | Stable sequela of prior gunshot wound involving the right frontal lobe without acute intracranial hemorrhage or mass-effect. |
Generate impression based on findings. | Drainage at drive line. Status post LVAD, drive line infection. Assess for fluid collection around the line. CHEST: Motion artifact in the lung bases somewhat limits evaluation.LUNGS AND PLEURA: Trace left pleural effusion.Intraluminal debris in the trachea. Small peripheral wedge-shaped groundglass opacity in the right upper lobe adjacent to the major fissure may represent aspiration although infarct is also a consideration.Bilateral lower lobe bronchial impaction with associated basilar atelectasis and aspiration.Mild paraseptal and centrilobular emphysema. Right apical bulla.Calcified micronodules consistent with healed granulomatous disease. Noncalcified micronodules are unchanged, most likely also post-inflammatory. MEDIASTINUM AND HILA: Multichamber cardiomegaly with interval insertion of an LVAD. There is no fluid collection around the drive line, which exits through the left anterior abdominal wall. No pericardial effusion.ICD with leads terminating in the right atrial appendage, coronary sinus, and right ventricle.Severe coronary calcification. Postsurgical findings of CABG.Mild enlarged mediastinal lymph nodes, which are likely reactive.CHEST WALL: Bilateral gynecomastia. Median sternotomy.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Significant streak artifact from the LVAD limits evaluation of the upper abdomen.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left lower pole renal cortical scarring. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Scattered colonic diverticula. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No fluid collection is seen around the LVAD drive line. Small peripheral wedge-shaped groundglass opacity in the right upper lobe may represent aspiration although infarct is also a consideration. Bibasilar aspiration and atelectasis. Trace left pleural effusion. |
Generate impression based on findings. | Male 63 years old Reason: History of metastatic renal cancer on sunitinib, assess for progression History: none CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules in all lobes are redemonstrated and again are highly suspicious for metastatic disease. The nodules are grossly unchanged.Reference left upper lobe metastatic lesion is stable and measures 0.7 x 0.7 cm (series 5, image 60), previously 0.7 x 0.7 cm.Reference right upper lobe metastatic lesion is stable and measures 0.6 x 0.6 cm (series 5, image 54) previously 0.6 x 0.6 cm.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy.Reference right perihilar node is stable and measures 1.8 x 2.0 cm (series 4, image 45), previously 1.8 x 2.1 cm.Reference left mediastinal precarinal node is stable and measures 1.1 x 0.9 cm (series 4, image 40), previously 1.1 x 0.8 cm.Normal heart size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN: Exam is suboptimal secondary to streak artifact from spinal fusion hardware.LIVER, BILIARY TRACT: Bilobar hepatic hypodensities are too small to characterize but most likely represent liver cysts. Right hepatic lobe subcentimeter hypodense lesion (series 4, image 98) may demonstrate some peripheral nodular enhancement is unchanged and is likely benign in etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific fullness of the left adrenal gland.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney demonstrates good excretion of contrast. No suspicious lesions in the right renal collecting system or the left prior tumor bed.RETROPERITONEUM, LYMPH NODES: Minimal aortic atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical hardware of the T12, L1, L3 and L4 vertebral body, unchanged. OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Punctate calcifications within the prostate, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination in a patient status post left nephrectomy with multiple bilateral pulmonary metastases. |
Generate impression based on findings. | Female 85 years old Reason: bilateral knee pain after fall 10/2014 History: bilateral knee pain after fall 10/2014 Right knee: Bone mineralization is reduced. Alignment is near-anatomic. Moderate osteoarthritis affects the right knee with tricompartmental osteophytes and joint space narrowing. There is chondrocalcinosis of the medial meniscus. Trace joint effusion.Left knee: Bone mineralization is reduced. Alignment is near-anatomic. Moderate osteoarthritis affects the left knee with tricompartmental osteophytes and joint space narrowing. There is chondrocalcinosis of the medial meniscus. Trace joint effusion.No acute fracture or malalignment is evident. | Osteoarthritis without definite fracture. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. No new mass effect, midline shift or downward herniation. The ventricle size does not show any significant interval change since prior exam. There is no change of ventricular shunt position, right frontal approach and the tip location near the foramen of Monro. Bilateral small subdural fluid collections do not show significant interval change either since prior exam. Dysgenesis of the corpus callosum, left occipital encephalomalacia, and periventricular white matter hypoattenuation do not show any significant interval change since prior exam. There is an unchanged hyperdense masslike appearance of the pituitary gland and dysmorphic sella. The paranasal sinuses and mastoid air cells are clear. Diffuse calvarial thickening is again seen which may be related to chronic shunting or seizure medication. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Unchanged size of the ventricles which appear dysmorphic and without evidence of hydrocephalus.3. Unchanged small chronic bilateral subdural collections, dysgenesis of the corpus callosum, left occipital encephalomalacia, diminished periventricular white matter volume, as well as hyperdense masslike appearance of the pituitary gland. MR can better evaluate the brain parenchymal abnormalities and can be considered if clinically indicated. |
Generate impression based on findings. | Reason: Tonsil cancer surveillance exam History: Tonsil cancer surveillance exam CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Multiple small basilar subpleural scar-like opacities. No focal air space consolidation.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Bilateral breast prostheses. Moderate to severe scoliosis, unchanged. Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered probable hepatic cysts, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Male 52 years old Reason: History of hep C/ETOH cirrhosis with significant volume overload, AKI not consistent with hepatorenal syndrome, please evaluate for thrombosis History: As above LIVER: The liver measures 17.8 cm in length and demonstrates cirrhotic morphology. There is no focal liver lesion. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.1 m/sec.GALLBLADDER, BILIARY TRACT: Sludge within the gallbladder. No shadowing gallstones. Gallbladder wall thickening is again noted which is nonspecific in the setting of chronic liver disease. Prominence of the common bile duct is again noted measuring 0.8 cm, previously 0.8 cm.PANCREAS: Visualized portion is unremarkable.KIDNEYS: The left kidney measures 10 4 cm. The right kidney measures 11.4 cm. Hyperechoic renal cortex bilaterally consistent with medical renal disease. No hydronephrosis.OTHER: Diffuse abdominal ascites. The spleen measures 10.9 cm in length. | Cirrhotic liver morphology. No focal hepatic lesion. Abdominal ascites. |
Generate impression based on findings. | pT1N2b right tonsil squamous cell carcinoma status post chemoradiotherapy completed in January 2014. There are postoperative findings in the right neck related to right tonsillar tumor resection and neck dissection with persistent mild asymmetric thickening of the right palatine tonsillar fossa mucosa. However, there is no evidence of measurable mass lesions within the surgical bed to suggest tumor recurrence. The salivary and thyroid glands are unremarkable. There is no evidence of cervical lymphadenopathy by CT size criteria. The airway is patent. There is mild multilevel degenerative spondylosis. The imaged intracranial structures and orbits are normal. The imaged lung apices are clear. | Post-treatment findings in the neck without evidence of measurable tumor recurrence or significant lymphadenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 61 years old; Left ankle pain x 5 years. Questionable trauma. Comes and goes but more regularly x 2 years now. Prominent bone spur at the posterior aspect of the talus, likely representing a Stieda process. 3mm ossicle adjacent to the medial malleolus likely reflects prior deltoid ligament injury.No joint effusion evident. No fracture or malalignment. No significant degenerative changes noted. | 1. Suspected Stieda process. Correlation for posterior impingement syndrome is recommended.2. 3mm ossicle adjacent to the medial malleolus likely reflects prior deltoid ligament injury. |
Generate impression based on findings. | 49 year old female with history of recurrent left breast abscess presents for annual 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 elements, unchanged in pattern and distribution. Mild skin thickening is present around the left nipple, possibly due to the recent episode of abscess. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: eval pulmonary nodule seen on last CT History: none LUNGS AND PLEURA: A small irregular subpleural nodule in the right lower lobe (series 5/244) measures 14 mm in maximum transverse diameter, unchanged from the previous scan. Review of multiple earlier scans dating back to 2012 do not show any consistent increase in the size or density, allowing for slight differences in section level on sequential scans. The solid component on the current exam is actually minimally smaller than in 2012 and the nodule has a flat scar like configuration on coronal reconstructions.. Therefore, a benign etiology seems more likely, and long-term surveillance at approximately 12 month intervals in this high risk patient would seem appropriate.Surgical staples in the left upper lobe and diffuse severe centrilobular emphysema, are unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification.Mild pericardial thickening, unchanged.CHEST WALL: Status post right mastectomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified hepatic granuloma and renal hypodensities compatible with cysts. | Stable right lower lobe nodule, unchanged since 2012 and most likely benign. Continued annual surveillance scans are recommended in this high risk patient. |
Generate impression based on findings. | Female 63 years old Reason: abnormality to explain LUE radiculopathy History: LUE pain Bone mineralization is normal. Alignment is anatomic. There is minimal glenohumeral joint space narrowing. No acute fracture or malalignment.Enthesopathic changes are noted at the supraspinatus footprint suggesting underlying rotator cuff disease. Additionally, there is a hook osteophyte extending from the inferior surface of the acromion. | Mild left shoulder osteoarthritis and other findings as detailed above. |
Generate impression based on findings. | Female 67 years old Reason: cholecystitis History: CT evidence of cholecystitis, febrile LIVER: The liver measures 16.7 cm in length. The hepatic parenchyma demonstrates increased echogenicity consistent with fatty infiltration. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Gallstones within the gallbladder. Severe abnormal thickening of the gallbladder wall with pericholecystic fluid, consistent with acute cholecystitis. The common duct is dilated measuring up to 0.9 cm. No filling defect is identified.PANCREAS: The pancreas is poorly visualized however is unremarkable where seen.KIDNEYS: The right kidney measures 12.5 cm. The left kidney measures 12.8 cm. No hydronephrosis.OTHER: The spleen measures 9.9 cm. | 1. Acute cholecystitis. Dilatation of the common bile duct without filling defect identified.2. Increased echogenicity of the liver suggestive of fatty infiltration.Findings discussed by myself Dr. Ward with Dr. Berg 02/12/15 at 9:20 a.m. |
Generate impression based on findings. | Call back from screening mammogram for focal asymmetry in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. Ill-defined focal asymmetry measuring approximately 25 mm at 5-6 o'clock position is again seen and persists with spot compression. Focused ultrasound for the right lower breast detect dilated ducts with increased blood flow measuring 33 x 8 mm at 6 o'clock position. This area corresponds to the focal asymmetry seen on the mammogram. This area could be normal breast parenchyma; however, the pathologic process such as papillomatosis cannot be ruled out. | Focal asymmetry in the right breast at the 5-6 o'clock position, with sonographic correlation. Ultrasound-guided biopsy is recommended for definitive diagnosis. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Intramedullary rod Interval removal of the cast and tibial fracture fixation with an intramedullary rod with screw device. The distal tibial and fibular fractures are in near-anatomic alignment. No significant callus formation is evident. There is no radiographic evidence of hardware complication. Note is made of an osteochondroma at the proximal tibia. | Post operative changes, as above. |
Generate impression based on findings. | Metastatic renal cell cancer, evaluate for progression of disease. Status post 24 weeks investigational immunotherapy. The previously seen, multiple subtle lesions in the ribs and spine, most compatible with metastatic foci are stable in appearance. However, there is one small and one medium focus of new increased activity in the medial left iliac wing suspicious for new osseous metastases. The right ninth rib fracture is again seen and is stable when compared to the prior bone scan and abdomen and same day abdomen/pelvis CT exam. | Slight progression of osseous metastases with two new lesions in the superior medial left iliac wing. |
Generate impression based on findings. | 44 year old male with history of Crohn's disease with large resection 3 months ago. Symptoms of diarrhea, severe abdominal pain and bloating. Evaluate for recurrence of Crohn's disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several subcentimeter low-attenuation hepatic lesions are too small to characterize but are likely benign. Main portal vein is dilated to 1.9 cm raising the possibility of portal hypertension. There is an apparent stricture of the SMV (coronal series, image 59) with reconstitution distally. Mesenteric venous collaterals are present.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: Mesenteric fibrofatty proliferation and numerous small mesenteric lymph nodes are compatible with history of Crohn's disease. Postsurgical changes of partial small bowel resection and ileocolonic anastomosis. There is an approximately 14 cm segment of small bowel in the right lower quadrant which demonstrates narrowing and circumferential wall thickening (coronal series, image 71) compatible with active inflammation. The small bowel proximal to the area of inflammation is nondistended. The small bowel and colon distal to the inflamed bowel is mildly distended and filled with fluid. There is increased enhancement and mild bowel wall thickening involving the distal-most sigmoid colon and proximal rectum suggestive of active inflammation (series 4, image 113).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: Mesenteric fibrofatty proliferation and numerous small mesenteric lymph nodes are compatible with history of Crohn's disease. Postsurgical changes of partial small bowel resection and ileocolonic anastomosis. There is an approximately 14 cm segment of small bowel in the right lower quadrant which demonstrates narrowing and circumferential wall thickening (coronal series, image 71) compatible with active inflammation. The small bowel proximal to the area of inflammation is nondistended. The small bowel and colon distal to the inflamed bowel is mildly distended and filled with fluid. There is increased enhancement and mild bowel wall thickening involving the distal-most sigmoid colon and proximal rectum suggestive of active inflammation (series 4, image 113).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical changes of prior ileocecectomy. 2.Active inflammation of an approximately 14 cm segment of distal small bowel. 3.Active inflammation of the distal-most sigmoid colon/proximal rectum with associated mild distention of the colon. 4.Additional sequela of Crohn's disease including mesenteric fibrofatty proliferation. No obvious fistulae. 5.Dilation of the main portal vein raising the question of portal venous hypertension.6.Apparent stricture of the superior mesenteric vein with mesenteric venous collaterals. |
Generate impression based on findings. | Metastatic prostate cancer. No abnormal osseous foci are identified to indicate metastatic disease.Low signal with distortion seen in the lower pole of the right kidney is consistent with a large cyst seen on CT. Faint diffuse activity in the soft tissues of the heart is nonspecific but pericarditis, hypercalcemia or amyloid deposition may be considered. | No evidence of bone metastases. |
Generate impression based on findings. | Right eyebrow trauma with deep laceration. There is an irregular defect in the skin and subcutaneous tissues overlying the right superior orbital rim with surrounding fat stranding. There is no evidence of maxillofacial fractures or radioattenuating foreign bodies. The orbital contents appear to be intact, without evidence of retrobulbar hematoma. The temporomandibular joints are intact. Tooth # 8 is absent. The paranasal sinuses and nasal cavity are clear. The imaged intracranial structures are grossly unremarkable. | Right supraorbital skin laceration and contusion without evidence of maxillofacial fractures or radioattenuating foreign bodies. |
Generate impression based on findings. | Male 75 years old Reason: EUS noted sludge in gallbladder History: as above LIVER: The liver measures 16.1 cm in length. The hepatic parenchyma is hyperechoic suggestive of diffuse fatty infiltration. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Small shadowing gallstones identified within the gallbladder. There is also a non-mobile echogenic focus adherent to the gallbladder wall, measuring 0.6 cm which is suggestive of a gallbladder polyp. No gallbladder wall thickening or pericholecystic fluid. No biliary dilatation.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 9.9 cm. The left kidney measures 10.8 cm. There is no hydronephrosis. Subcentimeter right renal cysts. The renal cortex is mildly hyperechoic bilaterally suggestive of medical renal disease.OTHER: The spleen measures 10.5 cm. | 1. Gallstones. 0.6-cm non-mobile focus adherent to the gallbladder wall suggestive of a gallbladder polyp.2. Medical renal disease.3. Hyperechoic hepatic parenchyma which likely represents fatty infiltration. |
Generate impression based on findings. | 85-year-old female with history of forgetfulness and urinary incontinence. There is no evidence of acute intracranial hemorrhage. There is mild periventricular white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. The gray-white differentiation is preserved. There is enlargement of the pituitary gland, measuring up to 14 mm in the craniocaudal dimension. The ventricles and sulci are minimally prominent, suggesting parenchymal volume loss. The paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are unremarkable. | 1. Mild periventricular white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. 2. No evidence of hydrocephalus or acute intracranial hemorrhage.3. Enlargement of the pituitary gland, measuring up to 14 mm in the craniocaudal dimension, may represent an underlying adenoma. A dedicated pituitary MRI may be useful if there are no contraindications.Discussed with Dr. Kostas on 2/12/15 at 1120. |
Generate impression based on findings. | 39-year-old with history of benign biopsy in the right breast presents for annual mammography. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Percutaneously placed clip at anterior 9 o'clock position is unchanged in the right breast. A circumscribed round mass at upper outer quadrant in the right breast is unchanged. There is a new circumscribed mass at lower inner quadrant in the left breast. No suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound for the left breast is performed. Detected is 11 x 6 mm simple cyst at 7 o'clock position, corresponding to the mammographic findings. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Increasing ICP, evaluate intracerebral hemorrhage Portable technique somewhat limits evaluation. Right thalamic intraparenchymal hemorrhage is again seen with slight interval evolution compared to 2/7/2015 measuring approximately 2.3 x 4.0 x 4.0 cm in the AP, transverse, and craniocaudal dimensions. There is mild decrease in blood products at the level of the right caudate head. There is no significant change in mass effect with approximately 13 mm of midline shift at the level of the third ventricle and 7 mm at the level of the foramen of Monro. Again seen is intraventricular extension of hemorrhage. There is dilatation of the ventricles with slight decrease in size of the left lateral ventricle. There is again diffuse effacement of the sulci. There is apparent increased low-attenuation involving the bilateral frontal and parietal lobes which may be artifactual. No new hemorrhage. Partial effacement of the suprasellar cistern remains unchanged. Partial paranasal sinus opacification and moderate opacification of the mastoid air cells again seen | 1. Evolution of right thalamic intraparenchymal hematoma with intraventricular extension. No new hemorrhage or new mass-effect. Shunted ventricular system remains dilated with slight decrease in size of the left lateral ventricle compared to 2/7/2015.2. Diffuse sulcal and partial suprasellar cistern effacement are again seen. There is interval increase in apparent hypoattenuation involving the bilateral frontal and parietal lobes which is favored to be artifactual related to the portable technique. |
Generate impression based on findings. | Female 16 years old knee painVIEWS: Left knee AP, lateral and oblique 2/12/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 11 years old Reason: evaluate healing of fracture History: left knee fractureVIEWS: Left knee AP, lateral and oblique 2/12/15 (two views) There is no evidence of acute or healing fracture, malalignment or soft tissue swelling. No joint effusion. | Normal examination. |
Generate impression based on findings. | Female 63 years old Reason: Nerve compression? History: LUE radiculopathy The lower cervical vertebra from C6 through T1 are obscured on the lateral view. The odontoid is unremarkable. Mild degenerative changes affect the mid cervical spine with small disk osteophytes. | Suboptimal evaluation of the lower cervical spine due to overlying anatomy. Mild osteoarthritis affects the mid cervical spine. |
Generate impression based on findings. | Metastatic breast cancer.RADIOPHARMACEUTICAL: 12.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 85 mg/dL. Today's CT portion grossly demonstrates left lung lower lobe atelectasis or scarring. Again identified are calcified splenic granulomas and calcified uterine fibroids. Innumerable sclerotic lesions throughout the skeleton indicate healed metastases. Presumed bilateral mastectomies are noted.Today's PET examination demonstrates a decease in the previous prominent benign degenerative activity at the T3 and T4 levels. Additional foci of activity in the lumbar spine correspond to degenerative changes. The left upper cervical facet spine activity is also consistent with degenerative changes. No suspicious FDG avid lesion to indicate tumor activity. | No FDG avid tumor currently. |
Generate impression based on findings. | Female 0 days old Reason: Evaluate bowel gas pattern History: no lines - increasing respiratory distress; increasing O2 requirementVIEW: Abdomen and chest AP (two views) 2/12/15 Dilation of the after esophagus noted. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Bilateral granular, diffuse haziness. RDS or TTN or considerations. No focal lung opacities. No effusions or pneumothorax.Generalized bowel distention with no free air. No pneumatosis intestinalis or portal venous gas. No ascites. Obstruction cannot be the | Findings consistent with RDS or TTN.Upper esophageal dilatation and bowel distention are concerning for esophageal atresia with TEF. Obstruction is also a concern.Findings were communicated to acknowledged by Dr. MULLER, AARON on 2/12/15 at 949 hours. |
Generate impression based on findings. | Female 66 years old Reason: pain History: pain Postsurgical changes in the first metatarsal head. There is valgus angulation at the first IP joint.Mild to moderate osteoarthritis affects the first metatarsophalangeal joint and first IP joint. Mild osteoarthritis affects the midfoot. | Postsurgical changes and osteoarthritis as detailed above. |
Generate impression based on findings. | Male 55 years old Reason: eval for dorsal bone protrusion and spur near 3rd Metacarpal History: dorsal hand pain. Lateral view of the right wrist shows mild degenerative arthritic changes at the base of the third metacarpal joint. Otherwise, there are no acute fractures or dislocation. | Degenerative arthritic changes of the third metacarpal joint as described above. |
Generate impression based on findings. | Male 60 years old Reason: evaluate left knee pain History: left knee pain. Three views of the left knee demonstrates tricompartmental osteophytes, joint space narrowing, and near bone to bone apposition of medial tibiofemoral compartment. Degenerative arthritic changes affect the patella. Frontal view of the right knee demonstrates severe degenerative arthritic changes with bone on bone apposition of the medial tibiofemoral compartment. | Severe osteoarthritis of the left knee as described above. |
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