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Generate impression based on findings. | Female 60 years old Reason: eval fracture History: s/p fall, with swelling Bone mineralization is normal. Alignment is anatomic. There is moderate lateral compartment joint space narrowing with osteophyte formation. No joint effusion is evident. There is moderate soft tissue swelling of the prepatellar soft tissues. No acute fracture or malalignment. | Prepatellar soft tissue swelling without evident underlying fracture.Moderate right knee osteoarthritis. |
Generate impression based on findings. | 59-year-old female with biopsy proven left breast carcinoma presents for bracketed wire localization. On review of the prior and today's studies, a spiculated asymmetry with calcifications at upper outer quadrant in the left breast. Calcifications span 5 cm, anterior-posterior. The procedure, risks including bleeding and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 5 cm Kopans needles were placed anterior and posterior of the calcifications. On orthogonal digital mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wires were then deployed. Repeat two view orthogonal digital mammograms reveal the spring wire to be in good position. The digital mammogram was annotated and reviewed with Dr. Kulkarni prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Abe performed the procedure.Orthogonal digital specimen radiographs revealed the calcifications and clip and spring wires to be within the specimen. Dr. Kulkarni will excise more tissue from lateral posterior margins, as calcifications extend toward those margins. | Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 37 years old; Reason: eval for recurrence History: testicular cancer, s/p chemo CHEST:LUNGS AND PLEURA: Subcentimeter right upper lobe pulmonary nodule (image 59/series 6). The pleural spaces are clear. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is hypoattenuating suggestive of mild fatty infiltration.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small nonspecific retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam without evident metastatic disease. |
Generate impression based on findings. | Male 70 years old; Reason: s/p resection of large IVC sarcoma in October 2014 f/b RT completed 1/14/15 - please eval for recurrence or metastatic disease History: Sarcoma CHEST:LUNGS AND PLEURA: Calcified nodular changes in the left upper lobe. A few scattered pulmonary nodules some of them along the fissure as seen on image 63/series 6 suggestive of intrapulmonary lymph nodes. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Postsurgical changes from median sternotomy and coronary bypass grafting.CHEST WALL: Degenerative changes affect the thoracic spine. Postsurgical changes from a median sternotomy.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are perfusional changes adjacent to the caudate that is undergoing atrophy. There is a new hypodense lesion in segment 6 of the liver measuring 1.3 x 0.9 cm (image 118/series 4). The lesion does not show much central enhancement but has an enhancing rim. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Postsurgical changes in the IVC from tumor resection and reconstruction. There is a new hypodense lesion on the lateral aspect of the IVC measuring 1.7 x 1.5 cm (image 119/series 4). This is in the area of prior resection and IVC reconstruction.The renal veins are widely patent. There is narrowing of the IVC as it passes through the liver.Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.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 | 1.Postsurgical changes from resection and reconstruction of the IVC. There is a new soft tissue mass along the lateral aspect of the IVC and a new hypodense hepatic lesion. These may represent areas of residual and metastatic disease. Further elevation with an abdominal MRI may have utility to further characterize the lesions as these are in the area of surgical change. |
Generate impression based on findings. | Female 51 years old Reason: pain History: pain Right knee: Severe osteoarthritis affects the right knee with tricompartmental osteophytes, severe medial compartment joint space narrowing. No joint effusion. There is genu varus. No significant joint effusion.Left knee: Severe osteoarthritis affects the left knee with tricompartmental osteophytes, severe medial compartment joint space narrowing. There is a genu varus. No significant joint effusion. | Severe bilateral knee osteoarthritis. |
Generate impression based on findings. | 19 years, Male. Reason: ng History: ng Residual contrast within the renal collecting systems and bladder. NG tube side-port projects over the distal esophagus with tip projecting over the gastric cardia. Persistent dilated small bowel loops measuring up to 5.9 cm with relative paucity of bowel gas distally.Note that the pelvis is excluded from the field-of-view. | NG tube side-port projects over the distal esophagus, advancement recommended. Dilated loop of small bowel compatible with small bowel obstruction better seen on recent CT. |
Generate impression based on findings. | Male 72 years old Reason: Eval for disease recurrence or metastasis s/p whipple for IPMN History: whipple for IPMN ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes related to Whipple procedure. No definite evidence of recurrent residual disease.ADRENAL GLANDS: Nonspecific left adrenal thickening, unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild degenerative changes of the thoracic spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable postsurgical changes in the pancreas. No evidence of recurrent or residual disease. |
Generate impression based on findings. | Ms. Heins is a 70 year old female with a personal history of left breast lumpectomy in 1992 for cancer followed by radiation and hormonal therapy. She also had a benign right breast surgery approximately 27 years ago. Family history of breast cancer in mother. 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, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and skin retraction present within the left lumpectomy site. In addition, there is some postsurgical architectural distortion in the right superior breast, compatible with stated history of prior benign breast surgery. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | New Stage 2B cervical cancer with positive pelvic and common iliac nodes on pelvic MRI.RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates scattered calcified nodules in lungs and subcarinal region compatible with prior granulomatous process, a mass-like soft tissue enlargement in the cervical region and enlarged retroperitoneal and bilateral iliac lymph nodes. Today's PET examination demonstrates a large markedly hypermetabolic cervical mass with a SUVmax of 17.4 consistent with the patients diagnosis of cervical cancer. Multiple hypermetabolic bilateral lymph nodes in the pelvic region with an SUVmax of 7.3 indicate regional pelvic metastases. Hypermetabolic lymph nodes in the left paraortic retroperitoneum with an SUVmax of 8.3 indicate an additional site of lymph node metastases. Slightly more superiorly is a punctate focus of mildly increased activity in a aortocaval retroperitoneal lymph node at the level of the mid right kidney (series 606, image 107) with an SUVmax of 3.1 and which is equivocal but suspicious for additional lymph node metastases. No FDG avid tumor activity is visualized elsewhere. Extensive benign brown fat hypermetabolism seen symmetrically in chest, neck and upper abdomen. | 1.Markedly hypermetabolic cervical mass consistent with the patients diagnosis of cervical cancer.2.Multiple hypermetabolic bilateral pelvic and abdominal retroperitoneal metastases at least to the level of the aortic bifurcation, or possibly slightly more superior to this level as detailed above. |
Generate impression based on findings. | Clinical question:Rule out bleed. Signs and symptoms: Left headache, CVA on January 28. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Periventricular and subcortical patchy foci of low attenuation of white matter concerning for age indeterminant small vessel ischemic strokes are again noted. Findings appear grossly similar to prior study. Cortical sulci a metatarsus primus the CSF spaces are unremarkable and midline is maintained.Unremarkable orbits, paranasal sinuses, mastoid air cells, calvarium and soft tissues of the scalp. | 1.No acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.2.Age indeterminant small vessel ischemic strokes. |
Generate impression based on findings. | Facial pain and pressure; nasal congestion. There is mild mucosal thickening and bubbly secretions in the right sphenoid sinus. There are also a subcentimeter right posterior ethmoid sinus retention cyst. The other paranasal sinuses are essentially clear. The nasal cavity is clear. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | Findings suggestive of acute right sphenoid sinusitis. |
Generate impression based on findings. | Male 27 years old Reason: right knee pain History: right knee pain Bone mineralization is normal. Alignment is anatomic. The joint spaces are normal. Small enthesophyte projects from the inferior pole of the patella. There is nonspecific mild edema along the anterior aspect of the knee. No acute fracture or dislocation is evident. | No evident fracture. |
Generate impression based on findings. | 59 year old woman with history of metastatic rectal cancer status post partial colectomy and lung resection now with lower abdominal pain and possible parastomal hernia. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Partially visualized cardiac pacemaker leads. No suspicious pulmonary nodules or masses.LIVER, BILIARY TRACT: Mild diffuse fatty filtration of the liver, which is unchanged. Status post cholecystectomy. No focal hepatic lesions, though evaluation limited without intravenous contrast.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Status post proctectomy and partial colectomy with colostomy in left lower quadrant. Loops of small bowel enter a parastomal hernia without evidence of associated obstruction or edema, similar to prior. Contrast traverses the loops of small bowel contained within the hernia.BONES, SOFT TISSUES: Moderate-severe degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Two subcentimeter left external iliac lymph nodes have not significantly increased in size.BOWEL, MESENTERY: Status post proctectomy and partial colectomy with colostomy in left lower quadrant. Loops of small bowel enter a parastomal hernia without evidence of associated obstruction or edema, similar to prior. Contrast traverses the loops of small bowel contained within the hernia.BONES, SOFT TISSUES: Moderate-severe degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality noted | 1.Post surgical changes of a proctectomy and partial colectomy with end colostomy.2.Parastomal hernia containing loops of small bowel without evidence of obstruction.3.Hepatic steatosis. |
Generate impression based on findings. | Female 57 years old Reason: liver dopplers - Evaluate liver for focal lesion, cirrhosis - evaluate for thrombus of liver vasculature History: elevated transaminases LIMITED ABDOMENLIVER: The liver measures 18.9 cm in length. The hepatic parenchyma is coarsely echogenic consistent with chronic liver disease.BILIARY TRACT: The gallbladder is distended and there is a shadowing calculus lodged within the gallbladder neck. Gallbladder wall is measured at upper limits of normal. There is no pericholecystic fluid.PANCREAS: Unremarkable where visualized.OTHER: No significant abnormalities noted. | 1. Coarsely echogenic hepatic parenchyma consistent with provided history of chronic liver disease. 2. Patent hepatic vasculature.3. The gallbladder is distended and there is a 1.9-cm shadowing gallstone lodged within the gallbladder neck.Findings discussed by myself Dr. Ward with J Labas APN 02/12/2015 |
Generate impression based on findings. | Female 65 years old Reason: right shoulder pain History: right shoulder pain Right shoulder: Bone mineralization is normal. Alignment is anatomic. Mild osteoarthritis affects the right shoulder with mild joint space narrowing and small inferomedial humeral head osteophytes.There are enthesopathic changes at the supraspinatus footprint suggesting underlying rotator cuff disease.Mild osteoarthritis affects the right AC joint.Left shoulder: Bone mineralization is normal. Alignment is anatomic. Minimal osteoarthritis affects the left shoulder joint.Mild enthesopathic changes are noted at the super status footprint suggesting underlying rotator cuff disease.Mild osteoarthritis affects the left AC joint.No acute fracture or malalignment. | Mild bilateral shoulder osteoarthritis, right greater than left. Enthesopathic changes suggests underlying rotator cuff disease. |
Generate impression based on findings. | 73-year-old female patient with concern for esophageal stricture or other abnormality. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. An AICD, right upper quadrant cholecystectomy clips, and posterior spinal fusion hardware was noted.There were no morphologic abnormalities in the hypopharynx or cervical esophagus.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces. There was no evidence of stricture or esophagitis. There was a hiatal hernia that measured 3.1 x 2.5 cm (series 8). There was a small volume of aspirated barium with an associated cough reflex. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the thoracic inlet with proximal escape. No tertiary waves were observed. TOTAL FLUOROSCOPY TIME: 3:58 minutes | 1.Hiatal hernia and minor motility abnormality.2.No evidence of esophagitis or esophageal stricture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A focal asymmetry is present in the right breast near 12:00. A typically benign morphology mass in the left superior breast is present (only seen on MLO view). No suspicious microcalcifications or areas of architectural distortion are present. | Right breast focal asymmetry and typically benign morphology mass in the left superior breast. Attempts to obtain patient's prior mammograms should be made in order to confirm benignity of these findings.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Clinical suspicion of breast cancer recurrence in R SCV node, evaluate for extent of disease. There is are enlarged right level 5 lymph nodes, with a dominant lymph node that measures up to 34 mm. There is stranding of the surrounding fat and possible infiltration of the adjacent deltoid. There is a punctate calcification in the right floor of mouth, which may represent a calculus. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is fluid within the bilateral maxillary and ethmoid sinuses. There is scarring in the lung apices. | 1. Right level 5 lymphadenopathy with suggestion of extracapsular spread and/or lymphedema.2. Evidence of acute sinusitis. |
Generate impression based on findings. | There is minimal right maxillary sinus mucosal thickening. The remaining paranasal sinuses and imaged mastoid air cells are clear. There are no sinus air-fluid levels or bubbly secretions. The ostiomeatal complexes are patent. The nasal septum is deviated to the left with a small left septal spur present. The nasal cavity is clear. The orbits and intracranial structures are unremarkable. The lamina papyracea are intact. The roots of ethmoids are relatively symmetric. | No significant paranasal sinus disease. |
Generate impression based on findings. | Male 70 years old; Reason: eval for progression History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Post surgical changes in the right lung base. No new dominant lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Hypodense right thyroid nodule. Subtle sclerotic changes in the left scapula is seen on image 12 of series 4 corresponds to the area of abnormal bony uptake on the nuclear medicine study.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Hepatic and portal veins are patent. Mild fundal thickening of the gallbladder may represent adenomyomatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is atrophic. Left kidney enhances normally without hydronephrosis or focal mass.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Sclerotic changes in the left scapula suspicious for bony metastases. No new sites of disease. Correlate with bone scan done on the same day for better evaluation of skeletal metastases. |
Generate impression based on findings. | Female 57 years old; Reason: history localized renal pelvis cancer, assess for recurrence History: none CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules are stable, for example series 5 and image 33. No suspicious pulmonary lesion. No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. No pericardial effusion. No significant coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence in the left nephrectomy bed. No suspicious right renal lesion.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node measures 1.3 x 1.0 cm (series 3, image 141), previously 1.3 x 1.0 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Pars defect at L5/S1 grade 1 anterolisthesis.OTHER: Stable appearance of pelvic fluid collection which measures 3.8 x 0.9 cm (series 3, image 200), previously 3.8 x 1.1 cm. | 1.Stable pulmonary micronodules which are nonspecific.2.No evidence of disease recurrence in the left nephrectomy bed.3.Stable reference left para-aortic lymph node.4.Stable appearance of anterior pelvic fluid collection. |
Generate impression based on findings. | Status post fractureVIEWS: Right forearm AP lateral and 2/12/15 (two views) Cast material obscures fine bone details. Healing fracture of the right radius and ulna with dorsal angulation are unchanged in alignment. | Healing fractures, unchanged in alignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Strong family history of breast cancer in two maternal aunts, maternal great aunt, maternal cousin, two paternal aunts, and paternal cousin. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign intramammary lymph node in the right superior breast. Stable focal asymmetry in the left central breast. No new suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 5-year-old male with sepsis, concern for intra-abdominal infectious source. ABDOMEN:LUNG BASES: Bibasilar atelectasis. No suspicious pulmonary nodules or masses. No pleural effusion.LIVER, BILIARY TRACT: Liver is normal with no intra-or extrahepatic biliary ductal dilatation. Gallbladder is normal. SPLEEN: Spleen is normal.PANCREAS: Pancreas is normal.ADRENAL GLANDS: Adrenal glands are normal.KIDNEYS, URETERS: The kidneys are enlarged from prior study measuring up to 10.5 cm bilaterally. Right renal scarring. Nephrograms are slightly delayed. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from appendectomy. Bowel is normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Bowel is normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right femoral catheter with tip in the right external iliac vein. Hyperdense collection along the right pelvic sidewall measuring 3.4 cm x 1.8 cm (series 3, image 87) with punctate focus of gas (series 3, image 87). Filling defect in the left common and external iliac vein new from prior study. | 1. New thrombus in the left common and external iliac vein. 2. Collection along the right pelvic sidewall may represent a hematoma, possible infected fluid collection given focus of gas, or an undescended testicle. 3. Interval enlargement of both kidneys as described above. |
Generate impression based on findings. | Reason: r/o PE, tachy s/p TKA History: tachycardia, post op PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Right middle lobe subsegmental atelectasis and scattered mild nodularity likely related to inflammatory process, including mucus plugging or aspiration.Additional scattered pulmonary micronodules are unchanged. No new suspicious pulmonary nodules or masses.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: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Right middle lobe subsegmental atelectasis likely related to mucus plugging or mild aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 65-year-old female with difficult, incomplete colonoscopy in the past, overdue for colon cancer screening The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum with visualization of the appendix. There is no evidence of obstructing or constricting lesions. The colonic mucosa is normal in appearance with no evidence of ulceration, edema, or mass lesions. Small scattered diverticula were noted. Barium was not refluxed into the terminal ileum. TOTAL FLUOROSCOPY TIME: 5:57 minutes | No evidence of mass or polyps. Small scattered diverticula. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother and maternal aunt. Two standard digital views (total of 10 images) of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Bilateral benign intramammary lymph nodes are identified. Scattered coarse benign calcifications are present in both breasts. No new suspicious masses, microcalcifications or areas of architectural distortion are present. | Bilateral benign calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are ultrasound images of left axilla (1/13/15) performed at Advocate Trinity Hospital, and digital mammographic images (1/26/15) performed at High Tech Medical Park. For comparison, digital mammographic images (11/12/12) are available. ULTRASOUND IMAGES OF LEFT AXILLA (1/13/15):A large mass with internal heterogeneous echo signal, measuring 58 x 52 mm in the left axilla. Heper-echoic area within the mass might be a necrotic region. Needle biopsy under ultrasound guidance was performed.Per EPIC report, the pathology of this biopsy was malignant.DIGITAL MAMMOGRAPHIC IMAGES (1/26/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Mild skin thickening is seen in the left breast, possible due to the presence of large metastatic lymph node in the left axilla.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. | Large mass in the left axilla, which is proven to be malignant. No mammographic evidence for malignancy in either breast. If the malignant mass in the left axilla is suspicious for metastatic lymph node from breast primary, breast MRI might be an option to look for a primary breast lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Ms. Silva is a 85 year old female with a personal history of left breast lumpectomy in 2010 for DCIS status post radiation and hormonal therapy. No current breast related complaints. Three standard views of both breasts with a laterally exaggerated left CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Scattered benign calcifications, including arterial calcifications, are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 55-year-old male status post esophagectomy with gastric pull up on 2/6/15, evaluate for leak Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Right chest port tip projects over the superior cavoatrial junction. Water-soluble contrast swallow demonstrated no leak at the anastomotic site. Barium swallow demonstrated no leak at the anastomotic site. TOTAL FLUOROSCOPY TIME: 3:40 minutes | No anastomotic leak is evident. |
Generate impression based on findings. | Male 4 years old Reason: evaluate for healing of fracture History: left elbow fractureVIEWS: Left elbow AP, lateral and oblique 2/12/15 (3 views) Cast material obscures fine bone details. Fracture line is not visualized. Alignment is anatomic. | Anatomic alignment after casting. |
Generate impression based on findings. | Thyroid cancer on clinical trialsRADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 92 mg/dL. Today's CT portion grossly demonstrates multiple osseous lesions in the spine and pelvis which have not significantly changed. A spinal stabilization device in the lower thoracic spine, with adjacent destructive appearing lesion in T11 vertebral body is stable. A gallstone is again noted. Nonobstructive left renal stones are noted. A left dynamic hip screw is again seen. Surgical clips are present in the thyroid bed. Today's PET examination demonstrates no definite evidence of a new lesion.The previously identified osseous lesions are grossly stable with SUVmax measurements below.The SUV max of T6 lesion measures 5.4 previously measured 4.2 The SUV max of T7 lesion measures 3.1 previously measured 3.7The SUV max of L2 lesion measures 6.0 previously measured 5.8The SUV max of L3 lesion measures 4.2 previously measured 3.4The SUV max of L5 lesion measures 6.7 previously measured 5.3The SUV max of right iliac bony lesion measures 2.2 previously measured 1.5Two additional subtle lesions were present previously but less well-visualized. Small foci of abnormal increased activity are visualized in the left inferior pubic ramus which has an SUVmax of 2.6, previously measured 2.2 as well as a right femoral head lesion with an SUVmax of 1.5, previously measured 1.1.No new osseous lesions are noted and there is no suspicious avid extraosseous lesions.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | Multifocal osseous metastases remain significantly metabolically active and have progressed slightly in activity from the previous exam, although no new lesions are identified. |
Generate impression based on findings. | Male 55 years old Reason: fracture History: eval for healing There is a healing tibial plateau fracture extending from the medial tibial metaphysis to the lateral tibial plateau with intra-articular cortical stepoff. There is callus formation at the fracture site. Alignment is unchanged from prior.There is severe medial compartment joint space narrowing.No new joint effusions. | Healing tibial plateau fracture without evident change in alignment. The severe medial compartment joint space narrowing which is new from prior and is likely due to the weight-bearing views. |
Generate impression based on findings. | Reason: evaluate PE History: exertional dyspnea, dizziness, PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Scattered benign appearing micronodules, some calcified. No suspicious pulmonary nodules or masses. Minimal basilar subsegmental scarring. No focal air space consolidations. No pleural effusions.MEDIASTINUM AND HILA: Heart is normal in size without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | No pulmonary embolism or other acute cardiopulmonary abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 50 years old Reason: knee pain for 3 weeks History: knee pain for 3 weeks Bone mineralization is normal. Alignment is near-anatomic. There is mild to moderate medial compartment joint space loss with developing tricompartmental osteophytes, worst in the medial compartment. No joint effusion is evident. No acute fracture or malalignment. | Mild/moderate left knee osteoarthritis. |
Generate impression based on findings. | 72-year-old with personal history of right lumpectomy for breast cancer. No current complaints. Status post left breast reduction. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Bilateral benign calcifications including dystrophic calcifications at the lumpectomy site are again noted. Surgical clips are present in the right breast and axilla. Skin thickening compatible with previous radiation therapy. Stable post breast reduction changes of the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Status post fractureVIEWS: Right wrist AP and lateral 2/12/15 (two views) Healing fracture of the distal radius with periosteal reaction is in anatomic alignment. | Healing fracture, in anatomic alignment as described. |
Generate impression based on findings. | Thyroid cancer. Compare to previous with measurements. CHEST:LUNGS AND PLEURA: Interval resolution of right middle lobe opacities with mild residual scarring.No suspicious pulmonary or pleural metastases.Mild radiation reaction in the right apex, unchanged. Small amount of debris in the left dependent trachea.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Postsurgical findings of total thyroidectomy with neck dissection.Normal heart size. Mild thickening of the anterior pericardium. No visible coronary artery calcification.CHEST WALL: Prior cervicothoracic vertebral surgery with internal stabilization device, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter right hepatic lobe hypodensity is too small to characterize, unchanged and most likely benign.SPLEEN: No significant abnormality noted. Splenule is noted.ADRENAL GLANDS: Stable right adrenal nodule, most likely benign.KIDNEYS, URETERS: Bilateral renal cysts. Subcentimeter hypoattenuating renal foci are too small to characterize, unchanged and most likely benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta without aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube terminates in the stomach.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of metastases. Interval resolution of right middle lobe opacities with residual mild scarring. |
Generate impression based on findings. | History of prostate cancer, evaluate for progression. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Moderate coronary artery calcifications noted. Moderate to severe hiatal hernia with a patulous esophagus but no evidence of focal wall thickening. No hilar or mediastinal lymphadenopathy.CHEST WALL: Bilateral gynecomastia noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Retroaortic left renal vein. Multiple simple cysts are noted in both kidneys.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the abdominal aorta and its branches. Focal ectatic aorta with some ulceration and plaques noted in the infra-renal region, unchanged. BOWEL, MESENTERY: Multiple colonic diverticula are identified without evidence of diverticulitis. BONES, SOFT TISSUES: Mild degenerative changes are seen throughout the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Cluster of right common iliac lymph nodes has slightly increased in size. Largest lymph node (series 4, image 153) measures 1.2 cm in short axis, 1.0 cm previously. BOWEL, MESENTERY: Multiple diverticula in the sigmoid colon without evidence of diverticulitis.BONES, SOFT TISSUES: Left pelvic lymphocele (series 4, image 180), unchanged. Bilateral fat containing hernia.OTHER: No significant abnormality noted | 1.Slight interval increase in size of right iliac lymph nodes. Otherwise stable exam. 2.No osseous metastasis identified, but nuclear medicine bone scan is more sensitive. |
Generate impression based on findings. | Fall on outstretched hand.VIEWS: Left wrist AP, lateral and oblique. Left elbow AP, lateral and oblique on 2/12/15. (Six views) Left wrist and elbow : There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Status for nonaccidental trauma. Evaluate for evidence of fracture with two weeks follow-up. 2/12/15EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 2/12/15 NG tube terminates in the stomach. There is no evidence of acute or healing fractures. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax. Normal abdomen gas pattern. | No evidence of acute or healing fractures. |
Generate impression based on findings. | Follow-up of recurrent follicular (poorly differentiated thyroid) carcinoma status post TFHX. There are extensive post-treatment findings in the neck, including total thyroidectomy, neck dissection, and mucosal edema related to radiation. There is no significant interval change in the ill-defined residual mass posterior to the cricoid and ill-defined nodularity in the left anterior neck treatment bed, which are otherwise not amenable to precise measurements. The esophagus remains patulous. There has been corpectomy at T1 with posterior surgical fusion, without evidence of hardware complications. There is no evidence of significant cervical lymphadenopathy. The salivary glands are unchanged, with evidence of post-treatment effects, particularly affecting the left submandibular gland. There is mild left and moderate right carotid bifurcation plaque. There is chronic thrombosis of the left internal jugular vein and the right internal jugular vein is absent. There is mild scattered paranasal sinus opacification. There is right apical scarring. | 1. No significant interval change in the residual mass posterior to the cricoid and nodularity in the left anterior neck treatment bed. However, a PET/CT may be useful for better delineation of residual tumor.2. Unremarkable corpectomy at T1 with posterior surgical fusion without evidence of hardware complications. |
Generate impression based on findings. | One day old male, 25 week premature intubated with UAC, UVC; assess lines and tubes. VIEW: Chest AP and Abdomen AP (Two views) 2/11/2015 20:19 Endotracheal tube below the thoracic inlet. NG tube with side port above the GE junction. Umbilical artery catheter tip at T7 vertebral body level. Umbilical venous catheter tip in the distal umbilical vein. Diffuse hazy lung opacities. Disorganized likely age-related bowel gas pattern with no evidence of obstruction, pneumatosis intestinalis or pneumoperitoneum, portal venous gas or ascites.. | 1. NG tube with side port above the GE junction.2. Diffuse bilateral pulmonary hazy opacities likely related to ARDS. |
Generate impression based on findings. | Male 56 years old Reason: r/o fracture History: shoulder pain, bony mets Bone mineralization is normal. Alignment is anatomic. There is mild joint space narrowing with developing osteophytes. No acute fracture or malalignment. Mild to moderate osteoarthritis affects the left AC joint.There are permeative changes involving the left third rib compatible with metastatic disease. | No acute fracture of the left shoulder.Metastases to the left third rib. |
Generate impression based on findings. | 75 year old female. Persistent crackles in bases. Apical scarring on XR. LUNGS AND PLEURA: Very mild bilateral lower lobe bronchiectasis. Mild paraseptal emphysema in the medial aspect of the lower lobes. Minimal centrilobular emphysema.No apical scarring. No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. Mild coronary artery calcification.Calcified atheroscleortic disease of the thoracic aorta with an ectatic ascending thoracic aorta measuring 4.3 cm in diameter.Small hiatal hernia.CHEST WALL: Healing nondisplaced left rib fractures. Mild degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Pneumobilia, correlate for history of biliary intervention. Post-surgical findings of cholecystectomy. Calcified atherosclerotic disease of the abdominal aorta. | Very mild lower lobe bronchiectasis. Mild emphysema. No significant acute abnormality to explain the patient's symptoms. |
Generate impression based on findings. | Female 77 years old Reason: eval for fracture healing History: eval Postsurgical changes in the fibula with plate and syndesmotic screws without hardware complication. Joint alignment is anatomic. The fracture lines are less evident indicating ongoing healing.Soft tissue swelling persists. | Orthopedic fixation of ankle fractures as detailed above. |
Generate impression based on findings. | 57F breast ca with lung, brain mets History: neutropenic fever history. Prior CT imaging with high suspicion for drug reaction; interval steroid treatment. LUNGS AND PLEURA: Interval near complete resolution of diffuse ground glass opacity throughout the lungs.Additional interval resolution of small bilateral pleural effusions.Innumerable bilateral pulmonary nodules, compatible with known metastatic disease appear similar to the prior exam.Reference right lower lobe mass measures 5.8 x 4.7 cm (series 5, image 50), previously measuring 5.7 x 4.7 cm.Reference left upper lobe nodule measures 1.4 x 1.1 cm (series 5, image 29), unchanged.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.Mediastinal and hilar lymphadenopathy appear similar to the prior exam.Reference right hilar lymph node (series 3, image 42) is not measurable on this noncontrast exam, but appears grossly stable from the prior exam.Reference right paratracheal lymph node measures 1.6 x 1.3 cm, unchanged.CHEST WALL: Surgical changes in the left breast. Status post left axillary lymph node dissection. Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Numerous poorly marginated hepatic hypodense nodules and confluent areas of hepatic hypodensity appear similar in extent to the prior exam accounting for differences in technique.A hypodense splenic lesion measures 4.2 x 4.5 cm (series 3, image 83) on noncontrast imaging, stable in appearance. | 1. Near complete resolution of diffuse ground glass opacities throughout the lungs and pleural effusions.2. Diffuse pulmonary metastases and mediastinal/hilar lymphadenopathy appear similar to the prior CT exam dated 01/23/2015.3. Stable hepatic and splenic metastatic disease. No new sites of disease identified. |
Generate impression based on findings. | Male 67 years old Reason: HBV, eval for HCC History: HBV LIVER: The liver measures 14.8 cm in length. Coarsened heterogeneous echotexture consistent with chronic liver disease. No focal liver lesion. The portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 8.9 cm. The left kidney measures 10.1 cm. There is no hydronephrosis.OTHER: The spleen measures 7.6 cm. | Coarsened heterogeneous hepatic echotexture consistent with chronic liver disease. No focal liver lesion. |
Generate impression based on findings. | Grayscale, Color and spectral Doppler were performed on inflow and outflow vessels of the liver.LIVER: Normal echogenicity measuring up to 15.5 cm in longitudinal dimension. No evidence of intrahepatic or extrahepatic biliary duct dilatation. Normal flow and direction of the main portal vein with peak systolic velocity of 35.3 cm/s. Normal flow and direction of the left portal vein with velocity of 0.25 m/s. Normal flow and direction of the right portal vein with velocity of 0.13 m/s. Common hepatic artery is patent with normal flow and direction with peak systolic velocity of 0.37 m/s, end diastolic velocity of 0.12 m/s, and Resistive index of 0.69. The left hepatic artery is patent with normal flow and direction with peak systolic velocity of 0.34 m/s, end diastolic velocity of 0.14 m/s and RI of 0.58. The right hepatic artery is patent with normal flow and direction with peak systolic velocity of 0.23 m/s, end diastolic velocity of 0.10 m/s and RI of 0.55. GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized. Common bile duct measures up to 5 mm in caliber. PANCREAS: Normal echogenicity with no pancreatic ductal dilatation.SPLEEN: Normal echogenicity measuring up to 8.1 cm in longitudinal dimension. Normal direction and flow of the splenic vein with peak systolic velocity of 38.9 cm/sec. normal direction and flow of the splenic artery with peak systolic velocity of 1.88 m/sec, end-diastolic velocity of 0.95 m/s and RI of 0.49. KIDNEYS: Normal echogenicity of both kidneys with no hydronephrosis. The right kidney measures up to 6.8 cm in longitudinal dimension and the left kidney measures 8.8 cm in longitudinal dimension.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. | Patent vasculature with no evidence of biliary dilatation as clinically questioned. |
Generate impression based on findings. | Ms. Blagojevich is a 49 year old female with a personal history of benign left breast biopsy 1994. Family history of breast cancer in mother (diagnosed at age of 42), sister (diagnosed at age of 44), and paternal grandmother (diagnosed at age of 50). Three standard views of both breasts, additional right MLO view, and a left laterally exaggerated cc view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear marker was placed on a scar overlying the left superior breast. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. The patient did ask about alternative screening methods, including whole breast ultrasound and tomosynthesis. She would like to get tomosynthesis for next year's annual mammogram, if possible. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 75-year-old female. Metastatic pancreatic cancer. Staging. LUNGS AND PLEURA: Moderate right pleural effusion with adjacent atelectasis..Multiple scattered ill-defined nodular opacities bilaterally, most in the left lung base, are favored to be infectious/inflammatory although follow-up is recommended to exclude metastases. For reference, a left lower lobe nodule is 10 mm (series 4, image 58).Calcified granulomas consistent with healed granulomatous disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Mild coronary calcification.Normal heart size without pericardial effusion.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hypoattenuating hepatic lesions, better seen on prior contrast enhanced CT, consistent with metastases. Left and right hepatic lobe biliary drains with expected pneumobilia. | 1. Moderate right pleural effusion, correlate with thoracentesis as clinically warranted to assess for a malignant effusion.2. Multiple bilateral ill-defined nodular opacities, favored to be infectious/inflammatory though follow-up recommended to exclude the less likely possibility of metastases.3. Known liver metastases. |
Generate impression based on findings. | Female 50 years old Reason: please eval liver echotexture and kidneys for obstruction History: AKI in liver failure LIVER: The liver is coarsely echogenic with a nodular contour consistent with cirrhosis. No focal liver lesion is identified .GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary dilatation.PANCREAS: Poorly visualized due to bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 9.5 cm. There is no hydronephrosis. Echogenic renal cortex bilaterally consistent with medical renal disease.OTHER: Increasing abdominal ascites. The spleen measures 12.3 cm. | 1. Cirrhotic liver morphology with increasing abdominal ascites. Sluggish bidirectional portal vein flow with poor visualization of the right and left portal vein branches as well as the hepatic veins. Consider triphasic MRI liver for further evaluation.2. Medical renal disease. |
Generate impression based on findings. | Male 31 years old; Reason: assess for progression of Hodgkin's lymphoma History: None CHEST:LUNGS AND PLEURA: Paramediastinal radiation changes are stable. Clustered micronodules in the right lower lobe (image 56 of series 5) are unchanged.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Centrally calcified mediastinal mass measures 1.6 x 1.3 cm (image 31/series 4) previously, 1.8 x 1.5 cm.Right pericardiophrenic lymph node measures 3.7 x 2.7 cm (image 77/series 4) previously, 3.0 x 1.7 cm. There is an additional new soft tissue density located medially.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Stable scattered hypodensities within the right hepatic lobe. Small lymph node within the porta hepatis appears unchanged.SPLEEN: Status post splenectomyPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic partially calcified lymph node measures 3.8 x 2.6 cm (image 97/series 4) previously, 3.4 x 2.7 cm.There remains lymphadenopathy in the upper abdomen including aortocaval and portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Decrease in the size of the calcified lymph nodes.2.Increase in the size of the noncalcified lymph node especially the right pericardiophrenic lymph node.3.Further evaluation of the abnormal lymph nodes it suggested as these nodes are showing increase in size. |
Generate impression based on findings. | Male 44 years old Reason: restaging scans s/p 6 cycles of investigational agent History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Nonspecific minimal right posterior pleural thickening. Interval resolution of left lower lobe micronodule seen on previous exam which was likely inflammatory in etiology.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Stable subcentimeter cardiophrenic lymph nodes, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality KIDNEYS, URETERS: Ill-defined right renal mass which is stable in size, now measuring 10.6 x 5.6 cm (series 3, image 101), previously measuring 10.0 x 5.8 cm. The mass extends to the level of the renal pelvis with a patent renal artery. No suspicious lesions in the left kidney. Interval development of abdominal soft tissue mass adjacent to the right renal mass measuring 4.2 x 3.0 cm (series 3, image 102).RETROPERITONEUM, LYMPH NODES: Minimal increase in size of the retroperitoneal lymph nodes. For reference, lymph node at the bifurcation of the aorta measures 1.4 x 1.1 cm (series 3, image 130).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered lytic lesions of the spine and sacrum which are grossly unchanged. One lesion involves the T10 vertebral body with associated chronic compression fracture.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 | 1.Stable right renal mass with interval development of adjacent abdominal wall soft tissue mass.2.Minimally increased size of retroperitoneal lymph nodes.3.Stable osseous metastatic disease. |
Generate impression based on findings. | Female 54 years old Reason: pain in thumb and possible carpal tunnel History: pain in thumb and possible carpal tunnel Bone mineralization is normal. Alignment is anatomic. There is interphalangeal joint space narrowing and developing osteophytes.Moderate osteoarthritis affects the basilar joint with joint space narrowing and osteophyte formation.Mild osteoarthritis affects the IP joint of the first digit. No acute fracture is evident. | Osteoarthritis without underlying fracture. |
Generate impression based on findings. | Male 73 years old; Reason: 73M s/p cystectomy with distention and leukocytosis; please abscess or fluid collection History: as above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or nephrolithiasis is evident.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Post surgical changes in the small bowel from a right lower abdomen conduit construction. There is a bowel obstruction with the proximal small bowel loops dilated up to 5 cm with a transition point in the right lower abdomen at the site of ileal harvest and inflammation.No free air is evident. There are scattered upper abdominal ascites.Enteric tube terminates in the second portion of the duodenum and can be withdrawn.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall. Right lower abdominal stoma.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystoprostatectomyLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the small bowel as detailed above. There is a pelvic abscess measuring 12.5 x 5.3 cm (image 150/series 3). Located in the pelvis in the surgical bed with extension into the right lower abdomen. There are additional pockets of abscess fluid in the vicinity that connect with the dominant pocket. Via a left transabdominal approach a drain terminates in the pelvis. BONES, SOFT TISSUES: Please see aboveOTHER: No significant abnormality noted. | 1.Persistent small bowel obstruction with a transition point in the right lower abdomen near the site of prior ileal harvest near an area of extensive inflammation extending to a large pelvic abscess as detailed above.2.Consider withdrawing enteric tube to the stomach |
Generate impression based on findings. | 8-year-old male status post surgery for hip dislocationVIEWS: Pelvis AP (one view) 2/12/15 11:15 Note is made of an overlying SPICA cast obscuring underlying osseous detail. Postoperative changes of varus derotation osteotomy, with a plate and screw device affixing the proximal femur in near-anatomic alignment without evidence of hardware complication. The right femoral head is now well directed within the acetabulum. There is a left coxa valga deformity without evidence of hip dislocation. | VDRO in near-anatomic alignment without evidence of complication. |
Generate impression based on findings. | 49-year-old with history of left mastectomy for breast cancer. No current complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Biopsy clip noted in the right upper outer breast. Several scattered benign calcifications are present. Probable intramammary lymph nodes in the outer breast are unchanged. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 35 years old; Reason: eval for SBO vs appy History: RLQ pain, diffuse abd pain ABDOMEN:LUNGS BASES: No significant abnormality.LIVER, BILIARY TRACT: No focal liver lesions. No biliary dilatation. Hepatic and portal veins enhance normally without evidence of thrombus. Gallstones.SPLEEN: Granulomata, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small kidneys consistent with known medical renal disease. Several hypodensities in both kidneys too small to characterize likely cysts as noted previously. Single punctate calcification left upper pole there present nonobstructive nephrolithiasis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bilateral Tinning in the region of the jejunum is again noted with mild dilation of a segment of bowel. Correlation with small bowel study may be helpful for further evaluation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of free fluid in the pelvis. No bowel wall thickening or dilatation in the pelvic loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites, slightly decreased compared to prior. | 1.Continual bowel wall thickening in the region of the jejunum as described previously; consider correlation with small bowel study. 2.Decreased ascites |
Generate impression based on findings. | Female 84 years old Reason: evaluate size of right renal mass; no need to visualize left kidney History: small right renal mass RIGHT KIDNEY: The right kidney measures 8.5 cm. There is a 2.2 x 1.8-cm exophytic hypoechoic mass arising from the lower pole of the right kidney and consistent with complex cystic/solid renal mass identified on recent CT. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 7.3 cm. The 0.8-cm left renal mass identified on recent CT is not clearly visualized.URINARY BLADDER: The urinary bladder is decompressed and not evaluated.OTHER: No significant abnormalities noted. | Solid right renal mass measuring 2.2 cm remains suspicious for renal cell carcinoma. The 0.8-cm left renal mass identified on recent CT is not clearly visualized. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. A few faint benign calcifications are again seen bilaterally. Normal morphology lymph nodes are partially visualized in each axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Status post left nephrectomy in 2011. AML with hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Probable hemangioma in the right lobe of the liver (image 50; series 8061) measures 3 cm in diameter, not substantially changed compared to prior. Subcentimeter cyst also noted in the right lobe, unchanged. 11-mm hypodense nodule in the left lobe (image 28; series 8) is also stable and probably benign.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Presumed lipid poor AML in the right kidney has enlarged compared to the prior examination and currently measures 4.5 x 5.3 cm (image 33; coronal series 8061) compared to 4.1 x 4.5 cm on the prior examination (image 31; series 501). No hydronephrosis. No other focal lesions identified.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 noted. Postsurgical changes in the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval enlargement of presumed lipid poor right angiomyolipoma. Unchanged hepatic hemangioma. Status post left nephrectomy and splenectomy |
Generate impression based on findings. | Chronic sinusitis. The frontal sinuses are not pneumatized and there is minimal mucosal thickening in the maxillary sinuses. The paranasal sinuses are clear. The nasal cavity is also clear. The nasal septum is deviated slightly to the left with an associated spur. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | 4-year-old male with history of supracondylar fractureVIEWS: Right elbow, AP and lateral (two views) 2/10/15 11:29 Interval removal of multiple K wires affixing a supracondylar fracture. There is mild residual deformity consistent with a healed fracture. Alignment is anatomic. No joint effusion. | Healed supracondylar fracture in near-anatomic alignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of prior benign left breast biopsy. Two standard digital views of both breasts, repeat right MLO view and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable left breast biopsy clip with associated stable small mass. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 50 years old Reason: please eval liver echotexture and kidneys for obstruction History: AKI in liver failure LIVER: The liver is coarsely echogenic with a nodular contour consistent with cirrhosis. No focal liver lesion is identified .GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary dilatation.PANCREAS: Poorly visualized due to bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 9.5 cm. There is no hydronephrosis. Echogenic renal cortex bilaterally consistent with medical renal disease.OTHER: Increasing abdominal ascites. The spleen measures 12.3 cm. | 1. Cirrhotic liver morphology with increasing abdominal ascites. Sluggish bidirectional portal vein flow with poor visualization of the right and left portal vein branches as well as the hepatic veins. Consider triphasic MRI liver for further evaluation.2. Medical renal disease. |
Generate impression based on findings. | Female 4 months old Reason: Is central line in correct placement? History: Peripheral TPNVIEW: Chest AP (one view) 2/12/15 at 1124 hours. Central line has been retracted and it is no longer in the venous system. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Retraction of central line which is no longer in the venous system. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Increasing obscured masses in the right breast are present in the right breast near 10 o'clock and 4 o'clock respectively. Other bilateral areas of focal asymmetry do not appear significantly changed. No suspicious microcalcifications or areas of architectural distortion are present. | 1. Two obscured masses in the right breast may represent enlarging cysts. Further evaluation with spot compression and ultrasound is recommended.2. At the time of diagnostic evaluation, the right CC view should be repeated due to motion artifact.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Male 70 years old; Reason: eval for mets History: prostate cancer, rising psa ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. Nonspecific hypodense focus is located in segment 8 of the liver measuring 9 mm - image 22/series 5. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney is mildly atrophic. Severe calcific arteriosclerotic disease affects the ostia of the left renal artery. Right kidney is normal in morphology.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Chronic left rib fractures in the left 11th, 10th and 9th ribs.Mild sclerotic changes involving the right 10th and 11th ribs.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No lymphadenopathy in the abdomen or pelvis.2.Sclerotic changes involving the right 10th and 11th ribs. Correlation with nuclear medicine bone scan results are suggested.3.Left renal atrophy due to ostial plaque at the origin of the left renal artery. This can be further evaluated and treated if needed.4.Nonspecific right hepatic lobe lesion. |
Generate impression based on findings. | 70 years, Male. Reason: 70yo M with IABP and back pain, assess location with 2 view film. History: IABP Atherosclerotic calcifications of the aorta and iliac arteries. Degenerative disk disease at the L4-L5 level. IABP marker projects over the L1 level. On the lateral view, the IABP marker is angled anteriorly with respect to the aorta and may be in the superior mesenteric artery.Nonobstructive bowel gas pattern. | IABP marker projects over the L1 vertebral body level and may be in the superior mesenteric artery. This was discussed with the clinical service at 1330 on 2/12/15. |
Generate impression based on findings. | Female 76 years old Reason: knee pain History: knee pain Status post total right knee arthroplasty. There is thin lucency at the bone cement interface of the tibial prosthesis . There is mild varus of the tibial shaft in relation to the femur.Heterotopic ossification in the lateral aspect the patella appears similar from prior exam. | Subtle new lucency at the bone cement interface of the right tibial prosthesis. Clinical correlation for loosening is suggested. |
Generate impression based on findings. | 73-year-old with history of left breast cancer status post lumpectomy presents for routine follow-up. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable asymmetries in the left central breast posteriorly and right upper breast. Postlumpectomy findings in the left breast, including architectural distortion, increased density and surgical clips, are unchanged. Benign bilateral calcifications are stable. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 63 years, Male. Reason: 63yo M with OHT on immunosuppression with new abd pain. History: abd pain Nonobstructive bowel gas pattern. Average stool burden. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Left ankle injuryVIEWS: Left ankle, AP, lateral and oblique 2/12/15 (3 view/s) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 59 years, Male. Reason: Dobbhoff History: Dobbhoff ECMO tubing, Swan-Ganz catheter, cholecystectomy clips, mediastinal staples, chest tubes, and mediastinal drains are noted. Dobbhoff tube tip objects over the proximal duodenum. Retrocardiac opacity persists.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip objects over the proximal duodenum. |
Generate impression based on findings. | Restaging diffuse large B-cell lymphoma. Posttreatment evaluation due to a questioned FDG avid focus on prior PET.RADIOPHARMACEUTICAL: 15.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 160 mg/dL. Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in right atrium. Large peripherally calcified gallstone is noted.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate tumor activity currently in the neck, chest, abdomen or pelvis. Previous residual portahepatic activity has resolved and was most likely inflammatory. | No suspicious FDG avid lesion to indicate tumor activity currently in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | Female 76 years old Reason: evaluate right hip pain History: s/p right THA, with continues pain in the right hip. Components of a total right hip arthroplasty are situated in near-anatomic alignment without radiographic evaluation of hardware complication.Pelvic radiograph demonstrates the aforementioned right hip arthroplasty. Moderate osteoarthritis affects the left hip with joint space narrowing and osteophytes.Degenerative changes affects the lower lumbar spine and pubic symphysis. Coarse calcification within the pelvis likely within the uterus. | Total right hip arthroplasty and degenerative changes as detailed above. |
Generate impression based on findings. | Male 48 years old Reason: MVC pt History: neck pain Bone mineralization is normal. Alignment is anatomic. There is disk space narrowing at C5-C6 with endplate osteophytes and sclerosis. There is mild bony neural foraminal narrowing at this level.No evident fracture. | Osteoarthritic changes without evidence of acute fracture. |
Generate impression based on findings. | Male 49 years old Reason: 49yo M w/ L hip pain History: L hip pain Bone mineralization is normal. Alignment is anatomic. The joint spaces are normal. No acute fracture or dislocation is evident. | Unremarkable radiographs of the left hip. |
Generate impression based on findings. | Female 80 years old Reason: eval of OA, pt s/p stroke, residual R sided weakness History: same Bone mineralization is normal. Alignment is anatomic. Moderate osteoarthritis affects the right knee with moderate lateral joint space narrowing and tricompartmental osteophytes. No joint effusion. No acute fracture or malalignment.Contralateral left knee has mild joint space narrowing in its medial compartment with developing osteoarthritis. | Moderate right knee osteoarthritis. |
Generate impression based on findings. | Initial treatment strategy for lymphoma. Anterior mediastinal mass with lymphadenopathy.RADIOPHARMACEUTICAL: 10.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 81 mg/dL. Today's CT portion of the neck grossly demonstrates extensive left posterior jugular and left supraclavicular enlarged lymph nodes. Air in the left subcutaneous tissues likely reflects recent instrumentation / biopsy. Please see diagnostic CT reports for details of the chest, abdomen and pelvis.Today's PET examination demonstrates multiple markedly hypermetabolic lymph nodes in the left posterior neck extending to the left supraclavicular region (SUV max = 19.6), compatible with tumor, likely lymphoma. Additional smaller but abnormal hypermetabolic right supraclavicular lymph nodes indicate additional tumor activity.Extensive enlarged markedly hypermetabolic mediastinal lymph nodes indicate additional tumor (SUV max = 23.0). These are most extensive in the anterior mediastinum but with some involvement of the middle mediastinum.Hypermetabolic intramuscular foci in the right inferior neck and left upper paraspinal locations (SUV max = 14.1) indicate additional tumor involvement. A hypermetabolic left cardiophrenic lymph node (SUV max = 6.9) indicates additional thoracic tumor. Extensive hypermetabolic bilateral axillary lymph nodes, left greater than right, indicate additional tumor involvement.Several hypermetabolic osseous foci in the thorax indicate additional tumor involvement. These are seen most notably within the T2 anterior vertebral body (SUV max = 14.7) but also involve the left third through fifth ribs near the costovertebral junctions. Diffuse uniform mildly elevated activity throughout remaining visualized red marrow more likely represents benign marrow stimulation rather than additional osseous tumor involvement.No convincing FDG avid lesion is seen within the abdomen or pelvis. Milder hypermetabolic activity involving bilateral adnexa (SUV max = 5.4), left greater than right, are most commonly benign in a premenopausal female. Several punctate cutaneous foci within the pelvis are most likely benign inflammatory. | 1.Extensive markedly hypermetabolic tumor, likely lymphoma, in the neck and thorax involving lymph nodes extending from the jugular through the cardiophrenic regions as well as thoracic osseous and intramuscular hypermetabolic tumor involvement.2.No convincing FDG avid tumor below the diaphragm. Several cutaneous and bilateral adnexal foci most likely benign.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Clinical question: Intraoperative head CT for navigation. Signs and symptoms: Intraoperative head CT 6876. Nonenhanced head CT:Preoperative study.Examination is performed while a stereotactic device in place to patient's calvarium. Examination is performed as a surgical guidance and is not a diagnostic test. There is a tiny focus of low-attenuation in the left posterior frontal -- right lobe consistent with a previously seen focus of vasogenic edema on MRI exam of the same date. Ventricular system are within normal size and maintained midline. There is no gross additional intracranial pathology.Nonenhanced head CT:Postoperative/biopsy study.Examination demonstrates a left frontal burr hole at the site of access for the left hemispheric biopsy. There is a punctate focus of high-density likely metallic is present within the focus of left frontal edema representing site of patient's known lesion. A tiny amount of subarachnoid air is also present in the left frontal region. No evidence of intracranial hemorrhage, mass effect or midline shift. | 1.Surgical planning head CT as detailed above.2.Postbiopsy exam via a left frontal burr hole demonstrate punctate high density likely metallic in the left frontal lobe within the region of edema and small amount of expected post procedural air. |
Generate impression based on findings. | Patient with cirrhosis. Acute kidney injury, likely prerenal with right pleural effusion after thoracentesis with bloody fluid. Concern for hepatic hydrothorax. Please evaluate. The following observations made given limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions (right greater than left with overlying compressive atelectasis. Motion artifact. Patchy ground glass opacity noted bilaterally.MEDIASTINUM AND HILA: Right PICC line terminates in the SVC.CHEST WALL: No significant abnormality notedABDOMEN: Detector artifact noted in the upper abdomen. LIVER, BILIARY TRACT: Perihepatic ascites. Liver is small in size with no focal lesions identified.SPLEEN: Spleen measures 14.6 cm in length, mildly enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Upper abdominal varices.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate pelvic ascites. | 1. Large bilateral pleural effusions (right greater than left) with overlying atelectasis and scattered groundglass opacity. 2. Moderate pelvic ascites. 3. Findings compatible with cirrhosis and portal hypertension including varices and splenomegaly. 4. Regarding the clinical query, there is no definite evidence of pneumothorax although the sensitivity of unenhanced CT for this finding is limited. Hepatic hydrothorax remains a consideration; consider correlation with nuclear medicine study as clinically indicated. |
Generate impression based on findings. | Male 60 years old Reason: 60yo M with hepatits B and ?complex renal cyst, liver protocol for HCC screening and evaluate renal cyst. History: HCC screening, eval of renal cyst. Noncontrast CT images are also obtained through the abdomen. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple small hepatic cysts in the liver. Liver is otherwise unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts. There is a subcentimeter cyst in the lower pole of the right kidney measuring 7 mm on image number 75 considers number 16, too small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fat containing periumbilical hernia.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: No significant abnormality notedOTHER: No significant abnormality noted | Hepatic and renal cysts. Fat containing umbilical hernia. |
Generate impression based on findings. | Female 74 years old Reason: evaluate for chronic pancreatitis History: abdominal pain ABDOMEN:LUNG BASES: Focal atelectasis in the right lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Slightly atrophic but otherwise unremarkable pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal vascular calcifications.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: Calcified fibroid in the uterus.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 | Slightly atrophic pancreas without any other abnormality.Calcified fibroid in the uterus. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. There is an area focal asymmetry in the anterior depth of the right upper central breast. Multiple intramammary lymph nodes are present in the right upper outer breast. Bilateral benign calcifications are present. Normal axillary lymph nodes are seen. No microcalcifications or areas of architectural distortion are present. | Right breast focal asymmetry for which comparison to prior outside mammograms is necessary.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Reason: 80 yo F with new SOB, reports only 5pky hx of smoking with moderate obstructive airway disease and low DLCO on PFTs. Eval for emphysema, ILD, mass History: sob LUNGS AND PLEURA: 4.9 by 4.5-cm left lower lobe mass abutting the diaphragm and present anteriorly on the major fissure (image 189 series 4) with internal cystic or bronchiectatic lucencies.Moderate upper lung zone predominant centrilobular emphysema is present, with right apical scarring.No evidence of fibrosis, and no air trapping identified.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy identified.There are no visible coronary calcifications, although there is some calcification of the aortic annulus.The heart and pericardium are otherwise unremarkable in appearance.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Vascular calcifications.Several hepatic hypodensities which may be cysts although cannot be fully characterized on this noncontrast study.Hypoattenuating right adrenal lesion likely benign. | 1. Right lower lobe mass consistent with lung cancer, although organizing pneumonia is in the differential diagnosis.2. Moderate upper lobe predominant emphysema, without evidence of pulmonary fibrosis or small airways disease..3. Hepatic and adrenal hypoattenuating lesions, not fully characterized without contrast but likely benign. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 51 years old Reason: possible scaphoid fracture History: possible scaphoid fracture Benign-appearing elongated lesion in the metadiaphysis is unchanged. A cortical step of along the distal radius is only subtly visible suggestive of ongoing healing.There is a subtle band of sclerosis through the waist of the scaphoid in the area of prior lucency suggestive of a healing non displaced fracture. | Findings most suggestive of a nondisplaced healing scaphoid fracture as there is a band of sclerosis in the area of prior lucency.Cortical step-of in the distal radius is less evident suggestive of healing. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of left cyst aspiration. Family history of breast cancer in maternal aunt. Two standard digital views, additional left MLO view, and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of bilateral benign breast biopsies. Family history of breast cancer in sister. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign intramammary lymph node present in the right upper outer breast. Stable focal asymmetries are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign lymph nodes project over the axilla. | Stable bilateral focal asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 74 years old Reason: oa assess History: pain Right hip: Two views of the right hip shows mild joint space narrowing and small acetabular osteophytes. No acute fracture or dislocation.Right hip: Bone mineralization is normal. Alignment is anatomic. There is moderate tricompartmental joint space loss and osteophyte formation, most pronounced in the extensor compartment. No joint effusion.Left knee: Bone mineralization is normal. Alignment is anatomic. There is moderate tricompartmental joint space loss and osteophyte formation, most pronounced in the extensor compartment. No joint effusion.No acute fracture or malalignment. | Moderate bilateral knee osteoarthritis.Mild right hip osteoarthritis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views along with additional bilateral MLO views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of bilateral breast reduction in 1998. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Architectural distortion compatible with prior breast reduction surgery is present. Scattered coarse benign calcifications are seen in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Changes compatible with breast reduction. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 64 years old; Reason: gross hematuria History: gross hematuria ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Small lipoma in the pancreatic head and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is normal in morphology. There is a partially obstructive 8mm calculus in the right ureteropelvic junction that causes minimal right collecting system dilatation. No left renal calculi identified. There are small multiple bilateral renal cortical cysts. The ureters are normal in caliber and course.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.8-mm right ureteropelvic junction stone likely the cause of the patient's hematuria. |
Generate impression based on findings. | Left wrist painVIEWS: Left wrist AP and lateral 2/12/15 (two views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 60 years old Reason: Patient w/ fever, dilation of right renal collecting system, eval for kidney stone History: malaise, fever, chills, dysuria, renal failure ABDOMEN: Lack of intravenous and enteric contrast makes the examination suboptimal. LUNG BASES: Small pleural effusions with overlying atelectasis. Multiple new ground glass opacities in the right lower lobe which are incompletely evaluated. Additional scattered opacities which appear scar like.LIVER, BILIARY TRACT: Postsurgical changes related to prior liver transplant.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydronephrosis with hydroureter which corresponds to findings from renal ultrasound from the same day. Associated distal ureteral calculus measuring up to 6 mm (series 3, image 111), Bilateral atrophic kidneys consistent medical renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral bowel-containing abdominal wall hernia without evidence of obstruction.Small fat-containing umbilical hernia.OTHER: Mild atherosclerotic calcifications of the aorta and its branches. Moderate coronary artery calcifications.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Acute obstructing right distal ureteral stone with hydroureter and mild hydronephrosis.2. Multiple new nonspecific ground glass opacities in the right lower lobe which may be due to aspiration, infection, edema, or malignancy. Recommend dedicated thoracic CT to further characterize. |
Generate impression based on findings. | 85 year-old female. History of breast cancer status post left lumpectomy. Left lung nodule. Follow-up. LUNGS AND PLEURA: Scattered pulmonary nodules, including a 10-mm left lower lobe nodule, unchanged from 2011 and most likely benign (series 4, image 62).Diffuse mild subpleural reticulation consistent with interstitial fibrosis, unchanged from immediate prior study.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Mild coronary artery calcification.Stable 7-mm left internal mammary lymph node compared to immediate prior exam (series 3, image 50).CHEST WALL: Post surgical findings of left lumpectomy with multiple surgical clips. No axillary lymphadenopathy. Mild degenerative changes of the thoracolumber spine. Focal lucency with coarsened trabeculae in T6 vertebral body, consistent with a hemangioma, unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating focus in the left hepatic lobe is too small to characterize, unchanged and mostly likely benign. Nonspecific subcentimeter splenic hypodensity, unchanged and most likely benign. | 1. Subcentimeter left internal mammary lymph node is unchanged, most likely benign.2. Stable pulmonary nodules since 2011, most likely benign. No additional CT follow-up for these nodules is recommended.3. Diffuse mild subpleural interstitial fibrosis consistent with interstitial lung disease, unchanged from 11/2014. |
Generate impression based on findings. | 76 show female: h/o exertional dyspnea x 2 months, h/o restrictive lung pattern 1/13 pfts, but has h/o lung surgery for benign mass. evaluate for emphysema History: dyspnea LUNGS AND PLEURA: Surgical changes of a left lower lobe resection, with linear scarring and focal emphysema distal to the suture line. Dilated airways lead into this region.Mild basilar bronchiectasis and mild air trapping seen on expiratory imaging, may be related to small airways disease.Additional scattered benign appearing pulmonary micronodules. No suspicious pulmonary nodules or masses.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. Atherosclerotic calcification of the thoracic aorta and its branches.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post left axillary lymph node dissection.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small splenules. Atherosclerotic calcification of the abdominal aorta. | 1. Mild bronchiectasis and air trapping may be related to mild small airways disease.2. Surgical changes of a left lower lobe resection with focal emphysema distal to the suture line.3. No evidence of diffuse emphysema or pulmonary fibrosis. |
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